Precise Control of Ultramicropores of Novel Carbons Molecule Sieves Derived from Coffee Bean for Efficient Sieving Propylene from Propane

The development of granular carbon materials with outstanding selectivity for the separation of alkenes and alkanes is highly desirable in the petrochemical industry but remains a significant challenge due to closely similar molecular sizes and physical properties of adsorbates. Herein, we report a facile approach of using natural biomass to prepare novel granular carbon molecule sieves with a molecular recognition accuracy of 0.44 Å and propose a new three-region model for the pore size distribution of amorphous porous carbons. Coffee bean-based granule carbon molecular sieves (CFGCs) were prepared with precise micropore regulation with subangstrom accuracy and characterized using molecular probes to reveal the evolution of carbon structure during preparation. The CFGC-0.09-750 demonstrates exceptional selectivity adsorption toward C3H6 while excluding C3H8, with an uptake ratio of 106.75 and a C3H6 uptake of 1.88 mmol/g at 298 K and 100 kPa, showcasing its immense potential in industrial applications for separating C3H6 and C3H8. The novel three-region model established in this work can clearly and reasonably elucidate why the samples CFGCs can screen propylene from propane at the subangstrom level. This study provides important guidance for the development of new carbon molecular sieves with subangstrom accuracy in molecular recognition and separation capacity.

Recognition of C4 Olefins by an Ultramicroporous ftw-Type Yttrium-Based Metal-Organic Framework with Distorted Cages

Developing porous adsorbents for efficient separation of C4 olefins is significant but challenging in the petrochemical industry due to their similar molecular sizes and physical properties. The separation efficiency is often limited when separating C4 olefins by a single separation mechanism. Herein, an ultramicroporous yttrium-based MOF, Y-dbai, is reported featuring cage-like pores connected by small windows, for recognition and efficient separation of C4 olefins through a synergistic effect of thermodynamic and kinetic mechanisms. At 298 K and 1 bar, the adsorption capacities of Y-dbai for C4H6, 1-C4H8, and i-C4H8 are 2.88, 1.07, and 0.14 mmol g-1, respectively, indicating a molecular sieving effect toward i-C4H8. The C4H6/i-C4H8 and 1-C4H8/i-C4H8 uptake selectivities of Y-dbai are 20.6 and 7.6, respectively, outperforming most of the reported adsorbents. The static and kinetic adsorption experiments coupled with DFT calculations indicate the separation should be attributed to a combined effect of thermodynamically and kinetically controlled mechanism. Breakthrough experiments have confirmed the excellent separation capability of Y-dbai toward C4H6/1-C4H8, C4H6/i-C4H8, and C4H6/1-C4H8/i-C4H8 mixtures.

First Measurement of Discrimination between Helium and Electron Recoils in Liquid Xenon for Low-Mass Dark Matter Searches

We report the first measurement of discrimination between low-energy helium recoils and electron recoils in liquid xenon. This result is relevant to proposed low-mass dark matter searches which seek to dissolve light target nuclei in the active volume of liquid-xenon time projection chambers. Low-energy helium recoils were produced by degrading α particles from ^{210}Po with a gold foil situated on the cathode of a liquid xenon time-projection chamber. The resulting population of helium recoil events is well separated from electron recoils and is also offset from the expected position of xenon nuclear recoil events.

Risk profiles and incidence of cardiovascular events across different cancer types

BACKGROUND

Cancer survivors are at increased risk for cardiovascular (CV) disease, although additional data are needed to better understand the incidence of CV events across different malignancies. This study sought to characterize the incidence of major adverse CV events [myocardial infarction, stroke, unstable angina (MACE), or heart failure (HF)] across multiple cancer types after cancer diagnosis.

PATIENTS AND METHODS

Patients were identified from a USA-based administrative claims database who had index cancer diagnoses of breast, lung, prostate, melanoma, myeloma, kidney, colorectal, leukemia, or lymphoma between 2011 and 2019, with continuous enrollment for ≥12 months before diagnosis. Baseline CV risk factors and incidence rates of CV events post-index were identified for each cancer. Multivariable Cox hazards models assessed the cumulative incidence of MACE, accounting for baseline risk factors.

RESULTS

Among 839 934 patients across nine cancer types, CV risk factors were prevalent. The cumulative incidence of MACE was highest in lung cancer and myeloma, and lowest in breast cancer, prostate cancer, and melanoma. MACE cumulative incidence for lung cancer was 26% by 4 years (2.7-fold higher relative to breast cancer). The incidence of stroke was especially pronounced in lung cancer, while HF was highest in myeloma and lung cancer.

CONCLUSIONS

CV events were especially increased following certain cancer diagnoses, even after accounting for baseline risk factors. Understanding the variable patient characteristics and associated CV events across different cancers can help target appropriate CV risk factor modification and develop strategies to minimize adverse CV events and improve patient outcomes.

Prediction of Xe/Kr Separation in Metal-Organic Frameworks by a Precursor-Based Neural Network Synergistic with a Polarizable Adsorbate Model

Adsorption and separation of Xe/Kr are significant for making high-density nuclear energy environmentally friendly and for meeting the requirements of the gas industry. Enhancing the accuracy of the adsorbate model for describing the adsorption behaviors of Xe and Kr in MOFs and the efficiency of the model for predicting the separation potential (SP) value of Xe/Kr separation in MOFs helps in searching for promising MOFs for Xe/Kr adsorption and separation within a short time and at a low cost. In this work, polarizable and transferable models for mimic Xe and Kr adsorption behaviors in MOFs were constructed. Using these models, SP values of 38 MOFs at various temperatures and pressures were calculated. An optimal neural network model called BPNN-SP was designed to predict SP value based on physical parameters of metal center (electronegativity and radius) and organic linker (three-dimensional size and polarizability) combined with temperature and pressure. The regression coefficient value of the BPNN-SP model for each data set is higher than 0.995. MAE, MBE, and RMSE of BPNN-SP are only 0.331, -0.002, and 0.505 mmol/g, respectively. Finally, BPNN-SP was validated by experiment data from six MOFs. The transferable adsorbate model combined with the BPNN-SP model would highly improve the efficiency for designing MOFs with high performance for Xe/Kr adsorption and separation.

