Residential exposure associations with ALS risk, survival, and phenotype: a Michigan-based case-control study

Background: Environmental exposures impact amyotrophic lateral sclerosis (ALS) risk and progression, a fatal and progressive neurodegenerative disease. Better characterization of these exposures is needed to decrease disease burden. Objective: To identify exposures in the residential setting that associate with ALS risk, survival, and onset segment. Methods: ALS and control participants recruited from University of Michigan completed a survey that ascertained exposure risks in the residential setting. ALS risk was assessed using logistic regression models followed by latent profile analysis to consider exposure profiles. A case-only analysis considered the contribution of the residential exposure variables via a Cox proportional hazards model for survival outcomes and multinomial logistic regression for onset segment, a polytomous outcome. Results: This study included 367 ALS and 255 control participants. Twelve residential variables were associated with ALS risk after correcting for multiple comparison testing, with storage in an attached garage of chemical products including gasoline or kerosene (odds ratio (OR) = 1.14, padjusted < 0.001), gasoline-powered equipment (OR = 1.16, padjusted < 0.001), and lawn care products (OR = 1.15, padjusted < 0.001) representing the top three risk factors sorted by padjusted. Latent profile analysis indicated that storage of these chemical products in both attached and detached garages increased ALS risk. Although residential variables were not associated with poorer ALS survival following multiple testing corrections, storing pesticides, lawn care products, and woodworking supplies in the home were associated with shorter ALS survival using nominal p values. No exposures were associated with ALS onset segment. Conclusion: Residential exposures may be important modifiable components of the ALS susceptibility and prognosis exposome.

Avocational exposure associations with ALS risk, survival, and phenotype: A Michigan-based case-control study

INTRODUCTION

Environmental exposures strongly influence ALS risk and identification is needed to reduce ALS burden. Participation in hobbies and exercise may alter ALS risk and phenotype, warranting an assessment to understand their contribution to the ALS exposome.

METHODS

Participants with ALS and healthy controls were recruited from University of Michigan and self-completed a survey to ascertain hobbies, exercise, and avocational exposures. Exposure variables were associated with ALS risk, survival, onset segment, and onset age.

RESULTS

ALS (n = 400) and control (n = 287) participants self-reported avocational activities. Cases were slightly older (median age 63.0 vs. 61.1 years, p = 0.019) and had a lower educational attainment (p < 0.001) compared to controls; otherwise, demographics were well balanced. Risks associating with ALS after multiple comparison correction included golfing (odds ratio (OR) 3.48, padjusted = 0.004), recreational dancing (OR 2.00, padjusted = 0.040), performing gardening or yard work (OR 1.71, padjusted = 0.040) five years prior to ALS and personal (OR 1.76, padjusted = 0.047) or family (OR 2.21, padjusted = 0.040) participation in woodworking, and personal participation in hunting and shooting (OR 1.89, padjusted = 0.040). No exposures associated with ALS survival and onset. Those reporting swimming (3.86 years, padjusted = 0.016) and weightlifting (3.83 years, padjusted = 0.020) exercise 5 years prior to ALS onset had an earlier onset age.

DISCUSSION

The identified exposures in this study may represent important modifiable ALS factors that influence ALS phenotype. Thus, exposures related to hobbies and exercise should be captured in studies examining the ALS exposome.

Oral impacts on daily performance: Validity, reliability and prevalence estimates among Indian adolescents

BACKGROUND

Dental diseases negatively influence people's oral health-related quality of life and thus their perceived need for dental care.

OBJECTIVES

To test the validity and reliability of an Indian version of Oral Impacts on Daily Performance (OIDP) index for college students and to identify age and sex-specific OIDP prevalence estimates.

METHODS

Cross-sectional descriptive survey was conducted among 800 professional and non-professional bachelor degree college students of Udaipur, India aged between 17 and 24 years. Oral health-related quality of life among the college students was assessed through OIDP, tested for validity and reliability and then prevalence rates were estimated. Chi square test was employed for statistical analysis. Cronbach's alpha was found to be 0.82.

