Type IIx muscle fibers are related to poor body composition, glycemic and lipidemic blood profiles in young females: the protective role of type I and IIa muscle fibers

PURPOSE

The aim of the present study was to investigate the association between muscle fiber composition, body composition, resting glycemic-lipidemic blood profiles, in apparently healthy, young, active females.

METHODS

Thirty-four young healthy female volunteers were allocated into two groups, depending on their Vastus Lateralis type IIx muscle fibers percent cross-sectional area (%CSA; H: high type IIx %CSA; L: low type IIx %CSA). Body composition was determined via dual-energy X-ray absorptiometry. Venous blood samples were collected for the determination of resting serum glucose, Insulin, Apo-A1, HOMA-IR, triglycerides (TG), total cholesterol (TC), High-density lipoprotein (HDL-C), and Low-density lipoprotein (LDL-C) concentrations. Nutritional intake was also evaluated.

RESULTS

Individuals of the H group have significantly higher body mass, body fat percentage-mass, and resting blood indices of glycemic and lipidemic profiles, compared to those of L group (p < 0.001). Increased type IIx and low type I, IIa muscle fibers %CSAs were linked with poorer body composition, glycemic and lipidemic blood profiles (r: - 0.722 to 0.740, p < 0.001). Linear regression analyses revealed that the impact of muscle fibers %CSA (B coefficients ranged between - 0.700 and 0.835) on the above parameters, was at least, of the same or even of greater magnitude as that of body composition and daily nutritional intake (B: - 0.700 to 0.666).

CONCLUSION

Increased type IIx and low Type I, IIa %CSAs are associated with poorer body composition and glycemic-lipidemic profiles in young healthy females. The contribution of the muscle fiber %CSA on health status seems to be comparable to that of nutrition and body composition.

Effect of a Diode Laser (445 nm) on Polymerization Efficiency of a Preheated Resin Composite Used for Luting of Indirect Composite Restorations

PURPOSE

The aim of this study was to evaluate the polymerization efficiency of a preheated resin composite used as a luting agent for indirect restorations light-cured by a blue diode laser (445 nm).

METHODS

Bronze molds were used to prepare cylindrical specimens of a laboratory composite (Ceramage) with dimensions 2, 3, and 4 mm in height and 8 mm in diameter. The molds had additional height of 120 μm for the placement of the preheated resin composite. A nanohybrid resin composite (Enamel Plus HRi) was preheated at 55°C to use as a luting agent. Photopolymerization was followed for 20 seconds using three light sources: a diode laser emitting at 445 nm (SiroLaser Blue) and two light-emitting diode (LED) units (Bluephase Style and Valo). Degree of conversion (DC) of the preheated resin composite was evaluated using Fourier transform infrared spectroscopy.

RESULTS

The results indicated that the main effects of the analysis were significant for both material thickness (p<0.001) and polymerization method (p<0.001). The preheated resin composite was not polymerized under 4-mm-thick specimens, independent of the light-curing unit. For 2-mm material thickness, there was no difference among the three light-curing units (p=0.383), while 3-mm Bluephase Style presented very low DC.

CONCLUSIONS

Diode laser (445 nm) achieved better polymerization efficiency at the same fluence compared to the LED unit at 3-mm depth, implying a better mechanical behavior and potential improved adhesion of the luting material to dentin.

Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry

AIMS

The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation.

METHODS AND RESULTS

Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin.

CONCLUSION

The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.

Local and regional air pollution characteristics in Cyprus: A long-term trace gases observations analysis

Observations of key gaseous trace pollutants, namely NO, NO_y, CO, SO₂ and O_3, performed at several curb, residential, industrial, background and free-troposphere sites were analyzed to assess the temporal and spatial variability of pollution in Cyprus. Notably, the analysis utilized one of the longest datasets of 17 years of measurements (2003-2019) in the East Mediterranean and the Middle East (EMME). This region is considered a regional hotspot of ozone and aerosol pollution. A trend analysis revealed that at several stations, a statistically significant decrease in primary pollutant concentration is recorded, most likely due to pollution control strategies. In contrast, at four stations, a statistically significant increase in ozone levels, ranging between 0.36 ppb_v y^-1 and 0.82 ppb_v y^-1_, has been observed, attributed to the above strategies targeting the reduction of nitrogen oxides (NO_x) but not that of Volatile Organic Compounds (VOCs). The NO and NO_y, and CO levels at the Agia Marina regional background station were two orders of magnitude and four times lower, respectively, than the ones of the urban centers. The latter denotes that local emissions are not negligible and control a large fraction of the observed interannual and diurnal variability. Speciation analysis showed that traffic and other local emissions are the sources of urban NO and NO_y. At the same time, 46 % of SO₂ and 40 % of CO, on average, originate from long-range regional transport. Lastly, a one-year analysis of tropospheric NO₂ vertical columns from the TROPOMI satellite instrument revealed a west-east low-to-high gradient over the island, with all major hotspots, including cities and powerplants, being visible from space. With the help of an unsupervised machine learning approach, it was found that these specific hotspots contribute overall around 10 % to the total NO₂ tropospheric columns.

Syncopal patients without prodromes exhibit a diverse pattern of adenosine release during head-up tilt test

Background/Introduction

In a significant proportion of patients with neurally-mediated syncope (NMS), the mechanism of syncope remains largely undetermined. Adenosine has been proposed as a central humoral factor in various forms of NMS: high Adenosine Plasma Levels (ADP) are encountered in patients with vasovagal syncope (VVS), low ADP in non-prodromes syncope (NPS), while ADP in patients with situational syncope SS are less well determined.

Purpose

We sought to assess ADP in patients with different clinical forms of syncope, with an emphasis on the presence or absence of prodromal symptoms, as well as the relation between ADP and the outcomes of Head-Up Tilt Table Test (HUTT) and Adenosine test (ADT).

