Background The potential influence of hyperuricemia on the genesis and progression of chronic kidney disease (CKD) remains controversial. In general, the correlation between blood levels of uric acid (UA) and the rate of progression of CKD is considered to be modest, if any, and the results of relevant trials oriented to disclose the effect of urate-lowering therapies on this outcome have been disappointing. Urinary excretion rates of UA could reflect more accurately the potential consequences of urate-related kidney injury. Method Using a cross-sectional design, we investigated the correlation between different estimators of the rates of urinary excretion of UA (total 24-hour excretion, mean urinary concentration, renal clearance and fractional excretion)(main study variables), on one side, and urinary levels of selected biomarkers of kidney injury and CKD progression (DKK3, KIM1, NGAL, interleukin 1b and MCP)(main outcome variables), in 120 patients with advanced CKD (mean glomerular filtration rate 21.5 mL/minute). We took into consideration essential demographic, clinical and analytic variables with a potential confounding effect on the explored correlations (control variables). Spearman’s rho correlation and nonlinear generalized additive regression models (GAM) with p-splines smoothers were used for statistical analysis. Main results Multivariate analysis disclosed independent correlations between urinary UA concentrations, clearances and fractional excretion rates (but not plasma UA or total 24-hour excretion rates of UA), on one side, and the scrutinized markers. These correlations were more consistent for DKK3 and NGAL than for the other biomarkers. Glomerular filtration rate, proteinuria and treatment with statins or RAA axis antagonists were other independent correlates of the main outcome variables. Conclusions Our results support the hypothesis that urinary excretion rates of UA may represent a more accurate marker of UA-related kidney injury than plasma levels of this metabolite, in patients with advanced stages of CKD. Further, longitudinal studies will be necessary, to disclose the clinical significance of these findings.

Background: Paracetamol has been related to a higher prevalence of asthma. However, the relationship between paracetamol and rhinitis is still under debate. ObjectiveS: Our objective was to evaluate the relationship between the paracetamol use with the prevalence of rhinitis symptoms in children and adolescents from our region (Galicia; North-West Spain). Methods: We carried out a cross-sectional study using the ISAAC questionnaire. Based on the answers to the questionnaire, four categories of rhinitis were defined: "Rhinitis ever" (RE); "Recent rhinitis" (RR); "Recent rhinoconjunctivitis" (RRC) and "Severe rhinoconjunctivitis" (SRC). Paracetamol consumption in the past year was evaluated based on the response to a questionnaire with 3 possible responses: never, at least once a year, at least once per month. Consumption of paracetamol in the first year of life was evaluated with two response options, yes or no. The Odds ratio (OR) and Confidence interval 95% (CI) of the prevalence of rhinitis symptoms according to the paracetamol use was calculated using logistic regression, adjusted by gender, body mass index, parental smoking, maternal education level, cat, and dog at home. Results: We included 10,690 children and 10,730 adolescents. In table 1 it is shown that more frequent use of paracetamol is associated with a higher prevalence of rhinitis, both in children and adolescents. Conclusions: Higher use or paracetamol seems to be associated with higher prevalence of rhinitis ACKNOWLEDGMENTS: Maria-Jose Jove Foundation.

