Prospective evaluation to characterize the real-world performance of the EMBOVAC aspiration catheter for neurothrombectomy: a post-market clinical follow-up trial

BACKGROUND

A direct aspiration first pass technique (ADAPT) is an effective alternative to stent retriever thrombectomy for patients with large vessel occlusion (LVO). The PERFECT study evaluated direct aspiration with the EMBOVAC large bore aspiration catheter in patients with LVO strokes.

METHODS

PERFECT was a prospective, post-market, single-arm, multicenter, observational study of patients enrolled across 11 European centers between October 2020 and July 2022. Three direct aspiration passes with EMBOVAC were mandated before switching strategy. The primary endpoint was core-lab assessed successful reperfusion (modified Thrombolysis In Cerebral Infarction (mTICI) ≥2b) post-procedure. Other outcomes included first pass mTICI ≥2c, independent 90-day modified Rankin Scale (mRS) evaluation, and symptomatic intracerebral hemorrhage (sICH) at 24 hours by a clinical events committee.

RESULTS

EMBOVAC was used in 100 patients (mean age 70.4±14.0 years, 59.0% (59/100) female). Final mTICI ≥2b was achieved in 98.0% (97/99), final mTICI ≥2b with no change in frontline therapy or thrombolytics use during the procedure was achieved in 87.9% (87/99), final mTICI ≥2c in 86.9% (86/99), and first pass mTICI ≥2c in 53.5% (53/99). sICH at 24 hours was 0%. The 90-day mRS ≤2 rate was 56.6% (56/99) and all-cause mortality was 12.9%. One device-related serious adverse event occurred within 90 days (1.0%).

CONCLUSIONS

PERFECT demonstrates that EMBOVAC achieves successful reperfusion rates and favorable clinical outcomes when used in the endovascular treatment of acute ischemic stroke (AIS) using a direct aspiration technique as first line therapy in a real-world setting in patients with AIS secondary to large vessel occlusion.

TRIAL REGISTRATION

www.

CLINICALTRIALS

gov Unique identifier: NCT04531904.

The respiratory syncytial virus prefusion F protein vaccine attenuates the severity of respiratory syncytial virus-associated disease in breakthrough infections in adults ≥60 years of age

Background

Respiratory syncytial virus (RSV) is a contagious pathogen causing acute respiratory infections (ARIs). Symptoms range from mild upper respiratory tract infections to potentially life-threatening lower respiratory tract disease (LRTD). In adults ≥60 years old, vaccine efficacy of a candidate vaccine for older adults (RSVPreF3 OA) was 71.7% against RSV-ARI and 82.6% against RSV-LRTD (AReSVi-006/NCT04886596). We present the patient-reported outcomes (PROs) from the same trial at the end of the first RSV season in the northern hemisphere (April 2022).

Methods

In this phase 3 trial, adults aged ≥60 years were randomized (1:1) to receive one dose of RSVPreF3 OA vaccine or placebo. PROs were assessed using InFLUenza Patient-Reported Outcome (FLU-PRO), Short Form-12 (SF-12), and EuroQol-5 Dimension (EQ-5D) questionnaires. Peak FLU-PRO Chest/Respiratory scores during the first 7 days from ARI episode onset were compared using a Wilcoxon test. Least squares mean (LSMean) of SF-12 physical functioning (PF) and EQ-5D health utility scores were estimated using mixed effects models.

Results

In the RSVPreF3 OA group (N = 12,466), 27 first RSV-ARI episodes were observed versus 95 in the Placebo group (N = 12,494). Median peak FLU-PRO Chest/Respiratory scores were lower in RSVPreF3 OA (1.07) versus Placebo group (1.86); p = 0.0258. LSMean group differences for the PF and EQ-5D health utility score were 7.00 (95% confidence interval [CI]: -9.86, 23.85; p = 0.4125) and 0.0786 (95% CI: -0.0340, 0.1913; p = 0.1695).

Conclusions

The RSVPreF3 OA vaccine, in addition to preventing infection, attenuated the severity of RSV-associated symptoms in breakthrough infections, with trends of reduced impact on PF and health utility.

Plain language summary of Pfizer-BioNTech BNT162b2 COVID-19 vaccine safety in participants 16 years or older and protection against COVID-19 in participants 12 years or older

What is this summary about?

This is a summary of an article about part of a clinical study for the BNT162b2 COVID-19 vaccine, also called the Pfizer-BioNTech vaccine. The article was published in the New England Journal of Medicine in September 2021. The part of the study described in the article began in July 2020 and is ongoing. This means that the final results may be different from the results included in this summary.

What happened in this study?

The participants in this study received 2 injections of either the BNT162b2 vaccine or a placebo, 21 days apart. The placebo looked like the BNT162b2 vaccine but had no active vaccine in it. None of the trial participants or study teams knew who received vaccine or placebo.

What were the results?

Most of the reactions to the injections were mild or moderate and lasted for a short period of time. The most common reactions were pain at the injection site, extreme tiredness (fatigue), and headache. These reactions usually happened in the first 7 days after receiving a vaccine dose. A small number of participants had severe reactions to the vaccine. Compared to participants who received the placebo, participants who received the BNT162b2 vaccine were much less likely to become ill if they were infected with the virus that causes COVID-19. The vaccine also had very good efficacy at preventing severe COVID-19. Participants in South Africa who received the BNT162b2 vaccine were less likely to become ill after infection with the beta variant of the virus compared to participants who received the placebo. The beta variant was very common in South Africa when the study was taking place. Clinical Trial Registration: NCT04368728 ( ClinicalTrials.gov )

Conflicts of interest in electrophysiology and devices presentations

AIMS

Industry collaboration with arrhythmia and devices research is common. However, this results in conflicts of interest (CoI) for researchers that should be disclosed. This study aimed to examine the quality of CoI disclosures in arrhythmia and devices presentations.

METHODS

Recorded presentations from the Arrhythmia & Devices section of the ESC Annual Congress 2016-2020 were assessed. The number of words, conflicts, and time displayed was documented for CoI declarations. Meta-data including sponsorship by an industry partner, presenter sex, and institution were obtained.

RESULTS

Of 1153 presentations assessed, 999 were suitable for inclusion. CoI statements were missing from 7.2% of presentations, and 58% reported ≥1 conflict. Those with conflicts spent less time-per-word on their disclosures (median 150 ms, interquartile range [IQR] 83-273 ms) compared with those without conflicts (median 250 ms, IQR 125-375 ms). One-in-eight presentations were sponsored (12.8%, n = 128). CoI statements were more likely to be missing in sponsored presentations (14.8%, n = 19) compared with non-sponsored presentations (6.1%, n = 53), P = 0.0003. Sponsored presentations contained a greater median number of CoIs (10, IQR 6-18) compared with non-sponsored sessions (1, IQR 0-5), P < 0.0001. Time-per-word spent on COI disclosures was 50% lower in sponsored sessions (125 ms, IQR 75-231 ms) compared with non-sponsored sessions (250 ms, IQR 125-375 ms), P < 0.0001.