Methods

Patients with different clinical types of NMS (n=124), i.e., VVS, NPS, or SS, were investigated using a standard protocol including HUTT and ADT. During HUTT, ADP was measured in the supine position, at table tilting, and in syncope.

Results

Baseline ADP did not differ among groups. ADP at syncope were higher in NPS compared to VVS (1.55±1.29 vs 0.16±0.05 μM, p=0.03) and SS (0.15±0.05 μM, p=0.02). In NPS, ADP increased from the supine position to the time of syncope (0.47±0.25 to 1.55±1.29 μM, p=0.04). In VVS, ADP increased only from the supine to the tilt position (0.23±0.04 to 0.35±0.10 μMu, p=0.02), while in SS ADP did not change in any stage of HUTT. SS was associated with cardioinhibitory HUTT (OR 3.40, 95% CI 1.05 to 9.56, p=0.04) and positive ADT (OR 4.22, 95% CI 1.47 to 11.46, p=0.012).

Conclusion(s)

A distinct pattern of ADP increase is noted during HUTT in NPS, suggesting that an excessive increase of ADP may play the key role in triggering this type of clinical presentation of syncope independently of the baseline ADP. Cardioinhibition prevails in patients with SS without clear adenosine involvement. Such observations contribute to an enhanced understanding of the pathophysiology of different clinical forms of syncope which may offer the possibility to tailor the management approach appropriately.

Funding Acknowledgement

Type of funding sources: None.

Adenosine plasma levels and adenosine receptor levels determine the outcome of adenosine test and head-up tilt test in syncopal patients with a normal heart

Background/Introduction

The neurohumoral profile underlying the manifestation of reflex syncope remains incompletely understood. Adenosine plasma (ADP) and adenosine receptor (ADR) levels may differentiate the outcomes of head-up tilt table test (HUTT) and adenosine test (ADT) but their role in the diagnostic evaluation of patients with syncope has yet to be determined.

Purpose

We sought to assess the ADP and ADR levels in patients without structural heart disease who underwent HUTT and ADT tests as part of the diagnostic workup of syncope. We specifically investigated differences in the outcomes of the HUTT and ADT tests as well as to the ADP levels during HUTT.

Methods

HUTT and ADT were performed as per the standard protocols. ADT was considered positive in the event of asystole &gt;6 seconds or heart block for &gt;10 seconds after intravenous Adenosine 0.15 mg/kg administration in the supine position. ADP levels were assessed at three timepoints during the HUTT: at baseline (supine), immediately after bed tilt and, in cases of a positive HUTT, at the time of syncope. Patients were categorized in quintiles of very low, low, intermediate, high and very high baseline ADP levels. We also assessed the A2A ADR levels of monocytes.

Results

We prospectively analyzed 124 patients (71 women, age 46.78±21.01 years). ADT was positive in 12.9% of patients and HUTT in 44.4% of patients. Patients with very low baseline ADP levels (lowest quintile) more frequently presented with a positive ADT (odds ratio [OR] 4.08, 95% Confidence Interval [CI] 1.40 to 13.13, p&lt;0.05). Baseline ADP did not differ between patients with positive and negative HUTT. However, patients with vasodepressor response to HUTT exhibited increase in ADP from baseline to bed tilt (0.33±1.03 vs. 0.42±1.14 ppm/Um/L, p&lt;0.05) and in syncope (0.70±1.89, P&lt;0.05), while no difference was noted in patients with cardioinhibitory or mixed response. Patients with positive ADT and negative HUTT had higher ADR levels (221.5±88.56 MFI) as compared to patients with negative ADT and positive HUTT (59.78±83.65 MFI, p&lt;0.05) and to patients with positive ADT and HUTT (33.29±35.77 MFI, p&lt;0.05). Within patients with positive HUTT, those with onset of syncope in the Isoprenaline provocation phase (&gt;20 min) had lower ADR levels (80.88±238.98 vs 89.43±96.08 MFI, p&lt;0.05).

Conclusion(s)

Baseline ADP levels are related to the outcome of ADT while an ADP increase immediately after bed tilt and in syncope is evident in vasodepressor response to HUTT. Higher ADR levels are related to positive ADT and negative HUTT. Lower ADR levels are associated with more delayed onset of syncope during HUTT. ADP and ADR levels warrant further investigation as they may characterize a subset of patients with specific responses to ADT and HUTT and may be implicated in the pathophysiology of reflex syncope.

Funding Acknowledgement

Type of funding sources: None.

Treatment with a fixed dose combination for cardiovascular disease-more than a health benefit?

Background

Despite the proven benefits of cardiovascular disease medication, adherence to treatment remains poor. Fixed-dose combinations (FDC) have been proposed as a measure to enhance adherence.

Objective

To assess compliance to treatment with an FDC, consisting of acetylsalicylic acid, atorvastatin and ramipril, and to gauge its impact on cardiovascular risk factors.

Methods

This was a prospective, multicenter, observational, phase 4 study conducted for 6 months in Greece. 1444 participants (67% males, mean age 63.7 years old) that were prescribed the FDC for primary or secondary prevention were included in the analysis. Descriptive statistical analysis was performed to analyze clinical, sociodemographic and safety parameters.

Results

Approximately equal number of participants was recruited in the primary and secondary prevention group. The majority of patients were overweight and hypertensive. Dosing compliance was 88.6% at 3 months and 86.8% at 6 months. Adherence to treatment was 99.1% at 3 months and 97.6% at 6 months. Statistically significant changes at 6 months compared to baseline were documented in systolic/diastolic blood pressure of 15.7/7.5 mmHg and LDL-c of 32.6 mg/dl, in both CVD and non-CVD participants and in total population as well. The total 10-year risk for CV events was reduced by 34.1% at 6 months. Only 1.2% of the participants reported an adverse event and 0.8% an adverse event reaction.

