A randomized, placebo-controlled, double-blind study of sapropterin to treat ADHD symptoms and executive function impairment in children and adults with sapropterin-responsive phenylketonuria

Symptoms of attention deficit-hyperactivity disorder (ADHD), particularly inattention, and impairments in executive functioning have been reported in early and continuously treated children, adolescents, and adults with phenylketonuria (PKU). In addition, higher blood phenylalanine (Phe) levels have been correlated with the presence of ADHD symptoms and executive functioning impairment. The placebo-controlled PKU ASCEND study evaluated the effects of sapropterin therapy on PKU-associated symptoms of ADHD and executive and global functioning in individuals who had a therapeutic blood Phe response to sapropterin therapy. The presence of ADHD inattentive symptoms and executive functioning deficits was confirmed in this large cohort of 206 children and adults with PKU, of whom 118 responded to sapropterin therapy. In the 38 individuals with sapropterin-responsive PKU and ADHD symptoms at baseline, sapropterin therapy resulted in a significant improvement in ADHD inattentive symptoms in the first 4 weeks of treatment, and improvements were maintained throughout the 26 weeks of treatment. Sapropterin was well-tolerated with a favorable safety profile. The improvements in ADHD inattentive symptoms and aspects of executive functioning in response to sapropterin therapy noted in a large cohort of individuals with PKU indicate that these symptoms are potentially reversible when blood Phe levels are reduced.

An extremely high-altitude plume seen at Mars' morning terminator

The Martian limb (that is, the observed 'edge' of the planet) represents a unique window into the complex atmospheric phenomena occurring there. Clouds of ice crystals (CO2 ice or H2O ice) have been observed numerous times by spacecraft and ground-based telescopes, showing that clouds are typically layered and always confined below an altitude of 100 kilometres; suspended dust has also been detected at altitudes up to 60 kilometres during major dust storms. Highly concentrated and localized patches of auroral emission controlled by magnetic field anomalies in the crust have been observed at an altitude of 130 kilometres. Here we report the occurrence in March and April 2012 of two bright, extremely high-altitude plumes at the Martian terminator (the day-night boundary) at 200 to 250 kilometres or more above the surface, and thus well into the ionosphere and the exosphere. They were spotted at a longitude of about 195° west, a latitude of about -45° (at Terra Cimmeria), extended about 500 to 1,000 kilometres in both the north-south and east-west directions, and lasted for about 10 days. The features exhibited day-to-day variability, and were seen at the morning terminator but not at the evening limb, which indicates rapid evolution in less than 10 hours and a cyclic behaviour. We used photometric measurements to explore two possible scenarios and investigate their nature. For particles reflecting solar radiation, clouds of CO2-ice or H2O-ice particles with an effective radius of 0.1 micrometres are favoured over dust. Alternatively, the plume could arise from auroral emission, of a brightness more than 1,000 times that of the Earth's aurora, over a region with a strong magnetic anomaly where aurorae have previously been detected. Importantly, both explanations defy our current understanding of Mars' upper atmosphere.

Dutch health-related quality of life measure for chronic otitis media

OBJECTIVE

Chronic otitis media (COM) describes a variety of symptoms and physical findings that result from prolonged damage to the middle ear by infection and inflammation. The Health-Related Quality of Life measure for COM (COMQ-12) is a new questionnaire for the assessment of COM that evaluates the overall burden of disease from the patient's perspective. The aim of this study was to develop and appraise the psychometric properties of the Dutch version of the COMQ-12.

MATERIALS AND METHODS

The Dutch version of the COMQ-12 was obtained through translation and back-translation. Fifty adult patients with a history of active COM completed the Dutch version of the COMQ-12. The internal consistency of this questionnaire was evaluated using Cronbach's alpha coefficient.

RESULTS

The average COMQ-12 score was 22.4 (SD 11.9). The internal consistency of the Dutch version of the COMQ-12 was high, with a Cronbach's alpha value of 0.833.

CONCLUSIONS

The Dutch version of the COMQ-12 provides appropriate health-related quality of life outcome measures in patients with a history of COM. This questionnaire is a useful tool to evaluate the overall burden of disease from the patient's perspective.

