The molecular basis of cereal mixed-linkage ß-glucan utilization by the human gut bacterium Segatella copri.

Mixed-linkage ß(1,3)/ß(1,4)-glucan (MLG) is abundant in the human diet through the ingestion of cereal grains, and is widely associated with healthful effects on metabolism and cholesterol levels. MLG is also a major source of fermentable glucose for the human gut microbiota (HGM). Bacteria from the Family Prevotellaceae are highly represented in the HGM of individuals who eat plant rich diets, including certain indigenous people and vegetarians in post-industrial societies. Here, we have defined and functionally characterized an exemplar Prevotellaceae MLG Polysaccharide Utilization Locus (MLG-PUL) in the type-strain Segatella copri (syn. Prevotella copri) DSM 18205 through transcriptomic, biochemical, and structural biological approaches. In particular, structure-function analysis of the cell-surface glycan-binding proteins (SGBP) and glycoside hydrolases (GH) of the S. copri MLG-PUL revealed the molecular basis for glycan capture and saccharification. Notably, syntenic MLG-PULs from human gut, human oral, and ruminant gut Prevotellaceae are distinguished from their counterparts in Bacteroidaceae by the presence of a ß(1,3)-specific endo-glucanase from Glycoside Hydrolase Family 5, Subfamily 4 (GH5_4) that initiates MLG backbone cleavage. The definition of a family of homologous MLG-PULs in individual species enabled a survey of nearly 2000 human fecal microbiomes using these genes as molecular markers, which revealed global population-specific distributions of Bacteroidaceae- and Prevotellaceae-mediated MLG utilization. Altogether, the data presented here provide new insight into the molecular basis of ß-glucan metabolism in the HGM, as a basis for informing the development of approaches to improve the nutrition and health of humans and other animals.

Effects of a telehealth-delivered Mediterranean diet intervention in adults with Rheumatoid Arthritis (MEDRA): a randomised controlled trial.

OBJECTIVE: To compare the effects a Mediterranean diet (MedDiet) versus the Irish Healthy Eating Guidelines (HEG) on physical function and quality of life in adults with rheumatoid arthritis (RA) in Ireland. METHODS: Forty-four adults with RA were randomised (1:1) to the MedDiet or HEG for 12 weeks. The intervention included three video teleconsultations and two follow-up telephone calls facilitated by a Registered Dietitian (RD). Changes in physical function by Health Assessment Questionnaire- Disability Index (HAQ-DI) and quality of life by Rheumatoid Arthritis Quality of Life Questionnaire (RAQoL) were the primary outcomes measured. Secondary outcomes included changes in dietary adherence, physical activity by Yale Physical Activity survey (YPAS), patient-perceived pain and general health, and anthropometric measures. All measurements were administered at baseline and repeated at 6 and 12 weeks. RESULTS: Forty participants completed the study. Participants were primarily females (87.5%), mean age was 47.5 ± 10.9 years. At the end of the intervention, participants in the MedDiet group reported significantly better physical function (p = 0.006) and quality of life (p = 0.037) compared to HEG group. From baseline to 12 weeks, physical function significantly improved in both diet groups, MedDiet (0.9 ± 0.5 to 0.5 ± 0.4 units, p < 0.001) and HEG (1.4 ± 0.7 to 1.0 ± 0.6 units, p < 0.001). Quality of life also significantly improved in the MedDiet (10.1 ± 7.5 to 4.0 ± 4.7 units, p < 0.001) and HEG group (11.25 ± 7.2 to 7.9 ± 6.4 units, p = 0.048). Physical activity improved significantly in the MedDiet (56.7 ± 28.6 to 70.6 ± 33.5 points, p = 0.01) but not within the HEG group despite similar recommendations. CONCLUSION: Adhering to the MedDiet and Irish Healthy Eating Guidelines resulted in improvements in RA patient-reported outcomes. The changes observed in both diet groups are likely due to the improvement in overall diet quality irrespective of dietary prescription. TRIAL REGISTRATION NUMBER: NCT04262505.

