THU0601 REFRACTORY ACUTE CORONARY SYNDROME AND CARDIOGENIC SHOCK AS ATYPICAL ONSET OF EOSINOPHILIC GRANULOMATOSIS WITH POLYANGIITIS

Background:Eosinophilic Granulomatosis with Polyangiitis (EGPA) is an ANCA-associated vasculitis, characterized by eosinophilic infiltration in tissues, intravascular and extravascular granuloma formation. It is a rare disease, affecting between 0 and 4 per million population per year. The cardiac involvement occurs in 15-60% of EGPA patients (generally ANCA-negative); it is often insidious, underestimated and it has a poor prognosis. The disease usually shows a prodromal phase characterized by asthma and allergic manifestations.Objectives:We report the case of a young patient with acute coronary syndrome (ACS) complicated by cardiogenic shock as the first manifestation of EGPA.Methods:A 36 year old Indian male patient, with a previous history of asthma, rhinitis, Raynaud syndrome and allergy to ketoprofen, presented to the emergency department with a complaint of chest pain and dyspnea. Cardiac troponin was elevated and he was admitted to intensive care unit with a diagnosis of ACS. The patient conditions rapidly deteriorated due to acute cardiogenic shock and an urgent coronary angiogram was performed. An occlusion of the left main coronary artery was treated with angioplasty and two drug-eluting stents. Echocardiography showed severe left ventricular dysfunction requiring inotropic and intra-aortic balloon pump support. A mild dermatitis after salicylic acid administration resolved with intravenous hydrocortisone 1 g. The thrombophilia screening was negative, as well as cardiovascular risk factors. Over the next days, the clinical conditions rapidly improved with recovery of normal ventricular function on discharge. However, two weeks later he was readmitted with recurrent mandibular and chest pain. Troponin levels were elevated and fluctuated, suggesting recurrent ischemic events. Repeated ECG during angina crisis showed ischemic alterations in different coronary territories. The coronary angiogram detected coronary vasospasm of the circumflex artery, reversible after nitroglycerin (Figure 1). Nitroglycerin and calcium channel blockers were initiated, but did not resolve the vasospastic angina crisis, occurring daily. Laboratory tests revealed eosinophilia (4390 cells/mcl), increased C reactive protein (9.4 mg/l) and positive antinuclear antibodies (1:320). The other serological and immunological tests were negative, including MPO-ANCA and PR3-ANCA. An abdomen and chest CT scan was negative.Figure 1.Coronary angiogram showing coronary vasospasm in the left circumflex artery (panel A, yellow arrow), reversible after nytroglicerin infusion (panel B, yellow arrow)Results:The eosinophilia and the history of asthma rose the suspect of EGPA vasculitis. The patient was treated with intravenous methylprednisolone 250 mg once daily for 3 days, followed by oral prednisone 1 mg/kg/day, with rapid and complete resolution of the recurrent angina episodes. Intravenous cyclophosphamide 10 mg/kg was administered every 2 weeks for 2 times, then 12 mg/kg every 4 weeks. Oral corticosteroid was tapered, with the persistence of a complete remission of the symptoms, after 2 months of immunosuppressive therapy.Conclusion:Coronary involvement in EGPA can mimic atherosclerotic artery disease and can be life threatening, if not promptly recognized. An accurate medical history and complete serological and immunological tests are crucial to detect an atypical onset of EGPA, prompting early immunosuppressive therapy which is pivotal for the patient survival.References:[1]MR Hazebroek et al. Prevalence and Prognostic Relevance of Cardiac Involvement in ANCA-associated Vasculitis: Eosinophilic Granulomatosis With Polyangiitis and Granulomatosis With Polyangiitis. Int J Cardiol 2015, 199: 170-9.Disclosure of Interests:None declaredDOI: 10.1136/annrheumdis-2020-eular.648

Human papillomavirus is not associated with colorectal cancer in a large international study

Recent publications have reported an association between colon cancer and human papillomaviruses (HPV), suggesting that HPV infection of the colonic mucosa may contribute to the development of colorectal cancer. The GP5+/GP6+ PCR reverse line blot method was used for detection of 37 types of human papillomavirus (HPV) in DNA from paraffin-embedded or frozen tissues from patients with colorectal cancer (n = 279) and normal adjacent tissue (n = 30) in three different study populations, including samples from the United States (n = 73), Israel (n = 106) and Spain (n = 100). Additionally, SPF10 PCR was run on all samples (n = 279) and the Innogenetics INNO-LiPA assay was performed on a subset of samples (n = 15). All samples were negative for all types of HPV using both the GP5+/GP6+ PCR reverse line blot method and the SPF10 INNO-LiPA method. We conclude that HPV types associated with malignant transformation do not meaningfully contribute to adenocarcinoma of the colon

