Novel cAMP binding protein-BP (CREBBP) mutation in a girl with Rubinstein-Taybi syndrome, GH deficiency, Arnold Chiari malformation and pituitary hypoplasia

Background

Rubinstein-Taybi syndrome (RTS) is a rare autosomal dominant disorder (prevalence 1:125,000) characterised by broad thumbs and halluces, facial dysmorphism, psychomotor development delay, skeletal defects, abnormalities in the posterior fossa and short stature. The known genetic causes are point mutations or deletions of the cAMP-response element binding protein-BP (CREBBP) (50-60% of the cases) and of the homologous gene E1A-binding protein (EP300) (5%).

Case presentation

We describe, for the first time in literature, a RTS Caucasian girl, 14-year-old, with growth hormone (GH) deficiency, pituitary hypoplasia, Arnold Chiari malformation type 1, double syringomyelic cavity and a novel CREBBP mutation (c.3546insCC).

Conclusion

We hypothesize that CREBBP mutation we have identified in this patient could be responsible also for RTS atypical features as GH deficiency and pituitary hypoplasia.

Early systemic sclerosis: short-term disease evolution and factors predicting the development of new manifestations of organ involvement

INTRODUCTION

We investigated early systemic sclerosis (SSc) (that is, Raynaud's phenomenon with SSc marker autoantibodies and/or typical capillaroscopic findings and no manifestations other than puffy fingers or arthritis) versus undifferentiated connective tissue disease (UCTD) to identify predictors of short-term disease evolution.

METHODS

Thirty-nine early SSc and 37 UCTD patients were investigated. At baseline, all patients underwent clinical evaluation, B-mode echocardiography, lung function tests and esophageal manometry to detect preclinical alterations of internal organs, and were re-assessed every year. Twenty-one early SSc and 24 UCTD patients, and 25 controls were also investigated for serum endothelial, T-cell and fibroblast activation markers.

RESULTS

At baseline, 48.7% of early SSc and 37.8% of UCTD patients had at least one preclinical functional alteration (P > 0.05). Ninety-two percent of early SSc patients developed manifestations consistent with definite SSc (that is, skin sclerosis, digital ulcers/scars, two or more teleangectasias, clinically visible nailfold capillaries, cutaneous calcinosis, X-ray bibasilar lung fibrosis, X-ray esophageal dysmotility, ECG signs of myocardial fibrosis and laboratory signs of renal crisis) within five years versus 17.1% of UCTD patients (X² = 12.26; P = 0.0005). Avascular areas (HR = 4.39 95% CI 1.18 to 16.3; P = 0.02), increased levels of soluble IL-2 receptor alpha (HR = 4.39; 95% CI 1.03 to 18.6; P = 0.03), and of procollagen III aminopropeptide predicted disease evolution (HR = 4.55; 95% CI 1.18 to 17; P = 0.04).

CONCLUSION

Most early SSc but only a few UCTD patients progress to definite SSc within a short-term follow-up. Measurement of circulating markers of T-cell and fibroblast activation might serve to identify early SSc patients who are more likely to develop features of definite SSc.

Dipeptidyl peptidase-4 inhibitors and HbA1c target of <7% in type 2 diabetes: meta-analysis of randomized controlled trials

AIM

We assessed the efficacy of dipeptidyl peptidase-4 (DPP-4) inhibitors vildagliptin, sitagliptin, saxagliptin and alogliptin to reach the haemoglobin HbA1c target of <7% in people with type 2 diabetes.

METHODS

We conducted an electronic search for randomized controlled trials (RCTs) involving DPP-4 inhibitors through September 2010. RCTs were included if they lasted at least 12 weeks, included 30 patients or more and reported the proportion of patients reaching the HbA1c target of <7%.

RESULTS

A total of 43 RCTs reporting 52 comparisons met the selection criteria, which included 19 101 study participants evaluated for the primary endpoint, 10 467 treated with a DPP-4 inhibitor and 8634 treated with placebo or a comparator drug. DPP-4 inhibitors showed a statistically significant reduction in HbA1c compared to placebo and approximately 40% of participants achieved the HbA1c goal of <7%: this was associated with weight neutrality and no greater hypoglycaemia. The reduction of the HbA1c level and the rate of HbA1c goal attainment was not different from comparator drugs, with similar hypoglycaemia, and different effect on weight owing to the nature of comparator (metformin, sulfonylurea or glitazones). Baseline HbA1c was the best predictor for achievement of A1C target (overall weighted r(2) value = 0.410, p < 0.001).

