Systemic inflammation and the risk of depression in people with type 2 diabetes

Background

Depression is a common co-morbidity in diabetes. The mechanisms underlying the association between depression and diabetes are poorly understood. Although risk factors, such as poor lifestyle behaviours, obesity, and stress have been identified, emerging evidence suggests that systemic inflammation may play an important role in the pathogenesis and recurrence of depression in people with diabetes. The aim of the present study was to evaluate if the inflammatory marker C-reactive protein (CRP) is associated with an increased risk of major depression episodes in people with type 2 diabetes.

Methods

A prospective, community-based study was conducted in Quebec, Canada. Individuals were recruited from the CARTaGENE (CaG) cohort, a population-based survey of Quebec residents aged 40 to 69 years. Our sample included 719 individuals with type 2 diabetes and 1423 individuals without diabetes. Individuals were assessed at baseline and 5 years after baseline. Major depression disorders were assessed using a clinical interview (CIDI). Inflammatory markers were assessed from blood samples. Elevated CRP levels were defined as ≥ 3 mg/L.

Results

Participants with both diabetes and elevated CRP levels had the highest risk of major depressive episodes (adjusted OR = 1.90, 95% CI 1.45, 2.50), compared to those without diabetes and without elevated CRP levels. The risk of major depressive episodes in individuals with diabetes without elevated CRP episodes was lower (adjusted OR = 1.21, 95% CI 0.85, 1.73) and similar to the risk of those without diabetes and elevated CRP levels (adjusted OR = 1.15, 95% CI 0.94, 1.39).

Discussion

The study highlights the interaction between diabetes, inflammatory makers, and depression in a community sample. Early identification, monitoring, and management of elevated inflammation levels might be an important depression prevention strategy in people with type 2 diabetes.

MEDB-57.GNAS inactivation as a driver for sonic hedgehog-activated medulloblastoma

INTRODUCTION: Sonic hedgehog (SHH)-activated medulloblastoma is one of the four consensus molecular subgroups of medulloblastoma and is typically associated with PTCH1, SUFU, and/or SMO mutations. GNAS inactivating mutations are a less commonly recognized tumorigenic driver for SHH pathway activation.

CASE PRESENTATION: We report the case of an 11-month-old male who presented with a large posterior fossa mass, cerebellar tonsillar herniation, and obstructive hydrocephalus. Following a successful gross total resection, pathology was consistent with desmoplastic/nodular medulloblastoma. Tumor molecular profiling using a DNA-based, next-generation sequencing platform detected a pathogenic frameshift mutation in the GNAS gene (p.D189Mfs*14, NM_000516.4:c.565_568del) at a variant allele frequency of 81%, suggestive of biallelic GNAS inactivation. The same mutation was detected from a buccal swab sample, confirming germline GNAS inactivation. Whole genome methylation profiling was consistent with medulloblastoma subclass SHH B (infant). Concurrent with this brain tumor evaluation, a skin biopsy was performed of scattered subcutaneous, plate-like nodules distributed over the patient’s back and extremities. This revealed metaplastic-appearing cancellous bone within the dermis and subcutaneous tissue consistent with plate-like osteoma cutis. He was treated with high-dose chemotherapy followed by autologous stem cell rescue and remains disease-free 15 months from diagnosis.

DISCUSSION: There have been scattered case reports describing germline loss-of-function GNAS mutations acting as tumorigenic drivers of SHH medulloblastoma. However, GNAS alterations are not covered by most standard diagnostic molecular sequencing panels for medulloblastoma. Other phenotypic manifestations of germline inactivating GNAS mutations include pseudohypoparathyroidism, pseudopseudohypoparathyroidism, progressive osseous heteroplasia, and osteoma cutis.

CONCLUSION: Knowledge of the possible association between germline GNAS inactivating mutations and the development of childhood SHH-activated medulloblastoma is essential for prompt diagnosis and treatment initiation. As such, consideration should be given for inclusion of GNAS alterations in diagnostic medulloblastoma sequencing panels, especially in the setting of osteoma cutis or other endocrinopathies.

Diagnostic and Prognostic Implications of GNAS Inactivation in Sonic Hedgehog-Activated Medulloblastoma: Case Report with Comprehensive Molecular Profiling and Review of Literature

SHH medulloblastoma from GNAS mutation (molecular profiling confirmation) with osteoma cutis & syndromic features.

