EEG rhythmic and arrhythmic spectral components and functional connectivity at resting state may predict the development of synucleinopathies in idiopathic REM sleep behavior disorder

STUDY OBJECTIVES

Idiopathic/isolated REM-sleep behavior disorder (iRBD) often precedes the onset of synucleinopathies. Here, we investigated whether baseline resting-state EEG advanced spectral power and functional connectivity differ between iRBD patients who converted towards a synucleinopathy at follow-up and those who did not.

METHODS

Eighty-one participants with iRBD (66.89±6.91 years) underwent a baseline resting-state EEG recording, a neuropsychological assessment and a neurological examination. We estimated EEG power spectral density using standard analyses and derived spectral estimates of rhythmic and arrhythmic components. Global and pairwise EEG functional connectivity analyses were computed using the weighted phase-lag index (wPLI). Pixel-based permutation tests were used to compare groups.

RESULTS

After a mean follow-up of 5.01±2.76 years, 34 patients were diagnosed with a synucleinopathy (67.81±7.34 years) and 47 remained disease-free (65.53±7.09 years). Among patients who converted, 22 were diagnosed with Parkinson's disease and 12 with dementia with Lewy bodies. As compared to patients who did not convert, patients who converted exhibited at baseline higher relative theta standard power, steeper slopes of the arrhythmic component and higher theta rhythmic power mostly in occipital regions. Furthermore, patients who converted showed higher beta global wPLI but lower alpha wPLI between left temporal and occipital regions.

CONCLUSION

Analyses of resting-state EEG rhythmic and arrhythmic components and functional connectivity suggest an imbalanced excitatory-to-inhibitory activity within large-scale networks, which is associated with later development of a synucleinopathy in iRBD patients.

Utilizing systems genetics to enhance understanding into molecular targets of skin cancer

Despite progress made with immune checkpoint inhibitors and targeted therapies, skin cancer remains a significant public health concern in the United States. The intricacies of the disease, encompassing genetics, immune responses, and external factors, call for a comprehensive approach. Techniques in systems genetics, including transcriptional correlation analysis, functional pathway enrichment analysis, and protein-protein interaction network analysis, prove valuable in deciphering intricate molecular mechanisms and identifying potential diagnostic and therapeutic targets for skin cancer. Recent studies demonstrate the efficacy of these techniques in uncovering molecular processes and pinpointing diagnostic markers for various skin cancer types, highlighting the potential of systems genetics in advancing innovative therapies. While certain limitations exist, such as generalizability and contextualization of external factors, the ongoing progress in AI technologies provides hope in overcoming these challenges. By providing protocols and a practical example involving Braf, we aim to inspire early-career experimental dermatologists to adopt these tools and seamlessly integrate these techniques into their skin cancer research, positioning them at the forefront of innovative approaches in combating this devastating disease.

Feasibility of Acquiring Radiotherapy Linac Commissioning Data with a Three-Dimensional Cubic Electronic Detector Array

PURPOSE/OBJECTIVE(S)

Linac commissioning data acquisition consists of measurements of PDDs/TMRs, profiles, and dosimetric factors done in water and lasting several weeks to complete. Data collected with an early prototype 3D cubic electronic detector suggests faster, reliable, accurate, and a cost-effective option for commissioning data collection in the future.

MATERIALS/METHODS

A 10 × 10 × 15 cm3 3D cubic electronic detector array prototype of acrylic, silicon rubber, and five 10 × 10 × 0.2 cm3 planar active matrices at 2.0, 4.0, 6.0, 8.0, and 10 cm depths, was constructed. Each active matrix has 25 pixels (diode, capacitor, MOSFET) of 2.0 cm separation in a 10 × 10 cm2 active area resulting in 125 pixels in the array. Data readout consists of a multiplex connectivity configuration where one channel provides data input/output to multiple pixels rather than one channel per pixel. Simultaneous absolute depth-dose (ADD) and profile measurements were performed using a 6 MV photon beam, 100 cm SSD, 10 × 10 cm2 open field, 100 MU, and 400 MU/min, without scanning. Also, ADDs and profiles were measured with 15-, 30- and 45-deg wedges. Data processing for these measurements, and 2D and 3D DD and profile displays, were done in a programming environment, and results were compared to calculated data in acrylic.

RESULTS

Table with ADD and profile results for the 10 × 10 cm2 open field. ADD and profiles with wedges showed similar results.

CONCLUSION

Absolute depth-dose and profile data acquired with an early prototype agreed within ±4 % of calculated values. This suggests that an improved 3D cubic electronic detector array could be used for commissioning data collection. If realized, it could reduce commissioning time from weeks to hours saving cost, staff time, and leveraging a new Linac into clinical operations sooner.

Health-related quality of life of X-linked hypophosphatemia in Spain

BACKGROUND

Health-related quality of life (HRQoL) of patients with X-linked hypophosphatemia (XLH) is lower than that of both the general population and the patients with other chronic diseases, mainly due to diagnostic delay, treatment difficulties, poor psychosocial support, and problems with social integration. Early diagnosis and optimal treatment are paramount to control the disease in patients with XLH, avoid complications, and maintain or improve their HRQoL. We, therefore, analyzed the HRQoL of pediatric and adult patients with XLH treated with conventional therapy in Spain.

