Skincare potential of a sustainable postbiotic extract produced through sugarcane straw fermentation by Saccharomyces cerevisiae

Postbiotics are defined as a "preparation of inanimate microorganisms and/or their components that confers a health benefit on the host." They can be produced by fermentation, using culture media with glucose (carbon source), and lactic acid bacteria of the genus Lactobacillus, and/or yeast, mainly Saccharomyces cerevisiae as fermentative microorganisms. Postbiotics comprise different metabolites, and have important biological properties (antioxidant, anti-inflammatory, etc.), thus their cosmetic application should be considered. During this work, the postbiotics production was carried out by fermentation with sugarcane straw, as a source of carbon and phenolic compounds, and as a sustainable process to obtain bioactive extracts. For the production of postbiotics, a saccharification process was carried out with cellulase at 55°C for 24 h. Fermentation was performed sequentially after saccharification at 30°C, for 72 h, using S. cerevisiae. The cells-free extract was characterized regarding its composition, antioxidant activity, and skincare potential. Its use was safe at concentrations below ~20 mg mL-1 (extract's dry weight in deionized water) for keratinocytes and ~ 7.5 mg mL-1 for fibroblasts. It showed antioxidant activity, with ABTS IC50 of 1.88 mg mL-1 , and inhibited elastase and tyrosinase activities by 83.4% and 42.4%, respectively, at the maximum concentration tested (20 mg mL-1 ). In addition, it promoted the production of cytokeratin 14, and demonstrated anti-inflammatory activity at a concentration of 10 mg mL-1 . In the skin microbiota of human volunteers, the extract inhibited Cutibacterium acnes and the Malassezia genus. Shortly, postbiotics were successfully produced using sugarcane straw, and showed bioactive properties that potentiate their use in cosmetic/skincare products.

The Association of Leptin with Left Ventricular Hypertrophy in End-Stage Kidney Disease Patients on Dialysis

Left ventricular hypertrophy (LVH) is a common cardiovascular complication in end-stage kidney disease (ESKD) patients. We aimed at studying the association of LVH with adiponectin and leptin levels, cardiovascular stress/injury biomarkers and nutritional status in these patients. We evaluated the LV mass (LVM) and calculated the LVM index (LVMI) in 196 ESKD patients on dialysis; the levels of hemoglobin, calcium, phosphorus, parathyroid hormone, albumin, adiponectin, leptin, N-terminal pro B-type natriuretic peptide (NT-proBNP) and growth differentiation factor (GDF)-15 were analyzed. ESKD patients with LVH (n = 131) presented higher NT-proBNP and GDF-15, lower hemoglobin and, after adjustment for gender, lower leptin levels compared with non-LVH patients. LVH females also showed lower leptin than the non-LVH female group. In the LVH group, LVMI presented a negative correlation with leptin and a positive correlation with NT-proBNP. Leptin emerged as an independent determinant of LVMI in both groups, and NT-proBNP in the LVH group. Low hemoglobin and leptin and increased calcium, NT-proBNP and dialysis vintage are associated with an increased risk of developing LVH. In ESKD patients on dialysis, LVH is associated with lower leptin values (especially in women), which are negatively correlated with LVMI, and with higher levels of biomarkers of myocardial stress/injury. Leptin and NT-proBNP appear as independent determinants of LVMI; dialysis vintage, hemoglobin, calcium, NT-proBNP and leptin emerged as predicting markers for LVH development. Further studies are needed to better understand the role of leptin in LVH in ESKD patients.

Anterolateral ligament of the knee-Cadaver study in a Caucasian population

INTRODUCTION

Despite the recognized importance of the anterolateral ligament (ALL) in rotational stability of the knee, some studies still deny its role and even its existence. We studied the prevalence of the ALL in a Caucasian population, as well as its characteristics and anatomical relationships.

MATERIALS AND METHODS

The study was performed on 20 knees from 10 embalmed cadavers. A lateral approach, as described by Steven Claes, was used and the relations of the ALL with the lateral epicondyle, lateral inferior genicular artery, lateral meniscus, Gerdy's tubercle and fibular head were recorded. Its length and its width were also measured.

RESULTS

The ALL was identified in 16 knees. Its origin was at a distance inferior to 1mm posterior and proximal to the lateral femoral epicondyle and insertion within a mean distance of 2.1±0.6mm from de tibial articular surface, 20.6±1.3mm from the Gerdy's tubercle and 20.3±1.2mm from the fibular head. In all cases ALL presented mutual fibers with the lateral meniscus. The length was 35.8±4.6mm and the width was 4.2±1.3/4.9±1.0/6.5±1.5mm at its proximal, middle and distal third, respectively. No difference was found between gender and the dimensions of the ligament.

CONCLUSIONS

The ALL was found in 80% of the knees. Its origin is closely related to the lateral collateral ligament and its insertion is halfway between the fibular head and the Gerdy's tubercle. In all cases, we verified the connection between ALL and the lateral meniscus.

Peritoneal Dialysis Exit-Site Care Protocols in Portugal and Its Association with Catheter-Related Infections

INTRODUCTION

Exit-site infection (ESi) prevention is a key factor in lowering the risk of peritonitis. This study aimed to evaluate the associations between exit-site (ES) care protocols and the annual incidence rates of ESi and peritonitis in Portugal.

METHODS

We performed a national survey using two questionnaires: one about the incidence of catheter-related infections and the other characterizing patients' education and ES care protocols.

RESULTS

In 2017 and 2018, 14 Portuguese units followed 764 and 689 patients. ESi incidence rate was 0.41 episodes/year, and the peritonitis incidence rate was 0.37. All units monitor catheter-related infections on a yearly basis, use antibiotic prophylaxis at the time of catheter placement, and treat nasal carriage of S. aureus, although with different approaches. Screening for nasal carriage of S. aureus is performed by 12 units, and daily topical antibiotic cream is recommended by 6 out of 14 of the units. We did not find statistical differences in ESi/peritonitis, comparing these practices. The rate of ESis was lower with nonocclusive dressing immediately after catheter insertion, bathing without ES dressing, with the use of colostomy bags in beach baths and was higher with the use of bath sponge. The peritonitis rate was lower with bathing without ES dressing and if shaving of the external cuff was performed in the presence of chronic ESi.

CONCLUSIONS

We found potential proceedings associated with ESi and peritonitis. A regular national audit of peritoneal dialysis units is an important tool for clarifying the best procedures for reduction of catheter-related infections.

MO674: Risk Factors for Abdominal Wall Hernias in Peritoneal Dialysis Patients

BACKGROUND AND AIMS

Abdominal hernias are relatively common non-infectious complications in peritoneal dialysis (PD) patients with reported prevalence rates ranging from 7% to 27.5%. This complication can be troublesome and is sometimes associated with PD suspension and transition to hemodialysis, that can be transiently or definitively. Several risk factors for hernia formation have been proposed and included male gender, advanced age, autosomal dominant polycystic kidney disease (ADPK) and previous hernia repair. A larger dialysate diffusion volume is associated with increased intra-abdominal pressure and has been reported to increase the risk of hernia. However, studies are in conflict regarding risk factors for hernia formation. The aim of this study was to establish the incidence and the risk factors for hernia formation in patients receiving PD at our center.

