Clinical features and immune mechanisms directly linked to the altered liver function in patients with rheumatoid arthritis

BACKGROUND

The aim of this study was to explore the impact of arthritis on liver function using different approaches in vivo and in vitro.

METHODS

A cross-sectional study was performed on 330 non-obese/non-T2DM subjects: 180 RA patients, 50 NAFLD non-RA patients, and 100 healthy donors (HDs). A longitudinal study was conducted on 50 RA patients treated with methotrexate for six months. Clinical and laboratory parameters and markers of liver disease were collected. Mechanistic studies were carried out in both the CIA mouse model and hepatocytes treated with anti-citrullinated protein antibodies (ACPAs).

RESULTS

RA patients have an increased risk of suffering from liver disease independent of obesity or T2DM. This risk was associated with factors such as insulin resistance, autoantibodies, inflammation, and component C3. Methotrexate treatment for six months was associated with liver abnormalities in those newly-diagnosed patients having CV risk factors. ACPAs induced a defective hepatocyte function, promoting IR and inflammation. The induction of arthritis in mice caused the infiltration of immune cells in the liver and increased inflammatory, apoptotic, and fibrotic processes.

CONCLUSION

RA patients may experience mild to moderate liver inflammation due to the infiltration of T, B cells, and macrophages, and the action of ACPAs. This is independent of obesity or diabetes and linked to systemic inflammation, and disease activity levels. The negative effects of methotrexate on liver function could be restricted to the concomitant presence of cardiovascular risk factors.

Splicing machinery is profoundly altered in systemic lupus erythematosus and antiphospholipid syndrome and directly linked to key clinical features

OBJECTIVES

To characterize the splicing machinery (SM) of leukocytes from primary antiphospholipid syndrome (APS), systemic lupus erythematosus (SLE) and antiphospholipid syndrome with lupus (APS + SLE) patients, and to assess its clinical involvement.

METHODS

Monocytes, lymphocytes and neutrophils from 80 patients (22 APS, 35 SLE and 23 APS + SLE) and 50 HD were purified, and 45 selected SM components were evaluated by qPCR-microfluidic array. Relationship with clinical features and underlying regulatory mechanisms were assessed.

RESULTS

APS, SLE and APS + SLE leukocytes displayed significant and specific alterations in SM-components (SMC), associated with clinical features [autoimmune profiles, disease activity, lupus nephritis (LN), and CV-risk markers]. A remarkable relationship among dysregulated SMC in monocytes and the presence of LN in SLE was highlighted, revealing a novel pathological mechanism, which was further explored. Immunohistology analysis of renal biopsies highlighted the pathological role of the myeloid compartment in LN. Transcriptomic analysis of monocytes from SLE-LN(+) vs SLE-LN(-) identified 271 genes differentially expressed, mainly involved in inflammation and IFN-signaling. Levels of IFN-related genes correlated with those of SMC in SLE-LN(+). These results were validated in two external SLE-LN(+) datasets of whole-blood and kidney biopsies. In vitro, SLE-LN(+)-serum promoted a concomitant dysregulation of both, the IFN signature and several SMC, further reversed by JAKinibs treatment. Interestingly, IFNs, key inflammatory cytokines in SLE pathology, also altered SMC. Lastly, the over/down-expression of selected SMC in SLE-monocytes reduced the release of inflammatory cytokines and their adhesion capacity.

CONCLUSION

Overall, we have identified, for the first time, a specific alteration of SMC in leukocytes from APS, SLE and APS + SLE patients that would be responsible for the development of distinctive clinical profiles.

Benefits of applying organic amendments from recycled wastes for fungal community growth in restored soils of a limestone quarry in a semiarid environment

Applying organic amendments to recover physical, chemical, and biological qualities of soil may enable recovery of soils degraded by mining in semiarid climates. This study's aim was to investigate the development and changes in the composition of fungal communities in restored soils with five different types of organic amendments (two types of vegetable compost and sewage sludge compost, and a mixture of both) compared with unamended soils and surrounding natural soils and to examine the relationships between the fungal taxa, the new physico-chemical and biological soil properties of technosoils after 18 months of restoration, and natural soils. Restoration improved soil quality and fungal diversity, placing these soils in an intermediate position between unrestored soils (with no fungi present) and undisturbed reference soils, which were the most fungal diverse. Sewage-treated soils and their mixtures showed high nitrogen and carbohydrate content as well as high basal respiration and fatty acid content, suggesting that they provided readily biodegradable organic matter. In contrast, greenhouse compost-treated soils showed high total organic carbon and polyphenol content, whereas garden compost-treated soils showed intermediate values. The biological soil properties of both composts showed were similar to those of the reference soils, suggesting that composts contained more resilient organic matter. Organic amendments of dissimilar origin caused significantly different fungal soil communities at the genus level among the restored soils. Results indicated that soil pH, electrical conductivity, total nitrogen content, soil basal respiration, fungi/bacteria-PLFA ratio, and dehydrogenase and β-glucosidase activities, together with Pearson's correlations, revealed that these properties and nutrient content (total organic carbon, C/N ratio, carbohydrates, and polyphenols) influenced 40 soil fungal taxa. Therefore, the organic amendments led to changes in soil properties that favoured plant cover by promoting the soil fungal community growth beneficial to the carbon cycle and symbiotic with plants.

Sinus bradycardia as the initial manifestation of multisystem inflammatory syndrome in children

Background

While cardiovascular complications, including arrhythmias are now a recognized manifestation of Multisystem inflammatory syndrome in children (MIS-C), there are no reports of primary bradycardia preceding the clinical presentation. We sought to describe a case series of sinus bradycardia as an initial manifestation of MIS-C.

Methods

We included a series of 10 consecutive patients with confirmed COVID-19 who met WHO and CDC criteria for MIS-C, who developed sinus bradycardia with a heart rate measured in the awake state that was below the normal range for age for children, as an initial manifestation of the disease, in a prospective observational multicenter study. Patients underwent clinical, laboratory evaluation, ECG, Holter, telemetry, echocardiogram, chest X Ray, and a chest CT scan.

