Interaction between the promoter MUC5B polymorphism and mucin expression: is there a difference according to ILD subtype?

The MUC5B promoter variant rs35705950 is associated with idiopathic pulmonary fibrosis (IPF). MUC5B glycoprotein is overexpressed in IPF lungs. We examined immunohistochemical expression of MUC5B in different interstitial lung disease patterns according to rs35705950 T-allele carriage. We observed increased expression of MUC5B in T-allele carriers in both distal airways and honeycomb cysts in patients with IPF (n=23), but no difference in MUC5B expression according to T-carrier status in the distal airways of patients with idiopathic non-specific interstitial pneumonitis (n=17), in scleroderma-associated non-specific interstitial pneumonitis (n=15) or in control lungs (n=20), suggesting that tissue overexpression in MUC5B rs35705950 T-carriers is specific to IPF.

Autoinflammatory gene polymorphisms and susceptibility to UK juvenile idiopathic arthritis

BACKGROUND

To investigate the autoinflammatory hereditary periodic fever syndrome genes MVK and TNFRSF1A, and the NLRP1 and IL1 genes, for association with juvenile idiopathic arthritis (JIA).

METHODS

For MVK, TNFRSF1A and NLRP1 pair-wise tagging SNPs across each gene were selected and for IL1A SNPs from a prior meta-analysis were included. 1054 UK Caucasian JIA patients were genotyped by Sequenom iPlex MassARRAY and allele and genotype frequencies compared with 5380 unrelated healthy UK Caucasian controls.

RESULTS

Four SNPs were significantly associated with UK JIA: rs2071374 within intron 4 of IL1A (ptrend=0.006), rs2228576 3' of TNFRSF1A (ptrend=0.009) and 2 SNPs, rs11836136 and rs7957619, within MVK (ptrend=0.006, ptrend=0.005 respectively). In all cases the association appeared to be driven by the systemic-onset JIA (SoJIA) subtype. Genotype data for the two MVK SNPs was available in a validation cohort of 814 JIA (oligoarticular and RF negative polyarticular) cases and 3058 controls from the US. Replication was not confirmed, however, further suggesting that this association is specific to SoJIA.

CONCLUSIONS

These findings extend the observations of the relevance of studying monogenic loci as candidates for complex diseases. We provide novel evidence of association of MVK and TNFRSF1A with UK JIA, specifically driven by association with SoJIA and further confirm that the IL1A SNP association with SoJIA is subtype specific. Replication is required in independent cohorts.

Mucin 5B promoter polymorphism is associated with idiopathic pulmonary fibrosis but not with development of lung fibrosis in systemic sclerosis or sarcoidosis

BACKGROUND

A polymorphism (rs35705950) 3 kb upstream of MUC5B, the gene encoding Mucin 5 subtype B, has been shown to be associated with familial and sporadic idiopathic pulmonary fibrosis (IPF). We set out to verify whether this variant is also a risk factor for fibrotic lung disease in other settings and to confirm the published findings in a UK Caucasian IPF population.

METHODS

Caucasian UK healthy controls (n=416) and patients with IPF (n=110), sarcoidosis (n=180) and systemic sclerosis (SSc) (n=440) were genotyped to test for association. The SSc and sarcoidosis cohorts were subdivided according to the presence or absence of fibrotic lung disease. To assess correlation with disease progression, time to decline in forced vital capacity and/or lung carbon monoxide transfer factor was used in the IPF and SSc groups, while a persistent decline at 4 years since baseline was evaluated in patients with sarcoidosis.

RESULTS

A significant association of the MUC5B promoter single nucleotide polymorphism with IPF (p=2.04 × 10(-17); OR 4.90, 95% CI 3.42 to 7.03) was confirmed in this UK population. The MUC5B variant was not a risk factor for lung fibrosis in patients with SSc or sarcoidosis and did not predict more rapidly progressive lung disease in any of the groups. Rather, a trend for a longer time to decline in forced vital capacity was observed in patients with IPF.

CONCLUSIONS

We confirm the MUC5B variant association with IPF. We did not observe an association with lung fibrosis in the context of SSc or sarcoidosis, potentially highlighting fundamental differences in genetic susceptibility, although the limited subgroup numbers do not allow a definitive exclusion of an association.

