Riding the waves from epidemic to endemic: Viral mutations, immunological change and policy responses

Nonpharmaceutical interventions (NPI) are an important tool for countering pandemics such as COVID-19. Some are cheap; others disrupt economic, educational, and social activity. The latter force governments to balance the health benefits of reduced infection and death against broader lockdown-induced societal costs. A literature has developed modeling how to optimally adjust lockdown intensity as an epidemic evolves. This paper extends that literature by augmenting the classic SIR model with additional states and flows capturing decay over time in vaccine-conferred immunity, the possibility that mutations create variants that erode immunity, and that protection against infection erodes faster than protecting against severe illness. As in past models, we find that small changes in parameter values can tip the optimal response between very different solutions, but the extensions considered here create new types of solutions. In some instances, it can be optimal to incur perpetual epidemic waves even if the uncontrolled infection prevalence would settle down to a stable intermediate level.

Severe methotrexate toxicity in elderly patients under diuretics

OBJECTIVES

To explore the toxicity of low-dose methotrexate (MTX), an uncommon, but life-threatening event.

METHODS

We analysed the presentation, course and risk factors of all patients admitted to the rheumatology ward with severe low-dose MTX toxicity. These patients were compared with patients without signs of relevant MTX toxicity.

RESULTS

The 12 patients admitted for MTX toxicity included 7 patients with rheumatoid arthritis, 2 with psoriatic arthritis or psoriasis, 2 patients with giant cell arteritis and 1 with myositis. 1 patient died from infections, while 11 survived under folinic acid administration. All patients suffering from severe MTX toxicity were older than 70 years and were therefore compared with 400 patients who were also older than 70 years, but without MTX toxicity. Of these 400 control patients, the group of patients not on MTX (n=232) had more renal impairment than the group of patients on MTX (n=168). Compared with the 168 MTX-treated patients without toxicity, the 12 patients with life-threatening toxic events had a lower median estimated glomerular filtration rate (eGFR) at the routine visit preceding the acute event (64 (range 32-77) vs 69 (range 8 to >90) mL/min x 1.73, p=0.0251). A multivariate analysis found that patients with toxicity were more frequently treated with diuretics (6/12 vs 24/168), proton pump inhibitors (PPIs; 10/12 vs 70/168) and levetiracetam (2/12 vs 1/168).

CONCLUSIONS

Patients older than 70 years with lower eGFR and being on diuretics, but also on PPIs and levetiracetam, have a significantly higher risk for MTX toxicity.

The hammer and the jab: Are COVID-19 lockdowns and vaccinations complements or substitutes?

The COVID-19 pandemic has devastated lives and economies around the world. Initially a primary response was locking down parts of the economy to reduce social interactions and, hence, the virus' spread. After vaccines have been developed and produced in sufficient quantity, they can largely replace broad lock downs. This paper explores how lockdown policies should be varied during the year or so gap between when a vaccine is approved and when all who wish have been vaccinated. Are vaccines and lockdowns substitutes during that crucial time, in the sense that lockdowns should be reduced as vaccination rates rise? Or might they be complementary with the prospect of imminent vaccination increasing the value of stricter lockdowns, since hospitalization and death averted then may be permanently prevented, not just delayed? We investigate this question with a simple dynamic optimization model that captures both epidemiological and economic considerations. In this model, increasing the rate of vaccine deployment may increase or reduce the optimal total lockdown intensity and duration, depending on the values of other model parameters. That vaccines and lockdowns can act as either substitutes or complements even in a relatively simple model casts doubt on whether in more complicated models or the real world one should expect them to always be just one or the other. Within our model, for parameter values reflecting conditions in developed countries, the typical finding is to ease lockdown intensity gradually after substantial shares of the population have been vaccinated, but other strategies can be optimal for other parameter values. Reserving vaccines for those who have not yet been infected barely outperforms simpler strategies that ignore prior infection status. For certain parameter combinations, there are instances in which two quite different policies can perform equally well, and sometimes very small increases in vaccine capacity can tip the optimal solution to one that involves much longer and more intense lockdowns.

Incidence of fatigue associated with immune checkpoint inhibitors in patients with cancer: a meta-analysis

Background

Fatigue is one of the most common adverse effects associated with cancer immunotherapy using checkpoint inhibitors (CPIs). Because treatment-related fatigue also frequently occurs in patients treated with non-immunological therapies, our study aimed to compare the incidence of fatigue in CPI-treated patients with that associated with non-immune therapies in randomised trials.

Methods

PubMed and ClinicalTrials.gov were searched for phase III studies using a CPI alone or in combination with chemotherapy or non-immunologic targeted therapy in the experimental arm and control arm using inactive therapies such as placebo or observation, chemotherapy, or non-immunologic targeted therapy. Adverse events listed in the full texts as well as those available from clinicaltrials.gov were reviewed for all identified studies.

Results

A total of 60 studies involving 41 435 patients were included in the analysis. All-grade fatigue was reported in 30.4% of patients [95% confidence interval (CI) 29.9% to 31.0%] in the immunotherapy arms of the analysed studies. Using anti-programmed cell death protein 1 agents as reference, the odds ratio (OR) for fatigue was significantly higher both for anti-cytotoxic T lymphocyte-associated antigen 4 agents (OR 1.46, 95% CI 1.04-2.04) and the combination of anti-cytotoxic T lymphocyte-associated antigen 4 and anti-programmed cell death protein agents (OR 1.43, 95% CI 1.12-1.83). Fatigue was significantly less likely to occur in patients treated with CPI compared with patients receiving chemotherapy (OR 0.79, 95% CI 0.73-0.85), but significantly was more common in patients receiving the combination of CPI/chemotherapy compared with patients receiving chemotherapy alone (OR 1.12, 95% CI 1.03-1.22).

Conclusions

Although immunotherapy using CPIs was associated with treatment-related fatigue, the occurrence of all-grade fatigue was significantly higher in patients treated with chemotherapy compared with patients receiving CPIs. The risk of fatigue was higher for CPI/chemotherapy combinations than for chemotherapy alone. These results suggest that although the effects of CPIs and chemotherapy are additive, chemotherapy was the dominant cause of treatment-related fatigue in the analysed trials.

•

Fatigue is a common adverse event associated with cancer immunotherapy but also with other therapies and with cancer itself.

•

This meta-analysis analysed the incidence of fatigue reported in phase III trials of checkpoint inhibitors.

•

Fatigue was more common in patients treated with chemotherapy compared with patients receiving checkpoint inhibitors.

•

Chemotherapy was the dominant cause of fatigue in combinations of chemotherapy and checkpoint inhibitors.

