Potential cellular targets of platinum in the freshwater microalgae Chlamydomonas reinhardtii and Nitzschia palea revealed by transcriptomics

Platinum group element levels have increased in natural aquatic environments in the last few decades, in particular as a consequence of the use of automobile catalytic converters on a global scale. Concentrations of Pt over tens of μg L-1 have been observed in rivers and effluents. This raises questions regarding its possible impacts on aquatic ecosystems, as Pt natural background concentrations are extremely low to undetectable. Primary producers, such as microalgae, are of great ecological importance, as they are at the base of the food web. The purpose of this work was to better understand the impact of Pt on a cellular level for freshwater unicellular algae. Two species with different characteristics, a green alga C. reinhardtii and a diatom N. palea, were studied. The bioaccumulation of Pt as well as its effect on growth were quantified. Moreover, the induction or repression factors of 16 specific genes were determined and allowed for the determination of possible intracellular effects and pathways of Pt. Both species seemed to be experiencing copper deficiency as suggested by inductions of genes linked to copper transporters. This is an indication that Pt might be internalized through the Cu(I) metabolic pathway. Moreover, Pt could possibly be excreted using an efflux pump. Other highlights include a concentration-dependent negative impact of Pt on mitochondrial metabolism for C. reinhardtii which is not observed for N. palea. These findings allowed for a better understanding of some of the possible impacts of Pt on freshwater primary producers, and also lay the foundations for the investigation of pathways for Pt entry at the base of the aquatic food web.

Drug Permeability - Best Practices for Biopharmaceutics Classification System (BCS)-Based Biowaivers: A workshop Summary Report

The workshop "Drug Permeability - Best Practices for Biopharmaceutics Classification System (BCS) Based Biowaivers" was held virtually on December 6, 2021, organized by the University of Maryland Center of Excellence in Regulatory Science and Innovation (M-CERSI), and the Food and Drug Administration (FDA). The workshop focused on the industrial, academic, and regulatory experiences in generating and evaluating permeability data, with the aim to further facilitate implementation of the BCS and efficient development of high-quality drug products globally. As the first international permeability workshop since the BCS based biowaivers was finalized as the ICH M9 guideline, the workshop included lectures, panel discussions, and breakout sessions. Lecture and panel discussion topics covered case studies at IND, NDA, and ANDA stages, typical deficiencies relating to permeability assessment supporting BCS biowaiver, types of evidence that are available to demonstrate high permeability, method suitability of a permeability assay, impact of excipients, importance of global acceptance of permeability methods, opportunities to expand the use of biowaivers (e.g. non-Caco-2 cell lines, totality-of-evidence approach to demonstrate high permeability) and future of permeability testing. Breakout sessions focused on 1) in vitro and in silico intestinal permeability methods; 2) potential excipient effects on permeability and; 3) use of label and literature data to designate permeability class.

Predicting Regions of Local Recurrence in Glioblastomas Using Voxel-Based Radiomic Features of Multiparametric Postoperative MRI

The globally accepted surgical strategy in glioblastomas is removing the enhancing tumor. However, the peritumoral region harbors infiltration areas responsible for future tumor recurrence. This study aimed to evaluate a predictive model that identifies areas of future recurrence using a voxel-based radiomics analysis of magnetic resonance imaging (MRI) data. This multi-institutional study included a retrospective analysis of patients diagnosed with glioblastoma who underwent surgery with complete resection of the enhancing tumor. Fifty-five patients met the selection criteria. The study sample was split into training (N = 40) and testing (N = 15) datasets. Follow-up MRI was used for ground truth definition, and postoperative structural multiparametric MRI was used to extract voxel-based radiomic features. Deformable coregistration was used to register the MRI sequences for each patient, followed by segmentation of the peritumoral region in the postoperative scan and the enhancing tumor in the follow-up scan. Peritumoral voxels overlapping with enhancing tumor voxels were labeled as recurrence, while non-overlapping voxels were labeled as nonrecurrence. Voxel-based radiomic features were extracted from the peritumoral region. Four machine learning-based classifiers were trained for recurrence prediction. A region-based evaluation approach was used for model evaluation. The Categorical Boosting (CatBoost) classifier obtained the best performance on the testing dataset with an average area under the curve (AUC) of 0.81 ± 0.09 and an accuracy of 0.84 ± 0.06, using region-based evaluation. There was a clear visual correspondence between predicted and actual recurrence regions. We have developed a method that accurately predicts the region of future tumor recurrence in MRI scans of glioblastoma patients. This could enable the adaptation of surgical and radiotherapy treatment to these areas to potentially prolong the survival of these patients.

Use of non-intrusive laser exfoliation to improve substance uptake into citrus leaves

Background: Despite the presence of stomata in leaves, foliar application of agrochemicals can be extremely inefficient due to the low permeability of leaf cuticular surfaces to polar compounds. Methods: This study introduced a laser-based “wax exfoliation” method to facilitate the penetration of substances into the leaf and, together with enhancing their uptake into the phloem and subsequent transport across tissue. This investigation demonstrated the effectiveness and non-invasive properties of laser exfoliation to improve the penetration of foliar-applied substances into citrus leaves. Results: This work presents the use of laser energy to exfoliate the cuticle of a leaf, with the highest energy density of 0.76 J/ cm2 resulting in 85-90% exfoliation across the entire laser-spot area. The infrared wavelength of the erbium laser is specifically chosen to target the wax cuticle without causing damage to the underlying epidermal cells. This selective ablation allows for increased penetration of therapeutic compounds into the leaf and transportation throughout the plant's vasculature. This is demonstrated using a fluorescent glucose analog applied to the laser treated leaves, showing increased penetration and transport throughout the leaf. Conclusions: Our findings demonstrate that the use of laser technology for the foliar application of agrochemicals provides significant advantages, including improved foliage uptake of therapeutic compounds. The method of cuticle exfoliation presented in this study is highly effective and non-intrusive, limiting its effects to the cuticle only. Future work should focus on the development of prototypes for in-field applications, including testing at longer distances as the Er:YAG laser does not require a lens for this application.

Use of non-intrusive laser exfoliation to improve substance uptake into citrus leaves

Background: Despite the presence of stomata in leaves, foliar application of agrochemicals can be extremely inefficient due to the low permeability of leaf cuticular surfaces to polar compounds. Methods: This study introduced a laser-based "wax exfoliation" method to facilitate the penetration of substances into the leaf and, together with enhancing their uptake into the phloem and subsequent transport across tissue. This investigation demonstrated the effectiveness and non-invasive properties of laser exfoliation to improve the penetration of foliar-applied substances into citrus leaves. Results: This work presents the use of laser energy to exfoliate the cuticle of a leaf, with the highest energy density of 0.76 J/ cm2 resulting in 85-90% exfoliation across the entire laser-spot area. The infrared wavelength of the erbium laser is specifically chosen to target the wax cuticle without causing damage to the underlying epidermal cells. This selective ablation allows for increased penetration of therapeutic compounds into the leaf and transportation throughout the plant's vasculature. This is demonstrated using a fluorescent glucose analog applied to the laser treated leaves, showing increased penetration and transport throughout the leaf. Conclusions: Our findings demonstrate that the use of laser technology for the foliar application of agrochemicals provides significant advantages, including improved foliage uptake of therapeutic compounds. The method of cuticle exfoliation presented in this study is highly effective and non-intrusive, limiting its effects to the cuticle only. Future work should focus on the development of prototypes for in-field applications, including testing at longer distances as the Er:YAG laser does not require a lens for this application.

