Type 1 and type 2 diabetes predisposed to higher Nd:YAG capsulotomy rates following cataract surgery: analysis of 53,471 consecutive cases

OBJECTIVE

To assess the effect of diabetes type on Nd:YAG capsulotomy rates following cataract surgery.

DESIGN

A retrospective cohort study.

METHODS

All patients who underwent cataract extraction at the Department of Ophthalmology, Bristol Eye Hospital, Bristol, UK, between 2003 and 2017 were included. The Nd:YAG capsulotomy rate following cataract surgery was assessed and compared between nondiabetic, type 1 diabetes (T1D), and type 2 diabetes (T2D) patients. Multivariate Cox regression analysis controlling for age and sex was used to estimate hazard ratios for Nd:YAG laser capsulotomies.

RESULTS

Included were 53,471 consecutive cataract surgeries. Overall, 42,651 eyes (79.8%) were in nondiabetic patients, 823 eyes (1.5%) were in T1D patients, and 9,997 eyes (18.7%) were in T2D patients. The mean follow-up time was 6.8 ± 4.2 years. In univariate analysis, the eyes of T1D patients (p < 0.001) and T2D patients (p = 0.003) had significantly higher Nd:YAG laser capsulotomy rates than the eyes of nondiabetic patients. In Cox regression analysis adjusted for the patient's age and sex, DM1 (HR 1.692, 95%CI 1.390-2.059, P<0.001) and DM2 (HR 1.157, 95%CI 1.075-1.244, P<0.001) remained significantly predictive for higher Nd:YAG laser capsulotomy rates.

CONCLUSION

In our large cohort study, patients with T1D and T2D were predisposed to high risk for Nd:YAG capsulotomy following cataract surgery. This study may be beneficial and raise awareness regarding the assessment of posterior capsular opacification development in pseudophakic diabetic patients, particularly those with T1D. The significance of ophthalmology screening for diabetes individuals is further supported by this issue.

Anesthetic Management of a Patient With Prinzmetal Angina

Prinzmetal angina (PA) is characterized by the development of reversible vasoconstriction of the coronary arteries, transient ischemic electrocardiographic changes in the ST segment, chest pain at rest, and prompt response to nitrates. Spasms of the coronary arteries can be precipitated during the perioperative period by an imbalance of vasodilator and vasoconstrictor factors of smooth muscle cells, which can lead to myocardial ischemia, cardiac arrhythmias, and death. Nevertheless, this is a relatively unrecognized topic, and literature is scarce about it. We present a case report detailing the successful anesthetic management of a patient diagnosed with PA and a documented nitrate allergy, who underwent bilateral ureterorenoscopy.

Perioperative Management of Lewis-Sumner Syndrome

Lewis-Sumner syndrome (LSS) is a rare immune-mediated neuromuscular disorder. It shares some clinical and pathological features with chronic inflammatory demyelinating polyneuropathy (CIDP). We report on the anaesthetic management of a patient with LSS. There are several concerns when anaesthetizing patients with demyelinating neuropathies, the main ones being the post-operative worsening of symptoms and respiratory depression related to muscle relaxants. In our experience, the rocuronium effect was prolonged and an even lower dosage (0.4 mg/kg) was sufficient for intubation and maintenance. Sugammadex allowed total reversion of neuromuscular block and no respiratory complications occurred. In conclusion, the combination of lower dose rocuronium and sugammadex was safely used in a patient with LSS.

Long-term outcome of redo discectomy for recurrent lumbar disc herniations

PURPOSE

Recurrent lumbar disc herniation (RLDH) is an important cause of morbidity and healthcare costs. The goal of this investigation is to assess surgical outcomes and their predictors in patients who underwent revision discectomy for RLDH, with a minimum follow-up of ten years, to shed light on the best treatment to offer to these patients.

METHODS

Patients who underwent revision discectomy to treat RLDH between 2004 and 2011 in our Department were enrolled. Demographic, clinical, and surgical data were collected. The need of third intervention for RLDH was the primary outcome. Patient's satisfaction, Core Outcome Measures Index, Oswestry Disability Index, and EuroQoL-5D scores were also evaluated.

RESULTS

This study includes 55 patients, with a mean follow-up time of 144 months [112-199]. In this period, a third intervention was needed in 30.9% (n = 17) of patients. Most recurrences took place in the first 2 years after the second surgery (58.8%, n = 10) and the risk of needing a third surgery decreased over time. After 5 years, the probability of not having surgery for recurrence was 71% [CI 95%: 60-84%], with a tendency to stabilize after that. An interval between the first discectomy and the surgery for recurrence shorter than 7.6 months was identified as a predictor for a second recurrence.

CONCLUSION

The risk of needing a third surgery seems to stabilize after five years. Patients with an early recurrence after the first discectomy seem to have a higher risk of a new recurrence, so an arthrodesis might be worth considering.

Does my TAVR patient have cardiac amyloidosis?

Introduction

Aortic stenosis (AS) is highly age-related, and its prevalence is increasing rapidly in high-income countries. There are 2 major types of amyloid protein responsible for cardiac amyloidosis (CA) - transthyretin (TTR) and immunoglobulin lightchain (AL). Previous cohorts report an incidence ranging from 9 to 16% for the presence of CA in patients with AS referred for TAVR. These patients appear to have a similar prognosis to those with lone AS when undergoing TAVR, but a trend toward worse prognosis if left treated. We aimed to investigate the prevalence of CA in patients with severe AS referred for TAVR in the Portuguese population.

Methods

We prospectively recruited 60 consecutive patients referred for TAVR at our tertiary center between November 2020 and May 2021. 59 patients agreed to participate and signed an informed consent, approved by the local Ethics Commission. All patients performed coronary angiogram, echocardiogram, thoracic abdominal pelvic CT scan, ECG, bone scintigraphy (99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid [DPD]) and blood and urine monoclonal immunoglobulin testing. (Figure 1).

Results

About half (54.2%) of patients were male, average age was 82 years and the prevalence of ischemic heart disease and cardiovascular risk factors was high. About one third of patients had atrial fibrillation and 27.1% were pacemaker carriers. Echocardiographic baseline findings were: maximum aortic valve gradient 72.77±18.18 mmHg; mean aortic valve gradient 43.49±11.60; aortic valve area 0.65±0.15 cm2; interventricular septum thickness 1.30±0.23 cm; left ventricular ejection fraction (LVEF) 52.06±11.35%; E/E' 14.63±7.5; tricuspid annular plane systolic excursion 19.2±4mm; right ventricle/ right atrial gradient 38.1±14.32mmHg.

CA was diagnosed in 6 (10.2%) patients. Perugini grade was 1 (n=3) and 3 (n=3). One patient (Perugini grade = 3) was found to have plasma cell dyscrasia, producing monoclonal IgG Kappa protein. CA patients were all male, older (86.5 vs 81.30 years, p=0.049), more frequently pacemaker carriers (66.7 vs 22.6%, p=0.041) and had a tendency to have a thicker interventricular septum (1.48 vs 1.28 cm, p=0.065).

Conclusions

We show that in the Portuguese population, the prevalence of CA in severe AS patients referred for TAVI is in line with what is observed in other countries. This has important consequences regarding the diagnosis and management of these patients.

Funding Acknowledgement

Type of funding sources: None.

IMPACTO-MR: a Brazilian nationwide platform study to assess infections and multidrug resistance in intensive care units

OBJECTIVE

To describe the IMPACTO-MR, a Brazilian nationwide intensive care unit platform study focused on the impact of health care-associated infections due to multidrug-resistant bacteria.

METHODS

We described the IMPACTO-MR platform, its development, criteria for intensive care unit selection, characterization of core data collection, objectives, and future research projects to be held within the platform.

RESULTS

The core data were collected using the Epimed Monitor System® and consisted of demographic data, comorbidity data, functional status, clinical scores, admission diagnosis and secondary diagnoses, laboratory, clinical, and microbiological data, and organ support during intensive care unit stay, among others. From October 2019 to December 2020, 33,983 patients from 51 intensive care units were included in the core database.

CONCLUSION

The IMPACTO-MR platform is a nationwide Brazilian intensive care unit clinical database focused on researching the impact of health care-associated infections due to multidrug-resistant bacteria. This platform provides data for individual intensive care unit development and research and multicenter observational and prospective trials.

IMPACTO-MR: a Brazilian nationwide platform study to assess infections and multidrug resistance in intensive care units

OBJECTIVE

To describe the IMPACTO-MR, a Brazilian nationwide intensive care unit platform study focused on the impact of health care-associated infections due to multidrug-resistant bacteria.

METHODS

We described the IMPACTO-MR platform, its development, criteria for intensive care unit selection, characterization of core data collection, objectives, and future research projects to be held within the platform.

RESULTS

The core data were collected using the Epimed Monitor System® and consisted of demographic data, comorbidity data, functional status, clinical scores, admission diagnosis and secondary diagnoses, laboratory, clinical, and microbiological data, and organ support during intensive care unit stay, among others. From October 2019 to December 2020, 33,983 patients from 51 intensive care units were included in the core database.

