Three Novel Structural Variations at MHC and IL12B Predisposing to Psoriasis

BACKGROUND

Structural variations (SVs, defined as DNA variants ≥50 bp) have been associated with various complex human diseases. However, research to screen the whole genome for SVs predisposing to psoriasis is still lacking.

OBJECTIVES

This study aimed to investigate the association of SVs and psoriasis.

METHODS

We performed a genome-wide screen on SVs using an imputation method on 5 independent cohorts with 45,386 subjects from the Chinese Han population. Fine mapping analysis, genetic interaction analysis and RNA expression analysis were conducted to explore the mechanism of SVs.

RESULTS

We obtained 4,535 SVs in total and identified 2 novel deletions (esv3608550, OR=2.73, P<2.00×10^-308 ; esv3608542, OR=0.47, P=7.40×10^-28 ) at 6q21.33 (MHC), 1 novel Alu element insertion (esv3607339, OR=1.22, P=1.18×10^-35 ) at 5q33.3 (IL12B), and confirmed 1 previously reported deletion (esv3587563, OR=1.30, P=9.52×10^-60 ) at 1q21.2 (LCE) for psoriasis. Fine mapping analysis including SNPs and small Insertions/Deletions (InDels) revealed that esv3608550 and esv3608542 were independently associated with psoriasis, and a novel independent SNP (rs9378188, OR=1.65, P=3.46×10^-38 ) was identified at 6q21.33. By genetic interaction analysis and RNA expression analysis, we speculate that the association of 2 deletions at 6q21.33 with psoriasis might relate to their influence on the expression of HLA-C.

CONCLUSIONS

Our study constructed the most comprehensive SV map for psoriasis thus far and enriched the genetic architecture and pathogenesis of psoriasis as well as highlighted the nonnegligible impact of SVs on complex diseases.

Genome-wide Analyses Identify a Novel Risk Locus for Nonsyndromic Cleft Palate

The 3 major subphenotypes observed in patients with nonsyndromic orofacial clefts (NSOFCs) are nonsyndromic cleft lip only (NSCLO), nonsyndromic cleft lip with palate (NSCLP), and nonsyndromic cleft palate only (NSCPO). However, the genetic architecture underlying NSCPO is largely unknown. Here we performed a 2-stage genome-wide association study (GWAS) on NSCPO and replication analyses of selected variants in other NSOFCs from the Chinese Han population. We identified a novel locus (15q24.3) and a known locus (1q32.2) where variants in or near the gene reached genome-wide significance (2.80 × 10^-13 < P < 1.72 × 10^-08) in a test for association with NSCPO in a case-control design. Although a variant from 15q24.3 was found to be significantly associated with both NSCPO and NSCLP, the direction of estimated effects on risk were opposite. Our functional annotation of the risk alleles within 15q24.3 coupled with previously established roles of the candidate genes within identified risk loci in periderm development, embryonic patterning, and/or regulation of cellular processes supports their involvement in palate development and the pathogenesis of cleft palate. Our study advances the understanding of the genetic basis of NSOFCs and provides novel insights into the pathogenesis of NSCPO.

Autologous breast reconstruction using the immediately lipofilled extended latissimus dorsi flap

BACKGROUND

The latissimus dorsi flap is a popular choice for autologous breast reconstruction. To dramatically improve volume, we report our experience of using the immediately lipofilled extended latissimus dorsi (ELD) flap and show it as a valid option for autologous breast reconstruction.

METHODS

Patients undergoing the procedure between December 2013 and June 2016 were included. Demographic, clinical and operative factors were analysed, together with in-hospital morbidity and duration of postoperative hospital stay.

RESULTS

A total of 71 ELD flaps with immediate lipofilling were performed. Forty-five reconstructions were immediate and the remaining 26 delayed. Median (range) volume of autologous fat injected immediately was 171 ml (40-630 ml). Contralateral reductions were performed in 25 patients with the median reduction volume 185 g (89-683 g). Median duration of admission was 6.5 (3-18) days and patients were followed up for 12 months (1-37). Three total flap failures occurred and had to be excised (4%). One haematoma occurred requiring drainage (1%). Signs of infection requiring intravenous antibiotics occurred in five patients (7%). In 5 patients wound dehiscence occurred, and only two of these required resuturing (3%). In total, 7 patients developed a seroma requiring repeated drainage (10%). Three reconstructions experienced mild mastectomy flap necrosis with no needing reoperation (4%).

