Potential cellular targets of platinum in the freshwater microalgae Chlamydomonas reinhardtii and Nitzschia palea revealed by transcriptomics

Platinum group element levels have increased in natural aquatic environments in the last few decades, in particular as a consequence of the use of automobile catalytic converters on a global scale. Concentrations of Pt over tens of μg L-1 have been observed in rivers and effluents. This raises questions regarding its possible impacts on aquatic ecosystems, as Pt natural background concentrations are extremely low to undetectable. Primary producers, such as microalgae, are of great ecological importance, as they are at the base of the food web. The purpose of this work was to better understand the impact of Pt on a cellular level for freshwater unicellular algae. Two species with different characteristics, a green alga C. reinhardtii and a diatom N. palea, were studied. The bioaccumulation of Pt as well as its effect on growth were quantified. Moreover, the induction or repression factors of 16 specific genes were determined and allowed for the determination of possible intracellular effects and pathways of Pt. Both species seemed to be experiencing copper deficiency as suggested by inductions of genes linked to copper transporters. This is an indication that Pt might be internalized through the Cu(I) metabolic pathway. Moreover, Pt could possibly be excreted using an efflux pump. Other highlights include a concentration-dependent negative impact of Pt on mitochondrial metabolism for C. reinhardtii which is not observed for N. palea. These findings allowed for a better understanding of some of the possible impacts of Pt on freshwater primary producers, and also lay the foundations for the investigation of pathways for Pt entry at the base of the aquatic food web.

Head circumference at birth and postnatal growth trajectory in vulnerable groups from Argentina

OBJECTIVES

To investigate the association between the anthropometric status at birth and brain and bone growth during the first year of life. According to the brain-sparing hypothesis, we expect catch-up to be faster in head circumference (HC) than in body length.

METHODS

This is a longitudinal design that included Argentinian infants under 12 months of age with at least three anthropometric records. We classified study participants into four growth status categories according to z-scores for HC (HCZ) and length (LAZ) at birth, with z-score = -2 as a threshold. We used the Count model to describe growth trajectories in HC and length in the first year of life according to the growth status at birth. Recovery indicator for HC and length was taken as the time until the predicted growth trajectory surpassed the threshold curve predicted by z-score = -2 for age.

RESULTS

Growth models included 3399 infants. There were significant differences in the growth parameters between groups in all cases (p < 0.05). Within the group with a low HCZ and a low LAZ at birth, HC recovery was faster than length. In the case of a low z-score for only one of the variables, newborns with a low HCZ recovered faster than individuals born with a low LAZ.

CONCLUSIONS

The postnatal growth pattern in HC and length is associated with the growth status of HC and length at birth. As we hypothesized, the fastest postnatal recovery occurs for HC in cases of intrauterine delayed growth.

Drug Permeability - Best Practices for Biopharmaceutics Classification System (BCS)-Based Biowaivers: A workshop Summary Report

The workshop "Drug Permeability - Best Practices for Biopharmaceutics Classification System (BCS) Based Biowaivers" was held virtually on December 6, 2021, organized by the University of Maryland Center of Excellence in Regulatory Science and Innovation (M-CERSI), and the Food and Drug Administration (FDA). The workshop focused on the industrial, academic, and regulatory experiences in generating and evaluating permeability data, with the aim to further facilitate implementation of the BCS and efficient development of high-quality drug products globally. As the first international permeability workshop since the BCS based biowaivers was finalized as the ICH M9 guideline, the workshop included lectures, panel discussions, and breakout sessions. Lecture and panel discussion topics covered case studies at IND, NDA, and ANDA stages, typical deficiencies relating to permeability assessment supporting BCS biowaiver, types of evidence that are available to demonstrate high permeability, method suitability of a permeability assay, impact of excipients, importance of global acceptance of permeability methods, opportunities to expand the use of biowaivers (e.g. non-Caco-2 cell lines, totality-of-evidence approach to demonstrate high permeability) and future of permeability testing. Breakout sessions focused on 1) in vitro and in silico intestinal permeability methods; 2) potential excipient effects on permeability and; 3) use of label and literature data to designate permeability class.

Micro-CT Imaging and Morphometric Analysis of Mouse Neonatal Brains

Neuroimages are a valuable tool for studying brain morphology in experiments using animal models. Magnetic resonance imaging (MRI) has become the standard method for soft tissues, although its low spatial resolution poses some limits for small animals. Here, we describe a protocol for obtaining high-resolution three-dimensional (3D) information on mouse neonate brains and skulls using micro-computed tomography (micro-CT). The protocol includes those steps needed to dissect the samples, stain and scan the brain, and obtain morphometric measurements of the whole organ and regions of interest (ROIs). Image analysis includes the segmentation of structures and the digitization of point coordinates. In sum, this work shows that the combination of micro-CT and Lugol's solution as a contrast agent is a suitable alternative for imaging the perinatal brains of small animals. This imaging workflow has applications in developmental biology, biomedicine, and other sciences interested in assessing the effect of diverse genetic and environmental factors on brain development.

Robust biomarker discovery through multiplatform multiplex image analysis of breast cancer clinical cohorts

Spatial profiling of tissues promises to elucidate tumor-microenvironment interactions and enable development of spatial biomarkers to predict patient response to immunotherapy and other therapeutics. However, spatial biomarker discovery is often carried out on a single patient cohort or imaging technology, limiting statistical power and increasing the likelihood of technical artifacts. In order to analyze multiple patient cohorts profiled on different platforms, we developed methods for comparative data analysis from three disparate multiplex imaging technologies: 1) cyclic immunofluorescence data we generated from 102 breast cancer patients with clinical follow-up, in addition to publicly available 2) imaging mass cytometry and 3) multiplex ion-beam imaging data. We demonstrate similar single-cell phenotyping results across breast cancer patient cohorts imaged with these three technologies and identify cellular abundance and proximity-based biomarkers with prognostic value across platforms. In multiple platforms, we identified lymphocyte infiltration as independently associated with longer survival in triple negative and high-proliferation breast tumors. Then, a comparison of nine spatial analysis methods revealed robust spatial biomarkers. In estrogen receptor-positive disease, quiescent stromal cells close to tumor were more abundant in good prognosis tumors while tumor neighborhoods of mixed fibroblast phenotypes were enriched in poor prognosis tumors. In triple-negative breast cancer (TNBC), macrophage proximity to tumor and B cell proximity to T cells were greater in good prognosis tumors, while tumor neighborhoods of vimentin-positive fibroblasts were enriched in poor prognosis tumors. We also tested previously published spatial biomarkers in our ensemble cohort, reproducing the positive prognostic value of isolated lymphocytes and lymphocyte occupancy and failing to reproduce the prognostic value of tumor-immune mixing score in TNBC. In conclusion, we demonstrate assembly of larger clinical cohorts from diverse platforms to aid in prognostic spatial biomarker identification and validation.

Relaxation of thoracic aorta and pulmonary artery rings of marmosets (Callithrix spp.) by endothelium-derived 6-nitrodopamine

6-Nitrodopamine is a novel catecholamine released by vascular tissues, heart, and vas deferens. The aim of this study was to investigate whether 6-nitrodopamine is released from the thoracic aorta and pulmonary artery rings of marmosets (Callithrix spp.) and to evaluate the relaxing and anti-contractile actions of this catecholamine. Release of 6-nitrodopamine, dopamine, noradrenaline, and adrenaline was assessed by liquid chromatography with tandem mass spectrometry (LC-MS/MS). The relaxations induced by 6-nitrodopamine and by the selective dopamine D2 receptor antagonist L-741,626 were evaluated on U-46619 (3 nM)-pre-contracted vessels. The effects of 6-nitrodopamine and L-741,626 on the contractions induced by electric-field stimulation (EFS), dopamine, noradrenaline, and adrenaline were also investigated. Both aorta and pulmonary artery rings exhibited endothelium-dependent release of 6-nitrodopamine, which was significantly reduced by the NO synthesis inhibitor L-NAME. Addition of 6-nitrodopamine or L-741,626 caused concentration-dependent relaxations of both vascular tissues, which were almost abolished by endothelium removal, whereas L-NAME and the soluble guanylate cyclase inhibitor ODQ had no effect on 6-nitrodopamine-induced relaxations. Additionally, pre-incubation with 6-nitrodopamine antagonized the dopamine-induced contractions, without affecting the noradrenaline- and adrenaline-induced contractions. Pre-incubation with L-741,626 antagonized the contractions induced by all catecholamines. The EFS-induced contractions were significantly increased by L-NAME, but unaffected by ODQ. Immunohistochemical assays showed no immunostaining of the neural tissue markers S-100 and calretinin in either vascular tissue. The results indicated that 6-nitrodopamine is the major catecholamine released by marmoset vascular tissues, and it acts as a potent and selective antagonist of dopamine D2-like receptors. 6-nitrodopamine release may be the major mechanism by which NO causes vasodilatation.

