The Challenge for Innovation in Direct Restorative Materials

During the past 50 years, a series of key UN conferences have established a framework to minimize human health risks from environmental exposures to key chemicals. In January 2013, more than 140 countries agreed to the text of new treaty to minimize Hg effects on the environment (the Minamata Convention). Dental caries is omnipresent around the globe, affecting 60% to 90% of school children and most adults, and producing discomfort that affects quality of life. Dental amalgam is frequently used to treat carious lesions and its use releases mercury into the environment. The best way to avoid the use of dental amalgam is to emphasize caries prevention. Alternatives to amalgam are suitable in some applications, but no replacement for amalgam has been found for large posterior restorations. For any restorative material, safety and environmental impacts are part of clinical risk assessment. Safety is freedom from unacceptable risks. Risk is a combination of probability of exposure and severity of harm. Best management practices are crucial to manage dental amalgam, but these impose additional that are disproportionately more for developing countries. The Minamata Convention seeks a phase-out of all mercury-based products except dental amalgam, where a phase-down is the present goal. For dentistry, the most important focus is the promotion of caries prevention and research on new materials.

Mechanisch induziertes Härten*

Seit dem Jahr 2001 wird an der Stiftung Institut für Werkstofftechnik Bremen (IWT) ein neues endwärmebehandlungsfreies Verfahren zur Herstellung von randschichtgehärteten Stahlbauteilen erforscht. Bei diesem Verfahren wird die Randschichthärtung durch eine mechanisch induzierte martensitische Phasenumwandlung in die Fertigungslinie integriert. Neben einer deutlichen Verkürzung der Produktionsdauer wird die lokale Härtung von Funktionsflächen eines Bauteils ermöglicht. Zudem kommt es durch die Einsparung einer abschlieβenden Wärmebehandlung zu einer signifikanten Reduzierung des Energieverbrauchs und der damit verbundenen CO2-Emission.

Um eine spannungs- bzw. dehnungsinduzierte martensitische Phasenumwandlung aufgrund von rein mechanischen Effekten zu ermöglichen, wird zunächst ein bei Raumtemperatur metastabiles austenitisches Gefüge hergestellt. Dieser Werkstoffzustand soll so stabil sein, dass eine spanende Bearbeitung keine ausgedehnte martensitische Phasenumwand-lung auslöst und das Werkstück somit noch “weich” bearbeitet werden kann. In einem anschlieβenden mechanischen Verfahren, wie z. B. einem Festwalzprozess, soll die auf die Werkstückoberfläche ausgeübte Pressung so weit gesteigert werden, dass die zur martensitischen Umwandlung des Austenits benötigte Spannung in der Bauteilrandzone erreicht wird.

The prevalence of refractive error in three communities of Cape Town, South Africa

The prevalence, distribution and demographic associations of refractive error in three communities in Cape Town, South Africa were assessed. In this cross-sectional study, a clustered random sampling procedure was used to recruit participants (n=176; age=40.6±14.7 years; males=76, females=96) from Khayelitsha, Milnerton, and Mitchell’s Plain. From March to May 2010, participants underwent autore-fraction and subjective refraction eye examinations.A structured interview was used to collect data on sociodemographics, age, gender, level of education, employment and race. Participants younger than 15 years, non-residents, or residents for less than six months, who declined signing the informed consent forms were excluded from the study. In this study myopia was defined as the spherical equivalent value in the better eye of −1.00D or worse and hyperopia as the spherical equivalent value in the better eye of ≥1.00D. Astigmatism was defined as −0.50 cylinder or worse in the better eye. The prevalence of myopia was 17.4% with a 90% confidence interval (CI) of 12.65-22.15, hyperopia was 13.4% (90% CI 9.13-17.67), and astigmatism was 60% (90% CI 53.86-66.14). Myopia was found to be significantly associated with race and age; while hyperopia was significantly associated with age, employment and race. The results of this study may assist in planning for eye care on district level. (S Afr Optom 2012 71(1) 32-38)

Does concomitant use of paracetamol potentiate the gastroduodenal mucosal injury associated with aspirin? A prospective, randomised, pilot study

BACKGROUND

Paracetamol is commonly prescribed for first-line symptomatic treatment in patients with osteoarthritis and aspirin is often co-administered for cardiovascular prophylaxis. It is not known if an interaction exists between aspirin and paracetamol in regards to gastroduodenal mucosal injury.

