Designing policy for Earth's urban future

Global impacts of cities must be better conveyed to multilateral organizations.

Ticagrelor inverse agonist activity at the P2Y12 receptor is non-reversible versus its endogenous agonist adenosine 5´-diphosphate

BACKGROUND AND PURPOSE

Ticagrelor is labelled as a reversible, direct-acting platelet P2Y12 receptor (P2Y12 R) antagonist that is indicated clinically for the prevention of thrombotic events in patients with acute coronary syndrome (ACS). As with many antiplatelet drugs, ticagrelor therapy increases bleeding risk in patients, which may require platelet transfusion in emergency situations. The aim of this study was to further examine the reversibility of ticagrelor at the P2Y12 R.

EXPERIMENTAL APPROACH

Studies were performed in human platelets, with P2Y12 R-stimulated GTPase activity and platelet aggregation assessed. Cell-based bioluminescence resonance energy transfer (BRET) assays were undertaken to assess G protein-subunit activation downstream of P2Y12 R activation.

KEY RESULTS

Initial studies revealed that a range of P2Y12 R ligands, including ticagrelor, displayed inverse agonist activity at P2Y12 R. Only ticagrelor was resistant to washout and, in human platelet and cell-based assays, washing failed to reverse ticagrelor-dependent inhibition of ADP-stimulated P2Y12 R function. The P2Y12 R agonist 2MeSADP, which was also resistant to washout, was able to effectively compete with ticagrelor. In silico docking revealed that ticagrelor and 2MeSADP penetrated more deeply into the orthosteric binding pocket of the P2Y12 R than other P2Y12 R ligands.

CONCLUSION AND IMPLICATIONS

Ticagrelor binding to P2Y12 R is prolonged and more akin to that of an irreversible antagonist, especially versus the endogenous P2Y12 R agonist ADP. This study highlights the potential clinical need for novel ticagrelor reversal strategies in patients with spontaneous major bleeding, and for bleeding associated with urgent invasive procedures.

Preoperative evaluation of nerve transfer recipients after spinal cord injury using stimulated manual muscle testing

Nerve transfer after spinal cord injury has become increasingly popular. Accurate preoperative identification of lower motor neuron involvement in potential recipient nerves is critical. Electrodiagnostic testing has been shown to correlate with intraoperative findings; however, it is time-consuming, costly and may not be readily available. Stimulated manual muscle testing is an alternative diagnostic approach. It is inexpensive and easily done by the surgeon or therapist in the office; however, correlation with intraoperative stimulation has not been reported. A retrospective review was conducted for patients who underwent nerve transfer for tetraplegia with recorded preoperative stimulated manual muscle testing and intraoperative stimulation results. Nine patients including 37 nerve transfers were included. Of the 37 nerve transfers, 36 were accurately graded preoperatively by stimulated manual muscle testing. Stimulated manual muscle testing had a sensitivity of 89%, specificity of 100%, positive predictive value of 100% and a negative predictive value of 97%. This study supports stimulated manual muscle testing for preoperative distinction between upper versus lower motor neuron injuries.Level of evidence: IV.

How do density, employment and transit affect the prevalence of COVID-19 pandemic? A study of 3,141 counties across the United States

Previous research has explored the effect of the built environment on the spread of the coronavirus disease (COVID-19) pandemic. This study extends the existing literature by examining the relationship between pandemic prevalence and density, employment, and transit factors at the county level. Using multilinear spatial-lag regressions and time series clustering analyses on the Smart Location Database encompassing 3141 counties in the United States, our findings reveal the following: (1) Density, employment, and transit variables yield heterogeneous effects to infection rate, death rate, and mortality rate. (2) Pedestrian-oriented road density is positively correlated to the prevalence of COVID-19, every 0.011 miles/acre increase is associated with 1% increase in the infection rate. (3) A consistent negative correlation is observed between jobs per household and infection rate, while a decrease in unemployment rate leads to an increase in the death rate. (4) The results from time series analysis suggest that areas characterized by low auto-oriented intersection density but high pedestrian-oriented road density are more susceptible to the impacts of pandemics. This highlights the need to prioritize pandemic prevention efforts in the suburban and rural areas with low population density, as emphasized in existing literature emphasized.

