Bidirectional interaction between oral contraception and lamotrigine in women with epilepsy - Role of progestins

PURPOSE

To investigate the effects of various progestins in combined oral contraceptives (COCs) on lamotrigine (LTG) serum concentrations and, vice versa, the potential impact of LTG on progestin serum levels during the menstrual cycle.

METHODS

Twenty women with epilepsy (WWE) undergoing LTG monotherapy and COC (LTG group; mean ± SD [median; range] age 24.2 ± 4.6 [23.0; 18-37] years) as well as fourteen controls on COC (24.9 ± 5.6 [22.5; 20-39] years) were assessed for eligibility and all agreed to participate in the study and remained for data analyses.

RESULTS

LTG levels differed significantly between phases of inactive pill and active pill use (p= 0.004), particularly with drospirenon (p= 0.018) and levonorgestrel (p= 0.068) as progestogen component but not with gestoden (p= 0.593). Furthermore, the LTG group showed significantly lower progestin levels during inactive pill when compared to active pill use with respect to levonorgestrel (p= 0.042) and drospirenon (p= 0.018) but not to gestoden (p= 0.109). Progestin concentrations did not differ between patients and controls (p> 0.05).

CONCLUSIONS

The findings suggest that drospirenon and levonorgestrel but not gestoden seem to reduce LTG serum concentrations when being co-administered in WWE which might be of importance concerning seizure risk. Vice versa, no effect of LTG on several progestins could be demonstrated, arguing against a potential loss of contraception safety with LTG.

An integrative correlation of myopathology, phenotype and genotype in late onset Pompe disease

AIMS

Pompe disease is caused by pathogenic mutations in the alpha 1,4-glucosidase (GAA) gene and in patients with late onset Pome disease (LOPD), genotype-phenotype correlations are unpredictable. Skeletal muscle pathology includes glycogen accumulation and altered autophagy of various degrees. A correlation of the muscle morphology with clinical features and the genetic background in GAA may contribute to the understanding of the phenotypic variability.

METHODS

Muscle biopsies taken before enzyme replacement therapy were analysed from 53 patients with LOPD. On resin sections, glycogen accumulation, fibrosis, autophagic vacuoles and the degree of muscle damage (morphology-score) were analysed and the results were compared with clinical findings. Additional autophagy markers microtubule-associated protein 1A/1B-light chain 3, p62 and Bcl2-associated athanogene 3 were analysed on cryosections from 22 LOPD biopsies.

RESULTS

The myopathology showed a high variability with, in most patients, a moderate glycogen accumulation and a low morphology-score. High morphology-scores were associated with increased fibrosis and autophagy highlighting the role of autophagy in severe stages of skeletal muscle damage. The morphology-score did not correlate with the patient's age at biopsy, disease duration, nor with the residual GAA enzyme activity or creatine-kinase levels. In 37 patients with LOPD, genetic analysis identified the most frequent mutation, c.-32-13T>G, in 95%, most commonly in combination with c.525delT (19%). No significant correlation was found between the different GAA genotypes and muscle morphology type.

CONCLUSIONS

Muscle morphology in LOPD patients shows a high variability with, in most cases, moderate pathology. Increased pathology is associated with more fibrosis and autophagy.

White and wonderful? Microplastics prevail in snow from the Alps to the Arctic

Microplastics (MPs) are ubiquitous, and considerable quantities prevail even in the Arctic; however, there are large knowledge gaps regarding pathways to the North. To assess whether atmospheric transport plays a role, we analyzed snow samples from ice floes in Fram Strait. For comparison, we investigated snow samples from remote (Swiss Alps) and populated (Bremen, Bavaria) European sites. MPs were identified by Fourier transform infrared imaging in 20 of 21 samples. The MP concentration of Arctic snow was significantly lower (0 to 14.4 × 10³ N liter^-1) than European snow (0.19 × 10³ to 154 × 10³ N liter^-1) but still substantial. Polymer composition varied strongly, but varnish, rubber, polyethylene, and polyamide dominated overall. Most particles were in the smallest size range indicating large numbers of particles below the detection limit of 11 μm. Our data highlight that atmospheric transport and deposition can be notable pathways for MPs meriting more research.

Expert consensus on a train-the-trainer curriculum for robotic colorectal surgery

AIM

Robotic techniques are being increasingly used in colorectal surgery. There is, however, a lack of training opportunities and structured training programmes. Robotic surgery has specific problems and challenges for trainers and trainees. Ergonomics, specific skills and user-machine interfaces are different from those in traditional laparoscopic surgery. The aim of this study was to establish expert consensus on the requirements for a robotic train-the-trainer curriculum amongst robotic surgeons and trainers.