RESULTS

We used several versions of the EuroQol-5 dimensions (EQ-5D) instrument according to the age of patients with XLH. Then we compared the HRQoL of patients to that of the general Spanish population. Children with XLH (n = 21) had moderate problems in walking about (61.9%), washing or dressing themselves (9.52%), and performing their usual activities (33.33%). They also felt moderate pain or discomfort (61.9%) and were moderately anxious or depressed (23.81%). Adults with XLH (n = 29) had lower HRQoL, with problems in walking (93%, with 3.45% unable to walk independently), some level of pain (86%, with 3.45% experiencing extreme pain), problems with their usual activities (80%) and self-care (> 50%), and reported symptoms of anxiety and/or depression (65%). There were important differences with the general Spanish population.

CONCLUSIONS

XLH impacts negatively on physical functioning and HRQoL of patients. In Spanish patients with XLH, the HRQoL was reduced despite conventional treatment, clearly indicating the need to improve the therapeutic approach to this disorder.

Repeat cryoablation as a redo procedure for atrial fibrillation ablation: Is it a good choice?

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Medtronic Inc.

Introduction

Catheter ablation of atrial fibrillation, both cryoablation and radiofrequency pulmonary vein isolation, have demonstrated to be safe and effective techniques for treating symptomatic atrial fibrillation as a first procedure. However, about one in three patients may face a redo procedure due to AF recurrence. The most suitable technique for redo is unknown.

Purpose

The aim of this study is to assess the efficacy of cryoballoon AF ablation as a redo technique in patients with prior cryoballoon or radiofrequency AF ablation.

Methods

We analyzed a nation-wide real-world cryoablation registry (RECABA) and compared patients who were referred for a first cryoballoon AF ablation procedure with those who had previously undergone cryoballoon or radiofrequency pulmonary vein isolation. The primary endpoint was AF recurrence during the first year after a 3-month blanking period. We performed survival analysis and built univariate and multivariate cox regression models.

Results

From 1742 patients, 1625 had a 12-month follow-up visit. 1551 (95.45%) underwent a first cryoballoon ablation, whereas 33 (2.03%) had a previous CB ablation performed and 41 (2.52%) a previous RF ablation.

Mean age was 58.6 ±10.4 years and 511 (31.5%) were women. 463 (28.5%) had persistent atrial fibrillation and there were no major clinical differences between groups.

Prior-CB group had a higher share of veins without electrogram visualization, with a median of 100% (IQR 75%-100%), compared to prior-RF group (median 67%, IQR 25%-75%) and first procedure group (median 25%, IQR 0%-50%). Kruskal-Wallis test Chi2=54.35, p<0.0001.

12-month Kaplan–Meier estimate of freedom from AF recurrence after the blanking period was 78.5% (95% CI 76.2% - 80.7%) in the first procedure group, 61.0% (95% CI 41.4% - 75.8%) in the prior-CB and 89.2% (95% CI 73.6% - 95.9%) in the prior-RF group. Log-rank test Chi2=17.49, p<0.0001.

Multivariate cox regression analysis pointed female sex, persistent AF, and prior-CB ablation as independent predictors of AF recurrence. The adjusted HR for AF recurrence of prior-CB ablation vs first-CB ablation was 3.13 (95% CI 1.82 -5.40) and for prior-RF vs first CB-ablation was 1.01 (95% CI 0.51 – 1.97).

Conclusion

Repeat cryoballoon AF ablation shows higher rates of AF recurrences compared to first CB procedures or after prior RF ablation. These data suggest that patients with AF recurrence after CB-ablation have worse arrhythmic outcomes and may benefit from other ablation techniques after a recurrence.

Brine residues and organics in the Urvara basin on Ceres

Ceres is a partially differentiated dwarf planet, as confirmed by NASA's Dawn mission. The Urvara basin (diameter ~170 km) is its third-largest impact feature, enabling insights into the cerean crust. Urvara's geology and mineralogy suggest a potential brine layer at the crust-mantle transition. Here we report new findings that help in understanding the structure and composition of the cerean crust. These results were derived by using the highest-resolution Framing Camera images acquired by Dawn at Ceres. Unexpectedly, we found meter-scale concentrated exposures of bright material (salts) along the crater's upper central ridge, which originate from an enormous depth, possibly from a deep-seated brine or salt reservoir. An extended resurfacing modified the southern floor ~100 Myr after crater formation (~250 Myr), long after the dissipation of the impact-generated heat. In this resurfaced area, one floor scarp shows a granular flow pattern of bright material, showing spectra consistent with the presence of organic material, the first such finding on Ceres beyond the vast Ernutet area. Our results strengthen the hypothesis that Ceres is and has been a geologically active world even in recent epochs, with salts and organic-rich material playing a major role in its evolution.

Participant Outcomes of a Student-Run, Intensive, Short-Term, Task-Specific Rehabilitation Program for Individuals Post-Stroke

Stroke survivors continue to face chronic disability and limited access to early, continuous, and long-term rehabilitation. This pilot study examined the impact of a 6-day, intensive, short-term, task-specific rehabilitation program (ISTRP) on outcomes post-stroke as part of a service-learning experience (SLE) for Doctor of Physical Therapy (DPT) students. Participants (n=19) post-stroke completed a 6-day, student-led ISTRP. Outcome measures were used to assess balance, functional gait, upper extremity motor impairment, and self-reported recovery. Significant differences from pre- to post-intervention were found for all outcome measures (p<0.05) except for the Stroke-Impact Scale-16. This pilot study addresses a gap in literature and suggests an ISTRP should be further explored while integrating other allied health disciplines.