CONCLUSION

The majority of those presenting arrhythmia and devices research have CoIs to declare. Declarations were often missing or displayed for short periods of time. Presenters in sponsored sessions, while being more conflicted, had a lower standard of declaration suggesting a higher risk of potential bias which viewers had insufficient opportunity to assess.

GPCR-dependent pathways promote nanodomain-specific cAMP signaling in human cardiomyocytes, which is severely remodeled in atrial fibrillation

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Deutsche Forschungsgemeinschaft, German Centre for Cardiovascular Research (DZHK)

Background

Cardiac arrhythmias, such as atrial fibrillation (AF), have been linked to the remodeling of membrane receptors and alterations in cAMP-dependent regulation of calcium handling mechanisms. For instance, decreased L-type calcium channel (LTCC) current density but upregulated ryanodine receptor 2 (RyR2) are major hallmarks of AF. Furthermore, adenosine A2A receptor (A2AR) stimulation increases calcium waves without affecting LTCC and serotonin (5-HT) receptors activation exerts stronger control over myofilaments than over RyR2 function. However, up to date no study has elucidated how the increase on cAMP upon different G-protein-coupled receptors (GPCR) stimulation can lead to different physiological compartmentalized responses. The aim of this study was to investigate the effects of various GPCRs on cAMP levels in different cellular compartments in human atrial myocytes from control patients in sinus rhythm (Ctl), and how these compartmentalized effects are altered in AF. Furthermore, alterations in downstream cAMP level control by phosphodiesterases (PDEs) between patient groups were investigated to further elucidate functional differences.

Methods

Atrial myocytes were isolated from tissues of 66 AF and 80 Ctl patients. Cells were then transduced with adenoviruses (Epac1-camps, pm-Epac1-camps and Epac1-JNC) and cultured for 48 hours to express the Förster-resonance energy transfer (FRET)-based cAMP sensor in the cytosolic, membrane and RyR2 nanodomains, respectively. FRET was then used to measure cAMP in 532 isolated human atrial myocytes. Stimulation with β-adrenergic agonist Isoprenaline (ISO, 100nM) was used and compared with 5-HT (100µM) and A2AR (with CGS, 200nM) stimulation. Additionally, a nonspecific PDE inhibitor (IBMX, 100µM) was applied, as well as PDE3 (Cilostamide, 1µM) and PDE4 (Ro 20-1724, 10µM) specific inhibitors.

Results

A desensitization to β-adrenergic receptor stimulation in AF myocytes was exclusively found in the cytosol, while no difference was seen in neither the RyR2 nor LTCC compartment in AF versus Ctl. Similar effects were observed upon 5-HT stimulation with a significant desensitization in the cytosol, and no difference in the RyR2 compartment. On the contrary, AF myocytes displayed a significantly higher increase in cAMP levels compared to Ctl myocytes in the cytosol upon A2ARs stimulation. Importantly, no effect on cAMP levels was observed in the LTCC compartment after A2ARs or 5-HT stimulation. However, PDE3 inhibition on top of 5-HT stimulation showed a significantly smaller effect on cAMP levels in AF myocytes within the LTCC compartment.

Conclusions

Collectively, our data show that cAMP levels are highly compartmentalized in human atrial myocytes and differentially regulated by different GPCRs. Furthermore, PDEs are to a certain extent responsible for the compartmentalized effects of the different GPCRs.

Outcomes of patients with severe mitral regurgitation treated with transcatheter mitral valve implantation or medical therapy

Funding Acknowledgements

Type of funding sources: None.

Background

Patients with severe mitral regurgitation (MR) unsuitable for standard therapy (i.e., open-heart surgery and transcatheter edge-to-edge repair [TEER]), often remain on medical therapy (MT) alone. Transcatheter mitral valve implantation (TMVI) may represent an alternative treatment option for these patients.

Purpose

We aimed to investigate differences in anatomical baseline characteristics and echocardiographic outcomes between MR patients unsuitable for standard therapy, that were either treated with TMVI or remained on MT.

Methods

Between 05/2016-02/2021, 121 high-risk patients with severe MR were evaluated for TMVI. Clinical, echocardiographic and functional outcomes between the subgroups of patients treated with TMVI and MT were compared. The primary combined endpoint was all-cause death or heart failure (HF) hospitalization at 1 year. Subgroup analyses were performed to define specific patient subsets favouring either TMVI or MT.

Results

At baseline, there were no differences between the TMVI group (n = 38) and the MT group (n = 44) regarding age (all TMVI vs. MT: 77.0 years [IQR 72.9, 80.1] vs. 79.0 [IQR 76.0, 81.7], p = 0.13), gender (42.1% female vs. 56.8% female, p = 0.27) and estimated surgical risk (EuroSCORE II 4.4% [IQR 2.8, 13.6] vs. 6.4 [IQR 3.4, 10.1], p = 0.72). Patients undergoing TMVI were more frequently treated for secondary MR (68.4%), while primary MR was the most prevalent MR etiology in patients remaining on medical therapy (50.0%). Left ventricular (LV) end-diastolic diameters (LVEDD) were larger and LV ejection fraction (LVEF) was lower in the TMVI group (LVEDD 58.0mm [IQR 51.4, 65.0], LVEF 37.0% [IQR 31.4, 51.2]) compared to the MT group (LVEDD 52.0mm [IQR 46.2, 58.8], LVEF 54.5% [IQR 40.8, 60.0]) (p = 0.02 for LVEDD, p &lt; 0.001 for LVEF). MR was effectively reduced to ≤ mild MR in all patients undergoing TMVI. In the MT group, MR remained severe in 90% of patients after 1 year. The primary composite endpoint occurred numerically more often in the MT group (72.2%) compared to the TMVI group (51.6%, p = 0.061). Regarding the primary endpoint, the subgroups of patients with LVEF 30-49% (HR 0.28 [95%-CI 0.11-0.67], p = 0.004), effective regurgitant orifice area (EROA) &lt;0.4 cm2 (HR 0.30 [95%-CI 0.13-0.71], p = 0.006), tricuspid annular plane systolic excursion (TAPSE) ≥17mm (HR 0.27 [95%-CI 0.11-0.67], p = 0.005) and New York Heart Association functional class III (HR 0.38 [95%-CI 0.18-0.81], p = 0.012) were more likely to benefit from TMVI compared to MT.

