Anti-Yo paraneoplastic cerebellar degeneration in a patient with stage IV ovarian adenocarcinoma during bevacizumab maintenance therapy

Anti-Yo paraneoplastic cerebellar degeneration (PCD) is a rare autoimmune neurological syndrome characterised by cerebellar symptoms and frequently associated with gynaecological malignancies. While typically preceding the diagnosis of the malignancy, rarely it may present later in the disease course, heralding a recurrence prior to biochemical or radiological confirmation. Disease management is challenging and prognosis remains poor.We present the case of a woman with stage IV ovarian adenocarcinoma who developed anti-Yo PCD 16 months post malignancy diagnosis while receiving bevacizumab maintenance therapy. We review the literature and outline the difficulties in diagnosis and the frequently refractory nature of PCD to available treatments.

Technical note: Investigating the suitability of existing facilities for a new Lu-177 prostate-specific membrane antigen therapy program

BACKGROUND

¹⁷⁷ Lu prostate-specific membrane antigen (PSMA) therapy prolongs survival for some prostate cancer patients. To adopt this technique, institutions may need to evaluate the suitability of existing infrastructure.

PURPOSE

Develop a methodology to determine whether existing facilities can accommodate a ¹⁷⁷ Lu-PSMA therapy program.

METHODS

Room suitability is defined by both the ability to accommodate ¹⁷⁷ Lu-PSMA therapy workflow and to provide appropriate radiation shielding. Two methods of shielding calculation were performed: (1) National Council on Radiation Protection and Measurements report 151 (NCRP-151), with workload defined in terms of the activity of ¹⁷⁷ Lu administered, and (2) using the RadPro shielding calculator. This methodology was applied to ¹³¹ I therapy, PET-CT uptake, PET-SPECT injection, and orthovoltage therapy rooms.

RESULTS

¹³¹ I therapy rooms were found to meet both shielding and workflow requirements. The shielding was found to be adequate for orthovoltage and PET-SPECT facilities, neglecting patient transit between external washrooms. The workflow was the limiting factor for these rooms due to the requirement of dedicated washrooms that shield the patient and contain possible contamination. The PET-CT facility did not meet either criteria. The NCRP-151 method generally predicted a higher dose rate on the other side of shielding than did the RadPro calculator. The dose rate on the other side of concrete shielding as predicted by the NCRP-151 method increased relative to the dose rate predicted by the RadPro calculator as shielding thickness increased. For lead shielding, the dose rate predicted by the NCRP-151 method decreased relative to the result predicted by the RadPro calculator with increasing material thickness.

CONCLUSIONS

¹³¹ I therapy, PET-CT uptake, PET-SPECT injection, and orthovoltage therapy rooms were considered. The ¹³¹ I treatment rooms were the best candidate for ¹⁷⁷ Lu-PSMA therapy, due to their shielding and capability to accommodate the necessary workflow.

Endovascular treatment for vaccine-induced cerebral venous sinus thrombosis and thrombocytopenia following ChAdOx1 nCoV-19 vaccination: a report of three cases

BACKGROUND

Vaccine-induced thrombosis and thrombocytopenia (VITT) is a rare complication following ChAdOx1 nCoV-19 vaccination. Cerebral venous sinus thrombosis (CVST) is overrepresented in VITT and is often associated with multifocal venous thromboses, concomitant hemorrhage and poor outcomes. Hitherto, endovascular treatments have not been reviewed in VITT-related CVST.

METHODS

Patient records from a tertiary neurosciences center were reviewed to identify patients who had endovascular treatment for CVST in VITT.

RESULTS

Patient records from 1 January 2021 to 20 July 2021 identified three patients who underwent endovascular treatment for CVST in the context of VITT. All were female and the median age was 52 years. The location of the CVST was highly variable. Two-thirds of the patients had multifocal dural sinus thromboses (sigmoid, transverse, straight and superior sagittal) as well as internal jugular vein thromboses. Intracerebral hemorrhage occurred in all patients; subarachnoid blood was noted in two of them, and intraparenchymal hemorrhage occurred in all. There was one periprocedural parenchymal extravasation which abated on temporary cessation of anticoagulation. Outcome data revealed a 90-day modified Rankin Scale (mRS) score of 2 in all cases.