SACCHARIS v2: Streamlining Prediction of Carbohydrate-Active Enzyme Specificities Within Large Datasets.

Carbohydrates are chemically and structurally diverse, composed of a wide array of monosaccharides, stereochemical linkages, substituent groups, and intermolecular associations with other biological molecules. A large repertoire of carbohydrate-active enzymes (CAZymes) and enzymatic activities are required to form, dismantle, and metabolize these complex molecules. The software SACCHARIS (Sequence Analysis and Clustering of CarboHydrate Active enzymes for Rapid Informed prediction of Specificity) provides a rapid, easy-to-use pipeline for the prediction of potential CAZyme function in new datasets. We have updated SACCHARIS to (i) simplify its installation by re-writing in Python and packaging for Conda; (ii) enhance its usability through a new (optional) interactive GUI; and (iii) enable semi-automated annotation of phylogenetic tree output via a new R package or the commonly-used webserver iTOL. Significantly, SACCHARIS v2 has been developed with high-throughput omics in mind, with pipeline automation geared toward complex (meta)genome and (meta)transcriptome datasets to reveal the total CAZyme content ("CAZome") of an organism or community. Here, we outline the development and use of SACCHARIS v2 to discover and annotate CAZymes and provide insight into complex carbohydrate metabolisms in individual organisms and communities.

Promoting physical activity in rheumatoid arthritis through a physiotherapist led behaviour change-based intervention (PIPPRA): a feasibility randomised trial.

Physical activity (PA) is recommended as a key component in the management of people with rheumatoid arthritis (RA). The objective of this study was to examine the feasibility of a physiotherapist led, behaviour change (BC) theory-informed, intervention to promote PA in people with RA who have low levels of current PA. A feasibility randomised trial (ClinicalTrials.gov NCT03644160) of people with RA over 18 years recruited from outpatient rheumatology clinics and classified as insufficiently physically active using the Godin-Shephard Leisure Time Physical Activity Questionnaire. Participants were randomised to intervention group (4 BC physiotherapy sessions in 8 weeks) delivered in person/virtually or control group (PA information leaflet only). Feasibility targets (eligibility, recruitment, and refusal), protocol adherence and acceptability were measured. Health care professionals (HCPs) involved in the study and patients in the intervention and control arms were interviewed to determine acceptability. Descriptive statistics were used to analyse the data with SPSS (v27) with interviews analysed using content analysis using NVivo (v14). Three hundred and twenty participants were identified as potentially eligible, with n = 183 (57%) eligible to participate, of which n = 58 (32%) consented to participate. The recruitment rate was 6.4 per month. Due to the impact of COVID-19 on the study, recruitment took place over two separate phases in 2020 and 2021. Of the 25 participants completing the full study, 23 were female (mean age 60 years (SD 11.5)), with n = 11 allocated to intervention group and n = 14 to control. Intervention group participants completed 100% of sessions 1 & 2, 88% of session 3 and 81% of session 4. The study design and intervention were acceptable overall to participants, with enhancements suggested. The PIPPRA study to improve promote physical activity in people with RA who have low PA levels was feasible, acceptable and safe. Despite the impact of COVID-19 on the recruitment and retention of patients, the study provides preliminary evidence that this physiotherapist led BC intervention is feasible and a full definitive intervention should be undertaken. Health care professionals involved in the study delivery and the patient participants described a number of positive aspects to the study with some suggestions to enhance the design. These findings hence inform the design of a future efficacy-focused clinical trial.

'I never thought exercise could help improve my sleep': experiences of people with rheumatoid arthritis on the impact of an 8-week walking-based exercise intervention in improving their sleep.

Objective: The purpose of this study was to explore the experiences of people with RA of participating in an exercise intervention to improve their sleep. Methods: Using a qualitative descriptive design, semi-structured face-to-face interviews were conducted with 12 people with RA who had completed an 8-week walking-based exercise intervention to improve their total sleep time, sleep quality and sleep disturbance. Data were analysed using thematic analysis. Results: Four themes were generated: positive impact of exercise on participants' sleep ('I really didn't think any type of exercise would help me sleep better, if I'm honest'); positive experiences of the exercise intervention ('I learnt so much regarding walking that I didn't even think about'); clear mental health benefits ('If you don't sleep well then it will have a knock-on effect to your mental health'); and achieving empowerment and ownership when exercising ('I feel empowered now and confident that I'm not doing harm to myself'). Conclusion: The findings demonstrated that participants had not expected exercise to improve their sleep. Although there is a growing consensus that exercise will benefit sleep and mitigate some disease symptoms, research is severely lacking in people with RA.

