The impact of the Val158Met catechol-O-methyltransferase genotype on neural correlates of sad facial affect processing in patients with bipolar disorder and their relatives

BACKGROUND

The Met allele of the catechol-O-methyltransferase (COMT) valine-to-methionine (Val158Met) polymorphism is known to affect dopamine-dependent affective regulation within amygdala-prefrontal cortical (PFC) networks. It is also thought to increase the risk of a number of disorders characterized by affective morbidity including bipolar disorder (BD), major depressive disorder (MDD) and anxiety disorders. The disease risk conferred is small, suggesting that this polymorphism represents a modifier locus. Therefore our aim was to investigate how the COMT Val158Met may contribute to phenotypic variation in clinical diagnosis using sad facial affect processing as a probe for its neural action.

METHOD

We employed functional magnetic resonance imaging to measure activation in the amygdala, ventromedial PFC (vmPFC) and ventrolateral PFC (vlPFC) during sad facial affect processing in family members with BD (n=40), MDD and anxiety disorders (n=22) or no psychiatric diagnosis (n=25) and 50 healthy controls.

RESULTS

Irrespective of clinical phenotype, the Val158 allele was associated with greater amygdala activation and the Met158 allele with greater signal change in the vmPFC and vlPFC. Signal changes in the amygdala and vmPFC were not associated with disease expression. However, in the right vlPFC the Met158 allele was associated with greater activation in all family members with affective morbidity compared with relatives without a psychiatric diagnosis and healthy controls.

CONCLUSIONS

Our results suggest that the COMT Val158Met polymorphism has a pleiotropic effect within the neural networks subserving emotional processing. Furthermore the Met158 allele further reduces cortical efficiency in the vlPFC in individuals with affective morbidity.

Do COMT, BDNF and NRG1 polymorphisms influence P50 sensory gating in psychosis?

BACKGROUND

Auditory P50 sensory gating deficits correlate with genetic risk for schizophrenia and constitute a plausible endophenotype for the disease. The well-supported role of catechol-O-methyltransferase (COMT), brain-derived neurotrophic factor (BDNF) and neuregulin 1 (NRG1) genes in neurodevelopment and cognition make a strong theoretical case for their influence on the P50 endophenotype.

METHOD

The possible role of NRG1, COMT Val158Met and BDNF Val66Met gene polymorphisms on the P50 endophenotype was examined in a large sample consisting of psychotic patients, their unaffected relatives and unrelated healthy controls using linear regression analyses.

RESULTS

Although P50 deficits were present in patients and their unaffected relatives, there was no evidence for an association between NRG1, COMT Val158Met or BDNF Val66Met genotypes and the P50 endophenotype.

CONCLUSIONS

The evidence from our large study suggests that any such association between P50 indices and NRG1, COMT Val158Met or BDNF Val66Met genotypes, if present, must be very subtle.

Achieving consensus in follow-up practice for routine ENT procedures: a Delphi exercise

OBJECTIVES

To generate consensus amongst faculty members regarding follow-up practice for well-defined clinical scenarios using a Delphi exercise and to identify whether disseminating the consensus guidelines changed follow-up practice.

STUDY DESIGN

Generation of consensus using a Delphi exercise and an audit of follow-up practice before and after dissemination of the resultant guidelines.

SETTING

The department of Otorhinolaryngology-Head and Neck Surgery at the Freeman Hospital, Newcastle upon Tyne, UK.

PARTICIPANTS AND METHODS

Panel members for this exercise included 11 consultants and two associate specialists and one co-ordinator. We identified clinical scenarios where ≥ 80% agreement existed that routine follow-up appointments should not be made and subsequently disseminated guidelines widely to all medical staff. The follow-up rates for the scenarios where consensus existed regarding follow-up practice were audited from clinic letters before and after the guidelines were disseminated.

MAIN OUTCOME MEASURES

Agreement on scenarios where routine follow-up appointments should not be made was assessed using a Likert scale (1-5).

RESULTS

Of 13 faculty members, 12 responded to rounds one and two, and 11 responded to round three. The Delphi exercise identified 18 clinical scenarios where there was ≥ 80% agreement on patients not routinely being followed up. Comparison of the follow-up practice prior to and after the Delphi exercise identified a reduction in follow-up for all 18 scenarios of 48%.

CONCLUSION

Consensus regarding routine follow-up can be reached by using the Delphi process in ENT practice. This can translate into a real change in clinical practice. Furthermore, this process could be applied for consensus building in other related areas.

Physiological responses to wearing a prototype firefighter ensemble compared with a standard ensemble

This study investigated the physiological responses to wearing a standard firefighter ensemble (SE) and a prototype ensemble (PE) modified from the SE that contained additional features, such as magnetic ring enclosures at the glove-sleeve interface, integrated boot-pant interface, integrated hood-SCBA facepiece interface, and a novel hose arrangement that rerouted self-contained breathing apparatus (SCBA) exhaust gases back into the upper portion of the jacket. Although the features of the PE increased the level of encapsulation of the wearer that could lead to increased physiological stress compared with the SE, it was hypothesized that the rerouted exhaust gases provided by the PE hose assembly would (1) provide convective cooling to the upper torso, (2) reduce the thermal stress experienced by the wearer, and (3) reduce the overall physiological stress imposed by the PE such that it would be either less or not significantly different from the SE. Ten subjects (seven male, three female) performed treadmill exercise in an environmental chamber (22°C, 50% RH) at 50% [image omitted]O(2max) while wearing either the SE with an SCBA or the PE with an SCBA either with or without the hose attached (designated PEWH and PENH, respectively). Heart rate (HR), rectal and intestinal temperatures (T(re), T(in)), sweat loss, and endurance time were measured. All subjects completed at least 20 min of treadmill exercise during the testing. At the end of exercise, there was no difference in T(re) (p = 0.45) or T(in) (p = 0.42), HR, or total sweat loss between the SE and either PEWH or PENH (p = 0.59). However, T(sk) was greater in PEWH and PENH compared with SE (p < 0.05). Total endurance time in SE was greater than in either PEWH or PENH (p < 0.05). Thus, it was concluded that the rerouting of exhaust gases to the jacket did not provide significant convective cooling or reduce thermal stress compared with the SE under the mild conditions selected, and the data did not support the hypotheses of the present study.

