Persistent hypercalcaemia associated with two pathogenic variants in the CYP24A1 gene and a parathyroid adenoma-a case report and review

Introduction

24-Hydroxylase, encoded by the CYP24A1 gene, is a crucial enzyme involved in the catabolism of vitamin D. Loss-of-function mutations in CYP24A1 result in PTH-independent hypercalcaemia with high levels of 1,25(OH)2D3. The variety of clinical manifestations depends on age, and underlying genetic predisposition mutations can lead to fatal infantile hypercalcaemia among neonates, whereas adult symptoms are usually mild.

Aim of the study

We report a rare case of an adult with primary hyperparathyroidism and loss-of-function mutations in the CYP24A1 gene and a review of similar cases.

Case presentation

We report the case of a 58-year-old woman diagnosed initially with primary hyperparathyroidism. Preoperatively, the suspected mass adjoining the upper pole of the left lobe of the thyroid gland was found via ultrasonography and confirmed by 99mTc scintigraphy and biopsy as the parathyroid gland. The patient underwent parathyroidectomy (a histopathology report revealed parathyroid adenoma), which led to normocalcaemia. After 10 months, vitamin D supplementation was introduced due to deficiency, and the calcium level remained within the reference range. Two years later, biochemical tests showed recurrence of hypercalcaemia with suppressed parathyroid hormone levels and elevated 1,25(OH)2D3 concentrations. Further investigation excluded the most common causes of PTH-independent hypercalcaemia, such as granulomatous disease, malignancy, and vitamin D intoxication. Subsequently, vitamin D metabolites were measured using LC-MS/MS, which revealed high levels of 25(OH)D3, low levels of 24,25(OH)2D3 and elevated 25(OH)2D3/24,25(OH)2D3 ratios, suggesting a defect in vitamin D catabolism. Molecular analysis of the CYP24A1 gene using the NGS technique revealed two pathogenic variants: p.(Arg396Trp) and p.(Glu143del) (rs114368325 and rs777676129, respectively).

Conclusions

The diagnostic process for hypercalcaemia becomes complicated when multiple causes of hypercalcaemia coexist. The measurement of vitamin D metabolites using LC-MS/MS may help to identify carriers of CYP24A1 mutations. Subsequent molecular testing may contribute to establishing the exact frequency of pathogenic variants of the CYP24A1 gene and introducing personalized treatment.

Free-Circulating Nucleic Acids as Biomarkers in Patients After Solid Organ Transplantation

A number types of extracellular DNA (eg, cell-free, cfDNA) circulate in human blood, including mitochondrial, transcriptome, and regulatory DNA, usually at low concentrations. Larger amounts of cfDNA appear in any inflammatory condition, including organ damage due to a variety of reasons. The role of cfDNA in solid organ transplantation is discussed in this review as a valuable additional tool in the standard of care of transplant patients. Post-transplant monitoring requires the use of high-quality biomarkers for early detection of graft damage or rejection to be able to apply early therapeutic intervention. CfDNA complements the traditional monitoring strategies, being a risk stratification tool and an important prognostic marker. However, improving the sensitivity and specificity of cfDNA detection is necessary to facilitate personalized patient management, warranting further research in terms of measurement, test standardization, and storage, processing, and shipping. A diagnostic test (Allosure, CareDx, Inc., Brisbane, CA) for kidney, heart and lung transplant patients is now commercially available, and validation for other organs (eg, liver) is pending. To date, donor-derived cfDNA in combination with other biomarkers appears to be a promising tool in graft rejection as it is minimally invasive, time-sensitive, and cost-effective. However, improvement of sensitivity and specificity is required to facilitate personalized patient management. Whether it could be an alternate to graft biopsy remains unclear.

Circular RNAs Could Encode Unique Proteins and Affect Cancer Pathways

circRNAs constitute a novel class of RNA, generally considered as non-coding RNAs; nonetheless, their coding potential has been under scrutiny. In this work, we systematically explored the predicted proteins of more than 160,000 circRNAs detected by exome capture RNA-sequencing and collected in the MiOncoCirc pan-cancer compendium, including normal and cancer samples from different types of tissues. For the functional evaluation, we compared their primary structure and domain composition with those derived from the same linear mRNAs. Among the 4362 circRNAs potentially encoding proteins with a unique primary structure and 1179 encoding proteins with a novel domain composition, 183 were differentially expressed in cancer. In particular, eight were associated with prognosis in acute myeloid leukemia. The functional classification of the dysregulated circRNA-encoded polypeptides showed an enrichment in the heme and cancer signaling, DNA-binding, and phosphorylation processes, and disclosed the roles of some circRNA-based effectors in cancer.

