Serological exposure to influenza A in cats from an area with wild birds positive for avian influenza

Influenza A is an emerging zoonotic virus with worldwide distribution. To our knowledge, no studies have been conducted to assess influenza A exposure in stray cats in regions with positive cases of wild birds. This study aimed to determine the seroprevalence of anti-influenza A antibodies in feral cats from a region in Spain with cases of positive wild birds. A cross-sectional study of stray cats (n = 183) was conducted between March 2022 and March 2023. The presence of antibodies against the influenza A virus was tested using a commercial enzyme-linked immunosorbent assay kit adapted for this study and confirmed by competitive enzyme-linked immunosorbent assay for the detection of antibodies against the haemagglutinin H5. During sample collection, none of the cats exhibited clinical signs of illness. Four of the 183 animals tested showed anti-influenza A antibodies by ELISA, and the seroprevalence of influenza A was 2.19% (95% confidence interval 0.85%-5.48%). Due to the low number of positive cases detected, it appears that cats did not have an important epidemiological role in influenza A transmission during this period.

Preclinical characterization of a non-peptidomimetic HIV protease inhibitor with improved metabolic stability

Protease inhibitors (PIs) remain an important component of antiretroviral therapy for the treatment of HIV-1 infection due to their high genetic barrier to resistance development. Nevertheless, the two most commonly prescribed HIV PIs, atazanavir and darunavir, still require co-administration with a pharmacokinetic boosting agent to maintain sufficient drug plasma levels which can lead to undesirable drug-drug interactions. Herein, we describe GS-9770, a novel investigational non-peptidomimetic HIV PI with unboosted once-daily oral dosing potential due to improvements in its metabolic stability and its pharmacokinetic properties in preclinical animal species. This compound demonstrates potent inhibitory activity and high on-target selectivity for recombinant HIV-1 protease versus other aspartic proteases tested. In cell culture, GS-9770 inhibits Gag polyprotein cleavage and shows nanomolar anti-HIV-1 potency in primary human cells permissive to HIV-1 infection and against a broad range of HIV subtypes. GS-9770 demonstrates an improved resistance profile against a panel of patient-derived HIV-1 isolates with resistance to atazanavir and darunavir. In resistance selection experiments, GS-9770 prevented the emergence of breakthrough HIV-1 variants at all fixed drug concentrations tested and required multiple protease substitutions to enable outgrowth of virus exposed to escalating concentrations of GS-9770. This compound also remained fully active against viruses resistant to drugs from other antiviral classes and showed no in vitro antagonism when combined pairwise with drugs from other antiretroviral classes. Collectively, these preclinical data identify GS-9770 as a potent, non-peptidomimetic once-daily oral HIV PI with potential to overcome the persistent requirement for pharmacological boosting with this class of antiretroviral agents.

Effects of suspension media on high pressure processing of starches with different crystalline structures

High pressure processing (HPP) is a starch modification method generally conducted in water, and little is known about the pressure-induced changes in different media. This study investigated the effects of water versus sodium sulfate on corn, potato, and pea starches subjected to HPP at 690 MPa. HPP in both media reduced gelatinization enthalpy and crystallinity for all starches. HPP in sodium sulfate promoted the transition of common corn and potato starches to C-type crystallites. HPP starches in sodium sulfate generally displayed lower pasting temperatures, higher peak viscosities, and greater breakdowns than in water. Alpha-amylase susceptibility increased for all HPP starches and was generally lower in sodium sulfate than in water. HPP common corn and potato starchs in sodium sulfate displayed a porous structure after α-amylase digestion. The competition of sodium sulfate for water molecules between starch helices induced variations in the properties of HPP starches with different crystalline structures.

Higher baseline resting metabolic rate is associated with 1-year frailty decline among older adults residing in an urban area

BACKGROUND

Dysregulated energy metabolism is one hypothesized mechanism underlying frailty. Resting energy expenditure, as reflected by resting metabolic rate (RMR), makes up the largest component of total energy expenditure. Prior work relating RMR to frailty has largely been done in cross section with mixed results. We investigated whether and how RMR related to 1-year frailty change while adjusting for body composition.

METHODS

N = 116 urban, predominantly African-American older adults were recruited between 2011 and 2019. One-year frailty phenotype (0-5) was regressed on baseline RMR, frailty phenotype, demographics and body composition (DEXA) in an ordinal logistic regression model. Multimorbidity (Charlson comorbidity scale, polypharmacy) and cognitive function (Montreal Cognitive Assessment) were separately added to the model to assess for change to the RMR-frailty relationship. The model was then stratified by baseline frailty status (non-frail, pre-frail) to explore differential RMR effects across frailty.

RESULTS

Higher baseline RMR was associated with worse 1-year frailty (odds ratio = 1.006 for each kcal/day, p = 0.001) independent of baseline frailty, demographics, and body composition. Lower fat-free mass (odds ratio = 0.88 per kg mass, p = 0.008) was independently associated with worse 1-year frailty scores. Neither multimorbidity nor cognitive function altered these relationships. The associations between worse 1-year frailty and higher baseline RMR (odds ratio = 1.009, p < 0.001) and lower baseline fat-free mass (odds ratio = 0.81, p = 0.006) were strongest among those who were pre-frail at baseline.

DISCUSSION

We are among the first to relate RMR to 1-year change in frailty scores. Those with higher baseline RMR and lower fat-free mass had worse 1-year frailty scores, but these relationships were strongest among adults who were pre-frail at baseline. These relationships were not explained by chronic disease or impaired cognition. These results provide new evidence suggesting higher resting energy expenditure is associated with accelerate frailty decline.

Adherence to antiseizure medications in an underserved population with epilepsy

BACKGROUND AND PURPOSE

Antiseizure medications (ASM) effectively prevent seizures in about 70% of adult epilepsy patients, but nonadherence to medication is the primary cause of breakthrough seizures, accounting for 26% to 79% of cases. Factors such as age, education, dosing frequency, forgetfulness, fear of side effects, and socioeconomic status contribute to poor adherence, especially among underserved populations. This study aimed to assess medication adherence during routine follow-up visits and identify the role of education in reducing non adherence in an underserved patient population.

METHODS

The study involved a retrospective chart review of adult epilepsy patients seen at the University of Illinois Hospital between December 2016 and April 2020. Data on patient demographics, epilepsy and seizure classification, medication details, emergency visits, and adherence were collected from electronic medical records using the RedCap system. Descriptive statistics and statistical tests were conducted using STATA 17.0 for data analysis, including chi-squared analysis for categorical data and t-tests for continuous data.

RESULTS

The study enrolled a total of 286 adult epilepsy patients who met the eligibility criteria. Among them, 111 patients (38.81 %) were classified as nonadherent based on ASM levels. Caucasian/white race and income > $50,000 per year, were significantly associated with adherence (p = 0.009 and p = 0.006 respectively). Moreover, patients with weekly seizures were more likely to be adherent (p = 0.042). No significant differences were found regarding medication adherence and sex, education, employment, epilepsy type, age at diagnosis, seizure type or number of current ASM medications. Even though not significant, a trend towards college educated patients being more adherent was observed (70.37 %). Of self-reported adherent patients, 33.33 % were found to be nonadherent based on ASM levels. Nurse phone calls reminding 70 non adherent patients about adherence increased the chances of becoming adherent by 80.39 %. Finally, although not statistically significant, the majority of adherent patients had no history of hospitalizations for breakthrough seizures (73.89 %).

CONCLUSION

More than a third of our patients were found to be non-adherent during routine follow-up visits. Lower socio-economic status and lower education were associated with increased chances of being non adherent. Rates of adherence were improved by nurse's phone calls discussing the importance of adherence and risks of SUDEP. The findings emphasize the importance of education in improving medication adherence among these populations, suggesting the need for social interventions, community outreach programs, and targeted educational initiatives.

Nonheme FeIV═O Complexes Supported by Four Pentadentate Ligands: Reactivity toward H- and O- Atom Transfer Processes

Four new pentadentate N5-donor ligands, [N-(1-methyl-2-imidazolyl)methyl-N-(2-pyridyl)-methyl-N-(bis-2-pyridylmethyl)-amine] (L1), [N-bis(1-methyl-2-imidazolyl)methyl-N-(bis-2-pyridylmethyl)amine] (L2), (N-(isoquinolin-3-ylmethyl)-1,1-di(pyridin-2-yl)-N-(pyridin-2-ylmethyl)methanamine (L3), and N,N-bis(isoquinolin-3-ylmethyl)-1,1-di(pyridin-2-yl)methanamine (L4), have been synthesized based on the N4Py ligand framework, where one or two pyridyl arms of the N4Py parent are replaced by (N-methyl)imidazolyl or N-(isoquinolin-3-ylmethyl) moieties. Using these four pentadentate ligands, the mononuclear complexes [FeII(CH3CN)(L1)]2+ (1a), [FeII(CH3CN)(L2)]2+ (2a), [FeII(CH3CN)(L3)]2+ (3a), and [FeII(CH3CN)(L4)]2+ (4a) have been synthesized and characterized. The half-wave potentials (E1/2) of the complexes become more positive in the order: 2a < 1a < 4a ≤ 3a ≤ [Fe(N4Py)(CH3CN)]2+. The order of redox potentials correlates well with the Fe-Namine distances observed by crystallography, which are 2a > 1a ≥ 4a > 3a ≥ [Fe(N4Py)(CH3CN)]2+. The corresponding ferryl complexes [FeIV(O)(L1)]2+ (1b), [FeIV(O)(L2)]2+ (2b), [FeIV(O)(L3)]2+ (3b), and [FeIV(O)(L4)]2+ (4b) were prepared by the reaction of the ferrous complexes with isopropyl 2-iodoxybenzoate (IBX ester) in acetonitrile. The greenish complexes 3b and 4b were also isolated in the solid state by the reaction of the ferrous complexes in CH3CN with ceric ammonium nitrate in water. Mössbauer spectroscopy and magnetic measurements (using superconducting quantum interference device) show that the four complexes 1b, 2b, 3b, and 4b are low-spin (S = 1) FeIV═O complexes. UV/vis spectra of the four FeIV═O complexes in acetonitrile show typical long-wavelength absorptions of around 700 nm, which are expected for FeIV═O complexes with N4Py-type ligands. The wavelengths of these absorptions decrease in the following order: 721 nm (2b) > 706 nm (1b) > 696 nm (4b) > 695 nm (3b) = 695 nm ([FeIV(O) (N4Py)]2+), indicating that the replacement of the pyridyl arms with (N-methyl) imidazolyl moieties makes L1 and L2 exert weaker ligand fields than the parent N4Py ligand, while the ligand field strengths of L3 and L4 are similar to the N4Py parent despite the replacement of the pyridyl arms with N-(isoquinolin-3-ylmethyl) moieties. Consequently, complexes 1b and 2b tend to be less stable than the parent [FeIV(O)(N4Py)]2+ complex: the half-life sequence at room temperature is 1.67 h (2b) < 16 h (1b) < 45 h (4b) < 63 h (3b) ≈ 60 h ([FeIV(O)(N4Py)]2+). Compared to the parent complex, 1b and 2b exhibit enhanced reactivity in both the oxidation of thioanisole in the oxygen atom transfer (OAT) reaction and the oxygenation of C-H bonds of aromatic and aliphatic substrates, presumed to occur via an oxygen rebound process. Furthermore, the second-order rate constants for hydrogen atom transfer (HAT) reactions affected by the ferryl complexes can be directly related to the C-H bond dissociation energies of a range of substrates that have been studied. Using either IBX ester or H2O2 as an oxidant, all four new FeII complexes display good performance in catalytic reactions involving both HAT and OAT reactions.