Relaxation of thoracic aorta and pulmonary artery rings of marmosets (Callithrix spp.) by endothelium-derived 6-nitrodopamine

6-Nitrodopamine is a novel catecholamine released by vascular tissues, heart, and vas deferens. The aim of this study was to investigate whether 6-nitrodopamine is released from the thoracic aorta and pulmonary artery rings of marmosets (Callithrix spp.) and to evaluate the relaxing and anti-contractile actions of this catecholamine. Release of 6-nitrodopamine, dopamine, noradrenaline, and adrenaline was assessed by liquid chromatography with tandem mass spectrometry (LC-MS/MS). The relaxations induced by 6-nitrodopamine and by the selective dopamine D2 receptor antagonist L-741,626 were evaluated on U-46619 (3 nM)-pre-contracted vessels. The effects of 6-nitrodopamine and L-741,626 on the contractions induced by electric-field stimulation (EFS), dopamine, noradrenaline, and adrenaline were also investigated. Both aorta and pulmonary artery rings exhibited endothelium-dependent release of 6-nitrodopamine, which was significantly reduced by the NO synthesis inhibitor L-NAME. Addition of 6-nitrodopamine or L-741,626 caused concentration-dependent relaxations of both vascular tissues, which were almost abolished by endothelium removal, whereas L-NAME and the soluble guanylate cyclase inhibitor ODQ had no effect on 6-nitrodopamine-induced relaxations. Additionally, pre-incubation with 6-nitrodopamine antagonized the dopamine-induced contractions, without affecting the noradrenaline- and adrenaline-induced contractions. Pre-incubation with L-741,626 antagonized the contractions induced by all catecholamines. The EFS-induced contractions were significantly increased by L-NAME, but unaffected by ODQ. Immunohistochemical assays showed no immunostaining of the neural tissue markers S-100 and calretinin in either vascular tissue. The results indicated that 6-nitrodopamine is the major catecholamine released by marmoset vascular tissues, and it acts as a potent and selective antagonist of dopamine D2-like receptors. 6-nitrodopamine release may be the major mechanism by which NO causes vasodilatation.

Use of non-intrusive laser exfoliation to improve substance uptake into citrus leaves

Background: Despite the presence of stomata in leaves, foliar application of agrochemicals can be extremely inefficient due to the low permeability of leaf cuticular surfaces to polar compounds. Methods: This study introduced a laser-based "wax exfoliation" method to facilitate the penetration of substances into the leaf and, together with enhancing their uptake into the phloem and subsequent transport across tissue. This investigation demonstrated the effectiveness and non-invasive properties of laser exfoliation to improve the penetration of foliar-applied substances into citrus leaves. Results: This work presents the use of laser energy to exfoliate the cuticle of a leaf, with the highest energy density of 0.76 J/ cm2 resulting in 85-90% exfoliation across the entire laser-spot area. The infrared wavelength of the erbium laser is specifically chosen to target the wax cuticle without causing damage to the underlying epidermal cells. This selective ablation allows for increased penetration of therapeutic compounds into the leaf and transportation throughout the plant's vasculature. This is demonstrated using a fluorescent glucose analog applied to the laser treated leaves, showing increased penetration and transport throughout the leaf. Conclusions: Our findings demonstrate that the use of laser technology for the foliar application of agrochemicals provides significant advantages, including improved foliage uptake of therapeutic compounds. The method of cuticle exfoliation presented in this study is highly effective and non-intrusive, limiting its effects to the cuticle only. Future work should focus on the development of prototypes for in-field applications, including testing at longer distances as the Er:YAG laser does not require a lens for this application.

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

AIMS

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

METHODS AND RESULTS

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

CONCLUSION

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

Incorporation of Comprehensive Examinations for a Time-Efficient Remediation Method

BACKGROUND

Remediation in medical school should be a time-limited, and highly structured process that addresses student deficiencies and allows them to prove content competency before progressing in the curriculum. In this study, we analyze the use of a comprehensive end-of semester final examination in the remediation process for pre-clinical students at Kirk Kerkorian School of Medicine (KSOM). Faculty time utilized is analyzed and compared with the previously employed remediation process.

METHODS

Administered to all students at the end of each semester is a comprehensive examination consisting of a sufficient number of faculty-selected questions relating to each organ system covered with a 75% passing threshold. A student must also demonstrate competency of any failed system examination content to remediate successfully. The performance of those who did not exhibit competency was analyzed to identify areas of deficiency then an individualized exam would then be administered. The total remediation time spent by faculties and students was then analyzed.

RESULTS

KSOM Class of 2024 results showed that faculty were able to yield significant savings in time spent on remediation. Faculty spent 45 total remediation hours for the Class of 2024, compared to 400 hours remediating using the paper-based assignment method for the Class of 2021. With the transition to comprehensive end-of-semester final examinations, a total of 355 hours were saved. Furthermore, faculty used an average 1.07 hours/student with end-of-semester comprehensive examinations. The saved time allows faculty to work on improving the overall curriculum for all students rather than focusing on a limited number of students.

CONCLUSION

Utilizing comprehensive end-of-semester final examinations notably decreased the amount of faculty time spent per semester on remediation. Further evaluation is required to evaluate long-term effectiveness on content competency and would further be strengthened by a multi-institutional comparison.

Pre-clerkship National Board of Medical Examiners Subject Examinations Versus End-of-Semester Final Examinations: How Well Do They Assess Preparedness for the United States Medical Licensing Examination Step 1?

Background The ability to provide performance insights of various United States Medical Licensing Examination (USMLE) Step 1 assessments is of great importance to medical educators. Two custom pre-clerkship assessments used at the Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas (KSOM) are National Board of Medical Examiners (NBME)-derived end-of-semester final examinations and subject examinations. The authors sought to determine if performance on these custom assessments can provide feedback on a medical student's readiness to undertake the USMLE Step 1 examination. Methodology Deidentified student performance data were provided by institutional databases for the KSOM graduating class of 2023 (N = 60). Pearson correlation analyses were utilized to evaluate the strength of the correlation between USMLE Step 1 performance and NBME subject examinations versus NBME end-of-semester final examinations. Results The results indicated that the NBME end-of-semester final examinations have a statistically higher correlation to the USMLE Step 1 score than the majority of the individual NBME subject examinations. However, the mean NBME subject examination score (Semester 1: r = 0.53, p < 0.05; Semester 2: r = 0.58, p < 0.05) demonstrated significantly higher correlation to the USMLE Step 1 performance than the NBME end-of-semester final examination score for both Semesters 1 and 2 (Semester 1: r = 0.50, p < 0.05; Semester 2: r = 0.48, p < 0.05). Conclusions These results showed that the mean of the NBME subject examination score was a better metric to assess readiness for the USMLE Step 1 than the NBME end-of-semester final examinations. However, each NBME end-of-semester final examination score showed a better correlation than the majority of the NBME subject examinations.

P-135 Clinical outcomes depending on post-warming culture duration of vitrified-warmed single blastocyst transfer cycles

Study question

What is the impact of post-warming blastocysts after very short-term culture (&lt;2 hours) or short-term culture (2–4 hours) on the clinical outcomes?

Summary answer

The clinical outcomes of very short-term culture and short-term culture were not significantly different in vitrified-warmed blastocyst transfer.

What is known already

In vitrified-warmed blastocyst transfer (VBT), complete blastomere survival and mitotic resumption during warming are generally considered to be the most important factors affecting pregnancy outcomes. It has been assumed that a sufficient warming time may be required for resumption of cell proliferation and development. Currently there is evidence that suggests a minimum mean time of 2.70 ± 1.20 necessary to complete the re-expansion of the embryo that allows evaluating its adequate development. However, the effect of culture duration on pregnancy outcomes in VBT remains controversial.

Study design, size, duration

A retrospective observational study was carried out, with all the patients who had frozen-thawed embryos transferred between January and December 202, in Clínica Alemana, Santiago, Chile. The average standard time for embryo thawing in our center is 2 hours. However, on certain occasions, due to its insufficient development and the pressing schedule of surgery rooms, a second embryo must be thawed, usually in less than 2 hours.

Participants/materials, setting, methods

Embryos were divided into two study groups depending on whether their post-warming culture period was very short-term (&lt;2 hours) or short-term culture (2–4 hours). Only transfers of 1 embryo on day 5-6 were included. Embryo morphology was analyzed with a Garner microscope score to estimate the quality of the embryos in both groups.

