Gaining access to treatment; life at the far side of atopic eczema

I have chronic eczema since I was 3 months old; eczema covers my entire body & scalp. I spent a lot of my childhood & young adult life in "Hume Street" hospital, each admission would last 2 - 3 weeks at a time in a bid to get my eczema under control again. My entire life.

AB0220 ANTI-CITRULLINATED PROTEIN ANTIBODY (ACPA) POSITIVITY IS ASSOCIATED WITH REDUCED WITHDRAWAL RATES OF ABATACEPT IN RHEUMATOID ARTHRITIS BUT ONLY IN PATIENTS WHO ARE ANTI-NUCLEAR ANTIBODY (ANA) NEGATIVE

Background:

Abatacept, a selective inhibitor of T cell co-stimulation, is often used as a second-line biologic disease-modifying anti-rheumatic drug (bDMARD) after the failure of tumour necrosis factor inhibitor (TNFi) in Rheumatoid Arthritis (RA). However, in comparison to TNFi very few survival analyses of abatacept have been reported.1,2

Objectives:

To investigate predictors of abatacept discontinuation due to either inefficacy or adverse events in RA patients over 5-years.

Methods:

A retrospective observational analysis was conducted on a tertiary hospital dataset of RA (according to 2010 ACR/EULAR criteria) patients who started abatacept (either intravenous or subcutaneous). Time to abatacept discontinuation over 5-years was estimated using Kaplan-Meier survival analyses. A multivariate cox-regression model to predict abatacept discontinuation was chosen by elastic net regularisation.

Results:

A total of 112 patients with RA [81% female, mean age 58.1 (SD 13.5) years] commenced abatacept therapy during the study period. 88 (78.6%) patients received intravenous abatacept, 14 (15.9%) of whom switched to subcutaneous injection, and 24 (21.4%) were initially treated with subcutaneous abatacept, 2 (8.3%) of whom switched to intravenous. More than half of the patients (65/112) were treated with at least one concomitant conventional synthetic DMARD (csDMARD). Methotrexate was the most commonly used (n = 37) csDMARD, followed by hydroxychloroquine (n = 23), sulfasalazine (n= 15), and leflunomide (n = 7). 42 (37.5%) patients were treated with glucocorticoids (either oral, intra-articular, or intramuscular injection) during the time they were treated with abatacept. Abatacept was most commonly used as 4th (n = 29) and 3rd line (n = 24) bDMARD but 19 patients received abatacept as their first line bDMARD. 75 (67%) patients were rheumatoid factor (RF) positive and 73 (65.2%) were anti-citrullinated protein antibody (ACPA) positive. Anti-nuclear antibody (ANA) was positive in 32 patients. Abatacept was discontinued in 54 patients (48.2%); 19 (35.2%) due to an adverse event and 35 (64.8%) due to loss of efficacy. Overall, the median time to discontinuation of abatacept was 3.8 years.

Multivariate cox regression (variables chosen by the elastic net and adjusted by whether or not abatacept was used as first-line therapy) showed that ACPA positivity was associated with a reduced risk of abatacept discontinuation with a hazard ratio (HR) of 0.40 (95% CI 0.18 to 0.85, p=0.02, N. of events 16/47) compared to ACPA negative patients (N. of events 15/23), but only if ANA was negative. In contrast, ACPA positivity did not reveal any retention benefit over ACPA negative patients, if they were ANA positive.

ACPA positive patients without positive ANA increased the time-to-discontinuation of abatacept predominantly after 3-months (unadjusted log-rank p=0.02), compared to ACPA, and ANA negative patients (Figure 1). Adding csDMARDs with abatacept, reduced the risk of discontinuation of abatacept by 59% (95% CI 24% to 77%, p = 0.004, N. of events 26/65) compared to monotherapy (N. of events 28/47).

Conclusion:

Our data suggests patients who are ACPA positive and ANA negative are more likely to remain on abatacept therapy. Concomitant csDMARD use also acts as a positive predictor of abatacept treatment retention.

References:

[1]Cagnotto G, et al. Arthritis Res Ther. 2020;22(1):15.

[2]Alten R, et al. Clin Rheumatol. 2019;38(5):1413-1424.

Figure 1.

Kaplan-Meier survival curve of retention of abatacept, stratified by Anti-citrullinated protein antibody (ACPA) and antinuclear antibody (ANA).+ACPA/-ANA = ACPA positive and ANA negative, +ACPA/+ANA = ACPA positive and ANA positive, -ACPA/-ANA = ACPA negative and ANA negative, -ACPA/+ANA = ACPA negative and ANA positive, HR = Hazard ratio.

Acknowledgements:

I have no acknowledgements to declare.

Disclosure of Interests:

None declared

Prospects for beyond the Standard Model physics searches at the Deep Underground Neutrino Experiment: DUNE Collaboration

The Deep Underground Neutrino Experiment (DUNE) will be a powerful tool for a variety of physics topics. The high-intensity proton beams provide a large neutrino flux, sampled by a near detector system consisting of a combination of capable precision detectors, and by the massive far detector system located deep underground. This configuration sets up DUNE as a machine for discovery, as it enables opportunities not only to perform precision neutrino measurements that may uncover deviations from the present three-flavor mixing paradigm, but also to discover new particles and unveil new interactions and symmetries beyond those predicted in the Standard Model (SM). Of the many potential beyond the Standard Model (BSM) topics DUNE will probe, this paper presents a selection of studies quantifying DUNE's sensitivities to sterile neutrino mixing, heavy neutral leptons, non-standard interactions, CPT symmetry violation, Lorentz invariance violation, neutrino trident production, dark matter from both beam induced and cosmogenic sources, baryon number violation, and other new physics topics that complement those at high-energy colliders and significantly extend the present reach.

