Polymorphisms of the steroid sulfatase (STS) gene are associated with attention deficit hyperactivity disorder and influence brain tissue mRNA expression

Previous studies in animals and humans have implicated the X-chromosome STS gene in the etiology of attentional difficulties and attention deficit hyperactivity disorder (ADHD). This family based association study has fine mapped a region of the STS gene across intron 1 and 2 previously associated with ADHD, in an extended sample of 450 ADHD probands and their parents. Significant association across this region is demonstrated individually with 7 of the 12 genotyped SNPs, as well as an allele specific haplotype of the 12 SNPs. The over transmitted risk allele of rs12861247 was also associated with reduced STS mRNA expression in normal human post-mortem frontal cortex brain tissue compared to the non-risk allele (P = 0.01). These results are consistent with the hypothesis arising from previous literature demonstrating that boys with deletions of the STS gene, and hence no STS protein are at a significantly increased risk of developing ADHD. Furthermore, this study has established the brain tissue transcript of STS, which except from adipose tissue, differs from that seen in all other tissues investigated. © 2010 Wiley-Liss, Inc.

Recognition of teaching excellence

The 2008-2009 Task Force for the Recognition of Teaching Excellence was charged by the AACP Council of Faculties Leadership to examine teaching excellence by collecting best practices from colleges and schools of pharmacy, evaluating the literature to identify evidence-based criteria for excellent teaching, and recommending appropriate means to acknowledge and reward teaching excellence. This report defines teaching excellence and discusses a variety of ways to assess it, including student, alumni, peer, and self-assessment. The task force identifies important considerations that colleges and schools must address when establishing teaching recognition programs including the purpose, criteria, number and mix of awards, frequency, type of award, and method of nominating and determining awardees. The report concludes with recommendations for the academy to consider when establishing and revising teaching award programs.

Randomized clinical trial of prehabilitation in colorectal surgery

BACKGROUND

'Prehabilitation' is an intervention to enhance functional capacity in anticipation of a forthcoming physiological stressor. In patients scheduled for colorectal surgery, the extent to which a structured prehabilitation regimen of stationary cycling and strengthening optimized recovery of functional walking capacity after surgery was compared with a simpler regimen of walking and breathing exercises.

METHODS

Some 112 patients (mean(s.d.) age 60(16) years) were randomized to either the structured bike and strengthening regimen (bike/strengthening group, 58 patients) or the simpler walking and breathing regimen (walk/breathing group, 54 patients). Randomization was done at the surgical planning visit; the mean time to surgery available for prehabilitation was 52 days; follow-up was for approximately 10 weeks after surgery.

RESULTS

There were no differences between the groups in mean functional walking capacity over the prehabilitation period or at postoperative follow-up. The proportion showing an improvement in walking capacity was greater in the walk/breathing group than in the bike/strengthening group at the end of the prehabilitation period (47 versus 22 per cent respectively; P = 0.051) and after surgery (41 versus 11 per cent; P = 0.019).

CONCLUSION

There was an unexpected benefit from the recommendation to increase walking and breathing, as designed for the control group. Adherence to recommendations was low. An examination of prehabilitation 'responders' would add valuable information.

On the magnetic field near the center of Helmholtz coils

We develop a series expansion for the calculation of the magnetic field near the center of Helmholtz coils and apply the result to a magnet of our design. Our analysis considers geometric details of the coils, the magnetic properties of the form and windings, conductor insulation effects, and several winding imperfections. We also consider the relaxation of coil symmetry which happens when the mean radius of each coil and the coil midplane separation distance are unequal. We compute the field uniformity near the coil's center for three cases, including one where axial symmetry remains but geometric imperfections of the order of 10(-3) of the coil "radius" exist.

Brain polysomes: response to environmental stimulation

Polysomes have been isolated from rat brain and characterized by their appearance in the electron microscope and by their sedimentation in sucrose density gradients. Rats were isolated for 3 days in the dark and were then returned to the light for 15 minutes. The polysomes in brain, but not in liver, decreased in rats deprived of light and increased in those stimulated with light. These findings together with an increased capacity for protein synthesis in the brain in vitro and in vivo suggest that an increase in the activity of messenger RNA in the brain may result from environmental changes.