Results

Of the 10 patients included, 6 were male, with a mean age of 6.52±5.35 years, range 4 months to 14 years. All cases were Hispanic. Bradycardia was transient and did not merit treatment. Coronary abnormalities were noted in 6 cases; 4 patients had mild coronary ectasia; 9 patients had pericardial effusion with no evidence of tamponade. All patients had a mild clinical course; none had shock, heart failure, the need for mechanical ventilation, or died. All blood markers (Troponin, BNP, Platelet count, C-reactive protein, D-dimer, Ferritin) returned to normal levels by discharge/follow-up with a favorable outcome including resolution of coronary dilatation in all but 2 in which aneurysm persisted.

Treatment

All patients received steroids and low-weight-molecular heparin 10 patients, 8 aspirin and 8 intravenous immunoglobulins.

Conclusion

Sinus bradycardia may be the initial manifestation of MIS-C, usually transient and mild. Physicians should be aware of this presentation.

Funding Acknowledgement

Type of funding sources: None.

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

Background

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

Purpose

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

Methods

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

Results

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

Conclusions

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

Funding Acknowledgement

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

Soil amendments from recycled waste differently affect CO₂ soil emissions in restored mining soils under semiarid conditions

Drylands affected by serious disturbances such as mining activities lose their vegetation cover and organic soil horizons, becoming CO₂ emissions sources. Applications of organic amendments could be a good restoration solution that favours vegetation establishment and soil carbon sequestration; however, they are also associated with CO₂ emissions. Experimental plots with different organic amendments (sewage sludge, garden and greenhouse vegetable composts, and mixtures of both) and unamended soils were installed in a quarry in southeast Spain. The aim of this study was: i) to evaluate the magnitude and changes of in situ CO₂ emission from each experimental plot during a year and a half, and ii) to assess the effects of several physical-chemical (total organic carbon, total nitrogen, water retention, pH and electrical conductivity) and environmental parameters (moisture and temperature) in CO₂ emissions. The results showed an initial CO₂ emission (priming effect), produced from all restored plots just after the application of the organic amendment, which was significantly higher (P < 0.05) in soils with sewage sludge and their mixtures in comparison to vegetable compost. Garden compost had low emission rates, similar to soils without amendment and showed lower CO₂ emission rates than the rest of the restoration treatments. Nevertheless, CO₂ emissions decreased in each field campaign over time, showing that all restored soils had lower emissions than natural soils at the end of the sampled period. The different composition of organic amendments had a different effect on soil CO₂ emissions. DistLM analysis showed that soil properties such as total organic carbon, total nitrogen, pH and soil moisture, associated with rainfall periods, strongly influenced CO₂ emissions, whereas temperature did not affect the CO₂ flow. In conclusion, the compost from plant remains could serve better as treatment to restore degraded soils in drylands than sewage sludge because of its lower CO₂ emissions and concomitant effect on climate warming and carbon balance.

Quarry restoration treatments from recycled waste modify the physicochemical soil properties, composition and activity of bacterial communities and priming effect in semi-arid areas

The selection of a suitable organic amendment for recovery of semi-arid soils degraded by mining is key to the success of an ecological restoration. The aim of this research is to study the short-term responses of physicochemical, biochemical and biological properties, as well as the changes of a soil bacterial community at the genus level after application of five types of organic amendments in a limestone quarry in Almería (SE, Spain). The relationship among bacterial taxa with biochemical and physicochemical properties and priming effect from restored soils was also analysed. Six months after the application of organic amendments, the values of different soil status, such as total organic carbon, total nitrogen, assimilable phosphorus and labile organic matter forms (carbohydrates and polyphenols), basal respiration (BR) and enzymatic activities increased significantly with respect to unrestored soils. Similarly, a positive priming effect of soil organic matter mineralisation was produced by all organic amendments, being significantly higher (p < 0.05) in sewage sludge-treated soils. Bacterial diversity was higher in restored than in control soils. The restoration caused changes in soil bacterial communities' composition at the phylum and genus levels. It was observed that soil bacterial communities were significantly related to several physical, chemical and biochemical soil properties, establishing two different co-occurrence patterns between restored and unrestored soils. A first bacterial co-occurrence pattern showed significant positive correlations to pH and C/N ratio and negativity with the rest of the soil properties. The second bacterial pattern was positively correlated with carbohydrates, μg of C, priming effect, BR, β-glucosidase and phosphatase and negatively with pH and C/N ratio. It was concluded that soil bacterial communities are clearly influenced by the types of organic amendments applied. Bacterial taxa such as Taibaiella or Pseudomonas could perform key functions in the carbon cycle in restored soils.

Urinary chlorine: a potential biomarker of diuretic resistant patients

Background

Natriuresis is gaining growing interest in identifying diuretic resistance (DR) patients. However, it has not been proved useful beyond the first day with intravenous (iv) furosemide. Moreover, data regarding urinary chlorine (uCl) or urinary potassium (uK) are scarce. We sought to assess the urine electrolyte pattern in acute heart failure (AHF) outpatients to identify those who will present DR.

Methods

Single-center prospective registry of outpatients with AHF who need iv furosemide. In visit 1 (V1), baseline spot urine sample was collected. Furosemide iv bolus plus intensification of oral diuretics were performed. In control visit (V2), baseline spot urine sample was collected and congestion data were evaluated. Urine electrolytes were assessed in relation to DR (defined as need of iv furosemide in V2 due to persistent congestion).

Results

From June to December 2019, 76 patients were included: median age of 75.5 years (68.2–82), glomerular filtration 40 ml/min/1.73m2 (29.2–59.2) and NT-proBNP 3340 ng/L (1296–7044).

In V1, DR patients showed higher levels of uK and lower uNa/uK than NDR (p=0.014 and p=0.007, respectively). In V2, after a median of 6 (6–15) days of intensified diuretic treatment, uNa and uCl dropped with adequate decongestion but not in DR patients (p=0.020 and p=0.001, respectively). Thus, DR patients showed in V2 higher uCl and similar uNa than NDR (table).

Conclusions

After several days of intensified diuretic treatment, uCl and uNa dropped during proper decongestion but not in DR patients, showing higher levels of uCl than NDR. Mantained levels of uCl could help to identify patients with persistent congestion.

