Tissue informative cell-free DNA methylation sites in amyotrophic lateral sclerosis

Cell-free DNA (cfDNA) is increasingly recognized as a promising biomarker candidate for disease monitoring. However, its utility in neurodegenerative diseases, like amyotrophic lateral sclerosis (ALS), remains underexplored. Existing biomarker discovery approaches are tailored to a specific disease context or are too expensive to be clinically practical. Here, we address these challenges through a new approach combining advances in molecular and computational technologies. First, we develop statistical tools to select tissue-informative DNA methylation sites relevant to a disease process of interest. We then employ a capture protocol to select these sites and perform targeted methylation sequencing. Multi-modal information about the DNA methylation patterns are then utilized in machine learning algorithms trained to predict disease status and disease progression. We applied our method to two independent cohorts of ALS patients and controls (n=192). Overall, we found that the targeted sites accurately predicted ALS status and replicated between cohorts. Additionally, we identified epigenetic features associated with ALS phenotypes, including disease severity. These findings highlight the potential of cfDNA as a non-invasive biomarker for ALS.

231 ESTABLISHING AN INTERVENTIONS BUNDLE TO IMPROVE INPATIENT CARE FOR PATIENTS WITH PARKINSON’S DISEASE: A MULTIDISCIPLINARY QUALITY IMPROVEMENT PROJECT

Background

Patients with Parkinson’s (PwP) are at a higher risk of complications once admited to hospital compared to their age-matched peers. Medication mismanagement is a well-known obstacle, which puts PwP at risk of sub-optimal treatment leading to an unnecessary deterioration of baseline and potentially increases risk of adverse sequelae.

Methods

Retrospective electronic patient records (EPR)/chart review of 47 admissions was conducted, across three hospital sites.

Data attaining to correct prescribing of medication on admission and discharge, prescribing of contraindicated medications, reasons for medication lapses and complications of inpatient stay were collected. EPR of 17 patients’ were reviewed to assess if Parkinson’s disease (PD) medication administrations occurred within 30 minutes of patient schedule, as recommended by NICE guidelines. Key areas for improvement were identified based on the results.

Results

47 charts (30 Males, 17 Females) with mean age 72 (range:57–90), were reviewed. Average number of co-morbidities:4.5 and Clinical Frailty Scale ranged 5–9 (n = 30). LOS averaged 12.4 days and 43% of patients had ≥2 hospital admissions in the preceeding year.

38% (17/44) of admissions correctly documented patient specific medication times. Only 48% of patients (n = 638) received their medications within 30 minutes of the scheduled time. 47% (22/47) experienced complications attributable to PD. Contraindicated medications were noted in 5 cases. 84% of discharging prescriptions did not mention timing of PD medication and 3 prescriptions had errors with regards to dosage/omission of medication.

Conclusion

We implemented across two sites: 1) Care protocol flag in patient’s chart highlighting simple avoidable complications. 2) Laminated over the bed signpost alerting ‘time critical medication’. 3) ‘Time critical medication’ stickers in drug kardex 4) Education sessions for Medical, Nursing and Ward staff. 6) Establishing out of hours access to PD medications and protocols for NPO/poor swallow. We plan to reassess significance of efforts post intervention.

Case report: Traumatic lingual hematoma

We describe a case of traumatic lingual hematoma in a patient on dual antiplatelet therapy. After securing the airway, bilateral lingual artery embolization successfully halted expanding hematoma formation. Patient subsequently required tracheostomy for continued airway edema. Although patient course was wrought with postoperative complications, we review this case to illustrate how prompt hematoma evacuation and embolization can resolve significant vasovagal bradycardia and hypotension secondary to expansile lingual hematoma.

Genotype-covariate interaction effects and the heritability of adult body mass index

Obesity is a worldwide epidemic, with major health and economic costs. Here we estimate heritability for body mass index (BMI) in 172,000 sibling pairs and 150,832 unrelated individuals and explore the contribution of genotype-covariate interaction effects at common SNP loci. We find evidence for genotype-age interaction (likelihood ratio test (LRT) = 73.58, degrees of freedom (df) = 1, P = 4.83 × 10^-18), which contributed 8.1% (1.4% s.e.) to BMI variation. Across eight self-reported lifestyle factors, including diet and exercise, we find genotype-environment interaction only for smoking behavior (LRT = 19.70, P = 5.03 × 10^-5 and LRT = 30.80, P = 1.42 × 10^-8), which contributed 4.0% (0.8% s.e.) to BMI variation. Bayesian association analysis suggests that BMI is highly polygenic, with 75% of the SNP heritability attributable to loci that each explain <0.01% of the phenotypic variance. Our findings imply that substantially larger sample sizes across ages and lifestyles are required to understand the full genetic architecture of BMI.

