Basilar artery occlusion: drip-and-ship versus direct-to-center for mechanical thrombectomy within the Neurovascular Network of Southwest Bavaria (NEVAS)

BACKGROUND

Recent clinical trials revealed a substantial clinical benefit for mechanical thrombectomy (MT) in patients with basilar artery occlusion (BAO). While urban areas are sufficiently covered with comprehensive stroke centers and MT expertise, rural areas lack such resources. Structured telemedical stroke networks offer rural hospitals instant consultation by stroke experts, enabling swift administration of intravenous thrombolysis (IVT) on-site and transportation for MT. For BAO patients, data on performance and clinical outcomes in telemedical stroke networks are lacking.

METHODS

We retrospectively analyzed data from patients with acute BAO eligible for MT: those treated directly in our comprehensive stroke center (direct-to-center/DC) and those treated in rural hospitals that were telemedically consulted by the Neurovascular Network of Southwest Bavaria (NEVAS) and transferred to our center for MT (drip-and-ship, DS). Key time intervals, stroke management performance and functional outcome after 90 days were compared.

RESULTS

Baseline characteristics, including premorbid status and stroke severity, were comparable. Time from symptom onset to IVT was identical in both groups (118 min). There was a delay of 180 min until recanalization in DS patients, mainly due to patient transport for MT. Procedural treatment time intervals, success of recanalization and complications were comparable. Clinical outcome at 3 months follow-up of DS patients was not inferior to DC patients.

CONCLUSION

We show for the first time that patients with BAO in rural areas benefit from a structured telemedicine network such as NEVAS, regarding both on-site processing and drip-and-ship for MT. Clinical outcomes are comparable among DS and DC patients.

Study of High-Transverse-Momentum Higgs Boson Production in Association with a Vector Boson in the qqbb Final State with the ATLAS Detector

This Letter presents the first study of Higgs boson production in association with a vector boson (V=W or Z) in the fully hadronic qqbb final state using data recorded by the ATLAS detector at the LHC in proton-proton collisions at sqrt[s]=13  TeV and corresponding to an integrated luminosity of 137  fb^{-1}. The vector bosons and Higgs bosons are each reconstructed as large-radius jets and tagged using jet substructure techniques. Dedicated tagging algorithms exploiting b-tagging properties are used to identify jets consistent with Higgs bosons decaying into bb[over ¯]. Dominant backgrounds from multijet production are determined directly from the data, and a likelihood fit to the jet mass distribution of Higgs boson candidates is used to extract the number of signal events. The VH production cross section is measured inclusively and differentially in several ranges of Higgs boson transverse momentum: 250-450, 450-650, and greater than 650 GeV. The inclusive signal yield relative to the standard model expectation is observed to be μ=1.4_{-0.9}^{+1.0} and the corresponding cross section is 3.1±1.3(stat)_{-1.4}^{+1.8}(syst)  pb.

Measurement of the Centrality Dependence of the Dijet Yield in p+Pb Collisions at sqrt[s_{NN}]=8.16 TeV with the ATLAS Detector

ATLAS measured the centrality dependence of the dijet yield using 165  nb^{-1} of p+Pb data collected at sqrt[s_{NN}]=8.16  TeV in 2016. The event centrality, which reflects the p+Pb impact parameter, is characterized by the total transverse energy registered in the Pb-going side of the forward calorimeter. The central-to-peripheral ratio of the scaled dijet yields, R_{CP}, is evaluated, and the results are presented as a function of variables that reflect the kinematics of the initial hard parton scattering process. The R_{CP} shows a scaling with the Bjorken x of the parton originating from the proton, x_{p}, while no such trend is observed as a function of x_{Pb}. This analysis provides unique input to understanding the role of small proton spatial configurations in p+Pb collisions by covering parton momentum fractions from the valence region down to x_{p}∼10^{-3} and x_{Pb}∼4×10^{-4}.

Search for New Phenomena in Two-Body Invariant Mass Distributions Using Unsupervised Machine Learning for Anomaly Detection at sqrt[s]=13 TeV with the ATLAS Detector

Searches for new resonances are performed using an unsupervised anomaly-detection technique. Events with at least one electron or muon are selected from 140  fb^{-1} of pp collisions at sqrt[s]=13  TeV recorded by ATLAS at the Large Hadron Collider. The approach involves training an autoencoder on data, and subsequently defining anomalous regions based on the reconstruction loss of the decoder. Studies focus on nine invariant mass spectra that contain pairs of objects consisting of one light jet or b jet and either one lepton (e,μ), photon, or second light jet or b jet in the anomalous regions. No significant deviations from the background hypotheses are observed. Limits on contributions from generic Gaussian signals with various widths of the resonance mass are obtained for nine invariant masses in the anomalous regions.

Observation of WZγ Production in pp Collisions at sqrt[s]=13 TeV with the ATLAS Detector

This Letter reports the observation of WZγ production and a measurement of its cross section using 140.1±1.2  fb^{-1} of proton-proton collision data recorded at a center-of-mass energy of 13 TeV by the ATLAS detector at the Large Hadron Collider. The WZγ production cross section, with both the W and Z bosons decaying leptonically, pp→WZγ→ℓ^{'}^{±}νℓ^{+}ℓ^{-}γ (ℓ^{(^{'})}=e, μ), is measured in a fiducial phase-space region defined such that the leptons and the photon have high transverse momentum and the photon is isolated. The cross section is found to be 2.01±0.30(stat)±0.16(syst)  fb. The corresponding standard model predicted cross section calculated at next-to-leading order in perturbative quantum chromodynamics and at leading order in the electroweak coupling constant is 1.50±0.06  fb. The observed significance of the WZγ signal is 6.3σ, compared with an expected significance of 5.0σ.

Combined Measurement of the Higgs Boson Mass from the H→γγ and H→ZZ^{*}→4ℓ Decay Channels with the ATLAS Detector Using sqrt[s]=7, 8, and 13 TeV pp Collision Data

A measurement of the mass of the Higgs boson combining the H→ZZ^{*}→4ℓ and H→γγ decay channels is presented. The result is based on 140  fb^{-1} of proton-proton collision data collected by the ATLAS detector during LHC run 2 at a center-of-mass energy of 13 TeV combined with the run 1 ATLAS mass measurement, performed at center-of-mass energies of 7 and 8 TeV, yielding a Higgs boson mass of 125.11±0.09(stat)±0.06(syst)=125.11±0.11  GeV. This corresponds to a 0.09% precision achieved on this fundamental parameter of the Standard Model of particle physics.

Search for Dark Photons in Rare Z Boson Decays with the ATLAS Detector

A search for events with a dark photon produced in association with a dark Higgs boson via rare decays of the standard model Z boson is presented, using 139  fb^{-1} of sqrt[s]=13  TeV proton-proton collision data recorded by the ATLAS detector at the Large Hadron Collider. The dark boson decays into a pair of dark photons, and at least two of the three dark photons must each decay into a pair of electrons or muons, resulting in at least two same-flavor opposite-charge lepton pairs in the final state. The data are found to be consistent with the background prediction, and upper limits are set on the dark photon's coupling to the dark Higgs boson times the kinetic mixing between the standard model photon and the dark photon, α_{D}ϵ^{2}, in the dark photon mass range of [5, 40] GeV except for the ϒ mass window [8.8, 11.1] GeV. This search explores new parameter space not previously excluded by other experiments.

Observation of Single-Top-Quark Production in Association with a Photon Using the ATLAS Detector

This Letter reports the observation of single top quarks produced together with a photon, which directly probes the electroweak coupling of the top quark. The analysis uses 139  fb^{-1} of 13 TeV proton-proton collision data collected with the ATLAS detector at the Large Hadron Collider. Requiring a photon with transverse momentum larger than 20 GeV and within the detector acceptance, the fiducial cross section is measured to be 688±23(stat) _{-71}^{+75}(syst)  fb, to be compared with the standard model prediction of 515_{-42}^{+36}  fb at next-to-leading order in QCD.

