Tdrd3-null mice show post-transcriptional and behavioral impairments associated with neurogenesis and synaptic plasticity

The Topoisomerase 3B (Top3b) - Tudor domain containing 3 (Tdrd3) protein complex is the only dual-activity topoisomerase complex that can alter both DNA and RNA topology in animals. TOP3B mutations in humans are associated with schizophrenia, autism and cognitive disorders; and Top3b-null mice exhibit several phenotypes observed in animal models of psychiatric and cognitive disorders, including impaired cognitive and emotional behaviors, aberrant neurogenesis and synaptic plasticity, and transcriptional defects. Similarly, human TDRD3 genomic variants have been associated with schizophrenia, verbal short-term memory and educational attainment. However, the importance of Tdrd3 in normal brain function has not been examined in animal models. Here we generated a Tdrd3-null mouse strain and demonstrate that these mice display both shared and unique defects when compared to Top3b-null mice. Shared defects were observed in cognitive behaviors, synaptic plasticity, adult neurogenesis, newborn neuron morphology, and neuronal activity-dependent transcription; whereas defects unique to Tdrd3-deficient mice include hyperactivity, changes in anxiety-like behaviors, olfaction, increased new neuron complexity, and reduced myelination. Interestingly, multiple genes critical for neurodevelopment and cognitive function exhibit reduced levels in mature but not nascent transcripts. We infer that the entire Top3b-Tdrd3 complex is essential for normal brain function, and that defective post-transcriptional regulation could contribute to cognitive and psychiatric disorders.

Prognostic impact of pretreatment cell-free DNA concentration in newly diagnosed peripheral T-cell lymphomas

Peripheral T-cell lymphomas (PTCLs) have a poor prognosis and, to date, there are no reliable predictive biomarkers of response. In this work we explored the prognostic impact of cell-free DNA (cfDNA) concentration in 75 newly diagnosed patients enrolled in a prospective multicenter study. Pre-treatment cfDNA was strongly associated with clinical risk factors and was identified as a superior predictor for shorter progression-free survival in multivariable analysis, outweighing canonical risk parameters. Furthermore, we identified a cfDNA value above which survival worsens. In conclusion, pre-treatment cfDNA concentration represents an easily usable predictive biomarker that is highly associated with survival of PTCL patients.

Radioimmunotherapy versus autologous hematopoietic stem cell transplantation in relapsed/refractory follicular lymphoma: a Fondazione Italiana Linfomi multicenter, randomized, phase III trial

BACKGROUND

Optimal consolidation for young patilents with relapsed/refractory (R/R) follicular lymphoma (FL) remains uncertain in the rituximab era, with an unclear benefit of autologous stem cell transplantation (ASCT). The multicenter, randomized, phase III FLAZ12 (NCT01827605) trial compared anti-CD20 radioimmunotherapy (RIT) with ASCT as consolidation after chemoimmunotherapy, both followed by rituximab maintenance.

PATIENTS AND METHODS

Patients (age 18-65 years) with R/R FL and without significant comorbidities were enrolled and treated with three courses of conventional, investigator-chosen chemoimmunotherapies. Those experiencing at least a partial response were randomized 1 : 1 to ASCT or RIT before CD34+ collection, and all received postconsolidation rituximab maintenance. Progression-free survival (PFS) was the primary endpoint. The target sample size was 210 (105/group).

RESULTS

Between August 2012 and September 2019, of 164 screened patients, 159 were enrolled [median age 57 (interquartile range 49-62) years, 55% male, 57% stage IV, 20% bulky disease]. The study was closed prematurely because of low accrual. Data were analyzed on 8 June 2023, on an intention-to-treat basis, with a 77-month median follow-up from enrollment. Of the 141 patients (89%), 70 were randomized to ASCT and 71 to RIT. The estimated 3-year PFS in both groups was 62% (hazard ratio 1.11, 95% confidence interval 0.69-1.80, P = 0.6662). The 3-year overall survival also was similar between the two groups. Rates of grade ≥3 hematological toxicity were 94% with ASCT versus 46% with RIT (P < 0.001), and grade ≥3 neutropenia occurred in 94% versus 41%, respectively (P < 0.001). Second cancers occurred in nine patients after ASCT and three after radioimmunotherapy (P = 0.189).

CONCLUSIONS

Even if prematurely discontinued, our study did not demonstrate the superiority of ASCT versus RIT. ASCT was more toxic and demanding for patients and health services. Both strategies yielded similar, favorable long-term outcomes, suggesting that consolidation programs milder than ASCT require further investigation in R/R FL.

The Sapienza count-down for a healthy and sustainable diet

Abstract

The prevalence of obesity and of other non-communicable diseases related to overnutrition is significantly increasing in the past few years. Policy makers are called to counteract this pandemic, orienting consumers towards a healthier and more sustainable diet. Most of the proposed initiatives are dedicated to the content of nutrients with "unfavourable" effects but, in fact, focusing the attention only or mainly on single foods or nutrients is not effective in decreasing the incidence/prevalence of non-communicable diseases. Whole dietary patterns play by far a more important role than specific dietary components in promoting health and modulating survival; and the adherence to eating patterns like the Mediterranean diet reduces the risk of non-communicable diseases. The challenge is therefore to be able to transmit information relating to a healthy eating pattern through positive messages in a few simple indications which in turn represent the nutritional, but also the socio-cultural, environmental and economic characteristics of a healthy and sustainable dietary model. The Mediterranean Diet is normally proposed through a graphic depiction that represents a pyramid which is a simple and effective representation but not of immediate impact. For this reason, we are proposing to adopt the "Sapienza Count-down for a Healthy and Sustainable Diet" that will integrate the pyramid with a more immediate approach.

