Search for Gamma-Ray Spectral Lines from Dark Matter Annihilation up to 100 TeV toward the Galactic Center with MAGIC

Linelike features in TeV γ rays constitute a "smoking gun" for TeV-scale particle dark matter and new physics. Probing the Galactic Center region with ground-based Cherenkov telescopes enables the search for TeV spectral features in immediate association with a dense dark matter reservoir at a sensitivity out of reach for satellite γ-ray detectors, and direct detection and collider experiments. We report on 223 hours of observations of the Galactic Center region with the MAGIC stereoscopic telescope system reaching γ-ray energies up to 100 TeV. We improved the sensitivity to spectral lines at high energies using large-zenith-angle observations and a novel background modeling method within a maximum-likelihood analysis in the energy domain. No linelike spectral feature is found in our analysis. Therefore, we constrain the cross section for dark matter annihilation into two photons to ⟨σv⟩≲5×10^{-28}  cm^{3} s^{-1} at 1 TeV and ⟨σv⟩≲1×10^{-25}  cm^{3} s^{-1} at 100 TeV, achieving the best limits to date for a dark matter mass above 20 TeV and a cuspy dark matter profile at the Galactic Center. Finally, we use the derived limits for both cuspy and cored dark matter profiles to constrain supersymmetric wino models.

Trends of risk behaviors in adolescents: a 10-year study in a representative sample of Tuscany, Italy

Background

The aim of the study was to evaluate the trends of prevalence of several health risk behaviors (HRBs) and health conditions over a 10-years period in a representative sample of adolescents of Tuscany Region, Italy.

Methods

The study had a repeated cross-sectional design, data from the last four survey waves of EDIT surveillance (2008-2018) were used. EDIT surveillance investigates HRBs in a representative sample of students attending the upper secondary schools of Tuscany. Prevalence of 17 HRBs and health conditions were considered and analyzed by age, sex, and socioeconomic status (SES).

Results

A total of 21.943 students were surveyed from 2008 to 2018. Declining trends in the participation in smoking, cocaine use, driving under the influence of alcohol and drugs, and problem gambling were observed, while alcohol abuse and at-risk sexual behaviors remained unchanged or increased during the study period. During the most recent survey males resulted more frequently involved in most of the HRBs, while females more frequently reported physical inactivity, regular smoking and not using a condom. Female participation in smoking and alcohol abuse behaviors, fruit and vegetables consumption, and bullying worsened over the study period. Smoking, poor dietary habits, physical inactivity, high distress level, and obesity were more frequently observed in low SES students than in high SES students.

Conclusions

In conclusion findings showed various different tendencies in adolescent participation in HRBs over the course of the last decade; concerning trends in at-risk sexual behaviors and alcohol consumption and females’ risk-taking behavior on the rise require careful monitoring and intervention.

Key messages

• Distinct tendencies according to sex, socio-economic condition and specific health risk behavior were observed in adolescent participation in health risk behaviors over the course of the last decade.

• Health promotion and prevention interventions tailored on specific health risk behaviors and population groups are needed.

OP0305 THE EMERGING EULAR NETWORK (EMEUNET) PEER-REVIEW MENTORING PROGRAM: TEN YEARS OF INITIATIVE

Background

In 2012, the Emerging EULAR (European Alliance of Associations for Rheumatology) Network (EMEUNET) started a mentoring program in collaboration with the editorial board of top-leading journals in rheumatology, the Annals of the Rheumatic Diseases (ARD) and a few years later RMD Open, with the aim of improving peer reviewing skills of young researchers (mentees).1 In this program, now in its 6th edition, senior reviewers (mentors) critically discuss manuscripts submitted to ARD or RMD Open with mentees. At the end of the program, senior reviewers certify the capability of mentees to independently conduct a good quality review. The program is organized by members of the EMEUNET Peer Mentoring Subcommittee, including facilitating communication within the groups. Several strategies, such as face-to-face meetings and periodic videoconferences, were implemented recently, following the outcome of a previous survey among mentees.1

Objectives

To assess the experienced benefits and challenges of the EMEUNET Peer Mentoring program of young rheumatologists and researchers and their mentors.

Methods

In November 2021, a survey was sent by email to mentors and mentees who successfully completed the first five editions of the program (launched between 2012 and 2019), asking for demographics, and potential benefits and challenges of the program. Felt change in peer-review skills before and after the program were rated on a scale from 0 (no skill) to 10 (perfect skill). Results were analysed descriptively.

Results

A response rate of 55% for mentors (11/20) and 43% for mentees (37/87) was obtained. Mentors had a mean(SD) age of 52(9.5) years, 64% were male and 7 different nationalities were included. Mentees had a mean age of 34(3.7), 43% were male and 16 nationalities were included. Mentees/mentors from all the editions were included, although recent editions were somewhat overrepresented. Almost all respondents said their overall experience with the program was positive (46/47), that the objectives of the peer-reviewing mentoring program were met (46/47) and that they would recommend the program to others (44/45).

Mentors indicated an initial average peer-review skill level of 5.2(1.8) for content and 4.2(1.9) for form, which improved by 2.7(1.3) points 3.2(1.8) points, respectively. Interestingly, improvement scores of the mentees paralleled those of mentors: content and form were initially rated at 4.9(1.7) and 5.1(1.8) and improved by 2.6(1.3) and 2.7(1.7), respectively. Nine out of ten mentors said the program had helped them improve their own skills (i.e., peer-reviewing, mentoring, and teaching). The number of peer reviews after completion of the program varied quite significantly between mentees (median 10, IQR 9.5-29). For most mentees, the number of peer-reviews stayed the same (18/32) or increased (12/32). Fifteen out of 32 respondents said they were invited as an independent reviewer for ARD and/or RMD Open after completion of the program. Potential benefits and challenges of the program are depicted in Figure 1. Added value mentioned by both mentors and mentees was the opportunity to contribute to high quality peer-review standards and improve their skills. Challenges reported by mentors were communication with mentees, stringent deadlines, and the program being time-consuming; challenges for mentees were the communication with their mentor, deadlines and insufficient clarity of the process.

Figure 1.

Rating of potential benefits and downsides of the program. X-axis: Items of the survey; Y-axis: the number of respondents (10/11 mentors and 35/37 mentees).