Characterization of the tilt (tt) phenotype in Drosophila melanogaster

In the early 20th century, Calvin Bridges and Thomas Morgan identified a number of spontaneous mutations that displayed visible phenotypes in adult flies and subsequent analysis of these mutations over the past century have provided fundamental insights into subdisciplines of biology such as genetics, developmental, and cell biology. One of the mutations they identified in 1915 was named tilt ( tt ) and was described by Bridges and Morgan as having two visible phenotype characteristics in the wing. The wings were "held out at a wider angle from the body" and had a break in wing vein L3. Subsequent analysis of the tilt phenotype identified another phenotype: the wings were missing a varying number of campaniform sensilla on L3. Though Bridges and Morgan provided an ink drawing of the wing posture phenotype, only the vein and campaniform sensilla loss images have been published. Here we confirm and document the tilt phenotypes that have been previously described. We also show the penetrance of these phenotypes: the vein break and the distinct outward wing posture have decreased since its discovery.

Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry

AIMS

The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation.

METHODS AND RESULTS

Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin.

CONCLUSION

The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.

P-135 Clinical outcomes depending on post-warming culture duration of vitrified-warmed single blastocyst transfer cycles

Study question

What is the impact of post-warming blastocysts after very short-term culture (&lt;2 hours) or short-term culture (2–4 hours) on the clinical outcomes?

Summary answer

The clinical outcomes of very short-term culture and short-term culture were not significantly different in vitrified-warmed blastocyst transfer.

What is known already

In vitrified-warmed blastocyst transfer (VBT), complete blastomere survival and mitotic resumption during warming are generally considered to be the most important factors affecting pregnancy outcomes. It has been assumed that a sufficient warming time may be required for resumption of cell proliferation and development. Currently there is evidence that suggests a minimum mean time of 2.70 ± 1.20 necessary to complete the re-expansion of the embryo that allows evaluating its adequate development. However, the effect of culture duration on pregnancy outcomes in VBT remains controversial.

Study design, size, duration

A retrospective observational study was carried out, with all the patients who had frozen-thawed embryos transferred between January and December 202, in Clínica Alemana, Santiago, Chile. The average standard time for embryo thawing in our center is 2 hours. However, on certain occasions, due to its insufficient development and the pressing schedule of surgery rooms, a second embryo must be thawed, usually in less than 2 hours.

Participants/materials, setting, methods

Embryos were divided into two study groups depending on whether their post-warming culture period was very short-term (&lt;2 hours) or short-term culture (2–4 hours). Only transfers of 1 embryo on day 5-6 were included. Embryo morphology was analyzed with a Garner microscope score to estimate the quality of the embryos in both groups.

Main results and the role of chance

During the study period, a total of 127 single VBT cycles were included: 48 in the very short-term group and 79 in the short-term group. Patients’ demographic characteristics did not significantly differ between the groups. (Age 34.9±3.6 vs 35±3.4, p=0.89; Infertility duration (yr) 2.75±1.1 vs 2.5 ±1.1, p=0.24; AMH 2.1 [0.2-5.4] vs 2.1 [0.2-5], p=0.84) An analysis of previous fresh in vitro fertilization cycles and subsequent VBT cycle parameters revealed no differences in the number of retrieved oocytes (11.7 vs 12, p=0.74), the number of fertilized oocytes (8.6 vs 8.5, p=0.86), the number of vitrified blastocysts (3.4 vs 3.6, p=0.87) and in both groups. The clinical pregnancy rate per embryo transferred were similar in the very short-term culture group and the short-term culture group (66.7% vs. 68.4%, p=0.44). There was no significant difference in the ongoing pregnancy rate per embryo transferred between the two groups (18,8% vs. 16.5.%, p=0.74). The miscarriage rate in both groups was comparable (p=0.77).

Limitations, reasons for caution

The small number of women recruited ant the retrospective design of the study, should be recognized as possible sources of bias.

Wider implications of the findings

This study showed that the culture time after warming was irrelevant for blastocyst implantation potential, and that the speed of re-expansion was not correlated with clinical outcomes.

Embryo transfer timing after warming may be determined by optimizing each laboratory’s work flow.

Trial registration number

0

Trophic transfer of copper decreases the condition index in Crassostrea gigas spat in concomitance with a change in the microalgal fatty acid profile and enhanced oyster energy demand

Due to new usages and sources, copper (Cu) concentrations are increasing in the Arcachon Basin, an important shellfish production area in France. In the present paper, the trophic transfer of Cu was studied between a microalga, Tetraselmis suecica, and Crassostrea gigas (Pacific oyster) spat. An experimental approach was developed to assess Cu exposure, transfer and toxicity on both phytoplankton and spat. Exposure of microalgal cultures to Cu for 7-8 days (3.1 ± 0.1, 15.7 ± 0.2 and 50.4 ± 1.0 μg Cu·L^-1 for the control, Cu15 and Cu50 conditions, respectively) led to concentrations in microalgae (28.3 ± 0.9 and 110.7 ± 11.9 mg Cu·kg dry weight^-1 for Cu15 and Cu50, respectively) close to those measured in the field. Despite Cu accumulation, the physiology of the microalgae remained poorly affected. Exposed cultures could only be discriminated from controls by a higher relative content in intracellular reactive oxygen species, and a lower relative content in lipids together with a reduced metabolic activity. By contrast, the fatty acid profile of microalgae was modified, with a particularly relevant lower content of the essential polyunsaturated fatty acid 22:6n-3 (docosahexaenoic acid [DHA]). Following 21 days of spat feeding with Cu15 and Cu50 microalgal cultures, trophic transfer of Cu was observed with a high initial Cu concentration in spat tissues. No effect was observed on oxidative stress endpoints. Cu exposure was responsible for a decrease in the spat condition index, an outcome that could be related to an insufficient DHA supply and extra energy demand as suggested by the overexpression of genes involved in energy metabolism, ATP synthesis and glycogen catabolism.

DIPG-34. Life and End-of-Life after Diffuse Intrinsic Pontine Glioma diagnosis

INTRODUCTION AND OBJECTIVES: Despite advances in pediatric oncology, Diffuse Intrinsic Pontine Glioma’s (DIPG) life expectancy remains &lt;10% at 2 years, and the mean survival time is 8-10 months from diagnosis. Its location associates multiple symptoms of complex management that condition their quality of life. The aim is to review our experience in the clinical course of the disease and the involvement of palliative care (PC). METHODS: Single-centre retrospective study of patients &lt;18 years diagnosed with DIPG between 2011-2022. A review of the electronic medical record was carried out, recording demographic data, oncological treatments, PC and advance care planning (ACP). RESULTS: We registered 14 patients (2 alive). Median age at diagnosis was 6.4 years (range 3.5-11.9). Median survival from diagnosis was 9.6 months (range 0.5-18) and 3.8 months from progression (range 0.1-12). At diagnosis, 92% received oncological treatment (radiotherapy 75%, chemotherapy 41%, oncolytic viruses 21%, partial resection 8%). After progression, 4 patients received metronomic chemotherapy or re-irradiation and in the last month of life 2 received chemotherapy. In the last 3 months of life, 64% were admitted at least once for progression or end-of-life. In the last month, all received oral dexamethasone. Follow-up by PC team was provided in 64%, with first contact in the last month of life in 36%. ACP was recorded in 4 patients, all of them followed up for PC. Death occurred at home in 33%, hospital in 58%. Palliative sedation was used in 5 patients. CONCLUSIONS: Despite the known prognosis of DIPG, some patients continue receiving oncological treatment after progression and in the last month of life. Contact with PC teams occurred mainly at advanced disease stage. Median survival of children with DIPG is below one year, with multiple symptoms in the progression phase. Therefore, early follow-up by PC teams is recommended.

POS1270 COVID19 VACCINATION IN PATIENTS WITH AXIAL AND PERIPHERAL SPONDYLOARTHRITIS AND PSORIATIC ARTHRITIS: ADVERSE EVENTS AND IMPACT ON DISEASE ACTIVITY

Background

There is scarce evidence on the rate of adverse events and the consequences on disease activity after vaccination against covid19

Objectives

To evaluate adverse events to vaccination and disease flares after vaccination in patients with axial spondyloarthritis (axSpA), peripheral spondyloarthritis (pSpA) and psoriatic arthritis (PsA) and to evaluate factors associated with adverse event.

