Maintenance of permanent sexual activity throughout the year in seasonal bucks using short photoperiodic cycles in open barns

Seasonality of reproductive activity in rams and bucks is the major constraint in temperate and subtropical zones. Rapid alternation between 1 month of short days and 1 month of long days (LD) over three years in lightproof buildings eliminates this seasonality. We examined if this would also work in open barns, using only supplementary light. Over two years, one group of bucks (n = 7) was subjected to alternate 1 month of LD and 1 month of permanent light (LD-LL) and another group (n = 7) to alternate 1 month of LD and 1 month of natural light (LD-NL). A simultaneous control group, used for both experiments (CG1, n = 6; CG2, n = 6), remained under natural photoperiod. BW, testis weight (TW), plasma testosterone (T) and cortisol (C) were evaluated in all bucks. CG1 and CG2 bucks showed identical dramatic seasonal variations in BW (stable or decreasing in summer), TW (from 85 ± 12 g in February to 127 ± 7 g in July) and T (from 2.7 ± 1.2 ng/mL in January-April to 24.3 ± 3.2 ng/mL in June-October). By contrast, BW of LD-LL and LD-NL bucks increased regularly during the experiment. From 5 and 9 months after the experiment onset, LD-LL and LD-NL bucks, respectively, maintained constant TW of 115 ± 5 g until the experiment end. After the first 3 months <5 ng/mL, T of LD-LL bucks remained constant (5-10 ng/mL) until the experiment end. By contrast, T of LD-NL bucks showed four periods of low (<5 ng/mL) and two periods of high concentrations (18.1 ± 2.6 and 11.9 ± 3.4 ng/mL). Plasma C remained low (5-8 ng/mL) and did not change with group or light treatment. These results show for the first time in any seasonal photoperiodic species that it is possible to maintain the sexual activity of males all year round in open buildings using alternating periods of LD and LL. By contrast, return to NL instead of LL every other month does not prevent seasonality in T concentration. These results raise interesting questions about the photoperiodic control of neuroendocrine regulation of seasonal sexual activity and suggest that these treatments can be used to manage males in open barns in farms and in artificial insemination centres. (Spanish and French versions of the full text are available as Supplementary Materials S1 and S2).

Recurrence of Metastatic Crohn's Disease after Surgical Resection

A 36-year-old woman presented to the emergency department with a 1-day history of purulent perianal and vulvar discharge. She had a 25-year history of Crohn's disease (CD), and 13 years prior had received a total colectomy with end ileostomy. She had vulvar biopsies 5 years prior to presentation, demonstrating noncaseating granulomas consistent with metastatic Crohn's disease (MCD). Throughout the course of her disease, she had a failed treatment with adalimumab, certolizumab, methotrexate, and 6-mercaptopurine. She had received a radical vulvectomy 1 year prior to presenting to control recurrent vulvar abscesses and MCD while receiving monthly subcutaneous infliximab 10 mg/kg body weight. Dermatology was consulted at presentation, and the physical examination revealed tender, linear ulcerations with a granulated appearance and depigmentation on the natal cleft and vulva (Figures 1 and 2). Computerized tomography (CT) scan of the abdomen and pelvis indicated thickening of soft tissue without evidence of abscesses, fluid collection, or fistulae. Given the distribution and morphology of lesions with a history of biopsy-proven MCD, the patient was diagnosed with a flare of MCD.

Ovarian cancer prevention by opportunistic salpingectomy is a new de facto standard in Germany

PURPOSE

The most prevalent and aggressive subtype of epithelial ovarian carcinoma (EOC), high-grade serous carcinoma (HGSC), originates in many cases from the fallopian tubes. Because of poor prognosis and lack of effective screening for early detection, opportunistic salpingectomy (OS) for prevention of EOC is being implemented into clinical routine in several countries worldwide. Taking the opportunity of a gynecological surgery in women at average cancer risk, extramural fallopian tubes are completely resected preserving the ovaries with their infundibulopelvic blood supply. Until recently, only 13 of the 130 national partner societies of the International Federation of Obstetrics and Gynecology (FIGO) have published a statement on OS. This study aimed to analyze the acceptance of OS in Germany.

METHODS

(1) Survey of German gynecologists in 2015 and 2022 by the Department of Gynecology of the Jena University Hospital in co-operation with the Department of Gynecology at Charité-University Medicine Berlin with support of NOGGO e. V. and AGO e. V. (2) Salpingectomy numbers in Germany for years 2005-2020 as retrieved from the Federal Statistical Office of Germany (Destatis).

RESULTS

(1) Survey: Number of participants was 203 in 2015 and 166 in 2022, respectively. Nearly all respondents (2015: 92%, 2022: 98%) have already performed bilateral salpingectomy without oophorectomy in combination with benign hysterectomy with the intention to reduce the risk for malignant (2015: 96%, 2022: 97%) and benign (2015: 47%, 2022: 38%) disorders. Compared to 2015 (56.6%), considerably more survey participants performed OS in > 50% or in all cases in 2022 (89.0%). Recommendation of OS for all women with completed family planning at benign pelvic surgery was approved by 68% in 2015 and 74% in 2022. (2) Case number analysis: In 2020, four times more cases of salpingectomy were reported by German public hospitals compared to 2005 (n = 50,398 vs. n = 12,286). Of all inpatient hysterectomies in German hospitals in 2020, 45% were combined with salpingectomy, and more than 65% in women at the age of 35 to 49 years.

CONCLUSION

Mounting scientific plausibility regarding involvement of fallopian tubes in the pathogenesis of EOC led to change of clinical acceptance of OS in many countries including in Germany. Case number data and widespread expert judgment demonstrate that OS has become a routine procedure in Germany and a de facto standard for primary prevention of EOC.

Time Course and Risk Factors for Repeat Procedures After Ureteroscopy or Shockwave Lithotripsy

OBJECTIVE

To determine risk factors and time course for repeat procedures after ureteroscopy (URS) or shockwave lithotripsy (SWL) procedure using a large employer-based claims database.

METHODS

We identified all patients who underwent treatment for ureteral or renal stone with URS or SWL from January 1, 2007 to December 31, 2014 using the IBM MarketScan Commercial Database. Repeat stone procedure was evaluated after a 90-day grace period from the index procedure. Patients were followed until December 31, 2017. We performed multivariate analyses using Cox proportional hazards to determine independent risk factors for repeat procedure after the initial stone removal.

RESULTS

A total of 189,739 patients underwent a SWL or URS and were included in the study. The incidence of repeat procedure per 100 person years was 6.8, and 4.4 after SWL and URS, respectively. The median time to reoperation was 12.5 months for SWL and 14.6 months for URS. On multivariable analysis, SWL was associated with an increased risk of repeat procedure compared to URS. (HR = 1.63). Paralysis, neurogenic bladder and inflammatory bowel disease were also associated with an increased risk of repeat procedure (HR = 1.66, 1.40, and 1.36 respectively) CONCLUSION: In a large national cohort, patients with paralysis and neurogenic bladder had a significantly higher risk of repeat stone procedure. SWL was associated with higher risk of repeat procedure than URS. Urologists can use these data to identify and counsel patients at high risk for need for recurrent procedure.

