Validation of dried blood spot sampling for detecting SARS-CoV-2 antibodies and total immunoglobulins in a large cohort of asymptomatic young adults

BACKGROUND

Detecting antibody responses following infection with SARS-CoV-2 is necessary for sero-epidemiological studies and assessing the role of specific antibodies in disease, but serum or plasma sampling is not always viable due to logistical challenges. Dried blood spot sampling (DBS) is a cheaper, simpler alternative and samples can be self-collected and returned by post, reducing risk for SARS-CoV-2 exposure from direct patient contact. The value of large-scale DBS sampling for the assessment of serological responses to SARS-CoV-2 has not been assessed in depth and provides a model for examining the logistics of using this approach to other infectious diseases. The ability to measure specific antigens is attractive for remote outbreak situations where testing may be limited or for patients who require sampling after remote consultation.

METHODS

We compared the performance of SARS-CoV-2 anti-spike and anti-nucleocapsid antibody detection from DBS samples with matched serum collected by venepuncture in a large population of asymptomatic young adults (N = 1070) living and working in congregate settings (military recruits, N = 625); university students, N = 445). We also compared the effect of self-sampling (ssDBS) with investigator-collected samples (labDBS) on assay performance, and the quantitative measurement of total IgA, IgG and IgM between DBS eluates and serum.

RESULTS

Baseline seropositivity for anti-Spike IgGAM antibody was significantly higher among university students than military recruits. Strong correlations were observed between matched DBS and serum samples in both university students and recruits for the anti-spike IgGAM assay. Minimal differences were found in results by ssDBS and labDBS and serum by Bland Altman and Cohen kappa analyses. LabDBS achieved 82.0% sensitivity and 98.2% specificity and ssDBS samples 86.1% sensitivity and 96.7% specificity for detecting anti-Spike IgGAM antibodies relative to serum samples. For anti-SARS-CoV-2 nucleocapsid IgG there was qualitatively 100% agreement between serum and DBS samples and weak correlation in ratio measurements. Strong correlations were observed between serum and DBS-derived total IgG, IgA, and IgM.

CONCLUSIONS

This is the largest validation of DBS against paired serum for SARS-CoV-2 specific antibody measurement and we have shown that DBS retains performance from prior smaller studies. There were no significant differences regarding DBS collection methods, suggesting that self-collected samples are a viable sampling collection method. These data offer confidence that DBS can be employed more widely as an alternative to classical serology.

Joint consensus statement on the vaccination of adult and paediatric haematopoietic stem cell transplant recipients: Prepared on behalf of the British society of blood and marrow transplantation and cellular therapy (BSBMTCT), the Children's cancer and Leukaemia Group (CCLG), and British Infection Association (BIA)

Haematopoietic stem cell transplant (HSCT) recipients have deficiencies in their adaptive immunity against vaccine preventable diseases. National and International guidance recommends that HSCT recipients are considered 'never vaccinated' and offered a comprehensive course of revaccination. This position statement aims to draw upon the current evidence base and existing guidelines, and align this with national vaccine availability and licensing considerations in order to recommend a pragmatic and standardised re-vaccination schedule for adult and paediatric HSCT recipients in the UK.

Resilience in cancer patients and how it correlates with demographics, psychological factors, and lifestyle

Background

Being diagnosed with cancer is challenging. Many patients wish to be actively involved in treatment and contribute to therapy, but the patients’ coping abilities and desire for involvement differ. The individual level of resilience seems to play a major role. Our study aims to learn more about the associations of resilience and factors as demographics and psychological factors.

Methods

This multicentric cross-sectional study was conducted in ten oncological centers in Germany in summer 2021. The questionnaire collected information on demographics, resilience, self-efficacy, general satisfaction with life, and sense of coherence. Considered lifestyle-aspects were diet and physical activity. 416 patients were included in the analyses.

Results

A moderate mean resilience score was achieved (M = 69). Significant correlations in demographics were found for resilience and education (r = 0.146, p = 0.003), income (r = 0.205, p = 0.001), and time since receiving diagnosis (r = − 0.115, p = 0.021). Resilience and self-efficacy correlated on a high level (r = 0.595, p < 0.001), resilience and sense of coherence, and resilience and general satisfaction with life in a moderate way (r = 0.339, p < 0.001; r = 0.461, p = 0.001).

Conclusions

Resilience portrays an important aspect in cancer treatment. Detecting patients at risk, stabilizing, or improving resilience are important to focus on and strengthen them accordingly. Possible negatively influencing factors (e.g., low self-efficacy) need to be considered. Factors affecting resilience but difficult to influence, as educational background, should be screened for. Also, the combination of low resilience and low income seems to describe a vulnerable patient group.

Local and regional air pollution characteristics in Cyprus: A long-term trace gases observations analysis

Observations of key gaseous trace pollutants, namely NO, NO_y, CO, SO₂ and O_3, performed at several curb, residential, industrial, background and free-troposphere sites were analyzed to assess the temporal and spatial variability of pollution in Cyprus. Notably, the analysis utilized one of the longest datasets of 17 years of measurements (2003-2019) in the East Mediterranean and the Middle East (EMME). This region is considered a regional hotspot of ozone and aerosol pollution. A trend analysis revealed that at several stations, a statistically significant decrease in primary pollutant concentration is recorded, most likely due to pollution control strategies. In contrast, at four stations, a statistically significant increase in ozone levels, ranging between 0.36 ppb_v y^-1 and 0.82 ppb_v y^-1_, has been observed, attributed to the above strategies targeting the reduction of nitrogen oxides (NO_x) but not that of Volatile Organic Compounds (VOCs). The NO and NO_y, and CO levels at the Agia Marina regional background station were two orders of magnitude and four times lower, respectively, than the ones of the urban centers. The latter denotes that local emissions are not negligible and control a large fraction of the observed interannual and diurnal variability. Speciation analysis showed that traffic and other local emissions are the sources of urban NO and NO_y. At the same time, 46 % of SO₂ and 40 % of CO, on average, originate from long-range regional transport. Lastly, a one-year analysis of tropospheric NO₂ vertical columns from the TROPOMI satellite instrument revealed a west-east low-to-high gradient over the island, with all major hotspots, including cities and powerplants, being visible from space. With the help of an unsupervised machine learning approach, it was found that these specific hotspots contribute overall around 10 % to the total NO₂ tropospheric columns.

Striking sex differences in magnetic resonance imaging findings in the sacroiliac joints in the population

Background

In patients with axial spondyloarthritis (axSpA), magnetic resonance imaging (MRI) is used to detect bone marrow edema (BME) in sacroiliac joints (SIJ) but SIJ BME are also detected in the population. Not much is known about sex differences in that regard.

