Enrichment of cis-regulatory gene expression SNPs and methylation quantitative trait loci among bipolar disorder susceptibility variants

We conducted a systematic study of top susceptibility variants from a genome-wide association (GWA) study of bipolar disorder to gain insight into the functional consequences of genetic variation influencing disease risk. We report here the results of experiments to explore the effects of these susceptibility variants on DNA methylation and mRNA expression in human cerebellum samples. Among the top susceptibility variants, we identified an enrichment of cis regulatory loci on mRNA expression (eQTLs), and a significant excess of quantitative trait loci for DNA CpG methylation, hereafter referred to as methylation quantitative trait loci (mQTLs). Bipolar disorder susceptibility variants that cis regulate both cerebellar expression and methylation of the same gene are a very small proportion of bipolar disorder susceptibility variants. This finding suggests that mQTLs and eQTLs provide orthogonal ways of functionally annotating genetic variation within the context of studies of pathophysiology in brain. No lymphocyte mQTL enrichment was found, suggesting that mQTL enrichment was specific to the cerebellum, in contrast to eQTLs. Separately, we found that using mQTL information to restrict the number of single-nucleotide polymorphisms studied enhances our ability to detect a significant association. With this restriction a priori informed by the observed functional enrichment, we identified a significant association (rs12618769, P(bonferroni)<0.05) from two other GWA studies (TGen+GAIN; 2191 cases and 1434 controls) of bipolar disorder, which we replicated in an independent GWA study (WTCCC). Collectively, our findings highlight the importance of integrating functional annotation of genetic variants for gene expression and DNA methylation to advance the biological understanding of bipolar disorder.

Molybdenum emission from impurity-induced m = 1 snake-modes on the Alcator C-Mod tokamak

A suite of novel high-resolution spectroscopic imaging diagnostics has facilitated the identification and localization of molybdenum impurities as the main species during the formation and lifetime of m = 1 impurity-induced snake-modes on Alcator C-Mod. Such measurements made it possible to infer, for the first time, the perturbed radiated power density profiles from which the impurity density can be deduced.

Depressive disorder moderates the effect of the FTO gene on body mass index

There is evidence that obesity-related disorders are increased among people with depression. Variation in the FTO (fat mass and obesity associated) gene has been shown to contribute to common forms of human obesity. This study aimed to investigate the genetic influence of polymorphisms in FTO in relation to body mass index (BMI) in two independent samples of major depressive disorder (MDD) cases and controls. We analysed 88 polymorphisms in the FTO gene in a clinically ascertained sample of 2442 MDD cases and 809 controls (Radiant Study). In all, 8 of the top 10 single-nucleotide polymorphisms (SNPs) showing the strongest associations with BMI were followed-up in a population-based cohort (PsyCoLaus Study) consisting of 1292 depression cases and 1690 controls. Linear regression analyses of the FTO variants and BMI yielded 10 SNPs significantly associated with increased BMI in the depressive group but not the control group in the Radiant sample. The same pattern was found in the PsyCoLaus sample. We found a significant interaction between genotype and affected status in relation to BMI for seven SNPs in Radiant (P<0.0057), with PsyCoLaus giving supportive evidence for five SNPs (P-values between 0.03 and 0.06), which increased in significance when the data were combined in a meta-analysis. This is the first study investigating FTO and BMI within the context of MDD, and the results indicate that having a history of depression moderates the effect of FTO on BMI. This finding suggests that FTO is involved in the mechanism underlying the association between mood disorders and obesity.

Parents Empowering Parents (PEP) Program: understanding its impact on the bleeding disorders community

The Parents Empowering Parents (PEP) Program gives parents tools to improve the lives of children with bleeding disorders. The aim of this study was to evaluate the efficacy of PEP. Eleven haemophilia treatment centres (HTC) participated in the study and 301 participants completed the survey. Parents who did not attend PEP were divided into three groups based on their reasons for not attending: (Not Offered, Bad Time and Don't Need). Those who attended (Attended) PEP reported less use of yelling, spanking, slapping and giving-in after attending PEP. The Not Offered group used Praising (P = 0.016), Natural Consequences (P = 0.002), Being Consistent (P = 0.016), Ignoring (P = 0.006), Distracting (P = 0.002), Setting Limits (P=0.009), Giving Choices (P = 0.049), Being Consistent (P = 0.014) and Distracting (P = 0.019) less than all other groups. The Bad Time group used Time-Out (P = 0.037) and Ignoring (P = 0.019) more than the other groups that did not attend PEP. The Don't Need group used Spanking (P = 0.008) and Time-Out (P = 0.003) and Yelling (P = 0.014) less than all other groups. Attending PEP seems to decrease the use of negative parenting techniques. Those who reported PEP was not offered to them used positive parenting techniques less than all other participants.

