Orychophragmus violaceus and/or chicory forage affects performance, egg quality, sensory evaluation and antioxidative properties in native laying hens

Orychophragmus violaceus (OV) and chicory (Cichorium intybus L., CC) can be used as fresh or dry forage for animals. To determine whether OV and/or CC have beneficial effects on performance and egg quality, a total of 1212 28-wk-old Beijing You Chicken (BYC) laying hens with similar performance were randomly allocated to 4 groups with 3 replicate pens per group, and 101 birds per pen. The birds were fed a basal diet (control), the basal diet + OV (3.507 kg/d/pen), the basal diet + CC (2.525 kg/d/pen), and the basal diet + OV + CC (OVC, 1.7535 kg/d/pen OV + 1.2625 kg/d/pen CC) for 3 wks after one wk of adaptation. The results showed that egg-laying rate was not affected by OV, CC and OVC (p > 0.05), but weekly average egg mass was significantly increased by OV and CC (p < 0.05). The feed egg ratio in the CC group (2.82) was significantly lower than that in the other three groups (p < 0.05). The eggshell thickness (EST), albumen height (AH) and Haugh unit (HU) were decreased by OV and CC (p < 0.05); while yolk color (YC) was increased in the CC and OVC groups (p < 0.05). Egg grade was decreased by OV (p < 0.05). Sensory evaluation showed that there was a trend for increased YC in OV, CC and OVC (p = 0.089). Serum total protein was significantly lower in OV group than those in the control and CC group (p < 0.05); serum albumin content was significantly decreased in OV, CC and OVC groups (p = 0.006). Serum glutathione peroxidase activity in CC and OVC groups was significantly higher than that in the control group (p < 0.05). In conclusion, the present study suggests that CC had a better effect on the performance of the native laying hens than OV. The OV and CC affected egg quality, while YC was increased in CC and OVC groups. The OVC improved YC and serum antioxidative properties of native laying hens without affecting the performance.

Association between workplace health promotion service utilisation and depressive symptoms among workers: a nationwide survey

OBJECTIVES

Workplace-related factors are associated with the risk of depression. Despite implementation of workplace health promotion (WHP) programmes in China to promote the physical and mental well-being of workers, the relationship between WHP and depression has received limited attention. This study investigated the association between WHP service utilisation and depressive symptoms among workers.

STUDY DESIGN

This was a cross-sectional survey.

METHODS

A researcher-designed questionnaire was used to collect information on socio-demographic and occupational characteristics, WHP service utilisation, and mental health status. The Lasso method was used for variable selection to achieve dimension reduction, and logistic regression was used to assess the association between WHP service utilisation and depressive symptoms.

RESULTS

The analysis included 11,710 workers, of whom 17.0% had depressive symptoms. Lasso regression resulted in 6 of 18 WHP services showing significant negative associations with depressive symptoms, including occupational safety training, mental health services, health check-ups, sports activities, fitness rooms, and healthy canteens. The logistic regression results showed that, after adjusting for sociodemographic and occupational factors, utilisation of these six services was associated with a decreased likelihood of depressive symptoms. The adjusted odds ratio (aOR) was 0.84 (95% confidence interval [CI]: 0.73-0.96) for occupational safety training, aOR: 0.82 (95% CI: 0.68-0.99) for mental health services, aOR: 0.80 (95% CI: 0.71-0.90) for health check-ups, aOR: 0.68 (95% CI: 0.57-0.80) for sports activities, aOR: 0.59 (95% CI: 0.47-0.74) for fitness rooms and aOR: 0.72 (95% CI: 0.59-0.87) for healthy canteens.

CONCLUSIONS

Utilisation of WHP services was associated with a lower prevalence of depressive symptoms. Implementation of WHP services and the provision of a supportive workplace environment should be prioritised to benefit the mental health of workers.

Achievement of Target Gain Larger than Unity in an Inertial Fusion Experiment

On December 5, 2022, an indirect drive fusion implosion on the National Ignition Facility (NIF) achieved a target gain G_{target} of 1.5. This is the first laboratory demonstration of exceeding "scientific breakeven" (or G_{target}>1) where 2.05 MJ of 351 nm laser light produced 3.1 MJ of total fusion yield, a result which significantly exceeds the Lawson criterion for fusion ignition as reported in a previous NIF implosion [H. Abu-Shawareb et al. (Indirect Drive ICF Collaboration), Phys. Rev. Lett. 129, 075001 (2022)PRLTAO0031-900710.1103/PhysRevLett.129.075001]. This achievement is the culmination of more than five decades of research and gives proof that laboratory fusion, based on fundamental physics principles, is possible. This Letter reports on the target, laser, design, and experimental advancements that led to this result.

Preparation and characterisation of novel casein-gum Arabic composite microcapsules for targeted in vivo delivery of Lactiplantibacillus plantarum A3

The health benefits of probiotics in the body are predicated on their ability to remain viable in harsh gastrointestinal conditions and complex pathological microenvironments. Casein and gum Arabic (GA), with dual emulsifying and stabilising effects in colloidal systems. Therefore, the objective of this research was to develop a novel microcapsule to encapsulate Lactiplantibacillus plantarum A3 using casein and GA as wall materials to improve the survival of the bacteria during gastrointestinal digestion, storage and lyophilization. The casein and GA composite microcapsules were prepared and characterised by Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD) and scanning electron microscopy (SEM). It was found that the microcapsules had stable morphology, uniform size and spherical shape. The results revealed that the encapsulation of microcapsules significantly improved the survival of L. plantarum A3 in gastrointestinal fluid environment (5.52 × 109 cfu/ml) and lyophilization treatment (6.25 × 109 cfu/ml). Furthermore, the microencapsulated L. plantarum A3 exhibited an improved ability to regulate intestinal microbiota by effectively increasing the relative abundance of Bacteroidetes, Proteobacteria and Actinobacteria and decreasing the relative abundance of Firmicutes in vivo. The findings of the study will help to design a lactic acid bacteria encapsulation system based on the gastrointestinal environment and provide a basis for the development of probiotic functional products.

AI Beam Angle Prediction in Proton Therapy for Brain Patients

PURPOSE/OBJECTIVE(S)

Patients receiving brain Intensity-modulated Proton Therapy (IMPT) are treated with 1-3 fields. Typically, beam angles must be selected manually, requiring substantial planner time and experience. The choice of beam angles has a major impact on the treatment plan quality. An AI model was developed to automate this process aiming to improve efficiency and potentially plan quality. AI performance was tested by comparing predicted beam angles to the human ground truth angles and evaluating plans resulting from each set of beam angles.

