POS0510 INFLUENCE OF CMV INFECTION ON DISEASE ACTIVITY IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background

The causes of the onset and progression of rheumatoid arthritis (RA) are complex and not yet understood. Some studies suspect viruses as triggers of inflammatory processes (1). Increased numbers of immunomodulatory cells have already been detected in patients with RA infected with the cytomegalovirus (CMV) (2) (3). Understanding the role this infection has on RA-specific disease parameters could help clarify predisposing and prognostic factors.

Objectives

The aim of this study was to determine the relationship between CMV serostatus and disease activity in patients with rheumatoid arthritis.

Methods

We performed a retrospective study in adult patients diagnosed with RA. The data was collected between 2008 and 2021 in the rheumatological outpatient department of the University Hospital in Leipzig, Germany. The parameters examined included age, gender, CMV-IgG and CMV-IgM, and the following parameters to record the disease activity of RA: disease duration, joint erosions, rheumatoid factor, anti-CCP antibodies, CRP, disease activity score (DAS28), visual analog scale (VAS) for pain detection, Health Assessment Questionnaire (HAQ), medication with DMARDs and prednisolone.

Results

A total of 89 RA patients were included, 78.7% of them were female. The mean age was 61.44 ± 10.89 years and the mean duration of illness was 9.48 ± 9.13 years. 56.2% of the patients were CMV-IgG positive, 2.2% CMV-IgM positive. With an OR of 5.04 (95% CI 1.63-15.64), the CMV-IgG titer in women was significantly higher than in men (115.16 vs. 50.75 p = 0.007). This has already been shown in other studies (4). One of the reasons discussed is the women’s closer relationship with children at work. It has also been shown that among women those medicated with DMARDs had significantly higher CMV-IgG titers (126.82 vs. 58.84 p = 0.036). This could be explained by an increased predisposition for CMV reactivation due to the intake of medication. Women with joint erosions were also more likely to be CMV-IgG positive (OR = 3.2; 95% CI 1.02-10.03) and had higher CMV-IgG titers (147.44 vs. 97.23 p = 0.024). Furthermore, seropositive RA women were significantly more likely to be CMV-IgG positive (p = 0.05). This association supports the assumption that CMV may play a role in the pathogenesis of RA.

Conclusion

The data presented shows that there is indeed a relationship between infection with CMV and parameters for disease activity in patients with RA. In summary, the integration of a CMV status determination into everyday clinical practice in patients with high disease activity could be quite useful and should be discussed.

References

[1]Davis, John M., et al. A profile of immune response to herpesvirus is associated with radiographic joint damage in rheumatoid arthritis. Arthritis Research & Therapy. 14, 2012, 1.

[2]Almanzar, Giovanni, et al. Significant IFNγ responses of CD8+ T cells in CMV-seropositive individuals with autoimmune arthritis. Journal of clinical virology: the official publication of the Pan American Society for Clinical Virology. 77, 2016.

[3]Hooper, M., et al. Cytomegalovirus seropositivity is associated with the expansion of CD4+CD28- and CD8+CD28- T cells in rheumatoid arthritis. The Journal of rheumatology. 26, 1999, 7.

[4]Cannon, Michael J., Schmid, D. Scott und Hyde, Terri B. Review of cytomegalovirus seroprevalence and demographic characteristics associated with infection. Reviews in medical virology. 4, 2010, 20.

Disclosure of Interests

None declared.

[The nasal and pharyngeal swab techniques during the COVID-19-pandemic - the ENT-perspective - SARS-CoV-2, Coronavirus, nasal swab, pharyngeal swab, complications]

Since the beginning of the SARS-CoV-2 pandemic, swabs or other samples have increasingly been taken from the upper aero-digestive tract, since high viral loads exist here, especially in the early stages of the disease. As diagnostic options, swabs from the anterior nose, from the nasopharynx, from the oropharynx or the extraction of throat rinse water or saliva are possible. The laboratory methods available are antigen tests that can be read in a few minutes or more lengthy RT-PCR methods in a lab. Swabs are carried out by physicians, medical staff, laypeople and in the self-test, in each case according to prior instructions. Many of these factors therefore have an influence on the informative value and the sensitivity of the entire diagnostic process. The PCR laboratory method is more sensitive than the antigen method; the swabs from the nasopharynx are considered the most valid smear site; correct execution of a test can be achieved even with non-professional individuals with good instructions. Complications with such swabs are reported very rarely, given the assumed number of procedures performed. Short-term nosebleeds after traumatic smears can be assumed without publications about it being found. Broken parts of swabs had to be removed by an ENT doctor. There are only very few reports on injuries to the skullbase with CSF-leaks, including 2 times with anomalies such as meningoceles. The choice of a suitable diagnostic medium depends on many parameters such as availability, the timing of the result, a smear test by knowledgeable staff or a self-test, and a number of other practical considerations.