VIII. On the movements of the flame in the explosion of gases

(1.) On the Rate of Movement of the Flam, and the produced in theExplosion of Gases. Humphry Davy was the first to observe the rate at which an explosion of gases was propagated in a tube, and he also made the first rough experiment on the tem­perature reached in an explosion. When gas from the distillation of coal (which he found more inflammable than fire-damp) was mixed with eight times its volume ofair, and was fired in a glass tube 1 foot long and 1/4 inch in diameter, the flame took more than a second to traverse the tube. When cyanogen mixed with twice its volume of oxygen was fired in a bent tube over water, the quantity of water displaced showed that the gases had expanded fifteen times their original bulk. Bunsen, in 1867, made the first careful measurement of the rate at which an explosion is propagated in gases, and he also made the first systematic researches on the pressure and temperature produced by the explosion of gases in closed vessels. His results led him to the remarkable conclusion that there was a discontinuous combustion in explosions. When electrolytic gas, or when carbonic oxide with haltits volume of oxygen, is fired, only one-third of the mixture is burnt, according to Bunsen, raising the temperature of the whole to about 3000° C. No further chemical action then occurs until the gaseous mixture falls, by cooling, below 2500° C. Then a further combustion begins, and so on<italic>per Saltum</italic>. These deductions were criticised by Berthelot, who pointed out that they assumed the constancy of the specific heats of steam and of carbonic acid at high temperatures.

The feasibility of using the EQ-5D-3L with adults with mild to moderate learning disabilities within a randomized control trial: a qualitative evaluation

Background

In trials incorporating a health economic evaluation component, reliable validated measures for health-related quality of life (HRQOL) are essential. The EQ-5D is the preferred measure for cost-effectiveness analysis in UK trials. This paper presents a qualitative evaluation of the use of the EQ-5D-3L in a feasibility randomised control trial with participants who had a mild- to  moderate learning disability and type 2 diabetes.

Methods

Researchers administered the EQ-5D-3L to 82 participants at baseline and 77 at follow-up. After each interview, researchers rated the ease of administering the EQ-5D-3L and made free-text entries on the administration experience. For a subset of 16 interviews, researchers audio-recorded more detailed journal entries. Ease of administration data were analysed using descriptive statistics. Free-text responses were subject to a basic content analysis. The EQ-5D-3L-related journal entries were transcribed, coded and analysed thematically.

Results

Over half of participants were perceived to experience difficulty answering some or all of the items in the EQ-5D-3L (60% at baseline; 54% at follow-up). Analysis of the free-text entries and audio journals identified four themes that question the use of the EQ-5D-3L in this population. The first theme is related to observations of participant intellectual ability and difficulties, for example, in understanding the wording of the measure. Theme 2 is related to the normalisation of adjustments for impairments, which rendered the measure less sensitive in this population. Theme 3 is related to researcher adaptation and non-standard administration. An overarching fourth theme was identified in that people with learning disabilities were viewed as ‘unreliable witnesses’ by both researchers and supporters.

Conclusions

It is recommended that the EQ-5D-3L should not be used in isolation to assess health-related quality of life outcomes in trials research in adults with a learning disability. Further research is required to develop and evaluate a version of the EQ-5D appropriate for this population in trials research. It is unrealistic to expect that adjustments to the wording alone will deliver an appropriate measure: supporter or researcher involvement will almost always be required. This requirement needs to be factored into the development and administration guidelines of any new version of the EQ-5D for adults with a learning disability.

Trial registration

Current Controlled Trials ISRCTN41897033 [registered 21 January 2013].

Electronic supplementary material

The online version of this article (10.1186/s40814-018-0357-6) contains supplementary material, which is available to authorized users.

The projected effect on insects, vertebrates, and plants of limiting global warming to 1.5°C rather than 2°C

In the Paris Agreement on Climate Change, the United Nations is pursuing efforts to limit global warming to 1.5°C, whereas earlier aspirations focused on a 2°C limit. With current pledges, corresponding to ~3.2°C warming, climatically determined geographic range losses of >50% are projected in ~49% of insects, 44% of plants, and 26% of vertebrates. At 2°C, this falls to 18% of insects, 16% of plants, and 8% of vertebrates and at 1.5°C, to 6% of insects, 8% of plants, and 4% of vertebrates. When warming is limited to 1.5°C as compared with 2°C, numbers of species projected to lose >50% of their range are reduced by ~66% in insects and by ~50% in plants and vertebrates.

