ALBERT

Description: Sustainability, Vol. 10, Pages 931: QSI Methods for Determining the Quality of the Surface Finish of Concrete Sustainability doi: 10.3390/su10040931 Authors: Francisco Benito Saorin Isabel Miñano Belmonte Carlos Parra Costa Carlos Rodriguez Lopez Manuel Valcuende Paya The surface finish of a concrete element may become an index of its quality, relating the external and internal porosity with the mechanical and durability properties. Few methods are used to determine the surface quality of concrete elements. Mention must be made the Quality Surface Index (QSI) proposes a simplified method to quantify the surface occupied by the pores in relation with the total surface inspected, analyzing groups of pores by their diameter. The method of the CIB W29 (Commission W29 “Concrete Surface Finishings”) proposes an inspection of the concrete element and its visual comparison with some standard templates. Finally, the digital processing of images allows the zones with surface defects to be delimited and quantified according to premises of quality introduced into the control software. These three methods are employed in this work and are applied in three concrete walls situated three meters from the observer (M-1, M-2 and M-3). Following the conversion of the results of the method with ImageJ and QSI, the results suppose differences that go from 0.1 tenths (2%) for M-3 up to 0.3 tenths (8%) for M-1. All values are within the obtained range with CIB W29 templates. This can validate the QSI and digital processing methods and allows a quick verification of the results. With the digital method, it is obtained that 23.5% of the total pores of M-1 have a diameter of less than 10 mm2 and 44% of less than 100 mm2. For M-2 and M-3 the proportions of pores with a dimension below 10 mm2 is of 43.1% and 27.7%, respectively, and that 77.5% and 60.7% are smaller than 100 mm2. From all the above it can be highlighted that M-1 is the one with the lowest amount of pores, however the proportion of the largest is greater than for M-2 and M-3. In the case of M-3, although it has a lower proportion of larger pores than M-1, its greater amount means it is the worst in terms of surface finish of the three.

Description: Background and aims: Significant efforts have been made in international guidelines since 2009 to establish recommendations for the initial work-up of patients with suspected immune thrombocytopenia (ITP), and to define who should be treated and how. A previous retrospective study of 101 ITP patients identified important areas of inappropriateness in the diagnostic and therapeutic management of ITP (Lozano et al, 2016), which could negatively impact patient outcomes. This study was aimed to further analyze the level of implementation of current recommendations in the standard practice of adult ITP patients in an independent validation cohort, and compare it to the pre-guideline period. Methods: We collected retrospectively the clinical data of 146 primary adult ITP patients who initiated treatment with thrombopoietin receptor agonists (TPO-RA) between January 2012 and December 2014. Data on patient characteristics were obtained from medical records from November 2016 to January 2018 in a multicenter study from 19 secondary and tertiary Spanish hospitals. To evaluate the laboratory diagnosis and the appropriateness of treatment according to guidelines, two cohorts of patients were considered: "pre-group" and "post-group" depending on the date of diagnosis (before or after January 2010). Results: Patients in pre-group (n=71) and post-group (n=75) had a median follow-up from diagnosis of 13.6 years (7.5-54.2 years), and 4.6 years (2.2-7.6 years), respectively. The level of compliance of general diagnostic tests was analyzed and compared. Peripheral blood smear, an examination recommended by all recent guidelines, was performed in 84% of patients in the post-group, and in only 64% of those in the pre-group (P=0.007). Bone marrow assessment at diagnosis of the disorder was ordinarily