Conclusions

In patients with severe MR unsuitable for standard therapy, TMVI represents a reasonable therapeutic alternative yielding effective elimination of MR. While most patients eligible for TMVI suffer from secondary MR, the majority of patients remaining on MT has primary MR. The primary endpoint occurred numerically, yet not statistically, more often in patients on MT. Baseline echocardiography was able to identify subgroups of patients with beneficial outcome after TMVI.

Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine through 6 Months

BACKGROUND

BNT162b2 is a lipid nanoparticle-formulated, nucleoside-modified RNA vaccine encoding a prefusion-stabilized, membrane-anchored severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) full-length spike protein. BNT162b2 is highly efficacious against coronavirus disease 2019 (Covid-19) and is currently approved, conditionally approved, or authorized for emergency use worldwide. At the time of initial authorization, data beyond 2 months after vaccination were unavailable.

METHODS

In an ongoing, placebo-controlled, observer-blinded, multinational, pivotal efficacy trial, we randomly assigned 44,165 participants 16 years of age or older and 2264 participants 12 to 15 years of age to receive two 30-μg doses, at 21 days apart, of BNT162b2 or placebo. The trial end points were vaccine efficacy against laboratory-confirmed Covid-19 and safety, which were both evaluated through 6 months after vaccination.

RESULTS

BNT162b2 continued to be safe and have an acceptable adverse-event profile. Few participants had adverse events leading to withdrawal from the trial. Vaccine efficacy against Covid-19 was 91.3% (95% confidence interval [CI], 89.0 to 93.2) through 6 months of follow-up among the participants without evidence of previous SARS-CoV-2 infection who could be evaluated. There was a gradual decline in vaccine efficacy. Vaccine efficacy of 86 to 100% was seen across countries and in populations with diverse ages, sexes, race or ethnic groups, and risk factors for Covid-19 among participants without evidence of previous infection with SARS-CoV-2. Vaccine efficacy against severe disease was 96.7% (95% CI, 80.3 to 99.9). In South Africa, where the SARS-CoV-2 variant of concern B.1.351 (or beta) was predominant, a vaccine efficacy of 100% (95% CI, 53.5 to 100) was observed.

CONCLUSIONS

Through 6 months of follow-up and despite a gradual decline in vaccine efficacy, BNT162b2 had a favorable safety profile and was highly efficacious in preventing Covid-19. (Funded by BioNTech and Pfizer; ClinicalTrials.gov number, NCT04368728.).

Diagnostic value and prognostic impact of various invasively derived hemodynamic parameters in patients with severe aortic stenosis undergoing TAVI

Background

Ejection time (ET) and Acceleration time (AT) have been described as echocardiographic markers for aortic stenosis (AS).1 Moreover, in a recent study time between invasively measured left ventricular and aortic systolic pressure peaks (T-LVAo) was associated with anatomic AS severity.2 However, the diagnostic value of these parameters has not been validated in a larger patient cohort and their prognostic impact in AS patients undergoing transcatheter aortic valve implantation (TAVI) remains unknown.

Purpose

We aimed to assess the diagnostic value and prognostic impact of ET, AT, and T-LVAo as assessed by invasive measurements in patients undergoing TAVI for severe AS.

Methods

This retrospective single-centre analysis studied 1478 patients undergoing TAVI from 2014 to 2019 for severe AS. All patients received echocardiographic, multislice computed tomography (MSCT) and invasive hemodynamic evaluation with simultaneous pressure measurements in left ventricle and aorta prior to TAVI. Anatomic AS severity was assessed according to MSCT-derived aortic valve calcification density (AVCd) defined as calcium volume per annulus area. All hemodynamic parameters were calculated offline using a dedicated software.

Results

Median patients' age was 81.2 (76.8–84.7) years and 807 (54.6%) were women. Predicted operative risk for mortality was 3.8 (2.6–5.7)% according to STS Score. Medians of invasively derived parameters were 70.0 ms (46.0–98.0) for T-LVAo, 308.0 ms (276.0–336.0) for ET, 180.0 ms (146.0–206.0) for AT. In spline analysis correlation of T-LVAo (Spearman: r=0.35; p&lt;0.001) and ET (Spearman: r=0.18; p&lt;0.001) with AVCd was significant but weak. AT showed negligible correlation with ACVd (Spearman: r=−0.05; p=0.089). The optimal cutoff for death (CD) according to C-statistic was 274 ms for ET and 158 ms for AT. Patients with ET or AT ≥ CD showed lower short and mid-term mortality rates compared to patients with ET or AT &lt; CD (ET ≥ vs. &lt; CD: mortality at 1-year: 14.5 vs. 31.9%, 3-years: 28.3 vs. 53.5%, all p&lt;0.001; AT ≥ vs &lt; CD: mortality at 1-year: 15.5 vs. 25.9%, p&lt;0.001, 3-years: 34.0 vs. 41.0%, p=0.0032). Moreover, multivariate analysis for mortality identified ET (HR 0.58 [95% CI 0.43–0.77; p&lt;0.001]) and AT (HR 0.65 [95% CI 0.49–0.86; p=0.0027]) to be associated with beneficial outcome after TAVI, independent from clinical risk factors and echocardiography-derived parameters like LVEF, mean gradient or stroke volume index. In contrast, T-LVAo showed no prognostic impact according to uni- or multivariate analyses.

Conclusion

T-LVAo provides the highest diagnostic value among the investigational hemodynamic parameters, however correlation with AVCd was weak. ET and AT are strong independent outcome predictors beyond clinical risk factors and standard echocardiographic parameters in AS patients following TAVI. Accordingly, use of ET and AT might improve risk assessment in patients scheduled for TAVI.

Funding Acknowledgement

Type of funding sources: None.

Does industry funding differ between men and women in electrophysiology and devices research?

Funding Acknowledgements

Type of funding sources: None.

Background

A significant gender bias has been identified in cardiology. Industry funding may be important developing electrophysiology (EP) and devices research. Such funding leads to potential conflicts of interest (COI) which must be disclosed on research presentations. There is limited evidence whether the gender bias in cardiology extends to industry funding of research.

Purpose

To assess whether COI disclosures in EP and devices presentations at the ESC Annual Congress differ between men and women.