CONCLUSIONS

We demonstrate that endovascular treatment for VITT-associated CVST is feasible and can be safe in cases that deteriorate despite medical therapy. Extensive clot burden, concomitant hemorrhage, rapid clinical progression and persistent rises in intracranial pressure should initiate multidisciplinary team discussion for endovascular treatment in appropriate cases.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

Prognostic indicators and outcomes of hospitalised COVID-19 patients with neurological disease: An individual patient data meta-analysis

Background

Neurological COVID-19 disease has been reported widely, but published studies often lack information on neurological outcomes and prognostic risk factors. We aimed to describe the spectrum of neurological disease in hospitalised COVID-19 patients; characterise clinical outcomes; and investigate factors associated with a poor outcome.

Methods

We conducted an individual patient data (IPD) meta-analysis of hospitalised patients with neurological COVID-19 disease, using standard case definitions. We invited authors of studies from the first pandemic wave, plus clinicians in the Global COVID-Neuro Network with unpublished data, to contribute. We analysed features associated with poor outcome (moderate to severe disability or death, 3 to 6 on the modified Rankin Scale) using multivariable models.

Results

We included 83 studies (31 unpublished) providing IPD for 1979 patients with COVID-19 and acute new-onset neurological disease. Encephalopathy (978 [49%] patients) and cerebrovascular events (506 [26%]) were the most common diagnoses. Respiratory and systemic symptoms preceded neurological features in 93% of patients; one third developed neurological disease after hospital admission. A poor outcome was more common in patients with cerebrovascular events (76% [95% CI 67–82]), than encephalopathy (54% [42–65]). Intensive care use was high (38% [35–41]) overall, and also greater in the cerebrovascular patients. In the cerebrovascular, but not encephalopathic patients, risk factors for poor outcome included breathlessness on admission and elevated D-dimer. Overall, 30-day mortality was 30% [27–32]. The hazard of death was comparatively lower for patients in the WHO European region.

Interpretation

Neurological COVID-19 disease poses a considerable burden in terms of disease outcomes and use of hospital resources from prolonged intensive care and inpatient admission; preliminary data suggest these may differ according to WHO regions and country income levels. The different risk factors for encephalopathy and stroke suggest different disease mechanisms which may be amenable to intervention, especially in those who develop neurological symptoms after hospital admission.

097 An undisputed case of left hand weakness

Introduction

Neurogenic thoracic outlet syndrome (NTOS) is a rare and sometimes overlooked cause of upper limb pain, weakness and disability and presents to a range of different healthcare professionals. Here we present a case of severe NTOS with characteristic clinical, radiological and electroclinical findings.

History

A 16 year old right-handed female presented with a two year history of progressive symptoms affecting her left hand. Initially she noticed weakness affecting initially the 4thand 5thleft digits which progressed to involve the whole hand. She described a burning sensation affecting the medial aspect of her left forearm at night.

Examination

Examination of the left arm revealed decreased bulk of the thenar, hypothenar and inter- ossei intrinsic muscles of the hand, power diminished to grade 4 in the left ADM, APB, FDIO and to grade 4+ in left EDC, and altered sensation in the T1 dermatome.

Investigations

A lordotic chest radiograph revealed bilaterally elongated C7 transverse processes, a finding confirmed on retrospective review of the brachial plexus MRI, which also revealed bilateral grade 1 cervical ribs and increased signal on STIR sequence of the left C8 and T1 nerve roots. Nerve conduction studies revealed electroclinical evidence of a left lower trunk brachial plexopathy.

Outcome

The patients neuropathic pain responded to low dose gabapentin. She was assessed at the Peripheral Nerve Injuries Unit at RNOH Stanmore and recently underwent successful left thoracic outlet decompression.

hamish.morrison@nhs.net

Changes in symptoms, sleep, oxidative stress, and inflammatory markers among community-dwelling stroke survivors after a tai chi exercise intervention

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Laurence B. Emmons Research Award

Background

Depression is prevalent among one-third to two-thirds of stroke survivors. Despite the availability of pharmacotherapies and/or psychotherapies, depression persists, even 5-10 years post-stroke, reflecting limited treatment responses and/or adherence to this conventional care. Mind-body interventions are commonly used among adults to ameliorate depressive symptoms, thus we investigated the feasibility of Tai Chi, alongside conventional care, to manage post-stroke depression.

