bluuebunny/crossref_metadata_2025 huggingface dataset:
Complete percutaneous angio-guided implantation and explantation of VA-ECMO using preclosing for cardiogenic shock or cardiac arrest
Authors: Gallet R , Martin-Tuffreau AS , Bagate F , Boukantar M , Saiydoun G , Folliguet T , Teiger E
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Background. The approach for veno-arterial extracorporeal membrane oxygenation implantation (VA-ECMO) in patients with cardiogenic shock can be either surgical or percutaneous. Angio-guided percutaneous implantation and explantation could decrease vascular complications.

Purpose

We sought to describe the feasibility and safety of complete percutaneous angio-guided ECMO implantation and explantation using preclosing.

Methods. All consecutive patients who underwent peripheral femoro-femoral VA-ECMO percutaneous implantation for refractory cardiogenic shock or cardiac arrest were enrolled in a prospective registry (03/2018-09/2020). Percutaneous preclosing using two closing devices (Perclose ProGlide, Abbott) inserted before cannulation was used in both femoral artery and vein. Explantation was performed using a crossover technique under fluoroscopic guidance. The occurrence of vascular complication was recorded.

Results. Forty-nine patients underwent percutaneous VA-ECMO implantation for cardiogenic shock (n = 36) or refractory cardiac arrest (n = 13). Femoral vessel cannulations were successful in all patients and total cannulation time was 21± 8 min. Weaning from ECMO was possible in 23 patients (47%) and 11 (22%) patients were alive at 30-day. Significant vascular complications occurred in 3 patients (6%); all were related to distal perfusion line. One patient experienced major bleeding, and 2 experienced lower limb ischemia requiring vascular intervention (one failure of distal perfusion sheath implantation and one self-uprooting of the reperfusion cannula). Percutaneous decannulation was performed in 17 patients with 16/17 technical success rate. All femoral arteries and veins were properly closed using the pre-closing devices without bleeding on the angiographic control except for one patient in whom surgical closure of the artery was required. Among these patients, none required transfusion for access related significant bleeding and no other vascular complication occurred. Furthermore, no groin infection was observed after full percutaneous implantation and removal of ECMO.

Conclusion. Emergent complete percutaneous angio-guided VA-ECMO implantation and explantation using pre-closing technique is an effective and safe strategy in patients referred for refractory cardiogenic shock or cardiac arrest.
The biofeedback training, controlled by capnometry is a successful method of rehabilitation after myocardial infarction
Authors: Leonova I , Yarmosh I , Boldueva S , Suvorov N , Sergeev T
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

The increasing activity of the sympathetic nervous system was shown during myocardial infarction (MI). There are data that bio management application increases the vagal influences on a heart rate for patients with chronic coronary artery disease.

The purpose of this study was the assessment of changes of vegetative regulation of heart rate in patients with MI, receiving along with standard methods of treatment and rehabilitation sessions of cardiorespiratory training (KRT).

48 patients with IM in an early period of disease at the age from 40 till 70 years were surveyed. The main group was created from 29 people by whom KRT (5–10 sessions) was carried out. The assessment of efficiency and safety of KRT was carried out on a clinical picture and parameters of heart rate variability (HRV) before, after, and during KRT. The Control group consisted of 19 patients receiving only standard treatment. To exclude hyperventilation syndrome, capnometry was performed before the start of the KRT session to determine the FetCO2 individual norm for the certain patient to control the training process in a particular session. After each active sample, the concentration of carbon dioxide in the air exhaled by the patient was measured, and when it decreased below 95% of the initial value, the depth of breathing was adjusted. The use of capnometry in the study avoided adverse events during the sessions.

During carrying out of KRT, and after KRT worsening of the clinical picture at patients of the main group was not observed. HRV analysis at patients of the main group showed that after the end of KRT decrease in an index of tension (p < 0,05), an increase in an indicator of the general dispersion of heart rate (p < 0,05), and also a tendency to increase of vagal part of total power during spectral analysis (р=0,05) was observed. Normalization of heart rate and arterial pressure, growth of cardiorespiratory index, and index of a variation took place, cardiorespiratory synchronization was restored. Persons from the control group had no such changes.

Thus, the application of KRT realizing a mode of functional bio management of heart rate, as the instrument of psychophysiological support of standard medicament therapy showed the efficiency of its use in the program of rehabilitation of patients with myocardial infarction. The result of a comprehensive approach is the reduction of sympathetic and increase of vagal influences on heart rate, normalization of the main indicators of the cardiovascular system.
Features of emotional status in patient with unstable angina
Authors: Ibatov A
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Purpose

to study emotional status at patients with unstable angina. 

Materials and methods

42 men with unstable angina in the age from 40 till 65 years (average age 55.8 ± 1.3 years) were examined. A level of anxiety and the depression were examined by the Hospital Anxiety and Depression Scale (HADS), personality characteristics - by the MMPI questionnaire. 

Results

The patients with unstable angina had 5.4 ± 0.6 (from 2 till 12) score of anxiety level and 5.5 ± 0.6 (from 0 till 16) score of depression level accordingly. Besides 23.5 % of the patients with unstable angina had clinical and subclinical level of anxiety (score > 7 by HADS), 76.5 % of the patients with unstable angina had no anxiety (score ≤ 7 by HADS). However 35.3% of patients with unstable angina had clinical and subclinical level of depression (score > 7 by HADS) and 64.7 % of patients with unstable angina had no depression (score ≤ 7 by HADS). The patients with unstable angina had the such MMPI test parameters accordingly: on scale of Hypochondriasis – 54.2 ± 1.0 score; on scale of Depression – 44.8 ± 2.2 score; on scale of Hysteria – 52.4 ± 1.1 score; on scale of Psychopathic Deviate – 43.5 ± 2.0 score; on scale of Paranoia – 52.2 ± 2.5 score; on scale of Psychasthenia – 48.6 ± 2.4 score; on scale of Schizophrenia – 48.7 ± 2.2 score; on scale of Hypomania – 45.1 ± 1.2 score. 