Free Interleukin (IL)-18 levels, and the impact of IL18 and IL18BP genetic variation, in CHD patients and healthy men

OBJECTIVE

To investigate free interleukin-18 (fIL-18) levels, and variation within the IL-18 system genes, in heart surgery patients, and healthy men.

METHODS AND RESULTS

fIL-18 was calculated from IL-18 and IL-18 binding protein (BP) levels, in 421 healthy men and 196 post-coronary artery bypass graft (CABG) patients. After surgery, fIL-18 peaked at 6 hours (from 117 to 331 pg/mL) but fell to below presurgery levels at 24 hours (99 pg/mL), because of changes in total IL-18 and IL-18BP. fIL-18 24 hours postsurgery was significantly higher in those who suffered a major complication after surgery (125 versus 80 pg/mL, P<0.01). Baseline total IL-18 was also higher in healthy men who went on to suffer an MI over 17 years of prospective study (276 versus 240 pg/mL, P=0.01). Tagging SNPs for IL18 (n=5) and IL18BP (n=3) were determined, in both studies the IL18 HapIII haplotype (frequency 30%) was associated with 36% lower baseline fIL-18 levels before surgery (P<0.01), and 7% lower in healthy men (P=0.04). The frequency of HapIII was lower in CABG patients than in healthy men (20.7 versus 29.8%, P<0.01).

CONCLUSIONS

IL-18 levels, which are determined in part by variation in IL18, play a role in CHD development and postsurgery outcome.

A polymorphism in the CTGF promoter region associated with systemic sclerosis

BACKGROUND

Systemic sclerosis (scleroderma) is a life-threatening autoimmune disease that is characterized by the presence of specific autoantibodies and fibrosis of the skin and major internal organs.

METHODS

We genotyped a polymorphism (G-945C) in the promoter of the connective-tissue growth factor (CTGF) gene in 1000 subjects in two groups: group 1, consisting of 200 patients with systemic sclerosis and 188 control subjects; and group 2, consisting of 300 patients with systemic sclerosis and 312 control subjects. The combined groups represented an estimated 10% of patients with systemic sclerosis in the United Kingdom. We tested the effect of the polymorphism on the transcription of CTGF.

RESULTS

The GG genotype was significantly more common in patients with systemic sclerosis than in control subjects in both groups, with an odds ratio for the combined group of 2.2 (95% confidence interval [CI], 1.5 to 3.2; P<0.001 for trend). Analysis of the combined group of patients with systemic sclerosis showed a significant association between homozygosity for the G allele and the presence of anti-topoisomerase I antibodies (odds ratio, 3.3; 95% CI, 2.0 to 5.6; P<0.001) and fibrosing alveolitis (odds ratio, 3.1; 95% CI, 1.9 to 5.0; P<0.001). We observed that the substitution of cytosine for guanine created a binding site of the transcriptional regulators Sp1 and Sp3. The C allele has high affinity for Sp3 and is associated with severely reduced transcriptional activity. A chromatin immunoprecipitation assay showed a marked shift in the ratio of Sp1 to Sp3 binding at this region, demonstrating functional relevance in vivo.

CONCLUSIONS

The G-945C substitution represses CTGF transcription, and the -945G allele is significantly associated with susceptibility to systemic sclerosis.

ADAMTS-1 and -4 are up-regulated following transient middle cerebral artery occlusion in the rat and their expression is modulated by TNF in cultured astrocytes

ADAMTS (a disintegrin and metalloproteinase with thrombospondin motifs) enzymes are a recently described group of metalloproteinases. The substrates degraded by ADAMTS-1, -4 and -5 suggest that they play a role in turnover of extracellular matrix in the central nervous system (CNS). ADAMTS-1 is also known to exhibit anti-angiogenic activity. Their main endogenous inhibitor is tissue inhibitor of metalloproteinases (TIMP)-3. The present study was designed to investigate ADAMTS-1, -4 and -5 and TIMP-3 expression after experimental cerebral ischaemia and to examine whether cytokines known to be up-regulated in stroke could alter their expression by astrocytes in vitro. Focal cerebral ischaemia was induced by transient middle cerebral artery occlusion in the rat using the filament method. Our results demonstrate a significant increase in expression of ADAMTS-1 and -4 in the occluded hemisphere but no significant change in TIMP-3. This was accompanied by an increase in mRNA levels for interleukin (IL)-1beta, IL-1 receptor antagonist (IL-1ra) and tumour necrosis factor (TNF). ADAMTS-4 mRNA and protein were up-regulated by TNF in primary human astrocyte cultures. The increased ADAMTS-1 and -4 in experimental stroke, together with no change in TIMP-3, may promote ECM breakdown after stroke, enabling infiltration of inflammatory cells and contributing to brain injury. In vitro studies suggest that the in vivo modulation of ADAMTS-1 and -4 may be controlled in part by TNF.