CONCLUSION

The IMPACTO-MR platform is a nationwide Brazilian intensive care unit clinical database focused on researching the impact of health care-associated infections due to multidrug-resistant bacteria. This platform provides data for individual intensive care unit development and research and multicenter observational and prospective trials.

Association of Blue Light-Filtering Intraocular Lenses With All-Cause and Traffic Accident-Related Injuries Among Patients Undergoing Bilateral Cataract Surgery in Finland

IMPORTANCE

Blue light-filtering (BLF) intraocular lenses (IOLs) have been widely used in clinical practice for more than 20 years and have been implanted in millions of patients with cataracts worldwide. However, little evidence on the association of BLF IOLs with injuries is available.

OBJECTIVE

To assess the association of BLF IOLs with all-cause and traffic accident-related injuries and quality of vision while driving after bilateral cataract surgery.

DESIGN, SETTING, AND PARTICIPANTS

This retrospective registry-based cohort study included patients who underwent bilateral cataract surgery between September 3, 2007, and December 14, 2018, and were followed until December 14, 2021. Surgery was performed at the Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland. The 4986 participants received non-BLF IOLs (n = 2609) or BLF IOLs (n = 2377) in both eyes. Patients undergoing bilateral surgery between 2015 to 2016 with non-BLF IOLs (n = 102) or BLF IOLs (n = 91) and currently driving a car were interviewed using a structured questionnaire for visual performance while driving.

EXPOSURES

Follow-up for a mean (SD) of 2166 (1110) days after second eye surgery.

MAIN OUTCOMES AND MEASURES

Kaplan-Meier and multivariable Cox proportional hazards regression analyses for the risk of all-cause and traffic accident-related injuries after surgery in the second eye obtained from the patient medical records were assessed. To improve follow-up precision, both death and the end of the follow-up were used as censoring events.

RESULTS

A total of 4986 patients were included in the analysis (1707 [34.2%] men and 3279 [65.8%] women; mean [SD] age, 73.2 [8.6] years at the first surgery and 74.3 [8.8] years at the second). Injury-free survival rates preceding the first eye surgery were comparable between the non-BLF and BLF IOL groups (hazard ratio adjusted for age and sex, 0.95 [95% CI, 0.81-1.13; P = .57]). In multivariable Cox proportional hazards regression analysis controlling for age and sex, the use of BLF IOLs showed no advantage in overall injuries compared with the use of non-BLF IOLs (hazard ratio, 0.99 [95% CI, 0.88-1.11]; P = .85) or in any injury subtype. Subjective visual performance parameters for driving were all comparable between the non-BLF and BLF IOL groups except for glare when driving in the dark (evening or night), which occurred among 9 of 80 patients with BLF IOLs compared with 0 of 83 non-BLF IOLs (P < .001).

CONCLUSIONS AND RELEVANCE

The findings of this cohort study suggest that use of BLF IOLs was not associated with reduced risk of injuries, whereas glare during nighttime driving was significantly worse in the BLF IOL group with pseudophakia.

P-064 Clinical outcomes of 127 patients with recurrent implantation failure treated with testicular sperm aspiration (TESA)

Study question

Are the embryological, clinical and newborn outcomes using aspirated testicular sperm improved in cases with recurrent implantation failure previously treated with ejaculated sperm?

Summary answer

Aspirated testicular sperm enabled to obtain significant higher embryological, clinical and newborn outcomes in cases with recurrent implantation failure previously treated with ejaculated sperm.

What is known already

High levels of sperm DNA fragmentation (SDF) were associated to poor clinical outcomes (1-Simon et al., 2017). Testicular sperm display lower SDF than ejaculated sperm (2-Sakas and Alvarez, 2010), improving clinical outcomes in cases with abnormal semen parameters (3-Awaga et al., 2018; 4-Kang et al., 2018), recurrent implantation failure (RIF) and pregnancy loss (RPL) (5-Esteves et al., 2017), and elevated SDF (6-Ambar et al., 2021). As only a few studies are specifically dedicated to RIF, we expanded the number of cases and first provided full demographic, stimulation, embryological, clinical and newborn outcomes.

References

1-(https://doi.org/10.4103/1008-682X.182822);

2-(https://doi.org/10.1016/j.fertnstert.2009.10.046);

3-(https://doi.org/10.1016/j.rbmo.2018.08.017);

4-(https://doi.org/10.1038/s41598-018-26280-0);

5-(https://doi.org/10.1016/j.fertnstert.2017.06.018);

6-(https://doi.org/10.5534/wjmh.200084

Study design, size, duration

We retrospectively evaluated during consecutive years (2010-2020) 63 patients with recurrent implantation failure, which accepted to perform testicular sperm aspiration (TESA) as an alternative treatment. These patients presented a long history of failed treatments (153 cycles) using ejaculated sperm. From these cycles, no pregnancy ensued. The present study compares 127 treatment cycles, 80 with testicular sperm (17 cases repeated TESA) and 47 with ejaculated sperm from the same patients performed at the present IVF clinic.

Participants/materials, setting, methods

Patients were screened for karyotype abnormalities, for Y-chromosome microdeletions (7-Gonçalves et al., 2016), and for SDF with the TUNEL assay (8-Sá et al., 2015). Conventional semen analysis was performed according to World Health Organization guidelines (9-WHO, 2010). Male evaluation and TESA was performed by the same experienced urologist (LF) according to established protocols (10-Madureira et al 2014). The procedure was performed entirely on an outpatient basis, with no complications reported.

References

7-(https://doi.org/10.4103/1008-682X.172827);

8-(https://doi.org/10.1016/j.rbmo.2015.06.019);

9-(https://apps.who.int/iris/handle/10665/44261);

10-(https://doi.org/10.1111/j.2047-2927.2014.00231.x).

Main results and the role of chance

The mean ages were 35.5±3.4 (26-42)-female and 38.1±5.7 (29-59)-male. There were 4 abnormal karyotypes (3-female, 1-male), all without known relevance. Most cases had asthenozoospermia and teratozoospermia (65.1%), or oligoasthenoteratozoospermia (41.8%). Of the 19 cases with &lt;5M/ml, none presented Y-chromosome microdeletions. Although we do not routinely perform SDF testing, 15 patients had previous SDF values (12, &gt;20%; 8, &gt;36%). Female basal characteristics and testicular evaluation were under normal values. The TESA procedure took about 15-20 min, and the time of laboratorial search around 30-60 min. Cases using testicular sperm showed significant higher rates of fertilization (64% vs 73%-p=0.005), blastocyst development (47% vs 62%-p=0.010), implantation (6% vs 27%-p=0.000), clinical pregnancy (10% vs 39%-p=0.001), live birth delivery (5% vs 28%-p=0.005) and newborn (5% vs 32%-p=0.000) than ejaculated sperm. No significant differences were observed regarding the rates of embryo cleavage (95% vs 94.8%) and high quality embryos (89.4% vs 94%), in the mean number of transferred embryos (1.8±0.4 vs 1.9±0.4), or in the abortion rate (2 cases-50% vs 7 cases-25.9%). Cases using testicular sperm had 22 frozen-thawed embryo transfer cycles, enabling per initiated cycle a cumulative pregnancy rate of 45%, live birth delivery rate of 31.3% and newborn rate of 37.5% (32 newborn).

Limitations, reasons for caution

Although presenting the higher number of cycles using TESA in the treatment of RIF, this number needs to be increased for drawing more definitive conclusions, as these women present a diversity of conditions, rendering subgrouping difficult. In the future, it would also be important to evaluate SDF in all cases.

Wider implications of the findings

In conclusion, the present results gave further evidence for the superiority of using testicular sperm instead of ejaculated sperm in cases with recurrent implantation failure. Data also evidences the security of using testicular sperm aspiration, as there were no pregnancy or delivery complications, or congenital anomalies among the 32 newborn.

Trial registration number

Not Applicable

Use of fermentation processes for improving the dissolution of phosphorus and its recovery from waste activated sludge

Recycling phosphorus from waste activated sludge has attracted a lot of interest to tackle the problem of phosphorus stocks depletion and the increase in food demand. In this study, the use of fermentation processes was investigated to enhance phosphorus dissolution from waste activated sludge to improve its recycling. Two fermentation processes, bioacidification and dark fermentation, were used on two different sludges fermented with wheat starch syrup in continuous operating conditions. Hydrogen yield from the co-substrate fermentation with waste activated sludge reached 3.9 mmolH₂.gCOD_cosubstrate^-1 yield during dark fermentation process and was negligible during bioacidification. Dissolved phosphorus in the waste activated sludge increased by 68% during bioacidification and by 43% during dark fermentation. In both processes, phosphorus dissolution was accompanied by iron, calcium and magnesium dissolution. Results show that fermentation enhances phosphorus dissolution in waste activated sludge to improve its recovery along with hydrogen and organic acids.