CONCLUSIONS

Our experience represents the largest series to date and shows that in carefully selected patients the technique is safe, can avoid the requirement for implants, and has the potential to streamline the reconstructive journey.

[Liquid milk exposure and risk assessment of thiocyanate in Chinese populations]

Objective: To analyze liquid milk exposure of thiocyanate among Chinese population and preliminarily assess its health risk. Methods: A total of 2 059 raw milk samples were collected during 2013 and 2014 from 12 Chinese provinces, New Zealand and Netherlands. Farms were chosed according to the main sources of dairy companies, the distribution of farms and the yield of milk. Content of thiocyanate were detected by ion chromatography. Liquid milk consumption data were taken from Chinese beverage and alcoholic beverage consumption survey in 18 cities or counties in 9 provinces, including 16 775 subjects older than 3. A simple distribution model was used to estimate the exposure of thiocyanate from liquid milk. The tolerable daily intake (TDI) of thiocyanate was made 0.08 mg·kg(-1)·d(-1). Then the exposures of different age groups were compared with TDI. Results: Finally, 1 331 samples out of 2 059 were detected to contain thiocyanate. The detection rate was 65%. The average concentration of thiocyanate was 2.11 mg/kg, with a range of 0.10-16.20 mg/kg. The general population's consumption of thiocyanate by drinking liquid milk was 0.001 mg · kg(-1) · d(-1), which was lower than TDI. The P(95) of general population and consumers were 0.009 mg · kg(-1) · d(-1) and 0.020 mg·kg( -1)·d(-1) respectively, which were also lower than TDI. Mean exposures of population aged 3-6, 7-12, 13-17, 18-59 as well as elderly aged 60 and above were 0.007, 0.003, 0.002, 0.001 and 0.001 mg · kg(-1)·d(-1) respectively, which were all lower than TDI. Conclusion: The results suggested that the health risk of thiocyanate exposure by drinking liquid milk among Chinese population was at a low level. However, milk products for children deserve more concern.

A cadaveric study of the distribution pattern of the cutaneous sensory fibres of the distal palm of the hand

We investigated the cutaneous innervation of the distal palm, an area frequently dissected by the hand surgeon. Ten (five paired) fresh-frozen cadaveric hands were dissected under 3.0× loupe magnification. Volar branches were found on both sides in the majority of digits. They originated alongside, or at the proximal margin of, the A1 pulley in 84% of digits. The mean distance from the palmar digital crease to the origin of volar branches was 21 mm.

Atypical focal cortical dysplasia in a patient with Cowden syndrome

A macrocephalic girl presented with generalised epilepsy due to focal cortical dysplasia. She later developed multiple hamartomatous lesions and was diagnosed to have Cowden syndrome. The diagnosis was confirmed by identification of a novel frameshift mutation in the PTEN gene of the patient.

Products of oxidized L-ascorbic acid damage acellular DNA

OBJECTIVE

L-ascorbic acid can be pro-oxidant and anti-oxidant in different reaction. This study aims to test the effects about products of oxidized L-Ascorbic Acid on acellular DNA.

MEASUREMENT

Acellular DNA, nuclear DNA fixed on slides, are used in our experiment. There are four groups and one negative. Negative control is sham-treated with buffer(pH 7.2 and AA/ H2O2/fenton free). Experimental groups are treated separately with 0.06 mM L-ascorbic acid (AA) alone(exposed in air), 0.06 mM L-ascorbic acid (AA) alone(no exposure in air), 1.2 mM hydrogen peroxide (H2O2) alone, and a mixture of final concentration of 0.03 mM L-ascorbic acid and 0. 6 mM hydrogen peroxide (AA+ H2O2). Each experimental group consists of 4 slides and each slide is treated for 4 hours at 4 °C in a dark place. The DNA damage is quantified by alkaline Comet Assay. The comet images are analysed by Comet A1.0 software. Differences among groups are compared with SPSS 11.0.

RESULTS

DNA singlestrand breakage is found to be treatment-dependent in the following sequence: AA+ H2O2> AA(oxidized) > H2O2, AA(without oxidization) and Control.

CONCLUSION

Acellular DNA can tolerate the low concentration H2O2, but is sensitive to free radical. The results indicate that AA expose in air and mixture of AA and H2O2 can produce •OH and L-dehydroascorbate (DHA), •OH can damage DNA.

