In contrast to earlier reports, we found that Enterococcus has emerged as the most frequently isolated microorganism from bile. The importance of enterococcal infection should be recognized, and currently recommended antibiotics need to be re-evaluated since in our bile cultures most provided inadequate coverage for the more frequently encountered microorganisms. The changes in the trends of microorganisms isolated from bile should be considered in cases where patients present with biliary obstruction.

Objectives: To determine accuracy of ultrasound (US) in classifying placental cord insertion (PCI) site in multiple gestations at a tertiary care center. Methods: A retrospective study of multiple gestations delivered from 2/2003 to 7/2009 was performed. Data included gestational age (GA) at PCI identification, use of in-vitro fertilization (IVF), and PCI characterization by both US and pathology. The distance from PCI to placental edge was measured. To correlate US with pathology data, PCI was classified as central/eccentric, marginal (≤ 1 cm from placental edge), or velamentous (into membranes). Statistical analysis was performed with Chi-square comparison amongst categorical variables. US images were reviewed in discordant cases to determine causality. Results: Twins and triplets were analyzed. 638 fetuses (302 pregnancies) met criteria. Mean GA at PCI evaluation was 20.9 wks, median 19.0. Using pathology results as gold standard, US correctly identified PCI as central/eccentric, marginal, or velamentous in 69.3% (P < 0.01). US was more accurate for diamniotic-dichorionic twins (73.8% of 382) than diamniotic-monochorionic (59.4% of 155, P = 0.002). US correctly classified 97.5% of central/eccentric, 8.5% of marginal, and 6.1% of velamentous PCIs (438, 118, and 82 cases). Conversely, pathology confirmed US diagnosis of central/eccentric in 71.4%, marginal in 32.3%, and velamentous in 11.1% (of 598, 31, and 9). Comparing normal (central/eccentric) to abnormal (marginal/velamentous), US was less accurate in identifying abnormal (7.5% of 200) than normal (97.5% of 438) PCIs (P < 0.01); no difference was seen for twins (71.9% of 549) vs. triplets (73.5% of 89, P > 0.05). No difference was found in occurrence of velamentous PCI in IVF vs. non-IVF cases (12.5% for both). Conclusions: US classification of PCI was often inconsistent with pathological results in multiple gestations. Discrepant cases were evaluated and suggest evolution/peripheral infarction of the placenta with apparent evolution of the PCI in many instances.

BackgroundHigh transmissibility and immune evasion of SARS-CoV-2 Omicron variant made it dominant variant worldwide since January 2022. Before Omicron era, several studies demonstrated that autoimmune inflammatory rheumatic disease (AIIRD) patients were vulnerable to COVID-19 infection compared to general population. However, there is a lack of epidemiologic data regarding COVID-19 outbreak in patients with AIIRD in Omicron era.ObjectivesTo identify incidence rate, hospitalization rate and potential risk factors for COVID-19 outcomes in AIIRD patients during Omicron outbreak.MethodsThis study was a prospective longitudinal study from January 1 to October 31, 2022. We included patients who visited rheumatology outpatient clinic in a nationwide, tertiary referral center in South Korea. Included patients were classified into two groups (AIIRD and non-AIIRD groups) based on underlying disease. Vaccination and infection history of COVID-19 were obtained through self-report via questionnaire and data from Korea Disease Control and Prevention Agency (KDCA). Main outcome of this study was an incidence of COVID-19 infection during the observation period. Clinical factors associated with the incidence of COVID-19 infection were investigated using Cox proportional hazard model. In the final multivariable model, clinical factors that showed a relevant association (P < 0.1) with the outcome in the univariable analysis were included as covariates.ResultsA total of 1,814 patients were analyzed (AIIRD group: 1,535, non-AIIRD group: 279). The COVID-19 incidence in AIIRD group (47.6%) was higher than that reported in general population of South Korea (43.9%) and this trend was prominent in those aged < 70 years. Longitudinal change in COVID-19 incidence during the observation period showed two peaks in March and