Single-nucleus and spatial landscape of the sub-ventricular zone in human glioblastoma

The sub-ventricular zone (SVZ) is the most well-characterized neurogenic area in the mammalian brain. We previously showed that in 65% of patients with glioblastoma (GBM), the SVZ is a reservoir of cancer stem-like cells that contribute to treatment resistance and emergence of recurrence. Here, we built a single-nucleus RNA-sequencing-based microenvironment landscape of the tumor mass (T_Mass) and the SVZ (T_SVZ) of 15 GBM patients and 2 histologically normal SVZ (N_SVZ) samples as controls. We identified a mesenchymal signature in the T_SVZ of GBM patients: tumor cells from the T_SVZ relied on the ZEB1 regulatory network, whereas tumor cells in the T_Mass relied on the TEAD1 regulatory network. Moreover, the T_SVZ microenvironment was predominantly characterized by tumor-supportive microglia, which spatially co-exist and establish heterotypic interactions with tumor cells. Lastly, differential gene expression analyses, predictions of ligand-receptor and incoming/outgoing interactions, and functional assays revealed that the IL-1β/IL-1RAcP and Wnt-5a/Frizzled-3 pathways are therapeutic targets in the T_SVZ microenvironment. Our data provide insights into the biology of the SVZ in GBM patients and identify specific targets of this microenvironment.

Metal cluster plasmons analyzed by energy-resolved photoemission

The optical response of size-selected metal clusters is studied by wavelength-dependent photoemission and energy-resolved photoelectron detection. Relative photodetachment cross sections giving information on the plasmon are determined for the example of closed-shell Ag₉₁^-. Notably, the peak energy of this anion (3.74 eV) is higher than the small particle limit in Mie theory of 3.5 eV. Different methods to extract cross sections from the spectra are applied. In particular, we compare the results obtained by integrating the full electron yields to analyses based on evaluating specified binding energy windows. The approach opens up new possibilities to conduct studies on Landau fragmentation as a result of multielectron excitations.

When narratives speak louder than numbers: the effects of narrative persuasion across the stages of behavioural change to reduce air pollution

Is narrative persuasion effective when promoting new behaviours in favour of the environment? Does this effectiveness vary depending on whether individuals are already thinking about changing? This paper has two main objectives: (1) to explore how individuals at different stages of the behavioural change process perceive air pollution, focussing on the perceived psychological distance of its environmental risks (Study 1); and (2) to test whether the effects of presenting the risks of air pollution in a narrative vs. statistical format on pro-environmental intentions vary depending on the individuals' stage of behavioural change (Study 2). Study 1 (N = 263) is based on a survey measuring individuals' perceived psychological distance of the environmental risks of air pollution, and the perceived effectiveness of different pro-environmental behaviours. Results suggest that perceived distance and perceived effectiveness vary across different stages of behavioural change. Study 2 (N = 258) presents a 2(Format: narrative vs. statistical) × 3(Stages of change) protocol, testing the effectiveness of a narrative format depending on individuals' stage of behavioural change. Results suggest that proximising a threat through a narrative format of communication is more effective especially for individuals in the pre-action stage of change. We also present a moderated mediation model explaining the influence of the interaction between the message format and the stage of behavioural change on behavioural intentions and on efficacy appraisal via narrative engagement. Findings are discussed with regards to the stage model and narrative persuasion.

Artificial intelligence-guided, single-lead EKG may be a game-changer for symptom-to-balloon time reduction in ST-elevated myocardial infarction

Background

Over decades, efforts to shave off life-saving minutes from ST-Elevated Myocardial Infarction (STEMI) care centred on reducing door-to-needle and door-to-balloon times. We firmly believe that symptom-to-balloon time should prove a better focus to this end. Challenges come with this goal as it heavily relies on a patient's perception and initiative to seek care, which we deem intelligent and wearable Artificial Intelligence (AI)-driven Single Lead EKG technologies as an attractive solution in modern-day cardiology.

Purpose

To provide an accurate, accessible, and cost-effective AI-driven Single Lead STEMI detection algorithm that can be embedded into wearable devices and employed in a self-administered fashion.

Methods

Database: EKG records from Mexico, Colombia, Argentina, and Brazil from April 2014 to December 2019. Dataset: A total of 11,567 12-lead EKG records of 10[s] length with a sampling frequency of 500 Hz, including the following balanced classes: angiographically confirmed and unconfirmed STEMI, branch blocks, non-specific ST-T abnormalities, normal and abnormal (200+ CPT codes, excluding those mentioned above). Cardiologists manually checked the label of each record to ensure precision. Pre-processing: We discard the first and last 250 samples as they may contain a standardisation pulse. The study applied a digital low pass filter of order 5 with a frequency cut-off of 35 Hz. The mean was subtracted from each Lead. Classification: The determined classes were “STEMI” (Including STEMI in different locations of the myocardium – anterior, inferior, and lateral); and “Not-STEMI” (Combination of randomly sample, branch blocks, non-specific ST-T changes, and abnormal records – 25% of each). Training and Testing: A 1-D Convolutional Neural Network was trained and tested with a dataset proportion of 90/10, respectively. A different model was trained and tested for each Lead, using the central 4,500 samples of the records. The last dense layer outputs a probability for each report of being STEMI or Not-STEMI. Lead V2 showed the best overall results. The model was further tested through the same methodology using the best Lead with a subset of the previous data, excluding the unconfirmed STEMI EKG records (Total 7,230 12-lead EKG records for Confirmed Only STEMI dataset). Performance metrics were reported for each experiment and compared.

Results

Combined STEMI data: Accuracy: 91.2%; Sensitivity: 89.6%; Specificity: 92.9%. Confirmed STEMI Only dataset: Accuracy: 92.4%; Sensitivity: 93.4%; Specificity: 91.4% (Figure 1).

Conclusion

By assiduously improving the quality of the model's input, we continue to assess our algorithm's performance and reliability for future clinical validation as a potential remote monitoring and early STEMI detection device.

Funding Acknowledgement

Type of funding sources: None.

Three dimensional modelling of mutant Kir2.1 channel PIP2 interactions help stratify arrhythmia severity in Andersen Tawil syndrome type 1

Background

Andersen-Tawil type 1 (ATS1) is associated with loss-of-function mutations in the inward rectifier potassium channel Kir2.1, which controls cardiac excitability and impulse conduction. Phosphatidylinositol-4,5-bisphosphate (PIP2) acts as an essential cofactor regulating the opening of Kir2.1 channels. Fifty percent of reported ATS1 mutations affect Kir2.1-PIP2 interactions, leading to ECG defects, ventricular arrhythmias and sudden cardiac death (SCD) by mechanisms that are poorly understood.

Purpose

To test the hypothesis that the degree of arrhythmogenic severity of ATS1 mutations disrupting PIP2-Kir2.1 binding may be predicted by the level of polarization of the mutant Kir2.1 channel pore.

Methods

We first used a statistical mean value approach to classify the 40 known arrhythmogenic ATS1 mutations impacting Kir2.1-PIP2 interaction (N=260 individuals) according to arrhythmogenic severity, ranging from SCD through ventricular bigeminy and QT prolongation. We then generated 3D in-silico atomic models of the wildtype channel and the 10 mutant channels with the most severe arrhythmic phenotype to assess the mechanism of the structural defects associated with Kir2.1-PIP2 disruption.