Media coverage and public reaction to a celebrity cancer diagnosis

BACKGROUND

Celebrity diagnoses can have important effects on public behaviour. UK television celebrity Jade Goody died from cervical cancer in 2009. We investigated the impact of her illness on media coverage of cervical cancer prevention, health information seeking behaviour and cervical screening coverage.

METHODS

National UK newspaper articles containing the words 'Jade Goody' and 'cancer' were examined for public health messages. Google Insights for Search was used to quantify Internet searches as a measure of public health information seeking. Cervical screening coverage data were examined for temporal associations with this story.

RESULTS

Of 1203 articles, 116 (9.6%) included a clear public health message. The majority highlighted screening (8.2%). Fewer articles provided advice about vaccination (3.0%), number of sexual partners (1.4%), smoking (0.6%) and condom use (0.4%). Key events were associated with increased Internet searches for 'cervical cancer' and 'smear test', although only weakly with searches for 'HPV'. Cervical screening coverage increased during this period.

CONCLUSION

Increased public interest in disease prevention can follow a celebrity diagnosis. Although media coverage sometimes included public health information, articles typically focused on secondary instead of primary prevention. There is further potential to maximize the public health benefit of future celebrity diagnoses.

Childhood vulval lichen sclerosus: autoimmunity to the basement membrane zone protein BP180 and its relationship to autoimmunity

Lichen sclerosus (LS) is associated with autoimmune disease in female children and adults. In adult women, there are antibody and T-cell responses to proteins in the basement membrane zone (BMZ). The aim of this study was to investigate reactivity to the BMZ in girls with LS. Nine girls with vulval LS were studied clinically and serologically. The presence of circulating BMZ autoantibodies was investigated. Autoimmunity was assessed by personal and family history of autoimmune diseases and autoantibodies. We detected circulating BMZ antibodies in four of the nine children, all with IgG responses. Three patients were positive by indirect immunofluorescence, one had a positive ELISA reaction to bullous pemphigoid antigen (BP)180, and three had a positive reaction on BP180 immunoblots. There was no association with autoimmune disease or clinical features. To our knowledge, this is the first study to find BMZ autoantibodies in children with vulval LS. The autoantibodies were directed at BP180 and were exclusively of the IgG class.

Taking a closer look: time sampling and measurement error

A person manufactured his in-seat behavior for 15, 30-min sessions so that there were three blocks of five sessions where the behavior occurred 20%, 50%, and 80% of the time. Whole interval, partial interval, and momentary time-sample measures of the behavior were taken and compared to the continuous measure of the behavior i.e., per cent of time the behavior occurred. For interval time sampling, the difference between the continuous and sample measures i.e., measurement error, was: (1) extensive, (2) unidirectional, (3) a function of the time per response, and (4) inconsistent across changes in the continuous measure. A procedural analysis demonstrated that the frequency and duration of behavior are confounded in interval time sampling. Momentary time sampling was found to be superior to interval time sampling in estimating the duration a behavior occurs.

Conditioned suppression as a sensitive baseline for social facilitation

The key pecking of pigeons maintained on a variable-interval schedule of food reinforcement was suppressed during occasional presentations of a warning stimulus paired with electric shock. On alternate sessions, a co-actor pigeon was visible in an adjoining chamber where it emitted the same food-reinforced key peck during the warning stimulus that signalled shock for the subject. With no shock and at low shock intensities, where the subject's responding was not suppressed or suppressed only slightly, the co-actor had little effect. At the higher shock intensities, where the subject's responding was reduced by at least 40%, the response rate during the warning stimulus was consistently higher when the co-actor was present. One explanation of these results assumes a special relationship between social stimuli and aversive stimuli in which the presence of another animal reduces emotional reactions and thereby allows operant responses to increase. This was not the case here because the mere presence of the co-actor did not maintain social facilitation. Rather, the present results, taken in conjunction with previous findings, suggest that changes in social and non-social variables which affect the rate of food-reinforced responding may produce proportionately larger changes in responding when that responding is suppressed by aversive stimulation than when it is not.

An evaluation of time-sample measures of behavior

Continuous and time-sample measures of the in-seat behavior of a secretary were obtained. Measurement error, i.e., the extent to which the sample measures deviated from the continuous measure, was a function of the frequency of the sample measurements and the criterion used to score an example of the behavior. If the behavior had to be exhibited throughout the observational interval (whole-interval time sampling), there was a consistent underestimate of the continuous measure. If the behavior had to be exhibited only briefly within the observational interval (partial-interval time sampling), there was a consistent overestimate of the continuous measure. And, if the behavior had to be exhibited at the end of the observational interval (momentary time sampling), overestimations and underestimations of the continuous measure occurred about equally often. As expected, the more frequently the sample measures were made the closer was the agreement between the sample and continuous measures. Two conclusions concerning measurement error in interval time sampling were made. The first was that the error will be a function of the mean time per response. The second is that this error will not be consistent across experimental conditions.

