Genome-wide expression and response to exposure-based psychological therapy for anxiety disorders

Exposure-based psychological treatments for anxiety have high efficacy. However, a substantial proportion of patients do not respond to therapy. Research examining the potential biological underpinnings of therapy response is still in its infancy, and most studies have focussed on candidate genes. To our knowledge, this study represents the first investigation of genome-wide expression profiles with respect to treatment outcome. Participants (n=102) with panic disorder or specific phobia received exposure-based cognitive behavioural therapy. Treatment outcome was defined as percentage reduction from baseline in clinician-rated severity of their primary anxiety diagnosis at post treatment and 6 month follow-up. Gene expression was determined from whole blood samples at three time points using the Illumina HT-12v4 BeadChip microarray. Linear regression models tested the association between treatment outcome and changes in gene expression from pre-treatment to post treatment, and pre-treatment to follow-up. Network analysis was conducted using weighted gene co-expression network analysis, and change in the detected modules from pre-treatment to post treatment and follow-up was tested for association with treatment outcome. No changes in gene expression were significantly associated with treatment outcomes when correcting for multiple testing (q<0.05), although a small number of genes showed a suggestive association with treatment outcome (q<0.5, n=20). Network analysis showed no association between treatment outcome and change in gene expression for any module. We report suggestive evidence for the role of a small number of genes in treatment outcome. Although preliminary, these findings contribute to a growing body of research suggesting that response to psychological therapies may be associated with changes at a biological level.

Prevalence of sun-protective behaviour and intentional sun tanning in German adolescents and adults: results of a nationwide telephone survey

BACKGROUND

The incidence rate of melanoma in the Caucasian population is rising worldwide. One of the major environmental risk factors for melanoma is the exposure to ultraviolet (UV) radiation. To prevent skin damage caused by UV exposure, several organizations recommend wearing protective clothing, staying in the shade, avoiding the outdoors during midday and using sunscreen.

OBJECTIVE

To provide representative data on factors associated with sun-protective behaviours and intentional sun exposure during summertime in the German population.

METHODS

A population-based sample of 3000 German residents aged 14-45 years (response: 32.1%) was interviewed via telephone from October to December 2015. Survey participants provided data on the use of recommended sun-protective measures on a sunny summer day and their intentional sun exposure during summertime. Data were weighted by age, sex, educational level and federal state to ensure the national representativeness of the sample.

RESULTS

Wearing long-sleeved clothes was the most frequently reported protective measure (53.9%), while wearing headgear was the least common (17.9%). Significantly lower frequencies of almost all recommended sun-protective measures were identified for males, participants between 14 and 25 years, those with an immigrant background and those with low levels of education. Using sun protection was positively associated with female gender (OR = 1.62), higher levels of education (OR_high = 1.27), sunburn during childhood (OR = 1.33) and paying attention to healthy nutrition (OR = 1.64; all P < 0.05). Sun tanning behaviour was associated with female gender (OR = 1.42), younger age, lower level of education, sunbed use (OR = 5.24) and smoking status (OR = 1.50; all P < 0.001).

CONCLUSION

As individual sun-protective measures are easy to implement and provide effective protection against high-risk UV exposure, campaigns on skin cancer prevention in Germany should put a stronger focus on young adults, men, less educated individuals and those with immigration background.

EMCD with an electron vortex filter: Limitations and possibilities

We discuss the feasibility of detecting spin polarized electronic transitions with a vortex filter. This approach does not rely on the principal condition of the standard electron energy-loss magnetic chiral dichroism (EMCD) technique, the precise alignment of the crystal in order to use it as a beam splitter, and thus would pave the way for the application of EMCD to new classes of materials and problems, like amorphous magnetic alloys and interface magnetism. The dichroic signal strength at the L_{2, 3}-edge of ferromagnetic Cobalt (Co) is estimated on theoretical grounds using a single atom scattering approach. To justify this approach, multi-slice simulations were carried out in order to confirm that orbital angular momentum (OAM) is conserved in amorphous materials over an extended range of sample thickness and also in very thin crystalline specimen, which is necessary for the detection of EMCD. Also artefact sources like spot size, mask tilt and astigmatism are discussed. In addition, the achievable SNR under typical experimental conditions is assessed.