METHOD

We developed a single-center, retrospective, observational study. Incident PD patients from January 2010 until October 2020 were screened for inclusion. Multiple logistic regression based on variables with P-value <0.05 in univariate comparative test and Cox regression were applied to estimate the predictors for hernia formation. A value of P < 0.05 was considered statistically significant.

RESULTS

A total of 163 PD patients were enrolled since and followed until December 2020, with 53 hernia events and 32 hernioplasties being registered in 28 patients (52.8%). The incidence rate was 0.09 hernias/patient/year. Table 1 summarizes the general characteristics of the patient with and without hernias. The umbilical hernias were the most common hernia type encountered (64.2%), followed by inguinal and incisional hernias. Median duration on PD therapy was 24.0 months (range: 18.5–35 months) and the median time from the start of PD to the development of hernia was 12.8 months (range: 6.1–18.9 months). The majority of patients who developed hernia were on continuous ambulatory PD (CAPD) (79.2%; n = 42).

In the univariate comparative test (Table 1), previous abdominal surgery (49.1% versus 11.8%, P < 0.001) and past history of hernia (34% versus 5.5%, P < 0.001) were identified as risk factors. We also observed significant differences between groups in relation to total dialysate fill-volume (P = 0.001) and PD modality (P = 0.026). There was no statistically significant difference in demographic characteristics and comorbidities.

Multivariate analysis showed ADPK as the only independent risk factor for development of hernia (OR 0.2, 95% CI [0.04–1.07]).

In Cox regression analysis, male gender, history of nephrectomy or other abdominal surgery, CAPD and largest total dialysate fill-volume were associated with an earlier development of hernias (P < 0.05), but no association was found with these variables in the adjusted models for the Cox regression analyses.

Overall, 32 hernias (60.4%) were surgically repaired, nearly all were handled electively (29 of 32, 90.6%); the remaining 3 hernias required emergency surgery. Six hernias (18.8%) recurred, with a median time to recurrence of 13.1 months (range: 3.7–29.6 months). Longer PD vintage was the only factor associated with the recurrence of hernia (P = 0.005).

CONCLUSION

In our study, abdominal hernias are very frequent in the PD population. ADPK was an independent risk factor for their development. We found that longer PD vintage is an important factor for recurrence of hernia after surgical repair.

Encapsulating peritoneal sclerosis: from early diagnosis to successful kidney transplantation

Encapsulating peritoneal sclerosis is an uncommon but serious complication of peritoneal dialysis. In most cases, the symptoms appear after peritoneal dialysis withdrawal, which hampers its diagnosis. We present the case of a 44-years-old Caucasian male who had been on peritoneal dialysis for 6 years and 3 months and was switched to hemodialysis due to ultrafiltration failure. During his last months on peritoneal dialysis, he developed anorexia and asthenia, which were initially attributed to dialysis inadequacy. After hemodialysis induction, the patient developed abdominal pain, increased abdominal volume, obstipation alternating with diarrhea, and weight loss. Computed tomography showed de novo ascites. A diagnosis of early encapsulating peritoneal sclerosis was considered, and treatment was promptly initiated with nutritional support, oral prednisolone, and tamoxifen for one year. The patient progressed with resolution of the symptoms. One month after the end of the treatment, he underwent a successful kidney transplant and remain without any major intercurrences. A high level of clinical suspicion is crucial for the early diagnosis of encapsulating peritoneal sclerosis as the disease can be fatal in advanced stages. This case highlights that with early treatment, kidney transplantation can be successfully performed after an episode of encapsulating peritoneal sclerosis.

Interleukin 6 (rs1800795) and pentraxin 3 (rs2305619) polymorphisms-association with inflammation and all-cause mortality in end-stage-renal disease patients on dialysis

Chronic inflammation plays an important role in the progression and outcome of chronic kidney disease (CKD). The circulating levels of the inflammatory biomarkers interleukin 6 (IL6) and pentraxin 3 (PTX3) are enhanced in CKD patients, and are associated with the progression of the disease and with higher risk for cardiovascular events, the major cause of death in CKD patients. Our aim was to study how specific polymorphisms of IL6 and PTX3 encoding genes affect the inflammatory response and outcome of end-stage renal disease (ESRD) patients on dialysis. Methodology included the analysis of two single nucleotide polymorphisms (SNP), namely the IL6 (rs1800795) polymorphism in the promoter region (-174G > C), and the PTX3 (rs2305619) polymorphism in the intron 1 (+ 281A > G), which were analyzed in ESRD patients on dialysis and in a group of heathy individuals. The allelic frequencies, genotype distribution and their association with circulating levels of the inflammatory markers C-reactive protein (CRP), IL6, growth differentiation factor 15 (GDF15) and PTX3, were determined in ESRD patients. Events of death were recorded along one year, to assess the association of the studied SNPs with all-cause mortality and the inflammatory biomarkers, in ESRD patients. Results showed that the allelic frequencies and genotype distribution for IL6 and PTX3 SNPs in the control group and ESRD patients were similar and in agreement with other European reports. For the IL6 polymorphism, we found a trend towards higher levels of high-sensitivity (hs) CRP, IL6 and PTX3 in the homozygous genotypes; the CC genotype also showed the highest levels of GDF15. The mortality rate after the 1-year follow-up was 10.4%. The CC genotype (IL6 SNP) was associated to a higher risk of mortality and deceased patients carrying this genotype also showed the highest levels of hsCRP. Regarding the studied PTX3 SNP, the AA genotype was linked to an enhanced inflammatory response, showing the highest values of hsCRP and IL6. Nevertheless, this genotype had no significant impact on the mortality rate. In conclusion, both studied SNPs seem to modulate the inflammatory response in ESRD and may, therefore, be determinant on disease progression and patients' outcome. Our data also highlights the importance of research on genetic variants that, although less frequent, may have significant biological value.

MO810INTERLEUKIN-6 (-174G/C) POLYMORPHISM, RS1800795, IN ESRD PATIENTS' OUTCOME*

Background and Aims

Chronic inflammation plays an important role in the progression of chronic kidney disease (CKD) to end-stage renal disease (ESRD). The single nucleotide polymorphism (SNP) in the promoter region (-174G/C) of interleukin-6 (IL6) gene regulates the levels of this cytokine, which have been associated with a poor outcome in several pathologies. Our aims were to determine, according to the genotype distribution of this polymorphism, the association between the inflammatory mediators, high sensitivity C-reactive protein (hsCRP), IL6, and pentraxin 3 (PTX3), shown to be increased in ESRD, and to estimate the risk for all-cause mortality over a period of one year.

