Effects of chronic hydrogen peroxide exposure on mitochondrial oxidative stress genes, ROS production and lipid peroxidation in HL60 cells

Hydrogen peroxide (H2O2) is a reactive species that is also involved in the redox regulation of cells because of it is relative stability. In numerous pathological situations, a chronic increase in the production of reactive species is observed, which is related to oxidative stress and cellular damage. This study aimed to evaluate the effects of long-term exposure to different H2O2 concentrations on oxidative stress biomarkers and mitochondrial dynamics in HL60 cells. HL60 cells were treated with a sustained production (0.1, 1.0 and 10.0 nM/s) of H2O2 for one hour. H2O2 production and malondialdehyde (MDA) levels, as a lipid peroxidation marker, increased progressively in HL60 cells in accordance with higher H2O2 exposure, with significant differences between the 10 nM/s H2O2 group and the control and 0.1 nM/s groups. Similarly, progressive increased expression in genes related to the mitochondrial antioxidant defences and mitochondrial dynamics were also observed. Significantly increased gene expression in the 10 nM/s H2O2 with respect to the control group was observed for manganese superoxide dismutase (MnSOD), peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PCG1α), nuclear respiratory factor 2 (Nrf2), mitochondrial transcription factor A (Tfam), mitofusins 1 and 2 (Mfn1 and Mfn2) and uncoupling protein 3 (UCP3), whereas no significant changes were observed in the cytochrome c oxidase subunit IV (COXIV) gene expression. In conclusion, exposure to different sustained production of H2O2 is related to a progressive increase in the gene expression of mitochondrial dynamics and redox processes in HL60 cells, but also to oxidative damage at higher H2O2 production levels.

Determining the optimal time to report mortality after lobectomy for lung cancer: An analysis of the time-varying risk of death

Objective

Surgical mortality has traditionally been assessed at arbitrary intervals out to 1 year, without an agreed optimum time point. The aim of our study was to investigate the time-varying risk of death after lobectomy to determine the optimum period to evaluate surgical mortality rate after lobectomy for lung cancer.

Methods

We performed a retrospective study of patients undergoing lobectomy for lung cancer at our institution from 2015 to 2022. Parametric survival models were assessed and compared with a nonparametric kernel estimate. The hazard function was plotted over time according to the best-fit statistical distribution. The time points at which instantaneous hazard rate peaked and stabilized in the 1-year period after surgery were then determined.

Results

During the study period, 2284 patients underwent lobectomy for lung cancer. Cumulative mortality at 30, 90, and 180 days was 1.3%, 2.9%, and 4.9%, respectively. Log-logistic distribution showed the best fit compared with other statistical distribution, indicated by the lowest Akaike information criteria value. The instantaneous hazard rate was greatest during the immediate postoperative period (0.129; 95% confidence interval, 0.087-0.183) and diminishes rapidly within the first 30 days after surgery. Instantaneous hazard rate continued to decrease past 90 days and stabilized only at approximately 180 days.

Conclusions

In-hospital mortality is the optimal follow-up period that captures the early-phase hazard during the immediate postoperative period after lobectomy. Thirty-day mortality is not synonymous to "early mortality," as instantaneous hazard rate remains elevated well past the 90-day time point and only stabilizes at approximately 180 days after lobectomy.

Are chest drains routinely required after thoracic surgery? A drainology study of on-table chest-drain removals

Objectives

Advances in perioperative management for thoracic surgery have accelerated the postoperative recovery of patients by decreasing postoperative pain and the incidence of complications. We aimed to study whether it's safe to remove chest drains on table in selected cases.

Methods

This was a 5-year retrospective analysis of protocolized chest-drain removal on the operating table. The chest drain was removed in patients undergoing sublobar/wedge lung resection and other minor thoracic procedure (pleural biopsy, mediastinal mass biopsy/resection) via a thoracoscopic approach (video-assisted thoracoscopic surgery). Chest drains were removed at the end of the operation if air leak as documented by the digital drain was less than 20 mL/min. Outcome data on postdrain removal pneumothorax, effusion, and need for further intervention were obtained by reviewing the postoperative chest films, all reported by a radiologist.

Results

Between 2016 and 2021, 107 patients underwent drain removal in theater. Mean age (standard deviation) was 58 (17) years and 54 (50.5%) were male. Postdrain removal pneumothorax occurred in 22 patients (21%), pleural effusion in 6 (5.6%), and 21 of 22 postoperative pneumothoraces were managed conservatively without reinsertion of chest drain. As it is our standard policy to leave no pneumothorax in patients undergoing surgical management of primary spontaneous pneumothorax, only 1 such patient (0.9%) had a drain reinserted as a result. The median (interquartile) length of hospital stay was 1 day (1-2), and 14 patients (13%) were discharged on surgery day.

Conclusions

Our results demonstrate that on table chest-drain removal in selected cases is safe and repeatable using a digital drain, challenging the practice of routine drain insertion after thoracic surgery.

Improving Thoracic Surgery Ward Round Quality and Enhancing Patient Safety in a Referral Centre

Introduction Ward rounds are vital clinical processes that facilitate an opportunity for daily review and management of thoracic surgery inpatients. The aim of this study was to compare thoracic surgery ward round documentation against locally agreed standards and design a template to improve the detail and uniformity of this process to enhance patient care. Materials and methods Data for this audit was collected retrospectively and prospectively. Data was collected during three auditing periods and managed on Microsoft Excel. Descriptive statistics were used for its analysis. Chi-square and Fisher's Exact tests were used to test for differences in reporting rates. Results and discussion Initially, a total of 199 ward round notes were reviewed. Imaging results (19%) and discharge planning (23%) were not reported. eCARE (electronic Clinical Assessment for Round Evaluation) was developed to ensure that all aspects of patient evaluation recommended by the guidelines were included. Reporting rates significantly improved after such changes. We analysed the effect of the new ward round note on discharge planning (23.3 vs 41%, p<0.001), complication rates (32.6 vs 21.9%, p=0.03), post-surgical length of stay (LOS) (7.0 vs 5.0, p<0.001). Conclusion Over a year, we audited the Thoracic Surgery Department's ward round documentation against locally agreed standards in line with national recommendations. Several important items were not regularly reported. Using closed-ended questions improved reporting rates, and patient care was optimised. Further research should explore the impact of this new documentation method on patient care and postoperative outcomes in our Trust as well as other cardiothoracic centres.

Outcomes of chest drain management using only air leak (without fluid) criteria for removal after general thoracic surgery-a drainology study

Background

Chest drain management is a variable aspect of postoperative care in thoracic surgery, with different opinion for air and drain volume output. We aim to study if acceptable safety was maintained using air leak criteria alone.

Methods

A 9-year retrospective analysis of protocolised chest drain management using digital drain air leak cut off less than 20 mL/min for more than 6 h for drain removal in patients undergoing general thoracic surgery. We excluded patients if a chest drain was not required nor removed during admission or if patients underwent volume reduction or pneumonectomy. Withdrawal criteria were suspected bleeding or chylothorax. Postoperative films were reviewed to document post-drain removal pneumothorax, pleural effusion, and reintervention (drain re-insertion).

Results

Between 2012 and 2021, 1,187 patients had thoracic surgery under a single surgeon. Following exclusion and withdrawal criteria, 797 patients were left for analysis. The mean age [standard deviation (SD)] was 61 [16] years and 383 (48%) were male. Median [interquartile range (IQR)] duration of drain insertion was 1 [1-2] day with a median length of hospital stay of 4 [2-6] days. Post-drain removal pneumothorax was observed in 141 (17.7%), post-drain removal pleural effusion was observed in 75 (9.4%) and re-intervention (reinsertion of chest drain) required in 17 (2.1%).

Conclusions

Our results demonstrate acceptable levels of safety using digital assessment of air leak as the sole criteria for drain removal in selected patients after general thoracic surgery.

Disparate behavioral types in wild and reared juveniles of gilthead seabream

Fish differ consistently in behavior within the same species and population, reflecting distinct behavioral types (BTs). Comparing the behavior of wild and reared individuals provides an excellent opportunity to delve into the ecological and evolutionary consequences of BTs. In this work, we evaluated the behavioral variation of wild and reared juvenile gilthead seabreams, Sparus aurata, a highly relevant species for aquaculture and fisheries. We quantified behavioral variation along the five major axes of fish behavioral traits (exploration-avoidance, aggressiveness, sociability, shyness-boldness, and activity) using standardized behavioral tests and a deep learning tracking algorithm for behavioral annotation. Results revealed significant repeatability in all five behavior traits, suggesting high consistency of individual behavioral variation across the different axes in this species. We found reared fish to be more aggressive, social and active compared to their wild conspecifics. Reared individuals also presented less variance in their aggressiveness, lacking very aggressive and very tame individuals. Phenotypic correlation decomposition between behavioral types revealed two different behavioral syndromes: exploration-sociability and exploration-activity. Our work establishes the first baseline of repeatability scores in wild and reared gilthead seabreams, providing novel insight into the behavior of this important commercial species with implications for fisheries and aquaculture.