AIM

To investigate whether or not co-administered aspirin with paracetamol results in an increased rate of endoscopic gastroduodenal mucosal injury as compared to either agent alone.

METHODS

In this prospective, double-blind, randomised, three-arm, placebo- and active-controlled, parallel-group pilot study healthy adult subjects (18-75 years old) with a normal baseline trans-nasal oesophagogastroduodenoscopy (TN-EGD), received oral paracetamol 4000 mg q.d.s. (n = 21), aspirin 325 mg q.d.s. (n = 19) or paracetamol 4000 mg q.d.s. and aspirin 325 mg q.d.s. (n = 20). Upper gastrointestinal mucosal injury was evaluated after 7 days of treatment with TN-EGD.

RESULTS

The rate of gastric ulcers in subjects receiving paracetamol (0/21, 0%) alone or aspirin (3/19, 16%) or both (2/20, 10%) was not different. There were, however, significantly more subjects with one or more lesions (erosion or ulcer) per subject in the paracetamol and aspirin (16/20, 80%) treated subjects as compared to the aspirin (8/19, 42%, P < 0.001) or the paracetamol (3/21, 14%, P < 0.01) exposed subjects. The mean number of lesions per subject was also greater (7.9 vs. 0.7, P < 0.01) in those treated with aspirin and paracetamol compared to paracetamol alone.

CONCLUSIONS

Co-administration of paracetamol and aspirin was not associated with a significant difference in endoscopic ulcer rates compared to either drug alone. There was a strong signal for increased endoscopic erosions and ulcers in the combined group compared to either aspirin or paracetamol alone.

Lost in reciprocal space? Determination of the scattering condition in spot profile analysis low-energy electron diffraction

The precise knowledge of the diffraction condition, i.e., the angle of incidence and electron energy, is crucial for the study of surface morphology through spot profile analysis low-energy electron diffraction (LEED). We demonstrate four different procedures to determine the diffraction condition: employing the distortion of the LEED pattern under large angles of incidence, the layer-by-layer growth oscillations during homoepitaxial growth, a G(S) analysis of a rough surface, and the intersection of facet rods with 3D Bragg conditions.

[Diagnosis and treatment of interstitial cystitis]

Interstitial Cystitis, first described in 1887 as an inflammatory disease of the bladder wall, is now regarded as a very common disease with an estimated number of unreported cases. Reasons for underdiagnosis is the widespread use of strict exclusion criteria. The disease can already be suspected by a careful medical history and physical examination in an early stage and then be treated with promising multimodal therapeutic approaches. In addition to a symptomatic oral therapy, local instillations with constituents of the protective glycosaminoglycan-layer are the most common therapeutic approach, because its defective integrity plays a key role in the pathogenesis of interstitial cystitis.

Morbidity, mortality and body weight gain of surgically spayed, yearling Brahman heifers

OBJECTIVE

To determine morbidity and mortality rates in yearling heifers spayed by two methods under commercial conditions in northern Australia.

DESIGN

In study 1,600 Brahman heifers were allocated to one of three treatments: physical restraint and ear-tagging (Control); physical restraint, ovariectomy by the Willis dropped ovary technique, ear-tagging and ear-marking (WDOT); or electroimmobilisation, ovariectomy via flank incision, ear-tagging and ear-marking (Flank). Heifers were monitored post spaying. Mortalities occurred at unanticipated times, so study 2 investigated their timing and cause in similar WDOT-spayed heifers (n=574).

RESULTS

In study 1, morbidity on the day of spaying was 6.0% in the Flank and 2.7% in the WDOT group (not statistically different). Spayed heifers showed behaviours indicative of acute pain/discomfort in the 6 h post spaying. Body weights and gains were significantly lower in the spayed compared with control heifers at days 21 and 42, and 5% of flank wounds were not healed at day 42. Mortalities were 0%, 1.5% and 2.5%, respectively, for Control, WDOT (3 estimated to have occurred on day 11) and Flank (2 on the day after spaying and 1 on each of days 5, 11 and 22). In study 2, the mortality was 0.5%, all within 4 days of spaying.