Introduction and objectiveThe use of well characterized osteoarthritis (OA) cohorts is mandatory for the study and knowledge of this disease. Currently, there is no prospective cohort in this pathology in Spain. The objective of this work is to describe the first osteoarthritis cohort in Spain, PROCOAC (Cohort PROspectiva de A Coruña).MethodsThe Unit of Rheumatology of the University Hospital of A Coruña started a prospective follow-up study in 2006. The patient inclusion criteria were: I) Patients older than 55 years who underwent an abdominal x-ray to study both hips II) Patients diagnosed with radiographic hand OA according to ACR criteria III) Patients diagnosed with radiographic knee or hip OA according to ACR criteria. Follow-up was performed every two years collecting clinical, analytical, genetic and radiographic information.ResultsThe cohort consists of 937 patients, 873 have radiographic knee OA, 783 hip OA and 679 hand OA. The mean age of the population is 63.9±8.9 years and the average BMI is 29.6±5.1. More than half of the population has high blood pressure and 17% diabetes. The predominant osteoarthritis in the hand is nodular (78.1%), followed by trapeziometacarpal (55.3%) and erosive (18.4%). Twenty-one point four percent and 43.1% are healthy at knee and hip level respectively; observing a grade 1 in 26% and 37%; a grade 2 in 26.7% and 11.5%; a grade 3 in 14.9% and 4%; and a grade 4 in 9.4% and 3.7% respectively. Of the population, 44.1% has only 1 joint affected, 39.9% has 2 and 13.4% has 3 joints affected. Age (OR=1.11; p<.001), BMI (OR=1.11; p=.002) and total WOMAC (OR=1.03; p=.005) are the only risk factors if we compare the involvement of a single location versus three. A discrepancy between pain and radiographic damage at the joint level was also detected in patients with KL≤2 grade, and therefore a significantly higher percentage of patients with knee OA experienced pain (66.1%) compared to patients with OA hip (21.1%) (p<.001).ConclusionsThe PROCOAC cohort is an instrument that allows studies of incidence and progression in hand, knee and hip OA; as well as determining factors that are associated with the different OA phenotypes.

Introducción y objetivo El uso de cohortes de osteoartritis bien caracterizadas es obligatorio para estudiar y profundizar en el conocimiento en esta enfermedad. En España no existe actualmente ninguna cohorte prospectiva en este ámbito; por ello, el objetivo de este trabajo es describir la primera cohorte de osteoartritis en España: la PROCOAC (PROspective COhort of A Coruña). Material y métodos El Servicio de Reumatología del Hospital Universitario de La Coruña inició un estudio de seguimiento prospectivo en el año 2006. Los criterios de inclusión fueron: a) pacientes mayores de 55 años a los que se les realizó una radiografía abdominal que permitiese estudiar ambas caderas; b) pacientes diagnosticados de osteoartritis radiográfica de mano según los criterios ACR; c) pacientes diagnosticados de osteoartritis radiográfica de rodilla o cadera según los criterios ACR. Se realizó seguimiento cada 2años y se recogió información clínica, analítica, genética y radiográfica. Resultados La cohorte consta de 937 individuos; 873 tienen osteoartritis radiográfica de rodilla, 783 de cadera y 679 de mano. La edad media de la población es 63,9±8,9 años y el IMC promedio de 29,6±5,1. Más de la mitad de la población tiene hipertensión arterial y el 17%, diabetes. La osteoartritis predominante en la mano es la nodular (78,1%), seguida de la rizartrosis (55,3%) y la erosiva (18,4%). El 21,4% y el 43,1% tienen sanas la rodilla y la cadera, respectivamente. Se observa un grado 1 en el 26% y 37%; un grado 2 en el 26,7% y 11,5%; un grado 3 en el 14,9% y 4%; y un grado 4 en el 9,4% y 3,7%, respectivamente. El 44,1% de la población tiene una articulación afectada, el 39,9% tiene 2 y el 13,4% tiene las 3 articulaciones afectadas. La edad (OR=1,11; p<0,001), el IMC (OR=1,11; p=0,002) y el WOMAC total (OR=1,03; p=0,005) son los únicos factores de riesgo si comparamos la afectación de una sola ubicación frente a 3. También se detectó una discrepancia entre el dolor y el daño radiográfico articular en pacientes con grado KL ≤ 2, de modo que un porcentaje significativamente mayor de pacientes con osteoartritis de rodilla experimentaron dolor (66,1%) en comparación con los pacientes de cadera (21,1%) (p <0,001). Conclusión La cohorte PROCOAC es un instrumento que permite realizar estudios de incidencia y progresión en la osteoartritis de mano, rodilla y cadera, así como conocer factores que se asocian con los diferentes fenotipos de osteoartritis.

