Clinical genomics expands the morbid genome of intellectual disability and offers a high diagnostic yield

Intellectual disability (ID) is a measurable phenotypic consequence of genetic and environmental factors. In this study, we prospectively assessed the diagnostic yield of genomic tools (molecular karyotyping, multi-gene panel and exome sequencing) in a cohort of 337 ID subjects as a first-tier test and compared it with a standard clinical evaluation performed in parallel. Standard clinical evaluation suggested a diagnosis in 16% of cases (54/337) but only 70% of these (38/54) were subsequently confirmed. On the other hand, the genomic approach revealed a likely diagnosis in 58% (n=196). These included copy number variants in 14% (n=54, 15% are novel), and point mutations revealed by multi-gene panel and exome sequencing in the remaining 43% (1% were found to have Fragile-X). The identified point mutations were mostly recessive (n=117, 81%), consistent with the high consanguinity of the study cohort, but also X-linked (n=8, 6%) and de novo dominant (n=19, 13%). When applied directly on all cases with negative molecular karyotyping, the diagnostic yield of exome sequencing was 60% (77/129). Exome sequencing also identified likely pathogenic variants in three novel candidate genes (DENND5A, NEMF and DNHD1) each of which harbored independent homozygous mutations in patients with overlapping phenotypes. In addition, exome sequencing revealed de novo and recessive variants in 32 genes (MAMDC2, TUBAL3, CPNE6, KLHL24, USP2, PIP5K1A, UBE4A, TP53TG5, ATOH1, C16ORF90, SLC39A14, TRERF1, RGL1, CDH11, SYDE2, HIRA, FEZF2, PROCA1, PIANP, PLK2, QRFPR, AP3B2, NUDT2, UFC1, BTN3A2, TADA1, ARFGEF3, FAM160B1, ZMYM5, SLC45A1, ARHGAP33 and CAPS2), which we highlight as potential candidates on the basis of several lines of evidence, and one of these genes (SLC39A14) was biallelically inactivated in a potentially treatable form of hypermanganesemia and neurodegeneration. Finally, likely causal variants in previously published candidate genes were identified (ASTN1, HELZ, THOC6, WDR45B, ADRA2B and CLIP1), thus supporting their involvement in ID pathogenesis. Our results expand the morbid genome of ID and support the adoption of genomics as a first-tier test for individuals with ID.

Cation distribution dependent magnetic properties in CoCr2−xFexO4 (x = 0.1 to 0.5): EXAFS, Mössbauer and magnetic measurements

Evolution of structure and rich magnetic transitions such as paramagnetic to ferrimagnetic phase transition at Curie temperature (T_C), spiral ordering temperature (T_S) and lock-in temperature (T_L) have been discussed in CoCr₂O₄ spinel multiferroic after substituting Fe.

Pre-overloading to Extend Fatigue Life of Cast Clasps

Permanent deformation in bending is associated with the development of residual stresses. The objective of this study was to characterize those residual stresses and test whether they can be manipulated to extend the fatigue lives of cast clasps. Simulations with validated non-linear finite element models were used to characterize the residual stresses in clasps cast from Ti-6Al-7Nb, Co-Cr, and Type IV gold alloys. In addition, two groups of as-cast and pre-overloaded (subjected to a load that produced 20 μm of permanent deformation) Ti-6Al-7Nb clasps (10 specimens each) were subjected to cyclic 0.5-mm deflections at 5 Hz until fatigue. Pre-overloaded specimens demonstrated significantly longer fatigue lives (32,200 ± 17,300 cycles) than did those tested in the as-cast condition (17,900 ± 7600 cycles), consistent with the maximum tensile stress values revealed by finite element analysis.

[Incidence and causes of visual impairment in the district of Mahdia, in east Tunisia: Retrospective study of 1487 cases]

OBJECTIVE

To study socio-demographic characteristics and main causes related to visual impairment (VI) as a function of age bracket and to analyze their trends over time in the district of Mahdia.

METHOD

A retrospective review was performed on 1487 cases of visual impairment registered with the social authorities in Mahdia, between 1980 and 2013. The social, demographic, vision exam findings and causes were ascertained and analyzed in an SPSS database. Incidence rates of VI and blindness due to various causes were calculated based on the demographic data from the NSI to estimate the time trends using the general linear regression model and Spearman correlation.

