Ligand-dependent interactions between SR-B1 and S1PR1 in macrophages and atherosclerotic plaques

HDLs carry sphingosine-1-phosphate (S1P) and stimulate signaling pathways in different cells including macrophages and endothelial cells, involved in atherosclerotic plaque development. HDL signaling via S1P relies on the HDL receptor scavenger receptor class B, type I (SR-B1) and the sphingosine-1-phosphate receptor 1 (S1PR1), which interact when both are heterologously overexpressed in the HEK293 cell line. In this study, we set out to test if SR-B1 and S1PR1 interacted in primary murine macrophages in culture and atherosclerotic plaques. We used knock-in mice that endogenously expressed S1PR1 tagged with eGFP-(S1pr1eGFP/eGFP mice), combined with proximity ligation analysis to demonstrate that HDL stimulates the physical interaction between SR-B1 and S1PR1 in primary macrophages, that this is dependent on HDL-associated S1P and can be blocked by an inhibitor of SR-B1's lipid transfer activity or an antagonist of S1PR1. We also demonstrate that a synthetic S1PR1-selective agonist, SEW2871, stimulates the interaction between SR-B1 and S1PR1 and that this was also blocked by an inhibitor of SR-B1's lipid transport activity. Furthermore, we detected abundant SR-B1/S1PR1 complexes in atherosclerotic plaques of S1pr1eGFP/eGFP mice that also lacked apolipoprotein E. Treatment of mice with the S1PR1 antagonist, Ex26, for 12 h disrupted the SR-B1-S1PR1 interaction in atherosclerotic plaques. These findings demonstrate that SR-B1 and S1PR1 form ligand-dependent complexes both in cultured primary macrophages and within atherosclerotic plaques in mice and provide mechanistic insight into how SR-B1 and S1PR1 participate in mediating HDL signaling to activate atheroprotective responses in macrophages.

Complex interplay between FMRP and DHX9 during DNA replication stress

Mutations in, or deficiency of, fragile X messenger ribonucleoprotein (FMRP) is responsible for the Fragile X syndrome (FXS), the most common cause for inherited intellectual disability. FMRP is a nucleocytoplasmic protein, primarily characterized as a translation repressor with poorly understood nuclear function(s). We recently reported that FXS patient cells lacking FMRP sustain higher level of DNA double-strand breaks (DSBs) than normal cells, specifically at sequences prone to forming R-loops, a phenotype further exacerbated by DNA replication stress. Moreover, expression of FMRP, and not an FMRPI304N mutant known to cause FXS, reduced R-loop-associated DSBs. We subsequently reported that recombinant FMRP directly binds R-loops, primarily through the carboxyl terminal intrinsically disordered region. Here, we show that FMRP directly interacts with an RNA helicase, DHX9. This interaction, which is mediated by the amino terminal structured domain of FMRP, is reduced with FMRPI304N. We also show that FMRP inhibits DHX9 helicase activity on RNA:DNA hybrids and the inhibition is also dependent on the amino terminus. Furthermore, the FMRPI304N mutation causes both FMRP and DHX9 to persist on the chromatin in replication stress. These results suggest an antagonistic relationship between FMRP and DHX9 at the chromatin, where their proper interaction leads to dissociation of both proteins from the fully resolved R-loop. We propose that the absence or the loss of function of FMRP leads to persistent presence of DHX9 or both proteins, respectively, on the unresolved R-loop, ultimately leading to DSBs. Our study sheds new light on our understanding of the genome functions of FMRP.

A Novel CT-Based Radiomic Analysis for the Prediction of Overall Survival in Rectal Cancer Patients Treated with Short Course RT Total Neoadjuvant Therapy

PURPOSE/OBJECTIVE(S)

Radiomics is a method based on the extraction of features from medical images, enriching the construction of predictive models for aiding patient management. The purpose of this study is to develop a model based on radiomic features for the overall survival (OS) in rectal cancer patients treated with total neoadjuvant therapy (TNT). Prediction of neoadjuvant rectal (NAR) score was also preliminarily evaluated.

MATERIALS/METHODS

A retrospective cohort including patients treated with TNT at a single center between 2017-2021 was identified. TNT consisted of short course pelvic radiotherapy (25 Gy in 5 fractions) followed by FOLFOX or XELOX. A single CTV included mesorectum and nodal regions. Two endpoints were used: OS at 3 years (from the start of RT) and NAR score binary classification. A cut-off of 8.4 was used for NAR based on a previous local study. CTV radiomic features were extracted from simulation CTs using Pyradiomics v3. Features were extracted from the unfiltered images as well as from a set of eight filtered images. Radiomic features consist of 7 classes: shape, first order statistics, glcm, gldm, glrlm, glszm and ngtdm. 1967 initial features were extracted. Features with 0 standard deviation were removed as well as highly correlated ones (0.99 Pearson Coefficient). Dimension reduction using PCA was applied to each feature class, preserving 95% of the explained variance. Supervised algorithms were evaluated using a 10-fold cross-validation technique. Demographic and clinical features were also considered (age, sex, cT stage and N positivity) RESULTS: Eighty-two patients were included (37 females). Median age was 61.5 years (IQR 53-70). Clinical staging was comprised of 5 cT2 patients, 57 cT3 and 20 cT4, with 69 cN+. 3y-OS was 72%, with a median follow-up of 43.7 months (IQR 35.3-48.6). For the 3y-OS endpoint two prediction models were developed. First, a reference model (KNN classifying algorithm) based on demographic and clinical features only resulting in an AUC of 0.659 (SD 0.029). The second model (CART classifying algorithm) included demographic, clinical and radiomic features resulting in an AUC of 0.744 (SD 0.032). For the binary NAR classification model, a subset of 77 patients was used. Twenty-three presented a NAR<8.4 and 54 a NAR≥8.4. The CART algorithm presented the best performance with an AUC of 0.808 (SD 0.037) considering demographic, clinical and radiomic features.

