POS0199 DETECTION OF SARS CoV-2 ANTIBODIES FOLLOWING VACCINATION IN PATIENTS WITH RHEUMATIC MUSCULOSKELETAL DISEASE (DECODIR) – AN INTERIM REPORT FROM A DANISH PROSPECTIVE COHORT STUDY

Background

During the COVID-19 pandemic, it remains a major concern whether patients with rheumatic musculoskeletal disease treated with conventional (cs) or biologic (b) disease modifying drugs (DMARDs) exhibit an adequate immune response to the currently available SARS-CoV2 vaccines. There remains an urgent need for more data on SARS-CoV-2 vaccine efficacy to inform healthcare providers on the efficiency of the applied vaccination, potential need of and period for booster and/ or re-vaccination.

Objectives

To assess and compare the efficacy of the SARS-CoV2 vaccines BNT162b2 vaccine (Pfizer/BioNTech) and mRNA-1273 vaccine (Moderna). (The vaccines were administered as part of the Danish vaccine roll out and offered each with two doses and approximately four weeks apart).

Patients’ SARS-CoV2 IgG serum level was used as proxy to determine vaccination response.

Methods

We established the ‘Detection of SARS-CoV2 antibodies in Danish Inflammatory Rheumatic Outpatients’ study (DECODIR) as a longitudinal prospective cohort study. Patients with rheumatoid arthritis (RA), spondyloarthropathies (SpA) or psoriatic arthritis (PsA) receiving their outpatient treatment and monitored in the Danish DANBIO registry at the Danish Hospital for Rheumatic Diseases (DG), Sonderborg were included (April - June 2021).

Bloods, patient reported outcome measurements (PROMS), clinical data and treatment information (cs/bDMARD) were collected at baseline (prior to vaccination) and after six weeks and six months. SARS-CoV2 IgG levels in serum were assessed by ELISA (ThermoFischer), and manufacturer’s cut-off (>=10 EliA U/mL) selected as definition of sufficient IgG response.

Associations between antibody response, age, gender, disease (RA/PsA/SpA), treatment with no or cs/bDMARDs and disease activity were tested using proportional odds regression and bootstrapped tests of medians. Results were reported using mean, median (IqR) and bootstrapped 95% confidence interval (CI) of the median.

Results

A total of 243 patients were included at baseline and after six weeks; at six months’ follow-up data were available for 233 patients.

After six weeks, vaccination was followed by a significant increase in IgG levels (median of <0.7 EliA U/mL at baseline versus 36.5 EliA U/mL). Patients treated with a combination of both cDMARD and bDMARD had significantly lower IgG levels compared to patients without any DMARD treatment (8,2 EliA U/mL vs 19.5 EliA U/mL (p<0.001)). Patients treated with oral prednisolone (any dose) also showed significantly lower median IgG levels compared to patients without DMARD treatment (3,8 EliA U/mL vs 19.5 EliA U/mL (p<0.01)).

The actual measurements six months after baseline demonstrated a significant decrease of IgG levels for the whole study population (median of 16 EliA U/mL at six month vs 36.5 EliA U/mL at six weeks, p < 0.001) (Figure 1).

Figure 1.

IgG-level stratified by treatment

Similar to week 6, lowest response rates were found in patients treated with prednisolone or combination of csDMARD and bDMARD. After 6 months, the proportional odds model revealed significantly lower median IgG antibody level in patients who received Pfizer compared to Moderna (median 15 EliA U/mL (95%CI: 13-18) vs 44.5 EliA U/mL (95%CI: 36-83) (p<0.001).

Conclusion

IgG levels decreased markedly six months after the initial double dose regimen. Patients treated with a combination of cs/bDMARD or oral prednisolone are at higher risk of inadequate vaccine response as measured by IgG level.

Our results support the decision for the need of a third booster vaccine in patients with inflammatory rheumatic diseases, especially in the case of cs/bDMARD combination treatment and prednisolone. The data may indicate a need for further revaccination in these patients.

