Safety and feasability of ureteroscopy for pediatric stone, in children under 5 Years (SFUPA 5): A French multicentric study

INTRODUCTION

Ureteroscopy (URS) can be proposed as first-line therapy for the management of pelvic stones from 10 to 20 mm and for lower ureteric stones in children. However, little is known about the success and the morbidity of URS in young children. Ureteroscopic treatment may present matters in young children because of the small size of the pediatric kidney and the small size of the collecting system.

OBJECTIVE

To assess safety and efficacy of URS for the treatment of urinary stones in children aged of 5 years or less.

STUDY DESIGN

After the institutional ethical board approval was obtained, we conducted a retrospective, analytic, multicentric study that included all URS performed between January 2016 and April 2022 in children aged of 5 years or less. In this non-comparative case series, anonymized pooled data were collected from 7 tertiary care centers of pediatric patients. Endpoints were the one-session SFR at 3 months and per and postoperatives complications. Descriptive statistics were applied to describe the cohort.

RESULTS

Eighty-three patients were included. For them, 96 procedures were performed at the median age of 3.5 years (IQR: 0.8-5) and median weight of 14 Kg (6.3-23). Median stone size was 13 mm (4-45). There were 65 (67 %) renal stones treated with flexible URS, most of which were in the renal pelvis (30 %) and in the lower calix (33 %). A ureteral access sheath was used in 91 % procedures. Preoperative ureteral stent was placed in 52 (54 %) of patients. None of patients had ureteral dilatation. The single-session SFR was 67.4 % (56.3 and 89.2 % for flexible URS and semi-rigid URS respectively) and children require 1.4 procedures to achieve complete stone clearance. The overall complication rate was 18.7 %, most of them were minor (Clavien I-II). Intraoperative perirenal extravasation (Clavien IIIb) due to forniceal rupture was documented in 6.2 % of cases, related to an increased intrapelvic pressure (IPP) performed in a closed pelvicalyceal system.

DISCUSSION

Pediatric urologists should be aware of forniceal rupture based on the presence of extravasation of contrast during endourological procedures especially when they have difficulties to reach lower caliceal stone in small patient.

CONCLUSION

URS in patients aged of 5 years or less, is a complex minimally invasive procedure with reasonable efficacy and low morbidity. Intrarenal stones treated by RIRS in young children carries the risk of additional procedures to complete stone clearance.

Calcium phosphate nanoparticles improve growth parameters and mitigate stress associated with climatic variability in avocado fruit

The avocado cv. Hass is one of the most dynamic fruits in the world and is of particular significance in tropical areas, where climate variability phenomena have a high impact on productivity and sustainability. Nanotechnology-based tools could be an alternative to mitigate and/or adapt plants to these phenomena. Our approach was based on identifying changes in temperature and precipitation associated with climate variability in avocado areas in Colombia and proposing mitigation strategies based on the use of nanotechnology. This study had two objectives: (i) to identify variations in temperature and precipitation in avocado-producing areas in Colombia and (ii) to evaluate the effect of calcium phosphate nanoparticles (nano CP) as an alternative to reduce stress in avocados under simulate climatic variability condition. Climatic clusters were determined based on the spatial K-means method and with the climatic temporal series data (1981-2020), a time series analysis we carried out. Later changes in each cluster were simulated in growth chambers, evaluating physiological and developmental responses in avocado seedlings subjected to nanoCaP after adjusting the application form and dose. XRD diffraction shows that the calcium phosphate phases obtained by solution combustion correspond to a mixture of hydroxyapatite and witocklite nanoparticles with irregular morphologies and particle sizes of 100 nm. Three clusters explained ∼90% of the climate variation, with increases and decreases in temperature and precipitation in the range of 1-1.4 °C and 4.1-7.3% respectively. The best-fitted time series models were of stationary autoregressive integrated moving averages (SARIMA). The avocado seedlings had differential responses (P<0.05) depending on the clusters, with a decrease in physiological behavior and development between 10 and 35%. Additionally, the nanoCaP reduced the climatic stress (P< 0.05) in a range between 10 and 22.5%. This study identified the negative effect of climate variability on avocado seedlings and how nanoCaP can mitigate these phenomena.

Superradiant emission in a high-mobility two-dimensional electron gas

We use terahertz time-domain spectroscopy to study gallium arsenide two-dimensional electron gas samples in external magnetic field. We measure cyclotron decay as a function of temperature from 0.4 to10Kand a quantum confinement dependence of the cyclotron decay time belowT0=1.2K. In the wider quantum well, we observe a dramatic enhancement in the decay time due to the reduction in dephasing and the concomitant enhancement of superradiant decay in these systems. We show that the dephasing time in 2DEG's depends on both the scatteringrateand also on the distribution of scattering angles.

Is There a Difference in Adenoma Detection Rates According to Indication? An Experience in a Panamanian Colorectal Cancer Screening Program

Background

The benefit of colorectal cancer screening in reducing cancer risk and related death is unclear. There are quality measure indicators and multiple factors that affect the performance of a successful colonoscopy. The main objective of our study was to identify if there is a difference in polyp detection rate (PDR) and adenoma detection rate (ADR) according to colonoscopy indication and which factors might be associated.

Methods

We conducted a retrospective review of all colonoscopies performed between January 2018 and January 2019, in a tertiary endoscopic center. All patients ≥ 50 years old scheduled for a nonurgent colonoscopy and screening colonoscopy were included. We stratified the total number of colonoscopies into two categories according to the indication: screening vs. non-screening, and then calculated PDR, ADR and serrated polyp detection rate (SDR). We also performed logistic regression model to identify factors associated with detecting polyps and adenomatous polyps.

Results

A total of 1,129 and 365 colonoscopies were performed in the non-screening and screening group, respectively. In comparison with the screening group, PDR and ADR were lower for the non-screening group (33% vs. 25%; P = 0.005 and 17% vs. 13%; P = 0.005). SDR was non-significantly lower in the non-screening group when compared with the screening group (11% vs. 9%; P = 0.53 and 22% vs. 13%; P = 0.007).