Conclusions

Among patients with or without CVD, the use of acetylsalicylic acid, atorvastatin and ramipril FDC resulted in good medication adherence at 6 months and statistically significant improvements in blood pressure, total cholesterol and LDL levels.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Galenica SA

Meta-analysis evaluating the risk of respiratory tract infections and acute respiratory distress syndrome with glucagon-like peptide-1 receptor agonists in cardiovascular outcome trials: Useful implications for the COVID-19 pandemic

Patients with type 2 diabetes mellitus (T2DM) are at increased risk for severe coronavirus disease 2019 (COVID-19) and related mortality. Glucagon-like peptide-1 receptor agonists (GLP-1-RAs) have significant cardiovascular and renal benefits for patients with T2DM and related comorbidities. Their anti-inflammatory properties could be beneficial in these patients. This work provides less-biased estimates regarding the risk for respiratory tract infections and acute respiratory distress syndrome by performing the first significant meta-analysis of cardiovascular outcome trials in the literature. Notably, GLP-1-RAs do not seem to increase the risk for respiratory tract infection, pneumonia, or acute respiratory distress syndrome in patients with T2DM and cardiovascular comorbidities.

[Meta-analysis evaluating the risk of respiratory tract infections and acute respiratory distress syndrome with glucagon-like peptide-1 receptor agonists in cardiovascular outcome trials: useful implications for the COVID-19 pandemic]

Patients with type 2 diabetes mellitus (T2DM) are at increased risk for severe coronavirus disease 2019 (COVID-19) and related mortality. Glucagon-like peptide-1 receptor agonists (GLP-1-RAs) have significant cardiovascular and renal benefits for patients with T2DM and related comorbidities. Their anti-inflammatory properties could be beneficial in these patients. This work provides less-biased estimates regarding the risk for respiratory tract infections and acute respiratory distress syndrome by performing the first significant meta-analysis of cardiovascular outcome trials in the literature. Notably, GLP-1-RAs do not seem to increase the risk for respiratory tract infection, pneumonia, or acute respiratory distress syndrome in patients with T2DM and cardiovascular comorbidities.

Aldolase A deficiency: Report of new cases and literature review

Aldolase A (ALDOA), is the predominant isoform of aldolase in skeletal muscle and erythrocytes that catalyzes the reversibleconversion of fructose-1,6-bisphosphate to glyceraldehyde 3-phosphate. Autosomal recessive mutations in ALDOA, are extremely rare and cause hemolytic anemia and/or recurrent episodes of rhabdomyolysis, usually precipitated by fever. In this report we describe, clinical, laboratory and genetic data of two novel unrelated patients harboring mutations in the ALDOA gene who presented with episodic rhabdomyolysis, we review all previously published cases and discuss the most valuable features for diagnosis of this rare disorder.

•

Recessive mutations in the ALDOA gene are rare cause of episodic rhabdomyolysis.

•

We report two novel, unrelated patients harboring mutations in the ALDOA gene presenting with recurrent rhabdomyloysis.

•

Patients with ALDOA deficiency show a rather homogeneous phenotype with episodes of rhabdomyolysis, associated either with hemolysis and/or learning disabilities.

Baseline adenosine plasma levels indicate differential response to adenosine test and head-up tilt test in syncopal patients

Background/Introduction

Head-up tilt table test (HUTT) and Adenosine test (ADT) can be useful in the diagnostic evaluation of syncope. Adenosine plasma (ADP) and Adenosine receptor (ADR) levels may differentiate the outcomes of HUTT and ADT but their precise role in the risk stratification of patients with syncope remains elusive.

Purpose

We sought to assess the ADP and ADR levels in patients without structural heart disease who underwent HUTT and ADT tests as part of the diagnostic workup of syncope. We specifically investigated differences in the outcomes of the HUTT and ADT tests as well as to the ADP levels during HUTT according to the baseline ADP levels.

Methods

HUTT and ADT were performed as per the standard protocols. ADT was considered positive in the event of asystole &gt;6 seconds or heart block for &gt;10 seconds after intravenous Adenosine 0.15 mg/kg administration in the supine position. ADP levels (ppm/Um/L) were assessed at three timepoints during the HUTT: at baseline (supine), immediately after bed tilt and, in cases of a positive HUTT, at the time of syncope. Patients were categorized in terciles of low, intermediate and high baseline ADP levels. We also assessed the A2A ADR levels of monocytes.

Results

We prospectively analyzed 106 patients (62 women, age 46.87±20.63 years). ADT was positive in 14.2% of patients and HUTT in 47.2% of patients. Females were more likely to have low ADP levels (odds ratio [OR] 2.70, 95% Confidence Interval [CI] 1.04 to 6.94, p&lt;0.05). Patients with low baseline ADP levels showed a trend for positive ADT (OR 3.15, 95% CI 1.05 to 10.85, p=0.07), while patients with high baseline ADP levels showed a trend for negative HUTT (OR 2.35, 95% CI 0.94 to 5.90, p=0.075). Within patients with positive HUTT, those with low baseline ADP levels, showed an increase in ADP in the tilt phase (0.063 vs 0.027 ppm/Um/L, p&lt;0.05) but not at the time of syncope (0.045 ppm/Um/L) while those with intermediate baseline ADP levels showed an increase in ADP in the tilt phase (0.16 vs 0.095 ppm/Um/L, p&lt;0.05) which persisted during syncope (0.18 ppm/Um/L, p&lt;0.05). Patients with high baseline ADP levels did not exhibit differences in ADP during positive HUTT. Higher baseline ADP levels were associated with smaller increases in the tilt phase (Pearson's r −0.621, p&lt;0.001). ADR levels in patients with positive HUTT correlated positively with baseline ADP levels (Pearson's r 0.878, p&lt;0.001).

Conclusion(s)

Baseline ADP levels may be related to the outcome of ADT and HUTT. ADP increases during HUTT except for patients with high baseline ADP. ADP and ADR levels warrant further investigation as they may characterize a subset of patients with specific responses to HUTT and may be implicated in the pathophysiology of reflex syncope.

