Distribution, reactivity and vertical fluxes of methane in the Guadalquivir Estuary (SW Spain)

The influence of temperature, salinity, sediment-water-atmosphere exchanges and oxidation rate on the variability of methane (CH4) in the Guadalquivir Estuary has been studied. The database corresponds to 3 intensive samplings carried out in summer (2021 and 2022) and winter (2022). An increase in CH4 concentration towards the interior of the estuary has been observed, more intense during summer (19-371 nmol L-1). The influence of temperature and salinity on the variability of CH4 concentration is negligible, with contributions below 1 nmol L-1. Water-atmosphere fluxes increase inland in summer (28-574 μmol m-2 d-1), being generally higher than in winter (18-80 μmol m-2 d-1). Similarly, benthic fluxes remain relatively constant in winter (10 ± 6 μmol m-2 d-1) and increase inland in summer (7-212 μmol m-2 d-1). In the innermost station of the estuary, with salinities lower than 1, there is a significant increase in benthic fluxes, with values above 9000 μmol m-2 d-1. CH4 oxidation rates increase towards low salinities, being especially high in summer (489 nmol L-1 d-1). Based on the information obtained, CH4 variability in the Guadalquivir Estuary is mainly controlled by water-atmosphere fluxes, benthic fluxes and oxidation in the water column. The uncertainty associated with the quantification of these processes does not allow an adequate assessment of the influence of lateral inputs, although there is experimental evidence of their importance in the Guadalquivir.

Dynamics of CO2, CH4, and N2O in Ria Formosa coastal lagoon (southwestern Iberia) and export to the Gulf of Cadiz

A first characterization of greenhouse gases had been carried out to study their role and impact in a productive transitional coastal system of the southern Portugal - Ria Formosa lagoon. To this purpose, the partial pressure of CO2 (pCO2) and the concentration of dissolved CH4 and N2O have been measured. Two surveys were carried out during 2020, at low tide under typical conditions of Spring (March) and end of Summer (October). The samplings sites were distributed along the costal lagoon covering: i) inner areas with strong human impact (influence of different flows of treated wastewater discharges); and ii) main channels in connection with the main inlets to study the exchanges with the ocean. In general, the highest values of the three greenhouse gases were found at the inner studied areas, especially affected by the disposal of treated effluents from wastewater treatment plans, in October. The mean water - atmosphere fluxes of the CO2, CH4 and N2O are positive, showing that the study area acts as a source of these gases to the atmosphere. On the other hand, it was calculated a rough estimation of the three gases globally exported from Ria Formosa to the ocean, through the main six inlets to evaluate the magnitude of the supply of these gases from Ria Formosa to the adjacent ocean. The mean CO2, CH4 and N2O horizontal water fluxes exported from all the inlets of Ria Formosa to the Gulf of Cadiz for both seasons, during low water, are 8.7 ± 3.9 mmol m-2 s-1, 8.0 ± 3.5 μmol m-2 s-1 and 3.2 ± 1.5 μmol m-2 s-1, which corresponds to a mass transport through the inlets section of 0.7 ± 0.7 kg s-1, 0.2 ± 0.2 g s-1 and 0.2 ± 0.3 g s-1 respectively. From these estimates, as expected, the higher mass transport was found at the larger and deeper inlets (Faro-Olhão and Armona).

Greenhouse gas assemblages (CO2, CH4 and N2O) in the continental shelf of the Gulf of Cadiz (SW Iberian Peninsula)

This study examines the simultaneous water-atmosphere exchange of carbon dioxide (CO2), methane (CH4) and nitrous oxide (N2O) on the continental shelf of the Gulf of Cadiz, as well as the effect it has in terms of the radiative balance in the atmosphere, between 2014 and 2016. The experimental database consists of new measurements of the spatial and seasonal distribution of CO2 partial pressure (pCO2) and N2O concentration in 2016. pCO2 shows a wide range of variation influenced mainly by seasonal thermal variations (8.0 μatm 0C-1), as well as with the relative intensity of biological activity. There is experimental evidence of a progressive increase of pCO2 over the last 2 decades, with an estimated gradient of 4.2 ± 0.7 μatm y-1. During 2016, the Gulf of Cadiz acted as a slight source of CO2 to the atmosphere, with a mean flux of 0.4 ± 2.2 mmol m-2 d-1. The analysis of concentration variations in the water column shows that nitrification is the main N2O production process in the study area, although in the more coastal zone there are signs of inputs related to continental and sediment contributions, most probably induced by denitrification processes. In 2016, the Gulf of Cadiz acted as a weak sink of atmospheric N2O, with a mean flux of -0.1 ± 0.9 μmol m-2 d-1. From previous studies, performed with a similar methodology, an interannual database (2014-2016) of water-atmosphere fluxes of CO2, CH4 and N2O, normalized to the mean wind speed in the area, has been generated. Considering their respective Global Warming Potential (GWP) a joint greenhouse gasses (GHG) flux, expressed in CO2 equivalents of 0.6 ± 2.0 mmol m-2 d-1, has been estimated, which extended to the area of study indicates an approximate emission of 67.9 Gg CO2 y-1. However, although there is a high uncertainty associated with the spatial, temporal and interannual variations of CO2, CH4 and N2O fluxes in the Gulf of Cadiz, the exchange of greenhouse gasses could be influencing a radiative forcing increase in the atmosphere. When considering the available information on local and global estimates, the uncertainty about the effect of the joint exchange of GHGs to the atmosphere from the coastal seas increases significantly.

Clinical and genomic characterisation of early-onset pancreatic cancer

BACKGROUND

The incidence of early-onset pancreatic cancer (EOPC) has risen dramatically in recent years. We aimed to characterise the clinical and genomic features of EOPC and evaluate their therapeutic implications.

METHODS

We performed a comparative, single-centre, retrospective analysis of clinical, germline, and genomic features in EOPC (≤50 years) patients and compared them with a control group of average-onset pancreatic cancer patients (AOPC, ≥70 years). Key molecular findings were compared with an external, publicly available cohort.