RESULTS

Analyses included 1487 participants with a median age of 47 years, 40.6% of cases were aged under 45 years. Children accounted for 11.1% (165 patients), while age was between 16 and 45 years in 29.5% (439 patients), between 46 and 65 years in 31.5% (469 patients) and greater than 65 years in 27.8% (414 patients). The sex-ratio (M/F) was 1.78. Socially, 51% came from rural areas, 62% were illiterate, and 84% were unemployed. We observed blindness in 70% of participants and low vision in 30%. In children, the causes were dominated by congenital cataract and congenital glaucoma, each present in 31 children (18.8%). Between 16 and 45 years, glaucoma and hereditary dystrophies of the retina were found in 62 and 61 patients respectively (14% each). For age between 46 and 65 years, trachoma was responsible for 19.8% of cases of VI, glaucoma in 15.8% and cataract in 15.1%. Beyond 65 years, glaucoma accounted for 30.7% of the causes of VI and cataract 27.8% of cases. Trend analysis shows a significant increase in the incidence rate of visual impairment with an average of 12% per year (P=0.001). The mean age increased by 46% (P=0.003). Trachoma increased by 118% (P<0.0001) between 1980 and 1990, then declined by 42% (P=0.0013) between 1991 and 2013. Incidence of VI significantly increased by 4% for cataract (P=0.001), 23% (P=0.001) for glaucoma and 20% (P=0.02) for diabetic retinopathy, while VI related to refractive errors and AMD showed no significant change.

CONCLUSION

Advanced age, lower educational and socio-economic status were associated with bilateral VI. Age related eye problems are the main causes of VI, and their incidence is tending to increase. Public health policies and procedures should be targeted to risk related populations and age-related diseases in order to control the incidence of visual impairment and avoid its consequences.

Differences Regarding Branded HA in Italy, Part 2: Data from Clinical Studies on Knee, Hip, Shoulder, Ankle, Temporomandibular Joint, Vertebral Facets, and Carpometacarpal Joint

OBJECTIVES

The aim of the current study is to collect scientific data on all branded hyaluronic acid (HA) products in Italy that are in use for intra-articular (IA) injection in osteoarthritis (OA) compared with that reported in the leaflet.

METHODS

An extensive literature research was performed for all articles reporting data on the IA use of HA in OA. Selected studies were taken into consideration only if they are related to products based on HAs that are currently marketed in Italy with the specific joint indication for IA use in patients affected by OA.

RESULTS

Sixty-two HA products are marketed in Italy: 30 products are indicated for the knee but only 8 were proved with some efficacy; 9 products were effective for the hip but only 6 had hip indication; 7 products proved to be effective for the shoulder but only 3 had the indication; 5 products proved effective for the ankle but only one had the indication; 6 products were effective for the temporomandibular joint but only 2 had the indication; only 2 proved effective for vertebral facet joints but only 1 had the indication; and 5 products proved effective for the carpometacarpal joint but only 2 had the indication.

CONCLUSIONS

There are only a few products with some evidences, while the majority of products remain without proof. Clinicians and regulators should request postmarketing studies from pharmaceuticals to corroborate with that reported in the leaflet and to gather more data, allowing the clinicians to choose the adequate product for the patient.

The andrologist's contribution to a better life for ageing men: part 2

The long-term intake of a judiciously composed nutriceutical containing low-dose vitamins, antioxidants, minerals and particular herbal preparations seems justified for older persons who take medication, or who consume an unbalanced diet, or who are exposed to environmental toxins. Recent reports suggest these nutriceuticals may delay age-related diseases and the occurrence of cancer, and reduce mortality in apparently healthy ageing men. Food supplementation with a nutriceutical that was formulated particularly for ageing men should result in an increase of at least one quality-adjusted life year and may lower the financial and social burden of disease in elderly people.

Dual-function theranostic nanoparticles for drug delivery and medical imaging contrast: perspectives and challenges for use in lung diseases

Theranostic nanoparticles with both therapeutic and imaging abilities have the promise to revolutionize diagnosis, therapy, and prognosis. Early and accurate detection along with swift treatment are the most important steps in the successful treatment of any disease. Over the last decade, a variety of nanotechnology-based platforms have been created in the hope of improving the treatment and diagnosis of a wide variety of diseases. However, significant hurdles still remain before theranostic nanoparticles can bring clinical solutions to the fight against chronic respiratory diseases. Some fundamental issues such as long-term toxicity, a precise understanding of the accumulation, degradation and clearance of these particles, and the correlation between basic physicochemical properties of these nanoparticles and their in vivo behavior have to be fully understood before they can be used clinically. To date, very little theranostic nanoparticle research has focused on the treatment and diagnosis of chronic respiratory illnesses. Nanomedicine approaches incorporating these theranostic nanoparticles could potentially be translated into clinical advances to improve diagnosis and treatment of these chronic respiratory diseases and enhance quality of life for the patients.