[Treatment options for acute respiratory distress syndrome in neurointensive care. Individual management due to enhanced neuromonitoring? : A case report series]

Severe pulmonary impairment can occur after traumatic brain injury or stroke. The resulting brain-lung interactions represent key points for the treatment and the subsequent outcome of the patient. Established treatment approaches, such as permissive hypercapnia and prone positioning, present the intensive care physician with divergent treatment goals in these patients with partially increased intracranial pressure. This case report series shows the instrument-based and noninstrument-based options for the treatment of acute respiratory distress syndrome (ARDS) in the simultaneous presence of intracranial pathologies. This includes equipment based therapies using extracorporeal CO₂ elimination, special positioning maneuvers in specially designed hospital beds and positional maneuvers, such as prone positioning. With enhanced neuromonitoring it is possible to optimally adapt treatment measures focused on the lungs early and before secondary damage to the brain.

Influenza B virus infections in Western Saxony, Germany in three consecutive seasons between 2015 and 2018: Analysis of molecular and clinical features

BACKGROUND

The impact of annual influenza epidemics and prevailing strains varies worldwide and regional. The majority of vaccines used contained two influenza A strains and only one influenza B strain (trivalent vaccine).

AIM

The aim of the study was to compare laboratory confirmed influenza B cases during three consecutive years with respect to vaccination history, clinical symptoms and molecular virology.

METHODS

Partial HA gene sequences were analyzed for lineage determination and complete HA sequence in cases with reported vaccination and in fatal cases. Clinical data were retrieved from patient charts.

FINDINGS

During the 2015/16 season, 75 influenza B cases were retrieved; 11 in 2016/17, and 274 in 2017/18. The frequency of Yamagata-lineage strains increased from 7.6% to 100%. No difference was detected in the relative frequency of co-morbidities in season 2017/18. 37.7% of the adult patients and 4.5% of pediatric patients were vaccinated against influenza.

INTERPRETATION

Phylogenetically, Yamagata strains clustered similarly in 2017/2018 when compared to the previous two influenza seasons. While the relative frequency of influenza B cases differed, the clinical symptoms remained similar.

CONCLUSION

World Health Organization recommendations for the use of tetravalent vaccines that contain two influenza B strains (Yamagata and Victoria) in addition to the two influenza A strains (H1N1 and H3N2) should be implemented in national vaccination guidelines.

FUNDING

This research was partially supported by the Association of Sponsors and Friends of Leipzig University.

Abundance correction for mass discrimination effects in polymer mass spectra

RATIONALE

Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOFMS) is frequently used to analyze homo- and copolymers, i.e. for computing copolymer fingerprints. However, the oligomer abundances are influenced by mass discrimination, i.e. mass- and composition-dependent ionization. We have developed a computational method to correct the abundance bias caused by the mass discrimination.

METHODS

MALDI-TOFMS in combination with computational methods was used to investigate three random copolymers with different ratios of styrene and isoprene. Furthermore, equimolar high- and low-mass styrene and isoprene homopolymers (2500 and 4200 Da) were mixed and also analyzed by MALDI-TOFMS. The abundances of both copolymers and homopolymers were corrected for mass discrimination effects with our new method.

RESULTS

The novel computational method was integrated into the existing COCONUT software. The method was demonstrated using the measured styrene and isoprene co- and homopolymers. First, the method was applied to homopolymer spectra. Subsequently, the copolymer fingerprint was computed from the copolymer MALDI mass spectra and the correcting function applied. The changes in the composition are plausible, indicating that correction of copolymer abundances was reasonable.