Label modification and bootstrapping for zero-shot cross-lingual hate speech detection.

The goal of hate speech detection is to filter negative online content aiming at certain groups of people. Due to the easy accessibility and multilinguality of social media platforms, it is crucial to protect everyone which requires building hate speech detection systems for a wide range of languages. However, the available labeled hate speech datasets are limited, making it difficult to build systems for many languages. In this paper we focus on cross-lingual transfer learning to support hate speech detection in low-resource languages, while highlighting label issues across application scenarios, such as inconsistent label sets of corpora or differing hate speech definitions, which hinder the application of such methods. We leverage cross-lingual word embeddings to train our neural network systems on the source language and apply them to the target language, which lacks labeled examples, and show that good performance can be achieved. We then incorporate unlabeled target language data for further model improvements by bootstrapping labels using an ensemble of different model architectures. Furthermore, we investigate the issue of label imbalance in hate speech datasets, since the high ratio of non-hate examples compared to hate examples often leads to low model performance. We test simple data undersampling and oversampling techniques and show their effectiveness.

Where to live? Landfast sea ice shapes emperor penguin habitat around Antarctica.

Predicting species survival in the face of climate change requires understanding the drivers that influence their distribution. Emperor penguins (Aptenodytes forsteri) incubate and rear chicks on landfast sea ice, whose extent, dynamics, and quality are expected to vary substantially due to climate change. Until recently, this species' continent-wide observations were scarce, and knowledge on their distribution and habitat limited. Advances in satellite imagery now allow their observation and characterization of habitats across Antarctica at high resolution. Using circumpolar high-resolution satellite images, unique fast ice metrics, and geographic and biological factors, we identified diverse penguin habitats across the continent, with no significant difference between areas with penguins or not. There is a clear geographic partitioning of colonies with respect to their defining habitat characteristics, indicating possible behavioral plasticity among different metapopulations. This coincides with geographic structures found in previous genetic studies. Given projections of quasi-extinction for this species in 2100, this study provides essential information for conservation measures.

Experience and perceptions among rheumatoid arthritis patients following a telehealth-delivered dietary intervention: a qualitative study.

The effects of dietary modifications have been assessed in people living with rheumatoid arthritis (RA) with consistent benefits reported from clinical trials. However, the lived experience of making and sustaining positive dietary changes for people with RA remains unknown. The aim of this qualitative study was to explore the experiences of adults with RA and their perceptions of a 12-week telehealth-delivered dietary intervention and to assess the acceptability of the programme. Qualitative data was collected via four online focus groups with participants who had just completed a 12-week dietary intervention programme delivered through telehealth methods. Thematic analysis was used to code and summarize the identified key themes. Twenty-one adults with RA (47.5 ± 12.3 years, 90.5% females) were included in this qualitative study. Overarching themes included: (a) motivation to join the programme, (b) benefits of the programme, (c) factors influencing adherence to dietary prescription, and (d) advantages and disadvantages of telehealth. The study demonstrated that a dietary intervention delivered through telehealth methods by a Registered Dietitian (RD) appears to be well-accepted and may be used to complement face-to-face care for people with RA. The identified factors influencing the adoption of a healthier eating pattern will aid in the development of future dietary interventions for a RA population.

'I learnt so much about being active': experiences of people with rheumatoid arthritis on the impact of a physiotherapist-led intervention to encourage physical activity.