METHOD

This is a modified Delphi-type study involving 14 experts in robotic surgery teaching. A reiterating 19-item questionnaire was sent out to the same group and agreement levels analysed. A consensus of 0.8 or higher was considered to be high-level agreement.

RESULTS

Response rates were 93-100% and most items reached high levels of agreement within three rounds. Specific requirements for a robotic faculty development curriculum included maximizing dual-console teaching, theatre team training, nontechnical skills training, patient safety, user-machine interface training and telementoring.

CONCLUSION

A clear need for the development of a train-the-trainer curriculum has been identified. Further research is needed to assess feasibility, effectiveness and clinical impact of a robotic train-the-trainer curriculum.

Immunolocalization of DMRTB1 in human testis with normal and impaired spermatogenesis

BACKGROUND

The transcription factor DMRTB1 plays a pivotal role in coordinating the transition between mitosis and meiosis in murine germ cells. No reliable data are available for human testis.

OBJECTIVES

The present study aims to examine the testicular expression pattern of DMRTB1 in men showing normal and impaired spermatogenesis.

MATERIALS AND METHODS

Immunohistochemistry was performed using 54 human testicular biopsy specimens and a commercial rabbit polyclonal anti-DMRTB1 primary antibody. RT-PCR complemented immunohistochemistry. To further characterize immunopositive cells and possible co-localization, the proliferation marker Ki-67, the tumor marker PLAP, and an anti-DMRT1 antibody were used.

RESULTS

In men with normal spermatogenesis, a strong immunoreactivity was detectable in a subset of spermatogonia (38.34 ± 2.14%). Some spermatocytes showed a weak immunostaining. Adjacent Sertoli cells were immunonegative. Compared with a hematoxylin and eosin overview staining, these immunopositive cells were almost exclusively identified as A_pale and B spermatogonia and primary spermatocytes in (pre-)leptotene, zygotene, and pachytene stages. In patients with spermatogenic arrest at spermatogonial level, an altered staining pattern was found. No immunoreactivity was detected in Sertoli cells in Sertoli cell-only syndrome. In germ cell neoplasia in situ (GCNIS) tubules, except for a few (0.4 ± 0.03%), pre-invasive tumor cells were immunonegative. Seminoma cells showed no immunostaining.

DISCUSSION

According to previous findings in mice, it seems reasonable that DMRTB1 is expressed in these normal germ cell populations. Moreover, altered staining pattern in spermatogenic arrest at spermatogonial stage suggests a correlation with mitosis and transformation into B spermatogonia. The absence of DMRTB1 in GCNIS cells and tumor cells might be associated with uncontrolled neoplastic cell proliferation and progression into invasive germ cell tumors. Further research is required to elucidate, for example, the role of DMRTB1 in the malignant transformation of human germ cells.

CONCLUSION

Our data indicate a relevant role for DMRTB1 regarding the entry of spermatogonia into meiosis in men.

Emerging investigator series: effect-based characterization of mixtures of environmental pollutants in diverse sediments

This study investigated whether cell-based bioassays were suitable to characterize profiles of mixture effects of hydrophobic pollutants in multiple sediments covering remote Arctic and tropical sites to highly populated sites in Europe and Australia. The total contamination was determined after total solvent extraction and the bioavailable contamination after silicone-based passive equilibrium sampling. In addition to cytotoxicity, we observed specific responses in cell-based reporter gene bioassays: activation of metabolic enzymes (arylhydrocarbon receptor: AhR, peroxisome proliferator activated receptor gamma: PPARγ) and adaptive stress responses (oxidative stress response: AREc32). No mixture effects were found for effects on the estrogen, androgen, progesterone and glucocorticoid receptors, or they were masked by cytotoxicity. The bioanalytical equivalent concentrations (BEQ) spanned several orders of magnitude for each bioassay. The bioavailable BEQs (passive equilibrium sampling) typically were 10-100 times and up to 420 times lower than the total BEQ (solvent extraction) for the AhR and AREc32 assays, indicating that the readily desorbing fraction of the bioactive chemicals was substantially lower than the fraction bound strongly to the sediment sorptive phases. Contrarily, the bioavailable BEQ in the PPARγ assay was within a factor of five of the total BEQ. We identified several hotspots of contamination in Europe and established background contamination levels in the Arctic and Australia.

