Computational Framework to Model the Selective Laser Sintering Process

Selective laser sintering (SLS) is one of the most well-regarded additive manufacturing (AM) sub-processes, whose popularity has been increasing among numerous critical and demanding industries due to its capabilities, mainly manufacturing parts with highly complex geometries and desirable mechanical properties, with potential to replace other, more expensive, conventional processes. However, due to its various underlying multi-physics phenomena, the intrinsic complexity of the SLS process often hampers its industrial implementation. Such limitation has motivated academic interest in obtaining better insights into the process to optimize it and attain the required standards. In that regard, the usual experimental optimization methods are time-consuming and expensive and can fail to provide the optimal configurations, leading researchers to resort to computational modeling to better understand the process. The main objective of the present work is to develop a computational model capable of simulating the SLS process for polymeric applications, within an open-source framework, at a particle-length scale to assess the main process parameters' impact. Following previous developments, virgin and used polymer granules with different viscosities are implemented to better represent the actual process feedstock. The results obtained agree with the available experimental data, leading to a powerful tool to study, in greater detail, the SLS process and its physical parameters and material properties, contributing to its optimization.

The BALA project: A pioneering monitoring of Azorean forest invertebrates over two decades (1999-2022)

Globally, there is a concerning decline in many insect populations, and this trend likely extends to all arthropods, potentially impacting unique island biota. Native non-endemic and endemic species on islands are under threat due to habitat destruction, with the introduction of exotic, and potentially invasive, species, further contributing to this decline. While long-term studies of plants and vertebrate fauna are available, long-term arthropod datasets are limited, hindering comparisons with better-studied taxa. The Biodiversity of Arthropods of the Laurisilva of the Azores (BALA) project has allowed gathering comprehensive data since 1997 in the Azorean Islands (Portugal), using standardised sampling methods across islands. The dataset includes arthropod counts from epigean (pitfall traps) and canopy-dwelling (beating samples) communities, enriched with species information, biogeographic origins, and IUCN categories. Metadata associated with the sample protocol and events, like sample identifier, archive number, sampled tree species, and trap type are also recorded. The database is available in multiple formats, including Darwin Core, which facilitates the ecological analysis of pressing environmental concerns, such as arthropod population declines and biological invasions.

Flexible tape-drive target system for secondary high-intensity laser-driven sources

We present the development of a flexible tape-drive target system to generate and control secondary high-intensity laser-plasma sources. Its adjustable design permits the generation of relativistic MeV particles and x rays at high-intensity (i.e., ≥1 × 1018 W cm-2) laser facilities, at high repetition rates (>1 Hz). The compact and robust structure shows good mechanical stability and a high target placement accuracy (<4 μm RMS). Its compact and flexible design allows for mounting in both the horizontal and vertical planes, which makes it practical for use in cluttered laser-plasma experimental setups. The design permits ∼170° of access on the laser-driver side and 120° of diagnostic access at the rear. A range of adapted apertures have been designed and tested to be easily implemented to the targetry system. The design and performance testing of the tape-drive system in the context of two experiments performed at the COMET laser facility at the Lawrence Livermore National Laboratory and at the Advanced Lasers and Extreme Photonics (ALEPH) facility at Colorado State University are discussed. Experimental data showing that the designed prototype is also able to both generate and focus high-intensity laser-driven protons at high repetition rates are also presented.

Leveraging a multivariate approach towards enhanced development of direct compression extended release tablets

Extended release formulations play a crucial role in the pharmaceutical industry by maintaining steady plasma levels, reducing side effects, and improving therapeutic efficiency and compliance. One commonly used method to develop extended release formulations is direct compression, which offers several advantages, such as simplicity, time savings, and cost-effectiveness. However, successful direct compression-based extended release formulations require careful assessment and an understanding of the excipients' attributes. The scope of this work is the characterization of the compaction behavior of some matrix-forming agents and diluents for the development of extended release tablets. Fifteen excipients commonly used in extended release formulations were evaluated for physical, compaction and tablet properties. Powder properties (e.g., particle size, flow properties, bulk density) were evaluated and linked to the tablet's mechanical properties in a fully integrated approach, and data were analyzed by constructing a principal component analysis (PCA). Significant variability was observed among the various excipients. The present work successfully demonstrates the applicability of PCA as an effective tool for comparative analysis, pattern and clustering recognition and correlations between excipients and their properties, facilitating the development and manufacturing of direct compressible extended release formulations.

ST-Segment Elevation: An Unexpected Culprit

The clinical presentation of pulmonary embolism (PE) and acute coronary syndrome can be similar. We report a case of a patient presenting with antero-septal ST-segment elevation after cardiac arrest, found to have acute-PE-mimicking ST-segment elevation myocardial infarction (STEMI), treated with aspiration thrombectomy and catheter-directed thrombolysis (CDT). A 78-year-old man was admitted with dyspnea, chest pain and tachycardia. During evaluation, cardiac arrest in pulseless electrical activity was documented. Advanced life support was started immediately. ECG post-ROSC revealed ST-segment elevation in V1-V4 and aVR. Echocardiography showed normal left ventricular function but right ventricular (RV) dilation and severe dysfunction. The patient was in shock and was promptly referred to cardiac catheterization that excluded significant CAD. Due to the discordant ECG and echocardiogram findings, acute PE was suspected, and immediate invasive pulmonary angiography revealed bilateral massive pulmonary embolism. Successful aspiration thrombectomy was performed followed by local alteplase infusion. At the end of the procedure, mPAP was reduced and blood pressure normalized allowing withdrawal of vasopressor support. Twenty-four-hour echocardiographic reassessment showed normal-sized cardiac chambers with preserved biventricular systolic function. Bedside echocardiography in patients with ST-segment elevation post-ROSC is instrumental in raising the suspicion of acute PE. In the absence of a culprit coronary lesion, prompt pulmonary angiography should be considered if immediately feasible. In these cases, CDT and aspiration in high-risk acute PE seem safe and effective in relieving obstructive shock and restoring hemodynamics.

A Randomized Controlled Trial Comparing BioMime Sirolimus-Eluting Stent With Everolimus-Eluting Stent: Two-Year Outcomes of the meriT-V Trial

BACKGROUND

Drug-eluting stents (DESs) based on biodegradable polymers (BPs) have been introduced to reduce the risk for late and very late stent thrombosis (ST), which were frequently observed with earlier generations of DES designs based on durable polymers (DPs); however, randomized controlled trials on these DES designs are scarce. The meriT-V trial is a randomized, active-controlled, non-inferiority trial with a prospective, multicenter design that evaluated the 2-year efficacy of a novel third-generation, ultra-thin strut, BP-based BioMime sirolimus-eluting stent (SES) versus the DP-based XIENCE everolimus-eluting stent (EES) for the treatment of de novo lesions.

METHODS

The meriT-V is a randomized trial that enrolled 256 patients at 15 centers across Europe and Brazil. Here, we report the outcomes of the extended follow-up period of 2 years. The randomization of enrolled patients was in a 2:1 ratio; the enrolled patients received either the BioMime SES (n = 170) or the XIENCE EES (n = 86). The three-point major adverse cardiac event (MACE), defined as a composite of cardiac death, myocardial infarction (MI), or ischemia-driven target vessel revascularization (ID-TVR), was considered as the composite safety and efficacy endpoint. Ischemia-driven target lesion revascularization (ID-TLR) was evaluated as well as the frequency of definite/probable ST, based on the first Academic Research Consortium definitions.

RESULTS

The trial had a 2-year follow-up completion rate of 98.44% (n = 252/256 patients), and the clinical outcomes assessment showed a nonsignificant difference in the cumulative rate of three-point MACE between both arms (BioMime vs. XIENCE: 7.74% vs. 9.52%, P = 0.62). Even the MI incidences in the BioMime arm were insignificantly lower than those of the XIENCE arm (1.79% vs. 5.95%, P = 0.17). Late ST was observed in 1.19% cases of the XIENCE arm, while there were no such cases in the BioMime arm (P = 0.16).

CONCLUSIONS

The objective comparisons between the novel BP-based BioMime SES and the well-established DP-based XIENCE EES in this randomized controlled trial show acceptable outcomes of both the devices in the cardiac deaths, MI, ID-TVR, and ST. Moreover, since there were no incidences of cardiac death in the entire study sample over the course of 2 years, we contend that the findings of the study are highly significant for both these DES designs. In this preliminary comparative trial, the device safety of BioMime SES can be affirmed to be acceptable, considering the lower three-point MACE rate and absence of late ST in the BioMime arm over the 2-year period.

Discussing the possibility of fertility treatment being unsuccessful as part of routine care offered at clinics: patients' experiences, willingness, and preferences

STUDY QUESTION

Are patients willing to discuss the possibility of treatment being unsuccessful as part of routine care offered at clinics, and what are the factors associated with this willingness?

SUMMARY ANSWER

Nine in every 10 patients are willing to discuss this possibility as part of routine care, with willingness being associated with higher perceived benefits, lower barriers, and stronger positive attitudes towards it.

WHAT IS KNOWN ALREADY

Fifty-eight percent of patients who complete up to three cycles of IVF/ICSI in the UK do not achieve a live birth. Offering psychosocial care for unsuccessful fertility treatment (PCUFT), defined as assistance and guidance on the implications of treatment being unsuccessful, could reduce the psychosocial distress patients experience when it happens, and promote positive adjustment to this loss. Research shows 56% of patients are willing to plan for an unsuccessful cycle, but little is known about their willingness and preferences towards discussing the possibility of definitive unsuccessful treatment.