Kilohertz serial crystallography with the JUNGFRAU detector at a fourth-generation synchrotron source

Serial and time-resolved macromolecular crystallography are on the rise. However, beam time at X-ray free-electron lasers is limited and most third-generation synchrotron-based macromolecular crystallography beamlines do not offer the necessary infrastructure yet. Here, a new setup is demonstrated, based on the JUNGFRAU detector and Jungfraujoch data-acquisition system, that enables collection of kilohertz serial crystallography data at fourth-generation synchrotrons. More importantly, it is shown that this setup is capable of collecting multiple-time-point time-resolved protein dynamics at kilohertz rates, allowing the probing of microsecond to second dynamics at synchrotrons in a fraction of the time needed previously. A high-quality complete X-ray dataset was obtained within 1 min from lysozyme microcrystals, and the dynamics of the light-driven sodium-pump membrane protein KR2 with a time resolution of 1 ms could be demonstrated. To make the setup more accessible for researchers, downstream data handling and analysis will be automated to allow on-the-fly spot finding and indexing, as well as data processing.

It's about time: small mammal communities and Lyme disease emergence

Theory predicts that biodiversity changes due to climate warming can mediate the rate of disease emergence. The mechanisms linking biodiversity-disease relationships have been described both theoretically and empirically but remain poorly understood. We investigated the relations between host diversity and abundance and Lyme disease risk in southern Quebec, a region where Lyme disease is rapidly emerging. We found that both the abundance of small mammal hosts and the relative abundance of the tick's natural host, the white-footed mouse (Peromyscus leucopus), influenced measures of disease risk in tick vectors (Borrelia burgdorferi infection abundance and prevalence in tick vectors). Our results suggest that the increase in Lyme disease risk is modulated by regional processes involving the abundance and composition of small mammal assemblages. However, the nature and strength of these relationships was dependent both on time and geographic area. The strong effect of P. leucopus abundance on disease risk we report here is of significant concern, as this competent host is predicted to increase in abundance and occurrence in the region, with the northern shift in the range of North American species under climate warming.

Fast, automated, continuous energy scans for experimental phasing at the BioMAX beamline

In X-ray macromolecular crystallography (MX), single-wavelength anomalous dispersion (SAD) and multi-wavelength anomalous dispersion (MAD) techniques are commonly used for obtaining experimental phases. For an MX synchrotron beamline to support SAD and MAD techniques it is a prerequisite to have a reliable, fast and well automated energy scan routine. This work reports on a continuous energy scan procedure newly implemented at the BioMAX MX beamline at MAX IV Laboratory. The continuous energy scan is fully automated, capable of measuring accurate fluorescence counts over the absorption edge of interest while minimizing the sample exposure to X-rays, and is about a factor of five faster compared with a conventional step scan previously operational at BioMAX. The implementation of the continuous energy scan facilitates the prompt access to the anomalous scattering data, required for the SAD and MAD experiments.

The structure of magnesium stearate trihydrate determined from a micrometre-sized single crystal using a microfocused synchrotron X-ray beam

Crystalline magnesium stearate has been extensively used as an additive in pharmaceutical and other industries for decades. However, the lack of suitably large crystals has hindered the determination of the crystal structure and thereby a more fundamental understanding of the structure-functionality relationship. Presented here is the structure of magnesium stearate trihydrate as determined from X-ray diffraction data of a micrometre-sized single crystal measured at a fourth-generation synchrotron facility. Despite the small size of the single crystals and the weak diffraction, it was possible to determine the positions of the non-hydrogen atoms reliably. Periodic dispersion-corrected density functional theory calculations were used to obtain the positions of the hydrogen atoms playing an important role in the overall organization of the structure via a hydrogen-bond network.

COVID-19 Infections, Pandemic-Related Social and Economic Impacts, and Changes to Mental and Self-Rated Health Among Latinx Immigrant Housecleaners in New York City: The Safe and Just Cleaners Study

Objectives. To estimate impacts of COVID-19 infections and social and economic sequelae on mental and self-rated health among Latinx immigrant housecleaners in New York City. Methods. From March to June 2021, we conducted a follow-up study with 74% retention of 402 housecleaners initially surveyed before the pandemic between August 2019 and February 2020. We measured rates of self-reported COVID-19 infections, COVID-19 antibodies, and pandemic-related social and economic sequelae and examined predictors of mental and self-rated health changes using logistic regression models. Results. Fifty-three percent reported COVID-19 infections, consistent with the rate demonstrating COVID-19 antibodies. During shutdown of nonessential services, from March 22 to June 8, 2020, 29% worked as housecleaners, although this was not associated with higher COVID-19 infection rates. COVID-19-related stigma at work, lost earnings owing to COVID-19 infections, housing insecurity, food insecurity, and unsafe homes, including experiencing intimate partner verbal abuse, were statistically associated with changes in mental or self-rated health compared with prepandemic measures. Conclusions. The disproportionate impact and virtually nonexistent safety net housecleaners experienced during the first year of the pandemic highlight the importance of inclusive stopgap measures to mitigate economic insecurity and its sequelae. (Am J Public Health. 2023;113(8):893-903. https://doi.org/10.2105/AJPH.2023.307324).

Herbivore-Dependent Induced Volatiles in Pear Plants Cause Differential Attractive Response by Lacewing Larvae

Biological control may benefit from the behavioral manipulation of natural enemies using volatile organic compounds (VOCs). Among these, herbivore-induced plant volatiles (HIPVs) provide potential tools for attracting or retaining predators and parasitoids of insect pests. This work aimed to characterize the VOCs emitted by pear plants in response to attack by Cacopsylla bidens (Hemiptera: Psyllidae), a major pest in pear orchards, to compare these with VOCs induced by a leaf chewing insect, Argyrotaenia sphaleropa (Lepidoptera: Tortricidae), and to evaluate the behavioral response of Chrysoperla externa (Neuroptera: Chrysopidae) to HIPVs from pear plants damaged by either herbivore. The results demonstrated that plants damaged by the pear psylla emitted VOC blends with increased amounts of aliphatic aldehydes. Leafroller damage resulted in increased amounts of benzeneacetonitrile, (E)-4,8-dimethylnona-1,3,7-triene, β-ocimene and caryophyllene. In olfactometer bioassays, larvae of C. externa were attracted to herbivore-damaged plants when contrasted with undamaged plants. When plant odors from psylla-damaged were contrasted with those of leafroller-damaged plants, C.externa preferred the former, also showing shorter response lag-times and higher response rates when psylla-damaged plants were present. Our results suggest that pear plants respond to herbivory by modifying their volatile profile, and that psylla-induced volatiles may be used as prey-specific chemical cues by chrysopid larvae. Our study is the first to report HIPVs in pear plants attacked by C. bidens, as well as the attraction of C. externa to psyllid-induced volatiles.

A simple goniometer-compatible flow cell for serial synchrotron X-ray crystallography

Serial femtosecond crystallography was initially developed for room-temperature X-ray diffraction studies of macromolecules at X-ray free electron lasers. When combined with tools that initiate biological reactions within microcrystals, time-resolved serial crystallography allows the study of structural changes that occur during an enzyme catalytic reaction. Serial synchrotron X-ray crystallography (SSX), which extends serial crystallography methods to synchrotron radiation sources, is expanding the scientific community using serial diffraction methods. This report presents a simple flow cell that can be used to deliver microcrystals across an X-ray beam during SSX studies. This device consists of an X-ray transparent glass capillary mounted on a goniometer-compatible 3D-printed support and is connected to a syringe pump via lightweight tubing. This flow cell is easily mounted and aligned, and it is disposable so can be rapidly replaced when blocked. This system was demonstrated by collecting SSX data at MAX IV Laboratory from microcrystals of the integral membrane protein cytochrome c oxidase from Thermus thermophilus, from which an X-ray structure was determined to 2.12 Å resolution. This simple SSX platform may help to lower entry barriers for non-expert users of SSX.