Results

Our cardiac lethality scoring stratifying Kir2.1 mutations according to arrhythmogenic severity was validated by three additional biostatical quantitative measures. On in-silico modelling, wildtype Kir2.1 channels without PIP2 binding had transmembrane and cytoplasmic pore radius of 1.5 and 3 Å, respectively. Kir2.1-PIP2 interactions increased transmembrane and cytoplasmic pore radius to 3 and 6 Å, respectively. All 10 Kir2.1 mutations had similar transmembrane and cytoplasmic pore radius of ∼1.0 and ∼3.0 Å, respectively. The most severe mutations yielded pore channels with highly polarized electrostatic forces. Remarkably, simulations showed a descending electrostatic pattern at the transmembrane region of PIP2 binding, where the more severe the mutation, the more positive that region was. Structural changes produced by mutations correlated with cardiac severity (R2=0.51; p<0.005) in that the most drastically altered protein structure correlated with the most severe arrhythmic phenotype.

Conclusions

Computer simulations of mutant Kir2.1 channel structure from the most arrhythmogenic to the least arrhythmogenic predict a gradual decrease in polarization of electrostatic forces along the Kir2.1 channel pore. The results reveal a novel mechanistic stratification of arrhythmogenic severity of ATS1 mutant Kir2.1 channel-PIP2 interactions and open new pathways for developing more personalized ATS1 patient therapies.

Funding Acknowledgement

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): La Caixa Banking Foundation under the project code HR18-00304Fundaciόn La Marato TV3: Ayudas a la investigaciόn en enfermedades raras 2020

Performance metrics of AI-enhanced single lead EKG maintained after entry of organised clustered data

Background

Our experience in creating innovative Artificial Intelligence-guided single lead EKG methodologies for ST-Elevation Myocardial Infarction (STEMI) detection within complex EKG records has been previously validated.

Purpose

By expanding the intricate variables of our previously tested algorithm input, we seek to further improve our STEMI detecting tool.

Methods

11,567 12-lead EKG records (10-s length, 500 Hz sample frequency) derived from the Latin America Telemedicine Infarct Network database from April 2014 to December 2019. From these records, we included the following balanced classes: angiographically confirmed and unconfirmed STEMI (divided by wall affected), branch blocks, non-specific ST-T changes, normal, and abnormal (Remaining 200+ CPT codes). Cardiologist annotations ensured precision (Ground truth). Determined classes were “STEMI” and “Not-STEMI”. A 1-D Convolutional Neural Network model was trained and tested for each lead with dataset proportions of 90/10, respectively. The last dense layer outputs a probability for each record being STEMI/Not-STEMI. The analysis also included performance metrics and false-negative reports.

Results

Overall, the most promising Single lead for STEMI detection was V2 (91.2% Accuracy, 89.6% Sensitivity, and 92.9% Specificity). 55% of false negatives were inferior wall STEMI (Table 1).

Conclusion

Appreciable progress of our new methodology compared to our previous experiences in AI-guided Single Lead for STEMI detection, especially for lead V2. By performing a thorough analysis of false-negative reports, we aspire to identify potential areas of STEMI detection weakness which will become the focus of future ventures.

Funding Acknowledgement

Type of funding sources: None.

No need for a cardiologist for AMI diagnosis – progress of transforming a behemoth telemedicine program with artificial intelligence

Background

The Latin American Telemedicine Infarct Network (LATIN) Telemedicine is a mammoth hub and spoke model that provides an umbrella of AMI protection for 100 million patients. In the program, 826,043 patients had a telemedicine encounter; 7,400 with AMI were diagnosed; 4,332 of them managed with guidelines-based strategies. We have gradually begun implementing a system for using Artificial Intelligence (AI) algorithms embedded into EKGs for rapid and accurate STEMI detection and validated the results with a cardiologist's interpretations.

Purpose

To test whether an AI-driven EKG algorithm can effectively substitute a cardiologist for STEMI telemedicine protocols.

Methods

The AI algorithm construction was in the following fashion. Sample: a selection of 8,511 EKG and 90,592 classified heartbeats. Pre-processing: segmentation of each EKG into individual heartbeats. Training & testing: 90% and 10% of the total dataset, respectively. Classification: 1-D Convolutional Neural Network; the study constructed classes for each heartbeat. The algorithm was next deployed on a consecutive series of LATIN EKG records to diagnose STEMI. We afterwards compared the algorithm's results with eight expert cardiologists' interpretations of the same sample.

Results

This study achieved a concordance of 91% between the AI algorithm and cardiologist interpretation (Figure 1).

Conclusions

The initial results with AI algorithms for STEMI diagnosis are encouraging and may provide the base work for new tools for cardiologists to improve their efficiency. Moreover, implementing this innovative tool may overcome current limitations associated with the telemedical management of this disease.

Funding Acknowledgement

Type of funding sources: None.

Stroke in patients with heart failure and reduced ejection fraction without atrial fibrillation: external validation of a risk model

Background

Heart failure (HF) ranks only second to atrial fibrillation (AF) as a cause of cardio-embolic stroke. Although anticoagulation reduces this risk in HF patients not in AF, the risk/benefit profile in relatively unselected populations is not favourable. Identification of patients at high risk of stroke may allow targeted and safer use of prophylactic anticoagulant therapy. Previously, we proposed a simple risk model for stroke in patients with HF and reduced ejection fraction (HFrEF). However, this model was derived from the two older trials (published in 2007/2008) and was not externally validated.

Purpose

We aimed to evaluate the current incidence of stroke in patients with HFrEF not in AF receiving modern pharmacological therapy and to validate our stroke prediction model.

Methods

We examined patient-level data from the PARADIGM-HF, ATMOSPHERE, and DAPA-HF trials. The risk score was calculated following: 7.39×(insulin-treated diabetes) + 6.53×(previous stroke) + 2.80×[ln(NT-proBNP (pg/ml)) × 0.1182]). According to the tertile of risk score, we divided the patients into three groups. Patients with AF were defined as those with either AF on an ECG or a history of AF.

Results

Of the total of 20,159 patients (who experienced 590 strokes) enrolled in the three trials, 12,751 patients did not have AF at baseline. Of those, 1,143 patients (9%) had insulin-treated diabetes, 873 patients (6.8%) had a history of the previous stroke, and the median value of NT-proBNP was 1,243 pg/ml. During a median follow-up of 2.0 years, 346 (2.7%) experienced a stroke (11.7 per 1000 patient-years). Figure 1 shows cumulative incidence function plots for stroke according to the tertile of risk score in 12,331 patients whose risk score can be calculated. The number of strokes in tertile 1, 2 and 3 were 80, 102 and 149, respectively. The 3-year cumulative incidence function rates of stroke were 2.0 (95% CI: 1.5–2.5) % in tertile 1, 2.6 (95% CI: 2.1–3.2) % in tertile 2, and 4.3 (95% CI: 3.6–5.2) % in tertile 3, respectively. In patients with tertile 3, the stroke rate was 18.1 per 1000 patient-years (compared to 20.1 per 1000 patient-years in patients with AF not receiving anticoagulation). In the Cox model, risk for stroke increased according to the elevation in the risk score (tertile 2: HR 1.47 (95% CI 1.09–1.97), tertile 3: HR 2.53 (95% CI 1.92–3.33), with tertile 1 as reference). Figure 2 shows calibration plots by comparing observed and predicted probabilities of stroke at 1 to 3 years. Discrimination evaluated using the overall c-index 0.84 (95% CI: 0.75–0.91) was good.

Conclusions

These findings validate a previously described predictive model and confirm that it is possible to identify a subset of HFrEF patients without AF who have a risk of stroke that approximates to that in patients with AF. In these patients, the risk/benefit balance might justify the use of prophylactic anticoagulation, but this hypothesis needs to be tested prospectively.

Funding Acknowledgement

Type of funding sources: Foundation.