Clinical outcomes of 77 TESE treatment cycles in non-mosaic Klinefelter syndrome patients

OBJECTIVE

The current study aimed to present the clinical outcomes of 76 azoospermic patients with non-mosaic Klinefelter syndrome (KS), treated with testicular spermatozoa extraction (TESE) followed by intracytoplasmic sperm injection (ICSI) using either fresh or cryopreserved testicular spermatozoa.

METHODS

We retrospectively evaluated 76 patients with non-mosaic KS belonging to a special group of cases that besides infertility did not present the classical signs and symptoms of testosterone deficiency. One of the patients repeated the TESE procedure (76 patients, 77 TESE cycles). Sixty of these 76 patients accepted to undergo TESE associated with ovarian stimulation, while 16 patients underwent TESE followed by testicular spermatozoa cryopreservation. Aneuploidy screening of the offspring was performed by Multiplex ligation-dependent probe amplification and by amniotic fluid karyotyping. Statistical analysis used the Chi-Squared Test, Fisher's Exact Test, 2-sided, for rates, and the Independent Samples T-test for equality of means, 2-sided.

RESULTS

Testicular spermatozoa were recovered in 31 (40.3%) of the attempts. The patients underwent 47 ICSI cycles, 25 with fresh testicular spermatozoa and 22 with cryopreserved testicular spermatozoa. Fertilization (63.5% vs. 41.6%, p=0.000), implantation (37% vs. 13.2%, p=0.014), clinical pregnancy (60.9% vs. 19%, p=0.005) and live birth (65.2% vs. 23.8%, p=0.006) rates were higher with fresh testicular spermatozoa. Chromosome analysis of the 21 newborns was normal.

CONCLUSIONS

The present data adds further information regarding the recovery rate of spermatozoa after TESE and the embryological and clinical outcomes with fresh and cryopreserved testicular spermatozoa, besides reassuring the safety concerning chromosomal transmission of KS from parents to their offspring.

173 Long Term Analysis of The Evolution of Practice and Results of Abdominal Wall Reconstruction by A Single Surgeon

Background

It is estimated that at least 12-15% of abdominal operations lead to incisional hernias, and Worldwide, evidence shows high rates of recurrence after surgical repair ranging from 12.7% in the Danish hernia registry to 23% in the Swedish registry.

Method

This is a retrospective analysis of the practice of a single surgeon at a tertiary centre. An electronic database provided all hernia surgeries done by the surgeon. A total of 185 patients with complete data were included who had open hernia repair. Electronic patient records were analysed to collect the data.

Results

185 patients, with a median age of 57 years (IQR 68 – 49), and BMI of 31.14 (IQR 36.02 – 27.52), had a hernia recurrence rate of 15.6% (29/185). More than 80% of the cases were complex hernias with a European Hernia classification of M3 and/ or W3, with dense intestinal adhesions and multiple previous repairs. Variability in techniques and mesh evolved over this period, from anterior component separation to transversus abdominis release to achieve closure of the abdomen. Polypropylene meshes were used for non-contaminated or less complex cases. The use of biologics in the early years has been superseded by biosynthetic.

Conclusions

The creation of the abdominal wall unit and subsequent MDT at this centre resulted in a rise of total procedures, complexity of cases and patients with significant co-morbidities. Specialised abdominal wall surgeons are associated with better results when performing complex abdominal wall reconstructions.

P–038 Clinical outcomes of 77 testicular sperm extraction treatment cycles in non-mosaic Klinefelter syndrome patients

Study question

What are the clinical results of patients with azoospermia and nonmosaic Klinefelter syndrome, using fresh and cryopreserved sperm?

Summary answer

The results showed a recovery rate of testicular sperm in the order of 40% and a life newborn rate of 52% when using fresh sperm

What is known already

In Klinefelter syndrome (KS), the rates of successful testicular sperm retrieval were shown to be similar either using conventional TESE or micro-TESE (Corona et al., 2017), which highlights that the variability observed between studies is due to differences in patient characteristics. There are a few works with a large number of KS patients elucidating the clinical outcomes using fresh and cryopreserved testicular sperm. However, these studies revealed contradictory outcomes, either revealing better (Greco et al., 2013; Vicdan et al., 2016) or worst (Madureira et al., 2014) results with cryopreserved testicular sperm, or finding no differences (Chen et al, 2019).

Study design, size, duration

This study includes all patients up to 2019 presenting azoospermia due to non-mosaic Klinefelter syndrome (n = 76) that went for infertility consultations in a private fertility clinic. Patients were evaluated by the same Urologist. The genetic analysis of the patients was performed at an academic institution. At examination patients did not refer other complaints besides infertility, and referred to have not received any hormone replacement therapy in the past.

Participants/materials, setting, methods

The 76 azoospermic patients with non-mosaic Klinefelter syndrome (KS) were treated by testicular sperm extraction (TESE) followed by intracytoplasmic sperm injection (ICSI), using fresh and cryopreserved testicular sperm. Most patients used fresh testicular sperm, where others preferred to postpone ICSI treatment cycles and used cryopreserved testicular sperm. Aneuploidy screening in children was performed by prenatal diagnosis and MLPA (Multiplex ligation-dependent probe amplification). Full embryological, clinical and newborn outcomes are provided.

Main results and the role of chance

Of the 76 patients with non-mosaic Klinefelter syndrome, one repeated the testicular sperm extraction (TESE) procedure. Testicular sperm were recovered in 31/77 (40.3%) of the cases. Comparisons between the 31 cases with successful sperm recover (group–1) and the 46 cases without a successful TESE (group–2) revealed no significant differences regarding age, time of infertility, testicular volume, serum levels of FSH, LH and testosterone, total number of testicular fragments analyzed, and time of search in samples. The mean male age was 34 years. In most of the cases, the testicular volume was reduced (96.1%), the levels of FSH (98.3%) and LH (94.1%) were increased, and the levels of testosterone were normal (77.6%). There were 25 intracytoplasmic sperm injection (ICSI) treatment cycles using fresh testicular sperm and 22 ICSI treatment cycles using frozen testicular sperm. The rates of fertilization (63.5% fresh sperm vs 41.6% frozen sperm), implantation (37% fresh sperm vs 13.2% frozen sperm), clinical pregnancy (60.9% fresh sperm vs 19% frozen sperm), live birth delivery (52.2% fresh sperm vs 19% frozen sperm) and newborn (65.2% fresh sperm vs 23.8% frozen sperm) were higher in the group using fresh testicular sperm. Chromosome analysis of the 21 newborn was normal.

Limitations, reasons for caution

Although presenting a high number of cases with azoospermic non-mosaic Klinefelter syndrome treated with testicular sperm extraction and intracytoplasmic sperm injection, future studies are needed with a higher number of cycles using frozen testicular sperm, in order to confirm or rebut that the freezing methodology affects negatively the clinical outcomes.

Wider implications of the findings: Data adds further information regarding testicular sperm retrieval rates and use of fresh or frozen testicular sperm in Klinefelter syndrome (KS) patients. High newborn rates were obtained only with fresh testicular sperm. Results also reassure KS patients about the safety relative to any abnormal chromosomal transmission to the born children.

Trial registration number

Not applicable

P–475 The mediator role of infertility-related psychological inflexibility in the relationship between infertility-stress domains and psychopathological symptoms

Study question

Does infertility-related psychological inflexibility play a role in the relationship between infertility-related stress domains and psychopathological symptoms (depression, anxiety)?

Summary answer

Infertility-related psychological inflexibility mediated the relationship between infertility-related stress domains and depression. There were no effects between infertility-related stress domains and anxiety symptoms.

What is known already

The emotional impact of infertility may include anxiety and depressive symptoms and these seem to be related to stress. Beliefs about the importance of parenthood (need for parenthood) and rejection of a childfree lifestyle, as well as the impact of infertility in several life areas (social, sexual, and relationship) are conceptually considered two infertility-related stress domains. Although the relationship between infertility-related stress and psychopathological symptoms has been previously recognized, the mechanism underlying this relationship remains undetermined. Psychological inflexibility has been pointed as a core transdiagnostic process contributing to the development and maintenance of several psychological difficulties.

Study design, size, duration

Cross-sectional study. Participants were recruited through the Associação Portuguesa de Fertilidade (patients’ association). Inclusion criteria were age (18 years or older) and an infertility medical diagnosis. Data were collected online through self-report instruments between June and December 2019. Participants/materials, setting, methods: A sample comprising 287 women pursuing infertility medical treatment (at different stages) completed online a sociodemographic questionnaire, the depression and anxiety subscales of the Depression, Anxiety and Stress Scales (DASS – 21), the Psychological Inflexibility Scale - Infertility (PIS-I), and the Fertility Problem Inventory (FPI). Descriptive and correlational analyses were computed through SPSS v. 26, and path analyses were estimated in AMOS (v. 24) with bootstrap procedures (2000 samples).