Method

289 ESRD patients on hemodialysis (high-flux hemodialysis and hemodiafiltration) were included in this study. Real-Time PCR TaqMan SNP genotyping assays were used to assess allelic frequencies of IL6 (rs1800795). We evaluated the circulating levels of PTX3, hsCRP and IL6 using commercially available kits. Deaths occurring along 1-year follow-up period were recorded, and the all-cause mortality hazard ratio (HR), according to IL6 polymorphisms in this patient cohort were determined by Cox regression analysis. A p < 0.05 value was considered statistically significant.

Results

In all IL6 (-174G>C) genotypes, hsCRP was positively and significantly correlated with IL6. For hsCRP and PTX3, a positive correlation with significance was only found for the GG genotype. All genotypes showed positive correlations between IL6 and PTX3 circulating levels, although only the GG genotype achieved a significant value. The Cox regression survival analysis for all-cause mortality in ESRD patients, using as reference the heterozygous patients for IL6 polymorphism, showed that CC patients presented a significant higher mortality risk, with a HR of 3.275 [1.165 to 9.204]. Moreover, the median survival time of CC patients (100 [54 - 138] days) was lower than that presented by the GG genotype patients (211 [83 - 290] days, p < 0.05 vs. CC) and by the heterozygous patients (291 [72 - 332] days, p = 0.157 vs. CC).

Conclusion

We observed different correlation profiles between inflammatory biomarkers within each IL6 (-174G>C) genotype. The association of the CC genotype of the IL6 polymorphism with a poorer outcome and shorter survival time for ESRD patients was also observed. However, further studies are required and must consider the underlying individual genetic background, since the inflammatory state appears to be influenced by IL6 polymorphisms, which, in turn, might be determinant for disease progression and outcome.

Acknowledgments

This work was supported by Applied Molecular Biosciences Unit-UCIBIO, financed by national funds from FCT/MCTES (UIDB/04378/2020), by North Portugal Regional Coordination and Development Commission (CCDR-N)/NORTE2020/Portugal 2020 (Norte-01-0145-FEDER-000024) and by REQUIMTE-Rede de Química e Tecnologia-Associação in the form of a researcher (S. Rocha) – project Dial4Life co-financed by FCT/MCTES (PTDC/MEC-CAR/31322/2017) and FEDER/COMPETE 2020 (POCI-01-0145-FEDER-031322).

MO824PREDICTORS OF MORTALITY OF COVID-19 IN CHRONIC HEMODIALYSIS PATIENTS

Background and Aims

Coronavirus disease 2019 (COVID-19) has affected the care of patients on chronic hemodialysis (HD). It has been reported that older adults and those with comorbidities, such as diabetes mellitus, hypertension, cardiovascular disease and chronic kidney disease are prone to develop severe disease and poorer outcomes. By virtue of their average old age, multiple comorbidities, immunosuppression and frequent contact with other patients in dialysis facilities, chronic HD patients are at particular risk for severe COVID-19 infection. The aim of this study was to compare clinical presentation, laboratory and radiologic data and outcomes between HD and non-HD COVID-19 patients and find possible risk factors for mortality on HD patients.

Method

A single center retrospective cohort study including patients on HD hospitalized with a laboratory confirmed COVID-19 infection, from March 1st to December 31st of 2020 and matched them to non-dialysis patients (non-HD) (1:1). Data regarding patient baseline characteristics, symptoms, laboratory and radiologic results at presentation were collected, as well as their outcomes. Categorical variables are presented as frequencies and percentages, and continuous variables as means or medians for variables with skewed distributions. A paired Student’s t-test was performed on parametric continuous values or Mann-Whitney for non-parametric continuous variables. Chi-squared test was performed for comparing categorical variables. Logistic regression was used to identify risk factors for mortality on HD patients. A p-value of less than 0,05 indicated statistical significance.

Results

A total of 34 patients HD patients were included, 70,6% male, mean age of 76,5 years, median time of dialysis of 3,0 years. Among them 85,3% were hypertensive, 47,1% diabetic, 47,1% had cardiovascular disease, 30,6% pulmonary chronic disease and 23,5% cancer. The most frequent symptoms were fever (67,6%), shortness of breath (61,8%) and cough (52,9%). At admission, 55,9% of patients needed oxygen supply, one required mechanic ventilation and was admitted to intensive care unit. Regarding laboratory data, the most common features were lymphopenia in 58,9% (median- 795/uL), elevated LDH in 64,7% (median- 255 U/L), raised C-reactive protein in 97,1% (median-6,3 mg/dlL, raised D-dimer in 95,8% (median 1,7 ng/mL), and all patients presented high ferritin (median 1658 ng/mL) and elevated Troponin T (median 130ng/mL). The majority presented with radiologic changes, particularly bilateral infiltrates in 29,4%. Concerning clinical outcomes, the median hospitalization time was 11 days and 13 patients (38,2%) developed bacterial superinfection. Mortality rate was 32,4%. When matched to 34 non-HD patients there was no statistical significant differences in sex, age and comorbidities. The HD group had a tendency to more ventilator support need (p=0,051), higher ferritin and troponin levels (p=<0,001 for both), whereas the non-HD group presented with greater levels of transaminases (p= 0,017). There was o significant difference in hospitalization time (median of 11 vs 7 days, p=0,222) neither in mortality (median of 32,4 vs 35,3%, p=0,798). When the logistic regression was performed, only bacterial superinfection was a predictor for mortality on hemodialysis patients (p=0,004).

Conclusion

Our study compared outcomes for COVID-19 patients on chronic HD to non-dialysis patients and showed no difference in hospitalization time nor in death rate. In spite of these results, the mortality in patients on chronic HD is still not negligible, with up to 32% of in-hospital mortality. Bacterial superinfection is a predictive risk factor for mortality. Hence the importance of interventions to mitigate the burden of COVID-19 in these patients, by preventing its spread, particularly in hemodialysis centers.

Cell-free DNA as a marker for the outcome of end-stage renal disease patients on haemodialysis

Background

DNA damage and inflammation are common in end-stage renal disease (ESRD). Our aim was to evaluate the levels of circulating cell-free DNA (cfDNA) and the relationship with inflammation, anaemia, oxidative stress and haemostatic disturbances in ESRD patients on dialysis. By performing a 1-year follow-up study, we also aimed to evaluate the predictive value of cfDNA for the outcome of ESRD patients.

Methods

A total of 289 ESRD patients on dialysis were enrolled in the study: we evaluated cfDNA, haemogram, serum iron, hepcidin, inflammatory and oxidative stress markers, and haemostasis. Events and causes of deaths were recorded throughout the follow-up period.

Results

ESRD patients, as compared with controls, presented significantly higher levels of cfDNA, hepcidin, and inflammatory and oxidative stress markers, and significantly lower values of iron and anaemia-related haemogram parameters. The all-cause mortality rate was 9.7%; compared with alive patients, deceased patients (n = 28) were older and presented significantly higher values of inflammatory markers and of cfDNA, which was almost 2-fold higher. Furthermore, cfDNA was the best predictor of all-cause mortality and cardiovascular mortality in ESRD patients, in both unadjusted and adjusted models for basic confounding factors in dialysis.

