POS0953 IMPACT OF A WEARABLE ACTIVITY TRACKER ON DISEASE ACTIVITY IN SPONDYLOARTHRITIS: A RANDOMIZED CONTROLLED TRIAL

Background

Other studies have shown the ability of a wearable activity tracker (TAP) to improve physical activity (PA) in different rheumatic diseases. Given the importance of PA in spondyloarthritis, our hypothesis is that the use of a TAP could improve physical activity and thus disease activity.

Objectives

The purpose of this study is to evaluate the impact of a TAP used to encourage PA on disease activity in patients with spondyloarthritis.

Methods

In this randomized controlled trial consisting of three 12-week stages (Figure 1). Patients with spondyloarthritis were randomized to a group with TAP (GT), or a group without TAP (GST). For the first stage, both groups received physical activity counseling. In the second 12-week stage, no patients received TAP. In the third 12-week stage, all patients received supervised PA combined with TAP for GT only. Disease activity, performance (assessed by the TM6 6-minute walk test), and quality of life (assessed by the Short Form 36 Health Survey Questionnaire [SF-36]) were assessed at 12, 24, and 36 weeks. The primary endpoint was the progression of relapses between baseline and 12 weeks.

Figure 1.

Results

A total of 108 patients were included in the study. At 12 weeks, both groups showed a non-significant improvement in the number of relapses: mean change (Δ), -0.32 [95% CI-0.68;60.09] in GT and Δ, -0.38 [95% CI-0.68;60.09] in GST. But, differences in outcome between groups were not significant (p=0.87). The TM6 was improved in the GT and GST groups at 12, 24, and 36 weeks (p < 0.01, and p < 0.001, respectively). We observed improvement in different dimensions of the SF36, mainly in physical function, emotional role, general health, and physical pain at 12 weeks (p < 0.01).

Multivariate analysis showed improvement over time in performance (p < 0.01) and moderate flare-ups (p < 0.01) without the influence of a PAR (p = 0.29, and p = 0.66, respectively).

Conclusion

To our knowledge, our study is the first to explore the impact of TAP use on disease activity in spondyloarthritis.

We observed an improvement in disease activity, physical performance and quality of life without significant difference between the two groups. The lack of difference could be explained by the encouragement of physical activity to both groups. But also by the fact that our patients presented a significant number of severe relapses. Indeed, authors have shown the limits of the use of TAP in severe diseases, particularly in pulmonary pathologies [1].

Our study did not show any effect of the use of a connected object on disease activity. However, this study confirmed the benefits of physical activity on disease activity, quality of life and physical performance in patients with spondyloarthritis.

References

[1]Bentley CL, Powell L, Potter S, et al. The use of a smartphone app and an activity tracker to promote physical activity in the management of chronic obstructive pulmonary disease: randomized controlled feasibility study. J.M.I.R. MHealth UHealth 2020;8:e16203. https://doi.org/10.2196/16203.

Disclosure of Interests

Guillaume Labat: None declared, Meggy Hayotte: None declared, Olilvier Brocq: None declared, laurent bailly: None declared, Roxane fabre: None declared, manuella Fournier: None declared, Véronique Breuil: None declared, fabienne d’arripe longueville: None declared, Christian Roux Speakers bureau: Pfizer, BMS, Novartis, Lilly, Grant/research support from: Novartis and Lilly

Cancer incidence in the vicinity of a waste incineration plant in the Nice area between 2005-2014

Introduction

Few studies on cancer incidence have been conducted since the EU 2000/76/EC Waste incineration directive.

Objective

To measure cancer incidence among the population exposed to atmospheric emissions from the Ariane waste incineration plant near Nice, in the Alpes-Maritimes (AM), compared to the unexposed AM population.