Measurement of Suppression of Large-Radius Jets and Its Dependence on Substructure in Pb+Pb Collisions at sqrt[s_{NN}]=5.02 TeV with the ATLAS Detector

This letter presents a measurement of the nuclear modification factor of large-radius jets in sqrt[s_{NN}]=5.02  TeV Pb+Pb collisions by the ATLAS experiment. The measurement is performed using 1.72  nb^{-1} and 257  pb^{-1} of Pb+Pb and pp data, respectively. The large-radius jets are reconstructed with the anti-k_{t} algorithm using a radius parameter of R=1.0, by reclustering anti-k_{t} R=0.2 jets, and are measured over the transverse momentum (p_{T}) kinematic range of 158 Collapse

Key Words Collapse

MESH Headings Collapse

Grants Collapse

Measurement of the Sensitivity of Two-Particle Correlations in pp Collisions to the Presence of Hard Scatterings

A key open question in the study of multiparticle production in high-energy pp collisions is the relationship between the "ridge"-i.e., the observed azimuthal correlations between particles in the underlying event that extend over all rapidities-and hard or semihard scattering processes. In particular, it is not known whether jets or their soft fragments are correlated with particles in the underlying event. To address this question, two-particle correlations are measured in pp collisions at sqrt[s]=13  TeV using data collected by the ATLAS experiment at the LHC, with an integrated luminosity of 15.8  pb^{-1}, in two different configurations. In the first case, charged particles associated with jets are excluded from the correlation analysis, while in the second case, correlations are measured between particles within jets and charged particles from the underlying event. Second-order flow coefficients, v_{2}, are presented as a function of event multiplicity and transverse momentum. These measurements show that excluding particles associated with jets does not affect the measured correlations. Moreover, particles associated with jets do not exhibit any significant azimuthal correlations with the underlying event, ruling out hard processes contributing to the ridge.

Observation of an Excess of Dicharmonium Events in the Four-Muon Final State with the ATLAS Detector

A search is made for potential ccc[over ¯]c[over ¯] tetraquarks decaying into a pair of charmonium states in the four muon final state using proton-proton collision data at sqrt[s]=13  TeV, corresponding to an integrated luminosity of 140  fb^{-1} recorded by the ATLAS experiment at LHC. Two decay channels, J/ψ+J/ψ→4μ and J/ψ+ψ(2S)→4μ, are studied. Backgrounds are estimated based on a hybrid approach involving Monte Carlo simulations and data-driven methods. Statistically significant excesses with respect to backgrounds dominated by the single parton scattering are seen in the di-J/ψ channel consistent with a narrow resonance at 6.9 GeV and a broader structure at lower mass. A statistically significant excess is also seen in the J/ψ+ψ(2S) channel. The fitted masses and decay widths of the structures are reported.

Observation of the γγ→ττ Process in Pb+Pb Collisions and Constraints on the τ-Lepton Anomalous Magnetic Moment with the ATLAS Detector

This Letter reports the observation of τ-lepton-pair production in ultraperipheral lead-lead collisions Pb+Pb→Pb(γγ→ττ)Pb and constraints on the τ-lepton anomalous magnetic moment a_{τ}. The dataset corresponds to an integrated luminosity of 1.44  nb^{-1} of LHC Pb+Pb collisions at sqrt[s_{NN}]=5.02  TeV recorded by the ATLAS experiment in 2018. Selected events contain one muon from a τ-lepton decay, an electron or charged-particle track(s) from the other τ-lepton decay, little additional central-detector activity, and no forward neutrons. The γγ→ττ process is observed in Pb+Pb collisions with a significance exceeding 5 standard deviations and a signal strength of μ_{ττ}=1.03_{-0.05}^{+0.06} assuming the standard model value for a_{τ}. To measure a_{τ}, a template fit to the muon transverse-momentum distribution from τ-lepton candidates is performed, using a dimuon (γγ→μμ) control sample to constrain systematic uncertainties. The observed 95% confidence-level interval for a_{τ} is -0.057 Collapse

Key Words Collapse

MESH Headings Collapse

Grants Collapse

Strong Constraints on Jet Quenching in Centrality-Dependent p+Pb Collisions at 5.02 TeV from ATLAS

Jet quenching is the process of color-charged partons losing energy via interactions with quark-gluon plasma droplets created in heavy-ion collisions. The collective expansion of such droplets is well described by viscous hydrodynamics. Similar evidence of collectivity is consistently observed in smaller collision systems, including pp and p+Pb collisions. In contrast, while jet quenching is observed in Pb+Pb collisions, no evidence has been found in these small systems to date, raising fundamental questions about the nature of the system created in these collisions. The ATLAS experiment at the Large Hadron Collider has measured the yield of charged hadrons correlated with reconstructed jets in 0.36  nb^{-1} of p+Pb and 3.6  pb^{-1} of pp collisions at 5.02 TeV. The yields of charged hadrons with p_{T}^{ch}>0.5  GeV near and opposite in azimuth to jets with p_{T}^{jet}>30 or 60 GeV, and the ratios of these yields between p+Pb and pp collisions, I_{pPb}, are reported. The collision centrality of p+Pb events is categorized by the energy deposited by forward neutrons from the struck nucleus. The I_{pPb} values are consistent with unity within a few percent for hadrons with p_{T}^{ch}>4  GeV at all centralities. These data provide new, strong constraints that preclude almost any parton energy loss in central p+Pb collisions.

Search for Heavy Neutral Leptons in Decays of W Bosons Using a Dilepton Displaced Vertex in sqrt[s]=13 TeV pp Collisions with the ATLAS Detector

A search for a long-lived, heavy neutral lepton (N) in 139  fb^{-1} of sqrt[s]=13  TeV pp collision data collected by the ATLAS detector at the Large Hadron Collider is reported. The N is produced via W→Nμ or W→Ne and decays into two charged leptons and a neutrino, forming a displaced vertex. The N mass is used to discriminate between signal and background. No signal is observed, and limits are set on the squared mixing parameters of the N with the left-handed neutrino states for the N mass range 3  GeV Collapse

Key Words Collapse

MESH Headings Collapse

Grants Collapse

Test of CP Invariance in Higgs Boson Vector-Boson-Fusion Production Using the H→γγ Channel with the ATLAS Detector

A test of CP invariance in Higgs boson production via vector-boson fusion has been performed in the H→γγ channel using 139  fb^{-1} of proton-proton collision data at sqrt[s]=13  TeV collected by the ATLAS detector at the LHC. The optimal observable method is used to probe the CP structure of interactions between the Higgs boson and electroweak gauge bosons, as described by an effective field theory. No sign of CP violation is observed in the data. Constraints are set on the parameters describing the strength of the CP-odd component in the coupling between the Higgs boson and the electroweak gauge bosons in two effective field theory bases: d[over ˜] in the HISZ basis and c_{HW[over ˜]} in the Warsaw basis. The results presented are the most stringent constraints on CP violation in the coupling between Higgs and weak bosons. The 95% C.L. constraint on d[over ˜] is derived for the first time and the 95% C.L. constraint on c_{HW[over ˜]} has been improved by a factor of 5 compared to the previous measurement.

Removal of a complex VOC mixture by potted plants-effects on soil microorganisms

Microorganisms in the soil of potted plants are important for removal of volatile organic compounds (VOCs) from indoor air, but little is known about the subject. The aim of this study was therefore to obtain a better understanding of the effect of VOCs on the microbial community in potted plants. Hedera helix was exposed to gasoline vapors under dynamic chamber conditions for 21 days and three main parameters were investigated. These were (1) removal of the target compounds heptane, 3-methylhexane, benzene, toluene, ethylbenzene, m,p-xylene, and naphthalene from the gasoline mixture; (2) toluene mineralization; and (3) bacterial abundance and bacterial community structure. H. helix was able to reduce the concentration of the target compounds in the continuously emitted gasoline by 25-32%, except for naphthalene, which was too low in concentration. The soil microcosm of gasoline exposed plants had for an initial 66 h increased toluene mineralization rate compared to the soil microcosm in the soil of plants exposed to clean air. Bacterial abundance was decreased in response to gasoline exposure while bacterial community structure was changed. The change in bacterial community structure was, however, different between the two experiments indicating that several taxonomic units can degrade gasoline components. Especially the genera Rhodanobacter and Pseudonorcardia significantly increased in abundance in response to gasoline vapors. Bauldia, Devosia, and Bradyrhizobium, on the other hand, decreased.