CONCLUSIONS

A greater proportion of type 2 diabetic patients can achieve the HbA1c goal <7% with DPP-4 inhibitors compared to placebo, with no weight gain, and no hypoglycaemic risk when used alone; DPP-4 inhibitors were not different from comparator drugs.

Technical solutions for analysis of grape juice, must, and wine: the role of infrared spectroscopy and chemometrics

Information about constituents of grape juice, must, and wine can be used for management and decision support systems in order to improve, monitor, and adapt grape and wine production to new challenges. Numerous sensors that gather this information are either currently available or in development. Nevertheless there is still a need to adapt these sensors to special requirements, for example robustness, calibration and maintenance, operating costs, duration, sensitivity, and specificity to a particular application. The sensors commonly used by the wine industry are those that are based on mid-infrared (MIR), near-infrared (NIR), visible (VIS) and ultraviolet (UV) spectroscopy. This article reviews some recent technical solutions for analysis of juice, must and wine based on the combination of infrared spectroscopy and chemometrics.

Identification of transgenic foods using NIR spectroscopy: a review

The utilization of chemometric methods in the quantitative and qualitative analysis of feeds, foods, medicine and so on has been accompanied with the great evolution in the progress and in the near infrared spectroscopy (NIRS). Hence, recently the application of NIR spectroscopy has extended on the context of genetics and transgenic products. The aim of this review was to investigate the application of NIR spectroscopy to identificate transgenic products and to compare it with the traditional methods. The results of copious researches showed that the application of NIRS technology was successful to distinguish transgenic foods and it has advantages such as fast, avoiding time-consuming, non-destructive and low cost in relation to the antecedent methods such as PCR and ELISA.

Effects of a mixed meal on hemodynamics and autonomic control of the heart in patients with type 1 diabetes

CONTEXT

Food intake induces relevant cardiovascular changes together with parallel increases in cardiac sympathetic activity and insulin plasma levels in man.

OBJECTIVE

We evaluated hemodynamics, neurohormones, and cardiac autonomic control after eating in patients with type 1 diabetes, a disease characterized by the absence of basal and stimulated insulin production.

DESIGN AND SETTING

Fifteen type 1 diabetic patients and 15 healthy controls underwent blood sampling, electrocardiogram, blood pressure and respiration recordings, and heart rate variability analysis while recumbent, during the 70 degrees head-up tilt, and 20 min after a mixed meal; on another occasion, diabetic patients were also studied 20 min after a mixed meal preceded by their scheduled bolus of exogenous insulin. Spectrum analysis of RR interval provided the indices of sympathetic (LF(RR)) and vagal (HF(RR)) modulation of the sinoatrial node.

RESULTS

At baseline, no significant differences were found between groups, except for metabolic parameters. Compared with baseline, heart rate, plasma catecholamines, and LF(RR) significantly (P < 0.005) increased, whereas HF(RR) significantly (P < 0.0001) decreased during the tilt in all subjects. Compared with baseline, plasma norepinephrine, heart rate, and LF(RR) significantly (P < 0.05) increased, whereas HF(RR) significantly (P < 0.02) decreased after eating in controls but not in diabetic patients (with and without insulin administered before eating). In both controls and diabetic patients, no relationship between postprandial changes of insulin and LF(RR) and HF(RR) was found.

CONCLUSIONS

Hemodynamic, neurohormonal, and cardiac neural responses to eating are abnormal in type 1 diabetic patients, independently of insulin.

Progress in the oral treatment of type 2 diabetes: update on DPP-IV inhibitors

Glucagon-like peptide-1 (GLP-1) is a gut hormone that plays an important role in regulating glucose homeostasis by both its pancreatic and extrapancreatic activity. Defects of GLP-1 characterize type 2 diabetes as a primary or perhaps consequent phenomenon, resulting in inappropriately low insulin secretion after oral ingestion of nutrients. The discovery that cleavage by the ubiquitous enzyme dipeptidyl peptidase-IV (DPP-IV) is the primary route of GLP-1 metabolism formed the rationale behind the proposal to prevent degradation of endogenously released GLP-1 by DPP-IV inhibition as a novel approach to the management of type 2 diabetes. Enhanced insulin secretion as well as delayed gastric emptying, reduced glucagon secretion, and inhibited apoptosis of beta cells resulting from blockade of incretin degradation, have been proposed as the major actions of DPP-IV inhibitors as antidiabetic agents. Clinical studies to date indicate that DPP-IV inhibitors effectively ameliorate islet dysfunction and improve glucose control in patients with type 2 diabetes. They appear to have excellent therapeutic effectiveness as monotherapy in patients inadequately controlled with diet and exercise and as add-on therapy in combination with metformin, thiazolidinediones, and insulin. Their pharmacokinetic and pharmacodynamic profiles support once-daily dosing, with relatively few adverse effects.

