Methotrexate polyglutamates as a potential marker of adherence to long-term therapy in children with juvenile idiopathic arthritis and juvenile dermatomyositis: an observational, cross-sectional study

Introduction: Methotrexate (MTX) is a cornerstone of treatment in a wide variety of inflammatory conditions, including juvenile idiopathic arthritis (JIA) and juvenile dermatomyositis (JDM). However, owing to its narrow therapeutic index and the considerable interpatient variability in clinical response, monitoring of adherence to MTX is important. The present study demonstrates the feasibility of using methotrexate polyglutamates (MTXPGs) as a biomarker to measure adherence to MTX treatment in children with JIA and JDM.
Methods: Data were collected prospectively from a cohort of 48 children (median age 11.5 years) who received oral or subcutaneous (SC) MTX therapy for JIA or JDM. Dried blood spot samples were obtained from children by finger pick at the clinic or via self- or parent-led sampling at home, and they were analysed to determine the variability in MTXPG concentrations and assess adherence to MTX therapy.
Results: Wide fluctuations in MTXPG total concentrations (>2.0-fold variations) were found in 17 patients receiving stable weekly doses of MTX, which is indicative of nonadherence or partial adherence to MTX therapy. Age (P = 0.026) and route of administration (P = 0.005) were the most important predictors of nonadherence to MTX treatment. In addition, the study showed that MTX dose and route of administration were significantly associated with variations in the distribution of MTXPG subtypes. Higher doses and SC administration of MTX produced higher levels of total MTXPGs and selective accumulation of longer-chain MTXPGs (P < 0.001 and P < 0.0001, respectively).
Conclusions: Nonadherence to MTX therapy is a significant problem in children with JIA and JDM. The present study suggests that patients with inadequate adherence and/or intolerance to oral MTX may benefit from SC administration of the drug. The clinical utility of MTXPG levels to monitor and optimise adherence to MTX in children has been demonstrated.Trial Registration: ISRCTN Registry identifier: ISRCTN93945409 . Registered 2 December 2011.

Calmodulin disruption impacts growth and motility in juvenile liver fluke

Background: Deficiencies in effective flukicide options and growing issues with drug resistance make current strategies for liver fluke control unsustainable, thereby promoting the need to identify and validate new control targets in Fasciola spp. parasites. Calmodulins (CaMs) are small calcium-sensing proteins with ubiquitous expression in all eukaryotic organisms and generally use fluctuations in intracellular calcium levels to modulate cell signalling events. CaMs are essential for fundamental processes including the phosphorylation of protein kinases, gene transcription, calcium transport and smooth muscle contraction. In the blood fluke Schistosoma mansoni, calmodulins have been implicated in egg hatching, miracidial transformation and larval development. Previously, CaMs have been identified amongst liver fluke excretory-secretory products and three CaM-like proteins have been characterised biochemically from adult Fasciola hepatica, although their functions remain unknown.

Methods: In this study, we set out to investigate the biological function and control target potential of F. hepatica CaMs (FhCaMs) using RNAi methodology alongside novel in vitro bioassays.

Results: Our results reveal that: (i) FhCaMs are widely expressed in parenchymal cells throughout the forebody region of juvenile fluke; (ii) significant transcriptional knockdown of FhCaM1-3 was inducible by exposure to either long (~200 nt) double stranded (ds) RNAs or 27 nt short interfering (si) RNAs, although siRNAs were less effective than long dsRNAs; (iii) transient long dsRNA exposure-induced RNA interference (RNAi) of FhCaMs triggered transcript knockdown that persisted for ≥ 21 days, and led to detectable suppression of FhCaM proteins; (iv) FhCaM RNAi significantly reduced the growth of juvenile flukes maintained in vitro; (v) FhCaM RNAi juveniles also displayed hyperactivity encompassing significantly increased migration; (vi) both the reduced growth and increased motility phenotypes were recapitulated in juvenile fluke using the CaM inhibitor trifluoperazine hydrochloride, supporting phenotype specificity.