Introduction of laparoscopic nephrectomy for autosomal dominant polycystic kidney disease as the standard procedure

PURPOSE

Autosomal dominant polycystic kidney disease (ADPKD) is a common hereditary disorder and accounts for 5-10% of all cases of kidney failure. 50% of ADPKD patients reach kidney failure by the age of 58 years requiring dialysis or transplantation. Nephrectomy is performed in up to 20% of patients due to compressive symptoms, renal-related complications or in preparation for kidney transplantation. However, due to the large kidney size in ADPKD, nephrectomy can come with a considerable burden. Here we evaluate our institution's experience of laparoscopic nephrectomy (LN) as an alternative to open nephrectomy (ON) for ADPKD patients.

MATERIALS AND METHODS

We report the results of the first 12 consecutive LN for ADPKD from August 2020 to August 2021 in our institution. These results were compared with the 12 most recent performed ON for ADPKD at the same institution (09/2017 to 07/2020). Intra- and postoperative parameters were collected and analyzed. Health related quality of life (HRQoL) was assessed using the SF36 questionnaire.

RESULTS

Age, sex, and median preoperative kidney volumes were not significantly different between the two analyzed groups. Intraoperative estimated blood loss was significantly less in the laparoscopic group (33 ml (0-200 ml)) in comparison to the open group (186 ml (0-800 ml)) and postoperative need for blood transfusion was significantly reduced in the laparoscopic group (p = 0.0462). Operative time was significantly longer if LN was performed (158 min (85-227 min)) compared to the open procedure (107 min (56-174 min)) (p = 0.0079). In both groups one postoperative complication Clavien Dindo ≥ 3 occurred with the need of revision surgery. SF36 HRQol questionnaire revealed excellent postoperative quality of life after LN.

CONCLUSION

LN in ADPKD patients is a safe and effective operative procedure independent of kidney size with excellent postoperative outcomes and benefits of minimally invasive surgery. Compared with the open procedure patients profit from significantly less need for transfusion with comparable postoperative complication rates. However significant longer operation times need to be taken in account.

Culture of 3D Bioprinted Bone Constructs Requires an Increased Fluid Dynamic Stimulation

In vitro flow-induced mechanical stimulation of developing bone tissue constructs has been shown to favor mineral deposition in scaffolds seeded with cells directly exposed to the fluid flow. However, the effect of fluid dynamic parameters, such as shear stress (SS), within 3D bioprinted constructs is still unclear. Thus, this study aimed at correlating the SS levels and the mineral deposition in 3D bioprinted constructs, evaluating the possible dampening effect of the hydrogel. Human mesenchymal stem cells (hMSCs) were embedded in 3D bioprinted porous structures made of alginate and gelatin. 3D bioprinted constructs were cultured in an osteogenic medium assessing the influence of different flow rates (0, 0.7 and 7 ml/min) on calcium and collagen deposition through histology, and bone volume (BV) through micro-computed tomography. Uniform distribution of calcium and collagen was observed in all groups. Nevertheless, BV significantly increased in perfused groups as compared to static control, ranging from 0.35±0.28 mm³, 11.90±8.74 mm³ and 25.81±5.02 mm³ at week 3 to 2.28±0.78 mm³, 22.55±2.45 mm³ and 46.05±5.95 mm³ at week 6 in static, 0.7 and 7 ml/min groups, respectively. SS values on construct fibers in the range 10-100 mPa in 7 ml/min samples were twice as high as those in 0.7 ml/min samples showing the same trend of BV. The obtained results suggest that it is necessary to enhance the flow-induced mechanical stimulation of cell-embedding hydrogels to increase the amount of mineral deposited by hMSCs, compared to what is generally reported for the development of in vitro bone constructs. STATEMENT OF SIGNIFICANCE: : Culture of 3D Bioprinted Bone Constructs Requires an Increased Fluid Dynamic Stimulation, In this study, we evaluated for the first time how the hydrogel structure dampens the effect of flow-induced mechanical stimulation during the culture of 3D bioprinted bone tissue constructs. By combining computational and experimental techniques we demonstrated that those shear stress thresholds generally considered for culturing cells seeded on scaffold surface, are no longer applicable when cells are embedded in 3D bioprinted constructs. Significantly, more bone volume was formed in constructs exposed to shear stress values generally considered as detrimental than in constructs exposed shear stress values generally considered as beneficial after 3 weeks and 6 weeks of dynamic culture using a perfusion bioreactor.

Perspectives on in silico bone mechanobiology: computational modelling of multicellular systems

Bone mechanobiology is the study of the physical, biological and mechanical processes that continuously affect the multiscale multicellular system of the bone from the organ to the molecular scale. Current knowledge derives from experimental studies, which are often limited to gathering qualitative data in a cross-sectional manner, up to a restricted number of time points. Moreover, the simultaneous collection of information about 3D bone microarchitecture, cell activity as well as protein distribution and level is still a challenge. In silico models can expand qualitative information with hypothetical quantitative systems, which allow quantification, testing and comparison to existing quantifiable experimental data. An overview of multiscale, multiphysics, agent-based and hybrid techniques and their applications to bone mechanobiology is provided in the present review. The study analysed how mechanical signals, cells and proteins can be modelled in silico to represent bone remodelling and adaptation. Hybrid modelling of bone mechanobiology could combine the methods used in multiscale, multiphysics and agent-based models into a single model, leading to a unified and comprehensive understanding of bone mechanobiology. Numerical simulations of in vivo multicellular systems aided in hypothesis testing of such in silico models. Recently, in silico trials have been used to illustrate the mechanobiology of cells and signalling pathways in clinical biopsies and animal bones, including the effects of drugs on single cells and signalling pathways up to the organ level. This improved understanding may lead to the identification of novel therapies for degenerative diseases such as osteoporosis.

Kalanchoë blossfeldiana naturally transformed with Rhizobium rhizogenes exhibits superior root phenotype

Plant transformation with root oncogenic loci (rol) genes and open reading frames (ORFs) from Rhizobium rhizogenes have not yet targeted the underground root phenotype of these transformants. Hence, there is a need to develop plants with more efficient root system architecture (RSA). Here, RSA was assessed in naturally transformed (NT) and single rol/ORF Kalanchoë blossfeldiana 'Molly' lines in an aeroponic growth system combined with gene expression analysis. Three NT lines; 306, 324 and 331; exhibited better-developed RSA with longer roots and increased root biomass. In line 306, longest root was 6.3 ± 0.3 cm while WT had 4.8 ± 0.1 cm. However, root length of all overexpressing lines was ca. 30% shorter than WT. Root fresh weight of NT lines was 4.5-fold higher than WT. The expression of rolB, ∆ORF13a and ORF14 in the leaves of overexpressing lines was many folds higher than in NT lines. Increased expression of ∆ORF13a and ORF14 in leaves and roots may contribute more to a stronger compact phenotype than previously assumed. The moderate compact phenotype of NT lines combined with improved RSA compared to the overexpressing lines and WT strongly indicate that the use of R. rhizogenes has great potential to produce Kalanchoë phenotypes with enhanced RSA.

A detailed map of Higgs boson interactions by the ATLAS experiment ten years after the discovery

The standard model of particle physics1-4 describes the known fundamental particles and forces that make up our Universe, with the exception of gravity. One of the central features of the standard model is a field that permeates all of space and interacts with fundamental particles5-9. The quantum excitation of this field, known as the Higgs field, manifests itself as the Higgs boson, the only fundamental particle with no spin. In 2012, a particle with properties consistent with the Higgs boson of the standard model was observed by the ATLAS and CMS experiments at the Large Hadron Collider at CERN10,11. Since then, more than 30 times as many Higgs bosons have been recorded by the ATLAS experiment, enabling much more precise measurements and new tests of the theory. Here, on the basis of this larger dataset, we combine an unprecedented number of production and decay processes of the Higgs boson to scrutinize its interactions with elementary particles. Interactions with gluons, photons, and W and Z bosons-the carriers of the strong, electromagnetic and weak forces-are studied in detail. Interactions with three third-generation matter particles (bottom (b) and top (t) quarks, and tau leptons (τ)) are well measured and indications of interactions with a second-generation particle (muons, μ) are emerging. These tests reveal that the Higgs boson discovered ten years ago is remarkably consistent with the predictions of the theory and provide stringent constraints on many models of new phenomena beyond the standard model.