A patient-instructor program to promote dental students' communication skills with diverse patients

This article describes the design and evaluation of a patient-instructor (PI) program that was developed to teach and assess dental student communication skills with patients, with an emphasis on cross-cultural patient encounters. The PIs were individuals from the community trained to portray specific simulated patients. One hundred eighteen dental students (three graduating classes) completed two half-day rotations that occurred in the junior year; seventy-nine of those students (two graduating classes) also completed a third rotation that occurred in the senior year. On each rotation, students worked with several simulated patients in mock clinic appointments. PIs used a standardized rating scale and case-specific content checklists to assess students' ability to elicit and provide essential information. Across counterbalanced cases, students improved as they progressed through encounters. Rate of improvement varied by rotation, but students improved most during their first rotation. Overall performance was best on the final rotation. Qualitative review of content checklist items indicated areas of strengths and weaknesses in communication regarding medical, dental, psychosocial, and cultural content. Results can direct curriculum changes to improve communication skills. Future research should address the effects of the PI program on students' diversity-related attitudes and behaviors.

Factors affecting the quality of life in childhood epilepsy in China

OBJECTIVES

To explore the level of, and factors affecting the quality of life (QOL) in childhood epilepsy in China.

SUBJECTS AND METHODS

At the Peking University First Hospital, we consecutively identified 418 parents whose children were with known epilepsy to complete a questionnaire, which included children's demographic characteristics, clinical message of epilepsy, QOL, familial message, parental symptoms of anxiety/depression.

RESULTS

Significant (p<0.05) affecting factors of children's quality of life included current educational degree, mental development, age at diagnosis, age at onset, seizure frequency, duration, AED number; parental significant (p<0.05) affecting factors included anxiety, depression and health. On regression analysis, parental anxiety was the most important factor in explaining lower QOL in childhood epilepsy. AEDs, familial economic state, paternal career, seizure frequency were also significant factors.

CONCLUSION

Parental anxiety outweighed the physical factors in determining QOL in childhood epilepsy. Recognition of this will be helpful for professionals to treat disease and improve the QOL of childhood epilepsy.

Borderline psychopathology in the first-degree relatives of borderline and axis II comparison probands

The purpose of this study was to assess the prevalence of each of the nine DSM criteria for borderline personality disorder and the prevalence of the disorder itself in the first-degree relatives of borderline probands and Axis II comparison subjects. Four hundred and forty-five inpatients were interviewed about familial borderline psychopathology using the Revised Family History Questionnaire--a semistructured interview of demonstrated reliability. Of these 445 subjects, 341 met both DIB-R and DSM-III-R criteria for BPD and 104 met DSM-III-R criteria for another type of personality disorder (and neither criteria set for BPD). The psychopathology of 1,580 first-degree relatives of borderline probands and 472 relatives of Axis II comparison subjects was assessed. Both DSM-III-R and DSM-IV BPD were found to be more common among the relatives of borderline than Axis II comparison probands. However, five of the criteria for BPD (inappropriate anger, affective instability, paranoia/dissociation, general impulsivity, and intense, unstable relationships) and all four sectors of borderline psychopathology (affect, cognition, impulsivity, and interpersonal relationships) were found to be both more common and discriminating than the BPD diagnosis itself. Taken together, the results of this study suggest that the subsyndromal phenomenology of BPD may be more common than the borderline diagnosis itself.

Diagrammatic recording of head and neck tumours

The increasing demands of clinical audit have resulted in the need for accurate data collection. The use of tumour maps allows standardization of the records of patients with head and neck cancer, which facilitates collation of data in multicentre studies and makes interdepartmental comparisons more meaningful. The aim of this study was to develop an improved standard set of tumour maps for recording the stage of head and neck tumours. A review of the existing tumour diagrams was performed to identify those anatomical areas that are not adequately represented or where ambiguity exists. The areas where improvements could be made were identified as: (1). the anterior commissure of the larynx; (2). axial and sagittal views of the larynx; (3). the pyriform fossa and cervical oesophagus; (4). the oropharynx and vallecula; (5). the nasal cavity and paranasal sinuses; and (6). cervical nodal involvement. A new set of tumour maps is presented in an attempt to correct some of the limitations of the existing diagrams.