Structure and cytotoxic properties of 1-hydroxy-5-methyl-7-phenylpyrido[3,4-d]pyridazin-4(3H)-one and its mono- and disubstituted ethyl acetates

Derivatives of pyrido[3,4-d]pyridazine, namely, 1-hydroxy-5-methyl-7-phenylpyrido[3,4-d]pyridazin-4(3H)-one dimethylformamide monosolvate, C14H11N3O2·C3H7NO (2), ethyl [1-(2-ethoxy-2-oxoethoxy)-5-methyl-4-oxo-7-phenyl-3,4-dihydropyrido[3,4-d]pyridazin-3-yl]acetate, C18H17N3O4 (3), and ethyl [(5-methyl-4-oxo-7-phenyl-3,4-dihydropyrido[3,4-d]pyridazin-1-yl)oxy]acetate, C22H23N3O6 (4), were synthesized with the aim of discovering new potential biologically active agents. The properties of all three derivatives were characterized by 1H NMR, 13C NMR and FT–IR spectroscopic analysis. All the crystals were obtained by a solvent diffusion method from dimethylformamide (DMF) or dimethyl sulfoxide (DMSO) and characterized by single-crystal X-ray diffraction. The collected X-ray data revealed that the crystals of 2 and 4 belong to the triclinic space group P\overline{1}, whereas the crystal of 3 belongs to the monoclinic space group P21/c. The presented derivatives crystallized with one molecule in the asymmetric unit, but only compound 2 crystallized as a solvate with DMF. Structure analysis showed that the molecule of 2 exists as its amide–imidic acid tautomer and that O-alkylation occurred before N-alkylation during the synthesis of the mono- and disubstituted derivatives, i.e. 3 and 4, respectively. The molecular geometries of the 5-methyl-7-phenylpyrido[3,4-d]pyridazine core within the studied derivatives differ in the mutual orientation of the rings. The interplanar angles between the heterocyclic ring and the bound aromatic ring are 1.71 (7), 18.16 (3) and 3.1 (1)° for 2, 3 and 4, respectively. The potential cytotoxicity of these compounds was evaluated against one normal (HaCat) and four human cancer cell lines (A549, DU145, MDA-MB-231 and SKOV-3).

The Object Segmentation from the Microstructure of a FSW Dissimilar Weld

Friction stir welding (FSW) is an environmentally friendly, solid-state welding technique. In this research work, we analyze the microstructure of a new type of FSW weld applying a two- stage framework based on image processing algorithms containing a segmentation step and microstructure analysis of objects occurring in different layers. A dual-speed tool as used to prepare the tested weld. In this paper, we present the segmentation method for recognizing areas containing particles forming bands in the microstructure of a dissimilar weld of aluminum alloys made by FSW technology. A digital analysis was performed on the images obtained using an Olympus GX51 light microscope. The image analysis process consisted of basic segmentation methods in conjunction with domain knowledge and object detection located in different layers of a weld using morphological operations and point transformations. These methods proved to be effective in the analysis of the microstructure images corrupted by noise. The segmentation parts as well as single objects were separated enough to analyze the distribution on different layers of the specimen and the variability of shape and size of the underlying microstructures, which was not possible without computer vision support.

Atypical Hemolytic Uremic Syndrome (aHUS) and Adenosine Deaminase (ADA)-Deficient Severe Combined Immunodeficiency (SCID)-Two Diseases That Exacerbate Each Other: Case Report

Hemolytic uremic syndrome (HUS) is defined by the triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury (AKI). Atypical HUS (aHUS), distinguished by its etiology, is caused by uncontrolled overactivation of the alternative complement pathway. The correct diagnosis of aHUS is complex and involves various gene mutations. Severe combined immunodeficiency (SCID), characterized by severe T-cell lymphocytopenia and a lack of antigen-specific T-cell and B-cell immune responses, is of seldom occurrence. In 10–15% of pediatric patients, SCID is caused by adenosine deaminase (ADA) deficiency. The authors describe the case of a boy who suffered from both aHUS and ADA-deficient SCID. At the age of 9 months, the patient presented acute kidney injury with anuria and coagulopathy. The diagnosis of aHUS was established on the basis of alternative complement pathway deregulation and disease-associated gene mutations. Further examination revealed immune system failure and, at the age of 13 months, the ADA deficiency was confirmed by genetic tests and the boy was diagnosed with ADA-SCID. ADA SCID has recently been described as a possible triggering factor of aHUS development and progression. However, more research is required in this field. Nevertheless, it is crucial in clinical practice to be aware of these two co-existing life-threatening diseases.

