Mutation analysis and embryonic expression of the HLXB9 Currarino syndrome gene

The HLXB9 homeobox gene was recently identified as a locus for autosomal dominant Currarino syndrome, also known as hereditary sacral agenesis (HSA). This gene specifies a 403-amino acid protein containing a homeodomain preceded by a very highly conserved 82-amino acid domain of unknown function; the remainder of the protein is not well conserved. Here we report an extensive mutation survey that has identified mutations in the HLXB9 gene in 20 of 21 patients tested with familial Currarino syndrome. Mutations were also detected in two of seven sporadic Currarino syndrome patients; the remainder could be explained by undetected mosaicism for an HLXB9 mutation or by genetic heterogeneity in the sporadic patients. Of the mutations identified in the 22 index patients, 19 were intragenic and included 11 mutations that could lead to the introduction of a premature termination codon. The other eight mutations were missense mutations that were significantly clustered in the homeodomain, resulting, in each patient, in nonconservative substitution of a highly conserved amino acid. All of the intragenic mutations were associated with comparable phenotypes. The only genotype-phenotype correlation appeared to be the occurrence of developmental delay in the case of three patients with microdeletions. HLXB9 expression was analyzed during early human development in a period spanning Carnegie stages 12-21. Signal was detected in the basal plate of the spinal cord and hindbrain and in the pharynx, esophagus, stomach, and pancreas. Significant spatial and temporal expression differences were evident when compared with expression of the mouse Hlxb9 gene, which may partly explain the significant human-mouse differences in mutant phenotype.

Covid-19 pandemic effects on food safety - Multi-country survey study

This study provides an important insight into the response of food safety systems during the first months of the pandemic, elevating the perspective of preventing Covid-19 within conventional food safety management systems. A multi-country survey was conducted in 16 countries involving 825 food companies. Based on the results of the survey, it is obvious that the level of maturity of a food safety system in place is the main trigger in classifying companies and their responses to the pandemic challenge. Staff awareness and hygiene are the two most important attributes in combating Covid-19, opposed to temperature checking of workers in food establishment and health protocols from the World Health Organization, recognized as attributes with limited salience and importance. Companies confirmed implementation of more restrictive hygiene procedures during the pandemic and the need for purchasing more additional personal protective equipment. Retailers were identified as the food supply chain link mostly affected by the pandemic opposed to food storage facilities ranked as least affected. During this challenging period, all companies declared that food safety has not been compromised at any moment. It is important to note that less than a half of the food companies had documented any emergency plans associated with pandemics and health issues in place.

Why do patients with lupus nephritis die?

Over 20 years 42 of 138 patients with systemic lupus erythematosus "died"--that is, suffered actual death or went into terminal renal failure, or both; data from 41 were available for analysis. In most patients the causes of death were multiple. Twenty seven patients went into terminal renal failure, of whom 25 were offered dialysis treatment. Three regained renal function later, 12 survived on dialysis or with functioning kidney allografts--almost all with inactive lupus--but 13 died after starting dialysis, most within a few weeks or months. The principal causes were active lupus or infection. In those patients with renal failure after rapid deterioration in renal function (n = 14) there were nine deaths, while of 10 patients with a slow evolution into renal failure, only four died. Four patients with impaired and 10 with normal renal function died, again most often from complications of lupus or from infection. Vascular disease was a major cause of death in seven patients, all but two of whom were young; of 15 postmortem examinations, eight showed severe coronary artery atheroma, and three surviving patients required coronary bypass operations. Analysis of the timing of death or entry into renal failure showed that in 12 out of 13 patients who died within two years of onset the lupus was judged to be active, while this was true in only eight out of 19 patients who died later. Six of the seven vascular deaths occurred later than two years from onset, while only nine of 26 renal "deaths" occurred before two years; deaths from infections (n = 13) were distributed equally. Despite this and aggressive treatment of active disease, the principal cause of actual death was uncontrolled lupus.

