Adjuvant Docetaxel in Node-Negative Breast Cancer Patients: A Randomized Trial of AGO-Breast Study Group, German Breast Group, and EORTC-Pathobiology Group

BACKGROUND

In node-negative breast cancer (NNBC), a high risk of recurrence is determined by clinico-pathological or tumor-biological assessment. Taxanes may improve adjuvant chemotherapy.

METHODS

NNBC 3-Europe, the first randomized phase-3 trial in node-negative breast cancer (BC) with tumor-biological risk assessment, recruited 4146 node-negative breast cancer patients from 2002 to 2009 in 153 centers. Risk assessment was performed by clinico-pathological factors (43%) or biomarkers (uPA/PAI-1, urokinase-type plasminogen activator/its inhibitor PAI-1). High-risk patients received six courses 5-fluorouracil (500 mg/m²), epirubicin (100 mg/m²), cyclophosphamide (500 mg/m²) (FEC), or three courses FEC followed by three courses docetaxel 100 mg/m² (FEC-Doc). Primary endpoint was disease-free survival (DFS).

RESULTS

In the intent-to-treat population, 1286 patients had received FEC-Doc, and 1255 received FEC. Median follow-up was 45 months. Tumor characteristics were equally distributed; 90.6% of tested tumors had high uPA/PAI-1-concentrations. Planned courses were given in 84.4% (FEC-Doc) and 91.5% (FEC). Five-year-DFS was 93.2% (95% C.I. 91.1-94.8) with FEC-Doc and 93.7% (91.7-95.3) with FEC. Five-year-overall survival was 97.0% (95.4-98.0) for FEC-Doc and 96.6% % (94.9-97.8) for FEC.

CONCLUSIONS

With adequate adjuvant chemotherapy, even high-risk node-negative breast cancer patients have an excellent prognosis. Docetaxel did not further reduce the rate of early recurrences and led to significantly more treatment discontinuations.

NCALD as a potential predictive biomarker for the efficacy of platinum-based chemotherapy in ovarian cancer

Aim: Since reliable response predictors to platinum-based chemotherapy in ovarian cancer (OC) are scarce, we characterize NCALD as a predictive biomarker. Materials & methods: NCALD mRNA (n = 100) and protein (n = 102) expression was analyzed in OC samples and associated with patient outcome. A stable OC cell line knockdown was generated and cellular response to platinum was explored. Results: High NCALD mRNA and protein expression was significantly associated with longer overall patient survival (p = 0.037/0.002). Knockdown experiments revealed a significant association between cisplatin sensitivity and NCALD expression. Conclusion: Low NCALD expression was associated with reduced sensitivity to platinum-based chemotherapy. NCALD may be a new biomarker candidate to identify patients who might benefit from platinum-based chemotherapy.

Lehramt-Studienwahlmotivation sagt Zielorientierungen vorher, pädagogisches Wissen und selbst eingeschätzte Kompetenz aber nur teilweise

Zusammenfassung. In Studie 1 wurde die Validität des Fragebogens FEMOLA (Fragebogen zur Erfassung der Motivation für die Wahl des Lehramtsstudiums) durch Überprüfung der internen Struktur untersucht. Hierzu wurden anhand von Daten von N = 1467 Lehramtsstudierenden zwei in der Literatur vorgeschlagene Faktorenstrukturen verglichen, wobei sich zeigte, dass eine Lösung mit sieben Faktoren besser zu den Daten passte als die ursprünglich vorgeschlagene Lösung mit sechs Faktoren. Anschließend wurde die Messinvarianz über nach angestrebter Schulform gebildete Gruppen von Lehramtsstudierenden (Grundschule, Förderschule, Sekundarstufe I und Gymnasium) untersucht; hier konnte schwache Invarianz (gleiche Faktorladungen) festgestellt werden. In Studie 2 wurde anhand von Längsschnittdaten ( N = 442) untersucht, ob pädagogisches Wissen und selbst eingeschätzte Unterrichtskompetenz bei Lehramtsstudierenden anhand der Studienwahlmotivation und Zielorientierungen (Lernziele, Annäherungs- und Vermeidungs-Leistungsziele sowie Arbeitsvermeidung) vorhergesagt werden können. Dabei wurde mittels eines Strukturgleichungsmodells u.a. die Annahme geprüft, dass die Effekte der Studienwahlmotivation durch die Zielorientierungen vermittelt werden; der Einfluss von Intelligenz wurde kontrolliert. Erwartungskonform war die Studienwahl aus intrinsischer Motivation mit einer höheren Lernzielorientierung und einer niedrigeren Tendenz zur Arbeitsvermeidung verbunden; die Studienwahl aus extrinsischer Motivation hingegen mit höheren Ausprägungen von Annäherungs- und Vermeidungs-Leistungszielen sowie einer stärkeren Tendenz zur Arbeitsvermeidung. Die durch die Zielorientierungen vermittelten Pfade von den Studienwahlmotivations-Faktoren zu den Kriterien erwiesen sich jedoch weitgehend als nicht signifikant. Beide Kriterien waren zudem nur schwach miteinander korreliert und für Intelligenz ergab sich nur mit dem pädagogischen Wissen ein signifikanter Zusammenhang. Ursachen für diese Befunde und Abweichungen von vorliegenden Studien werden diskutiert.

[Voiding dysfunction after TVT: A 20-year experience TVT-placement under local anesthesia and sedation]

BACKGROUND

Trans-vaginal tape has become the gold standard for the cure of urinary stress incontinence, but post-operative voiding dysfunction is frequently reported. The purpose of this study is to assess the incidence of voiding dysfunction, dysuria, chronic urinary retention, and necessity of reoperation after retropubic TVT placement under local anaesthesia and sedation.