RESULTS

We reviewed 336 patients who met all inclusion criteria (EOPC N = 139, AOPC N = 197). EOPC was associated with smoking status, lower prevalence of diabetes, better performance status, higher CA19.9 levels, and higher albumin levels at diagnosis. After adjustment for baseline covariates, we observed no differences in overall survival (OS). Age was associated with an increase in the incidence of KRASMUT both in our cohort and the validation cohort. EOPC were enriched in potentially actionable alterations according to ESCAT tiers I-IIIA when compared with AOPC in discovery and validation cohorts (19% versus 14% and 14% versus 8%, respectively). In the first-line metastatic setting, EOPC had a longer progression-free survival (hazard ratio [HR] 0.61, 95% confidence interval (CI) 0.43-0.87) and OS (HR 0.65, 95% CI 0.45-0.95), although there were no differences in response rate. After adjusting for the number of treatment lines, EOPC patients who did receive targeted therapies exhibited longer OS compared with EOPC who did not (HR 0.34, 95% CI 0.12-0.93).

CONCLUSIONS

EOPC patients have improved outcomes in the metastatic setting when compared to AOPC and are enriched for targetable alterations that open opportunities for precision oncology-based approaches.

Liquid biopsy after resection of pancreatic adenocarcinoma and its relation to oncological outcomes. Systematic review and meta-analysis

BACKGROUND

It has been hypothesised that manipulation during surgery releases tumoral components into circulation. We investigate the effect of surgery on plasma-borne DNA biomarkers and the oncological outcomes in resectable pancreatic ductal adenocarcinoma (PDAC). We also compare non-touch isolation techniques (NTIT) with standard techniques.

MATERIALS AND METHODS

We performed a systematic review and a meta-analysis of studies analysing liquid biopsy as circulating tumour DNA (ctDNA), circulating tumour cells (CTCs), and messenger RNA (mRNA) in resectable PDAC patients who underwent surgery and its association with overall survival (OS) and disease-free survival (DFS). Research in EMBASE, Web of Science and PubMed was performed. The ctDNA shift negative-to-positive (ctDNA -/+) or ctDNA shift positive-to-negative (ctDNA +/-) before and after surgery was evaluated.

RESULTS

Twelve studies comprising 413 patients were included. Shorter OS and DFS were identified in patients with positive ctDNA status before (HR = 2.28, p = 0.005 and HR = 2.16, p = 0.006) or after surgery (HR = 3.88, p < 0.0001 and HR = 3.81, p = 0.03), respectively. Surgical resection increased the rate of ctDNA +/-. There were no differences in OS or DFS in the ctDNA +/- group compared with ctDNA +/+ or ctDNA -/+. However, there was a trend to shorter OS in the ctDNA -/+ group (HR = 5.00, p = 0.09). No differences between NTIT and standard techniques on liquid biopsy status were found.

CONCLUSION

Positive ctDNA in the perioperative period is associated with a worse prognosis. Surgical resection has a role in the negativisation of liquid biopsy status. More studies are needed to assess the potential of minimally invasive techniques on ctDNA dynamics.

Early Dalmatian farmers specialized in sheep husbandry

The spread of farming in the central and western Mediterranean took place rapidly, linked to the Impressa Ware. The Impressa Ware originated somewhere in the southern Adriatic and spread westwards across the Mediterranean. These early farmers had an economy based on cereal agriculture and caprine husbandry, but there is still little information on how this agropastoral system functioned. This study aims to unravel the farming practices of the early Dalmatian farmers linked to the Impressa culture by using an integrated analysis, combining archaeozoology, palaeoproteomics and stable isotopes, applied to the faunal assemblages of Tinj-Podlivade and Crno Vrilo. The results show: (1) the composition of the flocks was overwhelmingly sheep; (2) sheep exploitation at both sites was similar, focusing on milk and meat; (3) sheep reproduction was concentrated at the beginning of winter, with no reproduction in autumn as in later sites in the western Mediterranean. We conclude that a common animal economy existed at both sites, which could be related to the mobility practiced by these early farming societies throughout the Mediterranean.

FGFR2 fusion detection in plasma: A new era in the clinical monitoring of iCCA

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Background: Actionable genetic alterations can be identified in over 50% of intrahepatic cholangiocarcinoma (iCCA). Since EMA approved Pemigatinib, a selective Fibroblast growth factor receptor 1-3 (FGFR1-3) inhibitor for the treatment of CCA with FGFR2 fusions or rearrangements, the screening of patients who may benefit from such targeted therapies is especially relevant. In addition, novel FGFR inhibitors that are effective for treatment of resistant mutant clones are under development. In patients with no available tissue for genomic profiling or at different timepoints after targeted therapy, NGS testing of circulating cell-free DNA (ccfDNA) would be the most convenient option. Hence, two important issues must be addressed: i) technical set-up and validation of detection of FGFR2 rearrangements in plasma, and ii) patient shedding in iCCA, in order to consider liquid biopsy for routine clinical care. Methods: We conducted a retrospective study in a cohort of 18 iCCA patients with known FGFR2 fusion or rearrangement events previously identified in tumor FFPE by NGS (FoundationOne CDx test). A custom-designed capture-based NGS panel for use in plasma or tissue (VHIO-iCCA test) was developed to detect FGFR2 rearrangements and other common altered genes in iCCA. After validating our VHIO-iCCA panel with fusion positive FFPE samples, a concordance study was conducted to evaluate the detection of FGFR2 fusion and rearrangements in matched-to-tissue timepoint plasmas. Finally, additional serial plasma samples taken during FGFR inhibitor treatment were also analyzed. Results: From the 18 rearrangement events previously detected with FoundationOne CDx, we were able to identify all 18 in FFPE samples and 15 in the paired plasma using our VHIO-iCCA panel, representing a 100% and 83% concordance, respectively. In the 3 discordant cases, no additional alterations were detected in plasma, indicating a lack of circulating tumor DNA (ctDNA) shedding. Serial sampling of these patients indicated persistent non-shedding. The analysis of fusion allele fraction (FAF) in serial plasma samples revealed that detection of fusion FGFR2 changed during treatment and correlated with best response. In general, patients with a stable FAF showed a SD, while patients which reduced FAF presented a PR. Conclusions: This extremely valuable set of cases has allowed us to validate our VHIO-iCCA panel to be used in tissue and plasma, and to determine that the sensitivity in plasma is >80%, making this a feasible option to avoid tissue biopsies, whenever patients cannot undergo the procedure and even to aid in cancer monitoring. Patient shedding is high in iCCA, yet a fraction of patients may not find a useful resource in liquid biopsy. For those who shed ctDNA, monitoring through the FAF may guide clinical management of iCCA.