Methods

Cross-sectional, observational, descriptive study. Consecutive patients with diagnosis of ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA) according to ASAS 2009 criteria; pSpA according to ASAS 2011 criteria and PsA according to CASPAR criteria were included. Demographic data, disease clinimetry, treatments, vaccination received and post-vaccination adverse events were recorded. We evaluated, according to medical criteria, whether the patient presented a flare disease after vaccination and whether it was mild, moderate or severe. We also evaluated the factors associated with the presence of at least one mild adverse event. Statistical analysis: descriptive statistics were performed, qualitative variables were expressed as frequency and percentage (%), numerical variables as mean and standard deviation (SD) or median and percentile25-75. Binary logistic regression was performed using the presence of at least one mild adverse event to vaccination as the dependent variable.

Results

210 patients were included with a mean age of 45 (SD 15) years. The diagnoses were: AS 50 (23.8%), nr-axSpA 10 (4.8), pSpA 9 (4.3%), PsA 141 (67%) and time of disease evolution in months 109 (SD 96). Regarding comorbidities, the following frequencies were reported: arterial hypertension 60 (30%), diabetes mellitus 25 (12%), heart failure 4 (2%), asthma/EPOC 15 (7%), inflammatory bowel disease 2 (1%), acute anterior uveitis 20 (9.5%), psoriasis 128 (61%). Sixteen percent (n=33) of the patients had SARS-CoV-2 infection prior to vaccination. Regarding treatments, those used were: antiTNF 88 (42%), Tofacitinib 6 (2.9%), Ustekinumab 2 (1%), Secukinumab 35 (17%), Ixekizumab 2 (1%), methotrexate 98 (47%), leflunomide 7 (3. 3), sulfasalazine 7 (3.3), apremilast 1 (0.5%), continuous NSAIDs 26 (12.4%) and NSAIDs on demand 103 (49%). Vaccines received were: Sputnik V 109 (51.9%), Oxford Vaccine, AstraZeneca 63 (30%), Janssen 1 (0.5%), BioNTech Vaccine, Pfizer 1 (0.5%), Sinopharm 33 (15.7%), Moderna 0%, Novavax 0% and others; 3 (1.4%). Thirty-eight percent (n=80) of patients reported having mild post-vaccination symptoms, of which 3.75% did not resolve, 41% resolved with medication and 39% resolved ad integrum without medication. The presence of mild adverse event to the vaccine was associated with lower use of methotrexate (31% vs 56 %, p<0.001), and lower age (54 (SD 14) vs 47 (SD 12), p<0.001), and lower BMI (25 (24-30.5) vs 28 (25-31), p<0.001); while no association was found with sex, diagnosis, comorbidities, treatments, desease activity or vaccines. In the logistic regression analysis all the variables remained independently associated with a lower probability of presenting a mild adverse event: methotrexate: OR: 0.30, 95%CI 0.15-0.58, p<0.001, age: OR: 0.97, 95%CI 0.95-0.99, p: 0.03, BMI: OR: 0.92, 95%CI 0.95-0.99, p: 0.02. Sixty-one percent (n=129) of patients received the 2nd dose of vaccination, which 27% (n=35) presented mild adverse event and only 1 (0.8%) patient suffered post vaccination disease flare.

Conclusion

Vaccination against COVID19 appears to be safe in this population, with only mild adverse events and low frequency of flare disease. Mild adverse events were associated with less use of methotrexate, younger age and lower BMI.

Disclosure of Interests

None declared

AB1503 MOST MEDICINE RESIDENTS WOULD LIKE TO LEARN JOINT ASPIRATION PROCEDURES BUT 2/3 HAVE NEVER DONE IT: SURVEY OF COMMUNITY HOSPITAL TRAINEES IN NORTHEASTERN USA

Background

Arthrocentesis is a procedure performed to aspirate synovial fluid from a joint cavity. It has both diagnostic and therapeutic utilization in outpatient and inpatient settings. While arthrocentesis is considered a minor surgical procedure, there is always potential to injure blood vessels, nerves, and tendons1. Although joint arthrocentesis is not an Accreditation Council for Graduate Medical Education procedural requirement for Internal Medicine (IM) residents in the United States, several studies have revealed that training on knee arthrocentesis and injection provided a solid foundation to medical residents toward increasing their confidence and refining motor skills2.

Objectives

To evaluate the current Roger Williams Medical Center (RWMC) IM residents’ confidence level in performing intra-articular injection. Results from this study will inform the design of resident-orientated quality improvement arthrocentesis teaching series in RWMC.

Methods

Project was incepted and designed by one rheumatology faculty, one fellow and five IM residents of RWMC. We selected the survey as a tool to elicit information from all current IM residents who filled out a 7-question survey regarding their residency experience and exposures to knee aspiration and injection. We used Survey Monkey as an anonymous survey tool (see Table 1). Data were collected between 1/14/22 until 1/27/22 and were verified by two members of the research team.

Table 1.

Survey from 39 total responses

QuestionResponses1.What post-graduate year are you?PGY1:41.03%PGY2: 35.90%PGY3: 9%2. Are you comfortable/confident with knee arthrocentesis/injection during residency?Not Comfortable/confident: 69.23%Somewhat comfortable/confident: 28.21%Quite comfortable/confident: 2.56%3. Do you think you have adequate exposure to knee procedures in residency?Strongly Agree: 0%Agree: 0%Undecided: 5.13%Disagree: 51.28%Strongly Disagree: 43.59%4. How many knee aspirations/injections have you done during residency?0: 73.68%1-4: 26.32%5-10: 0%>10: 0%5. Do you think our residency program is preparing you to do knee aspirations/injections?Strongly Agree: 0%Agree: 0%Undecided: 17.95%Disagree: 35.90%Strongly Disagree: 46.15%6. Would you be interested in doing more knee aspirations/injections?Yes: 94.87%No: 5.13%7. Having exposure to arthrocentesis is very important for me to have in my residency programStrongly Agree: 33.33%Agree: 35.90%Undecided: 23.08%Disagree: 5.13%Strongly Disagree: 2.56%

Results

A total of 47 IM residents within three classes in this community residency program were provided with the survey. The survey response rate was 82.9% (39 /47). 69.23% residents do not feel comfortable doing arthrocentesis. More than half of the resident population (51.28%) do not think they have adequate exposure to knee arthrocentesis. 73.68% respondents have never performed knee injections/arthrocentesis. According to the survey, 94.87% of the residents would be interested in learning to do knee procedures. Having exposure to knee arthrocentesis during residency was important to 36.84% and very important to 34.21% of the trainees.

Conclusion

The survey results demonstrate that most of the IM residents had no prior exposure and are uncomfortable with knee arthrocentesis. However we proved that there is high interest in learning this procedure. Literature review shows that structured training sessions have a long-term effect in competency and confidence with similar procedures. This survey provides us data to set up a system to improve the quality of joint procedures teaching in RWMC.

References

[1]Akbarnia H, Saber AY, Zahn E. Knee arthrocentesis. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK470229/. Published September 5, 2021

[2]Barilla-LaBarca M-L, Tsang JC, Goldsmith M, Furie R. Design, implementation, and outcome of a hands-on Arthrocentesis Workshop. J Clin Rheumatol. 2009;15(6):275-279.

Disclosure of Interests

Pamela Gonzalez: None declared, Ravinder Kaler: None declared, Neenu Sukumaran: None declared, Ahmed ElDib: None declared, Yana Turkowski: None declared, Zi Ying Li: None declared, Katarzyna Gilek-Seibert Speakers bureau: Abbvie, Consultant of: GSK

496. Comparison of Severe COVID 19 and Influenza Infections in Pediatric Patients Requiring PICU in Bogota, Colombia

Background

COVID 19 infection represents a global threat and now a frequent cause of hospitalization in pediatrics. COVID 19, as well as Influenza virus could have a severe course. There are few studies, and no local or regional information comparing severe disease between COVID 19 and Influenza virus in children.

Methods

Confirmed COVID 19 between March 2020 to October 2021 and influenza infections from Jan-2017 to dec-2019 were included. Asymptomatic or ambulatory COVID 19 infections were excluded. The main objective was to compare clinical, laboratory and outcome characteristic of PICU admitted patients.

Results

71 patients were included, 32(45,1%) with COVID 19 and 39 (54,9%) influenza virus. COVID 19 patients were older than influenza patients: 67 (20,5-143) vs. 10 (2- 46) p=0.0002. The majority of influenza patients were younger than two years, with different distributions in COVID 19 patients. Figure 1. Respiratory distress was more frequent in influenza (92,3% vs. 62,5%) p=0.002, but exanthema (28,1% vs 2,6%), shock (68,7% vs. 7,7%) and central nervous system manifestations (40,6% vs. 7,7%) were significantly more common in COVID19 than in Influenza respectively. COVID 19 had lower platelets and lymphocyte counts than inlfuenza. There were no differences in treatment, nor deceased either, but Influenza patients had slightly longer hospital stays 12 (7 – 23) vs. 9.5 (6–15.5) p=0.1592 than COVID 19 (Table 1).