Objective

To explore sex-specific differences associated with the extent of BME in the SIJ suggestive of axSpA in a general population cohort study.

Methods

Taking advantage of 793 recently evaluated MRIs of subjects < 45 years taking part in the SHIP cohort, we used negative-binomial (NB) count data regression to analyze factors associated with the extent of SIJ BME. Predictors were explored by model-based boosting (MBB), a machine learning approach.

Results

Estimates of NB regression showed strong effects of sex in interaction with age, BMI, back pain, and particularly HLA-B27. The NB regression model showed incidence rate ratios (IRR) for the main effect of sex (females vs. males): 0.94 [95% CI: 0.63; 1.41], HLA-B27: 4.32 [2.09; 9.8], and for the interaction of sex to HLA-B27: 0.22 [0.06; 0.75]. According to MBB, HLA-B27 positivity, BMI, current smoking, back pain in the last 3 months, the interaction of sex and HLA-B27, and delivery in the last 12 months were of highest importance to explain the extent of SIJ BME.

Conclusions

Different factors were associated with the extent of SIJ BME in females and males. Most importantly, HLA-B27 was relevant only in males but not in females in whom a postpartal state was important. This finding may be relevant for the pathogenesis of axSpA.

Epicardial adipose tissue and adrenal gland volume in patients with borderline personality disorder

Borderline personality disorder (BPD) is associated with an elevated mortality risk that is partially attributed to suicide, but few studies examined other possible causes of premature death. The present study compared epicardial adipose tissue (EAT) volume as a known early predictor of premature cardiovascular morbidity, cardiovascular risk indices, and adrenal gland volume (AGV) as an indicator for chronic hypothalamus-pituitary-adrenal (HPA) axis activation in females with borderline personality disorder (BPD), major depressive disorder (MDD) and in healthy individuals. Twenty-eight patients with BPD comorbid with MDD (BPD/MDD), 22 MDD patients and 26 healthy females (CTRL) of comparable age were included. EAT and AGV were assessed by magnetic resonance tomography; 10-year cardiovascular risk and diabetes risk were determined by PROCAM and FINDRISK score; metabolic syndrome was defined following National Cholesterol Education Adult Treatment Panel III R (NCEP/ATP III) criteria. MADRS was used to assess depression severity. After adjustment for age, body mass index (BMI), and physical activity, EAT and AGV were significantly increased in BPD/MDD compared to MDD and CTRL. EAT and AGV displayed a positive correlation. Finally, diabetes risk in BPD/MDD was elevated compared to CTRL and MDD. The present study highlights the increased cardiometabolic risk of BPD patients. We identify EAT accumulation as an early predictor and potential mediator of cardiovascular disease in BPD that appears to be driven at least in part by HPA axis dysregulation. Therefore, interventions that reduce EAT volume (i.e. exercise and diet) should be considered in the clinical management of BPD.

Comprehensive Test of the Brink-Axel Hypothesis in the Energy Region of the Pygmy Dipole Resonance

The validity of the Brink-Axel hypothesis, which is especially important for numerous astrophysical calculations, is addressed for ^{116,120,124}Sn below the neutron separation energy by means of three independent experimental methods. The γ-ray strength functions (GSFs) extracted from primary γ-decay spectra following charged-particle reactions with the Oslo method and with the shape method demonstrate excellent agreement with those deduced from forward-angle inelastic proton scattering at relativistic beam energies. In addition, the GSFs are shown to be independent of excitation energies and spins of the initial and final states. The results provide a critical test of the generalized Brink-Axel hypothesis in heavy nuclei, demonstrating its applicability in the energy region of the pygmy dipole resonance.

Modelling dielectric elastomer circuit networks for soft biomimetics

In order to obtain entirely soft bio-inspired robots, fully soft electronic circuits are needed. Dielectric elastomers (DEs) are electroactive polymers that have demonstrated multifunctionality. The same material can achieve different tasks like actuation, sensing, or energy harvesting. It has been shown that basic logic and memory functions can be realized with similar soft structures by combining multiple DE actuators and DE switches. Thus it would be possible to build, with the same materials and processes, a soft structure that mimics a biological being with all these capabilities. This contribution is focused on the modelling of the aforementioned soft electro-mechanical circuit networks. It is here reported the building process of a comprehensive SIMULINK model including the electro-mechanical behaviour of DE logic units and their interconnections. Conventional models deal with a single aspect of DEs, generating complex finite-element simulations. This contribution, based on a former model for an inverter-based DEO, shows how to integrate these various mathematical models and, with the help of direct measurements, create a software representation of DE circuit networks. This work is intended to demonstrate the validity of a recently introduced model and apply it to more complex circuit networks that have a higher number of components. Since, at the present state, the building processes are by hand, adding components generates more variability due to sample-to-sample variation and human error. Despite this, the model still shows a qualitatively good prediction of the devices' behaviour. Furthermore, the introduction of new materials and automatic processes will help to reduce this variability, allowing the model to reach even better performance.

COVID-19: Seroprevalence and Vaccine Responses in UK Dental Care Professionals

Dental care professionals (DCPs) are thought to be at enhanced risk of occupational exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, robust data to support this from large-scale seroepidemiological studies are lacking. We report a longitudinal seroprevalence analysis of antibodies to SARS-CoV-2 spike glycoprotein, with baseline sampling prior to large-scale practice reopening in July 2020 and follow-up postimplementation of new public health guidance on infection prevention control (IPC) and enhanced personal protective equipment (PPE). In total, 1,507 West Midlands DCPs were recruited into this study in June 2020. Baseline seroprevalence was determined using a combined IgGAM enzyme-linked immunosorbent assay and the cohort followed longitudinally for 6 mo until January/February 2021 through the second wave of the coronavirus disease 2019 pandemic in the United Kingdom and vaccination commencement. Baseline seroprevalence was 16.3%, compared to estimates in the regional population of 6% to 7%. Seropositivity was retained in over 70% of participants at 3- and 6-mo follow-up and conferred a 75% reduced risk of infection. Nonwhite ethnicity and living in areas of greater deprivation were associated with increased baseline seroprevalence. During follow-up, no polymerase chain reaction-proven infections occurred in individuals with a baseline anti-SARS-CoV-2 IgG level greater than 147.6 IU/ml with respect to the World Health Organization international standard 20-136. After vaccination, antibody responses were more rapid and of higher magnitude in those individuals who were seropositive at baseline. Natural infection with SARS-CoV-2 prior to enhanced PPE was significantly higher in DCPs than the regional population. Natural infection leads to a serological response that remains detectable in over 70% of individuals 6 mo after initial sampling and 9 mo from the peak of the first wave of the pandemic. This response is associated with protection from future infection. Even if serological responses wane, a single dose of the Pfizer-BioNTech 162b vaccine is associated with an antibody response indicative of immunological memory.

