SKELETAL MUSCLE SENSITIVITY TO WASTING INDUCED BY UROTHELIAL CARCINOMA

BACKGROUND

Skeletal muscle wasting is a common phenotypic feature of several types of cancer, and it is associated with functional impairment, respiratory complications, and fatigue. However, equivocal evidence remains regarding the impact of cancer-induced muscle wasting on the different fiber types.

AIM

The aim of this study was to investigate the impact of urothelial carcinoma induced in mice on the histomorphometric features and collagen deposition in different skeletal muscles.

MATERIALS AND METHODS

Thirteen ICR (CD1) male mice were randomly assigned into two groups: exposed to 0.05% N-butyl-N-(4-hydroxybutyl) nitrosamine (BBN) in drinking water for 12 weeks, plus 8 weeks of tap water (BBN, n = 8) or with access to tap water for 20 weeks (CONT, n = 5). Tibialis anterior, soleus, and diaphragm muscles were collected from all animals. For cross-sectional area and myonuclear domain analysis, muscle sections were stained with hematoxylin and eosin, and for collagen deposition assessment, muscle sections were stained with picrosirius red.

RESULTS

All animals from the BBN group developed urothelial preneoplastic and neoplastic lesions, and the tibialis anterior from these animals presented a reduced cross-sectional area (p < 0.001), with a decreased proportion of fibers with a higher cross-sectional area, increased collagen deposition (p = 0.017), and higher myonuclear domain (p = 0.031). BBN mice also showed a higher myonuclear domain in the diaphragm (p = 0.015).

CONCLUSION

Urothelial carcinoma induced muscle wasting of the tibialis anterior, expressed by a decreased cross-sectional area, higher infiltration of fibrotic tissue, and increased myonuclear domain, which also increased in the diaphragm, suggesting that fast glycolytic muscle fibers are more susceptible to be affected by cancer development.

PRELIMINARY RESULTS ON FUNCTIONALIZATION OF POLYPROPYLENE SURGICAL MESHES

Introduction

Due to inflammatory response in patients, many efforts have been devoted to developing advanced (biological or bioactive) surgical meshes. Some of them look for new synthetic materials and others work to improve their biocompatibility through different methods (coating, soaking, plasma). However, it is critical to avoid pore obstruction or lose mechanical properties while its amphiphilic behaviour is increased.

Methods

A deposition method was used to functionalize surgical meshes with a polypropylene derivative block copolymer that improved its amphiphilic behaviour. Therefore, this copolymer was dispersed on several solvents with different polarities and chemical natures. Then, meshes were immersed and a chemical adsorption-based coating was performed. Additionally, a qualitative study was carried out by optical and fluorescence microscopy on two size samples: small (1 cm2 squares) and large (standard T bone shapes).

Results

First, pore obstruction was perfectly avoided in small samples but was partially present in large samples. Second, the deposition was thicker with polar solvent in both sizes. And finally, fluorescence analysis showed a homogeneous and smooth coating with the most polar solvent.

Conclusions

After exposure to UV light, small samples show a better coating while large one's present irregular adherences on their surface. Moreover, the aprotic polar solvent provides a thickness layer and a smooth mesh surface.

Cytosolic aldose metabolism contributes to progression from cirrhosis to hepatocarcinogenesis

Oxidative stress modulates carcinogenesis in the liver; however, direct evidence for metabolic control of oxidative stress during pathogenesis, particularly, of progression from cirrhosis to hepatocellular carcinoma (HCC), has been lacking. Deficiency of transaldolase (TAL), a rate-limiting enzyme of the non-oxidative branch of the pentose phosphate pathway (PPP), restricts growth and predisposes to cirrhosis and HCC in mice and humans. Here, we show that mitochondrial oxidative stress and progression from cirrhosis to HCC and acetaminophen-induced liver necrosis are critically dependent on NADPH depletion and polyol buildup by aldose reductase (AR), while this enzyme protects from carbon trapping in the PPP and growth restriction in TAL deficiency. Both TAL and AR are confined to the cytosol; however, their inactivation distorts mitochondrial redox homeostasis in opposite directions. The results suggest that AR acts as a rheostat of carbon recycling and NADPH output of the PPP with broad implications for disease progression from cirrhosis to HCC.

Telmisartan for treatment of Covid-19 patients: an open randomized clinical trial

Background

The imbalance of the Renin Angiotensin System in favor of the angiotensin II has been described in Covid-19-patients. Angiotensin II regulates life processes, such as cell growth and division and can promote apoptosis initiating an inflammatory process with release of proinflammatory cytokines. Angiotensin receptor blockers (ARBs) block the AT1 receptor and could have a beneficial effect reducing Covid-19 inflammation.

Purpose

To assess whether Telmisartan is effective in reducing C-reactive protein (CRP) plasma levels in hospitalized patients with Covid-19, and improves clinical outcomes and length of stay and morbimortality.

Trial design

This is a parallel-group, randomized, two-arm, open-label, multicenter superiority trial with 1:1 allocation ratio.

Methods

Inclusion criteria: patients aged more than 18 years with less than 5 days of symptoms onset and after informed consent was obtained.

Exclusion criteria: Patients admitted to intensive care unit (ICU) or using mechanical ventilatory support or ongoing ARBs / angiotensin-converting enzyme inhibitors treatment at the time of randomization. Control arm received standard care alone and treatment arm Telmisartan 80 mg bid 14 days added to standard care. Primary outcome were CRP plasma levels at day 5 and 8 after randomization. Secondary outcomes included time to discharge at 15 days, admission to ICU and death at 15 and 30 days.

Results

158 patients were included in the analysis, 80 in the control and 78 in the telmisartan group. Day 5 control-group CRP levels were 6.06±6.95 mg/dL (n=66) while telmisartan group were 3.83±5.08 mg/dL (mean±SD; n=66, p&lt;0.05). Day 8 CRP levels were 6.30±8.19 mg/dL (n=44) and 2.37±3.47 mg/dl (mean±SD; n=43, p&lt;0.05) in the control and telmisartan groups, respectively. Kaplan-Meier analysis showed that Telmisartan-treated patients had lower median time to discharge (control=15 days; telmisartan=9 days). Death by day 30 was reduced by 81% in the telmisartan-treated group (control 22.54%, 16/71; telmisartan 4.29%, 3/70 participants; p=0.0023). Composite ICU, mechanical ventilation or death was reduced by telmisartan treatment at days 15 and 30. No telmisartan-related adverse events were reported.