Structure and local charging of electromigrated Au nanocontacts

We study the structure and the electronic properties of Au nanocontacts created by controlled electromigration of thin film devices, a method frequently used to contact molecules. In contrast to electromigration testing, a current is applied in a cyclic fashion and during each cycle the resistance increase of the metal upon heating is used to avoid thermal runaway. In this way, nanometer sized-gaps are obtained. The thin film devices with an optimized structure at the origin of the electromigration process are made by shadow evaporation without contamination by organic materials. Defining rounded edges and a thinner area in the center of the device allow to pre-determine the location where the electromigration takes place. Scanning force microscopy images of the pristine Au film and electromigrated contact show its grainy structure. Through electromigration, a 1.5 μm-wide slit is formed, with extensions only on the anode side that had previously not been observed in narrower structures. It is discussed whether this could be explained by asymmetric heating of both electrodes. New grains are formed in the slit and on the extensions on both, the anode and the cathode side. The smaller structures inside the slit lead to an electrode distance below 150 nm. Kelvin probe force microscopy images show a local work function difference with fluctuations of 70 mV on the metal before electromigration. Between the electrodes, disconnected through electromigration, a work function difference of 3.2 V is observed due to charging. Some of the grains newly formed by electromigration are electrically disconnected from the electrodes.

Effects of transcranial direct current stimulation on craving, heart-rate variability and prefrontal hemodynamics during smoking cue exposure

OBJECTIVE

Drug-related cue exposure elicits craving and risk for relapse during recovery. Transcranial direct current stimulation is a promising research tool and possible treatment for relapse prevention. Enhanced functional neuroconnectivity is discussed as a treatment target. The goal of this research was to examine whether transcranial direct current stimulation affected cortical hemodynamic indicators of functional connectivity, craving, and heart rate variability during smoking-related cue exposure in non-treatment-seeking smokers.

METHOD

In vivo smoking cue exposure supported by a 2mA transcranial direct current stimulation (anode: dorsolateral prefrontal cortex, cathode: orbitofrontal cortex; placebo-controlled, randomized, double-blind) in 29 (age: M=25, SD=5) German university students (smoking at least once a week). Cue reactivity was assessed on an autonomous (heart rate variability) and a subjective level (craving ratings). Functional near-infrared spectroscopy measured changes in the concentration of deoxygenated hemoglobin, and seed-based correlation analysis was used to quantify prefrontal connectivity of brain regions involved in cue reactivity.

RESULTS

Cue exposure elicited increased subjective craving and heart rate variability changes in smokers. Connectivity between the orbitofrontal and dorsolateral prefrontal cortex was increased in subjects receiving verum compared to placebo stimulation (d=0.66). Hemodynamics in the left dorsolateral prefrontal cortex, however, increased in the group receiving sham stimulation (η²=0.140). Transcranial direct current stimulation did not significantly alter craving or heart rate variability during cue exposure.

CONCLUSION

Prefrontal connectivity - between regions involved in the processing of reinforcement value and cognitive control - was increased by anodal transcranial direct current stimulation during smoking cue exposure. Possible clinical implications should be considered in future studies.

Simulation of the occupational radiation dose caused by contamination of primary circuit media in pressurized water reactors

The occupational radiation exposure of workers in NPPs during overall maintenance and refueling inspections and decommissioning is determined by numerous parameters. Radiation exposure caused by contamination of components may be minimised by the chemical operation mode and by applying systematic decontamination techniques. Data on occupational exposure in German NPPs as well as information about the radionuclide concentration in the coolant are available. The generic 3D model of the primary circuit presented is based on the analysis of technical documentation of German PWRs. Tasks are modeled as a combination of retention times at related local positions in the surroundings of work areas. The generic model allows the calculation of the resulting occupational doses generated by definable jobs and tasks. The KWU/Siemens-PWR generations are characterised by nuclide vectors, the thickness of shielding, and the material composition of components. It was possible to show that for a pre-Konvoi plant, the calculated occupational dose caused by a specific working task is close to measurements.