Primary mediastinal germ cell tumours: an immunohistochemical and molecular diagnostic approach

AIMS

Primary mediastinal germ cell tumours (PMGCTs) are rare mediastinal neoplasms and their diagnosis can be challenging due to small biopsy samples. The aim of this study was to elaborate a diagnostic algorithm using immunohistochemical stainings with focus on novel markers and molecular analysis of isochromosome 12p [i(12p)].

METHODS AND RESULTS

Paraffin-embedded tissues of 32 mediastinal tumours were analysed using immunohistochemical stainings for SALL4, LIN28, OCT3/4, D2-40, CD117, SOX17, SOX2, CD30, ß-hCG, GATA3, FOXA2, GPC3, AFP, TdT, NUT and pan-cytokeratin. Quantitative real-time polymerase chain reaction (qPCR) was performed to investigate i(12p) status. Fifteen seminomas, seven teratomas, one yolk sac tumour, one choriocarcinoma and seven mixed PMGCT were diagnosed. Each entity had different immunohistochemical staining patterns which helped to distinguish them: seminoma (OCT3/4, D2-40, CD117, TdT), embryonal carcinoma (OCT3/4, SOX2), yolk sac tumour (FOXA2, GPC3, AFP) and choriocarcinoma (ß-hCG, GATA3). Mature teratomas stained positive for pan-cytokeratin in epithelial components and focally for SALL4, SOX2, GATA3, D2-40 and FOXA2. Furthermore, a NUT carcinoma mimicking a PMGCT was diagnosed showing a strong nuclear SOX2 and speckled nuclear NUT staining. i(12p) was detected in 24 out of 27 PMGCTs [89%].

CONCLUSION

A diagnostic algorithm is of great importance for a reliable diagnosis of PMGCTs in the usually small tissue biopsy samples. Therefore, a combination of three to four antibodies to identify the correct histological subtype is usually necessary in addition to morphological features. The i(12p) status serves as an additional option to underline germ cell origin in selected cases.

Antibody responses after first and second Covid-19 vaccination in patients with chronic lymphocytic leukaemia

B-cell chronic lymphocytic leukaemia (CLL) is associated with immunosuppression and patients are at increased clinical risk following SARS-CoV-2 infection. Covid-19 vaccines offer the potential for protection against severe infection but relatively little is known regarding the profile of the antibody response following first or second vaccination. We studied spike-specific antibody responses following first and/or second Covid-19 vaccination in 299 patients with CLL compared with healthy donors. 286 patients underwent extended interval (10-12 week) vaccination. 154 patients received the BNT162b2 mRNA vaccine and 145 patients received ChAdOx1. Blood samples were taken either by venepuncture or as dried blood spots on filter paper. Spike-specific antibody responses were detectable in 34% of patients with CLL after one vaccine (n = 267) compared to 94% in healthy donors with antibody titres 104-fold lower in the patient group. Antibody responses increased to 75% after second vaccine (n = 55), compared to 100% in healthy donors, although titres remained lower. Multivariate analysis showed that current treatment with BTK inhibitors or IgA deficiency were independently associated with failure to generate an antibody response after the second vaccine. This work supports the need for optimisation of vaccination strategy in patients with CLL including the potential utility of booster vaccines.

[Answering epidemiologic rheumatologic questions by cooperation with the large population-based SHIP cohort-findings with relevance for the diagnosis of axial spondyloarthritis (axSpA)]

This article presents how, based on the availability of new imaging methods and medications, objectives regarding the rheumatic disease axial spondyloarthritis (axSpA) have developed over the course of more than two decades into a rheumatologic research group. During recent years, cooperation with the Study of Health in Pomerania (SHIP) cohort has given rise to new fundamental aspects. This involved intensive cooperation between the Ruhr University Bochum (Rheumazentrum Ruhrgebiet) and the Greifswald University Hospital (Community Medicine research collective). The design of the SHIP cohort was published 10 years ago and the cohort approach presented in the Bundesgesundheitsblatt, which also described central methodologic questions in detail. In 2014, a cooperation project between the Ruhr Rheumatology Center/Ruhr University Bochum and the SHIP Department of Clinical and Epidemiologic Research (Klinisch-Epidemiologische Forschung, KEF; SHIP-KEF) was established, which has already resulted in publication of interesting results in high-ranking journals. In order to stress the potential of such corporations, important contents thereof are presented herein, with a focus on MRI and consideration of historical aspects.

Validation of a combined ELISA to detect IgG, IgA and IgM antibody responses to SARS-CoV-2 in mild or moderate non-hospitalised patients

BACKGROUND

Frequently SARS-CoV-2 results in mild or moderate disease with potentially lower concentrations of antibodies compared to those that are hospitalised. Here, we validated an ELISA using SARS-CoV-2 trimeric spike glycoprotein, with targeted detection of IgG, IgA and IgM (IgGAM) using serum and dried blood spots (DBS) from adults with mild or moderate disease.

METHODS

Targeting the SARS-CoV-2 trimeric spike, a combined anti-IgG, IgA and IgM serology ELISA assay was developed using 62 PCR-confirmed non-hospitalised, mild or moderate COVID-19 samples, ≥14 days post symptom onset and 624 COVID-19 negative samples. The assay was validated using 73 PCR-confirmed non-hospitalised, mild or moderate COVID-19 samples, ≥14 days post symptom onset and 359 COVID-19 negative serum samples with an additional 81 DBSs. The assay was further validated in 226 PCR-confirmed non-hospitalised, mild or moderate COVID-19 samples, ≥14 days post symptom onset and 426 COVID-19 negative clinical samples.

RESULTS

A sensitivity and specificity of 98.6% (95% CI, 92.6-100.0), 98.3% (95% CI, 96.4-99.4), respectively, was observed following validation of the SARS-CoV-2 ELISA. No cross-reactivities with endemic coronaviruses or other human viruses were observed, and no change in results were recorded for interfering substances. The assay was stable at temperature extremes and components were stable for 15 days once opened. A matrix comparison showed DBS to correlate with serum results. Clinical validation of the assay reported a sensitivity of 94.7% (95% CI, 90.9-97.2%) and a specificity of 98.4% (95% CI, 96.6-99.3%).

CONCLUSIONS

The human anti-IgGAM SARS-CoV-2 ELISA provides accurate and sensitive detection of SARS-CoV-2 antibodies in non-hospitalised adults with mild or moderate disease. The use of dried blood spots makes the assay accessible to the wider community.