RESULTS

Sixty percent subjects reported at least one oral impact in last 6 months with overall mean OIDP score of 2.49±3.92. The most commonly affected performances were cleaning teeth (24%) and eating (12%). A significant association in oral impacts on daily performances among college students was observed with age (P=.001) but not with gender (P=.053).

CONCLUSIONS

The validity and reliability of OIDP and also the prevalence of oral health-related impacts were found to be high. OIDP index showed acceptable psychometric properties in the context of an oral health survey among Indian college students.

Epidemiological and survival analysis of triple-negative breast cancer cases in a retrospective multicenter study

INTRODUCTION

This is a retrospective study with data collected from breast cancer cases from five major Apollo Hospitals across India, as part of a biobanking process. One aspect of our study focused specifically on data from triple-negative breast cancer (TNBC) cases. The aim of this study was to analyze epidemiology, treatment options, and survival of the patients with TNBC. Our goal was to draw conclusions on the preponderance of the disease and also to understand the outcomes using the existing therapy options.

MATERIALS AND METHODS

Data were collected after due ethical clearances and were coded with regard to patient identifiers to protect patient privacy. Data were not only from the various departments of the respective hospitals and the treating physicians but also from the follow-up made by hospital staff and social workers.

RESULTS

About 20% of all cases of breast cancer comprised TNBC. Although the disease is generally thought to be an early onset disease, there was no major difference in the median age of diagnosis of TNBC compared to other breast cancer cases. More than 85% of the TNBC cases were of early stage disease with <4% of the cases of metastatic cancer. Data on follow-up were somewhat sporadic as a good number of cases were lost to follow-up, but from the available data, recurrence rate was about 11%. Death, when it occurred, was mostly in the early periods of treatment with 35% of the events occurring before 3 years. The overall survival rates beyond 3 years were more than 86%.

CONCLUSIONS

Data and sample collection are an ongoing process, so we expect this data set to be enriched with more cases and longer duration of follow-up in a year. Preliminary analysis sheds light on the potential of such a collection both for understanding the epidemiology of the disease and also for conducting future studies with an eye toward improving treatment outcomes.

Familial Hypodontia: A Case Series

The phenomenon of congenitally missing teeth has been described with different names: hypodontia, oligodontia, anodontia, congenitally missing teeth and dental agenesis. The present paper reports familial hypodontia, involving two siblings from a single family. Case I reported the absence of 18, 12, 22 and 31 teeth whereas case II reported the absence of 31 and 41. On the evaluation of the two reported cases that were offspring of same parents and absence of any clinical features associated with any syndrome the final diagnosis of non- syndromic familial hypodontia was made. Both the cases presented agenesis of the teeth leading to malocclusion and aesthetic disturbances. Cases were offered a treatment of interdisciplinary dental approach.

A randomised comparison of lidocaine 2% gel and proparacaine 0.5% eye drops in paediatric squint surgery

We conducted a randomised trial comparing lidocaine 2% gel with proparacaine 0.5% eye drops in children having elective squint surgery. One hundred and forty children aged between 3 and 14 years were recruited. The requirement for intra-operative fentanyl and postoperative ibuprofen was significantly less in the lidocaine group compared with the proparacaine group (1 (1.7%) vs 12 (18.5%), p=0.002 and 16 (27.6%) 38 (58.5%), p=0.001, respectively). The incidence of postoperative nausea and vomiting was significantly less in the lidocaine group compared with the proparacaine group (6 (10.3%) vs 16 (24.6%), p=0.04). There were no differences between the groups in terms of incidence and severity of the oculocardiac reflex. We conclude that, compared with proparacaine 0.5% eye drops, a single application of lidocaine 2% gel improves peri-operative analgesia and reduces the incidence of postoperative nausea and vomiting in elective paediatric squint surgery.

[Meningiomas. Clinical case examples]

Using four case reports as examples the best treatment is discussed by considering the specific history and magnetic resonance imaging (MRI) findings. In many cases different therapeutic alternatives are possible for treatment of meningiomas.