Conclusion

23.5 % of the patients with unstable angina had clinical and subclinical level of anxiety and 35.3% - depression. These patients need correction of anxiety and depression, that should be considered in treatment and rehabilitation.
Risk evaluation in adult congenital heart surgery: analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database risk models on data from the European Congenital Heart Surgeons Association Congenital Database
Authors: Pabst von Ohain Jelena , Sarris Georgios , Tobota Zdzislaw , Maruszewski Bohdan , Vida Vladimiro L , Hörer J
Published: April 2021

OBJECTIVES

We sought to evaluate the predictive power of the Society of Thoracic Surgeons–European Association for Cardio-Thoracic Surgery (STAT) mortality score and the adult congenital heart surgery (ACHS) mortality score for the adults undergoing congenital heart operations entered into the European Congenital Heart Surgeons Association (ECHSA) database.

METHODS

The data set comprised 17 662 major operations performed between 1997 and 2019, on patients 18 years of age or older, in European centres participating in the ECHSA database. Each operation was assigned a STAT mortality score and category and an ACHS mortality score. Operative mortality was based on the 30-day status and on the status at hospital discharge. The discriminatory power of the STAT and ACHS scores was assessed using the area under the receiver operating characteristic curve (c-index).

RESULTS

A total of 17 214 (97.46%) operations were assigned ACHS scores. The 3 most frequent primary procedures were closure of the atrial septal defect (19.0%), aortic valve replacement (8.8%) and non-valve-sparing aortic root replacement (6.1%). Operative mortality for ACHS-coded operations was 2.07%. The procedures with the highest mortality were atrial septal defect creation/enlargement (19.0%), lung transplantation (18.8%) and heart transplantation (18.2%). A total of 17 638 (99.86%) operations were assigned a STAT score and category. The operative mortality for STAT-coded operations was 2.27%. The c-index for mortality was 0.720 for the STAT mortality score and 0.701 for the ACHS score.

CONCLUSIONS

The ACHS mortality score and the STAT mortality score reached similar, moderate predictive power in adult patients undergoing congenital heart surgery in ECHSA database.
Antiplatelet therapy after transcatheter aortic valve implantation: a systematic review and meta-analysis
Authors: Costa GonçaloNuno Ferraz , Costa Marco , Gonçalves Lino , Teixeira Rogério
Published: April 2021

OBJECTIVES

The aim of this study was to compare antithrombotic regimens after transcatheter aortic valve implantation (TAVI) in patients without an indication for long-term anticoagulation. TAVI is a safe and effective approach for patients with symptomatic severe aortic stenosis and an intermediate-to-high surgical risk. Nevertheless, the antithrombotic regimen after procedure remains controversial.

METHODS

We systematically searched PubMed, Embase and Cochrane databases for interventional studies comparing single antiplatelet therapy with double antiplatelet therapy after TAVI. A meta-analysis was carried out to compare thrombotic and bleeding events between both strategies.

RESULTS

Four randomized clinical trials were included comprising a total of 1085 patients. Our meta-analysis revealed a higher odds ratio (OR) of major bleeding events (pooled OR 2.45, 95% confidence interval (CI) 1.29–4.67; P < 0.01; I2 = 0%) and minor bleeding (pooled OR 1.73, 95% CI 1.12–2.66; P = 0.01; I2 = 0%) for the double antiplatelet therapy group compared with the single antiplatelet therapy group. There was no difference between groups in the risk of stroke (pooled OR 1.04, 95% CI 0.58–1.86; P = 0.91; I2 = 0%), myocardial infarction (pooled OR 2.10, 95% CI 0.75–5.84; P = 0.16, I2 = 0%) and all-cause mortality (pooled OR 1.07, 95% CI 0.63–1.86; P = 0.08; I2 = 0%) after TAVI.

CONCLUSIONS

Our pooled analysis suggests that for patients who underwent TAVI, double antiplatelet therapy compared with single antiplatelet therapy alone increased the risk of bleeding without reducing mortality and ischaemic events.
Cefazolin prophylaxis in children undergoing cardiac surgery with the use of cardiopulmonary bypass—is the dosing correct?
Authors: Jaworski Radoslaw , Dzierzanowska-Fangrat Katarzyna , Czajkowska Agnieszka , Maruszewski Bohdan , Kansy Andrzej
Published: April 2021

OBJECTIVES

To determine the recommended concentrations of cefazolin to be used for antibiotic prophylaxis during paediatric cardiac surgery with extracorporeal circulation (ECC).

METHODS

Twenty paediatric patients undergoing cardiac surgery with ECC and cefazolin antibiotic prophylaxis were included in the study. Blood samples for measurement of total cefazolin plasma concentration were collected at the following measurement time points: directly after skin incision, 15 min after ECC start, 5 min after ECC cessation and at skin closure. The target concentration was set for ≥40 mg/l, which corresponded to ≥8 mg/l of unbound cefazolin concentration.

