SAT0604 FAST FOOD HABITS AND SERUM URATE CHANGE IN YOUNG ADULTS: 15-YEAR PROSPECTIVE ANALYSIS

Background:

Fast food consumption has strong positive associations with weight gain and insulin resistance.1Obesity and insulin resistance are in turn strongly associated with elevated serum urate (SU) levels, largely mediated by insulin’s anti-uricosuric ability.2

Objectives:

To investigate the relation between fast food consumption and changes in SU over a 15-year period among young black and white adults in the United States.

Methods:

Participants for the CARDIA study included 3,122 young (age 18-30 years in 1985-86) black and white adults in the United States who were followed up with repeated dietary and clinical assessments and had both baseline and year 15 SU measurement available. Frequency of fast food consumption (fast food frequency, FFF) was quantified on a semicontinuous scale and classified as <1, 1-2, or >2 times per week. We used multivariable linear regression models to investigate the association of FFF at baseline as well as change in FFF with 15-year changes in SU.

Results:

Our analysis included data from 3,122 subjects who had SU data available both at baseline and year 15 (Table 1). After adjustment for age, sex, education, baseline height and weight, and baseline SU, baseline FFF (defined as 3 times per week year 0 differences between participants) was independently associated with increases in SU among both black (beta=0.11, p=0.04) and white (beta=0.11, p=0.01) individuals (Table 2). Change in FFF (defined as 3 times a week 15-year change within participants) was also independently associated with increases in SU among white (beta=0.09, p=0.01) individuals but not blacks (beta=0.03, p=0.93) (Table 2). There was a significant correlation between weight change and SU change (correlation coefficient 0.34, p<0.001).Figure 1depicts the joint associations of year 0 FFF and 15-year changes in FFF with change in weight. Compared to the average 15-year SU change among participants with baseline FFF <1 time per week and 15-year FFF change <0 time per week, those with high FFF at both baseline and follow-up had an extra 0.21 mg/dL increase (i.e., 75% of overall population SU increase over 15 years [0.28 mg/dL]) in SU during that time. After adjusting for covariates in model 2, change in weight (beta=0.03, p<0.001) and homeostasis model for insulin resistance (HOMA) (beta=0.05, p<0.001) remained significantly associated with SU change.

Table 1.

Participant Characteristics

CharacteristicBlacks (n=1468)Whites (n=1654)Age, years (year 0)24.4 (3.8)25.6 (3.3)Male (%)4448Weight, kg (year 0)72.8 (16.7)70.0 (14.0)Weight, kg (year 15)87.9 (20.9)80.7 (18.6)Serum urate, mg/dL (year 0)5.1 (1.4)5.4 (1.4)Serum urate, mg/dL (year 15)5.6 (1.4)5.5 (1.4)

All values reported as mean (SD) unless otherwise noted.

Table 2.

Mean Adjusted Change in Serum Urate by Baseline and Change in Fast Food Frequency

Fast Food VariableBlacksWhitesBeta (SE)pBeta (SE)pModel 1Baseline0.11 (0.04)0.010.11 (0.04)0.01Change0.003 (0.033)0.930.09 (0.04)0.01Model 2Baseline0.12 (0.04)0.010.09 (0.04)0.02Change0.004 (0.03)0.880.08 (0.04)0.03

Model 1: age, sex, education, baseline height and weight, baseline SU

Model 2: model 1 + alcohol, physical activity, and smoking (both baseline and year 15 change)

Conclusion:

Fast-food consumption has strong positive associations with SU, suggesting that fast food increases the risk of hyperuricemia and gout. The observed association is likely mediated by weight gain and resultant changes in insulin resistance.

References:

[1]Pereira MA, Kartashov AI, Ebbeling CB, et al. Fast-food habits, weight gain, and insulin resistance (the CARDIA study): 15-year prospective analysis. Lancet 2005;365:36-42.

[2]Mount DB MT, Mandal A. Insulin: Genetic and Physiological Influences on Human Uric Acid Homeostasis [abstract]. Arthritis Rheumatol 2018; 70 (suppl 10).

