First-line therapy with palbociclib in patients with advanced HR+/HER2- breast cancer: The real-life study PALBOSPAIN

PURPOSE

To evaluate the efficacy and safety of first-line therapy with palbociclib in a Spanish cohort treated after palbociclib approval.

METHODS

PALBOSPAIN is an observational, retrospective, multicenter study evaluating real-world patterns and outcomes with 1 L palbociclib in men and women (any menopausal status) with advanced HR+/HER2- BC diagnosed between November 2017 and November 2019. The primary endpoint was real-world progression-free survival (rw-PFS). Secondary endpoints included overall survival (OS), the real-world response rate (rw-RR), the clinical benefit rate, palbociclib dose reduction, and safety.

RESULTS

A total of 762 patients were included. The median rw-PFS and OS were 24 months (95% CI 21-27) and 42 months (40-not estimable [NE]) in the whole population, respectively. By cohort, the median rw-PFS and OS were as follows: 28 (95% CI 23-39) and 44 (95% CI 38-NE) months in patients with de novo metastatic disease, 13 (95% CI 11-17) and 36 months (95% CI 31-41) in patients who experienced relapse < 12 months after the end of ET, and 31 months (95% CI 26-37) and not reached (NR) in patients who experienced relapse > 12 months after the end of ET. rw-PFS and OS were longer in patients with oligometastasis and only one metastatic site and those with non-visceral disease. The most frequent hematologic toxicity was neutropenia (72%; grade ≥ 3: 52.5%), and the most common non-hematologic adverse event was asthenia (38%).

CONCLUSION

These findings, consistent with those from clinical trials, support use of palbociclib plus ET as 1 L for advanced BC in the real-world setting, including pre-menopausal women and men.

TRIAL REGISTRATION NUMBER

NCT04874025 (PALBOSPAIN). Date of registration: 04/30/2021 retrospectively registered.

The role of snow in scavenging aerosol particles: A physical-chemical characterization

The below cloud scavenging of aerosols by snow has been analysed in León (NW Spain). Six snow events were registered over the course of one year of study. Ultrafine and accumulation aerosol particles were measured using a scanning mobility particle sizer spectrometer, while hydrometeors were characterized using a disdrometer. Furthermore, the chemical composition of the melted snow-water samples (soluble and insoluble fractions) was analysed. The scavenging coefficient (λ) showed a great variability among events. An effective washing of particles was observed during the first 30 min of snowfall. The mean change in the scavenging efficiency (%ΔC) of particle number concentration (PNC) and λ coefficient during this time interval were: i) nucleation mode: 36.3 % and 3.02 · 10-4 s-1; ii) Aitken mode: 30.4 % and 2.37 · 10-4 s-1 and iii) accumulation mode: 22.4 % and 1.77 · 10-4 s-1. The range of particle sizes that is less efficiently scavenged by snowfall was observed between 400 and 600 nm. When analyzing the whole snow event, an increase of PNC was observed. Two possible explanations underlie this behaviour: it could be caused by changes in air masses or by the resuspension of aerosol particles scavenged by snowflakes upon reaching the ground. A clear relationship was observed between Ca2+, SO42- and NO3- concentrations of aerosol particles before the snow event and the concentrations registered in the melted snow-water. The largest and smallest changes in aerosol number concentrations were caused by snowflakes of 3 and 6 mm in diameter, respectively. The particle size distributions (PSD) were fitted to log-normal distributions and the parameters were compared before and after snowfall.

Delirium and subsyndromal delirium in the intensive care unit: In-hospital outcomes and prognosis at discharge

BACKGROUND AND OBJECTIVE

The characteristics and outcomes of patients with subsyndromal delirium (SSD) at hospitalization are still under discussion. The objectives were to describe the incidence of delirium and SSD in the intensive care unit (ICU), to analyze the association with risk factors and to explore outcomes of delirium and SSD at hospitalization and three months after discharge.

PATIENTS AND METHODS

A prospective study, with telephone follow-up three months after discharge. The study included 270 patients over one year. Delirium and SSD were assessed with the CAM-ICU.

RESULTS

22.96% developed delirium and 17.03% SSD. The main risk factors associated with the development of delirium were cognitive impairment (P=.000), age ≥75years (P=.019), neurological admission (P=.003), shock (P=.043), bedsores (P=.010), polypharmacy (P=.017), ARM (P=.001) and fast (P=.028), and with the development of SSD were low schooling (P=.014), Charlson >5 (P=.028), AIVD <8 (P=.001), enteral feeding (P=.000) and non-cardiovascular admission (P=.019). Overall mortality was 6% in the group without delirium (reference), 8% in SSD (P=.516) and 30% in delirium (P=.000). Median ICU length of stay was 2 (IQR, 1-2) days in the group without delirium, 3 (IQR, 2-4) days in SSD (P=.0001), and 3 (IQR, 2-7) days in delirium group (P=.0001). Three months after discharge, instrumental ADL were preserved in 50% of the group without delirium, 30% of SSD (P=.026) and 26% of delirium (P=.005).

CONCLUSIONS

The SSD group presented an intermediate prognosis between no delirium and delirium groups. It is advisable to promote its diagnosis for better risk classification.

Adaptation culturally and linguistically to the Chilean population and validation the Dry Eye Questionnaire 5

BACKGROUND AND OBJECTIVE

There are different methods for evaluating dry eye disease (DID), including questionnaires that analyze different aspects of its symptoms, which are important for its better understanding and therapeutic management. The Dry Eye Questionnaire 5 (DEQ-5), is unique in its kind, because in addition to its simplicity, it measures symptoms in 4 dimensions. the aim of this study is to adapt culturally and linguistically and validate this instrument to the Chilean population.

MATERIAL AND METHODS

for the adaptation, the translation and retro-translation of the original version was carried out, its linguistic analysis, the pilot test and the expert panel review (which included a linguistics specialist) were used. For the validation, a psychometric analysis of reliability and validity of the construct was incorporated. The sample in which it was validated was constituted by 205 people with dry eye disease.

