Valorisation of the Invasive Macroalgae Undaria pinnatifida (Harvey) Suringar for the Green Synthesis of Gold and Silver Nanoparticles with Antimicrobial and Antioxidant Potential

Bacterial and fungal infections are a challenging global problem due to the reported increasing resistance of pathogenic microorganisms to conventional antimicrobials. Nanomaterials are a promising strategy to fight infections caused by multidrug-resistant microbes. In this work, gold (Au@UP) and silver (Ag@UP) nanoparticles were produced for the first time by green synthesis using an aqueous extract of the invasive macroalgae Undaria pinnatifida (UP). The nanoparticles were characterized by a wide range of physicochemical techniques. Au@UP and Ag@UP demonstrated to be spherical and crystalline with an average size of 6.8 ± 1.0 nm and 14.1 ± 2.8 nm, respectively. Carbohydrates and proteins of the UP extract may participate in the synthesis and capping of the nanoparticles. The UP extract, Ag@UP, and Au@UP were assessed for their antimicrobial activity against Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, Candida albicans, and Candida auris. Ag@UP showed the highest antimicrobial activity with very low MIC and MBC values for all the tested bacteria, and Au@UP demonstrated to be very effective against biofilm-producing bacteria. The antifungal properties of both Ag@UP and Au@UP were remarkable, inhibiting hyphae formation. This study points towards a very promising biomedical exploitation of this invasive brown algae.

HPAEC-PAD Analytical Evaluation of Carbohydrates Pattern for the Study of Technological Parameters Effects in Low-FODMAP Food Production

BACKGROUND

"FODMAPs" (fermentable-oligo-, di-, monosaccharides, and polyols) are a group of fermentable carbohydrates and polyols largely diffused in food products. Despite their beneficial effects as prebiotics, people affected by irritable bowel syndrome manifest symptoms when eating these carbohydrates. A low-FODMAP diet seems to be the only possible therapy proposed for symptom management. Bakery products are a common source of FODMAPs, whose pattern and total amount can be affected by their processing. This work aims at studying some of the technological parameters that can influence the FODMAPs pattern in bakery products during the production process.

METHODS

high-performance anion exchange chromatography coupled to a pulsed amperometric detector (HPAEC-PAD) was used as a highly selective system for carbohydrates evaluation analyses on flours, doughs, and crackers. These analyses were performed using two different columns, the CarboPac PA200 and CarboPac PA1, which are selective for oligosaccharide and simple sugar separation, respectively.

RESULTS

emmer and hemp flours were selected to prepare doughs as they contained low oligosaccharide content. Two different mixes of ferments were used at different times of fermentation to evaluate the best conditions to achieve low-FODMAP crackers.

CONCLUSION

the proposed approach allows carbohydrate evaluation during crackers processing and permits the selection of opportune conditions to obtain low-FODMAP products.

Mass Spectrometry-Based Techniques for the Detection of Non-Intentionally Added Substances in Bioplastics

The safety of food contact materials is a hot topic since chemicals can migrate from packaging into food, thus raising health concerns about and/or producing changes in the organoleptic properties of foodstuffs. Migration tests are required to demonstrate the compliance with current regulations and to investigate the transferred compounds. In this context, mass spectrometry is the analytical technique of choice for the detection and quantitation of both intentionally added substances, such as antioxidants, stabilizers, processing aids, and non-intentionally added substances (NIAS). Untargeted strategies represent a major analytical challenge, providing a comprehensive fingerprinting of the packaging material and migrating components, allowing for NIAS identification. Hyphenated mass spectrometry-based techniques have been devised for screening the presence of migrating contaminants and for quantitation purposes. Both low-resolution (LRMS) and high-resolution (HRMS) methods were screened, with a special emphasis on the latter because of its capability to directly characterize food contact materials with minimal/no sample preparation, avoiding chromatographic separation, and reducing sample handling, analysis costs, and time. Examples related to the migration of contaminants from existing or newly developed bioplastic materials will be discussed, providing an overview of the most used MS-based methods, covering the state-of-the-art approaches from 2012 up to 2022.

Flexible PBAT-Based Composite Filaments for Tunable FDM 3D Printing

Biobased composites with peculiar properties offer an attractive route for producing environmentally friendly materials. The reinforcement for poly(butylene adipate-co-terephthalate) (PBAT), based on zein-titanium dioxide (TiO₂) complex (ZTC) microparticles, is presented and used to produce composite filaments, successfully 3-dimensionally (3D) printed by fused deposition modeling (FDM). The outcome of ZTC addition, ranging from 5 to 40 wt %, on the thermo-mechanical properties of composite materials was analyzed. Results reveal that storage modulus increased with increasing the ZTC content, leading to a slight increase in the glass transition temperature. The creep compliance varies with the ZTC concentration, denoting a better resistance to deformation under constant stress conditions for composites with higher complex content. Scanning electron microscopy was used to assess the quality of interphase adhesion between PBAT and ZTC, showing good dispersion and distribution of complex microparticles in the polymer matrix. Infrared spectroscopy confirmed the formation of a valid interface due to the formation of hydrogen bonds between filler and polymer matrix. Preliminary tests on the biocompatibility of these materials were also performed, showing no cytotoxic effects on cell viability. Finally, the 3D printability of biobased composites was demonstrated by realizing complex structures with a commercial FDM printer.

