Genetic screening of South African families with Parkinson's disease

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Cost-Effectiveness of Prevention for People at Risk for Dementia: A Scoping Review and Qualitative Synthesis

Dementia is from an economic perspective a main challenge for economies worldwide because of increasing costs. Since there is no cure in sight, prevention seems the most promising approach for reducing health care cost due to Dementia. On the contrary, approximately 40% of dementias is attributable to modifiable risk factors and first studies showed that multidomain interventions may be effective for preventing dementia. Considering the increasing economic burden, for many health administrations worldwide, cost-effectiveness plays a mayor role. This scoping review wants to bring evidence to the question if prevention for people at risk may be cost-effective. Therefore, the four databases Medline (via Pubmed), CINHAL (via EBSCO), Business Source Complete (via EBSCO), and the Health Economic Evaluation database (HEED) were used to conduct a scoping review using PICO and a systematic search string. 3,629 studies were identified and seven met all inclusion criteria. The included studies showed clear cost-effectiveness for most multidomain interventions. The gained QALYs at mean were 0.08 (SD=0.08) and the intervention average costs 472.20 EUR per Person (SD=74.06 EUR). The Incremental Cost-Effectiveness Ratios varied between -80,427.97 and 104,189.82 EUR per QALY. The three core results are (i) prevention programs focusing on people at risk may be cost-effective and cost-efficient, (ii) multimodal prevention reveal cost saving potential, when the people at risk are defined well, (iii prevention in middle-aged cohorts may be also cost-effective if life-style related risk factors are addressed.

Are you better than me? Social comparisons in carrion crows (Corvus corone)

Comparing oneself to others is a key process in humans that allows individuals to gauge their performances and abilities and thus develop and calibrate their self-image. Little is known about its evolutionary foundations. A key feature of social comparison is the sensitivity to other individuals' performance. Recent studies on primates produced equivocal results, leading us to distinguish between a 'strong' variant of the social comparison hypothesis formulated for humans and a 'weak' variant found in non-human primates that would comprise some elements of human social comparison. Here, we focus on corvids that are distantly related to primates and renowned for their socio-cognitive skills. We were interested in whether crows' task performances were influenced (i) by the presence of a conspecific co-actor performing the same discrimination task and (ii) by the simulated acoustic cues of a putative co-actor performing better or worse than themselves. Crows reached a learning criterion quicker when tested simultaneously as compared to when tested alone, indicating a facilitating effect of social context. The performance of a putative co-actor influenced their performance: crows were better at discriminating familiar images when their co-actor was better than they were. Standard extremity (how pronounced the difference was between the performance of the subject and that of the co-actor), and category membership (affiliation status and sex), of the putative co-actors had no effect on their performance. Our findings are in line with the 'weak' variant of social comparison and indicate that elements of human social comparison can be found outside of primates.

The relationship between the recognition of specific basic emotions and negative symptom domains in patients with schizophrenia spectrum disorders

Introduction

Current research suggests emotion recognition to be significantly impaired in individuals with schizophrenia spectrum disorders (SSD), whereby negative symptoms are theorised to play a crucial role. Emotion recognition deficits are assumed to be predictors of transition from clinical high risk to schizophrenia. So far, little attention has been given hereby to the subdomains of negative symptoms and recognizing the individual basic emotions.

Objectives

Our study aimed to explore the relationship between the recognition of the basic emotions and each negative symptom domain.

Methods

66 patients with a SSD diagnosis were recruited at the Charité – Universitätsmedizin Berlin. Correlational and regression analyses to control for the covariates (age, education, sex) were conducted between the recognition of the six basic emotions (anger, disgust, fear, happiness, sadness, surprise) using the Emotion Recognition Task of the Cambridge Neuropsychological Test Automated Battery (CANTAB) and the seven different subdomains of negative symptoms of the Positive and Negative Syndrome Scale (PANSS).