performed in around half of the patients regardless of the period (54% and 47% in the pre- and post- groups, respectively; P=0.408). Remarkably, in 49% of the patients in the pre-group, bone marrow evaluation was primarily performed due to the department policy, whereas that reason decreased to 25% in the post-group (P=0.027). Moreover, in 21% and 9% of patients in the pre-group and post-group that underwent a bone marrow assessment at diagnosis, the peripheral blood film had not been previously examined (P=0.192). In our cohort, differences in the treatment patterns were analyzed. Prednisone was used as first line-therapy in 89% and 84% of pre- and post- groups, respectively (P=0.406). There was a significant decrease in the duration of first-line therapy with prednisone from start until withdrawal in the post-group compared with the pre-group (median 77 vs. 122 days, respectively; P=0.004). Following first-line treatment, more patients in the pre-group were exposed to further prednisone (45% vs. 25%, P=0.003), and also the number of second or subsequent lines of therapies with this corticosteroid were significantly higher (61 courses of prednisone retreatment in 32 patients vs. 22 courses in 19 patients in the pre- and post- groups, respectively; P=0.008). As expected, a higher proportion of patients in the pre-group underwent splenectomy, and also received more immunosuppressant and immunomodulatory drugs than those in the post-group prior to TPO-RA therapy (P

Description: Background. Increasing age is a risk factor for vascular events but also for bleeding in immune thrombocytopenia (ITP). In elderly, meta-analysis of clinical trials of romiplostim (ROM) and eltrombopag (ELT) show that thrombopoietin receptor agonists (TPO-RA) are effective and safe with the exception of increased thromboembolic risk (Olney et al, 2011; Michel et al 2015). Objective. To analyze how age influences the selection of TPO-RA, bleeding and thrombotic risk, comorbidities, and therapeutic management of ITP patients in a real-world setting. Methods. We conducted a multicenter retrospective study that included 121 adult patients with primary ITP from 19 secondary and tertiary Spanish hospitals who had initiated long-term therapy with ROM or ELT between January 2012 and December 2014. Information was collected from medical records (November 2016 to January 2018) to assess variables related to patient characteristics and outcomes of elderly (〉 65 years; n=54) compared with younger individuals (n=67). Results. Patients included initiated TPO-RA (ROM, n=54; ELT, n=67) and maintained this therapy for a median time to collection of data of 35.2 months (1 to 67.3 months). The median age at diagnosis of elderly and younger cohorts was respectively 75 years (66-96 years), and 48 years (19-65 years). Older age was associated with a previous history of vascular events (VE) (P=0.049), with more patients receiving antithrombotic therapy (P=0.001), and with a non-significant trend towards increased risk of current VE under TPO-RA therapy (Table). During treatment, 15 patients experienced 17 VE (9 arterial, 8 venous); no association was found between risk for VE in patients under TPO-RA and past history of thromboembolic or ischemic events (P=0.727). Patients that were offered TPO-RA at younger ages presented at diagnosis with significantly lower platelet counts, and increased cumulative bleeding score (Page et al, 2007) (P=0.003, and P=0.034) than elderly ones. Younger patients also had significantly higher visceral bleeding rates at the onset of TPO-RA therapy (P=0.042) and had increased requirement for hospital care (emergency treatment or hospital admission) both six months before and after the start of TPO-RA (P=0.016, and P=0.002, respectively). Older age was associated with comorbidities such as hypertension and diabetes (P65 years (P=0.028), although the proportion of patients that achieved therapy free response (TFR) (platelet count 〉50x109/l for at least 6 months) upon discontinuation was similar