Disclosure of Interests:

Chio Yokose: None declared, Leo Lu: None declared, Natalie McCormick: None declared, Jeewoong Choi: None declared, Yuqing Zhang: None declared, Hyon Choi Grant/research support from: Ironwood, Horizon, Consultant of: Takeda, Selecta, Horizon, Kowa, Vaxart, Ironwood

OP0171 MENDELIAN RANDOMIZATION SHOWS NO CAUSAL ASSOCIATION BETWEEN SERUM URATE OR GOUT AND TYPE-2 DIABETES

Background:

Positive associations between gout1,2or serum urate (SU)3and risk of type-2 diabetes (T2D) have been reported in population-based observational studies, but may be due to residual confounding. As such, causal roles of SU and gout on development of T2D are unclear.

Objectives:

Use two-sample mendelian randomization to estimate the causal effects of SU and gout on T2D and glycemic traits.

Methods:

Aggregate data from three large genome-wide association studies were used to identify genetic variants (SNPs) associated with the exposures and outcomes. Exposure SNPs were sourced from Global Urate Genetics Consortium (> 140,000 individuals); outcome SNPs sourced from DIAbetes Genetics Replication And Meta-analysis consortium (DIAGRAM; > 34,000 T2D cases and > 114,000 controls) and Meta-Analyses of Glucose and Insulin-related traits Consortium (MAGIC; > 46,000 non-diabetics).

We analysed SNPs associated with SU levels (n=28) and gout (n=6) for associations with T2D and three glycemic traits (insulin resistance, fasting insulin levels, and HbA1c) using inverse variance weighted meta-analysis methods. We also specifically examined two SNPs mapping to theSLC2A9gene, which encodes the GLUT9 transporter (for glucose and urate), estimating Wald ratios for these individual SNPs. Analyses were performed with TwoSampleMR package in R and mRnd power calculator.

Results:

Estimated effects of genetically-determined gout on each of the four outcomes (T2D, insulin resistance, fasting insulin levels, and HbA1c) were small and non-significant (p ≥ 0.18), as were the effects of changes in genetically-determined SU levels (Table).

Although the two SNPs in theSLC2A9gene were strongly associated with SU (rs12498742: R2=2.7%, beta=0.37 per mg/dL, p < 10-700) and gout (rs4475146: odds ratio=0.63, p=4.1x10-26), neither was associated with T2D nor any of the glycemic traits (Table).

Applying R2values ≥ 1.9%, we had ≥ 90% power to detect the increased odds of T2D (OR ≥1.151,3) from observational studies.

All Risk SNPs (meta-analysis)OUTCOMEn SNPsGout (vs. non-gout)Serum urate (per 1 mg/dL increase)Effect size (95% CI)pEffect size (95% CI)pHbA1c (%)450.0046 (-0.0087 to 0.0179)0.50-0.0046 (-0.0275 to 0.0183)0.70Insulin resistance (HOMA-IR: log units)450.0108 (-0.0049 to 0.0265)0.180.0016 (-0.0240 to 0.0272)0.90Fasting insulin levels (log pmol/L)180.0046 (-0.0037 to 0.0129)0.28-0.0221 (-0.1035 to 0.0593)0.59Type 2 Diabetes: odds ratio430.98 (0.90 to 1.07)0.721.01 (0.88 to 1.16)0.84SNPs inSLC29AGene (single-SNP analysis)OUTCOMErs4475146Gout (vs. non-gout)rs12498742Serum urate (per 1 mg/dL increase)Effect size (95% CI)pEffect size (95% CI)pHbA1c (%)0.0032 (-0.0139 to 0.0203)0.710.0005 (-0.0205 to 0.0216)0.96Insulin resistance (HOMA-IR: log units)0.0128 (-0.0073 to 0.0328)0.210.0126 (-0.0121 to 0.0373)0.32Fasting insulin levels (log pmol/L)0.0038 (-0.0070 to 0.0147)0.490.0048 (-0.0088 to 0.0185)0.49Type 2 Diabetes: odds ratio0.98 (0.87 to 1.10)0.700.98 (0.85 to 1.13)0.75

HOMA-IR=homeostasis model assessment of insulin resistance

Conclusion:

Evidence from this instrumental variable analysis suggests gout and SU are signals for future T2D, but neither SU or gout itself are causally associated with the development of this condition. As such, interventions targeting SU levels alone are unlikely to lower the risk of T2D.