Employment Quality and Mental and Self-Reported Health Inequities among Latinx Housecleaners: The Safe and Just Cleaners Study

Precarious employment, such as housecleaning, is one important structural contributor to health inequities. We used an employment quality (EQ) framework to characterize the impact of employment conditions on mental and self-reported ill-health among Latinx housecleaners in the New York City metropolitan area. Using a community-based participatory research approach, we collected cross-sectional survey data from 402 housecleaners between August 2019 and February 2020 to characterize housecleaners' EQ and its association with depression, perceived stress, and self-reported health. We also measured work-related irritant eye, skin, and respiratory symptoms, which have been shown in previous research to be associated with housecleaners' exposure to chemical components of cleaning products. Our housecleaner cohort was largely female and immigrant and most had worked at least five years. Survey items capturing the EQ dimensions of unbalanced interpersonal relations, low material resources, and violations of workers' rights were associated with increased odds of depression, perceived stress, and self-reported ill-health. Work-related irritant eye, skin, and respiratory symptoms were also independently associated with mental and self-reported ill-health and some of the effects of EQ on health were potentially partially mediated through their association with work-related irritant symptoms. Findings can inform directions for community-based educational and policy initiatives to improve housecleaners' employment quality.

CRANIUM: a quasi-experimental study to improve metabolic screening and HIV testing in community mental health clinics compared to usual care

BACKGROUND

Individuals with serious mental illness often do not receive guideline-concordant metabolic screening and human immunodeficiency virus (HIV) testing, contributing to increased morbidity and premature mortality. This study evaluates the effectiveness of CRANIUM (Cardiometabolic Risk Assessment and treatment through a Novel Integration model for Underserved populations with Mental illness), an intervention to increase metabolic screening and HIV testing among patients with serious mental illness in a community mental health clinic compared to usual care.

METHODS

The study used a quasi-experimental design, prospectively comparing a preventive care screening intervention at one community mental health clinic (n = 536 patients) to usual care at the remaining clinics within an urban behavioural health system (n = 4,847 patients). Psychiatrists at the intervention site received training in preventive health screening and had access to a primary care consultant, screening and treatment algorithms, patient registries, and a peer support specialist. Outcomes were the change in screening rates of A1c, lipid, and HIV testing post-intervention at the intervention site compared to usual care sites.

RESULTS

Rates of lipid screening and HIV testing increased significantly at the intervention site compared to usual care, with and without multivariable adjustment [Lipid: aOR 1.90, 95% CI 1.32-2.75, P = .001; HIV: aOR 23.42, 95% CI 5.94-92.41, P &lt; .001]. While we observed a significant increase in A1c screening rates at the intervention site, this increase did not persist after multivariable adjustment (aOR 1.37, 95% CI .95-1.99, P = .09).

CONCLUSIONS

This low-cost, reverse integrated care model targeting community psychiatrist practices had modest effects on increasing preventive care screenings, with the biggest effect seen for HIV testing rates. Additional incentives and structural supports may be needed to further promote screening practices for individuals with serious mental illness.

Artificial intelligence-guided, single-lead EKG may be a game-changer for symptom-to-balloon time reduction in ST-elevated myocardial infarction

Background

Over decades, efforts to shave off life-saving minutes from ST-Elevated Myocardial Infarction (STEMI) care centred on reducing door-to-needle and door-to-balloon times. We firmly believe that symptom-to-balloon time should prove a better focus to this end. Challenges come with this goal as it heavily relies on a patient's perception and initiative to seek care, which we deem intelligent and wearable Artificial Intelligence (AI)-driven Single Lead EKG technologies as an attractive solution in modern-day cardiology.

Purpose

To provide an accurate, accessible, and cost-effective AI-driven Single Lead STEMI detection algorithm that can be embedded into wearable devices and employed in a self-administered fashion.

Methods

Database: EKG records from Mexico, Colombia, Argentina, and Brazil from April 2014 to December 2019. Dataset: A total of 11,567 12-lead EKG records of 10[s] length with a sampling frequency of 500 Hz, including the following balanced classes: angiographically confirmed and unconfirmed STEMI, branch blocks, non-specific ST-T abnormalities, normal and abnormal (200+ CPT codes, excluding those mentioned above). Cardiologists manually checked the label of each record to ensure precision. Pre-processing: We discard the first and last 250 samples as they may contain a standardisation pulse. The study applied a digital low pass filter of order 5 with a frequency cut-off of 35 Hz. The mean was subtracted from each Lead. Classification: The determined classes were “STEMI” (Including STEMI in different locations of the myocardium – anterior, inferior, and lateral); and “Not-STEMI” (Combination of randomly sample, branch blocks, non-specific ST-T changes, and abnormal records – 25% of each). Training and Testing: A 1-D Convolutional Neural Network was trained and tested with a dataset proportion of 90/10, respectively. A different model was trained and tested for each Lead, using the central 4,500 samples of the records. The last dense layer outputs a probability for each report of being STEMI or Not-STEMI. Lead V2 showed the best overall results. The model was further tested through the same methodology using the best Lead with a subset of the previous data, excluding the unconfirmed STEMI EKG records (Total 7,230 12-lead EKG records for Confirmed Only STEMI dataset). Performance metrics were reported for each experiment and compared.

Results

Combined STEMI data: Accuracy: 91.2%; Sensitivity: 89.6%; Specificity: 92.9%. Confirmed STEMI Only dataset: Accuracy: 92.4%; Sensitivity: 93.4%; Specificity: 91.4% (Figure 1).

Conclusion

By assiduously improving the quality of the model's input, we continue to assess our algorithm's performance and reliability for future clinical validation as a potential remote monitoring and early STEMI detection device.

Funding Acknowledgement

Type of funding sources: None.

Type III collagen formation is significantly associated with risk of outcome in HFpEF patients but loses its significant association with underlying AF

Introduction

Heart failure with preserved ejection fraction (HFpEF) is the most common type of heart failure, associated with high morbidity and mortality. Atrial fibrillation (AF) has been associated with structural remodelling and fibrosis and can coexist with HFpEF. Type III collagen is the second most abundant collagen in the heart wall and has been associated with cardiac fibrosis. It has been previously shown that type III collagen formation, measured by PRO-C3, is prognostic for all-cause mortality in HFpEF.

Purpose

In this study, we aimed at investigating if the prognostic power of PRO-C3 in relation to all-cause mortality would be affected by underlying AF in HFpEF patients.

Methods

The analysis included 166 individuals with hypertensive HFpEF. The patients were classified in three groups according to NYHA classification, 43.2% in NYHA Class II, 52.5% NYHA Class III and 2.5% NYHA Class IV. A previous history of AF was present in 53.4% of the patients. Cardiac function was assessed by echocardiography and standard clinical measures. Type III collagen formation was evaluated by means of ELISA with the biomarker PRO-C3, which targets the released N-terminal pro-peptide of type III collagen.

Results

Levels of PRO-C3 were significantly elevated in HFpEF patients with AF (p=0.0063). PRO-C3 was significantly predictive of all-cause mortality in HFpEF patients (AUC=0.643, p=0.0053), but lost its significant association when factoring in AF (AUC=0.581, p=0.235). There was an increased risk of all-cause mortality (p=0.0089) but not statistically significant differences in HFpEF patients with AF (p=0.178) with increasing tertiles of PRO-C3.

Conclusions

Type III collagen formation as measured by PRO-C3, was increased in patients with HFpEF and previously diagnosed AF. However, while PRO-C3 can be predictive of all-cause mortality in HFpEF patients, it lacks predicting ability when AF is considered. The presented data suggest a potential role of increased type III collagen formation in HFpEF patients with adverse outcomes, which is consistent with the presence of increased fibrosis, and can potentially be used as a tool of risk stratification.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Nordic Bioscience A/S

Performance metrics of AI-enhanced single lead EKG maintained after entry of organised clustered data

Background

Our experience in creating innovative Artificial Intelligence-guided single lead EKG methodologies for ST-Elevation Myocardial Infarction (STEMI) detection within complex EKG records has been previously validated.

Purpose

By expanding the intricate variables of our previously tested algorithm input, we seek to further improve our STEMI detecting tool.

Methods

11,567 12-lead EKG records (10-s length, 500 Hz sample frequency) derived from the Latin America Telemedicine Infarct Network database from April 2014 to December 2019. From these records, we included the following balanced classes: angiographically confirmed and unconfirmed STEMI (divided by wall affected), branch blocks, non-specific ST-T changes, normal, and abnormal (Remaining 200+ CPT codes). Cardiologist annotations ensured precision (Ground truth). Determined classes were “STEMI” and “Not-STEMI”. A 1-D Convolutional Neural Network model was trained and tested for each lead with dataset proportions of 90/10, respectively. The last dense layer outputs a probability for each record being STEMI/Not-STEMI. The analysis also included performance metrics and false-negative reports.

Results

Overall, the most promising Single lead for STEMI detection was V2 (91.2% Accuracy, 89.6% Sensitivity, and 92.9% Specificity). 55% of false negatives were inferior wall STEMI (Table 1).

Conclusion

Appreciable progress of our new methodology compared to our previous experiences in AI-guided Single Lead for STEMI detection, especially for lead V2. By performing a thorough analysis of false-negative reports, we aspire to identify potential areas of STEMI detection weakness which will become the focus of future ventures.

Funding Acknowledgement

Type of funding sources: None.

No need for a cardiologist for AMI diagnosis – progress of transforming a behemoth telemedicine program with artificial intelligence

Background

The Latin American Telemedicine Infarct Network (LATIN) Telemedicine is a mammoth hub and spoke model that provides an umbrella of AMI protection for 100 million patients. In the program, 826,043 patients had a telemedicine encounter; 7,400 with AMI were diagnosed; 4,332 of them managed with guidelines-based strategies. We have gradually begun implementing a system for using Artificial Intelligence (AI) algorithms embedded into EKGs for rapid and accurate STEMI detection and validated the results with a cardiologist's interpretations.

Purpose

To test whether an AI-driven EKG algorithm can effectively substitute a cardiologist for STEMI telemedicine protocols.

