[Prehospital care of anaphylactic reactions by the air rescue and ground-based emergency services Dresden : An analysis of treatment and outcome]. / Präklinische Versorgung von anaphylaktischen Reaktionen durch die Dresdner Luft- und Bodenrettung : Analyse von Therapie und Outcome.

BACKGROUND: Anaphylaxis can lead to a life-threatening situation. Therefore, rapid diagnosis and emergency treatment is indicated. Immediate treatment with intramuscular adrenaline (or intravascularly with sufficient medical expertise) in anaphylaxis with cardiovascular and/or respiratory symptoms is recommended by various guidelines. Previous studies have shown that anaphylaxis is often not treated according to guidelines and that adrenaline in particular is rarely administered. OBJECTIVE: The aim of the study was to investigate the data on emergency treatment and outcomes of patients with anaphylaxis by the air rescue and ground-based emergency services Dresden. Moreover, the results of the air- and ground-based services were compared. The focus was on administration of adrenaline and outcomes. MATERIALS AND METHODS: Data from the ground-based emergency service Dresden (from 2012 to 2016) and the air rescue service Dresden (from 2008 to 2015) related to anaphylactic reactions were analyzed retrospectively. The severity of the anaphylaxis, the emergency medication administered, further monitoring, and outcomes were analyzed. RESULTS: Data from 152 adults/29 children were analyzed for air rescue and 1131 adults/223 children for the ground-based emergency service. Adults with grade II-IV anaphylaxis received adrenaline in 19% (air rescue) and 7% (ground rescue) of cases. Children with grade II-IV anaphylaxis received adrenaline in 7% (air rescue) and 8% (ground rescue) of cases. Immediate drug therapy led to an improvement in general condition in 96-98% (air rescue) and 72-77% (ground-based emergency service) of cases. A significant correlation was found between the administration of adrenaline and the improvement in outcome in the ground-based emergency cohort. CONCLUSION: Guideline-compliant first-line therapy with adrenaline was not performed in the majority of the cases analyzed in this study. The significant effect of adrenaline on outcome demonstrated in this study emphases the need to improve the emergency treatment of anaphylactic reactions.

Analysis of Air Rescue for Offshore Wind Energy: A Retrospective Analysis of Structural and Process Quality for the Years 2014 to 2017.

In order to achieve the emission targets required by the German Federal Environment Agency (Umweltbundesamt), the offshore wind industry has become 1 of the central building blocks of the so-called "energy turnaround." After the first offshore wind farm (OWF), Alpha Ventus, started operation in 2010, the number of OWFs in the North Sea and Baltic Sea has grown steadily. Because of the ongoing growth of the industry, the number of workers on-site has more than quadrupled in recent years. Although the majority of OWFs are located in the exclusive economic zone up to 130 km from the mainland, the same legal provisions of the Occupational Health and Safety Act (Arbeitsschutzgesetz) apply here as on the mainland. This means that the operators of the wind farms are legally obligated to maintain a seamless rescue chain. Because of the distance to the mainland, rescue helicopters are the means of choice to ensure prompt emergency preclinical care and, if necessary, rapid evacuation. The company Northern HeliCopter GmbH, part of the DRF Luftrettung since 2019, offers as part of WINDEACare rescue helicopters stationed at 3 locations on the North Sea and Baltic Sea to its contract partners an emergency medical staffed air rescue service, which is operational 24 hours a day, 365 days a year. This article is the first to provide a detailed overview of a new field in prehospital emergency care on the high seas and, to this end, has recorded all offshore missions performed from 2014 through 2017 with evaluation of related medical and aeronautical data.

National climate: Zhu Kezhen and the framing of the atmosphere in modern China.

Can climate be Chinese, and if so, then how? Drawing on personal writings, popular discourse, and scientific reports, this essay considers the work of early Chinese meteorologists in relation to the revolutionary national politics of the early twentieth century. Historians of China have established that nationalism motivated the pursuit of meteorology and other natural sciences, but I advance the more radical position that there was no clear distinction between the practice of climate science and the political ideology that motivated it. With special attention to the career and legacy of Zhu Kezhen from the Xinhai Revolution through World War II, I test this thesis in two arenas: Chinese meteorologists' production of spatial knowledge, and their production of cultural knowledge. The nation was integral to the questions, methods, and analyses of atmospheric science, which helped to reify the Chinese nation-state.