In vitro cleaning ability of root canal irrigants with and without endosonics

A variety of methods have been used to evaluate the cleanliness of root canals after endodontic preparation and irrigation. Few irrigation agents other than sodium hypochlorite (NaOCl) have been tested in conjunction with endosonics. The purpose of this study was to examine the cleaning ability of water, NaOCl, Hibiscrub and a biological washing liquid when used as intracanal irrigants, with and without endosonics. Two methods of evaluation were employed to assess the root canal cleanliness after endodontic preparation. A total of 56 teeth, divided into eight groups, were prepared manually using the step-down technique. Each irrigating agent was used in two experimental groups, with and without endosonics. Two additional teeth which received neither instrumentation nor irrigation served as the controls. The teeth were split longitudinally and the state of cleanliness of the root canal was assessed by scoring the amount of stained organic debris and smear layer. It was demonstrated that the results of debris and smear layer scoring were significantly influenced by the type of irrigant and whether endosonics had been used. All agents exhibited similar cleaning ability when introduced manually. With endosonics, NaOCl yielded significantly less stainable debris (P < 0.05) than the other groups which showed no significant difference. The ability to remove the smear layer was enhanced, but at some distance short of the working length, by endosonics for all irrigants tested. None of the solutions tested was able to produce a canal wall that was free of smear layer.

A comparison in vitro of two ultrasonic root canal preparation techniques

Two ultrasonic techniques were compared for their ability to clean and shape root canals in extracted human teeth. One technique was recommended by the manufacturer (Cavi-Endo, Dentsply), while the other was a modification by the authors of the stepdown technique. Mesiobuccal root canals of molars were instrumented using these techniques, after which a silicone impression material was injected into the prepared canals. The roots were then split longitudinally and one half was stained for debris scoring while the silicone impressions were assessed for shape. The results showed that the modified technique produced significantly cleaner canals than the recommended technique. The shaping ability of both techniques was difficult to evaluate because of the complex morphology of molar root canals. The final shape of the prepared canal depended more on the initial shape than on the instrumentation technique.

Endodontics in the UK 1990: an overview

The first workshop on endodontics, in 1978, pointed out that the standard of endodontics in the United Kingdom was poor. The British Endodontic Society has subsequently attempted to improve the remuneration in the NHS by conducting and publishing a survey, and also establishing guidelines for minimum acceptable standards. Despite this, in the author's opinion, there has been no improvement. However, four ways of raising the standards of endodontics are proposed.

Organizing a postgraduate course

The running of a section 63 hands-on course on endodontics requires prior planning. Suggestions on how to plan such course include the design of the programme, the number of course members and instructors, requirements from the postgraduate centre, equipment and materials needed, travel and accommodation, and finally reimbursement.

Current status of the use of ultrasound in endodontics

Although endosonics has received much attention in the literature, it is not clear whether it is recommended. This review discusses the types of endosonic unit available, ultrasonic phenomena such as cavitation and acoustic streaming, irrigation, cutting dentine, and clinical techniques for cleaning and shaping. The more recent evidence suggests that endosonics provides an efficient method of debridement providing sodium hypochlorite is used, but is less efficient at shaping the walls of the canals. New methods of filing have been introduced by the manufacturers but they have not taken into account the most recent research; for this reason an alternative approach is described.

Safe use of codeine in the recovering alcoholic or addict

The effect that codeine has on the process of addiction and recovery is unclear. Confusion about definitions, study endpoints, and a lack of well-controlled clinical studies has led to this uncertainty. Codeine addiction is uncommon in people who do not have existing vulnerability to addiction, including alcoholism. Codeine use can sustain addiction or increase the risk of relapse in patients afflicted with addiction. The risk of relapse must be considered when treating conditions such as pain or cough in a person recovering from addiction. Codeine use may be circumvented with the appropriate use of alternative treatments for pain or cough. If codeine use becomes necessary, cautious prescribing and reliance on the patient's recovery support network become imperative.

