Red and brown seaweeds extracts: A source of biologically active compounds

The biological activities of Porphyra sp., Gracilaria gracilis, Alaria esculenta and Saccharina latissima extracts prepared by enzymatic and ball milling-assisted methods and hot water were evaluated. Enzyme-assisted methods allowed the highest extraction yields. Alcalase-assisted extraction (EAA) was the most effective in the recovery of polyphenolic compounds and Porphyra sp. had the highest content. The efficiency of flavonoids extraction was highly dependent on the used method. Globally, Porphyra sp. and EAA extracts exhibited the highest antioxidant and chelating activities. The highest α-amylase inhibitory activity was determined in HW Porphyra sp. extract while EAA A. esculenta extract had the highest α-glucosidase inhibitory activity. The highest ACE inhibitory activity was obtained in EAA from S. latissima. None of the extracts showed antimicrobial activity against the tested bacteria. The results showed that Porphyra sp. and S. latissima are potentially useful as ingredient in functional foods and nutraceuticals.

POS0238 SIDE EFFECT PROFILE OF HYDROXYCHLOROQUINE USE IN PATIENTS WITH RA, SLE, AND OTHER RMDs OVER 20 YEARS

Background

During the pandemic, hydroxychloroquine (HCQ) became a household name, yet despite more than 70 years as a csDMARD treatment, relatively little is known about its overall side effect (SE) profile.

Objectives

To understand the types, severity, and rates of patient-reported side effects of HCQ in adults with RA, SLE, and other RMDs alone and in comparison with methotrexate (MTX).

Methods

Adult participants in the Forward Databank observational registry reported all medication use and medication side effects through biannual questionnaires from 1999 through 2021. Incident use of HCQ and MTX were measured at enrollment and longitudinally with additional reporting of severity of side effects, certainty of medication as cause of side effect, and affected body systems. We analyzed incident rates of side effects overall and by HCQ or MTX categorical use, respectively: monotherapy, with concomitant use of another csDMARD, or with concomitant use of a bDMARD or tsDMARD. Finally, the likelihood of having any side effects was analyzed in Cox regression models by comparing HCQ initiators to MTX initiation, and within each, combination MTX or HCQ with csDMARD or bDMARD to monotherapy; these models were adjusted for age, sex, RD Comorbidity Index, patient global, pain, disease duration, and number of bDMARDs used.

Results

Overall, 5874 patients initiated HCQ and 10420 initiated MTX, with RA as the predominant diagnosis. Mean baseline characteristics were similar for RA: 59 years old, 80% female and 12 years of RA duration. HCQ was mostly used with other csDMARDs, while MTX was mostly used with bDMARDs. In the other RMD and SLE groups, most were on HCQ monotherapy. For all RMDs, SE incidence for HCQ (16 – 17%) was lower than MTX (26 – 39%). The Table 1 provides incidence rates by HCQ/MTX for any SE, a SE that forces medication discontinuation, and SE leading to hospitalization. Reported SE rates were always higher for MTX vs. HCQ for all SE severity and diagnoses.

Table 1.

Incidence rates (IR) per 1000 patient-years of SEs by diagnoses for HCQ and MTX initiators

RASLEOtherPt-yrsIR (95% CI)Pt-yrsIR (95% CI)Pt-yrsIR (95% CI)Any HCQ SE1271126 (23, 29)130525 (18, 36)56741 (27, 61)Mono HCQ339728 (24, 33)79728 (18, 42)34752 (32, 82)HCQ + csDMARDs547328 (24, 33)41624 (13, 45)12732 (12, 84)HCQ + bDMARDs384122 (17, 27)9311 (2, 77)9311 (2, 76)SE stopping HCQ1271113 (11, 15)130512 (7, 19)56714 (6, 35)Mono HCQ339712 (9, 16)79711 (6, 22)34714 (6, 35)HCQ + csDMARDs547315 (12, 18)41613 (5, 31)12724 (8, 73)HCQ + bDMARDs384112 (9, 16)930930HCQ SE hospitalization127110.31 (0.12, 0.84)13050.77 (0.1, 5.4)5670Any MTX SE8123451 (49, 52)151659 (48, 72)214572 (61, 84)Mono HCQ2298049 (46,52)36941 (25, 67)80262 (47, 82)MTX + csDMARDs1544772 (68, 77)87269 (53, 89)229131 (91, 187)MTX + bDMARDs4274843 (41, 45)26549 (29, 85)110667 (53, 84)SE stopping MTX9147726 (25, 27)163841 (32, 52)233544 (36, 53)Mono MTX2606019 (17, 20)39033 (19, 57)88527 (17, 39)MTX + csDMARDs1743038 (36, 42)93348 (36, 65)25590 (60, 136)MTX + bDMARDs4783225 (23, 26)30526 (13, 53)118847 (36, 61)MTX SE hospitalization964362.4 (2.1, 2.8)16745.4 (2.8, 10.3)25023.2 (1.6, 6.4)