INTRODUCTION: Physical activity (PA) is an important component in improving the health of people with rheumatoid arthritis (RA). A Physiotherapist-led Intervention to Promote PA in people with RA (PIPPRA) was undertaken using the Behaviour Change (BC) Wheel. A qualitative study was conducted post intervention involving participants and healthcare professionals who participated in a pilot RCT. METHODS: Face-to-face semi-structured interviews were conducted with the schedule exploring: experience and views of the intervention; experience and suitability of outcome measures used; and perceptions of BC and PA. Thematic analysis was used as an analytical approach. The COREQ checklist provided guidance throughout. RESULTS: Fourteen participants and eight healthcare staff participated. Three main themes were generated from participants: (1) positive experience of intervention - 'I found it very knowledgeable to help me get stronger'; (2) improvement in self-management - '… motivate me maybe to go back to doing a little bit more exercise'; and (3) negative impact of COVID-19 - 'I don't think doing it online again would be really good at all'. Two main themes were generated from healthcare professionals: (1) positive learning experience of delivery - 'Really made me realise the importance of discussing physical activity with patients'; and (2) positive approach to recruitment - 'Very professional team showing the importance of having a study member on site'. DISCUSSION: Participants had a positive experience of being involved in a BC intervention in order to improve their PA and found it acceptable as an intervention. Healthcare professionals also had a positive experience, in particular the importance of recommending PA in empowering patients.

Feasibility of a physiotherapist-led behaviour change intervention to improve physical activity in people with rheumatoid arthritis.

INTRODUCTION: Physical activity (PA) interventions incorporating behaviour change (BC) theory are needed to improve PA levels in people with rheumatoid arthritis. A pilot feasibility study of a Physiotherapist-led Intervention to Promote PA in Rheumatoid Arthritis (PIPPRA) was undertaken to obtain estimates for recruitment rate, participant retention and protocol adherence. METHODS: Participants were recruited at University Hospital (UH) rheumatology clinics and randomly assigned to control group (physical activity information leaflet) or intervention group (four BC physiotherapy sessions in 8 weeks). Inclusion criteria were diagnosis of RA (ACR/EULAR 2010 classification criteria), aged 18+ years and classified as insufficiently physically active. Ethical approval was obtained from the UH research ethics committee. Participants were assessed at baseline (T0), 8 weeks (T1) and 24 weeks (T2). Descriptive statistics and t-tests were used to analyse the data with SPSS v22. RESULTS: 320 participants were approached about the study with n=183 (57%) eligible to participate and n=58 (55%) consented to participate (recruitment rate: 6.4 per month; refusal rate 59%). Due to the impact of COVID-19 on the study, n=25 (43%) participants completed the study (n=11 (44%) intervention and n=14 (56%) control). Of the 25, n=23 (92%) were female, mean age was 60 years (s.d. 11.5). Intervention group participants completed 100% of BC sessions 1 and 2, 88% completed session 3 and 81% completed session 4. DISCUSSION: The intervention to promote physical activity was feasible and safe and provides a framework for larger intervention studies. Based on these findings, a fully powered trial is recommended.

Outcomes of COVID-19 in people with rheumatic and musculoskeletal disease in Ireland over the first 2 years of the pandemic.

BACKGROUND: Poor COVID-19 outcomes occur with higher frequency in people with rheumatic and musculoskeletal diseases (RMD). Better understanding of the factors involved is crucial to informing patients and clinicians regarding risk mitigation. AIM: To describe COVID-19 outcomes for people with RMD in Ireland over the first 2 years of the pandemic. METHODS: Data entered into the C19-GRA provider registry from Ireland between 24th March 2020 and 31st March 2022 were analysed. Differences in the likelihood of hospitalisation and mortality according to demographic and clinical variables were investigated. RESULTS: Of 237 cases included, 59.9% were female, 95 (41.3%) were hospitalised, and 22 (9.3%) died. Hospitalisation was more common with increasing age, gout, smoking, long-term glucocorticoid use, comorbidities, and specific comorbidities of cardiovascular and pulmonary disease, and cancer. Hospitalisation was less frequent in people with inflammatory arthritis and conventional synthetic or biologic disease-modifying antirheumatic drug use. Hospitalisation had a U-shaped relationship with disease activity, being more common in both high disease activity and remission. Mortality was more common with increasing age, gout, smoking, long-term glucocorticoid use, comorbidities, and specific comorbidities of cardiovascular disease, pulmonary disease, and obesity. Inflammatory arthritis was less frequent in those who died. CONCLUSION: Hospitalisation or death were more frequently experienced by RMD patients with increasing age, certain comorbidities including potentially modifiable ones, and certain medications and diagnoses amongst other factors. These are important 'indicators' that can help risk-stratify and inform the management of RMD patients.

