Dynamics of SARS-CoV-2 Seroprevalence in a Large US population Over a Period of 12 Months

Due to a combination of asymptomatic or undiagnosed infections, the proportion of the United States population infected with SARS-CoV-2 was unclear from the beginning of the pandemic. We previously established a platform to screen for SARS-CoV-2 positivity across a representative proportion of the US population, from which we reported that almost 17 million Americans were estimated to have had undocumented infections in the Spring of 2020. Since then, vaccine rollout and prevalence of different SARS-CoV-2 variants have further altered seropositivity trends within the United States population. To explore the longitudinal impacts of the pandemic and vaccine responses on seropositivity, we re-enrolled participants from our baseline study in a 6- and 12- month follow-up study to develop a longitudinal antibody profile capable of representing seropositivity within the United States during a critical period just prior to and during the initiation of vaccine rollout. Initial measurements showed that, since July 2020, seropositivity elevated within this population from 4.8% at baseline to 36.2% and 89.3% at 6 and 12 months, respectively. We also evaluated nucleocapsid seropositivity and compared to spike seropositivity to identify trends in infection versus vaccination relative to baseline. These data serve as a window into a critical timeframe within the COVID-19 pandemic response and serve as a resource that could be used in subsequent respiratory illness outbreaks.

First Direct Observation of Collider Neutrinos with FASER at the LHC

We report the first direct observation of neutrino interactions at a particle collider experiment. Neutrino candidate events are identified in a 13.6 TeV center-of-mass energy pp collision dataset of 35.4  fb^{-1} using the active electronic components of the FASER detector at the Large Hadron Collider. The candidates are required to have a track propagating through the entire length of the FASER detector and be consistent with a muon neutrino charged-current interaction. We infer 153_{-13}^{+12} neutrino interactions with a significance of 16 standard deviations above the background-only hypothesis. These events are consistent with the characteristics expected from neutrino interactions in terms of secondary particle production and spatial distribution, and they imply the observation of both neutrinos and anti-neutrinos with an incident neutrino energy of significantly above 200 GeV.

O-125 Application of artificial intelligence using big data to devise and train a machine learning model on over 63,000 human embryos to automate time-lapse embryo annotation

Study question

Can a machine learning (ML) model, developed using modern neural network architecture produce comparable annotation data; utilisable for algorithmic outcome prediction, to manual time-lapse annotations?

Summary answer

The model automatically annotated unseen embryos with comparable results to manual methods, generating morphokinetic data to enable comparably predictive outputs from an embryo selection algorithm.

What is known already

The application of artificial intelligence across healthcare industries, including fertility, is increasing. Several ML models are available that seek to generate or analyse embryo images and morphokinetic data, and to determine embryo viability potential. Along with photographic images, the use of time-lapse in IVF laboratories has amassed numeric data, resulting predominantly from annotated manual assessment of images over time. Embryo annotation practice is variable in quality, can be subjective and is time-consuming; commonly taking several minutes per embryo. The development of rapid, accurate automatic annotation would represent a significant time-saving as well as an increase in reproducibility and accuracy.

Study design, size, duration

Multicentre quality assured annotation data from 63,383 time-lapse monitored embryos (EmbryoScope®), comprising over 400 million individual images, were used to train a ML model to automatically generate morphokinetic annotations. Data was derived from 8 UK clinics within a cohesive group between 2012-2021. Accuracy was assessed using 900 unseen embryos (with live birth outcome) by comparing the output of an established in-house, prospectively validated embryo selection model when the input was either ML-automated, or manual annotations.

Participants/materials, setting, methods

Multi-focal plane images were processed on the Azure cloud (Microsoft) and resampled to 300x300 pixels. A Laplacian-based focal stacking algorithm merged frames into a single image. The model consisted of an EfficientNetB4 Convolutional Neural Network classifier to extract features and classify the stage of embryo images. A Temporal Convolutional Network  interpreted a time-series of image features; producing annotations from pronuclear fading through to blastocyst. Soft localisation loss function used QA data to integrate annotation subjectivities.

Main results and the role of chance

The ML model rapidly and automatically generated annotations. Efficacy and comparability of the ML model to automate reliable, utilisable annotations was demonstrated by comparison with manual annotation data and the ML model’s ability to auto-generate annotations which could be used to predict live birth by providing annotation data to an established, validated in house embryo selection model. Live birth-predictive capability was measured, and benchmarked against manual annotation, using the area under the receiver operating characteristic curve (AUC).

When tested on time-lapse images, collected from pronuclear fading to full blastulation, representing 900 previously unseen, transferred blastocysts where live birth outcomes were blinded, the in-house developed auto-annotation ML model resulted in an AUC of 0.686 compared with 0.661 for manual annotations, for live birth prediction.

Auto annotation using the developed model took only milliseconds to complete per embryo. The developed auto-annotation model, built and tested on large data, is considered suitable for productionisation with the aim of being validated and integrated into an application to support IVF laboratory practice.

Limitations, reasons for caution

Whilst this model was trained to recognise key morphokinetic events, there are other morphokinetic variables that may be useful in the prediction of live birth and further improve embryo selection, or deselection, ability. Akin to manual interpretation, some embryos may fail to be annotated or need second opinion.

Wider implications of the findings

There is increasing evidence supporting the application of ML to utilise big data from time-lapse imaging and fertility care generally. Whilst promising benefits to IVF clinics and patients, responsible use of data is required alongside large high-quality datasets, and rigorous validation, to ensure safe and robust applications.

Trial registration number

N/A

P-722 Ending the anonymity of egg donors in shared donation programs could reduce the number of participants

Study question

Loss of egg donor anonymity could affect shared donation programs in Brazil?

Summary answer

Yes. Approximately 20% of the women who participated in this study would drop out of the program, especially those with higher incomes.

What is known already

The Brazilian Federal Council of Medicine seems to be increasingly flexible with regard to maintaining mandatory secrecy on the identity of donors. The resolution regarding assisted reproduction techniques, approved in 2021, concerns the possibility of donation between family members, up to fourth degree relatives. The possibility to know and have access to this identity or even the search for half-brothers can be a reality in many countries for children born through access to reproductive technology but the opinion or behaviour of this population about the presence or absence of anonymity is limited to a few studies.

Study design, size, duration

Women (n = 800) who applied for enrolment in the shared egg donation program at a private IVF clinic were invited to participate in an electronic survey developed using the online Survio® tool. The invitation to participate was sent by email from June to November 2021. 279 women (34.8%, 20-35 years) responded to the survey.

Participants/materials, setting, methods

The information was obtained through questioning and gaining information about: socioeconomic profile of the donors, their motives, ambivalence in relation to the sharing of eggs and feelings about a possible end of anonymity. Thereafter, answers given to 10 specific questions were recorded. Furthermore, a correlation analysis was performed to assess the relationship between acceptance of the end of donor anonymity and various study parameters.

Main results and the role of chance

Approximately 61% of patients would want to become egg donors for two reasons: to reduce IVF costs and to help another woman. However, significantly younger women want to be part of the egg donation program just to reduce their treatment costs (P < 0.05). Approximately 71% of women do not want any contact with the child born from their eggs; 69% of them would not like to meet the recipients and 75% would not like to meet the child, even if only the recipient had become pregnant. If donors lost a child, they would not even want to meet the child who was born with their donated eggs (76%).

Most participants also responded that they would be in the program even if the anonymity was not maintained (80%). However, women with higher income would drop out of the program if donor anonymity was not maintained (56.3%) compared to women with lower income (13.5%;P < 0.001).

Limitations, reasons for caution

Confounding variables related to the male partner's opinion cannot be excluded. Studies with larger samples are needed to confirm these findings.