Funding Acknowledgement

Type of funding source: None

The comparison between two different exercise training programs on the mobilization of endothelial progenitor cells in patients with chronic heart failure

Background

Vascular endothelial dysfunction is an underlying pathophysiological feature of chronic heart failure (CHF). Endothelial progenitor cells (EPCs) are being used as an index of vascular endothelial function. Cardiac rehabilitation (CR) programs have been shown to stimulate the mobilization of EPCs in CHF patients. However, the effect of different exercise training programs on the EPCs in CHF patients has not been investigated.

Purpose

The purpose of the study was to assess the effect of 2 different exercise training programs on the mobilization of EPCs in patients with CHF and investigate if there were differences between them.

Methods

Forty-four consecutive patients (35 males) with stable CHF [mean±SD, Age (years): 56±10, EF (%): 33±8, Peak VO2 (ml/kg/min): 18.4±4.4] enrolled a 36-session CR program and they were randomized in one exercise training protocol; either high-intensity interval training (HIIT) or HIIT combined with muscle strength (COM). Venous blood was drawn at rest before and after the CR program. Five circulating endothelial populations were identified and quantified by flow cytometry (Table 1). EPCs values are expressed as cells/million enucleated cells in medians (25th-75th percentiles).

Results

In both HIIT and COM groups, the mobilization of all circulating endothelial populations increased after the CR program (p&lt;0.05, Table 1). However, there was no difference in the mobilization of EPCs between HIIT and COM groups (p&gt;0.05, Table 1).

Conclusion

A 36-session cardiac rehabilitation program increases the mobilization of endothelial progenitor cells in patients with chronic heart failure. High-intensity interval exercise training and HIIT combined with muscle strength have similar beneficial effect on endothelial progenitor cells, and therefore on vascular endothelial function.

Funding Acknowledgement

Type of funding source: Public grant(s) – EU funding. Main funding source(s): Co-financed by Greece and the European Union (European Social Fund- ESF) through the Operational Programme “Human Resources Development, Education and Lifelong Learning” in the context of the project

Early-onset and recurrent reflex syncope is associated with left ventricular diastolic filling and left atrial function properties

Background/Introduction

The effects of the left atrial and ventricular function in the pathophysiology of reflex syncope remain elusive. Head-up tilt table test (HUTT) is frequently used in the diagnostic workup of patients with syncope, but the outcomes of HUTT have not been attributed to any anatomical or functional cardiac characteristics.

Purpose

We sought to assess the effects of anatomical and functional echocardiographic features of the left atrium and the left ventricle at rest in the clinical presentation of syncope and the outcomes of HUTT.

Methods

We investigated patients with a history of syncope and symptoms suggestive of reflex syncope who underwent HUTT. Specific echocardiographic indices of left cardiac morphology and function were assessed at rest. The patients were divided into two groups, those who presented with syncopal episodes at age &lt;35 years (group A) and those who presented with syncopal episodes at age &gt;35 years (group B).

Results

In 119 patients (age 46.75±21.17 years, 69 women), patients in group A exhibited a higher chance for numerous (&gt;3) syncopal episodes (odds ratio [OR] 3.4, 95% Confidence Interval [CI] 1.41 to 7.93, p&lt;0.05). Group A showed also a trend for positive HUTT (OR 1.99, 95% CI 0.97 to 4.23, p=0.08). In patients with positive HUTT, Group A had higher E-wave velocity (0.83 vs 0.65 m/sec, p&lt;0.05), lower A-wave velocity (0.60 vs 0.75 m/sec, p&lt;0.05), higher E/A ratio (1.54 vs 1.00, p&lt;0.05), higher e' wave velocity (0.16 vs 0.10 m/sec, p&lt;0.05) and lower E/e' (5.64 vs 7.85, p&lt;0.05). Also, patients in group A exhibited lower left atrial volumes (min 9.88 vs 16.21 ml, p&lt;0.05, max 30.42 vs 44.89 ml, p&lt;0.05), higher left atrial strain reservoir (40.56 vs 32.42%, p&lt;0.05) and higher left atrial strain booster (25.94 vs 18.06%, p&lt;0.05).

Conclusion(s)

Patients with a younger age of onset and recurrent syncopal episodes manifest smaller dimensions of the left atrium with distinct patterns of diastolic performance and better reservoir and booster function. These findings may indicate a more pronounced susceptibility of this group of patients to preload reduction, thereby triggering the mechanism of reflex syncope.

Funding Acknowledgement

Type of funding source: None

A pH-sensitive fluorescent protein sensor to follow the pathway of calcium phosphate nanoparticles into cells

Calcium phosphate nanoparticles (100 nm) were fluorescently labelled with poly(ethyleneimine) (PEI_ATTO490LS; red fluorescence). They were loaded with a Tandem fusion protein consisting of mRFP1-eGFP (red and green fluorescence in the same molecule)that acts as smart biological pH sensor to trace nanoparticles inside cells. Its fluorescence is also coupled to the structural integrity of the protein, i.e. it is also a label for a successful delivery of a functional protein into the cell. At pH 7.4, the fluorescence of both proteins (red and green) is detectable. At a pH of 4.5-5 inside the lysosomes, the green fluorescence is quenched due to the protonation of the eGFP chromophore, but the pH-independent red fluorescence of mRFP1 remains. The nanoparticles were taken up by cells (cell lines: HeLa, Caco-2 and A549) via endocytic pathways and then directed to lysosomes. Time-resolved confocal laser scanning microscopy confirmed mRFP1 and nanoparticles co-localizing with lysosomes. The fluorescence of eGFP was only detectable outside lysosomes, i.e. most likely inside early endosomes or at the cell membrane during the uptake, indicating the neutral pH at these locations. The Tandem fusion protein provides a versatile platform to follow the intracellular pathway of bioactive nanocarriers, e.g. therapeutic proteins. The transfection with a Tandem-encoding plasmid by calcium phosphate nanoparticles led to an even intracellular protein distribution in cytosol and nucleoplasm, i.e. very different from direct protein uptake. Neither dissolved protein nor dissolved plasmid DNA were taken up by the cells, underscoring the necessity for a suitable carrier like a nanoparticle. STATEMENT OF SIGNIFICANCE: A pH-sensitive protein ("tandem") was used to follow the pathway of calcium phosphate nanoparticles. This protein consists of a pH-sensitive fluorophore (eGFP; green) and a pH-independent fluorophore (mRFP1; red). This permits to follow the pathway of a nanoparticle inside a cell. At a low pH inside an endolysosome, the green fluorescence vanishes but the red fluorescence persists. This is also a very useful model for the delivery of therapeutic proteins into cells. The delivery by nanoparticles was compared with the protein expression after cell transfection with plasmid DNA encoding for the tandem protein. High-resolution image analysis gave quantitative data on the intracellular protein distribution.