KRAS mutation detection and cfDNA in liquid biopsy as prognostic factors in pancreatic adenocarcinoma

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Background: Approximately 80% of pancreatic ductal adenocarcinoma (PDAC) patients present with advanced disease at diagnosis, with a 5-year survival rate of less than 5%. According to molecular profiling, mutations in KRAS have been described in 90% of PDAC patients, and correlated with poor prognosis. Nevertheless, the invasiveness of tumor biopsy and the difficulties in obtaining quality samples in some patients remains a concern. Circulating free DNA (cfDNA) is considered a surrogate marker of tumor burden and may also act as a prognostic factor that can be used independently from tumor biopsy. In this study, we aim to explore molecular prognostic biomarkers using plasma samples. Methods: Patients with metastatic PDAC harboring KRAS mutation in tissue samples and treated with first-line chemotherapy were identified at Vall d’Hebron University Hospital. Clinical features and plasma samples were collected before starting any treatment. DNA mutations were analyzed in plasma and compared with tissue samples. In plasma, detection of KRAS mutation and total cfDNA concentration were evaluated for clinical significance. A cfDNA minimum 100 genome equivalent threshold was proposed based on results and utility. A Chi-square test was planned to prove the independence between cfDNA levels and KRAS detection in plasma. Survival analysis was performed using the Kaplan-Meier method. Results: We included 33 PDAC patients with a median age of 66.1 years old, 57% were women. All of them were treated with gemcitabine and Nab-paclitaxel. At the final analysis cut-off, 31 patients had died . KRAS mutation was detected in 25 patients’ blood samples (75.8%) and cfDNA-High levels were considered for 20 patients (60.6%). 19 of 20 (95%) patients with cfDNA-High correlated with KRAS blood detection, showing significant dependence (p-value 0.001). Median overall survival (OS) was 10.5 months in the KRAS detected group compared with 22.6 months in the KRAS non-detected group (HR for death 4.70; confidence interval (CI) 1.70-12.98, p-value 0.002). Better separation was seen using cfDNA where median OS was 9.8 months in the cfDNA-High group compared with 21.0 months in the cfDNA-Low group (HR for death 5.38; CI 2.17-13.31, p-value < 0.001). Conclusions: Liquid biopsy can provide quality prognostic information in metastatic PDAC patients. On account of this, the cfDNA level is proposed as a prognostic factor. However, prospective cohorts to validate this information are needed.[Table: see text]

Dynamic of CO2, CH4 and N2O in the Guadalquivir estuary

The concentration of dissolved CH₄ and N₂O, as well as the partial pressure of CO₂ (pCO₂) were studied in the Guadalquivir estuary. Samples were taken in March and April 2018 and 2019, under different rainy and tidal conditions. The available database for summer 2017 (Sierra et al., 2020) was included in the interpretation of the factors that determine the variability of these gases in the Guadalquivir estuary. Two different types of samplings were carried out: a longitudinal transect across the river with salinity values close to zero and another one during two consecutive tidal cycles in the mouth of the estuary. The highest concentrations were found in the upper zone of the estuary and during the low tide. This distribution was related to 4 factors: temperature, salinity, exchange with the atmosphere, and biochemical processes together with the river inputs. Temperature is one of the factors that clearly seems to determine the distribution of gases and fluxes, showing the highest values in the upper zone during the summer of 2017. Intense rains cause a dilution effect of the gas in the water column, this provoked, during the season of spring 2018, an increase in the salinity factor in the distribution of gases in the middle zone. High concentrations of the gases have been linked to production processes in the water column, as well as to benthic production and lateral inputs. While the gases concentrations at the mouth presented values close to those of the equilibrium with the atmosphere, the fluxes in the upper zone of the estuary reached average values of 89.6 mmol m^-2 d^-1, 121.7 μmol m^-2 d^-1 and 59.9 μmol m^-2 d^-1 for CO₂, CH₄ and N₂O, respectively. Generally, water-atmosphere fluxes are positive through the whole study, which means that the estuary acts as a source of these gasses to the atmosphere.

ESMO Scale for Clinical Actionability of Molecular Targets driving targeted treatment in patients with cholangiocarcinoma