Testing a knowledge-based approach for inferring spatio-temporal characteristics of groundwater in the Australian State of Victoria

Groundwater spatio-temporal characteristics are important information for groundwater development and management. However, such information is usually insufficient or even unavailable in many regions around the world due to insufficient or even lack of in-situ data such as from boreholes. Recently, a knowledge-based approach was proposed to infer 'where' and 'when' to find groundwater using Lake Victoria Basin (LVB) as an example for data-deficient regions. In this knowledge-based approach, groundwater model and inversion analysis of groundwater impact factors are used to infer groundwater storage potential and recharge timing. In the LVB's case, only 10 borehole data were used to test the spatio-temporal behaviours of groundwater, which are insufficient. In this contribution, therefore, using the Australian State of Victoria as an example, with over 15,000 boreholes data, the performance of the same knowledge-based approach is further tested in a well-controlled area. The results indicate that the knowledge-based approach is able to correctly infer regions with large groundwater storage potential suitable for extraction. The recharge timing of groundwater is also correctly indicated as the results show consistency with the borehole data. This provides further evidence of the reliability of the knowledge-based approach for inferring spatio-temporal characteristics of groundwater.

Effectiveness of Child-Focused Interventions for Externalizing Behavior: a Rapid Evidence Review

Parent behavior management training (BMT) is well established as an effective, evidence-based treatment for children with externalizing behavior. Despite the wealth of data supporting BMT, many community providers use a variety of child-focused and non-directive interventions to target behavior problems. There is lack of clarity as to whether the evidence supporting child-focused externalizing treatments is sufficiently compelling to support offering these treatments rather than or in addition to BMT. This rapid evidence review compares the effectiveness of BMT with several common child-focused interventions for externalizing behavior including cognitive behavioral (CBT), social skill (SS), and play/dynamic (PT) approaches. PubMed, PsychINFO, and Web of Science were searched for English-language articles from year 2000 onwards for each intervention type. Inclusion criteria were child age (12 and under), presence of a child-focused behavioral treatment condition, and externalizing behavior as an outcome variable. A total of 30 studies met inclusion criteria and were coded (13 CBT, 10 SS, 7 PT). Results supported social skills interventions with accompanying BMT as effective in improving externalizing problems, with generally moderate effect sizes. Individual social skills interventions were promising but needing further evaluation compared to treatment as usual. CBT treatments with and without accompanying BMT showed moderate effects over waitlist but produced less consistently significant effects compared to more robust controls. Play therapy approaches showed inconsistent effects and require further evaluation. This review supports social skills plus BMT treatments as a child-focused intervention with probable efficacy for child externalizing problems. Implications for policy and community practice are discussed.

Team Prenotification Reduces Procedure Times for Patients With Acute Ischemic Stroke Due to Large Vessel Occlusion Who Are Transferred for Endovascular Therapy

Background: The clinical benefit from endovascular therapy (EVT) for patients with acute ischemic stroke is time-dependent. We tested the hypothesis that team prenotification results in faster procedure times prior to initiation of EVT.

Methods: We analyzed data from our prospective database (01/2016–02/2018) including all patients with acute ischemic stroke who were evaluated for EVT at our comprehensive stroke center. We established a standardized algorithm (EVT-Call) in 06/2017 to prenotify team members (interventional neuroradiologist, neurologist, anesthesiologist, CT and angiography technicians) about patient transfer from remote hospitals for evaluation of EVT, and team members were present in the emergency department at the expected patient arrival time. We calculated door-to-image, image-to-groin and door-to-groin times for patients who were transferred to our center for evaluation of EVT, and analyzed changes before (–EVT-Call) and after (+EVT-Call) implementation of the EVT-Call.

Results: Among 494 patients in our database, 328 patients were transferred from remote hospitals for evaluation of EVT (208 -EVT-Call and 120 +EVT-Call, median [IQR] age 75 years [65–81], NIHSS score 17 [12–22], 49.1% female). Of these, 177 patients (54%) underwent EVT after repeated imaging at our center (111/208 [53%) -EVT-Call, 66/120 [55%] +EVT-Call). Median (IQR) door-to-image time (18 min [14–22] vs. 10 min [7–13]; p < 0.001), image-to-groin time (54 min [43.5–69.25] vs. 47 min [38.3–58.75]; p = 0.042) and door-to-groin time (74 min [58–86.5] vs. 60 min [49.3–71]; p < 0.001) were reduced after implementation of the EVT-Call.

Conclusions: Team prenotification results in faster patient assessment and initiation of EVT in patients with acute ischemic stroke. Its impact on functional outcome needs to be determined.

Inference of the spatio-temporal variability and storage potential of groundwater in data-deficient regions through groundwater models and inversion of impact factors on groundwater, as exemplified by the Lake Victoria Basin

Groundwater is an important resource for supporting domestic water use for people's livelihoods and for maintaining ecosystems. Borehole observations provide the first-hand data that characterise the fluctuation, depth, and aquifer conditions of the groundwater. Unfortunately, such observations are not available or are insufficient for scientific use in many regions. Taking the Lake Victoria Basin (LVB) as an example of data-deficient regions, this study proposes a simple knowledge-based approach that uses the Global Land Data Assimilation System (GLDAS) Catchment Land Surface Model (CLSM) for the main data, with rainfall, hydrological, topographical and geological datasets as supports, by which to infer the spatio-temporal variability and storage potential of groundwater. The method is based on analysis and inversion of impact factors on groundwater, and the feasibility of such a method is proven by showing that the groundwater results from GLDAS CLSM can correctly indicate the seasonality, as well as the link to topographical and geological features. For example, both results from the water balance equation (WBE) and GLDAS CLSM indicate that there are two groundwater recharge seasons in the basin, e.g., March to May and September to November. Compared to the eastern side of the LVB, the western side has mountains blocking surface runoff, and thus, reasonably, has larger storage potential estimates in GLDAS CLSM. Due to the low degree of weathering of the basement rocks, it is expected that there is only small storage potential and variation of groundwater in the southeastern parts of the LVB. GLDAS CLSM also correctly reflects this behaviour. Additionally, the largest groundwater storage potential over the LVB is found in regions near the Kagera River and the western shoreline, since it associates with unconsolidated rocks and behaviours of large groundwater recharge from GLDAS CSLM during the wet year of 2006. The major limitation of this knowledge-based method is that the uncertainty in terms of magnitude on GLDAS CLSM groundwater changes cannot be assessed, in addition to the fact that the reliability of the results cannot be quantified in terms of specific numbers. Therefore, the results and interpretation of groundwater behaviours using such methods can only be a guide for 'where' and 'when' to find groundwater.

Significant decrease of the pathological stage I rectal carcinoma in the era of neoadjuvant therapy-A matter of concern

BACKGROUND

Neoadjuvant treatment (nTx) for rectal cancer is commonly reserved for UICC stages II/III. Patients with stage I tumours (T1-2N0M0) are not candidates for nTx. The accuracy of treatment allocation depends on the precision of clinical staging, which is liable to understaging and overstaging. The study aimed at exploring changes in the proportion of stage pI patients with the introduction of nTx over a 26-year period.

MATERIALS AND METHODS

All consecutive patients with histologically proven rectal cancer excluding carcinoma in situ were retrieved from a prospective database of our colorectal unit. Time periods were defined as per the use of nTx: baseline phase 1994-1997; implementation phase 1998-2005 and guideline phase 2006-2019. Trends over time regarding proportion of applied nTx and stage pI tumours were investigated.