Monte Carlo simulations and phantom validation of low-dose radiotherapy to the lungs using an interventional radiology C-arm fluoroscope

PURPOSE

To use MC simulations and phantom measurements to investigate the dosimetry of a kilovoltage x-ray beam from an IR fluoroscope to deliver low-dose (0.3-1.0 Gy) radiotherapy to the lungs.

MATERIALS AND METHODS

PENELOPE was used to model a 125 kV, 5.94 mm Al HVL x-ray beam produced by a fluoroscope. The model was validated through depth-dose, in-plane/cross-plane profiles and absorbed dose at 2.5-, 5.1-, 10.2- and 15.2-cm depths against the measured beam in an acrylic phantom. CT images of an anthropomorphic phantom thorax/lungs were used to simulate 0.5 Gy dose distributions for PA, AP/PA, 3-field and 4-field treatments. DVHs were generated to assess the dose to the lungs and nearby organs. Gafchromic film was used to measure doses in the phantom exposed to PA and 4-field treatments, and compared to the MC simulations.

RESULTS

Depth-dose and profile results were within 3.2% and 7.8% of the MC data uncertainty, respectively, while dose gamma analysis ranged from 0.7 to 1.0. Mean dose to the lungs were 1.1-, 0.8-, 0.9-, and 0.8- Gy for the PA, AP/PA, 3-field, and 4-field after isodose normalization to cover ∼ 95% of each lung volume. Skin dose toxicity was highest for the PA and lowest for the 4-field, and both arrangements successfully delivered the treatment on the phantom. However, the dose distribution for the PA was highly non-uniform and produced skin doses up to 4 Gy. The dose distribution for the 4-field produced a uniform 0.6 Gy dose throughout the lungs, with a maximum dose of 0.73 Gy. The average percent difference between experimental and Monte Carlo values were -0.1% (range -3% to +4%) for the PA treatment and 0.3% (range -10.3% to +15.2%) for the 4-field treatment.

CONCLUSION

A 125 kV x-ray beam from an IR fluoroscope delivered through two or more fields can deliver an effective low-dose radiotherapy treatment to the lungs. The 4-field arrangement not only provides an effective treatment, but also significant dose sparing to healthy organs, including skin, compared to the PA treatment. Use of fluoroscopy appears to be a viable alternative to megavoltage radiation therapy equipment for delivering low-dose radiotherapy to the lungs.

Long-term follow-up of patients with Chagas cardiomyopathy living in a non-endemic area: moving towards identification of early markers of disease progression

Background

The number of patients with Chagas disease residing in Europe has increased significantly due to migration flows. Globally, Chagas cardiomyopathy has worse prognosis than other types of dilated cardiomyopathies and about 30% of patients develop cardiac involvement after a variable latency period (10–30 years). However, there is lack of data regarding the evolution of patients with Chagas disease living in a non-endemic area and potential early predictors of disease progression.

OBJETIVE

To describe the natural course of Chagas disease, the incidence rate of transformation into cardiac form and to assess if early predictors of myocardial involvement translate into a worse long-term prognosis in our non-endemic cohort.

Methods

Clinical and echocardiographic follow-up was performed in 202 individuals from endemic areas of Chagas disease. At baseline, electrocardiogram, BNP and a comprehensive echocardiography including diastolic function and longitudinal myocardial strain were performed. Four different groups were defined: healthy controls (N=77); Chagas indeterminate form (positive serology, normal ECG and left ventricle (LV) dimensions and LV ejection fraction (&gt;50%) and no segmental abnormalities, N=92); Chagas patients with abnormal ECG but normal LV dimensions and motility (N=15); and Chagas patients with LV diameter&gt;55 mm or LV ejection fraction&lt;50% or segmental abnormalities (N=18). The primary clinical outcome included advanced atrioventricular block, sustained ventricular tachycardia, heart failure, heart transplant, death or progression of cardiac disease defined as LV systolic dysfunction or new segmental abnormalities. Kaplan Meier with Long rank test and Cox regression analysis was used.

Results

Mean age was 37±9 and 34% were male. Median follow-up was 69 months (range 1 to 147). The primary endpoint occurred in a total of 17 (8.4%) individuals: 5 (5.4%) in the Indeterminate group; 3 (20%) in the abnormal ECG group; and 9 (50%) in the group with abnormal LV dimension or motility, with no events among controls (long-rank test&lt;0.01, Figure 2). Six patients evolved from the indeterminate phase to cardiac involvement (2 with isolated ECG changes and 4 with abnormal echocardiography without previous changes in ECG (Figure 1). On echocardiography, there were no differences regarding changes in LV dimensions or LV ejection fraction between Chagas patients with normal baseline echo and controls, but a significantly reduction of Em was observed (−1.6±3.0 vs. 0.2±1.0) in the former. Excluding patients with abnormal echo at baseline, BNP (HR=1.03, p=0.001), Em (HR=0.78, p=0.05) and left atrial diameter (1.23, p=0.01) were predictors of the combined event.

