Role of the X-linked gene GPR174 in autoimmune Addison's disease

CONTEXT

Autoimmune endocrinopathies demonstrate a profound gender bias, but the reasons for this remain obscure. The 1000 genes on the X chromosome are likely to be implicated in this inherent susceptibility; various theories, including skewed X chromosome inactivation and fetal microchimerism, have been proposed. GPR174 is an Xq21 putative purinergic receptor that is widely expressed in lymphoid tissues. A single-nucleotide polymorphism, rs3827440, encoding Ser162Pro, has recently been associated with Graves' disease in Chinese and Polish populations, suggesting a role of this X chromosome gene in autoimmune disease.

OBJECTIVE

We investigated the role of rs3827440 in a UK cohort of patients with autoimmune Addison's disease (AAD). Samples from 286 AAD cases and 288 healthy controls were genotyped using TaqMan single-nucleotide polymorphism genotyping assays (C_25954273_10) on the Applied Biosystems 7900HT Fast real-time PCR system.

DESIGN

Using a dominant (present/absent) model, the serine-encoding T allele of rs3827440 was present in 189 of 286 AAD patients (66%) compared with 132 of 288 unaffected controls (46%) [P = .010, odds ratio 1.80 (5%-95% confidence interval 1.22-2.67)]. An allele dosage model found a significant excess of the T allele in AAD patients compared with controls [P = .03, odds ratio 1.34 (5%-95% confidence interval 1.07-1.67)].

CONCLUSION

We have demonstrated a significant association of this X chromosome-encoded immunoreceptor with AAD for the first time. This X-linked gene could have a more generalized role in autoimmunity pathogenesis: G protein-coupled receptors are promising drugable targets, and further work to elucidate the functional role of GPR174 is now warranted.

Importance of getting the numbers right: quantifying the rapid and substantial decline of an abundant marsupial, Bettongia penicillata

Context A reliable measure of population size is fundamental to ecology and conservation but is often difficult to obtain. The woylie, Bettongia penicillata, provides an example where ‘getting the numbers right’ has important implications in verifying and quantifying the recent unexpected, rapid and substantial declines across much of its range. Initial estimates prompted a conservation-status upgrade for the species to Endangered by the Australian Government. The present paper constitutes the foundational paper addressing the first steps of a decline diagnosis framework intended to identify the causes of the recent declines. Aims To verify whether the declines in woylie trap-capture rates are representative of population change; better quantify the size of the largest woylie populations; and review what is understood about the ecology of the woylie and identify key knowledge gaps that may be relevant to identifying the causes of the recent declines. Methods Monitoring data from live-cage trapping (transects and grids), sandpads, woylie diggings and nest-density surveys and spotlighting were collated. Population measures derived from trapping data included capture rates, number of individuals, abundance estimates based on capture–mark–recapture modelling and density using spatially explicit capture–recapture models (SECR). Key results The declines in woylie trap-capture rates were verified as real population declines and corresponded closely with other measures of abundance derived from the same trapping data as well as with independent measures. A 95% decline occurred in the largest extant woylie populations (in the Upper Warren region, Western Australia) between 2002 and 2008. At a species level, woylies declined ~90% (1999–2006), from a peak of ~200 000 individuals in 1999. Conclusions An accurate formal conservation status is an important factor in promoting the conservation of a species. It is recommended that the woylie be considered for Critically Endangered status under the Australian EPBC Act. Implications Adequate and effective monitoring of species is critical to detecting and quantifying population changes in a timely manner. Having an accurate measure of population size can have a significant impact on the effectiveness of conservation and management efforts.

Multiple large enteroliths associated with an incisional hernia: a rare case

The surgeon frequently encounters renal and biliary stones but rarely may also encounter enteric stones or enteroliths. An enterolith is a stony foreign body that is formed in the gastrointestinal tract. We present a rare case of multiple, large enteroliths found associated with a longstanding incarcerated incisional hernia.

Improving outcomes for psychoses through the use of psycho-education; preliminary findings

A psycho-education programme is provided for patients suffering from psychosis in Scotland's only high secure hospital. An 18-month pilot study was carried out with consecutive case sample (treatment group) and 'treatment as usual' comparison group (control group). Pre, post and 6-month follow-up assessments were carried out. A range of outcome measures were used, including two measures of knowledge: a self-report assessment tool - Forensic Assessment of Knowledge Tool and the Understanding Medication Questionnaire. Other measures were used to establish level of insight, Schedule for the Assessment of Insight and assess mental state [Positive and Negative Syndrome Scale (PANSS)]. Results from (n = 48) participants indicate no statistical difference between the treatment and control group scores on any assessment prior to commencement of the intervention, indicating a well-matched sample group. However, all four assessments showed statistically significant changes post group. Treatment group showed an ability to improve knowledge and retain information about psychosis, which may account for their improved mental state and level of insight. Despite methodological limitations and a small sample group, this project has given an early indication of the positive value of this psycho-education programme in a forensic setting.