Conclusions

Telmisartan, an inexpensive safe drug, in high doses, demonstrated anti-inflammatory effects and reduced morbimortality in Covid-19-hospitalized patients.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s):Hospital Escuela José de San Martín, ArgentinaHospital Español de Buenos Aires, Argentina Probability of discharge up to

AB0015 STUDY OF VDR AND VDBP GENES AS CANDIDATE SUSCEPTIBILITY GENES FOR THE DEVELOPMENT OF IMMUNE-MEDIATED DISEASES IN THE PARAGUAYAN POPULATION

Background:

Immune Mediated Inflammatory Diseases (IMIDs) are complex diseases that are believed to have a strong interaction between the genome and the environment as part of their aetiology. In studies using the candidate gene strategy, genetic variation in a gene where functionality has been associated with the pathophysiology of the disease under study is being analyzed. In the last decade, polymorphisms of the vitamin D receptor (VDR) and VDBP genes have been more emphatically studied in IMIDs in different populations, but the results reported have not yet been conclusive.

Objectives:

To identify an association between vitamin D receptor (VDR) and vitamin D-binding protein (VDBP) gene polymorphisms, and IMIDs in Paraguayan patients.

Methods:

Association study of VDR (SNPs rs731236, rs7975232, rs2228570) and VDBP (rs4588) gene polymorphisms with susceptibility to IMIDs in Paraguayan population. A total of 399 patients with IMIDs (i.e. Systemic Lupus Erythematosus (SLE), Scleroderma (ES), Rheumatoid Arthritis (RA), and Cutaneous Psoriasis (CPS) and 100 hypernormal controls (HC) from the same population were included in this study. Genotyping was performed using Taqman real-time PCR-based technology (Life Technologies, USA). Statistical analysis was performed using Rv3.0.1 statistical language software (www.R-project.org). A p value ≤ 0.05 was used for statistical significance.

Results:

A total of 399 individuals, 100 controls and 299 patients (99 RA, 100 SLE, 50 ES, and 50 PSO) were included. Seventy-six percent were female and 24% were male. The mean age was 43.7±14 years. Four SNPs were genotyped: rs731236, rs7975232, rs2228570, rs4588. The HWE test was not statistically significant for any of the 4 SNPs considered (P>0.05), confirming the quality of genotyping and the absence of technical bias. (Table 1).

Table 1.

Genotyping of SNPs of the VDR and VDBP gene in Paraguayan population with IMIDs.

SNPIMIDMinor AlleleMajor AlleleMAFControlMAFCaseORIC.LIC.Hp allelicP.Geneticrs731236SLEGA0.50.40.640.420.970.0350.08rs731236RAGA0.50.410.690.461.050.0710.12rs731236SSGA0.50.420.710.421.180.180.37rs731236CPSGA0.50.380.60.361.010.0490.042rs2228570SLEAG0.360.381.140.741.740.60.45rs2228570RAAG0.360.310.830.531.280.40.56rs2228570SSAG0.360.361.020.61.7310.057rs2228570CPSAG0.360.391.160.681.960.610.83rs7975232SLECA0.360.320.820.531.260.40.072rs7975232RACA0.360.290.720.461.120.140.064rs7975232SSCA0.360.220.490.270.880.0120.0064rs7975232CPSCA0.360.411.210.722.030.450.016rs4588SLETG0.230.271.240.7720.420.48rs4588RATG0.230.220.930.561.530.810.84rs4588SSTG0.230.210.890.471.650.770.76rs4588CPSTG0.230.291.370.762.430.260.53

Conclusion:

There is evidence of nominal association between VDR SNPs: rs731236 (in SLE and CPS), and rs7975232 (in SS and CPS) and the presence of IMIDs disease in Paraguayan patients.

Disclosure of Interests:

None declared

AB0159 DIASTOLIC DYSFUNCTION IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

Rheumatoid arthritis (RA) presents with an elevated incidence of congestive heart failure disease, which has a strong association with diastolic dysfunction, defined by left ventricular delayed relaxation pattern assessed by echocardiography.(1,2)

Objectives:

To describe the frequency of left ventricular delayed relaxation pattern in patients with RA, and the relationship with its clinical and serological characteristics, as well as with traditional and non-traditional cardiovascular risk factors.

Methods:

Descriptive, cross sectional, prospective study, in a Paraguayan cohort of patients with RA. This study had two phases: the first one, included a standardized questionnaire according to the variables included in the Cardiovascular Risk project (PINV15-0346), from the Consejo Nacional de Ciencias y Tecnología (CONACYT), and physical examination; the second one included laboratory sample collection performed by a specialized laboratory for serum biomarkers measurement for cardiovascular risk prediction (i.e endothelin, alpha-TNF, E-selectin, t-PA, VCAM, PAI-1 and high sensitivity-CRP levels) and echocardiographic assessment with a Doppler 7 GE USA equipment at a private facility. All patients signed informed consent. SPSS Statistics v23 was used for data analysis. Quantitative variables were presented as means and qualitative variables as frequencies. Chi square test was performed for comparisons between dichotomous variables. A p value ≤ 0.05 was used for statistical significance.

Results:

100 patients were included, 87% women, with a mean age of 51.36 ± 11.03 years, mean disease duration of 130.9 ± 102.64 months. 84.4% had positive ACPA. 43.3% had bone erosions, with an average of DAS 28-ESR 3.42 ± 1.1. 60% of patients presented with echocardiographic left ventricular delayed relaxation pattern. Regarding traditional CV risk factors, the same ones presented more frequently HBP (40% vs 19.4%, p = 0.037), DM2 (11.7% vs 0%, p = 0.036), obesity (38.3% vs 16.7%, p = 0.025), altered glycemia (27.1% vs 6.5%, p = 0.02), altered HbA1C (50.8% vs 22.6%, p = 0.01), higher mean weight (75.9 ± 17.62 p = 0.02), higher Framingham index high (20% vs 3.2%, p = 0.03). Regarding to clinical parameters, a higher frequency of erosions was found (55.8% vs 22.2%, p = 0.004), without other significant differences for disease activity, seropositivity or disease duration. As for serum biomarkers, higher levels of fibrinogen (639.71 ± 189.84, p = 0.04), homocysteine (11.74 ± 7.81, p = 0.05) and VCAM (519, 16 ± 203.68, p = 0.02) were found.