Separating Xylene Isomers with a Calcium Metal-Organic Framework

The purification of p-xylene (pX) from its xylene isomers represents a challenging but important industrial process. Herein, we report the efficient separation of pX from its ortho- and meta- isomers by a microporous calcium-based metal-organic framework material (HIAM-203) with a flexible skeleton. At 30 °C, all three isomers are accommodated but the adsorption kinetics of o-xylene (oX) and m-xylene (mX) are substantially slower than that of pX, and at an elevated temperature of 120 °C, oX and mX are fully excluded while pX can be adsorbed. Multicomponent column breakthrough measurements and vapor-phase/liquid-phase adsorption experiments have demonstrated the capability of HIAM-203 for efficient separation of xylene isomers. Ab initio calculations have provided useful information for understanding the adsorption mechanism.

First Dark Matter Search Results from the LUX-ZEPLIN (LZ) Experiment

The LUX-ZEPLIN experiment is a dark matter detector centered on a dual-phase xenon time projection chamber operating at the Sanford Underground Research Facility in Lead, South Dakota, USA. This Letter reports results from LUX-ZEPLIN's first search for weakly interacting massive particles (WIMPs) with an exposure of 60 live days using a fiducial mass of 5.5 t. A profile-likelihood ratio analysis shows the data to be consistent with a background-only hypothesis, setting new limits on spin-independent WIMP-nucleon, spin-dependent WIMP-neutron, and spin-dependent WIMP-proton cross sections for WIMP masses above 9  GeV/c^{2}. The most stringent limit is set for spin-independent scattering at 36  GeV/c^{2}, rejecting cross sections above 9.2×10^{-48}  cm at the 90% confidence level.

[Multiple primary malignancies combined with SWI/SNF complex-deficient gastric cancer: a case report and literature review]

Multiple primary malignancies combined with SWI/SNF complex-deficient gastric cancer is a rare clinical entity and poorly documented. Herein we report a case of this disease in an 81-year-old male patient treated in our hospital. Before the established diagnosis of metachronous multiple primary malignancies, the patient received left lower lobectomy for a spaceoccupying mass in the left lung, which was confirmed by postoperative pathology as early stage lung cancer. SWI/SNF complex-deficiency gastric cancer with metastasis was subsequently detected by gastroscopy, and high-throughput sequencing identified ARID1A and TMB-H gene mutations in the tumor tissues. The patient received chemotherapy combined with immunotherapy but failed to respond to the treatment, and died 13 months later. We conducted a literature review and analyzed the occurrence, pathological and immunohistochemical characteristics, diagnosis, treatment and prognosis of this disease.

Efficient CO2 Capture under Humid Conditions on a Novel Amide-Functionalized Fe- Metal-Organic Framework

CO₂ is the main source of the greenhouse gases, and its capture from flue gas under humid conditions is challenging but important for promoting carbon neutrality. Herein, we report a novel soc topology Fe-based metal-organic framework (Fe-dbai) with highly efficient postcombusion CO₂ capture performance by integrating multiple specific functionalities, such as unsaturated metal sites and amide functional groups. The CO₂ adsorption capacity and CO₂/N₂ selectivity of Fe-dbai are high up to 6.4 mmol/g and 64 (298 K, 1 bar), respectively, superior to many other reported MOFs. More importantly, the CO₂ working capacity of Fe-dbai under 60% RH conditions preserves 94% of that under dry conditions in the breakthrough experiments of CO₂/N₂ (15:85, v/v) mixtures. The molecular simulation highlights that the electronegative amide CO- group has a good affinity for CO₂ and can improve the interaction between Fe UMS and CO₂. Although H₂O molecules will occupy a small fraction of the adsorption sites, the confinement effect it produces can enhance the adsorption affinity of the framework for CO₂, which results in Fe-dbai retaining most of the CO₂ adsorption capacity under humid conditions. The excellent CO₂ capture performance makes Fe-dbai a potential candidate for the practical application of CO₂ capture.

Acute thrombocytopenia during cesarean section

We report a case of a healthy 29-year-old parturient with a normal pre-operative platelet count who received combined spinal-epidural anesthesia for cesarean section, and who suffered the sudden intra-operative onset of severe thrombocytopenia (platelet count 3 × 10⁹/L). This event was likely due to cefoxitin administered for the prophylaxis of surgical infection.

[Susceptibility and mechanism of sodium salicylate-induced tinnitus model in low estrogen rats]

Objective: The susceptibility of tinnitus rats with low estrogen level induced by sodium salicylate and the changes of tumor necrosis factor α (TNF-α) in serum were observed to investigate the relationship between tinnitus occurrence and estrogen level. Methods: Forty-two healthy female Wistar rats were randomly divided into control group(n=6), normal group(n=6), sham operation group(n=6) and ovariectomized group(n=24). Control group was intraperitoneally injected with normal saline 200 mg/kg for 14 consecutive days. Normal group, sham operation group and ovariectomized group were intraperitoneally injected with sodium salicylate 200 mg/kg for 14 consecutive days. Before and after sodium salicylate induction, the tinnitus behavior of rats in each group was detected by prepulse inhibition (PPI) and gap pre-pulse inhibition of the acoustic startle (GPIAS) test. Before and after sodium salicylate induction, blood samples were collected from eyeballs of rats in each group, and serum levels of estradiol and TNF-α were detected by ELISA. SPSS 25.0 software was used to analyze the data. Results: (1) Following 14 days of sodium salicylate intervention, there was no significant difference in PPI inhibition rate between groups or within groups(all P>0.05). (2)There was no significant difference in the inhibition rate of GPIAS in the four groups before sodium salicylate injection(F=0.217, P>0.05). With sodium salicylate injected for 14 days, the inhibition rate of GPIAS in ovariectomized group (30.88%±15.40%) was significantly lower than that in the other three groups (44.11%±21.06%, 38.27%±10.92%, 51.59%±11.34%), and the difference was statistically significant(F=3.533, P<0.05). The inhibition rate of GPIAS in ovariectomized group with sodium salicylate injected for 14 days was significantly lower than that before injection, and the difference was statistically significant(t=2.977, P<0.05).There was no significant difference in GPIAS inhibition rate between the other three groups before and after sodium salicylate injection(P>0.05). (3)The level of TNF-α in ovariectomized rats was significantly higher than that in the other three groups, the difference was statistically significant(all P<0.05). With sodium salicylate injection for 14 days, TNF-α level in the ovariectomized group increased more significantly than that in the other three groups, the difference was statistically significant(F=8.045, P<0.05). TNF-α levels increased following salicylate injection in normal group, sham operation group and ovariectomized group, and the differences were statistically significant(t value was -4.843, -4.932 and -5.965 respectively, each P<0.05). There was no significant difference in TNF-α levels before and after normal saline injection in control group(all P>0.05). Conclusion: Low estrogen levels increase susceptibility to sodium salicylate-induced tinnitus. Decreased estrogen levels may increase susceptibility to tinnitus through the increased expression of pro-inflammatory factor TNF-α.