Use of Structured Self-Monitoring in Transplant Education

A self-assessment instrument for use at home by transplant recipients was developed to help foster partnership between patients and their healthcare provider. Self-monitoring at home has not replaced the need for close follow-up but does allow patients to provide concrete data to their healthcare provider in order to promote earlier detection of and response to adverse events. Patients are taught the essentials of self-monitoring while they are in the hospital for their transplant. Patients who perform routine self-assessment would be able to detect and provide information about problems early in the course of events. Thus, early intervention could potentially decrease the severity of the problem and prevent repeated hospitalizations. The concern that patients would not be able to perform a reliable self-assessment was unfounded; patients exceeded expectations and embraced the opportunity to communicate physical signs and symptoms effectively.

Effects of neratinib and combination with irradiation and chemotherapy in head and neck cancer cells

OBJECTIVE

Prognosis of patients with head and neck squamous cell carcinoma (HNSCC) is still poor. Novel therapeutic approaches are of great interest to improve the effects of radiochemotherapy. We evaluated the effects of tyrosine kinase inhibitor neratinib on HNSCC cell lines CAL27, SCC25 and FaDu as a single agent and in combination with irradiation and chemotherapy.

METHODS

Effects of neratinib were evaluated in HNSCC cell lines CAL27, SCC25 and FaDu. Effect on cell viability of neratinib and combination with cisplatin and irradiation was measured using CCK-8 assays and clonogenic assays. Western blot analysis was performed to distinguish the effect on epithelial growth factor receptor and HER2 expression. Apoptosis was evaluated by flow cytometry analysis.

RESULTS

Growth inhibition was achieved in all cell lines, whereas combination of cisplatin and neratinib showed greater inhibition than each agent alone. Apoptosis was induced in all cell lines. Combination of neratinib with irradiation or cisplatin showed significantly increased apoptosis. In clonogenic assays, significant growth inhibition was observed in all investigated cell lines.

CONCLUSION

Neratinib, as a single agent or in combination with chemo-irradiation, may be a promising treatment option for patients with head and neck cancer.

Concentration of Potassium in Plasma, Erythrocytes, and Muscle Tissue in Cows with Decreased Feed Intake and Gastrointestinal Ileus

BACKGROUND

Healthy cows consume large amounts of potassium and a sudden loss in appetite can lead to hypokalemia. The routine method to evaluate potassium homeostasis is the measurement of the extracellular potassium in plasma or serum, but this does not provide information about the intracellular potassium pool.

HYPOTHESIS/OBJECTIVES

To evaluate potassium homeostasis by comparing the extracellular and intracellular potassium concentration in cows with reduced feed intake and gastrointestinal ileus.

ANIMALS

Twenty cows 1-3 days postpartum (group 1) and 20 cows with gastrointestinal ileus (group 2).

METHODS

Observational cross-sectional study. Plasma potassium was measured by using an ion-sensitive electrode. Intracellular potassium was measured in erythrocytes and muscle tissue (muscle biopsy) by using inductively coupled plasma optical emission spectroscopy.

RESULTS

Cows of group 1 did not have hypokalemia. Overall cows with gastrointestinal ileus were hypokalemic (mean ± SD, 2.9 mmol/L ± 0.78), but potassium concentration in erythrocytes and muscle tissue was not lower than in postpartum cows. Intracellular potassium in erythrocytes varied very widely; group 1: 3497-10735 mg/kg (5559 ± 2002 mg/kg), group 2: 4139-21678 mg/kg (7473 ± 4034 mg/kg). Potassium in muscle tissue did not differ between group 1 (3356 ± 735 mg/kg wet weight) and group 2 (3407 ± 1069 mg/kg wet weight). No association between extracellular and intracellular potassium concentrations was detected.

CONCLUSIONS AND CLINICAL IMPORTANCE

That measurement of plasma potassium concentration is not sufficient to evaluate potassium metabolism of cows.