By body system, the patterns of any SE were similar between HCQ or MTX initiators. Gastrointestinal SEs were the most common for both. Only ocular SEs were higher for HCQ vs. MTX. Multivariable Cox regression models of HCQ vs MTX SEs had a HR 0.46 (0.41 - 0.51) for RA, HR 0.47 [0.27 – 0.82] for SLE, and HR 0.51 [0.25 – 1.02] for other RMDs. While there was no difference in HCQ SEs by concomitant category or diagnoses, there was consistently higher SE rates in MTX for those on concomitant csDMARD vs monotherapy: RA HR 1.27 (1.16 - 1.38), SLE HR 1.97 (1.03 - 3.52), and other RMDs HR 2.04 (1.28 - 3.24).

Conclusion

This is the largest study yet to review patient-reported SEs from HCQ and MTX in RA and other RMDs over a 20-year period. While validating SEs was beyond the scope of the current study, we found an overall low incidence of SEs from HCQ use, with an adjusted rate half of those reported for MTX, and that this low rate did not differ by diagnosis or concomitant DMARD use.

Disclosure of Interests

None declared

Measurable Levels of Short-Chain Chlorinated Paraffins in Western Hudson Bay Fishes but Limited Biomagnification from Fish to Ringed Seals

We investigated short-chain (C_10-13 ) chlorinated paraffins (SCCP) in an Arctic marine food web. In zooplankton, fishes, and ringed seals from western Hudson Bay, Canada, SCCP concentrations ranged from 38.3 to 687 ng g^-1 lipid weight. Monte Carlo-simulated trophic-adjusted biomagnification factors of individual SCCP congeners ranged from 0.07 to 0.55 for small pelagic fishes to seals. Despite relatively high concentrations in fishes, biomagnification of SCCPs within this food web appears limited. Environ Toxicol Chem 2021;40:2990-2999. © 2021 SETAC.

OP0039 HOSPITALIZATION AND MORTALITY OUTCOMES IN RHEUMATOID ARTHRITIS PATIENTS WITH LUNG DISEASE

Background:

Pulmonary manifestations such as interstitial lung disease (ILD) and chronic obstructive pulmonary disease (COPD) are frequent extra-articular features that carry a poor prognosis in rheumatoid arthritis (RA). Prior studies have demonstrated that respiratory-related mortality is the most overrepresented cause of death in RA.

Objectives:

To assess the risk of all-cause and respiratory-related hospitalization and mortality in RA patients with comorbid lung disease (LD) in comparison to those without and the differential risks associated with DMARD treatments.

Methods:

Eligible RA patients included those enrolled in the Forward Databank with ≥1 year observation after 2000 and had initiated a DMARD. Forward is a large longitudinal rheumatic disease registry in the US. RA patients’ diagnoses were rheumatologist-confirmed, and every 6 months participants completed comprehensive questionnaires regarding symptoms, disease outcomes, medications, and clinical events. LD was defined as one of the following: emphysema, asthma, bronchitis, COPD, pleural effusion, fibrosis of the lung, “RA lung“, or ILD (England 2019). DMARDs were categorized hierarchically into four groups: csDMARDs, TNFi and NTNFi (bDMARDs), and tsDMARDs. Patients were followed from DMARD initiation until event (death and/or hospitalization) or end of follow-up, whatever came first. Events were validated using medical records and the US National Death Index. Respiratory hospitalizations and deaths were identified with ICD9 (460-519). Events were analyzed using incidence rates (IR) and Cox regression models. Models were adjusted for LD, DMARDs, age, sex, education, HAQ disability, Rheumatic Disease comorbidity index, smoking, pain, glucocorticoids, year of entry, prior bDMARDs and csDMARDs counts and MRC breath scale.