Increasing perceptions of disease vulnerability through imagery

Increasing the cognitive availability of disease symptoms can increase perceptions of vulnerability to a fictitious disease. Research findings have also suggested that men and women respond differently to AIDS information; nevertheless, prior research has failed to examine the effects of imagery on both male and female perceptions of vulnerability to a real disease, such as AIDS. Undergraduates were presented with symptoms that were either hard to imagine or easy to imagine (labeled as related to either AIDS or hyposcenia-B) that the students then read or imagined. The results, which replicated prior research, indicated that imagining disease symptoms altered the students' perceived vulnerability to a fictitious disease. However, only imagery was significantly related to perceived vulnerability to AIDS, and gender interacted with this imagery process. Women expressed significant increases in perceived vulnerability when reading the disease symptoms, whereas men were more vulnerable when imagining the disease symptoms than they were when they read about the symptoms. The authors discuss the implications of their research for the integration of theory and experimentation in designing AIDS-intervention programs.

Capacity of the store-regulator in maintaining iron balance

There is evidence that iron stores alter iron absorption to meet body iron needs. In this study, quantitative aspects of this regulation of iron balance are examined. Two male subjects, one with low and one with average iron stores, were given additional dietary iron over 500 days. Changes in iron stores were monitored by plasma ferritin measurements, and the ferritin estimate of stores was validated at the end of the study by bleeding to the point of iron deficiency. The subject with low iron stores increased his ferritin by 39 micrograms/L or 0.8 mg/day, whereas the subject with average iron stores had no significant change. It is concluded that the mechanism by which stores regulate food iron absorption has a capacity of about 1 mg/day, sufficient to meet usual physiological needs, with the exception of pregnancy, as well as the ability to resist increase in stores above normal despite an iron rich diet.

Psychological immunization: theory, research, and current health behavior applications

A critical review of McGuire's Inoculation Theory, its research base and current health behavior applications in health education research is presented. Foci include research efforts in the areas of smoking, alcohol, and diabetes management. The theory and its utilization in future resistance-to-persuasion interventions in health education is exam ined.

Comparison between transillumination and the roentgenogram in diagnosing paranasal sinus disease

The reliability of transillumination versus roentgenogram to diagnose maxillary and frontal paranasal sinus disease was assessed in 52 subjects with rhinitis and/or asthma. Two different otolaryngologists transilluminated the sinuses while the roentgenograms were evaluated by a radiologist and a third otolaryngologist. Patients filled in questionnaires of symptoms. There was excellent agreement (p < 0.001) between otolaryngologists regarding transillumination of the frontal sinuses but not the maxillary sinuses. Similarly, transillumination of the frontal sinuses correlated well with the roentgenograms. This was not true for transillumination of the maxillary sinuses. Although pain in the upper teeth related well to the presence of frontal disease, sinus headache was a frequent complaint but not useful as a predictor of sinus disease. Even though transillumination of the frontal paranasal sinus has some predictive value, the technique of transillumination has limited usefulness as a diagnostic tool and is not an adequate substitute for roentgenogram.

Clinical and nasal biopsy response to treatment of perennial rhinitis

Nasal biopsies of patients with perennial rhinitis were performed at baseline and compared with biopsies performed 4 wk after active flunisolide, 50 micrograms four times per day, or placebo. An effort was made to relate histologic findings to other subjective and objective parameters as an indication of response to treatment. Although patients admitted to the study had severe subjective nasal symptoms, biopsies varied considerably. Some resembled biopsies from normal individuals, and others showed marked edema and inflammation; the latter findings were more typically present in the biopsies of patients with the most severe disease. A decrease in edema and loss of inflammatory cells on biopsy as well as a corresponding decrease in eosinophils on the nasal smear usually accompanied clinical improvement, which occurred in both the active and placebo groups.

Relationship between pancreozymin and cholinergic stimulation of pancreatic secretion

In conscious pancreatic-fistula dogs with low gastroenterostomies the interactions of pancreozymin (PZ) with methacholine were studied. Combinations of methacholine and PZ depressed amylase, lipase, and total protein secretion when doses were high, i.e. above 2 units/min PZ with 2 μg/min methacholine as background, and above 4 μg/min methacholine with 2 units/min PZ as background. Atropine depressed the enzyme response to Boots but not to Jorpes PZ. It did not alter the depression produced by high doses of PZ and methacholine in combination. These data are consistent with the view that the actions of PZ and methacholine on enzyme production are closely related.