Primary Ciliary Dyskinesia and Retinitis Pigmentosa: Novel RPGR Variant and Possible Modifier Gene

We report a novel RPGR missense variant co-segregated with a familial X-linked retinitis pigmentosa (XLRP) case. The brothers were hemizygous for this variant, but only the proband presented with primary ciliary dyskinesia (PCD). Thus, we aimed to elucidate the role of the RPGR variant and other modifier genes in the phenotypic variability observed in the family and its impact on motile cilia. The pathogenicity of the variant on the RPGR protein was evaluated by in vitro studies transiently transfecting the mutated RPGR gene, and immunofluorescence analysis on nasal brushing samples. Whole-exome sequencing was conducted to identify potential modifier variants. In vitro studies showed that the mutated RPGR protein could not localise to the cilium and impaired cilium formation. Accordingly, RPGR was abnormally distributed in the siblings' nasal brushing samples. In addition, a missense variant in CEP290 was identified. The concurrent RPGR variant influenced ciliary mislocalisation of the protein. We provide a comprehensive characterisation of motile cilia in this XLRP family, with only the proband presenting PCD symptoms. The variant's pathogenicity was confirmed, although it alone does not explain the respiratory symptoms. Finally, the CEP290 gene may be a potential modifier for respiratory symptoms in patients with RPGR mutations.

Evidence of the association between increased use of direct oral anticoagulants and a reduction in the rate of atrial fibrillation-related stroke and major bleeding at the population level (2012-2019)

BACKGROUND

The introduction of direct-acting oral anticoagulants (DOACs) has shown to decrease atrial fibrillation (AF)-related stroke and bleeding rates in clinical studies, but there is no certain evidence about their effects at the population level. Our aim was to assess changes in AF-related stroke and major bleeding rates between 2012 and 2019 in Andalusia (Spain), and the association between DOACs use and events rates at the population level.

METHODS

All patients with an AF diagnosis from 2012 to 2019 were identified using the Andalusian Health Population Base, that provides clinical information on all Andalusian people. Annual ischemic and hemorrhagic stroke, major bleeding rates, and used antithrombotic treatments were determined. Marginal hazard ratios (HR) were calculated for each treatment.

RESULTS

A total of 95,085 patients with an AF diagnosis were identified. Mean age was 76.1±10.2 years (49.7% women). An increase in the use of DOACs was observed throughout the study period in both males and females (p<0.001). The annual rate of ischemic stroke decreased by one third, while that of hemorrhagic stroke and major bleeding decreased 2-3-fold from 2012 to 2019. Marginal HR was lower than 0.50 for DOACs compared to VKA for all ischemic or hemorrhagic events.

CONCLUSIONS

In this contemporary population-based study using clinical and administrative databases in Andalusia, a significant reduction in the incidence of AF-related ischemic and hemorrhagic stroke and major bleeding was observed between 2012 and 2019. The increased use of DOACs seems to be associated with this reduction.

High life satisfaction reported among small-scale societies with low incomes

Global polls have shown that people in high-income countries generally report being more satisfied with their lives than people in low-income countries. The persistence of this correlation, and its similarity to correlations between income and life satisfaction within countries, could lead to the impression that high levels of life satisfaction can only be achieved in wealthy societies. However, global polls have typically overlooked small-scale, nonindustrialized societies, which can provide an alternative test of the consistency of this relationship. Here, we present results from a survey of 2,966 members of Indigenous Peoples and local communities among 19 globally distributed sites. We find that high average levels of life satisfaction, comparable to those of wealthy countries, are reported for numerous populations that have very low monetary incomes. Our results are consistent with the notion that human societies can support very satisfying lives for their members without necessarily requiring high degrees of monetary wealth.

Indigenous Peoples' rights in national climate governance: An analysis of Nationally Determined Contributions (NDCs)

Although the recognition of Indigenous Peoples' contributions to climate governance by the international community has gradually increased, a rights-based approach in national climate action is still largely absent. This article analyses the recognition of Indigenous Peoples' rights in Nationally Determined Contributions (NDCs) under the Paris Agreement. We conducted a content analysis of all NDCs submitted between 2016 and May 2022. Through a five-pronged framework of sustainable self-determination, we assessed how the NDCs recognise: i. Indigenous Peoples as rights-holders; ii. Indigenous jurisdiction over land; iii. Indigenous knowledge systems; iv. Indigenous Peoples' right to full and effective participation in climate governance; and v. the legacy of colonialism. NDCs with references related to Indigenous Peoples are increasing. However, questions remain regarding their sincerity and commitment to implementation. States must therefore make more significant efforts to ensure that the NDCs take a rights-based approach and contribute to strengthening Indigenous Peoples' role and say in climate governance.

Real-world evidence with a retrospective cohort of 15,968 COVID-19 hospitalized patients suggests 21 new effective treatments

PURPOSE

Despite the extensive vaccination campaigns in many countries, COVID-19 is still a major worldwide health problem because of its associated morbidity and mortality. Therefore, finding efficient treatments as fast as possible is a pressing need. Drug repurposing constitutes a convenient alternative when the need for new drugs in an unexpected medical scenario is urgent, as is the case with COVID-19.

METHODS

Using data from a central registry of electronic health records (the Andalusian Population Health Database), the effect of prior consumption of drugs for other indications previous to the hospitalization with respect to patient outcomes, including survival and lymphocyte progression, was studied on a retrospective cohort of 15,968 individuals, comprising all COVID-19 patients hospitalized in Andalusia between January and November 2020.

RESULTS

Covariate-adjusted hazard ratios and analysis of lymphocyte progression curves support a significant association between consumption of 21 different drugs and better patient survival. Contrarily, one drug, furosemide, displayed a significant increase in patient mortality.

CONCLUSIONS

In this study we have taken advantage of the availability of a regional clinical database to study the effect of drugs, which patients were taking for other indications, on their survival. The large size of the database allowed us to control covariates effectively.

Dosimetric Parameters Correlate with Taste Alterations in Head and Neck Radiotherapy

PURPOSE/OBJECTIVE(S)

Dysgeusia is an acute and chronic side effect of head and neck chemoradiation, with persistent taste dysfunction 1-2 years post radiotherapy occurring in 23-50% of patients. Several head and neck clinical trials set oral cavity mean doses between 30 to 40 Gy, however, there are no set guidelines accurately defining the composite structure and anatomic boundaries for the oral cavity or separating the tongue into specific quadrants. In this single institution cross sectional study, we sought to determine the effects of radiation doses to specific regions of the oral cavity and tongue on patient-reported long term dysgeusia. We hypothesize that radiation Dose to specific structures in the oral cavity will correlate with long-term dysgeusia in patients who have received head and neck radiotherapy.

MATERIALS/METHODS

Patients with primary head and neck cancer receiving definitive intensity modulated radiation therapy (RT) completed quality of life assessments that included patient-reported gustatory function, 1 year post RT. Dosimetric data from RT plans were collected for specific regions and organs at risk within the oral cavity. These structures included the anterior, posterior, superior and inferior tongue (OT), pharyngeal constrictors (as a surrogate for the corda-tympani) and the oral cavity. A forward binary logistic regression model was performed using these data points with scoring from the QLQ-H&N43 questionnaire subsection on taste (Q45) to determine the most predictive values for dysgeusia and the OR for moderate/severe alterations in taste.