Analysis of the human Sonic Hedgehog coding and promoter regions in sacral agenesis, triphalangeal thumb, and mirror polydactyly

The human Sonic Hedgehog gene (SHH) is one of the vertebrate homologs related to the Drosophila segment polarity gene hedgehog. The entire coding and promoter region of the SHH gene, including 2 kb 5' of the transcriptional start site has been screened for mutations in families with autosomal dominant sacral agenesis and autosomal dominant triphalangeal thumb, two conditions previously known to be linked to 7q36. We have also studied the SHH gene in five families with mirror polydactyly associated with tibial hemimelia and in 51 unrelated patients with neural tube defects. Except for two sequence variants in exon 3, no mutations were found in these disease categories. OFF

Rat salivary gland ligation causes reversible secretory hypofunction

AIM

To determine the influence of inflammation on salivary secretion. Secretion by salivary glands involves interactions between nerves, blood vessels and salivary cells. The present study investigated the effects of inflammation on rat submandibular gland function following acute ductal obstruction.

METHODS

Under recovery anaesthesia a metal clip was placed on the main duct of the submandibular gland. After 24 h salivary secretion was evoked by nerve and methacholine stimulation. For recovery experiments the clip was removed after 24 h and the animal left to recover for 3 days when salivary function was again assessed.

RESULTS

By 24 h of obstruction an inflammatory infiltrate had developed within the obstructed gland and stimulated salivary flows were just 20% of the normal secretion, whilst protein secretion and ion reabsorption were also severely impaired. If ductal obstruction was removed after 24 h the salivary function returned to normal after 3 days of recovery. In vitro analysis of cells from 24-h ligated glands revealed normal changes in intracellular calcium (the main secondary messenger involved in fluid secretion) in response to methacholine stimulation. Protein secretion from isolated cells indicated some changes in particular to methacholine-induced protein secretion although a significant protein secretion was still seen in response to isoprenaline - the main stimulus for protein secretion.

CONCLUSION

This report demonstrates reversible salivary inhibition associated with an inflammatory infiltrate within the salivary gland.

Development of a Questionnaire to Assess People’s Food Choices Determinants

Background:

Diet and nutrition are major determinants of public health and are associated with a large number of diseases. Therefore, in order to plan actions to promote global health, it is crucial to understand people’s food choices.

Objective:

The aim of this study was the development and validation of a new instrument, a questionnaire to measure psycho-social motivations associated with food choices and eating practices.

Methods:

A descriptive cross-sectional study was undertaken on a non-probabilistic sample of 382 adult participants. The questionnaires were applied after informed consent only to adults (aged 18 or over) and the data were collected from January to April 2017 among the Portuguese population. The analysis has been conducted to explore the item-item correlation and the reliability of this new instrument.

Results:

The results indicated satisfactory correlations between the items of the different variables, except for Variable D (Social and cultural motivations) that did not show strong and significant correlations for almost any items. Considering all the items in each of the variables studied, Cronbach’s alpha values ranged from 0.32 for the marketing and commercial motivations to 0.64 for the economical and availability motivations. When some items were removed from the variables, the values of Cronbach’s alpha increased and ranged from 0.66 for social and cultural motivations to 0.79 for health motivations.

Conclusion:

This work suggested that this questionnaire could be considered a suitable tool for exploring food choice determinants.

Development and multi-center evaluation of a novel immunoadsorption method for anti-DFS70 antibodies

OBJECTIVE

Antinuclear antibodies (ANA) represent a hallmark in the diagnosis of ANA-associated rheumatic diseases (AARD). However, anti-DFS70 antibodies are present in a higher portion of the healthy individuals (HI) than in patients with AARD. Consequently, we developed a novel, highly specific indirect immunofluorescence (IIF) method that blocks anti-DFS70 antibodies from binding to HEp-2 cells and to evaluate the method in a multi-center study.

