AB1328 A FEASIBILITY STUDY ON A NOVEL COMBINED THERMAL IMAGING AND CLINICAL JOINT ASSESSMENT APPROACH USING ULTRASOUND DETECTED JOINT INFLAMMATION OUTCOMES IN RHEUMATOID ARTHRITIS

Background

Thermal imaging (TI) is a portable, low cost imaging tool with high feasibility for use. Clinical joint assessment.

Is routinely performed in rheumatoid arthritis (RA) patient care.

Objectives

To assess a combined TI and clinical joint assessment (CTCA) approach in comparison with TI alone using ultrasound (US) detected joint inflammation outcomes as a gold standard.

Methods

Bilateral (BL) hand and wrist (22 joint sites) were assessed in this cross-sectional study. For TI (performed in a draft free room with a controlled temperature of around 22°C), the adjusted maximum (Tmax), minimum (Tmin) and average (Tavg) temperatures were derived by subtracting a control temperature (lowest Tmin at the joints per subject) from the Tmax, Tmin and Tavg per joint. US power Doppler (PD) and greyscale (GS) joint inflammation were graded semi-quantitatively (0-3) using validated scoring methods. Joint swelling and tenderness were graded as yes = 1 or no = 0. To increase the relative weightage of CTCA-MAX, CTCA-MIN and CTCA-AVG on the CTCA scores, if the joint was swollen and/or tender, the adjusted Tmax, Tmin and Tavg at each joint were multiplied by a factor of 2; otherwise, they remained unchanged. Receiver operating characteristic (ROC) analysis assessed the performance of TI and CTCA in identifying joints with US PD score > 1 and GS score > 1. A parameter was selected as a univariate predictor if statistically significant (P < 0.05) with area under the ROC curve (AUC) ≥ 0.70.

Results

This study included 814 joints from 37 RA patients (mean disease duration, 30.9 months; mean DAS28, 4.43). For both TI and CTCA, out of the 22 joints sites, 3 joint sites were evaluated for PD score > 1 and 14 joint sites for GS score > 1; the remaining joint sites had AUC results unavailable due to small number of outcomes. For TI (Table 1), 3 joint sites had ≥ 1 predictive parameter for either PD score > 1 and/or GS score > 1 as follows: left (L) wrist and right (R) MCPJ 1, AUCs (0.813 to 0.897) for PD score > 1; L wrist and R MCPJs 1 and 3, AUCs (0.808 to 0.947) for GS score > 1. For CTCA (Table 1), 6 joint sites had ≥ 1 predictive parameter for either PD score > 1 and/or GS score > 1 as follows: BL wrists, AUCs (0.726 to 0.899) for PD score > 1; BL wrists, MCPJs 2 and 3, AUCs (0.739 to 0.931) for GS score > 1.

Table 1.