Women in Neurosurgery: Historical Path to Self-Segregation and Proposal for an Integrated Future

Despite the rising percentage of women accessing the medical profession over the last few decades, surgical specialties are still largely male-dominated; in particular, a remarkable gender disparity is evident in neurosurgery, where only 19% of practitioners are females. Although women may be reluctant to choose a challenging specialty like neurosurgery due to concerns around how to balance family and career, it must be admitted that prejudices against female neurosurgeons have been deeply rooted for long, prompting many to give up and switch track to less demanding subspecialties. Among those who have persisted, many, if not most, have experienced difficulties in career progression and received unequal treatment in comparison with their male counterparts. In 1989, a group of 8 female neurosurgeons founded Women in Neurosurgery (WINS), an organization that aimed to guarantee inclusivity in neurosurgery, encouraging a better and more egalitarian working environment. Thereafter, WINS sessions were regularly promoted at international conferences, offering female neurosurgeons a platform to report issues related to gender discrimination. Over recent years, the mission of WINS sessions in national and international conferences has taken an unexpected deviation; they have progressively become supplementary scientific sessions with only women neurosurgeons as speakers, thus paving the road to a form of self-segregation. This tendency has also resulted in the establishment of sections of only female neurosurgeons within some national societies. Although there remains a faction that fiercely supports the WINS mindset of reserved spaces for women, such segregation is an upsetting prospect for those who believe that science and professionalism have no gender; a growing part of the global neurosurgical community believes that the conception of a “female neurosurgery” and a “male neurosurgery” is misguided and counterproductive and consider the existence of the WINS as anachronistic and no longer necessary.

AB0570 CLINICAL AND IMMUNOLOGICAL MANIFESTATIONS IN SLE PATIENTS IN A THIRD LEVEL HOSPITAL IN ROSARIO, ARGENTINA

Background

Systemic lupus erythematosus (SLE) is a chronic and complex inflammatory disease which predominantly affects young females during reproductive ages. Its prognosis is worse in males, young people, Afro-American and Latin patients. Clinical and immunological features had been described around the world but few reports had been done in Argentinian patients.

Objectives

The purpose of this study was to describe the clinical and immunological pattern in SLE patients, characteristics of lupus nephritis (LN), disease male’s course of SLE, treatments and causes of hospitalization.

Methods

Retrospective study including patients (>18 years) followed in Rheumatology Department, which had unless two visits in the last year before data collection, its clinical reports were complete, and fulfilled SLICC or EULAR/ACR SLE criteria. We recorded data from the medical reports.

Results

Of the 70 patients, 63 were female (90%). The mean age at diagnosis was 27,86 ± 9,4 years. The most frequent manifestations were arthritis (75,7%), malar rash (65,7%), photosensitivity (31,4%), leukopenia (31,4%), alopecia (31,4%), Raynaud’s phenomenon (24,3%) and nasal and oral ulcerations (21,4%).

94,3% of patients were positive for antinuclear antibodies, 45,7% had anti-Ro/SSa, 28,6% anti-RNP and 21% anti-Smith. 75% had low complement and 45,7% anti-DNA antibodies.

LN occurred in the 50% of patients, and class IV was the most prevalent in this group. 66% of patients developed LN in the first year of SLE diagnosis. Autoantibodies in this manifestation were: anti-DNA 60%, anti-Ro/SSa 37%, 31% anti-RNP and 26% anti-Smith.

The most common comorbidity was high blood pressure followed by hypothyroidism (34,3% and 25,7% respectively). All patients received hydroxychloroquine and 62,9% prednisone; half of the patients who were into prednisone treatment received 5mg or less. Other treatments were cyclophosphamide (42,9%), mycophenolate (28,6%) and methotrexate (15,7%). 60% of patients had been hospitalized because of SLE flares and 15,7% due to infections. 75% of flares were due to LN and 8% because of serositis.

Is known that SLE in male patients is more aggressive and with poor prognosis. Although this study had only 7 men, 86% had LN, 29% had pericardial and pleural effusion and 29% thrombocytopenia, were we found several differences in female’s SLE presentation.

Conclusion

This study shown similar results reported in other populations. We found that 50% of SLE patients developed LN, which is the most important cause of hospitalization. Although cutaneous and musculoskeletal manifestations were the most frequent, it’s important to take into account the clinical and prognostic differences between male and female.

References

[1]Pons Estel B et al. The GLADEL, multinational Latin American prospective inception cohort of 1214 patients with systemic lupus erythematosus: ethnic and disease heterogeneity among Hispanics. Medicine 2004;83;1-17

[2]Alarcón GS, Friedman AW, Straaton KV, et al. Systemic lupus erythematosus in three ethnic groups: III. A comparison of characteristics early in the natural history of the LUMINA cohort. LUpus in MInority populations: NAture vs. Nurture. Lupus 1999;8:197–209

[3]Aringer M et al. 2019 European League Against Rheumatism/American College of Rheumatology Classification Criteria for Systemic Lupus Erythematosus. Arthritis & Rheumatology. 2019;71;1400-1412

[4]Cervera R et al. Morbidity and mortality in systemic lupus erythematosus during a 10-year period. Medicine 2003; 82: 299-308

Disclosure of Interests

None declared

AB0389 EVOLUTION OF MONOTHERAPY IN RHEUMATOID ARTHRITIS: IMPACT OF THE RISE OF JAK INHIBITOR

Background

According to different international registries, the frequency of use of biological agents in monotherapy in RA ranges from 12 to 39%. Targeted synthetic DMARDs (tsDMARDs-Jaki) have shown great efficacy when used as monotherapy. The rationale for this study is based on the fact that the frequency has increased with the appearance of the Jaki.

Objectives

To estimate the frequency and reason of the use of biological drugs (bDMARDs) or tsDMARDs in monotherapy since 2013 (Year the Jaki were available in Argentina). To describe the frequency of monotherapy by treatment class and analyze the differential characteristics.

Methods

Retrospective and cross-sectional multicenter study (10 reference centers from Argentina). Consecutive patients, ≥18 years, diagnosis of RA (ACR / EULAR 2010), who were under treatment with bDMARDs or tsDMARDs, started after 2013. Socio-demographic, disease and therapeutic data were collected.

Statistical analysis

descriptive statistics, Chi2 test, Fisher’s exact test, Student’s T test and Mann Whitney were performed, according to the nature of the variables. A p <0.05 was considered significant.

Results

Total 505 patients were included, 87.7% women, with a mean age 58 years (SD ± 13.5) and disease duration of 13 years (SD ± 7.8). Treatment: TNF blocker 42.1%, JAKi 30.3%, IL-6 blocker 10.9% and other treatments 16.8%.

Since 2013, the frequency of monotherapy was 49% (95% CI: 45-53), in the last visit the current frequency was 41% (95% CI 37-45),of this 40% received JAKi. JAKi and IL-6 blocker were the treatments that were used more frequently in monotherapy vs combination modality (Figure 1).

Figure 1.

The main causes of monotherapy were intolerance (39.9%), adverse event (22%), physician’s decision (20.2%) and lack of adherence (17.7%) to DMARDs. Patients who were active workers (64% vs 55%, p <0.05), with higher socioeconomic status (31.4% vs 17.2% p <0.01), better mean HAQ at diagnosis (1.1 vs 1.3, p <0.05) an association was observed with monotherapy. In addition, an association was observed with the use of monotherapy in patients in the 2nd biological line or higher vs 1st line (53% vs 33%, p <0.01), lower polypharmacy (45.6% vs 60%, p <0.02) and a shorter mean time of biological treatment (47 months vs 39 months, p <0.01). These variables were entered in a logistic regression model, the results of the independently associated variables are shown in Table 1.