CONCLUSION

Radiomic models were developed for 3y-OS prediction and binary NAR classification. The addition of radiomic features to clinical and demographic information improved the predictive capability of the 3y-OS model. Radiomic prediction of NAR makes it a promising tool for the identification of potential short course RT TNT responders.

Non-invasive near-infrared spectroscopy assessment of the spinal neurovascular response in a patient with transverse myelitis: a case report

BACKGROUND

Transverse myelitis (TM) is characterized by acute development of motor, sensory and autonomic dysfunctions due to horizontally diffused inflammation in one or more segments of the spinal cord in the absence of a compressive lesion. The not well-known inflammation process induces demyelination resulting in neurological dysfunction.

CASE PRESENTATION

In this case report we used a functional Near-Infrared Spectroscopy (fNIRS) technique to evaluate changes in the peri-spinal vascular response induced by a peripheral median nerve electrical stimulation in a patient with chronic transverse myelitis (TM). fNIRS showed drastically reduced signal amplitude in the peri-spinal vascular response, compared to that obtained from a healthy control group throughout most of the C7-T1 and T10-L2 spinal cord segments.

CONCLUSION

The potential use of this relatively non-invasive fNIRS technology support the potential clinical application of this method for functional test of the spinal cord through the assessment of the spinal neurovascular response.

Explanations on school task procrastination reported by medical students: A qualitative study at a public university in South-eastern Brazil

Introduction

How do medical students, who have self-criticism of being procrastinators of their study obligations, deal psychologically with daily tasks? The experience of procrastination by those who are considered high-performance students involves resources of mental health to cope with guilt, exhaustion, or even self-sabotage. According to MeSH used by PubMed, procrastination is ‘the deferment of actions or tasks to a later time, or to infinity’.

Objectives

To explore the psychological meanings that medical students attribute to procrastination phenomena to better understand how they handle the usual curriculum overload.

Methods

Clinical-qualitative design. Sample of 13 participants closed by information saturation with 2nd, 3rd, 4th-year students. Semi-directed interviews with open-ended questions in-depth. Clinical-qualitative content analysis, free-floating readings with psychodynamic concepts. Results were validated by peers at the Laboratory of Clinical-Qualitative Research.

Results

Emergent categories: 1) between procrastination and despair: the process of stress in procrastination; 2) a proving mechanism: procrastination as an emotional defense; 3) a very delicate rumination: between procrastination and mere delay, an emotional dilemma; 4) this conflict is painful: the confrontation between the desire to comply with tasks with excellence and the enjoyment of life.

Conclusions

Procrastination is reported by students as a source of great tension generated by opposing forces and desires, in which exhaustion is eventually reached. There are emotional contradictions related to guilt for leaving tasks to the last moment and the need to live other things besides doing academic tasks. Procrastination is a message-metaphor. It is important that institutions listen to students to understand what procrastination is saying about them.

Disclosure

No significant relationships.

Ischaemic stroke caused by Group B Streptococcus associated meningoencephalitis in young, immunocompetent adults - a case series and systematic review of literature

A 51-year-old man presented with mild headache followed by sudden onset of right sided weakness and dysarthria on the background of one week history of right sided sciatica and malaise. He was apparently immunocompetent with only past medical history being hypertension. There was no consumption of tobacco or excess alcohol and he previously had normal liver and renal function.

HFIP Mediates a Direct C-C Coupling between Michael Acceptors and Eschenmoser's salt

A direct C-C coupling process merging Michael acceptors and Eschenmoser's salt is presented. Albeit reminiscent of the Morita-Baylis-Hillman reaction, this process requires no Lewis base catalyst. The underlying mechanism could be unveiled by a combination of kinetic, isotopic labelling experiments as well as computational investigations, showcasing the critical role of HFIP as a superior mediator for proton transfer events as well as the decisive role of the halide counterion.

Leadless pacemaker patients following cardiac valve intervention in a long-term follow-up

Introduction

Leadless pacemakers (LPM) have demonstrated adequate electrical performance and safety in patients with multiple commorbidities such as heart valve replacements at short-term follow-up.

Purpose

We present our experience in patients with LPM and heart valve replacements at long-term follow-up.

Methods

This was a prospective observational study including all consecutive LPM implantation from June 1 2005 to March 15 2021. Clinical, electrical, echocardiographic characteristics, related complications and electrical parameters were compared in 2 different groups with and with-out valve surgical procedure.

Results

A total of 255 LPM were implanted. Clinical, electrical and echocardiographic characteristics are described in table 1. Mean follow-up was of 24 months. There were no significant differences in electrical performance or related complications in between both groups (Figure 1).

Conclusions

Electrical performance and complications were no significantly different between both groups with and without heart valve replacements.

Funding Acknowledgement

Type of funding sources: None.

Leadless pacemaker implantation after transcatheter aortic valve implantation, should we go simple?

Funding Acknowledgements

Type of funding sources: None.

Introduction

Transcatheter aortic valve implantation (TAVI) is a valvular replacement that has been developed as an alternative in patients with high and intermediate risk. One of the more frequent complications are new on-set conduction abnormalities.

Purpose

The purpose of the study was to evaluate the performance of leadless pacemakers (LPM) after TAVI and compare it with conventional pacemaker implantations (VVI- PM).

Methods

This was a prospective observational study that included all consecutive patients in which a TAVI and a PM was implanted during the same hospitalization (January 1 2015 to December 31 2020). Clinical, echocardiographic, ECG at implant characteristics, and related complications were described.