STUDY DESIGN, SIZE, DURATION

The study was of cross-sectional design, comprising a theoretically driven and patient-centred bilingual (English, Portuguese) mixed-methods online survey. The survey was disseminated via social media (April 2021-January 2022). Eligibility criteria included being aged 18 or older, waiting to or undergoing an IVF/ICSI cycle, or having completed a cycle within the previous 6 months without achieving a pregnancy. Out of 651 people accessing the survey, 451 (69.3%) consented to participate. From these, 100 did not complete 50% of the survey questions, nine did not report on the primary outcome variable (willingness), and 342 completed the survey (completion rate 75.8%, 338 women).

PARTICIPANTS/MATERIALS, SETTING, METHODS

The survey was informed by the Health Belief Model (HBM) and Theory of Planned Behaviour (TPB). Quantitative questions covered sociodemographic characteristics and treatment history. Quantitative and qualitative questions gathered data on past experiences, willingness, and preferences (with whom, what, how and when) to receive PCUFT, as well as theory-informed factors hypothesized to be associated with patients' willingness to receive it. Descriptive and inferential statistics were used on quantitative data about PCUFT experiences, willingness, and preferences, and thematic analysis was applied to textual data. Two logistic regressions were used to investigate the factors associated with patients' willingness.

MAIN RESULTS AND THE ROLE OF CHANCE

Participants were, on average, 36 years old and most resided in Portugal (59.9%) and the UK (38.0%). The majority (97.1%) were in a relationship for around 10 years, and 86.3% were childless. Participants were undergoing treatment for, on average, 2 years [SD = 2.11, range: 0-12 years], with most (71.8%) having completed at least one IVF/ICSI cycle in the past, almost all (93.5%) without success. Around one-third (34.9%) reported having received PCUFT. Thematic analysis showed participants received it mainly from their consultant. The main topic discussed was patients' low prognosis, with the emphasis being put on achieving a positive outcome. Almost all participants (93.3%) would like to receive PCUFT. Reported preferences indicated that 78.6% wanted to receive it from a psychologist/psychiatrist/counsellor, mostly in case of a bad prognosis (79.4%), emotional distress (73.5%), or difficulties in accepting the possibility of treatment being unsuccessful (71.2%). The preferred time to receive PCUFT was before initiating the first cycle (73.3%), while the preferred format was in an individual (mean = 6.37, SD = 1.17; in 1-7 scale) or couple (mean = 6.34, SD = 1.24; in 1-7 scale) session. Thematic analysis showed participants would like PCUFT to provide an overview of treatment and all possible outcomes tailored to each patient's circumstances and to encompass psychosocial support, mainly focused on coping strategies to process loss and sustain hope towards the future. Willingness to receive PCUFT was associated with higher perceived benefit of building psychosocial resources and coping strategies (odds ratios (ORs) 3.40, 95% CI 1.23-9.38), lower perceived barrier of triggering negative emotions (OR 0.49, 95% CI 0.24-0.98), and stronger positive attitudes about PCUFT being beneficial and useful (OR 3.32, 95% CI 2.12-5.20).

LIMITATIONS, REASONS FOR CAUTION

Self-selected sample, mainly composed of female patients who had not yet achieved their parenthood goals. The small number of participants unwilling to receive PCUFT reduced statistical power. The primary outcome variable was intentions, and research shows a moderate association between intentions and actual behaviour.

WIDER IMPLICATIONS OF THE FINDINGS

Fertility clinics should provide patients with early opportunities to discuss the possibility of their treatment being unsuccessful as part of routine care. PCUFT should focus on minimizing suffering associated with grief and loss by reassuring patients they can cope with any treatment outcome, promoting coping resources, and signposting to additional support.

STUDY FUNDING/COMPETING INTEREST(S)

M.S.-L. holds a doctoral fellowship from the Portuguese Foundation for Science and Technology, I.P. [Fundação para a Ciência e a Tecnologia] (FCT; SFRH/BD/144429/2019). R.C. holds a post-doctoral fellowship supported by the European Social Fund (ESF) and FCT (SFRH/BPD/117597/2016). The EPIUnit, ITR and CIPsi (PSI/01662) are also financed by FCT through the Portuguese State Budget, in the scope of the projects UIDB/04750/2020, LA/P/0064/2020 and UIDB/PSI/01662/2020, respectively. Dr Gameiro reports consultancy fees from TMRW Life Sciences and Ferring Pharmaceuticals A/S, speaker fees from Access Fertility, SONA-Pharm LLC, Meridiano Congress International and Gedeon Richter, grants from Merck Serono Ltd, an affiliate of Merck KgaA, Darmstadt, Germany.

TRIAL REGISTRATION NUMBER

N/A.

RNA- and ATAC-sequencing Reveals a Unique CD83+ Microglial Population Focally Depleted in Parkinson's Disease

All brain areas affected in Parkinson's disease (PD) show an abundance of microglia with an activated morphology together with increased expression of pro-inflammatory cytokines, suggesting that neuroinflammation may contribute to the neurodegenerative process in this common and incurable disorder. We applied a single nucleus RNA- and ATAC-sequencing approach using the 10x Genomics Chromium platform to postmortem PD samples to investigate microglial heterogeneity in PD. We created a multiomic dataset using substantia nigra (SN) tissues from 19 PD donors and 14 non-PD controls (NPCs), as well as three other brain regions from the PD donors which are differentially affected in this disease: the ventral tegmental area (VTA), substantia inominata (SI), and hypothalamus (HypoTs). We identified thirteen microglial subpopulations within these tissues as well as a perivascular macrophage and a monocyte population, of which we characterized the transcriptional and chromatin repertoires. Using this data, we investigated whether these microglial subpopulations have any association with PD and whether they have regional specificity. We uncovered several changes in microglial subpopulations in PD, which appear to parallel the magnitude of neurodegeneration across these four selected brain regions. Specifically, we identified that inflammatory microglia in PD are more prevalent in the SN and differentially express PD-associated markers. Our analysis revealed the depletion of a CD83 and HIF1A- expressing microglial subpopulation, specifically in the SN in PD, that has a unique chromatin signature compared to other microglial subpopulations. Interestingly, this microglial subpopulation has regional specificity to the brainstem in non-disease tissues. Furthermore, it is highly enriched for transcripts of proteins involved in antigen presentation and heat-shock proteins, and its depletion in the PD SN may have implications for neuronal vulnerability in disease.

Ioxaglate Versus IoDixanol for the Prevention of Contrast-Induced Nephropathy: The IDPC Trial

BACKGROUND

Despite the potential benefits of percutaneous procedures for the assessment and treatment of coronary artery disease, these interventions require the use of iodine contrast, which might lead to contrast-induced nephropathy (CIN) and increased risk of dialysis and major adverse cardiac events (MACE).

AIMS

We sought to compare two different iodine contrasts (low vs. iso-osmolar) for the prevention of CIN among high-risk patients.

METHODS

This is a single-center, randomized (1:1) trial comparing consecutive patients at high risk for CIN referred to percutaneous coronary diagnostic and/or therapeutic procedures with low (ioxaglate) vs. iso-osmolarity (iodixanol) iodine contrast. High risk was defined by the presence of at least one of the following conditions: age >70 years, diabetes mellitus, non-dialytic chronic kidney disease, chronic heart failure, cardiogenic shock, and acute coronary syndrome (ACS). The primary endpoint was the occurrence of CIN, defined as a >25% relative increase and/or >0.5 mg/dL absolute increase in creatinine (Cr) levels compared with baseline between the 2nd and 5th day after contrast media administration.

RESULTS

A total of 2,268 patients were enrolled. Mean age was 67 years. Diabetes mellitus (53%), non-dialytic chronic kidney disease (31%), and ACS (39%) were highly prevalent. The mean volume of contrast media was 89 ml ± 48.6. CIN occurred in 15% of all patients, with no significant difference regarding the type of contrast used (iso = 15.2% vs. low = 15.1%, P>.99). Differences were not observed in specific subgroups such as diabetics, elderly, and ACS patients. At 30-day follow-up, 13 patients in the iso-osmolarity group and 11 in low-osmolarity group required dialysis (P =.8). There were 37 (3.3%) deaths in the iso-osmolarity cohort vs. 29 (2.6%) in the low-osmolarity group (P =.4).

CONCLUSION

Among patients at high risk for CIN, the incidence of this complication was 15%, and independent of the use of low- or iso-osmolar contrast.

Serial Assessment of Coronary Artery Healing of a Biodegradable Polymer Drug-Eluting Stent at 1, 2, and 3 Months by Optical Coherence Tomography (OCT)-The REPAIR Trial

BACKGROUND

Although first-generation drug-eluting stent (DES) devices have effectively achieved their main goal of reducing restenosis, their safety has been limited by suboptimal polymer biocompatibility, delayed stent endothelialization, and local drug toxicity, which ultimately prompted the development of new-generation DES options carrying biocompatible or even biodegradable polymers.

AIMS

We sought to assess the vessel-healing pattern of the novel sirolimus-eluting Inspiron DES (Scitech Medical) using serial optical coherence tomography (OCT) and assuming the hypothesis that this thin-strut (75-μm), biodegradable-polymer DES promotes a faster healing, with very early strut coverage.

