Collaborative research in myositis-related disorders: MIHRA, a global shared community model

Myositis International Health and Research Collaborative Alliance (MIHRA) is a newly formed purpose-built non-profit charitable research organization dedicated to accelerating international clinical trial readiness, global professional and lay education, career development and rare disease advocacy in IIM-related disorders. In its long form, the name expresses the community's scope of engagement and intent. In its abbreviation, MIHRA, conveys linguistic roots across many languages, that reflects the IIM community's spirit with meanings such as kindness, community, goodness, and peace. MIHRA unites the global multi-disciplinary community of adult and pediatric healthcare professionals, researchers, patient advisors and networks focused on conducting research in and providing care for pediatric and adult IIM-related disorders to ultimately find a cure. MIHRA serves as a resourced platform for collaborative efforts in investigator-initiated projects, consensus guidelines for IIM assessment and treatment, and IIM-specific career development through connecting research networks.MIHRA's infrastructure, mission, programming and operations are designed to address challenges unique to rare disease communities and aspires to contribute toward transformative models of rare disease research such as global expansion and inclusivity, utilization of community resources, streamlining ethics and data-sharing policies to facilitate collaborative research. Herein, summarises MIHRA operational cores, missions, vision, programming and provision of community resources to sustain, accelerate and grow global collaborative research in myositis-related disorders.

Limits to Gauge Coupling in the Dark Sector Set by the Nonobservation of Instanton-Induced Decay of Super-Heavy Dark Matter in the Pierre Auger Observatory Data

Instantons, which are nonperturbative solutions to Yang-Mills equations, provide a signal for the occurrence of quantum tunneling between distinct classes of vacua. They can give rise to decays of particles otherwise forbidden. Using data collected at the Pierre Auger Observatory, we search for signatures of such instanton-induced processes that would be suggestive of super-heavy particles decaying in the Galactic halo. These particles could have been produced during the post-inflationary epoch and match the relic abundance of dark matter inferred today. The nonobservation of the signatures searched for allows us to derive a bound on the reduced coupling constant of gauge interactions in the dark sector: α_{X}≲0.09, for 10^{9}≲M_{X}/GeV<10^{19}. Conversely, we obtain that, for instance, a reduced coupling constant α_{X}=0.09 excludes masses M_{X}≳3×10^{13}  GeV. In the context of dark matter production from gravitational interactions alone, we illustrate how these bounds are complementary to those obtained on the Hubble rate at the end of inflation from the nonobservation of tensor modes in the cosmological microwave background.

CD98 defines a metabolically flexible, proinflammatory subset of low-density neutrophils in systemic lupus erythematosus

BACKGROUND

Low-density neutrophils (LDN) are a distinct subset of neutrophils rarely detected in healthy people but appear in the blood of patients with autoimmune diseases, including systemic lupus erythematosus (SLE), and are mobilised in response to granulocyte colony-stimulating factor (G-CSF). The aim of this study was to identify novel mechanisms responsible for the pathogenic capacity of LDN in SLE.

METHODS

Neutrophils were isolated from donors treated with G-CSF, and whole-cell proteomic analysis was performed on LDN and normal-density neutrophils.

RESULTS

CD98 is significantly upregulated in LDN from G-CSF donors and defines a subset of LDN within the blood of SLE patients. CD98 is a transmembrane protein that dimerises with L-type amino acid transporters. We show that CD98 is responsible for the increased bioenergetic capacity of LDN. CD98 on LDN mediates the uptake of essential amino acids that are used by mitochondria to produce adenosine triphosphate, especially in the absence of glucose. Inhibition of CD98 reduces the metabolic flexibility of this population, which may limit their pathogenic capacity. CD98⁺ LDN produce more proinflammatory cytokines and chemokines than their normal density counterparts and are resistant to apoptosis, which may also contribute to tissue inflammation and end organ damage in SLE.

CONCLUSIONS

CD98 provides a phenotypic marker for LDN that facilitates identification of this population without density-gradient separation and represents a novel therapeutic target to limit its pathogenic capacity.

Using magnetic resonance imaging to map the hidden burden of muscle involvement in systemic sclerosis

BACKGROUND

Skeletal muscle can be directly affected by systemic sclerosis (SSc); however, a significant burden of SSc-associated myopathy is undetected because clinical parameters such as weakness and creatine kinase (CK) are unreliable biomarkers of muscle involvement. This study presents qualitative and quantitative magnetic resonance imaging (MRI) findings that quantify the prevalence of myopathy and evaluate any association between skeletal and cardiac muscle involvement in SSc.