METHODS

A total of 18 samples from systemic lupus erythematosus patients (SLE, n = 7) and HI (n = 11) were used for the initial development of the immunoadsorption method. For the multi-center evaluation, samples with a dense fine speckled (DFS) pattern (n = 99) were collected at three different sites based on their established IIF screening procedure at the respective laboratories. Additionally, four characterized samples with established clinically relevant IIF patterns (centromere, nucleolar, speckled, homogeneous) were blended in five different ratios (10%, 25%, 50%, 75%, 90%) with a sample positive for anti-DFS70 antibodies, which by itself showed a dense fine speckled (DFS) IIF pattern. All samples were tested by IIF with NOVA Lite HEp-2 ANA and NOVA Lite HEp-2 Select on the NOVA View® instrument, and also tested by QUANTA Flash DFS70 chemiluminescent immunoassay (CIA) for confirmation of anti-DFS70 antibodies (Inova Diagnostics, San Diego, CA, USA).

RESULTS

For the development of the immunoadsorption method, only 1/7 ANA-positive samples from SLE patients, but 8/10 ANA-positive samples from healthy individuals turned negative using the immunoadsorption. Subsequently, 73/99 (73.7%) of the DFS pattern samples were positive by CIA for anti-DFS70 antibodies showing a strong quantitative Spearman's correlation (rho = 0.57 (95% CI, 0.39-0.71, p < 0.0001)) between light intensity units (LIU) measured by NOVA View and CIA. Intensities measured with NOVA Lite HEp-2 and NOVA Lite HEp-2 Select demonstrated significantly lower intensity values after inhibition with DFS70 antigen (p < 0.0001). When samples were processed to mimic samples with mixed patterns (DFS + clinically relevant pattern), the new immunoadsorption method demonstrated that all clinically relevant patterns remained unchanged whereas the LIUs from NOVA View analysis significantly decreased after inhibition (p < 0.0001).

CONCLUSION

The data showed that the NOVA Lite HEp-2 Select kit effectively inhibits anti-DFS70 antibody binding to its cellular target antigen.

Clinical and biochemical studies in mucopolysaccharidosis type II carriers

The aim of the study was to characterize clinically and biochemically mucopolysaccharidosis type II (MPS II) heterozygotes. Fifty-two women at risk to be a carrier, with a mean age of 34.1 years (range 16-57 years), were evaluated through pedigree analysis, medical history, physical examination, measurement of iduronate sulfatase (IDS) activities in plasma and in leukocytes, quantification of glycosaminoglycans (GAGs) in urine, and analysis of the IDS gene. Eligibility criteria for the study also included being 16 years of age or older and being enrolled in a genetic counselling programme. The pedigree and DNA analyses allowed the identification of 40/52 carriers and 12/52 non-carriers. All women evaluated were clinically healthy, and their levels of urinary GAGs were within normal limits. Median plasma and leukocyte IDS activities found among carriers were significantly lower than the values found for non-carriers; there was, however, an overlap between carriers' and non-carriers' values. Our data suggests that MPS II carriers show lower plasma and leukocyte IDS activities but that this reduction is generally associated neither with changes in levels of urinary GAGs nor with the occurrence of clinical manifestations.

Chemical profiling of Portuguese Pinus pinea L. nuts

BACKGROUND

The first detailed chemical characterisation of Portuguese pine nut (Pinus pinea L.) is reported concerning proximate composition, fatty acid, mineral and vitamin contents.

RESULTS

Based on the analysis of 27 different populations, pine nuts were characterised by high contents of fat (47.7 g per 100 g dry matter (DM)), protein (33.8 g per 100 g DM) and phosphorus (1130 mg per 100 g DM) and low contents of moisture (5.9 g per 100 g DM) and starch (3.5 g per 100 g DM). They were also found to be a good source of zinc, iron and manganese.

CONCLUSION

Mineral composition seemed to be most prone to variation, suggesting its potentially useful role in discriminating Mediterranean pine nuts. A significant variability was found in the nut composition of Portuguese P. pinea populations.

Acute mastoiditis in children: Middle ear cultures may help in reducing use of broad spectrum antibiotics

BACKGROUND

Acute mastoiditis (AM) is a suppurative infection of the mastoid air cells, representing the most frequent complication of acute otitis media. AM remains an important entity in children due to its potential complications and sequelae. We aim to describe the cases of AM admitted at our department, identify risk factors potentially associated with complications and analyse the changes in clinical approach of AM over time.