Food determines ephemerous and non-stable gut microbiome communities in juvenile wild and farmed Mediterranean fish

Novel insights were provided by contrasting the composition of wild and farmed fish gut microbiomes because the latter had essentially different environmental conditions from those in the wild. This was reflected in the gut microbiome of the wild Sparus aurata and Xyrichtys novacula studied here, which showed highly diverse microbial community structures, dominated by Proteobacteria, mostly related to an aerobic or microaerophilic metabolism, but with some common shared major species, such as Ralstonia sp. On the other hand, farmed non-fasted S. aurata individuals had a microbial structure that mirrored the microbial composition of their food source, which was most likely anaerobic, since several members of the genus Lactobacillus, probably revived from the feed and enriched in the gut, dominated the communities. The most striking observation was that after a short fasting period (86 h), farmed gilthead seabream almost lost their whole gut microbiome, and the resident community associated with the mucosa had a very much reduced diversity that was highly dominated by a single potentially aerobic species Micrococcus sp., closely related to M. flavus. The results pointed to the fact that, at least for the juvenile S. aurata studied, most of the microbes in the gut were transient and highly dependent on the feed source, and that only after fasting for at least 2 days could the resident microbiome in the intestinal mucosa be determined. Since an important role of this transient microbiome in relation to fish metabolism could not be discarded, the methodological approach needs to be well designed in order not to bias the results. The results have important implications for fish gut studies that could explain the diversity and occasional contradictory results published in relation to the stability of marine fish gut microbiomes, and might provide important information for feed formulation in the aquaculture industry.

Impact of society and national guidelines on patient selection for lung cancer surgery in the United Kingdom

OBJECTIVES

We sought to evaluate the impact of different national clinical guidelines (with consistent and conflicting recommendations) on clinician's practice in the UK.

METHODS

In this cohort study, we analysed data from National Lung Cancer Audit comprising all patients diagnosed with lung cancer between 2008 and 2013 within England and Wales for consistent (British Thoracic Society and National Institute of Clinical Excellence) recommendations for lower/more permissive lung function but opposing stage (N2) selection parameters for surgery.

RESULTS

From 2008 to 2013, data from 167 192 patients with primary lung cancers were included. The proportion of patients undergoing surgery for lung cancer increased from 9.5% to 20.5% in 2013 (P < 0.001) as the number of general thoracic surgeons in the UK increased from 40 to 81 in the corresponding timeframe. Mean forced expiratory volume in 1 s of surgical patients increased from 76% (22) to 81% (22) in 2013 (P < 0.001). Of the patients undergoing surgery, the proportion of patients with N2 disease across the 6-year interval was broadly consistent between 8% and 11% without any evidence of trend (P = 0.125).

CONCLUSIONS

Within 3 years of new clinical guideline recommendations, we did not observe any overall change suggesting greater selection for surgery on lower levels of lung function. When presented with conflicting recommendation, no observable change in selection was noted on surgery for N2 disease. The observed increase in surgical resection rates is more likely due to greater access to surgery (by increasing number of surgeons) rather than any impact of guideline recommendations.

POS1185 PERFORMANCE OF ADENOSIN DEAMINASE ACTIVITY IN SYNOVIAL FLUID FOR THE EARLY DIAGNOSIS OF TUBERCULOUS ARTHRITIS: A META-ANALYSIS

Background

Adenosin deaminase activity (ADA) has shown good performance in diagnosing pleural, peritoneal and meningeal tuberculosis. Still, the performance of ADA activity in synovial fluid for the diagnosis of tuberculous arthritis has received less attention.

Objectives

To analyze the performance of ADA in synovial fluid to diagnosis tuberculous artrhritis.

Methods

We research Medline and EMBASE from the inception to October 2021 and the American College of Rheumatology and European League Against Rheumatism for conference abstracts (2012-2021) to assess the accuracy of ADA activity in synovial fluid compared to a composite reference standard (necrotizing granulomas in a synovial biopsy; acid-fast stain, Mycobacterium culture or RT-PCR assay for tuberculosis and/or clinical response to tuberculosis treatment) to early diagnosis tuberculous arthritis. We performed meta-analysis using a random-effects model and evaluated the sources of heterogeneity via subgroup analysis and meta-regression.

Results

Seven independent studies (N= 307 subjects) that compared ADA activity in synovial fluid with the composite reference standard were included. The pooled sensitivity and specificity of ADA activity was 0.939 (95% confidence Interval [CI], 0,873-0,977; heterogeneity p=0.297; I2=17.4%) and 0.885 (95% confidence Interval [CI], 0.833-0.925; heterogeneity p=0.002; I2=85.3%) compared to the composite reference standard, respectively. The random-effects model for pooled diagnostic Odds Ratio was 74.582 (95% CI, 19.826-280.57; heterogeneity p=0.133; I2=38.8%). The receiver operating characteristic curve area was 0.9617 (95% CI, 0.925-1.000). Meta-regression did not identify the type of study (prospective or retrospective), country of publication, type de assay, or cut-off value as sources of heterogeneity.

Conclusion

Measuring adenosine deaminase activity in synovial fluid demonstrates good performance for the early diagnosis joint tuberculosis.

Acknowledgements

El estudio fue apoyado con una beca de investigación de la Asociación para la Investigación en Reumatología de la Marina Baixa (AIRE-MB)

Disclosure of Interests

None declared

POS0369 IMPACT OF HYDROXYCHLOROQUINE LEVEL ON ECG QTC INTERVAL IN PATIENTS WITH RHEUMATIC SYSTEMIC AUTOIMMUNE DISEASES: A REAL-LIFE STUDY

Objectives

To analyze the impact of the serum level of hydroxychlroquine (OHCLQ) on the QTc interval of the ECG, in patients with rheumatic systemic autoimmune diseases (SARD), treated with this drug for a long time

Methods

Retrospective study, among patients with SARD, treated with OHCLQ ≥ 1 year, dose 200-400 mg/day. Serum OHCLQ level was measured by liquid chromatography and QTc interval by ECG (Welch Allyn 200; SF, N York, USA). Two control groups for QTc are included: Group-1: patients with SARD not treated with OHCQ; Group-2: healthy subjects without SARD. In both, weight and current treatment and an ECG were recorded.

In patients with SARD was collected: 1) Epidemiological data: age, sex, weight, concomitant diseases, current treatment. 2) SARD: diagnosis, year of diagnosis, disease evolution time, clinical and autoimmunity data, treatment and dose. 3) OHCLQ: time in treatment, toxicity, symptoms (dizziness, syncope) and serum level. 4) ECG; QTc and heart rate (HR).

Results

65 patients treated with OHCLQ, mean 10.8 (6.5) years are included, diagnosed with SLE: 43 (66%) patients, RA: 15 (23%), palindromic rheumatism: 4 (6%), SS1º: 2 (3 %) and PsA: 1 (1%). 63 (97%) patients are women, with a mean age (SD): 58 (14.7) years, weight: 69 (15) kg. Mean dose of OHCLQ: 221 mcg/L (64), 3.24 (1) mg/kg/day.

Mean serum OHCLQ level: 166 mcg/L (6.5): 18 (28%) patients with level <100 mcg/L (mean: 63 [0.7] mcg/L) and 47 (72%) with level >100 mcg/L L (mean 195 mg/XX [94]). On ECG, mean HR: 69 bpm (10) and mean QTc interval: 429.7 (84) ms, prolonged (>440 ms) in 23 (35%) of the patients.

12 (18%) patients reported dizziness at some time and 29 (45%) were being treated with a drug related to the risk of QTc prolongation: Possible (P: at authorized doses no risk of TdP): 1 (2%) patient, Conditional (C: risk under excessive dose, interactions): 13 (20%), P+C: 4 (8%), C+C: 11 (17%).

When comparing the mean QTc result of the group with OHCLQ and the control groups without OHCLQ (n: 41), the QTc is higher (p=0.062) than the group of healthy subjects (n: 23) and without differences with the control group EASR (n: 18), not treated with OHCLQ (p=0.70). Among patients with OHCLQ level >100 mcg/L (n: 47) vs <100 mcg/L (n: 18), patient weight (p=0.012), level (p<0.0001), and dose in mg /kg (p=0.03), is significantly higher at levels >100 mcg/L. No relationship was observed between the OHCLQ level and the QTc result.

In 6 (9%) patients the OHCLQ dose is >3 mg/kg (mean: 5.35 [1] mg/kg, HR: 73 [14] bpm, OHCLQ dose: 367 [71] mcg/L), no detected significant differences in QTc (1 patient presented QTC >440). In patients with QTc >440 ms, older patient age, QTc result, and heart rate were significant. However, the dose in mg/kg of OHCLQ was lower in the group with QTc <440 ms (p=007).

Conclusion

In patients with SARD treated with maintenance doses of OHCLQ of about 3 mg/kg/day, 1) The serum level of OHCLQ is not associated with QTc prolongation on the ECG. 2) QTc is significantly related to age and heart rate. 3) The EASR per se does not affect the QTc result.

Table 1.

Characteristics of patients with QTc greater than or less than 440 ms and with an OHCLQ level greater than or less than 100 mcg/L.