Conclusion

COVID 19 and influenza severe infections can have some differences including age of presentation. Inlfuenza main manifestation requiring UCIP is respiratory distress, while COVID19 can have other presentations including shock and central nervous manifestation. Lower lymphocyte counts as well as lower platelets were significantly more common in COVID 19 patients. Although there are no unique characteristics of each infection, some particularities could guide clinician to the etiology of the infection.

Disclosures

Ivan Felipe Gutiérrez Tobar, n/a, Pfizer and MSD (Advisor or Review Panel member, Research Grant or Support, Speaker’s Bureau, Has received support from Pfizer and MSD for participation in congresses and has received conference payments from Pfizer)Pfizer and MSD (Speaker’s Bureau, Other Financial or Material Support, Has received support from Pfizer for participation in congresses) Sandra Beltran, n/a, Pfizer (Other Financial or Material Support, Has received support from Pfizer for participation in congresses)

Effects of metals and persistent organic pollutants on the fitness and health of juveniles of the endangered european sturgeon Acipenser sturio Exposed to W1ater and sediments of the garonne and dordogne rivers

The last remaining population of European sturgeon (Acipenser sturio) lives in the Gironde-Garonne-Dordogne (France) catchment (GGD). Captive young individuals are released into the GGD hydrosystem each year, as part of a restocking programme. This study aims to assess the health status of juveniles A. sturio to current conditions in the GGD hydrosystem, to evaluate their capacity to survive and grow in a moderately anthropized ecosystems. 3-month-old farmed sturgeons were exposed for one month in experimental conditions that mimic the environmental conditions in the Garonne and Dordogne rivers, followed by five months of depuration. After one month of exposure, fish exposed to Dordogne and Garonne waters bioaccumulated higher levels of metals and persistent organic pollutants, displayed a reduced hepato-somatic index, and had depleted levels of lipids and glycogen content in their liver, when compared with the Reference group. However, metabolic and swimming performance, as well as the costs of swimming were not impaired. After the 5 months depuration, a significant decrease of K was observed for all exposure conditions. HSI also decreased with time. The overall health status and adaptive capacity of juvenile A. sturio appeared to be maintained over the experimental 6 months' period. Juveniles of A. sturio seem to have the adaptive capacity to survive and grow in the GGD hydrosystem, after being released as part of a restocking programme.

Prognostic factors of clot resolution on follow-up computed tomography angiography and recurrence after a first acute pulmonary embolism

BACKGROUND

Recent studies seem to confirm the relationship between residual pulmonary obstruction (RPO) in pulmonary embolism (PE) and risk of recurrent thrombosis and chronic thromboembolic pulmonary hypertension (CTEPH). However, the prognostic factors associated with PE resolution on follow-up computed tomography angiography (CTA) are not clear.

OBJECTIVES

To determine the prognostic factors of resolution of PE diagnosed and monitored by CTA and the impact of RPO on late complications.

METHODS

We retrospectively analyzed 241 patients with PE who had undergone a 12-month follow-up and CT scan evaluation at 6 months. Factors related to resolution and the impact of RPO on the outcome were analyzed.

RESULTS

Resolution was achieved in 74.3% of all cases after 6 months of treatment. Absence of chronic obstructive pulmonary disease (COPD) (OR, 3.22 [1.35-7.71]; p = 0.009), provoked PE (OR, 2.02 [1.08-3.79]; p = 0.028), early initiation of treatment (<7 days) (OR, 2.42 [1.22-4.78]; p = 0.011), and degree of obstruction caused by the initial PE as indicated by a Qanadli score lower than 16 (OR, 2.12 [1.03-4.37]; p = 0.043) were associated with complete resolution. RPO was associated with recurrent PE as well as the combined endpoint consisting of recurrent VTE and/or CTEPH (4.67 [95% CI, 1.26-17.26]; p = 0.02) and (OR 6.4 [95% CI, 1.9-21.2]; p < 0.005), respectively.

CONCLUSIONS

Resolution of PE is associated with a lower risk of recurrent thrombosis. Earlier initiation of treatment improves prognosis as measured by resolution on follow-up CTA.

POS1005 ASSESSMENT OF DAREA AND MODIFIED DAREA IN AN ARGENTINIAN-GUATEMALAN REACTIVE ARTHRITIS COHORT

Background:

Reactive Arthritis (ReA) is an inflammatory joint disease and, as in rheumatoid or psoriatic arthritis, composite indices are the most useful tools to measure disease activity. The Disease Activity Index for Reactive Arthritis (DAREA) is the only developed index for ReA, which requires a 66/68 joint count and CRP for its assessment, the latter being difficult to acquire in our setting. Therefore, we developed a simplified index, the modified DAREA (DAREAm), with a lower joint count and ESR for its evaluation.

Objectives:

1) To evaluate the DAREA and the DAREAm in a cohort of patients with diagnosis of ReA and post-infectious arthritis 2) To assess the correlation of the DAREA and DAREAm with several clinical variables, functional capacity and quality of life in a cohort of patients with ReA.

Methods:

Patients with diagnosis of ReA (Calin’79) and post-infectious arthritis were included. Demographic data were collected, patient´s pain and global assessment were evaluated through a visual analog scale (VAS) and a 3-point scale (no pain = 0, mild = 1, moderate = 2, severe = 3), physician´s global assessment, morning stiffness (MS) and VAS fatigue. Functional capacity was assessed by HAQ and quality of life according to EuroQol-5 dimensions (EQ-5D), and the activity indices DAS28, DAREA and DAREAm were calculated. Statistical analysis: a descriptive analysis of the variables and correlation between numerical variables with Spearman rank correlation were performed.

Results:

57 patients were included, 53 with diagnosis of ReA, the majority post urogenital (63%) and gastrointestinal (17%), and 4 with diagnosis of post-infectious arthritis. Fifty six percent were male, mean age: 40 years old (SD ± 14) and median ReA duration: 15 months (IQR 2-45). The number of painful and swollen joints in a 66/68 joint count showed a median of 2 (IQR 0-3) and 1 (IQR 1-2) respectively. Median VAS pain 43 (IQR 15-70), patient´s disease activity 40 (IQR 20-60) and physician´s 40 (IQR 20-60), MS 10 (IQR 0-50) and fatigue 30 (IQR 0-80). Median DAS28 3.6 (IQR 2.3-4.3), DAREA 7.4 (IQR 2.5-10.6), DAREAm 8.6 (IQR 4.6-12.7), HAQ 0.625 (IQR 0.125-1). The dimensions with the greatest compromise in the EQ-5D were pain/discomfort (63%) and anxiety/depression (51%), and the median VAS EQ-5D was 60 (IQR 32-80). DAREA correlated with DAREAm (rs= 0.89; p <0.001), DAS28 (rs= 0.84; p <0.001), medical VAS (rs= 0.60; p <0.001), MS (rs= 0, 50; p <0.001), HAQ (rs= 0.53; p <0.001), VAS fatigue (rs= 0.57; p <0.001) and mobility subscales of the EQ5D (rs= 0.56; p <0.001), pain/discomfort (rs= 0.49; p <0.001) and anxiety/depression (rs= 0.61; p <0.001). The DAREAm correlated with DAS28 (rs= 0.93; p <0.001), physician VAS (rs= 0.58; p <0.001), fatigue VAS (rs= 0.53; p <0.001), HAQ (rs= 0 .51; p <0.001) and the EQ5D subscales: mobility (rs= 0.64; p <0.001), pain/discomfort (rs= 0.56; p <0.001) and anxiety/depression (rs= 0.66; p <0.001)

Conclusion:

This is the first study that assess activity indices in a cohort of patients with ReA. The DAREAm demonstrated a very good correlation with both DAREA and DAS28. We encourage the use of this simplified index in daily practice to evaluate patients with ReA.

Disclosure of Interests:

None declared.

Efficacy of AS04-Adjuvanted Vaccine Against Human Papillomavirus (HPV) Types 16 and 18 in Clearing Incident HPV Infections: Pooled Analysis of Data From the Costa Rica Vaccine Trial and the PATRICIA Study

Clinical trial data and real-world evidence suggest that the AS04-adjuvanted vaccine targeting human papillomavirus types 16 and 18 (AS04-HPV-16/18) vaccine provides nearly 90% protection against cervical intraepithelial neoplasia grade 3 or higher irrespective of type, among women vaccinated before sexual debut. This high efficacy is not fully explained by cross-protection. Although AS04-HPV-16/18 vaccination does not affect clearance of prevalent infections, it may accelerate clearance of newly acquired infections. We pooled data from 2 large-scale randomized controlled trials to evaluate efficacy of the AS04-HPV-16/18 vaccine against clearance of nontargeted incident infections. Results of our analysis do not suggest an effect in expediting clearance of incident infections.

