Thalassophilia and marine identity: Drivers of 'thick' marine citizenship

Changing humanity's relationship with the ocean is identified as one of ten key challenges in the UN Decade of Ocean Science for Sustainable Development (2021-2030). Marine citizenship is one potential policy approach for reducing anthropogenic harms to the ocean and promoting ocean recovery, and there is a need to better understand marine citizenship motivating factors and their interactions. To contribute to a more holistic understanding, we approached this problem using an interdisciplinary, mixed methodology, which prioritised the voices and experiences of active marine citizens. An online survey and semi-structured interviews were conducted to examine factors spanning environmental psychology (values, environmental identity) and human geography (place attachment and dependency). Our data uncovered a unique marine place attachment, or thalassophilia, which is a novel conceptualisation of the human capacity to bond with a type of place beyond human settlements or defined localities. It is the product of strong emotional responses to the sensorial experience of the ocean and shared social or cultural understanding of ocean place identifications. A key driver of deeper marine citizenship is marine place dependency, and it is positively influence by stimulation and non-conformity values, environmental identity, and thalassophilia. We map significant motivating factors to identity process theory and describe a novel marine identity concept. We propose this as an operational mechanism of marine citizenship action, potentially filling the value- and knowledge-action gaps in the context of marine environmental action. This research provides a cornerstone in marine citizenship research by analysing together in one study a multitude of variables, which cross human-ocean relationships and experiences. The identification and characterisation of thalassophilia and marine identity process theory will enable research and practice to move forwards with a clearer framework of the role of the ocean as a place in environmental action.

Association of Metformin With the Development of Age-Related Macular Degeneration

Importance

Age-related macular degeneration (AMD) is a leading cause of blindness with no treatment available for early stages. Retrospective studies have shown an association between metformin and reduced risk of AMD.

Objective

To investigate the association between metformin use and age-related macular degeneration (AMD).

Design, Setting, and Participants

The Diabetes Prevention Program Outcomes Study is a cross-sectional follow-up phase of a large multicenter randomized clinical trial, Diabetes Prevention Program (1996-2001), to investigate the association of treatment with metformin or an intensive lifestyle modification vs placebo with preventing the onset of type 2 diabetes in a population at high risk for developing diabetes. Participants with retinal imaging at a follow-up visit 16 years posttrial (2017-2019) were included. Analysis took place between October 2019 and May 2022.

Interventions

Participants were randomly distributed between 3 interventional arms: lifestyle, metformin, and placebo.

Main Outcomes and Measures

Prevalence of AMD in the treatment arms.

Results

Of 1592 participants, 514 (32.3%) were in the lifestyle arm, 549 (34.5%) were in the metformin arm, and 529 (33.2%) were in the placebo arm. All 3 arms were balanced for baseline characteristics including age (mean [SD] age at randomization, 49 [9] years), sex (1128 [71%] male), race and ethnicity (784 [49%] White), smoking habits, body mass index, and education level. AMD was identified in 479 participants (30.1%); 229 (14.4%) had early AMD, 218 (13.7%) had intermediate AMD, and 32 (2.0%) had advanced AMD. There was no significant difference in the presence of AMD between the 3 groups: 152 (29.6%) in the lifestyle arm, 165 (30.2%) in the metformin arm, and 162 (30.7%) in the placebo arm. There was also no difference in the distribution of early, intermediate, and advanced AMD between the intervention groups. Mean duration of metformin use was similar for those with and without AMD (mean [SD], 8.0 [9.3] vs 8.5 [9.3] years; P = .69). In the multivariate models, history of smoking was associated with increased risks of AMD (odds ratio, 1.30; 95% CI, 1.05-1.61; P = .02).

Conclusions and Relevance

These data suggest neither metformin nor lifestyle changes initiated for diabetes prevention were associated with the risk of any AMD, with similar results for AMD severity. Duration of metformin use was also not associated with AMD. This analysis does not address the association of metformin with incidence or progression of AMD.

OR15-6 Epidemic of Subclinical Ovulatory Disturbances During SARS-COV2 Pandemic—an Experiment of Nature

 

During the SARS-COV2 pandemic (COVID-19) many studies have examined changes in women's stress, depression/anxiety, reproduction, plus post-vaccination cycle/flow changes¹. Although there are retrospective basal temperature data², we lack menstrual cycle and ovulation information during the pandemic. This analysis compared two independent, similar-design, convenience/community-based, single-cycle cohort studies 13 years apart: Menstruation Ovulation Study (MOS³, n=301, 2007-8) and MOS2 (n=112) during the pandemic. With MOS as a control, and given evidence subclinicalovulatory disturbances (SOD; short luteal phase/anovulatory menstrual cycles of normal lengths) occur before changed cycle lengths4 5, we hypothesized MOS2 would have increased SOD but similar cycle lengths as MOS.