POS0536 REFINING THE SEROLOGICAL SCORES OF THE ACR/EULAR 2010 RHEUMATOID ARTHRITIS CLASSIFICATION CRITERIA: AN INTERNATIONAL STUDY

Background

Rheumatoid factor (RF) and anti-cyclic citrullinated protein/peptide antibodies (ACPA) are included in the ACR/EULAR 2010 classification criteria for rheumatoid arthritis (RA)(1). Both markers are given the same weight in the criteria.

Objectives

As the performance characteristics differ significantly between RF and ACPA(2), we set out to refine the serological scores for RA classification.

Methods

Diagnostic samples from 398 RA patients and from 1073 diseased controls were evaluated with five RF assays (two RF IgM isotype-specific assays and three total RF assays) and five ACPA IgG assays from five different manufacturers.

Results

Firstly, we harmonized thresholds between manufacturers based on predefined specificity for low positive (at 92.5% specificity for RF and at 97.5% specificity ACPA) and high positive results (at 97.5% specificity RF and at 99.0% specificity for ACPA). Next, we determined likelihood ratios (LRs) for RF, ACPA, and combinations of both, for negative, low positive, and high positive results. The LR was higher for ACPA than for RF, for high positive results than for low positive results and for double positivity than for single positivity. Based on these data we refined the weights of serological scores for classification (Table 1).

Table 1.

Refined weights of serological scores for RA classification

RF negativeRF low positiveRF high positiveACPA negative011ACPA low positive233ACPA high positive344

Application of such refined serological weights significantly increased the area under the curve of receiver operating characteristics analysis to distinguish RA from controls, significantly reduced the serological scores in the controls as well as the number of RA misclassifications without affecting the diagnostic sensitivity.

Besides, we showed that combining predefined specificity thresholds with the refined serological scoring, reduced manufacturer-dependent variability in RA classification impacting RA classification for controls from 18.0-29.0% by ACR/EULAR to 11.0-13.0% (significantly increasing specificity) and for RA patients from 67.8-74.0% to 67.6-71.5% (without significantly affecting sensitivity).

Conclusion

Serological weight factors for RA classification can be improved by taking into account the antibody type (RF versus ACPA), the antibody level, and single or combined positivity.

References

[1]Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham COr, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 2010; 69: 1580-8.

[2]Bossuyt X. Anticitrullinated protein antibodies: taking into account antibody levels improves interpretation. Ann Rheum Dis 2017; 76: e33.

Acknowledgements

We thank all participating diagnostic companies for the in-kind support of assays, their technical training and the constructive discussions. Furthermore, we are very thankful to the laboratory technicians of all participating laboratories for their most appreciated assistance in the performance of the RF/ACPA analyses.

Disclosure of Interests

Lieve Van Hoovels Speakers bureau: Thermo Fisher, Consultant of: Thermo Fisher, Grant/research support from: Thermo Fisher, Bert Vander Cruyssen: None declared, Daniela Sieghart Speakers bureau: Thermo Fisher, Consultant of: Thermo Fisher, Carolien Bonroy: None declared, Eszter Nagy: None declared, Rille Pullerits: None declared, Saša Čučnik: None declared, Charlotte Dahle: None declared, Ingmar Heijnen Speakers bureau: Thermo Fisher, Luca Bernasconi Speakers bureau: Thermo Fisher, Farid Benkhadra: None declared, Laura Bogaert: None declared, Stefanie Van Den Bremt: None declared, Ann Vanliedekerke: None declared, Geert Vanheule: None declared, Johan Robbrecht: None declared, Lucy Studholme: None declared, Wirth Claudine: None declared, Rüdiger Müller: None declared, Diego Kyburz: None declared, Christopher Sjowall: None declared, Alf Kastbom: None declared, Rok Jese: None declared, Boja Jovancevic: None declared, Emese Virag Kiss: None declared, Peggy Jacques: None declared, Günter Steiner Speakers bureau: Thermo Fisher, Consultant of: Thermo Fisher, Patrick Verschueren: None declared, Xavier Bossuyt Speakers bureau: Thermo Fisher, Consultant of: Thermo Fisher.

POS0695 EFFECT OF METHOTREXATE AND FOLIC ACID CO-ADMINISTRATION IN ARTHRITIS

Background

Methotrexate (MTX) is the recommended first-line treatment for rheumatoid arthritis. Adjuvant-induced arthritis (AIA) rat is a robust model with a high prevalence of arthritis used to investigate arthritis. MTX reduces inflammation, but associated with adverse events, such as gastrointestinal, hepatic, and hematology toxicity (1). To reduce these side effects, folic acid (FA) is administrated at distance to MTX with no defined recommendation for its dosing (5-25mg/week) or time point of administration (2) (1-3 days after MTX application). Whether the complicated therapeutic regimen with MTX once a week and FA at another time point affects compliance is an open question. MTX is metabolized in polyglutamates derivates (MTX-PG), which is a biomarker of MTX efficacy as its half-life (1-4 weeks) is longer than MTX (4h) (3).

Objectives

The aim of this study was to assess efficacy and tolerance of co-administration of MTX and FA compared to MTX with FA applied one day after MTX in the AIA.

Methods

Female Lewis rat were randomly divided in three groups and received an injection of Mycobacterium butyricum defining day (D) 0 to induce arthritis. An historic AIA group was used as control. Treatment began on D9, one day before arthritis onset in this model. The first group rats were treated with MTX only (n=13), the second group received MTX and FA at the same day (n=14), and the third group received FA one day after MTX administration (n=14). MTX was administrated intraperitoneally (IP) at 1 mg/kg every 3 days (4) and FA was delivered IP at 0.17 mg/kg. Arthritic index (AI) and ankle circumference (AC) were monitored to assess arthritis. Microcomputed tomography of the ankle was performed to assess bone loss. Moreover, complete blood count, transaminases, and MTX-PG were assessed.

Results

Arthritis developed at D10 in all groups. AI and AC were similar in MTX groups at the various time points. At D17, arthritis severity was lower in MTX groups (AI (mean and standard deviation): 1.4 ± 1.6; AC: 35 ± 7 mm) compared to AIA historical group (AI: 3.3 ± 0.6; AC: 42 ± 4 mm). Bone erosion and bone loss parameters were similar in all groups. Cortical porosity was around 0.40% ± 0.15 and bone volume / total volume was around 0.22% ± 0.13. MTX-PG1 was found at similar levels in MTX groups and correlated negatively with AI in MTX alone or MTX and FA at the same day groups (p<0.05 and p<0.01, respectively). Finally, white and red blood cells, platelets, hemoglobin, mean corpuscular volume, transaminases, and creatinine were found at a similar level in MTX groups.

Conclusion

Co-administration of MTX with FA on the same day is effective compared to FA application one day after MTX. MTX metabolism was not affected, as demonstrated by the MTX-PG concentrations. The biological tolerance between the protocols was comparable. Thus, co-administration of MTX and FA seems to be possible and may be more convenient to the patients and improve compliance at the end.

References

[1]Albrecht K, Müller-Ladner U. Side effects and management of side effects of methotrexate in rheumatoid arthritis. Clin Exp Rheumatol 2010;28:S95-101.

[2]Gaujoux-Viala C, et al. Recommendations of the French Society for Rheumatology for managing rheumatoid arthritis. Joint Bone Spine 2014;81:287–297.

[3]Angelis-Stoforidis P, et al. Methotrexate polyglutamate levels in circulating erythrocytes and polymorphs correlate with clinical efficacy in rheumatoid arthritis. Clin Exp Rheumatol 1999;17:313–320.

[4]Le Goff B, et al. A combination of methotrexate and zoledronic acid prevents bone erosions and systemic bone mass loss in collagen induced arthritis. Arthritis Res Ther 2009;11:R185.

