Background Heterogeneity is a major obstacle to developing effective treatments for patients with primary Sjögren's syndrome. We aimed to develop a robust method for stratification, exploiting heterogeneity in patient-reported symptoms, and to relate these differences to pathobiology and therapeutic response. MethodsWe did hierarchical cluster analysis using five common symptoms associated with primary Sjögren's syndrome (pain, fatigue, dryness, anxiety, and depression), followed by multinomial logistic regression to identify subgroups in the UK Primary Sjögren's Syndrome Registry (UKPSSR). We assessed clinical and biological differences between these subgroups, including transcriptional differences in peripheral blood. Patients from two independent validation cohorts in Norway and France were used to confirm patient stratification. Data from two phase 3 clinical trials were similarly stratified to assess the differences between subgroups in treatment response to hydroxychloroquine and rituximab. FindingsIn the UKPSSR cohort (n=608), we identified four subgroups: Low symptom burden (LSB), high symptom burden (HSB), dryness dominant with fatigue (DDF), and pain dominant with fatigue (PDF). Significant differences in peripheral blood lymphocyte counts, anti-SSA and anti-SSB antibody positivity, as well as serum IgG, κ-free light chain, β2-microglobulin, and CXCL13 concentrations were observed between these subgroups, along with differentially expressed transcriptomic modules in peripheral blood. Similar findings were observed in the independent validation cohorts (n=396). Reanalysis of trial data stratifying patients into these subgroups suggested a treatment effect with hydroxychloroquine in the HSB subgroup and with rituximab in the DDF subgroup compared with placebo.Interpretation Stratification on the basis of patient-reported symptoms of patients with primary Sjögren's syndrome revealed distinct pathobiological endotypes with distinct responses to immunomodulatory treatments. Our data have important implications for clinical management, trial design, and therapeutic development. Similar stratification approaches might be useful for patients with other chronic immune-mediated diseases.
Spring N applications increase wheat (Triticum aestivum L.) grain yields in the Mid‐South. The interactive effect of increased N rates and foliar fungicide applications on the common Mid‐South winter wheat foliar diseases—leaf blotch (Septoria tritici Rob. in Desm.), glume blotch and leaf spot [S. nodorum (Berk.) Berk.], and leaf rust (Puccinia recondita Rob. ex Desm. f. sp. tritici)—is not clearly understood. Research was initiated in 1984 on a Collins silt loam soil (coarse‐silty, mixed, acid, thermic Aquic Udifluvents) and continued each year through 1987 to evaluate the effect of N rates and fungicide applications on disease severity in wheat. Spring N rates of 0, 30, 45, 60, 90, and 120 lb/acre were applied at Feekes' growth stage (GS) 3. Fungicides were applied twice during the spring at GS 8 to 9 and GS 10.1 to 10.5. The research was continued between 1988 and 1990 on a Loring silt loam soil (fine‐silty, mixed, thermic Typic Fragiudalfs), but with a reduced number of N treatments. Experimental sites were changed each year on these two soils. The effects of N rates and fungicide applications to wheat were evaluated through grain yields, kernel weights, test weights, and estimated percentage plant foliage and heads infected by diseases. The applied N rates did not have the same effect on increasing yields during the years of the experiment. Generally, yields were increased to a level and then decreased with higher N rates. Fungicide applications had a greater effect on yields produced at the higher N rates. Severity of diseases differed with year, N rate, and fungicides. The severity of the three diseases was increased with N rate, especially when fungicides were not applied, but fungicides reduced disease severity. Yield reductions could not be attributed to any single disease but to a combination of diseases, and reductions could not be ascertained from kernel weights or test weights. Research Question Throughout the Mid‐South, wheat yields may be reduced by one or more plant diseases that may incraese with incraesed N fertilization. This study evaluates spring N and foliar fungicide effects on grain components and disease severity of wheat. Literature Summary Diseases have had a negative but inconsistent effect on grain yields. Not only is severity inconsistent with years, but the predominate disease may differ. In this region, one or more diseases may affect wheat during the growing season. High N rates tend to increase infection by increasing plant susceptibility to these diseases. The disease severity increases with applied N when fungicides are not applied. Study Description Spring N rates and fungicides were applied over 7 yr, evaluating their effect on wheat. Experiment Design: Main‐plots, spring N rates of 0, 30, 45, 60, 90, and 120 lb/acre plus a split N rate (45 lb applied at Feekes’ GS 3 + 45 lb applied 3 to 4 wk later) were applied to a Collins silt loam soil for 1984 through 1987. Main plot N rates plus the split‐rate were applied to a Loring silt loam soil. Sub‐plots, fungicides, Bayleton p...
Surface‐broadcasting P is a management concern in no‐till (NT) corn (Zea mays L.) production. Field research was established in 1983 and continued through 1993 to evaluate broadcast and banded P applications for corn produced utilizing NT and disk‐till (DT) systems on a Loring silt loam (Oxyaquic Fragiudalfs). A wheat (Triticum aestivum L.) cover was established each fall. The tillage systems were main plots with a factorial arrangement of broadcast P rates, and the N + P band treatments were subplots. Annual broadcast P rates were 0, 20, 39, and 59 kg ha−1 A 22–20–0 kg ha−1 N + P band was applied after planting. All plots received a total of 168 kg N ha−1 each year. Disk‐till yields were higher than NT yields for 5 of the 11 yr and were increased by P rates up to 39 kg ha−1. No‐till yields were increased with P rates up to 20 kg ha−1. Yield response to banding N + P was inconsistent with year, tillage, and P rates. Three banded N + P plus broadcast P combinations equal to a broadcast P rate were applied each of the 11 yr. Yields for 5 of the 33 comparisons were increased by the banded plus broadcast P combination while three yields were reduced relative to broadcasting equal P rates. Yields for the other 25 comparisons were similar. Extractable P (EP) was increased with increased broadcast P rates, but the yield response was generally restricted to low EP situations.
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