An efficient isomorphic CNN-based prediction and decision framework for financial time series

Financial time series prediction and trading decision-making are priorities of computational intelligence for researchers in academia and the finance industry due to their broad application areas and substantial impact. However, these methods remain challenging because they retain various complex statistical properties, and the mechanism behind the processes is unknown to a large extent. A significant number of machine learning-based methods are proposed and demonstrate impressive results, especially deep learning-based models. Nevertheless, due to the high complexity of massive, nonlinear, and nonindependent data and the difficulties and time consumption of complicated training models of deep learning, the performance of online trading decisions is still inadequate for practical application. This paper proposes the Integrated Framework of Forecasting Based Online Trading Strategy (IFF-BOTS) to satisfy better prediction performance and dynamic decisions for real-world online trading systems. Our method adopts a novel isomorphic convolutional neural network (CNN)-based forecaster-classifier-executor architecture to exploit CNN-based price and trend integrated prediction and direct-reinforcement-learning-based trading decision-making. IFF-BOTS can also achieve better real-time performance for online trading. We empirically compare the proposed approach with state-of-the-art prediction and trading methods on real-world S&P and DJI datasets. The results show that the IFF-BOTS outperforms its competitors in predicting metrics, trading profits, and real-time performance.

AB0883 Real-World Treatment Patterns In Patients With Psoriatic Arthritis

Background

Psoriatic arthritis (PsA) is a complex inflammatory disease with manifestations that play an important role in treatment selection.1 Treatments include oral agents, biologic therapies (inhibitors of tumor necrosis factor [TNFi], interleukin [IL-17Ai, IL-12/23i], cytotoxic T lymphocyte–associated antigen 4 inhibitor [CTLA-4i]), and new targeted oral agents (inhibitors of phosphodiesterase-4 [PDE-4i] and Janus kinase [JAKi]).1 Few studies have examined real-world treatment patterns of recently approved therapies.

Objectives

Evaluate real-world treatment patterns for branded systemic therapy in patients with PsA.

Methods

In this retrospective study, medical and pharmacy claims from the US IBM MarketScan Commercial and Medicare databases (1/1/2012–12/31/2019) were used to identify patients with PsA who initiated treatment with a TNFi (adalimumab, etanercept, infliximab, golimumab, or certolizumab), IL-17Ai (secukinumab, ixekizumab), IL-12/23p40i (ustekinumab), IL-23p19i (guselkumab), CTLA-4i (abatacept), JAKi (tofacitinib), or PDE-4i (apremilast). Patients (≥18 years) with ≥1 prescription, ≥2 PsA claims separated by ≥1 day on or before the index date (first prescription date [1/1/13–12/31/2018]), and 1-year continuous enrollment before and after the index date were eligible. Treatment patterns were grouped into continuers, discontinuers, and patients with treatment modification (switchers [without a treatment gap], reinitiators [same drug with a treatment gap], and restarters [different drug with a treatment gap]) (Table 1). Patients were followed for 1 year or until treatment modification, whichever came first. Descriptive statistics were used.

Table 1.

Terminology

CohortDefinitionn/N (%)ContinuersOn index treatment during 1-year follow-up with no treatment gaps*1910/6455 (29.6)DiscontinuersNo prescription claims for any therapy during 1-year follow-up1614/6455 (25.0)Patients with treatment modificationsAll patients with a change in treatment during 1-year follow-up2908/6455 (45.1)SwitchersPrescription claims for treatments different than index therapy before permissible treatment gaps*794/6455 (12.3)ReinitiatorsPrescription claims for treatments SAME as index therapy AFTER treatment gaps*1686/6455 (26.1)RestartersPrescription claims for DIFFERENT therapy AFTER treatment gap*428/6455 (6.6)

Note: All terminology applies to cohorts within the first year of treatment.

*Treatment gap: gap of 200% of recommended dosing schedule from end of previous prescription’s days’ supply.

Results

A total of 6455 patients were included (mean age, 50.5 years; 55.5% female; mean Charlson Comorbidity Index score, 0.54). At baseline, the most commonly used therapies were immunosuppressants (58.5%), corticosteroids (52.2%), and nonsteroidal anti-inflammatory drugs (45.9%). Treatments most used at index were TNFi (72.5%; including adalimumab [41.6%] and etanercept [23.8%]) and the PDE-4i apremilast (21.1%). During the 1-year study period, 29.6% of patients maintained their index therapy and 25.0% discontinued. Treatment modification was observed in 45.1% of patients; 12.3% switched to a new therapy without a treatment gap, 26.1% restarted their index therapy, and 6.6% started a new therapy after a treatment gap.

Conclusion

Among patients with PsA, there is substantial variability, including high rates of discontinuation within the first year and after index therapy. Further studies are warranted to understand reasons for these treatment patterns.

References

[1]Ogdie A et al. Treatment guidelines in psoriatic arthritis. Rheumatology (Oxford). 2020;59(Suppl 1):i37-i46.

Acknowledgements

This study was sponsored by Bristol Myers Squibb. Statistical analysis support was provided by Arindom Borkakoti, formerly of Mu Sigma. Professional medical writing assistance was provided by LeeAnn Braun, MPH, MEd, of Peloton Advantage, LLC, an OPEN Health company, Parsippany, NJ, USA, and funded by Bristol Myers Squibb.