Energy-Spread Preservation and High Efficiency in a Plasma-Wakefield Accelerator

Energy-efficient plasma-wakefield acceleration of particle bunches with low energy spread is a promising path to realizing compact free-electron lasers and particle colliders. High efficiency and low energy spread can be achieved simultaneously by strong beam loading of plasma wakefields when accelerating bunches with carefully tailored current profiles [M. Tzoufras et al., Phys. Rev. Lett. 101, 145002 (2008)PRLTAO0031-900710.1103/PhysRevLett.101.145002]. We experimentally demonstrate such optimal beam loading in a nonlinear electron-driven plasma accelerator. Bunches with an initial energy of 1 GeV were accelerated by 45 MeV with an energy-transfer efficiency of (42±4)% at a gradient of 1.3  GV/m while preserving per-mille energy spreads with full charge coupling, demonstrating wakefield flattening at the few-percent level.

VBM sensitivity to localization and extent of mouse brain lesions: A simulation approach

BACKGROUND AND OBJECTIVES

Voxel-based morphometry (VBM) is a popular neuroimaging technique, used to detect and quantify morphological differences in brain tissues between groups. Widely used in human studies, VBM approaches have tremendous potential for neuroimaging studies in animal models. A significant challenge for applying VBM to small animal studies is the poor understanding of how the design of preprocessing pipelines impacts quantitative results. This is important because the large differences in size, resolution, and imaging parameters implies that human imaging preprocessing pipelines cannot be uncritically applied to small animal studies. In this work, we assessed and validated the performance of different VBM pipelines for the study of the mouse brain.

METHODS

We applied two pipelines -namely DARTEL VBM and Optimized VBM- by varying spatial normalization used during preprocessing. Using an automatic method, we simulated varying levels of volumetric gray matter (GM) loss and sizes of tissue atrophy on specific areas of the mouse brain. We evaluated the performance of each pipeline by comparing location and extent of the differences detected by them with the simulated ones. Finally, we applied both pipelines on magnetic resonance (MR) images of the brain derived from an experimental model of growth restriction on mice.

RESULTS

Our results demonstrated that some subtle atrophies were detected by the Optimized workflow but not by the DARTEL VBM workflow. Detection of less subtle atrophies was similar for the two workflows, but DARTEL VBM performed better at estimating their size and anatomical location. Both VBM pipelines had difficulties at finding atrophies with a very small level of volumetric loss and, in general, they underestimated the magnitudes of difference between groups. These results also varied across brain regions, with better performance on brain cortex than other regions such as the cerebellum.

CONCLUSIONS

The analysis and quantification of VBM pipelines on different areas of the mouse brain allows a better understanding of the advantages and limitations of their results. We performed a controlled and quantitative analysis of the method providing robust evidence to interpret changes in real contexts.

Durability of Cross-Protection by Different Schedules of the Bivalent HPV Vaccine: The CVT Trial

BACKGROUND

The Costa Rica HPV Vaccine Trial has documented cross-protection of the bivalent HPV vaccine against HPV31/33/45 up to 7 years after vaccination, even with one dose of the vaccine. However, the durability of such protection remains unknown. Here, we evaluate the efficacy of different schedules of the vaccine against HPV31/33/45 out to 11 years postvaccination, expanding to other nontargeted HPV types.

METHODS

We compared the rates of HPV infection in vaccinated women with the rates in a comparable cohort of unvaccinated women. We estimated the average vaccine efficacy (VEavg) against incident infections and tested for a change in VE over time.

RESULTS

Among 3-dose women, we observed statistically significant cross-protection against HPV31/33/45 (VEavg = 64.4%, 95% confidence interval [CI] = 57.7% to 70.0%). Additionally, we observed borderline, statistically significant cross-protection against HPV35 (VEavg = 23.2%, 95% CI = 0.3% to 40.8%) and HPV58 (VEavg = 21.2%, 95% CI = 4.2% to 35.3%). There was no decrease in VE over time (two-sided Ptrend > .05 for HPV31, -33, -35, -45, and -58). As a benchmark, VEavg against HPV16/18 was 82.0% (95% CI = 77.3% to 85.7%). Among 1-dose women, we observed comparable efficacy against HPV31/33/45 (VEavg = 54.4%, 95% CI = 21.0% to 73.7%). Acquisition of nonprotected HPV types was similar between vaccinated and unvaccinated women, indicating that the difference in HPV infection rates was not attributable to differential genital HPV exposure.

CONCLUSIONS

Substantial cross-protection afforded by the bivalent vaccine against HPV31/33/45, and to a lesser extent, HPV35 and HPV58, was sustained and remained stable after 11 years postvaccination, reinforcing the notion that the bivalent vaccine is an effective option for protection against HPV-associated cancers.

Evaluation of Durability of a Single Dose of the Bivalent HPV Vaccine: The CVT Trial

BACKGROUND

The authors investigated the durability of vaccine efficacy (VE) against human papillomavirus (HPV)16 or 18 infections and antibody response among nonrandomly assigned women who received a single dose of the bivalent HPV vaccine compared with women who received multiple doses and unvaccinated women.

METHODS

HPV infections were compared between HPV16 or 18-vaccinated women aged 18 to 25 years who received one (N = 112), two (N = 62), or three (N = 1365) doses, and age- and geography-matched unvaccinated women (N = 1783) in the long-term follow-up of the Costa Rica HPV Vaccine Trial. Cervical HPV infections were measured at two study visits, approximately 9 and 11 years after initial HPV vaccination, using National Cancer Institute next-generation sequencing TypeSeq1 assay. VE and 95% confidence intervals (CIs) were estimated. HPV16 or 18 antibody levels were measured in all one- and two-dose women, and a subset of three-dose women, using a virus-like particle-based enzyme-linked immunosorbent assay (n = 448).

RESULTS

Median follow-up for the HPV-vaccinated group was 11.3 years (interquartile range = 10.9-11.7 years) and did not vary by dose group. VE against prevalent HPV16 or 18 infection was 80.2% (95% CI = 70.7% to 87.0%) among three-dose, 83.8% (95% CI = 19.5% to 99.2%) among two-dose, and 82.1% (95% CI = 40.2% to 97.0%) among single-dose women. HPV16 or 18 antibody levels did not qualitatively decline between years four and 11 regardless of the number of doses given, although one-dose titers continue to be statistically significantly lower compared with two- and three-dose titers.

CONCLUSION

More than a decade after HPV vaccination, single-dose VE against HPV16 or 18 infection remained high and HPV16 or 18 antibodies remained stable. A single dose of bivalent HPV vaccine may induce sufficiently durable protection that obviates the need for more doses.

Regional variations in Helicobacter pylori infection, gastric atrophy and gastric cancer risk: The ENIGMA study in Chile

BACKGROUND

Regional variations in gastric cancer incidence are not explained by prevalence of Helicobacter pylori, the main cause of the disease, with several areas presenting high H. pylori prevalence but low gastric cancer incidence. The IARC worldwide H. pylori prevalence surveys (ENIGMA) aim at systematically describing age and sex-specific prevalence of H. pylori infection around the world and generating hypotheses to explain regional variations in gastric cancer risk.

METHODS

We selected age- and sex-stratified population samples in two areas with different gastric cancer incidence and mortality in Chile: Antofagasta (lower rate) and Valdivia (higher rate). Participants were 1-69 years old and provided interviews and blood for anti-H. pylori antibodies (IgG, VacA, CagA, others) and atrophy biomarkers (pepsinogens).

RESULTS

H. pylori seroprevalence (Age-standardized to world population) and antibodies against CagA and VacA were similar in both sites. H. pylori seroprevalence was 20% among children <10 years old, 40% among 10-19 year olds, 60% in the 20-29 year olds and close to or above 80% in those 30+ years. The comparison of the prevalence of known and potential H. pylori cofactors in gastric carcinogenesis between the high and the low risk area showed that consumption of chili products was significantly higher in Valdivia and daily non-green vegetable consumption was more common in Antofagasta. Pepsinogen levels suggestive of gastric atrophy were significantly more common and occurred at earlier ages in Valdivia, the higher risk area. In a multivariate model combining both study sites, age, chili consumption and CagA were the main risk factors for gastric atrophy.

CONCLUSIONS

The prevalence of H. pylori infection and its virulence factors was similar in the high and the low risk area, but atrophy was more common and occurred at younger ages in the higher risk area. Dietary factors could partly explain higher rates of atrophy and gastric cancer in Valdivia.