Results

revealed significantly negative correlations of blunted affect with the recognition of happiness, fear, and disgust. Difficulties in abstract thinking, also correlated positively with the recognition of fear. Additionally, we found a significant positive correlation between stereotyped thinking and difficulties in abstract thinking with the response latency in emotion recognition.

Conclusions

Individuals with SSD and domains of negative symptoms showed specific impairments in recognizing the representation of basic emotions. A longitudinal design to make causality statements would be useful for future research. Moreover, emotion recognition should be considered for early detection and individualized treatment.

Disclosure

No significant relationships.

Increasing sample diversity in psychiatric genetics - Introducing a new cohort of patients with schizophrenia and controls from Vietnam - Results from a pilot study

OBJECTIVES

Genome-Wide Association Studies (GWAS) of Schizophrenia (SCZ) have provided new biological insights; however, most cohorts are of European ancestry. As a result, derived polygenic risk scores (PRS) show decreased predictive power when applied to populations of different ancestries. We aimed to assess the feasibility of a large-scale data collection in Hanoi, Vietnam, contribute to international efforts to diversify ancestry in SCZ genetic research and examine the transferability of SCZ-PRS to individuals of Vietnamese Kinh ancestry.

METHODS

In a pilot study, 368 individuals (including 190 SCZ cases) were recruited at the Hanoi Medical University's associated psychiatric hospitals and outpatient facilities. Data collection included sociodemographic data, baseline clinical data, clinical interviews assessing symptom severity and genome-wide SNP genotyping. SCZ-PRS were generated using different training data sets: (i) European, (ii) East-Asian and (iii) trans-ancestry GWAS summary statistics from the latest SCZ GWAS meta-analysis.

RESULTS

SCZ-PRS significantly predicted case status in Vietnamese individuals using mixed-ancestry (R² liability = 4.9%, p = 6.83 × 10^-8), East-Asian (R² liability = 4.5%, p = 2.73 × 10^-7) and European (R² liability = 3.8%, p = 1.79 × 10^-6) discovery samples.

DISCUSSION

Our results corroborate previous findings of reduced PRS predictive power across populations, highlighting the importance of ancestral diversity in GWA studies.

Histopathologic spectrum of glomangioma: A clinico-pathologic review

Introduction/Objective

Glomus tumors are mesenchymal neoplasms with glomus body type modified smooth muscle cell differentiation. Most glomus tumors have a benign clinical course. However, rarely, they display malignant histologic features.

Methods/Case Report

We undertook a retrospective study using a natural language search in CoPath to find surgical pathology cases from 1993-2020 containing “glomus” in the pathology diagnosis. All relevant cases were included, and clinicopathologic data were reviewed in detail.

Results (if a Case Study enter NA)

A total of 66 tumors were identified, of which 42 were in female (63.6%) and 24 in male (36.4%) patients. The age at surgery ranged from 22 to 79 years with a median of 47.5. Females were significantly younger than males at presentation (p=0.025) by 8.8±3.8 years. Forty cases (60.6%) were located on the digits, 24 in nonvisceral soft tissue of extremities, trunk, and lip (36.4%), and one each in stomach and breast parenchyma. Sixty-three (95.5%) were benign (of which one recurred locally), 2 (3%) were malignant, and 1 (1.5%) was atypical. Four (6%) were multicentric. One case showed mixed histology (oncocytic and classic features) and one was classified as glomangiomatosis. The malignant cases each presented with a single tumor in lower extremity soft tissue in female patients (aged 33 and 49 years). The tumors measured 0.5 and 1.8 cm respectively and showed marked cytologic atypia in both and increased mitotic activity in the first. They were both completely excised.

Conclusion

The majority of glomus tumors are benign, however 3% are malignant. The most common location is the digits, followed by soft tissue. This tumor is more commonly seen in female patients. Unusual histologic variants such as glomangiomatosis and oncocytic component at times may create some difficulty to reach the diagnosis, especially on small biopsies. Unusual locations such as stomach can lead to a wrong diagnosis such as carcinoid, especially in a small biopsy material.