Stress of emergency physicians during helicopter operations: impact of patients' diagnoses, severity of diagnoses, and physicians' work experience.

PURPOSE: Emergency physicians are in danger of developing illnesses due to stress in their demanding work environment. Until today, scholars have not identified stressors or resilience factors that qualify to promote the preservation of emergency physicians' well-being. Therefore, potential influencing variables such as patients' diagnoses, the severity of diagnoses, as well as physicians' work experience have to be considered. The present study aims at investigating emergency physicians in the Helicopter Emergency Medical Service (HEMS)' autonomic nervous system activity during emergency operations in one shift with respect to patients' diagnoses, severity of diagnoses, and physicians' work experience. METHODS: Measurement of HRV (employing the parameters RMSSD and LF/HF) for 59 EPs (age: M = 39.69, SD = 6.19) was performed during two complete air-rescue-days, the alarm and landing phase being investigated in particular. Besides patients' diagnoses, the National Advisory Committee for Aeronautics Score (NACA) was included as an indicator for severity. Diagnoses' and NACA's effect on HRV were examined using a linear mixed model. RESULTS: Both HRV parameters indicate a significant decrease of the parasympathetic nervous system as a function of the diagnoses. Furthermore, high NACA scores (≥ V) predicted a significantly lower HRV. In addition, a lower HRV/RMSSD with increasing work experience was observed as well as a positive association between physicians' work experience and sympathetic activation (LF/HF). CONCLUSION: The present study showed that pediatric diagnoses as well as time-critical diagnoses are most stressful and have the highest impact on the physicians' ANS. This knowledge allows the development of specific training to reduce stress.

Structure of In Vitro-Synthesized Cellulose Fibrils Viewed by Cryo-Electron Tomography and 13C Natural-Abundance Dynamic Nuclear Polarization Solid-State NMR.

Cellulose, the most abundant biopolymer, is a central source for renewable energy and functionalized materials. In vitro synthesis of cellulose microfibrils (CMFs) has become possible using purified cellulose synthase (CESA) isoforms from Physcomitrium patens and hybrid aspen. The exact nature of these in vitro fibrils remains unknown. Here, we characterize in vitro-synthesized fibers made by CESAs present in membrane fractions of P. patens over-expressing CESA5 by cryo-electron tomography and dynamic nuclear polarization (DNP) solid-state NMR. DNP enabled measuring two-dimensional 13C-13C correlation spectra without isotope-labeling of the fibers. Results show structural similarity between in vitro fibrils and native CMF in plant cell walls. Intensity quantifications agree with the 18-chain structural model for plant CMF and indicate limited fibrillar bundling. The in vitro system thus reveals insights into cell wall synthesis and may contribute to novel cellulosic materials. The integrated DNP and cryo-electron tomography methods are also applicable to structural studies of other carbohydrate-based biomaterials.

Emergency Treatment of Anaphylactic Reactions in Air Rescue Missions: An Eight-Year Analysis of a German Rescue Helicopter Base.

