Title Participants "Persistence of Mycobacterium ulcerans disease (Buruli ulcer) in the historical focus of Kasongo territory, the Democratic Republic of Congo" "Patrick Suykerbuyk, J Wambacq, Mavinga Delphin Phanzu, H Haruna, Y Nakazawa, K Ooms, K Kamango, Pieter Stragier, JN Singa, F Ekwanzala, E De Herdt, P De Maeyer, Luc Kestens, Françoise Portaels" "Persistence of Mycobacterium ulcerans Disease (Buruli Ulcer) in the Historical Focus of Kasongo Territory, the Democratic Republic of Congo" "Eric De Herdt" "Fifty years after the last report of Mycobacterium ulcerans infections (Buruli ulcer [BU]) in Kasongo Territory, Maniema Province, Democratic Republic of Congo (DRC), we conducted a small-scale cross-sectional survey to assess if this historical BU focus was still active and if so to explore the disease epidemiology. Seventy-five active and inactive BU cases were identified on clinical grounds of which two of 28 BU active cases were laboratory confirmed. We used a modified BU02 form to reconstruct the local disease dynamics and we believe that the horrific conflict in eastern DRC and exceptional flooding were the most likely causes of the re-emergence of the disease. There is a need in the DRC to decentralize and integrate surveillance and control activities at local level to increase the effectiveness of patient management." "Persistence and genetic adaptation of Pseudomonas aeruginosa in patients with chronic obstructive pulmonary disease" "Josefin Eklöf, Maria A. Misiakou, Pradeesh Sivapalan, Karin Armbruster, Andrea Browatzki, Thyge L. Nielsen, Therese Lapperre, Helle F. Andreassen, Julie Janner, Charlotte S. Ulrik, Migle Gabrielaite, Helle K. Johansen, Annemette Jensen, Tine V. Nielsen, Frederik B. Hertz, Khaled Ghathian, Henrik Calum, Torgny Wilcke, Niels Seersholm, Jens-Ulrik S. Jensen, Rasmus L. Marvig" "Objectives: It is unclear whether recurrent sputum culture with Pseudomonas aeruginosa from patients with chronic obstructive pulmonary disease (COPD) is caused by intermittent airway carriage by different P. aeruginosa lineages or persistent carriage by the same lineage, and whether lineages genetically adapt during carriage. Methods: Whole-genome sequencing was performed for P. aeruginosa isolates sampled longitudinally from sputum cultures in patients with COPD who were enrolled in an ongoing randomized controlled trial (clinicaltrials.gov: NCT03262142). Results: A total of 153 P. aeruginosa isolates were sequenced for 23 patients during 365 days of follow-up. Recurrent presence of P. aeruginosa was seen in 19 patients (83%) and was caused by persistence of the same clonal lineage in all but one patient. We identified 38 genes mutated in parallel in two or more lineages, suggesting positive selection for adaptive mutations. Mutational enrichment analysis revealed genes important in antibiotic resistance and chronic infections to be more frequently mutated. Discussion: Recurrent P. aeruginosa was common and carried for a prolonged time after initial detection in the airways of patients with COPD. Recurrence was caused by persistence of the same clonal lineage and was associated with genetic adaptation. Trial data on possible clinical benefits of attempting antibiotic eradication of P. aeruginosa in COPD are warranted. Keywords: Chronic obstructive pulmonary disease; Genetic adaptation; Pseudomonas aeruginosa; Whole-genome sequencing." "Predictors of somatic symptom persistence in patients with chronic kidney disease (SOMA.CK): study protocol for a mixed-methods cohort study" "Omer Van den Bergh" "INTRODUCTION: Seven of 10 patients with non-dialysis chronic kidney disease (CKD) experience burdensome persistent somatic symptoms (PSS). Despite the high prevalence and relevance for quality of life, disease progression and mortality, the pathogenesis of PSS in CKD remains poorly understood. The SOMA.CK study aims to investigate biopsychosocial predictors and their interactions for PSS in non-dialysis CKD and to develop a multivariate prognostic