RESULTS

The median total cefazolin plasma concentrations at the measurement time points were 62.8, 67.7, 45.8 and 34.2 mg/l, respectively, and target concentrations were achieved in 90%, 85%, 65% and 40% of children, respectively. Among patients who received ≥30 mg of cefazolin per 100 ml of ECC priming, target concentrations after ECC cessation were reached in 80% of patients, while in those with <30 mg cefazolin per 100 ml in 20% of patients (P = 0.031).

CONCLUSIONS

Direct extrapolation of antibiotic prophylaxis recommendations from adults to children may result in suboptimal antibiotic concentrations. An additional cefazolin dose to ECC priming appears necessary and the dosing should be based on ECC priming volume rather than on the weight of the patient.
Simulation of near-fault ground strains and rotations from actual strike-slip earthquakes: case studies of the 2004Mw 6.0 Parkfield, the 1979Mw 6.5 Imperial Valley and the 1999Mw 7.5 Izmit earthquakes
Authors: Cao Yenan , Mavroeidis George P
Published: April 2021

Previous studies have demonstrated that finite-fault simulations of actual or hypothetical earthquakes using deterministic, physics-based simulation techniques constitute an effective tool for characterizing near-fault ground strains and rotations in the low-frequency range. The characteristics of these motions are further investigated in this study by performing forward ground-motion simulations of three well-documented strike-slip earthquakes (i.e. 2004 Mw 6.0 Parkfield, 1979 Mw 6.5 Imperial Valley and 1999 Mw 7.5 Izmit) using models of the seismic source and crustal structure available in the literature. Time histories of ground strains and rotations are numerically generated at near-fault stations and at a dense grid of observation points extending over the causative fault. This is achieved by finite differencing translational motions simulated at very closely spaced stations using a kinematic modelling approach. The simulation results show that the three strike-slip earthquakes produce large-amplitude pulse-like shear strain and torsion in the forward direction of rupture propagation. The time histories of specific components of displacement gradient, strain and rotation at near-fault stations can be estimated from those of ground velocities using a phase velocity, whereas peak ground torsions in the near-fault region can be reasonably estimated from peak horizontal ground velocities using a scaling factor. However, both the phase velocity and the scaling factor exhibit significant variability in the near-fault region of the considered earthquakes. The concept of isochrones is also utilized to associate fault rupture characteristics with near-fault ground strains and rotations. The results indicate that the seismic energy radiated from the high-isochrone-velocity region of the fault—which encompasses areas of large slip locally driven by high stress drop—arrives at a near-fault station in a short time interval that coincides with the time window of the large-amplitude pulse-like shear strain and torsion.
Systematic review and meta-analysis of mortality risk prediction models in adult cardiac surgery
Authors: Sinha Shubhra , Dimagli Arnaldo , Dixon Lauren , Gaudino Mario , Caputo Massimo , Vohra Hunaid A , Angelini Gianni , Benedetto Umberto
Published: April 2021

OBJECTIVES

The most used mortality risk prediction models in cardiac surgery are the European System for Cardiac Operative Risk Evaluation (ES) and Society of Thoracic Surgeons (STS) score. There is no agreement on which score should be considered more accurate nor which score should be utilized in each population subgroup. We sought to provide a thorough quantitative assessment of these 2 models.

METHODS

We performed a systematic literature review and captured information on discrimination, as quantified by the area under the receiver operator curve (AUC), and calibration, as quantified by the ratio of observed-to-expected mortality (O:E). We performed random effects meta-analysis of the performance of the individual models as well as pairwise comparisons and subgroup analysis by procedure type, time and continent.

RESULTS

The ES2 {AUC 0.783 [95% confidence interval (CI) 0.765–0.800]; O:E 1.102 (95% CI 0.943–1.289)} and STS [AUC 0.757 (95% CI 0.727–0.785); O:E 1.111 (95% CI 0.853–1.447)] showed good overall discrimination and calibration. There was no significant difference in the discrimination of the 2 models (difference in AUC −0.016; 95% CI −0.034 to −0.002; P = 0.09). However, the calibration of ES2 showed significant geographical variations (P < 0.001) and a trend towards miscalibration with time (P=0.057). This was not seen with STS.

CONCLUSIONS

ES2 and STS are reliable predictors of short-term mortality following adult cardiac surgery in the populations from which they were derived. STS may have broader applications when comparing outcomes across continents as compared to ES2.

REGISTRATION

Prospero (https://www.crd.york.ac.uk/PROSPERO/) CRD42020220983.
Role of von Willebrand Factor in COVID-19 Associated Coagulopathy
Authors: Mei Zhen W , van Wijk Xander M R , Pham Huy P , Marin Maximo J
Published: April 2021

Background

COVID-19, the disease caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) can present with symptoms ranging from none to severe. Thrombotic events occur in a significant number of patients with COVID-19, especially in critically ill patients. This apparent novel form of coagulopathy is termed COVID-19-associated coagulopathy (CAC), and endothelial derived von Willebrand factor (vWF) may play an important role in its pathogenesis.

Content

vWF is a multimeric glycoprotein molecule that is involved in inflammation, primary and secondary hemostasis. Studies have shown that patients with COVID-19 have significantly elevated levels of vWF antigen and activity, likely contributing to an increased risk of thrombosis seen in CAC. The high levels of both vWF antigen and activity have been clinically correlated with worse outcomes. Furthermore, the severity of a COVID-19 infection appears to reduce molecules that regulate vWF level and activity such as ADAMTS-13 and high-density lipoproteins (HDL). Finally, studies have suggested that patients with group O blood (a blood group with lower baseline levels of vWF) have a lower risk of infection and disease severity compared to other ABO blood groups; however, more studies are needed to elucidate the role of vWF.