Purpose

Describe changes in symptoms of depression, anxiety and stress, sleep, oxidative stress, and inflammatory markers post-intervention among community-dwelling stroke survivors with depressive symptoms.

Methods

In this feasibility study, a single-group pre-post intervention design was used. Due to COVID-19, participants attended a 1-hour Tai Chi exercise class three times per week for 8 weeks, instead of the planned 12-weeks. Symptoms of depression, anxiety and stress were assessed using standardized questionnaires (Center for Epidemiological Studies Depression scale, CESD; Generalized Anxiety Disorder Assessment; Perceived Stress Scale), objective sleep was assessed via a research-grade triaxial accelerometer (ActiGraph GT9X), and blood samples were taken to assess oxidative stress (plasma superoxide dismutase, SOD)  and inflammatory markers (serum tumor necrosis factor-alpha, interleukin-6, interleukin-10). Pre-post intervention changes were assessed using paired t-tests.

Results

Community-dwelling stroke survivors (N = 11) on average 69.7 ± 9.3 years old, mainly retired (73%, n = 8), married men (55%, n = 6) with >13 years education (91%, n = 10), reporting depression symptoms (CESD = 17.3 ± 11.4) and 55% taking anti-depressant medications, enrolled. The majority of participants reported having an ischemic stroke (82%, n = 9) with hemiparesis (55%, n = 6), but were able to walk 15 feet without assistance (91%, n = 10). After the Tai Chi intervention, we observed significant reductions in symptoms of depression (-5.3 ± 5.9, p = 0.01), anxiety (-2.2 ± 2.4, p = 0.01) and stress (-4.6 ± 4.8, p = 0.01); along with better sleep efficiency (+1.8 ± 1.8, p = 0.01), less wakefulness after sleep onset (-9.3 ± 11.6, p = 0.04), and less time awake (-9.3 ± 11.6, p = 0.04). In addition, there was a 36% decrease in SOD activity (p = 0.02) indicative of a decreased oxidative environment post-intervention; though no significant changes in any of the inflammatory markers were found (all p-values >0.05).

Conclusion

Symptoms of depression, anxiety and stress were observed in these community-dwelling stroke survivors along with sub-optimal sleep. Among community-dwelling stroke survivors, Tai Chi exercise is a feasible intervention that can be used alongside conventional care to manage post-stroke depression and may also aid in reducing symptoms of anxiety and stress, and improve sleep.  Further research is needed with rigorous study designs and larger samples, before widespread recommendations can be made.

Protocol for a scoping review of measurement of sleep in mild cognitive impairment and early dementia

Background

Sleep abnormalities are increasingly recognised to emerge early in dementia, at or before the Mild Cognitive Impairment (MCI) phase. Abnormal sleep accelerates cognitive decline and may directly contribute to pathophysiology. Its accurate measurement is therefore crucial, firstly to characterise sleep abnormalities in early disease potentially facilitating earlier identification of those at risk of dementia and secondly to test sleep intervention efficacy. However, it is our a priori hypothesis that sleep outcomes are reported heterogeneously inhibiting side-by-side comparison of study findings. As a translational step towards informing choice and decisions on optimal measures, this scoping review will describe measurement tools utilised and sleep parameters currently reported in early dementia and MCI.

Methods

This scoping review follows the Joanna Briggs Institute Manual for Evidence Synthesis for Scoping Reviews. The search strategy consists of an electronic search of the CINAHL Plus, Embase, Medline, Psychinfo and British Nursing Index databases and date limited to articles published from 2000. Search results will be merged using reference management software and duplicates removed. 10% of returned titles and abstracts will be checked by each reviewing member to ensure continuity of decision making. Full-texts will be reviewed by at least two reviewers with discrepancies resolved by whole team consensus. A PRISMA flow diagram will document the selection process. Extracted data will be analysed and reported narratively.

Discussion

This scoping review will identify which sleep parameters are reported and the means by which they are measured in people with MCI or early dementia. We intend to explore differences in reporting practice within group subsets, e.g. by dementia and study subtype.

Ethics and dissemination

Ethical approval is not required due to absence of human participants. Results will be published in a peer-reviewed journal and presented at relevant academic conferences. The search strategy will be made available publicly for transparency.