Behavioral engineering: the use of response priming to improve prescribed self-medication

A major problem in outpatient treatment has been the extreme irregularity with which patients use medication prescribed for them. As a new approach to resolving this problem, a portable operant apparatus was developed based on response priming and escape reinforcement. The apparatus sounded a tone at the time that a pill was to be taken. When the user turned a knob to terminate the tone, the apparatus delivered the pill into the user's hand. The apparatus was evaluated with six normal adults using a medically inert pill. A greater proportion of the pills were taken by each subject when using the special apparatus as compared with the use of a portable alarm timer or the usual wristwatch. These results demonstrate a new approach for increasing the regularity of self-administration of medicines.

The effects of shock as a punisher for cigarette smoking

An attempt was made to reduce the cigarette smoking of three subjects by means of a special cigarette case that delivered aversive shock when opened. The number of cigarettes smoked was recorded by a counter in the cigarette case. The validity of the counter readings as a measure of smoking was obtained by a specially designed participant-observer technique. It was found that the rate of smoking decreased as a function of the intensity of the shock. Also, the smoking returned to its previously unpunished level after the shock punisher was discontinued. Both of these findings confirm the results of laboratory studies of punishment of simpler responses and extends them to more complex responses in a naturalistic situation. Surprisingly, the duration for which the apparatus was worn also decreased as a function of the intensity of the shock. This finding reveals that this aversive shock technique produced avoidance behavior that prevents the technique from having extensive applicability for eliminating smoking. The same limitation may apply to the use of aversive shock for eliminating other undesirable behaviors.

Behavioral engineering: the reduction of smoking behavior by a conditioning apparatus and procedure

Recent findings from animal conditioning studies have revealed methods of reducing responses to a very low level with a minimum of aversive by-products. These findings were incorporated into the design of a cigarette case that automatically locked itself for a period of time after a cigarette was removed from it. The next cigarette could be taken at the end of the interval, which was signalled by distinctive stimuli. Five heavy smokers were allowed to become accustomed to using the case. Then, the duration for which the case was locked was gradually increased over a period of weeks to about 1 hr. Smoking gradually decreased to the target level of about one-half of a package of cigarettes per day. Control procedures showed that specific features of the apparatus were responsible for the reduction of smoking. The results indicated that this apparatus was sufficiently effective, convenient, and acceptable to smokers to constitute a practical procedure for reducing smoking to the level considered medically safe. The procedure may also have potential for reducing other habit-forming or addictive behaviors.

Positive reinforcement and suppression from the same occurrence of the unconditioned stimulus in a positive conditioned suppression procedure

Responding of rats was maintained on a variable-interval schedule of food reinforcement. The same response also produced a blinking light followed by electrical brain stimulation according to a fixed-interval schedule. This conjoint schedule produced two behavioral changes. First, instead of a steady rate of responding throughout the session, which would be characteristic of the variable interval food schedule alone, responding between occurrences of the light-brain stimulation pairings became positively accelerated and thus was more characteristic of the fixed-interval schedule of these pairings. Second, food responding was suppressed during the light that preceded brain stimulation. These results indicate that positive reinforcement and suppression resulted from the same occurrence of the light-brain stimulation combination. This finding suggests that stimuli such as conditioned reinforcers that precede an unconditioned reinforcer may have a suppressive effect upon responding in their presence that is being maintained by another reinforcer.

Cortisol awakening rise in middle-aged women in relation to psychological stress

OBJECTIVES

The cortisol awakening rise (CAR) is defined as cortisol secretory activity in the first 45-60 min immediately post-awakening. It has been suggested that psychological factors may disrupt the normal awakening rise. Recent research has shown that psychological stress may influence the magnitude of the CAR, however the findings have been mixed. This study examined the impact of stress on the CAR and the diurnal mean in a sample of middle-aged women.

METHOD

One hundred and eighteen healthy female participants who reported experiencing high or low stress were recruited. Salivary cortisol levels were measured immediately upon awakening (at 0, 15, 30, and 45 min) and at 3, 6, 9 and 12 h on two consecutive days. A number of metabolic and inflammatory biomarkers were also assessed together with measures of mood disturbance and health behaviour.

RESULTS

The magnitude of the CAR, assessed by the area under the response curve (AURC) estimate, was significantly lower in the high stress group compared to the low stress group indicating that participants who experienced high stress secreted lower levels of cortisol. The effect was largely accounted for by differences 30 min after waking. The diurnal mean was also lower for the high stress group. Although participants in the high stress group had a slightly worse inflammatory profile, only low-density lipoprotein levels were found to be significantly higher, compared to the low stress group. Lifestyle indicators and mood were also found to be significantly poorer in the high stress group.

CONCLUSIONS

The results suggest that psychological stress may be associated with a smaller cortisol awakening rise, a lower diurnal mean, poor lifestyle choices and high levels of psychological distress. These findings may have broader implications for future health risk and for an individual's ability to cope with imminent daily stressors and demands.