CAC is a significant contributor to morbidity and mortality. Endothelial dysfunction with the release of prothrombotic factors, such as vWF, needs further examination as a possible important component in the pathogenesis of CAC.
Large bowel obstruction secondary to gallstones
Authors: Crosen Matelin , Ghattas Paul , Sandhu Rovinder
Published: April 2021

Gallstone ileus is a rare complication of cholelithiasis, representing 1% of bowel obstructions. The usual site of obstruction is the ileocecal valve, though other sites have been reported. Here, we present two cases of gallstone ileus within the distal colon requiring surgical intervention. Two elderly females presented with vague abdominal symptoms secondary to large bowel obstruction from gallstone impaction. Both underwent attempted endoscopic retrieval without success. Patient 1 required laparoscopy converted to exploratory laparotomy with colotomy and removal of the stone. Patient 2 required partial colectomy and end colostomy formation due to acute sigmoid inflammation. Gallstone ileus is a rare cause of intestinal obstruction, though incidence increases with age. Cholecystocolonic fistulas allow stones to bypass the ileocecal valve, with the potential for impaction in the colon at the site of a stricture or tortuosity. Surgical intervention may be required in cases not amenable to successful endoscopic retrieval.
Managing passenger flows for seaborne transportation during COVID-19 pandemic
Authors: Niemelä Erik , Spohr Jonas , Hellström Magnus , Långstedt Johnny , Tsvetkova Anastasia , Sjöblom Joakim , Khan Fuad , Eriksson John E , Wikström Kim
Published: April 2021

The ongoing coronavirus disease 2019 (COVID-19) pandemic has negatively affected the cruise and ferry industry as the passenger numbers and revenues have plummeted. Therefore, we developed a holistic approach for mitigating COVID-19 during seaborne transportation in a cost-efficient way by combining behavioural changes, procedural workflows and technical innovations to reset the industry.
Rubisco production in maize mesophyll cells through ectopic expression of subunits and chaperones
Authors: Hotto Amber M , Salesse-Smith Coralie , Lin Myat , Busch Florian A , Simpson Isabelle , Stern David B
Published: April 2021

C4 plants, such as maize, strictly compartmentalize Rubisco to bundle sheath chloroplasts. The molecular basis for the restriction of Rubisco from the more abundant mesophyll chloroplasts is not fully understood. Mesophyll chloroplasts transcribe the Rubisco large subunit gene and, when normally quiescent transcription of the nuclear Rubisco small subunit gene family is overcome by ectopic expression, mesophyll chloroplasts still do not accumulate measurable Rubisco. Here we show that a combination of five ubiquitin promoter-driven nuclear transgenes expressed in maize leads to mesophyll accumulation of assembled Rubisco. These encode the Rubisco large and small subunits, Rubisco assembly factors 1 and 2, and the assembly factor Bundle sheath defective 2. In these plants, Rubisco large subunit accumulates in mesophyll cells, and appears to be assembled into a holoenzyme capable of binding the substrate analog CABP (carboxyarabinitol bisphosphate). Isotope discrimination assays suggest, however, that mesophyll Rubisco is not participating in carbon assimilation in these plants, most probably due to a lack of the substrate ribulose 1,5-bisphosphate and/or Rubisco activase. Overall, this work defines a minimal set of Rubisco assembly factors in planta and may help lead to methods of regulating the C4 pathway.
AnN-body population synthesis framework for the formation of moons around Jupiter-like planets
Authors: Cilibrasi M , Szulágyi J , Grimm S L , Mayer L
Published: April 2021

The moons of giant planets are believed to form in situ in circumplanetary discs (CPDs). Here, we present an N-body population synthesis framework for satellite formation around a Jupiter-like planet, in which the dust-to-gas ratio, the accretion rate of solids from the protoplanetary disc, the number, and the initial positions of protosatellites were randomly chosen from realistic distributions. The disc properties were from 3D radiative simulations sampled in 1D and 2D grids and evolved semi-analytically with time. The N-body satellitesimals accreted mass from the solid component of the disc, interacted gravitationally with each other, experienced close-encounters, both scattering and colliding. With this improved modeling, we found that only about $15{{\ \rm per\ cent}}$ of the resulting population is more massive than the Galilean one, causing migration rates to be low and resonant captures to be uncommon. In 10 per cent of the cases, moons are engulfed by the planet, and 1 per cent of the satellite-systems lose at least 1 Earth-mass into the planet, contributing only in a minor part to the giant planet’s envelope’s heavy element content. We examined the differences in outcome between the 1D and 2D disc models and used machine learning techniques (Randomized Dependence Coefficient together with t-SNE) to compare our population with the Galilean system. Detecting our population around known transiting Jupiter-like planets via transits and TTVs would be challenging, but $14{{\ \rm per\ cent}}$ of the moons could be spotted with an instrumental transit sensitivity of 10−5.
Nitrogen X-ray absorption in the local ISM
Authors: Gatuzz Efrain , García Javier A , Kallman Timothy R
Published: April 2021