Late-onset Leber's hereditary optic neuropathy presenting with longitudinally extensive myelitis harbouring the m.14484T>C mutation: Extending the genotype-phenotype spectrum

Leber's hereditary optic neuropathy (LHON) is a mitochondrial disease leading to visual loss, typically in young men, and rarely displays extra-ocular manifestations including spinal cord disease. We report the case of a 57-year-old man who presented with a longitudinally extensive dorsal column lesion as the first manifestation of LHON, with the onset of bilateral progressive optic neuropathy 11 months later, harbouring the m.14484T>C mutation. To our knowledge this is the most extensive cord lesion preceding optic neuropathy traversing the cervical and thoracic cord. We review the literature of all published cases of LHON in which spinal cord involvement was the presenting feature of the disease, summarising the clinical phenotype, demographics, radiological characteristics and genotype. We highlight the importance for diagnostic vigilance in patients with either longitudinally extensive dorsal column myelopathy, optic neuropathy or both.

Merlin modulates process outgrowth and synaptogenesis in the cerebellum

Neurofibromatosis type 2 (NF2) patients are prone to develop glial-derived tumors in the peripheral and central nervous system (CNS). The Nf2 gene product -Merlin is not only expressed in glia, but also in neurons of the CNS, where its function still remains elusive. Here, we show that cerebellar Purkinje cells (PCs) of isoform-specific Merlin-deficient mice were innervated by smaller vGluT2-positive clusters at presynaptic terminals than those of wild-type mice. This was paralleled by a reduction in frequency and amplitude of miniature excitatory postsynaptic currents (mEPSC). On the contrary, in conditional transgenic mice in which Merlin expression was specifically ablated in PCs (L7Cre;Nf2^fl/fl), we found enlarged vGluT2-positive clusters in their presynaptic buttons together with increased amplitudes of miniature postsynaptic currents. The presynaptic terminals of these PCs innervating neurons of the deep cerebellar nuclei were also enlarged. When exploring mice with Merlin-deficient granule cells (GCs) (Math1Cre;Nf2^fl/fl), we found cerebellar extracts to contain higher amounts of vGluT1 present in parallel fiber terminals. In parallel, mEPSC frequency was increased in Math1Cre;Nf2^fl/fl mice. On the contrary, VGluT2 clusters in cerebellar glomeruli composed of NF2-deficient presynaptic Mossy fiber terminals and NF2-deficient postsynaptic GC were reduced in size as shown for isoform-specific knockout mice. These changes in Math1Cre;Nf2^fl/fl-deficient mice were paralleled by an increased activation of Rac1-Cofilin signaling which is known to impact on cytoskeletal reorganization and synapse formation. Consistent with the observed synaptic alterations in these transgenic mice, we observed altered ultrasonic vocalization, which is known to rely on proper cerebellar function. No gross morphological changes or motor coordination deficits were observed in any of these transgenic mice. We therefore conclude that Merlin does not regulate overall cerebellar development, but impacts on pre- and post-synaptic terminal organization.

The Impact of Rimed Ice Hydrometeors on Global and Regional Climate

Rimed hydrometeors (graupel or hail) are added to a stratiform cloud scheme for global models and tested in a variety of configurations. Off-line tests compare well to other cloud microphysics schemes with rimed ice used in mesoscale models. Tests in single column and climate mode show expected production of small amounts of rimed ice in the middle troposphere and at high latitudes. The overall climate impacts of rimed ice (hail or graupel) at 100-km horizontal grid spacing are small. There are some changes to partitioning between cloud ice and snow that affect upper troposphere water budgets and clouds. High-resolution simulations are conducted with a global but regionally refined grid at 14 km over the Contiguous United States. High-resolution simulations show local production of graupel with realistic size and number concentrations. The maximum graupel frequency at high resolution is over Western U.S. mountain ranges. Differences in total precipitation with the addition of rimed ice in 8-year simulations are statistically significant only for orographic precipitation over the Cascade and Rocky mountains, reducing model biases when rimed ice is included. Rimed ice slightly improves summer precipitation intensity relative to observations. Thus, while the global climate impact of rimed ice in stratiform clouds may be negligible, there are potentially important and systematic regional effects, particularly for orographic precipitation. Rimed ice in cumulus clouds is not yet treated but is an important next step.