Running throughout middle-age keeps old adult-born neurons wired

Exercise may prevent or delay aging-related memory loss and neurodegeneration. In rodents, running increases the number of adult-born neurons in the dentate gyrus (DG) of the hippocampus, in association with improved synaptic plasticity and memory function. However, it is unclear if adult-born neurons remain fully integrated into the hippocampal network during aging and whether long-term running affects their connectivity. To address this issue we labeled proliferating DG neural progenitor cells with retrovirus expressing the avian TVA receptor in 2-month-old sedentary and running male C57Bl/6 mice. More than six months later, we injected EnvA-pseudotyped rabies virus into the DG as a monosynaptic retrograde tracer, to selectively infect TVA expressing 'old' new neurons. We identified and quantified the direct afferent inputs to the adult-born neurons within the hippocampus and (sub)cortical areas. Here we show that long-term running substantially modifies the network of the neurons generated in young adult mice upon middle-age. Exercise increases input from hippocampal interneurons onto 'old' adult-born neurons, which may play a role in reducing aging-related hippocampal hyperexcitability. In addition, running prevents the loss of adult-born neuron innervation from perirhinal cortex, and increases input from subiculum and entorhinal cortex, brain areas that are essential for contextual and spatial memory. Thus, long-term running maintains the wiring of 'old' new neurons, born during early adulthood, within a network that is important for memory function during aging.Significance statementExercise benefits brain function, however, the underlying mechanisms remain unclear. We show that long-term running increases hippocampal neurogenesis, and modifies the network of new neurons that were born in young adult mice, in a manner that optimally supports memory function at middle age.

Altered connectomes of adult-born granule cells following engraftment of GABAergic progenitors in the mouse hippocampus

Adult neurogenesis occurs in the dentate gyrus (DG) of the rodent hippocampus throughout life, producing new granule cells (GCs) that migrate from a stem cell niche called the subgranular zone (SGZ) into the adjacent granule cell layer (GCL). Seizures associated with temporal lobe epilepsy alter adult neurogenesis and promote the formation of hyperexcitable circuits. Stem cell therapies for treating intractable seizure disorders are based on the premise that transplantation of GABAergic interneurons will strengthen inhibitory connections within the hippocampus and reduce hyperexcitability. Grafts of medial ganglionic eminence (MGE)-derived fetal GABAergic progenitors into the DG of adult mice with pilocarpine-induced TLE have been shown to suppress spontaneous recurrent seizures. In addition, the transplanted cells formed functional inhibitory synaptic connections with hippocampal neurons, including adult-born GCs. However, it is unknown whether MGE grafts change adult-born GC connectivity. To address this question, we compared the first-order monosynaptic inputs to adult-born GCs in TLE mice with or without MGE-derived interneuron grafts. Here we show that TLE increased excitatory inputs from endogenous hippocampal, entorhinal cortex, and medial septum/diagonal band neurons onto adult-born GCs. In contrast, in TLE mice with grafts, these excitatory inputs were reduced, coinciding with transplanted GABAergic interneuron innervation of adult-born GCs. These findings indicate that GABAergic interneuron transplantation into the dentate gyrus may prevent epilepsy-associated alterations in the connectivity of adult-born GCs.

Tdrd3-null mice show post-transcriptional and behavioral impairments associated with neurogenesis and synaptic plasticity

The Topoisomerase 3B (Top3b) - Tudor domain containing 3 (Tdrd3) protein complex is the only dual-activity topoisomerase complex in animals that can alter the topology of both DNA and RNA. TOP3B mutations in humans are associated with schizophrenia, autism and cognitive disorders; and Top3b-null mice exhibit several phenotypes observed in animal models of psychiatric and cognitive disorders, including impairments in cognitive and emotional behaviors, aberrant neurogenesis and synaptic plasticity, and transcriptional defects. Similarly, human TDRD3 genomic variants have been associated with schizophrenia, verbal shorten-memory and learning, and educational attainment. However, the importance of Tdrd3 in normal brain function has not been examined in animal models. Here we built a Tdrd3-null mouse strain and demonstrate that these mice display both shared and unique defects when compared to Top3b-null mice. Shared defects were observed in cognitive behaviors, synaptic plasticity, adult neurogenesis, newborn neuron morphology, and neuronal activity-dependent transcription; whereas defects unique to Tdrd3-deficient mice include hyperactivity, changes in anxiety-like behaviors, increased new neuron complexity, and reduced myelination. Interestingly, multiple genes critical for neurodevelopment and cognitive function exhibit reduced levels in mature but not nascent transcripts. We infer that the entire Top3b-Tdrd3 complex is essential for normal brain function, and that defective post-transcriptional regulation could contribute to cognitive impairment and psychiatric disorders.

Exploring in vitro markers of potency of extracellular vesicles from cardiosphere-derived cells in the treatment of cardiac ageing

Background

Cardiac ageing is associated to heart failure with preserved ejection fraction (HF-pEF) and increased senescence, hypertrophy and diastolic dysfunction. No treatments have yet proved to reduce HF-pEF morbidity and mortality. Cardiosphere-derived cells (CDCs) and their secreted extracellular vesicles (CDC-EVs) have demonstrated efficacy in old animals with cardiac dysfunction, but variability of effect and lack of adequate potency tests remain as challenges.

Purpose

To explore in vitro predictors of cardiac protective potency of CDC-EVs, focusing on the chronological age of the CDC-donors, CDC-senescence, and their in vitro anti-senescent and pro-angiogenic effect.

Methods

CDCs derived from 34 patients (age range 0–81 years old, both sexes) were characterized in terms of senescence, proliferative and migration capacities, VEGF secretion, expression of specific surface markers and cardiosphere size. CDC-EVs were purified and their in vitro anti-senescent potential (at genetic, secretory and cellular level over cardiac stromal cells) and their pro-angiogenic potential (ability to induce tube formation over endothelial cells) quantified. According to the performance in each of these tests, potency was scored and CDC-EVs were classified as potent (P-EVs) and non-potent (NP-EVs). The effect of P-EVs and NP-EVs were then tested in vivo in rats with induced cardiac aging. SD-rats received 3-months of daily intraperitoneal injections (IP) of saline (healthy control) or D-galactose. Rats in the D-Gal group were randomly allocated to receive IP saline (sham control, n=12), P-EVs (n=7) or NP-EVs (n=6) and followed-up for one month.