MATERIALS/METHODS

Previously treated IMPT brain patients were divided into a training (n = 40) and validation set (n = 10) for the AI. Beam-angle selection in the AI was cast as a multi-label classification problem, training the convolution neural network with a Circular Earth Mover's Distance based regularization and multi-label circular-smooth label technique. An analytical post-processing algorithm is employed to minimize distance to the target and avoid organs-at-risk. Finalized gantry angle predictions are discretized in steps of 5°. For an independent test set of n = 10 patients beam angles were predicted by the AI and compared to those chosen by human planners. Both sets of angles were used to create treatment plans with an automated knowledge-based planning (KBP) tool for brain IMPT utilizing single-field optimization and robust optimization. Plan differences are therefore solely due to the choice of beam angles as automated KBP removes human optimization variability. Resulting plan quality was compared by standard clinical dosimetric parameters to the CTV, brain, brainstem, cochlea, cord, eye, lens, optic chiasm, optic nerves, pituitary, and temporal lobes.

RESULTS

All Human and AI selected beam angles are shown in the table. For cases 1-6, AI and Human selected beam angles were within ±15° and resulting plans showed minimal dosimetric differences. In cases 7-9 AI beam angles reduced max dose while keeping organ-at-risk dose within ±2 Gy. In case 10 the AI chosen beam angles reduced cord Dmax by 9.1 Gy but increased left eye Dmax by 4.9 Gy, other organs-at-risk showed minimal differences.

CONCLUSION

Gantry beam angle selection was automated by a newly developed AI model and tested on 10 brain IMPT patients. The comparison showed that the AI often chooses similar beam angles to the human planners. When there are differences, dosimetric analysis demonstrated that plans created from AI beam angles have at least the same quality as the human ones. Results motivate further research into this approach showing the AI being a promising tool to fill a current gap in the strive for automating proton treatment planning, increasing planning efficiency and potentially quality.

CEDAR: communication efficient distributed analysis for regressions

Electronic health records (EHRs) offer great promises for advancing precision medicine and, at the same time, present significant analytical challenges. Particularly, it is often the case that patient-level data in EHRs cannot be shared across institutions (data sources) due to government regulations and/or institutional policies. As a result, there are growing interests about distributed learning over multiple EHRs databases without sharing patient-level data. To tackle such challenges, we propose a novel communication efficient method that aggregates the optimal estimates of external sites, by turning the problem into a missing data problem. In addition, we propose incorporating posterior samples of remote sites, which can provide partial information on the missing quantities and improve efficiency of parameter estimates while having the differential privacy property and thus reducing the risk of information leaking. The proposed approach, without sharing the raw patient level data, allows for proper statistical inference. We provide theoretical investigation for the asymptotic properties of the proposed method for statistical inference as well as differential privacy, and evaluate its performance in simulations and real data analyses in comparison with several recently developed methods.

Deep Learning Segmentation of the Nucleus Basalis of Meynert on 3T MRI

BACKGROUND AND PURPOSE

The nucleus basalis of Meynert is a key subcortical structure that is important in arousal and cognition and has been explored as a deep brain stimulation target but is difficult to study due to its small size, variability among patients, and lack of contrast on 3T MR imaging. Thus, our goal was to establish and evaluate a deep learning network for automatic, accurate, and patient-specific segmentations with 3T MR imaging.

MATERIALS AND METHODS

Patient-specific segmentations can be produced manually; however, the nucleus basalis of Meynert is difficult to accurately segment on 3T MR imaging, with 7T being preferred. Thus, paired 3T and 7T MR imaging data sets of 21 healthy subjects were obtained. A test data set of 6 subjects was completely withheld. The nucleus was expertly segmented on 7T, providing accurate labels for the paired 3T MR imaging. An external data set of 14 patients with temporal lobe epilepsy was used to test the model on brains with neurologic disorders. A 3D-Unet convolutional neural network was constructed, and a 5-fold cross-validation was performed.

RESULTS

The novel segmentation model demonstrated significantly improved Dice coefficients over the standard probabilistic atlas for both healthy subjects (mean, 0.68 [SD, 0.10] versus 0.45 [SD, 0.11], P = .002, t test) and patients (0.64 [SD, 0.10] versus 0.37 [SD, 0.22], P < .001). Additionally, the model demonstrated significantly decreased centroid distance in patients (1.18 [SD, 0.43] mm, 3.09 [SD, 2.56] mm, P = .007).

CONCLUSIONS

We developed the first model, to our knowledge, for automatic and accurate patient-specific segmentation of the nucleus basalis of Meynert. This model may enable further study into the nucleus, impacting new treatments such as deep brain stimulation.

[Mediating effect of self-efficacy on self-management ability and self-management behavior in patients with type 2 diabetes mellitus]

OBJECTIVE

To investigate the mechanism of self-efficacy between self-management ability and self-management behavior and its differences among patients with different disease courses through mediation tests.

METHODS

In the study, 489 patients with type 2 diabetes who attended the endocrinology departments of four hospitals in Shanxi Province and Inner Mongolia Autonomous Region from July to September 2022 were enrolled as the study population. They were investigated by General Information Questionnaire, Diabetes Self-Management Scale, Chinese version of Diabetes Empowerment Simplified Scale, and Diabetes Self-Efficacy Scale. Mediation analyses were performed using the linear regression model, Sobel test, and Bootstrap test in the software Stata version 15.0 and divided the patients into different disease course groups for subgroup analysis according to whether the disease course was > 5 years.

RESULTS

In this study, the score of self-management behavior in the patients with type 2 diabetes was 6.16±1.41, the score of self-management ability was 3.99±0.74, and the score of self-efficacy was 7.05±1.90. The results of the study showed that self-efficacy was positively correlated with self-management ability (r=0.33) as well as self-management behavior (r=0.47) in the patients with type 2 diabetes (P < 0.01). The mediating effect of self-efficacy accounted for 38.28% of the total effect of self-management ability on self-management behaviors and was higher in the behaviors of blood glucose monitoring (43.45%) and diet control (52.63%). The mediating effect of self-efficacy accounted for approximately 40.99% of the total effect for the patients with disease course ≤ 5 years, while for the patients with disease course > 5 years, the mediating effect accounted for 39.20% of the total effect.