Activin A target genes are differentially expressed between normal and neoplastic adult human testes: clues to gonocyte fate choice

BACKGROUND

Human testicular germ cell tumours (TGCT) arise from germ cell neoplasia in situ (GCNIS) cells that originate from foetal germ cell precursors. Activin A is central to normal foetal testis development, and its dysregulation may contribute to TGCT aetiology.

OBJECTIVE

(i) To test whether the expression profiles of activin A targets in normal and neoplastic human testes indicates functional links with TGCT progression. (ii) To investigate whether activin A levels influence MMP activity in a neoplastic germ cell line.

MATERIALS AND METHODS

(1) Bouin's fixed, paraffin-embedded human testes were utilized for PCR-based transcript analysis and immunohistochemistry. Samples (n = 5 per group) contained the following: (i) normal spermatogenesis, (ii) GCNIS or (iii) seminoma. CXCL12, CCL17, MMP2 and MMP9 were investigated. (2) The human seminoma-derived TCam-2 cell line was exposed to activin A (24 h), and target transcripts were measured by qRT-PCR (n = 4). ELISA (n = 4) and gelatin zymography (n = 3) showed changes in protein level and enzyme activity, respectively.

RESULTS

(i) Cytoplasmic CXCL12 was detected in Sertoli and other somatic cells, including those surrounding seminoma cells. Anti-CCL17 labelled only the cytoplasm of Sertoli cells surrounding GCNIS, while anti-MMP2 and anti-MMP9 labelled germline and epithelial-like cells in normal and neoplastic testes. (ii) Exposing TCam-2 cells to activin A (50 ng/mL) elevated MMP2 and MMP9 transcripts (fourfold and 30-fold), while only MMP2 protein levels were significantly higher after activin A (5 ng/mL and 50 ng/mL) exposure. Importantly, gelatin zymography revealed activin A increased production of activated MMP2.

DISCUSSION

Detection of CCL17 only in GCNIS tumours may reflect a change in Sertoli cell phenotype to a less mature state. Stimulation of MMP2 activity by activin A in TCam-2 cells suggests activin influences TGCT by modulating the tumour niche.

CONCLUSION

This knowledge provides a basis for understanding how physiological changes that influence activin/TGF-β superfamily signalling may alter germ cell fate.

Local lubrication model for spherical particles within incompressible Navier-Stokes flows

The lubrication forces are short-range hydrodynamic interactions essential to describe suspension of the particles. Usually, they are underestimated in direct numerical simulations of particle-laden flows. In this paper, we propose a lubrication model for a coupled volume penalization method and discrete element method solver that estimates the unresolved hydrodynamic forces and torques in an incompressible Navier-Stokes flow. Corrections are made locally on the surface of the interacting particles without any assumption on the global particle shape. The numerical model has been validated against experimental data and performs as well as existing numerical models that are limited to spherical particles.

Arctic sea ice is an important temporal sink and means of transport for microplastic

Microplastics (MP) are recognized as a growing environmental hazard and have been identified as far as the remote Polar Regions, with particularly high concentrations of microplastics in sea ice. Little is known regarding the horizontal variability of MP within sea ice and how the underlying water body affects MP composition during sea ice growth. Here we show that sea ice MP has no uniform polymer composition and that, depending on the growth region and drift paths of the sea ice, unique MP patterns can be observed in different sea ice horizons. Thus even in remote regions such as the Arctic Ocean, certain MP indicate the presence of localized sources. Increasing exploitation of Arctic resources will likely lead to a higher MP load in the Arctic sea ice and will enhance the release of MP in the areas of strong seasonal sea ice melt and the outflow gateways.

Microplastic (MP) pollution in polar regions is a growing environmental concern, yet little is known regarding the role of sea-ice as a sink and transport vector of MPs. Here, the authors show that MPs in sea-ice have no uniform polymer composition and observe unique MP patterns in different sea-ice horizons.

Iron Metabolism under rEPO Therapy in Patients on Maintenance Hemodialysis

Therapy with recombinant human erythropoietin (rEPO) can correct anemia in RDT patients. However, iron deficiency can develop making treatment unsuccessful. Eighteen non-transfused RDT patients with hematocrit <26% were treated with rEPO to raise the HCT to 30–35%; then the dose was individually adjusted to maintain the HCT. The mean HCT rose from 22.3% to 31.5%. Ten patients received iron substitution before rEPO. During rEPO therapy five further patients had to be supplemented with iron; all patients needed an increase in the oral iron doses and three required i.v. iron. During the correction phase mean serum ferritin dropped from 203 μg/l to a minimum of 71 μg/l and was 102 μg/l after six months. Serum iron and TIBC changed only moderately. It thus appears that iron demand rises markedly during rEPO therapy, requiring iron substitution in most patients. Serum ferritin is the most sensitive parameter for development of iron deficiency.