Evidence that variation in the oligodendrocyte lineage transcription factor 2 (OLIG2) gene is associated with psychosis in Alzheimer's disease

Psychotic symptoms are common in individuals with Alzheimer's disease (AD), and define a phenotype associated with more rapid cognitive and functional decline. Evidence suggests that psychotic symptoms may be influenced by genetic factors, and recent studies in schizophrenia, bipolar affective disorder (BPAD) and Alzheimer's disease with psychosis (AD+P) suggest that psychosis susceptibility or modifier genes may act across diseases. We hypothesised that oligodendrocyte lineage transcription factor 2 (OLIG2), a regulator of white matter development and a candidate gene for schizophrenia, may also be associated with psychotic symptoms in AD. We genotyped 11 SNPs in OLIG2 previously tested for association with schizophrenia [L. Georgieva, V. Moskvina, T. Peirce, N. Norton, N.J. Bray, L. Jones, P. Holmans, S. Macgregor, S. Zammit, J. Wilkinson, H. Williams, I. Nikolov, N. Williams, D. Ivanov, K.L. Davis, V. Haroutunian, J.D. Buxbaum, N. Craddock, G. Kirov, M.J. Owen, M.C. O'Donovan, Convergent evidence that oligodendrocyte lineage transcription factor 2 (OLIG2) and interacting genes influence susceptibility to schizophrenia, Proc. Natl. Acad. Sci. U.S.A. 103 (33) (2006) 12469-12474] and tested these for association with AD and AD+P. Significant evidence for association of psychotic symptoms within cases was identified for two SNPs, rs762237 (allelic P=0.002, OR=1.42, corrected P=0.019) and rs2834072 (allelic P=0.004, OR=1.41, corrected P=0.05).

Mumps epidemiology in the mid-west of Ireland 2004-2008: increasing disease burden in the university/college setting

Mumps is a contagious vaccine-preventable viral disease that is experiencing a revival in students attending second and third level colleges. Large mumps outbreaks have been reported in several countries despite the presence of childhood immunisation programmes over many years, including measles, mumps, and rubella (MMR) vaccination. In 2008, 1,377 cases of mumps were notified in Ireland and 1,734 in the first three months of 2009 (provisional data). This paper reviews the recent epidemiology of mumps in the Mid-West region of Ireland and highlights preventive measures. A substantial proportion of cases were not laboratory-confirmed and it is important that doctors continue to notify suspected cases. In the Irish Mid-West, data from enhanced surveillance shows a high proportion of mumps in the age group 15-24 years. Complications were uncommon and rarely severe. Where data were available, over half of the cases did not recall having received two doses of MMR, but most recalled one dose. Parents should continue to ensure children receive both MMR vaccinations so that uptake is optimal for protection. Steps were taken to increase awareness of the disease in the school, college and university settings. Preventive measures implemented to limit mumps transmission in the school/college setting over recent years included vaccination of close contacts, isolation for five days and hand hygiene.

Mumps epidemiology in the Mid-West of Ireland 2004-2008: increasing disease burden in the university/college setting

Mumps is a contagious vaccine-preventable viral disease that is experiencing a revival in students attending second and third level colleges. Large mumps outbreaks have been reported in several countries despite the presence of childhood immunisation programmes over many years, including measles, mumps, and rubella (MMR) vaccination. In 2008, 1,377 cases of mumps were notified in Ireland and 1,734 in the first three months of 2009 (provisional data). This paper reviews the recent epidemiology of mumps in the Mid-West region of Ireland and highlights preventive measures. A substantial proportion of cases were not laboratory-confirmed and it is important that doctors continue to notify suspected cases. In the Irish Mid-West, data from enhanced surveillance shows a high proportion of mumps in the age group 15-24 years. Complications were uncommon and rarely severe. Where data were available, over half of the cases did not recall having received two doses of MMR, but most recalled one dose. Parents should continue to ensure children receive both MMR vaccinations so that uptake is optimal for protection. Steps were taken to increase awareness of the disease in the school, college and university settings. Preventive measures implemented to limit mumps transmission in the school/college setting over recent years included vaccination of close contacts, isolation for five days and hand hygiene.

Skunk and psychosis in South East London

Background:

Epidemiological studies have reported that the increased risk of developing psychosis in cannabis users is dose related. In addition, experimental research has shown that the active constituent of cannabis responsible for its psychotogenic effect is Delta-9-Tetrahydrocannabinol (THC) (Murray et al, 2007). Recent evidence has suggested an increased in potency (% TCH) in the cannabis seized in the UK (Potter et al, 2007).

Hypothesis:

We predicted that first episode psychosis patients are more likely to use higher potency cannabis and more frequently than controls.

Methods:

We collected information concerning socio-demographic, clinical characteristics and cannabis use (age at first use, frequency, length of use, type of cannabis used) from a sample of 191 first-episode psychosis patients and 120 matched healthy volunteers. All were recruited as part of the Genetic and Psychosis (GAP) study which studied all patients who presented to the South London and Maudsley Trust.

Results:

There was no significant difference in the life-time prevalence of cannabis use or age at first use between cases and controls. However, cases were more likely to be regular users (p=0.05), to be current users (p=0.04) and to have smoked cannabis for longer (p=0.01). Among cannabis users, 86.8% of 1st Episode Psychosis Patients preferentially used Skunk/Sinsemilla compared to 27.7% of Controls. Only 13.2 % of 1st Episode psychosis Patients chose to use Resin/Hash compared to 76.3% of controls. The concentration of TCH in these in South East London, ranges between 8.5 and 14 % (Potter et al, 2007). Controls (47%) were more likely to use Hash (Resin) whose average TCH concentration is 3.4% (Potter et al, 2007).

Conclusions:

Patients with first episode psychosis have smoked higher potency cannabis, for longer and with greater frequency, than healthy controls.

Fatal and non-fatal fire injuries in England 1995-2004: time trends and inequalities by age, sex and area deprivation

AIM

To examine time trends and deprivation gradients in fire-related deaths and injuries.