CONCLUSION

Self-efficacy enhanced the effect of self-management ability on the behavior of the patients with type 2 diabetes, and this positive effect was more significant for the patients with shorter disease course. Targeted health education should be carried out to enhance patients' self-efficacy and self-management ability according to their disease characteristics, to stimulate their inner action, to promote the development of their self-management behaviors, and to form a more stable and long-term mechanism for disease management.

Dietary metabolizable energy and crude protein levels affect pectoral muscle composition and gut microbiota in native growing chickens

The experiment aimed to study effects of dietary metabolizable energy (ME) and crude protein (CP) levels alone and in interaction on performance, pectoral muscle composition and gut microbiota in native growing chickens. A total of 648 10-wks-old Beijing-You Chicken (BYC) female chickens were randomly allocated to 9 groups with 6 replicates per group and 12 chickens per replicate, and the chickens were fed with a 3 × 3 factorial diets (3 levels of dietary ME: 11.31 MJ/kg, 11.51 MJ/kg, 11.71 MJ/kg; and 3 levels of dietary CP: 14%, 15%, 16%). The results showed that dietary ME and CP levels didn't affect average feed intake (AFI), body weight gain, feed gain ratio (P > 0.05), but ME level significantly affected the AFI (P < 0.05); mortality rate of 11.31 MJ/kg group was the highest (P < 0.05). Dietary ME, CP levels, and the interaction significantly affected pectoral CP and crude fat (CF) content of the growing chickens (P < 0.01). Dietary CP level had opposite effects on pectoral CP and CF content (P < 0.01). The 16% CP increased the pectoral CF content, which may have a negative impact on meat flavor. Dietary ME level affected 11 types of pectoral free amino acids (FAA) contents, including aspartic acid, L-threonine (P < 0.05), also amino acid classification, for example, total amino acid (TAA) and essential amino acid (EAA) content (P < 0.05). The 11.51 MJ/kg group had the highest TAA, EAA, delicious amino acid (DAA) content and EAA percentage (P < 0.05), while 11.31 MJ/kg group had the lowest bitter amino acid (BAA) content and BAA percentage and the highest fresh and sweet amino acid (FSAA) percentage (P < 0.05). Dietary CP level significantly affected glutamine and tyrosine content (P < 0.05). The interaction of dietary ME and CP level affected C20:3n6 content, saturated fatty acid (SFA), and unsaturated fatty acid (UFA) percentage (P < 0.05). The CP level significantly affected SFA percentage (P < 0.05). The 16% CP level increased the diversity of gut microbiota, but at the same time increased the relative abundance of Proteobacteria (P < 0.05), which is a sign of microbiota disorder. The increase of dietary ME level resulted in a gradual decrease in the diversity and relative abundance of gut microbiota. In conclusion, the present study suggested that the medium dietary ME (11.51 MJ/kg) and low CP (14-15%) levels can be helpful for enhancing pectoral muscle composition, increase meat quality such as flavor and nutritional value, and benefit for gut microbiota in native growing chickens.

In situ calibration of charged particle spectrometers on the OMEGA Laser Facility using 241Am and 226Ra sources

Charged particle spectrometry is a critical diagnostic to study inertial-confinement-fusion plasmas and high energy density plasmas. The OMEGA Laser Facility has two fixed magnetic charged particle spectrometers (CPSs) to measure MeV-ions. In situ calibration of these spectrometers was carried out using ²⁴¹Am and ²²⁶Ra alpha emitters. The alpha emission spectrum from the sources was measured independently using surface-barrier detectors (SBDs). The energy dispersion and broadening of the CPS systems were determined by comparing the CPS measured alpha spectrum to that of the SBD. The calibration method significantly constrains the energy dispersion, which was previously obtained through the measurement of charged particle fusion products. Overall, a small shift of 100 keV was observed between previous and the calibration done in this work.

Liquid-like atoms in dense-packed solid glasses

Revealing the microscopic structural and dynamic pictures of glasses is a long-standing challenge for scientists^1,2. Extensive studies on the structure and relaxation dynamics of glasses have constructed the current classical picture^3-5: glasses consist of some 'soft zones' of loosely bound atoms embedded in a tightly bound atomic matrix. Recent experiments have found an additional fast process in the relaxation spectra^6-9, but the underlying physics of this process remains unclear. Here, combining extensive dynamic experiments and computer simulations, we reveal that this fast relaxation is associated with string-like diffusion of liquid-like atoms, which are inherited from the high-temperature liquids. Even at room temperature, some atoms in dense-packed metallic glasses can diffuse just as easily as they would in liquid states, with an experimentally determined viscosity as low as 10⁷ Pa·s. This finding extends our current microscopic picture of glass solids and might help establish the dynamics-property relationship of glasses⁴.

Lower risk of gout in sodium glucose cotransporter 2 (SGLT2) inhibitors versus dipeptidyl peptidase-4 (DPP4) inhibitors in type-2 diabetes patients: a propensity score-matched study

Background

The effects of sodium-glucose cotransporter 2 inhibitors (SGLT2I) versus dipeptidyl peptidase-4 inhibitors (DPP4I) on the risk of new gout diagnosis have not been explored. This study aims to compare the effects of SGLT2I against DPP4I on gout risks in a Chinese population.

Methods

This was a retrospective population-based cohort study of patients with type-2 diabetes mellitus treated with SGLT2I or DPP4I between January 1st, 2015 and December 31st, 2020 in Hong Kong. The study outcomes are new-onset gout and all-cause mortality. Propensity score matching (1:1 ratio) between SGLT2I and DPP4I was performed. Univariable and multivariable Cox regression analysis models were conducted. Competing risks models and multiple approaches based on the propensity score were applied.

Patients

This study included 60996 patients (median age: 62.3 years old, 54.96% males; SGLTI group: n=21690; DPP4I group: n=39306).

Results

In the matched cohort, 1096 developed gout (IR: 2.52%) and 2195 died (IR: 5.05%). Univariable Cox regression showed that SGLT2I use was associated with lower risks of new diagnosis of gout (hazard ratio [HR]: 0.34; 95% confidence interval [CI]: 0.30–0.39; P-value&lt;0.0001) and all-cause mortality (HR: 0.35; 95% CI: 0.32–0.39; P-value&lt;0.0001) compared to DPP4I. The associated remained for both new diagnosis of gout (HR: 0.46; 95% CI: 0.37–0.57; P-value&lt;0.0001) and all-cause mortality (HR: 0.38; 95% CI: 0.33–0.44; P-value&lt;0.0001) after adjusting for significant demographics, past comorbidities, and non-SGLT2I/DPP4I medications. The risks of gout were lowered in each types of SGLT2I. The results were consistent on competing risk and other propensity score approaches analyses.