Methods

The AI algorithm construction was in the following fashion. Sample: a selection of 8,511 EKG and 90,592 classified heartbeats. Pre-processing: segmentation of each EKG into individual heartbeats. Training & testing: 90% and 10% of the total dataset, respectively. Classification: 1-D Convolutional Neural Network; the study constructed classes for each heartbeat. The algorithm was next deployed on a consecutive series of LATIN EKG records to diagnose STEMI. We afterwards compared the algorithm's results with eight expert cardiologists' interpretations of the same sample.

Results

This study achieved a concordance of 91% between the AI algorithm and cardiologist interpretation (Figure 1).

Conclusions

The initial results with AI algorithms for STEMI diagnosis are encouraging and may provide the base work for new tools for cardiologists to improve their efficiency. Moreover, implementing this innovative tool may overcome current limitations associated with the telemedical management of this disease.

Funding Acknowledgement

Type of funding sources: None.

Phenotypes of disease severity in a cohort of hospitalized COVID-19 patients: Results from the IMPACC study

BACKGROUND

Better understanding of the association between characteristics of patients hospitalized with coronavirus disease 2019 (COVID-19) and outcome is needed to further improve upon patient management.

METHODS

Immunophenotyping Assessment in a COVID-19 Cohort (IMPACC) is a prospective, observational study of 1164 patients from 20 hospitals across the United States. Disease severity was assessed using a 7-point ordinal scale based on degree of respiratory illness. Patients were prospectively surveyed for 1 year after discharge for post-acute sequalae of COVID-19 (PASC) through quarterly surveys. Demographics, comorbidities, radiographic findings, clinical laboratory values, SARS-CoV-2 PCR and serology were captured over a 28-day period. Multivariable logistic regression was performed.

FINDINGS

The median age was 59 years (interquartile range [IQR] 20); 711 (61%) were men; overall mortality was 14%, and 228 (20%) required invasive mechanical ventilation. Unsupervised clustering of ordinal score over time revealed distinct disease course trajectories. Risk factors associated with prolonged hospitalization or death by day 28 included age ≥ 65 years (odds ratio [OR], 2.01; 95% CI 1.28-3.17), Hispanic ethnicity (OR, 1.71; 95% CI 1.13-2.57), elevated baseline creatinine (OR 2.80; 95% CI 1.63- 4.80) or troponin (OR 1.89; 95% 1.03-3.47), baseline lymphopenia (OR 2.19; 95% CI 1.61-2.97), presence of infiltrate by chest imaging (OR 3.16; 95% CI 1.96-5.10), and high SARS-CoV2 viral load (OR 1.53; 95% CI 1.17-2.00). Fatal cases had the lowest ratio of SARS-CoV-2 antibody to viral load levels compared to other trajectories over time (p=0.001). 589 survivors (51%) completed at least one survey at follow-up with 305 (52%) having at least one symptom consistent with PASC, most commonly dyspnea (56% among symptomatic patients). Female sex was the only associated risk factor for PASC.

INTERPRETATION

Integration of PCR cycle threshold, and antibody values with demographics, comorbidities, and laboratory/radiographic findings identified risk factors for 28-day outcome severity, though only female sex was associated with PASC. Longitudinal clinical phenotyping offers important insights, and provides a framework for immunophenotyping for acute and long COVID-19.

FUNDING

NIH.

Molecular characterization of thioester-containing proteins in Biomphalaria glabrata and their differential gene expression upon Schistosoma mansoni exposure

Schistosomiasis is a disease caused by trematode parasites of the genus Schistosoma that affects approximately 200 million people worldwide. Schistosomiasis has been a persistent problem in endemic areas as there is no vaccine available, currently used anti-helmintic medications do not prevent reinfection, and most concerning, drug resistance has been documented in laboratory and field isolates. Thus, alternative approaches to curtail this human disease are warranted. Understanding the immunobiology of the obligate intermediate host of these parasites, which include the freshwater snail Biomphalaria glabrata, may facilitate the development of novel methods to stop or reduce transmission to humans. Molecules from the thioester-containing protein (TEP) superfamily have been shown to be involved in immunological functions in many animals including corals and humans. In this study we identified, characterized, and compared TEP transcripts and their expression upon S. mansoni exposure in resistant and susceptible strains of B. glabrata snails. Results showed the expression of 11 unique TEPs in B. glabrata snails. These transcripts present high sequence identity at the nucleotide and putative amino acid levels between susceptible and resistant strains. Further analysis revealed differences in several TEPs’ constitutive expression levels between resistant and susceptible snail strains, with C3-1, C3-3, and CD109 having higher constitutive expression levels in the resistant (BS90) strain, whereas C3-2 and TEP-1 showed higher constitutive expression levels in the susceptible (NMRI) strain. Furthermore, TEP-specific response to S. mansoni miracidia exposure reiterated their differential expression, with resistant snails upregulating the expression of both TEP-4 and TEP-3 at 2 h and 48 h post-exposure, respectively. Further understanding the diverse TEP genes and their functions in invertebrate animal vectors will not only expand our knowledge in regard to this ancient family of immune proteins, but also offer the opportunity to identify novel molecular targets that could aid in the efforts to develop control methods to reduce schistosomiasis transmission.

POS0707 POTENTIAL USE OF BELIMUMAB IN LUPUS PATIENTS FROM ARGENTINE COHORT ACCORDING DISEASE ACTIVITY STATE

Background

The goal of targeted treatment in patients with Systemic Lupus Erythematosus (SLE) is to achieve clinical remission or low disease activity, with the best quality of life, low damage rates and better survival 1-4. RELESSAR is a multicenter, cross-sectional study registry of ≥18 years SLE (ACR 97) patients 5.

Objectives

To describe demographic, clinical characteristics and treatments in SLE patients according to disease activity state. To evaluate the proportion of SLE and refractory SLE patients that are potentially candidates for Belimumab treatment (Active SLE despite standard treatment including increased acDNA autoantibodies and low complement).

Methods

We evaluated demographic and clinical data, treatments, score of damage (SLICC), activity (SLEDAI) and comorbidity (Charlson), hospital admissions and severe infections. The patients were compared according to disease activity: remission (SLEDAI = 0 and without corticosteroids), low disease activity (LDA, SLEDAI> 0 and ≤4 and without corticosteroids) and non-optimal control (SLEDAI> 4 and any dose of corticosteroids). Refractory SLE was defined according to Rituximab (RTX) use, non-response to cyclophosphamide or two or more immunosuppressant or splenectomized patients. Potential use of Belimumab according approved prescription in Argentina was analyzed.

Results

Overall, 1277 patients were analyzed: 299 (23.4%) were in remission, 162 (12.7%) in LDA and 816 (63.9%) with non-optimal control of the disease.

Patients in non-optimal control group were younger, less frequently female and they showed less time of disease and lower socioeconomic status (p < 0.001). They were also more prevalent mestizos (p= 0.004), had higher SLEDAI and SLICC indexes (p <0.001) and higher use of immunosuppressant therapy (p <0.001). There was no difference regarding biologic treatment (RTX p= 0.547 and Belimumab p= 0.08). This group had higher proportion of hospital admissions and severe infections (p<0.001, respectively).

Two hundred and one SLE patients fulfilled the use of Belimumab prescription criteria but only 45/201 patients (22,3%) received it in the last visit. Malar rash was the only clinical variable associated with the use of Belimumab (72.7% vs 29.8% p= 0.005).

Seventy-six patients classified as refractory SLE (15.7%) and 56/76 (75.7%) never received Belimumab. Patients on Belimumab therapy were associated to treatment with lower doses of corticoids (p= 0.018) and lower rate of hospital admission caused by SLE flare (p= 0.027).

Conclusion

A high percentage of patients had uncontrolled disease upon entry into the registry and were potential candidates for treatment with Belimumab. The patients who received biologic treatment showed the benefit of requiring fewer doses of corticosteroids and having a lower rate of hospitalizations.

References

[1]Mok CC. Treat-to-target in systemic lupus erythematosus: Are we there yet? Expert Rev Clin Pharmacol. 2016;9(5).

[2]Morand EF, Mosca M. Treat to target, remission and low disease activity in SLE. Vol. 31, Best Practice and Research: Clinical Rheumatology. 2017.

[3]Golder V, Tsang-A-Sjoe MWP. Treatment targets in SLE: Remission and low disease activity state. Rheumatol (United Kingdom). 2020;59.

[4]Ruiz-Irastorza G, Bertsias G. Treating systemic lupus erythematosus in the 21st century: new drugs and new perspectives on old drugs. Vol. 59, Rheumatology (United Kingdom). 2021.

[5]Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum [Internet]. 1997;40(9):1725. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9324032

Disclosure of Interests

Rosana Quintana: None declared, Lucila Garcia: None declared, Paula Alba: None declared, Susana Roverano: None declared, Analia Alvarez: None declared, Cesar Graf: None declared, Cecilia Pisoni: None declared, Alberto Spindler: None declared, Catalina Gomez: None declared, Heber Matias Figueredo: None declared, Silvia Papasidero: None declared, Raul Horacio Paniego: None declared, Maria DeLaVega: None declared, Emma Estela Civit De Garignani: None declared, Luciana Gonzalez Lucero: None declared, Victoria Martire: None declared, Rodrigo Águila Maldonado: None declared, Sergio Gordon: None declared, Carla Gobbi: None declared, Romina Nieto: None declared, Gretel Rausch: None declared, Vanina Góngora: None declared, Maria Agustina D´Amico: None declared, Diana Dubinsky: None declared, Alberto Omar Orden: None declared, Johana Zacariaz: None declared, Julia Romero: None declared, Mariana Alejandra Pera: None declared, Oscar Rillo: None declared, Roberto Baez: None declared, Valeria Arturi: None declared, Andrea Gonzalez: None declared, Florencia Vivero: None declared, Marcela Schmid: None declared, Victor Caputo: None declared, Maria Silvia Larroude: None declared, Graciela Gomez: None declared, Graciela Rodriguez: None declared, Josefina Marin: None declared, Maria Victoria Collado: None declared, Marisa Jorfen: None declared, Zaida Bedran: None declared, Judith Sarano: None declared, David Zelaya: None declared, MONICA SACNUN: None declared, Pablo Finucci: None declared, Romina Rojas Tessel: None declared, Maria Emilia Sattler: None declared, MAXIMILIANO MACHADO ESCOBAR: None declared, Pablo Astesana: None declared, Ursula Vanesa Paris: None declared, Alberto Allievi: None declared, Juan Manuel Vandale: None declared, Bernardo Pons-Estel: None declared, Guillermo Pons-Estel: None declared, Mercedes García Grant/research support from: GSK grant

POS0438 IDENTIFICATION OF ANTI-CYTOKINE AUTOANTIBODIES WITH POTENTIAL TO PREDICT FLARE IN RHEUMATOID ARTHRITIS PATIENTS UNDERGOING BIOLOGICAL THERAPIES: A DISCOVERY STUDY

Background

The presence of anti-cytokine autoantibodies (ACAAs) seems to be a physiologic mechanism to control the immune response and regulate cytokine activity. Biological therapies also regulate cytokine activities and have greatly improved the quality of life of RA patients. However, alteration of the cytokine network by the use of these treatments may lead to a disbalance in the regulatory system of ACAAs. We hypothesize the ACAAs network may influence the course of immune response in RA patients and may be useful to predict the therapy efficacy.

