Response to: "does ACPA-negative RA consist of subgroups related to sustained DMARD-free remission and serological markers at disease presentation" by Masi and Fleischmann

Pathophysiology and treatment of rheumatic disease

Actual and potential nitrogen fixation in pea and field bean as affected by combined nitrogen

Actual nitrogen fixation of pea and field-bean plants, grown in soil in the open air, was determined as the acetylene reduction of nodulated roots. During the major part of the vegetative growth of these plants, actual nitrogen fixation was equal to the potential maximum nitrogenase activity of the bacteroids present in the nodules. This means that increase of the actual nitrogen fixation could be achieved only if the potential nitrogenase activity of the bacteroids would be enhanced or if more nodules would be present. During the generative growth phase, the potential nitrogenase activity of the bacteroids was not entirely utilized irrespective of the shoot mass of the host plant or the nitrogen-fixing capacity of the Rhizobium microsymbiont.The addition of nitrate to nodulated plants sharply reduced actual nitrogen fixation but did not affect potential nitrogen fixation within 10 days. The nitrate effect was temporarily eliminated by treatment of the root nodules with benzyladenine, a synthetic plant-growth regulator with a photosynthate-attracting action. It is concluded that incomplete utilization of the nitrogenase present in the bacteroids is caused by an inadequate carbohydrate supply of the nodules upon supply of the leguminous plant with nitrate.In root systems of pea plants growing in symbiosis with R. leguminosarum strains of poor nitrogen-fixing capacity, the N-limited growth led to an accumulation of carbohydrates. Upon the supply of such plants with nitrate, the carbohydrate level was decreased concomitantly to an increase in alternative (i.e. cyanide-resistant) respiration. Low rates of alternative respiration were found when nitrate was added to pea plants inoculated with highly effective strains, as the N-limitation of the plants was less severe. The carbohydrates respired in the nodules amounted to 6.3 mg C/mg N fixed with a moderately effective strain but only 3.1 mg C/mg N fixed with a highly effective strain.Some rhizobial strains possess a hydrogenase that is capable of recirculating part of the hydrogen evolved in air by nitrogenase simultaneously with nitrogen fixation. However, the energy gain by hydrogen oxidation was very low, viz.0.6-4.3% Of the costs of nitrogen fixation. As hydrogen oxidation did not delay nodule senescence or increase nitrogenase utilization, the presence of hydrogenase in rhizobial strains seems to be an unimportant factor in determining the nitrogen-fixing capacity of the symbiosis.Strains of R. leguminosarum with a low nitrogen-fixing capacity showed a distinctly different nodule formation pattern on primary and lateral roots of pea plants as compared with highly effective strains. The estimates of the yield of fixed nitrogen, derived from the acetylene-reduction method, of plants inoculated with rhizobia] strains of different nitrogen-fixing capacity, equally deteriorated during the growth period. When rates of hydrogen production in air were subtracted from the acetylene reduction rates, the estimates of nitrogen fixation were severely biased in favour of a hydrogenase-containing strain.Nitrogen fixation of pea plants infected with a highly effective strain of R. leguminosarum was decreased by the supply of combined nitrogen to a greater extent than that of plants with a moderately effective strain. In plants inoculated with a strain of poor nitrogen-fixing capacity, nitrogen fixation per plant was even stimulated by a low dose of combined nitrogen. This increase was probably due to an enhanced photosynthetic capacity which counteracted the adverse effect of combined nitrogen. Seed yields were increased by nitrate dressings, regardless of the rhizobia] strain. Seed yields of plants inoculated with moderately effective strains were slightly higher than those of highly effective strains at high levels of combined nitrogen, owing to higher nitrate uptake, higher nitrogen fixation and increased photosynthesis.<p/

