The Radical Welcome Engagement Restoration Model and Assessment Tool for Community-Engaged Partnerships

People experiencing addiction, houselessness, or who have a history of incarceration have worse health outcomes compared with the general population. This is due, in part, to practices and policies of historically White institutions that exclude the voices, perspectives, and contributions of communities of color in leadership, socio-economic development, and decision-making that matters for their wellbeing. Community-based participatory research (CBPR) approaches hold promise for addressing health inequities. However, full engagement of people harmed by systemic injustices in CBPR partnerships is challenging due to inequities in power and access to resources. We describe how an Allentown-based CBPR partnership-the Health Equity Activation Research Team of clinicians, researchers, and persons with histories of incarceration, addiction, and houselessness-uses the Radical Welcome Engagement Restoration Model (RWERM) to facilitate full engagement by all partners. Data were collected through participatory ethnography, focus groups, and individual interviews. Analyses were performed using deductive coding in a series of iterative meaning-making processes that involved all partners. Findings highlighted six defining phases of the radical welcome framework: (a) passionate invitation, (b) radical welcome, (c) authentic sense of belonging, (d) co-creation of roles, (e) prioritization of issues, and (f) individual and collective action. A guide to assessing progression across these phases, as well as a 32-item radical welcome instrument to help CBPR partners anticipate and overcome challenges to engagement are introduced and discussed.

Lentiviral gene therapy reverts GPIX expression and phenotype in Bernard-Soulier syndrome type C

Bernard-Soulier syndrome (BSS) is a rare congenital disease characterized by macrothrombocytopenia and frequent bleeding. It is caused by pathogenic variants in three genes (GP1BA, GP1BB, or GP9) that encode for the GPIbα, GPIbβ, and GPIX subunits of the GPIb-V-IX complex, the main platelet surface receptor for von Willebrand factor, being essential for platelet adhesion and aggregation. According to the affected gene, we distinguish BSS type A1 (GP1BA), type B (GP1BB), or type C (GP9). Pathogenic variants in these genes cause absent, incomplete, or dysfunctional GPIb-V-IX receptor and, consequently, a hemorrhagic phenotype. Using gene-editing tools, we generated knockout (KO) human cellular models that helped us to better understand GPIb-V-IX complex assembly. Furthermore, we developed novel lentiviral vectors capable of correcting GPIX expression, localization, and functionality in human GP9-KO megakaryoblastic cell lines. Generated GP9-KO induced pluripotent stem cells produced platelets that recapitulated the BSS phenotype: absence of GPIX on the membrane surface and large size. Importantly, gene therapy tools reverted both characteristics. Finally, hematopoietic stem cells from two unrelated BSS type C patients were transduced with the gene therapy vectors and differentiated to produce GPIX-expressing megakaryocytes and platelets with a reduced size. These results demonstrate the potential of lentiviral-based gene therapy to rescue BSS type C.

Validation of immunofluorescence analysis of blood smears in patients with inherited platelet disorders

BACKGROUND

Inherited platelet disorders (IPDs) are rare diseases characterized by reduced blood platelet counts and/or impaired platelet function. Recognizing IPDs is advisable but often challenging. The diagnostic tools include clinical evaluation, platelet function tests, and molecular analyses. Demonstration of a pathogenic genetic variant confirms IPDs. We established a method to assess the platelet phenotype on blood smears using immunofluorescence microscopy as a diagnostic tool for IPDs.

OBJECTIVES

The aim of the present study was to validate immunofluorescence microscopy as a screening tool for IPDs in comparison with genetic screening.

METHODS

We performed a blinded comparison between the diagnosis made using immunofluorescence microscopy on blood smears and genetic findings in a cohort of 43 families affected with 20 different genetically confirmed IPDs. In total, 76% of the cases had inherited thrombocytopenia.

RESULTS

Immunofluorescence correctly predicted the underlying IPD in the vast majority of patients with 1 of 9 IPDs for which the typical morphologic pattern is known. Thirty of the 43 enrolled families (70%) were affected by 1 of these 9 IPDs. For the other 11 forms of IPD, we describe alterations of platelet structure in 9 disorders and normal findings in 2 disorders.

CONCLUSION

Immunofluorescence microscopy on blood smears is an effective screening tool for 9 forms of IPD, which include the most frequent forms of inherited thrombocytopenia. Using this approach, typical changes in the phenotype may also be identified for other rare IPDs.

STAT3 Activation as a Predictive Biomarker for Ruxolitinib Response in Head and Neck Cancer

PURPOSE

Increased activity of STAT3 is associated with progression of head and neck squamous cell carcinoma (HNSCC). Upstream activators of STAT3, such as JAKs, represent potential targets for therapy of solid tumors, including HNSCC. In this study, we investigated the anticancer effects of ruxolitinib, a clinical JAK1/2 inhibitor, in HNSCC preclinical models, including patient-derived xenografts (PDX) from patients treated on a window-of-opportunity trial.

EXPERIMENTAL DESIGN

HNSCC cell lines were treated with ruxolitinib, and the impact on activated STAT3 levels, cell growth, and colony formation was assessed. PDXs were generated from patients with HNSCC who received a brief course of neoadjuvant ruxolitinib on a clinical trial. The impact of ruxolitinib on tumor growth and STAT3 activation was assessed.

RESULTS

Ruxolitinib inhibited STAT3 activation, cellular growth, and colony formation of HNSCC cell lines. Ruxolitinib treatment of mice bearing an HNSCC cell line-derived xenograft significantly inhibited tumor growth compared with vehicle-treated controls. The response of HNSCC PDXs derived from patients on the clinical trial mirrored the responses seen in the neoadjuvant setting. Baseline active STAT3 (pSTAT3) and total STAT3 levels were lower, and ruxolitinib inhibited STAT3 activation in a PDX from a patient whose disease was stable on ruxolitinib, compared with a PDX from a patient whose disease progressed on ruxolitinib and where ruxolitinib treatment had minimal impact on STAT3 activation.

CONCLUSIONS

Ruxolitinib exhibits antitumor effects in HNSCC preclinical models. Baseline pSTAT3 or total STAT3 levels in the tumor may serve as predictive biomarkers to identify patients most likely to respond to ruxolitinib.

SAFETY AND EFFICACY OF THYMIC PEPTIDES IN THE TREATMENT OF HOSPITALIZED COVID-19 PATIENTS IN HONDURAS

Coronavirus disease 2019 (Covid-19) active cases continue to demand the development of safe and effective treatments. This is the first clinical trial to evaluate the safety and efficacy of oral thymic peptides. ; We conducted a nonrandomized phase 2 trial with a historic control group to evaluate the safety and efficacy of a daily 250-mg oral dose of thymic peptides in the treatment of hospitalized Covid-19 patients. Comparisons based on standard care from registry data were performed after propensity score matching. The primary outcomes were survival, time to recovery, and number of participants with treatment-related adverse events or side effects by day 20. ; A total of 44 patients were analyzed in this study: 22 in the thymic peptide group and 22 in the standard care group. There were no deaths in the intervention group compared to 24% mortality in standard care by day 20 (log-rank P=0.02). Kaplan-Meier analysis showed a significantly shorter time to recovery by day 20 in the thymic peptide group than in the standard care group (median, 6 days vs. 12 days; hazard ratio for recovery, 2.75 [95% confidence interval, 1.34 to 5.62]; log-rank P=0.002). No side effects or adverse events were reported. ; In patients hospitalized with Covid-19, the use of thymic peptides resulted in no side effects, adverse events, or deaths by day 20. Compared with the registry data, a significantly shorter time to recovery and mortality reduction were measured.

Detection of a GLIS3 fusion in an infant with AML refractory to chemotherapy

Infants diagnosed with acute myeloid leukemia (AML) frequently harbor cytogenetically cryptic fusions involving KMT2A, NUP98 or GLIS2. Those with AML driven specifically by CBFA2T3::GLIS2 fusions have a dismal prognosis and are currently risk-stratified to receive hematopoietic stem cell transplantation (HSCT) in first remission. Here we report an infant with AML who was refractory to multiple lines of chemotherapy but lacked an identifiable fusion despite cytogenetic, fluorescence in situ hybridization (FISH) and targeted next generation sequencing (NGS) testing. Research-grade RNASeq from a relapse sample revealed in-frame CBFA2T3::GLIS3 and GLIS3::CBFA2T3 fusions. A patient-derived xenograft (PDX) generated from this patient has a short latency period and represents a strategy to test novel agents that may be effective in this aggressive subtype of AML. This report describes the first case of AML with a CBFA2T3::GLIS3 fusion and highlights the need for unbiased NGS testing including RNASeq at diagnosis, as patients with CBFA2T3::GLIS3 fusions should be considered for HSCT in first remission.

OP0288 IMPACT OF CARDIOVASCULAR RISK ON THE DIAGNOSTIC ACCURACY OF THE ULTRASOUND HALO SCORE FOR GIANT CELL ARTERITIS

Background

The ultrasonographic (US) Halo Score provide a quantitative measure of the extent of vascular inflammation in patients with giant cell arteritis (GCA). High Halo Scores correlate with systemic markers of inflammation, rate of ocular ischaemia and may help to firmly diagnose GCA with high specificity. However, an increase in the intima media thickness (IMT) in patients with elevated cardiovascular risk (CVR) may lead to false-positive US findings.

Objectives

Our aim is to evaluate the impact of CVR on the diagnostic accuracy of the US Halo Score in patients with suspected GCA.

Methods

This is a retrospective observational study of patients suspected of having GCA and referred to our US fast track clinic. All patients underwent US exam within 24 hours per protocol. The IMT was measured in gray scale mode in cranial and extra-cranial (carotid, subclavian and axillary) arteries and the Halo Score was also determined to assess the extent of vascular inflammation. GCA diagnosis was confirmed after 6-month follow-up by the referring clinician. The European Society of Cardiology (ESC) Guidelines on CV Disease Prevention in clinical practice were used to define different categories of CVR. Patients were classified as very high, high, moderate or low CVR according to the Systemic Coronary Risk Evaluation (SCORE) obtained using the ESC CVD Risk Calculator app for mobile devices. Comparison between groups was performed and the diagnostic accuracy of the Halo Score in patients according to CVR was evaluated using ROC curves.