Purpose: Treatment options for advanced cholangiocarcinoma are limited and prognosis is poor. Cholangiocarcinomas are highly heterogeneous at the molecular level, with divergent patterns between intrahepatic and extrahepatic forms, intrahepatic being particularly rich in actionable alterations. We compared survival in patients with advanced cholangiocarcinoma harboring alterations matched to targeted drugs, with patients harboring non-actionable alterations. Experimental design: Patients with cholangiocarcinoma treated between 2011 and 2020 at one institution, with available molecular analyses, were retrospectively reviewed. Genomic alteration actionability was classified according to the ESMO Scale for Clinical Actionability of Molecular Targets (ESCAT) and correlated with efficacy endpoints. Results: Of 327 patients included, 78.9% had intrahepatic cholangiocarcinoma, 97.9% had received chemotherapy for metastatic disease. Actionable molecular alterations per ESCAT were identified in 184 patients (56.3%), including IDH1 mutations and FGFR2 fusions (23.1% and 8.0% of intrahepatic cholangiocarcinoma patients, respectively). Median overall survival in 50 patients with ESCAT I-IV alterations who received matched therapy (48 with intrahepatic cholangiocarcinoma) was 22.6 months (95%CI:20.1-32.8), compared to 14.3 months (95%CI:11.9-18.1) in 130 patients without actionable ESCAT alterations (HR=0.58, 95%CI:0.40-0.85; P=0.005). Among patients receiving matched targeted therapy, median progression-free survival was longer for patients with alterations classified as ESCAT I-II compared to ESCAT III-IV (5.0 versus 1.9 months; HR=0.36, 95%CI:0.15-0.87; P=0.02). Conclusions: ESCAT represents a tool to guide clinicians in fine-tuning use of molecular profiling data to choose matched targeted therapies. Our data demonstrate that targeted treatment administered per alteration actionability according to ESCAT is associated with improved survival in cholangiocarcinoma, particularly in ESCAT I-II intrahepatic cholangiocarcinoma.

[Chronic migraine with daily headache. Literature review]

INTRODUCTION

Despite representing a significant number of cases, patients with chronic migraine and daily headache are frequently excluded from large therapeutic clinical trials. These individuals have hardly been studied and could have specific properties. Development. A third of patients with chronic migraine may suffer from headaches every day, representing up to 1.7 - 3.3% of patients in a general neurology consultation. These patients are excluded from most studies, so little information is available. They may have a longer lasting migraine and different response to treatment. Patients with chronic migraine and daily headache may have complex pathophysiological mechanisms that favor the daily manifestation of migraine. The management of these patients is a therapeutic challenge, and OnabotulinumtoxinA may be useful.

CONCLUSION

Patients with chronic migraine and daily headache may have specific clinical and therapeutic characteristics. New studies could lead to differentiate it from chronic migraine.

Essential omega-3 fatty acids tune microglial phagocytosis of synaptic elements in the mouse developing brain

Omega-3 fatty acids (n-3 PUFAs) are essential for the functional maturation of the brain. Westernization of dietary habits in both developed and developing countries is accompanied by a progressive reduction in dietary intake of n-3 PUFAs. Low maternal intake of n-3 PUFAs has been linked to neurodevelopmental diseases in Humans. However, the n-3 PUFAs deficiency-mediated mechanisms affecting the development of the central nervous system are poorly understood. Active microglial engulfment of synapses regulates brain development. Impaired synaptic pruning is associated with several neurodevelopmental disorders. Here, we identify a molecular mechanism for detrimental effects of low maternal n-3 PUFA intake on hippocampal development in mice. Our results show that maternal dietary n-3 PUFA deficiency increases microglia-mediated phagocytosis of synaptic elements in the rodent developing hippocampus, partly through the activation of 12/15-lipoxygenase (LOX)/12-HETE signaling, altering neuronal morphology and affecting cognitive performance of the offspring. These findings provide a mechanistic insight into neurodevelopmental defects caused by maternal n-3 PUFAs dietary deficiency.

SAT0210 FACTORS ASSOCIATED WITH TIME TO SEVERE LUPUS NEPHRITIS IN A COHORT OF COLOMBIAN PATIENTS

Background:

Systemic lupus erythematosus (SLE) clinical manifestations, and their severity, vary according to age, ethnicity and socioeconomic status. Both Hispanic and Afro-Americans have a higher incidence and more sever presentation when compared to Caucasian patients with SLE

Objectives:

To analyze clinical and immunological characteristics associated with time to severe renal involvement in patients with Systemic Lupus Erythematous in a Colombian cohort followed for one year, between January 2015 and December 2018

Methods:

Retrospective follow-up study based in clinical records. Patients with SLE diagnosis that fulfilled either 1987 American College of Rheumatology Classification Criteria for SLE or 2011 Systemic Lupus International Collaborating Clinics (SLICC) classification criteria for SLE. We included patients with diagnosis of lupus nephritis according to Wallace and Dubois criteria. Patients who did not have at least two follow-up measurements or had a cause of nephritis other than lupus were excluded. The main outcome was defined as time from diagnosis to sever renal involvement defined as creatinine clearance ≤50 ml/min, 24-hour proteinuria ≥3.5 grams o end stage renal disease.

We analyzed clinical and immunological characteristics. Descriptive statistical analyses of participant data during the first evaluation are reported as frequencies and percentages for categorical variables, and as medians and interquartile ranges (IQR) for quantitative variables. Age and sex adjusted survival functions and Hazard ratios (HR) with 95% confidence intervals and p-values were estimated using parametric Weibull models por interval-censored data. P values < 0.05 were considered statistically significant

Results:

548 patients were analyzed: 67 were left-censored as they presented renal involvement at entry, 6 were interval censored as outcome occurred between study visits, and 475 were right-censored as involvement was not registered during follow-up. 529 (96.5%) patients were female, median age at entry was 46 (IQR = 23) and median age to diagnosis was 29.5 (IQR = 20.6). 67% were mestizo, 13% Caucasian and 0.3% Afro-Colombian. Age and sex adjusted variables associated with time to severe lupus nephritis were high blood pressure HR = 3.5 (95%CI 2.2-5.6; p-value <0.001) and Anti-RO (per unit increase) HR = 1.002 (95%CI 1.001-1.004; p-value = 0.04). Figure 1 shows age and sex adjusted survival function.

Conclusion:

In our cohort the appearance of severe lupus nephritis occurs in less than 15% of patients at 10 years. Both high blood pressure and elevated anti-Ro titers were associated with a higher rate of onset in the presentation of severe lupus nephritis, as seen in some polymorphs of anti Ro.