Risky Decision Making in Juvenile Myoclonic Epilepsy

It is not known whether patients with juvenile myoclonic epilepsy (JME) differ from healthy people in decision making under risk, i.e., when the decision-making context offers explicit information about options, probabilities, and consequences already from the beginning. In this study, we adopted the Game of Dice Task-Double to investigate decision making under risk in a group of 36 patients with JME (mean age 25.25/SD 5.29 years) and a group of 38 healthy controls (mean age 26.03/SD 4.84 years). Participants also underwent a comprehensive neuropsychological assessment focused on frontal executive functions. Significant group differences were found in tests of psychomotor speed and divided attention, with the patients scoring lower than the controls. Importantly, patients made risky decisions more frequently than controls. In the patient group, poor decision making was associated with poor executive control, poor response inhibition, and a short interval since the last seizure episode. Executive control and response inhibition could predict 42% of variance in the frequency of risky decisions. This study indicates that patients with JME with poorer executive functions are more likely to make risky decisions than healthy controls. Decision making under risk is of major importance in every-day life, especially with regard to treatment decisions and adherence to long-term medical therapy. Since even a single disadvantageous decision may have long-lasting consequences, this finding is of high relevance.

[Information services for melanoma patients and awareness among those affected]

BACKGROUND

Besides medical consultations, various sources of information and support are available for melanoma patients (MP) in Germany from commercial and non-commercial providers; however, little is known about how they are perceived and accepted by MPs.

MATERIAL AND METHODS

Between July and October 2016 a total of 529 melanoma patients were surveyed at 27 accredited German skin cancer centers by means of a standardized questionnaire. Their awareness and satisfaction with 12 given sources of information and counseling services (print, online and by telephone) were surveyed. The sources were recommended by renowned providers from the field of (dermatological) oncology for use by MPs.

RESULTS

The MPs reported that the booklets called The blue advisor - skin cancer (Die Blauen Ratgeber - Hautkrebs, 43%) and Patient guidelines melanoma (Patientenleitlinie Melanom 24%) and the online domain www.hautkrebs-screening.de (23%) were the best known sources. These also met the information needs of the majority of users (65-80%). Booklets from commercial providers (between 8-16% known) were satisfactory for 42-56% of users. At 14% and 11%, respectively, the cancer counseling services (Krebsinformationsdienst) and INFONETZ Krebs as mainly telephone advisory offers were less well known. Few MPs were familiar with the skin cancer or melanoma booklets of the Austrian Cancer Aid and the Swiss Cancer League (2% each).

CONCLUSION

The increased awareness and acceptance of booklets as well as information from principally non-commercial providers suggest that they are more often mediated to MPs and more frequently used and accepted by those affected.

Lebensqualität und Lebenserwartung am malignen Lymphom erkrankter Hunde unter Chemotherapie

Gegenstand und Ziel: Der Erfolg palliativer Chemotherapien bei Hunden mit malignem Lymphom wurde insbesondere in Bezug auf die Lebensqualität der Tiere evaluiert. Zudem wurden Faktoren erfasst, die für die Besitzer bei der Einschätzung der Lebensqualität ihrer Tiere sowie für ihre Gesamtbewertung der Therapie eine entscheidende Rolle spielten. Material und Methoden: Die retrospektive Befragung mittels eines Fragebogens bezüglich Krankheitsverlauf und Therapie ihrer Tiere richtete sich an 207 Hundebesitzer, deren Hunde in den letzten 13 Jahren zur Chemotherapie in der Medizinischen Kleintierklinik der LudwigMaximilians-Universität München vorgestellt worden waren. Ergebnisse: 123 Besitzer (59,4%) beantworteten den Fragebogen. Bei 64 Hunden (53,3%) ließ sich aus Sicht der Besitzer mit der Chemotherapie eine Verbesserung der Lebensqualität erreichen. Nur bei 24 Hunden (20,0%) kam es zu einer Verschlechterung der Lebensqualität, die in direktem Zusammenhang mit dem Remissionsstatus und Nebenwirkungen der Chemotherapie stand. Die Remissionsrate der Hunde lag bei 83,7%. Schlussfolgerung: Der Großteil der Besitzer (65,0%) war zufrieden mit der Chemotherapie. 90 Besitzer (73,2%) würden sich erneut für eine solche Behandlung entscheiden, wobei insbesondere die Lebensverlängerung ein wichtiges Entscheidungskriterium darstellte. Klinische Relevanz: Bei Tumorpatienten, die eine palliative Chemotherapie erhalten, muss die Lebensqualität konstant überwacht werden. Nur so kann sie bei der Auswahl geeigneter Chemotherapie-Protokolle helfen und zusätzlich Besitzer und Tierarzt die Entscheidung für den weiteren Verlauf der Therapie erleichtern.