RESULTS

A total of 78 patients were included in this study, of these patients, 63 had dosimetric data for the pharyngeal constrictors. The Oral Cavity Volume percentage receiving 50Gy (OC V50) and Pharyngeal Constrictors Volume percentage receiving 55Gy (PC V55) were the most predictive constraints for dysgeusia. (0.042, p = 0.011 and 0.041, p = 0.033). Holding all other variables constant in a forward binary logistic regression including 78 patients, the odds of having moderate to severe taste alterations increased by 56% (OR 1.045, 95% CI 1.012-1.079) for a 1% increase in OCV50. When analyzing the 68 patients with available pharyngeal constrictors data, taste alteration increased 20% for every 1% increase in PCV55 (OR 1.042, 95% CI 1.003-1.082). There was no correlation with taste alterations in any of the dose parameters tested (Dmax, mean and V50 up to V70) for superior, inferior, anterior or posterior regions of the tongue.

CONCLUSION

Dosimetric parameters for the oral cavity (OC V50) and pharyngeal constrictors (PC V55) were positively correlated with taste alterations, however, no other specific regions within the oral tongue predicted taste disfunction. Normal tissue complication probability modeling curves to identify OC V50 and PC V55 constraints for dysgeusia are needed.

Placing diverse knowledge systems at the core of transformative climate research

We argue that solutions-based research must avoid treating climate change as a merely technical problem, recognizing instead that it is symptomatic of the history of European and North American colonialism. It must therefore be addressed by decolonizing the research process and transforming relations between scientific expertise and the knowledge systems of Indigenous Peoples and of local communities. Partnership across diverse knowledge systems can be a path to transformative change only if those systems are respected in their entirety, as indivisible cultural wholes of knowledge, practices, values, and worldviews. This argument grounds our specific recommendations for governance at the local, national, and international scales. As concrete mechanisms to guide collaboration across knowledge systems, we propose a set of instruments based on the principles of consent, intellectual and cultural autonomy, and justice. We recommend these instruments as tools to ensure that collaborations across knowledge systems embody just partnerships in support of a decolonial transformation of relations between human communities and between humanity and the more-than-human world.

Fractal approaches to scaling transformations to sustainability

Responses to sustainability challenges are not delivering results at the scale and speed called for by science, international agreements, and concerned citizens. Yet there is a tendency to underestimate the large-scale impacts of small-scale, local, and contextualized actions, and particularly the role of individuals in scaling transformations. Here, we explore a fractal approach to scaling sustainability transformations based on "universal values." Universal values are proposed as intrinsic characteristics that connect humans and nature in a coherent, acausal way. Drawing on the Three Spheres of Transformation framework, we consider how enacting universal values can generate fractal-like patterns of sustainability that repeat recursively across scales. Fractal approaches shift the focus from scaling through "things" (e.g., technologies, behaviors, projects) to scaling through a quality of agency based on values that apply to all. We discuss practical steps involved in fractal approaches to scaling transformations to sustainability, provide examples, and conclude with questions for future research.

A crowdsourcing database for the copy-number variation of the Spanish population

BACKGROUND

Despite being a very common type of genetic variation, the distribution of copy-number variations (CNVs) in the population is still poorly understood. The knowledge of the genetic variability, especially at the level of the local population, is a critical factor for distinguishing pathogenic from non-pathogenic variation in the discovery of new disease variants.

RESULTS

Here, we present the SPAnish Copy Number Alterations Collaborative Server (SPACNACS), which currently contains copy number variation profiles obtained from more than 400 genomes and exomes of unrelated Spanish individuals. By means of a collaborative crowdsourcing effort whole genome and whole exome sequencing data, produced by local genomic projects and for other purposes, is continuously collected. Once checked both, the Spanish ancestry and the lack of kinship with other individuals in the SPACNACS, the CNVs are inferred for these sequences and they are used to populate the database. A web interface allows querying the database with different filters that include ICD10 upper categories. This allows discarding samples from the disease under study and obtaining pseudo-control CNV profiles from the local population. We also show here additional studies on the local impact of CNVs in some phenotypes and on pharmacogenomic variants. SPACNACS can be accessed at: http://csvs.clinbioinfosspa.es/spacnacs/ .

CONCLUSION

SPACNACS facilitates disease gene discovery by providing detailed information of the local variability of the population and exemplifies how to reuse genomic data produced for other purposes to build a local reference database.

Food democracy and sustainability in France and Chile: Community gardens promote ecological citizenship

This study explored cases of sustainable food production in urban and non-urban areas, including the development of urban gardens, and particularly the social relations involved in these community projects. A qualitative approach was used to compare four case studies in Chile and France: shared gardens in Lyon, family and workers' gardens in Santiago in Chile, an indigenous agricultural project in Lonquimay in the southern Andes, and the work of the NGO Cultivos Urbanos. The data was collected through surveys, participant observation and semi-structured in-depth interviews. The results show that tending gardens in these settings (worker, family, collective, or shared gardens) promotes social values that can lead to more sustainable forms of community living. As opposed to intensive agriculture, small-scale gardening practices, specifically in urban and peri-urban gardens, encourage human/non-human relationships, and the transmission of caring for nature and for others, which promotes ecological citizenship.

Respuestas locales para una crisis global: pueblos indígenas, sociedad civil y transdisciplina para enfrentar el cambio climático

El cambio climático se ha posicionado en la agenda de investigación de las ciencias sociales. El escaso éxito de las respuestas hegemónicas y el avance de los impactos han fortalecido la irrupción de actores no estatales. Sin embargo, su rol continúa siendo poco explorado, especialmente en América Latina. En este artículo indagamos en tres ámbitos centrales a considerar para enfrentar los desafíos y las políticas asociadas al cambio climático, que aún son áreas incipientes de investigación en Latinoamérica: las demandas de participación de los pueblos indígenas; la organización de la sociedad civil, y la colaboración entre comunidades locales, academia y otros actores sociales a través de la transdisciplina. Resulta urgente que las respuestas de los actores no estatales sean tomadas en mayor consideración. Además de fortalecer la democracia, la participación de estos actores conlleva el potencial de promover las transformaciones necesarias para responder de manera justa al cambio climático.

CIBERER: Spanish National Network for Research on Rare Diseases: a highly productive collaborative initiative

CIBER (Center for Biomedical Network Research; Centro de Investigación Biomédica En Red) is a public national consortium created in 2006 under the umbrella of the Spanish National Institute of Health Carlos III (ISCIII). This innovative research structure comprises 11 different specific areas dedicated to the main public health priorities in the National Health System. CIBERER, the thematic area of CIBER focused on rare diseases (RDs) currently consists of 75 research groups belonging to universities, research centers, and hospitals of the entire country. CIBERER's mission is to be a center prioritizing and favoring collaboration and cooperation between biomedical and clinical research groups, with special emphasis on the aspects of genetic, molecular, biochemical, and cellular research of RDs. This research is the basis for providing new tools for the diagnosis and therapy of low‐prevalence diseases, in line with the International Rare Diseases Research Consortium (IRDiRC) objectives, thus favoring translational research between the scientific environment of the laboratory and the clinical setting of health centers. In this article, we intend to review CIBERER's 15‐year journey and summarize the main results obtained in terms of internationalization, scientific production, contributions toward the discovery of new therapies and novel genes associated to diseases, cooperation with patients' associations and many other topics related to RD research.

POS0037 DOES IMAGING OF THE SACROILIAC JOINT DIFFER IN PATIENTS PRESENTING WITH UNDIAGNOSED BACK PAIN AND PSORIASIS, ACUTE ANTERIOR UVEITIS, AND COLITIS: AN INCEPTION COHORT STUDY

Background:

Axial spondyloarthritis (axSpA) presents diagnostic challenges incurring a delay of up to a decade and relies considerably on radiographic and MRI evidence of sacroiliitis which has led to the development of classification criteria which also rely on imaging. However, it has been suggested that such criteria may not be appropriate for axSpA patients presenting with other forms of SpA, especially psoriatic, because imaging features may vary in frequency and/or may be atypical. This hypothesis has never been tested in a prospective inception cohort of patients presenting with undiagnosed back pain.

Objectives:

We aimed to compare the spectrum of radiographic and MRI abnormalities in the sacroiliac joint (SIJ) of an inception cohort of patients presenting with undiagnosed back pain and psoriasis, iritis, and colitis.

Methods:

We used data from the prospective multicenter Screening for Axial Spondyloarthritis in Psoriasis, Iritis, and Colitis (SASPIC) Study, which is aimed at early detection of axial SpA in patients referred by the respective specialist after first presenting with these disorders. Consecutive patients ≤45 years of age with ≥3 months undiagnosed back pain with any one of psoriasis, AAU, or colitis undergo routine clinical evaluation by a rheumatologist for axial SpA followed by imaging. In SASPIC I, MRI evaluation of the SIJ was ordered per rheumatologist decision. In SASPIC II, MRI evaluation was ordered for all patients. Radiographs and MRI scans were assessed by two central readers and comparisons of the three groups were based on concordant assessments of imaging features. Evaluation of MRI scans included both global assessment for presence/absence of axSpA with confidence scale (-10 to +10), active and structural lesions typical of axSpA per recent ASAS definitions, and granular assessment of individual lesions according to SIJ quadrants and halves in consecutive semicoronal slices through the SIJ. Groups were compared by ANOVA and the chi-square test.

Results:

A total of 240 patients were recruited, 143 from SASPIC I and 97 from SASPIC II, 101 (42.1%) being diagnosed with axSpA (65.3% male, mean age 34.4 years, mean symptom duration 8.7 years, B27 positive 55.4%). Mean age of colitis (N=101), psoriasis (N=61), iritis (N=78) patients were 33.4, 36.6, 34.3 years, respectively, mean symptom duration was 6.8, 7.2, 9.4 years, respectively, and % males were 45.5%, 52.5%, 51.3%, respectively. There were no significant group differences for unilateral versus bilateral radiographic sacroiliitis and no significant differences in the frequencies, type, or distribution of MRI lesions (Table 1).

Conclusion:

Data from the SASPIC prospective inception cohort does not support the view that imaging of the SIJ differs in psoriatic axSpA, which appears similar to axSpA associated with iritis or colitis. These data support the umbrella concept of axSpA.

Imaging FeatureColitis (n=30)Psoriasis (n=19)Iritis (n=52)P valueUnilateral sacroiliitis (grade ≥2), N(%)1 (3.3%)0 (0%)2 (3.8%)0.69mNY criteria +, N(%)5 (16.7%)6 (31.2%)15 (28.8%)0.39Grade of sacroiliitis, mean(SD)1.8 (2.2)2.1 (2.7)2.2 (2.4)0.76MRI indicative of axSpA, N(%)15 (50.0%)11 (57.9%)32 (61.5%)0.60MRI indicative of axSpA (confidence ≥5/10), N(%)14 (46.7%)10 (52.6%)30 (57.7%)0.63MRI active lesion typical of axSpA, N(%)6 (20.0%)6 (31.6%)18 (34.6%)0.37MRI structural lesion typical of axSpA, N(%)11 (36.7%)7 (36.8%)18 (34.6%)0.98MRI with unilateral lesion (any)2 (6.7%)3 (15.8%)11 (21.2%)0.22MRI with unilateral lesion (BME)1 (3.3%)2 (10.5%)5 (9.6%)0.54MRI with unilateral lesion (Erosion)0 (0%)0 (0%)3 (5.8%)0.23MRI with unilateral lesion (Sclerosis)1 (3.3%)1 (5.3%)3 (5.8%)0.89MRI with unilateral lesion (Fat)0 (0%)0 (0%)0 (0%)NAMRI with iliac lesion17 (56.7%)12 (63.2%)32 (61.5%)0.88MRI with sacral lesion12 (40.0%)11 (57.9%)31 (59.6%)0.21

Disclosure of Interests:

Walter P Maksymowych Speakers bureau: Abbvie, Janssen, Novartis, Pfizer, UCB, Consultant of: Abbvie, BMS, Boehringer, Galapagos, Gilead, Lilly, Novartis, Pfizer, UCB, Grant/research support from: Abbvie, Novartis, Pfizer, Ulrich Weber: None declared, Jon Chan: None declared, Raj Carmona: None declared, James Yeung: None declared, Sibel Aydin: None declared, Jodie Reis: None declared, Liam Martin: None declared, Ariel Masetto: None declared, Olga Ziouzina: None declared, Dianne Mosher: None declared, Stephanie Keeling: None declared, Sherry Rohekar: None declared, Rana Dadashova: None declared, Joel Paschke: None declared, Amanda Carapellucci: None declared, Robert G Lambert: None declared.

CSVS, a crowdsourcing database of the Spanish population genetic variability

The knowledge of the genetic variability of the local population is of utmost importance in personalized medicine and has been revealed as a critical factor for the discovery of new disease variants. Here, we present the Collaborative Spanish Variability Server (CSVS), which currently contains more than 2000 genomes and exomes of unrelated Spanish individuals. This database has been generated in a collaborative crowdsourcing effort collecting sequencing data produced by local genomic projects and for other purposes. Sequences have been grouped by ICD10 upper categories. A web interface allows querying the database removing one or more ICD10 categories. In this way, aggregated counts of allele frequencies of the pseudo-control Spanish population can be obtained for diseases belonging to the category removed. Interestingly, in addition to pseudo-control studies, some population studies can be made, as, for example, prevalence of pharmacogenomic variants, etc. In addition, this genomic data has been used to define the first Spanish Genome Reference Panel (SGRP1.0) for imputation. This is the first local repository of variability entirely produced by a crowdsourcing effort and constitutes an example for future initiatives to characterize local variability worldwide. CSVS is also part of the GA4GH Beacon network. CSVS can be accessed at: http://csvs.babelomics.org/.

SMN1 copy-number and sequence variant analysis from next-generation sequencing data

Spinal muscular atrophy (SMA) is a severe neuromuscular autosomal recessive disorder affecting 1/10,000 live births. Most SMA patients present homozygous deletion of SMN1, while the vast majority of SMA carriers present only a single SMN1 copy. The sequence similarity between SMN1 and SMN2, and the complexity of the SMN locus makes the estimation of the SMN1 copy-number by next-generation sequencing (NGS) very difficult. Here, we present SMAca, the first python tool to detect SMA carriers and estimate the absolute SMN1 copy-number using NGS data. Moreover, SMAca takes advantage of the knowledge of certain variants specific to SMN1 duplication to also identify silent carriers. This tool has been validated with a cohort of 326 samples from the Navarra 1000 Genomes Project (NAGEN1000). SMAca was developed with a focus on execution speed and easy installation. This combination makes it especially suitable to be integrated into production NGS pipelines. Source code and documentation are available at https://www.github.com/babelomics/SMAca.

SAT0378 THE RELATIVE DIAGNOSTIC UTILITY OF INFLAMMATORY BACK PAIN CRITERIA IN AN INCEPTION COHORT OF PATIENTS WITH PSORIASIS, IRITIS, AND COLITIS PRESENTING WITH UNDIAGNOSED BACK PAIN

Background:

Clinicians rely on the elicitation of features of inflammatory back pain (IBP) for diagnosis of axial spondyloarthritis (axSpA) but the utility of IBP criteria in patients presenting with extra-articular features of axSpA remains unclear. Assessment of utility should include not only rheumatologist diagnosis as benchmark but imaging to address the circularity between elicitation of IBP and clinical diagnosis.

Objectives:

To assess the diagnostic utility of all criteria for IBP in patients with psoriasis, iritis, or colitis and undiagnosed back pain using the rheumatologist diagnosis and imaging as benchmarks.

Methods:

Consecutive patients (n=246) with undiagnosed back pain ≤45 years of age, ≥3 months, with any one of psoriasis (n=46), acute anterior uveitis (AAU)(n=73), or colitis (n=127) had diagnostic evaluation by a rheumatologist. Majority central reader assessment of MRI indicative of axSpA and diagnosis by the rheumatologist were external standards for testing the utility of these IBP criteria: ASAS, Berlin, Calin, rheumatologist global for IBP >5 (0-10 scale).

Results:

AxSpA was diagnosed in 44.4%, 61.6%, and 41.8% of patients with psoriasis, iritis, and IBD, respectively. Diagnostic utility for all IBP criteria was comparably poor (Table 1). MRI was indicative of axSpA in 21.2%, 43.5%, and 19.7% of patients with psoriasis, iritis, and IBD. The utility of the IBP criteria was even worse using MRI as the external reference (Table 2), especially in patients with psoriasis. Only 14% of psoriasis patients with a positive MRI reported “improvement with exercise but not rest” as compared to 70% and 62% of patients with iritis and IBD, respectively.

Table 1.

Rheumatologist diagnosis as external reference.

SensitivitySpecificityLR+LR-PsoriasisASAS IBP65.00%52.00%1.350.67Berlin IBP80.00%36.00%1.250.56Calin IBP80.00%28.00%1.110.71All 3 criteria sets60.00%56.00%1.360.71IBP global >585.00%36.00%1.330.42AAUASAS IBP84.44%42.86%1.480.36Berlin IBP80.00%57.14%1.870.35Calin IBP93.33%17.86%1.140.37All 3 criteria sets77.78%60.71%1.980.37IBP global >586.67%57.14%2.020.23IBDASAS IBP78.43%45.07%1.430.48Berlin IBP82.35%52.11%1.720.34Calin IBP84.31%19.72%1.050.80All 3 criteria sets70.59%57.75%1.670.51IBP global >580.39%66.20%2.380.30Table 2.

Central assessment that MRI is indicative of axSpA as external reference.

SensitivitySpecificityLR+LR-PsoriasisASAS IBP28.57%38.46%0.461.86Berlin IBP42.86%15.38%0.513.71Calin IBP71.43%23.08%0.931.24All 3 criteria sets14.29%42.31%0.252.03IBP global >585.71%23.08%1.110.62AAUASAS IBP75.00%26.92%1.030.93Berlin IBP70.00%38.46%1.140.78Calin IBP90.00%15.38%1.060.65All 3 criteria sets65.00%38.46%1.060.91IBP global >575.00%38.46%1.220.65IBDASAS IBP92.31%37.74%1.480.20Berlin IBP76.92%39.62%1.270.58Calin IBP92.31%16.98%1.110.45All 3 criteria sets76.92%45.28%1.410.51IBP global >592.31%47.17%1.750.16

Conclusion:

All IBP criteria have poor diagnostic utility for diagnosis of axSpA, especially in patients with psoriasis. This reinforces the desirability of less subjective assessment tools, especially imaging.

Disclosure of Interests:

Georg Kröber: None declared, Ulrich Weber: None declared, Raj Carmona: None declared, James Yeung: None declared, Jon Chan: None declared, Sibel Aydin: None declared, Liam Martin: None declared, Ariel Masetto: None declared, Stephanie Keeling: None declared, Olga Ziouzina: None declared, Sherry Rohekar: None declared, Rana Dadashova: None declared, Joel Paschke: None declared, Amanda Carapellucci: None declared, Robert G Lambert: None declared, Walter P. Maksymowych Grant/research support from: AbbVie, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Boehringer Ingelheim, Celgene, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, and UCB, Employee of: Chief Medical Officer of CARE Arthritis Limited, Speakers bureau: AbbVie, Janssen, Novartis, Pfizer, and UCB

SAT0383 ENHANCED PERFORMANCE OF THE ASAS CLASSIFICATION CRITERIA BY DELETION OF NON-DISCRIMINATORY CLINICAL ITEMS: DATA FROM THE SCREENING IN AXIAL SPONDYLOARTHRITIS IN PSORIASIS, IRITIS, AND COLITIS COHORT

Background:

The ASAS classification criteria for axial spondyloarthritis (axSpA) have overall sensitivity/specificity of 82.9%/84.4% but component imaging and clinical arms differ in performance (66.2%/97.3% and 56.6%/83.3%, respectively)1.

Objectives:

We aimed to demonstrate that a data-driven elimination of SpA clinical features that were non-discriminatory in comparisons of patients diagnosed with and without axSpA in a prospective cohort of patients with undiagnosed back pain could enhance the performance of the criteria.

Methods:

We used data from the prospective multicenter Screening for Axial Spondyloarthritis in Psoriasis, Iritis, and Colitis (SASPIC) Study. Consecutive patients ≤45 years of age with ≥3 months undiagnosed back pain with any one of psoriasis, AAU, or colitis undergo routine diagnostic evaluation by a rheumatologist for axial SpA, including imaging assessed by central readers. Univariable and multivariable logistic regression analysis was performed to determine which clinical SpA features were/were not discriminatory for the final diagnosis of axSpA. We then compared the sensitivity and specificity of the ASAS criteria with and without these features.

Results:

A total of 246 patients were recruited, 47.6% being diagnosed with axSpA (61.5% male, age 33.7 years, symptom duration 7.6 years, B27 positive 52.1%). The following clinical SpA features were non-discriminatory between axSpA/not axSpA: NSAID response, family history of SpA, heel enthesitis, peripheral arthritis, dactylitis. Specificity of the clinical arm and the overall criteria increased from 82.2% to 86.8% without impacting sensitivity. This effect was particularly noteworthy in patients with lower degree of symptomatology (back pain severity <5/10, specificity increases from 76.7% to 90.7%), short symptom duration (<5 years, specificity increases from 78% to 84.7%), and in females (specificity increases from 80.6% to 86.1%).

Conclusion:

In a prospective cohort with a high pre-test probability of axSpA certain clinical SpA features were not helpful in discriminating a diagnosis of SpA from not-SpA. Deletion of these features from the list of SpA features used in the ASAS classification criteria enhanced the performance of the criteria, especially in female patients and those with early disease.

References:

[1]Rudwaleit et al. Ann Rheum Dis 2009;68: 777-83

Patient CategoryNumberASAS criteriaImaging armClinical armSenSpecSenSpecSensSpecAll patients2466582.236.897.750.482.2High confidence in diagnosis19073.884.547.598.256.384.5Patients with back pain ≥5/1016563.384.934.298.851.984.9Patients with back pain <58168.476.742.195.347.476.7Patients with symptom duration ≥5 years10371.285.735.697.156.285.7Patients with symptom duration <5 years14354.57838.698.340.978Males12968.184.247.298.248.684.2Females1176080.62097.253.380.6After deletion of ‘NSAID response’, ‘Family Hx SpA’, ‘heel enthesitis’, ‘peripheral arthritis’, ‘dactylitis’ SpA featuresAll patients2466586.836.897.750.486.8High confidence in diagnosis19073.887.347.598.256.387.3Patients with back pain ≥5/1016563.384.934.298.851.984.9Patients with back pain <58168.490.742.195.347.490.7Patients with symptom duration ≥5 years10371.288.635.697.156.288.6Patients with symptom duration <5 years14354.584.738.698.340.984.7Males12968.187.747.298.248.687.7Females1176086.12097.253.386.1

Disclosure of Interests:

Walter P. Maksymowych Grant/research support from: AbbVie, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Boehringer Ingelheim, Celgene, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, and UCB, Employee of: Chief Medical Officer of CARE Arthritis Limited, Speakers bureau: AbbVie, Janssen, Novartis, Pfizer, and UCB, Raj Carmona: None declared, Jon Chan: None declared, James Yeung: None declared, Sibel Aydin: None declared, Liam Martin: None declared, Ariel Masetto: None declared, Olga Ziouzina: None declared, Stephanie Keeling: None declared, Sherry Rohekar: None declared, Rana Dadashova: None declared, Joel Paschke: None declared, Amanda Carapellucci: None declared, Robert G Lambert: None declared

FRI0298 ASAS MODIFICATION OF THE BERLIN ALGORITHM AND THE DUET ALGORITHM FOR DIAGNOSING AXIAL SPONDYLOARTHRITIS: RESULTS FROM THE SCREENING IN AXIAL SPONDYLOARTHRITIS FOR PSORIASIS, IRITIS, AND COLITIS COHORT

Background:

Patients presenting with back pain and psoriasis, iritis, or colitis, represent a high-risk population for the presence of axial spondyloarthritis (axSpA). The Dublin Evaluation Tool (DUET)1, the Berlin algorithm2, and the ASAS modification of this algorithm3are recommended referral strategies aimed at early diagnosis of axSpA. DUET was developed for patients presenting with AAU. Validation of these algorithms in inception cohorts is limited.

Objectives:

1. To assess the performance of referral algorithms for diagnosis of axSpA when tested against the final local rheumatologist diagnosis in an inception cohort of patients presenting with undiagnosed back pain and extra-articular manifestations. 2. To determine whether different criteria for inflammatory back pain (IBP) impact the performance of the algorithms.

Methods:

The multicenter Screening for Axial Spondyloarthritis in Psoriasis, Iritis, and Colitis (SASPIC) Study at 11 sites is aimed at early detection of axial SpA in patients presenting with undiagnosed back pain to the rheumatologist. Consecutive patients ≤45 years of age with ≥3 months undiagnosed back pain with any one of psoriasis, acute anterior uveitis (AAU), or colitis diagnosed by the relevant specialist undergo routine clinical evaluation by a rheumatologist for axial SpA. The rheumatologist determines the presence or absence of axial SpA at 3 consecutive stages: 1. After the clinical evaluation; 2. After the results of labs (B27, CRP) and radiography; 3. After the results of MRI evaluation. Final diagnosis by the rheumatologist was used as external standard to test the performance of the algorithms. We tested the following criteria for IBP in the algorithm: ASAS, Berlin, rheumatologist global for likelihood of IBP >5 (0-10 scale), and DUET algorithm in AAU patients.

Results:

A total of 246 patients were recruited, 73 presented with iritis, 46 with psoriasis, and 127 with colitis, 47.6% were diagnosed with axSpA. The diagnosis of axSpA was established in 45.7%, 61.6%, and 40.2% of patients with psoriasis, AAU, and IBD, respectively. The performance of the ASAS-modification of the Berlin algorithm was superior to the original algorithm as reported previously3, primarily for enhanced sensitivity, and this was observed irrespective of the criteria used to define IBP (Table 1). Conversely, the performance of the Duet algorithm in the subset of patients with AAU was substantially worse than previously reported1.

Conclusion:

The ASAS modification of the Berlin algorithm is the preferred referral strategy for patients presenting with undiagnosed back pain to the rheumatologist.

References:

[1]Haroon M, et al. Ann Rheum Dis 2015; 74: 1990-5

[2]Poddubnyy D, et al. J Rheumatol 2011; 38: 2452–60

[3]Van den Berg R, et al. Ann Rheum Dis 2013;72:1646–53

AlgorithmSensitivity (%)Specificity (%)Correct diagnosis (%)False negative (%)False positive (%)Original Berlin(ASAS criteria for IBP)65.376.671.116.712.2Original Berlin(Berlin criteria for IBP)64.476.670.717.112.2Original Berlin(IBP global >5)67.878.173.215.411.4ASAS Modification of Berlin algorithm (ASAS criteria for IBP)73.775.874.812.612.6ASAS Modification of Berlin algorithm (Berlin criteria for IBP)73.775.074.412.613.0ASAS Modification of Berlin algorithm(IBP global >5)76.377.376.811.411.8DUET84.450.071.29.619.2

Disclosure of Interests:

Ulrich Weber: None declared, Georg Kröber: None declared, Raj Carmona: None declared, James Yeung: None declared, Jon Chan: None declared, Sibel Aydin: None declared, Liam Martin: None declared, Ariel Masetto: None declared, Stephanie Keeling: None declared, Olga Ziouzina: None declared, Sherry Rohekar: None declared, Rana Dadashova: None declared, Amanda Carapellucci: None declared, Joel Paschke: None declared, Robert G Lambert: None declared, Walter P. Maksymowych Grant/research support from: AbbVie, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Boehringer Ingelheim, Celgene, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, and UCB, Employee of: Chief Medical Officer of CARE Arthritis Limited, Speakers bureau: AbbVie, Janssen, Novartis, Pfizer, and UCB

Bird population declines in the Chametla wetland (Southern Gulf of California): Evidence of stress at the assemblage level

The Chametla wetland is used by shorebirds as a stopover site during their autumn migration and it is also an important breeding area for several species of waterbirds. The objective of this work was to compare the bird assemblages in Chametla wetland during three sampling periods: 1) 1991–1992; 2) 1997–1998 which was subjected to El Nino Southern Oscillation (ENSO) climate conditions and 3) 2005–2006. Bird communities were characterized in terms of species composition and diversity, using similarity analysis. Bird assemblage composition differed across years and seasons. Seasonal variations in composition and diversity were related to the presence/absence of phenological-characterized species (migratory vs. wintering species). The highest species richness was recorded under the ENSO period (1997–1998). We observed a sharp decrease in shorebird numbers, with evident stress at the assemblage level throughout the entire study period. There seems to be a transition of the bird assemblages from shorebird dominance to a dominance by long-legged wading birds and waterfowl species, which could be related to water level variation and changes in the quality/availability of food in the intertidal zone. The joint pressures of regional climate variation combined with local anthropogenic perturbations may lead to changes in bird assemblage in the Chametla wetland.

Will there be cold-related mortality in Spain over the 2021-2050 and 2051-2100 time horizons despite the increase in temperatures as a consequence of climate change?

INTRODUCTION

Global warming is resulting in an increase in temperatures which is set to become more marked by the end of the century and depends on the accelerating pace of greenhouse gas emissions into the atmosphere. Yet even in this scenario, so-called "cold waves" will continue to be generated and have an impact on health.

OBJECTIVES

This study sought to analyse the impact of cold waves on daily mortality at a provincial level in Spain over the 2021-2050 and 2051-2100 time horizons under RCP4.5 and RCP 8.5 emission scenarios, on the basis of two hypotheses: (1) that the cold-wave definition temperature (T _threshold) would not vary over time; and, (2) that there would be a variation in T _threshold.

MATERIAL AND METHODS

The results of a retrospective study undertaken for Spain as a whole across the period 2000-2009 enabled us to ascertain the cold-wave definition temperature at a provincial level and its impact on health, measured by reference to population attributable risk (PAR). The minimum daily temperatures projected for each provincial capital considering the above time horizons and emission scenarios were provided by the State Meteorological Agency. On the basis of the T _threshold definition values and minimum daily temperatures projected for each province, we calculated the expected impact of low temperatures on mortality under the above two hypotheses. Keeping the PAR values constant, it was assumed that the mortality rate would vary in accordance with the available data.

RESULTS

If T _threshold remained constant over the above time horizons under both emission scenarios, there would be no cold-related mortality. If T _threshold were assumed to vary over time, however, then cold-related mortality would not disappear: it would instead remain practically constant over time and give rise to an estimated overall figure of around 250 deaths per year, equivalent to close on a quarter of Spain's current annual cold-related mortality and entailing a cost of approximately €1000 million per year.

CONCLUSION

Given that cold waves are not going to disappear and that their impact on mortality is far from negligible and is likely to remain so, public health prevention measures must be implemented to minimise these effects as far as possible.

Mortality attributable to high temperatures over the 2021-2050 and 2051-2100 time horizons in Spain: Adaptation and economic estimate

BACKGROUND

In recent years, a number of studies have been conducted with the aim of analysing the impact that high temperatures will have on mortality over different time horizons under different climate scenarios. Very few of these studies take into account the fact that the threshold temperature used to define a heat wave will vary over time, and there are practically none which calculate this threshold temperature for each geographical area on the assumption that there will be variations at a country level.

OBJECTIVE

To analyse the impact that high temperatures will have on mortality across the periods 2021-2050 and 2051-2100 under a high-emission climate scenario (RCP8.5), in a case: (a) where adaptation processes are not taken into account; and (b) where complete adaptation processes are taken into account.

MATERIAL AND METHODS

Based on heat-wave definition temperature (T_threshold) values previously calculated for the reference period, 2000-2009, for each Spanish provincial capital, and their impact on daily mortality as measured by population attributable risk (PAR), the impact of high temperatures on mortality will be calculated for the above-mentioned future periods. Two hypotheses will be considered, namely: (a) that T_threshold does not vary over time (scenario without adaptation to heat); and, (b) that T_threshold does vary over time, with the percentile to which said T_threshold corresponds being assumed to remain constant (complete adaptation to heat). The temperature data were sourced from projections generated by Coupled Model Intercomparison Project (CMIP5) climate models adapted to each region's local characteristics by the State Meteorological Agency (Agencia Estatal de Meteorología/AEMET). Population-growth projections were obtained from the National Statistics Institute (Instituto Nacional de Estadística/INE). In addition, an economic estimate of the resulting impact will be drawn up.

RESULTS

The mean value of maximum daily temperatures will rise, in relation to those of the reference period (2000-2009), by 1.6⁰C across the period 2021-2050 and by 3.3⁰C across the period 2051-2100. In a case where there is no heat-adaptation process, overall annual mortality attributable to high temperatures in Spain would amount to 1414 deaths/year (95% CI: 1089-1771) in the period 2021-2050, rising to 12,896 deaths/year (95% CI: 9852-15,976) in the period 2051-2100. In a case where there is a heat-adaptation process, annual mortality would be 651 deaths/year (95% CI: 500-807) in the period 2021-2050, and 931 deaths per year (95% CI: 770-1081) in the period 2051-2100. These results display a high degree of heterogeneity. The savings between a situation that does envisage and one that does not envisage an adaptive process is €49,100 million/year over the 2051-2100 time horizon.

CONCLUSION

A non-linear increase in maximum daily temperatures was observed, which varies widely from some regions to others, with an increase in mean values for Spain as a whole that is not linear over time. The high degree of heterogeneity found in heat-related mortality by region and the great differences observed on considering an adaptive versus a non-adaptive process render it necessary for adaptation plans to be implemented at a regional level.

Time trends in the impact attributable to cold days in Spain: Incidence of local factors

BACKGROUND

While numerous studies have shown that the impact of cold waves is decreasing as result of various processes of adaptation, far fewer have analysed the time trend shown by such impact, and still fewer have done so for the different provinces of a single country, moreover using a specific cold waves definition for each. This study thus aimed to analyse the time trend of the impact of cold days on daily mortality in Spain across the period 1983-2003.

METHODS

For study purposes, we used daily mortality data for all natural causes except accidents in ten Spanish provinces. The time series was divided into three subperiods. For each period and province, the value of T_threshold was obtained via the percentile corresponding to the cold day's definition for that province obtained in previous studies. Relative Risks (RRs) and Population Attributable Fraction (PARs) were calculated using Generalised Linear Models (GLMs) with the Poisson regression link. Seasonalities, trends and autoregressive components were controlled. Global RRs and ARs were calculated with the aid of a meta-analysis with random effects for each of the periods.

RESULTS

The results show that the RRs for Spain as a whole were 1.12 (95% CI: 1.08 1.16) for the first period, 1.15 (95% CI: 1.09 1.22) for the second and 1.18 (95% CI: 1.10 1.26) for the third. The impact of cold days has risen slightly over time, though the differences were not statistically significant. These findings show a clearly different behaviour pattern to that previously found for heat.

CONCLUSION

The results obtained in this study do not show a downward trend for colds days. The complexity of the biological mechanisms involved in cold-related mortality and the lack of robust results mean that more research must be done in this particular field of public health.

TransFlow: a modular framework for assembling and assessing accurate de novo transcriptomes in non-model organisms

BACKGROUND

The advances in high-throughput sequencing technologies are allowing more and more de novo assembling of transcriptomes from many new organisms. Some degree of automation and evaluation is required to warrant reproducibility, repetitivity and the selection of the best possible transcriptome. Workflows and pipelines are becoming an absolute requirement for such a purpose, but the issue of assembling evaluation for de novo transcriptomes in organisms lacking a sequenced genome remains unsolved. An automated, reproducible and flexible framework called TransFlow to accomplish this task is described.

RESULTS

TransFlow with its five independent modules was designed to build different workflows depending on the nature of the original reads. This architecture enables different combinations of Illumina and Roche/454 sequencing data, and can be extended to other sequencing platforms. Its capabilities are illustrated with the selection of reliable plant reference transcriptomes and the assembling six transcriptomes (three case studies for grapevine leaves, olive tree pollen, and chestnut stem, and other three for haustorium, epiphytic structures and their combination for the phytopathogenic fungus Podosphaera xanthii). Arabidopsis and poplar transcriptomes revealed to be the best references. A common result regarding de novo assemblies is that Illumina paired-end reads of 100 nt in length assembled with OASES can provide reliable transcriptomes, while the contribution of longer reads is noticeable only when they complement a set of short, single-reads.

CONCLUSIONS

TransFlow can handle up to 181 different assembling strategies. Evaluation based on principal component analyses allows its self-adaptation to different sets of reads to provide a suitable transcriptome for each combination of reads and assemblers. As a result, each case study has its own behaviour, prioritises evaluation parameters, and gives an objective and automated way for detecting the best transcriptome within a pool of them. Sequencing data type and quantity (preferably several hundred millions of 2×100 nt or longer), assemblers (OASES for Illumina, MIRA4 and EULER-SR reconciled with CAP3 for Roche/454) and strategy (preferably scaffolding with OASES, and probably merging with Roche/454 when available) arise as the most impacting factors.

Time trend in the impact of heat waves on daily mortality in Spain for a period of over thirty years (1983-2013)

Many of the studies that analyze the future impact of climate change on mortality assume that the temperature that constitutes a heat wave will not change over time. This is unlikely, however, given the process of adapting to heat changes, prevention plans, and improvements in social and health infrastructure. The objective of this study is to analyze whether, during the 1983-2013 period, there has been a temporal change in the maximum daily temperatures that constitute a heat wave (T_threshold) in Spain, and to investigate whether there has been variation in the attributable risk (AR) associated with mortality due to high temperatures in this period. This study uses daily mortality data for natural causes except accidents CIEX: A00-R99 in municipalities of over 10,000 inhabitants in 10 Spanish provinces and maximum temperature data from observatories located in province capitals. The time series is divided into three periods: 1983-1992, 1993-2003 and 2004-2013. For each period and each province, the value of T_threshold was calculated using scatter-plot diagram of the daily mortality pre-whitened series. For each period and each province capitals, it has been calculated the number of heat waves and quantifying the impact on mortality through generalized linear model (GLM) methodology with the Poisson regression link. These models permits obtained the relative risks (RR) and attributable risks (AR). Via a meta-analysis, using the Global RR and AR were calculated the heat impact for the total of the 10 provinces. The results show that in the first two periods RR remained constant RR: 1.14 (CI95%: 1.09 1.19) and RR: 1.14 (CI95%: 1.10 1.18), while the third period shows a sharp decrease with respect to the prior two periods RR: 1.01 (CI95%: 1.00 1.01); the difference is statistically significant. In Spain there has been a sharp decrease in mortality attributable to heat over the past 10 years. The observed variation in RR puts into question the results of numerous studies that analyze the future impact of heat on mortality in different temporal scenarios and show it to be constant over time.

Impact on mortality of biomass combustion from wildfires in Spain: A regional analysis

Studies that analyse the impact on mortality of particulate matter (PM) produced by biomass combustion from wildfires mostly focus on a single city or on cities in different countries, with very few concentrating on one country as a whole. Accordingly, the aim of this paper was to analyse the impact that PM has on daily mortality in Spain on days with biomass combustion from wildfires. To analyse natural PM advections the Ministry of Agriculture and Fishing, Food & Environment divides Spain into 9 geographical regions. One province representative of each region for was selected analysis purposes, with provincial daily natural-cause mortality across the period 2004-2009 as the dependent variable, and daily mean PM concentrations in the provincial capital as the independent variable. We controlled for the effect of other chemical pollutants (NO₂ and O₃), maximum daily temperature on heat-wave days, day of the week, trends, seasonalities and the autoregressive nature of the series, using generalised linear models with the Poisson regression link to calculate relative risks (RRs) and the increase in RR (IRR) of PM-related mortality. The analysis was performed for days with and without biomass advections (DBA and DNBA respectively), with a breakdown by year, summer, and the remainder of the year (i.e., excluding summer). The results indicated that daily mean PM concentrations were higher on DBA than on DNBA, with statistically significant differences in most provinces. Furthermore, PM₁₀ was associated with higher daily mortality on DBA in regions where wildfires were most frequent, but not in the remaining provinces. This translated as an IRR per 10μg/m³ of PM of 7.93 (2.36-13.81) in the North-west, 3.76 (1.36-6.22) in the Centre and 4.46 (2.99-5.94) in the South-west, values which in all cases were statistically higher than those obtained on DNBA. The increase in PM caused by biomass advections from wildfires is linked to a significant IRR of mortality in Spain. Hence, the fact that wildfires are likely to become increasingly frequent in the context of climate change makes this type of analysis particularly necessary.

Rukas en la ciudad. Cultura y participación política Mapuche en la región Metropolitana

Este artículo presenta una investigación sobre las rukas (construcción mapuche de carácter prehispánico) construidas durante la última década en Santiago de Chile, y propone una reflexión en torno al cruce que se produce entre la reproducción de un lugar de carácter ancestral y la participación política. Producto de las migraciones del siglo XX, actualmente en la Región Metropolitana habita un gran porcentaje de población mapuche, la cual durante las últimas décadas ha gestionado una progresiva reactivación de la identidad, siendo una de sus expresiones la construcción de rukas en la ciudad. Se propone que estos lugares juegan un papel fundamental en el posicionamiento del pueblo Mapuche. Este posicionamiento ha sido posible gracias a sujetos que, a la vez que resignifican y territorializan el espacio, configuran la ruka como un nuevo lugar de lo político. Si bien los terrenos que alojan las rukas en la ciudad rememoran el territorio de la zona sur, en donde las prácticas que se conciben como originarias surgieron, no se encuentran aislados, sino que se insertan en las dinámicas metropolitanas y contemporáneas. 

Spatial variability in threshold temperatures of heat wave mortality: impact assessment on prevention plans

Spain's current heat wave prevention plans are activated according to administrative areas. This study analyses the determination of threshold temperatures for triggering prevention-plan activation by reference to isoclimatic areas, and describes the public health benefits. We subdivided the study area - the Madrid Autonomous Region (MAR) - into three, distinct, isoclimatic areas: 'North', 'Central' and 'South', and grouped daily natural-cause mortality (ICD-10: A00-R99) in towns of over 10,000 inhabitants (2000-2009 period) accordingly. Using these three areas rather than the MAR as a whole would have resulted in a possible decrease in mortality of 73 persons (38-108) in the North area, and in aborting unnecessary activation of the plan 153 times in the Central area and 417 times in the South area. Our results indicate that extrapolating this methodology would bring benefits associated with a reduction in attributable mortality and improved effectiveness of public health interventions.

S-nitroso- and nitro- proteomes in the olive (Olea europaea L.) pollen. Predictive versus experimental data by nano-LC-MS

The data presented here are related to the research article entitled "Generation of nitric oxide by olive (Olea europaea L.) pollen during in vitro germination and assessment of the S-nitroso- and nitro-proteomes by computational predictive methods" doi:10.1016/j.niox.2017.06.005 (Jimenez-Quesada et al., 2017) [1]. Predicted cysteine S-nitrosylation and Tyr-nitration sites in proteins derived from a de novo assembled and annotated pollen transcriptome from olive tree (Olea europaea L.) were obtained after using well-established predictive tools in silico. Predictions were performed using both default and highly restrictive thresholds. Numerous gene products identified with these characteristics are listed here. An experimental validation of the data, consisting in nano-LC-MS (Liquid Chromatography-Mass Spectrometry) determination of olive pollen proteins after immunoprecipitation with antibodies to anti-S-nitrosoCys and anti-3-NT (NitroTyrosine) allowed identification of numerous proteins subjected to these two post-translational modifications, which are listed here together with information regarding their cross-presence among the predictions.

Automated identification of reference genes based on RNA-seq data

Background

Gene expression analyses demand appropriate reference genes (RGs) for normalization, in order to obtain reliable assessments. Ideally, RG expression levels should remain constant in all cells, tissues or experimental conditions under study. Housekeeping genes traditionally fulfilled this requirement, but they have been reported to be less invariant than expected; therefore, RGs should be tested and validated for every particular situation. Microarray data have been used to propose new RGs, but only a limited set of model species and conditions are available; on the contrary, RNA-seq experiments are more and more frequent and constitute a new source of candidate RGs.

Results

An automated workflow based on mapped NGS reads has been constructed to obtain highly and invariantly expressed RGs based on a normalized expression in reads per mapped million and the coefficient of variation. This workflow has been tested with Roche/454 reads from reproductive tissues of olive tree (Olea europaea L.), as well as with Illumina paired-end reads from two different accessions of Arabidopsis thaliana and three different human cancers (prostate, small-cell cancer lung and lung adenocarcinoma). Candidate RGs have been proposed for each species and many of them have been previously reported as RGs in literature. Experimental validation of significant RGs in olive tree is provided to support the algorithm.

Conclusion

Regardless sequencing technology, number of replicates, and library sizes, when RNA-seq experiments are designed and performed, the same datasets can be analyzed with our workflow to extract suitable RGs for subsequent PCR validation. Moreover, different subset of experimental conditions can provide different suitable RGs.

Electronic supplementary material

The online version of this article (doi:10.1186/s12938-017-0356-5) contains supplementary material, which is available to authorized users.

Association between environmental factors and emergency hospital admissions due to Alzheimer's disease in Madrid

INTRODUCTION

There are scarce studies of time series that analysed the short-term association between emergency hospital admissions due to Alzheimer's disease (AD) and environmental factors. The objective is to analyse the effect of heat waves, noise and air pollutants on urgent hospital admissions due to AD in Madrid.

METHODS

Longitudinal ecological time series study was performed. The dependent variable was the emergency AD hospital admissions occurred in Madrid during the period 2001-2009. Independent variables were: Daily mean concentrations (μg/m3) of air pollutants (PM_2.5 and PM₁₀; O3 and NO2); maximum daily temperature (°C) and daily and night noise levels (dB(A)). Relative Risk (RR) for an increment in interquartile range, and Attributable Risk (AR) values were calculated through GLM with Poisson link.

RESULTS

Our findings indicated that only PM_2.5 concentrations at lag 2 with a RR: 1.38 (95% CI: 1.15-1.65); AR 27.5% (95% CI: 13.0-39.4); and heat wave days at lag 3 with a RR: 1.30 (95% CI: 1.12-1.52); AR 23.1% (95% CI: 10.7-34.2) were associated with AD hospital admissions.

CONCLUSION

A reduction in AD patients' exposure levels to PM_2.5 and special care of such patients during heat wave periods could result in a decrease in both emergency AD admissions and the related health care costs.

Generation of nitric oxide by olive (Olea europaea L.) pollen during in vitro germination and assessment of the S-nitroso- and nitro-proteomes by computational predictive methods

Nitric oxide is recognized as a signaling molecule involved in a broad range of physiological processes in plants including sexual reproduction. NO has been detected in the pollen grain at high levels and regulates pollen tube growth. Previous studies demonstrated that NO as well as ROS are produced in the olive reproductive tissues in a stage- and tissue-specific manner. The aim of this study was to assess the production of NO throughout the germination of olive (Olea europaea L.) pollen in vitro. The NO fluorescent probe DAF-2DA was used to image NO production in situ, which was correlated to pollen viability. Moreover, by means of a fluorimetric assay we showed that growing pollen tubes release NO. GSNO -a mobile reservoir of NO, formed by the S-nitrosylation of NO with reduced glutathione (GSH) - was for the first time detected and quantified at different stages of pollen tube growth using a LC-ES/MS analysis. Exogenous NO donors inhibited both pollen germination and pollen tube growth and these effects were partially reverted by the specific NO-scavenger c-PTIO. However, little is known about how NO affects the germination process. With the aim of elucidating the putative relevance of protein S-nitrosylation and Tyr-nitration as important post-translational modifications in the development and physiology of the olive pollen, a de novo assembled and annotated reproductive transcriptome from olive was challenged in silico for the putative capability of transcripts to become potentially modified by S-nitrosylation/Tyr-nitration according to well-established criteria. Numerous gene products with these characteristics were identified, and a broad discussion as regards to their potential role in plant reproduction was built after their functional classification. Moreover, the importance of both S-nitrosylation/Tyr-nitrations was experimentally assessed and validated by using Western blotting, immunoprecipitation and proteomic approaches.

Identification and Functional Annotation of Genes Differentially Expressed in the Reproductive Tissues of the Olive Tree (Olea europaea L.) through the Generation of Subtractive Libraries

The olive tree is a crop of high socio-economical importance in the Mediterranean area. Sexual reproduction in this plant is an essential process, which determines the yield. Successful fertilization is mainly favored and sometimes needed of the presence of pollen grains from a different cultivar as the olive seizes a self-incompatibility system allegedly determined of the sporophytic type. The purpose of the present study was to identify key gene products involved in the function of olive pollen and pistil, in order to help elucidate the events and signaling processes, which happen during the courtship, pollen grain germination, and fertilization in olive. The use of subtractive SSH libraries constructed using, on the one hand one specific stage of the pistil development with germinating pollen grains, and on the other hand mature pollen grains may help to reveal the specific transcripts involved in the cited events. Such libraries have also been created by subtracting vegetative mRNAs (from leaves), in order to identify reproductive sequences only. A variety of transcripts have been identified in the mature pollen grains and in the pistil at the receptive stage. Among them, those related to defense, transport and oxidative metabolism are highlighted mainly in the pistil libraries where transcripts related to stress, and response to biotic and abiotic stimulus have a prominent position. Extensive lists containing information as regard to the specific transcripts determined for each stage and tissue are provided, as well as functional classifications of these gene products. Such lists were faced up to two recent datasets obtained in olive after transcriptomic and genomic approaches. The sequences and the differential expression level of the SSH-transcripts identified here, highly matched the transcriptomic information. Moreover, the unique presence of a representative number of these transcripts has been validated by means of qPCR approaches. The construction of SSH libraries using pistil and pollen, considering the high interaction between male-female counterparts, allowed the identification of transcripts with important roles in stigma physiology. The functions of many of the transcripts obtained are intimately related, and most of them are of pivotal importance in defense, pollen-stigma interaction and signaling.

Short-term association between environmental factors and hospital admissions due to dementia in Madrid

BACKGROUND

Spain has one of the highest proportions of dementia in the world among the population aged 60 years or over. Recent studies link various environmental factors to neurocognitive-type diseases. This study sought to analyse whether urban risk factors such as traffic noise, pollutants and heat waves might have a short-term impact on exacerbation of symptoms of dementia, leading to emergency hospital admission.

MATERIAL AND METHODS

We conducted a longitudinal ecological time-series study, with the dependent variable being the number of daily dementia-related emergency (DDE) hospital admissions to Madrid municipal hospitals (ICD-10 codes 290.0-290.2, 290.4-290.9, 294.1-294) from 01 to 01-2001 to 31-12-2009, as obtained from the Hospital Morbidity Survey (National Statistics Institute). The measures used were as follows: for noise pollution, Leqd, equivalent diurnal noise level (from 8 to 22h), and Leqn, equivalent nocturnal noise level (from 22 to 8h) in dB(A); for chemical pollution, mean daily NO2, PM2.5, PM1 as provided by the Madrid Municipal Air Quality Monitoring Grid; and lastly, maximum daily temperature (°C), as supplied by the State Meteorological Agency. Scatterplot diagrams were plotted to assess the type of functional relationship existing between the main variable of analysis and the environmental variables. The lags of the environmental variables were calculated to analyse the timing of the effect. Poisson regression models were fitted, controlling for trends and seasonalities, to quantify relative risk (RR).

RESULTS

During the study period, there were 1175 DDE hospital admissions. These admissions displayed a linear functional relationship without a threshold in the case of Leqd. The RR of DDE admissions was 1.15 (1.11-1.20) for an increase of 1dB in Leqd, with impact at lag 0. In the case of maximum daily temperature, there was a threshold temperature of 34°C, with an increase of 1°C over this threshold posing an RR of 1.19 (1.09-1.30) at lag 1. The only pollutant to show an association with DDE hospital admissions was O3 at lag 5, with an RR of 1.09 (1.04-1.15) for an increase of 10µg/m³ CONCLUSIONS: Diurnal traffic noise, heat waves and tropospheric ozone may exacerbate the symptoms of dementia to the point of requiring emergency admission to hospital. Lowering exposure levels to these environmental factors could reduce dementia-related admissions in Madrid.