Objectives

We aimed to explore the potential of circulating ACAAs to predict flare in a cohort of RA patients treated with biological therapy.

Methods

We employed sera at baseline from 194 RA patients of the clinical trial OPTIBIO1 (A Coruña), whose primary endpoint is to evaluate the usefulness of standardized protocol strategies of dose reduction in patients with RA in clinical remission treated with biologics. These patients were treated with TNF inhibitors (Etanercept, N=47; Infliximab, N=12; Adalimumab, N=35; Certolizumab (CTZ), N=17; Golimumab, N=5), Tocilizumab (TCZ, N=60) and Abatacept (ABA, N=18). Patients were in clinical remission (DAS 28 <2.6 or SDAI <5 or ACR/EULAR 2011 criteria) at least from 6 months. Patients were followed during a minimum period of one year and maximum period of 3 years. Flare was considered when remission criteria were not fulfilled. The bead-based antigen array MILLIPLEX MAP Human Cytokine Autoantibody Magnetic Bead Panel was used for the simultaneous detection and quantification in sera of anti-BAFF, anti-G-CSF, anti-IFNβ, anti-IFNγ, anti-IL-1α, anti-IL-6, anti-IL-8, anti-IL-10, anti-IL-12 (p40), anti-IL-15, anti-IL-17A, anti-IL-17F, anti-IL-18, anti-IL-22, and anti-TNFα. Non-parametrical tests, ROC curves and logistic regressions were performed for the statistical data analysis using SPSS. P-value < 0.05 was considered statistically significant.

Results

The levels of anti-17A and anti-IL-1α were increased in the sera from patients who suffered a flare during the follow-up period (N= 76), compared to those who remained in remission (N= 118), showing an area under the curve (AUC) of 0.586 and 0.594, respectively. Segregating by treatment, the levels of anti-17A were specifically increased in those relapsing patients under CTZ (N=6), ABA (N=12) and TCZ (N=20) treatment. The AUC of anti-17A within these three therapies was 0.867, 0.903 and 0.682, respectively. Logistic regression analysis also associated the levels of anti-17A with the risk of suffering a flare in TCZ-treated patients (OR=1.11; p=0.015, for 100 MFI increase). In addition, the TCZ-treated patients who suffered a flare also showed higher levels of anti-IL17F, anti-IL-1α, and anti-IL-18 compared to those that remained in remission, showing AUCs of 0.689, 0.657 and 0.698, respectively. Anti-IL-18 was also associated with the risk of flare in these patients (OR=1.65; p=0.028, for 100 MFI increase). The presence of these three ACAAs was also higher in the TCZ-treated patients who suffered a flare compared to those in remission.

Conclusion

Although further validation of our results is needed, we present a ground-breaking study showing the potential of anti-IL17A, anti-IL-1α, and anti-IL18 to predict flare in RA patients under biological therapies.

References

[1]Bejerano C, et al. Clinical evaluation usefulness of standardized protocol strategies of dose reduction in patients with RA in clinical remission treated with biologic therapies. The Optibio Study. Arthritis Rheumatol. 2016; 68 (suppl 10): 649.

Table 1.

Table showing a summary of the results. CI: confidence interval

• Treatments• ACAAs• AUC (CI 95%; p)Allanti-IL17A0.586 (0.504-0.668; 0.044)anti-IL-1α0.594 (0.512-0.676; 0.028)CTZanti-IL17A0.867 (0.675,1.000; 0.017)ABAanti-IL17A0.903 (0.761-1.000; 0.007)TCZanti-IL-1α0.657 (0.494-0.820; 0.049)anti-IL-17F0.689 (0.551-0.827; 0.018)anti-IL17A0.682 (0.528-0.835; 0.023)anti-IL180.698 (0.545-0.850; 0.013)

Disclosure of Interests

None declared.

Use of verbal de-escalation in reducing need for mechanical restraint in patients with psychotic disorders during non-voluntary transfers from home to the psychiatric emergency department

Introduction

Little is known about the need for mechanical restraint during non-voluntary transfers from patient’s homes to the psychiatric emergency department in patients diagnosed with Paranoid Schizophrenia. Although there is no evidence of its efficacy, one of the main tools used for the reduction of mechanical restraints is verbal de-escalation training.

Objectives

The aim is to describe which symptoms predispose to mechanical restrain in patients with Paranoid Schizophrenia transferred in a non-voluntary manner from home to the psychiatric emergency department, and the effect on reducing mechanical restraints after receiving verbal de-escalation training.

Methods

All patients with Paranoid Schizophrenia who, after being visited by a home psychiatry team, have required non-voluntary transfer from their homes to the psychiatric emergency department were selected (N = 442).

Results

Young age, being male, having a poor adherence to treatment, higher scores for de following variables; Excitement, Grandiosity, Suspiciousness, Hostility, Abstract thinking, Motor tension, Uncooperativeness, Poor attention, Lack of insight and Poor impulse control as well as lower scores in motor retardation on the PANSS, are related to a higher frequency of mechanical restrain (P<0,005). Before the verbal de-escalation training, 43.9% of the transferred patients required mechanical restraint, after the training, the need for restraints was reduced to 25.5% (P<0.001).

Conclusions

Training in verbal de-escalation has allowed an important reduction in mechanical restraints in patients with schizophrenia who have required non-voluntary transfers from home to the psychiatric emergency department.

Disclosure

No significant relationships.

Antithrombotic Treatment after Carotid Stenting in Patients with Concomitant Atrial Fibrillation

BACKGROUND AND PURPOSE

Antithrombotic therapy following carotid artery stent placement with concomitant atrial fibrillation is not well-established. Our aim was to assess the safety and efficacy of the combination of direct oral anticoagulants and a P2Y12 inhibitor at 30 days after carotid artery stent placement in patients with atrial fibrillation.

MATERIALS AND METHODS

We designed an observational single-center study including patients who underwent carotid artery stent placement with concomitant atrial fibrillation. We studied 3 groups according to antithrombotic therapy: 1) the direct oral anticoagulants plus clopidogrel (DC) group: receiving direct oral anticoagulants plus a P2Y12 inhibitor; 2) the triple therapy group: anticoagulation and dual antiplatelet therapy; and 3) the dual antiplatelet therapy group: following dual antiplatelet therapy alone. The safety outcome was a major or clinically relevant non-major bleeding event at the first month. The efficacy outcomes were the thromboembolic events (myocardial infarction, stroke, systemic embolism, or stent thrombosis).

RESULTS

Of 959 patients with carotid artery stent placement, 91 met the inclusion criteria, including 24 patients in the DC group, 42 patients in the triple therapy group, and 25 in the dual antiplatelet therapy group. The mean age was 72.27 (SD, 8.1 ) years, with similar baseline characteristics. The median CHA₂DS₂-VASc score for each group was 6 (interquartile range  = 5-6), 5 (interquartile range = 4-6), and 5 (interquartile range = 4-6), respectively. The median HAS-BLED score was 4 in the 3 groups (P = .17). The primary safety end point was 23.8% in the triple therapy group compared with 4% in the dual antiplatelet therapy group (P = .032), with no bleeding events in the DC group (P = .007). There was 1 stent thrombosis in DC group and a cardioembolic stroke in the dual antiplatelet therapy group (P = .41).

CONCLUSIONS

Among patients with carotid artery stent placement with atrial fibrillation, triple therapy confers a high bleeding risk. A regimen of direct oral anticoagulants plus a P2Y12 inhibitor might confer a good safety profile with significantly lower rates of bleeding and optimal efficacy.

Association of soluble ST2 and right ventricular dysfunction with mortality in chronic hemodialysis patients

Background

End stage kidney disease (ESKD), is a triggering and facilitating factor for cardiac remodelling (i.e., morphologic hypertrophy and/or dilatation associated with deterioration of systolic and/or diastolic function) that contribute to heart failure (HF). RV dysfunction (RVD) has been demonstrated to predict mortality in ESKD patients.

Purpose

The present study aimed to investigate the potential associations between RVD and circulating biomarkers of myocardial inflammation and fibrosis with all-cause mortality in HD patients.

Method

We performed a retrospective single-centre cohort study of prevalent patients admitted in a chronic HD program for more than 3 months. Clinical characteristics and echocardiographic parameters were assessed in all patients. Pre-dialysis blood samples for measurement of inflammatory (e.g., C reactive protein, interleukin-1, interleukin-18) and fibrotic (e.g., soluble suppression of tumorigenesis-2 [sST2], galectin-3, C-terminal pro-peptide of procollagen type I and N-terminal pro-peptide of procollagen type III) biomarkers were collected. RVD was defined using tricuspid annular plane systolic excursion (TAPSE) &lt;1.7 cm or pulsed Doppler peak annular velocity (S') &lt;9.5 cm/s. The ability of sST2 to discriminate between mortality was assessed using AuROC curve.

