Search

Background Iron deficiency in patients with heart failure with reduced left ventricular ejection fraction (LVEF) confers a poor prognosis in terms of hospital admissions and mortality, worsening functional class and quality of life. Its replacement with ferric carboxymaltose (FCM) has demonstrated to improve clinical parameters, however, the way it is achieved remains unclear. Improvement of myocardial contractility is proposed as possible hypothesis and global longitudinal strain (GLS) could behave as an early and high sensitive parameter to assess this improvement in myocardial deformation due to increased iron availability after replacement of iron deficiency. Purpose Evaluate the effect of replacement of iron deficiency with FCM on left ventricular global longitudinal strain in patients with stable heart failure with left ventricular ejection fraction Methods Observational, analytical, longitudinal and prospective study that enrolled 45 patients with stable heart failure with LVEF Results The study population's median age was 71 years, 67% were men, 76% had high blood pressure, 62% dyslipemia and 33% diabetes. At baseline they presented LVEF 32% ±8.75%, LV systolic volume index 62.3ml±29.56ml and LV GLS −9.09%±3.44%. Four weeks after iron deficiency replacement, they had a significant improvement in LVEF (difference 2.51%; 95% confidence interval [CI], 1.74% to 3.29%; P Conclusion In patients with stable heart failure and LVEF Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Fundaciόn Fisabio (Fomento de la Investigaciόn Sanitaria y Biomédica de la Comunidad Valenciana)

Background Healthcare associated infection (HAI) is a Public Health problem. Hands of healthcare workers are a key for transmission. Compliance with WHO 5 moments for hand hygiene (HH) has been emphasized, but there are other aspects: appropriate use of gloves and healthy hands skin of professionals. Gloves protect the professionals but it may increase cross-transmission. Hands dermatitis is a handicap for the use of alcohol-based handrubs. Data collection and analysis, to have a good communication system to improve training, information and to get feedback from professionals are necessary. The aim of this work is to develop the Safe Hands 3.0 Project in a General Hospital. Methods Preventive Medicine and Public Health Department carried out a descriptive study carried out in a 477-bed General Hospital in last semester 2021. Compliance with HH and the possible causes of non-compliance were assessed with observations and knowledge surveys included appropriate use of gloves in healthcare practice and the impact on hand in professionals. The surveys were carried out using Lime Survey for mobile devices and Google for WhatsApp. Results From 550 observations of HH compliance for the WHO 5 moments is less than 40%. Half of non-compliance was due to inappropriate use of gloves. 266 surveys answered highlighting the need for continued training. Survey on hand skin health perception was answered by 182 professionals, 44% reported dermatological issues and 81% notice that their work damaged their hands skin. A corporate logo was created, use the hospital website and a structured Communication Plan for its implementation. Conclusions To prevent HAI transmission, the concept of Hand Hygiene is limited. Safe Hands 3.0 Project comes up with a bundle of care: proper use of gloves, compliance the WHO 5 moments and skin care of healthcare workers’ hands. Update data management and a corporate communication plan with social networks is necessary to improve training and compliance. Key messages • A bundle of care is the key for Safe Hands: proper use of gloves, compliance the WHO 5 moments and skin care of healthcare workers’ hands. • Update data management and a corporate communication plan with social networks is necessary to improve training and compliance.

Background The Elizabethkingia genus is formed by a group of bacteria which are widely distributed in nature. Elizabethkingia is not part of human microbiota, therefore is considered to be an opportunistic pathogen. In the last years, it has become a cause of potentially fatal disease, becoming an emerging bacteria of increasing relevance. The objective of this study is to describe the impact of Elizabethkingia bacteria in infected patients in the ICU of a hospital in Granada. Methods Descriptive study. Patients who have been isolated in a biological sample of Elizabethkingia miricola throughout the year 2.021 in the ICU of San Cecilio University Hospital in Granada. Date and place of isolation were registered. Other variables registered were sex, age, length of ICU stay, days between ICU admission and bacterium isolation, days between bacterium isolation and death, infection, cause of admission or cause of death. Results Bacterium was isolated in 15 patients. Cause of admission was COVID-19 in 73.3% of patients. 73.3% were men and 26.6% women.The average age was 56.9 years. The average length of ICU stay was 43.8 days. 4 patients were diagnosed with ventilator-associated pneumonia and 5 patients were diagnosed with tracheobronchitis.The average days between ICU admission and bacterium isolation was 26,4 days. The average days between mechanical ventilation and bacterium isolation was 25.9 days. 53.3% of patients died. The average days between bacteria isolation and death was 18.2 days. Conclusions Elizabethkingia miricola is an emerging bacterium under special vigilance due to its capacity to cause major morbidity and mortality in admitted patients in ICU. The rapid identification and the study of the antibiotic susceptibility is considered of special relevance so they can be correctly managed to avoid infections and complications resulting from this microorganism. Key messages • Elizabethkingia is a special surveillance bacterie due to its morbidity and mortality effects. • Elizabethkingia could be a severity indicator in admitted patients to the ICU.

Background Control of multiresistant bacteria (MRB) outbreaks in the Intensive Care Unit (ICU) is a challenge of Public Health. There is strong evidence that surfaces, and sinks are reservoirs of MRB. In 2020, because of isolation of Klebsiella type IMP, OXA-48 and VIM in moist reservoirs in ICU of Clinico San Cecilio Hospital and another carbapenemase-producing Enterobacteriaceae (CPE) outbreak, it arises our aim, which is to highlight the relevance of periodic control of humid reservoirs and surfaces in ICU to prevent MRB transmission. Methods Retrospective, descriptive study from March to June 2021. Due to a rise of cases of a CPE outbreak in our ICU in Granada, samples of surfaces and taps of different boxes were taken, after discharging patients and their corresponding terminal cleaning, whether they were CPE-colonised patient or not. Results Samples of 20 boxes were taken (N = 325). CPE OXA-48 was isolated in 7,38% of the samples which correspond to 40% of the boxes, most of them Enterobacter cloacae. 25% of the positive samples isolated two types of resistance, OXA-48, and VIM. 79,2% of the positive samples were found in March. The rest of them in April and May, after establishing control measures in surfaces. CPE was isolated in blood pressure monitor, pulse oximeter, electrocardiogram and stethoscope from 6 boxes. 3 CPE humid reservoirs were found in the tap and drain sinks of 2 boxes, one of them with CPE colonised patient. Conclusions We have observed the existence of carbapenem-resistant plasmids in surfaces and the persistence of humid reservoirs in our ICU, despite of establishing control measures of an outbreak. In conjunction with classical monitoring measures such as observation and training of hand hygiene, we recommend the use of disposable materials, systematic disinfection of reservoirs, appropriate use of gloves, chlorination of sinks and the goal of an ICU without water should be fundamental elements in the prevention of MRB transmission. Key messages • Multifactorial approach for the control of multiresistant bacteria outbreaks in the Intensive Care Unit. • Intensive Care Unit without water to avoid humid reservoirs of multiresistant bacterias.

The natural frequencies of a turbine can be calculated from numerical methods. By comparing these natural frequencies with excitation sources, one can know the danger of a resonance and a possible failure in a component of the turbine. Therefore, it is often very important to have an accurate numerical model of the turbine to determine these natural frequencies. There are not many publications on the determination of the natural frequencies of reduced-scale models of Kaplan turbines. More papers exist for pump turbines or Francis turbines. For real Kaplan turbines, very few experiments can be found to determine mode shapes and natural frequencies. In this paper a Kaplan turbine of 37MW (maximum power), 12.5m (maximum head) and 50 m3 /s (maximum flowrate) was tested. The turbine was equipped to determine the natural frequencies of the runner in air. For this purpose, one accelerometer in each blade of the runner was installed and a total of 16 impacts were done in each blade. Frequencies and mode shapes were obtained. In parallel, a numerical model was obtained. Numerical and experimental results were compared and an accurate numerical model is presented. With this numerical model the natural frequencies of the runner in water were calculated. This research activity is framed within the context of the XFLEX HYDRO project. The project has received funding from the European Union’s Horizon 2020 research and innovation program under grant agreement No 857832. No. 857832).