August in both groups, which was the same trend with general population. There were 30 cases of hospitalization due to COVID-19 infection, with the rate was comparable between AIIRD and non-AIIRD groups (1.7% vs. 1.5%, P = 0.970). The incidence rate of COVID-19 in the AIIRD group was comparable to that in the non-AIIRD group (47.6% vs. 44.8%, P = 0.386). In the AIIRD group, COVID-19 infection occurred less frequently in patients with old age (≥70 years) and those receiving glucocorticoid treatment. Other clinical factors such as use of DMARDs and biologics, and underlying diseases were not associated with COVID-19 incidence in the multivariable analysis. Of note, at least one COVID-19 vaccination did not lower its incidence (unadjusted HR 1.06 [95% CI 0.82-1.38]). Although patients who received booster vaccination were less likely to be infected with COVID-19 (unadjusted HR 0.79 [0.68-0.92]), this protective effect was significant only in patient younger than 70 years (Figure 1).ConclusionDuring the Omicron outbreak in South Korea, incidence of COVID-19 infection in patients with AIIRD and non-AIIRD was comparable. Immunomodulatory agents and specific rheumatic diseases did not increase the COVID-19 incidence, and booster vaccination against COVID-19 decreased the infection only in patients younger than 70 years.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

Background:Interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH) are major causes of death in systemic sclerosis (SSc). Six-minute-walk test (6MWT) is a standard outcome measure for exercise capacity in cardiopulmonary diseases. However, the results of 6MWT may not reflect real cardiopulmonary function of SSc patients in whom musculoskeletal system is frequently inflicted.Objectives:This study aimed to evaluate the clinical utility of breath-holding test (BHT) in evaluating cardiopulmonary function in SSc patients, as compared with 6MWT.Methods:Seventy-two patients with SSc were prospectively enrolled and underwent BHT and 6MWT with measurement of Borg score and Scleroderma Health Assessment Questionnaire (SHAQ). Data on diffusing capacity for carbon monoxide (DLCO, %), forced vital capacity (FVC, % and liters), and ejection fraction and pulmonary arterial systolic pressure (PASP) measured by transthoracic echocardiography (TTE), were also collected. For BHT, participants were required to make a maximum expiration followed by a maximum inspiration and to hold the breath as long as possible at maximum inspiratory level. This procedure was repeated three times, with 5-minute intervals. 6MWT was performed according to the American Thoracic Society guidelines. Pearson’s correlation test was applied to demonstrate the relationship between BHT results and each clinical parameter.Results:Among 72 (66 female) patients, mean (SD) age was 57.1 (11.1) years, modified Rodnan skin score 10.6 (10.5), SHAQ 0.64 (0.61) and 6MWT distance 473.5 (95.5) m. Mean BHT time was 35.05 (14.90) sec at the first time, 38.92 (16.14) sec at the second time, and 41.11 (17.71) sec at the third time. The BHT time showed a statistically significant negative correlation with Borg scale (pre-test, r = -0.336, p = 0.002; post-test, r = -0.252, p = 0.034; Figure 1 and Table 1), while 6MWT showed a negative correlation with only post-test Borg scale (pre-test, r = -0.113 p = 0.343; post-test, r = -0.351 p = 0.002; Table 1). The BHT time was positively correlated with DLCO (%, r = 0.409, p < 0.001) and FVC (liters, r = 0.402, p < 0.001) (Table 1). We also found a statistically significant correlation between BHT time and SHAQ score (r = -0.451, p < 0.001; Table 1). However, EF and PASP by TTE showed no significant relationship with BHT time (EF, r = -0.108, p = 0.374; PASP, r = -0.246, p = 0.054; Table 1).Table 1.Pearson’s correlation coefficients (r) for the relation between BHT and clinical parameters in comparison to 6MWT.Pre-test Borg scalePost-test Borg scaleDLCO(%)FVC(L)FVC(%)FVC/DLCOEF(%)PSAP(mm Hg)SHAQ (score)BHT (sec)-0.366**-0.252*0.409***0.402**0.191-0.244***-0.108-0.246-0.451***6MWT (m)-0.113-0.351**0.297*0.321**0.063-0.250*0.137-0.354**-0.531***BHT, breath-holding test; 6MWT, 6-minute-walk test; DLCO, diffusing capacity for carbon monoxide; FVC, forced vital capacity; EF, ejection fraction estimated by transthoracic echocardiography; SHAQ, Scleroderma Health Assessment Questionnaire.