Conclusion:

We found a high frequency of diastolic dysfunction in patients with RA. They presented a significant association with traditional CV risk factors, erosions, and fibrinogen, homocysteine, and VCAM biomarkers. Adequate control of cardiovascular risk factors and echocardiographic assessment of these patients is essential in order to avoid the progression of heart functional damage.

References:

[1]Aslam F, Bandeali SJ, Khan NA, Alam M. Diastolic Dysfunction in Rheumatoid Arthritis: A Meta-Analysis and Systematic Review. Arthritis Care & Research. 2013;65(4):534-43.

[2]Liang KP, Myasoedova E, Crowson CS, Davis JM, Roger VL, Karon BL, et al. Increased prevalence of diastolic dysfunction in rheumatoid arthritis. Annals of the Rheumatic Diseases. 1 de septiembre de 2010;69(9):1665-70.

Disclosure of Interests:

None declared

Estrogens in schizophrenia: What do we know?

Introduction

Schizophrenia is a chronic disease that significantly impacts cognitive functioning. Sex differences in incidence, onset and course of schizophrenia suggest estrogens have a protective role.

Objectives

Our aim is to review the state of the art on this matter.

Methods

Through a selection of the most relevant articles found on PubMed and ClinicalKey searching the keywords: “estrogens” and “schizophrenia”.

Results

Accumulating evidence has led to the hypothesis that estrogens act as a protective factor in women regarding the onset of schizophrenia as their increase in puberty may help delay the onset of symptoms. Also, the estrogens abrupt decline in menopause may account for a second peak of onset and greater severity of the symptoms. During the menstrual cycle, when serum estrogens are at their lowest, there is an increase in the number of psychotic episodes and an exacerbation of psychotic symptoms. Pregnancy leads to an improvement of psychotic symptoms, which then worsen in postpartum. Clinical trials testing the efficacy of estrogens have been promising, which suggest they might be a useful adjuvant treatment. Despite the evidence of clinical efficacy, health risks for women using estrogen therapy should be considered, as they decrease its acceptability as a viable treatment option. The use of selective estrogen receptor modulators (SERMs), as raloxifene, could be a favorable and safer alternative.

Conclusions

In conclusion, estrogens are proving to be a promising option as a complementary therapy for schizophrenia; however, further studies are needed to investigate whether they might be overall beneficial.

Disclosure

No significant relationships.

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

BACKGROUND

80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality.

METHODS

This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494.

FINDINGS

Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70-8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39-8·80) and upper-middle-income countries (2·06, 1·11-3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26-11·59) and upper-middle-income countries (3·89, 2·08-7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications.

INTERPRETATION

Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications.

FUNDING

National Institute for Health Research Global Health Research Unit.

Biophony in a noisy tropical urban forest fragment

Anthropogenic noise, which is part of an urban soundscape, can negatively affect the behaviour of wild animals. Here we investigated how biophony (animal sounds) was affected by noise in an urban Brazilian forest fragment. Our hypothesis was that noise and biophony would differ between the border and the centre of the forest fragment (i.e., lower biophony predicted in noisy areas). Two passive acoustic monitoring devices were used to record soundscapes one week per month, 24 hour per day, from May to July 2012. The Acoustic Complexity Index (ACI) was used to quantify biophony and the Power Spectral Density (PSD) to quantify urban noise. PSD and ACI were higher on the border than in the centre of the fragment. PSD was lower in July, while the ACI did not significantly vary between months. Noise levels were also higher on the border. Conversely, potential species richness was higher in the centre of the forest fragment. Higher biophony at noisy sites can be interpreted as behavioural responses of species for communicating in noisy areas. Alternatively, they could be the result of species segregation by degree of vocal plasticity or due to differences in composition of communities.

Basic life support training with high schools’ teachers in Bahia, Brazil: an experimental study

Background

Early performing of cardiopulmonary resuscitation is the cornerstone of survival in out-of-hospital cardiac arrest, doubling the odds of survival when correctly performed. The American Heart Association and the European Resuscitation Council advocate for training the entire population in order to enable a quick and effective response to out-of-hospital cardiac arrests, improving its outcomes. In primary healthcare settings the health workers can act as trainers, using the family and territorial approach to deliver basic life support (BLS) basis to general population, assuring that key social actors are skilled enough to aid community when needed. This study aims to compare the knowledge and practice skill of high school teachers before and after a BLS training delivered by health workers and students in a primary healthcare setting.

Methods

Teachers of three public high schools in Bahia, Brazil were assessed by a test for theoretical and practical skill in BLS and then trained by a group of primary care workers and students. Training included a 20min lecture and 40min practice session in a simulated scenario. After the training the teachers were assessed with the same test for theoretical and practical skill. A paired-samples T test was used to detect the difference in the mean total score before and after the training, with a significance level of 0.05 (two-sided test) and 95% confidence interval.

Results

The mean total score after the BLS training (8.2 ± 1.5) was significantly higher (p &lt; 0.000) from before training (4.5 ± 1.7).

Conclusions

The high school teachers were unable to deliver proper cardiopulmonary resuscitation before the intervention. Following a BLS training a significant immediate improvement in the knowledge and practical skill was detected. Health workers were able to achieve these results in a primary healthcare setting. Further studies should assess this outcome with larger samples, evaluating the retention of knowledge and skills provided.

Key messages

Basic life support training can be delivered to general population by health workers in primary healthcare settings in order to improve the outcomes to out-of-hospital cardiac arrests. Teachers and health workers can act as key actors in intersetorial health-education initiatives, promoting the health of their communities.