Introducing a psychiatric genetic cohort of schizophrenia patients and controls from Vietnam

Introduction

Genome-wide association studies (GWAS) have successfully revealed genetic risk variants for schizophrenia (SCZ). However, the vast majority of GWAS largely comprise European samples. As a result, the derived polygenic risk scores (PRS) show decreased predictive power when applied to non-European populations.

Objectives

A long-term scientific cooperation between the Charité Universitätsmedizin Berlin and the Hanoi Medical University aims to address this limitation by recruiting a large genetic cohort of comprehensively phenotyped schizophrenia patients and controls in Vietnam.

Methods

A pilot study was conducted at the Department of Psychiatry of the Medical University Hanoi in 2017. Data collection encompassed i) genome-wide SNP genotyping of 200 schizophrenia patients and 200 control subjects ii) structured interviews to assess symptom severity (PANSS), iii) clinical parameters (e.g. duration of illness, medication) and demography.

Results

SCZ-PRS of the pilot sample (N=400) were generated using different training data sets: i) European, ii) East-Asian and iii) mixed GWAS summary statistics from the Psychiatric Genomics Consortium’s latest discovery sample. Most variance explained was observed using a mixed discovery sample (R²liability=0.053, p=3.11*10^-8, Pd <0.5), followed by PRS based on the East-Asian summary statistics (R²liability=0.0503, p=6.78*10^-8, Pd <1) and the European sample (R²liability=0.0363, p = 4.26*10^-6, Pd <0.01).

Conclusions

With this pilot project we established an efficient recruitment, genotyping and data analysis pipeline. Our results corroborate previous findings indicating that transferability of PRS across populations depends on the ancestral composition of the initial discovery dataset. We therefore aim to expand data collection efforts in the future in order to improve risk prediction across diverse populations.

Disclosure

No significant relationships.

Reform design, institutional and workforce factors affecting the pace of change

Background

When implementing health care reforms the pace of change is often lacking behind the expectations of policy makers. This research is exploring in-depth the experiences of a primary care initiative from the perspective of general practitioners. The physicians' perspectives on design features, supporting environment and acceptance of the pilot are being explored. Enabling and constraining factors that may influence the pace of change of health care reforms are identified. Implications can be drawn for the strategic planning and smooth implementation of the change process.

Methods

14 problem-focused interviews with general practitioners working in pilot projects and 2 focus group discussions with 4-6 general practitioners working in single practices have been conducted. In addition, document analysis of secondary qualitative data and relevant policy documents has been conducted.

Results

Analysis revealed 9 codes: (1) Status of the general practitioner; (2) Institutional and legal framework; (3) Between cooperation and competition; (4) Hesitation from the young generation; (5) Reluctance from sole practitioners; (6) Personal drivers for starting a pilot (7) Challenges during set-up phase; (8) Challenges during growth phase; (9) Working conditions in primary care pilot projects. Enabling factors were a strong desire to be pioneering primary care provision and improved working conditions. The main constraining factors were low status of the general practitioner, uncertainty about future directions, lack of information and advice, high perceived financial risk, fear of losing autonomy and uncertainty about functioning teamwork.

Conclusions

For a smooth implementation of the primary care reform, system changes should improve education and training, compensation schemes and competence profiles of the professional groups involved. Further, initiatives should provide information and advice for practitioners striving for participating in a pilot project.

Key messages

The success of health care reforms also depends on institutional and workforce factors that may affect the pace of change. Health care reforms need strategic planning for a smooth implementation.

P1836 Common carotid artery intima-media thickness correlates with the epicardial fat thickness in patients with ischemic stroke

Purpose

The aim of this study was to determine the relationship between common carotid artery intima–media thickness (CCA-IMT), the resistance index (RI) in the vertebral and carotid arteries and epicardial fat thickness (EFT) in patients with ischemic stroke.