Conclusion

After 5 editions over 10 years, the EMEUNET Peer-Review Mentoring Program continues to be a highly valued opportunity in the field of rheumatic diseases, as both mentors and mentees experience a significant impact on their skills. Areas for improvement were identified (e.g., communication, deadlines) and will be addressed in future editions.

References

[1]DOI: 10.1136/rmdopen-2017-000619

Acknowledgements

We would like to thank all mentors, EMEUNET and working group members that helped shaping the EMEUNET peer-reviewing program throughout the years, and the ARD and RMD Open journals for their kind and generous support.

Disclosure of Interests

None declared

AB1462 RHEUMATIC IMMUNE- AND NONIMMUNE-RELATED ADVERSE EVENTS IN PHASE 3 CLINICAL TRIALS ASSESSING PD-(L)1 CHECKPOINT INHIBITORS FOR LUNG CANCER: A SYSTEMATIC REVIEW AND META-ANALYSIS

Background

Several adverse events (AEs) occurring during immune checkpoint inhibitors (ICIs) therapy are clearly related to their mechanisms of action, and in this case they are indicated as immune-related AEs (irAEs). Every organ may be affected, including the musculoskeletal system; myositis, polymyalgia rheumatica, arthritis or arthritis have been reported in several retrospective and prospective case series and cohorts, with an incidence between 1.5% and 22%. While arthritis, vasculitis, myositis, and polymyalgia rheumatica are usually defined as “irAE” in RCTs, other rheumatic musculoskeletal conditions such as arthralgia, myalgia, back pain and muscular pain are often reported under the umbrella of “general” AEs.

Objectives

We aimed to analyze rheumatic irAE and non-irAE due to immune-checkpoint inhibitors (ICIs) targeting programmed cell death-1 or its ligand PD-(L)1 in lung cancer patients from the available literature.

Methods

We performed a systematic review and meta-analysis of phase III randomized clinical trials (RCTs) assessing PD-(L)1 -ICIs in lung cancer patients, from inception until January 12th, 2021. We extracted data of each trial to estimate odds ratio (OR) for rheumatic ir or non-irAE as classified in RCTs safety data. Sensitivity analyses (by ICI, treatment group and histology) were performed.

Results

Eighteen RCTs met the inclusion criteria (n=12172 subjects). The OR [95%IC] for rheumatic irAE in ICIs versus controls (either placebo or chemotherapy) was 2.20 [0.85,5.72].

Among rheumatic non-irAEs, both overall (any grade, Figure 1A) and severe (grade≥3, Figure 1B) back pain were significantly more frequent in ICIs versus controls (2.01 [1.09;3.73] and 2.90 [1.18;7.08], respectively).

Figure 1.

Forest plot showing pooled odds ratio (OR) for back pain (5 phase III trials) (A) and severe back pain (4 phase III trials) (B), respectively.

The overall frequency of arthralgia and severe arthralgia was similar between ICIs and controls (1.13 [0.86, 1.47] and 1.69 [0.68, 4.20], respectively). By sensitivity analysis RCTs assessing ICIs in combination with chemotherapy versus chemotherapy alone showed a significant association with arthralgia (1.55 [1.15;2.10]). Similarly, the frequency of myalgia did not differ between ICIs and controls, but was significantly lower in RCTs assessing ICIs alone versus chemotherapy (OR 0.32 [0.24;0.42]). Muscular pain was not significantly increased with ICI.

Conclusion

Rheumatic irAEs are not increased in RCTs assessing PD-(L)1 inhibitors, not reflecting the real-life incidence, therefore likely underreported or misclassified. Back pain is significantly associated with PD-(L)1-ICIs regardless its severity, suggesting a possible implication of the PD-(L)1 axis in the development of inflammatory back pain in some patients.

In addition, PD-(L)1-ICIs added on conventional chemotherapy are associated with a significantly higher frequency of arthralgia than ICI alone. This trend was seen in the other rheumatic AEs, suggesting that conventional chemotherapy might be a confounder in the interpretation of the occurrence of rheumatic AEs.

Disclosure of Interests

Antonello Veccia: None declared, Marie Kostine: None declared, Alice Tison: None declared, Mariachiara Dipasquale: None declared, Stefania Kingspergher: None declared, Guido Grandi: None declared, Orazio Caffo: None declared, Sandro Inchiostro: None declared, Giuseppe Paolazzi: None declared, Roberto Bortolotti: None declared, Divi Cornec: None declared, Alvise Berti Consultant of: GSK

AB0627 Evaluation of internal consistency, feasibility, and reliability of the Italian version of ANCA-associated vasculitis patient-reported outcome (AAV-PRO_ita) questionnaire: preliminary results from a multicenter study on a large cohort of Italian patients

Background

The ANCA-associated vasculitis patient-reported outcome (AAV-PRO) questionnaire is a 29-item disease-specific PRO measure for AAV[1]. The Italian version of the AAV-PRO questionnaire (AAV-PRO_ita) was translated in collaboration with Oxford and Bristol University (UK) and was preliminarily tested on a single-center Italian cohort[2].

Objectives

The main objective of this multicentric study was to assess the internal consistency, feasibility, and reliability of the AAV-PRO_ita in a large cohort of Italian AAV patients. The secondary objective was to investigate the clinical characteristics of AAV patients associated with AAV-PRO_ita domains.

Methods

The AAV-PRO_ita is describes the following disease domains: (1) organ-specific and systemic symptoms and signs (SSS); (2) physical function (PF); (3) social and emotional impact (SEI). In this study, Italian-speaking AAV patients were recruited from Italian Centres (N=13) with a large experience in the diagnosis and treatment of systemic vasculitis, belonging to the Vasculitis Study Group of the Italian Society of Rheumatology. Inclusion criteria were: a confirmed diagnosis of GPA, MPA, or EGPA; ANCA positivity in at least once occasion or biopsy-proven AAV; and age ≥18 years old. Participants completed the AAV-PRO_ita at three different time-points: baseline, after 5-7 days, and at month 3.