POS0820 PREDICTIVE VALUE OF OBJECTIVE EXAMINATION OF TA ON POSITIVITY OF TAB IN GIANT CELL ARTERITIS

Background

Previous studies have reported the utility of temporal artery examination for the diagnosis of GCA but no data are available on the correlation between clinical examination and the subsequent temporal artery biopsy (TAB) results of the biopsied vessel.

Objectives

Evaluate the predictive value of temporal artery (TA) examination in patients with suspected GCA on the results of TAB of the same vessel.

Methods

97 pts consecutively seen at our center because of suspected cranial arteritis between 01.01.2015 to 31.12.2021 were enrolled in the study. All patients had complete clinical examination, laboratory investigations (included ESR and CRP determination), clinical examination of the temporal arteries and their frontal and parietal branches for tenderness (P), reduced or absent pulse (R) and thickening (T). All patients underwent arterial ultrasound (US) followed by a TAB of the most US involved frontal branches. The presence of inflammatory infiltrate of the vessel wall or the inflammation of the periadventitial blood vessel were considered positive for the presence of arteritis. The clinical features of the biopsied vessel were compared with the histological results by chi square test and the correspondent OR with 95%CI. Sensitivity, specificity, negative and positive PV, negative and positive LR were calculated for every singular objective abnormalities.

Results

97 pts entered the study (F 56 (58%), mean age 73 ± 8, biopsy positive 56 (57%). At clinical examination of the biopsied vessel P was reported in 26 cases (27%) of TAB + and 10 (24.4%) in TAB- group (p=0.646, OR 1.24), R in 15 (15.5%) vs 2 (4.9%) (p=0.021, OR 5.69) and T in 16 (28.6%) vs 2 (4.9%) (p=0.003, OR 7.80), anyone (T or P or R) 30 (54.5% vs 11 (26.8%) (p=0.007, OR 3.27), presence of T or R 23 (41.8%) vs 4 (9.8%) (p=0.001, OR 6.65). Sensitivity, specificity, PPV, NPV, PLR, and NLR of any singular objective data and of US examination are reported in Table 1

Table 1.

SENS, SPEC, PPV, NPV. PLR, NLR, PRETEST probability, POST TEST probability of clinical objective examination and US results FOR TAB POSITIVITY

SENSSPECPPVNPVPLRNLRPREPOSTTA EXAMINATIONTENDERNESS (P)0.2860.7560.6150.4371.170.940.570.61REDUCED/ ABSENT PULSE (R)0.2320.9510.8670.4764.760,800.580.87THICKENING (T)0.2860.9510.8890.4945.860.750.570.89ANYONE (P or R or T)0.5450.7320.7320.5452.030.550.570.73R or T0.4180.9020.8510.5364.280.650.570.85USHALO0.8750.6430.6360.8782.450.190.420.64CT+0.8780.6540.6540.8782.540.190.430.65

Conclusion

Clinical examination (in particular reduced pulse and arterial thickening) of the temporal arteries is predictive of histological positivity of the TAB.

Acknowledgements

Gabriella Di Tommaso

Disclosure of Interests

None declared

Immunomodulatory and Antitumoral Activity of Gold Nanoparticles Synthesized by Red Algae Aqueous Extracts

This study reports on the green and cost-efficient synthesis of gold nanoparticles from three different red algae extracts. The nanoparticles synthesized were fully characterized by UV-Vis spectroscopy, HRTEM, and Z-potential. Relevant components occurring in the extracts, such as polysaccharides or phenolic content, were assessed by analytical techniques such as spectrophotometric assays and liquid chromatography. Finally, the antioxidant, antitumoral, and anti-inflammatory potential of both the extracts and the gold nanoparticles synthesized were analyzed in order to determine a possible synergistic effect on the nanoparticles. The results obtained confirmed the obtainment of gold nanoparticles with significant potential as immunotherapeutic agents. The therapeutic potential of these nanoparticles could be higher than that of inert gold nanoparticles loaded with bioactive molecules since the former would allow for higher accumulation into the targeted tissue.