METHODS

Case review of clinical files of children admitted with acute mastoiditis from June 1996 to May 2013 at a Lisbon metropolitan area hospital. Data was divided into two groups (prior and after May 2005) in order to evaluate changes in AM approach over the years.

RESULTS

135 AM episodes were included. The median age was 3.8 years and 42% children were less than 24 months of age. Symptoms at presentation included fever (69%), ear pain (56%) and otorrhea (40%). Complications occurred in 22% patients and were more common in children under 24 months (33% vs 15%, p ≤ 0.01). Leukocyte count was significantly higher in children with complications (16.7 vs 14.5 × 10⁹/μL, p ≤ 0.05) as was C-Reactive Protein value (13 vs 6.3 mg/dL, p ≤ 0.001). There was a significant association between the development of complications and C-Reactive Protein value at admission (OR 1.892; IC95%: 1.018-2.493, p ≤ 0.01). The optimal cut-off value was 7.21 mg/dL. Over time there was a significant increase in middle ear cultures obtained by tympanocentesis during surgery (2% vs 16%, p ≤ 0,01) and also a decrease in the use of broad spectrum antibiotherapy as initial treatment (52% vs 25%,p ≤ 0,001).

CONCLUSIONS

Children under 24 months, with high leukocyte count or with high C-Reactive Protein value should be monitored closely since complications tend to be more frequent. A CRP value of 7.21 mg/dL at admission seems to be a good cut-off to monitor children for potential complications. Throughout the period analysed more cultures were performed allowing identification of the pathogens and implementation of appropriate antibiotic therapy.

Effect of different thistle flower ecotypes as milk-clotting in Serra da Estrela cheese

Purpose

Thistle flower (Cynara cardunculus) aqueous extracts, as rich source of milk-clotting peptidases, have been widely used for cheeses marketed under the Registry of the Protected Designation of Origin, as it is the case of Serra da Estrela cheese, manufactured from raw ewes’ milk and without addition of any commercial starter culture. This paper aims at studying the influence of six different ecotypes of thistle flowers in cheese properties during the ripening and of final products.

Design/methodology/approach

Cheeses were produced with different thistle flower extracts and then the clotting time, weight and colour of cheeses, as well as texture properties and sensorial characteristics, were evaluated.

Findings

The clotting time varied from 47 to 66 min, and the weight loss along ripening varied between 32 and 40 per cent. There was some influence of thistle flower ecotype on the colour during ripening and in the final product. The results of texture analysis revealed significant differences between the thistle ecotypes: crust firmness varying from 2.4 to 5.6 N; inner firmness from 0.82 to 1.82 N; stickiness from −0.5 to −1.60 N; adhesiveness from −3.0 to −11.3 N.s; and Ecotype C was particularly distinguishable. Sensorial evaluation revealed differences among the cheeses, with Ecotype C receiving the highest score for global appreciation.

Originality/value

The usage of different extracts of thistle flower to produce Serra da Estrela cheese with different properties is a novelty, and it allows the possibility of manipulating this parameter in the future so as to produce cheeses with specific characteristics, addressed to different consumer targets.

A de novo complex chromosomal rearrangement with nine breakpoints characterized by FISH in a boy with mild mental retardation, developmental delay, short stature and microcephaly

A de novo complex chromosome rearrangement (CCR) involving chromosomes 1, 6, 7, 15 and Y was detected in a boy with mental retardation, short stature, and microcephaly. Fluorescence in situ hybridisation (FISH) with whole chromosome painting libraries, band-specific cosmids and telomeric probes was essential for the characterisation of the rearrangement. The CCR was shown to be the result of at least nine chromosomal breaks and involved the alternating insertion of two segments of the short arm of chromosome 1 and two segments of the long arm of chromosome 6 into a novel derived chromosome 7. A non-reciprocal translocation between the distal short arm of the same chromosome 7 and the distal long arm of the Y chromosome was also found, together with a paracentric inversion of the long arm of chromosome 15. The only detectable imbalance was a deletion of the heterochromatic Yq telomeric region. FISH investigations in this case have revealed an additional complexity in this CCR, which has implications for reproductive risk assessment and genetic counselling.