High pressure elastic properties of minerals from ab initio simulations: the case of pyrope, grossular and andradite silicate garnets

A computational strategy is devised for the accurate ab initio simulation of elastic properties of crystalline materials under pressure. The proposed scheme, based on the evaluation of the analytical stress tensor and on the automated computation of pressure-dependent elastic stiffness constants, is implemented in the CRYSTAL solid state quantum-chemical program. Elastic constants and related properties (bulk, shear and Young moduli, directional seismic wave velocities, elastic anisotropy index, Poisson's ratio, etc.) can be computed for crystals of any space group of symmetry. We apply such a technique to the study of high-pressure elastic properties of three silicate garnet end-members (namely, pyrope, grossular, and andradite) which are of great geophysical interest, being among the most important rock-forming minerals. The reliability of this theoretical approach is proved by comparing with available experimental measurements. The description of high-pressure properties provided by several equations of state is also critically discussed.

Patency rates of portal vein/superior mesenteric vein reconstruction after pancreatectomy for pancreatic cancer

BACKGROUND

Pancreatectomy with venous reconstruction (VR) for pancreatic cancer (PC) is occurring more commonly. Few studies have examined the long-term patency of the superior mesenteric-portal vein confluence following reconstruction.

METHODS

From 2007 to 2013, patients who underwent pancreatic resection with VR for PC were classified by type of reconstruction. Patency of VR was assessed using surveillance computed tomographic imaging obtained from date of surgery to last follow-up.

RESULTS

VR was performed in 43 patients and included the following: tangential resection with primary repair (7, 16%) or saphenous vein patch (9, 21%); segmental resection with splenic vein division and either primary anastomosis (10, 23%) or internal jugular vein interposition (8, 19%); or segmental resection with splenic vein preservation and either primary anastomosis (3, 7%) or interposition grafting (6, 14%). All patients were instructed to take aspirin after surgery; low molecular weight heparin was not routinely used. An occluded VR was found in four (9%) of the 43 patients at a median follow-up of 13 months; median time to detection of thrombosis in the four patients was 72 days (range 16-238).

CONCLUSIONS

Pancreatectomy with VR can be performed with high patency rates. The optimal postoperative pharmacologic therapy to prevent thrombosis requires further investigation.

Nuclear forward scattering of synchrotron radiation by 99Ru

We measured nuclear forward scattering spectra utilizing the (99)Ru transition, 89.571(3) keV, with a notably mixed E2/M1 multipolarity. The extension of the standard evaluation routines to include mixed multipolarity allows us to extract electric and magnetic hyperfine interactions from (99)Ru-containing compounds. This paves the way for several other high-energy Mössbauer transitions, E ∼ 90 keV. The high energy of such transitions allows for operando nuclear forward scattering studies in real devices.

Ab initio investigation of electronic and vibrational contributions to linear and nonlinear dielectric properties of ice

Electronic and vibrational contributions to the static and dynamic (hyper)polarizability tensors of ice XI and model structures of ordinary hexagonal ice have been theoretically investigated. Calculations were carried out by the finite field nuclear relaxation method for periodic systems (FF-NR) recently implemented in the CRYSTAL code, using the coupled-perturbed Kohn-Sham approach (CPKS) for evaluating the required electronic properties. The effect of structure on the static electronic polarizabilities (dielectric constants) and second-hyperpolarizabilities is minimal. On the other hand, the vibrational contributions to the polarizabilities were found to be significant. A reliable evaluation of these (ionic) contributions allows one to discriminate amongst ice phases characterized by different degrees of proton-order, primarily through differences caused by librational motions. Transverse static and dynamic vibrational (hyper)polarizabilities were found by extrapolating calculations for slabs of increasing size, in order to eliminate substantial surface contributions.

Corneal curvature gradient map: a new corneal topography map to predict the corneal healing process

PURPOSE

To evaluate a new curvature gradient topography map to predict postoperative corneal remodeling.

METHODS

In this retrospective study, 32 eyes of 16 patients with myopia underwent excimer ablation surgery with a postoperative high curvature gradient. The new curvature gradient map (acquired immediately postoperatively) shows the difference between the curvatures of two points over the distance between them; it was compared to the tangential curvature difference map between 1 and 12 months postoperatively to determine their relationship. Corneas were divided into 12 regions for analysis: four 90°-wide sectors centered on 0°, 90°, 180°, and 270°. There were three subdivisions in each sector: central (radius: 0 to 2.75 mm), paracentral (radius: 2.75 to 3.25 mm), and peripheral (radius: 3.25 to 4.5 mm). Linear regression analysis was performed by region.