Main results and the role of chance

Correlation analyses revealed that FPI domains (importance of parenthood and impact on life domains), depressive and anxiety symptoms were significantly and positively associated with PIS-I. A mediation analysis was conducted to examine whether PIS-I mediated the effect of FPI domains on depressive and anxiety symptoms. Paths showing not to be statistically significant were removed. This model showed a good fit to the empirical data: χ2(4) = 1.59, p = .810, CMIN/DF = .40; TLI = 1.00; CFI = 1.00; RMSEA = .00, 95% CI = .00 to .06. The effect of the importance of parenthood on depressive symptoms revealed to be both direct (b = .03; SEb = .01; Z = 2.46; p = .014; β= .15) and partially mediated by the PIS-I (b = .31, 95% CI = .24 to .37, p = .018). The effect of the impact of infertility in several life areason depressive symptoms was fully mediated by PIS-I (b = .15, 95% CI = .10 to .21, p = .008). This model explained 43% of the total variance of depressive symptoms. No significant effects were found for anxiety symptoms.

Limitations, reasons for caution

Participants were at different stages of their fertility treatment. Data collection was completed online and this tends to recruit participants with more access to online platforms. Results rely on cross-sectional and self-report data.

Wider implications of the findings: Results suggest the relevance of targeting processes encompassing psychological inflexibility, such as cognitive fusion, experiential avoidance, conceptualized self, conceptualized past and future, lack of values clarity, and inability to commit with values-driven actions, in psychological interventions designed for women with infertility.

Trial registration number

N/A.

P–491 The mediator role of pain-related psychological inflexibility in the relationship between psychopathological symptoms and pain intensity in endometriosis

Study question

Does pain-related psychological inflexibility play a role in the relationship between psychopathological symptoms (depression, anxiety, stress) and pain intensity in women with endometriosis?

Summary answer

Pain-related psychological inflexibility acts as a mediator exclusively between depressive symptoms and pain intensity. Psychopathological symptoms did not reveal a direct effect on pain intensity.

What is known already

Endometriosis is a chronic and incapacitating condition frequently involving the experience of pain (e.g., dysmenorrhea, ovulation pain, dyspareunia, chronic pelvic pain). Women dealing with endometriosis may present impaired health-related quality of life and psychological distress, with depressive, anxiety, and stress symptoms being commonly reported. Pain-related psychological inflexibility involves emotion regulation processes, such as avoidance of pain and cognitive fusion with pain. Cognitive and behavioural processes influence the relationship between pain and psychopathological symptoms, and pain-related psychological inflexibility showed to be an underlying mechanism in this relationship.

Study design, size, duration

Cross-sectional study. Participants’ recruitment was completed through the Associação Portuguesa de Apoio a Mulheres com Endometriose and the Associação Portuguesa de Fertilidade (endometriosis and infertility patients’ associations). Inclusion criteria were age (18 years or older) and an endometriosis medical diagnosis (self-reported). Data collection occurred between February 2018 and May 2018.

Participants/materials, setting, methods

A sample encompassing 209 women with an endometriosis diagnosis completed online a sociodemographic questionnaire, the Depression, Anxiety and Stress Scales (DASS – 21), the Numeric Pain Rating Scale (NPRS), and the Psychological Inflexibility in Pain Scale (PIPS-PT). Descriptive and correlational analyses were carried out using SPSS v. 26, and path analyses were estimated in AMOS (v. 24) with bootstrap procedures (2000 samples).

Main results and the role of chance

Participants’ age ranged from 18 to 50 years old with a mean of 34.03 (SD = 6.44) years. The majority of participants were married (n = 112; 53.6%), followed by single (n = 54; 25.8%). Regarding years of education, a mean of 14.62 years (SD = 2.80) was found. Participants reported that their endometriosis diagnosis had been established for 4.55 years (SD = 4.56). Correlation analyses showed that depressive, anxiety and stress symptoms were significantly and positively associated with pain intensity and pain-related psychological inflexibility. A mediation analysis was conducted to examine whether pain-related psychological inflexibility mediated the effect of psychopathological symptoms on pain intensity. Paths showing not to be statistically significant were removed. The final model defining an effect of depressive symptoms on pain intensity mediated by pain-related psychological inflexibility explained 26% of the variance. This model showed a good fit to the empirical data: χ2(5) = 10.75, p = .057, CMIN/DF = 2.15; TLI = .98; CFI = .99; RMSEA = .07, 95% CI = .00 to .14. Depressive symptoms predicted elevated pain intensity fully through higher pain-related psychological inflexibility (b = .05; SEb = .01; Z = 8.45; p &lt; .001; β= .51).

Limitations, reasons for caution

Although path analysis is a powerful statistical technique, our findings rely on cross-sectional and self-report data. The study was disseminated through patients’ associations, limiting the inclusion of people who do get in touch with such organizations. Moreover, online recruitment tends to recruit participants with more access to online platforms.

Wider implications of the findings: Pain-related psychological inflexibility seems to be a relevant construct to be addressed in the psychological assessment of women dealing with endometriosis. Furthermore, results suggest the relevance of targeting emotion regulation processes, and not only focus on reducing pain, in pain management interventions.

Trial registration number

N/A.

P–042 Impact of semen parameters, sperm DNA fragmentation and sperm aneuploidy in male infertility

Study question

Should sperm aneuploidies and sperm DNA fragmentation (sDNAfrag) be included as valid tests in the routine investigation of male infertility?

Summary answer

Sperm DNA fragmentation was associated with male age, oligozoospermia (OZ), oligoteratozoospermia (OT), astenoteratozoospermia (AT) and oligoastenoteratozoospermia (OAT). Sperm aneuploidies were associated with OT and OAT.

What is known already

Semen parameters assist male infertility diagnosis and treatment, but sDNAfrag and aneuploidy analysis could add useful information, as abnormal values compromise fertility. To include these tests in the routine diagnosis it should be determined if behave as informative parameter and add information regarding the fertility status. For that, further studies comparing these tests to semen parameters are needed, since previous results are not consensual. Additionally, standardization of a sDNAfrag cut-off is needed, as different sample sizes and techniques originate distinct results. Also, until a standardization of the protocol is missing, a cut-off value should be defined for each laboratory.

Study design, size, duration

A retrospective and prospective investigation was performed, within a 12 years period (April 2007-December 2019). A total of 835 infertile males with a normal karyotype (46,XY) were included. Karyotyping and evaluation of sDNAfrag and sperm aneuploidies were made at a public Genetic unit. All normozoospermic (NZ) patients with a born child and patients whose infertility treatments were done due to female factors were selected from our database and used as controls (60 individuals).

Participants/materials, setting, methods

Semen analysis followed WHO–2010 guidelines. sDNAfrag was evaluated using the TUNEL assay. Sperm aneuploidies were detected using FISH (chromosomes 13, 18, 21, X, Y). Several tests were applied: correlations for linear associations between numerical variables, ANOVA for comparisons between means, Dunn-test for post-hoc comparisons. To determine the sDNAfrag cut-off value, the area under the ROC curve, sensitivity and specificity, were calculated, with the Youden-Index used to find a threshold that maximizes both sensitivity and specificity.

Main results and the role of chance

Regarding male age, it was observed a positive correlation with sperm concentration, a negative correlation with sperm vitality (VT) and hypoosmolality, and a positive correlation with sDNAfrag. Regarding sDNAfrag, it was observed negative correlation with sperm concentration, total progressive motility (TPM), morphology, VT and hypoosmolality. Regarding sperm aneuploidies, both total sperm aneuploidy and total sperm disomy exhibited a negative association with sperm concentration, TPM and morphology. It was also investigated whose groups of individuals could be indicated for sDNAfrag or sperm aneuploidy testing. The NZ group evidenced significant lower sDNAfrag, total sperm aneuploidy and total sperm disomy in relation to the non-NZ group. In the NZ group, sDNAfrag was significantly lower in relation to the OZ, OT, AT and OAT groups. The NZ group presented significant lower percentages of sperm aneuploidy in relation to the OT and OAT groups, and significant lower percentages of sperm disomy in relation to the OAT group. Additionally, sDNAfrag was positively correlated with total sperm aneuploidy and total sperm disomy. From the present large population, ROC curve analysis allowed estimating a cut-off value of 18.8% for the TUNEL-assay (sDNAfrag), with 0.658 of area under the curve, 53.9% sensitivity and 76.7% specificity.

Limitations, reasons for caution

Although presenting a high number of cases and strict controls, the present study was unable to include as controls healthy men with proven fertility. Additionally, the present study did not take into account life-style factors and male associated pathologies besides infertility.

Wider implications of the findings: Semen parameters were shown to be negatively correlated with sDNAfrag and sperm aneuploidies. As sDNAfrag testing and sperm aneuploidy testing were associated with semen abnormalities and male age, it is suggested their inclusion in the routine evaluation of infertile men, thus adding important complementary information about the fertility status.