QTc >440 ms N: 23 (35%)QTc ≤440 ms N: 42 (65%)pAge, mean (SD)64 (15)56 (14.5)0.007Female, n (%)22 (96)40 (95)0.85QTc, mean (SD)454 (23.9)416 (23.7)0.0001Symptoms, n (%)4 (17)4 (10)0.77Heart rate, mean (SD)74 (10.3)67 (10.3)0.016Weight, mean (SD)69 (15.1)67 (15.6)0.61Risk factors QTc prolongation Concomitant disease, n (%)4 (17)4 (10)0.77 Drugs, n (%)14 (61)15 (36)0.18OHCLQ;Dosis, mean (SD)209 (64.5)229 (15.8)0.15Mg/kg OHCLQ, media (SD)2.91 (1.06)3.43 (1.08)0.07Years in treatment, mean (SD)9.3 (6.6)10.5 (6.5)0.48OHCLQ serum level, media (SD)174.27 (94.6)162,4 (80)0.51OHCLQ >100 mcg/LOHCLQ ≤100 mcg/LN: 47 (72%)N: 18 (28%)pOHCLQ serum level, mean (SD)166 (94)63 (96.5)0.0001QTc, mean (SD)430 (24)431 (23)0.87Dosis mg, mean (SD)221 (65)208 (66.5)0.48Mg/kg OHCLQ, mean (SD)3.32 (1.1)2.65 (1.08)0.03Years in OHCLQ, mean (SD)10.8 (6.8)11.5 (6.9)0.71Weight, mean (SD)69 (15.3)80 (15.2)0.012

Acknowledgements

El estudio fue apoyado con una beca de investigación de la Asociación para la Investigación en Reumatología de la Marina Baixa (AIRE-MB).

Disclosure of Interests

None declared

POS0657 SURVIVAL OF BARICITINIB VS ANTI-TNF AS THE FIRST BIOLOGICAL DRUG IN PATIENTS WITH RHEUMATOID ARTHRITIS, IN CLINICAL PRACTICE: RESULTS OF A LOCAL REGISTRY

Objectives

To evaluate survival in the first 4 years of treatment with Baricitinib (BARI) vs anti-TNF (TNFi), as the first biological drug (BIO-1), in patients with rheumatoid arthritis (RA).

Methods

Retrospective study of patients with RA, treated with the first BIO-1, with BARI or TNFi, from September-2017 to December-2021.

General data (current age, at diagnosis of RA and at the start of BIO-1) were collected; RA: evolution time, RF, ACPA; type of BIO-1: dose received, time in treatment, reason for withdrawal. Univariate analysis of drug survival was performed using Kaplan-Meyer curves and the Long Rank test to differentiate by groups. For the multivariate study, Cox regression with proportional hazards.

Results

The study includes 96 patients with RA, who have started treatment for > 1 month with BIO-1: BARI (n: 63/66% patients) or TNFi (33/34% patients): women: 82 (96%), current mean age (SD): 62 (1) years, at diagnosis: 51 (1) years and at the start of BIO-1: 59 (1) years. 36 (37%) patients are ≥65 years old, the mean time in AR is 7.6 years and the time in BIO-1: 1.34 (2.2) years. BIO-1 was withdrawn in 34 (40%) patients: Inefficacy: 17 (18%) patients, Complications: 14 (15%) [Cardiovascular/thrombosis: 2 (2%), rash: 2 (2%), infection-neoplasia-immunogenicity: 1 (1%) patient in each], loss to follow-up: 5 (5%) and others: 2 (2%).

When comparing the BARI vs. TNFI group, no differences were detected between the general data, the percentage of patients >65 years of age, or the mean time in treatment or the reasons for drug withdrawal (Table 1). However, survival in the BARI group was significantly superior to TNFi throughout the period (p=0.04; HR: 0.47, 95% CI: 0.24-0.91, p=0.026) (Figure 1A).

Table 1.

Characteristics of patients who receive Baricitinib (BARI) or anti-TNF as first BIO-1 (TNFi).

AllN: 96BARIN: 63 (66%)TNFiN: 33 (34%)PFemale, n (%)82 (85%)56 (89)26 (79)0.2Current age, mean (SD)62 (4.2)63 (6)59 (11)0.057Age at diagnosis RA, mean (SD)51 (4.9)52.5 (7.8)48.6 (15.5)0.17Age at start of BIO-1, mean (SD)59 (2.1)60 (4.9)55.9 (9.9)0.23≥ 65 years, n (%)36 (37)27 (43)9 (27)0.39RF positive, n (%)77 (80)54 (86)23 (70)0.1ACPA positive, n (%)74 (77)50 (79)24 (73)0.56Average time in BIO-1, years (DE)1.34 (2.2)1.85 (0.5)1.32 (2.4)0.21BARI 2 mg, n (%)-23 (36)--Withdrawal of BIO-1, n (%):38 (40)20 (32)18 (55)0.15- Complication14 (15)7 (13)7 (21)-- Loss of efficacy17 (18)8 (13)9 (27)-- Loss of follow up5 (5)5 (8)--- Other2 (2)-2 (6)-Figure 1.

Survival probability in patients with rheumatoid arthritis who receive the first BIO-1. A. Between TNFi drug vs Baricitinib. B. Between TNFi vs Baricitinib 2 mg or 4 mg.

In patients <65 years, the greatest survival of BARI is maintained (p=0.05), being significant in the first 24 months of treatment (p=0.02). In patients ≥65 years, significance was not reached throughout the overall period (p=0.5) and in the first 24 months of treatment (p=0.06).

When comparing the BARI 2 mg (n: 23/36%) and 4 mg (n: 40/64%) groups, the 2 mg group is significantly older at RA diagnosis (73 [SD: 2] years vs 56 [SD: 3] years; p<0.0001) and at the start of BIO-1 (72 [SD: 1.4] years vs 54 [SD: 2.8] years; p<0.0001). However, survival in the BARI 2 mg group was significantly higher in the first 24 months (p=0.003;) (Figure 1B): BARI 2 mg HR: 0.14, 95% CI; 0.04-0.56, p=0.005, HR BARI 4 mg: 0.44 (95% CI; 0.20-0.96, p=0.038).

Conclusion

1. Survival of BARI is superior to TNFi during the first 4 years of treatment, especially during the first 24 months of treatment. 2. There are no differences between the cause that causes drug withdrawal. 3. The use of the 2 mg dose of BARI predominates in patients older than 65 years, with survival being greater than TNFi, especially in the first 24 months of treatment.

Acknowledgements

The study was supported by a research grant from the Marina Baixa Association for Research in Rheumatology (AIRE-MB).

Disclosure of Interests

None declared

AB1023 CHARACTERISTICS OF PATIENTS REFERRED FOR FIRST BONE DENSITOMETRY TO A RHEUMATOLOGY FLS, WITH NORMAL RESULTS IN THE LUMBAR SPINE

Objectives

To analyze the characteristics of postmenopausal women referred for the first bone densitometry (BMD), with normal results in the lumbar spine.

Methods

Retrospective study of postmenopausal women, for a first BMD, at a rheumatology FLS, during February/2010-December/2021.

General patient data (age, gender), osteoporosis (OP) risk factors were collected: age at menopause, parental hip fracture, body mass index (BMI), smoking and alcohol habit, drugs and potentially osteopenizing diseases, low-impact fractures in adulthood (fractures of osteoporotic origin included: vertebral, hip, humeral head and distal radius and pelvis), current treatment for OP and FRAX index.

Results

2.930 postmenopausal women with normal lumbar BMD are included: 505 (17%) had suffered an OP fracture: mean age (SD): 63.2 years (8.5) and of menopause 48 years (10). Among the OP risk factors: early menopause: 818 (28%) women, active smoking: 521 (18%), alcohol > 3 units: 84 (2%), parents hip fracture: 310 (11%). Among osteopenizing diseases: rheumatoid arthritis/chronic arthritis: 112 (4%) patients, inflammatory bowel disease: 44 (2%), arteritis/polymyalgia rheumatica: 35 (1%) and the rest <1%. Among the osteopenizing drugs: omeprazole: 967 (33%) patients, thyroxine: 354 (12%), oral or inhaled corticosteroids: 261 (9%) and aromatase inhibitors: 168 (6%).

427 (15%) patients had had a previous OP fracture: distal radius: 188 (6%), vertebral: 146 (5%), humeral head: 46 (2%) and hip: 47 (2%). 808 (28%) patients were receiving treatment for OP: oral bisphosphonates: 518 (18%), SERM: 136 (5%), strontium ranelate: 75 (3%), denosumab: 51 (2%), teriparatide: 16 (0.7%) and zoledronate: 12 (0.5%) (Table 1).

Table 1.

Characteristics of patients with normal lumbar spine BMD.

TOTAL BMD LS NormalN: 2.930Normal BMD LS WITH fractureN: 505 (17%)Normal BMD LS WITHOUT fractureN: 2.425 (83%)pAge in BMD, years, mean (SD)63,270.5 (7.78)60.6 (26)0.0001Menopausal age, years, mean (SD)48 (8.4)45 (5.46)48 (8.48)0.0001Early menopause, n (%)814 (28)171 (34)643 (27)0.07BMI, kg/m2, media (SD)29,1 (10.3)29.5 (17.03)28,9 (10.3)0.44Active tobacco, n (%)521 (18)40 (8)481 (20)0.06Alcohol ≥ 3 units, n (%)84 (2)10 (2)74 (3)0.85Parent hip fracture, n (%)310 (11)60 (12)250 (10)0.65Ostepenizing drug, n (%):1.750289 (57)1.461 (60)0.34  Omeprazole967 (33)178 (35)789 (33)0.60  Thyroxine354 (12)53 (10)301 (12)0.67  Corticosteroids261 (9)42 (8)219 (9)0.83  Aromatasa Inhibitor168 (6)16 (3)152 (6)0.62Treatment, n (%):808 (34)226 (48)582 (24)0.0001  Oral bisphosphonate518 (18)127 (25)391 (16)  SERM136 (5)24 (5)112 (5)0.02  Strontium ranelate75 (3)20 (4)55 (2)1  Denosumab51 (2)31 (6)20 (0.8)0.35  Zoledronate12 (0.5)10 (2)2 (<0.1)0.84  Teriparatide16 (0.7)14 (3)2 (<0.1)0.84BMD, mean Tscore (SD):  Lumbar spine0.890.04 (1.49)0.05 (1.49)0.89  Femoral neck0.70-1.3 (1.06)-0.54 (1.06)0.0001   Osteoporosis, n (%)108 (4)51 (10)57 (2)0.07    Osteopenia, n (%)981 (33)247 (49)734 (30)0.0001  Total hip-0.31-0.8 (1.12)-0.17 (1.12)0,0001FRAX with BMD, mean (SD):  Mean fracture5.2310.6 (5.79)3.99 (5.78)0.0001  Hip fracture1.543.7 (3.58)1.09 (3.58)0.0001

The group with OP fractures, are significantly (Table 1): older (p<0.0001), with lower mean age of menopause (p<0.0001), receive more treatment (p<0.0001), especially oral bisphosphonates (p=0.02), have worse results in hip BMD (p<0.0001), with a higher percentage of osteopenia (50% vs 30%, p<0.0001) and worse result in FRAX of major fracture (p<0.0001) and of hip (p<0.001).