The concept of bimaxillary transverse osteodistraction: a paradigm shift?

Severe crowding due to narrow upper and lower apical bases can be corrected by the extraction of four premolars, or by bimaxillary transverse osteodistraction. The first strategy is prone to unaesthetic changes in lip posture, nasolabial angle and buccal corridors. Life-long retention is necessary because of the known correlation between increased intercanine distance and relapse of crowding. The second strategy involves surgery and the final outcome regarding stability is not yet known. Theoretically, because the canines have not been moved outside of the skeletal envelope, and because the functional matrix positively influences the dental arches, relapse of crowding should be less. Facial appearance is improved because of the reduction of the buccal corridors and the fullness of the mouth both at rest, and upon smiling.

Evaluation of phenolic and antioxidant properties of strawberry as a function of extraction conditions

Abstract We studied the extraction of antioxidant phenolic compounds, anthocyanins and the evaluation of antioxidant activity of strawberries in different extraction conditions, varying the type of solvent (ethanol:water (50%) and acetone:water (60%), the extraction time (15 and 60 min) and the solvent volume to sample mass ratio (5 mL/g and 20 mL/g). In addition, we performed principal component analysis and cluster analysis. The results showed that, although the two solvents tested had similar influence on total phenolic compounds extraction and antioxidant activity, the 60 minutes of extraction and the use of the solvent volume/sample mass ratio of 20 mL/g were the best extraction conditions, both for the 1st and 2nd recovered extracts. However, the solvent had a marked effect on anthocyanins’ extraction, so that acetone/water extracted almost the double as compared to ethanol/water, for the same extraction conditions. Finally, factor analysis allowed identifying a grouping structure of two components, which was confirmed by the dendogram obtained from cluster analysis.

Influence of Environmental and Political Determinants on Food Choices in a Sample of Portuguese Population

Background:

There is an increasing concern regarding the impacts of food choices in the environment. Therefore, in order to plan actions to promote more sustainable diets, it is crucial to understand the influence of environmental and political determinants on people’s food choices.

Objective:

This work aimed at studying the extent to which environmental and political determinants influence people’s food choices in a sample of the Portuguese population.

Methods:

A descriptive cross-sectional study was undertaken on a non-probabilistic sample of 1314 participants living in the Centre of Portugal. The questionnaires were applied after informed consent only to adults (aged 18 or over) and the data were collected from January and December 2017 among the Portuguese population.

Results:

The participants’ food choices were, in general, influenced by environmental and political determinants (0.77 ± 0.53, in a scale from -2 to +2). It was also observed that the elderly, men and the participants who had a university degree were more influenced by these determinants. These findings were similar for those who lived in urban areas, the retired, the participants who had a professional activity or studies in agriculture areas and those who were responsible for buying their own food. Furthermore, there were found significant differences between age groups, genders and the levels of education. There were also observed significant differences between the different living environments, professional status, regarding the areas of work or studies and also between the participants who were responsible for buying their one food and the ones who were not. These findings are very important because they highlight the complicity of people’s food choices and are determinant for the development of strategies that can improve people’s eating habits.

Conclusion:

This paper fulfills an identified need to study the environmental and political determinants underlying the Portuguese food choices.

Prospective study of loss of health-related quality adjusted life years in children and their families due to uncomplicated and hospitalised varicella

INTRODUCTION AND AIMS

Although usually benign, varicella can lead to serious complications and sometimes long-term sequelae. Vaccines are safe and effective but not yet included in immunisation programmes in many countries. We aimed to quantify the impact on health-related quality of life (HRQoL) in terms of quality-adjusted life years (QALY) in children with varicella and their families, key to assessing cost-utility in countries with low mortality due to this infection.