Trial registration number

Not Appliable

POS0263 CLINICAL RELEVANCE OF DFS70 ANTIBODIES – A MULTICENTRE STUDY

Background:

Anti-Dense Fine Speckled 70 (DFS70), also known as lens epithelium-derived growth factor (LEDGF) is a common finding when ANA are positive (1.7% in the whole population and 4.6% in the ANA-positive samples). DFS70 antibodies are rare in SARD, especially in the absence of clinical evidence or concomitant anti-extractable nuclear antigen (ENA) antibodies.

Objectives:

Our study aimed to understand the meaning of anti-DFS70 antibodies and characterize the clinical and serological features of patients with anti-DFS70 positivity.

Methods:

We performed a retrospective observational study of consecutive patients followed up at 9 Portuguese Rheumatology Centres observed from January 2018 until April of 2020 with anti-DFS70 antibodies positivity. Descriptive statistics were presented as mean ± standard deviation if normally distributed or as median and interquartile range if non-normally distributed (continuous variables) or as absolute and relative frequencies (categorical variables). Sensibility and specificity were calculated. Positive and negative predictive values were calculated between patients with and without SARD-specific autoantibodies. Associations between DFS70 with other disease-specific antibody and clinical manifestations were tested using Chi-Square or Fischer’s Exact Test, as appropriate.

Results:

120 patients were included, 99 (82.5%) were female with a mean age of 47.8 ± 18.2 years. 96.7% of the patients had ANA titters ≥1:160 (32.5% 1:160; 38.3% 1:320; 16.7% 1:640; 7.5% 1:1280 and 1.7% 1:2560) and 3.3% ANA <1:160.

The main clinical reasons for ANA determination was arthralgia (44.2%), arthritis (11.6%) and Raynaud Phenomenon (RP) (10%). The main analytical reason (7.5%) was an elevation of inflammatory parameters (C-Reactive Protein (CRP) or Erythrocyte Sedimentation Rate (ESR), leukopenia (3.3%) and anaemia (2.5%). Concerning the immunology: 58.3% of patients didn´t have an associated antibody, 9.2% had a positive rheumatoid factor, 5.8% positive ds-DNA, 4.2% histone and 3.3% SS-A. 26 patients had more than one associated antibody.

30 (25%) patients were healthy; 43 (35.8%) patients had Systemic Autoimmune Rheumatic Diseases (SARD) and 47 patients (39.2%) had other diseases (non-SARD). Among patients with a SARD, 16 patients presented an isolated positive anti-DFS70 and 27 patients had other antibodies associated. There was found a positive association with non-SARD and arthralgia (p=0.001) and SARD with arthritis (p<0.001). There was an association with SARD and raised inflammatory parameters (p=0.045), but no association was found with anaemia (p=1.000) or leukopenia (p=0.131). Comparative analysis is described in Table 1, with chi-square or Fischer tests, as appropriated.

The sensitivity of isolated DFS70 was 70.1% and specificity was 62.8%. The positive predictive value was 77.1% and the negative predictive value was 54.0%.

Table 1.

Comparative analysis using chi-square or Fischer test

SARDNon-SARDp-valueArthralgia, n10430.001Arthritis, n140<0.001Raynaud Phenomenon, n750.114Raised Inflammation parameters, n630.045Anaemia, n121.000Leukopenia, n310.131

Conclusion:

We concluded that 64.2% of patients with positive DFS70 did not present a SARD and if we only consider patients with isolated anti-DFS70, 77.1% didn´t present a SARD. Therefore, in our study, 22.9% of the patients presented a SARD, which was associated with some clinical features like arthritis or raised inflammatory parameters (p<0.05). Although isolated anti-DFS70 are not specific of a particular condition, our study supports that it can be used as a negative predictor of SARD, if a correlation with clinical and laboratory features is made.

References:

[1]Leuchten, N. et al. Performance of Antinuclear Antibodies for Classifying Systemic Lupus Erythematosus: A systematic literature review and meta-regression of diagnostic data. Arthritis Care Res. 70, 428–438 (2018).

[2]Carter JB, Carter S, Saschenbrecker S, Goeckeritz BE (2018) Recognition and relevance of anti-DFS70 autoantibodies in routine antinuclear autoantibodies testing at a community hospital.

Disclosure of Interests:

None declared

POS0640 EFFECTIVENESS AND SAFETY OF ORIGINAL AND BIOSIMILAR ETANERCEPT IN bDMARD-NAÏVE PATIENTS IN A REAL-WORLD COHORT OF PORTUGAL

Background:

The patent expiration of the original etanercept in Europe has facilitated the development of biosimilar products. Non-significant differences in efficacy and safety were noted in clinical trials which are not expected to influence clinical performance. Nonetheless, daily practice data should be gathered to support the claim for biosimilarity.

Objectives:

To compare the effectiveness and safety of original and biosimilar etanercept, in biological-Disease Modifying Antirheumatic Drug (bDMARD)-naïve patients.

Methods:

A retrospective multicenter non-interventional study, using data collected prospectively from Reuma.pt (The Rheumatic Diseases Portuguese Register) was done, including patients with: age ≥ 18 years old; diagnosis of Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA) or Spondyloarthritis (SpA) (axial or peripheral); active disease who initiated treatment with etanercept as first line of biological treatment after 2010. Kaplan-Meyer was used to calculate the persistence rate in treatment. Disease activity at baseline and follow-up data at 6, 12, 18 and 24 months of treatment was compared using the chi-square for categorical variables and t-student or Mann-Whitney tests for continuous variables. Reasons for discontinuing therapy were summarized using descriptive statistics. Statistical significance was assumed for 2-sided p-values >0.05.

Results:

We included 1694 patients (413 on biosimilar and 1280 on original etanercept) 864 with RA, 335 with PsA and 494 with SpA. The population’s baseline characteristics were not significantly different among both groups, except concomitant treatment in RA (higher use of conventional DMARDs in biosimilar group and higher use of NSAIDs in original group) and in SpA patients (higher use of corticosteroids in original group).

At baseline, a higher joint count was found in patients treated with original etanercept with a statistical difference for swollen (p=0.03) and tender (p=0.01) joints count (SJC and TJC, respectively) in RA and in TJC in SpA patients (p=0.02). In RA patients, CDAI and SDAI were higher in patients who started original (p=0.03; p=0.04, respectively). Pain measured by visual analogic scale was higher in SpA patients treated with biosimilar (p=0.03).

The 3-year PR was not significantly different between both treatment groups in RA, PsA and SpA (Figure1). In RA, PR in biosimilar was 72.6%, with a median time-on-drug (TOD) of 28.3 months; for original etanercept PR was 63.6%, with a median TOD of 27.4 months (p=0.566). In PsA patients, the PR for biosimilar was 70.6%, with a median TOD of 27.6 months, and in original drug 67.0%, with a median TOD of 28.1 months (p=0.743). In SpA patients, the PR were 78.4% for biosimilar (median TOD of 27.4 months) and 71.5% for original treatment (median TOD of 28.0 months (p=0.816)).

Figure 1.

Drug survival in biosimilar and original etanercept in Rheumatoid Arthritis, Psoriatic Arthritis and Spondyloarthritis

In RA patients, we did not find differences between the two treatment groups for the proportion of patients in remission or low disease activity by CDAI ≤10, SDAI≤11 or DAS28 <3.2 at 6, 12, 18 and 24 months of treatment. For PsA, no differences were found in the same timelines for DAPSA≤14, DAS28<3.2, BASDAI<4, ASDAS<2.1 or PsARC response. Also, in SpA patients, no differences were found in BASDAI<4, BASFI<4, ASDAS<2.1, ASDAS response and BASDAI response in all the timelines with the exception of BASDAI response at 18 months, which was achieved in fewer patients in biosimilar therapy (p=0.02).

Overall, 535 (31.6%) patients stopped etanercept (428 patients on original and 107 patients on biosimilar). Discontinuations due to inefficacy were the most frequent, but there were no significant differences between both groups as for adverse events. Discontinuations due to “other reasons” were higher for the original group, both in RA (p=0.01) and in SpA (p=0.04).

Conclusion:

Biosimilar and original used as first-line biological treatment showed similar effectiveness and safety in our long-term cohort of patients with RA, PsA, and SpA

Disclosure of Interests:

None declared

Moderator role of self-compassion in the relationship between borderline features and suicide ideation in adolescents

Introduction

Borderline Personality Disorder (BPD) is an impairing disorder with distinct features such as instability in self-image, relationships and affect. Considering the developmental nature of BPD, borderline features are not rarely exhibited in adolescence. These features tend to be associated with depression and suicide ideation, as well as with a negative self-to-self relationship. Self-compassion has been consistently identified as a positive attitude with oneself when experiencing suffering.

Objectives

The aim of the current study was to explore the role of self-compassion in the relationship between borderline features and suicide ideation, when controlled depressive symptoms.