THUR 038 Encephalopathy with MRI cortical ribbon and reversible white matter hyperintensities

We present an unusual case of encephalopathy with profound MR white matter and cortical abnormalities secondary to, and responsive to treatment for, hepatic encephalopathy alone.

A 52-year-old man with known alcohol related liver disease (now abstinent), previous intravenous drug abuse and treated Hepatitis C presented over 18 months with discrete episodes of fluctuating confusion, and altered consciousness progressing to coma.

Neuroimaging demonstrated symmetrical confluent white matter T2/ FLAIR hyperintensities in the posterior frontal and parietal lobes with symmetrical dWI cortical ribboning in the precentral gyrus. Due to his clinical state and the unusual neuroimaging findings he was transferred for further neurological investigation and management.

On admission a serum ammonia was 111 µmol/L (normal range 16 – 60 µmol/L). Further to this a detailed systemic blood, imaging and CSF analysis did not yield an alternative diagnosis. Electroencephalography revealed generalised slowing.

Serial imaging showed persistent, fluctuating, confluent, and symmetrical white matter T2/ FLAIR hyperintensities. Fluctuations in his clinical state correlated with serum ammonia levels, bowel motions, neuroimaging and the EEG findings. He was treated for hepatic encephalopathy alone, on one occasion in intensive care, with lactulose, phosphate enemas and diuretics. He was discharged home independently after a period of sustained clinical improvement.

Optical projection tomography permits efficient assessment of infarct volume in the murine heart postmyocardial infarction

Optical projection tomography permits rapid high-resolution imaging of intact murine heart in vitro and identification of tissue heterogeneity within individual optical slices of postmyocardial infarction hearts. Infarct volume derived from >400 slices correlates with in vivo magnetic resonance imaging and avoids the need for histological staining of multiple physical sections.

The extent of infarct injury is a key determinant of structural and functional remodeling following myocardial infarction (MI). Infarct volume in experimental models of MI can be determined accurately by in vivo magnetic resonance imaging (MRI), but this is costly and not widely available. Experimental studies therefore commonly assess injury by histological analysis of sections sampled from the infarcted heart, an approach that is labor intensive, can be subjective, and does not fully assess the extent of injury. The present study aimed to assess the suitability of optical projection tomography (OPT) for identification of injured myocardium and for accurate and efficient assessment of infarct volume. Intact, perfusion-fixed, optically cleared hearts, collected from mice 7 days after induction of MI by coronary artery occlusion, were scanned by a tomograph for autofluorescence emission after UV excitation, generating >400 transaxial sections for reconstruction. Differential autofluorescence permitted discrimination between viable and injured myocardium and highlighted the heterogeneity within the infarct zone. Two-dimensional infarct areas derived from OPT imaging and Masson's trichrome staining of slices from the same heart were highly correlated (r² = 0.99, P < 0.0001). Infarct volume derived from reconstructed OPT sections correlated with volume derived from in vivo late gadolinium enhancement MRI (r² = 0.7608, P < 0.005). Tissue processing for OPT did not compromise subsequent immunohistochemical detection of endothelial cell and inflammatory cell markers. OPT is thus a nondestructive, efficient, and accurate approach for routine in vitro assessment of murine myocardial infarct volume.

Status Report--Retracing the history of the early development of national chronic disease surveillance in Canada and the major role of the Laboratory Centre for Disease Control (LCDC) from 1972 to 2000

Health surveillance is the ongoing, systematic use of routinely collected health data to guide public health action in a timely fashion. This paper describes the creation and growth of national surveillance systems in Canada and their impact on chronic disease and injury prevention. In 2008, the authors started a review process to retrace the history of the early development of national chronic disease surveillance in Canada from 1960 to 2000. A 1967 publication describes the history of the development of the Laboratory of Hygiene from 1921 to 1967. This review is a sequel to that paper and describes the history of the development of national chronic disease surveillance in Canada before and after the formation of the Laboratory Centre for Disease Control (LCDC).

Glycemic index, glycemic load and cancer risk

BACKGROUND

Dietary glycemic index (GI) and glycemic load (GL) have been related to the risk of selected cancers, but the issue remains open.