Biological Activity of Naturally Derived Naphthyridines

Marine and terrestrial environments are rich sources of various bioactive substances, which have been used by humans since prehistoric times. Nowadays, due to advances in chemical sciences, new substances are still discovered, and their chemical structures and biological properties are constantly explored. Drugs obtained from natural sources are used commonly in medicine, particularly in cancer and infectious diseases treatment. Naphthyridines, isolated mainly from marine organisms and terrestrial plants, represent prominent examples of naturally derived agents. They are a class of heterocyclic compounds containing a fused system of two pyridine rings, possessing six isomers depending on the nitrogen atom's location. In this review, biological activity of naphthyridines obtained from various natural sources was summarized. According to previous studies, the naphthyridine alkaloids displayed multiple activities, i.a., antiinfectious, anticancer, neurological, psychotropic, affecting cardiovascular system, and immune response. Their wide range of activity makes them a fascinating object of research with prospects for use in therapeutic purposes.

Compound Haplotype Variants in CFH and CD46 Genes Determine Clinical Outcome of Atypical Hemolytic Uremic Syndrome (aHUS)-A Series of Cases from a Single Family

Atypical hemolytic uremic syndrome (aHUS) is a rare disease triggered by dysregulation of the alternative complement pathway, consisting of a characteristic triad of nonimmune hemolytic anemia, thrombocytopenia, and renal failure. The risk of aHUS onset, recurrence, and allograft loss depends on the genetic background of a patient. We show a series of cases from a single family whose five members were affected by aHUS and presented distinct clinical outcomes. Next-generation sequencing revealed combined mutations in both complement factor H and membrane cofactor protein CD46. Out of eight siblings, aHUS affected three adult brothers, and, subsequently, affected two children of an unaffected sister. The first patient died due to aHUS, and two other brothers underwent successful kidney transplantation with no aHUS recurrence. The younger, 10-month-old child presented with a severe course of the disease with cardiac involvement and persistent hemolytic anemia limited by eculizumab, while the 2-year-old recovered completely on eculizumab. The study shows a highly variable disease penetrance.

BMPR1B gene in brachydactyly type 2-A family with de novo R486W mutation and a disease phenotype

Background

Brachydactylies are a group of inherited conditions, characterized mainly by the presence of shortened fingers and toes. Based on the patients’ phenotypes, brachydactylies have been subdivided into 10 subtypes. In this study, we have identified a family with two members affected by brachydactyly type A2 (BDA2). BDA2 is caused by mutations in three genes: BMPR1B, BMP2 or GDF5. So far only two studies have reported the BDA2 cases caused by mutations in the BMPR1B gene.

Methods

We employed next‐generation sequencing to identify mutations in culpable genes.

Results and Conclusion

In this paper, we report a case of BDA2 resulting from the presence of a heterozygous c.1456C>T, p.Arg486Trp variant in BMPR1B, which was previously associated with BDA2. The next generation sequencing analysis of the patients’ family revealed that the mutation occurred de novo in the proband and was transmitted to his 26‐month‐old son. Although the same variant was confirmed in both patients, their phenotypes were different with more severe manifestation of the disease in the adult.

Modification of Mechanical Properties of Aluminum Alloy Rods via Friction-Extrusion Method

The elaboration of a modified friction-extrusion method aimed at obtaining 2017A aluminum rods of gradient microstructure is described. This was achieved by cutting spiral grooves on the face of the stamp used for alloy extrusion. The experiments were carried out at a constant material feed (~10 mm/min) and a range of tool rotation speeds (80 to 315 rpm). The microstructure observations were carried out using light microscopy (LM) and both scanning and transmission electron microscopy (SEM and TEM). The mechanical properties were assessed through hardness measurements and static tensile tests. The performed investigations show that material simultaneous radial and longitudinal flow, enforced by friction of the rotating tool head and extrusion, results in the formation of two zones of very different microstructures. At the perpendicular section, the outer zone stands out from the core due to circumferential elongation of strings of particles, while in the inner zone the particles are arranged in a more uniform way. Simultaneously, the grain size of the outer zone is refined by two to four times as compared with the inner one. The transfer from the outer zone to the core area is of gradient type. The hardness of the outer zone was found to be ~10% to ~20% higher than that of the core.