Conclusion

In conclusion, this observational study reported differences in PDR and ADR depending on screening and non-screening indication. These differences could be related to factors related to the endoscopist, time slot allotted for colonoscopy, population background, and external factors.

Clinical Utility of 18F-FDG PET/CT in the Work-up of Children with Uveitis

PURPOSE

To evaluate ¹⁸F-fluorodeoxyglucose Positron Emission Tomography/ultra low dose Computed Tomography (¹⁸F-FDG PET/ ULD CT) in the work-up of pediatric uveitis.

METHODS

Retrospective study of 12 children followed for uveitis who underwent whole body ¹⁸F-FDG PET/ULD CT between 2011 and 2019.

RESULTS

The average age of the patients was 11 years. A total of 100% of patients presented with bilateral uveitis, 50% had panuveitis and 92% had various choroidal involvement. Relevant information for diagnosis was provided in four patients. 5/12 had an abnormal 18F-FDG uptake. Of these, three patients had pathognomonic images of active granulomatous diseases. Three patients underwent PET CT-guided biopsies of which two were positive for sarcoidosis.

CONCLUSION

¹⁸F-FDG PET/CT provided important information for final diagnosis in approximately 30% (4/12) of pediatric patients with bilateral uveitis. Whole body FDG PET/ULD CT can contribute to the final diagnosis thanks to pathognomonic image of active granulomatous disease and/or by indicating metabolically active site of biopsy that would not be visualized in thorax CT.

Leaving no one behind: Defining and implementing an integrated life course approach to vaccination across the next decade as part of the immunization Agenda 2030

Strategic Priority 4 (SP4) of the Immunization Agenda 2030 aims to ensure that all people benefit from recommended immunizations throughout the life-course, integrated with essential health services. Therefore, it is necessary for immunization programs to have coordination and collaboration across all health programs. Although there has been progress, immunization platforms in the second year of life and beyond need continued strengthening, including booster doses and catch-up vaccination, for all ages, and recommended vaccines for older age groups. We note gaps in current vaccination programs policies and achieved coverage, in the second year of life and beyond. In 2021, the second dose of measles-containing vaccine (MCV2), given in the second year of life, achieved 71% global coverage vs 81% for MCV1. For adolescents, 60% of all countries have adopted human papillomavirus vaccines in their vaccination schedule with a global coverage rate of only 12 percent in 2021. Approximately 65% of the countries recommend influenza vaccines for older adults, high-risk adults and pregnant women, and only 25% recommended pneumococcal vaccines for older adults. To achieve an integrated life course approach to vaccination, we reviewed the evidence, gaps, and strategies in four focus areas: generating evidence for disease burden and potential vaccine impact in older age groups; building awareness and shifting policy beyond early childhood; building integrated delivery approaches throughout the life course; and identifying missed opportunities for vaccination, implementing catch-up strategies, and monitoring vaccination throughout the life course. We identified needs, such as tailoring strategies to the local context, conducting research and advocacy to mobilize resources and build political will. Mustering sufficient financial support and demand for an integrated life course approach to vaccination, particularly in times of COVID-19, is both a challenge and an opportunity.

321 UNMET NEEDS AFTER STROKE

Background

Unmet needs, such as lack of access to rehabilitation, support and information, are experienced by a high proportion of stroke survivors after discharge from acute and rehabilitation services. The UK guidelines on stroke (2016) recommend that all patients should be offered a structured health and social care review at 6 months post-stroke. However, no such clinics exist to date in Ireland. We aimed to explore the extent of unmet needs in the catchment area of a large teaching hospital.

Methods

A random selection of patients 6-months post-stroke were contacted by telephone and unmet needs were assessed using a validated tool, Post-Stroke Checklist. Following analysis of data, the need for a pilot clinic was identified. A separate random selection of patients discharged from acute services 6 months previously were invited to attend a review clinic. Patients were assessed using an adapted version of the Greater Manchester Stroke Assessment Tool. Assessments were conducted jointly by a physiotherapist and a speech and language therapist, and appropriate onward referrals were made.

Results

Telephone clinic: 51 patients completed the checklist. The most prevalent symptoms reported were fatigue (75%), reduced participation in hobbies and activities, decline in cognition (61%) and mobility problems (59%). Review clinic: 21 patients attended. The most prevalent symptoms reported were reduced memory/concentration (71%), low mood (71%), unintentional weight loss/gain (62%), and reduced mobility (43%). Onward referrals were made for in 16/21 (76%) cases; physiotherapy (n=12), occupational therapy (n=7), speech and language therapy (n=7), clinical nutrition (n=5), social work (n=7), psychology (n=5).

Conclusion

Data from this exploratory study supports previous research indicating a high number of stroke survivors with unmet needs. This highlights the importance of establishing post-acute stroke review clinics and pathways in the Irish setting.

Does the presence of conspecifics facilitate exploratory behaviour in a cichlid fish (Etroplus suratensis)?

Animals confronted with any kind of novelty show behavioural responses driven by avoidance and exploration. The expression of both tendencies is modulated by anxiety. Especially in group-living animals, the presence of conspecifics can reduce anxiety in novel situations and hence increase exploratory tendency. Such intensified behavioural responses triggered by the social environment of an individual are called social facilitation. Here, we tested for social facilitation on the exploratory tendency of group-living juvenile Green chromide cichlid fish (Etroplus suratensis) by assessing each individual twice in an open field test: once alone and once together with a conspecific. Contrary to our expectations, we found no difference in exploratory behaviour between the groups. However, our results suggest that changes in exploratory tendency across the two treatments were highly individual, both in extent and direction, and are likely driven by the presence of the conspecific and the focal individual’s own behavioural type.