Reinforcement/matrix interaction is recognized as a key issue in polymeric composite materials. From the mechanical point of view, being the link between the fibres and the polymer, a proper load transfer is ensured only if a good enough interphase exists. This is particularly critical in carbon fibre (CF) composites since, due to the non-polar characteristics and chemical inertness of carbon, sometimes they exhibit weak interfacial adhesion. In this sense, various surface treatments for CFs are currently being investigated, in order to improve their interaction with the polymeric matrices: wet chemical or electrochemical methods, chemically or physically activated oxidation procedures, application of thin coatings and plasma treatments. This is precisely one of the challenges addressed in the MODCOMP project. This paper describes part of the work carried out within the mentioned project in order to estimate the improvement of properties that can be achieved through enhancements of the CF/epoxy interphases. The study covers both elastic engineering constants and strengths predictions, and it has been performed using finite element models of RVEs of UD fibres and introducing cohesive elements to take into account the interfacial failure mode. The results obtained allow identifying which range of CF/epoxy interphase properties enhancement should be achieved in order to get significant effects in the composites mechanical response.

Introduction\ud \ud Patients with cancer who develop small bowel obstruction are at high risk of malnutrition and morbidity following compromise of gastrointestinal tract continuity. This study aimed to characterise current management and outcomes following malignant small bowel obstruction.\ud \ud \ud \ud Methods\ud \ud A prospective, multicentre cohort study of patients with small bowel obstruction who presented to UK hospitals between 16th January and 13th March 2017. Patients who presented with small bowel obstruction due to primary tumours of the intestine (excluding left-sided colonic tumours) or disseminated intra-abdominal malignancy were included. Outcomes included 30-day mortality and in-hospital complications. Cox-proportional hazards models were used to generate adjusted effects estimates, which are presented as hazard ratios (HR) alongside the corresponding 95% confidence interval (95% CI). The threshold for statistical significance was set at the level of P ≤ 0.05 a-priori.\ud \ud \ud \ud Results\ud \ud 205 patients with malignant small bowel obstruction presented to emergency surgery services during the study period. Of these patients, 50 had obstruction due to right sided colon cancer, 143 due to disseminated intraabdominal malignancy, 10 had primary tumours of the small bowel and 2 patients had gastrointestinal stromal tumours. In total 100 out of 205 patients underwent a surgical intervention for obstruction. 30-day in-hospital mortality rate was 11.3% for those with primary tumours and 19.6% for those with disseminated malignancy. Severe risk of malnutrition was an independent predictor for poor mortality in this cohort (adjusted HR 16.18, 95% CI 1.86 to 140.84, p = 0.012). Patients with right-sided colon cancer had high rates of morbidity.\ud \ud \ud \ud Conclusions\ud \ud Mortality rates were high in patients with disseminated malignancy and in those with right sided colon cancer. Further research should identify optimal management strategy to reduce morbidity for these patient groups.

Protrusions are one of the structures that cells use to sense their surrounding environment in a probing and exploratory manner as well as to communicate with other cells. In particular, osteoblasts embedded within a 3D matrix tend to originate a large number of protrusions compared to other type of cells. In this work, we study the role that mechanochemical properties of the extracellular matrix (ECM) play on the dynamics of these protrusions, namely, the regulation of the size and number of emanating structures. In addition, we also determine how the dynamics of the protrusions may lead the 3D movement of the osteoblasts. Significant differences were found in protrusion size and cell velocity, when degradation activity due to metalloproteases was blocked by means of an artificial broad-spectrum matrix metalloproteinase inhibitor, whereas stiffening of the matrix by introducing transglutaminase crosslinking, only induced slight changes in both protrusion size and cell velocity, suggesting that the ability of cells to create a path through the matrix is more critical than the matrix mechanical properties themselves. To confirm this, we developed a cell migration computational model in 3D including both the mechanical and chemical properties of the ECM as well as the protrusion mechanics, obtaining good agreement with experimental results.

Background and purpose In Parkinson's disease (PD), the course of the disorder is highly variable between patients. Well-designed, prospective studies for identifying PD progression biomarkers are necessary. Our aim was to show the results of baseline evaluations of an ongoing global PD project, COPPADIS-2015 (Cohort of Patients with PArkinson's DIsease in Spain, 2015). Methods This was an observational, descriptive, nationwide study (Spain). The recruitment period ended in October 2017. Baseline evaluation included more than 15 validated scales and complementary studies in a subgroup of participants. Results In total, 1174 subjects from 35 centres were considered valid for baseline analysis: 694 patients (62.6 ± 8.9 years old, 60.3% males), 273 caregivers (58.5 ± 11.9 years old, 31.8% males) and 207 controls (61 ± 8.3 years old, 49.5% males). The mean disease duration was 5.5 ± 4.4 years. Hoehn and Yahr stage was 1 or 2 in 90.7% of the patients whilst 33.9% and 18.1% of them presented motor fluctuations and dyskinesias, respectively. The mean Non-Motor Symptoms Scale total score was 45.4 ± 38.1, and 30.4% of the patients presented cognitive impairment, 16.1% major depression, 12.7% impulse control disorder, 7.2% compulsive behaviour, 57.2% pain and 13.2% falls. Compared to the control group, PD patients presented a significantly higher burden of non-motor symptoms and a worse quality of life. More than 300 subjects conducted complementary studies (serum biomarkers, genetic and neuroimaging). Conclusions Parkinson's disease is a complex disorder and different non-motor symptoms are frequently present and are more prevalent than in controls. In real clinical practice it is important to ask for them.

In order to satisfy the power demand in the electrical grid, hydraulic turbine units frequently work under off-design operation conditions and pass through transient events. These operation conditions can lead to high vibration amplitudes in the turbine runners, decreasing their useful life, and in some cases to premature failures. To determine and to understand the behaviour of the fluid damping is a relevant topic, because this parameter limits the maximum amplitude in resonance conditions. The runner of some types of turbines, such as reversible pump-turbine and high head Francis turbine, can be modelled as a disk-like structure, due to their similar mode shapes. Because of this, in this work, the fluid damping of a vibrating disk was studied. The disk was submerged in water and was put in a resonant state at different vibration amplitudes. Moreover, this structure was excited at different distances to a rigid surface, in order to analyse the effects of the distance between the runner and the casing. The main effects on the fluid damping were determined and characterized, showing a dependency of the fluid damping ratio on the different parameters.

COPPADIS Study Group., [Introduction] The aim of the present study was to examine the frequency of self-reported sleep problems and their associated factors in a large cohort of PD patients., [Methods] PD patients and controls, recruited from 35 centers of Spain from the COPPADIS cohort were included in this cross-sectional study. Sleep problems were assessed by the Spanish version of the Parkinson’s disease Sleep Scale version 1 (PDSS-1). An overall score below 82 or a score below 5 on at least 1 item was defined as sleep problems., [Results] The frequency of sleep problems was nearly double in PD patients compared to controls: 65.8% (448/681) vs 33.5% (65/206) (p < 0.0001). Mean total PDSS score was lower in PD patients than controls: 114.9 ± 28.8 vs 132.8 ± 16.3 (p < 0.0001). Quality of life (QoL) was worse in PD patients with sleep problems compared to those without: PDQ-39SI, 19.3 ± 14 vs 13 ± 11.6 (p < 0.0001); EUROHIS-QoL8, 3.7 ± 0.5 vs 3.9 ± 0.5 (p < 0.0001). Non-motor symptoms burden (NMSS; OR = 1.029; 95%CI 1.015–1.043; p < 0.0001) and impulse control behaviors (QUIP-RS; OR = 1.054; 95%CI 1.009–1.101; p = 0.018) were associated with sleep problems after adjustment for age, gender, disease duration, daily equivalent levodopa dose, H&Y, UPDRS-III, UPDRS-IV, PD-CRS, BDI-II, NPI, VAS-Pain, VAFS, FOGQ, and total number of non-antiparkinsonian treatments., [Conclusion] Sleep problems were frequent in PD patients and were related to both a worse QoL and a greater non-motor symptoms burden in PD. These findings call for increased awareness of sleep problems in PD patients.