in both groups (Table). Conclusion. The management of older patients with chronic ITP is still challenging, and widespread effort is made to avoid potential complications such as those related to splenectomy. Our study reflects that the introduction of TPO-RAs has caused a change in the outcomes of these patients. The increased awareness of the unfavorable conditions that are present in this population induces a preferential use of TPO-RAs in elderly patients with a lower bleeding history than in younger patients. Although these drugs associate with a potential risk of increased thrombotic risk, our data indicate that past thrombotic history does not predispose to the development of VE; rather neoplasia in elderly patients, and splenectomy at younger ages are factors that increase the likelihood to suffer from these events. The compromise towards effective therapies in these fragile patients associates with low discontinuation of TPO-RA to test for TFR, although once tapered off, sustained platelet responses are similar to those in younger patients. Disclosures Mingot-Castellano: Novonordisk: Consultancy; Sobi: Consultancy; Amgen: Consultancy; Takeda: Consultancy; Bayer: Consultancy; CSL Behring: Consultancy; Roche: Consultancy; Novartis: Consultancy. Jarque:Abbie: Consultancy, Speakers Bureau; Alexion: Consultancy, Speakers Bureau; Amgen: Consultancy, Speakers Bureau; Bristol-Myers Squibb: Consultancy, Speakers Bureau; Celgene: Consultancy, Speakers Bureau; CellTrion: Consultancy; Gilead: Consultancy, Speakers Bureau; Grifols: Consultancy; Janssen: Consultancy, Speakers Bureau; MSD: Consultancy, Speakers Bureau; Novartis: Consultancy, Speakers Bureau; Pfizer: Consultancy, Speakers Bureau; Roche: Consultancy, Speakers Bureau; Servier: Speakers Bureau; Shionogi: Consultancy, Speakers Bureau; Shire: Consultancy, Speakers Bureau; Takeda: Consultancy, Speakers Bureau. Campos:Novartis: Speakers Bureau; Amgen: Speakers Bureau. Lopez Fernandez:Amgen: Consultancy, Speakers Bureau. Valcarcel:MSD: Consultancy, Honoraria, Speakers Bureau; Astellas: Consultancy, Honoraria, Speakers Bureau; JAZZ: Consultancy, Honoraria, Speakers Bureau; Pfizer: Consultancy, Honoraria, Speakers Bureau; Celgene: Consultancy, Honoraria, Speakers Bureau; Novartis: Consultancy, Honoraria, Speakers Bureau; Amgen: Consultancy, Honoraria, Speakers Bureau. Casado:Amgen: Consultancy, Speakers Bureau; Novartis: Consultancy, Speakers Bureau. Álvarez Roman:Takeda: Research Funding; Amgen: Consultancy, Speakers Bureau; Novartis: Consultancy, Speakers Bureau; Bayer: Consultancy, Speakers Bureau; Pfizer: Consultancy, Speakers Bureau; Roche: Consultancy, Speakers Bureau; CSL Behring: Consultancy, Speakers Bureau; NovoNordisk: Consultancy, Speakers Bureau; Sobi: Consultancy, Speakers Bureau.

Description: Background . In clinical practice, tapering off thrombopoietin receptor agonists (TPO-RA) in immune thrombocytopenia (ITP) is considered if therapy is no longer needed due to a decrease in the disease activity favoring sustained treatment-free responses (TFR). To date, there are no predictors to identify when this approach is likely to be successful, other than earlier start of TPO-RA, and robust platelet responses. Aim. To evaluate clinical predictors of TFR in a real-world cohort of ITP patients treated with TPO-RA by dealing with confounding variables that could be minimized at the stage of the analysis. Methods. In this retrospective, multicenter study from 19 secondary and tertiary Spanish hospitals, patients aged 〉18 years with chronic ITP who had initiated TPO-RA (eltrombopag [EPG] or romiplostim [ROM]) between January 2012 and December 2014 were included. Data were collected from medical records (November 2016 to January 2018) on patient characteristics, history of disease and previous therapies, TPO-RA administration, response and discontinuation. Results. A total of 82 patients with a median age of 63 years (range 19-90 years), 59.9% females initiated TPO-RA (ROM, n=37; EPG, n=45). The median time from diagnosis