Results

Of the 157 patients referred to our US fast track clinic (67.5% female, mean age 73.7 years), 47(29.9%) had GCA confirmed after 6-month follow-up. There were no differences in CVR between patients with and without GCA (mean SCORE 20.6[21.6] vs 18.7[21];p=0.601). Among patients without GCA, extra-cranial artery IMT was significantly higher in patients with high/very high CVR than in those with low/moderate CVR (Table 1). The Halo Score was significantly higher in patients with high/very high CVR in non-GCA patients (9.38 (5.93) vs 6.16 (5.22);p=0.007). The area under the ROC curve of the Halo Score to identify GCA was 0.835 (CI95% 0.756-0.914), slightly greater in patients with low/moderate CVR (0.965 [CI95% 0.911-1]) versus patients with high/very high CVR (0.798[CI95% 0.702-0.895]) (Figure 1). A statistically weak positive correlation was found between the Halo Score and the SCORE (r 0.245;p=0.002).

Table 1.

Measurements of IMT in cranial and extracranial arteries and Halo Score values according to CVR

Artery IMT mm, mean (SD)Patients with GCA n=47Patients without GCA n=110Patients with high/very high CVR n=37(78.7%)Patients with low/moderate CVR n=10(21.3%)pPatients with high/very high CVR n=79(71.8%)Patients with low/moderate CVR n=31(28.2%)pSuperficial temporal artery (both)0.66(0.25)0.45(0.11)0.0250.35(0.09)0.32(0.07)0.354Frontal branch (both)0.42(0.18)0.31(0.15)0.0560.26(0.05)0.26(0.06)0.577Parietal branch (both)0.43(0.17)0.35(0.12)0.1020.27(0.04)0.28(0.08)0.173Carotid artery (both)0.88(0.21)1.2(0.6)<0.0010.83(0.16)0.74(0.13)<0.001Subclavian artery (both)0.86(0.31)1.2(0.5)0.0010.74(0.18)0.6(0.13)<0.001Axillary artery (both)0.92(0.38)1.22(0.73)0.0210.72(0.16)0.59(0.15)<0.001Halo Score, mean (SD)18.5(8.8)17.2(10.6)0.699.38(5.93)6.16(5.22)0.007Figure 1.

Diagnostic accuracy of the Halo Score for a clinical diagnosis of GCA after 6-month follow-up in (A) all GCA suspected patients, (B) patients with high/very high CVR and (C) patients with low/moderate CVR

Conclusion

High CVR may influence the diagnostic accuracy of the US Halo Score leading to false-positive findings in these patients. Higher IMT values may be found in extracranial arteries of subjects with high/very high CVR without GCA. Thus, CVR should be taken into consideration in the US vascular assessment of patients with suspected GCA. These results need to be confirmed in larger cohorts to develop a modified US Halo Score applicable to patients with high CVR.

Disclosure of Interests

None declared

The Collagen Receptor Discoidin Domain Receptor 1b Enhances Integrin β1-Mediated Cell Migration by Interacting With Talin and Promoting Rac1 Activation

Integrins and discoidin domain receptors (DDRs) 1 and 2 promote cell adhesion and migration on both fibrillar and non fibrillar collagens. Collagen I contains DDR and integrin selective binding motifs; however, the relative contribution of these two receptors in regulating cell migration is unclear. DDR1 has five isoforms (DDR1a-e), with most cells expressing the DDR1a and DDR1b isoforms. We show that human embryonic kidney 293 cells expressing DDR1b migrate more than DDR1a expressing cells on DDR selective substrata as well as on collagen I in vitro. In addition, DDR1b expressing cells show increased lung colonization after tail vein injection in nude mice. DDR1a and DDR1b differ from each other by an extra 37 amino acids in the DDR1b cytoplasmic domain. Interestingly, these 37 amino acids contain an NPxY motif which is a central control module within the cytoplasmic domain of β integrins and acts by binding scaffold proteins, including talin. Using purified recombinant DDR1 cytoplasmic tail proteins, we show that DDR1b directly binds talin with higher affinity than DDR1a. In cells, DDR1b, but not DDR1a, colocalizes with talin and integrin β1 to focal adhesions and enhances integrin β1-mediated cell migration. Moreover, we show that DDR1b promotes cell migration by enhancing Rac1 activation. Mechanistically DDR1b interacts with the GTPase-activating protein (GAP) Breakpoint cluster region protein (BCR) thus reducing its GAP activity and enhancing Rac activation. Our study identifies DDR1b as a major driver of cell migration and talin and BCR as key players in the interplay between integrins and DDR1b in regulating cell migration.

Investigating SARS-CoV-2 Test Positivity Calculations Across US Jurisdictions

Purpose

Throughout the COVID-19 pandemic, many US epidemiologists and policymakers turned to an indicator called test positivity, or the percent of tests coming back positive for SARS-CoV-2, to contextualize COVID-19 case counts with testing volume. But the nation's patchworked health data infrastructure, composed of 56 systems managed by each state and territory, complicated efforts to calculate the metric in a comparable way across US jurisdictions. We set out to map jurisdictional reporting differences in test positivity and investigate whether they interfered with its effectiveness and comparability as an indicator. Understanding these differences is important because jurisdictional test positivity informed consequential policy and individuals’ understanding of risk in their communities.

Methods & Materials

We surveyed the health department websites of all US states and territories to examine how these jurisdictions were presenting test positivity on COVID-19 dashboards. When details about definitions were unavailable on jurisdictional websites, we reached out to jurisdictional public health officials for clarification. We also scored jurisdictions' presentations against best practices we identified for calculating the metric.

Results

Among the 48 states and territories posting test positivity values, we observed no consensus on how to calculate the metric—jurisdictions used different units, test types, averaging techniques, and dating schemes. By looking at data for jurisdictions that posted multiple test positivity metrics, we observed that these definitional differences could result in variations from 31% to 300%. Only four states were following all ten of the best practices for reporting test positivity.

Conclusion

The sheer number of ways states and territories define test positivity is alarming, given how much the indicator influenced US COVID-19 policy. Based on our survey, we believe the confidence of regulators in the precision and national comparability of test positivity is misplaced: The metric's value reflects state and territorial reporting decisions as much as actual viral prevalence. These findings underscore the need to invest in centralized public health infrastructure and create national reporting standards to improve unity of state reporting.

Evaluating the Quality of Federal SARS-CoV-2 Diagnostic Testing Data

Purpose

In April 2020, the US Department of Health and Human Services (HHS) and the US Centers for Disease Control and Prevention established the COVID-19 Electronic Laboratory Reporting program (CELR) to collect data on SARS-CoV-2 laboratory tests. Over the course of the following year, the federal government, partnering with the Association for Public Health Laboratories, onboarded every state to submit laboratory results to this system—the first of its kind in the US. We set out to evaluate the quality of data collected by CELR.

Methods & Materials

We compared jurisdiction-level data collected through CELR and published by HHS to the testing data published by jurisdictions on their health department webpages. Because jurisdictions define their testing data differently, we anticipated some differences from federal testing data. However, jurisdictions also tend to prioritize their dashboard reporting—since it is what is used for policy decisions like reopening—so we hypothesized that differences from federal data absent a definitional explanation could point to problems with federal data. Where we found differences between jurisdictional and federal data, we conducted interviews with public health officials to understand their cause.

Results

Of the 56 states and territories, as of April 2021 (the first month when all states were onboarded to CELR), 38 had federal total data that diverges from state data by more than 5%. Of those states, the differences of 27 could not be explained by definitional factors. Based on our interviews, we identified three problems: non-electronic reporting streams, out-of-date surveillance systems, and deduplication of laboratory data.

Conclusion

The federal testing dataset displays major unresolved quality problems, and because states present testing data so differently, state-published data forms a poor alternative to federal datasets. The federal government, which is uniquely positioned to provide testing data on infectious diseases, must work to improve the quality of laboratory data submissions by states. To support better national laboratory data, the United States should invest in updating state and laboratory data surveillance infrastructure—including updates to state surveillance systems and laboratory system updates to eliminate outdated reporting methods like faxes—and in creating more national laboratory data infrastructure.

The Burden of Radiation Exposure During Transcatheter Closure of Atrial Septal Defect

Radiation reduction in the pediatric cardiac catheterization laboratory is well-suited for targeted quality improvement (QI) interventions. Transcatheter atrial septal defect (ASD) closure was chosen for this QI project based on a homogenous procedural population and inter-operator variability in radiation usage, with the aim to reduce radiation exposure during ASD device closure by 50% over 1 year. The aim for this project was defined and a Key Driver Diagram (KDD) was created with three domains for change: modification of procedural practice, reporting and monitoring/feedback, and team engagement. All patients undergoing attempted transcatheter ASD closure were considered for inclusion. The primary outcome, % reduction in median radiation dose (DAP/Kg), was determined through comparison with a historical cohort. Additional radiation metrics, procedural characteristics, and adverse events (AE) were compared to the historical cohort. Radiation exposure (DAP/kg) was reduced by 55% with a median dose reduction from 26 (15, 61) in a historical cohort to 12 (6, 22) in the intervention population (p <0.001). Fluoroscopy time and cine acquisition utilization significantly decreased. Procedure time, procedural success (defined as successful delivery of the device) and AE did not increase in the QI cohort. Successful practice changes included standardized procedural strategies to limit fluoroscopy and cine acquisition, improved fluoroscopic practice, engagement of the multidisciplinary team, and feedback with data reporting by electronic and in-person reminders. In conclusion, application of QI methodologies such as KDD with engagement of a multidisciplinary team can effectively reduce radiation in the pediatric catheterization laboratory.

POS1484-HPR THE ASSOCIATION OF STIGMA WITH DISEASE VARIABLES IN PATIENTS WITH FIBROMYALGIA (FM)

Background:

Stigma, defined as social devaluation of an individual, can be an important stressor for chronic pain patients [1]. Not every condition is stigmatized. A relevant factor for illness stigmatization seems to be whether the cause is mental-behavioural or physical. Chronic pain is often regarded as an imaginary illness or caused by psychological problems [2]. Sources of stigma for chronic pain patients are perceived negative attitudes from family members, the general public, and physicians [1]..