Funding models and expenditures with primary healthcare in Salvador, Bahia, Brazil metropolitan area

Background

The government investments in quality primary healthcare are the basis to strengthening the health systems and monitoring the public expenditure in this area is a way to assess the effectiveness and efficiency of the public health policies. The Brazil Ministry of Health changed, in 2017, the method of onlending federal resources to states and cities seeking to make the public funds management more flexible. This change, however, suppressed mandatory investments in primary healthcare. This research aims to determine the difference of expenditures on primary healthcare in Salvador, Bahia, Brazil metropolitan area before and after this funding reform, seeking to verify how it can impact the quality of primary healthcare services and programs.

Methods

This is an ecological time-series study that used data obtained in the Brazil Ministry of Health budget reports. The median and interquartile range of expenditures on primary healthcare (set as the percentage of total public health budget applied in primary care services and programs) of the 13 cities in the Salvador metropolitan area were compared two years before and after the reform.

Results

The median of expenditures on primary healthcare in Salvador metropolitan area was 25.5% (13,9% - 32,2%) of total public health budget before and 24.8% (20.8% - 30.0%) of total public health budget after the reform (-0.7% difference). Seven cities decreased the expenditures on primary healthcare after the reform, ranging from 1.2% to 10.8% reduction in the primary healthcare budget in five years.

Conclusions

Expenditures on primary healthcare in Salvador metropolitan area decreased after the 2017 funding reform. Seven of 13 cities reduced the government investments on primary healthcare services and programs in this scenario. Although the overall difference was -0.7%, the budget cuts ranged from 1.2% to 10.8% in the analyzed period and sample. More studies should assess these events in wide areas and with long time ranges.

Key messages

Public health funding models can impact the primary healthcare settings regardless of the health policy. Reforms in the funding models should consider the possible benefits before implementation. Funding models and methods that require mandatory investments in primary healthcare may be considered over more flexible ones.

Toxicity evaluation of nanocrystalline silver-impregnated coated dressing on the life cycle of worm Caenorhabditis elegans

In recent times, however, due to the emergence of bacterial strains with resistance to conventional antibiotics, silver has again gained attention as an alternative for developing new efficient bactericides, including the use of silver nanoparticles (AgNPs). However, the improper disposal of these items after use may cause toxicological effects on organisms in the environment. To evaluate the potential environmental hazard of nanosilver-coated dressings, the nematode Caenorhabditis elegans was chosen as a test organism. The assays were conducted in 24-well plates that contain four different sizes of coated dressing to obtain different concentrations. L1 and L4 C. elegans larval stages were exposed to these nanosilver concentrations. Dressing cutouts were arranged between two layers of agar for 3 days and Escherichia coli (OP 50 strain) was added as food source for the worms. After the exposure period, growth, reproduction, fertility, silver concentration in the medium and the concentration of reactive oxygen species (ROS) in the worms were evaluated. Scanning and transmission electron microscopy analyses were performed on the coated dressings, as well as analyses of zeta potential, ionic release and antibacterial power in two bacterial strains (Pseudomonas aeruginosa and Staphylococcus aureus). It was verified the antibacterial power of the coated dressing, in both bacteria strains tested. Characterization of the coated dressing indicated heterogeneous nanoparticles, as well as distinct zeta potentials for the medium in water and saline medium (0.9% NaCl). L1 larval worms exposed to nanosilver-coated dressing showed a high ROS concentration and reductions in growth, fertility and reproduction. Worms exposed to the coated dressing during the L4 stage showed almost no response. Overall, the obtained results indicate the potential environmental hazard of nanosilver-coated dressings.

AB0258 CAROTID INTIMA-MEDIA THICKNESS AND SERUM BIOMARKERS IN PARAGUAYAN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

The mechanism of increased cardiovascular risk in RA is not well understood and is independent of traditional CV risk factors. Intima-media thickness of the common carotid wall measured by ultrasonogram is a safe and useful biomarker of early stage atherosclerosis that correlates with coronary involvement; and it correlates with severity and duration of disease. Several studies have shown a relationship between inflammation markers, endothelial dysfunction markers, and carotid involvement. (1)

Objectives:

To determine the presence of inflammation biomarkers and its relationship with subclinical atherosclerosis measured by carotid ultrasound, and with the clinical characteristics in patients with established Rheumatoid Arthritis (RA)

Methods:

Descriptive, cross sectional, prospective study, in a Paraguayan cohort of patients with RA meeting ACR/EULAR2010 criteria. This study had two phases: the first one, included a standardized questionnaire according to the variables included in the Cardiovascular Risk project (PINV15-0346), from the National Sciences and Technology Council (CONACYT), and physical examination; the second one included laboratory sample collection performed by a specialized laboratory for serum biomarkers measurement for cardiovascular risk prediction (i.e endothelin, alpha-TNF, E-selectin, homocysteine, apolipoprotein, fibrinogen, and high sensitivity-CRP levels) and carotid ultrasound evaluation by a trained specialist, to evaluate subclinical atherosclerosis. Subclinical atherosclerosis was defined as carotid intima-media thickness (CIMT) >0,9mm and/or presence of carotid plaques. All patients signed informed consent. SPSS 23rd version was used for data analysis. Quantitative variables were presented as means and qualitative as frequencies. Chi square test was performed for comparisons between dichotomous variables and t Student for continuous, and p ≤ 0.05 for statistical significance.

Results:

100 patients were included, 87% were women, mean disease duration 130.9±102.64 months, 77% were RF positive, and 84.4% were ACPA positive, 43.4% had bone erosions, mean ESR-DAS28 was 3,42±1,1; 30% had remission criteria. 39% had extra-articular manifestations.

Elevated serum biomarkers were found: fibrinogen >400 mg/dL 88.2%, high sensitivity-CRP (hs-CRP) >5mg/dL 42.9%, endothelin >2 ng/mL 20%, alpha-TNF >15,6 pg/mL 13.1%, E-selectin >79,2 ng/mL 6%. 25.3% had CIMT >0,9 mm and mean CIMT was 0.68±0.25mm. 27.14% had carotid plaques. Patients with CIMT>1mm had higher frequency of family history of arterial hypertension (p=0.006), greater mean disease duration (p=0.0007), hip circumference (p=0.014), blood pressure (SBP p=0.038, DBP p=0.027), HAQ levels (p=0,019) and hs-CRP levels (p=0.013), also lower mean height (p=0,04); while carotid plaques were related to higher homocysteine (p=0.026) and hs-CRP levels (p=0.024).