RESULTS

141 (69%) of the respondents were women, the mean of age was 48 years ± 16,7, and the median of the total score DEQ-5 was 13 points (R.I 8 - 15 points). The adapted version resulted in a Cronbach alpha of 0.8085, scoring that classified it as good.

DISCUSSION

the questionnaire DEQ-5, which was adapted and validated, was a good instrument to be used in populations with similar characteristics of those in the study. More so, the factor analysis enriched comprehension of the way in which people with dry eye disease relate their symptoms and which questions relate more between them, representing in a better way the aspects evaluated of the symptomatology of this disease.

Effect of Smoking Exposure on Nonsurgical Periodontal Therapy: 1-Year Follow-up

This study investigated the influence of different levels of exposure to smoking on periodontal healing for 12 mo after nonsurgical periodontal therapy and supportive periodontal care every third month. Eighty smokers willing to quit smoking and with periodontitis were included. Participants were offered an individualized voluntary smoking cessation program. Data collection included questionnaires and a full-mouth periodontal examination. Group-based trajectory modeling was used to model smoking trajectories over the follow-up. The effect of smoking trajectory on periodontal parameters over time was estimated with mixed effects modeling. Three smoking patterns were identified: light smokers/quitters (n = 46), moderate smokers (n = 17), and heavy smokers (n = 17). For the periodontal data, the first factor, moderate periodontitis, included the number of sites with clinical attachment levels (CALs) of 4, 5, 6, and 7 mm; periodontal pocket depths (PPDs) of 4, 5, and 6 mm; and bleeding on probing. The second factor, severe periodontitis, consisted of the number of sites with a CAL ≥8 mm and PPD ≥7 mm. Heavy smokers commenced with a higher average CAL of 1.1 mm and 10 more sites with severe periodontitis than light smokers/quitters. While light smokers/quitters and moderate smokers obtained an average improvement of 0.6-mm PPD and 0.7-mm CAL, respectively, heavy smokers experienced 0.5-mm attachment loss. Heavy smokers had only a 50% reduction in the number of sites with moderate periodontitis when compared with light smokers/quitters and moderate smokers. While most participants benefited from nonsurgical periodontal therapy with results affected in a dose-response manner, the therapy had no effect on severe periodontitis among heavy smokers. Smoking cessation should be part of periodontal therapy; otherwise, limited benefits would be observed among heavy smokers, hindering the effect of treatment.

Limits to Gauge Coupling in the Dark Sector Set by the Nonobservation of Instanton-Induced Decay of Super-Heavy Dark Matter in the Pierre Auger Observatory Data

Instantons, which are nonperturbative solutions to Yang-Mills equations, provide a signal for the occurrence of quantum tunneling between distinct classes of vacua. They can give rise to decays of particles otherwise forbidden. Using data collected at the Pierre Auger Observatory, we search for signatures of such instanton-induced processes that would be suggestive of super-heavy particles decaying in the Galactic halo. These particles could have been produced during the post-inflationary epoch and match the relic abundance of dark matter inferred today. The nonobservation of the signatures searched for allows us to derive a bound on the reduced coupling constant of gauge interactions in the dark sector: α_{X}≲0.09, for 10^{9}≲M_{X}/GeV<10^{19}. Conversely, we obtain that, for instance, a reduced coupling constant α_{X}=0.09 excludes masses M_{X}≳3×10^{13}  GeV. In the context of dark matter production from gravitational interactions alone, we illustrate how these bounds are complementary to those obtained on the Hubble rate at the end of inflation from the nonobservation of tensor modes in the cosmological microwave background.

Phenolic and colour characteristics of must and wine obtained from red grapes treated by pulsed electric fields. Efficacy of PEF to reduce maceration time in elaboration of red wines

Pulsed electric fields effect was studied on the physico-chemical and general phenolic composition as colour characteristics and stilbene content in must and wine. For this purpose, a continuous pulsed electric fields equipment was used to treat three red grape varieties of DOCa Rioja. Graciano, Tempranillo and Grenache wines from these grapes were elaborated with different maceration times, 2 days in the untreated sample (control) and the PEF-treated sample (PEF), and normal maceration time in another untreated sample (control-NM). Parameters as colour intensity, anthocyanin content, total polyphenol index and tannin content showed no differences between the PEF sample with 2 days of maceration and the control-NM sample, except in the case of Tempranillo wines. Total stilbenes, trans-resveratrol and trans-piceid of Graciano wines elaborated from PEF samples showed a higher concentration than the control wines. Alternatively, PEF wines and control-NM wines showed no differences between them. Tempranillo variety wines presented no differences between the three types of samples. In the Grenache variety, only trans-piceid levels showed differences between control and PEF wines. Moreover, relationship between must and wine characteristics was evaluated and compared between different samples. The trend lines obtained for the CI, TPI and AC parameters for samples of Graciano, Tempranillo and Garnacha indicate that the initial content of compounds extracted significantly affected the days of maceration necessary to obtain the appropriate wine. The results obtained increase the knowledge of pulsed electric fields as a technology available for use in the winery to elaborate red wines with reduced maceration time.

Factors that affect physicochemical and acid-base properties of compost and vermicompost and its potential use as a soil amendment

Composting and vermicomposting have attracted attention in relation to both waste management and the potential to produce organic amendments that could improve soil quality. The main differences between compost depend on the feedstock, the production process, and the degree of maturity. In the present study, samples of compost of different origin (food and green waste, livestock waste, algae waste, urban waste or sewage sludge) or subjected to different composting methods (traditional or using earthworms) were collected for analysis. Additionally, samples collected at various stages of the composting process were compared (raw material, 15 and 30 days of composting, and final compost). Different analysis and techniques were used to establish the chemical composition, physicochemical and acid-base properties of compost samples and the organic matter extracts. The correlations obtained (between the abundance of acid groups in different extracts of the compost or between the cation exchange capacity and the C/N atomic ratio) would allow for predicting the compost behaviour based on certain characteristics, and a reduction in the number of parameters determined experimentally, thus facilitating comparisons between different compost. In addition, the potential value of the compost as amendment was tested with a Haplic Cambisol from a mining area. The application of compost increased the pH, the organic matter and nutrient content, and promoted seed germination and root growth.