Results:

Of the 21,525 eligible RA patients, 13.8% had LD at the time of DMARD initiation. Patients had 59 years old in both groups and 15% were male for LD+ vs 21% for LD-. Patients with LD+ showed worse disease outcomes (HAQ: 1.3 (0.7) vs 1.0 (0.7)) and comorbidities (2.9 (1.9) vs 1.5 (1.4)) overall and for all treatment groups, especially for NTNFi and tsDMARDi. The overall IR of any all-cause or respiratory-related events were higher in LD+ than LD- RA patients and across any DMARD treatments, with NTNFi having higher IR (Figure). In survival analyses, LD+ was associated with an increased risk for all-cause hospitalizations/deaths (HR 1.3; 95% CI 1.1-1.4) and a 3.95-fold increased risk of respiratory-related events (HR 4.0; 3.2-4.9) (Table). These risks did not differ significantly across DMARD treatment groups. Increased age, HAQ disability, comorbidities, glucocorticoids, prior bDMARDs and worse MRC breath scales were associated with an increased risk in both outcomes and smoking in respiratory-specific events.

Conclusion:

An increased risk of hospitalizations and/or deaths was demonstrated for RA patients with lung disease, most notably a 4-fold increased risk for respiratory-related events. No differences were found between incident DMARD groups. Additional studies accounting for channeling of treatments by baseline health status are needed.

References:

[1]England BR, et alArth Care Res. doi:10.1002/acr.24043.

Figure.

 IR (95% CI): all-cause and respiratory-related events by LD+/LD- and DMARDs

Table.

HR (95% CI) for Cox models.

VariablesAll causeAll respiratory specificLD+ vs LD-1.34.0(1.1 - 1.4)(3.2 - 4.9)Tnf vs csDMARD1.01.1(0.8 - 1.1)(0.8 - 1.5)NTNF vs csDMARD1.00.9(0.8 - 1.2)(0.6 - 1.5)tsDMARD vs csDMARD0.81.8(0.4 - 1.4)(0.7 - 4.7)

Disclosure of Interests:

Sofia Pedro: None declared, Ted Mikuls Grant/research support from: Horizon Therapeutics, BMS, Consultant of: Pfizer, Joe Zhuo Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Kaleb Michaud Grant/research support from: Janssen

FRI0072 DISCONTINUATION OF DMARD USE IN RHEUMATOID ARTHRITIS PATIENTS WITH LUNG DISEASE

Background:

Pulmonary manifestations such as interstitial lung disease (ILD) and chronic obstructive pulmonary disease (COPD) are frequent extra-articular features that carry a poor prognosis in Rheumatoid Arthritis (RA). Little data is available on how RA patients (pts) with pulmonary disease are managed in real-world settings.

Objectives:

To assess treatment patterns and DMARD discontinuation in RA patients with comorbid lung disease in comparison with other RA patients.

Methods:

The study included RA Patients enrolled in the Forward Databank with ≥1 year observation after 2000 initiating a DMARD. Forward is a large longitudinal rheumatic disease registry in the US. RA patients’ diagnoses were rheumatologist-confirmed, and every 6 months participants completed comprehensive questionnaires regarding symptoms, disease outcomes, medications, and clinical events. Lung disease (LD+) was defined as at least one of the following: emphysema, asthma, bronchitis, COPD, pleural effusion, fibrosis of the lung, “RA lung”, or ILD, the later classified by ICD9 codes (England 2019). DMARDs were categorized hierarchically into four groups: csDMARDs, TNFi and NTNFi (bDMARDs), and tsDMARDs. Percentage of patients who initiated different DMARDs were reported for pts with LD+/LD-. Discontinuation was analyzed by Kaplan Meier (KM) curves, log-ranks tests, and Cox regression models using time-varying covariates. Best models were created using backward selection models (10% probability of removal) and pre-defined clinical models.

Results:

Of the 21,525 eligible RA patients, 13.8% had LD+ at the time they initiated a DMARD (follow-up: 69,597 pt-yrs (median 1.9 yrs/pt)). LD+ patients tended to have more severe RA outcomes and comorbidities. MTX-monotherapy (48% vs 44%, p<0.001) and NTNFi were initiated more frequently in LD+ pts with lower use of TNFi (Figure). DMARD discontinuation rates were higher among LD+ patients for all DMARD groups, but KM curves were only significantly different for csDMARDs and TNFi. Different HRs for LD+ were found depending on the model used ranging from 1.18 to 1.28, and all models revealed an increased risk of discontinuation for LD+ patients. Compared to csDMARDs, TNFi were more often discontinued (Table). Other variables associated with an increased risk of discontinuation included: HAQ, Rheumatoid Disease (RD) comorbidity index, pain, prior bDMARDs, and csDMARDs.