Genetic background of atypical hemolytic-uremic syndrome and its influence on the course of disease and therapeutic effects

Atypical hemolytic-uremic syndrome (aHUS) results from excessive, uncontrolled activation of the alternative pathway of the complement system. It is important to distinguish aHUS from other thrombotic microangiopathies. The aim of this paper is to discuss the complexity and relevance of the genetic background of aHUS patients. The review discusses the genetic variants that are important for diagnosis, treatment and prognosis of patients, which is inevitably important for the qualification of patients for treatment with eculizumab. These variants are not only found in the genes involved in the control of complement system but are also related to the coagulation system. The paper emphasizes the diagnostic difficulties resulting from the extremely diverse genetic background of the patients. It is important to conduct further genetic studies of aHUS patients, also paying attention to genes unrelated to the complement system. The paper contains information on the role of genetic predisposition in tailoring the risk for aHUS and determining its clinical outcome, including qualification for eculizumab therapy.

Next-generation sequencing reveals microRNA markers of adrenocortical tumors malignancy

Background

Adrenocortical carcinoma is a rare finding among common adrenocortical tumors, but it is highly aggressive and requires early detection and treatment. Still, the differential diagnosis between benign and malignant lesions is difficult even for experienced pathologists and there is a significant need for novel diagnostic methods. In this study we aimed to reveal a complete set of microRNAs expressed in the adrenal gland and to identify easily detectable, stable and objective biomarkers of adrenocortical malignancy.

Methods

We employed next-generation sequencing to analyze microRNA profiles in a unique set of 51 samples, assigned to either a learning dataset including 7 adrenocortical carcinomas (ACCs), 8 adrenocortical adenomas (AAs) and 8 control samples (NAs), or a validation dataset including 8 ACCs, 10 AAs and 10 NAs. The results were validated in real-time Q-PCR.

Results

We detected 411 miRNAs expressed in 1763 length isoforms in the examined samples. Fifteen miRNAs differentiate between malignant (ACC) and non-malignant (AA + NA) tissue in the test set of independent samples. Expression levels of 6 microRNAs, miR-503-5p, miR-483-3p, miR-450a-5p, miR-210, miR-483-5p, miR-421, predict sample status (malignancy/non-malignancy) with at least 95% accuracy in both datasets. The best single-gene malignancy marker, miR-483-3p, has been validated by real-time RT PCR.

Conclusions

As a result of the study we propose clinically valid and easily detectable biomarkers of adrenocortical malignancy that may significantly facilitate morphological examination. Since microRNAs can be detected in blood, the study brings tools for development of non-invasive diagnostics of adrenocortical carcinomas.

MicroRNA Analysis Using the Quantitative Real-Time PCR Reaction

The analysis of microRNA expression patterns provides new insights into numerous cellular processes and their aberrances in diseases. Despite its potential pitfalls, the quantitative real-time polymerase chain reaction (qPCR) is the most commonly used tool for microRNA profiling. The method requires extraction and quality analysis of RNA, which is further reverse transcribed using specific primers and used as a template in a qPCR reaction. All these elements have been addressed in this chapter.

A Novel Method for Gene-Specific Enhancement of Protein Translation by Targeting 5'UTRs of Selected Tumor Suppressors

Background

Translational control is a mechanism of protein synthesis regulation emerging as an important target for new therapeutics. Naturally occurring microRNAs and synthetic small inhibitory RNAs (siRNAs) are the most recognized regulatory molecules acting via RNA interference. Surprisingly, recent studies have shown that interfering RNAs may also activate gene transcription via the newly discovered phenomenon of small RNA-induced gene activation (RNAa). Thus far, the small activating RNAs (saRNAs) have only been demonstrated as promoter-specific transcriptional activators.

Findings

We demonstrate that oligonucleotide-based trans-acting factors can also specifically enhance gene expression at the level of protein translation by acting at sequence-specific targets within the messenger RNA 5’-untranslated region (5’UTR). We designed a set of short synthetic oligonucleotides (dGoligos), specifically targeting alternatively spliced 5’UTRs in transcripts expressed from the THRB and CDKN2A suppressor genes. The in vitro translation efficiency of reporter constructs containing alternative TRβ1 5’UTRs was increased by up to more than 55-fold following exposure to specific dGoligos. Moreover, we found that the most folded 5’UTR has higher translational regulatory potential when compared to the weakly folded TRβ1 variant. This suggests such a strategy may be especially applied to enhance translation from relatively inactive transcripts containing long 5’UTRs of complex structure.

Significance

This report represents the first method for gene-specific translation enhancement using selective trans-acting factors designed to target specific 5’UTR cis-acting elements. This simple strategy may be developed further to complement other available methods for gene expression regulation including gene silencing. The dGoligo-mediated translation-enhancing approach has the potential to be transferred to increase the translation efficiency of any suitable target gene and may have future application in gene therapy strategies to enhance expression of proteins including tumor suppressors.