Identifying joints with ultrasound PD score >1 & GS score >1

Thermal Imaging aloneCTCAJointUScriterionParameter (AUC ≥ 0.7& P <0.05)AUC(95% CI)Cut-offJointUScriterionParameter (AUC ≥ 0.7& P <0.05)AUC (95% CI)Cut-offLRLRLPD score >1Adjusted Tmax**0.841 (0.691, 0.992)4.7L & RPD score >1CTCA-MAX**0.899 (0.797, 1)**0.776 (0.578, .973)9.47.3WristAdjusted Tmin**0.813 (0.669, 0.958)2.85WristCTCA-MIN**0.861 (0.735, 0.987)*0.7265.74.45(0.526, 0.926)Adjusted Tavg**0.849 (0.714, 0.985)3.9CTCA-AVG**0.889 (0.781, 0.997)*0.7617.35.95(0.563, 0.959)GS score >1Adjusted Tmax**0.827 (0.687, 0.966)4.7GS score >1CTCA-MAX**0.918 (0.833, 1)**0.81387.3(0.632, 0.994)Adjusted Tmin**0.808 (0.67, 0.947)2.85CTCA-MIN**0.873 (0.761, 0.986)**0.7664.44.45(0.581, 0.951)Adjusted Tavg**0.837 (0.707, 0.967)3.9CTCA-AVG**0.913**0.8025.55.95(0.824, 1)(0.62, 0.985)RPD score >1Adjusted Tmax*0.897 (0.726, 1)5.7L & RGS score >1CTCA-MAX-*0.758-9.8(0.494, 1)MCPJ 1MCPJ 2GS score >1Adjusted Tmax*0.936 (0.813, 1)7.2CTCA-MIN*0.902*0.7392.753.9(0.775, 1)(0.443, 1)Adjusted Tmin*0.932 (0.793, 1)3.95CTCA-AVG*0.931**0.7634.75.5(0.835, 1)(0.474, 1)Adjusted Tavg*0.947 (0.868, 1)4.9L & RGS score >1CTCA-MAX*0.914*0.8736.3512.2(0.735, 1)(0.617, 1)RGS score >1Adjusted Tmax*0.922 (0.76, 1)4.6MCPJ 3CTCA-MIN-*0.902-3.15(0.75, 1)MCPJ 3CTCA-AVG-*0.902-4.1(0.728, 1)

Corresponding P-value: statistically significance at *P <0.05, **P<0.01.

Conclusion

A novel CTCA approach helps discriminate the severity of US detected joint inflammation in RA at more joint sites when compared to TI alone; this includes the commonly affected BL wrists, MCPJs 2 and 3. Further validation work in a larger RA cohort will be required.

Disclosure of Interests

None declared

AB0787 RECEIVER OPERATING CHARACTERISTIC ANALYSIS OF JOINT INFLAMMATION IN RELATION TO DISEASE ACTIVITY IN RHEUMATOID ARTHRITIS ASSESSED USING A NOVEL COMBINED THERMAL AND ULTRASOUND IMAGING

Background:

A novel combined thermal and ultrasound (CTUS) imaging approach in rheumatoid arthritis (RA) was recently shown to be superior to either imaging modality alone in terms of correlation with the 28-joint disease activity score (DAS28).

Objectives:

To determine the performance of CTUS imaging in identifying RA patients with at least moderate disease activity (DAS28 > 3.2).

Methods:

Bilateral hand (22 joints) thermal and ultrasound (US) imaging was performed. Thermal imaging provides the surface temperature readings at the joints with MAX, AVG and MIN derived per patient by summing the temperature differences with a control temperature, for the respective maximum (Tmax), average (Tavg) and minimum (Tmin) temperatures at each joint. US imaging assesses joint inflammation by summing up the power Doppler (PD) and grey-scale (GS) joint inflammation scores (graded 0-3 at each joint recess) at each joint to obtain the respective total PD and total GS scores per patient. CTUS imaging utilizes data from both thermal and US imaging to derive the MAX (PD), AVG (PD) and MIN (PD) by multiplying MAX, AVG and MIN by a factor of 2 when a patient’s Total PD > median score, which otherwise remained the same as the MAX, AVG and MIN. The results of the imaging parameters were compared between patients with DAS28 ≤ 3.2 and those with DAS28 > 3.2. Sensitivity (Sn), specificity (Sp) and receiver operating characteristic (ROC) curve analysis was performed to determine if the use of CTUS imaging can help identify patients with DAS28 > 3.2.

Results:

In this cross-sectional study, 814 joints from 37 RA patients (75.7% female; 75.7% Chinese; baseline mean disease duration, 30.9 months; baseline mean DAS28, 4.43) were imaged. The mean (SD) values for the CTUS—but not single modality—imaging parameters (Table 1) were all significantly greater among patients with DAS28 > 3.2 versus those with DAS28 ≤ 3.2 (P-values were all <0.01). Based on cut-off levels of (a) MAX (PD) ≥ 94.5, (b) MIN (PD) ≥ 42.3 and (c) AVG (PD) ≥ 64.6 in identifying patients with DAS28 > 3.2, the respective area under the ROC curves (AUCs) (95%CIs) were (a) 0.731 (0.541, 0.921) with Sn = 58.1%; Sp = 100.0%; negative predictive value (NPV) = 31.6%; positive predictive value (PPV) = 100.0%; accuracy = 64.9%, (b) 0.758 (0.591, 0.925) with Sn = 61.3%; Sp = 100.0%; NPV = 33.3%; PPV = 100.0%; accuracy = 67.6% and (c) 0.763 (0.596, 0.931) with Sn = 61.3%; Sp = 100.0%; NPV = 33.3%; PPV = 100.0%; accuracy = 67.6%.