Funding Acknowledgement

Type of funding source: None

Sub-clustering in skeletal class III malocclusion phenotypes via principal component analysis in a southern European population

The main aim of this study was to generate an adequate sub-phenotypic clustering model of class III skeletal malocclusion in an adult population of southern European origin. The study design was conducted in two phases, a preliminary cross-sectional study and a subsequent discriminatory evaluation by main component and cluster analysis to identify differentiated skeletal sub-groups with differentiated phenotypic characteristics. Radiometric data from 699 adult patients of southern European origin were analyzed in 212 selected subjects affected by class III skeletal malocclusion. The varimax rotation was used with Kaiser normalization, to prevent variables with more explanatory capacity from affecting the rotation. A total of 21,624 radiographic measurements were obtained as part of the cluster model generation, using a total set of 55 skeletal variables for the subsequent analysis of the major component and cluster analyses. Ten main axes were generated representing 92.7% of the total variation. Three main components represented 58.5%, with particular sagittal and vertical variables acting as major descriptors. Post hoc phenotypic clustering retrieved six clusters: C1:9.9%, C2:18.9%, C3:33%, C4:3.77%, C5:16%, and C6:16%. In conclusion, phenotypic variation was found in the southern European skeletal class III population, demonstrating the existence of phenotypic variations between identified clusters in different ethnic groups.

Long-term effects of two organic amendments on bacterial communities of calcareous mediterranean soils degraded by mining

The application of organic amendments to improve the chemical and biological properties of degraded soils from calcareous quarries is necessary to accelerate restoration processes. The aim of this study is to assess the success of different restoration treatments in the long-term using two organic amendments (sewage sludge from urban waste water (SS) and compost from domestic solid waste (CW)). The chemical properties and bacterial communities of restored soils were compared with unamended soils (NA) and surrounding natural soils (NS) from a limestone quarry in a semi-arid ecosystem. After 10 years of the addition of organic amendments, the abundance of soil bacteria, diversity, and taxonomic composition at the phylum and genus level in each soil type was analysed by rRNA 16 S amplification (PCR), sequencing using Illumina, and comparison with the SILVA database using QIIME2 software. The relationships between soil bacterial taxa and chemical soil properties (pH, electrical conductivity (EC), total organic carbon (TOC), and total nitrogen content (TN)) were also studied, as well as the interrelations between soil bacterial taxa at the genus level or the next upper taxonomic level identified. The organic amendments changed the chemical properties of the restored soils, influencing the microbial communities of the restored soils. CW treatment was the organic amendment that most resembled NS, favouring in the long-term a greater diversity and proliferation of bacteria. Several bacterial communities, more abundant in NA and CW soils, were strongly correlated with each other (Craurococcus, Phaselicystis, Crossiella, etc.), forming a bacterial co-occurrence pattern (Co-occurrence pattern 1). Those bacteria showed high significant positive correlations with TOC, TN, and EC and negative correlations with the soil pH. In contrast, NA soils presented other groups of bacterial communities (Co-occurrence pattern 2) represented by Sphingomonas, Rubellimicrobium, Noviherbaspirillum, Psychroglaciecola and Caenimonas, which showed high significant positive correlations with soil pH and negative correlations with TOC, TN, and EC. The distance-based redundancy analysis indicated that SS soils remained in an intermediate stage of chemical and biological quality between NS and NA soils. Our results demonstrate that soil chemical properties and soil bacterial communities significantly changed with organic amendments in calcareous Mediterranean soils degraded by mining.

Effect of biocrusts on bacterial community composition at different soil depths in Mediterranean semi-arid ecosystems

This study analyzed the influence of biocrusts on the chemical properties and bacterial diversity and community composition in the underlying soils along a depth gradient (the biocrust (C1), middle (S2) and deep (S3) soil layers) in two semi-arid Mediterranean ecosystems. Organic carbon, pH, electric conductivity and calcium carbonate content were estimated by wet oxidation, potentiometrically (pHmeter), with a conductivity-meter and volumetrically with a Bernard calcimeter, respectively. Bacterial diversity and community composition were estimated by 16S rRNA gene high-throughput amplicon sequencing. Chemical properties in C1 were significantly different from the other soil layers, showing higher organic carbon content and lower pH (p < 0.05). The relative abundance of several bacterial taxa, such as Bryocella, Methylobacterium, Segitebacter and Actinomycetospora showed significant positive correlations with organic carbon (r = 0.53 to 0.75) and negative with pH (r = -0.72 to -0.84), and were also highly correlated with each other (p < 0.01), suggesting a bacterial co-occurrence pattern associated with the biocrust. On the contrary, other bacterial taxa, such as Euzebyaceae, Truepera, Alphaproteobacteria and Caldinilaceae, showed positive correlations with electrical conductivity and calcium carbonate and were also correlated with each other (p < 0.01), in a second type of co-occurrence pattern associated with bare soil. The C1 and S2 layers had several taxa in common, while S3 layers had taxa common to bare soil, suggesting that the effect of biocrusts was limited to the first centimeters of soil and progressively decreased in depth. Bacterial diversity was lower in C1 than in the underlying layers and increased progressively from biocrust to deeper soil layers. The results suggest that the diversity and composition of soil microbial communities in biologically crusted sites in Mediterranean semi-arid environments are mainly controlled by chemical properties which in turn are modified by the biocrust along a depth gradient.

International Nosocomial Infection Control Consortium (INICC) report, data summary of 45 countries for 2012-2017: Device-associated module

BACKGROUND

We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2012 to December 2017 in 523 intensive care units (ICUs) in 45 countries from Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific.

METHODS

During the 6-year study period, prospective data from 532,483 ICU patients hospitalized in 242 hospitals, for an aggregate of 2,197,304 patient days, were collected through the INICC Surveillance Online System (ISOS). The Centers for Disease Control and Prevention-National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI) were applied.