Methods

98 patients with ischemic stroke (31 females and 67 males, mean age was 68.2 ± 12.1 years) were studied. All patients had arterial hypertension (AH). Most of them (96.9%) had grade 3 hypertension according to ESH/ESC Guidelines for the management of arterial hypertension, 2018. Forty-two (43.1%) patients had coronary artery disease and 35 (35.4%) - atrial fibrillation (AF). The exclusion criteria was the presence of chronic obstructive pulmonary disease or other diseases associated with pulmonary hypertension. Patients were categorized according to National Institutes of Health Stroke Scale (NIHSS) severity in mild NIHSS (≤8) - 54 (55.1%) patients, moderate NIHSS (9–15) - 23 (23.5%) patients, and severe stroke NIHSS (≥16) - 21 (21.4%) patients. Median NIHSS score was 11.2 ± 1.7. All patients underwent a transthoracic echocardiography and a carotid ultrasound examination.

Results

The common carotid artery intima–media thickness correlated with EFT (r =0.78, p &lt; 0.001), the body mass index (r = 0.7, p &lt; 0.001) and systolic blood pressure (r = 0.25, p = 0.045). The resistance index in the vertebral and carotid arteries correlated only with EFT (r = 0.7, p &lt; 0.001 and r = 0.78, p &lt; 0.001, respectively) and body mass index (r = 0.58, p &lt; 0.001 and r = 0.68, p &lt; 0.001, respectively).

A multiple regression analysis in which the CCA-IMT was a dependent variable and age, body mass index, systolic blood pressure, blood cholesterol level and epicardial fat thickness were independent variables, showed that CCA-IMT was independently correlated with blood cholesterol level (β=0.714, р&lt;0.001) and EFT (β =0.255, р=0.002) in patients with ischemic stroke.

Conclusions

The common carotid artery intima–media thickness and parameters of the arterial stiffness of the extracranial vessels of the head are associated with the epicardial fat thickness and blood cholesterol level in patients with ischemic stroke. The common carotid artery intima–media thickness does not depend on age, gender, body mass index, systolic and diastolic blood pressure in patients with ischemic stroke.

P1837 The severity of acute ischemic stroke is associated with the right heart remodeling in patients with arterial hypertension

Purpose

The aim of this study was to determine the relationship of echocardiographic signs of the right heart remodeling and the stroke severity in patients with arterial hypertension and ischemic stroke.

Methods

98 patients with acute ischemic stroke (31 females and 67 males, mean age was 68.2 ± 12.1 years) were studied. All patients had arterial hypertension. Most of them (96.9%) had grade 3 hypertension according to ESH/ESC Guidelines for the management of arterial hypertension, 2018. Forty-two (43.1%) patients had coronary artery disease, 35 (35.4%) - atrial fibrillation (AF). The exclusion criteria was the presence of chronic obstructive pulmonary disease or other diseases associated with pulmonary hypertension. Patients were categorized according to National Institutes of Health Stroke Scale (NIHSS) severity in mild NIHSS (≤8) - 54 (55.1%) patients, moderate NIHSS (9–15) - 23 (23.5%) patients, and severe stroke NIHSS (≥16) - 21 (21.4%) patients. Median NIHSS score was 11.2 ± 1.7. All patients underwent a transthoracic echocardiography. A comparative assessment of echocardiographic parameters was performed in patients of lower (NIHSS score ≤ 4.5) and upper (NIHSS score≥14.5) quartile according to the NIHSS score.

Results

Linear regression analysis revealed that stroke severity was significantly correlated with right atrium end-diastolic volume (EDV) (r = 0.48, p &lt; 0.0001), right ventricular EDV (r = 0.62, p &lt; 0.0001), left atrium EDV (r = 0.41, p = 0.002), left ventricular ejection fraction (LVEF) (r = 0.4, p = 0.003) and pulmonary artery systolic pressure (PASP) (r = 0.89, p &lt; 0.0001). A multiple regression analysis showed that stroke severity was independently correlated with PASP (β=0.471, р=0.01), left atrium EDV (β=0.961, р=0.02) and LVEF (β=0.931, р=0.005) in patients with arterial hypertension and ischemic stroke.