CONCLUSIONS

Our computational method may help to avoid erroneous conclusions when analyzing copolymer MS spectra. The software is freely available and represents a step towards comprehensive computational support in polymer science. Copyright © 2016 John Wiley & Sons, Ltd.

Feed-borne exposure to deoxynivalenol leads to acute and chronic effects on liver enzymes and histology in carp

Deoxynivalenol (DON) is a frequent contaminant of feeds in aquaculture, but the consequences of this contamination have rarely been evaluated. Previous studies on carp indicated effects of DON on liver function and histology after four weeks of feeding. The present study aimed to unravel the time course of liver responses of carp to orally applied DON. Therefore, liver enzyme activities and histology have been investigated after 7, 14, 26 and 56 days of DON feeding. The acute response comprises down-regulation of biotransformation enzymes, whereas the chronic response to DON is characterised by activation of alanine aminotransferase which indicates damage to liver tissue. Examination of histological sections of liver tissue revealed that changes such as fat aggregation, vacuolisation and hyperaemia were present after 14 and 26 days of exposure to DON but not thereafter. Several enzymes involved in glutathione cycling and reduction of oxidative stress were found to be reduced after 26 and 56 days of DON feeding. The results suggest that supporting the antioxidative system, e.g. by using glutathione-enriched yeast extracts as a food additive, might be successful in preventing the effects of DON in carp. This is the basis of a fundamental hypothesis since DON contamination of fish feed leads to pronounced effects on liver histology and liver enzyme activities which may also cause changes in the normal liver metabolism of endogenous and xenobiotic compounds.

Comparison of the uptake of methacrylate-based nanoparticles in static and dynamic in vitro systems as well as in vivo

Polymer-based nanoparticles are promising drug delivery systems allowing the development of new drug and treatment strategies with reduced side effects. However, it remains a challenge to screen for new and effective nanoparticle-based systems in vitro. Important factors influencing the behavior of nanoparticles in vivo cannot be simulated in screening assays in vitro, which still represent the main tools in academic research and pharmaceutical industry. These systems have serious drawbacks in the development of nanoparticle-based drug delivery systems, since they do not consider the highly complex processes influencing nanoparticle clearance, distribution, and uptake in vivo. In particular, the transfer of in vitro nanoparticle performance to in vivo models often fails, demonstrating the urgent need for novel in vitro tools that can imitate aspects of the in vivo situation more accurate. Dynamic cell culture, where cells are cultured and incubated in the presence of shear stress has the potential to bridge this gap by mimicking key-features of organs and vessels. Our approach implements and compares a chip-based dynamic cell culture model to the common static cell culture and mouse model to assess its capability to predict the in vivo success more accurately, by using a well-defined poly((methyl methacrylate)-co-(methacrylic acid)) and poly((methyl methacrylate)-co-(2-dimethylamino ethylmethacrylate)) based nanoparticle library. After characterization in static and dynamic in vitro cell culture we were able to show that physiological conditions such as cell-cell communication of co-cultured endothelial cells and macrophages as well as mechanotransductive signaling through shear stress significantly alter cellular nanoparticle uptake. In addition, it could be demonstrated by using dynamic cell cultures that the in vivo situation is simulated more accurately and thereby can be applied as a novel system to investigate the performance of nanoparticle systems in vivo more reliable.

Abdominelle Sonografie bei Patienten mit Diabetes mellitus. Teil 1: Leber

Die abdominelle Sonografie ist geeignet, Folgeschäden und Begleiterkrankungen des Diabetes mellitus an Leber, Pankreas, Nieren, Gastrointestinaltrakt und abdominell-retroperitonealen arteriellen Gefäßen zu erfassen und zu verfolgen. Darüber hinaus ermöglicht die abdominelle Sonografie die Erfassung von Pankreas- und Lebererkrankungen, die ursächlich für einen Diabetes mellitus sind. Auf der Grundlage einer systematischen Literaturanalyse wird in einer 3-teiligen Übersichtsarbeit der Stellenwert der abdominellen Sonografie bei Patienten mit Diabetes mellitus dargestellt. Teil 1 beschreibt die Relevanz und konkrete Befunde sonografischer Methoden für die Diagnostik der hepatischen Manifestationen und Komplikationen des Diabetes mellitus.