Effect of Addition of Green Coffee Parchment on Structural, Qualitative and Chemical Properties of Gluten-Free Bread

Green coffee parchment (GCP) is becoming interesting, due to the diffusion of wet processing in which coffee parchment is collected separately; it is one of the less studied coffee by-products, but it is reported to be rich in phenolic compounds and dietary fiber. The addition of GCP (355–500 μm) at 2% to gluten-free breads was investigated in terms of physical properties (volume, moisture content, water activity, crumb grain, texture, and color), total antioxidant capacity (TAC) and total phenol content during three days of storage. Moreover, the effects of GCP on sensorial characteristics, 5-hydroxymethylfurfural (HMF), and oxidative stability was evaluated. From the sensorial analysis, bread with 2% addition resulted in being acceptable for consumers with no significant differences from the control, while 4% of GCP was discarded by consumers, as it resulted in being too bitter. Moreover, GCP at 2% addition did not modify volume, moisture content, and water activity. On the contrary, GCP deeply affected the color with a darker aspect that was appreciated by consumers. Regarding texture, 2% of GCP did not affect hardness, cohesiveness, and staling process during storage. Interestingly, 2% of GCP significantly improved the TAC and oxidative stability of the bread; in accordance with these results, 2% of GCP reduced the HMF content, thanks to its antioxidant compounds.

Effect of different atmospheric and subatmospheric cooking techniques on qualitative properties and microstructure of artichoke heads

Quartered Violetto artichokes were cooked with different treatments (boiling, steaming, sous vide and vacuum cooking) at the same cooking value at the thermal centre. Then, the physical (moisture content, texture and colour), histological and chemical (phenolic, 5-hydroxymethylfurfural (HMF) and furan content, total antioxidant capacity) features of bracts and hearts were assessed. A deeply modified microstructure was observed in boiled and steamed samples with an evident decrease in hardness both for bracts and hearts. Lightness of two anatomical parts was decreased by all the treatments (with the exception of sous vide bracts). The highest total colour difference was recorded for steamed samples, whereas the lowest was noted for sous vide samples. Steamed and sous vide artichoke exhibited the highest total phenolic content and total antioxidant capacity. Sous vide samples exhibited the highest concentrations of HMF, 2-furan-methanol and 2,4-dihydroxy-2,5-dimetyl-3(2H)-furanone, whereas the by-product 5-metylfuraldheide was only detected in the steamed product.

Immunostimulant and biocompatible gold and silver nanoparticles synthesized using the Ulva intestinalis L. aqueous extract

This is the first study to report on the biocompatible and immunogenic properties of one-pot synthesised gold and silver nanoparticles (Au@UI and Ag@UI) using the macroalgae Ulva intestinalis (UI). The UI aqueous extract, Au@UI, and Ag@UI were obtained under sterile conditions and fully characterized by UV-vis spectroscopy, TEM, HRTEM, STEM and FTIR spectroscopy. Moreover, for the first time, the composition of carbohydrates in the UI extract has been reported along with the changes observed after nanoparticle synthesis by size exclusion chromatography, in order to investigate their possible role in the biosynthetic process. This study suggested that the polysaccharide fraction of the extract is involved in the formation and stabilization of the nanoparticles. The potential toxicity of the samples was evaluated using different cell lines and the hemocompatibility was tested in mouse erythrocytes. In addition, ROS production, complement activation and cytokine release were evaluated to determine the immunogenicity. The results showed that Au@UI and Ag@UI exhibit good biocompatibility and hemocompatibility, with the exception of Ag@UI nanoparticles at high concentration, which were hemolytic. The samples induced ROS release and complement activation, two key mechanisms in innate immunity. The samples also induced the release of cytokines from Th1 and Th2 profiles, and other cytokines implicated in the activation of the immune system. Au@UI and Ag@UI were biocompatible and preserved the immunostimulant properties of the UI extract. Hence, Au@UI and Ag@UI could be useful as adjuvants in vaccine development and promote a balanced Th1 and Th2 immune response mediated by ROS production, cytokine release and complement activation.

FRI0204 COMPARISON BETWEEN TRANSMURAL AND ISOLATED (PERI)ADVENTITIAL INFLAMMATION AT TEMPORAL ARTERY BIOPSY: A SINGLE CENTER COHORT OF BIOPSY-POSITIVE GCA WITH LONG TERM FOLLOW-UP

Background:

Temporal artery biopsy (TAB) showing transmural inflammation is considered the gold standard for the diagnosis of giant cell arteritis (GCA). In some cases, inflammation is confined to periadventitial small vessels and/or the adventitia. However, the clinical significance of this more limited inflammation remains unclear. Up to date, no studies have compared treatment, prognosis and long-term outcomes of patients with transmural inflammation with those of patients with isolated (peri)adventitial inflammation.

Objectives:

To compare treatment and long-term outcomes of patients with transmural inflammation with those of patients with (peri)adventitial inflammation in a single center cohort of patients with biopsy-positive GCA with long-term follow-up.