Interferon-alpha--a new therapeutic option in refractory juvenile Behçet's disease with CNS involvement

OBJECTIVE

To report the successful treatment with recombinant human IFN- alpha 2a (rhIFN-alpha2a) in two male adolescents suffering from severe treatment-resistant Behçet's disease (BD) with central nervous system (CNS) involvement.

METHODS

The patients were 14- and 15-yrs old. Both met the International Study Group for Behçet's disease, O'Duffy and the Japanese criteria for the classification or diagnosis of BD. Signs of CNS involvement were impaired sensorimotor function of the left arm, hemiparesis of right arm and leg, dizziness and walking instability in Patient 1, weakness of both legs, impaired bladder-, bowel- and sexual function in Patient 2 and vasculitic lesions on cranial MRI in both patients. RhIFN-alpha2a was administered initially at 3 million IU/day for 4 weeks followed by 3 x 3 million IU/week.

RESULTS

Complete remission was achieved in Patient 1 (reduction in BD activity score from 17 to 2). Patient 2 experienced remarkable improvement (reduction of BD activity score from 23 to 15). In both patients the MRI lesions improved. Patient 2 had mild flu-like symptoms as adverse effect.

CONCLUSION

RhIFN-alpha2a was effective and well tolerated in these juvenile patients with severe neurological BD. Regarding the serious consequences following ocular and CNS affection and adverse effects of steroid dependency, administration of rhIFN-alpha2a at an earlier time point needs to be considered.

Distal radius fracture management in the emergency departments in UK: are we doing enough?

The objective of this study was to ascertain knowledge of the normal anatomy and appreciation of components of an 'adequate' or 'acceptable' reduction by the medical staff responsible for management of distal radius fractures in the emergency departments (A&E) in UK. A nationwide structured questionnaire survey based on literature review was performed on 138 doctors. Of the 100 (72%) respondents, only 40% could cite the correct values for volar tilt, radial inclination and ulnar variance, there being a significant difference between orthopaedic, n = 16 (64%) and A&E staff, n = 24 (32%); p = 0.031; chi(2) = 12.17. Only 18% respondents were aware of the acceptable ranges of adequate reduction; with orthopaedic staff, n = 12 (48%) being more aware than A&E staff, n = 6 (8%); p = 0.002; chi(2) = 6.38. Only 19% formally measure the key parameters before decision making (52% orthopaedic vs. 8% A&E staff; p = 0.018; chi(2) = 7.31). Only 14% of respondents from hospitals equipped with picture archive navigation system stated that they used the angle measurement function.A lack of knowledge of the normal anatomical values and implementation of generally accepted measurement criteria predictive of fractures unlikely to benefit from repeat manipulations is evident. It is important to emphasise the influence of factors reported to affect stability such as age, functional demands of the patient and extent of initial fracture displacement in decision making. The introduction of a set of guidelines and further education of the medical staff could reduce the number of inappropriately treated distal radial fractures in the A&E setting with significant economic implications.

A new in-vitro agglutination technique for potency estimation of antisnake venom serum (ASVS)

Traditionally the potency of ASVS is assayed quantitatively by in-vivo neutralization test for lethality in mice. A sensitive and simple in-vitro agglutination assay for the quantitative determination of Antisnake Venom Serum (ASVS) potency is reported. The method is rapid, cheap, simple, economical and above all does not require the use of experimental animals for potency assay of in process, unpurified and purified sera batches. Among in-vitro procedures, agglutination assay was favored in comparison to flocculation as the later was found to give variable results and also time consuming (high Kf value). Before application, the method was standardized and validated for choice and concentration of particulate material (latex vs. bentonite), temperature and optimum antiserum concentration. It is well known fact that venoms lose toxicity on dilution however this study demonstrated that the bentonite adsorbed venoms of the entire four snake species viz., Cobra, Krait, Russell's viper and Echis are stable even up to 30 days of storage. Among five lots each of unpurified serum, unprocessed plasma and purified sera tested, the results were found comparable with universally accepted in-vivo biological assay. The coefficient of correlation was found to be near 1.0 within 95% fiducial limits of acceptance and also significantly less variation was observed in the mean potency values and standard deviations. For all results p value was observed to be <0.01. Results indicate that in-vitro agglutination assay is suitable and can be used for potency estimation of in process as well as unpurified and purified ASVS batches.