Dielectric Elastomer Actuator Driven Soft Robotic Structures With Bioinspired Skeletal and Muscular Reinforcement

Natural motion types found in skeletal and muscular systems of vertebrate animals inspire researchers to transfer this ability into engineered motion, which is highly desired in robotic systems. Dielectric elastomer actuators (DEAs) have shown promising capabilities as artificial muscles for driving such structures, as they are soft, lightweight, and can generate large strokes. For maximum performance, dielectric elastomer membranes need to be sufficiently pre-stretched. This fact is challenging, because it is difficult to integrate pre-stretched membranes into entirely soft systems, since the stored strain energy can significantly deform soft elements. Here, we present a soft robotic structure, possessing a bioinspired skeleton integrated into a soft body element, driven by an antagonistic pair of DEA artificial muscles, that enable the robot bending. In its equilibrium state, the setup maintains optimum isotropic pre-stretch. The robot itself has a length of 60 mm and is based on a flexible silicone body, possessing embedded transverse 3D printed struts. These rigid bone-like elements lead to an anisotropic bending stiffness, which only allows bending in one plane while maintaining the DEA's necessary pre-stretch in the other planes. The bones, therefore, define the degrees of freedom and stabilize the system. The DEAs are manufactured by aerosol deposition of a carbon-silicone-composite ink onto a stretchable membrane that is heat cured. Afterwards, the actuators are bonded to the top and bottom of the silicone body. The robotic structure shows large and defined bimorph bending curvature and operates in static as well as dynamic motion. Our experiments describe the influence of membrane pre-stretch and varied stiffness of the silicone body on the static and dynamic bending displacement, resonance frequencies and blocking forces. We also present an analytical model based on the Classical Laminate Theory for the identification of the main influencing parameters. Due to the simple design and processing, our new concept of a bioinspired DEA based robotic structure, with skeletal and muscular reinforcement, offers a wide range of robotic application.

Depression is associated with hyperconnectivity of an introspective socio-affective network during the recall of formative relationship episodes

BACKGROUND

Depression and the experience of early adversity are associated with impairments in interpersonal and social cognitive functioning. The neural mechanisms involved in these impairments remain insufficiently understood.

METHODS

In a sample of 48 depressed and 50 healthy participants, we explored seed-to-voxel functional connectivity (FC) during the recall of formative relationship episodes using functional magnetic resonance imaging.

RESULTS

While depressive symptoms were associated with increased FC of brain regions that form an introspective socio-affective network, such as the precuneus, bilateral anterior insula, dorsal anterior cingulate cortex, left amygdala, and medial prefrontal cortex, early adversity linked to decreased FC of brain regions mediating emotion processing such as the bilateral anterior insula and increased FC of the bilateral parahippocampal gyrus.

LIMITATIONS

We report both results that are corrected for the number of seeds tested in FC analyses using strict Bonferroni adjustments and unadjusted results as part of an exploratory analysis.

DISCUSSION

Our findings suggest that depression and early adversity are associated with differential FC patterns in the brain during the recall of formative relationship episodes. Hyperconnectivity of an introspective socio-affective network associated with depressive symptoms may link to enhanced self-focus and emotional reactivity. Patterns of neural activation associated with early adversity may underpin numbed affective states or enhanced affective memory regulation. Overall, these findings inform about the neural underpinnings of a reflective ability that is predictive of the adaptation to depression and to early adversity and relevant for psychotherapy outcomes.

[Should statistical significance be retired?]

In the journal Nature, under the headline "Retire statistical significance", Amrhein et al. called for the concept of statistical significance to be abolished. This appeal, which was signed by about 800 other researchers, triggered a controversial discussion. One reason for the deliberately provocative call is the scientific practice in which the concept of statistical significance is often applied in an incorrect way for yes/no decisions. The criticism is not new and has been repeatedly expressed over the last 50 years. We refer to current and previously published caveats, give an overview of different applications of the concept of statistical significance as well as possible alternatives. We agree in principle with the criticism of the concept expressed by Amrhein et al. but in the absence of agreed alternatives and insufficient consideration of the many different applications of the concept of statistical significance, we consider the demand for its abolition to be exaggerated. A more pragmatic approach to the problem, supported by targeted instructions for scientists and reviewers, seems to be a more appropriate way forward.

OP0086 THE DEGREE OF BONE MARROW EDEMA AS DETECTED BY MAGNETIC RESONANCE IMAGING IN THE SACROILIAC JOINTS AND THE SPINE SUSPICIOUS OF AXIAL SPONDYLOARTHRITIS IN THE GENERAL POPULATION IS ASSOCIATED WITH DIFFERENT FACTORS

Background:

Taking advantage of a large population-based study we have recently reported that the frequency of bone marrow edema (BME) and fatty lesions (FL) in the sacroiliac joints (SIJ) and the spine of individuals <45 years detected by magnetic resonance imaging (MRI) suggestive of axial spondyloathritis (axSpA) is higher than expected.

Objectives:

To identify and compare factors associated with the extension of MRI lesions in the spine and the SIJ in the general population.

Methods:

All available spinal- (sagittal T1/T2 sequences) and SIJ- (semicoronal STIR sequences) MRIs were evaluated by two trained readers blinded to clinical data. BME (SIJ and spine) suggestive of axSpA were recorded. The extension of BME was quantified using the Berlin MRI score. Discrepancies were resolved by consensus. Degenerative lesions of the Modic type were excluded. The association of age (increase per decade), sex, HLA-B27 and hsCRP positivity, smoking (ever smoker vs. no smoker), spinal pain (yes vs. no in last 3 months), body mass index (BMI) categories (WHO definition), physically demanding job, and giving birth within the last 12 month with the severity of BME were examined. Associations between clinical factors and the Berlin MRI score were analyzed by negative binomial regression models resulting in incidence rate ratios (IRRs).

Results:

MRIs of 793 volunteers from the general population, mean age 37.3±6.3 years, 49.4% male, 8.9% HLA B27+, 7% CRP-positive, 56.9% with back pain in the last 3 months (28.8% with back pain NRS ≥4/10), 35.7% reported physically heavy work, 55% with BMI > 25 kg/m2, 16.2% current smokers, and 5% of females with pregnancy in the last year before MRI examination, were evaluated.

For BME on SIJ-MRIs, significant associations (IRR, 95% confidence level) were found for pregnancy in the last year (3.82, 1.17-14.24), HLA-B27+ (2.42, 1.33-4.55), BMI (25-30 vs. <25; 2.09 (1.33-3.31)) and presence of back pain in the last 3 months (1.54, 1.02-2.33).