Conclusion:

Different DMARD treatment patterns were found for LD+ patients, who tended to initiate more csDMARD and NTNFi and less likely to initiate a TNFi. LD+ patients were at a higher risk of discontinuation irrespectively of the DMARD treatment, but with greater risk for TNF users.

References:

[1]England BR, et al. Arth Care Res. doi:10.1002/acr.24043.

Figure.

DMARD treatment initiators by disease group

Table .

Cox models for DMARD discontinuation by stepwise (removal probability 10%) and clinical models including DMARD treatment.

Model of DMARD persistence*Model 1- Stepwise-Without drugsModel 2 – StepwiseModel 3 - ClinicalLD+ vs LD–1.181.281.20(1.08 - 1.29)(1.13 - 1.45)(1.08 - 1.34)TNF vs csDmard1.321.22(1.08 - 1.63)(1.04 - 1.44)NTNF vs csDmard1.131.13(0.83 - 1.52)(0.90 - 1.41)tsDmard vs csDmard1.301.02(0.65 - 2.60)(0.64 - 1.62)

*Best models searched/Clinical adjusted for LD+/LD-, DMARDs, age, sex, education, HAQ disability, RD comorbidity index, smoking, pain, glucocorticoids, year of entry, prior bDMARDs and csDMARDs counts and MRC breath scale.

Disclosure of Interests:

Sofia Pedro: None declared, Ted Mikuls Grant/research support from: Horizon Therapeutics, BMS, Consultant of: Pfizer, Joe Zhuo Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Kaleb Michaud: None declared

Are vitamins A and E associated with persistent organic pollutants and fatty acids in the blubber of highly contaminated killer whales (Orcinus orca) from Greenland?

We quantified blubber concentrations of vitamins A (retinol) and E (α-tocopherol) and evaluated associations with persistent organic pollutants (ΣPOPs) in 14 highly-contaminated killer whales (Orcinus orca) sampled in Greenland from 2012 to 2014. We considered the influence of blubber depth, sex/age class and diet (based on biomass % of major fatty acids) in these relationships. Blubber concentrations of vitamin A averaged 34.1 ± 4.7 μg g^-1 wet weight (ww) and vitamin E averaged 35.6 ± 4.4 μg g^-1 ww. Although overall vitamin A concentrations did not vary between inner (closer to the muscle) and outer (closer to the skin) blubber layer or between sub-adults and adult females, concentrations in the outer layer of sub-adults were lower compared to the outer layer of adult females (p = 0.03). Outer layer may therefore reflect age accumulation of vitamin A, while in the more active inner layer, age effects might be masked by metabolic needs such as lactation. Neither diet nor ΣPOPs affected vitamin A variation, suggesting this vitamin is highly regulated in the body. Given the high exposures in these killer whales, vitamin A might not be a sensitive biomarker for POPs adverse effects. Vitamin E concentrations were significantly higher in inner compared to outer layer (p < 0.001), likely associated with blubber composition, suggesting that biopsies may not fully represent vitamin E concentrations in blubber. Age-accumulation of vitamin E also occurred with higher concentrations in adult females compared to sub-adults, independent of blubber depth (p < 0.01). Diet, ΣPOPs, and an interaction between these two variables significantly affected vitamin E variation in inner blubber, explaining 91% of this variation. The negative relationship between ΣPOPs (especially Σdichlorodiphenyltrichloroethane (DDT) and Σchlordanes in outer layers) and vitamin E was observed only in killer whales with a diet poorer in polyunsaturated fatty acids, suggested that killer whales feeding more consistently on marine mammals in Arctic environments over a fish-based diet, may be at higher risk of POP-induced disruption in vitamin E homeostasis. Considering diet is therefore important to understand the potential effects of elevated contaminant exposures on levels of certain essential nutrients, i.e., vitamin E, in killer whales.