Methods

Sample was composed by 665 adolescents (58.5% females and 41.5% males), with a mean of 15.54 years of age (SD = 1.52), who completed self-report questionnaires. Data was analyzed using SPSS (version 23) and PROCESS Macro.

Results

showed that girls presented higher borderline features and suicide ideation and lower self-compassion compared to boys. The moderation model explained 66% of suicide ideation, with gender and depression as covariates. The interaction of borderline features and self-compassion had a unique and significant effect on suicide ideation, when controlled depression and gender. Adolescents with higher levels of borderline features and lower self-compassion presented significantly higher suicide ideation, compared to those with higher self-compassion.

Conclusions

These findings suggest that developing self-compassion in adolescents with evident borderline features might attenuate their tendency to think about committing suicide.

FRI0165 RISK OF CKD IN MEMBRANOUS AND PROLIFERATIVE LUPUS NEPHRITIS - ANALYSIS OF A NATIONWIDE MULTICENTRE COHORT

Background:

Lupus nephritis (LN) is one of the most severe manifestations of Systemic Lupus Erythematosus.

Objectives:

1) To compare proliferative (PLN), membranous (MLN) and mixed LN regarding clinical and laboratory presentation. 2) To investigate predictors of progression to chronic kidney disease (CKD).

Methods:

Multicentre observational study, with retrospective analysis of a prospective cohort, using data from the Portuguese registry of rheumatic diseases – Reuma.pt. Patients with biopsy-proven PLN, MLN and mixed LN were included. Groups were compared using Pearson’s Chi-Square for categorical variables and One-Way ANOVA or Kruskal-Wallis for numerical variables. COX regression analysis was used to investigate predictors of CKD (defined as estimated glomerular filtration rate [eGFR] lower than 60 mL/min/1.73m2for at least 3 months) and Kaplan-Meier curves were drawn.

Results:

236 patients were included. Median follow-up was 8 years (IQR 11; maximum 35 years). As seen in table 1, the level of proteinuria did not differ between groups; however, MLN patients presented with significantly lower serum creatinine. Levels of complement C3 and C4 were reduced in PLN but normal in MLN patients, and there were fewer patients with positive anti-dsDNA antibodies in the MLN group (p<0.001). On univariable COX regression, mixed histology was associated with progression to CKD (HR 26 [95% CI 3 - 255], p 0.005) (figure 1), however, it lost significance after adjusting for eGFR. In fact, eGFR≤75 at one year after the renal biopsy (HR 21 [95% CI 7 - 65], p<0.001) was the strongest predictor of CKD, even after adjusting for hypertension or histology.

Table 1.

Comparative description of the Reuma.pt cohort of patients with proliferative, membranous and mixed LN

PLNMLNMixedPTotal, N186428Females, N (%)157 (85)39 (95)4 (50)0.004EthnicityWhite European, N (%)163 (90)31 (78)7 (88)0.115Other, N (%)19 (10)9 (23)1 (13)Age LN diagnosis(y), median (IQR)30 (20)34 (16)42 (25)0.409SLEDAI at LN diagnosis, median (IQR)16 (9)10 (10)21 (17)0.006*uPCR at LN diagnosis, median (IQR)1675 (2598)1698 (2153)2160 (3320)0.629Creatinine at LN diagnosis, median (IQR)0.80 (0.32)0.70 (0.20)1.00 (0.95)0.006*eGFR at LN diagnosis, mean ± SD98 ± 33112 ± 1782 ± 450.019*Albumin at LN diagnosis, mean ± SD34 ± 734 ± 730 ± 60.390C3 at LN diagnosis, mean ± SD0.65 ± 0.260.90 ± 0.350.53 ± 0.30<0.001*Positive anti-dsDNA LN diagnosis, N (%)115 (91)11 (48)6 (86)<0.001*Use of antimalarials, N (%)166 (94)36 (92)8 (100)0.688Use of immunosuppressants, N (%)163 (94)33 (87)8 (100)0.245Use of corticosteroids, N (%)145 (84)33 (85)7 (100)0.511CKD after LN diagnosis, N (%)27 (15)1 (3)3 (38)0.018*ESRD, N (%)7 (4)1 (3)2 (25)0.016Deaths, N (%)14 (8)2 (5)00.610

uPCR: urinary protein-creatinine ratio, mg/g; y: years; Creatinine presented in mg/dL, eGFR in mL/min/1.73m2,albumin in g/L and C3 in g/L

Note: Baseline data (LN diagnosis) in grey; other data refer to the course of disease

*Significant difference between the proliferative and membranous groups

Figure 1.

Kaplan-Meir curves showing cumulative survival free of CKD in patients with PLN, MLN and mixed LN

Conclusion:

Our results support previous findings from single-centre studies suggesting that MLN has a different serological profile than PLN, possibly reflecting different pathogenesis. Renal function at one year predicts long-term outcome in LN.

Disclosure of Interests:

Filipa Farinha: None declared, Sofia C Barreira: None declared, Maura Couto: None declared, Margarida Cunha: None declared, Diogo Fonseca: None declared, Raquel Freitas: None declared, Luís Inês: None declared, Mariana Luis: None declared, Carla Macieira: None declared, Ana Rita Prata: None declared, Joana Rodrigues: None declared, Bernardo Santos: None declared, Rita Pinheiro Torres: None declared, Ruth J. Pepper: None declared, Anisur Rahman: None declared, Maria Jose Santos Speakers bureau: Novartis and Pfizer

Self-compassion, Well-being and Health in Elderly: Are there Related?

Introduction

The increase in aging population is a major advance in society, but also a great challenge, imposing the need for actions that promote successful aging, with higher subjective well-being and better health.

Objectives

(1) analyse the possible influence of socio-demographic variables in self-compassion, satisfaction with life, affection, physical and mental health (study variables); (2) understand how is that the study variables are associated with each other in old age; and (3) explore which variables best predict satisfaction with life and health in the elderly.

Method

The study sample consists of 155 individuals, aged between 65 and 94 years old, institutionalised and non-institutionalised.

Results

(1) significant correlations were found between some demographic and the study variables. (2) Significant associations were also found between self-compassion, subjective well-being and health. (3) linear regression analysis revealed that physical health is best predicted by greater life satisfaction and lower age; mental health is best predicted by increased satisfaction with life, self-compassion and decreased negative affect; and, finally, life satisfaction is predicted by a higher physical health and self-compassion.

Conclusions

These results suggest the importance of developing psychological skills such as warmth, tolerance and the acceptance of suffering bearing in mind that the elderly may experience difficulties resulting from the developmental characteristics of old age. Our findings suggest the possible beneficial effect of compassion, focused therapies designed for this specific population, particularly contributing to the promotion of life satisfaction and mental health of the Portuguese elderly.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

The impact of the economic crisis on the mental health of Portuguese primary-school children

Objective

To measure the impact of the economic crisis on the mental health correlates of Portuguese children attending primary school during 2016.

Methods

Cross-sectional analysis of primary school-aged children and their parents (n = 1157), conducted in public and private schools of three Portuguese districts. Parent reports of children mental health symptoms (Strengths and Difficulties Questionnaire - SDQ) and children self-reports of health-related quality of life (KIDSCREEN-27) and depressive, anxiety and stress symptoms (Depression, Anxiety and Stress Scales, Children version - DASS-C), were compared according to a set of yes/no questions on how the economic crisis changed the normal aspects of routine life (e.g. During the financial crisis did you had to use savings? Started buying cheaper food?). Linear regression models were fitted for the SDQ, the KIDSCREEN-27 and the DASS-C as dependent variables adjusted for children sex, socioeconomic status and district of residence.

Results

Affirmative answers to the crisis impact questions were associated with more frequent psychosocial functioning problems in children, with poorer self-reported health-related quality of life and with more frequent symptoms of depression, anxiety and stress.

Conclusions

Portuguese children mental health correlates show significant worse scores for those whose parents declared having to change daily routine habits as a result of the recent macroeconomic financial crisis, compared to those who did not change habits. Public Health programs should be developed to mitigate the potential negative impact of the financial crisis to the mental health of children.

Key messages

A negative impact on children mental health was observed as a result of the economic crisis. Public health programs designed to mitigate the impact of the economic crisis should include primary-school aged children.

Mytilus galloprovincialis CYP1A-like mRNAs reveal closer proximity of mytilid CYP1A to the eumetazoan CYP2 family

Due to the role of Cytochrome P450, Family 1, Subfamily A (CYP1A) in the detoxification of many polycyclic aromatic hydrocarbons (PAHs), there has been an effort to characterise the gene and the products from its expression in organisms that are relevant for biomonitoring and toxicity testing procedures. Nonetheless, the existence of functional homologues in aquatic invertebrates is not entirely consensual, especially in bivalve molluscs, which pose as one of the most important models for aquatic toxicologists, especially mytilids. After isolation and sequencing of CYP1A-like mRNA from the Mediterranean mussel, Mytilus galloprovincialis, phylogenetics incorporating homologues from molluscs and other eumetazoans, vertebrates included, yielded notorious similarity to sequences belonging to the CYP2 Family. Altogether, the findings further indicate that CYP1A-like CYPs may be absent in bivalves, in lieu of Families CYP2, 3 and 4, suggesting caution when interpreting data from common biomarkers of exposure to aromatic hydrocarbons that have been developed for CYP1A activity and expression in higher deuterostomes.