P–492 Knowledge about reproductive health among cohort of oocyte donors in Spain

Study question

What degree of reproductive health knowledge have oocyte donors?

Summary answer

The results of this study reveal that although oocyte donors are aware of the risks of possible fertility disorders, reproductive health knowledge is insufficient

What is known already

Sterility affects approximately 15% of the population of reproductive age, that is, young people. However, the information that young people have about fertility is scarce. Gamete donors are a group especially involved in reproductive issues since they help many people to solve their fertility problems and must undergo numerous tests before being accepted as such. However, there are no studies in Spain that deal with the knowledge that young people and, more specifically, donors, have about reproductive health and fertility

Study design, size, duration

A prospective, cross-sectional multicenter study including oocyte donors at ten fertility clinics performing gamete donation treatment in Spain. During a 2-month period (September-October 2020), 63 donors aged between 19 and 35 years old were recruited consecutively and a total of 63 oocyte donors were included as sample population. Most of them (78%) had not donated before

Participants/materials, setting, methods

54% oocyte donors had secondary education and 43% have achieved university studies. Participants anonymously completed a questionnaire containing 41 questions divided into three sections: sociodemographic characteristics (11 items), knowledge on fertility and reproduction (22 items) and with a Likert scale, response to determine general reproductive health information as well as known risks for fertility disorders (8 items).

Besides descriptive statistics, statistical analysis was performed with Chi square test. p &lt; 0.05 was considered significant

Main results and the role of chance

In the survey 96.8% of the participants reported that they had already known the tests for fertility disorders.

The increasing age of the women was correctly assessed by the participants of the study as a decisive risk factor for fertility, but it was found that exact knowledge was lacking: the decrease of a woman’s fertility by 39.7% was stated to occur on average at the age of 35–40 and by 30% at 40–45. Nevertheless, 66% of donors considered that fertility preservation should be carried out before the age of 35.

61.1% of the non-university donors reported that fertility can drop as a woman ages due to the decreasing number and quality of the remaining eggs. Among university donors, this percentage increases to 92,6% (p:0,034). Merely 47% of the participants informed what they understood that ovarian reserve is and 47.6% of donors believed that women create new eggs every month.

Regarding the known risk factors for fertility, lifestyle was mentioned most frequently by all participants (91,2%), followed by chemo/radiotherapy (83,8%) and smoking, alcohol, and drugs (82,4%). Concerning the influence of the body mass index on fertility, differences were found between non-university (61%) and university donors (88,9%) (p:0,012).

Limitations, reasons for caution

Financial compensation has been found to be a motivating factor for oocyte donors and therefore one could question the representativeness of the participating oocyte donors. It would be of great interest to explore the significance of the financial compensation further.

Wider implications of the findings: The present study reveals an existing requirement for information among oocyte donors, which is not only important for the success of prevention plans but also provides a foundation for possible strategies for the prevention of fertility disorder.

Trial registration number

Not applicable

[Toxic epidermal necrolysis: idiosyncratic reaction to drugs]

Toxic epidermal necrolysis (NET) and Steven Johnson syndrome (SJS) are infrequent mucocutaneous hypersensitivity reactions with systemic involvement. They are predominantly caused by drugs. We report the case of a patient over 60 years of age who presented with extensive mucocutaneous and ophthalmic injury with hemodynamic failure, associated with the rapid onset of lamotrigine in a short period of time. Although the incidence is low, the mortality rate is high. It requires early suspicious and diagnosis in addition to an interdisciplinary therapeutic approach.

Measurement of the Fluctuations in the Number of Muons in Extensive Air Showers with the Pierre Auger Observatory

We present the first measurement of the fluctuations in the number of muons in extensive air showers produced by ultrahigh energy cosmic rays. We find that the measured fluctuations are in good agreement with predictions from air shower simulations. This observation provides new insights into the origin of the previously reported deficit of muons in air shower simulations and constrains models of hadronic interactions at ultrahigh energies. Our measurement is compatible with the muon deficit originating from small deviations in the predictions from hadronic interaction models of particle production that accumulate as the showers develop.

Management of off-specification compost by using co-hydrothermal carbonization with olive tree pruning. Assessing energy potential of hydrochar

In this work the management of a waste called off-specification compost (OSC) was proposed via hydrothermal carbonization (HTC). The composition of this residue makes it not suitable for agronomic purposes because of the Spanish regulation requirements. Therefore, a way of management and/or valorisation needs to be found. The energy recovery through co-HTC with olive tree pruning (OTP) was evaluated. Blending of OSC with lignocellulosic biomass allows to obtain a coal-like product with physicochemical properties similar to those of a lignite, characterised by its high carbon content. Blends of 25, 50 and 75% of OSC with OTP were analysed. The individual OSC does not present good parameters for being used as solid fuel based on its chemical composition, however, the blend of 75% of biomass with 25% of OSC does. With a higher heating value of 26.19 MJ/kg, this blend shows the best energy yield and energy densification ratio. Thermogravimetric and kinetic analysis reveal that as biomass content in the blend increases, the more the hydrochar behaves as a solid fuel, therefore OSC can be used for energy purposes while its current use of landfill disposal can be reduced.