RESULTS

Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the medical-surgical ICUs, the pooled central line-associated bloodstream infection rate was higher (5.05 vs 0.8 per 1,000 central line-days); the ventilator-associated pneumonia rate was also higher (14.1 vs 0.9 per 1,000 ventilator-days,), as well as the rate of catheter-associated urinary tract infection (5.1 vs 1.7 per 1,000 catheter-days). From blood cultures samples, frequencies of resistance, such as of Pseudomonas aeruginosa to piperacillin-tazobactam (33.0% vs 18.3%), were also higher.

CONCLUSIONS

Despite a significant trend toward the reduction in INICC ICUs, DA-HAI rates are still much higher compared with CDC-NHSN's ICUs representing the developed world. It is INICC's main goal to provide basic and cost-effective resources, through the INICC Surveillance Online System to tackle the burden of DA-HAIs effectively.

Biocrust cover and successional stages influence soil bacterial composition and diversity in semiarid ecosystems

Biocrusts are an important drylands landscape component, which enriches the upper millimeters of the soil with organic matter and initiates biogeochemical cycles. However, little is known about the influence of biocrusts on soil bacterial community structure and diversity. Different biocrust types representing a successional gradient were studied. This gradient, from the earliest to the latest successional stages, consisted of an incipient cyanobacterial biocrust < mature cyanobacterial biocrusts < biocrust dominated by the Squamarina lentigera and Diploschistes diacapsis lichens < Biocrust characterized by the Lepraria isidiata lichen. Moreover, in each biocrust type, four different percentages of biocrust cover were also selected. Soil diversity gradually increased with biocrust successional stage and percentage of biocrust cover. The biocrust cover had an important role in the total abundance of bacteria, generally increasing in soils colonized by the highest percentages of cover. Biocrust successional stage was the most important factor, significantly influencing 108 soil bacteria genera, whereas biocrust cover showed significant differences in only 10 genera. Principal Component Analysis showed contrasting microbial composition across the biocrust successional gradient. Some bacterial taxa were dominant in the soil colonized by different biocrust types. Thus, Leptolyngbya, Rubrobacter, Solirubrobacter, Geodermatophilus, etc., were more abundant in incipient cyanobacteria; Nostocales, Chroococcidiopsaceae, Coleofasciculaceae etc., under mature cyanobacterial biocrusts; Truepera, Sphingobacteriaceae, Actinophytocola, Kribella, etc., below the S. lentigera and D. diacapsis community, and Bryobacter, Ohtaekwangia, Opitutus, Pedosphaeraceae, etc., in soils colonized by L. isidiata. Several soil bacteria taxa showed significant correlations (p < 0.05) with chemical soil properties (pH, total nitrogen, total organic carbon, available phosphorous and electrical conductivity). We discuss the role of biocrusts influencing these chemical soil parameters, including the presence of certain metabolites secreted by biocrusts, and also their effects on soil moisture and several physical soil features, as well as their association with different microclimates, all of which could favor a more selective environment for certain bacteria.

Immediate fire-induced changes in soil microbial community composition in an outdoor experimental controlled system

Short-term fire-induced changes to the soil microbial community are usually closely associated to fire severity, which essentially consists in the fire-induced loss or decomposition of organic matter above ground and below ground. Many functional processes and soil properties, including plant recolonization and soil microorganism activity, depend on fire severity. Seven days after burning, we evaluated the impact of two fire severities (low and high) on basic soil properties and the microbial communities in an outdoor experimental controlled system composed of six forest soil monoliths. The magnitude of change in microbial community was far greater than the change in physical and chemical soil properties. Total N was the only selected soil property that significantly varied depending on fire severity. The severely burned soils experienced significant changes in overall microbial biomass composition and phylogenetic composition of bacterial communities in comparison with control plots. Immediately after the fire, in fact, phyla and genera such as Acidobacteria-Gp4 or Bacteroidetes-Ohtaekwangia were much more abundant in the control monoliths. On the other hand, Firmicutes or Proteobacteria (e.g. Firmicutes Paenibacillus, Proteobacteria Phenylobacterium) were relatively more abundant in the monoliths burned with high severity in comparison with the low severity burned ones. Overall, the effect of fire on soil microbial communities was greater in the high severity burned monoliths than in the low severity burned ones. We concluded that in Mediterranean forest ecosystems, fire significantly alters soil bacterial composition depending on its severity.

Visual Immunoprecipitate Assay Eight Hour Method for Detection of Enterohemorrhagic Escherichia coli O157:H7 in Raw and Cooked Beef (Modification of AOAC Official Method 996.09): Collaborative Study

AOAC Official Method 996.09, Visual Immunoprecipitate Assay (VIP®) for Escherichia coli O157:H7, was modified to incorporate a new enrichment protocol using BioControl EHEC8™ medium for testing raw and cooked beef. Foods were tested by VIP assay and the U.S. Department of Agriculture/Food Safety and Inspection Service (USDA/FSIS) enrichment procedure and the FDA Bacteriological Analytical Manual (BAM) isolation and confirmation techniques. A total of 15 collaborators participated. Raw and cooked ground beef were inoculated with E. coli O157:H7 at 2 different levels: a high level, where predominantly positive results were expect d, and a low level where fractional recovery was anticipated. Collaborators tested 396 test portions and controls by both methods, for a total of 792 test portions. Of the 396 paired test portions, 75 were positive and 230 were negative by both the VIP and culture methods. Eleven test portions were presumptively positive by VIP and could not be confirmed culturally; 32 were negative by VIP, but confirmed positive by culture; and 65 were negative by the culture method, but confirmed positive by the VIP method. There was no statistical difference between results obtained with the VIP for EHEC 8 h method and the culture method except for cooked beef, where the VIP had significantly higher recovery for one inoculation level.