Identification of a practical and reliable method for the evaluation of litter moisture in turkey production

1. An experiment was conducted to compare 5 different methods for the evaluation of litter moisture. 2. For litter collection and assessment, 55 farms were selected, one shed from each farm was inspected and 9 points were identified within each shed. 3. For each device, used for the evaluation of litter moisture, mean and standard deviation of wetness measures per collection point were assessed. 4. The reliability and overall consistency between the 5 instruments used to measure wetness were high (α = 0.72). 5. Measurement of three out of the 9 collection points were sufficient to provide a reliable assessment of litter moisture throughout the shed. 6. Based on the direct correlation between litter moisture and footpad lesions, litter moisture measurement can be used as a resource based on-farm animal welfare indicator. 7. Among the 5 methods analysed, visual scoring is the most simple and practical, and therefore the best candidate to be used on-farm for animal welfare assessment

Comprehensive Pan-Genomic Characterization of Adrenocortical Carcinoma

SummaryWe describe a comprehensive genomic characterization of adrenocortical carcinoma (ACC). Using this dataset, we expand the catalogue of known ACC driver genes to include PRKAR1A, RPL22, TERF2, CCNE1, and NF1. Genome wide DNA copy-number analysis revealed frequent occurrence of massive DNA loss followed by whole-genome doubling (WGD), which was associated with aggressive clinical course, suggesting WGD is a hallmark of disease progression. Corroborating this hypothesis were increased TERT expression, decreased telomere length, and activation of cell-cycle programs. Integrated subtype analysis identified three ACC subtypes with distinct clinical outcome and molecular alterations which could be captured by a 68-CpG probe DNA-methylation signature, proposing a strategy for clinical stratification of patients based on molecular markers

Integrated genomic characterization of oesophageal carcinoma

Oesophageal cancers are prominent worldwide; however, there are few targeted therapies and survival rates for these cancers remain dismal. Here we performed a comprehensive molecular analysis of 164 carcinomas of the oesophagus derived from Western and Eastern populations. Beyond known histopathological and epidemiologic distinctions, molecular features differentiated oesophageal squamous cell carcinomas from oesophageal adenocarcinomas. Oesophageal squamous cell carcinomas resembled squamous carcinomas of other organs more than they did oesophageal adenocarcinomas. Our analyses identified three molecular subclasses of oesophageal squamous cell carcinomas, but none showed evidence for an aetiological role of human papillomavirus. Squamous cell carcinomas showed frequent genomic amplifications of CCND1 and SOX2 and/or TP63, whereas ERBB2, VEGFA and GATA4 and GATA6 were more commonly amplified in adenocarcinomas. Oesophageal adenocarcinomas strongly resembled the chromosomally unstable variant of gastric adenocarcinoma, suggesting that these cancers could be considered a single disease entity. However, some molecular features, including DNA hypermethylation, occurred disproportionally in oesophageal adenocarcinomas. These data provide a framework to facilitate more rational categorization of these tumours and a foundation for new therapies

Avaliação da Umidade e da Resistência Superficial ao Cisalhamento em Argamassas de Revestimento Medida Através do Equipamento Vane Shear Test.

A utilização de argamassas de cimento Portland para a produção de revestimentos de tetos e paredes é uma realidade em obras civis no Brasil. Dentre as etapas de produção do revestimento argamassado, o acabamento superficial, conhecido popularmente como sarrafeamento, é tido como um procedimento empírico, onde o oficial pedreiro pressiona a superfície das argamassas com os dedos das mãos para definir em qual momento (resistência), após a aplicação da argamassa sob o substrato, deverá aplicar o cisalhamento com a régua niveladora. Este procedimento, por ser totalmente empírico, carece de um sistema de controle de qualidade para que falhas de execução e manifestações patológicas nesta etapa sejam menos recorrentes. Deste modo, este trabalho visa avaliar o comportamento da umidade das argamassas aplicadas no substrato, e a evolução da resistência das argamassas de revestimento no estado fresco tendo como base medidas superficiais de resistência ao cisalhamento com auxílio do aparelho Vane Shear Test, em que utilizou-se dois tipos de cimentos (CPII-Z-32 e CPIII-40-RS), dois tipos de substratos (bloco cerâmico e bloco de concreto), com e sem a aplicação de chapisco e dois traços comumente utilizados em obra, 1:1:6 e 1:2:9 (cimento:cal:areia). Os ensaios permitiram avaliar que a evolução da Resistência Superficial ao Cisalhamento (RSC) para blocos cerâmicos é de 4,45 vezes maior que o bloco de concreto. As argamassas produzidas com cimento CPII-Z-32 gera um crescimento de aproximadamente 30% maior quando comparada com argamassas produzidas com CPIII-40-RS. Já os substratos com chapisco e com traço 1:1:6 (cimento:cal:areia) geram um acréscimo de 15% na RSC quando comparados com a base não chapiscada e o traço 1:2:9 (cimento:cal:areia), respectivamente. Palavras-chave: Argamassa de revestimento; Resistência Superficial ao Cisalhamento (RSC); Vane Shear Test