Improving hand function after spinal cord injury

Nerve transfer surgery has expanded reconstructive options for restoring upper extremity function following spinal cord injury. By adding new motor donors to the pool already available through tendon transfers, the effectiveness of treatment should improve. Planning which procedures and in which order to perform, along with their details must be delineated. To meet these demands, refined diagnostics are needed, along with awareness of the remaining challenges to restore intrinsic muscle function and to address spasticity and its consequences. This article summaries recent advances in surgical reanimation of upper extremity motor control, together with an overview of the development of neuro-prosthetic and neuromodulation techniques to modify recovery or substitute for functional losses after spinal cord injuries.

Comparing tweet sentiments in megacities using machine learning techniques: In the midst of COVID-19

COVID-19 was announced by the World Health Organization as a pandemic on March 11, 2020. Not only has COVID-19 struck the economy and public health, but it also has deep influences on people's feelings. Twitter, as an active social media, is a great database where we can investigate people's sentiments during this pandemic. By conducting sentiment analysis on Tweets using advanced machine learning techniques, this study aims to investigate how public sentiments respond to the pandemic from March 2 to May 21, 2020 in New York City, Los Angeles, London, and another six global mega-cities. Results showed that across cities, negative and positive Tweet sentiment clustered around mid-March and early May, respectively. Furthermore, positive sentiments of Tweets from New York City and London were positively correlated with stricter quarantine measures, although this correlation was not significant in Los Angeles. Meanwhile, Tweet sentiments of all three cities did not exhibit a strong correlation with new cases and hospitalization. Last but not least, we provide a qualitative analysis of the reasons behind differences in correlations shown above, along with a discussion of the polarizing effect of public policies on Tweet sentiments. Thus, the results of this study imply that Tweet sentiment is more sensitive to quarantine orders than reported statistics of COVID-19, especially in populous megacities where public transportation is heavily relied upon, which calls for prompt and effective quarantine measures during contagious disease outbreaks.

Health care cost impact associated with adverse events (AEs) among treatments in third-line+ (3L+) relapsed/refractory follicular lymphoma (R/R FL)

e18836

Background: Tazemetostat, a first-in-class oral, selective methyltransferase inhibitor of enhancer of zeste homolog 2 (EZH2) activity, was approved by the US Food and Drug Administration for treatment of patients with R/R FL after demonstrating single-agent antitumor activity in patients with wild-type or mutant EZH2. Phosphoinositide 3-kinase inhibitors (PI3Kis; idelalisib, duvelisib, and copanlisib) are also indicated for 3L+ R/R FL, but these drugs are associated with serious toxicities, such as neutropenia, infection, and immune-mediated toxicities. A matching-adjusted indirect comparison (MAIC) of tazemetostat with these 3 PI3Kis was previously presented in 3L+ R/R FL, showing that tazemetostat is associated with more favorable safety, and similar efficacy compared to each of the PI3Kis. The objective of this study was to estimate the difference in AE-related health care costs for each treatment. Methods: AE-related costs were sourced from a study of costs in patients hospitalized with AEs, using oncology-specific data when available. Matching-adjusted AE incidence was multiplied by costs related to each AE. Grade ≥3 AEs with incidence ≥5% for any of the evaluated treatments were included. Cost differences were estimated per treatment episode, based on duration of exposure in the tazemetostat clinical trial (9.3 months for tazemetostat, <7 months for the 3 comparators). Incidence rates were then converted to a monthly basis using an exponential curve. Results: The PI3Kis are estimated to incur $13,534 to $18,737 higher AE-related management costs per episode compared with tazemetostat. Adjusting for duration of exposure, each of the PI3Kis is project to cost $2,563 to $3,820 more per month than tazemetostat in AE-related costs. These estimates indicate that the AE-related cost impact of PI3Kis compared with tazemetostat is 3.4- to 6.1-fold higher on a per-episode basis, and 5.0- to 10.4-fold higher on a monthly basis. Conclusions: Quantifying the AE cost impact of tazemetostat based on AE incidence rates estimated by MAIC analysis adjusts for population differences and allows for more direct cost savings comparisons when accounting for duration of exposure to different treatments. Patients with 3L+ R/R FL who are treated with tazemetostat are estimated to incur substantially lower AE-related costs compared with PI3Kis (idelalisib, duvelisib, and copanlisib). [Table: see text]

A qualitative investigation into the perceived therapeutic benefits and barriers of a surf therapy intervention for youth mental health

OBJECTIVE

This study aims to investigate potential therapeutic pathways and barriers to participation in a surf therapy program for youth at risk of mental health problems from the perspective of participants, surf mentors and program coordinator.