Conclusion:

The severity of joint inflammation as detected by CTUS—but not single modality—imaging parameters were significantly greater among patients with DAS28 > 3.2 versus those with DAS28 ≤ 3.2. For the first time ever, by applying ROC analysis, this has helped to determine cut-off MAX (PD), MIN (PD) and AVG (PD) levels for identifying patients with DAS28 > 3.2; the usefulness of these cut-off levels will require further validation in independent RA cohorts.

Table 1.

Comparison of imaging parameters between patient groups.

Imaging ParameterDAS28 Mean (95% CI)Difference (95% CI)P-valueDAS28 ≤ 3.2DAS28 > 3.2MAX (PD)75.25 (58.8, 91.7)119.5 (101.12, 137.87)-44.25 (-70.49, -18.01)0.0022**MIN (PD)33.72 (25.82, 41.61)57.51 (47.63, 67.39)-23.79 (-37.13, -10.45)0.0012**AVG (PD)50.72 (39.45, 61.98)85.39 (71.89, 98.88)-34.67 (-53.27, -16.07)0.0008***MAX67.38 (50.75, 84.02)82.23 (74.71, 89.75)-14.85 (-34.11, 4.42)0.1268MIN30.27 (22.06, 38.47)40.02 (35.02, 45.03)-9.75 (-22.18, 2.66)0.1198AVG45.45 (33.94, 56.96)59.11 (52.99, 65.23)-13.66 (-29.04, 1.72)0.0801Total PD2.83 (-0.23, 5.9)3.65 (2.71, 4.58)-0.82 (-3.39, 1.77)0.5269Total GS6.67 (1.31, 12.02)6.58 (4.12, 9.04)0.09 (-6.21, 6.38)0.9780

Statistically significant: **P<0.01, ***P<0.001.

Disclosure of Interests:

None declared

SAT0646-HPR PATTERN AND INFLUENTIAL FACTORS IN PROMOTING TREAT-TO-TARGET (T2T) FOR FOLLOW-UP OF ANKYLOSING SPONDYLITIS (AS) PATIENTS WITH A RHEUMATOLOGIST-PATIENT INTERACTIVE SMART SYSTEM OF DISEASE MANAGEMENT (SSDM): A COHORT STUDY FROM CHINA

Background:

Ankylosing Spondylitis Disease Activity Score (ASDAS) is adopted to evaluate the degree of disease activity and the inflammatory response in AS patients. ASDAS score <= 1.3 represents inactive disease status and achievement of T2T. SSDM is a mobile application for disease management.

Objectives:

To evaluate the patterns of T2T and related influential factors among AS patients after applying SSDM in the real world.

Methods:

AS Patients were trained to master SSDM by healthcare professionals (HCPs) and to conduct ASDAS self-assessments. Patients were also required for repeating self-assessments after leaving the hospital. After entry by patients, data can be synchronized to the SSDM terminal of authorized rheumatologists. Based on these data, the patients can apply for consultation to their physicians and rheumatologists can provide medical advices to their patients.

Results:

From Jan 2015 to Jan 2020, 17,870 AS patients enrolled in SSDM with the mean age of 34.62±10.98 years old and the median disease duration of 3.58 years. Among them, 1,127 AS patients from 150 hospitals were followed up for more than 6 months through SSDM. The results at baseline and in final follow up were summarized in Table 1.

Table 1.

The T2T results at baseline and in final follow up.