CONCLUSIONS

In yearling heifers, WDOT spaying resulted in lower morbidity and short-term mortality compared with flank spaying. Both methods compromised the health and welfare of some animals for up to 4 days and body weight gains were reduced during the 6 weeks post spaying.

Tolerability and safety of novel half milliliter formulation of glatiramer acetate for subcutaneous injection: an open-label, multicenter, randomized comparative study

Daily glatiramer acetate (GA) 20 mg/1.0 mL is a first-line treatment for relapsing-remitting multiple sclerosis (RRMS). To reduce the occurrence of injection pain and local injection site reactions (LISRs), a reduced volume formulation of GA was developed. This study compared pain and LISRs after injecting the marketed and the novel formulations. RRMS patients currently injecting GA participated in this multicenter, randomized, crossover comparative study. All patients administered once-daily subcutaneous injections of GA 20 mg/1.0 mL (marketed formulation) or GA 20 mg/0.5 mL (reduced volume formulation) for 14 days. Patients were crossed-over to the alternate treatment for an additional 14 days. Using a Visual Analog Scale (VAS), patients recorded in daily diaries the severity of injection pain immediately and 5 min post-injection, and the presence and severity of LISRs (swelling, redness, itching, lump) within 5 min and 24 h post-injection. VAS pain scores were ranked significantly lower immediately and 5 min after GA 20 mg/0.5 mL injections (p < 0.0001). Although LISRs were rare for both preparations, the severity of reactions ranked significantly lower and fewer symptoms occurred within 5 min and 24 h of using the reduced volume formulation (p < 0.0001). GA injected subcutaneously in a reduced volume formulation is a more tolerable option.

The bifidogenic effect of inulin and oligofructose and its consequences for gut health

The bifidogenic effect of inulin and oligofructose is now well established in various studies, not only in adult participants but also in other age groups. This bifidogenic shift in the composition of the colonic microbiota is likely the basis for the impact of these prebiotic compounds on various parameters of colonic function. Mainly from animal and in vitro studies and also from some human trials, there are indications, for instance, that inulin-type fructans may reduce the production of potentially toxic metabolites and may induce important immune-mediated effects. This review discusses how these changes in the composition and activity of the colonic microbiota may affect gut health in healthy people, including in those who may experience some form of gastrointestinal discomfort.

Selective dissolution of Am in basic media in the presence of ferricyanide ions: a mechanistic and structural study on Am(V) and Am(VI) compounds

Americium exhibits a soluble form in aqueous alkaline media in the presence of ferricyanide ions (Fe(CN)6 3−), which is not the case for the other transplutonium elements (TPE). This soluble Am compound can be obtained by addition of a concentrated basic solution of ferricyanide ions on a trivalent americium hydroxide precipitate. Thus, this technique enables a complete and rapid extraction of americium through its soluble form in alkaline solutions whereas under these conditions, other TPE and the lanthanides remain in the solid state as trivalent hydroxides. In the case of dissolution involving large amounts of americium, the formation of the soluble americium species is followed by the appearance of a reddish precipitate in the basic solution. Dissolution of the reddish solid in NaOH or NaOH/Fe(CN)6 3− media demonstrated the existence of a media-dependent solubility of the precipitate, and therefore the existence of at least two forms of soluble Am.

Spectroscopic (UV-visible, EXAFS-XANES, Raman) and electrochemical investigations were carried out on the different forms of americium to determine the nature of the compounds. This study points out that the reddish solid Am compound is probably a Am(V) hydroxide: Na2AmO2(OH)3·3H2O while the other Am species is a mixed americyl–ferricyanide complex. This work demonstrates that this dissolution of Am(III) solid compound is much more complex than a simple oxidation by the ferricyanide ions. The existence of a molecular interaction between Am(V)O2 + and ferricyanide ions is highly probable. This selective dissolution of americium by a basic ferricyanide solution can be used to define a separation process of Am from lanthanides and other transplutonium elements in the field of high level liquid waste treatment.