Fibroblast-fibronectin patterning and network formation in 3D fibrin matrices

PURPOSE

We previously reported that fibroblasts migrating within 3-D collagen matrices move independently, whereas fibroblasts within 3-D fibrin matrices form an interconnected network. Similar networks have been identified previously during in vivo corneal wound healing. In this study, we investigate the role of fibronectin in mediating this mechanism of collective cell spreading, migration and patterning.

METHODS

To assess cell spreading, corneal fibroblasts were plated within fibrillar collagen or fibrin matrices. To assess migration, compacted cell-populated collagen matrices were nested inside cell-free fibrin matrices. Constructs were cultured in serum-free media containing PDGF, with or without RGD peptide, anti-α5 or anti-fibronectin blocking antibodies. In some experiments, LifeAct and fluorescent fibronectin were used to allow dynamic assessment of cell-induced fibronectin reorganization. 3-D and 4-D imaging were used to assess cell mechanical behavior, connectivity, F-actin, α5 integrin and fibronectin organization.

RESULTS

Corneal fibroblasts within 3-D fibrin matrices formed an interconnected network that was lined with cell-secreted fibronectin. Live cell imaging demonstrated that fibronectin tracks were formed at the leading edge of spreading and migrating cells. Furthermore, fibroblasts preferentially migrated through fibronectin tracks laid down by other cells. Interfering with cell-fibronectin binding with RGD, anti α5 integrin or anti fibronectin antibodies inhibited cell spreading and migration through fibrin, but did not affect cell behavior in collagen.

CONCLUSIONS

In this study, a novel mode of cell patterning was identified in which corneal fibroblasts secrete and attach to fibronectin via α5β1 integrin to facilitate spreading and migration within 3-D fibrin matrices, resulting in the formation of localized fibronectin tracks. Other cells use these fibronectin tracks as conduits, resulting in an interconnected cell-fibronectin network.

Quantification of elemental and organic carbon in atmospheric particulate matter using color space sensing-hue, saturation, and value (HSV) coordinates

A fast and cost effective application of color sensing was used to quantify color coordinates of atmospheric particulate matter collected on filters to quantify elemental and organic carbon (EC/OC) loading. This is a unique and novel approach for estimating OC composition. The method used a colorimeter and digital photography to obtain XYZ color space values and mathematically transformed them to HSV cylindrical-coordinates; a quantification method was applied to estimate the NIOSH and IMPROVE (TOR) EC/OC loadings from a set of globally diverse PM samples. When applied to 315 samples collected at three US EPA Chemical Speciation Network (CSN) sampling sites, the HSV model proved to be a robust method for EC measurement with an R(2)=0.917 for predicted versus measured loading results and a CV(RMSE)=16.1%. The OC quantified from the same sample filters had an R(2)=0.671 and a CV(RMSE)=24.8% between the predicted and measured results. The method was applied to NIOSH EC/OC results from a set of samples from rural China, Bagdad, and the San Joaquin Valley, CA, and the EC and OC CV(RMSE) were 30.8% and 49.3%, respectively. Additionally, the method was applied to samples with color quantified by a digital photographic image (DPI) with EC results showing good agreement with a CV(RMSE) of 22.6%. OC concentrations were not captured as accurately with the DPI method, with a CV(RMSE) of 77.5%. The method's low analytical cost makes it a valuable tool for estimating EC/OC exposure in developing regions and for large scale monitoring campaigns.