Zelkovamycin is an OXPHOS Inhibitory Member of the Argyrin Natural Product Family

Natural products (NPs) are an important inspirational source for developing drugs and chemical probes. In 1999, the group of Ōmura reported the constitutional elucidation of zelkovamycin. Although largely unrecognized so far, this NP displays structural similarities as well as differences to the argyrin NP family, a class of peptidic NPs with promising anticancer activities and diverse mode‐of‐action at the molecular level. By a combination of structure elucidation experiments, the first total synthesis of zelkovamycin and bioassays, the zelkovamycin configuration was determined and its previously proposed molecular structure was revised. The full structure assignment proves zelkovamycin as an additional member of the argyrins with however unique OXPHOS inhibitory properties. Zelkovamycin may therefore not only serve as a new starting point for chemical inhibitors of the OXPHOS system, but also guide customized argyrin NP isolation and biosynthesis studies.

Glucagon-like peptide-1 receptor agonists or sodium-glucose cotransporter-2 inhibitors as add-on therapy for patients with type 2 diabetes? A systematic review and meta-analysis of surrogate metabolic endpoints

OBJECTIVE

As sodium-glucose cotransporter-2 inhibitors (SGLT-2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) are second-line treatment options in type 2 diabetes mellitus (T2DM), our study sought to provide precise effect estimates regarding the role of GLP-1RAs vs SGLT-2is as add-on treatments in patients uncontrolled by metformin monotherapy.

RESEARCH DESIGN AND METHODS

PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL) and 'grey literature' were searched from their inception up to December 2019 for randomized controlled trials (RCTs) with durations≥12weeks to evaluate the safety and efficacy of adding a GLP-1RA vs an SGLT-2i in patients with T2DM.

RESULTS

Three eligible RCTs were identified. Administration of GLP-1RAs vs SGLT-2is resulted in significant decreases in HbA1c with no significant impact on either body weight or fasting plasma glucose. GLP-1RA treatment led to a significant increase in odds for achieving an HbA1c<7% compared with SGLT-2is, whereas no difference was detected in body weight reductions of>5%. Significantly greater risk for any hypoglycaemia, nausea and diarrhoea, and lower risk for genital infections, was also observed with GLP-1RAs, while no differences regarding severe hypoglycaemia, treatment discontinuation and impact on blood pressure levels were identified. No other major safety issues arose.

CONCLUSION

Our meta-analysis suggests that GLP-1RAs provide better glycaemic effects than SGLT-2is in patients with T2DM uncontrolled by metformin, albeit while increasing risk for hypoglycaemia and gastrointestinal adverse events.

The ubiquitin-conjugating enzyme UBE2QL1 coordinates lysophagy in response to endolysosomal damage

The autophagic clearance of damaged lysosomes by lysophagy involves extensive modification of the organelle with ubiquitin, but the underlying ubiquitination machinery is still poorly characterized. Here, we use an siRNA screening approach and identify human UBE2QL1 as a major regulator of lysosomal ubiquitination, lysophagy, and cell survival after lysosomal damage. UBE2QL1 translocates to permeabilized lysosomes where it associates with damage sensors, ubiquitination targets, and lysophagy effectors. UBE2QL1 knockdown reduces ubiquitination and accumulation of the critical autophagy receptor p62 and abrogates recruitment of the AAA-ATPase VCP/p97, which is essential for efficient lysophagy. Crucially, it affects association of LC3B with damaged lysosomes indicating that autophagosome formation was impaired. Already in unchallenged cells, depletion of UBE2QL1 leads to increased lysosomal damage, mTOR dissociation from lysosomes, and TFEB activation pointing to a role in lysosomal homeostasis. In line with this, mutation of the homologue ubc-25 in Caenorhabditis elegans exacerbates lysosome permeability in worms lacking the lysosome stabilizing protein SCAV-3/LIMP2. Thus, UBE2QL1 coordinates critical steps in the acute endolysosomal damage response and is essential for maintenance of lysosomal integrity.

P6573Adenosine plasma levels may determine tilt table test outcome in syncopal patients with prodromal symptoms

Background/Introduction

Head-up tilt table test (HUTT) and Adenosine test (ADT) are tools frequently used in the diagnostic workup of syncope. It has been suggested that patient responses to HUTT and ADT can be related to the plasma levels of Adenosine (ADPL) and Adenosine receptors (ADR). However, the exact type of association and the role of (ADPL) and ADR levels in the risk stratification and management of patients with syncope has not yet been clarified.

Purpose

We sought to assess the ADPL and ADR levels in patients without structural heart disease who underwent HUTT and ADT tests as part of the diagnostic workup of syncope. We specifically investigated differences with regards to the presence of a history of prodromal symptoms.

Methods

HUTT and ADT were performed as per the standard protocols. ADT was considered positive in the event of asystole >6 seconds or heart block for >10 seconds after intravenous Adenosine administration in a supine position at a dose of 0.15 mg/kg. ADPL were assessed at three timepoints during the HUTT: in the supine position, immediately after bed tilt and, in cases of a positive test, at the time of syncope. Furthermore, we assessed the A2A ADR of monocytes in the study patients.