A retrospective review of the management and outcomes of patients diagnosed with complex regional pain syndrome type II using electrodiagnostic findings.

Objectives: The objective of this study was to assess the outcomes of the use of electrodiagnosis in the diagnosis and management of discrete nerve injuries in patients with complex regional pain syndrome (CRPS). Design: This study is a secondary retrospective cohort analysis of patients diagnosed with CRPS from a single outpatient physical medicine and rehabilitation clinic and included all patients who had abnormal electrodiagnostic findings, in addition to CRPS. Results: Sixty patients of 248 diagnosed with CRPS underwent electrodiagnosis, 41 of whom had abnormal electrodiagnostic findings indicating a discrete nerve injury. Only 51% of the 41 referrals had indicated the suspicion of a nerve injury. Nearly all patients had undergone physiotherapy. Forty-one percent responded to treatment with oral prednisone alone, 54% had a functional improvement after a combination of treatments including corticosteroids, and 5% improved with treatments that did not involve corticosteroids. Surgical interventions for nerve injuries were required for 34% of patients in the cohort. All surgeries involved the median or ulnar nerve, with the exception of one fibular nerve. After treatment, 39 of 41 patients had functional recoveries or better. Conclusions: Electrodiagnosis can inform diagnosis of nerve injury and direct intervention including the need for surgical intervention. Electrodiagnosis should be considered for patients with initial signs of concomitant discrete nerve injury or with CRPS who are not responding to treatments because a nerve injury may be underlying.What is Known Complex Regional Pain Syndrome (CRPS) is a poorly understood pain condition. CRPS has been divided into two subtypes, the second subtype involves a discrete nerve injury with pain that extends beyond the territory of the nerve injury.What is New We observed that nerve injuries that may require surgical intervention are diagnosed just over half of the time upon initial assessment in patients with suspected CRPS. We observed that nerve injuries frequently required specifically directed interventions in place of or in conjunction with CRPS treatments. We suggest that electrodiagnosis is an important part of the triage protocol for CRPS II to reveal discrete nerve injuries that may be hidden. We recommend that electrodiagnosis be considered for patients with initial signs of concomitant discrete nerve injury or for CRPS patients who do not improve with medical therapies.

CRPS typically occurs after an injury or inciting event and can be accompanied by severe pain, sensitivity, swelling, changes in the color of the skin, changes in the texture of the skin, changes in hair and nail growth, weakness, muscle wasting, range of motion reduction, and temperature changes in the affected area. Little is known about type II CRPS, which may present with all of the same signs and symptoms as above but with damage to a nerve in the area. This study examined cases of CRPS where patients had electrodiagnostic findings that suggested a nerve injury. We found that the referring physicians reported nerve injuries in just over half of the cases. Oral prednisone was often the chosen treatment for these patients, although many required additional treatments, including surgery, to address their nerve injury. We recommend that electrodiagnosis be considered for patients with CRPS who are not responding to corticosteroids because a nerve injury could be preventing CRPS symptoms from resolving. When the CRPS trigger was a trauma that likely simultaneously injured the nerve, patients needed to have surgery more frequently than those with atraumatic onsets.

Antarctic calving loss rivals ice-shelf thinning.