Severity of reported childhood sexual abuse and its relationship to severity of borderline psychopathology and psychosocial impairment among borderline inpatients

This study has two purposes. The first purpose is to describe the severity of sexual abuse reported by a well-defined sample of borderline inpatients. The second purpose is to determine the relationship between the severity of reported childhood sexual abuse, other forms of childhood abuse, and childhood neglect and the severity of borderline symptoms and psychosocial impairment. Two semistructured interviews of demonstrated reliability were used to assess the severity of adverse childhood experiences reported by 290 borderline inpatients. It was found that more than 50% of sexually abused borderline patients reported being abused both in childhood and in adolescence, on at least a weekly basis, for a minimum of 1 year, by a parent or other person well known to the patient, and by two or more perpetrators. More than 50% also reported that their abuse involved at least one form of penetration and the use of force or violence. Using multiple regression modeling and controlling for age, gender, and race, it was found that the severity of reported childhood sexual abuse was significantly related to the severity of symptoms in all four core sectors of borderline psychopathology (affect, cognition, impulsivity, and disturbed interpersonal relationships), the overall severity of borderline personality disorder, and the overall severity of psychosocial impairment. It was also found that the severity of childhood neglect was significantly related to five of the 10 factors studied, including the overall severity of borderline personality disorder, and that the severity of other forms of childhood abuse was significantly related to two of these factors, including the severity of psychosocial impairment. Taken together, the results of this study suggest that the majority of sexually abused borderline inpatients may have been severely abused. They also suggest that the severity of childhood sexual abuse, other forms of childhood abuse, and childhood neglect may all play a role in the symptomatic severity and psychosocial impairment characteristic of borderline personality disorder.

Intraperitoneal hypothermia during surgery enhances postoperative tumor growth

BACKGROUND

Recent work has shown that intraoperative hypothermia is a significant source of surgical trauma, with wide-ranging physiological and immunological sequelae. The aim of this study was to examine the effects of intraperitoneal hypothermia during laparoscopy on tumor growth in an animal model.

METHODS

Thirty WAG rats were randomized to undergo anesthesia alone (n = 10), insufflation with cold carbon dioxide (CO2) (n = 10), or insufflation with warm CO2 (n = 10). During insufflation, 1 x 105/ml CC531s colon cancer cells in suspension were injected into the peritoneal cavity. The control group was anesthetized and tumor cells were injected without insufflation. After 3 weeks, total tumor weight and the extent of tumor spread, as assessed by the modified Peritoneal Cancer Index (PCI), were compared at autopsy.

RESULTS

Laparoscopy with cold CO2 resulted in a significant reduction in local and core body temperatures (p <0.05). Tumor growth in both groups that underwent CO2 pneumoperitoneum was significantly increased compared with the group that did not (p <0.0001, control vs warm CO2 and cold CO2). There was significantly more tumor growth in the rats insufflated with unwarmed CO2 than in the normothermic group (mean total tumor 0.01 g +/- 0.03 vs. 0.043 g +/- 0.07; p = 0.025 Mann-Whitney U test). Tumor spread as shown by the PCI scores was less in the warm gas group than it was in the animals insufflated with cold gas (151 vs 266).

CONCLUSIONS

These data demonstrate that the peritoneal insufflation of CO2 enhances tumor growth and that the prevention of perioperative hypothermia during laparoscopy attenuates tumor growth. This effect may be partially mediated by the increased peritoneal trauma that results from insufflation with cold gas.

Systematic review of laparoscopic surgery for colorectal malignancy

BACKGROUND

We set out to evaluate the current literature on the use of laparoscopic surgery for malignant colorectal disease and identify its place in current practice.

METHODS

We performed a systematic review of the literature that included papers published from January 1991 to March 1997. Inclusion criteria were used to select the most robust studies. The quality of each study was assessed against predefined criteria and weighted according to hierarchy of evidence and sample size.

RESULTS

The published literature was found to be low in the hierarchy of evidence. Of the 157 studies located, only 42 papers were found to be of sufficiently high quality to be included in the review. Only 13 of these 42 papers concentrated specifically on malignant colorectal disease. We noted the following findings: The average age of patients was 63.2 years. The most frequently reported contraindication to laparoscopic surgery was obesity. Conversion rate to open procedure varied between 1.5% and 48%. The most common postoperative complication was wound infection. Thirty-day mortality varied between 0 and 5.1%. Disease stage and pathology were poorly reported. Patient recovery benefits varied. It was not possible to identify the effectiveness, safety, survival outcome, or cost of laparoscopic surgery for colorectal malignancy in comparison to open surgery.