Results

We prospectively analyzed 77 patients (48 women, age 47.05±21.10 years). ADT was positive in 16.7% of patients and HUTT in 49.4% of patients. ADPL in the supine position did not differ between patients with negative vs. positive ADT but showed a significant correlation with the body mass index (p=0.002). There was a trend for reduced ADPL at the tilt phase in patients with positive HUTT (0.32±0.89 vs. 0.42±0.77 ppm/Um/L, p=0.09). Of all patients, 60 (77.9%, 41 women, age 46.80±21.83 years) had reported a history of prodromal symptoms at syncope. In the subset of patients with prodromal symptoms, the ADL at the tilt phase were lower in patients with positive vs. negative HUTT (0.15±0.23 vs. 0.51±0.89, p<0.05). ADR did not differ among groups but showed a significant correlation with the ADL during syncope in patients with prodromal symptoms (p<0.05).

Conclusion(s)

Patients with prodromal symptoms and a positive HUTT demonstrate reduced ADPL at the tilt phase of HUTT preceding syncope. In these patients, ADPL in syncope correlate with the ADR. Adenosine plasma levels and receptors warrant further investigation and may predict the response to HUTT thereby contributing to the diagnostic evaluation and risk stratification of patients with syncope.

Repair or Lysophagy: Dealing with Damaged Lysosomes

Lysosomal membrane permeabilization or full rupture of lysosomes is a common and severe stress condition that is relevant for degenerative disease, infection and cancer. If damage is limited, cells can repair lysosomes by means of the endosomal sorting complex required for transport (ESCRT) machinery. Presumably, if repair fails, lysosomes are tagged with ubiquitin to initiate clearance by selective macroautophagy, termed lysophagy. Accumulating evidence suggests damage-induced exposure of luminal glycans to the cytosol as the key trigger for ubiquitination. In this review, we discuss recent data on cellular damage sensing, the underlying ubiquitination and autophagy machinery as well as additional layers of regulation such as processing of ubiquitinated proteins by the AAA-ATPase VCP/p97. We conclude with thoughts on how these mechanisms may regulate decision making between lysosome repair and lysophagy.

The ESC ACCA EAPCI EORP acute coronary syndrome ST-elevation myocardial infarction registry

Aims 

The Acute Cardiac Care Association (ACCA)–European Association of Percutaneous Coronary Intervention (EAPCI) Registry on ST-elevation myocardial infarction (STEMI) of the EurObservational programme (EORP) of the European Society of Cardiology (ESC) registry aimed to determine the current state of the use of reperfusion therapy in ESC member and ESC affiliated countries and the adherence to ESC STEMI guidelines in patients with STEMI.

Methods and results 

Between 1 January 2015 and 31 March 2018, a total of 11 462 patients admitted with an initial diagnosis of STEMI according to the 2012 ESC STEMI guidelines were enrolled. Individual patient data were collected across 196 centres and 29 countries. Among the centres, there were 136 percutaneous coronary intervention centres and 91 with cardiac surgery on-site. The majority of centres (129/196) were part of a STEMI network. The main objective of this study was to describe the demographic, clinical, and angiographic characteristics of patients with STEMI. Other objectives include to assess management patterns and in particular the current use of reperfusion therapies and to evaluate how recommendations of most recent STEMI European guidelines regarding reperfusion therapies and adjunctive pharmacological and non-pharmacological treatments are adopted in clinical practice and how their application can impact on patients’ outcomes. Patients will be followed for 1 year after admission.

Conclusion 

The ESC ACCA-EAPCI EORP ACS STEMI registry is an international registry of care and outcomes of patients hospitalized with STEMI. It will provide insights into the contemporary patient profile, management patterns, and 1-year outcome of patients with STEMI.

VCP maintains lysosomal homeostasis and TFEB activity in differentiated skeletal muscle

Differentiated tissue is particularly vulnerable to alterations in protein and organelle homeostasis. The essential protein VCP, mutated in hereditary inclusion body myopathy, amyotrophic lateral sclerosis and frontotemporal dementia, is critical for efficient clearance of misfolded proteins and damaged organelles in dividing cells, but its role in terminally differentiated tissue affected by disease mutations is less clear. To understand the relevance of VCP in differentiated tissue, we inactivated it in skeletal muscle of adult mice. Surprisingly, knockout muscle demonstrated a necrotic myopathy with increased macroautophagic/autophagic proteins and damaged lysosomes. This was not solely due to a defect in autophagic degradation because age-matched mice with muscle inactivation of the autophagy essential protein, ATG5, did not demonstrate a myopathy. Notably, myofiber necrosis was preceded by upregulation of LGALS3/Galectin-3, a marker of damaged lysosomes, and TFEB activation, suggesting early defects in the lysosomal system. Consistent with that, myofiber necrosis was recapitulated by chemical induction of lysosomal membrane permeabilization (LMP) in skeletal muscle. Moreover, TFEB was activated after LMP in cells, but activation and nuclear localization of TFEB persisted upon VCP inactivation or disease mutant expression. Our data identifies VCP as central mediator of both lysosomal clearance and biogenesis in skeletal muscle. Abbreviations: AAA: ATPases Associated with diverse cellular Activities; TUBA1A/α-tubulin: tubulin alpha 1a; ATG5: autophagy related 5; ATG7: autophagy related 7; ACTA1: actin alpha 1, skeletal muscle; CLEAR: coordinated lysosomal expression and regulation; CTSB/D: cathepsin B/D; Ctrl: control; DAPI: diamidino-2-phenylindole; EBSS: Earle's balanced salt solution; ELDR: endolysosomal damage response; ESCRT: endosomal sorting complexes required for transport; Gastroc/G: gastrocnemius; H&E: hematoxylin and eosin; HSPA5/GRP78: heat shock protein family A (Hsp70) member 5; IBMPFD/ALS: inclusion body myopathy associated with Paget disease of the bone, frontotemporal dementia and amyotrophic lateral sclerosis; i.p.: intraperitoneal; LAMP1/2: lysosomal-associated membrane protein 1/2; LLOMe: Leu-Leu methyl ester hydrobromide; LGALS3/Gal3: galectin 3; LMP: lysosomal membrane permeabilization; MTOR: mechanistic target of rapamycin kinase; MYL1: myosin light chain 1; MAP1LC3/LC3: microtubule associated protein 1 light chain 3; MSP: multisystem proteinopathy; PBS: phosphate-buffered saline; PCR: polymerase chain reaction; Quad/Q: quadriceps; RHEB: Ras homolog, mTORC1 binding; SQSTM1: sequestosome 1; TFEB: transcription factor EB; TA: tibialis anterior; siRNA: small interfering RNA; SQSTM1/p62, sequestosome 1; TARDBP/TDP-43: TAR DNA binding protein; TBS: Tris-buffered saline; TXFN, tamoxifen; UBXN6/UBXD1: UBX domain protein 6; VCP: valosin containing protein; WT: wild-type.