Antarctica's ice shelves help to control the flow of glacial ice as it drains into the ocean, meaning that the rate of global sea-level rise is subject to the structural integrity of these fragile, floating extensions of the ice sheet1-3. Until now, data limitations have made it difficult to monitor the growth and retreat cycles of ice shelves on a large scale, and the full impact of recent calving-front changes on ice-shelf buttressing has not been understood. Here, by combining data from multiple optical and radar satellite sensors, we generate pan-Antarctic, spatially continuous coastlines at roughly annual resolution since 1997. We show that from 1997 to 2021, Antarctica experienced a net loss of 36,701 ± 1,465 square kilometres (1.9 per cent) of ice-shelf area that cannot be fully regained before the next series of major calving events, which are likely to occur in the next decade. Mass loss associated with ice-front retreat (5,874 ± 396 gigatonnes) has been approximately equal to mass change owing to ice-shelf thinning over the past quarter of a century (6,113 ± 452 gigatonnes), meaning that the total mass loss is nearly double that which could be measured by altimetry-based surveys alone. We model the impacts of Antarctica's recent coastline evolution in the absence of additional feedbacks, and find that calving and thinning have produced equivalent reductions in ice-shelf buttressing since 2007, and that further retreat could produce increasingly significant sea-level rise in the future.

A cost-effectiveness analysis of reverse total shoulder arthroplasty compared with locking plates in the management of displaced proximal humerus fractures in the elderly: the DelPhi trial.

AIM: To evaluate the cost-effectiveness of surgical treatment with reverse total shoulder arthroplasty (RTSA) compared with open reduction and internal fixation (ORIF) with a locking plate for patients 65-85 years old with a displaced proximal humerus fracture. METHODS: A cost-utility analysis was conducted alongside a multicenter randomized controlled trial, taking a health care perspective. A total of 124 patients with displaced proximal humerus fractures were randomized to treatment with RTSA (n = 64) or ORIF (n = 60) during a 2-year period. The outcome measure was quality-adjusted life years derived from the generic questionnaire 15D in an intention to treat population. The results were expressed as incremental cost-effectiveness ratios, and a probabilistic sensitivity analysis was performed to account for uncertainty in the analysis. RESULTS: At 2 years, 104 patients were eligible for analyses. The mean quality-adjusted life year was 1.24 (95% confidence interval: 1.21-1.28) in the RTSA group and 1.26 (95% confidence interval: 1.22-1.30) in the ORIF group. The mean cost in the RTSA group (€36.755 [€17,654-€55,855]) was higher than that in the ORIF group (€31.953 [€16,226-€47,279]). Using incremental cost-effectiveness ratio, ORIF was the dominant treatment. When using a probabilistic sensitivity analysis with 1000 replications, the plots were centered around origo. This indicates that there is no significant difference in cost or effect. CONCLUSION: In the cost-utility analysis of treatment of displaced proximal humeral fractures, there were no differences between RTSA and ORIF.

A randomised controlled trial of a Mediterranean Dietary Intervention for Adults with Rheumatoid Arthritis (MEDRA): Study protocol.

Background: Rheumatoid arthritis (RA) is the most common type of autoimmune arthritis affecting 0.5-1% of the adult population worldwide. While the primary line of treatment of RA includes pharmacological therapies, people living with the condition often seek non-pharmacological therapies such as diet and exercise in an attempt to attenuate their symptoms. Established, evidence-based dietary guidelines for RA are currently lacking. The MEDRA study aims to explore the effectiveness of implementing, via telehealth, a Mediterranean type diet (MedDiet) compared to a standard healthy diet as per the Healthy Eating Guidelines (HEG) in Ireland in terms of differences in physical function and quality of life in adults with RA living in Ireland. Methods: The MEDRA study is a parallel, randomised controlled trial delivered through telehealth methods. Forty-four eligible participants who have RA will be randomly allocated to either a MedDiet or HEG group for a 12 weeks intervention period. Primary outcome measures include changes in physical function and quality of life, both of which will be measured using validated questionnaires at baseline, six and twelve weeks. Both intervention arms will attend a total five teleconsultations with a Registered Dietitian (RD). The MedDiet intervention arm focuses on recommendations from the traditional Mediterranean diet and HEG intervention arm will use the dietary recommendations as currently advised in Ireland. Discussion: This study will provide evidence as to whether dietary treatment of RA can improve physical function and quality of life in a small cohort of participants with RA. The results of the study will be disseminated at national scientific conferences and published in peer-reviewed journals. Ethics: This protocol has been approved by the Education and Health Sciences Research Ethics Committee at the University of Limerick (2020_09_05_EHS) and by the Health Service Executive Mid-Western Regional Hospital Research Ethics Committee (REC Ref 103/19). Trial registration: ClinicalTrials.gov NCT04262505. Trial registration date: April 2, 2020.