Acknowledgements

We thank Ghislaine Roux, Diane Denis and Valentine Berrucas for their support in animal experiments. We thank Xavier Delavenne for MTX-PG dosage. We thank Nadia Boutahar for transaminases and creatinine dosage.

Disclosure of Interests

Elisa Dalix Grant/research support from: GEBRO, Mathieu Maalouf Grant/research support from: GEBRO, Sylvie Peyroche Grant/research support from: GEBRO, Arnaud Vanden-Bossche Grant/research support from: GEBRO, Charles-Antoine Arthaud Grant/research support from: GEBRO, Sophie Hodin Grant/research support from: GEBRO, Hubert MAROTTE Grant/research support from: GEBRO, Nordic Pharma, Rüdiger Müller Grant/research support from: GEBRO, Nordic Pharma

POS1420 DOUBLY ROBUST ESTIMATOR FOR AVERAGE TREATMENT EFFECT AS SENSITIVITY ANALYSIS FOR COMPARATIVE EFFECTIVENESS RESEARCH. AN EXAMPLE COMPARING DRUG MAINTENANCE BETWEEN BARICITINIB AND ALTERNATIVE BIOLOGIC DMARDS

Background

Drug maintenance is a common outcome measure of real world effectiveness studies, because it combines a measure of drug effectiveness and its tolerance / safety. Major hurdles of observational studies are potential selection biases and confounding. Cox proportional hazard ratio models address this issue by adjusting for potential confounders, but misspecification of the model may lead to biased estimates. ‘Augmented Inverse Probability Treatment Weighting’ (AIPTW) has the attractive property of being doubly robust, meaning that only one of the two underlying models has to be correctly specified to obtain consistent estimates. It can be used as a sensitivity analysis for Cox models, when analyzing time-to-event data.

Objectives

To evaluate AIPTW estimator and test the robustness of the results obtained by a Cox model.

Methods

Previous analyses in the Swiss rheumatoid arthritis (RA) registry (SCQM) had demonstrated that time to all-cause-discontinuation was significantly longer in RA patients on bariticinib (BARI, N = 273) compared to TNF-inhibitors (TNFi, N = 473); but not compared to other mode of actions biologics (OMA, N = 378) [1], in an adjusted Cox regression including age, gender, BMI, concomitant csDMARD, prednisone, CDAI score, disease duration, smoking status, line of therapy and seropositivity.

Here we repeat the same analysis using AIPTW, including the same potential confounders. We combine a propensity score using a logistic regression model and an inverse probability weighted Cox regression. Two implementations of the AIPTW estimator are considered. First we use the RiskRegression package in R, to obtain risk ratios. Then we implement the AIPTW manually to obtain the average treatment effect as the difference in median survival time.

Results

Time to treatment discontinuation measured with Cox model was significantly longer for RA patients on BARI compared to patients on TNFi according to the adjusted Cox model (HR = 1.79), and a similar non-significant trend existed when compared to OMA (HR = 1.29).

When considering 90-day treatment discontinuation measured with the AIPTW, the results were qualitatively very similar: the risk ratio between BARI and TNFi groups is statistically significant (RR = 2.51), while that of BARI against OMA is larger than one (RR = 1.47), but not statistically significant. Confidence intervals are larger with the AIPTW estimation.

Table 1.

Cox Regression HR and AIPTW risk ratios

Cox Regression Hazard Ratio (95% CI)AIPTW Estimate of 90-day risk ratio of treatment discontinuation (95% CI)BARI vs. TNFi1.79* (1.34-2.38)2.51* (1.19 – 3.83)BARI vs. OMA1.29 (0.96-1.73)1.47 (0.76 – 2.18)

Legend: BARI: baricitinib; TNFi: TNF-inhibitors; OMA: Other Mode of Actions biologics; AIPTW: Augmented Inverse Probability Treatment Weighting. 95% CI: 95% Confidence Interval. *: statistically significant result at the p<0.05 level.

Figure 1.

Absolute risk of treatment discontinuation over time between patients on baricitinib and patients on TNF inhibitors, estimated with AIPTW.

Conclusion

Time to treatment discontinuation measured with Cox model was significantly longer for RA patients on BARI compared to patients on TNFi according to the adjusted Cox model (HR = 1.79), and a similar non-significant trend existed when compared to OMA (HR = 1.29).

When considering 90-day treatment discontinuation measured with the AIPTW, the results were qualitatively very similar: the risk ratio between BARI and TNFi groups is statistically significant (RR = 2.51), while that of BARI against OMA is larger than one (RR = 1.47), but not statistically significant. Confidence intervals are larger with the AIPTW estimation.

Conflict of Interest:

This analysis has been made possible by financial support of Eli Lilly (Suisse) SA to the Geneva University Hospitals (HUG).

References

[1]Ann Rheum Dis, supplement 1, year 2021. DOI: 10.1136/annrheumdis-2021-eular.1781

Disclosure of Interests

Romain Aymon: None declared, Benoit GILBERT: None declared, Denis Mongin: None declared, Eric Nham: None declared, Cedric Laedermann Employee of: Eli Lilly, Rüdiger Müller Consultant of: Streuli Pharma, Gebro Pharma, AbbVie, Kim Lauper Speakers bureau: Pfizer, Viatris and Celltrion, Consultant of: Pfizer, Delphine Courvoisier: None declared, Axel Finckh: None declared

POS0435 IMPACT OF COMBINATION THERAPY WITH csDMARDs ON THE EFFECTIVENESS OF BIOLOGIC OR TARGETED SYNTHETIC DMARDs IN A REAL-LIFE SETTING: RESULTS FROM THE SWISS RHEUMATOID ARTHRITIS REGISTER (SCQM-RA)

Background

Management guidelines of RA suggest to administer biological or targeted synthetic DMARD (b/tsDMARD) in combination with conventional synthetic DMARD (csDMARD). Limited data exists about the impact of such csDMARD combination therapy (co-therapy) in real life settings, in particular for baricitinib use compared to other types of b/tsDMARD.

Objectives

To assess the impact of concomitant csDMARD prescription on b/tsDMARD maintenance, in a real-world setting.

Methods

This is a nested cohort study within the Swiss registry of RA patients (Swiss Clinical Quality Management (SCQM-RA)), of treatment courses with bDMARDs or baricitinib (BARI) initiated between 2017-09-01 and 2020-06-01, with at least one follow-up visit. We compared the time-to-drug-discontinuation (drug maintenance), as a measure of drug effectiveness of b/tsDMARDs, with or without csDMARD co-therapy. Our exposure of interest was the impact of csDMARD co-therapy compared to monotherapy in 3 categories of b/tsDMARDs: baricitinib (BARI), TNFi inhibitors (TNFi) and other modes of action bDMARDs (OMA). Co-therapy was defined as receiving at least one csDMARD during at least 40% of the b/tsDMARD treatment courses (TC) duration.

Baseline characteristics were compared using t-tests or χ2. Survival Kaplan-Meier curves, with Log-rank test, were used to assess time-to-discontinuation. Cox models were applied to obtain adjusted hazard ratios (HR) using age, BMI, corticosteroid treatment, CDAI score, disease duration, smoking, line of therapy, seropositivity, gender as covariates. Missing baseline CDAI values were imputed using linear model with quadratic regression time.

Results

1065 TC were included (273 BARI, 319 OMA, 473 TNFi), about half of which were initiated with csDMARD co-therapy (Table 1). In the co-therapy groups, csDMARD were taken on average 98% of the TC duration. Methotrexate was the most prescribed csDMARD (Table 1).

Table 1.