METHODS

Thirty-two patients with SSc who fulfilled the 2013 American College of Rheumatology/European League Against Rheumatism classification criteria underwent skeletal muscle MRI in addition to cardiac MRI. Skeletal muscles were independently assessed by two musculoskeletal radiologists for evidence of oedema, fatty infiltration and atrophy. Skeletal muscle T2 mapping times and percentage fat fraction were calculated. Linear regression analysis was used to evaluate the clinical and myocardial associations with skeletal muscle oedema and fatty infiltration. Cardiac MRI was performed using post gadolinium contrast imaging and parametric mapping techniques to assess focal and diffuse myocardial fibrosis.

RESULTS

Thirteen participants (40.6%) had MRI evidence of skeletal muscle oedema. Five (15.6%) participants had fatty infiltration. There was no association between skeletal muscle oedema and muscle strength, creatine kinase, inflammatory markers or fibroinflammatory myocardial disease. Patients with skeletal muscle oedema had higher T2-mapping times; there was a significant association between subjective assessments of muscle oedema and T2-mapping time (coef 2.46, p = 0.02) and percentage fat fraction (coef 3.41, p = 0.02). Diffuse myocardial fibrosis was a near-universal finding, and one third of patients had focal myocardial fibrosis. There was no association between skeletal myopathy detected by MRI and burden of myocardial disease.

CONCLUSIONS

MRI is a sensitive measure of muscle oedema and systematic assessment of SSc patients using MRI shows that myopathy is highly prevalent, even in patients without symptoms or other signs of muscle involvement. Similarly, cardiac fibrosis is highly prevalent but occurs independently of skeletal muscle changes. These results indicate that novel quantitative MRI techniques may be useful for assessing sub-clinical skeletal muscle disease in SSc.

Measurement of the Fluctuations in the Number of Muons in Extensive Air Showers with the Pierre Auger Observatory

We present the first measurement of the fluctuations in the number of muons in extensive air showers produced by ultrahigh energy cosmic rays. We find that the measured fluctuations are in good agreement with predictions from air shower simulations. This observation provides new insights into the origin of the previously reported deficit of muons in air shower simulations and constrains models of hadronic interactions at ultrahigh energies. Our measurement is compatible with the muon deficit originating from small deviations in the predictions from hadronic interaction models of particle production that accumulate as the showers develop.

Lettuce (Lactuca sativa) productivity influenced by microbial inocula under nitrogen-limited conditions in aquaponics

The demand for food will outpace productivity of conventional agriculture due to projected growth of the human population, concomitant with shrinkage of arable land, increasing scarcity of freshwater, and a rapidly changing climate. While aquaponics has potential to sustainably supplement food production with minimal environmental impact, there is a need to better characterize the complex interplay between the various components (fish, plant, microbiome) of these systems to optimize scale up and productivity. Here, we investigated how the commonly-implemented practice of continued microbial community transfer from pre-existing systems might promote or impede productivity of aquaponics. Specifically, we monitored plant growth phenotypes, water chemistry, and microbiome composition of rhizospheres, biofilters, and fish feces over 61-days of lettuce (Lactuca sativa var. crispa) growth in nitrogen-limited aquaponic systems inoculated with bacteria that were either commercially sourced or originating from a pre-existing aquaponic system. Lettuce above- and below-ground growth were significantly reduced across replicates treated with a pre-existing aquaponic system inoculum when compared to replicates treated with a commercial inoculum. Reduced productivity was associated with enrichment in specific bacterial genera in plant roots, including Pseudomonas, following inoculum transfer from pre-existing systems. Increased productivity was associated with enrichment of nitrogen-fixing Rahnella in roots of plants treated with the commercial inoculum. Thus, we show that inoculation from a pre-existing system, rather than from a commercial inoculum, is associated with lower yields. Further work will be necessary to test the putative mechanisms involved.

Features of the Energy Spectrum of Cosmic Rays above 2.5×10^{18} eV Using the Pierre Auger Observatory

We report a measurement of the energy spectrum of cosmic rays above 2.5×10^{18}  eV based on 215 030 events. New results are presented: at about 1.3×10^{19}  eV, the spectral index changes from 2.51±0.03(stat)±0.05(syst) to 3.05±0.05(stat)±0.10(syst), evolving to 5.1±0.3(stat)±0.1(syst) beyond 5×10^{19}  eV, while no significant dependence of spectral features on the declination is seen in the accessible range. These features of the spectrum can be reproduced in models with energy-dependent mass composition. The energy density in cosmic rays above 5×10^{18}  eV is [5.66±0.03(stat)±1.40(syst)]×10^{53}  erg Mpc^{-3}.