MECHANISMS IN ENDOCRINOLOGY: MicroRNA in diagnostics and therapy of thyroid cancer

MicroRNAs, short non-coding regulators of the gene expression, are subjects of numerous investigations assessing their potential use in the diagnostics and management of human diseases. In this review, we focus on studies that analyze the utility of microRNAs as novel diagnostic and therapeutic tools in follicular cell-derived thyroid carcinomas. This very interesting and promising field brings new insight into future strategies for personalized medicine.

The diagnosis of nonclassic congenital adrenal hyperplasia due to 21-hydroxylase deficiency, based on serum basal or post-ACTH stimulation 17-hydroxyprogesterone, can lead to false-positive diagnosis

OBJECTIVE

As nonclassic congenital adrenal hyperplasia (NCCAH) needs to be taken into account in women with hyperandrogenism, we aimed to assess whether the recommended level of poststimulated 17OHP ≥30 nmol/l confirms NCCAH.

PATIENTS AND METHODS

Forty, consecutive women with biochemical and/or clinical hyperandrogenism (aged 25·4, 18-38) suspected of having NCCAH were recruited to the study. In patients with 17OHP level between 5·1 and 29·9 nmol/l an ACTH stimulation test was performed. In patients with basal or poststimulated 17OHP ≥30 nmol/l, twenty-four-hour urinary steroid profile (USP) analysis was performed and CYP21A2 mutation was assessed. In selected patients with poststimulated 17OHP <30 nmol/l USP was also performed.

RESULTS

The group was divided into two subgroups with basal or poststimulated 17OHP ≥30 nmol/l (group A) and with poststimulated 17OHP <30 nmol/l (group B). Among 40 patients, basal or poststimulated 17OHP ≥30 nmol/l was found in 21, but NCCAH was confirmed by USP followed by genetic testing only in 5 (24%). Four patients were diagnosed as heterozygotes, and in twelve, no CYP21A2 mutation was detected.

CONCLUSION

The diagnosis of NCCAH based only on serum 17OHP measurements (basal or poststimulated) may lead to false-positive diagnosis when performed by immunoassay with a cut-off value of ≥30 nmol/l. The definitive diagnosis can be established based on USP and/or genetic testing.

SYNTHESIS, ANTI-HEPATITIS B AND C VIRUS ACTIVITY AND ANTITUMOR SCREENING OF NOVEL THIAZOLO[4,5-D]-PYRIMIDINE DERIVATIVES

The paper describes the synthesis, antivirus and antitumor evaluation of novel thiazolo[4,5-d]pyrim- idine derivatives. The target compounds 3a-h were synthesized by cyclocondensation of 4-amino-N'-(phenyl- methylidene)-3-phenyl-2-thioxo-2,3-dihydrothiazole-5-carbohydrazides 2a-d with aromatic aldehydes. The structures of new compounds were determined by IR, ¹H-NMR and elemental analysis. Thiazolopyrimidines 3a and 3d-h were screened by the National Institute of Allergy and Infectious Diseases against various viruses. Four compounds 3e-h showed in vitro anti-HCV activity. One (3e) demonstrated significant activity against HBV and was submitted to an anti-HBV in vivo assay but had a low bioavailability. As a result of antitumor study, compound 3h was found to be most potent against leukemia SR.

Association between GWAS-Derived rs966423 Genetic Variant and Overall Mortality in Patients with Differentiated Thyroid Cancer

PURPOSE

Five germline genetic variants (rs116909374, rs965513, rs944289, rs966423, and rs2439302) have been associated in genome-wide association studies (GWAS) with increased risk of differentiated thyroid cancer (DTC), but their role in mortality of patients has not been established. Also, no preoperative marker of the clinical outcome of thyroid cancer had yet been identified. The aim of the study was to investigate the relationship between the variants and overall mortality in patients with DTC.

EXPERIMENTAL DESIGN

Retrospective study of 1,836 patients (1,643 women, 193 men) with median age at diagnosis of 49 years and overall median follow-up time of 8.7 years after initial treatment at a single comprehensive cancer center between 1990 and 2013.