Methods

All primary invasive cancers and malignant haematological conditions diagnosed among AM residents from 01/01/2005 to 31/12/2014 recorded by the CRISAPPACA Cancer Observatory, public and private hospitals and the ONCOPACA-Corsica Network were included. The exposed area, based on an average dioxin deposition model, was that with a concentration ≥4.25ng/m2/year. Each case was geolocated and assigned to a predefined geographic unit (IRIS): 36 units in the exposed area, 462 in the unexposed area. The adjusted incidence rate, the standardized incidence ratio (SIR) and the Comparative Morbidity Figure (CMF) were calculated for two periods: 2005-2009/2010-2014.

Results

We recorded 80,865 new cancers in the AM population (1,083,974 residents; 87,462 exposed). For the 2005-2009 period, among exposed women, excess SIR were recorded of acute myeloid leukaemia (SIR = 1.81 [1.03-2.93]), myelodysplastic syndromes (SIR = 2.58 [1.70-3.76]) and myeloma (SIR = 1.64 [1.09-2.37]); in exposed men, of soft tissue sarcomas (SIR = 1.65 [1.05-2, 48]), myeloma (SIR = 2.04 [1.39-2.90]) and lung cancer (SIR = 1.19 [1.03-1.36]). For the 2010-2014 period, there was no excess SIR among women, while among men an excess SIR of myeloma (SIR = 1.76 [1.21-2.47]) and lung cancer (SIR = 1.24 [1.08-1.41]) was observed.

Conclusions

The higher incidence of myeloma and lung cancer in both periods can be explained by their long latency and by other risk factors. The EU Directive appears to have resulted in limiting atmospheric emissions from the incinerator.

Study funded by the Nice Côte d’Azur Metropolis and with the support of the South-PACA Regional Health Agency.

Key messages

Few studies on cancer incidence have been conducted since the EU 2000/76/EC Waste incineration directive. The EU Directive appears to have resulted in limiting atmospheric emissions from the incinerator.

BiCl3-Mediated direct functionalization of unsaturated C–C bonds with an electrophilic SCF2PO(OEt)2 reagent

A general access to challenging and unprecedented C(sp)–, C(sp²)– and C(sp³)–SCF₂PO(OEt)₂ bonds via a BiCl₃ mediated transformation.

Impact of improved urban environment and coaching on physical condition and quality of life in elderly women: a controlled study

BACKGROUND

Physical activity can slow the ageing process and preserve autonomy in the elderly. The aim of this study was to assess the combined impact of an organized urban walking circuit and individual coaching on women senior citizens' physical well-being and quality of life.

METHODS

Insufficiently physically active women >65 years were included in a quasi-experimental trial. Active arm: District with improved urban environment (IUE). Control arm: District without improved urban environment (WIUE). In each district, subjects were randomly allocated to receive coaching (C+ vs. C-). The main outcome measures were endurance, physical activity score, flexibility, quality of life, physical self-esteem, ageing exercise stereotypes, functional health and perceived health at baseline, three (M3) and six (M6) months.

RESULTS

Fifty-two insufficiently physically active women were included, 23 in IUE and 29 in WIUE. Groups were comparable at baseline. At M3, endurance and physical activity score significantly improved compared with baseline in the IUE group and in the C+ group while no statistically significant change was observed for the WIUE group and the C- group. Moreover, endurance score was higher in the IUE group, whether coupled with coaching or not. After the coaching was removed, the IUE group regresses to baseline overall and the WIUE shows a decrement in endurance.

CONCLUSION

Our study highlights the positive impact of an improved environment and of individual coaching on the level of physical activity and quality of life of insufficiently physically active elderly women.

Are dietary reports in a case-control study on thyroid cancer biased by risk perception of Chernobyl fallout?

BACKGROUND

In retrospective case-control studies performed following nuclear tests or nuclear accidents, individual thyroid radiation dose reconstructions are based on fallout and meteorological data from the residential area, demographic characteristics, and lifestyle as well as dietary information. Collecting the latter is a controversial step, as dietary declarations may be affected by the subjects' beliefs about their risk behavior. This report analyses the potential for such bias in a case-control study performed in eastern France.