Reference

[1]Schreiber K. et al. Reduced Humoral Response of SARS-CoV-2 Antibodies following Vaccination in Patients with Inflammatory Rheumatic Diseases— an Interim Report from a Danish Prospective Cohort Study. Vaccines 2022, 10(1), 35.

Acknowledgements

We acknowledge all patients contributing to the DANBIO registry. The Danish

Rheumatologic Biobank is acknowledged for handling and storage of biological material. Lab technician Charlotte Drachmann is acknowledged for her assistance

Disclosure of Interests

Christine Graversgaard: None declared, Karen Schreiber Consultant of: UCB Advisory Board, Randi Petersen: None declared, Henning Jakobsen: None declared, Anders Bo Bojesen: None declared, Niels Steen Krogh: None declared, Bente Glintborg Grant/research support from: AbbVie, BMS, Pfizer, Merete Lund Hetland Grant/research support from: AbbVie, Biogen, BMS, Celtrion, Eli Lilly Denmark A/S, Janssen Biologics B.V, Lundbeck Fonden, MSD, Pfizer, Roche, Samsung Biopis, Sandoz. MLH chairs the steering committee of the Danish Rheumatology Quality Registry (DANBIO), which receives public funding from the hospital owners and funding from pharmaceutical companies. MLH co-chairs EuroSpA, which generates real-world evidence of treatment of psoriatic arthritis and axial spondylorthritis based on secondary data and is partly funded by Novartis., Oliver Hendricks Grant/research support from: AbbVie, Novartis, Pfizer

OP0211-HPR EXPERIENCES DURING THE COVID-19 PANDEMIC AMONG PEOPLE WITH INFLAMMATORY ARTHRITIS. “REOPENING OF SOCIETY IS HARDER THAN LOCK-DOWN” - A QUALITATIVE INTERVIEW STUDY

Background

People with inflammatory arthritis (IA) treated with conventional or biological immunosuppressive disease-modifying anti rheumatic drugs (DMARDs), were initially considered to have an increased risk of severe illness from SARS-CoV-19 (COVID-19) infection compared to the general population. Although resent studies have not confirmed this, people with IA have reported high level of anxiety and self-isolation during the pandemic (1). Only few studies have qualitatively explored how people with IA experience the impact the COVID-19 pandemic and the SARS-CoV-19 vaccinations.

Objectives

To explore how people with IA experienced restrictions during the COVID-19 pandemic and the possible impact of vaccination on their protection against COVID-19 and their everyday lives.

Methods

Semi-structured in-depth interviews were conducted via telephone or video with 19 people with IA in May – August 2021, shortly after they were enrolled in the national COVID-19 vaccination programme (all Danish citizens >18 years of age invited for SARS-CoV-19 vaccination, free of charge, with timing depending on age and comorbidities). At the same time, society gradually reopened after a complete lock-down. Qualitative content analysis, inspired by Graneheim and Lundman (2), was applied to analyse the data. Two patient research partners were involved in development of the study protocol, an interview guide and in the interpretation of findings.

Results

The participants’ age ranged from 21 to 64 years, median 50 years. 7 male and 12 female, all diagnosed with IA (Psoriatic arthritis n=4, Axial Spondyloarthropathy n=4, Rheumatoid arthritis n=9, and Juvenile arthritis n=2) and 14 were treated with DMARDs. Two had not accepted vaccination.

The analysis derived five themes: 1: “Changing and divergent information”. The participants experienced there was an overload of general information to the public, while targeted information on the specific risk for people with IA was lacking; 2: “Individual interpretation of own risk”, reflecting that participants had to find their own level of daily-life restrictions, a task they found to be very difficult; 3: “Impact on everyday life”. They took self-imposed precautions to protect themselves and their families from attracting COVID-19; 4: “Position in society and the vaccination programme”, emphasizing that participants were affected by the inconsistent announcements from authorities whether they were considered to be in particular risk or not, and some expressed concerns regarding the DMARDs influence on the effect of the vaccine and 5: “Reopening is somehow harder than lock down”. A societal spirit of being “in this together” emerged through the lock-down and some were concerned that fewer restrictions during reopening of the society would put them in higher risk of a COVID-19 infection and force them to continue self-isolation.