Conclusion:

A considerable percentage of patients had subclinical atherosclerosis. Patients with CIMT>0,9mm had a longer disease duration, higher HAQ levels, hip circumference, as well as higher BP. High levels of hs-CRP were more frequently related to the presence of subclinical atherosclerosis

References:

[1]Aday, A. targeting residual inflammatory risk: a shifting paradigm for atherosclerotic disease. Frontiers in cardiovascular medicine. 2019. 6:16.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6403155/pdf/fcvm-06-00016.pdf

Disclosure of Interests:

None declared

AB1026 INFLAMMATORY MANIFESTATIONS IN PATIENTS WITH HUMAN LEUKOCYTE ANTIGEN-B*51 POSITIVE AND WITHOUT BEHÇET’S DISEASE

Background:

Human leukocyte antigen (HLA) B*51 allele is the most important genetic factor in susceptibility to Behçet’s disease (BD), an immune-mediated systemic disorder of unknown etiology, characterized by recurrent episodes of inflammatory manifestations. In fact there is a considerable clinical overlap of BD with autoinflammatory syndromes. As it’s known, the majority of HLA-B*51 positive individuals do not develop BD. But do these individuals also present inflammatory manifestations?

Objectives:

Characterize the group of individuals in our hospital with positive HLA-B*51, without BD diagnosis and review whether inflammatory manifestations are present in these individuals.

Methods:

A retrospective study of HLA-B*51 positive patients between 2000 and 2019. Genomic DNA was obtained from peripheral blood and HLA genotyping was performed using a PCR with Sequence Specific Primers (PCR–SSP) methodology. From the group of 289 B*51 positive patients, BD diagnosis were excluded. Demographic and clinical data were collected by review of clinical files in December 2019.

Results:

176 patients, mean age of 48.5 ± 16.5 years (5 to 84 years). Most were female (68%). The HLA study was motivated by multiple diagnostic suspicions: spondyloarthritis (SpA, 25.0%), BD (22.7%) and systemic sclerosis (SSc, 10.8%). The mean time elapsed since the immunogenetic study was 8.3 years, with 12 deaths recorded. 69 (39.2%) subjects had no diagnosis for immune-mediated disease (IMD). Of the other 107 patients, the majority had 1 IMD (64.5%), and the rest were diagnosed with 2 to 4 IMD. The most frequent IMD were SpA (20.8%), psoriasis (10.4%), psoriatic arthritis (9.7%), SSc (9.7%) and rheumatoid arthritis (7.1%). Autoantibodies were detected in 94 individuals (53.4%): antinuclear antibodies (64 patients), rheumatoid factor (26 patients) and CCP antibodies (11 patients). In 55 individuals no inflammatory manifestation was identified but the 68.8% of them presented between 1 to 7 manifestations:

System involvedClinical manifestationFrequencyEars, nose and throatChronic rhinitis32 (13.2%)∑ = 76 (31.4%)Recurrent tonsillitis20 (8.3%)Other24 (9.9%)Cutaneous, mucous and serousRecurrent oral aphtous ulcers34 (14.0%)∑ = 57 (23.6%)Serositis10 (4.1%)Other13 (5.4%)NeurologicalChronic headache34 (14.0%)∑ = 36 (14.9%)Asseptic meningitis2 (0.8%)OcularOcular inflammation31 (12.8%)∑ = 31 (12.8%)UrinaryRecurrent cystitis15 (6.2%)∑ = 15 (6.2%)VascularVenous thromboembolism7 (2.9%)∑ = 14 (5.8%)Aneurysm6 (2.5%)Spontaneous coronary dissection1 (0.4%)RheumaticArthromyalgia6 (2.5%)∑ = 9 (3.7%)Gout3 (1.2%)ConstitutionalRecurrent fever syndrome1 (0.4%)∑ = 1 (0.4%)DigestiveRecurrent abdominal pain1 (0.4%)∑ = 1 (0.4%)LymphaticAxillary and inguinal adenopathies1 (0.4%)∑ = 1 (0.4%)PulmonaryChronic pulmonary infiltrate1 (0.4%)∑ = 1 (0.4%)

Conclusion:

Inflammatory manifestations are common in HLA-B*51 positive individuals, even in those without BD diagnosis. Further research is needed, considering other HLA alleles associated with increased risk of BD and including control groups.

References:

[1]Burillo-Sanz S, Montes-Cano M, García-Lozano J,et al. Behçet´s disease and genetic interactions between HLA-B*51 and variants in genes of autoinflammatory syndromes.Sci Rep2019;9:2777.

[2]McGonagle D, McDermott MF. A Proposed Classification on the Immunological Diseases.PLoS Med2006;3(8):e297.

[3]Tong B, Liu X, Xiao J, Su G. Immunopathogenesis of Behcet´s Disease.Front. Immunol2019;10:665.

Disclosure of Interests:

None declared

SAT0085 METABOLIC SYNDROME AND ITS ASSOCIATION WITH RHEUMATIC DISEASES IN PARAGUAYAN PATIENTS

Background:

Metabolic syndrome (MS) is associated with increased abdominal adipose tissue and production of inflammatory cytokines. Patients with MS are at increased risk for developing cardiovascular disease and diabetes mellitus, which are among the leading causes of death in chronic rheumatic diseases.

Objectives:

To characterize patients with rheumatic disease and MS and its association with inflammatory markers.

Methods:

Descriptive, cross sectional, prospective study, in 3 Paraguayan cohorts of patients with rheumatoid arthritis (RA), systemic sclerosis (SSc) and systemic lupus erythematosus (SLE). This study had two phases: the first one, included a standardized questionnaire according to the variables included in the Cardiovascular Risk project (PINV15-0346), from the Consejo Nacional de Ciencias y Tecnología (CONACYT), and physical examination; the second one included laboratory sample collection performed by a specialized laboratory for serum biomarkers measurement for cardiovascular risk prediction (i.e endothelin, alpha-TNF, E-selectin, t-PA, VCAM, PAI-1 and high sensitivity-CRP levels). MS patients were categorized according to 2007 ALAD criteria. All patients signed informed consent. SPSS Statistics v23 was used for data analysis. Quantitative variables were presented as means and qualitative variables as frequencies. Chi square test was performed for comparisons between dichotomous variables. A p value ≤ 0.05 was used for statistical significance.

