P3543Rehospitalization burden in heart failure with mid-range ejection fraction and morbidity burden. Is it a distinct phenotype?

Methods

We prospectively included 2,961 consecutive patients discharged for acute HF in our institution from 2004 to 2017. Patients were categorized according to their ejection fraction (EF) obtained by an echocardiography during the index admission: HFmrEF (EF 41–49%), HFrEF (EF≤40%) and HFpEF (EF≥50%). Negative binomial regression method was used to evaluate the association between EF status and recurrent all-cause and HF-related admissions. Risk estimates were expressed as incidence ratio ratios (IRR).

Results

Mean age of the cohort was 73.9±11.1 years, 49% were women, and 46.0% had suffered from previous HF admissions. 472 patients (15.9%) had HFmrEF, 956 (32.3%) had HFrEF, and 1,533 (51.8%) had HFpEF. At a median (interquartile range) follow-up of 2.4 (4.4) years, 1,821 (61.5%) patients died and 6,035 all-cause readmissions were registered in 2,026 patients (68.4%), being 2,163 of them HF-related. Rates of all-cause readmission per 100 patients-years of follow-up were 43.4, 47.1 and 50.1 per HFrEF, HFmrEF and HFpEF categories, respectively. After multivariable adjustment, and compared to patients with HFrEF, HFmrEF status was not associated with a higher risk of all-cause or HF-related recurrent admissions (IRR=1.06; 95% confidence interval (CI), 0.93–1.20; p=0.89), and IRR=1.07; 95% CI, 0.91–1.26; p=0.389, respectively), whereas HFpEF status was associated with a non-significant increase in the risk of all-cause recurrent admissions but a similar risk of HF-related readmissions (IRR=1.10; 95% confidence interval (CI), 0.99–1.22; p=0.06, and IRR=1.01; 95% CI, 0.88–1.16; p=0.900, respectively)

Conclusion

Following an admission for acute HF, patients with HFmrEF have a similar all-cause and HF-related rehospitalization burden when compared to patients with HFrEF, by means of recurrent events analysis.

Evaluation of two alternative ablation treatments for cervical pre-cancer against standard gas-based cryotherapy: a randomized non-inferiority study

INTRODUCTION

Gas-based cryotherapy is the conventional ablative treatment for cervical pre-cancer in low-income settings, but the use of gas poses significant challenges. We compared the depth of necrosis induced by gas-based cryotherapy with two gas-free alternatives: cryotherapy using CryoPen,and thermoablation.

METHODS

We conducted a five-arm randomized non-inferiority trial: double-freeze carbon dioxide (CO2) cryotherapy (referent), single-freeze CO2 cryotherapy, double-freeze CryoPen, single-freeze CryoPen, and thermoablation. Subjects were 130 women scheduled for hysterectomy for indications other than cervical pathology, and thus with healthy cervical tissue available for histological evaluation of depth of necrosis post-surgery. The null hypothesis was rejected (ie, conclude non-inferiority) if the upper bound of the 90% confidence interval (90% CI) for the difference in mean depth of necrosis (referent minus each experimental method) was <1.14 mm. Patient pain during treatment was reported on a scale of 0 (no pain) to 10 (worst pain).

RESULTS

A total of 133 patients were enrolled in the study. The slides from three women were deemed unreadable. One patient was excluded because her hysterectomy was postponed for reasons unrelated to the study, and two patients were excluded because treatment application did not follow the established protocol. For the remaining 127 women, mean depth of necrosis for double-freeze CO2 (referent) was 6.0±1.6 mm. Differences between this and other methods were: single-freeze CO2 = 0.4 mm (90% CI -0.4 to 1.2 mm), double-freeze CryoPen= 0.7 mm (90% CI 0.04 to 1.4 mm), single-freeze CryoPen= 0.5 mm (90% CI -0.2 to 1.2 mm), and thermoablation = 2.6 mm (90% CI 2.0 to 3.1 mm). Mean pain levels were 2.2±1.0 (double-freeze CO2 cryotherapy), 1.8±0.8 (single-freeze CO2 cryotherapy), 2.5±1.4 (double-freeze CryoPen), 2.6±1.4 (single-freeze CryoPen), and 4.1±2.3 (thermoablation).

DISCUSSION

Compared with the referent, non-inferiority could not be concluded for other methods. Mean pain scores were low for all treatments. Depth of necrosis is a surrogate for treatment efficacy, but a randomized clinical trial is necessary to establish true cure rates.