Conclusion

Among the patients referred to BMD, although the result of lumbar spine is normal, 17% have suffered an OP fracture, presenting this group: 1) Older age, 2) Osteopenia in hip BMD 50%, with high risk of fracture due to FRAX and they followed treatment for OP, especially oral bisphosphonates. 3) It is advisable to simultaneously perform BMD at the lumbar and hip levels, especially in older subjects

Acknowledgements

The study was supported by a research grant from the Marina Baixa Association for Research in Rheumatology (AIRE-MB).

Disclosure of Interests

None declared

The effects of ischaemic conditioning on lung ischaemia-reperfusion injury

Ischaemia-reperfusion injury (IRI) encompasses the deleterious effects on cellular function and survival that result from the restoration of organ perfusion. Despite their unique tolerance to ischaemia and hypoxia, afforded by their dual (pulmonary and bronchial) circulation as well as direct oxygen diffusion from the airways, lungs are particularly susceptible to IRI (LIRI). LIRI may be observed in a variety of clinical settings, including lung transplantation, lung resections, cardiopulmonary bypass during cardiac surgery, aortic cross-clamping for abdominal aortic aneurysm repair, as well as tourniquet application for orthopaedic operations. It is a diagnosis of exclusion, manifesting clinically as acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). Ischaemic conditioning (IC) signifies the original paradigm of treating IRI. It entails the application of short, non-lethal ischemia and reperfusion manoeuvres to an organ, tissue, or arterial territory, which activates mechanisms that reduce IRI. Interestingly, there is accumulating experimental and preliminary clinical evidence that IC may ameliorate LIRI in various pathophysiological contexts. Considering the detrimental effects of LIRI, ranging from ALI following lung resections to primary graft dysfunction (PGD) after lung transplantation, the association of these entities with adverse outcomes, as well as the paucity of protective or therapeutic interventions, IC holds promise as a safe and effective strategy to protect the lung. This article aims to provide a narrative review of the existing experimental and clinical evidence regarding the effects of IC on LIRI and prompt further investigation to refine its clinical application.

How to optimize your set-up for a VATS right upper lobectomy

A 77-year-old woman with multiple ground-glass opacities, the largest of which measured 21 mm, has a biopsy-proven primary lung adenocarcinoma in her right upper lobe. We performed a 3-port right-sided VATS using the Copenhagen approach. There was no pleural effusion or evidence of pleural metastatic spread. A tumor was identified in the upper lobe. The surrounding lung tissue appeared normal.  We performed a multilevel intercostal block using 0.25% levobupivacaine. The inferior pulmonary ligament was divided. The superior pulmonary vein and 2 branches of the pulmonary artery to the right upper lobe were dissected, encircled, and divided using tan reloads of the Endo GIA stapler. The right upper lobe bronchus was dissected, encircled, and divided in a similar fashion using a purple reload of the Endo GIA stapler following a successful test inflation of the lower and middle lobes. The horizontal fissure was completed with further firings of the stapler. Lymph nodes from stations 2, 4, 7, 8, 9, 10, and 11 were sampled and sent separately for histological analysis. There was no parenchymal or stump leak to 20 cm H20 on the test inflation. Hemostasis and pneumostasis were checked and ensured. A single 24 Fr drain was placed in the apex. Hemostasis was complete. The incision was closed in layers.

Impact of society and national guidelines on patient selection for lung cancer surgery in the United Kingdom

8544

Background: In 2010 the British Thoracic Society (BTS) guidelines introduced clinical decision based on patient perception of risk to make surgery more permissive and revised recommendations for broader oncologic criteria such as surgery for N2 disease to improve surgical resection rates. In 2011 the National Institute for Health and Care Excellence (NICE) guidelines were updated with similar recommendations, but notable disagreement on surgery for N2 disease. We sought to conduct one of the largest cross-sectional studies to ascertain the impact of national clinical guidelines (with conflicting recommendations) on clinician behaviour. Methods: We analysed data from the UK national registry (National Lung Cancer Audit) comprising all patients diagnosed with lung cancer between 2008 to 2013 within England and Wales. Categorical data was summarised as frequency (%) and continuous data was summarised as mean (SD). Linear and logistic regression analyses were used with each year as an independent categorical outcome to determine global and year specific changes in FEV1 and proportions with N2 undergoing surgery respectively. Results: From January 2008 to December 2013, data from 167,192 patients with primary lung cancers were submitted to the NLCA. In 2008, 23,293 new lung cancers were diagnosed in England and Wales increasing annually by 2013 to 29,224. The most common presentation was advanced disease stage IV (49.7%), IIIB (13.2%) and IIIA (12.0%) and early-stage disease was less frequent with presentations IA (7.0%), IB (6.7%), IIA (2.9%) and IIB (4.27%). Lung function tests were undertaken in a subset of 53,905 of all diagnosed patients from 2008 to 2013. The mean FEV1 (SD) increased annually from 67 (22)% in 2008 to 71 (24)% in 2013 (p < 0.001). Overall, 28% (n = 46,742) of the patients were preoperatively staged as N2 disease at diagnosis. The proportion of patients with N2 disease increased from 24 to 29% in this timeframe (P = 0.003). The proportion of patients undergoing surgery for lung cancer increased from 9.5% in 2008 to 20.5% in 2013 (p < 0.001). Mean FEV1 of surgical patients were higher at 79 (22)% than the population average of 69 (23)%, an accepted reflection of surgical selection. Over time, mean FEV1 of surgical patients increased from 76 (22)% in 2008 to 81 (22)% in 2013 (p < 0.001). Of the patients undergoing surgery, the proportion of patients across the 6-year interval were broadly consistent between 8 to 11% without any evidence of trend (P = 0.125). Conclusions: Within 3 years of new clinical guidelines, we did not observe any overall change in selection based on lower levels of lung function and when presented with conflicting recommendation no observable change in attitudes of clinicians on surgery for N2 disease. The observed increase in surgical resection rates is more likely due to (greater access to surgery by) increasing number of surgeons rather than any impact of guideline recommendations.

Simultaneous analysis of saturated and unsaturated oxylipins in 'ex vivo' cultured peripheral blood mononuclear cells and neutrophils

Oxylipins are a family of saturated and unsaturated fatty acids peroxidation products with bioactive properties. We have developed an improved method for the measurement of ex vivo oxylipin production by peripheral blood mononuclear cells (PBMCs) and neutrophils. We aimed to develop an analytical method to determine the production rates of polyunsaturated fatty acids (PUFAs), PUFA-oxylipin, and saturated-oxylipins by stimulated PBMCs and neutrophils based on solid phase extraction and HPLC-MS/MS technology. A UHPLC system coupled to a Q-Exactive Hybrid Quadrupole-Orbitrap mass spectrometer was used to identify and quantify oxylipin production. For each oxylipin and PUFA their differential response was calculated with respect to a deuterated internal standard factor (ISF). To calculate oxylipin and PUFAs in the culture samples, the individual ISF was used for each oxylipin and PUFA with respect to the deuterated internal standard. PBMCs and neutrophils showed a different pattern of oxylipin production and fatty acid secretion. Lipopolysaccharide (LPS) did not stimulate oxylipin production or fatty acids secretion in PBMCs, whereas phorbol myristate acetate (PMA) stimulation increased the production rate of 5-HETE, 15-HETE, 15-HEPE, 17-DoHE, PGE2, AA, and DHA. LPS stimulation decreased 16-hydroxyl-palmitatte (16-OHPAL) production and DHA secretion in neutrophils, while PMA stimulation increased the production rate of AA and its derivate oxylipins, 5-HETE, 15-HETE, and PGE2. In conclusion, we have developed a new method to determine oxylipins derived from both saturated and unsaturated fatty acids in culture cell media. This method has enough sensitivity, and accuracy, to determine oxylipin production and fatty acid secretion by PBMCs and neutrophils.

FRI0295 ADALIMUMAB LEVELS ARE ASSOCIATED WITH DRUG RETENTION RATES IN AXIAL SPONDYLOARTHRITIS PATIENTS

Background:

Production of anti-drug antibodies (ADA) could cause low serum anti-TNF levels and low drug retention rates.

Objectives:

To assess the relationship between serum adalimumab (ADL) levels and drug retention rates in patients with axial SpA.