Hip displacement and overall function in severe cerebral palsy

OBJECTIVE

The aim of this study was to investigate the relationship between hip displacement (HD) in individuals with severe cerebral palsy with function and quality of life (QOL). The second aim was to identify differences in these outcomes when comparing surgical and non-surgical management for HD.

DESIGN

Cross-sectional study of 26 participants born between 1988 and 1998 who had hip displacement on their most recent hip radiograph.

METHOD

Caregivers completed the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD©) questionnaire. Hip migration percentage and a validated hip classification were used.

RESULTS

Significant positive correlation coefficients (CC) were found for mobility and comfort (CC=0.620, ρ = 0.001) as well as for QOL and comfort (CC=0.683, ρ < 0.001). Orthopedic hip surgery was associated with better scores for mobility (median [95% CI]); surgery vs. none; (36.1 [27.7, 44.4]) vs. (25.6 [22.2, 29.8]) and personal care, (32.1 [27.1, 43.2]) vs. (25.9 [22.7, 30.8]). Severity of HD had no significant association with comfort or QOL.

CONCLUSION

Mobility and personal care scores were significantly better in children who had undergone reconstructive hip surgery. However, QOL and pain scores were not associated with the severity of hip displacement or undertaking reconstructive hip surgery.

Innate Immune Responses in Swine Resuscitated from Severe Traumatic Hemorrhagic Shock with Hemoglobin-Based Oxygen Carrier-201

Hemoglobin-based oxygen carrier-201 transports oxygen and improves survival in swine with hemorrhagic shock, but has potential to be immune activating. Herein, we evaluated HBOC-201's immune effects in swine with more severe hemorrhagic shock due to soft tissue injury and 55% blood volume catheter withdrawal over 15 minutes followed by fluid resuscitation at 20 minutes with HBOC-201, Hextend, or no treatment (NON) before hospital arrival. Survival rates were similar with HBOC-201 and Hextend (p > 0.05), but were higher than in (p = 0.007). There were no significant group differences in blood cell count, percentages of leukocyte sub-populations and immunophenotype (CD4:CD8 ratio), adhesion markers expression (neutrophil CD11b; monocyte or neutrophil CD49d) and apoptosis. There was a trend to higher plasma IL-10 in HBOC-201 and groups vs. Hextend. We conclude that in swine with severe controlled HS and soft tissue injury, immune responses are similar with resuscitation with HBOC-201 and Hextend.

Depression, migraine with aura and migraine without aura: their familiality and interrelatedness

Migraine is frequently comorbid with depression. There appear to be common aetiological factors for both disorders, but the aetiology of migraine within depressed patients, in particular the significance of aura, has been little studied. A large sample of concordantly depressed sibling pairs [the Depression-Network (DeNT) sample] was assessed as having migraine with aura (MA), migraine without aura (MoA), probable migraine or no migraine according to International Headache Society guidelines. Correlations between siblings' migraine status were used to assess the nature of familial liability to migraine. A multiple threshold isocorrelational model fit best, in which different syndromes are conceptualized as different severities of one underlying dimension rather than as having separate aetiologies. Thus, MA and MoA were found to be different forms of the same disorder, with MA occupying the more extreme end of the spectrum of liability. Implications for our understanding of the relationship between migraine and depression are discussed.

Mutations in CHD7 in patients with CHARGE syndrome cause T-B + natural killer cell + severe combined immune deficiency and may cause Omenn-like syndrome

More than 11 genetic causes of severe combined immunodeficiency (SCID) have been identified, affecting development and/or function of T lymphocytes, and sometimes B lymphocytes and natural killer (NK) cells. Deletion of 22q11.2 is associated with immunodeficiency, although less than 1% of cases are associated with T-B + NK + SCID phenotype. Severe immunodeficiency with CHARGE syndrome has been noted only rarely Omenn syndrome is a rare autosomal recessive form of SCID with erythroderma, hepatosplenomegaly, lymphadenopathy and alopecia. Hypomorphic recombination activating genes 1 and 2 mutations were first described in patients with Omenn syndrome. More recently, defects in Artemis, RMRP, IL7Ralpha and common gamma chain genes have been described. We describe four patients with mutations in CHD7, who had clinical features of CHARGE syndrome and who had T-B + NK + SCID (two patients) or clinical features consistent with Omenn syndrome (two patients). Immunodeficiency in patients with DiGeorge syndrome is well recognized--CHARGE syndrome should now be added to the causes of T-B + NK + SCID, and mutations in the CHD7 gene may be associated with Omenn-like syndrome.