RESULTS

Among 5 variants, rs966423 was associated with increased mortality, which was 6.4% (33 of 518) versus 3.7% (47 of 1,259) in TT carriers versus CC/CT carriers (P = 0.017). The HR of TT versus TC/CC carriers was 1.6 [95% confidence interval (CI), 1.02-2.49; P = 0.038] after adjustment for age at diagnosis and sex. Importantly, the association of rs966423 with mortality remained valid when clinicopathologic risk factors were included in the model (HR, 1.89; 95% CI, 1.14-3.13; P = 0.014). Higher rs966423-associated patient mortality of TT versus CC/CT carriers was also observed in interaction with angioinvasion (adjusted HR, 3.48; 95% CI, 1.67-7.22; P < 0.001), lymph node metastasis (adjusted HR, 3.47; 95% CI, 1.16-10.4; P = 0.018), extrathyroidal invasion (adjusted HR, 2.07; 95% CI, 1.15-3.73; P = 0.013).

CONCLUSIONS

The presence of the rs966423-TT genotype was associated with a significant increase in overall mortality of patients with DTC. Contrary to BRAF mutation and other somatic changes, the status of germline rs966423 is known before the treatment and might be used in the management of mortality risk by means of modification of therapy.

SYNTHESIS AND IN VITRO ANTIPROLIFERATIVE SCREENING OF NEW 2,7-NAPHTHYRIDINE-3-CARBOXYLIC ACID HYDRAZIDE DERIVATIVES

The new pyrrolo[3,4-c]pyridines and 2,7-naphthyridine derivatives have been synthesized. 4-Hydroxy-8-methyl-l-oxo-6-phenyl-1,2-dihydro-2,7-naphthyridine-3-carboxylic acid hydrazide (4) was the key intermediate for the synthesis of the novel derivatives of various chemical structures: Schiff bases, 1,3,4-oxadiazoles, pyrazoles, carbohydrazides, semi- and thiosemicarbazides. The structures of these new compounds were confirmed by elemental analysis and IR, NMR and MS spectra. The antitumor activities of the obtained derivatives were examined. Eight of the twenty one newly synthesized compounds were qualified by the NCI (Bethesda, MD, USA) for in vito screening against 60 different human tumor cell lines. The most active proved to be the Schiff bases.

The assessment of sIgA, histatin-5, and lactoperoxidase levels in saliva of adolescents with dental caries

BACKGROUND

Saliva contains a number of protective factors such as mucins, immunoglobulins (e.g., IgA, IgG, and IgM), and enzymes (e.g., lysozyme and lactoperoxidases) that play an important role in the maintenance of oral health. The aim of this study was to compare levels of sIgA, histatin-5, and lactoperoxidase in saliva of adolescents with dental caries.

MATERIAL AND METHODS

Thirty-five adolescents (age 18 years) from high school were examined. Eight subjects with DMF=3 (Group I) and 27 adolescents with DMF>11 (Group II) were enrolled for this study. Clinical evaluation procedures comprised oral examination (including tooth, periodontal, and oral mucosal status) and collection of saliva samples. Saliva was collected for enzyme-linked immunosorbent assay (ELISA) and was used for determination of sIgA, histatin-5, and lactoperoxidase levels.

RESULTS

Our results showed that adolescents with very high intensity of dental caries (DMF>11) had increased levels of sIgA, histatin-5, and lactoperoxidase compared to adolescents with lower intensity of caries. The increase was statistically significant (p<0.05).

CONCLUSIONS

We suggest that high intensity of caries is associated with increased levels of some salivary components - sIgA, histatin-5 and lactoperoxidase - that possess strong bactericidal or bacteriostatic effects, resulting in aggregation of oral bacteria and their clearance from the oral cavity.

Variants in the ATM-CHEK2-BRCA1 axis determine genetic predisposition and clinical presentation of papillary thyroid carcinoma

The risk of developing papillary thyroid carcinoma (PTC), the most frequent form of thyroid malignancy, is elevated up to 8.6-fold in first-degree relatives of PTC patients. The familial risk could be explained by high-penetrance mutations in yet unidentified genes, or polygenic action of low-penetrance alleles. Since the DNA-damaging exposure to ionizing radiation is a known risk factor for thyroid cancer, polymorphisms in DNA repair genes are likely to affect this risk. In a search for low-penetrance susceptibility alleles we employed Sequenom technology to genotype deleterious polymorphisms in ATM, CHEK2, and BRCA1 in 1,781 PTC patients and 2,081 healthy controls. As a result of the study, we identified CHEK2 rs17879961 (OR = 2.2, P = 2.37e-10) and BRCA1 rs16941 (odds ratio [OR] = 1.16, P = 0.005) as risk alleles for PTC. The ATM rs1801516 variant modifies the risk associated with the BRCA1 variant by 0.78 (P = 0.02). Both the ATM and BRCA1 variants modify the impact of male gender on clinical variables: T status (P = 0.007), N status (P = 0.05), and stage (P = 0.035). Our findings implicate an important role of variants in the ATM- CHEK2- BRCA1 axis in modification of the genetic predisposition to PTC and its clinical manifestations.