Associations between the big five personality factors and multiple mini-interviews

Given the accumulating evidence that performance in medical school and beyond is related to personality, it is important for research to consider how personality assessment can be included as part of the process of selecting medical students. Interviews are one way of measuring personality and this study extends prior research investigating whether the multiple mini interview (MMI) is related to the five factor model of personality. In contrast to prior results (Kulasegaram et al. in Adv Health Sci Edu 15:415-423, 2010), examination of MMI scores for 868 applicants to an Australian medical school over 3 years showed significant uncorrected correlations every year with extraversion (.19, .19, .30) and conscientiousness (.20, .22, .25) and with agreeableness in 2 years (.17, .19). Investigation of personality at a facet-level revealed differing relationships with the MMI within the five factors of personality. MMI scores were also correlated in 2 years (.17, .22) with a situational judgment test of interpersonal understanding (UMAT Section 2) but were unrelated to tests of logical reasoning ability (UMAT Section 1), non-verbal reasoning (Section 3), or past academic performance (Higher School Certificate results).

Management of proximal femoral fractures 2011: Association of Anaesthetists of Great Britain and Ireland

There should be protocol-driven, fast-track admission of patients with hip fractures through the emergency department. Patients with hip fractures require multidisciplinary care, led by orthogeriatricians. Surgery is the best analgesic for hip fractures. Surgical repair of hip fractures should occur within 48 hours of hospital admission. Surgery and anaesthesia must be undertaken by appropriately experienced surgeons and anaesthetists. There must be high-quality communication between clinicians and allied health professionals. Early mobilisation is a key part of the management of patients with hip fractures. Pre-operative management should include consideration of planning for discharge from hospital. Measures should be taken to prevent secondary falls. 10. Continuous audit and targeted research is required in order to inform and improve the management of patients with hip fracture.

Is laparoscopic appendicectomy a safe procedure for trainees in the peripheral hospital setting?

Laparoscopic appendicectomy has become standard in the treatment of acute appendicitis in most hospitals in Ireland. Studies have shown that it is a safe procedure for trainees to perform. However, these studies were conducted in university teaching hospitals whereas a significant proportion of training in Ireland takes place in peripheral hospitals which provide a different training environment. The aim of this study was to determine whether laparoscopic appendicectomy is a safe procedure for surgical trainees to perform in a peripheral hospital setting. A retrospective analysis was performed of appendicectomies carried out at a peripheral hospital over a 12 month period. Comparisons were made between consultant surgeons and trainees for a variety of outcomes. Of 155 appendicectomies, 129 (83.2%) were performed laparoscopically, of which 10 (7.75%) were converted to open. Consultants performed 99 (77%) laparoscopic appendicectomies. There were no statistically significant differences between consultants and trainees in complication rates (19 (19.2%) vs. 4 (13.3%), p = 0.46), mean length of hospital stay (4.7 +/- 4.0 vs. 3.4 +/- 3.3 days, p = 0.13), or rate of conversion to open operation (9 (9.1%) vs. 1 (3.3%), p = 0.45). For cases of complicated appendicitis there were no significant differences between consultants and trainees in complication rates (12 vs. 2, p = 0.40) or length of hospital stay (6.4 +/- 3.9 vs. 4.7 +/- 5.6 days, p = 0.27). We conclude that laparoscopic appendicectomy is a safe procedure for trainees to perform in the peripheral hospital setting and should be incorporated into surgical training programs at an early stage of training.

Stellate ganglion blockade (SGB) for refractory index finger pain - a case report

OBJECTIVE

To identify through case study the presentation and possible pathophysiological cause of complex regional pain syndrome and its preferential response to stellate ganglion blockade.

SETTING

Complex regional pain syndrome can occur in an extremity after minor injury, fracture, surgery, peripheral nerve insult or spontaneously and is characterised by spontaneous pain, changes in skin temperature and colour, oedema, and motor disturbances. Pathophysiology is likely to involve peripheral and central components and neurological and inflammatory elements. There is no consistent approach to treatment with a wide variety of specialists involved. Diagnosis can be difficult, with over-diagnosis resulting from undue emphasis placed upon pain disproportionate to an inciting event despite the absence of other symptoms or under-diagnosed when subtle symptoms are not recognised. The International Association for the Study of Pain supports the use of sympathetic blocks to reduce sympathetic nervous system overactivity and relieve complex regional pain symptoms. Educational reviews promote stellate ganglion blockade as beneficial. Three blocks were given at 8, 10 and 13 months after the initial injury under local anaesthesia and sterile conditions. Physiotherapeutic input was delivered under block conditions to maximise joint and tissue mobility and facilitate restoration of function.