Wider implications of the findings

A possible end to the anonymity of egg donors in Brazil would pose numerous challenges to the current practice of gamete donation. These concerns give rise to a broad discussion in society about how best to safeguard and promote the interests of donor-conceived children and protect the rights of donors.

Trial registration number

Not applicable.

P-535 Preimplantation Genetic Testing for Aneuploidy (PGT-A) for patients aged ≤ 37 years: Today, evidence-based medicine does not support its use. A meta-analysis

Study question

Do patients aged ≤37 years truly benefit from using PGT-A as an add-on to increase ongoing pregnancy rate (OPR)/live birth rate (LBR) in their first IVF/ICSI cycle?

Summary answer

The use of PGT-A is not superior to classic morphological embryonic selection to increase OPR/LBR in patients aged ≤37 years in their first IVF/ICSI cycle.

What is known already

The embryonic aneuploidies increase exponentially with advancing-maternal-age, ranging from 30-50% up to 37 years to 80% in women ≥42 years. Consequently, the use of PGT-A seems to be a useful add-on for patients with advanced-maternal-age, but not necessarily for young women undergoing their first IVF/ICSI cycle. Recent studies investigated the benefit of PGT-A, concluding that it was accompanied with lower OPR/LBR, when compared to conventional-cycles in women aged ≤37 years. However, the use of this add-on in IVF/ICSI cycles is increasing alarmingly. Furthermore, adding PGT-A in reproductive treatments is related with increased costs and limitations inherent to the test itself.

Study design, size, duration

A systematic review based on electronics searches of databases (PubMed/MEDLINE, EMBASE, Web of Science, Scopus, and Cochrane database. Keywords: PGT-A; Morphological embryonic selection; ongoing pregnancy; live birth) up to December 2021 was conducted to identify randomised controlled trials (RCTs) comparing clinical outcomes of IVF/ICSI cycles with PGT-A versus Morphological embryonic selection. The primary outcomes were ongoing pregnancy and live birth rates.

Participants/materials, setting, methods

Seven RCTs were included as targets for data extraction and meta-analysis. Three studies reported on OPR and five reported LBR of patients who underwent their first IVF/ICSI cycle. Data were combined for meta-analysis using StatsDirect statistical software. Dichotomous data were expressed as Relative Risk(RR) with a 95% confidence interval(CI). The amount of heterogeneity was evaluated using Cochran’sQ and I2. Study data were combined using a Random-effects model. P-values <0.05 were considered to be statistically significant.

Main results and the role of chance

-Ongoing pregnancy rates (three trials): PGT-A group: 67.4% (485/720) versus morphological embryo selection group: 63.2% (460/728) with no statistically significant differences (RR = 1.11; 95% CI = 0.89–1.39; P=0.35)

-Live birth rate (five trials): PGT-A group: 58.9% (578/981) versus Morphological embryo selection group: 57.9% (585/1010) with no statistically significant differences (RR = 1.01; 95% CI = 0.81–1.26; P=0.91).

Table 1 shows the data.

Limitations, reasons for caution

The main limitation of this meta-analysis is the low number and heterogeneity of studies included. However, all of the included studies are randomised controlled trials, and the data were meta-analysed using Random-effects.

Wider implications of the findings

This meta-analysis brings to light a fundamental discussion currently, in which physicians and embryologists employ add-ons to improve clinical outcomes even without adequate scientific support.Medical practices are based on scientific evidence and Reproductive Medicine is not different. Therefore, at the moment, PGT-A should not be indicated for patients aged ≤37years.

Trial registration number

Not applicable

O-190 Endometrial compaction in artificial frozen-thawed embryo transfer cycles is associated with improvement in pregnancy outcomes: a meta-analysis

Study question

Does the decrease in endometrial thickness between the end of oestrogen phase and embryo transfer day (endometrial compaction) impact the pregnancy outcomes in frozen-thawed embryo transfer (FET) cycles?

Summary answer

The combined data indicated that cycles with endometrial compaction resulted in significantly higher ongoing pregnancy/live birth rate than cycles with no decrease in endometrial thickness.

What is known already

In FET cycles the monitoring of endometrial thickness was mostly concentrated at the end of the endometrium proliferation phase, while research on endometrial thickness in the luteal phase around the embryo transfer day was relatively rare. In addition, few studies have investigated the change in endometrial thickness after progesterone administration, and the conclusions are contradictory. Some studies included women who used hormone replacement therapy for endometrial preparation and showed that endometrial compaction (decreased thickness between the end of oestrogen phase and embryo transfer day) was associated with higher pregnancy rates. However, others reached different conclusions.

Study design, size, duration

A systematic review and meta-analyses was carried out to analyse the effect of endometrial compaction on FET cycle outcomes. The search strategy included online searching of databases (MEDLINE, EMBASE, The Science Citation Index, Google scholar, Cochrane Controlled Trials Register and OVID) up to December 2021. There was no language restriction and included grey literature. The following Medical Subject Headings and text words were used: frozen-thawed embryo transfer, hormonal preparation, endometrial thickness, endometrial compaction.

Participants/materials, setting, methods

Only cycles with artificial endometrial lining preparation (oestrogen-progesterone) and that compared outcomes of endometrial compaction cycles versus no endometrial compaction (no change/increased in endometrial thickness) cycles were considered. The primary outcomes were clinical pregnancy(CPR), miscarriage(MR) and ongoing pregnancy/livebirth (OPR/LBR) rates. The Breslow–Day-statistic, Q-statistic and I² (inconsistency) were used to determine the combinability of the trials. The random effects model was used for odds ratio(OR). The StatsDirect statistical software (Cheshire, UK) was used for data analysis.

Main results and the role of chance

Although endometrial compaction does not significantly affect CPR (OR:1.31[0.91-1.89],P=0.14) and MR (OR:1.18[0.87-1.59];P=0.27, it seems to be associated with a higher OPR/LBR (OR:1.54[1.12-2.13];P=0.007). Table 1 shows the data.

Limitations, reasons for caution

Some trials did not report clinical pregnancy or miscarriage rate. It could be associated with differences in the results. The retrospective nature and lack of standardisation of procedures across studies should be highlighted. Some analyses show high heterogeneity. Although statistically significant, the results in both arms are very close. 

Wider implications of the findings

The combined results support the change in endometrial thickness as an easy, low-cost, potential noninvasive marker of endometrial receptivity. However, additional trials are still needed.

Trial registration number

Not applicable

O-180 Body mass index (BMI) is not associated with ovarian response to gonadotropin during IVF/ICSI treatment: An evaluation of 4499 IVF/ICSI cycles

Study question

Is there an association between body mass index (BMI) and ovarian response in IVF/ICSI treatment?

Summary answer

BMI does not seem to be associated with the ovarian response to gonadotropin.

What is known already

Obesity is becoming an increasingly widespread health problem. Elevated BMI in patients who undergo assisted reproduction technology has been associated with higher doses of gonadotropins, higher risks of ovarian hyperstimulation syndrome, increased cancellation rates, and lower oocyte recovery compared to women with normal BMI. In addition, overweight and obese women submitted to IVF may present reduced rates of clinical pregnancy and live births and an increased miscarriage rate. However, population differences should be considered.

Study design, size, duration

This prospective cohort study included 4499 women who underwent IVF/ICSI cycles. Only one cycle per couple was considered. Inclusion criteria included normal karyotype, presence of two ovaries as observed by ultrasound examination, and no history of ovarian surgery, endometriosis, hydrosalpinx, infection, or endocrine disorders. Patients were stratified into four groups by BMI: <18.5 kg/m2 (underweight); 18.5-24.9 kg/m2 (normal weight); 25-29.9 kg/m2 (overweight); and ≥30 kg/m2 (obesity).