Expression of 14 von Willebrand factor mutations identified in patients with type 1 von Willebrand disease from the MCMDM-1VWD study

BACKGROUND

Candidate von Willebrand factor (VWF) mutations were identified in 70% of index cases in the European study 'Molecular and Clinical Markers for the Diagnosis and Management of type 1 von Willebrand Disease'. The majority of these were missense mutations.

OBJECTIVES

To assess whether 14 representative missense mutations are the cause of the phenotype observed in the patients and to examine their mode of pathogenicity.

METHODS

Transfection experiments were performed with full-length wild-type or mutant VWF cDNA for these 14 missense mutations. VWF antigen levels were measured, and VWF multimer analysis was performed on secreted and intracellular VWF.

RESULTS

For seven of the missense mutations (G160W, N166I, L2207P, C2257S, C2304Y, G2441C, and C2477Y), we found marked intracellular retention and impaired secretion of VWF, major loss of high molecular weight multimers in transfections of mutant constructs alone, and virtually normal multimers in cotransfections with wild-type VWF, establishing the pathogenicity of these mutations. Four of the mutations (R2287W, R2464C, G2518S, and Q2520P) were established as being very probably causative, on the basis of a mild reduction in the secreted VWF or on characteristic faster-running multimeric bands. For three candidate changes (G19R, P2063S, and R2313H), the transfection results were indistinguishable from wild-type recombinant VWF and we could not prove these changes to be pathogenic. Other mechanisms not explored using this in vitro expression system may be responsible for pathogenicity.

CONCLUSIONS

The pathogenic nature of 11 of 14 candidate missense mutations identified in patients with type 1 VWD was confirmed. Intracellular retention of mutant VWF is the predominant responsible mechanism.

Desferrioxamine as immunomodulatory agent during microorganism infection

Southern Africa is burdened with Human Immunodeficiency Virus (HIV) and Mycobacterium tuberculosis (M.tuberculosis) infections as well as conditions of iron (Fe) overload. Highly Active Antiretroviral Therapy (HAART) is used to treat HIV-infection, many drugs exist for the treatment of tuberculosis (new solutions are also being sought because of the existence of multi drug resistant strains of M.tuberculosis) and Fe chelators are commonly used to treat Fe overload. Chelators have also been shown to inhibit the multiplication of numerous microorganisms and hence there are publications suggesting a role for chelators like desferrioxamine (DFO) in the dual treatment of microorganism infection and excess iron. Excess iron fuels pathogen survival which in turn lowers host cell functionality (manifested as altered proliferation, cytokine secretion, etc); withholding iron (via a chelator) reverses the process, even more so when the cells are chelated for longer periods of time. Chelation with DFO is reviewed here by commenting on its immunomodulatory effect.

In vitro anti-HIV activity of five selected South African medicinal plant extracts

AIM OF THE STUDY

Five South African medicinal plants, Bulbine alooides (L.) Willd. (Asphodelaceae), Crinummacowani Baker (Amaryllidaceae), Hypoxis sobolifera var. sobolifera (Jacq.) Nel (Hypoxidaceae), Leonotisleonurus (L.) R.Br. (Lamiaceae) and Tulbaghiaviolacea Harv (Liliaceae) used for the treatment of various ailments, including infectious diseases, were screened for activity against human immunodeficiency virus (HIV).

MATERIALS AND METHODS

Aqueous and ethanol extracts were tested for inhibitory activity in HIV-1 infected CEM.NK(R)-CCR5 cells, and against HIV-1 reverse transcriptase (RT) and HIV-1 protease (PR).