Methods:

Single-center prospective study in patients with axial SpA, according to ASAS criteria, being treated with ADL. In the first part of the study, from December 2010 to June 2016, data was collected and serum samples were taken. In a second part of the study, clinical records were reviewed to find out the dates and reasons of treatment discontinuation. Information was collected on age gender, body mass index (BMI), date of diagnosis of SpA, laboratory data, including HLAB27, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), prior biological treatment for SpA, concomitant conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs). SpA disease activity was assessed by BASDAI, ASDAS and PGA scores. A serum sample was taken from all patients just before the next adalimumab dose. ADL and ADA levels were analysed with ELISA Promonitor®, (Proteomika, Progénica, Griffols) and correlated with SpA activity using BASDAI and ASDAS scores. Cox proportional hazards model was performed in order to assess the relation of variables with drug interruption.

Results:

Up to January 2016, 51 consecutive patients were included. The mean (range) age was 46,9 (18–68) and 47.1% were women. HLAB27 was positive in 82,4% of patients. Mean disease duration was 122,9 months (2-408) and mean duration of treatment with adalimumab was 17,8 months (1-69). ADL was the first biological agent received in 36 patients (70.6%). Eleven patients (21.6%) were on concomitant treatment with receiving concomitant csDMARDs, mainly methotrexate (MTX) (15.7%) and sulfasalazine (5.9%). The mean (SD) activity scores were BASDAI 4,0 ± 2,3; ASDAS-PCR 2,1 ± 1,1 and ASDAS-VSG 2,1 ± 1,0.

ADA prevalence was 27.5%, with none detected in the 21.6% taking csDMARDs (p = 0.021). ADL level was normal (> 3 mg/l) in 36 patients (70.6%), all without ADA. Fifteen patients (29.4%) had subtherapeutic ADL levels (< 3 mg/l), with ADA in 14 (93%).

Total ADL treatment time was 241,16 patient/years, and mean ADL treatment time was 4,73 years. Cox model results were resumed in table 1. Multivariate study show that ADL level > 3 mg/L was a protective factor for ADL interruption (HR 0.01 (0.00-0.59, p=0.026), while previous etanercept treatment was a risk factor for ADL interruption 9.54 (1.23-74.08, p=0.031).

Table 1.

Cox model.

ContinueDiscon=tinueUnivariateHRMultivariateHRADL level<3 mg/L13 (86,7%)2 (13,3%)0.05 (0.00-0.65, p=0.022)0.01 (0.00-0.59, p=0.026)≥3 mg/L28 (77,8%)8 (22,2%)Concomitant DMARDYes8 (72,7%)3 (27,3%)0.56 (0.14-2.26, p=0.419)0.28 (0.05-1.65, p=0.159)No33 (82,5%)7 (17,5%)BMINormal13 (86,7%)2 (13,3%)2.56 (0.54-12.23, p=0.239)0.48 (0.02-9.75, p=0.634)Overweight/obese27 (77,1%)8 (22,9%)AgeMean (SD)46,4 (12,2)48,7 (11,6)0.93 (0.24-3.60, p=0.912)0.60 (0.10-3.84, p=0.594)GenderMen19 (70,4%)8 (29,6%)0.43 (0.09-2.03, p=0.283)0.58 (0.03-10.06, p=0.705)Women22 (91,7%)2 (8,3%)InfliximabpreviousYes4 (40,0%)6 (60,0%)3.31 (0.92-11.87, p=0.066)1.37 (0.23-8.24, p=0.731)No37(90,2%)4 (9,8%)EtanerceptpreviousYes2 (22,2%)7 (77,7%)8.17 (2.09-31.90, p=0.003)9.54 (1.23-74.08, p=0.031)No39 (92,9%)3 (7,1%)

ADL: adalimumab; BMI: body mass index; DMARD: disease modifying antirheumatic drug; SD: standard deviation.

Conclusion:

Adalimumab drug levels > 3 mg/L is a protective factor against treatment interruption.

Etanercept previous treatment was a risk factor for treatment interruption.

Acknowledgments:

The study was supported by a grant from “Asociación para la Investigación en Reumatología de la Marina Baixa” (AIRE-MB).

Disclosure of Interests:

None declared

AB0318 CHARACTERISTICS OF PATIENTS WITH RHEUMATOID ARTHRITIS WHO HAVE WITHDRAWN THE LAST BIOLOGICAL DRUG: REAL-LIFE RESULTS FROM A LOCAL REGISTRY

Objectives:

To assess the characteristics of patients with rheumatoid arthritis (RA), who have withdrawn the last biological drug (bDMARD), and to know the reasons for withdrawal of treatment.

Methods:

Retrospective and cross-sectional study on December 31, 2019, of patients with RA, treated with any of the bDMARDs, including JAK (JAKi) inhibitor drugs, commonly used, from 1/1/2000 to 12/31/2019. General data were collected from patients, and RA: time of evolution, presence of rheumatoid factor (RF) and anti-citrullinated peptide antibodies (ACPA), type of bDMARD, time in bDMARD, and cause of withdrawal.

Results:

Of 252 patients, who have received some bDMARD, 81 (32%) patients had withdrawn on 12/31/2019. 62 (77%) patients were women, with a mean age at diagnosis of RA of 48 years (SD: 16.5 years) and 59.5 (15) years at the beginning of the first bDMARD (F1), with an average evolution of RA 10.2 (2.5) years. 68% and 74% of patients were positive for RF and ACPA, respectively.

In 64 (79%) patients, bDMARD was withdrawn as second to fifth bDMARD received (F2 to F5): as F2: 37/81 (46%) patients, F3: 14 (18%), F4: 8 (10%) and as F5: (6%) patients.

When comparing the last bDMARD received, before the suspension as F1 vs F2-F5, 95% vs. 61% of patients (p <0.0001), the drug was an anti-TNF (TNFi); Abatacept: 1 (1%) vs 9 (14%); Tocilizumab: 0% vs 8 (12%); Rituximab: 1 (1%) vs 5 (8%) and JAKi: 4 (5%) vs 3 (5%). The mean time in treatment with some bDMARD was 2.6 (SD: 3) years in the F1 group vs 1.7 (2) years in the F2-F5 group (p = 0.034). Among the F3-F5 patients, 9 (14%) patients had failed at 2 different previous therapeutic targets and 6 (9%) at 3 targets.

No differences were detected between the F1 group vs F2-F5, regarding the causes of withdrawal of bDMARD: whether it had occurred due to 1) loss of efficacy (25/31% patients vs 19/30%); 2) adverse events (31/38% vs. 29/45%): infection: 18/81 (22%) patients, malignancy: 5 (6%), malaise/pain: 11 (14%), laboratory parameters alteration: 7 (9%), death: 5 (6%), others: 14 (17%); 3) change of address/loss of follow-up (20/25% vs. 7/11%) or by 4) voluntary abandonment of treatment by the patient (5/6% vs. 9/14%).

Conclusion:

1. 32% of patients with RA withdraw the bDMARD. 2. The group treated with TNFi withdraws it significantly higher among the F1 group. 3. Survival of bDMARD is significantly higher in group F1 compared to F2-F5. 4. No differences were detected between the groups regarding the cause of withdrawal of bDMARD. 25% -30% of patients withdraw it due to loss of follow-up or voluntary abandonment of bDMARD.

Acknowledgments:

The study was supported by a research grant from the Association for Research in Rheumatology of the Marina Baixa (AIRE-MB).

Disclosure of Interests:

None declared

OP0299 CLINICAL FEATURES ASSOCIATED WITH FRAGILITY FRACTURE AFTER DISCONTINUATION OF TREATMENT WITH DENOSUMAB: A CASE-CONTROL STUDY

Background:

Discontinuation of denosumab treatment causes an increase in bone resorption that has been linked to the emergence of vertebral fractures.

Objectives:

To evaluate the association of clinical features and demographic characteristics with the emergence of new fragility fractures in patients with osteoporosis who interrupt treatment with denosumab.

Methods:

Retrospective case-control study. Medical records of all patients with osteoporosis, from our local densitometry database, who received treatment with denosumab (at least one dose) and discontinue the treatment, have been studied.

Information was collected on demographic variables (age, sex), risk factors for osteoporosis (alcohol and tobacco consumption, personal history of fragility fracture and history of maternal hip fracture), secondary osteoporosis (due to early menopause, disease or osteopenizing treatment), previous treatment for osteoporosis, start and end date of denosumab treatment and subsequent treatments.

All patients who suffered a fragility fracture from 6 months after the last dose of denosumab up to 20 months later were defined as a case. Prior treatment with bisphosphonate was considered to those who had received it for at least 1 year, and subsequent treatment with bisphosphonate was considered to those who received it immediately or up to 8 months after the last dose of denosumab.

Results:

In total, 63 patients who discontinued treatment with denosumab were included. Ten of them presented fragility fractures (6 vertebral, 3 forearm and 1 hip). Two patients had a fracture after 24 months of the last dose of denosumab, so don’t were considered cases. 61 patients were women (96.83%) and the mean age (SD) was 70.22 (8.95) years. The mean time (SD) of treatment with denosumab was 42.25 (17.32) months, with a mean (SD) doses of 7.85 (2.78). The reasons for interruption of denosumab were: improvement 39 (65%), dental procedure 9 (15%), patient decision 6 (10%), adverse event 4 (6.66%) and inefficacy 2 (3.33%). Demographic and clinical features by fragility fracture are shown in Table 1. We found that subsequent treatment with bisphosphonates after denosumab was initiated in less patients in the fracture group than in the control group (10% vs 42,9%; p=0,05), and we found no fractures in patients diagnosed with secondary osteoporosis. No statistically significant differences were found in the rest of the variables.