Vitality diagnostics and preventive medicine for the well-being of people at advanced age

This paper emphasises the importance of vitality diagnostics in relation to healthy ageing and prevention of age-associated diseases. Ageing, reducing the reserve capacity, decreases the adaptability of various systems and increases the risk of functional disorders. The early recognition and treatment of functional disorders in vitality diagnostics laboratories provides an opportunity to prevent or delay the onset of degenerative diseases related to advanced age.

HIV type 1 envelope subtype C sequences from recent seroconverters in Zimbabwe

HIV-1 envelope sequence patterns have implications for virus cell tropism and for the development of an effective vaccine. To identify the sequence characteristics of recently transmitted HIV-1 isolates in southern Africa, we sequenced the V3-V5 envelope regions of 24 male seroconverters in Harare, Zimbabwe. Each of the sequences clustered with previously reported subtype C isolates and there was a mean 17% intersequence pairwise genetic distance between the Zimbabwean isolates. Three isolates were syncytium inducing (SI). One of the SI isolates had an unusual GIGK crown and a deletion at codon 23; one had the codon 23 deletion alone; and one had a high net positive charge in the V3 loop. The extensive genetic diversity within the envelope of subtype C HIV-1 isolates must be considered in vaccine development. Further analysis of subtype C SI isolates and site-directed mutagenesis experiments are required to determine the molecular basis of SI activity in global HIV-1 isolates.

Primary subtype C HIV-1 infection in Harare, Zimbabwe

Heterosexual transmission of HIV-1 is widespread in Southern Africa. Heteroduplex mobility assays (HMA) and phylogenetic analyses of V3-V5 envelope (env) gene sequences demonstrate that subtype C predominates in Zimbabwe. To elucidate factors contributing to the epidemic in Zimbabwe, clinical and virologic characteristics of recently acquired subtype C HIV-1 infection among 21 men and 1 woman were determined. In 12 of 19 men providing clinical histories, a sexually transmitted infection preceded serologic evidence of HIV-1, and 14 of 19 men complained of rash or fever before seroconversion. Quantitative p24 antigen levels, reverse transcriptase activity, and HIV RNA levels of 22 viral isolates correlated with in vitro infectivity in peripheral blood mononuclear cells (p < .05). Biologic phenotype assessed in MT-2 cells demonstrated that 3 of 22 isolates (14%) were syncytia inducing (SI) and the remaining 19 nonsyncytium inducing (NSI). Early growth of virus in culture was associated with increased plasma HIV RNA levels, decreased CD4 cell levels, and SI virus. Recent subtype C HIV-1 infection through heterosexual transmission in Zimbabwe demonstrated clinical and virologic features consistent with reports of seroconversion to subtype B viruses.

Histologic comparison of breast implant shells with smooth, foam, and pillar microstructuring in a rat model from 1 day to 6 months

The purpose of this study was to determine the soft-tissue response to silicone breast implants with different surface morphologies and to correlate implant microtexturing with capsular formation. Using a rat model, we inserted breast implants having three types of shells: micropillared, silicone foam, and smooth silicone (control). We used 96 adult male Sprague-Dawley rats weighing between 250 and 300 gm. Thirty-two rats were assigned to each of the three shell groups. Within each shell group, 4 rats were implanted for 24 hours, 4 for 4 weeks, 4 for 8 weeks, 4 for 12 weeks, 4 for 16 weeks, 4 for 20 weeks, and 4 for 24 weeks. The rats were sacrificed at the end of each time interval, and periprosthetic tissue was obtained for histologic analysis. Our results show a stable soft-tissue response with some macrophages and fibroblasts for the smooth silicone shell group; capsule thicknesses were 10 to 12 cells with interwoven collagen. The silicone foam prolonged the active cellular response with regard to macrophages, fibroblasts, and multinucleated giant cells, along with random collagen deposition and alternating thin and thick capsular areas. The micropillar group had a more stable cellular response, with macrophages and fibroblasts, along with disruption of the long-range orientation of collagen fibers.

