Effects of caloric restriction and aerobic exercise on circulating cell-free mitochondrial DNA in patients with moderate-to-severe chronic kidney disease

Circulating cell-free mitochondrial DNA (ccf-mtDNA) may induce systemic inflammation, a common condition chronic kidney disease (CKD), by acting as a damaged-associated molecular pattern. We hypothesized that in patients with moderate to severe CKD, aerobic exercise would reduce ccf-mtDNA levels. We performed a post hoc analysis of a multicenter randomized trial (NCT01150851), measuring plasma concentrations of ccf-mtDNA at baseline and two and four months after aerobic exercise and caloric restriction. A total of 99 participants had baseline ccf-mtDNA, and 92 completed the study. The median age was 57 years, 44% were female, 23% had diabetes, and 92% had hypertension. After adjusting for demographics, blood pressure, BMI, diabetes, and eGFR, median ccf-mtDNA concentrations at baseline, two, and four months were 3.62, 3.08, 2.78 picomolar for the usual activity group, and 2.01, 2.20, 2.67 picomolar for the aerobic exercise group, respectively. A 16.1% greater increase per month in ccf-mtDNA was seen in aerobic exercise versus usual activity (p = 0.024) that was more pronounced with the combination of aerobic exercise and caloric restriction (29.5% greater increase per month). After four months of intervention, ccf-mtDNA increased in the aerobic exercise group by 81.6% (95% confidence intervals [CI] 8.2-204.8; p = 0.024) compared to usual activity and was more marked in the aerobic exercise and caloric restriction group (181.7% increase, 95% CI 41.1-462.2; p = 0.003). There was no statistically significant correlation between markers of oxidative stress and inflammation with ccf-mtDNA. Our data indicate that aerobic exercise increased ccf-mtDNA levels in patients with moderate-to-severe CKD.

Health-related quality of life for glioblastoma short and long-term survivors receiving treatment with TTfields.

2055 Background: The aim of this study was to administer the first large-scale, international survey eliciting real-world patient-reported quality-of-life (QoL) for patients with newly diagnosed and long-term glioblastoma (GBM) currently receiving treatment with TTFields. Methods: A survey was designed and mailed to 2,815 patients actively using TTFields for treatment of GBM in the United States (US, n = 2,182) and Europe (EU, n = 633). The survey included 1) demographic information, 2) patient-reported clinical information and 3) EuroQol’s EQ-5D-5L and EQ visual analogue scale (EQ-VAS) surveys. Univariate and multivariate analyses were performed on five dimensions (mobility, self-care, usual activity, pain/discomfort, anxiety/depression) of the EQ-5D-5L and EQ-VAS to understand the impact of patient demographics and clinical characteristics on QOL. Results: A total of 1,106 patients were included (39.3% response rate) with 782 and 324 responses in the US and EU, respectively. The median time from diagnosis was 14 mos (range, 0-301 mos) and ≥24 mos in 28.4% of patients. Patients were mostly male (62.3%) with a mean age of 58.5 (SD = 12.5) and 69.3% had stable disease. Mean EQ-VAS was 68.2 for all patients and was significantly higher for those with > 15 months since diagnosis compared to < 15 months since diagnosis (p = 0.008). There were significantly fewer problems reported on self-care ( p = 0.04) and usual activity ( p = 0.007) in patients with a longer time since diagnosis in the univariate analysis. In the multivariate analysis, patients with a longer time since diagnosis reported significantly better EQ-VAS ( p = 0.04). The effect size in the multivariate analysis for time since diagnosis on EQ-VAS was higher in the progressed subgroup ( p = 0.17) compared to the broader sample (0.08). The EQ-VAS and all five dimensions including mobility, self-care, usual activity, pain/discomfort, and anxiety/depression were improved for stable patients compared to progressed patients in the univariate and multivariate analyses. However, when stratified by progression status, progressed patients with longer time from diagnosis had significantly fewer reported problems with mobility ( p = 0.04), self-care ( p = 0.004) and usual activity ( p = 0.008), and significantly better self-rated health status ( p = 0.02). Conclusions: GBM survivors receiving TTFields reported significantly improved health status over time since diagnosis. Long-term survival with TTFields does not have a detriment in patient reported quality of life, in fact with longer time from diagnosis QOL significantly improves. This is true for patients with stable and progressed disease. Future prospective clinical trials are needed to further study the impact of our treatment and tumor progression on patient QOL.