Dentine-removing characteristics of an ultrasonically energized K-file

This in vitro study evaluated the pattern of dentine removal when an ultrasonically energized file (Cavi-Endo-size 25 file) was applied to flat surfaces of dentine under standardized conditions. The influences of power setting, interfacial force between file and dentine, direction of file oscillation and operator-assisted movement were examined. Impressions of the instrumented surfaces revealed characteristic patterns consisting of a series of oblique crests, each one parallel to the next and separated by a constant distance along the line of contact with the file. Determination of height, width and separation of these crests with a Reflex microscope aided objective assessment. The simplest pattern was formed when the energized file was held against the dentine (power setting = 1; interfacial force = 30 g). Increasing the power setting to 8 caused deeper troughs over the apical 5 mm. The width of the crests corresponded to the taper of the file except at the apical tip where the crests were relatively wider. However, increasing the interfacial force to 60 g reduced the efficiency of the apical part of the file. The superimposition of operator-induced movement greatly increased the extent of dentine removal, resulting in a tapering groove with a persistent crestal pattern. Oscillation of the file perpendicular to the dentine surface had a significantly greater influence on dentine removal, producing a deeper groove than was obtained with oscillation parallel to the surface. These findings may be of relevance in aiding controlled root canal preparation when using the Cavi-Endo instrument.

An in vitro comparison of ultrasonic and conventional methods of irrigant replacement

The effectiveness of irrigant replacement in fine canals was compared using three sizes of irrigating needle and an ultrasonic method. The results showed that irrigant replacement became progressively less effective towards the apex regardless of the method of irrigation or needle size. With conventional methods, irrigation performance varied with the size of needle and volume of irrigant. With the ultrasonic method results depended on irrigation time, but was independent of irrigant flow rate through the handpiece, the size of the canal or the file size.

An in vitro method for comparing the effects of different root canal preparation techniques on the shape of curved root canals

This study introduced an in vitro model which was designed to observe the effects of instrumentation on the shape of curved root canals. The model may be accurately rotated through 90 degrees allowing reproducible radiographs to be taken from two different angles. The root canals were filled with a radiopaque contrast medium before radiographs were taken. Two-dimensional evaluation of the shape of the root canals, before and after preparation was made on enlarged photographic prints obtained from the radiographs. A custom-made grid was used as a guide for measurement and accurate transfer from the pre- to postpreparation prints. Reproducibility of measurement was within 4 per cent. This method is feasible for quantitative comparison of the effect of instrumentation on the shape of root canals.

The effect of hand, sonic and ultrasonic instrumentation on the shape of curved root canals

This study compared the effects of hand, sonic and ultrasonic instrumentation on the shape of curved root canals in 60 extracted human lateral incisors and premolars. Each root of moderate or severe canal curvature was mounted onto a simulated crown and filled with a radiocontrast medium. Enlarged photographic prints obtained from radiographs taken before and after root canal preparation were measured. The results indicated a lower incidence of apical zip and elbow formation in the ultrasonic preparations when compared with those prepared by hand and sonic, irrespective of the canal curvature. A more prominent hour-glass shape was prepared by hand and sonic instruments particularly in severely curved root canals. A distinctive taper was produced by each method of preparation. All three instrumentation techniques showed preferential dentine removal from the convex aspect of the canal in the apical portion and the concave aspect in the middle portion of the root canal.

1977 annual meeting in Seattle

You are invited to Seattle for the 1977 Annual Meeting, its theme to be "Change, Comparison, and Controversy." Suggestions are made for activities in Seattle and the Pacific Northwest, including the cohost city, Vancouver, British Columbia.

An experimental cancer information service using AIM-TWX

The Pacific Northwest Regional Health Sciences Library and the Washington/Alaska Regional Medical Program jointly conducted a service to provide photocopies of articles on cancer topics within twenty-four hours after receiving telephone requests for information from Central Washington physicians. AIM-TWX was utilized as the initial source of references whenever possible, and its benefit as such was evaluated. In the three-month experimental period, twenty-seven requesters made fifty-six requests and received photocopies of 185 articles; the estimated total cost was $1,000, less than $18 per request.A sample of requests showed AIM-TWX to have reduced the total work time per search; moreover, when it was used, AIM-TWX retrieved more than 70% of the articles selected to be sent. Physician response indicated that the service was both needed and appreciated. Further investigation by a similar information service is suggested.