METHODS

The study included 765 cases of differentiated thyroid carcinoma matched with 831 controls. Risk perceptions and beliefs of cases and controls were compared using Chi² tests and differences in dietary reports were analyzed using a two-way ANOVA.

RESULTS

In general, atmospheric pollution and living near a nuclear power plant were the two major risks that may influence thyroid cancer occurrence cited by cases and controls. When focusing in particular on the consequences of the Chernobyl accident, cases were more likely to think that the consequences were responsible for thyroid cancer occurrence than controls. Vegetable consumption during the two months after the Chernobyl accident was correlated with the status of subjects, but not to their beliefs. Conversely, consumption of fresh dairy products was not correlated with the status or beliefs of subjects.

CONCLUSION

We found no evidence of systematic bias in dietary reports according to the status or beliefs held by subjects about the link between thyroid cancer occurrence and Chernobyl fallout. As such, these dietary reports may be used in further studies involving individual dosimetric reconstructions.

Indirect Comparison of Two Quantitative Immunochemical Faecal Occult Blood Tests in a Population with Average Colorectal Cancer Risk

Magstream and OC Sensor quantitative immunochemical faecal occult blood tests (IFOBT) have shown better performances than guaiac (G) tests in colorectal cancer screening, however Magstream and OC Sensor have never been compared. We hypothesized that similar performances could be observed with Magstream and OC Sensors, provided a similar cut-off (expressed in concentration of haemoglobin in the stools) is used. We performed a literature-based indirect comparison between these tests, taking into account the cut-off, the number of samples, and the way they were combined (I2+: at least one positive sample of 2; I2++: both positive samples; I1: only one sample). Six studies conducted in general average-risk populations were included in this review. For each [test]*[cut-off], positivity rate (PR) decreased and predictive positive value (PPV) increased from I2+ to I1 and I2++. For similar PR, PPV with OC Sensor was greater than with Magstream. This could be due to factors other than the test, because PPVs associated with GFOBT in studies evaluating OC Sensor were greater than PPVs associated with GFOBT in the study evaluating Magstream. Direct comparison between Magstream and OC Sensor is needed to confirm the suspected superiority of OC Sensor.

[Screening digital mammography: one year result for the Alpes-Maritimes region]

PURPOSE

After one year of experience with screening digital mammography, the results of this technique (n=9640) are compared to screen-film mammography (n=240 376) with double reading.

METHODS

Evaluation for each technique of the rate of call-back, positive results before and after work-up by the first reader and distribution based on the BI-RADS classification by the ACR, rate of complementary US, detected abnormalities (microcalcifications) and detected cancers.

RESULTS

The rate of positive mammograms was significantly higher for the digital technique (17.3% versus 15.1%) because of the first reader (16.3% versus 13.9%) whereas it was significantly lower after complementary work-up (3% versus 3.7%). The rate of BI-RADS 0 was significantly higher with digital imaging irrespective of patient age. The rate of US was higher for type 1 and 2 breasts at digital imaging (46% versus 36%, p<0.0001) while the reverse was true for denser breasts (49% versus 54%; p:0.0005). More microcalcifications were detected on digital imaging (24.4% versus 21.8%) without impact on the rate of DCIS and invasive carcinomas. The rate of cancers detected with both technique were identical.

CONCLUSION

The increased number of positive results at first reading and increased number of US for digital mammography may relate to a learning curve and difficulties in comparing with prior examinations. These results should continuously be monitored and compared to national averages.

Activité de consultation de trois services de dermatologie hospitalo-universitaires français

BACKGROUND

We recently carried out a study concerning consultations by French dermatologists in private practice. We evaluated consultations at the dermatology departments of 3 university teaching hospitals in France.