Conclusions

SGLT2I use was associated with lower risks of new gout diagnosis compared to DPP4I use.

Funding Acknowledgement

Type of funding sources: None.

Predictive value of neutrophil-to-lymphocyte ratio for atrial fibrillation and stroke in type 2 diabetes mellitus: a population-based cohort study

Introduction

Neutrophil-to-lymphocyte ratio (NLR) is a routinely available biomarker that reflects systemic inflammation. The study evaluated the predictive value of NLR for ischemic stroke and atrial fibrillation (AF) in patients with type 2 diabetes mellitus.

Methods

This was a population-based cohort study of patients with type 2 diabetes mellitus and complete blood count tests at baseline between January 1st, 2009 to December 31st, 2009 at government-funded hospitals/clinics in Hong Kong. Follow-up was until December 31st, 2019 or death.

Results

A total of 85351 patients (age=67.6±13.2 years old, male=48.8%, follow-up=3101±1441 days) were included. Univariable Cox regression found that increased NLR at quartiles 2, 3 and 4 was significantly associated with higher risks of new onset ischemic stroke (HR: 1.28 [1.20–1.37], P&lt;0.001, HR: 1.41 [1.32–1.51], P&lt;0.001 and HR: 1.38 [1.29–1.47], P&lt;0.001) and AF (hazard ratio [HR]: 1.09 [1.02–1.17], P&lt;0.015; HR: 1.28 [1.20–1.37], P&lt;0.001; HR: 1.39 [1.31–1.49], P&lt;0.001) compared to quartile 1. On multivariable analysis, NLR remained a significant predictor of ischemic stroke risk for quartiles 2 and 3 (quartile 2: HR: 1.14 [1.05, 1.22], p=0.001; quartile 3: HR: 1.14 [1.06, 1.23], p&lt;0.001) but not quartile 4 (HR: 1.08 [0.994, 1.17], p=0.070). By contrast, NLR was not predictive of AF after adjusting for confounders (quartile 2: HR: 0.966 [0.874, 1.07], p=0.499; quartile 3: HR: 0.978 [0.884, 1.08], p=0.661; quartile 4: HR: 1.05 [0.935, 1.16], p=0.462).

Conclusion

NLR is a significant predictor of new onset ischaemic stroke but not AF after adjusting for significant confounders.

Funding Acknowledgement

Type of funding sources: None.

[Artificial intelligence-assisted identification of mucus plugs in asthma]

Airway mucus plug is an important clinical feature of bronchial asthma and is related to the prognosis of the disease. Clinically, chest CT is a preferred tool for evaluating airway mucus plugs. At present, the interpretation of CT images relies on manual reading, but the airway mucus plugs of patients with bronchial asthma are mostly distributed in the small and medium airways, which are difficult to identify with the naked eye. In recent years, with the continuous progress of deep learning and big data technology, artificial intelligence (AI)-assisted image reading technology has been introduced into clinical application, which has significantly improved the efficiency and accuracy of mucus plug identification. Currently, AI-assisted airway mucus plug identification has been used in respiratory diseases such as cystic fibrosis, chronic obstructive pulmonary disease, and bronchial asthma. Therefore, the application of AI counting to mucus plugs in patients with bronchial asthma is of great significance.

Impact of variation in practice in the prenatal reporting of variants of uncertain significance by commercial laboratories: NEED FOR GREATER ADHERENCE TO PUBLISHED GUIDELINES

OBJECTIVE

To evaluate the impact of implementing commercial whole exome sequencing (WES) and targeted gene panel testing in pregnancies with fetal anomalies.

METHODS

A retrospective chart review of 124 patients with sequencing performed by commercial laboratories.

RESULTS

The diagnostic yield of WES and panel testing was 21.5% and 26% respectively, based on likely pathogenic (LP) or pathogenic (P) variants. Forty-two per cent of exomes and 32% of panels analyzed had one or more variant of uncertain significance (VUS) reported. A multidisciplinary in depth review of the fetal phenotype, disease phenotype, variant data, and, in some patients, additional prenatal or postnatal investigations increased the diagnostic yield by 5% for exome analysis and 6% for panel analysis.

CONCLUSIONS

The diagnostic yield of WES and panel testing combined was 23% based on LP and P variants. Although the reporting of VUS contributed to a 5% increase in diagnostic yield for WES and 6% for panels, the large number of VUS reported by commercial laboratories has significant resource implications. Our results support the need for greater adherence to the recommendations on the prenatal reporting of VUS and the importance of a multidisciplinary approach that brings together clinical and laboratory expertise in prenatal genetics and genomics. This article is protected by copyright. All rights reserved.

Lawson Criterion for Ignition Exceeded in an Inertial Fusion Experiment

For more than half a century, researchers around the world have been engaged in attempts to achieve fusion ignition as a proof of principle of various fusion concepts. Following the Lawson criterion, an ignited plasma is one where the fusion heating power is high enough to overcome all the physical processes that cool the fusion plasma, creating a positive thermodynamic feedback loop with rapidly increasing temperature. In inertially confined fusion, ignition is a state where the fusion plasma can begin "burn propagation" into surrounding cold fuel, enabling the possibility of high energy gain. While "scientific breakeven" (i.e., unity target gain) has not yet been achieved (here target gain is 0.72, 1.37 MJ of fusion for 1.92 MJ of laser energy), this Letter reports the first controlled fusion experiment, using laser indirect drive, on the National Ignition Facility to produce capsule gain (here 5.8) and reach ignition by nine different formulations of the Lawson criterion.

