Ashcroft v. Iqbal: The Question of a Heightened Standard of Pleading in Qualified Immunity Cases

Background We have previously shown that Lactobacillus reuteri supplementation from pregnancy week 36 and to the infant through the first year of life decreased the prevalence of IgE-associated eczema at 2 years. The underlying immunological mechanisms are unknown, however. Objective To investigate the immunomodulatory effect of probiotic supplementation on allergen- and mitogen-induced immune responses in children until 2 years of age. Methods Blood mononuclear cells were collected at birth, 6, 12 and 24 months from 61 children (29 probiotic and 32 placebo treated) and cultured with ovalbumin, birch and cat extract and Phytohaemagglutinin (PHA). Cytokine and chemokine secretion was determined using an in-house multiplexed Luminex assay and ELISA. Real-time PCR was performed to investigate the Ebi3, Foxp3, GATA-3 and T-bet mRNA expression. Results Probiotic treatment was associated with low cat-induced Th2-like responses at 6 months (IL-5, P = 0.01, and IL-13, P = 0.009), with a similar trend for IL-5 at 12 months (P = 0.09). Cat-induced IFN-γ responses were also lower after probiotic than after placebo treatment at 24 months (P = 0.007), with similar findings for the anti-inflammatory IL-10 at birth (P = 0.001) and at 12 months (P = 0.009). At 24 months, Th2-associated CCL22 levels were lower in the probiotic than in the placebo group after birch stimulation (P = 0.02), with a similar trend after ovalbumin stimulation (P = 0.07). Lower CCL22 levels were recorded at 12 and 24 months (P = 0.03 and P = 0.01) after PHA stimulation. Conclusion and Clinical Relevance Lactobacillus reuteri supplementation decreases allergen responsiveness and may enhance immunoregulatory capacity during infancy. L. reuteri supplementation from week 36 and during the first year of life significantly decreases IgE-associated eczema and lowers allergen and mitogen responsiveness.Funding Agencies|Swedish Research Council|K2011-56X-21854-01-06|Ekhaga Foundation||Olle Engkvist Foundation||Heart and Lung foundation||Research Council for the South-East Sweden|F2000-106|Swedish Asthma and Allergy Association||Cancer and Allergy Association||BioGaia AB, Stockholm, Sweden||University Hospital of Linkoping, Sweden||</p

Marked improvement of overall survival in mantle cell lymphoma: a population based study from the Swedish Lymphoma Registry.

Abstract In recent years, more intensive chemotherapy regimens for mantle cell lymphoma (MCL) have been associated with prolongation of survival. In this study, our aim was to investigate prognostic factors and evaluate improvement in survival in MCL on a population level. The cohort included all patients diagnosed with MCL from 1 January 2000 to 31 March 2010 in the Swedish Lymphoma Registry. At total of 785 patients with MCL were identified. Age, performance status, and B-symptoms were significant prognostic factors for overall survival (OS) in multivariate analysis. In addition, OS was markedly improved (hazard ratio 0.8, 95% confidence interval 0.7-0.9) for patients diagnosed during the latest time period, 2006-2010, also when corrected for prognostic factors as above. Estimated OS at 3 years was 62%, compared to 47% for patients diagnosed earlier (p < 0.01). The reasons for this dramatic improvement in OS are not yet clear, but may be due to the introduction of specific and more potent therapeutic regimens

Partial validation of the Vcheck canine pancreatic lipase assay

Measurement of canine pancreatic lipase immunoreactivity (cPLI) is used for diagnosing pancreatitis in dogs. Because pancreatitis can be a life-threatening disease with severe complications, an in-house cPLI test would be valuable to obtain rapid test results. The aim of this study was to evaluate a point-of-care cPLI test, Vcheck cPL. Precision, determined according to EP15, and linearity under dilution were determined and judged against preset quality goals. Results from the Vcheck cPL were compared with a previously validated cPLI ELISA, Spec cPL. In a retrospective study, cPLI results from dogs with and without acute pancreatitis, as determined by pancreatic ultrasound examination, were investigated to assess the performance of the assay in a clinical setting. Statistical analysis included the Mann-Whitney test, Chi-square test, and Passing-Bablok regression analysis with a significance level of 0.05. Precision of the assay was acceptable, with intra-, inter-, and total coefficients of variation (CV%) less than 12.1%, 6.4%, and 12.1%, respectively. Results from the linearity study indicated that the method was acceptably linear at lower concentrations but not in the high-concentration range. The method comparison study revealed that Vcheck generally measured higher concentrations compared with Spec cPL, and that the methods should not be used interchangeably. Dogs with acute pancreatitis had significantly higher cPLI concentrations compared with dogs without pancreatitis (P < 0.01), but there was a marked overlap in cPL concentrations between the two groups