Assurance® Enzyme Immunoassay Eight Hour Method for Detection of Enterohemorrhagic Escherichia coli O157:H7 in Raw and Cooked Beef (Modification of AOAC Official Method 996.10): Collaborative Study

AOAC Official Method 996.10, Assurance® Enzyme Immunoassay (EIA) for Escherichia coli O157:H7 (EHEC), was modified to incorporate a new enrichment protocol using BioControl EHEC8™ medium for testing raw and cooked beef. Foods were tested by EIA and the U.S. Department of Agriculture/Food Safety and Inspection Service (USDA/FSIS) enrichment conditions and the FDA Bacteriological Analytical Manual (BAM) isolation and confirmation techniques. A total of 14 collaborators participated. Raw and cooked ground beef were inoculated with E. coli O157:H7 at 2 different levels: a high level where predominantly positive results were expected, and a low level where fractional recovery was anticipated. Collaborators tested 378 test portions and controls by both the 8 h EIA and the USDA/FSIS enrichment methods, for a total of 756 test portions. Of the 378 paired test portions, 75 were positive and 212 were negative by both methods. Thirteen test portions were presumptively positive by EIA and could not be confirmed culturally; 30 were negative by EIA, but confirmed positive by culture; and 65 were negative by the culture method, but confirmed positive by the EIA method. There was no statistical difference between results obtained with the Assurance EIA for EHEC 8 h method and the culture method for raw ground beef. The Assurance EIA had a significantly higher recovery for cooked beef.

Abstract P2-08-58: Prognostic factors of survival in node positive breast cancer patients after neoadjuvant chemotherapy in a large series after 5y follow-up: Can response overcome the poor prognosis of nodal stage?

Background: Status of the axilla is one of the most significant prognostic factors in breast cancer (BC) patients. On the other hand, response to neoadjuvant chemotherapy (NACT) is related to survival. The aim of the present study is to analyze which prognostic factors impact most on Node positive (N+) BC patient survival after NATC. Material and methods: Retrospective analyses on a series of N+ BC patients treated with NATC based on anthracyclines and taxanes +/- trastuzumab if HER2 positive tumors, between June 2008 and December 2016. Clinical, radiological and pathological outcomes have been evaluated. Residual cancer burden (RCB) 1 and the neoadjuvant response index (INR) 2 have been recorded. Survival was calculated with Kaplan-Meier survival curve since the start of NATC to the first documented disease recurrence (DFS) or death (OS). Hazard ratios (HRs) with 95% CIs were estimated with cox proportional hazards regression analysis and subgroups were compared with a two-sided log-rank test. Results: A total of 345 N+ BC patients were included. Pathological complete response was achieved in 72 (20.8%) patients. After NACT, 137 (39.6%) become ypN0, 9 (2.6%) ypN1 mic, 113 (32.7%) ypN1, 60 (17.3%) ypN2 and 26 (7.6%) N3. Those independent predictive factor of ypN0 were molecular subtype (TN and Her2+) with OR: 7.7, p&lt;0.001 and clinical response with OR 6.88, p: 0.04. At a mean follow-up of 58 months there have been 73 (21.1%) recurrences: 9 (2.3%) local, 45 (13%) systemic, 15 (4.3%) systemic+ local, 3 (0.9%) axilla, 1 (0.3%) supraclavicular. The estimated 5y OS was 87.8%. The univariate analysis according to DSF is detailed in Table1.

Adjusted univariate anaalysis cox regression of clinical and pathological factors of desease free survivalBMI10.989-1.010.963AGE0.9960.953-1.0420.876Dose NATC0.9940.979-1.0080.402Clinical Stage1.4021.077-1.8260.012Rx Image1.260.803-1.9940.311Rx size1.0090.995-1.0240.217Number suspicious ALN1.0950.801-1.4970.57Molecular subtype TN,HER20.8800.534-1.450.616Nottinghan grade1.0460.753-1.4530.789Histological subtype1.4651.044-2.0570.27MOlecular subtype1.1510.956-1.3850.137Vascular invasion1.6761.137-24710.009Clinical response2.3691.709-3.284&lt;0.001Fibrosis tumor bed0.980.972-0.989&lt;0.001Nodal fibrosis&gt;50%1.7950.874-3.6860.111Pathological tumoral response1.6861.175-2.4180.005ypN03.561.853-6.838&lt;0.001NRI0.330.192-0.565&lt;0.001RCB1.2741.106-1.4680.001

In the multivariate model those parameters that were independently prognostic were clinical response HR: 5.44 (IC95% 2.275-13.042, p&lt;0.001) and clinical stage HR: 2.364 (IC95% 1.018-5.490, p: 0.045). Conclusions: The most significant prognostic factor in our N+ series was response to NATC, followed by clinical stage. Those independently predictive factors of axillar response (ypN0) were molecular subtype (TN and Her2+) and clinical response. In conclusion, in those patients with chemo sensitive tumors, lymphadenectomy could be safely spared with a more selective axillary approach.

Citation Format: Fernandez S, Garcia A, Vethencourt A, Vazquez S, Petit A, Pla MJ, Ortega R, Pérez J, Gil M, Ponce J, Pernas S, Lopez A, Falo C. Prognostic factors of survival in node positive breast cancer patients after neoadjuvant chemotherapy in a large series after 5y follow-up: Can response overcome the poor prognosis of nodal stage? [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 P2-08-58.

Influence of short implants geometry on primary stability

BACKGROUND

A correct design is needed in short implants to improve primary stability (PS) in low quality bone. This study aimed to compare PS of double thread and single thread short implants.

MATERIAL AND METHODS

Thirty implants with single thread design (PHI/SHORT-I) and 30 implants with double thread design (PHIA/SHORT-I) (Radhex®, Inmet-Garnick S.A., Guadalajara, Spain) were placed in 30 randomly selected bovine ribs. PS was assessed in implant stability quotients (ISQ) and periotest values (PV) with Osstell™ and Periotest® devices, respectively. Computed tomographies of the ribs were taken and bone quality was evaluated in Hounsfield Units (HU) using Ez3D Plus software (Vatech Co., Korea). Only implants placed in low quality bone according to Misch and Kircos classification were selected (D3 bone: 350-850 HU; and D4 bone: 150-350 HU). Ten implants were not included in the study for being placed in D1 and D2 bone. Finally, 50 implants were selected: 17 and 9 PHI/SHORT-I in D3 and D4 bone respectively, and 15 and 9 PHIA/SHORT-I in D3 and D4 bone respectively.