METHODS

A cross-sectional study and time trend analysis using data on fire casualties in England between 1995 and 2004 obtained from the Department for Communities and Local Government. Injury rates were calculated assuming a Poisson distribution. Incidence rate ratios (IRRs) were calculated to compare changes in deprivation gradients over time.

RESULTS

There were significant reductions in fatal and non-fatal fire injuries in children (fatal injuries IRR chi(2)(1) = 11.18, P < 0.001; non-fatal injuries IRR chi(2)(2) = 61.44, P < 0.001), adults (fatal injuries IRR chi(2)(1) = 15.99, P < 0.001; non-fatal injuries IRR chi(2)(2) = 183.25, P < 0.001) and older people (fatal injuries IRR chi(2)(1) = 56.88, P < 0.001; non-fatal injuries IRR chi(2)(2) = 54.09, P < 0.001) between 1995 and 2004. Adult and child fire deaths were most commonly caused by smokers' materials (e.g. cigarettes, cigars and tobacco), and cigarette lighters and matches, respectively. Cooking appliances caused most non-fatal fire injuries. Injury rates increased with increasing levels of deprivation and deprivation gradients did not change over 10 years.

CONCLUSIONS

Fire prevention interventions should promote the safe use of cooking and heating appliances and the responsible use of smokers' materials, lighters and matches, and should target those at greater risk of fire, including the socially disadvantaged.

Stromal gene signatures in large-B-cell lymphomas

BACKGROUND

The addition of rituximab to combination chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), or R-CHOP, has significantly improved the survival of patients with diffuse large-B-cell lymphoma. Whether gene-expression signatures correlate with survival after treatment of diffuse large-B-cell lymphoma is unclear.

METHODS

We profiled gene expression in pretreatment biopsy specimens from 181 patients with diffuse large-B-cell lymphoma who received CHOP and 233 patients with this disease who received R-CHOP. A multivariate gene-expression-based survival-predictor model derived from a training group was tested in a validation group.

RESULTS

A multivariate model created from three gene-expression signatures--termed "germinal-center B-cell," "stromal-1," and "stromal-2"--predicted survival both in patients who received CHOP and patients who received R-CHOP. The prognostically favorable stromal-1 signature reflected extracellular-matrix deposition and histiocytic infiltration. By contrast, the prognostically unfavorable stromal-2 signature reflected tumor blood-vessel density.

CONCLUSIONS

Survival after treatment of diffuse large-B-cell lymphoma is influenced by differences in immune cells, fibrosis, and angiogenesis in the tumor microenvironment.

Improved spiral tube assembly for high-speed counter-current chromatography

The original spiral tube support (STS) assembly is improved by changing the shape of the tubing, with 1-cm presses perpendicularly along the length. This modification interrupts the laminar flow of the mobile phase. The tubing in the four return grooves to the center of the rotor is flattened by a specially made pressing tool to increase the number of spiral layers and decrease the dead space volume, thus increasing the column efficiency. The performance of this spiral tube assembly was tested in separations of dipeptides and proteins with suitable polar two-phase solvent systems. The results revealed that the present system yields high partition efficiency with a satisfactory level of stationary phase retention in a short elution time. The present high-speed counter-current chromatographic (HSCCC) system will be efficiently applied to a broad spectrum of two-phase solvent systems including aqueous-aqueous polymer phase systems (TPAS) which are used for separation of biopolymers such as proteins and nucleic acids.

Association analysis of 528 intra-genic SNPs in a region of chromosome 10 linked to late onset Alzheimer's disease

Late-onset Alzheimer's disease (LOAD) is a genetically complex neurodegenerative disorder. Currently, only the epsilon4 allele of the Apolipoprotein E gene has been identified unequivocally as a genetic susceptibility factor for LOAD. Others remain to be found. In 2002 we observed genome-wide significant evidence of linkage to a region on chromosome 10q11.23-q21.3 [Myers et al. (2002) Am J Med Genet 114:235-244]. Our objective in this study was to test every gene within the maximum LOD-1 linkage region, for association with LOAD. We obtained results for 528 SNPs from 67 genes, with an average density of 1 SNP every 10 kb within the genes. We demonstrated nominally significant association with LOAD for 4 SNPs: rs1881747 near DKK1 (P = 0.011, OR = 1.24), rs2279420 in ANK3 (P = 0.022, OR = 0.79), rs2306402 in CTNNA3 (P = 0.024, OR = 1.18), and rs5030882 in CXXC6 (P = 0.046, OR = 1.29) in 1,160 cases and 1,389 controls. These results would not survive correction for multiple testing but warrant attempts at confirmation in independent samples.

Standardised consent forms on the website of the British Orthopaedic Association

The British Orthopaedic Association has endorsed a website, www.orthoconsent.com, allowing surgeons free access to a bank of pre-written consent forms. These are designed to improve the level of information received by the patient and lessen the risk of successful litigation against surgeons and Health Trusts.

Payment to healthcare professionals for patient recruitment to trials: systematic review and qualitative study

OBJECTIVES

To review UK guidelines regarding the use of financial incentives for healthcare professionals to become involved in clinical trials, and to survey perceptions and current practice.

DATA SOURCES

Electronic databases were searched from inception to June 2006. Interviews were held with NHS healthcare professionals, research managers from the pharmaceutical industry and members of the public.

REVIEW METHODS

From the searches, 634 identified studies were assessed for inclusion in the systematic review, but only three met the criteria for data extraction. Fifty-eight individuals were interviewed: 38 chief investigators, six non-research active clinicians, eight public and six pharmaceutical managers. Investigators were selected from those funded by the HTA Programme, the other by 'snowballing' and personal contact.