Table 1.

Demographic and clinical features by fragility fracture.

No fractureFractureTotalpAge, mean (SD)70.2 (9.5)70.5 (5.5)70.2 (8.9)0.956BMI, mean (SD)25.0 (4.8)25.3 (3.2)25.1 (4.6)0.844Secondary OP (%)26 (49.1)0 (0)26 (41.3)0.004Tobacco (%)17 (32.1)2 (25.0)19 (31.1)0.687Alcohol (%)3 (5.7)0 (0.0)3 (4.9)0.490Previous fracture (%)20 (37.7)6 (66.7)26 (41.9)0.104Mother hip (%)6 (11.3)0 (0.0)6 (9.8)0.316Previous BP (%)29 (67.4)2 (50.0)31 (66.0)0.481Denosumab dose, mean (SD)7.9 (2.8)7.5 (3.0)7.9 (2.8)0.676Subsequent BP (%)21 (42.9)1 (10.0)22 (37.3)0.050

BMI: body mass index; BP: bisphosphonate; OP: osteoporosis; SD: standard deviation.

Conclusion:

Sequential treatment with bisphosphonates and diagnosis of secondary osteoporosis are related to the absence of fractures after discontinuation of denosumab treatment.

Acknowledgments:

This study was supported by a research grant from Asociación para la Investigación en Reumatología de la Marina Baixa (AIRE-MB).

Disclosure of Interests:

None declared

AB0912 CLINICAL UTILITY OF THE WARD TRIANGLE OF HIP BONE DENSITOMETRY: DATA FROM AN FLS UNIT

Objectives:

To evaluate the clinical utility of Ward’s triangle (W) of bone densitometry (BMD) of the hip in a population of postmenopausal women referred to BMD from a FLS Unit coordinated by Rheumatology (FLS-REU).

Methods:

Retrospective study, which includes, after informed consent, postmenopausal women referred by any department of specialized medicine or primary care medicine, of the health department, to the FLS-REU Unit of our center, during the period of February 2010 to October 2019.

General patient data were collected (age, gender), and risk factors for OP. BMD of the lumbar spine (CL) and hip (femoral neck, total hip and W) was performed, except if there was lumbar surgery, severe scoliosis, or a bilateral hip prosthesis. The BMD outcome was distributed in normal (T index [Ts] to -1 SD), osteopenia (Ts: -1.1 to -2.5 SD) and OP (Ts: <-2.5 SD), separated into two groups: mild OP- moderate (Ts: from <-2.5 DE to -3 DE) or severe OP (Ts: <-3 DE).

Results:

5,740 postmenopausal women referred for BMD are included, with the W result available (Table 1). The result of the mean Ts (SD) was: in CL: -1.49 (1.48) SD, femoral neck: -1.33 (1.11) SD and in W: -2.05 (1.12) SD. In 947 (16%) women, the W was normal, with a mean Ts: -0.28 (1.12) SD; osteopenia in 2,606 (45%): -1.83 (1,12) SD and OP in 2,197 (39%) SD, of which 1,010 (61%) had mild-moderate OP and 967 (49%), severe OP.

The table shows the BMD results of W and CL, the correlation coefficient between them being 0.52 (0.5-0. P <0.001), although with a Kappa coefficient of 0.26 (0.24-0.28. P = 0). The probability that a result in W of normal BMD is normal also in CL is 73% (70% -76%), in osteopenia in both: 47% (45% -49%) and OP: 46% (44 % -48%). In the analysis by ROC curve, the cut-off point of Ts in W for osteopenia in CL is -1.85 SD (sensitivity: 0.648, specificity: 0.649, with AUC: 00.702. [0.687-0.716]) and for OP in CL -2.35 DE (sensitivity: 0.69, specificity: 0.70, with AUC: 0.757 [0.744-0.770]).

LUMBAR SPINE (LS)NormalOsteopeniaOsteoporosis(OP)OP<-2.5 a -3 SDOP<-3.0 SDWard normalN (%): 947 (16)Tscore: -0.28 ± 1.12 SD6810.41±1.78211-1.61±1.7839-2.95±1.7826-2.7±1.7813-3.46±1.78Ward osteopeniaN (%): 2.606 (45)Tscore: -1.83±1.12 SD899-0.07±1.481.192-1.73±1.48463-2.96±1.48310-2.72±1.48153-3.43±1.48Ward OsteoporosisN (%): 2.187 (39)Tscore: -3.07±1.13 SD346-0.19±1.48800-1.83±1.48975-3.23±1.48--Ward Osteoporosis <-2.5 a-3 SDN: 1.010 (51)Tscore: -2.78±1.12 SD188-0.16±1.48416-1.83±1.48-173-2.77±1.48378-3.08±1.48Ward Osteoporosis <-3 SDN: 967 (49)Tscore: -3.51±1.13 SD114-0.24±1.48304-1.84±1,48-193-2.78±1.48327-3.73±1.48

Conclusion:

1.For clinical practice, the usefulness of the W result is low, although if the BMD result is normal, there is a 73% probability that in CL it will also be. 2. The correlation between the result of W and CL, although significant, is slight. 3. The cut-off points of Ts, with better sensitivity and specificity, that correlate a W osteopenia or osteoporosis with the result in CL is -1.85 and -2.35 SD, respectively.

Acknowledgments:

The study was supported by a research grant from the Association for Research in Rheumatology of the Marina Baixa (AIRE-MB).

Disclosure of Interests:

None declared

Activation of innate immunity by 14-3-3 ε, a new potential alarmin in osteoarthritis

OBJECTIVE

The innate immune system plays a central role in osteoarthritis (OA). We identified 14-3-3ε as a novel mediator that guides chondrocytes toward an inflammatory phenotype. 14-3-3ε shares common characteristics with alarmins. These endogenous molecules, released into extracellular media, are increasingly incriminated in sustaining OA inflammation. Alarmins bind mainly to toll-like receptor 2 (TLR2) and TLR4 receptors and polarize macrophages in the synovium. We investigated the effects of 14-3-3ε in joint cells and tissues and its interactions with TLRs to define it as a new alarmin involved in OA.

DESIGN

Chondrocyte, synoviocyte and macrophage cultures from murine or OA human samples were treated with 14-3-3ε. To inhibit TLR2/4 in chondrocytes, blocking antibodies were used. Moreover, chondrocytes and bone marrow macrophage (BMM) cultures from knockout (KO) TLRs mice were stimulated with 14-3-3ε. Gene expression and release of inflammatory mediators [interleukin 6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), tumor necrosis factor alpha (TNFα)] were evaluated via reverse transcription quantitative polymerase chain reaction (RT-qPCR) and ELISA.

RESULTS

In vitro, 14-3-3ε induced gene expression and release of IL6 and MCP1 in the treated cells. The inflammatory effects of 14-3-3ε were significantly reduced following TLRs inhibition or in TLRs KO chondrocytes and BMM.

CONCLUSIONS

14-3-3ε is able to induce an inflammatory phenotype in synoviocytes, macrophages and chondrocytes in addition to polarizing macrophages. These effects seem to involve TLR2 or TLR4 to trigger innate immunity. Our results designate 14-3-3ε as a novel alarmin in OA and as a new target either for therapeutic and/or prognostic purposes.

Low genome-wide homozygosity in 11 Spanish ovine breeds

The population of Spanish sheep has decreased from 24 to 15 million heads in the last 75 years due to multiple social and economic factors. Such a demographic reduction might have caused an increase in homozygosity and inbreeding, thus limiting the viability of local breeds with excellent adaptations to harsh ecosystems. The main goal of our study was to investigate the homozygosity patterns of 11 Spanish ovine breeds and to elucidate the relationship of these Spanish breeds with reference populations from Europe, Africa and the Near East. By using Ovine SNP50 BeadChip data retrieved from previous publications, we have found that the majority of studied Spanish ovine breeds have close genetic relatedness with other European populations; the one exception is the Canaria de Pelo breed, which is similar to North African breeds. Our analysis has also demonstrated that, with few exceptions, the genomes of Spanish sheep harbor fewer than 50 runs of homozygosity (ROH) with a total length of less than 350 Mb. Moreover, the frequencies of very long ROH (>30 Mb) are very low, and the inbreeding coefficients (F_ROH ) are generally small (F_ROH  < 0.10), ranging from 0.008 (Rasa Aragonesa) to 0.086 (Canaria de Pelo). The low levels of homozygosity observed in the 11 Spanish sheep under analysis might be due to their extensive management and the high number of small to medium farms.

Index for the evaluation of the general photometric performance of photometers

The General V(λ) Mismatch Index, f1 ^', was defined for a general description of the photometric performance of photometers. This index is widely-used in photometry, and it is very relevant for selecting photometers for low-uncertainty photometric measurements. It quantifies the spectral mismatch between the relative spectral responsivity of a photometer and the luminous efficiency function for photopic vision, V(λ). The linear correlation between the real general photometric measurement error and f1 ^' of 77 photometers was studied for four sets of light sources: R, G and B LEDs (narrowband spectral power distributions, SPDs), blackbodies at different colour temperatures (broadband SPDs), phosphor-based LEDs at different correlated color temperatures (SPDs with narrow- and broad-band features), and a mixture of blackbodies and phosphor-based LED sources. This article shows that it can be defined an alternative index which is notably better correlated with the real general photometric measurement error of the photometers under light sources with broadband features in their SPDs, adequate for general lighting. This index is based on filtering the high spectral frequencies variations between the relative spectral responsivity of the photometer and V(λ). The use of this new index for the assessment of the general photometric performance of photometers would improve the selection of high quality photometers and, consequently, would contribute to the general improvement of photometric measurements.