Immune microenvironment characterisation and dynamics during anti-HER2-based neoadjuvant treatment in HER2-positive breast cancer

Despite their recognised role in HER2-positive (HER2+) breast cancer (BC), the composition, localisation and functional orientation of immune cells within tumour microenvironment, as well as its dynamics during anti-HER2 treatment, is largely unknown. We here investigate changes in tumour-immune contexture, as assessed by stromal tumour-infiltrating lymphocytes (sTILs) and by multiplexed spatial cellular phenotyping, during treatment with lapatinib-trastuzumab in HER2+ BC patients (PAMELA trial). Moreover, we evaluate the relationship of tumour-immune contexture with hormone receptor status, intrinsic subtype and immune-related gene expression. sTIL levels increase after 2 weeks of HER2 blockade in HR-negative disease and HER2-enriched subtype. This is linked to a concomitant increase in cell density of all four immune subpopulations (CD3+, CD4+, CD8+, Foxp3+). Moreover, immune contexture analysis showed that immune cells spatially interacting with tumour cells have the strongest association with response to anti-HER2 treatment. Subsequently, sTILs consistently decrease at the surgery in patients achieving pathologic complete response, whereas most residual tumours at surgery remain inflamed, possibly reflecting a progressive loss of function of T cells. Understanding the features of the resulting tumour immunosuppressive microenvironment has crucial implications for the design of new strategies to de-escalate or escalate systemic therapy in early-stage HER2+ BC.

Acute and Chronic Anti-ganglioside Neuropathies: From Theory to Practice in Buenos Aires, Argentina

Background and Aims

During the last two decades important advances have been made regarding the knowledge of immunomediated neuropathies, which entitled them to evolve from a theoretical existence to subtype differentiation. Nevertheless, questions regarding antigen topography or antibody's pathogenicity still need to be answer. Moreover, antibody typification is not necessarily available during clinical practice and usually diagnostic decisions or follow-up are done without it. The aim of this study is to raise awareness of the importance of divergent clinical findings in patients with immunomediated neuropathies.

Methods

We present an acute and a chronic case of anti-ganglioside neuropathy immunologically studied with the best anti-ganglioside antibody panel available nowadays in our country along with an update of the current knowledge of these entities.

Results

Although there is no consensus regarding the pathogenicity of these antibodies, diverging clinical features (mainly ataxia and ophthalmoparesis) and disease prognosis (as markers of axonal damage) are known to be associated with different antibodies.

Conclusions

Antibody characterization in anti-ganglioside neuropathies is an evolving field, which we believe should periodically updated and minded for patient's diagnosis and follow-up, even if laboratory confirmation is not immediate, if available at all.

Features of the Energy Spectrum of Cosmic Rays above 2.5×10^{18} eV Using the Pierre Auger Observatory

We report a measurement of the energy spectrum of cosmic rays above 2.5×10^{18}  eV based on 215 030 events. New results are presented: at about 1.3×10^{19}  eV, the spectral index changes from 2.51±0.03(stat)±0.05(syst) to 3.05±0.05(stat)±0.10(syst), evolving to 5.1±0.3(stat)±0.1(syst) beyond 5×10^{19}  eV, while no significant dependence of spectral features on the declination is seen in the accessible range. These features of the spectrum can be reproduced in models with energy-dependent mass composition. The energy density in cosmic rays above 5×10^{18}  eV is [5.66±0.03(stat)±1.40(syst)]×10^{53}  erg Mpc^{-3}.

Characterization of inflammatory bowel disease in Colombia: Results of a national register

AIM

To determine the clinical, sociodemographic, and treatment characteristics of inflammatory bowel disease (IBD) in a Colombian population register.

METHODS

A descriptive, analytic, observational, cross-sectional, multicenter study on patients with IBD from 17 hospital centers in 9 Colombian cities was conducted.

RESULTS

A total of 2,291 patients with IBD were documented, 1,813 (79.1%) of whom presented with ulcerative colitis (UC), 456 (19.9%) with Crohn's disease (CD), and 22 with IBD unclassified (0.9%). The UC/CD ratio was 3.9:1. A total of 18.5% of the patients with UC and 47.3% with CD received biologic therapy. Patients with extensive UC had greater biologic therapy use (OR = 2.78, 95% CI: 2.10-3.65, p = 0.000), a higher surgery rate (OR = 5.4, 95% CI: 3.5-8.3, p = 0.000), and greater frequency of hospitalization (OR = 4.34, 95% CI: 3.47-5.44, p = 0.000). Patients with severe UC had greater biologic therapy use (OR = 5.04, 95% CI: 3.75-6.78, p = 0.000), a higher surgery rate (OR = 8.64, 95% CI: 5.4-13.78, p = 0.000), and greater frequency of hospitalization (OR = 28.45, 95% CI: 19.9-40.7, p = 0.000). CD patients with inflammatory disease behavior (B1) presented with a lower frequency of hospitalization (OR = 0.12, 95% CI: 0.07-0.19, p = 0.000), a lower surgery rate (OR = 0.08, 95% CI: 0.043-0.15, p = 0.000), and less biologic therapy use (OR = 0.26, 95% CI: 0.17-0.41, p = 0.000).

CONCLUSION

In Colombia, there is a predominance of UC over CD (3.9:1), as occurs in other Latin American countries. Patients with extensive UC, severe UC, or CD with noninflammatory disease behavior (B2, B3) have a worse prognosis.

Circulating MicroRNA Profile Associated with Obstructive Sleep Apnea in Alzheimer's Disease

The diagnosis of obstructive sleep apnea (OSA) in Alzheimer's disease (AD) by polysomnography (PSG) is challenging due to the required collaboration of the patients. In addition, screening questionnaires have demonstrated limited usefulness with this subpopulation. Considering this, we investigated the circulating microRNA (miRNA) profile associated with OSA in AD patients. This study included a carefully selected cohort of females with mild-moderate AD confirmed by biological evaluation (n = 29). The individuals were submitted to one-night PSG to diagnose OSA (apnea-hypopnea index ≥ 15/h) and the blood was collected in the following morning. The plasma miRNA profile was evaluated using RT-qPCR. The patients had a mean (SD) age of 75.8 (5.99) years old with a body mass index of 28.6 (3.83) kg m^-2. We observed a subset of 15 miRNAs differentially expressed between OSA and non-OSA patients, of which 10 were significantly correlated with the severity of OSA. Based on this, we built a prediction model that generated an AUC (95% CI) of 0.95 (0.88-1.00) including 5 of the differentially expressed miRNAs that correlated with OSA severity: miR-26a-5p, miR-30a-3p, miR-374a-5p, miR-377-3p, and miR-545-3p. Our preliminary results suggest a plasma miRNA signature associated with the presence of OSA in AD patients. Further studies will be necessary to validate these findings.