Mucin levels in saliva of adolescents with dental caries

Background

Human saliva, a complex secretion that contains a mixture of inorganic and organic molecules, plays an essential role in the maintenance of oral health. Mucins are the major macromolecular component of the secretion and are considered the first line of defense for epithelial tissues. The aim of this study was to compare levels of mucins (MUC5B, MUC7, and MUC1) in saliva of young subjects with dental caries.

Material/Methods

All patients had DMF (decay/missing/filled) higher than value 0. Eight subjects with DMF=3 (control group) and 27 adolescents with DMF >11 (research group) were recruited for this study. Clinical evaluation procedures were oral examination, including tooth, periodontal, oral mucosal status, and collection of saliva samples. Saliva was collected for mucin assay. Enzyme-linked immunosorbent assay was used to quantitate MUC5B, MUC7, and MUC1.

Results

Our results indicate that adolescents with very high intensity of dental caries disease had increased levels of MUC1 and MUC5B. The membrane mucin MUC1 protein levels in the group with DMF>11 (research group) were higher compared to the group with DMF=3 (control group), and the increase was statistically significant (p=0.011). Similarly, secreted mucin MUC5B protein levels were higher (p=0.06) in the group with DMF>11 (research group). Although MUC7 protein levels were slightly reduced in symptomatic subjects, the decrease was statistically insignificant (p=0.918).

Conclusions

Our data suggest links between the production of mucins, especially MUC1 and MUC5B in saliva, and dental caries disease.

[Dental caries of the developmental age as a civilization disease]

According to the definition of the World Health Organization (WHO), dental caries is a local pathological process of the extrasomatic background, leading to enamel decalcification, decomposition of dental hard tissue, and in consequence to formation of a dental cavity. Morbidity of dental caries increases with age, reaching 100% of children, aged from 6 to 7. Poland is one of few European countries where the incidence of dental caries in children did not decrease, despite recommendations of WHO for 2000 year, aimed at the decrease in the incidence of dental caries among 6-year-old children to the level of 50%. The recommendation of WHO for 2015 year is to reduce the incidence of dental caries to 30% among 6-year-olds, i.e., 70% of 6 year-old children should be free of dental caries. Apart from genetic conditioning, inappropriate health behaviors, nutritional habits and gastroesophageal reflux disease influence the development of dental caries. Consumption of 'fast food' and drinking sweetened beverages of low pH contribute markedly to the development of dental caries, decreasing simultaneously consumption of pro healthy foods, including milk and cereals. Taking into consideration perspective clinical examinations of children and adolescents, evaluating the relationship between dental caries and nutritional habits as well as environmental conditioning, the study shows current data about factors, contributing to the incidence of dental caries in children, collected from the literature. The attention was paid to the relationship between dental caries and gastroesophageal reflux disease and the necessity of its early diagnostics and proper treatment.

Pro-inflammatory cytokines in saliva of adolescents with dental caries disease

INTRODUCTION AND OBJECTIVE

Dental caries is an inflammatory disease with multifactorial etiology. The presented study was conducted to test the hypothesis that the elevation of salivary cytokines - interleukin-6 (IL-6), interleukin-8 (IL-8) and tumour necrosis factor (TNF-a) is changed in dental caries patients. IL-6, IL-8 and TNF-a are particularly relevant to inflammation, one of the very first responses of the host to a pathological insult.

MATERIALS AND METHODS

Whole saliva from 26 patients with dental caries, as well as 10 healthy persons, was investigated for the presence of IL-6, IL-8 and TNF-a by enzyme immunoassay - ELISA.

RESULTS

The results showed that an elevation of IL-6, IL-8 and TNF-a in unstimulated whole saliva in subjects with dental caries, compared with controls, increased and was statistically significant in all cases (p <0.05). The study also show a positive correlation between TNF-a and IL-8.

CONCLUSIONS

These data suggest links between the production of tumour necrosis factor (TNF-a), interleukin-6 (IL-6), interleukin-8 (IL-8) in saliva and dental caries disease.

[Selected eating habits and caries occurrence in adolescents]

INTRODUCTION

Normal nutrition is an important element of caries prophylaxis. The aim of the study was to evaluate the influence of chosen bad eating habits on caries occurrence in adolescents.

MATERIAL AND METHODS

The examination was carried out in the group of 367 (68.5% girls and 31.5% boys) pupils of the 3rd year of high schools in Białystok in 2011. Own questionnaire was used for the evaluation of eating habits. Caries intensity (PUW) was assessed by dental examination. To verify statistic hypotheses, the level of significance was estimated at p < 0.05. All calculation was performed with the use of the Statistic programme Statistica 7.0 (StatSoft).