Nitrogen is one of the most abundant metals in the interstellar medium (ISM), and thus it constitutes an excellent test to study a variety of astrophysical environments, ranging from nova to active galactic nuclei. We present a detailed analysis of the gaseous component of the N K-edge using high-resolution XMM–Newton spectra of 12 Galactic and 40 extragalactic sources. For each source, we have estimated column densities for N i, N ii, N iii, N v, N vi, and N vii ionic species, which trace the cold, warm, and hot phases of the local Galactic ISM. We have found that the cold-warm component column densities decrease with the Galactic latitude, while the hot component does not. Moreover, the cold column density distribution is in good agreement with UV measurements. This is the first detailed analysis of the nitrogen K-edge absorption due to ISM using high-resolution X-ray spectra.
AzTEC survey of the central molecular zone: data reduction, analysis, and preliminary results
Authors: Tang Yuping , Wang Q Daniel , Wilson Grant W , Heyer Mark H , Gutermuth Robert A , Schloerb Peter , Yun Min S , Bally John , Loinard Laurent , Silich Sergiy , Chávez Miguel , Haggard Daryl , Montaña Alfredo , Sánchez-Argüelles David , Zeballos Milagros , Zavala Jorge A , León-Tavares Jonathan
Published: April 2021

We present a large-scale survey of the central molecular zone (CMZ) of our Galaxy, as well as a monitoring program of Sgr A*, with the AzTEC/Large Millimeter Telescope in the 1.1 mm continuum. Our 1.1 mm map covers the main body of the CMZ over a field of 1.6 × 1.1 deg2 with an angular resolution of 10.5 arcsec and a depth of 15 mJy beam−1. To account for the intensity loss due to the background removal process, we combine this map with lower resolution CSO/Bolocam and Planck/HFI data to produce an effective full intensity 1.1 mm continuum map. With this map and existing Herschel surveys, we have carried out a comprehensive analysis of the spectral energy distribution of dust in the CMZ. A key component of this analysis is the implementation of a model-based deconvolution approach, incorporating the Point Spread Functions (PSFs) of the different instruments, and hence recovering a significant amount of spatial information on angular scales larger than 10.5 arcsec. The monitoring of Sgr A* was carried out as part of a worldwide, multiwavelength campaign when the so-called G2 object was undergoing the pericentre passage around the massive black hole. Our preliminary results include (1) high-resolution maps of column density, temperature and dust spectral index across the CMZ; (2) a 1.1 mm light curve of Sgr A* showing an outburst of $140{{\ \rm per\ cent}}$ maximum amplitude on 2014 May 9th May, 2014 but otherwise only stochastic variations of $10{{\ \rm per\ cent}}$ and no systematic long-term change, consistent with other observations.
Further support for a trio of mass-to-light deviations in Abell 370: free-form grale lens inversion using BUFFALO strong lensing data
Authors: Ghosh Agniva , Williams Liliya L R , Liesenborgs Jori , Acebron Ana , Jauzac Mathilde , Koekemoer Anton M , Mahler Guillaume , Niemiec Anna , Steinhardt Charles , Faisst Andreas L , Lagattuta David , Natarajan Priyamvada
Published: April 2021

We use the Beyond Ultra-deep Frontier Fields and Legacy Observations (BUFFALO) strong lensing image catalogue of the merging galaxy cluster Abell 370 to obtain a mass model using free-form lens inversion algorithm grale. The improvement of the strong lensing data quality results in a lens plane rms of only 0.45 arcsec, about a factor of two lower than that of our existing HFF v4 reconstruction. We attribute the improvement to spectroscopic data and use of the full reprocessed HST mosaics. In our reconstructed mass model, we found indications of three distinct mass features in Abell 370: (i) a ∼35 kpc offset between the northern BCG and the nearest mass peak, (ii) a ∼100 kpc mass concentration of roughly critical density ∼250 kpc east of the main cluster, and (iii) a probable filament-like structure passing N-S through the cluster. While (i) is present in some form in most publicly available reconstructions spanning the range of modelling techniques: parametric, hybrid, and free-form, (ii) and (iii) are recovered by only about half of the reconstructions. We tested our hypothesis on the presence of the filament-like structure by creating a synthetic cluster – Irtysh IIIc – mocking the situation of a cluster with external mass. We also computed the source plane magnification distributions. Using them, we estimated the probabilities of magnifications in the source plane, and scrutinized their redshift dependence. Finally, we explored the lensing effects of Abell 370 on the luminosity functions of sources at zs = 9.0, finding it consistent with published results.
RNAnue: efficient data analysis for RNA–RNA interactomics
Authors: Schäfer Richard A , Voß Björn
Published: April 2021

RNA–RNA inter- and intramolecular interactions are fundamental for numerous biological processes. While there are reasonable approaches to map RNA secondary structures genome-wide, understanding how different RNAs interact to carry out their regulatory functions requires mapping of intermolecular base pairs. Recently, different strategies to detect RNA–RNA duplexes in living cells, so called direct duplex detection (DDD) methods, have been developed. Common to all is the Psoralen-mediated in vivo RNA crosslinking followed by RNA Proximity Ligation to join the two interacting RNA strands. Sequencing of the RNA via classical RNA-seq and subsequent specialised bioinformatic analyses the result in the prediction of inter- and intramolecular RNA–RNA interactions. Existing approaches adapt standard RNA-seq analysis pipelines, but often neglect inherent features of RNA–RNA interactions that are useful for filtering and statistical assessment. Here we present RNAnue, a general pipeline for the inference of RNA–RNA interactions from DDD experiments that takes into account hybridisation potential and statistical significance to improve prediction accuracy. We applied RNAnue to data from different DDD studies and compared our results to those of the original methods. This showed that RNAnue performs better in terms of quantity and quality of predictions.
pLannotate: engineered plasmid annotation
Authors: McGuffie Matthew J , Barrick Jeffrey E
Published: April 2021