Environmental and economical assessment for a sustainable Zn/air battery

Metal/Air batteries are being developed and soon could become competitive with other battery technologies already in the market, such as Li-ion battery. The main problem to be addressed is the cyclability, although some progress has been recently achieved. A Life Cycle Assessment (LCA) of the manufacturing process of a Zn/Air battery is presented in this article, including raw extraction and process of materials and battery assembly at laboratory scale (cradle to gate approach). The results indicate that Zn/Air battery can be fabricated with low environmental impacts in most categories and only four deserve attention (still being low impacts), such as Human Toxicity (cancer and non-cancer), Freshwater Ecotoxicity and Resource Depletion (the later one depending mainly on Zn use, which is not a critical material, but has a strong impact on this category). Cathode fabrication arises as the subassembly with higher impacts, followed by membrane, then anode and finally electrolyte. An economic cost calculation indicates that if cyclability of Zn/Air batteries is achieved, they can become competitive with other technologies already in the market.

AB1180 THE EVOLUTION OF AN FLS IN SEARCH OF EXCELLENCE: THE EXPERIENCE OF GRAN CANARIA

Background:

The implementation of an FLS in the Spanish public health system is not an easy task since there are no official plans for the incorporation of personnel dedicated to the unit

Objectives:

To expose the consolidation and improvement of an FLS after its implementation as well as the problems that have arisen over time.

Methods:

The health program for secondary fracture prevention was implemented in 2012. Initially worked with the same staff assigned to the Rheumatology service, since 2016 we have a part-time support nurse. Patients are identified from the emergency registry and, more recently, from patients admitted for hip fracture and treated in a monographic osteoporosis clinic. The baseline visit consists of consultation with the nurse, DXA and bone metabolism analytics. Falling patients are referred to a fall prevention school. Most patients are referred to their primary care physician to start a treatment.

Results:

Of the 2,416 patients attended the baseline visit, 30% were forearm fractures, 27% hip, 20% humerus, 10% spine and 11% other fractures. In comparison to 2012, in 2019 the monthly average of patients has doubled, increased the number of hip and spine fractures, and increased the percentage of captured patients (Table). In spite of consolidating the unit, getting a support nurse for the admitted patients and establishing a solid alliance with primary care, it is pending the involvement of Primary Care Nurses and start first prescription at the hospital.

Table.

Comparison of the first year with the last year of implementation of our FLS.

20122019Mean monthly number of fractures, N2242Type of fracture: forearm/hip/spine, %37/20/628/40/11Captured patients of elegible, %5777Delay in weeks until first visit to FLS, median1412Patient origin: emergency list/inpatient/outpatient, %100/0/059/31/9DXA performed, %10061Referral to fall prevention school, %026Criteria to start a treatment, %6790*Referral to the osteoporosis clinic, %377

*We apply the 2019 recommendations of the Spanish Society of Rheumatology

Conclusion:

We present the achievements made by our FLS along 8 years and the difficulties within the Spanish public health system.

Disclosure of Interests:

Antonio Naranjo Grant/research support from: amgen, Consultant of: UCB, Speakers bureau: AMGEN, Amparo Molina Speakers bureau: AMGEN, STADA, Cristina Sepúlveda: None declared, Candelaria Torres: None declared, Fabiola Santana: None declared, Francisco Rubiño: None declared, Rubén López: None declared, Soledad Ojeda Speakers bureau: AMGEN, LILLY, GEBRO

Level of understanding of Alzheimer disease among caregivers and the general population

INTRODUCTION

Understanding of Alzheimer disease (AD) is fundamental for early diagnosis and to reduce caregiver burden. The objective of this study is to evaluate the degree of understanding of AD among informal caregivers and different segments of the general population through the Alzheimer's Disease Knowledge Scale (ADKS).

PATIENTS AND METHODS

We assessed the knowledge of caregivers in different follow-up periods (less than one year, between 1 and 5 years, and over 5 years since diagnosis) and individuals from the general population. ADKS scores were grouped into different items: life impact, risk factors, symptoms, diagnosis, treatment, disease progression, and caregiving.

RESULTS

A total of 419 people (215 caregivers and 204 individuals from the general population) were included in the study. No significant differences were found between groups for overall ADKS score (19.1 vs 18.8, P = .9). There is a scarce knowledge of disease risk factors (49.3%) or the care needed (51.2%), while symptoms (78.6%) and course of the disease (77.2%) were the best understood aspects. Older caregiver age was correlated with worse ADKS scores overall and for life impact, symptoms, treatment, and disease progression (P < .05). Time since diagnosis improved caregivers' knowledge of AD symptoms (P = .00) and diagnosis (P = .05).

CONCLUSION

Assessing the degree of understanding of AD is essential to the development of health education strategies both in the general population and among caregivers.

Treatment patterns for metastatic colorectal cancer in Spain

Purpose

The primary aim of this retrospective study was to describe the treatment patterns according to the type of treatment received by patients with metastatic colorectal cancer (mCRC) in Spain.

Methods

This was a retrospective, observational, multicenter study performed by 33 sites throughout Spain that included consecutive patients aged 18 years or older who had received or were receiving treatment for mCRC.

Results

At the time of inclusion, of the 873 evaluable patients, 507 (58%) had received two lines, 235 (27%) had received three lines, 106 (12%) had received four lines, and the remaining patients had received up to ten lines. The most frequent chemotherapy schemes were the FOLFOX or CAPOX regimens (66%) for first-line treatment, FOLFOX, CAPOX or FOLFIRI (70%) for second-line treatment, and FOLFOX, FOLFIRI or other fluoropyrimidine-based regimens for third- and fourth-line (over 60%) treatment. Sixty percent of patients received targeted therapy as part of their first-line treatment, and this proportion increased up to approximately 70% of patients as part of the second-line of treatment. A relevant proportion of patients were treated with unknown KRAS, and especially the BRAF, mutation statuses.