Main results and the role of chance

During the study period, a total of 127 single VBT cycles were included: 48 in the very short-term group and 79 in the short-term group. Patients’ demographic characteristics did not significantly differ between the groups. (Age 34.9±3.6 vs 35±3.4, p=0.89; Infertility duration (yr) 2.75±1.1 vs 2.5 ±1.1, p=0.24; AMH 2.1 [0.2-5.4] vs 2.1 [0.2-5], p=0.84) An analysis of previous fresh in vitro fertilization cycles and subsequent VBT cycle parameters revealed no differences in the number of retrieved oocytes (11.7 vs 12, p=0.74), the number of fertilized oocytes (8.6 vs 8.5, p=0.86), the number of vitrified blastocysts (3.4 vs 3.6, p=0.87) and in both groups. The clinical pregnancy rate per embryo transferred were similar in the very short-term culture group and the short-term culture group (66.7% vs. 68.4%, p=0.44). There was no significant difference in the ongoing pregnancy rate per embryo transferred between the two groups (18,8% vs. 16.5.%, p=0.74). The miscarriage rate in both groups was comparable (p=0.77).

Limitations, reasons for caution

The small number of women recruited ant the retrospective design of the study, should be recognized as possible sources of bias.

Wider implications of the findings

This study showed that the culture time after warming was irrelevant for blastocyst implantation potential, and that the speed of re-expansion was not correlated with clinical outcomes.

Embryo transfer timing after warming may be determined by optimizing each laboratory’s work flow.

Trial registration number

0

Trophic transfer of copper decreases the condition index in Crassostrea gigas spat in concomitance with a change in the microalgal fatty acid profile and enhanced oyster energy demand

Due to new usages and sources, copper (Cu) concentrations are increasing in the Arcachon Basin, an important shellfish production area in France. In the present paper, the trophic transfer of Cu was studied between a microalga, Tetraselmis suecica, and Crassostrea gigas (Pacific oyster) spat. An experimental approach was developed to assess Cu exposure, transfer and toxicity on both phytoplankton and spat. Exposure of microalgal cultures to Cu for 7-8 days (3.1 ± 0.1, 15.7 ± 0.2 and 50.4 ± 1.0 μg Cu·L^-1 for the control, Cu15 and Cu50 conditions, respectively) led to concentrations in microalgae (28.3 ± 0.9 and 110.7 ± 11.9 mg Cu·kg dry weight^-1 for Cu15 and Cu50, respectively) close to those measured in the field. Despite Cu accumulation, the physiology of the microalgae remained poorly affected. Exposed cultures could only be discriminated from controls by a higher relative content in intracellular reactive oxygen species, and a lower relative content in lipids together with a reduced metabolic activity. By contrast, the fatty acid profile of microalgae was modified, with a particularly relevant lower content of the essential polyunsaturated fatty acid 22:6n-3 (docosahexaenoic acid [DHA]). Following 21 days of spat feeding with Cu15 and Cu50 microalgal cultures, trophic transfer of Cu was observed with a high initial Cu concentration in spat tissues. No effect was observed on oxidative stress endpoints. Cu exposure was responsible for a decrease in the spat condition index, an outcome that could be related to an insufficient DHA supply and extra energy demand as suggested by the overexpression of genes involved in energy metabolism, ATP synthesis and glycogen catabolism.

POS1270 COVID19 VACCINATION IN PATIENTS WITH AXIAL AND PERIPHERAL SPONDYLOARTHRITIS AND PSORIATIC ARTHRITIS: ADVERSE EVENTS AND IMPACT ON DISEASE ACTIVITY

Background

There is scarce evidence on the rate of adverse events and the consequences on disease activity after vaccination against covid19

Objectives

To evaluate adverse events to vaccination and disease flares after vaccination in patients with axial spondyloarthritis (axSpA), peripheral spondyloarthritis (pSpA) and psoriatic arthritis (PsA) and to evaluate factors associated with adverse event.

Methods

Cross-sectional, observational, descriptive study. Consecutive patients with diagnosis of ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA) according to ASAS 2009 criteria; pSpA according to ASAS 2011 criteria and PsA according to CASPAR criteria were included. Demographic data, disease clinimetry, treatments, vaccination received and post-vaccination adverse events were recorded. We evaluated, according to medical criteria, whether the patient presented a flare disease after vaccination and whether it was mild, moderate or severe. We also evaluated the factors associated with the presence of at least one mild adverse event. Statistical analysis: descriptive statistics were performed, qualitative variables were expressed as frequency and percentage (%), numerical variables as mean and standard deviation (SD) or median and percentile25-75. Binary logistic regression was performed using the presence of at least one mild adverse event to vaccination as the dependent variable.

Results

210 patients were included with a mean age of 45 (SD 15) years. The diagnoses were: AS 50 (23.8%), nr-axSpA 10 (4.8), pSpA 9 (4.3%), PsA 141 (67%) and time of disease evolution in months 109 (SD 96). Regarding comorbidities, the following frequencies were reported: arterial hypertension 60 (30%), diabetes mellitus 25 (12%), heart failure 4 (2%), asthma/EPOC 15 (7%), inflammatory bowel disease 2 (1%), acute anterior uveitis 20 (9.5%), psoriasis 128 (61%). Sixteen percent (n=33) of the patients had SARS-CoV-2 infection prior to vaccination. Regarding treatments, those used were: antiTNF 88 (42%), Tofacitinib 6 (2.9%), Ustekinumab 2 (1%), Secukinumab 35 (17%), Ixekizumab 2 (1%), methotrexate 98 (47%), leflunomide 7 (3. 3), sulfasalazine 7 (3.3), apremilast 1 (0.5%), continuous NSAIDs 26 (12.4%) and NSAIDs on demand 103 (49%). Vaccines received were: Sputnik V 109 (51.9%), Oxford Vaccine, AstraZeneca 63 (30%), Janssen 1 (0.5%), BioNTech Vaccine, Pfizer 1 (0.5%), Sinopharm 33 (15.7%), Moderna 0%, Novavax 0% and others; 3 (1.4%). Thirty-eight percent (n=80) of patients reported having mild post-vaccination symptoms, of which 3.75% did not resolve, 41% resolved with medication and 39% resolved ad integrum without medication. The presence of mild adverse event to the vaccine was associated with lower use of methotrexate (31% vs 56 %, p<0.001), and lower age (54 (SD 14) vs 47 (SD 12), p<0.001), and lower BMI (25 (24-30.5) vs 28 (25-31), p<0.001); while no association was found with sex, diagnosis, comorbidities, treatments, desease activity or vaccines. In the logistic regression analysis all the variables remained independently associated with a lower probability of presenting a mild adverse event: methotrexate: OR: 0.30, 95%CI 0.15-0.58, p<0.001, age: OR: 0.97, 95%CI 0.95-0.99, p: 0.03, BMI: OR: 0.92, 95%CI 0.95-0.99, p: 0.02. Sixty-one percent (n=129) of patients received the 2nd dose of vaccination, which 27% (n=35) presented mild adverse event and only 1 (0.8%) patient suffered post vaccination disease flare.

Conclusion

Vaccination against COVID19 appears to be safe in this population, with only mild adverse events and low frequency of flare disease. Mild adverse events were associated with less use of methotrexate, younger age and lower BMI.

Disclosure of Interests

None declared

AB1503 MOST MEDICINE RESIDENTS WOULD LIKE TO LEARN JOINT ASPIRATION PROCEDURES BUT 2/3 HAVE NEVER DONE IT: SURVEY OF COMMUNITY HOSPITAL TRAINEES IN NORTHEASTERN USA

Background

Arthrocentesis is a procedure performed to aspirate synovial fluid from a joint cavity. It has both diagnostic and therapeutic utilization in outpatient and inpatient settings. While arthrocentesis is considered a minor surgical procedure, there is always potential to injure blood vessels, nerves, and tendons1. Although joint arthrocentesis is not an Accreditation Council for Graduate Medical Education procedural requirement for Internal Medicine (IM) residents in the United States, several studies have revealed that training on knee arthrocentesis and injection provided a solid foundation to medical residents toward increasing their confidence and refining motor skills2.