Baseline\Final follow-upn%x <= 1.3%1.3 < x <= 2.1%2.1 < x <= 3.5%3.5 < x%x <= 1.331527.95%20665.40%7423.49%268.25%92.86%1.3 < x <= 2.134030.17%13840.59%11433.53%7522.06%133.82%2.1 < x <= 3.536332.21%9526.17%10629.20%13336.64%297.99%3.5 < x1099.67%2422.02%2522.94%4238.53%1816.51%Total1,127100%46341.08%31928.31%27624.49%696.12%

The rate of T2T achievers were 27.95% (315/1,127) at baseline, and improved significantly to 41.08% (463/1,127) after 6 months follow up, p<0.01. Among T2T achievers at baseline, 65.40% (206/315) maintained T2T, 34.60% (109/315) relapsed. Of patients who didn’t achieve T2T at baseline, only 31.65% (257/812) achieved T2T after 6 months follow up.

The impact of the online interaction between patients and physicians and the frequency of self-assessment for ASDAS on T2T has been analyzed. Compared with 544 patients who didn’t interact online with their physicians and self-assessed less than 3times, 104 patients with online interaction and monthly assessments achieved significant higher improvement rate of T2T (9.19% vs 23.08%, p<0.01). The more frequent of the self-assessments being performed by patients, the higher improvement of T2T rate will be. The improvement of T2T rate(y) was positively correlated with times of self-assessment for ASDAS(x) independently. The regression equation as “y = 0.0304x + 0.0521”, r = 0.9107, p<0.01 (Figure 1).

Figure 1.

Conclusion:

Significant improvement was observed under applying SSDM through empowering AS patients. After proactive disease management via SSDM for more than 6 months, patients with ASDAS<=1.3 score at baseline had a significantly higher retention rate of inactive disease activity. The patients who performed more frequent self-assessments had lower probability of relapse and higher rate of T2T. Online interaction between patients and physicians contributed to promote the improvement rate of T2T. SSDM is a valuable tool for long term follow-up through empowering patients.

Acknowledgments:

SSDM was developed by Shanghai Gothic Internet Technology Co., Ltd.

Disclosure of Interests:

None declared

Tempol Alleviates Chronic Intermittent Hypoxia-Induced Pancreatic Injury Through Repressing Inflammation and Apoptosis

Obstructive sleep apnea (OSA) has been demonstrated to be implicated in disorder of insulin secretion and diabetes mellitus. In this study, we aimed to evaluate the protective role of tempol, a powerful antioxidant, in chronic intermittent hypoxia (IH)-induced pancreatic injury. The rat model of OSA was established by IH exposure. The pathological changes, increased blood-glucose level, and raised proinsulin/insulin ratio in pancreatic tissues of rats received IH were effectively relieved by tempol delivery. In addition, the enhanced levels of pro-inflammatory cytokines, TNF-α, IL-1β, IL-6, and inflammatory mediators, PGE2, cyclooxygenase-2 (COX-2), NO, and inducible nitric oxide synthase (iNOS) in pancreatic tissue were suppressed by tempol. Moreover, tempol inhibited IH-induced apoptosis in pancreatic tissue as evidenced by upregulated Bcl-2 level, and downregulated Bax and cleaved caspase-3 levels. Finally, the abnormal activation of mitogen-activated protein kinase (MAPK) and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) signaling pathways induced by IH was restrained by tempol administration. In summary, our study demonstrates that tempol relieves IH-induced pancreatic injury by inhibiting inflammatory response and apoptosis, which provides theoretical basis for tempol as an effective treatment for OSA-induced pancreatic injury.

Online breath analysis of propofol during anesthesia: clinical application of membrane inlet-ion mobility spectrometry

BACKGROUND

Breath analysis of propofol is a potential noninvasive method for approximating the plasma propofol concentration. There have been various reported techniques for measuring the exhaled propofol concentration at steady state; however, the propofol concentration undergoes marked changes during clinical anesthesia. Therefore, this study investigated the use of membrane inlet-ion mobility spectrometry (MI-IMS) to monitor exhaled propofol discontinuously and continuously during propofol anesthesia.