Conclusions

This study reveals inconsistencies regarding adherence to the recommendations of the ESMO guidelines for the management of mCRC in Spain. Improved adherence to the standard practice described in such guidelines for the determination of RAS and BRAF mutation statuses and the use of targeted therapies in first-line treatment should be considered to guarantee that patients can benefit from the best therapeutic approaches available.

Are targeted prostate biopsies ready to replace systematic prostate biopsies?

OBJECTIVES

To evaluate the efficacy and efficiency of systematic prostatic biopsy (SPB) and cognitive fusion PB (CFPB) to diagnose prostate cancer (PCa) and significant PCa (SPCa), and to analyse if CFPB could safely replace SPB.

MATERIAL AND METHODS

A cohort of 314 consecutive men having PI-RADS ≥2 in a pre-biopsy 3T mp-MRI were prospectively subjected to trans-rectal ultrasound CFPB (two cores per suspicious area until a maximum of three areas) and a 12 peripheral core SPB. SPCa was considered when the WHO grade was higher than 2 (Gleason 4+3 or higher).

RESULTS

PCa was diagnosed in 133 patients (42.4%), being 83 (62.4%) SPCa. SPB detected PCa in 114 men (85.7%) while CFPB in 103 (77.4%), P<.001. SPB detected SPCa in 64 men (77.1%) while CFPB in 71 (85.5%), P<.001. In 52 of the 81 men (64.2%) SPCa was detected in SPB and CFPB. In 19 men SPCa was only detected in CFPB (23.5%) while in 10, it was only detected in SPB (12.3%). 33.1 cores were needed to diagnose one PCa in SPB while 8.5 in CFPB, P<.001. 58.9 cores were needed to diagnose one SPCa in SPB, while 12.4 in CFPB, P<.001.

CONCLUSIONS

CFPB are more effective and also more efficient than SPBs in detecting SPCa. However, CFPBs still can't safely replace SPBs because they are not able to detect up to 15% of SPCa.

Normative Data for Executive Function and Emotion Interaction Assessment in Adolescents from Rural Areas

Objective

The present work is part of the ongoing project of examining the validation and standardization of the Executive Functions and Emotion Assessment for Adolescents with Risk Behaviors (EFEAA) test in the rural areas of Northwest Mexico. The objectives of the present study were (1) to examine the effects of age and risk behavior on emotionally interfered working memory ability, measured as performance on the Emotionally Interfered Working Memory Task (EIWMT) section of the EFEAA in a group of healthy adolescents from rural areas; and (2) to use these results to construct normative data that can be used in clinical practice.

Participants and Method

A total of 275 adolescents, 14.1 years old, geographically distributed among northwest Mexico were included in the sample. They were individually assessed using the Montreal Cognitive Assessment, Risk Behavior Questionnaire, including: sexual risk behavior, impulsiveness, drug, alcohol, and tobacco consumption, unhealthy food intake, and physical inactivity; for measuring emotion-cognition interaction we used the EIWMT.

Results

Results of this study present a database supported by factors of risk behavior and working memory, which includes: predictors for conduct disorders, drug use, and delinquency, in addition to correlations between the performance of emotionally interfered working memory and risk behaviors associated to health. Percentile and normal distribution tables were generated, demonstrating that there is a high prevalence of risk behavior in rural areas.

Conclusions

This study demonstrates data related to rural areas in northwest Mexico, a region where adolescents are frequently involved in risk behaviors. Additionally, protective factors are understudied in Mexico-US border cities. Further analyses are needed to find reward delay skills on the studied sample as well as urban area comparisons.

Advanced-stage mycosis fungoides: role of the signal transducer and activator of transcription 3, nuclear factor-κB and nuclear factor of activated T cells pathways

BACKGROUND

The malignant mechanisms that control the development of cutaneous T-cell lymphoma (CTCL) are beginning to be identified. Recent evidence suggests that disturbances in specific intracellular signalling pathways, such as RAS-mitogen-activated protein kinase, T-cell receptor (TCR)-phospholipase C gamma 1 (PLCG1)-nuclear factor of activated T cells (NFAT) and Janus kinase (JAK)-signal transducer and activator of transcription (STAT), may play an essential role in the pathogenesis of CTCL.

OBJECTIVES

To investigate the mechanisms controlling disease development and progression in mycosis fungoides (MF), the most common form of CTCL.

METHODS

We collected 100 samples that were submitted for diagnosis of, or a second opinion regarding, MF between 2001 and 2018, 80% of which were in the early clinical stages of the disease. Formalin-fixed paraffin-embedded tissues were used for histological review and to measure the expression by immunohistochemistry of surrogate markers of activation of the TCR-PLCG1-NFAT, JAK-STAT and NF-κB pathways. Folliculotropism and large-cell transformation were also examined.

RESULTS

NFAT and nuclear factor kappa B (NF-κB) markers showed a comparable activation status in early and advanced stages, while STAT3 activation was more frequent in advanced stages and was associated with large-cell transformation. Consistently with this observation, STAT3 activation occurred in parallel with MF progression in two initially MF-negative cases. A significant association of NFAT with NF-κB markers was also found, reflecting a common mechanism of activation in the two pathways. Genomic studies identified nine mutations in seven genes known to play a potential role in tumorigenesis in T-cell leukaemia/lymphoma, including PLCG1, JAK3 and STAT3, which underlies the activation of these key cell-survival pathways. A higher mutational allele frequency was detected in advanced stages.