Participants/materials, setting, methods

The BMI values were associated with age, anti-Müllerian hormone (AMH) levels, antral follicle counts (AFC), total dose of FSH and LH, number of follicles and number of retrieved oocytes (total and metaphase II) of IVF/ICSI cycles. The statistical analyses for group comparisons were performed using t test, Mann–Whitney test and the Kruskal–Wallis test.

Main results and the role of chance

No statistically significant differences were observed between BMI groups regarding age, AMH levels, AFC, dose of gonadotropin used (FSH and LH), days of stimulation, number of follicles and number of retrieved eggs (total and metaphase II). Table 1 summarizes the results.

Limitations, reasons for caution

A possible limitation is the cross-sectional nature of the data. Differences in sample size between BMI groups may have influenced the results.

Wider implications of the findings

Against common sense in the literature, the results did not reveal a relationship between BMI and the ovarian response to gonadotropins. BMI as an additional tool in the individualization of ovarian stimulation protocols should be reviewed.

Trial registration number

Not applicable.

O-157 Female body mass index (BMI) influences pregnancy outcomes: An evaluation of 4349 IVF/ICSI cycles

Study question

Does female body mass index (BMI) impair pregnancy outcomes after IVF/ICSI cycles?

Summary answer

High BMI (overweight and obesity) and low BMI (underweight) are associated with decreased clinical pregnancy and live birth rates and an increased miscarriage rate.

What is known already

Obese women undergoing treatment for infertility may face problems, such as the need for higher doses of drugs to stimulate ovulation, oocyte morphological changes, reduction in fertilization and implantation rates, and embryo quality. Compared to women of normal BMI, obese women submitted to IVF may present reduced rates of clinical pregnancy and live births and an increased miscarriage rate. Regarding the effects of low BMI, unfavourable pregnancy outcomes and infertility problems have been described, but evidence is still scarce and conflicting.

Study design, size, duration

A prospective analysis was performed of 4349 couples who underwent IVF/ICSI treatment and fresh embryo transfer. Only one cycle per couple was considered. Exclusion criteria included abnormal karyotype, uterine defects, evidence of hydrosalpinx, infections, endocrine problems, coagulation defects or thrombophilia and autoimmune defects. Couples were stratified into four groups by female BMI: <18.5kg/m2 (underweight); 18.5-24.9kg/m2 (normal weight); 25-29.9kg/m2 (overweight); and ≥30kg/m2 (obesity). Clinical pregnancy, miscarriage and live birth rates were the outcomes analysed.

Participants/materials, setting, methods

Variables such as age, duration/type of infertility, previous embryo transfers, aetiologies, endometrial thickness, type of ovarian stimulation, and number/quality/development stage of embryo transferred were included as potential confounding factors. For group comparisons, the t test or chi-square test was used. Multivariate logistic regression analyses were performed to evaluate the associations between BMI and the probabilities of clinical pregnancy (CP), miscarriage and live birth (LB). Normal-weight patients were considered as the reference group.

Main results and the role of chance

Regarding confounding factors, no significant differences between BMI groups were observed.

-BMI-group comparisons showed that CP, miscarriage and LB rates significantly worsened with the increase in BMI (overweight and obesity groups). Miscarriage and LB rates also worsened with the decrease in BMI (underweight group) (Table 1).

-Compared with the normal-weight group, the overweight and obesity groups had significantly reduced rates of CP (19%/29%, respectively) and LB (27%/40%, respectively) and an increased rate of miscarriage (1.7x and 2.3x, respectively). Underweight was associated with a 49%-reduced rate of LB and a 3.0x increase in the rate of miscarriage (Table 2).

Limitations, reasons for caution

Differences in sample size between BMI groups may have influenced the results. In clinical outcomes, only fresh transfers were considered (not cumulative data). Population characteristics should be considered when interpreting the results.

Wider implications of the findings

The study suggests that higher BMI (overweight and obesity) and lower BMI (underweight) in women have a detrimental effect on ART outcomes, especially regarding the evolution of pregnancies. Problems associated with abnormal BMI should be discussed when advising couples interested in fertility treatment.

Trial registration number

Not applicable.

Quality of life and patient-perceived symptoms in patients with psoriasis undergoing proactive or reactive management with the fixed-dose combination Cal/BD foam: A post-hoc analysis of PSO-LONG

Background

Psoriasis has important physical and psychosocial effects that extend beyond the skin. Understanding the impact of treatment on health‐related quality of life (HRQoL) and patient‐perceived symptom severity in psoriasis is key to clinical decision‐making.

Objectives

This post hoc analysis of the PSO‐LONG trial data assessed the impact of long‐term proactive or reactive management with fixed‐dose combination calcipotriene 50 µg/g and betamethasone dipropionate 0.5 mg/g (Cal/BD) foam on patient‐reported outcomes (PROs) in patients with psoriasis vulgaris.

Methods

Five hundred and twenty‐one patients from the Phase 3, randomized, double‐blind PSO‐LONG trial were included. An initial 4‐week, open‐label phase of fixed‐dose combination Cal/BD foam once daily (QD) was followed by a 52‐week maintenance phase, at the start of which patients were randomized to a proactive management arm (Cal/BD foam twice weekly) or reactive management arm (vehicle foam twice weekly). Patient‐perceived symptom severity and HRQoL were assessed using the Psoriasis Symptom Inventory (PSI), the Dermatology Life Quality Index (DLQI) and the EuroQol‐5D for psoriasis (EQ‐5D‐5L‐PSO).

Results

Statistically and clinically significant improvements were observed across all PRO measures. The mean difference (standard deviation) from baseline to Week 4 was −8.97 (6.18) for PSI, −6.02 (5.46) for DLQI and 0.11 (0.15) for EQ‐5D‐5L‐PSO scores. During maintenance, patients receiving reactive management had significantly higher DLQI (15% [p = 0.007]) and PSI (15% [p = 0.0128]) and a numerically lower EQ‐5D‐5L‐PSO mean area under the curve score than patients receiving proactive management (1% [p = 0.0842]).

Conclusions

Cal/BD foam significantly improved DLQI, EQ‐5D‐5L‐PSO and PSI scores during the open‐label and maintenance phases. Patients assigned to proactive management had significantly better DLQI and PSI scores and numerically better EQ‐5D‐5L‐PSO versus reactive management. Additionally, baseline flare was associated with worse PROs than the start of a relapse, and patients starting a relapse also had worse PROs than patients in remission.

P–164 Mulitcentre derived time lapse algorithms developed using 6228 transferred embryos with known birth outcome incorporating novel morphological and morphokinetic markers

Study question

Can incorporation of novel markers of morphology with known temporal events successfully rank embryos to enable prediction of propensity for live birth?

Summary answer

Incorporation of variables for trophectoderm and morula grading demonstrably enhanced the model to rank embryos in order of potential for live birth.

What is known already

Models built using morphokinetic markers of development are widely used to rank embryos within a cohort. Such models include defined temporal parameters which are closely related to morphological grade. However, morphological grading by an embryologist is subjective and is not strongly correlated to outcome. Combining with defined kinetic events has been suggested to improve prediction of outcome.

Study design, size, duration

Data from 6228 known live birth outcome embryos from 8 UK clinics between 2011 – 2018 were investigated using an exploratory approach to identify novel markers of development.

Participants/materials, setting, methods

Five significant variables were defined, a derivative of time to start of blastulation; a derivative of trophectoderm grade; a kinetic variable utilising t3, t4, t5 and t8; an interval variable of tB-tSB and a variable based on novel morula classification. To maximise the output, a proxy value was derived for missing datapoints. The model was built using logistical regression and validated using fivefold cross validation with the data split as 80% training and 20% test.

Main results and the role of chance

An algorithm was developed including the five significant variables identified with an AUC of 0.685 demonstrating reliable prediction of live birth. Without morphological variables, the AUC was 0.674 demonstrating the improvement in the prediction value by including the derivative of the trophectoderm and morula grade. This resulted in ten classes of algorithm scores, 1–10, giving a live birth rate from 2% to 46%, irrespective of patient variables, for chance of live birth.