RESULTS

In CEM.NK(R)-CCR5 cells, ethanol extracts of Leonotisleonurus inhibited HIV-1 significantly (33% reduction in HIV-1 p24, P<0.05). HIV-1 RT inhibition (> or =50%) was shown for extracts of Bulbine alooides (aqueous and ethanol), Hypoxis sobolifera (aqueous and ethanol) and Leonotisleonurus (aqueous), but inhibitory activity was lost upon dereplication for removal of non-specific tannins/polysaccharides. HIV-1 PR inhibition was observed for extracts of Hypoxis sobolifera (aqueous), Bulbine alooides (aqueous and ethanol) and Leonotisleonurus (ethanol). Only ethanolic extracts of Bulbine alooides and Leonotisleonurus retained HIV-1 PR inhibition after dereplication with IC50 of 94 microg/ml and 120 microg/ml, respectively.

CONCLUSION

The dereplicated ethanolic extracts of Leonotisleonurus and Bulbine alooides showed the greatest anti-HIV potential in this study through inhibition of HIV-1 PR.

Comparative 1H NMR-based metabonomic analysis of HIV-1 sera

(1)H NMR spectroscopy of sera from HIV-1 infected and uninfected individuals was performed on 300 and 600 MHz instruments. The resultant spectra were automatically data reduced to 90 and 180 integral segments of equal length. Analysis of variance identified significant differences between the sample groups, especially for the samples analyzed on 600 MHz and reduced to fewer segments. Linear discriminant analysis correctly classified 100% of the samples analyzed on the 300 MHz NMR (reduced to 180 segments); an increase in instrument sensitivity resulted in lower percentages of correctly classified samples. Multinomial logistic regression (MLR) resulted in 100% correct classification of all samples from both instruments. Thus (1)H-NMR metabonomics on either instrument distinguishes HIV-positive individuals using or not using anti retroviral therapy, but the sensitivity of the instrument impacts on data reduction. Furthermore, MLR is a novel multivariate statistical technique for improved classification of biological data analyzed in NMR.

A double-blind, multicentered study comparing the accuracy of diagnostic markers to predict short- and long-term clinical events and their utility in patients presenting with chest pain

BACKGROUND

Millions of patients present annually with chest pain, but only 10% have myocardial infarction (MI). We recently reported comparative sensitivity and specificity of available markers in the diagnosis of MI; however, optimum interpretation of marker results requires prognostic follow-up data.

HYPOTHESIS

The study was undertaken to study the accuracy of CK-MB subforms, troponin I and T, myoglobin, and CK-MB in predicting clinical events at 30 days and 6 months.

METHODS

In all, 955 consecutive patients with chest pain were enrolled in a prospective, multicenter, double-blind study to test the prognostic accuracy of these markers.

RESULTS

Myocardial infarction was diagnosed in 119 by CK-MB mass criteria and unstable angina (UA) in 203 patients by clinical criteria. Follow-up at 30 days and 6 months was available in 824 and 724 patients, respectively, with mortalities of 2.8 and 4.14%, respectively. Cumulative 6-month mortality was 5.6% in MI, 4.4% in UA, and 3.0% in others. Revascularization was reported in 9.3% of patients by 6 months. A positive test on each of the markers except myoglobin was predictive of revascularization. The composite endpoint of death or revascularization occurred in 107 patients by 6 months and a positive result on each of the markers was predictive of this composite endpoint (p < 0.05). The relative risk of death or revascularization for patients who did not have MI but tested positive on each of the markers was > 1.0 but did not reach statistical significance.

CONCLUSIONS

With the possible exception of myoglobin, each of the diagnostic markers displayed similar prognostic performance in patients with chest pain presenting to emergency departments. The most appropriate markers to triage patients with chest pain, which has both adequate early diagnostic sensitivity and prognostic accuracy, are the CK-MB subforms.

Aplastic anemia presenting as spontaneous orbital hemorrhage

We report a case of a 51-year-old female presenting with a three-day history of a painful swollen right eye associated with loss of vision. She presented with no light perception in the affected eye, periocular ecchymosis, hemorrhagic chemosis, and an axial proptosis. CT scan revealed a unilateral proptosis with tension on the optic nerve and accompanying diffuse retrobulbar hemorrhage. Bone marrow studies confirmed aplastic anemia. A review of the English literature failed to reveal previous cases of aplastic anemia presenting with spontaneous orbital hemorrhage. We suggest that aplastic anemia be included in the differential diagnosis of a patient presenting with painful spontaneous orbital hemorrhage.