Results

229 AAV-patients (56.3% women) with a median age of 61 (IQR 51-72) were recruited and completed the questionnaires. The subtype of AAV was mainly GPA (131, 57.2%), followed by EGPA (58, 25.3%), and MPA (40, 17.5%). Median BVASv3 at baseline was 0 (IQR 0-3), whereas the median BVASv3 at the onset of disease was 14 (IQR 9-20). Participants had a median duration of disease of 67 (IQR 24-126) months. Patients who experienced at least one relapse, one hospitalization, and one severe infection were 40.2%, 53.3%, and 24%, respectively. 83% of the patients were on immunosuppressant therapy and 71.6% were still receiving glucocorticoids (GC).

AAV-PRO_ita questionnaire had good internal consistency (Cronbach’s Alpha range 0.81-0.93) and good test-retest reliability (ICCs range 0.93-0.96). Item response rates were high overall (maximum 0.87% missing data), supporting the feasibility of the questionnaire.

Concerning the domains of the questionnaire, female AAV patients scored higher (i.e. worse) in all three domains, especially in the SEI domain (p-value<0.001). Older participants (≥65 years) scored higher in the PF domain (p-value<0.05) in all three times of self-completions of the questionnaire. The ongoing treatment also influenced the results. In fact, patients on GC showed higher scores in the PF domain (p-value=0.003) and SEI domain (p-value=0.021). The VDI value seemed to be related to AAV-PRO_ita scores more than disease duration or disease activity, especially in the SSS domain (ρ>0.3, p-value<0.001). Conversely, subtype of AAV did not influence the item scores.

Conclusion

The AAV-PRO_ita questionnaire is a new 29-item, disease-specific PRO measure for use in AAV in the Italian language. It is a self-administered Italian questionnaire with good internal consistency, feasibility, and reliability. AAV-PRO_ita proved to be a useful tool to explore the AAV patient’s perception of quality of life, and it could become an important way of measuring the unmet needs of AAV patients.

References

[1]Robson, J.C. et al. Validation of the ANCA-Associated Vasculitis Patient-Reported Outcomes (AAV-PRO) Questionnaire. Ann. Rheum. Dis.2018, 77, 1157–1164, doi:10.1136/annrheumdis-2017-212713.

[2]Treppo, E.; Palese, A.; Vita, S.D.; Quartuccio, L. AB0392 PRELIMINARY VALIDATION OF THE ITALIAN VERSION OF ANCA-ASSOCIATED VASCULITIS PATIENT-REPORTED OUTCOME (AAV-PRO_ita) QUESTIONNAIRE: FATIGUE AND CHRONIC PAIN AS UNMET NEEDS BY CURRENT TREATMENTS. Ann. Rheum. Dis.2021, 80, 1224–1224, doi:10.1136/annrheumdis-2021-eular.2123.

Acknowledgements

We thank the Italian Study Group on Systemic Vasculitis.

Disclosure of Interests

None declared

POS0837 EFFICACY OF ULTRA-LOW DOSE RITUXIMAB FOR REMISSION MAINTENANCE THERAPY IN ANCA-ASSOCIATED VASCULITIS

Background

Rituximab (RTX) achieved high remission-induction and sustained maintenance rates for patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) [1], [2]. However, RTX is an expensive medication, which may potentially lead to serious side effects. Defining the best dose regimen for maintenance in AAV is still an unmet need.

Objectives

The aim of the present study is to compare the effects of ultra-low dose RTX (500 mg or 1000 mg once per year) to standard low dose RTX (500 or 1000 mg twice per year) as remission-maintenance therapy in AAV patients.

Methods

We included consecutive AAV patients (classified as GPA and MPA [3]) referring to four different Rheumatology centers in Italy. We assessed all AAV patients who successfully achieved disease remission (BVASv3=0) with conventional RTX or cyclophosphamide regimens and have been subsequently treated with RTX for maintenance of remission. All included patients received at least three maintenance infusions with either 1000 mg or 500 mg, twice per year (standard low dose) or once per year (ultra-low dose). After a period of 18 months, we assessed the remission rate, damage (VDI), glucocorticoids intake, ANCA status, B-cells depletion and serum IgG levels.

Results

From January 2011 to December 2021, 83 AAV patients (mean age 51±16, 49.4% female, 95.2% ANCA positive, 65.8% anti PR3, 34.2% anti MPO), 61 classified as GPA and 22 MPA, achieved complete disease remission with conventional RTX induction regimen. After 7 [6-9] months, 29.9% patients started maintenance treatment with ultra-low dose RTX (once per year), while 70.1% patients with standard low dose (twice per year), for 18 months. No significant differences at baseline were noted between patients receiving ultra-low dose when compared to those treated with conventional low-dose.

At the end of observation period, a disease flare was observed in 22.7% of the low-dose group, and 21.2% in those treated with the standard dose (p=0.881). Relapse-free survival was comparable between the two group (log-rank p=0.818, Figure 1).

Figure 1.

When comparing AAV patients treated with ultra-low dose regimen to those treated with low-dose, no differences were noted in negative ANCA rate (72.2% vs 67.1%, p=0.262), ANCA titer (0 [0-7.8] vs 0 [0-50] UI/mL, p=0.232), B-cells depletion rate (70.6% vs 75%, p=0.725), mean serum IgG (811 [146-922] vs 680 [429-861] mg/dL, p=0.367), mean daily glucocorticoid dosage (2.5 [0-5] vs 3.75 [0-5] mg/d, p=0.647), VDI (4 [1-5] vs 2 [1-4], p=0.098), hypogammaglobulinaemia rate (31.8% vs 36.5%, p=0.697) and deaths (4.5% vs 5.8%, p=0.831).

Although not significant, patients treated with ultra-low dose had lower severe infection rate (10.5% vs 26.8%, p=0.154). Notably, in the all cohort 5 deaths were related to COVID19 pneumonia.

Conclusion

Reduced exposure to RTX was not associated with an impaired efficacy of maintenance therapy in patients with AAV. Remission maintenance with ultra-low dose RTX is a safe and more cost-effective option.

References

[1]B. Terrier et al., “ANCA-associated vasculitides: Recommendations of the French Vasculitis Study Group on the use of immunosuppressants and biotherapies for remission induction and maintenance,” Press. Medicale, vol. 49, no. 3, 2020, doi: 10.1016/j.lpm.2020.104031.

[2]S. V. Moiseev, N. M. Bulanov, A. S. Zykova, and P. I. Novikov, “Rituximab in ANCA-associated vasculitis: Fewer infusions or ultra low-dose maintenance therapy,” Ann. Rheum. Dis., vol. 78, no. 9, pp. 1–2, 2019, doi: 10.1136/annrheumdis-2018-213873.