of ITP to therapy with TPO-RA was 5.5 years (1.1-50.3 years). In all cases the TPO-RA was started with intention to treat indefinitely; the median initial doses of EPG were 350 mg/week (175-525 mg/week), and those of ROM 2.0 μg/kg/week (1.0-7.0 μg/kg/week). The median time on TPO-RA treatment was 2.9 years (0.1 to 5.6 years), and the median follow-up from start of TPO-RA until collection of data was of 3.9 years (1.3 to 5.6 years). A total of 29 patients (35.4%) switched TPO-RA during follow-up. The most frequent cause for switching was lack of efficacy (44.8% of cases -in all cases the initial TPO-RA was EPG-). Due to switching, 58 patients received ROM, and 53 were treated with EPG, yielding 122.3, and 100.8 patient-years of total exposure, respectively. During follow-up almost one half of the patients (47.6%, n=39) stopped TPO-RA. After a median of 1.4 years (0.1-3.3 yrs) under TPO-RA treatment, 19 patients (23.2% of the whole cohort) maintained TFR defined as platelet counts 〉50x109/l for a median follow-up of 2.8 years (1.5-4.4 years) in the absence of any platelet increasing drug. Remarkably, while the specific TPO-RA that was discontinued did not influence the probability to achieve TFR (P=0.582), there was a trend towards receiving ROM as first TPO-RA and attaining sustained responses (P=0.073), while switching TPO-RA negatively predicted TFR (P=0.010). In univariate analysis with logistic regression, switching TPO-RA was associated with a 6.4 risk of not achieving TFR (P= 0.019). The overall comparison of the Kaplan-Meier curves indicated an association (log-rank P=0.041) among the initial TPO-RA that was prescribed and the probability of TFR (Fig 1A), but the estimated median time to achieve TFR was not reached for either TPO-RA. When switching and initial TPO-RA were considered, patients receiving ROM and not experiencing switching were the best performing group in terms of achieving TFR; the median time to taper off the drug and sustain platelet responses was 3.3 years (95% CI 2.7-4.0 years) (Fig. 1B). Conclusion. In this observational research analysis, we have tried to minimize the possible bias of some studies that could mistakenly attribute TPO-RA induced TFR, when in fact it may be the natural course of the underlying disease. By analyzing a group of chronic ITP patients with a particularly poor baseline prognosis (median time from diagnosis 5.5 years) we address potential confounding variables by disease severity. Our data show that assuring that long duration under TPO-RA therapy is provided (median of 3.3 years), one half of chronic ITP patients treated with ROM and not undergoing switching can achieve TFR. Disclosures Mingot-Castellano: Roche: Consultancy; Bayer: Consultancy; Novartis: Consultancy; Takeda: Consultancy; Sobi: Consultancy; Amgen: Consultancy; Novonordisk: Consultancy; CSL Behring: Consultancy. Jarque:Abbie: Consultancy, Speakers Bureau; Alexion: Consultancy, Speakers Bureau; Janssen: Consultancy, Speakers Bureau; Grifols: Consultancy; Gilead: Consultancy, Speakers Bureau; CellTrion: Consultancy; Celgene: Consultancy, Speakers Bureau; Bristol-Myers Squibb: Consultancy, Speakers Bureau; Amgen: Consultancy, Speakers Bureau; Servier: Speakers Bureau; Roche: Consultancy, Speakers Bureau; Pfizer: Consultancy, Speakers Bureau; Novartis: Consultancy, Speakers Bureau; MSD: Consultancy, Speakers Bureau; Takeda: Consultancy, Speakers Bureau; Shire: Consultancy, Speakers Bureau; Shionogi: Consultancy, Speakers Bureau. Campos:Novartis: Speakers Bureau; Amgen: Speakers Bureau. Lopez Fernandez:Amgen: Consultancy, Speakers Bureau. Casado:Amgen: Consultancy, Speakers Bureau; Novartis: Consultancy, Speakers Bureau. Álvarez Roman:Amgen: Consultancy, Speakers Bureau; Novartis: Consultancy, Speakers Bureau; Bayer: Consultancy, Speakers Bureau; Pfizer: Consultancy, Speakers Bureau; Roche: Consultancy, Speakers Bureau; CSL Behring: Consultancy, Speakers Bureau; Sobi: Consultancy, Speakers Bureau; Takeda: Research Funding; NovoNordisk: Consultancy, Speakers Bureau.