Methods

In both studies, recruitment of menstruating women ages 19-35 years, not using systemic or combined hormonal contraceptives (CHC) used posters/eblasts/social media. In MOS, ovulation was assessed by 3-fold increased follicular (FP)-to-luteal (LP/premenstrual) urinary progesterone (PdG); in MOS2, by validated Quantitative Basal Temperature© (QBT)6 7 (normal LP=10+ days). We performed the same interviewer-administered (CaMos©) questionnaire for demographics, SES, and reproduction, measured anthropomorphic variables, plus collected daily Menstrual Cycle Diary© (Diary) for all. FP and LP/premenstrual PdG or salivary progesterone (Ps) samples were respectively collected. Participants in MOS2 were not different from MOS in: average age 29, menarche age 12.5, BMI 24, living situation and education (≥75% university graduates). Cohorts also differed: MOS2 women were less likely to to be White (56% vs 76%), work fulltime, ever use CHC (68% vs 79%) or to be parous (8% vs 20%); they were younger at starting CHC (17.9 vs 18.6 years).

Results

MOS2 and MOS had similar cycle (30.3 vs 29.9 days, P =.306) and flow lengths (median 6.0 days; P=.055). MOS2 recorded significantly more SOD cycles (>50% anovulatory) vs MOS³ (63% vs 10%; P<.001). MOS2 Diary analyses by Principal Components Analysis showed significantly increased anxiety/depression/frustration (negative moods) and "outside stresses" plus sleep problems and headaches vs MOS (all P<.001).

Discussion

This is the first evidence that ovulatory disturbances without cycle length changes may be associated with the multidimensional stresses women experience during the pandemic. Increased SOD may also relate to greater nulliparity, younger CHC teen use and more non-White women in MOS2, as well higher prevalence of negative moods, outside stresses and sleep problems. Salivary progesterone, cortisol and estradiol levels remain pending. Prevalent SOD cycles, if persistent/recurrent, risk increased infertility, bone loss⁵, early heart attacks, and breast and endometrial cancers⁸. In this 'experiment of nature,' the pandemic was associated with disturbed ovulation rather than menstrual cycles. ¹Edelman AB Ob Gyn 2022; ²Nguyen JK PLOS ONE 2021; ³Prior JC IJERPH 2018; ⁴Prior JC NEJM 1990; ⁵Li D Epidiol Rev 2014; ⁶Prior JC Clin Invest. Med 1990; ⁷Bedford JL Eur J ObGyn Reprod Biol 2009; ⁸Prior JC DDDM 2020.

Presentation: Sunday, June 12, 2022 12:15 p.m. - 12:30 p.m.

Investigation of dose profile across the junction of deep inspiration breath hold, breast with supra-clavicle fossa treatments

Breast with supraclavicular fossa (Br+SCF) radiotherapy treatments can utilise a monoisocentric technique to concurrently treat the breast area (tangent fields) and supraclavicular area (opposing fields). The region where these treatment areas adjoin is known as the junction region, field junction, or match line. Dose variations that may occur about the junction region, due to geometrical inaccuracies, are typically feathered out in patient free-breathing treatments. However, there is limited information on how dose at the junction is influenced in deep inspiration breath hold (DIBH) treatments. This study aims to investigate dose variation at the field junction for a patient population undertaking a DIBH Br+SCF treatment course. GAFChromic EBT3 film was used to record the dose across the junction at skin surface for approximately one third of the 25 fraction treatment course for 11 patients undergoing DIBH Br+SCF treatment. Single fraction and summated fraction profiles for each patient were compared to profiles in the treatment planning system and assessed the: (1) local dose variations, (2) position of the 50% dose gradient, and (3) relative dose at the nominal junction. Local dose variations of 10% or greater, position displacement of the junction greater than 5 mm, and relative dose differences at the match line greater than 10% can be found within single fraction dose profiles. When these single fractions are summed over the treatment course, the position variations reduce to 2 mm and dose variations reduced to within 10% for 10 of the 11 patients. Only one of 11 patients recorded a summed dose difference greater than ±10% over their treatment, recording 76% ± 8% of the planned dose in this region. This was due to a small overall position displacement of 1.8 ± 1.6 mm from the nominal junction. A feathering of the dose at the junction is present for DIBH Br+SCF patient treatments. The feathering effect is sufficient, in the majority of cases studied, to reduce any differences in dose and displacement present in single fractions. This work also demonstrates that there may be exceptions from this observed behavior that should be considered. Further study in this area using a larger patient cohort is recommended.

Feasibility of Integration of Yoga in a Behavioral Weight-Loss Intervention: A Randomized Trial

OBJECTIVE

This study examined the feasibility and comparison of two styles of yoga within the context of a standard behavioral weight-loss intervention (SBWI).

