The prevalence of injection-site reactions with disease-modifying therapies and their effect on adherence in patients with multiple sclerosis: an observational study

<p>Abstract</p> <p>Background</p> <p>Interferon beta (IFNβ) and glatiramer acetate (GA) are administered by subcutaneous (SC) or intramuscular (IM) injection. Patients with multiple sclerosis (MS) often report injection-site reactions (ISRs) as a reason for noncompliance or switching therapies. The aim of this study was to compare the proportion of patients on different formulations of IFNβ or GA who experienced ISRs and who switched or discontinued therapy because of ISRs.</p> <p>Methods</p> <p>The Swiss MS Skin Project was an observational multicenter study. Patients with MS or clinically isolated syndrome who were on the same therapy for at least 2 years were enrolled. A skin examination was conducted at the first study visit and 1 year later.</p> <p>Results</p> <p>The 412 patients enrolled were on 1 of 4 disease-modifying therapies for at least 2 years: IM IFNβ-1a (n = 82), SC IFNβ-1b (n = 123), SC IFNβ-1a (n = 184), or SC GA (n = 23). At first evaluation, ISRs were reported by fewer patients on IM IFNβ-1a (13.4%) than on SC IFNβ-1b (57.7%; <it>P </it>< 0.0001), SC IFNβ-1a (67.9%; <it>P </it>< 0.0001), or SC GA (30.4%; <it>P </it>= not significant [NS]). No patient on IM IFNβ-1a missed a dose in the previous 4 weeks because of ISRs, compared with 5.7% of patients on SC IFNβ-1b (<it>P </it>= 0.044), 7.1% of patients on SC IFNβ-1a (<it>P </it>= 0.011), and 4.3% of patients on SC GA (<it>P </it>= NS). Primary reasons for discontinuing or switching therapy were ISRs or lack of efficacy. Similar patterns were observed at 1 year.</p> <p>Conclusions</p> <p>Patients on IM IFNβ-1a had fewer ISRs and were less likely to switch therapies than patients on other therapies. This study may have implications in selecting initial therapy or, for patients considering switching or discontinuing therapy because of ISRs, selecting an alternative option.</p

Aircraft-based mass balance estimate of methane emissions from offshore gas facilities in the Southern North Sea

Atmospheric methane (CH4) concentrations have more than doubled since the beginning of the industrial age, making CH4 the second most important anthropogenic greenhouse gas after carbon dioxide (CO2). The oil and gas sector represent one of the major anthropogenic CH4 emitters as it is estimated to account for 22 % of global anthropogenic CH4 emissions. An airborne field campaign was conducted in April&ndash;May 2019 to study CH4 emissions from offshore gas facilities in the Southern North Sea with the aim to derive emission estimates using a top-down (measurement-led) approach. We present CH4 fluxes for six UK and five Dutch offshore platforms/platform complexes using the well-established mass balance flux method. We identify specific gas production emissions and emission processes (venting/fugitive or flaring/combustion) using observations of co-emitted ethane (C2H6) and CO2. We compare our top-down estimated fluxes with a ship-based top-down study in the Dutch sector and with bottom-up estimates from a globally gridded annual inventory, UK national annual point-source inventories, and with operator-based reporting for individual Dutch facilities. In this study, we find that all inventories, except for the operator-based facility-level reporting, underestimate measured emissions, with the largest discrepancy observed with the globally gridded inventory. Individual facility reporting, as available for Dutch sites for the specific survey date, shows better agreement with our measurement-based estimates. For all sampled Dutch installations together, we find that our estimated flux of (122.7 &plusmn; 9.7) kg h-1 deviates by a factor 0.7 (0.35&ndash;12) from reported values (183.1 kg h-1). Comparisons with aircraft observations in two other offshore regions (Norwegian Sea and Gulf of Mexico) show that measured, absolute facility-level emission rates agree with the general distribution found in other offshore basins despite different production types (oil, gas) and gas production rates, which vary by two orders of magnitude. Therefore, mitigation is warranted equally across geographies.</p