Conclusions

Conversion from the indeterminate to Chagas cardiomyopathy in our cohort was approximately 1.1%/year, but it may happen directly with contractility disturbances. BNP and comprehensive echocardiography may help to early detect disease progression.

Figure 1. Distribution of patients and KM curves

Funding Acknowledgement

Type of funding source: None

Relationship between episodes of unsustained VTs detected early after an ICD implant and subsequent monomorphic VTs causing appropriate therapy

Introduction

Non-sustained ventricular tachycardias (NSVT) are observed frequently among ICD patients with left ventricular dysfunction (LVD).

Purpose

To analyze the relationship between episodes of NSVTs and monomorphic VTs (MVTs) that subsequently cause appropriate therapies.

Methods

416 ICD patients with LVD (LVEF &lt;45%) followed for 41±27 months. ICD programming (detection and therapies) was standardized. NSVT was defined as any VT of ≥5 beats which did not met the detection criteria occurring within the first 6 months after ICD implant. We analyzed 2201 NSVTs (10+7 beats), which occurred in 250 of the 416 patients (Median=2; IQR=0–7). The mean cycle length (CL) of NSVT was 323±32 ms (adjusted per multiple episodes/patient, generalized estimating equation method (GEEM)).

Results

During the follow-up, 1441 MVT occurred in 183 patients. After showing a significant correlation between burden of NSVT and the occurrence of appropriate therapies due to MVT (C coefficient=0.68; p&lt;0.001), we observed that subjects with &gt;5 NSVT presented an excess of adjusted risk: HR=1.97 (95% CI=1.45–2.72); p&lt;0.001. However, the adjusted mean CL of NSVTs was similar in patients with (322±34) vs. without MVT (324±26 ms); p=0.3.

Among patients who presented NSVTs and MVTs (n=145 subjects), we analyzed the relationship between the adjusted mean CL of the NSVTs (n=1288 episodes) and the CL of the first appropriate therapy due to MVT occurring subsequently. We found a significant and positive correlation between the two (r=0.88; p&lt;0.001); the strongest correlation was observed in subjects with &gt;5 NSVTs (r=0.97, n=52)). The robustness of such correlation was similar in individuals with ischemic (r=0.86; n=91) versus non-ischemic cardiomyopathy (r=0.90; n=54), and in primary (r=0.86; n=75) versus secondary prevention (r=0.90; n=70). The agreement between the CL of first MVT and the adjusted mean CL of NSVT episodes (GEEM) was determined according to the Bland-Altman Method. The difference between the two values was 2±8.3 ms, with only 7.6% (11/145) of patients in whom the difference between the two CL was outside the concordance limits. The agreement was greater, again, in individuals with &gt;5 NSVTs. As shown in the Figure, in more than 95% of patients both values were within the interval of agreement (0.32±4 ms).

Conclusions

1-The burden of NSVTs occurring early after an ICD implant, but not their CL, is associated with a higher incidence of appropriate therapies due to MVT at follow-up.

2-The CL of the NSVTs and that of the first and subsequent MVTs is virtually the same in patients with higher NSVT burden. Therefore, it could be the same tachycardia, but with different duration.

Figure 1

Funding Acknowledgement

Type of funding source: None

Implication of heat shock proteins in rotavirus entry into Reh cells

The mechanisms of rotavirus entry into the target cell are described as a multi-step event in which the virions are bound to sialic acid (SA), followed by interaction with heat shock cognate protein 70 (Hsc70), some integrins and protein disulfide isomerase (PDI). However, the cell surface receptor molecules facilitating the entry of tumor cell-adapted rotavirus are not completely characterized. Using infection blocking assays with antibodies to some heat shock proteins (HSPs) and also some inhibitors of these cellular proteins, we were able to identify the cell surface Hsp90, Hsp70, Hsc70, Hsp60, Hsp40, PDI and integrin β3 as receptors of tumor cell-adapted rotavirus in Reh cells. Furthermore, the results also indicated that these rotavirus receptors are associated with lipid microdomains (rafts). Our findings provide evidence that rotavirus tropism for these human acute lymphocytic leukemia cells is explained by the relatively high expression of some HSPs in rafts. The results shown here encourage further research aim at evaluating the potential use of rotaviruses as an oncolytic agent for the treatment of some cancers. Keywords: heat shock proteins; rotavirus; cell receptor; cancer; oncolytic virus.

Design and microfabrication strategies for thin-film, flexible optical neural implant

Advanced polymer science and design technologies are constantly evolving to meet ever-growing expectations for flexible optical MEMS. In this work, we present design and microfabrication considerations for designed flexible Polymeric Opto-Electro-Mechanical Systems (POEMS). The presented methods integrate waveguide fabrication and laser diode (LD) chip assembly with Lawrence Livermore National Laboratory's (LLNL's) flexible thin-film technology to enable LLNL's first neural optoelectrode that can deliver guided light for neural activation. We support our findings with electrical and optical bench verification tests, present thermal simulation models to analyze heat dissipation of laser light sources on polymer substrates and discuss potential modifications for next generation prototypes. This fully integrated approach will allow spatial precision, scalability and more particularly, longer lifetime, needed to enable chronic studies of brain activities.