Methods:

All TABs performed for suspected GCA between 1986 and 2013 were reviewed by a single pathologist. Based on the localization of the inflammation, inflamed TABs were classified into 2 categories: transmural inflammation (TMI), with external elastic lamina disruption and extension of the inflammation to the media; (peri)adventitial inflammation (PAI), with inflammation limited to small periadventitial vessels and/or to the adventitia without extension to the media. All medical records of these patients were retrospectively reviewed from the date of TAB to 31 December 2018 or death. Only patients with a follow-up of at least 18 months after GCA diagnosis were included. Cohort characteristics were compared using Wilcoxon rank sum tests for continuous variables and chi-square tests for categorical variables. Kaplan-Meier methods and log-rank tests were used to estimate the rate of development of outcomes.

Results:

In the study period 254 TMI and 80 PAI were identified. Baseline clinical manifestations and laboratory findings of the 2 cohorts were previously reported (1). Similar frequencies of systemic symptoms, visual manifestations and polymyalgia rheumatica were found in the 2 cohorts. Compared with patients with TMI, those with PAI had a significantly lower frequency of cranial symptoms, abnormalities of TA at physical examination, halo at TA color duplex sonography, lower levels of ESR and CRP and higher frequency of male gender and peripheral arthritis. Large vessel involvement was found in 6/22 (27%) patients with PAI and 32/81 (40%) patients with TMI, p=0.292.

118 patients with TMI and 35 with PAI had a follow-up longer than 18 months and were included for outcome analysis. Median (IQR) follow-up was 79.8 months (52, 115) for patients with TMI and 67.9 (34, 125) for those with PAI, p=0.125. Compared to patients with TMI, those with PAI received a significantly lower initial prednisone dose (35.8±22.0 vs 46.8±15.0 mg, p<0.0001), reached sooner a prednisone dose <10 mg/day (median 4.7 months vs 6.3, p=0.001) and <5 mg/day (median 7.5 months vs 10.3, p=0.005), had a lower cumulative prednisone dose at 1 year (5.7±3.8 vs 7.2±2.3 g, p=0.005) and at the end of the follow-up period (10.0±9.0 vs 12.9±9.6 g, p=0.015). There were no differences in the frequencies of relapses, long-term remission, time to first GC discontinuation and treatment duration between patients with TMI and PAI (p>0.05).

Conclusion:

Patients with PAI seem to have a disease course similar to those with the transmural pattern, but may require lower GC dosage. Our data confirm that inflammation confined to periadventitial small vessels and/or the adventitia could be considered part of the histopathologic spectrum of GCA.

References:

[1]Restuccia G, et Al. Small-vessel vasculitis surrounding an uninflamed temporal artery and isolated vasa vasorum vasculits of the temporal artery: Two subsets of giant cell arteritis. Arthritis Rheum. 2011.

Disclosure of Interests:

None declared

FRI0213 ASSOCIATION BETWEEN SPECIMEN LENGTH AND NUMBER OF SECTIONS AND DIAGNOSTIC YIELD OF TEMPORAL ARTERY BIOPSY: A RETROSPECTIVE, SINGLE CENTER EXPERIENCE OVER A 21 YEARS’ PERIOD

Background:

Temporal artery biopsy (TAB) showing inflammation is considered the gold standard for the diagnosis of giant cell arteritis (GCA). However, sampling error may lead to a negative TAB, and a negative TAB does not rule out GCA. The diagnostic sensitivity of TAB can be affected by the discontinuous character of the histopathologic changes (skip lesions) and by the length of specimens. The optimal TAB length and the optimal number of sections that need to be evaluated in order to avoid missing skip lesions are controversial.

Objectives:

To investigate the association between specimen length and number of section and the diagnostic yield of TAB for GCA.

Methods:

A pathologist with expertise in vasculitis and blinded to clinical data and final diagnosis reviewed all TABs performed for suspected GCA at our hospital between January 1991 and December 2012. The biopsies were routinely fixed in formalin and completely embedded in paraffin. Sections of 4 microns thickness were cut from paraffin blocks and stained with hematoxylin-eosin. TABs were classified into three categories: inadequate, when the biopsy did not sample the muscular artery; negative when the temporal artery was devoid of inflammation and positive when the temporal artery showed inflammation, arbitrarily defined as at least 1 aggregate of at least 15 inflammatory cells. The blocks of all the inadequate and negative biopsies were recut, and at least three further slides at deeper levels were stained with hematoxylin-eosin.