Limited effects of changing prey fish communities on food quality for aquatic predators in the eastern Canadian Arctic in terms of essential fatty acids, methylmercury and selenium

We determined concentrations of eicosapentaenoic and docosahexaenoic acids (EPA + DHA), Σomega-3, polyunsaturated fatty acids (ΣPUFA), selenium, methylmercury, and selenium:methylmercury (Se:Hg) ratios in native and northward-redistributing sub-Arctic marine fish and invertebrates from low, mid-, and high Canadian Arctic latitudes. There was no clear latitudinal trend in nutrient or contaminant concentrations. Among species, EPA + DHA concentrations in native Arctic cod (Boreogadus saida) were similar to concentrations in sub-Arctic capelin (Mallotus villosus) and sand lance (Ammodytes spp.) (444-658 mg.100 g^-1), and higher than in most other species. Concentrations of EPA + DHA were related to lipid content, but to a greater extent for higher trophic position species (R² = 0.83) than for species at lower trophic positions (R² = 0.61). Selenium concentrations were higher in sand lance (1.15 ± 0.16 μg g^-1) than in all other species (0.30-0.69 μg g^-1), which was significantly, but weakly, explained by more pelagic feeding in sand lance. Methylmercury concentrations were similar (and Se:Hg ratios were higher) in capelin, sand lance, and Arctic cod (0.01-0.03 μg g^-1 wet weight (ww)) and lower than in other prey (0.12-0.26 μg g^-1 ww), which was significantly explained by the smaller size of these species and more pelagic feeding habits than other fish. These results suggested that a shift in prey fish composition from Arctic cod to capelin and/or sand lance is unlikely to reduce the food quality of the prey available to marine predators at least with respect to concentrations of essential fatty acids, selenium, and Se:Hg ratios.

Blubber-depth distribution and bioaccumulation of PCBs and organochlorine pesticides in Arctic-invading killer whales

Sightings of killer whales (Orcinus orca) in Greenland have increased in recent years, coincident with sea ice loss. These killer whales are likely from fish-feeding North Atlantic populations, but may have access to marine mammal prey in Greenlandic waters, which could lead to increased exposures to biomagnifying contaminants. Most studies on polychlorinated biphenyl (PCB) and organochlorine (OC) contaminants in killer whales have used biopsies which may not be representative of contaminant concentrations through the entire blubber depth. Here, we measured PCB and OC concentrations in 10 equal-length blubber sections of 18 killer whales harvested in southeast Greenland (2012-2014), and 3 stranded in the Faroe Islands (2008) and Denmark (2005). Overall, very high concentrations of ΣPCB, Σchlordanes (ΣCHL), and Σdichlorodiphenyltrichloroethane (ΣDDT) were found in the southeast Greenland and Denmark individuals (means of ~40 to 70mgkg^-1 lipid weight). These concentrations were higher than in the Faroe Island individuals (means of ~2 to 5mgkg^-1 lipid weight) and above those previously reported for other fish-feeding killer whales in the North Atlantic, likely in part due to additional feeding on marine mammals. On a wet weight basis, concentrations of all contaminants were significantly lower in the outermost blubber layer (0.15-0.65cm) compared to all other layers (p<0.01), except for Σhexachlorocyclohexanes. However, after lipid correction, no variation was found for ΣCHL and Σchlorobenzene concentrations, while the outermost layer(s) still showed significantly lower ΣPCB, ΣDDT, Σmirex, Σendosulfan, and dieldrin concentrations than one or more of the inner layers. Yet, the magnitude of these differences was low (up to 2-fold) suggesting that a typical biopsy may be a reasonable representation of the PCB and OC concentrations reported in killer whales, at least on a lipid weight basis.

Mercury and persistent organic pollutants in native and invading forage species of the Canadian Arctic: Consequences for food web dynamics