Methods

Recorded presentations from the Arrhythmia & Devices section of ESC Annual Congresses 2016-2020 were assessed. Presentations were excluded if the original presentation contained no slides, it was a panel discussion, it was a non-scientific presentation, or part of the presentation was missing. Presentations with multiple speakers were also excluded. Chi-squared and Mann-Whitney U tests were used to assess differences between groups for dichotomous and continuous data respectively.

Results

Of 1,153 presentations assessed, 999 were suitable for inclusion. Women made up 22% (n = 221) of presenters. There was no difference in whether COI declaration slides were missing between women (5.9%, n = 13) and men (7.6%, n = 56), p = 0.38. In those with COI disclosure slides (n = 927), women declared significantly lower median number of COIs (0, IQR 0-3) compared with men (2, IQR 0-8), p &lt; 0.0001. In contrast, women spent a greater time-per-word on their COI disclosure slides (250ms, IQR 125-375ms) compared with men (200ms, IQR 118-333ms), p &lt; 0.0001.

Conclusions

Women made up a minority of presenters in EP/devices talks at the ESC annual congress. Women were less likely to have COIs which may suggest that they are less likely to receive industry funding. Despite this, women spent a greater amount of time-per-word on their COI slides. The lower number of declared COIs in women highlights another potential area of gender bias in cardiology that needs further investigation so that it can be addressed.

Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine

BACKGROUND

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the resulting coronavirus disease 2019 (Covid-19) have afflicted tens of millions of people in a worldwide pandemic. Safe and effective vaccines are needed urgently.

METHODS

In an ongoing multinational, placebo-controlled, observer-blinded, pivotal efficacy trial, we randomly assigned persons 16 years of age or older in a 1:1 ratio to receive two doses, 21 days apart, of either placebo or the BNT162b2 vaccine candidate (30 μg per dose). BNT162b2 is a lipid nanoparticle-formulated, nucleoside-modified RNA vaccine that encodes a prefusion stabilized, membrane-anchored SARS-CoV-2 full-length spike protein. The primary end points were efficacy of the vaccine against laboratory-confirmed Covid-19 and safety.

RESULTS

A total of 43,548 participants underwent randomization, of whom 43,448 received injections: 21,720 with BNT162b2 and 21,728 with placebo. There were 8 cases of Covid-19 with onset at least 7 days after the second dose among participants assigned to receive BNT162b2 and 162 cases among those assigned to placebo; BNT162b2 was 95% effective in preventing Covid-19 (95% credible interval, 90.3 to 97.6). Similar vaccine efficacy (generally 90 to 100%) was observed across subgroups defined by age, sex, race, ethnicity, baseline body-mass index, and the presence of coexisting conditions. Among 10 cases of severe Covid-19 with onset after the first dose, 9 occurred in placebo recipients and 1 in a BNT162b2 recipient. The safety profile of BNT162b2 was characterized by short-term, mild-to-moderate pain at the injection site, fatigue, and headache. The incidence of serious adverse events was low and was similar in the vaccine and placebo groups.

CONCLUSIONS

A two-dose regimen of BNT162b2 conferred 95% protection against Covid-19 in persons 16 years of age or older. Safety over a median of 2 months was similar to that of other viral vaccines. (Funded by BioNTech and Pfizer; ClinicalTrials.gov number, NCT04368728.).

Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine

BACKGROUND

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the resulting coronavirus disease 2019 (Covid-19) have afflicted tens of millions of people in a worldwide pandemic. Safe and effective vaccines are needed urgently.

METHODS

In an ongoing multinational, placebo-controlled, observer-blinded, pivotal efficacy trial, we randomly assigned persons 16 years of age or older in a 1:1 ratio to receive two doses, 21 days apart, of either placebo or the BNT162b2 vaccine candidate (30 μg per dose). BNT162b2 is a lipid nanoparticle-formulated, nucleoside-modified RNA vaccine that encodes a prefusion stabilized, membrane-anchored SARS-CoV-2 full-length spike protein. The primary end points were efficacy of the vaccine against laboratory-confirmed Covid-19 and safety.

RESULTS

A total of 43,548 participants underwent randomization, of whom 43,448 received injections: 21,720 with BNT162b2 and 21,728 with placebo. There were 8 cases of Covid-19 with onset at least 7 days after the second dose among participants assigned to receive BNT162b2 and 162 cases among those assigned to placebo; BNT162b2 was 95% effective in preventing Covid-19 (95% credible interval, 90.3 to 97.6). Similar vaccine efficacy (generally 90 to 100%) was observed across subgroups defined by age, sex, race, ethnicity, baseline body-mass index, and the presence of coexisting conditions. Among 10 cases of severe Covid-19 with onset after the first dose, 9 occurred in placebo recipients and 1 in a BNT162b2 recipient. The safety profile of BNT162b2 was characterized by short-term, mild-to-moderate pain at the injection site, fatigue, and headache. The incidence of serious adverse events was low and was similar in the vaccine and placebo groups.

CONCLUSIONS

A two-dose regimen of BNT162b2 conferred 95% protection against Covid-19 in persons 16 years of age or older. Safety over a median of 2 months was similar to that of other viral vaccines. (Funded by BioNTech and Pfizer; ClinicalTrials.gov number, NCT04368728.).

Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine

BACKGROUND

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the resulting coronavirus disease 2019 (Covid-19) have afflicted tens of millions of people in a worldwide pandemic. Safe and effective vaccines are needed urgently.

METHODS

In an ongoing multinational, placebo-controlled, observer-blinded, pivotal efficacy trial, we randomly assigned persons 16 years of age or older in a 1:1 ratio to receive two doses, 21 days apart, of either placebo or the BNT162b2 vaccine candidate (30 μg per dose). BNT162b2 is a lipid nanoparticle-formulated, nucleoside-modified RNA vaccine that encodes a prefusion stabilized, membrane-anchored SARS-CoV-2 full-length spike protein. The primary end points were efficacy of the vaccine against laboratory-confirmed Covid-19 and safety.

RESULTS

A total of 43,548 participants underwent randomization, of whom 43,448 received injections: 21,720 with BNT162b2 and 21,728 with placebo. There were 8 cases of Covid-19 with onset at least 7 days after the second dose among participants assigned to receive BNT162b2 and 162 cases among those assigned to placebo; BNT162b2 was 95% effective in preventing Covid-19 (95% credible interval, 90.3 to 97.6). Similar vaccine efficacy (generally 90 to 100%) was observed across subgroups defined by age, sex, race, ethnicity, baseline body-mass index, and the presence of coexisting conditions. Among 10 cases of severe Covid-19 with onset after the first dose, 9 occurred in placebo recipients and 1 in a BNT162b2 recipient. The safety profile of BNT162b2 was characterized by short-term, mild-to-moderate pain at the injection site, fatigue, and headache. The incidence of serious adverse events was low and was similar in the vaccine and placebo groups.