Conclusions

Our data show cfDNA to be a valuable predictive marker of prognosis in ESRD patients on dialysis treatment; high levels of cfDNA were associated with a poor outcome.

Mixed cryoglobulinemia; a rare presentation of Waldenström macroglobulinemia

Type II mixed cryoglobulinemia is a systemic disease mediated by immune complexes. Renal involvement is present in almost one third of the cases and the membranoprolifer-ative pattern is the most common histological presentation. In turn, in Waldenström macroglobulinemia, renal impairment is rare, with few cases of associated cryoglobu-linemia being reported. The authors present the case of a patient with type II mixed cry-oglobulinemia associated with Waldenström macroglobulinemia diagnosis.

P1502IS AGE JUST A NUMBER? - HEMODIALYSIS IN OCTOGENARIAN PATIENTS IN A PORTUGUESE CENTRAL HOSPITAL

Background and Aims

The option of a non-dialytic or conservative approach to elderly patients with End-Stage Renal Disease (ESRD) as an alternative to dialysis has a great interest in clinical practice. Among elderly patients with ESRD, the octogenarian ones raise the most difficult decisions with respect to indication and dialysis therapy management, furthermore the evidence about the clinical outcomes is lacking in this group of patient. The main objectives of this study were the analysis the comorbidities and clinical condition of pre-ESRD octogenarians who initiated dialysis and the estimation of the effect of such treatment on this patient group’s comorbid status.

Method

The authors performed a retrospective and statistical analysis on patients with aged ≥ 80 years who initiated hemodialysis treatment in a Portuguese Central Hospital between 2007 and 2017. A total of 88 patients were included in the study.

Results

The mean age of the group was 84±2.8 years; 61.4% were men. Nearly all the patients (97.7%) had one or more comorbid conditions of which the most common were hypertension (86.4%), heart disease (58%) and diabetes (43.2%). In 60.2% of the patients the functional activity was normal (Karnofsky score ≥80). Hemodialysis was initiated in an emergency situation in 58% of the patients and the majority (59.1%) had an arteriovenous fistula as vascular access. In the 2 years previous to dialysis therapy, most patients (54.5%) had at least one hospitalization (min=1; max=4). During the two years of follow-up, the number of hospital admissions decreased (p=0.034) and only 39.8% of the patients required hospital admission (min=1; max=3) (table 1), with shorter average hospital stay (p=0.013) (table 2). The main causes of hospitalization in the pre-dialysis period were renal related-diseases, in contrast the admissions were due to non-access related infections and vascular access complications after dialysis had initiated. Most patients died (67%) at the end of follow-up mainly due to non-vascular access infections or sepsis (32.2%). The significant causes of death found by Cox regression were chronic kidney disease secondary to systemic disease, Karnofsky score and hospital stay in the 2-year-dialysis period (table 3).

Conclusion

Advanced age in itself should not be used as an excluding factor of dialysis treatment. Comorbidity and performance status are the factors that should exert the greatest influence on such decision. In this sample, the majority of patients had few comorbidities, a good functional activity and they initiated dialysis by an autologous vascular access which may have contributed to the good outcomeS. This study found a decrease in the number of hospitalizations in the dialysis period which can be explained by regular clinical monitoring in every dialysis treatment, preventing or even treating intercurrent illnesses and avoiding hospital admissions.

P1531DIURETIC USE IN HEMODIALYSIS PATIENTS: BENEFIC ASSOCIATION WITH RESIDUAL RENAL FUNCTION AND ALL-CAUSE MORTALITY

Background and Aims

In patients with end-stage renal disease (ESRD) on hemodialysis, the preservation of residual kidney function may result in a diversity of benefits in terms of survival and quality of life. The control of fluid and electrolyte homeostasis may play an important role in this setting. Elevated predialysis serum potassium is a common electrolyte disturbance that may worsen patient’s outcomes. Our aim was to study the impact of furosemide therapy in predialysis serum potassium levels, indicators of estimated residual renal function, and inflammatory markers, in ESRD patients under hemodialysis; moreover, we aimed to study the impact of furosemide-associated changes on mortality rate.

Method

A cross-sectional study was carried out on 289 adult patients on chronic dialysis therapy (hemodiafiltration and high flux hemodialysis). Patients were divided in 2 groups: the diuretic group (DG, n=116; 120.0 (IQR: 80-160) mg/daily median furosemide dose) and the non-diuretic group (NDG, n = 173), in which patients did not use furosemide. A large set of data was analyzed, encompassing hematological data, serum electrolyte parameters, inflammatory markers, dialysis adequacy, and biomarkers of residual kidney function. A 2-year follow up study was also performed by registering events of death (all-cause mortality).

Results

The DG patients, compared with NDG patients, presented: significantly lower predialysis serum potassium; more favorable blood biomarkers of kidney function - lower β-trace protein, cystatin C, creatinine and urea; greater residual glomerular filtration rate derived from equations with cystatin C, creatinine and creatinine–cystatin C; lower inflammation (significantly lower levels of high-sensitivity C-reactive protein); intradialytic ultrafiltration volume (L) was similar for the two groups. Mortality was significantly lower for DG patients, compared with NDG (13.6% versus 24.7%; P=0.029).

Conclusion

In ESRD patients under chronic dialysis, we found a significant association between current diuretic therapy and lower predialysis serum potassium levels, more favorable biomarkers of kidney function and a decreased inflammatory response that seem to contribute to a higher survival rate.

Acknowledgments: The work was supported by UIDB/04378/2020 with funding from FCT/MCTES through national funds, by North Portugal Regional Coordination and Development Commission (CCDR-N)/NORTE2020/Portugal 2020 (Norte-01-0145-FEDER-000024) and by REQUIMTE-Rede de Química e Tecnologia-Associação in the form of a researcher (S. Rocha) – project Dial4Life co-financed by FCT/MCTES (PTDC/MEC-CAR/31322/2017) and FEDER/COMPETE 2020 (POCI-01-0145-FEDER-031322).

P0765RHEUMATOID ARTHRITIS AND CHRONIC KIDNEY DISEASE: DOES INFLAMMATION SAY IT ALL?

Background and Aims

Rheumatoid arthritis (RA) increase risk of developing chronic kidney disease (CKD), but it is unknow which risk factors contributes to CKD in this population. This study aims to determine predictors for the development of CKD in RA patients.

Method

A retrospective study was conducted in 106 patients with RA followed at a sub-specialized internal medicine appointment between January 2007 and December 2017. RA was defined according to the American College of Rheumatology criteria and CKD was defined as an estimated glomerular filtration rate less than 60mL/min/ 1.73m2 or presence of abnormalities of urinary sediment for 3 months.

