Cross-Sectional Characteristics of Pediatric-Onset Discoid Lupus Erythematosus: Results of a Multicenter, Retrospective Cohort Study

• Discoid lupus may be associated with SLE. In this study, most children with discoid lupus did not have systemic disease. Concurrent SLE was highest in female adolescents (>10 years of age) with generalized discoid lupus, who had clinically aggressive disease. • Discoid lupus in adolescence should prompt thorough evaluation for SLE.

Increasing experience with the LIFT procedure in Crohn's disease patients with complex anal fistula

BACKGROUND

Surgical management of anal fistulas in Crohn's disease (CD) is associated with high failure rates, and treatment options are limited due to ongoing proctitis, multiple tracts, and concern for incontinence and non-healing wounds. The aim of this study was to investigate the healing rate of ligation of the inters-sphincteric fistula tract (LIFT) for anal fistulas in Crohn's disease and identify prognostic factors for healing.

METHODS

This prospective analysis compared long-term healing rates of CD patients undergoing LIFT for anal fistulas. Consecutive patients with CD who underwent LIFT procedure at our institution, in the period from March 2012 to September 2019 were included. The main outcome was anal fistula healing rate.

RESULTS

The study cohort of 46 patients (mean age of 34.2 ± 13.0 years, 18 (40%) males). After a mean follow-up time of 33 ± 28 months, fistula healing was seen in 30 (65%) patients. A total of 8 patients were noted to have inter-sphincteric recurrence and 8 patients had trans-sphincteric recurrence. Smoking at the time of surgery was significantly associated with LIFT failure (HR 3.18, 95% CI 1.18-8.61, p = 0.02). Other factors, such as age, sex, race, disease duration and location, type of fistula history of proctitis, preoperatively use of biologics or a seton, and previous repair attempts, did not appear to influence LIFT healing. Although not statistically significant, there was a trend toward increase in failure among patients with active proctitis at the time of surgery (HR 1.97, 95% CI 0.71-5.42, p = 0.19).

CONCLUSION

Our increasing experience with LIFT for anal fistula in CD demonstrates a higher rate of healing (65%) than previously reported (48%). Smoking appears to negatively influence healing of LIFT in CD.

Optical response of magnetically actuated biocompatible membranes

Biocompatible suspended magneto-elastic membranes were prepared. They consist of PDMS (polydimethylsiloxane) films, with embedded arrays of micrometric magnetic pillars made with lithography techniques. For visible light wavelengths, our membranes constitute magnetically tunable optical diffraction gratings, in transmission and reflection. The optical response has been quantitatively correlated with membrane structure and deformation, through optical and magneto-mechanical models. In contrast to the case of planar membranes, the diffraction patterns measured in reflection and transmission vary very differently upon magnetic field application. Indeed, the reflected beam is largely affected by the membrane bending, whereas the transmitted beam remains almost unchanged. In reflection, even weak membrane deformation can produce significant changes of the diffraction patterns. This field-controlled optical response may be used in adaptive optical applications, photonic devices, and for biological applications.

Quadrupole shift of nuclear magnetic resonance of donors in silicon at low magnetic field

Shifts from the expected nuclear magnetic resonance frequencies of antimony and bismuth donors in silicon of greater than a megahertz are observed in electrically detected magnetic resonance spectra. Defects created by ion implantation of the donors are discussed as the source of effective electric field gradients generating these shifts via quadrupole interaction with the nuclear spins. The experimental results are modeled quantitatively by molecular orbital theory for a coupled pair consisting of a donor and a spin-dependent recombination readout center.

Clinical and pathologic differences in interstitial lung disease based on antisynthetase antibody type

BACKGROUND

Interstitial lung disease (ILD) is a common extramuscular manifestation of the idiopathic inflammatory myopathies (IIMs), dermatomyositis (DM) and polymyositis (PM). Patients with antisynthetase antibodies (ASA) demonstrate some or all of the features of the antisynthetase syndrome including IIM and ILD. It has been hypothesized that the clinical expression of antisynthetase syndrome varies between specific ASAs.

OBJECTIVE

We sought to determine whether the myositis-associated ILD (MA-ILD) phenotype differs based on the presence of ASAs and by ASA subtype.

METHODS

A cross-sectional and longitudinal analysis of consecutive patients enrolled at the Johns Hopkins Myositis Center with ILD in the setting of clinically diagnosed autoimmune myositis was conducted.