RESULTS

The following regions had significant relationships between the initial curvature gradient and curvature difference between 1 and 12 months postoperatively: the paracentral zone of the 90° sector (P = .0145; R(2) = 0.1832) and both the central (P = .0034; R(2) = 0.2522) and paracentral (P = .0452; R(2) = 0.1271) zones of the 270° sector. The greatest average initial tangential curvature was in the 270° sector.

CONCLUSIONS

The initial curvature gradient after surgery predicted change in tangential curvature over the subsequent 12 months in areas where initial tangential curvature was greatest. When the curvature gradient was high, the surface curvature modification remained in progress months after surgery.

Pressurised electro-osmotic dewatering of activated and anaerobically digested sludges: electrical variables analysis

Pressurised electro-osmotic dewatering (PEOD) of two sewage sludges (activated and anaerobically digested) was studied under constant electric current (C.C.) and constant voltage (C.V.) with a laboratory chamber simulating closely an industrial filter. The influence of sludge characteristics, process parameters, and electrode/filter cloth position was investigated. The next parameters were tested: 40 and 80 A/m², 20, 30, and 50 V-for digested sludge dewatering; and 20, 40 and 80 A/m², 20, 30, and 50 V-for activated sludge dewatering. Effects of filter cloth electric resistance and initial cake thickness were also investigated. The application of PEOD provides a gain of 12 points of dry solids content for the digested sludge (47.0% w/w) and for the activated sludge (31.7% w/w). In PEOD processed at C.C. or at C.V., the dewatering flow rate was similar for the same electric field intensity. In C.C. mode, both the electric resistance of cake and voltage increase, causing a temperature rise by ohmic effect. In C.V. mode, a current intensity peak was observed in the earlier dewatering period. Applying at first a constant current and later on a constant voltage, permitted to have better control of ohmic heating effect. The dewatering rate was not significantly affected by the presence of filter cloth on electrodes, but the use of a thin filter cloth reduced remarkably the energy consumption compared to a thicker one: 69% of reduction energy input at 45% w/w of dry solids content. The reduction of the initial cake thickness is advantageous to increase the final dry solids content.

Novel diabetes mellitus treatment: mature canine insulin production by canine striated muscle through gene therapy

Muscle-targeted gene therapy using insulin genes has the potential to provide an inexpensive, low maintenance alternative or adjunctive treatment method for canine diabetes mellitus. A canine skeletal muscle cell line was established through primary culture, as well as through transdifferentiation of canine fibroblasts after infection with a myo-differentiation gene containing adenovirus vector. A novel mutant furin-cleavable canine preproinsulin gene insert (cppI4) was designed and created through de novo gene synthesis. Various cell lines, including the generated canine muscle cell line, were transfected with nonviral plasmids containing cppI4. Insulin and desmin immunostaining were used to prove insulin production by muscle cells and specific canine insulin ELISA to prove mature insulin secretion into the medium. The canine myoblast cultures proved positive on desmin immunostaining. All cells tolerated transfection with cppI4-containing plasmid, and double immunostaining for insulin and desmin proved present in the canine cells. Canine insulin ELISA assessment of medium of cppI4-transfected murine myoblasts and canine myoblast and fibroblast mixture proved presence of mature fully processed canine insulin, 24 and 48 h after transfection. The present study provides proof of principle that canine muscle cells can be induced to produce and secrete canine insulin on transfection with nonviral plasmid DNA containing a novel mutant canine preproinsulin gene that produces furin-cleavable canine preproinsulin. This technology could be developed to provide an alternative canine diabetes mellitus treatment option or to provide a constant source for background insulin, as well as C-peptide, alongside current treatment options.

First Report of Charcoal Rot Caused by Macrophomina phaseolina in Sunflower in Turkey