INTRODUCTION: Anaphylactic reactions can lead to a life-threatening situation. In the event of anaphylaxis, rapid and targeted emergency treatment is indicated. STUDY OBJECTIVE: The study sought to determine the emergency therapy administered for anaphylaxis in children and adults. Focus was placed on therapy with adrenaline. In addition, the study aimed to investigate demographic data, triggers, and hospitalization rates of the different severities of anaphylaxis. METHODS: A retrospective analysis of anaphylactic reactions was conducted using data from prehospital emergency missions performed by the Air Rescue Dresden/Germany from 2008 through 2015 using the standardized application protocol EPRO-5.0 (MIND 3) anonymized. Data from 152 adults and 29 children were evaluated, focusing especially on the acute treatment as well as demographic information, triggers, and symptoms of anaphylactic reactions. RESULTS: In total, 152 adults (73 female, 79 male) from 18 to 87 years (mean 50.5 years) and 29 children (9 female, 20 male) from 1 to 16 years (mean 7.5 years) with anaphylactic reactions were analyzed. The most common trigger for severe anaphylactic reactions (Grade II-IV; classification modified according to Ring and Messmer) was food in children (33%) and insect venom in adults (59%). The data show that 19% of adults with Grade II-IV anaphylactic reactions (classification modified according to Ring and Messmer) received adrenaline. Regarding children, the appliance of adrenaline was only administered in seven percent of the cases of Grade II-IV anaphylactic reactions. Adults with Grade II or higher anaphylactic reactions were hospitalized in 92%. Three percent refused hospitalization and five percent were not transferred to hospital. One-hundred percent of the children with Grade II-IV anaphylaxis were hospitalized. CONCLUSIONS: Analysis of data from the Air Rescue Dresden/Germany shows that despite existing recommendations, only 19% of adults with severe anaphylaxis received adrenaline. Among children, only in seven percent was a treatment with adrenaline performed.On the other hand, all patients survived the acute emergency treatment without apparent adverse outcomes. Thus, further studies are needed to determine the proper use of adrenaline in anaphylactic reactions.

Frontier atmosphere: observation and regret at Chinese weather stations in Tibet, 1939-1949.

Across Tibet during the 1940s, young Han Chinese weather observers became stranded at their weather stations, where they faced illness, poverty and isolation as they pleaded with their superiors for relief. Building on the premise that China exercised 'imperial nationalism' in Tibet, and in light of scholarship that emphasizes the desirous 'gaze' of imperial observers toward the frontier, this essay considers how the meteorological archive might disrupt our understanding of the relationship between observation and empire. Meteorology presented a new way of viewing the landscape that deliberately disregarded the embodied experience of the observer in favour of instrument-mediated readings. The process produced a bifurcated archive, in which stations disseminated quantitative weather charts as a matter of public interest while privately recording the embodied and often miserable experiences of observational staff on the frontier. Unpublished letters between observers and supervisors offer a rare glimpse into the frontier as experienced by reluctant or unwilling agents of the state.

Injury incidence and patterns associated with electric scooter accidents in a major metropolitan city.

PURPOSE: Despite increased use of e-scooters globally, actionable data around injury incidence and patterns associated with e-scooter accidents are limited. This study aimed to determine the prevalence of imaging exams, injury incidence, and patterns related to e-scooter injuries, with the hope of guiding an appropriate policy response. METHODS: This was a retrospective observational study of imaging exams ordered for injuries related to e-scooters seen in an Emergency Department (ED) setting within our health system from September 2018 through December 2019. Our institutional Radiology Information System (RIS) was searched for the presence of the word "scooter." Manual query of search results was conducted in the electronic medical record (EMR) and only studies confirmed to be related to e-scooters were included. RESULTS: A total of 477 radiologic studies performed on 192 unique patients were confirmed to be performed for injuries related to e-scooters. The median patient age was 28 years and 58.3% were male. One hundred forty patients (72.9%) had injuries identified on imaging, with an overall exam positivity rate of 44.4%. The most common injuries were soft tissue and musculoskeletal in nature. Over half (51.9%) of the entries with the keyword "scooter" were excluded because of lack of EMR specificity regarding scooter type. CONCLUSION: While this study showed that injuries following e-scooter accidents are common and frequently involve the face and extremities, it is limited by lack of documentation in the EMR. Further research with a standardized documentation protocol will be needed to better understand injuries patterns following e-scooter accidents.

Just in Time Radiology Decision Support Using Real-time Data Feeds.