Limitations, reasons for caution

Successful application of the algorithm is reliant on stringent quality assurance for maintenance of accurate annotation and grading, and may not be transferable between laboratories with different SOPs.

Wider implications of the findings: The addition of a trophectoderm and morula grade in combination with morphokinetic parameters, increases the predictive value of the algorithm in relation to live birth outcome. Using proxy values allows maximization of data for model generation, and allows the model to be applied when missing values are present.

Trial registration number

Not applicable

Investigating correlates of athletic identity and sport-related injury outcomes: a scoping review

OBJECTIVES

To conduct a scoping review that (1) describes what is known about the relationship between athletic identity and sport-related injury outcomes and (2) describes the relationship that an injury (as an exposure) has on athletic identity (as an outcome) in athletes.

DESIGN

Scoping review.

PARTICIPANTS

A total of n=1852 athletes from various sport backgrounds and levels of competition.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary measure used within the studies identified was the Athletic Identity Measurement Scale. Secondary outcome measures assessed demographic, psychosocial, behavioural, physical function and pain-related constructs.

RESULTS

Twenty-two studies were identified for inclusion. Samples were dominated by male, Caucasian athletes. The majority of studies captured musculoskeletal injuries, while only three studies included sport-related concussion. Athletic identity was significantly and positively associated with depressive symptom severity, sport performance traits (eg, ego-orientation and mastery-orientation), social network size, physical self-worth, motivation, rehabilitation overadherence, mental toughness and playing through pain, as well as injury severity and functional recovery outcomes. Findings pertaining to the association that an injury (as an exposure) had on athletic identity (as an outcome) were inconsistent and limited.

CONCLUSIONS

Athletic identity was most frequently associated with psychosocial, behavioural and injury-specific outcomes. Future research should seek to include diverse athlete samples (eg, women, athletes of different races, para-athletes) and should continue to reference theoretical injury models to inform study methodologies and to specify variables of interest for further exploration.

SinEx DB 2.0 update 2020: database for eukaryotic single-exon coding sequences

Single-exon coding sequences (CDSs), also known as ‘single-exon genes’ (SEGs), are defined as nuclear, protein-coding genes that lack introns in their CDSs. They have been studied not only to determine their origin and evolution but also because their expression has been linked to several types of human cancers and neurological/developmental disorders, and many exhibit tissue-specific transcription. We developed SinEx DB that houses DNA and protein sequence information of SEGs from 10 mammalian genomes including human. SinEx DB includes their functional predictions (KOG (euKaryotic Orthologous Groups)) and the relative distribution of these functions within species. Here, we report SinEx 2.0, a major update of SinEx DB that includes information of the occurrence, distribution and functional prediction of SEGs from 60 completely sequenced eukaryotic genomes, representing animals, fungi, protists and plants. The information is stored in a relational database built with MySQL Server 5.7, and the complete dataset of SEG sequences and their GO (Gene Ontology) functional assignations are available for downloading. SinEx DB 2.0 was built with a novel pipeline that helps disambiguate single-exon isoforms from SEGs. SinEx DB 2.0 is the largest available database for SEGs and provides a rich source of information for advancing our understanding of the evolution, function of SEGs and their associations with disorders including cancers and neurological and developmental diseases.

Database URL:http://v2.sinex.cl/

Non-invasive MRI quantification of cerebrospinal fluid dynamics in amyotrophic lateral sclerosis patients

Background

Developing novel therapeutic agents to treat amyotrophic lateral sclerosis (ALS) has been difficult due to multifactorial pathophysiologic processes at work. Intrathecal drug administration shows promise due to close proximity of cerebrospinal fluid (CSF) to affected tissues. Development of effective intrathecal pharmaceuticals will rely on accurate models of how drugs are dispersed in the CSF. Therefore, a method to quantify these dynamics and a characterization of differences across disease states is needed.

Methods

Complete intrathecal 3D CSF geometry and CSF flow velocities at six axial locations in the spinal canal were collected by T2-weighted and phase-contrast MRI, respectively. Scans were completed for eight people with ALS and ten healthy controls. Manual segmentation of the spinal subarachnoid space was performed and coupled with an interpolated model of CSF flow within the spinal canal. Geometric and hydrodynamic parameters were then generated at 1 mm slice intervals along the entire spine. Temporal analysis of the waveform spectral content and feature points was also completed.

Results

Comparison of ALS and control groups revealed a reduction in CSF flow magnitude and increased flow propagation velocities in the ALS cohort. Other differences in spectral harmonic content and geometric comparisons may support an overall decrease in intrathecal compliance in the ALS group. Notably, there was a high degree of variability between cases, with one ALS patient displaying nearly zero CSF flow along the entire spinal canal.

Conclusion

While our sample size limits statistical confidence about the differences observed in this study, it was possible to measure and quantify inter-individual and cohort variability in a non-invasive manner. Our study also shows the potential for MRI based measurements of CSF geometry and flow to provide information about  the hydrodynamic environment of the spinal subarachnoid space. These dynamics may be studied further to understand the behavior of CSF solute transport in healthy and diseased states.

A phase I study of panobinostat and ruxolitinib in patients with primary myelofibrosis (PMF) and post--polycythemia vera/essential thrombocythemia myelofibrosis (post--PV/ET MF)

Ruxolitinib, a selective JAK1/JAK2 inhibitor, is the current first line therapy for myelofibrosis (MF), which reduces symptomatology and splenomegaly, but does not clearly modify disease course. Panobinostat, a histone deacetylase inhibitor, was shown to be safe and tolerable in phase I and II trials and demonstrated clinical activity in approximately a third of treated patients. Combination therapy of ruxolitinib and panobinostat showed synergistic activity in a preclinical MF model, which prompted clinical evaluation of this combination in both ruxolitinib naïve and treated MF patients. Herein, we report the results of an investigator-initiated, dose escalation, phase I trial of ruxolitinib and panobinostat in 15 patients with primary MF and post-polycythemia vera/essential thrombocythemia MF. This combination treatment proved to be safe and tolerable without dose limiting thrombocytopenia and a maximum tolerated dose of both agents in combination was not determined. The majority of patients maintained stable disease with this combination treatment and 40 % attained a clinical improvement (spleen n = 5, anemia n = 1) by modified IWG-MRT at the end of 6 cycles. This is one of the first attempts of rationally designed, JAK inhibitor-based, combination therapy studies and exemplifies the feasibility of such an approach in patients with advanced MF.

Evidence-Based Clinical Practice Guidelines for Microcystic Adnexal Carcinoma: Informed by a Systematic Review

Importance

Microcystic adnexal carcinoma (MAC) occurs primarily in older adults of white race/ethnicity on sun-exposed skin of the head and neck. There are no formal guiding principles based on expert review of the evidence to assist clinicians in providing the highest-quality care for patients.

Objective

To develop recommendations for the care of adults with MAC.

Evidence Review

A systematic review of the literature (1990 to June 2018) was performed using MEDLINE, Embase, Web of Science, and the Cochrane Library. The keywords searched were microcystic adnexal carcinoma, sclerosing sweat gland carcinoma, sclerosing sweat duct carcinoma, syringomatous carcinoma, malignant syringoma, sweat gland carcinoma with syringomatous features, locally aggressive adnexal carcinoma, and combined adnexal tumor. A multidisciplinary expert committee critically evaluated the literature to create recommendations for clinical practice. Statistical analysis was used to estimate optimal surgical margins.