Charcoal rot symptoms were observed on 2-month-old oilseed sunflower plants (Helianthus annuus L.) in the Eskişehir Province of Turkey in June 2009. The disease was observed in 70% of the fields surveyed and incidence ranged from 10 to 50%. Symptoms were first observed in plants approaching physiological maturity and consisted of silver-gray lesions girdling the stem at the soil line, reduced head diameter compared with noninfected plants, and premature plant death. Pith in the lower stem was completely absent or compressed into horizontal layers. Black, spherical microsclerotia were observed in the pith area of the lower stem, underneath the epidermis, and on the exterior of the taproot. The internal stem had a shredded appearance. Later, the vascular bundles became covered with small, black flecks or microsclerotia of the fungus. Forty plant samples were collected from 10 fields. After surface sterilization with 2% NaOCl, outer tissues sampled from diseased tissues (2 to 3 mm long) of root and stems were removed and transferred to potato dextrose agar containing 250 mg liter^-1 of chloramphenicol. Petri plates were incubated for 7 days at 26 ± 2°C in the dark. Ninety-eight percent of the fungal colonies were identified as Macrophomina phaseolina (Tassi) Goidanich based on gray colony color, colony morphology, and the size of the microsclerotia, which ranged from 80 to 90 μm in diameter, from both infected sunflowers and compared with pure cultures (3). All resulting cultures produced abundant microsclerotia. The only other sunflower pathogen known to form microsclerotia is Verticillium dahliae Kleb., whose microsclerotia are irregular in shape and 15 to 50 μm in diameter. Sequence-related amplified polymorphisms technique was used for diversity of M. phaseolina since it has proven to be more informative than amplified fragment length polymorphism, random amplified polymorphic DNA, and simple sequence repeat (2). Results showed a high level of genetic diversity (60%) among the 26 isolates of M. phaseolina. Sequencing of the internal transcribed spacer region (1) showed high homology (>96%) to M. phaseolina (GenBank Accession No. HQ380051). Pathogenicity tests for 20 isolates of M. phaseolina were carried out on three commercially used cultivars, SANAY, TUNCA, and TR-3080. Groups of 10 seedlings were grown separately in an autoclaved peat/soil mixture in 30-cm-diameter plastic pots in a greenhouse at 30 ± 2°C. Soil infestation was performed 1 day before sowing. Two-week-old cultures on barley medium (4) were blended in distilled sterile water and adjusted to 10⁵ sclerotia ml^-1. Each pot received 250 ml of inoculant. Each treatment had three replications. Three pots for each cultivar were left uninoculated. Within 3 weeks, five to seven inoculated plants in each pot died. Identical disease symptoms were observed 30 days after inoculation; on the control plants no symptoms were observed. Microsclerotia were produced after 7 weeks at the stem base on 85% of the surviving plants. To our knowledge, this is the first report of M. phaseolina in sunflower in Turkey. References: (1) B. D. Babu et al. J. Plant Dis. Prot. 96:797, 2007. (2) H. Budak et al. Theor. Appl. Genet. 109:280, 2004. (3) P. Holliday and E. Punithalingam. No. 275 in: Description of Pathogenic Fungi and Bacteria. CMI, Kew, Surrey, UK, 1970. (4) M. R. Omar et al. J. Plant Dis. Prot. 114:196, 2007.

A comparison of surgical resection for distal esophageal, gastroesophageal junction, and proximal gastric cancers in the Memphis metropolitan area (MMA)

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Background: The incidence of distal esophageal (DE) and gastroesophageal junction (GEJ) tumors has increased rapidly in recent decades. They are often included in gastric cancer trials. The 7th AJCC staging has reclassified tumors of the DE, GEJ, and proximal stomach (PS) as esophageal cancers. We compared the historical management of these tumors in our community.

Methods: Review of all curative-intent DE, GEJ, and PS cancer resections at two healthcare institutions in the MMA from 1999-2008.

Results: Seventy patients were identified (Table). Males predominated. The histology was adenocarcinoma in 48% of DE, 91% of GEJ, and 100% of PS cancers. Preoperative endoscopic ultrasound (EUS) was performed in 10% of DE, 6% of GEJ, and 7% of PS patients. Neoadjuvant therapy was given to 29% of DE, 35% of GEJ and 0% of PS patients. R0 resection rates were similiar. Fewer DE and GEJ patients had up to 15 lymph nodes removed, yet lymph node metastasis was identified in 52% and 35% respectively, compared to 20% of PS patients (Table). Five-year survival rates were numerically higher in the DE and GEJ patients.

Conclusions: We identified differences in DE, GEJ, and PS tumors in a community setting with respect to preoperative management and lymph node sampling. Reclassification of DE, GEJ, and PS tumors by the AJCC suggests these groups now be treated uniformly as esophageal cancers, a shift from previous management as gastric cancers. Further, prospective evaluation is needed to assess the patterns of management and outcomes in tumors of the DE, GEJ and PS.

[Table: see text]

No significant financial relationships to disclose.

Short-term aromatase inhibition: effects on glucose metabolism and serum leptin levels in young and elderly men

OBJECTIVE

To assess and compare the effects of short-term aromatase inhibition on glucose metabolism, lipid profile, and adipocytokine levels in young and elderly men.

DESIGN AND METHODS

Ten elderly and nine young healthy men were randomized to receive letrozole 2.5 mg daily or placebo for 28 days in a crossover design.