References:

[1]Rho YH, Lu N, Peloquin CE, et al. Independent impact of gout on the risk of diabetes mellitus among women and men: a population-based, BMI-matched cohort study.Ann Rheum Dis. 2016;75(1):91-95.

[2]Choi HK, De Vera MA, Krishnan E. Gout and the risk of type 2 diabetes among men with a high cardiovascular risk profile.Rheumatology. 2008;47(10):1567-1570.

[3]Bhole V, Choi JWJ, Woo Kim S, De Vera M, Choi H. Serum Uric Acid Levels and the Risk of Type 2 Diabetes: A Prospective Study.Am J Med. 2010;123(10):957-961.

Disclosure of Interests:

Natalie McCormick: None declared, Jeewoong Choi: None declared, Shelby Marozoff: None declared, Hyon Choi Grant/research support from: HC reports research support from Ironwood and Horizon, Consultant of: HC reports consulting fees from Ironwood, Selecta, Horizon, Takeda, Kowa, and Vaxart.

OP0247 PERSISTENT PREMATURE MORTALITY GAP IN IDIOPATHIC INFLAMMATORY MYOPATHY: A GENERAL POPULATION-BASED COHORT STUDY

Background:

Idiopathic inflammatory myopathy (IIM) is associated with significant premature mortality; however, whether the mortality gap has improved over recent years is unknown.

Objectives:

To determine trends in premature mortality in patients with IIM in a large cohort, representative of the United Kingdom (UK) general population.

Methods:

Using The Health Improvement Network (THIN), an electronic medical record database representative of the UK general population, we identified patients with incident IIM between 18 and 89 years of age (defined by at least one Read diagnosis code for dermatomyositis, polymyositis, or interstitial myositis with at least one year of continuous enrollment in THIN prior to the cohort entry date) and up to 10 controls without IIM matched on age, sex, birth year, and database entry year. The cohort was divided in two based on the year of IIM diagnosis: the early cohort (1999-2006) and the late cohort (2007-2014). We calculated adjusted hazard ratios for death using a multivariable Cox-proportional hazards model and adjusted rate differences using an additive hazard model.

Results:

The early cohort consisted of 355 patients with IIM and 3182 matched controls, while the late cohort consisted of 396 IIM patients and 3551 matched controls. In both cohorts, IIM patients had excess mortality compared to matched controls [57.4 vs. 15.2 deaths/1000 person-years (PY) in the early cohort and 43.2 vs. 14.1 deaths/1000 PY in the late cohort] (Table). The corresponding multivariate mortality hazard ratios were 2.73 (95% CI, 1.85 to 4.03) vs. 2.61 (95% CI, 1.75 to 3.89) in the early and late cohorts, respectively (p-value for interaction = 0.63) (Figure). The absolute multivariate mortality differences were 36.6 (95% CI, 20.4 to 52.8) and 25.8 (95% CI, 13.7 to 37.9) deaths/1000 PY, in the early and late cohorts, respectively (p-value for interaction = 0.24).

Conclusion:

In this general population-based cohort study, patients with IIM had over 2.5 times the risk of death compared to matched controls, even after adjusting for comorbidities and medications. Unlike trends seen in rheumatoid arthritis and granulomatosis with polyangiitis, there appears to be no improvement in mortality in IIM in recent years. This highlights the need for improved strategies for the management of patients with IIM and its comorbidities.

Table.

Association between idiopathic inflammatory myopathy (IIM) and all-cause mortality according to time period.