Citizen scientists reveal: Marine litter pollutes Arctic beaches and affects wild life

Recent data indicate accumulation areas of marine litter in Arctic waters and significant increases over time. Beaches on remote Arctic islands may be sinks for marine litter and reflect pollution levels of the surrounding waters particularly well. We provide the first quantitative data from surveys carried out by citizen scientists on six beaches of Svalbard. Litter quantities recorded by cruise tourists varied from 9-524gm^-2 and were similar to those from densely populated areas. Plastics accounted for >80% of the overall litter, most of which originated from fisheries. Photographs provided by citizens show deleterious effects of beach litter on Arctic wildlife, which is already under strong pressure from global climate change. Our study highlights the potential of citizen scientists to provide scientifically valuable data on the pollution of sensitive remote ecosystems. The results stress once more that current legislative frameworks are insufficient to tackle the pollution of Arctic ecosystems.

Sensitivity and specificity of an in-clinic point-of-care PCR test for the diagnosis of canine leishmaniasis

Canine leishmaniasis is an important infectious disease worldwide. Although commonly used, antibody tests are often falsely negative, and in such cases direct detection of the pathogen, such as PCR, is necessary. However, PCR is only performed in specialized laboratories and not available in all localities. The aim of this study was to compare the sensitivity and specificity of an in-clinic point-of-care (ICPOC) PCR for the diagnosis of canine Leishmania spp. infection to those of a well characterized reference real-time PCR. In this study, 515 samples from 251 dogs (201 EDTA blood samples, 244 conjunctival swabs, 19 lymph node aspirates, and 51 bone marrow aspirates) were collected prospectively and analysed for the presence of Leishmania DNA using an ICPOC test. The results were compared to those of a reference real-time PCR for identification of Leishmania kinetoplast minicircle DNA. Sensitivity and specificity with 95% confidence interval (CI 95%) were determined. Specificity was 100% for all samples examined. Sensitivity was 57.1% (CI 95%, 34.0-78.2) in bone marrow aspirates, 58.8% (CI 95%, 32.9-81.6) in lymph node aspirates, 46.9% (CI 95%, 32.5-61.7) in conjunctival swabs, and 10.0% (CI 95%, 3.3-21.8) in blood. The ICPOC PCR was easy to perform and was reliable in the case of positive test results. A negative result, however, did not exclude infection and therefore requires further diagnostics.

High Quantities of Microplastic in Arctic Deep-Sea Sediments from the HAUSGARTEN Observatory

Although mounting evidence suggests the ubiquity of microplastic in aquatic ecosystems worldwide, our knowledge of its distribution in remote environments such as Polar Regions and the deep sea is scarce. Here, we analyzed nine sediment samples taken at the HAUSGARTEN observatory in the Arctic at 2340-5570 m depth. Density separation by MicroPlastic Sediment Separator and treatment with Fenton's reagent enabled analysis via Attenuated Total Reflection FTIR and μFTIR spectroscopy. Our analyses indicate the wide spread of high numbers of microplastics (42-6595 microplastics kg^-1). The northernmost stations harbored the highest quantities, indicating sea ice as a possible transport vehicle. A positive correlation between microplastic abundance and chlorophyll a content suggests vertical export via incorporation in sinking (ice-) algal aggregates. Overall, 18 different polymers were detected. Chlorinated polyethylene accounted for the largest proportion (38%), followed by polyamide (22%) and polypropylene (16%). Almost 80% of the microplastics were ≤25 μm. The microplastic quantities are among the highest recorded from benthic sediments. This corroborates the deep sea as a major sink for microplastics and the presence of accumulation areas in this remote part of the world, fed by plastics transported to the North via the Thermohaline Circulation.