Kokemuksia Oman muotoinen koti -hankkeesta nuorten silmin

Opinnäytetyön tilaaja on Helsingin kaupungin nuorisoasiainkeskuksen Oman muotoinen koti -hanke. Hanke on aloitettu 2015 ja se tarjoaa nuorille eri asumiskokeilujen avulla ratkaisua haastaviin asumistilanteisiin Helsingissä. Oman muotoinen koti -hankkeessa nuoret muuttivat 2017 vuoden alussa asumaan Kannelmäkeen. Asunnon lisäksi nuorille avautui mahdollisuus tehdä töitä 20 tuntia kuukaudessa yhdessä mietittyjen tehtävien parissa. Opinnäytetyön idea oli seurata neljän nuoren alkuvaihetta Oman muotoinen koti -hankkeessa. Opinnäytetyöni tavoite oli keskittyä nuorten kokemusten taltiointiin hankkeen edetessä, mistä saatu tieto auttaisi hankkeen kehittämisessä tilaajaa. Sain tilaajalta vapaat kädet opinnäytetyön toteuttamiseen. Valitsin nuorten kokemusten taltioimiseen teemahaastattelun menetelmän. Haastateltavien keski-ikä oli 20 vuotta, joista osa oli maahanmuuttajataustaisia ja osa kantasuomalaisia. Kaikki haastateltavat olivat erilaisia, tein haastatteluun kysymysrungon, mutta annoin tilaa haastattelussa nuorille kertoa valitsemasta aiheesta enemmän. Äänitin haastattelut ja litteroin ne. Haastattelun teemat vaihtelivat haastateltavan kanssa. Vaikka kysymykset olivat samat, tunsi osa nuorista tarvetta puhua enemmän toisesta teemasta. Tein haastattelut hankkeen alkuvaiheessa, joten haastattelujen tulokset puhuvat vain hankkeen alkuvaiheen tunnelmista. Opinnäytetyön teoreettisessa viitekehyksessä käsittelen asunnottomuuden lisäksi nuorten työllisyyttä. Pohdin mikä motivoi nuoria työllistymiseen ja mitkä keinot auttavat nuoria löytämään sopivaa työtä ja mitkä asiat voivat vaikuttaa nuorten työllistymiseen. Aineiston analyysiosiossa avaan nuorten ajatuksia hankkeesta ja työnteosta. Yhdistän teoreettista viitekehystä omaan pohdintaan. Oman muotoinen koti hankkeen alkuvaiheen aineiston analyysin perusteella, hankkeelle on kova tarve ja sitä olisi hyvä laajentaa isommaksi eri puolille pääkaupunkiseutua. Hanke tukee nuorten hankalaa asumistilannetta ja työllistymistä alati muuttuvassa työelämässä.The thesis focuses on City of Helsinki’s youth Departments Home That Fits Project. The project started at the beginning of 2015 and its objective is to provide solution for the housing crisis among the youth population in Helsinki. Home That Fits project’s youth moved to shared apartment in Kannelmäki at the beginning of 2017. Apart from housing the youth were provided with opportunity to work 20 hours a month in a agreed contract between all the partners involved. The thesis goal was to follow four young people in the project’s early stage. The main focus was to understand on how the project can be develop through the experiences of the young participants in the Home That Fits project. From the young people’s experiences I did choose with the cooperation of the parties involved a particular themes that we could base our questions on. The interviewee’s average age was early 20’s. All the participants shared their experiences differently. The interview’s theme changed from time to time although the questions stayed the same. Some of the youth felt the need to talk more about other subject than the agreed themes. The interviews were conducted at the early stages of the project. Therefore the results are based on that. The Thesis theory part deals with the youth's employment: What motivates young people to seek employment , what are the mechanisms that have been created to help the youth find the right work and the issues that can affect youth employment. The findings shows that there is a certain need for Home That Fits project in the Helsinki area of Kannelmäki and it could expand to other parts of Helsinki metropolitan area

How to fulfill the expert role in public dialogue:The Dutch dialogue on human germline genetic modification as a case

Over the last decades science communication theory appears to have evolved at a much faster pace than science communication practice. Scientists seem willing to step into the public domain, but a genuine two-way interaction with the public is only rarely observed. We argue that part of this discrepancy between theory and practice may actually be caused by the lacking of a clear description of the modern expert role; the role a scientist should take in contemporary science communication. In this contribution we use an example of good practice—the Dutch dialogue on human germline genetic modification—to inform theory. We analyse guiding principles for the design and execution of this dialogue and observe expert behavior in three separate dialogue sessions. With the combined findings, we present a detailed description of the modern expert role in terms of three responsibilities, with for each responsibility three prompts for behavior. For the responsibility to share these are to select expert knowledge that is relevant to the goal; to present expert knowledge in a meaningful and accessible language; and to be cautious in sharing personal considerations. For the responsibility to listen and learn these are to consider interactions with members of the public as opportunities to learn; to be patient and supportive; and to assist in stimulating in-depth dialogue. For the responsibility to invest in relationships these are to assist in creating an ambiance of safety and relevance; to preserve trust; and to convey respect for every contribution and every point of view. Each behavioral prompt is further concretized with concomitant actions and practice examples as collected from observing experts in action. The implications for scientists engaging in contemporary science communication, as well as for science communication trainers, are discussed.</p

DMARD-free remission as novel treatment target in rheumatoid arthritis: A systematic literature review of achievability and sustainability