Acceptability of self-sampling and human papillomavirus testing among non-attenders of cervical cancer screening programs in El Salvador

In a cross-sectional study carried out in El Salvador between February 2016 and July 2017, self-sampling and human papillomavirus (HPV) testing was found to be highly acceptable among 2019 women who had not attended a cervical cancer screening in at least 3 years. Within this population, HPV positivity rates differed according to age, marital status, number of children, and lifetime sexual partners. The proportion of women who tested HPV positive or who were diagnosed with cervical intraepithelial neoplasia grade 2 (CIN2) or more severe diagnoses (CIN2+) was similar to the general population of the area. Among the reasons for failing to participate in previous screening programs, non-attending women described logistic concerns, but also erroneous beliefs regarding HPV and cervical cancer, misconceptions regarding the screening procedure, discomfort with male providers, and confidentiality fears. The aim of this study was to identify opportunities and challenges that emerged from the use of self-sampling and HPV testing as part of a public cervical cancer control effort in a low-resource setting.

The asthma-rhinitis multimorbidity is associated with IgE polysensitization in adolescents and adults

BACKGROUND

Children with multimorbid asthma and rhinitis show IgE polysensitization to several allergen sources. This association remains poorly studied in adolescents and adults using defined allergen molecules. We investigated IgE sensitization patterns towards a broad panel of aeroallergen components in adults and adolescents with a focus on individuals with asthma and rhinitis multimorbidity.

METHODS

IgE reactivity to 64 micro-arrayed aeroallergen molecules was determined with the MeDALL-chip in samples from the French EGEA study (n = 840, age = 40.7 ± 17.1) and the Swedish population-based birth cohort BAMSE (n = 786, age = 16 ± 0.26). The age- and sex-adjusted associations between the number of IgE-reactive allergen molecules (≥0.3 ISU) and the asthma-rhinitis phenotypes were assessed using a negative binomial model.

RESULTS

Groups representing 4 phenotypes were identified: no asthma-no rhinitis (A-R-; 30% in EGEA and 54% in BAMSE), asthma alone (A+R-; 11% and 8%), rhinitis alone (A-R+; 15% and 24%) and asthma-rhinitis (A+R+; 44% and 14%). The numbers of IgE-reactive aeroallergen molecules significantly differed between phenotypes (median in A-R-, A+R-, A-R+ and A+R+: 0, 1, 2 and 7 in EGEA and 0, 0, 3 and 5 in BAMSE). As compared to A-R- subjects, the adjusted ratio of the mean number of IgE-reactive molecules was higher in A+R+ than in A+R- or A-R+ (10.0, 5.4 and 5.0 in EGEA and 7.2, 0.7 and 4.8 in BAMSE).

CONCLUSION

The A+R+ phenotype combined the sensitization pattern of both the A-R+ and A+R- phenotypes. This multimorbid polysensitized phenotype seems to be generalizable to various ages and allergenic environments and may be associated with specific mechanisms.

High Acceptability of Human Papillomavirus Self-Sampling Among Nonattenders of a Public Cervical Cancer Screening Program in El Salvador

Abstract 29

Purpose

In high-income countries, human papillomavirus (HPV) self-sampling has been demonstrated to increase adherence to cervical cancer prevention initiatives in underscreened women. El Salvador recently completed the Cervical Cancer Prevention in El Salvador (CAPE) program using a high-risk HPV test as the screening method. Although successful, 12% of targeted women did not attend their screening appointments. HPV self-sampling may offer the opportunity to reach these nonattending women. In the current study, we evaluated HPV self-sampling as a way to increase screening among CAPE nonattenders and to report factors that impact self-sampling acceptability in a low- to middle-income country.

Methods

Nonattending and underscreened women age 30 to 59 years from the Paracentral region of El Salvador were invited to participate (N = 2,019). Women were visited at home and offered self-sampling with an HPV test. Women who provided consent also received a series of questionnaires to collect demographic and test acceptability data. After tests were analyzed, women were provided with results during another home visit. HPV-positive women were asked to make an appointment at a local clinic to undergo colposcopy, biopsy, and, if eligible, cryotherapy treatment. Women with contraindications for cryotherapy were referred to appropriate treatment or follow-up.

Results

Of 1,989 eligible women, 94% accepted the HPV self-sampled test. Of these, 11.8% (n = 221) tested positive. All but 13 women attended the colposcopy appointment, and 190 women received cryotherapy. Biopsy results revealed low-grade precancer in 6.3% of women, whereas 12.6% received diagnoses of high-grade precancer. Reasons for not attending the original CAPE appointment included logistic concerns, but also discomfort with male providers, confidentiality fears, and misconceptions regarding HPV, cervical cancer, and the screening procedure.