Baseline characteristics of studied population

VariableBARIOMATNFiBARIBARI + csDMARDp valuesOMAOMA + csDMARDp valuesTNFiTNFi + csDMARDp valuesn = 164n = 109n = 170n = 149n = 183n = 290Mean (SD)Mean (SD)Mean (SD)Otherwise: %*Otherwise: %*Otherwise: %*Prednisone21 %24 %0.7322 %29 %0.1820 %20 %1.00Line of Therapy- 1st (= bio-naive)17 %18 %0.0419 %22 %0.5142 %51 %0.15-2nd17 %24 %24 %22 %26 %20 %-3rd24 %11 %27 %20 %14 %10 %-4th or later42 %48 %31 %36 %19 %18 %Female82 %73 %0.1475 %71 %0.4281 %70 %0.01Age60 (15)57 (11)0.0560 (13)57 (12)0.0352 (16)53 (14)0.66Disease duration (years)13 (10)12 (9)0.8211 (9)11 (10)0.589 (10)8 (8)0.36CDAI baseline19 (10)18 (8)0.5320 (14)21 (12)0.5318 (10)18 (11)0.64Seropositivity77 %72 %0.3574 %75 %0.9668 %71 %0.64csDMARD type- MTX-48 %--50 %--60 %-- MTX + other-2 %-5 %-4 %-- Other-50 %-45 %-36 %-

TC = treatment course, BARI = baricitinib, TNFi = TNF inhibitors, OMA = Other Mode of Action drugs, DMARDs = Disease Modifying Anti-Rheumatic Drugs, csDMARDs = classical synthetic DMARDs, SD = standard deviation. CDAI = Clinical Disease Activity Index. csDMARD = conventional synthetic DMARD. MTX = Methotrexate. Other: Other csDMARD. * Percentages relate to total n treatment courses. p values in bold highlight statistically significant difference between respective groups. All % mean and SD values are rounded to integers.

Even after adjustment, we found no difference in drug maintenance with and without concomitant csDMARD in the BARI group (crude p = 0.67; HR co-therapy 2.17, 95% CI [0.61;7.77], p = 0.16) and in the TNFi group (crude p = 0.13; HR co-therapy 1.24, 95% CI [0.56;2.74], p = 0.60). Adjusted drug maintenance with or without csDMARD was also similar in the OMA group, despite non-adjusted p-value in favor of monotherapy (Figure 1) (crude p = 0.007; HR co-therapy 0.66, 95% CI [0.25;1.80], p = 0.39).

Figure 1.

Drug maintenance of monotherapy vs csDMARD co-therapy (Non-adjusted Kaplan-Meier).

Conclusion

Our data suggest that drug maintenance of BARI, OMA and TNFi, were not significantly modified by concomitant csDMARD therapy.

Disclosure of Interests

Benoit GILBERT Speakers bureau: Once for Lilly, outside of the presented work., Denis Mongin: None declared, Eric Nham: None declared, Delphine Courvoisier: None declared, Kim Lauper Speakers bureau: for Pfizer, Viatris and Celltrion, outside of the submitted work., Consultant of: for Pfizer, outside of the submitted work., Cedric Laedermann Employee of: Currently employed by Eli Lilly., Rüdiger Müller: None declared, Axel Finckh Speakers bureau: Lilly, Grant/research support from: Research Grant by Lilly, to the rheumatology division.

Injection Molding of Reinforced Thermosets

The orientation of glass fibers (initial length 20 mm) and the mold filling of reinforced unsaturated polyester compounds have been studied. Observations of the fiber orientation have been made in three molds where shear and elongational flows occur in variable ways. A part of the fibers are split and broken into filaments. Reinforcement can be more or less buckled. A thin skin layer without fibers is observed. The great thickness of a core region with an orientation perpendicular to the flow direction shows the importance of negative elongational flows. Efficiency of positive elongational flows to suppress buckling and to give a well flow aligned orientation is also observed. On the contrary the efficiency of shear flows is limited compared to elongational flows. The incidence of injection conditions on the pressure inside a rectangular plaque has been studied both experimentally and theoretically. Experimental difficulties due to the material heterogeneity leads to measure viscosity data of the uncured material on a special capillary rheometer and rheological kinetic data on a simplified compound. Numerical results are in good agreement with experimental measurements. For instance the effect of crosslinking which leads to a pressure rise at low flow rate or high mold temperature is well predicted.

DNA identification of species of the Anopheles maculipennis complex and first record of An. daciae in Belgium

The present study aimed at identifying the members of the Anopheles maculipennis complex (Diptera: Culicidae) occurring in Belgium. Therefore, the second internal transcribed spacer of nuclear ribosomal DNA (ITS2) and the mitochondrial cytochrome oxidase subunit I (COI) loci were sequenced in 175 and 111 specimens, respectively, collected between 2007 and 2019. In parallel, the suitability of two species-diagnostic PCR-RFLP assays was tested. The identified specimens included: An. maculipennis s.s. (N = 105), An. daciae (N = 62), An. atroparvus (N = 6) and An. messeae (N = 2). Each species was characterized by unique ITS2 haplotypes, whereas COI only supported the monophyly of An. atroparvus, a historical malaria vector in Belgium. Species identification results were further supported by unique PCR-RFLP banding patterns. We report for the first time An. daciae in Belgium, where it was found to co-occur with An. maculipennis s.s. The latter was the most prevalent in the collection studied (60%) and appears to have the widest distribution in Belgium. As in other studies, An. daciae and An. messeae appeared the most closely related species, up to the point that their species status remains debatable, while their ecological differences, including vector competences, need further study.

Saliva and Serum Protein Adsorption on Chemically Modified Silica Surfaces

Biomaterials, once inserted in the oral cavity, become immediately covered by a layer of adsorbed proteins that consists mostly of salivary proteins but also of plasma proteins if the biomaterial is placed close to the gingival margin or if it becomes implanted into tissue and bone. It is often this protein layer, rather than the pristine biomaterial surface, that is subsequently encountered by colonizing bacteria or attaching tissue cells. Thus, to study this important initial protein adsorption from human saliva and serum and how it might be influenced through chemical modification of the biomaterial surface, we have measured the amount of protein adsorbed and analyzed the composition of the adsorbed protein layer using gel electrophoresis and western blotting. Here, we have developed an in vitro model system based on silica surfaces, chemically modified with 7 silane-based self-assembled monolayers that span a broad range of physicochemical properties, from hydrophilic to hydrophobic surfaces (water contact angles from 15° to 115°), low to high surface free energy (12 to 57 mN/m), and negative to positive surface charge (zeta potentials from –120 to +40 mV at physiologic pH). We found that the chemical surface functionalities exerted a substantial effect on the total amounts of proteins adsorbed; however, no linear correlation of the adsorbed amounts with the physicochemical surface parameters was observed. Only the adsorption behavior of a few singular protein components, from which physicochemical data are available, seems to follow physicochemical expectations. Examples are albumin in serum and lysozyme in saliva; in both, adsorption was favored on countercharged surfaces. We conclude from these findings that in complex biofluids such as saliva and serum, adsorption behavior is dominated by the overall protein-binding capacity of the surface rather than by specific physicochemical interactions of single protein entities with the surface.

Transgenic Kalanchoë blossfeldiana, Containing Individual rol Genes and Open Reading Frames Under 35S Promoter, Exhibit Compact Habit, Reduced Plant Growth, and Altered Ethylene Tolerance in Flowers

Reduced growth habit is a desirable trait for ornamental potted plants and can successfully be obtained through Rhizobium rhizogenes transformation in a stable and heritable manner. Additionally, it can also be obtained by transformation with Agrobacterium tumefaciens harboring specific genes from R. rhizogenes. The bacterial T-DNA harbors four root oncogenic loci (rol) genes and 14 less known open reading frames (ORFs). The four rol genes, i.e., rolA, rolB, rolC, and rolD, are conceived as the common denominator for the compact phenotype and the other less characterized ORFs seem auxiliary but present a potential breeding target for less aberrant and/or more tailored phenotypes. In this study, Kalanchoë blossfeldiana 'Molly' was transformed with individual rol genes and selected ORFs in 35S overexpressing cassettes to comprehensively characterize growth traits, gene copy and expression, and ethylene tolerance of the flowers. An association of reduced growth habit, e.g. height and diameter, was observed for rolB2 and ORF14-2 when a transgene single copy and high gene expression were detected. Chlorophyll content was reduced in overexpressing lines compared to wild type (WT), except for one ΔORF13a (a truncated ORF13a, where SPXX DNA-binding motif is absent). The flower number severely decreased in the overexpressing lines compared to WT. The anthesis timing showed that WT opened the first flower at 68.9 ± 0.9 days and the overexpressing lines showed similar or up to 24 days delay in flowering. In general, a single or low relative gene copy insertion was correlated to higher gene expression, ca. 3 to 5-fold, in rolB and ΔORF13a lines, while in ORF14 such relation was not directly linked. The increased gene expression observed in rolB2 and ΔORF13a-2 contributed to reducing plant growth and a more compact habit. Tolerance of detached flowers to 0.5 μl L-1 ethylene was markedly higher for ORF14 with 66% less flower closure at day 3 compared to WT. The subcellular localization of rolC and ΔORF13a was investigated by transient expression in Nicotiana benthamiana and confocal images showed that rolC and ΔORF13a are soluble and localize in the cytoplasm being able to enter the nucleus.