1999-20062007-2014IIM cohort (n=355)Non-IIM cohort (n=3182)IIM cohort (n=396)Non-IIM cohort (n=3551)p-value for interactionFollow-up time, years (mean ± SD)2.6 ± 2.12.9 ± 2.13.2 ± 2.43.5 ± 2.4Number of deaths5314055177Death rate/1000 PY (95% CI)57.4 (43.0, 75.1)15.2 (12.7, 17.9)43.2 (32.5, 56.2)14.1 (12.1, 16.3)Age-, sex-, and entry year-matched hazard ratio (95% CI)4.02 (2.89, 5.59)1.00 (ref)3.43 (2.49, 4.73)1.00 (ref)0.50Multivariable-adjusted hazard ratio (95% CI)*2.73 (1.85, 4.03)1.00 (ref)2.61 (1.75, 3.89)1.00 (ref)0.63Age-, sex-, and entry year-matched rate difference/1000 PY (95% CI)42.2 (26.6, 57.9)0.0 (ref)29.1 (17.5, 40.7)0.0 (ref)0.24Multivariable-adjusted rate difference/1000 PY (95% CI)36.6 (20.4, 52.8)0.0 (ref)25.8 (13.7, 37.9)0.0 (ref)0.24

* Multivariable models were adjusted for age, sex, entry year, number of GP visits, BMI, smoking status (i.e., non-smokers, ex-smokers, current smokers), alcohol consumption (i.e., non-drinkers, ex-drinkers, current drinkers), comorbidities, and medication use.

PY, person-year; BMI, body mass index; GP, general practitioner

Figure.

Cumulative mortality of patients with idiopathic inflammatory myopathy and matched controls without IIM in early versus late cohorts (1999-2006 versus 2007-2014).

Disclosure of Interests:

Kristin D’Silva: None declared, Leo Lu: None declared, Alexis Ogdie Grant/research support from: Pfizer to Penn, Novartis to Penn, Amgen to Forward/NDB, Consultant of: Abbvie, Amgen, Bristol-Myers Squibb, Celgene, Corrona, Janssen, Eli Lilly, Novartis, Pfizer, Antonio Aviña: None declared, Hyon Choi Grant/research support from: Ironwood, Horizon, Consultant of: Takeda, Selecta, Horizon, Kowa, Vaxart, Ironwood

FRI0532 THE IMPACT OF GENETICALLY DETERMINED SERUM URATE LEVELS ON THE DEVELOPMENT OF CARDIOVASCULAR DISEASES: A SYSTEMATIC REVIEW AND META-ANALYSIS OF MENDELIAN RANDOMIZATION STUDIES

Background:

Conventional observational studies have identified serum urate (SU) as an independent risk factor for cardiovascular diseases (CVDs),1,2but the causal relationships remain unsettled, with potential confounding and reverse causality. When applied correctly, Mendelian randomization (MR) employing genetic variants as instrumental variables can eliminate these biases and allow for causal inference.

Objectives:

To conduct a systematic review and meta-analysis of English-language, peer-reviewed MR studies on the causal effects of SU on CVDs and assess validation of key MR assumptions.

Methods:

A research librarian conducted a search (inception to January 2020) of four databases (Medline, Embase, Cochrane Library, and Web of Science), which was supplemented by hand-search. Titles and abstracts were screened by two independent reviewers, who subsequently evaluated and extracted data from full-text of selected articles. Pooled meta-analysis was performed using random-effects weighting.

Results:

Of 1014 articles identified, 40 were selected for full-text review and 13 studies reporting on CVDs were included in the systematic review (Figure 1). The first was published in 2009 and five were published in 2018 or 2019 alone. The included studies were of varying quality in regards to satisfying the assumptions for MR design.

Fig. 1

: PRISMA flow diagram.

Overall, there was little evidence for a causal association between SU and risk of CVDs (Table 1). Random-effects meta-analysis revealed that SU was not significantly associated with risk of CVDs (OR=1.04; 95% CI=0.99-1.09) (Figure 2). 11 of the 13 studies reported null estimates for the effects of genetically-determined SU levels on CVDs. Two studies with small numbers of cases (N=125 and 222) reported significant associations, but these pertained to highly-specific subgroups.

Table 1.