Immune-mediated necrotising myopathy: A critical review of current concepts

Immune-mediated necrotising myopathy (IMNM) is a relatively recently described form of idiopathic inflammatory myopathy (IIM) that is characterised by progressive proximal weakness and few extra-muscular manifestations. Prominent myonecrosis, muscle fibre regeneration and a relative paucity of intramuscular lymphocytes are seen histologically. Immunological mechanisms are believed to underpin the pathogenesis, and intense immunotherapy is frequently required. Disease is often severe and neuromuscular recovery may be poor. Recently there has been an impressive international research effort to understand and characterise this emerging condition, although much remains unknown. Significant advances in the field include the discovery of specific autoantibodies, increased understanding of the risk factors, clinical characteristics and treatment options owing to a wealth of observational studies, and the development of novel classification criteria. Herein we review the current evidence regarding the pathophysiology, clinical presentation, histological features and serological profiles associated with this condition. Diagnostic approaches are discussed, including the role of muscle MRI and antibodies targeting 3‑hydroxy-3-methylglutaryl-CoA reductase (HMGCR) and signal-recognition peptide (SRP), and a review of current treatment recommendations is provided.

Temporal variability in particle-associated pesticide exposure in a temporarily open estuary, Western Cape, South Africa

This study assesses the risk of current-use pesticides in a temporarily open estuary in South Africa by developing probabilistic risk estimates. Particle-associated pesticides (chlorpyrifos, prothiofos, cypermethrin, fenvalerate, endosulfan and p,p-DDE) and physicochemical parameters (salinity, temperature, flow, and total organic content (TOC)) were measured in the Lourens River estuary (Western Cape) twice a month over a period of two years and equilibrium partitioning theory was applied to calculate concentrations of pesticides in the water. The 90th percentile concentrations of pesticides associated to suspended particles and the calculated concentrations in water were 34.0microg kg(-1) and 0.15microg l(-1) for prothiofos, 19.6microg kg(-1) and 0.45microg l(-1) for chlorpyrifos and 18.6microg kg(-1) and 0.16microg l(-1) for endosulfan. Highest average concentrations were found around the summer season due to higher application rates and as a result of the low flow during this season. Species sensitivity distribution indicated a 1.5-2.8 times higher toxicity (hazardous concentration HC5) for marine organisms compared to freshwater organisms. The calculated concentrations in the water exceeded all threshold values suggested by international water guidelines. Chlorpyrifos and endosulfan posed the highest acute risk to the Lourens River estuary. No sufficient toxicity data and threshold values were found for prothiofos.

Separation of metalloporphyrins by capillary electrophoresis with UV detection and inductively coupled plasma mass spectrometric detection

Vitamin B12, cobalt protoporphyrin, manganese protoporphyrin, and zinc protoporphyrin were separated using capillary electrophoresis, and a comparison was made between detection with inductively coupled plasma mass spectrometry (ICP-MS) and UV detection. Absolute limits of detection were slightly better with ICP-MS detection than with UV detection, but for both methods absolute detection limits were in the picogram range. The migration times of the analytes decreased by several minutes when ICP MS detection was employed, and this phenomenon was believed to be a result of a "suction effect" that developed when the CE capillary was interfaced to the ICP-MS nebulizer. However, the resolution between species containing the same metal atom was not altered significantly, and the separation was completed in much less time relative to separations performed with UV detection.

Mucormycosis in a patient with sarcoidosis

Mucormycosis is a rare complication of sarcoidosis. We report only the third instance of mucormycosis occurring in a patient with sarcoidosis. Corticosteroid therapy, even short courses of less than one month duration, appears to be a major risk factor for the development of mucormycosis. Mucormycosis should be suspected upon the development of signs and symptoms of chronic sinusitis, necrotic nasal discharge, proptosis or periorbital edema. Mucormycosis is confirmed on routine hematoxylin and eosin stains by the identification of tissue invasion by the broad, aseptate mucor fungi. Prompt identification of the infection is essential to reduce morbidity and prevent mortality.

Spuriously high free thyroxine with the Amerlite MAB FT4 assay

In the Amerlite MAB FT4 assay, as stated by the manufacturer, FT4 values should be normal in patients with anti-thyroid hormone autoantibodies. The case of a 69 year old woman with a spuriously high FT4 using the Amerlite MAB FT4 assay is reported. Laboratory investigations showed that her spurious FT4 result was likely to have been caused by anti-thyroid hormone autoantibodies.

Hemoptysis during sexual intercourse. Unusual manifestation of coronary artery disease

Sexual activity increases physiologic demands on the cardiovascular system. A patient with stable angina pectoris experienced recurrent bouts of hemoptysis caused by left ventricular failure that occurred only during sexual activity. Severe atherosclerotic coronary vascular disease was confirmed by cardiac catheterization. The patient underwent successful coronary artery bypass grafting; nine months after surgery, he is sexually active and symptom-free.