For BME on spinal MRIs, significant associations were found for age per decade increase (1.45, 1.10-1.91) and physically demanding work (1.45, 1.04-2.00), while HLA-B27+ (1.32, 0.79-2.24), BMI (>30: 0.84, 0.53-1.32 (<25 reference)) and back pain in the last 3 months (1.29, 0.95-1.77) showed no association. Overall, spinal BME was more frequent than SIJ BME in the participants working at a desktop (61.5% vs. 54.4%), while smokers (66.9% vs. 63.8%) and participants with back pain in the last 3 months (62.5% vs. 56.9%) had more often SIJ BME than spinal BME, respectively.

Conclusion:

In this population-based study, individuals aged <45 years, HLA-B27+, women with pregnancy in the last year and presence of back pain were associated with the extent of BME in the SIJ, while age and physically demanding work were associated with the extent of BME in the spine. These data support the hypothesis of a mechanic origin of BME in the general population aged <45 years, while HLA B27 is a severity but not a susceptibility factor for BME in the SIJ.

Acknowledgments:

n/a

Disclosure of Interests:

Xenofon Baraliakos Grant/research support from: Grant/research support from: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Consultant of: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Speakers bureau: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Adrian Richter: None declared, Daniel Feldmann: None declared, Anne Ott: None declared, Robin Buelow: None declared, Carsten Schmidt: None declared, Juergen Braun Grant/research support from: Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, Eli Lilly and Company, Medac, MSD (Schering Plough), Mundipharma, Novartis, Pfizer (Wyeth), Roche, Sanofi- Aventis, and UCB Pharma, Consultant of: Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, EBEWE Pharma, Eli Lilly and Company, Medac, MSD (Schering-Plough), Mundipharma, Novartis, Pfizer (Wyeth), Roche, Sanofi-Aventis, and UCB Pharma, Speakers bureau: Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, EBEWE Pharma, Eli Lilly and Company, Medac, MSD (Schering-Plough), Mundipharma, Novartis, Pfizer (Wyeth), Roche, Sanofi-Aventis, and UCB Pharma

Partial Time-Reversal Invariance Violation in a Flat, Superconducting Microwave Cavity with the Shape of a Chaotic Africa Billiard

We report on the experimental realization of a flat, superconducting microwave resonator, a microwave billiard, with partially violated time-reversal (T) invariance, induced by inserting a ferrite into the cavity and magnetizing it with an external magnetic field perpendicular to the resonator plane. In order to prevent its expulsion caused by the Meissner-Ochsenfeld effect, we used a cavity of which the top and bottom plate were made from niobium, a superconductor of type II, and cooled it down to liquid-helium temperature T_{LHe}≃4  K. The cavity had the shape of a chaotic Africa billiard. Superconductivity rendered possible the accurate determination of complete sequences of the resonance frequencies and of the widths and strengths of the resonances, an indispensable prerequisite for the unambiguous detection of T invariance violation, especially when it is only partially violated. This allows for the first time the precise specification of the size of T invariance violation from the fluctuation properties of the resonance frequencies and from the strength distribution, which actually depends sensitively on it and thus provides a most suitable measure. For this purpose we derived an analytical expression for the latter which is valid for isolated resonances in the range from no T invariance violation to complete violation.

The United Kingdom Primary Immune Deficiency (UKPID) registry 2012 to 2017

This is the second report of the United Kingdom Primary Immunodeficiency (UKPID) registry. The registry will be a decade old in 2018 and, as of August 2017, had recruited 4758 patients encompassing 97% of immunology centres within the United Kingdom. This represents a doubling of recruitment into the registry since we reported on 2229 patients included in our first report of 2013. Minimum PID prevalence in the United Kingdom is currently 5·90/100 000 and an average incidence of PID between 1980 and 2000 of 7·6 cases per 100 000 UK live births. Data are presented on the frequency of diseases recorded, disease prevalence, diagnostic delay and treatment modality, including haematopoietic stem cell transplantation (HSCT) and gene therapy. The registry provides valuable information to clinicians, researchers, service commissioners and industry alike on PID within the United Kingdom, which may not otherwise be available without the existence of a well-established registry.

Confocal Raman microscopy in life sciences

Microscopy techniques are widely used in life sciences to study cells and tissues. Fluorescence microscopy, for example, is a very common method in many laboratories. While reliable and strong fluorescence signals are a clear advantage of this method, the labelling procedure with fluorescent dyes, the availability of required antibodies or the potentially necessary genetic modifications of the studied organism all introduce potential complications. By contrast, confocal Raman microscopy is a label-free and non-destructive imaging technique. In contrast to infrared microscopy, it is easily applicable in aqueous environments. Different microscope setups and combinations allow for the examination of various solid and liquid samples, even in their typical environments. The article demonstrates the analyzing capability of confocal Raman microscopy and correlative techniques through application examples of eukaryotic and prokaryotic cells, and cancerous and normal tissues and shows how confocal Raman microscopy provides valuable information for a more comprehensive understanding of the investigated sample.

Measurement of deformation heterogeneities in additive manufactured lattice materials by Digital Image Correlation: Strain maps analysis and reliability assessment

The mechanical behaviour of porous lattice materials for potential orthopaedic applications was investigated at a fine scale by means of digital image correlation (DIC). Specimens with cubic, body cubic-centered reinforced (BCCZ), and diamond mesostructures were tested in quasi-static compression up to failure. Images were continuously recorded by an imaging setup and processed by a custom DIC program, OpenDIC. The resulting strain maps were analyzed in both spatial and temporal scales, displaying the onset and evolution of strain heterogeneities. The three geometries show different failure modes, i.e. collective buckling of an entire row for cubic, diagonal shearing band for BCCZ, and generalized crushing for diamond. The strain maps correlate well with these patterns. Most importantly, they show early strain localization below the macroscopic elastic limit. After failure, a phenomenon of strain release was witnessed and evaluated in the parts of the specimen that do not fracture. In the cubic geometry, the vertical struts sustain most of the deformation. Further analysis shows that the rows of vertical struts have similar, yet scattered, evolutions until failure. Interestingly, the row that leads to specimen failure is not necessarily the first one to deform. In addition to these experimental results, the uncertainties of the method were thoroughly assessed by means of calibration procedures.

Enhancing antibiotic stewardship by tackling "spurious" penicillin allergy

Approximately 90-99% of patients with a label of penicillin allergy (PenA) are not allergic when comprehensively investigated. An inaccurate label of PenA has major public health implications-longer hospital stay, more frequent hospital admissions, greater use of fluoroquinolones, glycopeptides, cephalosporins and other expensive antibiotics resulting in significantly higher costs to the health service and predisposing to Clostridium difficile, methicillin-resistant Staphylococcus aureus infections and vancomycin-resistant enterococcus. We describe lessons learnt from recent studies regarding possible reasons contributing to an inaccurate label of PenA as well as propose a concerted multidisciplinary approach to address this important public health problem. Given the unmet need for allergy services in the UK and several other countries and knowledge gaps regarding PenA amongst healthcare professionals, we describe the potential role for a computerized clinical decision support system to enable non-specialists rapidly identify and de-label "low-risk" hospitalized patients with a label of PenA thereby obviating the need for allergy tests. This approach however needs rigorous evaluation for feasibility, safety, patient and physician acceptability, cost-effectiveness and its compatibility with information technology systems currently employed in the health service.