Disclosure of Interests

Jiyoon Choi Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Antoine Sreih Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Thomas Lehman Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Manasi Suryavanshi Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Qian Xia Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Miroslawa Nowak Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb

Selective, Stable Production of Ethylene Using a Pulsed Cu-Based Electrode

Ethylene (C₂H₄) is an important product in carbon dioxide electroreduction (CO₂RR) because of the essential role it plays in chemical industry. While several strategies have been proposed to tune the selectivity of Cu-based catalysts in order to achieve high C₂H₄ faradaic efficiency, maintaining high selectivity toward C₂H₄ in CO₂RR remains an unresolved problem hampering the deployment of CO₂ conversion technology due to the lack of stable electrocatalysts. Here, we develop a facile method to deposit a layer of Cu₂O on Cu foil by an electrochemical pulsed potential treatment. This method is capable to easily scale up and synthesize multiple electrodes in one step. After the synthesis, the pulsed copper foil, denoted as P-Cu, exhibits good C₂H₄ faradaic efficiency of ∼50% in CO₂RR at a potential around -1.0 V vs. RHE. The C₂H₄ selectivity is also found to be quantitatively correlated with the roughness factor (RF) of Cu-based catalysts. More importantly, for the first time, we demonstrate that the P-Cu electrode is quite durable in CO₂RR to produce C₂H₄ for more than 6 months.

A Microporous Metal-Organic Framework Incorporating Both Primary and Secondary Building Units for Splitting Alkane Isomers

We demonstrate the assembly of a mononuclear metal center, a hexanuclear cluster, and a V-shaped, trapezoidal tetracarboxylate linker into a microporous metal-organic framework featuring an unprecedented 3-nodal (4,4,8)-c lyu topology. The compound, HIAM-302, represents the first example that incorporates both a primary building unit and a hexanuclear secondary building unit in one structure, which should be attributed to the desymmetrized geometry of the organic linker. HIAM-302 possesses optimal pore dimensions and can separate monobranched and dibranched alkanes through selective molecular sieving, which is of significant value in the petrochemical industry.

Robust Nickel-Based Metal-Organic Framework for Highly Efficient Methane Purification and Capture

Developing energy-efficient alternatives for methane (CH₄) purification from natural gas and methane capture of coal-mine gas is of great significance and challenge in the chemical industry. Herein, we report a robust nickel-based metal-organic framework (MOF), Ni-BPZ, featuring one-dimensional (1D) rhombic channels decorated with abundant pyrazole rings. Ni-BPZ exhibits excellent separation performance toward both C₂H₆/CH₄ and CH₄/N₂ binary mixtures. The C₂H₆/CH₄ selectivity of Ni-BPZ is high, up to 50.2, exceeding those of most MOF adsorbents reported, and it simultaneously possesses a remarkable C₂H₆ uptake of 2.46 mmol/g at 298 K and 0.1 bar. The CH₄/N₂ selectivity of Ni-BPZ reaches 6.6, and its high CH₄ uptake is 1.56 mmol/g, which is also superior to most high-performance CH₄ adsorbents. The molecular simulation reveals that the uniform 1D rhombic channels with abundant pyrazole rings provide a high density of potential adsorption sites for efficient C₂H₆/CH₄ and CH₄/N₂ separations.

Pore Distortion in a Metal-Organic Framework for Regulated Separation of Propane and Propylene

The development of porous solids for adsorptive separation of propylene and propane remains an important and challenging line of research. State-of-the-art sorbent materials often suffer from the trade-off between adsorption capacity and selectivity. Here, we report the regulated separation of propylene and propane in a metal-organic framework via designed pore distortion. The distorted pore structure of HIAM-301 successfully excludes propane and thus achieved simultaneously high selectivity (>150) and large capacity (∼3.2 mmol/g) of propylene at 298 K and 1 bar. Dynamic breakthrough measurements validated the excellent separation of propane and propylene. In situ neutron powder diffraction and inelastic neutron scattering revealed the binding domains of adsorbed propylene molecules in HIAM-301 as well as host-guest interaction dynamics. This study presents a new benchmark for the adsorptive separation of propylene and propane.

[Application of DNA origami in nanobiomedicine]

The development of DNA nanotechnology make it possible to artificially generate complex nucleic acid nanostructures with controllable sizes and shapes. DNA origami emerges as an effective and versatile approach to construct two- and three-dimensional programmable nanostructures, and represents a milestone in the development of structural DNA nanotechnology. Due to its high degree of controllable geometry, spatial addressability, easy chemical modification and good biocompatibility, DNA origami has great potentials for applications in many fields. In this review, we briefly summarize the applications of DNA origami in antigen-antibody interaction, targeted drug delivery and the synthesis of biomaterials.

Tuning the Structural Flexibility for Multi-Responsive Gas Sorption in Isonicotinate-Based Metal-Organic Frameworks

Flexible metal-organic frameworks (MOFs) are of high interest as smart programmable materials for gas sorption due to their unique structural changes triggered by external stimuli. Owing to this property, which leads to opportunities such as maximizing deliverable gas capacity, flexible MOFs sometimes offer more advantages in sorption applications compared to their more rigid counterparts. Herein, we elucidate the effect of transition metal identity of a series of isonicotinate-based flexible MOFs, M(4-PyC)₂ [M═Mg, Mn, and Cu; 4-PyC = 4-pyridine carboxylic acid] on the structural dynamic response to different gases (C₂H₄, C₂H₆, Xe, Kr, and SO₂). Isotherms at different temperatures show that C₂H₄, C₂H₆, and Xe can form sufficiently strong interactions with both Mg(4-PyC)₂ and Mn(4-PyC)₂ frameworks resulting in gate-opening behavior due to the rotation of the linker's pyridine ring, while Kr cannot induce this phenomenon for the two MOFs under the measured conditions. In contrast, the gate-opening behavior occurs for Cu(4-PyC)₂ solely in the presence of C₂H₄, and no other measured gas, due to the open metal sites of Cu centers. In comparison, SO₂, a strong polar molecule, triggers the gate-opening effect in all three MOFs. Interestingly, a shape memory effect is observed for Cu(4-PyC)₂ during the second SO₂ sorption cycle. When comparing the different gate-opening pressures of each gas, we observed that the structural flexibility of the three frameworks is highly sensitive to the chemical hardness of the Lewis acidic metal ions (Mg²⁺ > Mn²⁺ > Cu²⁺). As a result, the gate opening behavior is observed at lower pressures for the MOFs containing weaker M-N bonds (harder metal ions), with the exception of Cu(4-PyC)₂ toward C₂H₄. These observations reveal that different transition metals can be used to finely control the structural flexibility of the frameworks.