Results

Chronological age of the donor or expression of surface markers did not relate to most CDC properties nor to their in vitro potency. CDC senescence did relate to other CDC bioactive properties, but this was insufficient to predict CDC-EV anti-senescence and pro-angiogenic in vitro potency. In vivo, EV classified as P-EVs, but not NP-EVs, prevented D-gal induced hypertrophy (2.4 vs. 2.9 mg/gr, p=0.05). This finding was in parallel to the levels of galactosidase-beta 1 expression in cardiac tissue, which were increased in sham vs. P-EVs (1.22 vs. 0.73, p=0.03) but levels in NP-EVs were not significantly different to the sham group (0.86, p=0.1). P-EVs tended to reduce TGFB1 expression, while NP-EVs significantly increased cardiac fibrosis and reduced cardiac perfusion. At systemic level, while P-EVs significantly improved glucose metabolism and tended to drive total antioxidant capacity and hair growth to a healthier profile, NP-EVs did not significantly improve any of the explored parameters and significantly increased total antioxidant capacity.

Conclusions

After further validation, the matrix potency assay proposed here, scoring the anti-senescent and pro-angiogenic in vitro effect of CDC-EVs could be used to predict EV suitability as an allogenic product in the treatment of cardiac ageing.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Instituto de Salud Carlos III, Ministerio de Ciencia e Innovaciόn, Spain: PI16/01123; PI19/00161; Red de Terapia Celular, Tercel, (RD16.0011.0029) and CIBERCV (CB16.11.00292)

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

Senescence-based predicted potency of extracellular vesicles determines their rejuvenating cardiac effects in an ageing rodent model

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación

CIBERCV

Background

Cardiac ageing is characterized by increased cell senescence, hypertrophy and diastolic dysfunction, which can frequently lead to heart failure with preserved ejection fraction. Still, this is an unmet medical need for treatment development. Cardiosphere-derived cells (CDCs) have demonstrated efficacy in old animals with cardiac dysfunction, however variability of effect among different CDC-donors is observed.

Purpose

To identify if the in vitro anti-senescent potential of CDC-secreted extracellular vesicles (CDC-EVs) predicts the in vivo anti-senescent effect in a model of cardiac ageing.

Methods

CDCs were derived from cardiac biopsies of 18 patients (age range 0 - 81 years old, both sexes included) who underwent cardiac surgery for other reasons. CDC-secreted extracellular vesicles (CDC-EVs) from the 18 donors were purified and used in vitro and in vivo experiments. Their in vitro anti-senescent potential (at genetic, secretory and cellular level) was evaluated over cardiac stromal cells from two human patients. CDC-EVs with the most anti-senescent potential and with the least anti-senescent potential were classified as potent (P-EVs) and non-potent (NP-EVs), respectively. Cardiac anti-senescent effect of P-EVs and NP-EVs were then tested in vivo in rats with induced cardiac aging. 3-months old SD-rats (30% female) received 3-months of daily intraperitoneal injections of saline (healthy control) or D-galactose. Animals in the D-Gal group were randomly allocated to receive intraperitoneal injection of saline (sham control, n=12), P-EVs (n=7) or NP-EVs (n=6) and followed-up for one month.

Results

Variations in the extent of the anti-senescent potential were observed in vitro among the CDC-EVs from the different donors. While most CDC-EVs significantly reduced cellular senescence and increased IL-6 secretion of human cardiac stromal cells, most CDC-EVs decreased the expression of senescence-related genes (p21, p16, p53, TGF-b). In vivo, D-gal induced cardiac hypertrophy (2.5 mg/g vs. 2.2 mg/g, p&lt;0.01). P-EVs, but not NP-EVs, prevented this hypertrophy (2.4 vs. 2.9 mg/gr, p=0.05). This finding was in parallel to the levels of galactosidase-beta 1 expression in cardiac tissue, which were increased in sham vs healthy (1.22 vs. 0.78, p=0.04) and in sham vs. P-EVs (1.22 vs. 0.73, p=0.03) but levels in NP-EVs were not significantly different to the sham group (0.86, p=0.1).

Conclusions

The anti-senescent in vitro effect of CDC-EVs is correlated to their anti-senescent and anti-hypertrophic effect in an in vivo model of cardiac ageing. This study shows the relevance of exploring senescence-related markers as determinant of therapeutic potency of the tested product and confirms the potential utility of CDC-EVs as a therapy for cardiac ageing-related pathologies.

Antisenescence in vitro potency of extracellular vesicles secreted by cardiosphere-derived cells predicts the antihypertrophic effect in a rat model of cardiac ageing

Background

Cardiac ageing is characterized by hypertrophy and diastolic dysfunction and related with heart failure with preserved ejection fraction, an unmet medical need for treatments development. Cardiosphere-derived cells (CDCs) have demonstrated glimpses of efficacy in old animals with cardiac dysfunction, however variability of effect among different CDC-donors is observed.

Purpose

To identify markers of in vitro potency of CDCs and to test it in an in vivo model of cardiac ageing.

Methods

CDCs were derived from cardiac biopsies of forty patients (age range 0 - 81 years old, 16 females) who underwent cardiac surgery for other reasons. CDC-secreted extracellular vesicles (CDC-EVs) were purified and used in in vitro and in vivo experiments. Since anti-ageing effect was targeted in vivo, in vitro potency of CDC-EVs was checked in terms of their anti-senescence bioactivity. A panel of six parameters (genetic, secretory and cellular) related with cellular senescence were analysed in vitro for all 40-donors CDC-EVs and those with most favourable and unfavourable profiles were classified as potent (P-EVs) and non-potent (NP-EVs), respectively. P-EVs and NP-EVs were then tested in vivo in 25 rats with D-galactose-induced cardiac ageing and 7-healthy controls in a randomized blinded study.

Results

In vitro, despite variations in the extent of the observed effect, all CDC-EVs significantly reduced cellular senescence and increased IL-6 secretion of human cardiac stromal cells. Most CDC-EVs decreased the expression of senescence-related genes (p21, p16, p53, TGF-b). Based on the observed profiles as P-EVs were selected CDC-EVs from 75- and 14-years old donors and as NP-EVs from 73-years old. In vivo, 3-months old SD-rats (30% female) after 3-months of daily intraperitoneal injections of saline (healthy control) or D-Gal, were randomly allocated (D-Gal group) to receive intraperitoneal injection of saline (sham control, n=12), P-EVs (n=7), NP-EVs (n=6) and followed-up for one month. While sham control group developed myocardial hypertrophy compared to healthy control animals (heart/body weight 2.7 vs. 2.2 mg/gr, p=0.03), this effect was prevented by P-EVs but not by NP-EVs (2.5 vs. 2.9 mg/gr, p=0.02). This finding was in parallel to the levels of serum antioxidants which were increased in sham vs healthy (p=0.02) and in sham vs. P-EVs (p=0.01) but levels in NP-EVs were similar to the sham group.