Reductions in indoor black carbon concentrations from improved biomass stoves in rural India

Deployment of improved biomass burning cookstoves is recognized as a black carbon (BC) mitigation measure that has the potential to achieve health benefits and climate cobenefits. Yet, few field based studies document BC concentration reductions (and resulting human exposure) resulting from improved stove usage. In this paper, data are presented from 277 real-world cooking sessions collected during two field studies to document the impacts on indoor BC concentrations inside village kitchens as a result of switching from traditional stoves to improved forced draft (FD) stoves. Data collection utilized new low-cost cellphone methods to monitor BC, cooking duration, and fuel consumption. A cross sectional study recorded a reduction of 36% in BC during cooking sessions. An independent paired sample study demonstrated a statistically significant reduction of 40% in 24 h BC concentrations when traditional stoves were replaced with FD stoves. Reductions observed in these field studies differ from emission factor reductions (up to 99%) observed under controlled conditions in laboratory studies. Other nonstove sources (e.g., kerosene lamps, ambient concentrations) likely offset the reductions. Health exposure studies should utilize reductions determined by field measurements inside village kitchens, in conjunction with laboratory data, to assess the health impacts of new cooking technologies.

The Role of Thrombin and Cell Contractility in Regulating Clustering and Collective Migration of Corneal Fibroblasts in Different ECM Environments

PURPOSE

We previously reported that extracellular matrix composition (fibrin versus collagen) modulates the pattern of corneal fibroblast spreading and migration in 3-D culture. In this study, we investigate the role of thrombin and cell contractility in mediating these differences in cell behavior.

METHODS

To assess cell spreading, corneal fibroblasts were plated on top of fibrillar collagen and fibrin matrices. To assess 3-dimensional cell migration, compacted collagen matrices seeded with corneal fibroblasts were embedded inside acellular collagen or fibrin matrices. Constructs were cultured in serum-free media containing platelet-derived growth factor (PDGF), with or without thrombin, the Rho kinase inhibitor Y-27632, and/or the myosin II inhibitor blebbistatin. We used 3-dimensional and 4-dimensional imaging to assess cell mechanical behavior, connectivity and cytoskeletal organization.

RESULTS

Thrombin stimulated increased contractility of corneal fibroblasts. Thrombin also induced Rho kinase-dependent clustering of cells plated on top of compliant collagen matrices, but not on rigid substrates. In contrast, cells on fibrin matrices coalesced into clusters even when Rho kinase was inhibited. In nested matrices, cells always migrated independently through collagen, even in the presence of thrombin. In contrast, cells migrating into fibrin formed an interconnected network. Both Y-27632 and blebbistatin reduced the migration rate in fibrin, but cells continued to migrate collectively.

CONCLUSIONS

The results suggest that while thrombin-induced actomyosin contraction can induce clustering of fibroblasts plated on top of compliant collagen matrices, it does not induce collective cell migration inside 3-D collagen constructs. Furthermore, increased contractility is not required for clustering or collective migration of corneal fibroblasts interacting with fibin.

TCF4 Triplet Repeat Expansion and Nuclear RNA Foci in Fuchs' Endothelial Corneal Dystrophy

PURPOSE

Expansion of the intronic CTG18.1 triplet repeat locus within TCF4 contributes significant risk to the development of Fuchs' endothelial corneal dystrophy (FECD) in Eurasian populations, but the mechanisms by which the expanded repeats result in degeneration of the endothelium have been hitherto unknown. The purpose of this study was to examine FECD endothelial samples for the presence of RNA nuclear foci, the hallmark of toxic RNA, as well as evidence of haploinsufficiency of TCF4.

METHODS

Using fluorescence in situ hybridization, we examined for the presence of nuclear RNA foci containing expanded CUG transcripts in corneal endothelial samples from FECD subjects with CTG18.1 expansion. We also examined for any changes in expression levels of TCF4 by quantitative real-time PCR.

RESULTS

Numerous discrete nuclear RNA foci were identified in endothelial samples of FECD subjects (n = 8) harboring the CTG18.1 expansion, but not in controls lacking the expansion (n = 5) (P = 7.8 × 10(-4)). Percentage of cells with foci in expansion-positive endothelial samples ranged from 33% to 88%. RNA foci were absent in endothelial samples from an FECD subject without CTG18.1 expansion and a subject with endothelial dysfunction without FECD. Expression of the constitutive TCF4 exon encoding the basic helix-loop-helix domain was unaltered with CTG18.1 expansion.

CONCLUSIONS

Our findings suggest that the RNA nuclear foci are pathognomonic for CTG18.1 expansion-mediated endothelial disease. The RNA nuclear foci have been previously found only in rare neurodegenerative disorders caused by repeat expansions. Our detection of abundant ribonuclear foci in FECD implicates a role for toxic RNA in this common disease.

