Management of youth with suicidal ideation: Challenges and best practices for emergency departments

Suicide is a leading cause of death among youth, and emergency departments (EDs) play an important role in caring for youth with suicidality. Shortages in outpatient and inpatient mental and behavioral health capacity combined with a surge in ED visits for youth with suicidal ideation (SI) and self-harm challenge many EDs in the United States. This review highlights currently identified best practices that all EDs can implement in suicide screening, assessment of youth with self-harm and SI, care for patients awaiting inpatient psychiatric care, and discharge planning for youth determined not to require inpatient treatment. We will also highlight several controversies and challenges in implementation of these best practices in the ED. An enhanced continuum of care model recommended for youth with mental and behavioral health crises utilizes crisis lines, mobile crisis units, crisis receiving and stabilization units, and also maximizes interventions in home- and community-based settings. However, while local systems work to enhance continuum capacity, EDs remain a critical part of crisis care. Currently, EDs face barriers to providing optimal treatment for youth in crisis due to inadequate resources including the ability to obtain emergent mental health consultations via on-site professionals, telepsychiatry, and ED transfer agreements. To reduce ED utilization and better facilitate safe dispositions from EDs, the expansion of community- and home-based services, pediatric-receiving crisis stabilization units, inpatient psychiatric services, among other innovative solutions, is necessary.

Review of pediatric emergency care and the COVID-19 pandemic

The coronavirus disease 2019 (COVID-19) pandemic posed new challenges in health care delivery for patients of all ages. These included inadequate personal protective equipment, workforce shortages, and unknowns related to a novel virus. Children have been uniquely impacted by COVID-19, both from the system of care and socially. In the initial surges of COVID-19, a decrease in pediatric emergency department (ED) volume and a concomitant increase in critically ill adult patients resulted in re-deployment of pediatric workforce to care for adult patients. Later in the pandemic, a surge in the number of critically ill children was attributed to multisystem inflammatory syndrome in children. This was an unexpected complication of COVID-19 and further challenged the health care system. This article reviews the impact of COVID-19 on the entire pediatric emergency care continuum, factors affecting ED care of children with COVID-19 infection, including availability of vaccines and therapeutics approved for children, and pediatric emergency medicine workforce innovations and/or strategies. Furthermore, it provides guidance to emergency preparedness for optimal delivery of care in future health-related crises.

Characteristics of Sports-Related Injuries Presenting to a Pediatric Emergency Department

OBJECTIVE

Pediatric injuries associated with participation in sports are common. Understanding the epidemiology and trends of sports-related injuries is an important component of injury prevention efforts and is the objective of this study.

METHODS

A retrospective review of sports injuries presenting during the course of 1 year (2019) to the emergency department (ED) of Benjamin Russell Hospital for Children, a large academic children's hospital, was performed. Inclusion criteria focused on patients 18 years old and younger whose ED visit resulted from active participation in a sport. Cases were identified using International Classification of Diseases, Tenth Revision codes. Demographic data were collected and included sex, age, race, injury specifics (sport, location, type, and mechanism). Descriptive statistics were performed and categorical variables were analyzed using the χ2 test.

RESULTS

A total of 1333 injuries seen by the ED during 2019 were sports injuries. Most commonly, these injuries were associated with football (43%), basketball (36%), soccer (11%), or baseball (8%). Considering sports-related injuries, 428 (32%) patients were 12 years and younger and 905 (68%) were 12 years old and older. The median age was 13 years (interquartile range 4 years). Other demographic findings included male sex 1143/1333 (86%) and Black race 835/1333 (63%). School was the most common location for sports injuries (28%). When comparing injuries by age groups (younger than 12 vs 12 and older), football and baseball injuries were more common in those younger than 12 years (53% vs 38%, z = 5.2, P < 0.00001; and 14.0% vs. 5.6%, z = 4.9, P < 0.00001, respectively), whereas basketball and soccer injuries were more common in those 12 years and older (43% vs 22%, z = 7.4, P < 0.00001; and 11.4% vs 9.3%, z = 5.9, P < 0.00001, respectively). When comparing injuries by sex, football and baseball injuries were more common in males (49% vs 6%, z = 11.1, P < 0.00001; and 9.4% vs. 2.1%, z = 3.3, P < 0.00001, respectively), whereas basketball and soccer injuries were more common in females (59% vs 32%, z = 7.2, P < 0.00001; and 27% vs 8%, z = 7.8, P < 0.00001, respectively.

CONCLUSIONS

Sports injuries that are commonly encountered in the ED differ in age and sex. Basketball and soccer injuries were more likely to be encountered in older females, whereas baseball and football injuries were more likely seen in younger males. This may reflect efforts that have been previously focused on the sports considered to be higher risk, especially for concussive injuries. This information can help guide future preventive efforts provided by primary physicians, schools, and coaches.

Pulsed electrolysis - explained

Lately, there has been high interest in electrolysis under dynamic conditions, the so-called pulsed electrolysis. Different studies have shown that in pulsed electrolysis, selectivity towards certain products can be improved compared to steady-state operation. Many groups also demonstrated that the selectivity can be tuned by selection of pulsing profile, potential limits, as well as frequency of the change. To explain the origin of this improvement, some modeling studies have been performed. However, it seems that a theoretical framework to study this effect is still missing. In the present contribution, we suggest a theoretical framework of nonlinear frequency response analysis for the evaluation of the process improvement under pulsed electrolysis conditions. Of special interest is the DC component, which determines how much the mean output value under dynamic conditions will be different from the value under steady-state conditions. Therefore, the DC component can be considered as a measure of process improvement under dynamic conditions compared to the steady-state operation. We show that the DC component is directly dependent on nonlinearities of the electrochemical process and demonstrate how this DC component can be calculated theoretically as well as how it can be obtained from measurements.

The Management of Children and Youth With Pediatric Mental and Behavioral Health Emergencies

Mental and behavioral health (MBH) emergencies in children and youth continue to increasingly affect not only the emergency department (ED), but the entire spectrum of emergency medical services for children, from prehospital services to the community. Inadequate community and institutional infrastructure to care for children and youth with MBH conditions makes the ED an essential part of the health care safety net for these patients. As a result, an increasing number of children and youth are referred to the ED for evaluation of a broad spectrum of MBH emergencies, from depression and suicidality to disruptive and aggressive behavior. However, challenges in providing optimal care to these patients include lack of personnel, capacity, and infrastructure, challenges with timely access to a mental health professional, the nature of a busy ED environment, and paucity of outpatient post-ED discharge resources. These factors contribute to prolonged ED stays and boarding, which negatively affects patient care and ED operations. Strategies to improve care for MBH emergencies, including systems level coordination of care, is therefore essential. The goal of this policy statement and its companion technical report is to highlight strategies, resources, and recommendations for improving emergency care delivery for pediatric MBH.