Objectives

To evaluate the current Roger Williams Medical Center (RWMC) IM residents’ confidence level in performing intra-articular injection. Results from this study will inform the design of resident-orientated quality improvement arthrocentesis teaching series in RWMC.

Methods

Project was incepted and designed by one rheumatology faculty, one fellow and five IM residents of RWMC. We selected the survey as a tool to elicit information from all current IM residents who filled out a 7-question survey regarding their residency experience and exposures to knee aspiration and injection. We used Survey Monkey as an anonymous survey tool (see Table 1). Data were collected between 1/14/22 until 1/27/22 and were verified by two members of the research team.

Table 1.

Survey from 39 total responses

QuestionResponses1.What post-graduate year are you?PGY1:41.03%PGY2: 35.90%PGY3: 9%2. Are you comfortable/confident with knee arthrocentesis/injection during residency?Not Comfortable/confident: 69.23%Somewhat comfortable/confident: 28.21%Quite comfortable/confident: 2.56%3. Do you think you have adequate exposure to knee procedures in residency?Strongly Agree: 0%Agree: 0%Undecided: 5.13%Disagree: 51.28%Strongly Disagree: 43.59%4. How many knee aspirations/injections have you done during residency?0: 73.68%1-4: 26.32%5-10: 0%>10: 0%5. Do you think our residency program is preparing you to do knee aspirations/injections?Strongly Agree: 0%Agree: 0%Undecided: 17.95%Disagree: 35.90%Strongly Disagree: 46.15%6. Would you be interested in doing more knee aspirations/injections?Yes: 94.87%No: 5.13%7. Having exposure to arthrocentesis is very important for me to have in my residency programStrongly Agree: 33.33%Agree: 35.90%Undecided: 23.08%Disagree: 5.13%Strongly Disagree: 2.56%

Results

A total of 47 IM residents within three classes in this community residency program were provided with the survey. The survey response rate was 82.9% (39 /47). 69.23% residents do not feel comfortable doing arthrocentesis. More than half of the resident population (51.28%) do not think they have adequate exposure to knee arthrocentesis. 73.68% respondents have never performed knee injections/arthrocentesis. According to the survey, 94.87% of the residents would be interested in learning to do knee procedures. Having exposure to knee arthrocentesis during residency was important to 36.84% and very important to 34.21% of the trainees.

Conclusion

The survey results demonstrate that most of the IM residents had no prior exposure and are uncomfortable with knee arthrocentesis. However we proved that there is high interest in learning this procedure. Literature review shows that structured training sessions have a long-term effect in competency and confidence with similar procedures. This survey provides us data to set up a system to improve the quality of joint procedures teaching in RWMC.

References

[1]Akbarnia H, Saber AY, Zahn E. Knee arthrocentesis. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK470229/. Published September 5, 2021

[2]Barilla-LaBarca M-L, Tsang JC, Goldsmith M, Furie R. Design, implementation, and outcome of a hands-on Arthrocentesis Workshop. J Clin Rheumatol. 2009;15(6):275-279.

Disclosure of Interests

Pamela Gonzalez: None declared, Ravinder Kaler: None declared, Neenu Sukumaran: None declared, Ahmed ElDib: None declared, Yana Turkowski: None declared, Zi Ying Li: None declared, Katarzyna Gilek-Seibert Speakers bureau: Abbvie, Consultant of: GSK

Effects of metals and persistent organic pollutants on the fitness and health of juveniles of the endangered european sturgeon Acipenser sturio Exposed to W1ater and sediments of the garonne and dordogne rivers

The last remaining population of European sturgeon (Acipenser sturio) lives in the Gironde-Garonne-Dordogne (France) catchment (GGD). Captive young individuals are released into the GGD hydrosystem each year, as part of a restocking programme. This study aims to assess the health status of juveniles A. sturio to current conditions in the GGD hydrosystem, to evaluate their capacity to survive and grow in a moderately anthropized ecosystems. 3-month-old farmed sturgeons were exposed for one month in experimental conditions that mimic the environmental conditions in the Garonne and Dordogne rivers, followed by five months of depuration. After one month of exposure, fish exposed to Dordogne and Garonne waters bioaccumulated higher levels of metals and persistent organic pollutants, displayed a reduced hepato-somatic index, and had depleted levels of lipids and glycogen content in their liver, when compared with the Reference group. However, metabolic and swimming performance, as well as the costs of swimming were not impaired. After the 5 months depuration, a significant decrease of K was observed for all exposure conditions. HSI also decreased with time. The overall health status and adaptive capacity of juvenile A. sturio appeared to be maintained over the experimental 6 months' period. Juveniles of A. sturio seem to have the adaptive capacity to survive and grow in the GGD hydrosystem, after being released as part of a restocking programme.

Correlates of condomless anal intercourse with different types of sexual partners among men who have sex with men and transgender women in Lima, Peru

CLINICAL TRIAL REGISTRATION

The Sabes study was registered in March 2013 with the National Institutes of Health at ClinicalTrials.gov (identifier: NCT01815580).

Long-Term Decrease of Intraocular Pressure in Rats by Viral Delivery of miR-146a

Purpose

To evaluate the effects of miR-146a in trabecular meshwork (TM) cells and on intraocular pressure (IOP) in vivo via viral delivery of miR-146a to the anterior chamber of rat eyes.

Methods

Human TM cells were transfected with miR-146 mimic or inhibitor. Some cells from each group were then subjected to cyclic mechanical stress (CMS). Other cells from each group had no force applied. Gene expression was then analyzed by quantitative polymerase chain reaction (qPCR). Replication-deficient adenovirus and lentivirus expressing miR-146a were inoculated into the anterior segment of Brown Norway rat eyes. IOP was monitored by rebound tonometry, visual acuity was evaluated by optokinetic tracking (OKT), and inflammation markers in the anterior segment were examined by slit-lamp, qPCR, and semi-thin sections.

Results

miR-146 affected the expression of genes potentially involved in outflow homeostasis at basal levels and under CMS. Both lentiviral and adenoviral vectors expressing miR-146a resulted in sustained decreases in IOP ranging from 2.6 to 4.4 mmHg. Long term follow-up of rats injected with lentiviral vectors showed a sustained effect on IOP of 4.4 ± 2.9 mmHg that lasted until rats were sacrificed more than 8 months later. Eyes showed no signs of inflammation, loss of visual acuity, or other visible abnormalities.

Conclusions

Intracameral delivery of miR-146a can provide a long-term decrease of IOP in rats without signs of inflammation or other visible adverse effects.

Transitional Relevance

The IOP-lowering effects of miR-146 observed in rats provides a necessary step toward the development of an effective gene therapy for glaucoma in humans.

POS1005 ASSESSMENT OF DAREA AND MODIFIED DAREA IN AN ARGENTINIAN-GUATEMALAN REACTIVE ARTHRITIS COHORT

Background:

Reactive Arthritis (ReA) is an inflammatory joint disease and, as in rheumatoid or psoriatic arthritis, composite indices are the most useful tools to measure disease activity. The Disease Activity Index for Reactive Arthritis (DAREA) is the only developed index for ReA, which requires a 66/68 joint count and CRP for its assessment, the latter being difficult to acquire in our setting. Therefore, we developed a simplified index, the modified DAREA (DAREAm), with a lower joint count and ESR for its evaluation.

Objectives:

1) To evaluate the DAREA and the DAREAm in a cohort of patients with diagnosis of ReA and post-infectious arthritis 2) To assess the correlation of the DAREA and DAREAm with several clinical variables, functional capacity and quality of life in a cohort of patients with ReA.