METHOD

Nineteen individuals, consisting of youth (n = 9, 5 male, 4 female, M = 12.8, SD = 2.6), mentors (n = 9, male 5, female 4, M = 37.60, SD = 13.62) and the Ocean Mind program coordinator (n = 1, male, age 26 years), participated in semi-structured focus groups or follow-up interviews. This qualitative study analysed data using inductive thematic analysis.

RESULTS

Six themes were identified in total, with self-efficacy, interpersonal skills and forming a mentorship being potential therapeutic pathways of the surf therapy intervention. Surf instruction techniques and family engagement were both identified as potential barriers that negatively affect participant engagement. Additionally, the natural environment was identified as both a potential therapeutic pathway and a barrier.

CONCLUSION

Surf therapy interventions appears to hold a number of benefits for youth mental health via pathways relating to the promotion of mental health protective factors.

VIDAS® Enzyme-Linked Immunofluorescent Assay for Detection of Listeria in Foods: Collaborative Study

The VIDAS LIS method and the traditional culture methods for detection of Listeria species in food were evaluated in a multilaboratory comparative study. The 6 foods tested were either naturally contaminated or inoculated with 3 different concentrations of Listeria. Results for each food and each contamination level with the VIDAS LIS method were as good as or better than those obtained with the traditional culture method. Of 1558 samples tested, 935 were positive: 839 by the VIDAS method and 809 by standard culture methods. Overall false negative rates were 10.3 and 13.5% for the VIDAS LIS and culture methods, respectively. The false positive rate for the VIDAS LIS assay was 1.4% based on 9 VIDAS LIS positive assays that did not confirm positive by isolation of Listeria. The agreement between the VIDAS LIS and culture methods for all samples tested was 86%.

Novel use of rituximab in macrophage activation syndrome secondary to systemic lupus erythematosus

Macrophage activation syndrome (MAS) is a rare disease characterised by aberrant immune hyperactivation of T lymphocytes and macrophages driven by cytokine dysfunction. The HLH-2004 protocol is commonly used for the treatment of MAS, but significant toxicities are associated. We describe a case of MAS secondary to systemic lupus erythematosus in a young female that responded well to rituximab in lieu of etoposide. She continues to be in remission 1 year following the completion of rituximab infusion and is maintained on hydroxychloroquine. This case highlights the need for further research on the use of rituximab and other available biologics in the setting of MAS in order to help guide further alternative treatment decisions.

Lanthanum carbonate oral powder: satisfaction, preference and adherence in French and Spanish patients with end-stage renal disease

BACKGROUND

Phosphate binders, such as lanthanum carbonate, control elevated serum-phosphate levels in patients with end-stage renal disease (ESRD). Lanthanum carbonate is available in oral powder and tablet form. The aim of this survey was to investigate satisfaction with, preference for, and adherence to lanthanum carbonate oral powder in patients with ESRD.

SCOPE

Patients from France and Spain who had been taking lanthanum carbonate powder for at least 4 weeks, and who had experience of other phosphate binders of any formulation, were asked to complete an online or telephone survey. Treatment satisfaction was measured using the Treatment Satisfaction Questionnaire for Medication-9; preference was measured using 5-point Likert scale agreement ratings; and adherence was measured using the Morisky Medication Adherence Scale-4. Data were evaluated using bivariate analyses.

FINDINGS

Overall, 160 patients participated (80 per country). Lanthanum carbonate powder was reported to have a higher effectiveness rating (p<0.05), be more convenient (p<0.05), and provide a higher level of satisfaction (p<0.01) than previous binders. There was an overall preference for lanthanum carbonate powder over previous binders of any formulation (p<0.001). Adherence to medication was similar for all binders analysed: 66.3% of French patients adhered to lanthanum carbonate powder, and 65.0% adhered to previous binder treatment (p=not significant); 52.5% of Spanish patients adhered to lanthanum carbonate powder, and 56.3% adhered to previous binder treatment (p=not significant).