Changes to dentin extracellular matrix following treatment with plant-based polyphenols

This study investigated whether treatment with plant-based polyphenols (PB-P) affected the biochemical and/or biomechanical properties of dentin extracellular matrix (ECM). Three PB-Ps were evaluated: luteolin (LT), galangin (GL), and proanthocyanidin (PAC). Because dentin ECM requires demineralization before treatment, this study also assessed the effect of these PB-Ps on dentin demineralized by two different chemicals. Dentin samples from extracted third molars were obtained, sectioned, and randomly assigned for demineralization with either phosphoric acid (PA) or ethylenediaminetetraacetic acid (EDTA). Following demineralization, baseline infrared (IR) spectra and apparent elastic modulus (AE) of each specimen were independently acquired. Based upon these initial tests, samples were randomly assigned to one of the PB-P treatments to ensure that distribution of baseline AE was similar across treatment groups. IR and AE specimens were individually immersed in either 0.2% LT, 0.4% GL or 1% PAC for 2 min. IR spectra of treated samples were compared to baseline IR spectra, looking for any interaction of PB-Ps with the demineralized dentin. The IR spectrum and AE of each PB-P-treated specimen were compared with their own correspondent baseline measurement. The ability of PB-Ps to inhibit proteolytic activity of dentin ECM was assessed by the hydroxyproline assay. Finally, the effect of PB-Ps on immediate bond strength of a dental adhesive to PA- or EDTA-etched dentin was also evaluated. PB-Ps exhibited distinctively binding affinity to dentin ECM and promoted significant increase in AE. PB-P treatment reduced the degradation rate of dentin ECM without causing detrimental effect on immediate bond strength to dentin. Our work represents the first-time that LT and GL have been assessed as dentin ECM biomodifiers.

Connecting to the oceans: supporting ocean literacy and public engagement

Improved public understanding of the ocean and the importance of sustainable ocean use, or ocean literacy, is essential for achieving global commitments to sustainable development by 2030 and beyond. However, growing human populations (particularly in mega-cities), urbanisation and socio-economic disparity threaten opportunities for people to engage and connect directly with ocean environments. Thus, a major challenge in engaging the whole of society in achieving ocean sustainability by 2030 is to develop strategies to improve societal connections to the ocean. The concept of ocean literacy reflects public understanding of the ocean, but is also an indication of connections to, and attitudes and behaviours towards, the ocean. Improving and progressing global ocean literacy has potential to catalyse the behaviour changes necessary for achieving a sustainable future. As part of the Future Seas project (https://futureseas2030.org/), this paper aims to synthesise knowledge and perspectives on ocean literacy from a range of disciplines, including but not exclusive to marine biology, socio-ecology, philosophy, technology, psychology, oceanography and human health. Using examples from the literature, we outline the potential for positive change towards a sustainable future based on knowledge that already exists. We focus on four drivers that can influence and improve ocean literacy and societal connections to the ocean: (1) education, (2) cultural connections, (3) technological developments, and (4) knowledge exchange and science-policy interconnections. We explore how each driver plays a role in improving perceptions of the ocean to engender more widespread societal support for effective ocean management and conservation. In doing so, we develop an ocean literacy toolkit, a practical resource for enhancing ocean connections across a broad range of contexts worldwide.

Connecting to the oceans: supporting ocean literacy and public engagement

Improved public understanding of the ocean and the importance of sustainable ocean use, or ocean literacy, is essential for achieving global commitments to sustainable development by 2030 and beyond. However, growing human populations (particularly in mega-cities), urbanisation and socio-economic disparity threaten opportunities for people to engage and connect directly with ocean environments. Thus, a major challenge in engaging the whole of society in achieving ocean sustainability by 2030 is to develop strategies to improve societal connections to the ocean. The concept of ocean literacy reflects public understanding of the ocean, but is also an indication of connections to, and attitudes and behaviours towards, the ocean. Improving and progressing global ocean literacy has potential to catalyse the behaviour changes necessary for achieving a sustainable future. As part of the Future Seas project (https://futureseas2030.org/), this paper aims to synthesise knowledge and perspectives on ocean literacy from a range of disciplines, including but not exclusive to marine biology, socio-ecology, philosophy, technology, psychology, oceanography and human health. Using examples from the literature, we outline the potential for positive change towards a sustainable future based on knowledge that already exists. We focus on four drivers that can influence and improve ocean literacy and societal connections to the ocean: (1) education, (2) cultural connections, (3) technological developments, and (4) knowledge exchange and science-policy interconnections. We explore how each driver plays a role in improving perceptions of the ocean to engender more widespread societal support for effective ocean management and conservation. In doing so, we develop an ocean literacy toolkit, a practical resource for enhancing ocean connections across a broad range of contexts worldwide.

P–272 The aneuploid embryo secretome

Study question

Does the metabolomic analysis of the embryonic culture medium predict the embryo aneuploidy?

Summary answer

The presence and quantity of some metabolites in the culture medium can select euploid embryos for transfer.

What is known already

Advances in analytical techniques for metabolomics have brought the possibility of better tools for the characterization of molecules. Embryonic metabolism can be used as a good indicator of viability, regardless of the morphology of the blastocysts, since differences were observed in the metabolic activities between the days of embryo development and in the rates of live births.

Study design, size, duration

17 patients had their embryos biopsied between January to July 2019 in a human reproduction laboratory. All cases had PGT-A indication and after the biopsy, the embryos were frozen. The culture medium samples were individually prepared for metabolites extraction according to the Bligh and Dyer protocol. Controlled ovarian stimulation and dose adjustments according to the response of each patient. The metabolomics analysis was performed by mass spectrometry.

Participants/materials, setting, methods

Ovum pick up will be performed 35 hours after r-hCG administration. The embryos were kept in individual 50ul drops until the blastocyst stage. The biopsy was performed in 26 blastocysts. The samples were sent to the 337 metabolites analysis by mass spectrometry. 15 molecules with the highest score on the PLS-Da was submitted the ROC curves to illustrate the power of the metabolic ploidy analysis. Besides, we performed the functional enrichment analysis for each group.