Summary of included studies. CAD: Coronary Artery Disease; CHD: Coronary Heart Disease; IHD: Ischaemic heart disease; MI: Myocardial Infarction; MR: Mendelian Randomization; PVD: Peripheral Vascular Disease; SNP: Single Nucleotide Polymorphism

First author; yearNumber of SNPs analyzedOutcome(n cases)PowerMR criteria validated:1. relevance2. pleiotropy3. confoundingConclusionStark; 200910 separatelyCAD (1,473)30%-66%1, 3NullYang; 20108 combinedCHD (3,050)<80%1, 2, 3NullPalmer; 20131 (rs7442295)IHD (3,742)N/A1, 2*, 3NullKleber; 20158 combinedCAD (2,418)PVD (295)N/A1, 2, 3NullHan; 20152 separatelyCHD (1,146)80%1, 2*, 3NullTesta; 20151 (rs734553)CVD events (CVD death, stroke, MI) (222)N/A1, 2*Significant for CV eventsWhite; 201631 combinedCAD (65,877)83%1, 2, 3NullKeenan; 201614 combinedCHD (54,501)Stroke (14,779)>80%1, 2, 3NullLi; 201831 combinedIHD (9,467)MI (3,625)70%1, 2, 3NullLi; 201931 combinedCHD (60,801)MI (43,676)Stroke (10,307)N/A1, 2, 3NullMacias-Kauffer; 20192 separatelyCAD (704)N/A1, 2*, 3NullEfstathiadou; 201928 separatelyCHD (184,305)MI (54,162) Stroke (514,791)>80%1, 2, 3NullChiang; 20198 combinedCHD (125)Stroke (57)N/A1, 2, 3Significant for CHD

* Risk of pleiotropy (assumption 2) is low when utilizing few well-established SNPs

Fig. 2

: Pooled meta-analysis results.

Conclusion:

Evidence from this systematic review does not support a causal role for SU levels and CVDs. As such, interventions targeting SU levels alone are unlikely to lower the risk of CVDs.

References:

[1] Zhu Y, Pandya BJ, Choi HK. Comorbidities of gout and hyperuricemia in the US general population: NHANES 2007-2008. Am J Med 2012;125:679-87 e1.

[2] Choi HK, Curhan G. Independent impact of gout on mortality and risk for coronary heart disease. Circulation 2007;116:894-900

Disclosure of Interests:

Jeewoong Choi: None declared, Natalie McCormick: None declared, Shelby Marozoff: None declared, Mary De Vera: None declared, Hyon Choi Grant/research support from: Ironwood, Horizon, Consultant of: Takeda, Selecta, Horizon, Kowa, Vaxart, Ironwood

0800 Posttraumatic Stress Disorder and REM Sleep Without Atonia in Veterans

Introduction

In veterans, the prevalence of rapid eye movement (REM) sleep behavior disorder(RBD) is higher than the general population, and there is some evidence that this is related to posttraumatic stress disorder(PTSD). In addition, trauma related nightmares (TRNs) interfere with REM sleep and are often accompanied by motor activity. (rem sleep without atonia; RSWA). The purpose of this study is to determine whether the frequency of dream enactment behavior(DEB) and RSWA is different according to the presence of PTSD or trauma.

Methods

The patients (n = 2262) who underwent video assisted polysomnography (PSG) and sleep-related questionnaire surveys at Veteran Health Service Medical Center in Republic of Korea were reviewed retrospectively and cross-sectionally. Based on patients diagnosed with PTSD (N = 20; 100% male; 67.9 ± 8.5 years of age), those exposed to trauma but not diagnosed with PTSD (N = 23; 100% male; age 64.0 ± 13.4) and trauma unexposed controls (N = 21; 100% male; age 59.86 ± 10.9) were matched.