Failure of first-line eradication treatment significantly increases prevalence of antimicrobial-resistant Helicobacter pylori clinical isolates

OBJECTIVES

Helicobacter pylori infection is a major health problem worldwide, and effective eradication of the infection is mandatory. The efficacy of recommended eradication regimens is approximately 70%. To avoid treatment failure and the consequent development of secondary resistance(s), it is important to choose the most appropriate first-line treatment regimen. This choice should also be made based on the knowledge of the antimicrobial resistance peculiar to a given geographical area. We evaluated the prevalence of antimicrobial-resistant H pylori strains isolated from naive patients and from patients with previous unsuccessful treatments.

METHODS

This study examined 109 H pylori-infected subjects (Group 1) who had never received an eradication treatment and 104 H pylori-infected subjects (Group 2) who had failed one or more eradication treatments. Resistance to amoxicillin (AMO), tetracycline (TET), clarithromycin (CLA), metronidazole (MET) and levofloxacin (LEV) was determined using the epsilometer test. The significance of differences was evaluated by the chi2 test.

RESULTS

The prevalence of antimicrobial resistance was 0% versus 3.1% to AMO, 0% versus 2% to TET, 27% versus 41.3% to MET (p<0.05), 18% versus 45.8% to CLA (p<0.05) and 3% versus 14.6% to LEV (p<0.05) in Group 1 vs Group 2, respectively. In Group 2, there was an increased prevalence of H pylori strains resistant to multiple antimicrobials.

CONCLUSIONS

This study confirms the high prevalence of H pylori strains resistant to CLA and MET, and indicates that unsuccessful treatments significantly increase resistance. Choosing eradication regimens other than standard triple therapy as a first-line therapy should be advisable in areas with high primary antimicrobial resistance prevalence.

Verification of silage type using near-infrared spectroscopy combined with multivariate analysis

The ability to authenticate the feed given to animals has become a major challenge in animal production, where the diet fed to the animal is one of the most important production factors affecting the composition of milk and meat from cattle, sheep, and goats. Hence, there is currently an increased consumer demand for information on herbivore production factors and particularly the animal diet. The aim of this study was to evaluate the reliability and accuracy of near-infrared (NIR) reflectance spectroscopy as a tool to verify and authenticate the type of silage used as fed for ruminants. Grain silage (GrS, n = 94), grass and legume silage (GLegS, n = 121), and sunflower silage (SunS, n = 50) samples were collected from commercial farms and analyzed in the visible and NIR regions (400-2500 nm) in a monochromator instrument in reflectance. Principal component analysis (PCA), partial least-squares discriminant analysis (PLS1-DA), and linear discriminant analysis (LDA) models were used as methods to verify the different silage types. The classification models based on the NIR data correctly classified more than 90% of the silage samples according to their type. The results from this study showed that NIR spectra combined with multivariate analysis could be used as a tool to objectively authenticate silage samples used as a feed for ruminants.

Analysis of elements in wine using near infrared spectroscopy and partial least squares regression

The use of visible (VIS) and near infrared spectroscopy (NIRS) to measure the concentration of elements in Australian wines was investigated. Both white (n=32) and red (n=94) wine samples representing a wide range of varieties and regions were analysed by inductively coupled plasma mass spectrometry (ICP-MS) for the concentrations of calcium (Ca), potassium (K), magnesium (Mg), phosphorus (P), sodium (Na), sulphur (S), iron (Fe), boron (B) and manganese (Mn). Samples were scanned in transmittance mode (1mm path length) in a monochromator instrument (400-2500nm). The spectra were pre-treated by second derivative and standard normal variate (SNV) prior to developing calibration models using partial least squares (PLS) regression method with cross-validation. The highest coefficients of determination in cross-validation (R(val)(2)) and the lowest errors of cross-validation (SECV) were obtained for Ca (0.90 and 9.80mgL(-1)), Fe (0.86 and 0.65mgL(-1)) and for K (0.89 and 147.6mgL(-1)). Intermediate R(val)(2) (<0.80) and SECV were obtained for the other minerals analysed. The results showed that some macro- and microelements present in wine might be measured by VIS-NIRS spectroscopy.

