Posterior urethral valves in patients with trisomy 21: Similar renal outcomes and rates of volitional voiding

INTRODUCTION

Posterior urethral valves (PUV) occur in patients with Down Syndrome (DS) at a rate of 3-4%; far higher than the general population. Our understanding of the relationship between PUVs and DS is in its infancy, with the majority of the literature consisting of case reports. In this study, we present the largest known series of DS patients with PUVs.

AIM

We hypothesized that patients with DS and PUVs would have worse functional bladder outcomes and renal outcomes when compared to PUV patients without DS.

STUDY DESIGN

We queried our prospectively managed multi-institutional database of PUV patients from 1990 to 2021. We identified patients with a concomitant diagnosis of DS and PUV. In addition, we performed a systematic review of the literature describing the presentation of children with PUV and DS. Patient demographics, renal outcomes, voiding habits, surgical interventions, and radiologic images were aggregated and analyzed.

RESULTS

Out of the 537 patients in our PUV database, we identified 18 patients with a concomitant diagnosis of PUV and DS, as well as 14 patients with a concomitant diagnosis of PUV and DS from the literature. DS and non-DS patients had a similar age at presentation, 31.5 days (2-731) and 17 (4-846), and length of follow up 6.32 years (2-11.2) and 6.98 (1-13). Both groups had similar nadir creatinines DS 0.43 (0.4-0.8), non-DS 0.31 (0.2-0.5) and similar rates of renal failure (DS 11.1% and non-DS 14.5%). With respect to bladder outcomes, a similar percentage of patients were volitionally voiding at last follow up (DS 72.2% and non-DS 72.3%). Our literature review corroborated these findings.

CONCLUSIONS

Patients with DS and PUV have similar renal outcomes to other PUV patients in terms of renal function, progression to renal failure, and probability of volitional voiding with continence. Given the increased rate of PUVs in the DS population, physicians should have a high index of suspicion for PUV when patients with DS present with voiding dysfunction.

Single-nuclei RNA sequencing uncovers heterogenous transcriptional signatures in Parkinson's disease associated with nuclear receptor-related factor 1 defect

Previous studies have found that deficiency in nuclear receptor-related factor 1 (Nurr1), which participates in the development, differentiation, survival, and degeneration of dopaminergic neurons, is associated with Parkinson's disease, but the mechanism of action is perplexing. Here, we first ascertained the repercussion of knocking down Nurr1 by performing liquid chromatography coupled with tandem mass spectrometry. We found that 231 genes were highly expressed in dopaminergic neurons with Nurr1 deficiency, 14 of which were linked to the Parkinson's disease pathway based on Kyoto Encyclopedia of Genes and Genomes analysis. To better understand how Nurr1 deficiency autonomously invokes the decline of dopaminergic neurons and elicits Parkinson's disease symptoms, we performed single-nuclei RNA sequencing in a Nurr1 LV-shRNA mouse model. The results revealed cellular heterogeneity in the substantia nigra and a number of activated genes, the preponderance of which encode components of the major histocompatibility II complex. Cd74, H2-Ab1, H2-Aa, H2-Eb1, Lyz2, Mrc1, Slc6a3, Slc47a1, Ms4a4b, and Ptprc2 were the top 10 differentially expressed genes. Immunofluorescence staining showed that, after Nurr1 knockdown, the number of CD74-immunoreactive cells in mouse brain tissue was markedly increased. In addition, Cd74 expression was increased in a mouse model of Parkinson's disease induced by treatment with 6-hydroxydopamine. Taken together, our results suggest that Nurr1 deficiency results in an increase in Cd74 expression, thereby leading to the destruction of dopaminergic neurons. These findings provide a potential therapeutic target for the treatment of Parkinson's disease.

