MM, McDonald C, Padula L, Porco K, Rozga M. Effect of Cystic Fibrosis Transmembrane Receptor Modulators on Anthropometric and Growth Parameters in Individuals with Cystic Fibrosis: A Systematic Review (OR36-08-19)

Objectives

Individuals with cystic fibrosis (CF) are at high risk for malnutrition and poor growth. New drugs that modulate CF transmembrane receptor (CFTR) function are available, although their effects on anthropometric parameters are not clear. This systematic review aimed to determine if various CFTR modulator therapies affect weight and growth parameters in individuals with CF.

Methods

A literature search was conducted using MEDLINE, CINAHL and Embase databases for peer-reviewed, randomized controlled trials (RCT) published from January 2002 to May 2018 that examined the effect of CFTR modulation therapy on weight and growth parameters in children and adults with CF. Articles were screened for relevance, data was extracted and summarized, and risk of bias was assessed to determine the quality of evidence.

Results

A total of 612 original articles were identified, and 13 articles representing 10 RCTs were included in qualitative synthesis and three were included in quantitative synthesis. All but one RCT demonstrated low risk of bias. The targeted class of CFTR mutation varied by RCT. Studies indicated that, in children and adults with CF with class III mutations, ivacaftor treatment alone increased weight and BMI (4 RCTs), but it did not influence growth in individuals with class II (1 RCT) or class IV mutations (1 RCT). Treatment with ivacaftor + lumacaftor in adults homozygous for the F508del CFTR mutation (class II) increased BMI following 24 weeks of treatment (2 RCTs), but there was no effect in adults heterozygous for the mutation treated for 8 weeks (1 RCT). Treatment with lumacaftor + tezacaftor in individuals ages 12–20 years with class II mutations did not change growth parameters (1 RCT).

Conclusions

Effects of CFTR modulators on increasing weight and growth in individuals with CF are likely dependent on the therapy formulation (single vs combination therapy) and the targeted CFTR mutation. Whereas ivacaftor alone increases weight and growth parameters in individuals with class III mutations, ivacaftor + lumacaftor is more effective at increasing BMI in adults homozygous for the class II F508del CFTR mutation. Additional studies are needed to determine effects of other CFTR modulator drugs on growth parameters in individuals with varying CFTR mutations.

Funding Sources

Academy of Nutrition and Dietetics/Medical Nutrition DPG, National Institutes of Health.

Optimisation and validation of a PCR to detect viable Tenacibaculum maritimum in salmon skin tissue samples

A PCR protocol was optimised and validated for the detection of viable Tenacibaculum maritimum cells in salmon skin tissue. Viability conventional (vPCR) and quantitative PCR (v-qPCR) assays both had a limit of detection of 10³ CFU mL^-1 viable cells. The v-qPCR assay showed a linear quantification over 4 log units. Conventional vPCR showed complete signal suppression when only dead cells were present at concentrations lower than 10⁶ CFU mL^-1. While the v-qPCR did not result in complete suppression when only dead cells were present, a method was developed to determine if viable cells were present based on the % Δ in cycle threshold (Ct) value. The procedure was validated for high-throughput processing and an enrichment protocol was validated to reliably detect low concentrations of viable cells both with and without a high background of dead cells. Performing this protocol on naturally infected tissues showed that vPCR and v-qPCR reduced the potential for false positives compared to using conventional PCR and qPCR. The optimised protocol developed for this study provides an efficient, reliable and robust alternative for the detection of viable T. maritimum in skin tissue.

An Unusual Case of a Facial Guard Causing Penetrating Soft Tissue Injury in the Game of Hurling

Aim To highlight the dangers of hurling helmet modification. Methods A case report highlighting the consequences of modifying a hurling helmet from factory settings. Results Photographic evidence of a penetrating injury from helmet modification. Conclusion Rule changes to allow referees to inspect helmets before games take place.

A Review of School Nurses' Self-Efficacy in Asthma Care

Asthma is the most common pediatric chronic respiratory illness and has a significant influence on children's health, school attendance, and overall school success. Despite the effect of education and training, gaps remain in understanding school nurses' self-efficacy (SE) in asthma care. The purpose of this integrative literature review is to gain a greater understanding of school nurses' SE in asthma care. Themes and topics in the current school nursing literature regarding SE in asthma care include the value of continuing education, educational interventions, and the use of resources in clinical practice such as the asthma action plan. This review indicates the importance of developing a greater understanding of the unique features of school nursing, the necessary resources, and the external factors that influence practice. Further research to establish a framework to evaluate how a change in practice may support school nurses' SE and promote positive student health outcomes is needed.

Associations between psychosis endophenotypes across brain functional, structural, and cognitive domains

BACKGROUND

A range of endophenotypes characterise psychosis, however there has been limited work understanding if and how they are inter-related.

METHODS

This multi-centre study includes 8754 participants: 2212 people with a psychotic disorder, 1487 unaffected relatives of probands, and 5055 healthy controls. We investigated cognition [digit span (N = 3127), block design (N = 5491), and the Rey Auditory Verbal Learning Test (N = 3543)], electrophysiology [P300 amplitude and latency (N = 1102)], and neuroanatomy [lateral ventricular volume (N = 1721)]. We used linear regression to assess the interrelationships between endophenotypes.

RESULTS

The P300 amplitude and latency were not associated (regression coef. -0.06, 95% CI -0.12 to 0.01, p = 0.060), and P300 amplitude was positively associated with block design (coef. 0.19, 95% CI 0.10-0.28, p 0.38). All the cognitive endophenotypes were associated with each other in the expected directions (all p < 0.001). Lastly, the relationships between pairs of endophenotypes were consistent in all three participant groups, differing for some of the cognitive pairings only in the strengths of the relationships.