[Significance of aspergillus fumigatus-specific IgG in the diagnosis of allergic bronchopulmonary aspergillosis]

The data of 18 patients with allergic bronchopulmonary aspergillosis (ABPA) who received aspergillus fumigatus-specific IgG detection from 2015 to 2021 in Peking University Third Hospital were retrospectively analyzed. Among them, 11 were male and 7 were female, aged 18-79 years. All patients had a history of asthma or symptoms of cough and asthma, and aspergillus fumigatus-specific IgE was positive; 16 patients had total serum IgE>500 U/ml, of which 13 patients had total serum IgE>1 000 U/ml. Among other diagnostic indicators, peripheral blood eosinophils were >0.5×10⁹/L in 16 cases; lung CT showed bronchiectasis in 15 cases; serum aspergillus fumigatus-specific IgG was positive (>120 AU/ml) in 10 cases. There was no significant difference in serum total IgE level, peripheral blood eosinophil count, and bronchiectasis ratio between positive and negative cases of aspergillus fumigatus-specific IgG (all P>0.05). In this study, the positive rate of aspergillus fumigatus-specific IgG in patients with ABPA was more than 50%, which has auxiliary value in the diagnosis of ABPA.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

Moving beyond the 'CAP' of the Iceberg: Intrinsic connectivity networks in fMRI are continuously engaging and overlapping

Resting-state functional magnetic resonance imaging is currently the mainstay of functional neuroimaging and has allowed researchers to identify intrinsic connectivity networks (aka functional networks) at different spatial scales. However, little is known about the temporal profiles of these networks and whether it is best to model them as continuous phenomena in both space and time or, rather, as a set of temporally discrete events. Both categories have been supported by series of studies with promising findings. However, a critical question is whether focusing only on time points presumed to contain isolated neural events and disregarding the rest of the data is missing important information, potentially leading to misleading conclusions. In this work, we argue that brain networks identified within the spontaneous blood oxygenation level-dependent (BOLD) signal are not limited to temporally sparse burst moments and that these event present time points (EPTs) contain valuable but incomplete information about the underlying functional patterns. We focus on the default mode and show evidence that is consistent with its continuous presence in the BOLD signal, including during the event absent time points (EATs), i.e., time points that exhibit minimum activity and are the least likely to contain an event. Moreover, our findings suggest that EPTs may not contain all the available information about their corresponding networks. We observe distinct default mode connectivity patterns obtained from all time points (AllTPs), EPTs, and EATs. We show evidence of robust relationships with schizophrenia symptoms that are both common and unique to each of the sets of time points (AllTPs, EPTs, EATs), likely related to transient patterns of connectivity. Together, these findings indicate the importance of leveraging the full temporal data in functional studies, including those using event-detection approaches.

370 Evaluating Knowledge of Common Surgical Instruments During Early Surgical Training in the United Kingdom: A Call for Formalised Training?

Aim

Knowledge of surgical instruments and their use is essential to effective surgical practice, enabling efficient task-specific utilisation and promoting clear intraoperative communication; thus, reducing the risk of error. However, variations in surgical instruments across different specialities and eponymous names can pose barriers to learning for early surgical trainees. There is a paucity of data on surgical instrument knowledge among early surgical trainees, and their knowledge acquisition route.

Method

questionnaire was distributed among early surgical trainees (ST3 and below) between 18 August 2020 and 18 November 2020 across various UK regions. Respondents were asked to answer ten multiple-choice questions to assess their surgical instrument knowledge levels. Respondents were also asked about their training level, experience, and opinion regarding formal surgical instrument teaching.

Results

Thirty-seven trainees responded to the questionnaire. The majority (81%) received no formal surgical instrument training. Most respondents (96%) feel they would benefit from formal training. The average test score was 50%. There was no evidence of improved performance with formal training, though the formal training received averaged less than one hour. Higher scores were associated with increased seniority and training years, indicating most trainees are learning ‘on-the-job‘.

Conclusions

There is generally an unsatisfactory level of knowledge in surgical instruments in early surgical trainees. Trainees have also overwhelmingly indicated a desire for formalised training on surgical instruments. The authors believe the lack of formal training may contribute to this knowledge gap and intend to design a new short course to address this.

704 An Audit of Marking of Cutaneous Lesions in A Two-Week Wait Skin Malignancy Service

Aim

Clinical photography enhances a medical record and facilitates communication with other professionals involved in care. It is utilised frequently in the management of skin malignancy. The essence of good photography lies in accurate identification of the cutaneous lesion in question. National guidelines and local policy advise the use of circumferential marking to delineate a lesion of interest, and an alphabetical system for marking of multiple lesions. We audited compliance to standards for medical illustrations of cutaneous lesions in the two-week wait skin cancer clinic at University Hospital North Durham.

Method

Prospective audit of patients attending the clinic over a 7-day period (07/09/20-15/09/20). Data was collated from electronic records on a number of variables.

Results

175 patients met inclusion criteria. The majority (n = 160, 89.9%) were referred for a single lesion, the rest for multiple lesions. Hospital clinical photography was obtained in 148 patients (83.2%). Marking was deemed inappropriate in 44.6% of those in which clinical photography was obtained. Of these 66 cases, 12 cases were multiple lesions marked without letters, 52 had an incorrect indicator for the lesion (such as arrows or dots, allowing more ambiguous interpretation), and 8 had no indicator at all. Incidentally, one patient was photographed with dressings covering the lesions.

Conclusions

Compliance with standards for demarcation of skin lesions for clinical photography was found to be poor. This permits the wrong identification of lesions in future treatment episodes and could potentially have a significant impact on care. We propose the introduction of a referral document illustrating correct marking guidelines.

Effects of light regime on the hatching performance, body development and serum biochemical indexes in Beijing You Chicken

The paper aimed to study the effects of light regime during the incubation on hatching performance, body development and serum biochemical indexes in Beijing You Chicken (BYC). A total of 1,408 BYC eggs were randomly allocated into 4 groups: 24 h dark as the control (Inc24D); 3 light regimes were 8 h light and 16 h dark group (Inc8L:16D); 12 h light and 12 h dark group (Inc12L:12D); 16 h light and 8 h dark group (Inc16L:8D), respectively. There were 352 eggs in each group, 4 replicates each group and 1 tray each replicate, 88 eggs each tray. Light-emitting diode (LED) strips, white light with temperature of 4,500 to 5,000 K, 150 to 200 lx were set up. The results showed that light regimes had no significant effects on hatching rate of eggs, hatching rate of fertile eggs and healthy rate of chicks (P > 0.05), but the hatching rate of eggs was the lowest in the Inc24D group (87.22%), and the highest in the Inc12L:12D group (93.64%); Lighted incubation significantly affected the incidence of leg problems of 1-day-old chicks (P < 0.05). The incidence rate of leg problems was the highest in the Inc24D group (4.21%), and was decreased in Inc12L:12D and Inc16L:8D groups (P < 0.05). Femur length in the Inc12L:12D group was greater than that in the Inc24D and Inc16L:8D groups (P = 0.011), but there were no differences between Inc8L:16D group and other three groups (P > 0.05). The relative brain weight of 1-day-old chicks was higher in Inc24D and Inc16L:8D groups than in Inc8L:16D group (P = 0.052), but had no difference with Inc12L:12D group. Light regimes during incubation had no effects on serum total protein, albumen, globulin, and urea nitrogen content of 1-day-old chicks (P > 0.05), while the globulin content in Inc12L:12D group was numerically greater than in other three groups (P = 0.063). Lysozyme content in Inc12L:12D group was higher than that in the Inc24D and Inc8L:16D groups (P < 0.05), but had no difference with that in Inc16L:8D group. Light regime had no effect on serum total antioxidant capability (T-AOC) (P > 0.05), but significantly affected the activities of glutathione peroxidase (GSH-Px) and total superoxide dismutase (T-SOD) (P < 0.05). The GSH-Px and T-SOD activities in the Inc12L:12D group were higher than those in the Inc24D and Inc8L:16D groups. The MDA content of Inc24D was the highest (9.67 nmol/mL) compared to the others, which was very close to the significant level (P = 0.056). In conclusion, 12 h light and 12 h dark incubation has the potential to improve the hatching performance of BYC eggs, benefit for the long bone development, improve some serum immune and antioxidant indexes, and reduce the leg problems in 1-day-old chicks.