Preferential adsorption of ethane over ethylene on a Zr-based metal–organic framework: impacts of C–H⋯N hydrogen bonding

C–H⋯N interactions are more important than C–H⋯π interactions for ethane-selective adsorption.

Structural Diversity of Zirconium Metal-Organic Frameworks and Effect on Adsorption of Toxic Chemicals

While linkers with various conformations pose challenges in the design and prediction of metal-organic framework (MOF) structures, they ultimately provide great opportunities for the discovery of novel structures thereby enriching structural diversity. Tetratopic carboxylate linkers, for example, have been widely used in the formation of Zr-based MOFs due to the ability to target diverse topologies, providing a promising platform to explore their mechanisms of formation. However, it remains a challenge to control the resulting structures when considering the complex assembly of linkers with unpredicted conformations and diverse Zr₆ node connectivities. Herein, we systematically explore how solvents and modulators employed during synthesis influence the resulting topologies of Zr-MOFs, choosing H₄TCPB-Br₂ (1,4-dibromo-2,3,5,6-tetrakis(4-carboxyphenyl)benzene) as a representative tetratopic carboxylate linker. By modulating the reaction conditions, the conformations of the linker and the connectivities of the Zr₆ node can be simultaneously tuned, resulting in four types of structures: a new topology (NU-500), she (NU-600), scu (NU-906), and csq (NU-1008). Importantly, we have synthesized the first 5-connected Zr₆ node to date with the (4,4,4,5)-connected framework, NU-500. We subsequently performed detailed structural analyses to uncover the relationship between the structures and topologies of these MOFs and demonstrated the crucial role that the flexible linker played to access varied structures by different degrees of linker deformation. Due to a variety of pore structures ranging from micropores to hierarchical micropores and mesopores, the resulting MOFs show drastically different behaviors for the adsorption of n-hexane and dynamic adsorption of 2-chloroethyl ethyl sulfide (CEES) under dry and humid conditions.

Tuning the Atrazine Binding Sites in an Indium-Based Flexible Metal-Organic Framework

Constructing flexible metal-organic frameworks (MOFs) with targeted properties is of high interest given their demonstrated potential as smart materials that undergo structural transformations in response to external stimuli. Herein, we report a flexible and interpenetrated indium-based MOF, NU-50, comprising four-connected [In(CO₂)₄]^- nodes and tetracarboxylate pyrene-based ligands assembled in the pts topology. The flexible framework of NU-50 exhibits intricate structural transformations upon exposure to external stimuli, namely, guest solvent molecules and elevated temperatures. The high density of pyrene moieties throughout the interpenetrated framework offers numerous sites for the adsorption of highly conjugated guest molecules such as atrazine via π-π interactions. As a result, NU-50 efficiently removes atrazine from water, achieving a maximum atrazine uptake capacity of 74 mg of atrazine per gram of NU-50. Molecular simulations reveal that the dynamic behavior of NU-50 involves the distortion of metal-ligand bonds, resulting in a narrow pore structure that affords effective adsorption of atrazine molecules in a sandwich-like geometry. Moreover, washing in acetone quickly regenerates the sorbent.

Measurement of the Spectral Shape of the β-Decay of ^{137}Xe to the Ground State of ^{137}Cs in EXO-200 and Comparison with Theory

We report on a comparison between the theoretically predicted and experimentally measured spectra of the first-forbidden nonunique β-decay transition ^{137}Xe(7/2^{-})→^{137}Cs(7/2^{+}). The experimental data were acquired by the EXO-200 experiment during a deployment of an AmBe neutron source. The ultralow background environment of EXO-200, together with dedicated source deployment and analysis procedures, allowed for collection of a pure sample of the decays, with an estimated signal to background ratio of more than 99 to 1 in the energy range from 1075 to 4175 keV. In addition to providing a rare and accurate measurement of the first-forbidden nonunique β-decay shape, this work constitutes a novel test of the calculated electron spectral shapes in the context of the reactor antineutrino anomaly and spectral bump.

SAT0219 PATIENT CHARACTERISTICS, TREATMENT PATTERNS, AND RESOURCE UTILIZATION OF SJOGREN’S SYNDROME PATIENTS IN A LARGE US HEALTH NETWORK

Background:

Sjogren’s syndrome (SS) is a chronic progressive autoimmune disorder which occurs as primary (pSS) or secondary SS (sSS). With no approved disease modifying therapy, there is limited information on the treatment patterns and resource utilization among these patients (pts).

Objectives:

To describe pts characteristics, treatment patterns and healthcare resource utilization (HCRU) using electronic health records (EHR) of pts with pSS and sSS treated at the Providence St. Josephs Health system (PSJH).

Methods:

Pts ≥18 years of age with at least one clinical encounter with ICD-9-CM or ICD-10-CM diagnosis of SS, between Jan 2013 and Mar 2019 were included. Date of first encounter with SS diagnosis (index date) was used to assess pts demographics. Pt baseline comorbidities were evaluated during the 24 months pre-index period. Treatment patterns and HCRU were assessed during the 12 months post-index follow-up. Descriptive statistics were used to describe pts’ demographic and clinical characteristics, and medications use in the baseline and follow up.

Results:

Study cohort included 9,108 SS pts of which 76.5% had sSS diagnosis on index date. Majority of SS pts were women, Caucasian, with mean age of 58.3 yrs, and from western states in the US (Table 1). Endocrine conditions including hypo- and hyperthyroidism, and diabetes was the most common (45.5%) comorbidity at baseline, followed by rheumatologic disorders (25.6%) and neurological conditions (22.2%). Among patients with treatment information (4088, 44.88%), 42.95% were using symptomatic treatments for dry eye and mouth at baseline (Table 1). In the follow-up, SS pts had average 5.8 healthcare visits per patient per year (PPPY), including 0.6 inpatient and 3.4 outpatient visit respectively. About 40% of the SS pts (53.8% pSS and 35.8% sSS) were diagnosed by rheumatologists. Majority of the SS pts initiated treatment with cDMARDs (82%) and remained on the same treatment during 1 year follow-up (Fig 2).

