Psychosocial, feeding, and drooling outcomes in children with Beckwith Wiedemann syndrome following tongue reduction surgery

OBJECTIVE

Macroglossia is a common feature of Beckwith Wiedemann Syndrome (BWS). Tongue reduction surgery (TRS) is advocated to overcome, or reduce, the secondary effects of macroglossia. Macroglossia may affect a child's cosmetic appearance, feeding, and drooling function. However, no study has systematically reported on feeding, drooling, or psychosocial outcomes preoperatively and postoperatively in this group. This study aimed to describe the presurgical and postsurgical psychosocial, feeding, and drooling outcomes of children with macroglossia associated with BWS and to determine the effect of TRS on these areas.

DESIGN

Clinical cohort study.

PARTICIPANTS

Ten consecutively admitted children with BWS (age at surgery from 9 months to 4 years, 9 months [4;9]; mean, 2;7) were assessed preoperatively, 3 months postoperatively, and at long-term follow-up.

MAIN OUTCOME MEASURES

A parental report questionnaire, the Brodsky drooling scale, and a feeding rating scale.

RESULTS

Parents reported that macroglossia had a negative impact cosmetically that was ameliorated following surgery. Macroglossia caused a range of feeding difficulties presurgically by preventing lip seal and bolus manipulation during the oral preparatory phase. Excessive drooling was present in all cases presurgically. This resolved partially across the group postsurgically, with almost complete recovery at longer-term follow-up assessment.

CONCLUSIONS

Presurgically, children show a common profile of feeding and drooling impairment with negative effects on cosmetic appearance. Our preliminary results demonstrate that TRS has a positive impact on these features with good outcomes for children with BWS.

Markers of bone turnover across a competitive season in female athletes: a preliminary investigation

AIM

Higher levels of bone formation have been observed in athletes performing high impact exercise when compared to non-impact exercisers. This study was designed to determine if bone formation and resorption fluctuate across a competitive season (4-6 months) in females training at different levels of mechanical stress.

METHODS

Markers of bone formation (osteocalcin [OC]; bone specific alkaline phosphatase [BAP]) and resorption (cross-linked N-telopeptides [NTx]) were measured in serum at pre-, mid- and post-season in 33 female athletes and controls (19.6±1.4 yr). Participants were divided into impact groups of high (HIGH, basketball, N.=6), medium (MED, soccer, N.=12), and non (NON, swimmers, N.=11), and compared to sedentary controls (CON, N.=4). Bone mineral density (BMD) and bone mineral content (BMC) were assessed by DXA in a subset of each group.

RESULTS

BAP was greater in HIGH and MED (31.82±12.21 and 33.09±6.78 U/L) than both NON and CON (23.96±5.71 and 16.66±2.07 U/L); no significant changes over time were noted. Hip BMD was greater in HIGH (1.17±0.14 g×cm-2) than NON and CON (0.98±0.09 and 1.02±0.04 g×cm-2, respectively), while hip BMC was greater in HIGH and MED (41.76±3.06 and 38.56 ± 3.94 g) than NON and CON (32.37 ±3.5 and 30.51 ± 5.91).

CONCLUSION

Women involved in HIGH and MED impact activities have higher levels of bone formation throughout a season than those involved in non-impact activities which may have long term implications for bone health.

The contribution of club participation to adolescent health: evidence from six countries

BACKGROUND

Social networks have been recognised as an important factor for enhancing the health of people and communities. Bridging social capital, characterised by numerous and varied weak ties, exemplifies a particular type of network that can help people reach their goals and improve their health. This study seeks to contribute to the evidence base on the use of positive social networks for young people's health by exploring the importance of club participation in predicting the health and health-related behaviours of 15-year-old girls and boys across Europe and North America.

METHODS

Data are derived from a 2005-6 World Health Organization collaborative study, to establish the relationships between different types of club and a range of health outcomes (self-perceived health, wellbeing and symptoms) and health-related behaviours (smoking, drinking). Multi-level logistic regression was used to assess the independent effects of club participation by controlling for gender and socioeconomic position. Data were compared across six countries.

RESULTS

All the considered outcomes, both in terms of perceived health and wellbeing and health behaviours were associated with participation in formal associations. The associations are in the expected direction (participation corresponding to better health) except for some particular association types.

CONCLUSIONS

Participation in formal associations seems supportive for good health and health behaviours in adolescence, and should be promoted in this age group.