Abstract P3-02-02: Targeting the tumor microenvironment: A phase II study of copper-depletion using tetrathiomolybdate (TM) in patients (pts) with breast cancer (BC) at high risk for recurrence

Background: Bone marrow derived VEGFR2+ endothelial progenitor cells (EPCs) and copper-dependent pathways, including lysyl oxidase (LOX), are critical components to remodeling the tumor microenvironment and establishing the pre-metastatic niche. In preclinical models, it has been well established that copper depletion (CD) inhibits tumor progression. We hypothesized that TM-associated CD would reduce EPCs and other copper dependent processes in the pre-metastatic niche in BC pts at high risk for relapse. We investigated the relationship between CD and its effect on EPCs and other components of the tumor microenvironment including LOX, an enzyme critical for cross-linkage of collagen and priming the pre-metastatic niche.

Methods: In this single arm, phase II study, BC pts at high risk for recurrence, defined as node+ triple negative (TN), stage 3 and 4 with no evidence of disease (NED) were enrolled on a trial of CD with TM. Pts received oral TM to maintain ceruloplasmin (Cp) between 5-17 mg/dl for 2 years on the primary study. The primary endpoint was change in EPCs measured by flow cytometry before and during treatment with TM. Secondary endpoints included tolerability, safety and effect of copper depletion on other markers including LOX, quantified by ELISA.

Results: We enrolled 75 pts. The study treatment duration was 24 cycles (each cycle is 28 days). Over 2200 cycles have been administered. The median age is 51 (range 29-66). 45 pts have Stage 2/3 BC and 30 are Stage 4 NED. TNBC pts represent 48%, and 40% of pts are Stage 4 NED. Median Cp level decreased from 28 at baseline to 15.5 (p&lt;0.0001) after one cycle. Copper depletion was most efficient in TNBC, with 91% achieving a target CP within 4 weeks. TM was well tolerated and the only grade 3/4 toxicities were reversible neutropenia (3.2%) and anemia (0.0005%). CD was associated with a significant decrease in EPCs (p=0.0014) and LOX (p&lt;0.001). At a median follow-up of 5.4 years, the PFS for all 75 pts from the start of TM treatment was 71%, including a PFS of 90% for all stage 2/3 pts with TNBC. The overall survival of all patients enrolled in the trial is 86%. Relapse after two years is a rare event. Conclusions: TM is safe, well tolerated and appears to affect multiple copper dependent biologic processes in the tumor microenvironment known to be important for tumor progression. This seems to be most striking in TNBC. We believe, further phase III trials in a high risk for relapse population are warranted.

Citation Format: Nackos E, Willis A, Kornhauser N, Ward M, Andreopoulou E, Cigler T, Moore A, Fitzpatrick V, Cobham M, Schneider S, Wiener A, Guillaume-Abraham J, Warren JD, Rubinchik A, Lane M, Mittal V, Vahdat L. Targeting the tumor microenvironment: A phase II study of copper-depletion using tetrathiomolybdate (TM) in patients (pts) with breast cancer (BC) at high risk for recurrence. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-02-02.

Differentiating tremor patients using spiral analyses

Essential tremor follows an autosomal dominant type of inheritance in the majority of patients, yet its genetic basis has not been identified. The age of onset in this tremor is bimodal, one in young age and another when they are old. The old onset is referred to as senile tremor in this study. The precise pathology is still not completely understood for both these tremors. We wanted to develop an easy diagnostic tool to differentiate these two tremors clinically. In this study, the spirals were asked to be drawn by 30 patients, 15 from each group. The spirals were recorded digitally from each hand, with and without the spiral template, using a Wacom intuos version 4 tablets. The aim of the study was to look at the easy diagnostic measures from these spirals to distinguish the two cohorts of patients. The first measure was to use the well-known clinical scores like the number of complete circles without the template, width, height, axis, and degree of severity. The second measure was to estimate the peak frequency and the peak amplitude for the position, velocity, and acceleration data, in the frequency domain. The well-known clinical scores, most of them, did not show any significant difference between the two patient cohorts except the degree of severity which showed significant difference. The peak frequency and the peak amplitude in most of the data were not significantly different between the two cohorts of patients, only the peak amplitude from the acceleration data showed significant difference. Thus, we could use these two parameters to differentiate between the two tremors patient groups, which would be an easy clinical diagnostic tool without the need for any complicated analyses.