LIMITATIONS

The survey enrolled patients who had already experienced phosphate binders before the study began. Information on patient preferences for and adherence to previous phosphate binders was therefore based on the patients' memories of these experiences, which may have been subject to change over time. Although most participants completed the online survey in this study, a telephone survey was used for individuals who could not access the online version; if only one method of data recording had been used, there may have been reduced variation in responses.

CONCLUSION

Patients with ESRD report increased satisfaction with and preference for lanthanum carbonate powder over other formulations, suggesting that lanthanum carbonate powder is more convenient and easier to use than other formulations.

Dysregulation of type II interferon associated mediators precedes autoantibody accumulation and type I interferon elevation and predicts transition to systemic lupus erythematosus classification (BA3P.109)

Autoantibodies and interferon (IFN) are associated with clinical illness in systemic lupus erythematosus (SLE), but how these factors influence autoimmune disease development is unknown. This study evaluates the timing and changes in SLE-linked autoantibody specificities, serum IFN-α activity, and IFN-associated soluble mediator levels in the years preceding SLE classification. Serial sera from 55 SLE cases spanning pre- and post-SLE classification (average time = 4.3 years) and matched healthy controls (HC) were obtained from the Department of Defense Serum Repository. Cases with positive serum IFN-α activity had more SLE-linked autoantibody specificities (p&lt;0.05). Growth curve modeling and path analysis corroborated that most autoantibody specificities precede IFN-α activity, and IFN-γ and IP-10 were elevated prior to or concurrent with autoantibody positivity (p&lt;0.01). The number of autoantibody specificities and IFN-associated soluble mediators, as well as female gender, predicted increases in IFN-α activity (p&lt;0.04; ANCOVA). IFN-γ and MCP-3 levels, as well as the presence of anti-chromatin and spliceosomal autoantibodies, best predicted transition to SLE with 93% accuracy &gt;4 years before SLE classification (Random Forest). These data indicate that pre-clinical immune system perturbations allow for the accumulation of autoantibodies and subsequent elevation in IFN-α activity immediately preceding clinical symptoms and SLE classification.

Fever acquired overseas is not always infectious in etiology: adult-onset Still's disease in a soldier deployed to Afghanistan

Adult-onset Still's disease (AOSD) is a rare systemic inflammatory disorder of unknown etiology characterized by spiking fever, arthritis or arthralgia, rash, and leukocytosis. The nonspecific findings and epidemiology of the disease can complicate the diagnosis among deployed U.S. personnel, because they are exposed to infectious etiologies that can present in a similar fashion. We present a case of 19-year-old U.S. Army soldier who was deployed to Afghanistan and eventually medevaced to Walter Reed National Military Medical Center complaining of arthralgia, diffuse myalgia, daily spiking fever, and laboratory abnormalities including leukocytosis and elevated liver-associated enzymes. After an initial concern for an infectious etiology, the patient met Yamaguchi criteria for the diagnosis for AOSD. The patient's clinical course, pertinent laboratory, and pathology data are reviewed in the context of approaching the diagnosis and treatment of AOSD. This case highlights that providers need to maintain a high clinical suspicion for less common conditions such as AOSD in the setting of unresolving nonspecific findings such as fever, rash, and leukocytosis.

Interferon and TNF family soluble inflammatory mediators are detected prior to and increase at Systemic Lupus Erythematosus classification in serum samples from military personnel acquired from the Department of Defense Serum Repository (P3087)

Processes that lead to clinical illness in SLE years before diagnosis are not well characterized. This study evaluates the temporal relationship between autoantibody production, cytokine levels and the onset of SLE. Serial sera from 60 SLE cases before diagnosis with no ACR criteria to SLE classification (average timespan=4.4 years) and matched healthy controls (HC) were obtained from the DODSR. Sera samples were tested for autoantibodies (BioPlex2200), C-reactive protein (hs-CRP), Von Willebrand’s Factor (VWF) and 32 soluble inflammatory mediators, including cytokines, chemokines, and soluble receptors. Patient samples before ACR classification had significant (p &lt; 0.01) alterations in 16 soluble mediators of inflammation, as well as VWF and hs-CRP. TNF Receptor levels, TNFRI, TNFRII, BLyS, and APRIL, dramatically increased as lupus classification approached (p &lt; 0.001). The increase in TNFR shedding parallels the accumulation of autoantibodies in SLE cases. Interferon (IFN)-associated mediators of inflammation, IFN-γ, IP-10, MIG, and MIP-1α (p &lt; 0.01), were also increased leading up to classification. That these alterations are present prior to the transition to active SLE suggests that multiple perturbations in immune-mediated inflammatory processes occur long before clinical classification and suggest that high-risk, pre-clinical individuals, can be identified before their illness is clinically manifested and damage occurs.