Oral feeding of Lactobacillus bulgaricus N45.10 inhibits the lung inflammation and airway remodeling in murine allergic asthma: Relevance to the Th1/Th2 cytokines and STAT6/T-bet

Asthma is a chronic disease with impacts on public health. It affects the airways causing pulmonary inflammation mediated by CD4 T cells type Th2, eosinophilia, mucus hypersecretion, and elevated IgE. The unbalance between cytokines and transcription factors is an important feature in asthma. Probiotics has gaining highlight as a therapy for chronic diseases. Thus, we investigate the Lactobacillus bulgaricus (Lb) effect in murine allergic asthma. BALB/c-mice were sensitized to ovalbumin (OA) on days 0 and 7 and were challenged from day 14-28 with OA. Mice received Lb seven days prior to sensitization and it was kept until day 28. The Lb attenuated the eosinophils infiltration, mucus and collagen secretion, IgE production, pro-inflammatory cytokines, TLR4 expression, GATA3, STAT6 and RORγt in lung. Otherwise, Lb increased the anti-inflammatory cytokines, the T-bet and foxp3. Finally, Lb attenuated the allergic asthma-induced inflammation and airway remodeling by interfering on Th1/Th2 cytokines and STAT6/T-bet transcription factors.

Carbonic anhydrases are involved in mitochondrial biogenesis and control the production of lactate by human Sertoli cells

The process that allows cells to control their pH and bicarbonate levels is essential for ionic and metabolic equilibrium. Carbonic anhydrases (CAs) catalyse the conversion of CO₂ to HCO 3 - and H⁺ and are thus essential for this process. Herein, we inhibited CAs with acetazolamide - ACT and SLC-0111 - to study their involvement in the metabolism, mitochondrial potential, mitochondrial biogenesis and lipid metabolism of human Sertoli cells (hSCs), obtained from biopsies from men with conserved spermatogenesis. We were able to identify three isoforms of CAs, one mitochondrial isoform (CA VB) and two cell membrane-bound isoforms (CA IX and CA XII) in hSCs. When assessing the expression of markers for mitochondrial biogenesis, we observed a decrease in HIF-1α, SIRT1, PGC1α and NRF-1 mRNAs after all CAs were inhibited, resulting in decreased mitochondrial DNA copy numbers. This was followed by an increased production of lactate and alanine in the same conditions. In addition, consumption of glucose was maintained after inhibition of all CAs in hSCs. These results indicate a reduced conversion of pyruvate to acetyl-coA, possibly due to decreased mitochondrial function, caused by CA inhibition in hSCs. Inhibition of CAs also caused alterations in lipid metabolism, since we detected an increased expression of hormone-sensitive lipase (HSL) in hSCs. Our results suggest that CAs are essential for mitochondrial biogenesis, glucose and lipid metabolism in hSCs. This is the first report showing that CAs play an essential role in hSC metabolic dynamics, being involved in mitochondrial biogenesis and controlling lactate production.

The 'Woman in Red' effect: pipefish males curb pregnancies at the sight of an attractive female

In an old Gene Wilder movie, an attractive woman dressed in red devastated a man's current relationship. We have found a similar 'Woman in Red' effect in pipefish, a group of fish where pregnancy occurs in males. We tested for the existence of pregnancy blocks in pregnant male black-striped pipefish (Syngnathus abaster). We allowed pregnant males to see females that were larger and even more attractive than their original high-quality mates and monitored the survival and growth of developing offspring. After exposure to these extremely attractive females, males produced smaller offspring in more heterogeneous broods and showed a higher rate of spontaneous offspring abortion. Although we did not observe a full pregnancy block, our results show that males are able to reduce investment in current broods when faced with prospects of a more successful future reproduction with a potentially better mate. This 'Woman in Red' life-history trade-off between present and future reproduction has similarities to the Bruce effect, and our study represents, to our knowledge, the first documentation of such a phenomenon outside mammals.

Y-chromosome microdeletions in nonobstructive azoospermia and severe oligozoospermia

The aim of the present work was to present the outcomes of the patients with Y-chromosome microdeletions treated by intracytoplasmic sperm injection (ICSI), either using fresh (TESE) or frozen-thawed (TESE-C) testicular sperm and ejaculated sperm (EJAC). The originality of this work resides in the comparisons between the different types of Y-microdeletions (AZFa, AZFb, and AZFc) and treatments, with detailed demographic, stimulation, embryological, clinical, and newborn (NB) outcomes. Of 125 patients with Y-microdeletions, 33 patients presented severe oligozoospermia (18 performed ICSI with ejaculated sperm) and 92 secretory azoospermia (65 went for TESE with 40 having successful sperm retrieval and performed ICSI). There were 51 TESE treatment cycles and 43 TESE-C treatment cycles, with a birth of 19 NB (2 in AZFa/TESE-C, 12 in AZFc/TESE, and 5 in AZFc/TESE-C). Of the 29 EJAC cycles, there was a birth of 8 NB (in AZFc). In TESE and EJAC cycles, there were no significant differences in embryological and clinical parameters. In TESE-C cycles, there was a significant lower oocyte maturity rate, embryo cleavage rate and mean number of embryos transferred in AZFb, and a higher mean number of oocytes and lower fertilization rate in AZFc. In conclusion, although patients with AZFc microdeletions presented a high testicular sperm recovery rate and acceptable clinical outcomes, cases with AZFa and AZFb microdeletions presented a poor prognosis. Due to the reported heredity of microdeletions, patients should be informed about the infertile consequences on NB and the possibility of using preimplantation genetic diagnosis for female sex selection.

Epiphytic fungal community in Vitis vinifera of the Portuguese wine regions

In this work, fungi present in the grapevine's phyllosphere collected from the main demarcated wine regions of Portugal were identified, and their phylogenetic relationships were analysed. A total of 46 vine samples (leaves and berries) were collected from different parts of the country, being isolated a total of 117 fungal colonies that were identified to the genus level and sequenced in the following genetic regions: internal transcribed spacer region and 18S rRNA and β-tubulin gene. Next, a phylogenetic tree reconstruction for each genetic region was built. The isolates retrieved from environmental samples belonged to the genera Alternaria (31%), Cladosporium (21%), Penicillium (19%), Aspergillus (7%) and Epicoccum (3%). No genetic signatures of exchange of genetic material were detected, and consequently, the reconstructed phylogenetic trees allowed to distinguish between these different species/genera. In the fungal composition of the Vitis vinifera phyllosphere, several potential pathogens were identified that can be associated with decreases in crop productivity. Knowledge of fungi identification and genetic diversity is pivotal for the development of more adequate crop management strategies. Furthermore, this information will provide guidelines for a more specific and wiser use of fungicides.

SIGNIFICANCE AND IMPACT OF THE STUDY

The knowledge on the composition of the phyllosphere microbial community is still limited, especially when fungi are concerned. These micro-organisms not only play a crucial role in crop health and productivity but also interact with the winemaking process, determining the safety and quality of grape and grape-derived products. The elucidation of the micro-organisms present in the phyllosphere will have a notorious impact on plant breeding and protection programmes and disease management strategies, allowing a better control of pesticide applications.

Assessment of test anxiety in Portuguese adolescents: Psychometric properties of the Cognitive Test Anxiety Revised

Introduction

Test anxiety represents a considerable personal burden due to its interfering nature and is associated with a range of deleterious life trajectories, encompassing school difficulties and health consequences. Although test anxiety seems to be highly prevalent and the pathological symptoms are similar to those of other childhood anxiety disorders, there are specificities that deserve a more in-depth approach. Given that adolescents seem to experience test anxiety in several school grades there is a need for a valid and reliable scale to measure test anxiety in school age students.

Objective

This study aims to adapt and analyse the psychometric properties of the Cognitive Test Anxiety Revised (CTAR25) for Portuguese adolescents. In addition, the convergent and divergent validities were examined with related constructs.

Methods

Participants were 279 adolescents, with ages between 12 and 19 years old, attending middle and high schools. Together with CTAR25, participants also filled out self-report questionnaires assessing tests anxiety (TAI), self-esteem (RSES), procrastination (QPE) and worry (PSWQ-C).

Results

The scale showed good internal consistency, good test-retest reliability, and good validity. Factor analysis revealed the existence of two factors with good internal consistency.

Discussion

Results showed that the Portuguese version of CTAR-25 is a valid and reliable self-report instrument for the assessment of test anxiety in adolescents, replicating the findings of the original version.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Sperm donation and surrogacy from a male perspective

Introduction

Societal changes in the last decades led to the arise of new paradigms on gender equity. Studies addressing fertility/infertility issues have been conducted mainly in women and in this research area, male partners have deserved less attention. More recently there has been a major focus on the idea that fertility/infertility aspects have to be conceptualized from a couples’ perspective.