Methods:

Patients with diagnosis of ReA (Calin’79) and post-infectious arthritis were included. Demographic data were collected, patient´s pain and global assessment were evaluated through a visual analog scale (VAS) and a 3-point scale (no pain = 0, mild = 1, moderate = 2, severe = 3), physician´s global assessment, morning stiffness (MS) and VAS fatigue. Functional capacity was assessed by HAQ and quality of life according to EuroQol-5 dimensions (EQ-5D), and the activity indices DAS28, DAREA and DAREAm were calculated. Statistical analysis: a descriptive analysis of the variables and correlation between numerical variables with Spearman rank correlation were performed.

Results:

57 patients were included, 53 with diagnosis of ReA, the majority post urogenital (63%) and gastrointestinal (17%), and 4 with diagnosis of post-infectious arthritis. Fifty six percent were male, mean age: 40 years old (SD ± 14) and median ReA duration: 15 months (IQR 2-45). The number of painful and swollen joints in a 66/68 joint count showed a median of 2 (IQR 0-3) and 1 (IQR 1-2) respectively. Median VAS pain 43 (IQR 15-70), patient´s disease activity 40 (IQR 20-60) and physician´s 40 (IQR 20-60), MS 10 (IQR 0-50) and fatigue 30 (IQR 0-80). Median DAS28 3.6 (IQR 2.3-4.3), DAREA 7.4 (IQR 2.5-10.6), DAREAm 8.6 (IQR 4.6-12.7), HAQ 0.625 (IQR 0.125-1). The dimensions with the greatest compromise in the EQ-5D were pain/discomfort (63%) and anxiety/depression (51%), and the median VAS EQ-5D was 60 (IQR 32-80). DAREA correlated with DAREAm (rs= 0.89; p <0.001), DAS28 (rs= 0.84; p <0.001), medical VAS (rs= 0.60; p <0.001), MS (rs= 0, 50; p <0.001), HAQ (rs= 0.53; p <0.001), VAS fatigue (rs= 0.57; p <0.001) and mobility subscales of the EQ5D (rs= 0.56; p <0.001), pain/discomfort (rs= 0.49; p <0.001) and anxiety/depression (rs= 0.61; p <0.001). The DAREAm correlated with DAS28 (rs= 0.93; p <0.001), physician VAS (rs= 0.58; p <0.001), fatigue VAS (rs= 0.53; p <0.001), HAQ (rs= 0 .51; p <0.001) and the EQ5D subscales: mobility (rs= 0.64; p <0.001), pain/discomfort (rs= 0.56; p <0.001) and anxiety/depression (rs= 0.66; p <0.001)

Conclusion:

This is the first study that assess activity indices in a cohort of patients with ReA. The DAREAm demonstrated a very good correlation with both DAREA and DAS28. We encourage the use of this simplified index in daily practice to evaluate patients with ReA.

Disclosure of Interests:

None declared.

Energy-Spread Preservation and High Efficiency in a Plasma-Wakefield Accelerator

Energy-efficient plasma-wakefield acceleration of particle bunches with low energy spread is a promising path to realizing compact free-electron lasers and particle colliders. High efficiency and low energy spread can be achieved simultaneously by strong beam loading of plasma wakefields when accelerating bunches with carefully tailored current profiles [M. Tzoufras et al., Phys. Rev. Lett. 101, 145002 (2008)PRLTAO0031-900710.1103/PhysRevLett.101.145002]. We experimentally demonstrate such optimal beam loading in a nonlinear electron-driven plasma accelerator. Bunches with an initial energy of 1 GeV were accelerated by 45 MeV with an energy-transfer efficiency of (42±4)% at a gradient of 1.3  GV/m while preserving per-mille energy spreads with full charge coupling, demonstrating wakefield flattening at the few-percent level.

279. Dalbavancin for Bloodstream Infections and Endocarditis: Real-World Outcomes From the DRIVE Registry

Background

Dalbavancin, a long-acting lipoglycopeptide approved by the US FDA and EMA for acute bacterial skin and skin structure infections (ABSSSI) has potent activity against Gram-positive pathogens including MRSA. A total of 39 of 39 patients with baseline S aureus bacteremia from previous studies who received dalbavancin (1500 mg or 1000 mg followed by 500 mg 1 week later) had clearance of bacteremia (100%). We describe the clinical features and efficacy of dalbavancin in patients with bacteremia or endocarditis from a retrospective registry study of dalbavancin.

Methods

Dalvance Utilization Registry Investigating Value and Efficacy (DRIVE) was a phase 4 observational, multicenter, retrospective cohort study of the real-world use of dalbavancin in adults across the US. Data collected between 03/25/2017 and 11/27/2018 included patient, disease, and pathogen characteristics, antibiotic use, clinical outcome, and safety. Clinical outcome was assessed by chart review from last dalbavancin dose through 60 days. Success was defined as presumed or documented clinical or microbiological cure with no need for rescue IV antibiotic therapy. Failure was defined as presumed or documented clinical or microbiologic failure, or the need for rescue IV antibiotic therapy, or death. Outcome was indeterminate if there were insufficient data to determine status at 60 days.

Results

Of 1092 evaluable patients treated with dalbavancin for any indication, 32 had baseline bloodstream pathogen data and Gram-positive bacteremia (Figure). 29 of 32 patients were previously treated with antibiotics (91%) with a median duration of 8.5 days. The 3 patients with endocarditis were among those most heavily pretreated (9, 4, and 4 prior IV antibiotics each). Clinical success was achieved in 30/32 (94%); outcome was indeterminate in 2/32 (6%). Most common dalbavancin regimens were 1500 mg x 1 (50%) or 1500 mg weekly x 2 (13%). Negative blood cultures for baseline pathogen prior to dalbavancin were documented in 53% of patients. There were no adverse events assessed as related to dalbavancin.

Conclusion

Dalbavancin use in Gram-positive bacteremia appears well tolerated and effective in the real-world setting.

Disclosures

Pedro Gonzalez, MD, MT, AbbVie (Employee) Urania Rappo, MD, MS, PharmD, Allergan (before its acquisition by AbbVie) (Employee) Jennifer McGregor, RPh, AbbVie (Employee) Lisa DiPompo-Day, n/a, AbbVie (Employee) Matthew W. McCarthy, MD, Allergan (prior to its acquisition by AbbVie) (Consultant, Grant/Research Support)

1247. Dalbavancin in Osteomyelitis and Joint Infections: An Analysis From an Observational, Multicenter, Retrospective Cohort Study of the Real-World Use in Adult Patients

Background

Dalbavancin (DAL) is approved in the United States (US) and Europe for acute bacterial skin and skin structure infections and exhibits broad spectrum activity against clinically important Gram-positive pathogens including methicillin-sensitive and methicillin-resistant Staphylococcus aureus, and Streptococcus spp. We describe the use of DAL in patients with osteomyelitis or joint infection from a phase 4 observational, multicenter, retrospective cohort study of the real-world use of DAL in adult patients across the US: Dalvance Utilization Registry Investigating Value and Efficacy (DRIVE).

Methods

Data were collected between 03/25/2017 and 11/27/2018 and included demographics, disease and pathogen characteristics, antibiotic use, clinical outcome, and safety. Patients with a determinate clinical outcome (success/failure) were included in the evaluable population.

Results

Data for 96 patients with osteomyelitis and 33 patients with joint infection (safety population) were entered into this subanalysis. Patient demographics and medical history were broadly similar for patients with osteomyelitis or joint infection. The majority (80.4–100%) of patients received DAL as concurrent therapy and clinical success, defined qualitatively, was achieved in 64.7-87.5% of patients (Fig. 1). Most patients received 1 or 2 IV DAL doses (osteomyelitis, 33.3% and 34.6%, respectively; joint infection, 37.5% and 31.3%, respectively); 11.5% and 6.3% of patients with osteomyelitis or joint infection, respectively received &gt;4 doses (Fig. 2). Staphylococcus spp. was the most frequently isolated organism at baseline (Fig. 3); 61.1% and 35.7% of osteomyelitis and joint infection isolates tested, respectively were resistant to oxacillin. At 60 days post-DAL treatment, numbers of Staphylococcus spp. isolated from both groups decreased (Fig. 3), confirming microbiological cure. The rate of serious adverse events was low (16 events in 7 [7.3%] patients with osteomyelitis, 2 events in 2 [6.1%] patients with joint infection) and consistent with the safety profile of DAL.