METHODS

This is a prospective, multicenter, open-label, single-arm study enrolling 68 patients who underwent percutaneous coronary intervention guided by OCT. These patients were consecutively assigned into 3 groups. The first group had its OCT imaging follow-up performed at 3 months, the second group at 2 months, and the third group at 1 month.

RESULTS

Mean age was 59.5 years, 70.6% were male, 41.2% had type 2 diabetes, and 29.4% presented with acute coronary syndrome. A total of 72 lesions were treated and 1.06 stents were implanted per patient. OCT assessment of the stents at 1, 2, and 3 months showed a strut coverage of 90.41%, 93.96%, and 97.21%, respectively (P=.04).

CONCLUSION

The Inspiron DES showed an early strut healing pattern, with >90% of the struts covered by neointima within the first month and with almost all struts covered by the third month.

Abstract 3197: Adoptive T cell therapy using IL-7 and IL-15 expanded HER2-specific CD4 T cells for metastatic breast cancer

BACKGROUND: Adoptive cell therapy (ACT) has had limited success due to low T cell infiltration in breast cancer (BC) patients. We have shown that administration of class II HER2 peptide pulsed type I polarized dendritic cell (DC1) vaccines leads to increase in CD4 T cells in the periphery of BC patients. In this study, we investigated the feasibility of expanding CD4 T cells from peripheral blood mononuclear cells (PBMC) of HER2-DC1 vaccinated BC patients.

METHODS: PBMCs from BC patients receiving HER2-DC1 vaccines were used for CD4 T cell expansion. PBMCs were co-cultured with HER2-DC1 at 10:1 ratio for initial activation followed by expansion with cytokines- IL-2 and IL-7 or IL-15. Expanded T cells were assessed for immune marker phenotyping by flow cytometry and TCRvb analysis. For TCRvB analysis, pre, post DC1, IL-7 and IL-15 expanded CD4 T cells were pelleted for DNA isolation and sequenced using Immunoseq Analyzer platform. In addition, we investigated the in vivo efficacy of adoptively transferred mouse IL-7/IL-15 expanded Her2 specific CD4 T cells in HER2+ TUBO mouse model.

RESULTS: Co-culturing of patient PBMCs with HER2-DC1 in the presence of cytokines IL-2, IL-7 and IL-15 expanded CD4 T cells ranging from 8-43 fold expansion in different samples with 92-98% CD4 phenotype. CD4 T cells expanded in IL-7 had stem like memory phenotype while IL-15 skewed to terminally differentiated CD4 T cells. IL-7 expanded T cells had significantly higher Tim3 and Ox40 expression, and effector memory proportion as compared to the IL-15 expanded T cells. Restimulation of expanded T cells with HER2 pulsed DCs showed HER2 specificity as measured by increased interferon-gamma production We identified top five clones in PBMCs from DC1-HER2 vaccinated BC patients compared to baseline. We observed differential abundance of TCR clones under IL-7 and IL-15 conditions and identified unique clones for IL-7 and IL-15. ACT using a combination of IL-7 and IL-15 expanded mouse CD4 T cells led to 50% tumor regression in HER2+ model.

CONCLUSION: These studies demonstrate that HER2 specific CD4 T cells can be successfully expanded from HER2-DC1 vaccinated patients. Post HER2 DC1 vaccine can generate a pool of antigen specific CD4 T cells and may offer a promising ACT for HER2 BC. Further studies are warranted to demonstrate the efficacy in the clinical setting.

Citation Format: Namrata Gautam, Krithika Kodumudi, Colin Snyder, Amber Beyer, Ricardo Costa, Heather Han, Brian Czerniecki. Adoptive T cell therapy using IL-7 and IL-15 expanded HER2-specific CD4 T cells for metastatic breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 3197.

Post-acute sequelae of COVID-19 is characterized by diminished peripheral CD8+β7 integrin+ T cells and anti-SARS-CoV-2 IgA response

Several millions of individuals are estimated to develop post-acute sequelae SARS-CoV-2 condition (PASC) that persists for months after infection. Here we evaluate the immune response in convalescent individuals with PASC compared to convalescent asymptomatic and uninfected participants, six months following their COVID-19 diagnosis. Both convalescent asymptomatic and PASC cases are characterised by higher CD8⁺ T cell percentages, however, the proportion of blood CD8⁺ T cells expressing the mucosal homing receptor β7 is low in PASC patients. CD8 T cells show increased expression of PD-1, perforin and granzyme B in PASC, and the plasma levels of type I and type III (mucosal) interferons are elevated. The humoral response is characterized by higher levels of IgA against the N and S viral proteins, particularly in those individuals who had severe acute disease. Our results also show that consistently elevated levels of IL-6, IL-8/CXCL8 and IP-10/CXCL10 during acute disease increase the risk to develop PASC. In summary, our study indicates that PASC is defined by persisting immunological dysfunction as late as six months following SARS-CoV-2 infection, including alterations in mucosal immune parameters, redistribution of mucosal CD8⁺β7Integrin⁺ T cells and IgA, indicative of potential viral persistence and mucosal involvement in the etiopathology of PASC.

Abstract OT3-19-01: Phase II Study of Screening Brain MRIs in Stage IV Breast Cancer

Background: As systemic therapy improves, there has been an increasing number of breast cancer patients who develop brain metastasis. Screening of asymptomatic stage IV breast cancer patients with brain MRIs is not currently recommended by the National Comprehensive Cancer Network (NCCN) Guidelines. Retrospective reports suggest breast cancer patients are more likely to present with more advanced central nervous system disease at the time of brain metastasis diagnosis compared to melanoma and non-small cell lung cancer (NSCLC) patients. This may be in part due to routine screening recommendations in melanoma and NSCLC. Early detection and treatment of brain metastases may improve outcomes for breast cancer patients. Trial Design: The study is designed as a single arm, nonrandomized phase II study, with the goal of investigating the role of screening brain MRIs in neurologically asymptomatic patients with metastatic breast cancer. Breast cancer patients will be allocated based on receptor subtypes into triple negative (TN), HER2+, and hormone receptor (HR)+/HER2- breast cancer. Following study enrollment, patients will undergo a screening brain MRI. Patients will undergo a second brain MRI at first systemic progression or at 6 months whichever event occurs sooner. Eligibility: Asymptomatic, stage IV breast cancer patients that have progressed past first line therapy in the metastatic setting with an ECOG/= 6 months are eligible. Specific Aims: The primary objective is to determine the incidence of asymptomatic brain metastasis in metastatic breast cancer by subtype. Secondary objectives include determining the incidence of asymptomatic leptomeningeal disease, the number and size of brain metastases at diagnosis, the number of patients requiring whole brain radiation therapy vs. stereotactic radiation following diagnosis and overall survival and brain metastasis specific survival following brain metastasis diagnosis in metastatic breast cancer by subtype. Statistical Methods: A total of 30, 30, and 40 TN, HER2+, and HR+/HER2-, breast cancer patients will be enrolled, respectively. Using an incidence rate of 17%, the 95% CI by subtype will be (0.06,0.351), (0.06,0.351), and (0.07,0.322). Patient Accrual: This study is open with 30 patients enrolled at the time of submission. A total of 100 patients will be enrolled. Contact Information: Kamran A. Ahmed MD, Moffitt Cancer Center, email: kamran.ahmed@moffitt.org, Clinical trial information: NCT05115474. Funding: Florida Breast Cancer Foundation.

Citation Format: Kamran A. Ahmed, Youngchul Kim, Avan Armaghani, John Arrington, Ricardo Costa, Brian J. Czerniecki, Roberto Diaz, Peter A. Forsyth, Hung Khong, Kimberley Lee, Loretta Loftus, Marilin Rosa, Hatem H. Soliman, Iman Washington, Aixa Soyano, Hyo S. Han. Phase II Study of Screening Brain MRIs in Stage IV Breast Cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr OT3-19-01.

Oncolytic T-VEC virotherapy plus neoadjuvant chemotherapy in nonmetastatic triple-negative breast cancer: a phase 2 trial

Talimogene laherparepvec (T-VEC) is an oncolytic virus hypothesized to enhance triple-negative breast cancer (TNBC) responses to neoadjuvant chemotherapy (NAC). This article describes the phase 2 trial of T-VEC plus NAC (ClinicalTrials.gov ID: NCT02779855 ). Patients with stage 2-3 TNBC received five intratumoral T-VEC injections with paclitaxel followed by doxorubicin and cyclophosphamide and surgery to assess residual cancer burden index (RCB). The primary end point was RCB0 rate. Secondary end points were RCB0-1 rate, recurrence rate, toxicity and immune correlates. Thirty-seven patients were evaluated. Common T-VEC toxicities were fevers, chills, headache, fatigue and injection site pain. NAC toxicities were as expected. Four thromboembolic events occurred. The primary end point was met with an estimated RCB0 rate = 45.9% and RCB0-1 descriptive rate = 65%. The 2-year disease-free rate is equal to 89% with no recurrences in RCB0-1 patients. Immune activation during treatment correlated with response. T-VEC plus NAC in TNBC may increase RCB0-1 rates. These results support continued investigation of T-VEC plus NAC for TNBC.