RESULTS

Both in young and elderly men, active treatment significantly increased serum testosterone (+128 and +99%, respectively) and decreased estradiol levels (-41 and -62%, respectively). Fasting glucose and insulin levels decreased in young men after active intervention (-7 and -37%, respectively) compared with placebo. Leptin levels fell markedly in both age groups (-24 and -25%, respectively), while adiponectin levels were not affected by the intervention. Lipid profile was slightly impaired in both groups, with increasing low density lipoprotein-cholesterol levels (+14%) in the younger age group and 10% lower levels of APOA1 in the elderly. A decline in IGF1 levels (-15%) was observed in the younger age group. No changes in weight or body mass index were observed in either young or old men.

CONCLUSIONS

Short-term aromatase inhibition appears to affect glucose metabolism in young men, and lipid metabolism, including leptin secretion, in young and elderly men. Furthermore, the short period of exposure suggests that these changes might be mediated by direct effects of sex steroids rather than by changes in body composition.

Reconstructed epidermis and full-thickness skin for absorption testing: influence of the vehicles used on steroid permeation

A protocol for percutaneous absorption studies has been validated, based on the use of reconstructed human epidermis (RHE) and aqueous solutions of test substances. However, it is often the case that it is more-complex formulations of drugs or chemicals which will make contact with the skin surface. To investigate whether RHE and the reconstructed full-thickness skin model (FT-model) can be used to predict uptake from formulations, we compared the permeation of hydrocortisone and testosterone when applied in emulsion form and as a solution containing the penetration enhancer, ethanol. Human and pig skin and a non-cornified alveolar model served as references. The results were compared with steroid release from the formulations. The permeation rates of the steroids were ranked as: alveolar model >> RHE > FT-model, pig skin > human skin. In accordance with the rapid hydrocortisone release from the formulations, the permeation rates of this steroid exceeded those of testosterone. Only minor differences were observed when comparing the testosterone formulations, in terms of release and permeation. However, the ranking of the permeation of the hydrocortisone formulations was: solution > w/o emulsion > o/w emulsion, which permitted the elucidation of penetration enhancing effects, which is not possible with drug release studies. Differences in penetration were most obvious with native skin and reconstructed tissues, which exhibited a well-developed penetration barrier. In conclusion, RHE and skin preparations may be useful in the development of topical dermatics, and in the framework of hazard analysis of toxic compounds and their various formulations.

The decline of serum testosterone levels in community-dwelling men over 70 years of age: descriptive data and predictors of longitudinal changes

OBJECTIVE

This study was designed to assess longitudinal changes in serum testosterone levels, explore relationships with aging, genetic-, health-, and lifestyle-related factors, and investigate predictors of changes in healthy elderly men.

DESIGN

Population-based, longitudinal, 4-year observational study in 221 community-dwelling men aged 71-86 years at baseline.

METHODS

Hormone levels assessed by immunoassay, anthropometry, questionnaires on general health, and genetic polymorphisms. Predictors of changes in testosterone levels explored using linear mixed-effects modeling for longitudinal analyses.

RESULTS

Total testosterone (TT), free testosterone, and bioavailable testosterone (BioT) levels decreased with aging, decreases in BioT being most marked. No changes in sex hormone-binding globulin (SHBG) or estradiol (E(2)), while LH and FSH levels increased during follow-up. Subjects who gained weight displayed a greater decline in TT levels, mainly due to decreasing SHBG levels. However, baseline body composition was not predictive of subsequent changes in testosterone levels. Baseline E(2) (P=0.023 to 0.004), LH (P=0.046 to 0.005), and FSH (P<0.002) levels were independently positively associated with a faster decline in testosterone fractions, although only FSH remained significant when adjusting for baseline testosterone (P=0.041-0.035). Carriers of a 'TA' haplotype of the estrogen receptor alpha gene (ER alpha) PvuII and XbaI polymorphisms displayed a slower decline of TT and BioT (P=0.041-0.007).

CONCLUSIONS

In elderly men with already low serum testosterone levels, a further decline was observed, independent of baseline age. The identification of FSH levels as a predictor of this decline appears to reflect the testicular mechanisms of aging-related changes in testosterone production, whereas associations with E(2) and ER alpha polymorphisms are suggestive of estrogen-related processes, possibly related to changes in the neuroendocrine regulation of testosterone production.