Results

 From a total of 126 patients (21.3%) with PM implantation: 2 required cardiac resynchronization system, 73 DDD-PM, 29 VVI-PM, 22 LPM. Clinical and echocardiographic characteristics are described in table 1. Main follow-up was of 12 months and 22 patients (79.7%) developed AF. Electrical parameters were stable in conventional and LPM. Total mortality was of 33 patients (26.2%), there was one case of infectious endocarditis in a DDD-PM, and there were no complications in LPM patients.

Conclusions. New on-set of conductions abnormalities are one of the main related complications in TAVI patients. In our study, patients with LPM had a safe performance with low complications rate. Table 1 DDD-PM (73) VVI-PM(29) LPM(22) p Age 84.2 83,1 79,4 0.1753 Men 35 (47.9%) 19 (65,5%) 12 (54,5%) 0.108746 Hypertension 67 (91.8%) 23 (79,3%) 10 (45,4%) 0.077846 Diabetes Mellitus 19 (26%) 12 (41,4%) 7 (31,8%) 0.128362 COPD 13 (17.8%) 7 (24.1%) 4 (18.2%) 0.073172 Renal insufficiency 15 (20.5%) 9 (31%) 10 (45,4%) 0.260054 AF 13 (17.8%) 27 (93.1%) 21 (95.4%) &lt; 0.00001 Ischemic cardiomiopathy 24 (32.9%) 16 (55.2%) 7 (31.8%) 0.063504 LVEF 57.5 56 59 0.298312 Sinus Rhythm at implant 72 (98.6%) 2 (6.9%) 1 (4.5%) &lt; 0.00001 RBBB Pre-TAVI 22 (30.1%) 3 (10.3%) 7 (31.8%) 0.06561 AF at follow-up 11 (15.1%) 28 (96.6%) 22 (100%) &lt; 0.00001 Mortality 14 (19.2%) 14 (48.3%) 5 (22.7%) 0.002973 Complications 4 (5.5%) 1 (3.4%) 0 0.668225 Clinical, electrical and echocardiographic characteristics.

One-center experience in leadless pacemakers after heart valve replacement

Funding Acknowledgements

Type of funding sources: None.

Introduction

Leadless pacemakers (LPM) have demonstrated adequate electrical performance and safety in patients with multiple commorbidities. Limited information has been published about patients with LPM and heart valve replacements.

Purpose

We were interested to present our experience in patients with LPM and heart valve replacements.

Methods

This was a prospective observational study in which we include all consecutive LPM implantation in a 5 year period (June 1 2005 to January 1 2020). Clinical, electrical and echocardiographic characteristics were described and evaluated in 2 different groups with and with-out surgical procedure.

Results

A total of 242 LPM were implanted. We describe clinical and echocardiographic characteristics in patients table 1. There were no significant differences in electrical performance in between both groups (Figure 1).

Conclusions

In our series with LPM we observed adequate electrical performance as well as safety at implant and follow-up in patients with heart valve replacements. No valve procedure185Valve procedure61pAge79.2 (±6.4)79.7 (±8)0.6395Men114340.78866Hypertension151440.899914Diabetes Mellitus58190.635131COPD3470.345258Renal insufficiency29160.000717Ischemic cardiomiopathy36140.495789LVEF59.9 (±7.6)590.036577Single mechanical replacement18Single bioprosthetic replacement12Bioprosthetic valve + TV annuloplasty3Bioprosthetic valve + MV & TV annuloplasty1Mechanical valve + TV annuloplasty2Sigle MV annuloplasty1MV & TV annuloplasty2Abstract Figure.

Esc2 orchestrates substrate-specific sumoylation by acting as a SUMO E2 cofactor in genome maintenance

In this study, Li et al. set out to investigate the conserved genome stability factor Esc2 in budding yeast and its roles in DNA damage-induced sumoylation. Using in vitro and in vivo approaches, the authors propose that Esc2 acts as a SUMO E2 cofactor at distinct DNA structures to promote the sumoylation of specific substrates and genome maintenance.

SUMO modification regulates diverse cellular processes by targeting hundreds of proteins. However, the limited number of sumoylation enzymes raises the question of how such a large number of substrates are efficiently modified. Specifically, how genome maintenance factors are dynamically sumoylated at DNA replication and repair sites to modulate their functions is poorly understood. Here, we demonstrate a role for the conserved yeast Esc2 protein in this process by acting as a SUMO E2 cofactor. Esc2 is required for genome stability and binds to Holliday junctions and replication fork structures. Our targeted screen found that Esc2 promotes the sumoylation of a Holliday junction dissolution complex and specific replisome proteins. Esc2 does not elicit these effects via stable interactions with substrates or their common SUMO E3. Rather, we show that a SUMO-like domain of Esc2 stimulates sumoylation by exploiting a noncovalent SUMO binding site on the E2 enzyme. This role of Esc2 in sumoylation is required for Holliday junction clearance and genome stability. Our findings thus suggest that Esc2 acts as a SUMO E2 cofactor at distinct DNA structures to promote the sumoylation of specific substrates and genome maintenance.

Saturn-ring proton backlighters for the National Ignition Facility

Proton radiography is a well-established technique for measuring electromagnetic fields in high-energy-density plasmas. Fusion reactions producing monoenergetic particles, such as D³He, are commonly used as a source, produced by a capsule implosion. Using smaller capsules for radiography applications is advantageous as the source size decreases, but on the National Ignition Facility (NIF), this can introduce complications from increasing blow-by light, since the phase plate focal spot size is much larger than the capsules. We report a demonstration of backlighter targets where a "Saturn" ring is placed around the capsule to block this light. The nuclear performance of the backlighters is unperturbed by the addition of a ring. We also test a ring with an equatorial cutout, which severely affects the proton emission and is not viable for radiography applications. These results demonstrate the general viability of Saturn ring backlighter targets for use on the NIF.