Detailed von Willebrand factor multimer analysis in patients with von Willebrand disease in the European study, molecular and clinical markers for the diagnosis and management of type 1 von Willebrand disease (MCMDM-1VWD)

BACKGROUND

Type 1 von Willebrand disease (VWD) is a congenital bleeding disorder characterized by a partial quantitative deficiency of plasma von Willebrand factor (VWF) in the absence of structural and/or functional VWF defects. Accurate assessment of the quantity and quality of plasma VWF is difficult but is a prerequisite for correct classification.

OBJECTIVE

To evaluate the proportion of misclassification of patients historically diagnosed with type 1 VWD using detailed analysis of the VWF multimer structure.

PATIENTS AND METHODS

Previously diagnosed type 1 VWD families and healthy controls were recruited by 12 expert centers in nine European countries. Phenotypic characterization comprised plasma VWF parameters and multimer analysis using low- and intermediate-resolution gels combined with an optimized visualization system. VWF genotyping was performed in all index cases (ICs).

RESULTS

Abnormal multimers were present in 57 out of 150 ICs; however, only 29 out of these 57 (51%) had VWF ristocetin cofactor to antigen ratio below 0.7. In most cases multimer abnormalities were subtle, and only two cases had a significant loss of the largest multimers.

CONCLUSIONS

Of the cases previously diagnosed as type 1 VWD, 38% showed abnormal multimers. Depending on the classification criteria used, 22 out of these 57 cases (15% of the total cohort) may be reclassified as type 2, emphasizing the requirement for multimer analysis compared with a mere ratio of VWF functional parameters and VWF:Ag. This is further supported by the finding that even slightly aberrant multimers are highly predictive for the presence of VWF mutations.

[Antibody treatment in colorectal cancer--what the surgeon needs to know]

Advances in the medical treatment of colorectal cancer patients have resulted in considerable improvements through the introduction of new cytotoxic drugs. The significant progress in molecular and tumour biology has produced a great number of targeted, tumour-specific, monoclonal antibodies that are now in various stages of clinical development. Two of these antibodies, cetuximab (Erbitux) und bevacizumab (Avastin), directed against the epidermal growth factor receptor (EGFR) and the vascular epithelial growth factor (VEGF), respectively, have recently been approved for use in metastatic colorectal cancer. The combination of well-known and newly developed cytotoxic agents with monoclonal antibodies makes the medical treatment of colorectal cancer patients considerably more complex, but also provides additional therapeutic strategies for patients in advanced stages of disease.

The biological basis of immune heparin-induced thrombocytopenia

Heparin induced thrombocytopenia (HIT) remains the most severe adverse effect of heparin therapy. Recently, new information has been uncovered regarding the pathogenesis of this disorder. This review summarizes the clinical state, pathogenesis and diagnosis of HIT. It was stimulated by the recent recognition of heparin-platelet factor 4 (H.PF4) complexes as the major target antigen for heparin-dependent antibodies involved in this pathology. The formation of complexes between PF4 and heparin or other glycosaminoglycans, leading in some circumstances to the generation of antigenic structures reactive with HIT antibodies, is analysed. We also discuss how antibodies develop in heparin-exposed patients and why these antibodies can become pathogenic only in some patients, while their presence remains asymptomatic in others. This review also focuses on the mechanisms that could be involved in the development of thrombocytopenia and thrombosis. This new understanding of HIT pathogenesis has permitted the introduction of new tools for retrospective or prospective diagnosis, and may provide new strategies for the avoidance or treatment of HIT and its complications.

