The US national registry for childhood interstitial and diffuse lung disease: Report of study design and initial enrollment cohort

INTRODUCTION

Childhood interstitial and diffuse lung disease (chILD) encompasses a broad spectrum of rare disorders. The Children's Interstitial and Diffuse Lung Disease Research Network (chILDRN) established a prospective registry to advance knowledge regarding etiology, phenotype, natural history, and management of these disorders.

METHODS

This longitudinal, observational, multicenter registry utilizes single-IRB reliance agreements, with participation from 25 chILDRN centers across the U.S. Clinical data are collected and managed using the Research Electronic Data Capture (REDCap) electronic data platform.

RESULTS

We report the study design and selected elements of the initial Registry enrollment cohort, which includes 683 subjects with a broad range of chILD diagnoses. The most common diagnosis reported was neuroendocrine cell hyperplasia of infancy, with 155 (23%) subjects. Components of underlying disease biology were identified by enrolling sites, with cohorts of interstitial fibrosis, immune dysregulation, and airway disease being most commonly reported. Prominent morbidities affecting enrolled children included home supplemental oxygen use (63%) and failure to thrive (46%).

CONCLUSION

This Registry is the largest longitudinal chILD cohort in the United States to date, providing a powerful framework for collaborating centers committed to improving the understanding and treatment of these rare disorders.

AB1357 THE BEST CUT-OFF POINT FOR MEDIAN NERVE CROSS SECTIONAL AREA AT THE LEVEL OF PISIFORM BONE

Background

Carpal tunnel syndrome (CTS) is a focal neuropathy caused by compression of the median nerve (MN) at the wrist. Electromyography (EMG) is the gold standard for the diagnosis of CTS. Currently, the ultrasound (US) is frequently used as an initial screening exam by measuring the cross-sectional area (CSA) of the MN. The cut-off point of the CSA at the pisiform bone level to define CTS remains controversial with previous studies reporting values between 6.5mm2 and 15mm2 (1).

Objectives

The aim of this study is to determine the best cut-off point of the CSA for the diagnosis of CTS.

Methods

Cross-sectional study at a Tertiary Rheumatology Department including patients aged ≥ 18 years with symptoms compatible with CTS. Sociodemographic and clinical data, visual analogue scale for pain (VAS), Boston Questionnaire (BQ), and the results of EMG and US performed in each patient were collected. The EMG was performed according to the standardized protocol (sensory conduction velocity, sensory amplitude, distal sensory and motor latency), and the patients were categorized in 4 groups: normal, mild, moderate, and severe. A rheumatologist with expertise in imaging performed all the US evaluations by means of a 6–18-MHz (Siemens ACUSON S 2000) linear array transducer. The largest CSA of the MN was measured at the level of the pisiform bone. Receiver operating characteristic (ROC) curve was used to determine optimal cut-off values of the CSA taking the EMG result as the gold-standard. One-way ANOVA test was used to compare CSA between the 4 EMG groups.

Results

Fifty patients were included, 90% were female, mean age was 52.1 ± 10.8 years and median duration of symptoms was 28.0 (IQR 23.0-31.0) months. The mean VAS was 4.2 ± 2.9. In the BQ there was a mean symptom severity score of 2.4 ± 0.6 and a mean functional status score of 2.0 ± 0.9. One-way ANOVA showed that mean CSA values were significantly different in the 4 groups of patients. The Ryan-Einot-Gabriel-Welsch post hoc analysis showed that only the mean CSA of patients with severe STC is different from the remaining groups defined by EMG results. The best cut-off point for CSA at the pisiforme bone level for CTS diagnosis was 6.6 mm2 with a sensitivity and specificity of 92.9% and 75.0% (AUC=0.9, P<0.001). The positive and negative predictive values were 95.1% and 66.7%, respectively. For severe CTS diagnosis the best cut-off point for CSA was 12.3mm2 with a sensitivity of 82.4% and a specificity of 72.7% (AUC=0.8, P<0.001). The positive and negative predictive values were 60.9% and 88.9%, respectively.

Conclusion

In our study we found that the best cut-off point of the CSA was 6.6mm2 for distinguishing patients with/without CTS based on EMG alterations, with a high sensitivity and moderate specificity. This is a lower cut-off value than usually used in clinical practice and could be explained by small sample and the greater number of patients with mild and moderate STC on EMG.

References

[1]McDonagh C, Alexander M, Kane D. The role of ultrasound in the diagnosis and management of carpal tunnel syndrome: A new paradigm. Rheumatology (Oxford, England). 2014;54.

Disclosure of Interests

None declared

Clinical Characteristics and Management Strategies for Adult Obese Asthma Patients

The rates of asthma and obesity are increasing concurrently in the United States. Epidemiologic studies demonstrate that the incidence of asthma increases with obesity. Furthermore, obese individuals have asthma that is more severe, harder to control, and resistant to standard medications. In fact, specific asthma-obesity phenotypes have been identified. Various pathophysiologic mechanisms, including mechanical, inflammatory, metabolic and microbiome-associated, are at play in promulgating the obese-asthma phenotypes. While standard asthma medications, such as inhaled corticosteroids and biologics, are currently used to treat obese asthmatics, they may have limited effectiveness. Targeting the underlying aberrant processes, such as addressing steroid resistance, microbiome, metabolic and weight loss approaches, may be helpful.