METHODS

Fifty adults with obesity (BMI: 31.3 ± 3.8 kg/m² ) participated in this 6-month study that included a SBWI and a calorie- and fat-reduced diet. Randomization was to restorative Hatha (SBWI+RES) or Vinyasa (SBWI+VIN) yoga. Yoga was prescribed to increase from 20 to 40 to 60 minutes per session across the intervention. Weight was assessed at baseline and 6 months. Perceptions of yoga were assessed at the completion of the intervention.

RESULTS

Adjusted weight loss was -3.4 kg (95% CI: -6.4 to -0.5) in SBWI+RES and -3.8 kg (95% CI: -6.8 to -0.9) in SBWI+VIN (P < 0.001), with no difference between groups. Of all participants, 74.4% reported that they would continue participation in yoga after the SBWI. Session duration was a barrier as yoga increased from 20 to 40 to 60 minutes per day, with 0%, 7.5%, and 48.8% reporting this barrier, respectively.

CONCLUSIONS

Among adults with obesity, yoga participation, within the context of a SBWI, appears to be feasible, with weight loss not differing by style of yoga. Progressing to 60 minutes per session appears to be a barrier to engagement in yoga in this population.

Relationship Between Genetic Risk and Age of Diagnosis in Systemic Lupus Erythematosus

OBJECTIVE

Specific risk alleles for childhood-onset systemic lupus erythematosus SLE (cSLE) vs adult-onset SLE (aSLE) patients have not been identified. The aims of this study were to determine if there is an association (1) between non-HLA-related genetic risk score (GRS) and age of SLE diagnosis, and (2) between HLA-related GRS and age of SLE diagnosis.

METHODS

Genomic DNA was obtained from 2001 multiethnic patients and genotyped using the Immunochip. Following quality control, genetic risk counting (GRCS), weighted (GRWS), standardized counting (GRSCS), and standardized weighted (GRSWS) scores were calculated based on independent single-nucleotide polymorphisms from validated SLE loci. Scores were analyzed in a regression model and adjusted by sex and ancestral population.

RESULTS

The analyzed cohort consisted of 1540 patients: 1351 females and 189 males (675 cSLE and 865 aSLE). There were significant negative associations between all non-HLA GRS and age of SLE diagnosis: P = 0.011 and r² = 0.175 for GRWS; P = 0.008 and r² = 0.178 for GRSCS; P = 0.002 and r² = 0.176 for GRSWS (higher GRS correlated with lower age of diagnosis.) All HLA GRS showed significant positive associations with age of diagnosis: P = 0.049 and r² = 0.176 for GRCS; P = 0.022 and r² = 0.176 for GRWS; P = 0.022 and r² = 0.176 for GRSCS; P = 0.011 and r² = 0.177 for GRSWS (higher GRS correlated with higher age of diagnosis).

CONCLUSION

Our data suggest that there is a linear relationship between genetic risk and age of SLE diagnosis and that HLA and non-HLA GRS are associated with age of diagnosis in opposite directions.

Effects of self-guided e-counseling on health behaviors and blood pressure: Results of a randomized trial

OBJECTIVE

1) Evaluate the efficacy of e-Counseling vs. Control to promote lifestyle behaviors at 4 and 12-month follow-ups, 2) examine whether these behaviors changes were associated with lower blood pressure (BP), and Framingham Risk Index (FRI) at 12-month.

METHODS

Hypertensive patients (n = 264) were randomized to the e-Counseling or the Control group. Primary trial outcome was BP and secondary outcomes included exercise and diet behaviors. This study presented the results of secondary outcomes. Linear mixed models evaluated treatment effects at 4 and 12-month. Treatment-by-sex exploratory analyses were conducted if no main treatment effect was observed.

RESULTS

Daily steps significantly improved in e-Counseling vs. Controls at 12-month. Urinary sodium at 12-month did not significantly differ between the groups, but treatment-by-sex analysis showed that e-Counseling females lowered urinary sodium relative to Controls at 12 months. Improvements in steps and dietary sodium were significantly associated with improvements in BP and FRI at 12-month.

CONCLUSION

This hypertension e-Counseling protocol can promote long-term lifestyle behavior changes. Adherence to the lifestyle behavior change was associated with BP and FRI reduction at 12-month.

PRACTICE IMPLICATIONS

The hypertension e-counseling protocol has the potential to improve hypertension care and intervention reach.

Canadian Rheumatology Association Recommendations for the Assessment and Monitoring of Systemic Lupus Erythematosus

OBJECTIVE

To develop recommendations for the assessment of people with systemic lupus erythematosus (SLE) in Canada.