RESULTS

The evidence from the literature was limited and inconclusive. In UK guidelines, the issues around payments to clinicians or patients were implied rather than stated, usually linked to discussion of conflict of interest and disclosure of any such conflicts. Developments in NHS research governance had led to increased transparency in all payments for research participation and for payments to be made to NHS Trusts rather than individual clinicians. While reimbursement of costs incurred by research was strongly supported by the interviewees, payments to incentivise recruitment were not. A code of practice was suggested for payments in publicly funded trials, which was closely linked to the principles of Good Clinical Practice in research. Factors such as interest in the topic, scope for patient benefit and good communication were considered more important than payment. Interviews with the general public indicated low levels of awareness of the existence of payments to clinicians linked to patient recruitment in trials, and unanimous support for full disclosure. Interviews with managers in the pharmaceutical industry showed greater familiarity with payments for research involvement. GPs were seen as the only group for whom scope existed for individual payments. Concerns were expressed by the pharmaceutical company interviewees at the rising cost of research and unnecessary bureaucracy.

CONCLUSIONS

The ethical stances outlined in Good Clinical Practice in research were widely endorsed by the three groups interviewed. These allow reasonable payments to clinicians, subject to disclosure of any possible conflicts of interest. The potential for incentivising clinicians to recruit was limited as any payments should be based on the cost of inputs and should not be made to individuals but to their host organisation. NHS professionals were concerned that payments could damage the quality of research and also considered full disclosure to patients as challenging. Patients and members of the public favoured full disclosure and payment of expenses to patients involved in research. Pharmaceutical company interviewees viewed payment to the NHS for all research activities as normal and highly regulated. They complained that the prices charged were high and so variable that they required benchmarking. Considerable scope exists for compiling data on the factors that help and hinder the progress of clinical trials and also for experimenting with different incentives to encourage involvement in clinical research. Further research should focus on improved reporting of those organisational aspects of trials that are known to affect recruitment; retrospective analysis of the factors associated with different levels of recruitment to RCTs; prospective comparative research on trial recruitment; qualitative research on participants' experiences of being involved in different kinds of trials, and proposals to include within trials experiments with payments methods.

Spiral Tube Assembly for High-Speed Countercurrent Chromatography: Choice of Elution Modes for Four Typical Two-Phase Solvent Systems

Optimal elution modes were determined for four typical two-phase solvent systems each with different physical parameters to achieve the best peak resolution and retention of the stationary phase by spiral tube high-speed countercurrent chromatography using a suitable set of test samples. Both retention of the stationary phase and partition efficiency are governed by an interplay between two forces, i.e., Archimedean Screw force and radial centrifugal force gradient of the spiral channel. In the polar solvent system represented by 1-butanol./acetic acid/water (4:1:5, v/v/v) with settling time of over 30 s, the effect by the radial centrifugal gradient force dominates giving the best separation of dipeptides either by pumping the lower phase from the inner terminal or the upper phase from the outer terminal of the spiral channel. In the moderately hydrophobic two-phase solvent system represented by hexane/ethyl acetate/methanol/0.1 M HCl (1:1:1:1) with settling time of 19 s, and two hydrophobic solvent systems of hexane/ethanol/water (5:4:1, v/v/v) and non-aqueous binary system of hexane/acetonitrile both having settling time of 9, the effect of the Archimedean screw force play a major role in hydrodynamic equilibrium, giving the best separations by pumping the lower phase from the head or the upper phase from the tail of the spiral channel.

Increased familial risk and genomewide significant linkage for Alzheimer's disease with psychosis

Psychotic symptoms are common in Alzheimer's disease (AD) and are associated with increased cognitive impairment and earlier institutionalization. One study has suggested that they are genetically modified and two genome screens have been performed to search for susceptibility loci for AD with psychosis (AD + P). The aim of this study was to further investigate the familial aggregation of AD + P and perform a genome screen for AD, conditioning on the presence or absence of psychotic symptoms. Samples from the UK and US were combined, providing data from 374 families in which at least two members met criteria for AD and had complete data regarding psychotic symptoms. Generalized estimating equations (GEE) were used to assess the relationship of psychotic symptoms between siblings. A total of 321 affected relative pairs (ARPs) were genotyped for linkage. There was a significant association between proband psychosis status and the occurrence of AD + P in siblings in the UK (OR = 4.17, P = 0.002) and US (OR = 3.2, P < 0.001) samples. Chromosomewide and genomewide significant linkage peaks were observed on chromosomes 7 (LOD = 2.84) and 15 (LOD = 3.16), respectively, with the strongest evidence coming from pairs concordant for AD without psychosis. A LOD score of 2.98 was observed close to a previously reported AD + P linkage region on chromosome 6, however the increase in LOD attributable to psychosis was not significant. These findings support the hypothesis that psychotic symptoms in AD are genetically modified and that a gene/s implicated in their aetiology may be located on chromosome 7 and 15.