Results:

We included a total of 253 patients, 100 with RA, 100 with SLE and 52 with SSc. Metabolic syndrome was found in 23,58% (50/212). There was no significant difference in MS prevalence between diseases, but there was a higher frequency of increased abdominal circumference in RA and low HDL in SLE. Frequencies for different features of MS in RA, SLE and SSc are detailed in table 1.

Table 1.

Frequencies of MS component in SLE, SSc and RA.

SLESScRAphsCRP23,52% (16/68)26,31% (10/38)42,85% (36/84)0,027E-Selectin5,88% (4/68)21,05% (8/38)5,95% (5/84)0,014t-PA0% (0/68)2,63% (1/38)5,95% (5/84)0,111VCAM20,58% (14/68)8,1% (3/37)0% (0/83)0,000TNF-α7,35% (5/68)18,42% (7/38)13,09% (11/84)0,229Endotelin20,58% (14/68)31,57% (12/38)19,75% (16/81)0,192PAI-111,36% (5/44)0% (0/38)0% (0/83)0,002Table 2.

Frequency of high serum inflammatory biomarkers in SLE, RA and SSc.

SLESScRApAbdominal circumference criteria43,4% (43/99)46,66% (21/46)64% (64/100)0,009Hypertension criteria67% (67/100)67,3% (35/52)55% (55/100)0,152HDL criteria55,22% (37/67)52,63% (20/38)16,12% (15/93)0,000TAG criteria22,38% (15/67)28,94% (11/38)22,58% (21/93)0,703Glycemia criteria7,69% (4/52)13,15% (5/38)25,67% (19/74)0,114Metabolic Syndrome24,35% (19/78)25% (9/36)22,44% (22/98)0,934

Regarding inflammatory biomarkers, there was a significant difference between biomarkers elevated in each disease: hsCRP was found more frequently in RA, E-Selectin in SSc and VCAM and PAI-1 were more prevalent in SLE.

Conclusion:

We found a similar frequency of metabolic syndrome in our cohorts of RA, SSc and SLE Paraguayan patients but they had a different clinical and serological profile, suggesting that the pathways leading to metabolic syndrome are dissimilar in each disease. We need more studies to confirm this hypothesis.

Disclosure of Interests:

None declared

Dietary Pattern and Mental Health: Review of Literature

Introduction

If we are what we eat, are we eating ourselves into depression and anxiety? There has been an emerge evidence supporting a role for lifestyle factors in the development of these conditions.

Objective

To review evolving concepts and gain insight on the phenomenon of dietary pattern and mental health.

Methods

Bibliographic search in Pubmed for articles published between 2010 and 2015, using the keywords words mental health, diet and depression, from the 220 articles found, 68 were included.

Results

From the 68 selected articles, 19 were reviews, 3 randomized controlled trials and 2 meta-analysis. The scientific community agrees that substantial global changes in the food system have had a highly detrimental impact on dietary patterns. Thirty-three articles found a positive correlation between unhealthy dietary patterns and poorer mental health or better mental health with healthy eating habits, such as a potential protective role of mediterranean diet (or similar) with regard to the prevention of depressive disorders. A recent systematic review by Baskin et al (2015) revealed positive associations between poor quality and unhealthy diets and antenatal depressive and stress symptoms. Healthy diets were inversely associated with antenatal depressive and anxiety symptoms.

Conclusion

Although there is some evidence on the association between dietary quality and mental health, we can’t tell if it's a casual linkage or what are the biological pathways that mediate these relationships. Therefore, randomized control trials of diet are necessary to disentangle the effects of multiple health behaviors on mental health.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Resource recovery assessment at a pulp mill wastewater treatment plant in Uruguay

Using a mathematical model, a resource recovery assessment was carried out at a pulp mill activated sludge wastewater treatment plant (WWTP) located in Uruguay. Through the evaluation of different scenarios, the potential production of methane from secondary sludge, with its inherent energy savings, and the recovery of phosphorus (P) as struvite were estimated. Considering the current WWTP configuration with a sludge retention time (SRT) of 32 days, and according to the model, which is a simplification of reality, the assessment indicates that the implementation of an anaerobic digester (AD) to treat the excess sludge can lead to a methane production of approximately 1736 m³ CH₄ d^-1, being a promising alternative to increase the WWTP treatment performance. Furthermore, the model predictions suggest that by shortening the SRT from 32 to 5 days, the methane production could increase by up to 5568 m³ CH₄ d^-1. If the methane produced is used to generate electrical energy to operate the WWTP, energy savings of about 88% can be achieved. Regarding the potential recovery of P as struvite, the addition of a struvite reactor could be an efficient option to recover approximately 1611 mg L^-1 of struvite (corresponding to a load of about 433 kg d^-1). By optimizing the process performance, these findings highlight the potential recovery of resources in pulp mill WWTP, while complying with stringent effluent discharge standards. In addition, further research activities such as pilot-test or detailed laboratory studies may be needed to validate the previous recommendations for industrial scale application.

Sequential steps in Tat trans-activation of HIV-1 mediated through cellular DNA, RNA, and protein binding factors

The regulation of HIV expression is controlled by the activity of the Long Terminal Repeat (LTR). Trans-activation by the virally encoded Tat protein is one of the main mechanisms of LTR activation. Tat binds to its target, TAR RNA, and cellular proteins that bind the LTR, Tat, or TAR RNA are important components of the trans-activation process. We will review the factors that have been characterized for a possible involvement in this mechanism. Whereas LTR binding proteins consist of Sp1 and TBP, a large number of factors that bind TAR RNA have been isolated. We have previously cloned two of them by RNA probe recognition: TRBP and La. We have shown that the in vitro and in vivo binding of TRBP to TAR RNA correlates with a constant expression of the protein during HIV-1 infection. Several proteins that interact with Tat have mainly positive, but some negative, effects on trans-activation. Genetic studies have defined that human chromosome 12 encodes a protein that will allow trans-activation in rodent cells. The binding and the functional data about these proteins suggest sequential steps for the Tat trans-activation mechanism. Each of these intracellular molecular events could be the target for molecular intervention against the virus.