In vivo treatment with progestogens causes immunosuppression of carp Cyprinus carpio leucocytes by affecting nitric oxide production and arginase activity

In this study, carp Cyprinus carpio were injected with various steroid compounds, including synthetic and natural progestogens and the glucocorticoid cortisol, to investigate effects on leucocytes isolated from their kidneys. Injection of cortisol led to an increased spleeno-somatic index (I(S)) on day 21 post-injection (pi) and immunosuppressive effects measured as decreased nitric oxide (NO) production and increased arginase activity in isolated leucocytes on days 14 and 21 pi, respectively. Moreover, reduced NO production was also observed after injection of the synthetic progestogens, levonorgestrel (LEV) and medroxyprogesterone acetate. In addition, LEV influenced arginase activity in head kidney cells on day 14 and day 21 pi. This study is the first demonstration in fishes that the application of these steroid compounds in vivo affects NO production and arginase activity of isolated leucocytes.

Aqueous polymeric sensors based on temperature-induced polymer phase transitions and solvatochromic dyes

This feature article provides, for the first time, an overview of the research that guided the way from fundamental studies of the thermo-responsive phase separation of aqueous polymer solutions to polymeric sensor systems. The incorporation of solvatochromic dyes into thermoresponsive polymers as well as the concepts of polymeric sensors are presented and discussed in detail.

A hospital based study on inter- and intragenotypic diversity of human rotavirus A VP4 and VP7 gene segments, Germany

BACKGROUND

Efforts to reduce the impact of group A rotaviruses on human morbidity and mortality rely on oral immunisation with live attenuated or recombinant vaccines. A major challenge in immunisation is the vast inter- and intragenotypic diversity accomplished by circulating rotaviruses.

OBJECTIVES

To monitor rotavirus inter- and intragenotypic diversity in hospitalised children.

STUDY DESIGN

From January 2008 to December 2009 stool samples from 1994 paediatric in-patients suffering from diarrhoea were screened for rotavirus. Rotavirus G- and P-genotypes were determined by nucleotide sequencing and phylogenetic analysis was performed.

RESULTS

Rotavirus A was detected in stool samples of 341 children, comprising G1P[8], G2P[4], G3P[8], G4P[8], G9P[8], as well as uncommon G12P[6] genotypes and mixed infections. Predominant strains shifted from G1P[8] and G9P[8] genotypes in the first season to G3P[8] and G4P[8] genotypes in the second season. The highest intragenotypic diversity was detected in G1 strains and consisted of co-circulating G1-Ic, G1-Id, G1-Ie and G1-II rotaviruses. The G2 analysis revealed different intragenotypic lineages: G2-IIa, G2-IIb and G2-IIc. Interestingly, the circulating G4-Ib rotaviruses were characterised by insertions of 3 or 6 additional coding nucleotides within variable region 4 of VP7. Whereas different G9-III VP7 gene segments were detected G3-Ia sequences were highly homologous. In the VP4 analysis P[8]-III gene segment predominated over P[4]-Vb, P[8]-I, P[8]-IV and P[6]-I.

CONCLUSIONS

A remarkable rotavirus heterogeneity was detected in the limited local setting and time span. Continued monitoring and nucleotide sequencing is necessary to document possible effects of rising immunisation levels on intragenotypic rotavirus diversity.

[The department of interdisciplinary emergency medicine: organization, structure and process optimization]

The essential tasks of a department of interdisciplinary emergency medicine are the initial triage and assessment of vital function as well as the subsequent organization und initiation of emergency treatment. A previously defined set of diagnostic and therapeutic measures is carried out before the patient is allocated to an in-hospital clinical service and is admitted to a ward. Moreover, diagnosis and treatment for outpatients are performed. "Time" is a critical factor to be considered for all organizational and structural aspects of a department of interdisciplinary emergency medicine.

[Mediastinal emphysema after a simple maxillofacial fracture]

Mediastinal emphysema is usually seen in cases of blunt thoracic trauma or cervical injury accompanied by tracheobronchial or esophageal perforation. Characteristic of this injury is severe retrosternal pain. We present the case of a man with extensive mediastinal and cervical emphysema caused by a simple midfacial fracture and accompanied by no symptoms.