RESULTS

Overall, 1468 patients met the inclusion criteria. There were no major differences in patients' characteristics, especially proportion of synchronous metastases (stage IV) over time. nTx was applied to 1.2% of patients without metastases in the baseline phase, to 29.6% in the implementation phase, and to 59.6% in the guideline phase (p < 0.001). Corresponding proportions for patients with stage pI were 31.0%, 26.3% and 14.2%, respectively (p < 0.001).

CONCLUSION

With a stable proportion of stage IV carcinomas indicating no major changes in the patient cohorts, we could document a significant decrease of stage pI patients with increasing use of nTx. This trend clearly signals overtreatment caused by clinical T- and N-staging. More precise criteria are needed to better select patients with rectal cancer for nTx.

Impacts of extreme climate on Australia's green cover (2003-2018): A MODIS and mascon probe

Australia as a continent represents a semi-arid environment that is generally water-limited. Changes in rainfall pattern will inevitably occur due to rising temperatures caused by climate change, which has a direct impact on the distribution of Australia's vegetation (green cover). As variability in rainfall continues to increase, i.e., in frequency and/or magnitude, due to climate change, extreme climate events such as droughts are predicted to become more pervasive and severe that will have an adverse effect on vegetation. This study investigates the effects of extreme climate on Australia's green cover during 2003-2018 for the end of rainy seasons of April and October in the northern and southern parts, respectively, to (i) determine the state of vegetation and its changes, (ii) identify "hotspots", i.e., regions that constantly experienced statistically significant decrease in NDVI, and (iii), relate changes in the identified hotspots to GRACE-hydrological changes. These are achieved through the exploitation of the statistical tools of Principal Component Analysis (PCA) and Mann-Kendel Test on Gravity Recovery and Climate Experiment (GRACE) hydrological products on the one hand, and the utilization of Australia's rainfall product and Moderate Resolution Imaging Spectroradiometer Normalized Difference Vegetation Index (MODIS-NDVI) used here with its native spatial resolution of 0.002413^∘ × 0.002413^∘ on the other hand. Differences between 3-year intervals from 2003 to 2018 for both April and October datasets are used to quantify vegetation variations. Through area change analysis, the vegetation differences (2003-2018) indicate that April exhibited larger increase (13.77% of total vegetation area) than decrease (7.83%) compared to October, which experienced slightly larger decrease (9.41%) than increase (8.71%). South Australia and Western Australia emerge as "hotspots" in which vegetation statistically decreased in October, with no noticeable change in April. GRACE-based hydrological changes in both hotspots reflect a decreasing trend (2003-2009) and increasing trend (2009-2012) that peaks in 2011, which then transitions towards a gradually decreasing trend after 2012. Australia-wide climate variability (ENSO and IOD) influenced vegetation variations during the data period 2003 to 2018.

Scanning Compton X-ray microscopy

X-ray microscopy offers the opportunity to image biological and radiosensitive materials without special sample preparations, bridging optical and electron microscopy capabilities. However, the performance of such microscopes, when imaging radiosensitive samples, is not limited by their intrinsic resolution, but by the radiation damage induced on such samples. Here, we demonstrate a novel, to the best of our knowledge, radio-efficient microscope, scanning Compton X-ray microscopy (SCXM), which uses coherently and incoherently (Compton) scattered photons to minimize the deposited energy per unit of mass for a given imaging signal. We implemented SCXM, using lenses capable of efficiently focusing 60 keV X-ray photons into the sub-micrometer scale, and probe its radio-efficient capabilities. SCXM, when implemented in high-energy diffraction-limited storage rings, e.g., European Synchrotron Radiation Facility Extremely Brilliant Source and PETRA IV, will open the opportunity to explore the nanoscale of unstained, unsectioned, and undamaged radiosensitive materials.

Efficacy of Retreatment After Failed Direct-acting Antiviral Therapy in Patients With HCV Genotype 1-3 Infections

Hepatitis C virus infection is causing chronic liver disease, cirrhosis, and hepatocellular carcinoma. By combining direct-acting antivirals (DAAs), high sustained virologic response rates (SVRs) can be achieved. Resistance-associated substitutions (RASs) are commonly observed after DAA failure, and especially nonstructural protein 5A (NS5A) RASs may impact retreatment options.^1-3 Data on retreatment of DAA failure patients using first-generation DAAs are limited.^4-7 Recently, a second-generation protease- and NS5A-inhibitor plus sofosbuvir (voxilaprevir/velpatasvir/sofosbuvir [VOX/VEL/SOF]) was approved for retreatment after DAA failure.⁸ However, this and other second-generation regimens are not available in many resource-limited countries or are not reimbursed by regular insurance, and recommendations regarding the selection of retreatment regimens using first-generation DAAs are very important. This study aimed to analyze patients who were re-treated with first-generation DAAs after failure of a DAA combination therapy.

Identifying Genetic Lesions in Ocular Adnexal Extranodal Marginal Zone Lymphomas of the MALT Subtype by Whole Genome, Whole Exome and Targeted Sequencing

The pathogenesis of ocular adnexal marginal zone lymphomas of mucosa-associated lymphatic tissue-type (OAML) is not fully understood. We performed whole genome sequencing (WGS) and/or whole exome sequencing (WES) for 13 cases of OAML and sequenced 38 genes selected from this analysis in a large cohort of 82 OAML. Besides confirmation of frequent mutations in the genes transducin beta like 1 X-linked receptor 1 (TBL1XR1) and cAMP response element binding protein (CREBBP), we newly identifed JAK3 as a frequently mutated gene in OAML (11% of cases). In our retrospective cohort, JAK3 mutant cases had a shorter progression-free survival compared with unmutated cases. Other newly identified genes recurrently mutated in 5-10% of cases included members of the collagen family (collagen type XII alpha 1/2 (COL12A1, COL1A2)) and DOCK8. Evaluation of the WGS data of six OAML did not reveal translocations or a current infection of the lymphoma cells by viruses. Evaluation of the WGS data for copy number aberrations confirmed frequent loss of TNFAIP3, and revealed recurrent gains of the NOTCH target HES4, and of members of the CEBP transcription factor family. Overall, we identified several novel genes recurrently affected by point mutations or copy number alterations, but our study also indicated that the landscape of frequently (>10% of cases) mutated protein-coding genes in OAML is now largely known.

Spatio-temporal groundwater variations associated with climatic and anthropogenic impacts in South-West Western Australia

South-West Western Australia (SWWA) is a critical agricultural region that heavily relies on groundwater for domestic, agricultural and industrial use. However, the behaviours of groundwater associated with climate variability/change and anthropogenic impacts within this region are not well understood. This study investigates the spatio-temporal variability of groundwater in SWWA based on 2997 boreholes over the past 36 years (1980-2015). Results identify the decline in groundwater level (13 mm/month) located in the central coastal region of SWWA (i.e., north and south of Perth) to be caused by anthropogenic impacts (primary factor) and climate variability/change (secondary). In detail, anthropogenic impacts are mainly attributed to substantial groundwater abstraction, e.g., hotspots (identified by above 7 m/month groundwater level change) mostly occur in the central coastal region, as well as close to dams and mines. Impacts of climate variability/change indicate that coupled ENSO and positive IOD cause low-level rainfall in the coastal regions, subsequently, affecting groundwater recharge. In addition, correlation between groundwater and rainfall is significant at 0.748 over entire SWWA (at 95% confidence level). However, groundwater in northeastern mountainous regions hardly changes with rainfall because of very small amounts of rainfall (average 20-30 mm/month) in this region, potentially coupled with terrain and geological impacts. A marked division for groundwater bounded by the Darling and Gingin Scarps is found. This is likely due to the effects of the Darling fault, dams, central mountainous terrain and geology. For the region south of Perth and southern coastal regions, a hypothesis through multi-year analysis is postulated that rainfall of at least 60 and 65-70 mm/month, respectively, are required during the March-October rainfall period to recharge groundwater.