References:

Disclosure of Interests:

Sebastian Herrera Speakers bureau: academic conference, Juan camilo Diaz-Coronado: None declared, Diego Rojas-Gualdrón: None declared, Laura Betancur-Vasquez: None declared, Daniel Gonzalez-Hurtado: None declared, Juanita Gonzalez-Arango: None declared, laura Uribe-Arango: None declared, Maria Fernanda Saavedra Chacón: None declared, Jorge Lacouture-Fierro: None declared, Santiago Monsalve: None declared, Sebastian Guerra-Zarama: None declared, Juan david Lopez: None declared, Juan david Serna: None declared, Julian Barbosa: None declared, Ana Sierra: None declared, Deicy Hernandez-Parra: None declared, Ricardo Pineda.Tamayo: None declared

AB0246 FACTORS ASSOCIATED WITH THE TIME OF PRESENTATION OF CARDIOVASCULAR EVENTS IN A COHORT OF COLOMBIAN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Background:

Systemic lupus erythematosus is a systemic disease characterized by a compromise of vital organs. The autoimmune activity has been linked to accelerated endothelial damage and increased cardiovascular risk and its outcomes such as heart attack, stroke, and peripheral arterial disease(1). Patients with Lupic nephritis have been characterized by requiring aggressive immunosuppressive therapies apart from prolonged and progressive use of corticosteroids, what you have shown can accelerate these outcomes(2). Other factors such as secondary arterial hypertension, dyslipidemia among others are factors to consider (3).

Objectives:

To analyze clinical and immunological characteristics associated with time to severe renal involvement in patients with Systemic Lupus Erythematous in a Colombian cohort followed for one year, between January 2015 and December 2018.

Methods:

Retrospective follow-up study based on clinical records of patients with SLE diagnosis that fulfilled either 1987 American College of Rheumatology Classification Criteria for SLE or 2011 Systemic Lupus International Collaborating Clinics (SLICC) classification criteria for SLE. Patients with cardiovascular disease outcomes such as angina, acute myocardial infarction, stroke, transient cerebral ischemia and chronic arterial occlusive disease were included. Patients who did not have at least two follow-up measurements or had structural heart disease, valvulopathies, arrhythmias, myocarditis, pericarditis were excluded. The main outcome was defined as the time from diagnosis to cardiovascular diseases.

Clinical and immunological characteristics were analyzed. Descriptive statistical analyses of participant data during the first evaluation are reported as frequencies and percentages for categorical variables, and as medians and interquartile ranges for quantitative variables. Age and sex adjusted survival functions and Hazard Ratios (HR) with 95% confidence intervals and p-values were estimated using parametric Weibull models for interval-censored data. P values < 0.05 were considered statistically significant

Results:

547 patients were analyzed: 29 were left-censored as they presented renal involvement at entry, 22 were interval censored as outcome occurred between study visits, and 496 were right-censored as involvement was not registered during follow-up. 528 (96.5%) patients were female, median age at entry was 46 (IQR = 23) and median age to diagnosis was 29.4 (IQR = 20.9). Statistically significant age and sex adjusted variables were High Blood Pressure (HBP) HR = 2.0 (95%CI 1.1-3.6; p-value <0.018) and cumulative prednisolone dose (>10 gr vs <2 gr) HR = 2.4 (95%CI 1. 1-5.1; p-value = 0.023). Figure 1 shows the age and sex adjusted survival function for HBP

Conclusion:

HBP and cumulative steroid doses accelerate the onset of cardiovascular diseases in patients with lupus more than two times. Maintaining blood pressure in goals and performing early clearance of glucocorticoids could improve outcomes in these patients who are already considered a high cardiovascular risk

References:

[1]Hans-Joachim Anders, Ramesh Saxena, Ming-Hui Zhao. Lupus Nephritis. Nat Rev Dis Primers. 2020 Jan 23;6(1):7.

[2]Shanthini Kasturi, Lisa R Sammaritano. Corticosteroids in Lupus. Rheum Dis Clin North Am, 42 (1), 47-62, viii

[3]César Magro-Checa, Juan Salvatierra, José Luis Rosales-Alexander, et al. Cardiovascular risk in systemic lupus erythematosus: implicated factors and assessment methods. Semin Fund Esp Reumatol. 2012;13(3):95–102

Disclosure of Interests:

Sebastian Herrera Speakers bureau: academic conference, Juan camilo Diaz-Coronado: None declared, Diego Rojas-Gualdrón: None declared, Laura Betancur-Vasquez: None declared, Daniel Gonzalez-Hurtado: None declared, Juanita Gonzalez-Arango: None declared, laura Uribe-Arango: None declared, Maria Fernanda Saavedra Chacón: None declared, Jorge Lacouture-Fierro: None declared, Santiago Monsalve: None declared, Sebastian Guerra-Zarama: None declared, Juan david Serna: None declared, Julian Barbosa: None declared, Deicy Hernandez-Parra: None declared, Ana Sierra: None declared, Ricardo Pineda.Tamayo: None declared

DNA damage repair (DDR) gene mutations (mut) are predictors of response to platinum-based chemotherapy in advanced pancreatic cancer (PC) patients (pts)

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Background: Somatic DDR mut have been reported in close to 10% of PC samples. In this study we investigate their predictive value for response to platinum-based chemotherapy. Methods: Case-control study with pts deriving response to oxaliplatin-based treatment (partial or complete response at any line) [n = 30] versus no response (progression in first restaging at 1st line) [n = 18]. An in-house NGS panel test of 420 genes was performed on tumor samples. DDR mut were classified in 2 subgroups: (a) functional BRCA1, BRCA2 or PALB2; and (b) any functional DDR gene mut, including those in (a). Results: 48 pts were included, median ages was 54.5 years (30-74), 29 male, 26 were diagnosed with stage IV, 36 pts (75%) received FOLFIRINOX and 37 received platinum-based chemotherapy as 1st. line treatment. Prevalence of DDR mut are described in the table. Among responders, 3 tumors had BRCA2 mt, 3 BRCA1, 2 ATM, and 1 each with BRCA2 + MSH2, PALB2, PMS2, MUYTH, RECQL4 + MDC1. Among non-responders 1 tumor each had ATM, FANCD2 and BLM. Median progression-free survival (PFS) with oxaliplatin-based chemotherapy in pts with BRCA1, BRCA2 or PALB2 mut tumors was 21.7 months (95% CI 12.3-NA); among those with any DDR mt was 12.3 months (95% CI 9.13-NA); while in pts whose tumors had no DDR mut was 6.4 months (95% CI 3.07-13)(Log-rank P-value = 0.02 comparison subgroup [a] vs. others; P-value = 0.1 subgroup [b] vs. others). Conclusions: The subgroup of pts with PC whit tumors harboring DDR gene mut, particularly functional BRCA1, BRCA2 or PALB2, have higher response rate and longer PFS with oxaplatin-based chemotherapy. [Table: see text]