RESULTS

The one-way ANOVA showed statistically significant differences in ISQ (61.35 ± 4.77 in PHI/SHORT-I and 66.43 ± 4.49 in PHIA/SHORT-I, P<0.005) and PV (-2.76 ± 0.8 and -4.11 ± 1.24 respectively, P<0.005) between two implant designs in D3 bone, and statistically significant differences in ISQ (53.44 ± 3.34 in PHI/SHORT-I and 60.56 ± 1.53 in PHIA/SHORT-I, P<0.0001) and PV (1.13 ± 0.95 and -2.5 ± 0.61 respectively, P<0.0001) between two groups in D4 bone.

CONCLUSIONS

Double thread design short implants resulted to have higher PS in comparison with single thread design short implants in D3 and D4 bone.

Defective glucose and lipid metabolism in rheumatoid arthritis is determined by chronic inflammation in metabolic tissues

BACKGROUND

Rheumatoid arthritis (RA) patients are at increased risk of insulin resistance (IR); however, the specific mechanisms mediating this association are currently unknown.

OBJECTIVE

To investigate whether the inflammatory activity associated with RA accounts for the observed defective glucose metabolism and lipid metabolism in these patients.

METHODS

We followed two main strategies: (i) extensive metabolic profiling of a RA cohort of 100 patients and 50 healthy control subjects and (ii) mechanistic studies carried out in both a collagen-induced arthritis mouse model and 3T3-L1 adipocytes treated with conditioned serum from RA patients.

RESULTS

Following the exclusion of obese and diabetic subjects, data from RA patients demonstrated a strong link between the degree of systemic inflammation and the development of IR. These results were strengthened by the observation that induction of arthritis in mice resulted in a global inflammatory state characterized by defective carbohydrate and lipid metabolism in different tissues. Adipose tissue was most susceptible to the RA-induced metabolic alterations. These metabolic effects were confirmed in adipocytes treated with serum from RA patients.

CONCLUSIONS

Our results show that the metabolic disturbances associated with RA depend on the degree of inflammation and identify inflammation of adipose tissue as the initial target leading to IR and the associated molecular disorders of carbohydrate and lipid homeostasis. Thus, we anticipate that therapeutic strategies based on tighter control of inflammation and flares could provide promising approaches to normalize and/or prevent metabolic alterations associated with RA.

Maxillary sinus balloon lifting and deferred implantation of 50 osseointegrated implants: a prospective, observational, non-controlled study

The aim of this study was to assess the effectiveness of minimally invasive antral membrane balloon elevation (MIAMBE). Twenty-seven patients with severe resorption of the posterior maxilla were treated by balloon catheter-assisted sinus lift procedure with deferred implant placement. Panoramic radiographs and computed tomography scans were obtained prior to surgery and at 6 months after surgery, before implantation. Data collected following surgery included inflammation, pain, bleeding, infection, and haematoma. Pain and inflammation were recorded using a six-point verbal rating scale (VRS). The patients were followed up for an average of 15 months. The initial sinus floor height was measured for each planned implant and compared with the height at 6 months post-surgery. The average bone height gain was 8.10±3.45mm (range 0.5-13.95mm). Inflammation on the VRS ranged from 0 to 3 (mean 0.97±0.85), while pain ranged from 0 to 4 (mean 0.87±1.19). There was a perforation of the Schneiderian membrane smaller than 2mm in one case. In another case, the balloon lift procedure had to be aborted and changed to the conventional Tatum technique due to breakage of the balloon inside the sinus. The results of this study show the balloon sinus lift technique to be an easy procedure to perform, with apparently low rates of inflammation and pain, and to provide sufficient quantity and quality of bone for the placement of osseointegrated implants.

Abstract P4-08-08: Biomarkers to predict distant recurrence free survival after neoadjuvant endocrine therapy in breast cancer. A long follow up retrospective study

Background:

Neoadjuvant endocrine therapy (NET) is gaining more acceptances for the management of estrogen receptor (ER) positive breast cancer (BC). Rate of patients achieving pathological complete response is very low and Ki67 suppression and PEPI score are the only prognostic factors associated with relapse free survival.

The aim of our study was to identify biomarkers of prediction of distant relapse risk that could help clinicians in the decision-making of systemic adjuvant treatment in patients previously treated with NET

Material & Methods:

Retrospective study of 119 postmenopausal women with ER or progesterone receptor (PR) positive BC treated with NET in ICO-HUB from 1997 to 2009. Clinical-pathological data and treatments administered were reviewed. IHC expression of ER, PR, Ki67, Androgen receptor (AR), BCL-2, Cyclin D1 (CD1), p16, p53, CD 44 and synaptophysin were analyzed in post-NET surgical formalin-fixed paraffin-embedded tumor samples through a tissue microarray. Survival was calculated by Kaplan-Meier method. Univariate and multivariate analysis of variables associated with distant relapse free survival (DRFS) was evaluated by Cox proportional hazard model.

Results:

Mean age was 74 (63-88). cT: T2 5%, T3 6.5%, T4 43.5%. cN: N0 59%, N1 25%, N2-3 16%. Stage: I 21%, II 49.5%, III 29.5%. Histological subtype: ductal 84%, lobular 6%, others 10%. Histological grade: G1 20%, G2 55%, G3 25%.

Vascular invasion 15%. NET: Aromatase Inhibitors 64%, SERM 36%. Median duration of NET 8.5 months. Clinical Response: Complete 4%, Partial 55%, Stable 37%, Progression 4%. Surgery: Lumpectomy 72%, Mastectomy 28%;Lymphadenectomy 70.5%, Sentinel lymph node biopsy 6%, No surgical approach of axilla 23.5%. Surgical specimen: ypT1 36%, ypT2 54%, ypT3 6%, ypT4 4%; ypN0 28%, ypN1 22%, ypN2 13.5%, ypN3 12% ypNx 23.5%. Surgical margins: Negative 89% Positive 11%. Median fibrosis rate 20% (0-95). PR and Ki67 showed a statistically significant decrease after NET(p&lt;0,05) but no ER (p=0,29).

