Propranolol treatment was safe in our patients who did not show signs of perfusion changes. The high sensitivity for detecting functional impairment makes brain perfusion SPECT useful in the diagnosis and follow-up of patients with PS considered at risk of neurovascular impairment. Accurate knowledge of its pathophysiological basis, together with the appropriate technique and careful interpretation of reporting, will enhance the clinical use of brain SPECT in those patients.

LT is a realistic option to treat CF-related ESLD children. IDD is common in these patients. En bloc liver-pancreas transplantation is an appealing option, since it simultaneously restores exocrine function and prevents IDD. This procedure has clear technical advantages over simultaneous isolated liver and pancreas transplantation.

The study objectives were to analyze the changes in exhaled carbon monoxide (COex) induced by histamine provocation challenge in asthmatic patients and to evaluate the relationship between COex and airway sensitivity and reactivity. Levels of COex were measured in 105 nonsmoking mildly asthmatic subjects before and after histamine provocation challenge. Dose-response curves were characterized by their sensitivity (PD20) and reactivity. Dose-response slope (DRS), continuous index of responsiveness (CIR), and bronchial reactivity index (BRI) were determined as reactivity indices. Bronchial challenge was positive for 47 subjects and negative for 58. The COex levels rose significantly after bronchial challenge in the positive response group (4.49 +/- 0.4 vs. 5.74 +/- 0.57 ppm, p = 0.025) and in the negative response group (2.84 +/- 0.25 vs. 4.00 +/- 0.41 ppm, p = 0.000). An inverse relation between basal COex and PD20 was found (r = -0.318, p = 0.030). In all subjects, a proportional direct relationship between COex and DRS (r = 0.214, p = 0.015), CIR (r = 0.401, p = 0.000), and BRI (r = 0.208, p = 0.012) was observed. On stepwise multiple linear regression analysis, COex only significantly correlated with CIR (multiple r2 = 0.174, p = 0.000). In conclusion, exhaled CO determination is a noninvasive inflammatory marker of the respiratory tract, which shows an acceptable association with airway hyperresponsiveness.

We examined the usefulness of some bronchial reactivity indices to identify bronchial asthma in patients with airway hyperresponsiveness. Eighty-eight consecutive patients with positive response to histamine bronchial challenge (> or = 20% fall in FEV1) were included in the study. Dose-response curves were characterised by their sensitivity (PD20) and reactivity. Dose-response slope, continuous index of responsiveness (CIR) and bronchial reactivity index (BRI) with respect to baseline and post-diluent baseline values were determined as reactivity indices. The clinical diagnosis remaining in the case history 2 years after the bronchial challenge was considered the definitive diagnosis. Asthmatic patients had higher baseline BRI (12.121+/-0.412 vs. 11.615+/-0.201; P<0.001) and post-diluent baseline BRI (12.054+/-0.368 vs. 11.563+/-0.531; P = 0.003) than other subjects. Area beneath their receiver operating characteristic (ROC) curve was 82.68% (standard error: 0.77) for the baseline BRI and 81.73 (standard error: 0.76). By multiple logistic regression analysis, baseline BRI was the only independent variable identified as a predictor for diagnosis of bronchial asthma (r = 0.387, P = 0.0007). A cut-off of 11.76 for baseline BRI reached an 87.2% sensitivity and an 80% specificity for bronchial asthma diagnosis. In conclusion, BRI calculated with respect to baseline FEV1 should be useful in identifying asthmatic patients among subjects with airway hyperresponsiveness.