Conclusions

Anti-senescence in vitro effect of CDC-EVs is correlated to their therapeutic efficacy in vivo model of cardiac ageing. The relevance of this study is double: identification of senescence-related markers as determinant of therapeutic potency of the tested product and confirming the potential utility of CDC-EVs as therapy for cardiac ageing-related pathologies.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Instituto de Salud Carlos III, Ministerio de Ciencia e Innovaciόn,CIBERCV, Spain

The impact of the cardiac rehabilitation program in patients with mid-range heart failure (40-50%) in improving cardio respiratory predictors

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Centro Hospitalar Universitário Lisboa Central

Methods

We studied 30 patients (P) with ejection fraction (EF) 40-50%, in a number of 198 P that participated in cardiac rehabilitation program (CRP). Of these P, 24 (80%) male and 6 (20%) female, 20 P were diagnosed myocardial infarction with ST-segment elevation, 2 P myocardial infarction non ST and 8 P with myocardial hypertrophy non ischemic. Of these P 30% were diabetics, 56% hypertension, 70% dyslipidemia, 36% smokers previous to CRP and body mass index 26,3 medium.

All P were submitted to previous echocardiogram, cardiopulmonary exercise testing (CET) and a rehabilitation program minimum 4 sessions and maximum 52 sessions. At the end of the total sessions the echocardiogram and CET were repeated.

Results

Of the 30 P that participated in CRP only 20 completed the program, while the other 10 P dropped out because of social and economic problems. Of the P that completed the CRP, 70% got better on EF, 80% improved VE/VCO2 slope &lt; 33 therefore are classified VC-II in ventilatory classification (VC), 5% VE/VCO2 slope &gt; 40  VC-III classification, and 15% maintained the initial classification.  50% of the P increased at least one level metabolic equivalent of task (MET) from the first CET. Only 3 of the 20 patients came, once, to the hospital after the CRP with heart failure, and one died but did not fulfill the program.

Conclusion

Patients with mid-range heart failure submitted to a CRP can improve cardiorespiratory predictors, leading to a better quality of life. However, it is important to find solutions to minimize the causes that make patients to give up CRP.

The role of periodontal bacteria, Porphyromonas Gingivalis, in Alzheimer's disease pathogenesis and aggravation: a review

The aim of this study was to establish the role of Porphyromonas gingivalis in Alzheimer's disease. An electronic search of publications was established from three electronic databases: Cochrane, PubMed and Web of Science. The search strategy used a combination of controlled vocabulary and free-text words. Inclusion and exclusion criteria were defined by the authors before the start of the study. The inclusion criteria were: all studies published in English language; in vitro analysis; in vivo on animals and postmortem biopsies on humans; studies analyzing the correlation between periodontal disease and Alzheimer. The search resulted in 262 titles. Only 9 articles were included in the quantitative analysis. An inflammatory status in the oral cavity might be connect to a brain degeneration syndrome such as dementia and AD. However, a strictly connection is still not evincible. More trials are recommended in order to investigate the role of periodontal bacteria and Porphyromonas gingivalis in AD pathogenesis and aggravation.

Upper-lip laser frenectomy with a diode laser in a pediatric patient: a case report

The case report aims to describe the parameters of performing upper labial frenectomy with the use of diode laser beams without infiltrated local anaesthesia. A 6-year-old patient was referred by the orthodontist for assessment of the upper anterior labial frenum. The dental treatment plan reported only the presence of caries on deciduous teeth and seals on the first permanent molars. The clinical examination reported the presence of a high attachments of labial frenum with a pathologically attachment and the presence of a diastema supports this theory. The laser used to remove the frenulum was a diode laser used with a wavelength of 980 nm with 320 microns of fiber in contact with a power of 2.0 W in continuous wave mode. The clinical examination showed an acceptable healing by secondary intention of the wound and the initial functional recovery of a physiological upper lip movements. The patient reported that the procedure was well tolerated. The diode laser can be used with good result for the removal of pathological frenum. The diode laser can be used in pediatric dentistry because of its application, adequate coagulation, no need for sutures and less inflammation and pain.

Effects of Combined Anti-Hypertensive and Statin Treatment on Memory, Fear Extinction, Adult Neurogenesis, and Angiogenesis in Adult and Middle-Aged Mice

Hyperlipidemia and hypertension are modifiable risk factors for cognitive decline. About 25% of adults over age 65 use both antihypertensives (AHTs) and statins to treat these conditions. Recent research in humans suggests that their combined use may delay or prevent dementia onset. However, it is not clear whether and how combination treatment may benefit brain function. To begin to address this question, we examined effects of atorvastatin, a 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor, and Captopril, an angiotensin-converting enzyme inhibitor (ACEI), administration on memory function, anxiety-like behavior, adult hippocampal neurogenesis and angiogenesis in adult and middle-aged male C57Bl/6J mice. In adult mice (3-months-old) combination (combo) treatment, as well as administration of each compound individually, for six weeks, accelerated memory extinction in contextual fear conditioning. However, pattern separation in the touchscreen-based location discrimination test, a behavior linked to adult hippocampal neurogenesis, was unchanged. In addition, dentate gyrus (DG) neurogenesis and vascularization were unaffected. In middle-aged mice (10-months-old) combo treatment had no effect on spatial memory in the Morris water maze, but did reduce anxiety in the open field test. A potential underlying mechanism may be the modest increase in new hippocampal neurons (~20%) in the combo as compared to the control group. DG vascularization was not altered. Overall, our findings suggest that statin and anti-hypertensive treatment may serve as a potential pharmacotherapeutic approach for anxiety, in particular for post-traumatic stress disorder (PTSD) patients who have impairments in extinction of aversive memories.

AB0317 ADHERENCE TO MEDITERRANEAN DIET AND NUTRITIONAL STATE IN ITALIAN WOMEN WITH ISOLATED SJÖGREN’S SYNDROME

Background:

The Mediterranean Diet (MD) has anti-inflammatory and immunomodulatory effects1,2 suggesting a protective role in rheumatic diseases. There is limited knowledge about the eating habits and the nutritional state in patients with isolated Sjögren Syndrome (SS) living within the Mediterranean area.