GRACE-derived groundwater changes over Greater Horn of Africa: Temporal variability and the potential for irrigated agriculture

Greater Horn of Africa (GHA) is projected to face negative impacts on per capita food production due to dwindling nature of water resources forced by climate change and rising population growth. The region has limited groundwater irrigated agriculture and also lacks groundwater monitoring infrastructure. This study (i) employs Independent Component Analysis (ICA) to localize Gravity Recovery and Climate Experiment (GRACE)-derived groundwater changes and analyses the corresponding temporal variabilities and their link to climate indices (Indian Ocean Dipole (IOD) and El Niño-Southern Oscillation (ENSO)), and (ii), explores the irrigation potentials of the localized groundwater. Monthly GRACE-derived groundwater changes showed similar temporal variability to WaterGap Hydrological Model (WGHM), i.e., a correlation of 0.7 (significant at 95% confidence level), highlighting GRACE's potential to provide GHA-wide changes in groundwater. Based on GHA aquifer location maps, the study associated the localized groundwater changes to nine major aquifers namely; Nubian sandstone, Karoo Carbonate, Upper Nile, Ethiopian highlands, Lake Tana region, Kenya-Somalia, Central Tanzania, Karoo sandstone, and Ruvuma. All temporal groundwater changes, except Nubian sandstone and Kenya-Somalia, showed an annual (cyclic) pattern indicating an annual (yearly) recharge cycle. Weak relationships with rainfall and both climate indices were noted. Maximum correlation occurred when rainfall preceded the temporal groundwater changes by several months. Based on water availability (from GRACE), water quality (indicated by the total dissolved substance) and dominant soil types, potential for groundwater irrigated agriculture results showed: low potentials for Nubian Sandstone and Kenya-Somalia areas; low to moderate potentials for Karoo Carbonate, Lake Tana region, central Tanzania, and Ruvuma; moderate to high potentials for Upper Nile and Karoo Sandstone; and high potential for Ethiopian highland. Even though the study has considered relatively short time period (10 years), these results are critical to the sustainable management of the region's groundwater resources and appropriate/informed policy formulation.

Polymerase Chain Reaction Techniques for Food Allergen Detection

Food allergies represent an important health problem in industrialized countries. Undeclared allergenic foods as contaminants in food products pose a major risk for sensitized persons. Reliable detection and quantification methods for food allergens are necessary to ensure compliance with food labeling and improve consumer protection. The methods currently used for the detection of potential allergens in foods are to target either the allergen itself or a marker that indicates the presence of the offending food. As markers for the presence of potentially allergenic foods or ingredients, specific proteins or DNA fragments are targeted. In routine food analysis, the enzyme-linked immunosorbent assay (ELISA) and the polymerase chain reaction (PCR) in the form of a real-time PCR or in combination with an ELISA have been used. The availability, the characteristics, and some future aspects ofDNA-based methods in the rapid and sensitive detection of potentially allergenic food constituents or contaminations are discussed in this review.

Early-Onset Myopathies: Clinical Findings, Prevalence of Subgroups and Diagnostic Approach in a Single Neuromuscular Referral Center in Germany

BACKGROUND

Early-onset myopathies are a heterogeneous group of neuromuscular diseases with broad clinical, genetic and histopathological overlap. The diagnostic approach has considerably changed since high throughput genetic methods (next generation sequencing, NGS) became available.

OBJECTIVE

We present diagnostic subgroups in a single neuromuscular referral center and describe an algorithm for the diagnostic work-up.

METHODS

The diagnostic approach of 98 index patients was retrospectively analysed. In 56 cases targeted sequencing of a known gene was performed, in 44 patients NGS was performed using large muscle specific panels, and in 12 individuals whole exome sequencing (WES) was undertaken. One patient was diagnosed via array CGH. Clinical features of all patients are provided.

RESULTS

The final diagnosis could be found in 63 out of 98 patients (64%) with molecular genetic analysis. In 55% targeted gene sequencing could establish the genetic diagnosis. However, this rate largely depended on the presence of distinct histological or clinical features. NGS (large myopathy-related panels and WES) revealed genetic diagnosis in 58.5% (52% and 67%, respectively). The genes detected by WES in our cohort of patients were all covered by the panels. Based on our findings we propose an algorithm for a practical diagnostic approach.Prevalences:MTM1- and LAMA2-patients are the two biggest subgroups, followed by SEPN1-, RYR1- and Collagen VI-related diseases. 31% of genetically confirmed cases represents a group with overlap between "congenital myopathies (CM)" and "congenital muscular dystrophies (CMD)". In 36% of the patients a specific genetic diagnosis could not be assigned.

CONCLUSIONS

A final diagnosis can be confirmed by high throughput genetic analysis in 58.5% of the cases, which is a higher rate than reported in the literature for muscle biopsy and should in many cases be considered as a first diagnostic tool. NGS cannot replace neuromuscular expertise and a close discussion with the geneticists on NGS is mandatory. Targeted candidate gene sequencing still plays a role in selected cases with highly suspicious clinical or histological features. There is a relevant clinical and genetic overlap between the entities CM and CMD.

Sequential H. pylori eradication and radiation therapy with reduced dose compared to standard dose for gastric MALT lymphoma stages IE & II1E: a prospective randomized trial

BACKGROUND

In Helicobacter pylori (H. pylori) positive stage I gastric low-grade MALT lymphoma, eradication is the accepted first-line therapy. The role of eradication therapy in lymphoma > stage IE is still unclear. However, about 20% of patients show persistent lymphoma following successful eradication or primary H. pylori-negative lymphoma. A prospective study for salvage radiation therapy with standard 36 Gy in comparison to a reduced dose of 25.2 Gy is still missing.

METHODS

A prospective, multicentre study investigated the efficacy of eradication in H. pylori-positive gastric low-grade MALT lymphoma stages IE and II1E (HELYX I). Refractory lymphoma or H. pylori-negative patients were treated in a prospective, randomised, multicentre, phase II study to receive either 25.2 Gy or 36 Gy radiotherapy (HELYX II).

RESULTS

102 patients (3 drop outs) were included in HELYX I: 75/99 (75.8%) showed complete remission after a median of 2.8 months. 18 (18.2%) had partial remission (PR) and 6 (6.0%) no change (NC). 29 patients (7 drop outs) were randomized in HELYX II (7 primarily H. pylori-negative, 15 patients from HELYX I with refractory disease after eradication). All patients achieved stable CR irrespective of radiation dose. Both presence of the t(11,18) translocation (OR 9.0, p = 0.01) and monoclonality of the tumour cells (OR 6.3, p = 0.006) were predictors for persistant lymphoma after eradication therapy.