Results

We enrolled forty-eight patients, mean patients age was 74 (64 – 79)years, and 62.5% were males. 95.8% of the patients had high blood pressure, and at least 70.8% had HF criteria. About 52.1% of the patients were on OnLine HDF. Regarding the echocardiogram parameters, 56.3% had no functional heart disease, 10.4% had LVD (LVEF ≤45% and diastolic dysfunction ≥ grade 2), and 33.3% had RVD (TAPSE &lt;17mm and/or S'&lt;9.5cm/s), with or without LVD. Mortality was higher 45.5% (log-rank, p=0.003) in patients with RVD as diagnosed by S' than in patients without RVD. No difference in mortality was observed for RVD defined by TAPSE. There were no differences in the morphology and function parameters of the left ventricle between patients with and without RVD. From all biomarkers measured only sST2 was associated with RVD. Indeed, an age- and sex-adjusted analyses showed that doubling of sST2 was inversely associated with a decreased in S' (estimate = −2.03, 95% CI [−3.04 to −1.00] cm/s; P=0.002). Mortality was increased in patients with sST2 ≥40.45 ng/mL compared to patients with sST2 &lt;40.45 ng/mL (66.7% vs. 18.9%, log-rank; p=0.004).

Conclusion

This preliminary data would suggest that patients on chronic HD, circulating levels of sST2 were independently associated with RVD. In addition, elevated sST2 levels and RVD were associated with increased all-cause mortality. The myocardial pro-remodelling effect of sST2 in HD patients with RVD warrants further investigation.

Funding Acknowledgement

Type of funding sources: None.

Impact of previous cardiac conditions in prognosis and clinical management of patient with COVID-19 infection

Background

Recent studies suggest a higher mortality rate because of COVID-19 in patients with previous cardiac conditions compared to those without. Given the limited resources of intensive care units (ICU) during the pandemic outbreak, this fact has important implications.

Purpose

The main purpose of this study was to compare the 30-day mortality of the COVID-19 infection in patients with and without previous cardiac conditions. The secondary end point was to assess the differences in clinical severity of the infection (as development of Acute Respiratory Distress Syndrome – ARDS) and ICU admission amongst these patients.

Methods

A total of 1708 consecutive patients were prospectively included. The inclusion criteria were: a confirmed positive diagnosis of COVID-19 infection by PCR and being admitted to our centre between 18th and 23rd March 2020 and 22nd August and 9th January 2021. Patients were classified in two groups according to the presence of previous cardiac conditions (defined as previous history of myocardial infarction, heart failure and atrial fibrillation). Other comorbidities were extensively explored and Charlson Comorbidity Index was calculated. A propensity-score matching was performed and 145 patients with previous cardiac conditions were matched with 145 patients without.

Results

The group of patients with a previous cardiac condition included 421 patients (24.6%). The crude analysis showed a higher 30-day mortality rate among patients with previous cardiac affections (35.6% vs. 14.6%, p&lt;0.001). They were also less likely to be admitted to the ICU (9.8% vs. 6.2%, p=0.022) and had a higher prevalence ARDS (48.9% vs. 33.9%, p&lt;0.001). In the matched cohort, there were no significant differences between both groups regarding mortality (24.8% in the group of patients with previous cardiac conditions vs. 31.0%, p=0.272) nor ARDS prevalence (50.3% vs. 53.1%, p=0.655). There was a trend toward patients with previous cardiac conditions to be less likely to be admitted to the ICU (4.8% vs. 9.7%, p=0.090).

Conclusions

Patients with a personal history of previous cardiac conditions were less likely to be admitted to the ICU. However, our results show that when comparing cohorts with similar comorbidity burden, a previous cardiopathy “per se” does not significantly increase the risk of death in patients with a concomitant COVID infection.

Funding Acknowledgement

Type of funding sources: None. Mortality unmatched vs matched cohort

Endotrophin is significantly associated with disease severity and increased risk of adverse outcome in HFpEF but not in HFrEF patients

Introduction

The global burden of heart failure (HF), with either reduced (HFrEF) or preserved (HFpEF) ejection fraction, has increased dramatically over the past years, and HFpEF is projected to become the dominant type of HF. Fibrogenesis, promoted by fibroblast activity, plays an important role in the pathology of HF regardless of subtype, causing impaired cardiac function. Endotrophin is a bioactive molecule released from collagen type VI during its maturation, and it is a marker of fibroblast activity. The aim of this post-hoc analysis was to confirm the previously observed prognostic potential of endotrophin (measured by PRO-C6) for adverse outcome in HFpEF and to test its prognostic abilities in HFrEF.

Methods

234 patients with hypertension and either HFrEF (30.3%) or HFpEF (69.7%) were included for analysis. 43.2% were NYHA Class II, 52.5% NYHA Class III and 2.5% NYHA Class IV. 53.4% of patients had a previous history of atrial fibrillation. The cohort did not include diabetic patients. Cardiac function was assessed by echocardiography and standard clinical measures, including left ventricle ejection fraction (EF), blood pressure (BP) and measurement of N-terminal natriuretic brain-peptide (NT-proBNP). Circulating endotrophin was quantified at baseline in serum by means of an enzyme-linked immunosorbent assay, PRO-C6.

Results

PRO-C6 levels increased significantly with disease severity in HFpEF patients (NYHA Class III vs II, p=0.0003), but not in HFrEF patients (NYHA Class III vs II, p=0.33). In HFpEF patients, PRO-C6 was able to discriminate between patients that were hospitalized for HF (AUC=0.69, p&lt;0.001), died from cardiovascular (CV) causes (AUC=0.74, p&lt;0.001), or by any other cause (AUC=0.73, p&lt;0.001). PRO-C6 was not associated with none of these outcomes in HFrEF patients (AUC=0.56, p=0.42; AUC=0.53, p=0.73; AUC=0.56, p=0.53, respectively). Adding PRO-C6 to a risk prediction model containing age, sex, body mass index and systolic BP significantly increased the discriminatory power of the model for mortality (deltaAUC=0.037, p=0.04). When looking at patients stratified in PRO-C6 tertiles, patients in the upper tertile had a significantly higher risk of mortality (p&lt;0.0001, hazard ratios 3 vs 1=4.1, 3 vs 2=3.5, respectively) and HF hospitalization (p&lt;0.0001, hazard ratio 3 vs 1=4.4, 3 vs 2=1.6, respectively) compared to tertiles 1 and 2.

Conclusion

In this population of hypertensive HF patients, circulating endotrophin, measured by PRO-C6, was increased with increasing disease severity, and associated with a higher risk of adverse outcome in HFpEF, but not in HFrEF patients. The data presented here suggest a potential role of endotrophin in HFpEF pathophysiology and further underline the differences between HFpEF and HFrEF. These data confirm previous observations, and strengthen the usefulness of endotrophin, measured by the PRO-C6 biomarker, as a prognostic tool aiding in assessment of HFpEF patients.

Funding Acknowledgement

Type of funding sources: None.

Prognostic factors at admission on patients with cancer and COVID-19: Analysis of HOPE registry data

Background

Previous works seem to agree in the higher mortality of cancer patients with COVID-19. Identifying potential prognostic factors upon admission could help identify patients with a poor prognosis.

Methods

We aimed to explore the characteristics and evolution of COVID-19 cancer patients admitted to hospital in a multicenter international registry (HOPE COVID-19).

Our primary objective is to define those characteristics that allow us to identify cancer patients with a worse prognosis (mortality within 30 days after the diagnosis of COVID-19).

Results

5838 patients have been collected in this registry, of whom 770 had cancer among their antecedents. In hospital mortality reached 258 patients (33.51%). The median was 75 years (65–82). Regarding the distribution by sex, 34.55% of the patients (266/770) were women.

The distribution by type of cancer: genitourinary 238/745 (31.95%), digestive 124/745 (16.54%), hematologic 95/745 (12.75%).

In multivariate regression analysis, factors that are independently associated with mortality at admission are: renal impairment (OR 3.45, CI 97.5% 1.85–6.58), heart disease (2.32, 1.47–3.66), liver disease (4.69, 1.94–11.62), partial dependence (2.41, 1.34–4.33), total dependence (7.21, 2.60–21.82), fatigue (1.84, 1.16–2.93), arthromialgias (0.45, 0.26–0.78), SatO2 < 92% (4.58, 2.97–7.17), elevated LDH (2.61, 1.51–4.69) and abnormal decreased Blood Pressure (3.57, 1.81–7.15). Analitical parameters are also significant altered.

Conclusion

In patients with cancer from the HOPE registry, 30-day mortality from any cause is high and is associated with easily identifiable clinical factors upon arrival at the hospital. Identifying these patients can help initiate more intensive treatments from the start and evaluate the prognosis of these patients.

The transcription factor CREB1 is a mechanistic driver of immunogenicity and reduced HIV-1 acquisition following ALVAC vaccination

Development of effective human immunodeficiency virus 1 (HIV-1) vaccines requires synergy between innate and adaptive immune cells. Here we show that induction of the transcription factor CREB1 and its target genes by the recombinant canarypox vector ALVAC + Alum augments immunogenicity in non-human primates (NHPs) and predicts reduced HIV-1 acquisition in the RV144 trial. These target genes include those encoding cytokines/chemokines associated with heightened protection from simian immunodeficiency virus challenge in NHPs. Expression of CREB1 target genes probably results from direct cGAMP (STING agonist)-modulated p-CREB1 activity that drives the recruitment of CD4+ T cells and B cells to the site of antigen presentation. Importantly, unlike NHPs immunized with ALVAC + Alum, those immunized with ALVAC + MF59, the regimen in the HVTN702 trial that showed no protection from HIV infection, exhibited significantly reduced CREB1 target gene expression. Our integrated systems biology approach has validated CREB1 as a critical driver of vaccine efficacy and highlights that adjuvants that trigger CREB1 signaling may be critical for efficacious HIV-1 vaccines.