MATERIAL AND METHOD

We perform a retrospective study of a cohort of patient treated with the placement of a retropubic TVT under local anaesthesia and sedation between 1999 and 2019 for a SUI. Post-operative voiding dysfunction and necessity of reoperation were reviewed to access the principal aim of this study.

RESULTS

Three hundred and two patients who met the eligibility criteria were included in the study. At 3 months, the dysuria rate and chronic urinary retention rate was 4.3% and 1%. At 12 months it was 2.6% and 0.3% respectively. The 12-month sling section rate was 1% and long-term self-catherization rate was 0.3%. The objective cure rate was 93% and subjective cure was 92%.

CONCLUSION

TVT placement under local anaesthesia and sedation resulted in few voiding dysfunctions at medium/long-term, necessity of re-operation for refractory obstructive disorder and well functional results. Even if these results support more frequent use of this type of anaesthesia, it would be interesting to be able to follow them in a prospective study to conclude.

LEVEL OF EVIDENCE

4.

A school rampage threatens beliefs in justice: A longitudinal study of the belief in a just world among Chinese adolescents

INTRODUCTION

The current study examined whether and how severe injustice such as a school attack threatens the belief in a just world (BJW).

METHOD

We collected longitudinal data on the BJW from adolescents in China who witnessed random school attacks on the news (N = 227).

RESULTS

Change analyses provided evidence that the BJW increased after witnessing severe injustice. Furthermore, we tested for moderating effects of buffer variables, such as life satisfaction and perceived social support, on change in the BJW. Findings showed that these variables buffered the threat to the BJW after observing unfairness.

DISCUSSION

We discuss these results in the context of justice motive theory and suggest implications for future research and practical implications.

POS1129 OPTIMIZATION OF DUAL ENERGY COMPUTED TOMOGRAPHY POST-PROCESSING TO REDUCE LOWER LIMB ARTIFACTS IN GOUT

Background:

Dual energy computed tomography (DECT) is highly accurate for the diagnosis of gout. However, many artifacts have been described (1,2) such as nail bed, skin, beam hardening, sub-millimeter and vascular artifacts). Their presence can lead to a risk of over-diagnosis (false positives).

Objectives:

Main objective of this case-control study was to determine the optimal DECT settings post-treatment parameters (ratio and attenuation coefficient (HU)) in order to reduce the frequency of lower limb artifacts in patients with suspected gout of the lower limbs.

Methods:

Seventy-seven patients hospitalized for suspected gout arthritis (feet/ankles and/or knees) who received a DECT imaging were consecutively included (final diagnosis of 43 gout and 34 other rheumatic disorders). Different post-treatment settings were evaluated from the Syngovia software: an R1 (standard) setting with a ratio at 1.36 and minimum attenuation at 150 HU; an R2 setting with a ratio at 1.28 and minimum attenuation at 170 HU and an R3 setting with a ratio at 1.28 and minimum attenuation at 120 HU. The frequency of each artifact according to the 3 settings was determined. Diagnostic accuracy of R1 and R2 settings has been calculated. Correlations between artefacts and patient’s clinical characteristics were obtained by performing a Spearman test.

Results:

The R2 setting (170 HU, ratio=1.28) significantly reduced the presence of knee and foot/ankle artifacts compared to the standard R1 setting (85% and 94% decrease in beam hardening and clumpy artifacts in the ankle and foot, respectively (p < 0.001); a decrease of 71%, 60% and 88% respectively of meniscal beam hardening, beam hardening and submillimeter artifacts in the knee (p < 0.001). The use of R3 setting lead to a significant increase of some artifacts (clumpy artifacts, skin artifacts, beam hardening and nail beds.). In addition, our results found a positive correlation between the presence of deposits of knee menisci beam hardening chondrocalcinosis. Body mass index was also positively correlated with the presence of knee beam hardening artifact. Compared to standard setting, the use of R2 settings decreased sensitivity (0.79 [95CI: 0.65;0.88] versus 0.90 [95CI: 0.78;0.96] and increased specificity (0.86 [95CI: 0.71;0.93) versus 0.63 [95CI: 0.47;0.77] (p<0.001).

Conclusion:

Applying a ratio of 1.28 and a minimum attenuation of 170 HU (R2 settings) in DECT post-processing eliminates the majority of the artifacts located on the lower limbs, particularly the clumpy artifact and the beam hardening artifact.

References:

[1]Neogi T, Jansen TLTA, Dalbeth N, Fransen J, Schumacher HR, Berendsen D, et al. 2015 Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis. 2015;74:1789-98.

[2]Mallinson PI, Coupal T, Reisinger C, Chou H, Munk PL, Nicolaou S, et al. Artifacts in dual-energy CT gout protocol: a review of 50 suspected cases with an artifact identification guide. AJR 2014;203:W103-109.

Disclosure of Interests:

None declared.

Physical Fitness and Motor Competence in Chinese and German Elementary School Children in Relation to Different Physical Activity Settings

(1) Background: Children with greater physical activity (PA) may show a higher physical fitness (PF) and motor competence (MC) compared to peers with less PA. The purpose of this study was to examine the relationship between moderate-to-vigorous physical activity (MVPA), PF, and MC in 8- to 9-year old children in Germany and China. MVPA was differentiated into five PA settings: family sport, club training, school sport, leisure sport, and outside play. (2) Methods: This longitudinal study comprised N = 577 children (n = 311 girls, n = 266 boys) who were studied over a one-year period. Each child's PF and MC was determined using sports motor tests. The children's PAs were measured using a questionnaire. (3) Results: The children's PA was positively associated with PF and MC. The MVPA-settings: family sport, leisure sport, outside play, school, and club sport, explained between 18 and 23 percent of the variance in selected PF and MC characteristics in a multivariate linear regression analysis. (4) Conclusions: An increase in the children's MVPA might be an appropriate aim in the school sport in Germany as well as in the club sport system in China. Furthermore, family sport should be enhanced in Germany and outside play activities in China, respectively.