Dissolved natural organic matter (NOM) impacts photosynthetic oxygen production and electron transport in coontail Ceratophyllum demersum

Dissolved natural organic matter (NOM) is dead organic matter exceeding, in freshwater systems, the concentration of organic carbon in all living organisms by far. 80-90% (w/w) of the NOM is made up of humic substances (HS). Although NOM possesses several functional groups, a potential effect on aquatic organisms has not been studied. In this study, direct effects of NOM from various origins on physiological and biochemical functions in the aquatic plant Ceratophyllum demersum are presented. Environmentally relevant concentrations of NOM cause inhibitory effects on the photosynthetic oxygen production of C. demersum. Various NOM sources and the synthetic humic substance HS1500 inhibit the photosynthetic oxygen production of the plant as observed with 1-amino-anthraquinone, a known inhibitor of plant photosynthesis. 1-Aminoanthraquinone may serve as an analogue for the quinoid structures in NOM and HS. Most likely, the effects of NOM may be related to quinoid structures and work downstream of photosynthesis at photosystem (PS) II.

Chromosomal anchoring of linkage groups and identification of wing size QTL using markers and FISH probes derived from microdissected chromosomes in Nasonia (Pteromalidae: Hymenoptera)

Nasonia vitripennis is a small parasitic hymenopteran with a 50-year history of genetic work including linkage mapping with mutant and molecular markers. For the first time we are now able to anchor linkage groups to specific chromosomes. Two linkage maps based on a hybrid cross (N. vitripennis x N. longicornis) were constructed using STS, RAPD and microsatellite markers, where 17 of the linked STS markers were developed from single microdissected banded chromosomes. Based on these microdissections we anchored all linkage groups to the five chromosomes of N. vitripennis. We also verified the chromosomal specificity of the microdissection through in situ hybridization and linkage analyses. This information and technique will allow us in the future to locate genes or QTL detected in different mapping populations efficiently and fast on homologous chromosomes or even chromosomal regions. To test this approach we asked whether QTL responsible for the wing size in two different hybrid crosses (N. vitripennis x N. longicornis and N. vitripennis x N.giraulti) map to the same location. One QTL with a major effect was found to map to the centromere region of chromosome 3 in both crosses. This could indicate that indeed the same gene/s is involved in the reduction of wing in N. vitripennis and N. longicornis.

The effects of a cyanobacterial crude extract on different aquatic organisms: evidence for cyanobacterial toxin modulating factors

In an aquatic ecosystem, during cyanobacterial bloom lysis, a mixture of toxins and other cyanobacterial and bacterial components will be present in the water, acting on aquatic organisms. Most of the research into toxic effects of cyanobacteria has involved the use of purified toxins. In this study, the "real-life" situation of a cyanobacterial lysis event was investigated. For this purpose, intact cells from a natural cyanobacterial bloom from Lake Müggelsee, Berlin, were taken and the cells were broken by repeated freeze/thaw cycles. This crude extract was used to expose several aquatic organisms ranging from microalgae (Scenedesmus armatus), macrophyte (Ceratophyllum demersum), invertebrate (Chaoborus crystallinus) up to fish eggs (Danio rerio) to look at several physiological parameters such as detoxication enzyme activity and, in the case of the microalgae and the macrophyte, also the effect on activity of photosynthesis. In all the tests, the cyanobacterial crude extract caused stronger effects than the pure cyanobacterial toxins used in equivalent concentrations.

High-performance liquid chromatographic determination of amino acids in protein hydrolysates and in plasma using automated pre-column derivatization with o-phthaldialdehyde/2-mercaptoethanol

A sensitive and reproducible method for the routine determination of amino acids in plasma and in protein hydrolysates based on reversed-phase high-performance liquid chromatography and o-phthaldialdehyde pre-column derivatization is described. The resolution of all amino acids was found to be good. The total time for analysis, including separation and reconditioning, ranged from 38 min for protein hydrolysates to 62 min for 29 physiological amino acids. The precision of hydrolysate analysis was within a relative standard deviation of 0.8-7.3% depending on the use of internal or external standards. The relative standard deviations of peak areas for physiological amino acids (standard) ranged between 1.8 and 5.6%. The relative standard deviations of retention times were less than 0.5% for all amino acids. This method can be used for routine analysis. One single column with 4-microns end-capped C18 material was found to be sufficient for 400-500 successive runs.