Background Although depression is known to be frequent in Parkinson's disease (PD), it is unclear how mood can change and/or impact on patient's quality of life (QoL) over time. Our aim was to analyze the frequency of depression, mood related factors and the contribution of mood to a patient's QoL perception in regard to disease duration. Methods PD patients recruited from the COPPADIS cohort from January 2016 to November 2017 were included in this cross-sectional study. Three groups were defined: = 10 years (Group C). Analysis with well-planned linear regression models was conducted to determine how different factors contribute to mood (Beck Depression Inventory-II [BDI-II] as dependent variable), to health-related QoL (39-item Parkinson's Disease Questionnaire [PDQ-39SI] as dependent variable) and to global QoL (European Health Interview Survey - Quality of Life Eight-Item Index [EUROHIS-QOL8] as dependent variable). Results Six hundred and sixty-three PD patients (62.6 +/- 8.9 years old, 59.6% males) were included: Group A, 50.1% (n = 332); Group B, 33.3% (n = 221) and Group C, 16.6% (n = 110). There were no differences between the three groups in terms of the frequency of depressive symptoms nor the frequency of depression type (major vs. minor vs. subthreshold) (p = 0.729). However, the unique percent variance of PDQ-39SI and EUROHIS-QOL8 explained by BDI-II total score was 2 (23.7%) and threefold (26.9%), respectively, in Group C compared to the other two groups. EUROHIS-QOL8 total score provided the highest unique contribution to mood (16.8%). Conclusions Although depression-type frequency does not appear to change over time in PD; the contribution of mood on QoL perception is greater in patients with longer disease duration.

The link between chronic inflammation and atherosclerosis is well known. More specifically, we know there is a direct association between chronic inflammatory joint diseases (IJD) such as rheumatoi...

Despite the significant technical/scientific progress achieved in the lasts years, design and modelling of adhesive joints is still an active research area. Among different approaches, the ...

Background: Depression and impulse control disorders (ICDs) are both common in Parkinson's disease (PD) patients and their coexistence is frequent. Our aim was to determine the relationship between depression and impulsive-compulsive behaviors (ICBs) in a large cohort of PD patients. Methods: PD patients recruited from 35 centers of Spain from the COPPADIS cohort from January 2016 to November 2017 were included in the study. The QUIP-RS (Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale) was used for screening ICDs (cutoff points: gambling >6, buying >8, sex >8, eating >7) and compulsive behaviors (CBs) (cutoff points: hobbyism-punding >7). Mood was assessed with the BDI-II (Beck Depression Inventory - II) and major, minor, and subthreshold depression were defined. Results: Depression was more frequent in PD patients with ICBs than in those without: 66.3% (69/104) vs 47.5% (242/509); p

BackgroundGlucocorticoids (GC) are the mainstay therapy in Giant Cell Arteritis (GCA), initially at high doses (40-60 mg/day) followed by gradual glucocorticoid tapering. This treatment, especially in older patients, is associated with numerous adverse effects (AE). In addition, there are frequent relapses. Therefore, conventional synthetic immunosuppressants such as methotrexate (MTX), leflunomide, azathioprine, cyclophosphamide or mycophenolate, have been used with controversial results. Studies with biological immunosuppressants, such as TNFi have been ineffective; in contrast, tocilizumab (TCZ) has obtained positive results and was approved for the treatment of GCA.ObjectivesIn the ARTESER study we describe a) treatment with GC, synthetic or biological immunosuppressants; b) AE of CG; and c) evolution.MethodsARTESER is a retrospective observational study sponsored by the Spanish Society of Rheumatology. 26 Spanish centers participated and all new patients diagnosed with GCA from June 1, 2013 to March 29, 2019 were included. Data on GC and immunosuppressants were collected at the beginning and during the follow-up of GCA patients. For the calculation of the cumulative dose of GC, an application was developed that, by including the periods of time, dose and type of GC received during follow-up, performs the automatic calculation in mg of prednisone.ResultsOf the 1675 patients included, GC treatment was adequately recorded in 1650 patients (Table 1). All received oral treatment, being prednisone the most frequently drug used (N=1602, 97.09%). In addition, 426 (25.82%) patients received at least one iv pulse of methylprednisolone, being the 1000 mg regimen the most frequent (n=217; 50.9%). The total mean duration of GC treatment was 22.65 months. The mean cumulative dose per patient at the end of follow-up was 8514.98 mg of prednisone.Table 1.Corticosteroid treatment and immunosuppressive treatmentPatients taking oral corticosteroid1650 Prednisone, n (%)1602 (97.09) Methylprednisolone, n (%)164 (9.94) Deflazacort, n (%)64 (3.88)Patients receiving intravenous corticosteroid, n (%)426 (25.82)Mean duration of steroid treatment, mean (SD)22.65 (17.36)Mean cumulative dose at the end of follow-up per patient, mg of prednisone, mean (SD)8514.98 (6570.21)Methotrexate at diagnosis*, n (%)165 (9.9)Leflunomide at diagnosis*, n (%)2 (0.1)Azathioprine at diagnosis*, n (%)3 (0.2)Cyclophosphamide at diagnosis*, n (%)7 (0.4)Mycophenolate at diagnosis*, n (%)1 (0.1)Tocilizumab at diagnosis*, n (%)22 (1.3)Methotrexate during follow-up, n (%)532 (31.8)Leflunomide during follow-up, n (%)19 (1.2)Azathioprine during follow-up, n (%)26 (1.5)Cyclophosphamide during follow-up, n (%)10 (0.6)Mycophenolate during follow-up, n (%)10 (0.6)Tocilizumab during follow-up, n (%)153 (9.1)The most widely used immunosuppressant was MTX both at diagnosis (n=165; 9.9%) and during follow-up (n=532; 31.8%), followed by TCZ, at diagnosis (22; 1.3%) and at follow-up (153; 9.1%).AE with GC were described in 393 patients (23.8%), highlighting serious infections (n=67; 10.03%) followed by diabetes mellitus (n=63; 9.43%), steroid myopathy (n=53; 7.9%), vertebral fractures (n=47; 7.04%), non-vertebral fractures (n=36; 5.39%), heart failure (n=36; 5.39%), arterial hypertension (n=34; 5.09%) and neuropsychiatric alterations (n=27; 4.04%).During the follow-up, 334 (19.9%) patients had relapses, 532 (31.8%) were hospitalized on some occasion, and 142 patients (8.48%) died. The main cause of death were infections (n=44; 30.99%), neoplasms (n=23; 16.2%), cardiovascular (n=15; 10.56%), and cerebrovascular (n=10; 7.04%).ConclusionThe main treatment for GCA was oral GC, which were required for almost two years on average, in a quarter of patients associated with IV pulses. The cumulative steroid dose was high as well as the side effects. MTX was the most widely used immunosuppressant and TCZ was prescribed in 10%. Relapses and admissions at the hospital were relatively frequent.AcknowledgementsThis study has been funded by ROCHE Farma. The funder has not participated in the design, analysis, or interpretation of the resultsDisclosure of InterestsNone declared

BackgroundThe lockdown and mobility restrictions in early COVID19 pandemic had a great impact in chronic patient care due to limited access and scheduled visits. In our hospital, coordinated non-pharmacological interventions (NPI) were designed in Rheumatology and Pharmacy services to maintain the accessibility and continuity of care for patients with IMID.ObjectivesTo evaluate the patient reported experience (PRE), health status and quality of life in Rheumatology outpatient IMID subjects since March 14, 2020 when lockdown was imposed and during subsequent restrictions, related to the healthcare team and medications accessibility, and continuity of care.MethodsObservational study, using a patient survey. Adult patients attending the rheumatology outpatient clinic between Nov 2, 2020 to Feb 13, 2021, with rheumatoid arthritis (RA), psoriatic arthritis (PsA), spondylarthritis (SpA) or systemic autoimmune diseases (SAD), with at least 1 year from diagnosis and 1 month of treatment with conventional synthetic (cs) targeted synthetic (ts) or biological (b) disease modifying antirheumatic drugs (DMARD). Face to face or phone interviews were conducted using an ad hoc designed questionnaire that included COVID19 related questions, the 11 IEXPAC scale items (5 point Likert scale ranging from never to always) (www.iexpac.org), and 4 items (5 points, very good to very bad) of the global scale PROMIS 10 (Patient-Reported Outcomes, PRO). All questions refer to the patient’s experience during the 6 months prior to data collection.ResultsFrom 174 screening patients, 158 completed the survey, mainly woman (66.5%) with a median age of 60 (IQR 47-69,3) years. The most frequent diagnosis was RA (43%) followed by ESAP (35%), EAS (22%) and PsA (13%). 46.8% of the patients have been prescribed b or ts DMARD and 53.2% sc DMARD, 32.9% in combination. From 158, 39 persons requested healthcare for COVID-19 related symptoms and diagnosis was confirmed in 17 (10,8%). Just 2 patients required hospital admission. Clinical control and continuity of care for COVID19+ patients were carried out from their primary care center and by phone consultation. Some key results of the survey are displayed in Table 1.Table 1.PRO and Patients’ perception during COVID19 lockdown and restrictions.During confinement and restrictions due to covid-19, in the last 6 months …Responses (%)N= 158Your degree of concern about the COVID19 crisis is.High + Quite high (86.7)PRO (PROMIS 10)How good was your health …?Very good (11.4), Good: (43.7)and your emotional/mental health, including mood and ability to think?Very good (10.1)Good (41.1)your quality of life was.Very good (8.25) Good (49,4)Your satisfaction in performing daily tasks (home, work, family) was.Very good (7.8)Good (55.1)Accessibility to care and medicationsI could contact my rheumatologist whenever I needed (email, phone).Always (79.9)My rheumatologist changed my face-to-face visit for a phone callYes (53)I received my medication at home from the hospital pharmacyYes (16)I picked up my medication from the hospital pharmacy, without incident.Yes (21)I maintained the prescribed dose medication…Always + almost always (96,2)At some point I modify a medication by my own decisionYes (6)My doctor changed the dose or route of administrationYes (7)Your satisfaction with the care provided from all professionals in the team wasVery + Quite satisfied (75)PREMS (IEXPAC)Item 2. The professionals … are coordinated to offer me good healthcareAlways (34.18)Item 8. They make sure that I take my medication correctlyAlways (73.42)Item 9. They worry about my welfareAlways (74.68)ConclusionLessons have learned during the COVID19 lockdown and restrictions by assessing patients’ health status and patients-reported experience. Coordinated NPI such as medication monitoring and home delivery, appointment reorganization and protocolized phone visits can result in a good patient perception and medication adherence whilst receiving care in a challenging situation.Disclosure of InterestsNone declared