An Analysis of Demographics and Inhaled Corticosteroid Use on COVID-19 Outcomes Among Hospitalized Adult Asthmatics: An Early Experience at a NY Hospital System

Purpose

It is unclear whether asthma is a risk factor for the development of COVID-19; however, severe asthma is a risk factor for morbidity and mortality. While systemic corticosteroids are beneficial during the inflammatory phase of COVID-19, the impact of inhaled corticosteroids (ICS) is unclear. We sought to characterize asthmatics admitted with COVID-19 early in the pandemic, determine if baseline factors are associated with more severe COVID-19 disease, and if the use of ICS may mitigate the severity of COVID-19.

Patients and Methods

A retrospective chart review of hospitalized asthma patients >18 years testing positive for SARS-CoV2 from March to June 2020 was performed. Baseline demographic and asthma variables were collected. COVID-19 outcomes and laboratory values were extracted and compared between sex, race, ethnicity, and ICS use.

Results

Of the 906 patient charts reviewed, 787 asthmatics were confirmed to be admitted for symptomatic COVID-19. Sex differences were found in hospitalization and intubation. Non-Hispanic patients had a significantly greater number of days on ventilator. Patients on ICS were 1.6 times more likely to be discharged on supplemental oxygen compared to patients not on ICS (p = 0.01).

Conclusion

While our findings confirm trends observed by others with respect to risk factors among asthmatics with COVID-19, differences based on sex, ethnicity and ICS use in asthmatics were observed. Our finding that ICS use was associated with discharge with oxygen is novel. Future research is needed to study the trajectory of asthmatics from diagnosis to outcomes.

Synthesis, RL and OSL characterization of thulium doped NaMgF3 neighborite

The aim of this work is to study the dosimetric properties of tissue-equivalent thulium doped NaMgF₃ neighborites and to determine their possible application as dosimeters in personal dosimetry. In this aspect, radioluminescence (RL) and optically stimulated luminescence (OSL) dosimetric properties of undoped and Tm³⁺ -doped NaMgF₃ have been investigated for the first time. Samples were synthesized by solid state reaction and by considering a stoichiometric mixture of pure NaF and MgF₂ reagents. Two emission peaks centered at 460 and 360 nm have been found in the RL emission spectrum of the doped samples, which can be ascribed to the ¹D₂ - ³F₄ and ¹D₂ - ³H₆ transitions of Tm³⁺ cations, respectively. Maximum OSL emission under blue light stimulation has been found for samples doped with 0.2 mol % of thulium. Furthermore, the OSL signal of this compound depends linearly on dose within the range 0.05-100 Gy. Besides, its OSL signal features satisfactory repeatability and a minimum detectable dose of 0.04 Gy. Finally, it has been found a low fading of the OSL signal of approximately 13% after the first 60 h, after which the OSL response remains constant. The obtained results suggest the feasibility of using this compound as an OSL detector in personal dosimetry.

OP0164 BLISS-LN: A RANDOMISED, DOUBLE-BLIND, PLACEBO-CONTROLLED PHASE 3 TRIAL OF INTRAVENOUS BELIMUMAB IN PATIENTS WITH ACTIVE LUPUS NEPHRITIS

Background:

Lupus nephritis (LN), a serious manifestation of systemic lupus erythematosus (SLE), affects nearly 70% of patients (pts) in high-risk groups. To preserve renal function, LN requires fast and effective treatment. Despite medical advances, progression rates at 15 years to end-stage renal disease (ESRD) remain >40% for pts with diffuse proliferative LN. Belimumab (BEL), approved in pts aged ≥5 years with active SLE, improved renal parameters in pts with baseline renal involvement in apost hocanalysis of Phase 3 trials data.

Objectives:

To assess efficacy and safety of intravenous (IV) BEL vs placebo (PBO), plus standard therapy (ST), in pts with active LN.

Methods:

BLISS-LN is a Phase 3, randomised, double-blind, PBO-controlled, 104-week study (GSK Study BEL114054,NCT01639339). Adults with SLE and biopsy-proven LN (class III, IV, and/or V) were randomised (1:1) to monthly BEL 10 mg/kg IV or PBO, plus ST. Primary endpoint: Primary Efficacy Renal Response (PERR); defined as urine protein creatinine ratio [uPCR] ≤0.7; estimated glomerular filtration rate [eGFR] within 20% of the pre-flare value or ≥60 ml/min/1.73m2; no rescue therapy) at Week (Wk) 104. Key secondary endpoints: Complete Renal Response (CRR; defined as uPCR <0.5; eGFR within 10% of the pre-flare value or ≥90 ml/min/1.73m2; no rescue therapy) at Wk 104; PERR at Wk 52; time to renal-related event (defined as ESRD/doubling of serum creatinine/renal worsening/renal disease-related treatment failure) or death. Other endpoints: time to PERR/CRR sustained through Wk 104; SLEDAI-S2K score <4 points at Wk 104; safety.

Results:

Overall, 448 pts were randomised (efficacy: 223/group; safety: 224/group). Significantly more BEL (43%) than PBO (32.3%) pts achieved PERR at Wk 104 (OR 1.55, 95% CI 1.04, 2.32; p=0.0311). More BEL than PBO pts achieved key secondary and other efficacy endpoints (Table).