CONCLUSIONS

A two-dose regimen of BNT162b2 conferred 95% protection against Covid-19 in persons 16 years of age or older. Safety over a median of 2 months was similar to that of other viral vaccines. (Funded by BioNTech and Pfizer; ClinicalTrials.gov number, NCT04368728.).

Prevalence and prognostic impact of left ventricular outflow tract calcification in patients with severe aortic stenosis undergoing transfemoral TAVI using second-generation devices

Introduction

Left ventricular outflow tract (LVOT) calcification is known to be associated with adverse outcomes after TAVI in patients receiving first-generation transcatheter heart valves (THV). Second-generation THV have been shown to improve outcomes of TAVI patients. Thus, aim of this study is to assess the prevalence of LVOT calcification as well as its impact on procedural and clinical outcomes in patients with severe aortic stenosis undergoing transfemoral TAVI with second-generation THV in a real-world patient cohort.

Methods

In this retrospective single-center analysis patients receiving transfemoral TAVI with second-generation THV for the treatment of aortic stenosis (AS) between 05/2012 and 06/2018 and with adequate CT data were included (n=836). Amount of LVOT calcification was measured quantitatively from contrast-enhanced multislice CT using a dedicated software. Baseline characteristics and outcomes were compared according to presence of significant LVOT calcification (none/≤10 mm3 vs. &gt;10 mm3). Procedural and clinical outcome were assessed in accordance with VARC-2 criteria. All-cause mortality was assessed by Kaplan-Meier method, median follow-up was 1.4 years.

Results

Significant LVOT calcification was present in 37.0% of patients. Patients with LVOT calcification were older (all results as follows without (w/o) vs. with (w) LVOT calcification: 81.4 (77.1, 84.8) vs. 82.3 (78.0, 86.3) years, p=0.006), but presented similar STS scores compared to those without LVOT calcification (5.4±4.7 vs. 5.4±3.5%, p=0.94). Moreover, patients with LVOT calcification had higher mean transvalvular gradients at baseline (30.0 (21.0, 41.0) vs. 37.0 (25.7, 47.0) mmHg, p&lt;0.001) and higher aortic valve calcium volume (380.7 (226.8, 632.1) vs. 663.6 (364.5, 1070.3) mm3, p&lt;0.001). There were no significant differences in rate of device success (97.0 vs. 94.2%, p=0.11), renal failure (2.6 vs. 2.3%, p=1.00), myocardial infarction (0.9 vs. 1.2%, p=1.00) or rate of permanent pacemaker implantation at 30 days after TAVI (16.6 vs. 17.2%, p=0.91). However, rate of TIA/stroke was significantly higher in patients with LVOT calcification (2.1 vs. 6.2%, p=0.0098). Furthermore, patients with LVOT calcification had a higher rate of more than mild paravalvular leakage at discharge (3.8 vs. 7.6%, p=0.033). Rate of 1 year all-cause mortality (17.8 vs. 21.2%, p=0.23) was not significantly different between both groups.

Conclusions

Significant LVOT calcification is present in a substantial proportion of patients receiving TAVI. In such patients, higher rates of cerebrovascular events and more than mild PVL occurred compared to those without significant LVOT calcification even with currently available second-generation THV. Although these findings did not translate into higher mortality rates in the present study, they underline the need for further optimization of THV technology in order to improve outcomes among all TAVI patients.

Figure 1. 1-year mortality

Funding Acknowledgement

Type of funding source: None

Efficacy of two dosing schemes of a liquid containing ivy leaves dry extract EA 575 versus placebo in the treatment of acute bronchitis in adults

Introduction

The results of a clinical trial published in 2016 showed the efficacy of ivy leaves dry extract EA 575 versus placebo in the treatment of patients suffering from acute cough. A clinical trial with a very similar design was conducted to not only show the reproducibility of former results but also to investigate an alternative dosing scheme.

Methods

This randomised, placebo-controlled, multicentre, double-blind clinical trial was conducted to assess the efficacy and safety of a liquid containing EA 575 in the treatment of acute bronchitis. A total of 209 patients were treated with a liquid containing EA 575 as an active investigational medicinal product (verum) either two (7.5 mL) or three (5 mL) times a day or placebo in the respective dosing scheme for 1 week, with a total observational period of 2 weeks. The primary efficacy outcome was a change in Bronchitis Severity Score (BSS) of the pooled placebo and pooled verum groups between visits 1 and 5. Additional secondary parameters were assessed, including, for example, change in cough severity as assessed by a visual analogue scale (VAS) and the Verbal Category Descriptive (VCD) score.

Results

Superiority of verum over placebo was during and at the end of treatment, as measured by BSS. No significant differences between the dosing schemes were observed. VCD scores and VAS measurements also showed the superiority of verum over placebo.

Conclusion

The existing data on the clinical efficacy of EA 575 were confirmed. Furthermore, a new dosing scheme was shown to be noninferior to the currently used scheme while maintaining the safety and tolerability of the well-established cough liquid containing EA 575.

Ivy leaves dry extract EA 575 provides an effective and safe therapeutic option in the treatment of acute bronchitishttp://bit.ly/318CZys

P962Follow-up of protected high-risk percutaneous coronary intervention with microaxial Impella pump. Results from the retrospective German Impella Registry

Background

Percutaneous coronary intervention (PCI) presents a relevant alternative to coronary bypass surgery for the treatment of patients with complex coronary artery disease and high perioperative risk. By temporary implantation of a percutaneous ventricular assist devices (pVAD) interventionalists attempt to anticipate the hemodynamic risk of those high-risk patients in a so-called protected PCI. The Impella® system presents the currently most common device for protected PCI and could show hemodynamic stability in earlier trials.

Methods

This study is a retrospective, observational multi-center registry of ten hospitals in Germany. We included patients undergoing protected high-risk PCI with Impella® support. The primary endpoint was defined as major adverse cardiac events (MACE) during a 180-day follow-up and consisted of all-cause mortality, myocardial infarction (MI) and stroke.

Results

Six of the participating hospitals performed a follow-up. In total, 157 patients (80.3% male; mean age 71.8±10.8 years) were included in the present study. Prior to PCI, median left ventricular ejection fraction was 39.0% (25.0%-50.0%) and median SYNTAX-Score I was 33.0 (24.0–40.5). The 180-day follow-up was available for 149 patients (94.9%). Eight patients (5.1%) were lost to follow-up. During the follow-up period, 34 patients (22.8%) suffered from a MACE. A total of 27 patients (18.1%) died. Nine patients (6.0%) sustained a MI, while 4 patients (2.7%) had a stroke.

