The protective effect of farm animal exposure on childhood allergy is modified by NPSR1 polymorphisms

BACKGROUND

Little is known about the asthma candidate gene neuropeptide S receptor 1 (NPSR1) in relation to environmental exposures, but recent evidences suggest its role as an effect modifier.

OBJECTIVES

To explore the interaction between NPSR1 polymorphisms and environmental exposures related to farming lifestyle and to study the in vitro effects of lipopolysaccharide (LPS) stimulation on NPSR1 expression levels.

METHODS

We studied 3113 children from PARSIFAL, a European cross-sectional study on environmental/lifestyle factors and childhood allergy, partly focused on children brought up on a farm. Information on exposures and outcomes was primarily obtained from parental questionnaires. Seven tagging polymorphisms were analysed in a conserved haplotype block of NPSR1. Multivariate logistic regression was used to evaluate a multiplicative model of interaction. NPSR1 protein and messenger RNA (mRNA) levels in monocytes were measured after LPS stimulation by fluorescence activated cell sorting (FACS) and quantitative real-time polymerase chain reaction (PCR).

RESULTS

A strong interaction was seen between current regular contact to farm animals and several NPSR1 polymorphisms, particularly rs323922 and rs324377 (p<0.005), with respect to allergic symptoms. Considering the timing of initiation of such current regular farm animal contact, significant interactions with these and two additional polymorphisms (SNP546333, rs740347) were revealed. In response to LPS, NPSR1-A protein levels in monocytes were upregulated (p = 0.002), as were NPSR1-A mRNA levels (p = 0.02).

CONCLUSIONS

The effect of farm animal contact on the development of allergic symptoms in children is modified by NPSR1 genetic background.

Cloning, expression and characterisation of FKB-6, the sole large TPR-containing immunophilin from C. elegans

We have cloned, expressed, purified and characterised ceFKB-6, the only large tetratricopeptide repeat motif-containing immunophilin in Caenorhabditis elegans which is similar to the human orthologues FKBP51 and FKBP52. It shows increased peptidyl prolyl isomerase activity, the measured k(cat)/K(m) of 1.3 x 10(6) M(-1) s(-1)is twofold greater than that of hFKBP12 and hFKBP51. NMR studies of the interaction between FKB-6 and the C-terminal DAF-21 pentapeptide MEEVD show interactions consistent with those found between the large human immunophilin TPR domains and human Hsp90. In vivo localisation studies show that the fkb-6 gene is expressed in all stages from embryo to adult with predominant expression being noted in the adult dorsal and ventral nerve cords.

Beta-cell response to metformin-glibenclamide combination tablets (Glucovance) in patients with type 2 diabetes

This exploratory double-blind, randomised, 20-week study evaluated the mechanism of action of metformin-glibenclamide combination tablets (Glucovance) vs. metformin and glibenclamide in 50 type 2 diabetes patients inadequately controlled by diet and exercise. A glycaemic target of HbA1C 7.0% was used. Final HbA(1C), fasting glucose and post-oral glucose tolerance test (OGTT) glucose were similar between groups, although average doses of metformin and glibenclamide from combination tablets (708 and 3.5 mg) were lower than monotherapy doses (1500 and 6.6 mg). Second-phase insulin during a hyperglycaemic clamp increased by 93% with combination tablets, 36% with metformin and 46% with glibenclamide. The insulin response post-OGTT was more rapid with the combination tablets vs. glibenclamide. First-phase insulin responses improved modestly in all groups, possibly due to reduced glucotoxicity. Changes in insulin sensitivity were minor. Larger beta-cell responses between combination tablets and glibenclamide may reflect more rapid glibenclamide absorption.

Metformin-glibenclamide versus metformin plus rosiglitazone in patients with type 2 diabetes inadequately controlled on metformin monotherapy

AIM

This double-blind study evaluated the efficacy and safety of metformin-glibenclamide tablets vs. metformin plus rosiglitazone therapy in patients with type 2 diabetes inadequately controlled on metformin monotherapy.