Adjuvant treatment: chemotherapy 7%, radiotherapy 76%, endocrine therapy 96%. Median follow-up: 104 months. Only 21 patients developed distance relapse. Median OS was 139 months [95% CI = 98-181]. Univariate analysis for DRFS showed statistically significant differences in cN (HR=3), histological grade 3 (HR=3.61), ypN (HR=3.62), p16 (HR=6.1) and p53 (HR=2.79). Multivariate analysis of post-NET biomarkers showed that negative nuclear p16 expression (HR=4.79)and positive p53 (HR=2.83)were independently associated with worse DRFS. In multivariate analysis of all clinico-pathological and molecular factors, histological grade 3 (HR=2.82) was the sole DRFS independent factor.

Conclusions:

Negative nuclear p16 expression and positive p53 post-NET were associated with worseDRFS. Whenall clinico-pathological and molecular factors were analysed, G3 was the sole DRFS independent factor. Patients with G3, negative p16 or positive p53 after NET could probably benefit from adjuvant chemotherapy or CDK 4-6 inhibitors treatment. In our series, we did not find usefulness in analysing ER, PR and Ki67 post-NET changes to predict DRFS.

Citation Format: Gil-Gil M, Morilla I, Petit A, Soler T, Perez-Martin X, Guma A, Pla MJ, Ortega R, Garcia-Tejedor A, Falo C, Montal R, Perez-Casanova L, Loayza C, Pernas S. Biomarkers to predict distant recurrence free survival after neoadjuvant endocrine therapy in breast cancer. A long follow up retrospective study [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 P4-08-08.

Identification of a divergent genotype of equine arteritis virus from South American donkeys

A novel equine arteritis virus (EAV) was isolated and sequenced from feral donkeys in Chile. Phylogenetic analysis indicates that the new virus and South African asinine strains diverged at least 100 years from equine EAV strains. The results indicate that asinine strains belonged to a different EAV genotype.

International Nosocomial Infection Control Consortium report, data summary of 50 countries for 2010-2015: Device-associated module

BACKGROUND

We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2010-December 2015 in 703 intensive care units (ICUs) in Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific.

METHODS

During the 6-year study period, using Centers for Disease Control and Prevention National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 861,284 patients hospitalized in INICC hospital ICUs for an aggregate of 3,506,562 days.

RESULTS

Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the INICC medical-surgical ICUs, the pooled rate of central line-associated bloodstream infection, 4.1 per 1,000 central line-days, was nearly 5-fold higher than the 0.8 per 1,000 central line-days reported from comparable US ICUs, the overall rate of ventilator-associated pneumonia was also higher, 13.1 versus 0.9 per 1,000 ventilator-days, as was the rate of catheter-associated urinary tract infection, 5.07 versus 1.7 per 1,000 catheter-days. From blood cultures samples, frequencies of resistance of Pseudomonas isolates to amikacin (29.87% vs 10%) and to imipenem (44.3% vs 26.1%), and of Klebsiella pneumoniae isolates to ceftazidime (73.2% vs 28.8%) and to imipenem (43.27% vs 12.8%) were also higher in the INICC ICUs compared with CDC-NHSN ICUs.

CONCLUSIONS

Although DA-HAIs in INICC ICU patients continue to be higher than the rates reported in CDC-NSHN ICUs representing the developed world, we have observed a significant trend toward the reduction of DA-HAI rates in INICC ICUs as shown in each international report. It is INICC's main goal to continue facilitating education, training, and basic and cost-effective tools and resources, such as standardized forms and an online platform, to tackle this problem effectively and systematically.

Analytical tools for speciation in the field of toxicology

The knowledge of the speciation of elements at trace and ultra-trace level, in biological and environmental media is essential to acquire a better understanding of the mechanisms of toxicity, transport and accumulation in which they are involved. Determining the speciation of an element in a given medium is challenging and requires the knowledge of different methodological approaches: the calculation approach and the experimental approach through the use of dedicated analytical and spectroscopic tools. In this framework, this mini-review reports the approaches to investigate the speciation of elements in biological and environmental media as well as the experimental techniques of speciation analysis, illustrated by recent examples. The main analytical and spectroscopic techniques to obtain structural, molecular, elemental and isotopic information are described. A brief overview of separation techniques coupled with spectrometric techniques is given. Imaging and micro-localisation techniques, which aim at determining the in situ spatial distribution of elements and molecules in various solid samples, are also presented. The last part deals with the development of micro-analytical systems, since they open crucial perspectives to speciation analysis for low sample amounts and analysis on field.

Dosimetry of a cone beam CT device for oral and maxillofacial radiology using Monte Carlo techniques and ICRP adult reference computational phantoms

OBJECTIVES

The aim of this study was to calculate organ and effective doses for a range of available protocols in a particular cone beam CT (CBCT) scanner dedicated to dentistry and to derive effective dose conversion factors.

METHODS

Monte Carlo simulations were used to calculate organ and effective doses using the International Commission on Radiological Protection voxel adult male and female reference phantoms (AM and AF) in an i-CAT CBCT. Nine different fields of view (FOVs) were simulated considering full- and half-rotation modes, and also a high-resolution acquisition for a particular protocol. Dose-area product (DAP) was measured.

RESULTS

Dose to organs varied for the different FOVs, usually being higher in the AF phantom. For 360°, effective doses were in the range of 25-66 μSv, and 46 μSv for full head. Higher contributions to the effective dose corresponded to the remainder (31%; 27-36 range), salivary glands (23%; 20-29%), thyroid (13%; 8-17%), red bone marrow (10%; 9-11%) and oesophagus (7%; 4-10%). The high-resolution protocol doubled the standard resolution doses. DAP values were between 181 mGy cm(2) and 556 mGy cm(2) for 360°. For 180° protocols, dose to organs, effective dose and DAP were approximately 40% lower. A conversion factor (DAP to effective dose) of 0.130 ± 0.006 μSv mGy(-1) cm(-2) was derived for all the protocols, excluding full head. A wide variation in dose to eye lens and thyroid was found when shifting the FOV in the AF phantom.

CONCLUSIONS

Organ and effective doses varied according to field size, acquisition angle and positioning of the beam relative to radiosensitive organs. Good positive correlation between calculated effective dose and measured DAP was found.