BackgroundAutoimmune rheumatic diseases (ARD) are associated with multiple organ dysfunction, which may require admission to Intensive Care Units (ICU), constituting a challenge for rheumatologists and intensivists. The new immunomodulatory treatments may be changing the characteristics and mortality of these patients.ObjectivesThe primary objective of the study is to know the mortality and the characteristics related to this event of our patients admitted to the ICU in the last 5 years. The secondary objective is to compare the characteristics of our series with the series of our patients admitted to the ICU in the previous decade.MethodsWe conducted a retrospective transversal observational study using computerized medical records. A database was created with patients with ARD admitted to the ICU of the Princess University Hospital between October 1, 2015 and September 30, 2020, excluding those with a stay of less than 24 hours. Information was collected about the characteristics and treatments of the disease prior to their admission to the ICU, as well as the clinical characteristics and therapeutic measures established in the ICU during their stay.Statistical analysis was performed using SPSS.ResultsAfter ruling out admissions of less than 24 hours, a population of 45 patients with a mean age of 65.3 ± 12.2 years and 69% women were included. Connectivopathies (40%) and rheumatoid arthritis (37.8%) were the most prevalent ARDs that required admission to the ICU. Cardiovascular events (51%) were the main reason for ICU admission, followed by infectious processes (27%). The median ICU stay was 5 days. It is striking that 77% of the patients had received glucocorticoids prior to admission throughout their disease. The median score on the severity scales was 34 in SAPS II and 17 in APACHE II. Mortality during the ICU stay was 30.4% and in the multivariate analysis it was associated with the previous administration of glucocorticoid boluses and the APACHE II scale score. This mortality is higher compared to historical series of patients admitted to Spanish ICUs with similar APACHE II severity scores.In the comparative study with the previous period, similar mortality rates were observed, an increase in the mean age of those admitted, a decrease in patients with vasculitis and an increase in patients with rheumatoid arthritis. Likewise, an increase in cardiovascular events is observed as a fundamental reason for admission to the ICU.ConclusionThe mortality of our patients with ARD admitted to the ICU in the last five years is 30.4%, similar to the previous decade but higher than the observed in other pathologies with similar severity characteristics. It is related to the APACHE II score and to the prior administration of glucocorticoid boluses. Connectivopathies and rheumatoid arthritis are the diseases that are most frequently admitted to the ICU and the fundamental reasons are cardiovascular events and infections.Disclosure of InterestsNone declared

Maruca vitrata(Fabricius, 1787) is a cryptic pantropical species of Lepidoptera that are comprised of two unique strains that inhabit the American continents (New World strain) and regions spanning from Africa through to Southeast Asia and Northern Australia (Old World strain). In this study, wede novoassembled the complete mitochondrial genome sequence of the New World legume pod borer,M. vitrata, from shotgun sequence data generated on an Illumina HiSeq 2000. Phylogenomic comparisons were made with other previously published mitochondrial genome sequences from crambid moths, including the Old World strain ofM.vitrata. The 15,385 bpM. vitrata(New World) sequence has an 80.7% A+T content and encodes the 13 protein-coding, 2 ribosomal RNA and 22 transfer RNA genes in the typical orientation and arrangement of lepidopteran mitochondrial DNAs. Mitochondrial genome-wide comparison between the New and Old World strains ofM. vitratadetected 476 polymorphic sites (4.23% nucleotide divergence) with an excess of synonymous substitution as a result of purifying selection. Furthermore, this level of sequence variation suggests that these strains diverged from ~1.83 to 2.12 million years ago, assuming a linear rate of short-term substitution. Thede novoassemblies of mitochondrial genomes from next-generation sequencing (NGS) reads provide readily available data for similar comparative studies.

Background:Different Jakinibs (JAKi) have shown efficacy in rheumatoid arthritis (RA) but in an important proportion of patients, insufficient response leads to therapy withdrawal. The different JAKi show variable selectivity for the four Jak isoforms (Jak1,2,3 y Tyk2) but there are no clinical trials analyzing the response to a JAKi after the suspension of another JAKi and therefore, observational data may be useful in this regard.Objectives:To describe efficacy and safety of the second JAKi in patients with suspension of the first due to failure or side effects.Methods:Spanish observational multicentric study. Data were retrospectively obtained from medical records of 28 patients with RA sequentially treated with baricitinib o tofacitinib in any order.Results:We identified 28 patients with RA treated with baricitinib and tofacitinib. Patient´s characteristics are summarized in Table 1. Half of the patients received tofacitinib first, and the other half baricitinib as the first JAKi. Mean survival for the first JAKi was 7,6 ± 6,1 months. The reason for withdrawal was inefficacy in 17 cases (61%) and adverse effects in 11 (39%). Mean follow-up after starting on the second JAKi was 9,6 ± 5,6 [3-19] months. Disease activity data along follow-up are depicted in Table 2. Survival on the second JAKi was 82% at 3, 76% at 6, and 62% at 12 months when 13 of the 21 patients maintained the therapy. In all 8 patients who discontinued the second JAKi, the reason was inefficacy. The treatment suspension rate was similar among patients discontinuing the first JAKi for inefficacy (n=5, 29,4%) or for adverse effects (n=3; 27,3%).Table 1.Baseline Charateristics.N 28Clinical characteristicsFemale24 (86%)Age*61.2 ± 13.2ACPA (+)19 (67,9%)Erosions13 (46,4%)Extra-articular manifestations8 (28,6%)TJC*10,8 ± 5,4SJC *7,4 ± 4,6DAS28-CPR*5,4 ± 0,91 High disease activity71,5% Moderate disease activity23,8% Low disease activity4,7%Previous treatmentbDMARD24 (86%)N° of previous bDMARDs *3,9±2,2 iTNF75% No-iTNF67,9%(*) Mean ± SDTabla 2.Treatment results during the follow-up period.Baseline (n 28)3 m (n 28)6 m (n 25)12 m (n 21)TJC10,8±5,43,8±3,34,23±2,51,9±1,5SJC7,2±4,61,8±1,71,7±20,7±1CPR mg/dL1±0,60,54±0,480,64±0,90,33±0,24DAS28CPR5,4±0,913,29±0,973,15±1,22,15±0,6Prednisone mg7,2±4,26,8±3,55,3±2,53,1±2,1Conclusion:Our data show that therapy with a second JAKi is a safe and efficacious option after discontinuation of the first JAKi due to either inefficacy or side effects. The response rate to the second JAKi is similar in patients with inefficacy or side effects which suggests that failure to the first does not reduce the chance of response to the second.Acknowledgments:M. Retuerto was recipient of a training grant from Sociedad Española de Reumatología (SER).Disclosure of Interests:None declared