Conclusion

HPV self-sampling was shown to be overwhelmingly acceptable to nonattending and underscreened rural women in El Salvador. This method may be a feasible alternative that circumvents barriers to cervical cancer screening in low- to middle-income countries.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

No COIs from the authors

Cervical Cancer Screening in Transgender Men in El Salvador: A Pilot Study

Abstract 27

Purpose

Transgender persons are particularly vulnerable to a lack of adequate health care, particularly with regard to sexual and reproductive health. In El Salvador, where cervical cancer is a leading cause of cancer death, transgender men are at high risk of developing this disease. Whereas the Papanicolaou test is the most widely used screening method for cervical cancer, there are reports of high numbers of unsatisfactory results among transgender men compared with nontransgender persons. Human papillomavirus (HPV) testing may be a more viable screening option in this population. In this pilot study, we assessed the feasibility of cervical cancer screening among transgender men using a self-sampling HPV test as an alternative to the Papanicolaou test.

Methods

Participants were transgender men of the Organización Generación Hombres Trans El Salvador (Trans Men Generation Organization of El Salvador) between age 19 and 55 years. After obtaining informed consent, a questionnaire was administered to 24 participants to collect sociodemographic, lifestyle, and sexual behavior data, and to assess knowledge about cervical cancer prevention. Participants then performed a vaginal, self-sampling HPV test. Participants who received a positive HPV result were offered a colposcopy evaluation.

Results

Almost all participants—23 of 24—agreed to conduct vaginal self-sampling. Of these, three (13%) of 23 participants tested positive, with the remainder obtaining a negative result. Colposcopies and biopsies were accepted by all three participants who tested positive. One participant was diagnosed with CIN3, whereas two2 were diagnosed with CIN1.

Conclusion

There is limited information on cervical cancer prevention among transgender men, particularly in low and middle-income countries. Use of HPV self-sampling tests is a viable method that can significantly improve participation in and acceptance of screening in this vulnerable population. HPV testing may reduce the number of unsatisfactory results generated when using Papanicolaou tests as a screening method.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

No COIs from the authors.

Delivering aminopyridine ligands into cancer cells through conjugation to the cell-penetrating peptide BP16

Peptide conjugates incorporating the N-based ligands (Me2)PyTACN or (S,S')-BPBP at the N- or the C-terminus of the cell-penetrating peptide were synthesized (PyTACN-BP16 (), BP16-PyTACN (), BPBP-BP16 (), and BP16-BPBP ()). Metal binding peptides bearing at the N-terminus the ligand, an additional Lys and a β-Ala were also prepared (PyTACN-βAK-BP16 () and BPBP-βAK-BP16 ()). Moreover, taking into account the clathrin-dependent endocytic mechanism of , the enzymatic cleavable tetrapeptide Gly-Phe-Leu-Gly was incorporated between the ligand and the N- or C-terminus of (BPBP-GFLG-BP16 () and BP16-GLFG-BPBP ()). Analysis of the cytotoxicity of all the peptide conjugates showed that: (i) the position of the ligand influenced the IC50 values, (ii) the incorporation of the βAla-Lys dipeptide rendered non active sequences, (iii) peptide conjugates derived from the (S,S')-BPBP ligand were more active than those bearing (Me2)PyTACN, and (iv) the introduction of the cleavable tetrapeptide significantly enhanced the activity of the BPBP conjugates (IC50 of 4.3 to 11.7 μM ( and ) compared to 26.0 to >50 μM (, and )). The most active peptide was BPBP-GFLG-BP16 () (IC50 of 4.3 to 5.0 μM). This high activity was attributed to its high internalization in MCF-7 cells, as shown by flow cytometry, and to the subsequent release of the ligand by the intracellular cleavage of the enzyme-labile spacer, as observed in cathepsin B enzymatic assays. Therefore, these results pave the way for the design of novel peptide conjugates to be used in pro-oxidant anticancer therapies.

Evaluation of fire severity via analysis of photosynthetic pigments: Oak, eucalyptus and cork oak leaves in a Mediterranean forest

Few studies to date have examined the effect of the high temperatures attained during wildfire events on the pigments present in forest foliage. Here, we seek to analyse the main photosynthetic pigments in the leaves of the oak, cork oak and eucalyptus following a wildfire. We also subject leaves of these last two species to a range of contact temperatures (100-500 °C) in the laboratory using a muffle furnace. The samples were left in the muffle for two hours at 100, 150, 200, 250, 300, 350, 400 and 500 °C, in line with other soil study models (Úbeda et al., 2009; Düdaite et al., 2013). At temperatures above 250 °C, chromatography fails to detect any pigments. A minimal increase in temperature degrades chlorophyll, the process being more rapid in eucalyptus than in cork oak, while it increases pheophytin concentrations.