Objectives:

To assess perceived stigma and the associations with disease variables in a cohort of patients with FM.

Methods:

We invited 18 FM self-help groups in Germany to participate anonymously in our survey, and we sent the survey battery to 192 potential participants via postal mail. To measure perceived stigma, we used the Chronic Pain Stigma Scale (CPSS) developed by Reed [3], which has 30 items and 3 subscales (public, physicians, family). We also assessed sociodemographic characteristics, disease related variables (e.g., pain, stress, depression, anxiety), and other health-related factors, including health related quality of life [Healthy Days Core Module (CDC HDQOL-4)], disease specific impact (FIQ), fear avoidance belief questionnaire (physical activity subscale) (FABQ-PA), pain catastrophizing scale (PCS) and pain self-efficacy questionnaire (PSEQ).

Results:

In total 162 FM patients participated (=84% response rate). Their mean age was 58 years (SD=10), 84% (N=135) were female. Highest level of education was: Elementary School 29%, Junior High School 35%, High School 15%, College 12%, and other 10%. Duration of chronic pain was 18.2 years (SD=12.0). There was no significant gender difference in the stigma subscales, nor was there an association with duration of chronic pain. Table 1 presents the significant Pearson correlations.

Table 1.

Correlations of CPSS stigma subscales with health variables. *<.05; **<.01; ns=not significant.

CPSS-publicCPSS-physicianCPSS-familyRegional pain scalens.19*.20*VAS pain todaynsnsNsFIQ.20*.16*.22**HADS-anxiety.37*.20*.24*HADS-depression.41**.16*.25**CDC-HDQOL-4 General health.19*.18*.22** Physical health.19*nsns Mental health.20*ns.21* Impairment.24*nsnsPerceived stress scale.44**.24**.37**FABQ-PAns-.17*nsPCS.21*nsnsPSEQ.19*ns.18*

Conclusion:

Perceived stigma in our FM patient cohort has an important impact on a variety of different disease variables including mental and general health, physical functioning, and on pain coping. Stigmatizing attitudes perceived from the general public exhibited the greatest association with most variables in our chronic pain patients. Perceived stigma from physicians and the family were also related to negative disease consequences in our FM patients. To conclude, we assert that assessing and addressing multi-source perceived stigmatization in routine clinical care may improve the management and wellbeing of patients with FM.

References:

[1]Waugh OC, Byrne DG, Nicholas MK. Internalized stigma in people living with chronic pain. J Pain 2014;15(5):550 e1-10.

[2]Werner A, Isaksen LW, Malterud K. ‘I am not the kind of woman who complains of everything’: illness stories on self and shame in women with chronic pain. Soc Sci Med 2004;59(5): 1035-45

[3]Reed P. Chronic pain stigma: developement of the Chronic Pain Stigma Scale. 2005.

Disclosure of Interests:

None declared

AB0185 ULTRASOUND IN INFLAMMATORY ARTHRALGIA: SHOULD WE ALWAYS SCAN?

Background:

Patients with inflammatory arthralgia (IA) are considered to be at increased risk for progression to RA. Ultrasound (US) has shown high sensitivity to detect synovitis compared with physical examination. Thus, US is recommended to identify subclinical synovitis in patients without clinical signs of inflammation.

Objectives:

To determine the frequency and pattern of US detected active inflammation in patients with IA and investigate factors contributing to predict this outcome.

Methods:

An US clinic is scheduled in an academic center running twice every week. A retrospective analysis of our US unit cohort during a period of 12 months was undertaken. Patients with IA and no previous diagnosis of inflammatory arthropathies were included for analysis. Inclusion criteria of IA definition included: severe symptoms presenting in the morning, duration of morning stiffness ≥60 min, symptoms predominantly located in MCP joints and absence of clinically detected synovitis by the referral rheumatologist. The following routinely collected variables were included in the analysis: demographics, clinical features and laboratory tests. Patients underwent bilateral US examination of hands and/or feet according to the European League Against Rheumatism (EULAR) guidelines. The presence of synovitis and tenosynovitis was assessed on a semi quantitative scale (0–3) for Grey Scale(GS)/Power Doppler(PD). Active inflammation was defined as PD synovitis and/or tenosynovitis >1 at any location. First, differences between groups were tested using chi-squared/Fisher and Student-t tests in the univariate analysis. Second, multivariate logistic regression models were employed to investigate the association between possible predictive factors of US active inflammation.

Results:

A total of 110 patients were included in the analysis. Mean age was 53.6±15.6 years, 80 (72.7%) were females, and mean symptoms duration was 11.7±9.9 months (Table1). A total of 76 (69.1%) patients presented with a polyarticular arthralgia pattern. US active inflammation were present in 38 (34.5%) patients (28.2% showed PD synovitis and 19.1% PD tenosynovitis). Hands were most commonly involved with PD synovitis at wrists in 18.2% and at MCP in 14.5% of patients. For PD tenosynovitis, the flexor MCP 2-5 (4.5%) and 6th extensor tenosynovitis (5.5 %) were the most frequent affected locations. Only 9 (8.2%) patients had erosions in hands and/or feet at baseline examination. In the univariate analysis, the higher ESR values, the shorter time from symptoms onset and the presence of ACPA were significantly associated with the presence of US active inflammation (p<0.001, p=0.035 and p=0.01, respectively). In the multivariate analysis, only ACPA and ESR values (OR=1,0003; 95%CI 1,000-1,006 and OR=1.054; 95%CI 1.016-1.094), remained significantly associated with the detection of US active inflammation.

Conclusion:

US features of active inflammation are found in 1 over 3 patients with IA being PD synovitis the most common finding, specially at the wrists and MCP joints. Higher ESR and ACPA values are significantly associated with the presence of US active inflammation. Thus, we strongly recommend the use of PD US to detect subclinical inflammation in at-risk patients with IA with no sign of inflammation on clinical examination, especially those with high ESR and ACPA values.

Table 1.

Baseline characteristics of patients with IA

Totaln= 110US inflammatoryfindingsn= 38 (34.5%)Non-US inflammatoryfindingsn=72 (65.5%)pAge53.6 ± 15.657.2±16.251.6±13.40.071SexFemale80 (72.7%)26 (68.4%)54 (75%)0.461Smokingn= 87Non smoker45 (51.7%)12 (44.4%)33 (55%)0.412Smoker34 (39.1%)11 (40.7%)23 (38.3%)Former smoker8 (9.2%)4 (14.8%)4 (6.7%)ExtensionMonoarticular12 (10.9%)6 (15.8%)6 (8.3%)0.176Oligoarticular 22 (20%)10 (26.3%)12 (16.7%)Polyarticular76 (69.1%)22 (57.9%) 54 (75%)Time (months)from symptoms onset11.7 ± 9.99.1±8.113±10.50.035ESR (mm/h) n=4524.7 ± 18.233.1±21.820.3 ±14.4<0.001RF (IU/mL) n=5339.1 ± 230.528.5±5645.1±286.10.647ACPA (IU/mL) n=5698.1 ± 331.2209.4±488.426±125.20.01

Disclosure of Interests:

None declared

AB0889-HPR PERCEIVED SATISFACTION WITH CHRONIC PAIN CARE IN GERMAN PATIENTS WITH FIBROMYALGIA (FM)

Background:

In chronic pain care a multidimensional perspective with attention to patients’ cognitions, emotions, and their ability to cope is needed (1). Previous studies are also pointing to the role of experiencing meaningfulness in life in the adjustment to disability.Therefore care should additionally focus on the existential domain of patients’ lives to live up to a holistic care approach (2). However, there are only a few studies on how FM patients are satisfied with practitioners’ attention to multiple aspects of life with a chronic pain condition.

Objectives:

To assess perceived satisfaction with chronic pain care and its associations with health variables in a cohort of patients with FM.

Methods:

We invited 18 FM self-help groups in Germany to participate anonymously in our survey and sent them in total 192 paper-and-pencil surveys. Sociodemographics, disease related variables (e.g. pain, general health) and psychological variables [e.g. depression, anxiety, hope, stress] were assessed with standardized instruments, including 5 items (answer format 1=very unsatisfied – 10=very satisfied) assessing subjective satisfaction with medical care in different domains with the following questions: How satisfied are you with the attention of your treatment team/physician at home for physiological aspects of your pain (Physio)/ the consequences of the pain on your physical functioning (Physical)/ on your psychological well-being (Mental)/ on your social life (Social)/ on your meaning in life (Meaning).

Results:

In total 162 FM patients participated (=84% response rate). Their mean age was 58 years (SD=10), 84% (N=135) were female. Highest level of education was: Elementary School 29%, Junior High School 35%, High School 15%, College 12%, and other 10%. Duration of chronic pain was 18.2 years (SD=12.0). The satisfaction with care scale showed good internal consistency and measured one factor. The means of the subscale were: Physio 5.7 (SD=2.5)/ Physical 5.5 (SD=2.5)/ Mental 5.5 (SD=2.6)/ Social 5.0 (SD=2.5)/ Meaning 5.3 (SD=2.6). Correlations of the subscales are depicted in Table 1. There were no associations between pain variables and satisfaction with care, but satisfaction with care was associated with mental health, but not physical health, outcomes.

Table 1.

Correlations of satisfaction of care with different health variables. Subscales physiological and physical aspects and HADS-anxiety were not significantly correlated. *<.05; **<.01; ns=not significant.

PhysioPhysicalMentalSocialMeaningHADS-depression-.10 (ns)-.12 (ns)-.19*-.16*-.14 (ns)General Health .02 (ns) .14 (ns) .13 (ns) .18* .12 (ns)Stress-.15 (ns)-.14 (ns)-.17*-.17*-.13 (ns)Hope .18 (ns) .18 (ns) .26** .26* .22*

Conclusion:

In this cohort of German FM patients the average satisfaction with care overall, as well as the specific aspects of care, was only moderate. Interestingly we found associations between satisfaction with care in mental, social and meaning in life aspects with psychological well-being pointing to the fact that care for chronic pain patients should also include those aspects in addition to just addressing biomedical aspects.