Estradiol mitigates stress-induced cardiac injury and inflammation by downregulating ADAM17 via the GPER-1/PI3K signaling pathway

Stress-induced cardiovascular diseases characterized by inflammation are among the leading causes of morbidity and mortality in postmenopausal women worldwide. Estradiol (E2) is known to be cardioprotective via the modulation of inflammatory mediators during stress. But the mechanism is unclear. TNFα, a key player in inflammation, is primarily converted to its active form by 'A Disintegrin and Metalloprotease 17' (ADAM17). We investigated if E2 can regulate ADAM17 during stress. Experiments were performed using female FVB wild-type (WT), C57BL/6 WT, and G protein-coupled estrogen receptor 1 knockout (GPER-1 KO) mice and H9c2 cells. The study revealed a significant increase in cardiac injury and inflammation during isoproterenol (ISO)-induced stress in ovariectomized (OVX) mice. Additionally, ADAM17's membrane content (mADAM17) was remarkably increased in OVX and GPER-1 KO mice during stress. However, in vivo supplementation of E2 significantly reduced cardiac injury, mADAM17, and inflammation. Also, administering G1 (GPER-1 agonist) in mice under stress reduced mADAM17. Further experiments demonstrated that E2, via GPER-1/PI3K pathway, localized ADAM17 at the perinuclear region by normalizing β1AR-Gαs, mediating the switch from β2AR-Gαi to Gαs, and reducing phosphorylated kinases, including p38 MAPKs and ERKs. Thus, using G15 and LY294002 to inhibit GPER-1 and its down signaling molecule, PI3K, respectively, in the presence of E2 during stress resulted in the disappearance of E2's modulatory effect on mADAM17. In vitro knockdown of ADAM17 during stress significantly reduced cardiac injury and inflammation, confirming its significant inflammatory role. These interesting findings provide novel evidence that E2 and G1 are potential therapeutic agents for ADAM17-induced inflammatory diseases associated with postmenopausal females.

Musculoskeletal discomfort and wrist flexor tendonitis among street sweepers and associated risk factors

BACKGROUND

Street sweepers are reported to suffer from high rates of work-related musculoskeletal discomfort worldwide, especially in their wrists.

OBJECTIVE

The study aimed to 1) determine the prevalence of musculoskeletal disorders and 2) specifically determine the prevalence of wrist flexor tendonitis and its associated risk factors among street sweepers.

METHODS

Three hundred and eighty-five sweepers employed by the Faisalabad Waste Management Company (FWMC) participated in this cross-sectional study. A self-structured questionnaire was used to collect data: the first section provided demographic information, the second assessed musculoskeletal disorders, and the third section assessed the wrist flexor tendonitis among street sweepers.

RESULTS

The mean age of the sweepers was 38.34 years. Out of 385 street sweepers, the prevalence of musculoskeletal discomfort was reported in 265 (68.83%). The prevalence of musculoskeletal discomfort in sweepers reported during COVID-19 according to the past 12 months, the highest three prevalence rates were 46.5% in the wrists/hands, 37.9% in the shoulders and 35.1% in the lower back. The three highest prevalence rates of musculoskeletal discomfort in sweepers according to the last 7 days were 29.6% in the wrists/hands, 24.4% in the lower back and 24.2% in the shoulders. Out of total 385 participants, prevalence of wrist flexor tendonitis was reported in 103 (26.8%) sweepers. Significant association was found (p < 0.05) between wrist flexor tendonitis and gender (p < 0.003), age (p < 0.05), working experience (p < 0.003), street sweeping distance (p < 0.01), number of brooms used per month (p < 0.002) and getting tired at the end of work (p < 0.001).

CONCLUSION

The prevalence of musculoskeletal discomfort and wrist flexor tendonitis seen during COVID-19 is high among sweepers, with wrist/hand being the most commonly reported region for pain. This study emphasizes the importance of providing guidelines about effective precautionary healthcare measures for street sweepers.

Nodular Lymphocytic Predominant Hodgkin Lymphoma (NLPHL); Treatment Outcome Study in a Tertiary Care Cancer Hospital in Pakistan