CONCLUSIONS

Most H. pylori-positive low grade gastric MALT lymphoma stage IE and II1E respond with stable CR after eradication therapy. In patients with refractory disease or H. pylori negative low grade gastric MALT lymphoma a dosage-reduced radiation therapy with 25.2 Gy is an effective standard dose in stage IE and II1E.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT00154440.

Assessing data assimilation frameworks for using multi-mission satellite products in a hydrological context

With a growing number of available datasets especially from satellite remote sensing, there is a great opportunity to improve our knowledge of the state of the hydrological processes via data assimilation. Observations can be assimilated into numerical models using dynamics and data-driven approaches. The present study aims to assess these assimilation frameworks for integrating different sets of satellite measurements in a hydrological context. To this end, we implement a traditional data assimilation system based on the Square Root Analysis (SQRA) filtering scheme and the newly developed data-driven Kalman-Takens technique to update the water components of a hydrological model with the Gravity Recovery And Climate Experiment (GRACE) terrestrial water storage (TWS), and soil moisture products from the Advanced Microwave Scanning Radiometer - Earth Observing System (AMSR-E) and Soil Moisture and Ocean Salinity (SMOS) in a 5-day temporal scale. While SQRA relies on a physical model for forecasting, the Kalman-Takens only requires a trajectory of the system based on past data. We are particularly interested in testing both methods for assimilating different combination of the satellite data. In most of the cases, simultaneous assimilation of the satellite data by either standard SQRA or Kalman-Takens achieves the largest improvements in the hydrological state, in terms of the agreement with independent in-situ measurements. Furthermore, the Kalman-Takens approach performs comparably well to dynamical method at a fraction of the computational cost.

New insights into the crystallization of polymorphic materials: from real-time serial crystallography to luminescence analysis

This article unravels reaction conditions governing the formation of polymorphic structures in solution down to the single particle level applying, for instance, unprecedented real-time serial crystallography measurements during a synthesis process.

Understanding the association between climate variability and the Nile's water level fluctuations and water storage changes during 1992-2016

With the construction of the largest dam in Africa, the Grand Ethiopian Renaissance Dam (GERD) along the Blue Nile, the Nile is back in the news. This, combined with Bujagali Dam on the White Nile are expected to bring ramification to the downstream countries. A comprehensive analysis of the Nile's waters (surface, soil moisture and groundwater) is, therefore, essential to inform its management. Owing to its shear size, however, obtaining in-situ data from "boots on the ground" is practically impossible, paving way to the use of satellite remotely sensed and models' products. The present study employs multi-mission satellites and surface models' products to provide, for the first time, a comprehensive analysis of the changes in Nile's stored waters' compartments; surface, soil moisture and groundwater, and their association to climate variability (El Niño Southern Oscillation (ENSO) and Indian Ocean Dipole (IOD)) over the period 1992-2016. In this regard, remotely sensed altimetry data from TOPEX/Poseidon (T/P), Jason-1, and Jason-2 satellites along with the Gravity Recovery And Climate Experiment (GRACE) mission, and the Tropical Rainfall Measuring Mission Project (TRMM) rainfall products are applied to analyze the compartmental changes over the Nile River Basin (NRB). This is achieved through the creation of 62 virtual gauge stations distributed throughout the Nile River that generate water levels, which are used to compute surface water storage changes. Using GRACE total water storage (TWS), soil moisture data from multi-models based on the Triple Collocation Analysis (TCA) method, and altimetry derived surface water storage, Nile basin's groundwater variations are estimated. The impacts of climate variability on the compartmental changes are examined using TRMM precipitation and large-scale ocean-atmosphere ENSO and IOD indices. The results indicate a strong correlation between the river level variations and precipitation changes in the central part of the basin (0.77 on average) in comparison to the northern (0.64 on average) and southern parts (0.72 on average). Larger water storages and rainfall variations are observed in the Upper Nile in contrast to the Lower Nile. A negative groundwater trend is also found over the Lower Nile, which could be attributed to a significantly lower amount of rainfall in the last decade and extensive irrigation over the region.

Islet-reactive CD8+ T cell frequencies in the pancreas, but not in blood, distinguish type 1 diabetic patients from healthy donors

The human leukocyte antigen-A2 (HLA-A2)-restricted zinc transporter 8_186-194 (ZnT8_186-194) and other islet epitopes elicit interferon-γ secretion by CD8⁺ T cells preferentially in type 1 diabetes (T1D) patients compared with controls. We show that clonal ZnT8_186-194-reactive CD8⁺ T cells express private T cell receptors and display equivalent functional properties in T1D and healthy individuals. Ex vivo analyses further revealed that CD8⁺ T cells reactive to ZnT8_186-194 and other islet epitopes circulate at similar frequencies and exhibit a predominantly naïve phenotype in age-matched T1D and healthy donors. Higher frequencies of ZnT8_186-194-reactive CD8⁺ T cells with a more antigen-experienced phenotype were detected in children versus adults, irrespective of disease status. Moreover, some ZnT8_186-194-reactive CD8⁺ T cell clonotypes were found to cross-recognize a Bacteroides stercoris mimotope. Whereas ZnT8 was poorly expressed in thymic medullary epithelial cells, variable thymic expression levels of islet antigens did not modulate the peripheral frequency of their cognate CD8⁺ T cells. In contrast, ZnT8_186-194-reactive cells were enriched in the pancreata of T1D patients versus nondiabetic and type 2 diabetic individuals. Thus, islet-reactive CD8⁺ T cells circulate in most individuals but home to the pancreas preferentially in T1D patients. We conclude that the activation of this common islet-reactive T cell repertoire and progression to T1D likely require defective peripheral immunoregulation and/or a proinflammatory islet microenvironment.

Cerebral Venous Drainage in Patients With Space-Occupying Middle Cerebral Artery Infarction: Effects on Functional Outcome After Hemicraniectomy

Background: Cerebral venous drainage might influence brain edema characteristics and functional outcome of patients with severe ischemic stroke. The purpose of the study was to evaluate whether hypoplasia of transverse sinuses or the internal jugular veins is associated with poor functional outcome in patients with space-occupying middle cerebral artery (MCA) infarction who underwent decompressive surgery. Methods: We performed a retrospective analysis of patients with space-occupying MCA infarction treated with decompressive surgery at our university hospital. The transverse sinuses and the internal jugular veins were evaluated on baseline images and categorized as normal, hypoplastic or occluded. We defined composite variables for ipsilateral, contralateral or any abnormal cerebral venous drainage. We assessed the functional outcome at 12 months with the modified Rankin scale (mRS) score and defined poor functional outcome as mRS scores 5 and 6. Results: We analyzed 88 patients with available baseline imaging data [mean [SD] patient age 53 (±9) years; median[IQR] time to decompressive surgery 31(22-51) h]. At 12 months 44 patients (50%) had a poor outcome. In univariate analysis neither ipsilateral (OR 1.98;95%CI: 0.75-5.40), nor contralateral (OR 1.56;95%CI: 0.59-4.24) or any (OR 1.6; 95%CI: 0.68-3.79) hypoplasia or occlusion of venous drainage were significantly associated with poor functional outcome. In multivariate analyses, higher patient age (OR 1.07;95%CI 1.01-1.14) and baseline stroke severity (OR 3.42;95%CI 1.31-9.40) were independent predictors of poor functional outcome, but not ipsilateral hypoplasia or occlusion of venous drainage (OR 1.31;95%CI 0.47-3.67). Conclusions: The cerebral venous drainage pattern was not significantly associated with poor functional outcome in our cohort of patients with space-occupying MCA infarction who underwent decompressive surgery.