References:

[1]Flor H and Turk D. Chronic pain: an integrated approach. Seattle, WA: IASP Press, 2011.

[2]Dezutter J, Casalin S, Wacholtz A, et al. Meaning in life: An important factor for the psychological well-being of chronically ill patients? Rehabilitat Psychol 2013; 58:334–341.

Disclosure of Interests:

None declared

761. Antimicrobial Resistance Trends at a Pediatric Hospital in Guatemala City, 2005-2019

Background

Antimicrobial resistance (AMR) is an increasing global threat to public health, particularly in Latin America. Most published data are based on adults with limited pediatric reports regarding resistance trends. Our study evaluated AMR rates in a large tertiary pediatric hospital in Guatemala City and the association with clinical outcomes.

Methods

We analyzed AMR rates for six bacterial species (Acinetobacter baumannii, Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Staphylococcus aureus) identified from blood cultures from the WHONET database between 2005-2019. Resistance was determined using CLSI cut-offs on the VITEK and Sensititre systems. Student’s t tests and simple linear regression models were performed. A retrospective review was performed on 99 pediatric patient charts with positive blood cultures (June 2018-May 2019) to assess clinical outcomes.

Results

Klebsiella and Acinetobacter were the most prevalent organisms throughout the 15 years of surveillance, with 2019 sensitivities demonstrating carbapenem-resistance in 99 (57%) and 57 (91%) of isolates, respectively. Increased resistance rates were noted for all Gram-negative organisms evaluated, with particular clinical and statistical significance noted for K. pneumoniae with imipenem (4.3% average resistance increase per year (PARPY), p-value < 0.0001), ciprofloxacin (4.5 PARPY, < 0.0001), and piperacillin-tazobactam (3.4 PARPY, < 0.0001), as well as A. baumannii with imipenem (2.9 PARPY, p-value < 0.0001), cefepime (1.7 PARPY, < 0.0001), and ciprofloxacin (2.5 PARPY, 0.0002). In contrast, resistance rates decreased for S. aureus with oxacillin (-2.7 PARPY, 0.0015). A mortality rate of 20% among our 99-patient cohort was detected. Of the 37% who received optimal therapy, the median time to optimal therapy was 90 hours.

Acinetobacter baumannii resistance to imipenem, 2005-2019

Klebsiella pneumoniae resistance to imipenem, 2005-2019

Staphylococcus aureus resistance to oxacillin, 2005-2019

Conclusion

Significant rises in AMR among pediatric patients in a large tertiary hospital in Guatemala City have occurred over 15 years. This likely contributed to delays in optimal antimicrobial therapy, increased exposure to broad spectrum antibiotics, and potentially increased mortality. Improved antimicrobial stewardship, infection prevention, and rapid diagnostic testing are needed in order to combat this growing problem.

Disclosures

Kelly E. Graff, MD, BioFire Diagnostics, LLC (Grant/Research Support) Samuel Dominguez, MD, PhD, BioFire (Consultant, Research Grant or Support)

Preparation and in vitro evaluation of PLA/biphasic calcium phosphate filaments used for fused deposition modelling of scaffolds

Ceramic materials such as calcium phosphates (CaPs) with a composition similar to the mineral phase of bones and polymeric polylactic acid (PLA) are potential candidates for the manufacturing of scaffolds to act as bone substitutes and for tissue engineering applications, due to their bioresorbability and biocompatibility. Variables such as porosity, topography, morphology, and mechanical properties play an essential role in the scaffolds response. In this paper, a polymer/ceramic composite filament of 1.7 mm in diameter based on PLA and biphasic calcium phosphates (BCPs) was obtained by hot-melt extrusion in a single screw extruder. The particles of BCP were obtained by solution-combustion synthesis, and the PLA used was commercial grade. The BCPs ceramics were characterized by X-ray diffraction (XRD), scanning electron microscopic (SEM), transmission electron microscopy (TEM), and Brunauer, Emmett, and Teller (BET). It was possible to confirm that the main inorganic phases were hydroxyapatite (HAP) and tricalcium phosphate (TCP) with grain sizes below 100 nm and with high porosity. The Filaments obtained are a bit fragile but were able to be used in fused deposition modelling (FDM) using low-cost commercial printers. The filaments were characterized by SEM and energy dispersive X-ray (EDX). The in-vitro tests of filaments showed deposition of apatite phases on their surface, non-cytotoxic behavior, adequate cell proliferation and cell adhesion.

A-09 The Relationship Between Subjective Cognitive Complaints, Depression, and Executive Functioning in mTBI Veterans

Objective

Among individuals with mild traumatic brain injury (mTBI), those with depression report greater subjective cognitive complaints than those without depression. In mTBI patients with general cognitive complaints, depression may account for poor performance on objective neuropsychological measures. This study seeks to expand this research by examining depression, subjective executive functioning (EF) complaints, and objective EF performance in Veterans with mTBI.

Method

Fifty-seven Veterans with deployment-related mTBI (12% female; age M = 42.0, SD = 13.6; years education M = 15.0, SD = 1.8) with (n = 29) or without (n = 28) a chart diagnosis of depression. Participants were administered the Behavioral Rating Inventory of Executive Functioning (BRIEF) and objective neuropsychological measures of working memory (i.e., Weschler Adult Intelligence Scale-IV Working Memory Index) and aspects of EF (i.e., Trail Making Test B and Delis-Kaplan Executive Functioning System (D-KEFS) subtests).

Results

Principal component analysis identified similar domains of EF to the BRIEF, including: task monitoring (Trail Making Test B, D-KEFS Letter Fluency, and D-KEFS Tower Test, eigenvalue = 1.93) and shifting (D-KEFS: Color-Word Interference Conditions 3 and 4, and Category Switching, eigenvalue = 1.24). Individuals with depression had greater subjective EF complaints in each BRIEF domain than non-depressed individuals (p’s ≤ .01). However, subjective complaints in these domains were not related to objective performance (r’s = −0.17,-0.19, p’s &gt; .05). Moreover, depressed and non-depressed individuals performed similarly on all EF measures (p’s &gt; .05).

Conclusions

mTBI Veterans with depression report more subjective EF complaints than those without depression. The lack of association between subjective complaints and objective EF performance suggests it is important to treat depression in mTBI patients to remedy perceived cognitive deficits.

THU0445 PREVALENCE AND INFLUENCE OF DISEASE DURATION IN THE AMOUNT OF ARTICULAR AND PERIARTICULAR DEPOSITS OF MONOSODIUM URATE (MSU) CRYSTALS IN NON-TREATED GOUTY ARTHRITIS PATIENTS

Background:

Monosodium urate crystals deposition arthritis (Gout) is the most prevalent inflammatory arthropathy in our society. The use of muskuloskeletal ultrasound (MSUS) is emerging as a diagnostic method of patients with gout, mainly in the past few years.

Objectives:

Our objective is to establish the prevalence of articular and periarticular ultrasound lesions in patients with known or recent gout diagnosis without urate-lowering therapy (ULT) as well as to analyze the influence of disease duration on these findings.

Methods:

Observational, cross-sectional and descriptive study, including patients with diagnosis of Gout (fulfilling the ACR / EULAR Classification Criteria 2015) between September and November 2019 in our Rheumatology service of a tertiary center. Demographic and clinical records were collected (table 1) and MSUS was performed on each patient systematically by two rheumatologists, exploring a total of 20 structures (8 tendons and 12 joints). Suggestive images of MSU crystals deposition were defined following the OMERACT 2015 ultrasound elementary lesions definitions. Deposits included lesions as tophus, hyperechoic aggregates (HA) and double contour (DC).

Table 1.

Demographic and laboratory data

FeaturesPatients (n=38)%SexMen 34 Women 489,5 10,5Age (years)Mean ±SD 60±14,43ComorbiditiesArterial hypertension18 Mellitus diabetes 4 Dyslipidemia 13 Smoking 7 Alcohol 1447,4 10,5 34,2 18,4 36,8BMI (Kg/m2)Mean±SD 27,3±4,23Blood urate levels (mg/dL)Mean±SD 8,2±1,74Blood creatinine levels (mg/dL)Mean±SD 1,09±0,75

Results:

A total of 38 patients were included, 34 men (89.5%) and 4 women (10.5). Twenty seven (71.1%) presented MSU crystals in synovial fluid samples, while rest of them (28.9%) met 2015 ACR / EULAR Clasiffication Criteria for Gout. Disease duration (since onset of symptoms) was less than 6 months in 20 patients (52.6%) and longer than 6 months in 18 (47.36%). Thirty seven patients (97.36%) presented some type of MSU deposits on the explored areas. One hundred and thirty (17,10%), out of 760 explored locations, had MSU deposits. Patients with disease duration less than 6 months had 56 locations with deposits (43.07%), while those with a symptomathology longer than 6 months had 74 locations with deposits (56.92%). Left knee was the most frequent location of UMS deposits (78.95%). Out of the 145 MSUS images with elementary lesions due to MSU crystal deposits, 28 were tophi (19.31%), 33 HA (22.75) and 84 DC (57.93%). Out of the total images with deposits (DC, HA and tophi), DC in the left knee was the most frequent (21.38%), followed by DC in right knee (17.24%) and DC in 1st MTP (10.24%).

Conclusion:

Almost 100% of patients with recently diagnosed gout without ULT, presented on at least one of the scanned locations MSUS images suggestive by MSU crystals deposition. Most of MSU crystals deposits were on knees and 1st MTP. Patients with non-treated longer than 6 months of disease duration gout had a greater number of MSU crystals deposit locations detected by MSUS. The presence of tophi and HA was statistically higher in patients with disease duration longer than 6 months (table 2).

Table 2.

MSU crystals median locations and MSUS images in both groups

<6months (n,%)>6months (n,%)p valueDeposits locations56 (43,07)74 (56,92)0,0751MSUS images with deposits -Tophi Median, IR () - HA Median, IR () - DC Median, IR ()8 (28,57) 0 (0-0) 7 (21,21) 0 (0-0) 39 (46,43) 0,5 (0-1)20 (71,43) 0 (0-1) 26 (78,79) 0 (0-1) 45 (53,57) 0 (0-2)0,01810,02310,8531

1Mann-Whitney U test comparing medians between both groups IR: interquartile range

References:

[1]Norkuviene E, Petraitis M, Apanaviciene I, Virviciute D and Baranauskaite A. An optimal ultrasonographic diagnostic test for early gout: A prospective controlled study. J Int Med Res. 2017 Aug.