METHODS

The study included 19 patients of American Society of Anesthesiologists physical status I or II. In experiment I (discontinuous study), breath and blood samples were collected discontinuously, with stable target propofol concentrations of 2.8 μg/ml, 3.2 μg/ml, 3.5 μg/ml, and 3.8 μg/ml. In experiment II (continuous study), propofol concentration was maintained at 3.5 μg/ml after induction, and exhaled breath was collected continuously every 3 min during propofol infusion. Relationships of the exhaled propofol concentration with the plasma propofol concentration, measured by high-performance liquid chromatography and the continuously measured bispectral (BIS) index were investigated.

RESULTS

Comparison of the exhaled and plasma propofol concentrations revealed a bias ± precision of 2.1% ± 14.6% (95% limits of agreement: - 26.5-30.7%) in experiment I and - 10.4% ± 13.2 (- 36.3-15.4%) in experiment II. In both experiments, exhaled propofol concentrations measured by MI-IMS were consistent with, the propofol effect represented by the BIS index.

CONCLUSIONS

MI-IMS may be a suitable method to predict plasma propofol concentration online during propofol anesthesia. Monitoring exhaled propofol may improve the safety of propofol anesthesia.

Effect of tanshinone IIA on cardiomyocyte hypertrophy and apoptosis in spontaneously hypertensive rats

In the present study, the effects of tanshinone IIA (TSN) on the prevention of left ventricular hypertrophy (LVH) and apoptotic processes were observed in spontaneously hypertensive rats (SHRs). A total of 18 SHRs (age, 8 weeks) were randomly divided into three groups. The SHRs in the control group (group S8) were sacrificed at week 8 of the experiment. The SHRs in the treatment group (group D18) and the placebo group (group S18) were injected with TSN and distilled water (1 ml/kg body weight/day), respectively, for 10 weeks, commencing at week 8, and were subsequently sacrificed at week 18. The systolic blood pressure (SBP) and left ventricular mass index (LVMI) were determined. Using hematoxylin and eosin and van Gieson staining, together with immunohistological methods, cardiomyocyte size and diameter, collagen volume fraction (CVF) and perivascular circumferential area (PVCA) were measured. Evaluation of Bcl-2, Bax and p53 expression levels for apoptosis analysis was performed using western blotting. It was observed that the SBP, LVMI, cardiomyocyte size and diameter, CVF, PCVA and cardiomyocyte apoptosis index (Bax and p53 expression) were increased significantly in group S18 compared with group S8. However, Bcl-2 expression levels were decreased in group S18 compared with group S8. The administration of TSN in group D18 resulted in higher Bcl-2 expression levels and significantly decreased LVMI, cardiomyocyte size and diameter, CVF, PCVA, Bax and p53 expression levels compared with group S18. LVH and apoptosis of the cardiac tissues increased with the increasing age of the SHRs. TSN may inhibit the development of LVH and decrease the level of apoptosis in SHRs, possibly via the upregulation of Bcl-2 and the downregulation of Bax and p53 expression.

Failure to protect against myocardial ischemia-reperfusion injury with sevoflurane postconditioning in old rats in vivo

BACKGROUND

Sevoflurane post-conditioning (SpostC) protects young hearts against ischemia-reperfusion injury. It is unknown whether the infarct-limiting effect is also maintained in aged cohorts and whether there are age-associated differences in the underlying mechanisms.

METHODS

Young or old rats were randomly subjected to 30-min myocardial ischemia, followed by 120-min reperfusion in vivo, with or without SpostC in the presence or absence of phosphatidylinositol 3-kinase (PI3K) or mitogen-activated protein kinase kinase 1/2 (MEK1/2) inhibitor. Western blotting was used to determine the phosphorylation of protein kinase B (Akt) and extracellular signal-regulated kinase 1/2 (ERK1/2). Myocardial nicotinamide adenine dinucleotide (NAD(+) ) level was measured to indicate mitochondrial permeability transition pore (mPTP) opening.