Introduction and Background Mediterranean diet (MD) seems to be related with less prevalence of asthma symptoms. However, the relationship between MD and rhinitis is still under debate. Aims and Objectives: The objective of our study was to evaluate the relationship of the MD with the prevalence of rhinitis symptoms in the child and adolescent population in our region Methods: We carried out a cross-sectional study using a questionnaire on rhinitis by the ISAAC study, for children (6-7 years) and adolescents (13-14 years) from Galicia (North-West Spain). Based on the answers to the questionnaire, the following categories of rhinitis were defined: “Rhinitis ever” (RE); “Recent rhinitis” (RR); “Recent rhinoconjunctivitis” (RRC) and “Severe rhinoconjunctivitis” (SRC). The Mediterranean Diet Score (MDS) was calculated according to the method developed by Garcia-Marcos (Thorax 2007: 62: 503–8). The Odds ratio (OR) and Confidence interval 95% (CI) of the prevalence of rhinitis symptoms according to adherence to MDS in quartiles was calculated using logistic regression. Results: In our study 10,690 children and 10,730 adolescents were included. Higher adherence to the MD is associated with a higher prevalence of RR in children (OR: 1.205, CI: 1.035-1.402) and of RRC in adolescents (OR: 1.306, CI: 1.042-1.637) (Table 1) Conclusions: Higher adherence to MD seems to be associated with higher prevalence of rhinitis

The most frequent endocrine disease in obese patients is hypothyroidism. To date, there are no clear data regarding what happens to the dose of levothyroxine (LT4) after bariatric surgery (BS). The objective of the present study was to evaluate thyroid hormone replacement dose in morbidly obese hypothyroid patients after BS-induced weight loss. We explore the best type of measured or estimated body weight for LT4 dosing. We performed an observational study evaluating patients with morbid obesity and hypothyroidism who underwent BS. We included 48 patients (three men). In morbidly obese hypothyroid patients 12 months after BS-induced weight loss, the total LT4 dose or the LT4 dose/kg ideal body weight did not change, while there was a significant increase in LT4 dose/body surface area, LT4 dose/kg weight, LT4 dose/kg adjusted body weight, LT4 dose/kg body fat, and LT4 dose/kg lean body weight. There were no differences in LT4 dose and its variation between sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). The present study strongly suggests that LT4 dosing in obese hypothyroid patients can be individually adapted more precisely if it is based on ideal body weight.

Introduction: Necrotizing enterocolitis, is the most common gastrointestinal emergency in the preterm infant and is associated with high mortality and morbidity. Predict which infants will progress to more severity stages of the illness and are in high risk for mortality is one of the challenges in relation to this disease. The objective of this study is to identify which factors are associated with mortality in infants diagnoses of NEC in our centre along a 12-year period. Material and Methods: A total of 124 consecutively patients were included in the study diagnosed of NEC at the Complejo Hospitalario Universitario de A Coruña, Spain. Information was obtained from medical records to compare patient demographics characteristics, prenatal information, clinical and radiological findings, relevant analytical data, therapeutic management and outcomes of infants who survived NEC and infants who died. Informed consent and ethical review board was obtained. Associations were analyzed by bivariate and multivariate analysis. Results: Among 124 patients, 110 patients survived NEC and 14 died. In multivariate analysis, the patients who died presented at birth low Apgar levels at minute one, apneas in the neonatal period, coagulopathy and low levels of serum proteins at diagnoses of NEC.