PATIENTS AND METHODS

Mailed questionnaires were completed between 1994 and 1997 in eight Canadian provinces for incident, histologically confirmed cases of the stomach (n=1182), colon (n=1727), rectum (n=1447), liver (n=309), pancreas (n=628), lung (n=3341), breast (n=2362), ovary (n=442), prostate (n=1799), testis (n=686), kidney (n=1345), bladder (n=1029), brain (n=1009), non-Hodgkin's lymphomas (NHL, n=1666), leukemias (n=1069), multiple myelomas (n=343), and 5039 population controls. Dietary information on eating habits 2 years before participants' enrollment in the study was obtained using a validated food frequency questionnaire (FFQ). Odds ratios (ORs) and 95% confidence intervals (CI) were derived by unconditional logistic regression including recognized confounding factors.

RESULTS

Dietary GI was positively associated with the risk of prostate cancer (OR, 1.26 for the highest versus the lowest quartile). A higher dietary GL significantly increased the risk of colorectal (OR, 1.28), rectal (OR, 1.44) and pancreatic (OR, 1.41) cancers. No other significant associations were found.

CONCLUSIONS

Our findings suggest that a diet high in GI and GL is associated with increased risk of selected cancers.

Dietary cholesterol intake and cancer

BACKGROUND

This study assesses the association between dietary cholesterol intake and the risk of various cancers.

PATIENTS AND METHODS

Mailed questionnaires were completed between 1994 and 1997 in eight Canadian provinces by 1182 incident histologically confirmed cases of the stomach, 1727 of the colon, 1447 of the rectum, 628 of the pancreas, 3341 of the lung, 2362 of the breast, 442 of the ovary, 1799 of the prostate, 686 of the testis, 1345 of the kidney, 1029 of the bladder, 1009 of the brain, 1666 non-Hodgkin's lymphomas (NHL), 1069 leukemia and 5039 population controls. Information on dietary habits and nutrition intake were obtained using a food frequency questionnaire, which provided data on eating habits 2 years before the study. Odds ratios (ORs) were derived by unconditional logistic regression to adjust for total energy intake and other potential confounding factors.

RESULTS

Dietary cholesterol was positively associated with the risk of cancers of the stomach, colon, rectum, pancreas, lung, breast (mainly postmenopausal), kidney, bladder and NHL: the ORs for the highest versus the lowest quartile ranged from 1.4 to 1.7. In contrast, cholesterol intake was inversely associated with prostate cancer.

CONCLUSIONS

Our findings add to the evidence that high cholesterol intake is linked to increased risk of various cancers. A diet low in cholesterol may play a role in the prevention of several cancers.

Dietary sodium intake among Canadian adults with and without hypertension

Introduction

Almost 30% of hypertension among Canadians may be attributed to excess dietary sodium.

Methods

We examined the average sodium intake of Canadians aged 30 years and over, with and without hypertension, by age, sex and diabetes status using 24-hour recall data from the 2004 Canadian Community Health Survey, Cycle 2.2, Nutrition. We compared absolute (crude) average sodium intake levels of those with and without hypertension to the 2009 Canadian Hypertension Education Program (CHEP) guidelines and adjusted average sodium intake between those with and without hypertension.

Results

Both those with and without diagnosed hypertension display average sodium intakes well above the 1500 mg/day recommended by the 2009 CHEP guidelines (2950 mg/day and 3175 mg/day, respectively). After confounding adjustment, those with hypertension have significantly higher average sodium intake (p = .0124). Stratified subgroup analyses found the average sodium intake among those with hypertension was higher for men between 30 and 49 years old (p = .0265), women between 50 and 69 years old (p = .0083) and those without diabetes (p = .0071) when compared to their counterparts without hypertension.

Conclusion

Better approaches are needed to reduce sodium intake in hypertension patients, as well as the general population.

Dietary sodium intake among Canadian adults with and without hypertension

INTRODUCTION

Almost 30% of hypertension among Canadians may be attributed to excess dietary sodium.

METHODS

We examined the average sodium intake of Canadians aged 30 years and over, with and without hypertension, by age, sex and diabetes status using 24-hour recall data from the 2004 Canadian Community Health Survey, Cycle 2.2, Nutrition. We compared absolute (crude) average sodium intake levels of those with and without hypertension to the 2009 Canadian Hypertension Education Program (CHEP) guidelines and adjusted average sodium intake between those with and without hypertension.