Assessment of short readmissions following elective pulmonary lobectomy

BACKGROUND

Reducing readmissions is critical for improving patient care and lowering costs. Despite this, few studies have assessed length of readmission following pulmonary lobectomy.

METHODS

Using the Healthcare Cost and Utilization Project New York State Inpatient Database, we identified adult patients undergoing elective pulmonary lobectomy (2007-2015) and assessed readmission within 30 days of hospital discharge. We analyzed the relationship between length of readmission and post-operative morbidity and mortality as well as primary diagnoses at readmission.

RESULTS

Of 19947 included patients, 2173 (10.9%) were readmitted within 30 days. The median (IQR) length of readmission was 5 (2-8) days. Longer length of readmission was associated with significantly higher likelihood of major complication (for every 1-day increase, aOR = 1.14, 95% CI = 1.12-1.17, p < 0.001) and mortality (aOR = 1.03, 95% CI = 1.02-1.04, p < 0.001) within 90 days. Primary diagnosis codes at readmission differed significantly with length of readmission.

CONCLUSIONS

Interventions that target short readmissions may help to prevent a proportion of readmissions following elective lung resection.

National Trends in Pediatric Metabolic and Bariatric Surgery: 2010-2017

BACKGROUND

The childhood obesity epidemic has grown exponentially and is known to disproportionately affect minority groups. Successful treatment of this complex health issue requires a multidisciplinary approach including metabolic and bariatric surgery (MBS) for qualifying pediatric patients. This study examines current national trends in pediatric bariatric surgery from 2010 to 2017 using the National Inpatient Sample.

METHODS

This study analyzed MBS among pediatric patients <19 years old using weighted discharge data from 2010 to 2017. The primary outcome was national procedure rates. Secondary analyses included procedure type, demographics, BMI, comorbidities, length of stay, and complication rates.

RESULTS

From 2010 to 2017, annual bariatric procedure rates increased from 2.29 to 4.62 per 100 000 (P < .001). Laparoscopic sleeve gastrectomy outpaced Roux-en-Y gastric bypass and laparoscopic adjustable gastric band over time (0.31-3.99 per 100 000, P < .0001). The mean age was stable over time 18.10-17.96 (P = .78). The cohort was primarily female (76.5% to 75.4%), white (54.0% to 45.0%), and privately-insured (59.9% to 53.4%). Preoperative BMI increased from 2010 to 2017 (P < .001), whereas number of obesity-related comorbidities was stable (P > .05). Length of stay was <2 days (2.02-1.75, P = .04) and in-hospital complication rates were low (7.2% to 6.45%, P = .88).

CONCLUSIONS

Pediatric MBS is underutilized nationally with disproportionately lower rates among minority groups. Despite incremental progress, further investigation into the racial and social determinants that limit access to pediatric weight loss surgery is critical.

Factors Associated With Dermatologic Follow-up vs Emergency Department Return in Patients With Hidradenitis Suppurativa After an Initial Emergency Department Visit

Importance

Emergency department (ED) visitation is common for the treatment of hidradenitis suppurativa (HS), whereas dermatology outpatient care is low. The reasons underlying this differential follow-up have not been elucidated.

Objective

To assess the interventions and patient factors associated with ED return following an initial ED visit for HS.

Design, Setting, and Participants

This retrospective cohort study used data from the IBM® MarketScan® Commercial and Multi-State Medicaid databases (trademark symbols retained per database owner requirement). An HS cohort was formed from patients who had 2 or more claims for HS during the study period of 2010 to 2019 and with at least 1 ED visit for their HS or a defined proxy. Data were analyzed from November 2021 to May 2022.

Exposures

Factors analyzed included those associated with the ED visit and patient characteristics.

Main Outcomes and Measures

Primary outcomes were return to the ED or dermatology outpatient follow-up for HS or related proxy within 30 or 180 days of index ED visit.

Results

This retrospective cohort study included 20 269 patients with HS (median [IQR] age, 32 [25-41] years; 16 804 [82.9%] female patients), of which 7455 (36.8%) had commercial insurance and 12 814 (63.2%) had Medicaid. A total of 9737 (48.0%) patients had incision and drainage performed at the index ED visit, 14 725 (72.6%) received an oral antibiotic prescription, and 9913 (48.9%) received an opioid medication prescription. A total of 3484 (17.2%) patients had at least 1 return ED visit for HS or proxy within 30 days, in contrast with 483 (2.4%) who had a dermatology visit (P < .001). Likewise, 6893 (34.0%) patients had a return ED visit for HS or proxy within 180 days, as opposed to 1374 (6.8%) with a dermatology visit (P < .001). Patients with Medicaid and patients who had an opioid prescribed were more likely to return to the ED for treatment of their disease (odds ratio [OR], 1.48; 95% CI, 1.38-1.58; and OR, 1.48; 95% CI, 1.39-1.58, respectively, within 180 days) and, conversely, less likely to have dermatology follow-up (OR, 0.16; 95% CI, 0.14-0.18; and OR, 0.81; 95% CI, 0.71-0.91, respectively, within 180 days).

Conclusions and Relevance

This cohort study suggests that many patients with HS frequent the ED for their disease but are not subsequently seen in the dermatology clinic for ongoing care. The findings in this study raise the opportunity for cross-specialty interventions that could be implemented to better connect patients with HS to longitudinal care.

Hospital trajectories and early predictors of clinical outcomes differ between SARS-CoV-2 and influenza pneumonia

BACKGROUND

A comparison of pneumonias due to SARS-CoV-2 and influenza, in terms of clinical course and predictors of outcomes, might inform prognosis and resource management. We aimed to compare clinical course and outcome predictors in SARS-CoV-2 and influenza pneumonia using multi-state modelling and supervised machine learning on clinical data among hospitalised patients.

METHODS

This multicenter retrospective cohort study of patients hospitalised with SARS-CoV-2 (March-December 2020) or influenza (Jan 2015-March 2020) pneumonia had the composite of hospital mortality and hospice discharge as the primary outcome. Multi-state models compared differences in oxygenation/ventilatory utilisation between pneumonias longitudinally throughout hospitalisation. Differences in predictors of outcome were modelled using supervised machine learning classifiers.

FINDINGS

Among 2,529 hospitalisations with SARS-CoV-2 and 2,256 with influenza pneumonia, the primary outcome occurred in 21% and 9%, respectively. Multi-state models differentiated oxygen requirement progression between viruses, with SARS-CoV-2 manifesting rapidly-escalating early hypoxemia. Highly contributory classifier variables for the primary outcome differed substantially between viruses.