CONCLUSION

This case demonstrates the need for practitioners from all disciplines to be able to identify the clinical characteristics of complex regional pain syndrome to instigate immediate treatment and supports the notion that stellate ganglion blockade is preferable to upper limb intravenous regional anaesthetic block for refractory index finger pain associated with complex regional pain syndrome.

A novel hydrogen sulfide donor causes stomatal opening and reduces nitric oxide accumulation

Effects of hydrogen sulfide (H(2)S) on plant physiology have been previously studied, but such studies have relied on the use of NaSH as a method for supplying H(2)S to tissues. Now new compounds which give a less severe H(2)S shock and a more prolonged exposure to H(2)S have been developed. Here the effects of one such compound, GYY4137, has been investigated to determine its effects on stomatal closure in Arabidopsis thaliana. It was found that both NaSH and GYY4137 caused stomatal opening in the light and prevented stomatal closure in the dark. Nitric oxide (NO) has been well established as a mediator of stomatal movements and here it was found that both NaSH and GYY4137 reduced the accumulation of NO in guard cells, perhaps suggesting a mode of action for H(2)S in this system. GYY4137, and future related compounds, will be important tools to unravel the effects of plant exposure to H(2)S and to determine how H(2)S may fit into plant cell signalling pathways.

Nitric oxide scavenging by food: implications for in vivo effects of diet

Recent advice to the general public is to increase intake of fresh fruit and vegetables, a message based on the assumed benefits of the antioxidant content of plant substances. Although there have been numerous studies on the reactive oxide species scavenging of fresh food products, few studies have focused on whether or not compounds in the diet can modulate the levels of nitric oxide (NO). Nitric oxide is a key signalling molecule that controls vasodilation and blood pressure, along with a range of other physiological events. Here, it is shown that commonly used food substances, such as cabbage, broccoli, kidney bean and oranges, all have the capacity to scavenge NO from solution, and therefore can potentially alter the level of NO in humans, with ramifications for the physiological systems that NO regulates. Using spinach, at least one element of the NO scavenging ability was shown to be heat-unstable, although heat-treating of other leaf materials had little effect, showing that NO scavenging will still occur after cooking. It is proposed that the NO scavenging of dietary components needs to be investigated more thoroughly before the full effects of increasing antioxidants through increased intake of fresh fruit and vegetables can truly be understood.

The Efficacies of 3,4,3-LIHOPO and DTPA for Enhancing the Excretion of Plutonium and Americium from the Rat: Comparison with Other Siderophore Analogues

With DTPA as a comparison, the siderophore analogue code named 3,4,3-LIHOPO has been tested for its ability to remove 238Pu and 241Am from rats after their inhalation or intravenous injection as nitrate. The most effective treatment regimen for inhaled Pu was the repeated administration of 30 mumol kg-1 3,4,3-LIHOPO. By 7 days after exposure, the Pu contents of the lungs and total body were reduced respectively to 2 and 4% of those in untreated animals. These values were six and three times less than when DTPA was administered using the same protocol. For inhaled Am, 3,4,3-LIHOPO and DTPA were considered equally effective, the lung and total body contents being reduced respectively to 13 and 10% of those in controls. Some animals showed slight degenerative changes in the liver and proximal tubules of the kidneys after the repeated administration of 30 mumol kg-1 of 3,4,3-LIHOPO; however these changes were less marked than after DTPA treatment. After the intravenous injection of Pu, the most effective regimen was the single administration of 3 mumol kg-1 3,4,3-LIHOPO. The body content at 7 days was reduced to 7% controls compared with 19% after the repeated administration of 30 mumol kg-1 DTPA. At a dosage of 30 mumol kg-1, 3,4,3-LIHOPO was less effective owing to the higher retention of Pu in the liver. With repeated dosages of 30 mumol kg-1 3,4,3-LIHOPO was more effective than DTPA for the decorporation of Am; the body contents were 16 and 31% of those in controls respectively. Importantly, the body content was still reduced to 28% of control after a single administration of 3 mumol kg-1. The ligand 3,4,3-LIHOPO, which is also superior to other siderophore analogues, could represent a most significant development in the decorporation of Pu and Am.