Kaplan-Meier curves for primary endpoint

Conclusions

Patients undergoing protected high-risk PCI with Impella® support show a good 180-day clinical outcome regarding rates of MACE and mortality. However, a head-to-head comparison of Impella supported patients to protected PCI with other pVADs is pending.

Acknowledgement/Funding

S.B., N.W., F.A.-R., J.-M.S., A.S., R.S., I.A. receive consulting fees/honoraria from Abiomed (Danvers, MA, USA).

P1706Neurological outcome in patients with out-of-hospital cardiac arrest undergoing a standardised protocol including therapeutic hypothermia and routine coronary angiography

Purpose

To establish cut-offs for neuromarkers such as neuron-specific enolase (NSE) and S-100 predicting good neurological outcome for patients treated with therapeutic hypothermia with out-of-hospital cardiac arrest (OHCA) and return of spontaneous circulation (ROSC) as current cut-offs had been derived from normothermic cohorts.

Methods

Consecutive data of all patients with OHCA admitted to our institution between 01/2011 and 12/2016 were collected in a database. Patient received standard intensive care according to the Hannover Cardiac Resuscitation Algorithm (HaCRA) including mandatory hypothermia. Neurological markers such as neuron-specific enolase (NSE) and S-100 have been used to assess neurological damage following OHCA.

Results

Mean age of overall patient population (n=302) was 63±14 [54–74] years with a male predominance (77%). Cardiac arrest was witnessed in 81% and bystander cardiopulmonal resuscitation (CPR) was performed in 67%. Initial rhythm was ventricular fibrillation in 69%. ROSC had been achieved after 24±17 minutes. Hypothermia was applied in all patients. In 95% percutaneous coronary angiography and in 57% of them coronary intervention was performed. After ROSC, STEMI was present in 44%. Mechanical support was required in 19%. 30 day mortality was 44% in the total cohort. Mean NSE was 27±69 μg/l, mean NSE with good neurological outcome was 20±8.7 μg/l, highest NSE with good neurological outcome was 46 μg/l. Mean S-100 was 0.114±2.037μg/l, mean S-100 with good neurological outcome was 0.068±0.067 μg/l, highest S-100 with good neurological outcome was 0.360 μg/l.

Conclusion

Even when using a strict protocol for OHCA patients and routinely applying therapeutic hypothermia, the cut-offs for NSE and S-100 regarding good neurological outcome are similar to those reported before without therapeutic hypothermia, but they must not be used solitary to withdraw life support as even very high markers can be associated with goof neurological outcome in individual patients.

P5736Mortality in infarct-related cardiogenic shock patients treated with an microaxial pump: influence of timing and predicted risk

Background

In-hospital mortality in acute myocardial infarction-related cardiogenic shock (AMI-CS) remains high at ∼40%. No prospective trials have been finished investigating the influence of mechanical support in AMI-CS. We compared observed to individually predicted mortality using CardShock-, Shock II-, and SAVE-scores in AMI-CS patients treated between 2013 and 2017 with an Impella microaxial pump, who met the IABP-Shock II-trials inclusion/exclusion criteria in order to determine whether standardised use of an Impella microaxial flow-pump in AMI-CS is associated with lower than predicted mortality rates and whether timing of implantation or selecting patients based on predicted risk is meaningful.

Methods

We analyzed data from 166 consecutive AMI-CS patients meeting the inclusion/exclusion criteria of the IABP-Shock II-trial (age 65±12 years), who received an Impella microaxial pump and compared observed vs. individually predicted mortality using CardShock-, Shock II-, and SAVE-scores. 39% (n=65) had been resuscitated before Impella implantation.

Results

Overall 30-day mortality was 43%. Mortality was higher in resuscitated patients (50% vs. 36%, p=0.0324) and when Impella was implanted post-PCI (Impella-pre-PCI: 29%, Impella-post-PCI: 50%, p=0.0130). In all score systems predicted mortality was significantly higher than observed mortality on Impella support for individuals with highest predicted risk (IABP-Shock II predicted 77% vs observed 44%, p=0.010; CardShock predicted 77% vs observed 51%, p=0.017; SAVE predicted 81% vs observed 56%, p<0.001).

Conclusion

In the absence of prospective trials, our retrospective analysis encourages the use of active mechanical circulatory support by Impella microaxial pumps in high-risk patients with AMI-CS and supports the concept of early implantation prior to PCI.

Defect-Induced Water Bilayer Growth on Anatase TiO2(101)

Preparing an anatase TiO₂(101) surface with a high density of oxygen vacancies and associated reduced Ti species in the near-surface region results in drastic changes in the water adsorption chemistry compared to adsorption on a highly stoichiometric surface. Using synchrotron radiation excited photoelectron spectroscopy, we observe a change in the water growth mode, from layer-by-layer growth on the highly stoichiometric surface to bilayer growth on the reduced surface. Furthermore, we have been able to observe Ti³⁺ enrichment at the surface upon water adsorption. The Ti³⁺ enrichment occurs concomitant with effective water dissociation into hydroxyls with a very high thermal stability. The water bilayer on the reduced surface is thermally more stable than that on the stoichiometric surface, and it is more efficient in promoting further water dissociation upon heating. The results thus show how the presence of subsurface defects can alter the wetting mechanism of an oxide surface.

Human Cerebellar Sub-millimeter Diffusion Imaging Reveals the Motor and Non-motor Topography of the Dentate Nucleus

The reciprocal cortico-cerebellar loops that underlie cerebellar contributions to motor and cognitive behavior form one of the largest systems in the primate brain. Work with non-human primates has shown that the dentate nucleus, the major output nucleus of the cerebellum, contains topographically distinct connections to both motor and non-motor regions, yet there is no evidence for how the cerebellar cortex connects to the dentate nuclei in humans. Here we used in-vivo sub-millimeter diffusion imaging to characterize this fundamental component of the cortico-cerebellar loop, and identified a pattern of superior motor and infero-lateral non-motor connectivity strikingly similar to that proposed by animal work. Crucially, we also present first evidence that the dominance for motor connectivity observed in non-human primates may be significantly reduced in man - a finding that is in accordance with the proposed increase in cerebellar contributions to higher cognitive behavior over the course of primate evolution.

Analysis of Minimally Invasive Left Thoracotomy HVAD Implantation – A Single-Center Experience

Background Minimally invasive left ventricular assist device (LVAD) implantation may reduce peri-/postoperative complications and risks associated with resternotomies. In this study, we describe our first results using a minimally invasive LVAD implantation technique (lateral thoracotomy [LT] group). These results were compared with LVAD implantations done via full median sternotomy (STX group).