INTERPRETATION

SARS-CoV-2 and influenza pneumonia differ in presentation, hospital course, and outcome predictors. These pathogen-specific differential responses in viral pneumonias suggest distinct management approaches should be investigated.

FUNDING

This project was supported by NIH/NCATS UL1 TR002345, NIH/NCATS KL2 TR002346 (PGL), the Doris Duke Charitable Foundation grant 2015215 (PGL), NIH/NHLBI R35 HL140026 (CSC), and a Big Ideas Award from the BJC HealthCare and Washington University School of Medicine Healthcare Innovation Lab and NIH/NIGMS R35 GM142992 (PS).

Sexually active male goats stimulate the endocrine and sexual activities of other males in seasonal sexual rest through the "buck-to-buck effect"

Male goats rendered sexually active by exposure to a photoperiodic treatment are more efficient than untreated goats in stimulating LH secretion and ovulation in seasonally anestrous goats. This phenomenon is called the "male effect." Here, we determined whether sexually active bucks are able to stimulate the endocrine and sexual activities of other bucks in seasonal sexual rest through the phenomenon that we called the "buck-to-buck effect." We used bucks rendered sexually active (SA) during sexual rest by exposure to 2.5 mo of artificial long days (16 h of light per d) and untreated, sexually inactive (SI) bucks. In Experiment 1, we determined the short-term (21 d) LH and testosterone responses of sexually inactive bucks joined with a SA or SI buck. In Experiment 2, we determined the long-term (60 d) testosterone and sexual behavior responses of sexually inactive bucks joined with 2 SA or SI bucks. In Experiment 3, we determined the efficacy of bucks initially exposed to the buck-to-buck effect, the SABB bucks, to thereafter induce a "classical" male effect in seasonally anestrous goats. In Experiments 1 and 2, there was an interaction between time and groups in LH and testosterone plasma concentrations (P < 0.01). In Experiment 1, plasma LH concentrations were greater in bucks joined with a SA buck than in those joined with an SI buck (P < 0.05). In Experiments 1 and 2, testosterone concentrations were greater in bucks joined with SA bucks than in those joined with SI bucks (P < 0.05). In addition, in Experiment 2, the sexually inactive bucks joined with SA bucks displayed more nudging than those joined with SI bucks (P < 0.001). In Experiment 3, kidding rates did not differ between females joined with SA (34 of 40: 85%) or SABB bucks (32 of 40: 80%; P > 0.05). We concluded that the endocrine and sexual activities of bucks during sexual rest can be stimulated by SA bucks. In addition, SABB bucks are able to stimulate the reproductive activity of seasonally anestrous goats.

SARS-CoV-2 Delta-Omicron Recombinant Viruses, United States

To detect new and changing SARS-CoV-2 variants, we investigated candidate Delta-Omicron recombinant genomes from Centers for Disease Control and Prevention national genomic surveillance. Laboratory and bioinformatic investigations identified and validated 9 genetically related SARS-CoV-2 viruses with a hybrid Delta-Omicron spike protein.

The Impact of COVID-19 on Inpatient Consultations and the Role of Telehealth: A Retrospective Cohort

Falls in non-COVID-19-related hospital admissions during the pandemic affected the reasons for dermatology consultation and mode of consultation delivery. In order to assess the impact of the pandemic and the effects of telehealth on the inpatient dermatology service, we compared consultations completed between March 17, 2020 and October 31, 2020 with the same period of 2019. Dermatology received fewer consultations for management assistance during the pandemic, possibly due to patients with chronic dermatoses not meeting admission criteria or avoiding hospitalization. Consultations were also less likely to require laboratory work, imaging, and biopsies in 2020, potentially due to frequent consultation of benign conditions enabled by telehealth and stricter enforcement of only completing the biopsies necessary for acute inpatient management. Despite the shift toward remote consultations in 2020, the impact on diagnosis and management remained unchanged compared to 2019. Providers were less likely to document clinical improvement in 2020, potentially attributable to inferior communication regarding management recommendations or an increase in diagnoses not expected to improve. While remote consultations allowed dermatologists to provide comparable care during the pandemic, further research on clinical outcomes of remote consultations is required to maximize its benefits to patients and the healthcare system. (SKINmed. 2022;20:197-204).

Five Extracurricular Things Commonly Overlooked by Dermatology Residents

Dermatology residents have 3 years to master core competencies related to the delivery of patient care, preservation of medical professionalism, and responsible use of health care; however, it is crucial for residents to recognize other things outside of their formal curriculum that are equally vital to their training. Over the years, we have observed residents and now offer our own perspectives. We have collectively observed five extracurricular aspects commonly overlooked by dermatology residents that are important to their education and future practice. (SKINmed. 2022;20:123-125).

Splints and immobilisation approaches used for second to fifth metacarpal fractures: a systematic review

BACKGROUND: The second to fifth metacarpal fractures are immobilised with splints, plaster of Paris (POP) or buddy strapping for a period of time. However, no recent evidence-based splinting and immobilisation programme exists for the management thereof, leaving a gap in the literature to inform clinical practice. This review aimed to review, appraise and collate the literature on splints and immobilisation approaches used for second to fifth metacarpal fractures after surgical and conservative management in adults aged 20 to 59 years. METHODS: The review included experimental study designs, quasi-experimental studies, cohort studies and case-control studies from January 2008 to September 2018. Two reviewers independently screened, selected, appraised and extracted data from the included studies. Preferred reporting items for systematic reviews and meta-analysis (PRISMA) guided the reporting. Joanna Briggs Institute (jBl) critical appraisal tools were used to assess the risk of bias for each included study. RESULTS: Database searches generated 1 005 articles with ten additional articles found on Google Scholar. Ten articles were included: two randomised controlled trials (RCTs), one quasi-RCT, four prospective studies, one retrospective record review, one retrospective study and one comparative study with descriptive reporting of the results. CONCLUSION: High level 1b evidence suggests that no reduction, a soft wrap and buddy strapping for three weeks with early active finger and wrist mobilisation are effective for individuals who sustained boxer's fractures with < 70° angulation. To guide clinical practice, high-level research is needed to determine the immobilisation of second to fifth metacarpal fracture types. Level of evidence: Level 2

The Role of Inpatient Dermatology Consultations

Inpatient dermatology has been shown to have profound effects on the care of hospitalized patients. However, dermatology consultations remain an underutilized resource. The purpose of this study was to demonstrate how dermatology affects the hospitalization of inpatients while highlighting the breadth of services provided. This cross-sectional retrospective study included all inpatient dermatology consultations completed at a large tertiary-care facility in an urban setting. It aimed to investigate the reasons for consultation, as well as the effects on diagnosis, management, disposition, and cutaneous condition by time of discharge. This study provides evidence supporting the integration of the dermatologist into the care of hospitalized patients by illuminating lesser-known areas of impact.