Table 1.

Quotation to illustrate the findings

“… you felt like one in the crowd and then everything is easier. Even though it was difficult. But then; it was difficult for all of us. It had nothing to do with my rheumatic disease… we were in this together... But it was harder when the reopening started. Because it´s like; I’m back on the platform and can’t just jump on the train, can’t go anywhere, that is...I’m just not quite ready to jump into society like everyone else...”

Conclusion

The COVID-19 pandemic affected the everyday lives of people with IA due to the authorities’ restrictions and further self-imposed precautions throughout lock down and reopening of society. People with IA experienced a lack of consistent information and felt alone to assess their own SARS-Cov-19 infection risk.

References

[1]GLINTBORG, B et al. 2021. Self-protection strategies and health behaviour in patients with inflammatory rheumatic diseases during the COVID-19 pandemic. RMD Open, 7.

[2]GRANEHEIM, U. H. & LUNDMAN, B. 2004. Qualitative content analysis in nursing research. Nurse Educ Today, 24, 105-12.

Disclosure of Interests

None declared

The Institute on Methods and Protocols for Advancement of Clinical Trials in ADRD (IMPACT-AD): A Novel Clinical Trials Training Program

BACKGROUND

Alzheimer's Disease and Related Dementias (ADRD) clinical trials require multidisciplinary expertise in medicine, biostatistics, trial design, biomarkers, ethics, and informatics.

OBJECTIVES

To provide focused interactive training in ADRD clinical trials to a diverse cadre of investigators.

DESIGN

The Institute on Methods and Protocols for Advancement of Clinical Trials in ADRD (IMPACT-AD) is a novel multidisciplinary clinical trial training program funded by the National Institute on Aging and the Alzheimer's Association with two educational tracks. The Professionals track includes individuals who fill a broad variety of roles including clinicians, study coordinators, psychometricians, and other study professionals who wish to further their knowledge and advance their careers in ADRD trials. The Fellowship track includes current and future principal investigators and focuses on the design, conduct and analysis of ADRD clinical trials.

SETTING

The 2020 inaugural iteration of IMPACT-AD was held via Zoom.

PARTICIPANTS

Thirty-five trainees (15 Fellowship track; 20 Professionals track) were selected from 104 applications (34% acceptance rate). Most (n=25, 71%) identified as female. Fifteen (43%) were of a non-white race; six (18%) were of Hispanic ethnicity; eight (23%) indicated they were the first person in their family to attend college.

MEASUREMENTS

Participants completed daily evaluations as well as pre- and post-course assessments of learning.

RESULTS

Across topic areas, >90% of trainees evaluated their change in knowledge based on the lectures as "very much" or "somewhat increased." The mean proportion correct responses in pre- and post-course assessments increased from 55% to 75% for the Professionals track and from 54% to 78% for the Fellowship track.

CONCLUSIONS

IMPACT-AD successfully launched a new training opportunity amid a global pandemic that preliminarily achieved the goals of attracting a diverse cohort and providing meaningful training. The course is funded through 2025.

