Common genetic variants differentially influence the transition from clinically defined states of fasting glucose metabolism

AIMS/HYPOTHESIS

Common genetic variants have been associated with type 2 diabetes. We hypothesised that a subset of these variants may have different effects on the transition from normal fasting glucose (NFG) to impaired fasting glucose (IFG) than on that from IFG to diabetes.

METHODS

We identified 16 type 2 diabetes risk variants from the Illumina Broad Candidate-gene Association Resource (CARe) array genotyped in 26,576 CARe participants. Participants were categorised at baseline as NFG, IFG or type 2 diabetic (n = 16,465, 8,017 or 2,291, respectively). Using Cox proportional hazards and likelihood ratio tests (LRTs), we compared rates of progression by genotype for 4,909 (NFG to IFG) and 1,518 (IFG to type 2 diabetes) individuals, respectively. We then performed multinomial regression analyses at baseline, comparing the risk of assignment to the NFG, IFG or diabetes groups by genotype.

RESULTS

The rate of progression from NFG to IFG was significantly greater in participants carrying the risk allele at MTNR1B (p = 1 × 10(-4)), nominally greater at GCK and SLC30A8 (p < 0.05) and nominally smaller at IGF2BP2 (p = 0.01) than the rate of progression from IFG to diabetes by the LRT. Results of the baseline, multinomial regression model were consistent with these findings.

CONCLUSIONS/INTERPRETATION

Common genetic risk variants at GCK, SLC30A8, IGF2BP2 and MTNR1B influence to different extents the development of IFG and the transition from IFG to type 2 diabetes. Our findings may have implications for understanding the genetic contribution of these variants to the development of IFG and type 2 diabetes.

Helping the general physician to improve outcomes after PEG insertion: how we changed our practice

During their careers, most general physicians are involved in the decision-making process for patients that potentially require percutaneous endoscopic gastrostomy (PEG) insertion. However, poor patient selection and less than favourable outcomes are frequently observed in this group. With the aim of identifying and addressing the underlying issues, the PEG service at University Hospital Llandough was radically changed over an eight-year period. The development of a nurse-led pre-assessment service and design of a specific referral form was successful in reducing the number of PEG referrals and consequently the 30-day mortality rate. Furthermore, the educational and training needs of general physicians of all grades regarding the issues surrounding PEG placement were identified and addressed at formal teaching sessions. A combination of these factors has positively impacted on our service, with more appropriate patient selection and a reduced 30-day mortality rate.

The views of older women towards mammographic screening: a qualitative and quantitative study

Background:

Mammographic screening has improved breast cancer survival in the screened age group. This improved survival has not been seen in older women (>70 years) where screening uptake is low. This study explores the views, knowledge and attitudes of older women towards screening.

Methods:

Women (>70 years) were interviewed about breast screening. Interview findings informed the development of a questionnaire that was sent to 1000 women (>70 years) to quantify their views regarding screening.

Results:

Twenty-six women were interviewed and a questionnaire was designed. The questionnaire response rate was 48.3% (479 out of 992). Over half (52.9%, 241 out of 456) of the respondents were unaware that they could request a mammography by voluntary self-referral and were unaware how to arrange this. Most (81.5%, 383 out of 470) had not attended breast screening since turning 70 years. Most (75.6%, 343 out of 454) felt screening was beneficial and would attend if invited. Most (90.1%, 412 out of 457) felt screening should be offered to all women regardless of age or health.

Conclusions:

There is a lack of knowledge about screening in older women. The majority felt that invitation to screening should be extended to the older age group regardless of age or health. The current under-utilised system of voluntary self-referral is not supported by older women.

[The study of characteristics of overdose among users of opioid drug injections]

Overdose is a serious problem as for people addicted to opioid drug injections (ODI) as well as for the community in general. To study characteristics of overdose, authors examined 60 ODI users and analyzed 27 overdose death cases. It has been shown that overdose is rather common among ODI users. Fatal and nonfatal overdoses most frequently take place among men at home or in the street. People often did not receive sufficient help in the overdose situation. We confirm the role of alcohol, long abstinence and variability in drug quality in the development of overdose. Witnesses of overdose in other users reported more health problems, family and social relations, were more concerned with their own and others risk in future compared to those reporting no overdose. Additional predictors were determined: a higher number of overdoses in the past; disturbances of family relations and somatic disorders. Mental disorders predicted the opioid overdose risk among ODI users. ODI users are interested in counseling and training to prevent overdose. Family psychotherapy and early diagnosis of comorbid disorders may be important ways of overdose prevention.

