Thrombophilia in the young

Venous thromboembolism (VTE) is a rare disease that is being increasingly diagnosed and recognized in paediatrics in the past decade, usually as a secondary complication of primary severe underlying diseases. Apart from acquired thrombophilic risk factors, such as lupus anticoagulants, inherited thrombophilias (IT) have been established as risk factors for venous thromboembolic events in adults. In children with idiopathic VTE and in paediatric populations in which thromboses were associated with underlying medical diseases, IT have been described as additional prothrombotic risk factors. Follow-up data for VTE recurrence in children are available and suggest a recurrence rate of approximately 3% in neonates and 8% in other children. Here we present a review of the impact of IT on early onset of VTE and recurrence in children. Statistically significant associations between the IT traits investigated, e.g. factor V G1691A, factor II G20210A, protein C-, protein S-, antithrombin deficiency, elevated lipoprotein (a), combined IT and VTE onset were reported. In addition, statistically significant associations with recurrent VTE were calculated for protein S-, antithrombin-deficiency, and the factor II variant and combined IT. The absolute risk increase for VTE recurrence associated with IT ranged from 9.8 % for children carrying the factorII variant to 26% and 29% in children with combined IT and protein S-deficiency, respectively. Data obtained gave evidence that the detection of IT is clinically meaningful in children with VTE and underlines the importance of a paediatric thrombophilia screening program. Based on these data treatment algorithms have to be discussed.

A sandwich ELISA for porcine alpha-1 acid glycoprotein (pAGP, ORM-1) and further demonstration of its use to evaluate growth potential in newborn pigs

A simple, reproducible sandwich, ELISA was developed to measure porcine alpha-1 acid glycoprotein (pAGP, ORM-1) in pig plasma. Porcine AGP isolated from serum was purchased and a polyclonal antisera was prepared in rabbits using the whole pAGP molecule as immunogen. The antiserum was affinity purified, and a portion of the purified antibody fraction was labeled with horseradish peroxidase. Porcine AGP protein was used as a standard, whereas commercially available buffers and reagents were utilized throughout the assay. The assay was specific for pAGP, had a lower limit of detection of 3.2 ng/mL, and could be used to quantify pAGP in plasma or serum. Using this ELISA, we corroborated our previous findings obtained by RID assay, which demonstrated that the AGP concentration in newborn piglets is negatively associated with preweaning growth rate. The current data were obtained using piglets from a different geographical location and genetic background and showed that elevated AGP at birth was associated with reduced preweaning growth rate (P < 0.001, r = 0.433, n = 19 litters). In addition, litters with a greater average AGP at birth were at a growth disadvantage compared with litters with reduced average AGP plasma concentrations (P < 0.001, r = 0.708, n = 19 litters). Litter average plasma AGP was a better predictor of litter preweaning growth rate than average litter birth weight. The data represent further support for using perinatal AGP concentrations as a tool to identify potential slower growing pigs and as a plasma biomarker for predicting litter growth rate.

Randomised, double-blind, clinical investigation to compare orlistat 60 milligram and a customized polyglucosamine, two treatment methods for the management of overweight and obesity

BACKGROUND

The efficacy of a non-prescription drug to support weight loss programs has yet to be compared. This clinical trial investigates the comparability of orlistat 60 milligram (mg) and polyglucosamine.

METHODS

Sixty-four overweight or obese subjects were included in a two-center double-blind study. One center was in Germany [center 1] and the other was in Italy [center 2]. The subjects (26 in center 1 and 38 in center 2) were recommended to follow a calorie deficit of about 2000 kilojoules/day and to increase their physical activity to 3 metabolic equivalent hours (MET h)/day. In both centers, subjects were randomized to receive polyglucosamine (2 tablets x 2) or orlistat (1 capsule x 3) for a period of 12 weeks. Weight loss was considered as a main variable together with the reduction of 5 per cent (%) of body weight (5R). Body Mass Index (BMI) and waist circumference (WC) were taken as secondary variables.