Results

The mean age was 61 ± 12.83 years, and 67.9% (n=72) were female. The prevalence of CKD was 20.8% (n=22). Renal disease had multifactorial etiology in 20 patients, and one case of ANCA negative glomerulonephritis and other of diabetic nephropathy. Individuals with RA and CKD were older, presented more cardiovascular disease, diabetes and hypertension. There was no statistically significant association between gender and the presence of CKD (p = 0.131). Age (p = 0.031) and diabetes (p = 0.031) were independent risk factors for development of CKD in RA patients. RA duration in patients with CKD (8, 4-13) was not statistically different from RA duration in non-CKD patients (7.50, 4,75 – 12,25), (p=0.890).

Conclusion

Patients with RA and CKD had higher incidence of cardiovascular events, diabetes and hypertension which are a major cause of mortality and morbidity in this group. The presence of diabetes mellitus that often arise as an adverse effect of drugs used in the treatment of RA, significantly increased the risk of developing CKD. Otherwise, RA duration didn’t represent a risk factor for developing CKD. Thus, it is important to control diabetes, particularly glucocorticoid-induced diabetes to prevent development of CKD in AR patients.

P1570INTERLEUKIN-6 (RS1800795) AND PENTRAXIN 3 (RS2305619) GENETIC POLYMORPHISMS AND THEIR RELATION WITH INFLAMMATION AND ALL-CAUSE MORTALITY IN ESRD PATIENTS ON DIALYSIS

Background and Aims

Chronic inflammation plays an important role in progression and outcome of chronic kidney disease (CKD) patients. The interleukin-6 (IL-6) polymorphism, rs1800795, is a single nucleotide polymorphism (SNP) in the promoter region (-174G/C) that regulates gene transcription and affects the levels of this cytokine. Genetic variants in the promotor region have been associated with a poor outcome in several pathologies, namely in coronary artery disease. Pentraxin 3 (PTX3) is an inflammatory protein, produced locally by different cell types (e.g. mononuclear phagocytes, dendritic cells, fibroblasts and endothelial cells). PTX3 polymorphism, rs2305619, is a SNP (+281A&gt;G) in the intron 1 of PTX3 gene. PTX3 polymorphisms have been described as risk factor for development of coronary artery disease and for an impairment of kidney function. Our aim was to determine the allelic frequencies of IL6 and PTX3 in end-stage renal disease (ESRD) patients and controls, as well as their relationship with the inflammatory response.

Method

We studied 289 ESRD patients on hemodialysis (high-flux hemodialysis or hemodiafiltration) and 22 healthy individuals, matched for gender, body mass index, and, as far as possible, for age. Real-Time PCR TaqMan SNP genotyping assays were used to assess allelic frequencies of IL6 (rs1800795) and PTX3 (rs2305619). We evaluated the circulating levels of PTX3, growth differentiation factor (GDF)-15, high-sensitivity C-reactive protein (hsCRP), IL-6, tumor necrosis factor-alpha (TNF-α), soluble TNF receptor 2 (sTNFR2), hepcidin and transferrin, using commercially available kits. Deaths occurring along 1-year follow-up period were recorded and mortality rates were evaluated for homozygous and heterozygous alleles.

Results

Compared to controls, all inflammatory biomarkers were significantly higher in ESRD patients. Allelic frequencies in ESRD patients and controls were similar for both SNPs, IL-6 -174G/C and PTX3 +281A&gt;G, considering the homozygous and the heterozygous alleles. For the IL-6 -174G/C, the CC patients, compared to GG and heterozygous patients, showed significantly higher GDF-15 and CRP concentrations and significantly lower values of transferrin; moreover, we found that CC patients presented a trend towards higher mortality rate (21%, 10% and 7% for CC, GG and GC, respectively; P=0.072). For PTX3 +281A&gt;G polymorphism, the AA patients, compared to GG and heterozygous patients, presented higher hsCRP; no significant differences were found in mortality rate between different allele carrier groups (P=0.703).

Conclusion

Although no differences were found in the allelic frequencies between controls and ERSD patients, the CC patients for IL6 polymorphism (rs1800795) and AA patients for PTX3 polymorphism (rs2305619), showed an enhanced inflammatory response; the association of the IL6 polymorphism with a higher mortality needs further studies.

P1581IMPACT OF ACHIEVING LDL CHOLESTEROL LOWER THAN 100 MG/DL WITH STATINS, ON LIPID PROFILE AND INFLAMMATION IN END-STAGE RENAL DISEASE PATIENTS

Background and Aims

Dyslipidemia is common in chronic kidney disease (CKD) and cardiovascular disease (CVD)-related events are the main causes of death in end-stage renal disease (ESRD) patients on dialysis. Concerning lipid management, clinical practice emphasized treatment escalation to achieve specific low-density lipoprotein cholesterol (LDLc) targets, which implies repeated LDLc evaluations, and enhancement of statin doses or combination of lipid-lowering therapies. However, the LDLc target is not consensual, with some entities suggesting 100 mg/dl and others a more conservative level. It has been hypothesized that lipoprotein’s quality (size, composition and functionality) may be more important than their total circulating levels, as CVD risk factor. Our aim was to evaluate and compare, in ESRD patients on dialysis and under statins treatment, the levels of lipoprotein fractions and subfractions and inflammatory markers, between patients who achieved LDLc levels &lt; 100 mg/dl and those who did not achieve that target.

Method

We studied 110 ESRD patients on dialysis (high-flux hemodialysis or hemodiafiltration) and under statin therapy; 87 presented a LDLc &lt; 100 mg/dl (group 1) and 23 a value &gt; 100 mg/dl (group 2); levels of high-sensitivity C-reactive protein (hsCRP), interleukin(IL)-6, lipid profile including lipoprotein fractions/subfractions, and oxidized LDL (oxLDL) were evaluated.

Results

Group 1, as compared to group 2, presented lower values of total cholesterol (TC), triglycerides, oxLDL, TC/high-density lipoprotein cholesterol (HDLc) and LDLc/HDLc ratios. Concerning lipoprotein fractions/subfractions, group 1 presented significantly higher larger and intermediate LDL, and a trend towards lower small LDL (P=0.063), higher large HDL (P=0.069) and lower small HDL (P=0.080); no significant alterations were found for very-low-density lipoprotein and intermediate-density lipoprotein. Regarding inflammatory markers, no significant differences were observed between the 2 groups.

Conclusion

Patients who achieved the LDLc &lt; 100 mg/dl target presented a better non-conventional lipid profile, including lower oxLDL levels and an increase in larger (less atherogenic) LDL subfractions. According to our data, a lower LDLc level associates with a better lipid profile; the benefits of this improvement on HDL fractions and CVD-related events in ESRD patients on dialysis needs to be better clarified.

P1132EXIT-SITE CARE PROTOCOLS IN PORTUGAL AND ITS ASSOCIATION WITH CATHETER-RELATED INFECTIONS RATE

Background and Aims

Exit-site infections (ESi) are frequent complications in peritoneal dialysis (PD) patients and their prevention and treatment are key aspects to lower peritonitis’ risk.