[Efficacy and safety of ticagrelor versus clopidogrel in Chinese patients with acute coronary syndrome treated with glycoprotein Ⅱb/Ⅲa receptor antagonist]

Objective: To explore the efficacy and safety of ticagrelor versus clopidogrel in acute coronary syndrome (ACS) Chinese patients using glycoprotein Ⅱb/Ⅲa inhibitor (GPI). Methods: The data from CCC-ACS (Improving Care for Cardiovascular Disease in China-ACS) project were systematically reviewed in ACS patients with GPI. The patients were divided into ticagrelor and clopidogrel groups. A logistic analysis and propensity score matching (PSM) were performed to compare occurrences of major cardiovascular events (MACE) and bleeding events between the two groups during hospitalization. Results: A total of 63 641 ACS patients were collected from 150 hospitals. Logistic regression analyses showed that there was no statistically significant difference in the reduction of MACE between ticagrelor and clopidogrel when using GPI (OR=0.881, 95%CI 0.599-1.296; P=0.521). However, major bleeding rate was higher in the ticagrelor group than that in the clopidogrel group (OR=1.401, 95%CI 1.075-1.852; P=0.013). Similar results were observed after PSM. No statistic difference in MACE between the ticagrelor and clopidogrel group (OR=0.919, 95%CI 0.613-1.376; P=0.681). Major bleeding rate was higher in the ticagrelor group (OR=1.559, 95%CI 1.130-2.150; P=0.007). Conclusion: In ACS patients with GPI, ticagrelor did not reduce MACE, but increased the major bleeding risk compared with clopidogrel.

The impact of PM2.5 on lung function in adults with asthma

OBJECTIVE: To conduct a systematic review of the literature and assess the effect of PM2.5 (particulate matter with diameter <2.5 μm) exposure on lung function in adults with asthma.METHODS: We searched all literature published between 1 January 2010 and 26 March 2019 in the EMBASE, PubMed, Cochrane Central Library, Chinese National Knowledge Infrastructure (CNKI), Wanfang and Chinese Biomedical Literature (CBM) databases. The studies were assessed for analytic methods, risk of bias and results of statistical analysis.RESULTS: The selected studies all had a low or moderate risk of bias. Overall, PM2.5 exposure was positively associated with a decrease in forced expiratory volume in 1 sec (FEV₁)/forced vital capacity (FVC) in adults with asthma (standardised mean difference 0.20, 95% CI 0.02-0.38; P = 0.03).CONCLUSION: We observed a negative correlation between PM2.5 exposure and FEV₁/FVC in patients with asthma. Our meta-analysis provides evidence suggesting that PM2.5 is a risk factor for acute asthma exacerbation in adults.

Prospects for beyond the Standard Model physics searches at the Deep Underground Neutrino Experiment: DUNE Collaboration

The Deep Underground Neutrino Experiment (DUNE) will be a powerful tool for a variety of physics topics. The high-intensity proton beams provide a large neutrino flux, sampled by a near detector system consisting of a combination of capable precision detectors, and by the massive far detector system located deep underground. This configuration sets up DUNE as a machine for discovery, as it enables opportunities not only to perform precision neutrino measurements that may uncover deviations from the present three-flavor mixing paradigm, but also to discover new particles and unveil new interactions and symmetries beyond those predicted in the Standard Model (SM). Of the many potential beyond the Standard Model (BSM) topics DUNE will probe, this paper presents a selection of studies quantifying DUNE's sensitivities to sterile neutrino mixing, heavy neutral leptons, non-standard interactions, CPT symmetry violation, Lorentz invariance violation, neutrino trident production, dark matter from both beam induced and cosmogenic sources, baryon number violation, and other new physics topics that complement those at high-energy colliders and significantly extend the present reach.

Dark Energy Survey Year 1 Results: Cosmological Constraints from Cluster Abundances, Weak Lensing, and Galaxy Correlations

We present the first joint analysis of cluster abundances and auto or cross-correlations of three cosmic tracer fields: galaxy density, weak gravitational lensing shear, and cluster density split by optical richness. From a joint analysis (4×2pt+N) of cluster abundances, three cluster cross-correlations, and the auto correlations of the galaxy density measured from the first year data of the Dark Energy Survey, we obtain Ω_{m}=0.305_{-0.038}^{+0.055} and σ_{8}=0.783_{-0.054}^{+0.064}. This result is consistent with constraints from the DES-Y1 galaxy clustering and weak lensing two-point correlation functions for the flat νΛCDM model. Consequently, we combine cluster abundances and all two-point correlations from across all three cosmic tracer fields (6×2pt+N) and find improved constraints on cosmological parameters as well as on the cluster observable-mass scaling relation. This analysis is an important advance in both optical cluster cosmology and multiprobe analyses of upcoming wide imaging surveys.