Results:

694 TABs were performed in the study period and were reviewed. 32 (4.6%) were classified as inadequate and were excluded from the analysis. Of the remaining 662 TABs [71% female; mean (SD) age, 73.2 (8.8) years], mean (SD) post fixation length was 6.63 (4.42) mm, and median number of sections evaluated was 3 (range 1-33). 382 (58%) TABs were classified as negative and 280 (42%) as positive. Compared with negative TAB, patients with positive TAB were older [mean age (SD) 74 (7.5) years vs 72 (9.6), p=0.009] and there was a trend for female predominance (75% vs 68%, p=0.077). Post fixation length of the specimens was significantly lower in negative compared with positive TAB [mean (SD) 6.37 (4.26) mm vs 6.99 (4.61) respectively, p=0.026]. Piecewise logistic regression identified 5 mm as the TAB length change point for diagnostic sensitivity. Compared with TAB length of <5 mm, age- and sex-adjusted odds ratio for positive TAB in samples ≥5 mm long were 1.536 (95% confidence interval, 1.108 to 2.130).

The median (IQR) number of sections evaluated were 2 (1-3) for positive TAB and 4 (2-5) for negative TAB, p<0.0001. In 26/280 (9.3%) positive TABs, the first section was negative, and the inflammation was detected only in deeper sections (the positive section was the second in 14 TABs, the third in 9 and the fourth in 3). In all 26 cases, inflammation detected in deeper section was not transmural, but limited to adventitial or periadventitial small vessels.

Conclusion:

Our data confirm that a post fixation TAB length of at least 5 mm should be sufficient to make a histological diagnosis of inflamed temporal artery. According to our data, in order to avoid missing skip inflammatory lesions, at least 3 further sections at deeper levels should be cut and evaluated in all negative TABs.

Disclosure of Interests:

None declared

THU0314 RELAPSES AND LONG-TERM REMISSION IN LARGE VESSEL GIANT CELL ARTERITIS IN NORTHERN ITALY: CHARACTERISTICS AND PREDICTORS IN A LONG-TERM FOLLOW-UP STUDY

Background:

Previous studies evaluated clinical relapses and long-term remission mainly in patients with biopsy-proven GCA and/or patients satisfying the ACR 1990 criteria for GCA classification. Also, radiological involvement was unfrequently used to define relapses and monitor disease activity in patients with LV-GCA

Objectives:

To evaluate characteristics and predictors of relapses and long-term remission in an Italian cohort of patients with large-vessel (LV) giant cell arteritis (GCA).

Methods:

We evaluated 87 consecutive patients with LV-GCA followed up at the Rheumatology Unit of Reggio Emilia Hospital (Italy) for at least 2 years. Patients with relapses and long-term remission were compared to those without. A comparison group of 34 patients with biopsy proven GCA without LV vasculitis (LVV) at diagnosis was considered for comparison.

Results:

37 patients (42.5%) experienced one or more relapses. Nineteen (37.2%) of the 51 relapses were experienced during the first year after diagnosis. The majority of relapses occurred with doses of prednisone (PDN) ≤ 10 mg/day (74.5%). Polymyalgia rheumatica (PMR) (41.2%) and worsening at imaging of LVV (39.2%) were the most frequently observed relapsing manifestations. The total cumulative prednisone dose was significantly higher (p = 0.0001) and the total duration of PDN treatment longer (p = 0.0001) in relapsing patients compared to those without relapses. Relapsing patients had at diagnosis more frequently fever ≥ 38°C (p = 0.03) and visual manifestations (p = 0.03), and less frequently long-term remission (p = 0.003). In the multivariate model fever ≥ 38 °C (HR 3.22, 95%CI:1.43-7.27),duration of PDN treatment (HR 1.01, 95%CI: 1.00-1.02) and total cumulative PDN dose (HR 1.20, 95%CI: 1.09-1.33) were significantly associated with an increased risk of relapses, while aortic arch involvement at imaging at diagnosis (HR 0.22, 95%CI: 0.09-0.55) and long-term remission (HR 0.30, 95%CI: 0.12-0.75) with a reduced risk. 37 patients (42.5%) experienced long-term remission. PMR and disease relapses were less frequently observed (p = 0.003 for both), and the total cumulative prednisone dose was lower (p = 0.005) in patients with long-term remission compared to those without. In the multivariate model the presence of relapses (HR 0.33, 95%CI: 0.14-0.78) and the total cumulative PDN dose (HR 0.89, 95%CI: 0.83-0.96) were significantly negatively associated with long-term remission.

Conclusion:

In our cohort of patients with LV GCA we identified predictors of a relapsing course and long-term remission, which were observed in around half of the patients.