Methods HVAD (HeartWare, Framingham, Massachusetts, United States) implantations in 70 patients (LT group n = 22, 52 ± 15 years old; STX group n = 48, 59 ± 11 years old) were retrospectively analyzed. Minimally invasive access via left thoracotomy was feasible in 22 patients. Peri- and postoperative analyses of survival and adverse events were performed.

Results No survival differences were observed between the LT and STX group (p = 0.43). LT patients without temporary right ventricular assist device (tRVAD) showed a significantly better survival rate compared to LT patients with concomitant tRVAD implantation (p = 0.02), which could not be demonstrated in the STX group (p = 0.11). Two LT and four STX patients were successfully bridged to heart transplantation and three STX patients were successfully weaned with subsequent LVAD explantations. LVAD-related infections (n = 4 LT group vs n = 20 STX group, p = 0.04) were less likely in the LT group. No wound dehiscence occurred in the LT group, whereas five were observed in the STX group (p = 0.17). The amount of perioperative blood transfusions (within the first 7 postoperative days) did not differ in both study groups (p = 0.48).

Conclusion The minimally invasive approach is a viable alternative with the possibility to reduce complications and should be particularly considered for bridge-to-transplant patients.

A randomized, controlled, double-blind, multi-center trial to evaluate the efficacy and safety of a liquid containing ivy leaves dry extract (EA 575®) vs. placebo in the treatment of adults with acute cough

This randomized, placebo-controlled, double-blind trial was conducted to assess the efficacy and safety of ivy leaves cough liquid in the treatment of acute cough. A total of 181 adult patients with acute cough were treated with either ivy leaves cough liquid containing EA 575® or with placebo three times a day for one week. The primary efficacy outcome was cough severity (CS) assessed by Visual Analogue Scale (VAS) over the whole treatment period (area-under-the-curve (AUC0-168 h) over 7 days (visit (V)1, V2, V3, V4, and V5). The secondary endpoints were defined as the CS assessed by VAS over the whole observation period (V1 - V6) and by Bronchitis Severity Score (BSS) and Verbal Category Descriptive (VCD) score. The evaluation of the VAS, BSS and VCD score revealed that subjects treated with ivy leaves cough liquid showed statistically significant and clinically relevant reductions in CS, severity of symptoms associated with cough and bronchitis compared to the placebo group. Furthermore, a remarkable early onset of efficacy was observed as significant reductions of cough severity were detected within 48 hours after the first drug intake. At all following visits and even 7 days after the end of treatment (V6) this significant treatment advantage was detected in comparison to placebo. All adverse events (AEs) in this clinical trial were non-serious, mild or of moderate severity and not drug-related. This clinical trial proved consistent superiority of the ivy leaves cough liquid treatment versus placebo and confirmed the EA 575® preparation to be a safe and efficacious option for the treatment of acute cough.

Die Strahlenexposition des Patienten durch die Transmissionsmessung bei der Myokardperfusions-SPECT

Ziel: Ziel war die Bestimmung der Strahlenexposition des Patienten durch die Transmissionsmessung bei der Myokardperfusions-SPECT. Methode und Material: Simultan zur Emissionsmessung (Tc-99m-MIBI, A = 500 MBq) erfolgt bei der Myokardperfusions-SPECT eine Transmissionsmessung mit Hilfe einer Am-241-Linienquelle (A = 5550 MBq). Bei der Simulation der Myokardperfusions-SPECT (ohne Tc-99m-MIBI) wurden Dosismessungen mit Thermolumineszenzdosimetem unter Verwendung eines Thoraxphantoms durchgeführt. Ergebnisse: Bei einer Aufnahmedauer von 20 min ergaben sich folgende Energiedosen: Oberfläche (Xyphoid) 30 μGy, Herz 25 μGy, Lunge 14 μGy, 2. BWK 16 μGy, oberes anteriores Mediastinum 16 μGy, Leber 0 μGy. Eine Abschätzung des Verhältnisses zwischen den effektiven Dosen durch Transmissions- und Emissionsmessung (3,6 x 10-3 bzw. 4,1 mSv) ergab einen Wert von 9 x 10-4. Schlußfolgerung: Die Strahlenexposition des Patienten durch die Transmissionsmessung ist vernachlässigbar gering und damit kein limitierender Faktor im Hinblick auf die generelle Anwendung der Transmissionsmessung bei der klinischen Myokardperfusions-SPECT.

Radiation exposure to the patient caused by single-photon transmission measurement for 3D whole-body PET

Aim: The aim of the study was the determination of the radiation exposure to the patient caused by singlephoton transmission mesasurement for 3D whole-body PET. Material and Method: Single-photon-transmission measurement is performed using two Cs-137 pointsources (Eγ = 662 keV, A = 2*614 MBq) on a 3D PET scanner (ECAT ART). During a simulation of a whole body transmission scan (axial length: 75 cm, 6 contigous bed positions) dose measurements with thermoluminescent dosimeters were carried out using a thorax and an abdomen phantom. Following the guidelines of the ICRU report No. 60 an estimation of the effective dose caused by a single-photon transmission measurement was calculated. Results: For a total acquisition time of 360 min (6 beds with an acquisition time of 60 min per bed) the absorbed doses amounted to: surface (xyphoid) 189 μGy, heart 196 μGy, lungs 234 μGy, vertebra 240 μGy, liver 204 μGy, gonads 205 μGy, thyroid 249 μGy and bladder 185 μGy resulting in a conversion factor of 1.7*10–4 mSv/( h*MBq). The estimation of the effective dose for a patient’s transmission (acquisition time of 3.2 min per bed) yields a value of 11 μSv. An estimation of the ratio of the conversion factors for transmission measurements in single-photonand in coincidence mode (two Ge-68/Ga-68 rod sources of 40 MBq each), respectively, resulted in a value of 0.18. The comparison of the effective doses caused by single-photon transmission and by emission measurement (injection of 250 MBq of FDG) yields a ratio of 2.3*10–3. Conclusion: The radiation exposure of the patient caused by the transmission measurement for 3D whole-body-PET can be neglected. In comparison with the coincidence-transmission using uncollimated line sources of low activity the radiation exposure is still reduced using single photon transmission with collimated point sources of high activity.

Physical aspects of scintigraphybased dosimetry for nuclear medicine therapy

In nuclear medicine therapy the treatment of tumours by radiation exposure from internally deposited labelled antibodies or labelled peptides is currently an active field of investigation. To permit the efficient delivery of high amounts of radiation dose to tumours while limiting the radiation dose to critical organs dosimetry calculations have to be performed. These are relying on scintigraphic data being input to the well known MIRD formalism.