Understanding body image in patients with chronic oedema

Chronic oedema is a complex, long term condition which can affect individuals on many levels. Body image is an important issue which can have implications on patients' ability to adjust to living with a long term chronic condition, accept appropriate treatment and remain motivated in their self management programmes. Healthcare Professionals are ideally placed to help identify and support patients with altered body image issues so that patients can adapt to and accept their condition.

MAST3: a novel IBD risk factor that modulates TLR4 signaling

Inflammatory bowel disease (IBD) is a chronic disorder caused by multiple factors in a genetically susceptible host. Significant advances in the study of genetic susceptibility have highlighted the importance of the innate immune system in this disease. We previously completed a genome-wide linkage study and found a significant locus (IBD6) on chromosome 19p. We were interested in identifying the causal variant in IBD6. We performed a two-stage association mapping study. In stage 1, 1530 single-nucleotide polymorphisms (SNPs) were selected from the HapMap database and genotyped in 761 patients with IBD. Among the SNPs that passed the threshold for replication, 26 were successfully genotyped in 754 additional patients (stage 2). One intronic variant, rs273506, located in the microtubule-associated serine/threonine-protein kinase gene-3 (MAST3), was found to be associated in both stages (pooled P=1.8 x 10(-4)). We identified four MAST3 coding variants, including a non-synonymous SNP rs8108738, correlated to rs273506 and associated with IBD. To test whether MAST3 was expressed in cells of interest, we performed expression assays, which showed abundant expression of MAST3 in antigen-presenting cells and in lymphocytes. The knockdown of MAST3 specifically decreased Toll-like receptor-4-dependent NF-kappaB activity. Our findings are additional proofs of the pivotal role played by modulators of NF-kappaB activity in IBD pathogenesis.

Inhibition of colon tumor metastasis in an orthotopic nude mouse model with the dual selective Src/Abl kinase inhibitor, AZD0530

14032

Background: Colorectal cancer is the leading cause of cancer deaths in the USA, largely due to metastatic disease in the liver. The specific activity of the non-receptor protein tyrosine kinase, Src, is increased during colon tumor progression and contributes to metastasis; thus, Src inhibitors may have efficacy in the treatment of advanced-stage colon cancer. AZD0530 is a potent, orally available Src/Abl kinase inhibitor currently in clinical trials. Methods: We examined the effects of AZD0530 alone and in combination with oxaliplatin on two colon tumor cell lines, KM12L4 and LS174T in vitro and in orthotopic nude mouse models. AZD0530 inhibits in vitro proliferation and cellular migration of KM12L4 and LS174T, and decreases phosphorylation of the Src substrates FAK and paxillin in a dose- dependent manner. To examine the ability of AZD0530 to affect colon cancer growth and metastasis in a nude mouse model, we inoculated 1x106 cells into the cecum of nude mice. After 2 weeks, mice were treated with vehicle (n=12), AZD0530 alone (n=13; 25mg/kg/day by oral gavage), oxaliplatin alone (n=13; 5mg/kg/day twice weekly), or AZD0530 and oxaliplatin (n=13). Mice were sacrificed after 4 weeks of treatment. Results: Tumor incidence in all groups of mice was greater than 80%. Mice treated with AZD0530 had an average cecal tumor weight of 0.26 g compared with 0.32 g for control (P=0.24). In contrast, the incidence of liver metastases was reduced by 50% in mice treated with AZD0530 alone or oxaliplatin alone, and no mice developed pathologically evident liver metastases when the combination of inhibitors was used. Furthermore, in mice that developed liver metastases, AZD0530 decreased the size of these metastases 9-fold compared with control. Immunohistochemical analysis of primary cecal tumors demonstrated a decrease in phosphorylated Src (Y418) and FAK (Y861) in AZD0530-treated mice compared with control. Conclusions: These results support further investigation of AZD0530, both alone and in combination, as a new therapeutic strategy for the treatment of advanced colon cancer.

No significant financial relationships to disclose.