Engineered plasmids are widely used in the biological sciences. Since many plasmids contain DNA sequences that have been reused and remixed by researchers for decades, annotation of their functional elements is often incomplete. Missing information about the presence, location, or precise identity of a plasmid feature can lead to unintended consequences or failed experiments. Many engineered plasmids contain sequences—such as recombinant DNA from all domains of life, wholly synthetic DNA sequences, and engineered gene expression elements—that are not predicted by microbial genome annotation pipelines. Existing plasmid annotation tools have limited feature libraries and do not detect incomplete fragments of features that are present in many plasmids for historical reasons and may impact their newly designed functions. We created the open source pLannotate web server so users can quickly and comprehensively annotate plasmid features. pLannotate is powered by large databases of genetic parts and proteins. It employs a filtering algorithm to display only the most relevant feature matches and also reports feature fragments. Finally, pLannotate displays a graphical map of the annotated plasmid, explains the provenance of each feature prediction, and allows results to be downloaded in a variety of formats. The webserver for pLannotate is accessible at: http://plannotate.barricklab.org/
O13 Which composite measure best reflects disease activity and predicts treatment change in psoriatic arthritis?
Authors: Tucker Laura , Helliwell Philip , Coates Laura ,   GRACE collaboration
Published: April 2021

Background/Aims 

Multiple composite measures of disease activity are available and used in psoriatic arthritis (PsA) research; however, poor agreement remains amongst clinicians on the optimal measure of disease activity. Research to date has focused on polyarticular PsA, despite oligoarticular disease accounting for around half of cases in clinical practice. We aim to compare the ability of Composite Psoriatic Disease Activity Index (CPDAI), Psoriatic ArthritiS Disease Activity Score (PASDAS), Disease Activity score for PSoriatic Arthritis (DAPSA), GRAppa Composite scorE (GRACE) and Disease Activity Score 28 CRP (DAS28-CRP) to assess disease activity and predict treatment change, amongst usual care patients with oligoarticular and polyarticular psoriatic disease.

Methods 

The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis Composite Exercise (GRACE) dataset was utilised. Oligoarthritis was defined as < 5 active joints. Reference measures were clinician and patient opinions on disease control and whether treatment was escalated. Patients with baseline data for all composite measures were included. The ability of each composite measure to predict treatment change and capture disease activity was compared using the Mann-Whitney U test.

Results 

Data were available for 271 patients (152 oligoarthritis, 119 polyarthritis). The mean age, duration of PsA and psoriasis were similar for both groups. A higher proportion of oligoarticular patients were male. Patients with polyarticular disease had higher disease activity in skin, enthesitis and dactylitis.

Using both patient and physician definitions of disease control, all composite measures were able to differentiate between patients with active and quiescent disease, regardless of disease subtype (p < 0.05). PASDAS demonstrated the largest differentiation in score. Differences between active and inactive disease scores were more pronounced in oligoarticular disease. PASDAS demonstrated the greatest ability to predict treatment change in both oligoarticular and polyarticular disease. Interestingly, DAPSA could not predict treatment change in polyarticular patients, p = 0.074 (Table 1).

Conclusion 

This is the first study to compare composite measures, in oligoarticular and polyarticular PsA in a multinational cohort. All composite measures of disease activity were able to differentiate between active and inactive disease in both subtypes. PASDAS demonstrated the largest discrimination in both polyarticular and oligoarticular disease, suggesting greatest clinical and research utility.

Disclosure 

L. Tucker: None. P. Helliwell: None. L. Coates: None.
P060 Pilot study showing the efficacy and acceptability of an acceptance and commitment therapy based brief psychological intervention on mood and disability in patients with early inflammatory arthritis
Authors: Maher-Edwards Lorraine , Ng Nora , Gillanders David
Published: April 2021

Background/Aims 

Psychiatric comorbidities are common in patients living with rheumatological conditions and are associated with poorer health outcomes and treatment response. The evidence base for psychological intervention is scarce and of poor quality. One trial has found CBT intervention early post-diagnosis of rheumatoid arthritis has small to medium effect sizes for depression and anxiety and no effect on disability. Acceptance and Commitment Therapy (ACT) is a psychological therapy with a good evidence base for a number of long term health conditions. The target process in ACT is psychological flexibility, which relates closely to a number of positive life outcomes including adaptive response to illness and trauma. Psychological inflexibility has been shown to be associated with poorer function and psychological wellbeing in chronic pain populations and more recently juvenile idiopathic arthritis specifically. We aimed to evaluate outcomes for a sample (n = 12) of newly diagnosed (within 3 years of diagnosis) patients with inflammatory arthritis who underwent an individualised ACT intervention using patient satisfaction data, qualitative feedback and measures of mood, quality of life and psychological flexibility.

Methods 

Patients received up to 7 sessions of one to one therapy. Outcome measures included PHQ-9, GAD-7, compACT, and Brief Pain Inventory (BPI) and a satisfaction questionnaire with open questions inviting qualitative responses. Paired t-tests were conducted, and the Jacobson and Truax method used to calculate Reliable Change Index and Clinically Significant Change criteria. Effect sizes were calculated using Cohens’ d. Correlation analysis was conducted using Pearsons correlation coefficients.