IMPACT

The ENIGMA study in Chile contributes to better understanding regional variations in gastric cancer incidence and provides essential information for public health interventions.

Efficacy of the AS04-Adjuvanted HPV16/18 Vaccine: Pooled Analysis of the Costa Rica Vaccine and PATRICIA Randomized Controlled Trials

BACKGROUND

The AS04-adjuvanted HPV16/18 (AS04-HPV16/18) vaccine provides excellent protection against targeted human papillomavirus (HPV) types and a variable degree of cross-protection against others, including types 6/11/31/33/45. High efficacy against any cervical intraepithelial neoplasia grade 3 or greater (CIN3+; >90%) suggests that lower levels of protection may exist for a wide range of oncogenic HPV types, which is difficult to quantify in individual trials. Pooling individual-level data from two randomized controlled trials, we aimed to evaluate AS04-HPV16/18 vaccine efficacy against incident HPV infections and cervical abnormalities .

METHODS

Data were available from the Costa Rica Vaccine Trial (NCT00128661) and Papilloma Trial Against Cancer in Young Adults trial (NCT00122681), two large-scale, double-blind randomized controlled trials of the AS04-HPV16/18 vaccine. Primary analyses focused on disease-free women with no detectable cervicovaginal HPV at baseline.

RESULTS

A total of 12 550 women were included in our primary analyses (HPV arm = 6271, control arm = 6279). Incidence of 6-month persistent oncogenic and nononcogenic infections, excluding known and accepted protected types 6/11/16/18/31/33/45 (focusing on 34/35/39/40/42/43/44/51/52/53/54/56/58/59/66/68/73/70/74), was statistically significantly lower in the HPV arm than in the control arm (efficacy = 9.9%, 95% confidence interval [CI] = 1.7% to 17.4%). Statistically significant efficacy (P < .05) was observed for individual oncogenic types 16/18/31/33/45/52 and nononcogenic types 6/11/53/74. Efficacy against cervical abnormalities (all types) increased with severity, ranging from 27.7% (95% CI = 21.7% to 33.3%) to 58.7% (95% CI = 34.1% to 74.7%) for cytologic outcomes (low-grade squamous intraepithelial neoplasia lesion or greater, and high-grade squamous intraepithelial neoplasia lesion or greater, respectively) and 66.0% (95% CI = 54.4% to 74.9%) to 87.8% (95% CI = 71.1% to 95.7%) for histologic outcomes (CIN2+ and CIN3+, respectively). Comparing Costa Rica Vaccine Trial and Papilloma Trial Against Cancer in Young Adults results, there was no evidence of heterogeneity, except for type 51 (efficacy = -28.6% and 20.7%, respectively; two-sided P = .03).

CONCLUSIONS

The AS04-HPV16/18 vaccine provides some additional cross-protection beyond established protected types, which partially explains the high efficacy against CIN3+.

OP0266-HPR WORK PRODUCTIVITY IN PATIENTS WITH AXIAL AND PERIPHERAL SPONDYLOARTHRITIS

Background:

Work disability is an important outcome in the treatment of Spondyloarthritis (SpA) since this disease affects people in the most productive stage of life.

Objectives:

The aim of this study is to investigate the working status and the factors associated with work productivity loss (WPL) in patients with axial (axSpA) and peripheral SpA (pSpA).

Methods:

Patients with SpA according to ASAS criteria were included consecutively in this multicentric cross-sectional study. Evaluation of activity through a visual analogue scale (0-100), enthesitis (LEI), functional capacity (HAQ and BASFI), disease activity (DAS28 and BASDAI), health status (ASAS Health Index) and quality of life (ASQoL) were calculated. The Ankylosing Spondylitis Disease Activity Score (ASDAS) was recorded. The Work Productivity and Activity Impairment Spondyloarthritis (WPAI SpA) questionnaire was used to assess work productivity.

Spearman’s correlation coefficient (ρ) was used to assess the correlation with the percentage of WPL.

Results:

274 patients with SpA were recruited, 129 (47.1%) with axSpA and 145 (52.9%) with pSpA. 56.6% were women and 33.2% stopped working due to the underlying disease.

Among axSpA patients, 70% were radiographic and 30% non radiographic, mean age 45.5 (SD14) yrs, median disease duration 72 (IQR 36-144) months and diagnosis delay 20 (IQR 11-70) months. 45.7% were employed, median hours worked in the last week was 40 (IQR 25-45), median scores for absenteeism was 0% (IQR 0-2), presenteeism 30% (IQR 5-40), WPL 30% (IQR 10-52.5) and activity impairment 30% (IQR 10-50). A positive correlation was found between WPL and the following variables: HAQ (ρ:0.40, p<0.001), BASDAI (ρ:0.48, p<0.001), ASDAS (ρ:0.46, p<0.001), BASFI (ρ:0.59, p<0.001), ASQoL (ρ:0.60, p<0.0001), LEI (ρ:0.31, p:0.02) and ASAS health index (ρ:0.54, p<0.001).

Among pSpA patients, mean age was 52.3 (SD13) yrs, median disease duration 60 (IQR 14-120) months and diagnosis delay 12 (IQR 3-24) months. 46.9% were employed, median hrs worked in the last week was 30 (IQR 14-40), absenteeism 0% (IQR 0-7), presenteeism 30% (IQR 2.5-58), WPL 30% (IQR 5-52) and activity impairment 20% (IQR 0-40). A positive correlation was found between WPL and: HAQ (ρ:0.49, p<0.001), ASDAS (ρ:0.58, p<0.001), ASQoL (ρ:0.57, p<0.0001), DAS28 (ρ:0.50, p<0.001), LEI (ρ:0.36, p:0.04) and ASAS health index (ρ:0.52, p<0.001). No statistically significant differences were found in absenteeism, presenteeism, WPL and activity impairment between axSpA and pSpA.

Conclusion:

Our study showed that WPL in this national cohort was 30% in both groups of patients and is associated with disease activity, enthesitis, health status, quality of life and functional ability.

Disclosure of Interests:

None declared

FRI0318 REAL-LIFE EVALUATION OF HEALTH STATUS USING ASAS HEALTH INDEX ON PATIENTS WITH AXIAL AND PERIPHERAL SPONDYLOARTHRITIS IN ARGENTINA

Background:

The questionnaire “Assessment of Spondyloarthritis international Society Health Index” (ASAS HI) was developed to measure functionality and health status in patients with spondyloarthritis (SpA)1.

Objectives:

To describe the state of health measured by ASAS HI in Argentinian patients with SpA and to evaluate factors associated with poor health.

Methods:

Analytical, cross sectional, multicenter study. Patients with SpA according to ASAS criteria were consecutively included from 15 Argentinian centers. Statistical analysis: frequencies and percentages (%), mean and standard deviation (SD) or median and interquartile range (IQR). Bivariate analysis and logistic regression were performed to evaluate the factors associated with poor health status (ASAS HI > or equal to 12). Correlation with other parameters was evaluated by Spearman correlation.

Results:

We included 274 patients with a mean age 49 (SD 14) years, median disease duration 60 month (IQR 24-135), 155 (56.6%) of patients are male, 47% (n:129) axial SpA and 52.9 (n:145) peripheral SpA. One hundred and nine patients (43.4%) presented good health status, 117 (42.7%) had moderate state of health and 38 (13.9%) had poor health. In the bivariate analyses patients with ASAS health index greater than or equal to 12 (poor status), were older [54 (11) vs 48 (14), p: 0.01], had higher disease duration [11(IQR 57-192) vs 60 (IQR 24-120), p: 0.02], more hypertension [20 (52.6%) vs 67 (28.4%), p:0.004], more diabetes mellitus [10 (26.3%) vs 22(9.3%), p: 0.006], depression [6 (15.8%) vs 10 (4.2%), p:0.013], anxiety [8 (21%) vs (22 (9.3%),p:0.046], less years of education [9.8 (SD 3.5) vs 13 (SD 10), p:0.001], higher ASQol [12.6 (SD 4.6) vs 5.7 (SD4), p < 0.001], BASFI [7(SD2) vs 4(SD6), p: 0.001], DAS28 [4.71 (SD3.2) vs 2.8 (SD1),p: <0.001]. In the multivariate analyses the following variables were independently associated with poor health status: duration of disease, ASQol and DAS28. ASAS HI showed positive correlation with the following parameters: BASDAI (r:0.67, p< 0.001), HAQ (r:0.54, p< 0.001), ASDAS (r:0.67, p< 0.001), ASQol (r:0.80, p< 0.001), BASFI (r:0.72, p< 0.001) and DAS28 (0.56, p< 0.001).