Overall, 214 (95.5%) BEL and 211 (94.2%) PBO pts had ≥1 adverse event (AE); 58 (25.9%) BEL and 67 (29.9%) PBO pts had ≥1 serious AE; 29 (12.9%) pts in each group had ≥1 AE resulting in study treatment discontinuation; 4 (1.8%) BEL and 3 (1.3%) PBO pts developed on-treatment fatal AEs.

Conclusion:

In the largest LN study to date, data from BLISS-LN demonstrate that BEL plus ST significantly improves LN renal responses compared with ST alone with a favourable safety profile.

Study funding: GSK.

Table.Endpoint, n (%)PBO(n=223)BEL(n=223)OR/HR (95% CI) vs PBOp-valueCRR at Wk 104*44 (19.7)67 (30.0)OR 1.74(1.11, 2.74)0.0167PERR at Wk 52*79 (35.4)104 (46.6)OR 1.59(1.06, 2.38)0.0245Time to PERR throughWk 104†72 (32.3)96 (43.0)HR 1.46(1.07, 1.98)0.0157Time to CRR throughWk 104†44 (19.7)67 (30.0)HR 1.58(1.08, 2.31)0.0189Time to renal-related event or death†63 (28.3)35 (15.7)HR 0.51(0.34, 0.77)0.0014SLEDAI-S2K score <4 points at Wk 104*41 (18.4)62 (27.8)OR 1.76(1.11, 2.78)0.0164

*PBO and BEL columns represent the n (%) responders

†Data presented as n (cumulative incidence)

Disclosure of Interests:

Richard Furie Grant/research support from: GSK, Consultant of: GSK, Brad H Rovin Grant/research support from: GSK, Consultant of: GSK, Frederic Houssiau Grant/research support from: UCB, Consultant of: GSK, Zahir Amoura Grant/research support from: GSK, Roche, Consultant of: GSK, Astra Zeneca, Amgen, Mittermayer Santiago: None declared, Gabriel Contreras Grant/research support from: Genentech, Merck, Consultant of: Genentech, Merck, Ana Malvar Consultant of: GSK and Roche, chi chiu mok: None declared, Amit Saxena Consultant of: GSK, AZ, BMS, Xueqing Yu: None declared, Y.K. Onno Teng Grant/research support from: GSK, Consultant of: GSK, Aurinia Pharmaceuticals, Novartis, Carly Barnett Shareholder of: GSK, Employee of: GSK, Susan Burriss Shareholder of: GSK, Employee of: GSK, Yulia Green Shareholder of: GSK, Employee of: GSK, Beulah Ji Shareholder of: GSK, Employee of: GSK, Christi Kleoudis Shareholder of: GSK, Consultant of: GSK, Employee of: Parexel, David Roth Shareholder of: GSK, Employee of: GSK

Examining Students' Attitudes toward Academic Dishonesty in California Pharmacy Schools

Academic dishonesty is prevalent in the California pharmacy academic setting. Most student-respondents had heard about or witnessed their classmates cheating. This is highly concerning, as dishonest behavior may translate into the workplace once students graduate. Students, pharmacy school administrators and faculty should work together to discourage and prevent cheating.

How much of skin improvement over time in systemic sclerosis is due to normal ageing? A prospective study with shear-wave elastography

Background

Measurement of skin involvement is essential for the diagnosis and assessment of prognosis and disease progression in systemic sclerosis (SSc). The modified Rodnan skin score (mRSS) is the gold standard measure of skin thickness, but it has been criticised for the lack of objectivity, poor inter-observer reproducibility and lack of sensitivity to change. Recently, shear-wave elastography (SWE) emerged as a promising tool for the objective and quantitative assessment of the skin in SSc patients. However, no studies have evaluated its sensitivity to change over time.

Objective

To assess changes in skin stiffness in SSc patients using SWE during a 5-year follow-up.

Methods

Skin stiffness [i.e. shear-wave velocity values (SWV) in metres per second] was assessed by SWE ultrasound (using virtual touch image quantification) at the 17 sites of the mRSS, in each participant, at baseline and follow-up. mRSS was performed at both time points. Differences between groups were analysed using the related-samples Wilcoxon signed-rank test and the Mann–Whitney U test.

Results

We included 21 patients [85.7% females; mean age 56.3 (10.4) years at baseline, 57.1% with limited SSc] and 15 healthy controls [73.3% females; mean age 53.6 (14.1) years)]. The median follow-up was 4.9 (0.4) years.

Skin stiffness decreased significantly at all Rodnan sites (p ≤ 0.001) (except in the fingers), in SSc patients, over time. The same phenomenon occurred in controls, but to a lesser degree, in terms of percentage change.

The percentage reduction in skin stiffness varied in the different Rodnan sites and in different phases of the disease. In addition, SWV values also decreased significantly in 15/16 skin sites with local normal Rodnan at baseline, whereas local Rodnan skin score only changed significantly in the upper arm (p = 0.046) and forearm (p = 0.026).

Conclusion

This study provides first-time evidence suggesting that skin SWV values are more sensitive to change over time than mRSS and reduce significantly over time in SSc and normal controls.