Objectives:

assessment of adherence to the MD and analysis of the nutritional state in women with SS and their correlations with the clinical, laboratory and histological data of the disease.

Methods:

patients classified as isolated SS according to AECG criteria 20023 who had undergone to minor salivary gland biopsy during the previous twelve months were consecutively enrolled during follow-up visits. The adherence to the MD was assessed by the Med Diet (MDiet)4 which includes eleven groups of foods; to each group is assigned a value ranging between 0 and 5 based on the frequency of monthly intake. The total score spans from 0 (poor adherence) to 55 (maximum adherence). The level of physical activity was measured by the 6-minutes walking test (6MWT) and by the International Physical Activity Questionnaire (IPAQ). Systemic disease activity was evaluated with the EULAR SS disease activity index (ESSDAI); EULAR SS patient-reported index (ESSPRI) was calculated as well. A subgroup of patients was asked to fill a daily food diary processed with FOOD CONS software which allows to study in detail their eating habits. Nutritional state, muscle strength and basal metabolic rate were assessed. Alcoholism or drug abuse, diabetes mellitus, specific dietary models, treatment with drugs and/or food supplements with anti-inflammatory and/or antioxidant activity were considered exclusion criteria. Multivariate linear regression was performed with R project for Statistical Computing.

Results:

N= 40 N= 26Age, median (range) 53 (25-80) 33 (25-71)BMI, median (range) 21 (19-29.3) 25.1 (19-33.7)MedDiet score, median (range) 33 (26-43) 33 (23-40)ESSDAI, median (range) 2 (0-16) 1 (0-16)ESSPRI, median (range) 6 (0-8.6) 5.3 (1.6-9)ESSPRI dryness, median (range) 6 (0-10) 6 (2-10)Focus score, median (range) 2.5 (0-9.6) 1.7 (0.8-6.24)ASM kg, median (range) - 16.8 (13.3-21.7)IPAQ meters, median (range) - 1386 (99-11865)6MWT meters, median (range) - 595 (536-680)

BMI, body mass index; ASM appendicular skeletal mass; IPAQ International Physical Activity Questionnaire; 6MWT, six minute walking test.

MDiet was administered to 40 female SS outpatients. Even if not reaching significativity, patients with a higher focus score in their MSG have a lower value of MDiet score (p = 0.058, r = -1.00). The MDiet score is not associated with ESSDAI (p = 0.85, r 0.02), but only with lower serum levels of C3 (p = 0.004, r = - 0.08).

In 26 patients, daily food questionnaire shows that their diet consists of 43% of carbohydrates while fats represent 40% of total energy intake, the remaining 17% daily energy comes from proteins. Fat consumption is higher compared to the levels of energy and nutrient intake for the Italian population5. Six patients had a reduction in muscle mass; sarcopenia is not associated to ESSDAI (p = 0.610).The MDiet score and the amount eaten of polyunsaturated fatty acids (PUFA) were reduced in patients with high value of subscale dryness of ESSPRI (p = 0.057, r -1.21; p =0.610, r -1.00).

Conclusion:

This study highlights a lower degree of glandular lymphocytic infiltration (expressed as focus score) in minor salivary glands in patients following MD, so its anti-inflammatory role of seems to be confirmed. SS patients have an unbalanced diet because of a higher intake of fat foods, likely for their lubricating effect. Despite the absence of correlation with objective parameters, the increased dryness in patients with a reduced intake of PUFA arouses our interest in a future study including omega-3 supplementation.

References:

[1]Schwingshackl L et al., Nutr Metab Cardiovasc Dis 2014

[2]Mena MP et al., Am J Clin Nutr. 2009

[3]Vitali C et al, ARD 2002

[4]Panagiotakos D et al., J Med Food 2007

[5]LARN 2014

Disclosure of Interests:

None declared

Lithium treatment and estimate glomerular filtration rate in bipolar disorder patients: A cross-sectional study

Introduction

Lithium has been the mainstay therapy for bipolar disorder (BD) for decades, but there is little consensus regarding its possible effects on kidney function and the rate of change in estimated glomerular flow rate (eGFR) over time.

Objectives

To describe patients with BD regarding their renal function and their sociodemographic and clinical characteristics potentially related to eGFR.

Methods

This is a cross-sectional study with an initial sample of 95 patients with BD. Multiple linear regression analysis was applied to investigate the association of lithium serum levels and their duration of treatment with eGFR, independent of confounding factors. We excluded patients without data regarding any of the variables from the final model.

Results

In the multivariable analysis, the model was composed of eight variables (Figure 1). The mean duration of treatment was 10 years (Figure 2). Serum lithium level was associated with low levels of eGFR (β = -18.06 [-34.70 - -1.42], p = 0.03); among the other variables, only age remained associated with it (β = -0.72 (-1.10 - -0.33), p = <0.01).

The targeting of preschoolers, children, adolescents and adults by the Canadian food and beverage industry on television: a cross-sectional study

Unhealthy food advertising can negatively impact children's food preferences and nutritional health. In Canada, only companies participating in the self-regulatory Children's Food and Beverage Advertising Initiative (CAI) commit to limiting unhealthy food advertising to children. We analyzed food advertising from 182 Canadian television stations in 2018. A principal component analysis explored patterns of advertising by 497 food companies and their targeting of preschoolers, children, adolescents, and adults. Chi-square analyses tested differences in the volume of advertising between target age groups by heavily advertising food companies and by CAI-participating and non-participating companies. In 2018, Maple Leaf Foods, Boulangerie St-Méthode, Exceldor Foods, Goodfood Market and Sobeys advertised most frequently during preschooler-programming. General Mills, Kellogg's, the Topps Company, Parmalat and Post Foods advertised most frequently during child-programming, while Burger King, McDonald's, General Mills, Kellogg's and Wendy's advertised most frequently during adolescent-programming. CAI-participating companies were responsible for over half of the food advertising broadcast during programs targeted to children (55%), while they accounted for less than half of the food advertising aired during programs targeting preschoolers (24%), adolescents (41%) and adults (42%). Statutory food advertising restrictions are needed to limit food companies' targeting of young people on television in Canada. Novelty: Advertising from fast food restaurant chains dominated television programming targeted to adolescents in 2018. Advertising from breakfast cereal, candy, and snack manufacturers dominated television programming targeted at children in 2018. Over 100 Canadian and transnational companies contravened broadcast restrictions on advertising to preschoolers in 2018.