Use of Modified Swallow Study to Measure Posterior Airway Space in Obstructive Sleep Apnea Patients

Objectives:

Obstructive sleep apnea affects over 15% of the population, presenting a major health burden. Research has focused on exploring imaging modalities that supplement polysomnography, eliciting potential sites of airway obstruction. While computed tomography (CT) imaging and sleep endoscopy have been used to accurately assess the posterior airway space (PAS), sedated endoscopy is invasive, and repeated CT imaging risks higher radiation exposure and does not assess the dynamics of the tongue base and PAS. We propose the use of modified barium swallow study as a simple modality to measure PAS. Advantages include its simplicity, lower radiation, and dynamic tongue base visualization, which may help predict surgical outcomes. We hypothesize cephalometric measurements obtained using modified barium swallow (MBS) will correlate well with CT.

Methods:

Retrospective chart review, tertiary care hospital. Thirty-six adult patients who underwent both CT imaging and MBS for head and neck cancer were included. Cephalometric measurements of the PAS were obtained using each imaging modality. Statistical analysis focused on correlating measurements taken using CT or MBS.

Results:

The average PAS measurements were 12.53 ± 1.81 mm and 12.80 ± 1.75 mm when using MBS and CT imaging, respectively. There were no statistical differences based on age, sex, or cancer site. In comparing the 2 modalities, Pearson correlation between CT and MBS measurements revealed an extremely significant positive correlation between r = 0.6382 and 0.8932 ( P < .0001).

Conclusions:

Cephalometric measurement of the PAS using MBS appears to correlate well with CT imaging. These data suggest MBS may be an effective way to assess the PAS in patients with OSA.

Distinct iron architecture in SF3B1-mutant myelodysplastic syndrome patients is linked to an SLC25A37 splice variant with a retained intron

Perturbation in iron homeostasis is a hallmark of some hematologic diseases. Abnormal sideroblasts with accumulation of iron in the mitochondria are named ring sideroblasts (RS). RS is a cardinal feature of refractory anemia with RS (RARS) and RARS with marked thrombocytosis (RARS/-T). Mutations in SF3B1, a member of the RNA splicing machinery are frequent in RARS/-T and defects of this gene were linked to RS formation. Here we showcase the differences in iron architecture of SF3B1-mutant and wild-type (WT) RARS/-T and provide new mechanistic insights by which SF3B1 mutations lead to differences in iron. We found higher iron levels in SF3B1 mutant vs WT RARS/-T by transmission electron microscopy/spectroscopy/flow cytometry. SF3B1 mutations led to increased iron without changing the valence as shown by the presence of Fe(2+) in mutant and WT. Reactive oxygen species and DNA damage were not increased in SF3B1-mutant patients. RNA-sequencing and Reverse transcriptase PCR showed higher expression of a specific isoform of SLC25A37 in SF3B1-mutant patients, a crucial importer of Fe(2+) into the mitochondria. Our studies suggest that SF3B1 mutations contribute to cellular iron overload in RARS/-T by deregulating SLC25A37.

Prevalence and incidence rate of injuries in runners at a local athletic club in Cape Town

People across the world are running on a daily basis to improvetheir health status. However, running can predispose an individual to injuryto the back and lower limb. Baseline data on prevalence, incidence rate ofinjury and aetiological factors associated with running injuries are neededby physiotherapists to develop and implement effective prevention programmesto allow optimal performance in runners. Thus, the purpose of this study wasto determine the prevalence and incidence of injuries in runners at a localathletic club.Methods: A prospective, non-experimental cohort study was conductedover a 16 week period. A sample of 50 runners completed a self-administeredquestionnaire and an injury report form recording injuries sustained during the 16 week study period. Injury prevalence andcumulative incidence was calculated as a proportion rate along with 95% confidence interval.Results: The prevalence rate of injuries was 32%. The incidence rate of injuries was 0.67 per 1000km run (95% CI: 0.41- 1.08).The most common anatomical sites for new injuries were the calf (20%) and the knee (18%).Conclusions: The study found a moderate prevalence and incidence rate of injury in runners, thus the need for physiotherapyledinjury surveillance and prevention programmes have been highlighted.