A fast magnetic vector characterization method for quasi two-dimensional systems and heterostructures

The use of magnetic vector tomography/laminography has opened a 3D experimental window to access the magnetization at the nanoscale. These methods exploit the dependence of the magnetic contrast in transmission to recover its 3D configuration. However, hundreds of different angular projections are required leading to large measurement times. Here we present a fast method to dramatically reduce the experiment time specific for quasi two-dimensional magnetic systems. The algorithm uses the Beer-Lambert equation in the framework of X-ray transmission microscopy to obtain the 3D magnetic configuration of the sample. It has been demonstrated in permalloy microstructures, reconstructing the magnetization vector field with a reduced number of angular projections obtaining quantitative results. The throughput of the methodology is × 10-× 100 times faster than conventional magnetic vector tomography, making this characterization method of general interest for the community.

Pediatric injury due to wheeled recreational devices: a single-institution retrospective study

BACKGROUND

Injuries are the number one cause of death in children and cause significant morbidity. Common scenarios for injury include wheeled recreational devices (WRDs) that allow children to be mobile and independent (example ATV-all terrain vehicles, dirt bikes, bicycles, skateboards, and scooters). We present a case series review of these external causes of injury. This study aims to evaluate epidemiologic trends in WRD injuries and patterns in usage of protective gear.

RESULTS

A total of 263 patients were identified as meeting criteria for inclusion with the following causes of injuries-103 bicycle, 73 ATV, 27 dirt bike, 14 skateboard, 13 motorcycle, 7 go carts, 3 hover board, 3 roller skates, 1 dune buggy, 1 motor scooter, 1 rip stick, and 1 tractor toy. Ages of patients ranged from 2 to 18 years of age with the greatest range being noted for bicycles (2-17 years) and motorcycles (3-18 years). The mean age was higher for motorcycle and skateboard (12.9 and 11.6, respectively) and lowest for scooter and bicycle (8.3 and 9.2, respectively). The majority of [overall study (97%) and for each mode of transportation] patients were Caucasian, which is in contrast to our overall ED population, which is only 42% Caucasian. The majority of patients were male [190 (72%)]. Over half of the overall patients, 159 of the 263 (60%), were not wearing a helmet (with only 10 charts having no documentation of helmet use). In regard to ATV riders specifically, 58% were not wearing helmets at the time of injury, with an additional 5 patients who reported their helmet came off. The lowest percentage of riders reporting appropriate helmet use was skateboarders with only 21% wearing helmets, and the highest percentage was dirt bike riders with 74% reporting helmet use.

CONCLUSION

Common scenarios for injury include WRDs that allow children to be mobile and independent. Most of these injuries were found in Caucasian males between the ages of 9-12 with low rates of helmet use. This study adds to the literature with a description of the breadth of products children use and are injured while using.

Glycerol amendment enhances biosulfidogenesis in acid mine drainage-affected areas: An incubation column experiment

Microbial sulfate (SO₄²⁻) reduction in Acid Mine Drainage (AMD) environments can ameliorate the acidity and extreme metal concentrations by consumption of protons via the reduction of SO₄²⁻ to hydrogen sulfide (H₂S) and the concomitant precipitation of metals as metal sulfides. The activity of sulfate-reducing bacteria can be stimulated by the amendment of suitable organic carbon sources in these generally oligotrophic environments. Here, we used incubation columns (IC) as model systems to investigate the effect of glycerol amendment on the microbial community composition and its effect on the geochemistry of sediment and waters in AMD environments. The ICs were built with natural water and sediments from four distinct AMD-affected sites with different nutrient regimes: the oligotrophic Filón Centro and Guadiana acidic pit lakes, the Tintillo river (Huelva, Spain) and the eutrophic Brunita pit lake (Murcia, Spain). Physicochemical parameters were monitored during 18 months, and the microbial community composition was determined at the end of incubation through 16S rRNA gene amplicon sequencing. SEM-EDX analysis of sediments and suspended particulate matter was performed to investigate the microbially-induced mineral (neo)formation. Glycerol amendment strongly triggered biosulfidogenesis in all ICs, with pH increase and metal sulfide formation, but the effect was much more pronounced in the ICs from oligotrophic systems. Analysis of the microbial community composition at the end of the incubations showed that the SRB Desulfosporosinus was among the dominant taxa observed in all sulfidogenic columns, whereas the SRB Desulfurispora, Desulfovibrio and Acididesulfobacillus appeared to be more site-specific. Formation of Fe³⁺ and Al³⁺ (oxy)hydroxysulfates was observed during the initial phase of incubation together with increasing pH while formation of metal sulfides (predominantly, Zn, Fe and Cu sulfides) was observed after 1–5 months of incubation. Chemical analysis of the aqueous phase at the end of incubation showed almost complete removal of dissolved metals (Cu, Zn, Cd) in the amended ICs, while Fe and SO₄²⁻ increased towards the water-sediment interface, likely as a result of the reductive dissolution of Fe(III) minerals enhanced by Fe-reducing bacteria. The combined geochemical and microbiological analyses further establish the link between biosulfidogenesis and natural attenuation through metal sulfide formation and proton consumption.

POS0731 ASSOCIATION OF PATIENT-REPORTED OUTCOMES WITH TYPE I INTERFERON GENE SIGNATURE FROM THE INTERNATIONAL SYSTEMIC LUPUS ERYTHEMATOSUS PROSPECTIVE OBSERVATIONAL COHORT STUDY (SPOCS)

Background

The aim of the Systemic Lupus Erythematosus Prospective Observational Cohort Study (SPOCS) is to examine the disease course of patients with systemic lupus erythematosus (SLE) in relation to their type I interferon gene signature (IFNGS) status.1 IFNGS has been associated with SLE disease activity.2

Objectives

To identify associations between IFNGS status and patient-reported outcomes (PROs) among patients receiving clinical care while enrolled in SPOCS.