This paper focuses on the methods and the difficulties associated with the scintigraphic determination of organ kinetics. The physical properties of the well-known scintigraphic imaging modalities, PET, SPECT and planar scintigraphy, are discussed thereby taking into account the properties of the appropriate radionuclides currently being available for therapy and dosimetry. Several arguments are given and disputed for the limited clinical use of PET and SPECT in dosimetry and the ongoing preference of planar whole-body imaging as the method of choice. The quantitative restrictions still inherent to this method are also discussed in detail. Procedural recommendations are proposed covering all processes related to data acquisition, data correction and data analysis which finally lead to reliable estimations of organ dose.

Para-[123I]iodo-L-phenylalanine in patients with pancreatic adenocarcinoma

Recently, p-[123I]iodo-L-phenylalanine (IPA) was clinically validated for brain tumour imaging. Preclinical studies demonstrated uptake of IPA into pancreatic adenocarcinoma suggesting its diagnostic application in patients with pancreatic tumours. The aim was to study the tumour uptake of IPA in patients with pancreatic adenocarcinoma and to analyse its biodistribution and dosimetry to assess the radiation dose resulting from its diagnostic use. Patients, methods: Seven patients with pancreatic adenocarcinoma underwent whole-body scintigraphies and SPECT up to 24 h after administration of 250 MBq of IPA. Tumour uptake of IPA was assessed visually. Time activity curves and the corresponding residence times were determined for whole-body, kidneys, liver, spleen, lung, heart content, brain, and testes. Mean absorbed doses for various organs and the effective dose were assessed based on the MIRD formalism using OLINDA/EXM. Results: IPA exhibited no accumulation in proven manifestations of pancreatic adenocarcinomas. IPA was exclusively eliminated by the urine and showed a delayed clearance from blood. Residence times were 0.26 ± 0.09 h for kidneys, 0.38 ± 0.19 h for liver, 0.15 ± 0.07 h for spleen, 0.51 ± 0.20 h for lungs, 0.22 ± 0.07 h for heart content, 0.11 ± 0.05 h for brain, 0.014 ± 0.005 h for testes and 6.4 ± 2.2 h for the remainder. The highest absorbed doses were determined in the urinary bladder wall and in the kidneys. According to the ICRP 60 the effective dose resulting from 250 MBq IPA was 3.6 ± 0.7 mSv. Conclusion: Para-[123I]iodo-L-phenylalanine can be used in diagnostic nuclear medicine with acceptable radiation doses. Besides its proven validity for brain tumour imaging, IPA does not appear to be suitable as tracer for pancreatic cancer.

From Maps to Multi-dimensional Network Mechanisms of Mental Disorders

The development of advanced neuroimaging techniques and their deployment in large cohorts has enabled an assessment of functional and structural brain network architecture at an unprecedented level of detail. Across many temporal and spatial scales, network neuroscience has emerged as a central focus of intellectual efforts, seeking meaningful descriptions of brain networks and explanatory sets of network features that underlie circuit function in health and dysfunction in disease. However, the tools of network science commonly deployed provide insight into brain function at a fundamentally descriptive level, often failing to identify (patho-)physiological mechanisms that link system-level phenomena to the multiple hierarchies of brain function. Here we describe recently developed techniques stemming from advances in complex systems and network science that have the potential to overcome this limitation, thereby contributing mechanistic insights into neuroanatomy, functional dynamics, and pathology. Finally, we build on the Research Domain Criteria framework, highlighting the notion that mental illnesses can be conceptualized as dysfunctions of neural circuitry present across conventional diagnostic boundaries, to sketch how network-based methods can be combined with pharmacological, intermediate phenotype, genetic, and magnetic stimulation studies to probe mechanisms of psychopathology.

Integration of Murine and Human Studies for Mapping Periodontitis Susceptibility

Periodontitis is one of the most common inflammatory human diseases with a strong genetic component. Due to the limited sample size of available periodontitis cohorts and the underlying trait heterogeneity, genome-wide association studies (GWASs) of chronic periodontitis (CP) have largely been unsuccessful in identifying common susceptibility factors. A combination of quantitative trait loci (QTL) mapping in mice with association studies in humans has the potential to discover novel risk loci. To this end, we assessed alveolar bone loss in response to experimental periodontal infection in 25 lines (286 mice) from the Collaborative Cross (CC) mouse population using micro-computed tomography (µCT) analysis. The orthologous human chromosomal regions of the significant QTL were analyzed for association using imputed genotype data (OmniExpress BeadChip arrays) derived from case-control samples of aggressive periodontitis (AgP; 896 cases, 7,104 controls) and chronic periodontitis (CP; 2,746 cases, 1,864 controls) of northwest European and European American descent, respectively. In the mouse genome, QTL mapping revealed 2 significant loci (-log P = 5.3; false discovery rate = 0.06) on chromosomes 1 ( Perio3) and 14 ( Perio4). The mapping resolution ranged from ~1.5 to 3 Mb. Perio3 overlaps with a previously reported QTL associated with residual bone volume in F2 cross and includes the murine gene Ccdc121. Its human orthologue showed previously a nominal significant association with CP in humans. Use of variation data from the genomes of the CC founder strains further refined the QTL and suggested 7 candidate genes ( CAPN8, DUSP23, PCDH17, SNORA17, PCDH9, LECT1, and LECT2). We found no evidence of association of these candidates with the human orthologues. In conclusion, the CC populations enabled mapping of confined QTL that confer susceptibility to alveolar bone loss in mice and larger human phenotype-genotype samples and additional expression data from gingival tissues are likely required to identify true positive signals.

Nanoscale analysis of the oxidation state and surface termination of praseodymium oxide ultrathin films on ruthenium(0001)

The complex structure and morphology of ultrathin praseodymia films deposited on a ruthenium(0001) single crystal substrate by reactive molecular beam epitaxy is analyzed by intensity-voltage low-energy electron microscopy in combination with theoretical calculations within an ab initio scattering theory. A rich coexistence of various nanoscale crystalline surface structures is identified for the as-grown samples, notably comprising two distinct oxygen-terminated hexagonal Pr₂O₃(0001) surface phases as well as a cubic Pr₂O₃(111) and a fluorite PrO₂(111) surface component. Furthermore, scattering theory reveals a striking similarity between the electron reflectivity spectra of praseodymia and ceria due to very efficient screening of the nuclear charge by the extra 4f electron in the former case.