SUBJECTS AND METHODS

After an open-label, metformin lead-in phase, 318 patients were randomly assigned to treatment based on metformin-glibenclamide 500/2.5 mg tablets (initial daily dose 1000/5 mg) or metformin 500 mg plus rosiglitazone 4 mg (initial daily dose 1000-2000 mg + 4 mg, depending on previous treatment) for 24 weeks. Doses were titrated to achieve the therapeutic glycaemic target. The primary efficacy variable was the change in HbA1C.

RESULTS

At week 24, metformin-glibenclamide tablets resulted in significantly greater reductions in HbA1C (-1.5%) and fasting plasma glucose [-2.6 mmol/l (-46 mg/dl)] than metformin plus rosiglitazone [-1.1%, p < 0.001; -2 mmol/l (-36 mg/dl), p = 0.03]. More patients receiving metformin-glibenclamide attained HbA1C <7.0% than did those in the metformin plus rosiglitazone group (60 vs. 47%) and had fasting plasma glucose levels <7 mmol/l (<126 mg/dl) by week 24 (34 vs. 25%). Both treatments were well tolerated. Frequency of adverse gastrointestinal events was comparable between groups. Four per cent of patients receiving metformin-glibenclamide withdrew because of symptomatic hypoglycaemia contrasted with 3% of patients receiving metformin plus rosiglitazone who withdrew because of persistent hyperglycaemia. Hypoglycaemic events were mild or moderate in intensity and were easily self-managed.

CONCLUSIONS

Metformin-glibenclamide tablets resulted in significantly greater reductions in HbA1C and fasting plasma glucose compared with metformin plus rosiglitazone in patients with type 2 diabetes inadequately controlled on metformin monotherapy.

Postmortem diagnosis of chronic granulomatous disease: how worthwhile is it?

A previously healthy 11 year old boy died unexpectedly after a rapid course of progressive pneumonia. Postmortem microbiology and histopathology suggested an underlying diagnosis of chronic granulomatous disease. This was confirmed by neutrophil oxidative burst and gene mutation analysis of other family members, one of whom benefited from early bone marrow transplantation.

Mum knows best? Psychological status in an oncology sample

OBJECTIVE

To examine the influence of age, gender and diagnosis upon agreement of children's psychological status between children with cancer and their parents.

METHODS

Total 51 families (49 mothers, 45 fathers and 51 children) completed the Strengths and Difficulties Questionnaire. Children's ages ranged from 11 to 16 years, with a mean age of 13.4 years. Eleven of the children had central nervous system (CNS) disease.

RESULTS

Age, gender and diagnosis did not impact upon level of agreement between parents and children. There were no significant differences between father/child and mother/child reports of children's psychological status.

CONCLUSIONS

Both mothers and fathers are perceptive to their child's psychological status, and it is therefore satisfactory to consider their opinions about their children. Children in the age range 11-16 years are able to express their views with as much accuracy as parents irrespective of their gender and diagnosis and so should be included in assessment.

Global analysis of uniparental disomy using high density genotyping arrays

BACKGROUND

Uniparental disomy (UPD), the inheritance of both copies of a chromosome from a single parent, has been identified as the cause for congenital disorders such as Silver-Russell, Prader-Willi, and Angelman syndromes. Detection of UPD has largely been performed through labour intensive screening of DNA from patients and their parents, using microsatellite markers.

METHODS

We applied high density single nucleotide polymorphism (SNP) microarrays to diagnose whole chromosome and segmental UPD and to study the occurrence of continuous or interspersed heterodisomic and isodisomic regions in six patients with Silver-Russell syndrome patients who had maternal UPD for chromosome 7 (matUPD7).

RESULTS

We have devised a new high precision and high-throughput computational method to confirm UPD and to localise segments where transitions of UPD status occur. Our method reliably confirmed and mapped the matUPD7 regions in all patients in our study.

CONCLUSION

Our results suggest that high density SNP arrays can be reliably used for rapid and efficient diagnosis of both segmental and whole chromosome UPD across the entire genome.