Results 

Patients who took part in the brief intervention showed significant improvement in depression, anxiety, quality of life and psychological flexibility. Effect sizes were large. Correlation analysis showed strong correlations between PF and both depression and quality of life. Changes in PF from baseline to end of therapy strongly correlated with changes in depression and disability, and moderately correlated with anxiety. Subanalyses will be presented to understand which particular components of PF most closely relate to improvements in outcomes on disability and mood.

Conclusion 

A brief one to one ACT-based psychological intervention conferred good benefit for a rheumatology population. Results suggest PF is a key therapeutic target in psychological interventions for people with arthritis and that ACT is a viable, highly acceptable and promising alternative to CBT in this population. More studies are needed to understand whether this effect is generalisable and longer-term outcomes.

Disclosure 

L. Maher-Edwards: None. N. Ng: None. D. Gillanders: None.
P070 Tele-consultations from the patient’s perspective: during the pandemic and beyond
Authors: Cleaton Natasha , Raizada Sabrina
Published: April 2021

Background/Aims 

The current COVID-19 pandemic has challenged healthcare systems worldwide stimulating a transformation of NHS services to cope with increased acute demand, while aiming to minimise viral transmission. A significant proportion of rheumatology patients are considered ‘clinically extremely vulnerable’ and are at increased risk of COVID-19. With this in mind, alongside national guidance from the British Society for Rheumatology and the National Institute of Clinical Excellence we adapted our services in response to COVID by mostly suspending face-to-face appointments for follow up patients, instead relying on telephone or virtual consultations with a face-to-face appointment if necessary in order to minimise risk to our patients. We aimed to evaluate our use of telephone consultations during the pandemic and gain understanding of our patients views of telephone consultations longer term.

Methods 

We retrospectively surveyed rheumatology patients under active follow-up at the royal Wolverhampton trust who had a telephone consultation with a rheumatology consultant over a 4-week period (11/5/20- 4/6/20). Patients were invited to participate via a SMS text message containing an embedded web-link to the survey. Results were analysed using SPSS version 26.

Results 

Surveys were sent to 1,213 patients; 306 (25.2%) patients completed the survey. Responders were mostly female; the predominant diagnosis was inflammatory arthritis. Ages included: 1 (0.3%) patient 16-29 years, 46 (15.0%) 30-49, 180 (58.8%) 50-69, and 79 (25.8%) aged >70 years. Regarding their telephone consultation, 86.6% of responders were satisfied with the consultation. During the current pandemic 81.4% of responders were pleased to have a telephone consult rather than face-to-face; 57.2% of responders would be happy for their next routine appointment to be a telephone clinic. A significantly higher proportion of patients <50 years preferred telephone consultations when compared to older patients (Chi2 [DF = 3]= 10.075, P = 0.018) and more younger patients had access to a smartphone than those in the older cohort (Chi2 [DF 3]= 20.919, P = <0.001).

Conclusion 

Overall, the short-term switch to telephone consultation was well received by our cohort. The majority of patients were satisfied with their telephone consultation and most were pleased to have a telephone consult rather than a face-to-face appointment in the current pandemic. Just over half would be happy for their next routine appointment to be a telephone consultation, however, a significantly higher proportion of younger patients prefer telephone consultations compared to older patients and a greater number of younger patients have access to a smartphone compared to older patients. Further planning is required to ensure patients in older and other vulnerable groups are not excluded should telephone clinics become a more permanent fixture.

Disclosure 

N. Cleaton: None. S. Raizada: None.
P096 Pregnancy outcomes in women attending a joint obstetric and rheumatology clinic in a tertiary centre over a 2-year period
Authors: David Trixy , Hum Ryan Malcolm , Lau Yen June , Thornber Sue , Simcox Louise , Bruce Ian N , Tower Clare , Ho Pauline
Published: April 2021

Background/Aims 

The Lupus in Pregnancy Scanning (LIPS) clinic, a joint obstetrics and rheumatology clinic was established in 2010 at Saint Mary’s Hospital, Manchester, UK for women with systemic lupus erythematosus (SLE) and other complex rheumatological conditions. We aimed to describe pregnancy outcomes of women attending this clinic to establish a baseline for future changes aimed at improving the service.

Methods 

Data were collected retrospectively from electronic records of patients who attended the LIPS clinic at least once between 1st January 2018 and 31st December 2019.

Results 

Pregnancy outcomes were available in 105/125 (84%) women (Table). The median age [inter-quartile range] was 30.6 years [IQR 27.7 - 33.6] and 40 (38%) were of non-Caucasian background. Sixty-one (58%) had a connective tissue disease (CTD) of whom 36 (59%) had SLE. Other rheumatological diagnoses included inflammatory arthritis, primary anti-phospholipid syndrome (APS) and systemic vasculitis. Anti-Ro was found in 32 (31%) and anti-phospholipid antibodies in 25 (24%). During pregnancy, 65 (62%) received aspirin and 40 (38%) had low molecular weight heparin (LMWH). In the antenatal period, 43 (41%) took steroids, 52 (50%) had conventional disease modifying anti-rheumatic drugs and 8 (8%) received biologics. Active disease in the antenatal period was noted in 14 (13%) women. Regarding pregnancy outcomes (Table), still-births were low (0.95%). The rate of C-sections (45%) and assisted deliveries (19.6%) was comparable to previously published data from similar clinics. P096 Table 1:Pregnancy outcomes over a 2-year period in women attending the LIPS clinic at St. Mary's HospitalPregnancy Outcomen (%)Miscarriage3 (2.9)Deliveries• Live101 (96.2)• Still-birth1 (0.95)Median Gestation (weeks) [inter-quartile range (IQR)]38 [37 - 39]Sex of Neonate• Female57 (56)• Male45 (44)Mode of Delivery• Normal vaginal36 (35.3)• Assisted20 (19.6)• Elective Caesarean Section15 (14.7)• Emergency Caesarean Section31 (30.4)Median Neonatal Birth Weight (grams) [IQR]3137 [2724 - 3428]• Low Birth Weight <2500g15 (15)Maternal Complications (Antenatal and Peri-Partum)• Infection22 (22)• Pre-Eclampsia1 (1)• Post-Partum Haemorrhage56 (55)Neonatal Intensive Care Admission7 (7)Neonatal Complications• Sepsis1 (1)• Congenital Heart Block2 (2)• Prematurity (<36 weeks)39 (38)