Cell type-specific novel long non-coding RNA and circular RNA in the BLUEPRINT hematopoietic transcriptomes atlas

Transcriptional profiling of hematopoietic cell subpopulations has helped to characterize the developmental stages of the hematopoietic system and the molecular bases of malignant and non-malignant blood diseases. Previously, only the genes targeted by expression microarrays could be profiled genome-wide. High-throughput RNA sequencing, however, encompasses a broader repertoire of RNA molecules, without restriction to previously annotated genes. We analyzed the BLUEPRINT consortium RNA-sequencing data for mature hematopoietic cell types. The data comprised 90 total RNA-sequencing samples, each composed of one of 27 cell types, and 32 small RNA-sequencing samples, each composed of one of 11 cell types. We estimated gene and isoform expression levels for each cell type using existing annotations from Ensembl. We then used guided transcriptome assembly to discover unannotated transcripts. We identified hundreds of novel non-coding RNA genes and showed that the majority have cell type-dependent expression. We also characterized the expression of circular RNA and found that these are also cell type-specific. These analyses refine the active transcriptional landscape of mature hematopoietic cells, highlight abundant genes and transcriptional isoforms for each blood cell type, and provide a valuable resource for researchers of hematologic development and diseases. Finally, we made the data accessible via a web-based interface: https://blueprint.haem.cam.ac.uk/bloodatlas/.

Normative Data that Does Not Exclude Participants with Mild Cognitive Impairment Results in Lower Than Expected Memory Impairment Rates, Particularly in Females

Objective

Mayo’s Older Adult Normative Studies (MOANS) have served as an important resource for clinicians for three decades. Data collection was completed prior to the development and widespread use of Mild Cognitive Impairment (MCI) as a construct. Therefore, a portion of individuals included in the MOANS normative studies likely had undetected cognitive impairment.

Method

The Mayo Clinic Study of Aging (MCSA) is a population-based study of cognitive aging among Olmsted County, Minnesota, residents that began in October 2004. We applied age-adjusted MOANS norms (Ivnik et al., 1992) for the Auditory Verbal Learning Test (AVLT) long delay recall to cognitively unimpaired participants age 56 or older in the MCSA (N = 3,603). We used 1-sample tests of proportions comparing observed impairment rates to impairment rates expected based on a normal distribution of performance.

Results

Results showed that a significantly lower than expected number of participants demonstrated impaired delayed recall based on MOANS norms (all p’s < .001). Using a lenient cut-off (< -1 SD), only 7.3% of participants demonstrated impaired performance (vs. 15.9% expected), and this was more pronounced for females (3.5% impaired) relative to males (11.1% impaired). Further, only 0.6% of participants demonstrated impaired performance at a cut-off of < -2 SD, and no participants aged 80-91 reached this cut-off (2.3% expected).

Conclusions

Results suggest that the sensitivity of the original MOANS norms is lowered by likely inclusion of individuals with MCI, particularly in females. Updated normative data for the AVLT that exclude individuals with MCI and adjust for sex are needed.

Platelet function is modified by common sequence variation in megakaryocyte super enhancers

Linking non-coding genetic variants associated with the risk of diseases or disease-relevant traits to target genes is a crucial step to realize GWAS potential in the introduction of precision medicine. Here we set out to determine the mechanisms underpinning variant association with platelet quantitative traits using cell type-matched epigenomic data and promoter long-range interactions. We identify potential regulatory functions for 423 of 565 (75%) non-coding variants associated with platelet traits and we demonstrate, through ex vivo and proof of principle genome editing validation, that variants in super enhancers play an important role in controlling archetypical platelet functions.

Numerous genetic variants, including those located in the non-coding regions of the genome, are known to be associated with blood cells traits. Here, Frontini and colleagues investigate their potential regulatory functions using epigenomic data and promoter long-range interactions.