Integrated rearing system proposal for Cantareus aspersus in experimental orchards: Growth models

An integrated rearing system for Cantareus aspersus under environmental conditions in an experimental orchard is proposed. In this study, the natural behaviour, circadian rhythms and suitable rearing conditions of the edible snail were optimised to produce homogeneous growth and low variability. The growth was standardised, and growth pattern fit was assessed with various models. One thousand fry were cultured in the orchard, and a random sample of 100 snails were measured weekly for 23 weeks. The rearing system had the following characteristics: snails and earthworms were included in the experimental rearing orchard; a homogeneous group of juvenile snails of the same age and size and high rearing density (500 snails/m²) was used; snails were fed with layers mash ad libitum; and mixed and fringes vegetation was planted in the orchard. A commercial size of 60% of snails was achieved in 21 weeks and 95% in 23 weeks. The different models showed a good fit, and the quadratic model obtained the best fit. This experimental snail orchard proposal can be extended to other areas, although it must be corrected according to different environmental conditions and fit to other species of interest. This experimental model could constitute a viable alternative to traditional models of animal experimentation with mammals, and given its high adaptability, it could be applied in different fields of science.

Consistent evidence of indirect effects of impulsive delay discounting and negative urgency between childhood adversity and adult substance use in two samples

RATIONALE

Exposure to adverse life experiences (ACEs) is robustly associated with problematic alcohol and other drug use. In addition, both ACEs and substance use have been independently associated with impulsivity.

OBJECTIVE

To examine whether impulsivity is implicated in the link between ACE and adult substance use in two samples.

METHODS

The primary sample was a cohort of community adults (N = 1431) who completed a one-time in-person assessment. A second sample was crowdsourced using Amazon Mechanical Turk (N = 3021). All participants were assessed for ACEs using the Adverse Childhood Experience Questionnaire and for current alcohol and other drug use. Given its multidimensional nature, impulsivity was assessed using the UPPS-P measure of impulsive personality traits, Go/NoGo (GNG) task (in-person community adult sample only), and delay discounting (Monetary Choice Questionnaire [MCQ] in the community adults and Effective Delay-50 [ED₅₀] in the crowdsourced sample. Structural equation modeling was used to examine the hypothesized indirect effects for the measures of impulsivity between ACEs and substance use.

RESULTS

In the community adults, significant indirect effects were observed from ACEs to substance use via UPPS-Negative Urgency (β = 0.07, SE = 0.02, 95% CI [0.04, 0.10]), and the MCQ (β = 0.02 SE = .01, 95% CI [0.01, 0.03]). In the crowdsourced sample, significant indirect effects were observed from ACEs to substance use via UPPS-Negative Urgency (β = 0.05, SE = .01, 95% CI [0.04, 0.07]), UPPS-Premeditation (β = 0.04, SE = .01, 95% CI [0.02, 0.05), and the ED₅₀ (β = 0.02, SE = .01; 95% CI [0.01, 0.03]).

CONCLUSION

These findings provide consistent evidence that decrements in regulation of negative emotions and overvaluation of immediate rewards indirectly link ACE and substance use. These robust cross-sectional findings support the need for elucidating the underlying neural substrates implicated and for longitudinal evaluations.

Pilot Randomized Controlled Trial of an Intervention to Improve Coping with Intersectional Stigma and Medication Adherence Among HIV-Positive Latinx Sexual Minority Men

We developed and pilot-tested an eight-session community-based cognitive behavior therapy group intervention to improve coping with intersectional stigma, address medical mistrust, and improve antiretroviral treatment adherence. Seventy-six HIV-positive Latinx sexual minority men (SMM; 38 intervention, 38 wait-list control) completed surveys at baseline, and 4- and 7-months post-baseline. Adherence was electronically monitored. Intention-to-treat, repeated-measures regressions showed improved adherence in the intervention vs. control group from baseline to follow-up [electronically monitored: b (95% CI) 9.24 (- 0.55, 19.03), p = 0.06; self-reported: b (95% CI) 4.50 (0.70, 8.30), p = .02]. Intervention participants showed marginally decreased negative religious coping beliefs in response to stigma [b (95% CI) = - 0.18 (- 0.37, 0.01), p = .06], and significantly lower medical mistrust [b (95% CI) = - 0.47 (- 0.84, - 0.09), p = .02]. Our intervention holds promise for improving HIV outcomes by empowering Latinx SMM to leverage innate resilience resources when faced with stigma.ClinicalTrials.gov ID (TRN): NCT03432819, 01/31/2018.

POS0185 IDENTIFICATION AND VALIDATION OF TWO NOVEL SERUM BIOMARKERS ASSOCIATED WITH THE SEROLOGICAL STATUS OF RHEUMATOID ARTHRITIS PATIENTS

Background:

Despite the diagnostic value of Rheumatoid Factor (RF) and Anti-Citrullinated Protein Antibodies (ACPA), more serological markers are needed in order to improve early diagnosis and treatment response of the Rheumatoid Arthritis (RA) patients. Increased knowledge about how these two major autoreactivities arise is crucial for understanding how RA develops and what mechanisms drive pathogenesis.

Objectives:

We aimed to investigate, using a proteomic strategy, novel protein biomarkers associated with RF and/or ACPA that might be useful to stratify seropositive and seronegative RA patients.

Methods:

A shotgun proteomic analysis was performed on 80 sera from the RA cohort of the Rheumatology Unit of the University Hospital of Santiago de Compostela (CHUS). Sera were classified as seropositive or seronegative according to their RF and ACPA values, and were then analyzed employing the iTRAQ labelling technique (Sciex) followed by LC-MALDI-MS/MS analysis (MALDI-TOF). A Multiple Reaction Monitoring (MRM) method was subsequently developed using the Skyline Software for the simultaneous quantification of 26 peptides belonging to ten putative protein biomarkers. The quantitative targeted analysis was performed using peptides with isotope labelled amino acids as internal standards. Serum levels of orosomucoid 1 (ORM1) and haptoglobin (HPT) were measured using commercially available ELISA Kits in the whole RA cohort (n=260) from the Rheumatology Unit of the University Hospital of A Coruña (HUAC).

Results:

For the initial screening, eighty sera were grouped according to the ACPA/RF status in 4 pools (20 patients/pool). Using an iTRAQ technology-based quantitative proteomic approach, the abundance of eleven proteins was altered in the sera from ACPApos/RFpos, 13 proteins in ACPAneg/RFpos and 12 proteins in ACPApos/RFneg, compared to ACPAneg/RFneg. Vitamin D binding protein (VTDB) was the unique protein that resulted increased in all the comparisons. For the biomarker verification phase, all the samples from the CHUS cohort were analyzed individually (n=80). Using the MRM technology, 26 peptides belonging to ten putative protein biomarkers associated with double positivity were simultaneously quantified. The statistical analysis showed a significant modulation of 9 peptides (belonging to 4 different proteins) in ACPApos/RFpos, 7 peptides (5 proteins) in ACPAneg/RFpos, and 9 peptides (6 proteins) in ACPApos/RFneg compared to ACPAneg/RFneg (p<0.05). Two acute phase reactants (ORM1 and HPT) displayed the same modulation in both screening and verification phases, thus confirming their association with the double positivity. Finally, in the biomarker validation phase, a total of 260 patients from CHUAC were included (Table 1). RA patients were classified as follows: (1) 112 patients (43.1%) were ACPApos/RFpos; (2) 73 patients (28.1%) were ACPAneg/RFneg; (3) 51 patients (19.6%) were ACPAneg/RFpos; and (4) 24 patients (9.2%) were ACPApos/RFneg. Serum levels of ORM1 and HPT (Figure 1), measured by commercial immunoassays, confirmed their increased values in double seropositive patients (p=0,0053 ORM1; p=0,0026 HPT). Finally, the increased level of ORM1 resulted associated with RF rather than ACPA status (p=0,0008 ACPAneg/RFpos); whereas HPT was associated with ACPA rather than RF status (p=0,0112 ACPApos/RFneg).

Table 1.

The different phases of RA biomarker development followed in this study.

DISCOVERYPHASEVERIFICATIONPHASEVALIDATIONPHASESource centerCHUSCHUSCHUACN° ofsamplesn= 4n= 80n= 260ACPA+RF+Pool 1ACPA+RF+20ACPA+RF+112ACPA-RF-Pool 2ACPA-RF-20ACPA-RF-73ACPA-RF+Pool 3ACPA-RF+20ACPA-RF+51ACPA+RF-Pool 4ACPA+RF-20ACPA+RF-24N° ofbiomarkersORM1, ORM2, HPT, A2GL, AACT, RBP4, PLMN, IC1, VDBP, APOBORM1, HPT, A2GL, AACTORM1, HPTFigure 1.

Conclusion:

The determination of ORM1 and HPT in sera provides novel information useful for patient stratification, which might improve diagnostic and prognostic approaches and facilitate the development of personalized medicine strategies in RA.

Acknowledgements:

This work is supported by grants from Fondo de Investigación Sanitaria (RD16/0012/0002, PT17/0019/0014) integrated in the National Plan for Scientific Program, Development and Technological Innovation 2013–2016 and funded by the ISCIII-General Subdirection of Assessment and Promotion of Research-European Regional Development Fund (FEDER) “A way of making Europe”.

Disclosure of Interests:

None declared

Robotic-assisted, laparoscopic, and open incisional hernia repair: early outcomes from the Prospective Hernia Study

PURPOSE

To provide a comparative analysis of short-term outcomes after open, laparoscopic, and robotic-assisted (RAS) ventral incisional hernia (VIH) repairs that include subject-reported pain medication usage and hernia-related quality of life (QOL).

METHODS

Subjects were ≥ 18 years old and underwent elective open, laparoscopic or RAS VIH repair without myofascial release. Perioperative clinical outcomes through 30 days were analyzed as were prescription pain medication use and subject-reported responses to the HerQLes Abdominal QOL questionnaire. Observed differences in baseline characteristics were controlled using a weighted propensity score analysis to obviate potential selection bias (inverse probability of treatment weighting, IPTW). A p value < 0.05 was considered statistically significant.