RESULTS

A significant difference in weight loss between the two groups was shown, 6.7 ± 3.14 kilogram (kg) in group polyglucosamine versus 4.8 ± 2.24 kg in group orlistat (t test p < 0.05) respectively; BMI and WC reduction were also more consistent with polyglucosamine treatment than with orlistat treatment (t test p < 0.05). No significant difference was found in the number of subjects who achieved 5R (70% for polyglucosamine and 55% for orlistat group; chi square p > 0.05). The administration of polyglucosamine following energy restriction and increase in physical activity reduces body weight, BMI and WC more efficiently than orlistat.

CONCLUSIONS

Even though both groups were instructed to adopt a calorie restricted diet together with increased physical activity an additional weight loss in the polyglucosamine group of 1.6 kilogram (kg) compared to the orlistat group (6.2 ± 3.46 versus 4.6 ± 2.36 kg) in both centers was seen despite the higher consumption of carbohydrates in Italy (center 2). A typical Italian diet is usually high in carbohydrate content whereas Germans tend to consume meals with higher fat content. This leads to the assumption that polyglucosamine limits both fat and carbohydrate absorption which would explain the comparable effective weight reduction in the Italian participants.

TRIAL REGISTRATION

Trial registration at ClinicalTrials.gov NCT02529631, registered on Aug 19, 2015 retrospectively registered.

Impact of gravity, collector surface roughness and fracture orientation on colloid retention kinetics in an artificial fracture

The interaction of monodisperse fluorescent carboxylated polystyrene colloids (25nm and 1000nm diameter) with a cut granodiorite surface (Grimsel granodiorite; Switzerland) and with acrylic glass is investigated both experimentally and numerically. Colloid transport experiments are conducted in a parallel plate type fracture flow cell with an aperture of 0.75mm at pH5 under low ionic strength (1mM NaCl) and under laminar flow (7mL/h) conditions. The study focuses on the effect of residence time, colloid size, collector material and fracture orientation on colloid retention. Long colloid residence times are achieved by stop-flow experiments. Using atomic force microscopy and, more specifically, the colloid probe technique surface roughness and force distance information of the collector material (granodiorite or acrylic glass) as a function of probe size (cantilever) are obtained. The experiments are modeled using COMSOL Multiphysics® (2-D numerical simulations). The experimental and the modeled results lead to the conclusion that large colloids (1000nm diameter) undergo sedimentation and deposition on the surface during stop-flow. Collector interaction is not affected by the surface roughness variation. Contrariwise, for the investigated 25nm colloids sedimentation does not play a role under the experimental conditions and collector interaction is triggered by surface inhomogeneities such as surface roughness.