Incidence of venous thromboembolic events in cancer patients receiving immunotherapy: a single-institution experience

BACKGROUND

Cancer and cancer therapies have been associated with an increased incidence of venous thromboembolic events (VTE). However, the incidence of VTE in patients on immunotherapy has not been well characterized. The aim of this study was to assess the incidence of VTE in cancer patients receiving immunotherapy and ascertain its prognostic utility.

MATERIALS AND METHODS

We conducted a single-institution retrospective study, including all cancer patients treated with anti-Programmed cell Death 1 (PD-1), anti-Programmed cell Death Ligand-1 (PD-L1), anti-Cytotoxic T-Lymphocyte-Associated Protein 4 (CTLA4), a combination of anti-PD-1/anti-PD-L1 and anti-CTLA4 or a combination including any of these drugs with chemotherapy, antiangiogenic agents or both between June 2013 and April 2019 at La Paz University Hospital, Madrid (Spain).

RESULTS

We selected 229 patients. VTE occurred in 16 of 229 patients (7%). VTE occurred more frequently in patients with lung cancer followed by melanoma. Female sex and melanoma were independently associated with an increased risk of VTE. 12 of 16 VTE (75%) were symptomatic. Progressive disease to immunotherapy [HR 31.60 (95% CI 11.44-87.22), p = 0.00], lung cancer [HR 2.55 (95% CI 1.34-4.86), p = 0.00] and melanoma [HR 2.42 (1.20-4.86), p = 0.01] were independently associated with shorter OS. VTE occurrence was not independently associated with shorter OS [HR 1.33 (95% CI 0.63-2.80), p = 0.44].

CONCLUSIONS

The incidence of VTE in cancer patients receiving immunotherapy in our study appeared to be similar to the incidence previously reported in other series of cancer patients treated with systemic therapies. VTE occurrence did not correlate with the prognosis. Further and prospective studies are needed to derive definitive conclusions.

Primary care organizational model mix and avoidable hospitalization: an ecological study in Portugal

Background

In Portugal, there are different organizational models in primary health care (PHC), mainly regarding the payment scheme. USF-B is the only type with financial incentives to the professional (pay-for-performance). Our goal was to assess the relationship between groups of primary healthcare centres (ACES) with higher proportion of patients within USF-B model and the rate of avoidable hospitalizations, as proxy of primary care quality.

Methods

We conducted a cross-sectional study considering the 55 ACES from mainland Portugal, in 2017. We used data from public hospitalizations to calculate the prevention quality indicator (avoidable hospitalizations) adjusted for age and sex, using direct standardization. The main independent variable was the proportion of patients in one ACES registered in the USF-B model. Unemployment rate, proportion of patients with family doctor and presence of Local Health Unit (different organization model) within ACES were also considered. The association was assessed by means of a linear regression model.

Results

Age-sex adjusted PQI value varied between 490 and 1715 hospitalizations per 100,000 inhabitants across ACES. We observed a significant effect of the proportion of patients within USF-B in the crude PQI rate (p = 0.001). However, using the age-sex adjusted PQI, there was not a statistical significant association (p = 0.504). This last model was also adjusted for confounding variables and the association remains non-significant (p = 0.865).

Conclusions

Our findings suggest that, when adjusting for age and sex, there is no evidence that ACES with more patients enrolled in a pay-for-performance model is associated with higher quality of PHC (using avoidable hospitalizations as proxy). Further studies addressing individual data should be performed.

This work was financed by FEDER funds through the COMPETE 2020 - POCI, and by Portuguese funds through FCT in the framework of the project POCI-01-0145-FEDER-030766 “1st.IndiQare”.

Key messages

Adjusting PQI to sex and age seems to influence its value more than the type of organizational model of primary health care. Groups of primary healthcare centres with more units under the pay-for-performance scheme was not associated with different rate of avoidable hospitalizations.

The Many Faces of Covid-19: Organizing Pneumonia (OP) Pattern HRCT Features

Covid-19 (coronavirus disease 2019) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). On 30 January 2020 the World Health Organization (WHO) declared that the outbreak of Covid-19 realizes a public health emergency of international concern. Because of the primary involvement of the respiratory system, chest CT is strongly recommended in suspected Covid-19 cases, for both initial and follow-up. We present the case of a Covid-19 patient, a 57-year-old man, with a typical HRCT course of OP reaction.

Efficiency of groups of primary healthcare centres: a frontier analysis of primary care in Portugal

Background

Primary health care (PHC) is the cornerstone of several health systems. The Portuguese PHC is organized in five mainland regions (ARS), that oversee 55 local groups of primary healthcare centres (ACES). We assessed the efficiency of all 55 ACES in mainland Portugal, as well as organizational and socioeconomic determinants of the efficiency.

Methods

A cross-sectional non-parametric frontier analysis was performed for 2017. The first model included two inputs (i.e. number of physicians and number of nurses) and a single output (i.e. number of PHC visits), while the second model included an additional output, i.e. Prevention Quality Indicator (PQI) overall composite (avoidable hospitalizations) adjusted for age and sex - as undesirable output. In a second stage, a (multivariate) Tobit regression was used to assess organizational and socioeconomic determinants of efficiency.

Results

In the first model, only 8 ACES (14.5%) were on the efficiency frontier, while 25 ACES should readjust their human resource balance. In the second model, 9 ACES (16.4%) were considered efficient. When considering quality, one ACES previously considered inefficient moved to the frontier and two ACES lost their benchmark position. The second-stage analysis indicates that groups with a higher proportion of PHC units with pay-for-performance incentives were associated with higher efficiency.

Conclusions

Most ACES have the potential to improve their production levels., A better management of human resources can contribute to improve overall efficiency. ACES with a higher proportion of units with pay-for-performance schemes seem to be more efficient. These findings contribute to the evaluation of policies to integrate and scale up PHC services locally, such as the recent primary care networks in the NHS UK.

This work was financed by FEDER funds through the COMPETE 2020 - POCI, and by Portuguese funds through FCT in the framework of the project POCI-01-0145-FEDER-030766 “1st.IndiQare”.