Comparative bench study evaluation of a modified snorkeling mask used during COVID-19 pandemic and standard interfaces for non-invasive ventilation

PURPOSE

The aim of this bench study is to compare the standard NIV and nCPAP devices (Helmet, H; Full face mask, FFM) with a modified full face snorkeling mask used during COVID-19 pandemic.

METHODS

A mannequin was connected to an active lung simulator. The inspiratory and expiratory variations in airways pressure observed with a high simulated effort, were determined relative to the preset CPAP level. NIV was applied in Pressure Support Mode at two simulated respiratory rates and two cycling-off flow thresholds. During the bench study, we measured the variables defining patient-ventilator interaction and performance.

RESULTS

During nCPAP, the tested interfaces did not show significant differences in terms of ∆Pawi and ∆Pawe. During NIV, the snorkeling mask demonstrated a better patient-ventilator interaction compared to FFM, as shown by significantly shorter Pressurization Time and Expiratory Trigger Delay (p < 0.01), but no significant differences were found in terms of Inspiratory Trigger Delay and Time of Synchrony between the interfaces tested. At RR 20sim, the snorkeling mask presented the lower ΔPtrigger (p < 0.01), moreover during all the conditions tested the snorkeling mask showed the longer Pressure Time Product at 200, 300, and 500 ms compared to FFM (p < 0.01). A major limitation of snorkeling mask is that during NIV with this interface it is possible to reach maximum 18 cmH₂O of peak inspiratory pressure.

CONCLUSIONS

The modified snorkeling mask can be used as an acceptable alternative to other interfaces for both nCPAP and NIV in emergencies.

Ticagrelor Loading on ST-Elevation Myocardial Infarction: Interaction With Prodromal Angina on Infarct Size and Clinical Events

INTRODUCTION

Ticagrelor might reduce infarct size by exerting a more potent antiplatelet effect or by promoting a potential conditioning stimulus in ST-elevation myocardial infarction (STEMI) patients. Pre-infarction angina (PIA) is an effective preconditioning stimulus that reduces ischemia-reperfusion injury. Because little is known on the interaction of PIA in STEMI-patients loaded with ticagrelor, we sought to determine if patients loaded with ticagrelor had improved clinical outcomes as compared to clopidogrel and to study if it is modulated by the presence of PIA.

METHODS

From 1272 STEMI patients submitted to primary percutaneous coronary intervention and treated with clopidogrel or ticagrelor from January 2008 to December 2018, 826 were analyzed after propensity score matching. Infarct size was estimated using peak creatine kinase (CK) and troponin T (TnT), and clinical impact was evaluated through cumulative major cardiac and cerebrovascular events (MACCE) at 1-year follow-up. Matched patients and their interaction with PIA were analyzed.

RESULTS

Patients loaded with ticagrelor had lower peak CK [1405.50 U/L (730.25-2491.00), P < .001] and TnT [3.58 ng/mL (1.73-6.59), P < .001)], regardless of PIA. The presence of PIA was associated with lower CK (P = .030), but not TnT (P = .097). There was no interaction between ticagrelor loading and PIA (P = .788 for TnT and P = .555 for CK). There was no difference in MACCE incidence between clopidogrel or ticagrelor loading (P = .129). Cumulative survival was also similar between clopidogrel or ticagrelor, regardless of PIA (P = .103).

CONCLUSION

Ticagrelor reduced infarct sizes independently and without a synergic effect with PIA. Despite reducing infarct size, clinical outcomes were similar across both groups.

SLAM Project - Long Term Ecological Study of the Impacts of Climate Change in the natural forests of Azores: V - New records of terrestrial arthropods after ten years of SLAM sampling

Background

A long-term study monitoring arthropods (Arthropoda) is being conducted since 2012 in the forests of Azorean Islands. Named "SLAM - Long Term Ecological Study of the Impacts of Climate Change in the natural forest of Azores", this project aims to understand the impact of biodiversity erosion drivers in the distribution, abundance and diversity of Azorean arthropods. The current dataset represents arthropods that have been recorded using a total of 42 passive SLAM traps (Sea, Land and Air Malaise) deployed in native, mixed and exotic forest fragments in seven Azorean Islands (Flores, Faial, Pico, Graciosa, Terceira, São Miguel and Santa Maria). This manuscript is the fifth data-paper contribution, based on data from this long-term monitoring project.

New information

We targeted taxa for species identification belonging to Arachnida (excluding Acari), Chilopoda, Diplopoda, Hexapoda (excluding Collembola, Lepidoptera, Diptera and Hymenoptera (but including only Formicidae)). Specimens were sampled over seven Azorean Islands during the 2012-2021 period. Spiders (Araneae) data from Pico and Terceira Islands are not included since they have been already published elsewhere (Costa and Borges 2021, Lhoumeau et al. 2022). We collected a total of 176007 specimens, of which 168565 (95.7%) were identified to the species or subspecies level. For Araneae and some Hemiptera species, juveniles are also included in this paper, since the low diversity in the Azores allows a relatively precise species-level identification of this life-stage. We recorded a total of 316 named species and subspecies, belonging to 25 orders, 106 families and 260 genera. The ten most abundant species were mostly endemic or native non-endemic (one Opiliones, one Archaeognatha and seven Hemiptera) and only one exotic species, the Julida Ommatoiulusmoreleti (Lucas, 1860). These ten species represent 107330 individuals (60%) of all sampled specimens and can be considered as the dominant species in the Azorean native forests for the target studied taxa. The Hemiptera were the most abundant taxa, with 90127 (50.4%) specimens. The Coleoptera were the most diverse with 30 (28.6%) families.We registered 72 new records for many of the islands (two for Flores, eight for Faial, 24 for Graciosa, 23 for Pico, eight for Terceira, three for São Miguel and four for Santa Maria). These records represent 58 species. None of them is new to the Azores Archipelago. Most of the new records are introduced species, all still with low abundance on the studied islands. This publication contributes to increasing the baseline information for future long-term comparisons of the arthropods of the studied sites and the knowledge of the arthropod fauna of the native forests of the Azores, in terms of species abundance, distribution and diversity throughout seasons and years.

Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry

AIMS

The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation.

METHODS AND RESULTS

Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin.

CONCLUSION

The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.

Right Ventricular Septal Versus Apical Pacing: Long-Term Incidence of Heart Failure and Survival

The clinical benefits of right ventricular septal (RVS) pacing compared to those of right ventricular apical (RVA) pacing are still in debate. We aimed to compare the incidence of heart failure (HF) and all-cause mortality in patients submitted to RVS and RVA pacing during a longer follow-up. This a single-center, retrospective study analysis of consecutive patients submitted to pacemaker implantation. The primary outcome was defined as the occurrence of HF during follow-up. The secondary outcome was all-cause death. A total of 251 patients were included, 47 (18.7%) with RVS pacing. RVS pacing was associated to younger age, male gender, lower body mass index, ischemic heart disease, and atrial fibrillation. During a follow-up period of 5.2 years, the primary outcome occurred in 89 (37.1%) patients. RVS pacing was independently associated with a 3-fold lower risk of HF, after adjustment. The secondary outcome occurred in 83 (34.2%) patients, and pacemaker lead position was not a predictor. Fluoroscopy time and rate of complications (rarely life-threatening) were similar in both groups. Our study points to a potential clinical benefit of RVS positioning, with a 3.3-fold lower risk of HF, without accompanying increase in procedure complexity nor complication rate.

SLAM Project - Long Term Ecological Study of the Impacts of Climate Change in the natural forest of Azores: IV - The spiders of Terceira and Pico Islands (2019-2021) and general diversity patterns after ten years of sampling

Background

Long-term studies are key to understand the drivers of biodiversity erosion, such as land-use change and habitat degradation, climate change, invasive species or pollution. The long-term project SLAM (Long Term Ecological Study of the Impacts of Climate Change in the natural forest of Azores) started in 2012 and focuses on arthropod monitoring, using SLAM (Sea, Land and Air Malaise) traps, aiming to understand the impact of the drivers of biodiversity erosion on Azorean native forests (Azores, Portugal). This is the fourth contribution including SLAM project data and the second focused on the spider fauna (Arachnida, Araneae) of native forests on two islands (Pico and Terceira). In this contribution, we describe data collected between 2019 and 2021 and we analyse them together with a previously published database that covered the 2012-2019 period, in order to describe changes in species abundance patterns over the last ten years.

New information

We present abundance data of Azorean spider species for the 2019-2021 period in two Azorean Islands (Terceira and Pico). We also present analyses of species distribution and abundance of the whole sampling period. In the period of 2019-2021, we collected a total of 5110 spider specimens, of which 2449 (48%) were adults. Most juveniles, with the exception of some exotic Erigoninae, were also included in the data presented in this paper, since the low diversity of spiders in the Azores allows a relatively precise species-level identification of this life-stage. We recorded a total of 45 species, belonging to 39 genera and 16 families. The ten most abundant species were composed mostly of endemic or native non-endemic species and only two exotic species (Tenuiphantestenuis (Blackwall, 1852) and Dysderacrocata C. L. Koch, 1838). They included 4308 individuals (84%) of all sampled specimens and were the dominant species in Azorean native forests. The family Linyphiidae was the richest and most abundant taxon, with 15 (33%) species and 2630 (51%) specimens. We report Cheiracanthiummildei L. Koch, 1864, a non-native species, from Pico Island for the first time. We found no new species records on Terceira Island. This publication contributes to increasing the baseline information for future long-term comparisons of the spiders on the studied sites and the knowledge of the arachnofauna of the native forests of Terceira and Pico, in terms of species abundance, distribution and diversity across seasons for a 10 years period.