METHODS

Recommendations were developed using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. The Canadian SLE Working Group (panel of Canadian rheumatologists and a patient representative from Canadian Arthritis Patient Alliance) was created. Questions for recommendation development were identified based on the results of a previous survey of SLE practice patterns of members of the Canadian Rheumatology Association. Systematic literature reviews of randomized trials and observational studies were conducted. Evidence to Decision tables were prepared and presented to the panel at 2 face-to-face meetings and online.

RESULTS

There are 15 recommendations for assessing and monitoring SLE, with varying applicability to adult and pediatric patients. Three recommendations focus on diagnosis, disease activity, and damage assessment, suggesting the use of a validated disease activity score per visit and annual damage score. Strong recommendations were made for cardiovascular risk assessment and measuring anti-Ro and anti-La antibodies in the peripartum period and conditional recommendations for osteoporosis and osteonecrosis. Two conditional recommendations were made for peripartum assessments, 1 for cervical cancer screening and 2 for hepatitis B and C screening. A strong recommendation was made for annual influenza vaccination.

CONCLUSION

These are considered the first guidelines using the GRADE method for the monitoring of SLE. Existing evidence is largely of low to moderate quality, resulting in more conditional than strong recommendations. Additional rigorous studies and special attention to pediatric SLE populations and patient preferences are needed.

Functional biocompatibility testing of silicone breast implants and a novel classification system based on surface roughness

PURPOSE

Increasing numbers of women undergo breast implantation for cosmetic and reconstructive purposes. Contracture of the fibrous capsule, which encases the implant leads to significant pain and reoperation. Texture, wettability and the cellular reaction to implant surfaces are poorly understood determinants of implant biocompatibility. The aim of this study was to evaluate the in-vitro characteristics of a range of commercial available implants using a macrophage based assay of implant biocompatibility and a quantitative assessment of wettability and texture.

METHODS

Thirteen commercially available surfaces were subjected to wettability and texture characterisation using scanning and laser confocal microscopy. THP-1 macrophages were cultured on their surfaces and assessed using Integrin αV immunocytochemistry, SEM and RT-PCR for the expression of TNF-Alpha, IL-6, IL-10 and a cytokine array for the production of TNF-alpha, IL-10, IL-1RA and IL1β; important indicators of inflammation and macrophage polarization.

RESULTS

Textured surfaces can be accurately sub-categorized dependent upon roughness and re-entrant features into four main types (macro, micro, meso and nano-textured surfaces). Significant (P < 0.0001) differences in implant hydrophobicity and texture exist. Certain surfaces promoted poor macrophage polarization and an innate potential to foster a proinflammatory response. A subgroup analysis showed that texture had a variable effect on markers of inflammation in these surfaces.

CONCLUSIONS

We propose a classification of implant surfaces based on roughness and present a macrophage based assay of breast implant biocompatibility with a quantitative assessment of implant wettability and texture. The breast implant surface-cell interaction is variable and sufficient to alter healing response and capsular contracture fate in-vivo.

Development, fabrication and evaluation of a novel biomimetic human breast tissue derived breast implant surface

Breast implant use has tripled in the last decade with over 320,000 breast implant based reconstructions and augmentations performed in the US per annum. Unfortunately a considerable number of women will experience capsular contracture, the irrepressible and disfiguring, tightening and hardening of the fibrous capsule that envelops the implant. Functionalising implant surfaces with biocompatible tissue-specific textures may improve in vivo performance. A novel biomimetic breast implant is presented here with anti-inflammatory in vitro abilities. Topographical assessment of native breast tissue facilitated the development of a statistical model of adipose tissue. 3D grayscale photolithography and ion etching were combined to successfully replicate a surface modelled upon the statistics of breast tissue. Pro-inflammatory genes ILβ1, TNFα, and IL6 were downregulated (p<0.001) and anti-inflammatory gene IL-10 were upregulated on the novel surface. Pro-inflammatory cytokines Gro-Alpha, TNFα and neutrophil chemoattractant IL8 were produced in lower quantities and anti-inflammatory IL-10 in higher quantities in culture with the novel surface (p<0.01). Immunocytochemistry and SEM demonstrated favourable fibroblast and macrophage responses to these novel surfaces. This study describes the first biomimetic breast tissue derived breast implant surface. Our findings attest to its potential translational ability to reduce the inflammatory phase of the implant driven foreign body reaction.

STATEMENT OF SIGNIFICANCE

Breast implants are still manufactured using outdated techniques and have changed little since their inception in the 1960's. Breast implants can cause a medical condition, capsular contracture which often results in disfigurement, pain, implant removal and further surgery. This condition is due to the body's reaction to these breast implants. This article describes the successful development and testing of a novel breast implant surface inspired by the native shapes present in breast tissue. Results show that this novel implant surface is capable of reducing the negative reaction of human cells to these surfaces which may help reduce capsular contracture formation. This work represents the first steps in producing a biocompatible breast implant.