Potency of Human Cardiosphere-Derived Cells from Patients with Ischemic Heart Disease Is Associated with Robust Vascular Supportive Ability

Cardiosphere-derived cell (CDC) infusion into damaged myocardium has shown some reparative effect; this could be improved by better selection of patients and cell subtype. CDCs isolated from patients with ischemic heart disease are able to support vessel formation in vitro but this ability varies between patients. The primary aim of our study was to investigate whether the vascular supportive function of CDCs impacts on their therapeutic potential, with the goal of improving patient stratification. A subgroup of patients produced CDCs which did not efficiently support vessel formation (poor supporter CDCs), had reduced levels of proliferation and increased senescence, despite them being isolated in the same manner and having a similar immunophenotype to CDCs able to support vessel formation. In a rodent model of myocardial infarction, poor supporter CDCs had a limited reparative effect when compared to CDCs which had efficiently supported vessel formation in vitro. This work suggests that not all patients provide cells which are suitable for cell therapy. Assessing the vascular supportive function of cells could be used to stratify which patients will truly benefit from cell therapy and those who would be better suited to an allogeneic transplant or regenerative preconditioning of their cells in a precision medicine fashion. This could reduce costs, culture times and improve clinical outcomes and patient prognosis. Stem Cells Translational Medicine 2017;6:1399-1411.

The Allelic Landscape of Human Blood Cell Trait Variation and Links to Common Complex Disease

Many common variants have been associated with hematological traits, but identification of causal genes and pathways has proven challenging. We performed a genome-wide association analysis in the UK Biobank and INTERVAL studies, testing 29.5 million genetic variants for association with 36 red cell, white cell, and platelet properties in 173,480 European-ancestry participants. This effort yielded hundreds of low frequency (<5%) and rare (<1%) variants with a strong impact on blood cell phenotypes. Our data highlight general properties of the allelic architecture of complex traits, including the proportion of the heritable component of each blood trait explained by the polygenic signal across different genome regulatory domains. Finally, through Mendelian randomization, we provide evidence of shared genetic pathways linking blood cell indices with complex pathologies, including autoimmune diseases, schizophrenia, and coronary heart disease and evidence suggesting previously reported population associations between blood cell indices and cardiovascular disease may be non-causal.

Columnar apple primary roots share some features of the columnar-specific gene expression profile of aerial plant parts as evidenced by RNA-Seq analysis

BACKGROUND

Primary roots (radicles) represent the first visible developmental stages of the plant and are crucial for nutrient supply and the integration of environmental signals. Few studies have analyzed primary roots at a molecular level, and were mostly limited to Arabidopsis. Here we study the primary root transcriptomes of standard type, heterozygous columnar and homozygous columnar apple (Malus x domestica) by RNA-Seq and quantitative real-time PCR. The columnar growth habit is characterized by a stunted main axis and the development of short fruit spurs instead of long lateral branches. This compact growth possesses economic potential because it allows high density planting and mechanical harvesting of the trees. Its molecular basis has been identified as a nested Gypsy-44 retrotransposon insertion; however the link between the insertion and the phenotype as well as the timing of the phenotype emergence are as yet unclear. We extend the transcriptomic studies of columnar tissues to the radicles, which are the earliest developmental stage and investigate whether homozygous columnar seedlings are viable.

RESULTS

Radicles mainly express genes associated with primary metabolism, growth and development. About 200 genes show differential regulation in a comparison of heterozygous columnar radicles with non-columnar radicles, whereas the comparison of homozygous columnar radicles with non-columnar radicles yields about 300 differentially regulated genes. Genes involved in cellulose and phenylpropanoid biosynthesis, cell wall modification, transcription and translation, ethylene and jasmonate biosynthesis are upregulated in columnar radicles. Genes in the vicinity of the columnar-specific Gypsy-44 insertion experience an especially strong differential regulation: the direct downstream neighbor, dmr6-like, is downregulated in heterozygous columnar radicles, but strongly upregulated in columnar shoot apical meristems.

CONCLUSIONS

The transcriptomic profile of primary roots reflects their pivotal role in growth and development. Homozygous columnar embryos are viable and form normal radicles under natural conditions, and selection towards heterozygous plants most likely occurs due to breeders' preferences. Cell wall and phytohormone biosynthesis and metabolism experience differential regulation in columnar radicles. Presumably the first step of the differential regulation most likely happens within the region of the retrotransposon insertion and its tissue-specificity suggests involvement of one (or several) tissue-specific regulator(s).