Coenzyme Q10 in patients undergoing CABG: Effect of statins and nutritional supplementation

BACKGROUND

The hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) are effective cholesterol lowering medications, however, statins may interfere with CoQ(10) biosynthesis. We examined the effect of statin therapy as well as nutritional supplements on plasma, cardiac and skeletal muscle concentrations of CoQ(10).

METHODS

Forty patients with left ventricular dysfunction had fasting blood samples collected at baseline and following four weeks of supplementation (150mg/day of CoQ(10)). Cardiac and skeletal muscle biopsies were collected at the time of surgery and frozen in liquid nitrogen until analyzed for CoQ(10) levels by high performance liquid chromatography.

RESULTS

Nutrient supplementation significantly increased plasma [(1.8 (1.2, 2.7) vs 0.8 (0.6, 0.94) mug/ml plasma, median+IQR; p=0.001)] and cardiac tissue concentrations of CoQ(10) [(120.5 (76.5, 177.1) vs 87.3 (60.5, 110.8) nmol/g wet weight, p=0.04)]. No effect of supplementation was seen on samples of skeletal muscle from the chest wall. Statin therapy was not found to influence plasma, cardiac or chest wall levels of CoQ(10).

CONCLUSION

Nutrient supplementation significantly increased plasma and cardiac tissue levels of CoQ(10) but did not influence chest wall muscle concentrations. Statin therapy did not significantly influence tissue concentrations of CoQ(10). Longer term studies are needed to confirm this observation.

Can anthropogenic variables be used as threat proxies for South African plant richness?

Human demographic and socio-economic measures (anthropogenic variables) reflect the detrimental impact of humans on plant diversity globally. The Pretoria (PRE) Computerised Information System (PRECIS) of the South African National Biodiversity Institute (SANBI), provided three sets of South Afncan plant richness data, overall (OPR), endemic (EPR), and threatened (TPR), to investigate the relationships between richness and six anthropogenic variables. Spearman’s Rank order correlations, Kruskal Wallis Analysis of Variance (ANOVA) and Generalized Linear Models (GLZ) were used. Although all three plant richness measures were correlated with anthropogenic variables, individual anthropogenic variables contributed a small fraction to the explained variation in richness. Differences in spatial and temporal scaling of the datasets, or the response to another causal mechanism, may have contributed to this low explained variation. Because more variation was accounted for in OPR than EPR or TPR, OPR is a more suitable surrogate measure of plant biodiversity when investigating the anthropogenic variables used here. Average human density (HD), infrastructure (degree of urbanization and road cover) (LRU) and percentage land area transformed and degraded (LTD) were identified as useful surrogates of human impacts on OPR. LTD may be a more inclusive human impact measure when conducting analyses of human impacts using OPR. LTD includes the effects of urban expansion, road networks and other land transformation impacts, such as agriculture.

Coeliac disease is associated with impaired expression of acyl-CoA-synthetase 5

BACKGROUND AND AIMS

Coeliac disease and other disorders of the small intestine are associated with disturbances in mucosal architecture. The most severe injury to tissue architecture is villus atrophy. In coeliac disease, molecules reflecting the state of the villus architecture are not well characterized at present.

MATERIALS AND METHODS

Expression of acyl-CoA-synthetase 5 (ACS5) was studied in unaffected human small/large intestinal tissue and in coeliac disease using several methods including molecular techniques, as well as an in situ approach using a novel established monoclonal antibody directed against human ACS5.