Determining personalized treatment by gene expression profiling in metastatic breast carcinoma patients: a pilot study

PURPOSE

The present study evaluates the massive study of gene expression in metastatic breast carcinoma (MBC) patients using microarray gene expression profiling (MAGE) complemented with conventional sequencing, immunohistochemistry (IHC) and fluorescent "in situ" hybridization (FISH), seeking to optimize the treatment in a subset of heavily pretreated patients and with limited life expectancy.

PATIENTS, MATERIAL AND METHODS

MBC patients in hormone therapy progression with survival expectancy of at least 3 months (m) have been included. The MAGE contains gene probes representing genes known to potentially interact with available drugs as cited in the literature.

RESULTS

Thirty-nine procedures were performed from October 2010 to April 2016. Within the 30 evaluable procedures, considering all hormonal manipulations as a single line, the patients had received a median of 4 treatment lines prior to MAGE (range 1-7). Progression was observed in 6 cases, stable disease (SD) in 7 cases and partial response (PR) in 16 cases, which implies a clinical benefit rate (SD + PR) of 76%. Actuarial median progression-free survival (PFS) was 6 m (95% CI 2.5-9.5) in patients with clinical benefit. The median overall survival (OS) for the entire series was 11 m (95% CI 2.2-19.8).

CONCLUSION

Data presented here indicate that the use of MAGE provides relevant information to establish personalized treatment in frail patients with limited life expectancy in which therapeutic futility is a particularly difficult burden to assume.

Diagnostic stability in the first episode of psychosis

Introduction

Early intervention programs in psychosis have demonstrated efficiency in reduction the duration of untreated psychosis, relapse prevention, socio-professional integration and prognosis improvement. In daily practice, it is evident the clinical heterogeneity of the first episodes of psychosis (FEP), as well as the difficulty in initially assigning a specific diagnosis, being difficult to do the differential diagnosis and verifying, during follow-up, very different clinical outcomes among patients.

Objectives/aims

Two years after the start of specific consultation for FEP, the authors intended to characterize the followed patients and their evolution, comparing socio-demographic and clinical parameters, with emphasis on diagnosis at the first visit and after two years assessing their variability/stability.

Methods

Data research from a 48 patients sample followed up on the FEP consultation.

Results

The diagnostics on the first consultation were 79% psychosis with no other specification (NOS), followed by cannabinoids addiction in 35%. After two years, in 29% of cases, there was a diagnostic change being actually 46% Psychosis NOS, 21% cannabinoids addiction and 17% schizophrenia. Initially, only 39% did not have previous history of toxic substances use, being 75% the current percentage. Six percent abandoned the consultation.

Conclusions

The authors conclude that, in this specific psychiatry consultation, it is important to initially keep an unspecified diagnostic, with further progressive evaluation allowing a more accurate diagnostic, since the initial diagnostic specification is often found to be incorrect, with adverse consequences for the patient. It would be useful to compare the results with a sample of patients under “as usual” treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Treating bipolar disorder in pregnancy

Introduction

Bipolar disorder is a chronic psychiatric illnesses characterized by alternating episodes of mania/hypomania and major depression, or with mixed features. Acute exacerbations and maintenance treatment with appropriate pharmacotherapy are mandatory. Long-term treatment with mood-stabilizing medications is typically required. The incidence of bipolar disorders in women during the primary reproductive years is very high, and the episodes of mania or depression are thought to occur in an estimated 25%–30% of women with bipolar disorder during pregnancy.

Objectives

Provide a clinically focused review of the available information on the effectiveness and safety of the different pharmacotherapies in the treatment of bipolar disorder during pregnancy.

Methods

A bibliographic review is made of the pregnancy in bipolar disorder, based on the data published in PubMed.

Results

Clinical decision making about the use of mood stabilizers and atypical anti-psychotics by pregnant women can be conceptualized as balancing the competing risks imposed by withholding or stopping pharmacotherapeutic treatment against that of continuing or initiating pharmacotherapy during pregnancy. Some of the most effective pharmacotherapies have been associated with the occurrence of congenital malformations or other adverse neonatal effects in offspring. There is few information about the safety profile and clinical effectiveness of atypical anti-psychotic drugs when used to treat bipolar disorder during pregnancy.

Conclusions

Treating women with bipolar disorders during pregnancy is a challenge. There are no uniformly effective or risk-free treatment options. Fully informed decision-making requires the review of the risks of both untreated maternal bipolar disorder and risks associated with potentials interventions.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Using Quick Response Codes with Videos in the Laboratory

Using QR codes to access low-cost, educational, short videos in engineering laboratory classes might be a successful way of building a bridge from concrete to digital content. With QR codes placed on the apparatus, students will know exactly which video to watch. The scanned QR codes can be saved, enabling students to watch them again while performing the experiment or at home. Low-cost videos do not require expensive equipment and software, and keeping the videos short assures a minimum download time, making them compatible for use with smartphones and tablets. The aim of this research is to evaluate the importance undergraduate engineering students attribute to these videos and their reaction to the possibility of accessing them with QR codes scanned by a smartphone or a tablet. Results show students attributed some importance to the videos, and that the QR codes are very helpful as means to quickly and easily access the videos.

Emissions from the combustion of eucalypt and pine chips in a fluidized bed reactor

Interest in renewable energy sources has increased in recent years due to environmental concerns about global warming and air pollution, reduced costs and improved efficiency of technologies. Under the European Union (EU) energy directive, biomass is a suitable renewable source. The aim of this study was to experimentally quantify and characterize the emission of particulate matter (PM2.5) resulting from the combustion of two biomass fuels (chipped residual biomass from pine and eucalypt), in a pilot-scale bubbling fluidized bed (BFB) combustor under distinct operating conditions. The variables evaluated were the stoichiometry and, in the case of eucalypt, the leaching of the fuel. The CO and PM2.5 emission factors were lower when the stoichiometry used in the experiments was higher (0.33±0.1 g CO/kg and 16.8±1.0 mg PM2.5/kg, dry gases). The treatment of the fuel by leaching before its combustion has shown to promote higher PM2.5 emissions (55.2±2.5 mg/kg, as burned). Organic and elemental carbon represented 3.1 to 30 wt.% of the particle mass, while carbonate (CO3(2-)) accounted for between 2.3 and 8.5 wt.%. The particulate mass was mainly composed of inorganic matter (71% to 86% of the PM2.5 mass). Compared to residential stoves, BFB combustion generated very high mass fractions of inorganic elements. Chloride was the water soluble ion in higher concentration in the PM2.5 emitted by the combustion of eucalypt, while calcium was the dominant water soluble ion in the case of pine.