Immune effects of decreasing low-molecular weight hemoglobin components of hemoglobin-based oxygen carriers (HBOC) in a swine model of severe controlled hemorrhagic shock

Hemoglobin-based oxygen carriers (HBOCs) show potential as safe, efficacious, pre-hospital resuscitation fluids. The major criticism of HBOC-201 is its vasoactive property, attributed partially to low-molecular weight (low-MW) tetrameric/dimeric (TD) hemoglobin (Hb) in HBOC solution. Here we sought to determine whether resuscitation with decreasing concentrations of low-MW Hb component of HBOC affects immune responses in hemorrhagic swine. 28 anesthetized swine underwent a soft muscle crush and controlled hemorrhage of 55% blood volume, followed by resuscitation with HBOC containing 31%, 2%, or 0.4% low-MW Hb in four 10 ml/kg infusions at 20, 30, 45 and 60 minutes before hospital arrival at 75 minutes. IL-10, cell activation and adhesion markers and CD4:CD8 ratio remained unchanged in all 3 groups compared to baseline. Leukocyte apoptosis was equally elevated across all groups. Purification from 31% to 0.4% low-MW Hb in HBOC solution did not alter immune effects in a swine model of severe controlled hemorrhagic shock.

Quantifying adherence to treatment and its relationship to quality of life in a well-characterized haemophilia population

It is known that chronically ill patients adhere to medical treatment plans only 50% of the time. Adherence to treatment with factor infusion therapy in haemophilia patients is essential to stop bleeding. It also prevents both acute and chronic life and limb threatening complications. This study, performed in a well-described haemophilia population, was completed in an effort to understand the critical issue of adherence in patients with haemophilia. A major component of the methodology of this study was the development of a unique scoring system to quantify adherence. Adherence scores in patients on On-Demand treatment strategies were then compared to those on High Intensity treatment strategies. Quality of life (QoL) studies were also performed on the study population to assess the association of treatment regimen and adherence scores to QoL measures. Results of this study demonstrated that adherence to On-Demand therapy was significantly greater than adherence to High Intensity treatment regimens and in children, High Intensity treatment regimens, which included prophylaxis, correlated with better QoL scores in body pain. It is envisioned that the development of an objective scoring system for adherence will prove useful in future studies of adherence as well as in the development of intervention strategies that can overcome barriers to adherence in haemophilia patients.

Production of 89Sr in solution reactor

The new method for medical (89)Sr production in a reactor with solution fuel is proposed which is characterized by simplicity, high production efficiency and low buildup of radioactive waste. The main advantages of the new technology were validated by numerous experiments. The proposed new technology selectively extracts (89)Sr from a fuel of solution reactor and precludes penetration of (90)Sr into the final product. This method is based on the presence of gaseous radionuclide (89)Kr (T(1/2)=190.7s) in the decay chain (89)Se-->(89)Br-->(89)Kr-->(89)Rb-->(89)Sr. The performed experiments on taking the gas probes from internal volume of the solution 20 kW mini-reactor "Argus" have confirmed that the mechanism for (89)Sr delivery to the sorption volume of the reactor experimental loop is based on transport of gaseous (89)Sr predecessor-radionuclide (89)Kr. According to the measurements of radioactive impurities in a final (89)SrCl(2) solution, the filtration of the gas flow with cermet filters followed by cleaning of (89)Sr chloride solution in chromatographic columns with DOWEX-50 x 8 or Sr-Resin ensures reception of (89)Sr fully meeting the requirements for medical application. The experimental estimations have shown that the proposed new technology is multiply more productive than the traditional industrial methods of (89)Sr reception.

Rapid prototyping in the assessment, classification and preoperative planning of acetabular fractures

AIM

To evaluate the use of rapid prototyping in the assessment, classification and preoperative planning of acetabular fractures.

INTRODUCTION

The complex three-dimensional anatomy of the pelvis and acetabulum make assessment, classification and treatment of fractures of these structures notoriously difficult. Conventional imaging only provides two-dimensional images of these fractures. While interpretation of traditional imaging techniques becomes better with experience, novel techniques may assist in the understanding of these complex injuries.

METHODS

Twenty patients with acetabular fractures were studied. Life size three-dimensional models were manufactured from standardised CT scans, using the rapid prototyping process, selective laser sintering. Each model was presented to the operating surgeon prior to surgery. The surgeons found that the models greatly assisted in their understanding of the personality of the fracture. Three consultant orthopaedic surgeons and three senior trainees were asked to classify each fracture using conventional radiographs (AP pelvis, Judet views and CT scans) and then using the model. The kappa statistic was used to evaluate inter- and intraobserver agreement.

RESULTS

Interobserver agreement was not absolute using either conventional radiographs or the models. For the consultants the kappa statistic using conventional radiographs was 0.61 while the kappa value using the model was 0.76 (p<0.05). For the trainees the kappa value was 0.42, using conventional radiographs and 0.71 using the model (p<0.01).

CONCLUSION

Full sized models of acetabular fractures greatly assisted surgeons understand the personality of complex fractures prior to surgery and have been shown in this study to significantly reduced the degree of interobserver variability in fracture classification. This effect is particularly evident for less experienced surgeons. This technique is available and relatively inexpensive. The use of these models should prove invaluable as a tool to aid clinical practice.