Comparative effectiveness of antitumour necrosis factor agents, biologics with an alternative mode of action and tofacitinib in an observational cohort of patients with rheumatoid arthritis in Switzerland

Background

Multiple biologic and targeted synthetic disease-modifying rheumatic drugs (b/tsDMARDs) are approved for the management of rheumatoid arthritis (RA), including TNF inhibitors (TNFi), bDMARDs with other modes of action (bDMARD-OMA) and Janus kinase inhibitors (JAKi). Combination of b/tsDMARDs with conventional synthetic DMARDs (csDMARDs) is recommended, yet monotherapy is common in practice.

Objective

To compare drug maintenance and clinical effectiveness of three alternative treatment options for RA management.

Methods

This observational cohort study was nested within the Swiss RA Registry. TNFi, bDMARD-OMA (abatacept or anti-IL6 agents) or the JAKi tofacitinib (Tofa) initiated in adult RA patients were included. The primary outcome was overall drug retention. We further analysed secondary effectiveness outcomes and whether concomitant csDMARDs modified effectiveness, adjusting for potential confounding factors.

Results

4023 treatment courses of 2600 patients were included, 1862 on TNFi, 1355 on bDMARD-OMA and 806 on Tofa. TNFi was more frequently used as a first b/tsDMARDs, at a younger age and with shorter disease duration. Overall drug maintenance was significantly lower with TNFi compared with Tofa [HR 1.29 (95% CI 1.14 to 1.47)], but similar between bDMARD-OMA and Tofa [HR 1.09 (95% CI 0.96 to 1.24)]. TNFi maintenance was decreased when prescribed without concomitant csDMARDs [HR: 1.27 (95% CI 1.08 to 1.49)], while no difference was observed for bDMARD-OMA or Tofa maintenance with respect to concomitant csDMARDs.

Conclusion

Tofa drug maintenance was comparable with bDMARDs-OMA and somewhat higher than TNFi. Concomitant csDMARDs appear to be required for optimal effectiveness of TNFi, but not for bDMARD-OMA or Tofa.

Characterization of an ester-based core-multishell (CMS) nanocarrier for the topical application at the oral mucosa

OBJECTIVES

Topical drug administration is commonly applied to control oral inflammation. However, it requires sufficient drug adherence and a high degree of bioavailability. Here, we tested the hypothesis whether an ester-based core-multishell (CMS) nanocarrier is a suitable nontoxic drug-delivery system that penetrates efficiently to oral mucosal tissues, and thereby, increase the bioavailability of topically applied drugs.

MATERIAL AND METHODS

To evaluate adhesion and penetration, the fluorescence-labeled CMS 10-E-15-350 nanocarrier was applied to ex vivo porcine masticatory and lining mucosa in a Franz cell diffusion assay and to an in vitro 3D model. In gingival epithelial cells, potential cytotoxicity and proliferative effects of the nanocarrier were determined by MTT and sulphorhodamine B assays, respectively. Transepithelial electrical resistance (TEER) was measured in presence and absence of CMS 10-E-15-350 using an Endohm-12 chamber and a volt-ohm-meter. Cellular nanocarrier uptake was analyzed by laser scanning microscopy. Inflammatory responses were determined by monitoring pro-inflammatory cytokines using real-time PCR and ELISA.

RESULTS

CMS nanocarrier adhered to mucosal tissues within 5 min in an in vitro model and in ex vivo porcine tissues. The CMS nanocarrier exhibited no cytotoxic effects and induced no inflammatory responses. Furthermore, the physical barrier expressed by the TEER remained unaffected by the nanocarrier.

CONCLUSIONS

CMS 10-E-15-350 adhered to the oral mucosa and adhesion increased over time which is a prerequisite for an efficient drug release. Since TEER is unaffected, CMS nanocarrier may enter the oral mucosa transcellularly.

CLINICAL RELEVANCE

Nanocarrier technology is a novel and innovative approach for efficient topical drug delivery at the oral mucosa.

Ethephon-induced changes in antioxidants and phenolic compounds in anthocyanin-producing black carrot hairy root cultures

Hairy root (HR) cultures are quickly evolving as a fundamental research tool and as a bio-based production system for secondary metabolites. In this study, an efficient protocol for establishment and elicitation of anthocyanin-producing HR cultures from black carrot was established. Taproot and hypocotyl explants of four carrot cultivars were transformed using wild-type Rhizobium rhizogenes. HR growth performance on plates was monitored to identify three fast-growing HR lines, two originating from root explants (lines NB-R and 43-R) and one from a hypocotyl explant (line 43-H). The HR biomass accumulated 25- to 30-fold in liquid media over a 4 week period. Nine anthocyanins and 24 hydroxycinnamic acid derivatives were identified and monitored using UPLC-PDA-TOF during HR growth. Adding ethephon, an ethylene-releasing compound, to the HR culture substantially increased the anthocyanin content by up to 82% in line 43-R and hydroxycinnamic acid concentrations by >20% in line NB-R. Moreover, the activities of superoxide dismutase and glutathione S-transferase increased in the HRs in response to ethephon, which could be related to the functionality and compartmentalization of anthocyanins. These findings present black carrot HR cultures as a platform for the in vitro production of anthocyanins and antioxidants, and provide new insight into the regulation of secondary metabolism in black carrot.

Improved Access to Organo-Soluble Di- and Tetrafluoridochlorate(I)/(III) Salts

A facile one-pot gram-scale synthesis of tetraalkylammonium tetrafluoridochlorate(III) [cat][ClF4 ] ([cat]=[NEt3 Me]+ , [NEt4 ]+ ) is described. An acetonitrile solution of the corresponding alkylammonium chloride salt is fluorinated with diluted fluorine at low temperatures. The reaction proceeds via the [ClF2 ]- anion which is structurally characterized for the first time. The potential application of [ClF4 ]- salts as fluorinating agents is evaluated by the reaction with diphenyl disulfide, Ph2 S2 , to pentafluorosulfanyl benzene, PhSF5 . The CN moieties in acetonitrile and [B(CN)4 ]- are transferred in CF3 groups. Exposure of carbon monoxide, CO, leads to the formation of carbonyl fluoride, COF2 , and elemental gold is dissolved under the formation of tetrafluoridoaurate [AuF4 ]- .

Generation of intense and coherent sub-femtosecond X-ray pulses in electron storage rings

Temporally short X-ray pulses are an indispensable tool for the study of electron transitions close to the Fermi energy and structural changes in molecules undergoing chemical reactions which take place on a time-scale of hundreds of femtoseconds. The time resolution of experiments at 3^rd generation light sources which produce intense synchrotron radiation is limited fundamentally by the electron-bunch length in the range of tens of picoseconds. Here we propose a new scheme for the generation of intense and coherent sub-femtoseconds soft X-ray pulses in storage rings by applying the Echo-Enabled Harmonic Generation (EEHG) method. Many issues for obtaining the EEHG structure such as two modulators and a radiator are solved by a paradigm shift in an achromatic storage ring cell. Numerical demonstration of the feasibility of the scheme for the BESSY II beam parameters is presented.