[2]Neogi T, Jansen TLA A, Dalbeth N, Fransen J, Schumacher HR, Berendsen D et al. 2015 Gout Classification Criteria. An American College of Rheumatology/European League Against Rheumatism Collaborative Initiative. Arthritis & Rheumatology. Vol. 67, No. 10, October 2015.

Disclosure of Interests: :

Luis A Torrens Cid: None declared, Juan Molina Collada: None declared, Christian Y Soleto: None declared, Liz R. Caballero Motta: None declared, Ana Melissa Anzola Alfaro: None declared, Alfonso Ariza: None declared, Isabel Castrejón Fernández: None declared, Javier Rivera: None declared, Jose-Maria Alvaro-Gracia Grant/research support from: Abbvie, Elli-Lilly, MSD, Novartis, Pfizer, Consultant of: Abbvie, BMS, Janssen-Cilag, Elli-Lilly, MSD, Novartis, Pfizer, Sanofi, Tigenix, Roche, UCB, Paid instructor for: Elli-Lilly, Pfizer, Roche, Speakers bureau: Abbvie, BMS, Janssen-Cilag, Elli-Lilly, Gedeon Richter, MSD, Novartis, Pfizer, Sanofi, Tigenix, Roche, UCB, Juan Carlos Nieto Speakers bureau: Pfizer, Abbvie, MSD, Novartis, Janssen, Lilly, Nordic Pharma, BMS, Gebro, FAES Farma, Roche, Sanofi

AB0357 USE OF TOFACITINIB AND REASONS FOR DISCONTINUATION IN CLINICAL PRACTICE

Background:

Tofacitinib is an oral JAK 1 and 3 inhibitor for the treatment of moderate to severe active rheumatoid arthritis (RA) or psoriatic arthritis (PsA) in adults with inadequate response or intolerant to one or more conventional disease-modifying antirheumatic drugs (cDMARDs). Since its approval by the European Medicines Agency (EMA), there is limited data about its use in daily practice in Europe.

Objectives:

To describe rates and reasons for discontinuation of Tofacitinib in patients with RA and other inflammatory conditions

Methods:

We identified patients with a prescription for tofacitinib at our academic center from January 2017 to January 2020. Patients were treated according to their rheumatologist evaluation following standards of care. The following variables were retrospectively collected from the electronic medical chart: age, gender, diagnosis, date of treatment initiation, date and reasons for treatment discontinuation, the use of concomitant or previous cDMARDs and of biologics. A comparison between patients continuing and stopping tofacitinib was performed through chi2or t-test for qualitative and quantitative variables, respectively. Survival analysis was done by Kaplan-Meier method

Results:

Ninety patients receiving tofacitinib were identified, 81 with RA, 6 with PsA, 1 with Dermatomyositis, 1 with Sjögren´s and 1 with juvenile idiopathic arthritis. Table 1 shows the baseline characteristics. 84% percent patients were women and the mean (SD) age was 58.5 (14.2) years. 51% patients started tofacitinib in monotherapy. When used, methotrexate was the most frequent cDMARD (61.3%); 10% patients used tofacitinib as first line after cDMARD and the majority used it after 1 or 2 previous biologics (46.7%).

Table 2.

Clinical coutcome of patients who developed HZ at initiation of baricitinib

All patients(n=90, 100%)Continue Tofacitinib(n=58; 64%)Not continue Tofacitinib(n=32; 35.5%)p-valueFemale (%)76 (84.4)48 (82.7)28 (87.5)0.55Age (year) – mean (SD)58.5 (14.2)58 (12.9)59.5 (16.5)0.63Diagnosis0.66Rheumatoid arthritis81 (90)52 (89.6)29 (90.6)Psoriatic arthritis6 (6.7)4 (6.8)2 (6.2)Other3 (3.3)2 (3.4)1 (3.1)Treatment duration (months) – mean (SD)10.6 (6.9)11.9 (7.3)8.2 (5.5)0.02Prednisone (mg) – mean (SD)1.75 (3.2)1.20 (2.5)2.73 (4.1)0.03Monotherapy (%)46 (51.1)28 (48.2)18 (56.2)0.244Concomitant csDMARDs (%)44 (48.8)30 (51.7)14 (43.7)0.62Methotrexate (%)27 (30)17 (29.3)10 (31.2)Leflunomide (%)10 (11.1)8 (13.7)2 (6.2)Other (%)7 (7.7)5 (8.6)2 (6.2)Prior biologic treatment0.13None (%)9 (10)6 (10.3)3 (9.3)1-2 (%)42 (46.6)28 (48.2)14 (43.7)≥3 (%)39 (43.3)24 (41.3)15 (46.8)

Survival rates when used as first or second line were 85% at 6 months and 70% at 12 months; when used as third line or further, 76% and 70%, respectively (graphic 1).

Factors associated to tofacitinib discontinuation were treatment duration and baseline prednisone dose. In contrast concomitant csDMARD and number of previous biologics were not. Reasons for tofacitinib discontinuation were: lack/loss of efficacy 46.9%, adverse events 50% (including intolerance -22%- herpes zoster -16%-, other infections 12%) and others.

Conclusion:

Tofacitinib in our experience is mostly used in RA patients after biologic failure. Overall survival rate at 12 months was good regardless line of therapy. Adverse event rates were similar to other biologic treatments. Herpes zoster was the most common infectious AE.

Graphic 1:

References:

[1]Wollenhaupt J, Lee EB, Curtis JR, et al. Safety and efficacy of tofacitinib for up to 9.5 years in the treatment of rheumatoid arthritis: final results of a global, open-label, long-term extension study. Arthritis Res Ther. 2019;21(1):89.

Disclosure of Interests:

Christian Y Soleto: None declared, Belén Serrano Benavente: None declared, Luis A Torrens Cid: None declared, Julia Martínez-Barrio Consultant of: UCB Pharma, Juan Molina Collada: None declared, Javier Rivera: None declared, Teresa González: None declared, Indalecio Monteagudo: None declared, Carlos Gonzalez Consultant of: Gilead, Janssen, Novartis,, Speakers bureau: Abbvie, Celgene, Gilead, Janssen, Novartis, Pfizer, Roche, Isabel Castrejon: None declared, Jose-Maria Alvaro-Gracia Grant/research support from: Abbvie, Elli-Lilly, MSD, Novartis, Pfizer, Consultant of: Abbvie, BMS, Janssen-Cilag, Elli-Lilly, MSD, Novartis, Pfizer, Sanofi, Tigenix, Roche, UCB, Paid instructor for: Elli-Lilly, Pfizer, Roche, Speakers bureau: Abbvie, BMS, Janssen-Cilag, Elli-Lilly, Gedeon Richter, MSD, Novartis, Pfizer, Sanofi, Tigenix, Roche, UCB

AB0205 PREDICTORS OF ULTRASOUND DETECTED INFLAMMATORY FINDINGS IN PATIENTS WITH INFLAMMATORY ARTHRALGIA

Background:

Patients with inflammatory arthralgia (IA) are considered to be at increased risk for progression to RA. US has shown high sensitivity to detect synovitis compared with physical examination. Thus, US is recommended to identify subclinical synovitis in patients without clinical signs of inflammation.

Objectives:

The objective of our study is to determine the frequency and pattern of US detected inflammatory findings in patients with IA and investigate factors contributing to predict these findings.

Methods:

An US clinic is scheduled in an academic center running three days every week. A retrospective analysis of our US unit cohort during a period of 6 months was undertaken. Patients with IA and no previous diagnosis of inflammatory arthropathies were included for analysis. Inclusion criteria of IA definition included: severe symptoms presenting in the morning, duration of morning stiffness ≥60 min, symptoms predominantly located in MCP joints and abscense of clinically detected synovitis by the referral rheumatologist. The following routinely collected variables were included in the analysis: demographics, clinical features and laboratory tests. Patients underwent bilateral US examination in GS and PD mode of hands and/or feet according to the European League Against Rheumatism (EULAR) guidelines. The presence of synovitis, tenosynovitis and enthesitis was assessed on a semi quantitative scale (0–3) for Grey Scale(GS)/Power Doppler(PD) or using enthesitis OMERACT definition, respectively. Patients were stratified in two groups based on the presence of US inflammatory findings (synovitis, tenosynovitis or enthesitis with PD signal). First, differences between groups were tested using chi-squared and Student-t tests in the univariate analysis. Second, multivariate logistic regression models were employed to investigate the association between possible predictive factors of US detected inflammatory findings.

Results:

A total of 57 patients were included in the analysis. Mean age was 55.8±15.2 years, 41 (71.9%) were females, and mean symptoms duration was 11.4±10.4 months (Table 1). A total of 42 (73.7%) patients presented with a polyarticular arthralgia pattern. US inflammatory findings were present in 20 (35.1%) patients (26.3% PD synovitis, 21.1% PD tenosynovitis and 3.5% PD enthesitis). Hands were most commonly involved with PD synovitis at wrists in 19.3% and at MCP in 12.3% of patients (Table 2). For PD tenosynovitis, the flexor MCP 2-5 (5.3%) and compartment IV tenosynovitis (1.8 %) were the most frequent affected locations. Only two patients had PD enthesitis at feet and 6 (10.5%) had erosions in hands or feet at baseline examination. In the univariate analysis, the higher ESR values and the shorter time from symptoms onset were significantly associated with US detected inflammatory findings (p=0.044 and 0.049, respectively). In the multivariate analysis, only ESR values (OR=1,04; 95%CI 1,002-1,078), remained significantly associated with the presence of US inflammatory findings (Table 3).

Table 3.