The role of cytochrome–P450 inhibitors in the prevention of hepatotoxicity after paracetamol overdose in rats

Despite the understanding that some cytochrome P450 isoforms are responsible for activation of paracetamol to the hepatotoxic metabolite, N–acetyl–p–benzoquinineimine (NAPQI), the use of enzyme inhibitors for prevention and/or treatment of paracetamol hepatotoxicity is still not well researched. Here, a mixture of ketoconazole, isoniazid and caffeine (inhibitor solution), known inhibitors of CYP3A, CYP2E1 and CYP1A2, was investigated for prevention of hepatotoxicity after paracetamol over–dose in rats. The appropriate doses of paracetamol (1000 mg/kg/day) and the ‘inhibitor solution’ (ketoconazole 5 mg/kg, isoniazid 5 mg/kg and caffeine 10 mg;kg;KIC–5–50), were selected in preliminary experiments. Thereafter, two groups of 15 male Sprague–Dawley rats each were treated with the toxic dose of paracetamol intraperitoneally to induce severe hepatotoxicity. But one of the two groups was treated with the KIC–5–50 intraperitoneally 5 min after administration of paracetamol. Five rats were killed at 24, 48 and 72 hours after paracetamol administration. Plasma concentrations of paracetamol were determined by the polarization fluorescent immunoassay and a piece of liver was sent for histopathology examination. Liver function tests at 48 hours were higher in the ‘paracetamol only’ treated group than in the ‘KIC–5–50+paracetamol’ treated group’ (P<0.05), i.e., median (range) AST 2025 (530–4329) g/mL for the ‘paracetamol only’ treated group versus 0.17 (0.07–0.33) μg/ml for the ‘KIC–5–50-paracetamol’ treated group. Centrilobular necrosis, the pathogmonomic feature of paracetamol hepatotoxicity, was demonstrated only in the ‘paracetamol only’ treated group. In conclusion, coadministration of paracetamol with inhibitors of cytochrome P450 prevented the development of paracetamol–induced hepatotoxicity in rats, and this calls for research for enzyme inhibitors that may be of therapeutic value.

How to Attract Trainees, a Pan-Canadian Perspective: Phase 1 of the “Training the Rheumatologists of Tomorrow” Project

Objective.

To identify what learners and professionals associated with rheumatology programs across Canada recommend as ways to attract future trainees.

Methods.

Data from online surveys and individual interviews with participants from 9 rheumatology programs were analyzed using the thematic framework analysis to identify messages and methods to interest potential trainees in rheumatology.

Results.

There were 103 participants (78 surveyed, 25 interviewed) who indicated that many practitioners were drawn to rheumatology because of the aspects of work life, and that educational events and hands-on experiences can interest students. Messages centered on working life, career opportunities, and the lifestyle of rheumatologists. Specific ways to increase awareness about rheumatology included information about practice type, intellectual and diagnostic challenges, diversity of diseases, and patient populations. Increased opportunity for early and continued exposure for both medical students and internal medicine residents was also important, as was highlighting job flexibility and availability and a good work-life balance. Although mentors were rarely mentioned, many participants indicated educational activities of role models. The relatively low pay scale of rheumatologists was rarely identified as a barrier to choosing a career in rheumatology.

Conclusion.

This is the first pan-Canadian initiative using local data to create a work plan for developing and evaluating tools to promote interest in rheumatology that could help increase the number of future practitioners.

Reducing risk with e-based support for adherence to lifestyle change in hypertension (REACH): protocol for a multicentred randomised controlled trial

INTRODUCTION

Web-based lifestyle counselling designed to improve adherence to self-management behaviours for diet, exercise and medication has been shown to reduce blood pressure (BP). However, the long-term clinical outcome of these interventions is not established. Our aim was to establish whether an e-counselling program is independently associated with improved clinical outcomes over a 12-month period, as defined by the following criteria: (1) reduction of systolic BP, diastolic BP, pulse pressure and associated risk factors for cardiovascular events; and (2) adherence to self-management behaviour (diet, exercise, smoke-free living and prescribed medication).

METHODS AND ANALYSIS

Reducing risk with e-based support for adherence to lifestyle change in hypertension is a two-parallel group, double-blind randomised controlled trial that will utilise a two (Groups: e-counselling vs control) by three (assessment intervals: baseline, 4-month and 12-month outcome) design. BP, lipoprotein cholesterol, physical activity and dietary behaviours and psychological distress will be measured at each assessment. We plan to recruit 528 participants (35-74 years of age) diagnosed with stage 1 or 2 hypertension (systolic BP, 140-180 mm Hg; diastolic BP 90-110 mm Hg) from three major cities (Toronto, London, Vancouver) and one rural area (Grey Bruce region) across Canada between February 2012 and July 2015. Controls will receive general educational e-messages on heart healthy living and the e-counselling group will receive tailored e-messages that are matched to their stage of readiness for change. For both groups, e-messages will be sent proactively on a weekly basis during months 1-4, then bi-weekly during months 5-8 and then monthly during months 9-12.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from all recruitment sites. This will be one of the first studies to evaluate the long-term efficacy of preventive e-counselling strategies for cardiovascular disease prevention in patients with hypertension. Findings from this study will be used to guide the ongoing development of e-counselling services.