Genotype-phenotype correlation at codon 1740 ofSETD2

The SET domain containing 2, histone lysine methyltransferase encoded by SETD2 is a dual-function methyltransferase for histones and microtubules and plays an important role for transcriptional regulation, genomic stability, and cytoskeletal functions. Specifically, SETD2 is associated with trimethylation of histone H3 at lysine 36 (H3K36me3) and methylation of α-tubulin at lysine 40. Heterozygous loss of function and missense variants have previously been described with Luscan-Lumish syndrome (LLS), which is characterized by overgrowth, neurodevelopmental features, and absence of overt congenital anomalies. We have identified 15 individuals with de novo variants in codon 1740 of SETD2 whose features differ from those with LLS. Group 1 consists of 12 individuals with heterozygous variant c.5218C>T p.(Arg1740Trp) and Group 2 consists of 3 individuals with heterozygous variant c.5219G>A p.(Arg1740Gln). The phenotype of Group 1 includes microcephaly, profound intellectual disability, congenital anomalies affecting several organ systems, and similar facial features. Individuals in Group 2 had moderate to severe intellectual disability, low normal head circumference, and absence of additional major congenital anomalies. While LLS is likely due to loss of function of SETD2, the clinical features seen in individuals with variants affecting codon 1740 are more severe suggesting an alternative mechanism, such as gain of function, effects on epigenetic regulation, or posttranslational modification of the cytoskeleton. Our report is a prime example of different mutations in the same gene causing diverging phenotypes and the features observed in Group 1 suggest a new clinically recognizable syndrome uniquely associated with the heterozygous variant c.5218C>T p.(Arg1740Trp) in SETD2

Quantification and assessment of methane emissions from offshore oil and gas facilities on the Norwegian continental shelf

The oil and gas (O&G) sector is a significant source of methane (CH4) emissions. Quantifying these emissions remains challenging, with many studies highlighting discrepancies between measurements and inventory-based estimates. In this study, we present CH4 emission fluxes from 21 offshore O&G facilities collected in 10 O&G fields over two regions of the Norwegian continental shelf in 2019. Emissions of CH4 derived from measurements during 13 aircraft surveys were found to range from 2.6 to 1200 t yr−1 (with a mean of 211 t yr−1 across all 21 facilities). Comparing this with aggregated operator-reported facility emissions for 2019, we found excellent agreement (within 1σ uncertainty), with mean aircraft-measured fluxes only 16 % lower than those reported by operators. We also compared aircraft-derived fluxes with facility fluxes extracted from a global gridded fossil fuel CH4 emission inventory compiled for 2016. We found that the measured emissions were 42 % larger than the inventory for the area covered by this study, for the 21 facilities surveyed (in aggregate). We interpret this large discrepancy not to reflect a systematic error in the operator-reported emissions, which agree with measurements, but rather the representativity of the global inventory due to the methodology used to construct it and the fact that the inventory was compiled for 2016 (and thus not representative of emissions in 2019). This highlights the need for timely and up-to-date inventories for use in research and policy. The variable nature of CH4 emissions from individual facilities requires knowledge of facility operational status during measurements for data to be useful in prioritising targeted emission mitigation solutions. Future surveys of individual facilities would benefit from knowledge of facility operational status over time. Field-specific aggregated emissions (and uncertainty statistics), as presented here for the Norwegian Sea, can be meaningfully estimated from intensive aircraft surveys. However, field-specific estimates cannot be reliably extrapolated to other production fields without their own tailored surveys, which would need to capture a range of facility designs, oil and gas production volumes, and facility ages. For year-on-year comparison to annually updated inventories and regulatory emission reporting, analogous annual surveys would be needed for meaningful top-down validation. In summary, this study demonstrates the importance and accuracy of detailed, facility-level emission accounting and reporting by operators and the use of airborne measurement approaches to validate bottom-up accounting

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Measuring the Prong Velocity of Quartz Tuning Forks Used to Probe Quantum Fluids

Recently, quartz tuning forks have been used to probe the dynamics of quantum fluids. For many of these measurements it is important to know the velocity amplitude of the tips of the vibrating fork prongs. We have used different techniques to establish, with an accuracy of a few percent, the relationship between the electrical and mechanical properties of several commercial quartz tuning forks with fundamental resonant frequency similar to 32 kHz. The velocity is usually inferred from an electro-mechanical calibration that models a quartz prong as a clamped, rectangular cantilever beam. We have tested the accuracy of this calibration using three methods: measurement of the amplitude at which the fork prongs touch each other; direct optical measurement of the moving fork prongs using strobe microscopy; and a Michelson interferometry technique operating with a 670 nm laser. All three methods yield consistent results. The velocity so determined is found to be 10% lower than that of the standard electro-mechanical calibration