Case report: Lymphoma in a nasopharyngeal branchial cleft cyst

OBJECTIVE

Nasopharyngeal branchial cleft cysts are rare, and only case reports have been published. We present a patient whose nasopharyngeal cyst contained a malignant lymphoma, and we review previous reports of this condition.

METHODS

Case report with a relevant literature review.

RESULTS

Sixteen case reports of nasopharyngeal branchial cleft cysts in 24 patients were included. The average age was 36 years; most cysts were on one side. Five patients underwent aspiration, 18 underwent surgery. The cyst wall was lined by stratified squamous epithelium in seven patients and by ciliated colomunar epithelium in 14. All previous cysts showed benign pathology. Our case is the first report of a malignant disease hidden in a nasopharyngeal branchial cleft cyst.

CONCLUSIONS

To our knowledge, malignant lymphoma in a nasopharyngeal branchial cleft cyst has not been reported previously. Nevertheless, the possibility of this finding should be kept in mind when evaluating patients with nasopharyngeal cystic lesions.

Angiographic and clinical outcomes of patients treated with everolimus-eluting bioresorbable stents in routine clinical practice: Results of the ISAR-ABSORB registry

OBJECTIVES

We aimed to analyze angiographic and clinical results of patients undergoing BRS implantation in a real-world setting.

BACKGROUND

Angiographic and clinical outcome data from patients undergoing implantation of drug-eluting bioresorbable stents (BRS) in routine clinical practice is scant.

METHODS

Consecutive patients undergoing implantation of everolimus-eluting BRS at two high-volume centers in Munich, Germany were enrolled. Data were collected prospectively. All patients were scheduled for angiographic surveillance 6-8 months after stent implantation. Quantitative coronary angiographic analysis was performed in a core laboratory. Clinical follow-up was performed to 12 months and events were adjudicated by independent assessors.

RESULTS

A total of 419 patients were studied. Mean age was 66.6 ± 10.9 years, 31.5% had diabetes mellitus, 76.1% had multivessel disease, and 39.0% presented with acute coronary syndrome; 49.0% of lesions were AHA/ACC type B2/C, 13.1% had treatment of bifurcation lesions. Mean reference vessel diameter was 2.89 ± 0.46 mm. At angiographic follow-up in-stent late loss was 0.26 ± 0.51 mm, in-segment diameter stenosis was 27.5 ± 16.1, and binary angiographic restenosis was 7.5%. At 12 months, the rate of death, myocardial infarction, or target lesion revascularization was 13.1%. Definite stent thrombosis occurred in 2.6%.

CONCLUSIONS

The use of everolimus-eluting BRS in routine clinical practice is associated with high antirestenotic efficacy in patients undergoing angiographic surveillance. Overall clinical outcomes at 12 months are satisfactory though stent thrombosis rates are not insignificant. Further study with longer term follow-up and larger numbers of treated patients is required before we can be sure of the role of these devices in clinical practice.

Impact of body weight on antidiabetic treatment and predictors of weight control under real-world conditions: a 2-year follow-up of DiaRegis cohort

AIMS

Treatment strategies for obese patients with type 2 diabetes mellitus aim to increase physical activity, reduce body weight, and improve glucose control using weight-beneficial antidiabetic drugs. The objective of this study was to determine whether these strategies are implemented, and to identify factors predictive of glucose control and body weight management in a large, real-world patient population.

METHODS

The prospective DiaRegis cohort study included 3807 patients with type 2 diabetes in whom the treating physician decided to intensify and optimize treatment because of insufficient glucose control.

RESULTS

Antidiabetic treatment of overweight and obese patients was compared with that of normal-weight patients over a 2-years follow-up period, and multivariate analyses were performed to identify predictors of body weight loss. Among the 3807 participants, 92.5 % were overweight or obese. Normal-weight participants were more often treated with sulfonylureas or insulin, and overweight and obese patients with metformin or glucagon-like peptide (GLP)-1 analogues. Predictors of weight loss were body mass index (BMI) ≥30 kg/m(2) and any reported physical activity.