Objective: To determine the demographics, clinical characteristics and treatment outcomes of nodular lymphocytic predominant Hodgkin lymphoma (NLPHL) patients treated at our hospital. Study Design: Retrospective longitudinal study. Place and Duration of Study: Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan from 1996 to 2016. Methodology: We collected clinical data of all the cases of HL diagnosed over twenty years (between 1996 and 2016) from our electronic hospital information system (HIS). A total of 3426 HL patients were identified, out of whom the pathologically confirmed diagnosis of nodular lymphocytic predominant Hodgkin lymphoma (NLPHL) was identified. Results: In this study, eighty-four patients were studied. The majority of the patients were male (80%). B symptoms were present in 35%. There were 24% patients in stage-I (n=20/84), 33% in stage-II (n=28/84), 12% in stage III (n=10/84) and 31% in stage IV (n=26/84). Hence, early-stage was seen in 57% (n=48/84) and advanced stage was 43% (n=36/84) respectively. The Median follows up time was 30 months (range: 1-60 months). Patients were treated with chemotherapy in most cases (48%), radiotherapy alone in 14% cases, and combined modality (chemotherapy and radiotherapy) was used in 38% patients. The estimated 5–year disease-free survival was 73% and overall survival was 86%. Autologous stem cell transplant was done in only one patient whose disease had transformed from NLPHL to T-rich cell B cell lymphoma. Conclusion: This study confirmed the divergent features of NLPHL with a comparatively good long-term prognosis. Most patients achieved an excellent response to first-line therapy. There was...

Caregiver distress: A mixed methods evaluation of the mental health burden of caring for children with bladder exstrophy

INTRODUCTION

Caring for children with bladder exstrophy-epispadias complex (BEEC) exacts a long-term emotional toll on caregivers. Previous studies leave a gap in understanding the impact that caring for a child with BEEC has on caregivers in low- and middle-income countries (LMIC). We hypothesize that families and caregivers experience psychological distress that has long gone unaddressed.

MATERIALS AND METHODS

From 2018 to 2020, researchers conducted a multi-method evaluation of caregiver distress with participants recruited as part of the annual International Bladder Exstrophy Collaboration based in Ahmedabad, Gujarat, India. In 2018, pilot data was collected through cognitive interviews. In 2019, researchers conducted structured interviews predicated on themes from the previous year, which subsequently prompted formal mental health screenings in 2020. Caregivers who reported suicidal thoughts were immediately referred for intervention.

RESULTS

In 2018, caregivers described the primary source of stigma arose from their village (n = 9, 26.5%). Caregivers also identified long-term concerns (n = 18, 52.9%), including future fertility and marital prospects, as sources of anxiety. In 2019, caregivers substantiated preliminary findings with the primary source of anticipated (n = 9, 31%) and experienced (n = 19, 65.5%) stigma again stemming from their communities. Both cohorts identified the collaboration as a positive source of support (n = 23, 36.5%). In 2020, caregivers stated decreased emotional wellbeing as number of subsequent repairs increased (n = 54, 75%, p = 0.002). Caregivers of children who underwent initial surgery within 5 years of screening reported higher anxiety (n = 46, 63.8%) and this was exacerbated as the number of subsequent repairs increased (p = 0.043).

CONCLUSION

Complex, long-term course of care, including additional surgeries, significantly impacts caregiver distress in the LMIC setting. Screening for caregivers of children with complex congenital anomalies, like BEEC, should be an essential element of any comprehensive effort to alleviate the global burden of disease.

ADAM17, A Key Player of Cardiac Inflammation and Fibrosis in Heart Failure Development During Chronic Catecholamine Stress

Heart failure development is characterized by persistent inflammation and progressive fibrosis owing to chronic catecholamine stress. In a chronic stress state, elevated catecholamines result in the overstimulation of beta-adrenergic receptors (βARs), specifically β2-AR coupling with Gαi protein. Gαi signaling increases the activation of receptor-stimulated p38 mitogen-activated-protein-kinases (p38 MAPKs) and extracellular signal-regulated kinases (ERKs). Phosphorylation by these kinases is a common way to positively regulate the catalytic activity of A Disintegrin and Metalloprotease 17 (ADAM17), a metalloprotease that has grown much attention in recent years and has emerged as a chief regulatory hub in inflammation, fibrosis, and immunity due to its vital proteolytic activity. ADAM17 cleaves and activates proinflammatory cytokines and fibrotic factors that enhance cardiac dysfunction via inflammation and fibrosis. However, there is limited information on the cardiovascular aspect of ADAM17, especially in heart failure. Hence, this concise review provides a comprehensive insight into the structure of ADAM17, how it is activated and regulated during chronic catecholamine stress in heart failure development. This review highlights the inflammatory and fibrotic roles of ADAM17’s substrates; Tumor Necrosis Factor α (TNFα), soluble interleukin-6 receptor (sIL-6R), and amphiregulin (AREG). Finally, how ADAM17-induced chronic inflammation and progressive fibrosis aggravate cardiac dysfunction is discussed.

