C. Carvalho

Noninvasive positive pressure ventilation can prevent reintubation after acute respiratory failure: results of a prospective and randomized study

We hypothesize that the use of noninvasive positive pressure ventilation can be helpful in preventing reintubation after weaning of mechanical ventilation in patients with acute respiratory failure (ARF).

Low tidal volume in association with low positive end expiratory pressure in acute respiratory distress syndrome: a suboptimal strategy? A computed tomography-based analysis

In a recent trial, ARDSNet investigators found no benefit with the association of an intermediary PEEP to a low-tidal-volume (6 ml/kg) ventilatory strategy. The goal of maximal recruitment strategy (MRS) guided by thoracic CT scan is to minimize alveolar collapse and tidal recruitment (TR).

Depression symptoms in multiple sclerosis patients – The role of IL1B

Andreia Bettencourt1,2, Bárbara Leal1,2, Marta Ferreira1, Cláudia Carvalho1,2, Inês Moreira4, Ernestina Santos3, Paulo Pinho e Costa1,2,5, Berta Silva1,2, Sara Cavaco4, Ana Martins da Silva2,3 1. Laboratório de Imunogenética, Instituto de Ciências Biomédicas Abel Salazar (ICBAS) – Universidade do Porto. 2. Unidade Multidisciplinar de Investigação Biomédica, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto UMIB/ICBAS/UP. 3. Serviço de Neurologia, Centro Hospitalar do Porto – Hospital de Santo António (CHP-HSA). 4. Unidade de Neuropsicologia Centro Hospitalar do Porto – Hospital de Santo António (CHP-HSA). 5. Instituto Nacional de Saúde Dr. Ricardo Jorge – INSA.

Long-term effects of two protective-ventilation strategies in an ARDS model: Open Lung Approach by EIT versus ARDSnet

Different ventilatory strategies for the acute respiratory distress syndrome have been proposed. The Open Lung Approach (OLA) emphasizes the recruitment of airway units with avoidance of tidal recruitment. The ARDSnet strategy simply emphasizes the reduction of and hyperdistension. We studied the long-term VT consequences of both strategies in a controlled experiment where pigs where randomized and submitted to one of both strategies for 48 hours. Lung injury was induced by saline lavage followed by 3 hours of injurious mechanical ventilation. In the OLA arm, PEEP was selected by the EIT after a recruitment maneuver (RM), trying to keep lung collapse to a minimum, while the ARDSnet group followed a PEEP × FiO2 table. We scrutinized lung function at the end of a 48-hour period of lung protection, after a standardized RM. The concept was to provide equivalent conditions for lungs to perform, irrespective of lung history or treatment in previous days, in terms of gas exchange or alveolar stability during slow-deflation maneuvers. Before sacrifice and after maximum RM, we collected blood gases and expiratory pressure versus ΔZ (impedance changes by electric impedance tomography). Oxygenation and alveolar stability were equally impaired in both arms after injury. However, at the end of the 48 hours there was significant improvement in the capacity of oxygenation in the OLA arm (mean = 494 mmHg; P = 0.043), but not in the ARDSNet arm (mean = 278; P = 0.285). The potential to maintain airspace volumes improved along the protective period in the OLA arm, but deteriorated in the ARDSnet arm. (See Figure ​Figure11.) Figure 1

446 Relation of vitamin d levels in sle number of severe flares

Background and aims The aim of this study was to evaluate retrospective data of Vitamin D levels in SLE patients, at the beginning of the disease and mean values during 10-years follow-up, and correlate them with severe flares frequency. Methods We selected, from a cohort of 675 SLE patients, 112 patients who had baseline Vitamin D levels at SLE diagnosis and 68 patients with at least three evaluations of Vitamin D levels during the last 10-years follow-up. The number of severe flares (defined by the SELENA-SLEDAI flare composite index) was required for all patients. We correlated the baseline Vitamin D levels with severe flare number and with patients with three or more and less than three severe flares. We also correlated severe flares with mean Vitamin D value in the last 10-years follow-up. Results We observed a higher number of flares in patients with low disease baseline Vitamin D levels (p=0.045). We also observed that patients with three or more flares have significant lower baseline Vitamin D levels (p=0.004). The mean Vitamin D levels in the previous 10-years of disease, were lower in patients with more severe flares, although not significant (p=0.178). However, if we divide them in two subgroups (patients with three or more and less than three severe flares), the difference is significant (p=0.044). Conclusions Vitamin D levels at the beginning of the disease and the vitamin D burden during disease are related to the number of severe flares and so resulting in more aggressive phenotypes.

293 Effect of high dose cholecalciferol during sle flares in mir-146a expression, regulatory t-cells and il-17a expression