Conclusions: These data indicate that the Ca(2+)-modulating functions of FhCaMs are important for juvenile fluke growth and movement and provide the first functional genomics-based example of a growth-defect resulting from gene silencing in liver fluke. Whilst the phenotypic impacts of FhCaM silencing on fluke behaviour do not strongly support their candidature as new flukicide targets, the growth impacts encourage further consideration, especially in light of the speed of juvenile fluke growth in vivo.

Glycosylation of Vitamin D Binding Protein Reduced in Juvenile Idiopathic Arthritis Patients At Risk of Disease Extension.

Background/Purpose:Juvenile idiopathic arthritis (JIA) comprises a poorly understood group of chronic, childhood onset, autoimmune diseases with variable clinical outcomes. We investigated whether profiling of the synovial fluid (SF) proteome by a fluorescent dye based, two-dimensional gel (DIGE) approach could distinguish the subset of patients in whom inflammation extends to affect a large number of joints, early in the disease process. The post-translational modifications to candidate protein markers were verified by a novel deglycosylation strategy.Methods:SF samples from 57 patients were obtained around time of initial diagnosis of JIA. At 1 year from inclusion patients were categorized according to ILAR criteria as oligoarticular arthritis (n=26), extended oligoarticular (n=8) and polyarticular disease (n=18). SF samples were labeled with Cy dyes and separated by two-dimensional electrophoresis. Multivariate analyses were used to isolate a panel of proteins which distinguish patient subgroups. Proteins were identified using MALDI-TOF mass spectrometry with vitamin D binding protein (VDBP) expression and siaylation further verified by immunohistochemistry, ELISA test and immunoprecipitation. Candidate biomarkers were compared to conventional inflammation measure C-reactive protein (CRP). Sialic acid residues were enzymatically cleaved from immunopurified SF VDBP, enriched by hydrophilic interaction liquid chromatography (HILIC) and analysed by mass spectrometry.Results:Hierarchical clustering based on the expression levels of a set of 23 proteins segregated the extended-to-be oligoarticular from the oligoarticular patients. A cleaved isoform of VDBP, spot 873, is present at significantly reduced levels in the SF of oligoarticular patients at risk of disease extension, relative to other subgroups (p<0.05). Conversely total levels of vitamin D binding protein are elevated in plasma and ROC curves indicate an improved diagnostic sensitivity to detect patients at risk of disease extension, over both spot 873 and CRP levels. Sialysed forms of intact immunopurified VDBP were more prevalent in persistent oligoarticular patient synovial fluids.Conclusion:The data indicate that a subset of the synovial fluid proteome may be used to stratify patients to determine risk of disease extension. Reduced conversion of VDBP to a macrophage activation factor may represent a novel pathway contributing to increased risk of disease extension in JIA patients.

A definition of literary literacy: a content analysis of literature syllabuses and interviews with Portuguese lecturers of literature

The aim of this paper is to present a definition of literary literacy in the context of majors in languages, literatures and cultures, in Portugal. A definition of literary literacy was deduced from a content analysis of primary data sources and from the theoretical underpinnings of the transactional theory of reading. The primary data sources are fourteen Portuguese and English literature syllabuses from four Portuguese universities (Lisboa, Nova, Coimbra and Porto) and twelve interviews with Portuguese university lecturers of literature. Based on the findings of a content analysis of both syllabuses and interviews, from the lecturers‘ point of view, a literary literate student doing a major in languages, literatures and cultures must, above all, be able to contextualize literary texts and their authors both historically and culturally, must be able to present an interpretation as a coherent text, and must be able to do and organize bibliographical research.

Seawater acidification by CO2 in a coastal lagoon environment: Effects on life history traits of juvenile mussels Mytilus galloprovincialis