Disclosure of Interests:

luigi boiardi: None declared, Francesco Muratore: None declared, Giovanna Restuccia: None declared, Alberto Cavazza: None declared, Maria Grazia Catanoso: None declared, Pierluigi Macchioni: None declared, Lucia Spaggiari: None declared, Luca Cimino: None declared, Raffaella Aldigeri: None declared, Nicolò Pipitone: None declared, Antonio Fontana: None declared, Massimiliano Csaali: None declared, Stefania Croci: None declared, Nicolò Girolimetto: None declared, Carlo Salvarani Grant/research support from: consulting and investigator fees from Abbvie, Pfizer, MSD, Roche, Celgene, Novartis, Consultant of: consulting and investigator fees from Abbvie, Pfizer, MSD, Roche, Celgene, Novartis

AB0515 COMPARISON OF THE PERFORMANCE OF THE 1990 ACR CLASSIFICATION CRITERIA AND THE GIACTA INCLUSION CRITERIA FOR THE CLASSIFICATION OF GCA: RESULTS FROM A SINGLE-CENTRE STUDY

Background:

The classification criteria currently used to define giant cell arteritis (GCA) were developed in 1990 by the American College of Rheumatology (ACR), and strongly focus on patients with cranial manifestations. Patients with large-vessel GCA (LV-GCA) have less frequently cranial symptoms and a positive temporal artery biopsy, and are less likely to be captured by the ACR criteria. GiACTA, a trial of tocilizumab in GCA, has recognized the concept of GCA as a clinical syndrome, and included patients with cranial and/or polymyalgic symptoms as long as GCA diagnosis was supported by either biopsy or appropriate LV imaging results. However, these inclusion criteria were elaborated by experts and were not validated in patients with GCA.

Objectives:

To compare the performance of the 1990 ACR classification criteria and the GiACTA inclusion criteria for the classification of GCA in a single-center cohort of patients with GCA.

Methods:

All consecutive patients with a diagnosis of GCA seen between January 2008 and December 2016 in our center were included (GCA cohort). Control cohort consisted of consecutive patients with a negative temporal artery biopsy (TAB) performed in the same time period and a final diagnosis different than GCA. For both study cohort, the final diagnosis was made at the end of the follow-up period by consensus by 2 rheumatologists, who retrospectively evaluated all the medical records from symptoms’ onset to December 2019, last visit, or death. Subjects were classified by each of the different criteria. TABs showing inflammation limited to adventitial or periadventitial small vessels were considered negative for both ACR and GiACTA criteria.

Two-by-two classification tables were generated to estimate sensitivity and specificity, and receiver operating characteristic (ROC) curves with corresponding areas under the curve (AUC) were calculated.

Results:

213 patients were included in the study (75% female, mean age 71.7 years). 55 patients had TAB showing transmural inflammation (TMI); 30 patients had TAB showing inflammation limited to adventitial or periadventitial small vessels (PAI); 67 patients had evidence of LV-GCA at imaging (LV-GCA) and 61 patients had TAB without inflammatory changes (negTAB). 1990 ACR and GiACTA criteria were satisfied respectively by 55 (100%) and 51 (93%) TMI, 18 (60%) and 1 (3%) PAI, 23 (35%) and 31 (46%) LV-GCA and 27 (44%) and none (0%) negTAB patients.

After a median follow-up of 52.6 months, 174 of the 213 (84%) patients had a final diagnosis of GCA (55 TMI, 22 PAI; 67 LV-GCA and 30 negTAB) and the remaining 33 patients had a diagnosis different than GCA (2 PAI and 31 negTAB). Sensitivity and specificity of 1990 ACR classification criteria for GCA were 67% and 90%, AUC (95% CI) 0.790 (0.715 – 0.864). Sensitivity and specificity of GiACTA inclusion criteria were 48% and 100%, AUC (95% CI) 0.740 (0.669 – 0.811). By adding systemic symptoms in the symptoms domain of GiACTA inclusion criteria, sensitivity increased to 59% and sensitivity remained 100%, AUC (95% CI) 0.792 (0.730 – 0.854).

Conclusion:

Both 1990 ACR classification criteria and GiACTA inclusion criteria showed a good specificity but a low sensitivity in classifying patients with a clinical diagnosis of GCA from this large monocentric cohort. There is an urgent need for new classification criteria for GCA.

Disclosure of Interests:

Francesco Muratore: None declared, Luigi Boiardi: None declared, Elena Galli: None declared, Giulia Pazzola: None declared, Alberto Cavazza: None declared, Giovanna Restuccia: None declared, Carlo Salvarani Grant/research support from: consulting and investigator fees from Abbvie, Pfizer, MSD, Roche, Celgene, Novartis, Consultant of: consulting and investigator fees from Abbvie, Pfizer, MSD, Roche, Celgene, Novartis

Experience of the implementation and outcomes of universal testing for Lynch syndrome in the United Kingdom

AIM

Colorectal cancer (CRC) is diagnosed in approximately 45 000 people annually in the UK, and it is estimated that Lynch syndrome (LS) accounts for 3.1% of these cases. In February 2017, National Institute for Health and Care Excellence (NICE guideline DG27 recommended universal testing of new cases of CRC for mismatch repair (MMR) status. The aim of this study was to implement universal testing for LS in CRC patients in a secondary care setting.