Controllo e valutazione nelle universit\ue0 statali tra continuit\ue0 e riforma

Il saggio \ue8 il frutto di una ricerca avente per oggetto il sistema di valutazione e controllo dell\u2019azienda-universit\ue0; in particolare, l\u2019attenzione \ue8 rivolta all\u2019analisi economico-aziendale del ruolo e delle funzioni svolte dai Nuclei di Valutazione, quali organi locali coordinati a livello nazionale e, dunque, collocati in un pi\uf9 ampio sistema valutativo. Il tema di ricerca \u2013 pur nella sua unitariet\ue0 \u2013 \ue8 affrontato secondo una duplice prospettiva: da un lato, si \ue8 voluto indagare il rinnovato set di funzioni che i Nuclei di Valutazione sono chiamati ad assumere in base alle recenti riforme della pubblica amministrazione (D. Lgs. 150/2009) e della stessa governance universitaria (L. 240/2010); dall\u2019altro lato, sottolineando l\u2019assoluta peculiarit\ue0 del Nucleo di Valutazione nel panorama dei vari organi interni di valutazione e controllo in ambito pubblico, si \ue8 inteso analizzare criticamente il collocamento di tale organo entro il complessivo processo decisionale dell\u2019ateneo. Tali due prospettive sono strettamente interrelate, in quanto sono complementari le attivit\ue0 di valutazione e controllo esercitata dai Nuclei, le quali costituiscono un unico oggetto di ricerca. Il saggio si colloca nel filone degli studi sul controllo nelle amministrazioni pubbliche, trovando ispirazione nella migliore tradizione economico-aziendale, dove l\u2019indagine, pur considerando inevitabilmente il dettato normativo nei suoi contenuti prescrittivi, analizza le concrete manifestazioni aziendali e le conseguenze delle scelte e dei comportamenti gestionali. Proprio per questo, come si preciser\ue0 nella nota metodologica, il momento di validazione empirica \ue8 centrale nella costruzione delle argomentazioni logiche e delle riflessioni conclusive

Interventi di consolidamento dei terreni di fondazione di una torre campanaria con iniezioni di resina ad alta pressione di espansione

La memoria mira ad illustrare le modalit\ue0 d\u2019esecuzione di iniezioni di resina espandente ad alta pressione d\u2019espansione ed i suoi effetti nel sottosuolo trattato. Dopo un inquadramento geotecnico preliminare sull\u2019evoluzione del processo generato da una serie ordinata di iniezioni, vengono successivamente riportati alcuni significativi risultati registrati nel corso del monitoraggio dell\u2019intervento di consolidazione del terreno d\u2019imposta della fondazione della torre campanaria della chiesa parrocchiale di Borgolavezzaro (NO). Di questo intervento vengono in particolare sottolineate le modalit\ue0 operative, la modesta invasivit\ue0 ed, infine, le caratteristiche fisico-meccaniche del materiale iniettato che si mantengono pressoch\ue9 inalterate nel tempo. L\u2019aumentata conoscenza sul comportamento a breve e lungo termine della resina utilizzata e sui fenomeni d\u2019interazione che si sviluppano tra la stessa resina espandente ed il terreno trattato consentono d\u2019intervenire in assoluta sicurezza nel risanamento di edifici di elevato pregio

Method for determining rigidity of geological layer underlying the foundations of building, determines shear velocity of elastic waves in layer from seismic signal so as to indicate rigidity of layer

The method involves arranging a source (4) suitable to generate seismic waves within the second geological layer (5) whose rigidity is intended to be measured. The source of seismic waves is activated. The seismic signal is detected by sensor (8) coupled with the free surface (2). The shear velocity of the elastic waves in the second layer is determined from the seismic signal so as to indicate the rigidity of second layer. USE - Method for determining rigidity of geological layer underlying the foundations of building. ADVANTAGE - The rigidity of geological layer can be determined easily. The velocity of the elastic waves in the subsoil can be measured easily while improving the elastic parameters such as Young's modulus and the rigidity modulus. The need for large number of sensors for measuring the velocity of the shear waves can be eliminated while reducing the cost for measuring velocity of the shear waves. DETAILED DESCRIPTION - An INDEPENDENT CLAIM is included for system for determining rigidity of geological layer. DESCRIPTION OF DRAWING(S) - The drawing shows a schematic view illustrating process for determining rigidity of geological layer