Impact of Psoriasis on Quality of Life: A Qualitative Study Focused on Patient Perspectives

Psoriasis is a chronic skin condition that can affect any part of the body, is often present in visible areas, and may occasionally be difficult to treat. Psoriasis can lead to depression and decreased quality of life. We performed a qualitative survey to examine patient perspectives on how psoriasis impacts their lives. Patients with psoriasis are vulnerable to embarrassment and stigmatization in public spaces, as well as discrimination at work, school, or in society. Further studies are needed to determine the best interventions for improving the quality of life in this patient population.

Classic bedside diagnostic techniques

Correctly performing bedside diagnostic tests is an important fundamental skill for practicing dermatologists. Even with new technologies, bedside diagnostic tests have been useful in contemporary practice. When properly implemented, bedside diagnostic techniques can efficiently and economically aid in diagnosis and treatment. We have reviewed the most commonly used diagnostic procedures while considering them in their historical context, outlined the procedures for performing the tests, and discussed the relevance and regulatory requirements of the tests.

The burden of COVID-19 infection in a rural Tamil Nadu community

Background

There have been over 30 million cases of COVID-19 in India and over 430,000 deaths. Transmission rates vary from region to region, and are influenced by many factors including population susceptibility, travel and uptake of preventive measures. To date there have been relatively few studies examining the impact of the pandemic in lower income, rural regions of India. We report on a study examining COVID-19 burden in a rural community in Tamil Nadu.

Methods

The study was undertaken in a population of approximately 130,000 people, served by the Rural Unit of Health and Social Affairs (RUHSA), a community health center of CMC, Vellore. We established and evaluated a COVID-19 PCR-testing programme for symptomatic patients—testing was offered to 350 individuals, and household members of test-positive cases were offered antibody testing. We also undertook two COVID-19 seroprevalence surveys in the same community, amongst 701 randomly-selected individuals.

Results

There were 182 positive tests in the symptomatic population (52.0%). Factors associated with test-positivity were older age, male gender, higher socioeconomic status (SES, as determined by occupation, education and housing), a history of diabetes, contact with a confirmed/suspected case and attending a gathering (such as a religious ceremony, festival or extended family gathering). Amongst test-positive cases, 3 (1.6%) died and 16 (8.8%) suffered a severe illness. Amongst 129 household contacts 40 (31.0%) tested positive. The two seroprevalence surveys showed positivity rates of 2.2% (July/Aug 2020) and 22.0% (Nov 2020). 40 tested positive (31.0%, 95% CI: 23.02 − 38.98). Our estimated infection-to-case ratio was 31.7.

Conclusions

A simple approach using community health workers and a community-based testing clinic can readily identify significant numbers of COVID-19 infections in Indian rural population. There appear, however, to be low rates of death and severe illness, although vulnerable groups may be under-represented in our sample. It’s vital these lower income, rural populations aren’t overlooked in ongoing pandemic monitoring and vaccine roll-out in India.

Equal incidence of COVID-19 among homeless and non-homeless ED patients when controlling for confounders

Introduction

The World Health Organization (WHO) declared severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) a pandemic in March 2020. Theoretically, homeless patients could have disproportionately worse outcomes from COVID-19, but little research has corroborated this claim. This study aimed to examine the demographics and incidence of COVID-19 in homeless vs non-homeless emergency department (ED) patients.

Methods

This is a retrospective study of all patients seen in the University of Louisville Hospital Emergency Department (ULH ED) from March 2019 to December 2020, excluding January and February 2020. Data was collected from the Kentucky Homeless Management Information System (HMIS) and ULH electronic health records.

Results

A total of 51,532 unique patients had 87,869 visits during the study period. There was a 18.1% decrease in homeless patient visits over the time period, which was similar to the decrease in non-homeless patient visits (19.2%). In the total population, 9471 individuals had known COVID-19 testing results, with a total of 610 positive (6.4% positivity rate). Of the 712 homeless ED patients, 39 tested positive (5.5% positivity rate). After adjusting for age, gender identity, race, and insurance, there was no statistically significant difference in test positivity between homeless and non-homeless patients, OR 1.23 (0.88, 1.73). Homeless patients were less likely to be admitted to either the intensive care unit (ICU) or hospital (OR = 0.55, 95% CI: OR 0.51, 0.60) as they were more likely to be discharged (OR = 1.65, 95% CI: 1.52, 1.79).

Conclusion

Previous literature has indicated that higher disease burden, lack of access to social distancing, and poor hygiene would increase the risk of homeless individuals contracting COVID-19 and experiencing serious morbidity. However, this study found that homelessness was not an independent risk factor for COVID-19 infection.

Influence of migrant background on patient preference and expectations in breast and gynecological malignancies (NOGGO-expression V study): results of a prospective multicentre study in 606 patients in Germany

Background

An effective cross-cultural doctor-patient communication is vital for health literacy and patient compliance. Building a good relationship with medical staff is also relevant for the treatment decision-making process for cancer patients. Studies about the role of a specific migrant background regarding patient preferences and expectations are lacking. We therefore conducted a multicentre prospective survey to explore the needs and preferences of patients with a migrant background (PMB) suffering from gynecological malignancies and breast cancer to evaluate the quality of doctor-patient communication and cancer management compared to non-migrants (NM).

Methods

This multicentre survey recruited patients with primary or recurrence of breast, ovarian, peritoneal, or fallopian tube cancer. The patients either filled out a paper form, participated via an online survey, or were interviewed by trained staff. A 58-item questionnaire was primarily developed in German and then translated into three different languages to reach non-German-speaking patients.

Results

A total of 606 patients were included in the study: 54.1% (328) were interviewed directly, 9.1% (55) participated via an online survey, and 36.8% (223) used the paper print version. More than one quarter, 27.4% (166) of the participants, had a migrant background. The majority of migrants and NM were highly satisfied with the communication with their doctors.

First-generation migrants (FGM) and patients with breast cancer were less often informed about participation in clinical trials (p < 0.05) and 24.5% of them suggested the help of an interpreter to improve the medical consultation. Second and third-generation migrants (SGM and TGM) experienced more fatigue and nausea than expected.

Conclusions

Our results allow the hypothesis that training medical staff in intercultural competence and using disease-related patient information in different languages can improve best supportive care management and quality of life in cancer patients with migrant status.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-021-08731-6.