METHOD

We prospectively collected data on consecutive newly diagnosed CRC patients at our centre from November 2016 to August 2018, including evidence of MMR status determined by immunohistochemistry. We recorded clinicopathological data including age at diagnosis, stage, tumour site, reported histological findings and MMR tumour status. Statistical analysis was performed using the chi-square test and the two-tailed t-test for binary and continuous variables, respectively.

RESULTS

A cohort of 203 consecutive patients were diagnosed with CRC during this period. Universal MMR testing was performed for the 198 CRC patients in whom a diagnosis of adenocarcinoma was confirmed, with colonoscopic biopsy used as the source material in 68.6% of cases. Twenty-three CRCs (11.6%) were MMR deficient (dMMR). Most dMMR CRCs (21/23) were early stage tumours (Dukes A or B, P = 0.002). In 39 Dukes B CRCs in patients under 70 years of age, the result of MMR testing influenced decision-making about personalized treatment with 5-fluorouracil based chemotherapy.

CONCLUSION

Our results demonstrate that universal testing of all new cases of CRC for features suggestive of LS is feasible and effective in the UK. Our data also indicate the importance of genetic testing and personalized oncological care.

Histopathology of vasculitis

The range of pathologies that are related to primitive vasculitis is broad, complex and not as typical as we would expect. Clinicians should be aware that several forms of primitive and systemic vasculitis, regardless of the size of the affected vessel, may exhibit identical histological alterations. This observation has important clinical implications as it means that cases of vasculitis do not correspond clinically and histologically. Thus, while histology remains the diagnostic gold standard, it can be used only as part of the most complete clinical assessment possible. Another point worth of the clinician's attention is that vasculitis histology changes over time, as do disease evolution and activity, even without considering the masking effects of treatment and the possibility of sampling error due to the patchy occurrence of vasculitis. The purpose of this review is to identify the most common forms of vasculitis in clinical practice, and to provide guidance to the clinician on the pathology of the vessels.

The 2015 World Health Organization Classification of lung tumors: new entities since the 2004 Classification

In the last few years different new pulmonary neoplastic lesions have been recognised and some of them, namely NUT carcinoma, PEComatous tumors, pneumocytic adenomyoepithelioma, pulmonary myxoid sarcoma, myoepithelial tumors/carcinomas entered in the last 2015-WHO classification of lung tumors. In addition angiomatoid fibrous histiocytoma and ciliated muconodular papillary tumor have been morphologically and genetically characterized albeit not yet included in the 2015-WHO classification. In the present paper we summarised the clinical, morphological, immunohistochemical and molecular features of these new entities. The knowledge of key histologic and molecular characteristics may help pathologists in achieving a correct diagnosis thus leading to an adequate therapeutic approach.

Adenocarcinoma classification: patterns and prognosis

Lung cancer is the most frequent human malignancy and the principal cause of cancer-related death worldwide. Adenocarcinoma is now the main histologic type, accounting for almost half of all the cases. The 2015 World Health Organization has adopted the classification recently developed by the International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society. This new adenocarcinoma classification has incorporated up-to-date advances in radiological, molecular and oncological knowledge, providing univocal diagnostic criteria and terminology. For resection specimens, new entities have been defined such as adenocarcinoma in situ and minimally invasive adenocarcinoma to designate adenocarcinomas, mostly nonmucinous and ≤ 3 cm in size, with either pure lepidic growth or predominant lepidic growth with ≤ 5 mm invasion, respectively. For invasive adenocarcinoma, the new classification has introduced histological subtyping according to the predominant pattern of growth of the neoplastic cells: lepidic (formerly non mucinous brochioloalveolar adenocarcinoma), acinar, papillary, micropapillary, and solid. Of note, micropapillary pattern is a brand new histologic subtype. In addition, four variants of invasive adenocarcinoma are recognized, namely invasive mucinous (formerly mucinous brochioloalveolar adenocarcinoma), colloid, fetal, and enteric. Importantly, three variants that were considered in the previous classification have been eliminated, specifically mucinous cystadenocarcinoma, signet ring cell, and clear cell adenocarcinoma. This review presents the changes introduced by the current histological classification of lung adenocarcinoma and its prognostic implications.