Fig. 1

Conclusion

In this real-world study in patients with Staphylococcal osteomyelitis and joint infection, DAL resulted in high rates of clinical and microbiological success.

Disclosures

Jennifer McGregor, RPh, AbbVie (Employee) Anathakrishnan Ramani, MD, FACP, AAHIVS, CIC, Allergan (prior to its acquisition by AbbVie) (Speaker’s Bureau) John Lock, PharmD, BCPS, AQ-ID, AbbVie (Employee) Pedro Gonzalez, MD, MT, AbbVie (Employee)

Assessment of Visual and Retinal Function Following In Vivo Genipin-Induced Scleral Crosslinking

Purpose

Genipin has been proposed as a possible neuroprotective therapy in myopia and glaucoma. Here, we aim to determine the effects of prolonged genipin-induced scleral stiffening on visual function.

Methods

Eyes from Brown Norway rats were treated in vivo with either a single 15 mM genipin retrobulbar injection or sham retrobulbar injection and were compared to naïve eyes. Intraocular pressure, optomotor response, and electroretinograms were repeatedly measured over 4 weeks following retrobulbar injections to determine visual and retinal function. At 4 weeks, we quantified retinal ganglion cell axon counts. Finally, molecular changes in gene and protein expression were analyzed via real-time polymerase chain reaction (RT-PCR) and proteomics.

Results

Retrobulbar injection of genipin did not affect intraocular pressure (IOP) or retinal function, nor have a sustained impact on visual function. Although genipin-treated eyes had a small decrease in retinal ganglion cell axon counts compared to contralateral sham-treated eyes (−8,558 ± 18,646; mean ± SD), this was not statistically significant (P = 0.206, n = 9). Last, we did not observe any changes in gene or protein expression due to genipin treatment.

Conclusions

Posterior scleral stiffening with a single retrobulbar injection of 15 mM genipin causes no sustained deficits in visual or retinal function or at the molecular level in the retina and sclera. Retinal ganglion cell axon morphology appeared normal.

Translational Significance

These results support future in vivo studies to determine the efficacy of genipin-induced posterior scleral stiffening to help treat ocular diseases, like myopia and glaucoma.

OP0266-HPR WORK PRODUCTIVITY IN PATIENTS WITH AXIAL AND PERIPHERAL SPONDYLOARTHRITIS

Background:

Work disability is an important outcome in the treatment of Spondyloarthritis (SpA) since this disease affects people in the most productive stage of life.

Objectives:

The aim of this study is to investigate the working status and the factors associated with work productivity loss (WPL) in patients with axial (axSpA) and peripheral SpA (pSpA).

Methods:

Patients with SpA according to ASAS criteria were included consecutively in this multicentric cross-sectional study. Evaluation of activity through a visual analogue scale (0-100), enthesitis (LEI), functional capacity (HAQ and BASFI), disease activity (DAS28 and BASDAI), health status (ASAS Health Index) and quality of life (ASQoL) were calculated. The Ankylosing Spondylitis Disease Activity Score (ASDAS) was recorded. The Work Productivity and Activity Impairment Spondyloarthritis (WPAI SpA) questionnaire was used to assess work productivity.

Spearman’s correlation coefficient (ρ) was used to assess the correlation with the percentage of WPL.

Results:

274 patients with SpA were recruited, 129 (47.1%) with axSpA and 145 (52.9%) with pSpA. 56.6% were women and 33.2% stopped working due to the underlying disease.

Among axSpA patients, 70% were radiographic and 30% non radiographic, mean age 45.5 (SD14) yrs, median disease duration 72 (IQR 36-144) months and diagnosis delay 20 (IQR 11-70) months. 45.7% were employed, median hours worked in the last week was 40 (IQR 25-45), median scores for absenteeism was 0% (IQR 0-2), presenteeism 30% (IQR 5-40), WPL 30% (IQR 10-52.5) and activity impairment 30% (IQR 10-50). A positive correlation was found between WPL and the following variables: HAQ (ρ:0.40, p<0.001), BASDAI (ρ:0.48, p<0.001), ASDAS (ρ:0.46, p<0.001), BASFI (ρ:0.59, p<0.001), ASQoL (ρ:0.60, p<0.0001), LEI (ρ:0.31, p:0.02) and ASAS health index (ρ:0.54, p<0.001).

Among pSpA patients, mean age was 52.3 (SD13) yrs, median disease duration 60 (IQR 14-120) months and diagnosis delay 12 (IQR 3-24) months. 46.9% were employed, median hrs worked in the last week was 30 (IQR 14-40), absenteeism 0% (IQR 0-7), presenteeism 30% (IQR 2.5-58), WPL 30% (IQR 5-52) and activity impairment 20% (IQR 0-40). A positive correlation was found between WPL and: HAQ (ρ:0.49, p<0.001), ASDAS (ρ:0.58, p<0.001), ASQoL (ρ:0.57, p<0.0001), DAS28 (ρ:0.50, p<0.001), LEI (ρ:0.36, p:0.04) and ASAS health index (ρ:0.52, p<0.001). No statistically significant differences were found in absenteeism, presenteeism, WPL and activity impairment between axSpA and pSpA.

Conclusion:

Our study showed that WPL in this national cohort was 30% in both groups of patients and is associated with disease activity, enthesitis, health status, quality of life and functional ability.

Disclosure of Interests:

None declared

FRI0318 REAL-LIFE EVALUATION OF HEALTH STATUS USING ASAS HEALTH INDEX ON PATIENTS WITH AXIAL AND PERIPHERAL SPONDYLOARTHRITIS IN ARGENTINA

Background:

The questionnaire “Assessment of Spondyloarthritis international Society Health Index” (ASAS HI) was developed to measure functionality and health status in patients with spondyloarthritis (SpA)1.

Objectives:

To describe the state of health measured by ASAS HI in Argentinian patients with SpA and to evaluate factors associated with poor health.

Methods:

Analytical, cross sectional, multicenter study. Patients with SpA according to ASAS criteria were consecutively included from 15 Argentinian centers. Statistical analysis: frequencies and percentages (%), mean and standard deviation (SD) or median and interquartile range (IQR). Bivariate analysis and logistic regression were performed to evaluate the factors associated with poor health status (ASAS HI > or equal to 12). Correlation with other parameters was evaluated by Spearman correlation.

Results:

We included 274 patients with a mean age 49 (SD 14) years, median disease duration 60 month (IQR 24-135), 155 (56.6%) of patients are male, 47% (n:129) axial SpA and 52.9 (n:145) peripheral SpA. One hundred and nine patients (43.4%) presented good health status, 117 (42.7%) had moderate state of health and 38 (13.9%) had poor health. In the bivariate analyses patients with ASAS health index greater than or equal to 12 (poor status), were older [54 (11) vs 48 (14), p: 0.01], had higher disease duration [11(IQR 57-192) vs 60 (IQR 24-120), p: 0.02], more hypertension [20 (52.6%) vs 67 (28.4%), p:0.004], more diabetes mellitus [10 (26.3%) vs 22(9.3%), p: 0.006], depression [6 (15.8%) vs 10 (4.2%), p:0.013], anxiety [8 (21%) vs (22 (9.3%),p:0.046], less years of education [9.8 (SD 3.5) vs 13 (SD 10), p:0.001], higher ASQol [12.6 (SD 4.6) vs 5.7 (SD4), p < 0.001], BASFI [7(SD2) vs 4(SD6), p: 0.001], DAS28 [4.71 (SD3.2) vs 2.8 (SD1),p: <0.001]. In the multivariate analyses the following variables were independently associated with poor health status: duration of disease, ASQol and DAS28. ASAS HI showed positive correlation with the following parameters: BASDAI (r:0.67, p< 0.001), HAQ (r:0.54, p< 0.001), ASDAS (r:0.67, p< 0.001), ASQol (r:0.80, p< 0.001), BASFI (r:0.72, p< 0.001) and DAS28 (0.56, p< 0.001).