Temporal trends in COVID-19 outcomes in people with rheumatic diseases in Ireland: data from the COVID-19 Global Rheumatology Alliance registry.

OBJECTIVES: Although evidence is accumulating globally, data on outcomes in rheumatic disease and COVID-19 in Ireland are limited. We used data from the COVID-19 Global Rheumatology Alliance (C19-GRA) to describe time-varying COVID-19 outcomes for people with rheumatic disease in Ireland. METHODS: Data entered into the C19-GRA provider registry from Ireland between 24 March 2020 and 9 July 2021 were analysed. Differences in the likelihood of hospitalization and mortality according to demographic and clinical variables were investigated using Chi-squared test or Fisher's exact test, as appropriate. Trends in odds of hospitalization and mortality over time were investigated using logistic regression with the time period as a categorical variable. RESULTS: Of 212 cases included, 59.4% were female and median age was 58.0 years (range 13-96). Of the 212 cases, 92 (43%) were hospitalized and 22 (10.4%) died. Increasing age, a diagnosis of gout, ever smoking, glucocorticoid use, having comorbidities and specific comorbidities of cancer, cardiovascular and pulmonary disease were more common in those hospitalized. A diagnosis of inflammatory arthritis, csDMARD and/or b/tsDMARD use were less frequent in those hospitalized. Increasing age, a diagnosis of gout, ever smoking, having comorbidities and specific comorbidities of obesity, cardiovascular and pulmonary disease were more common in those who died. Odds of hospitalization or mortality did not change over time. CONCLUSION: No temporal trend was observed in either COVID-19-related hospitalization or mortality outcomes for people with rheumatic disease in Ireland.

Pegs not superior to screws for fixation of fractures of the proximal humerus.

BACKGROUND: Angular stable plates were introduced two decades ago as a promising treatment for fixation of displaced fractures of the proximal humerus (PHF). However, high rates of adverse events and reoperations have been reported. One frequent reason is secondary penetration of screws into the glenohumeral joint, due to sinking of the fracture or avascular head necrosis. To prevent joint penetrations angular stable plates with smooth locking pegs instead of locking screws have been developed. The aim of the present study was to investigate whether blunt pegs instead of pointed screws reduced the risk of secondary penetration into the glenohumeral joint during fracture healing after operatively treated PHFs. METHODS: From two different patient cohorts with displaced PHFs (60 treated with PHILOS plate with screws and 50 with ALPS-PHP plate with pegs), two groups were matched according to fracture type AO/OTA 11-B2 and 11-C2 and age (55-85 years). They were followed up at 3, 6 and 12 months. Primary outcome was radiographic signs of peg or screw penetrations into the glenohumeral joint at 12 months. Secondary outcomes were Oxford shoulder score (OSS) and Constant Score (CS) and radiographic signs of avascular humeral head necrosis (AVN). RESULTS: Eighteen PHILOS patients with B2 and C2 fractures could be matched with a corresponding group of 18 operated with ALPS-PHP with pegs. The number of penetrations of pegs and screws were equal between the two groups and the development of avascular head necrosis did not differ either. The functional outcomes for both OSS and CS at 12 months was clearly in favor of patients without joint penetrations in both groups. CONCLUSION: We found no differences in the number of screw or peg penetrations in the PHILOS and ALPS-PHP group and the occurrence of AVN was equal. Joint penetrations led to inferior functional outcomes at 1 year. The ClinicalTrials.gov identifier 20/11/12 prospectively for the Philos Group is NCT01737060, and for the ALPS group 11/03/20 retrospectively is NCT04622852.

External validity in a multicenter randomized clinical trial of proximal humeral fractures: the DelPhi trial.