Evidence for multiplication of the leafhopper-borne maize yellow stripe virus in its vector using ELISA and dot-blot hybridization

Maize yellow stripe virus (MYSV) has several features in common with tenuiviruses, but is transmitted by a leafhopper, Cicadulina chinai (Cicadellidae, Hemiptera), rather than planthoppers (Delphacidae, Hemiptera). Herein, MYSV was shown to be propagatively transmitted like tenuiviruses. MYSV RNA was not detected in leafhoppers by dot blot hybridization one day following a 2-day acquisition access period (AAP), but was detected in single or groups of leafhoppers 5-20 days post-acquisition. Likewise, capsid protein of MYSV was not detected by ELISA in single leafhoppers until the third day after the beginning of a 1- or 3-day AAP, but subsequently, mean absorbance values (405 nm) increased gradually, reaching their highest levels 8-14 days post-acquisition. The percentage of ELISA-positive leafhoppers also increased during the same period. Unlike most tenuiviruses, transovarial transmission of MYSV was not detected in 600 C. chinai nymphs that hatched from eggs laid by females that had acquired MYSV from diseased plants. The implications of our findings for MYSV classification are discussed.

Is inhibin B involved in the toxic effect of lead on male reproduction?

Human studies indicate exposure to lead is associated with decreased sperm quality with modest, if any, effects on conventional reproductive endocrine profile. Inhibin B is a marker of Sertoli cell function and spermatogenesis. The present study evaluates possible effects of lead exposure on serum levels of inhibin B in a group of lead workers as compared with a non-exposed group of hospital personnel. The study population included 68 healthy Belgian workers from a lead smelter (Hoboken, Belgium) and for comparison a control group of 91 hospital personnel (University Hospital Ghent, Belgium). Semen analysis and measurement of current blood lead levels and serum levels of inhibin B, follicle stimulating hormone (FSH) and estradiol (E2). Lead workers had significantly lower sperm concentration (35 vs. 51 million/mL) and higher serum inhibin B (259 vs. 177 pg/mL) as well as lead blood levels 30.9 vs. 3.4 mug/dL) compared with the hospital personnel (all p < 0.05). Serum FSH and E2 levels were similar in both groups. Overall, inhibin B levels correlated significantly positively with blood lead levels and sperm concentration while it was negatively correlated with serum FSH. In multiple regression analysis of data from all participants, blood lead and serum FSH (p < 0.0001 for both) followed by sperm count (p = 0.007) were selected as the only independent variables for inhibin B with an R-adjusted coefficient of determination of 0.3714. The results of the present study suggest that the exposure of the cells of Sertoli to excessive amounts of lead results in inappropriate inhibin B overproduction that may be involved in the impairment of spermatogenesis.

Reconstructed epidermis versus human and animal skin in skin absorption studies

European chemical policy in general and the REACH initiative in particular will increase the number of chemical substances submitted to toxicological evaluation by several orders of magnitude compared to the current status. To limit animal exposure the resulting enormous increase in testing, however, asks for validated in vitro test systems. While the OECD favours in vitro testing for cutaneous absorption using viable human and animal skin (Guideline 428) the availability of viable human skin is already limited today. We present a comparison of various in vitro techniques suitable for routine skin absorption studies including commercially available reconstructed human epidermis which may be a reliable alternative to excised human and animal skin. In order to develop a protocol for the subsequent transfer to partner laboratories the experimental set-up was analysed stepwise using the OECD reference compounds caffeine and testosterone. Franz cell type, the donor and receptor media for hydrophilic/lipophilic substances, albumin and tensid addition, and storage conditions of the excised skins were systematically varied. A protocol has been developed which now allows to proceed to the pre-validation process.

Combined conventional/antioxidant "Astaxanthin" treatment for male infertility: a double blind, randomized trial

AIM

To evaluate the treatment of male infertility with a strong natural antioxidant, in addition to conventional treatment.

METHODS

Using a double blind, randomized trial design, 30 men with infertility of > or =2 months and female partners with no demonstrable cause of infertility received conventional treatment according to the guidelines of the World Health Organization (WHO), and either a strong antioxidant Astaxanthin 16 mg/day (AstaCarox, AstaReal AB, Gustavsberg, Sweden) or placebo for 3 months. The effects of treatment on semen parameters, reactive oxygen species (ROS), zona-free hamster oocyte test, serum hormones including testosterone, luteinizing hormone (LH), follicle stimulating hormone (FSH) and Inhibin B, and spontaneous or intrauterine insemination (IUI)-induced pregnancies were evaluated.

RESULTS

ROS and Inhibin B decreased significantly and sperm linear velocity increased in the Astaxanthin group (n = 11), but not in the placebo group (n = 19). The results of the zona-free hamster oocyte test tended to improve in the Astaxanthin group in contrast with the placebo group, though not reaching statistical significance. The total and per cycle pregnancy rates among the placebo cases (10.5 % and 3.6 %) were lower compared with 54.5 % and 23.1 % respectively in the Astaxanthin group (P = 0.028; P = 0.036).