Table 1.

Baseline Demographic and Clinical Pts Characteristics

SS Pts (n=9,108)DemographicsAge (years) on index date, mean (SD)58.3 (15.1)Female, n (%)8,338 (91.6)Caucasian, n (%)6.936 (76.2)Western Region, n (%)8,998 (98.8)Married, n (%)5,164 (56.7)Never Smoked, n (%)4,847 (53.2)Primary diagnosis, n (%)2,137 (23.5)Comorbidities, n (%)Cardiovascular1,408 (17.2)Endocrine3,733 (45.5)Oncology800 (9.8)Blood disorders1,221 (14.9)Pulmonary1,802 (22.0)Neurological1,821 (22.2)Liver/Kidney1,782 (21.7)Rheumatologic disorders2,096 (25.6)Autoimmune/ Immune related1,527 (18.6)Baseline Medications, n (%)Symptomatic11,756 (43.0)NSAIDs21,578 (38.6)cDMARDs31,435 (35.1)Corticosteroid41,393 (34.1)bDMARDs5266 (6.5)

1cevimeline, pilocarpine hydrochloride, ophthalmic insert etc;2aspirin, ibuprofen, naproxen;3methotrexate, hydroxychloroquine, sulfasalazine, leflunomide, myophenolate mofetil, azathioprine;4prednisone;5sarilumab, belimumab, ustekinumab, infliximab, adalimumab, certolizumab pegol, golimumab, etanercept, abatacept, tocilizumab, rituximab, tofacitinib, baricitinib

Figure 1.

HCRU for pSS and sSS Pts

Figure 2.

Treatment Sequencing for pSS and sSS Pts. Note: Discontinued: pts who discontinued and didn’t advance to any therapy; same treatment: pts continued on index treatment till we have information.

Conclusion:

Observation of higher comorbidities suggests substantial burden of SS pts on healthcare system, with majority of pts being diagnosed outside of rheumatology offices.

Acknowledgments: :

We acknowledge the contributions of Manasi Suryavanshi towards drafting and reviewing the abstract.

Disclosure of Interests:

Philip J Mease Grant/research support from: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – grant/research support, Consultant of: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – consultant, Speakers bureau: Abbott, Amgen, Biogen Idec, BMS, Eli Lilly, Genentech, Janssen, Pfizer, UCB – speakers bureau, Joe Zhuo Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Roshanthi Weerasinghe Grant/research support from:., Qian Xia Shareholder of: I own shares of Bristol-Myers Squibb Company, Employee of: I am a paid employee of Bristol-Myers Squibb Company, Chidananda Samal Consultant of: I work as a consultant for Bristol-Myers Squibb Company, Niyati Sharma Consultant of: I work as a consultant for Bristol-Myers Squibb Company

SAT0129 ROLE OF SHARED EPITOPE ON THE EFFECTIVENESS OF TNFI TREATMENT FOR PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

Rheumatoid arthritis (RA) has been shown a strong genetic association with particularHLA–DRB1alleles containing shared epitope (SE). However, whether SE is clinically useful in treatment choices is insufficiently investigated1and previous studies have presented mixed findings in the role of SE in the response of TNFi therapies2,3.

Objectives:

To assess the role of SE in response to TNFi treatment in real-world RA patients (pts).

Methods:

Pts enrolled in a large RA registry, Brigham and Women’s Hospital RA Sequential Study, with known SE and received TNFi therapies were included for the analysis. TNFi pts were identified by the first-time use of the drugs between March 2003 to June 2018. For this analysis, all pts were followed up to 1 year. Summary statistics are reported for demographics, serostatus and disease activity (DA) at baseline and follow-up, stratified by SE status. Given the strong association of SE and anti-citrullinated protein antibody (ACPA), the analysis was further stratified by ACPA status. The effect of SE on change in DA was assessed using linear regression model with age, gender, RA disease duration, baseline DA, smoking status, SE, ACPA and ACPA-SE interaction as covariates.

Results:

Of the 484 TNFi pts included in the study, 68.8% were SE+. SE+ pts (vs SE-) were more likely to be rheumatoid factor positive, have erosive disease and a higher disease duration, irrespective of ACPA status. No difference in the change of DA was observed by SE. In SE- pts, ACPA+ pts had a greater reduction of DA than ACPA- pts (Table 1). After accounting for baseline differences, there was no significant effect of SE status on the mean change from baseline in any of the 3 DA measures.(Figure 1) The change in DA was not associated with ACPA but was significantly affected by disease duration and baseline DA.

Table 1.

Disease Activity in TNFi Patients, Stratified by SE and ACPA Status

ParameterSE+ (1 & 2 alleles, n=333)SE- (n=151)ACPA+ACPA–OverallACPA+ACPA-Overall(n=264)(n=69)(n=333)(n=90)(n=61)(n=151)Baseline, Mean (SD)DAS28 CRP3.94 (1.69)3.57 (1.61)3.86 (1.67)3.85 (1.49)3.45 (1.65)3.69 (1.57)CDAI23.06 (18.13)18.95 (15.96)22.25 (17.78)21.91 (15.96)17.72 (17.06)20.26 (16.48)SDAI24.08 (18.82)19.96 (16.59)23.27 (18.45)22.58 (16.34)18.55 (17.87)20.99 (17.01)Follow-up, Mean (SD)DAS28 CRP3.42 (1.55)2.69 (1.32)3.27 (1.53)3.19 (1.43)3.11 (1.53)3.16 (1.47)CDAI17.61 (15.53)12.11 (12.65)16.51 (15.14)15.15 (13.35)14.94 (14.73)15.07 (13.84)SDAI18.35 (15.73)12.45 (12.78)17.15 (15.34)15.31 (13.81)15.71 (15.45)15.46 (14.38)Change, Mean (SD)DAS28 CRP-0.48 (1.31)-0.65 (1.53)-0.52 (1.36)-0.52 (1.50)-0.24 (0.93)-0.42 (1.34)CDAI-4.29 (13.16)-4.79 (13.13)-4.39 (13.12)-6.45 (13.56)-2.63 (9.58)-4.99 (12.28)SDAI-4.74 (14.13)-5.07 (13.90)-4.80 (14.05)-6.87 (14.21)-2.97 (10.32)-5.41 (12.98)Figure 1.