CONCLUSIONS

DiaRegis study shows that under real-world conditions, antidiabetic drug therapy is performed dependent on body weight. This strategy results in adequate glucose control and moderate weight reductions in overweight and obese patients. Weight loss is affected by treatment with weight-beneficial drugs, but also by any reported physical activity. However, only a small subgroup of patients perform physical activity. Initiation and maintenance of a physically active lifestyle remains a significant challenge for physicians, and patients with type 2 diabetes.

[Differences in the Provision of Lifestyle Counseling for Cardiovascular Disease Prevention Between Urban and Rural Regions in Germany. Findings from a National Survey of Primary Care Physicians]

AIMS

In Germany, shortages in primary care physicians (PCPs) were reported in some rural regions. In this paper, we explored if regional differences in the distribution of PCPs are associated with the provision of lifestyle counseling in primary care.

METHODS

In a nationwide study, a total of 4,074 randomly selected PCPs were asked about provision of lifestyle counseling to their patients, their attitudes, and perceived barriers.

RESULTS

PCPs from rural regions provided less frequently lifestyle advice for cardiovascular disease prevention. Compared to their colleagues in urban areas, more PCPs from rural regions believed that were inadequately qualified for the lifestyle counseling and that they had been less successful in helping patients to modify their lifestyles. Physicians from rural practices named more often than PCPs from urban practices a lack of adherence by the patients (65 vs. 57%), insufficient opportunities to collaborate with providers of preventive services (62 vs. 55%), and lack of time (66 vs. 52%; all p<0.001) as barriers in providing patients with lifestyle counseling.

CONCLUSION

Taking into account the expected increased shortages in PCPs in rural regions, the results show the need for targeted interventions for improving lifestyle counseling in rural practices.

The impact of long-term confinement and exercise on central and peripheral stress markers

Long-term isolation has been reported to have impact on psycho-physiological performance in humans. As part of the 520 days isolation study (MARS500, n=6) from June 3rd 2010 to November 4th 2011, this study aimed to show that stress caused by isolation and confinement is mirrored in cortical activity and cortisol levels and that exercise is a valid countermeasure. Cortical activity was measured by electroencephalography (EEG) pre- and post-moderate exercise every two weeks, salivary cortisol was taken every 60 days. Data show a decrease of global cortical activity, in both alpha- and beta-activity (p<.05-p<.001), and an increase of salivary cortisol (p<.05-p<.001), during the isolation, indicating that isolation acts as a chronic stressor with impact on cortical activity and cortisol levels. Moderate exercise leads to an increase (p<.01) in cortical activity. Therefore, during long-term space missions the factor isolation must be kept in mind as the reduction of cortical activity and the heightened stress level could impair performance. However moderate exercise might be able to counteract this impairment.

Fostering interest in research: evaluation of an introductory research seminar at hospitals in rural Rwanda

SETTINGS

Partners In Health Rwanda, in collaboration with the Ministry of Health, leads a multipronged approach to develop research capacity among health workers, particularly in rural areas.

OBJECTIVES

To describe the characteristics of participants and to assess the impact of an introductory research seminar series in three district hospitals in rural Rwanda.

DESIGN

This was a retrospective cohort study of seminar participants. Data were sourced from personnel records, assessment sheets and feedback forms.

RESULTS

A total of 126 participants, including 70 (56%) clinical and 56 (44%) non-clinical staff, attended the research seminar series; 61 (48%) received certification. Among those certified, the median assessment score on assignments was 79%. Participants read significantly more articles at 6 and 12 months (median 2 and 4 respectively, compared to 1 at baseline, P < 0.01). There was also a significant increase (P ⩽ 0.05) in self-reported involvement in research studies (28%, baseline; 59%, 12 months) and attendance at other research training (36%, baseline; 65%, 12 months).

CONCLUSION

The introductory research seminar series provided an important opportunity for engagement in research among clinical and non-clinical staff. Such an activity is a key component of a comprehensive research capacity building programme at rural sites, and serves as an entry point for more advanced research training.