Effects of dietary almond- and olive oil-based docosahexaenoic acid- and vitamin E-enriched beverage supplementation on athletic performance and oxidative stress markers

Functional beverages based on almonds and olive oil and enriched with α-tocopherol and docosahexaenoic acid (DHA) could be useful in modulating oxidative stress and enhancing physical performance in sportsmen. The aim of this work was to evaluate the effects of supplementation with functional beverages on physical performance, plasma and erythrocyte fatty acids' and polyphenol handling, oxidative and nitrative damage, and antioxidant and mitochondrial gene expression in young and senior athletes. Athletes performed maximal exercise tests before and after one month of dietary supplementation and blood samples were taken immediately before and one hour after each test. The beverages did not alter performance parameters during maximal exercise. Supplementation increased polyunsaturated and reduced saturated plasma fatty acids while increasing the DHA erythrocyte content; it maintained basal plasma and blood polyphenol levels, but increased the blood cell polyphenol concentration in senior athletes. Supplementation protects against oxidative damage although it enhances nitrative damage in young athletes. The beverages enhance the gene expression of antioxidant enzymes in peripheral blood mononuclear cells after exercise in young athletes.

MicroRNAs 142-3p, miR-155 and miR-203 Are Deregulated in Gastric MALT Lymphomas Compared to Chronic Gastritis

BACKGROUND

Over the last years, our knowledge on pathogenesis of gastric MALT lymphoma has greatly improved, but its morphological diagnosis is still hampered by overlapping histological features with advanced chronic gastritis. MicroRNAs are deregulated in lymphomas, but their role and usefulness in gastric MALT lymphoma has not been extensively investigated.

MATERIALS AND METHODS

We analyzed the expression of 384 miRNAs using TaqMan microRNA assay in a training series of 10 gastric MALT lymphomas, 3 chronic gastritis and 2 reactive lymph nodes. Then, significantly deregulated miRNAs were individually assessed by real-time PCR in a validation series of 16 gastric MALT lymphomas and 12 chronic gastritis.

RESULTS

Gastric MALT lymphoma is characterized by a specific miRNA expression profile. Among the differentially expressed miRNAs, a significant overexpression of miR-142-3p and miR-155 and down-regulation of miR-203 was observed in gastric MALT lymphoma when compared to chronic gastritis.

CONCLUSION

miR-142-3p, miR-155 and miR-203 expression levels might be helpful biomarkers for the differential diagnosis between gastric MALT lymphomas and chronic gastritis.

Preradiotherapy MR Imaging: A Prospective Pilot Study of the Usefulness of Performing an MR Examination Shortly before Radiation Therapy in Patients with Glioblastoma

BACKGROUND AND PURPOSE

Current protocols in patients with glioblastoma include performing an MR examination shortly after surgery and then 2-6 weeks after ending concomitant chemoradiotherapy. The assessment of this first postradiotherapy examination is challenging because the pseudoprogression phenomenon may appear. The aim of this study was to explore if performing an MR examination shortly before radiation therapy (preradiotherapy MR imaging) could improve the radiologic assessment of patients with glioblastoma.

MATERIALS AND METHODS

A preradiotherapy MR imaging examination was prospectively performed before the start of radiation therapy in 28 consecutive patients with glioblastoma who had undergone surgical resection. Tumor response to chemoradiotherapy was assessed twice: with the early postoperative MR examination as baseline and with the preradiotherapy MR imaging examination as baseline. In addition, tumor growth in the preradiotherapy MR imaging examination was evaluated, and its correlation with patient survival was assessed with Kaplan-Meier analysis and Cox regression.

RESULTS

Tumor progression after radiation therapy was found in 16 patients, corresponding to pseudoprogression in 7 of them (44%). Four assessments of pseudoprogression switched to partial response or stable disease when preradiotherapy MR imaging was the baseline examination, and the ratio of pseudoprogression was reduced to 25% (3 of 12). Significant differences in survival were found when patients were stratified according to the pattern of tumor growth on preradiotherapy MR imaging (median overall survival "no-growth," 837 days; "focal-growth," 582 days; "global-growth," 344 days; P = .001).

CONCLUSIONS

Performing a preradiotherapy MR imaging examination may improve the clinical management of patients with glioblastoma by reducing the ratio of pseudoprogression assessments and providing prognostic information.

Effects of dietary Docosahexaenoic, training and acute exercise on lipid mediators

Background

Eicosanoids mediate initiation and resolution of inflammation. Our aim was evaluating the effects of training, exercise and docosahexaenoic (DHA) supplementation on plasma eicosanoids levels and peripheral blood mononuclear cells (PBMCs) eicosanoids production.

Methods

Fifteen male footballers were distributed to placebo and experimental groups. Experimental group consumed DHA-enriched beverage (1.16 g DHA/day) for 8 weeks, placebo group consumed a placebo beverage. Blood samples were taken before and after the nutritional intervention in basal conditions and 2 h after acute exercise.

Results

Training increased basal Prostaglandin E1 (PGE₁) plasma levels and PBMCs cyclooxygenase 2 (COX-2) protein levels in both groups, but COX-1 protein levels only in the experimental group. Acute exercise increased plasma PGE₂ and PBMCs active NFκβ levels. Lipopolysaccharide (LPS)-stimulated PBMCs increases eicosanoids production (PGE₁, PGE₂, RvD1) in both groups and increased LPS-stimulated PBMCs active NFκβ. DHA supplementation increased COX-2 levels but decreased LPS-stimulated PBMCs PGE₁ and PGE₂ production. Neither DHA supplementation nor acute exercise altered the expression of NFκβ, COX-2, 15-LOX2, 5-LOX, or IL-1β genes in PBMCs.

Conclusions

The increase of PGE₁ plasma levels after training promoted systemic anti-inflammatory and vasodilator environment. Exercise and DHA supplementation acted synergistically by increasing plasma PGE₂ with anti-inflammatory effects. Exercise primed PBMCs to enhance PGE₁, PGE₂ and RvD1 production in response to LPS.

Trial registration

The project was registered at ClinicalTrial.gov (NCT02177383).

Competitive apnea diving sessions induces an adaptative antioxidant response in mononucleated blood cells

The aim was evaluating the effects of hypoxia/reoxygenation repetitive episodes during 5 days of apnea diving (3-day training/2-day competition) on peripheral blood mononuclear cells (PBMCs) antioxidant defenses, oxidative damage, and plasma xanthine oxidase activity. Blood samples, from seven professional apnea divers, were taken under basal conditions the previous morning to the first training session (pre-diving basal), 4 h after ending the competition (4 h post-diving) and the following morning (15 h after last dive) in basal conditions (post-diving basal). Glucose levels significantly decreased whereas triglycerides increased at 4 h post-diving, both returning to basal values at post-diving basal. Glutathione reductase and catalase activity significantly increased after 4 h post-diving remaining elevated at post-diving basal. Glutathione peroxidase and superoxide dismutase activities and catalase protein levels progressively increased after diving with significant differences respect to initial values at post-diving basal. No significant differences were observed in circulating PBMCs and oxidative damage markers. Plasma xanthine oxidase activity and nitrite levels, but not the inducible nitric oxide synthetase, significantly increased 4 h post-diving, returning to the basal values after 15 h. In conclusion, chronic and repetitive episodes of diving apnea during five consecutive days increased plasma xanthine oxidase activity and nitric oxide production which could enhance the signalling role of reactive oxygen and nitrogen species for PBMCs antioxidant adaptation against hypoxia/reoxygenation.

Modulation of TNF-α, TNF-α receptors and IL-6 after treatment with AM3 in professional cyclists

AIM

Changes in IL-6, TNF-α, and TNF-α receptors - sTNFRI and sTNFRII - were evaluated in a group of professional cyclists treated with immunomodulator AM3 (Inmunoferón®) for 6 months of training and competition.

METHODS

Sixteen male professional cyclists with a similar training program participated in the study which was designed as a randomized, placebo-controlled, double-blind clinical trial. Venous blood samples were collected in basal conditions, before beginning the supplementation program, and after 90 and 180 days of training and competition season.

RESULTS

No significant differences in biochemical parameters or in IL-6 were evidenced between placebo and AM3-treated groups throughout the study. Plasma TNF-α levels significantly decreased (P<0.05) after 90 days of training in the AM3 treated group. TNF-α receptors increased during training season in both placebo and AM3 treated groups, although the increase was significantly higher (P<0.05) in the AM3 group with respect to the placebo group.

CONCLUSION

The changes produced by regular training and competition were modified throughout the season by AM3 treatment which could reduce the inflammatory response to excessive exercise.

Effects of total dietary polyphenols on plasma nitric oxide and blood pressure in a high cardiovascular risk cohort. The PREDIMED randomized trial

BACKGROUND AND AIM

Hypertension is one of the main cardiovascular risk factors in the elderly. The aims of this work were to evaluate if a one-year intervention with two Mediterranean diets (Med-diet) could decrease blood pressure (BP) due to a high polyphenol consumption, and if the decrease in BP was mediated by plasma nitric oxide (NO) production.