Linear Regression Model for Change in Disease Activity*Estimates, p-values are shown as data labels on the graphs; The above model is adjusted for age, gender, RA duration, smoking status, SE status, baseline DA, ACPA and ACPA*SE status

Conclusion:

This real-world study validates the finding from previous studies conducted in clinical settings that SE does not differentiate treatment response for TNFi therapies.

References:

[1]Saruhan-Direskeneli G, et al.Rheumatology (Oxford) 2007;46(12):1842-44

[2]Skapenko A, et al.Clin Exp Rheumatol2019;37(5):783-790

[3]Rigby W, et al.Annals of the Rheumatic Diseases2019;78(2):263-264

Disclosure of Interests:

Joe Zhuo Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Joshua Bryson Shareholder of: I own shares of Bristol-Myers Squibb Company, Employee of: I am a paid employee of Bristol-Myers Squibb Company, Qian Xia Shareholder of: I own shares of Bristol-Myers Squibb Company, Employee of: I am a paid employee of Bristol-Myers Squibb Company, Niyati Sharma Consultant of: I work as a consultant for Bristol-Myers Squibb Company, Chidananda Samal Consultant of: I work as a consultant for Bristol-Myers Squibb Company, Sonie Lama Shareholder of: I own shares of Bristol-Myers Squibb Company., Employee of: I am a paid employee of Bristol-Myers Squibb Company., Michael E. Weinblatt Grant/research support from: BMS, Amgen, Lilly, Crescendo and Sonofi-Regeneron, Consultant of: Horizon Therapeutics, Bristol-Myers Squibb, Amgen, Abbvie, Crescendo, Lilly, Pfizer, Roche, Gilead, Nancy Shadick Grant/research support from: Mallinckrodt, BMS, Lilly, Amgen, Crescendo Biosciences, and Sanofi-Regeneron, Consultant of: BMS

AB1344-HPR POOLED ANALYSIS OF ASSOCIATION BETWEEN ABATACEPT OR OTHER TARGET DISEASE-MODIFYING ANTI-RHEUMATIC DRUGS (TDMARD) AND TYPE 2 DIABETES MELLITUS (T2DM)-RELATED HEALTHCARE RESOURCE UTILIZATION (HCRU) AND COSTS IN TNFI-NAÏVE RHEUMATOID ARTHRITIS (RA) PATIENTS WITH T2DM

Background:

Limited information is available on the impact of target disease-modifying anti-rheumatic drugs (tDMARD) on patients with rheumatoid arthritis (RA) and type 2 diabetes mellitus (T2DM).

Objectives:

The objective was to compare T2DM-related healthcare resource utilization (HCRU) and cost for TNF inhibitors (TNFi)-naive patients pooled from two commercial databases with RA and T2DM receiving abatacept, other non-TNFi, or TNFi.

Methods:

A retrospective, observational study was conducted with MarketScan and PharMetrics (January 2008-September 2018). The study population included TNFi-naïve adult patients with RA and T2DM newly initiating abatacept, TNFi (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab) or other non-TNFi (tocilizumab, anakinra, sarilumab, rituximab, tofacitinib). Date of tDMARD initiation was the index date. Patients had ≥2 RA diagnoses separated by ≥7 days, ≥1 T2DM diagnosis, and had ≥12 months of pre-index continuous enrollment. Follow-up ended at the end of patient insurance enrollment, study period or index treatment. T2DM-related HCRU and costs including inpatient stay, outpatient visits, ER visits, and pharmacy use were measured on a per-patient-per-month (PPPM) basis (2018 USD). Patients treated with abatacept were matched to TNFi and non-TNFi cohorts separately by propensity score adjusted with patients baseline comorbidities, HCRU, and costs.

Results:

A total of 16,236 patients meeting criteria were identified. Most patients were female (74.3%), and the overall average age of 55.4 years (Table 1). After matching, 850 pairs of abatacept vs non-TNFi patients, and 1,096 pairs of abatacept vs TNFi patients were included in the adjusted results. Patients initiating abatacept had $144 lower adjusted T2DM-related costs as compared to non-TNFi and $79 lower costs than TNFi cohorts (Table 2).

Table 1.

Patient Characteristics

Abataceptn=1,134Non-TNFin=1,353TNFin=13,749TotalN=16,236Age, mean years (SD)58.5 (11.3)57.7 (11.2)54.9 (10.6)55.41 (10.7)Gender, female, n (%)936 (82.5)993 (73.4)10,142 (73.8)12,071 (74.3)CCI, mean (SD)2.2 (1.4)2.3 (1.4)1.8 (1.1)1.89 (1.14)DCSI, n (%) Cardiovascular361 (31.8)406 (30.0)2,500 (18.2)3,267 (20.1) Neuropathy294 (25.9)374 (27.6)3,161 (23.0)3,829 (23.6) Nephropathy146 (12.9)193 (14.3)1,151 (8.4)1,490 (9.2) PVD131 (11.6)155 (11.5)874 (6.4)1,160 (7.1) Retinopathy103 (9.1)119 (8.8)922 (6.7)1,144 (7.0) Cerebrovascular74 (6.5)102 (7.5)620 (4.5)796 (4.9) Metabolic9 (0.8)20 (1.5)141 (1.0)170 (1.0)

CCI: Charlson comorbidity index; DCSI: diabetes complications severity index; PVD: peripheral vascular disease.

Table 2.

Adjusted T2DM-related HCRU and Costs after Propensity Score Matching

Abataceptn=850Non-TNFin=850Diff (ABA- Non-TNF)Abataceptn=1,096TNFin=1,096Diff (ABA- TNF)T2DM-related HCRU (per 1000 Patients per Month)Number of Hospitalizations13.920.4-6.5*12.614.9-2.3*Number ofER Visits22.016.15.9*18.416.32.0*Number ofOutpatient Visits311334.8-23.7*299.3286.912.4T2DM-related Costs (PPPM $)Inpatient Costs507535-28413475-62ER Costs271710*2225-3Outpatient Costs190323-13318617016*Pharmacy Costs1071007*97128-31Total Costs831975-144719798-79*

*P<0.05

Conclusion:

TNFi-naive RA patients with T2DM newly initiating abatacept had lower adjusted rates of T2DM-related hospitalizations compared to patients who initiated a non-TNFi or a TNFi. Total costs were lower among patients initiating abatacept vs. patients who initiated a non-TNFi or a TNFi. Findings suggest that initial abatacept among TNFi-naïve patients may be able to reduce healthcare utilization arising from T2DM complications and reduce T2DM-related costs in RA patients.