Residue concentration of cefquinome after intramammary dry cow therapy and short dry periods

Short dry periods and their effects on milk production, reproductive performance, as well as cow and udder health have been widely studied. A dearth of information is available about the consequences of short dry periods on the residue concentrations of dry cow antibiotics in milk after calving. The objective of our study was to determine the residue concentration of a dry cow antibiotic in milk after short dry periods during the colostrum period and early lactation. Quarters of 19 dry cows were treated with an intramammary (IMM) dry cow antibiotic containing 150 mg of cefquinome on d 21, 14, and 7 before calculated calving date. One quarter of each cow did not receive treatment and served as negative control. After calving, quarter foremilk samples were collected twice daily until 21 d and once daily until 36 d after IMM dry cow treatment (i.e., end of withdrawal period). A total of 588 foremilk samples from odd milking numbers were chosen for the determination of the residue concentration of cefquinome using HPLC-tandem mass spectrometry until the residue concentration fell below the limit of quantification (1 ng/g), which occurred at the latest in milking number 37. The dry period length of the treated quarters was categorized in 3 dry period groups ranging from 1 to 7 d (4.8 ± 2.4), 8 to 14 d (11.5 ± 2.3), and 15 to 26 d (19.5 ± 3.3; ±SEM), in dry period group 1, 2, and 3, respectively. In dry period group 1, the cefquinome concentration increased after calving until the third milking and decreased considerably until the fifth milking. In dry period group 2, the cefquinome concentration peaked at the second milking and decreased considerably until the fifth milking as well. There was no increase in cefquinome after calving in dry period group 3. Up to the 37th milking, the cefquinome concentration was higher in dry period group 1 than in dry period group 2 and 3. On average, 31.3 ± 1.2, 19.0 ± 1.1, and 6.7 ± 0.8 milkings and 19.4 ± 0.4, 20.6 ± 0.5, and 24.1 ± 0.7 d after treatment were necessary for the concentration of cefquinome to fall below the maximum residue limit (MRL) in dry period group 1, 2, and 3, respectively. These results indicate that shorter dry periods lead initially to higher cefquinome residues in milk. The residue concentration after experimental short dry periods still falls below the MRL within the recommended withdrawal period for milk of 36 d after IMM dry cow treatment. For the sake of food safety and economics, these short dry periods should not be used in the dry cow management, as they lead up to a maximum of 31.3 ± 1.2 milkings and 19.4 ± 0.4 d after treatment with cefquinome residues above the MRL. Therefore, a considerable number of milkings have to be discarded due to long withdrawal periods after calving.

Decitabine demonstrates antileukemic activity in B cell precursor acute lymphoblastic leukemia with MLL rearrangements

Background

Promotor hypermethylation of CpG islands is common in B cell precursor acute lymphoblastic leukemia (BCP-ALL) with mixed lineage leukemia (MLL) gene rearrangements. Hypomethylating agents (HMA) such as azacitidine (AZA) and decitabine (DEC) reduce DNA hypermethylation by incorporation into DNA and were successfully introduced into the clinic for the treatment of myeloid neoplasias.

Methods

Here, we investigated whether HMA induce comparable biological effects in MLL-positive BCP-ALL. Further, efficacy of HMA and concomitant application of cytostatic drugs (cytarabine and doxorubicin) were evaluated on established SEM and RS4;11 cell lines. In addition, promising approaches were studied on BCP-ALL cell line- and patient-derived xenograft models.

Results

In general, DEC effects were stronger compared to AZA on MLL-positive BCP-ALL cells. DEC significantly reduced proliferation by induction of cell cycle arrest in G0/G1 phase and apoptosis. Most sensitive to HMA were SEM cells which are characterized by a fast cell doubling time. The combination of low-dose HMA and conventional cytostatic agents revealed a heterogeneous response pattern. The strongest antiproliferative effects were observed when ALL cells were simultaneously exposed to HMA and cytostatic drugs. Most potent synergistic effects of HMA were induced with cytarabine. Finally, the therapeutic potential of DEC was evaluated on BCP-ALL xenograft models. DEC significantly delayed leukemic proliferation in xenograft models as demonstrated longitudinally by non-invasive bioluminescence as well as ¹⁸F-FDG-PET/CT imaging. Unexpectedly, in vivo concomitant application of DEC and cytarabine did not enhance the antiproliferative effect compared to DEC monotherapy.

Conclusions

Our data reveal that DEC is active in MLL-positive BCP-ALL and warrant clinical evaluation.

Electronic supplementary material

The online version of this article (10.1186/s13045-018-0607-3) contains supplementary material, which is available to authorized users.

Diacetylene polymerization on a bulk insulator surface

Molecular electronics has great potential to surpass known limitations in conventional silicon-based technologies. The development of molecular electronics devices requires reliable strategies for connecting functional molecules by wire-like structures. To this end, diacetylene polymerization has been discussed as a very promising approach for contacting single molecules with a conductive polymer chain. A major challenge for future device fabrication is transferring this method to bulk insulator surfaces, which are mandatory to decouple the electronic structure of the functional molecules from the support surface. Here, we provide experimental evidence for diacetylene polymerization of 3,3'-(1,3-butadiyne-1,4-diyl)bisbenzoic acid precursors on the (10.4) surface of calcite, a bulk insulator with a band gap of around 6 eV. When deposited on the surface held at room temperature, ordered islands with a (1 × 3) superstructure are observed using dynamic atomic force microscopy. A distinct change is revealed upon heating the substrate to 485 K. After heating, molecular stripes with a characteristic inner structure are formed that excellently match the expected diacetylene polymer chains in appearance and repeat distance. The corresponding density functional theory computations reveal molecular-level bonding patterns of both the (1 × 3) superstructure and the formed striped structure, confirming the assignment of on-surface diacetylene polymerization. Transferring the concept of using diacetylene polymerization for creating conductive connections to bulk insulator surfaces paves the way towards application-relevant systems for future molecular electronic devices.