Enhanced target gene knockdown by a bifunctional shRNA: a novel approach of RNA interference

RNA interference (RNAi) is a natural cellular regulatory process that inhibits gene expression by transcriptional, post-transcriptional and translational mechanisms. Synthetic approaches that emulate this process (small interfering RNA (siRNA), short hairpin RNA (shRNA)) have been shown to be similarly effective in this regard. We developed a novel 'bifunctional' RNAi strategy, which further optimizes target gene knockdown outcome. A bifunctional construct (bi-sh-STMN1) was generated against Stathmin1, a critical tubulin modulator that is overexpressed in human cancers. The bifunctional construct is postulated to concurrently repress the translation of the target mRNA (cleavage-independent, mRNA sequestration and degradation) and degrade (through RNase H-like cleavage) post-transcriptional mRNA through cleavage-dependent activities. Bi-sh-STMN1 showed enhanced potency and durability in parallel comparisons with conventional shRNA and siRNAs targeting the same sequence. Enhanced STMN1 protein knockdown by bi-sh-STMN1 was accompanied by target site cleavage at the mRNA level showed by the rapid amplification of complementary DNA ends (RACE) assay. Bi-sh-STMN1 also showed knockdown kinetics at the mRNA level consistent with its multieffector silencing mechanisms. The bifunctional shRNA is a highly effective and advantageous approach mediating RNAi at concentrations significantly lower than conventional shRNA or siRNA. These results support further evaluations.

Prevalence of Methylenetetrahydrofolate Reductase C677T and A1298C Polymorphisms and Risk of Breast Cancer in Mexican Women: An Interim Report of a Case-Control Study

Background: Among other causes, Breast Cancer (BC) appears as a result of genetic and epigenetic changes. Modifications in important pathways, such as the reactions that provide essential cofactors for synthesis of S-adenosylmethionine (one-carbon metabolism), and those involved in DNA synthesis and methylation could be linked to the development of this disease. Research has been conducted about whether MTHFR polymorphisms are related to the development of breast cancer in at least 10 different races, with different outcomes. Two of the most frequently studied MTHFR polymorphisms are C677T and A1298C, and their frequency is unknown among Mexican women. Our objective was to determine the frequency of these two polymorphisms and to ascertain weather their presence increases the risk of developing BC in our population.Materials and methods: 37 blood samples from histopatologically confirmed breast cancer patients were collected from hospitals in Monterrey, Uruapan and Villahermosa, all in Mexico. 115 healthy control samples were obtained from the same cities, and were matched for age in 5-year interval-groups. Cases and controls were third generation Mexican and older than 18 years. Genotyping of every sample was performed by PCR and restriction with enzymes.Results: The C677T Polymorphism was found in 28 cases (75.67%), whereas 76/115 controls (66.08%) showed the polymorphic allele. Case-controls analysis was adjusted to the confounding variable age group, an odds ratio of 1.58 (IC 95% de 0.66 – 3.82) was obtained. We did not find a significant relationship between the presence of the C677T polymorphism and the presence of breast cancer. The A1298C Polymorphism was found in 19/37 cases (51.35%), while only 32/115 (27.82%) of the control samples contained the allele. The odds ratio adjusted for the same confounding variable was 2.72 (IC 95%: 1.26 – 5.87). These results suggest a significant association between the presence of the polymorphism and BC.Discussion: Despite the exhaustive research that has been conducted regarding MTHFR polymorphisms C677T and A1298C, their association to the risk of breast cancer remains unclear. Some research groups even suggest that the presence of the polymorphisms, either individually or combined, confers certain protection against the disease. Up until now there were no data in Mexican population. Differences in the results of different works probably lie in the nature of the populations analyzed and the experimental design. We believe that a bigger sample size will allow us to determine if A1298C polymorphism is indeed, a risk factor for BC in Mexican women.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3064.

The relationship between birth with a health professional and maternal mortality in observational studies: a review of the literature

OBJECTIVE

To examine the nature of the association between maternal mortality and birth with a health professional in observational studies.

METHODS

Review of ecological studies relating the overall proportion of births with a health professional with the maternal mortality ratio at national level, and studies exploring the relationship between the presence of a health professional at birth and the risk of dying at the individual level. We report methodological challenges, including data quality and sources and the analytical approaches used. For the individual studies, crude odds ratios and 95% confidence intervals were calculated.

RESULTS

The 10 ecological studies are largely descriptive, a causal inference is tentative and there is poor controlling of confounders. The 10 individual studies examining the risk of death with and without a health professional showed little evidence that giving birth with a health professional reduces a woman's risk of dying, and in some settings it appears to be associated with an increased risk of death.

CONCLUSIONS

None of these study designs are optimal in evaluating the impact of births with a health professional on reducing maternal mortality. Analytically, greater insights can be gained by examining ecological relationships within countries, and by complementing the individual analyses with information on the health status of women when they first reach the health professional and whether or not the women planned to have a health professional present during birth.

Resource utilisation and costs of palliative cancer care in an interdisciplinary health care model

This paper presents a detailed description of health care resource utilisation and costs of a pilot interdisciplinary health care model of palliative home care in Ontario, Canada. The descriptive evaluation entailed examining the use of services and costs of the pilot program: patient demographics, length of stay broken down by disposition (discharged, alive, death), access to services/resources, use of family physician and specialist services, and drug use. There were 434 patients included in the pilot program. Total costs were approximately CAN$2.4 million, and the cost per person amounted to approximately CAN$5586.33 with average length of stay equal to over 2 months (64.22 days). One may assume that length of stay would be influenced by the amount of service and support available. Future research might investigate whether in-home palliative home care is the most cost effective and suitable care setting for those patients requiring home care services for expected periods of time.