Drivers and Barriers for Inland Waterway Transportation

Inland waterway transportation (IWT) in Sweden could be a substitute for road transports with the prospects of improving the environmental performance. Sweden currently has no systematic strategies or policies for transports on inland waterways (IWW), and despite available capacity the waterways are barely utilized. In the Netherlands, for example, the IWW capacity is embedded in the transport system and utilized to a large extent. For a successful modal shift it is important to understand the drivers and barriers for the shift and develop strategies to leverage the drivers and mitigate the barriers. This study aims to identify drivers and barriers for IWT based on successful benchmark cases in the Netherlands. Furthermore, based on the learning from these benchmarks the study aims to point out strategic actions for Sweden regarding IWT. The data for this study was collected from IWT organizations, shippers and local administrations in the Netherlands. The results showed that main drivers for IWT are congestion relief, cost reduction and lower environmental impact. On the other hand, main barriers are slow pace of development, high investment costs and poor hinterland connectivity. For a successful modal shift in Sweden, it is crucial to prepare governmental support, a change in stakeholders’ mindset, decisive attitude to modal shift process and a strong long-term perspective

DNA Methylation Signatures Predict Cytogenetic Subtype and Outcome in Pediatric Acute Myeloid Leukemia (AML)

Pediatric acute myeloid leukemia (AML) is a heterogeneous disease composed of clinically relevant subtypes defined by recurrent cytogenetic aberrations. The majority of the aberrations used in risk grouping for treatment decisions are extensively studied, but still a large proportion of pediatric AML patients remain cytogenetically undefined and would therefore benefit from additional molecular investigation. As aberrant epigenetic regulation has been widely observed during leukemogenesis, we hypothesized that DNA methylation signatures could be used to predict molecular subtypes and identify signatures with prognostic impact in AML. To study genome-wide DNA methylation, we analyzed 123 diagnostic and 19 relapse AML samples on Illumina 450k DNA methylation arrays. We designed and validated DNA methylation-based classifiers for AML cytogenetic subtype, resulting in an overall test accuracy of 91%. Furthermore, we identified methylation signatures associated with outcome in t(8;21)/RUNX1-RUNX1T1, normal karyotype, and MLL/KMT2A-rearranged subgroups (p < 0.01). Overall, these results further underscore the clinical value of DNA methylation analysis in AML

DNA Methylation Signatures Predict Cytogenetic Subtype and Outcome in Pediatric Acute Myeloid Leukemia (AML)

Pediatric acute myeloid leukemia (AML) is a heterogeneous disease composed of clinically relevant subtypes defined by recurrent cytogenetic aberrations. The majority of the aberrations used in risk grouping for treatment decisions are extensively studied, but still a large proportion of pediatric AML patients remain cytogenetically undefined and would therefore benefit from additional molecular investigation. As aberrant epigenetic regulation has been widely observed during leukemogenesis, we hypothesized that DNA methylation signatures could be used to predict molecular subtypes and identify signatures with prognostic impact in AML. To study genome-wide DNA methylation, we analyzed 123 diagnostic and 19 relapse AML samples on Illumina 450k DNA methylation arrays. We designed and validated DNA methylation-based classifiers for AML cytogenetic subtype, resulting in an overall test accuracy of 91%. Furthermore, we identified methylation signatures associated with outcome in t(8;21)/RUNX1-RUNX1T1, normal karyotype, and MLL/KMT2A-rearranged subgroups (p < 0.01). Overall, these results further underscore the clinical value of DNA methylation analysis in AML

Proteogenomic analysis of acute myeloid leukemia associates relapsed disease with reprogrammed energy metabolism both in adults and children