Efficacy, dose-response relationship and safety of once-daily extended-release metformin (Glucophage XR) in type 2 diabetic patients with inadequate glycaemic control despite prior treatment with diet and exercise: results from two double-blind, placebo-controlled studies

AIM

The efficacy, dose-response relationships and safety of an extended-release formulation of metformin (Glucophage) XR) were evaluated in two double-blind, randomized, placebo-controlled studies of 24 and 16 weeks' duration, in patients with inadequate glycaemic control despite diet and exercise. Protocol 1 provided an evaluation of metformin XR at a commonly used dosage. Protocol 2 evaluated different dosages of metformin XR.

METHODS

In Protocol 1, 240 patients were randomized to receive metformin XR 1000 mg once daily. or placebo in a 2:1 ratio for 12 weeks (patients could receive metformin XR 1500 mg during weeks 12-24 if required). In Protocol 2, 742 patients were randomized to receive metformin XR 500 mg once daily, 1000 mg once daily, 1500 mg once daily, 2000 mg once daily, 1000 mg twice daily or placebo for 16 weeks. The primary endpoint in each study was the change from baseline in HbA(1C) at 12 weeks (Protocol 1) or 16 weeks (Protocol 2).

RESULTS

Metformin XR reduced HbA(1C) in Protocol 1, with mean treatment differences for 1000 mg once daily vs. placebo of -0.7% at 12 weeks and -0.8% at 24 weeks (p < 0.001 for each). In Protocol 2, a clear dose-response relationship was evident at doses up to 1500 mg, with treatment differences vs. placebo of -0.6% (500 mg once daily), -0.7% (1000 mg once daily), -1.0% (1500 mg once daily) and -1.0% (2000 mg once daily). The efficacy of metformin XR 2000 mg once daily and 1000 mg twice daily were similar (mean treatment differences vs. placebo in HbA(1C) were -1.0% and -1.2%, respectively). More patients achieved HbA(1C) < 7.0% with metformin XR vs. placebo in Protocol 1 (29% vs. 14% at 12 weeks) and with once-daily metformin XR in Protocol 2 (up to 36% vs. 10% at 16 weeks). No significant changes in fasting insulin or body weight occurred. Total and low-density lipoprotein (LDL)-cholesterol improved (p < 0.05-p < 0.001) in metformin XR groups in Protocol 2. Metformin XR was well tolerated; gastrointestinal side effects were more common with metformin XR vs. placebo, but few patients withdrew for this reason (1.3% vs. 1.3% in Protocol 1 and 1.6% vs. 0.9% in Protocol 2).

CONCLUSIONS

Once-daily metformin XR presents an effective and well-tolerated therapeutic option for delivering metformin in a convenient manner, which supports good compliance with therapy.

Preparing to respond: Joint Trauma Training Center and USAF Nursing Warskills Simulation Laboratory

Injuries related to the events of September 11, 2001, and continuing military actions associated with Operation Enduring Freedom underscore the accurate focus of the Joint Trauma Training Center and the Warskills Simulation Laboratory. These two programs ensure that nurses are prepared to respond to diverse medical situations worldwide. Outcome measures from both initiatives attest to the effectiveness of an integrated program that facilitates critical thinking skills and clinical judgment to increase the nurses' ability to provide trauma care to severely injured military personnel.

Drosophila yolk protein produced in E. coli is accumulated by mosquito ovaries

Despite similar functions, the yolk proteins of the higher dipteran flies and the vitellogenins found in other insects are unrelated at the sequence level and have evolved from different genes. Both are selectively endocytosed into the ovary via receptors belonging to the LDLR receptor subfamily. We cloned the Drosophila yp1 gene into an E. coli expression vector and showed that the yolk protein produced by E. coli is taken up into ovaries of both Drosophila melanogaster and the malaria mosquito Anopheles gambiae, which normally uses vitellogenin.

Crystallization and preliminary X-ray analysis of ocr, the product of gene 0.3 of bacteriophage T7

Ocr, the product of gene 0.3 of bacteriophage T7, prevents the action of restriction endonucleases of the host bacteria. The amino-acid sequence of ocr has less than 20% similarity to any protein of known three-dimensional structure. Ocr has been crystallized in a number of different crystal forms and X-ray data for the seleno-L-methionine-substituted form has been collected to a resolution of 1.8 A. The presence of caesium was found to be required for good crystal growth. Anomalous X-ray data was used to identify possible positions for Se and Cs atoms in the unit cell.