Contaminant dynamics within Arctic marine food webs may be altered through the climate-driven northward invasions of temperate/boreal species. Here, we compare tissue concentrations of total mercury (THg) and legacy and emerging persistent organic pollutants (POPs) in native versus invading forage species sampled from 2012 to 2014 near Arviat, Clyde River, and Resolute Bay, NU, representing, low, mid- and high eastern Canadian Arctic regions, respectively. Concentrations of THg, legacy Σ-polychlorinated biphenyls (ΣPCB) and Σ-organochlorine (ΣOC) pesticides were detected in all forage species, whereas emerging halogenated flame retardants were detected in only a few individuals. Concentrations of major contaminant groups among regions did not vary for Arctic cod (Boreogadus saida), while for sculpin (Cottoidea) there was no clear latitudinal trend. Thus, considering interspecific variation, native sculpin and northern shrimp (Pandalus borealis) had the highest overall concentrations of THg (0.17 ± 0.02 and 0.21 ± 0.01 μg g^-1 wet weight, respectively), ΣPCB (322 ± 35 and 245 ± 25 ng g^-1 lipid weight (lw), respectively), and ΣOC (413 ± 38 and 734 ± 64 ng g^-1 lw, respectively). Comparing the keystone native species, Arctic cod, to its 'replacement' species, capelin (Mallotus villosus) and sandlance (Ammodytes spp.), THg concentrations were higher in Arctic cod compared to capelin (p < 0.001), which was partly explained by differences in fish length. Conversely, capelin and sandlance had higher concentrations of most POPs than Arctic cod (p < 0.02). Neither feeding habitat (based on δ¹³C), trophic position (based on δ¹⁵N), nor fish length significantly explained these differences in POPs between Arctic cod, capelin and sandlance. Higher POPs concentrations, as well as variation in congener/compound patterns, in capelin and sandlance relative to Arctic cod seem, therefore, more likely related to a more "temperate"-type contaminant signature in the invaders. Nevertheless, the relatively small (up to two-fold) magnitude of these differences suggested limited effects of these ecological changes on contaminant uptake by Arctic piscivores.

Ecological Change Drives a Decline in Mercury Concentrations in Southern Beaufort Sea Polar Bears

We evaluated total mercury (THg) concentrations and trends in polar bears from the southern Beaufort Sea subpopulation from 2004 to 2011. Hair THg concentrations ranged widely among individuals from 0.6 to 13.3 μg g^-1 dry weight (mean: 3.5 ± 0.2 μg g^-1). Concentrations differed among sex and age classes: solitary adult females ≈ adult females with cubs ≈ subadults > adult males ≈ yearlings > cubs-of-the-year ≈ 2 year old dependent cubs. No variation was observed between spring and fall samples. For spring-sampled adults, THg concentrations declined by 13% per year, contrasting recent trends observed for other Western Hemispheric Arctic biota. Concentrations also declined by 15% per year considering adult males only, while a slower, nonsignificant decrease of 4.4% per year was found for adult females. Lower THg concentrations were associated with higher body mass index (BMI) and higher proportions of lower trophic position food resources consumed. Because BMI and diet were related, and the relationship to THg was strongest for BMI, trends were re-evaluated adjusting for BMI as the covariate. The adjusted annual decline was not significant. These findings indicate that changes in foraging ecology, not declining environmental concentrations of mercury, are driving short-term declines in THg concentrations in southern Beaufort Sea polar bears.

Feathers as a Tool to Assess Mercury Contamination in Gentoo Penguins: Variations at the Individual Level

Feathers have been widely used to assess mercury contamination in birds as they reflect metal concentrations accumulated between successive moult periods: they are also easy to sample and have minimum impact on the study birds. Moult is considered the major pathway for mercury excretion in seabirds. Penguins are widely believed to undergo a complete, annual moult during which they do not feed. As penguins lose all their feathers, they are expected to have a low individual-variability in feather mercury concentration as all feathers are formed simultaneously from the same somatic reserves. This assumption is central to penguin studies that use feathers to examine the annual or among-individual variation in mercury concentrations in penguins. To test this assumption, we measured the mercury concentrations in 3-5 body feathers of 52 gentoo penguins (Pygoscelis papua) breeding at Bird Island, South Georgia (54°S 38°W). Twenty-five percent of the penguins studied showed substantial within-individual variation in the amount of mercury in their feathers (Coefficient of Variation: 34.7-96.7%). This variation may be caused by differences in moult patterns among individuals within the population leading to different interpretations in the overall population. Further investigation is now needed to fully understand individual variation in penguins' moult.