Despite improvement of current treatment strategies and novel targeted drugs, relapse and treatment resistance largely determine the outcome for acute myeloid leukemia (AML) patients. To identify the underlying molecular characteristics, numerous studies have been aimed to decipher the genomic- and transcriptomic landscape of AML. Nevertheless, further molecular changes allowing malignant cells to escape treatment remain to be elucidated. Mass spectrometry is a powerful tool enabling detailed insights into proteomic changes that could explain AML relapse and resistance. Here, we investigated AML samples from 47 adult and 22 pediatric patients at serial time-points during disease progression using mass spectrometry-based in-depth proteomics. We show that the proteomic profile at relapse is enriched for mitochondrial ribosomal proteins and subunits of the respiratory chain complex, indicative of reprogrammed energy metabolism from diagnosis to relapse. Further, higher levels of granzymes and lower levels of the anti-inflammatory protein CR1/CD35 suggest an inflammatory signature promoting disease progression. Finally, through a proteogenomic approach, we detected novel peptides, which present a promising repertoire in the search for biomarkers and tumor-specific druggable targets. Altogether, this study highlights the importance of proteomic studies in holistic approaches to improve treatment and survival of AML patients.Peer reviewe

Effect of circadian rhythm, age, training and acute lameness on serum concentrations of cartilage oligomeric matrix protein (COMP) neo-epitope in horses

Molecular serum markers that can identify early reversible osteoarthritis (OA) in horses are lacking. Objectives: We studied serum concentrations of a novel cartilage oligomeric matrix protein (COMP) neo-epitope in horses subjected to short-term exercise and with acute lameness. The effects of circadian rhythm and age were also evaluated. Study design: Longitudinal studies in healthy horses and cross-sectional comparison of lame and non-lame horses. Methods: Sera were collected from five horses before and after short-term interval exercise and during full-day box rest. Sera from 32 acutely lame horses were used to evaluate age-related effects. Independent samples from control horses (n = 41) and horses with acute lameness (n = 71) were included. COMP neo-epitope concentrations were analysed using custom-developed inhibition ELISAs validated for equine serum. The presence of COMP neo-epitope was delineated in healthy and osteoarthritic articular cartilage with immunohistochemistry. Results: COMP neo-epitope concentrations decreased after speed training but returned to baseline levels post-exercise. No correlations between age and serum COMP neo-epitope concentrations were found (r = 0.0013). The mean (±s.d.) serum concentration of COMP neo-epitope in independent samples from non-lame horses was 0.84 ± 0.38 μg/mL, and for lame horses was 5.24 ± 1.83 μg/mL (P<0.001). Antibodies against COMP neo-epitope did not stain normal articular cartilage, but intracytoplasmic staining was found in superficial chondrocytes of mild OA cartilage and in the extracellular matrix of moderately osteoarthritic cartilage. Main limitations: ELISA was based on polyclonal antisera rather than a monoclonal antibody. There is a sex and breed bias within the groups of horses, also it could have been of value to include horses with septic arthritis and tendonitis and investigated joint differences. Conclusions: This COMP neo-epitope can be measured in sera, and results indicate that it could be a biomarker for pathologic fragmentation of cartilage in connection with acute joint lameness.Western Region Research Funding (ALF GBG‐716171), the Swedish‐Norwegian Foundation for Equine Research (H0947014), Swedish Research Council grant (VR 2015‐02959) and the Swedish Research Council for Environment, Agricultural Sciences and Spatial Planning (FORMAS 221‐2013‐317) supported this research.Peer Reviewe

Three-dimensional echocardiography using single-heartbeat modality decreases variability in measuring left ventricular volumes and function in comparison to four-beat technique in atrial fibrillation

BACKGROUND: Three dimensional echocardiography (3DE) approaches the accuracy of cardiac magnetic resonance in measuring left ventricular (LV) volumes and ejection fraction (EF). The multibeat modality in comparison to single-beat (SB) requires breath-hold technique and regular heart rhythm which could limit the use of this technique in patients with atrial fibrillation (AF) due to stitching artifact. The study aimed to investigate whether SB full volume 3DE acquisition reduces inter- and intraobserver variability in assessment of LV volumes and EF in comparison to four-beat (4B) ECG-gated full volume 3DE recording in patients with AF. METHODS: A total of 78 patients were included in this study. Fifty-five with sinus rhythm (group A) and 23 having AF (group B). 4B and SB 3DE was performed in all patients. LV volumes and EF was determined by these two modalities and inter- and intraobserver variability was analyzed. RESULTS: SB modality showed significantly lower inter- and intraobserver variability in group B in comparison to 4B when measuring LV volumes and EF, except for end-systolic volume (ESV) in intraobserver analysis. There were significant differences when calculating the LV volumes (p<0.001) and EF (p<0.05) with SB in comparison to 4B in group B. CONCLUSION: Single-beat three-dimensional full volume acquisition seems to be superior to four-beat ECG-gated acquisition in measuring left ventricular volumes and ejection fraction in patients having atrial fibrillation. The variability is significantly lower both for ejection fraction and left ventricular volumes