CONCLUSION

Although the present study suggests a positive effect of Astaxanthin on sperm parameters and fertility, the results need to be confirmed in a larger trial before recommending Astaxanthin for the complementary treatment of infertile men.

Corneal flap thickness and topography changes induced by flap creation during laser in situ keratomileusis

PURPOSE

To determine the corneal flap thickness profile produced by 3 microkeratomes and the topographic changes induced by flap creation in laser in situ keratomileusis (LASIK).

SETTING

Cornea and Refractive Surgery Unit, Instituto de Microcirugia Ocular de Barcelona, Autonoma University, Barcelona, Spain.

METHODS

In this prospective consecutive nonrandomized comparative study, patients were divided into 2 groups. In Group 1 (75 eyes), 3 microkeratomes were used: Moria LSX One, Moria M2, and Amadeus (AMO); 25 eyes per microkeratome. Pachymetry was measured with a DGH pachymeter in the center of the cornea and 3.0 mm from the center at 4 cardinal points (superior, inferior, nasal, and temporal; 3 measurements at each point) before and after the cut. The flap thickness in each sector was calculated by subtracting the mean post-flap corneal thickness from the mean pre-flap corneal thickness. In Group 2 (33 eyes), the M2 microkeratome with a 130 microm plate was used to create a superotemporal hinged flap (9 eyes) or a superonasal hinged flap (24 eyes). The topographic change induced by the microkeratome cut was evaluated using 4 sequential data acquisitions by the Keratron Scout topographic unit (Optikon) before and immediately after the cut (before laser ablation). Cardinal and oblique astigmatism and change in the axis were calculated by vectorial analysis of the simulated keratometry. Topographic Zernike analysis was performed in a subgroup.

RESULTS

With the LSX One microkeratome, the mean flap thickness was 151.7 microm centrally, 161.9 microm superiorly, 151.4 microm inferiorly, 156.1 microm temporally, and 167.5 microm nasally. There was no statistically significant difference between the areas studied (P<.05). With the M2, the mean flap thickness was 131.7 microm centrally, 155.5 microm superiorly, 146.7 microm inferiorly, 143.7 microm temporally, and 160.5 microm nasally. There was a statistically significant difference between flap thickness centrally and in the other areas (P>.05). With the Amadeus microkeratome, the mean flap thickness was 140.0 microm centrally, 152.5 superiorly, 128.5 microm inferiorly, 145.0 microm temporally, and 147.0 microm nasally. Statistically significant differences (P>.05) were found in the 4 sectors of the flap. With vectorial analysis, there was no statistically significant difference between superonasal and superotemporal hinge placement in the cardinal and oblique components but there was a statistically significant difference in the axis change with both placements (P>.05).

CONCLUSIONS

The LSX One microkeratome was the most predictable. A significant difference was noted in all sectors except superiorly with the M2 and in all sectors with the Amadeus. No differences between nasal and superior hinge placement were found with the M2. Topographic Zernike analysis demonstrated a difference in the orientation of the induced coma as a function of hinge position.

Cutaneous Estradiol Permeation, Penetration and Metabolism in Pig and Man

AIM AND METHODS

Drug development in dermatotherapy and also development of transdermal therapeutic systems (TTS) demand high-predictive in vitro models to estimate drug levels in skin and systemic uptake. Here we compare three ready-to-use models, reconstructed human epidermis, split porcine skin and the perfused porcine forelimb. 17beta-Estradiol (E(2)), which is highly metabolized by skin cells, serves as model drug since E(2) application is of high relevance in hormone replacement therapy while topical E(2) may promote wound healing. E(2) TTS, gel and an ethanolic solution were investigated for cutaneous penetration, permeation and metabolism.

RESULTS

E(2) TTS enabled an E(2) uptake of 42.9% of the applied dose accompanied by a high percentage of E(2) metabolism (30% of the penetrated dose) in the perfused porcine forelimb. In Franz cell experiments with reconstructed human epidermis and split porcine skin, the gel allowed an E(2) uptake of 41.7 and 22.9% of the applied dose accompanied by a high E(2) metabolism (42.6 and 28.6% of the penetrated dose). Due to toxic effects of the vehicle, this was not true with an ethanolic solution, then E(2) permeation and metabolism were clearly diminished. Most importantly, the in vitro models proved to be predictive with respect to the E(2)/estrone ratio in female plasma under transdermal hormone replacement therapy.

CONCLUSION

In vitro tests should reduce the need for both animal and human studies for cutaneous uptake and metabolism in the future.