Recurrent membranoproliferative glomerulonephritis after second renal graft treated with plasmapheresis and rituximab

We present a case of a 45-year-old man who suffered from idiopatic membranoproliferative glomerulonephritis (MPGN) in the native kidney that relapsed after his first and second renal grafts. The patient was diagnosed in 1990 with lobular MPGN type I, receiving his first renal graft in 1996. In 2001, a biopsy showed recurrence of MPGN type I (rMPGN). He underwent a second renal graft in 2008. In January 2010, he experienced increased proteinuria and creatinine. Upon electron microscopy of a renal graft biopsy we diagnosed a new rMPGN. At the time of the biopsy, complement levels were normal, although C3 and C4 decreased further. We administered 12 plasmapheresis (PP) sessions and four doses of rituximab. Due to persistent renal impairment, we performed a new biopsy 3 months later, showing less severity of the acute lessions. He received a new cycle of treatment (PP+rituximab). One year later, his renal function was stable with a creatinine ranging between 2 and 2.5 mg/dL and a protein/creatinine ratio less than 1 mg/mg. We concluded that the treatment stopped the disease progression.

Impact of recurrent glomerulonephritis on renal graft survival

BACKGROUND

Glomerular disease causes graft loss in the intermediate and long term, especially recurrent primary renal disease, negatively impacting graft survival. Thus, it must be considered a differential diagnosis in the evaluation of chronic graft dysfunction.

METHODS

The objectives of our study were to compare the impacts of primary glomerular disease on graft survival and association with interstitial fibrosis/tubular atrophy (IFTA) or transplant glomerulopathy. We examined the influence of the relapse of glomerulonephritis (GN) on renal graft survival in a retrospective study of 1057 patients undergoing renal transplantations between March 1981 and October 2009. Among this group, 128 patients were diagnosed with pretransplant GN by renal biopsy. We examined graft survival on recurrence compared with IFTA and transplant glomerulopathy using Kaplan-Meier analysis.

RESULTS

We analyzed a cohort of 128 patients who were diagnosed with pretransplant GN by renal biopsy, including 28.9% (37) of whom were males. The mean age was 42.04 ± 13.82 years. The most frequent type was immunoglobulin A GN (IgAGN; 31.3%), followed by membranoproliferative GN (MPGN; 28.9%), rapidly progressive GN (RPGN; 16.4%), focal-segmental GN (FSGN; 13.3%), membranous GN (9.4%), and minimal change GN; (0.8%). Among the 16 cases (12.5%) of GN recurrence; MPGN was associated most frequently (n = 10, 28.9%), followed by FSGN (n = 4, 23.5%), RPGN (n = 1, 4.8%), and IgAGN (n = 1, 2.5%). We noted that 11.8% of subjects to be positive for hepatitis C virus; while 3.9% were hepatitis B virus(HBV)-positive. We observed no differences in hepatic serology between patients who experienced recurrence (HBV 6.3% vs hepatitis C virus [HCV] 18.8%) compared with IFTA (HBV 3.1% vs HCV 9.4%). Fifty-one patients (39.8%) were biopsied after transplantation due to impaired renal function: there were recurrences of GN in 12.5% (n = 16), IFTA in 25% (n = 32), and transplant glomerulopathy in 2.3% (n = 3) cases. The average graft survival in our cohort was 8.36 ± 0.59 years. The median patient survival among those who experienced a recurrence was 8.36 ± 1.79 years; 7.19 ± 1.01 years in IFTA patients; and 3.31 ± 0.91 years in patients with transplant glomerulopathy (log-rank P = .06). Upon multivariate analysis, recurrence of GN was not an independent predictor of renal loss.

CONCLUSIONS

MPGN was the type of GN that recurred most frequently followed by FSGN. No differences in graft survival were noted between long-term recurrence of GN and other causes of chronic graft dysfunction. The recurrence of primary disease did not worsen the renal graft prognosis versus other causes of chronic graft dysfunction.

Autonomic and metabolic effects of OSA in childhood obesity

This study investigates the effects of exposure to intermittent hypoxia on cardiovascular autonomic control and metabolic function in obese children with obstructive sleep apnea (OSA). Each subject underwent: (1) a polysomnography; (2) morning fasting blood samples and a subsequent FSIVGTT; (3) noninvasive measurement of respiration, arterial blood pressure, and heart rate during supine and standing postures. Assessment of adiposity was performed using a DEXA scan. From these measurements, we deduced the pertinent sleep parameters, Bergman minimal model parameters and the parameters characterizing a minimal model of cardiovascular variability. Results suggest that intermittent hypoxia in OSA contributes independently to insulin resistance and autonomic dysfunction in overweight children.

Continuous versus interrupted sutures for repair of episiotomy or second-degree perineal tears: a randomised controlled trial

OBJECTIVE

To evaluate the repair techniques of continuous and interrupted methods for episiotomy or perineal tears.

DESIGN

A randomised controlled trial.

SETTING

The Hospital Universitario Principe de Asturias, a state hospital belonging to the community of Madrid.

SAMPLE

Four hundred forty-five women who had undergone vaginal deliveries with episiotomies or second-grade tearing of the perineum between September 2005 and July 2007.

METHODS

One group was repaired with continuous, nonlocking sutures involving the vagina, perineum, and subcutaneous tissues. The other group had continuous, locking sutures of the vagina, interrupted sutures in the perineal muscles, and interrupted transcutaneous sutures. The threads used for stitching were identical in both groups.

MAIN OUTCOME MEASURES

The participants were questioned regarding the sensation of pain and the use of painkillers on the second and the tenth days, and 3 months postpartum.

RESULTS

When comparing the group with continuous suture to the group with interrupted sutures, the differences included less repair time (1 minute; P= 0.017) and less suture material used (relative risk [RR], 3.2, 95% CI: 2.6-4.0). The comparison of pain on the second and tenth days, and 3 months postpartum were not statistically different between the two techniques (RR, 1.08, 95% CI: 0.74-1.57; RR, 0.96, 95% CI: 0.59-1.55; and RR, 0.68, 95% CI: 0.19-2.46, respectively).

CONCLUSIONS

Although we did not demonstrate that one technique was better than the other in the incidence of pain in the short or long term, we showed that episiotomy and perineal tear repairs with continuous suturing were quicker and used less suture material without an increase in complication than interrupted suturing.