Patterns of Gene Expression, Splicing, and Allele-Specific Expression Vary among Macular Tissues and Clinical Stages of Age-Related Macular Degeneration

Age-related macular degeneration (AMD) is a leading cause of blindness, and elucidating its underlying disease mechanisms is vital to the development of appropriate therapeutics. We identified differentially expressed genes (DEGs) and differentially spliced genes (DSGs) across the clinical stages of AMD in disease-affected tissue, the macular retina pigment epithelium (RPE)/choroid and the macular neural retina within the same eye. We utilized 27 deeply phenotyped donor eyes (recovered within a 6 h postmortem interval time) from Caucasian donors (60-94 years) using a standardized published protocol. Significant findings were then validated in an independent set of well-characterized donor eyes (n = 85). There was limited overlap between DEGs and DSGs, suggesting distinct mechanisms at play in AMD pathophysiology. A greater number of previously reported AMD loci overlapped with DSGs compared to DEGs between disease states, and no DEG overlap with previously reported loci was found in the macular retina between disease states. Additionally, we explored allele-specific expression (ASE) in coding regions of previously reported AMD risk loci, uncovering a significant imbalance in C3 rs2230199 and CFH rs1061170 in the macular RPE/choroid for normal eyes and intermediate AMD (iAMD), and for CFH rs1061147 in the macular RPE/choroid for normal eyes and iAMD, and separately neovascular AMD (NEO). Only significant DEGs/DSGs from the macular RPE/choroid were found to overlap between disease states. STAT1, validated between the iAMD vs. normal comparison, and AGTPBP1, BBS5, CERKL, FGFBP2, KIFC3, RORα, and ZNF292, validated between the NEO vs. normal comparison, revealed an intricate regulatory network with transcription factors and miRNAs identifying potential upstream and downstream regulators. Findings regarding the complement genes C3 and CFH suggest that coding variants at these loci may influence AMD development via an imbalance of gene expression in a tissue-specific manner. Our study provides crucial insights into the multifaceted genomic underpinnings of AMD (i.e., tissue-specific gene expression changes, potential splice variation, and allelic imbalance), which may open new avenues for AMD diagnostics and therapies specific to iAMD and NEO.

Clinical and functional correlates of posttraumatic stress disorder in urban adolescent girls at a primary care clinic

OBJECTIVE

To identify clinical and functional correlates of posttraumatic stress disorder (PTSD) in trauma-exposed urban adolescent girls.

METHOD

Ninety female adolescents aged 12 to 21 years (mean 17.3 years) who presented for routine medical care at an adolescent primary care clinic were assessed with self-report questionnaires and interviews for trauma exposure, posttraumatic stress symptoms, other psychopathology, and psychosocial, family, and school function.

RESULTS

Ninety-two percent (n = 83) endorsed at least one trauma. Witnessing community violence (85.6%) and hearing about a homicide (67.8%) were the most common traumatic events endorsed. Twelve (14.4%) and 10 (11.6%) traumatized girls met DSM-IV symptom criteria for full and partial PTSD, respectively. Compared with traumatized girls without PTSD, girls with PTSD were significantly more depressed, used more cigarettes and marijuana, and were more likely to have failed a school grade, been suspended from school, or been arrested.

CONCLUSIONS

Urban adolescent girls are exposed to multiple types of trauma. Whereas most develop at least one posttraumatic stress symptom, girls who meet full symptom criteria for PTSD show evidence of other psychopathology, increased cigarette and marijuana use, and poorer school performance. Further research is needed to identify and treat inner-city girls with PTSD.

Swimming and central venous catheter-related infections in the child with cancer

Although there have been many studies evaluating risk factors for catheter-related infections in children with cancer, none have examined whether swimming presents such a risk. Families of children with cancer were asked about specific swimming practices and central line care to determine whether there is an association between swimming and infection. Parents completed a self-report questionnaire and medical records were reviewed to document catheter-related intraluminal, tunnel, and exit-site infections. Ninety-one children with a total of 101 tunneled catheters participated in the study. Forty-nine children with a total of 50 catheters were swimmers; 46 children with 51 catheters were nonswimmers (four children had two catheters and swam with one catheter but not the other, therefore, these children were counted twice). There were no statistically significant differences in rates of catheter-related infections between the two groups (0.04/catheter-month in swimmers versus 0.25/in non-swimmers, relative risk; RR = 1.6, p = .16). When the analysis was confined to summertime infections per summertime catheter month, there were no significant differences in the rates of infections per summer month (0.06 for swimmers vs. 0.05 for non-swimmers, RR = 1.4; p = .50). When the analyses were performed to compare frequent swimmers with infrequent/non-swimmers, once again there were no differences found in rates of catheter-related infections between the two groups. These results suggest that swimming does not increase the risk of catheter-related infections in children with tunneled catheters.

Identifying substance use: an assessment tool for the school nurse

A nursing assessment tool was developed to identify students who may be using drugs or alcohol. The three-part tool enables the school nurse to identify those students who require immediate medical care, as well as those who are impaired by substance use but medically stable. The use of the tool and implications for school nurses are discussed.