Thermo- radio- and optically stimulated luminescence of Ce-doped KYF4 single crystals

The goals of this work are to determine the luminescence properties of KYF₄ single crystals doped with different concentrations of Ce³⁺ ions and to evaluate their possible application as a detector of beta radiation. In particular, thermoluminiscence, radioluminiscence and optically stimulated luminescence properties of KYF₄: Ce³⁺ exposed to beta radiation have been studied and very good dosimetric properties have been obtained within the dose range 0.02-20 Gy.

Abstract WP542: Basilar Artery Curvature is Associated With Migraine With Aura in the Northern Manhattan Study

Introduction: Genetic and imaging studies demonstrate a link between vascular morphology and migraine with aura (MA). As aura typically originates from the occipital cortex, the vertebrobasilar system that supplies this area is of particular interest. We examined the relationship between basilar artery (BA) curvature and MA in a large, population-based cohort of stroke-free participants.

Methods: We analyzed Northern Manhattan Study participants who had undergone time of flight MRA at 1.5 Tesla. Migraine, with or without aura, was ascertained through structured interviews. BA curvature was defined as the sum of the total horizontal deviation of the BA at the distal tip, mid-pons, and vertebrobasilar junction, and was used as the primary independent variable in unadjusted and adjusted logistic regression analyses. BA measurements were obtained blinded to migraine status.

Results: Of 805 participants (mean age 70±9.3 years, 55% women, 66% Hispanic), migraine without aura was present in 13% (N=105) and MA in 3% (N=24). MA was more common among women (P=0.03) and Hispanics (P=0.001). Mean BA curvature was 16 ± 10 mm. In unadjusted analysis, BA curvature was greater in participants with MA than those without MA (19 vs 15 mm, P=0.02). In a model adjusted for demographics, vascular risk factors, head size and height, greater BA curvature was associated with MA (OR 1.06 per mm, 95% CI 1.01-1.11) compared to participants with no migraine. The association between BA curvature and migraine without aura did not reach significance (OR 1.01, 95% CI 0.99-1.04).

Conclusions: Greater BA curvature was associated with migraine with aura but not migraine without aura. Understanding the physiopathology of this association may provide clues to the underlying mechanisms of migraine and the relationship between migraine and stroke.

Portuguese recommendations for the prevention, diagnosis and management of primary osteoporosis - 2018 update

BACKGROUND

Advances in osteoporosis (OP)case definition, treatment options, optimal therapy duration and pharmacoeconomic evidence in the national context motivated the Portuguese Society of Rheumatology (SPR) to update the Portuguese recommendations for the diagnosis and management of osteoporosis published in 2007.

METHODS

SPR bone diseases' working group organized meetings involving 55 participants (rheumatologists, rheumatology fellows and one OP specialist nurse) to debate and develop the document. First, the working group selected 11 pertinent clinical questions for the diagnosis and management of osteoporosis in standard clinical practice. Then, each question was investigated through literature review and draft recommendations were built through consensus. When insufficient evidence was available, recommendations were based on experts' opinion and on good clinical practice. At two national meetings, the recommendations were discussed and updated. A draft of the recommendations full text was submitted to critical review among the working group and suggestions were incorporated. A final version was circulated among all Portuguese rheumatologists before publication and the level of agreement was anonymously assessed using an online survey.

RESULTS

The 2018 SPR recommendations provide comprehensive guidance on osteoporosis prevention, diagnosis, fracture risk assessment, pharmacological treatment initiation, therapy options and duration of treatment, based on the best available evidence. They attained desirable agreement among Portuguese rheumatologists. As more evidence becomes available, periodic revisions will be performed. Target audience and patient population: The target audience for these guidelines includes all clinicians. The target patient population includes adult Portuguese people. Intended use: These recommendations provide general guidance for typical cases. They may not be appropriate in all situations - clinicians are encouraged to consider this information together with updated evidence and their best clinical judgment in individual cases.

Central nervous system vasculitis in systemic lupus erythematosus: a case series report in a tertiary referral centre

Central nervous system (CNS) vasculitis (CNS) in systemic erythematosus lupus (SLE) is a rare and challenging diagnosis. We report four cases of CNS vasculitis that occurred 5 to 16 years after the diagnosis of SLE. Magnetic resonance imaging (MRI) detected different features suggestive of CNS vasculitis: enhancement and thickening of the vascular wall, vascular stenosis, ischemic brain lesions and intracerebral haemorrhage unlikely to correspond to other mimic aetiologies. Three patients received combination therapy with glucocorticoids (GC) and cyclophosphamide (CYC). Intravenous human immunoglobulin (IVIG) was administered when the patient had a past history of serious adverse event to CYC or high infectious risk. All patients showed imagiological improvement, at least partially, 5 to 23 days after starting treatment. We discuss the management of CNS in SLE including the role of magnetic resonance imaging (MRI).

Abstract WP184: Differential Risk of Embolic Stroke Among Stroke Free Community Dwellers With Distinct Categories of Subcortical Infarct

Introduction: Cortically-based subclinical infarcts are considered risks for embolic stroke, but few studies have stratified subcortical SBI by penetrating versus medullary artery location. We hypothesized that subclinical medullary infarcts are due to small emboli and are predictors of embolic stroke.

