THU0415 MELTING OF TOPHI WITH LOCAL STEROIDS IN CHRONIC TOPHACEOUS GOUT: AN OBSERVATIONAL STUDY

Background:Chronic tophaceous gout is usually difficult to treat with urate lowering therapy (ULT) [1]. Faster resolution of tophi has been seen with use of pegloticase [2], but this drug is costly and not widely available. Local steroid use is recommended in acute gouty arthritis but its role in reduction of tophi has not been studied. This study was aimed to see the effect of local steroids in tophi resolution.Objectives:To study the change in size of gouty tophi with local steroid injection compared to conventional treatment.Methods:Four crystal proven chronic tophaceous gout patients with multiple tophi were screened and enrolled in the study after taking informed consent. Total 12 tophi in 4 patients were imaged by using Duel Energy Computed Scan (DECT) for their size and volume. All 4 patients were treated with ULT as per recommended dose to achieve target serum uric acid (SUV) level. Six tophi were treated with local steroids injection (methylprednisolone acetate) at two months interval till complete resolution of tophi. Dose of steroid varied from 10 mg to 40 mg depending upon tophi size but subsequent repeat doses were same in each tophi. Six tophi not treated with local steroid served as internal control in the same patients. All 4 patients were followed up regularly in out-patient department to monitor treatment response and local side effects if any.Results:All 4 patients achieved target SUV (&lt;356 µmol/L) at three months of follow up. Six tophi which were treated with local steroids injection clinically had marked reduction in size at 7-12 months of follow up [Table-1], while other 6 tophi which served as internal control had no clinically significant change in size and volume of tophi. DECT was repeated in the same settings to confirm the clinical findings. DECT revealed near complete resolution of 5 tophi [Image-1], and 50% reduction in size of one tophi. Six tophi which were not treated with local steroid had no significant reduction in size in DECT as well. Only side effect noted was skin discoloration in 5 out of 6 injected sites, none of the tophi had infection.Conclusion:Interestingly this is the first such study to document the use of local steroid in tophi. Thus intralesional steroids can be alternative to pegloticase or surgery where faster dissolution of tophi is required. This observation needs to be explored in large number of patients to calculate the total dose requirement of steroid as per volume and urate burden of tophi. Possible explanation of melting tophi with steroids is breaking down outer fibrous layer of tophi by local steroids which might be acting as barrier in dissolution of urate crystals with ULT.References:[1]Dalbeth N, House ME, Horne A et al. Prescription and dosing of urate-lowering therapy, rather than patient behaviours, are the key modifiable factors associated with targeting serum urate in gout.BMC Musculoskelet Disord2012;13:174[2]Baraf HS, Becker MA, Gutierrez-Urena SR, et al: Tophus burden reduction with pegloticase: results from phase 3 randomized trials and open-label extension in patients with chronic gout refractory to conventional therapy. Arthritis Res Ther 15:R137, 2013Table 1.Age/sexTotal TophiTreated TophiOutcome of treated tophiInternal control tophiDuration in monthsCase 122/M21Near complete resolutionNo Change 7Case 245/F11Complete resolutionNA 8Case 358/M52Near complete resolutionNo change12Case 424/M42Completely resolved=1,50% size reduction=1No change12Figure 1a: DECT of Rt foot shows urate crystal deposition at 1stMTP joint and 5thtoe. Figure1b: DECT after 7 months of steroid injection in Rt 1stMTP joint tophi shows almost complete resolution but no change in 5thtoe tophi (served as internal control).Disclosure of Interests: :None declared</jats:sec

Prioritizing Industry 4.0 Technologies (I4.0T) through an Interpretive Ranking Process (IRP): A Design and Manufacturing Perspective

In the competitive business environment, industries are searching for new manufacturing techniques to develop quality products and to enhance their productivity and value addition by eliminating wastage. Industry 4.0 (I4.0) is a new paradigm that integrates different digital technologies in manufacturing and industrial organizations. It addresses the challenges of increasing complexity through modernization and automation of processes, thereby improving the performance and competitiveness. Therefore, these technologies have to be prioritized in order to realize their adoption depending on the process and type of organization/industry. In present work, seven different I4.0 technologies identified from literature and inputs from researchers and industrial experts are prioritized using Interpretive Ranking Process (IRP) technique with reference to the measurable performance indicators (PI) via a cross-interaction matrix. Further, to validate the ranks, a dominance system graph and net dominance system are used. The developed model provides the analytic thinking behind the dominant relationship of different technologies. The result reveals that Cyber-Physical Systems, 3D Printing, and the Internet of Things are the top three technologies influencing and playing crucial roles in implementing the I4.0 paradigm. The ranking indicates that CPS blends computational and physical processes for real data extraction, 3D printing/Additive manufacturing can minimize lead time and manufacturing cost, while the IoT competences of an organization makes their business operations more agile and integrated using information and communication. Consequently, these technologies may serve as the cornerstone for the successful implementation of the I4.0 concept in any project. The other techniques are equally important but not as critical as these three. The study presents a unique contribution by ranking the technologies, providing a roadmap for managers, academicians, and researchers interested in practising these emerging technologies and their effectiveness for proper adoption and successful implementation at their workplace, which are highly relevant to meeting their objectives

Influence of Crystal Structure on Thermo-Mechanical Properties of Injection Molded 𝛃-Nucleated iPP

Abstract Isotactic polypropylene (iPP) was nucleated in-situ with calcium pimelate during melt compounding. Calcium pimelate is a highly effective β-nucleator for isotactic polypropylene (iPP). The β-nucleated iPP was characterized by wide angle x-ray diffraction (WAXD) and differential scanning calorimetry (DSC) for its crystallinity and crystal structure. In addition, the injection-molded samples were tested for thermo-mechanical properties. It is found that very low quantity (&lt; 0.1 wt. %) of β-nucleator is required to produce sufficiently high β-crystal fraction (Kβ) in isotactic polypropylene. β-nucleated iPP shows increment of 11 to 14 °C in its heat deflection temperature (HDT). It was also observed that slow cooling rate of β-nucleated iPP promotes the formation of β-crystals and that tensile stretching leads to complete transformation of β crystals into a-crystals at room temperature. It was also revealed that the presence of maleic anhydride grafted polypropylene (PP-g-MA), a well-known coupling agent (or compatibilizer), may reduce the (Kβ) value to a marginal extent. It was also observed that the thermo-mechanical properties were not much affected by the presence of PP-g-MA. Therefore, calcium pimelate may be used as β-nucleator in case of neat as well as reinforced polypropylene containing maleic anhydride as coupling agent.</jats:p