INTRODUCTION:Spontaneous subarachnoid haemorrhage is a rare cause of stroke, but it causes great socioeconomic impact and high morbidity and mortality. The aim of this study is to describe the clinical profile and evolution of a series of patients with SAH admitted to a tertiary hospital, as well as the diagnostic and therapeutic management. MATERIAL AND METHODS:Retrospective study of 536 patients diagnosed with SAH admitted to the ICU of the Hospital Universitario de A Coruña between 2003 and 2013 (Age: 56.9±14.1 years, female/male ratio: 1.5:1). Demographic characteristics, risk factors, aetiologies and clinical signs, prognostic scales, diagnostic tests and treatment were collected. A comparative analysis was made between the general series and subgroups of patients with aneurysmal (SAH-A) and idiopathic (SAH-I) subarachnoid haemorrhage. RESULTS:There were 49.0±15.1 patients/year (2013 incidence: 4.3/100,000 inhabitants). 60.3% presented Glasgow Coma Scale 14-15, with scarce symptomatology (Hunt-Hess I-II 61.9%, World Federation Neurosurgeons Scale I-II 60.4%). 50.7% presented Fisher IV. SAH-A was diagnosed in 78.3% (n=396); perimesencephalic subarachnoid haemorrhage (SAH-PM) in 3.2%; and SAH-I in 17.9%. During the study period there was an increase in the prevalence of aneurysms, causing an increased number of surgeries in recent years. Both SAH-A and SAH-I presented greater severity upon admission. Patients with SAH-A had higher percentage of complications and mortality, with lesser degree of independence at 6 and 12 months. CONCLUSIONS:The incidence of SAH appears to have decreased in recent years, with SAH-I comprising 17.9% of the cases. Patients with SAH-I have better prognosis and lower risk of complications, highlighting the benignity of SAH-PM.

Introduction: Currently there is lack of data regarding the impact of a home telehealth program on readmissions and mortality rate after a COPD exacerbation-related hospitalization. Objective: To demonstrate if a tele-monitoring system after a COPD exacerbation admission could have a favorable effect in 1-year readmissions and mortality in a real-world setting. Methods: This is an observational study where we compared an intervention group of COPD patients treated after hospitalization that conveyed a telehealth program with a followance period of 1 year with a control group of patients evaluated during one year before the intervention began. A propensity-score analyses was developed to control for confounders. The main clinical outcome was 1-year all-cause mortality or COPD-related readmission. Results: The analysis comprised 351 telemonitoring patients and 495 patients in the control group. The intervention resulted in less mortality or readmission after 12 months (35.2% vs. 45.2%; hazard ratio [HR] 0.71 [95% CI = 0.56 & ndash;0.91]; p = 0.007). This benefit was maintained after the propensity score analysis (HR = 0.66 [95% CI = 0.51-0.84]). This benefit, which was seen from the first month of the study and during its whole duration, is maintained when mortality (HR = 0.54; 95% CI = [0.36-0.82]) or readmission (subdistribution hazard ratio [SHR] 0.66; 95% CI = [0.50-0.86]) are analyzed separately. Conclusion: Telemonitoring after a severe COPD exacerbation is associated with less mortality or readmissions at 12 months in a real world clinical setting. (C) 2020 SEPAR. Published by Elsevier Espana, S.L.U. All rights reserved.