MATERIALS AND METHODS

This was a 2-month prospective study conducted in 2003 at the dermatology departments of the university teaching hospitals of Amiens, Lille and Rouen. Each consultant completed a questionnaire covering the duration of the study. The following data were recorded: consultation date, function of the consultant, study centre, type of consultation, type of disease, and whether or not the patient was hospitalised after the consultation.

RESULTS

7296 files were examined during the study. 38% of the consultations were performed by part-time hospital consultants, 29% by dermatology interns, 18% by hospital practitioners, 9% by university professors and 6% by clinical heads or assistant heads. The most commonly encountered diseases were allergies (17%), cancer (16%), arteriovenous disease (15%) and infectious disease (11%). Three types of consultation were identified: emergency consultations without an appointment, consultations by appointment for a specific problem and consultations by appointment without a specific problem. The number of resulting hospital admissions ranged from 2 to 10% of consultations, depending on the type of consultation and the role of the consultant in question.

DISCUSSION

This study shows that in France, consultations at hospital dermatology departments differ greatly from those of dermatologists in private practice. The main diseases seen (cancer, arteriovenous disease, allergy, infectious dermatosis) accounted for the majority of hospitalisations in these departments. The organisation of hospital consultations is increasingly tending both towards treatment of highly specialised diseases through specifically oriented consultations and also towards the emergency treatment of certain forms of acute dermatosis.

Targeting of acetylcholine receptor and 43 kDa rapsyn to the postsynaptic membrane in Torpedo marmorata electrocyte

In this study we have investigated the intracellular routing of two major components of the postsynaptic membrane in Torpedo electrocytes, the nicotinic acetylcholine receptor and the extrinsic 43 kDa protein rapsyn, and of a protein from the non-innervated membrane, the Na+,K+ ATPase. We isolated subpopulations of post-Golgi vesicles (PGVs) enriched either in AChR or in Na+,K+ ATPase. Rapsyn was associated to AChR-containing PGVs suggesting that both AChR and rapsyn are targeted to intracellular organelles in the secretory pathway before delivery to the postsynaptic membrane. In vitro assays further show that rapsyn-containing PVGs do bind more efficiently to microtubules compared to Na+,K+ ATPase-enriched PVGs. These data provide evidence in favor of the contribution of the secretory pathway to the delivery of synaptic components.

[Long-term reproducibility of programmed atrial stimulation]

Programmed atrial stimulation is a technique increasingly used to assess different pathologies but the reproducibility of the results is totally unknown. The aim of this study was to determine its reproducibility. Two electrophysiological studies were undertaken without antiarrhythmic therapy in an interval of one to three months (average 18 months) in 48 patients. The programmed atrial stimulation used 1 and 2 extrastimuli delivered in sinus rhythm and then three paced rhythms (sinus cycle -10%, 600 ms, 400 ms). Twenty-one patients had documented atrial arrhythmias (atrial fibrillation n = 13, flutter n = 3 or tachycardia n = 5) (group 1) and the 27 other patients had no spontaneous arrhythmias (group II). In group I, clinical tachycardial was reproduced in 18 patients during the initial stimulation procedure. During the second investigation, 17 remained inducible and in the 3 in whom stimulation was negative, it remained so in 2 of the cases. The reproducibility was therefore 90%. In group II, 12 patients had inducible sustained (for over 1 minute) tachycardia during the first procedure (44%) but this only remained inducible in 6 patients. In the other 15 subjects, stimulation was negative during the first procedure but 7 of them had inducible tachycardial during the second procedure. The reproducibility of the technique was therefore only of 52%. The authors conclude that the reproducibility of programmed atrial stimulation in patients with documented spontaneous paroxysmal arrhythmias is excellent. However, the reproducibility is mediocre in subjects without spontaneous arrhythmias and the induction of tachycardial in this group of patients should be interpreted with caution given the variability of the response to programmed atrial stimulation.