The aim of this study was to evaluate the annual incidence rate of ESi and peritonitis in Portugal and to study possible associations between exit-site (ES) care protocols in each Portuguese unit and the number / rate of ESi and peritonitis.

Method

We performed a national study using two questionnaires at each Portuguese PD Unit: one about the incidence of catheter-related infections, the other characterizing patients’ education and ES care protocols. ESi and peritonitis were defined according to ISPD guidelines. Associations between variables were performed using T-student test or pairwise correlation test. STATA software was used.

Results

Of the 23 Portuguese PD Units, 14 units answered both questionnaires. In the last two years (2017 & 2018), those units followed 1453 patients. Portuguese ESi incidence rate was 0.41 episodes per year [1 episode per 29.2 months (MSSA incidence rate 0.13; MRSA incidence rate 0.03; Pseudomonas incidence rate 0.07)] and the peritonites incidence rate was 0.37 (1 episode per 32.5 months). We found a trend between the absolute number of ESi episodes and the number of peritonites in each unit (r=0.5, p=0.05).

Although ESi prevention guidelines were known by 100% of the Portuguese units, only three out of 5 of the selected guidelines for this study were followed by 100% of the units: monitoring catheter-related infections on a yearly basis; using antibiotic prophylaxis at time of catheter placement and treating nasal carriage of S. aureus. The other 2 guidelines have variable implementation: 12 out of 14 units (86%) perform screening of nasal carriage of S. aureus and only 6 out of 14 (43%) of the units recommend daily topic antibiotic cream at the ES. We didn’t find associations between those differences and ESi incidence.

Whenever S. aureus carriage is detected, 100% of the units proceed treating with mupirocine using different posology (twice or three times a day, 5 or 7 or 21 days, with/out chlorexidine). Also, the screening of nasal carriage of S. aureus is different: only pre catheter implantation (n=4); annually (n=4); semi annually (n=3); bimonthly (n=2). Oral antibiotics are prescribed after catheter placement in 4 units. We didn’t find statistical differences in ESi / peritonitis, comparing those practices.

Regarding to ES care protocols, ESi rate was lower with non-occlusive dressing (0.38 vs. 0.57) immediately after catheter insertion. ESi and peritonitis rate were lower in units where bathing without ES dressing is advocated (n=9, 0.58 & 0.37 vs. 0.32 & 0.34). The use of bath sponge is associated with higher ESi rate (0.57 vs. 0.34). The use of colostomy bags in beach baths was associated with lower incidence rate of ESi compared to regular dressing or waterproof dressing (o.32 vs. 0.54).

100% of units use two different empirical antibiotics for initial ESi treatment. In the presence of chronic ESi, 3 units don’t perform shaving of external cuff and peritonitis rate is higher in those who do not apply this procedure (0.38 vs. 0.31).

Conclusion

in Portuguese PD units there is a wide variability in ISPD guidelines implementation and ES care protocols. We found that using non-occlusive dressing immediately after catheter insertion, removing ES dressing before shower, bathing not using a sponge and using colostomy bags at beach baths were associated with lower incidence rate of ESi. Shaving of the external cuff was associated with lower incidence rate of peritonitis. A regular national audit of PD Units is an important tool of quality improvement to clarify the best procedures for reduction of catheter-related infections in PD.

Hepcidin and diabetes are independently related with soluble transferrin receptor levels in chronic dialysis patients

Background: Soluble transferrin receptor (sTfR) is a biomarker of erythropoiesis, which is often impaired in dialysis patients. The aim of our study was to evaluate sTfR levels in chronically dialyzed patients and assess potential determinants of its levels. Methods: We performed a cross-sectional study by evaluating 246 end-stage renal disease patients undergoing dialysis and 32 healthy controls. Circulating levels of interleukin (IL)-6, C-reactive protein (CRP), tumor necrosis factor (TNF)-α, hepcidin, sTfR, growth differentiation factor 15 (GDF15), and traditional iron metabolism markers were measured, as well as hemogram parameters. Clinical data was obtained from all patients. Results: Compared to controls, patients presented similar values of sTfR, reticulocytes and reticulocyte production index (RPI), and significantly higher levels of IL-6, CRP, ferritin, hepcidin, TNF-α, and GDF15. Iron, transferrin, hemoglobin levels, erythrocyte count, mean cell hemoglobin (MCH), and mean cell hemoglobin concentration (MCHC) values were significantly lower in dialysis group. Within patients, sTfR values were higher in diabetic patients and were positively and significantly correlated with reticulocytes and erythrocytes, RPI, and therapeutic doses of erythropoiesis stimulating agents (ESA) and intravenous iron; and inversely and significantly correlated with circulating iron, ferritin, transferrin saturation, hepcidin, MCH, and MCHC. In multiple linear regression analysis, ESA dose, RPI, serum iron, diabetes, and hepcidin levels were independently associated with sTfR levels in dialysis patients and, thus, with erythropoiesis. Conclusion: Our data suggest that, besides RPI and ESA dose, diabetes and hepcidin are closely related to erythropoiesis in dialysis patients. The influence of diabetes on sTfR levels deserves further investigation.

Non-linear conduction due to depinning of charge order domains in Fe3O2BO3

The oxyborate Fe₃O₂BO₃ presents a charge density wave (CDW) transition close to room temperature. As we show here, this is associated with a well defined anomaly in the specific heat. Below this transition, when applying in a single crystal of Fe₃O₂BO₃ a DC voltage above a temperature dependent threshold, a high current is liberated in this material. We study the conduction in single crystals of Fe₃O₂BO₃ with voltage applied parallel and perpendicular to the crystallographic c axis direction. The observed currents are attributed to the depinning of charge ordered domains above a threshold voltage V _T2 that gives rise to a collective conduction due to coherent domains. Compliance limited DC data shows that above a lower threshold voltage depinning is smooth and follows a power law scaling. Similar depinning with power law scaling is also revealed in the AC conductivity.

The impact of a standardized order set for the management of non-hip fragility fractures in a Fracture Liaison Service

We analysed the impact of a standardized order set empowering staff nurses to independently manage a Fracture Liaison Service over a 9-month period. Nurses identified between 30 and 70 % of non-hip fragility fractures to the unit in charge of management over time. The latter managed 58 % of referred patients.

INTRODUCTION

The main goal of this study was to evaluate the impact of a standardized order set empowering nurses to independently manage a fracture liaison service (FLS).

METHODS

Since November 2014, an order set allowed nurses of a Montreal hospital, Quebec, Canada to entirely manage an FLS on their own. Nurses followed an 6-h training program on-site. Emergency department (ED) and orthopaedic outpatient clinic (OC) nurses identified non-hip fragility fractures. Medical day treatment unit (MDTU) nurses were in charge of the management (investigation and treatment initiation). The list of patients, 50 years and older, with a fracture were retrieved for the period of November 2014 to July 2015. Performance was assessed with the rate of identification over time and the rate of management of non-hip fragility fractures.