Methods: Stroke-free participants in the Northern Manhattan Study underwent a brain MRI to assess for subclinical biomarkers of vascular disease. Subcortical brain infarcts were defined voids >3mm on axial T1 and FLAIR images, with perilesional FLAIR hyperintensities referred to as pathology-informed subclinical brain infarcts (PI-SBI). Each subcortical PI-SBI was rated as penetrating or medullary by two vascular neurologists blinded to stroke subtypes. Participants were followed prospectively for incident stroke. Two vascular neurologists ascertained ischemic stroke subtypes independent of brain MRI imaging at baseline. Embolic stroke required a cardiac source or based on a superficial location. Cox proportional risk models generated hazard ratios and 95% confidence intervals (HR, 95% CI) adjusting for age, sex, ethnicity and traditional vascular risk.

Results: The sample included 1290 NOMAS participants (mean age 71±9 years, 60% women, 66% Hispanic, 75% with hypertension) who were followed on average 9±3 years. At baseline, 19% of participants had PI-SBI (11% medullary artery, 7% penetrating artery and 3% cortical). During follow up, 80 participants (6.2%) had stroke (3.6% embolic, 2.4% due to intracranial artery disease (i.e. small and large), and 0.2% other subtypes). In a fully adjusted model, medullary artery (2.04, 1.00-4.14) and not penetrating artery PI-SBI (1.64, 0.99-2.70) predicted risk of embolic stroke. Distal field PI-SBI (i.e. cortical + medullary artery) were even more robust predictors of embolic stroke (2.17, 1.11-4.25). Penetrating artery (1.98, 1.09-3.61) and not medullary artery PI-SBI (HR 1.03, 0.34-3.06) predicted risk of intracranial artery stroke.

Conclusions: Subtyping PI-SBI by location and plausible mechanisms may help with risk stratification for clinical trials testing stroke prevention strategies. Our data suggest not all subcortical infarcts are due to small vessel disease.

Performance of ZnSe(Te) as fiberoptic dosimetry detector

Fiberoptic dosimetry (FOD) is an experimental technique suitable for in-vivo, real time dosimetry in radiotherapy treatments. FOD relies on using a small scintillator coupled to one end of a long optical fiber. The scintillator is placed at the point where the dose rate is to be determined whereas a light detector at the other end of the fiber measures the intensity of the radioluminescence emitted by the scintillator. One of the problems hampering the straightforward application of this technique in clinics is the presence of Cherenkov radiation generated in the fiber by the ionizing radiation, which adds to the scintillating light and introduces a bias in the dose measurement. Since Cherenkov radiation is more important in short wavelength range of the visible spectrum, using red-emitting scintillators as FOD detectors permits to reduce the Cherenkov contribution by using optical filters. In this work, the performance of red-emitting tellurium-doped zinc selenide crystal as FOD detector is evaluated and compared to the response of an ion-chamber.

Chronic myelomonocytic leukemia mimicking hematologic systemic lupus erythematosus

The relationship between primary hematologic disease and rheumatologic manifestations is well known, especially acute lymphocytic leukemia, lymphomas, plasma cell dyscrasias and myelodysplastic syndrome (MDS). Currently, more has been described about autoimmune manifestations in chronic myelomonocytic leukemia (CMML). Many different clinical scenarios may lead a patient with MDS/CMML initially to seek a rheumatological unit. Autoimmune features such as polymyalgia rheumatic symptoms, myositis, neutrophilic dermatosis, cutaneous vasculitis and positive antinuclear antibodies (ANA) are some examples of clinical presentation of MDS/CMML. Moreover, peripheral cytopenias are a common initial presentation both for systemic lupus erythematous (SLE) and MDS/CMML. The aim of this study was to describe a case of an elderly woman with thrombocytopenia and positivity of antibodies to anti-extractable nuclear antigens (anti-ENA) as initial manifestation of CMML mimicking SLE, and to present some clues that encourage the clinician to perform a bone marrow study in such a clinical scenario.

Septic arthritis caused by Peptostreptococcus asaccharolyticus

Peptostreptococcus spp are commensal organisms, usually involved in periodontal disease. Peptostreptococcus asaccharolyticus is an anaerobic gram-negative cocci, difficult to isolate due to its slow growth. Septic arthritis by this microorganism is a rare entity, but it can occur by hematogenous dissemination from a distant focus. Colonization and growth are more likely to occur in an already damaged articulation. We report the case of a 57 year-old woman with peripheral spondyloarthritis who developed knee septic arthritis by Peptostreptococcus asaccharolyticus.

Detection of circulating melanoma cells in choroidal melanocytic lesions

PURPOSE

To detect and quantify circulating tumour cells (CTCs) in peripheral blood of patients with uveal melanoma primary non-metastatic tumours, and to analyze the possible relationship between CTCs and clinical risk factors.

METHODS

Prospective study with two clinical groups: 4 patients diagnosed with choroidal nevus and 8 patients with choroidal melanoma prior to treatment. A single sample of 7.5 mL of peripheral blood was taken and the CTCs were isolated using a CellSearch system that captures positive cells for the CD146 antigen (MUC18).

RESULTS

None of the patients with choroidal nevus showed CTCs in peripheral blood. More than one CTC/7.5 mL was detected in 50 % of patients with choroidal melanoma prior to treatment. The higher level of CTC cells in peripheral blood (3/7.5 mL) was detected in the patient with the larger choroidal melanoma which also presented extrascleral extension and epithelioid pathology.

CONCLUSION

Performing an analysis with the CellSearch system allows to quantify the choroidal melanoma CTCs in peripheral blood. This finding highlights the potential usefulness of this technique to achieve the correct stratification and monitoring of the treatment.