A-29 Incidence of Invalid ImPACT Baseline Test Results on Initial and Follow-up Assessments among English-Speaking, Spanish-Speaking, and Bilingual Test-takers

Objective

To identify the rate of ImPACT baseline test results falling below cut-offs for invalidity indicators among English-speaking, Spanish-speaking, and bilingual-speaking, individuals, upon initial assessment and on a follow-up baseline.

Method

Participants were a large sample of test-takers who completed annual ImPACT baseline assessments in Greater Houston, TX, as a requirement for participation in club- or school-sponsored athletics. Participants were 12–18 years old (mean 15.3, SD = 1.5), predominantly male (69%), and assigned to independent groups on the basis of primary/secondary language: English (N = 9332), English/Spanish (N = 1380), or Spanish (N = 4720). A sub-sample of each group (English N = 815, English/Spanish N = 173, Spanish N = 63) completed 2 baseline assessments (mean 1.2 years between tests, SD = 0.55 years).

Results

Chi-square analysis revealed a significantly greater likelihood [X2(2) = 28.05; p &lt; .001] of obtaining an invalid baseline for individuals with Spanish as a First (6.3%) or Second (6.9%) Language as compared to individuals speaking only English (4.8%), with an overall rate of 5.6% across all three groups. Upon re-assessment, 5.7% of English, 19% of English-Spanish, and 0% of Spanish-speakers obtained a second “invalid” assessment. The Three Letters (Total Correct &lt; 8) and Design Memory (Learning Percentage &lt; 50) indicators were the most common contributing indicators, across all three groups.

Conclusions

Primary language appears to be a contributing factor in scoring below cut-offs for invalidity indicators, especially for bilingual English-Spanish speakers. The continued rate of invalidity for the English-Spanish speakers on follow baseline assessments also warrants further review. Given the retrospective nature of this study, potential influences of acculturation and language proficiency were not available and therefore, could not be assessed.

The ZGRF1 Helicase Promotes Recombinational Repair of Replication-Blocking DNA Damage in Human Cells

Replication-blocking DNA lesions are particularly toxic to proliferating cells because they can lead to chromosome mis-segregation if not repaired prior to mitosis. In this study, we report that ZGRF1 null cells accumulate chromosome aberrations following replication perturbation and show sensitivity to two potent replication-blocking anticancer drugs: mitomycin C and camptothecin. Moreover, ZGRF1 null cells are defective in catalyzing DNA damage-induced sister chromatid exchange despite accumulating excessive FANCD2, RAD51, and γ-H2AX foci upon induction of interstrand DNA crosslinks. Consistent with a direct role in promoting recombinational DNA repair, we show that ZGRF1 is a 5'-to-3' helicase that catalyzes D-loop dissociation and Holliday junction branch migration. Moreover, ZGRF1 physically interacts with RAD51 and stimulates strand exchange catalyzed by RAD51-RAD54. On the basis of these data, we propose that ZGRF1 promotes repair of replication-blocking DNA lesions through stimulation of homologous recombination.

Liquid Chromatographic Method for Determining Capsaicinoids in Capsicums and Their Extractives: Collaborative Study

Sixteen laboratories participated in an AOAC–American Spice Trade Association (ASTA) collaborative study of a liquid chromatographic (LC) method for determining capsaicinoids in capsicums and their extractives. Capsicums are extracted with ethanol by refluxing and then filtered. Capsaicinoids in the filtrate are separated by re- versed-phase LC and detected spectrophotometri� cally with external standard quantitation. Participants analyzed 6 ground capsicum and 3 oleoresin products as 12 samples from a mixed scheme of blind duplicates and Youden matched pairs. Average repeatability and reproducibility standard deviations (sr and sR, respectively) and average relative standard deviations (RSDr and RSDR, respectively) for ground red pepper were as follows: sr, 610 Scoville heat units (SHU); sR, 1730 SHU; RSDr, 1.7%; RSDR, 4.9%. For ground chili peppers, the values were sr, 60 SHU; sR, 160 SHU; RSDr, 4.0%; RSDR, 10.6%. For oleoresin red pepper, the averages were sr, 46820 SHU; sR, 54990 SHU; RSDr, 8.5%; RSDR, 11.2%. The LC method has been adopted first action by AOAC INTERNATIONAL.

Hyperglycemia Aggravates Diet-Induced Coronary Artery Disease and Myocardial Infarction in SR-B1-Knockout/ApoE-Hypomorphic Mice

Diabetes is a risk factor for development of atherosclerotic cardiovascular disease. Animal model studies in mice revealed that hyperglycemia increases development of atherosclerosis in the aorta as well as myocardial fibrosis in surgical models of coronary artery ligation; however, the impact of hyperglycemia on coronary artery atherosclerosis and subsequent heart disease is less clear. To investigate the effect of hyperglycemia on atherosclerosis and coronary heart disease, we used a mouse model of diet-induced coronary artery atherosclerosis and myocardial infarction, the high fat/high cholesterol (HFC) diet fed SR-B1 knockout (KO)/apoE-hypomorphic (HypoE) mouse. Hyperglycemia was induced in these mice by streptozotocin (STZ) treatment. This increased HFC diet-dependent atherosclerosis development (p = 0.02) and necrotic core formation (p = 0.0008) in atherosclerotic plaques in the aortic sinus but did not increase the extent of atherosclerosis in coronary arteries. However, it did increase the extent of platelet accumulation in atherosclerotic coronary arteries (p = 0.017). This was accompanied by increased myocardial fibrosis (p = 0.005) and reduced survival (p = 0.01) compared to control-treated, normoglycemic mice. These results demonstrate that STZ-treatment exerted differential effects on the level of atherosclerosis in the aortic sinus and coronary arteries. These results also suggest that SR-B1-KO/HypoE mice may be a useful non-surgical model of diabetic cardiomyopathy in the context of coronary artery atherothrombosis.