Knowledge, attitudes, and self-efficacy and compliance with medical regimen, number of emergency department visits, and hospitalizations in adults with asthma

PURPOSE

The purpose of this study was to examine the relationship between knowledge, attitudes, and self-efficacy and compliance with prescribed medical regimen, number of emergency department (ED) visits, and hospitalizations in adults with asthma.

METHOD

The sample consisted of 29 adults with a diagnosis of asthma. The relationship among knowledge, attitudes, self-efficacy, and compliance with medical regimen was explored through use of a survey design. The Knowledge, Attitude, and Self-Efficacy Asthma Questionnaire and the Asthma Management Questionnaire that measured compliance were mailed to subjects' homes. Once completed, questionnaires were returned, and demographic data and number of ED visits and hospitalizations were obtained through a retrospective chart review.

RESULTS

There was a significant correlation between knowledge and attitudes and knowledge and self-efficacy. The more positive persons' attitudes toward their asthma, the higher their knowledge and self-efficacy scores. There were significant correlations between select demographic variables and knowledge, attitude, and self-efficacy. Women scored higher on attitudes, persons with a college education scored higher on knowledge and attitudes, and persons with mild asthma scored highest on the self-efficacy scale. Compliance with use of peak-flow meters correlated with higher scores on the attitude and self-efficacy scales. The higher total compliance score group had significantly higher self-efficacy scores. In addition, higher self-efficacy scores correlated with lower numbers of hospitalizations.

CONCLUSION

Attitudes and self-efficacy rather than knowledge had the most significant impact on compliance and number of ED visits and hospitalizations. The Knowledge, Attitude, and Self-Efficacy Asthma Questionnaire provides a means for nurses to assess patients' knowledge, attitudes, and self-efficacy regarding their asthma. Patients with low scores could be channeled into programs that would help them improve their ability to manage their asthma.

Photodynamic therapy: another option in cancer treatment

Photodynamic therapy (PDT)--also called phototherapy, photoradiation therapy, or photochemotherapy--is a relatively new treatment option being used to treat certain types of cancer, including endobronchial and esophageal cancers. PDT is a two-step process that involves administration of a photosensitizing agent followed by exposure to non thermal laser light. Intensive patient education and support are required during PDT. In the immediate post-procedure period, patients require intensive monitoring to ensure that a patient airway is maintained and pain is alleviated. Photosensitivity persist for four to six weeks post-PDT; to avoid photosensitivity reactions, patients must adhere to specific recommendations to avoid exposure to light. PDT is noted for extending the life expectancy and improving the quality of life of patients.

Angiotensin-I converting enzyme genotype-dependent benefit from hormone replacement therapy in isometric muscle strength and bone mineral density

Low bone mineral density (BMD) and muscle weakness are major risk factors for postmenopausal osteoporotic fracture. Hormone replacement therapy (HRT) reverses the menopausal decline in maximum voluntary force of the adductor pollicis and reduces serum angiotensin-I converting enzyme (ACE) levels. The insertion (I) allele of the ACE gene polymorphism is associated with lower ACE activity and improved muscle efficiency in response to physical training. Therefore, we examined whether the presence of the I allele in postmenopausal women would affect the muscle response to HRT. Those taking HRT showed a significant gain in normalized muscle maximum voluntary force slope, the rate of which was strongly influenced by ACE genotype (16.0 +/- 1.53%, 14.3 +/- 2.67%, and 7.76 +/- 4.13%, mean +/- SEM for II, ID, and DD genotype, respectively; P = 0.017 for gene effect, P = 0.004 for I allele effect). There was also a significant ACE gene effect in the response of BMD to HRT in Ward's triangle (P = 0.03) and a significant I allele effect in the spine (P = 0.03), but not in the neck of femur or total hip. These data suggests that low ACE activity associated with the I allele confers an improved muscle and BMD response in postmenopausal women treated with HRT.