A review of ecological impacts of global climate change on persistent organic pollutant and mercury pathways and exposures in arctic marine ecosystems

Bioaccumulative and biomagnifying contaminants, such as persistent organic pollutants (POPs) and mercury (Hg), have for decades been recognized as a health concern in arctic marine biota. In recent years, global climate change (GCC) and related loss of arctic sea ice have been observed to be driving substantial change in arctic ecosystems. This review summarizes findings documenting empirical links between GCC-induced ecological changes and alterations in POP and Hg exposures and pathways in arctic marine ecosystems. Most of the studies have reported changes in POP or Hg concentrations in tissue in relation to GCC-induced changes in species trophic interactions. These studies have typically focused on the role of changes in abundance, habitat range or accessibility of prey species, particularly in relation to sea ice changes. Yet, the ecological change that resulted in contaminant trend changes has often been unclear or assumed. Other studies have successfully used chemical tracers, such as stable nitrogen and carbon isotope ratios and fatty acid signatures to link such ecological changes to contaminant level variations or trends. Lower sea ice linked-diet changes/variation were associated with higher contaminant levels in some populations of polar bears, ringed seals, and thick-billed murres, but the influence of changing trophic interactions on POP levels and trends varied widely in both magnitude and direction. We suggest that future research in this new area of GCC-linked ecotoxicology should focus on routine analysis of ancillary ecological metrics with POP and Hg studies, simultaneous consideration of the multiple mechanisms by which GCC and contaminant interactions can occur, and targeted research on changing exposures and toxicological effects in species known to be sensitive to both GCC and contaminants.

Quality Changes During Storage of Minced Fish Products Containing Dietary Fiber and Fortified with ω3 Fatty Acids

Two ready-to-eat minced fish products from hake were developed, their proximate composition and fatty acid profiles determined and their quality changes followed during 3.5 months under refrigeration at 2 ± 1 °C and 10 ± 1 °C. These products contain dietary fiber and are innovative and healthy. The formulation was identical, except vegetable oil (VO), 5.6% (w/w) in one group and 2.7% (w/w) plus 2.9% (w/w) cod liver oil (CLO) in the other. CLO products had a higher ω3/ω6 ratio (0.54 ± 0.02 versus 0.08 ± 0.02) and ensured, per 100 g serving, the 500 mg recommended daily intake of eicosapentaenoic and docosahexaenoic acids. CLO products showed lower gel strength (p ≤ 0.05), however, other textural properties were similar to those of the VO group. Thiobarbituric acid reactive substances values were higher in CLO products. All groups presented acceptable sensory scores and no microbiological growth. During storage products became redder and less yellow, while seafood aroma and flavor declined and saltiness perception augmented. Temperature had a negative effect on sensory elasticity and instrumental texture.

Patients- and physicians- priorities for improvement. The case of rheumatic diseases

OBJECTIVES

To compare the health priorities elected by patients with rheumatic diseases and by their attending rheumatologists.

PATIENTS AND METHODS

We undertook a cross-sectional study among patients and rheumatologists in Portuguese rheumatology outpatient clinics. 75% of all Portuguese Rheumatology Departments agreed to participate. Rheumatologists from non-participating hospital departments were asked to collaborate through their private practices. All patients were eligible for inclusion except if they were under 18 years of age or had a mental disorder that would affect their participation. Data were collected through dedicated questionnaires. Patients were asked to indicate 3 priorities for improvement out of 12 health domains (Arthritis Impact Measurement Scale 2) regarding their rheumatic disease. Rheumatologists were asked similar questions focused around rheumatoid arthritis (RA) and osteoarthritis (OA).

RESULTS

1,868 patients and 56 rheumatologists entered the study. The most commonly selected priorities by patients with rheumatic diseases were: "Rheumatic pain" (70%), "Walking and bending" (45%), and "Hand and Finger Function" (40%). The main priority for improvement among patients with RA was "Rheumatic Pain" (69%), while rheumatologists more commonly elected "Work" (55%) as their main priority for these patients. Among patients with OA, "Rheumatic Pain" was the first priority for both patients and doctors (elected by 75%, and 55% of respondents, respectively).

CONCLUSIONS

Our study showed discordance between the priorities for improvement elected by patients and by their respective physicians. This was more pronounced in RA than in OA. Studying and addressing such differences may support physicians and institutions to better achieve the prime goal of incorporating and responding to patients' needs and preferences.