Findings

In total, 55 studies met our inclusion criteria. The mean age of 1968 patients across the studies was 61.8 years; 54.1% were women. Recommendations were generated for diagnosis, treatment, and follow-up of MAC. There are 5 key findings of the expert committee based on the available evidence: (1) A suspect skin lesion requires a deep biopsy that includes subcutis. (2) MAC confined to the skin is best treated by surgery that examines the surrounding and deep edges of the tissue removed (Mohs micrographic surgery or complete circumferential peripheral and deep margin assessment). (3) Radiotherapy can be considered as an adjuvant for MAC at high risk for recurrence, surgically unresectable tumors, or patients who cannot have surgery for medical reasons. (4) Patients should be seen by a physician familiar with MAC every 6 to 12 months for the first 5 years after treatment. Patient education on photoprotection, periodic skin self-examination, postoperative healing, and the possible normal changes in local sensation (eg, initial hyperalgesia) should be considered. (5) There is limited evidence to guide the treatment of metastasis in MAC due to its rarity. Limitations of our findings are that the medical literature on MAC comprises only retrospective reviews and descriptions of individual patients and there are no controlled studies to guide management.

Conclusions and Relevance

The presented clinical practice guidelines provide an outline for the diagnosis and management of MAC. Future efforts using multi-institutional registries may improve our understanding of the natural history of the disease in patients with lymph node or nerve involvement, the role of radiotherapy, and the treatment of metastatic MAC with drug therapy.

Successful knock-in of Hypertrophic Cardiomyopathy-mutation R723G into the MYH7 gene mimics HCM pathology in pigs

Familial Hypertrophic Cardiomyopathy (HCM) is the most common inherited cardiac disease. About 30% of the patients are heterozygous for mutations in the MYH7 gene encoding the ß-myosin heavy chain (MyHC). Hallmarks of HCM are cardiomyocyte disarray and hypertrophy of the left ventricle, the symptoms range from slight arrhythmias to sudden cardiac death or heart failure. To gain insight into the underlying mechanisms of the diseases' etiology we aimed to generate genome edited pigs with an HCM-mutation. We used TALEN-mediated genome editing and successfully introduced the HCM-point mutation R723G into the MYH7 gene of porcine fibroblasts and subsequently cloned pigs that were heterozygous for the HCM-mutation R723G. No off-target effects were determined in the R723G-pigs. Surprisingly, the animals died within 24 h post partem, probably due to heart failure as indicated by a shift in the a/ß-MyHC ratio in the left ventricle. Most interestingly, the neonatal pigs displayed features of HCM, including mild myocyte disarray, malformed nuclei, and MYH7-overexpression. The finding of HCM-specific pathology in neonatal R723G-piglets suggests a very early onset of the disease and highlights the importance of novel large animal models for studying causative mechanisms and long-term progression of human cardiac diseases.

122 A New Maturation Medium Improves Porcine Embryo Production In Vitro

Recently (Spate et al. 2017 Reprod. Fertil. Dev. 29, 150), a new medium [TCM-199 supplemented with hCG 10 IU, pregnant mare serum gonadotropin (PMSG) 10 IU mL−1, fibroblast growth factor (FGF) 40 ng mL−1, leukemia inhibitory factor (LIF) 2000 U mL−1, IGF-1 20 ng mL−1, epidermal growth factor (EGF) 10 ng mL−1], termed FLI medium, was demonstrated to improve porcine oocyte maturation in vitro. The effects on embryo development and quality have not yet been investigated. The purpose of the present study was to compare the FLI medium in porcine in vitro embryo production (IVP) with our standard maturation medium (DMEM supplemented with 10 IU mL−1 PMSG and hCG, 50 ng mL−1 EGF, 100 ng mL−1 IGF1, and 5 ng mL−1 FGF). Briefly, gilt oocytes were collected via aspiration of follicles from abattoir ovaries and matured for 44 h in either FLI or standard DMEM medium at 39°C, 5% CO2 in humidified air. In vitro fertilization was performed with freshly ejaculated sperm (250,000 mL−1) of a multi-transgenic boar (GGTA1-KO/hCD46/hCD55/hCD59/hHO-1/hA20) by co-incubation with the matured oocytes in PGMTac4 medium for 4 h. Zygotes were washed twice and then cultured for 6 days in PZM3 medium. Development to the blastocyst stage was recorded at Day 6 of culture. Blastocysts were fixed and Hoechst33342 stained for counting the nuclei. Each of the experiments was repeated 3 times. In a second step, Day 5 blastocysts derived from the FLI medium were transferred to synchronized pubertal gilts to test the in vivo developmental competence of the IVF embryos. Maturation of oocytes in FLI medium resulted in a significantly higher blastocyst rate (49.3 vs. 13.5; P ≤ 0.001, Chi-squared test) and nuclei number (41.3 ± 12.2 vs. 35.3 ± 10.8; P ≤ 0.001, one-way ANOVA) compared with the standard medium, whereas the cleavage rate was not affected. Transfer of Day 5 blastocysts (average 35 embryos/recipient) derived from the FLI system using 8 recipients resulted in 7 pregnancies (87.5%) as determined by ultrasound scanning on Day 25 of gestation. At the time of writing, one recipient had delivered 5 healthy piglets after a gestation length of 114 days. Results indicate that the FLI medium significantly improves blastocyst rates and the cell number of the resulting blastocysts (Table 1) and yields pig IVF embryos with a high developmental capacity in vivo. By producing high-quality porcine embryos, this FLI-based IVF system provides an efficient method to modify the porcine genome by cytoplasmic microinjection of CRISPR/Cas molecules into IVF-derived zygotes. Table 1.Results of maturation of oocytes in FLI medium compared with DMEM

Comparison of Kaposi Sarcoma Risk in Human Immunodeficiency Virus-Positive Adults Across 5 Continents: A Multiregional Multicohort Study

BACKGROUND

We compared Kaposi sarcoma (KS) risk in adults who started antiretroviral therapy (ART) across the Asia-Pacific, South Africa, Europe, Latin, and North America.

METHODS

We included cohort data of human immunodeficiency virus (HIV)-positive adults who started ART after 1995 within the framework of 2 large collaborations of observational HIV cohorts. We present incidence rates and adjusted hazard ratios (aHRs).

RESULTS

We included 208140 patients from 57 countries. Over a period of 1066572 person-years, 2046 KS cases were diagnosed. KS incidence rates per 100000 person-years were 52 in the Asia-Pacific and ranged between 180 and 280 in the other regions. KS risk was 5 times higher in South African women (aHR, 4.56; 95% confidence intervals [CI], 2.73-7.62) than in their European counterparts, and 2 times higher in South African men (2.21; 1.34-3.63). In Europe, Latin, and North America KS risk was 6 times higher in men who have sex with men (aHR, 5.95; 95% CI, 5.09-6.96) than in women. Comparing patients with current CD4 cell counts ≥700 cells/µL with those whose counts were <50 cells/µL, the KS risk was halved in South Africa (aHR, 0.53; 95% CI, .17-1.63) but reduced by ≥95% in other regions.

CONCLUSIONS

Despite important ART-related declines in KS incidence, men and women in South Africa and men who have sex with men remain at increased KS risk, likely due to high human herpesvirus 8 coinfection rates. Early ART initiation and maintenance of high CD4 cell counts are essential to further reducing KS incidence worldwide, but additional measures might be needed, especially in Southern Africa.

3D Morphometric Analysis of Normal Sacroiliac Joints: A New Classification of Surface Shape Variation and the Potential Implications in Pain Syndromes

BACKGROUND

Normal sacroiliac (SI) joints vary widely in shape, and it is unclear whether SI joint morphology plays a role in the development of pain. To answer this question, we used 3D-CT surface rendering to image healthy study participants and used the resulting images to develop a classification system for SI joint morphology. In a case-control study comparing health research participants to patients with SI pain, we assessed whether the classification of SI joint morphology was associated with pain.

OBJECTIVES

We aimed to define normal variation in area and shape of the synovialized SI joint. We also aimed to determine interactions between joint area and shape and SI pain in men and women.