Independent predictors of US detected inflammatory findings

pOdds ratio95% C.I.LowerUpperESR (mm/h)0.0391.041.0021.078Time (months) from symptoms onset0.10.9240.8411.015

Conclusion:

PD US inflammatory findings are found in 1 over 3 patients with IA being PD synovitis the most common finding, specially at the wrists and MCP joints. Higher ESR values were significantly associated with the presence of US inflammatory findings. Our data highlights how the use of PD US may be useful to detect subclinical synovitis in patients with IA.

Disclosure of Interests:

Katerine López Gloria: None declared, Isabel Castrejon: None declared, Laura Trives Folguera Speakers bureau: ROCHE, Juan Carlos Nieto Speakers bureau: Pfizer, Abbvie, MSD, Novartis, Janssen, Lilly, Nordic Pharma, BMS, Gebro, FAES Farma, Roche, Sanofi, Belén Serrano Benavente: None declared, Julia Martínez-Barrio Consultant of: UCB Pharma, Javier Rivera: None declared, Carlos Gonzalez Consultant of: Gilead, Janssen, Novartis,, Speakers bureau: Abbvie, Celgene, Gilead, Janssen, Novartis, Pfizer, Roche, Indalecio Monteagudo: None declared, Jose-Maria Alvaro-Gracia Grant/research support from: Abbvie, Elli-Lilly, MSD, Novartis, Pfizer, Consultant of: Abbvie, BMS, Janssen-Cilag, Elli-Lilly, MSD, Novartis, Pfizer, Sanofi, Tigenix, Roche, UCB, Paid instructor for: Elli-Lilly, Pfizer, Roche, Speakers bureau: Abbvie, BMS, Janssen-Cilag, Elli-Lilly, Gedeon Richter, MSD, Novartis, Pfizer, Sanofi, Tigenix, Roche, UCB, Juan Molina Collada: None declared

AB0431 SALIVARY GLAND ULTRASOUND IN CLINICAL PRACTICE

Background:

Sjogren’s syndrome (SS) is characterized by lymphocytic infiltration of the exocrine glands and marked B-lymphocytic cell hyperreactivity involving a variety of serum autoantibodies.1Salivary Gland Ultrasound (SGU) is a simple, fast, and well- tolerated examination, wich provides information about glandular structure and has proven to be very useful in the Sjögren Syndrome diagnosis2. A prognostic value has also been proposed due to its posible relationship with lymphomas and extra-glandular manifestations.

Objectives:

The objective of our study is to evaluate ultrasound results in patients who went through an SGU in clinical practice, its usefulness in the diagnosis of Sjögren’s syndrome and the presence of complications (lymphomas, extra-glandular manifestations or factors related to increased lymphoma risk).

Methods:

We conducted a retrospective cross-sectional study with review of clinical records that included all those patients coded as SGU in the Ultrasound unit of Rheumatology Department from 2016 to December 2019. Information collected included final diagnosis, laboratory results, clinical manifestations and ultrasound results. We performed an analysis on the frequency of pathological SGU and on the relationship between this lesions in patients with final SS diagnosis and the presence of lymphoma, extra-glandular manifestations and the laboratory values related with increased lymphoma risk (low complement levels, cryoglobulinemia, positive autoimmunity).

Results:

SGU was performed in 171 patients in four years, 162 women (94.7%). The previous diagnoses, reason for the request and final diagnosis are shown in Table 1. The vast majority of the SGU were normal, only 28 (16,3%) were pathological, 13 with a grade II and 8 with a grade III. In the other 7 patients grading was not available. Of the 28 patients with pathological SGU, none had lymphoma, only 3 had recurrent parotitis and 15 had had extra-glandular manifestations, mainly arthralgia / arthritis (12). Only 1 patient, with rheumatoid arthritis, had had a lymphoma and the SGU was normal. Antibody positivity was frequent in pathological SGU, 16/23 antinuclear antibodies, 13/22 anti-Ro and 9/23 rheumatoid factor. Of the 86 patients without previous diagnosis, 18 were diagnosed with Sjogren syndrome, 9 with pathological SGU and the rest were normal. No patient diagnosed with a dry non-autoimmune syndrome presented pathological SGU.

Table 1.

Previous diagnoses, reason for request and final diagnoses.

Previous diagnoses (n: 171)Reason for request (n: 171)Final diagnosis (n: 78)Without prior diagnosis (n: 86)Dry non- autoinmune syndrome (n: 127)Dry non-autoimmune syndrome (n: 60)Primary Sjögren’s syndrome (n: 11)Primary Sjögren’s syndrome (n: 12)Primary Sjögren’s syndrome (n: 18)Systemic Lupus Erythematosus (n: 9)Lymphoma (n: 0)Secondary Sjögren’s syndrome (n: 0)Rheumatoid arthritis (n: 24)Control (n: 13)Other diagnoses (n: 7)Other diagnoses (n: 18)Other reasons (n: 11)

Conclusion:

The impact of the SGU is low and its use cannot, for now, displace other methods (e.g. salivary gland biopsy) in the diagnosis of SS. Also our low number of patients with pathological SGU together with the low prevalence of the complications studied (e.g. lymphomas = 1) prevents the expected comparisons.

References:

[1]Ramos-Casals M, Solans R, Rosas J, et al. Primary Sjogren syndrome in Spain: clinical and immunologic expression in 1010 patients. Medicine (Baltimore) 2008; 87: 210–219.

[2]Damjanov N, Milic V, Nieto-Gonzalez JC, et al. Multiobserver Reliability of Ultrasound Assessment of Salivary Glands in Patients with Established Primary Sjogren Syndrome. J Rheumatology 2016; 43: 1858–1863.

Disclosure of Interests:

Fernando Montero: None declared, Karen Carpio: None declared, Iustina Janta: None declared, Juan Molina Collada: None declared, Belén Serrano Benavente: None declared, Julia Martínez-Barrio Consultant of: UCB Pharma, Alfonso Ariza: None declared, Javier Rivera: None declared, Carlos Gonzalez Consultant of: Gilead, Janssen, Novartis,, Speakers bureau: Abbvie, Celgene, Gilead, Janssen, Novartis, Pfizer, Roche, Indalecio Monteagudo: None declared, Juan Carlos Nieto Speakers bureau: Pfizer, Abbvie, MSD, Novartis, Janssen, Lilly, Nordic Pharma, BMS, Gebro, FAES Farma, Roche, Sanofi

AB1117 CLINICAL IMPACT OF MUSCULOSKELETAL ULTRASOUND ON RHEUMATOID ARTHRITIS IN ROUTINE CLINICAL PRACTICE

Background:

Musculoskeletal ultrasound (MSUS) is a useful tool to assess disease activity in rheumatoid arthritis (RA) patients. However, it has not yet been established if its use would change treatment decisions within a treat to target strategy or whether it would lead to better outcomes in RA patients

Objectives:

Our aim was to determine the impact of MSUS in the clinical management of RA patients and investigate factors associated with subsequent clinical actions by the referring rheumatologist

Methods:

A prospective analysis of RA patients seen at an MSUS clinic over a 6-month period was undertaken. Pre- and post-US follow-up data (± 3 months) were analyzed. Baseline assessment included clinical features, physical examination and laboratory tests. All MSUS examinations were performed according to EULAR guidelines and using an Esaote MyLab 8 (Esaote, Genoa) with a high frequency (8-15 MHz) transducer. Patients were stratified in groups based on the clinical impact of the MSUS visit: 1) No clinical impact and 2) US findings leading to subsequent clinical action by the referring rheumatologist (including changes in dosages of current rheumatologic treatments, addition/substraction of medications or interventional procedures based on the MSUS results). First, differences between groups were tested using chi-squared and Student-t tests in the univariate analysis. Second, multivariate logistic regression models were employed to investigate factors associated to a change in clinical management

Results:

A total of 61 RA patients were included for analysis. Mean age was 61.9± 11.4 years and 51 (83.6%) were female. Disease activity assessment was the most frequent referral reason (43; 70.5%). Overall, MSUS led to a subsequent therapeutic action by the referring rheumatologist in 39 (63.9%) patients, and to a change in the underlying diagnosis and/or in the clinical impression of the chief complaint that generated the referral in 7 (11.5%) patients. Baseline characteristics between both groups are compared in Table 1. In the univariate analysis, the detection of Power Doppler (PD) synovitis/tenosynovitis and 28 swollen joint count were significantly associated with a subsequent clinical action. In the multivariate analysis only PD synovitis/tenosynovitis (OR=3.28; 95%CI 1.06-10.27) remained significantly associated with a change in clinical management (Table 2)

Table 1.

Baseline characteristics of RA patients

Total n= 61Change in clinical management n= 39 (63.9%)No change in clinical management n= 22 (36.1%)pAge61.9±11.461.5±12.562.6±9.20.7SexFemale51(83.6%)35(89.7%)16(72.7%)0.09SmokingNon smoker33(54.1%)17(43.6%)16(72.7%)0.08Smoker13(21.3%)11(28.2%)2(9.1%)Former smoker15(24.6%)11(28.2%)13(21.3%)Radiographic erosions29(48.3%)22(57.9%)7(31.8%)0.0528 Tender Joint Count2.3±3.42.7±3.91.6±2.40.228 Swollen Joint Count2±32.6±3.51.1±1.6<0.05ESR (mm/h)28.1±20.626.1±15.531.7±27.40.4CRP (g/L)1±1.51±1.40.9±1.70.7RF (IU/mL)175.8±452.8139.9±249.5243.9±697.40.4ACPA (IU/mL)775.6±998.6619.4±797.11079.9±1,275.90.2US PD synovitis/tenosynovitis37(60.7%)28(71.8%)9(40.9%)<0.05Table 2.