Main results and the role of chance

After the genetic analysis by PGT-a, 10 aneuploid embryos and 16 euploid embryos were found. Comparing the quantitative target metabolomic analysis of the 337 metabolites in the embryo culture medium, we observed the L-Alanine, Cytosine, Guanosine monophosphate, Homocysteine, Hypoxanthine, and Xanthine hiperrepresented in the aneuploid embryos, and the Citrulline, L-Glutamic acid, Kynurenine, L-Leucine, Methionine, Ornithine, L-Phenylalanine, L-Tyrosine, L-Valine were hiperrepresented in the euploid embryos. Through the ROC curve, we can verify AUC = 0.987. This result suggests that the analysis of euploid embryos through the metabolomic analysis of the culture medium is valid to be used as a noninvasive aneuploid diagnostic. The functional enrichment analysis shows the urea cycle and the glycine and serine metabolism as the principal function alter by aneuploid.

Limitations, reasons for caution

Small number of samples and not validate sample group.

Wider implications of the findings: Further studies are needed to validate these findings for the diagnostic of embryo euploidy.

Trial registration number

N/A

P–170 The secretomy of embryo sex

Study question

Does the analysis of the metabolites of the embryonic culture medium can predict the sex of the embryo?

Summary answer

The presence and quantity of some metabolites in the culture medium can predict the sex of the human embryos.

What is known already

Advances in analytical techniques for metabolomics have brought the possibility of better tools for the characterization of molecules. Embryonic metabolism can be used as a good indicator of viability, regardless of the morphology of the blastocysts, since differences were observed in the metabolic activities between the days of embryo development and in the rates of live births.

Study design, size, duration

16 patients had their embryos biopsied between the months of January to July 2019 in a human reproduction laboratory. All cases had PGT-A indication and after the biopsy, the embryos were frozen. The culture medium samples were individually prepared for metabolites extraction according to the Bligh and Dyer protocol. Controlled ovarian stimulation and dose adjustments according to the response of each patient. The metabolomics analysis was performed by mass spectrometry.

Participants/materials, setting, methods

Follicular puncture were performed 35 hours after r-hCG. The eggs were kept in individual culture until the blastocyst stage. The blastocysts biopsy was performed (20). After the culture medium was sent to the 337 metabolites analysis by mass spectrometry. 14 molecules with the highest score on the PLS-Da was submitted to the ROC curves showing the power of metabolic analysis to predict the sex of euploid embryos. Besides, we performed the functional enrichment analysis.

Main results and the role of chance

After the genetic analysis by PGT-a, we obtain 20 euploid embryos, being 12 female embryos and 08 male embryos. Comparing the quantitative target metabolomic analysis of the 337 metabolites in the embryo culture medium, we observed the Asymmetric dimethylarginine, FAD, Malic Acid, Serotonin, increased in female embryos and Adenosine monophosphate, L-Alanine, L-Arginine, Cysteamine, DL-Dopa, Flavin Mononucleotide, Methionine sulfone, Nicotinic acid, L-Tyrosine, Uracil in male embryos. Through the ROC curve, we can verify AUC = 0.937. This result suggests that the metabolomic analysis of the culture medium is valid to be used as a complement of PGT-A to know embryo sex diagnostic. The functional enrichment analysis shows the Asymmetric dimethylarginine and Malic Sulfone metabolism as the principal function alter by female embryos.

Limitations, reasons for caution

Small number of samples

Wider implications of the findings: Further studies are needed to validate these findings for the diagnostic of sex embryos

Trial registration number

N/A

May the brief physical activity assessment tool accurately measure physical activity in patients with resistant hypertension?

Funding Acknowledgements

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): FEDER Funds through the Operational Competitiveness Factors Program—COMPETE National Funds through the Portuguese Foundation for Science and Technology (FCT) “PTDC/DTP-DES/1725/2014”. SL is a PhD fellow supported by the FCT (Grant Ref: SFRH/BD/129454/2017).

Introduction

Resistant hypertension is a major health problem due to the increased risk of cardiovascular events and mortality. Physical activity and exercise reduces blood pressure in resistant hypertension and is associated with lower cardiovascular risk and mortality. It is presently recommended that physical activity assessment should be a priority in all visits to health settings

Purpose

This study aims to determine if the Brief Physical Activity Assessment Tool (BPAAT), a 2-question tool to assess physical activity, is a valid instrument to detect inactive patients with resistant hypertension. 

Methods

Sixty patients with a diagnosis of resistant hypertension were recruited. Outcome measures included clinical data, blood pressure and daily physical activity. Physical activity was objectively measured over a 7-day period with an accelerometer and subjectively assessed (self-assessment) by the BPAAT. The association between the BPAAT and accelerometry, according to the BPAAT scoring categories, was assessed bythe percentage of agreement, Cohen’s Kappa and sensitivity and specificity.

Results

Patients (33 were male) had a mean age of 59.4 ± 9.1years, were on average overweight (BMI 29.5 ± 4.5 kg/m2) and on an average of 4.5 ± 0.7 antihypertensive medications. Forty-two patients (70%) were classified as insufficiently active by the BPAAT compared to the 38 (63.3%) insufficiently active patients identified by the accelerometry data. Regarding the questionnaire’s specificity and sensitivity, the BPAAT correctly identified 32 [84.2 (73.1 – 95.3) %] of the 38 ‘insufficiently active’ patients and 12 [54.5 (34.3 – 74.7) %] of the 22 ‘sufficiently active’ patients identified by accelerometry. The agreement between BPAAT and accelerometry to identify sufficiently/insufficiently active patients, according to the BPAAT’s cut-off values was fair to moderate (Kappa = 0.403 (0.162 – 0.674), with a percentage of agreement of 73.3%.

Conclusion

The BPAAT, a 2-question tool to assess physical activity, seems to be a valid and fast solution to identify insufficiently active adults with resistant hypertension during routine clinical visits.