TRIAL REGISTRATION

Clinicaltrial.gov NCT01541540; http://clinicaltrials.gov/ct2/show/NCT01541540.

Cause of death in Alzheimer's disease: a cohort study

BACKGROUND

Reporting of cause of death in patients with Alzheimer's disease (AD) has changed over the past few decades but concerns persist over the accuracy of death certificate completion in this setting.

OBJECTIVES

To examine the causes of death in AD and examine how this compares with those affecting the normal population.

METHODS

Death certificates were obtained for 85 AD patients and 52 control subjects from a cohort of 396 participants. Underlying causes of death and other conditions mentioned on the death certificates of the AD patients were analysed and compared with the Northern Ireland population age-and-sex adjusted mortality rates and subsequently to the death certificates of control subjects.

RESULTS

AD and pneumonia were causes of significant excess mortality and the most common underlying causes of death in the AD patient group (23.53 and 17.65%, respectively). When compared with the control subjects, AD and gastrointestinal diseases were found to be more prevalent. AD was recorded on 63.5% of death certificates of AD subjects who died during follow-up.

CONCLUSION

The cause of death documented for AD patients may be affected by the physician's knowledge of the patient or reflects the approach to management of patients with end-stage dementia.

Cancer risk in systemic lupus: an updated international multi-centre cohort study

OBJECTIVE

To update estimates of cancer risk in SLE relative to the general population.

METHODS

A multisite international SLE cohort was linked with regional tumor registries. Standardized incidence ratios (SIRs) were calculated as the ratio of observed to expected cancers.

RESULTS

Across 30 centres, 16,409 patients were observed for 121,283 (average 7.4) person-years. In total, 644 cancers occurred. Some cancers, notably hematologic malignancies, were substantially increased (SIR 3.02, 95% confidence interval, CI, 2.48, 3.63), particularly non-Hodgkin's lymphoma, NHL (SIR 4.39, 95% CI 3.46, 5.49) and leukemia. In addition, increased risks of cancer of the vulva (SIR 3.78, 95% CI 1.52, 7.78), lung (SIR 1.30, 95% CI 1.04, 1.60), thyroid (SIR 1.76, 95% CI 1.13, 2.61) and possibly liver (SIR 1.87, 95% CI 0.97, 3.27) were suggested. However, a decreased risk was estimated for breast (SIR 0.73, 95% CI 0.61-0.88), endometrial (SIR 0.44, 95% CI 0.23-0.77), and possibly ovarian cancers (0.64, 95% CI 0.34-1.10). The variability of comparative rates across different cancers meant that only a small increased risk was estimated across all cancers (SIR 1.14, 95% CI 1.05, 1.23).

CONCLUSION

These data estimate only a small increased risk in SLE (versus the general population) for cancer over-all. However, there is clearly an increased risk of NHL, and cancers of the vulva, lung, thyroid, and possibly liver. It remains unclear to what extent the association with NHL is mediated by innate versus exogenous factors. Similarly, the etiology of the decreased breast, endometrial, and possibly ovarian cancer risk is uncertain, though investigations are ongoing.

Comparison of radiographic scoring methods in a cohort of RA patients treated with anti-TNF therapy

OBJECTIVE

To compare the ability of the simple erosion narrowing score (SENS) to classify radiographic progression relative to the Sharp/van der Heijde score (SHS) in a prospective cohort of anti-TNF-treated RA patients.

METHODS

Radiographs of the hands, wrists and feet of patients enrolled in a pharmacovigilance programme are performed every 2 years. These radiographs were read in chronological order by three rheumatologists and scored using the SHS. SENS scores were derived from the SHS. Additionally, one rheumatologist scored the radiographs using the SENS method only. Patients with radiographic progression in excess of the smallest detectable change were classified as progressors. The probability of agreement and κ-value between the SHS and SENS methods for determining progression was calculated.

RESULTS

A sample of 25 patients was selected from the database. The annualized mean (s.d.) change in SHS score was 6.61 U (7.48 U) and in SENS score was 2.27 U (2.17 U). Five patients were classified as progressors using SHS and seven using SENS, with a probability of agreement of 84% (κ = 0.565).