Gastrocnemius flap reconstruction of soft-tissue defects following infected total knee replacement

A soft-tissue defect over an infected total knee replacement (TKR) presents a difficult technical problem that can be treated with a gastrocnemius flap, which is rotated over the defect during the first-stage of a revision procedure. This facilitates wound healing and the safe introduction of a prosthesis at the second stage. We describe the outcome at a mean follow-up of 4.5 years (1 to 10) in 24 patients with an infected TKR who underwent this procedure. A total of 22 (92%) eventually obtained a satisfactory result. The mean Knee Society score improved from 53 pre-operatively to 103 at the latest follow-up (p < 0.001). The mean Western Ontario and McMaster Universities osteoarthritis index and Short-Form 12 score also improved significantly (p < 0.001).

This form of treatment can be used reliably and safely to treat many of these complex cases where control of infection, retention of the components and acceptable functional recovery are the primary goals.

Cite this article: Bone Joint J 2013;95-B:1217–21.

Immunity through early development of coral larvae

As a determinant of survival, immunity is likely to be significant in enabling coral larvae to disperse and successfully recruit, however, whether reef-building coral larvae have immune defenses is unknown. We investigated the potential presence and variation in immunity in the lecithotrophic larvae of Acropora tenuis through larval development. Enzymes indicative of tyrosinase and laccase-type melanin-synthesis were quantified, and the concentration of three coral fluorescent proteins was measured over six developmental stages; egg, embryo, motile planula, planula post-exposure to crustose coralline algae (CCA; settlement cue), settled, settled post-exposure to Symbiodinium (endosymbiont). Both types of melanin-synthesis pathways and the three fluorescent proteins were present in A. tenuis throughout development. Laccase-type activity and red fluorescence increased following exposure of planula to CCA, whereas tyrosinase-type activity and cyan fluorescence increased following settlement. No change was detected in the measured parameters following exposure to Symbiodinium. This study is the first to document coral larval immune responses and suggests the melanin-synthesis pathways have disparate roles-the laccase-type potentially non-immunological and the tyrosinase-type in cytotoxic defense. Our results indicate that corals have the potential to resist infection from the earliest life history phase.

Hip anatomy and ontogeny of lower limb musculature in three species of nonhuman primates

The hip region is examined to determine what aspects of musculoskeletal anatomy are precociously developed in primate species with highly specialized modes of locomotion. Muscles of the hind limb were removed and weighed in each specimen, and the hip joint of selected specimens was studied in stained serial sections. No perinatal differences among species are evident, but in adults, the hip joint of Galago moholi (a leaping specialist) appears to have proportionally thick articular cartilage (relative to the subchondral plate) compared to two species of cheirogaleids. Muscle mass distribution in the hind limbs confirms previous observations that the quadriceps femoris muscle is especially large in Galago (in percent mass of the entire hind limb), while the hip region is smaller compared to the more quadrupedal cheirogaleids. Across age groups, the species with the least specialized locomotion as adults, Cheirogaleus medius, shows little or no change in proximal to distal percentage distribution of muscle mass. Galago has a larger percentage mass gain in the thigh. We suggest that muscle mass gain to specific limb segments may be a critical milestone for primates with extremely specialized modes of locomotion.

On the fringes of conquest: maya-spanish contact in colonial belize

The defeat of the Aztecs of Mexico by Hernán Cortés in 1521 was but the beginning of a long and torturous conquest of Central America that did not always result in the mastery of people and production for which the Spanish had hoped. The Maya of the resource-poor Yucatán peninsula were spared the heavy colonial hand that held fast to central Mexico and its riches. In addition, the dense forests of the peninsula served as a haven for refugees fleeing oppressive conditions in colonial towns. Despite the paucity of documentary information on Maya communities of the frontier, knowledge of Maya-Spanish relations in the 16th and 17th centuries has advanced in recent years through archeological and ethnohistorical research. Work in one region of the Maya lowlands has brought us closer to an understanding of the early interaction of the rulers and the ruled.

A case of aspergillus endophthalmitis in an immuncompetent woman: intra-ocular penetration of oral voriconazole: a case report

Background

There are very few reports of Aspergillus fumigatus causing endogenous endophthalmitis (EAE) in immunocompetent individuals although it is well recognised in the immunocompromised. Treatment can be with intravitreal, intravenous and oral antifungal agents. The benefit of an oral agent is clear however the concentration of voriconazole in the inflamed eye after oral administration has not previously been documented.