The carbonate chemistry of seawater fromthe Ria Formosa lagoon was experimentallymanipulated, by diffusing pure CO2, to attain two reduced pH levels, by−0.3 and−0.6 pH units, relative to unmanipulated seawater. After 84 days of exposure, no differences were detected in terms of growth (somatic or shell) or mortality of juvenile mussels Mytilus galloprovincialis. The naturally elevated total alkalinity of the seawater (≈3550 μmol kg−1) prevented under-saturation of CaCO3, evenunder pCO2 values exceeding 4000 μatm, attenuating the detrimental effects on the carbonate supply-side. Even so, variations in shell weight showed that net calcification was reduced under elevated CO2 and reduced pH, although the magnitude and significance of this effect varied among size-classes. Most of the loss of shell material probably occurred as post-deposition dissolution in the internal aragonitic nacre layer. Our results show that, even when reared under extreme levels of CO2- induced acidification, juvenileM. galloprovincialis can continue to calcify and grow in this coastal lagoon environment. The complex responses of bivalves to ocean acidification suggest a large degree of interspecific and intraspecific variability in their sensitivity to this type of perturbation. Further research is needed to assess the generality of these patterns and to disentangle the relative contributions of acclimation to local variations in seawater chemistry and genetic adaptation.

A juvenile recruitment prediction model for Ruditapes decussatus (L.) (Bivalvia : Mollusca)

Despite the importance of larval abundance in determining the recruitment of benthic marine invertebrates and as a major factor in marine benthic community structure, relating planktonic larval abundance with post-settlement post-larvae and juveniles in the benthos is difficult. It is hampered by several methodological difficulties, including sampling frequency, ability to follow larval and post-larval or juvenile cohorts, and ability to calculate growth and mortality rates. In our work, an intensive sampling strategy was used. Larvae in the plankton were collected at weekly intervals, while post-larvae that settled into collectors were analysed fortnightly. Planktonic larval and benthic post-larval/juvenile cohorts were determined, and growth and mortality rates calculated. Integration of all equations allowed the development of a theoretical formulation that, based on the abundance and planktonic larval duration, permits an estimation of the future abundance of post-larvae/juveniles during the first year of benthic life. The model can be applied to a sample in which it was necessary only to measure larval length.

Examining how post-secondary L2 readers make use of background knowledge when reading literary texts an exploratory study

Literary texts offer rich opportunities for language learning. However, can second language (L2) learners fully understand L2 literary texts? According to Bernhardt (2001):"the act of reading in a second language is extremely tricky -- is even trickier with literary texts that are inherently ambiguous, full of metaphor and intertextual relations to texts to which the readers have no access" (p.198). In other words, L2 readers are often poorly equipped grammatically, linguistically and culturally to cope with literary texts in which it might be difficult to recognize figurative language, to comprehend metaphors, to identify underlying cultural assumptions and above all to think critically while navigating those complexities. Therefore, during the reading process, L2 readers encounter gaps in the text which necessarily compel them to use whatever background knowledge they possess in order to create meaning. The purpose of this research is to see exactly how post-secondary L2 readers use their existing background knowledge to understand literary texts and what they do when confronted with text passages for which they lack such knowledge.

Characterizing the effects of ocean acidification in larval and juvenile Manila clam, Ruditapes philippinarum, using a transcriptomic approach

Ocean acidification as a result of anthropogenic carbon dioxide (CO2) emissions and global climate change poses a risk to the ecological landscape of intertidal and shallow subtidal communities. The organisms that inhabit these waters will have to cope with changing environmental conditions through the appropriate modulation of physiological processes. Calcifying organisms are particularly at risk, as increased atmospheric levels of CO2 in the atmosphere increase the partial pressure of CO2 (pCO2) in the oceans. Increased pCO2 reduces the saturation of carbonate minerals required to form calcified structures. Being able to cope with the increased energetic demand of maintaining these structures, in addition to other vital physiological processes, will be the key driver that determines which organisms will persist. Assessment of larval and juvenile Manila clam mortality and physiology in this study suggests that this species is capable of coping with elevated pCO2 conditions. The use of high throughput sequencing and RNA sequence analysis in larval clams revealed several physiological processes that play important roles in the Manila clam’s ability to tolerate elevated pCO2 conditions during this life stage. Exposure of juvenile Manila clams, acclimated to elevated pCO2 conditions, to a thermal stress revealed that this species might also be capable of coping with multiple stressors associated with global climate change. Manila clams could therefore represent a model for studying physiological mechanisms associated with successful acclimation of populations to ocean acidification.

The Invention of Hebrew Prose: Literary Language and the Dilemmas of Mimesis, pt. 3, sect. 1

DIscussion of how the Hebrew literary language developed and how it is used to create a reality.