RESULTS

Seventy-seven subjects were included; 36 were ASA negative, 28 were anti-Jo1 positive, and 13 were non-Jo1 ASA positive (5 anti-PL-12, 4 anti-PL-7, 2 anti-EJ, and 2 anti-OJ). Non-Jo1 ASA positive participants were more likely to be African-American than Caucasian as compared to both the anti-Jo1 positive (p = 0.01) and ASA negative groups (p < 0.01). ASA negative participants had better mean forced vital capacity percent predicted (FVC%) and total computed tomography scores over time compared to those with anti-Jo1 after controlling for potential confounders.

CONCLUSIONS

ASA status was significantly different by race. Those with anti-Jo1 antibodies had worse lung function and CT scores over time compared to those without detectable antisynthetase antibodies. Further prospective study in a larger cohort is needed to determine whether these apparent antibody-specific differences in demographics and manifestations of disease translate into meaningful disparities in clinical outcomes.

Abstract P4-19-03: Breast cancer oriented biobank and associated biobank management system: Preliminary analysis on 9043 samples from 274 individuals

Four years ago, after our Baylor College of Medicine (BCM) Breast and Cancer Centers experience, we decided to initiate a related translational research Project at the Breast Center Buenos Aires (BCBA) in Argentina. This included the development of a breast cancer-oriented Management System for clinical and lab data attached to a biorepository of tumor and normal breast tissue with matched blood specimens. We strictly followed ISBER Best Practices for Biorepositories, and shared the same protocols and strategies with BCM to facilitate international collaborative breast cancer research, being extremely aware of international standards.

Objectives: Creation of a breast cancer-oriented blood, breast tissue and tumor biobank for translational research purposes. Creation of a Biobank Management and Tracking System, with a breast cancer database for associated epidemiological, pathological, clinical, and follow-up data of each patient.

Methods: From April 2011 to June 2013 we processed blood and tissue samples from BCBA. Blood is collected at several time points during the breast cancer disease process: pre-surgical, pre-systemic treatment, and, if applicable, in the metastatic setting. Blood products are stored as whole blood, plasma, buffy coat, red blood cell pellet, serum and clot at -80°C or in GenPlates®. Fresh tissue and tumor samples were collected during surgical or core biopsy proceedings and stored fresh at -80°C in 1 ml cryovials and as FFPE (formalin-fixed paraffin embedded) tissue. Upon enrollment, participants completed an extensive epidemiological and risk factor questionnaire, which is supplemented by medical record abstraction for relevant pathological and clinical data, and re-contacted once a year for follow-up.

Preparation and adaptation processes were compliant with the Population Sciences Biorepository and Smith Breast Center Tumor Bank at BCM: 1) IRB-approved informed consent documents 2) Epidemiological and risk factor questionnaires (Core/Breast module); 3) Blood and tissue collection and processing protocols.

A web-based data management and tracking system was specifically designed for the BCBA biobank.

Results:

To date, we have collected 9043 samples, from 274 individuals, in 293 sample collections. Of 5449 frozen samples, 5054 (92.7%) are blood and 395 (7.3%) are tissue. We also collected 3264 blood samples in GenPlate® wells from 68 patients on 17 plates, and extracted DNA from them into Gentegra® tubes, all stored at room temperature.

230 FFPE breast cancer tissue biopsies from 20 surgical specimens, given by the pathologist after diagnosis, stored in cassettes at room temperature in our lab, were also included in the system starting from January 2013.

All of them have been classified by the physician into three categories: Healthy Control 15.3% (n = 42), Benign 55.1% (n = 151) and Cancer 29.6% (n = 81). We collected epidemiological, and cancer data from all of them in our system.

Conclusion: It took nearly 4 years from inception to realization for this biobank; however, the potential benefit to translation breast cancer research is large. The overall value of this biobank will depend on the number of individuals/samples accrued, the follow-up attained and data accuracy.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-19-03.

Search for a two-Higgs-boson doublet using a simplified model in pp collisions at sqrt[s] = 1.96 TeV

We present a search for new particles in an extension to the standard model that includes a heavy Higgs boson (H(0)), a lighter charged Higgs boson (H(±)), and an even lighter Higgs boson h(0), with decays leading to a W-boson pair and a bottom-antibottom quark pair in the final state. We use events with exactly one lepton, missing transverse momentum, and at least four jets in data corresponding to an integrated luminosity of 8.7 fb(-1) collected by the CDF II detector in proton-antiproton collisions at sqrt[s]= 1.96 TeV. We find the data to be consistent with standard model predictions and report the results in terms of a simplified Higgs-cascade-decay model, setting 95% confidence level upper limits on the product of cross section and branching fraction from 1.3 pb to 15 fb as a function of H(0) and H(±) masses for m(h)(0) = 126 GeV/c(2).