Goals

The current study sought to explore attitudes towards gamete donation and surrogacy in a sample of young men in reproductive age.

Methods

A total of 111 males with ages ranging from 18 to 40 years old and without children completed an online questionnaire addressing attitudes towards gamete donation and surrogacy.

Results

The majority of participants (77.3%) would be willing to donate their sperm, and their main motivation for doing that would be to feel “happy to help a couple struggling to have a child”. Participants stated that the likelihood of donating would increase if they were able to attend counseling, to complete the procedure in an IVF center located in their residence area, and being provided with more information about infertility. Regarding surrogacy 82% are in favor of this procedure legalization and 49.5% would be willing to use it if they needed.

Conclusion

Men showed a positive attitude towards sperm donation and surrogacy, emphasizing the importance of counseling and information availability on these topics. This may suggest that they are willing to get involved when fertility issues are addressed.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Compassionate Attributes and Action Scale for adolescents: Adaptation and validation

Introduction

Compassion can be defined as an intentional sensitivity to the suffering, with a motivation and commitment to try to relieve it, which can have a positive impact on individuals’ emotional and psychological well-being. The relevance of compassion focused therapies is well established and this makes the development of reliable instruments for the assessment of the different facets of compassion targeting different age groups crucial for research and clinical practice. The Compassionate Attributes and Actions Scale (CAAS) aims to assess compassion on three directions: self-compassion, compassion for others or compassion received from others. Each of the scales assesses one's compassionate attributes and compassionate actions separately when dealing with difficult or painful situations.

Objective/aim

This study aimed to adapt the CAAS for adolescents and to explore its factor structure and psychometric properties in a sample of Portuguese adolescents.

Methods

A total of 336 Portuguese adolescents with ages ranging from 12 to 19 years old participated in the study. Several exploratory factor analyses were conducted.

Results

Exploratory factor analysis showed that, except for the attributes section of the self-compassion scale (that showed to be bi-factorial), all the other scales (and their sections) presented a single-factor structure. The three scales, and its sections, demonstrated a good reliability and excellent test-retest reliability and good convergent and discriminant validity.

Conclusion

Results were in line with the factor structure found in the adults’ version. The scales and its sections have shown good psychometric characteristics and constitute a useful instrument to assess and investigate the three directions of the compassion.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Assessing Obsessive-compulsive Symptoms: The Portuguese Version of the Padua Inventory

Introduction

Self-report instruments are useful tools for the assessment of psychopathological symptoms such as obsessive-compulsive symptoms. The Padua Inventory (PI) is a measure that has been widely used in clinical and research settings and studied in several countries.

Objectives

This study explores the psychometric properties and factor structure of the Portuguese version of the PI.

Methods

Translation and translation-back of the original version were executed. A total of 847 participants (468 women and 379 men) from the general population was recruited through a snowball procedure and completed the PI and other mental health measures. The data set was randomly split in order to conduct principal component analysis (PCA) and confirmatory factor (CFA) analysis in two different samples. Moreover, internal consistency, convergent and discriminant validity and test-retest reliability analyses were conducted.

Results

From the PCA analysis four factors emerged, comprising clusters of items related to doubting/impaired control over mental activities, contamination/washing/cleaning, checking and worries about losing control over motor behaviors. CFA results revealed that the model presented a poor fit to the data and indicated that the model would benefit from the establishment of correlations between pairs of error terms of items with identical contents. The PI exhibited excellent internal consistency, good test-retest reliability and good convergent and discriminant validity.

Conclusions

The PI Portuguese version showed a similar factor structure to the one presented in other studies and revealed good psychometric properties. Nevertheless, results from the CFA suggest that shortening the PI may be advantageous.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

[Predictive value of cerebellar growth and general movements assessments for neurodevelopment of very preterm infants at 18-24 months' corrected age]

INTRODUCTION

Fidgety movements assessments is very sensitive predicting long-term outcome or cerebral palsy of preterm, disrupted cerebellar growth has been reported in these patients.

AIM

To compare the predictive value of cerebellar ultrasound growth and fidgety movements assessments, for neurodevelopment outcome of very preterm at 18-24 month's corrected age (CA).

SUBJECTS AND METHODS

Prospective study of 88 infants cohort (<= 32 weeks' gestation), transverse cerebellar diameter was obtained by ultrasound via mastoid fontanel, in a weekly basis, until 40 weeks CA. Fidgety movements were assessed at 3 months CA. Neurodevelopment outcome at 18-24 month's CA was evaluated in 68 using Schedule of Growing Skills II Scale (SGS-II) and Amiel-Tison Neurologic Assessment (ATNA).

RESULTS

At term age, cerebellar growth was under 3rd percentile in 11 (10.3%). Fidgety movements were normal in 42 (61.8%) and abnormal or absent in 7 (10.3%). At 18-24 months CA, 54 (79.4%) were normal by the SGS-II and in 6 (8.8%) ATNA classified as cerebral palsy. Cerebellar diameter under 3rd percentile at term was associated with abnormal motor outcome and normal fidgety movements correlated with normal neurodevelopment.

CONCLUSION

Ultrasound cerebellar measurements and functional examinations (fidgety movements) have important complementary roles in predicting neurodevelopment of very preterm.

NanOx, a new model to predict cell survival in the context of particle therapy

Particle therapy is increasingly attractive for the treatment of tumors and the number of facilities offering it is rising worldwide. Due to the well-known enhanced effectiveness of ions, it is of utmost importance to plan treatments with great care to ensure tumor killing and healthy tissues sparing. Hence, the accurate quantification of the relative biological effectiveness (RBE) of ions, used in the calculation of the biological dose, is critical. Nevertheless, the RBE is a complex function of many parameters and its determination requires modeling. The approaches currently used have allowed particle therapy to thrive, but still show some shortcomings. We present herein a short description of a new theoretical framework, NanOx, to calculate cell survival in the context of particle therapy. It gathers principles from existing approaches, while addressing some of their weaknesses. NanOx is a multiscale model that takes the stochastic nature of radiation at nanometric and micrometric scales fully into account, integrating also the chemical aspects of radiation-matter interaction. The latter are included in the model by means of a chemical specific energy, determined from the production of reactive chemical species induced by irradiation. Such a production represents the accumulation of oxidative stress and sublethal damage in the cell, potentially generating non-local lethal events in NanOx. The complementary local lethal events occur in a very localized region and can, alone, lead to cell death. Both these classes of events contribute to cell death. The comparison between experimental data and model predictions for the V79 cell line show a good agreement. In particular, the dependence of the typical shoulders of cell survival curves on linear energy transfer are well described, but also the effectiveness of different ions, including the overkill effect. These results required the adjustment of a number of parameters compatible with the application of the model in a clinical scenario thereby showing the potential of NanOx. Said parameters are discussed in detail in this paper.

Assessing soil erosion risk using RUSLE through a GIS open source desktop and web application

Soil erosion is a serious environmental problem. An estimation of the expected soil loss by water-caused erosion can be calculated considering the Revised Universal Soil Loss Equation (RUSLE). Geographical Information Systems (GIS) provide different tools to create categorical maps of soil erosion risk which help to study the risk assessment of soil loss. The objective of this study was to develop a GIS open source application (in QGIS), using the RUSLE methodology for estimating erosion rate at the watershed scale (desktop application) and provide the same application via web access (web application). The applications developed allow one to generate all the maps necessary to evaluate the soil erosion risk. Several libraries and algorithms from SEXTANTE were used to develop these applications. These applications were tested in Montalegre municipality (Portugal). The maps involved in RUSLE method-soil erosivity factor, soil erodibility factor, topographic factor, cover management factor, and support practices-were created. The estimated mean value of the soil loss obtained was 220 ton km(-2) year(-1) ranged from 0.27 to 1283 ton km(-2) year(-1). The results indicated that most of the study area (80 %) is characterized by very low soil erosion level (<321 ton km(-2) year(-1)) and in 4 % of the studied area the soil erosion was higher than 962 ton km(-2) year(-1). It was also concluded that areas with high slope values and bare soil are related with high level of erosion and the higher the P and C values, the higher the soil erosion percentage. The RUSLE web and the desktop application are freely available.

Revisiting the Term Neuroprotection in Chronic and Degenerative Diseases

Thanks to the development of several new researches, the lifetime presented a significant increase, even so, we still have many obstacles to overcome - among them, manage and get responses regarding neurodegenerative diseases. Where we are in the understanding of neuroprotection? Do we really have protective therapies for diseases considered degeneratives such as amyotrophic lateral sclerosis and its variants, Parkinson's disease, Alzheimer's disease and many others? Neuroprotection is defined by many researches as interactions and interventions that can slow down or even inhibit the progression of neuronal degeneration process. We make some considerations on this neuroprotective effect.