Elevated age-related cortical iron, ferritin and amyloid plaques in APPswe/PS1ΔE9 transgenic mouse model of Alzheimer’s disease

Iron is very important element for functioning of the brain. Its concentration changes with aging the brain or during disease. The aim of our work was the histological examination of content of ferritin and free iron (unbound) in brain cortex in association with Aβ plaques from their earliest stages of accumulation in amyloid plaque forming APP/PS1 transgenic mice. Light microscopy revealed the onset of plaques formation at 8-monthage. Detectable traces of free iron and no ferritin were found around plaques at this age, while the rate of their accumulation in and around Aβ plaques was elevated at 13 months of age. Ferritin accumulated mainly on the edge of Aβ plaques, while the smaller amount of free iron was observed in the plaque-free tissue, as well as in and around Aβ plaques. We conclude that free iron and ferritin accumulation follows the amyloid plaques formation. Quantification of cortical iron and ferritin content can be an important marker in the diagnosis of Alzheimer’s disease.

Distribution of N2O in the eastern shelf of the Gulf of Cadiz (SW Iberian Peninsula)

Distribution of N₂O has been determined in eight cruises along three transects (Guadalquivir, Sancti Petri and Trafalgar) in the Gulf of Cadiz, during 2014 and 2015. The mean N₂O value for this area was 10.0±0.9nM, with large spatial and temporal variations. Stratification in the water column has been observed; the concentration of this gas increases with the depth, because of the presence of the Eastern North Atlantic Central Water (ENACW) and the Mediterranean Outflow Waters (MOW). The N₂O production measured in this study is mainly due to nitrification. N₂O yields from nitrification were estimated from the linear correlation of the excess of N₂O (ΔN₂O) with Apparent Oxygen Utilization (AOU) and nitrate (NO₃^-), with values of their slopes ranged between 0.010 and 0.021% and 0.017-0.025% respectively. There is an onshore - offshore gradient of N₂O; the highest values were found at the shallower stations, indicating coastal input and benthic remineralization. The seawater-air flux of N₂O is affected by several variables (temperature, AOU and NO₃^-), and the average flux calculated is 2.7±2.0μmolm^-2d^-1. The fluxes show a decrease with increasing distance from the coast, and with proximity to the Strait of Gibraltar. The study area behaves as a source of N₂O to the atmosphere, with a global emission of 0.18Ggyear^-1.

Spatial and seasonal variability of CH4 in the eastern Gulf of Cadiz (SW Iberian Peninsula)

Methane (CH₄) concentrations were measured along three sections of the eastern Gulf of Cadiz (designated "Guadalquivir", "Sancti Petri" and "Trafalgar") during eight cruises in 2014 and 2015. The concentration of CH₄ varied from 3.6 to 19.7nmolkg^-1 (CH₄ saturation percent of 122 and 916%), showing seasonal variation. The highest values were found in December 2014 and November 2015. In most of the sampling area the highest concentration of CH₄ was found in subsurface waters at depths close to the thermocline, and in the bottom waters near the coast. The seawater-air flux of CH₄ ranged between 0.8 and 59.7μmolm^-2d^-1, showing seasonal variation in function of the temperature of the surface water. In the "Guadalquivir" and "Sancti Petri" sections, the CH₄ fluxes increased with proximity to the coast; this may be a result of continental inputs and CH₄ emissions from sediments. The whole study area behaves as a source of CH₄ to the atmosphere with mean values of 0.5 and 0.6GgCH₄yr^-1 in 2014 and 2015, respectively.

Stem cell-like transcriptional reprogramming mediates metastatic resistance to mTOR inhibition

Inhibitors of the mechanistic target of rapamycin (mTOR) are currently used to treat advanced metastatic breast cancer. However, whether an aggressive phenotype is sustained through adaptation or resistance to mTOR inhibition remains unknown. Here, complementary studies in human tumors, cancer models and cell lines reveal transcriptional reprogramming that supports metastasis in response to mTOR inhibition. This cancer feature is driven by EVI1 and SOX9. EVI1 functionally cooperates with and positively regulates SOX9, and promotes the transcriptional upregulation of key mTOR pathway components (REHB and RAPTOR) and of lung metastasis mediators (FSCN1 and SPARC). The expression of EVI1 and SOX9 is associated with stem cell-like and metastasis signatures, and their depletion impairs the metastatic potential of breast cancer cells. These results establish the mechanistic link between resistance to mTOR inhibition and cancer metastatic potential, thus enhancing our understanding of mTOR targeting failure.

Genetic relationships among American donkey populations: insights into the process of colonization

This study presents the first insights into the genetic diversity and structure of the American donkey metapopulation. The primary objectives were to detect the main structural features underlying variability among American donkey populations, identify boundaries between differentiated gene pools, and draw the main colonization pathways since the introduction of donkeys into America in the 15th century. A panel of 14 microsatellite markers was applied for genotyping 350 American donkeys from 13 countries. The genetic structure of this metapopulation was analysed using descriptive statistics and Bayesian model-based methods. These populations were then compared to a database containing information on 476 individuals from 11 European breeds to identify the most likely ancestral donor populations. Results showed the presence of two distinct genetic pools, with confluence of the two in Colombia. The southern pool showed a unique genetic signature subsequent to an older founder event, but lacked any significant influence of modern gene flow from Europe. The northern pool, conversely, may have retained more ancestral polymorphisms and/or have experienced modern gene flow from Spanish breeds. The Andalusian and, to a lesser extent, the Catalan breeds have left a more pronounced footprint in some of the American donkey populations analysed.