[Acute upper limb ischemia in a young adult without cardiac disease. Value of transesophageal echocardiography]

The authors report the case of a 34-year old woman with no previous cardiovascular disease who was admitted to hospital for acute ischaemia of the right arm due to embolism, preceded by two episodes of pain and tingling of the left arm related to subacute ischaemia. After right embolectomy, with no possibility of controlateral disobliteration an effective anticoagulation, no cardiac source of embolism could be found; However, transoesophageal echography showed a large mobile thrombus in the aortic arch implanted just before the origin of the left subclavian artery. The only explanation for embolism to the right arm was a retro-oesophageal subclavian artery which was confirmed by scanner. Doppler and arteriography. These investigations, however, did not allow visualisation of the aortic thrombus. In view of the risk of recurrent embolism, a thrombectomy was performed without cardiopulmonary bypass, associated with correction of the vascular abnormality with no complications. This case shows that oesophageal echography is a useful investigation in the work up of acute arterial obstruction in young patients with no cardiac disease.

[Late complication of blunt injuries of the thorax: acute pericarditis. Apropos of a case]

The authors report a case of closed trauma of the thorax, complicated after a symptom-free period by acute pericarditis, combined with pleural effusion. The clinical outcome was favorable and the pericardial effusion, which was considerable at the first ultrasound scan, spontaneously recovered fully. The incidence of this delayed complication of closed trauma of the thorax is unknown. Its mechanism, related to that of the Dresler syndrome and post-pericardiotomy syndrome differs from that of initial hemopericardium which is of mechanical origin. This case highlights the capital importance of ultrasound in the diagnosis and assessment of cardiac complications of thoracic trauma.

[Anaphylactic shock complicated by myocardial infarction: side effect of glaphenine?]

The authors report a case of anaphylactic shock complicated by coronary spasm and infarction attributed to glafenine medication in a 43-year-old male patient. The outcome was positive and coronary angiography showed healthy coronary vessels. The ergonovine maleate was negative. A review of the literature confirms the rarity of this complication of anaphylactic shock and study the ECG changes induced by this type of reaction and to analyze the mechanisms responsible for this coronary spasm in this situation. These consists basically of histamine release and prostaglandin-synthesis inhibition.

[A case of acute cardiac insufficiency caused by 5-fluorouracil]

The authors report a case of acute cardiac failure linked to 5 fluoro-uracil. The toxicity seen most commonly involves ischemia. The pathophysiological mechanisms are discussed as well as the role played by pharmacokinetic characteristics in the occurrence of adverse reactions. 5 fluoro-uracil (5 FU) is a compound widely used in the treatment of ENT, breast and gastrointestinal carcinomas. The finding of dose-effect relationship may lead the clinician to use different modes of administration. Continuous administration at high dose 3 g/m2/day from D1 to D5) in combination or not with cisplatin, or continuously at low dose (300 mg/m2/day from D1 to D31) can reduce hematopoietic toxicity but, in contrast, increases gastrointestinal toxicity.

[Complete neuroleptic withdrawal in patients with schizophrenia with intense symptoms and resistant to treatment]

We report 2 studies evaluating the effects of a complete and progressive neuroleptic withdrawal on the symptomatology of 2 groups of 10 young chronically ill schizophrenic inpatients. In a preliminary open study, we compare the psychiatric symptomatology during a 4-week-period before the beginning of withdrawal and during a similar period following the end of withdrawal. We observe the significative improvement of the blunted affect, the deterioration of an aspecific psychiatric symptomatology (including irritability, excitement, hostility) and the non-modification of the specific schizophrenic symptomatology (in its 3 main components: positive signs, negative signs, disorganization). The second study (a double blind one) reports the effects of a complete neuroleptic withdrawal maintained during a longer period (8 weeks): 1. The improvement of the blunted affect is transiently observed during the 2 first weeks after the end of withdrawal but not after this time. 2. The deterioration of the aspecific psychiatric symptomatology by opposition to the non-significative modification of the specific schizophrenic symptomatology is a fact confirmed by this second study. Even if we can not exclude that the influence of neuroleptic withdrawal on the specific psychotic symptoms may require a longer time frame than 8 weeks to detect, this dichotomic evolution raises the problem of the specific action of neuroleptics in this particular category of patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Incidence and significance of inducible supraventricular tachyarrhythmias in patients with chronic myocardial infarction