Background: The role of subthreshold depression (subD) in Parkinson's Disease (PD) is not clear. The present study aimed to compare the quality of life (QoL) in PD patients with subD vs patients with no depressive disorder (nonD). Factors related to subD were identified. Material and methods: PD patients and controls recruited from the COPPADIS cohort were included. SubD was defined as Judd criteria. The 39-item Parkinson's disease Questionnaire (PDQ-39) and the EUROHIS-QOL 8-item index (EUROHIS-QOL8) were used to assess QoL. Results: The frequency of depressive symptoms was higher in PD patients (n = 694) than in controls (n = 207) (p < 0.0001): major depression, 16.1% vs 7.8%; minor depression, 16.7% vs 7.3%; subD, 17.4% vs 5.8%. Both health-related QoL (PDQ-39; 18.1 +/- 12.8 vs 11.6 +/- 10; p < 0.0001) and global QoL (EUROHIS-QOL8; 3.7 +/- 0.5 vs 4 +/- 0.5; p < 0.0001) were significantly worse in subD (n = 120) than nonD (n = 348) PD patients. Non-motor Symptoms Scale (NMSS) total score was higher in subD patients (45.9 +/- 32 vs 29.1 +/- 25.8;p < 0.0001). Non-motor symptoms burden (NMSS;OR = 1.019;95%CI 1.011-1.028; p < 0.0001), neuropsychiatric symptoms (NPI; OR = 1.091; 95%CI 1.045-1.139; p < 0.0001), impulse control behaviors (QUIP-RS; OR = 1.035; 95%CI 1.007-1063; p = 0.013), quality of sleep (PDSS; OR = 0.991; 95%CI 0.983-0.999; p = 0.042), and fatigue (VAFS-physical; OR = 1.185; 95%CI 1.086-1.293; p < 0.0001; VAFS-mental; OR = 1.164; 95%CI 1.058-1.280; p = 0.0001) were related to subD after adjustment to age, disease duration, daily equivalent levodopa dose, motor status (UPDRS-III), and living alone. Conclusions: SubD is a frequent problem in patients with PD and is more prevalent in these patients than in controls. QoL is worse and non-motor symptoms burden is greater in subD PD patients.

Aims: Guidelines recommend down-titration of loop diuretics (LD) once euvolaemia is achieved. In outpatients with heart failure (HF), we investigated LD dose changes in daily cardiology practice, agreement with guideline recommendations, predictors of successful LD down-titration and association between dose changes and outcomes. Methods and results: We included 8130 HF patients from the ESC-EORP Heart Failure Long-Term Registry. Among patients who had dose decreased, successful decrease was defined as the decrease not followed by death, HF hospitalization, New York Heart Association class deterioration, or subsequent increase in LD dose. Mean age was 66 ± 13 years, 71% men, 62% HF with reduced ejection fraction, 19% HF with mid-range ejection fraction, 19% HF with preserved ejection fraction. Median [interquartile range (IQR)] LD dose was 40 (25–80) mg. LD dose was increased in 16%, decreased in 8.3% and unchanged in 76%. Median (IQR) follow-up was 372 (363–419) days. Diuretic dose increase (vs. no change) was associated with HF death [hazard ratio (HR) 1.53, 95% confidence interval (CI) 1.12–2.08; P = 0.008] and nominally with cardiovascular death (HR 1.25, 95% CI 0.96–1.63; P = 0.103). Decrease of diuretic dose (vs. no change) was associated with nominally lower HF (HR 0.59, 95% CI 0.33–1.07; P = 0.083) and cardiovascular mortality (HR 0.62,. 95% CI 0.38–1.00; P = 0.052). Among patients who had LD dose decreased, systolic blood pressure [odds ratio (OR) 1.11 per 10 mmHg increase, 95% CI 1.01–1.22; P = 0.032], and absence of (i) sleep apnoea (OR 0.24, 95% CI 0.09–0.69; P = 0.008), (ii) peripheral congestion (OR 0.48, 95% CI 0.29–0.80; P = 0.005), and (iii) moderate/severe mitral regurgitation (OR 0.57, 95% CI 0.37–0.87; P = 0.008) were independently associated with successful decrease. Conclusion: Diuretic dose was unchanged in 76% and decreased in 8.3% of outpatients with chronic HF. LD dose increase was associated with worse outcomes, while the LD dose decrease group showed a trend for better outcomes compared with the no-change group. Higher systolic blood pressure, and absence of (i) sleep apnoea, (ii) peripheral congestion, and (iii) moderate/severe mitral regurgitation were independently associated with successful dose decrease. © 2020 European Society of Cardiology

Aims: This study aimed to assess age- and sex-related differences in management and 1-year risk for all-cause mortality and hospitalization in chronic heart failure (HF) patients. Methods and results: Of 16 354 patients included in the European Society of Cardiology Heart Failure Long-Term Registry, 9428 chronic HF patients were analysed [median age: 66 years; 28.5% women; mean left ventricular ejection fraction (LVEF) 37%]. Rates of use of guideline-directed medical therapy (GDMT) were high (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers and mineralocorticoid receptor antagonists: 85.7%, 88.7% and 58.8%, respectively). Crude GDMT utilization rates were lower in women than in men (all differences: P ≤ 0.001), and GDMT use became lower with ageing in both sexes, at baseline and at 1-year follow-up. Sex was not an independent predictor of GDMT prescription; however, age >75 years was a significant predictor of GDMT underutilization. Rates of all-cause mortality were lower in women than in men (7.1% vs. 8.7%; P = 0.015), as were rates of all-cause hospitalization (21.9% vs. 27.3%; P 75 years. Conclusions: There was a decline in GDMT use with advanced age in both sexes. Sex was not an independent predictor of GDMT or adverse outcomes. However, age >75 years independently predicted lower GDMT use and higher all-cause mortality in patients with LVEF ≤45%. © 2019 The Authors. European Journal of Heart Failure © 2019 European Society of Cardiology

Aims: We assessed the interplay between hyperkalaemia (HK) and renin–angiotensin–aldosterone system inhibitor (RAASi) use, dose and discontinuation, and their association with all-cause or cardiovascular death in patients with chronic heart failure (HF). We hypothesized that HK-associated increased death may be related to RAASi withdrawal. Methods and results: The ESC-HFA-EORP Heart Failure Long-Term Registry was used. Among 9222 outpatients (HF with reduced ejection fraction: 60.6%, HF with mid-range ejection fraction: 22.9%, HF with preserved ejection fraction: 16.5%) from 31 countries, 16.6% had HK (≥5.0 mmol/L) at baseline. Angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) was used in 88.3%, a mineralocorticoid receptor antagonist (MRA) in 58.7%, or a combination in 53.2%; of these, at ≥50% of target dose in ACEi: 61.8%; ARB: 64.7%; and MRA: 90.3%. At a median follow-up of 12.2 months, there were 789 deaths (8.6%). Both hypokalaemia and HK were independently. associated with higher mortality, and ACEi/ARB prescription at baseline with lower mortality. MRA prescription was not retained in the model. In multivariable analyses, HK at baseline was independently associated with MRA non-prescription at baseline and subsequent discontinuation. When considering subsequent discontinuation of RAASi (instead of baseline use), HK was no longer found associated with all-cause deaths. Importantly, all RAASi (ACEi, ARB, or MRA) discontinuations were strongly associated with mortality. Conclusions: In HF, hyper- and hypokalaemia were associated with mortality. However, when adjusting for RAASi discontinuation, HK was no longer associated with mortality, suggesting that HK may be a risk marker for RAASi discontinuation rather than a risk factor for worse outcomes. © 2020 European Society of Cardiology