RESULTS

Over the 9-month period, 346 patients of ≥50 years old were seen for a fracture, of which 190 met fragility criteria (excluding hip fractures). A sinusoid pattern of rates of identification between 30-70 % was observed over time. An average proportion of 58.1 % of fracture patients were managed by MDTU nurses.

CONCLUSIONS

A standardized order set legally allowing nurses to manage an FLS led to identification rates varying from 30-70 % and a management rate close to 60 % for referred patients over a 9-month period, which largely exceeds that of standard care. Identification was mostly compromised by difficulty integrating the order set into routine practice. Enforcement of the hospital policy on fragility fractures could help yield efficiency of identification of osteoporosis-related fractures by the staff.

Immunolocalization of cell wall polymers in grapevine (Vitis vinifera) internodes under nitrogen, phosphorus or sulfur deficiency

The impact on cell wall (CW) of the deficiency in nitrogen (-N), phosphorus (-P) or sulphur (-S), known to impair essential metabolic pathways, was investigated in the economically important fruit species Vitis vinifera L. Using cuttings as an experimental model a reduction in total internode number and altered xylem shape was observed. Under -N an increased internode length was also seen. CW composition, visualised after staining with calcofluor white, Toluidine blue and ruthenium red, showed decreased cellulose in all stresses and increased pectin content in recently formed internodes under -N compared to the control. Using CW-epitope specific monoclonal antibodies (mAbs), lower amounts of extensins incorporated in the wall were also observed under -N and -P conditions. Conversely, increased pectins with a low degree of methyl-esterification and richer in long linear 1,5-arabinan rhamnogalacturonan-I (RG-I) side chains were observed under -N and -P in mature internodes which, in the former condition, were able to form dimeric association through calcium ions. -N was the only condition in which 1,5-arabinan branched RG-I content was not altered, as -P and -S older internodes showed, respectively, lower and higher amounts of this polymer. Higher xyloglucan content in older internodes was also observed under -N. The results suggest that impairments of specific CW components led to changes in the deposition of other polymers to promote stiffening of the CW. The unchanged extensin amount observed under -S may contribute to attenuating the effects on the CW integrity caused by this stress. Our work showed that, in organized V. vinifera tissues, modifications in a given CW component can be compensated by synthesis of different polymers and/or alternative linking between polymers. The results also pinpoint different strategies at the CW level to overcome mineral stress depending on how essential they are to cell growth and plant development.

Agreement between physicians' and nurses' clinical decisions for the management of the fracture liaison service (4iFLS): the Lucky Bone™ program

We determined if nurses can manage osteoporotic fractures in a fracture liaison service by asking a rheumatologist and an internist to assess their clinical decisions. Experts agreed on more than 94 % of all nurses' actions for 525 fragility fracture patients, showing that their management is efficient and safe.

INTRODUCTION

A major care gap exists in the investigation of bone fragility and initiation of treatment for individuals who have sustained a fragility fracture. The implementation of a fracture liaison service (FLS) managed by nurses could be the key in resolving this problem. The aim of this project was to obtain agreement between physicians' and nurses' clinical decisions and evaluate if the algorithm of care is efficient and reliable for the management of a FLS.

METHODS

Clinical decisions of nurses for 525 subjects in a fracture liaison service between 2010 and 2013 were assessed by two independent physicians with expertise in osteoporosis treatment.

RESULTS

Nurses succeeded in identifying all patients at risk and needed to refer 27 % of patients to an MD. Thereby, they managed autonomously 73 % of fragility fracture patients. No needless referrals were made according to assessing physicians. Agreement between each evaluator and nurses was of >97 %. Physicians' decisions were the same in >96 %, and Gwet AC11 coefficient was of >0.960 (almost perfect level of agreement). All major comorbidities were adequately managed.

CONCLUSIONS

High agreement between nurses' and physicians' clinical decisions indicate that the independent management by nurses of a fracture liaison service is safe and should strongly be recommended in the care of patients with a fragility fracture. This kind of intervention could help resolve the existing care gap in bone fragility care as well as the societal economic burden associated with prevention and treatment of fragility fractures.

New combined CFH/MCP mutations and a rare clinical course in atypical haemolytic uraemic syndrome

Atypical haemolytic uraemic syndrome (aHUS) is a rare, life-threatening, chronic, genetic disease due to uncontrolled alternative pathway complement activation. In this report, we discuss the case of a heterozygous carrier of a mutation on both factor H and membrane cofactor protein, who persistently presents haemolytic anaemia without need for blood transfusions, normal platelet count, normal renal function and no signs or symptoms of organ injury due to thrombotic microangiopathy 4 years after the diagnosis of aHUS.

Relating Water Deficiency to Berry Texture, Skin Cell Wall Composition, and Expression of Remodeling Genes in Two Vitis vinifera L. Varieties

The cell wall (CW) is a dynamic structure that responds to stress. Water shortage (WS) impacts grapevine berry composition and its sensorial quality. In the present work, berry texture, skin CW composition, and expression of remodeling genes were investigated in two V. vinifera varieties, Touriga Nacional (TN) and Trincadeira (TR), under two water regimes, Full Irrigation (FI) and No Irrigation (NI). The global results allowed an evident separation between both varieties and the water treatments. WS resulted in increased anthocyanin contents in both varieties, reduced amounts in cellulose and lignin at maturation, but an increase in arabinose-containing polysaccharides more tightly bound to the CW in TR. In response to WS, the majority of the CW related genes were down-regulated in a variety dependent pattern. The results support the assumption that WS affects grape berries by stiffening the CW through alteration in pectin structure, supporting its involvement in responses to environmental conditions.

Effect of Aging in the Perception of Health-Related Quality of Life in End-Stage Renal Disease Patients under Online-Hemodiafiltration

This work aimed to evaluate how aging could influence patients' perception of health quality of life (HRQOL), as well as, the effect of aging on dialysis adequacy and in hematological, iron status, inflammatory and nutritional markers. In this transversal study were enrolled 305 ESRD patients under online-hemodiafiltration (OL-HDF) (59.67% males; 64.9 ± 14.3 years old). Data about comorbidities, hematological data, iron status, dialysis adequacy, nutritional and inflammatory markers were collected from patient's records. Moreover, HRQOL score, by using the Kidney Disease Quality of Life-Short Form (KDQOL-SF), was assessed. Analyzing the results according to quartiles of age, significant differences were found for some parameters evaluated by the KDQOL-SF instrument, namely for work status, physical functioning and role-physical, which decreased with increasing age. We also found a higher proportion of diabetic patients, a decrease in creatinine, iron, albumin serum levels, transferrin saturation and nPCR, with increasing age. Moreover, significant negative correlations were found between age and mean cell hemoglobin concentration, iron, transferrin saturation, albumin, nPCR, work status, physical functioning and role-physical. In conclusion, our results showed that aging is associated with a decreased work status, physical functioning and role-physical, with a decreased dialysis adequacy, iron availability and nutritional status, and with an increased proportion of diabetic patients and of patients using central venous catheter, as the vascular access. The knowledge of these changes associated with aging, which have impact in the quality of life of the patients, could be useful in their management.