Dynamik der Elektrolytkonzentrationen im Blutplasma von Rindern mit operativ beendeter Torsio uteri intra partum

Gegenstand und Ziel: Es sollte überprüft werden, inwieweit beim Rind die Elektrolyte im Blutplasma durch eine Torsio uteri intra partum einschließlich operativer Behandlung (Gruppe 1) im Vergleich zu mit Sectio caesarea beendeten Dystokien ohne Torsio uteri (Gruppe 2) bzw. Normalgeburten (Gruppe 3) während der ersten 10 Tage post operationem/partum beeinflusst werden. Material und Methoden: In die Studie gingen 45 schwarzbunte Rinder mit chirurgisch therapierter Torsio uteri intra partum ein. Im Abstand von 24 Stunden, beginnend unmittelbar präoperativ, bis 10 Tage post operationem (p. o.) wurden Blutproben aus der Vena jugularis externa entnommen und Gesamtkalzium, anorganisches Phosphat, Mg2+, Na+, und K+ bestimmt. Die Vergleichsgruppen umfassten jeweils 11 Tiere. Ergebnisse: Die Veränderungen der Plasmaspiegel von Gesamtkalzium, anorganischem Phosphat, Na+ und K+ waren bei den 33 überlebenden Rindern mit Torsio uteri und den Tieren der Gruppen 2 und 3 gering. Der Magnesiumplasmaspiegel fiel postoperativ besonders bei Gruppe 1, aber auch bei Gruppe 2 im Vergleich zu Gruppe 3 signifikant ab und verblieb bis zum Ende der Beobachtungszeit unterhalb des Referenzbereichs. Bei den 12 verendeten Patienten mit Torsio uteri traten im Vergleich zu den überlebenden Rindern mit Gebärmutterdrehung eine deutlichere, am vierten postoperativen Tag signifikante Hypomagnesiämie und ein signifikant erniedrigter Plasmakaliumspiegel auf. Schlussfolgerung: Nach geburtshilflich-chirurgischen Eingriffen sollten bei Rindern die Elektrolytplasmaspiegel insbesondere von Magnesium und Kalium überprüft und die Elektrolyte gegebenenfalls substituiert werden. Klinische Relevanz: Ein postoperativ niedriger Plasmakaliumspiegel in Verbindung mit einer Hypomagnesiämie ist bei Rindern, die wegen einer Torsio uteri operiert wurden, ein Hinweis auf eine schlechte Prognose quoad vitam.

Untersuchungen zur Eignung des ultrasonographisch ermittelten Uterusgewichtes und der uterinen Echotextur zur Prognose der Fertilität beim weiblichen Schwein

Gegenstand und Ziel: Es wurde untersucht, ob sich ultrasonographisch ermitteltes Uterusgewicht (UG) und uterine Echotextur (ET) zur Prognose der Fertilität beim weiblichen Schwein eignen. Gleichzeitig sollte eruiert werden, ob ein optimales UG, das für Jung- (JS) und Altsauen (AS) 400-600 bzw. 500-700 g betragen soll, existiert. Material und Methoden: Insgesamt 67 abgesetzte AS (Betrieb A = B-A) sowie 44 JS und 64 AS mit unterschiedlichen Reproduktionsstörungen (Betrieb B = B-B) wurden einen Tag nach dem Absetzen (B-A) oder am Ende einer 15-tägigen Altrenogest- Applikation (B-B) transkutan sonographisch untersucht. Das UG wurde mithilfe der sonographisch ermittelten Querschnittsfläche der Uterushörner (QF) errechnet (UG = 357,6 × QF0,801; beide B), die ET in die Grade 1-4 eingeteilt (homogen bis hochgradig heterogen; nur B-B) und Uteri mit ET-Grad 1 als physiologisch betrachtet. Tiere wurden nur dann berücksichtigt, wenn sie zum Zeitpunkt der Erfassung von UG und ET sonographisch Follikel mit einer Größe von 2-4 mm aufwiesen und im darauf folgenden Östrus zeitgerecht ovuliert hatten. Eine Sau galt als fertil, wenn sie tragend wurde. Ergebnisse: Die UG betrugen 306-1789 g. Tragende und nicht tragende AS (B-A) bzw. JS und AS (B-B) wiesen jeweils ein ähnliches mittleres UG und zu ähnlichen Anteilen UG von < 400 / > 600 g (JS) oder < 500 / > 700 g (AS) auf. Sauen mit ET-Grad 4 wurden seltener (p ≤ 0,05) bzw. tendenziell seltener (p ≤ 0,1) tragend als Tiere mit den ET-Graden 1 und 2 (57,1% vs. 87,0% bzw. 82,2%). Uteri mit dem ET-Grad 4 waren schwerer als die mit den ET-Graden 1-3 (p ≤ 0,05). Schlussfolgerungen: JS und AS werden unabhängig davon tragend, ob die Uteri leicht oder schwer sind. Weisen Sauen kleine Follikel, aber hochgradig heterogen texturierte Uteri auf, sind die Uteri häufig funktionsgestört und überwiegend schwer. Derartige Sauen haben verringerte Trächtigkeitschancen. Klinische Relevanz: Die sonographisch beurteilte ET eignet sich zur Prognose der Fertilität beim weiblichen Schwein, das UG nicht. Optimale UG sind zu bezweifeln.

Immobilization of pH-sensitive CdTe Quantum Dots in a Poly(acrylate) Hydrogel for Microfluidic Applications

Microfluidic devices present the basis of modern life sciences and chemical information processing. To control the flow and to allow optical readout, a reliable sensor material that can be easily utilized for microfluidic systems is in demand. Here, we present a new optical readout system for pH sensing based on pH sensitive, photoluminescent glutathione capped cadmium telluride quantum dots that are covalently immobilized in a poly(acrylate) hydrogel. For an applicable pH sensing the generated hybrid material is integrated in a microfluidic sensor chip setup. The hybrid material not only allows in situ readout, but also possesses valve properties due to the swelling behavior of the poly(acrylate) hydrogel. In this work, the swelling property of the hybrid material is utilized in a microfluidic valve seat, where a valve opening process is demonstrated by a fluid flow change and in situ monitored by photoluminescence quenching. This discrete photoluminescence detection (ON/OFF) of the fluid flow change (OFF/ON) enables upcoming chemical information processing.

[The first biologic for rheumatoid arthritis: factors influencing the therapeutic decision]

BACKGROUND AND AIMS

Biologics (disease modifying antirheumatic drugs, bDMARD) have been in use in Germany for the treatment of rheumatoid arthritis (RA) since 2001, usually after failure of at least one conventional synthetic (cs)DMARD. We analyzed temporal changes in factors that influence the decision for either a first bDMARD or a further csDMARD.

MATERIAL AND METHODS

We analyzed data from 9513 bDMARD-naive RA patients in the German biologics register RABBIT who switched to a new therapy. For three recruitment periods (2001-2003, 2004-2006 and 2009-2015) factors influencing the therapeutic decision were analyzed by means of machine learning methods and logistic regression analysis.