Angiotensin-(1-9) reduces cardiovascular and renal inflammation in experimental renin-independent hypertension

Hypertension-induced cardiovascular and renal damage can be mediated by activation of the renin-angiotensin-aldosterone system. There are different factors beyond renin-angiotensin-aldosterone system involved in hypertension and renal damage. Inflammation has emerged as an important mediator of hypertension and cardiovascular and kidney damage. Angiotensin-(1-9), a peptide of the renin-angiotensin system, counter-regulates both the physiological and pathological actions of angiotensin II. Recent data has shown that angiotensin-(1-9) protects the heart and blood vessels from adverse cardiovascular remodeling in experimental models of hypertension and/or heart failure and reduces cardiac fibrosis in stroke-prone, spontaneously hypertensive rats. These effects are mediated by the angiotensin II type 2 receptor (AT2R). However, it remains unknown whether angiotensin-(1-9) also has an anti-inflammatory effect. In the present study, we investigate whether angiotensin-(1-9) reduces inflammation and fibrosis in the heart, arteries, and kidney in a DOCA-salt hypertensive model and explore the mechanisms underlying the amelioration of end-organ damage. DOCA-salt hypertensive rats received: a) vehicle, b) angiotensin-(1-9), c) PD123319 (AT2R blocker), d) angiotensin-(1-9) plus A779 (a Mas receptor blocker) or e) angiotensin-(1-9) plus PD123319, and sham rats were used as a control. Our results showed that angiotensin-(1-9) decreased hypertension and increased vasodilation in DOCA-salt hypertensive rats. These actions were partially inhibited by PD123319. Moreover, angiotensin-(1-9) decreased diuresis, fibrosis, and inflammation. These beneficial effects were not mediated by Mas or AT2R blockers. We concluded that angiotensin-(1-9) protects against volume overload-induced hypertensive cardiovascular and kidney damage by decreasing inflammation in the heart, aortic wall, and kidney, through mechanisms independent of the Mas or AT2R.

Clinical Significance of Cathepsin D Concentration in Tumor Cytosol of Primary Breast Cancer

Background

Cathepsin D is the proteolytic enzyme most frequently implicated as a prognostic factor in primary breast cancer. In the present study we evaluated by means of an immunoradiometric assay the tumor content of this protease in primary breast cancer, its relationship with tumor-related clinical and pathological parameters, and its prognostic significance in a large series of breast cancer patients.

Method

The study comprised 1033 women with histologically established invasive breast cancer. Cathepsin D was measured in cytosol samples by means of an immunoradiometric assay to determine the total amount of cathepsin D (52 kDa, 48 kDa and 34 kDa). Evaluation of relapse-free survival and cause-specific survival was performed in the group of 1003 patients without evidence of metastasis at the time of initial diagnosis. The median follow-up of the patients who were free of recurrence was 54 months.

Results

Cathepsin D levels showed a wide range among the studied tumors (n=1033; median (range) 41 (0.9–2504) pmol/mg protein). Statistical analysis showed that the median cathepsin D levels were considerably higher in large tumors (T2–4) than in smaller ones (T1) (p=0.017), as well as in node-positive than in node-negative tumors (p=0.004). Cathepsin D levels were also higher in ductal tumors than in the other histological types (p=0.001), as well as in moderately or poorly differentiated tumors (p<0.001). Likewise, the median value of the protease was significantly higher in ER or PgR-positive tumors than in hormone receptor-negative ones (p=0.011 and p=0.004, respectively), as well as in aneuploid tumors than in diploid tumors (p=0.029). Multivariate analysis demonstrated that elevated cathepsin D levels (>59 pmol/mg protein) were notably associated with a shorter cause-specific survival in the whole group of patients with breast cancer, as well as in the subgroup of node-positive patients (p<0.05).

Conclusions

This study suggests that elevated intratumoral cathepsin D levels may identify a subset of node-positive breast cancer patients showing a high probability of earlier death.

Sphingosine-1-Phosphate Receptor 1, Expressed in Myeloid Cells, Slows Diet-Induced Atherosclerosis and Protects against Macrophage Apoptosis in Ldlr KO Mice

We generated myeloid specific sphingosine-1-phosphate receptor 1 (S1pr1) deficient mice by crossing mice that had myeloid specific expression of Cre recombinase (lyzM^Cre) with mice having the S1pr1 gene flanked by loxP recombination sites. We transplanted bone marrow from these mice and control lyzM^Cre mice with intact macrophage S1pr1 gene expression into low-density lipoprotein (LDL) receptor gene (Ldlr) deficient mice. The resulting chimeras were fed a high fat atherogenic diet for nine or twelve weeks and evaluated for atherosclerosis development in the aortic sinus. Selective S1pr1 deficiency in bone marrow-derived myeloid cells resulted in accelerated development of atherosclerosis, necrotic core formation and the appearance of apoptotic cells within atherosclerotic plaques of Ldlr knockout mice in response to a high fat diet. Examination of macrophages in culture revealed that the sphingosine-1-phosphate receptor 1 selective agonist, SEW2871 or high density lipoprotein (HDL), protected macrophages against apoptosis induced by endoplasmic reticulum (ER) stress or oxidized LDL, through activation of phosphatidylinositol-3-kinase/Akt signaling. Targeted S1pr1-deletion prevented Akt activation and protection against apoptosis by either SEW2871 or HDL. Our data suggests that sphingosine-1-phosphate receptor 1 in macrophages plays an important role in protecting them against apoptosis in vitro and in atherosclerotic plaques in vivo, and delays diet induced atherosclerosis development in Ldlr deficient mice.