Structural Integrity Evaluation of Large MOD Restorations Fabricated With a Bulk-Fill and a CAD/CAM Resin Composite Material

AIMS

To evaluate the effect of two composite restorative techniques (direct bulk fill vs indirect CAD/CAM) on the fracture resistance and mode of fracture of extended mesio-occlusal-distal (MOD) cavity preparations.

METHODS

Fifty-one sound human mandibular third molars were divided into three groups (n=17). Extended bucco-lingual MOD cavities were prepared. Teeth in group 1 were restored with a bulk-fill resin composite (Filtek Bulk-Fill Posterior Restorative), teeth in group 2 were restored with composite computer-aided design/computer-aided manufacturing (CAD/CAM) inlays (Lava Ultimate), and teeth in group 3 served as control and remained intact. All specimens were submitted to thermocycling, and a fracture resistance test was performed using a Universal testing machine (0.5 mm/min). Mode of fracture was classified into five types. One-way analysis of variance and the Duncan test were used to analyze the fracture load data at a significance level of α = 0.05. A chi-square test was used for the analysis of fracture mode between the restorative groups.

RESULTS

Statistical analysis showed significant differences in fracture resistance among the experimental groups. The teeth restored with the bulk-fill composite exhibited lower fracture resistance (1285.3±655.0 N) when compared to the teeth restored with the composite CAD/CAM inlays (1869.8±529.4 N) (p<0.05). Mode of fracture showed the same distribution between the restorative groups.

CONCLUSIONS

Although both types of restorations failed at loads larger than those found in the oral cavity, the CAD/CAM composite inlays increased the fracture resistance of teeth with large MOD cavities when compared to direct bulk-fill composite restorations. The majority of fracture types were intraorally repairable for both restorative techniques.

Detection and Clearance of Damaged Lysosomes by the Endo-Lysosomal Damage Response and Lysophagy

Lysosomal membrane permeabilization or lysosomal rupture is recognized as a common and severe stress condition relevant for infection, cellular degeneration and cancer. However, the cellular response mechanisms that protect cells from the consequences of lysosomal damage and ensure lysosomal quality control and homeostasis have only recently been explored. Key elements of this response involve the specific sensing of the damage followed by extensive modification of the organelles with ubiquitin to mark them for clearance by selective macroautophagy, termed lysophagy. Efficient lysophagy is ensured by additional layers of regulation, including modulation by the ubiquitin-directed AAA-ATPase VCP/p97. Lysophagy shares many features with mitophagy, the macroautophagic removal of damaged mitochondria. This review aims to gather available data from different fields and to define the key steps necessary for sensing and subsequent clearance of damaged lysosomes. We conclude with a discussion of disease implications with a focus on neurodegeneration.

Understanding the risk and protective factors associated with obesity amongst Libyan adults - a qualitative study

Background

There are a range of multifaceted behavioural and societal factors that combine to contribute to the causes of obesity. However, it is not yet known how particularly countries’ cultural norms are contributing to the global obesity epidemic. Despite obesity reaching epidemic proportions in Libya, since the discovery of oil in 1959, there is a lack of information about obesity in Libyan adults. This study sought to explore the views of key informants about the risk and protective factors associated with obesity among Libyan men and women.

Methods

A series of qualitative semi-structured interviews were conducted with Libyan healthcare professionals and community leaders.

Results

Eleven main themes (risk and protective factors) were identified, specifically: socio-demographic and biological factors, socioeconomic status, unhealthy eating behaviours, knowledge about obesity, social-cultural influences, Libya’s healthcare facilities, physical activity and the effect of the neighbourhood environment, sedentary behaviour, Libyan food-subsidy policy, and suggestions for preventing and controlling obesity.

Conclusions

Key recommendations are that an electronic health information system needs to be implemented and awareness about obesity and its causes and consequences needs to be raised among the public in order to dispel the many myths and misconceptions held by Libyans about obesity. The current political instability within Libya is contributing to a less-active lifestyle for the population due to security concerns and the impact of curfews. Our findings have implications for Libyan health policy and highlight the urgent need for action towards mitigating against the obesity epidemic in Libya.

GNE-Myopathy in a Greek Romani Family with Unusual Calf Phenotype and Protein Aggregation Pathology

BACKGROUND

GNE-myopathy is increasingly diagnosed in different ethnicities worldwide. No clear genotype-phenotype correlation has been established to date.

CASE REPORTS

We describe two affected members of the same family from Balkan population carrying an already known homozygous pathogenic mutation in the kinase domain of the UDP-N-acetylglucosamine 2 epimerase/N-acetylmannosamime kinase (GNE) gene. The patients presented with severe distal weakness of lower legs combined with rimmed vacuoles in muscle biopsy. However, in contrast to the typical pattern of muscle involvement, one of them showed severe involvement of posterior calf muscles with spared anterior compartment of the lower leg muscles.