STUDY DESIGN

A retrospective cohort study.

SETTING

University hospital tertiary care center.

METHODS

We conducted a retrospective case-control study. We acquired 3D-CT surface rendered images of the SI joint in 223 normal controls and 34 patients with SI pain syndrome. We measured the sacral and iliac surface areas and performed morphologic 3D assessment of both articular surfaces. We classified SI joints into 3 types based on morphology (types one, 2, and 3). We used descriptive statistics to provide a reference standard for normal SI joints. We used multivariate models to assess whether articular surface area differed between study participants with and without SI pain. We also assessed the association between morphology type and the presence of pain.

RESULTS

Sacral and iliac surface areas differ by participant gender. Sacral and iliac surface area was associated with SI joint pain in both men (P = 0.0007) and in women (P = 0.02). In women (P = 0.04), but not in men (P = 0.11), joint shape was associated with pain.

LIMITATIONS

A retrospective study may create potential for misclassification bias if SI joint symptoms/histories were present but not well-documented in the electronic medical record. A lack of clinical standardization in the pre-procedural assessment of SI joint pain via provocative maneuvers (FABER, etc.) is also a limitation.

CONCLUSIONS

Our study provides insight into the association between shape and joint surface area and SI joint pain. Further, prospective studies will allow us to determine the role of joint shape and surface area in the patho-etiology of SI joint pain, and thus provide information for patients and physicians about prevention or treatment.

KEY WORDS

Sacroiliac joint, spine pain, 3D reformation, SI joint area, SI joint shape, SI joint pain syndrome.

Complement activation contributes to ventilator-induced lung injury in rats

The complement system contributes to ventilator induced lung injury (VILI). We hypothesized that pretreatment with the C1 esterase inhibitor (C1INH) Berinert® constrains complement activation consecutively inducing improvements in arterial oxygenation and histological pulmonary damage. At baseline, male Sprague-Dawley rats underwent mechanical ventilation in a conventional mode (PIP 13 cm H₂O, PEEP 3 cm H₂O). In the Control group, the ventilator setting was maintained (Control, n = 15). The other animals randomly received intravenous pretreatment with either 100 units/kg of the C1-INH Berinert® (VILI-C1INH group, n = 15) or 1 ml saline solution (VILI-C group, n = 15). VILI was induced by invasive ventilation (PIP 35 cm H₂O, PEEP 0 cm H₂O). After two hours of mechanical ventilation, the complement component C3a remained low in the Control group (258 ± 82 ng/ml) but increased in both VILI groups (VILI-C: 1017 ± 283 ng/ml; VILIC1INH: 817 ± 293 ng/ml; P < 0.05 for both VILI groups versus Control). VILI caused a profound deterioration of arterial oxygen tension (VILI-C: 193 ± 167 mmHg; VILI/C1-INH: 154 ± 115 mmHg), whereas arterial oxygen tension remained unaltered in the Control group (569 ± 26 mmHg; P < 0.05 versus both VILI groups). Histological investigation revealed prominent overdistension and interstitial edema in both VILI groups compared to the Control group. C3a plasma level in the VILI group were inversely correlated with arterial oxygen tension (R = -0.734; P < 0.001). We conclude that in our animal model of VILI the complement system was activated in parallel with the impairment in arterial oxygenation and that pretreatment with 100 units/kg Berinert® did neither prevent systemic complement activation nor lung injury.

Defining "intermittent UVR exposure"

BACKGROUND

Cutaneous malignant melanoma (CMM) has been associated with "intermittent UVR exposure", which in previous studies has mainly been assessed by retrospective questionnaire data. Further, there is no uniform definition of the term "intermittent UVR exposure".

OBJECTIVES

We aimed to define and quantify "intermittent UVR exposure" by an objective measure.

METHODS

A broad study population of adults and children had data collected during a summer period. Data were personal UVR dosimetry measurements, from which the number of "intermittent days" was derived, sun behaviour diaries and retrospective questionnaires. Two definitions of intermittent UVR exposure were tested: (1) days when UVR dose exceeded 3 times individual average daily UVR dose, and (2) days when UVR dose exceeded individual constitutive skin type. Measures of nevi and lentigines were used as surrogates for CMM.

RESULTS

Using the first definition based solely on UVR dosimetry data we found 1241 "intermittent days" out of a total of 17 277 days (7.2%) among 148 participants. The numbers for nevi and lentigo density were significantly predicted by the number of intermittent days (R(2) = 0.15 and R(2) = 0.40, p < 0.001). The corresponding numbers for prediction of nevi and lentigo density by retrospective questionnaire data was lower (R(2) = 0.11, R(2) = 0.26, p < 0.001).

CONCLUSIONS

We introduce a well-defined objective measure of intermittent UVR exposure. This measure may provide a better prediction of solar skin damage and CMM than retrospective questionnaire data.

Lateral Acetabular Coverage Predicts the Size of the Hip Labrum

BACKGROUND

Bony morphological abnormalities of the hip joint are often accompanied by adaptive soft tissue changes. These adaptive changes, if better understood and characterized, may serve to inform clinical decision making.

PURPOSE

To investigate the correlation between the size of the hip labrum and lateral acetabular coverage in patients at our hip preservation clinic.

STUDY DESIGN

Cross-sectional study; Level of evidence, 3.

METHODS

A cohort of 236 patients seen at a dedicated hip preservation service between June 2013 and June 2015 were retrospectively analyzed. Patients were grouped according to the degree of acetabular coverage, as measured by the lateral center-edge angle (LCEA): normal acetabular coverage (25°-39.9°), acetabular overcoverage (≥40°), borderline dysplasia (20°-24.9°), and frank dysplasia (<20°). Preoperative magnetic resonance imaging was utilized to measure the length of the labrum at 3 locations: laterally, anteriorly, and anteroinferiorly.

RESULTS

Frankly dysplastic and borderline dysplastic hips exhibited larger values of labral length at all locations when compared with hips with normal acetabular coverage (P < .001) or acetabular overcoverage (P < .001). Interestingly, mean labral length values in frank dysplasia were statistically similar to corresponding measurements in borderline dysplasia. In hips with frank dysplasia, borderline dysplasia, or normal acetabular coverage, labral length was consistently greatest at the lateral labrum and correspondingly lowest at the anteroinferior labrum (P < .001). In hips with acetabular overcoverage, labral length did not vary significantly between the lateral, anterior, and anteroinferior locations. Multivariate analyses confirmed LCEA to be the strongest predictor of labral length, irrespective of measurement location.

CONCLUSION

Patients with borderline dysplasia and frank dysplasia exhibited increased values of labral length in the weightbearing zone, potentially indicating a compensatory reaction to the lack of bony coverage. Labral length may serve as an instability marker and inform clinical decision making for patients with borderline dysplasia.

Beneficial Immune Effects of Myeloid-Related Proteins in Kidney Transplant Rejection

Acute rejection is a risk factor for inferior long-term kidney transplant survival. Although T cell immunity is considered the main effector in clinical acute rejection, the role of myeloid cells is less clear. Expression of S100 calcium-binding protein A8 (S100A8) and S100A9 was evaluated in 303 biopsies before and after transplantation from 190 patients. In two independent cohorts of patients with acute rejection (n = 98 and n = 11; mostly cellular rejections), high expression of S100 calcium-binding protein A8 (S100A8) and A9 (S100A9) was related to improved graft outcome. Mechanisms of action of the S100 molecules were investigated. In the graft and peripheral blood cells, S100A8 and S100A9 expression correlated with myeloid-derived suppressor markers. In line with this finding, recombinant S100A8 and S100A9 proteins inhibited maturation and the allogeneic T cell stimulatory capacity of dendritic cells. S100A9 enhanced the production of reactive oxygen species by macrophages, which suppressed T cell activity at low concentrations in the form of hydrogen peroxide. Intragraft S100A8 and S100A9 expression linked to reduced expression of T cell immunity and tissue injury markers and higher expression of immune regulatory molecules. This study sheds new light on the importance of myeloid cell subsets in directing the outcome of T cell-mediated acute rejection.