14th International HLA and Immunogenetics Workshop: report of progress in methodology, data collection, and analyses

The Biostatistics Component of the 13th International Histocompatibility Workshop (IHWS) developed the PyPop (Python for Population Genomics) software framework for high-throughput analysis and quality control (QC) assessments of highly polymorphic genotype data. Since its initial release, the software has had several new analysis modules added to it. These additions, combined with improved data filtering and QC modules, facilitate analyses of data at different levels (allele, haplotype, amino acid sequence, and nucleotide sequence). Since the 13th IHWS, much of the human leukocyte antigen (HLA) data from the workshop, QCed via PyPop and other methods, have been made publicly available through the Major Histocompatibility Complex database web site at the National Center for Biotechnology Information (http://ncbi.nih.gov/mhc/). The Anthropology/Human Genetic Diversity component (AHGDC) data have been used in a variety of studies. Prugnolle et al. used this data to corroborate a model of pathogen-driven selection as a factor related to high levels of diversity at HLA loci. Using a comparative genomics approach contrasting results for HLA and non-HLA markers, Meyer et al. analyzed a subset of the 13th IHWS AHGDC data and showed that HLA loci show detectable signs of both natural selection and the demographic history of populations.

Population samples and genotyping technology

The 14th International HLA (human leukocyte antigen) Immunogenetics Workshop (14th-IHIWS) Biostatistics and Anthropology/Human Genetic Diversity project continues the population sampling, genotype data generation, and biostatistic analyses of the 13th International Histocompatibility Workshop Anthropology/Human Genetic Diversity Component, with the overall goal of further characterizing global HLA allele and haplotype diversity and better describing the relationships between major histocompatibility complex diversity, geography, linguistics, and population history. Since the 13th Workshop, new investigators have and continue to be recruited to the project and new high-resolution class I and class II genotype data are being generated for 112 population samples from around the world.

Impact of plasma von Willebrand factor levels in the diagnosis of type 1 von Willebrand disease: results from a multicenter European study (MCMDM-1VWD)

BACKGROUND

Presence of bleeding symptoms, inheritance and reduced von Willebrand factor (VWF) contribute to the diagnosis of type 1 von Willebrand disease (VWD). However, quantitative analysis of the importance of VWF antigen (VWF:Ag) and ristocetin cofactor activity (VWF:RCo) levels in the diagnosis is lacking.

OBJECTIVES

To evaluate the relative contribution of VWF measurement to the diagnosis of VWD.

PATIENTS AND METHODS

From the MCMDM-1VWD study cohort, 204 subjects (considered as affected by VWD based on the enrolling Center diagnoses and the presence of linkage with the VWF locus) were compared with 1155 normal individuals. Sensitivity, specificity and diagnostic positive likelihood ratios (LR) of VWF:Ag and VWF:RCo were computed.

RESULTS

ABO blood group was the variable most influencing VWF levels, but adjustment of the lower reference limit for the ABO group did not improve sensitivity and specificity of VWF:Ag or VWF:RCo. The lower reference limit (2.5th percentile) was 47 IU dL(-1) for both VWF:Ag and VWF:RCo and showed similar diagnostic performance [receiver-operator curve area: 0.962 and 0.961 for VWF:Ag and VWF:RCo, respectively; P = 0.81]. The probability of VWD was markedly increased only for values below 40 IU dL(-1) (positive LR: 95.1 for VWF:Ag), whereas intermediate values (40 to 60 IU dL(-1)) of VWF only marginally indicated the probability of VWD.

CONCLUSIONS

Although the conventional 2.5 lower percentile has good sensitivity and specificity, only VWF:Ag or VWF:RCo values below 40 IU dL(-1) appear to significantly indicate the likelihood of type 1 VWD. The LR profile of VWF level could be used in a diagnostic algorithm.

Impact of education on women with perinatal depression

OBJECTIVE

To assess the impact that education through participation in a depression screening program has on mental health literacy and help seeking behavior in perinatal women.

METHODS

Responses to a hypothetical case of depression, help seeking behavior, and screening levels for risk of depression using the Edinburgh Postnatal Depression Scale were compared between two groups of postnatal women; one group who had participated in a screening program and the other who had not. Those who participated in the screening program were also asked to evaluate the educational material they had received.

RESULTS

A total of 1309 women, broadly representative of postnatal women, answered one or more questionnaires. Those who had participated in the screening program were better able to recognize depression in a hypothetical case, and also assess their own mental state more appropriately. Those women who had been part of the program and did not score high on the EPDS were less likely to seek help, were more satisfied when they did and tended to benefit more from the educational booklet.