Independent factors associated with a change in clinical management based on logistic regression model

pOdds ratio95% C.I.LowerUpper28 Tender Joint Count0.131.240.941.64US PD synovitis/tenosynovitis0.043.281.0610.17

Conclusion:

The most common indication of MSUS examination in RA patients was disease activity assessment. MSUS findings led frequent changes in therapeutic management and even to a change in the diagnosis in some of cases. The presence of PD synovitis/tenosynovitis was significantly associated to a change in the therapeutic management. These data highlight the impact of MSUS inflammatory findings in RA patients in daily clinical practice

Disclosure of Interests:

Juan Molina Collada: None declared, María Pérez: None declared, Isabel Castrejon: None declared, Juan Carlos Nieto Speakers bureau: Pfizer, Abbvie, MSD, Novartis, Janssen, Lilly, Nordic Pharma, BMS, Gebro, FAES Farma, Roche, Sanofi, Teresa González: None declared, Javier Rivera: None declared, Carlos Gonzalez Consultant of: Gilead, Janssen, Novartis,, Speakers bureau: Abbvie, Celgene, Gilead, Janssen, Novartis, Pfizer, Roche, Indalecio Monteagudo: None declared, Jose-Maria Alvaro-Gracia Grant/research support from: Abbvie, Elli-Lilly, MSD, Novartis, Pfizer, Consultant of: Abbvie, BMS, Janssen-Cilag, Elli-Lilly, MSD, Novartis, Pfizer, Sanofi, Tigenix, Roche, UCB, Paid instructor for: Elli-Lilly, Pfizer, Roche, Speakers bureau: Abbvie, BMS, Janssen-Cilag, Elli-Lilly, Gedeon Richter, MSD, Novartis, Pfizer, Sanofi, Tigenix, Roche, UCB

A New Species of Praying Mantis from Peru Reveals Impaling as a Novel Hunting Strategy in Mantodea (Thespidae: Thespini)

A new species of lichen-mimicking praying mantis, Carrikerella simpira n. sp., is described from Tingo María region in Peru. The new species differs from its congeners in having reduced tergal lobes, a relatively sinuous pronotum, and it is found in the highland tropical rainforest of the Central Andes. Behavioral observations conducted on captive individuals revealed that juveniles and adults hunt by impaling prey using modified foretibial structures. Anatomical examinations of the incumbent trophic structures revealed functional adaptations for prey impaling in the foretibiae, primarily consisting of prominent, forwardly oriented, barbed spines. We provide an overall description of this novel hunting behavior in Mantodea and hypothesize on its evolutionary origin and adaptive significance for the Thespidae.

Multiresidue Determination of Pesticides in Drinking and Related Waters by Solid-Phase Extraction and Liquid Chromatography with Ultraviolet Detection: Interlaboratory Study

As part of a project funded by the European Commission (EC) for the development and evaluation of multiresidue methods for analysis of drinking and related waters, 17 European laboratories evaluated a method using styrene–divinylbenzene copolymer solid-phase extraction followed by liquid chromatography with diode array detection. The main aim of the study was to evaluate whether the method meets the requirements of EC Drinking Water Directive 98/83 in terms of accuracy, precision, and detection limit for 21 pesticides according to the following requirements: limit of detection, ≤0.025 μg/L; accuracy expressed as recovery, between 75 and 125%; and precision expressed as repeatability relative standard deviation of the method, &lt;12.5%, and as reproducibility relative standard deviation of the method, &lt;25%. Analyses for unknown concentrations were performed with commercial bottled and tap waters. All laboratories were able to achieve detection limits of 0.01 μg/L for all pesticides except pirimicarb (0.02 μg/L). The criteria for repeatability were met for all compounds. Terbutryn in bottled water and carbendazim in tap water did not meet the criteria for reproducibility. In terms of accuracy, the method met the requirements for all pesticides in both matrixes, except for metamitron. However, several compounds (linuron, terbutryn, propazine, metobromuron, and isoproturon) showed recoveries slightly below 75%.

Multiresidue Determination of Pesticides in Drinking and Related Waters by Gas Chromatography/Mass Spectrometry after Solid-Phase Extraction: Interlaboratory Study

As part of a project funded by the European Commission (EC) for the development and evaluation of multiresidue methods for analysis of drinking and related waters, 15 European laboratories evaluated a method using styrene–divinylbenzene copolymer solid-phase extraction followed by gas chromatography/mass spectrometry. The main aim of the study was to evaluate whether the method meets the requirements of EC Directive 98/83 in terms of accuracy, precision, and detection limit for 22 pesticides according to the following requirements: limit of detection, ≤0.025 μg/L; accuracy, expressed as recovery between 75 and 125%; and precision, expressed as repeatability relative standard deviation of the method of &lt;12.5% and as reproducibility relative standard deviation of the method of &lt;25%. Analyses for unknown concentrations were performed with fortified commercial bottled and tap waters. All laboratories were able to achieve detection limits of 0.01 μg/L for all pesticides except dimethoate and desisopropylatrazine (0.02 μg/L). The criteria for repeatability were met for all compounds except trifluralin, dimethoate, and lindane in bottled water and chlorpyrifos, dimethoate, and lindane in tap water. The criteria for reproducibility were met for all compounds except trifluralin, dimethoate, and lindane in bottled water and pendimethalin, chlorpyrifos, dimethoate, terbutryn, and lindane in tap water. In terms of accuracy, the method meets the requirements for all pesticides in both matrixes, except for lindane in bottled water and lindane and chlorpyrifos in tap water.

Prevalence of eosinophilic esophagitis: A multicenter study on a pediatric population evaluated at thirty-six Latin American gastroenterology centers

INTRODUCTION AND OBJECTIVE

Eosinophilic esophagitis is a chronic, immune-mediated disease described in case series and publications worldwide. Over the past twenty years, the authors of different studies have attempted to evaluate its incidence and prevalence. The objetive of the present study was to estimate the prevalence of eosinophilic esophagitis in a group of children seen at 36 pediatric gastroenterology centers in ten Latin American countries.

MATERIALS AND METHODS

A multicenter, observational, and cross-sectional study was conducted that estimated the period prevalence of eosinophilic esophagitis in children seen at outpatient consultation and that underwent diagnostic upper gastrointestinal endoscopy for any indication at 36 centers in 10 Latin American countries, within a 3-month time frame.

RESULTS

Between April and June 2016, 108 cases of eosinophilic esophagitis were evaluated. Likewise, an average of 29,253 outpatient consultations and 4,152 diagnostic upper gastrointestinal endoscopies were carried out at the 36 participating centers. The period prevalence of eosinophilic esophagitis in the population studied (n=29,253) was 3.69 cases×1,000 (95% CI: 3.04 to 4.44), and among the children that underwent routine upper gastrointestinal endoscopy (n=4,152), it was 26x1,000 (95% CI: 22.6 to 29.4).

CONCLUSIONS

The general period prevalence of eosinophilic esophagitis in a group of children evaluated at 36 Latin American pediatric gastroenterology centers was 3.69×1,000, and in the children that underwent endoscopy, it was 26×1,000. There was important prevalence variability between the participating countries and centers. The present analysis is the first study conducted on the prevalence of pediatric eosinophilic esophagitis in Latin America.

Antithrombotic prophylaxis for surgery-associated venous thromboembolism risk in patients with inherited platelet disorders. The SPATA-DVT Study

Major surgery is associated with an increased risk of venous thromboembolism (VTE), thus the application of mechanical or pharmacologic prophylaxis is recommended. The incidence of VTE in patients with inherited platelet disorders (IPD) undergoing surgical procedures is unknown and no information on the current use and safety of thromboprophylaxis, particularly of low-molecular-weight-heparin in these patients is available. Here we explored the approach to thromboprophylaxis and thrombotic outcomes in IPD patients undergoing surgery at VTE-risk participating in the multicenter SPATA study. We evaluated 210 surgical procedures carried out in 155 patients with well-defined forms of IPD (VTE-risk: 31% high, 28.6% intermediate, 25.2% low, 15.2% very low). The use of thromboprophylaxis was low (23.3% of procedures), with higher prevalence in orthopedic and gynecological surgeries, and was related to VTE-risk. The most frequently employed thromboprophylaxis was mechanical and appeared to be effective, as no patients developed thrombosis, including patients belonging to the highest VTE-risk classes. Low-molecular-weight-heparin use was low (10.5%) and it did not influence the incidence of post-surgical bleeding or of antihemorrhagic prohemostatic interventions use. Two thromboembolic events were registered, both occurring after high VTE-risk procedures in patients who did not receive thromboprophylaxis (4.7%). Our findings suggest that VTE incidence is low in patients with IPD undergoing surgery at VTE-risk and that it is predicted by the Caprini score. Mechanical thromboprophylaxis may be of benefit in patients with IPD undergoing invasive procedures at VTE-risk and low-molecular-weight-heparin should be considered for major surgery.

A-65 Verbal Abilities May Influence Performance in Assessment of Verbal Short-Term Memory Tasks

Objective

Examine whether verbal abilities may help explain the learning strategies people employ when completing a short-term verbal memory task.

Methods

The assessment records of 296 American Veterans with diverse neuropsychiatric conditions were analyzed using Exploratory Factor Analyses. There were no exclusion criteria. All participants completed the Benton Serial Digit Learning Test – 9 Digits (SDL-9) and Visual Naming (VisNam), Sentence Repetition (SenRep), Controlled Word Association (COWA), and Token Tests of the Multilingual Aphasia Examination (MAE). Individual assessment instruments were factored using Principal Component Analyses (PCA). A three-factor solution of the SDL-9 was co-factored with the verbal components of the MAE to identify common sources of variance.

Results

A three-factor solution of the SDL-9 separated trials into three overlapping factors consisting of early (SDL-9_Early), middle (SDL-9_Middle), and late (SDL-9_Late) trials. Co-factoring the three new scales with the verbal components of the MAE produced a four-factor model explaining 67.85% of the shared variance: 1) SenRep loaded with SDL-9_Early, 2) COWAT loaded with SDL-9_Middle and SDL-9_Late, 3) Token loaded with SDL-9_Late, and 4) Vis Nam loaded with SDL-9_Late.

Conclusions

The results suggest that individuals may engage verbal abilities differently as they progress from simpler to more difficult verbal short-term memory tasks. It appears performance in early trials is mostly associated with rote repetition and performance on middle trials is mostly associated with verbal fluency, while performance on the late trials is associated with a combination of verbal fluency, auditory comprehension, and conceptual organization/naming. This may therefore indicate a shift in learning strategy to meet increased cognitive demands.

A-53 Exploring the Relationship between Spoken Language and Verbal Short-term Memory Assessment Tasks

Objective

Examine whether performance on spoken language assessment measures may be associated with performance at different phases of verbal learning and recall tasks.