Background and aims A few microRNAs have known gene expression regulatory roles in innate immunity. The miR-146a, seems to be a negative regulator of innate immunity. Interestingly, miR-146a has been reported to be downregulated in PBMCs of SLE patients, being negatively correlated with clinical disease activity and with IFN levels. The ability of vitamin D to regulate miRs and their emerging relationship have been proposed through several experimental approaches. The aim of this study was to determine the Vitamin D effect in miR-146a expression and in T-Reg and TCD4+ IL-17A producing cells, in SLE. Methods An interventional study with 3 weeks follow-up of SLE patients with a high dose vitamin D supplementation (50.000 UI or 100.000 UI/Week) was done. We assessed four female patients who had a SLEDAI >6 and at least one BILAG A. At screening, relevant data were compiled: SLEDAI-2K, BILAG score, concomitant therapy, previous SLE manifestations, 25(OH)D levels, T-Reg/IL-17A ratio and miR-146a expression. At Week 3: 25(OH) D levels, T-Reg/IL-17A+ ratio, miR-146a expression, SLEDAI 2 K, BILAG and concomitant therapy. Results No significant difference were found, regarding Vitamin D levels, before and after supplementation. Regarding Tregs/IL-17A ratio before and after supplementation, no benefits, regarding enhancing of T-regs or decrease of Il 17-A producing cells. No significative differences were found in miR-146a expression between controls and SLE active patients before and after vitamin D supplementation. Conclusions Severe SLE activity may cause resistance to Vitamin D therapeutical effects, including enhancing of Vitamin D levels and immunogenetic effects.

AB0504 HTR2A Polymorphisms Influence in Systemic Lupus Erythematous Clinical, Immunological Manifestation and Damage Accrual

Background Serotonin receptor 1A and 2A genes polymorphisms (HTR1A and HTR2A) have been associated to increased risk of depression and suicide. Hypomethylated HTR1A has been associated to Systemic Lupus Erythematosus (SLE) patients manifestations. Preliminary results in our cohort showed an association between HTR2A polymorphisms and SLE manifestations development risk and depression risk in SLE patients. Objectives To investigate the association of 5-HTR2A polymorphisms (rs6314, rs6313) and clinical organ involvement, specific antibodies expression and damage accrual and time to damage accrual in SLE patients. Methods 75 SLE patients were evaluated for 5-HTR2A polymorphisms rs6314 and rs6313, by a Taqman assay and PCR-RFLP methodology, respectively. SLE diagnosis was based in ACR 1999 criteria, the organic involvement and specific antibodies were reviewed in the charts (Cumulative SLE manifestations for genetic studies) and damage was assessed by SDI (Systemic Lupus International Collaborating Clinics - Damage Index). Statistical analysis was made with SPSS 22.0. Results 75 SLE patients (70 female) with a mean age of diagnosis of 29.55 years old (SD 12.0) and mean follow-up time of 17,39 years (SD 7,70). Mucocutaneous involvement occurred in 88%, articular 85,3%, renal 46,7%, 30,7% neuropsychiatric. 38 patients (50,7%) had organ damage acrrual with a mean time to first damage accrual of 3,75 years (SD 6,88). 7 (9,3%) accrued renal damage and 15 (20%) neuropsychiatric. Polymorphism distribution was rs6313 (CC 22,7%, CT 54,7% e TT 14,7%) and rs 6314 (CC 86,7%, CT 13,3%). No association was found between these polymorphisms and any clinical involvement, cytopenias, antibodies, damage accrual or time to damage. Neuropsychiatric damage accrual was earlier in patients carrying CC rs6314. Conclusions Contradictory results are a very common phenomena in studies of complex diseases mainly due to the interaction fo several genes. Although poorly studied the serotonin receptor and transporter genes have been linked to SLE development and depression in SLE patients. In our study, there was no relation between any clinical or serological manifestations and the rs6313 and rs6314 HTR2A polymorphism but the earlier neuropsychiatric damage accrual opens a window of doubt of what might be the role of serotonin in SLE heterogeneity. Disclosure of Interest None declared

Maximal recruitment strategy guided by thoracic computed tomography scan in acute respiratory distress syndrome patients: preliminary results of a clinical study.

There is great controversy concerning protective ventilatory strategy in ARDS. Recruitment maneuvers and PEEP titration sufficient to avoid collapse and tidal recruitment in the lung are the major goals of the maximal recruitment strategy (MRS) guided by computed tomography (CT).

Presentation of 50 cases of Wegener's granulomatosis from São Paulo, Brazil

The purpose of this study is to analyze 50 cases of Wegeners granulomatosis admitted at Hospital das Clinicas (Sao Paulo, Brazil) from 1985 to 2000, regarding the clinical presentation, sites of accomitment, diagnostic procedures, therapeutics and prognosis of this systemic vasculitis that involves preferentially the upper airways, lungs and kidneys. The initial clinical presentation was characterized by upper airways involvement in 42/50, pulmonary 39/50, kidney 31/50, ocular manifestations 23/50, osteoarticular in 21/50, cutaneous 21/50 and nervous system involvement in 15/50. The mean age of the patients was 39 ± 15 years, and 26 were female. The diagnosis was confirmed in biopsies or necropsies in 44/50 patients. C-ANCA was positive in 26/40 and P-ANCA in 7/40 patients. The initial pulmonary manifestations were characterized by nodules with or without cavitation in 27/50, masses with or without cavitation in 13/50, and alveolar hemorrhage in 9/50. The treatment was prednisone (1 mg/kg) and cyclophosphamide (2-3 mg/kg). The severe cases also received 3 days methylprednisolone 1 g/day. From the 50 patients attended 11 died, 10 lost follow up, and 29 are in remission. The pneumologist should be aware of the pulmonary and systemic presentation of WG in order to diagnose and treat these patients properly.

PxV curve behavior inside and outside the thorax in normal rats

PxV curve is a good way to study the mechanical behavior of the respiratory system in animal models; however, it is important to distinguish between the behavior of the PxV curve inside the thorax (PxV curve of the respiratory system) and outside the thorax (PxV curve of the lung) as we studied in isolated lungs models.