Ethanol inactivation of orthonairoviruses in ixodid ticks

Ixodid ticks represent vectors and reservoirs for a broad range of zoonotic pathogens. Collected ticks from field studies are therefore usually stored in ethanol, which in higher concentrations effectively inactivates most of the known tick-borne pathogens. Although commonly practiced as gold standard for inactivation, hardly any scientific data demonstrate that ethanol sufficiently penetrates the comparatively thick cuticula of ticks. Therefore, Amblyomma hebraeum tick pools were stored for 21 days in ethanol (96%). Afterwards, the ethanol was removed and the ticks were homogenized. Quantitative ¹H-NMR spectroscopic analysis was applied to determine the residual concentration of ethanol inside the ticks. ¹H-NMR spectroscopic analysis revealed that ethanol constituted 28.3-42.6 mg of the total weight of three ticks in the pools (89.9-121.5 mg). In addition, the low-pathogenic Hazara orthonairovirus (HAZV) was used as a cell culture model for this study. The virus was exposed to ethanol concentrations between 0 and 60% and incubated under various temperature conditions for four time periods. Afterwards, the residual virus infectivity was determined by titration. Following ethanol exposure, HAZV did not grow in cells after 9 h of exposure to an ethanol concentration of 25%. These results demonstrate an extremely low ethanol resistance of the virus, which was generally in line with previously reported ethanol inactivation data for Crimean-Congo hemorrhagic fever orthonairovirus (CCHFV). After prolonged storage and impregnation, comparable ethanol concentrations are achieved in the ticks, indicating the suitability of this inactivation method also for Bunyaviruses in ticks. At the very least, a massive virus inactivation can be assumed. Definitive proof of virus inactivation would require a bioassay of ethanol-treated infected ticks under appropriate biosafety conditions.

AB0024 IN VITRO CHARACTERIZATION OF CENERIMOD, A POTENT AND SELECTIVE SPHINGOSINE 1-PHOSPHATE RECEPTOR 1 (S1P1) MODULATOR IN PREVENTING MIGRATION OF NON-ACTIVATED AND ACTIVATED PRIMARY HUMAN B CELLS IN THE PRESENCE OR ABSENCE OF GLUCOCORTICOIDS

Background:

Cenerimod is a potent, selective, and orally active sphingosine 1-phosphate receptor 1 (S1P1) modulator that is currently being evaluated in a Phase 2b study in patients with systemic lupus erythematosus (SLE) (NCT03742037). S1P1 receptor modulators sequester circulating lymphocytes within lymph nodes, thereby reducing pathogenic autoimmune cells (including B lymphocytes) in the blood stream and in inflamed tissues. Extensive clinical experience has become available for the nonselective S1P receptor modulator fingolimod in relapsing forms of multiple sclerosis, supporting this therapeutic concept for the treatment of autoimmune disorders.

Objectives:

Although the effect of S1P-receptor modulators in reducing peripheral B cells is well documented1,2, the role of the S1P1 receptor on this cell type is only incompletely understood. In this study, the mode of action of cenerimod on primary human B cells was investigated in a series of in vitro experiments, including S1P1 receptor cell surface expression and chemotaxis towards S1P. Moreover, S1P1 expression following B cell activation in vitro was studied. As glucocorticoids (GC) are frequently used in the treatment of patients with autoimmune disorders including SLE, the potential influence of GC on the mode of action of cenerimod was evaluated.

Methods:

Primary human B lymphocytes from healthy donors were isolated from whole blood. In one set of experiments, cells were treated with different concentrations of cenerimod to measure S1P1 receptor internalization by flow cytometry. In a second set of experiments, isolated B cells were activated using different stimuli or left untreated. Cells were then analysed for S1P1 and CD69 cell surface expression and tested in a novel real-time S1P-mediated migration assay. In addition, the effect of physiological concentrations of GCs (prednisolone and prednisone) on cenerimod activity in preventing S1P mediated migration was tested.

Results:

In vitro, cenerimod led to a dose-dependent internalization of the S1P1 receptor on primary human B lymphocytes. Cenerimod also blocked migration of nonactivated and activated B lymphocytes towards S1P in a concentration-dependent manner, which is in line with the retention of lymphocytes in the lymph node and the reduction of circulating lymphocytes observed in the clinical setting. Upon B cell activation, which was monitored by CD69 upregulation, a simultaneous downregulation of S1P1 expression was detected, leading to less efficient S1P-directed cell migration. Importantly, physiological concentrations of GC did not affect the inhibitory activity of cenerimod on B cell migration.

Conclusion:

These results show that cenerimod, by modulating S1P1, blocks B lymphocyte migration towards its natural chemoattractant S1P and demonstrate compatibility of cenerimod with GC. These results are consistent with results of comparable experiments done previously using primary human T lymphocytes.

References:

[1]Nakamura M et al., Mult Scler. 2014 Sep; 20(10):1371-80.

[2]Strasser DS et al., RMD Open 2020;6:e001261.

Disclosure of Interests:

None declared

Automated, multiparametric monitoring of respiratory biomarkers and vital signs in clinical and home settings for COVID-19 patients

Capabilities in continuous monitoring of key physiological parameters of disease have never been more important than in the context of the global COVID-19 pandemic. Soft, skin-mounted electronics that incorporate high-bandwidth, miniaturized motion sensors enable digital, wireless measurements of mechanoacoustic (MA) signatures of both core vital signs (heart rate, respiratory rate, and temperature) and underexplored biomarkers (coughing count) with high fidelity and immunity to ambient noises. This paper summarizes an effort that integrates such MA sensors with a cloud data infrastructure and a set of analytics approaches based on digital filtering and convolutional neural networks for monitoring of COVID-19 infections in sick and healthy individuals in the hospital and the home. Unique features are in quantitative measurements of coughing and other vocal events, as indicators of both disease and infectiousness. Systematic imaging studies demonstrate correlations between the time and intensity of coughing, speaking, and laughing and the total droplet production, as an approximate indicator of the probability for disease spread. The sensors, deployed on COVID-19 patients along with healthy controls in both inpatient and home settings, record coughing frequency and intensity continuously, along with a collection of other biometrics. The results indicate a decaying trend of coughing frequency and intensity through the course of disease recovery, but with wide variations across patient populations. The methodology creates opportunities to study patterns in biometrics across individuals and among different demographic groups.

Increased Utilization of Total Joint Arthroplasty After Medicaid Expansion

BACKGROUND

The expansion of state Medicaid programs under the U.S. Affordable Care Act has led to a dramatic increase in the number of Americans with health insurance coverage. Prior analyses of a limited number of states have suggested that greater utilization of total hip arthroplasty (THA) and total knee arthroplasty (TKA) should be expected after Medicaid expansion. The purpose of our study was to examine whether increased utilization of THA and TKA occurred across a broader range of states after Medicaid expansion.

METHODS

We analyzed administrative data from the Healthcare Cost and Utilization Project from 9 states (Arkansas, Arizona, Colorado, Iowa, Massachusetts, Maryland, Nevada, New York, and Vermont) that expanded Medicaid in 2014 and 2 states that did not expand Medicaid (Florida and Missouri). We included patients who were 18 to 64 years of age and had a primary THA or TKA from 2012 to 2015 with Medicaid as the primary payer. Other payers (including dual-eligible Medicaid and Medicare beneficiaries) were excluded. We performed multivariable regression modeling with the number of Medicaid-insured THAs or TKAs as the dependent variable and the interaction between the state Medicaid expansion status and year as the main policy independent variable, with adjustment for community characteristics.