CONCLUSION

The SENS method captures radiographic progression reliably compared with the more detailed SHS method. SENS is suitable for application in clinical practice or in observational cohorts.

Novel GLIS3 mutations demonstrate an extended multisystem phenotype

INTRODUCTION

Mutations in the GLI-similar 3 (GLIS3) gene encoding the transcription factor GLIS3 are a rare cause of neonatal diabetes and congenital hypothyroidism with six affected cases from three families reported to date. Additional features, described previously, include congenital glaucoma, hepatic fibrosis, polycystic kidneys, developmental delay and facial dysmorphism.

SUBJECTS

We report two new cases from unrelated families with distinct novel homozygous partial GLIS3 deletions. Both patients presented with neonatal diabetes mellitus, severe resistant hypothyroidism in the presence of elevated thyroglobulin and normal thyroid anatomy, degenerative liver disease, cystic renal dysplasia, recurrent infections and facial dysmorphism. These novel mutations have also resulted in osteopenia, bilateral sensorineural deafness and pancreatic exocrine insufficiency, features that have not previously been associated with GLIS3 mutations. Gene dosage analysis showed that the parents were carriers of a deletion encompassing exons 1-2 (case 1) or exons 1-4 (case 2) of the 11 exon gene. Genome-wide SNP analysis did not reveal a common ancestral GLIS3 haplotype in patient 2.

CONCLUSIONS

Our results confirm partial gene deletions as the most common type of GLIS3 mutations, accounting for four of five families identified to date. We propose that mutations in GLIS3 lead to a wider clinical phenotype than previously recognised. We also report the first case of a recessive GLIS3 mutation causing neonatal diabetes and congenital hypothyroidism in a child from a non-consanguineous pedigree, highlighting the importance of molecular genetic testing in any patient with this phenotype.

Suggested baseline ranges for performance testing of the Fujifilm FCR Capsula XL computed radiography system

Due to the difficulty in obtaining expected baseline values from the supplier for the performance testing of the Fujifilm FCR Capsula XL computed radiography system, performance test results from the acceptance testing of 42 Capsula systems were reviewed. Guidance ranges are provided for nine system performance tests which can be applied to future testing of calibrated systems.

Patterning of novel breast implant surfaces by enhancing silicone biocompatibility, using biomimetic topographies

INTRODUCTION AND AIMS

Silicone biocompatibility is dictated by cell-surface interaction and its understanding is important in the field of implantation. The role of surface topography and its associated cellular morphology needs investigation to identify qualities that enhance silicone surface biocompatability. This study aims to create well-defined silicone topographies and examine how breast tissue-derived fibroblasts react and align to these surfaces.

METHODS

Photolithographic microelectronic techniques were modified to produce naturally inspired topographies in silicone, which were cultured with breast tissue-derived human fibroblasts. Using light, immunofluorescent and atomic force microscopy, the cytoskeletal reaction of fibroblasts to these silicone surfaces was investigated.

RESULTS

Numerous, well-defined micron-sized pillars, pores, grooves, and ridges were manufactured and characterized in medical grade silicone. Inimitable immunofluorescent microscopy represented in our high magnification images of vinculin, vimentin, and the actin cytoskeleton highlights the differences in fibroblast adhesion between fabricated silicone surfaces. These unique figures illustrate that fibroblast adhesion and the reactions these cells have to silicone can be manipulated to enhance biointegration between the implant and the breast tissue. An alteration of fibroblast phenotype was also observed, exhibiting the propensity of these surfaces to induce categorical remodeling of fibroblasts.

CONCLUSIONS

This unique study shows that fibroblast reactions to silicone topographies can be tailored to induce physiological changes in cells. This paves the way for further research necessary to develop more biocompatible constructs capable of eliminating capsular contracture by subverting the foreign body response.

Dietary patterns in Canadian men and women ages 25 and older: relationship to demographics, body mass index, and bone mineral density

BACKGROUND

Previous research has shown that underlying dietary patterns are related to the risk of many different adverse health outcomes, but the relationship of these underlying patterns to skeletal fragility is not well understood. The objective of the study was to determine whether dietary patterns in men (ages 25-49, 50+) and women (pre-menopause, post-menopause) are related to femoral neck bone mineral density (BMD) independently of other lifestyle variables, and whether this relationship is mediated by body mass index.

METHODS

We performed an analysis of 1928 men and 4611 women participants in the Canadian Multicentre Osteoporosis Study, a randomly selected population-based longitudinal cohort. We determined dietary patterns based on the self-administered food frequency questionnaires in year 2 of the study (1997-99). Our primary outcome was BMD as measured by dual x-ray absorptiometry in year 5 of the study (2000-02).