RESULTS

Three hundred and seventy-one subjects (RAS, n = 159; open, n = 130; laparoscopic, n = 82) were enrolled in the study across 17 medical institutions within the United States. Operative times were significantly different between the RAS and laparoscopic groups (126.2 vs 57.2, respectively; p < 0.001). Mean length of stay was comparable for RAS vs laparoscopic (1.4 ± 1.0 vs 1.4 ± 1.1, respectively; p = 0.623) and differed for the RAS vs open groups (1.4 ± 1.0 vs 2.0 ± 1.9, respectively; p < 0.001). Conversion rates differed between RAS and laparoscopic groups (0.6% vs 4.9%; p = 0.004). The number of subjects reporting the need to take prescription pain medication through the 2-4 weeks visit differed between RAS vs open (65.2% vs 79.8%; p < 0.001) and RAS vs laparoscopic (65.2% vs 78.75%; p < 0.001). For those taking prescription pain medication, the mean number of pills taken was comparable for RAS vs open (23.3 vs 20.4; p = 0.079) and RAS vs laparoscopic (23.3 vs 23.3; p = 0.786). Times to return to normal activities and to work, complication rates and HerQLes QOL scores were comparable for the RAS vs open and RAS vs laparoscopic groups. The reoperation rate within 30 days post-procedure was comparable for RAS vs laparoscopic (0.6% vs 0%; p = 0.296) and differed for RAS vs open (0.6% vs 3.1%; p = 0.038).

CONCLUSIONS

Short-term outcomes indicate that open, laparoscopic, and robotic-assisted approaches are effective surgical approaches to VIH repair; however, each repair technique may demonstrate advantages in terms of clinical outcomes. Observed differences in the RAS vs laparoscopic comparison are longer operative time and lower conversion rate in the RAS group. Observed differences in the RAS vs open comparison are shorter LOS and lower reoperation rate through 30 days in the RAS group. The operative time in the RAS vs open comparison is similar. The number of subjects requiring the use of prescription pain medication favored the RAS group in both comparisons; however, among subjects reporting a need for pain medication, there was no difference in the number of prescription pain medication pills taken. While the study adds to the body of evidence evaluating the open, laparoscopic, and RAS approaches, future controlled studies are needed to better understand pain and QOL outcomes related to incisional hernia repair.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT02715622.

Prognostic factors at admission on patients with cancer COVID-19: Analysis of hope registry data

Background

Previous works seem to agree in the higher mortality of cancer patients with COVID-19. Identifying potential prognostic factors upon admission could help identify patients with a poor prognosis.

Methods

We aimed to explore the characteristics and evolution of COVID-19 cancer patients admitted to hospital in a multicenter international registry (HOPE COVID-19).

Our primary objective is to define those characteristics that allow us to identify cancer patients with a worse prognosis (mortality within 30 days after the diagnosis of COVID-19).

Results

5838 patients have been collected in this registry, of whom 770 had cancer among their antecedents. In hospital mortality reached 258 patients (33.51%). The median was 75 years (65–82). Regarding the distribution by sex, 34.55% of the patients (266/770) were women.

The distribution by type of cancer: genitourinary 238/745 (31.95%), digestive 124/745 (16.54%), hematologic 95/745 (12.75%).

In multivariate regression analysis, factors that are independently associated with mortality at admission are: renal impairment (OR 3.45, CI 97.5% 1.85–6.58), heart disease (2.32, 1.47–3.66), liver disease (4.69, 1.94–11.62), partial dependence (2.41, 1.34–4.33), total dependence (7.21, 2.60–21.82), fatigue (1.84, 1.16–2.93), arthromialgias (0.45, 0.26–0.78), SatO2 < 92% (4.58, 2.97–7.17), elevated LDH (2.61, 1.51–4.69) and abnormal decreased Blood Pressure (3.57, 1.81–7.15). Analitical parameters are also significant altered.

Conclusion

In patients with cancer from the HOPE registry, 30-day mortality from any cause is high and is associated with easily identifiable clinical factors upon arrival at the hospital. Identifying these patients can help initiate more intensive treatments from the start and evaluate the prognosis of these patients.

A cross-sectional study of Leishmania infantum infection in stray cats in the city of Zaragoza (Spain) using serology and PCR

BACKGROUND

Feline leishmaniosis is a vector-borne parasitic disease caused by Leishmania spp. Leishmania infection in dogs is prevalent in the Mediterranean basin, but in other animals, such as cats, it could also play a role in the epidemiology of the disease. Information on the geographical distribution and epidemiological features of L. infantum infection in cats is scarce, particularly in urban stray cats living in regions where canine leishmaniosis is endemic. As diagnosis can be challenging, combining different serological and molecular methods is a useful approach. Our aim was to investigate the prevalence of infection of L. infantum in apparently healthy stray cats in an endemic region of Spain (Zaragoza city) using serological and molecular methods, and to compare the results of the different techniques.

METHODS

The prevalence of Leishmania infection was studied in stray cats captured in urban and peri-urban areas of Zaragoza. Blood was collected from each animal for serology and molecular analysis. Three serological methods, namely the immunofluorescent antibody test (IFAT), enzyme-linked immunosorbent assay (ELISA) and western blot (WB), were used to detect L. infantum antibodies and a real-time PCR (qPCR) assay was used to detect L. infantum DNA. The results were analyzed by Fisher's exact test and Cohen's kappa statistic (κ)  to assess the level of agreement between the diagnostic techniques.

RESULTS

Serological analysis of blood samples from 180 stray cats revealed 2.2% (4/179) Leishmania infection positivity by IFAT, 2.8% (5/179) by ELISA and 14.5% (26/179) by WB. Leishmania DNA was detected by qPCR in 5.6% (10/179) of the cats. Sixteen cats (8.9%) tested positive by only one serological technique and four tested positive by all three serological methods used. The overall rate of infected cats (calculated as the number of cats seropositive and/or qPCR positive) was 15.6%, and only two cats tested positive by all the diagnostic methods. A significant association was found between male cats and a positive qPCR result. Comparison of the techniques revealed a fair agreement in seropositivity between blood qPCR and IFAT (κ = 0.26), blood qPCR and ELISA (κ = 0.24), WB and ELISA (κ = 0.37) and WB and IFAT (κ = 0.40). The highest agreement between seropositive results was between IFAT and ELISA (κ = 0.89), and the lowest was between blood qPCR and WB (κ = 0.19). The prevalence of the feline leukemia virus antigen was 4.49% (8/178 cats) and that of the feline immunodeficiency virus (FIV) antibody was 6.74% (12/178), while co-infection with both retroviruses was observed in one female cat (1/178). Leishmania ELISA and IFAT seropositivity were statistically associated with FIV status by the chi-square test.

CONCLUSIONS

The results obtained in this study, using serological tests and qPCR, indicate the existence of L. infantum asymptomatic infection in apparently healthy stray cats in the city of Zaragoza, an endemic area in Spain.

38 Developmental competence of bovine cumulus–oocyte complexes collected from cows fed rumen-protected methionine and lysine

Supplementation of rumen-protected amino acids (RPAA) has proven to be an effective tool to supply limiting AA in dairy diets. Methionine and lysine are the two most limiting AA for lactating dairy cows. Recently, it has been shown that methionine supplementation seems to affect pre-implantation embryos collected from superovulated cows enhancing their developmental competence because there is strong evidence that endogenous lipid reserves serve as an energy substrate (Acosta et al. 2016 Theriogenology 85, 1669–1679). Moreover, higher concentrations of methionine were determined in the follicular fluid of the first dominant follicle postpartum in cows supplemented with rumen-protected methionine and rumen-protected choline from 21 days before calving to 30 days postpartum and it was assumed that higher methionine concentrations in the follicular fluid could affect oocyte quality (Acosta et al. 2017 Theriogenology 96, 1–9). There is no information available so far regarding the effect of a combined methionine and lysine supplementation (each rumen-protected) on oocyte quality. Therefore, the objective of this study was to evaluate the effect of a combined methionine and lysine supplementation during early to mid-lactation on the developmental competence of oocytes collected from lactating dairy cows (days 0 to 100 p.p.). Thirty pregnant multiparous German Holstein dairy cows were grouped 3 weeks before their expected calving date, receiving identical diets. After calving, they were randomly allocated to 2 groups fed a total mixed ration supplemented with (N=14 cows; RPAA) or without (N=16 cows; CON) LysiGEMTM (encapsulated lysine; Kemin Industries) and Metasmart DryTM (isopropyl ester of the hydroxylated analogue of methionine adsorbed onto a silicon dioxide carrier; Adisseo). Starting from 45 days p.p., animals from both groups were submitted to an ovum pickup (OPU) session once a week for at least 8 weeks. Collected cumulus–oocyte complexes (COC) were subjected to a standard invitro production (IVP) protocol (Stinshoff et al. 2014 Reprod. Fertil. Dev. 26, 502–10) including IVM, IVF, and invitro culture (IVC). Cleavage and developmental rates up to the morula/blastocyst stage were recorded on Days 3, 7, and 8. In total, 1211 follicles have been aspirated from RPAA animals compared with 1413 from CON animals, from which 742 and 885 COC were collected, respectively. The calculated recovery rate based on the number of aspirated follicles and collected COC was similar for both groups (61.3±29.4% vs. 62.6±33.5%). Cleavage and developmental rates based on 240 (RPAA group) and 299 (CON group) COC also showed similar results [RPAA: 84.1±5.9% (202/240), 18.3±4.4% (44/240), 18.8±4.7% (45/240); CON: 81.9±8.6% (245/299), 15.4±8.9% (46/299), 16.7±8.4% (50/299)]. In conclusion, supplementation of RPAA (methionine and lysine) had no beneficial effect on the developmental competence of COC obtained from these animals compared with those collected from cows fed the diet without RPAA supplementation.