RESULTS

Among all 11 states, there were 39,452 total joint arthroplasties (42% THA and 58% TKA) funded by Medicaid from 2012 to 2015. After adjusting for community characteristics, within expansion states, compared with 2013, THA and TKA increased 15% in 2014 (p < 0.0001) and 23% in 2015 (p < 0.0001) within expansion states. Within non-expansion states, compared with 2013, there were significant utilization decreases of 18% in 2014 (p < 0.0001) and 11% in 2015 (p = 0.0002).

CONCLUSIONS

Medicaid expansion was associated with significant increases in Medicaid-funded THA and TKA utilization in 9 states. As additional states consider expanding Medicaid programs and as alternative health reforms that increase insurance eligibility are debated, surgeons, administrators, and policymakers should prepare for a surge in the utilization of THA and TKA.

Nutritional supplementation improves the sexual response of bucks exposed to long days in semi-extensive management and their ability to stimulate reproduction in goats

In confined management systems, well-nourished bucks rendered sexually active by exposure to long days are efficient in fertilizing out-of-season goats. However, underfeeding is common in semi-extensive management systems and may reduce the reproductive efficiency of bucks. The objective of the present study was to determine whether nutritional supplementation improved the sexual activity of bucks submitted to long days in semi-extensive management systems and their ability to stimulate the reproduction of goats in semi-extensive or confined conditions. In experiment 1, three groups of bucks were placed in different flocks and grazed daily with females for 7 h. Each day after grazing, males were separated from females and moved into open pens. One group did not receive any treatment (control group; n = 6). Two other groups were submitted to artificially long days from 15 November to 15 January. From 16 January, one group did not receive nutritional supplementation (long-day group; n = 5), whereas bucks from the other group each received 600 g of a commercial concentrate (long-day+supplementation group; n = 5). The fourth group was kept in confined conditions, exposed to long days and fed alfalfa hay (long-day confined group; n = 6). On 26 March, anovulatory goats from other flocks were assigned to four groups (n = 27 each) and confined separately in open pens. Three bucks of each group were housed with the females. Pregnancy rates were greater in the goats housed with the long-day group than those housed with the control group (P < 0.01). However, pregnancy rates did not differ between the long-day confined group (89%) and long-day+supplementation group (70%; P = 0.09), but these rates were greater than those from the long-day (37%) and control groups (0%; P < 0.05). In experiment 2, two groups of males (n = 3 each) were incorporated into two flocks under semi-extensive management and grazed daily with females for 7 h. One group of males did not receive any treatment (control group). The other group was submitted to long days and nutritional supplementation as in experiment 1 (long-day+supplementation group). Males remained with females during the whole study. The pregnancy rate was greater in the goats joined by males of the long-day+supplementation group (78%) than in those from the control group (0%; P < 0.001). We conclude that long days and nutritional supplementation improve the ability of bucks kept in semi-extensive management to stimulate reproduction of out-of-season goats in confined or semi-extensive management systems.

Pharmacological stress test for myocardial ischemia when Adenosine is contraindicated: prospective documentation of side effects in over 700 patients with COPD or bronchial asthma

Background

In the face of an increasingly elder population, physical exercise tests become less feasible with an increasing need for pharmacological stress tests, preferably with imaging techniques. For myocardial stress tests provoking myocardial ischemia, vasodilator stress is most frequently used. Whereas Dipyridamole should be obsolete, the predominant drug applied within this context is Adenosine for myocardial scintigraphy, magnetic resonance imaging and FFR. Adenosine, however, is contraindicated in patients with COPD or bronchial asthma, predominantly due to a possible exacerbation of bronchospasm or other pulmonary side effects. In contrast, Regadenoson, was especially developed as a highly selective A2A receptor agonist to circumvent these problems.

Methods

Regadenoson was applied with the standard injection dose of 400 μg in 780 consecutive patients with a history of COPD or bronchial asthma for SPECT myocardial perfusion scintigraphy. 12% of the patients had a preexisting first degree AV-block. Blood pressure, heart rate and possible side effects were prospectively monitored and documented for 10 minutes after the injection.

Results

The mean age was 70.8±8.9 years, 52% of the patients were female, 48% were male. 69% had a history of COPD and 31% of bronchial asthma. The maximum increase in heart rate was significant from 66.1±8.1 to 98.3±17.4 bpm. The maximum decrease in systolic blood pressure was significant from 124.3±12.9 to 117.3±24.7 mmHg. Most frequent side effects were a feeling if increased breathing (73%), headache (22%), feeling of warmth (22%), pressure in the stomach (17%) and pressure in the chest (16%). Complications: only 1 patient (without preexisting first degree AV-block) developed a systolic drop in blood pressure from 107 to 60 mmHg with transient severe dyspnoea. No induction of bronchospasm or other pulmonary side effects were observed.

Conclusion

In patients with COPD or bronchial asthma undergoing a pharmacological stress test, Adenosine is contraindicated due to its – potentially severe – pulmonary side effects, Regadenoson is the vasodilator of choice in these patients. In our series, no severe complication was observed – even not in patients with a preexisting first degree AV-block.

Funding Acknowledgement

Type of funding source: None

Usefulness of the coronary artery calcium (CAC) score for statin prescription in primary prevention: results in over 16.000 assessments

Background

The latest AHA/ACC cholesterol guidelines on primary prevention of coronary artery disease (CAD) recommend the use of the CAC-score to help in decision making for not using or using statins: If the CAC-score is 0, it is reasonable to withhold statin therapy (as long as higher conditions are absent). If CAC-score is 1 - 99, it is reasonable to initate statin therapy for patients ≥55 years of age. If the CAC-score is ≥100, it is reasonable to initiate statin therapy. Therefore, in the present analysis, we assessed the impact of these guidelines in everyday cardiology practice.

Methods

We analysed our data base with 16083 assessments of the CAC-score in persons with no known coronary or other cardiovascular disease and no exercise-dependent chest pain or shortness of breath. The CAC-score was determined with a multi-slice CT. Using the “step-and-shoot” acquisition protocol, the average dose was around 1 mSv.

Results

In the total group, a CAC-score of 0 was found in 35%, a CAC-score of &gt;0 up to &lt;100 in 36% and ≥100 in 29%. The percentage of the above mentioned 3 CAC-score groups depending on age and gender are listed in table 1.

Conclusion

With the support of the CAC-score, a prescription of statins can be avoided in up to appr. 60% of middle-aged male and up to appr. 80% of middle-aged female persons. On the other hand, the use of statin is reasonable in appr. two thirds of higher-aged male and one third of higher-aged female persons for primary prevention.