SAT0567 USE OF THERMOGRAPHY OF HANDS AND MACHINE LEARNING TO DIFFERENTIATE PATIENTS WITH ARTHRITIS FROM HEALTHY SUBJECTS

Background:

The early diagnosis of rheumatic diseases improves their prognosis. However, patients take several months to reach the rheumatologist from the beginning of the first symptoms. Thermography is a safe and fast technique that captures the heat of an object through infrared photography. The inflammation of the joints causes an increase in temperature and, therefore, can be measured by thermography. Machine learning methods have shown that they are capable of analyzing medical images with an accuracy similar or superior to that of a healthcare professional.

Objectives:

Develop an algorithm that, based on thermographic images of hands and machine learning, differentiates healthy subjects from patients with rheumatoid arthritis (RA), psoriatic arthritis (PA), undifferentiated arthritis (UA) and arthritis of hands secondary to other diseases (SA).

Methods:

Multicenter observational study conducted in the rheumatology and radiology service of two hospitals. Patients with RA, PA, UA and SA who attended the followup visit and healthy subjects (companions and healthcare proffesionals) were recruited. In all cases, a thermal image of the hands was taken using a Flir One Pro or Thermal Expert TE-Q1 camera connected to the mobile and an ultrasound of both hands. The degree of synovial hypertrophy (SH) and power doppler (PD) was assessed for each joint (score from 0 to 3). Inflammation was defined as the presence of SH> 1 or PD> 0. Machine learning was used to classify patients with RA, PA, UA and SA with inflammation evidenced by ultrasound and healthy subjects from thermographic images. The evaluation of the classifier was performed by leave-one-out cross-validation and the area under the ROC curve (AUCROC) in those subjects whose thermal image was performed with the Thermal Expert TE-Q1 camera. The study was approved by the Clinical Ethics and Research Committee of the centers.

Results:

500 subjects were recruited from March 2018 to January 2020, of these 73 were excluded due to poor quality in the thermal image (moved or absence of temperature contrast between hand and background). Of the 427 subjects analyzed, 129 corresponded to healthy subjects, 138 to patients without evidence of inflammation and 160 to patients with inflammation evidenced by ultrasound (116 RA and 44 PA, UA or SA). Of these, 42% were taken using the Thermal Expert TE-Q1 camera. An AUCROC of 0.73 (p-value <0.01) was obtained for the healthy classifier vs RA and 0.72 (p-value <0.01) for the healthy classifier vs PA, UA and SA.

Conclusion:

A classification model has been developed capable of differentiating patients with RA, PA, UA and SA with evidence of inflammation from healthy subjects. These results open an opportunity to develop tools that facilitate early diagnosis.

References:

[1]Barhamain AS, Magliah RF, Shaheen MH, Munassar SF, Falemban AM, Alshareef MM, Almoallim HM. The journey of rheumatoid arthritis patients: a review of reported lag times from the onset of symptoms. Open Access Rheumatol. 2017 Jul 28;9:139-150. doi: 10.2147/OARRR.S138830. eCollection 2017. Review.

[2]Lynch CJ, Liston C. New machine-learning technologies for computer-aided diagnosis. Nat Med. 2018 Sep;24(9):1304-1305. doi: 10.1038/s41591-018-0178-4.

[3]Brenner M, Braun C, Oster M, Gulko PS. Thermal signature analysis as a novel method for evaluating inflammatory arthritis activity. Ann Rheum Dis. 2006 Mar;65(3):306-11.

Disclosure of Interests:

None declared

P2879Effectiveness of first versus subsequentes ATP attemps: predictors and clinical consequences

Introduction

Antitachycardia pacing (ATP) terminates the majority (but not all) of slow VTs (S-VT) with a cycle length (CL) >320 ms.

Purpose

To analyze the efficacy, safety and predictors of ATP, comparing the first (ATP-1) to the second (ATP-2) and third (ATP-3) attempts.

Methods

We studied 556 S-VT (CL=354±18 ms; range: 321–415 ms; 1.6% syncopes) occurring in 67 patients. ATP programming was standardized, including three consecutive bursts of 15 pulses at 91% of VT CL.

Results

ATP effectiveness declined significantly from ATP-1 (436/556: 78%) compared to ATP-2 (24/103: 23%) and ATP-3 (10/79: 13%), p<0.01 for all comparisons. The percentage of variation of RR intervals (P-RR, %) was significantly higher prior to effective ATP-1 (2.73±1.45 vs 1.23±0.9; p<0.001). After an ineffective ATP-1, the P-RR decreased dramatically, with no differences between episodes terminated or not at ATP-2 (0.6±0.14 vs 0.44±0.16; p=0.6) or ATP-3 (0.54±0.15 vs. 0.52±0.14; p=0.7). The postpacing interval – CL difference (PPI-CLd) after an unsuccessful ATP-1 was shorter in episodes terminating at ATP-2 or ATP-3 (180±24 vs 211±15 ms; p<0.001) being 200 ms the cut-off point with the best sensitivity and specificity for non-effective ATP-2 and ATP-3 (93% and 74%, respectively). By multivariate analysis, the duration of native QRS complex (dQRS) (ms) was found the only independent predictor of a PPI-CLd ≥200 ms (OR=1.04; p=0.003). The best cutoff point of dQRS for PP-CLd ≥200 ms was 120 ms (sensitivity and specificity of 66% and 79%, respectively).

Several predictors of ATP efficacy were found by logistic regression: a) ATP-1: P-RR (OR=7.3; p<0.001), beta-blockers (OR=4.1; p<0.001) and dQRS (OR=0.95; p<0.001); b) ATP-2: PPI-CLd (OR=0.94; p=0.001) and dQRS (OR=0.96; p=0.04); c) ATP-3: PPI-CLd (OR=0.93; p=0.009).

Patients with a dQRS≥120 ms had a lower adjusted effectiveness of ATP and a higher proportion of S-VT causing syncope. Table.

Table 1 Patients with QRS <120 ms Patients with QRS ≥120 ms p value Adjusted effectiveness of ATP-1 89% (82–96) 70% (59–80) 0.008 Adjusted effectiveness of ATP-2 47% (32–63) 23% (11–35) 0.036 Adjusted effectiveness of ATP-3 18% (3–33) 3% (0–6) 0.003 Adjusted incidence of syncope due to S-VT 0.18% (0–0.6) 4.1% (2.1–6.1) 0.025 Values are expressed as mean (95% CI). Generalized Estimating Equations Method.

Conclusions

The efficacy of ATP in terminating S-VT is mainly due to the ATP-1. The regularization of RR intervals after ineffective ATP-1 underlies the lower efficacy of ATP-2 and ATP-3. Since the dQRS correlated significantly with the PPI-CLd, patients with a dQRS≥120 ms had a lower ATP-1, ATP-2 and ATP-3 effectiveness, leading to a higher incidence of syncope.

P2874Predictors of Electrical Strom among ICD patients: the importance of the burden of non-sustained VTs

Background

Among ICD patients, the burden of non-sustained ventricular tachycardias (NSVT) occurring during the first 6 months after implant is associated independently with an increase in cardiac death. It is unknown whether there are differences between the incidence of Electrical Storm (ES) and the cause of cardiac mortality (CM) according to the burden of NSVT.

Purpose

To determine the relationship between the burden of NSVT occurring early after ICD implant and the risk of ES in the long-term among ICD patients with left ventricular dysfunction.

Methods

In this prospective study, 416 patients (age: 65±11; LVEF: 30±8; ischemic etiology: 62%, primary prevention: 63%) with LVEF <45% and ICD without cardiac resynchronization therapy were followed-up for 41±27 after implant. ICD programming was standardized. NSVT was defined as any ventricular tachyarrhythmia with >5 beats at ≥150 bpm terminating spontaneously before therapy that occurred within the first six months after ICD implant.

Results

A total of 31 patients (7.5%) presenting with ES during the follow-up. After classifying the subjects into three groups according to the burden of NSVT (tertiles): no NSVT (N=166, group 1); 1–5 NSVT (n=130, group 2) and >5 NSVT (n=120, group 3), the cumulative incidence of ES was higher in group 3: 2.4% vs. 3.1% vs. 19.2%, with an average of time from implant to ES significantly shorter (mean [95% CI, months]): 97 (94–100) vs. 103 (99–106) vs. 86 (79–93); p<0.001 for groups 1–2 vs. 3 (log-rank test). Figure. All ESs were due to monomorphic VT in individuals with ≤5 NSVT; however, 19% of ESs were caused by polymorphic VT or VF among patients with >5 NSVT (p<0.05). By multivariate analysis (Cox-regression), LVEF, % (HR=1.06; p=0.026) and >5 TVNS (HR=4.66; p=0.001) were identified as independent predictors of ES. Cardiac mortality (CM) was independently higher in subjects with >5 NSVT (HR=1.7; p=0.03). The most frequent cause of CM was cardiac failure irrespective of NSVT burden (93% in patients with ≤5 NSVT and 79% in >5 NSVT); however CM due to ES was exclusive of individuals with >5 NSVT: 15% vs. 0% (p<0.05).

Figure 1

Conclusions

1. The burden of NSVT occurring during the first 6 months after an ICD implant is associated independently with a higher risk of ES in the long-term. 2. The adjusted risk of ES is 4-fold higher in individuals with >5 NSVT. 3. The most frequent etiology of CM is heart failure; CM due to ES is exclusive of patients with >5 NSVT causing the 15% of deaths in such population.

P1810May early myocardial involvement detection in chagas disease have a prognosis impact?

Background

Brain natriuretic peptide (BNP) and novel echocardiographic techniques such as speckle-tracking and a comprehensive evaluation of diastolic function can detect early myocardial involvement in patients with Chagas disease. However, there is lack of longitudinal studies that can confirm whether this early myocardial involvement translates into a worse prognosis.

Purpose

To assess if early myocardial involvement detected by BNP or a comprehensive echocardiographic evaluation was associated with future events in Chagas disease.

Methods

182 consecutive individuals from endemic areas who underwent T. cruzi screening where prospectively included from 2007 to 2014. ECG, BNP and a comprehensive echocardiography including diastolic function and longitudinal myocardial strain were performed. Four different groups were defined: healthy controls (N=77); Chagas indeterminate form (positive serology, normal ECG and left ventricle (LV) diameter (<55 mm), LV ejection fraction (>50%) and no segmental abnormalities, N=88); Chagas patients with abnormal ECG but normal LV dimensions and motility (N=7); and Chagas patients with LV diameter>55 mm or LV ejection fraction<50% or segmental abnormalities (N=13). The primary outcome included advanced atrioventricular block, sustained ventricular tachycardia, heart failure, heart transplant or death. Kaplan Meier with Long rank test and Cox regression analysis was used.