RESULTS

We identified two underlying dietary patterns using factor analysis and then derived factor scores. The first factor (nutrient dense) was most strongly associated with intake of fruits, vegetables, and whole grains. The second factor (energy dense) was most strongly associated with intake of soft drinks, potato chips and French fries, certain meats (hamburger, hot dog, lunch meat, bacon, and sausage), and certain desserts (doughnuts, chocolate, ice cream). The energy dense factor was associated with higher body mass index independent of other demographic and lifestyle factors, and body mass index was a strong independent predictor of BMD. Surprisingly, we did not find a similar positive association between diet and BMD. In fact, when adjusted for body mass index, each standard deviation increase in the energy dense score was associated with a BMD decrease of 0.009 (95% CI: 0.002, 0.016) g/cm(2) for men 50+ years old and 0.004 (95% CI: 0.000, 0.008) g/cm(2) for postmenopausal women. In contrast, for men 25-49 years old, each standard deviation increase in the nutrient dense score, adjusted for body mass index, was associated with a BMD increase of 0.012 (95% CI: 0.002, 0.022) g/cm(2).

CONCLUSIONS

In summary, we found no consistent relationship between diet and BMD despite finding a positive association between a diet high in energy dense foods and higher body mass index and a strong correlation between body mass index and BMD. Our data suggest that some factor related to the energy dense dietary pattern may partially offset the advantages of higher body mass index with regard to bone health.

One scan for all: extended role of cardiac CT angiography in acute myocardial infarction

BACKGROUND

Cardiac computed-tomographic angiography (CTA) has gained widespread acceptance as a useful non-invasive technique in the assessment of coronary artery disease. Although most interest has focused on coronary vessels, analysis of myocardial perfusion, left ventricular wall motion, ejection fraction and left ventricular structure can easily be performed at the same time allowing comprehensive assessment of anatomy and function in a single examination. We present a case of acute ST elevation myocardial infarction where cardiac catheterization was deferred, but assessment by CTA permitted a management plan to be constructed using rest perfusion and blood pool inversion analyses of the dataset obtained during the coronary artery study.

CONCLUSION

Coronary CT angiography can provide a comprehensive assessment of coronary arteries, myocardial perfusion and structural features in those not suitable for coronary angiography after myocardial infarction.

Current implant surface technology: an examination of their nanostructure and their influence on fibroblast alignment and biocompatibility

Systematic reviews indicate that breast implant texture confers a protective effect on capsular contracture. Fibroblasts are affected by micro- and nanotopographies. Few previous studies have investigated the inherent topographies of existing breast implants and the surfaces with which body tissue is exposed.

AIMS

To examine currently available breast implant surfaces at high resolution and evaluate features within their surface that have been demonstrated to influence fibroblast alignment.

METHODS

Using scanning electron and light microscopy, 5 distinct smooth and textured silicone implants including the Mentor Siltex (Mentor Corporation, Santa Barbara, Calif) and Allergan Biocell (Allergan Medical Corporation, Santa Barbara, Calif) surfaces were investigated at high magnification to illustrate their intrinsic surface topographies.

RESULTS

The images obtained illustrate remarkable micro- and nanoscale topographies. Each surface produced a distinctive microenvironment capable of influencing cell shape and thus biointegration. These features are illustrated by our unique, high-magnification images. The smooth surface exhibits a shallow, regular, 5-microm period rippled texture that may explain higher reported contracture rates, while the Biocell and Siltex surfaces show 100- to 200-microm deep but random features that have been shown to anchor the implant to breast tissue and reduce contracture. Results allow a cell's eye view of these implants, with an explanation of why these types of topographies influence the success of these implants.

CONCLUSIONS

We assessed commonly available silicone implants and offer a unique overview into their surface topographies and how they are manufactured. We conclude that these surfaces require modernization. Our findings provide further insight into potential interactions between cellular assemblies and artificial surfaces and may contribute to the development of improved implant surfaces.

Elective primary cesarean section: weighing the risks and benefits

The increasing understanding of the nature and extent of pelvic floor injury during childbirth, coupled with an increasing medico-legal demand to present a flawless baby at the completion of the birth process, has helped fuel the rising cesarean section rate. As more women become educated in the controversies surrounding the protective benefits of cesarean, they may increasingly elect to undergo cesarean delivery primarily. Evidence concerning maternal, fetal, and ethical considerations in this decision is presented.

A framework for supporting rainwater harvesting in the UK

Numerous policy vehicles have been introduced in the UK promoting the use of rainwater harvesting (RWH). However, an 'implementation deficit' exists where legislation limits action by failing to provide adequate support mechanisms. This study uses an interdisciplinary approach to construct a framework to address the issue of overcoming this deficit. Evidence bases have identified six deficit categories, which confirm a lack of enabling of stakeholders. Outline recommendations, such as coordinated information provision and reconsideration of incentive schemes are made in relation to these categories to complete the framework for supporting RWH in the UK.