Longitudinal variations of brain functional connectivity: A case report study based on a mouse model of epilepsy

Brain Functional Connectivity (FC) quantifies statistical dependencies between areas of the brain. FC has been widely used to address altered function of brain circuits in control conditions compared to different pathological states, including epilepsy, a major neurological disorder. However, FC also has the as yet unexplored potential to help us understand the pathological transformation of the brain circuitry. Our hypothesis is that FC can differentiate global brain interactions across a time-scale of days. To this end, we present a case report study based on a mouse model for epilepsy and analyze longitudinal intracranial electroencephalography data of epilepsy to calculate FC changes from the initial insult (status epilepticus) and over the latent period, when epileptogenic networks emerge, and at chronic epilepsy, when unprovoked seizures occur as spontaneous events. We found that the overall network FC at low frequency bands decreased immediately after status epilepticus was provoked, and increased monotonously later on during the latent period. Overall, our results demonstrate the capacity of FC to address longitudinal variations of brain connectivity across the establishment of pathological states.

Anthropogenic effects on greenhouse gas (CH4 and N2O) emissions in the Guadalete River Estuary (SW Spain)

Coastal areas are subject to a great anthropogenic pressure because more than half of the world's population lives in its vicinity causing organic matter inputs, which intensifies greenhouse gas emissions into the atmosphere. Dissolved concentrations of CH4 and N2O have been measured seasonally during 2013 in the Guadalete River Estuary, which flows into the Cadiz Bay (southwestern Spanish coast). It has been intensely contaminated since 1970. Currently it receives wastewater effluents from cities and direct discharges from nearby agriculture crop. Eight sampling stations have been established along 18 km of the estuary. CH4 and N2O were measured using a gas chromatograph connected to an equilibration system. Additional parameters such as organic matter, dissolved oxygen, nutrients and chlorophyll were determinate as well, in order to understand the relationship between physicochemical and biological processes. Gas concentrations increased from the River mouth toward the inner part, closer to the wastewater treatment plant discharge. Values varied widely within 21.8 and 3483.4 nM for CH4 and between 9.7 and 147.6 nM for N2O. Greenhouse gas seasonal variations were large influenced by the precipitation regime, masking the temperature influence. The Guadatete Estuary acted as a greenhouse gas source along the year, with mean fluxes of 495.7 μmol m(-2)d(-1) and 92.8 μmol m(-2)d(-1) for CH4 and N2O, respectively.

Breast cancer brain metastases: a review of the literature and a current multidisciplinary management guideline

Breast cancer represents the second most frequent etiology of brain metastasis (BM). It is estimated that 10–30 % of patients with breast cancer are diagnosed with BM. Breast cancer BM are increasing due to the aging population, detection of subclinical disease, and better control of systemic disease. BM is a major cause of morbidity and mortality affecting neurocognition, speech, coordination, behavior, and quality of life. The therapy of BM remains controversial regarding use and timing of surgical resection, application of whole-brain radiotherapy, stereotactic radiosurgery and systemic drugs in patients with particular tumor subtypes. Despite numerous trials, the range of interpretation of these has resulted in differing treatment perspectives. This paper is a review of the state of the art and a multidisciplinary guideline on strategies to improve the therapeutic index in this situation.

Ozone sensitivity to its precursor emissions in northeastern Mexico for a summer air pollution episode

A summer episode was modeled to address the expected response of ambient air O3 to hypothetical emission control scenarios in northeastern Mexico, and in particular in the Monterrey Metropolitan Area (MMA). This region is of interest because the MMA holds one of the worst air quality problems in the country and levels of air pollutants in the rest of northeastern Mexico are starting to be a concern. The MM5-SMOKE-CMAQ platform was used to conduct the numerical experiments. Twenty-four control scenarios were evaluated, combining the level of emission controls of O3 precursors (NO(x) and volatile organic compounds [VOCs]) from 0% to 50%. For the MMA, VOC-only controls result in the best option to reduce O3 concentrations, though the benefit is limited to the urban core. This same strategy results in negligible benefits for the rest of northeastern Mexico. NO(x) controls result in an increase in O3 concentration within the MMA of up to 20 ppbv and a decrease at downwind locations of up to 11 ppbv, with respect to the base-case scenario. Indicator ratios were also used to probe for NO(x)-sensitive and VOC-sensitive areas. Locations with an important influence of NO(x) point sources (i.e., Monclova and Nava/Acuña) are quite sensitive to changes in NO(x) emissions. Border cities in the Rio Bravo/Grande Valley tend to be marginally NO(x)-sensitive. Overall, the MMA seems to be dominated by a VOC-sensitive regime, while the rest of the region would tend to have a NO(x)-sensitive response. The results obtained serve to expand the current knowledge on the chemical regimes that dominate this region (VOC- or NO(x)-sensitive), and thus could help guide public policies related to emission regional control strategies.