Ready access to relevant real-time information in medical imaging offers several potential benefits. Knowing both when important information will be available and that important information is available can facilitate optimization of workflow and management of time. Unexpected findings, as well as deficiencies in reporting and documentation, can be immediately managed. Herein, we present our experience developing and implementing a real-time web-centric dashboard system for radiologists, clinicians, and support staff. The dashboards are driven by multi-sourced HL7 message streams that are monitored, analyzed, aggregated, and transformed into multiple real-time displays to improve operations within our department. We call this framework Pipeline. Ruby on Rails, JavaScript, HTML, and SQL serve as the foundations of the Pipeline application. HL7 messages are processed in real-time by a Mirth interface engine which posts exam data into SQL. Users utilize web browsers to visit the Ruby on Rails-based dashboards on any device connected to our hospital network. The dashboards will automatically refresh every 30 seconds using JavaScript. The Pipeline application has been well received by clinicians and radiologists.

Stress load of emergency service: effects on the CAR and HRV of HEMS emergency physicians on different working days (N = 20).

PURPOSE: The occupation of the emergency physicians (EPs) of helicopter emergency medical services (HEMS) can be characterized as a high-strain occupation (Karasek in Adm Sci Q 24(2):285-308. https://doi.org/10.2307/2392498 , 1979). Therefore, the aim of this study was to measure and compare the stress load of the EPs of HEMS on duty on air ambulance workdays and on 2 control days. METHODS: In this field study (within-subjects design), hormonal, physiological, and self-perceived stress levels of 20 EPs [3 females, 17 males; mean age (M) = 44.95 years, SD = 4.80, 95% confidence interval (CI) (42.71, 47.19)] of HEMS, were recorded on different test days. Measurements of the cortisol awakening response (CAR) and the heart rate variability (HRV) were performed while on duty on the air ambulance and during workdays at the outpatient clinic as well as at home on days of rest. RESULTS: There were significant differences in the CAR (area under the curve with respect to ground F(2,38) = 12.81, p < 0.001) between the 3 test days with the highest values on the workday at the outpatient clinic [M = 81.24; 98.75% CI (61.24, 101.24)] and not on the air ambulance day [M = 61.82; 98.75% CI (45.18, 78.46)] or on the day of rest [M = 52.96; 98.75% CI (38.17, 67.76)]. In addition, the HRV parameter SDNN [F(2,38) = 6.369; p = 0.004] presented significant differences between the 3 test days with lower levels on the day at the outpatient clinic [M = 101.44; 98.75% CI (83.50, 119.38)] in contrast to the air ambulance day [M = 120.16; 98.75% CI (100.02, 140.30)] and to the resting day [M = 123.79; 98.75% CI (106.49, 141.10)]. Furthermore, there were significant differences in the HRV parameter LF/HF [F(2,38) = 6.215; p = 0.005] between the 3 testing days with the highest values on the workday at the outpatient clinic [M = 8.69; 98.75% CI (6.29, 11.09)] compared to the air ambulance day [M = 6.54; 98.75% CI (4.50, 8.57)] and the day of rest [M = 6.43; 98.75% CI (4.57, 8.29)]. CONCLUSIONS: Compared with the standard values and previous studies, EPs of HEMS have an increase in hormonal reactivity in the morning and a lack of recovery of the ANS. It can be concluded that-with respect to the psychobiological stress model by McEwen and Lasley (The end of stress as we know it, National Academic Press, Washington, 2003)-work-related stressors persist too long or the stress response is exaggerated (allostatic load) due to chronic stress induction and lack of recovery.

Evaluation of Gadolinium Deposition in the Brain After MR Arthrography.