METHODS AND RESULTS

An intervention substudy of 200 participants at high cardiovascular risk was carried out within the PREDIMED trial. They were randomly assigned to a low-fat control diet or to two Med-diets, one supplemented with extra virgin olive oil (Med-EVOO) and the other with nuts (Med-nuts). Anthropometrics and clinical parameters were measured at baseline and after one year of intervention, as well as BP, plasma NO and total polyphenol excretion (TPE) in urine samples. Systolic and diastolic BP decreased significantly after a one-year dietary intervention with Med-EVOO and Med-nuts. These changes were associated with a significant increase in TPE and plasma NO. Additionally, a significant positive correlation was observed between changes in urinary TPE, a biomarker of TP intake, and in plasma NO (Beta = 4.84; 95% CI: 0.57-9.10).

CONCLUSIONS

TPE in spot urine sample was positively correlated with plasma NO in Med-diets supplemented with either EVOO or nuts. The statistically significant increases in plasma NO were associated with a reduction in systolic and diastolic BP levels, adding to the growing evidence that polyphenols might protect the cardiovascular system by improving the endothelial function and enhancing endothelial synthesis of NO.

Obstructive sleep apnoea in people with Type 1 diabetes: prevalence and association with micro- and macrovascular complications

AIMS

Few reports have assessed the relationship between Type 1 diabetes and sleep disorders. The purposes of our study were to determine the prevalence of obstructive sleep apnoea in Type 1 diabetes and to compare the clinical profile of people with Type 1 diabetes with or without obstructive sleep apnoea.

METHODS

In this cross sectional study of 67 consecutive people with Type 1 diabetes, we performed polysomnography as part of their yearly check-ups.

RESULTS

In our cohort, with a mean BMI of 25.8 ± 4.7 kg/m(2), the prevalence of obstructive sleep apnoea [apnoea-hypopnoea index (AHI) > 10/h] was 46%. Severe obstructive sleep apnoea (AHI ≥ 30/h) was present in 19% of the patients. We found no significant differences in age, sex, body mass index, HbA1c or Epworth sleepiness scale score between people with or without obstructive sleep apnoea. People with obstructive sleep apnoea had a longer course of diabetes mellitus (P < 0.01) and a higher prevalence of retinopathy (P < 0.01), neuropathy (P = 0.05), cardiovascular disease (P < 0.01) and hypertension (P < 0.01). The occurrence of macrovascular complications was independently associated with the presence of OSA [odds ratio (OR) 8.28; 95% confidence interval (CI), 1.56-43.97; P = 0.013] and the duration of diabetes (OR 1.08; 95% CI, 1.02-1.15; P = 0.01). Moreover, retinopathy was independently associated with OSA (OR 4.54; 95% CI, 1.09-18.82; P = 0.04) and the duration of diabetes (OR 1.09; 95% CI, 1.04-1.15; P = 0.001).

CONCLUSIONS

The prevalence of obstructive sleep apnoea was high in people with Type 1 diabetes. Obstructive sleep apnoea was independently associated with macrovascular complications and retinopathy. Obesity and excessive daytime sleepiness were uncommon in this population.

Docosahexaenoic acid supplementation promotes erythrocyte antioxidant defense and reduces protein nitrosative damage in male athletes

The aim of this study was to determine the influence of long-term docosahexaenoic acid (DHA) dietary supplementation on the erythrocyte fatty acid profile and oxidative balance in soccer players after training and acute exercise. Fifteen volunteer male athletes (age 20.0 ± 0.5 years) were randomly assigned to a placebo group that consumed an almond-based beverage (n = 6), or to an experimental group that consumed the same beverage enriched with DHA (n = 9) for 8 weeks. Blood samples were taken in resting conditions at the beginning and after 8 weeks of nutritional intervention and training in resting and in post-exercise conditions. Oxidative damage markers (malonyldialdehyde, carbonyl and nitrotyrosine indexes) and the activity and protein level of antioxidant enzymes (catalase, superoxide dismutase, glutathione reductase and peroxidase) were assessed. The results showed that training increased antioxidant enzyme activities in erythrocytes. The experimental beverage increased DHA from 34.0 ± 3.6 to 43.0 ± 3.6 nmol/10(9) erythrocytes. DHA supplementation increased the catalytic activity of superoxide dismutase from 1.48 ± 0.40 to 10.5 ± 0.35 pkat/10(9) erythrocytes, and brought about a reduction in peroxidative damage induced by training or exercise. In conclusion, dietary supplementation with DHA changed the erythrocyte membrane composition, provided antioxidant defense and reduced protein peroxidative damage in the red blood cells of professional athletes after an 8-week training season and acute exercise.

Technical note: Advantages and limitations of authenticating Palmera goat dairy products by pyrosequencing the melanocortin 1 receptor (MC1R) gene

Inferring the breed of origin of dairy products can be achieved through molecular analysis of genetic markers with a population-specific pattern of segregation. The goal of the current work was to generate such markers in goats by resequencing several pigmentation genes [melanocortin 1 receptor (MC1R), v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog (KIT), tyrosinase (TYR), and tyrosinase-related protein 2 (TYRP2)]. This experiment revealed 10 single nucleotide polymorphisms (SNP), including 5 missense mutations and 1 nonsense mutation. These markers were genotyped in 560 goats from 18 breeds originally from Italy, the Iberian Peninsula, the Canary Islands, and North Africa. Although the majority of SNP segregated at moderate frequencies in all populations (including 2 additional markers that were used as a source of information), we identified a c.764G>A SNP in MC1R that displayed highly divergent allelic frequencies in the Palmera breed compared with the Majorera and Tinerfeña breeds from the Canary Islands. Thus, we optimized a pyrosequencing-based technique that allowed us to estimate, very accurately, the allele frequencies of this marker in complex DNA mixtures from different individuals. Once validated, we applied this method to generating breed-specific DNA profiles that made it possible to detect fraudulent cheeses in which Palmero cheese was manufactured with milk from Majorera goats. One limitation of this approach, however, is that it cannot be used to detect illegal manufacturing where Palmero dairy products are produced by mixing milk from Palmera and Majorera goats, because the c.764G>A SNP segregates in both breeds.

Optical quality of the diabetic eye: a review

Diabetes mellitus is a metabolic disorder characterized by the presence of chronic hyperglycaemia. Several structural, morphological, and physiological changes in each of ocular component have been described in detail during the past decades. Due to these abnormalities, the diabetic patient undergoes a degradation of the retinal image by an increase of higher ocular aberrations and ocular scattering coming from mainly tear film, cornea, and crystalline lens. This review aims to provide an overview of current knowledge about the effects of diabetes mellitus in these optical phenomena and its consequence on the visual quality of the diabetic patient.

Docosahexanoic acid diet supplementation attenuates the peripheral mononuclear cell inflammatory response to exercise following LPS activation

Exercise induces changes in circulating pro- and anti-inflammatory cytokines. The aim was to investigate the effect of docosahexaenoic acid (DHA) diet supplementation on the plasma cytokine levels and on the peripheral mononuclear (PBMCs) cells cytokine production after a training season or an acute bout of exercise. Fifteen male soccer players were randomly assigned to a placebo or an experimental group. The experimental group consumed an almond-based beverage enriched with DHA, whereas the placebo group consumed the same beverage without DHA. Three blood samples were taken: in basal conditions at the beginning of the nutritional intervention and after eight weeks of training season in basal and post-exercise conditions. The DHA content increased in erythrocytes after 8weeks of training and supplementation. Neither diet supplementation with DHA nor training season altered the basal plasma cytokines and growth factors. Only acute exercise significantly increased plasma IL6 in experimental and placebo groups. Lipopolysaccharide (LPS) activation induced the inflammatory response in PBMCs, with a significant production rate of TNFα, IL6 and IL8 mainly after acute exercise. DHA supplementation significantly reduced the rate of TNFα and IL6 production by stimulated PBMCs. Acute exercise increased the Toll-like receptor 4 (TLR4) protein levels in PBMCs, although the increase was only statistically significant in the placebo group. In conclusion, a training season does not induce significant changes in the circulating cytokine profile in well-trained soccer players. Exercise increases the PBMCs cell capabilities to produce cytokines after TLR4 stimulation with LPS and this rate of cytokine production is attenuated by diet DHA supplementation.

Fluid intake from beverages across age groups: a systematic review

BACKGROUND

Fluid intake, especially water, is essential for human life and also necessary for physical and mental function. The present study aimed to assess beverage consumption across age groups.

METHODS

A systematic review was conducted. Original research in English language publications and available studies (or abstracts in English) from 2000 to 2013 was searched for by using the medical subheading (MeSH) terms: ('beverage' OR 'fluid' [Major]) AND ('consumption' [Mesh] OR 'drinking' [Mesh] OR 'intake' [Mesh]) AND ('child' [Mesh] OR 'adolescent' [Mesh] OR 'adult' [Mesh]). Article selection was restricted to those papers covering healthy populations of all age groups in a nationwide sample, or from a representative sample of the population of a city or cities, which examined the trends or patterns of beverage intake and the determinants of beverage intake. Sixty-five studies were identified with respect to beverage consumption across age groups. The papers were screened by thoroughly reading titles or abstracts. Full-text articles were assessed by three investigators.

RESULTS

Total beverage intake varied between 0.6 and 3.5 L day(-1) among all age groups (males more than females). Plain water contributed up to 58%, 75% and 80% of the total beverage intake in children, adolescents and adults, respectively. Milk consumption was higher among children; consumption of soft drinks was higher among adolescents; and the consumption of tea, coffee and alcoholic beverages was higher among adults.

CONCLUSIONS

Plain water is the main water source for all age groups and the consumption of other beverages varies according to age.