Enterotoxigenic Escherichia coli CS21 pilus contributes to adhesion to intestinal cells and to pathogenesis under in vivo conditions

Colonization surface antigens (CSs) represent key virulence-associated factors of enterotoxigenic Escherichia coli (ETEC) strains. They are required for gut colonization, the first step of the diarrhoeal disease process induced by these bacteria. One of the most prevalent CSs is CS21, or longus, a type IV pili associated with bacterial self-aggregation, protection against environmental stresses, biofilm formation and adherence to epithelial cell lines. The objectives of this study were to assess the role of CS21 in adherence to primary intestinal epithelial cells and to determine if CS21 contributes to the pathogenesis of ETEC infection in vivo. We evaluated adherence of a CS21-expressing wild-type ETEC strain and an isogenic CS21-mutant strain to pig-derived intestinal cell lines. To determine the role of CS21 in pathogenesis we used the above ETEC strains in a neonatal mice challenge infection model to assess mortality. Quantitative adherence assays confirmed that ETEC adheres to primary intestinal epithelial cells lines in a CS21-dependent manner. In addition, the CS21-mediated ETEC adherence to cells was specific as purified LngA protein, the CS21 major subunit, competed for binding with the CS21-expressing ETEC while specific anti-LngA antibodies blocked adhesion to intestinal cells. Neonatal DBA/2 mice died after intra-stomach administration of CS21-expressing strains while lack of CS21 expression drastically reduced the virulence of the wild-type ETEC strain in this animal model. Collectively these results further support the role of CS21 during ETEC infection and add new evidence on its in vivo relevance in pathogenesis.

[Health personnel assessment about medical order entry systems of pharmacologic treatments in hospitalized patients]

OBJECTIVE

to evaluate health personnel perceptions about medical order entry systems concerning the effect on workflow, medication errors risk and assessment of its potential advantages.

MATERIAL AND METHODS

A cross-section opinion interview was conducted in a tertiary care hospital. Questionnaire consisted of three sections: perception of its effect on workflow, influence on medication error risk and assessment of potential advantages. We also asked them to assess drawbacks and provide suggestions about this prescription system.

RESULTS

76 health professionals were interviewed (58 physicians, 9 pharmacists and 9 nurses). They were satisfied mainly due to decrease the workload (85.5%; IC 95%: 75.58-92.55). They thought that the main characteristics that contribute to reduce medication errors are clinical decision supports related to predefined aspects which the program provided by default. Among potential benefits of medical order entry systems, legibility and warnings triggered by the program (98.7%; IC 95%: 92.90-99.97 and 97,4%; IC 95%: 90.81-99.68 respectively) were the most valuable. High technology dependence, IT failures and lack of infrastructure and medication therapy discontinuities at times of transition between different hospitals' units were the main drawbacks considered. The most repeated suggestion was related to the improvement of links between other health informatics applications used in the hospital.

CONCLUSION

health personnel were highly satisfied with the CPOE system, which is considered to be effective and safe. Technology dependence and IT failures were the main disadvantages reported. According to them, a greater coordination and unification of all software applications available in the hospital would be desirable.

Rifampicin-miconazole-impregnated catheters save cost in jugular venous sites with tracheostomy

Antimicrobial-impregnated catheters are more expensive than standard catheters (S-C). A higher incidence of catheter-related bloodstream infection (CRBSI) has been found in jugular venous access with tracheostomy than without tracheostomy. The objective of this study was to determine central venous catheter (CVC)-related costs (considering only the cost of the CVC, diagnosis of CRBSI, and antimicrobial agents used to treat CRBSI) using rifampicin-miconazole-impregnated catheters (RM-C) or S-C in jugular venous access with tracheostomy. We performed a retrospective cohort study of patients admitted to the intensive care unit (ICU) with tracheostomy who received one or more jugular venous catheters. RM-C showed a lower incidence of CRBSI compared with S-C (0 vs. 20.16 CRBSI episodes/1,000 catheter-days; odds ratio=0.05; 95% confidence interval=0.001-0.32; p<0.001) and lower CVC-related costs (including the cost of the CVC, diagnosis, and treatment of CRBSI) (<euro>11.46 ± 6.25 vs. <euro>38.11 ± 77.25; p<0.001) in jugular venous access with tracheostomy. The use of RM-C could reduce CVC-related costs in jugular venous access with tracheostomy. The results of our study may contribute to clinical decision-making and selection of those patients who could benefit from the use of antimicrobial-impregnated catheters.

Measurement of body temperature in adult patients: comparative study of accuracy, reliability and validity of different devices

BACKGROUND AND AIMS

We compared a range of alternative devices with core body temperature measured at the pulmonary artery to identify the most valid and reliable instrument for measuring temperature in routine conditions in health services.

METHODS

201 patients from the intensive care unit of the Candelaria University Hospital, Canary Islands, admitted to hospital between April 2006 and July 2007. All patients (or their families) gave informed consent. Readings from gallium-in-glass, reactive strip and digital in axilla, infra-red ear and frontal thermometers were compared with the pulmonary artery core temperature simultaneously. External factors suspected of having an influence on the differences were explored. The cut-off point readings for each thermometer were fixed for the maximum negative predictive value in comparison with the core temperature. The validity, reliability, accuracy, external influence, the waste they generated, ease of use, speed, durability, security, comfort and cost of each thermometer was evaluated. An ad hoc overall valuation score was obtained from these parameters for each instrument.

RESULTS

For an error of ± 0.2°C and concordance with respect to fever, the gallium-in-glass thermometer gave the best results. The largest area under the receiver operating characteristic (ROC) curve is obtained by the digital axillar thermometer with probe (0.988 ± 0.007). The minimum difference between readings was given by the infrared ear thermometer, in comparison with the core temperature (-0.1 ± 0.3°C). Age, weight, level of conscience, male sex, environmental temperature and vaso-constrictor medication increases the difference in the readings and fever treatment reduces it, although this is not the same for all thermometers. The compact digital axillar thermometer and the digital thermometer with probe obtained the highest overall valuation score.

CONCLUSION

If we only evaluate the aspects of validity, reliability, accuracy and external influence, the best thermometer would be the gallium-in-glass after 12 min. The gallium-in-glass thermometer is less accurate after only 5 min in comparison with the reading taken after being placed for 12 min. If we add the evaluation of waste production, ease-of-use, speed, durability, security, patient comfort and costs, the thermometers that obtain the highest score are the compact digital and digital with probe in right axilla.