prediction model for PSS in CKD. METHODS AND ANALYSIS: The study is a mixed-methods cohort study with assessments at baseline, 6 and 12 months. It aims to include 330 patients with CKD stages G2-4 (eGFR=15-89 mL/min/1.73 m2). Primary outcome is the CKD-specific somatic symptom burden assessed with the CKD Symptom Burden Index. Secondary outcomes include quality of life, general somatic symptom burden and functioning. The interplay of biomedical (eg, biomarkers, epigenetics), treatment-related (eg, therapies and medication) and psychosocial variables (eg, negative affectivity, expectations) will be investigated to develop a prognostic prediction model for PSS. In an embedded mixed-methods approach, an experimental study in 100 patients using an affective picture paradigm will test the effect of negative affect induction on symptom perception. An embedded longitudinal qualitative study in 40-50 newly diagnosed patients will use thematic analysis to explore mechanisms of symptom development after receiving a CKD diagnosis. SOMA.CK is part of the interdisciplinary research unit 'Persistent SOMAtic Symptoms ACROSS Diseases'. ETHICS AND DISSEMINATION: The study was approved by the Ethics Committee of the Hamburg Medical Association (2020-10195-BO-ff). Findings will be disseminated through peer-reviewed publications, scientific conferences, the involvement of our patient advisory board and the lay public. Focusing on subjective symptom burden instead of objective disease markers will fundamentally broaden the understanding of PSS in CKD and pave the path for the development of mechanism-based tailored interventions. TRIAL REGISTRATION NUMBER: ISRCTN16137374." "Persistence and clearance of Ebola virus RNA from seminal fluid of Ebola virus disease survivors: a longitudinal analysis and modelling study" "Liana Kafetzopoulou" "BACKGROUND: By January, 2016, all known transmission chains of the Ebola virus disease (EVD) outbreak in west Africa had been stopped. However, there is concern about persistence of Ebola virus in the reproductive tract of men who have survived EVD. We aimed to use biostatistical modelling to describe the dynamics of Ebola virus RNA load in seminal fluid, including clearance parameters. METHODS: In this longitudinal study, we recruited men who had been discharged from three Ebola treatment units in Guinea between January and July, 2015. Participants provided samples of seminal fluid at follow-up every 3-6 weeks, which we tested for Ebola virus RNA using quantitative real-time RT-PCR. Representative specimens from eight participants were then inoculated into immunodeficient mice to test for infectivity. We used a linear mixed-effect model to analyse the dynamics of virus persistence in seminal fluid over time. FINDINGS: We enrolled 26 participants and tested 130 seminal fluid specimens; median follow up was 197 days (IQR 187-209 days) after enrolment, which corresponded to 255 days (228-287) after disease onset. Ebola virus RNA was detected in 86 semen specimens from 19 (73%) participants. Median duration of Ebola virus RNA detection was 158 days after onset (73-181; maximum 407 days at end of follow-up). Mathematical modelling of the quantitative time-series data showed a mean clearance rate of Ebola virus RNA from seminal fluid of -0·58 log units per month, although the clearance kinetic varied greatly between participants. Using our biostatistical model, we predict that 50% and 90% of male survivors clear Ebola virus RNA from seminal fluid at 115 days (90% prediction interval 72-160) and 294 days (212-399) after disease onset, respectively. We also predicted that the number of men positive for Ebola virus RNA in affected countries would decrease from about 50 in January 2016, to fewer than 1 person by July, 2016. Infectious virus was detected in 15 of 26 (58%) specimens tested in mice. INTERPRETATION: Time to clearance of Ebola virus RNA from seminal fluid varies greatly between individuals and could be more than 13 months. Our predictions