Table 1.VariablepORCI 95%Employment status (active).0,1911,3270,8682,029Socioeconomic level (medium-high stratum)0,0022,151,3233,494HAQ at diagnosis, M (SD)0,0190,7040,5240,944First Line of biological treatment or Jaki (yes)0,020,4590,30,7Polypharmacy (>4 drugs) (yes)0,0180,6030,3950,918bDMARDs or tsDMARDs exposure time (months)0,0540,9940,9871

Conclusion

The frequency of monotherapy, since the Jaki’s emergence, was 49% (all follow-up) and 41% (current-last visit). Intolerance to cDMARDs doctor and the patient decision were the main cause. The monotherapy use pattern was greater in those who received JAKi and anti IL6. The use of monotherapy was associated with work activity, socioeconomic status, and functional capacity at diagnosis. An association was also observed with less polypharmacy.

References

[1]Smolen JS, et al. Ann Rheum Dis 2020;79:685–699.

[2]Emery P, Sebba A, Huizinga TW. Ann Rheum Dis.2013;72(12):1897–904.

[3]F. Sommerfleck et al. Rev Arg Reumatol. 2013;24(4): 30-36

[4]Aletaha D, Neogi T, Silman AJ,et al. Arthritis Rheum 2010. 2010;62(9):2569–81.

Disclosure of Interests

Rodrigo Garcia Salinas Speakers bureau: Abbvie, Lilly, BMS, Jassen, Novartis, boehringer ingelheim, Consultant of: Lilly, Jassen, Grant/research support from: Abbvie, Fernando Sommerfleck Speakers bureau: Abbvie, Janssen, Novartis, Grant/research support from: Abbvie, Alfredo Vargas Caselles: None declared, Luis Palomino Romero: None declared, Javier Rosa: None declared, Mariana Benegas: None declared, Etel Saturansky: None declared, Pamela Giorgis: None declared, Florencia Martinez: None declared, Marcelo Abdala: None declared, Jimena Sanchez Alcover: None declared, Emma Estela Civit De Garignani: None declared, Gabriela Vanesa Espasa: None declared, Verónica Inés Bellomio: None declared, Juan Manuel Bande: None declared, Silvia Papasidero: None declared, Veronica Saurit: None declared, Leticia Ibañez Zurlo: None declared, Emilio Buschiazzo: None declared

AB1358 AN OLD METHOD FOR CURRENT CHALLENGES: SKIN TEST CONVERSION OF PURIFIED PROTEIN DERIVATIVE (PPD) IN RHEUMATOLOGICAL PATIENTS TREATED WITH ANTI-TNF-α

Background

Anti-TNF-α are a cornerstone for the treatment of multiple rheumatic diseases. They are associated with an increased risk of developing tuberculosis (TB), which is endemic in several countries and an important burden across the globe. Purified protein derivative (PPD) is one of the tests used to demonstrate a latent TB infection (LTBI). Screening is recommended for TB prior to the onset of anti-TNF-α and monitoring evaluating possible conversion of PPD during treatment, defined as the change from a negative (<5 mm) to positive result (≥5 mm). Identification and treatment of LTBI can reduce the risk of disease development by up to 90%. Currently the results of PPD conversion and its interpretation during anti-TNF-α treatment are variable and that is why we set out to know the frequency of conversion of PPD in this group of patients in our environment.

Objectives

To identify PPD conversion in patients with rheumatological diseases undergoing anti-TNF-α treatment.

Methods

A descriptive, analytical, observational, retrospective study was conducted from January 1, 2018 to January 1, 2022. Inclusion criteria: Patients >18 years old, diagnosed with rheumatological diseases and treated with anti-TNF-α for more than 3 consecutive months, with a negative PPD (<5 mm diameter) previous starting anti-TNF-α and a normal chest X-ray.

Results

62 patients (age 45.8 ± 12.5 years), with rheumatological diseases (41 rheumatoid arthritis, 7 juvenile idiopathic arthritis, 5 ankylosing spondylitis, 4 psoriatic arthritis, 4 uveitis and 1 interstitial keratitis) under anti-TNF-α therapy (35 adalimumab, 18 certolizumab, 9 etanercept) were included. Concomitant use of immunomodulators (52 methotrexate, 23 leflunomide, 10 hidroxicloroquine, 3 sulfasalazine, 2 azathioprine and 1 mycophenolate mofetil) and glucocorticoids (33/62) was observed. The conversion of PPD took place in 4 patients (6.5%) (Table 1).

Table 1.

“Patient’s characteristics”

SexAgeRDanti-TNF-αTime doing anti-TNF-αDMARDGCSPPDChest X-rayTB prophylaxis1Male66PsAadalimumab6 yearsmethotrexateNo5 mmNormalIsoniazid2Female56RAadalimumab10 yearsmethotrexateNo5 mmNormalIsoniazid3Female62RAadalimumab5 yearsmethotrexateYes10 mmNormalIsoniazid4Male45AScertolizumab1 yearNoNo20 mmNormalIsoniazid

AS, ankylosing spondylitis; DMARD, disease-modifying antirheumatic drugs; GCS, glucocorticosteroids; PPD, purified protein derivative; PsA, psoriatic arthritis; RA, rheumatoid arthritis; RD, rheumatological disease; TB, tuberculosis.

Conclusion

Considering the prevalence of TB in our country, this research showed a lower PPD conversion percentage compared to previous reports. Anti-TNF-α have radically changed the evolution of rheumatological diseases, considerably improving the patient’s quality of life. With the increase in the accessibility of anti-TNF-α worldwide, new challenges have arisen regarding infectious diseases such as TB, which is endemic in some countries. PPD is a well known, cheap, sensitive and widely available method, suitable for LTBI diagnosis. Although sensitivity could be increased using, in addition, other LTBI detection methods such as IGRAs (interferon gamma release assays), they are usually unavailable in developing countries (1-3).

References

[1]Lewinsohn DM, Leonard MK, LoBue PA, et al. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of Tuberculosis in Adults and Children. Clin Infect Dis 2017; 64(2):e1-e33.

[2]Cerda O, Correa M, Granel A, Marcos A, Giraldo C, Rillo O et al. Tuberculin test conversion in patients with chronic inflammatory arthritis receiving biological therapy. European Journal of Rheumatology. 2019;6(1):19-22

[3]Busquets-Pérez N, Ponce A, Ortiz-Santamaria V, de Agustín de Oro J, Hernández-Rico Y, Vidal I et al. How many patients with rheumatic diseases and TNF inhibitors treatment have latent tuberculosis? 2020; 13(5):282-286.

Disclosure of Interests

None declared

A versatile setup for studying size and charge-state selected polyanionic nanoparticles

Using the example of metal clusters, an experimental setup and procedure is presented, which allows for the generation of size and charge-state selected polyanions from monoanions in a molecular beam. As a characteristic feature of this modular setup, the further charging process via sequential electron attachment within a three-state digital trap takes place after mass-selection. In contrast to other approaches, the rf-based concept permits access to heavy particles. The procedure is highly flexible with respect to the preparation process and potentially suitable for a wide variety of anionic species. By adjusting the storage conditions, i.e., the radio frequency, to the change in the mass-to-charge ratio, we succeeded in producing clusters in highly negative charge states, i.e., Ag₈₀₀ ^7-. The capabilities of the setup are demonstrated by experiments extracting electronic and optical properties of polyanionic metal clusters by analyzing the corresponding photoelectron spectra.