OBJECTIVES: Although current treatment guidelines for rheumatoid arthritis (RA) suggest tapering disease-modifying anti-rheumatic drugs (DMARDs), it is unclear whether DMARD-free remission (DFR) is an achievable and sustainable outcome. Therefore, we systematically reviewed the literature to determine the prevalence and sustainability of DFR and evaluated potential predictors for DFR. METHODS: A systematic literature search was performed in March 2019 in multiple databases. All clinical trials and observational studies reporting on discontinuation of DMARDs in RA patients in remission were included. Our quality assessment included a general assessment and assessment of

Does the presence of magnetic resonance imaging-detected osteitis at diagnosis with rheumatoid arthritis lower the risk for achieving disease-modifying antirheumatic drug-free sustained remission: Results of a longitudinal study

Background: Although infrequent, some rheumatoid arthritis (RA) patients achieve disease-modifying antirheumatic drug (DMARD)-free sustained remission. The absence of RA-specific autoantibodies, such as anticitrullinated protein antibodies (ACPA), is known to be associated with this outcome but further mechanisms underlying the chronic nature of RA are largely unknown. Magnetic resonance imaging (MRI)-detected bone marrow edema (BME), or osteitis, strongly predicts erosive progression and is associated with ACPA positivity. Therefore, we hypothesized that the presence of MRI-detected osteitis is also predictive of not achieving DMARD-free sustained remission and that the presence of osteitis mediates the association between ACPA and DMARD-free sustained remission. Methods: A 1.5 T unilateral hand and foot MRI was performed at disease presentation in 238 RA patients, evaluating BME, synovitis, and tenosynovitis (summed as MRI inflammation score). DMARD-free sustained remission, defined as the absence of clinical synovitis after DMARD cessation that persisted during the total follow-up, was assessed (median follow-up 3.8 years). Associations between the different MRI-detected inflammatory features and this outcome were studied. A mediation analysis was performed to study whether the presence of BME mediated the association between ACPA and DMARD-free sustained remission. Finally, patterns of MRI-detected inflammation with regard to DMARD-free sustained remission were studied using partial least squares (PLS) regression. Results: Forty-six (19.3%) patients achieved DMARD-free sustained remission. ACPA positivity associated independently with remission (hazard ratio (HR) 0.16, 95% confidence interval (CI) 0.06-0.39). In contrast, no associations were observed between MRI-detected BME (HR 0.99, 95% CI 0.94-1.03), or other MRI inflammatory features, and achieving DMARD-free sustained remission. Thus, the presence of BME did not mediate the association between ACPA and DMARD-free sustained rem

Improvement of symptoms in clinically suspect arthralgia and resolution of subclinical joint inflammation: a longitudinal study in patients that did not progress to clinical arthritis

INTRODUCTION: Arthralgia and MRI-detected subclinical inflammation can precede the development of clinically evident rheumatoid arthritis (RA). However, part of the patients presenting with clinically suspect arthralgia (CSA) do not progress to RA. In these 'non-progressors', we aimed to study the frequencies of spontaneous improvement of arthralgia and its relation with the course of subclinical inflammation. METHODS: Between April 2012 and April 2015, 241 patients were considered at risk for RA based on the clinical presentation and included in the CSA cohort. One hundred fifty-two patients with complete data on clinical follow-up did not develop clinical arthritis, of which 98 underwent serial 1.5T MRI scans (wrist, MCP2-5, and MTP1-5 joints) at baseline and after 2 years. MRI scans were scored for synovitis, tenosynovitis, and bone marrow oedema (summed: MRI inflammation score). MRI scores were compared to scores of symptom-free persons. RESULTS: After a 2-year follow-up, 33% of the 'non-progressors' had complete resolution of symptoms; 67% had no symptom resolution and were diagnosed as persistent CSA (44%), osteoarthritis (10%), and tendinomuscular complaints (13%). With symptom-free controls as a reference, patients without resolution did not have increased MRI scores at any time point. However, patients achieving resolution of symptoms had increased MRI inflammation scores at baseline (4.0 vs. 2.6, p = 0.037), but not after 2 years (3.0 vs. 2.6; p = 0.57), and during follow-up, their MRI inflammation score decreased significantly (p = 0.036). CONCLUSIONS: A subgroup of CSA patients that did not progress to RA had spontaneous improvement of symptoms and resolution of subclinical joint inflammation. This time relationship suggests that symptoms and inflammation were causally related in these patients. Further research is needed to identify the mechanisms underlying the resolution of inflammation

Is shoulder involvement in clinically suspect arthralgia an early feature of rheumatoid arthritis? A longitudinal ultrasound study

Pathophysiology and treatment of rheumatic disease