Abstract 602: High-Density Lipoprotein Protects Macrophages Against Apoptosis Through BH3-only Bcl-2 Family Member Bim

Macrophage apoptosis contributes to the formation of necrotic cores within atherosclerotic lesions, increasing the susceptibility of atherosclerotic plaques to rupture and the risk of cardiovascular events. In advanced atherosclerotic plaques, lipid-laden foam cells are exposed to a diverse number of apoptosis inducers, including prolonged endoplasmic reticulum (ER) stress. The pro-apoptotic BH3-only protein Bim has been reported to mediate apoptosis in response to ER stress induction in a variety of cells including macrophages. Treatment of macrophages with high-density lipoprotein (HDL) protects them against apoptosis induced by a variety of stressors. We hypothesize that HDL mediated protection against macrophage apoptosis occurs via pathways that regulate Bim activity. To test this, thioglycollate-elicted peritoneal macrophages were treated in lipoprotein deficient culture with different apoptosis inducers in the absence or presence of HDL. Cell apoptosis was assessed by cleaved caspase 3 staining and terminal deoxynucleotidal transferase dUTP nick end labeling. Treatment of mouse peritoneal macrophages in culture with 50μg/ml of human HDL protected against apoptosis induced by tunicamycin (P<0.05) without affecting ER stress markers, Grp78, Grp94 and CHOP. Peritoneal macrophages from mice deficient in Bim were less susceptible to apoptosis induced by treatment with either tunicamycin or 7-ketocholesterol. Furthermore, treatment with HDL provided no additional protection to apoptosis in Bim KO macrophages. Our results suggest that protection of macrophage apoptosis by HDL is regulated through pathways involving the activity of BH3-only Bcl-2 family member Bim.

The cat and the mouse game: Is there a shift towards more dangerous substances in the cathinone illicit market?

Introduction

After mephedrone's ban in March 2010 new cathinones proliferated widely, even a new branch of atypical derivatives was launched into the market, represented by MDPV. The cardiovascular and central nervous system toxicity draws attention to this new family of cathinones, also known as pyrovalerones. MDPV was scheduled in 2011, leading to the apparition of Alpha-PVP from which there is little information.

Objectives

The aim of the present study is to describe the evolution of different cathinones in the samples delivered for analysis to the harm reduction NGO energy control from March 2009 to March 2016 in Spain.

Methods

Energy control is a Spanish harm reduction NGO that offers to drug users the possibility of analyzing the substances they intend to consume. From March 2009 to March 2016 a total of 24,528 samples were analyzed by the NGO from which 760 contained cathinones. Substance analysis was done by gas chromatography–mass spectrometry.

Results

From 2009 to 2016, cathinones represented a 2.82% from all analyzed samples. From March 2009 to March 2010, only 5 different cathinones were detected, in this same period methylone (n = 16; 37.20%) and mephedrone (n = 17; 39.53%) represented 76% of analyzed cathinones (n = 43). From March 2015 to March 2016, 132 cathinones were detected: methylone and mephedrone represented only 19.69%, giving prominence to clephedrone (n = 25; 18.93%) and Alpha-PVP (n = 24; 18.18%).

Conclusions

The evolution of synthetic cathinones detected by energy control is consistent with the evolution described in the literature. From 2009 to 2016, the cathinones detected diversify and new substances with higher toxicity potential appear.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Prospective assessment of cosmesis before and after genital surgery

INTRODUCTION

Little data exist about the surgical interventions taking place for children with disorders of sex development (DSD). Most studies that have evaluated cosmetic outcomes after genitoplasty have included retrospective ratings by a physician at a single center.

OBJECTIVE

The present study aimed to: 1) describe frequency of sex assignment, and types of surgery performed in a cohort of patients with moderate-to-severe genital ambiguity; and 2) prospectively determine cosmesis ratings by parents and surgeons before and after genital surgery.

STUDY DESIGN

This prospective, observational study included children aged <2 years of age, with no prior genitoplasty at the time of enrollment, moderate-to-severe genital atypia, and being treated at one of 11 children's hospitals in the United States of America (USA). Clinical information was collected, including type of surgery performed. Parents and the local pediatric urologist rated the cosmetic appearance of the child's genitalia prior to and 6 months after genitoplasty.

RESULTS

Of the 37 children meeting eligibility criteria, 20 (54%) had a 46,XX karyotype, 15 (40%) had a 46,XY karyotype, and two (5%) had sex chromosome mosaicism. The most common diagnosis overall was congenital adrenal hyperplasia (54%). Thirty-five children had surgery; 21 received feminizing genitoplasty, and 14 had masculinizing genitoplasty. Two families decided against surgery. At baseline, 22 mothers (63%), 14 fathers (48%), and 35 surgeons (100%) stated that they were dissatisfied or very dissatisfied with the appearance of the child's genitalia. Surgeons rated the appearance of the genitalia significantly worse than mothers (P < 0.001) and fathers (P ≤ 0.001) at baseline. At the 6-month postoperative visit, cosmesis ratings improved significantly for all groups (P < 0.001 for all groups). Thirty-two mothers (94%), 26 fathers (92%), and 31 surgeons (88%) reported either a good outcome, or they were satisfied (see Summary Figure); there were no significant between-group differences in ratings.

DISCUSSION

This multicenter, observational study showed surgical interventions being performed at DSD centers in the USA. While parent and surgeon ratings were discordant pre-operatively, they were generally concordant postoperatively. Satisfaction with postoperative cosmesis does not necessarily equate with satisfaction with the functional outcome later in life.