RESULTS

In all recruitment periods the number of previous csDMARDs, high dosages of glucocorticoids (>7.5 mg/day) and a higher DAS28 (>5.1) were significantly associated with the decision for a first bDMARD. Over time, the chance of receiving a bDMARD increased in patients with moderate disease activity, moderate glucocorticoid dosages (5-7.5 mg/day) and those with comorbidities, such as congestive heart failure or prior malignancy. Men had a higher chance of receiving a bDMARD than women only in the first recruitment period. Private health insurance, high education and gainful employment were significantly associated with more frequent prescription of bDMARDs in all recruitment periods.

DISCUSSION

The time-dependent changes in the impact of disease activity, concomitant drugs, gender and comorbidity on the prescription of bDMARDs mirror the increasing therapeutic options and the growing experience in the application of the new substances in patients at higher risk. The influence of demographic and social factors may reflect safety concerns in patients at increased risk of adverse events but also the need to economize drug costs..

Test of the Brink-Axel Hypothesis for the Pygmy Dipole Resonance

The gamma strength function and level density of 1^{-} states in ^{96}Mo have been extracted from a high-resolution study of the (p[over →], p[over →]^{'}) reaction at 295 MeV and extreme forward angles. By comparison with compound nucleus γ decay experiments, this allows a test of the generalized Brink-Axel hypothesis in the energy region of the pygmy dipole resonance. The Brink-Axel hypothesis is commonly assumed in astrophysical reaction network calculations and states that the gamma strength function in nuclei is independent of the structure of the initial and final state. The present results validate the Brink-Axel hypothesis for ^{96}Mo and provide independent confirmation of the methods used to separate gamma strength function and level density in γ decay experiments.

Generic nature of long-range repulsion mechanism on a bulk insulator?

Dynamic atomic force microscopy measurements are reported that provide evidence for the presence of long-range repulsion in molecular self-assembly on a bulk insulator surface. We present the structures formed from four different benzoic acid derivatives on the (10.4) cleavage plane of calcite kept in ultra-high vacuum. These molecules have in common that they self-assemble into molecular stripes when deposited onto the surface held at room temperature. For all molecules tested, a detailed analysis of the stripe-to-stripe distance distribution reveals a clear deviation from what would be expected for randomly placed, non-interacting stripes (i.e., geometric distribution). When excluding kinetic effects during growth, this result gives evidence for a long-range repulsion mechanism acting during the assembly of these stripes. The fact that this finding is robust against changes in the molecular structure indicates a generic nature of the observed mechanism, implying a ubiquitous origin such as electrostatic repulsion. Finally, we discuss parameters that might affect the unambiguous observation of this generic repulsion under specific experimental conditions.

Comprehensive assessment of food and nutrient intake of children and adolescents in Germany: EsKiMo II - the eating study as a KiGGS module

Background

As part of the second wave of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2), food and nutrient intake of children and adolescents aged 6–17 years living in Germany is assessed in EsKiMo II – the Eating Study as a KiGGS Module.

Methods

EsKiMo II is a cross-sectional study, conducted from June 2015 until September 2017. The study population comprises 6 to 17-year-old study participants from the cross-sectional sample of KiGGS Wave 2 in 167 KiGGS sample points, which are revisited by trained nutritionists. Dietary intake is assessed by weighted food records during three consecutive days plus one randomly selected day within the following 3 months for children aged 6–11 years. Dietary intake for adolescents aged 12–17 years is assessed by computer-assisted dietary history interviews, reflecting the past four weeks, using the software DISHES. Further information, for example, about specific diets and dietary supplement intake, is reported during a standardised computer assisted interview for all participants. Food items are coded by the German Food Code and Nutrient Database (BLS 3.02).

Discussion

EsKiMo II provides actual data on the dietary behaviour of children and adolescents living in Germany and their determinants. Results of EsKiMo II will be relevant for decision-making, measures, and evaluations within nutrition, consumer and health policy.

Serious adverse events and the risk of stroke in patients with rheumatoid arthritis: results from the German RABBIT cohort

OBJECTIVE

In the general population, the incidence of stroke is increased following other serious events and hospitalisation. We investigated the impact of serious adverse events on the risk of stroke in patients with rheumatoid arthritis (RA), taking risk factors and treatment into account.

METHODS

Using data of the German biologics register RABBIT (Rheumatoid Arthritis: Observation of Biologic Therapy) with 12354 patients with RA, incidence rates (IRs) and risk factors for stroke were investigated using multi-state and Cox proportional hazard models. In addition, in a nested case-control study, all patients with stroke were matched 1:2 to patients with identical baseline risk profile and analysed using a shared frailty model.

RESULTS

During follow-up, 166 strokes were reported. The overall IR was 3.2/1000 patient-years (PY) (95% CI 2.7 to 3.7). It was higher after a serious adverse event (IR: 9.0 (7.3 to 11.0)), particularly within 30 days after the event (IR: 94.9 (72.6 to 121.9)). The adjusted Cox model showed increased risks of age per 5 years (HR: 1.4 (1.3 to 1.5)), hyperlipoproteinaemia (HR: 1.6 (1.0 to 2.5)) and smoking (HR: 1.9 (1.3 to 2.6)). The risk decreased with better physical function (HR: 0.9 (0.8 to 0.96)). In the case-control study, 163 patients were matched to 326 controls. Major risk factors for stroke were untreated cardiovascular disease (HR: 3.3 (1.5 to 7.2)) and serious infections (HR:4.4 (1.6 to 12.5)) or other serious adverse events (HR: 2.6 (1.4 to 4.8)).

CONCLUSIONS

Incident adverse events, in particular serious infections, and insufficient treatment of cardiovascular diseases are independent drivers of the risk of stroke. Physicians should be aware that patients who experience a serious event are at increased risk of subsequent stroke.

Electric Dipole Polarizability of ^{48}Ca and Implications for the Neutron Skin

The electric dipole strength distribution in ^{48}Ca between 5 and 25 MeV has been determined at RCNP, Osaka from proton inelastic scattering experiments at forward angles. Combined with photoabsorption data at higher excitation energy, this enables the first extraction of the electric dipole polarizability α_{D}(^{48}Ca)=2.07(22)  fm^{3}. Remarkably, the dipole response of ^{48}Ca is found to be very similar to that of ^{40}Ca, consistent with a small neutron skin in ^{48}Ca. The experimental results are in good agreement with ab initio calculations based on chiral effective field theory interactions and with state-of-the-art density-functional calculations, implying a neutron skin in ^{48}Ca of 0.14-0.20 fm.