Effects of early or late-evening fatiguing physical activity on sleep quality in non-professional sportsmen

AIMS

This study aims to understand whether night sleep--quality is distorted by fatiguing physical activity (PA) when conducted early or late in the evening.

METHODS

Participants and Intervention: 9 males (18--38yrs) performed sessions of fatiguing--PA over 3 consecutive days (Mon--Wed), for 2 weeks. One week the PA was performed at 17h, and in the other week at 21h. A Control--week included no PA (PA ABSENT ). The fatiguing--PA sessions comprised several sets of the 20m Shuttle--Run--Test (20mSRT). Sleep was assessed by actigraphic recordings acquired over 3 nights each week. It included the nights following the PA--sessions and the same days in the week of PA ABSENT . Sleep--quality perception was evaluated by mean of the National Sleep Foundation--Sleep Diary. The heart--rate (HR) and body--temperature (BT) at bed--time and waking--up were also registered.

RESULTS

Neither the 20mSTR--estimated VO 2max nor the number of maximal 20mSRT sets were different in the PA 17h and PA 21h sessions. Compared to the PA ABSENT , the PA 17h and PA 21h sessions increased the HR at bedtime, which recovered to baseline level after the night of sleep. BT was also reduced when waking--up compared to bed--time, but this was also observed in PA ABSENT . Sleep parameters measured by means of actigraphy were not modified by fatiguing activity when compared to PA ABSENT. Nevertheless, the subjective perception of sleep--quality was negatively altered by fatiguing PA.

CONCLUSIONS

Fatiguing PA performed early or late at the evening has no impact on objective sleep--quality but, subjectively, a deterioration of sleep--quality is perceived by the subjects.

Abstract W P148: Elevated Fibroblast Growth Factor 23 Associates with Greater White Matter Lesion Load and MRI-Defined Infarction: The Northern Manhattan Study (NOMAS)

INTRODUCTION: Elevated fibroblast growth factor 23 (FGF23) regulates phosphate homeostasis and has been linked with mortality, cardiovascular events, and stroke. However, the role of FGF23 as a risk factor for subclinical cerebrovascular damage (SCVD) is not known.

METHODS: We used multivariable linear and logistic regression to evaluate associations between FGF23, continuously and by quartiles, with white matter hyperintensity volume (WMHV), expressed as percent intracranial volume (%ICV), and subclinical brain infarction (SBI) in a race/ethnically diverse communitybased sample.

RESULTS: There were 1,170 strokefree NOMAS participants with FGF23 levels and quantitative MRI data on WMHV and SBI. Participants with FGF23 levels in the top quartile (range=84.98 to1424.59 RU/mL) had greater WMHV (β=0.19 %ICV, 95% CI=0.04 to 0.33 %ICV, p=0.01) compared to those in the lowest quartile (range=15.41 to 48.96 RU/mL), adjusted for demographics, vascularrisk factors, and estimated glomerular filtration rate (eGFR). These findings remained significant in those without evidence of chronic kidney disease (CKD). The highest quartile of FGF23 also associated with greater odds of SBI, but this effect was not significant after adjusting for demographic factors and eGFR. However, sex was an effect modifier ofFGF23 in relation to odds of SBI (p for interaction=0.03). Stratified by sex, FGF23 was associated with greater odds of SBI in men (OR=1.7, 95% CI=1.0 to 2.6, p=0.03) after adjusting for demographics, vascular risk factors, and eGFR, but not among women.

CONCLUSIONS: These crosssectional communitybased data from a diverse urban sample suggest elevated FGF23 may be a risk factor for small vessel disease, as well as MRIdefined brain infarction in men, independent of CKD. Prospective data on elevated FGF23 and SCVD are needed.

Abstract T MP47: Ideal Cardiovascular Health Predicts Functional Status: The Northern Manhattan Study

Background: The American Heart Association’s metric of ideal cardiovascular health (CVH) has been previously associated with vascular events, mortality, and subclinical atherosclerotic disease, but its association with functional impairment independent of cardiovascular disease and stroke has not been explored. We hypothesized that ideal CVH predicts improved long-term functional status after adjusting for incident stroke and myocardial infarction.

Methods: In the prospective, multiethnic Northern Manhattan Study, stroke-free individuals in northern Manhattan aged >=40 years had annual assessments of disability with the Barthel index (BI), for a median of 13 years. Baseline demographics, medical risk factors, and laboratory studies were collected. Ideal CVH was calculated as a composite of 7 measures, each scored on a scale of 0-2: smoking, body mass index, physical activity, diet, total cholesterol, blood pressure, and fasting plasma glucose. This analysis was based on: 1) number of ideal CVH metrics, and 2) total score of all CVH metrics.

Results: Of 3219 participants, mean age was 69 years (SD 10), 63% were female, 21% non-Hispanic White, 25% non-Hispanic black, and 54% Hispanic. Twenty percent had 0-1 ideal CVH metrics, 32% had 2, 30% had 3, 14% had 4, and 4% had 5-7. Both the number of ideal CVH categories and higher total CVH metric scores were associated with higher mean BI scores at 5 and 10 years. These gradients persisted when results were adjusted for incident stroke and MI, when mobility and non-mobility domains of the BI were analyzed separately, and when the BI was analyzed dichotomously. At 10 years, in a fully adjusted model, differences in mean BI score were lower for poor versus ideal physical activity (3.48 points, p<0.0001) and fasting glucose (4.58 points, p<0.0001).