Pulse photodynamic therapy reduces inflammation without compromising efficacy in the treatment of multiple mild actinic keratoses of the face and scalp: a randomized clinical trial

BACKGROUND

The main side-effects of photodynamic therapy (PDT) for actinic keratoses (AKs) are post-treatment erythema and oedema, and pain during illumination. Severe erythema after PDT enhances the down time associated with the treatment.

OBJECTIVES

To evaluate in a randomized intraindividual study whether pulse-PDT and corticosteroid pulse-PDT would reduce treatment-induced erythema compared with conventional PDT.

METHODS

Twenty-two patients with multiple mild AKs on the face and scalp were treated with methyl aminolaevulinate (MAL)-PDT in three similar areas. Two areas were incubated with MAL for 30 min (pulse-PDT) and one area was incubated with MAL for 3 h (conventional PDT). All areas were illuminated with red light after 3 h. In one of the pulse-PDT areas a superpotent corticosteroid was applied before and just after PDT (S-pulse-PDT).

RESULTS

Pulse-PDT significantly reduced PDT-induced erythema (P = 0·020), and erythema was even further reduced by S-pulse-PDT (P < 0·001). The complete lesion response rate 3 months after PDT did not differ significantly between the three treated areas.

CONCLUSIONS

Pulse-PDT and S-pulse-PDT reduced erythema 24 h after treatment of multiple mild AKs on the face and scalp. The use of a short MAL application time and topical corticosteroid did not affect the efficacy of PDT and may be an easy way to make PDT treatment of large visible areas more acceptable.

Validation of neck axis distance as a radiographic measure for acetabular anteversion

Excessive acetabular anteversion is an important treatment consideration in hip preservation surgery. There is currently no reliable quantitative method for determining acetabular anteversion utilizing radiographs alone. The three main purposes of this study were to: (i) define and validate the neck axis distance (NAD) as a new visual and reproducible semi-quantitative radiographic parameter used to measure acetabular anteversion; (ii) determine the degree of correlation between NAD and computed tomography (CT)-measured acetabular anteversion; (iii) establish a sensitive and specific threshold value for NAD to identify excessive acetabular anteversion. This retrospective cohort study included all patients presenting to a single institution over a 14-month period who had undergone a dedicated musculoskeletal CT pelvis along with a standardized anteroposterior (AP) pelvis radiograph. Trained observers measured the NAD on the AP pelvis radiograph and equatorial acetabular anteversion on CT for all hips. Mixed model analysis was used to find prediction equations, and ROC analysis was used to evaluate the diagnostic accuracy of NAD. NAD is a valid semi-quantitative predictor of acetabular anteversion and strongly correlates with CT-measured equatorial acetabular anteversion (P  <  0.0001). A NAD measurement of greater than 14 mm predicts excessive acetabular anteversion with 76% sensitivity and 78% specificity. NAD is an accurate radiographic predictor of acetabular anteversion, which may be readily used as an effective screening tool during the evaluation of patients with hip pain.

15 HISTONE ACETYLATION PROFILE OF PORCINE EMBRYOS PRODUCED BY 2 CLONING METHODS WITH OR WITHOUT IN VITRO CULTURE

Conventional “Dolly”-based cloned (CNT) embryos maintain zona pellucida and can be transferred early in development. Handmade cloned (HMC) embryos are zona free and are cultured to later stages for transfer. We have shown differences between HMC and CNT embryos (Rep. Fert. Dev. 26, 123), and both in vitro culture and cloning method (NT) are associated with alterations in histone acetylation. More studies are needed to clarify whether CNT and HMC embryos differ in epigenetic profiles due to NT method or culture condition. Here we investigated histone acetylation profile of NT embryos produced by CNT or HMC with or without 5 to 6 days in vitro culture, emphasising quality and gene expression in resulting embryos. Both NT methods were performed on Day 0 (D0) with same oocyte batch, donor cells, and culture medium (CNT in group, HMC in well of well). On D0, 5, and 6 after CNT (Clon. Stem Cells 10, 355) or HMC (Zygote 20, 61), all developed embryos of all morphological qualities were collected for immunostaining of H3K18ac, and on D0 and 6 for mRNA expression of the genes KAT2A/2B, EP300, HDAC1/2, DNMT1o/s, and GAPDH. Embryo quality was evaluated normal (clear inner cell mass, high cell number, no fragments) or bad (no clear inner cell mass, low cell number, fragments). Cell numbers per blastocyst were counted on D5 and 6. Differences in cell number and H3K18ac level between different groups and days were analysed by ANOVA; gene expression data were analysed by GLM (SAS version 9.3, SAS Institute Inc., Cary, NC, USA). Embryo development rates of both NT methods were reported previously (Rep. Fert. Dev. 26, 123). On D5 and 6, all HMC embryos were evaluated as normal, but the CNT group contained both normal and bad embryos. Regarding cell numbers (Table 1), on D5 there was no difference between normal CNT and HMC embryos, but numbers were lower in CNT bad embryos. On D6 the blastocyst cell number was lower in both normal and bad CNT embryos compared with HMC. Regarding H3K18ac levels (Table 1), no differences were found on D5 between normal CNT and HMC embryos, but on D6 both CNT normal and bad embryos had higher H3K18ac level compared with HMC. On D0, no difference was found in mRNA expression of all 8 genes. On D6, KAT2A expression was slight increased (1.8-fold) in CNT compared with HMC embryos (P < 0.05). In conclusion, no differences were found between CNT and HMC embryos after completed NT procedure (D0) or after 5 days in vitro culture. However, differences in quality (cell number and H3K18ac) and gene expression between the 2 NT methods were observed when blastocyst expansion was initiated (D6). Thus, the 2 NT methods seem to produce embryos of similar quality, which is maintained over 5 days in vitro culture, but thereafter gene expression and histone acetylation are more active in CNT embryos. Table 1.Cell number and H3K18ac level1

223 GENERATION OF INTERSPECIES CHIMERAS BETWEEN PRIMATE INDUCED PLURIPOTENT STEM CELLS AND PORCINE PARTHENOGENETIC EMBRYOS