The glycaemic index of fermented and non-fermented legume-based snack food

A study was conducted to estimate the glycaemic index (GI) of four isocaloric and equicarbohydrate variations of the snack food 'cheela' (a savoury pancake) made from powdered whole legumes Phaseolus aureus (green gram) and Cicer arierinum (sengai gram) and their respective fermented batters. Fifteen healthy, normal weight females aged 18-23 years comprised the sample. Glucose was used as a reference food. The test meals were given within 4 weeks of reference food administration, with at least 2 days interval between the test meals. The meals and reference food were served at a fixed time in the morning, after a 12-h overnight fast. Blood glucose was estimated at 0, 30, 60 and 120 min after eating using an Ames glucometer II. The GI for the test meals ranged from 36% to 45%. The green gram cheela (unfermented) had the lowest Gl (36 ± 0.6%), peak blood sugar value (111 .6 ± 1.5 mg%) and AUC (2319 ± 72) as compared to the other three products. There was no significant difference between the fermented and the corresponding unfermented preparations.

Morphological and physiological studies on Indian national kabaddi players

Twenty-five national kabaddi players (Asiad gold medalists 1990), mean age 27.91 years, who attended a national camp at the Sports Authority of India, Bangalore before the Beijing Asian Games in 1990, were investigated for their physical characteristics, body fat, lean body mass (LBM) and somatotype. The physiological characteristics assessed included back strength, maximum oxygen uptake capacity and anaerobic capacity (oxygen debt) and related cardiorespiratory parameters (oxygen pulse, breathing equivalent, maximum pulmonary ventilation, maximum heart rate). Body fat was calculated from skinfold thicknesses taken at four different sites, using Harpenden skinfold calipers. An exercise test (graded protocol) was performed on a bicycle ergometer (ER-900) using a computerized EOS Sprint (Jaeger, West Germany). The mean(s.d.) percentage body fat (17.56(3.48)) of kabaddi players was found to be higher than normal sedentary people. Their physique was found to be endomorphic mesomorph (3.8-5.2-1.7). Mean(s.d.) back strength, maximum oxygen uptake capacity (VO2max) and oxygen debt were found to be 162.6(18.08) kg, 42.6(4.91) ml kg-1 min-1 and 5.02(1.29) litre respectively. Physical characteristics, percentage body fat, somatotype, maximum oxygen uptake capacity and anaerobic capacity (oxygen debt) and other cardiorespiratory parameters were compared with other national counterparts. Present data are comparable with data for judo, wrestling and weightlifting. Since no such study has been conducted on international counterparts, these data could not be compared. These data may act as a guideline in the selection of future kabaddi players and to attain the physiological status comparable to the present gold medalists.

Sequence and antigenic diversity in two immunodominant regions of the L2 protein of human papillomavirus types 6 and 16

To assess the extent of sequence and antigenic diversity in the minor capsid proteins (L2) of human papillomavirus (HPV) types 6 and 16, 24 clinical samples were obtained, and the regions encoding the immunodominant epitopes 6U3 and 16REx were amplified by polymerase chain reaction, sequenced, cloned into pATH plasmids, and tested for reactivity with human sera. Two of 11 HPV-6 DNAs were identical to the prototype strain in the 6U3 region, while 9 variants had a G to A transition at nt5020, changing a valine residue to isoleucine. Of 16 sera that did not react with the prototype HPV-6L2 fusion protein, 2 reacted with the 6U3-isoleucine variant, and all 8 sera that reacted with the prototype also reacted with the variant. Twelve of 13 HPV-16 DNAs were identical to the prototype strain in the 16REx region, while 1 variant had a C to G transversion at nt4825, changing a proline to an arginine, but not affecting antigenicity.