Results

Mean age was 37±9 and 34% were male. Median follow-up was 63 months (range 1 to 137). The primary endpoint occurred in a total of 11 (10%) individuals: 2 (2.4%) in the Indeterminate group; 3 (43%) in the abnormal ECG group; and 6 (46%) in the group with abnormal LV dimension or motility, with no events among controls (long-rank test<0.01, Figure). In the global population, age, BNP, diastolic dysfunction parameters and longitudinal strain at the inferior and lateral walls were significant predictors. In the cohort of Chagas patients with normal standard echocardiography (N=92), ECG abnormalities (HR=49, p=0.001), Em (HR=0.68, p=0.03), deceleration time (HR=0.01, p=0.01), left atrial diameter (HR=1.24, p<0.01) and longitudinal strain at the midventricular lateral wall (HR=0.75, p=0.028) remained significantly associated with outcome.

Cumulative survival without events

Conclusions

Outcome was significantly more frequent in Chagas patients with abnormalities in ECG or standard echocardiography. In early forms of the disease, myocardial involvement detected by BNP or a comprehensive echocardiography was associated with prognosis, and may help to individualize treatment and follow-up.

Evaluation of the intraoperative human papillomavirus test as a marker of early cure at 12 months after electrosurgical excision procedure in women with cervical high-grade squamous intraepithelial lesion: a prospective cohort study

OBJECTIVE

To evaluate if the intraoperative human papillomavirus (IOP-HPV) test has the same prognostic value as the HPV test performed at 6 months after treatment of high-grade squamous intraepithelial lesion (HSIL) to predict treatment failure.

DESIGN

Prospective cohort study.

SETTING

Barcelona, Spain.

POPULATION

A cohort of 216 women diagnosed with HSIL and treated with loop electrosurgical excision procedure (LEEP).

METHODS

After LEEP, an HPV test was performed using the Hybrid Capture 2 system. If this was positive, genotyping was performed with the CLART HPV2 technique. The IOP-HPV test was compared with HPV test at 6 months and with surgical margins.

MAIN OUTCOME MEASURE

Treatment failure.

RESULTS

Recurrence rate of HSIL was 6%. There was a strong association between a positive IOP-HPV test, a positive 6-month HPV test, positive HPV 16 genotype, positive surgical margins and HSIL recurrence. Sensitivity, specificity, and positive and negative predictive values of the IOP-HPV test were 85.7, 80.8,24.0 and 98.8% and of the HPV test at 6 months were 76.9, 75.8, 17.2 and 98.0%.

CONCLUSION

Intraoperative HPV test accurately predicts treatment failure in women with cervical intraepithelial neoplasia grade 2/3. This new approach may allow early identification of patients with recurrent disease, which will not delay the treatment. Genotyping could be useful in detecting high-risk patients.

TWEETABLE ABSTRACT

IOP-HPV test accurately predicts treatment failure in women with CIN 2/3.

From big flow cytometry datasets to smart diagnostic strategies: The EuroFlow approach

The rise in the analytical speed of mutiparameter flow cytometers made possible by the introduction of digital instruments, has brought up the possibility to manage progressively higher number of parameters simultaneously on significantly greater numbers of individual cells. This has led to an exponential increase in the complexity and volume of flow cytometry data generated about cells present in individual samples evaluated in a single measurement. This increase demands for new developments in flow cytometry data analysis, graphical representation, and visualization and interpretation tools to address the new big data challenges, i.e. processing data files of ≥10-25 parameters per cell in samples with >5-10 million cells (= up to 250 million data points per cell sample) obtained in a few minutes. Here, we present a comprehensive review of some of the tools developed by the EuroFlow consortium for processing flow cytometric big data files in diagnostic laboratories, particularly focused on automated EuroFlow approaches for: i) identification of all cell populations coexisting in a sample (automated gating); ii) smart classification of aberrant cell populations in routine diagnostics; iii) automated reporting; together with iv) new tools developed to visualize n-dimensional data in 2-dimensional plots to support expert-guided automated data analysis. The concept of using reference data bases implemented into software programs, in combination with multivariate statistical analysis pioneered by EuroFlow, provides an innovative, highly efficient and fast approach for diagnostic screening, classification and monitoring of patients with distinct hematological and immune disorders, as well as other diseases.

Effect of imidacloprid ingestion on immune responses to porcine reproductive and respiratory syndrome virus

Nicotine and acetylcholine cause immunosuppresion by signaling to the α7 nicotinic acetylcholine receptor (α7 nAChR) on immune cells. Neonicotinoids are nAChR agonists and widly used insecticides. We aimed to define the immunosuppressive potential of dietary exposure to the neonicotinoid imidacloprid (IMI) on the generation of innate and adaptive immune responses to porcine reproductive and respiratory syndrome virus (PRRSV). Piglets were randomized into groups based on diet and infection. Behavioral signs of illness were recorded. Urine IMI levels were measured by high performance liquid chromatography-mass spectrometry. Flow cytometry was used to determine the expression pattern of the α7 nAChR on porcine leukocytes as well as the effects of infection and treatment on circulating leukocyte populations. Serum cytokines and PRRSV-specific antibody levels were determined by ELISA. Viral RNA in lung, spleen and plasma was determined by RT-qPCR. Pigs in the treatment group had elevated urine levels of IMI. Treatment with IMI reduced body weight, caused bouts of hypothermia, increased serum IL-10 and elevated levels of virus-specific antibodies. Viral RNA levels in the spleen showed a trend toward being increased in pigs fed IMI. Our data indicates that IMI injection may modulate virus specific immune function during PRRSV infection.