Stroke Work Damping Ratio is Increased in Trained Athletes

INTRODUCTION

Athletes training is often associated with morphological changes in the heart. In this sense, the ventricular pressure-volume (PV) relation provides a complete characterization of cardiac pump performance. Regarding the arterial system (AS), arterial wall viscosity is a source of energy dissipation, that takes place during mechanical transduction. Left ventricular stroke work (SW) constitutes the useful fraction of ventricular energy that is delivered to the AS.

OBJECTIVE

Left ventricular PV-loops were evaluated in terms of AS viscous property, by means of the interaction of two SW components (Stroke Work Damping Ratio, SWDR), both in untrained and trained subjects.

MATERIAL AND METHODS

Fourteen healthy individuals (seven trained) were noninvasively evaluated in terms of echocardiographic and aortic pressure measurements.

RESULTS

SWDR was observed to be increased in trained subjects.

CONCLUSION

SWDR was evaluated in trained individuals, being increased in comparison with the non-trained group. This effect is a consequence of a significant increase of SWD, which could be related with the viscous mechanical property of AS.

Arterial-Ventricular Coupling Impairment is Evidenced in Both Normal and Ischemic Subjects by Applying Cluster Analysis

INTRODUCTION

Left ventricular (LV) interaction with the arterial system (arterial-ventricular coupling, AVC) is a central determinant of cardiovascular performance and cardiac energetics. Stress Echocardiography (SE) constitutes a valuable clinical tool in both diagnosis and risk stratification of patients with suspected and established coronary artery disease. Cluster Analysis (CA), an unsupervised Machine Learning technique, defines an exploratory statistical method which can be used to uncover natural groups within data.

OBJECTIVE

To evaluate the capacity of CA to identify uncoupled groups with ischemic condition based on SE baseline information.

MATERIAL AND METHODS

CA was applied to SE data acquired at baseline and peak exercise (PE) conditions. Obtained clusters were evaluated in terms of coupling conditions and LV wall motility alterations.

RESULTS

Inter cluster significant AVC differences were obtained in terms of baseline data and changes in wall motility, confirmed by CA applied to PE data.

CONCLUSION

AVC impairment was evidenced in both normal and ischemic subjects by applying CA.

Size and charge-state dependence of detachment energies of polyanionic silver clusters

The electronic properties of silver clusters (N up to 800) charged by attachment of up to z = 7 excess electrons are investigated. As an essential preparation step, the technique of in-trap electron attachment to size-selected monoanions within a linear Paul trap is applied. By taking advantage of tunable laser pulses, the photoelectron spectra allow us to evaluate details of the electronic structure of polyanionic metal clusters, giving a multidimensional dataset. The subsequent analysis based on the liquid drop model provides information about the atomic structure and the bulk work function at a hitherto unknown quality.

Elevated markers of liver function are associated with poorer outcomes in HFREF: an analysis of DAPA-HF

Background

Abnormalities of liver tests in patients with heart failure with reduced ejection fraction (HFrEF) is a well-recognised phenomenon. We examined the prognostic value of measures of liver function in a large contemporary cohort of patients with HFrEF enrolled in the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure (DAPA-HF) trial

Methods

In this post-hoc analysis of the DAPA-HF trial we studied 4625 patients with liver function tests available at baseline. Cox proportional hazards models were used to assess the association between liver tests (total bilirubin, alkaline phosphatase [ALP], alanine transaminase [ALT], aspartate transaminase [AST]) and the Model for End-stage Liver Disease excluding INR (MELD-XI) score (calculated as 5.11 Ln [total bilirubin as mg/dL] + 11.76 Ln [creatinine as mg/dL] + 9.44), and the risk of the primary composite endpoint (hospitalisation or urgent visit for heart failure or cardiovascular death). Models were adjusted for age, sex, race, region, systolic blood pressure, heart rate, LVEF, eGFR, log-transformed NT-proBNP, NYHA class, history of hypertension, stroke, myocardial infarction, atrial fibrillation, heart failure aetiology and randomized treatment to dapagliflozin and stratified by diabetic status at baseline. An interaction term between each measure and the effect of treatment on the primary composite outcome was tested as a fractional polynomial.

Results

Total bilirubin, ALP, and MELD-XI score were associated with a higher risk of all the primary outcome (Figure 1) but not ALT or AST. These relationships persisted after adjustment: total bilirubin per log unit increase (HR=1.46; 95% CI 1.28 – 1.67, p&lt;0.001), ALP per log unit increase (HR=1.39; 95% CI 1.15 – 1.66, p&lt;0.001), MELD-XI per 1 SD increase (HR 1.27; 95% CI 1.13 – 1.42, p&lt;0.001). The effect of dapagliflozin on the primary outcome was not modified by the baseline levels of either total bilirubin, ALP or MELD-XI score (Figure 2)

Conclusions

Higher total bilirubin, ALP and MELD-XI score were independently associated with a higher risk of cardiovascular death or worsening HF and may be useful routinely available biomarkers to assess prognosis. The efficacy of dapagliflozin was the not modified by baseline levels of any of these markers.

Funding Acknowledgement

Type of funding sources: None. Figure 2

P-631 Embryo euploidy rates following follicular or luteal start ovarian stimulation. A prospective study with repeated ovarian stimulation ovarian stimulation cycles

Study question

Is there any difference in embryo euploidy rates following luteal phase phase (LS) and follicular phase (FS) start ovarian stimulation.

Summary answer

The number of euploid blastocysts and embryo euploidy rate are comparable when comparing FS and LS.

What is known already

Random start ovarian stimulation (starting at any time of the cycle) has been traditionally used in women undergoing urgent fertility preservation for medical reason. Although there is accumulating evidence that in infertile women, LS can result in equivalent number of oocytes and embryos as compared with FS, no study has evaluated the effect of luteal phase start ovarian stimulation on embryo euploidy rates. The current study is the first prospective study designed to evaluate embryo euploidy rates in donors undergoing two identical consecutive ovarian stimulation protocols within a period of 6 months starting either in the (FS), or (LS).

Study design, size, duration

In a prospective study, conducted between May 2018 and January 2020, 40 oocyte donors underwent two consecutive ovarian stimulation protocols within a period of 6 months with an identical fixed GnRH antagonist protocol starting either in the early follicular (FS), or and luteal menstrual cycle phase (LS).

Participants/materials, setting, methods

All participants underwent two identical consecutive ovarian stimulation cycles with 150μg corifollitropin alfa followed by 200 IU rFSH in a fixed GnRH antagonist protocol either in the FS or LS. Six MII oocytes from the same oocyte donor, from each stimulation cycle, were allocated to the recipients and were inseminated with the same sperm sample (recipients partner sperm or donor sperm). Embryos were cultivated to blastocyst stage followed by preimplantation genetic testing for aneuploidies (PGT-A).

Main results and the role of chance

When comparing FP with LP, the duration of ovarian stimulation was significantly shorter (9.68± 2.09 vs 10.93± 1.55 days), 95% CI [-1.95; -0.55] and a higher total additional dose of daily recFSH was significantly lower (526.14± 338.94 IU vs 726.14± 366.27), 95% CI [-315,12; -84,88] when CPT was administered in the luteal phase. . There were no differences in the hormone values on the triggering day (Estradiol 2137.61±1198.25 pg/ml vs 2362.96±1472.89); 95% CI [-1160.45;709.76]. Overall no differences were observed in the number of oocytes (24.84± 11.200 vs 24.27± 9.08); 95% CI[-2,61; 3.75] and MII oocytes (21.41±10.19 vs 21.59± 8.81), 95%CI [-2.72; 2.35] retrieved between FP and LP cycles in the oocytes donors. Following oocyte allocation and fertilization to the recipients, a total of 245 blastocysts were biopsied (blastocyst formation rate 245/408, 60.05%), 117 in FP group and 128 in LP group. The overall blastocyst euploidy rate was 59.18% . There were no differences in the number of euploid embryos between FS (1.59±1.32) and LS (1.70±1.29), mean difference 0.11, 95%CI [-0.65; 0.46]. Finally, there were no differences in the percentage of euploid embryos per oocytes inseminated between FS [70/287 (24.4%)] and LP [75/278 (24.7%), mean difference -0.027, 95%CI [-0.11; 0.06].