The relationship between comorbid personality disorders and treatment received in patients with anxiety disorders

Few studies have addressed the relationship between the presence of a comorbid personality disorder and the amount of psychiatric treatment received by patients with an Axis I disorder. This issue has not been studied in patients with anxiety disorders. In a prospective, naturalistic, longitudinal study of anxiety disorders, 526 subjects were assessed with the Personality Disorder Examination, and types of treatment received in 1991 and 1996 were identified. In 1991, compared to subjects without a personality disorder, subjects with a personality disorder were as likely to receive medication and they received a greater number of medications. Subjects with borderline personality disorder were more likely to receive heterocyclic antidepressants and interventions characteristic of psychodynamic psychotherapy and cognitive therapy; they also reported receiving a greater number of medications and types of psychosocial treatment than other subjects. In 1996, subjects with borderline personality disorder were more likely to receive psychodynamic interventions. These findings suggest that in patients with an anxiety disorder, the presence of a comorbid personality disorder is associated with receiving a greater number of medications but not with a greater likelihood of receiving pharmacologic or psychosocial treatment. However, the presence of borderline personality disorder is associated with a greater likelihood of receiving, and receiving a greater number of, certain types of somatic and psychosocial treatments.

Cardiac sympathetic denervation in Parkinson disease

BACKGROUND

In Parkinson disease, orthostatic hypotension can result from L-dopa treatment or from sympathetic neurocirculatory failure. The latter is detected by abnormal blood pressure responses to the Valsalva maneuver and can be associated with loss of functional cardiac sympathetic nerve terminals.

OBJECTIVE

To determine the frequency of cardiac sympathetic denervation in Parkinson disease, with or without sympathetic neurocirculatory failure, and its association with disease duration, severity, and L-dopa treatment

DESIGN

Intergroup comparisons in resting patients.

SETTING

National Institutes of Health Clinical Center, Bethesda, Maryland.

PATIENTS

29 patients with Parkinson disease (9 with sympathetic neurocirculatory failure, 10 who had stopped receiving or had never been treated with L-dopa), 24 patients with multiple-system atrophy (17 with sympathetic neurocirculatory failure, 8 receiving L-dopa), 7 patients with pure autonomic failure, 33 controls with episodic or persistent orthostatic intolerance without sympathetic neurocirculatory failure, and 19 normal volunteers.

MEASUREMENTS

Beat-to-beat blood pressure responses to the Valsalva maneuver, interventricular septal 6-[18F]fluorodopamine-derived radioactivity, cardiac extraction fraction of [3H]norepinephrine, appearance rate of norepinephrine in coronary sinus plasma (cardiac norepinephrine spillover) and venous-arterial differences in levels of dihydroxyphenylglycol (DHPG) and endogenous L-dopa.

RESULTS

Of the 29 patients with Parkinson disease, 9 with sympathetic neurocirculatory failure and 11 without had low septal 6-[18F]fluorodopamine-derived radioactivity (2861 +/- 453 Bq/mL per MBq/kg and 5217 +/- 525 Bq/mL per MBq/kg, respectively). All 6 patients with Parkinson disease and decreased 6-[18F]fluorodopamine-derived radioactivity who underwent right-heart catheterization had a decreased cardiac extraction fraction of [3H]norepinephrine and virtually no cardiac norepinephrine spillover or venous-arterial increments in plasma levels of DHPG and L-dopa. Sympathetic neurocirculatory failure and decreased 6-[18F]fluorodopamine-derived radioactivity were unrelated to disease duration, disease severity, or L-dopa treatment

CONCLUSIONS

Many patients with Parkinson disease-including all those with sympathetic neurocirculatory failure-have evidence of cardiac sympathetic denervation. This suggests that loss of catecholamine innervation in Parkinson disease occurs in the nigrostriatal system in the brain and in the sympathetic nervous system in the heart

Armadillo exposure and Hansen's disease: an epidemiologic survey in southern Texas

BACKGROUND

Naturally occurring leprosy has been demonstrated in wild nine-banded armadillos (Dasypus novemcinctus ). This suggests a possible mode of transmission of human leprosy in regions where armadillo contact is prevalent.

OBJECTIVE

Our purpose was to study the possible relationship between armadillo exposure and Hansen's disease.