The orphan nuclear receptor Nurr1 agonist amodiaquine mediates neuroprotective effects in 6-OHDA Parkinson's disease animal model by enhancing the phosphorylation of P38 mitogen-activated kinase but not PI3K/AKT signaling pathway

Recent studies implicate the defects or altered expression of the orphan nuclear receptor Nurr1 gene in the substantia nigra in Parkinson's disease pathogenesis. In an attempt to corroborate the treatment-modifying disease that would replicate the effect of Nurr1, it has been found that amodiaquine and Nurr1 had the same chemical scaffolding, indicating a crucial structure-activity relationship. Interestingly, amodiaquine stimulate the transcriptional function of Nurr1 by physical interaction with its ligand-binding domain (LBD). However, the signaling route by which Nurr1 is activated by amodiaquine to cause the protective effect remains to be elucidated. We first demonstrated that amodiaquine treatment ameliorated behavioural deficits in 6-OHDA Parkinson's disease mouse model, and it promoted dopaminergic neurons protection signified by Tyrosine hydroxylase (TH) and dopamine transporter (DAT) mRNA; Tyrosine hydroxylase (TH) protein expression level and the immunoreactivity in the substantia nigra compacta. Subsequently, we used inhibitors to ascertain the effect of amodiaquine on Akt and P38 Mapk as crucial signaling pathways for neuroprotection. Wortmannin (Akt Inhibitor) induced a significant reduction of Akt mRNA; however, there was no statistical difference between the amodiaquine-treated group and the control group suggesting that amodiaquine may not be the active stimulant of Akt. Western blot analysis confirmed that the phosphorylated Akt decreased significantly in the amodiaquine group compared to the control group. In the same vein, we found that amodiaquine substantially increased the level of phosphorylated P38 Mapk. When P38 Mapk inhibited by SB203580 (P38-Mapk Inhibitor), the total P38 Mapk but not the phosphorylated P38 Mapk decreased significantly, while tyrosine hydroxylase significantly increased. These results collectively suggest that amodiaquine can augment tyrosine hydroxylase expression via phosphorylated P38 Mapk while negatively regulating the phosphorylated Akt in protein expression.

Failure of Glial Cell-Line Derived Neurotrophic Factor (GDNF) in Clinical Trials Orchestrated By Reduced NR4A2 (NURR1) Transcription Factor in Parkinson's Disease. A Systematic Review

Parkinson’s disease (PD) is one of the most common neurodegenerative maladies with unforeseen complex pathologies. While this neurodegenerative disorder’s neuropathology is reasonably well known, its etiology remains a mystery, making it challenging to aim therapy. Glial cell-line derived neurotrophic factor (GDNF) remains an auspicious therapeutic molecule for treating PD. Neurotrophic factor derived from glial cell lines is effective in rodents and nonhuman primates, but clinical findings have been equivocal. Laborious exertions have been made over the past few decades to improve and assess GDNF in treating PD (clinical studies). Definitive clinical trials have, however, failed to demonstrate a survival advantage. Consequently, there seemed to be a doubt as to whether GDNF has merit in the potential treatment of PD. The purpose of this cutting edge review is to speculate as to why the clinical trials have failed to meet the primary endpoint. We introduce a hypothesis, “Failure of GDNF in clinical trials succumbed by nuclear receptor-related factor 1 (Nurr1) shortfall.” We demonstrate how Nurr1 binds to GDNF to induce dopaminergic neuron synthesis. Due to its undisputable neuro-protection aptitude, we display Nurr1 (also called Nr4a2) as a promising therapeutic target for PD.

Diabetic Inner- City Kidney Patients Eat Less Sugar and Grains but Also Fewer Healthy Nutrients Than Non-Diabetic Patients

Objectives

We evaluated dietary intake in patients with kidney disease with and without diabetes in inner-city Brooklyn clinics.

Methods

A face-to-face survey was conducted in a random convenience sample of pts from CKD (23) and transplant (45) clinics. Diet was studied by 24-hour recall using ASA24 software. Healthy Eating Index was calculated using the HEI-15 score and the DASH index as standard. Between group comparison was by t-test unless noted.