Results

In the PTSD group, patients who reported self-reported DEB tended to be more than the traumatic exposure group and the control group (P = 0.022). In-lab video assisted PSG showed no differences in DEB between the three groups, but RSWA. (p = 0.026) After adjusting for age, hypnotics, apnea hypopnea index (AHI), Beck depression inventory (BDI), and periodic limb movement (PLM) arousal factors, RSWA was significantly higher in the PTSD group than in the traumatic exposure group. (p = 0.006)

Conclusion

The result that RSWA was significantly higher in the PTSD group than in the traumatic exposure group suggests that there may be an associated pathophysiology between PTSD and RBD. Longitudinal studies are needed to establish the link between RBD with PTSD and neurodegenerative diseases associated with synucleinopathy.

Support

This study was supported by a VHS Medical Center Research Grant, Republic of Korea. (grant number: VHSMC 19033)

0505 Insomnia: Entrapment of Binaural Auditory Beats on Subjects with Insomnia Symptoms

Introduction

It has been reported that binaural beat stimulation, which has two different frequencies on both ears, is effective in increasing alertness, memory, reducing anxiety, and controlling mood. This study aims to clarify the brain wave entrainment effect of binaural beat and to identify the mechanism of action of the binaural beat.

Methods

Subjects with subclinical insomnia symptoms between 20 and 59 years of age were recruited from the community. Quantitative electroencephalography (EEG) was measured two times before and after the 2 weeks of binaural beat intervention period. An audio apparatus without the distortion of a sound source is set with theta (6 Hz) binaural beat. Participants used the apparatus for 30 minutes before going to bed for 2 weeks.

Results

When the music with binaural beat was played, the relative power of theta frequency increased (occipital, P=0.009). When the music only was played in the laboratory, the relative power of delta (temporal, P=0.004; parietal, P=0.005; occipital, P=0.006) and theta frequency (temporal, P=0.004; central, P=0.001; parietal, P=0.001; occipital, P=0.003) increased and the relative power of alpha decreased (frontal, P=0.008; temporal, P=0.012; central, P=0.008; parietal, P=0,004; occipital, P=0.005). After listening to music with binaural beat for two weeks, the difference of beta power before and after listening to music first in the laboratory was lower than the difference after using music-only devices (P=0.008).

Conclusion

When the binaural beat was played, the entrapment of theta wave appeared. And the music was presumed to have a nonspecific relaxation effect. After exposure to music with binaural beat for 2 weeks, beta power decreased compared to exposure to music alone. Continuous music with binaural beat exposure for 2 weeks is likely to reduce hyper-arousal state and contribute to sleep induction.

Support

None

Analysis of the relationship between changes in the auditory brainstem response and prognosis in patients with sudden hearing loss

OBJECTIVE

To analyse how the auditory brainstem response changes in patients with sudden sensorineural hearing loss.

METHOD

Data were collected via retrospective medical chart review.

RESULTS

Forty-three patients were included in this study. The mean latency of auditory brainstem response wave 1 was significantly longer for the affected side than for the unaffected side (p = 0.003). The mean latency of auditory brainstem response wave 1 was significantly shorter, and the mean amplitude of auditory brainstem response wave 1 was significantly larger, in the good response group compared to the poor response group. In forward conditional logistic regression analysis, auditory brainstem response wave 1 latency was an independent predictor of a good response (odds ratio = 34.37, 95 per cent confidence interval = 1.56-757.15, p = 0.025).

CONCLUSION

In patients with sudden sensorineural hearing loss, the latency of wave 1 of the auditory brainstem response was significantly increased and was related to prognosis.

Chicken PRDX3 is required for proliferation of chicken embryo fibroblast cells

1. This experiment investigated the influence of chicken PRDX3 on cell proliferation in chick embryo fibroblast cells using PRDX3 knockdown technology.2. A methyl thiazolyl tetrazolium (MTT) assay was performed to assess the effect of chPRDX3 knockdown on fibroblast proliferation. The antioxidant effect was investigated to determine if it directly mediated fibroblast cell proliferation.3. To determine the role of chPRDX3 on cell proliferation, an siRNA mediated knockdown was performed in chick fibroblast cells using an in vitro assay. The proliferation of fibroblast cells transfected with siPRDX3 #3 and siPRDX3 Mix was significantly decreased after 48 h (P < 0.01). In addition, the knockdown of chicken PRDX3 suppressed cell proliferation through an increase in oxidative stress.4. The results demonstrated that chPRDX3 is required for cell proliferation in chicken fibroblast cells. Such findings have important implications for the maintenance of chicken fibroblast cells.