[Reliability and validity of Stanford Presenteeism Scale (SPS-6) in Chinese occupational population]

Objective: To investigate the reliability and validity of Stanford attendance scale (sps-6) in the study of attendance among professional groups. Methods: In August, 2018, the 1455 employees from 81 workplaces in Beijing, Shanghai, Jiangsu and Guangdong were randomly investigated as the subjects. The reliability and validity of sps-6 were analyzed by using the internal consistency reliability (Cronbach's coefficient) , half split half coefficient, content validity, integration validity, discrimination validity, cluster analysis and structural validity analysis. Results: Cronbach's coefficients of sps-6 scale, working process and work results were 0.692, 0.918 and 0.907, respectively; Guttman of scales and dimensions The split half coefficients were 0.792, 0.803 and 0.794, respectively; Pearson correlation coefficients of the total score of each item and scale were 0.526-0.673 (P<0.01) ; the qualification rate of set validity and differentiation validity were 100%; the results of cluster analysis supported the theoretical basis for the formation of the scale. The general non-standard fitting index (TLI) =0.982, approximate error mean square root mean square (RMSEA) =0.071, comparative fit index (CFI) =0.990, fit goodness index (GFI) =0.987, modified fit goodness index (AGFI) =0.965, Norm fit index (NFI) =0.990. The results showed that the scale had higher structural validity, and the results of sps-6 in the occupational population were (21.36±4.04) , and the distribution was normal (deviation was 0.053, peak was 0.023) . The scores of sps-6 scale were statistically different in various charactoristics of gender, age, education level, marital status, annual income, position, position level and industry (P< 0.01) . Conclusion: Stanford attendance scale has high reliability and validity, and can be applied to the study of attendance in professional groups.

Somatotropin increases plasma ceramide in relation to enhanced milk yield in cows

Recombinant bovine somatotropin (rBST) changes metabolism to spare glucose for milk synthesis in cows. Ceramides inhibit insulin responsiveness in bovine adipocytes and are associated with insulin resistance and milk production in cows. The mechanisms by which rBST supports lactation may involve ceramide. Eight multiparous lactating Holstein cows were enrolled in a 2 × 2 replicated Latin square design with 14-d periods. Cows received a single rBST injection (Posilac; Elanco Animal Health, Indianapolis, IN; 0.062 mg/kg BW) or no injection (CON). An epinephrine challenge, insulin tolerance test, and liver biopsy were performed. Somatotropin enhanced the conversion of feed nutrients into milk components and increased plasma free fatty acid (FFA) concentrations (P < 0.01). Area-under-the-curves for FFA in response to epinephrine and insulin were greater in rBST-treated cows. In response to insulin, glucose concentrations (20- and 30-min post-challenge) and insulin area-under-the-curve were higher with rBST treatment (P < 0.05, <0.10, and <0.01), suggesting insulin resistance. Somatotropin modified the plasma lipidome. For example, rBST decreased plasma di- and triacylglycerol levels (eg, DG-50:1 and TG-18:0/16:0/16:1), phosphatidylcholines and sphingomyelins (P < 0.05). Somatotropin increased plasma total and very-long-chain (C22:0-, C24:0-, C26:0-) ceramide concentrations (P < 0.01). Liver ceramide concentrations were not modified. Plasma ceramides were positively correlated with circulating FFA (r ~ 0.57; P < 0.05) and milk yield (r ~ 0.63; P < 0.05). We conclude that rBST administration modifies the bovine lipidome and increases plasma ceramide concentrations in association with increased milk production in cows.

Three-year outcomes of selective incomplete versus complete revascularization in heart failure patients receiving multivessel percutaneous coronary intervention

Background

Heart failure (HF) patients with multi-vessel disease (MVD) are often associated with comorbidities to limit the possibility to achieve complete revascularization (CR) in percutaneous coronary intervention (PCI). The planned selective incomplete revascularization (SIR) may be an alternative opinion for these patients.

Purpose

To investigate 3-year clinical outcomes of SIR versus CR in HF patients with MVD in a real-word registry.

Methods

A total of 566 HF patients with MVD receiving either SIR or CR were enrolled. SIR was planned pre-PCI based on clinical exams to avoid non-viable tissue revascularization. Major adverse cardiac events (MACEs) was a composite of in-hospital death, recurrent myocardial infarction, any revascularization, and all-cause death at 3-year follow-up.

Results

There was no significant differences between SIR and CR groups in in-hospital death, any revascularization, all-cause death and MACEs (24.3% vs. 24.9%, p=0.922). However, SIR had a significant lower incidence of recurrent myocardial infarction than CR (3.2% vs. 7.2%, p=0.032).

Conclusion

The 3-year outcomes of PCI with planned SIR were completely comparable to with CR in HF patients with MVD. Planned SIR can be an opinion for HF patients with MVD who are not suitable to achieve CR.

Kaplan-Meier curve of 3-year MACEs

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): Chang Gung Medical Research Program

Cenozoic evolution of the steppe-desert biome in Central Asia

The origins and development of the arid and highly seasonal steppe-desert biome in Central Asia, the largest of its kind in the world, remain largely unconstrained by existing records. It is unclear how Cenozoic climatic, geological, and biological forces, acting at diverse spatial and temporal scales, shaped Central Asian ecosystems through time. Our synthesis shows that the Central Asian steppe-desert has existed since at least Eocene times but experienced no less than two regime shifts, one at the Eocene-Oligocene Transition and one in the mid-Miocene. These shifts separated three successive "stable states," each characterized by unique floral and faunal structures. Past responses to disturbance in the Asian steppe-desert imply that modern ecosystems are unlikely to recover their present structures and diversity if forced into a new regime. This is of concern for Asian steppes today, which are being modified for human use and lost to desertification at unprecedented rates.

OP0291 TOFACITINIB FOR THE TREATMENT OF POLYARTICULAR COURSE JUVENILE IDIOPATHIC ARTHRITIS: RESULTS OF A PHASE 3, RANDOMISED, DOUBLE-BLIND, PLACEBO-CONTROLLED WITHDRAWAL STUDY

Background:

Tofacitinib is an oral JAK inhibitor that is being investigated for JIA.

Objectives:

To assess tofacitinib efficacy and safety in JIA patients (pts).

Methods:

This was a Phase 3, randomised, double-blind (DB), placebo (PBO)-controlled withdrawal study in pts aged 2−<18 years with polyarticular course JIA (pcJIA), PsA or ERA (NCT02592434). In the 18-week open-label Part 1, pts received weight-based tofacitinib doses (5 mg BID or lower). Pts with ≥JIA ACR30 response at Week (W)18 were randomised 1:1 in the DB Part 2 (W18−44) to continue tofacitinib or switch to PBO. Primary endpoint: disease flare rate by W44. Key secondary endpoints: JIA ACR50/30/70 response rates; change from Part 2 baseline (Δ) in CHAQ-DI at W44. Other efficacy endpoints: time to disease flare in Part 2; JADAS27-CRP in Parts 1 and 2. PsA/ERA pts were excluded from these efficacy analyses. Safety was evaluated in all pts up to W44.