Optimization of mass spectrometry acquisition parameters for determination of polycarbonate additives, degradation products, and colorants migrating from food contact materials to chocolate

The interest towards "substances of emerging concerns" referred to objects intended to come into contact with food is recently growing. Such substances can be found in traces in simulants and in food products put in contact with plastic materials. In this context, it is important to set up analytical systems characterized by high sensitivity and to improve detection parameters to enhance signals. This work was aimed at optimizing a method based on UHPLC coupled to high resolution mass spectrometry to quantify the most common plastic additives, and able to detect the presence of polymers degradation products and coloring agents migrating from plastic re-usable containers. The optimization of mass spectrometric parameter settings for quantitative analysis of additives has been achieved by a chemometric approach, using a full factorial and d-optimal experimental designs, allowing to evaluate possible interactions between the investigated parameters. Results showed that the optimized method was characterized by improved features in terms of sensitivity respect to existing methods and was successfully applied to the analysis of a complex model food system such as chocolate put in contact with 14 polycarbonate tableware samples. A new procedure for sample pre-treatment was carried out and validated, showing high reliability. Results reported, for the first time, the presence of several molecules migrating to chocolate, in particular belonging to plastic additives, such Cyasorb UV5411, Tinuvin 234, Uvitex OB, and oligomers, whose amount was found to be correlated to age and degree of damage of the containers.

Correlation between different markers for the assessment of red chilli pepper powders stability during shelf-life

Pungency and red colour of Capsicum powders deteriorate during processing and storage, resulting in a decrease in market value. Two varieties of pepper with different pungencies were monitored for capsaicinoids, colour and furosine. Aliquots were stored at room and at low temperature during one year. At low temperature all indicators were stable in both varieties, while at room temperature, redness and capsacinoids decreased significantly, while furosine increased. High correlation was found between those markers. The more pungent variety exhibited higher stability in terms of all parameters. Differences observed suggest a potential protective effect exerted by capsaicinoids on powder stability. The decrease in capsaicinoids and redness accompanied by furosine increase showed a linkage between those markers never reported before. Considering that capsaicinoids and furosine occurrence have strong impact on the nutritional profile, the findings of this work show relevant changes in the nutritional value of chilli pepper powder after storage.

Hypersensitivity Pneumonitis: A Comprehensive Review

Hypersensitivity pneumonitis (HP), also known as extrinsic allergic alveolitis, is a complex pulmonary syndrome mediated by the immune system and caused by inhalation of a wide variety of antigens to which the individual has been previously sensitized. The pathobiology of the disease is not fully understood, but in addition to the triggers that initiate the disease, host/genetic factors are likely to be important, as only a minority of exposed individuals develop HP. Due to the lack of a diagnostic gold standard, the diagnosis of HP is not straightforward and relies on the integration of a number of factors, including history of exposure, precipitating antibodies to the offending antigen, clinical features, bronchoalveolar lavage, and radiological and pathologic features. However, in the appropriate setting, a high index of suspicion is critically important and may obviate the need for more invasive tests. Clinical presentation and natural history vary widely. Acute forms generally resolve without sequelae, while chronic forms, which are caused by persistent low-grade exposures, are associated with poor prognosis. Corticosteroids may be useful in acute episodes for symptomatic relief or in chronic and progressive disease, but their long-term efficacy has never been validated in prospective clinical trials. Ideally, patients with HP should be referred to centers with expertise, as the overlap with other forms of interstitial lung disease may be substantial. Making the correct diagnosis has critical therapeutic and prognostic implications.

Large cell carcinoma of the lung: clinically oriented classification integrating immunohistochemistry and molecular biology

This study aimed at challenging pulmonary large cell carcinoma (LLC) as tumor entity and defining different subgroups according to immunohistochemical and molecular features. Expression of markers specific for glandular (TTF-1, napsin A, cytokeratin 7), squamous cell (p40, p63, cytokeratins 5/6, desmocollin-3), and neuroendocrine (chromogranin, synaptophysin, CD56) differentiation was studied in 121 LCC across their entire histological spectrum also using direct sequencing for epidermal growth factor receptor (EGFR) and v-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog (KRAS) mutations and FISH analysis for ALK gene translocation. Survival was not investigated. All 47 large cell neuroendocrine carcinomas demonstrated a true neuroendocrine cell lineage, whereas all 24 basaloid and both 2 lymphoepithelioma-like carcinomas showed squamous cell markers. Eighteen out of 22 clear cell carcinomas had glandular differentiation, with KRAS mutations being present in 39 % of cases, whereas squamous cell differentiation was present in four cases. Eighteen out of 20 large cell carcinomas, not otherwise specified, had glandular differentiation upon immunohistochemistry, with an exon 21 L858R EGFR mutation in one (5 %) tumor, an exon 2 KRAS mutation in eight (40 %) tumors, and an ALK translocation in one (5 %) tumor, whereas two tumors positive for CK7 and CK5/6 and negative for all other markers were considered adenocarcinoma. All six LCC of rhabdoid type expressed TTF-1 and/or CK7, three of which also harbored KRAS mutations. When positive and negative immunohistochemical staining for these markers was combined, three subsets of LCC emerged exhibiting glandular, squamous, and neuroendocrine differentiation. Molecular alterations were restricted to tumors classified as adenocarcinoma. Stratifying LCC into specific categories using immunohistochemistry and molecular analysis may significantly impact on the choice of therapy.