RESULTS

SpostC significantly decreased infarct size in young (35 ± 4% vs. 56 ± 3%, P < 0.05) but not old rats (45 ± 3% vs. 47 ± 4%, P > 0.05) compared with each control group. SpostC substantially augmented phosphorylation of Akt (0.74 ± 0.03 arbitrary units vs. 0.27 ± 0.03 arbitrary units, P < 0.05) or ERK1/2 (0.85 ± 0.04 arbitrary units vs. 0.29 ± 0.04 arbitrary units, P < 0.05) compared with control group, which was abolished by PI3K or MEK1/2 inhibitor in young rats, respectively, but failed to activate Akt and ERK1/2 in old rats. NAD(+) level (nmol/g tissue) was higher in SpostC group in young (118.57 ± 9.27 vs. 46.78 ± 4.54, P < 0.05) but not old rats (58.50 ± 7.16 vs. 61.15 ± 5.50, P > 0.05) compared with each control group. PI3K or MEK1/2 inhibitor abrogated the infarct-sparing effect and inhibition of loss of NAD(+) induced by SpostC in young rats, respectively.

CONCLUSION

SpostC-mediated cardioprotection in young rats is not effective in senescent rats, which may at least be the consequence of failure to activate Akt and ERK1/2, and resultant failure to inhibit mPTP opening.

New hypothesis of chronic back pain: low pH promotes nerve ingrowth into damaged intervertebral disks

The pathogenesis of low back pain is still elusive. Here, we proposed a new hypothesis that low pH is a possible cause of the development and progression of low back pain. We propose that low pH promotes the production of the inflammatory mediators and the depletion of proteoglycan in the damaged intervertebral disk. The inflammation response, evoked by the dorsal root ganglia, changes the delicate nutrient balance in the nucleus, resulting in a vicious cycle and leading to choronic back pain. Our hypothesis may explain many of the available clinical and experimental data on low back pain, thus it may help elucidate the pathogenesis of low back pain and improve clinical management.

Epidemiological and molecular analysis of a waterborne outbreak of norovirus GII.4

Contaminated water is one of the main sources of norovirus (NoV) gastroenteritis outbreaks globally. Waterborne NoV outbreaks are infrequently attributed to GII.4 NoV. In September 2009, a NoV outbreak affected a small school in Guangdong Province, China. Epidemiological investigations indicated that household use water, supplied by a well, was the probable source (relative risk 1·9). NoV nucleic acid material in concentrated well-water samples was detected using real-time RT-PCR. Nucleotide sequences of NoV extracted from diarrhoea and well-water specimens were identical and had the greatest sequence identity to corresponding sequences from the epidemic strain GII.4-2006b. Our report documents the first laboratory-confirmed waterborne outbreak caused by GII.4 NoV genotype in China. Our investigations indicate that well water, intended exclusively for household use but not for consumption, caused this outbreak. The results of this report serve as a reminder that private well water intended for household use should be tested for NoV.

Chemistry of Rare Earth Oxalate Vitrification

Mixtures of rare earth and actinide oxalates will be vitrified into boro-aluminosilicate-based glasses for intermediate term stabilization according to current plans. The reaction chemistry involved with converting these oxalate feed stocks into glass products determines the potential for foaming, redox, and other melt and off gas related phenomena associated with this process. We've undertaken a detailed study of this conversion process using a variety of complementary techniques. A closed quartz crucible contained in a vertical furnace equipped with a quartz window and video camera was used to study volume expansion of the feed/melt during heating while monitoring the off-gas using a gas chromatograph-mass spectrometer. Simultaneous thermogravimetric and differential thermal analyses were conducted on small samples of feed and frit mixtures. Samples containing Ce were analyzed using established wet chemical techniques to determine Ce3+/Ce4+ ratio (redox) as a function of temperature. We evaluate the results and provide a description of the reaction chemistry of these oxalate feeds during vitrification.