Exclusive breastfeeding during the COVID-19 pandemic in 17 WHO European Region countries

Background

Maternal experience of labour and delivery is multidimensional and is influenced by a variety of factors.

Aim

to report maternal childbirth experience as described by the women themselves during the COVID-19 pandemic in Sweden using a WHO Standards-based tool adapted for an online survey (Quality of maternal and newborn care-QMNC).

Methods

Women ≥ 18 years of age who gave birth from March 1, 2020 to June 30, 2021 were asked to give voluntary consent to participate in an online survey. The survey included 40 questions on four key domains: provision of care, experience of care, availability of human and physical resources and organisational changes due to COVID-19.

Results

5003 women were included in the analysis. Among those who underwent labour (n = 4528), 46.7% perceived a reduction in QMNC due to the COVID-19 pandemic, 50.7% were not allowed a companion of choice, 62.5% reported that health workers were not always using protective personal equipment and 36.5% rated the number of health workers as “insufficient”. Fundal pressure was applied in 22.2% of instrumental vaginal births and 36.8% received inadequate breastfeeding support. In addition, 18.4% of women did not feel treated with dignity and 6.9% reported some form of abuse. In general, findings were significantly worse among women who did not undergo labour (n = 475).

Conclusions

Swedish mothers’ satisfaction of care provided during childbirth was strongly influenced by many variables. Actions to promote high-quality, evidence-based, patient-centered respectful care for all mothers and newborns are urgently needed.

Health-related quality of life among five-year-old extremely preterm children with motor disorders

Background

Motor disorders resulting from extremely preterm birth (EPT; &lt;28 weeks’ gestation) can limit daily activities, schooling and social relationships. Cerebral palsy (CP) affects about 10% of children and non-CP movement difficulties (MD) are highly prevalent, although they tend to be under-diagnosed, especially in children without other developmental difficulties. We investigated the association between motor disorders and health-related quality of life (HRQoL) among five-year-old children born EPT.

Methods

We included children at age five from a population-based EPT birth cohort born in 2011-2012 in 11 European countries (N = 1,021). Children without CP were classified using the Movement Assessment Battery for Children - 2nd edition as having significant MD (≤5th percentile of standardised norms) or being at risk of MD (6th-15th percentile). Parents reported on CP diagnoses and HRQoL using the Pediatric Quality of Life InventoryTM. We used linear regression to compare HRQoL scores by motor status adjusting for social characteristics.

Results

Children born EPT with CP, significant MD and at risk of MD had lower adjusted HRQoL total scores [95% confidence intervals] than those without MD: -26.1 [-31.0; -21.2], -9.1 [-12.0; -6.1] and -5.0 [-7.7; -2.3]. Decreases were greater for physical scores: -35.3 [-42.7; -27.9], -11.9 [-16.1; -7.8] and -5.4 [-9.1; -1.6] than psychosocial scores: -20.6 [-25.2; -16.0], -7.4 [-10.3; -4.5] and -4.9 [-7.6; -2.1]. These differences persisted after exclusion of children with other developmental difficulties.

Conclusions

Motor disorders among 5-year-old children born EPT were associated with lower HRQoL, even among children with less severe motor difficulties and without other developmental difficulties.

Key messages

Individual and country-level variables associated with the medicalization of birth

Introduction

According to the World Health Organization, the medicalisation of birth tends “to undermine the woman's own capability to give birth and negatively impacts her childbirth experience”. The COVID-19 pandemic has disrupted maternity care, with potential increase in the medicalisation of birth and in occurrences of disrespectful maternity care. We aim to investigate potential associations between individual and country-level factors and medicalisation of birth in 15 European countries during the COVID-19 pandemic.

Methods

We collected data through an online, anonymous survey for women who gave birth in 2020-2021. We ran multivariable, multi-level logistic regression models estimating associations between indicators of medicalisation (caesarean section (CS), instrumental vaginal birth (IVB), episiotomy, fundal pressure) and proxy variables related to care culture and contextual factors at the individual and country-level.

Results

Among 27173 women, 24.4% had a CS, and 8.8% an IVB. Among women with IVB, 41.9% reported receiving fundal pressure. Among women with spontaneous vaginal births, 22.3% had an episiotomy. Less respectful care, as perceived by the women, was associated with higher levels of medicalisation. For example, women who reported having CS, IVB and episiotomy reported not feeling treated with dignity more frequently than women who didn't have those interventions (respectively: OR: 1.37; OR: 1.61; OR: 1.51; all: p < 0.001). Country-level variables contributed to explaining some of the variance between countries.

Conclusions

We recommend a greater emphasis in health policies on the promotion of respectful and patient-centered care approaches to birth to enhance women's experiences of care, and the development of a European-level indicator to monitor the medicalisation of reproductive care.

Speakers/Panellists

Emanuelle Pessa Valente

WHO Collaborating Centre, Institute for Maternal and Child Health IRCCS, Trieste, Italy

Quality of facility-based maternal and newborn care around the time of childbirth during the COVID-19 pandemic

Background

Multi-country studies assessing the quality of maternal and newborn care (QMNC) during the COVID19 pandemic, as defined by WHO Standards, are lacking.

Methods

Women who gave birth in 12 countries of the WHO European Region from March 1, 2020 - March 15, 2021 answered an online questionnaire, including 40 WHO Standard-based Quality Measures.

Results

21,027 mothers were included in the analysis. Among those who experienced labour (N = 18,063), 41.8% (26.1%- 63.5%) experienced difficulties in accessing antenatal care, 62% (12.6%-99.0%) were not allowed a companion of choice, 31.1% (16.5%-56.9%) received inadequate breastfeeding support, 34.4% (5.2%-64.8%) reported that health workers were not always using protective personal equipment, and 31.8% (17.8%-53.1%) rated the health workers’ number as “insufficient”. Episiotomy was performed in 20.1% (6.1%-66.0%) of spontaneous vaginal births and fundal pressure applied in 41.2% (11.5% -100%) of instrumental vaginal births. In addition, 23.9% women felt they were not treated with dignity (12.8%-59.8%), 12.5% (7.0%-23.4%) suffered abuse, and 2.4% (0.1%-26.2%) made informal payments. Most findings were significantly worse among women with prelabour caesarean birth (N = 2,964). Multivariate analyses confirmed significant differences among countries, with Croatia, Romania, Serbia showing significantly lower QMNC Indexes and Luxemburg showing a significantly higher QMNC Index than the total sample. Younger women and those with operative births also reported significantly lower QMNC Indexes.

Conclusions

Mothers reports revealed large inequities in QMNC across countries of the WHO European Region. Quality improvement initiatives to reduce these inequities and promote evidence-based, patient-centred respectful care for all mothers and newborns during the COVID-19 pandemic and beyond are urgently needed.

Funding: The study was financially supported by the Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy.

Mechanical circulatory support devices in left main occlusion: a multicenter study from 2008 to 2020

Introduction

Evidence of benefit in the use of mechanical circulatory support devices (MCS) in patients with acute myocardial infarction (AMI) is scarce. We aimed to evaluate the clinicalcharacteristics, prognosis and factors associated with the use of MCS in patients with AMI due to left main (LM) occlusion.

Methods

We performed a retrospective multicenter study of 128 consecutive patients with AMI with ≤12h of presentation with LM occlusion submitted to immediate reperfusion between January 1, 2008, until December 31, 2020 in three terciary hospitals of Portugal. Among this cohort, we divided patients into two groups according to the use of MCS devices.

Results

Regarding the baseline characteristics no statistically significant differences were found, except for the presence of cerebrovascular disease (2.9% in group with vs 16.9% in group without MCS, p=0.007) and peripheral artery disease (8.8% in group with vs 22% in group without MCS, p=0.037). We observed that the use of MCS devices was statistically different between the three centers (47.8%, 42%, 8.7%, p&lt;0.001). No differences were found at presentation for ST-segment elevation vs non-ST segment elevation AMI (p=NS). The presence of cardiogenic shock (72.4% vs 45.8%, p=0.002), cardiac arrest (27.5% vs 23.7%, p=0.034) and more severe thrombolysis in myocardial infarction (TIMI) flow at presentation (55.1% vs 35.6%, p=0.015) were more frequent in group with MCS. The rate of 1-year cumulative mortality was high in both groups (31/59=52.5% in the group without vs 47/69=68.1%, p=NS). Also, no statistically significant differences were found in terms of survival, but we observed a trend to higher mortality in those who received MCS as Kaplan-Meier survival curves show (log rank=0.062). Finally, in multivariable analysis, older age [odds ratio (OR), 0.935; 95% CI, 0.87–0.99], the presence of diabetes (OR, 0.223; 95% CI, 0.056–0.88), peripheral artery disease (OR, 0.070; 95% CI, 0.009–0.566) and extra-hospitalar cardiac arrest (OR, 0.06; 95% CI, 0.007–0.543) were characteristics associated with lower odds of receiving MCS. Contrarily, male sex (OR, 5; 95% CI, 1–20.4) and the presence of cardiogenic shock (OR, 5.7; 95% CI, 1.42–23) were factors associated with higher use of MCS.