BACKGROUND: Randomized controlled trials (RCT) are regarded as the gold standard for effect evaluation in clinical interventions. However, RCTs may not produce relevant results to all patient groups. We aimed to assess the external validity of a multicenter RCT (DelPhi trial). METHODS: The DelPhi RCT investigated whether elderly patients with displaced proximal humeral fractures (PHFs) receiving reversed total shoulder prosthetic replacement (RTSA) gained better functional outcomes compared to open reduction and internal fixation (ORIF) using an proximal humerus locking plate (PHILOS). Eligible patients were between 65 and 85 years old with severely displaced 11-B2 or 11-C2 fractures (AO/OTA-classification, 2007). We compared baseline and follow-up data of patients for two of the seven hospitals that were included in the DelPhi trial (n = 54) with non-included patients (n = 69). Comparisons were made based on reviewing medical records regarding demographic, health and fracture parameters. RESULTS: Forty-four percent of the eligible patients were included in the DelPhi trial. Comparing included and non-included patients indicated higher incidences of serious heart disease (P = 0.044) and a tendency toward higher tobacco intake (P = 0.067) in non-included patients. Furthermore, non-included patients were older (P = 0.040) and had higher ASA classification (P < 0.001) and were in more need for resident aid (in-home assistance) (P = 0.022) than included patients. The cause of PHF was more frequently related to fall indoors in non-included vs. included patients (P = 0.018) and non-included patients were more prone to other concomitant fractures (P = 0.004). Having concomitant fractures was associated with osteoporosis (P = 0.014). We observed no significant differences in rates of complications or deaths between included and non-included patients within 3 months after treatment. In descending order, non-included patients were treated conservatively, with PHILOS, RTSA, anatomic hemi-prothesis or an alternative type of ORIF. RTSA was the preferred treatment choice for C2-type fractures (P < 0.001). CONCLUSIONS: Results from the DelPhi RCT may not directly apply to older PHFs patients with lower health status or concomitant fractures. LEVEL OF EVIDENCE: Level 4.

Monitoring the Sialome on Human Immune Cells.

The sialome or display of sialic acids on the surface of human immune cells can vary according to immune response and activation state. Here, human peripheral blood mononuclear cells (PBMCs) were isolated and activated with anti-CD3 antibody and the cell surface sialome was quantified using a combination of click chemistry, confocal microscopy and flow cytometry techniques. Carbohydrate click chemistry was used to detect and measure the incorporation of an azido-m65odified sialic acid precursor molecule, N-acetylmannosamine (ManNaz) sugar into the PBMC surface sialome. Incorporation of sialic acid into the PBMC glycocalyx was visualized using copper-catalyzed click conjugation of Alexa 488 alkyne and confocal microscopy and further quantified using flow cytometry. The use of these methods indicate that regulating the sialome content on the surface of activated immune cells may be monitored during immunomodulatory responses and anti-inflammatory therapies.

Dietary Interventions with or without Omega-3 Supplementation for the Management of Rheumatoid Arthritis: A Systematic Review.

Rheumatoid Arthritis (RA) is a chronic autoimmune condition characterized by symptoms of inflammation and pain in the joints. RA is estimated to have a worldwide prevalence of 0.5-1%, with a predominance in females. Diet may play an important role in the symptoms of RA; however, little is known about the effects of various diets. The aim of this systematic review is to explore the effect of dietary interventions, with or without omega-3 supplementation for the management of RA. The electronic databases MEDLINE, EMBASE, CINAHL, and the Cochrane Library were systematically searched for clinical trials investigating dietary interventions, with or without omega-3 supplementation to retrieve papers from inception to April 2021. Randomized and non-randomized controlled trials of dietary interventions in adults with RA were eligible for inclusion. Twenty studies with a total of 1063 participants were included. The most frequently reported outcomes were pain, duration of morning stiffness, joint tenderness, grip strength and inflammatory markers. Dietary interventions with an anti-inflammatory basis may be an effective way for adults with RA seeking complementary treatments, potentially leading to improvements in certain parameters. However, there is a need for longer duration studies that are well-designed and sufficiently powered to investigate the influence of diet on RA.