Background: In the last few years, an association has been described between lower bone mass at the onset of disease and higher severity of rheumatoid arthritis (RA). Objectives: To identify single nucleotide polymorphisms (SNPs) in genes related to bone remodeling associated with severity of disease and bone mineral density (BMD) in patients with early-onset arthritis. Methods: We included 268 PEARL (Princess Early Arthritis Register Longitudinal) patients genotyped with Ilumina Inc. Immunochip. This array includes 556 SNPs with different density levels in semaphorins 4b, 4d and 4f, DKK1, 2 and 3, sclerostin, osteoprotegerin (OPG), RANK and RANKL. All SNPs with genotyping rate Results: As shown in the attached table, 11 SNPs were associated with the severity of the disease; 7 of them were also associated with BMD, although only 3 confirmed the previously described relationship between severity of disease and BMD. Conclusion: This preliminary study highlights the relationship between gene variants of molecules involved in bone remodeling and the severity of early-onset arthritis. However, more studies are needed to confirm this relationship and validate it in other populations. This would confirm the involvement of these gene variants in disease activity and bone mass variation. References: [1] Llorente. I, et al. Anti-citrullinated protein antibodies are associated with decreased bone mineral density: baseline data from a register of early arthritis patients. Rheumatol Int. 2017;37(5):799-806 [2] Forslind K. et al. Hand bone loss measured by digital X-ray radiogrammetry is a predictor of joint damage in early rheumatoid arthritis. Scand J Rheumatol. 2009;38(6):431-8. Disclosure of Interests: Noelia Garcia Castaneda: None declared, Amalia Lamana: None declared, Nuria Montes: None declared, Ana Ortiz: None declared, DOLORES MARTINEZ-QUINTANILLA JIMENEZ: None declared, Cristina Valero: None declared, PABLO MORENO FRESNEDA: None declared, Irene Llorente : None declared, Javier Martin Ibanez: None declared, Carmen Martinez: None declared, Rosa P. Gomariz: None declared, Ana Triguero-Martinez: None declared, Santos Castaneda Consultant for: Amgen, BMS, Pfizer, Lilly, MSD, Roche, Sanofi, UCB, Isidoro Gonzalez-Alvaro: None declared

Plantar fasciitis is a common cause of heel pain. The aetiology of this condition remains unclear. Patients typically have pain upon palpation of the medial plantar calcaneal region. Extracorporeal shockwave therapy has shown favourable outcomes in various studies. The aim of this study was to compare the effect of focused extracorporeal shockwave therapy with radial pressure wave therapy.Seventy-nine non-randomised patients diagnosed with plantar fasciitis were included between January 2017 and June 2018. Patients from the Arnau de Vilanova Hospital in Valencia were treated with focused extracorporeal shockwave therapy, and patients from Llíria Hospital with radial pressure wave therapy. Measured outcome variables were: visual analog scale; ultrasonographic measurement of plantar fascia thickness; self-reported foot-specific pain and disability using the Foot Function Index; self-reported health-related quality of life using the Euroqol-5D; self-reported pain and limitations of activity using the RolesMaudsley Scale.At inclusion, the 2groups showed no significant differences in demographic or clinical characteristics. Three months after treatment completion, both groups showed improvement in all outcome variables, without statistically significant differences between the 2groups. No adverse effects or complications were observed.Both extracorporeal shockwave therapy and radial pressure wave therapy are effective treatments for plantar fasciitis.

Background:Biological therapy in combination is discouraged in the guidelines for the treatment of immune-mediated inflammatory diseases, attending to safety reasons. However, combined biological therapy could be a valid alternative in patients with highly refractory spondyloarthritis (SpA) as has been previously demonstrated in some reluctant inflammatory bowel disease patients. Published experiences in the literature are very scarce and the follow-up is limited.Objectives:The aim of this study is to determine the effectiveness and safety of the association of biological drugs in patients with SpA and describe the clinical profile of these patients.Methods:This is a retrospective, cross-sectional and descriptive study. We included patients with SpA who had received simultaneously at least two biological drugs with different therapeutic targets. We reviewed the database of our hospital that included all patients diagnosed with SpA meeting the ASAS criteria for axial SpA under active biological treatment.Demographics, clinical and laboratory data, previous treatments, disease activity index (ASDAS CRP) and adverse events were collected. Remission and low activity criteria were considered according to cut-off descriptions in ASDAS CRP, Results:We identified six patients with SpA receiving combined biological therapy (Table 1). All patients showed high disease activity at the start of combination treatment and most of them presented several disease domains involvement. The average of previous biologics drugs was 5.33 ± 1.75. Four patients received an anti-TNF in combination with an anti-IL17 agent and one patient with concomitant Crohn disease was prescribed an anti-TNF combined with an anti-IL23 agent. The sixth patient, with SpA and concomitant systemic lupus erythematosus, received rituximab with an anti-IL17 (Table 1). The median treatment duration of the combined biological therapy was 12.5 months (IQR 4-43.5; range: 4-117). All patients achieved low disease activity or clinical remission at some point during follow-up, allowing for initial de-escalation of initial dose in some patients. Only one patient experienced a transient relapse (unic uveitis episode). No relevant adverse effects have been found clearly attributable to combination therapy. A 60-year-old patient with multiple comorbidities has stopped treatment due to aggravation of a previous liver cirrhosis.Conclusion:Combined biological therapy could be an effective therapeutic alternative to patients with multidomain and refractory SpA. In our series, we provide acceptable safety data for follow-up periods that it are longer than the majority of reported cases to date.Table 1.Main characteristics of patients with SpA and treatment schedules.CharacteristicsPatients (N= 6)Male, n3Age at diagnosis (years) mean (IQR)25 (8-52)Ethnicity, n5 Caucasian; 1 HispanicSmoker, n1Diagnosis 3 Juvenile SpA-ERA, 2 PsA, 1 SpA + SLEDuration of disease (years) mean (IQR)20.5 (5.25-33.5)Domains involved, n6 Axial6 Peripheral6 Enthesis5 Extra-articular2 psoriasis (1 with aortic insufficiency), 2 uveitis, 1 Crohn diseaseHLA-B27 +, n4Previous biological or targeted therapy, n Anti-TNF6 (5 etanercept, 5 adalimumab, 4 infliximab, 4 golimumab, 3 certolizumab) Anti-IL176 (5 secukinumab, 1 ixekizumab) Jakinibs1 (1 tofacitinib) Other3 (1 anakinra, 1 tocilizumab, 1 apremilast)Combined biological TherapyTreatment 1 + Treatment 2Time of follow-up (months)Actual state1.GOL 100 mg/4w + SEC 150 mg/1w117Remission2.ETN 50 mg/1w + SEC 150 mg/2w9*Low activity3.ETN 50 mg/1w + SEC 150 mg/4w;16Remission4.GOL 100 mg/4w + SEC 150 mg/2w4Low activity5.GOL 100 mg/3w + RIS 250 mg/12w4Low activity6.RTX 2g infusion + SEC 150 mg/4w19Remission*At treatment interruptionAbbreviations: ERA: enthesitis-related arthritis; ETN: etanercept; GOL: golimumab; IQR: interquartile range; PsA: psoriatic arthritis; RIS: risankizumab; RTX: rituximab SEC: secukinumab; SLE: systemic lupus erythematosus; SpA: spondyloarthritis; w: week.Disclosure of Interests:None declared