will assist in decision-making about surveillance and preventive measures in EVD outbreaks. FUNDING: This study was funded by European Union's Horizon 2020 research and innovation programme, Directorate-General for International Cooperation and Development of the European Commission, Institut national de la santé et de la recherche médicale (INSERM), German Research Foundation (DFG), and Innovative Medicines Initiative 2 Joint Undertaking." "Effectiveness and persistence of Vedolizumab in patients with inflammatory bowel disease : results from the Belgian REal-LIfe study with VEdolizumab (Be-RELIVE)" "C Reenaers, A Cremer, O Dewit, B De Vroey, W Van Moerkercke, Peter Bossuyt, V Muls, J Imschoot, S Block, A Hantson, P Van Hootegem" "Background and study aims: Vedolizumab (VDZ) is a gutselective integrin inhibitor used to treat Crohn's disease (CD) and ulcerative colitis (UC). This retrospective study assessed effectiveness and treatment persistence of VDZ in a Belgian reallife cohort of CD and UC patients. Patients and methods: CD and UC patients from 15 Belgian centers, who started VDZ between 01/09/2015 and 31/06/2016 and attended ≥1 visit after the first VDZ infusion, were included. Data were collected before first infusion, at week (W)10, W14 (CD patients only), month (M)6 and last follow-up. Treatment response and remission rates (changes in disease activity scores) and treatment persistence (Kaplan-Meier analysis) were assessed. Results: Of the 348 patients receiving at least one dose of VDZ, 325 (202 CD, 45 biologic-naïve; and 123 UC, 42 biologic-naïve) patients were included in data analyses. At M6, 87.6% (176/201) of CD and 86.1% (105/122) of UC patients were still on VDZ treatment, 75.6% (34/45) and 83.9% (26/31) achieved clinical response, and 66.7% (44/66) and 42.9% (15/35) were in remission. At M6 remission rates was significantly higher while response rates tended to be higher among biologic-naïve versus biologic-failure CD patients. Conclusions: VDZ offers an effective treatment option in real-life settings and treatment effectiveness appears higher in biologic-naïve versus biologic-failure CD patients. (Acta gastroenterol. belg., 2020, 83, 15-23)." "USTEKINUMAB EFFECTIVENESS, DRUG PERSISTENCE AND SERUM EXPOSURE IN CROHN'S DISEASE ARE AFFECTED BY ITS POSITIONING" "Dahham Alsoud, João Guedelha Sabino, Marc Ferrante, Séverine Vermeire, Bram Verstockt" "Persistence of Mycobacterium ulcerans disease (buruli ulcer) in the historical foci of Kongo Central Province, The Democratic Republic of Congo" "Delphin Mavinga Phanzu, E. K. Luzolo, O. N. Kiabanzawoko, N. M. Mintsey, Koen Vandelannoote, Miriam Eddyani, P. Suykerbuyk, E. van der Grinten, Françoise Portaels, Bouke de Jong, Marleen Boelaert" "Prolonged environmental persistence requires efficient disinfection procedures to control Devriesea agamarum associated disease in lizards" "Tom Hellebuyck, Frank Pasmans, Mark Blooi, An Martel" "Phenotyping by persistent inflammation in systemic sclerosis associated interstitial lung disease : a EUSTAR database analysis" "Sabina Guler, Adela-Cristina Sarbu, Odile Stalder, Yannick Allanore, Vera Bernardino, Joerg Distler, Armando Gabrielli, Anna-Maria Hoffmann-Vold, Marco Matucci-Cerinic, Ulf Müller-Ladner, Vera Ortiz-Santamaria, Simona Rednic, Valeria Riccieri, Vanessa Smith, Susanne Ullman, Ulrich A Walker, Thomas K Geiser, Oliver Distler, Britta Maurer, Florian Kollert" "Background Systemic sclerosis (SSc) is a heterogeneous disease with frequently associated interstitial lung disease (SSc-ILD). We aimed to determine the prognostic potential of phenotyping patients with SSc and SSc-ILD by inflammation and to describe disease trajectories stratified by inflammation and immunosuppressive treatment.Methods Patients from the European Scleroderma Trials and Research (EUSTAR) group cohort were allocated to persistent inflammatory, intermediate and non-inflammatory phenotypes if C-reactive protein (CRP) levels were >= 5 mg/L at >= 80%, at 20-80% and at"