Bacillus licheniformis FMCH001 Increases Water Use Efficiency via Growth Stimulation in Both Normal and Drought Conditions

Increasing agricultural losses due to biotic and abiotic stresses caused by climate change challenge food security worldwide. A promising strategy to sustain crop productivity under conditions of limited water availability is the use of plant growth promoting rhizobacteria (PGPR). Here, the effects of spore forming Bacillus licheniformis (FMCH001) on growth and physiology of maize (Zea mays L. cv. Ronaldinho) under well-watered and drought stressed conditions were investigated. Pot experiments were conducted in the automated high-throughput phenotyping platform PhenoLab and under greenhouse conditions. Results of the PhenoLab experiments showed that plants inoculated with B. licheniformis FMCH001 exhibited increased root dry weight (DW) and plant water use efficiency (WUE) compared to uninoculated plants. In greenhouse experiments, root and shoot DW significantly increased by more than 15% in inoculated plants compared to uninoculated control plants. Also, the WUE increased in FMCH001 plants up to 46% in both well-watered and drought stressed plants. Root and shoot activities of 11 carbohydrate and eight antioxidative enzymes were characterized in response to FMCH001 treatments. This showed a higher antioxidant activity of catalase (CAT) in roots of FMCH001 treated plants compared to uninoculated plants. The higher CAT activity was observed irrespective of the water regime. These findings show that seed coating with Gram positive spore forming B. licheniformis could be used as biostimulants for enhancing plant WUE under both normal and drought stress conditions.

The influence of muzzle gas on the temporary cavity

Shot range, the muzzle-target distance, is a crucial parameter for forensic reconstruction of deaths by firearms. In a large number of cases, especially suicides, the forensic pathologist is confronted with contact or near-contact shots, where muzzle gases play an additional role. This study was conducted to systematically investigate the influence of muzzle gases on the temporary cavity (TC). A total of 72 shots were fired using full metal-jacketed bullets in four forensically relevant calibres from 10-, 5-, 3-, 2- and 1-cm distance and in close contact. Target model was the so-called reference cube (10% gelatine at 4 °C) with 12-cm edge length. The TC was recorded using high-speed video (HSV). Cross-sectional analysis was performed by cutting the blocks to 1-cm slices, which were evaluated by applying the polygon method. The TC of shots from 10 and 5 cm distance had a tubular form. This aspect changed depending on the cartridge with decreasing distance (≤ 3 cm) into a pear-like form, which was typical for contact shots. The cumulated heights of the TC increased with decreasing distance below 3 cm. Contact shots approximately doubled the extension of the TC compared with exclusive energy transfer. Whereas HSV documented an increasingly asymmetric profile with ballooning at the entry side, cross-sectional analysis of cracks in gelatine resulted in convex graphs with only slight asymmetry for contact shots. Additional damage in gelatine was detected for 3-cm distance or less in calibre .357 Magnum and ≤ 2 cm for .32 auto, .38 special and 9mm Luger. The increasing influence of muzzle gas pressure is detectable with decreasing shot range below 3 cm.

Analysis of microscopic bone properties in an osteoporotic sheep model: a combined biomechanics, FE and ToF-SIMS study

The present study deals with the characterization of bone quality in a sheep model of postmenopausal osteoporosis. Sheep were sham operated ( n = 7), ovariectomized ( n = 6), ovariectomized and treated with deficient diet ( n = 8) or ovariectomized, treated with deficient diet and glucocorticoid injections ( n = 7). The focus of the study is on the microscopic properties at tissue level. Microscopic mechanical properties of osteoporotic bone were evaluated by a combination of biomechanical testing and mathematical modelling. Sample stiffness and strength were determined by compression tests and finite-element analysis of stress states was conducted. From this, an averaged microscopic Young's modulus at tissue level was determined. Trabecular structure as well as mineral and collagen distribution in samples of sheep vertebrae were analysed by micro-computed tomography and time-of-flight secondary ion mass spectrometry. In the osteoporotic sheep model, a disturbed fibril structure in the triple treated group was observed, but bone loss only occurred in form of reduced trabecular number and thickness and cortical decline, while quality of the residual bone was preserved. The preserved bone tissue properties in the osteoporotic sheep model allowed for an estimation of bone strength which behaves similar to the human case.

Long-term immunogenicity after yellow fever vaccination in immunosuppressed and healthy individuals

BACKGROUND

The live-attenuated yellow fever vaccine (YFV) is generally contraindicated in immunosuppressed patients. Our aim was to investigate if immunosuppressive therapy impairs the long-term protection against yellow fever virus in patients who had received YFV prior to the start of their immunosuppressive therapy.

METHODS

Our study examined 35 healthy individuals and 40 immunosuppressed patients with autoimmune diseases or organ transplants. All individuals had received YFV prior to the onset of their immunosuppression. We analysed the long-term influence of the immunosuppressive therapy on the YFV protective immunity by measuring neutralising antibodies (NA) with the Plaque Reduction Neutralisation Test (PRNT). We assessed risk factors for a negative PRNT result (titre below 1: 10) and their influence on the magnitude of the NA.

RESULTS

A median time interval of 21.1 years (interquartile range 14.4-31.3 years) after the YFV in all patients, a total of 35 immunosuppressed patients (88%) were seropositive (PRNT ≥ 1:10) compared to 31 patients (89%) in the control group. The geometric mean titres of NA did not differ between the groups. The duration of an underlying rheumatic disease was the only risk factor found for a lower magnitude of NA. An insufficient level of NA was found in nine subjects (12%) who had received a single dose of YFV (in one subject, the number of YFV doses was unknown).

CONCLUSION

The use of an immunosuppressive drug started after the administration of the YFV did not affect long-term persistence of NA. A second dose of YFV may be necessary to secure long-term immunity.

Aquatic mesocosms exposed to a fungicide in warm and cold temperate European climate zones: Long-term macroinvertebrate response

At present, the European Union legislation facilitates the use of similar pesticides among European Member States, thereby assuming that biodiversity and ecosystems have equal sensitivities to contaminants throughout the whole of Europe. However, with this assumption, fundamental environmental and biological differences between climatic zones are being ignored in Environmental Risk Assessment. Such differences may strongly influence the behaviour of contaminants, their effects on biodiversity and on the natural functioning of ecosystems. Furthermore, toxicity testing in European ecoregions other than cold-temperate has largely depended on standardized tests using cold-temperate species and conditions, which may lead to a false estimation of risks to organisms from other ecoregions. The present study aim was to determine the response of freshwater macroinvertebrate communities to the fungicide pyrimethanil by conducting aquatic mesocosm experiments in two different ecoregions with different climates: cold-temperate (Frankfurt, Germany) and warm-temperate (Coimbra, Portugal). The results indicate that the community in the cold-temperate climate was more sensitive to the fungicide in comparison to the warm-temperate community. This difference was most likely related to a different rate of fungicide disappearance, which was slower in the colder climate. Based upon our results we discuss important implications for improving Environmental Risk Assessment across climate zones and under present-day global climate change scenarios.

Removal of volatile gasoline compounds by indoor potted plants studied by pixel-based fingerprinting analysis

Indoor potted plants are able to remove volatile organic compounds (VOC) from air, but only few studies have investigated the removal of compounds in mixtures. Here, we present a non-targeted pixel-based fingerprinting analysis documenting the removal of a complex mixture of gasoline VOCs by Hedera helix under dynamic chamber conditions allowing for air exchange and continuous gasoline exposure. For 15 days, the entire potted plant was exposed to gasoline; subsequently, the epigeous plant parts were removed and the soil microcosm (i.e. soil, plant roots and microorganisms) was exposed to gasoline for another eight days. Quantitative analysis was performed for heptane, 3-methylhexane, toluene, ethylbenzene and m,p-xylenes, and the CHEMSIC method (CHEMometric analysis of Selected Ion Chromatograms) was used for non-targeted pixel-based fingerprinting analysis. The quantitative analysis demonstrated that the presence of potted plants or pots without epigeous plant parts led to a reduction of selected VOCs by 16.7-22.6%. The CHEMSIC method confirmed this and revealed that all gasoline VOCs were reduced in concentration when H. helix was present. The estimate for the total VOC removal was in the range of 11-32%. The removal was highest for samples where the epigeous plant parts were absent and compounds known to be hard to degrade by microorganisms such as dimethylcyclopentanes were removed the least compared to compounds more easily degraded by microorganisms such as heptane when epigeous plant parts were removed. All findings support the conclusion that the soil microcosm was the main responsible for the removal of VOCs.