Conclusion:

Poor health status is associated with disease activity, poor quality of life and functional activity. ASAS HI has a good correlation with other parameters to evaluate SpA, reinforcing the construct validity of this new tool.

References:

[1]Kiltz U,et al.Ann Rheum Dis2018;0:1–7.

Disclosure of Interests:

None declared

FLASHForward: plasma wakefield accelerator science for high-average-power applications

The FLASHForward experimental facility is a high-performance test-bed for precision plasma wakefield research, aiming to accelerate high-quality electron beams to GeV-levels in a few centimetres of ionized gas. The plasma is created by ionizing gas in a gas cell either by a high-voltage discharge or a high-intensity laser pulse. The electrons to be accelerated will either be injected internally from the plasma background or externally from the FLASH superconducting RF front end. In both cases, the wakefield will be driven by electron beams provided by the FLASH gun and linac modules operating with a 10 Hz macro-pulse structure, generating 1.25 GeV, 1 nC electron bunches at up to 3 MHz micro-pulse repetition rates. At full capacity, this FLASH bunch-train structure corresponds to 30 kW of average power, orders of magnitude higher than drivers available to other state-of-the-art LWFA and PWFA experiments. This high-power functionality means FLASHForward is the only plasma wakefield facility in the world with the immediate capability to develop, explore and benchmark high-average-power plasma wakefield research essential for next-generation facilities. The operational parameters and technical highlights of the experiment are discussed, as well as the scientific goals and high-average-power outlook. This article is part of the Theo Murphy meeting issue 'Directions in particle beam-driven plasma wakefield acceleration'.

Is Ductography Still Warranted in the 21st century?

OBJECTIVE

To determine the utility of ductography in conjunction with mammography and ultrasound in patients with pathologic nipple discharge, and the incremental role of MRI after triple-modality evaluation.

MATERIALS AND METHODS

We retrospectively reviewed the medical records of patients who had presented with pathologic nipple discharge and had undergone mammography and/or ultrasound and ductography between January 1, 2005, and October 31, 2010. We tested the diagnostic sensitivity, specificity and accuracy of combined triple-modality evaluation as well as of MRI performed in addition to these imaging techniques. We used the gold standard of image-guided biopsies, surgical excision, or long-term clinical and imaging follow-up.

RESULTS

Among 94 study patients, benign papillomas were identified in 42 (44.7%), abscess in one (1%), duct ectasia in four (4.3%), and malignancy (invasive ductal carcinoma or ductal carcinoma in situ) or high-risk lesion (atypical ductal hyperplasia) in 10 (10.6%). Forty-six patients (49%) underwent surgical excision; 89.1% of which had presurgical planning with ductography. In 35 (37.2%) with negative imaging, resolution of nipple discharge was confirmed on median clinical and imaging follow-up of 36 months. Two patients with negative imaging were lost to follow-up. Sensitivity, specificity, PPV, and NPV for accurately demonstrating the etiology of pathologic nipple discharge were 13%, 97%, 89%, and 37% respectively for mammography; 73%, 97%, 98%, and 64% respectively for ultrasound; 76%, 72%, 84%, and 61% respectively for ductography; 86%, 70%, 85%, and 72% respectively for combined ultrasound and ductography; and 75%, 100%, 100% and 67% respectively for DCE-MRI.

CONCLUSION

The combination of mammography, ultrasound and ductography is highly accurate for identifying the etiology of pathologic nipple discharge. DCE-MRI can be used as an alternate to ductography if necessary.

Transcriptome-wide analysis of wild Asari (=Manila) clams affected by the Brown Muscle Disease: Etiology and impacts of the disease

Recently, we reported an emerging pathology named Brown Muscle Disease (BMD) affecting Asari clams inhabiting the most productive area for this species in France, the Arcachon Bay. The main macroscopic feature of the pathology relies on the atrophy of the posterior adductor muscle, affecting the ability of clams to burry. The research of the etiological agent of BMD privileged a viral infection. Contrary to healthy clams, infected animals are always found at the surface of the sediment and exhibit 30 nm virus-like particles in muscle, granulocytic and rectal cells. In order to get more insights on the etiology and impacts of the BMD on clams, we took advantage in the present study of next generation sequencing technologies. An RNA-Seq approach was used (i) to test whether viral RNA sequences can be specifically found in the transcriptome of diseased animals and (ii) to identify the genes that are differentially regulated between diseased and healthy clams. Contrary to healthy buried animals, in diseased clams one sequence showing extensive homologies with retroviridae-related genes was detected. Among the biological processes that were affected in diseased clams, the synaptic transmission process was the most represented. To deepen this result, a new sampling was carried out and the transcription level of genes involved in synaptic transmission was determined in healthy and diseased clams but also in clams with no visible sign of pathology but located at the surface of the sediment. Our findings suggest that muscle atrophy is a latter sign of the pathology and that nervous system could be instead a primary target of the BMD agent.

Abstract P4-12-04: Use of complementary and integrative medicine therapies in Chilean patients with breast cancer. Experience of a private center: prevalence and characteristics of patients

Background: During the last decade several studies have been reported that the use of complementary and integrative medicine (CIM), defined as health care methods generated outside of standard Western, or conventional clinical practices has been increasing among breast cancer patients in developed countries. However, there is little information about the use of CIM in developing countries. Chile currently has no published statistics on the use of CIM in breast cancer.

Methods: We conducted a cross-sectional survey between March and June 2017 in breast cancer patients treated in Clinica Alemana de Santiago to determine the prevalence of CIM use and the types of preferred CIM. We also analyzed associations between CIM and several variables including sociodemographic variables, the reasons that motivated the use of CIM and the subjective benefits that patients attributed to CIM. Statistical analysis included two tailed t–test for continuous variables, Fischer's exact test for categorical variables and logistic regression for association between CIM use and other variables.

Results: 288 patients answered the survey. Among them, 98.9% were women, mostly between 41 and 50 years (40.4%). 44.9% (n = 129) reported using CIM. No association was found between the use of CIM and sociodemographic variables (sex, age, education, income). Most used CIM types were: vitamins / minerals (50.4%), herbs (48.8%), special diets (42.6%), meditation/prayers (37.2%). The reasons for CIM use were "to do everything possible" (72%), "improve immunity" (67.8%), "reduce side effects of treatment" (32.7%), recommendation by family member or friend (32.7%). Regarding CIM habits, 50.8% of patients reported having started CIM use at the time of diagnosis and only 51.6% reported about CIM use to their attending physician. Most patients reported benefits associated to CAM use (61%) but no differences were found in reported quality of life.

Conclusions: Great amount of the patients reported using CIM and half of them mentioned that they shared this information with their attending physician. It is necessary incorporate to medical routines questions regarding CIM use and to educate the patients regarding the safe use of CIM and the possible interactions of these approaches with conventional clinical practices.

Citation Format: Salas C, Lopez G, Cadiz F, Barriga C, Gonzalez P, Acevedo S, Raimilla P, Pincheira P, Naing A, Quiroga M. Use of complementary and integrative medicine therapies in Chilean patients with breast cancer. Experience of a private center: prevalence and characteristics of patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-12-04.

Abstract P5-05-14: Withdrawn

This abstract was withdrawn by the authors.

Citation Format: Elia AM, Rojas P, Liguori M, Gonzalez P, Caillet I, Martínez Vazquez P, Burruchaga J, Gass H, Lanari C. Withdrawn [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-05-14.