Purpose: Erosive hand osteoarthritis (EHOA) is often considered a more severe form of hand OA that includes pain and inflammation. However, more data are needed regarding the different hand OA phenotypes, especially erosive and non-erosive, to conclude if they represent two different subsets of hand OA or even different degrees of affectation of the same disease. The purpose of this work is to define a specific clinical pattern of patients with EHOA and identify putative biochemical markers associated with this phenotype. Methods: This cross-sectional study was conducted in the Prospective Cohort of Osteoarthritis A Coruna (PROCOAC). This cohort consists of 1136 subjects, from which 834 were diagnosed of hand OA following ACR criteria. After reviewing the x-rays, the cohort was split into patients with and without erosive hand OA. Then, both clinical and demographic data within each group were subsequently analyzed. A Univariate analysis comparing different variables between both groups, followed by a stepwise regression logistic regression analysis was performed to characterize the clinical pattern of EHOA. The identification of biochemical markers was carried out following a two-step workflow: in a first discovery phase, a proteomic approach based on peptide labelling with Isobaric tags for relative and absolute quantitation (iTRAQ) was employed using two different sets of sera (n=20) from EHOA or non-EHOA patients. In a second validation phase an independent set of 346 individual serum samples from the PROCOAC cohort (EHOA, n=127; non-EHOA, n= 219) was used to quantify serum concentrations of the extracellular matrix protein 1 (ECM1) by ELISA. The Mann-Whitney test was carried out in order to look for significant differences between EHOA and non-EHOA groups. All the statistical analyses were performed using SPSS software v.24. Results: The univariate analysis showed that EHOA patients were younger (p<0.001), smokers (p=0.011), with lower both body mass index (p=0.006) and arterial hypertension (p=0.002); increased frequency of inflammatory symptoms in hands (p<0.001), more presence of nodular hand OA (p=0.001) but lower frequency of other forms of hand OA, specially thumb-base (p=0.005) and metacarpophalangeal (p=0.036). In addition, these patients also showed a lower number of damaged joints (p<0.001), specially the knee (p<0.001). The stepwise logistic regression model (Table 1) confirmed the strong association of age (OR=0.963;95%CI=0.937-0.989;p=0.005), inflammatory symptoms (OR=4.575;95%CI=2.621-7.985;p<0.001), increased prevalence of nodal OA (OR=2.125;95%CI=1.118-4.037;p=0.021) and, in patients over 64 years old, MetS (OR=2.029;95%CI=1.183-3.478;p=0.010) with the erosive phenotype. In addition, erosive patients show a lower prevalence of knee OA (OR=0.416;95%CI=0.252-0.687;p=0.001) and to carry this phenotype at baseline does not confer a significant increased risk for radiographic knee OA progression over time). Regarding the proteomic analysis for the identification of potential biomarkers associated with the EHOA phenotype, a total of 257 different proteins were identified in the serum samples with more than two peptides and a total score ≥2 at 95% confidence. Thirty-six proteins were found quantitatively altered between those patients with or without EHOA. A significant reduction (p=0.029) of ECM1 concentrations was found in the serum from patients with the EHOA phenotype (0.154 ± 0.010 μg/ml vs 0.169 ± 0.007 μg/ml) (Figure 1). Conclusions: A specific clinical pattern of patients with EHOA has been defined. It has been associated with altered levels of 36 proteins in serum. Particularly, decreased amounts of ECM1 have been found in patients with this erosive phenotype.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Exercise echocardiography (ExE) can predict overall and cardiovascular mortality. We aimed to assess the value of ExE for the prediction of cardiovascular (CV), cancer (CA) and non-cardiovascular non-cancer (NCV-NCA) death in women. Retrospective analysis of prospectively collected data on 4,714 women (age 64 ± 11 years) with a first treadmill ExE performed in our center for known/suspected coronary artery disease. Exclusion criteria were significant valve disease, cardiomyopathy, congenital heart disease, and age <18 year-old. Ischemia was defined as the development of new wall motion abnormalities (WMAs) with exercise; abnormal ExE as ischemia or resting WMAs. A good functional capacity was defined as a maximal workload of 10 metabolic equivalents (METs). The end point was death (CV, CA or NCV-NCA). During a follow-up of 4.6± 4.7 years (interquartile range 0.04-8.0 years) there were 345 CV, 164 CA, and 203 NCV-NCA deaths. Multivariate analysis included clinical characteristics, resting echocardiography, exercise testing and peak exercise echocardiography. Different clinical characteristics predicted CV death, along with maximal achieved workload in Metabolic Equivalents (METs: Hazard Ratio [HR] = 0.92, 95% Confidence Interval [CI] = 0.88-0.96, p < 0.001) and ExE variables. CA death was independently predicted by age and achieved METs (HR = 0.93, 95% CI =0.87-0.99, p < 0.02). Similarly NCV-NCA death was predicted by clinical characteristics (age, diabetes mellitus, diuretics, nitrites) and also by achieved METs (HR = 0.83, 95% CI= 0.78-0.88, p < 0.001). Nor ischemia nor abnormal ExE increased the risk for CA or NCV-NCA death. Annualized CV deaths were almost quadruple in women with bad functional capacity as compared to those with good functional capacity (2.2% vs. 0.6%, p < 0.001). The same occurred for NCV-NCA death (1.4% vs. 0.3%, p < 0.001), whereas CA deaths were double in patients with bad functional capacity (0.9% vs. 0.4%, p < 0.001). In conclusion, an ExE study can predict not only CV death, but death due to CA or to NCV-NCA. Fit women based on the achievement of 10 METs during exercise testing, have less chance of death from any cause.