Conclusions: Ideal CVH predicts functional impairment, even after accounting for incident vascular events. Vascular functional impairment is an important outcome, and further research is needed to determine whether it may be improved by optimizing vascular health. Achieving the AHA 2020 goal will not only have favorable effects on stroke and MI, but also likely reduce functional impairment.

Right ventricular myocardial responses to progressive exercise in young adult males

Recent attention has been focused on possible unique features of the right ventricular response to exercise. This study investigated a) the responses of right ventricular cardiac dynamics and myocardial function to a standard bout of progressive cycle exercise in healthy young males, and b) the effect of level of aerobic fitness on these responses. 14 athletically-trained males (20.4±1.5 years) and 11 normally-active males (21.1±1.3 years) underwent a progressive upright cycle test to exhaustion with measurement of gas exchange variables and assessment of right ventricular stroke volume, systolic and diastolic myocardial velocities, and tricuspid inflow velocities by standard Doppler echocardiographic techniques at rest, submaximal and peak exercise. Stroke volume rose initially by approximately 27% in each group, followed by stable values to exhaustion. Values of maximal stroke index and maximal oxygen uptake were significantly greater in the trained group than the normally-active males (62±10 ml m(-2), 54.3±4.0 ml kg(-1) min(-1); 49±7 ml m(-2), 40.3±5.6 ml kg(-1) min(-1), respectively). No significant differences were observed in increases in systolic or diastolic myocardial velocities, peak pulmonary outflow velocity, systolic ejection rate, or tricuspid inflow velocity between the 2 groups. The magnitude of change of these variables was similar to those previously described for left ventricular responses to similar exercise. This study revealed no unique features of right ventricular functional responses to an acute exercise challenge in young males.

Analysis of the main dosimetric peak of Al2O3:C compounds with a model of interacting traps

The glow curve of Al2O3:C compounds has been analyzed by employing a model consisting of two active traps, thermally disconnected traps and one recombination centre. The analysis takes into account interaction among traps and the thermal quenching of the thermoluminescent emission.

Radioluminescence of rare-earth doped aluminum oxide

Al(2)O(3):C is one of the most used radioluminescence materials for fiberoptic dosimetry due mainly to its high efficiency. However, this compound presents the drawback of emitting in the spectral region, where the spurious radioluminescence of fibers is also important. In this work, sintered samples of Al(2)O(3):C doped with Tb, Sm, Ce and Tm have been prepared by combustion synthesis and their radioluminescence responses have been evaluated. The influence of the different activators on the radioluminescence spectra has been investigated.

Abstract 79: A Population-based Study Of Arterial Diameters In Dolichoectasia: The Northern Manhattan Study

Background: Dolichoectasia (DE) of cerebral vessels has been associated with adverse neurological outcomes, including stroke. The subjectivity of the DE diagnosis is a limiting factor in the study of this condition. We examined arterial diameters of intracranial vessels in relation to a diagnosis of DE using standard criteria.

Methods: The Northern Manhattan Study (NOMAS) is a multiethnic, community-based cohort of stroke-free participants. Participants who underwent head MRA were rated for the presence or absence of DE based on symmetry, parenchymal impingement, and Smoker criteria (posterior circulation). We used a semi-automated 3D tool to measure vessel lumen cross-sectional areas, and estimated artery diameters.

Results: There were 718 NOMAS participants with MRA data available (mean age 72±8 years, 62% women, 56% Hispanic, 23% black, 18% white). Dolichoectasia was more frequent in the posterior circulation (25%), followed by the anterior circulation and both territories (12% for each). Diameters were obtained from 7,207 arteries. All dolichoectatic vessels had greater diameters compared to non-dolichoectatic vessels. Subjects with basilar artery DE had larger non-DE internal carotid artery diameters (at least 0.2 mm larger, P=0.003) but controlling for total cranial volume made this difference non-significant. The intra-rater reliability for visual DE ratings was poor to good (kappa=0.34-0.68) but reliability of vessel diameter measurements was excellent (intraclass correlations >0.85).

Conclusions: The subjective attribution of DE corresponds with larger arterial diameters. Having DE in one artery seems to be associated with larger non-DE arteries. This is suggestive of a dilatatory propensity in patients with DE. Using arterial diameters appears to be reliable method to study this dilatatory arteriopathy.

Abstract 2346: Traditional Cardiovascular Risk Factors Explain Only Small Proportion of the Variation in Carotid Plaque

Background and Objectives: Subclinical atherosclerotic plaque is an important marker of increased vascular risk. Traditional risk factors explain less than 50% of the variance in atherosclerotic carotid plaque (ACP). Identifying factors underlying unexplained ACP, either deleterious or protective, may help targeting preventive strategies with significant scientific impact and health relevance. We aimed to identify individuals with unexplained subclinical ACP or unexplained protection against ACP using 2-D high-resolution B-mode carotid ultrasound.