Description: Background The high inter-individual variability in pharmacokinetics (PK) of factor VIII (FVIII) justifies the use of PK-guided prophylaxis, especially in switching between different products. A proposed definition of extended half-life (EHL) FVIII requires improvements of at least 1.3 times in half-life (t1/2) and 1.25 times the area under the curve (AUC) compared to standard half-life (SHL) products (Mahlangu et al. Haemophilia. 2018;24(3):348-358). The objective of this multicenter study was to analyze the results of a PK-guided switch from SHL to EHL in patients with hemophilia A (HA). Methods Multicenter comparative, cross-sectional, prospective study in HA severe/moderate patients in prophylaxis analyzing PK differences after switch from SHL to EHL (efmoroctocog alfa [rFVIII-Fc] and rurioctocog alfa pegol [PEG-rFVIII]). WAPPS-Hemo® was used to analyze PK parameters with 2-3 samples: t1/2; AUC, peak level (PL); trough level at 24, 48 and 72 h (TL24, TL48, TL72); and time to reach FVIII levels of 1, 2, 5% (T1%, T2%, T5%). We have also compared the ratio of t1/2 and AUC, the number of weekly doses and the dose/kg/week before and after the switch. Wilcoxon and Kruskal-Wallis tests (SPSS®) were used to compare the PK parameters. Results are expressed with the median and interquartile range (IQR) or range, and mean and standard deviation (SD). Results Eighty-one patients from 8 Spanish hospitals were analyzed (61 rFVIII-Fc; 20 PEG-rFVIII), 78 had severe HA and 3 moderate HA. Mean age was 30 years (range=3-64) and no differences in weight were observed between both periods [70 (range=12-116) vs 70 (13.7-116) kg; p=0,141]. Dose/kg/week and weekly infusion frequency were reduced after the switch to EHL, and significant improvements were observed in all PK parameters after the change from SHL to EHL (Table 1). These results were similar in adult and pediatric patients switching to rFVIII-Fc. The median ratios of t1/2 and AUC were 1.3 (IQR:1.2-1.6) and 1.5 (IQR:1.3-2.3) in the entire cohort. These results were reproduced in the subset of patients with ≥12 years treated with rFVIII-Fc and PEG-rFVIII (ratio t1/2: 1.4 [IQR:1.3-1.6]; ratio AUC: 1.6 [IQR:1.3-2.3]), and were slightly in the cohort of 15 patients

Description: The World Health Organization has warned that, in children, the second cause of death from unintentional injuries are falls. The objective of this study was to analyze the motor response of primary schoolchildren when a backwards fall occurs. These analyses occurred before and after interventions of the Safe Fall program, which aims to teach safe and protected ways of backward falling. A quasi-experimental research design was used, with a sample of 122 Spanish (Sevillian) schoolchildren in the 10–12 age bracket. The INFOSECA ad-hoc observation scale was used for data collection: this scale registers 5 essential physical reactions throughout the process of a safe and protected backwards fall. After that, a number of descriptive, correlational and contrast statistics were applied. The value used in the McNemar test to establish statistical significance was p 〈 0.05. Results showed that over 85% of students had developed the competence to correctly perform all five physical motions that allow for a safer backward fall. The teaching of safe and protected techniques for falling backwards in child population in Primary Education is possible through the implementation of the Safe Fall program in Physical Education classes, which can help making falls safer, diminishing the risk and severity of the injuries they cause.

Description: Very few data exist on when a particular thrombopoietin-receptor agonist (TPO-RA) is favored in clinical practice for the treatment of patients with immune thrombocytopenia (ITP), about novel risk factors for vascular events (VE) with these drugs, nor about predictive factors for therapy free responses (TFR). We conducted an observational, retrospective, long-term follow-up multicenter study from November 2016 to January 2018 of 121 adult ITP patients initiating TPO-RA between January 2012 to December 2014. Data reflected that a platelet count ≤25 × 109/l at the time when the TPO-RA was initiated was associated with a 2.8 higher probability of receiving romiplostim vs. eltrombopag (P = 0.010). VE on TPO-RA was related to previous neoplasia in patients over 65 years (50% vs. 2.2%, P