Survival-promoting functions of 14-3-3 proteins

The 14-3-3 proteins are a family of phosphoserine/phosphothreonine-binding molecules that control the function of a wide array of cellular proteins. We suggest that one function of 14-3-3 is to support cell survival. 14-3-3 proteins promote survival in part by antagonizing the activity of associated proapoptotic proteins, including Bad and apoptosis signal-regulating kinase 1 (ASK1). Indeed, expression of 14-3-3 inhibitor peptides in cells is sufficient to induce apoptosis. Interestingly, these 14-3-3 antagonist peptides can sensitize cells for effective killing by anticancer agents such as cisplatin. Thus, 14-3-3 may be part of the cellular machinery that maintains cell survival, and targeting 14-3-3-ligand interactions may be a useful strategy to enhance the efficacy of conventional anticancer agents.

Pharmacological differences between immunoisolated native brain and heterologously expressed rat alpha4beta2 nicotinic receptors

Native brain and heterologously expressed rat alpha4beta2 nicotinic receptors (in Xenopus oocytes and CV-1 cells) were immunoisolated with the anti-alpha4 antibody mAb 299 and their pharmacological properties were compared using [3H](+/-)epibatidine, the novel N-alkylnicotinium analog N-n-octylnicotinium iodide (NONI), and the ganglionic antagonist trimethaphan (TRM). The equilibrium dissociation constant (K(d)) for [3H](+/-)epibatidine binding to the native and heterologously expressed receptors ranged from 13 to 21 pM. The Hill coefficients for [3H](+/-)epibatidine binding to the native and expressed receptors ranged from 0.8 to 1.1 and were consistent with a single high-affinity site. NONI inhibited 30 pM [3H](+/-)epibatidine binding to the native and expressed receptors with similar potency (IC(50) values of 6-7 microM). However, [3H](+/-)epibatidine dissociated 2-3 times more slowly from the native, than from the expressed receptors and TRM inhibited 30 pM [3H](+/-)epibatidine binding to the native receptors (IC(50) value of 330 microM) less potently than it did to the receptors expressed in oocytes (IC(50) value of 16 microM) or CV-1 cells (IC(50) value of 55 microM). The differences between the native and expressed [3H](+/-)epibatidine dissociation rate constants and IC(50) values for TRM were significant for both host cell types, although the values for the CV-1-expressed receptors were closer to the native ones than were those for the oocyte-expressed receptors. Thus, the epibatidine and trimethaphan binding sites in native and expressed alpha4beta2 receptors appear to have significantly different structural or chemical properties.

Superficial fungal infections in adolescence

Cutaneous fungal infections occur frequently in the adolescent population, and are second only to acne in generating skin-related adolescent anguish. Though superficial fungal infections of the skin are rarely life-threatening, they can cause significant worrisome cutaneous findings (e.g., white spots from pityriasis versicolor, distorted nails from onychomycosis). Such changes are particularly threatening to an adolescent who wants to be just like everybody else. This article focuses on several of the more common cutaneous fungal infections in adolescence, including pityrosporum (tinea) versicolor and dermatophyte infections of the feet, groin, skin, and nails. The prevalence of each disease is discussed, along with its clinical presentation, differential diagnosis, and methods of treatment.

Potentiation of beta-folding of beta-amyloid peptide 25-35 by aluminum salts

The formation of the beta pleated configuration of the amyloid peptide fragment 25-35 in aqueous solution, has been studied using thioflavin-T fluorescence as an indicator of such folding. Both phosphate and adenosine triphosphate (ATP) enhance the formation of aggregated beta-sheets. This phosphate-induced aggregation is greater in the presence of aluminum sulfate in a dose dependent manner. In the absence of ATP or phosphate, aluminum salts do not promote aggregation. It is proposed that a particulate aluminum phosphate complex may form critical nuclei upon whose surface the amyloid peptide can change its configuration. This capacity for seeding may be a relevant factor in the formation of insoluble proteinaceous materials such as amyloid plaques and neurofibrillary tangles found in Alzheimer's disease.