Higher levels of physical activity is associated with lower arterial stiffness in patients with resistant hypertension

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Portuguese Foundation for Science and Technology (FCT) European Regional Development Fund – Operational Competitiveness Factors Program (COMPETE)

Background

 Physical activity has been associated with reduced arterial stiffness in patients with hypertension. However, in resistant hypertension, a specific population with an increased risk for target organ damage, cardiovascular morbidity, and mortality, the evidence is sparse. 

Purpose

 The present study aimed to determine the association between daily physical activity and arterial stiffness in patients with resistant hypertension.

Methods

 Fifty-seven patients with resistant hypertension were recruited. Physical activity was objectively assessed during 7 consecutive days with accelerometers. Arterial stiffness was evaluated using carotid-femoral pulse wave velocity (cf-PWV) . 

Results

 Participants (50.9% men), aged 58.8 ± 9.4 years, were mainly overweight and were taking in average 4.5 antihypertensive medications. The cf-PWV showed an inverse correlation with light-intensity physical activity (r = -0.290, p = 0.029) and total daily physical activity (r = -0.287, p = 0.030). Additionally, cf-PWV tended to be inversely associated with the number of steps per day (r = -0.242, p = 0.069). Patients with higher risk of cardiovascular events (cf-PWV ≥ 10 m/s) tended to spend less time in light-intensity physical activity (324.0 ± 129.4 vs. 380.5 ± 103.1 min/day, p = 0.090) and to perform less total daily physical activity (351.5 ± 141.7 vs. 411.7 ± 109.1 min/day, p = 0.091) than participants with cf-PWV below the risk threshold value.

Conclusions

 Higher levels of total physical activity and daily levels of light-intensity were associated to lower arterial stiffness. These results emphasize the importance of physical activity as a nonpharmacological tool for patients with resistant hypertension.

Marine macrofaunal traits responses to dredged material disposal

Currently, our understanding of the mechanisms for, and potential functional implications of, changes in seabed assemblages resulting from dredged material disposal is relatively unknown. Based on empirical data from 17 disposal sites, we address this by quantifying the nature and magnitude of shifts in the relative composition of response and effects traits within disposal site assemblages relative to their reference assemblages. Differing shifts in both response and effects traits were observed across sites, regardless of the trait composition of the reference assemblages. Notable differences in the magnitude of traits changes were also observed for both trait types. Traits shifts are difficult to predict as they appear to reflect both environmental conditions and disposal regime. Temporal data revealed that some sites display relatively consistent responses while others presented large inter-annual variability. These findings are discussed in relation to dredged material monitoring and with respect to conservation objectives of marine protected areas.

Characterization and Outcomes in Patients Treated With Apremilast in Routine Clinical Practice in Spain: Results From the APPRECIATE Study

BACKGROUND AND OBJECTIVES

It is necessary to expand the knowledge in the use of apremilast in clinical practice. The APPRECIATE study (NCT02740218) aims to describe the characteristics of patients with psoriasis treated with apremilast, to evaluate their perspectives and those of dermatologists, as well as the outcomes obtained in clinical practice in Spain.

METHODS

Observational, retrospective, cross-sectional, multicenter study of patients with chronic plaque psoriasis who could be contacted 6 (±1) months after apremilast initiation. The data were obtained from medical records and questionnaires from patients and physicians.

RESULTS

A total of 80 patients were evaluated; at apremilast onset, they showed mean (standard deviation, SD) Psoriasis Area and Severity Index (PASI) = 8.3 (5.3), mean (SD) Dermatology Life Quality Index (DLQI) = 8.9 (6.6). At six months, 58.8% (n=47) of patients continued apremilast treatment (discontinuations due to lack of efficacy [16.3%], safety/tolerability [20.0%]). In patients continuing treatment, PASI75 was achieved by 36.7% of patients; mean (95% CI) DLQI score was 2.2 (0.7-3.6) and mean (SD) Patient Benefit Index score was 2.8 (0.8). Compliance with physicians' expectations was correlated with benefits reported by patients (r=0.636). Adverse events were reported by 56.3% of patients (the most common were diarrhoea and nausea).

CONCLUSIONS

Patients receiving apremilast for 6 months in Spanish clinical practice, reported substantial improvements in their quality of life (mean DLQI reduced by more than 6 points) and disease severity (PASI75 achieved by over one-third of patients), despite less skin involvement than patients who enrolled in clinical trials.

Synchronous bilateral breast cancer treated with a 3-week hypofractionated radiotherapy schedule: clinical and dosimetric outcomes

Background and purpose

Synchronous bilateral breast cancer (SBBC) accounts for 1–3.5% of breast cancer patients. The aim of this study was to evaluate dosimetric issues, clinical outcomes, and acute toxicities for SBBC patients receiving synchronous bilateral hypofractionated radiotherapy (SBHRT) and to compare them with patients treated with synchronous bilateral normofractionated RT schedule (SBNRT).

Materials and methods

From April 2016 to March 2020, 39 SBBC patients were referred to our institution. Patients were divided according to their prescription dose: Group A: 50 Gy/25fx (fractions), B: 60–64 Gy/25fx, C: 40.05 Gy/15fx; D: 48 Gy/15fx. Toxicity was evaluated using Common Terminology Criteria for Adverse Events (CTCAE)v.5.0.

Results

34 patients were finally evaluated. Median follow-up was 24 months for NF schedule and 9 months for HF schedule. In the HF schedule, no acute side-effects > G2 were observed and no dermatitis was reported in 6^th month´s assessments. 95% of patients have no evidence of disease and only 1 patient presented local relapse in the first mammography after RT. No distant failures or deaths were observed. Regarding dosimetric issues, the inter-patient average D_mean for the heart was: Group A: 5.0 Gy (4.6–5.5), Group B: 4.4 Gy (4.1–5.4), Group C: 4.8 Gy (4.5–5.1) and Group D: 5.3 Gy (4.4–5.6). For the lungs, the inter-patient average D_mean was: Group A: 10.8 Gy (9.8–12.2), Group B: 11.5 Gy (11.3–12), Group C: 9.8 Gy (9.3–10.5) and Group D: 10.5 Gy (10–11.3).

Conclusions

This is the first study reporting the safety, feasibility, and tolerability of 40.05 Gy/15fx over 3 weeks for the treatment of SBBC patients. Further study with larger accrual is mandatory.

648. BioFire® FilmArray® Pneumonia plus Panel Performance Evaluation: A Multicenter, International Collaborative Study

Background

Classical methods to identify causes of community acquired, healthcare and ventilator associated pneumonia can be insensitive and slow, leading to unnecessary or inappropriate antimicrobial therapy. The BioFire® FilmArray® Pneumonia plus Panel (PNplus) detects 15 bacteria (in semi-quantitative log bin values from 10^4 to &gt; 10^7), 7 antibiotic resistance markers (mecA/C/MREJ, CTX-M, KPC, VIM, IMP, NDM, OXA-48 like), 3 atypical bacteria (AB), and 8 viral classes directly from bronchoalveolar lavage (BAL)-like and sputum-like specimens (including endotracheal aspirates) in about 1 hr. This study compared PNplus results to standard of care testing (SOC).

Methods

2476 samples (1234 BAL-like; 1242 sputum-like) were tested at 52 laboratories from 13 European countries and Israel by PNplus and SOC. SOC varied by site and physician prescription. Pathogen detection rates were compared. PNplus bin values and SOC descriptive or numerical quantities were evaluated for 1297 bacterial detections.

Results

13 samples (0.5%) gave invalid PNplus results. 3278 bacteria in PNplus were detected by PNplus and/or SOC. SOC detected 1878 bacteria (57.1%) compared to 3128 bacteria (95.8%) for PNplus (p=&lt; 0.0001). SOC detected 73 AB (70.9%) and 134 viruses (21.1%), PNplus detected 93 AB (90.3%) and 618 viruses (97.9%) (p=&lt; 0.0001). Mean number of analytes/sample detected by PNplus and SOC were 1.99 and 1.44, respectively. PNplus bin values were less than SOC, equal to SOC or greater than SOC in 5.9%, 25.4% and 69.6% of results, respectively. PNplus values were on average &gt; 1 log than SOC values (58.5% 1-2 logs; 11.0% 3-4 logs). PNplus identified 98.2% of MRSA and SOC 55.6%. All gram-negative resistance markers were detected at least once. PNplus and SOC results were fully concordant (positive or negative) or partially concordant for 49.1% and 26.4% of samples, respectively.

Conclusion

PNplus detected significantly more potential pathogens than SOC. Lack of routine SOC viral testing was a missed opportunity to define the cause of pneumonia. Semi-quantification may assist in understanding the significance of the pathogens detected. Pathogen and resistance marker detection in about 1 hr could dramatically impact antimicrobial use and enhance patient outcomes.

Disclosures

Christine C. Ginocchio, PhD, MT(ASCP), bioMerieux (Employee)bioMerieux (Employee, Shareholder) Barbara Mauerhofer, Pharmacist, bioMerieux (Employee) Cory Rindlisbacher, n/a, BioFire Diagnostics (Employee) Carolina Garcia, BS, bioMerieux (Employee)

Preparation and in vitro evaluation of PLA/biphasic calcium phosphate filaments used for fused deposition modelling of scaffolds

Ceramic materials such as calcium phosphates (CaPs) with a composition similar to the mineral phase of bones and polymeric polylactic acid (PLA) are potential candidates for the manufacturing of scaffolds to act as bone substitutes and for tissue engineering applications, due to their bioresorbability and biocompatibility. Variables such as porosity, topography, morphology, and mechanical properties play an essential role in the scaffolds response. In this paper, a polymer/ceramic composite filament of 1.7 mm in diameter based on PLA and biphasic calcium phosphates (BCPs) was obtained by hot-melt extrusion in a single screw extruder. The particles of BCP were obtained by solution-combustion synthesis, and the PLA used was commercial grade. The BCPs ceramics were characterized by X-ray diffraction (XRD), scanning electron microscopic (SEM), transmission electron microscopy (TEM), and Brunauer, Emmett, and Teller (BET). It was possible to confirm that the main inorganic phases were hydroxyapatite (HAP) and tricalcium phosphate (TCP) with grain sizes below 100 nm and with high porosity. The Filaments obtained are a bit fragile but were able to be used in fused deposition modelling (FDM) using low-cost commercial printers. The filaments were characterized by SEM and energy dispersive X-ray (EDX). The in-vitro tests of filaments showed deposition of apatite phases on their surface, non-cytotoxic behavior, adequate cell proliferation and cell adhesion.

Effects of educational efforts in tribal homes and schools to reduce asthma triggers, symptoms and missed school days

Native American asthma prevalence has been estimated higher than for the U.S. population average, and uncontrolled asthma results in absence from schools. This study analyzed effects of targeted education campaigns in both homes and schools on reducing asthma triggers and symptoms among 119 children with asthma, who were recruited from Cherokee and Nez Perce communities. The education campaigns were developed in collaboration with the researchers and the tribes, tailoring strategies to reduce asthma triggers adapted to tribal lifestyles. There was a special emphasis in identification of Traditional Ecological Knowledge (TEK) aspects, which were woven into the study plan and implementation. Some 62 study homes were investigated and the parents received targeted education at the beginning of the study, whereas the remaining control homes received the same education at the end of the study. In Cherokee homes, allergen levels were significantly increased in both control and study groups throughout the study. In Nez Perce homes, dog and cockroach allergen levels decreased significantly in the study homes. The parents reported asthma control test (ACT) scores of the children were significantly improved in both study and control groups, whereas respiratory illness days were reduced in the study group. In schools, allergen levels, particularly cat, dog and cockroach allergens, increased throughout the year in both study and control schools. However, high contact surface cleaning effectiveness based on adenosine tri phosphate (ATP) readings was improved in the study schools. It was also found that high contact surface cleaning effectiveness may have effects on students' absence rates tracked by schools. In conclusion, the results indicate partial improvements in parent reported health symptoms, although the improvements could not be definitively attributed to reduction of any specific exposure in the home environment. In the school environment, effective cleaning throughout the flu season could result in decreased absence rates.