Limitations, reasons for caution

The study was performed in oocyte derived from potentially fertile young oocyte donors thus caution is needed when extrapolating the results in oocytes derived from infertile women of older age.

Wider implications of the findings

Luteal phase stimulation does not alter embryo euploidy status as compared with follicular phase stimulation and thus it appears that it can be safely used not only in cases of urgent medical fertility preservation but also in patients undergoing ovarian stimulation for IVF/ICSI.

Trial registration number

Clinical Trials Gov (NCT03555942).

P–631 Embryo euploidy rates following follicular or luteal start ovarian stimulation. A prospective study with repeated ovarian stimulation ovarian stimulation cycles

Study question

Is there any difference in embryo euploidy rates following luteal phase phase (LS) and follicular phase (FS) start ovarian stimulation. Summary answer: The number of euploid blastocysts and embryo euploidy rate are comparable when comparing FS and LS.

What is known already

Random start ovarian stimulation (starting at any time of the cycle) has been traditionally used in women undergoing urgent fertility preservation for medical reason. Although there is accumulating evidence that in infertile women, LS can result in equivalent number of oocytes and embryos as compared with FS, no study has evaluated the effect of luteal phase start ovarian stimulation on embryo euploidy rates. The current study is the first prospective study designed to evaluate embryo euploidy rates in donors undergoing two identical consecutive ovarian stimulation protocols within a period of 6 months starting either in the (FS), or (LS).

Study design, size, duration

In a prospective study, conducted between May 2018 and January 2020, 40 oocyte donors underwent two consecutive ovarian stimulation protocols within a period of 6 months with an identical fixed GnRH antagonist protocol starting either in the early follicular (FS), or and luteal menstrual cycle phase (LS).

Participants/materials, setting, methods

All participants underwent two identical consecutive ovarian stimulation cycles with 150μg corifollitropin alfa followed by 200 IU rFSH in a fixed GnRH antagonist protocol either in the FS or LS. Six MII oocytes from the same oocyte donor, from each stimulation cycle, were allocated to the recipients and were inseminated with the same sperm sample (recipients partner sperm or donor sperm). Embryos were cultivated to blastocyst stage followed by preimplantation genetic testing for aneuploidies (PGT-A).

Main results and the role of chance

When comparing FP with LP, the duration of ovarian stimulation was significantly shorter (9.68± 2.09 vs 10.93± 1.55 days), 95% CI [–1.95; –0.55] and a higher total additional dose of daily recFSH was significantly lower (526.14± 338.94 IU vs 726.14± 366.27), 95% CI [–315,12; –84,88] when CPT was administered in the luteal phase. . There were no differences in the hormone values on the triggering day (Estradiol 2137.61±1198.25 pg/ml vs 2362.96±1472.89); 95% CI [–1160.45;709.76]. Overall no differences were observed in the number of oocytes (24.84± 11.200 vs 24.27± 9.08); 95% CI[–2,61; 3.75] and MII oocytes (21.41±10.19 vs 21.59± 8.81), 95%CI [–2.72; 2.35] retrieved between FP and LP cycles in the oocytes donors. Following oocyte allocation and fertilization to the recipients, a total of 245 blastocysts were biopsied (blastocyst formation rate 245/408, 60.05%), 117 in FP group and 128 in LP group. The overall blastocyst euploidy rate was 59.18% . There were no differences in the number of euploid embryos between FS (1.59±1.32) and LS (1.70±1.29), mean difference 0.11, 95%CI [–0.65; 0.46]. Finally, there were no differences in the percentage of euploid embryos per oocytes inseminated between FS [70/287 (24.4%)] and LP [75/278 (24.7%), mean difference –0.027, 95%CI [–0.11; 0.06].

Limitations, reasons for caution

The study was performed in oocyte derived from potentially fertile young oocyte donors thus caution is needed when extrapolating the results in oocytes derived from infertile women of older age.

Wider implications of the findings: Luteal phase stimulation does not alter embryo euploidy status as compared with follicular phase stimulation and thus it appears that it can be safely used not only in cases of urgent medical fertility preservation but also in patients undergoing ovarian stimulation for IVF/ICSI.

Trial registration number

Clinical Trials Gov (NCT03555942).

Cresting the Coulomb Barrier of Polyanionic Metal Clusters

Combining photoelectron spectroscopy with tunable laser pulse excitation allows us to characterize the Coulomb barrier potential of multiply negatively charged silver clusters. The spectra of mass- and charge-selected polyanionic systems, with z=2-5 excess electrons, show a characteristic dependence on the excitation energy, which emphasizes the role of electron tunneling through the barrier. By evaluating experimental data from an 800-atom system, the electron yield is parametrized with respect to tunneling near the photoemission threshold. This analysis results in the first experimentally based potential energy functions of polyanionic metal clusters.

Global differences in heart failure with preserved ejection fraction: the paragon-hf trial

Background

Heart failure with preserved ejection fraction (HFpEF) is a global public health problem with important regional differences. We investigated these differences in the PARAGON-HF trial, the largest, most inclusive global HFpEF trial.

Methods

We studied differences in clinical characteristics, outcomes and regional treatment effects of Sacubitril/Valsartan in 4796 patients with HFpEF from the PARAGON-HF trial, grouped according to geographic region.

Results

Regional differences in patient characteristics and comorbidities were observed (Figure 1): patients from Western Europe were oldest (75±7 years) with the highest prevalence of atrial fibrillation (36%); Central/Eastern European patients were youngest (71±8 years) with the highest prevalence of coronary artery disease (CAD, 49%); North American patients had the highest prevalence of obesity (64%) with metabolic syndrome; Latin American patients were youngest and had a high prevalence of obesity (53%); Asia-Pacific patients had a high prevalence of diabetes (44%) despite low prevalence of obesity (26%). Rates of the primary composite endpoint of total hospitalizations for HF and death from cardiovascular causes was lowest in patients from Central Europe (9 per 100 patient years) and highest in patients from North America (28 per 100 patient years), which was primarily driven by a greater number of total hospitalizations for HF and independent of confounders. In the total population, sacubitril–valsartan did not result in a significantly lower rate of total hospitalizations for heart failure and death from cardiovascular causes with no significant heterogeneity in treatment response to sacubitril-valsartan across regions.

Conclusion

This first report on regional differences in the largest prospective global trial in HFpEF suggests substantial regional heterogeneity with respect to phenotype, outcomes and quality of life.