Structure-activity relationships of the Kvbeta1 inactivation domain and its putative receptor probed using peptide analogs of voltage-gated potassium channel alpha- and beta-subunits

Certain beta-subunits exert profound effects on the kinetics of voltage-gated (Kv) potassium channel inactivation through an interaction between the amino-terminal "inactivation domain" of the beta-subunit and a "receptor" located at or near the cytoplasmic mouth of the channel pore. Here we used a bacterial random peptide library to examine the structural requirements for this interaction. To identify peptides that bind Kv1.1 we screened the library against a synthetic peptide corresponding to the predicted S4-S5 cytoplasmic loop of the Kv1.1 alpha-subunit (residues 313-328). Among the highest affinity interactors were peptides with significant homology to the amino terminus of Kvbeta1. We performed a second screen using a peptide from the amino terminus of Kvbeta1 (residues 2-31) as "bait" and identified peptide sequences with significant homology to the S4-S5 loop of Kv1.1. A series of synthetic peptides containing mutations of the wild-type Kvbeta1 and Kv1.1 sequences were examined for their ability to inhibit Kvbeta1/Kv1.1 binding. Amino acids Arg20 and Leu21 in Kvbeta1 and residues Arg324 and Leu328 in Kv1.1 were found to be important for the interaction. Taken together, these data provide support for the contention that the S4-S5 loop of the Kv1.1 alpha subunit is the likely acceptor for the Kvbeta1 inactivation domain and provide information about residues that may underlie the protein-protein interactions responsible for beta-subunit mediated Kv channel inactivation.

Late operating room starts: experience with an education trial

PURPOSE

This study was undertaken to determine if late starts of first cases in the Operating theatres at the SMBD-Jewish General Hospital remained a problem after identification of the causes of late starts and remedial actions being taken.

METHODS

Hospital approval was obtained. A retrospective chart audit analyzed a two week period (10 days with 90 elective surgical cases) in October 1993. The time of entry by the first patient into each Operating Room (OR) was transcribed from the nursing records from each OR. A late start was defined as patient entry into the OR after 0745 hr. This audit revealed 77.8% of patients scheduled' for surgery at 0745 entered the OR late with a cumulative time lost of 1101 min. The reasons for this inefficiency were identified by a follow-up assessment in April 1995 as a result of this audit. Corrective measures included presentation of inpatients for the first case, reorganization of transport personnel schedules to facilitate arrival of patients to the OR, alteration of patient verification procedures prior to entry to the OR, and education of nursing, anaesthesia, and surgical personnel of the scope of the problem of late OR starts. All attending surgeons were notified either by letter or by discussion at departmental rounds. These measures were in effect by July 1995. A second audit, using the same methodology as the first, evaluated a two week period (10 days with 87 elective surgical cases) in October 1995.

RESULTS

The second audit showed 65.5% of patients (average of 9 operating rooms daily) scheduled for surgery at 0745 entered the OR late with 601 min lost. The average delay for late starting cases decreased from 15.73 +/- 4.56 to 10.54 +/- 3.92 min (P < 0.05).

CONCLUSION

Late OR starts are common and only modest improvements can be achieved without cooperation from anaesthetists and surgeons to arrive on time.

Chemical induction of fenestrae in vessels of the blood-brain barrier

The endothelium responsible for the blood-brain barrier to hydrophilic solutes has been converted here, by chemical means, to the fenestrated, permeable type of vessel (FV). During development, some brain vessels are reported to be transiently fenestrated. Endothelial fenestrae of adrenal glands are known to be reinduced in vitro by retinoic acid (RA) or phorbol myristate acetate (PMA). Could fenestrae be likewise reinduced in brain barrier vessels? When RA or PMA were infused continuously by an osmotic pump for 28 days into the cerebral cortex of rats, some brain vessels in the lesion cavity created by the reagents were FV. There were no FV in adjacent brain. When 100 microM RA was infused, about 20% of vessels in the cyst were FV, as were about 29% after infusion of 150 ng/ml PMA. Fenestra development depended on concentration and time. Reversibility of fenestra formation was complete at 1-2 months after delivery of RA or PMA had ceased. It is proposed that the RA and PMA effect is mediated by the plasminogen activator urokinase, in as much as both RA and PMA stimulate its production. This notion is supported by preliminary experiments in which urokinase infusion into brain also produced fenestrae. It is further suggested that the reversible induction of fenestrae in the mature brain by RA, PMA, and, perhaps, a variety of other conversion factors may be confined to a subset of brain barrier vessels that must be regenerating and of the kind that were temporarily fenestrated during fetal life.