Background:Musculoskeletal manifestations (MEM) are frequent extraintestinal symptoms in patients suffering from inflammatory bowel disease (IBD), affecting up to 40% of them. Tumor necrosis factor inhibitors (TNFi) are effective in both IBD and IBD-related spondylarthritis (SpA). Additionally, vedolizumab (VDZ), an α4β7 integrin inhibitor with selective action on intestinal tissue, has been recently proposed as 1st line treatment on TNFi refractory IBD. The effectiveness of VDZ in MEM has not been properly evaluated but even exacerbation of previously diagnosed SpA has been described.Objectives:The main objective is to analyse the occurrence of articular exacerbations in patients with IBD-related SpA treated with VDZ. The secondary objective is to analyse the new-onset MEM in IBD patients treated with VDZ.Methods:Descriptive study of a retrospective cohort of every adult with IBD (Crohn’s disease -CD- and ulcerative colitis -UC-) patients starting treatment with VDZ in a tertiary hospital. All data were collected as a collaboration between the Rheumatology and Gastroenterology Departments, through revision of the clinical history and databases from both departments. In patients previously diagnosed of SpA exacerbation was assessed, defined as a clinical worsening causing a treatment modification. The patients with new-onset MEM were classified as: i) nonspecific arthralgia (NsA), not suggestive of SpA; and ii) SpA according to ASAS criteria. A statistical analysis was performed using frequency chartsResults:A total of 61 patients were included, 55.7% women and with an mean (SD) age of 50 (17) years. The proportion of UC and CD was similar (49% and 51%, respectively). Among the patients studied, 12 (19.7%) had a diagnosis of IBD-related SpA and 3 (25%) of them suffered articular exacerbation of SpA within 3,5 and 6 months of treatment. On the other hand, 9 (14.7%) patients showed new-onset MEM, 3 (33%) of them showed symptoms and clinical and/or radiological findings compatible with axial SpA. In 2 of the cases a treatment with a cDMARD was used and the other one required a combination therapy between iTNF and VDZ. The remaining 6 (67%) patients were classified as NsA and inflammatory arthritis was discarded. Table 1 shows the demographic and clinical characteristics of patients included in the analysis.Table 1.Demographic, clinical characteristics and symptoms onset in patients included in the study.Total (n=61)Diagnosed SpA (n=12New-Onset MEM (n=9)Stable (n=9)Exacerbation (n=3New-onset SpA (n=3)NsA (n=6)Age (years), mean ± SD50 ± 1755 ± 1950 ± 7.538 ± 1350 ± 14Gener (female), n (%)34 (55.7%)6 (66.7%)3 (100%)1 (33.3%)3 (50%)BMI (Kg/m2), mean ± SD24.7 ± 4.327.5 ± 5.528.3 ± 3.930.2 ± 0.524.3 ± 4.6Smoking habit (smokers), n (%)11 (18%)1 (11.1%)0 (0%)2 (66.7%)0 (0%)CD diagnosis, n (%)31 (50.8%)2 (22.2%)1 (33.3%)3 (100%)2 (33.3%)UC diagnosis, n (%)30 (49.2%)7 (77.8%)2 (66.7%)0 (0%)4 (66.7%)IBD follow-up, (years) mean ± SD11 ± 9.610.6 ± 102 (1-29) *12 ± 6.89.8 ± 4.6bDMARD naïve, n (%)7 (11.5%)2 (22.2%)0 (0%)0 (0%)0 (0%)*shown as median (range).Conclusion:Switching TNFi treatment to VDZ in patients with IBD-related SpA was found to be associated with articular exacerbation of SpA in 1 out of 4 patients within the first 5 months. New-onset MEM is also observed in up to 15% of patients with IBD treated with VDZ. A multidisciplinary assessment of these patients is necessary in order to achieve a proper management of their diseases.Disclosure of Interests:Pablo Rodríguez-Merlos: None declared, MARIA ANGELES RUIZ- RAMIREZ: None declared, Chamaida Plasencia: None declared, Victoria Navarro-Compán Consultant of: Abbvie, Lilly, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Lilly, Novartis, Pfizer, UCB, Cristina Suarez-Ferrer: None declared, Eduardo Martin-Arranz: None declared, Maria Dolores Martín Arranz: None declared, Diana Peiteado: None declared, Gemma Bonilla: None declared, María Sánchez Azofra: None declared, Joaquín Poza Cordón: None declared, Karen Nathalie Franco Gomez: None declared, Alejandro Balsa Grant/research support from: BMS, Roche, Consultant of: AbbVie, Gilead, Lilly, Pfizer, UCB, Sanofi, Sandoz, Speakers bureau: AbbVie, Lilly, Sanofi, Novartis, Pfizer, UCB, Roche, Nordic, Sandoz