Endocrine disorders are common in obesity, including altered somatotropic axis. Obesity is characterized by reduced growth hormone (GH) secretion, although the insulin-like growth factor-1 (IGF-1) values are controversial. The aim of this study was to evaluate the effect of weight loss after bariatric surgery in the GH–IGF-1 axis in extreme obesity, in order to investigate IGF-1 values and the mechanism responsible for the alteration of the GH–IGF-1 axis in obesity. We performed an interventional trial in morbidly obese patients who underwent bariatric surgery. We included 116 patients (97 women) and 41 controls (30 women). The primary endpoint was circulating GH and IGF-1 values. Circulating IGF-1 values were lower in the obese patients than in the controls. Circulating GH and IGF-1 values increased significantly over time after surgery. Post-surgery changes in IGF-1 and GH values were significantly negatively correlated with changes in C-reactive protein (CRP) and free T4 values. After adjusting for preoperative body mass index (BMI), free T4 and CRP in a multivariate model, only CRP was independently associated with IGF-1 values in the follow-up. In summary, severe obesity is characterized by a functional hyposomatotropism at central and peripheral level that is progressively reversible with weight loss, and low-grade chronic inflammation could be the principal mediator.

Endocrine abnormalities are common in obesity, including altered thyroid function. The altered thyroid function of obesity may be due to a mild acquired resistance to the thyroid hormone. The aim of this study was to investigate the effect of weight loss after bariatric surgery (BS) on resistance to thyroid hormones in patients with extreme obesity compared with a control group. We performed an observational study evaluating patients with extreme obesity who underwent BS. We included 106 patients (83 women) and 38 controls (24 women). The primary endpoint was the thyrotroph thyroxine resistance index (TT4RI) and thyroid stimulating hormone (TSH) index (TSHRI). The parameters were studied before and after surgery. TSHRI and TT4RI were higher in the obese patients than in the control group. TT4RI and TSHI decreased significantly over time after surgery, with this decrease being associated with the excessive body mass index (BMI) loss and C-reactive protein (CRP). In extreme obesity, BS promotes a significant decrease in the increased TT4RI and TSHI. This decrease of TT4RI and TSHI is progressive over time after BS and significantly associated with excess BMI lost and CRP. Extreme obesity is characterized by a mild reversible central resistance to thyroid hormones.

Despite being a rare cause of stroke, spontaneous subarachnoid hemorrhage (SAH) is associated with high mortality rates. The prediction models that are currently being used on SAH patients are heterogeneous, and few address premature mortality. The aim of this study was to develop a mortality risk stratification score for SAH. A retrospective study was carried out with 536 patients diagnosed with SAH who had been admitted to the intensive care unit (ICU) at the University Hospital Complex of A Coruña (Spain) between 2003 and 2013. A multivariate logistic regression model was developed to predict the likelihood of in-hospital mortality, adjusting it exclusively for variables present on admission. A predictive equation of in-hospital mortality was then computed based on the model’s coefficients, along with a points-based risk-scoring system. Its discrimination ability was also tested based on the area under the receiver operating characteristics curve and compared with previously developed scores. The mean age of the patients included in this study was 56.9 ± 14.1 years. Most of these patients (73.9%) had been diagnosed with aneurysmal SAH. Their median length of stay was 7 days in the ICU and 20 days in the general hospital ward, with an overall in-hospital mortality rate of 28.5%. The developed scales included the following admission variables independently associated with in-hospital mortality: coma at onset [odds ratio (OR) = 1.87; p = 0.028], Fisher scale score of 3–4 (OR = 2.27; p = 0.032), Acute Physiology and Chronic Health Evaluation II (APACHE II) score within the first 24 h (OR = 1.10; p < 0.001), and total Sequential Organ Failure Assessment (SOFA) score on day 0 (OR = 1.19; p = 0.004). Our predictive equation demonstrated better discrimination [area under the curve (AUC) = 0.835] (bootstrap-corrected AUC = 0.831) and calibration properties than those of the HAIR scale (AUC = 0.771; p ≤ 0.001) and the Functional Recovery Expected after Subarachnoid Hemorrhage scale (AUC = 0.814; p = 0.154). In addition to the conventional risk factors for in-hospital mortality, in our study, mortality was associated with the presence of coma at onset of the condition, the physiological variables assessed by means of the APACHE II scale within the first 24 h, and the total SOFA score on day 0. A simple prediction model of mortality was developed with novel parameters assessed on admission, which also assessed organ failure and did not require a previous etiological diagnosis.

BACKGROUND:The selective impact of strategies for prevention of PD-related peritonitis (PDrP) may have modified, in the long term, the causal spectrum, clinical presentation and outcomes of these infections.OBJECTIVES:To compare trends in the incidence of PDrP by different microorganisms during a 30-year period, with a particular focus on streptococcal infections. To analyze the clinical presentation and outcomes of these infections. Secondarily, to investigate how the isolation of different species of streptococci can influence the clinical course of PDrP by this genus of bacteria.METHOD:Following a retrospective, observational design we investigated 1061 PDrP (1990-2019). We used joinpoint regression analysis to explore trends in the incidence of PDrP by different microorganisms, and compared the risk profile (Cox), clinical presentation and outcomes (logistic regression) of these infections.MAIN RESULTS:Our data showed a progressive decline in the incidence of PDrP by staphylococci and Gram negative bacteria, while the absolute rates of streptococcal (average annual percent change +1.6%, 95% CI -0.1/+3.2) and polymicrobial (+1.8%, +0.1/+3.5) infections tended to increase, during the same period. Remarkably, streptococci were isolated in 58.6% of polymicrobial infections, and patients who suffered a streptococcal PDrP had a 35.8% chance of presenting at least one other infection by the same genus. The risk profile for streptococcal infections was comparable to that observed for PDrP overall. Streptococcal PDrP were associated with a severe initial inflammatory response, but their clinical course was generally nonaggressive thereafter. We did not observe a differential effect of different groups of streptococci on the clinical presentation or outcome of PDrP.CONCLUSIONS:Time trends in the incidence of PDrP by different microorganisms have granted streptococci an increasing relevance as causative agents of these infections, during the last three decades. This behaviour suggests that current measures of prevention of PDrP may not be sufficiently effective, in the case of this genus of microorganisms.

Background Osteoarthritis (OA) is an incurable disease and methods for its early diagnosis are still an unmet clinical need. Raman spectroscopy (RS) presents potential as a diagnosis technique based on the detection of peaks that can be assigned to cartilage components and molecular rearrengements during disease progression.1Mankin score (MS) is the main validated method to evaluate severity of cartilage degradation considering structure, cell distribution, Safranin-O staining and tidemark integrity.2 Objectives To evaluate the correlations between OA cartilage RS assigned peaks and MS, considering the inter- and intra-variability of different observers. Methods MS analysis (Subscore-I, structure: 0-6; -II, cellularity: 0-3; and -III, safranin-O staining: 0-4; Total Score: 0-13) of human OA cartilage explants from 22 donors (age range: 32-92), obtained from lesion (n=22) and/or adjacent tissues (n=14), was performed by 3 blinded observers (O1, 2 and 3). Moreover, one of the observers performed the scoring in triplicate, with at least one month between observations. Inter- and intra-observer variability was determined by kappa and intraclass correlation (ICC) coeficients. Raman spectra were obtained with a FT-Raman Bruker RFS100 (λ=1064nm) and main peaks assigned (6 ratios related to proteoglycans, collagen, lipid index or calcium phosphate). Spearman’s nonparametric correlation coefficient rho was used to compare MS and RS assigned peaks. Results Inter-observers variability indicated good (ICC>0.74) or moderate agreement (ICC>0.5) for all scores in lesions, whilst only a good agreeement (ICC=0.70) was found for subscore-I, in adjacent tissues, and no agreeement for the remaining parameters (subscores -II, -III, and total scoring). However, when performing analysis using kappa coefficients, a simultaneous agreement between the 3 observers was not observed. Intra-observer variability revealed good concordance (ICC>0.6) for all subscores and total scoring in cartilage for both sites, except for subscore –III, in adjacent tissues. In this case, ICC results were confirmed by kappa coefficients. Spearman’s correlation coefficient between cartilage main peaks assigned by RS and MS indicated significant differences between observers(Fig.1). Correlations were found for a greater number of MS subscores in O1 (6) regarding O2 (4) or O3 (3) which could be related to the observers’ experience (being O1>O2>O3). These correlations were mostly found in lesions (5, 3 and 1 for O1, 2 and 3, respectively) in comparison to adjacent tissues (2, 1 and 2 for O1, 2 and 3, respectively). Conclusion Eventhough inter-observation correlations for MS were in the moderate- good range, when analyzing kappa coefficients (categorical variables) these were not maintained. In addition, inter- and intra-observer variability results for adjacent tissues revealed possible limitations when characterizing early to mild OA. In view of MS-RS correlations, a reader dependency is underlined, indicating MS subjectivity and further limitations in the validation of RS using MS. References [1] Esmonde-White, et al. Analyst2011,136(8),1675-1685; [2] Mankin, et al. J. Bone Jt. Surg.1971,53,3,523-537. Acknowledgement The authors thank Cooperation Program INTERREG V A España – Portugal (POCTEP) 2014-2020 Proyect: 0245_IBEROS_1_E and CIBER-BBN for funding. CIBER-BBN is an initiative of the ISCIII. Disclosure of Interests Paula Casal-Beiroa: None declared, Vanesa Balboa-Barreiro: None declared, Noa Goyanes: None declared, Purificación Filgueira-Fernández : None declared, Pío González: None declared, Sonia Pertega: None declared, Francisco J. Blanco Consultant for: AbbVie, Bioiberica, BMS, GSK, Grünenthal, Janssen, Lilly, Pfizer, Regeneron, Roche, Sanofi, TRB Chemedica, and UCB, joana magalhães: None declared

Background In recent years, interest in donation after cardiac death (DCD) has increased. Although DCD liver transplantation (LT) has demonstrated satisfactory long-term outcomes, different studies have shown poorer patient and graft survival after DCD than after donation after brain death (DBD). This study aimed to evaluate the results of LT using controlled DCD (cDCD) donors, specifically the incidence of primary non-function and ischemic cholangiopathy (IC), and to compare these results with those of LT using DBD in the same time period. Methods Between June 2012 and July 2018, we performed 66 transplants using cDCD and 258 with DBD grafts. Results The incidence of IC was similar in both groups (2% in DBD, 1.5% in DCD; P = .999). No significant differences were found for overall graft and patient survival rates between the groups at 1 and 2 years post-transplantation. Conclusions This study provided evidence that cDCD donors exhibit excellent graft and patient survival outcomes. When the warm ischemia time is <30 minutes and cold ischemia time is <6 hours, the graft and patient survival rates and the incidence of IC in DCD are similar to those in DBD, even when using donors without age restrictions.