Recognition, clinical diagnosis and management of patients with primary antibody deficiencies: a systematic review

The primary purpose of this systematic review was to produce an evidence-based review of the literature as a means of informing current clinical practice in the recognition, diagnosis and management of patients with suspected primary antibody deficiency. Randomized controlled trials (RCTs) were identified from a search of MEDLINE, EMBASE, The Cochrane Library, DARE (CRD website) and CINAHL by combining the search strategies with The Cochrane Collaboration's validated RCT filter. In addition, other types of studies were identified in a separate search of MEDLINE and EMBASE. Patients at any age with recurrent infections, especially in the upper and lower respiratory tracts, should be investigated for possible antibody deficiency. Replacement therapy with immunoglobulin in primary antibody deficiencies increases life expectancy and reduces infection frequency and severity. Higher doses of immunoglobulin are associated with reduced infection frequency. Late diagnosis and delayed institution of immunoglobulin replacement therapy results in increased morbidity and mortality. A wide variety of organ-specific complications can occur in primary antibody deficiency syndromes, including respiratory, gastroenterological, hepatic, haematological, neurological, rheumatological and cutaneous. There is an increased risk of malignancy. Some of these complications appear to be related to diagnostic delay and inadequate therapy. High-quality controlled trial data on the therapy of these complications is generally lacking. The present study has identified a number of key areas for further research, but RCT data, while desirable, is not always obtained easily for rare conditions. Few data from registries or large case-series have been published in the past 5 years and a greater focus on international collaboration and pooling of data is needed.

Statistics and public health at CDC

Since CDC's inception, an important function of the agency has been the compilation, analysis, and interpretation of statistical information to guide actions and policies to improve health. Sources of data include vital statistics records, medical records, personal interviews, telephone and mail surveys, physical examinations, and laboratory testing. Public health surveillance data have been used to characterize the magnitude and distribution of illness and injury; to track health trends; and to develop standard curves, such as growth charts. Beyond the development of appropriate program study designs and analytic methodologies, statisticians have played roles in the development of public health data-collection systems and software to analyze collected data. CDC/ATSDR employs approximately 330 mathematical and health statisticians. They work in each of the four coordinating centers, two coordinating offices, and the National Institute for Occupational Safety and Health.

Src kinase activity in early breast cancer (EBC): A quantitative luminometric and immunohistochemical (IHC) approach

13010

Background: Src kinase expression and activity is increased in many solid tumors including breast cancer, and Src kinase has a role in the regulation of cancer cell invasion. Thus, Src kinase is a potential therapeutic target. Targeting cancer cell invasion may be of particular value in early disease, although drug effects are unlikely to be measurable by conventional endpoints, for example tumor regression. This prospective study aimed to establish robust measures of Src activity in invasion-related pathways in tissue derived from EBC and to assess the variability between these measures, in order to establish a methodology for pharmacodynamic assessment of Src inhibition in clinical disease. Methods: Duplicate sets of core biopsies were taken from 30 patients, both at diagnosis and surgery. Biopsies were fixed immediately in either liquid nitrogen (luminometric analysis) or pre-cooled isopentane (IHC analysis). Formalin-fixed, paraffin-embedded tissue (FFPET) was also collected at the time of diagnosis. Levels of phospho-paxillin, phospho-focal adhesion kinase (FAK), total phosphotyrosine and total paxillin were measured in lysed tumor tissue using the Luminex system. Expression of activated Src, phospho-paxillin, phospho-FAK, total paxillin and total FAK was determined in sections of frozen tissue and FFPET, and assessed semi-quantitatively by visual examination. An analysis of variance (ANOVA) model was fitted to the Luminex data ( Table ). Results: All tumors expressed active Src, and there was a high level of expression, but low variability, of paxillin, FAK, phospho-paxillin and phospho-FAK. The subcellular localization of these markers could also be assessed in FFPET sections. Conclusion: The results indicate the feasibility of assessing the effect of a Src inhibitor on invasion-related endpoints in women awaiting surgery for EBC.

[Table: see text]

[Table: see text]

Chronic oedemas: identification and referral pathways

In order to treat chronic oedemas correctly it is essential that the condition has been correctly identified and a differential diagnosis made as to the cause of the swelling. This article aims to provide definitions and characteristics of the different types of oedema/chronic oedema, how to recognize chronic oedema and provide suggestions for onward referral to the appropriate healthcare professionals who should be involved in the patients care.