CONCLUSIONS

Six years after the first report of laparoscopic surgery, studies low in the hierarchy of evidence continue to be reported. This reflects a lack of control following the introduction of this new technology. The majority of reports continue to be feasibility studies. The variable nature and content of the literature demonstrate the lack of standardization and the absence of an agreed core minimum data set. The benefit of laparoscopic surgery for malignant colorectal disease remains unclear. Until the mechanisms of port site recurrences are elucidated and long-term data on survival outcomes become available, laparoscopic surgery for malignant disease should be carried out only in the context of a large, multicenter randomized controlled trial.

Electron spin relaxation of triarylmethyl radicals in fluid solution

Electron spin relaxation times of a Nycomed triarylmethyl radical (sym-trityl) in water, 1:1 water:glycerol, and 1:9 water:glycerol were measured at L-band, S-band, and X-band by pulsed EPR methods. In H(2)O solution, T(1) is 17+/-1 micros at X-band at ambient temperature, is nearly independent of microwave frequency, and exhibits little dependence on viscosity. The temperature dependence of T(1) in 1:1 water:glycerol is characteristic of domination by a Raman process between 20 and 80 K. The increased spin-lattice relaxation rates at higher temperatures, including room temperature, are attributed to a local vibrational mode that modulates spin-orbit coupling. In H(2)O solution, T(2) is 11+/-1 micros at X-band, increasing to 13+/-1 micros at L-band. For more viscous solvent mixtures, T(2) is much shorter than T(1) and weakly frequency dependent, which indicates that incomplete motional averaging of hyperfine anisotropy makes a significant contribution to T(2). In water and 1:1 water:glycerol solutions continuous wave EPR linewidths are not relaxation determined, but become relaxation determined in the higher viscosity 1:9 water:glycerol solutions. The Lorentzian component of the 250-MHz linewidths as a function of viscosity is in good agreement with T(2)-determined contributions to the linewidths at higher frequencies.

Laser in situ Keratomileusis Enhancement After Radial Keratotomy

PURPOSE

To present results of laser in situ keratomileusis (LASIK) enhancement after radial keratotomy (RK).

METHODS

Sixteen eyes of 10 patients were treated with LASIK for residual myopia and hyperopia after RK. Mean preoperative spherical equivalent refraction was -3.14+/-3.04 D (range, -6.675 to +6.00 D). Best spectacle-corrected visual acuity was 20/20 in 9 eyes, 20/25 in 6 eyes, and 20/30 in 1 eye. Uncorrected visual acuity was better than 20/40 in only 2 eyes. Patients were followed at 1 day, 1 week, 1, 3, and 6 months, and 1 year. Mean follow-up was 8.3 months (range, 1 to 17 mo).

RESULTS

All eyes received one LASIK enhancement. Mean final spherical equivalent refraction was +0.16+/-0.68 D (range, -1.00 to +1.75 D). No eyes experienced any visual loss. Five eyes gained 1 line of best spectacle-corrected visual acuity. Uncorrected visual acuity was 20/20 in 9 eyes, 20/25 in 6 eyes, and 20/30 in 1 eye. Two eyes of one patient had the previous RK incisions open.

CONCLUSION

LASIK was an effective treatment for correction of residual myopia and hyperopia after RK.

Reported pathological childhood experiences associated with the development of borderline personality disorder

OBJECTIVE

The purpose of this study was to assess a full range of pathological childhood experiences reported by patients with criteria-defined borderline personality disorder and comparison patients with other personality disorders.

METHOD

The pathological childhood experiences reported by 467 inpatients with personality disorders were assessed by interviewers who used a semistructured research interview and were blind to clinical diagnosis.

RESULTS

Of the 358 patients with borderline personality disorder, 91% reported having been abused, and 92% reported having been neglected, before the age of 18. The borderline patients were significantly more likely than the 109 patients with other personality disorders to report having been emotionally and physically abused by a caretaker and sexually abused by a noncaretaker. They were also significantly more likely to report having a caretaker withdraw from them emotionally, treat them inconsistently, deny their thoughts and feelings, place them in the role of a parent, and fail to provide them with needed protection. The borderline patients with a childhood history of sexual abuse were significantly more likely than those without such a history to report having experienced all but one of the types of abuse and neglect studied. When all significant risk factors were considered together, four were found to be significant predictors of a borderline diagnosis: female gender, sexual abuse by a male noncaretaker, emotional denial by a male caretaker, and inconsistent treatment by a female caretaker.

CONCLUSIONS

The results suggest that sexual abuse is neither necessary nor sufficient for the development of borderline personality disorder and that other childhood experiences, particularly neglect by caretakers of both genders, represent significant risk factors.