In the group of patients with the upper quartile of NIHSS score, the right atrium EDV (64.7 ± 21.1 mm versus 47.6 ± 25.2 mm, р=0.04) and PASP (25.8 ± 9.3 mm versus 20.8 ± 8.0 mm, р=0.045) were higher. The left atrium EDV was higher in patients with LVEF below 50% ( 73.3 ± 36.9 mm vs 49.9 ± 18.5 mm, р=0.02) and in patients with AF (55.3 ± 19.8 vs 36.4 ± 14.6 mm, p &lt; 0.0001). At the same time PASP did not depend on the LVEF (22.1 ± 10.7 mm vs 21.6 ± 8.1 mm, р=0.9) and the presence of AF (21.9 ± 9.0 mm vs 21.7 ± 8.1 mm, р=0.9).

Conclusions

In patients with arterial hypertension the severity of acute ischemic stroke is associated with increases in right atrium end-diastolic volume and in pulmonary artery systolic pressure. An increase in pulmonary artery systolic pressure in patients with arterial hypertension and ischemic stroke does not depend on the left ventricular ejection fraction and atrial fibrillation.

Site-specific gene expression analysis from archived human intestine samples combining laser-capture microdissection and multiplexed color-coded probes

BACKGROUND

Alterations of site-specific gene expression profiles in disease-relevant networks within the different layers of the intestinal wall may contribute to the onset and clinical course of gastrointestinal disorders. To date, no systematic analysis has assessed and compared sub-regional gene expression patterns in all distinct layers of the gut using fresh frozen human samples. Our aim was to establish an optimized protocol for site-specific RNA isolation in order to achieve maximum RNA quality and amount for subsequent gene expression analysis combining laser-capture microdissection (LCM) with a probe-based technology, the NanoString nCounter Analysis system.

METHODS

Four full-thickness colon samples from patients who underwent surgery due to pathological conditions were processed and separated into epithelium, lamina propria, myenteric plexus, submucosa, and tunica muscularis by LCM. Site-specific marker expression by nCounter technology was performed on total RNA from each sub-region, respectively.

KEY RESULTS

Collecting ~10 mm² (~100 000-250 000 cells) of tissue from the epithelial layer, lamina propria, and myenteric plexus provided sufficient amounts of RNA of appropriate quality for subsequent analyses. In contrast, ~40 mm² (~250 000-650 000 cells) of tissue were dissected from the less cell-rich submucosal and tunica muscularis layer. nCounter analysis revealed a site-specific expression pattern of marker genes in the different layers of the colonic wall which were highly correlating (r > .9).

CONCLUSIONS AND INFERENCES

LCM in combination with nCounter expression analysis enables site-specific, sensitive, reliable detection, and quantification of mRNA from histologically heterogeneous tissues.

Lamin B1 regulates somatic mutations and progression of B-cell malignancies

Somatic hypermutation (SHM) is a pivotal process in adaptive immunity that occurs in the germinal centre and allows B cells to change their primary DNA sequence and diversify their antigen receptors. Here, we report that genome binding of Lamin B1, a component of the nuclear envelope involved in epigenetic chromatin regulation, is reduced during B-cell activation and formation of lymphoid germinal centres. Chromatin immunoprecipitation-Seq analysis showed that kappa and heavy variable immunoglobulin domains were released from the Lamin B1 suppressive environment when SHM was induced in B cells. RNA interference-mediated reduction of Lamin B1 resulted in spontaneous SHM as well as kappa-light chain aberrant surface expression. Finally, Lamin B1 expression level correlated with progression-free and overall survival in chronic lymphocytic leukaemia, and was strongly involved in the transformation of follicular lymphoma. In summary, here we report that Lamin B1 is a negative epigenetic regulator of SHM in normal B-cells and a 'mutational gatekeeper', suppressing the aberrant mutations that drive lymphoid malignancy.