In order to evaluate the incidence and significance of inducible supra-ventricular (SVTA) in patients with chronic myocardial infarction (MI), the results of systematic programmed atrial stimulation were compared in two groups of patients: 150 patients (group I) without MI or underlying heart disease, studied for syncope or conduction disturbances, 296 patients (group II) studied after an acute Mi (greater than 1 month). None of them had spontaneous SVTA, and 24-h Holter monitoring showed no SVTA. The atrial stimulation programme used one and two extra stimuli delivered during sinus rhythm and atrial pacing (600 ms and 10% less than the sinus cycle length). A sustained (S) (greater than 30 s) supraventricular tachycardia (SVT) (atrial flutter, fibrillation, tachycardia) was induced in 17 patients in group I (11%) and in 120 patients in group II (40.5%). In group II inducible SVTA could not be correlated with the occurrence of a SVT during acute MI, the location of MI, the value of LV ejection fraction (EF), the incidence of inducible sustained ventricular tachycardia (VT), or fibrillation (VF). However, inducible SVTA could be correlated with a significantly shorter effective atrial refractory period (197 +/- 23 ms vs 220 +/- 35 ms, P less than 0.001) and a shorter retrograde block cycle length (518 +/- 215 vs 585 +/- 215 ms, P less than 0.03). The patients in group II were followed-up for at least 6 months; 12 of them developed sustained episodes of supraventricular tachycardia; 11 of them had inducible SVTA (P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

[Frequency of the onset of supraventricular tachyarrhythmias as a function of underlying heart disease]

The prevalence of inducible ventricular arrhythmias is related to the underlying pathology. This study was undertaken to determine the prevalence of supraventricular tachyarrhythmias (SVT), atrial tachycardia, flutter or fibrillation, sustained for over 30 seconds. Programmed atrial stimulation was used to deliver 1 or 2 extrastimuli during sinus and paced rhythm in 230 subjects without obvious cardiac disease (149 without and 81 with spontaneous SVT) and 432 patients with documented cardiac pathology (407 without and 25 with spontaneous SVT). The incidence of inducible SVT with respect to that of spontaneous SVT and in relation to cardiac pathology was as follows: (table; see text) The prevalence of inducible SVT in patients without spontaneous SVT was related to the type of pathology: (table; see text) These results show that in patients with spontaneous SVT the induction of the arrhythmia was facilitated by the presence of underlying cardiac pathology (sensitivity increasing from 67% to 88%). In patients without spontaneous SVT, the nature of the underlying disease was related to the prevalence of inducible SVT, the risk being major in SA block, right ventricular dysplasia and mitral valve prolapse (60-80%) and moderate in dilated CMP and myocardial infarction (35 to 40%).

Increased oxidative capacity in skeletal muscles from cold-acclimated ducklings: a comparison with rats

1. The effects of prolonged cold exposure on cytochrome oxidase activity were investigated in skeletal muscles, liver and adipose tissues from cold-acclimated (CA) and control (TN) ducklings and rats. 2. Cold acclimation increased the oxidative capacity of skeletal muscles (+33% in gastrocnemius and +195% in pectoral) and liver (+47%) from CA ducklings, but decreased the oxidative capacity of gastrocnemius muscle (-22%) from CA rats. On the other hand, in these CA rats it increased the oxidative capacity of liver by 88% and, above all, brown adipose tissue by 544%. 3. The significance of these changes due to acclimation to cold in ducklings and rats is discussed. Such an increase in oxidative capacity of CA duckling muscles may explain the non-shivering thermogenesis observed in these birds.