Conclusion 

In this cohort we report a high live birth rate and comparable rates of assisted delivery to similar cohorts. Infection and post-partum haemorrhage are maternal complications that are common, and reflect the complex clinical presentations and therapeutic regimes in these conditions. Overall this specialist clinic achieves favourable maternal and foetal outcomes in this high-risk population.

Disclosure 

T. David: None. R. Hum: None. Y. Lau: None. S. Thornber: None. L. Simcox: None. I. Bruce: None. C. Tower: None. P. Ho: None.
P210 Tocilizumab versus prednisolone only treatment for giant cell arteritis: an observational study
Authors: Preston Hannah , Cronin Owen , Kuske Barbara , McKay Neil D , Hauser Barbara
Published: April 2021

Background/Aims 

Giant cell arteritis (GCA) is a medical emergency that requires prolonged high dose glucocorticoids (GC). Tocilizumab (TCZ) is currently approved for GCA in combination with GC tapering for those at high risk of glucocorticoid toxicity, who relapse or have refractory disease. The aim is to evaluate indications and characteristics of patients who were started on TCZ and to assess the rate of relapse and steroid tapering for patients on TCZ compared with an age matched prednisolone (PDN) only treated control group (CTRL).

Methods 

Retrospective review of electronic patient health record data of patients who were diagnosed and treated for GCA in a single rheumatology centre from January 2017- July 2020. All patients were initially treated with high dose PDN (40-60 mg/day) with subsequent steroid tapering with or without TCZ (162 mg/week).

Results 

We included 36 GCA patients who were treated with TCZ+PDN and 26 patients with PDN only. Mean age of patients started on TCZ was 69.3±6.8, 81% were female. There was no significant demographic difference to the CTRL group.The most common reason for starting TCZ (50%) was a GCA relapse requiring uptitration of PDN. 13 patients (36%) started TCZ as they had developed significant steroid side effects including steroid-induced diabetes, hypertension and osteoporosis related fragility fractures. Almost one fifth of patients (19.4%) who were started on TCZ had imaging evidence of large vessel involvement.The mean PDN dose of patients who started TCZ was 26.6±13.1 mg/day. Patients who started TCZ were able to approximately half the PDN dose every 3 months. The average daily PDN dose was 11.3±7.0 mg after 3 months, 6.0±4.3 mg after 6 months, and 3.3±4.7 mg after 12 months of starting TCZ. When compared with the CTRL group (4%), significantly more TCZ patients (41.7%) were able to reduce the PDN dose to a low dose (0-5 mg) after 6 months treatment (p = 0.001).During the course of treatment more CTRL patients (34.6%) relapsed than patients receiving TCZ (11.1% vs CTRL, p = 0.013). The majority of TCZ patients (88.9%) stayed in remission and 2 (5.6%) patients completed 12 months treatment and have ceased therapy. 4 (11.1%) patients stopped Tocilizumab due to side effects (diarrhoea, diverticulitis, scalp irritation) and 2 stopped due to concerns over long term risks.

Conclusion 

Our real-world study shows that TCZ is predominantly initiated in those who relapse or develop GC related side effects. Patients who received TCZ were able to half their PDN dose every 3 months and had lower 6 and 12-month PDN requirements compared to those on PDN solely. The relapse rate was significantly higher in the PDN only treated group than in the TCZ group. TCZ is a good option as steroid sparing agent for the treatment of GCA.

Disclosure 

H. Preston: None. O. Cronin: None. B. Kuske: None. N.D. McKay: None. B. Hauser: Honoraria; Dr Hauser has received speaker fees from Roche.
Esophageal Gland RNA-Seq Resource of a Virulent and Avirulent Population of the Soybean Cyst Nematode Heterodera glycines
Authors: Maier Tom R. , Masonbrink Rick E. , Vijayapalani Paramasivan , Gardner Michael , Howland Amanda D. , Mitchum Melissa G. , Baum Thomas J.
Published: April 2021

The soybean cyst nematode Heterodera glycines is the most economically devastating pathogen of soybean in the United States and threatens to become even more damaging through the selection of virulent nematode populations in the field that can overcome natural resistance mechanisms in soybean cultivars. This pathogen, therefore, demands intense transcriptomic/genomic research inquiries into the biology of its parasitic mechanisms. H. glycines delivers effector proteins that are produced in specialized gland cells into the soybean root to enable infection. The study of effector proteins, thus, is particularly promising when exploring novel management options against this pathogen. Here, we announce the availability of a gland cell–specific RNA-seq resource. These data represent an expression snapshot of gland cell activity during early soybean infection of a virulent and an avirulent H. glycines population, providing a unique and highly valuable resource for scientists examining effector biology and nematode virulence.

[Formula: see text] Copyright © 2021 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .