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Young refugees are a high-risk group for mental disorders, particularly for posttraumatic stress disorder (PTSD). Individuals with PTSD suffer from an altered time perspective with a focus on negative experiences in the past and a disregard for positive life events and the future. This study investigates time perspectives and psychological distress in 30 adolescent refugees from Syria and Afghanistan in Germany. Time perspective was assessed using the Zimbardo Time Perspective Inventory. The refugees exhibited a distorted time perspective that is common for individuals with PTSD: a high orientation toward the negative past and a low orientation toward the positive past and future. A high orientation toward the negative past was associated with high levels of general psychological distress, PTSD symptoms, and depression. A low orientation toward the future was related to high levels of anxiety. Taking time perspective and corresponding beliefs into consideration may be advantageous when treating refugees with trauma-related disorders.

BackgroundDelayed diagnosis of inflammatory arthritis (IA) such as rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) is associated with joint damage and disability. So regular timely assessment by both family physicians and specialists is necessary for favorable disease outcomes. Sex (biology) and gender (socio-cultural) related factors influence clinical patterns of IA, patient behavior and their interaction with care providers. This influence could be reflected in patterns of healthcare utilization.ObjectivesTo compare patterns of musculoskeletal (MSK)-related healthcare utilization before and after diagnosis between male and female patients with IA in Ontario, Canada.MethodsWe assembled 3 inception cohorts of adult RA, AS and PsA patients diagnosed between April 2010 and March 2017 using Ontario health administrative data. MSK-related healthcare utilization patterns in terms of visits to physicians, MSK imaging and laboratory tests were assessed yearly for 3 years before and after the diagnosis date, and compared between male and female patients. Among individuals ≥ 66 years, prescriptions for rheumatic drugs (NSAIDs, corticosteroids, csDMARDs, advanced therapy (bDMARDs and tsDMARDs)) and opioids were ascertained. Regression models were used to compare healthcare utilization indicators between males and females after adjusting for demographics and comorbidities.ResultsA total of 41,277 patients with RA (69% females), 8,150 patients with AS (51% females) and 6,446 patients with PsA (54% female) were analyzed. Male patients were significantly older than female patients only in the RA cohort (mean age M 60.4 y, F 57.1 y). Multimorbidity, depression and osteoporosis were more common in female patients and cardiovascular disease in male patients across the 3 cohorts.Similar trends of sex-related differences were observed in all three cohorts. Female patients were more likely to visit rheumatologists and family physicians than male patients especially in earlier pre-diagnosis periods (Figure 1). Male patients were more likely to visit emergency department immediately before diagnosis. A similar female predominance was observed in imaging modalities of X-rays and ultrasounds (adjusted ORs for F:M 1.15 - 1.2 for X-rays and 1.07 -1.44 for ultrasounds), and laboratory tests before diagnosis (adjusted ORs for F:M 1.10 to 2.17) across the three cohorts.Overall DMARD prescription patterns in older male and female patients were similar across the three cohorts except more csDMARD prescriptions in female AS patients (Table 1). Female RA patients were more likely to use NSAIDs and opioids.Table 1.Odds ratios for prescription patterns in inflammatory arthritis for older female to male patients after diagnosisMedication ClassAdjusted Odds Ratio (95% Confidence Interval)Rheumatoid ArthritisAnkylosing SpondylitisPsoriatic ArthritiscsDMARDYr 11.00 (0.92, 1.09)1.82 (1.38, 2.41)1.05 (0.81, 1.37)Yr 21.00 (0.92, 1.08)1.66 (1.24, 2.22)0.94 (0.73, 1.20)Yr 31.05 (0.97, 1.14)1.51 (1.12, 2.04)0.85 (0.66, 1.09)Advanced therapyYr 10.99 (0.78, 1.25)0.79 (0.49, 1.25)0.75 (0.47, 1.19)Yr 21.17 (0.99, 1.39)0.80 (0.53, 1.23)0.91 (0.61, 1.37)Yr 31.23 (1.05, 1.45)1.04 (0.67, 1.61)0.88 (0.6, 1.30)NSAIDYr 11.14 (1.04, 1.25)1.22 (0.91, 1.63)0.94 (0.71, 1.24)Yr 21.1 (0.99, 1.22)1.04 (0.77, 1.43)0.98 (0.73, 1.32)Yr 31.16 (1.04, 1.30)1.35 (0.96, 1.89)1.02 (0.73, 1.41)OpioidYr 11.39 (1.22, 1.58)1.23 (0.85, 1.78)1.32 (0.87, 1.98)Yr 21.51 (1.32, 1.72)1.22 (0.85, 1.76)1.14 (0.75, 1.75)Yr 31.46 (1.27, 1.68)1.42 (0.96, 2.09)1.45 (0.95, 2.23)Bolded results are statistically significant (p < 0.05). Odds ratios for female to male patients adjusted for age, residence, income quintiles, comorbidities and access to rheumatologistsConclusionFemale patients with IA have higher MSK-related healthcare utilization which may indicate biological differences in disease course or sociocultural differences in healthcare seeking behavior between male and female patients.ReferencesN/AAcknowledgementsDr. Sanjana Tarannum received funds from the Enid Walker Graduate Student Award for Research in Women’s Health for this study.Dr. Widdifield receives support from the Arthritis Society Stars Career Development Award (STAR-19-0610).Dr. Johnson has been awarded a Canadian Institutes of Health Research New Investigator Award.Dr. Paula Rochon holds the RTOERO Chair in Geriatric Medicine at the University of Toronto.Dr. Lihi Eder has been awarded Early Researcher Award from the Ontario Ministry of Research, Innovation and Science and Canada Research Chair (Tier 2) in Inflammatory Rheumatic Diseases.Disclosure of InterestsSanjana Tarannum: None declared, Jessica Widdifield: None declared, Fangyun Wu: None declared, Sindhu Johnson: None declared, Paula Rochon: None declared, Lihi Eder Grant/research support from: UCB, Abbvie, Pfizer, Janssen, Novartis, Eli Lily, SandozAdvisory board: Abbvie, Pfizer, Janssen, Novartis, Eli Lily

BackgroundObesity is a risk factor for psoriatic arthritis (PsA) and is associated with higher disease activity [1].ObjectivesWe aimed to evaluate whether obese patients with PsA were less likely to achieve remission/low disease in a real-life multi-centre cohort.MethodsWe used data from the ReFlap study (NCT03119805)[2], which recruited consecutive adult patient with definite PsA for more than 2 years of disease duration from 14 countries. We collected demographic characteristics, self-reported weight and height, clinical data and patient reported outcomes. Remission/low disease was defined as Disease Activity in PSoriatic Arthritis (DAPSA) ≤ 4, or Minimal disease activity (MDA). Obesity was defined as body mass index (BMI) ≥ 30kg/m2. We compared patient characteristics, disease activity parameters and impact scores between patients with obesity versus non-obese. A multivariable regression model was performed for demographic variables associated with reaching each definition of remission/low disease, adjusted on age, sex, level of education, disease duration, current use of conventional (c-) and biological (b-) disease modifying anti-rheumatic drugs (DMARDs).ResultsAmong 414 patients (49.3% women, mean disease duration 11.0 ±8.2 years), 119 (28.7%) had BMI ≥ 30kg/m2 (obese). Obese patients were more likely to be female, had higher swollen joint and enthesitis counts, higher self-reported pain, poorer physical function, more fatigue and poorer mental health (Table 1). Obese patients were half as likely to achieve MDA or DAPSA remission in multivariable analysis with odd ratios of 0.6 (95% confidence interval, CI: 0.3, 0.8, p=0.049) and 0.4 (95% CI: 0.2, 0.8, p=0.012), respectively for obese compared to non-obese patients (Figure 1).Table 1.Patient characteristics and remission achievement between obese and non-obese patients with psoriatic arthritisNon-obese (n=295)BMI ≥30 (n=119)pFemale, %44.361.50.002Number of comorbidities1.61 (0.93)2.83 (2.01)Tender joints, 0-683.56 (7.81)5.75 (10.0)0.018Swollen joints, 0-662.19 (7.29)1.46 (2.39)0.285Leeds enthesitis index, 0-60.48 (1.23)0.86 (1.70)0.012PGA disease activity, 0-103.90 (2.73)4.76 (2.67)0.004DAPSA14.9 (15.5)18.3 (16.1)0.045HAQ-DI, 0-30.56 (0.65)0.89 (0.70)PsAID-12, 0-103.11 (2.36)3.96 (2.50)0.001pain, 0-103.80 (2.81)4.54 (2.83)0.017fatigue, 0-103.93 (3.01)4.68 (3.17)0.025work or leisure activities, 0-103.39 (3.01)4.75 (3.11)functional capacity, 0-103.36 (2.97)4.40 (3.16)0.002depression, 0-101.88 (2.70)2.75 (3.26)0.006Mean (SD) shown unless specified otherwise. HAQ-DI: Health Assessment Questionnaire – Disability Index; PsA: psoriatic arthritis; PGA: patient global assessment of disease activity; DAPSA: Disease Activity in PSoriatic Arthritis; PsAID: Psoriatic Arthritis Impact of Disease.ConclusionIn this real-life data from 14 countries, obesity was frequent and PsA patients with BMI ≥ 30kg/m2 were more likely to be female, and had higher subjectively reported disease activity and illness impact compared to those with lower BMI. Obese patients had a two-fold lower likelihood of achieving remission/low disease defined by both MDA and DAPSA compared to non-obese patients. PsA patients with comorbid obesity may have different disease profiles from non-obese patients, and require specific management.References[1]Eder, L., et al., Obesity is associated with a lower probability of achieving sustained minimal disease activity state among patients with psoriatic arthritis. Ann Rheum Dis, 2015. 74(5): p. 813-7.[2]Gorlier, C., et al., Comparing patient-perceived and physician-perceived remission and low disease activity in psoriatic arthritis: an analysis of 410 patients from 14 countries. Ann Rheum Dis, 2019. 78(2): p. 201-208.AcknowledgementsThis study was funded by Pfizer.Disclosure of InterestsNone declared

BackgroundPatients with psoriatic arthritis and psoriasis, collectively termed psoriatic disease (PsD), have an increased risk for cardiovascular (CV) disease.ObjectivesWe aimed to identify traditional CV risk factors and PsD-related risk factors associated with CV events.MethodsPatients from a longitudinal PsD cohort without a prior history of CV events were included. Detailed information on demographics, comorbidities including traditional cardiovascular risk factors, medications and disease activity is collected according to a standard protocol. The study outcome included any of the following CV events occurring within the first 10 years of patients’ initial clinic visit: angina, myocardial infarction, congestive heart failure, transient ischemic attack, cerebrovascular accident, revascularization procedures and CV death. A total of 10 traditional CV risk factors and 15 PsD-related risk factors were assessed. The association of each risk factor with incident CVEs were analyzed separately using Cox proportional hazards regression models with time-dependent covariates, adjusted for age and sex.ResultsA total of 1,376 patients with PsD, followed between 1978 and 2020, were analyzed (mean age 48.3 ± 12.9 years, 46.8% female). During the follow-up period, 102 (7.4%) patients developed incident CV events. In Cox regression models adjusted for age and sex, age (Hazard Ratio (HR) 1.08, 95% Confidence Interval (CI) 1.06, 1.10), diabetes (HR 1.88, 95% CI 1.17, 3.02), systolic blood pressure (HR 1.02, 95% CI 1.01, 1.03), body mass index (BMI) (HR 1.04, 95% CI 1.01, 1.08), triglycerides (HR 1.24, 95% CI 1.07, 1.43), treatment for hypertension (HR 1.70, 95% CI 1.13, 2.56), and use of lipid-lowering medications (HR 1.70, 95% CI 1.13, 2.56) were among the traditional CV risk factors associated with increased CV risk. Among the PsD-related risk factors, psoriasis area and severity index (PASI) (HR 1.05, 95% CI 1.02, 1.08), erythrocyte sedimentation rate (ESR) (HR 1.02, 95% CI 1.01, 1.02), number of tender joints (HR 1.03, 95% CI 1.01, 1.05), number of swollen joints (HR 1.06, 95% CI 1.01, 1.12), health assessment questionnaire (HAQ) score (HR 1.63, 95% CI 1.23, 2.17), and daily use of non-steroidal anti-inflammatory drugs (NSAIDs) (HR 1.72, 95% CI 1.16, 2.55) were associated with increased CV risk. Use of biologic medications (HR 0.63, 95% CI 0.40, 1.00) was not found to be significantly protective against CV events.ConclusionIn patients with PsD, we identified six PsD-related risk factors that were significantly associated with incident CV events. These risk factors may be useful for the development of a PsD-specific CV risk prediction score that uses routine clinical assessments in combination with PsD-related biomarkers.References[1]Eder L, Wu Y, Chandran V, et al. Incidence and predictors for cardiovascular events in patients with psoriatic arthritis. Ann Rheum Dis 2016;75(9):1680-6.AcknowledgementsKeith Colaco is supported by the Enid Walker Estate, Women’s College Research Institute, and Arthritis Society (TGP-19-0446). Lihi Eder is supported by a Young Investigator Award from the Arthritis Society (YIA-16-394) and an Early Researcher Award from the Ontario Ministry of Science and Innovation. The Psoriatic Disease Program has been supported by a grant from the Krembil Foundation.Disclosure of InterestsNone declared.

At the 2019 annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), members received updates on several ongoing efforts. Among them were updates on research, including the trainee symposium, pilot research grants, and the Collaborative Research Network; GRAPPA's patient research partners; education, including the slide collection; treatment recommendations; and additional work related to advancing the understanding of disease aspects, including the Outcome Measures in Rheumatology (OMERACT)-GRAPPA outcome measure, axial involvement, and ultrasound enthesitis projects; as well as the early psoriatic disease systematic literature review and magnetic resonance imaging.

Additional file 2: Supplementary Table 2. Categorization of questions by domain of health.

Additional file 1: Supplementary Table 1. Survey questions and responses.

Additional file 3: Supplementary Figure 1. Patient-reported impact of PsA on work. Data represent the percentage of responders using the weighted base of each country in Table 1. Data are reported in response to the question, “Have you done any of the following as a result of psoriatic arthritis? Please select all that apply.” Countries are represented by colored data bars. Significant differences (p

Background:Psoriatic arthritis and psoriasis, collectively termed psoriatic disease (PsD), are associated with increased cardiovascular (CV) risk. Metabolites comprise biomarkers that may add predictive value over traditional CV risk factors.Objectives:We aimed to identify metabolites associated with CV events (CVEs) and to determine whether they could improve CV risk prediction beyond traditional CV risk factors.Methods:Patients from a longitudinal PsD cohort without a prior history of CVEs were included. In the first available serum sample, a targeted nuclear magnetic resonance (NMR) metabolomics platform was used to quantify 64 metabolite measures comprised of lipoprotein subclasses, fatty acids, glycolysis precursors, ketone bodies and amino acids. The study outcome included any of the following CVEs occurring within the first 10 years of biomarker assessment: angina, myocardial infarction, congestive heart failure, transient ischemic attack, cerebrovascular accident, revascularization procedures and CV death. The association of each metabolite with incident CVEs were analyzed separately using Cox proportional hazards regression models first adjusted for age and sex, and subsequently for traditional CV risk factors. Variable selection was performed using penalization with boosting after adjusting for age and sex. The added predictive value of the selected metabolites to improve risk prediction beyond traditional CV risk factors was assessed using the area under the receiver operator characteristic curve (AUC).Results:A total of 977 patients with PsD, followed between 2002 and 2019, were analyzed (mean age 49.1 ± 12.6 years, 45.1% female). During a mean follow-up of 7.1 years, 70 (7.2%) patients developed incident CVEs. In Cox regression models adjusted for CV risk factors, alanine, tyrosine, total high-density lipoprotein (HDL) cholesterol, medium and large HDL particles, and the degree of unsaturation of fatty acids were significantly associated with decreased CV risk. Glycoprotein acetyls, apolipoprotein B, remnant cholesterol, very low-density lipoprotein (VLDL) cholesterol, and very small VLDL particles were associated with an increased CV risk. In proportional sub-distribution hazards regression models adjusted for age and sex, 13 metabolites were selected (Table 1). The age- and sex-adjusted expanded model (base model + 13 metabolites) significantly improved prediction of CVEs beyond the base model (only age and sex) with an AUC of 79.9 vs. 72.6, respectively (p=0.019) (Figure 1).Table 1.Regression coefficients of the selected metabolites in a model adjusted for age and sex.CategoryMetaboliteModel adjusted for Age and SexAmino AcidsAlanine-0.1179Glycine-0.0339Tyrosine-0.1010Fatty acid ratios, relative to total fatty acidsDocosahexaenoic acid-0.0862Unsaturation degree, double bonds per fatty acid-0.1265Fluid BalanceAlbumin+0.0685GlyceridesTriglycerides in IDL cholesterol+0.1546Glycolysis precursorsGlucose+0.1391InflammationGlycoprotein acetyls+0.1478Ketone bodiesAcetoacetate+0.0464Lipoprotein subclassesHDL3 Cholesterol-0.0211Medium HDL-0.0296Large HDL-0.0309Figure 1.Predictive performance of a model with age and sex alone is compared to a model with age and sex plus selected metabolites.Conclusion:Using NMR metabolomics profiling, we identified a variety of metabolites associated with a lower and higher risk of developing CVEs in patients with PsD. Further study of their underlying association with CVEs is needed to clarify the clinical utility of these biomarkers to guide CV risk assessment in this population.References:[1]Eder L, Wu Y, Chandran V, et al. Incidence and predictors for cardiovascular events in patients with psoriatic arthritis. Ann Rheum Dis 2016;75(9):1680-6.[2]Soininen P, Kangas AJ, Wurtz P, et al. Quantitative serum nuclear magnetic resonance metabolomics in cardiovascular epidemiology and genetics. Circ Cardiovasc Genet 2015;8(1):192-206.Acknowledgements:Keith Colaco is supported by the Enid Walker Estate, Women’s College Research Institute, Arthritis Society (TGP-19-0446), National Psoriasis Foundation (Early Career Grant) and the Edward Dunlop Foundation. Lihi Eder is supported by a Young Investigator Award from the Arthritis Society and an Early Researcher Award from the Ontario Ministry of Science and Innovation. The study was supported in part by a discovery grant from the National Psoriasis Foundation and an operating grant from the Arthritis Society (YIO-16-394).Disclosure of Interests:None declared

Background:It remains unclear whether patients with IMID are at greater risk for severe COVID-19.Objectives:To investigate the risk of COVID-19 hospitalizations and their outcomes in patients with IMID compared with matched non-IMID patents from the general population.Methods:A population-based, matched cohort study was conducted in adults living in Ontario, Canada using health administrative data. Ten cohorts of the following IMID were assembled: rheumatoid arthritis, psoriasis, psoriatic arthritis, ankylosing spondylitis, systemic autoimmune rheumatic diseases (SARDs, including systemic lupus, systemic sclerosis, Sjogren’s, myositis), multiple sclerosis (MS), iritis, inflammatory bowel disease, polymyalgia rheumatica (PMR), and vasculitis (including giant cell arteritis and other types of vasculitidies). Each patient was matched with 5 non-IMID comparators based on age, sex, area of residence and living in long-term care (LTC). Patients who were admitted to hospital from January 1st to July 31th, 2020 and had ICD-10 COVID-19 diagnosis codes (U07.2 or U07.1) were identified. Among those with COVID-19 hospitalizations, we determined those with admissions to intensive care unit or required mechanical ventilation or died in hospital (‘complicated hospitalization’). Age-sex-standardized rates were compared between IMID and non-IMID patients and risk factors for hospitalizations were identified by multivariable logistic regression analysis.Results:In total, 493,499 IMID (417 hospitalized) and 2,466,946 non-IMID patients (1,519 hospitalized) were assessed. The age-sex-standardized rate of COVID-19 hospitalization was higher in IMID (6.4 per 10,000, 95% confidence interval (CI) 5.8, 7.2) versus non-IMID patients (4.8 per 100,000, 95% CI 4.5, 5). The highest rates of hospitalizations were found in vasculitis (18/10,000), MS (16.7/10,000) and PMR (10.1/10,000). IMID diagnosis was associated with 37% higher risk of being hospitalized for COVID-19 (Odds Ratio (OR) 1.37, 95% CI 1.23, 1.53) (Figure 1). This risk was slightly attenuated after adjusting for sociodemographic factors and comorbidities but remained elevated by 23% compared to non-IMID (OR 1.23, 95% CI 1.10, 1.37). The risk for hospitalizations was increased in RA, vasculitis, SARDs, PsA, MS and iritis (Figure 1). Risk factors for COVID-19 hospitalizations included older age, male sex, lower income, multimorbidity and living in long-term care (Table 1). The risk for complicated COVID-19 hospitalizations was higher by 21% in IMID patients (OR 1.21, 95% CI 1.02, 1.43), however, this association was attenuated after adjustment for demographics and comorbidities (OR 1.08).Table 1.Risk Factors for COVID-19 Hospitalizations in IMIDs vs. non-IMIDsVariableOR95% CIIMIDs vs. Non-IMID1.231.10, 1.37Age (10 yrs)1.491.44, 1.54Sex: Female0.680.62, 0.75Long term care resident8.287.32, 9.37ADG: 5-9 vs. 0-41.451.22, 1.7110-14 vs. 0-42.261.92, 2.6715+ vs. 0-43.232.73, 3.82Income (quintile) Quintile 2 vs. 10.820.73, 0.93 Quintile 3 vs. 10.760.67, 0.86 Quintile 4 vs. 10.560.48, 0.64 Quintile 5 vs. 10.460.40, 0.54Urban vs. rural4.333.32, 5.67ADG - Aggregated Diagnosis GroupsConclusion:Patients with IMID were at higher risk of being hospitalized with COVID-19 and for having complicated hospitalizations. Hospitalization risk was partially independent of their comorbid conditions.Acknowledgements:The study is supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). Parts of this material are based on data and information compiled and provided by MOHLTC and the Canadian Institute for Health Information. The opinions, results and conclusions reported in this paper are those of the authors and are independent of the funding or data sources; no endorsement is intended or should be inferred.Disclosure of Interests:None declared

Background:N-terminal pro-brain-type natriuretic peptide (NT-proBNP) and troponin I (TnI) are established cardiac biomarkers that predict cardiovascular events (CVEs) in the general population. While patients with psoriatic arthritis and psoriasis, collectively termed psoriatic disease (PsD), have an increased risk of developing CVEs, the use of these cardiac biomarkers to predict CV risk has not been investigated in this population.Objectives:We aimed to evaluate the association between these cardiac biomarkers and incident CVEs, and assess their predictive value beyond the Framingham Risk Score (FRS).Methods:A longitudinal cohort study was conducted in patients with PsD without prior history of CVEs. NT-proBNP and TnI concentrations were measured using automated clinical assays in the first available serum sample. The study outcome included any of the following CVEs occurring within the first 10 years of biomarker assessment: angina, myocardial infarction, transient ischemic attack, stroke, revascularization and CV death. Associations with incident CVEs were analyzed separately for each biomarker using Cox proportional hazards regression models first adjusted for age and sex, and subsequently for the FRS. The added value of cardiac biomarkers to improve predictive performance beyond the FRS was assessed using the area under the receiver operator characteristic curve (AUC), net reclassification index (NRI) and integrated discrimination index (IDI).Results:A total of 1000 patients with PsD were assessed between 2002 and 2019 (mean age 49 ± 12.8 years, 44.6% female) (Table 1). During a mean follow-up of 7.1 years, 64 patients developed incident CVEs. Both TnI (Hazard Ratio (HR) 3.02, 95% Confidence Interval (CI) 1.12, 8.16) and NT-proBNP (HR 2.02; 95% CI 1.28, 3.18) predicted CVEs independently of the FRS (Figure 1). The association was stronger in males than females. Including all cardiac biomarkers and the FRS in a single model, NT-proBNP retained statistical significance (HR 1.91, 95% CI 1.23, 2.97), while TnI did not (HR 2.60, 95% CI 0.98, 6.87). When comparing the predictive performance of the base model (FRS alone, AUC 75.4) to the expanded models, there was no significant improvement in any of the predictive indices with the addition of TnI (AUC 73.5, p = 0.21; NRI 0.08, p = 0.67; IDI 0.005, p = 0.37), NT-proBNP (AUC 71.0, p = 0.35; NRI 0.20, p = 0.06; IDI 0.017, p = 0.10), or both TnI and NT-proBNP (AUC 70.0, p = 0.23; NRI 0.27, p = 0.05; IDI 0.021, p =0.05).Conclusion:In patients with PsD, elevated NT-proBNP and TnI predict incident CVEs independent of the FRS. We did not observe a significant improvement in the performance of the predictive model when combining these cardiac biomarkers with the FRS.References:[1]Eder L, Wu Y, Chandran V, et al. Incidence and predictors for cardiovascular events in patients with psoriatic arthritis. Ann Rheum Dis 2016;75(9):1680-6.Table 1.Baseline characteristics of the study population (n=1000)VariableMean ± SD / Frequency (%)PsA, no. (%)648 (64.8)PsC, no. (%)352 (35.2)Age (years)49 ± 12.8Male sex, no. (%)554 (55.4)Disease duration (years)20.2 ± 14.1Ethnicity, Caucasian (%)834 (83.4)Current smoker (%)164 (16.4)FRS (%)8.2 ± 8.6Diabetes77 (7.7)Hypertension274 (27.4)BMI (kg/m2)28.7 ± 5.9PASI4.1 ± 6.3Use of lipid-lowering medications (%)100 (10)Current use of DMARDs362 (36.2)Current use of Biologics214 (21.4)Current use of NSAIDs (daily use)265 (26.5)1 Applicable only to patients with PsA CVE, cardiovascular events; DMARD, disease-modifying antirheumatic drug; FRS, Framingham Risk Score; NSAID, non-steroidal anti-inflammatory drug; PASI, Psoriasis Area Severity Index; PsA, psoriatic arthritis; PsC, psoriasis without arthritisFigure 1.Hazard ratios of cardiac biomarker measures for incident cardiovascular events (n = 1000, 64 events). Error bars denote 95% confidence intervals. CI indicates confidence interval; CVEs, cardiovascular events; FRS, Framingham Risk Score; NT-proBNP, N-terminal pro-brain-type natriuretic peptide; TnI, troponin I.Acknowledgements:Keith Colaco is supported by the Enid Walker Estate, Women’s College Research Institute, Arthritis Society (TGP-19-0446), National Psoriasis Foundation (Early Career Grant) and the Edward Dunlop Foundation. Lihi Eder is supported by a Young Investigator Award from the Arthritis Society and an Early Researcher Award from the Ontario Ministry of Science and Innovation. The study was supported in part by a discovery grant from the National Psoriasis Foundation and an operating grant from the Arthritis Society (YIO-16-394).Disclosure of Interests:None declared.

Background:Population-based data about the COVID-19 risk in patients with IMID remain scarce.Objectives:To investigate the cumulative incidence and risk factors for laboratory-confirmed COVID-19 infection and SARS-CoV2 testing in patients with IMID compared with matched non-IMID patients from the general population.Methods:A population-based, matched cohort study was conducted using health administrative data from adults living in Ontario, Canada from January to December 2020. Cohorts for each of the following IMID were assembled: rheumatoid arthritis (RA), psoriasis, psoriatic arthritis, ankylosing spondylitis, systemic autoimmune rheumatic diseases (including lupus, systemic sclerosis, Sjogren’s, inflammatory myositis), multiple sclerosis (MS), iritis, inflammatory bowel disease (IBD), polymyalgia rheumatica (PMR) and vasculitis. Each patient was matched with 5 non-IMID comparators based on age, sex, area of residence and living in long term care (LTC). Standardized cumulative rates of testing for SARS-CoV2, and for receiving a positive test between IMID and non-IMID were compared between IMID and non-IMID patients. Multivariable logistic regression analyses assessed sociodemographic factors associated with COVID-19 testing and positivity.Results:A total of 493,499 IMID patients and 2,466,946 non-IMID comparators were assessed. Significantly more IMID patients versus non-IMID were tested for SARS-CoV2 (27.4% vs. 22.7%), while the proportions of those positive for COVID-19 were identical (0.9% of all patients in both groups). Overall, IMID patients were more likely to undergo SARS-CoV2 testing (odds ratio (OR) 1.28, 95% CI 1.27, 1.29), but their overall risk of laboratory-confirmed COVID-19 was not elevated (OR 0.97 (95% CI 0.93, 1)). However, the risk of laboratory-confirmed COVID-19 infection was lower in IBD (OR 0.75), MS (OR 0.77) and psoriasis (OR 0.94) and marginally higher in RA (OR 1.07) and iritis (OR 1.13) compared with non-IMID comparators (Figure 1A). The highest standardized rates of COVID-19 infection were found in vasculitis (115 per 10,000 patients) and iritis (109 per 10,000 patients) (Figure 1B). Risk factors for COVID-19 infection included younger age, living in LTC, multimorbidity, urban living and lower income (Table 1).Conclusion:Patients across all IMID were more likely to be tested for COVID-19 versus non-IMID patients. IMID patients were not at higher risk for testing positive for COVID-19 as an overall group, yet risk varied across disease subgroups.Table 1.Factors associated with COVID-19 infection in IMID vs. Non-IMID – Multivariable Logistic RegressionVariableORCI 95%IMID vs. Non-IMID0.970.93, 1.00Age (10-year increase)0.890.89, 0.90Sex: Female vs. Males0.950.93, 0.97LTC18.6417.9, 19.42ADG score:•5-9 vs. 0-41.401.35, 1.45•10-14 vs. 0-41.731.67, 1.80•15+ vs. 0-41.181.13, 1.23Urban vs. Rural3.493.26, 3.72Income quintile•Quintile 2 vs. 10.920.89, 0.96•Quintile 3 vs. 10.900.86, 0.93•Quintile 4 vs. 10.730.70, 0.76•Quintile 5 vs. 10.600.58, 0.63ADG - Aggregated Diagnosis Groups; IMIDs – Immune medicated inflammatory disease; LTC – long term careAcknowledgements:The study is supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). Parts of this material are based on data and information compiled and provided by MOHLTC and the Canadian Institute for Health Information. The opinions, results and conclusions reported in this paper are those of the authors and are independent of the funding or data sources; no endorsement is intended or should be inferred.Disclosure of Interests:None declared.

Channel catfish (Ictalurus punctatus) are a popular target for Nebraska anglers, and the proportion of Nebraska anglers targeting catfish is consistently 50% or greater on an annual basis. Commercial fishing for channel catfish was legal on the Missouri River, in Nebraska, from the 1800s until 1992. Several studies have been published regarding channel catfish population characteristics in this reach prior to the closure of commercial fishing; however, there have been no long-term assessments done post-closure. There is concern among anglers and managers about numbers and size of channel catfish in the Missouri River and a desire to better understand population dynamics in order to better manage channel catfish stocks. The goal of this study was to assess spatial and temporal changes in population characteristics of channel catfish in the Missouri River, Nebraska from 1998 – 2013. Specifically, we asked: (1) did channel catfish population characteristics differ among four reaches of the river fro...

Summary Habitat selection has been quantified for age-0 and adult pallid sturgeon Scaphirhynchus albus Bull. Illinois State Lab. Nat. Hist., 7, 1905, 37, but little is known regarding habitat use of the juvenile fish. The objective of this study was to quantify habitat use and selection of juvenile pallid sturgeon in the Missouri River, Nebraska, USA. Thirty-seven age-4 pallid sturgeon with transmitters were released in July of 2014, plus an additional 21 in September, with habitat monitored using biotelemetry. Age-1 and age-4 hatchery reared pallid sturgeon were found to avoid areas associated with the outside bend and thalweg habitats that were characterized by rapid water velocity (>1 ms−1), which accounted for 50% of the area in the channelized Missouri River. Age-1 pallid sturgeon selected an off-channel habitat and inside bend habitat while age-4 pallid sturgeon selected an off-channel and inside bend channel border habitat. Juvenile pallid sturgeon in unaltered rivers have been shown to associate with island tips and sand bars, habitat that is largely absent in the channelized Missouri River. This study indicates that juvenile pallid sturgeon in the Missouri River, Nebraska are selecting habitats with shallow water and slow water velocity, similar to those associated with island tips and sand bars in unaltered reaches.

Channel Catfish Ictalurus punctatus is an important species among anglers in North America. Channel Catfish management strategies vary greatly in the United States and Canada, and there are few examples of regulations aimed at improving size structure in the literature. The goal of this study was to model the response of Channel Catfish to changes in regulations that meet specific management objectives. We modeled a suite of regulations to determine if minimum length limits or a protected slot limit could be used to improve size structure or avoid growth overfishing of Channel Catfish in a large river. We modeled three minimum length limits (304, 356, and 406 mm) and a 356–456-mm protected slot limit to assess the effectiveness of each at delaying or eliminating growth overfishing and increasing the number of quality-sized fish in the Missouri River, Nebraska. Our models indicated a 406-mm minimum length limit could be used to avoid growth overfishing until exploitation rates were greater than 45%...

Background The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) – Outcome Measures in Rheumatology (OMERACT) Psoriatic Arthritis (PsA) Core Set working group is developing a core instrument set to guide selection of outcome measures (instruments) for PsA randomised controlled trials (RCTs) and longitudinal observational studies (LOS). Candidate instrument measurement properties are being appraised in systematic literature reviews by working group members. Objectives Appraise the content and face validity (domain match) and feasibility of PsA instruments with GRAPPA stakeholders using the OMERACT Filter 2.1 instrument selection process1. Methods The PsA Core set workshop held at the GRAPPA 2017 annual meeting comprised an introductory plenary session and breakout group discussions. Working group members facilitated six breakout groups, with two patient research partners (PRPs) per group, discussing pre-selected domain-instrument pairs. Participants individually reviewed the instrument(s). After group discussion, they completed anonymised paper-based OMERACT questionnaires examining domain match and feasibility, with votes for each aspect of domain match and feasibility centralised by instrument. A final vote (show of hands) on whether the assigned instrument met the requirements for domain match and feasibility using the OMERACT traffic-light scoring system was taken. Consensus was defined as more than 70% agreement, and majority as more than 50% agreement within a group. Consensus represents stronger evidence than majority agreement. Results There were 145 participants across all breakout groups and 116 returned completed questionnaires. Anonymized votes are summarised across groups and instruments in figure 1. More than 70% in the respective breakout groups endorsed the PsA instrument 66 swollen and 68 tender joint count (66/68 SJC/TJC) as a good match with the target domain of arthritis, a subset of MSK disease activity, FACIT-Fatigue as a good match with fatigue, and PsAID12 as a good match with HRQoL. There was consensus or majority agreement for all feasibility questions for the 66/68 SJC/TJC, HAQ-DI and PsAID9 and PsAID12. For the SPARCC enthesitis index only one item in both domain match and feasibility did not reach majority agreement. Conclusions The first two steps of the OMERACT Filter 2.1 instrument selection process for five candidate instruments have been completed. The first set of candidate instruments selected to undergo the next phase of the OMERACT Filter 2.1, construct validity and discrimination appraisal are 66/68 SJC/TJC, SPARCC enthesitis index, PsAID9, PsAID12, HAQ-DI and FACIT-Fatigue. Additional PsA instruments will undergo the OMERACT selection process. Reference [1] Boers M, Kirwan JR, Tugwell P, et al. The OMERACT Handbook. Accessed 8 January 2018. https://www.omeract.org/resources. Disclosure of Interest None declared

Background Fatigue is a critical element of life impact for patients with Psoriatic Arthritis (PsA) and is not considered in remission definitions. In PsA, remission can be defined using composite scores (Minimal Disease Activity (MDA), Disease Activity in PSoriatic Arthritis (DAPSA)≤4), Patient Acceptable Symptom State (PASS), Patient Global Assessment (PGA)(for example ≤1/10), or as a single for remission item. Objectives To explore the relationship between fatigue and remission in PsA, when using different definitions of remission. Methods ReFlaP (NCT03119805) is a cross-sectional study in 14 countries of consecutive adult patients with definite PsA and more than 2 years of disease duration. Patient-perceived fatigue was assessed by a 11-point numerical rating scale. Remission status was defined from the physician’s perspective as MDA, DAPSA≤4 and physician-perceived remission (single question yes/no), and from the patient’s perspective as PASS, PGA ≤1 and patient-perceived remission (single question yes/no). We calculated fatigue group means and deltas by remission status and compared these by Student’s t test. For known groups validity of each remission definition we used ROC curves and corresponding areas under the curve (AUC). Results Of 366 patients, 304 had both fatigue and remission data available: 148 (49.8%) were male, mean age was 53.9±12.3 years, mean disease duration was 10.8±7.7 years; 90.3% had predominant peripheral disease, 56.3% were taking methotrexate, 66.5% a biologic and 19.4% oral glucocorticoids. Disease activity was moderate: 41.1% had no current psoriasis skin lesions, mean Tender Joint Count (TJC) was 4.3±8.9, mean Swollen Joint Count (SJC) was 2.66±8.3, mean Physician’s global assessment was 3.0±2.4, mean PGA was 4.19%±2.7. 80.6% patients had DAPSA levels Conclusions Fatigue levels were relatively high in these PsA patients whose disease was often well-controlled. Fatigue was lower in patients in remission, according to all definitions of remission; the remission definition with best known-groups validity for fatigue was DAPSA remission. Moreover both composite measures perform better than the physicians opinion of remission. These elements may be important in a context of shared decision-making. Acknowledgements This study was funded by Pfizer. Disclosure of Interest None declared

In this article, the author discusses the intersection between psychotherapy and social activism. She argues that activism is a form of empathy in action and is a natural extension of her work as a therapist. The author reviews the history of psychoanalysis and social activism, demonstrating that the roots of psychoanalysis were embedded in the work of social activism. She discusses some of the recent history of events in her state that led her to engage in activism and some issues this presents for clinical practice.

Summary In the summer and fall of 2014, Nebraska Game and Parks Commission crews monitored juvenile pallid sturgeon, Scaphirhynchus albus (Forbes & Richardson, 1905) (age-1 and age-4) implanted with telemetry tags that were stocked in a side channel of the Missouri River in Nebraska, USA to gain knowledge into post-stocking survival and dispersal. For this study, specific questions were asked: (i) what is the short-term survival of stocked pallid sturgeon, (ii) do pallid sturgeon stocked in summer exhibit decreased survival rates due to increased water temperatures or high river discharge, and (iii) how quickly do pallid sturgeon disperse from a stocking site? Detection histories for two rounds were used to estimate apparent survival (O) and detection (p) rates using maximum likelihood estimators based on the standard mark-recapture Cormack-Jolly-Seber model structure within program MARK. Overall apparent survival was 98.6% and dispersal was rapid; therefore, moratoriums on stocking pallid sturgeon during summer months or during high flow events do not appear to be warranted.

Floodplain connectivity has been identified as an important element of river ecosystem function for enhancing biological productivity, yet most of the world's large rivers have been managed to reduce river–floodplain connectivity to protect human interests. Flow events in the Missouri River basin during the summers of 2010 and 2011 offered a unique opportunity to investigate the influence of floodplain connectivity on fish communities. The floods created aquatic habitats not generally available on the main stem and the magnitude and duration of the 2011 event have not occurred since the main-stem dams were closed. Therefore, the objectives were to: (1) document species use on available floodplain habitats and assess age-0 fish presence, (2) compare spatial and temporal distribution of fish species, and (3) evaluate fish community responses at different discharges. Age-0 fish dominated the fish community during the 2010 and 2011 floods, representing 90% and 94% of all fish collected each year. Species comp...

Use of geographic information systems (GIS) in fisheries science has increased in prevalence since its introduction in the late 1980s, but use among and within fisheries management agencies has not been quantified. We surveyed 89 administrators of fisheries management agencies in the United States and Canada to determine the current status of GIS in fisheries management and received 54 responses (61% return rate). Survey respondents indicated that GIS was used to help manage fish populations, and 63% of respondents believed that GIS was either “very useful” or “extremely useful” for meeting agency objectives. However, most GIS work conducted by fisheries management agencies was executed by few individuals within the agency or by contracted service. Barriers preventing more widespread use by managers within agencies included lack of knowledge or training and limited time to use GIS in job duties. Our results suggest that GIS is an important tool for fisheries management. Further, GIS use within an...

Trotlines have proved to be an effective collection method for riverine fish species, but an understanding of the interaction between fish and gear post-deployment is lacking. The objectives of this study were to use trotlines rigged with hook timers that record the time when fish are hooked to determine the activation rate of hook timers, to determine the retention rate of fish on trot lines, to document hourly catch rates and to document whether hooking duration causes stress or mortality. Four thousand hook timers were deployed in an 80.5 rkm reach of the Missouri River during April 2011, resulting in a mean catch rate of 14.6 fish per line, while 3.1 timers per line were activated but did not capture a fish. Over half of all fish were captured within 4 h post-deployment. Stress and mortality associated with trotlines did not appear to be related to hooking duration. This study showed that hourly catch rates and retention rates can be ascertained from the use of trotlines rigged with hook timers. Information gathered from this study and further investigation with hook timers could aid in targeting specific time of day and set duration to collect river fish more efficiently, especially sturgeons, Scaphirhynchus species.

Trotlines have historically been used by commercial fishers to target ictalurids and have recently been shown to be effective for collecting sturgeons Scaphirhynchus spp. However, little is known about the gear–fish interaction after trotlines are deployed. Therefore, the objectives of this study were to determine whether trotlines equipped with Lindgren-Pitman (LP) hook timers could withstand harsh riverine conditions and whether catch rates, retention rates of hooked fish, capture times of targeted species, and bycatch would be affected. Our results showed no difference between standardized trotlines and trotlines with hook timers and indicated that 31% of pulled hook timers resulted in no fish being collected. Hook timers were activated by 69% of all the fish collected. The majority of fish collected were shovelnose sturgeon S. platorynchus (77%), of which 70% activated the timer. The fork length of the shovelnose sturgeon that did activate the timer (571.0 ± 60.1 mm [mean ± SE]) did not diffe...

Resource selection analyses of telemetry data are often conducted on categorical measurements of use and availability. Refinement of early resource selection analysis techniques has resulted in use of individuals as the sample unit rather than the number of telemetry detections. However, the minimum number of telemetry detections required for an individual animal to be included as a sample unit must reflect the number of detections needed to accurately describe the individual's resource use. We developed a method to determine the minimum number of detections required to accurately describe categorical resource use of an animal. The mean standard selection ratio (MSSR) described herein can be used to effectively design telemetry projects and efficiently allocate field resources by knowing, a priori, the number of telemetry detections needed to explain resource selection for individual animals and ultimately for an animal population. Additionally, the MSSR technique can be used following data colle...

Acquired uniparental disomy (aUPD) is a common finding in myeloid malignancies and typically acts to convert a somatically acquired heterozygous mutation to homozygosity. We sought to identify the target of chromosome 14 aUPD (aUPD14), a recurrent abnormality in myeloid neoplasms and population cohorts of elderly individuals. We identified 29 cases with aUPD14q that defined a minimal affected region (MAR) of 11.2 Mb running from 14q32.12 to the telomere. Exome sequencing (n=7) did not identify recurrently mutated genes, but methylation-specific PCR at the imprinted MEG3-DLK1 locus located within the MAR demonstrated loss of maternal chromosome 14 and gain of paternal chromosome 14 (P

Transmitter release was elicited in two ways from cultured cells filled with acetylcholine: (a) in a biochemical assay by successive addition of a calcium ionophore and calcium and (b) electrophysiologically, by electrical stimulation of individual cells and real-time recording with an embryonic Xenopus myocyte. Glioma C6-Bu-1 cells were found to be competent for Ca(2+)-dependent and quantal release. In contrast, no release could be elicited from mouse neuroblastoma N18TG-2 cells. However, acetylcholine release could be restored when N18TG-2 cells were transfected with a plasmid coding for mediatophore. Mediatophore is a protein of nerve terminal membranes purified from the Torpedo electric organ on the basis of its acetylcholine-releasing capacity. The transfected N18TG-2 cells expressed Torpedo mediatophore in their plasma membrane. In response to an electrical stimulus, they generated in the myocyte evoked currents that were curare sensitive and calcium dependent and displayed, discrete amplitude levels, like in naturally occurring synapses.

Geographic information systems (GIS) are powerful tools for analysis and interpretation of spatial data commonly encountered in fisheries science. We presented details of GIS use in fisheries management in a prior study and found cost to be a factor limiting GIS use. This article introduces fisheries managers to free or open-source GIS. Free or open-source GIS are readily available, powerful tools capable of performing a variety of spatial analyses. We strongly encourage managers wishing to perform spatial analyses, but who are unable to purchase software, to consider free GIS.

The Portfolio is an assessment tool of learning that recently appears in academic forums, and since 2008 is part of the University Teacher Education Program (Teaching Training) at University Institute of Hospital Italiano. Was included to allow teachers reflect on their own practices and accompany them in their educational work everyday. This paper shares the evaluative experience focused on the educational value of the writing process of the Portfolio, as long as is a reflection and a learning tool, by the relationship that promotes between theory and practice. Writing promotes psychological processes that enable students gain new meanings of the knowledge and take over them. At the same time, it can attend the construction of practical rationality that governs the ways of intervening in the classroom, because they write and reflect from their own teaching work. They have been introduced changes in the proposed during the course of its implementation to preserve its purposes: to accompany the draft review, jointly define index, etc. Students point that it is high impact training and conclude that writing is re-think about what they have learned, and therefore keep learning.

From the Pedagogical Advisory of Italian Hospital's University Institute is a need to develop training processes regarding teaching practices that promote changes in regular teaching proposals. Teachers "in training", involved in counseling under the Teacher Education Program, in most cases have a career in the practice of teaching. That's why it is intended to recover their experiences and, at the same time, conduct them to a critical analysis towards improving their daily work. In this paper we review, and consider the perspective of those who have been trained under this system, the principles supporting the pedagogical counseling approach: the dialectical relationship between theory and practice, the reflection on action, and interventions redefinitions towards maintaining and reviewing its educational purposes.

Several neuronal and non-neuronal cell lines express a Ca(2+)-dependent mechanism of transmitter release that can be demonstrated after loading the cells with acetylcholine during culture. In contrast, a particular cell line, the neuroblastoma N18TG-2, was found to be deficient for release. We transfected N18TG-2 cells with a plasmid encoding Torpedo mediatophore, a protein able to translocate acetylcholine in response to calcium. The N18TG-2 cells expressed the Torpedo protein which reached their plasma membrane. At the same time, these cells acquired a Ca(2+)-dependent quantal release mechanism similar to the one naturally expressed by other cell lines. Hence, the presence of mediatophore in the plasma membrane seems essential for quantal release.

Mediatophore is a protein of approximately 200 kDa able to translocate acetylcholine in response to calcium. It was purified from the presynaptic plasma membranes of the electric organ nerve terminals. Mediatophore is a homooligomer of a 16-kDa subunit, homologous to the proteolipid of V-ATPase. Cells of the N18TG-2 neuronal line are not able to produce quantal acetylcholine release. We show here that transfection of N18TG-2 cells with a plasmid encoding the mediatophore subunit restored calcium-dependent release. The essential feature of such a release was its quantal nature, similar to what is observed in situ in cholinergic synapses from which mediatophore was purified.

A methionine/valine polymorphism at amino acid 129 of the major histocompatibility complex class I chain-related gene A (MICA-129) categorizes alleles into strong and weak binders of the natural killer (NK) and T-cell receptor NKG2D. We investigated whether MICA-129 is differentially associated with skin and joint manifestations of psoriatic disease (PsD) independently of human leukocyte antigen (HLA)-C and HLA-B in patients and controls from Toronto and St. John's. The MICA-129 methionine (Met) allele, particularly Met/Met homozygosity, was strongly associated with both cutaneous psoriasis (PsC) and psoriatic arthritis (PsA) independently of HLA-B and HLA-C in Toronto patients, and was also associated with PsA in St. John's patients, but with no additional effect of Met/Met homozygosity. No association remained after adjustment for HLA alleles in St. John's patients. MICA-129 was not associated with PsA when compared with PsC. We conclude that MICA-129 is a marker of skin manifestations of PsD that is independent of HLA class I in Toronto patients.

In this article, we aimed to investigate plasma Factor XIII levels after extracorporeal circulation in cardiac surgery by thromboelastometric detection, as extracorporeal circulation causes various coagulation disorders due to the exposure of blood to artificial surfaces, inflammatory induction and mechanical destruction of platelets and coagulation factors, which may particularly affect factors with long half-lives, such as Factor XIII.Since transfusion algorithms are often empirical and laboratory analysis of Factor XIII plasma levels may not be available 24 h a day, bed-side testing using rotational thromboelastometry (ROTEM) could offer a splendid option to define the cause of excessive peri-operative bleeding disorders in general and Factor XIII levels in particular in a timely manner and thus facilitating exact substitution therapy.In this trial, we investigated 25 cardiac surgery patients with extracorporeal bypass times over 100 min. Standard laboratory and ROTEM analyses were performed post-operatively at the time of intensive care unit admission and 6 h later. We implemented EXTEM with additional Factor XIII (teenTEM) as additional test by adding 0·625 IU Factor XIII to standard EXTEM reagents.In this observational study, we could not demonstrate a correlation between Factor XIII and MCFEXTEM , CFTEXTEM or MLEXTEM . Neither Factor XIII plasma levels nor MCFEXTEM could predict blood loss. In accordance with previous findings, we were able to demonstrate increased maximum clot firmness (MCF), decreased clot formation time and decreased maximum lysis by adding Factor XIII in vitro (teenTEM vs EXTEM) indicating an improvement in the coagulation process. As shown before, we also found a strong correlation between MCF and platelet and fibrinogen plasma levels.In summary, 'teenTEM' test does not seem to detect Factor XIII deficient patients in cardiac surgery. Furthermore, post-operative blood loss could not be predicted neither by ROTEM nor by laboratory analysis of Factor XIII. In vitro administration of Factor XIII appears to improve laboratory measures of haemostasis.

This is the publisher's official version. It is also available electronically from: http://www.jstor.org/stable/2995609.

1. Electrophysiological detection of acetylcholine (ACh) release by synaptosomes from the electric organ of Torpedo was searched for by laying the isolated nerve terminals on a culture of Xenopus embryonic muscle cells (myocytes), and by recording the ACh-induced inward currents in the myocytes. 2. Whole-cell recording in one of the myocytes revealed rapid inward currents that where generated soon after synaptosome application. These pulsatile events strongly resembled those occurring normally during the early phase of synaptogenesis after nerve-muscle contact in Xenopus cell cultures. They were called spontaneous synaptic currents (SSCs). 3. The SSCs produced by the synaptosomes had a rapid time course, with mean time-to-peak and half-decay times of 2.6 +/- 0.4 ms and 6.0 +/- 1.1 ms, respectively. Most events had a falling phase that could be fitted with a single exponential. The mean time constant of decay was 6.2 +/- 1.1 ms. More than half of the SSCs (approximately 60%) constituted a rather homogenous population in which the time-to-peak versus amplitude showed a positive relationship, the smallest events displaying a shorter time course. The rest of the SSCs had a more variable and slower time course. Such events are also observed in young and mature junctions in situ. 4. The amplitudes of SSCs had a wide distribution which was skewed towards the smallest values. The mean amplitude was 65.2 +/- 16.1 pA. 5. During the minutes following an application of synaptosomes, the frequency of the SSCs tended to decrease, but their mean amplitude remained constant. Such behaviour could be reproduced during several successive additions of synaptosomes while recording in the same myocyte. 6. Just after synaptosome application, the SSCs were superposed to a noisy inward current that lasted for 20-60 s. Noise analysis of this current gave the values of 0.7 +/- 0.1 pA for the mean amplitude of the elementary event, and 4.7 +/- 0.2 ms for its mean duration, values that compare well with those reported for the activation of frog embryonic nicotinic receptor. This suggests that the noisy current was due to ACh molecules set free by synaptosomes which were either damaged or which released ACh at some distance. This view was strengthened by biochemical analysis of ACh release by synaptosomes in vitro. 7. Tubocurarine reversibly abolished the appearance of both the noise and the synaptosome-generated SSCs, showing that these currents were due to the action of ACh.(ABSTRACT TRUNCATED AT 400 WORDS)

A 56-year-old woman with psoriatic arthritis is presented whose initially ankylosed digit was later found to develop pencil-in-cup change. The patient was treated over that period with etanercept and had no signs of active arthritis. The possible mechanisms for these changes are discussed.

Only a limited number of cases of Behçet's disease and hematological malignancies have been reported in the literature. We report the case of a 45 year old female patient with Behçet's disease who developed myelodysplastic syndrome, refractory anemia with excess blasts in transformation subtype, with complex chromosomal abnormalities, including excess of chromosome 8, following several years of treatment with chlorambucil for Behçet's disease. As has been described in most such cases, gastrointestinal involvement was most prominent. This case is described and the occurrence of myelodysplastic syndrome in Behçet's disease reviewed.

The blue sucker (Cycleptus elongatus) is listed as threatened in the state of Nebraska, and little is known about its life history. Nebraska Game and Parks Commission monitoring crews collected 13 age-0 blue suckers in three constructed side channels of the Missouri River from 2006 to 2008. Eleven of the 13 fish were sampled in shallow areas (

Choline acetyltransferase (ChAT), the enzyme which catalyses the biosynthesis of the neurotransmitter acetylcholine, exists in a soluble and membrane-bound form in cholinergic nerve terminals of different animal species. This study was performed on the enzyme present in Drosophila central nervous system. We show that the two forms of the enzyme have the same apparent molecular weight (75 kDa) when analysed by immunoblotting using an antibody we raised against the recombinant enzyme. According to different authors, membrane-bound enzyme might be associated with synaptic vesicles or plasma membrane. Subfractionation of Drosophila head homogenates in linear glycerol gradients showed that ChAT does not associate with synaptic vesicles. Analysis of ChAT activity and immunoreactivity showed that two peaks of ChAT were produced. One peak was present in fractions containing soluble components and the other was associated with rapidly sedimenting membranes containing plasma membranes. ChAT in the first peak was mainly hydrophilic. A large proportion of ChAT associated with rapidly sedimenting membranes was amphiphilic. Further fractionation of these membranes by flotation in sucrose gradients showed that membrane-associated ChAT sedimented in fractions containing plasma membrane marker. Membrane-bound ChAT was neither solubilized nor converted to hydrophilic enzyme after membrane treatment with 1 M hydroxylamine, suggesting that the enzyme is not palmitoylated and therefore not anchored to membrane through thioester-linked long chain fatty acid. Partial solubilization of ChAT present on membranes with urea and carbonate suggests that this form of ChAT is a peripheral membrane protein. Carbonate solubilization of membrane-bound ChAT converted the enzyme from hydrophobic to hydrophilic protein.