CONCLUSION

In this cohort of children with genital atypia, the majority had surgery. Parents and surgeons all rated the appearance of the genitalia unfavorably before surgery, with surgeons giving worse ratings than parents. Cosmesis ratings improved significantly after surgery, with no between-group differences.

Macrophage Apoptosis and Necrotic Core Development in Atherosclerosis: A Rapidly Advancing Field with Clinical Relevance to Imaging and Therapy

Cardiovascular diseases represent 1 of the main causes of death worldwide, and atherosclerosis is 1 of the major contributors leading to ischemic heart disease. Macrophages actively participate in all stages of atherosclerosis development, from plaque initiation to the transition to vulnerable plaques. Macrophage apoptosis, in particular, has been recognized as a critical step in the formation of the necrotic core, a key characteristic of unstable lesions. In this review, we discuss the role of macrophage apoptosis and clearance of apoptotic cells by efferocytosis in the development of atherosclerosis, with particular emphasis on their contribution to the development of the necrotic core and the clinical implications of this process for plaque stabilization. We consider the molecular triggers of macrophage apoptosis during atherogenesis, the role of endoplasmic reticulum (ER) stress, the roles of key cellular mediators of apoptosis and efferocytosis, and mechanisms of defective efferocytosis in the progression of atherosclerotic plaques. Finally, we discuss the important clinical implications of rapidly evolving macrophage science, such as novel approaches to imaging vulnerable atherosclerotic plaques with macrophage-sensitive positron emission tomography and magnetic resonance imaging, the role of macrophages in mediating beneficial pleiotropic actions of lipid-lowering therapies, and novel therapeutic modalities targeting ER stress, autophagy, and deficient efferocytosis. Advances in understanding the critical role of macrophages in the progression and destabilization of atherosclerosis have the potential to greatly improve the prevention and management of atherosclerotic diseases over the next decade.

Recovery position significantly associated with a reduced admission rate of children with loss of consciousness

BACKGROUND

Loss of consciousness (LOC) is often seen in children. The response of caregivers to a child with LOC has been poorly investigated. Potential caregivers (parents, teachers) seem to have a poor knowledge of the recovery position (RP)-that is, the position into which an unconscious child should be placed in order to protect the airway.

OBJECTIVES

To report the management and diagnoses of LOC in childhood, and to evaluate variables associated with an increased hospital admission rate.

METHODS

We conducted a prospective cohort study of consecutive children aged between 0 and 18 years diagnosed with LOC at 11 paediatric emergency departments (PEDs) of 6 European countries. The enrolment period was 3 months. Data were obtained from parental interviews, PED reports and clinical examination.

RESULTS

553 children were enrolled. The most frequent final diagnoses causing LOC were seizures (n=278, 50.3%), and vasovagal syncope (n=124, 22.4%). Caregivers put the child in the RP in 145 cases (26.2%). The RP was independently associated with a significant decrease in the admission rate (aOR=0.28; 95% CI 0.17 to 0.48; p<0.0001).

CONCLUSIONS

Our study demonstrates for the first time that the RP may reduce the admission rate of infants with LOC. Caregivers often perform inadequate manoeuvres when a child becomes unconscious. Campaigns aiming at increasing knowledge of the RP should be promoted.

Perceptual symptoms in the latino psychiatric patients attending inner city outpatient clinic

Introduction

Psychotic symptoms occur in a variety of psychiatric disorders and medical conditions. In addition, a significant proportion of the general population reports history of psychotic symptoms in the apparent absence of a psychiatric disorder. Reviewed literature suggests that Latino patients report certain forms of visual and auditory hallucinations without other indications of psychotic illness. In addition, it is common that some individuals with diverse religious or cultural backgrounds may present with psychotic transient experiences, which can be culturally normative.

Objective

To determine the prevalence of hallucinations and describe the nature of hallucinatory experiences in relation to cultural belief in Latino and non-Latino psychiatric outpatients.

Methods

We conducted a retrospective case control study of 146 patients who were admitted to the outpatient psychiatric clinic for a period of ten months. We assessed clinical characteristics of these patients and reviewed the extended mental status examination, which contained questions about various form of hallucinations and spiritual experiences. This poster will explore the prevalence of hallucinations in the Latino population and determine the percentage of patients with a diagnosis of psychotic illness. A discussion of the phenomenological hallucinatory experiences and its relationship to cultural beliefs in the Latino psychiatric patients will also be presented.

Conclusions

Psychotic symptoms present differently across cultures. The Latino population is most likely to have psychotic like symptoms related to their cultural beliefs. Clinicians must understand the diverse cultural experiences and beliefs of the patients they work with to prevent misdiagnosis of culturally normative experiences.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Evolution of diagnostic frequency in schizophrenia spectrum disorders in Acute Psychiatric Unit in Barcelona

Introduction

Several studies have suggested variations in the prevalence of schizophrenia spectrum disorders diagnosis across time. This could be due to a change in diagnostic practice motivated either for changes in DSM criteria as for local culture factors. The aim of this study is to explore the evolution of the schizophrenia spectrum disorders. We hypothesize that we would observe a transference from the schizophrenia diagnosis to psychosis not otherwise specified.

Methods

A retrospective review of all psychiatric discharges in acute unit in the INAD of Parc de Salut Mar of Barcelona, between 2002 and 2014 was performed, relating each discharge to its axis I psychiatric diagnostic. An ANOVA analysis was used to calculate the differences between the months and the frequency of the diagnosis.

Conclusion

We have not been able to observe any transference between diagnoses across years. We observe a decrease of the proportion of schizophrenic spectrum disorders in its prevalence at discharge from 2012 to 2014. The proportion of not otherwise specified psychosis remains quite constant as a third of the schizophrenia diagnoses.