Methods

This noninterventional, international, prospective, observational cohort study included adult patients (≥18 years) with moderate to severe SLE receiving standard therapy. Short Form 36 Health Survey version 2 (SF-36; 0–100), Lupus Quality of Life (LupusQoL; 0–100) and Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F; 0–52) were assessed at baseline, 6 months, and 12 months. Higher scores indicate better outcomes. Analyses were stratified by high or low IFNGS status (4-gene test) at baseline.

Results

Of 827 patients, mean (standard deviation [SD]) age was 45.1 (14.0) years, 771 (93%) were female, 525 (63%) were IFNGS high, and 219 (26%) were IFNGS low. IFNGS-high patients were younger than IFNGS-low (mean [SD] 43.0 [13.7] vs 50.7 [12.9] years), had fewer comorbidities (83% vs 91%) and similar baseline disease activity (mean [SD]: SLE Disease Activity Index 2000, 9.8 [4.3] vs 9.2 [5.2]; Physician’s Global Assessment, both 1.5 [0.6]). At baseline, there were some differences in PROs between IFNGS-high and -low patients. At Month 12, changes in most domains did not meet the minimal clinically important difference (MCID). Slight improvement was observed only in selected domains in the IFNGS-high group. This group was younger and had fewer comorbidities at baseline. (Table 1, Figure 1).

Table 1.

PRO Scores at Baseline and Month 12 by IFNGS Status

BaselineMonth 12Change From BaselineMCID (≥)PROTotal (n=810)IFNGS HighIFNGS Low (n=219)Total (n=431)IFNGS HighIFNGS Low (n=147)TotalIFNGS HighIFNGS Low(n=525)(n=279)SF-36Physical Component Summary37.4 (10.5)38.3 (10.5)+35.2 (10.6)139.8 (10.8)41.7 (10.4)+35.7 (10.8)2.3 (7.6)3.0 (8.1)*0.6 (6.4)2.5Mental Component Summary43.2 (11.6)43.6 (11.7)42.7 (11.6)44.9 (11.2)45.9 (10.6)43.4 (11.5)0.9 (9.2)1.4 (9.6)-0.3 (8.4)2.5LupusQoLPhysical health56.4 (27.4)58.1 (27.0)+52.1 (27.7)60.5 (26.9)65.0 (25.3)+52.5 (27.7)2.6 (18.1)5.0 (19.2)*-1.4 (16.4)3.4Pain54.3 (30.3)55.7 (29.8)50.2 (30.8)61.4 (28.5)66.0 (26.5)+52.6 (29.1)5.4 (23.8)8.1 (25.2)0.7 (21.3)8.5Planning61.4 (32.2)63.7 (31.8)+57.0 (32.2)66.3 (29.6)70.8 (27.8)+58.5 (30.8)2.9 (24.4)4.2 (24.7)-1.0 (22.9)6.5Intimate relationships58.0 (34.8)61.2 (34.1)+50.9 (34.8)59.8 (33.9)65.6 (32.3)+50.6 (34.7)-0.6 (24.5)-0.7 (25.9)-0.8 (22.3)9.2Burden to others50.7 (32.6)50.7 (32.6)50.4 (33.5)56.4 (30.7)59.7 (29.5)51.8 (31.7)3.1 (25.4)5.6 (26.0)*0.1 (23.9)5.3Emotional health66.3 (25.6)66.1 (26.0)67.8 (24.8)71.1 (24.7)72.9 (23.8)69.2 (24.7)1.8 (19.4)3.1 (20.3)-0.5 (18.1)3.4Body image62.6 (29.4)61.0 (30.1)66.4 (28.3)68.2 (27.6)70.3 (27.4)65.1 (27.0)2.0 (23.9)*4.1 (24.3)*-0.4 (22.1)1.1Fatigue48.6 (27.8)49.9 (27.6)45.5 (28.2)53.7 (26.9)57.4 (26.2)+46.9 (25.7)2.1 (19.3)3.5 (20.0)-0.9 (18.7)3.9FACIT-F25.8 (13.4)26.9 (13.4)+23.4 (12.9)28.7 (13.2)31.1 (12.7)+24.6 (12.9)2.3 (9.6)3.2 (10.2)0.6 (8.5)4.0

Data are mean (SD). Asterisks (*) indicate changes from baseline ≥ MCID. +Comparison between high and low IFNGS status by Mann-Whitney U test (nominal p-value<0.01).

Data for n are patients per subgroup and do not reflect responses per PRO assessment.

Conclusion

In this cohort study, patients with moderate to severe SLE had poor health status, health-related quality of life, and fatigue. A clinically meaningful change was not met in most PROs, suggesting patients continue to have a high need for improved treatment options.

References

[1]Hammond ER. BMJ Open 2020;10:e036563.

[2]Dall’era MC. Ann Rheum Dis 2005;64:1692–7.

Acknowledgements

Writing assistance by Shelley Harris, PhD (Fishawack). This study was sponsored by AstraZeneca.

Disclosure of Interests

Martin Aringer Speakers bureau: AbbVie, AstraZeneca, BMS, Boehringer Ingelheim, Chugai, HEXAL, Lilly, MSD, Mylan, Novartis, Roche, Sanofi, UCB, Consultant of: AbbVie, AstraZeneca, BMS, Boehringer Ingelheim, Galapagos, GSK, Pfizer, Roche, Sanofi, Laurent Arnaud Speakers bureau: AstraZeneca, Consultant of: AstraZeneca, Grant/research support from: AstraZeneca, Christine Peschken Consultant of: AstraZeneca, GSK, Grant/research support from: AstraZeneca, Richard Furie Speakers bureau: AstraZeneca, Genentech, Consultant of: AstraZeneca, Grant/research support from: AstraZeneca, Eric F. Morand Speakers bureau: GSK, Novartis, Paid instructor for: AstraZeneca, Biogen, Eli Lilly, Consultant of: AstraZeneca, Biogen, Bristol Myers Squibb, Eli Lilly, EMD Serono, Genentech, GSK, Janssen, Servier, Grant/research support from: Abbvie, AstraZeneca, Bristol Myers Squibb, GSK, Janssen, Caroline Seo Shareholder of: AstraZeneca, Employee of: AstraZeneca, Eleni Rapsomaniki Employee of: AstraZeneca, Jonatan Hedberg Shareholder of: AstraZeneca, Employee of: AstraZeneca, Jacob Knagenhjelm Shareholder of: AstraZeneca, Employee of: AstraZeneca, Tina Grünfeld Eén Shareholder of: AstraZeneca, Employee of: AstraZeneca, Barnabas Desta Shareholder of: AstraZeneca, Employee of: AstraZeneca, Raj Tummala Shareholder of: AstraZeneca, Employee of: AstraZeneca, Alessandro Sorrentino Shareholder of: Galapagov, Abbott Laboratories, Gilead Sciences, Moderna, Employee of: Janssen, Sanofi, AstraZeneca, Heide Stirnadel-Farrant Shareholder of: AstraZeneca, GSK, Employee of: AstraZeneca

POS0733 DISCORDANCE BETWEEN PATIENT GLOBAL ASSESSMENT AND PHYSICIAN GLOBAL ASSESSMENT OF DISEASE ACTIVITY IN THE MODERATE TO SEVERE SYSTEMIC LUPUS ERYTHEMATOSUS PROSPECTIVE OBSERVATIONAL COHORT STUDY (SPOCS)

Background

Emphasis in clinical research and care has been placed on the need to include evaluations that reflect the perspectives of both patients and physicians.