Comparison of open and pneumovesical approaches for Politano-Leadbetter ureteric reimplantation: a single-center long-term follow-up study

PURPOSE

To report our experience with the laparoscopic pneumovesical approach for Politano-Leadbetter ureteric reimplantation and to compare the results to those obtained using a traditional open approach.

METHODS

We retrospectively reviewed the medical records of 52 patients who underwent Politano-Leadbetter ureteral reimplantation between 2012 and 2017. The peri-operative parameters, postoperative outcomes, and complication rates of patients who underwent the open approach for the Politano-Leadbetter procedure and those who underwent the laparoscopic pneumovesical approach were compared.

RESULTS

During the study period, 52 ureteric reimplantation procedures were analyzed. Among these, 28 and 24 patients underwent surgery using the open and pneumovesical approaches, respectively. The mean operative time did not differ between the groups (143.64 min vs. 128.12 min, P = 0.092). However, the pneumovesical group had a shorter duration of hospital stay (5.08 days vs 7.43 days, P = 0.001) and required less morphine analgesic for pain than did the open group (7.7% vs 32.1%, P = 0.027). No significant differences in the success rates (94.9% vs 92.5%, P = 0.512) or procedure-related complications were noted between the pneumovesical and open techniques.

CONCLUSIONS

The transvesicoscopic Politano-Leadbetter technique with pneumovesicum is safe and effective for ureteric reimplantation and is comparable to the open approach.

Chronic exposure to non-eruptive volcanic activity as cause of bronchiolar histomorphological alteration and inflammation in mice

It is estimated that 10% of the worldwide population lives in the vicinity of an active volcano. However, volcanogenic air pollution studies are still outnumbered when compared with anthropogenic air pollution studies, representing an unknown risk to human populations inhabiting volcanic areas worldwide. This study was carried out in the Azorean archipelago of Portugal, in areas with active non-eruptive volcanism. The hydrothermal emissions within the volcanic complex of Furnas (São Miguel Island) are responsible for the emission of nearly 1000 tons of CO₂ per day, along with H₂S, the radioactive gas - radon, among others. Besides the gaseous emissions, metals (e.g., Hg, Cd, Al, Ni) and particulate matter are also released into the environment. We test the hypothesis that chronic exposure to volcanogenic air pollution alters the histomorphology of the bronchioles and terminal bronchioles, using the house mouse, Mus musculus, as bioindicator species. Mus musculus were live-captured at three different locations: two villages with active volcanism and a village without any type of volcanic activity (reference site). The histomorphology of the bronchioles (diameter, epithelium thickness, smooth muscle layer thickness, submucosa thickness and the histological evaluation of the peribronchiolar inflammation) and of the terminal bronchioles (epithelium thickness and classification) were evaluated. Mice chronically exposed to volcanogenic air pollution presented bronchioles with increased epithelial thickness, increased smooth muscle layer, increased submucosa thickness and increased peribronchiolar inflammation. Similarly, terminal bronchioles presented structural alterations consistent with bronchodysplasia. For the first time we demonstrate that chronic exposure to non-eruptive volcanically active environments causes inflammation and histomorphological alterations in mice lower airways consistent with asthma and chronic bronchitis. These results reveal that chronic exposure to non-eruptive volcanic activity represents a risk factor that can affect the health of the respiratory system of humans inhabiting hydrothermal areas.

Prevalence of and factors related to latent tuberculous infection among all employees in a referral hospital

SETTING

Referral hospital, South Korea.

OBJECTIVE

To investigate the prevalence of and factors related to latent tuberculous infection (LTBI) among all hospital employees.

DESIGN

A cross-sectional study of 479 health care workers (HCWs) undergoing LTBI screening.