Electroconvulsive therapy in elderly - a preliminary study

Introduction

Studies with electroconvulsive therapy (ECT) in elderly focus mainly on the assessment of possible side effects on the cognitive functioning; there are few studies that evaluate the effectiveness.

Objective

Evaluate the effectiveness of this treatment in the population over 65 years.

Aims

Perform a preliminary study to evaluate the response to ECT of ≥ 65 years patients with depression.

Methods

We carry out a descriptive study based on patients treated in the last 10 years in the ECT Unit of Centro Hospitalar Psiquiátrico de Lisboa.

Results

Our initial sample consisted of 457 patients. We select patients aged ≥ 65 years with depression, and with complete data, including electroconvulsive parameters, and initial and final Hamilton Rating Scale for Depression (HRSD) scores (n = 59). Of this, 81.36% (n = 48) had unipolar depression, and 18.64% (n = 11) had bipolar depression. In the first group, the mean variation between the initial and final scores in HRSD was 13.88 points, and 27.10% (n = 13) of the patients ended the treatment in the normal range of HRSD score. In the second group, the mean variation was 12.82, and 63.60% (n = 7) ended the treatment in the normal range of HRSD. Considering the initial and final HRSD scores, it appears that unipolar depression group presents higher values (severe depression) (P < 0.05). When we compare the mean variation between the initial and final HRSD scores, we didn’t observe a statistically significant difference between the two groups. There was a clinical improvement in both.

Conclusions

The acute treatment with ECT appears to improve depressive symptoms in bipolar and unipolar depression, when considering an elderly population.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Upcycling spent petroleum cracking catalyst: pulsed laser deposition of single-wall carbon nanotubes and silica nanowires

From waste to single-wall carbon nanotubes and silica nanowires: the first high-tech outlet for FC3R.

Epstein-Barr virus-specific CD8(+) T lymphocytes from diffuse large B cell lymphoma patients are functionally impaired

Epstein-Barr virus (EBV) is a persistent virus with oncogenic capacity that has been implicated in the development of aggressive B cell lymphomas, primarily in immunosuppressed individuals, although it can be present in immunocompetent individuals. Changes in the function and clonal diversity of T lymphocytes might be implied by viral persistence and lymphoma development. The aim of the present study was to evaluate the frequency, phenotype, function and clonotypical distribution of EBV-specific T cells after peripheral blood stimulation with a virus lysate in newly diagnosed patients with diffuse large B cell lymphoma (DLBCL) aged more than 50 years without prior histories of clinical immunosuppression compared with healthy controls. Our results showed impaired EBV-specific immune responses among DLBCL patients that were associated primarily with decreased numbers of central and effector memory CD8(+) T lymphocytes. In contrast to healthy controls, only a minority of the patients showed CD4(+)/tumour necrosis factor (TNF)-α(+) T cells expressing T cell receptor (TCR)-Vβ17 and CD8(+)/TNF-α(+) T cells with TCR-Vβ5·2, Vβ9 and Vβ18 in response to EBV. Notably, the production of TNF-α was undetectable among TCR-Vβ5·3(+), Vβ11(+), Vβ12(+), Vβ16(+) and Vβ23(+) CD8(+) T cells. In addition, we observed decreased numbers of CD4(+)/TNF-α(+) and CD8(+)/TNF-α(+), CD8(+)/interleukin (IL)-2(+) and CD8(+)/TNF-α(+)/IL-2(+) T lymphocytes in the absence of T cells capable of producing TNF-α, IL-2 and IFN-γ after EBV stimulation simultaneously. Moreover, DLBCL patients displayed higher IL-10 levels both under baseline conditions and after EBV stimulation. These findings were also observed in patients with positive EBV viral loads. Prospective studies including a large number of patients are needed to confirm these findings.

Simultaneous detection of IgG, IgM, IgA complexes and C3d attached to erythrocytes by flow cytometry

INTRODUCTION

Immune complexes attached to erythrocyte membrane are involved in autoimmune hemolytic anemia (AIHA) pathogenesis. Currently, direct antiglobulin test (DAT) is used for AIHA diagnosis; however, its performance can be variable. The aim of this study was to design a flow cytometry protocol for simultaneous detection of IgG, IgM, IgA immune complexes and C3d attached to erythrocytes in AIHA patients .

METHODS

A procedure was standardized for assessing independent or simultaneous IgG, IgM, IgA immune complexes and C3d, which were detected using secondary antibodies. The protocol developed was applied to blood samples of patients with AIHA, donors at risk of developing the disease, and healthy controls.

RESULTS

Twenty-four blood samples were assessed: nine patients with AIHA, five donors at risk of developing the disease, and 10 healthy controls. In the AIHA group, all were positive for C3d, seven for IgG, four for IgA, and one for IgM. Two AIHA patients that were negative for DAT-IgG and C3d were positive for C3d by flow cytometry.

CONCLUSION

Flow cytometry is a consistent method for identifying the presence of IgG, IgM, IgA immune complexes and C3d attached to erythrocytes and can be helpful for understanding the mechanisms involved in AIHA pathogenesis.

Cell supermarket: adipose tissue as a source of stem cells

Adipose tissue is derived from numerous sources, and in recent years this tissue has been shown to provide numerous cells from what seemingly was a population of homogeneous adipocytes. Considering the types of cells that adipose tissue-derived cells may form, these cells may be useful in a variety of clinical and scientific applications. The focus of this paper is to reflect on this area of research and to provide a list of potential (future) research areas.