The availability of human induced pluripotent stem cell (hiPSC) paves the way to generate regenerative tissue or organs from patient’s own stem cells. The production of chimeric piglets carrying organs that are entirely derived from human stem cells, or at least have a high contribution of human cells or tissues, could be used as a new tissue or an organ replacement in the future treatment of the patients. Here, we produced porcine-nonhuman primate chimeric embryos to assess the feasibility of the potential use of human iPSC for production of human stem cell-derived organs in pigs. Because in vitro culture conditions for cynomolgus monkey iPSC and porcine blastocysts are different, we first identified an effective in vitro culture system for porcine blastocysts and monkey iPSC. We compared blastocyst rates (Days 7 and 8) and number of cells of porcine parthenogenetic blastocysts (Day 8) cultured in 8 different monkey iPSC media and in porcine zygote medium 3 (PZM-3). The best developmental rates of porcine blastocysts were achieved in Knockout DMEM+20% serum replacement monkey medium (iPS 20% medium; N = 65, n = 3). The number of blastocysts on Day 8 cultured in iPS 20% medium was significantly higher (91%; P < 0.05) than in the commonly used porcine PZM-3 medium (65%). We found significantly fewer (P < 0.05) degenerate porcine embryos on Day 8 after culture in iPS 20% medium (9%) compared to PZM-3 (35%). The number of nuclei per blastocyst in iPS 20% medium (88 nuclei; N = 30, n = 3) was significantly higher (P < 0.0001) than in the PZM-3 medium (57 nuclei; N = 54, n = 3). Therefore, we decided to use iPS 20% medium for culture of porcine blastocysts injected with monkey iPSC. Thereafter, we injected clusters of 10 to 15 monkey iPSC transgenic with AAVS1-CAG-Venus into porcine parthenogenetic embryos from Days 4 and 6. Interspecies chimeras were cultured in iPS 20% medium for 24 (for Day 6 embryos) or 48 h (for Day 4 embryos) and observed by confocal microscopy to determine the proportion of Venus-expressing monkey iPSC in porcine embryos. Approximately 37% of blastocysts contained Venus-positive cells after injection of Day 6 embryos (N = 133, n = 4). In contrast, injection into porcine embryos from Day 4 resulted in 73% of Venus-positive blastocysts (N = 69, n = 3). Finally, we investigated proliferation and survival of monkey iPSC in interspecies chimeras after blastocyst plating onto murine fibroblasts. Chimeric blastocyst outgrowth resulted in Venus-expressing monkey iPSC proliferating over 1 week in culture. Outgrowths of all chimeric blastocysts established distinct but separate monkey and porcine stem cell colonies. Here, we optimized the culture conditions for an in vitro interspecies chimera assay in which monkey iPSC are able to survive in porcine embryos. Integration of monkey iPSC to host inner cell mass is relevant for the further contribution to the embryo development. Therefore, to verify this, analysis of cell-cell connection between monkey iPSC and porcine blastocysts and experiments using vivo-derived embryos are currently underway.

Effect of the Location of Endplate Cement Extravasation on Adjacent Level Fracture in Osteoporotic Patients Undergoing Vertebroplasty and Kyphoplasty

BACKGROUND

The most widely researched risk/complication following vertebroplasty (VP) or kyphoplasty (KP) is that of adjacent level fracture (ALF). Current literature results regarding the effect of intradiscal extravasation of cement on the risk of ALF is conflicting with about half of the studies concluding there is no added risk with endplate extravasation and half of the studies reporting opposite conclusions.

OBJECTIVE

The purpose of the study is to further stratify the data to determine whether specifically the location and extent of endplate cement extravasation more strongly affect ALF risk in osteoporotic patients following either VP or balloon KP.

STUDY DESIGN

Retrospective cohort study.

SETTING

University teaching hospital.

METHODS

One hundred and fifty-six cemented levels in 80 patients, treated at a single center between 2008 and 2012 were reviewed. Age, gender, T-score, body mass index, and osteoporosis type (primary or secondary) were recorded. An ALF was defined as a fracture: 1) in a non-cemented vertebra; 2) adjacent to a cemented level; and 3) not due to trauma or malignancy. Location of the cement extravasation (anterior, middle, or posterior third of the vertebral body) and extravasation extent (percentage of the intervertebral disc height occupied by the bolus) were measured. A logistic modeling strategy permitted examining the association between the location and extent of extravasation and the odds of ALF.

RESULTS

ALF occurred in 14 of the 52 patients (27%) and 20 of the 98 levels (20.4%) remaining after exclusions. Odds of ALF were 5.9 times higher (95% CI: 1.6 to 21.2, P = 0.008) with extravasation when compared to no leakage. Odds of ALF in a given patient were 22.6 times higher (95% CI: 3.0 to 170.9, P = 0.003) with anterior extravasation when compared to no leakage. Leakage in the middle or posterior thirds and extent of extravasation were not associated with ALF.

LIMITATIONS

Limitations of the study include the retrospective study design and small sample size as well as the retrospective implementation of follow-up criteria posing risk of selection bias.

CONCLUSIONS

Cement endplate extravasation isolated to the anterior third of the vertebral body is associated with is significantly higher odds of ALF after VP or KP in patients with osteoporosis.

Paraneoplastic orthostatic hypotension associated with acute myeloid leukemia

Paraneoplastic neuropathies associated with leukemia are rare, and early diagnosis and treatment are crucial due to the potential for irreversible neurological deficits and delay in treatment of the leukemia. This is the first report to describe severe paraneoplastic orthostatic hypotension which resolved after treatment of the acute myeloid leukemia (AML). The patient is a 76 year-old woman who presented with progressive dizziness, anorexia, and fatigue. She had severe orthostatic hypotension (supine systolic blood pressure 186 mmHg and standing 79 mmHg). She was found to have AML, for which azacitidine was initiated, and orthostatic hypotension resolved after initiation of treatment. This case demonstrates a unique example of paraneoplastic sequelae remitting with treatment of the underlying hematologic neoplasm. Physicians should be aware of this unusual occurrence of autonomic neuropathy with AML as delay in treatment of the hematologic malignancy can lead to irreversible neurologic deficit and increased morbidity and mortality.

UVR exposure and vitamin D in a rural population. A study of outdoor working farmers, their spouses and children

BACKGROUND

Living and working in the countryside may result in excessive UVR exposure, with increased risk of skin cancer. Some sun exposure is, however, recommended, since vitamin D production is UVB-dependent.

OBJECTIVES

To examine UVR exposure and vitamin D levels in a rural population of outdoor working male farmers, their indoor working spouses and their children, expected to receive high UVR exposure.

METHODS

Prospective, cohort study. During the summer 2009 daily, personal UVR exposure and sun behaviour were recorded by dosimetry and diaries (17 403 days). Vitamin D was measured at the end of summer and the following winter.

RESULTS

Risk behaviour (= exposure of shoulders/upper body to the sun), beach days, sunscreen use and sunburns were infrequent. Farmers and boys had the highest daily UVR exposure (both 1.5 SED per day), likewise on work days. On non-work days the UVR exposure was even higher (up to 2.0 SED per day). Farmers, girls and boys had a higher chronic UVR exposure than the spouses, who had more intermittent high UVR exposure. Vitamin D levels did not differ between family members. At the end of summer 16% of the participants were vitamin D insufficient, the following winter, 61%. Some UVR exposure variables correlated positively, but weakly, with vitamin D levels.

CONCLUSIONS

UVR exposure was generally high among this study population, however, vitamin D levels still dropped below the recommended level during winter for most participants. Differences in UVR exposure between the groups did not result in differences in vitamin D levels.

siRNA mediated knockdown of tissue factor expression in pigs for xenotransplantation

Acute vascular rejection (AVR), in particular microvascular thrombosis, is an important barrier to successful pig-to-primate xenotransplantation. Here, we report the generation of pigs with decreased tissue factor (TF) levels induced by small interfering (si)RNA-mediated gene silencing. Porcine fibroblasts were transfected with TF-targeting small hairpin (sh)RNA and used for somatic cell nuclear transfer. Offspring were analyzed for siRNA, TF mRNA and TF protein level. Functionality of TF downregulation was investigated by a whole blood clotting test and a flow chamber assay. TF siRNA was expressed in all twelve liveborn piglets. TF mRNA expression was reduced by 94.1 ± 4.7% in TF knockdown (TFkd) fibroblasts compared to wild-type (WT). TF protein expression in PAEC stimulated with 50 ng/mL TNF-α was significantly lower in TFkd pigs (mean fluorescence intensity TFkd: 7136 ± 136 vs. WT: 13 038 ± 1672). TF downregulation significantly increased clotting time (TFkd: 73.3 ± 8.8 min, WT: 45.8 ± 7.7 min, p < 0.0001) and significantly decreased thrombus formation compared to WT (mean thrombus coverage per viewing field in %; WT: 23.5 ± 13.0, TFkd: 2.6 ± 3.7, p < 0.0001). Our data show that a functional knockdown of TF is compatible with normal development and survival of pigs. TF knockdown could be a valuable component in the generation of multi-transgenic pigs for xenotransplantation.