OBJECTIVE: Although significant investigation has been done into the deposition of gadolinium in the brains of patients receiving IV gadolinium, there is little research concerning nonintravenous uses of gadolinium, specifically in conjunction with musculoskeletal MR arthrography. Although small in volume, intraarticular administration is an off-label use of gadolinium, necessitating careful scrutiny for patient safety. Thus, we investigated the relationship between intraarticular gadolinium administration during MR arthrography and the presence of intracranial gadolinium deposition on subsequent brain MRI. MATERIALS AND METHODS: An institutional review board-approved retrospective study was performed of patients with no history of gadolinium exposure who underwent MR arthrography from 2006 to 2016 followed by an unenhanced brain MRI examination. ROIs were manually placed within bilateral dentate nuclei (DN), bilateral globus pallidi (GP), bilateral thalami, bilateral middle cerebral peduncles (MCP), and the central pons (CP) on T1-weighted sequences. The left and right ROIs were averaged, and ratios of signal intensity were calculated for DN/MCP, DN/CP, GP/MCP, GP/CP, thalamus/MCP, and thalamus/CP. Similar ROIs were placed and ratios calculated for age-matched control subjects who had a history of brain MRI but no prior gadolinium exposure. We used t testing to compare signal intensity ratios between patients and control subjects. RESULTS: A total of 31 patients met the inclusion criteria. We found no significant difference in signal intensity between patients and control subjects for DN/MCP (p = 0.40), DN/CP (p = 0.76), GP/MCP (p = 0.51), GP/CP (p = 0.86), thalamus/MCP (p = 0.93), and thalamus/CP (p = 0.30). CONCLUSION: No association was found between intraarticular gadolinium administration for MR arthrography and detectable gadolinium deposition within the brain.

Modeling Transcriptional Rewiring in Neutrophils Through the Course of Treated Juvenile Idiopathic Arthritis.

Neutrophils in children with the polyarticular form of juvenile idiopathic arthritis (JIA) display abnormal transcriptional patterns linked to fundamental metabolic derangements. In this study, we sought to determine the effects of therapy on mRNA and miRNA expression networks in polyarticular JIA. Using exon and miRNA microarrays, we studied children with untreated active JIA (ADU, n = 35), children with active disease on therapy with methotrexate ± etanercept (ADT, n = 26), and children with inactive disease also on therapy (ID, n = 14). We compared the results to findings from healthy control children (HC, n = 35). We found substantial re-ordering of mRNA and miRNA expression networks after the initiation of therapy. Each disease state was associated with a distinct transcriptional profile, with the ADT state differing the most from HC, and ID more strongly resembling HC. Changes at the mRNA level were mirrored in changes in miRNA expression patterns. The analysis of the expression dynamics from differentially expressed genes across three disease states indicated that therapeutic response is a complex process. This process does not simply involve genes slowly correcting in a linear fashion over time. Computational modeling of miRNA and transcription factor (TF) co-regulatory networks demonstrated that combinational regulation of miRNA and TF might play an important role in dynamic transcriptome changes.

Electronic and Social Media-based Radiology Learning Initiative: Development, Implementation, Viewership Trends, and Assessment at 1 Year.

RATIONALE AND OBJECTIVES: We report the development of a new "Case of the Day" (COTD) educational initiative using email, social media (SoMe), and a website to disseminate content, as well as its trends in viewership and assessment of utility for the first year of implementation. MATERIALS/METHODS: Using an image-rich format, a new unknown case was disseminated to radiology trainees and attendings at our institution by email twice per week, including history, salient images, and follow-up questions. Simultaneously, content was externally disseminated on Twitter and a publicly viewable departmental website. On subsequent days, the answer was posted via email, Twitter, and website in the form of a brief YouTube video lecture. Viewership data were collected over the first 12 months (July 1, 2016 to June 30, 2017), and an anonymous survey of participants was performed. RESULTS: Sixty-five COTDs had complete viewership data and were included in our analysis, yielding 4911 "case" email views (mean = 76), 3798 "answer" email views (mean = 58), 68,034 "case" Twitter impressions (mean = 1047), 75,724 "answer" Twitter impressions (mean = 1164), 5465 "case" Twitter engagements (mean = 84), and 5307 "answer" Twitter engagements (mean = 82). COTD YouTube video lectures garnered 3657 views (mean = 61) amounting to 10,358 minutes of total viewing time. Viewers were very satisfied with COTD quality, with 97% (n = 63) reporting the quality as "good" or "excellent." CONCLUSIONS: Email and SoMe can serve as effective tools for disseminating radiology educational content. SoMe offers substantial external visibility and branding potential for programs.

Social Media Utilization at an Academic Radiology Practice.