Disclosure of Interests:

Xue Han Employee of: BMS, Qian Xia Shareholder of: I own shares of Bristol-Myers Squibb Company, Employee of: I am a paid employee of Bristol-Myers Squibb Company, Ying Bao Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Vardhaman PATEL Employee of: Bristol Myers Squibb, Amrina Roy Employee of: Mu-Sigma, Varshini Rajagopalan Employee of: Mu-Sigma, Francis Lobo Shareholder of: Bristol-Myers Squibb (US), Employee of: Bristol-Myers Squibb (US)

SAT0061 ROLE OF SHARED EPITOPE IN THE PROGNOSIS OF RHEUMATOID ARTHRITIS IN RELATION TO ACPA POSITIVITY

Background:

The mechanistic association ofHLA-DRB1alleles that code a “shared epitope” (SE) with rheumatoid arthritis (RA) is not yet clear. Previous data has suggested the carriage of SE is associated with the production of cyclic citrullinated peptide antibodies (anti-CCP)1and severe RA2-4. The interrelationship among SE, anti-citrullinated protein antibody (ACPA) positivity and disease outcomes is not fully understood.

Objectives:

To assess the RA prognosis associated with the carriage of SE, in relation to ACPA positivity.

Methods:

Pts enrolled in a large RA registry, Brigham and Women’s Hospital RA Sequential Study between March 2003 to June 2018, with known SE and ACPA status were included in the analysis. HLA-DRB1 SE status was determined by allele-specific polymerase chain reaction and DNA sequencing for most of the subjects and by GWAS-based imputation for the rest. Disease activity (DA) was measured at baseline (BL) and 1-year follow-up by DAS28(CRP), CDAI and SDAI. Pts were stratified by SE+ (1 or 2 SE alleles) and SE- (0 alleles) and ACPA status. We analyzed the relationship of SE with ACPA positivity and change in DA by a linear regression model separately. A mediation analysis was used to examine the mediating effect of ACPA on association between SE and change in DA.

Results:

Out of 926 pts included in the analysis, 65.1% were SE+, of whom 75.6% were ACPA+. In comparison, 51.7% were ACPA+ in SE- pts. SE+ pts were similar with SE- pts in age, gender, BMI and smoking status, but had longer disease duration, were more likely to be rheumatoid factor positive, have erosive disease and higher comorbidity burden irrespective of ACPA status. The differences were more pronounced if the pts were also ACPA+. Adjusting for BL differences, pts with SE 1 and 2 alleles (vs 0) had an odd ratio of 1.97 (95% CI:1.36-2.84; p=0.0003) and 3.82 (95% CI: 2.44-5.98; p<.0001) to be ACPA +, respectively. The regression analysis suggests that SE+ (vs SE-) pts had an average increase in DAS28 (CRP) of 0.22 (p=0.033), CDAI of 2.07 (p=0.045) and SDAI of 2.43 (p=0.029) over a year (Fig 1). Using a mediation analysis, the direct effect of SE+ account for 78.8% to 81.0% of total effect in the increase in DAS28 (CRP), CDAI and SDAI, and the indirect effect mediated by ACPA account for 19.0% to 21.2% (Table 1).

Table 1.

Mediation Analysis for SE and ACPA Association with Change in DA

ParameterChange in DAS28 CRP (N=666)Change in CDAI (N=653)Change in SDAI (N=629)EstimateP-valueEstimateP-valueEstimateP-valueTotal Effect of SE on DA change0.220.0342.050.0472.400.030Direct effect of SE on DA change excluding mediation of ACPA0.170.1011.570.1401.890.098Indirect effect of SE on DA change due to ACPA mediation and interaction0.040.1830.480.1330.510.143

The model is adjusted with other covariates: Age, Gender, Charlson comorbidity score; baseline biologic use, Smoking status, baseline DA, Interaction term (ACPA*SE)

Figure 1.

Linear Regression Model for SE Association with Change in Disease Activity *Estimates, p-values are shown as data labels on the graphs; Change in disease activity (DA) = (follow-up DA- baseline DA); The above model is adjusted for age, gender, CCI, baseline DA, baseline biologic use, SE status and smoking status

Conclusion:

SE is strongly related to ACPA and a greater burden of disease in RA pts. In pts receiving standard treatments including biologics, SE is predictive of a greater increase in DA, which is partially mediated by the presence of ACPA.

References:

[1] Dayan I, et al.,Arch of Rheumatology, 2010;25:012-018.

[2] Gregerson PK, et al,Arthritis Rheum. 1987;30:1205-1213.

[3] Turesson C, et al.Arthritis Res Ther. 2005;7:R1386-1393.

[4] Moreno I, et al.J Rheumatol. 1996;23:6-9.

Disclosure of Interests:

Joe Zhuo Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Joshua Bryson Shareholder of: I own shares of Bristol-Myers Squibb Company, Employee of: I am a paid employee of Bristol-Myers Squibb Company, Qian Xia Shareholder of: I own shares of Bristol-Myers Squibb Company, Employee of: I am a paid employee of Bristol-Myers Squibb Company, Niyati Sharma Consultant of: I work as a consultant for Bristol-Myers Squibb Company, Sheng Gao Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Sonie Lama Shareholder of: I own shares of Bristol-Myers Squibb Company., Employee of: I am a paid employee of Bristol-Myers Squibb Company., Michael E. Weinblatt Grant/research support from: BMS, Amgen, Lilly, Crescendo and Sonofi-Regeneron, Consultant of: Horizon Therapeutics, Bristol-Myers Squibb, Amgen, Abbvie, Crescendo, Lilly, Pfizer, Roche, Gilead, Nancy Shadick Grant/research support from: Mallinckrodt, BMS, Lilly, Amgen, Crescendo Biosciences, and Sanofi-Regeneron, Consultant of: BMS