Tunable Plasma-Based Energy Dechirper

A tunable plasma-based energy dechirper has been developed at FLASHForward to remove the correlated energy spread of a 681 MeV electron bunch. Through the interaction of the bunch with wakefields excited in plasma the projected energy spread was reduced from a FWHM of 1.31% to 0.33% without reducing the stability of the incoming beam. The experimental results for variable plasma density are in good agreement with analytic predictions and three-dimensional simulations. The proof-of-principle dechirping strength of 1.8  GeV/mm/m significantly exceeds those demonstrated for competing state-of-the-art techniques and may be key to future plasma wakefield-based free-electron lasers and high energy physics facilities, where large intrinsic chirps need to be removed.

Rapid identification of Huanlongbing-infected citrus plants using laser-induced breakdown spectroscopy of phloem samples

Huanglongbing (HLB) is the most destructive disease of citrus worldwide. The disease is caused by the proto-bacteria Candidatus Liberibacter asiaticus and transmitted by the Asian citrus psyllid Diaphorina citri. HLB symptoms are slow to appear while the tree continues to be a source of inoculum. Monitoring tree health and rapid detection of HLB is critical for sustainable citrus production. Currently, scientists are working on developing new techniques for pre-symptomatic detection of HLB, as there is no available method for real-time assessment of tree health. In this study, we demonstrate the rapid and efficient discrimination between healthy and HLB-affected citrus by laser-induced breakdown spectroscopy combined with chemometric analysis. Healthy and HLB-affected trees were differentiated with a high degree of precision. The novelty of this method lies in the fingerprinting of healthy and diseased plants based on their organic and inorganic constituents, and the use of a multi-pulse laser coupled with a microscope to take spectra of the plant phloem.

Simvastatin interferes with cancer 'stem-cell' plasticity reducing metastasis in ovarian cancer

Cell plasticity of 'stem-like' cancer-initiating cells (CICs) is a hallmark of cancer, allowing metastasis and cancer progression. Here, we studied whether simvastatin, a lipophilic statin, could impair the metastatic potential of CICs in high-grade serous ovarian cancer (HGS-ovC), the most lethal among the gynecologic malignancies. qPCR, immunoblotting and immunohistochemistry were used to assess simvastatin effects on proteins involved in stemness and epithelial-mesenchymal cell plasticity (EMT). Its effects on tumor growth and metastasis were evaluated using different models (e.g., spheroid formation and migration assays, matrigel invasion assays, 3D-mesomimetic models and cancer xenografts). We explored also the clinical benefit of statins by comparing survival outcomes among statin users vs non-users. Herein, we demonstrated that simvastatin modifies the stemness and EMT marker expression patterns (both in mRNA and protein levels) and severely impairs the spheroid assembly of CICs. Consequently, CICs become less metastatic in 3D-mesomimetic models and show fewer ascites/tumor burden in HGS-ovC xenografts. The principal mechanism behind statin-mediated effects involves the inactivation of the Hippo/YAP/RhoA pathway in a mevalonate synthesis-dependent manner. From a clinical perspective, statin users seem to experience better survival and quality of life when compared with non-users. Considering the high cost and the low response rates obtained with many of the current therapies, the use of orally or intraperitoneally administered simvastatin offers a cost/effective and safe alternative to treat and potentially prevent recurrent HGS-ovCs.

Identification of sieve elements and companion cell protoplasts by a combination of brightfield and fluorescence microscopy

PREMISE OF THE STUDY

Phloem-limited diseases are becoming increasingly pervasive, threatening the existence of crops worldwide. Studies of phloem diseases are complicated by the inaccessibility of the phloem tissue. Phloem cells are located deep inside the plant body, are interspersed with other cell types, are among the smallest cells in the plant kingdom, and make up a small percentage of the total cell population in a plant. These properties make phloem cells difficult to investigate.

METHODS

We used leaf midrib protoplasts and a combination of organelle-specific dyes including Neutral Red (acidic compartments), MitoTracker Green (mitochondria), Hoechst 3342 (nucleus), and chloroplast autofluorescence. We examined the protoplasts under light and fluorescence microscopy.

RESULTS

When observed using brightfield and fluorescence microscopy, sieve element protoplasts were distinguished by the lack of vacuole and a nucleus, and by containing various mitochondria. Companion cells showed a dense cytoplasm and various small vacuoles. They also revealed their characteristic large nucleus and abundant mitochondria.

DISCUSSION

We present evidence that a combination of organelle-specific dyes and autofluorescence allows for the identification of sieve elements and companion cell protoplasts from citrus leaf tissue.

Consensus recommendations for trabecular meshwork cell isolation, characterization and culture

Cultured trabecular meshwork (TM) cells are a valuable model system to study the cellular mechanisms involved in the regulation of conventional outflow resistance and thus intraocular pressure; and their dysfunction resulting in ocular hypertension. In this review, we describe the standard procedures used for the isolation of TM cells from several animal species including humans, and the methods used to validate their identity. Having a set of standard practices for TM cells will increase the scientific rigor when used as a model, and enable other researchers to replicate and build upon previous findings.

Abstract OT1-04-02: Mifepristone treatment for breast cancer patients expressing levels of progesterone receptor isoform A (PRA) higher than those of isoform B (PRB)

Seventy percent of breast cancers express estrogen (ER) and progesterone receptors (PR) and respond to antiestrogen therapies. Emerging evidence from experimental studies and human epidemiology, points to a relevant role for progestins in breast carcinogenesis and cancer growth. Others and we have proposed that there is a role for antiprogestins in the therapeutic armamentarium, but the challenge remains to identify which patients would benefit from targeting the PR in addition to ER. Preclinical data indicates that antiprogestins block cell proliferation and increase apoptosis only in ER+ breast cancers expressing levels of PRA higher than those of PRB. The aim of this study is to evaluate the therapeutic effects of Mifepristone (MFP) on breast cancer patients selected by their PRA/PRB isoform ratio, for 14 days in between core biopsy and surgery (MIPRA trial ClinicalTrials.gov Identifier: NCT02651844). Methods: This is an open label, interventional with single group assignment study. We perform core biopsies on menopausal patients with clinically palpable breast cancers larger than 1.5 cm to confirm diagnosis. We will assess the PRA/PRB ratio by western blotting in frozen samples and total PR in formalin-fixed samples by immunohistochemistry (IHC). Twenty eligible PR+ patients (PR &gt; 50 %) with PRA/PRB ≥1.5 who have signed consent forms, and meet the inclusion criteria will be recruited. Patients will be treated for 14 days with MFP p.o 200 mg. Surgery will be performed on day 15. Samples will be frozen for molecular studies or fixed for IHC. The primary outcome is the evaluation of Ki-67 staining pre- and post treatment. Secondary outcomes include comparatively expression of proliferation/apoptosis/PR signaling markers in core and surgical biopsy samples. Other pre-specified outcomes include molecular profiling, study of liquid biopsies, mammography, and ultrasound studies. Wilcoxon signed rank test will be used to evaluate differences in biomarker expression between core biopsy and surgical samples of each patient.

Citation Format: Liguori M, Lanari C, Gass H, Rojas P, Elia A, Martinez Vazquez P, Burruchaga J, Gonzalez P, Caillet Bois I, Ventura C, San Martin G, Castets A, Lovisi S, Acosta Haab G, Lamb C, Fabris V, Novaro V, Molinolo A. Mifepristone treatment for breast cancer patients expressing levels of progesterone receptor isoform A (PRA) higher than those of isoform B (PRB) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT1-04-02.

Recruitment manoeuvres in anaesthesia: How many more excuses are there not to use them?

Pulmonary recruitment manoeuvres (RM) are intended to reopen collapsed lung areas. RMs are present in nature as a physiological mechanism to get a newborn to open their lungs for the first time at birth, and we also use them, in our usual anaesthesiological clinical practice, after induction or during general anaesthesia when a patient is desaturated. However, there is much confusion in clinical practice regarding their safety, the best way to perform them, when to do them, in which patients they are indicated, and in those where they are totally contraindicated. There are important differences between RM in the patient with adult respiratory distress syndrome, and in a healthy patient during general anaesthesia. Our intention is to review, from a clinical and practical point of view, the use of RM, specifically in anaesthesia.