Results:

225 enrolled pts with pcJIA (n=184), PsA (n=20) or ERA (n=21) received tofacitinib in Part 1. At W18, 173/225 (76.9%) pts entered Part 2 (pcJIA n=142, PsA n=15, ERA n=16). In pcJIA pts, disease flare rate in Part 2 was significantly lower with tofacitinib vs PBO by W44 (p=0.0031; Fig 1a). JIA ACR50/30/70 response rates (Fig 1b) and ΔCHAQ-DI (Fig 1c) at W44, and time to disease flare in Part 2 (Fig 2a), were improved with tofacitinib vs PBO. Tofacitinib reduced JADAS27-CRP in Part 1; this effect was sustained in Part 2 (Fig 2b). Overall, safety was similar with tofacitinib or PBO (Table): 77.3% and 74.1% had adverse events (AEs); 1.1% and 2.4% had serious AEs. In Part 1, 2 pts had herpes zoster (non-serious) and 3 pts had serious infections (SIs). In Part 2, SIs occurred in 1 tofacitinib pt and 1 PBO pt. No pts died.

Conclusion:

In pcJIA pts, tofacitinib vs PBO resulted in significantly fewer disease flares, and improved time to flare, disease activity and physical functioning. Tofacitinib safety was consistent with that in RA pts.

Table.

Safety in all pts

Part 1Part 2TofacitinibaN=225TofacitinibaN=88PBO N=85Pts with events, n (%)AEs153 (68.0)68 (77.3)63 (74.1)SAEs7 (3.1)1 (1.1)2 (2.4)Permanent discontinuations due to AEs26 (11.6)16 (18.2)29 (34.1)AEs of special interest Death000 Gastrointestinal perforationb000 Hepatic eventb3 (1.3)00 Herpes zoster (non-serious and serious)2 (0.9)c00 Interstitial lung diseaseb000 Major adverse cardiovascular eventsb000 Malignancy (including non-melanoma skin cancer)b000 Macrophage activation syndromeb000 Opportunistic infectionb000 SI3 (1.3)1 (1.1)d1 (1.2) Thrombotic event (deep vein thrombosis, pulmonary embolismbor arterial thromboembolism)000 Tuberculosisb000

a5 mg BID or equivalent weight-based lower dose in pts <40 kg

bAdjudicated events

cBoth non-serious

dOne SAE of pilonidal cyst repair was coded to surgical procedures instead of infections, and was inadvertently not identified as an SI. Following adjudication, the SAE did not meet opportunistic infection criteria; it is also included in the table as an SI

AE, adverse event; BID, twice daily; PBO, placebo; pts, patients; SAE, serious AE; SI, serious infection

Acknowledgments:

Study sponsored by Pfizer Inc. Medical writing support was provided by Sarah Piggott of CMC Connect and funded by Pfizer Inc.

Disclosure of Interests:

Nicolino Ruperto Grant/research support from: Bristol-Myers Squibb, Eli Lily, F Hoffmann-La Roche, GlaxoSmithKline, Janssen, Novartis, Pfizer, Sobi (paid to institution), Consultant of: Ablynx, AbbVie, AstraZeneca-Medimmune, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lily, EMD Serono, GlaxoSmithKline, Hoffmann-La Roche, Janssen, Merck, Novartis, Pfizer, R-Pharma, Sanofi, Servier, Sinergie, Sobi, Takeda, Speakers bureau: Ablynx, AbbVie, AstraZeneca-Medimmune, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lily, EMD Serono, GlaxoSmithKline, Hoffmann-La Roche, Janssen, Merck, Novartis, Pfizer, R-Pharma, Sanofi, Servier, Sinergie, Sobi, Takeda, Olga Synoverska Speakers bureau: Sanofi, Tracy Ting: None declared, Carlos Abud-Mendoza Speakers bureau: Eli Lilly, Pfizer Inc, Alberto Spindler Speakers bureau: Eli Lilly, Yulia Vyzhga Grant/research support from: Pfizer Inc, Katherine Marzan Grant/research support from: Novartis, Vladimir Keltsev: None declared, Irit Tirosh: None declared, Lisa Imundo: None declared, Rita Jerath: None declared, Daniel Kingsbury: None declared, Betül Sözeri: None declared, Sheetal Vora: None declared, Sampath Prahalad Grant/research support from: Novartis, Elena Zholobova Grant/research support from: Novartis and Pfizer Inc, Speakers bureau: AbbVie, Novartis, Pfizer Inc and Roche, Yonatan Butbul Aviel: None declared, Vyacheslav Chasnyk: None declared, Melissa Lerman Grant/research support from: Amgen, Kabita Nanda Grant/research support from: Abbott, AbbVie, Amgen and Roche, Heinrike Schmeling Grant/research support from: Janssen, Pfizer Inc, Roche and USB Bioscience, Heather Tory: None declared, Yosef Uziel Speakers bureau: Pfizer Inc, Diego O Viola Grant/research support from: Bristol-Myers Squibb, GSK, Janssen and Pfizer Inc, Speakers bureau: AbbVie and Bristol-Myers Squibb, Holly Posner Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Keith Kanik Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Ann Wouters Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Cheng Chang Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Richard Zhang Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Irina Lazariciu Consultant of: Pfizer Inc, Employee of: IQVIA, Ming-Ann Hsu Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Ricardo Suehiro Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Alberto Martini Consultant of: AbbVie, Eli Lily, EMD Serono, Janssen, Novartis, Pfizer, UCB, Daniel J Lovell Consultant of: Abbott (consulting and PI), AbbVie (PI), Amgen (consultant and DSMC Chairperson), AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb (PI), Celgene, Forest Research (DSMB Chairman), GlaxoSmithKline, Hoffman-La Roche, Janssen (co-PI), Novartis (consultant and PI), Pfizer (consultant and PI), Roche (PI), Takeda, UBC (consultant and PI), Wyeth, Employee of: Cincinnati Children’s Hospital Medical Center, Speakers bureau: Wyeth, Hermine Brunner Consultant of: Hoffman-La Roche, Novartis, Pfizer, Sanofi Aventis, Merck Serono, AbbVie, Amgen, Alter, AstraZeneca, Baxalta Biosimilars, Biogen Idec, Boehringer, Bristol-Myers Squibb, Celgene, EMD Serono, Janssen, MedImmune, Novartis, Pfizer, and UCB Biosciences, Speakers bureau: GSK, Roche, and Novartis