T-cell receptor-α repertoire of CD8+ T cells following allogeneic stem cell transplantation using next-generation sequencing

Alloreactivity or opportunistic infections following allogeneic stem cell transplantation are difficult to predict and contribute to post-transplantation mortality. How these immune reactions result in changes to the T-cell receptor repertoire remains largely unknown. Using next-generation sequencing, the T-cell receptor alpha (TRα) repertoire of naïve and memory CD8⁺ T cells from 25 patients who had received different forms of allogeneic transplantation was analyzed. In parallel, reconstitution of the CD8⁺/CD4⁺ T-cell subsets was mapped using flow cytometry. When comparing the influence of anti-T-cell therapy, a delay in the reconstitution of the naïve CD8⁺ T-cell repertoire was observed in patients who received in vivo T-cell depletion using antithymocyte globulin or post-transplantation cyclophosphamide in case of haploidentical transplantation. Sequencing of the TRα identified a repertoire consisting of more dominant clonotypes (>1% of reads) in these patients at 6 and 18 months post transplantation. When comparing donor and recipient, approximately 50% and approximately 80% of the donors’ memory repertoire were later retrieved in the naïve and memory CD8⁺ T-cell receptor repertoire of the recipients, respectively. Although there was a remarkable expansion of single clones observed in the recipients’ memory CD8⁺ TRα repertoire, no clear association between graft-versus-host disease or cytomegalovirus infection and T-cell receptor diversity was identified. A lower TRα diversity was observed in recipients of a cytomegalovirus-seropositive donor (P=0.014). These findings suggest that CD8⁺ T-cell reconstitution in transplanted patients is influenced by the use of T-cell depletion or immunosuppression and the donor repertoire.

A study of Bangladesh's sub-surface water storages using satellite products and data assimilation scheme

Climate change can significantly influence terrestrial water changes around the world particularly in places that have been proven to be more vulnerable such as Bangladesh. In the past few decades, climate impacts, together with those of excessive human water use have changed the country's water availability structure. In this study, we use multi-mission remotely sensed measurements along with a hydrological model to separately analyze groundwater and soil moisture variations for the period 2003-2013, and their interactions with rainfall in Bangladesh. To improve the model's estimates of water storages, terrestrial water storage (TWS) data obtained from the Gravity Recovery And Climate Experiment (GRACE) satellite mission are assimilated into the World-Wide Water Resources Assessment (W3RA) model using the ensemble-based sequential technique of the Square Root Analysis (SQRA) filter. We investigate the capability of the data assimilation approach to use a non-regional hydrological model for a regional case study. Based on these estimates, we investigate relationships between the model derived sub-surface water storage changes and remotely sensed precipitations, as well as altimetry-derived river level variations in Bangladesh by applying the empirical mode decomposition (EMD) method. A larger correlation is found between river level heights and rainfalls (78% on average) in comparison to groundwater storage variations and rainfalls (57% on average). The results indicate a significant decline in groundwater storage (∼32% reduction) for Bangladesh between 2003 and 2013, which is equivalent to an average rate of 8.73 ± 2.45mm/year.

Multi-component relaxation in clinically isolated syndrome: Lesion myelination may predict multiple sclerosis conversion

We performed a longitudinal case-control study on patients with clinically isolated syndrome (CIS) with the aid of quantitative whole-brain myelin imaging. The aim was (1) to parse early myelin decay and to break down its distribution pattern, and (2) to identify an imaging biomarker of the conversion into clinically definite Multiple Sclerosis (MS) based on in vivo measurable changes of myelination.

Imaging and clinical data were collected immediately after the onset of first neurological symptoms and follow-up explorations were performed after 3, 6, and, 12 months. The multi-component Driven Equilibrium Single Pulse Observation of T1/T2 (mcDESPOT) was applied to obtain the volume fraction of myelin water (MWF) in different white matter (WM) regions at every time-point. This measure was subjected to further voxel-based analysis with the aid of a comparison of the normal distribution of myelination measures with an age and sex matched healthy control group. Both global and focal relative myelination content measures were retrieved.

We found that (1) CIS patients at the first clinical episode suggestive of MS can be discriminated from healthy control WM conditions (p < 0.001) and therewith reproduced our earlier findings in late CIS, (2) that deficient myelination in the CIS group increased in T2 lesion depending on the presence of gadolinium enhancement (p < 0.05), and (3) that independently the CIS T2 lesion relative myelin content provided a risk estimate of the conversion to clinically definite MS (Odds Ratio 2.52).

We initially hypothesized that normal appearing WM myelin loss may determine the severity of early disease and the subsequent risk of clinically definite MS development. However, in contrast we found that WM lesion myelin loss was pivotal for MS conversion. Regional myelination measures may thus play an important role in future clinical risk stratification.

•

The multicomponent relaxation method mcDESPOT allowed 3D resolved data acquisition appropriate for group comparison and voxel-wise analysis.

•

Myelin imaging in early clinically isolated syndrome revealed initial imaging widespread myelin loss even in normal appearing brain tissue.

•

In clinically isolated syndrome the myelin measures varied depending on the presence of Gadolinium enhancement.

•

Short-term risk of clinically isolated syndrome to convert to multiple sclerosis was determined by myelin measures within white matter lesions.

Post-stroke insomnia in community-dwelling patients with chronic motor stroke: Physiological evidence and implications for stroke care

Questionnaire studies suggest that stroke patients experience sustained problems with sleep and daytime sleepiness, but physiological sleep studies focussing specifically on the chronic phase of stroke are lacking. Here we report for the first time physiological data of sleep and daytime sleepiness obtained through the two gold-standard methods, nocturnal polysomnography and the Multiple Sleep Latency Test. Data from community-dwelling patients with chronic right-hemispheric stroke (>12 months) were compared to sex- and age-matched controls. Behavioural and physiological measures suggested that stroke patients had poorer sleep with longer sleep latencies and lower sleep efficiency. Patients further spent more time awake during the night, and showed greater high-frequency power during nonREM sleep than controls. At the same time the Multiple Sleep Latency Test revealed greater wake efficiency in patients than controls. Importantly these findings were not due to group differences in sleep disordered breathing or periodic limb movements. Post-stroke insomnia is presently not adequately addressed within the care pathway for stroke. A holistic approach to rehabilitation and care provision, that includes targeted sleep interventions, is likely to enhance long-term outcome and quality of live in those living with chronic deficits after stroke.