AB0540 COMPARISON OF EQ-5D HEALTH STATUS IN PSORIATIC ARTHRITIS PATIENTS WITH OR WITHOUT AXIAL DISEASE: RESULTS OF SUBANALYSIS OF THE PATERA STUDY

Background:Netakimab (NTK) is an anti-interleukin-17A monoclonal antibody approved for psoriasis, ankylosing spondylitis, psoriatic arthritis (PsA) in Russia and Belarus. PATERA is an ongoing phase 3 international double-blind, placebo-controlled clinical study of NTK in PsA (NCT03598751).Objectives:A subanalysis was performed to assess the effect of NTK on domains of the 5-level EuroQol 5 Dimensions questionnaire (EQ-5D-5L) in patients with inflammatory back pain (IBP) (IBP(+)) and without (IBP(-)) at baseline according to self-reported ASAS IBP criteria, 2009.Methods:194 adult patients with PsA (CASPAR criteria, 2006) with inadequate response to csDMARD or one TNFi, were randomly assigned to receive NTK 120mg or placebo at weeks 0,1,2,4,6,8,10,14,18,22. The proportion of patients reported >1 problem in each domain was evaluated. Patients with missing values were considered as non-responders in the analysis.Results:97 PsA patients (N=54 IBP(+), N=43 IBP(-)) received NTK. The subpopulations didn’t differ significantly in gender, age, and PsA activity at baseline. Comparable percentage of patients reported any problems for each domain at baseline (p≥0.05) (data not shown). IBP(-) subpopulation had a greater improvement for all domains except of anxiety/depression. The absolute declines for IBP(+) vs IBP(-) patients were as followed: 24.1% vs 41.9% (mobility), 18.5 vs 41.9% (self-care), 24.0% vs 51.1% (usual activities), 24.1% vs 37.2% (pain/discomfort), 33.3% vs 9.3% (anxiety/depression). However, the only significant difference between IBP(+) and IBP(-) was observed in usual activity (Figure 1).Conclusion:NTK resulted in the growing improvement of each EQ-5D-5L domain through 24 weeks irrespectively of the presence of IBP. IBP(-) subjects showed trend to greater benefit compared to IBP(+).Figure 1Percentage of patients reported any problems in (A) pain/discomfort, (B) in usual activity at each visitAcknowledgements:This study was sponsored by JSC BIOCAD.Disclosure of Interests:Inna Gaydukova Speakers bureau: Abbvie, Biocad, Eli Lilly, MSD, Novartis, Pfizer, Sandoz, Tatiana Korotaeva Speakers bureau: Abbvie, Biocad, Eli Lilly, Johnson & Johnson, Janssen, Novartis, Pfizer, UCB, V Mazurov: None declared., Aleksey Samtsov: None declared., Vladislav Khayrutdinov: None declared., Andrey Bakulev: None declared., Alena Kundzer: None declared., Nikolaj Soroka: None declared., Anna Eremeeva Employee of: Biocad.

A prospective comparative study of outcome between open lichtenstein versus laparoscopic repair of inguinal hernia

Background: Laparoscopic hernia repair is technically difficult and has long learning curve than open repair. Moreover, with increased cost of procedure do patient really get benefited in terms of intraoperative time duration, post-operative pain and complications, length of hospital stays, and time taken to return to usual activity needs to be studied.Methods: In this prospective observational study of 100 patients including unilateral, bilateral, direct and indirect inguinal hernia and excluding obstructed and strangulated hernia, 61 patients underwent open repair and 39 patients underwent laparoscopic hernia repair. Pain analysis was done with visual analogue scale. Unpaired student T test and Chi square test used (p<0.05).Results: Baseline characteristics age, sex of the two groups were similar. Mean operative time in laparoscopic group was 105.38±35.13 minutes and in open group was 79.95±31.12 minutes (p<0.001). There was statistically significant difference in mean pain score of laproscopic verses open techniques (p<0.001). Urinary retention was the most common post-operative complication in both groups but was statistically not significant. Mean hospital stay in laparoscopic group was 1.56±0.50 days and in open group was 1.9±0.50 days (p-0.002). Mean time taken to return to usual activity in open repair was 41.10±27.15 days and in laparoscopic group was 16.23±6.37 days (p-0.001).Conclusions: This study showed that in laparoscopic repair of inguinal hernia patients have less post-operative pain, shorter hospital stays and early return to work. However, the laparoscopic technique had longer operative time duration.

Characterization of Prolonged COVID-19 Symptoms in an Outpatient Telemedicine Clinic

We identified patients with coronavirus disease 2019 in a telemedicine clinic who requested ongoing follow-up calls 6 weeks after symptom onset. In this group, respiratory symptoms are the most common complaints, asthma and lung disease are frequent comorbidities, and patients often have not returned to work or usual activity.