Conclusion

The use of MCS does not seem to modify prognosis in patients admitted withAMI due to left main occlusion. Only cardiogenic shock and male gender were predictors of MCS use.

Funding Acknowledgement

Type of funding sources: None.

Evaluation of the Efficacy of Paracetamol in the Control of Pain After Adenotonsillectomy in the Pediatric Population

Introduction Adenotonsillectomy is a common surgical procedure in otolaryngology. Over the years, several techniques have been developed and modified in order to reduce mortality and morbidity. Postoperative pain control remains controversial. The aim of this study was to evaluate the efficacy of paracetamol alone in the control of postoperative pain. Methods A prospective study was conducted between May 2018 and February 2019, including 76 pediatric patients (age < 18 years), who underwent adenotonsillectomy. The surgeries were performed by the lead author with the same surgical technique. Patients were evaluated one week and one month after surgery through the application of the visual analog pain scale and the number of days of pain was assessed by the need for medication. Results Seventy-six total adenotonsillectomy were performed, with a total of 152 tonsils removed. The majority of patients were male (n=39, 51.3%), with an average age of 6.9 years (min 5, max 15 years). The most frequent surgical indication was sleep breathing disorders, present in 86.9% of the cases. The average duration of postoperative pain was 3 days, with no significant difference between groups (p>0.05). The average intensity of postoperative pain was 3.36 and was higher in patients with infectious criteria as surgical indications (p<0.05). Postoperative bleeding occurred in 3.9% (n=3) of the children, self-limited, without the need for readmission or surgical revision. Conclusion Pain after adenotonsillectomy was more intense in patients undergoing surgery for infectious criteria. Paracetamol used in monotherapy has shown safety and efficacy in controlling postoperative pain.

PSX-B-11 Classification Performance of Multinomial Logistic Regression for Identifying Resistance, Resilience, and Susceptibility to Gastrointestinal Nematode Infections in Sheep

The objective was to investigate the feasibility of using easy-to-measure phenotypic traits to predict resistant, resilient and susceptible sheep to gastrointestinal nematodes via multinomial logistic regression (MLR). The database comprised 3,654 records on 1,250 Santa Ines sheep from six farms. The animals were classified into three responses to infection classes (resistant, resilient and susceptible) according to fecal egg count and packed cell volume. The MLR was used to predict such classes using the information of age, month of record, sex, Famacha degree, weight and body condition score as predictors, and a leave-one-farm-out cross-validation technique was used to assess prediction quality across farms. The MLR was able to predict with satisfactory performance the resistant and susceptible animals in two of the farms, with resistant precision equal to 79 and 77%, and susceptible recall equal to 68 and 83%, respectively. In addition, at least one of the classes was well predicted in four farms, with susceptible recall equal to 71 and 89% in two of these farms, and resistant precision equal to 86 and 100% in the other two farms. The model was not able to satisfactorily classify resilient class. The proposed approach could help attenuate the negative impacts related to infections caused by gastrointestinal nematodes, contributing to design deworming strategies that take into account the risk of an animal being contaminated, consequently reducing the costs with anthelmintic administration and laboratory analyses based on blood or fecal samples. The results suggest that the use of easily measurable traits may provide useful information for supporting management decisions on the farm level that could potentially contribute to reducing parasitic contamination and production costs. In addition, the animals identified as resistant can also be incorporated as selection candidates into breeding programs for genetic improvement of flocks.Supported by the São Paulo Research Foundation (FAPESP) grants #2020/03575-8, #2018/01540-2 and #2016/14522-7, SP, Brazil.

Does intestinal epithelial integrity status in response to high-protein dairy milk beverage with or without progressive resistance training impact systemic inflammatory responses in an active aging population?

Increased resting systemic anti-inflammatory responses have previously been reported after a period of progressive resistance training (PRT) with daily consumption of a high-protein dairy beverage. The study aimed to investigate the independent and combined effects of consuming a high protein dairy milk beverage with or without a PRT on markers of intestinal epithelial integrity and selected systemic inflammatory responses in active older (≥50 yrs) adults. Thirty two (males n = 24, females n = 8) active older adults [mean (SD): Age 62 (7) years, weight 74.2 (14.0) kg, height 1.73 (10.0) cm, BMI 24.9 (4.0) kg/m2, and body fat mass: 25.8 (9.1)%)], that reported exercising ≥3/week (211 (91) min/week) were randomly allocated into one of four groups: dairy milk (DM), exercise and dairy milk (EX+DM), exercise alone (EX), and control (CON). Groups with EX underwent 12-weeks whole-body PRT program (x3 sessions/week), groups with DM consumed the beverage twice daily (30g protein/day), and CON was required to carry out their ad libitum dietary and exercise habits. Plasma concentrations of CRP, IL-1ß, IL-1ra, LBP, and sCD14 were determined by ELISA from samples collected at weeks 0, 6, and 12. Data were analyzed (SPSS v25.0) for group and time differences using a two-way repeated-measures ANOVA with post hoc analysis. No significant differences were observed for any of the measured plasma biomarkers. The previously observed increase in anti-inflammatory cytokine response is likely due to a muscular cellular response and not an indication of intestinal epithelial integrity disturbance and/or subsequent translocation of luminal originated pathogenic bacterial compounds.

Thought on Food: A Systematic Review of Current Approaches and Challenges for Food Intake Detection

Nowadays, individuals have very stressful lifestyles, affecting their nutritional habits. In the early stages of life, teenagers begin to exhibit bad habits and inadequate nutrition. Likewise, other people with dementia, Alzheimer's disease, or other conditions may not take food or medicine regularly. Therefore, the ability to monitor could be beneficial for them and for the doctors that can analyze the patterns of eating habits and their correlation with overall health. Many sensors help accurately detect food intake episodes, including electrogastrography, cameras, microphones, and inertial sensors. Accurate detection may provide better control to enable healthy nutrition habits. This paper presents a systematic review of the use of technology for food intake detection, focusing on the different sensors and methodologies used. The search was performed with a Natural Language Processing (NLP) framework that helps screen irrelevant studies while following the PRISMA methodology. It automatically searched and filtered the research studies in different databases, including PubMed, Springer, ACM, IEEE Xplore, MDPI, and Elsevier. Then, the manual analysis selected 30 papers based on the results of the framework for further analysis, which support the interest in using sensors for food intake detection and nutrition assessment. The mainly used sensors are cameras, inertial, and acoustic sensors that handle the recognition of food intake episodes with artificial intelligence techniques. This research identifies the most used sensors and data processing methodologies to detect food intake.

O-090 Patients’ willingness and preferences about being counselled for the possibility of fertility treatment being unsuccessful

Study question

What are the factors associated with patients’ willingness to be counselled about the possibility of treatment being unsuccessful and their preferences towards it?

Summary answer

Nine in ten patients are willing to be counselled, with willingness being associated with stronger positive attitudes towards counselling, higher perceived benefit and lower barriers

What is known already

Around 57% of patients in the UK end all cycles of IVF/ICSI without having a live birth. Counselling patients on this outcome could reduce the psychosocial distress they experience when it actually happens and facilitate adjustment. Patients perceive they do not have opportunity to discuss the end of treatment with staff. Staff express concerns about such counselling ‘crushing patients’ optimism’ and compromising their engagement with treatment. Research shows 56% of patients are willing to plan in advance for an unsuccessful cycle, but little is known about their willingness and preferences to be counselled about the possibility of treatment being unsuccessful.

Study design, size, duration

Cross-sectional, mixed-methods. Bilingual (Portuguese/English), online survey, disseminated via social media (April-December 2021). Eligibility criteria include being aged 18 or older, waiting to/undergoing an IVF/ICSI cycle, or completing one within the last six months without achieving pregnancy. Out of 651 people accessing the survey, 451 consented to participate. From these, 100 did not complete 50% of survey questions, nine did not report on willingness to be counselled, and 342 completed the survey (75.8%, 338 women).

Participants/materials, setting, methods

Theoretically informed survey. Quantitative questions covered sociodemographic, fertility history and treatment, willingness (yes, no), preferences (by whom, when, why, how), and perceptions (Theory of Planned Behaviour predictors: attitudes, perceived norms, perceived behavioural control; Health belief Model predictors: perceived susceptibility, severity, benefits, barriers) towards being counselled about the possibility of treatment being unsuccessful. Qualitative questions gathered textual data on past experiences of counselling (by whom, topics addressed). Descriptive, logistic regressions, and thematic analysis were used.

Main results and the role of chance

Participants were on average 36 years old, most resident in Portugal (59.9%) and the UK (37.7%). The majority (97.1%) were in a relationship for 10 years, and 86.3% were childless. Participants were undergoing treatment for on average two years [SD=2.11, 0-12 years]. Most (71.8%) completed at least one cycle in the past, with 93.5% not having achieved a positive outcome. Almost all (93.3%) would like to be counselled for possible unsuccessful treatment. Reported preferences indicated that 78.3% wanted to be counselled by a counsellor/psychologist/psychiatrist; 73.3% before initiating the first cycle; mostly in case of a bad prognosis (79.4%), emotional distress (73.5%) or difficulties in accepting the possibility treatment being unsuccessful (71.2%); and mainly in an individual (M=6.37, SD=1.17; in 1-7 scale) or couple (M=6.34, SD=1.24; in 1-7 scale) session. Willingness was associated with stronger positive attitudes towards counselling (OR[95% CI]; 3.11[2.02-4.78]), higher perceived benefits of discussing psychosocial resources and strategies to cope with the loss (12.83[1.72-95.67]), and lower concerns about counselling triggering negative emotions (0.15[0.03-0.74]). Around one-third (34.9%) reported having been counselled, with thematic analysis showing patients were mostly counselled by their consultant and the main topic addressed was low prognosis, with emphasis being put on a future positive outcome.