Dexamethasone shifts bone marrow stromal cells from osteoblasts to adipocytes by C/EBPalpha promoter methylation

Dexamethasone (Dex)-induced osteoporosis has been described as the most severe side effect in long-term glucocorticoid therapy. The decreased bone mass and the increased marrow fat suggest that Dex possibly shifts the differentiation of bone marrow stromal cells (BMSCs) to favor adipocyte over osteoblast, but the underlying mechanisms are still unknown. In this paper, we established a Dex-induced osteoporotic mouse model, and found that BMSCs from Dex-treated mice are more likely to differentiate into adipocyte than those from control mice, even under the induction of bone morphogenetic protein-2 (BMP2). We also discovered both in vitro and in vivo that the expression level of adipocyte regulator CCAAT/enhancer-binding protein alpha (C/EBPalpha) is significantly upregulated in Dex-induced osteoporotic BMSCs during osteoblastogenesis by a mechanism that involves inhibited DNA hypermethylation of its promoter. Knockdown of C/EBPalpha in Dex-induced osteoporotic cells rescues their differentiation potential, suggesting that Dex shifts BMSC differentiation by inhibiting C/EBPalpha promoter methylation and upregulating its expression level. We further found that the Wnt/beta-catenin pathway is involved in Dex-induced osteoporosis and C/EBPalpha promoter methylation, and its activation by LiCl rescues the effect of Dex on C/EBPalpha promoter methylation and osteoblast/adipocyte balance. This study revealed the C/EBPalpha promoter methylation mechanism and evaluated the function of Wnt/beta-catenin pathway in Dex-induced osteoporosis, providing a useful therapeutic target for this type of osteoporosis.

Vitis vinifera secondary metabolism as affected by sulfate depletion: diagnosis through phenylpropanoid pathway genes and metabolites

Grapevine (Vitis vinifera L.) is rich in phenylpropanoid compounds, namely flavonoids and stilbenes which, present in most tissues, are described as antioxidants and known to accumulate in response to biotic and abiotic stress. Grapevine is then a choice model for studying the interplay between the phenylpropanoid pathway and nutrient deficiency. Here we report the response to sulfur deficiency (-S) of flavonoids and stilbenes biosynthetic pathways in chlorophyll tissues (plantlets) and cell culture. Anthocyanins and trans-resveratrol accumulated in plantlets and trans-resveratrol glucoside in cell cultures in response to sulfur deficiency, while a significant decrease in chlorophyll was observed in -S plantlets. The up-regulation of chalcone synthase gene and the downstream flavonoid biosynthesis genes dihydroflavonol reductase and anthocyanidin synthase matched the accumulation of anthocyanins in -S V. vinifera plantlets. The mRNA level of stilbene synthase gene(s) was correlated tightly with the increase in trans-resveratrol and trans-resveratrol glucoside levels, respectively in -S plantlets and cell cultures. As a whole, the present study unveil that V. vinifera under sulfur deficiency allocates resources to the phenylpropanoid pathway, probably consecutive to inhibition of protein synthesis, which can be advantageous to resist against oxidative stress symptoms evoked by -S conditions.

The in vitro and in vivo genotoxicity of isotretinoin assessed by cytokinesis blocked micronucleus assay and comet assay

Isotretinoin is a retinoic acid frequently used in monotherapy or combined with narrow-band ultraviolet B (NBUVB) irradiation to treat patients with acne and psoriasis vulgaris. As both diseases need frequent and/or prolonged therapeutic interventions, the study of the genotoxicity of retinoids becomes important. Our aim was to study the genotoxic effects of isotretinoin alone or combined with NBUVB. In vitro studies were performed in the absence of S9 metabolic activation using blood from five healthy volunteers, incubated 72 h with isotretinoin (1.2-20 μM) (i.e., at concentrations usually achieved in blood with therapeutic doses as well as at higher concentrations). In vivo studies were also performed using blood from two patients with acne and three patients with psoriasis vulgaris treated with isotretinoin in monotherapy (8 or 20mg/day) or combined with NBUVB (20mg isotretinoin/day+NBUVB). The genotoxic effect was evaluated by the cytokinesis-blocked micronucleus and the comet assays. Our studies showed that isotretinoin alone was not genotoxic when tested in human lymphocytes in vitro and in vivo. There was no clear genotoxic effect in psoriatic patients treated with isotretinoin and NBUVB. The in vitro studies showed that isotretinoin induced apoptosis and necrosis in human lymphocytes at higher doses.

Evaluation of antimicrobial edible coatings from a whey protein isolate base to improve the shelf life of cheese

The objective of this work was to evaluate the effectiveness of antimicrobial edible coatings to wrap cheeses, throughout 60 d of storage, as an alternative to commercial nonedible coatings. Coatings were prepared using whey protein isolate, glycerol, guar gum, sunflower oil, and Tween 20 as a base matrix, together with several combinations of antimicrobial compounds-natamycin and lactic acid, natamycin and chitooligosaccharides (COS), and natamycin, lactic acid, and COS. Application of coating on cheese decreased water loss (~10%, wt/wt), hardness, and color change; however, salt and fat contents were not significantly affected. Moreover, the antimicrobial edible coatings did not permit growth of pathogenic or contaminant microorganisms, while allowing regular growth of lactic acid bacteria throughout storage. Commercial nonedible coatings inhibited only yeasts and molds. The antimicrobial edible coating containing natamycin and lactic acid was the best in sensory terms. Because these antimicrobial coatings are manufactured from food-grade materials, they can be consumed as an integral part of cheese, which represents a competitive advantage over nonedible coatings.

Strength evaluation of a variable diameter acetabular trial implant under realistic loading conditions

A variable diameter acetabular trial implant (VDATI) was designed to reduce the costs related to cleaning, sterilisation and storage of surgical instruments used for total hip arthroplasty. The purpose of this study was to evaluate the mechanical strength of a functional prototype of the VDATI. Experimental testing was performed to identify if the VDATI can resist loading conditions similar to the ones occurring during the surgical procedure and to validate a finite element model (FEM) of the VDATI. The results highlighted the potential of the current concept of the VDATI and demonstrated the relevance to continue its development.

Finite element analysis of an acetabular trial implant

A variable diameter trial liner (VDTL) was designed to reduce the costs related to cleaning, sterilisation and storage of surgical instruments used for total hip arthroplasty. The purpose of this study was to develop a finite element model to evaluate the mechanical behavior of the VDTL before manufacturing of a functional prototype. The finite element analysis consists to identify the maximum stresses applied on the VDTL and compare these values to the yield strength of stainless steel 17-4 (540 MPa) to asses if the VDTL will resist to loading conditions similar to the ones occurring during the surgical procedure. The results demonstrated the need to improve the mechanical strength of the current concept of the VDTL. These results will serve as indications for upcoming design refinements.