Figure 1

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Study funded by Novartis

Exploring the inhibition boundaries of mixed cultures of purple phototrophic bacteria for wastewater treatment in anaerobic conditions

The development of novel wastewater platforms should include the analysis of the most critical functional factors including the effects of toxic or inhibitory substances. Due to the novelty of purple phototrophic bacteria (PPB)-based wastewater treatment systems, this analysis has not been done yet in mixed cultures. In this work, various relevant chemical compounds, including aromatic (phenol, 2,4,6-trichlorophenol or 246TCP, 4-nitrophenol or 4CP, sulfathiazole) and aliphatic organics (methanol, trichlorethylene or TCE, oleic acid, ethanol, propionic acid), inorganic salts (ammonium, ClO₃^-, Na⁺), and metals (Fe³⁺, Fe²⁺, Cu²⁺, Zn²⁺, Ni²⁺, Al³⁺), as well as pH, are analyzed for their effect on mixed PPB cultures in anaerobic photoheterotrophic conditions using acetate as the model organic substrate. The most toxic substances detected were 246TCP, 4NP, Cu²⁺, Fe²⁺ and Ni²⁺, (K_i for activity: 23 ± 2, 97 ± 12, 3.1 ± 0.4, 13 ± 3, 13 ± 1 mg/L, and K_i (or toxicity threshold) for growth: 17 ± 2, (119), 3.5 ± 0.4, (4.8), (22.9) mg/L, respectively). Some substances inhibited the activity more than the growth (sulfathiazole, Ni²⁺ and Fe³⁺), or the growth more than the activity (TCE, 4NP and Fe²⁺). In addition, some organic substrates, such as phenol, ethanol and propionate, specifically inhibited the acetate uptake, being noncompetitive in the case of phenol and ethanol, and most likely competitive in the case of propionate. These findings are relevant for the wastewater treatment and resource recovery applications of the PPB technology, as well as for the upgrading of current models (Photo-Anaerobic Model). In addition, the data will open possibilities to promote the production of specific compounds (as PHA or single-cell proteins) by selectively inhibiting some parts of the PPB metabolism.

Cuina sense pares / Cooking without parents

Issue

Health promotion in Catalunya isn't a mandatory competency for councils; hence fomenting healthy eating habits isn't a priority for many municipalities because they have to destiny the resources in required issues. To revert this situation, Barcelona Provincial Council, a second level local administration, gives both technical and economic support for health promotion which is specially needed for municipalities with fewer inhabitants.

Description of the Problem

Adolescence implies autonomy to eat and often it turns in unhealthy eating habits. For this reason, Barcelona Provincial Council, in 2010 creates the project “Cuina sense pares” to promote a healthy eating and an optimum nutritional state from 14 to 18 teenagers in the province of Barcelona. The project counts on cooking workshops throughout territory and on a website www.cuinasensepares.cat that facilitates resources and cooking proposals adapted to the collective.

Questions

What was the response of the municipalities in the project? How municipalities value the project? Has it been echoed in the media?

Results

In 10 years, 673 workshops have been realised in 154 municipalities from the 311 in the province of Barcelona with a participation of 9.069 teenagers. Additionally, a 60% of the applicant municipalities have less than 10.000 inhabitants. The municipal technicians have rated the cooking workshops with an average of 9.11 among all. It has appeared 126 times in news media. In addition, the website has had more than 94.000 views and the Youtube channel has had 33.400.

Lessons

Involve the young in their eating by the elaboration of easy and healthy recipes. As an innovation, healthy cooking workshops are offered to municipalities complemented by a website.

Key messages

Facilitate tools to municipalities to boost healthy promotion eating programmes between the young. Foment a healthy eating between the young by attractive cooking proposals.

Arterial-Ventricular Coupling Evaluation in Individuals with Stress-Evidenced Diastolic Dysfunction: A Pilot Study. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020;2020:2598-2601. [PMID: 33018538 DOI: 10.1109/embc44109.2020.9176106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

INTRODUCTION

Arterial-ventricular coupling (AVC) has been recognized as a key determinant of global cardiovascular performance. Diastolic dysfunction (DD) occurs when inadequate filling of the ventricles is related to an abnormal elevation of intracardiac filling pressures. In some cases, DD is evidenced during cardiac stress, provoked by exercise.

OBJECTIVE

To evaluate AVC in individuals with stress evidenced DD, in relation to controls.

MATERIALS AND METHODS

Stress echocardiography was applied to assess cardiac function during exercise. Arterial-ventricular coupling was evaluated, based on the assessment of left ventricular and arterial elastances.

RESULTS

AVC showed a significant difference at peak exercise compared to controls, basically due to a loss of cardiac contractility.

CONCLUSION

The manifestation of AVC coupling imbalance could act as a complementary parameter to support the diagnosis of DD.

0556 Sex-Specific Relationship Between Anxiety and Autonomic Nervous System Dysfunction in Obstructive Sleep Apnea

Introduction

Cardiovascular co-morbidities in obstructive sleep apnea (OSA) are hard to treat, perhaps due to autonomic nervous system (ANS) dysfunction. In OSA, intermittent hypoxia and poor tissue oxygen perfusion damage endothelial and nervous tissue, potentially underlying the dysfunction. Moreover, OSA is strongly associated with anxiety, which is independently associated with ANS dysfunction. We assessed sex-specific relationships between anxiety and cardiovascular markers of ANS dysfunction in OSA.

Methods

We studied people diagnosed with OSA and healthy controls. We collected 5 minutes of wakeful resting ECG, continuous non-invasive blood pressure, and respiration data. We calculated heart rate (HR), heart rate variability (HRV; sympathetic-vagal balance related to brainstem ANS output), mean arterial blood pressure (MAP), beat-to-beat MAP variability (BPV; related to peripheral autonomic function) and breathing rate (BR). We analyzed these measures with a multivariate regression model of anxiety symptoms (generalized anxiety disorder; GAD-7 scores), sex, and group (OSA vs. control), age/BMI/AHI covariates, and Bonferroni-corrected post-hoc comparisons (p≤0.05).

Results

We analyzed 64 subjects (32 OSA: AHI [mean±SEM] 24±4events/hour, 12 female, age 52±21years, BMI 33±2kg/m2; 32 control: 19 female, age 46±2; BMI 26±1). We observed significant main effects of anxiety, BMI, AHI, sex on HRV, but only group on BPV; post-hoc comparisons revealed high BPV only in OSA females. Secondary analyses included classifying by anxiety symptoms (GAD-7≥5), showing only OSA females with anxiety had higher BPV. Males showed higher HRV. AHI and anxiety were positively correlated with HRV in OSA males. AHI was negatively correlated with BR in OSA females.

Conclusion

We observed higher anxiety associated with higher BPV in OSA, especially in females. Unexpectedly, BR was lower in OSA females; longer breaths may have led to the greater BPV. Higher HRV in males complicated by OSA severity and anxiety could be related to higher sympathetic tone. The slightly older control group may have influenced the findings. Overall, our findings suggest anxiety in OSA is associated with peripheral and centrally-mediated autonomic dysfunction, but in a sex-specific manner.

Support

National Institutes of Health R56-NR-017435 and RO1-HL-135562.

Low serum progesterone the day prior to frozen embryo transfer of euploid embryos is associated with significant reduction in live birth rates

A retrospective cohort study was performed to examine whether, in artificial endometrial preparation for frozen embryo transfer (FET) cycles, progesterone (P) levels the day prior to embryo transfer of euploid embryos have an impact on pregnancy outcomes. In a private university clinic, 244 FETs between January 2016 and June 2017 were analyzed. Endometrial preparation was achieved with estradiol valerate and vaginal micronized progesterone. Serum P and estradiol levels the day prior to embryo transfer were measured. A multivariable analysis to assess the relationship between serum P level and pregnancy outcomes was performed, adjusted for confounding variables. Mean P value was 11.3 ± 5.1 ng/ml. Progesterone levels were split in quartiles: Q1: ≤ 8.06 ng/ml; Q2: 8.07-10.64 ng/ml; Q3: 10.65-13.13 ng/ml; Q4: > 13.13 ng/ml. Patients included in the lower P quartile had a significantly higher miscarriage rate and significantly lower live birth rate (LBR) compared to the higher ones. A low serum P level (≤ 10.64 ng/ml) one day before FET is associated with a lower pregnancy and LBR following FET of euploid embryos.