Conclusion:

Poor health status is associated with disease activity, poor quality of life and functional activity. ASAS HI has a good correlation with other parameters to evaluate SpA, reinforcing the construct validity of this new tool.

References:

[1]Kiltz U,et al.Ann Rheum Dis2018;0:1–7.

Disclosure of Interests:

None declared

Cervicovaginal microbiome and natural history of HPV in a longitudinal study

BACKGROUND

Human papillomavirus (HPV) infection is one of the most common sexually transmitted infections. However, only a small percentage of high-risk (HR) HPV infections progress to cervical precancer and cancer. In this study, we investigated the role of the cervicovaginal microbiome (CVM) in the natural history of HR-HPV.

METHODS

This study was nested within the placebo arm of the Costa Rica HPV Vaccine Trial that included women aged 18-25 years of age. Cervical samples from two visits of women with an incident HR-HPV infection (n = 273 women) were used to evaluate the prospective role of the CVM on the natural history of HR-HPV. We focus specifically on infection clearance, persistence, and progression to cervical intraepithelial neoplasia grade 2 and 3 (CIN2+). The CVM was characterized by amplification and sequencing the bacterial 16S V4 rRNA gene region and the fungal ITS1 region using an Illumina MiSeq platform. OTU clustering was performed using QIIME2. Functional groups were imputed using PICRUSt and statistical analyses were performed using R.

RESULTS

At Visit 1 (V1) abundance of Lactobacillus iners was associated with clearance of incident HR-HPV infections (Linear Discriminant Analysis (LDA)>4.0), whereas V1 Gardnerella was the dominant biomarker for HR-HPV progression (LDA>4.0). At visit 2 (V2), increased microbial Shannon diversity was significantly associated with progression to CIN2+ (p = 0.027). Multivariate mediation analysis revealed that the positive association of V1 Gardnerella with CIN2+ progression was due to the increased cervicovaginal diversity at V2 (p = 0.040). A full multivariate model of key components of the CVM showed significant protective effects via V1 genus Lactobacillus, OR = 0.41 (0.22-0.79), V1 fungal diversity, OR = 0.90 (0.82-1.00) and V1 functional Cell Motility pathway, OR = 0.75 (0.62-0.92), whereas V2 bacterial diversity, OR = 1.19 (1.03-1.38) was shown to be predictive of progression to CIN2+.

CONCLUSION

This study demonstrates that features of the cervicovaginal microbiome are associated with HR-HPV progression in a prospective longitudinal cohort. The analyses indicated that the association of Gardnerella and progression to CIN2+ may actually be mediated by subsequent elevation of microbial diversity. Identified features of the microbiome associated with HR-HPV progression may be targets for therapeutic manipulation to prevent CIN2+.

TRIAL REGISTRATION

ClinicalTrials.gov NCT00128661.

FLASHForward: plasma wakefield accelerator science for high-average-power applications

The FLASHForward experimental facility is a high-performance test-bed for precision plasma wakefield research, aiming to accelerate high-quality electron beams to GeV-levels in a few centimetres of ionized gas. The plasma is created by ionizing gas in a gas cell either by a high-voltage discharge or a high-intensity laser pulse. The electrons to be accelerated will either be injected internally from the plasma background or externally from the FLASH superconducting RF front end. In both cases, the wakefield will be driven by electron beams provided by the FLASH gun and linac modules operating with a 10 Hz macro-pulse structure, generating 1.25 GeV, 1 nC electron bunches at up to 3 MHz micro-pulse repetition rates. At full capacity, this FLASH bunch-train structure corresponds to 30 kW of average power, orders of magnitude higher than drivers available to other state-of-the-art LWFA and PWFA experiments. This high-power functionality means FLASHForward is the only plasma wakefield facility in the world with the immediate capability to develop, explore and benchmark high-average-power plasma wakefield research essential for next-generation facilities. The operational parameters and technical highlights of the experiment are discussed, as well as the scientific goals and high-average-power outlook. This article is part of the Theo Murphy meeting issue 'Directions in particle beam-driven plasma wakefield acceleration'.

Cervical determinants of anal HPV infection and high-grade anal lesions in women: a collaborative pooled analysis

BACKGROUND

Cervical cancer screening might contribute to the prevention of anal cancer in women. We aimed to investigate if routine cervical cancer screening results-namely high-risk human papillomavirus (HPV) infection and cytohistopathology-predict anal HPV16 infection, anal high-grade squamous intraepithelial lesions (HSIL) and, hence, anal cancer.

METHODS

We did a systematic review of MEDLINE, Embase, and the Cochrane library for studies of cervical determinants of anal HPV and HSIL published up to Aug 31, 2018. We centrally reanalysed individual-level data from 13 427 women with paired cervical and anal samples from 36 studies. We compared anal high-risk HPV prevalence by HIV status, cervical high-risk HPV, cervical cytohistopathology, age, and their combinations, using prevalence ratios (PR) and 95% CIs. Among 3255 women with anal cytohistopathology results, PRs were similarly calculated for all anal HSIL and HPV16-positive anal HSIL.

FINDINGS

Cervical and anal HPV infections were highly correlated. In HIV-negative women, anal HPV16 prevalence was 41% (447/1097) in cervical HPV16-positive versus 2% (214/8663) in cervical HPV16-negative women (PR 16·5, 95% CI 14·2-19·2, p<0·0001); these values were 46% (125/273) versus 11% (272/2588) in HIV-positive women (4·4, 3·7-5·3, p<0·0001). Anal HPV16 was also associated with cervical cytohistopathology, with a prevalence of 44% [101/228] for cervical cancer in HIV-negative women (PR vs normal cytology 14·1, 11·1-17·9, p<0·0001). Anal HSIL was associated with cervical high-risk HPV, both in HIV-negative women (from 2% [11/527] in cervical high-risk HPV-negative women up to 24% [33/138] in cervical HPV16-positive women; PR 12·9, 95% CI 6·7-24·8, p<0·0001) and HIV-positive women (from 8% [84/1094] to 17% [31/186]; 2·3, 1·6-3·4, p<0·0001). Anal HSIL was also associated with cervical cytohistopathology, both in HIV-negative women (from 1% [5/498] in normal cytology up to 22% [59/273] in cervical HSIL; PR 23·1, 9·4-57·0, p<0·0001) and HIV-positive women (from 7% [105/1421] to 25% [25/101]; 3·6, 2·5-5·3, p<0·0001). Prevalence of HPV16-positive anal HSIL was 23-25% in cervical HPV16-positive women older than 45 years (5/20 in HIV-negative women, 12/52 in HIV-positive women).

INTERPRETATION

HPV-based cervical cancer screening programmes might help to stratify anal cancer risk, irrespective of HIV status. For targeted secondary anal cancer prevention in high-risk groups, HIV-negative women with cervical HPV16, especially those older than 45 years, have a similar anal cancer risk profile to that of HIV-positive women.

FUNDING

International Agency for Research on Cancer.

Tongue position assessment during oral phase deglutition in children with anterior open bite and normal vertical overbite

INTRODUCTION

Tongue position during deglutition presents great variability and can be assessed clinically or with different techniques.

AIM

This study aims to determine tongue position during deglutition in children aged 8-16 years with anterior open bite (AOB) and normal vertical overbite (NVO) using a fluorescein technique.

SETTINGS AND DESIGN

A cross-sectional analytical study was conducted to assess tongue contact points during the oral phase of deglutition.

SUBJECTS AND METHODS

A total of 132 children with AOB and 132 children with NVO were included in this study. The difference between tongue contacts in both groups was performed, and the association between tongue position and anterior occlusion was establish.

STATISTICAL ANALYSIS USED

Normal distribution analysis, Parson's Chi-square test (P < 0.05).

RESULTS

In AOB, about 28.8% showed tongue contact on the palatal surface of the incisors during the oral phase, 25.8% at the gingival margin, and 22% on the palatal rugae. Regarding NVO, 53% showed contact on the palatal rugae, 28.8% at the gingival margin, and 13.6% at the palatal surface.

CONCLUSION

AOB group presented a higher prevalence of impaired tongue positions compared to NVO controls. The palatal surface was the most frequent contact point in the AOB, whereas tongue showed contact points at the palatal rugae in NVO.