The Chemokine CX3CL1 Improves Trastuzumab Efficacy in HER2 Low-Expressing Cancer In Vitro and In Vivo

A crucial mode of action of trastuzumab is the labeling of HER2-positive (HER2⁺) tumor cells for the eradication by natural killer (NK) cells, a process called antibody-dependent cellular cytotoxicity (ADCC). However, despite widespread HER2 expression among cancer entities, only a fraction, with robust HER2 overexpression, benefits from trastuzumab therapy. ADCC requires both sufficient lymphocytic infiltration and close binding of the immune cells to the antibody-tagged tumor cells. We hypothesized that the chemokine CX3CL1 could improve both processes, as it is synthesized as a membrane-bound, adhesive form that is eventually cleaved into a soluble, chemotactic protein. Here, we show that CX3CL1 overexpression is a positive prognostic marker in breast cancer. CX3CL1 overexpression attracted tumor-suppressive lymphocytes, including NK cells, and inhibited tumor growth and lung metastasis in the syngeneic 4T1 breast cancer mouse model. In HER2⁺ SKBR3, MDA-MB-453, and HT-29 tumor cells, CX3CL1 overexpression increased NK cell-mediated cytotoxicity in vitro and acted synergistically with trastuzumab. Even though CX3CL1 did not further improve trastuzumab efficacy in vivo in the trastuzumab-sensitive MDA-MB-453 model, it compensated for NK-cell depletion and prolonged survival. In the HER2 low-expressing HT-29 model, however, CX3CL1 overexpression not only prolonged survival time but also overcame trastuzumab resistance in a partly NK cell-dependent manner. Taken together, these findings identify CX3CL1 as a feasible pharmacologic target to enable trastuzumab therapy in HER2 low-expressing cancers and render it a potential predictive biomarker to determine therapy responders.

Disorder-Free Localization in an Interacting 2D Lattice Gauge Theory

Disorder-free localization has been recently introduced as a mechanism for ergodicity breaking in low-dimensional homogeneous lattice gauge theories caused by local constraints imposed by gauge invariance. We show that also genuinely interacting systems in two spatial dimensions can become nonergodic as a consequence of this mechanism. This result is all the more surprising since the conventional many-body localization is conjectured to be unstable in two dimensions; hence the gauge invariance represents an alternative robust localization mechanism surviving in higher dimensions in the presence of interactions. Specifically, we demonstrate nonergodic behavior in the quantum link model by obtaining a bound on the localization-delocalization transition through a classical correlated percolation problem implying a fragmentation of Hilbert space on the nonergodic side of the transition. We study the quantum dynamics in this system by introducing the method of "variational classical networks," an efficient and perturbatively controlled representation of the wave function in terms of a network of classical spins akin to artificial neural networks. We identify a distinguishing dynamical signature by studying the propagation of line defects, yielding different light cone structures in the localized and ergodic phases, respectively. The methods we introduce in this work can be applied to any lattice gauge theory with finite-dimensional local Hilbert spaces irrespective of spatial dimensionality.

Proposal of Measurement Occasions for Unbiased Evaluation of Psychotherapy

Studies complementing the assessment of symptoms right before (t1), right after therapy (t2), and at follow-up (t3) with an assessment of symptoms preceding the waiting period without intervention (t0) have revealed substantial t0–t1 changes. We discuss this phenomenon based on our own data and address the following questions: does it make sense to compare symptoms at the beginning of therapy (t1) with symptoms at the end of therapy (t2) or at follow-up (t3)? Or does it make more sense to use t0 instead of t1? We argue for the latter alternative based on the following reasons. (1) Symptom descriptions at t0 are realistic. (2) Expecting therapy success mitigates symptom descriptions at t1. (3) Security signals emitted from the therapy context also mitigate symptoms, especially anxiety, at t1. (4) Regression toward the mean reduces the validity of single occasion assessments. Controlling for regression requires two occasions of measurement with a short time interval at t0 (t01 and t02). It follows from this reasoning that therapy success should be evaluated using the t02–t2 and t02–t3 intervals. Single case evaluations require reliable critical differences. This will be illustrated using a concrete example. The validity of treatment evaluation can be increased via the elimination of non-pathological symptom scores. A simplified calculation of cut-off scores can facilitate applied treatment evaluation. Unspecific t0–t1 changes do not challenge therapy effects according to t1–t2 changes. Rather, they are part of the whole therapy process.

Risk stratification and prognostic value of CMR in DCM; parametric mapping and GLS- value beyond EF and LGE?

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Dr Pamela Brown was suppoerted by funding from Alliance Medical.

Background; Arrhythmia risk stratification and device implantation in dilated cardiomyopathy (DCM) poses significant challenges and as demonstrated by the DANISH trial appears to have reached the asymptote of clinical efficacy. A body of evidence now demonstrates that risk stratification of and device selection for DCM patients may be enhanced by inclusion of patients" LGE-status. Furthermore, it has been suggested that CMR based parametric mapping and strain analysis may further advance risk stratification.