Decannulation and Functional Outcome After Tracheostomy in Patients with Severe Stroke (DECAST): A Prospective Observational Study

BACKGROUND

Tracheostomy is performed in ventilated stroke patients affected by persisting severe dysphagia, reduced level of consciousness, or prolonged mechanical ventilation. The study aim was to determine the frequency and predictors of successful decannulation and long-term functional outcome in tracheotomized stroke patients.

METHODS

A prospective single-center observational study recruited ventilated patients with ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. Follow-up visits were performed at hospital discharge, 3, and 12 months. Competing risk analyses were performed to identify predictors of decannulation.

RESULTS

We included 53 ventilated stroke patients who had tracheostomy. One year after tracheostomy, 19 patients were decannulated (median [IQR] time to decannulation 74 [58-117] days), 13 patients were permanently cannulated, and 21 patients died without prior removal of the cannula. Independent predictors for decannulation in our cohort were patient age (HR 0.95 [95% CI: 0.92-0.99] per one year increase, p = 0.003) and absence of sepsis (HR 4.44 [95% CI: 1.33-14.80], p = 0.008). Compared to surviving patients without cannula removal, decannulated patients had an improved functional outcome after one year (median modified Rankin Scale score 4 vs. 5 [p < 0.001]; median Barthel index 35 vs. 5 [p < 0.001]).

CONCLUSIONS

Decannulation was achieved in 59.4% of stroke patients surviving the first 12 months after tracheostomy and was associated with better functional outcome compared to patients without decannulation. Further prospective studies with larger sample sizes are needed to confirm our results.

Normothermia after decompressive surgery for space-occupying middle cerebral artery infarction: a protocol-based approach

Background

Moderate hypothermia after decompressive surgery might not be beneficial for stroke patients. However, normothermia may prove to be an effective method of enhancing neurological outcomes. The study aims were to evaluate the application of a pre-specified normothermia protocol in stroke patients after decompressive surgery and its impact on temperature load, and to describe the functional outcome of patients at 12 months after treatment.

Methods

We analysed patients with space-occupying middle cerebral artery (MCA) infarction treated with decompressive surgery and a pre-specified temperature management protocol. Patients treated primarily with device-controlled normothermia or hypothermia were excluded. The individual temperature load above 36.5 °C was calculated for the first 96 h after hemicraniectomy as the Area Under the Curve, using °C x hours. The effect of temperature load on functional outcome at 12 months was analysed by logistic regression.

Results

We included 40 stroke patients treated with decompressive surgery (mean [SD] age: 58.9 [10.1] years; mean [SD] time to surgery: 30.5 [16.7] hours). Fever (temperature > 37.5 °C) developed in 26 patients during the first 96 h after surgery and mean (SD) temperature load above 36.5 °C in this time period was 62,3 (+/− 47,6) °C*hours. At one year after stroke onset, a moderate to moderately severe disability (modified Rankin Scale score of 3 or 4) was observed in 32% of patients, and a severe disability (score of 5) in 37% of patients, respectively. The lethality in the cohort at 12 months was 32%. The temperature load during the first 96 h was not an independent predictor for 12 month lethality (OR 0.986 [95%-CI:0.967–1.002]; p < 0.12).

Conclusions

Temperature control in surgically treated patients with space-occupying MCA infarction using a pre-specified protocol excluding temperature management systems resulted in mild hyperthermia between 36.8 °C and 37.2 °C and a low overall temperature load. Future prospective studies on larger cohorts comparing different strategies for normothermia treatment including temperature management devices are needed.

Electronic supplementary material

The online version of this article (10.1186/s12883-017-0988-x) contains supplementary material, which is available to authorized users.

Modulation of defensive reactivity by GLRB allelic variation: converging evidence from an intermediate phenotype approach

Representing a phylogenetically old and very basic mechanism of inhibitory neurotransmission, glycine receptors have been implicated in the modulation of behavioral components underlying defensive responding toward threat. As one of the first findings being confirmed by genome-wide association studies for the phenotype of panic disorder and agoraphobia, allelic variation in a gene coding for the glycine receptor beta subunit (GLRB) has recently been associated with increased neural fear network activation and enhanced acoustic startle reflexes. On the basis of two independent healthy control samples, we here aimed to further explore the functional significance of the GLRB genotype (rs7688285) by employing an intermediate phenotype approach. We focused on the phenotype of defensive system reactivity across the levels of brain function, structure, and physiology. Converging evidence across both samples was found for increased neurofunctional activation in the (anterior) insular cortex in GLRB risk allele carriers and altered fear conditioning as a function of genotype. The robustness of GLRB effects is demonstrated by consistent findings across different experimental fear conditioning paradigms and recording sites. Altogether, findings provide translational evidence for glycine neurotransmission as a modulator of the brain's evolutionary old dynamic defensive system and provide further support for a strong, biologically plausible candidate intermediate phenotype of defensive reactivity. As such, glycine-dependent neurotransmission may open up new avenues for mechanistic research on the etiopathogenesis of fear and anxiety disorders.

Neurotrophin Receptor p75NTR Regulates Immune Function of Plasmacytoid Dendritic Cells

Plasmacytoid dendritic cells (pDCs) regulate innate and adaptive immunity. Neurotrophins and their receptors control the function of neuronal tissue. In addition, they have been demonstrated to be part of the immune response but little is known about the effector immune cells involved. We report, for the first time, the expression and immune-regulatory function of the low affinity neurotrophin receptor p75 neurotrophin receptor (p75NTR) by the antigen-presenting pDCs, mediated by toll-like receptor (TLR) 9 activation and differential phosphorylation of interferon regulatory factor 3 and 7. The modulation of p75NTR on pDCs significantly influences disease progression of asthma in an ovalbumin-induced mouse model mediated by the TLR9 signaling pathway. p75NTR activation of pDCs from patients with asthma increased allergen-specific T cell proliferation and cytokine secretion in nerve growth factor concentration-dependent manner. Further, p75NTR activation of pDCs delayed the onset of autoimmune diabetes in RIP-CD80GP mice and aggravated graft-versus-host disease in a xenotransplantation model. Thus, p75NTR signaling on pDCs constitutes a new and critical mechanism connecting neurotrophin signaling and immune response regulation with great therapeutic potential for a variety of immune disorders.

Accuracy of recommended sampling and assay methods for the determination of plasma-free and urinary fractionated metanephrines in the diagnosis of pheochromocytoma and paraganglioma: a systematic review

PURPOSE

To determine the accuracy of biochemical tests for the diagnosis of pheochromocytoma and paraganglioma.

METHODS

A search of the PubMed database was conducted for English-language articles published between October 1958 and December 2016 on the biochemical diagnosis of pheochromocytoma and paraganglioma using immunoassay methods or high-performance liquid chromatography with coulometric/electrochemical or tandem mass spectrometric detection for measurement of fractionated metanephrines in 24-h urine collections or plasma-free metanephrines obtained under seated or supine blood sampling conditions.