Transcriptome-wide analysis of wild Asari (=Manila) clams affected by the Brown Muscle Disease: Etiology and impacts of the disease

Recently, we reported an emerging pathology named Brown Muscle Disease (BMD) affecting Asari clams inhabiting the most productive area for this species in France, the Arcachon Bay. The main macroscopic feature of the pathology relies on the atrophy of the posterior adductor muscle, affecting the ability of clams to burry. The research of the etiological agent of BMD privileged a viral infection. Contrary to healthy clams, infected animals are always found at the surface of the sediment and exhibit 30 nm virus-like particles in muscle, granulocytic and rectal cells. In order to get more insights on the etiology and impacts of the BMD on clams, we took advantage in the present study of next generation sequencing technologies. An RNA-Seq approach was used (i) to test whether viral RNA sequences can be specifically found in the transcriptome of diseased animals and (ii) to identify the genes that are differentially regulated between diseased and healthy clams. Contrary to healthy buried animals, in diseased clams one sequence showing extensive homologies with retroviridae-related genes was detected. Among the biological processes that were affected in diseased clams, the synaptic transmission process was the most represented. To deepen this result, a new sampling was carried out and the transcription level of genes involved in synaptic transmission was determined in healthy and diseased clams but also in clams with no visible sign of pathology but located at the surface of the sediment. Our findings suggest that muscle atrophy is a latter sign of the pathology and that nervous system could be instead a primary target of the BMD agent.

Abstract P4-12-04: Use of complementary and integrative medicine therapies in Chilean patients with breast cancer. Experience of a private center: prevalence and characteristics of patients

Background: During the last decade several studies have been reported that the use of complementary and integrative medicine (CIM), defined as health care methods generated outside of standard Western, or conventional clinical practices has been increasing among breast cancer patients in developed countries. However, there is little information about the use of CIM in developing countries. Chile currently has no published statistics on the use of CIM in breast cancer.

Methods: We conducted a cross-sectional survey between March and June 2017 in breast cancer patients treated in Clinica Alemana de Santiago to determine the prevalence of CIM use and the types of preferred CIM. We also analyzed associations between CIM and several variables including sociodemographic variables, the reasons that motivated the use of CIM and the subjective benefits that patients attributed to CIM. Statistical analysis included two tailed t–test for continuous variables, Fischer's exact test for categorical variables and logistic regression for association between CIM use and other variables.

Results: 288 patients answered the survey. Among them, 98.9% were women, mostly between 41 and 50 years (40.4%). 44.9% (n = 129) reported using CIM. No association was found between the use of CIM and sociodemographic variables (sex, age, education, income). Most used CIM types were: vitamins / minerals (50.4%), herbs (48.8%), special diets (42.6%), meditation/prayers (37.2%). The reasons for CIM use were "to do everything possible" (72%), "improve immunity" (67.8%), "reduce side effects of treatment" (32.7%), recommendation by family member or friend (32.7%). Regarding CIM habits, 50.8% of patients reported having started CIM use at the time of diagnosis and only 51.6% reported about CIM use to their attending physician. Most patients reported benefits associated to CAM use (61%) but no differences were found in reported quality of life.

Conclusions: Great amount of the patients reported using CIM and half of them mentioned that they shared this information with their attending physician. It is necessary incorporate to medical routines questions regarding CIM use and to educate the patients regarding the safe use of CIM and the possible interactions of these approaches with conventional clinical practices.

Citation Format: Salas C, Lopez G, Cadiz F, Barriga C, Gonzalez P, Acevedo S, Raimilla P, Pincheira P, Naing A, Quiroga M. Use of complementary and integrative medicine therapies in Chilean patients with breast cancer. Experience of a private center: prevalence and characteristics of patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-12-04.

Abstract P5-05-14: Withdrawn

This abstract was withdrawn by the authors.

Citation Format: Elia AM, Rojas P, Liguori M, Gonzalez P, Caillet I, Martínez Vazquez P, Burruchaga J, Gass H, Lanari C. Withdrawn [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-05-14.

Tunable Plasma-Based Energy Dechirper

A tunable plasma-based energy dechirper has been developed at FLASHForward to remove the correlated energy spread of a 681 MeV electron bunch. Through the interaction of the bunch with wakefields excited in plasma the projected energy spread was reduced from a FWHM of 1.31% to 0.33% without reducing the stability of the incoming beam. The experimental results for variable plasma density are in good agreement with analytic predictions and three-dimensional simulations. The proof-of-principle dechirping strength of 1.8  GeV/mm/m significantly exceeds those demonstrated for competing state-of-the-art techniques and may be key to future plasma wakefield-based free-electron lasers and high energy physics facilities, where large intrinsic chirps need to be removed.

Simvastatin interferes with cancer 'stem-cell' plasticity reducing metastasis in ovarian cancer

Cell plasticity of 'stem-like' cancer-initiating cells (CICs) is a hallmark of cancer, allowing metastasis and cancer progression. Here, we studied whether simvastatin, a lipophilic statin, could impair the metastatic potential of CICs in high-grade serous ovarian cancer (HGS-ovC), the most lethal among the gynecologic malignancies. qPCR, immunoblotting and immunohistochemistry were used to assess simvastatin effects on proteins involved in stemness and epithelial-mesenchymal cell plasticity (EMT). Its effects on tumor growth and metastasis were evaluated using different models (e.g., spheroid formation and migration assays, matrigel invasion assays, 3D-mesomimetic models and cancer xenografts). We explored also the clinical benefit of statins by comparing survival outcomes among statin users vs non-users. Herein, we demonstrated that simvastatin modifies the stemness and EMT marker expression patterns (both in mRNA and protein levels) and severely impairs the spheroid assembly of CICs. Consequently, CICs become less metastatic in 3D-mesomimetic models and show fewer ascites/tumor burden in HGS-ovC xenografts. The principal mechanism behind statin-mediated effects involves the inactivation of the Hippo/YAP/RhoA pathway in a mevalonate synthesis-dependent manner. From a clinical perspective, statin users seem to experience better survival and quality of life when compared with non-users. Considering the high cost and the low response rates obtained with many of the current therapies, the use of orally or intraperitoneally administered simvastatin offers a cost/effective and safe alternative to treat and potentially prevent recurrent HGS-ovCs.

Evidence for single-dose protection by the bivalent HPV vaccine-Review of the Costa Rica HPV vaccine trial and future research studies

The Costa Rica Vaccine Trial (CVT), a phase III randomized clinical trial, provided the initial data that one dose of the HPV vaccine could provide durable protection against HPV infection. Although the study design was to administer all participants three doses of HPV or control vaccine, 20% of women did not receive the three-dose regimens, mostly due to involuntary reasons unrelated to vaccination. In 2011, we reported that a single dose of the bivalent HPV vaccine could be as efficacious as three doses of the vaccine using the endpoint of persistent HPV infection accumulated over the first four years of the trial; findings independently confirmed in the GSK-sponsored PATRICIA trial. Antibody levels after one dose, although lower than levels elicited by three doses, were 9-times higher than levels elicited by natural infection. Importantly, levels remained essentially constant over at least seven years, suggesting that the observed protection provided by a single dose might be durable. Much work has been done to assure these non-randomized findings are valid. Yet, the group of recipients who received one dose of the bivalent HPV vaccine in the CVT and PATRICIA trials was small and not randomly selected nor blinded to the number of doses received. The next phase of research is to conduct a formal randomized, controlled trial to evaluate the protection afforded by a single dose of HPV vaccine. Complementary studies are in progress to bridge our findings to other populations, and to further document the long-term durability of antibody response following a single dose.

Design and statistical considerations for studies evaluating the efficacy of a single dose of the human papillomavirus (HPV) vaccine

Cervical cancer is a leading cause of cancer mortality in women worldwide. Human papillomavirus (HPV) types 16 and 18 cause about 70% of all cervical cancers. Clinical trials have demonstrated that three doses of either commercially available HPV vaccine, Cervarix ® or Gardasil ®, prevent most new HPV 16/18 infections and associated precancerous lesions. Based on evidence of immunological non-inferiority, 2-dose regimens have been licensed for adolescents in the United States, European Union, and elsewhere. However, if a single dose were effective, vaccine costs would be reduced substantially and the logistics of vaccination would be greatly simplified, enabling vaccination programs in developing countries. The National Cancer Institute (NCI) and the Agencia Costarricense de Investigaciones Biomédicas (ACIB) are conducting, with support from the Bill & Melinda Gates Foundation and the International Agency for Research on Cancer (IARC), a large 24,000 girl study to evaluate the efficacy of a 1-dose regimen. The first component of the study is a four-year non-inferiority trial comparing 1- to 2-dose regimens of the two licensed vaccines. The second component is an observational study that estimates the vaccine efficacy (VE) of each regimen by comparing the HPV infection rates in the trial arms to those in a contemporaneous survey group of unvaccinated girls. In this paper, we describe the design and statistical analysis for this study. We explain the advantage of defining non-inferiority on the absolute risk scale when the expected event rate is near 0 and, given this definition, suggest an approach to account for missing clinic visits. We then describe the problem of estimating VE in the absence of a randomized placebo arm and offer our solution.