Funding Acknowledgement

Type of funding source: None

SARS-CoV-2 spike D614G variant confers enhanced replication and transmissibility

During the evolution of SARS-CoV-2 in humans a D614G substitution in the spike (S) protein emerged and became the predominant circulating variant (S-614G) of the COVID-19 pandemic 1 . However, whether the increasing prevalence of the S-614G variant represents a fitness advantage that improves replication and/or transmission in humans or is merely due to founder effects remains elusive. Here, we generated isogenic SARS-CoV-2 variants and demonstrate that the S-614G variant has (i) enhanced binding to human ACE2, (ii) increased replication in primary human bronchial and nasal airway epithelial cultures as well as in a novel human ACE2 knock-in mouse model, and (iii) markedly increased replication and transmissibility in hamster and ferret models of SARS-CoV-2 infection. Collectively, our data show that while the S-614G substitution results in subtle increases in binding and replication in vitro , it provides a real competitive advantage in vivo , particularly during the transmission bottle neck, providing an explanation for the global predominance of S-614G variant among the SARS-CoV-2 viruses currently circulating.

Is it time to reconsider the relative weight of sociosexual relationships compared with photoperiod in the control of reproduction of small ruminant females?

In goats and sheep from the temperate and subtropical latitudes, the breeding season lasts from early autumn to late winter, whereas the anestrous season lasts from late winter to late summer. In prepubertal or postpartum females, the duration of the quiescent period depends mainly on the season of parturition and of nursing duration. In both situations, the ovulatory activity starts only during the breeding season. Photoperiod has been generally considered as a major regulator of all these periods of reproductive activity/inactivity in female sheep and goats (ie puberty, seasonal anestrus, postpartum anestrus). In particular, regarding seasonal anestrus, the sociosexual interactions between males and females have been considered to have only a modulatory role, limited to few weeks preceding the onset or after the offset of the breeding season. Nonetheless, we recently showed that the use of sexually active males plays a crucial role to trigger ovulatory and estrous activities during the anestrous season and also in prepubertal and postpartum females. In fact, in females exposed to sexually active males, puberty is strikingly advanced in comparison with females exposed to sexually inactive castrated males or to isolated females (6 mo vs 7.5 mo). Most females (>85%) exposed during the anestrous season to sexually active males ovulated, whereas a low proportion of them ovulated when in contact with sexually inactive males (<10%). Interestingly, the presence of these sexually active males allows females to ovulate all the year round and prevents the seasonal decrease of LH plasma concentrations in ovariectomized females treated with an estradiol implant. Finally, the presence of sexually active males triggers ovulation in postpartum anestrous females nursing their offspring. All these findings show that sexually active males can play an important role to reduce anestrous periods. We need, therefore, to reconsider the relative weight of sociosexual relationships, compared with photoperiod, in the management of reproduction of goat does and ewes.

Unmet Need for Total Joint Arthroplasty in Medicaid Beneficiaries After Affordable Care Act Expansion

BACKGROUND

The utilization of total hip arthroplasty (THA) and total knee arthroplasty (TKA) increased after Medicaid expansion under the U.S. Affordable Care Act (ACA), suggesting a potential unmet need for THA and TKA. We examined the timing of THA and TKA in patients after obtaining Medicaid expansion insurance coverage. We hypothesized that patients with Medicaid expansion insurance would undergo a surgical procedure sooner than patients in traditional Medicaid populations.

METHODS

We used administrative data from a Medicaid managed care company to determine the timing of primary THA and TKA in patients who were 18 to 64 years of age in 4 states with Medicaid expansion (Illinois, Ohio, Oregon, and Washington) and 4 states without Medicaid expansion (Louisiana, Mississippi, Texas, and Wisconsin) from 2008 to 2015. The insurance types were Medicaid expansion, Medicaid plans for Supplemental Security Income (SSI), or Temporary Assistance for Needy Families (TANF). Roughly, these 3 groups correspond to relatively healthy childless adults, relatively unhealthy disabled adults, and parents of children with Medicaid insurance. The main outcome measure was time from enrollment to the surgical procedure. The primary exposure of interest was insurance type. We used a generalized linear regression model to adjust for patient age, sex, social deprivation, surgeon supply and reimbursement, and state-level Medicaid enrollment.

RESULTS

In the unadjusted analysis of 4,117 patients, there was a significantly shorter time from enrollment to THA and TKA for the expansion group (median, 7.5 months) relative to the SSI group (median, 16.1 months; p < 0.0001) and the TANF group (median, 12.2 months; p < 0.0001). In the adjusted analysis, the time from enrollment to THA and TKA was significantly shorter in the expansion group (β, -1.21 [95% confidence interval (CI), -1.35 to -1.07]; p < 0.001) compared with the TANF group (β, -0.27 [95% CI, -0.38 to -0.17]; p < 0.001) and the SSI group (reference). Compared with the SSI group, these coefficients are equivalent to a 70% shorter time to the surgical procedure in the expansion group and a 24% shorter time to the surgical procedure in the TANF group.

CONCLUSIONS

Our findings suggest an unmet need for THA and TKA among newly enrolled Medicaid expansion beneficiaries. This need should be considered by surgeons, hospitals, and policymakers in ensuring access to care. Furthermore, consideration should be given to existing insurance-based disparities in access to orthopaedic care, as these may be exacerbated by an increased demand for THA and TKA from Medicaid expansion beneficiaries.

THU0008 DEVELOPMENT OF A NOVEL TRANSLATIONAL IN SILICO INDICATION DISCOVERY FRAMEWORK: EXEMPLIFIED BY THE CLINICAL COMPOUND CENERIMOD

Background:

To explore the full therapeutic spectrum of a drug it is crucial to consider its potential effectiveness in all diseases. Serendipitous clinical observations have often shown that approved drugs and those in development to be efficacious in indications different to those originally tested for. Traditional approaches to match a drug candidate with possible indications are mostly based on matching drug mechanistic knowledge with disease pathophysiology. Proof-of-concept trials or elaborate pre-clinical studies in animal models do not allow for a broad assessment due to high costs and slow progress. Gene expression changes in patients or animal models represent a good proxy to comprehensively assess both disease and drug effects. Furthermore, this data type can be integrated with a plethora of publicly available data.

Objectives:

Generation of a novel in silico framework to support the selection and expansion of potential indications which associate with a compound or approved drug. The framework was exemplified by the clinical compound cenerimod, a potent, selective, and orally active sphingosine-1-phosphate receptor 1 modulator (Piali et al., 2017).

Methods:

A total of ~13’000 public patient gene expression datasets from ~140 diseases were evaluated against cenerimod gene expression data generated in mouse disease models. To improve comparability of studies across platforms and species, computer algorithms (neural networks) were trained and employed to reduce noise within the data sets and improve signal. The predicted response to cenerimod for individual patients was contrasted against clinical patient characteristics.