Objectives

The goal of this study was to analyze patient and physician assessments and to determine characteristics associated with concordance and discordance of these assessments.

Methods

Baseline data of patients with moderate to severe SLE enrolled in the Systemic Lupus Erythematosus Prospective Observational Cohort Study (SPOCS)1 were analyzed. Physician’s Global Assessment (PGA) representing disease activity during the 4-week interval prior to baseline and Patient Global Assessment (PtGA) representing the impact of disease during a 1-month interval prior to baseline were independently scored on visual analogue scales (PGA 0-3; PtGA 0-100). Spearman’s rank (rho) was calculated to assess their correlation. A difference between PGA and PtGA scores ≥25 points defined discordance (after rescaling PGA to 0–100).2 Baseline characteristics associated with concordance and discordance were assessed.

Results

827 patients were included in this analysis. At baseline, the mean PGA score was 1.5 (SD 0.6, n=824), and the mean PtGA score was 51.1 (SD 25.5, n=790). The correlation between PGA and PtGA was low (rho=0.19, P<0.001, n=787) (Figure 1). PGA and PtGA scores were discordant in 301 (38%) of patients. Among those patients exceeding the threshold defining discordance, 152 (19%) had higher PGA scores than PtGA scores, and 149 (19%) had higher PtGA scores than PGA scores. The subgroup of PGA-higher discordant patients had higher mean SLEDAI-2K scores, greater serological activity, and more frequent type 1 interferon gene signature positivity, whereas PtGA-higher discordant patients were more likely to be using analgesics and/or anti-depressants, had higher mean BMI and were less likely to be employed (Table 1).

Table 1.

Characteristics associated with PGA and PtGA scoresa

Concordant (N=486)PGA higher (N=152)PtGA higher (N=149)P-value-1bP-value-2bAge, years45.5 (13.7)42.7 (14.4)46.4 (14.0)0.0220.043Race, White326 (71%)96 (66%)94 (69%)0.1920.360BMI, kg/m227.6 (7.2)25.6 (5.4)27.2 (6.4)0.0320.011Employed249 (51%)80 (53%)51 (34%)0.0010.001SLEDAI-2K total score10.0 (4.8)10.8 (5.1)8.2 (3.0)<0.001<0.001Positive ANA/anti-dsDNA436 (90%)143 (94%)127 (85%)0.0120.041Low Complement (C3 or C4)132 (46%)58 (60%)41 (43%)0.0140.026High IFNGS313 (71%)101 (78%)89 (64%)0.0140.049≥1 mild flare115 (24%)20 (13%)45 (30%)<0.0010.001≥1 moderate flare88 (18%)37 (24%)23 (16%)0.0570.120≥1 severe flare39 (8%)11 (7%)15 (10%)0.3720.628OCS daily dose0.0520.129No OCS214 (44%)57 (38%)62 (42%)>0–7.5 mg139 (29%)38 (25%)52 (35%)>7.5–15 mg75 (15%)37 (25%)18 (12%)>15 mg57 (12%)19 (13%)17 (11%)Immunosuppressants271 (56%)80 (53%)75 (50%)0.6900.467Biologics106 (22%)25 (16%)19 (13%)0.3640.032Analgesics152 (31%)22 (14%)46 (31%)<0.001<0.001Antidepressants123 (25%)31 (20%)52 (35%)0.0050.013

aMean (SD) for continuous, n (%) for nominal variables. Missing data was <10% of patients for the variables displayed. Denominators exclude missing data. bP-value-1 compares PGA higher vs PtGA higher. P-value-2 compares all 3 groups. Based on the chi-squared test for categorical variables and t-test or ANOVA for continuous variables.

IFNGS, type 1 interferon gene signature; OCS, oral corticosteroid; PGA, physician global assessment; PtGA, patient global assessment

Conclusion

Low correlation between PGA and PtGA suggests both should be used to acquire a broad perspective of the impact of disease on the overall health of patients. Different baseline characteristics were associated with the PGA-higher compared to the PtGA-higher discordant subgroups.

References

[1]Hammond ER, et al. BMJ Open. 2020;10:e036563.

[2]Challa DNV, et al. Rheumatol Ther. 2017;4:201–8.

Acknowledgements

Editing assistance by Rebecca S. Jones, PhD (Fishawack). This study was sponsored by AstraZeneca.

Disclosure of Interests

Laurent Arnaud Speakers bureau: AstraZeneca, Consultant of: AstraZeneca, Grant/research support from: AstraZeneca, Richard Furie Speakers bureau: AstraZeneca, Genentech, Consultant of: AstraZeneca, Grant/research support from: AstraZeneca, Eric F. Morand Speakers bureau: GSK, Novartis, Paid instructor for: AstraZeneca, Biogen, Eli Lilly, Consultant of: AstraZeneca, Biogen, Bristol Myers Squibb, Eli Lilly, EMD Serono, Genentech, GSK, Janssen, Servier, Grant/research support from: Abbvie, AstraZeneca, Bristol Myers Squibb, GSK, Janssen, Christine Peschken Consultant of: AstraZeneca, GSK, Grant/research support from: AstraZeneca, Martin Aringer Speakers bureau: AbbVie, AstraZeneca, BMS, Boehringer Ingelheim, Chugai, HEXAL, Lilly, MSD, Mylan, Novartis, Roche, Sanofi, UCB, Consultant of: AbbVie, AstraZeneca, BMS, Boehringer Ingelheim, Galapagos, GSK, Pfizer, Roche, Sanofi, Eleni Rapsomaniki Employee of: AstraZeneca, Jonatan Hedberg Shareholder of: AstraZeneca, Employee of: AstraZeneca, Jacob Knagenhjelm Shareholder of: AstraZeneca, Employee of: AstraZeneca, Caroline Seo Shareholder of: AstraZeneca, Employee of: AstraZeneca, Tina Grünfeld Eén Shareholder of: AstraZeneca, Employee of: AstraZeneca, Barnabas Desta Shareholder of: AstraZeneca, Employee of: AstraZeneca, Alessandro Sorrentino Shareholder of: Galapagov, Abbott LAboratories, Gilead Sciences, Moderna, Employee of: Janssen, Sanofi, AstraZeneca, Raj Tummala Shareholder of: AstraZeneca, Employee of: AstraZeneca, Heide Stirnadel-Farrant Shareholder of: AstraZeneca, GSK, Employee of: AstraZeneca

Beta-blocker/ACE inhibitor therapy differentially impacts the steady state signaling landscape of failing and non-failing hearts

Background

The molecular underpinnings of heart failure with reduced ejection fraction (HFrEF) involves a complex remodeling of the contractile, metabolic and electrical functions. Current pharmacotherapy for patients presenting HFrEF includes combination of angiotensin-converting enzyme inhibitors (ACEi) and β-adrenergic receptor blockers (β-AR blockers). Yet, a knowledge gap exists regarding the molecular changes accompanying such treatment.

Purpose

The present study takes an omics approach to study protein and phosphorylation signaling derangement in HFrEF and to define the global changes resulting from treatment with β-AR blocker (metoprolol) and ACE inhibitor (enalapril) in control- and HFrEF hearts.

Methods and results

For induction of HFrEF, a tight and permanent ligature was applied to constrict the transverse aorta in male C57BL6 mice. Eight weeks post-surgery, an osmotic pump was implanted delivering either vehicle or treatment (enalapril, ACE inhibitor, and metoprolol, β-AR blocker) for a two week period. The proteome- and phosphoproteome of left ventricular tissue was resolved using high-resolution liquid chromatography-mass spectrometry. The resulting dataset covered 6,004 proteins and 14,967 phosphorylation events. HFrEF was characterized by profound downregulation of mitochondrial proteins coupled with derangement of β-adrenergic and pyruvate dehydrogenase signaling. Upon treatment, phosphorylation changes consequent to HFrEF were reversed, including a reversal of Pdhk4 activity. In controls, treatment mainly led to downregulation of canonical PKA signaling. Overall, the signaling response elicited by treatment was profoundly different for failing than for control hearts.

Conclusions

We used state-of-the-art proteomics and phosphoproteomics approaches to analyze changes in protein abundance and phosphorylation state of the left ventricle resulting from combination therapy with a β-AR blocker and an ACE inhibitor in failing and non-failing hearts. Our observation of divergent signaling outcomes depending on the disease state of the heart underscores the importance of evaluating drug effects within the context of the specific conditions present in the recipient heart.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): The Danish Council for independent ResearchLundbeck FoundationFondation Leducq Transatlantic Network of Excellence

The chaperonin CCT controls T cell receptor-driven 3D configuration of centrioles

T lymphocyte activation requires the formation of immune synapses (IS) with antigen-presenting cells. The dynamics of membrane receptors, signaling scaffolds, microfilaments, and microtubules at the IS determine the potency of T cell activation and subsequent immune response. Here, we show that the cytosolic chaperonin CCT (chaperonin-containing TCP1) controls the changes in reciprocal orientation of the centrioles and polarization of the tubulin dynamics induced by T cell receptor in T lymphocytes forming an IS. CCT also controls the mitochondrial ultrastructure and the metabolic status of T cells, regulating the de novo synthesis of tubulin as well as posttranslational modifications (poly-glutamylation, acetylation, Δ1 and Δ2) of αβ-tubulin heterodimers, fine-tuning tubulin dynamics. These changes ultimately determine the function and organization of the centrioles, as shown by three-dimensional reconstruction of resting and stimulated primary T cells using cryo-soft x-ray tomography. Through this mechanism, CCT governs T cell activation and polarity.

Child passenger safety education in the emergency department: teen driving, car seats, booster seats, and more

BACKGROUND

The leading cause of death in children less than 19 years old is motor vehicle crashes (MVC). Non-use or improper use of motor vehicle car seats significantly adds to the morbidity and mortality. Emergency department (ED) encounters provide an opportunity for caregiver education. Our objective was to determine the effect of an educational intervention on knowledge and counseling behaviors of pediatric ED nurses regarding child passenger safety (CPS).

METHODS

A pre/post educational intervention study was conducted with nursing staff in an urban ED. Responses to CPS related knowledge and counseling behaviors were collected using surveys administered before and after the intervention. The ED nurse education intervention was a one-hour lecture based on the American Academy of Pediatrics (AAP) CPS guidelines and Alabama state law regarding ages for each car seat type and teen driving risky behaviors. Individual data from pre and post surveys were matched, and nominal variables in pre-post matched pairs were analyzed using McNemar's test. To compare categorical variables within pre or post test data, we used the Chi-square test.

RESULTS

Pretests were administered to 83/110 ED nurses; 64 nurses received the educational intervention and posttest. On the pretests, nurses reported "never" or "occasionally" counseling about CPS for the following: 56% car seats, 62% booster seat, 56% teen driving, 32% seat belts. When comparing the pretest CPS knowledge between nurses working 0-1 year vs. ≥ 2 years there was no statistically significant difference. Two CPS knowledge questions did not show significance due to a high correct baseline knowledge rate (> 98%), including baseline knowledge of MVC being the leading cause of death. Of the remaining 7 knowledge questions, 5 questions showed statistically significant improvement in knowledge: age when children can sit in front seat, state GDL law details, seat belt state law for back seat riders, age for booster seat, and rear facing car seat age. All four counseling behavior questions showed increases in intent to counsel families; however, only intent to counsel regarding teen driving reached statistical significance.

CONCLUSIONS

Educational efforts improved pediatric ED nursing knowledge regarding CPS. Intent to counsel was also improved following the education.

Planning considerations for persons with access and functional needs in a disaster-Part 2: Evacuation and sheltering

Although disasters can affect anyone in a given community or region, those with access and functional needs have the highest rates of morbidity and mortality during an emergency or disaster. There are many unique and complex issues that should be considered when dealing with these individuals in a disaster situation. Who are these individuals, what specific issues should be addressed, and what recommendations can be made in order to address their unique needs? How can we include them as part of the all-hazard, comprehensive approach to disaster management? The first part of this three-part series identifies who is included in this population and what are the legal considerations that arise in caring for not only this unique group but also all of the members of the community in a disaster. The second part considers evacuation, sheltering, sheltering in place, communication, medical needs, independence, supervision, and transportation (CMIST) with a focus on mental health. The third part deals with the medical aspect of CMIST and with recommendations that may aid disaster responders and planners in caring for these high-risk individuals in a disaster.

Planning considerations for persons with access and functional needs in a disaster-Part 3: Medical CMIST and recommendations

Although disasters can affect anyone in a given community or region, those with access and functional needs have the highest rates of morbidity and mortality during an emergency or disaster. There are many unique and complex issues that should be considered when dealing with these individuals in a disaster situation. Who are these individuals, what specific issues should be addressed when considering these members of the population, and what recommendations can be made in order to address their unique needs? How can we include them as part of the all-hazard, comprehensive approach to disaster management? The first part of this three-part series identifies who is included in this population and what are the legal considerations that arise in caring for not only this unique group but also all of the members of the community in a disaster. The second part considers evacuation, sheltering, sheltering in place, communication, medical needs, independence, supervision, and transportation (CMIST) with a focus on mental health. The third part deals with the medical aspect of CMIST and with recommendations that may aid disaster responders and planners in caring for these high-risk individuals in a disaster.

Characterization of sustainable polyhydroxyls, produced from bio-based feedstock, and polyurethane and copolymer urethane-amide foams

This manuscript presents data related to the research article entitled "Synthesis and characterization of sustainable polyurethane foams based on polyhydroxyls with different terminal groups" (DOI: 10.1016/j.polymer.2018.06.077) [1]. We provide Supplementary data on the chemical properties, in terms of FTIR characterization, of polyhydroxyls produced starting from bio-based feedstock (biosuccinic acid and 1,4 butandiol) and thermal properties (glass transition temperature-Tg and thermal degradation behavior) of polyurethane and copolymer urethane-amide foams manufactured from the aforementioned polyhydroxyls. The FTIR characterization elucidates the chemical structure of polyhydroxyls and allows to make some hypothesis on their reaction routes with the isocyanate molecules. The thermal characterization revealed that the addition of bio-based polyhydroxyls to the sample formulations improves both the glass transition and degradation temperature of the foams. These foamed products exhibit potential performances to be applied as a substitute for conventional polyurethane foams.

Planning considerations for persons with access and functional needs in a disaster-Part 1: Overview and legal

Although disasters can affect anyone in a given community or region, those with access and functional needs have the highest rates of morbidity and mortality during an emergency or disaster. There are many unique and complex issues that should be considered when planning and caring for these individuals in a disaster situation. Who are these individuals, what specific issues should be addressed when considering these members of the population, and what recommendations can be made to address their unique needs? How can we include them as part of the all-hazard, comprehensive approach to disaster management? The first part of this three-part series identifies who is included in this population and what are the legal considerations that arise in caring for, not only this unique group but also all the members of the community in a disaster. The second part considers evacuation, sheltering, sheltering in place, communication, medical needs, independence, supervision, and transportation (CMIST) with a focus on mental health. The third part deals with the medical aspect of CMIST and with recommendations that may aid disaster responders and planners in caring for these high-risk individuals in a disaster.

Human PRDM2: Structure, function and pathophysiology

PRDM2/RIZ is a member of a superfamily of histone/protein methyltransferases (PRDMs), which are characterized by the conserved N-terminal PR domain, with methyltransferase activity and zinc finger arrays at the C-terminus. Similar to other family members, two main protein types, known as RIZ1 and RIZ2, are produced from the PRDM2 locus differing by the presence or absence of the PR domain. The imbalance in their respective amounts may be an important cause of malignancy, with the PR-positive isoform commonly lost or downregulated and the PR-negative isoform always being present at higher levels in cancer cells. Interestingly, the RIZ1 isoform also represents an important target of estradiol action downstream of the interaction with hormone receptor. Furthermore, the imbalance between the two products could also be a molecular basis for other human diseases. Thus, understanding the molecular mechanisms underlying PRDM2 function could be useful in the pathophysiological context, with a potential to exploit this information in clinical practice.

Differences between graphene and graphene oxide in gelatin based systems for transient biodegradable energy storage applications

A comparison between graphene flakes and graphene oxide as filler in gelatin based systems for low-cost transient biodegradable energy storage applications has been carried out. The two bio-composites have been prepared and characterized by rheological measurements, cyclic voltammetry measurements, chronopotentiometry measurements and impedance spectroscopy. Differences in dielectric and mechanical properties have been correlated to the different structural organizations determinate by the hydrophobic/hydrophilic character of the used filler. In particular, the addition of the graphene oxide to the gelatin causes an increase in the elastic modulus with a parallel increase in the mechanical stability with time as compared to the composites obtained by adding graphene. Conversely, the surface capacitance is slightly increased by the graphene oxide addition compared to the pure gelatin sample. On the other hand, the introduction of the graphene flakes into the gelatin leads to a marked increase of the dielectric properties of the resulting bio-composite.

Light irradiation tuning of surface wettability, optical, and electric properties of graphene oxide thin films

In this work the preparation of flexible polymeric films with controlled electrical conductivity, light transmission and surface wettability is reported. A drop casted graphene oxide thin film is photo-reduced at different levels by UV light or laser irradiation. Optical microscopy, IR spectroscopy, electrical characterization, Raman spectroscopy and static water contact angle measurements are used in order to characterize the effects of the various reduction methods. Correlations between the optical, electrical and structural properties are reported and compared to previous literature results. These correlations provide a useful tool for independently tuning the properties of these films for specific applications.

Optical pseudomotors for soft x-ray beamlines

Optical elements of soft x-ray beamlines usually have motorized translations and rotations that allow for the fine alignment of the beamline. This is to steer the photon beam at some positions and to correct the focus on slits or on sample. Generally, each degree of freedom of a mirror induces a change of several parameters of the beam. Inversely, several motions are required to actuate on a single optical parameter, keeping the others unchanged. We define optical pseudomotors as combinations of physical motions of the optical elements of a beamline, which allow modifying one optical parameter without affecting the others. We describe a method to obtain analytic relationships between physical motions of mirrors and the corresponding variations of the beam parameters. This method has been implemented and tested at two beamlines at ALBA, where it is used to control the focus of the photon beam and its position independently.

Nanoscale imaging of buried topological defects with quantitative X-ray magnetic microscopy

Advances in nanoscale magnetism increasingly require characterization tools providing detailed descriptions of magnetic configurations. Magnetic transmission X-ray microscopy produces element specific magnetic domain images with nanometric lateral resolution in films up to ∼100 nm thick. Here we present an imaging method using the angular dependence of magnetic contrast in a series of high resolution transmission X-ray microscopy images to obtain quantitative descriptions of the magnetization (canting angles relative to surface normal and sense). This method is applied to 55–120 nm thick ferromagnetic NdCo₅ layers (canting angles between 65° and 22°), and to a NdCo₅ film covered with permalloy. Interestingly, permalloy induces a 43° rotation of Co magnetization towards surface normal. Our method allows identifying complex topological defects (merons or ½ skyrmions) in a NdCo₅ film that are only partially replicated by the permalloy overlayer. These results open possibilities for the characterization of deeply buried magnetic topological defects, nanostructures and devices.

Transmission X-ray microscopy allows for the imaging of magnetic domains in thin film materials. Here, the authors exploit the angular dependence of the magnetic contrast to extract out-of-plane canting angles of stripe domains and topological defects in NdCo₅ films buried under a NiFe layer.

Fast mold surface temperature evolution: relevance of asymmetric surface heating for morphology of iPP molded samples

It is widely accepted that mold temperature has a strong effect on the amount of molecular orientation and morphology developed in a non-isothermal flowing melt.

Performance of different commercial methods for determining minimum inhibitory concentrations of glycopeptides and linezolid against blood isolates of Staphylococcus aureus

The aim of this study was to determine the accuracy of commercial systems (VITEK^® 2, Etest and Sensititre^®) in determining the minimum inhibitory concentrations of vancomycin, teicoplanin and linezolid of Staphylococcus aureus strains and to evaluate the reproducibility of each system in a clinical microbiology laboratory. In total, 115 strains of S. aureus isolated from blood cultures were tested with all three commercial methods as well as the broth microdilution method, which is designated as the standard for glycopeptides and linezolid. Fourteen different S. aureus strains were included in a reproducibility test for all methods and antibiotics. For these strains, antimicrobial susceptibility testing was repeated 10 times on different days with all four methods, each time using the same inoculum. All three commercial methods exhibited similar performance in categorisation of nearly all of the meticillin-susceptible S. aureus (MSSA) isolates. Discrepancies were registered for meticillin-resistant S. aureus (MRSA); 2.5% of the strains in the intermediate or resistant category with the VITEK 2 system were not recognised as resistant by Etest and Sensititre. Moreover, none of the three commercial methods provided accurate results compared with homemade broth microdilution. Reproducibility of vancomycin and teicoplanin was 100% with VITEK 2 and Sensititre and 98.75% with Etest. Microdilution showed a reproducibility of 95.6% with vancomycin and 83.1% with teicoplanin. In contrast to previous reports, the best agreement with microdilution was exhibited by VITEK 2 both for MSSA and MRSA. For the antibiotics tested, the best reproducibility was obtained with the VITEK 2 and Sensititre systems.

The emerging role of large immunophilin FK506 binding protein 51 in cancer

FK506 binding protein 51 (FKBP51) is an immunophilin physiologically expressed in lymphocytes. Very recently, aberrant expression of this protein was found in melanoma; FKBP51 expression correlates with melanoma aggressiveness and is maximal in metastatic lesions. FKBP51 promotes NF-κB activation and is involved in the resistance to genotoxic agents, including anthracyclines and ionizing radiation. FKBP51 is a cochaperone with peptidyl-prolyl isomerase activity that regulates several biological processes through protein-protein interaction. There is increasing evidence that FKBP51 hyperexpression is associated with cancer and this protein has a relevant role in sustaining cell growth, malignancy, and resistance to therapy. There is also evidence that FKBP ligands are potent anticancer agents, in addition to their immunosuppressant activity. In particular, rapamycin and its analogs have shown antitumor activity across a variety of human cancers in clinical trials. Although, classically, rapamycin actions are ascribed to inhibition of mTOR, recent studies indicate FKBP51 is also an important molecular determinant of the drug's anticancer activity. The aim of this article is to review the functions of FKBP51, especially in view of the recent findings that this protein is a potential oncogene when deregulated and a candidate target for signaling therapies against cancer.

Short communication: technological and genotypic comparison between Streptococcus macedonicus and Streptococcus thermophilus strains coming from the same dairy environment

The species Streptococcus thermophilus is widely used for the preparation of several dairy products, and its technological contribution is clear. On the other hand, although Streptococcus macedonicus was first described more than 10 yr ago and, despite the scientific interest around this issue, the exact role of Strep. macedonicus in cheese making has yet to be clarified. In this study, 121 strains belonging to both species and isolated from the same dairy environment were genetically characterized by random amplification of polymorphic DNA (RAPD)-PCR and compared for the main biochemical features of technological interest, such as acid production, galactose utilization, citrate metabolism, exopolysaccharide production, and lipolytic, ureolytic, exocellular proteolytic, and decarboxylasic activities. Analysis by RAPD-PCR highlighted a remarkable genotypic heterogeneity among strains in both species, and, at a similarity level of 78%, all the isolates and reference strains of Strep. thermophilus grouped together and were well separated from the strains of Strep. macedonicus, confirming that these 2 species are different microbial entities. Comparison between genetic and phenotypic or biotechnological data did not reveal any relationships.

Iterative retrieval of one-dimensional x ray wave field using a single intensity measurement

The problem of retrieving a complex function from the modulus of its Fourier transform has non-unique solutions in one dimension. Therefore iterative phase retrieval methods cannot in general be confidently applied to one-dimensional problems, due to the presence of ambiguities. We present a method for a posteriori reduction of the ambiguities based on the correlation analysis of the solution of a large number of runs of an iterative phase retrieval algorithm with different random starting phases. The method is applied to experimentally measured diffraction patterns from an x ray waveguide illuminated by hard x rays. We demonstrate the possibility of retrieving the complex wave field at the exit face of the waveguide and compare the result with theoretical prediction.

Pediatric patients in a disaster: part of the all-hazard, comprehensive approach to disaster management

Disasters affect all ages of patients from the newborn to the elderly. Disaster emergency management includes all phases of comprehensive emergency management from preparedness to response and recovery. Disaster planning and management has frequently overlooked the unique issues involved in dealing with the pediatric victims of a disaster. The following will be addressed: disaster planning and management as related to pediatric patients and the integration of pediatric disaster management as part of an all-hazard, comprehensive emergency management approach. Key recommendations for dealing with children, infants, and special needs patients in a disaster are delineated.

Most common sports-related injuries in a pediatric emergency department

BACKGROUND

Participation in sports is a popular activity for children across the country. Prevention of sports-related injuries can be improved if details of injuries are documented and studied.

METHODS

A retrospective medical record review of injuries that occurred as a direct result of sports participation (both organized and non-organized play) from November 2006 to November 2007. Because the vast majority of injuries were a result of participation in football or basketball, these injuries were focused upon. The injuries specifically examined were closed head injury (CHI), lacerations and fractures.

RESULTS

There were 350 football and 196 basketball injuries (total 546). Comparing injuries between the two groups fractures were found to be more prevalent in football compared to basketball (z = 2.14; p = 0.03; 95%CI (0.01, 0.16)). Lacerations were found to be less prevalent among helmeted patients than those without helmets. (z = 2.39; p = 0.02; 95%CI (-0.17,-0.03)). CHI was more prevalent among organized play compared to non-organized (z = 3.9; p<0.001; 95%CI (0.06, 0.16)). Among basketball related visits, non-organized play had a higher prevalence of injury compared to organized play. (z = 2.87; p = 0.004; 95% CI (0.04, 0.21)). Among football related visits, organized play had a higher prevalence of injury compared to non-organized play (z = 2.87; p = 0.004; 95%CI (0.04.0.21)). No differences in fracture or laceration prevalence were found between organized and non-organized play.

CONCLUSIONS

Football and basketball related injuries are common complaints in a pediatric Emergency Department. Frequently seen injuries include CHI, fractures and lacerations. In our institution, fractures were more prevalent among football players and CHI was more prevalent among organized sports participants.

Fennel waste-based films suitable for protecting cultivations

Biodegradable, flexible, and moisture-resistant films were obtained by recycling fennel waste and adding to fennel homogenates the bean protein phaseolin that was modified or not modified by the enzyme transglutaminase. All films were analyzed for their morphology, mechanical properties, water vapor permeability, and susceptibility to biodegradation under soil-like conditions. Our experiments showed that transglutaminase treatment of the phaseolin-containing fennel waste homogenates allowed us to obtain films comparable in their mechanical properties and water vapor permeability to the commercial films Ecoflex and Mater-Bi. Furthermore, biodegradability tests demonstrated that the presence of the enzyme in the film-casting sample significantly influences the integrity of such a product that lasts longer than films obtained either with fennel waste alone or with a mixture of fennel waste and phaseolin. These findings indicate the fennel-phaseolin film prepared in the presence of transglutaminase to be a promising candidate for a new environmentally friendly mulching bioplastic.

Adenylate cyclase/cAMP pathway downmodulation counteracts apoptosis induced by IFN-alpha in human epidermoid cancer cells

We have reported previously that interferon-alpha (IFN-alpha) induces apoptosis that is counteracted by an epidermal growth factor (EGF) --> Ras --> extracellular signal-regulated kinase (ERK)-dependent survival response in human epidermoid cancer KB cells. We have studied the effects of the cytokine on the cAMP-dependent pathway in these cells. A decrease in the intracellular cAMP levels was recorded in KB cells treated with IFN-alpha, whereas forskolin induced an increase in the production of cAMP that was reduced in the presence of IFN-alpha, suggesting a reduction in the activity of adenylate cyclase (AC) induced by IFN-alpha. These effects were paralleled by significant change in the expression of some AC catalytic subunit(s) and by reduction in the activity of protein kinase A (PKA). 8-Br-cAMP completely antagonized the reduction of PKA activity induced by IFN-alpha, whereas PKA inhibitor KT5720 enhanced the reduction of the enzyme activity induced by IFN-alpha. We have found that IFN-alpha induced a decrease in cAMP response element binding protein (CREB) phosphorylation without changes in its total expression. The concomitant treatment with IFN-alpha and 8-Br-cAMP potentiated and KT5720 counteracted apoptosis induced by IFN-alpha alone. In conclusion, these data suggest that the decrease in AC/cAMP pathway activity is a survival response to the apoptosis induced by IFN-alpha. Therefore, this pathway could represent a target to enhance the antitumor activity of IFN-alpha.

Structure and expression of a novel gene family showing male germline specific expression in Drosophila melanogaster

We report the characterization of two novel genes of Drosophila melanogaster, named mst36Fa and mst36Fb. They define a novel gene family, showing identical time and tissue-specificity limited to male germ cells where their transcription starts during meiotic prophase. These two genes encode for two slightly basic proteins highly homologous to each other and fairly rich in leucine and glutamic acid. Although strictly clustered, these genes utilize different promoter regions as revealed by examination of transgenic flies bearing mst36F-promoter-lacZ reporter constructs and by reverse transcription-polymerase chain reaction assays. Our data suggest that at least one gene (mst36Fa) of the cluster is under translational repression until spermiogenesis suggesting a putative role in the spermatides differentiation. The present study is aimed at the structural analysis of these genes.

Natural Polysaccharide-Based Gels for Dairy Food Preservation

The innovative packaging systems described in the present work, based on natural gels, have been shown to increase the shelf life of the Mozzarella cheese, without adding any chemical substance and without thermal procedures. Physical, physicochemical, microbiological, analytical, and mechanical analyses were used to monitor the quality of the cheese as a function of storage type and storage time. In particular, microbiological analysis confirmed that the characteristics of the Mozzarella cheese stored at 4 degrees C in gel are maintained for more than 15 d, whereas samples stored in the mother solution lost important characteristics after 5 d. A penetration test (texture) confirmed that the Mozzarella cheese preserved in the gel maintained mechanical properties similar to those of the fresh product, even after storage for 30 d at 4 degrees C.

Assembly of HCV E1 and E2 glycoproteins into coronavirus VLPs

Hepatitis C virus (HCV) is believed to assemble by budding into membranes of the early secretory pathway, consistent with the membrane location where the viral envelope glycoproteins E1 and E2 accumulate when expressed. Coronavirus assembly also takes place at pre-Golgi membranes. Here, we generated coronavirus-like particles carrying in their envelope chimeric HCV glycoproteins composed of the ectodomains of E1 and E2, each fused to the transmembrane plus endodomain of the mouse hepatitis coronavirus spike glycoprotein. The chimeric particle system will enable structural and functional studies of the HCV glycoproteins.