Trends in genital chlamydia infection in the Mid-West of Ireland, 2001-2006

Genital Chlamydia trachomatis (GCT) infection is the most common bacterial sexually transmitted infection (STI) in Ireland. A retrospective analysis of 2,087 laboratory-confirmed GCT patient episodes from 2001 to 2006 in the Mid-West of Ireland was undertaken in conjunction with statutorily notifiable data that were reported by the Sexually Transmitted Disease/Genito-Urinary Medicine (STD/GUM) services in the region and used in national surveillance. Data were analysed by year, source, sex and age. The annual incidence of GCT in the Mid-West is increasing. A substantial proportion of GCT infections were diagnosed in the non-STD/GUM setting. The issue of sexually active young people seeking STI screening is a sensitive one, and delays increase the potential for transmission and the possibility of long-term complications when the disease is not treated. Based on this sample, national surveillance would significantly underestimate the burden of disease in Ireland, due to under-reporting. This would have implications for any national chlamydia screening programme. Among those who sought testing, women aged 15 to 19 years are five times more likely to be found positive than men in the same age group. Of those diagnosed in the non-STD/GUM setting, 83% were women. General practitioners and clinicians might consider targeting those aged 15 to 29 years for opportunistic screening and sexual health advice. Contact tracing and follow-up in the non-STD/GUM setting, as well as access for general practitioners to ongoing education on STIs are challenges to be addressed.

Development of a molecular assay to detect predation on Anopheles gambiae complex larval stages

We developed a molecular assay to detect predation on Anopheles gambiae sensu lato (s.l.) mosquitoes. This intergenic spacer ribosomal DNA polymerase chain reaction assay and restriction enzyme analysis uses An. gambiae-specific primers to detect mosquito DNA in the DNA extracts from whole invertebrate predators, which enables identification of species (An. gambiae s.s. versus An. arabiensis) and molecular forms (M versus S in An. gambiae s.s.). We show that An. gambiae s.l. DNA can be detected after ingestion by members of the families Lestidae (order Odonata) after four hours, Libellulidae (order Odonata) after six hours, and Notonectidae (order Hemiptera) after 24 hours. This method is an improvement over previously published methods because of ease of execution and increased time of detection after ingestion.

The effect of altering the 20:5n-3 and 22:6n-3 content of a meal on the postprandial incorporation of n-3 polyunsaturated fatty acids into plasma triacylglycerol and non-esterified fatty acids in humans

Previous studies suggest that consuming meals containing large amounts of fish oil is associated with selective postprandial incorporation of 20:5n-3 and 22:6n-3 into plasma non-esterified fatty acids (NEFA). We investigated the effect of consuming meals containing different amounts of 20:5n-3 and 22:6n-3 comparable to dietary habits of western populations on the postprandial incorporation of 18:3n-3, 20:5n-3 and 22:6n-3 into plasma triacylglycerol (TAG) and NEFA over 6h in middle aged subjects. 20:5n-3 incorporation into plasma TAG was greater than 22:6n-3 irrespective of the test meal. Conversely, 22:6n-3 incorporation into plasma NEFA was greater than 20:5n-3, irrespective of the test meal. There was no effect of the amount of 20:5n-3+22:6n-3 in the test meal on the 18:3n-3 incorporation into plasma TAG or NEFA. These findings suggest differential metabolism of 20:5n-3 and 22:6n-3 in the postprandial period when consumed in amounts typical of western dietary habits.

Interaction between the ADAM12 and SH3MD1 genes may confer susceptibility to late-onset Alzheimer's disease

The neuropathology of Alzheimer's disease (AD) is characterized by intracellular neurofibrillary tangles and the extracellular deposition of beta-amyloid (Abeta) in senile plaques. Abeta has been shown to mediate neurodegenerative and inflammatory changes associated with amyloid plaques, although the pathological mechanism of Abeta remains largely unknown. Recent evidence suggests that the FISH adapter protein binds to, and potentially regulates, ADAM12 (a disintegrin and metalloprotease 12) to mediate a neurotoxic effect of Abeta. The ADAM12 gene lies on chromosome 10q26.3, and the gene encoding FISH, SH3MD1, lies within a region of linkage to late-onset AD (LOAD) on 10q25.1. This study investigates whether there is a relationship between variation in ADAM12 and SH3MD1 and susceptibility to LOAD in a sample of 1,051 AD cases and 1,269 matched controls. We observe significant interactions between variants in the two genes that may influence susceptibility to LOAD. The most significant statistical interaction is between rs3740473, a synonymous single nucleotide polymorphism (SNP) in SH3MD1 and rs11244787, an intronic SNP in ADAM12 (effect size = 2.1 for interaction term, P = 0.006).

Vacuum and forceps training in residency: experience and self-reported competency

OBJECTIVE

Determine chief residents' experience with vacuum and forceps deliveries and self-perceived competencies with the procedures.

STUDY DESIGN

Study 1: A written questionnaire was mailed to all fourth year residents in US RRC approved Ob/Gyn programs. Study 2: The study was replicated using a web-based survey the following year. Data were analyzed with chi (2) and Wilcoxon Signed Rank tests using SPSS.

RESULTS

Surveys were received from 238 residents (20%) in Study 1 and 269 residents in Study 2 (23%, representing 50% of all residency programs). In both studies, residents reported performing significantly less forceps than vacuum deliveries. Virtually all residents wanted to learn to perform both deliveries, indicated attendings were willing to teach both, and felt competent to perform vacuum deliveries (Study 1, 94.5%; Study 2, 98.5%); only half felt competent to perform forceps deliveries (Study 1, 57.6%; Study 2, 55.0%). The majority of residents who felt competent to perform forceps deliveries reported that they would predominately use forceps or both methods of deliveries in their practice (Study 1, 75.8%; Study 2, 64.6%). The majority of residents who reported that they did not feel competent to perform forceps deliveries reported that they would predominately use vacuum deliveries in their practice (Study 1, 86.1%; Study 2, 84.2%).