RESULTS

Both those with and without diagnosed hypertension display average sodium intakes well above the 1500 mg/day recommended by the 2009 CHEP guidelines (2950 mg/day and 3175 mg/day, respectively). After confounding adjustment, those with hypertension have significantly higher average sodium intake (p = .0124). Stratified subgroup analyses found the average sodium intake among those with hypertension was higher for men between 30 and 49 years old (p = .0265), women between 50 and 69 years old (p = .0083) and those without diabetes (p = .0071) when compared to their counterparts without hypertension.

CONCLUSION

Better approaches are needed to reduce sodium intake in hypertension patients, as well as the general population.

Evaluation of multiplex ligation-dependent probe amplification as a method for the detection of copy number abnormalities in B-cell precursor acute lymphoblastic leukemia

Recent genomic studies have shown that copy number abnormalities (CNA) of genes involved in lymphoid differentiation and cell cycle control are common in B-cell precursor acute lymphoblastic leukemia (BCP-ALL). We have evaluated Multiplex Ligation-dependent Probe Amplification (MLPA) on 43 BCP-ALL patients for the detection of the most common deletions among these genes and compared the results to those obtained by fluorescence in situ hybridization (FISH) and genomic quantitative PCR (qPCR). There was good correlation between methods for CDKN2A/B, IKZF1, and PAX5 deletions in the majority of cases and MLPA confirmed the presence of deletions within the PAR1 region in two of three cases identified by FISH. Small intragenic aberrations detected by MLPA, which were below the resolution of FISH for CDKN2A/B (n = 7), IKZF1 (n = 3), and PAX5 (n = 3) were confirmed by qPCR. MLPA and qPCR were unable to detect populations present at a low level (<20%) by FISH. In addition, although MLPA identified the presence of a deletion, it was unable to discern the presence of mixed cell populations which had been identified by FISH: CDKN2A/B (n = 3), IKZF1 (n = 1), PAX5 (n = 2), and PAR1 deletion (n = 1). Nevertheless, this study has demonstrated that MLPA is a robust technique for the reliable detection of CNA involving multiple targets in a single test and thus is ideal for rapid high throughput testing of large cohorts with a view to establishing incidence and prognostic significance.

IL-12 prevents the inhibitory effects of cis-urocanic acid on tumor antigen presentation by Langerhans cells: implications for photocarcinogenesis

UV radiation induces skin cancer primarily by its DNA-damaging properties, but also by its capacity to suppress the immune system. The photoisomer of urocanic acid (UCA), cis-UCA, is an important mediator of UV-induced immunosuppression and is involved in the inhibition of tumor immunity. The immunomodulatory cytokine IL-12 is known to counteract many of the immunosuppressive effects of UV radiation, including UV-induced immune tolerance. In this study, we addressed whether IL-12 also reverts the immunosuppressive activities of cis-UCA. Cis-UCA inhibits the ability of Langerhans cells to present tumor Ags for primary and secondary tumor immune responses. IL-12 treatment completely prevented the suppression by cis-UCA. IL-12 also protected mice from cis-UCA-induced suppression of contact hypersensitivity responses. To study the effects of cis-UCA on Ag-processing and Ag-presenting function in vitro, Langerhans cells were treated with UCA isomers and incubated with OVA or OVA peptide(323-339) before exposure to OVA-specific transgenic T cells. Cis-, but not trans-UCA suppressed Ag presentation, which was completely reversed upon addition of IL-12. Since these findings suggest that cis-UCA may play an important role in photocarcinogenesis by inhibiting a tumor immune response, mice were chronically UVB irradiated to induce skin cancer. Whereas all mice in the control groups developed tumors, mice treated with a mAb with specificity for cis-UCA showed a significantly reduced tumor incidence. These data strongly indicate the importance of cis-UCA during photocarcinogenesis and support the concept of counteracting cis-UCA as an alternative strategy to prevent UV-induced skin cancer, possibly via the application of IL-12.