Key messages

Most Portuguese ACES have the potential to improve their outputs given their current level of human resources. Local groups that aggregate more PHC units with pay-for-performance schemes are associated with high efficiency.

Oxidative stress biomarkers in Fabry disease: is there a room for them?

BACKGROUND

Fabry disease (FD) is an X-linked lysosomal storage disorder, caused by deficient activity of the alpha-galactosidase A enzyme leading to progressive and multisystemic accumulation of globotriaosylceramide. Recent data point toward oxidative stress signalling which could play an important role in both pathophysiology and disease progression.

METHODS

We have examined oxidative stress biomarkers [Advanced Oxidation Protein Products (AOPP), Ferric Reducing Antioxidant Power (FRAP), thiolic groups] in blood samples from 60 patients and 77 healthy controls.

RESULTS

AOPP levels were higher in patients than in controls (p < 0.00001) and patients presented decreased levels of antioxidant defences (FRAP and thiols) with respect to controls (p < 0.00001). In a small group of eight treatment-naïve subjects with FD-related mutations, we found altered levels of oxidative stress parameters and incipient signs of organ damage despite normal lyso-Gb3 levels.

CONCLUSIONS

Oxidative stress occurs in FD in both treated and naïve patients, highlighting the need of further research in oxidative stress-targeted therapies. Furthermore, we found that oxidative stress biomarkers may represent early markers of disease in treatment-naïve patients with a potential role in helping interpretation of FD-related mutations and time to treatment decision.

THU0628-HPR SSCENTRY: A PERSONAL DISEASE DIARY APP FOR SYSTEMIC SCLEROSIS PATIENTS

Background:

Systemic Sclerosis (SSc) is a connective tissue disease characterized by severe alterations in the microvasculature and progressive fibrosis of the skin and internal organs [1]. Management of SSc is not easy, for both patients and physicians [2]. Symptoms are manifold and have a significant impact on patient’s daily autonomy and psychological well-being.

Objectives:

SScEntry (SSc data Entry tool; Figure 1) is a solution conceived to assist SSc patients in monitoring their disease, as a kind of “sentry”. The core idea is to provide patients with a personal diary to annotate and track the onset, evolution and resolution of symptoms as well as any changes in their general health condition, through an app for iOS and Android smartphones and tablets.

Figure 1.

SScEntry logo.

Methods:

SScEntry is a smartphone/tablet app designed by rheumatology and computer science engineering specialists in close partnership [3]. A carefully designed user interface (UI), inspired to a social network wall, allows annotating the evolution of symptoms by means of standard clinical investigation methods such as scientifically validated questionnaires. The UI facilitates data collection through speech-based interaction as well as touch and gestures optimized for patients with finger skin lesions and joints impairments. User engagement over the course of time is fostered by: follow-up reminders to update information on the evolution of past events and periodic questionnaires for general health assessment; the integration of symptom photos taken with on-device camera and health data collected from wearable devices; gamification features. Privacy and security have been a primary design concern, with app access protection and full on-device data encryption; no personal data transmission occurs without explicit user consent. SScEntry generates a disease activity summary report, for displaying to the physician during visit or emailing/printing.

Results:

SScEntry is ready for Android and iOS smartphones and tablets. All planned features have been implemented (Figure 2). Currently supported languages are English and Italian. Areas of interest include vascular, cutaneous, articular, visceral (gastro-intestinal and cardio-pulmonary) as well as relationship, sexual and working life.

Figure 2.

SScEntry features.

Conclusion:

Novel Narrative-based Medicine approaches are getting increasing attention to enhance the mutual understanding between patient and physician, reinforcing the therapeutic adherence at the core of healthcare. This is particularly important with chronic and disabling diseases like SSc. Involving patients in disease management with SScEntry will increase their compliance and confidence, with benefits on psychological well-being. Expected benefits for rheumatologists include better evaluation of target therapy and outcomes, as no data on disease activity is lost during the patient clinical history.

References:

[1]J. Varga et al. (2017) Pathogenesis of systemic sclerosis: recent insights of molecular and cellular mechanisms and therapeutic opportunities. J Scleroderma Relat Disord 2:137–52.

[2]L. Mouthon et al. (2017) Patients’ views and needs about systemic sclerosis and its management: a qualitative interview study. BMC Musculoskelet Disord 18(1):230.

[3]M. Bradway et al. (2015) Mobile Health: empowering patients and driving change. Trends in Endocrinology & Metabolism, 26(3):114-117.

Disclosure of Interests:

Emanuela Praino: None declared, Floriano Scioscia: None declared, Crescenzio Scioscia: None declared, Giuseppe Loseto: None declared, Filippo Gramegna: None declared, Saverio Ieva: None declared, Agnese Pinto: None declared, Michele Ruta: None declared, Eugenio Di Sciascio: None declared, Giovanni Lapadula: None declared, Florenzo Iannone Consultant of: Speaker and consulting fees from AbbVie, Eli Lilly, Novartis, Pfizer, Roche, Sanofi, UCB, MSD, Speakers bureau: Speaker and consulting fees from AbbVie, Eli Lilly, Novartis, Pfizer, Roche, Sanofi, UCB, MSD

RETIRADO: El impacto de la pandemia de COVID-19 en la utilización de los servicios urológicos de urgencias

Este artículo ha sido retirado a petición del autor del artículo. La editorial lamenta los inconvenientes ocasionados.

Puede consultar la política de Elsevier sobre la retirada de artículos en https://www.elsevier.com/about/our-business/policies/article-withdrawal

Rehabilitation of a severe mandibular atrophy with four millimeter extra-short implant and guided bone regeneration (GBR): case report with 7-years follow-up

The aim of this study was to report the use of extra-short and short implants in combination with Guided Bone Regeneration (GBR) to rehabilitate a case of severe mandibular reabsorption. A 55-yearold female patient asked for a fixed implant supported rehabilitation in 4.5 - 4.6 zone which showed severe atrophy. It was decided to use an extra-short 4 mm length and 4.1 mm Ø, Roxolid and SLActive implant (Straumann Standard Plus Regular Neck, Institut Straumann AG) in 4.5 position and a short 6 mm length and 4.8 mm Ø, Roxolid and SLActive implant (Straumann Standard Plus Wide Neck, Institut Straumann AG) in 4.6 position. The implants supported cemented fixed prosthesis. Examinations were performed at the day of the surgery and up to 7-years in function to evaluate implant stability and periapical radiography. One extra-short implant and one short implant were placed. After 7 years in function no biological or prosthetic complication were recorded. Within the limitation of this case report, the use of short and extra-short implants to support fixed prosthesis seem to be a feasible treatment alternative in severe mandibular atrophy.