109 COMPARISON OF METHODS FOR SYNCHRONIZING RECIPIENTS OF IN VITRO PRODUCED EMBRYOS

The present study compared fertility, as pregnancy per embryo transfer (P/ET), and efficiency of recipient utilisation, as pregnancy per treated potential recipient (P/TX), in heifers receiving in vitro-produced embryos using synchronized oestrus after prostaglandin F2α (OESTRUS) or synchronized ovulation and fixed timed embryo transfer (FTET) with new or reused CIDR. In Expt. 1, heifers (n = 520) were randomly assigned to 1 of 3 groups: OESTRUS, FTET with new CIDR, or FTET with second-use CIDR (previously used for 5 days). Heifers in OESTRUS group (n = 166) were synchronized with two prostaglandin F2α 14 days apart and detection of oestrus performed using tail chalk during 5 days after the second prostaglandin F2α. Heifers in FTET were synchronized with a new CIDR (n = 178) or second-use CIDR (n = 176) using a modified 5-day CIDR-Synch; Day –8: CIDR inserted; Day –3: CIDR removed, prostaglandin F2α; Day –2: second prostaglandin F2α; Day 0: gonadotropin-releasing hormone to induce ovulation. In Expt. 2, heifers (n = 422) were randomly assigned to 1 of 2 groups: FTET with new CIDR or FTET with third-use CIDR (previously used twice for 5 days each time) using the FTET protocol described for Expt. 1. Fresh in vitro-produced embryos were transferred between 6 and 8 days after OESTRUS or gonadotropin-releasing hormone (FTET). All heifers were evaluated by transrectal ultrasonography on Day 32 and 60 for pregnancy detection. Measurements of P/ET and P/TX for both experiments were analysed by logistic regression (LOGISTIC procedure, SAS 9.4) using biologically meaningful covariates such as embryo stage and quality, interval from oestrus or GnRH to transfer, and technician in the statistical analyses. In Expt. 1, two preplanned contrasts were performed to compare differences between OESTRUS v. FTET, and between FTET with new v. second-use CIDR. The P/ET at Day 32 was similar (P = 0.50) with 41.3% (45/109) for OESTRUS and 43.4% (134/309) for FTET groups. Similarly, P/ET on Day 60 was 30.3% (33/109) for OESTRUS and 32.4% (100/309) for FTET groups (P = 0.37). However, P/TX heifer on Day 60 was greater (P = 0.04) in the FTET (28.2%; 100/354) compared to OESTRUS (19.9%; 33/166). This difference is attributed to a greater (P < 0.001) utilisation efficiency (transferred/treated) of heifers in FTET (87.3%) v. OESTRUS (65.6%). In the second contrast, P/ET on Day 32 were similar (P = 0.87) for FTET heifers synchronized with a new CIDR (43.9%, 69/157) v. second-use CIDR (42.8%, 65/152). In addition, P/TX heifer on Day 60 was also similar (P = 0.52) for heifers receiving a new or second-use CIDR (29.8%, 53/178 v. 26.7% 47/176). In Expt. 2, P/ET on Day 32 was similar (P = 0.73) for FTET with a new CIDR (41.0%, 77/188) or third-use CIDR (42.3%, 83/196). The P/TX heifer on Day 60 was also not different (P = 0.58) for new CIDR (28.6%, 61/213) v. third-use CIDR (31.1%, 65/209). Thus, use of FTET with new or used CIDR can produce similar P/ET and greater efficiency of recipient utilisation compared to OESTRUS.

Growth, Yield and Fruit Quality of Grapevines under Organic and Biodynamic Management

The main objective of this study was to determine growth, yield and fruit quality of grapevines under organic and biodynamic management in relation to integrated viticultural practices. Furthermore, the mechanisms for the observed changes in growth, yield and fruit quality were investigated by determining nutrient status, physiological performance of the plants and disease incidence on bunches in three consecutive growing seasons. A field trial (Vitis vinifera L. cv. Riesling) was set up at Hochschule Geisenheim University, Germany. The integrated treatment was managed according to the code of good practice. Organic and biodynamic plots were managed according to Regulation (EC) No 834/2007 and Regulation (EC) No 889/2008 and according to ECOVIN- and Demeter-Standards, respectively. The growth and yield of the grapevines differed strongly among the different management systems, whereas fruit quality was not affected by the management system. The organic and the biodynamic treatments showed significantly lower growth and yield in comparison to the integrated treatment. The physiological performance was significantly lower in the organic and the biodynamic systems, which may account for differences in growth and cluster weight and might therefore induce lower yields of the respective treatments. Soil management and fertilization strategy could be responsible factors for these changes. Yields of the organic and the biodynamic treatments partially decreased due to higher disease incidence of downy mildew. The organic and the biodynamic plant protection strategies that exclude the use of synthetic fungicides are likely to induce higher disease incidence and might partially account for differences in the nutrient status of vines under organic and biodynamic management. Use of the biodynamic preparations had little influence on vine growth and yield. Due to the investigation of important parameters that induce changes especially in growth and yield of grapevines under organic and biodynamic management the study can potentially provide guidance for defining more effective farming systems.