RESULTS

Application of the Standards for Reporting of Diagnostic Studies Accuracy Group criteria yielded 23 suitable articles. Summary receiver operating characteristic analysis revealed sensitivities/specificities of 94/93% and 91/93% for measurement of plasma-free metanephrines and urinary fractionated metanephrines using high-performance liquid chromatography or immunoassay methods, respectively. Partial areas under the curve were 0.947 vs. 0.911. Irrespective of the analytical method, sensitivity was significantly higher for supine compared with seated sampling, 95 vs. 89% (p < 0.02), while specificity was significantly higher for supine sampling compared with 24-h urine, 95 vs. 90% (p < 0.03). Partial areas under the curve were 0.942, 0.913, and 0.932 for supine sampling, seated sampling, and urine. Test accuracy increased linearly from 90 to 93% for 24-h urine at prevalence rates of 0.0-1.0, decreased linearly from 94 to 89% for seated sampling and was constant at 95% for supine conditions.

CONCLUSIONS

Current tests for the biochemical diagnosis of pheochromocytoma and paraganglioma show excellent diagnostic accuracy. Supine sampling conditions and measurement of plasma-free metanephrines using high-performance liquid chromatography with coulometric/electrochemical or tandem mass spectrometric detection provides the highest accuracy at all prevalence rates.

The Bleeding on Brushing Index: a novel index in preventive dentistry

BACKGROUND

The aim of this study was to evaluate the suitability of a dichotomous index, based on a special interdental brushing tool, to detect initial pathological processes in interproximal areas. Furthermore, different techniques of interdental hygiene were compared.

METHODS

Participants (n = 108) were instructed to clean their teeth using the Bass technique and were randomly assigned to three groups according to the type of interdental cleaning used: group A, use of interdental brushes; group B, no interdental hygiene (the control group); and group C, use of dental floss. Approximal Plaque Index (API), Plaque Index (PI), modified Sulcus Bleeding Index (mSBI) and the Bleeding on Brushing Index (BOB) were measured at baseline, and after 2 (t1) and 4 (t2) weeks. Statistical analysis was performed using the Wilcoxon test and the Mann-Whitney U-test.

RESULTS

One-hundred and six participants completed the study. The BOB decreased significantly in all groups (P < 0.001) with the most pronounced reduction being recorded for group A (baseline: 49.3 ± 23.0%; 4 weeks: 5.1 ± 6.9%). Also, the mSBI (P < 0.001) decreased significantly in all groups during the study. The API appeared to be less affected by the oral hygiene than other indices. The highest correlation was observed between BOB and mSBI (r = 0.785, P < 0.001).

CONCLUSION

The BOB is a valuable complement for the existing array of indices in preventive dentistry, and is able to detect potential pathological processes in interproximal spaces. Additionally, this study suggests that interdental hygiene with individually selected brushes is superior to flossing.

CLINICAL RELEVANCE

With the BOB, gingival inflammation can be demonstrated to patients, which could increase compliance.

Neural correlates of behavioral inhibition in healthy people and in patients with borderline personality disorder and ADHD

Introduction

Deficits in behavioral inhibition leading to impulsivity occur frequently in many otherwise different psychiatric diseases, mainly ADHD and borderline personality disorder (BPD). However, the research is complicated by using of different tests and their parameters. Further, the role of frontoparietal network in behavioral inhibition has been questioned recently.

Objectives

The aims of our studies were:

– to present the influence of differences in inhibition tasks parameters;

– to describe neural correlates of behavioral inhibition in healthy people;

– to compare them with BPD and ADHD patients.

Methods

We implemented two different variants of Go/NoGo Task, one designed for behavioral research and the second for neuroimaging. Thirty healthy participants (37% of women, age range 15 to 33 years) underwent behavioral and fMRI measurement. Further, groups of patients with BPD, ADHD and their healthy controls underwent the Go/NoGo Task under both fMRI and EEG.

Results

The results show differences in behavioral performance based on different task parameters. The fMRI results in healthy people show specific activation patterns within the frontoparietal network associated with inhibition trials (mainly inferior frontal gyrus, insula, cingulate gyrus, SMA, inferior parietal lobule). Further, we present differences between patients with BPD, ADHD and controls in BOLD signal and ERPs.

Conclusions

Go/NoGo Task design substantially influences the subjects’ behavioral performance. Our results with methodologically upgraded Go/NoGo Task design provide support for the inhibition frontoparietal brain network and its different activations in BPD and ADHD patients. The research was supported by Ministry of Health of the Czech Republic, grant nr. 15-30062A.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

T cell receptor repertoires after adoptive transfer of expanded allogeneic regulatory T cells

Regulatory T cell (T_reg ) therapy has been exploited in autoimmune disease, solid organ transplantation and in efforts to prevent or treat graft-versus-host disease (GVHD). However, our knowledge on the in-vivo persistence of transfused T_reg is limited. Whether T_reg transfusion leads to notable changes in the overall T_reg repertoire or whether longevity of T_reg in the periphery is restricted to certain clones is unknown. Here we use T cell receptor alpha chain sequencing (TCR-α-NGS) to monitor changes in the repertoire of T_reg upon polyclonal expansion and after subsequent adoptive transfer. We applied TCR-α-NGS to samples from two patients with chronic GVHD who received comparable doses of stem cell donor derived expanded T_reg . We found that in-vitro polyclonal expansion led to notable repertoire changes in vitro and that T_reg cell therapy altered the peripheral T_reg repertoire considerably towards that of the infused cell product, to different degrees, in each patient. Clonal changes in the peripheral blood were transient and correlated well with the clinical parameters. We suggest that T cell clonotype analyses using TCR sequencing should be considered as a means to monitor longevity and fate of adoptively transferred T cells.

Collateral state and the effect of endovascular reperfusion therapy on clinical outcome in ischemic stroke patients

PURPOSE

Clinically successful endovascular therapy (EVT) in ischemic stroke requires reliable noninvasive pretherapeutic selection criteria. We investigated the association of imaging parameters including CT angiographic collaterals and degree of reperfusion with clinical outcome after EVT.

METHODS

In our database, we identified 93 patients with large vessel occlusion in the anterior circulation treated with EVT. Besides clinical data, we assessed the baseline Alberta Stroke Program Early CT score (ASPECTS) on noncontrast CT (NCCT) and CT angiography (CTA) source images, collaterals (CT-CS) and clot burden score (CBS) on CTA and the degree of reperfusion after EVT on angiography. Three readers, blinded to clinical information, evaluated the images in consensus. Data-driven multivariable ordinal regression analysis identified predictors of good outcome after 90 days as measured with the modified Rankin Scale.

RESULTS

Successful angiographic reperfusion (OR 26.50; 95%-CI 9.33-83.61) and good collaterals (OR 9.69; 95%-CI 2.28-59.27) were independent predictors of favorable outcome along with female sex (OR 0.35; 95%-CI 0.14-0.85), younger age (OR 0.88; 95%-CI 0.83-0.92) and higher NCCT ASPECTS (OR 2.54; 95%-CI 1.01-6.63). Outcome was best in patients with good collaterals and successful reperfusion, but there was no statistical interaction between collaterals and reperfusion.

CONCLUSIONS

CTA-collateral status was the strongest pretherapeutic predictor of favorable outcome in ischemic stroke patients treated with EVT. CTA-collaterals are thus well suited for patient selection in EVT. However, the independent effect of reperfusion on outcome tended to be stronger than that of CTA-collaterals.