[3]J. C. Jennette et al., “2012 Revised International Chapel Hill consensus conference nomenclature of vasculitides,” Arthritis Rheum., vol. 65, no. 1, pp. 1–11, 2013, doi: 10.1002/art.37715.

Disclosure of Interests

None declared

Observation of Massless and Massive Collective Excitations with Faraday Patterns in a Two-Component Superfluid

We report on the experimental measurement of the dispersion relation of the density and spin collective excitation modes in an elongated two-component superfluid of ultracold bosonic atoms. Our parametric spectroscopic technique is based on the external modulation of the transverse confinement frequency, leading to the formation of density and spin Faraday waves. We show that the application of a coherent coupling between the two components reduces the phase symmetry and gives a finite mass to the spin modes.

Allergic rhinitis and COVID-19: friends or foes?

Summary

Allergic rhinitis (AR) is a common disease affecting up to 40% of the general population worldwide. In the Coronavirus 2019 (COVID-19) pandemic era, many observational studies analysing the effect of asthma and chronic obstructive pulmonary disease on the risk of developing COVID-19 were conducted, while data on AR are limited.In this paper, we review the risk of developing SARS-Cov-2 infection carried by AR patients, the outcomes of those with COVID-19 disease, and the COVID-19 influence on the allergic and nasal symptoms and the psychological status of AR patients, in both adult and paediatric populations.AR patients seem to be protected from COVID 19 infection. Even if data about the influence of AR on the severity of COVID-19 disease are still not conclusive, it seems that being an AR patient does not increase the risk of poor COVID-19 prognoses. The clinical manifestation of AR can be distinguished by COVID-19 symptoms. Treating AR adequately is also strongly recommended, especially during pandemic.

AB0373 PSYCHOMETRIC PROPERTIES OF OUTCOME MEASUREMENT INSTRUMENTS FOR LARGE VESSEL VASCULITIS: A SYSTEMATIC LITERATURE REVIEW

Background:

Giant cell arteritis (GCA) and Takayasu arteritis (TAK) are two forms of chronic progressive large-vessel vasculitis (LVV) of unknown etiology. In 2016, the OMERACT Vasculitis Working Group proposed the development of a Core Domain Set of outcome measures for LVV including organ and arterial function, fatigue, pain, biomarkers, and death (1). Understanding the psychometric properties of outcome measurement instruments is essential when selecting among instruments to use in research; a summary of such properties for measures of LVV has not been developed.

Objectives:

To systematically review and summarize the psychometric properties of outcome measurement instruments used to measure the domains of the OMERACT core domain set for LVV.

Methods:

A comprehensive search of several databases (Medline, EMBASE, Cochrane, among others) from inception to July 14, 2020 was conducted. Articles were included if they covered psychometric properties of instruments used in LVV. Following the COSMIN and OMERACT frameworks, different psychometric properties (validity, inter- and intra-observer reliability, sensitivity to change, and feasibility) of outcome measurement instruments used in LVV (GCA and TAK) were assessed. Risk of bias was assessed according to the COSMIN checklist.

Results:

Among the 3534 articles identified, 15 studies focusing on the development or validation of psychometric properties on LVV met the predefined criteria. Two were development studies and 13 were validation studies. These studies provided information on 13 instruments: 5 instruments specific to TAK, 2 specific to systemic vasculitides, and 6 general, non-disease-specific instruments. No instruments specific to GCA were identified.

Of the main psychometric properties assessed in the included studies, 40% had a low, 47% had moderate, and 13% had high risk of bias. Construct validity was the property most frequently assessed (in 93% of the tools) (Figure 1).

In TAK, the Indian Takayasu Clinical Activity Score 2010 (ITAS2010) showed good consistency (r=0.97), reliability (intra-observer, ICC=0.60; inter-observer, ICC=0.92) and validity (correlation with Physician Global Assessment (PGA) (r=0.73)) for disease activity. Regarding disease damage, the Disease Extent Index-Takayasu (DEI-Tak) showed good validity (correlation with NIH score 94%, k=0.85). Non-specific vasculitis instruments such as the Vasculitis Damage Index (VDI) and the Birmingham Vasculitis Activity Score (BVAS) showed moderate validity in the assessment of disease damage in GCA (cumulative glucocorticoid dose and disease duration, r=0.30 and r=0.29) and TAK (cumulative glucocorticoid dose and disease duration, r=0.29 and r=0.25) in the former and disease activity in GCA in the later (PGA, r=0.50).

Six non-vasculitis-specific patient-reported outcomes (PROs) instruments were identified, all showing low to moderate validity in GCA/TAK.

Conclusion:

The psychometric properties of 13 outcome measures to study LVV covering the OMERACT domains of disease activity, damage, and patient-reported outcomes were assessed. ITAS2010, DEI-Tak, VDI, and BVAS were the instruments with better psychometric properties for disease activity and/or damage. Disease activity and/or damage instruments specific for GCA, and validated PROs for both GCA and TAK are needed.

References:

[1]Sreih GA, Alibaz-Oner F, Kermani TA, Aydin SZ, Cronholm PF, Davis T, et al. Development of a Core Set of Outcome Measures for Large-vessel Vasculitis: Report from OMERACT 2016 | The Journal of Rheumatology [Internet]. [cité 26 avr 2020]. Disponible sur: http://www.jrheum.org/content/44/12/1933.long

Disclosure of Interests:

None declared

POS0248 PSYCHOMETRIC PROPERTIES OF OUTCOME MEASUREMENT INSTRUMENTS FOR ANCA-ASSOCIATED VASCULITIS: A SYSTEMATIC LITERATURE REVIEW

Background:

The OMERACT Vasculitis Working Group has defined a Core Domain Set of outcome measures for ANCA-associated vasculitis (AAV). However, the psychometric properties of available outcome measurement instruments in AAV, an essential consideration when choosing among instruments, have not been summarized.

Objectives:

To systematically review and summarize the psychometric properties of outcome measurement instruments used in AAV.