First description of a herpesvirus infection in genus Lepus

During the necropsies of Iberian hares obtained in 2018/2019, along with signs of the nodular form of myxomatosis, other unexpected external lesions were also observed. Histopathology revealed nuclear inclusion bodies in stromal cells suggesting the additional presence of a nuclear replicating virus. Transmission electron microscopy further demonstrated the presence of herpesvirus particles in the tissues of affected hares. We confirmed the presence of herpesvirus in 13 MYXV-positive hares by PCR and sequencing analysis. Herpesvirus-DNA was also detected in seven healthy hares, suggesting its asymptomatic circulation. Phylogenetic analysis based on concatenated partial sequences of DNA polymerase gene and glycoprotein B gene enabled greater resolution than analysing the sequences individually. The hare’ virus was classified close to herpesviruses from rodents within the Rhadinovirus genus of the gammaherpesvirus subfamily. We propose to name this new virus Leporid gammaherpesvirus 5 (LeHV-5), according to the International Committee on Taxonomy of Viruses standards. The impact of herpesvirus infection on the reproduction and mortality of the Iberian hare is yet unknown but may aggravate the decline of wild populations caused by the recently emerged natural recombinant myxoma virus.

Full-digital workflow to rehabilitate a high value aesthetic zone. A case report

Replacing missing teeth in the aesthetic area is a clinical challenge which must be solved by a multidisciplinary approach in order to obtain an esthetic and functional implant-prosthetic rehabilitation. First therapeutic choice should be the less invasive option, in accordance with patients' expectations. The present clinical case presents the rehabilitation of the upper incisor group using a full-digital workflow to reduce operative time, costs and patient discomfort. The use of computer-guided-surgery and 3D technologies, as intraoral scanners or cone-beam-computed-tomography, allows the clinician to visualize all patient's information when planning the rehabilitation in order to obtain a more predictable and a less invasive surgery.

Acoustic field generated by an innovative airborne power ultrasonic system with reflectors for coherent radiation

In order to obtain the maximum efficiency in industrial processes assisted by airborne power ultrasound, the ultrasonic systems must be capable of generating an acoustic field with a maximum energy concentration in the desired areas. In this paper, the acoustic performance of two different ultrasonic systems is presented. The first system corresponds to an airborne power ultrasonic transducer with a flat rectangular plate radiator, and the second system is composed by the same transducer mounted in a set of reflectors that allow the generation of coherent radiation. The acoustic pressure field for each system has been determined numerically and the spatial pattern has been experimentally measured. In the experiment, the system with reflectors obtained higher pressure amplitude in a wider area, due to the coherent radiation achieved. The directivity pattern obtained in the experiment confirms this coherent radiation field. This is the first time that the acoustical behavior of two different ultrasonic systems with flat rectangular radiator, vibrating in a complex flexural mode, has been numerically and experimentally described and compared in terms of pressure amplitude distribution and directivity pattern.

JS1.2 Increased frequency of paraneoplastic encephalitis with anti-Ma2 antibodies in the cancer immunotherapy era

BACKGROUND

Given the mechanism of action of immune checkpoint inhibitors (ICIs), a possible association with the development of paraneoplastic neurological syndromes (PNS) has been hypothesized. We sought to determine if ICI treatment might trigger anti-Ma2 antibody-associated paraneoplastic neurological syndromes (Ma2-PNS).

MATERIAL AND METHODS

We performed a retrospective nationwide study of all patients with Ma2-PNS developed during ICI treatment between 2017–2018. The frequency of neuronal-antibody detection before and after ICI implementation was also analyzed.

RESULTS

Our series of patients included 5 men and 1 woman (median age, 63 years). The patients were receiving either nivolumab (n = 3), pembrolizumab (n = 2) or a combination of nivolumab and ipilimumab (n=1), for treatment of neoplasms that included lung (n=4) and kidney (n=1) cancers, and pleural mesothelioma (n=1). Median delay between ICI introduction and onset of the neurological syndrome was 4 months. Clinical syndromes included a combination of limbic encephalitis and diencephalitis (n=3), isolated limbic encephalitis (n=2) and a syndrome characterized by opthalmoplegia and head-drop (n=1). Patients with diencephalitis manifested hyperphagia, weight gain and somnolence. Post-ICI Ma2-PNS accounted for 35% of the total 17 Ma2-PNS diagnosed in our center over the 2017–2018 biennium. Eight cases had been detected in the preceding biennium 2015–2016, corresponding to a 112% increase of Ma2-PNS frequency since the implementation of ICIs in France. No other neuronal-antibody demonstrated a similar increment.

CONCLUSION

We show a clear association between ICI use and increased frequency of Ma2-PNS. Physicians need to be aware that ICIs can trigger Ma2-PNS since clinical presentation can be challenging.

Management of colorectal peritoneal metastases: Expert opinion

When peritoneal metastases are diagnosed (strong agreement of experts): (i) seek advice from a multidisciplinary coordination meeting (MCM) with large experience in peritoneal disease (e.g. BIG RENAPE network); (ii) transfer (or not) the patient to a referral center with experience in hyperthermic intraperitoneal chemotherapy (HIPEC), according to the advice of the MCM. With regard to systemic chemotherapy (strong agreement of experts): (i) it should be performed both before and after surgery, (ii) for no longer than 6 months; (iii) without postoperative anti-angiogenetic drugs. With regard to cytoreductive surgery (strong agreement of experts): (i) Radical surgery requires a xiphopubic midline incision; (ii) no cytoreductive surgery via laparoscopy. With regard to HIPEC: HIPEC can be proposed for trials outside an HIPEC referral center (weak agreement between experts): (i) if surgery is radical; (ii) if the expected morbidity is "reasonable"; (iii) if the indication for HIPEC was suggested by a MCM, and; (iv) mitomycin is preferred to oxaliplatin (which cannot be recommended) for this indication.