CONCLUSIONS

The P300 amplitude and latency are independent endophenotypes; the former indexing spatial visualisation and working memory, and the latter is hypothesised to index basic processing speed. Individuals with psychotic illnesses, their unaffected relatives, and healthy controls all show similar patterns of associations between endophenotypes, endorsing the theory of a continuum of psychosis liability across the population.

Oxidative Stress and Cardiovascular Risk in Type 1 Diabetes Mellitus: Insights From the DCCT/EDIC Study

Background

Hyperglycemia leading to increased oxidative stress is implicated in the increased risk for the development of macrovascular and microvascular complications in patients with type 1 diabetes mellitus.

Methods and Results

A random subcohort of 349 participants was selected from the DCCT / EDIC (Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications) cohort. This included 320 controls and 29 cardiovascular disease cases that were augmented with 98 additional known cases to yield a case cohort of 447 participants (320 controls, 127 cases). Biosamples from DCCT baseline, year 1, and closeout of DCCT , and 1 to 2 years post‐ DCCT ( EDIC years 1 and 2) were measured for markers of oxidative stress, including plasma myeloperoxidase, paraoxonase activity, urinary F 2α isoprostanes, and its metabolite, 2,3 dinor‐8 iso prostaglandin F 2α . Following adjustment for glycated hemoblobin and weighting the observations inversely proportional to the sampling selection probabilities, higher paraoxonase activity, reflective of antioxidant activity, and 2,3 dinor‐8 iso prostaglandin F 2α , an oxidative marker, were significantly associated with lower risk of cardiovascular disease (−4.5% risk for 10% higher paraoxonase, P <0.003; −5.3% risk for 10% higher 2,3 dinor‐8 iso prostaglandin F 2α , P =0.0092). In contrast, the oxidative markers myeloperoxidase and F 2α isoprostanes were not significantly associated with cardiovascular disease after adjustment for glycated hemoblobin. There were no significant differences between DCCT intensive and conventional treatment groups in the change in all biomarkers across time segments.

Conclusions

Heightened antioxidant activity (rather than diminished oxidative stress markers) is associated with lower cardiovascular disease risk in type 1 diabetes mellitus, but these biomarkers did not change over time with intensification of glycemic control.

Clinical Trial Registration

URL : https://www.clinicaltrials.gov . Unique identifiers: NCT 00360815 and NCT 00360893.

Widespread white matter microstructural differences in schizophrenia across 4322 individuals: results from the ENIGMA Schizophrenia DTI Working Group

The regional distribution of white matter (WM) abnormalities in schizophrenia remains poorly understood, and reported disease effects on the brain vary widely between studies. In an effort to identify commonalities across studies, we perform what we believe is the first ever large-scale coordinated study of WM microstructural differences in schizophrenia. Our analysis consisted of 2359 healthy controls and 1963 schizophrenia patients from 29 independent international studies; we harmonized the processing and statistical analyses of diffusion tensor imaging (DTI) data across sites and meta-analyzed effects across studies. Significant reductions in fractional anisotropy (FA) in schizophrenia patients were widespread, and detected in 20 of 25 regions of interest within a WM skeleton representing all major WM fasciculi. Effect sizes varied by region, peaking at (d=0.42) for the entire WM skeleton, driven more by peripheral areas as opposed to the core WM where regions of interest were defined. The anterior corona radiata (d=0.40) and corpus callosum (d=0.39), specifically its body (d=0.39) and genu (d=0.37), showed greatest effects. Significant decreases, to lesser degrees, were observed in almost all regions analyzed. Larger effect sizes were observed for FA than diffusivity measures; significantly higher mean and radial diffusivity was observed for schizophrenia patients compared with controls. No significant effects of age at onset of schizophrenia or medication dosage were detected. As the largest coordinated analysis of WM differences in a psychiatric disorder to date, the present study provides a robust profile of widespread WM abnormalities in schizophrenia patients worldwide. Interactive three-dimensional visualization of the results is available at www.enigma-viewer.org.

Effectiveness of a low support, remotely accessible, cognitive remediation training programme for chronic psychosis: cognitive, functional and cortical outcomes from a single blind randomised controlled trial

BACKGROUND

Cognitive remediation (CR) training has emerged as a promising approach to improving cognitive deficits in schizophrenia and related psychosis. The limited availability of psychological services for psychosis is a major barrier to accessing this intervention however. This study investigated the effectiveness of a low support, remotely accessible, computerised working memory (WM) training programme in patients with psychosis.

METHODS

Ninety patients were enrolled into a single blind randomised controlled trial of CR. Effectiveness of the intervention was assessed in terms of neuropsychological performance, social and occupational function, and functional MRI 2 weeks post-intervention, with neuropsychological and social function again assessed 3-6 months post-treatment.

RESULTS

Patients who completed the intervention showed significant gains in both neuropsychological function (measured using both untrained WM and episodic task performance, and a measure of performance IQ), and social function at both 2-week follow-up and 3-6-month follow-up timepoints. Furthermore, patients who completed MRI scanning showed improved resting state functional connectivity relative to patients in the placebo condition.

CONCLUSIONS

CR training has already been shown to improve cognitive and social function in patient with psychosis. This study demonstrates that, at least for some chronic but stable outpatients, a low support treatment was associated with gains that were comparable with those reported for CR delivered entirely on a 1:1 basis. We conclude that CR has potential to be delivered even in services in which psychological supports for patients with psychosis are limited.