Prevalence and Determinants of Mental Distress During COVID-19 Outbreak in Bangladesh: Evidence from an Online Survey

Background: Coronavirus disease 2019 (COVID-19) is an ongoing pandemic and life-threatening highly infectious disease. The people of Bangladesh are at high risk of COVID-19 and have already experienced various socio-economic, health and psychological (mental) consequences. Particularly, mental health problems are dominantly reported in the literature and should be controlled. The main objective of this epidemiological study is to assess the mental distress and identify its determinants using online-based survey. Such information is urgently needed to develop feasible strategies for Bangladesh. Methods: An online survey was conducted for this study from May 01 to May 05, 2020. A total of 240 respondents provided self-reported online responses. Respondent&rsquo;s mental distress was measured by the General Health Questionnaire 12 (GHQ-12) and by the self-rated mental health (SRMH) question. Various kinds of statistical analyses ranging from simple to multivariable logistic recession were performed using SPSS 23.0. Results: About 31.3% and 48.3% of respondents were mentally distressed by GHQ-12 and SRMH question, respectively. Logistic regression analysis revealed that mental distress was significantly higher among those respondents, whose usual activity was affected by the coronavirus (OR = 6.40, 95% CI: 1.87 - 21.90, p&lt;0.001) and whose financial stress was increased due to lockdown (OR = 2.12, 95% CI: 1.01 &ndash; 4.46, p&lt;0.05) on GHQ-12. Female sex (OR = 1.97, 95% CI: 1.03 &ndash; 3.75, p&lt;0.05) and respondents with poor mental health before the outbreak (OR = 3.38, 95% CI: 1.18 &ndash; 9.72, p&lt;0.05) were also significantly affected by mental distress on SRMH. Conclusions: At least thirty percent of the respondents were found to be mentally distressed. Some of the study findings, particularly significant determinants, should be considered while developing strategies to reduce the burden of mental distress among study respondents or similar group in Bangladesh.

Characterization of prolonged COVID-19 symptoms and patient comorbidities in an outpatient telemedicine cohort

We identified patients with coronavirus disease 2019 (COVID-19) in a telemedicine clinic who requested ongoing follow-up 6 weeks after symptom onset. Patients with prolonged symptoms often have not returned to work or usual activity. Respiratory symptoms are most common, and underlying asthma and lung disease occur frequently.

The benefit of Curcuma longa and Boswellia serrata to improve quality of life in osteoarthritis patients: a randomized controlled trial

<p class="abstract"><strong>Background:</strong> Quality of life (QoL) can be affected by chronic pain in osteoarthritis (OA). Previous studies showed that combination of <em>Curcuma longa</em> (CL) and <em>Boswellia serrata</em> (BS) extract (CB extract) are promising for alternative treatment for pain in OA. This study aimed to measure the benefit of CB extract to improve QoL in patients with OA.</p><p class="abstract"><strong>Methods:</strong> This was a randomized controlled trial (RCT) in OA patients. Subjects were randomized to 3 different group (Group 1: CB extract (350 mg of CL and 150 mg BS) and NSAID (400 mg ibuprofen or 50 mg diclofenac sodium); group 2: CB extract; group 3: NSAID). Each medication was taken two times per day for 4 weeks. QoL measured using 5Q-5D-5L that include five dimensiones in 5Q-5D: mobility, self-care, usual activities, pain/discomfort, anxiety/depression, with 5 levels of severity.<strong></strong></p><p class="abstract"><strong>Results:</strong> There were 105 subjects at baseline. After 4 weeks of study, remained 95 subjects. The most common problem in group 1, 2, and 3 was pain (n=23, n=8, n=15 respectively). The improvement of level of severity in group 1 after 4 weeks of treatment was significant in mobility problems (p=0.002), pain/discomfort (p&lt;0.001), and anxiety/depression (p=0.008). A significant improvement was only seen in usual activity problems (p=0.013) in group 2. The decrease of level of severity in usual activity problems (p=0.034), pain/discomfort (p=0.005), and anxiety/depression (p=0.018) in group 3 were also statistically significant.</p><p class="abstract"><strong>Conclusions:</strong> CB extract was beneficial to improve QoL in OA patients with a less side effect compared to NSAID.</p>

Probability Analysis of Traffic Accident Occurrence Based on Incomplete and Unreliable Evidence

The paper presents a methodology for analyzing a traffic accident and evaluating the existence of a traffic accident in the conditions of incomplete and unreliable evidence. Namely, the examination of the causes of a traffic accident is the usual activity of traffic experts who, with their knowledge, experience and skills, help the court and parties in the court proceedings to find out from the qualified, experienced and impartial person the reasons for the occurrence of a traffic accident, and in relation to that, mistakes and responsibilities participants in a traffic accident. In contrast, lately there are phenomena of traffic accidents in which individuals and/or groups try to improvise traffic accidents in order to achieve their various benefits and interests. This paper provides a methodological approach to such an expert evaluation of probability of traffic accident evaluation with examples in the cases of vehicle-vehicle and vehicle-pedestrian collision.