Methods:

A comprehensive search of several databases (Medline, EMBASE, Cochrane, Scopus, among others) from inception to July 14, 2020 and without language limitations was conducted. Articles were included if they covered psychometric properties of instruments used in AAV (granulomatosis with polyangiitis, GPA; microscopic polyangiitis, MPA; eosinophilic granulomatosis with polyangiitis, EGPA); articles encompassing other systemic vasculitides and not presenting the data for AAV separately were excluded. Following the COSMIN and OMERACT frameworks, different psychometric properties (validity, inter- and intra-observer reliability, sensitivity to change, and feasibility) of outcome measurement instruments used in AAV were assessed. Risk of bias was assessed according to the COSMIN checklist.

Results:

From 2505 articles identified, 20 met the predefined criteria. Three were identified as development studies, 14 were validation studies, and 3 pursued both objectives.

These studies provided information on 16 instruments: 8 assessing disease activity, 1 assessing disease damage, 3 assessing patient-reported outcome, 4 assessing function (Figure 1). Overall, a few psychometric properties have been considered in each study, ranging from one to five. Most of the instruments were tested in GPA only (n=7), followed by AAV as a group (GPA, MPA and EGPA; n=5), MPA and GPA (n=3), and EGPA only (n=1). Sample sizes of the studies ranged between 27 and 626 patients. The studies with a higher risk of bias, according to COSMIN definitions, were those assessing RAPID3, MVIA, ENT/GPA DAS, and ODSS.

There was a wide heterogeneity of the psychometric proprieties assessed for each instrument. Validity was the most frequently assessed domain in 88% of the instruments, and few properties other than construct validity were reported (Figure 1).

Within each domain, BVAS/WG for activity, VDI for damage, AAV-PRO for patient-reported outcomes, and ODSS for function were the instruments with more psychometric features assessed. For the disease activity domain, BVAS/WG showed a good validity having the highest correlation with physician global assessment (r=0.90), a good reliability (intra-observer ICC=0.62; inter-observer ICC=0.97), and good feasibility and responsiveness. For disease damage, VDI showed moderate validity (correlations with BVAS/WG at 5-year with r=0.20 and BVAS/WG at 1-year with r=0.40) and good feasibility. Among patient-reported outcomes, AAV-PRO had the best performance in terms of validity (construct validity: correlations of the 6 disease domains and EQ-5D-5L, with r ranging between -0.78 and -0.55; discriminating validity between active disease versus remission of the 6 disease domains, p<0.0001 for all comparisons). The performance of instruments assessing function domain was low-to-moderate.

Conclusion:

Sixteen instruments covering the OMERACT domains of disease activity, damage, patient-reported outcome, and function had their psychometric properties assessed in the study of AAV. The majority were developed or validated for GPA only or AAV as a group. Overall, validity was the domain most frequently assessed. BVAS/WG, VDI, AAV-PRO, and ODSS were the instruments with more psychometric features assessed. More rigorous studies aimed at estimating a wider range of psychometric properties in larger numbers of patients with AAV are warranted.

References:

[1]Castrejon I, et al. Clin Exp Rheumatol. 2015

[2]Merkel PA, Journal of Rheumatology, July 2011

Disclosure of Interests:

None declared

Patterns of risky driving behaviors among Tuscan adolescent drivers: a cluster analysis

Background

Adolescents have a high risk of road traffic accident (RTA) because of their high engagement in risky driving behaviors (RDBs); to date, very few studies have investigated the patterns of RDBs. The aim of the study is to identify distinctive RDBs patterns and to examine their associations with RTAs in a sample of adolescent drivers

Methods

The EDIT project is a cross-sectional survey carried out in a representative sample (6.824) of Tuscany Region students aged 14-19 years. The study analyses a subsample of students who reported to drive/ride at least once a week (2764). Self-reported frequency in the last year of the following RDBs was determined: talking on phone; texting; using GPS; talking to passengers; smoking; eating; listening to loud music; fatigued driving; speeding; and driving under the influence (DUI) of alcohol or drugs. A cluster analysis was conducted to identify RDBs patterns. A multivariate model was used to evaluate the difference in the risk of RTA across clusters; ANOVA and post-hoc pairwise comparisons were used to further characterize cluster membership

Results

Four distinct RDBs clusters were identified: “safe”(45.6%), “average”(21.8%), “careless but not DUI”(21.5%) and “reckless and DUI”(11.2%) drivers. When compared with “safe” drivers, “careless but not DUI” and “reckless and DUI” drivers showed a significantly higher risk of RTA (respectively, OR 1.68, 95%CI 1.29-2.18, p &lt; 0.001; OR 2.88; 95%CI 2.10-3.95, p &lt; 0.001). Clusters were characterized by several significant differences in sociodemographic variables, cell-phone use, quality of the relationships with parents, school performances, mental health and well-being, health behaviors, gaming, bullying and risky sexual behaviors

Conclusions

RDBs evidently occur in typical patterns that are linked with different RTA risks. Several domains of adolescent life seem to be involved in cluster membership. An awareness of this clustering enables to better targeting adolescents at higher risk of RTA

Key messages

RDBs occur in patterns in adolescents, and indicators of risky behaviors and of mental and social well-being may help to identify RDBs clusters at high risk of road traffic accidents. Multimodal prevention approaches in risky driving behaviors are likely to be more successful than targeting a single behavior in adolescents.

Argentine tango in the care of Parkinson's disease: A systematic review and analysis of the intervention

OBJECTIVE

To analyse the content of the interventions reported in studies investigating the applicability and efficacy of Argentine tango in participants with Idiopathic Parkinson Disease.

METHODS

Independent reviewers searched databases (PubMed, CINAHL, EMBASE, PsycINFO, and PEDro) from their inception to November 2019. Eligible studies were randomised, controlled and uncontrolled clinical trials, and case reports.

MAIN OUTCOME MEASURE

The Template for Intervention Description and Replication guidelines and checklist were used to assess quality and quantity of the content of Argentine tango interventions' description.

RESULTS

We found 21 papers investigating the applicability and efficacy of Argentine tango in participants with Idiopathic Parkinson Disease. Completeness of the reporting of intervention was satisfying. The intervention is intended to affect a variety of aspects of functioning relevant to individuals with Idiopathic Parkinson Disease. Detailed information on the intervention's procedure and dosing is usually provided. The delivery of the Tango dance program was predominantly extensive; however, the intervention has been provided with various approaches and showed to be very adaptable. Attrition- and adherence- rates described are acceptable. The Adapted Tango dance program is the earliest and most researched modality of tango intervention in participants with Idiopathic Parkinson Disease.