SAT0109 DISTINCT EFFECTS OF METHOTREXATE IN COMBINATION WITH ADALIMUMAB OR ETANERCEPT ACCORDING TO CCP ANTIBODY STATUS IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

Considerable evidence suggesting enhanced efficacy of anti-TNF therapy for rheumatoid arthritis (RA) when co-administered with methotrexate (MTX) led us to explore the applicability of the published data to our patient cohort.

Objectives:

This retrospective study aimed to investigate the efficacy of MTX in combination with adalimumab (ADA) and etanercept (ETN) for RA, examining changes in disease activity score (DAS28-CRP) on first starting treatment, and rates of withdrawal due to inefficacy over up to 10 years of treatment in routine clinical practice.

Methods:

309 patients with RA who had started ADA or ETN as a first-line biologic at UCLH from 2003 onwards were identified. Demographic and treatment details, DAS28-CRP (DAS) at the biologic-naïve baseline and at a first appointment for review on anti-TNF were extracted from clinical records. ANOVA was used to investigate the level of association between change in DAS and anti-TNF type, concomitant therapy, anti-CCP (CCP), rheumatoid factor (RF), age, disease duration and number of DMARD trials by anti-TNF initiation, year of initiation and gender. Kaplan-Meier with log rank tests were used to explore associations between anti-TNF type, MTX, CCP and RF and rates of withdrawal due to inefficacy, and Cox Proportional Hazards to check whether these remained significant after controlling for any other significant factors.

Results:

179 patients were on ADA and 130 ETN; 44% were on concomitant MTX (Table 1).

Table 1.

Numbers of patients co-prescribed MTX with ADA or ETN according to CCP status

CCP positive nTotal nETN without MTX3754with MTX5776ADA without MTX5482with MTX6597

Median follow up since anti-TNF initiation was 7 years. Median age at initiation was 51 years, and disease duration 4 years. 82% were female. 241 were seropositive, including 24 positive for CCP only and 28 RF only.

Mean biologic-naïve (baseline) DAS was 5.75, and 3.52 on first review (mean 20 weeks of treatment, n= 274) with mean change -2.23. MTX, even accounting for dose, failed to explain a significant amount of the variance in DAS response at first review either as a main effect or in interaction with anti-TNF type, CCP or RF. The only significant factor was 4+ DMARD trials prior to initiation (lower mean DAS response, p=0.010).

Next, we analysed withdrawal of anti-TNF for inefficacy over up to 10 years. Kaplan-Meier analyses revealed that CCP positive patients had higher inefficacy withdrawal rates (p =0.004). Of note, CCP positive patients treated with MTX had lower withdrawal rates for inefficacy (Figure 1, p=0.006). Intriguingly, there was a trend towards higher rates in patients treated with MTX if CCP negative (p=0.14). Co-administration of MTX appeared to reduce rates of inefficacy withdrawal for patients on ETN (p=0.006) but not ADA (p =0.784). For CCP positive patients on ETN, MTX was strongly associated with lower rates of inefficacy withdrawal (Figure 1, p=.002).

CCP status and the CCP*MTX interaction remained significant in the multivariate Cox model (Table 2). The MTX*ETN interaction was also included by the backward stepwise variable selection procedure although with p 0.069.

Table 2.

Variables in the Cox Model

Hazard Ratio for discontinuation related to inefficacy95% CI for HRMTX2.180.93, 5.13CCP3.711.74, 7.92CCP*MTX0.350.14, 0.91ETN*MTX0.610.36, 1.04Disease duration > 5 years0.610.41, 0.90Gender (male)0.620.36, 1.054+ DMARD trials1.651.02, 2.67Biologic-naive Global VAS/cm1.261.11, 1.42

Overall model p < .0005

RF with a univariate Cox significance of 0.172 was less closely associated with rate of withdrawal for inefficacy compared to anti-CCP positivity (p 0.005).

Conclusion:

There was no apparent benefit of MTX with anti-TNF with respect to initial DAS response, but MTX was associated with a reduction in withdrawals for inefficacy though only in CCP positive patients treated with ETN.

Disclosure of Interests:

None declared

AB0948 TIME TO CONSIDER HYPERMOBILITY AS A CAUSE OF SYMPTOMS IN PATIENTS PRESENTING TO EARLY ARTHRITIS CLINICS: A RETROSPECTIVE ANALYSIS OF 279 PATIENTS

Background:

Joint hypermobility is a common, although largely ignored physical sign. It is often asymptomatic but can be associated with significant musculoskeletal symptoms. Joint hypermobility may also be a feature of an underlying genetic disorder and patients may present with arthralgia, recurrent soft tissue injuries and intermittent joint swelling due to mechanical instability and poor proprioception. At University College London Hospital, we run a national service for the diagnosis and management of patients with hypermobility related disorders including hypermobility spectrum disorders, Ehlers-Danlos syndromes and Marfan syndrome. Over the years we observed that a significant number of our patients had been referred to the early arthritis clinics years prior to the recognition of their hypermobility. For example, one patient with a vascular type of Ehlers-Danlos syndrome EDS (confirmed COL3A mutation) presented to 3 different hospitals over a 5-year period, with possible inflammatory arthritis prior to the EDS diagnosis. Several studies have shown that a significant proportion of patients attending early arthritis clinics do not have inflammatory rheumatic diseases. In our experience, heritable disorders of connective tissue and hypermobility spectrum disorders are often overlooked and should be included in the differential diagnosis in patients seen in the early arthritis clinics.

Objectives:

We aimed to audit the outcome of patients who were seen in the early arthritis clinics focusing on those who were not found to have inflammatory rheumatic diseases and to explore if joint hypermobility was considered as a possible cause of patient’s symptoms.

Methods:

A retrospective analysis of medical records was conducted of patients attending the early arthritis clinics at University College London Hospital between May 2018 and December 2019.

Results:

279 patients (90 males, 189 females) were seen in the early arthritis clinics with a mean age of 48 (range 19-91). 131 patients (47%) did not have inflammatory rheumatic diseases. Sixty-three of these patients (48%) were not given any diagnosis and joint hypermobility was not assessed during the appointment. Eleven patients (8%) had features of hypermobility, 11 patients (8%) were diagnosed with fibromyalgia, 20 patients (15%) received a diagnosis of osteoarthritis, and 27 patients (21%) were given other diagnoses including tendonitis and soft tissue pathology.

Conclusion:

Almost 50 % of patients who were seen in the early arthritis clinics did not have inflammatory rheumatic diseases and 21 % of patients were discharged without a clear diagnosis. In these patients, hypermobility was not assessed and this is consistent with our observation. In our experience recognising joint hypermobility as a cause of arthralgia and intermittent joint swelling usually reassures patients and motivates them to follow appropriate treatment protocols including physiotherapy and occupational therapy thus allowing a more efficient utilization of early arthritis clinic resources towards those with true inflammatory rheumatic diseases. Going forward, we have planned to embed a cognisant attitude towards hypermobility within the relevant clinics to ensure that patients who do not have inflammatory arthritis are assessed for hypermobility and directed towards appropriate management.

References:

[1]Castori M, Hakim A. Contemporary approach to joint hypermobility & related disorders. Current Opinion in Pediatrics. 2017;29(6):640-649.

[2]Emma Connelly, Alan Hakim, Sally Davenportc & Jane Simmonds, A study exploring the prevalence of Joint Hypermobility Syndrome in patients attending a Musculoskeletal Triage Clinic. Physiotherapy Practice & Research 36 (2015) 43–53

[3]Feuchtenberger M, Nigg A, Kraus M, Schäfer A. Rate of Proven Rheumatic Diseases in a Large Collective of Referrals to an Outpatient Rheumatology Clinic under Routine Conditions. Clin Med Insights Arthritis Musculoskelet Disord. 2016; 9: 181–187.

Disclosure of Interests:

None declared

Evaluation of a Chemiluminescence Method for Measuring Alkaline Phosphatase Activity in WholeMilk of Multiple Species and Bovine Dairy Drinks: Interlaboratory Study

Alkaline phosphatase (ALP) is a ubiquitous enzyme in milk with timetemperature destruction similar to that of certain pathogens destroyed in pasteurization. Measurement of ALP to indicate proper pasteurization is a common practice. Recently the public health level for ALP was decreased to 350 mU/L, a level below the sensitivity of older colorimetric ALP methods. This study was conducted within the structure of the International Dairy Federation and the International Organization for Standardization to evaluate the reproducibility of the chemiluminescence method (Charm PasLite) for ALP at 50, 100, 350, and 500 mU/L in whole milk of multiple species to meet new regulations in the United States and proposed regulations in the European Union (EU). Fifteen laboratories from 8 countries evaluated bovine, goat, sheep, and buffalo milk, bovine skim milk, 20% fat cream, and 2% fat chocolate milk. At ALP levels of 350 and 500 mU/L, the average relative standard deviation for repeatability (RSDr) was 7.5%, and the average relative standard deviation of reproducibility was (RSDR) 15%. For ALP at 100 and 50 mU/L, the average RSDr values were 10.5 and 12.6%, respectively, and the average RSDR values were 18 and 25%, respectively. The limit of detection was 20 mU/L. Results are comparable to those obtained with other enzymatic photo-activated system methods such as the fluorometric method. Results indicate that the method is suitable for measuring ALP in the milk of multiple species and in dairy drinks at U.S. and proposed EU levels.

Human Disease/Clinical Medical Sciences in Dentistry: Current state and future directions of undergraduate teaching in the UK and Ireland

In March 2017, a group of teachers of human disease/clinical medical science (HD/CMSD) representing the majority of schools from around the UK and Republic of Ireland met to discuss the current state of teaching of human disease and also to discuss how the delivery of this theme might evolve to inform improved healthcare. This study outlines how the original teaching in medicine and surgery to dental undergraduate students has developed into the theme of HD/CMSD reflecting changing needs as well as guidance from the regulators, and how different dental schools have developed their approaches to reach their current state. Each school was also asked to share a strengths, weakness, opportunities and threats (SWOT) analysis of their programme and to outline how they thought their HD/CMSD programme may develop. The school representatives who coordinate the delivery and assessment of HD/CMSD in the undergraduate curriculum have extensive insight in this area and are well-placed to shape the HD/CMSD development for the future.

Oral health and dental morbidity in long-term allogeneic blood and marrow transplant survivors in Australia

BACKGROUND

Oral and dental disease is a major cause of long-term morbidity following allogeneic blood and marrow transplantation (Allo-BMT). This study aimed to describe the extent and range of oral and dental complications in BMT recipients and to identify gaps in service provision provided to this high-risk group.

METHODS

Participants were Allo-BMT recipients, aged >18 years, and received transplants between 2000 and 2012 in NSW. They completed seven surveys, the purpose-designed Sydney Post-BMT Study survey and six other validated instruments.

RESULTS

Of 441 respondents, many reported dry mouth (45.1%), dental caries (36.7%), mouth ulcers (35.3%), oral GVHD (35.1%), gingivitis (16.2%), tooth abscess (6.1%) and oral cancer (1.5%). Regular dental visits were reported by 66.2% of survivors. Middle-high income, older age and geographic location showed a positive association with regular dental visits. Of those who did not visit the dentist regularly, 37% stated they did not feel it necessary, 36% reported cost and 20% stated it was not advised by the treating team.

CONCLUSION

Despite oral complications commonly occurring after Allo-BMT, many survivors receive inadequate dental care. These results emphasize the need for improved oral health education, the importance of regular dental checks and improvement in the delivery of dental health services for BMT survivors.

Proceedings of the Thirteenth International Society of Sports Nutrition (ISSN) Conference and Expo

P1 Impact of antioxidant-enriched nutrient bar supplementation on the serum antioxidant markers and physical fitness components of track and field athletes

Lalitha Ramaswamy, Supriya Velraja

P2 The effects of phosphatidic acid supplementation on fitness levels in resistance trained women

Guillermo Escalante, Phil Harvey, Michelle Alencar, Bryan Haddock

P3 The effects of phosphatidic acid supplementation on cardiovascular risk factors in resistance trained men

Phil Harvey, Guillermo Escalante, Michelle Alencar, Bryan Haddock

P4 The efficacy of sodium bicarbonate supplementation on physical capacity and selected biochemical markers in elite wrestlers

Krzysztof Durkalec-Michalski, Jan Jeszka, Bogna Zawieja, Tomasz Podgórski

P5 Effects of different nutritional strategies in hydration and physical performance in healthy well-trained males

Ana Paula Trussardi Fayh, Alexandre Hideki Okano, Amanda Maria de Jesus Ferreira

P6 Reduction of plasma creatine concentrations as an indicator of improved bioavailability

Ralf Jäger, Martin Purpura, Roger C Harris

P7 Effect of three different breakfast meals on energy intake and nutritional status in college-age women

Molly M. Krause, Kiley A. Lavanger, Nina O. Allen, Allison E. Lieb, Katie A. Mullen, Joan M. Eckerson

P8 Accuracy of the ASA24® Dietary Recall system for assessing actual dietary intake in normal weight college-age women.

Kiley A. Lavanger, Molly M. Krause, Nina O. Allen, Allison E. Lieb, Katie A. Mullen, Joan M. Eckerson

P9 β-aminoisobutyric acid does not regulate exercise induced UCP-3 expression in skeletal muscle

Elisa Morales, Jeffrey Forsse, Thomas Andre, Sarah McKinley, Paul Hwang, Grant Tinsley, Mike Spillane, Peter Grandjean, Darryn Willoughby

P10 The ability of collegiate football athletes to adhere to sport-specific nutritional recommendations

A. Jagim, G. Wright, J. Kisiolek, M. Meinking, J. Ochsenwald, M. Andre, M.T. Jones, J. M. Oliver

P11 A single session of low-volume high intensity interval exercise improves appetite regulation in overweight men

Victor Araújo Ferreira, Daniel Costa de Souza, Victor Oliveira Albuquerque dos Santos, Rodrigo Alberto Vieira Browne, Eduardo Caldas Costa, Ana Paula Trussardi Fayh

P12 Acute effects of oral peppermint oil ingestion on exercise performance in moderately-active college students

Suresh T. Mathews, Haley D. Bishop, Clara R. Bowen, Yishan Liang, Emily A. West, Rebecca R. Rogers, Mallory R. Marshall, John K. Petrella

P13 Associations in body fat and liver triglyceride content with serum health markers in sedentary and exercised rats fed a ketogenic diet, Western diet or standard chow over a 6-week period

A. Maleah Holland, Wesley C. Kephart, Petey W. Mumford, C. Brooks Mobley, Ryan P. Lowery, Jacob M. Wilson, Michael D. Roberts

P14 Physiological changes following competition in male and female physique athletes: A pilot study

Eric T. Trexler, Katie R. Hirsch, Bill I. Campbell, Meredith G. Mock, Abbie E. Smith-Ryan

P15 Relationship between cognition and hydration status in college students at a large Southwestern university

Kate Zemek, Carol Johnston

P16 Whey protein-derived exosomes increase protein synthesis in C2C12 myotubes

C. Brooks Mobley, Petey W. Mumford, David D. Pascoe, Christopher M. Lockwood, Michael E. Miller, Michael D. Roberts

P17 The effect of three different energy drinks on 1.5-mile running performance, oxygen consumption, and perceived exertion

Gabriel J. Sanders, Willard Peveler, Brooke Warning, Corey A. Peacock

P18 The Ketogenic diet improves rotarod performance in young and older rats

Wesley C. Kephart, Petey W. Mumford, Ryan P. Lowery, Michael D. Roberts, Jacob M. Wilson

P19 Absorption of bonded arginine silicate compared to individual arginine and silicon components

David Sandler, Sara Perez Ojalvo, James Komorowski

P20 Effects of a high (2.4 g/kg) vs. low/moderate (1.2 g/kg) protein intake on body composition in aspiring female physique athletes engaging in an 8-week resistance training program

Bill I. Campbell, Danielle Aguilar, Andres Vargas, Laurin Conlin, Amey Sanders, Paola Fink-Irizarry, Layne Norton, Ross Perry, Ryley McCallum, Matthew R. Wynn, Jack Lenton

P21 Effects of a high (2.4 g/kg) vs. low/moderate (1.2 g/kg) protein intake on maximal strength in aspiring female physique athletes engaging in an 8-week resistance training program

Bill I. Campbell, Chris Gai, Seth Donelson, Shiva Best, Daniel Bove, Kaylee Couvillion, Jeff Dolan, Dante Xing, Kyshia Chernesky, Michael Pawela, Andres D. Toledo, Rachel Jimenez

P22 Monitoring of female collegiate athletes over a competitive season reveals changes in nutritional biomarkers

M. Rabideau, A. Walker, J. Pellegrino, M. Hofacker, B. McFadden, S. Conway, C. Ordway, D. Sanders, R. Monaco, M. S. Fragala, S. M. Arent

P23 Comparison of prediction equations to indirect calorimetry in men and women athletes

Jason D. Stone, Andreas Kreutzer, Jonathan M. Oliver, Jacob Kisiolek, Andrew R. Jagim

P24 Regional variations in sweat-based electrolyte loss and changes in plasma electrolyte content in Division I female athletes over the course of a competitive season

M. Hofacker, A. Walker, J. Pellegrino, M. Rabideau, B. McFadden, S. Conway, D. Sanders, C. Ordway, R. Monaco, M. S. Fragala, S. M. Arent

P25 In-season changes in plasma amino acid levels in Division I NCAA female athletes

Ozlem Tok, Joseph K. Pellegrino, Alan J. Walker, David J. Sanders, Bridget A. McFadden, Meaghan M. Rabideau, Sean P. Conway, Chris E. Ordway, Marissa Bello, Morgan L. Hofacker, Nick S. Mackowski, Anthony J. Poyssick, Eddie Capone, Robert M. Monaco, Maren S. Fragala, Shawn M. Arent

P26 Effects of a ketogenic diet with exercise on serum markers of bone metabolism, IGF-1 and femoral bone mass in rats

Petey W. Mumford, A. Maleah Holland, Wesley C. Kephart, Ryan P. Lowery, C. Brooks Mobley, Romil K. Patel, Annie Newton, Darren T. Beck, Michael D. Roberts, Jacob M. Wilson, Kaelin C. Young

P27 Casein supplementation in trained men and women: morning versus evening

Tobin Silver, Anya Ellerbroek, Richard Buehn, Leo Vargas, Armando Tamayo, Corey Peacock, Jose Antonio

P28 A high protein diet has no harmful effects: a one-year crossover study in resistance-trained males

Anya Ellerbroek, Tobin Silver, Richard Buehn, Leo Vargas, Armando Tamayo, Corey Peacock, Jose Antonio

P29 SUP (Stand-up Paddling) athletes: nutritional intake and body composition

Adam Pollock, Anya Ellerbroek, Tobin Silver, Corey Peacock, Jose Antonio

P30 The effects of 8 weeks of colostrum and bio-active peptide supplementation on body composition in recreational male weight lifters

A. Kreutzer, P. Zavala, S. Fleming, M. Jones, J. M. Oliver, A. Jagim

P31 Effects of a Popular Women’s Thermogenic Supplement During an Energy-Restricted High Protein Diet on Changes in Body Composition and Clinical Safety Markers

Cody T. Haun, Petey W. Mumford, Parker N. Hyde, Ciaran M. Fairman, Wesley C. Kephart, Darren T. Beck, Jordan R. Moon, Michael D. Roberts, Kristina L. Kendall, Kaelin C. Young

P32 Three days of caffeine consumption following caffeine withdrawal yields small strength increase in knee flexors

Geoffrey M Hudson, Tara Hannings, Kyle Sprow, Loretta DiPietro

P33 Comparison of cellular nitric oxide production from various sports nutrition ingredients

Doug Kalman, Sara Perez Ojalvo, James Komorowski

P34 The effects of 8 weeks of bio-active peptide supplementation on training adaptations in recreational male weight lifters

P. Zavala, S. Fleming, M. Jones, J. Oliver, A. Jagim

P35 Effects of MusclePharm Assault Black^TM on lower extremity spinal excitability and postactivation potentiation: A pilot study

Brian Wallace, Haley Bergstrom, Kelly Wallace

P36 Effects of four weeks of Ketogenic Diet alone and combined with High intensity Interval Training or Continuous-Moderate intensity on body composition, lipid profile and physical performance on healthy males

Matias Monsalves-Alvarez, Sebastian Oyharçabal, Victoria Espinoza

P37 Effect of branched-chain amino acid supplementation on creatine kinase, muscular performance, and perceived muscle soreness following acute eccentric exercise

Trisha A. VanDusseldorp, Kurt A. Escobar, Kelly E. Johnson, Nathan Cole, Terence Moriarty, Matthew Stratton, Marvin R. Endito, Christine M. Mermier, Chad M. Kerksick

P38 Effects of endurance training on markers of ribosome biogenesis in rodents fed a high fat diet

Matthew A. Romero, C. Brooks Mobley, Melissa Linden, Grace Margaret-Eleanor Meers, R. Scott Rector, Michael D. Roberts

P39 The effects of acute citrulline-malate on lower-body isokinetic performance in recreationally active individuals

Joshua L Gills, Hocheng Lu, Kimberly Parker, Chris Dobbins, Joshua N Guillory, Braden Romer, David Szymanski, Jordan Glenn

P40 The effect pre-ingested L-isoleucine and L-leucine on blood glucose responses and glycemic hormones in healthy inactive adults: Preliminary data.

Daniel E. Newmire, Eric Rivas, Sarah E. Deemer, Robert Wildman, Victor Ben-Ezra

P41 Does protein and source impact substrate oxidation and energy expenditure during and after moderate intensity treadmill exercise?

C Kerksick, B Gieske, R Stecker, C Smith, K Witherbee

P42 Effects of a pre-workout supplement on peak power and power maintenance during lower and upper body testing

Michael T. Lane, M. Travis Byrd, Zachary Bell, Emily Frith, Lauren M.C. Lane

P43 Effects of a pre-workout supplement on peak power production during lower and upper body testing in college-age females

Michael T. Lane, M. Travis Byrd, Zachary Bell, Emily Frith, Lauren M.C. Lane

P44 A comparison of whey versus casein protein supplementation on resting metabolic rate and body composition: a pilot study

Corey A. Peacock, Tobin A. Silver, Megan Colas, Mauricio Mena, Winter Rodriguez, Gabriel J. Sanders, Jose Antonio

P45 A novel mixed-tocotrienol intervention enhances recovery after eccentric exercise: preliminary findings

Andrea Vansickle, Brittany DiFiore, Stephanie Stepp, Grant Slack, Bridget Smith, Kayla Ruffner, Ronald Mendel, Lonnie Lowery

P46 The effects of post-exercise ingestion of a high molecular weight glucose on cycle performance in female cyclists

Katie R. Hirsch, Meredith G. Mock, Malia M.N. Blue, Eric T. Trexler, Erica J. Roelofs, Abbie E. Smith-Ryan

P47 Inclusive vs. exclusive dieting and the effects on body composition in resistance trained individuals

Laurin Conlin, Danielle Aguilar, Bill I. Campbell, Layne Norton, Katie Coles, Eric T. Trexler, Nic Martinez

P48 A whey protein hydrolysate may positively augment resting metabolism compared to intact whey protein

Jordan M. Joy, Roxanne M. Vogel, Thomas H. Hoover, K. Shane Broughton

P49 Seven days of high and low dose creatine nitrate supplementation I: hepatorenal, glucose and muscle enzyme function

R Dalton, R Sowinski, T Grubic, PB Collins, A Colletta, A Reyes, B Sanchez, M Kozehchain, YP Jung, C Rasmussen, P Murano, CP Earnest, M Greenwood, RB Kreider

P50 Seven days of high and low dose creatine nitrate supplementation II: performance

T Grubic, R Dalton, R Sowinski, PB Collins, A Colletta, A Reyes, B Sanchez, M Kozehchain, YP Jung, C Rasmussen, P Murano, CP Earnest, M Greenwood, RB Kreider

P51 Seven days of high and low dose creatine nitrate supplementation III: hemodynamics

R Sowinski, R Dalton, T Grubic, PB Collins, A Colletta, A Reyes, B Sanchez, M Kozehchain, YP Jung, C Rasmussen, P Murano, CP Earnest, M Greenwood, RB Kreider

P52 The efficacy of a β-hydroxy-β-methylbutyrate supplementation on physical capacity, body composition and biochemical markers in highly-trained combat sports athletes

Krzysztof Durkalec-Michalski, Jan Jeszka, Tomasz Podgórski

P53 Does protein and source impact substrate oxidation and energy expenditure during and after moderate intensity treadmill exercise?

C Kerksick, B Gieske, R Stecker, C Smith, K Witherbee

P54 Effects of 30 days of Cleanse™ supplementation on measure of body composition, waist circumference, and markers of gastrointestinal distress in females

Stacie Urbina, Emily Santos, Katelyn Villa, Alyssa Olivencia, Haley Bennett, Marissa Lara, Cliffa Foster, Colin Wilborn, Lem Taylor

P55 The effects of moderate- versus high-load training on body composition, muscle growth, and performance in college aged females

Jason M Cholewa, Amy Hewins, Samantha Gallo, Ashley Micensky, Christian De Angelis, Christopher Carney, Bill Campbell, Laurin Conlin, Layne Norton, Fabricio Rossi

P56 Effect of a multi-ingredient preworkout supplement on cognitive function and perceptions of readiness to perform

MS Koozehchian, PB Collins, R Sowinski, T Grubic, R Dalton, A O’Connor, SY Shin, Y Peter Jung, BK Sanchez, A Coletta, M Cho, A Reyes, C Rasmussen, CP Earnest, PS Murano, M Greenwood, RB Kreider

Evaluation of ATP bioluminescence swabbing as a monitoring and training tool for effective hospital cleaning

Effective cleaning in hospitals is an important aspect of infection control of pathogens such as methicillin resistant Staphylococcus aureus (MRSA). There is a need for simple, rapid methods of assessing cleanliness in order to effectively audit cleaning programmes and to educate staff. The aim of this study was to evaluate the use of adenosine triphosphate (ATP) bioluminescence swabs for assessing cleanliness in hospitals. Sites (n=108) in three hospital wards, including floors, patient equipment and clinical workstations were examined by visual assessment, microbiological swabbing and ATP bioluminescence swabbing. Overall, ATP swabbing detected a similar number of undesirably high results compared to microbiological swabbing, but visual assessment gave significantly fewer unsatisfactory results. Highest median contamination levels (both ATP and microbiological) were obtained from floor sites under patient beds, and the lowest levels from patient equipment. It was concluded that ATP bioluminescence swabbing, while not directly equivalent to microbiological swabbing, was a useful tool for monitoring cleanliness. In addition, because of its ability to produce on-the-spot results, it proved useful during education sessions with ward staff and cleaning staff, as a novel way of demonstrating the importance of cleaning.

General medicine and surgery for dental practitioners: part 3. Management of specific medical emergencies in dental practice

In this paper, the actions needed to manage specific medical emergencies are discussed. Each emergency requires a correct diagnosis to be made for effective and safe management. Contemporary management in dental practice avoids the intravenous route when drugs are required to treat the emergency.

Epigenetic Control of the Vasopressin Promoter Explains Physiological Ability to Regulate Vasopressin Transcription in Dehydration and Salt Loading States in the Rat

The synthesis of arginine vasopressin (AVP) in the supraoptic nucleus (SON) and paraventricular nucleus (PVN) of the hypothalamus is sensitive to increased plasma osmolality and a decreased blood volume, and thus is robustly increased by both dehydration (increased plasma osmolality and decreased blood volume) and salt loading (increased plasma osmolality). Both stimuli result in functional remodelling of the SON and PVN, a process referred to as functional-related plasticity. Such plastic changes in the brain have recently been associated with altered patterns of DNA methylation at CpG (cytosine-phosphate-guanine) residues, a process considered to be important for the regulation of gene transcription. In this regard, the proximal Avp promoter contains a number of CpG sites and is recognised as one of four CpG islands for the Avp gene, suggesting that methylation may be regulating Avp transcription. In the present study, we show that, in an immortalised hypothalamic cell line 4B, the proximal Avp promoter is highly methylated, and treatment of these cells with the DNA methyltransferase inhibitor 5-Aza-2'-deoxycytidine to demethylate DNA dramatically increases basal and stimulated Avp biosynthesis. We report no changes in the expression of DNA methyltransferases, Dnmt1 and Dnmt3a, whereas there is decreased expression of the demethylating enzyme ten-eleven-translocation 2, Tet2, in the SON by dehydration and salt loading. We found higher methylation of the SON Avp promoter in dehydrated but not salt-loaded rats. By analysis of individual CpG sites, we observed hypomethylation, hypermethylation and no change in methylation of specific CpGs in the SON Avp promoter of the dehydrated rat. Using reporter gene assays, we show that mutation of individual CpGs can result in altered Avp promoter activity. We propose that methylation of the SON Avp promoter is necessary to co-ordinate the duel inputs of increased plasma osmolality and decreased blood volume on Avp transcription in the chronically dehydrated rat.

Utility of ¹⁸fluoro-deoxyglucose positron emission tomography for prognosis and response assessments in a phase 2 study of romidepsin in patients with relapsed or refractory peripheral T-cell lymphoma

BACKGROUND

For patients with peripheral T-cell lymphoma (PTCL), the value of (18)fluoro-deoxyglucose positron emission tomography (FDG-PET) scans for assessing prognosis and response to treatment remains unclear. The utility of FDG-PET, in addition to conventional radiology, was examined as a planned exploratory end point in the pivotal phase 2 trial of romidepsin for the treatment of relapsed/refractory PTCL.

PATIENTS AND METHODS

Patients received romidepsin at a dose of 14 mg/m(2) on days 1, 8, and 15 of 28-day cycles. The primary end point was the rate of confirmed/unconfirmed complete response (CR/CRu) as assessed by International Workshop Criteria (IWC) using conventional radiology. For the exploratory PET end point, patients with at least baseline FDG-PET scans were assessed by IWC + PET criteria.

RESULTS

Of 130 patients, 110 had baseline FDG-PET scans, and 105 were PET positive at baseline. The use of IWC + PET criteria increased the objective response rate to 30% compared with 26% by conventional radiology. Durations of response were well differentiated by both conventional radiology response criteria [CR/CRu versus partial response (PR), P = 0.0001] and PET status (negative versus positive, P < 0.0001). Patients who achieved CR/CRu had prolonged progression-free survival (PFS, median 25.9 months) compared with other response groups (P = 0.0007). Patients who achieved PR or stable disease (SD) had similar PFS (median 7.2 and 6.3 months, respectively, P = 0.6427). When grouping PR and SD patients by PET status, patients with PET-negative versus PET-positive disease had a median PFS of 18.2 versus 7.1 months (P = 0.0923).

CONCLUSIONS

Routine use of FDG-PET does not obviate conventional staging, but may aid in determining prognosis and refine response assessments for patients with PTCL, particularly for those who do not achieve CR/CRu by conventional staging. The optimal way to incorporate FDG-PET scans for patients with PTCL remains to be determined.

TRIAL REGISTRATION

NCT00426764.

Overexpression of corticotropin releasing factor in the central nucleus of the amygdala advances puberty and disrupts reproductive cycles in female rats

Prolonged exposure to environmental stress activates the hypothalamic-pituitary-adrenal (HPA) axis and generally disrupts the hypothalamic-pituitary-gonadal axis. Because CRF expression in the central nucleus of the amygdala (CeA) is a key modulator in adaptation to chronic stress, and central administration of CRF inhibits the hypothalamic GnRH pulse generator, we tested the hypothesis that overexpression of CRF in the CeA of female rats alters anxiety behavior, dysregulates the HPA axis response to stress, changes pubertal timing, and disrupts reproduction. We used a lentiviral vector to increase CRF expression site specifically in the CeA of preweaning (postnatal day 12) female rats. Overexpression of CRF in the CeA increased anxiety-like behavior in peripubertal rats shown by a reduction in time spent in the open arms of the elevated plus maze and a decrease in social interaction. Paradoxically, puberty onset was advanced but followed by irregular estrous cyclicity and an absence of spontaneous preovulatory LH surges associated with proestrous vaginal cytology in rats overexpressing CRF. Despite the absence of change in basal corticosterone secretion or induced by stress (lipopolysaccharide or restraint), overexpression of CRF in the CeA significantly decreased lipopolysaccharide, but not restraint, stress-induced suppression of pulsatile LH secretion in postpubertal ovariectomized rats, indicating a differential stress responsivity of the GnRH pulse generator to immunological stress and a potential adaptation of the HPA axis to chronic activation of amygdaloid CRF. These data suggest that the expression profile of this key limbic brain CRF system might contribute to the complex neural mechanisms underlying the increasing incidence of early onset of puberty on the one hand and infertility on the other attributed to chronic stress in modern human society.

Invasive pneumococcal disease following adult allogeneic hematopoietic stem cell transplantation

BACKGROUND

Allogeneic hematopoietic stem cell transplantation (alloHSCT) recipients are at high risk of invasive pneumococcal disease (IPD). We investigated the incidence and risk factors of IPD in alloHSCT recipients from 4 regional transplant centers over an 11-year period. This study aimed to inform future improvements in post-transplant care.

METHODS

We conducted a retrospective nested 1:2 case-control study in patients aged ≥18 years who underwent alloHSCT between 2001 and 2011 in 4 major allogeneic transplant centers. Controls were matched with IPD cases on the basis of conditioning intensity and donor relationship (related or unrelated). Demographics and clinical characteristics of cases and controls were summarized. Univariate analysis of risk factors in matched case-control sets, and multivariate conditional logistic regression to control for confounding, were performed.

RESULTS

In 23 alloHSCT recipients, 26 IPD episodes were identified. The cumulative incidence over 11 years was 2.3% (95% confidence interval [CI] 1.45-3.15) and the incidence density 956 per 100,000 transplant years of follow-up (95% CI 580-1321). Multivariate risk factor analysis and backwards elimination showed a significant positive association between mycophenolate mofetil (MMF), hyposplenism/asplenia, and IPD, whereas trimethoprim-sulfamethoxazole (TMP/SMX) prophylaxis for Pneumocystis jirovecii pneumonia (PJP) was associated with lower odds of IPD cases. Of alloHSCT recipients with IPD, 38.5% required intensive care, and, of deaths documented in cases over the period of review, 30% were attributable to IPD. Serotypes causing IPD matched currently available vaccines in 15/22 (68.1%) episodes.

CONCLUSIONS

The incidence of IPD in alloHSCT recipients is an important cause of morbidity and mortality, with rates of disease being many fold higher than the general population. Patients with evidence of hyposplenism/asplenia define a high-risk group in the alloHSCT population for IPD, and the independent association with IPD and MMF in the adjusted model from this study requires further evaluation. The occurrence of post-transplant IPD may be reduced by measures such as vaccination with both 13-valent and 23-valent pneumococcal vaccines. TMP/SMX prophylaxis for the prevention of PJP may offer incidental protection against IPD in alloHSCT recipients.

Final-year dental students' opinions of their training in medical emergency management

The management of medical emergencies is clearly of vital importance in dental practice. The starting point of training in this area is the undergraduate dental degree programme. The aim of this study was to examine the opinions of final-year dental students at Newcastle School of Dental Sciences in relation to their undergraduate training in medical emergency management. Overall the responses were positive but the need for further practical training in the use of emergency drugs and equipment was highlighted.