Structure-function study of mammalian Munc18-1 and C. elegans UNC-18 implicates domain 3b in the regulation of exocytosis

Munc18-1 is an essential synaptic protein functioning during multiple stages of the exocytotic process including vesicle recruitment, docking and fusion. These functions require a number of distinct syntaxin-dependent interactions; however, Munc18-1 also regulates vesicle fusion via syntaxin-independent interactions with other exocytotic proteins. Although the structural regions of the Munc18-1 protein involved in closed-conformation syntaxin binding have been thoroughly examined, regions of the protein involved in other interactions are poorly characterised. To investigate this we performed a random transposon mutagenesis, identifying domain 3b of Munc18-1 as a functionally important region of the protein. Transposon insertion in an exposed loop within this domain specifically disrupted Mint1 binding despite leaving affinity for closed conformation syntaxin and binding to the SNARE complex unaffected. The insertion mutation significantly reduced total amounts of exocytosis as measured by carbon fiber amperometry in chromaffin cells. Introduction of the equivalent mutation in UNC-18 in Caenorhabditis elegans also reduced neurotransmitter release as assessed by aldicarb sensitivity. Correlation between the two experimental methods for recording changes in the number of exocytotic events was verified using a previously identified gain of function Munc18-1 mutation E466K (increased exocytosis in chromaffin cells and aldicarb hypersensitivity of C. elegans). These data implicate a novel role for an exposed loop in domain 3b of Munc18-1 in transducing regulation of vesicle fusion independent of closed-conformation syntaxin binding.

Chaperoning the SNAREs: a role in preventing neurodegeneration?

Despite their potential importance as therapeutic targets, the initial events in neurodegenerative diseases are poorly understood. Emerging evidence suggests that presynaptic dysfunction might be an early event in these pathologies, and three papers now link dysregulation of SNAREprotein levels and function caused by the absence of synuclein or cysteine string protein (CSP) to activity-dependent neurodegeneration.

Hyperglycaemia confers resistance to chemotherapy on breast cancer cells: the role of fatty acid synthase

The prognosis for women with breast cancer is adversely affected by the comorbidities of obesity and diabetes mellitus (DM), which are conditions associated with elevated levels of circulating fatty acids, hyperglycaemia and hyperinsulinaemia. We investigated the effects of exposure of non-malignant and malignant human breast epithelial cells to elevated levels of fatty acids and glucose on their growth, survival and response to chemotherapeutic agents. We found that palmitate induced cell death in the non-malignant cells but not in the malignant cells, which was abrogated through the inhibition of ceramide production and by oleate but not by IGF1. Fatty acid synthase (FAS) is responsible for the de novo synthesis of fatty acids from sugars, and is over-expressed in many epithelial cancers. Abundance of FAS was higher in malignant cells than in non-malignant cells, and was up-regulated by IGF1 in both cell types. IGF-induced growth of non-malignant cells was unaffected by suppression of FAS expression, whereas that of malignant cells was blocked as was their resistance to palmitate-induced cell death. Palmitate did not affect cell proliferation, whereas oleate promoted the growth of non-malignant cells but had the opposite effect, that is, inhibition of IGF1-induced growth of malignant cells. However, when the phosphatidylinositol 3-kinase pathway was inhibited, oleate enhanced IGF1-induced growth in both cell types. Hyperglycaemia conferred resistance on malignant cells, but not on non-malignant cells, to chemotherapy-induced cell death. This resistance was overcome by inhibiting FAS or ceramide production. Understanding the mechanisms involved in the associations between obesity, DM and breast cancer may lead to more effective treatment regimens and new therapeutic targets.

Invasive lobular carcinoma of the breast: should this be regarded as a chronic disease?

BACKGROUND

The surgical treatment of patients with invasive lobular carcinoma is still controversial due to its different clinical and pathological features. Most studies report local recurrence after relatively short follow-up periods, which is usually 5 years. However there is some evidence to suggest that local recurrence may occur late in the course of follow-up.

AIM OF THE STUDY

To study the implications and outcome of extending the follow-up period of patients treated for invasive lobular carcinoma.

PATIENTS AND METHODS

Patients (268) treated between 1989 and 1996 were reviewed. Thirty-three patients were excluded as they had primary hormonal therapy. The outcomes for 235 patients were analyzed.