Invasive Methicillin-Resistant Staphylococcus aureus USA500 Strains from the U.S. Emerging Infections Program Constitute Three Geographically Distinct Lineages

USA500 isolates are clonal complex 8 (CC8) Staphylococcus aureus strains closely related to the prominent community- and hospital-associated USA300 group. Despite being relatively understudied, USA500 strains cause a significant burden of disease and are the third most common methicillin-resistant S. aureus (MRSA) strains identified in the U.S. Emerging Infections Program (EIP) invasive S. aureus surveillance. To better understand the genetic relationships of the strains, we sequenced the genomes of 539 USA500 MRSA isolates from sterile site infections collected through the EIP between 2005 and 2013 in the United States. USA500 isolates fell into three major clades principally separated by their distribution across different U.S. regions. Clade C1 strains, found principally in the Northeast, were associated with multiple IS256 insertion elements in their genomes and higher levels of antibiotic resistance. C2 was associated with Southern states, and E1 was associated with Western states. C1 and C2 strains all shared a frameshift in the gene encoding AdsA surface-attached surface protein. We propose that the term "USA500" should be used for CC8 strains sharing a recent common ancestor with the C1, C2, and E1 strains but not in the USA300 group.IMPORTANCE In this work, we have removed some of the confusion surrounding the use of the name "USA500," placed USA500 strains in the context of the CC8 group, and developed a strategy for assignment to subclades based on genome sequence. Our new phylogeny of USA300/USA500 will be a reference point for understanding the genetic adaptations that have allowed multiple highly virulent clonal strains to emerge from within CC8 over the past 50 years.

Examination of synovial fluid and serum following intravenous injections of hyaluronan for the treatment of osteoarthritis in dogs

A randomized, blinded, prospective clinical trial was performed to determine the effects of intravenous (IV) administration of hyaluronan sodium (HA) on serum glycosaminoglycans (GAG) concentrations, synovial fluid (SF) hyaluronan concentrations and viscosity in dogs treated for unilateral rupture of the cranial cruciate ligament. Twenty-two dogs undergoing tibial plateau leveling osteotomy were used in this study. Synovial fluid from both stifles and serum were collected prior to surgery and at 2, 4, and 8 weeks following surgery. Dogs received either 1.0 ml (10 mg) of sodium hyaluronate (treatment group 1; n = 10) or equal volume of 0.9% NaCl (treatment group 2; n = 12), IV immediately, 2 and 4 weeks following surgery. Synovial fluid viscosity was evaluated using a magnetically driven, acoustically tracked, translating-ball rheometer. Synovial fluid HA disaccharide content was measured by fluorophore-assisted carbohydrate electrophoresis. Serum GAG concentrations were measured by alcian blue spectrophotometric assay. Data were analyzed using a Wilcoxon sign rank test (p<0.05). Mean ± SD viscosity (cP) was significantly higher (p=0.011) in SF obtained from the intact stifle (450 ± 604.1) than injured (54.8 ± 60.8) prior to surgery. Mean ± SD HA concentrations (ug/ml) were significantly higher (p=0.02) in synovial fluid obtained from the injured stifles (281.4 ± 145.9) than intact stifles (141.6 ± 132.5). No significant difference was noted within or between treatment groups in SF viscosity, HA concentrations, or serum GAG concentrations at any time following surgery. Stifles with cranial cruciate ligament insufficiency had significant alterations in SF viscosity and HA concentrations.

Comparison of surrogate indices for insulin sensitivity with parameters of the intravenous glucose tolerance test in early lactation dairy cattle

The aim of this study was to investigate the correlation between different surrogate indices and parameters of the intravenous glucose tolerance test (IVGTT) in dairy cows at the start of their lactation. Ten dairy cows underwent IVGTT on Days 3 to 7 after calving. Areas under the curve during the 90 min after infusion, peak and nadir concentrations, elimination rates, and times to reach half-maximal and basal concentrations for glucose, insulin, nonesterified fatty acids, and β-hydroxybutyrate were calculated. Surrogate indices were computed using the average of the IVGTT basal samples, and their correlation with the IVGTT parameters studied through the Spearman's rank test. No statistically significant or strong correlation coefficients (P > 0.05; |ρ| < 0.50) were observed between the insulin sensitivity measures derived from the IVGTT and any of the surrogate indices. Therefore, these results support that the assessment of insulin sensitivity in early lactation cattle cannot rely on the calculation of surrogate indices in just a blood sample, and the more laborious tests (ie, hyperinsulinemic euglycemic clamp test or IVGTT) should be employed to predict the sensitivity of the peripheral tissues to insulin accurately.