Engineered Recombinant Escherichia coli Probiotic Strains Integrated with F4 and F18 Fimbriae Cluster Genes in the Chromosome and Their Assessment of Immunogenic Efficacy in Vivo

F4 (K88) and F18 fimbriaed enterotoxigenic Escherichia coli (ETEC) are the predominant causes of porcine postweaning diarrhea (PWD), and vaccines are considered the most effective preventive approach against PWD. Since heterologous DNA integrated into bacterial chromosomes could be effectively expressed with stable inheritance, we chose probiotic EcNc (E. coli Nissle 1917 prototype cured of cryptic plasmids) as a delivery vector to express the heterologous F4 or both F4 and F18 fimbriae and sequentially assessed their immune efficacy of anti-F4 and F18 fimbriae in both murine and piglet models. Employing the CRISPR-cas9 technology, yjcS, pcadA, lacZ, yieN/trkD, maeB, and nth/tppB sites in the chromosome of an EcNc strain were targeted as integration sites to integrate F4 or F18 fimbriae cluster genes under the P_tet promotor to construct two recombinant integration probiotic strains (RIPSs), i.e., nth integration strain (EcNcΔnth/tppB::P_tetF4) and multiple integration strain (EcNc::P_tetF18x4::P_tetF4x2). Expression of F4, both F4 and F18 fimbriae on the surfaces of two RIPSs, was verified with combined methods of agglutination assay, Western blot, and immunofluorescence microscopy. The recombinant strains have improved adherence to porcine intestinal epithelial cell lines. Mice and piglets immunized with the nth integration strain and multiple integration strain through gavage developed anti-F4 and both anti-F4 and anti-F18 IgG immune responses. Moreover, the serum antibodies from the immunized mice and piglets significantly inhibited the adherence of F4⁺ or both F4⁺ and F18⁺ ETEC wild-type strains to porcine intestinal cell lines in vitro, indicating the potential of RIPSs as promising probiotic strains plus vaccine candidates against F4⁺/F18⁺ ETEC infection.

[Para valvular leak closure in TAVI]

Literature concerning transcutaneous symptomatic para valvular cardiac leaks closure (PVLC) after trans aortic valve implantation (TAVI) is relatively scarce. Hereby we present 2 clinical cases, one on an Edwards® Sapien 3 valve and the other one on a Medtronic® Evolut R valve. We present also the preliminary results of the 7 PVLC on TAVI included in our prospective FFPP registry during the 2 first years of enrolment (2017-2018), for a total of 158 inclusions for all valves. Seven procedures were performed on 8 leaks, using a majority of vascular plugs (3 Abbott® Amplatzer Vascular Plugs 2 (AVP2), 3 AVP3, 1 AVP4, and 1 muscular Ventricular Septal Defect (VSD) occluder). All procedures were successful without complication. At 1-month follow-up, all patients became asymptomatic. One-year follow-up was already available for 4 patients: 3 of them were symptoms free, and one-who had a second leak not suitable for PVLC-, underwent a « TAVI in TAVI » procedure 2 months after PVLC. This short experience demonstrates the feasibility, the efficacy and the safety of PVLC on TAVI. We expect to be able to offer more in depth information at the end of our prospective ongoing study.

Quantifying the dark data in museum fossil collections as palaeontology undergoes a second digital revolution

Large-scale analysis of the fossil record requires aggregation of palaeontological data from individual fossil localities. Prior to computers, these synoptic datasets were compiled by hand, a laborious undertaking that took years of effort and forced palaeontologists to make difficult choices about what types of data to tabulate. The advent of desktop computers ushered in palaeontology's first digital revolution-online literature-based databases, such as the Paleobiology Database (PBDB). However, the published literature represents only a small proportion of the palaeontological data housed in museum collections. Although this issue has long been appreciated, the magnitude, and thus potential significance, of these so-called 'dark data' has been difficult to determine. Here, in the early phases of a second digital revolution in palaeontology--the digitization of museum collections-we provide an estimate of the magnitude of palaeontology's dark data. Digitization of our nine institutions' holdings of Cenozoic marine invertebrate collections from California, Oregon and Washington in the USA reveals that they represent 23 times the number of unique localities than are currently available in the PBDB. These data, and the vast quantity of similarly untapped dark data in other museum collections, will, when digitally mobilized, enhance palaeontologists' ability to make inferences about the patterns and processes of past evolutionary and ecological changes.

Risk-adjusted early invasive strategy in patients with non-ST-segment elevation acute coronary syndrome in Intensive Cardiac Care Units

OBJECTIVE

Current guidelines recommend a risk-adjusted early invasive strategy (EIS) in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). The present study assesses the application if this strategy, the conditioning factors and prognostic impact upon patients with NSTEACS admitted to Intensive Cardiac Care Units (ICCU).

DESIGN

A prospective cohort study was carried out.

SETTING

The ICCUs of 8 hospitals in Catalonia (Spain).

PATIENTS

Consecutive patients with NSTEACS between October 2017 and March 2018. The risk profile was defined by the European Society of Cardiology criteria.

INTERVENTIONS

EIS was defined as the performance of coronary angiography within the first 6hours in patients at very high-risk or within 24hours in high-risk patients.

OUTCOME VARIABLES

Mortality or readmission at 6 months.

RESULTS

A total of 629 patients were included (mean age 66.6 years), of whom 225 (35.9%) were at very high risk, and 392 (62.6%) at high risk. Most patients (96.2%) underwent an invasive strategy. EIS was performed in 284 patients (45.6%), especially younger patients with fewer comorbidities. These patients had a shorter ICCU and hospital stay, as well as a lesser incidence of ACS, revascularization and death or readmission at 6 months. After adjusting for confounders, the association between EIS and death or readmission at 6 months remained significant (hazard ratio: .66, 95% confidence interval .45-.97; P=.035).