METHOD

One hundred one patients (67 men, 34 women) with established Hansen's disease seen in the Hansen's Disease Clinic in Houston, Texas, were questioned about their exposure to armadillos. These patients were divided into two groups: Asian (n = 32) and non-Asian (n = 69).

RESULTS

Seventy-one percent of the non-Asian patients surveyed reported either direct or indirect armadillo exposure. None of the Asian patients reported armadillo exposure (P <.001). Of the non-Asian patients, 75.4% had lepromatous disease versus 50.0% of the Asian patients (P <.001). The average age at diagnosis for the non-Asian group with Hansen's disease in this study was 51 versus 38 years for the Asian group (P <.001).

CONCLUSION

Although it is yet to be determined whether direct transmission from the armadillo to human occurs, it is likely based on the high incidence of armadillo exposure in non-Asian patients with Hansen's disease in our study population that this animal acts as a reservoir for human disease. However, the Asian patients reporting no known armadillo exposure likely obtained the disease from person-to-person contact in their respective countries of origin where Hansen's disease has a much higher prevalence.

A randomized phase II study comparing four different interferon therapies in patients with recalcitrant condylomata acuminata

BACKGROUND

Interferon (IFN) alpha and IFN gamma have synergistic in vitro and in vivo effects and have each been used in the treatment of anogenital condylomata acuminata.

STUDY GOALS

To compare the efficacy and safety of regional 3 x 10(6) U IFN alpha (Group A), 3 x 10(6) U IFN gamma (Group B), 1.5 x 10(6) U IFN alpha plus 1.5 x 10(6) U IFN gamma (Group C), and 3 x 10(6) U IFN alpha plus 1.5 x 10(6) U IFN gamma (Group D) in the treatment of recalcitrant anogenital condylomata acuminata.

STUDY DESIGN

Six-week courses of regional IFNs were administered in a randomized, double-blind, multicenter study. Response was assessed as change in the total area affected by condylomata.

RESULTS

The treatments of Groups A, B, and C were similarly effective (complete response in 13.6%, 18.5%, and 16.0%, respectively). Group D had the lowest rate of complete response (3.8%), but this combination was the most effective when partial and complete responses were combined (73.0%).

CONCLUSION

Regional IFN is a moderately effective and safe treatment in patients with recalcitrant anogenital condylomata acuminata. Combinations of IFNs alpha and gamma were not superior to IFN monotherapy.

Cutaneous sarcoidosis in a patient with Philadelphia-positive chronic myelogenous leukemia treated with interferon-alpha

A patient with Philadelphia-positive (Ph+) chronic myelogenous leukemia (CML) was diagnosed with cutaneous sarcoidosis after treatment with interferon-alpha (IFN-alpha). Following IFN-alpha dose reduction, the skin lesions disappeared. Few cases of sarcoidosis associated with IFN treatment have been reported, and only in one patient with pre-existing CML. Our patient was unique in that (1) the sarcoidosis was induced by the IFN-alpha treatment alone, (2) it developed de novo, and (3) it was confined to the skin.

Use of Voigt lineshape for quantification of in vivo 1H spectra

Quantification of NMR visible metabolites by spectral modeling usually assumes a Lorentzian or Gaussian lineshape, despite the fact that experimental lineshapes are neither. To minimize systematic fitting errors, a mixed Lorentzian-Gaussian (Voigt) lineshape model was developed. When tested with synthetic FIDs, the Voigt lineshape model gave more accurate results (maximum error 2%) than either Lorentzian (maximum error 20%) or Gaussian models (maximum error 12%). The three lineshape models gave substantially different peak areas in an in vitro experiment, with the Voigt model having a much lower chi2 (2.1 compared with 5.2 for the Lorentzian model and 6.2 for the Gaussian model). In a group of 10 healthy volunteers, fitting of 1H spectra from cerebral white matter gave significantly different peak areas between the methods. Even when area ratios were taken, the Lorentzian model gave higher values (+5% for NAA/choline and +2% for NAA/creatine) than the Voigt lineshape model, whereas the Gaussian model gave lower values (-2% and -1%, respectively).