RESULTS

Seventy-nine patients (33.6%) had breast conservation surgery (group I), which was followed by re-excision due to positive margins in 23 patients (29%), and 156 patients (66.3%) had mastectomy (group II). Compared to group II, tumours in group I were smaller (mean size 17 vs. 37 mm, P=0.001), multifocal [20 (25%) vs. 14 (9%), P=0.003] and with more positive margins [23 (29%) vs. 24 (15%), P=0.0009]. Only 33 patients (21%) in group II, and all patients in group I had post-operative radiotherapy (P=0.0001). Forty-eight patients (17.9%) developed local recurrence [27 (34%) in group I and 21 (13.4%) in group II, P=0.0005] after a median follow-up period of 167.8 months. The mean time to local recurrence was 127 (range 24-196) months. Univariate analysis showed that the type of surgery, margin status, adjuvant radiotherapy and chemotherapy significantly affected local recurrence (P=0.0005, 0.02, 0.04 and 0.05 respectively). Cox regression analysis showed that the only factor affected local recurrence was the type of surgery (relative risk 2.43, 95% confidence interval 1.22-4.83, P=0.01) The overall survival was 99.3 months (78.2%). Univariate and Cox regression analyses showed that only the patients age at diagnosis significantly affected survival (P=0.003).

CONCLUSION

Local recurrence may be a late event in patients treated for invasive lobular carcinoma of the breast and extended follow-up may be considered. In this study mastectomy offers better local control.

Calorie restriction reduces rDNA recombination independently of rDNA silencing

Calorie restriction (CR) extends lifespan in yeast, worms, flies and mammals, suggesting that it acts via a conserved mechanism. In yeast, activation of the NAD-dependent histone deacetylase, Sir2, by CR is thought to increase silencing at the ribosomal DNA, thereby reducing the recombination-induced generation of extrachromosomal rDNA circles, hence increasing replicative lifespan. Although accumulation of extrachromosomal rDNA circles is specific to yeast aging, it is thought that Sirtuin activation represents a conserved longevity mechanism through which the beneficial effects of CR are mediated in various species. We show here that growing yeast on 0.05 or 0.5% glucose (severe and moderate CR, respectively) does not increase silencing at either sub-telomeric or rDNA loci compared with standard (2% glucose) media. Furthermore, rDNA silencing was unaffected in the hxk2Δ, sch9Δ and tor1Δ genetic mimics of CR, but inhibited by FOB1 deletion. All these interventions extend lifespan in multiple yeast backgrounds, revealing a poor correlation between rDNA silencing and longevity. In contrast, CR and deletion of the FOB1, HXK2, SCH9 and TOR1 genes, all significantly reduced rDNA recombination. This silencing-independent mechanism for suppressing rDNA recombination may therefore contribute to CR-mediated lifespan extension.

The functions of Munc18-1 in regulated exocytosis

The activation of regulated exocytosis occurs by a rise in cytosolic Ca(2+) concentration. Synaptotagmins act as the Ca(2+) sensors, whereas the machinery that allows fusion of secretory vesicles with the plasma membrane consists of the soluble N-ethylmaleimide-sensitive factor attachment protein receptor (SNARE) proteins, including syntaxin 1, SNAP-25, and VAMP. Within the pathway leading to exocytosis, there is an essential requirement for a member of the conserved Sec1/Munc18 (SM) protein family, which in neurotransmitter and neurohormone release in mammalian cells is Munc18-1. The exact role of Munc18-1 and the steps within exocytosis in which it acts have been intensively investigated. Current evidence suggests that Munc18-1 acts via distinct modes of interactions with syntaxin 1 and the other SNARE proteins and influences all of the steps leading to exocytosis, including vesicle recruitment, tethering, docking, priming, and membrane fusion.

A conceptual framework for public health: NICE's emerging approach

This paper outlines the National Institute for Health and Clinical Excellence's (NICE) emerging conceptual framework for public health. This is based on the experience of the first 3 years of producing public health guidance at NICE (2005-2008). The framework has been used to shape the revisions to NICE's public health process and methods manuals for use post 2009, and will inform the public health guidance which NICE will produce from April 2009. The framework is based on the precept that both individual and population patterns of disease have causal mechanisms. These are analytically separate. Explanations of individual diseases involve the interaction between biological, social and related phenomena. Explanations of population patterns involve the same interactions, but also additional interactions between a range of other phenomena working in tandem. These are described. The causal pathways therefore involve the social, economic and political determinants of health, as well as psychological and biological factors. Four vectors of causation are identified: population, environmental, organizational and social. The interaction between the vectors and human behaviour are outlined. The bridge between the wider determinants and individual health outcomes is integration of the life course and the lifeworld.