CONCLUSIONS

Argentine tango is appropriately described in the studies investigating the applicability and efficacy of the intervention in participants with Idiopathic Parkinson Disease. However, the reporting could be ameliorated.

Bounds on Lorentz Invariance Violation from MAGIC Observation of GRB 190114C

On January 14, 2019, the Major Atmospheric Gamma Imaging Cherenkov telescopes detected GRB 190114C above 0.2 TeV, recording the most energetic photons ever observed from a gamma-ray burst. We use this unique observation to probe an energy dependence of the speed of light in vacuo for photons as predicted by several quantum gravity models. Based on a set of assumptions on the possible intrinsic spectral and temporal evolution, we obtain competitive lower limits on the quadratic leading order of speed of light modification.

Does musical interaction in a jazz duet modulate peripersonal space?

Researchers have widely studied peripersonal space (the space within reach) in the last 20 years with a focus on its plasticity following the use of tools and, more recently, social interactions. Ensemble music is a sophisticated joint action that is typically explored in its temporal rather than spatial dimensions, even within embodied approaches. We, therefore, devised a new paradigm in which two musicians could perform a jazz standard either in a cooperative (correct harmony) or uncooperative (incorrect harmony) condition, under the hypothesis that their peripersonal spaces are modulated by the interaction. We exploited a well-established audio-tactile integration task as a proxy for such a space. After the performances, we measured reaction times to tactile stimuli on the subjects' right hand and auditory stimuli delivered at two different distances, (next to the subject and next to the partner). Considering previous literature's evidence that integration of two different stimuli (e.g. a tactile and an auditory stimulus) is faster in near space compared to far space, we predicted that a cooperative interaction would have extended the peripersonal space of the musicians towards their partner, facilitating reaction times to bimodal stimuli in both spaces. Surprisingly, we obtained complementary results in terms of an increase of reaction times to tactile-auditory near stimuli, but only following the uncooperative condition. We interpret this finding as a suppression of the subject's peripersonal space or as a withdrawal from the uncooperative partner. Subjective reports and correlations between these reports and reaction times comply with that interpretation. Finally, we determined an overall better multisensory integration competence in musicians compared to non-musicians tested in the same task.

THU0040 PROTEINASE 3-REACTIVE B CELL RECONSTITUTION AFTER TREATMENT WITH RITUXIMAB FOR ANCA-ASSOCIATED VASCULITIS

Background:

Proteinase 3 (PR3)-reactive B cells are present in PR3-ANCA-associated vasculitis (AAV) at levels higher than healthy controls.

Objectives:

To evaluate the dynamics of the PR3-reactive B cell repopulation in patients with PR3-AAV after treatment with rituximab, and to analyze possible associations between these immunological changes and long-lasting remissions.

Methods:

We analyzed all available frozen peripheral blood mononuclear cells (n=148) from 23 randomly-selected PR3-AAV patients who participated in the RAVE trial and achieved complete remission (BVAS=0, prednisone=0) after treatment with rituximab.

We measured PR3-reactive B cells and the relative subsets by a multi-color flow cytometry panel including CD19, IgD, CD27, CD38, CD24, and a biotinylated PR3 revealed by fluorescent streptavidin. The clinical data of the trial were correlated with flow-cytometry data.

Results:

10/23 (43%) patients relapsed during the follow up, 8/10 relapses were severe. At baseline, clinical features, PR3-ANCA levels, % of total PR3-reactive B cells and PR3-reactive B cell subsets were similar between relapsers and non-relapsers. All patients were followed until the end of the trial, for a mean of 44 months (25-75%IQR 31-54), without difference in follow-up time between relapsers and non-relapsers (p=0.98).

The majority of patients had B cell repopulation at 12 (range 12-24) months after rituximab. At the time of B cell repopulation, transitional (CD19+CD24+CD38+) and naïve (CD19+CD27+IgD-) B cells were higher compared to baseline, while total plasmablasts (PB) were unchanged, and mature B cells significantly decreased in both relapsers and non relapsers. PR3-reactive B cells reappeared in all the patients, and the % of PR3-reactive of B cells were higher at the B cell repopulation visit compared to baseline (5.82% vs 4.25%, p<0.05), while total B cells were lower (66/μL vs 151/μL, p<0.01), regardless of future relapse.

Within PR3-reactive B cells, only the % of PB (CD19+CD27+CD38+PR3+) were higher in relapsers vs. non-relapsers (median [25-75%IQR]; 1.95% [1.315-3.845] vs 0.84% [0.05-1.66], p=0.022) and severe relapsers vs non-severe relapsers (2.165% [1.66-4.315] vs 0.84% [0.1-1.74], p=0.015). Time-to-relapse and time-to severe-relapse were significantly shorter in patients with circulating PR3-PB higher than the median value of the cohort (1.6%) during B cell reconstitution (Figure 1A-B).

Conclusion:

In PR3-AAV, during B cell reconstitution after rituximab, the total fraction of PR3-B cells increases, due to the expansion of the transitional and naïve B cell compartments. Circulating PR3-PB within PR3-B cells are enriched in the peripheral blood of relapsing and severely relapsing patients compared to non-relapsing patients. Higher levels of PR3-PB after rituximab during B cell reappearance significantly increased the risk of subsequent relapse and severe relapse.

References:

[1]Cornec D, Berti A, Hummel A, et al. J Autoimmun. 2017

Disclosure of Interests:

Alvise Berti: None declared, Sophie Hillion: None declared, Amber Hummel: None declared, Eva Carmona: None declared, Tobias Peikert: None declared, Carol Langford: None declared, Peter A. Merkel: None declared, Paul Monach: None declared, Philip Seo: None declared, Robert Spiera Grant/research support from: Roche-Genetech, GSK, Boehringer Ingelheim, Chemocentryx, Corbus, Forbius, Sanofi, Inflarx, Consultant of: Roche-Genetech, GSK, CSL Behring, Sanofi, Janssen, Chemocentryx, Forbius, Mistubishi Tanabe, E. William St. Clair: None declared, Fernando Fervenza: None declared, Kristina Harris: None declared, John H. Stone Grant/research support from: Roche, Consultant of: Roche, Jacques-Olivier Pers: None declared, Ulrich Specks: None declared, Divi Cornec: None declared

Disease trends over time and CD4+CCR5+ T-cells expansion predict carotid atherosclerosis development in patients with systemic lupus erythematosus

BACKGROUND AND AIM

Patients with Systemic Lupus Erythematosus (SLE) present increased cardiovascular mortality compared to the general population. Few studies have assessed the long-term development and progression of carotid atherosclerotic plaque in SLE patients. Our aim was to investigate the association of clinical and laboratory markers of disease activity and classical cardiovascular risk factors (CVRF) with carotid atherosclerosis development in SLE patients in a prospective 5-year study.