The prediction of total anthocyanin concentration in red-grape homogenates using visible-near-infrared spectroscopy and artificial neural networks

This study compares the performance of partial least squares (PLS) regression analysis and artificial neural networks (ANN) for the prediction of total anthocyanin concentration in red-grape homogenates from their visible-near-infrared (Vis-NIR) spectra. The PLS prediction of anthocyanin concentrations for new-season samples from Vis-NIR spectra was characterised by regression non-linearity and prediction bias. In practice, this usually requires the inclusion of some samples from the new vintage to improve the prediction. The use of WinISI LOCAL partly alleviated these problems but still resulted in increased error at high and low extremes of the anthocyanin concentration range. Artificial neural networks regression was investigated as an alternative method to PLS, due to the inherent advantages of ANN for modelling non-linear systems. The method proposed here combines the advantages of the data reduction capabilities of PLS regression with the non-linear modelling capabilities of ANN. With the use of PLS scores as inputs for ANN regression, the model was shown to be quicker and easier to train than using raw full-spectrum data. The ANN calibration for prediction of new vintage grape data, using PLS scores as inputs, was more linear and accurate than global and LOCAL PLS models and appears to reduce the need for refreshing the calibration with new-season samples. ANN with PLS scores required fewer inputs and was less prone to overfitting than using PCA scores. A variation of the ANN method, using carefully selected spectral frequencies as inputs, resulted in prediction accuracy comparable to those using PLS scores but, as for PCA inputs, was also prone to overfitting with redundant wavelengths.

Effect of a single high-fat meal on endothelial function in patients with the metabolic syndrome: role of tumor necrosis factor-alpha

BACKGROUND AND AIMS

A single high-fat meal may induce endothelial activation and dysfunction in both normal subjects and in patients with type 2 diabetes. The aim of this study was to assess the effect of a high-fat meal on endothelial function in patients with the metabolic syndrome.

METHODS AND RESULTS

Twenty-five patients with the metabolic syndrome (ATP III criteria) were matched for sex, age and body mass index with 25 subjects without the metabolic syndrome. All subjects ate under supervision a high fat meal (760 calories) with 59% energy from fat, 12% energy from protein and 29% energy from carbohydrates. Compared with the control group, subjects with the metabolic syndrome had reduced endothelial function, as assessed with the l-arginine test, and higher circulating levels of TNF-alpha. Following the high-fat meal, both triglyceride and TNF-alpha levels increased more in subjects with the metabolic syndrome than in subjects without, while endothelial function decreased more in subjects with the metabolic syndrome. There was a significant relation between increases in TNF-alpha levels and decreases in endothelial function score in subjects with the metabolic syndrome (r=-0.39, P=0.03).

CONCLUSION

TNF-alpha levels are increased in subjects with the metabolic syndrome; moreover, a high-fat meal produces further increase in its levels associated with endothelial dysfunction.

The use of visible (VIS) and near infrared (NIR) reflectance spectroscopy to predict fibre diameter in both clean and greasy wool samples

Abstract Visible (VIS) and near infrared (NIR) reflectance spectroscopy combined with multivariate data analysis were explored to predict fibre diameter in both clean and greasy Merino wool samples. Fifty clean and 400 greasy wool samples were analysed. Samples were scanned in a large cuvette using a NIRSystems 6500 monochromator instrument by reflectance in the VIS and NIR regions (400 to 2500 nm). Partial least square (PLS) regression was used to develop a number of calibration models between the spectral and reference data. Different mathematical treatments were used during model development. Cross validation was used to assess the performance and avoid overfitting of the models. The NIR calibration models gave a coefficient of determination in calibration (R2) > 0·90 for clean wool samples and a R2 < 0·50 for greasy wool samples. The values for the residual predictive value, RPD (ratio of standard deviation (s. d.) to the root mean square of the standard error of cross validation (RMSECV)) were 3 for clean and 0·6 for greasy wool samples, respectively. The results indicated that fibre diameter in greasy wool samples was poorly predicted with NIR, while clean wool showed good relationships.

More research is required to improve the calibration on greasy wool samples if the technology is to be used for rapid analysis to assist in the selection of animals in breeding programmes.