CONCLUSIONS

The EIS was performed in a minority of NSTEACS admitted to ICCU, being associated with better outcomes.

A31 Diversity change of influenza A (H3N2) strains circulating in Brazil during 2017–8: What to expect in the coming winter?

The H3N2 subtype of influenza A (H3N2) was the predominant strain during the early months of the 2017 influenza epidemic in Brazil. In Australia, it was responsible for a strong and prolonged 2017 season and reached the Northern hemisphere causing an intense 2017/8 influenza season. Several genetic and antigenic A(H3N2) variants were circulating, which made the decision about which strain to incorporate into the influenza vaccine challenging. For 2018, the WHO selected a new H3N2 strain, A/Singapore/INFIMH-16-0019/2016-like, to replace the strain A/HongKong/4801/2014-like in the Southern Hemisphere trivalent vaccine. The aim of this study was to describe the genetic diversity of influenza A (H3N2) viruses circulating in Brazil between January 2017 and January 2018, checking the match between the vaccines and worldwide circulating strains with the Brazilian influenza strains. Hemagglutinin gene sequencing of the influenza A (H3N2) was performed, followed by a phylogenetic reconstruction using additional database sequences to define genetic groups and compare with other worldwide circulating strains. We observed a large diversity of H3N2 genetic clusters, including 3C.2a, 3C.2a1, 3C.3a, and their subgroups. During the 2016–7, inter-epidemic and 2017 epidemic period the cluster most frequently detected belonged to clade 3C.2a1 (148/185; 80.0%), a distinct group related to the 2017 vaccine strain A/HongKong/4801/2014-like (3C.2a). However, the genetic profile changed during the study period and in the inter-epidemic season 2017–8 the most commonly detected genetic group was the 3C.2a cluster (43/58; 74.1%). Inside this cluster, the majority (34/43; 79.1%) of strains belonged to a single genetic 3C.2a subgroup 2 (3C.2a2), bearing antigenic substitutions T131K and R142K (site A) and R261Q (site E). The dominance of this 3C.2a2 in the 2017–8 inter-epidemic period in Brazil was similar to the 2017–8 season in Europe and Canada according their surveillance data. The new vaccine strain has five to six antigenic changes in comparison to the predominant 3C.2a2 circulating in South America since September 2017 until now. It is possible that the vaccine mismatch will not protect the population against a majority of circulating strains. Surveillance of the vaccine effectiveness supported by antigenic and serological analysis are necessary to prove this hypothesis. However, this highlights the difficulty of vaccine strain selection and highlights the need for of a universal influenza vaccine.

First case of Campylobacter rectus and Solobacterium moorei mixed bacteraemia successfully identified by MALDI TOF-MS

Campylobacter rectus and Solobacterium moorei are anaerobic Gram-negative and Gram-positive rods, respectively, that are occasionally members of the human oral flora. Bacteraemia has rarely been reported. We present the first case of mixed C. rectus–S. moorei bacteraemia in an individual with diabetes and human immunodeficiency virus infection. Both bacteria were successfully identified by MALDI-TOF MS.

The use of dynamic prevalence maps to assess the prevalence of Salmonella in broiler flocks in the Valencian Community, Spain

The aim of this study was to design and implement a dynamic prevalence map for managing the data collected within the framework of the Salmonella spp. National control plan in broiler flocks, using a data set from the Valencian Community, Spain. Such a map would be a useful tool for veterinarians seeking to define control options. The development of the mapping tool for this study involved three main phases: data collection, data analysis and data representation. The data used were obtained from the results of the National Control Programme (based on European Commission [EC] Regulation No. 2160/2003). The Salmonella prevalence data were represented on a map of the Valencian Community, which included geographical information on flock locations to facilitate the interpretation of the results from monitoring. The average prevalence of Salmonella spp. was 2.74% from 2009 to 2013. Moreover, the proportion of broiler flocks that remained positive for the target serovars according to EC Regulation No. 2160/2003 (S. Enteritidis and/orS. Typhimurium [including monophasic S. Typhimurium]) was less than 1%. Over the five-year period of the study (2009-2013), the area of Bajo Maestrazgo had the highest level of Salmonella spp. prevalence every year, thereby validating the usefulness of this mapping tool. The aim of the study is to detect geographical 'highpressure' Salmonella zones over time and make suggestions on where efforts should be focused in this region to reduce future Salmonella spp. prevalence. Local Veterinary Services could, using the map, identify the infection pressure of Salmonella in the geographical areas where farms are located. Proximity to higher prevalences may imply an increased risk of flock contamination. Although annual data are represented, data can be presented in real time with regular frequency (daily, weekly, monthly or quarterly) or even over periods of several years. Therefore, the dynamic prevalence map provides extremely useful epidemiological information to veterinarians on the prevention of Salmonella.

Casting Away the Shadows: Elucidating the Role of Light-mediated Posttranscriptional Control in Plants

Light signals trigger precise changes in gene expression networks that activate distinctive developmental programs in plants. The transcriptome is shaped at different stages, both by the regulation of gene expression and also by posttranscriptional mechanisms that alter the sequence or abundance of the transcripts generated. Posttranscriptional mechanisms have attracted much interest in recent years with the advent of high-throughput technologies and bioinformatics tools. One such posttranscriptional process, alternative splicing, increases proteome diversity without increasing gene number by changing the function of individual proteins, while another, miRNA-mediated gene silencing, fine-tunes the amount of mRNA produced. The manner in which plants make use of these two crucial posttranscriptional mechanisms to respond to light and adapt to their environment is the focus of active research. In this review, we summarize the current knowledge of light-mediated posttranscriptional control in Arabidopsis thaliana and focus on the biological impact of the various posttranscriptional processes. We also discuss a potential cross talk between the alternative splicing and miRNA pathways, highlighting the complexity of light responsiveness.