CONCLUSIONS

Our results show that STAT3 is activated in advanced cases and is associated with large-cell transformation, while the activation of NFAT and NF-κB is maintained throughout the disease. These findings could have important diagnostic and therapeutic implications. What's already known about this topic? Mycosis fungoides is characterized by a clonal expansion of T cells in the skin. The mechanisms controlling disease development and progression are not fully understood. What does this study add? An association of the nuclear factor of activated T cells and nuclear factor kappa B pathways was found, which could reflect a common mechanism of activation. These pathways were activated in early and advanced stages at the same level. Signal transducer and activator of transcription 3 activation was associated with large-cell transformation and was more frequent in advanced stages. A genomic analysis of cutaneous T-cell lymphoma-associated genes was performed. Nine mutations were detected. What is the translational message? These results could have important implications for the treatment of MF in the near future.

A predictive model of pathologic response based on tumor cellularity and tumor-infiltrating lymphocytes (CelTIL) in HER2-positive breast cancer treated with chemo-free dual HER2 blockade

Background

The presence of stromal tumor-infiltrating lymphocytes (TILs) is associated with increased pathologic complete response (pCR) and improved outcomes in HER2-positive early-breast cancer (BC) treated with anti-HER2-based chemotherapy. In the absence of chemotherapy, the association of TILs with pCR following anti-HER2 therapy-only is largely unknown.

Patients and methods

The PAMELA neoadjuvant trial treated 151 women with HER2-positive BC with lapatinib and trastuzumab [and hormonal therapy if hormone receptor (HR)-positive] for 18 weeks. Percentage of TILs and tumor cellularity were determined at baseline (N = 148) and at day 15 (D15) of treatment (N = 134). Associations of TILs and tumor cellularity with pCR in the breast were evaluated. A combined score based on tumor cellularity and TILs (CelTIL) measured at D15 was derived in PAMELA, and validated in D15 samples from 65 patients with HER2-positive disease recruited in the LPT109096 neoadjuvant trial, where anti-HER2 therapy-only was administer for 2 weeks, then standard chemotherapy was added for 24 weeks.

Results

In PAMELA, baseline and D15 TILs were significantly associated with pCR in univariate analysis. In multivariable analysis, D15 TILs, but not baseline TILs, were significantly associated with pCR. At D15, TILs and tumor cellularity were found independently associated with pCR. A combined score (CelTIL) taking into account both variables was derived. CelTIL at D15 as a continuous variable was significantly associated with pCR, and patients with CelTIL-low and CelTIL-high scores had a pCR rate of 0% and 33%, respectively. In LPT109096, CelTIL at D15 was found associated with pCR both as a continuous variable and as group categories using a pre-defined cut-off (75.0% versus 33.3%).

Conclusions

On-treatment TILs, but not baseline TILs, are independently associated with response following anti-HER2 therapy-only. A combined score of TILs and tumor cellularity measured at D15 provides independent predictive information upon completion of neoadjuvant anti-HER2-based therapy.

Clinical trial number

NCT01973660.

The number of biopsied trophectoderm cells may affect pregnancy outcomes

OBJECTIVE

To study if the number of trophectoderm (TE) biopsied cells has an impact on implantation rates.

DESIGN

A retrospective cohort study in a single-center study.

SETTING

In vitro fertilization center.

PATIENTS

Patients who underwent PGT-A from January 2013 to March 2016. In total, 482 vitrified/warmed single embryo transfers were included.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Clinical pregnancies rate, implantation rate.

RESULTS

Overall, clinical pregnancies per embryo transfer were higher when a regular TE were biopsied compared to larger size biopsy cells (66% (175/267) vs 53% (115/215) (p < 0.005) respectively). Pregnancy rates were also analyzed according to embryo morphology at the moment of embryo biopsy, when a good-quality embryo was transferred the clinical outcome was 75% (81/108) in group 1 and 61% (60/99) in group 2 (p < 0.05). Data was also stratified by age in patients ≤ 35 years and > 35 years. The clinical pregnancy was 67% (51/76) in women ≤ 35 years and 65% (124/191) in women > 35 years when a regular size biopsy was performed. These results significantly reduced when a larger size biopsy was performed 54% (49/91) and 53% (66/124), respectively (p < 0.05). Further investigation indicated that miscarriage rate was similar between these groups (4% (7/182) in group 1 and 5% (6/121) in group 2).

CONCLUSIONS

These findings underscore that when a large amount of TE cells are biopsied, it may negatively affect implantation rates, but once implanted, the embryos have the same chance to miscarry or reach term.

Wine aromatic compound production and fermentative behaviour within different non-Saccharomyces species and clones

AIMS

Twenty-five enological yeasts belonging to nine different species (Candida zeylanoides, Cryptococcus uzbekistanensis, Debaryomyces hansenii, Lachancea thermotolerans, Metschnikowia pulcherrima, Torulaspora delbrueckii, Williopsis pratensis, Zygosaccharomyces bailii and Saccharomyces cerevisiae) were screened for aroma formation and fermentative behaviour as part of a non-Saccharomyces yeast selection programme.

METHODS AND RESULTS

Pure cultures were inoculated in pasteurized grape juice in order to perform alcoholic fermentations. Some non-Saccharomyces species did not ferment, others did not get established and none of them completed alcoholic fermentations. The physico-chemical parameters of the wines and the abundance of aromatic compounds at the end of alcoholic fermentation highlighted the notable differences in the aroma-forming ability and fermentative behaviour of the different non-Saccharomyces species, but not within clones.

CONCLUSIONS

Lower diversity was detected within non-Saccharomyces species than that reported in S. cerevisiae with regard to enological behaviour and aromatic profiles. Metschnikowia pulcherrima and L. thermotolerans are the two species with higher possibilities to become an inoculum.

SIGNIFICANCE AND IMPACT OF THE STUDY

Few significant differences were found within clones of the same species, but very important parameters in wine quality, such as volatile acidity, ethyl acetate and acetoin, which would justify selection programmes within those species. The results also demonstrated that T. delbrueckii and L. thermotolerans are two close species in their aromatic profiles.