Methods; 703 patients with DCM undergoing clinically indicated CMR scans and prospectively enrolled into the UHSM-CMR study (NCT02326324) between 03/2015-12/2018 were analysed. Multivariable Cox proportional hazard models and Youden index driven C-statistics were used to assess additive prognostic value of GLS, T1 and ECV mapping on the combined endpoint of cardiovascular death, cardiac transplantation, LVAD  insertion  or hospitalisation for heart failure in models incorporating NHYA class, EF and LGE status. Additionally. the value of GLS, T1, and ECV on predicting significant arrhythmic events (SAV) (ventricular arrhythmia (VA), resuscitated cardiac arrest (rCA) or sudden cardiac death (SCD)) was assessed.

Results; Patients (mean age 59, 66% male, 60% ≥NYHA II, mean EF 42%, mean GLS -12%, mean ECV 27%) were on good medical therapy (beta blocker 74%%, ACE 79%, MRA 38%, Entresto 5%, CRT 23%). Mean follow-up was 21 months; the combined endpoint occurred in 34 patients (5%). On univariate analysis NYHA class (HR 2.44 (1.67-3.57), p &lt; 0.001), ECV (HR 1.14 (1.05-1.22), p &lt; 0.001), GLS% (HR 1.14 (1.07-1.21) p &lt; 0.001,) T1 (HR 1.06 (1.005-1.1), p = 0.03), RVEF (HR 0.95 (0.93-0.98), p &lt; 0.001), LVEF (HR 0.92 (0.9-0.95), p &lt; 0.001) were all significantly associated with outcome. On multivariate analysis only EF and NYHA class was associated with outcome.

SAV occurred as the first manifestation of disease or during follow up in 27 patients (4%). At univariate analysis LGE, ECV, GLS, EF and NYHA class were all associated with SAV. However, on multivariable analysis only EF, LGE  and ECV (HR 1.11 (1.01-1.22), p = 0.03) but not GLS remained independently predictive in a model already incorporating EF, NYHA and LGE.

Conclusion

Optimally treated DCM populations have very low event rates. CMR based assessment of fibrosis status/burden with both LGE and ECV assessment has the potential to enhance patient selection for ICD therapy. Whilst GLS is increasingly recognised as a sensitive imaging biomarker of early disease detection it provides no additive value,  likely because of it’s high co-linearity with EF, in models already containing EF, NYHA class and LGE status.

Geeignete Messzeitpunkte in der Psychotherapieevaluation: Ein Vorschlag

Untersucht man Therapieverläufe nicht nur zwischen unmittelbarem Beginn und Beendigung, können Fortschritte be­reits zwischen Anmeldung und Beginn, noch ohne Intervention, aufgezeigt werden. Diese t₀-t₁-Veränderungen werden anhand eigener Befunde diskutiert: Ist der Vergleich Beginn (t₁) – Ende der Therapie (t₂) bzw. Katamnese (t₃) sinnvoll, oder erfordert die angemessene Erfolgsbeurteilung nicht gerade Anmeldezeitpunkt t₀? Wir plädieren für t₀. (1) Anmeldung (t₀) impliziert eine ausgeprägte, realistische Symptomschilde­rung, (2) positive Erwartungen zur erfolgreichen Behandlung verbessern Messwerte zu t₁ (Aufnahme), (3) Aufnahmezeitpunkt t₁ ist durch Sicherheitssignale der Klinik/der Behandler beeinflusst, Patientenratings – z.B. bei Angst – sind geringer (Kontextfaktoren), (4) Regression zur Mitte relativiert die Aussagekraft eines Einzelmesszeitpunkts: Hohe Messwerte dort fallen zu einem zweiten Zeitpunkt geringer aus. Um dies zu kontrollieren, müssen zu t₀ (in geringem Abstand) 2 Messungen durchgeführt werden, nämlich t₀₁ und t₀₂. In der Praxis dient das Intervall t₀₂–t₂ zur geeigneten Erfolgsbeurteilung, aber auch t₀₂–t₃ sollte, wenn möglich, Auswertungsroutine sein. Einzelfallbeurteilungen erfordern die Berücksichtigung kritischer Differenzen, um messfehlerbereinigte Unterschiede zu sichern (Beispielerläuterung). Die Möglichkeit erweiterter Auswertung mittels Ausschluß nichtpathologischer Werte, der vereinfachten Auswertung mittels Cutoff-Bestimmung und einige Praxishinweise komplettieren die Arbeit. Unspezifische t₀–t₁-Veränderungen bedeuten keine Relativierung der Ergebnisse aktiver Intervention (t₁–t₂), sind vielmehr Bestandteil der Gesamttherapie.

A Multilab Replication of the Ego Depletion Effect

There is an active debate regarding whether the ego depletion effect is real. A recent preregistered experiment with the Stroop task as the depleting task and the antisaccade task as the outcome task found a medium-level effect size. In the current research, we conducted a preregistered multilab replication of that experiment. Data from 12 labs across the globe (N = 1,775) revealed a small and significant ego depletion effect, d = 0.10. After excluding participants who might have responded randomly during the outcome task, the effect size increased to d = 0.16. By adding an informative, unbiased data point to the literature, our findings contribute to clarifying the existence, size, and generality of ego depletion.

On the Road to the Unconscious Self: Understanding when People Gain Self–knowledge of Implicit Disgust Sensitivity from Behavioural Cues

On the basis of an integration of dual–process models of information processing and the lens model framework of person perception, we conducted two studies to investigate whether self–perceivers could detect their implicit disposition from video feedback of behavioural cues and whether these cues were used for explicit dispositional inferences under conditions that maximized the presumed self–perception process. Using an approach that differed from previous research, we used the following: (i) a more detailed and stepwise self–perception procedure; (ii) a specific explicit measure compared with a global explicit measure; and (iii) disgust sensitivity as a domain with clear, unambiguous cues and an assumed low self–presentation bias. The results from two studies (N = 117 and N = 130) on disgust sensitivity provide the first evidence for the assumed process with regard to bodily reaction cues but not with regard to facial expression cues. These novel findings suggest that people can get to know their unconscious selves better if supporting conditions are met and the right behavioural cues are attended to. Additional boundary conditions of this self–perception process were investigated using display rules and need for closure in Study 2. Copyright © 2013 John Wiley & Sons, Ltd.

Recommendations for Increasing Replicability in Psychology

Replicability of findings is at the heart of any empirical science. The aim of this article is to move the current replicability debate in psychology towards concrete recommendations for improvement. We focus on research practices but also offer guidelines for reviewers, editors, journal management, teachers, granting institutions, and university promotion committees, highlighting some of the emerging and existing practical solutions that can facilitate implementation of these recommendations. The challenges for improving replicability in psychological science are systemic. Improvement can occur only if changes are made at many levels of practice, evaluation, and reward. Copyright © 2013 John Wiley & Sons, Ltd.

Justice Sensitivity and the Processing of Justice–Related Information

We investigated how Justice Sensitivity (JS) shapes the processing of justice–related information. We proposed that due to frequently perceiving and ruminating about injustices, persons high in JS develop highly accessible and differentiated injustice concepts that shape attention, interpretation and memory for justice–related information. Three studies provided evidence for these assumptions. After witnessing injustice, persons high in JS attended more strongly to unjust stimuli than to negative control stimuli (Study1) and interpreted an ambiguous situation as less just than persons low in JS (Study2). Finally, they displayed a memory advantage for unjust information (Study3). Results suggest that JS involves the availability and accessibility of injustice concepts as parameters of cognitive functioning and offer explanations for effects of JS on justice–related behaviour. Copyright © 2010 John Wiley & Sons, Ltd.

The road to the unconscious self not taken: Discrepancies between self‐ and observer‐inferences about implicit dispositions from nonverbal behavioural cues

To what extent can individuals gain insight into their own or another person's implicit dispositions' We investigated whether self‐perceivers versus neutral observers can detect implicit dispositions from nonverbal behavioural cues contained in video feedback (cue validity) and whether these cues are in turn used as a valid basis for explicit dispositional inferences (cue utilization). Across three studies in the domains of extraversion and anxiety we consistently obtained reliable cue validity and cue utilization for neutral observers but not for self‐perceivers. An additional measure of state inferences in Study 3 showed that one reason for the lack of mediation in self‐perceivers is their reluctance to use their state inferences as a basis for more general trait inferences. We conclude that people have a ‘blind spot’ with respect to the nonverbal behavioural manifestations of their unconscious selves, even though neutral observers may readily detect and utilize this information for dispositional inferences. Copyright © 2009 John Wiley & Sons, Ltd.

Discrepancies between Implicit and Explicit Self–concepts of Intelligence Predict Performance on Tests of Intelligence

Three studies investigated the correspondence between implicit and explicit self–concepts of intelligence and how that correspondence is related to performance on different intelligence tests. Configurations of these two self–concepts were found to be consistently related to performance on intelligence tests in all three studies. For individuals who self–reported high intelligence (high explicit self–concept), a negative implicit self–concept (measured with the Implicit Association Test) led to a decrease in performance on intelligence tests. For participants whose self–report indicated a low self–concept of intelligence, positive automatic associations between the self and intelligence had a similar effect. In line with a stress hypothesis, the results indicate that any discrepant configuration of self–concepts will impair performance. Importantly, the prediction of performance on intelligence tests by the self–concept of intelligence was shown to be independent of self–esteem (Study 3). Copyright © 2011 John Wiley & Sons, Ltd.

Prevalence, correlates and prognostic relevance of mid-wall late gadolinium enhancement in patients with ischaemic cardiomyopathy

Background

LGE imaging is an established CMR imaging technique for the assessment of myocardial replacement fibrosis. The presence of mid-wall LGE has been described in ∼30% of patients with non-ischemic dilated cardiomyopathy and is known to be associated with poor outcome. Conversely, little is known regarding the clinical significance of mid-wall LGE in patients with ischemic cardiomyopathy (ICM). Aim of the present study was to investigate the prevalence, correlates and prognostic role of mid-wall late gadolinium enhancement (LGE) in a consecutive cohort of patients with ICM.

Methods

A total of 319 consecutive outpatients with ICM (mean age 64±11 years, 87% males) were included. All patients had CMR with LGE imaging and were followed for a median of 13 months. The outcome end-point was a composite of cardiovascular death, aborted sudden cardiac death, appropriate implantable cardioverter-defibrillator therapy, heart failure hospitalisations, implantation of left ventricular (LV) assist device or occurrence of heart transplant.

Results

Mean LV ejection was 37±9%, mean ischemic-type LGE expressed as % of LV mass was 16±9%, while mid-wall LGE was observed in 32 (10%) patients. LVEDV index (OR 1.02, 95% CI 1.01–1.03, p=0.001) and LV sphericity index (OR 1.04, 95% CI 1.01–1.07, p=0.024) were the only variables significantly and independently related to the presence of mid-wall LGE. The outcome end-point was documented in 37 (12%) patients. Ischemic-type LGE expressed as % of LV mass (HR 1.04, 95% CI 1.01–1.08; p=0.015) and the presence of mid-wall LGE (HR 4.5, 95% CI 2.2–9.2; p&lt;0.001) were the only independent predictors of the composite outcome. Mid-wall LGE had significant incremental predictive value compared to the extent of ischemic-type LGE (Δχ2=16.5, p&lt;0.001). The Kaplan-Meier survival curves showing survival from the composite end-point according to the presence/absence of mid-wall LGE in patients with ischemic-type LGE expressed as % of LV mass &lt; the median value 14.6% and. ≥14.6% are shown in the Figure.

Conclusions

Mid-wall LGE is observed in a substantial minority of patients with ICM. In this population, the presence of mid-wall LGE is associated with adverse LV remodeling and worse prognosis.

Figure 1

Funding Acknowledgement

Type of funding source: None

Adenosine stress native T1 mapping demonstrates impaired myocardial perfusion reserve in non-ischemic dilated cardiomyopathy

Background

Impaired myocardial perfusion reserve has been demonstrated in non-ischemic dilated cardiomyopathy (NIDCM) by positron emission tomography (PET) and adenosine-stress first-pass perfusion cardiac magnetic resonance (CMR) imaging. Adenosine stress native T1 mapping is a novel CMR technique able to assess myocardial perfusion without the use of contrast agents. The aim of the present study was to determine the clinical utility of this novel CMR technique in NIDCM.

Methods

A total of 20 consecutive patients (mean age 61±12 years, 80% males) with diagnosis of NIDCM who consented to be enrolled in the UHSM CMR registry were included in the present study. CMR at 3T including 1. cine imaging for the assessment of LV volumes, mass and global longitudinal strain (GLS) by tissue-tracking imaging; 2. rest and stress (adenosine 140 mcg/kg/min) MOLLI T1 mapping of mid-ventricular slice for the assessment of rest and stress T1 values and T1 reactivity (ΔT1%); 3. first-pass perfusion imaging for the assessment of myocardial perfusion reserve index (MPRI) and 4. late gadolinium enhancement (LGE) imaging for the assessment of myocardial replacement fibrosis, was performed. Twenty control patients without history of known coronary artery disease and evidence of reversible ischemia or previous myocardial infarct on CMR imaging were included for comparison purposes.

Results

NIDCM patients had significantly higher native T1 value (1263±47 ms vs. 1234±38 ms, p=0.031), significantly lower ΔT1% (3.2±1.5% vs. 5.7±1.7%, p&lt;0.001, Figure A), significantly lower MPRI (1.32±0.18 vs. 1.67±0.13, p&lt;0.001) and significantly impaired GLS (−10±4% vs. −16±2%, p&lt;0.001) as compared to controls. A significant strong relation between ΔT1% and MPRI (β=0.76, p&lt;0.001, Figure B) and significant moderate relation between ΔT1% and GLS (β=−0.54, p&lt;0.001) were observed.

Conclusion

T1 reactivity, myocardial perfusion reserve and GLS are significantly reduced in NIDCM patients compared to controls. Adenosine stress T1 mapping holds promise for detection of impaired myocardial perfusion reserve in NIDCM without the requirement for contrast agents.

Funding Acknowledgement

Type of funding source: None

Side-effect management of chimeric antigen receptor (CAR) T-cell therapy

Chimeric antigen receptor (CAR) T cells directed against the B-cell marker CD19 are currently changing the landscape for treatment of patients with refractory and/or relapsed B-cell malignancies. Due to the nature of CAR T cells as living drugs, they display a unique toxicity profile. As CAR T-cell therapy is extending towards other diseases and being more broadly employed in hematology and oncology, optimal management strategies of side-effects associated with CAR T-cell therapy are of high relevance. Cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), and cytopenias constitute challenges in the treatment of patients with CAR T cells. This review summarizes the current understanding of CAR T-cell toxicity and its management.

Synthesis and characterization of crystalline niobium and tantalum carbonyl complexes at room temperature

A variety of homoleptic transition metal carbonyl complexes are known as bulk compounds for group 7-12 metals. These metals typically feature a maximum of 6 CO ligands to form complexes with 18 valence electrons. In contrast, group 3-5 metals, with fewer valence electrons, have been shown to form highly coordinated heptacarbonyl and octacarbonyl complexes-although they were only identified by gas-phase mass spectrometry and/or matrix isolation spectroscopy work. Now we have prepared heptacarbonyl cations of niobium and tantalum as crystalline salts that are stable at room temperature. The [M(CO)₇]⁺ (M = Nb or Ta) complexes were formed by the oxidation of [M(CO)₆]^- with 2Ag⁺[Al(OR^F)₄]^- (R^F, C(CF₃)₃) under a CO atmosphere; their experimental characterization was supported by density functional theory calculations. Other unusual carbonyl compounds were also synthesized: two isostructural salts that contained the 84-valence-electron cluster cation [Ag₆{Nb(CO)₆}₄]²⁺, the piano-stool complexes [(1,2-F₂C₆H₄)M(CO)₄]⁺ and two polymorphs of neutral Ta₂(CO)₁₂ with a long, unsupported Ta-Ta bond.

THU0441 DIAGNOSTIC ACCURACY OF THE NIJMENGEN SCORE FOR GOUTY ARTHRITIS IN PATIENTS HOSPITALIZED FOR ACUTE MONOARTHRITIS

Background:

The gold-standard for diagnosis of gout is the identification of monosodium urate (MSU) crystal in joint fluid. However, the sensitivity, specificity, and reproducibility of such analysis are not excellent, and joint aspiration is sometimes difficult, or impossible. The Nijmengen score is an easy-to-use rule without joint fluid analysis with excellent validity, in primary as well as in secondary care (1, 2). However, it’s validity as not been evaluated in the particular situation of patients whose acute arthritis necessitates hospitalization.

Objectives:

The objective of the present study was to assess diagnosis performances of the score in patients hospitalized for acute monoarthritis.

Methods:

Inclusion: all patients hospitalized for acute monoarthritis in the rheumatology department of the Dijon University Hospital between 2016 and 2019.Assessment: 1- clinical examination by an experimented rheumatologist; 2- joint aspiration and synovial fluid analysis following aspiration; 3- ultrasound (US) examination of the knees, first metatarso-phalangeal joints, and arthritic joint by a trained rheumatologist; 4- dual-energy computed tomography (DECT) of the arthritic joint; 5- Nijmengen score (cutoff scores of ≥ 8 needed for diagnosis of gout, and ≤ 4 to rule out gout) and ACR/EULAR 2015 classification criteria (3) (cut-off score of ≥ 8 needed for diagnosis of gout).Analysis: positive and negative predictive values, and ROC curve analysis of the Nijmengen score, using as gold-standard on one hand the results of the MSU crystal research, on the other hand those of the ACR/EULAR criteria.

Results:

A total of 39 patients were included (mean age = 69.8 ± 15 years, 74.4 % males, mean BMI = 27.5 ± 4.6 Kg/m2, mean serum uric acid = 354.6 ± 117.5 µmol/l). The affected joints were the knee (n = 31), ankle (n = 3), hip (n = 2), wrist (n = 2), shoulder (n = 1). Joint fluid analysis revealed MSU crystal in 11 patients. The ACR/EULAR was ≥ 8 in 15 patients. The Nijmengen score was ≥ 8 in 11 patients, including 5 with MSU crystal on joint fluid analysis and 9 with an ACR/EULAR score ≥ 8. The Nijmengen score was ≤ 4 in 15 patients, including 14 with no MSU crystal on joint fluid analysis and 14 with an ACR/EULAR score < 8. The positive predictive values of a Nijmengen score ≥ 8 were 45 % (joint fluid analysis as gold standard) and 81.8 % (ACR/EULAR). The negative predictive values of a Nijmengen score ≤ 4 were 93.3 % (joint fluid analysis and ACR/EULAR as gold standard). On ROC curve analyses, the areas under the curve were 0.763 (95% CI = 0.612 – 0.914) using joint fluid analysis as gold standard (figure 1) and 0.908 (95% CI = 0.814 – 1.0) using the ACR/EULAR score as gold standard (figure 2).

Fig. 1

ROC curve (fluid analysis as gold standard)

Fig. 2

Roc curve (ACR/EULAR as gold standard)

Conclusion:

Although having been developed for use in primary-care, the Nijmengen score appears to be useful in patients hospitalized for acute monoarthritis in a rheumatology unit.

References:

[1]Janssens et al. A diagnostic rule for acute gouty arthritis in primary care without joint fluid analysis. Arch Intern Med 2010; 170:1120-6.

[2]Kienhorst L et al. The validation of a diagnostic rule for gout without joint fluid analysis: a prospective study. Rheumatology 2015; 54:609-14.

[3]Neogi T et al. 2015 Gout Classification Criteria: An American College of Rheumatology/European League Against Rheumatism Collaborative Initiative: ACR/EULAR CLASSIFICATION CRITERIA FOR GOUT. Arthritis and Rheumatology. oct 2015;67(10):2557-68.

Disclosure of Interests: :

marie Schmitt: None declared, André Ramon: None declared, Paul Ornetti: None declared, jean Francis Maillefert Grant/research support from: Abbot, shugai, Roche, pfiser, BMS,, Speakers bureau: Abbot, Shugai, Roche, Pfiser, BMS

A Cross-Cultural Study of Justice Sensitivity and Its Consequences for Cooperation

In Western samples, individuals differ systematically in the importance they assign to matters of justice and injustice, and dispositional Justice Sensitivity can be differentiated according to the perspectives of victim, observer, beneficiary, and perpetrator. In a cross-cultural comparison between the Philippines, Germany, and Australia ( N = 677 students), we investigated whether Justice Sensitivity can be equivalently described by these four perspectives, whether measurement instruments have invariant psychometric properties, and whether the psychological relevance of the Justice Sensitivity perspectives for cooperation behavior differs between these cultural contexts. The results of multigroup confirmatory factor analyses support weak measurement invariance and invariant associations between Justice Sensitivity perspectives and trust game decisions. Across cultures, victim sensitivity predicted reluctance to cooperate under threat of exploitation, and observer, beneficiary, and perpetrator sensitivities predicted cooperation under temptation. Our study extends insight into Justice Sensitivity to underresearched cultural contexts of urban and rural Philippines.

IgG antibody response against Plasmodium falciparum aminopeptidase 1 antigen in Gabonese children living in Makokou and Franceville

The search for novel chemical classes of anti-malarial compounds to cope with the current state of chemoresistance of malaria parasites has led to the identification of Plasmodium falciparum aminopeptidase 1 (PfA-M1) as a new therapeutic target. PfA-M1, known to be involved in the hemoglobin digestion cascade which helps to provide most of the amino acids necessary to the parasite's metabolism, is currently considered as a promising target for anti-malarial chemotherapy. However, its immunogenic properties have not yet been tested in the Gabonese population. In Gabon, the prevalence of malaria remains three times higher in semi-urban areas (60·12%) than in urban areas (17·06%). We show that malaria-specific PfA-M1 antibodies are present in children and increase with the level of infection. Children living in semi-urban areas have higher anti-PfA-M1 antibody titers (0·14 ± 0·02 AU) than those living in urban areas (0·08 ± 0·02 AU, P = 0·03), and their antibody titers increase with age (P < 0·0001). Moreover, anti-PfA-M1 antibody titers decrease in children with hyperparasitemia (0·027 ± 0·055 AU) but they remain high in children with low parasite density (0·21 ± 0·034 AU, P = 0·034). In conclusion, our results suggest that malaria-specific PfA-M1 antibodies may play an important role in the immune response of the host against P. falciparum in Gabonese children. Further studies on the role of PfA-M1 during anemia are needed.

Causal underpinnings of working memory and Stroop interference control: Testing the effects of anodal and cathodal tDCS over the left DLPFC

By means of transcranial direct current stimulation applied to the left dorsolateral prefrontal cortex, we investigated the causal role of increased or decreased excitability of this brain region for two facets of executive functions: working memory and Stroop interference control. We tested 1) whether anodal tDCS of the left DLPFC enhances working memory 15 minutes after termination of stimulation and in the absence of direct task practice under stimulation; 2) whether anodal tDCS of the left DLPFC enhances interference control, as evidenced by Stroop performance and Stroop sequence effects; and 3) whether cathodal tDCS leads to compromised executive functioning compared to anodal stimulation. In a between-subject design with 88 healthy psychology students, we compared the impact of anodal and cathodal stimulation against a sham condition, on performance on a Stroop task (during active stimulation) and on an n-back task (completed 15 minutes after active stimulation ended). We found significantly enhanced accuracy in the n-back task after anodal stimulation compared with sham, as well as speeded reactions in the Stroop tasks independent of trial type. By contrast, we found no modulation of Stroop interference effects or Stroop sequence effects. No inhibitory effects of cathodal stimulation were observed. These results support the causal role of the left DLPFC in working memory but lend no support to its involvement in Stroop interference control.

Blood CD9+ B cell, a biomarker of bronchiolitis obliterans syndrome after lung transplantation

Bronchiolitis obliterans syndrome is the main limitation for long-term survival after lung transplantation. Some specific B cell populations are associated with long-term graft acceptance. We aimed to monitor the B cell profile during early development of bronchiolitis obliterans syndrome after lung transplantation. The B cell longitudinal profile was analyzed in peripheral blood mononuclear cells from patients with bronchiolitis obliterans syndrome and patients who remained stable over 3 years of follow-up. CD24^hi CD38^hi transitional B cells were increased in stable patients only, and reached a peak 24 months after transplantation, whereas they remained unchanged in patients who developed a bronchiolitis obliterans syndrome. These CD24^hi CD38^hi transitional B cells specifically secrete IL-10 and express CD9. Thus, patients with a total CD9⁺ B cell frequency below 6.6% displayed significantly higher incidence of bronchiolitis obliterans syndrome (AUC = 0.836, PPV = 0.75, NPV = 1). These data are the first to associate IL-10-secreting CD24^hi CD38^hi transitional B cells expressing CD9 with better allograft outcome in lung transplant recipients. CD9-expressing B cells appear as a contributor to a favorable environment essential for the maintenance of long-term stable graft function and as a new predictive biomarker of bronchiolitis obliterans syndrome-free survival.

6030Effects of adjunctive treatment with low-dose alteplase during primary percutaneous coronary intervention according to ischaemic time

Background

Microvascular obstruction affects half of patients with acute ST-segment elevation myocardial infarction and confers an adverse prognosis.

Purpose

We aimed to determine whether the efficacy and safety of a therapeutic strategy involving low-dose intra-coronary alteplase infused early after coronary reperfusion associates with ischaemic time.

Methods

We conducted a prospective, multicentre, parallel group, 1:1:1 randomised, dose-ranging trial in patients undergoing primary percutaneous coronary intervention. Ischaemic time, defined as the time from symptom onset to coronary reperfusion, was a pre-specified sub-group of interest. Between March 17, 2016, and December 21, 2017, 440 patients presenting at 11 hospitals in the UK were enrolled with follow up to 3 months. Patients with acute myocardial infarction due to occlusion of a major coronary artery presenting ≤6 hours from symptom onset were randomly assigned to treatment with placebo, alteplase 10mg or alteplase 20mg. The primary outcome was the amount of microvascular obstruction disclosed by cardiac magnetic resonance imaging at 2–7 days. Secondary outcomes included infarct size, myocardial haemorrhage, left ventricular ejection fraction, and troponin T area-under-the curve.

Results

440 patients were randomized (figure), the primary endpoint was achieved in 396 (90%), seventeen (3.9%) withdrew and all other patients were followed up to 3 months. In the primary analysis, the amount of microvascular obstruction did not differ between the groups. Their ischaemic times were: ≤2 hours, n=98; ≥2–<4 hours, n=215; and ≥4–6 hours, n=83.

In patients with an ischaemic time ≥4 hours, treatment with alteplase (10 mg, n=26; 20 mg, n=30) was associated with a dose dependent increase in the amount (mean) of microvascular obstruction (% left ventricular mass) compared to placebo (n=27) 1.14 vs. 3.11 vs. 5.20; mean difference on square root scale 0.81 (95% CI 0.21, 1.42), p=0.009. The interaction test between ischaemic time and treatment (active vs. placebo) was not statistically significant p=0.06, however when the interaction was assessed for a trend across treatment groups this did reach statistical significance, p=0.018.

Furthermore, a higher proportion of patients presenting ≥4–6 hours treated with 20 mg of alteplase had myocardial haemorrhage (59.3%) compared to the placebo group (28.0%), odds ratio 3.81 (95% CI 1.19, 12.25), p=0.025. The amount of haemorrhage was also greater; estimated mean difference 3.49 (95% CI 1.22, 5.75), p=0.0026. No between-treatment group differences for myocardial haemorrhage were observed in patients presenting with shorter ischaemic times.

Study flow diagram

Conclusions

In patients presenting with an ischaemic time ≥4 hours, adjunctive treatment with low-dose intra-coronary alteplase during primary PCI was associated with increases in microvascular obstruction and myocardial haemorrhage. The mechanism may involve haemorrhagic transformation within the infarct core.

Acknowledgement/Funding

NIHR EME programme (reference: 12/170/45); British Heart Foundation (BHF reference FS/16/74/32573)