Background:Anti-NOR 90 autoantibodies (anti-NOR90 Ab) are autoantibodies that target nucleolar transcription factor 1 or hUBF, involved in transcription of RNA polymerase I. These autoantibodies have been detected in 6.1% of patients with Systemic Sclerosis (SSc), but their clinical or prognostic significance has not been clearly defined. Anti-NOR90 Ab have been mostly associated with limited scleroderma with mild organ involvement and can also be found in other rheumatic diseases such as rheumatoid arthritis, systemic lupus erythematosus or Sjogren’s syndrome.Objectives:The aim of this study was to identify the main clinical characteristics of patients with positive anti-NOR90 in our Centre.Methods:This is a retrospective, descriptive, cross-sectional study of all patients with positive anti-NOR90 Ab between January 2013 and December 2020 in a single center. Autoantibodies testing was performed using Euroimmun EUROLINE SSc profile IgG autoAb assay kit. Patient demographics, clinical characteristics, associated diagnoses, laboratory and immunological findings were collected.Results:We identified a total of 26 patients with at least a positive value for anti-NOR90 Ab (Table 1). In most cases anti-NOR90 patients were ANA positive, predominantly with nucleolar pattern and coexisted with other SSc autoantibodies. 12 patients had rheumatic diseases and two had SSc, both with limited cutaneous SSc and absence of organ involvement. 14 patients had no definite diagnosis. Clinical features of anti-NOR90 patients are represented in Figure 1. Five patients presented Raynaud’s phenomenon, two cases with pathological nailfold capillaroscopy and one patient had SSc. There was no patient with skin ulcers, calcinosis, interstitial lung disease or pulmonary hypertension. Four patients had gastroesophageal reflux disease and one patient presented antral vascular ectasia. Six patients developed some neoplasm.Figure 1.Clinical characteristics of anti-NOR90 Ab patients.Conclusion:In our case series anti-NOR90 Ab were associated with multiple rheumatic diseases with heterogeneity of clinical manifestations. We did not observe a further progression to SSc or presence of organ involvement or severe scleroderma, so these autoantibodies could be related with a favorable prognosis. In contrast with previous reports, a striking association with cancer has been detected in our population.Table 1.Demographic characteristics and main diagnoses of anti-NOR90 positive patients.CharacteristicsTotal Anti-NOR90: 26 patientsSex, n19 women/ 7 menAge, mean (years)58,9 IQR [46,3-72,2]Race, nAsian: 1; Hispanic: 7; Caucasian: 18Smoker, n3Positive ANA (>1/160), nPattern, n247 Homogeneous, 4 Nucleolar, 4 Speckled, 1 Centromere, 5 Speckled -nucleolar, 3 Homogeneous-nucleolar.Positive ENA, n32 Anti-SSA-Ro52 and Ro60, 1 anti-RNP and anti-SmSystemic sclerosisautoantibodies, n•Anti-Ku: 7•Anti-U3RNP (Fibrilarin): 6•Anti-RNA polymerase III: 5•Anti Th/To: 4•Anti-centromere: 4 (CENP B +/- CENPA)•Anti-topoisomerase I: 2•Anti-Ro52: 3•Anti-PM-Scl: 3Main diagnosis, n12 Rheumatic diseases:2 systemic Sclerosis (2 limited/0 diffuse)1 rheumatoid arthritis1 LES1 Sjögren’s syndrome,3 undifferentiated conective tissue disease2 overlap (1 Sjögren + LES, 1 Sjögren + MCTD 1)s: 1 morphea, 1 cutaneous graft versus host diseaseNeoplasm, n6: 2 solid organ cancer (bladder, kidney), 1 lung adenocarcinoma, 1multiple myeloma, 1 acute myeloid leukemia: 1 basal cell carcinoma.Abbreviations: LES: systemic lupus erythematosus; MCTD: mixed connective tissue diseaseDisclosure of Interests:None declared

Barium hexaferrite (BaFe 12 O 19 ) is a novel and effective catalyst in the photo-Fenton like system for the rapid degradation of Methylene Blue (MB). The BaFe 12 O 19 catalyst was synthesized by the chemical co-precipitation method and characterized by X-ray Diffraction (XRD), Transmission Electron Microscopy (TEM), Dynamic Light Scattering (DLS), Brunauer–Emmet–Teller ( S BET ) surface area and optical adsorption analysis. The BaFe 12 O 19 catalyst generated a good catalytic activity for MB degradation for a photo-Fenton like system under visible light irradiation, this is possible due to the catalyst can be activated using photons of visible light region as a consequence of its narrow band gap estimated of ∼1.77 eV, corresponding to absorption edge in the visible region from a wavelength of ∼700 nm. In such conditions the BaFe 12 O 19 was able to decolorize and to mineralize up to 70.8% and 63.7% of the dye, respectively, after 360 min using a 3 W Light Emitting Diode (LED) lamp ( λ = 420–700 nm). In addition, the energy consumption of the Vis/BaFe 12 O 19 /H 2 O 2 system was estimated at 11.1 W h/L/order.

Bone regeneration is strongly dependent on the capacity of cells to move in a 3D microenvironment, where a large cascade of signals is activated. To improve the understanding of this complex process and to advance in the knowledge of the role of each specific signal, it is fundamental to analyze the impact of each factor independently. Microfluidic-based cell culture is an appropriate technology to achieve this objective, because it allows recreating realistic 3D local microenvironments by taking into account the extracellular matrix, cells and chemical gradients in an independent or combined scenario. The main aim of this work is to analyze the impact of extracellular matrix properties and growth factor gradients on 3D osteoblast movement, as well as the role of cell matrix degradation. For that, we used collagen-based hydrogels, with and without crosslinkers, under different chemical gradients, and eventually inhibiting metalloproteinases to tweak matrix degradation. We found that osteoblast''s 3D migratory patterns were affected by the hydrogel properties and the PDGF-BB gradient, although the strongest regulatory factor was determined by the ability of cells to remodel the matrix.

Background:In recent years there is a growing interest in the assessment of rheumatoid arthritis through patient reported outcomes measures (PROMs). Nonetheless, discrepancies in the disease global disease assessment reported by patients (PtGA) or physicians (PhGA) have been previously described.Objectives:Our aim was to evaluate differences between PtGA and PhGA and their predictors in an early arthritis cohort.Methods:Cross-sectional study analyzing data from the baseline visit of patients included in the PEARL study (Princess Early Arthritis Register Longitudinal Study) in which demographic, laboratory and clinical characteristics including PtGA and PhGA (0-100 mm) are systematically collected.The main variable was the difference between PtGA and PhGA (ΔGA). The descriptive analysis was performed using the Kruskal-Wallis, Mann-Whitney or Pearson correlation tests as appropriate.A multivariate linear regression model was developed with ΔGA as a dependent variable. All those predictors available at the baseline visit reaching a p 2parameter considering those that had a p> 0.15. To categorize the dependent variable, differences between PtGA and PhGA were considered relevant when greater than 5 points.Results:530 patients were included, 422 (79.6%) were women with a mean age of 55.3 +/- 16 years, 21.2% current smokers, 54% and 50.4% rheumatoid factor and anti-CCP positive respectively. A 43.3% had moderate activity and 33.6% high, measured by DAS28-VSG.The median of ΔGA was 4, (interquartile range; -10 to 18; see figure 1). In 22% of the cases patients and physicians scored the same, in 46.5% the patients’ scores were higher and physicians’ were so in 31.5% of the cases.The variables that explained ΔGA after adjusting the multivariate model were pain [β=0.36 (95%CI 0.28 to 0.44)], number of swollen joints [β= -3.19 (95%CI -3.7 to -2.7)] and ESR [β=-0.11 (95%CI -0.2 to -0.03)]. Pain had a greater influence on patients’ opinion while the number of swollen joints and ESR were more relevant for physicians. Other variables such as race, marital status, profession, sex, smoking, seropositivity or disease activity were not relevant in the prediction of ΔGA.Conclusion:In our cohort, disagreements between PtGA and PhGA were observed. Patients scored higher based on painful perception and physicians did so relying on objective evidence of inflammation.Disclosure of Interests:Cristina Valero: None declared, Sebastian C Rodriguez-García Speakers bureau: Novartis Farmaceutica, S.A., Merck Sharp & Dohme España, S.A., Sanofi Aventis, UCB Pharma, Noelia García Castañeda: None declared, Juan Pablo Baldivieso: None declared, Esther Patiño: None declared, Ana Ortiz: None declared, Isidoro González-Álvaro Grant/research support from: Roche Laboratories, Consultant of: Lilly, Sanofi, Paid instructor for: Lilly, Speakers bureau: Abbvie, MSD, Roche, Lilly