METHODS

Children with varicella in the community and admitted to hospitals in Portugal were included over 18 months from January 2019. Children's and carers' HRQoL losses were assessed prospectively using standard multi-attribute utility instruments for measuring HRQoL (EQ-5D and CHU9D), from presentation to recovery, allowing the calculation of QALYs.

RESULTS

Among 109 families with children with varicella recruited from attendees at a pediatric emergency service (community arm), the mean HRQoL loss/child was 2.0 days (95 % CI 1.9-2.2, n = 101) (mean 5.4 QALYs/1000 children (95 % CI 5.3-6.1) and 1.3 days/primary carer (95 % CI 1.2-1.6, n = 103) (mean 3.6 QALYs /1000 carers (95 % CI 3.4-4.4). Among 114 families with children admitted to hospital because of severe varicella or a complication (hospital arm), the mean HRQoL loss/child was 9.8 days (95 % CI 9.4-10.6, n = 114) (mean 26.8 QALYs /1000 children (95 % CI 25.8-29.0) and 8.5 days/primary carer (95 % CI 7.4-9.6, n = 114) (mean 23.4 QALYs/1000 carers (95 % CI 20.3-26.2). Mean QALY losses/1000 patients were particularly high for bone and joint infections [67.5 (95 % CI 43.9-97.6)]. Estimates for children's QALYs lost using the CHU9D tool were well correlated with those obtained using EQ-5D, but substantially lower.

CONCLUSIONS

The impact of varicella on HRQoL is substantial. We report the first measurements of QALYs lost in hospitalised children and in the families of children both in the community and admitted to hospital, providing important information to guide vaccination policy recommendations.

Corrélation entre les données échographiques et radiographiques dans l’évaluation de la maturation du cal osseux symphysaire après distraction

OBJECTIVE

To search for means of reducing ionizing radiation during treatment planning for transmandibular osteodistraction.

MATERIAL AND METHODS

Eleven patients (6 female, 5 male) underwent combined bimaxillary osteodistraction at a mean age of 18 Years. The following investigations were performed to determine symphyseal callus maturation: occlusal radiographs (O-RX) preoperatively, after the active phase of distraction (mean 27 days); ultrasound investigations (US) after the active and consolidation phase.

RESULTS

US showed calcification foci at the end of the active phase, when O-RX failed to do so. Both US and O-RX detected callus immaturity after 2 Months of consolidation in 1 patient. Both detected bridging ossification one Month later.

DISCUSSION

US can replace radiography in the diagnosis of callus maturation related to distractor removal.

Ischemic stroke on hormonal contraceptives: Characteristics, mechanisms and outcome

Introduction

Systemic contraceptives increase the risk of ischemic stroke but little is known about the characteristics, mechanisms and long-term outcome post stroke of patients on hormonal contraception. We sought to To assess characteristics and outcome of acute ischemic stroke (AIS) in young women using systemic hormonal contraceptives (SHC) and compare them to strokes in non-contraceptive users.

Patients and methods

Using the Acute STroke Registry and Analysis of Lausanne (ASTRAL), we analyzed demographics, risk factors, clinical, radiological and treatment data of consecutive female patients of <50 years between 2003 to 2015. We compared groups with and without SHC in a logistic regression analysis.

Results

Of the 179 female patients of <50 years during the observation period, 57 (39.6%) used SHC, 71.9% of whom, a combined oral contraceptive pill. On logistic regression contraceptive users were significantly younger but had comparable stroke severity. They had less migraine with aura and tobacco use, and more hyperlipidaemia. Also, contraceptive users had significantly less intra and extracranial stenosis and occlusion on arterial imaging, but more focal hypoperfusion on CT-perfusion. Undetermined mechanism of stroke was more frequent with SHC users, whereas rare mechanisms were more frequent in non-users. The contraceptive user group had a more favourable adjusted 12-month outcome with significantly fewer ischemic recurrences after stopping systemic contraception in all.

Conclusion

Contraceptive users with ischemic strokes are younger and have lesser tobacco use and migraine with aura and more hyperlipidemia. Their stroke mechanism is more often undetermined using a standardised work-up, and their adjusted long-term outcome is more favourable with less stroke recurrence.