Human antibodies recognize multiple distinct type-specific and cross-reactive regions of the minor capsid proteins of human papillomavirus types 6 and 11

Human serum samples derived from a case-control study of patients with cervical carcinoma (n = 174) or condyloma acuminatum (n = 25) were tested for the presence of immunoglobulin G antibodies to human papillomavirus type 6 (HPV6) L2 and HPV11 L2 recombinant proteins in a Western immunoblot assay. Thirty-six samples (18%) were positive for HPV6 L2 antibodies alone, 25 (13%) were positive for HPV11 L2 antibodies alone, and 34 (17%) were positive for both HPV6 L2 and HPV11 L2 antibodies. Thirty samples that were positive for both antibodies were tested for the presence of HPV6-HPV11 L2 cross-reactive antibodies. Fifteen (50%) serum samples contained HPV6-HPV11 L2 cross-reactive antibodies, and 15 (50%) contained independent, type-specific HPV6 L2 and HPV11 L2 antibodies. Altogether, 82% of the HPV6 L2 and HPV11 L2 antibody reactivities were type specific and 18% were HPV6-HPV11 cross-reactive. There was no significant difference in the prevalence of antibody reactivities between samples from patients with cervical carcinoma and those with condyloma acuminatum. Deletion mapping identified five HPV6 L2 regions that reacted with HPV6 type-specific antibodies: 6U1 (amino acids [aa] 152 to 173), 6U2 (aa 175 to 191), 6U3 (aa 187 to 199), 6U4 (aa 201 to 217), and 6U5 (aa 351 to 367). Five HPV11 L2 regions that reacted with HPV11 type-specific antibodies were identified: 11U1 (aa 49 to 84), 11U2 (aa 147 to 162), 11U3 (aa 179 to 188), 11U4 (aa 180 to 200), and 11U5 (aa 355 to 367). Two HPV6-HPV11 cross-reactive regions were identified: 6CR1 (HPV6 L2 aa 106 to 128)/11CR1 (HPV11 L2 aa 103 to 127) and 6CR2 (HPV6 L2 aa 187 to 199)/11CR2 (HPV11 L2 aa 180 to 200).

A comparative in vivo study of local neurotoxicity of lidocaine, bupivacaine, 2-chloroprocaine, and a mixture of 2-chloroprocaine and bupivacaine

This study was undertaken because of several recent reports of adverse neurologic reactions following the use of 2-chloroprocaine. Carotid sheaths containing undisturbed vagus nerve were surgically exposed in rabbits and bathed in situ for up to 1 hour in one of the following-isotonic solutions: physiologic salt solution, lidocaine 2%, bupivacaine 0.75%, 2-chloroprocaine 3%, or a mixture of 2-chloroprocaine 1.5% and bupivacaine 0.375%. Each solution contained epinephrine, 5 micrograms/ml, (1:200,000). In other animals the carotid sheaths were bathed in physiologic salt solution, or 2-chloroprocaine 3% without epinephrine. The nerves were excised 10 to 12 days later. C-fiber impulse conduction was normal in nerves that had been exposed to physiologic salt solution with or without epinephrine, to lidocaine, or to bupivacaine. Conduction was absent or markedly impaired in several nerve specimens following exposure to 2-chloroprocaine. Histologic sections revealed the presence of epineurial cellular infiltration and fibrosis, perineurial fibrosis, and axonal degeneration in nerves that had been exposed to 2-chloroprocaine or the mixture of 2-chloroprocaine and bupivacaine. Histologic abnormalities were minor or absent following exposure to lidocaine, to bupivacaine, or to physiologic salt solution. These findings suggest that, under the conditions of the experiments, 2-chloroprocaine is more neurotoxic than lidocaine or bupivacaine.