Results

There were 37 males (54%) and 31 (46%) females, 56 (82%) Black, 24/62 (24%) received SNAP benefits. 24 (53%) transplant (TXP) and 13 (57%) CKD pts had diabetes (DIAB). By Chi square, DIAB were more likely to make &lt; $20 K/yr (58% vs 23%, P = 0.015) and be unemployed (89% vs 61%, P = 0.018). DIAB were older (61.8 ± 1.6 vs 50.3 ± 2.25 yrs, P &lt; 0.0001). Creatinine was 1.86 ± 1.09 mg/dl. HbA1c was 11.1 ± 3.1, time with diabetes 206.03 ± 26.9 months. Blood pressure, BMI, albumin, potassium and total cholesterol did not differ but HDL was lower (DIAB 41.8 ± 3.5 vs 55.1 ± 4.3, P = 0.026). DIAB ate fewer calories (1386.5 ± 83.9 vs 1779.9 ± 129.1, P = 0.014), carbohydrates (131.8 ± 10.8 vs 211.8 ± 13.4, P &lt; 0.0001), sugar (41.5 ± 5.2 vs 89.4 ± 9.5, P &lt; 0.0001), added sugar (5.4 ± 0.86 vs 10.15 ± 1.89, P = 0.02) and refined grains (3.01 ± 0.43 vs 4.61 ± 0.59, P = 0.035), less fiber (11.1 ± 1.0 vs 16.1 ± 1.4, p-P = 0.006), vitamin C (49.7 ± 8.9 vs 110.2 ± 23.3, P = 0.014), fruit (0.37 ± 0.1 vs 1.96 ± 0.6, P = 0.009), potassium (1928.3135.8 vs 2578.1 ± 224.9, P = 0.014), magnesium (229.3 ± 16.8 vs 304.4 ± 32.9, P &lt; 0.05) and calcium (548.3 ± 60.1 vs 738.6 ± 67.9, P = 0.04). There was no difference for DASH (3.6 ± 0.15 vs 3.9 ± 0.18) or HEI score (57.8 ± 1.9 vs 59.4 ± 2.3) or dairy, meat, total protein, fat or sodium intake.

Conclusions

In our population: 1. DIAB pts reported more unemployment and lower income. 2. DIAB pts ate fewer total calories, but similar intake of protein and fat. 3. DIAB pts ate fewer carbohydrates, sugars, added sugars, and refined grains but did not have lower BMI and diabetes control was poor, with lower HDL values. 4. DIAB pts also ate less fresh fruit, potassium, calcium, magnesium, fiber and vitamin C. 5. Education of our pts with kidney disease and diabetes should reinforce positive dietary habits but encourage overall healthy eating that includes fruits and fiber, as patients may be focusing on restricting sugar and carbohydrates to the detriment of other nutrients.

Funding Sources

None.

Beliefs About Plant-Based Diet in Inner City CKD and Family Medicine Patients and Relationship to Dietary Patterns

Objectives

We compared beliefs about plant-based eating and dietary intake in patients attending inner-City CKD and Family Medicine (FM) clinics.

Methods

A face-to-face survey was conducted in a random convenience sample of pts in CKD (23) and FM clinics (22). Patients were asked to answer 5 multiple choice questions assessing their beliefs regarding difficulty in finding plant-based foods in restaurants, affordability, ability to get proteins and vitamins, and ability to find good tasting recipes. A mean score was calculated. Lower score indicates more difficulty (PBE-score). Diet analysis was based on 24hr recall and analyzed using ASA-24 software. Comparisons are by t-test unless noted.