Limitations, reasons for caution

Self-selected sample, mostly composed of female patients who had not yet achieved their parenthood goals. Small number of unwilling participants reduced statistical power. The main outcome variable was intentions and research shows intentions are only moderately associated with actual behaviour.

Wider implications of the findings

To meet patients’ preferences, fertility clinics should provide more opportunities for patients to discuss the possibility of their treatment being unsuccessful, both before and during treatment. Such counselling should reassure patients they can cope with any treatment outcome and signpost them to coping resources and support sources.

Trial registration number

Not applicable

Abstract OT1-16-01: A multicenter phase II study of vaccines to prevent recurrence in patients with HER-2 positive breast cancer

Background: HER2-positive breast cancer patients are commonly treated with neoadjuvant therapy including HER2-targeted therapy. Patients who have residual invasive disease have less favorable outcomes with an increased risk of recurrent disease than patients with complete pathologic response (pCR). It has also been observed that these non-pCR patients have low or absent anti-HER-2 CD4 Th1 responses. We hypothesized that correcting the anti-HER-2 CD4 Th1 response using vaccines will increase interferon gamma production which we have shown is a potent inducer of apoptosis and senescence in HER2-positive breast cancer. This study will be evaluating safety and immunogenicity of two vaccines (multivalent anti-oncodriver DNA vaccine (WOKVAC) or HER-2-pulsed dendritic cell vaccine (DC1)). Methods: This is a multi-center, phase 2, randomized study to determine the safety and tolerability of HER2 vaccines (DC1 and WOKVAC), assess immunogenicity, and evaluate recurrence free survival. Patients with HER2-positive early breast cancer (stage I-III) are eligible if they have residual invasive disease in the breast or axilla at surgery after receiving neoadjuvant chemotherapy plus HER2 -targeted therapy. Patients are randomly assigned in a 1:1 ratio to receive 1 of 2 adjuvant HER2 vaccines, either DC1 or WOKVAC for 1 year. A permuted-block randomization scheme was used with stratification according to residual cancer burden (RCB) (1+2 vs 3). The primary end points are safety and immunogenicity (immune response rate measured by ELISPOT). Each treatment arm will be assessed separately. Any statistical comparison between arms is purely exploratory, as this study is neither designed nor powered for comparative hypotheses. Secondary endpoints include recurrence-free survival. Exploratory analyses include the assessment of prognostic and predictive biomarkers including circulating tumor cells, serum HER2 levels, and other immune markers. The enrollment began in 2018 and we plan to accrue the total of 110 patients. ClinicalTrials.gov Identifier: NCT03384914

Citation Format: Hyo S Han, Mary Disis, Robert Wesolowski, Carla Fisher, Shipra Gandhi, Nancy Chan, William Gwin, Keerthi Gogineni, Rosemarie Mick, Christina Sierra Rodriguez, Deanna Hogue, Hien Liu, Ricardo Costa, Brian Czerniecki. A multicenter phase II study of vaccines to prevent recurrence in patients with HER-2 positive breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr OT1-16-01.

Abstract P2-14-01: Phase II neoadjuvant trial of Interferon-gamma plus weekly paclitaxel, trastuzumab and pertuzumab in patients with HER-2 positive breast cancer

Background: IFN-γ, a cytokine that plays diverse roles in innate and adaptive immunity, has been shown to be essential in anti-tumor immune response. In vitro and in vivo studies have shown the synergistic effect of IFN-γ in combination with HER2-targeting monoclonal antibodies with or without taxane chemotherapy. We previously conducted a phase I trial of IFN-γ in combination with paclitaxel, trastuzumab and pertuzumab (IPTP) in metastatic HER2-positive breast cancer (HER2+ BC) based on which we initiated a phase II neoadjuvant study with this combination. Methods: Early stage HER2+ BC patients (pts) were eligible. Treatment included 12 weeks of weekly paclitaxel 80 mg/m2 IV, trastuzumab IV every 3 weeks x 4 (8 mg/kg loading dose, then 6 mg/kg) and pertuzumab IV every 3 weeks x 4 (840 mg loading dose, then 420 mg) in combination with IFN-γ 50 mcg/m2 subcutaneous injection three times weekly starting on day 1. The primary objective was to evaluate the pathologic complete response rate (pCR) in breast and nodes. This study had a planned interim analysis after 23 patients were evaluable for pCR based on a Simon’s two stage design with 90% power and a type I error rate of 0.1. The final proportion of hormone receptor (HR) status among accrued patients will be used for comparison to historical control because pCR is expected to be lower for HR+HER2+BC compared to HR-HER2+ BC subtype (25% vs 50% respectively). Here we are reporting the final results. Results: Thirty-nine pts were enrolled between 1/2018 and 11/2020. Most patients had clinical stage II/III (90%) and 46% were clinically and pathologically node positive. Thirty four out of 39 (87%) had HR+ BC. The pCR for all patients was 44% (17/39). The pCR for HR+ HER2+ and HR-HER2+ BC subgroup was 47% (16/34) and 20% (1/5) respectively. Further evaluation using RCB (residual cancer burden) showed 17 pts RCB-0, 6 RCB-I,14 RCB-II, and 2 RCB-III. Two SAE included pneumonitis/heart failure and hematochezia. The most frequently observed grade 1 and 2 AEs were diarrhea (74%), fatigue (74%), rash (56%) and nausea (56%). Grade 3 AE (5% or higher) included diarrhea (18%), syncope (5%) and rash (5%). No grade 4 AE was noted. Conclusion: The addition of IFN-γ to neoadjuvant chemotherapy using paclitaxel, trastuzumab and pertuzumab was well tolerated with manageable toxicities. This study evaluated de-escalated treatments only 12 weeks duration and the anthracycline-free regimen which was highly effective with pCR of 44%. The pCR for HR+ HER2 + BC subtype was 47% (16/34) which compares favorably to the expected pCR of 25% with neoadjuvant chemotherapy alone in HR+HER2+ patients. Updated results will be presented at the meeting including correlative studies.

Citation Format: Hyo S Han, Ricardo Costa, Avan Armaghani, Aixa Soyano, Loretta Loftus, Hatem Soliman, Brooke Fridley, Junmin Whiting, Aiana Cerezo, Marilin Rosa, Martine Extermann, Hung Khong, Brian Czerniecki. Phase II neoadjuvant trial of Interferon-gamma plus weekly paclitaxel, trastuzumab and pertuzumab in patients with HER-2 positive breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-14-01.

Heart Failure Incidence Following ST-Elevation Myocardial Infarction

ST-elevation myocardial infarction (STEMI) survivors have a heightened risk of developing heart failure (HF). The magnitude of this risk with the advent of primary percutaneous coronary intervention is less characterized. We aimed to examine the incidence and predictors of incident HF and all-cause mortality in a contemporary STEMI cohort. We performed a retrospective analysis of 700 consecutive patients with STEMI treated with primary percutaneous coronary intervention at a tertiary hospital. The primary outcome was the occurrence of HF during follow-up. HF was defined by HF hospitalization or the presence of congestion that led to de novo prescription or up-titration of diuretics in the outpatient clinic. The secondary outcome was defined by the occurrence of HF or all-cause mortality. During a median follow-up period of 43.6 months, HF events occurred in 110 patients (15.7%), 34 (4.8%) managed as outpatient and 76 (10.9%) requiring hospitalization. Left ventricular ejection fraction (LVEF) <50% was present in 76% of those who developed HF. Age (hazard ratio [HR] 1.03, 95% confidence interval [CI] 1.01 to 1.06), diabetes (HR 1.85, 95% CI 1.12 to 3.05), door-to-balloon time (HR 1.002, 95% CI 1.000 to 1.003), Killip-Kimball class ≥II (HR 2.24, 95% CI 1.32 to 3.80) and LVEF <50% (HR 1.71, 95% CI 1.01 to 2.92) were independent predictors. All-cause mortality incidence was 8.7%. HF was independently associated with a threefold increased risk of dying (HR 3.52, 95% CI 1.85 to 6.69, p <0.001). In conclusion, a substantial proportion of contemporary patients with STEMI develop HF, which triplicates the risk of dying. Older age, diabetes and LVEF <50% independently predicted the development of HF and all-cause death.

Monitoring Arthropods in Azorean Agroecosystems: the project AGRO-ECOSERVICES

BACKGROUND

The data we present are part of the AGRO-ECOSERVICES project (Assessing ecosystem services and disservices provided by arthropod species in Azorean agroecosystems). The project aims to evaluate the relative importance of native and non-native organisms as ecosystem services (ES) and disservices (ED) providers, by combining novel, direct and quantitative tools for monitoring agro-biodiversity. Ecosystem services include evaluation of natural pest control by predation, seed predation on weed plants, pollination, decomposition and ecosystem disservices, herbivory and seed predation on crop plants. Active Aerial Searching (AAS) (only in maize-fields) and pitfall traps were used to sample the arthropod biodiversity (predatory spiders, true-bugs and beetles and main insect pests) on four agricultural habitats of Terceira Island, namely citrus orchards, low and high elevation maize fields and vineyards.