Professional assistance during birth and maternal mortality in two Indonesian districts

OBJECTIVE

To examine determinants of maternal mortality and assess the effect of programmes aimed at increasing the number of births attended by health professionals in two districts in West Java, Indonesia.

METHODS

We used informant networks to characterize all maternal deaths, and a capture-recapture method to estimate the total number of maternal deaths. Through a survey of recent births we counted all midwives practising in the two study districts. We used case-control analysis to examine determinants of maternal mortality, and cohort analysis to estimate overall maternal mortality ratios.

FINDINGS

The overall maternal mortality ratio was 435 per 100,000 live births (95% confidence interval, CI: 376-498). Only 33% of women gave birth with assistance from a health professional, and among them, mortality was extremely high for those in the lowest wealth quartile range (2303 per 100,000) and remained very high for those in the lower middle and upper middle quartile ranges (1218 and 778 per 100,000, respectively). This is perhaps because the women, especially poor ones, may have sought help only once a serious complication had arisen.

CONCLUSION

Achieving equitable coverage of all births by health professionals is still a distant goal in Indonesia, but even among women who receive professional care, maternal mortality ratios remain surprisingly high. This may reflect the limitations of home-based care. Phased introduction of fee exemption and transport incentives to enable all women to access skilled delivery care in health centres and emergency care in hospitals may be a feasible, sustainable way to reduce Indonesia's maternal mortality ratio.

Functional and computational assessment of missense variants in the ataxia-telangiectasia mutated (ATM) gene: mutations with increased cancer risk

The functional consequences of missense variants are often difficult to predict. This becomes especially relevant when DNA sequence changes are used to determine a diagnosis or prognosis. To analyze the consequences of 12 missense variants in patients with mild forms of ataxia-telangiectasia (A-T), we employed site-directed mutagenesis of ataxia-telangiectasia mutated (ATM) cDNA followed by stable transfections into a single A-T cell line to isolate the effects of each allele on the cellular phenotype. After induction of the transfected cells with CdCl2, we monitored for successful ATM transcription and subsequently assessed: 1) intracellular ATM protein levels; 2) ionizing radiation (IR)-induced ATM kinase activity; and 3) cellular radiosensitivity. We then calculated SIFT and PolyPhen scores for the missense changes. Nine variants produced little or no correction of the A-T cellular phenotype and were interpreted to be ATM mutations; SIFT/PolyPhen scores supported this. Three variants corrected the cellular phenotype, suggesting that they represented benign variants or polymorphisms. SIFT and PolyPhen scores supported the functional analyses for one of these variants (c.1709T>C); the other two were predicted to be "not tolerated" (c.6188G>A and c.6325T>G) and were classified as "operationally neutral." Genotype/phenotype relationships were compared: three deleterious missense variants were associated with an increased risk of cancer (c.6679C>T, c.7271T>G, and c.8494C>T). In situ mutagenesis represents an effective experimental approach for distinguishing deleterious missense mutations from benign or operationally neutral missense variants.

Non-astigmatic imaging with matched pairs of spherically bent crystals or reflectors

This paper defines the exact conditions for the application of a previously proposed, general, non-astigmatic, imaging scheme, consisting of a matched pair of spherically bent crystals or reflectors, to x rays. These conditions lead to two specific experimental arrangements, of which one can provide large magnifications. Potential applications include the x-ray diagnosis of laser-produced plasmas and x-ray imaging of, e.g., biological samples, using the highly monochromatic radiation at synchrotron light sources. The results obtained for x rays are, however, valid for a wide spectrum of the electromagnetic radiation so that, for instance, an application of one of the imaging schemes to lithography in the EUV wavelength range should also be possible, if the spherically bent crystals are replaced by appropriate spherical reflectors. Also described is the design of an x-ray crystal spectrometer, which meets the here defined, necessary requirements for the observation of the x-ray spectra of helium-like argon.

Rehabilitation outcomes for veterans with polytrauma treated at the Tampa VA

Returning soldiers from Iraq and Afghanistan who have sustained polytrauma have a combination of complex physical and mental morbidities that require extensive therapy and rehabilitation. This study examined the effect of rehabilitation on 116 polytrauma patients with service-connected injuries treated at the Tampa VA; improvements in functional and cognitive abilities were measured using the Functional Independence Measure (FIM) scores and healthcare costs for rehabilitation treatment were also assessed. Intensive rehabilitation therapy increased functional ability in this cohort with an average improvement in total FIM scores of 23 points. Total inpatient costs for these patients exceeded $4 million in approximately 3 years. Rehabilitation nurses face challenges providing quality care to this target patient population, including characterizing war-related polytrauma, providing surveillance, coordinating care, synchronizing care for patients with multiple injuries, and conducting evidence-based pain management.