Natural history of fever following seizure

Generalized tonic-clonic seizure, like vigorous exercise, can cause a rise in body temperature. To describe the course of fever following a generalized seizure, the temperature curves of 93 hospitalized postictal patients were reviewed retrospectively. Forty patients (43%) had an elevation of body temperature above 37.8 degrees C (100 degrees F). No underlying infectious illness was identified in two thirds of the febrile patients, 89% of whom had become and remained afebrile by 48 hours. One third of the febrile patients who did have an infection were still febrile after 48 hours. This finding may help clinicians determine the timing of appropriate tests to rule out infections during the postictal period.

Effect of massage on serum level of beta-endorphin and beta-lipotropin in healthy adults

We conducted this study to evaluate the effect of massage on the levels of endogenous opiates in peripheral venous blood. The results were based on findings from 21 healthy, adult volunteers. After separation by sex, the volunteers were assigned randomly to either the Control Group (n = 11) that rested but received no massage or the Experimental Group (n = 10) that received a 30-minute complete back massage. We found no significant pretreatment or posttreatment difference in blood beta-endorphin or beta-lipotropin levels between the groups. The results indicate that massage did not change significantly the measured serum levels of beta-endorphin or beta-lipotropin in our healthy subjects without pain. A follow-up study using patients experiencing acute or chronic back pain is recommended. Massage is used routinely in the treatment of such patients, and endogenous opiates are recognized as a possible mechanism for pain relief.

Graduate Record Examination Analytical scores as predictors of academic success in four entry-level master's degree physical therapy programs

This study was conducted to determine the efficacy of the Graduate Record Examination-Analytical (GRE-A) score in predicting the final grade point averages (GPAs) of student in physical therapy education programs. Data from four entry-level master's degree physical therapy programs were analyzed using a step-wise multiple regression analysis procedure. The data were grouped to determine differences between the experimental and the newly revised formats of the GRE-A measure, in addition to any differences among programs. The GRE-A score was a significant (p less than .05) predictor of final GPA in some instances in two of the four programs, regardless of format. In two programs, the GRE-A score was not a statistically significant predictor, regardless of format or how scores were grouped. The GRE-A score was not as useful alone as when combined with other predictor variables such as preadmission overall GPA, sex, and race. Further research is needed with a larger sample of students to assess more thoroughly the newly revised format of the GRE-A measure.

Beyond lecture and laboratory in the physical therapy classroom

The purpose of this paper is to describe how two teaching models, the Inquiry Training Model and the Simulation Model, have been adapted for use in the physical therapy classroom. To help students synthesize the various physical therapy skills they were learning, variations of the Inquiry Training Model and the Simulation Model were used in addition to standard lectures and laboratories to teach the Evaluation Unit to junior level physical therapy students. The feedback obtained at the end of each class from both students and faculty members indicated that the learning experiences were considered both helpful and fun. This article summarizes the important components of the Inquiry Training Model and the Simulation Model. I recommend learning experiences based on these models to augment lecture and laboratory classes.

Inter-population comparisons of urinary catecholamines: a pilot study

Urinary catecholamine excretion rates, previously shown to be related to lifestyles and environmental influences, were investigated in three traditional-living populations and in an English population. Significant inter-population differences in excretion rates and in creatinine-related excretion were observed. These included high daytime levels of adrenaline output in the traditional groups relative to the English group. Methodological problems are discussed.

Experimental validation of self-instructional modules on the topic of donor phlebotomy

This validation study investigated the effectiveness of an instructional unit on the topic of donor phlebotomy. The unit consisting of 3 modules based on a videotape and 3 booklets covered (1) donor selection, (2) donor arm preparation, (3) donor phlebotomy. A separate-sample pretest-post-test design was used. All 3 modules were found to be instructionally effective as measured by objective referenced tests. Student appraisal data also was collected for the purpose of revising and improving these materials.

Repeated gonorrhea: an analysis of importance and risk factors

This study was designed to assess the epidemiological importance of repeated infections due to Neisseria gonorrhoeae and to analyze variables potentially associated with repeated gonorrhea. The retrospective analysis was of 7,347 patients seen during one year, and the prospective study was of a stratified randomly selected sample of 429 patients. The 492 retrospectively identified repeaters constituted 0.06% of the county population and 6.7% of the clinic population. The 492 repeaters had 21.6% of the cases of gonorrhea reported from the county and 29.4% of the cases reported from the clinic. The repeaters tended to be younger than those without repeated infection (P less than 0.001), male (62%), black (81.7%), and residents of areas of lower socioeconomic status than those who were not repeaters (P less than 0.001). Most repeaters (73.5%) had not graduated from high school. Repeaters did not have significantly greater numbers of sex partners (P greater than 0.05) or greater exposure to prostitutes or clients than those who did not have repeated infections and less frequently had sexual contact while symptomatic. Intensive follow-up of the small number of high-risk repeaters and their contacts could result in a major reduction in the number of reported cases of gonorrhea.