RESULTS

Strong expression, synthesis, and enzymatic activity of ACS5 were found in normal small intestinal mucosa compared with unaffected colon mucosa. In normal small intestine, ACS5 preferentially located to the epithelium covering villi. In coeliac disease, expression of ACS5 was regularly associated with differentiation of villi. Thus, ACS5 was found in the villus epithelium of the small intestine with coeliac disease of Marsh grades I, II, IIIa, or IIIb respectively. In Marsh grade IIIc coeliac disease lesions, strong expression of ACS5 was detectable neither in the surface epithelium nor in the epithelium lining hyperplastic crypts.

CONCLUSION

These data suggest that ACS5 is a very suitable marker molecule for the detection of villus atrophy in the small intestine.

Expression of acyl-CoA synthetase 5 in human endometrium and in endometrioid adenocarcinomas

AIM

Fatty acid metabolism of the endometrium is important for tissue homeostasis in the proliferative and secretory phase of the menstrual cycle. The enzyme acyl-CoA synthetase 5 (ACS5) plays a crucial role in fatty acid metabolism, mainly through the generation of multifunctional long-chain-fatty-acid-CoA esters. The aim of the present study was to characterize expression and localization of ACS5 in the normal human endometrium and in endometrioid adenocarcinomas.

METHODS AND RESULTS

Expression of ACS5 in the human endometrium was investigated by in situ techniques (immunohistochemistry, mRNA in situ hybridization) and a molecular approach (reverse transcriptase-polymerase chain reaction, Western blot). ACS5 protein and mRNA were localized to the epithelium of the human endometrium. Here, ACS5 expression was found throughout the menstrual cycle as well as in the postmenopausal endometrium. Notably, in endometrioid adenocarcinomas, the ACS5 molecule was found abundantly in well-differentiated tumours, but not in poorly differentiated adenocarcinomas.

CONCLUSIONS

The abundance of ACS5 in the endometrial epithelium throughout the menstrual cycle provides support for its role in the regulation of tissue homeostasis. With regard to its value for histopathological diagnosis, immunohistochemical characterization of endometrioid adenocarcinomas shows that a decrease in ACS5 expression correlates with tumour dedifferentiation.

Characterization of metaplastic and heterotopic epithelia in the human gastrointestinal tract by the expression pattern of acyl-CoA synthetase 5

Metaplastic and heterotopic epithelia are frequently found in the human intestine. The recently cloned human acyl-CoA synthetase 5 (ACS5) is a key enzyme in providing cytosolic acyl-CoA thioesters. The aim of the study was to identify and to locate the expression of ACS5 in the gastric body and the small intestine with metaplasia or heterotopia by different methods. In the normal gastrointestinal tract, ACS5 was predominantly found in the villus epithelium of the small intestine, but not in the gastric mucosa. Of note, strong expression of ACS5 was also detectable in intestinal metaplasia of the stomach. Inversely, ACS5 expression could neither be detected in heterotopic gastric mucosa of the corpus type nor in gastric, pseudopyloric, or antral metaplasia of the small intestine. In conclusion, our data implicate that ACS5 is a suitable differentiating marker molecule in the gastrointestinal tract.

Satisfaction with upper-extremity surgery in individuals with tetraplegia

OBJECTIVE

To measure the satisfaction of individuals with tetraplegia with their upper-extremity reconstructive surgery.

DESIGN

Survey.

SETTING

Two Spinal Cord Injury Model Systems centers.

PARTICIPANTS

Sixty-seven individuals with spinal cord injury at the C4 through C8 motor level (107 arms).

INTERVENTIONS

Participants had upper-extremity surgery to improve function. The surgical procedures included tendon transfers for elbow extension, wrist extension, hand grasp, and pinch or hand grasp neuroprosthesis.

MAIN OUTCOME MEASURE

A survey was mailed to participants, who were asked to respond to statements such as, "If I had it to do over, I would have the hand/arm surgery again," using a 5-level Likert scale (ranging from strongly agree to strongly disagree).

RESULTS

Seventy percent of the participants were generally satisfied with the results of their upper-extremity surgery, 77% reported a positive impact on their lives, 68% reported improvements in activities of daily living (ADLs), 66% reported improved independence, 69% reported improvement in occupation, 71% reported improved appearance or neutral, 78% reported their hand worked as well (or neutral) as it did when surgery was first performed, and 86% reported postoperative therapy as being beneficial.

CONCLUSIONS

Upper-extremity surgery had a positive impact on life, increased ability to perform ADLs and to be independent, and improved quality of life.