Background:The Janus Kinase (JAK) inhibitors Baricitinib (BAR) and Tofacitinib (TOF), both in monotherapy or in combination with methotrexate, are indicated for moderate to severe active rheumatoid arthritis (RA) with inadequate response to conventional synthetic disease modifying anti-rheumatic drugs (csDMARD). Data about cost-effectiveness in a real-world setting are still scarce.Objectives:To assess the cost-effectiveness (C-E) of BAR and TOF in patients with RA in usual clinical practice.Methods:Retrospective observational study of adult RA patients who started BAR and TOF between September 2017 and December 2019, in a university hospital. Data were collected from the electronic medical records and the Dominion® External Patient Dispensing program. Demographic, clinical and laboratory parameters [erytrocyte sedimentation rate (ESR), C reactive protein (CRP), Rheumatoid factor (RF), anti-citrullinated peptide antibodies (ACPA)], concomitant csDMARD, previous biological (b) DMARD, DAS28-ESR activity score items, and treatment duration were registered. DAS28-ESR remission or low disease activity (LDA) were used as the effectiveness measure to estimate C-E. The official Spanish prices were considered to calculate the costs of the treatments. Statistical analysis was performed with SPSS v.15 program. Descriptive statistics are shown in proportions, medians and interquartile ranges (IQR). The Wilcoxon signed ranges test was applied for the changes from baseline of DAS28-ESR and CRP.Results:39 patients were included, 87.2% women, median age 62.9 (49.9-74.4) years. 9/39 patients (23.1%) werenaiveto bDMARD, 6 (15.4%) had received 1, 18 (46.1%) 2, and 6 (15.4 %) ≥3 previous bDMARD. Demographic, clinical and effectiveness characteristics are shown by drug in the Table:Table 2.Median for the time of survival of remission or LDA in RA patients treated with tofacitinib.Baricitinib (n=30)Tofacitinib (n=9)p valueSex (women, n, %)26 (86,7)8 (88,9)0,676Age [med (IQR)]63,3 (49,7-74,8)59,7 (49,8-68,6)0,857Rheumatoid Factor + (n, %)23 (76,7)9 (100)0,132ACPA + (n, %)21 (70,0)7 (77,8)0,501Erosive disease (n, %)16 (53,3)6 (66,7)0,377Concomitant csDMARD (n, %)26 (86,7)8 (88,9)0,676bDMARD-naive(n, %)7 (23,3)2 (22,2)0,419Treatment duration (months) [med (IQR)]8,4 (6,5-20,3)13,2 (3,9-20,7)0,909Baseline CRP (mg/dl) [med (IQR)]2,2 (0,3-1,0)1,4 (0,3-1,0)0,806Final CRP (mg/dl) [med (IQR)]0,9 (0,1-0,3)1,0 (0,1-0,4)-Baseline DAS28-ESR [med (IQR)]5,5 (3,6-4,3)6,1 (3,8-5,3)0,315Final DAS28-ESR [med (IQR)]3,9 (2,2-2,8)5,5 (2,6-3,6)-DAS28-ESR Remission (n, %)10 (33,3)3 (33,3)0,663DAS28-ESR LDA (n, %)8 (26,7)1 (11,1)0,316Regarding BAR, 17 patients (56.6%) continue on treatment and 3 (10%) changed to TOF. The change in DAS28VSG was statistically significant (p = 0.000), as well as difference in CRP (p = 0.008). The total cost per analysed period was € 357,806.40, with 18/30 patients (60%) achieving remission or LDA. The C-E was € 19,878.13. As for TOF, 6 patients (66.6%) remain on drug, with no switch to BAR. Neither the difference from baseline in DAS28VSG nor the CRP changes reached statistical significance (p = 0.08 and p = 0.735, respectively). The total cost per analysed period was € 90,201.72, with 4/9 patients (44.4%) achieving remission or LDA. The C-E was € 22,573.0Conclusion:In our daily practice, JAK inhibitors are mainly used in combination with csDMARD and commonly after failure to ≥ 1 bDMARD. In this real setting, BAR proves to be cost-effective, while TOF renders less effectiveness. However, results should be addressed with caution because of the smaller sample size of TOF population. Additional studies with greater follow-up and sample size are needed to confirm these findings.Disclosure of Interests:Alberto Calvo Garcia: None declared, Noelia García Castañeda: None declared, Cristina Valero: None declared, Irene Llorente Speakers bureau: Lilly, Janssen, Novartis, Sanofi, Gebro, Blanca Varas: None declared, Alberto García-Vadillo: None declared, Isidoro González-Álvaro Grant/research support from: Roche Laboratories, Consultant of: Lilly, Sanofi, Paid instructor for: Lilly, Speakers bureau: Abbvie, MSD, Roche, Lilly, Alberto Morell: None declared, Esther Ramirez: None declared, Rosario Garcia de Vicuna Grant/research support from: BMS, Lilly, MSD, Novartis, Roche, Consultant of: Abbvie, Biogen, BMS, Celltrion, Gebro, Lilly, Mylan, Pfizer, Sandoz, Sanofi, Paid instructor for: Lilly, Speakers bureau: BMS, Lilly, Pfizer, Sandoz, Sanofi

Background:The Janus Kinase (JAKi) inhibitors Baricitinib (BAR) and Tofacitinib (TOF) are indicated for moderate to severe active rheumatoid arthritis (RA). Data about safety, effectiveness in refractory patients and adherence in real clinical practice in our population are scarce.Objectives:An evaluation of safety, adherence and reasons to consider suspension of JAKi in routine clinical practice.Methods:Retrospective observational study of patients with RA treated with BAR and TOF according to usual clinical practice between September 2017 - December 2019. Data were collected from the electronic medical record and from the Dominion® Outpatient Drug Dispensing program.Demographic, clinical, laboratory and treatment-related variables were collected, including reasons for discontinuing JAKi (inefficiency and toxicity). Adherence was calculated using the Compliance Questionnaire on Rheumatology (CQR-5), and the average possession ratio (RMP), which is defined as the number of days with treatment dispensed between the total days of the period analyzed, considering the adherent patient when RMP had a ≥ 0.8.Laboratory abnormalities were defined according to normal limit values (NLV) and specifications of data sheet. A descriptive analysis was performed using proportions, medians and interquartile ranges (IQR) using the SPSS v.15 program.Results:Thirty patients were included in treatment with BAR and nine with TOF. The median age was 62.9 (RIQ 49.9-74.4), 34 (87.2%) were women, 28 (71.2%) anti-CCP and 32 (82.1%) were rheumatoid factor positive, with erosive disease in 34 (87,2%) patients. In the previous treatment, 9 (23.1%) were naive to biological, 6 (15.4%) had received 1 biological, 18 (46.1%) 2 biologicals, and 6 (15.4%) ≥ 3 biologicals. The median treatment time was 8.4 months (RIQ 6.5-20.3) in BAR and 13.2 (RIQ 3.9-20.7) in TOF.The reasons for consider suspension shown in Table 1.Table 1.Treatment DiscontinuationBARICITINIBInitial DAS28[median (IQR)]Final DAS28[median (IQR)]Continue treatmentn (%): 17/30 (55.6)4.20 (2.95-5.72)2.60 (1.70-2.77)Reasons for suspension-Refractory n (%): 7/13 (55.8%)4.38 (4.16-5.43)4,16 (3.56-5.23)-Side effects n (%): 4/13 (30.7)4.16 (3.45-4.84)3.15 (2.69-4.41) ◦Thrombocytosis (1) ◦Herpes Zoster (1) ◦Anemia (1) ◦Tubaritis (1)-Patient decisión n (%): 2/13 (15.4)TOFACITINIBContinue treatmentn (%): 6/9 (66.6)4.82 (3.28-6.20)2.61 (2.45-3.70)Reasons for suspension-Refractory n (%): 2/3 (66.6)5.27 (5.23-5.31)5.48 (5.04-5.92)-Side effects n (%): 1/3 (33.33)Based on the CQR5 questionnaire, all patients treated with BAR and TOF were adherent “HIGH” class, and a median of RMP = 1.01 (IQR = 0.93-1.06) was obtained for BAR and RMP = 1, 00 (IQR = 0.91-1.01) for TOF, all adherents (≥ 0.8).Table 2.Safety results of the treatment shows the safety results.Side EffectBaricitinib(n, %)Tofacitinib(n, %)Hb 7 (23,3)0Hb < 8 g/dl0 (0)/Hb Recovery >11 g/dl2/7 (28,6)/Neutrophils < 1500/mm30 (0)/Lymphocytes < 1000/mm33 (10,0)2 (22,2)Platelets > 600 × 103/mm31 (3,3)0AST o ALT > 1 NLV4 (13.3)0 (0)Hypercholesterolemia (> 1 NLV)13 (43.3)5 (55.5)Infections13 (43.3)0 (0)Herpes zoster6 (20,0)0 (0)Conclusion:In our population, mostly refractory to biological, more than half of the patients maintain treatment with JAKi, with optimal adherence. The main reason for the suspension of both drugs was inefficiency. The most frequent adverse effects were hypercholesterolemia in both groups and infections in BAR, with a high frequency of herpes zoster. No cardiovascular or thromboembolic events were observed.Disclosure of Interests:Cristina Valero: None declared, Alberto Calvo Garcia: None declared, Noelia García Castañeda: None declared, Ana Ortiz: None declared, Irene Llorente Speakers bureau: Gebro, Janssen, Sanofi, Lilly., Blanca Varas: None declared, Santos Castañeda: None declared, Rosario Garcia de Vicuna Grant/research support from: BMS, Lilly, MSD, Novartis, Roche, Consultant of: Abbvie, Biogen, BMS, Celltrion, Gebro, Lilly, Mylan, Pfizer, Sandoz, Sanofi, Paid instructor for: Lilly, Speakers bureau: BMS, Lilly, Pfizer, Sandoz, Sanofi, Esther Ramirez: None declared