Case presentation

We present a case of EAE in an immunocompetent 78-year-old Caucasian female who was subsequently managed with oral voriconazole. Using a bioassay, we show an appropriate voriconazole concentration in serum and vitreous samples.

Conclusion

This case adds to the limited literature on the prevalence of endogenous endophthalmitis in immunocompetent patients and supports the use of voriconazole in such cases.

Development of homogeneous high-affinity agonist binding assays for 5-HT2 receptor subtypes

The serotonin (5-hydroxytryptamine) 5-HT2 receptor subfamily consists of three members, 5-HT2A, 5-HT2B, and 5-HT2C. These receptors share high homology in their amino acid sequence, have similar signaling pathways, and have been indicated to play important roles in feeding, anxiety, aggression, sexual behavior, mood, and pain. Subtype-selective agonists and antagonists have been explored as drugs for hypertension, Parkinson's disease, sleep disorders, anxiety, depression, schizophrenia, and obesity. In this study, we report the development of homogeneous agonist binding assays in a scintillation proximity assay (SPA) format to determine the high-affinity binding state of agonist compounds for the human 5-HT2C, 5-HT2A, and 5-HT2B receptors. The 5-HT2 agonist 1-(4- [125I]iodo-2,5-dimethoxyphenyl)-2-aminopropane ([125I]DOI) was used to label the high-affinity sites for the 5-HT2A and 5-HT2C receptors. The high-affinity sites for the 5-HT2B receptor were labeled with [3H]lysergic acid diethylamide. Total receptor expression was determined with the 5-HT2 antagonist [3H]mesulergine for the 5-HT2B and 5-HT2C receptors, and [3H]ketanserin for the 5-HT2A receptor. The agonist high-affinity binding sites accounted for 2.3% (5-HT(2C) receptor), 4.0% (5-HT2A receptor), and 22% (5-HT2B receptor) of the total receptor population. Competition binding studies using known agonists indicated high Z' values of the agonist binding assays in SPA format (Z' > 0.70). The Ki values of 5-HT, (R)(-)DOI, and VER-3323 for the 5-HT2A, 5-HT2B, and 5-HT2C receptors by SPA format were equivalent to published data determined by filtration binding assays. These results indicate that agonist binding assays in SPA format can be easily adapted to a high throughput assay to screen for selective 5-HT2C receptor agonists, as well as for selectivity profiling of the compounds.

Dopaminergic dysfunction in unrelated, asymptomatic carriers of a single parkin mutation

Parkin disease is usually autosomal recessive; however, two studies have shown that asymptomatic heterozygotes have nigrostriatal dysfunction and even manifest subtle extrapyramidal signs. The authors used 18F-dopa PET to study 13 asymptomatic parkin heterozygotes and found a significant reduction of (18)F-dopa uptake in caudate, putamen, ventral, and dorsal midbrain compared with control subjects. Four had subtle extrapyramidal signs. Parkin heterozygosity is a risk factor for nigrostriatal dysfunction and in some may contribute to late-onset Parkinson disease.

Acoustic streaming: a new technique for assessing adnexal cysts

OBJECTIVES

To determine whether acoustic streaming has clinical value in the differentiation between various ovarian and adnexal cysts.

METHODS

We assessed 29 adnexal cysts, for which pathological diagnosis was available, for the presence of acoustic streaming during B-mode and color sonographic evaluation.

RESULTS

Acoustic streaming was detected in 15 (52%) of the cysts. The most common cyst, endometrioma (n = 7), did not exhibit acoustic streaming in any case, while of the remaining 22 cysts, 15 exhibited acoustic streaming (P = 0.0017). Dermoid cysts exhibited acoustic streaming in two of six (33%) cases. In addition acoustic streaming was noted in two of two (100%) hemorrhagic cysts, eight of ten (80%) cystadenomas, two of three (67%) malignant cysts and in the one abscess.

CONCLUSIONS

Acoustic streaming is the first sonographic feature that may be able to completely exclude endometrioma as a possible diagnosis for an adnexal cyst.