The emerging risk of overdiagnosis in rheumatoid arthritis and polymyalgia rheumatica.

Overdiagnosis occurs when patients are diagnosed with a disease that would otherwise never have affected the quality or duration of their lives. This often happens unintentionally through well-meaning screening programmes that aim to detect diseases during so-called subclinical stages. Recently, it has been suggested that patients with polymyalgia rheumatica should be screened for giant cell arteritis to identify those at higher risk of relapse or vascular complications. Screening for interstitial lung disease for patients with rheumatoid arthritis has also been recommended to identify patients who could benefit from pulmonary interventions. These potential benefits must be weighed against foreseeable harms. Such harms include the uncovering of incidental findings that necessitate additional medical follow-up, the financial costs associated with screening initiatives, the risk of overtreatment through increased immunosuppression in patients who might not have otherwise required it, and the psychosocial burden of a new diagnosis. Randomised clinical trials and prospective cohort studies of screening interventions should be conducted to establish the risks and benefits and identify patients most likely to benefit from them. This Viewpoint covers risks that overdiagnosis presents to the field of rheumatology, with focus on rheumatoid arthritis and polymyalgia rheumatica.

Incidence of Pneumocystis Jiroveci Pneumonia in Patients With ANCA-Associated Vasculitis Initiating Therapy With Rituximab or Cyclophosphamide.

OBJECTIVE: This manuscript assesses the incidence of Pneumocystis jiroveci pneumonia (PJP) among patients receiving contemporary treatment regimens for antineutrophil cytoplasmic antibody-associated vasculitis (AAV) and adverse events associated with PJP prophylaxis. METHODS: Incident users of rituximab or cyclophosphamide for AAV were identified in the TriNetX electronic health records database from 2011 to 2022. The incidence rates (IRs) of PJP in the first 6 months of induction therapy with rituximab and/or cyclophosphamide and during postinduction maintenance therapy with rituximab were calculated. Cox proportional hazard models were used to estimate hazard ratios (HRs) and confidence intervals (CIs) for the risk of adverse events commonly associated with PJP prophylaxis. RESULTS: We identified 1,461 AAV cases who received induction therapy with rituximab (69.7%), cyclophosphamide (18.9%), or both (11.4%). Prophylaxis prescribed within 30 days of induction included trimethoprim-sulfamethoxazole (30.7%), atovaquone (5.4%), dapsone (3.8%), and pentamidine (0.8%). During induction therapy, 10 cases of PJP were identified (IR 15.0 cases per 1,000 patient-years); no deaths occurred. In adjusted analyses, those who received prophylaxis had a higher risk of leukopenia (HR 3.1; 95% CI 1.1-8.6), rash (HR 1.9; 95% CI 1.0-3.6), and nephropathy (HR 2.6; 95% CI 1.3-5.1) than those who did not. During rituximab maintenance therapy (n = 709), five cases of PJP were identified (IR 2.1 cases per 1,000 person-years), one of whom died during the hospitalization associated with a PJP diagnosis. CONCLUSION: Rates of PJP in patients with AAV were lower than previously observed, and few cases occurred during rituximab maintenance therapy. PJP prophylaxis was associated with adverse events.

Correlated electrochemical and optical tracking of discrete collision events.

Optical tracking of collisions between insulating microbeads and an ultramicroelectrode surface are correlated to electrochemical measurements and 3D simulations. The experiments are based on partial blocking of the electrode surface by the beads. Results obtained using these three methods provide details regarding the radial distribution of landing locations, the extent of current blockage, collision frequency, motion of beads on the electrode surface following collisions, and aggregation behavior both prior to collisions and afterward on the electrode surface.

Synthesis and characterization of NiSn dendrimer-encapsulated nanoparticles.

We report the synthesis and characterization of NiSn dendrimer-encapsulated nanoparticles (DENs) with sizes in the range of approximately 1.2 nm. These types of materials have potential applications in energy storage, and particles in the 1-3 nm size range are particularly attractive for this use. The NiSn DENs described here contain an average of 147 atoms and are encapsulated within hydrophobic, sixth-generation poly(amidoamine) dendrimers. DENs prepared using four different Ni/Sn ratios, along with monometallic Ni and Sn DENs, are described. To prevent oxidation, the synthesis was carried out under dry conditions in toluene. These bimetallic DENs were characterized by UV-vis spectroscopy, transmission electron microscopy, energy-dispersive X-ray spectroscopy, and X-ray photoelectron spectroscopy. The results indicate that the compositions of the nanoparticles reflect the ratio of Ni(2+) and Sn(2+) used in the first step of the synthesis; the NiSn nanoparticles remain encapsulated within the dendrimers, and when dry they have a degree of stability even after a short exposure to air.

The SWI/SNF ATPase BRG1 stimulates DNA end resection and homologous recombination by reducing nucleosome density at DNA double strand breaks and by promoting the recruitment of the CtIP nuclease.

DNA double strand breaks (DSBs) are among the most toxic DNA lesions and can be repaired accurately through homologous recombination (HR). HR requires processing of the DNA ends by nucleases (DNA end resection) in order to generate the required single-stranded DNA (ssDNA) regions. The SWI/SNF chromatin remodelers are 10-15 subunit complexes that contain one ATPase (BRG1 or BRM). Multiple subunits of these complexes have recently been identified as a novel family of tumor suppressors. These complexes are capable of remodeling chromatin by pushing nucleosomes along the DNA. More recent studies have identified these chromatin remodelers as important factors in DNA repair. Using the DR-U2OS reporter system, we show that the down regulation of BRG1 significantly reduces HR efficiency, while BRM has a minor effect. Inactivation of BRG1 impairs DSB repair and results in a defect in DNA end resection, as measured by the amount of BrdU-containing ssDNA generated after DNA damage. Inactivation of BRG1 also impairs the activation of the ATR kinase, reduces the levels of chromatin-bound RPA, and reduces the number of RPA and RAD51 foci after DNA damage. This defect in DNA end resection is explained by the defective recruitment of GFP-CtIP to laser-induced DSBs in the absence of BRG1. Importantly, we show that BRG1 reduces nucleosome density at DSBs. Finally, inactivation of BRG1 renders cells sensitive to anti-cancer drugs that induce DSBs. This study identifies BRG1 as an important factor for HR, which suggests that BRG1-mutated cancers have a DNA repair vulnerability that can be exploited therapeutically.

Electrochemical detection of individual DNA hybridization events.

We report on real-time electrochemical detection of individual DNA hybridization events at an electrode surface. The experiment is carried out in a microelectrochemical device configured with a working electrode modified with single-stranded DNA probe molecules. When a complementary DNA strand labelled with a catalyst hybridizes to the probe, an easily detectable electrocatalytic current is observed. In the experiments reported here, the catalyst is a platinum nanoparticle and the current arises from electrocatalytic oxidation of hydrazine. Two types of current transients are observed: short bursts and longer-lived steps. At low concentrations of hydrazine, the average size of the current transients is proportional to the amount of hydrazine present, but at higher concentrations the hydrazine oxidation reaction interferes with hybridization.