Do plastic surgery division heads and program directors have the necessary tools to provide effective leadership?

BACKGROUND

Effective leadership is imperative in a changing health care landscape driven by increasing expectations in a setting of rising fiscal pressures. Because evidence suggests that leadership abilities are not simply innate but, rather, effective leadership can be learned, it is prudent for plastic surgeons to evaluate the training and challenges of their leaders because there may be opportunities for further growth and support.

OBJECTIVE

To investigate the practice profiles, education/training, responsibilities and challenges of leaders within academic plastic surgery.

METHODS

Following research ethics board approval, an anonymous online survey was sent to division heads and program directors from all university-affiliated plastic surgery divisions in Canada. Survey themes included demographics, education/training, job responsibilities and challenges.

RESULTS

A response rate of 74% was achieved. The majority of respondents were male (94%), promoted to their current position at a mean age of 48 years, did not have a leadership-focused degree (88%), directly manage 30 people (14 staff, 16 faculty) and were not provided with a job description (65%). Respondents worked an average of 65 h per week, of which 18% was devoted to their leadership role, 59% clinically and the remainder on teaching and research. A discrepancy existed between time spent on their leadership role (18%) and related compensation (10%). Time management (47%) and managing conflict (24%) were described as the greatest leadership challenges by respondents.

CONCLUSIONS

Several gaps were identified among leaders in plastic surgery including predominance of male sex, limitations in formal leadership training and requisite skill set, as well as compensation and human resources management (emotional intelligence). Leadership and managerial skills are key core competencies, not only for trainees, but certainly for those in a position of leadership. The present study provides evidence that academic departments, universities and medical centres may benefit by re-evaluating how they train, promote and support their leaders in plastic surgery.

Do plastic surgery division heads and program directors have the necessary tools to provide effective leadership?

Background

Effective leadership is imperative in a changing health care landscape driven by increasing expectations in a setting of rising fiscal pressures. Because evidence suggests that leadership abilities are not simply innate but, rather, effective leadership can be learned, it is prudent for plastic surgeons to evaluate the training and challenges of their leaders because there may be opportunities for further growth and support.

Objective

To investigate the practice profiles, education/training, responsibilities and challenges of leaders within academic plastic surgery.

Methods

Following research ethics board approval, an anonymous online survey was sent to division heads and program directors from all university-affiliated plastic surgery divisions in Canada. Survey themes included demographics, education/training, job responsibilities and challenges.

Results

A response rate of 74% was achieved. The majority of respondents were male (94%), promoted to their current position at a mean age of 48 years, did not have a leadership-focused degree (88%), directly manage 30 people (14 staff, 16 faculty) and were not provided with a job description (65%). Respondents worked an average of 65 h per week, of which 18% was devoted to their leadership role, 59% clinically and the remainder on teaching and research. A discrepancy existed between time spent on their leadership role (18%) and related compensation (10%). Time management (47%) and managing conflict (24%) were described as the greatest leadership challenges by respondents.

Conclusions

Several gaps were identified among leaders in plastic surgery including predominance of male sex, limitations in formal leadership training and requisite skill set, as well as compensation and human resources management (emotional intelligence). Leadership and managerial skills are key core competencies, not only for trainees, but certainly for those in a position of leadership. The present study provides evidence that academic departments, universities and medical centres may benefit by re-evaluating how they train, promote and support their leaders in plastic surgery.

EU./U.S. CTAD Task Force on Alzheimer's Trial Populations

Successful therapeutic trials require well-targeted populations to demonstrate the effectiveness of a drug candidate. Most trials in the field of Alzheimer's disease (AD) have been conducted in patients with mild to moderate dementia. However, the advent of amyloid PET imaging has demonstrated that a significant proportion of individuals enrolled in such studies do not have evidence of brain amyloidosis and may in fact not have Alzheimer's disease. Further, dementia represents an advanced stage of neurodegeneration, perhaps too late for significant benefits of disease-modifying interventions. The successful development of effective disease-slowing therapies requires a study population selected in accordance with the mechanism of the specific intervention. An international task force of investigators from academia, industry, non-profit foundations, and regulatory agencies met in San Diego, California, USA, on November 13, 2013, to address issues related to screening and identification of clinical trial participants, and the ramifications of decisions made in this regard for drug development in AD and other dementias.