Regulation of alpha-1 acid glycoprotein synthesis by porcine hepatocytes in monolayer culture

Alpha-1 acid glycoprotein (AGP, orosomucoid, ORM-1) is a highly glycosylated mammalian acute-phase protein, which is synthesized primarily in the liver and represents the major serum protein in newborn pigs. Recent data have suggested that the pig is unique in that AGP is a negative acute-phase protein in this species, and its circulating concentration appears to be associated with growth rate. The purpose of the present study was to investigate the regulation of AGP synthesis in hepatocytes prepared from suckling piglets and to provide a framework to compare its regulation with that of haptoglobin (HP), a positive acute-phase protein. Hepatocytes were isolated from preweaned piglets and maintained in serum-free monolayer culture for up to 72 h. The influences of hormones, cytokines, and redox modifiers on the expression and secretion of AGP and HP were determined by relative polymerase chain reaction and by measuring the concentration of each protein secreted into culture medium. The messenger RNA abundance and/or secretion of AGP protein was enhanced by interleukin (IL)-17a, IL-1, and resveratrol and inhibited by tumor necrosis factor-α (TNF), oncostatin M, and thyroid hormone (P < 0.05). HP expression and synthesis were upregulated by oncostatin M, IL-6, and dexamethasone and downregulated by TNF (P < 0.01). The overall messenger RNA expression at 24 h was in agreement with the secreted protein patterns confirming that control of these proteins in hepatocytes is largely transcriptional. Moreover, these data support the consideration that AGP is a negative acute-phase reactant and appears to be regulated by cytokines (with the exception of TNF) and hormones primarily in a manner opposite to that of the positive acute-phase protein, HP.

Soil water-holding capacity mediates hydraulic and hormonal signals of near-isohydric and near-anisohydric Vitis cultivars in potted grapevines

Grapevine (Vitis vinifera L.) expresses different responses to water stress, depending not only on genotype, but also on the influence of vineyard growing conditions or seasonality. Our aim was to analyse the effects on drought response of two grapevine cultivars growing on two soils, one water draining (WD) containing sand 80% volume and the other water retaining (WR), with no sand. Under these two different water-holding capacities Syrah, displaying a near-anisohydric response to water stress, and Cabernet Sauvignon (on the contrary, near-isohydric) were submitted to water stress in a pot trial. Xylem embolism contributed to plant adaptation to soil water deprivation: in both cultivars during late phases of water stress, however, in Syrah, already at moderate early stress levels. By contrast, Syrah showed a less effective stomatal control of drought than Cabernet Sauvignon. The abscisic acid (ABA) influenced tightly the stomatal conductance of Cabernet Sauvignon on both pot soils. In the near-anisohydric variety Syrah an ABA-related stomatal closure was induced in WR soil to maintain high levels of water potential, showing that a soil-related hormonal root-to-shoot signal causing stomatal closure superimposes on the putatively variety-induced anisohydric response to water stress.

[Cost of Illness of HIV Patients under Anteretroviral Therapy in Germany - Results of the 48-Week Interim Analysis of the Prospective Multicentre Observational Study 'CORSAR']

BACKGROUND

With the introduction of highly active combined antiretroviral therapy (c-ART) mortality and morbidity of HIV patients declined substantially. Earlier studies reported that c-ART was able to save health-care costs due to a reduction of other direct medical costs, particularly for inpatient treatments and concomitant medication. To date, analyses of costs and health-related quality of life (HRQOL) of patients under c-ART are lacking in Germany. Hence, this study aims to estimate the current cost of illness and HRQOL of HIV-patients under c-ART in different treatment lines.

METHODS

A multicenter, prospective observational study was carried out in 12 specialised German centres for infectious diseases: 8 private practices/outpatient centres and 4 specialised hospitals offering both inpatient and outpatient services. Demographic, clinical and medication data were derived from patient records. Resource utilisation, information on productivity, out of pocket costs and HRQOL (EQ-5D) were collected every 12 weeks via a patient questionnaire. All costs were calculated based on price information from publicly accessible databases.