RESULTS

It was stated that 5 meals a day were consumed by 29.4% of examined pupils, 4 meals were eaten by 33.2%, 3 meals--by 31.3%, 2 meals--by 5.4%, and one meal was consumed by 0.5% of pupils. There were 55.3% of pupils who had irregular meals while 24.3% did not eat breakfast and 62.9%--did not have elevenses. Eating between meals was stated in 96.7% of pupils. Sweets consumption was revealed as follows: 16.8% several times a day, 19%--once a day, 40.5%--several times a week, 18.5%--several times a month, 5.2%--rarely or never. "Fast food" was not consumed by 34% of examined pupils while 54.6% consumed such meals several times a month, 10.9%--several times a week, and 0.5%--once a day. Higher level of caries intensity was observed in girls (mean coefficient PUW = 11.3) than in boys (mean coefficient PUW = 10.8). Mean coefficient PUW = 11.5 concerned pupils with consumption of fast food several times a month while PUW = 11.0 in those who consumed it several times a week, and PUW = 10.7 in pupils who eat rarely or never such food. As far as eating sweets, PUW was higher than mean (12.4) in pupils who eat sweets several times a day. Persons who eat between meals were characterized by higher coefficient (PUW = 13.0) as compared to those who eat between meals rarely (PUW = 11.3) and those who do not eat between meals (PUW = 8.9).

CONCLUSIONS

(1) Bad eating habits (irregular meals, skipping breakfast, eating between meals as well as overeating sweets) in the developmental age can be a significant caries coefficient in adolescents. 2. High mean coefficient PUW in the examined group of 18-year-old pupils, in relation to abnormal eating habits in the significant percentage of those pupils, indicates the necessity of health education as far as caries prophylaxis is concerned.

[Stress oxidative in schizophrenia]

Etiopathogenesis of schizophrenia development is unknown yet in 1% of human population. There is damaged metabolism of biological membranes, abused production of free radicals and altered activity of antioxidant enzymes in patients with schizophrenia. Recently, a study showed that many of the genes and proteins whose expression is modified in the schizophrenic brain are related to glutathione and oxidative stress pathways. According to the researchers changes in permeability of biological membranes in brain could involve the pathophisiology of all--subtypes of schizophrenia as a result of oxidative stress. Brain is particularly sensitive to oxidative damage. There is a lot of phospholipids and polyunsaturated fatty acids in brain tissue under physiological conditions. The changes in polyunsaturated fatty acids metabolism, increased lipid peroxidation and the presence of oxidative stress are found in schizophrenia. They can course to appear instabilities of neuron membranes or even cell death owing to oxidative stress. Mainly to getting to know the molecular disease mechanism is associated with a disorder of the brain. The results suggest that at least some of the schizophrenia disease process can be traced in peripheral tissue like plasma, blood cells or liver. In various types of schizophrenia antipsychotic treatment affects oxidative state of erythrocyte membranes in a different way. Research into changes of antioxidant enzymes level during the treatment of typical and atypical neuroleptic drugs could contribute to widening the knowledge on the reasons of undesirable effects during pharmacotherapy with typical neuroleptic drugs.

[Use of high-dose olanzapine for treatment of acute relapse of schizophrenia in a patient with bad tolerance of typical neuroleptics. Case report]

AIM

The purpose of the study was to assess the efficacy of high doses of olanzapine for treatment of the patient suffering from schizophrenia with predominance of positive symptoms. The blood levels of prolactin and glucose were monitored in order to determine the influence of high dose of olanzapine on these levels and to make a comparison between olanzapine and typical neuroleptics in this aspect.

METHOD

The patient suffering from schizophrenia with predominance of positive symptoms, poorly tolerating typical neuroleptics and with no positive result of a standard dose of olanzapine treatment, was treated with high doses of olanzapine. PANSS was used to assess severity of symptoms, to rate side effects. The authors used Webels modification of Simpson and Angus scale.

RESULTS

During the high dose olanzapine treatment a marked reduction of PANSS score was achieved. Also the reduction of score in Simpson and Angus scale was observed, high level of this score at the beginning was due to classical neuroleptic treatment. There was no increase in blood prolactin level (in comparison with the high earlier one after typical neuroleptic treatment), whilst glucose level was not elevated.

CONCLUSIONS

High dose olanzapine seems to be an effective and safe method of treatment of paranoid schizophrenia with predominance of positive symptoms in patients poorly tolerating typical neuroleptics.