Tracing a key player in the regulation of plant architecture: the columnar growth habit of apple trees (Malus × domestica)

Plant architecture is regulated by a complex interplay of some key players (often transcription factors), phytohormones and other signaling molecules such as microRNAs. The columnar growth habit of apple trees is a unique form of plant architecture characterized by thick and upright stems showing a compaction of internodes and carrying short fruit spurs instead of lateral branches. The molecular basis for columnar growth is a single dominant allele of the gene Columnar, whose identity, function and gene product are unknown. As a result of marker analyses, this gene has recently been fine-mapped to chromosome 10 at 18.51-19.09 Mb [according to the annotation of the apple genome by Velasco (2010)], a region containing a cluster of quantitative trait loci associated with plant architecture, but no homologs to the well-known key regulators of plant architecture. Columnar apple trees have a higher auxin/cytokinin ratio and lower levels of gibberellins and abscisic acid than normal apple trees. Transcriptome analyses corroborate these results and additionally show differences in cell membrane and cell wall function. It can be expected that within the next year or two, an integration of these different research methodologies will reveal the identity of the Columnar gene. Besides enabling breeders to efficiently create new apple (and maybe related pear, peach, cherry, etc.) cultivars which combine desirable characteristics of commercial cultivars with the advantageous columnar growth habit using gene technology, this will also provide new insights into an elevated level of plant growth regulation.

Evaluation of the hormonal state of columnar apple trees (Malus x domestica) based on high throughput gene expression studies

The columnar phenotype of apple trees (Malus x domestica) is characterized by a compact growth habit with fruit spurs instead of lateral branches. These properties provide significant economic advantages by enabling high density plantings. The columnar growth results from the presence of a dominant allele of the gene Columnar (Co) located on chromosome 10 which can appear in a heterozygous (Co/co) or homozygous (Co/Co) state. Although two deep sequencing approaches could shed some light on the transcriptome of columnar shoot apical meristems (SAMs), the molecular mechanisms of columnar growth are not yet elaborated. Since the influence of phytohormones is believed to have a pivotal role in the establishment of the phenotype, we performed RNA-Seq experiments to study genes associated with hormone homeostasis and clearly affected by the presence of Co. Our results provide a molecular explanation for earlier findings on the hormonal state of columnar apple trees. Additionally, they allow hypotheses on how the columnar phenotype might develop. Furthermore, we show a statistically approved enrichment of differentially regulated genes on chromosome 10 in the course of validating RNA-Seq results using additional gene expression studies.

Spinal loads during position changes

BACKGROUND

Recommendations exist how patients should change from one body position to another in order to keep the spinal loads low. However, until now it is not clear whether the loads are in fact lower if the patients follow these recommendations. The aim was to measure the loads while changing the body position.

METHODS

Telemeterized vertebral body replacements have been inserted into 5 patients who had a severe compression fracture of a lumbar vertebral body. The acting loads were measured during a changing of the body position while lying and when moving from lying to sitting, from sitting to standing and vice versa.

FINDINGS

When the lying patients changed their position according to the physiotherapist's recommendations, the resultant force was nearly as high as it was during relaxed standing. Otherwise, the force was nearly twice as high. Changing from a lateral lying position to sitting and vice versa caused forces of about 180% of those seen for standing when the recommendations were heeded. Without instructions, the loads were about 70% higher. Use of a trapeze bar mounted to the bed did not increase the loads. Rising from a chair with the arms hanging down laterally led to average resultant forces of 380% related to standing. Placing the hands on armrests reduced this value to 180%.