Results:

The neural network algorithm efficiently reduced experimental noise and improved sensitivity in the gene expression data. The results predicted cenerimod to be efficacious in several auto-immune diseases foremost SLE. Additionally, focused analysis on individual patients rather than disease cohorts revealed potential determinants predictive of maximal clinical response, with the highest predicted clinical response for cenerimod in patients with severe inflammatory endotype and/or high SLE Disease Activity Index (SLEDAI).

Conclusion:

Combining preclinical compound data with the wealth of public disease gene expression data, provides great potential to support indication selection. The novel in silico framework identified SLE as a prime potential indication for cenerimod and supported the cenerimod phase 2b clinical trial in patients with SLE (CARE study,NCT03742037).

References:

[1]Piali, L., Birker-Robaczewska, M., Lescop, C., Froidevaux, S., Schmitz, N., Morrison, K., … Nayler, O. (2017). Cenerimod, a novel selective S1P1 receptor modulator with unique signaling properties. Pharmacology Research & Perspectives, 5(6), 1–12.https://doi.org/10.1002/prp2.370

Disclosure of Interests:

Dominik Hartl Shareholder of: Idorsia shares, Employee of: Idorsia employee, Marcel Keller Shareholder of: Idorsia options/shares, Employee of: Idorsia employee, Axel Klenk Shareholder of: Idorsia option/shares, Employee of: Idorsia employee, Mark Murphy Shareholder of: Idorsia shares and stock options, Employee of: Idorsia employee, Marianne Martinic Shareholder of: Idorsia options/shares, Employee of: Idorsia employee, Gabin Pierlot Shareholder of: Idorsia options/shares, Employee of: Idorsia employee, Peter Groenen Shareholder of: Idorsia options/shares, Employee of: Idorsia employee, Daniel Strasser Shareholder of: Idorsia options/shares, Employee of: Idorsia employee

SAT0165 PRECLINICAL AND CLINICAL CHARACTERIZATION OF CENERIMOD, A POTENT, SELECTIVE, AND ORALLY ACTIVE SPHINGOSINE-1-PHOSPHATE RECEPTOR 1 MODULATOR IN SLE

Background:

SLE is an autoimmune disease characterized by aberrant lymphocyte activation and autoantibody production. In SLE, autoreactive lymphocytes migrate from lymphoid organs into the blood, and subsequently into tissue. This leads to systemic and multiorgan inflammation and pathology resulting in significant morbidity and mortality. Lymphocyte migration is a tightly controlled process driven by chemokine gradients. The chemotactic gradient across the vascular barrier established by sphingosine-1-phosphate (S1P) orchestrates egress of lymphocytes out of peripheral lymphoid organs into the blood. Cenerimod is a potent, selective, and orally active S1P receptor 1 (S1P1) receptor modulator that induces receptor internalization and thereby prevents lymphocyte egress from lymphoid organs into the blood [1].

Objectives:

In-depth preclinical and clinical characterization of cenerimod in modulating SLE.

Methods:

Lymphocytes from patients with SLE and healthy subjects were assessed for cenerimod-induced S1P1receptor internalization. Efficacy of cenerimod was evaluated in the MRL/lpr lupus mouse model. In a 12-week phase 2 clinical trial in patients with SLE treated with multiple doses of cenerimod (NCT02472795), lymphocyte subsets and inflammatory biomarkers were characterized.

Results:

Cenerimod was potent and efficacious at inducing S1P1receptor internalization in T and B lymphocytes with an EC50of 15 nM in both healthy subjects and patients with SLE. In lupus-like MRL/lpr mice treated with cenerimod, circulating T and B lymphocytes were reduced, which resulted in reduced immune infiltrates into tissue, reduced autoantibody production and inflammation, decreased proteinuria, and increased survival. In patients with SLE treated with cenerimod for 12 weeks, a dose-dependent reduction of circulating T cells (95%), B cells (90%), and antibody-secreting cells (85%) was evident. Furthermore, a reduction in anti-dsDNA antibodies and IFN-α, associated with an inflammatory phenotype, was observed.

Conclusion:

Cenerimod was potent and efficacious in reducing S1P1receptor surface expression on lymphocytesin vitro, and in reducing circulating T and B lymphocyte populations, including antibody-secreting cells, and in decreasing inflammatory biomarkers in patients with SLEin vivo. Furthermore, cenerimod significantly ameliorated systemic and organ-specific autoimmunity in a mouse model of SLE. These results support the further investigation of the clinical efficacy and safety of cenerimod in the ongoing phase 2b clinical trial (NCT03742037).

References:

[1]Piali L, Birker-Robaczewska M, Lescop C, Froidevaux S, Schmitz N, Morrison K, et al. Cenerimod, a novel selective S1P1 receptor modulator with unique signaling properties. Pharmacol Res Perspect. 2017 Dec; 5(6).

Acknowledgments:

This research was funded by Idorsia Pharmaceuticals Ltd

Disclosure of Interests:

Daniel Strasser Shareholder of: Idorsia options/shares, Employee of: Idorsia employee, Estelle Gerossier Shareholder of: Idorsia options/shares, Employee of: Idorsia employee, Virginie Sippel Shareholder of: Idorsia options/shares, Employee of: Idorsia employee, Ursula Grieder Shareholder of: Idorsia options/shares, Employee of: Idorsia, Andrea Kieninger: None declared, Gabin Pierlot Shareholder of: Idorsia options/shares, Employee of: Idorsia employee, Hervé Farine Shareholder of: Idorsia options/shares, Employee of: Idorsia employee, Paulina Kulig Shareholder of: Idorsia options/shares, Employee of: Idorsia employee, Marcel Keller Shareholder of: Idorsia options/shares, Employee of: Idorsia employee, Sylvie Froidevaux Shareholder of: Idorsia options/shares, Employee of: Idorsia employee, Marten Trendelenburg Grant/research support from: Idorsia Pharmaceuticals Ltd, Novartis Institute of Biomedical Research, F. Hoffmann-La Roche Ltd, Marianne Martinic Shareholder of: Idorsia options/shares, Employee of: Idorsia employee, Mark Murphy Shareholder of: Idorsia shares and stock options, Employee of: Idorsia employee

Public social media consultations for dermatologic conditions: an online survey

The use of social media in medicine has been increasingly studied in recent years, especially concerning its role in patient outreach, education, diagnosis, and management. Dermatology is a unique field in that patients can post photographs of their skin ailments when seeking online medical advice and information. This study examines the role of public social media consultations for dermatologic conditions. A large portion of patients utilize social media for dermatologic consultations and many do not seek care from a dermatologist afterward. Future studies should trend this phenomenon, especially as the use of social media continues to expand.