CONCLUSION

Current training results in a substantial portion of residents graduating who do not feel competent to perform forceps deliveries. Perceived competency affected future operative delivery plans.

Absorptance of nonferrous alloys to Nd:YLF and Nd:YAG laser light at room temperature

The measurement of absorptance is important for the analysis and modeling of laser-material interactions. Unfortunately, most of the absorptance data currently available consider only polished pure metals rather than the commercially available (unpolished, oxidized) alloys that are actually being processed in manufacturing. We present the results of absorptance measurements carried out at room temperature on as-received engineering grade nonferrous metals (Al, Cu, and Zn alloys). The measurements were made using an integrating sphere with a Nd:YLF laser at two wavelengths (1053 and 527 nm, which means that the results are also valid for Nd:YAG radiation at 1064 and 532 nm). The absorptance results obtained differ considerably from the existing data for polished, pure metals and should help improve the accuracy of laser-material interaction models. Some clear trends were identified. For all 22 cases studied the absorptance was higher than for ideal pure, polished metals. For all Al and Cu samples the absorptance was higher for the green than it was for the infrared wavelength, while for all Zn coatings this trend was reversed. No clear correlation between absorptance and surface roughness was found at low roughness values (Sa 0.15-0.60), but one rougher set of samples (Sa 2.34) indicated a roughness-absorptance correlation at higher roughness levels.

Influence of habitual diet on antioxidant status: a study in a population of vegetarians and omnivores

BACKGROUND

Antioxidant status can be used as a biomarker to assess chronic disease risk and diet can modulate antioxidant defence.

OBJECTIVE

To examine effects of vegetarian diet and variations in the habitual intakes of foods and nutrients on blood antioxidants.

SUBJECTS AND SETTING

Thirty-one vegetarians (including six vegans) and 58 omnivores, non-smokers, in Northern Ireland.

DESIGN

A diet history method was used to assess habitual diet. Antioxidant vitamins, carotenoids, uric acid, zinc- and ferric-reducing ability of plasma (FRAP) were measured in fasting plasma and activities of glutathione peroxidase (GPX), superoxide dismutase (SOD) and glutathione S-transferase (GST) and level of reduced glutathione (GSH) were measured in erythrocytes.

RESULTS

Vegetarians had approximately 15% higher levels of plasma carotenoids compared with omnivores, including lutein (P< or =0.05), alpha-cryptoxanthin P< or =0.05), lycopene (NS), alpha-carotene (NS) and beta-carotene (NS). The levels/activities of all other antioxidants measured were similar between vegetarians and omnivores. Total intake of fruits, vegetables and fruit juices was positively associated with plasma levels of several carotenoids and vitamin C. Intake of vegetables was positively associated with plasma lutein, alpha-cryptoxanthin, alpha-carotene and beta-carotene, whereas intake of fruits was positively associated with plasma beta-cryptoxanthin. Intake of tea and wine was positively associated with FRAP value, whereas intake of herbal tea associated positively with plasma vitamin C. Intakes of meat and fish were positively associated with plasma uric acid and FRAP value.

CONCLUSIONS

The overall antioxidant status was similar between vegetarians and omnivores. Good correlations were found between intakes of carotenoids and their respective status in blood.

Small cell oesophageal carcinoma: an institutional experience and review of the literature

Primary small cell oesophageal carcinoma (SCOC) is rare, prognosis is poor and there is no established optimum treatment strategy. It shares many clinicopathologic features with small cell carcinoma of the lung; therefore, a similar staging and treatment strategy was adopted. Sixteen cases referred to Velindre hospital between 1998 and 2005 were identified. Patients received platinum-based combination chemotherapy if appropriate. Those with limited disease (LD) received radical radiotherapy (RT) to all sites of disease on completion of chemotherapy. Median survival of all patients was 13.2 months. Median survival of patients with LD was significantly longer than those with extensive disease (24.4 vs 9.1 months, P=0.034). This is one of the largest single institution series in the world literature. Combined modality therapy using platinum-based combination chemotherapy and radical RT may allow a nonsurgical approach to management, avoiding the morbidity of oesophagectomy. Prophylactic cranial irradiation is controversial, and should be discussed on an individual basis.

Proteome-based plasma biomarkers for Alzheimer's disease

Alzheimer's disease is a common and devastating disease for which there is no readily available biomarker to aid diagnosis or to monitor disease progression. Biomarkers have been sought in CSF but no previous study has used two-dimensional gel electrophoresis coupled with mass spectrometry to seek biomarkers in peripheral tissue. We performed a case-control study of plasma using this proteomics approach to identify proteins that differ in the disease state relative to aged controls. For discovery-phase proteomics analysis, 50 people with Alzheimer's dementia were recruited through secondary services and 50 normal elderly controls through primary care. For validation purposes a total of 511 subjects with Alzheimer's disease and other neurodegenerative diseases and normal elderly controls were examined. Image analysis of the protein distribution of the gels alone identifies disease cases with 56% sensitivity and 80% specificity. Mass spectrometric analysis of the changes observed in two-dimensional electrophoresis identified a number of proteins previously implicated in the disease pathology, including complement factor H (CFH) precursor and alpha-2-macroglobulin (alpha-2M). Using semi-quantitative immunoblotting, the elevation of CFH and alpha-2M was shown to be specific for Alzheimer's disease and to correlate with disease severity although alternative assays would be necessary to improve sensitivity and specificity. These findings suggest that blood may be a rich source for biomarkers of Alzheimer's disease and that CFH, together with other proteins such as alpha-2M may be a specific markers of this illness.