Abstract P2-09-14: A predictive model of pathological response following dual HER2 blockade-only based on tumor cellularity and tumor-infiltrating lymphocytes (CelTIL) in HER2-positive breast cancer

Background: Increased number of tumor-infiltrating lymphocytes (TILs) at baseline is associated with pathological complete response (pCR) and improved outcomes in HER2-positive early breast cancer treated with anti-HER2-based chemotherapy. In the absence of chemotherapy, the association of TILs with pCR following anti-HER2 therapy-only is currently unknown.

Methods: The PAMELA (NCT01973660)neoadjuvant trial treated 151 women with HER2-positive breast cancer with lapatinib and trastuzumab (and hormonal therapy if hormone receptor-positive) for 18 weeks. Percentage of TILs and tumor cellularity were determined at baseline (n=148) and after 2 weeks of treatment (n=134). Associations of TILs and tumor cellularity with pCR in the breast were evaluated using univariate and multivariable logistic regression models. The regression coefficients were used to derive a score based on TILs and tumor cellularity measured at week 2 (CelTIL) was derived in PAMELA,and tested in week 2 samples from 65 patients with HER2+ disease recruited in the LPT109096 (NCT00524303) phase 2 neoadjuvant trial, where anti-HER2 therapy-only (trastuzumab, lapatinib or the combination) was administered for 2 weeks, followed by the addition of standard multi-agent chemotherapy for 24 weeks.

Results: In PAMELA, at baseline, TILs were significantly associated with pCR in univariate analysis but not in multivariable analysis (adjusted odds ratio [OR]=1.01, 0.98-1.03; p-value=0.620). A statistically significant increase in TILs was observed at week 2 compared to baseline (mean difference +6.9%; p-value&lt;0.001). At week 2, TILs were significantly associated with pCR in univariate and multivariable analyses (adjusted OR=1.04, 1.01-1.06; p-value=0.009). TILs and tumor cellularity at week 2 were independently associated with pCR and a combined score (from 0 to 100) taking into account both variables was derived. CelTIL as a continuous variable was significantly associated with pCR, and patients with CelTIL-low and CelTIL-high scores (cutoff &lt; 33.59) had a pCR rate of 0% and 33%, respectively. Independent validation of CelTIL in week 2 samples from 65 patients with HER2+ disease recruited in the LPT109096 phase 2 neoadjuvant trial will be presented at the conference.

Conclusions: A combined score of TILs and tumor cellularity at week 2 following anti-HER2 therapy-only is associated with pCR upon completion of neoadjuvant anti-HER2-based therapy.

Citation Format: Nuciforo P, Holgado E, Llombart A, Fasani R, Paré L, Pascual T, Oliveira M, Martínez N, Bermejo B, Vidal M, Pernas S, López R, Muñoz M, Garau I, Manso L, Alarcón J, Martínez E, Villagrasa P, Cortés J, Prat A. A predictive model of pathological response following dual HER2 blockade-only based on tumor cellularity and tumor-infiltrating lymphocytes (CelTIL) in HER2-positive breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-09-14.

Hydrocarbon Degradation and Lead Solubility in a Soil Polluted with Lead and Used Motor Oil Treated by Composting and Phytoremediation

Used lubricant oils and metals can be common soil pollutants in abandoned sites. When soil is contaminated with various hazardous wastes, the efficiency of biological treatments could be affected. The purpose of this work was to investigate the effect of combining phytoremediation and composting on the efficiency of hydrocarbon degradation and lead solubility in a soil contaminated with 31,823 mg/kg of total petroleum hydrocarbon (TPH) from used motor oil and 8260 mg/kg of lead. Mexican cactus (Opuntia ficus indica) and yard trimmings were added in the composting process, and lucerne (Medicago sativa) was used in the phytoremediation process. After a 9 week composting process, only 13% of the initial TPH concentration was removed. The following 20 week phytoremediation process removed 48% of TPH. The highest TPH degradation percentage (66%), was observed in the experiment with phytoremediation only. This work demonstrates sustainable technologies, such as biological treatments, represent low-cost options for remediation; however, they are not frequently used because they require long periods of time for success.

Plasma ctDNA RAS mutation analysis for the diagnosis and treatment monitoring of metastatic colorectal cancer patients

Background

RAS assessment is mandatory for therapy decision in metastatic colorectal cancer (mCRC) patients. This determination is based on tumor tissue, however, genotyping of circulating tumor (ct)DNA offers clear advantages as a minimally invasive method that represents tumor heterogeneity. Our study aims to evaluate the use of ctDNA as an alternative for determining baseline RAS status and subsequent monitoring of RAS mutations during therapy as a component of routine clinical practice.

Patients and methods

RAS mutational status in plasma was evaluated in mCRC patients by OncoBEAM™ RAS CRC assay. Concordance of results in plasma and tissue was retrospectively evaluated. RAS mutations were also prospectively monitored in longitudinal plasma samples from selected patients.

Results

Analysis of RAS in tissue and plasma samples from 115 mCRC patients showed a 93% overall agreement. Plasma/tissue RAS discrepancies were mainly explained by spatial and temporal tumor heterogeneity. Analysis of clinico-pathological features showed that the site of metastasis (i.e. peritoneal, lung), the histology of the tumor (i.e. mucinous) and administration of treatment previous to blood collection negatively impacted the detection of RAS in ctDNA. In patients with baseline mutant RAS tumors treated with chemotherapy/antiangiogenic, longitudinal analysis of RAS ctDNA mirrored response to treatment, being an early predictor of response. In patients RAS wt, longitudinal monitoring of RAS ctDNA revealed that OncoBEAM was useful to detect emergence of RAS mutations during anti-EGFR treatment.

Conclusion

The high overall agreement in RAS mutational assessment between plasma and tissue supports blood-based testing with OncoBEAM™ as a viable alternative for genotyping RAS of mCRC patients in routine clinical practice. Our study describes practical clinico-pathological specifications to optimize RAS ctDNA determination. Moreover, OncoBEAM™ is useful to monitor RAS in patients undergoing systemic therapy to detect resistance and evaluate the efficacy of particular treatments.