RESULTS

Overall prevalence of LTBI was 15.7%, 43.1% of whom initiated and completed LTBI treatment. Compared with HCWs without LTBI, those with LTBI were more likely to be older (P < 0.001), male (P = 0.003), work in low-risk departments (P = 0.013) and have more years of employment (P < 0.001). LTBI prevalence was highest in physicians (27.8%), followed by HCWs without patient contact (23.4%), nurses (8.3%) and other HCWs in contact with patients (6.9%). In multivariate analysis, compared with HCWs aged <20 years, those aged 40 years were 4.08 times more likely to have LTBI (P = 0.007). In addition, compared with HCWs working for <1 year, those working for 1-5 years or for 5 years were respectively 7.55 (P = 0.014) and 13.69 (P = 0.001) times more likely to have LTBI.

CONCLUSIONS

Our results suggest that modified LTBI screening strategies, including HCWs with no patient contact and encouraging LTBI treatment participation, might be helpful in improving LTBI control in HCWs.

Effectiveness of Levetiracetam Monotherapy in Pediatric Patients With Epilepsy

The main objective of this study was to assess the efficacy, safety, and retention rates of levetiracetam monotherapy in children with epilepsy. A retrospective review of pediatric patients receiving levetiracetam monotherapy at 2 large tertiary epilepsy centers over an 11-year period was conducted. One hundred two patients using levetiracetam monotherapy with a mean age of 13.1 years were identified. For the entire cohort, a 6-month retention rate was 61.1% and a 12-month retention rate 53.1%. With regard to seizure freedom, 46.8% of those patients that remained on monotherapy for at least 6 months became seizure free. Twelve-month seizure freedom was reached by 41.2%. About one-third (32.4%) of patients reported adverse effects, with irritability, moodiness, and depression being the most common. Despite a number of patients that reported adverse events, levetiracetam monotherapy was found to be potentially effective in this cohort of children with epilepsy and warrants further, prospective studies.

Sex-Related Abnormalities in Substantia Nigra Lipids in Parkinson's Disease

Parkinson’s disease (PD) is a neurodegenerative movement disorder involving the selective loss of dopamine-producing neurons in the substantia nigra (SN). Differences in disease presentation, prevalence, and age of onset have been reported between males and females with PD. The content and composition of the major glycosphingolipids, phospholipids, and cholesterol were evaluated in the SN from 12 PD subjects and in 18 age-matched, neurologically normal controls. Total SN ganglioside sialic acid content and water content (%) were significantly lower in the male PD subjects than in the male controls. The content of all major gangliosides were reduced in the male PD subjects to some degree, but the neuronal-enriched gangliosides, GD1a and GT1b, were most significantly reduced. The distribution of phosphatidylethanolamine, phosphatidylcholine, and phosphatidylinositol was also significantly lower in the male PD subjects than in the male controls. However, the distribution of myelin-enriched cerebrosides and sulfatides was significantly higher in the male PD subjects than in the male controls suggesting myelin sparing in the male PD subjects. No elevation was detected for astrocytosis-linked GD3. These neurochemical changes provide evidence of selective neuronal loss in SN of the males with PD without robust astrocytosis. In contrast to the SN lipid abnormalities found in the male PD subjects, no significant abnormalities were found in the female PD subjects for SN water content or for any major SN lipids. These data indicate sex-related differences in SN lipid abnormalities in PD.

Augmented manipulation ability in humans with six-fingered hands

Neurotechnology attempts to develop supernumerary limbs, but can the human brain deal with the complexity to control an extra limb and yield advantages from it? Here, we analyzed the neuromechanics and manipulation abilities of two polydactyly subjects who each possess six fingers on their hands. Anatomical MRI of the supernumerary finger (SF) revealed that it is actuated by extra muscles and nerves, and fMRI identified a distinct cortical representation of the SF. In both subjects, the SF was able to move independently from the other fingers. Polydactyly subjects were able to coordinate the SF with their other fingers for more complex movements than five fingered subjects, and so carry out with only one hand tasks normally requiring two hands. These results demonstrate that a body with significantly more degrees-of-freedom can be controlled by the human nervous system without causing motor deficits or impairments and can instead provide superior manipulation abilities.