Results

Mean age was 54.3 ± 2.5 yrs. There were 16 (35.6%) males and 22 (62.2%) females with 40 black (89%). 36 (80%) had not completed college. 23 (51%) had an income &lt; $20 K. 16 (35%) were employed. 20 (44%) had diabetes. 22 (49%) received SNAP benefits. Mean BMI was 30.4 ± 1.6 with 41% &gt; 30. There were no differences between clinics. CKD pts had higher creatinine (2.01 ± 0.39 vs 0.85 ± 0.05) and lower albumin (3.92 ± 0.12 vs 4.32 ± 0.09, P = 0.012). CKD pts had more positive attitude towards plant-based eating (PBE-score 2.57 ± 0.1 vs 2.21 ± 0.13, P &lt; 0.05), and ate more cholesterol (411.6 ± 65.2 vs 248.7 ± 30.3, P = 0.031), fatty seafood (1.41 ± 0.54 vs 0.17 ± 0.1, P = 0.034) and eggs (1.05 ± 0.27 vs 0.42 ± 0.16, P = 0.048) and drank more fluid (2499.0 ± 335.6 vs 1367.9 ± 167.1, P = 0.005) than FM pts. Protein, carbohydrate intake and total calories were similar and fruit and vegetable intake was low (1.33 ± 0.3 and 1.34 ± 0.19 respectively). PBE-score did not correlate with dietary intake and serum cholesterol did not differ (184.3 ± 9.4 vs 170.2 ± 8.0, P = NS).

Conclusions

In our population: 1. Pts with CKD had a more positive attitude towards plant-based eating and were more likely to believe they could eat more plant-based. 2. CKD pts ate more cholesterol with higher intake of eggs and fatty seafood, and drank more fluid. 3.Vegetable intake was poor and there was no difference between the groups. 4. The positive attitude of CKD pts towards plant-based eating and our indigent population as a whole suggests that education could be successful and should be explored further as our population as a whole has a high prevalence of CKD, obesity and diabetes.

Funding Sources

None.

Abstract 497: Higher nucleolar index of nucleolin as an indicator of aberrant cellular DNA damage response (DDR)

Nucleoli provide a survival advantage for various tumor types, exemplified in prostate neoplasia, leukemia, lung, and breast carcinomas. Unregulated expression and increased nucleolar localization of many stress-responsive factors often correlate with hyper-proliferative status. Therefore, nucleolar changes in cancer cells are the first cytological indicators that can serve as an index for diagnostic and prognostic purposes. In this study, we examine an abundant nucleolar stress factor, nucleolin (NCL) for its sub-nuclear localization under normal and DNA damage conditions. NCL is a multifunctional RNA-binding phosphoprotein that plays critical role/s in many cellular processes including regulation of gene expression during normal cell cycle as well as in the cellular DNA damage response (DDR). NCL-mediated DDR involves changes in its phosphorylation status, sub-nuclear translocation and a multi-level regulation of p53-checkpoint signaling. However, the role/s of p53 status and the signaling pathways triggered during NCL-mediated stress response remain elusive, and forms the focus of this study. Taking advantage of two human ductal breast epithelial tumor cell lines with different genetic backgrounds (wild type, wt-p53 and mutant, mut-p53 L194F), we demonstrate that NCL is predominantly nucleolar in unstressed conditions irrespective of the p53 status. Upon genotoxic stress, however, wt-p53 is required for NCL to mobilize from nucleoli to the nucleoplasmic region. We observed a significant increase in nucleoplasmic index for NCL that is wt-p53 dependent and specific to the type of DNA damage. In contrast, in the presence of mut-p53, NCL failed to translocate even under various DNA damage conditions, resulting in a higher nucleolar index. Interestingly, another nucleolar factor, nucleophosmin (NPM) remained unaltered upon stress conditions even in the presence of wt-p53. This study corroborates the previous research that suggests NCL translocation requires wt-p53 and provides new insights into the role of p53-mutations (e.g. the zinc finger mutation in the central DNA binding region-L194F) in NCL-mediated DDR. Further, we also assessed the role of NCL and p53 (wt vs. mut) in regulating stress signaling (ATM/ATR and p38-kinase) pathways and gene expression in apoptosis. Together, our study elaborates a novel approach that correlates NCL sub-nuclear localization, downstream signaling pathways and gene expression during the cellular DDR.

Citation Format: Iqra Nadeem, Amna Aslam, Jingyuan Wang, Anna Kozlova, Danielle Gordon, Rumsha Javed, Ruchama Steinberg, Rachele Dolce Rameau, Xinyin Jiang, Anjana D. Saxena. Higher nucleolar index of nucleolin as an indicator of aberrant cellular DNA damage response (DDR) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 497. doi:10.1158/1538-7445.AM2017-497