RATIONALE AND OBJECTIVES: We report social media (SoMe) utilization trends at an academic radiology department, highlighting differences between trainees and faculty and between Baby Boomers versus Generation X and Millennials. MATERIALS AND METHODS: An anonymous online survey regarding SoMe utilization and SoMe-based educational curriculum was distributed to all radiologists (trainees and faculty) in our department. Regular chi-square, ordered (Mantel-Haenszel) chi-square, and Fischer exact tests were performed. RESULTS: The survey instrument was sent to 172 radiologists with a 65% completion rate (N = 112). Eighty-three percent (n = 92) of the respondents use SoMe, with Facebook (67%, n = 75), YouTube (57%, n = 64), Instagram (26%, n = 29), and Twitter (21%, n = 23) as the most commonly used platforms. Eighty-one percent (n = 91) use SoMe for 30 minutes or less per day. Thirty-five percent (n = 39) reported previously using SoMe for educational purposes, although 66% (n = 73) would be willing to join SoMe for educational activities. The faculty are more likely than trainees to avoid using SoMe (30% vs 9%, P < 0.03). Trainees are more likely than faculty to find an electronic case-based curriculum valuable (95% vs 83%, P < 0.05) and are willing to spend more time on cases (P < 0.01). Baby Boomers are less interested in joining SoMe for educational activities than Generation X and Millennials (24% vs 73%, P = 0.0001). CONCLUSIONS: Generation gaps between trainees and faculty, as well as between Generation X and Millennials versus Baby Boomers, exist with regard to the use of SoMe, which may be underutilized in radiology education.

Emotion and aggressive intergroup cognitions: The ANCODI hypothesis.

Previous research has suggested an important role for the emotion of hatred in intergroup aggression. Recent theoretical and empirical work has strongly suggested that the combination of anger, contempt, and disgust (ANCODI) comprise the basic elements of hatred, and are the key emotions associated with intergroup aggression. No study, however, has provided evidence that these emotions cause hostile cognitions about specific groups. We report two studies that provide initial evidence. In both, participants were members of ideologically motivated groups and were primed with ANCODI. In Study 1 participants primed with ANCODI produced more aggressive cognitions relative to their opponent outgroup than a neutral outgroup; this effect did not occur for participants primed with fear-sadness. In Study 2 participants primed with ANCODI engaged in more competitive decision making against their opponent outgroups than a neutral outgroup; this effect did not occur for participants primed with disgust only. These findings contribute to the literature on the role of emotion in intergroup aggression and hostility, and provide a more nuanced view of the role of emotions in intergroup relations, possibly identifying the basic emotional elements of hatred. Aggr. Behav. 43:93-107, 2017. © 2016 Wiley Periodicals, Inc.

Complexity and Specificity of the Neutrophil Transcriptomes in Juvenile Idiopathic Arthritis.

NIH projects such as ENCODE and Roadmap Epigenomics have revealed surprising complexity in the transcriptomes of mammalian cells. In this study, we explored transcriptional complexity in human neutrophils, cells generally regarded as nonspecific in their functions and responses. We studied distinct human disease phenotypes and found that, at the gene, gene isoform, and miRNA level, neutrophils exhibit considerable specificity in their transcriptomes. Thus, even cells whose responses are considered non-specific show tailoring of their transcriptional repertoire toward specific physiologic or pathologic contexts. We also found that miRNAs had a global impact on neutrophil transcriptome and are associated with innate immunity in juvenile idiopathic arthritis (JIA). These findings have important implications for our understanding of the link between genes, non-coding transcripts and disease phenotypes.

The Transcription Factor ARID3a Is Important for In Vitro Differentiation of Human Hematopoietic Progenitors.