INTERPRETATION

High forces may act on the spine when changing from one body position to another. These loads can be minimized when following the physiotherapist's instructions and when supporting the upper body by the arms.

Gestational age at cervical length measurement and preterm birth in twins

OBJECTIVES

To estimate the risk of preterm delivery of twin pregnancies based upon sonographic cervical length measurement and gestational age at measurement.

METHODS

Twin pregnancies that delivered between 1999 and 2005 and that underwent sonographic measurement of cervical length between 13 and 34 + 6 weeks' gestation were identified and a retrospective review performed. Women with anomalous pregnancies, multifetal reduction, cerclage placement or medically indicated deliveries before 35 weeks were excluded. Logistic regression analysis was used to estimate the risk of preterm delivery before 35 weeks.

RESULTS

A total of 561 women underwent 2975 sonographic cervical length measurements during the study period. The rate of preterm delivery before 35 weeks was 19.4%. The risk of delivery before 35 weeks decreased by approximately 5% for each additional mm of cervical length (odds ratio (OR) 0.95 (95% CI, 0.93-0.97); P < 0.001) and by approximately 6% for each additional week at which the cervical length was measured (OR 0.94 (95% CI, 0.92-0.96); P < 0.001).

CONCLUSION

The gestational age at which cervical length is measured is an important consideration when estimating the risk of spontaneous preterm birth in twins. The risk of preterm delivery is increased at earlier gestational ages and as cervical length decreases.

Similar clinical and neuroimaging features in monozygotic twin pair with mutation in progranulin

OBJECTIVE

To report the phenotypic characterization of monozygotic twins with mutations encoding progranulin (PGRN).

METHODS

We studied a twin pair with an exon 4 gene deletion in the PGRN gene. Both twins had clinical and neuropsychological examinations as well as structural MRI and fluorodeoxyglucose PET (FDG-PET) scans. PGRN gene sequencing was performed followed by progranulin ELISA in plasma.

RESULTS

Both twins manifested symptoms within 3 years of each other, with early behavioral, language, dysexecutive, and memory problems. MRI and FDG-PET imaging demonstrated a strikingly similar topography of findings with clear left hemisphere predominance. Serum progranulin levels in both were well below those from a normal population sample.

CONCLUSIONS

Compared with the heterogeneity seen in many families with PGRN mutations, these monozygotic twins demonstrated strong clinical, neuroimaging, and serum progranulin level similarities, demonstrating the importance of shared genetic profiles beyond environmental influences in the symptomatic expression of the disease.

Alzheimer's disease therapeutic trials: EU/US Task Force report on recruitment, retention, and methodology

While we may not be able to find a cure for Alzheimer's disease (AD) in the near future, several drugs presently in trials have shown promise as possible modifiers of disease progression. However, we may not be able to demonstrate efficacy due to issues of recruitment, retention, site-to-site variability, and other methodological issues. It is thus incumbent on the scientific community to find solutions to these problems, particularly as the field moves toward preventing illness or treating the disease in its prodromal stages, where these methodological issues will become even more critical. We need to better understand why participants agree or refuse to enter drug trials, and why both primary care physicians and Alzheimer's specialists agree or refuse to involve their patients. We also need to quantify the impact of requiring imaging studies, extensive questionnaires, cognitive testing, and lumbar punctures on recruitment and retention. With these concerns in mind, an international task force meeting of experts from academia and industry in the United States, European Union, and Japan in San Diego, California on November 2, 2011 to focus on recruitment, retention and other methodological issues related to clinical trials for AD. Based on the recommendations of this Task force meeting, this Perspectives article critically reflects on the most critical and timely methodological issues related to recruitment and retention in prevention and therapeutic trials in AD, which are paralleled by a paradigm shift in the diagnostic conceptualization of this disease, as reflected by recently new proposed diagnostic criteria involving preclinical stages of the disease.