Breast Cancer Patients Receiving Neoadjuvant, Adjuvant and Palliative Chemotherapy Have Different DNA Oxidative Damage and Repair Profiles

Background: Antineoplastic agents induce oxidative stress in biological systems leading to lipid, carbohydrate, protein and DNA damage and affecting cell structure and function. These adverse effects may fuel up the acquisition of new mutations and the development of treatment resistances and secondary malignancies.Methods: We selected 90 breast cancer patients receiving neoadjuvant, adjuvant or palliative chemotherapy, to test the effect of this treatment on the systemic oxidative stress. The patients were distributed in equal groups and paired blood samples, before and after chemotherapy, were extracted. DNA oxidative damage was assessed by alkaline comet assay and a specific inmnoenzymoassay was employed to determine RPA and Ku86 DNA repair activity.Results: We found that neoadjuvant patients presented a marked raise in DNA damage after chemotherapy (Figure 1A). DNA repair activity of KU86 was significantly higher in the adjuvant setting and significantly lower in the neoadjuvant and metastatic settings after chemotherapy. Before chemotherapy administration, KU86 activity was higher in the metastatic and neoadjuvant groups compared to the adjuvant group (Figure 1B).Discussion: Our results show that chemotherapy induces the production of free radicals to an extent that causes a severe DNA damage. High levels of DNA damage are maintained along successive clinical interventions, due to continued production of free radicals during breast cancer treatment, despite the activation of the repair mechanisms that are not sufficient to overcome the effects of the oxidative stress at this level. Our work shows that breast cancer treatment affects the redox status of the patients and, because of its effects into cellular signaling pathways and gene expression, it must be considered as a potential therapeutic target to improve breast cancer treatment and minimize the associated toxicity.Figure legend 1.- Oxidative DNA damage and DNA repair markers in neoadjuvant, adjuvant and metastatic patients, before and after chemotherapy. (A) Percentage of DNA in the tail of lymphocytes, as measured by comet assay. (B) DNA repair activity of KU86. Intragroup statistical differences owed to chemotherapy are indicated as ‡ (P&lt;0.001) or * (P&lt;0.05). Intergroup statistical differences for each period (before and after chemotherapy) (P&lt;0.05) are indicated by the letters a and b, in such a way that the measures with different superscript letters, are statistically different.Figure legend 2.- Fluorescent microscope images of damaged lymphocytes from a neoadjuvant patient before (A) and after (B) chemotherapy.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1123.

Report on the measles situation in Portugal

A measles case, imported from the United Kingdom (UK), was reported in Portugal in late August 2008. Previously, measles cases imported from Romania, and import-related cases, were reported in 2005. There was no transmission to the autochthonous Portuguese population.

Prevalence and pattern of cognitive impairment in a community cohort of men in South Wales: methodology and findings from the Caerphilly Prospective Study

BACKGROUND/AIMS

The prevalence of dementia and cognitive impairment not dementia was investigated in the Caerphilly Prospective Study cohort (men currently aged 65-84 years).

METHODS

Of 1,633 men eligible for cognitive screening, 1,225 (75%) were seen, with those failing the screening criteria (CAMCOG <83 or decline in CAMCOG >9) being neurologically examined.

RESULTS

For dementia, diagnosed by DSM-IV criteria, the population prevalence was 5.2% rising to 6.1% in the screened population. For cognitive impairment not dementia, the prevalence in the screened population was 15.6% giving an overall prevalence of cognitive impairment of 21.8%. Prevalence rose fivefold between ages of 65 and 84 years to reach over 50%.

CONCLUSION

These figures are likely to underestimate actual prevalence in this population, and developing effective interventions should be a public health priority.

Molecular studies in Portuguese patients with Smith-Lemli-Opitz syndrome and report of three new mutations in DHCR7

Smith-Lemli-Opitz syndrome (SLO) is an autosomal recessive disorder characterised by craniofacial dysmorphism, mental retardation, multiple congenital anomalies, and increased levels of 7-dehydrocholesterol (7-DHC) in body tissues and fluids. SLO is caused by mutations in the DHCR7 gene which encodes 7-dehydrocholesterol reductase, the last enzyme of cholesterol biosynthesis pathway. In our investigation, we screened 682 dysmorphic/mentally retarded Portuguese patients for abnormal levels of 7-DHC in blood by UV spectrometry. We identified six unrelated patients with SLO (0.87% of total). Mutational analysis of the DHCR7 gene led to the identification of seven distinct mutations, three of which are new (F174S, H301R, and Q98X). The common IVS8-1G > C and T93M variants together with the H301R accounted for 70% of the all SLO alleles in our population. Our findings contribute to the variegate array of pathological changes in the DHCR7 gene among different European populations.