Disclosure of interest

The authors report no conflict of interest in this study. LG is funded by the Instituto.de.Salud.Carlos.III (CM14/00111).

27 AN IMPROVED LARGE ANIMAL MODEL FOR THE STUDY OF ADULT STEM CELLS

Murine models for the study of adult stem cell populations have broadened the understanding of previously uncharacterized stem cell niches. The development of murine reporter lines for the leucine-rich repeat-containing G-protein-coupled receptor-5 (Lgr5) has highlighted the importance of this gene as a stem cell marker in the stomach, intestine, hair follicle, liver, and kidney in mice. These models however have significant limitations in terms of translational applications because of anatomical and physiological differences between humans and mice. In order to overcome these limitations, we have sought to develop a porcine LGR5 reporter line. We report the generation of a porcine stem cell reporter line using the combination of transcription activator-like effector nucleases and somatic cell NT. Transcription activator-like effector nuclease-mediated homologous recombination was used to drive the integration of an internal ribosome entry site green fluorescent protein fusion into the 3′ untranslated region of the LGR5 locus in porcine fetal fibroblast cells. Multiple cell lines were developed and screened for the proper integration event. Upon confirmation of proper integration by genomic DNA sequencing, these lines were used as donors for somatic cell NT. Transfer of the somatic cell NT reconstructed embryos to a surrogate gilt resulted in 3 live births, and the establishment of a founder line of LGR5-green fluorescent protein reporter pigs. We have begun to characterise these lines, having observed fluorescent labelling of putative stem cell populations in the intestinal crypts and hair follicles from these animals. Many of these observations parallel the expression patterns observed in similar murine models. We have confirmed the fluorescent reporter signal by immunohistochemistry using an anti-green fluorescent protein antibody, and are working towards colocalization studies using anti-LGR5 antibodies and RNA in situ hybridization, as well as the characterisation of additional stem cell populations in the pig. The development of this line of transgenic pigs represents significant progress toward the study of adult stem cells, their progenitors, and the stem cell niche, using a large animal model with an anatomy, physiology, and ability to recapitulate human disease that overcomes the current limitations of rodent models. Funding was provided by NIH R21OD019738.

42 DIFFUSION OF THE CRYOPROTECTANTS ETHYLENE GLYCOL AND GLYCEROL INTO DAY 9 TO 11 EQUINE EMBRYOS: PRELIMINARY RESULTS

The impermeability of the capsule to cryoprotectants (CPA) has been blamed for poor cryosurvival of equine embryos. We hypothesised that ethylene glycol, with its lower molecular weight and higher permeability, would be preferred over glycerol for equine embryos. The purpose of this study was to determine concentrations of glycerol and ethylene glycol within equine blastocoele fluid of Day 9 to 11 equine embryos following 30 min of exposure to a 1.5 M solution. Fourteen grade 1 embryos were recovered from May through September, using standard transcervical lavage techniques. Day of ovulation (Day 0) was determined as first appearance of the corpus luteum by daily transrectal ultrasonography, following insemination and administration of an ovulatory induction agent (Chorulon, 2500 IU; Intervet, Canada). Embryos were graded, measured, and washed in holding media (emP3TM Partnar Animal Health, Ontario, Canada), blocked by age, and randomly assigned to either 1.5 M ethylene glycol in holding solution (EG; n = 7) or 1.5 M glycerol in holding solution (Gly; n = 7) each containing 1% dimethyl sulfone as the internal standard, for 30 min at room temperature. Following CPA exposure, embryos were moved to a sterile, dry dish, all fluid was removed with a micropipette, and the dish dried with fine tissue. The embryonic capsule was punctured, and aspirated blastocoele fluid was analysed for CPA concentration by gas chromatography using a CP-3800 gas chromatograph (Varian Canada Inc., Mississauga, Ontario, Canada). The CPA concentration was determined by comparing the internal standard count to the accumulated CPA in millimoles per liter by gas chromatograph. A two-sample Kolmogorov-Smirnov test for equality of distribution was used because data were not normally distributed. Post-hoc 2-way t-test with unequal variances was used to compare mean effective CPA concentration across treatments, with significance set at P = 0.05. Collected embryos ranged from 1470 μm to 9240 μm in diameter, but there was no difference in embryo size between groups (P = 0.59). Mean concentrations of EG from blastocoele fluid were significantly higher than Gly (71.58 ± 18.9 mmol L–1 v. 50.71 ± 11.2 mmol L–1, respectively; P = 0.016). This represents 4.8 and 3.4% of available CPA, respectively. Mean EG concentrations by embryo age were not different (Day 9: 68.3 ± 23.1 mmol L–1; Day 10: 83.0 ± 15.4 mmol L–1; Day 11: 71.0 ± 21.9 mmol L–1; P = 0.75). Mean Gly concentrations by embryo age were not different (Day 9: 47.0 ± 12.7 mmol L–1; Day 10: 46.0 ± 7.1 mmol L–1; Day 11: 56.3 ± 13.6 mmol L–1; P = 0.35). The low concentrations of EG and Gly found in this preliminary study are in agreement with indirect evidence from other studies. Ethylene glycol reached higher concentrations inside the embryo than glycerol because of lower molecular weight and higher permeability. However, permeation appeared to be minimal for both agents despite exposure to solutions of high CPA molarity.

Correction: Orbital entanglement and CASSCF analysis of the Ru-NO bond in a Ruthenium nitrosyl complex

Correction for ‘Orbital entanglement and CASSCF analysis of the Ru–NO bond in a Ruthenium nitrosyl complex’ by Leon Freitag et al., Phys. Chem. Chem. Phys., 2015, DOI: ; 10.1039/c4cp05278a.