Changes in Plasma Levels of Protease and Fibrinolytic Inhibitors Induced by Treatment in Acute Myeloid Leukemia

We have studied the main protease inhibitors of leukocytes, alpha-1-protease (α1-PI), alpha- 1-antichymotrypsin (α1-Achy) and alpha-2-macroglobulin (α2-M), as well as different parameters of coagulation and fibrinolysis in 21 cases of acute nonlymphoblastic leukemia (ANLL) before, during and after therapy.

Nine of the patients presented signs of DIC, 8 of whom belonged to subtype M3 and to subtype 1 M1.

The initial α1-PI and α1-Achy levels, which were elevated, increased during the treatment period. There was no significant difference between patients with and without DIC. However, those leukemic patients with DIC showed a significant decrease in plasminogen (p <0.005) and fast antiplasmin (p <0.01) only during the treatment compared with DIC free patients. All DIC cases demonstrated circulating plasmin-antiplasmin complex (P-AP) both before and during treatment.

Independent of a possible proteolytic action of leukocyte enzymes on clotting factors in the clinical course of ANLL (mainly M3 subtype), our results suggest an activation of plasminmediated fibrinolysis related to the activation of plasminogen by leukocytes, reactive DIC or both.

Toxicity assessment of pharmaceutical compounds on mixed culture from activated sludge using respirometric technique: The role of microbial community structure

Micropollutants of emerging concern such as pharmaceuticals can significantly affect the performance of secondary biological processes in wastewater treatment plants. The present study is aimed to evaluate the toxicity and inhibition of three pharmaceutical compounds (caffeine, sulfamethoxazole and carbamazepine) on two cultures of microbial consortia enriched from wastewater aerobic activated sludge. One of them was acclimated to pharmaceuticals and the other was non-acclimated as control bioassay. The toxic and inhibitory effects on these cultures were assessed by respirometric tests through the oxygen uptake rate as an indicator of their capacity to degrade a readily available carbon source. Higher values of toxicity and inhibition of pharmaceutical compounds were observed for the control culture as compared to the acclimated one. Sulfamethoxazole and carbamazepine exhibited higher toxicity and inhibition effects than caffeine in both acclimated and control cultures. The microbial diversity of the two cultures was also studied. The composition of microbial community of acclimated and control cultures, was determined by targeting the 16S ribosomal RNA gene. It was observed that Proteobacteria was the most abundant phylum, with Gammaproteobacteria dominating both cultures. Control culture was dominated by Gammaproteobacteria and mostly by the genera Pseudomonas and Sodalis, which belong to common families present in wastewater. Results suggested that the acclimated culture to the three pharmaceuticals was mostly comprised of the extremely multiresistant genera Escherichia-Shigella (38%) of Gammaproteobacteria, resulting to higher resistance as compared to the control culture (Escherichia-Shigella, 7%). Finally, the microbial structure of the microorganisms present in a real bioreactor, which was initially seeded with the acclimated culture and fed in a continuous mode with the selected pharmaceuticals, was also analyzed. The continuous loading of pharmaceuticals in the bioreactor affected its microbial diversity, leading to the dominance of Betaproteobacteria and to the resistant genus Rhizobium of Alphaproteobacteria.

Clinical implication of FMR1 intermediate alleles in a Spanish population

FMR1 premutation carriers (55-200 CGGs) are at risk of developing Fragile X-associated primary ovarian insufficiency as well as Fragile X-associated tremor/ataxia syndrome. FMR1 premutation alleles are also associated with a variety of disorders, including psychiatric, developmental, and neurological problems. However, there is a major concern regarding clinical implications of smaller CGG expansions known as intermediate alleles (IA) or gray zone alleles (45-54 CGG). Although several studies have hypothesized that IA may be involved in the etiology of FMR1 premutation associated phenotypes, this association still remains unclear. The aim of this study was to provide new data on the clinical implications of IA. We reviewed a total of 17 011 individuals: 1142 with primary ovarian insufficiency, 478 with movement disorders, 14 006 with neurodevelopmental disorders and 1385 controls. Similar IA frequencies were detected in all the cases and controls (cases 1.20% vs controls 1.39%, P = .427). When comparing the allelic frequencies of IA ≥ 50CGGs, a greater, albeit not statistically significant, number of alleles were detected in all the cohorts of patients. Therefore, IA below 50 CGGs should not be considered as risk factors for FMR1 premutation-associated phenotypes, at least in our population. However, the clinical implication of IA ≥ 50CGGs remains to be further elucidated.

A sensitive EUV Schwarzschild microscope for plasma studies with sub-micrometer resolution

We present an extreme ultraviolet (EUV) microscope using a Schwarzschild objective which is optimized for single-shot sub-micrometer imaging of laser-plasma targets. The microscope has been designed and constructed for imaging the scattering from an EUV-heated solid-density hydrogen jet. Imaging of a cryogenic hydrogen target was demonstrated using single pulses of the free-electron laser in Hamburg (FLASH) free-electron laser at a wavelength of 13.5 nm. In a single exposure, we observe a hydrogen jet with ice fragments with a spatial resolution in the sub-micrometer range. In situ EUV imaging is expected to enable novel experimental capabilities for warm dense matter studies of micrometer-sized samples in laser-plasma experiments.

miR-328 mediates a metabolic shift in colon cancer cells by targeting SLC2A1/GLUT1

Purpose

Increasing evidence shows that altered metabolism is a critical hallmark in colon cancer. There is a strong need to explore the molecular mechanisms underlying cancer metabolism. Whether the aberrant expression of microRNAs contributes to cancer metabolism is not fully understood. miR-328 is a putative potential target of SLC2A1, but the regulating mechanism between them remains unknown. We have examined whether miR-328 directly regulates SLC2A1/GLUT1 expression in colon cancer cells.

Methods

We performed in silico bioinformatic analyses to identify miR-328-mediated molecular pathways and targets. We also performed luciferase assays and western blot analyses in LOVO and SW480 colon cancer cell lines. In addition, we assessed miR-328 expression in 47 paired tumor and normal tissue specimens from resected colon cancer patients.

Results

Luciferase reporter assays showed that miR-328 directly targeted SLC2A1 3′-untranslated region (UTR), with a significant decrease in luciferase activity in both LOVO and SW480 cell lines. These results were validated by western blot. miR-328 expression was significantly downregulated in tumor tissue compared with paired normal tissue.

Conclusions

Our results show that miR-328 targets SLC2A1/GLUT1. We suggest that miR-328 may be involved in the orchestration of the Warburg effect in colon cancer cells. Furthermore, miR‐328 expression is reduced in colon cancer patients and thus inversely correlates with the classically reported upregulated SLC2A1/GLUT1 expression in tumors.

The Mayak Worker Dosimetry System (MWDS 2013): Soluble Plutonium Retention in the Lungs of An Occupationally Exposed USTUR Case

For the first time, plutonium retention in human upper airways was investigated based on the dosimetric structure of the human respiratory tract proposed by the International Commission on Radiological Protection (ICRP). This paper describes analytical work methodology, case selection criteria, and summarizes findings on soluble (ICRP 68 Type M material) plutonium distribution in the lungs of a former nuclear worker occupationally exposed to plutonium nitrate [239Pu(NO3)4]. Thirty-eight years post-intake, plutonium was found to be uniformly distributed between bronchial (BB), bronchiolar (bb) and alveolar-interstitial (AI) dosimetric compartments as well as between the left and right lungs. 239+240Pu and 238Pu total body activity was estimated to be 2333 ± 23 and 42.1 ± 0.7 Bq, respectively. The results of this work provide key information on the extent of plutonium binding in the upper airways of the human respiratory tract.