The development of articular cartilage: evidence for an appositional growth mechanism

It is well-established that cartilage grows by a combination of matrix secretion, cell hypertrophy and cell proliferation. The extent to which this growth is by appositional, as opposed to interstitial mechanisms, however, remains unclear. Using the knee joints of the marsupial Monodelphis domestica to study cartilage growth, we have combined an immunohistochemical study of the TGF-beta family of cartilage growth and differentiation factors between 30 days postpartum to 8 months, together with a stereological analysis of cartilage morphology during growth. Furthermore, to gain an insight into the generation of the characteristic zones within cartilage, we have examined the effects of intra-articular administration of bromodeoxyuridine, an agent that is incorporated into DNA during cell division and blocks further cell cycling. During early growth, TGF-beta2 and -beta3 were widely expressed but TGF-beta1 was less so. After the formation of the secondary centre of ossification, all isoforms became more restricted to the upper half of the tissue depth and their distribution was similar to that previously described for IGFs, and PCNA-positive cells. Stereological analysis of tissue sections from the femoral condylar cartilage at 3 and 6 months showed that there was a 17% increase in total cartilage volume but a 31% decrease in cell density on a unit volume basis. Finally, cell-cycle perturbation with BrDU, which was injected into the knee joints of 3-month-old animals and analysed 1 and 4 months post-injection, revealed that the chondrocytes occupying the transitional zone were depleted 1 month post-injection, resulting in thinning of the articular cartilage. This effect was reversed 4 months post-injection. Immunohistochemical analysis revealed that BrDU-treatment altered the expression patterns of all TGF-beta isoforms, with a marked reduction in labelling of TGF-beta1 and -beta3 isoforms in the upper half of the cartilage depth. Overall, the data lends further support to the notion of articular cartilage growing by apposition from the articular surface rather than by interstitial mechanisms.

The NF2 tumor suppressor gene product, merlin, mediates contact inhibition of growth through interactions with CD44

The neurofibromatosis-2 (NF2) gene encodes merlin, an ezrin-radixin-moesin-(ERM)-related protein that functions as a tumor suppressor. We found that merlin mediates contact inhibition of growth through signals from the extracellular matrix. At high cell density, merlin becomes hypo-phosphorylated and inhibits cell growth in response to hyaluronate (HA), a mucopolysaccharide that surrounds cells. Merlin's growth-inhibitory activity depends on specific interaction with the cytoplasmic tail of CD44, a transmembrane HA receptor. At low cell density, merlin is phosphorylated, growth permissive, and exists in a complex with ezrin, moesin, and CD44. These data indicate that merlin and CD44 form a molecular switch that specifies cell growth arrest or proliferation.

Do we need another randomized controlled trial of folic acid alone?

As a public health strategy to help prevent neural tube defect-affected pregnancies, enriched flour and pasta in the United States and Canada are being fortified with folic acid, and women are being advised to take supplementary folic acid around the time of pregnancy to ensure an adequate intake. But in spite of the recently published results of a public health campaign in China, the burden of proof that folic acid alone is responsible for a decreased risk of these birth defects rests on the results of a randomized controlled trial conducted by the Medical Research Council of the United Kingdom. Supporting evidence comes primarily from studies that have shown a protective effect of multivitamins containing folic acid as one of many nutrients. Based on a striking and potentially hazardous type of non-compliance observed in an earlier study in which a participant took multiple vitamin doses simultaneously and a suggestion of similar incidents in the Medical Research Council study, we conclude that a further randomized controlled trial of the protective effect of folic acid alone may be necessary.

Low-copy-number human transgene is recognized as an X inactivation center in mouse ES cells, but fails to induce cis-inactivation in chimeric mice

X chromosome inactivation is initiated from a segment of the mammalian X chromosome called the X inactivation center. Transgenes from this region of the murine X chromosome are providing the means to identify the DNA needed for cis inactivation in mice. We recently showed that chimeric mice carrying transgenes from the human X inactivation center (XIC) region also provide a functional assay for human XIC activity; approximately 6 copies of a 480-kb human transgene (ES-10) were sufficient to initiate random X inactivation in cells of male chimeric mice (Migeon et al., 1999, Genomics, 59, 113-121). Now, we report studies of another human transgene (ES-5), which contains less than 300 kb of the human XIC region on Xq13.2 including an intact XIST locus and which has inserted in one or two copies into mouse chromosome 6. The ES-5 transgene is recognized as an X inactivation center in mouse embryonic stem cells, but is not sufficient to induce random X inactivation in somatic cells of highly chimeric mice. Human transgenes in chimeric mice provide a means to uncouple the key steps in this complex pathway and facilitate the search for essential components of the human XIC region.