Methods: As a part of the NINDS carotid imaging project of the Northern Manhattan Study, 1,790 stroke-free individuals (mean age 69±9; 60% women; 61% Hispanic, 19% black, 18% white) were assessed for total ACP burden (TACP), the sum of plaque areas in all carotid arteries (mm 2 ) within an individual and transformed using a cube root function (x 1/3 ) for normality. Multiple linear regression models were conducted: (1) including pre-specified traditional risk factors (age, sex, LDL-cholesterol, diabetes, pack-years of smoking, blood pressure (BP), and treatment for BP); and (2) the best-fit model with addition of socioeconomic and less traditional factors including inflammation biomarkers and homocysteine. The standardized TACP residual scores were constructed from the best-fit regression model to select individuals with unexplained TACP.

Results: Prevalence of carotid plaque was 58%. Mean TACP was 12.1±mm 2 before the x 1/3 transformation. Traditional model (model 1) explained 21% of the variance in TACP ( R 2 = 0.21). Age (15%), smoking (3%), systolic BP (1.2%), and diabetes (1%) were most contributing factors. The best-fit model (model 2) explained 23% of TACP, with most contribution by age (14%), smoking (3%), systolic BP (1%), fasting glucose (1%), LDL:HDL ratio (1%), diastolic BP (1%), homocysteine (1%) and white blood cell count (1%).

Conclusion: Variation in subclinical carotid plaque is largely unexplained by traditional and novel risk cardiovascular risk factors. Identification of genetic and environmental factors underlying unexplained subclinical atherosclerosis is of utmost importance for successful prevention of cardiovascular disease and stroke.

Serum DJ-1/PARK 7 is a potential biomarker of choroidal nevi transformation

PURPOSE

There is substantial evidence that intraocular melanomas arise from benign nevi in the uveal tract. Previous studies performed by the authors revealed that uveal melanoma cells secrete the oncoprotein DJ-1/PARK7 into the extracellular environment and circulation. The aim of this study was to determine whether circulating DJ-1 serum levels correlate with known clinical risk factors of nevi growth.

METHODS

Standardized ultrasonography, optical coherence tomography, and eye fundus examinations were used to evaluate the clinical risk factors of nevi growth. These clinical risk factors (including nevi size, distance of margins to the optic disc, detection of acoustic hollowness, presence of ocular symptoms, orange pigment, subretinal fluid, and absence of drusen) were examined in 53 consecutive patients from January 2009 to February 2011. Serum levels of DJ-1/PARK7 in these patients and in healthy age- and sex-matched controls (n = 32) were analyzed using ELISA.

RESULTS

Within the choroidal nevi group, DJ-1 serum levels were higher in those with symptoms (P < 0.033), with a nevus thickness greater than 1.5 mm (P < 0.001), a large basal diameter greater than 8 mm (P < 0.001), and the presence of acoustic hollowness (P < 0.001), compared to those patients without these risk factors. Similar significant differences were found when these at risk nevi subgroups were compared to healthy persons.

CONCLUSIONS

Elevated serum levels of DJ-1 are associated with choroidal nevi transformation risk factors. Therefore, DJ-1 appears to be a promising factor for predicting the growth of choroidal nevi and may be a potential biomarker of malignancy.

Inflammatory Animal Model for Parkinson's Disease: The Intranigral Injection of LPS Induced the Inflammatory Process along with the Selective Degeneration of Nigrostriatal Dopaminergic Neurons

We have developed an animal model of degeneration of the nigrostriatal dopaminergic neurons, the neuronal system involved in Parkinson's disease (PD). The implication of neuroinflammation on this disease was originally established in 1988, when the presence of activated microglia in the substantia nigra (SN) of parkinsonians was reported by McGeer et al. Neuroinflammation could be involved in the progression of the disease or even has more direct implications. We injected 2 μg of the potent proinflammatory compound lipopolysaccharide (LPS) in different areas of the CNS, finding that SN displayed the highest inflammatory response and that dopaminergic (body) neurons showed a special and specific sensitivity to this process with the induction of selective dopaminergic degeneration. Neurodegeneration is induced by inflammation since it is prevented by anti-inflammatory compounds. The special sensitivity of dopaminergic neurons seems to be related to the endogenous dopaminergic content, since it is overcome by dopamine depletion. Compounds that activate microglia or induce inflammation have similar effects to LPS. This model suggest that inflammation is an important component of the degeneration of the nigrostriatal dopaminergic system, probably also in PD. Anti-inflammatory treatments could be useful to prevent or slow down the rate of dopaminergic degeneration in this disease.

Peripheral inflammation increases the damage in animal models of nigrostriatal dopaminergic neurodegeneration: possible implication in Parkinson's disease incidence

Inflammatory processes described in Parkinson's disease (PD) and its animal models appear to be important in the progression of the pathogenesis, or even a triggering factor. Here we review that peripheral inflammation enhances the degeneration of the nigrostriatal dopaminergic system induced by different insults; different peripheral inflammations have been used, such as IL-1β and the ulcerative colitis model, as well as insults to the dopaminergic system such as 6-hydroxydopamine or lipopolysaccharide. In all cases, an increased loss of dopaminergic neurons was described; inflammation in the substantia nigra increased, displaying a great activation of microglia along with an increase in the production of cytokines such as IL-1β and TNF-α. Increased permeability or disruption of the BBB, with overexpression of the ICAM-1 adhesion molecule and infiltration of circulating monocytes into the substantia nigra, is also involved, since the depletion of circulating monocytes prevents the effects of peripheral inflammation. Data are reviewed in relation to epidemiological studies of PD.