* p < 0.05, ** p < 0.01, *** p < 0.001Figure 1.Association of Borg dyspnea scale with breath-holding time.Conclusion:The BHT is a simple, safe, and less time-consuming test, reflective of pulmonary parameters and SHAQ, as compared with 6MWT. Our results suggest that the BHT might be a useful surrogate marker of cardiopulmonary capacity in SSc patients.References:[1]Villalba WO, Sampaio-Barros PD, Pereira MC, Cerqueira EM, Leme CA, Jr., Marques-Neto JF, et al. Six-minute walk test for the evaluation of pulmonary disease severity in scleroderma patients. Chest. 2007;131(1):217-22.[2]Garin MC, Highland KB, Silver RM, Strange C. Limitations to the 6-minute walk test in interstitial lung disease and pulmonary hypertension in scleroderma. J Rheumatol. 2009;36(2):330-6.[3]Barnai M, Laki I, Gyurkovits K, Angyan L, Horvath G. Relationship between breath-hold time and physical performance in patients with cystic fibrosis. Eur J Appl Physiol. 2005;95(2-3):172-8.Acknowledgements:This study would not have been possible without help from research assistant, Sung-Soon Cho.Disclosure of Interests:Jina Yeo: None declared, Mi Hyeon Kim: None declared, Jun Won Park: None declared, Jin Kyun Park: None declared, Eun Bong Lee Consultant of: Pfizer, Grant/research support from: GC Pharma and Handok Inc.

Objectives:To assess the efficacy of prenasal thickness measurements on second trimester ultrasound examination in prenatal prediction of Down syndrome fetuses. Methods: Prenasal thickness was measured from stored fetal profile images during 16-24 week second trimester scans. Images from 115 women with normal fetuses and 15 women with Down syndrome were included. Prenasal thickness was measured as the shortest distance from the anterior edge of the lowest part of the frontal bone to the skin. Delta values for each gestational week for prenasal thickness were calculated for statistical analysis. Results: In the normal group prenasal thickness increased with gestation (prenasal thickness = −28.747 + (2.254 × GA, R2, P < 0.01). There was a statistically significant increase in the mean prenasal thickness measurement in Down syndrome fetuses. The prenasal thickness measurement was above the 95 th centile in 66.7% (10/15) of all Down syndrome cases, including 4 of 5 with an absent nasal bone and 6 of 10 with a nasal bone length above 2.5 mm. Conclusions: Prenasal thickness is increased in fetuses with Down syndrome as compared to normal fetuses. Prenasal thickness may be an additional predictor for Down syndrome on the second trimester ultrasound. Objectives: To determine if sonographic dimensions of the facial profile on a population of fetuses with absent nasal bone, differs from the normal population. Methods: 16 fetuses with absent nasal bone and with an adequate volume dataset of the fetal profile where included in the study. After a multi-planar manipulation to obtain a mid sagittal plane of the profile, 3 different operator measured the distance between the tip of the nose and the mouth (A), between the mouth and the gnathion (B), between the upper philtrum and the mouth (a) and between the mouth and the upper concavity of the chin (b), as recently reported by Goldstein et al, 2010. The values were plotted between the reported confidence limits, analyzing its percentage of distribution when it was corresponding or not to trisomy 21 (T21). Prenasal thickness was also measured. Wilcoxon non parametric test was used to determine differences between groups of measurement. Results: 2 cases were excluded (gestational age more than 26+6 weeks). The mean gestational age of the remaining was 21+3 (range, 18+2-26+5). 10/14 (71.5%) were carriers of T21 and the remaining were fetuses with normal karyotype. The A, B and (a) measurements were registered between the reported intervals of confidence, without statistical differences between both groups of fetuses with/without nasal bone. 60% of the fetuses with T21 had (b) measurement below the interval of confidence. The same measurement, on normal karyotype/absent nasal bone fetuses, were in the normal interval. Concordance between the three operators was found for the measurements, particularly (b). Mean prenatal thickness was 6.26 (T21) and 3.9 mm (non T21). OP09.06 Conclusions:Although the sample is small and ideally must be compared with our own population of healthy fet...