RESULTS

N=1,154 patients were included in the analysis. Mean direct disease-related costs of -patients under c-ART amounted to 22,563 Euro/year. Patients beyond the 3(rd) line of treatment -incurred considerably higher costs 24,654 Euro/year. In the 1(st) treatment line, c-ART accounted for 83.2% of the total direct costs, in the 2(nd)/3(rd) line for 80.8% and in >3(rd) line for 83.4%, respectively. Indirect costs due to impaired productivity were higher in the 2(nd)/3(rd) treatment line (2,843 Euro) compared to the 1(st) (1,604 Euro) and >3(rd) (1,752 Euro) treatment lines, respectively. The average HRQOL (EQ-5D) varied between 0.77 (self-assessment via visual analogue scale) and 0.91 (utility score based on the German time trade-off tariff).

CONCLUSIONS

Over the last decade, cost of illness of HIV patients under c-ART decreased slightly with average costs per year still being substantial. Main cost driver of overall costs is c-ART. There have been, however, noticeable shifts between different cost domains.

Increased T-cell turnover is associated with spondyloarthritis in virally suppressed patients with HIV-1 infection

OBJECTIVES

Spondyloarthritis (SpA) is one of the most frequently observed inflammatory joint diseases in HIV-1-seropositive patients. T-cells were described frequently as one of the major driving forces in SpA, therefore we tried to look for T-cell aberrancies in our HIV-positive patients with SpA.

METHODS

A total of 1098 files for HIV-positive patients who attended the HIV out-patient clinic of the Department of Clinical Immunology and Rheumatology at the Medical University Hanover for at least one visit between January 2004 and December 2010 were screened for the presence of a diagnosis of SpA. A cross-sectional study was conducted to investigate aberrancies in T-cell homeostasis induced by HIV-1 in these subjects.

RESULTS

The prevalence of SpA in the HIV-positive patients was 1.6% (18 of 1098). Interestingly, the percentage of patients with SpA who were human leucocyte antigen (HLA)-B27 negative in our HIV-positive cohort was 80%. Despite combination antiretroviral therapy (cART) and viral suppression, an incomplete immune recovery of T-cell naïve/memory distribution and turnover, as identified by intracellular Ki-67 expression, was observed in HIV-positive patients with SpA.

CONCLUSIONS

Independent of HLA-B27 status and despite cART, HIV-positive patients can develop SpA and exhibit an increased T-cell turnover rate.

Autoantibodies binding to ubiquitin-fold modifier-conjugating enzyme 1 (Ufc1) and pleckstrin homology domain containing, family G (with RhoGef domain) member 2 (Plekhg2) are associated with mycobacterial infections

OBJECTIVES

The diagnosis of extrapulmonary tuberculous infections and nontuberculous mycobacterial (NTM) infections is difficult because the symptoms are nonspecific and suitable specimens for bacterial culture are often not available. Recent publications reported the existence of autoantibodies in tuberculous infections. We screened for specific autoantibodies in mycobacterial infections.

METHODS

We screened four in 29 patients with active mycobacterial infections and different controls using protein array technology. We could identify autoantibodies against ubiquitin-fold modifier-conjugating enzyme 1 (Ufc1) and pleckstrin homology domain containing, family G (with RhoGef domain) member 2 (Plekhg2) in all four patients. Subsequently, we designed enzyme-linked immunosorbent assays (ELISAs) for the detection of autoantibodies binding to Ufc1 and Plekhg2.

RESULTS

Autoantibodies binding to Ufc1 and Plekhg2 were found in 19 of 29 patients (66%) with active mycobacterial infections. In comparison, we found these autoantibodies in one of 31 patients (3%) with successfully treated mycobacterial infections, in three of 40 (8%) HIV-infected patients not receiving combination antiretorviral therapy (cART) and in six of 134 (5%) blood donors. Interestingly, six of eight (75%) patients with HIV-associated B-cell non-Hodgkin lymphoma (B-NHL) at the onset of disease had autoantibodies against Ufc1 and Plekhg2, but none of nine (0%) patients after treatment of HIV-associated B-NHL, none of seven patients with non-HIV-associated B-NHL and 11 of 115 (10%) patients with other malignant diseases had autoantibodies against both proteins.

CONCLUSIONS

In view of the high frequency of these autoantibodies, we postulate that they might be of potential use for additional diagnostics for mycobacterial infections, and further studies may shed light on the pathomechanisms of these two autoantibodies.