CONCLUSIONS

Participation in a screening program with educational material had significant benefits for mental health literacy and the health service use for perinatal women at risk for depression.

Ultrafast bond softening in bismuth: mapping a solid's interatomic potential with X-rays

Intense femtosecond laser excitation can produce transient states of matter that would otherwise be inaccessible to laboratory investigation. At high excitation densities, the interatomic forces that bind solids and determine many of their properties can be substantially altered. Here, we present the detailed mapping of the carrier density-dependent interatomic potential of bismuth approaching a solid-solid phase transition. Our experiments combine stroboscopic techniques that use a high-brightness linear electron accelerator-based x-ray source with pulse-by-pulse timing reconstruction for femtosecond resolution, allowing quantitative characterization of the interatomic potential energy surface of the highly excited solid.

A double-blind placebo-controlled study to establish the bifidogenic dose of inulin in healthy humans

OBJECTIVE

To evaluate the bifidogenic efficacy of two inulin doses in healthy human adults.

DESIGN

A double-blind, placebo-controlled, crossover human study.

SETTING

Food Microbial Sciences Unit, The University of Reading, Reading, UK.

SUBJECTS

Thirty healthy volunteers, 15 men, 15 women (age range 19-35).

INTERVENTIONS

Subjects consumed a chocolate drink containing placebo (maltodextrin, 8 g/day), 5 g/day inulin and 8 g/day inulin for a 2-week treatment period. Each treatment was followed by a 1-week washout at the end of which volunteers progressed to the next treatment. Faecal samples were obtained at the start of the study (baseline) and at the end of each treatment and washout period. Fluorescent in situ hybridization was used to monitor populations of Bifidobacterium genus, Bacteroides - Prevotella, Lactobacillus - Enterococcus and Clostridium perfringens - histolyticum subgroup.

RESULTS

Bifidobacterial levels increased significantly upon ingestion of both the low (9.78+/-0.29 log(10) cells/g faeces, P<0.05) and the high inulin dose (9.79+/-0.38 log(10) cells/g faeces, P=0.05) compared to placebo (9.64+/-0.23 log(10) cells/g faeces).

CONCLUSIONS

Both inulin doses exhibited a bifidogenic effect but a higher volunteer percentage responded to the high dose. A dose response effect was not observed but the magnitude of increase in bifidobacteria levels depended on their initial numbers. The higher the initial concentrations the smaller was the increase upon ingestion of the active treatments.

Paraoxonase 2 (PON2) polymorphisms and development of renal dysfunction in type 2 diabetes: UKPDS 76

AIMS/HYPOTHESIS

Identification of variants predicting development of renal dysfunction would offer substantial clinical benefits. There is evidence that coding non-synonymous variants in the gene encoding paraoxonase 2 (PON2) are associated with nephropathy in both type 1 and type 2 diabetes.

METHODS

We examined the relationship between variation at the C311S and A148G polymorphisms (together with PON2 intronic variant rs12704795) and indices of renal dysfunction (progression to micro- and macroalbuminuria, plasma creatinine increases) in 3,374 newly diagnosed type 2 diabetic subjects from the UK Prospective Diabetes Study followed prospectively (median 14.0 years), using proportional hazards models, adjusted for sex, ethnicity and other known or putative risk factors.

RESULTS

rs12704795 genotypes were associated with differing rates of development of microalbuminuria (relative risk [RR] for CC vs AA homozygotes 0.68 [95% CI 0.54-0.87], p=0.002) but not other measures of worsening renal function. Heterozygotes for C311S were more likely to develop microalbuminuria (RR=1.31 [95% CI 1.11-1.54], p=0.001) but less likely to double creatinine levels during follow-up (RR=0.49 [95% CI 0.27-0.89], p=0.02). There was no corroboration of this latter association for related outcomes and no prior evidence supports heterosis effects at this locus.

CONCLUSIONS/INTERPRETATION

We conclude that the PON2 variants typed in this study have, at best, a small effect on the risk of renal dysfunction in type 2 diabetes.