Method

The assessment records of 222 American Veterans with diverse neuropsychiatric conditions were analyzed using Exploratory Factor Analyses. There were no exclusion criteria. All participants completed the Visual Naming (VisNam), Sentence Repetition (SenRep), Controlled Word Association (COWA), and Token Tests of the Multilingual Aphasia Examination (MAE), and Benton Serial Digit Learning Test – 8 Digits (SDL8). Individual assessment instruments were factored using Principal Component Analyses (PCA). A three-factor solution of the SDL-8 was co-factored with the spoken language components of the MAE to identify common sources of variance.

Results

A three-factor solution of the SDL8 separated trials into three overlapping factors consisting of early (SDL8_Early), middle (SDL8_Middle), and late (SDL8_Late) trials. Co-factoring the three new scales with the verbal components of the MAE produced a five-factor model explaining 84.563% of the shared variance: 1) SDL8_Early loaded with SenRep, 2) SDL8_Middle loaded with SenRep, 3) SDL8_Late loaded with Token, 4) SDL8_Late loaded with COWA, and 5) VisNam alone formed the fifth factor.

Conclusions

The results suggest that rote repetition is largely associated with early trials and slightly associated with middle trials, while late trials are largely associated with auditory comprehension and slightly associated with verbal fluency. This may be indicative of a shift in use of spoken language abilities to accommodate increasing levels of complexity in presented verbal short-term memory tasks and thus reflective of a change on learning strategy to optimize performance.

A-52 An Exploratory Factor Analysis Investigation of the Role of Verbal Mediation in the Interaction between Intelligence and Visual Memory Tasks

Objective

Examine whether verbal mediation may play a role in the interaction between visual memory tasks and the four-factor model of intelligence as operationalized by standard neuropsychological assessment instruments.

Method

The assessment records of 101 American Veterans with diverse neuropsychiatric conditions were examined using Exploratory Factor and Principal Component Analyses (EFA and PCA respectively). There were no exclusion criteria. All participants completed the Wechsler Adult Intelligence Scale, third edition (WAIS-III), Benton’s Visual Retention Test (BVRT), and Multilingual Aphasia Examination (MAE). Individual assessment instruments were factored using PCA. The factor solution of the BVRT was co-factored with the scales of the WAIS-III, then the resulting factor scales were again factored with the verbal components of the MAE to identify common sources of variance.

Results

A three-step analysis revealed a four-factor model explaining 69.44% of the shared variance: 1) Items 1-4 of the BVRT (BVRT-E) loaded with Verbal Comprehension and Visual Naming. 2) BVRT-E also loaded with Processing Speed and Controlled Word Association. 3) Items 5-10 of the BVRT (BVRT-L) loaded with Perceptual Organization and the Token Test. 4) Working Memory loaded with Sentence Repetition on a fourth factor.

Conclusions

The results indicate a strong relationship between assessed performance on visual memory tasks and performance on measures based on the four-factor model of intelligence. The results also appear to support the idea that verbal mediation plays a role in the interaction between visual memory and intelligence, particularly when comparing performance on simple versus more complex visual memory tasks.

Effects of chronic inhibition of Testosterone metabolism on cardiac remodeling after ischemia/reperfusion-induced myocardial damage in gonadectomized rats

The effects of testosterone on cardiovascular homeostasis are still not well understood. The objective of this work was to evaluate the effects of testosterone in the absence or presence of inhibition of Aromatase (4-hydroxyandrostenedione) and/or 5α reductase (Finasteride) enzymatic activities on the myocardial remodeling 30 days after ischemia/reperfusion (I/R) injury in gonadectomized rats. Results showed that testosterone administration to ORX rats resulted in decreased myocardial damaged area, inflammatory infiltrates and reduced MMP-3 and 13 expressions. Interestingly, Finasteride administration resulted in a greater decrease in scar tissue, inflammatory infiltrates, along with a significant decrease in MMP-3 and 13 expressions. In contrast, 4-hydroxyandrostenedione administrations increased all parameters. Our results suggest that testosterone does not have a direct effect since simultaneous inhibition of aromatase and 5α-reductase did not induce significant changes in I/R induced myocardial injury.

Summary: Coronary ischemia/reperfusion-induced injury in gonadectomyzed male rats is decreased by testosterone, protection is increased by blocking its 5α-reduction and blocked by inhibition of its aromatization.

Identification of novel variants in ten patients with Hermansky-Pudlak syndrome by high-throughput sequencing

Background: Hermansky-Pudlak syndrome (HPS) is a rare inherited platelet disorder characterized by bleeding diathesis, oculocutaneous albinism (OCA) and a myriad of often-serious clinical complications. Methods: We established the clinical and laboratory phenotype and genotype of six unrelated pedigrees comprising ten patients with clinical suspicion of HPS; including platelet aggregation, flow cytometry, platelet dense granule content, electron microscopy and high-throughput sequencing (HTS). Results: The clinical presentation showed significant heterogeneity and no clear phenotype-genotype correlations. HTS revealed two known and three novel disease-causing variants. The Spanish patients carried a homozygous p.Pro685Leufs17* deletion (n = 2) in HPS4, or the novel p.Arg822* homozygous variant (n = 1) in HPS3. In the case of two Turkish sisters, a novel missense homozygous HPS4 variant (p.Leu91Pro) was found. In two Portuguese families, genetic studies confirmed a previously reported nonsense variant (p.Gln103*) in DTNBP1 in three patients and a novel duplication (p.Leu22Argfs*33) in HPS6 in two unrelated patients. Conclusions: Our findings expand the mutational spectrum of HPS, which may help in investigating phenotype-genotype relationships and assist genetic counselling for affected individuals. This approach is a proof of principle that HTS can be considered and used in the first-line diagnosis of patients with biological and clinical manifestations suggestive of HPS. Key messages We established the relationships between the clinical and laboratory phenotype and genotype of six unrelated pedigrees comprising ten patients with clinical suspicion of HPS. Molecular analysis is useful in confirming the diagnosis and may offer some prognostic information that will aid in optimizing monitoring and surveillance for early detection of end-organ damage. This approach is a proof of principle that HTS can be considered and used in the first-line diagnosis of patients with biological and clinical manifestations suggestive of HPS.

Identical and Nonidentical Twins: Risk and Factors Involved in Development of Islet Autoimmunity and Type 1 Diabetes

OBJECTIVE

There are variable reports of risk of concordance for progression to islet autoantibodies and type 1 diabetes in identical twins after one twin is diagnosed. We examined development of positive autoantibodies and type 1 diabetes and the effects of genetic factors and common environment on autoantibody positivity in identical twins, nonidentical twins, and full siblings.

RESEARCH DESIGN AND METHODS

Subjects from the TrialNet Pathway to Prevention Study (N = 48,026) were screened from 2004 to 2015 for islet autoantibodies (GAD antibody [GADA], insulinoma-associated antigen 2 [IA-2A], and autoantibodies against insulin [IAA]). Of these subjects, 17,226 (157 identical twins, 283 nonidentical twins, and 16,786 full siblings) were followed for autoantibody positivity or type 1 diabetes for a median of 2.1 years.

RESULTS

At screening, identical twins were more likely to have positive GADA, IA-2A, and IAA than nonidentical twins or full siblings (all P < 0.0001). Younger age, male sex, and genetic factors were significant factors for expression of IA-2A, IAA, one or more positive autoantibodies, and two or more positive autoantibodies (all P ≤ 0.03). Initially autoantibody-positive identical twins had a 69% risk of diabetes by 3 years compared with 1.5% for initially autoantibody-negative identical twins. In nonidentical twins, type 1 diabetes risk by 3 years was 72% for initially multiple autoantibody-positive, 13% for single autoantibody-positive, and 0% for initially autoantibody-negative nonidentical twins. Full siblings had a 3-year type 1 diabetes risk of 47% for multiple autoantibody-positive, 12% for single autoantibody-positive, and 0.5% for initially autoantibody-negative subjects.

CONCLUSIONS

Risk of type 1 diabetes at 3 years is high for initially multiple and single autoantibody-positive identical twins and multiple autoantibody-positive nonidentical twins. Genetic predisposition, age, and male sex are significant risk factors for development of positive autoantibodies in twins.

Antioxidant and Anti-Inflammatory Strategies Based on the Potentiation of Glutathione Peroxidase Activity Prevent Endothelial Dysfunction in Chronic Kidney Disease

BACKGROUND/AIMS

Accelerated atherosclerosis in chronic kidney disease (CKD) is preceded by endothelial dysfunction (ED), which exhibits a proinflammatory and prothrombotic phenotype and enhanced oxidative stress. In this study, the effect of several compounds with anti-inflammatory and/or antioxidant properties on uremia-induced endothelial dysfunction has been evaluated in an in vitro model.

METHODS

Endothelial cells (ECs) were exposed to sera from uremic patients in the absence and presence of the flavonoids apigenin, genistein and quercetin, the antioxidant enzyme mimetics (AEM) ebselen (glutathione peroxidase mimetic), EUK-134 and EUK-118 (both superoxide dismutase mimetics), and the pharmacological drug N-acetylcysteine (NAC). We explored changes in the expression of adhesion receptors on the cell surface, by immunofluorescence, the production of radical oxygen species (ROS), by fluorescence detection, and the activation of signaling proteins related to inflammation, by both a phosphospecific antibody cell-based ELISA and immunoblotting techniques.

RESULTS

Uremic media induced a significantly increased expression of ICAM-1, overproduction of radical oxygen species (ROS) and activation of p38 mitogen activated protein kinase (p38MAPK) and Nuclear Factor kB (NFkB) in ECs. Quercetin, the AEM and NAC showed a significant inhibitory effect on both ICAM-1 expression and ROS generation (p<0.05). All the compounds reduced p38MAPK activation, but only the AEM, especially ebselen, and NAC, both potentiating the glutathione peroxidase pathway, also inhibited NFkB activation. These two compounds were capable of increasing endothelial glutathione levels, especially in response to uremia.

CONCLUSION

Our results indicate that the potentiation of the antioxidant pathways can be an effective strategy to improve endothelial dysfunction in uremia and a potential target to reduce the cardiovascular risk in this population.