NEW INFORMATION

We provided an inventory of all arthropods recorded in four Azorean agroecosystems (citrus orchards, low and high elevation maize fields and vineyards) from Terceira Island. A total of 50412 specimens were collected, belonging to four classes, 20 orders, 81 families and 200 identified species of arthropods. A total of 127 species are considered introduced (n = 22646) and 69 native non-endemic (n = 24117). Four endemic species were recorded with very few specimens (n = 14) and 3635 specimens belong to unidentified taxa recorded only at genus or family level. Five species are new records for Terceira Island, with Lagriahirta (Linnaeus, 1758) (Coleoptera, Tenebrionidae) being also a new record for the Azores. This publication contributes to a better knowledge of the arthropods communities present in agro-ecosystems of Terceira Island and will serve as a baseline for future monitoring schemes targeting the long-term change in arthropod diversity and abundance.

Risk-Benefit of 1-Year DAPT After DES Implantation in Patients Stratified by Bleeding and Ischemic Risk

BACKGROUND

Although a 1-year duration of dual antiplatelet therapy (DAPT) is used in many patients after drug-eluting stent (DES) implantation, the evidence supporting this duration is uncertain.

OBJECTIVES

The authors investigated the risk-benefit profile of 1-year vs ≤6-month DAPT after DES using 2 novel scores to risk stratify bleeding and ischemic events.

METHODS

Ischemic and bleeding risk scores were generated from ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents), a multicenter, international, "all-comers" registry that enrolled 8,665 patients treated with DES. The risk-benefit profile of 1-year vs ≤6-month DAPT was then investigated across risk strata from an individual patient data pooled dataset of 7 randomized trials that enrolled 15,083 patients treated with DES.

RESULTS

In the derivation cohort, the ischemic score and the bleeding score had c-indexes of 0.76 and 0.66, respectively, and both were well calibrated. In the pooled dataset, no significant difference was apparent in any ischemic endpoint between 1-year and ≤6-month DAPT, regardless of the risk strata. In the overall dataset, there was no significant difference in the risk of clinically relevant bleeding between 1-year and ≤6-month DAPT; however, among 2,508 patients at increased risk of bleeding, 1-year compared with ≤6-month DAPT was associated with greater bleeding (HR: 2.80; 95% CI: 1.12-7.13) without a reduced risk of ischemic events in any risk strata, including those with acute coronary syndromes. These results were consistent in a network meta-analysis.

CONCLUSIONS

In the present large-scale study, compared with ≤6-month DAPT, a 1-year duration of DAPT was not associated with reduced adverse ischemic events in any risk strata (including acute coronary syndromes) but was associated with greater bleeding in patients at increased risk of bleeding.

Imaging and 2-year clinical outcomes of thin strut sirolimus-eluting bioresorbable vascular scaffold: The MeRes-1 extend trial

OBJECTIVES

This study explores the safety and efficacy of thin strut MeRes100 sirolimus-eluting bioresorbable vascular scaffold (BRS) in patients with de novo coronary artery lesions.

BACKGROUND

In interventional cardiology, the emergence of BRS technology is catalyzing the next paradigm shift.

METHODS

The MeRes-1 Extend was a multicenter, prospective, single-arm, open-label study enrolling 64 patients in Spain, Macedonia, Brazil, South Africa, Malaysia, and Indonesia. The safety endpoint was major adverse cardiac events (MACE) which composed of cardiac death, myocardial infarction (MI), and ischemia-driven target lesion revascularization (ID-TLR). The imaging efficacy endpoint was mean in-scaffold late lumen loss (LLL) evaluated by quantitative coronary angiography (QCA). Optical coherence tomography (OCT) imaging was performed at baseline and 6-month follow-up.

RESULTS

A total of 69 target lesions were identified in 64 enrolled patients (mean age 58.30 ± 9.02 years). Of the treated lesions, 49 (71.01%) lesions were of type B2/C. Procedural and device success was achieved in 64 and 62 patients, respectively. At 2-year follow-up, MACE was reported in one patient (1.61%) in the form of ID-TLR. There was no case of MI, cardiac death or scaffold thrombosis through 2-year. In a subset of 32 patients, paired QCA showed mean in-scaffold LLL of 0.18 ± 0.31 mm at 6-month follow-up. In a subset of 21 patients, OCT revealed 97.95 ± 3.69% strut coverage with mean scaffold area of 7.56 ± 1.79 mm² and no evidence of strut malapposition.

CONCLUSIONS

The clinical and imaging outcomes of MeRes-1 Extend trial demonstrated favorable safety and efficacy of MeRes100 sirolimus-eluting BRS in patients with de novo coronary artery lesions.

Brazil: The profile of COVID-19 deaths among Nurses

 

Health-care workers (HCWs) on the frontlines have a high risk of acquiring and dying from covid-19. Nursing professionals (NP) represent over half of HCWs in Brazil, a country with high morbidity and mortality from covid-19, above all in 2021. The absenteeism and death of nursing professionals due to covid-19 have a major impact on the workforce. As part of the research by Fiocruz on working conditions among HCWs, including those considered “invisible,” we have conducted this study of death among graduated nurses. Although they represent 4 out of 5 members of nursing teams in Brazil, the technicians and assistant nurses remains largely unseen and are covered by the “invisible” HCW study. We analyzed data from Federal Council of Nurses, publicized at the website Observatorio da Enfermagem. The sociodemographic profile, professional category and timeline of nursing professional deaths were considered. The time period of the study was from March 2020 to March 2021. A total of 670 professionals of the nursing team died, 200 of these were nurses. Among nurses: 59.5% were female and 81.5% were up to 60 years old. Our study registers a concentration of deaths in the North region. Despite having fewer registered professionals, it had the highest number of deaths (29.5%), and the Southeast had the second highest percentage (26.5%). A slow decline was observed until December, when Brazil experienced a “second wave” of Covid-19. Vaccination of Nurses began in late January 2021; therefore, there was not enough time to assess the impact on morbidity and mortality. The results of a study of almost 50 professional categories are under analysis and will be published shortly.

Key messages

This study is about death by COVID-19 among nurses in Brazil.

This study is part of a large one on professional categories, essentials to supporting health care system, conducted by FIOCRUZ.

Bone scintigraphy in the diagnosis of transthyretin amyloidosis: a different performance in Portuguese hereditary variant?

Introduction

Bone scintigraphy using radioactive technetium-99m and 3,3-diphosphono-1,2-propanodicarboxylic acid (DPD) has been increasingly used to diagnose myocardial involvement of mutated or wild-type transthyretin amyloidosis (ATTR).

However, most studies that proved a high sensitivity and specificity of the technique were not in patients with the “Portuguese variant” (Val30Met) mutation in transthyretin (TTR). Other authors had already suggested that in these patients the DPD scan could be less accurate.

Methods

Observational study of patients referred to Cardiology clinic with suspicion of ATTR cardiomyopathy. We only included patients with data from echocardiogram and DPD scan.

For statistical analyses, SPSS was used, p&lt;0.05 for statistical significance. Logistic regressions were used to test an association between DPD result and different covariates.

Results

Of 273 patients referred with suspicion of cardiac ATTR, we studied 97 patients that did an echocardiogram and a DPD scan.

Among the 75 cases with mutated TTR (Val30Met), median age was 36 (IQR 34) and 60% were males. 60 had increased ventricular wall thickness (IVWT) &gt;12 mm, but only 24 had a positive DPD (defined as a visual score &gt;2). Even though a higher wall thickness was associated with a positive DPD (p=0.004), 18 patients with a negative scan had IVWT &gt;14 mm. The DPD results was significantly associated with prior liver transplantation (LT) – p&lt;0.001; 95% CI (7.1; 503.6) – and age at first symptoms – p&lt;0.001; 95% CI (1.036; 1.113); 66.7±10.5 versus 34.8±10.2 years-old for those with and without a positive scan, respectively. Interestingly, fewer patients with a positive scan had neurologic symptoms (74% versus 96%, p=0.009), ophthalmologic, urologic or renal involvement, even though creatinine clearance was on average lower (p=0.01). We did not find a significant association between DPD result and sex, conduction disorders, NT-proBNP, troponin T or treatment with tafamidis. Patients on tafamidis had on average lower IVWT, independent of age (median of 13 versus 14 mm; p=0.020). 4 patients with negative DPD did an endomyocardial biopsy, that was positive for amyloid in 3 cases.

In comparison, in the 22 cases with wild-type TTR, there were significantly more males (86%) and patients were older (median age was 81 (IQR 9)). All patients had IVWT (that was significantly higher than in mutated ATTR) and DPD scan was negative in only 2 patients (that had a visual score of 1). Systolic dysfunction was significantly more frequent (59% versus 8%). The occurrence of death or hospitalization for heart failure was significantly higher.

Conclusions

DPD-scintigraphy seems more sensitive in patients with late onset mutated ATTR or with wild-type ATTR. It is less accurate in early onset patients with Val30Met mutation and particularly if they underwent LT. In those patients, further investigation is needed before excluding myocardial involvement.

Funding Acknowledgement

Type of funding sources: None.