We recently reported that the transcription factor ARID3a is expressed in a subset of human hematopoietic progenitor stem cells in both healthy individuals and in patients with systemic lupus erythematosus. Numbers of ARID3a(+) lupus hematopoietic stem progenitor cells were associated with increased production of autoreactive Abs when those cells were introduced into humanized mouse models. Although ARID3a/Bright knockout mice died in utero, they exhibited decreased numbers of hematopoietic stem cells and erythrocytes, indicating that ARID3a is functionally important for hematopoiesis in mice. To explore the requirement for ARID3a for normal human hematopoiesis, hematopoietic stem cell progenitors from human cord blood were subjected to both inhibition and overexpression of ARID3a in vitro. Inhibition of ARID3a resulted in decreased B lineage cell production accompanied by increases in cells with myeloid lineage markers. Overexpression of ARID3a inhibited both myeloid and erythroid differentiation. Additionally, inhibition of ARID3a in hematopoietic stem cells resulted in altered expression of transcription factors associated with hematopoietic lineage decisions. These results suggest that appropriate regulation of ARID3a is critical for normal development of both myeloid and B lineage pathways.

Dynamic tracking of functional gene modules in treated juvenile idiopathic arthritis.

BACKGROUND: We have previously shown that childhood-onset rheumatic diseases show aberrant patterns of gene expression that reflect pathology-associated co-expression networks. In this study, we used novel computational approaches to examine how disease-associated networks are altered in one of the most common rheumatic diseases of childhood, juvenile idiopathic arthritis (JIA). METHODS: Using whole blood gene expression profiles derived from children in a pediatric rheumatology clinical trial, we used a network approach to understanding the impact of therapy and the underlying biology of response/non-response to therapy. RESULTS: We demonstrate that therapy for JIA is associated with extensive re-ordering of gene expression networks, even in children who respond inadequately to therapy. Furthermore, we observe distinct differences in the evolution of specific network properties when we compare children who have been treated successfully with those who have inadequate treatment response. CONCLUSIONS: Despite the inherent noisiness of whole blood gene expression data, our findings demonstrate how therapeutic response might be mapped and understood in pathologically informative cells in a broad range of human inflammatory diseases.

Cultivation of an Adaptive Domestic Network for Surveillance and Evaluation of Emerging Infections.

Accomplishments of this program have provided numerous dividends and might benefit areas outside infectious diseases.

Ribosomal and immune transcripts associate with relapse in acquired ADAMTS13-deficient thrombotic thrombocytopenic purpura.

Approximately 40% of patients who survive acute episodes of thrombotic thrombocytopenic purpura (TTP) associated with severe acquired ADAMTS13 deficiency experience one or more relapses. Risk factors for relapse other than severe ADAMTS13 deficiency and ADAMTS13 autoantibodies are unknown. ADAMTS13 autoantibodies, TTP episodes following infection or type I interferon treatment and reported ensuing systemic lupus erythematosus in some patients suggest immune dysregulation. This cross-sectional study asked whether autoantibodies against RNA-binding proteins or peripheral blood gene expression profiles measured during remission are associated with history of prior relapse in acquired ADAMTS13-deficient TTP. Peripheral blood from 38 well-characterized patients with autoimmune ADAMTS13-deficient TTP in remission was examined for autoantibodies and global gene expression. A subset of TTP patients (9 patients, 24%) exhibited a peripheral blood gene signature composed of elevated ribosomal transcripts that associated with prior relapse. A non-overlapping subset of TTP patients (9 patients, 24%) displayed a peripheral blood type I interferon gene signature that associated with autoantibodies to RNA-binding proteins but not with history of relapse. Patients who had relapsed bimodally expressed higher HLA transcript levels independently of ribosomal transcripts. Presence of any one potential risk factor (ribosomal gene signature, elevated HLA-DRB1, elevated HLA-DRB5) associated with relapse (OR = 38.4; p = 0.0002) more closely than any factor alone or all factors together. Levels of immune transcripts typical of natural killer (NK) and T lymphocytes positively correlated with ribosomal gene expression and number of prior episodes but not with time since the most recent episode. Flow cytometry confirmed elevated expression of cell surface markers encoded by these transcripts on T and/or NK cell subsets of patients who had relapsed. These data associate elevated ribosomal and immune transcripts with relapse history in acquired, ADAMTS13-deficient TTP.