METHODS AND RESULTS

Clinical history and information on principal CVRFs were collected at baseline and after 5 years in 40 SLE patients (36 women, mean age 42 ± 9 years; 14.4 ± 7 years of mean disease duration) and 50 age-matched controls. Carotid Doppler ultrasonography was employed to quantify the atherosclerotic burden at baseline and at follow up. Clinimetrics were applied to assess SLE activity over time (SLEDAI). The association between basal circulating T cell subsets (including CD4⁺CCR5⁺; CD4⁺CXCR3⁺; CD4⁺HLADR⁺; CD4⁺CD45RA⁺RO^-, CD4⁺CD45RO⁺RA^- and their subsets) and atherosclerosis development was evaluated. During the 5-year follow up, 32% of SLE patients, developed carotid atherosclerosis compared to 4% of controls. Furthermore, considering SLEDAI changes over time, patients within the highest tertile were those with increased incidence of carotid atherosclerosis independently of CVRF. In addition, increased levels of CD4⁺CCR5⁺ T cells were independently associated with the development of carotid atherosclerosis in SLE patients.

CONCLUSION

Serial clinical evaluations over time, rather than a single point estimation of disease activity or CVRF burden, are required to define the risk of carotid atherosclerosis development in SLE patients. Specific T cell subsets are associated with long-term atherosclerotic progression and may further be of help in predicting vascular disease progression.

Isolation and genetic analysis of pure cells from forensic biological mixtures: The precision of a digital approach

Latest genotyping technologies allow to achieve a reliable genetic profile for the offender identification even from extremely minute biological evidence. The ultimate challenge occurs when genetic profiles need to be retrieved from a mixture, which is composed of biological material from two or more individuals. In this case, DNA profiling will often result in a complex genetic profile, which is then subject matter for statistical analysis. In principle, when more individuals contribute to a mixture with different biological fluids, their single genetic profiles can be obtained by separating the distinct cell types (e.g. epithelial cells, blood cells, sperm), prior to genotyping. Different approaches have been investigated for this purpose, such as fluorescent-activated cell sorting (FACS) or laser capture microdissection (LCM), but currently none of these methods can guarantee the complete separation of different type of cells present in a mixture. In other fields of application, such as oncology, DEPArray™ technology, an image-based, microfluidic digital sorter, has been widely proven to enable the separation of pure cells, with single-cell precision. This study investigates the applicability of DEPArray™ technology to forensic samples analysis, focusing on the resolution of the forensic mixture problem. For the first time, we report here the development of an application-specific DEPArray™ workflow enabling the detection and recovery of pure homogeneous cell pools from simulated blood/saliva and semen/saliva mixtures, providing full genetic match with genetic profiles of corresponding donors. In addition, we assess the performance of standard forensic methods for DNA quantitation and genotyping on low-count, DEPArray™-isolated cells, showing that pure, almost complete profiles can be obtained from as few as ten haploid cells. Finally, we explore the applicability in real casework samples, demonstrating that the described approach provides complete separation of cells with outstanding precision. In all examined cases, DEPArray™ technology proves to be a groundbreaking technology for the resolution of forensic biological mixtures, through the precise isolation of pure cells for an incontrovertible attribution of the obtained genetic profiles.

Patients with breakthrough reactions to iodinated contrast media have low incidence of positive skin tests

BACKGROUND

The term "breakthrough reactions" designates repeated hypersensitivity reactions to iodinated contrast media (ICM) despite premedication with glucocorticoids and antihistamines. We aimed to retrospectively evaluate the rate of positive skin test (STs) in our cohort of patients with previous breakthrough reactions to different ICMs.

METHODS

A series of 35 patients, who experienced at least one breakthrough reaction to ICM and who underwent STs within 6 months from the reaction were studied, and results were compared to a control group of patients with a first hypersensitivity reaction occurred without premedication. Skin prick tests (SPT), intradermal tests (IDT) and patch tests (PT) at different dilutions, with a set of three to four ICM were performed.

RESULTS

Of the 35 patients with prior breakthrough reactions, 57% had an immediate reaction (IR) and 43% had a non-immediate reaction (NIR). Patients who experienced the first hypersensitivity IR or NIR, later had one or more breakthrough IR or NIR, respectively. Overall, 29% (10/35) of patients with prior breakthrough reactions resulted positive to STs compared to 57% (16/28) of the control group (p < 0.05). No significant difference in allergy history, age, sex, other clinical / demographic features nor chronic use of ACE-inhibitor, beta-blockers or NSAIDs was observed.

CONCLUSION

This preliminary finding suggests that patients with prior breakthrough reactions have significantly lower immunologically proven ICM reactions (positive STs) if compared to non-breakthrough patients. According to that, a considerable number of breakthrough reactions seems to be non-allergic hypersensitivity reactions or reactions which could be mostly prevented by a proper, well-timed skin testing. Larger prospective studies are needed to confirm these results, with a more careful analysis of patients' risk factors, a laboratory assessment that includes an in vitro allergy diagnostics, and hopefully a drug provocation test for selected cases.

Bimanual non-congruent actions in motor neglect syndrome: a combined behavioral/fMRI study

In Motor Neglect (MN) syndrome, a specific impairment in non-congruent bimanual movements has been described. In the present case-control study, we investigated the neuro-functional correlates of this behavioral deficit. Two right-brain-damaged (RBD) patients, one with (MN+) and one without (MN−) MN, were evaluated by means of functional Magnetic Resonance Imaging (fMRI) in a bimanual Circles-Lines (CL) paradigm. Patients were requested to perform right-hand movements (lines-drawing) and, simultaneously, congruent (lines-drawing) or non-congruent (circles-drawing) left-hand movements. In the behavioral task, MN− patient showed a bimanual-coupling-effect, while MN+ patient did not. The fMRI study showed that in MN−, a fronto-parietal network, mainly involving the pre-supplementary motor area (pre-SMA) and the posterior parietal cortex (PPC), was significantly more active in non-congruent than in congruent conditions, as previously shown in healthy subjects. On the contrary, MN+ patient showed an opposite pattern of activation both in pre-SMA and in PPC. Within this fronto-parietal network, the pre-SMA is supposed to exert an inhibitory influence on the default coupling of homologous muscles, thus allowing the execution of non-congruent movements. In MN syndrome, the described abnormal pre-SMA activity supports the hypothesis that a failure to inhibit ipsilesional motor programs might determine a specific impairment of non-congruent movements.

IgG4-related disease in Italy: clinical features and outcomes of a large cohort of patients

OBJECTIVES

To describe the clinical features, treatment response, and follow-up of a large cohort of Italian patients with immunoglobulin (Ig)G4-related disease (IgG4-RD) referred to a single tertiary care centre.

METHOD

Clinical, laboratory, histological, and imaging features were retrospectively reviewed. IgG4-RD was classified as 'definite' or 'possible' according to international consensus guidelines and comprehensive diagnostic criteria for IgG4-RD. Disease activity was assessed by means of the IgG4-RD Responder Index (IgG4-RD RI).

RESULTS

Forty-one patients (15 females, 26 males) were included in this study: 26 with 'definite' IgG4-RD and 15 with 'possible' IgG4-RD. The median age at diagnosis was 62 years. The median follow-up was 36 months (IQR 24-51). A history of atopy was present in 30% of patients. The pancreas, retroperitoneum, and major salivary glands were the most frequently involved organs. Serum IgG4 levels were elevated in 68% of cases. Thirty-six patients were initially treated with glucocorticoids (GCs) to induce remission. IgG4-RD RI decreased from a median of 7.8 at baseline to 2.9 after 1 month of therapy. Relapse occurred in 19/41 patients (46%) and required additional immunosuppressive drugs to maintain long-term remission. Multiple flares occurred in a minority of patients. A single case of orbital pseudotumour did not respond to medical therapy and underwent surgical debulking.

CONCLUSIONS

IgG4-RD is an elusive inflammatory disease to be considered in the differential diagnosis of isolated or multiple tumefactive lesions. Long-term disease control can be achieved with corticosteroids and immunosuppressive drugs in the majority of cases.

Proposal of a skin tests based approach for the prevention of recurrent hypersensitivity reactions to iodinated contrast media

The purpose of the present work is to evaluate the efficacy of an approach that combines clinical history, skin tests results, and premedication, in preventing recurrent hypersensitivity reactions to iodinated contrast media (ICM). Skin Prick tests, Intradermal tests, and Patch tests were performed in 36 patients with a previous reaction to ICM. All patients underwent a second contrast enhanced radiological procedure with an alternative ICM selected on the basis of the proposed approach. After alternative ICM re-injection, only one patient presented a mild NIR. The proposed algorithm, validated in clinical settings where repeated radiological exams are needed, offers a safe and practical approach for protecting patients from recurrent hypersensitivity reactions to ICM.

Cardiovascular manifestations of Erdheim-Chester disease

Erdheim-Chester disease (ECD) is a rare inflammatory disorder of unknown etiology, characterised by diffuse organ infiltration of CD68-positive, CD1a-negative, S100-low/negative foamy histiocytes. It is a non-Langerhans cell histiocytosis which invariably involves bones (96% of cases). Extraskeletal involvement is observed in about 50% of cases. Cardiovascular involvement affects more than 20% of patients and associates with poor prognosis, conferring a reduced response to treatment. Frequent findings are pericardial effusion (24% of patients), "coated aorta", a perivascular circumferential thickening of the aorta, and pericardial thickening. Other typical features include right atrial mass with pseudo-tumoural appearance and histiocytes' infiltration of right atrial walls, atrioventricular sulcus and interatrial septum. After the recent introduction of cardiac cine MRI in the clinical assessment of patients affected by ECD, a growing body of case reports and retrospective data showed that cardiovascular involvement is present more frequently than previously thought and that it is relatively often asymptomatic. Hence, clinicians should systematically screen ECD patients for occult cardiovascular involvement by means of highly sensitive imaging tools. Despite these recent novelties, comprehensive literature reviews focusing on ECD cardiovascular involvement and its imaging assessment in the last decade are lacking.

Social and behavioral determinants as risk of sexually transmitted diseases. Report by a sample from the Sexually Transmitted Disease Unit in Florence, Italy

AIM

Sexually transmitted infections (STIs) are increasing worldwide, mostly due to changing sexual behavior s (larger numbers of sexual partners, concurrent relationships, increasing proportion of adolescents engaging in sexual intercourse at young age, and inconsistent condom use with new partners). In Italy, few data are available about STI spread, since most infections are not subjected to mandatory notification.

METHODS

In this article, the occurrence of STIs in a random sample attending a STI Unit in Florence, Italy, is reported. Results were obtained through the administration of an anonymous questionnaire that patients could complete spontaneously in the waiting room while waiting for the visit. Self-reported questions allowed to collect information about socio-demographic and clinical data, sexual behavior and perception of risk.

RESULTS

Overall, 469 patients (321 males, 148 females) participated in the study. Age ranged from 16 to 70 years. Male patients who referred to engage sexual intercourse with men (MSM) were 133; females who had sex with women (FSF) were 5, while 24 patients declared to have sex with both males and females (bisexual); 59.7% (N.=280) of participants reported they had a stable relationship, but 20% of these reported they had had sex with more than five partners during the last 12 months. The use of condoms is declared to be very infrequent, especially in the two extreme age ranges. Fifty percent of patients had been diagnosed an STI in their life, particularly syphilis (39.3%), genital warts (64.6%) and chlamydial infections (42.9%). Among those subjects who had contracted an STI (including non-curable viral infections, i.e., HIV and herpes genitalis) 32.4% referred they never used condoms.

CONCLUSION

The authors discuss their results compared to the existing literature, and focus on identification of risk factors associated with self-reported STIs. Although conducted on a small population, this study provides a basis for targeting prevention and control strategies on our high-risk patients.