CONCLUSIONS

These patients provide evidence for a larger variability and further extend the phenotypic spectrum of GNE-myopathy to include preferential calf involvement.

DYRK1B mutations associated with metabolic syndrome impair the chaperone-dependent maturation of the kinase domain

Two missense mutations of the DYRK1B gene have recently been found to co-segregate with a rare autosomal-dominant form of metabolic syndrome. This gene encodes a member of the DYRK family of protein kinases, which depend on tyrosine autophosphorylation to acquire the catalytically active conformation. The mutations (H90P and R102C) affect a structural element named DYRK homology (DH) box and did not directly interfere with the conformation of the catalytic domain in a structural model of DYRK1B. Cellular assays showed that the mutations did not alter the specific activity of mature kinase molecules. However, a significant part of the mutant DYRK1B protein accumulated in detergent-insoluble cytoplasmic aggregates and was underphosphorylated on tyrosine. The mutant DYRK1B variants were more vulnerable to the HSP90 inhibitor ganetespib and showed enhanced binding to the co-chaperone CDC37 as compared to wild type DYRK1B. These results support the hypothesis that the mutations in the DH box interfere with the maturation of DYRK1B by tyrosine autophosphorylation and compromise the conformational stability of the catalytic domain, which renders the kinase susceptible to misfolding.

Delivery of the autofluorescent protein R-phycoerythrin by calcium phosphate nanoparticles into four different eukaryotic cell lines (HeLa, HEK293T, MG-63, MC3T3): Highly efficient, but leading to endolysosomal proteolysis in HeLa and MC3T3 cells

Nanoparticles can be used as carriers to transport biomolecules like proteins and synthetic molecules across the cell membrane because many molecules are not able to cross the cell membrane on their own. The uptake of nanoparticles together with their cargo typically occurs via endocytosis, raising concerns about the possible degradation of the cargo in the endolysosomal system. As the tracking of a dye-labelled protein during cellular uptake and processing is not indicative of the presence of the protein itself but only for the fluorescent label, a label-free tracking was performed with the red-fluorescing model protein R-phycoerythrin (R-PE). Four different eukaryotic cell lines were investigated: HeLa, HEK293T, MG-63, and MC3T3. Alone, the protein was not taken up by any cell line; only with the help of calcium phosphate nanoparticles, an efficient uptake occurred. After the uptake into HeLa cells, the protein was found in early endosomes (shown by the marker EEA1) and lysosomes (shown by the marker Lamp1). There, it was still intact and functional (i.e. properly folded) as its red fluorescence was detected. However, a few hours after the uptake, proteolysis started as indicated by the decreasing red fluorescence intensity in the case of HeLa and MC3T3 cells. 12 h after the uptake, the protein was almost completely degraded in HeLa cells and MC3T3 cells. In HEK293T cells and MG-63 cells, no degradation of the protein was observed. In the presence of Bafilomycin A1, an inhibitor of acidification and protein degradation in lysosomes, the fluorescence of R-PE remained intact over the whole observation period in the four cell lines. These results indicate that despite an efficient nanoparticle-mediated uptake of proteins by cells, a rapid endolysosomal degradation may prevent the desired (e.g. therapeutic) effect of a protein inside a cell.

VCP/p97 cooperates with YOD1, UBXD1 and PLAA to drive clearance of ruptured lysosomes by autophagy

Rupture of endosomes and lysosomes is a major cellular stress condition leading to cell death and degeneration. Here, we identified an essential role for the ubiquitin-directed AAA-ATPase, p97, in the clearance of damaged lysosomes by autophagy. Upon damage, p97 translocates to lysosomes and there cooperates with a distinct set of cofactors including UBXD1, PLAA, and the deubiquitinating enzyme YOD1, which we term ELDR components for Endo-Lysosomal Damage Response. Together, they act downstream of K63-linked ubiquitination and p62 recruitment, and selectively remove K48-linked ubiquitin conjugates from a subpopulation of damaged lysosomes to promote autophagosome formation. Lysosomal clearance is also compromised in MEFs harboring a p97 mutation that causes inclusion body myopathy and neurodegeneration, and damaged lysosomes accumulate in affected patient tissue carrying the mutation. Moreover, we show that p97 helps clear late endosomes/lysosomes ruptured by endocytosed tau fibrils. Thus, our data reveal an important mechanism of how p97 maintains lysosomal homeostasis, and implicate the pathway as a modulator of degenerative diseases.

VEEVVIE: Visual Explorer for Empirical Visualization, VR and Interaction Experiments

Empirical, hypothesis-driven, experimentation is at the heart of the scientific discovery process and has become commonplace in human-factors related fields. To enable the integration of visual analytics in such experiments, we introduce VEEVVIE, the Visual Explorer for Empirical Visualization, VR and Interaction Experiments. VEEVVIE is comprised of a back-end ontology which can model several experimental designs encountered in these fields. This formalization allows VEEVVIE to capture experimental data in a query-able form and makes it accessible through a front-end interface. This front-end offers several multi-dimensional visualization widgets with built-in filtering and highlighting functionality. VEEVVIE is also expandable to support custom experimental measurements and data types through a plug-in visualization widget architecture. We demonstrate VEEVVIE through several case studies of visual analysis, performed on the design and data collected during an experiment on the scalability of high-resolution, immersive, tiled-display walls.

Spastin binds to lipid droplets and affects lipid metabolism

Mutations in SPAST, encoding spastin, are the most common cause of autosomal dominant hereditary spastic paraplegia (HSP). HSP is characterized by weakness and spasticity of the lower limbs, owing to progressive retrograde degeneration of the long corticospinal axons. Spastin is a conserved microtubule (MT)-severing protein, involved in processes requiring rearrangement of the cytoskeleton in concert to membrane remodeling, such as neurite branching, axonal growth, midbody abscission, and endosome tubulation. Two isoforms of spastin are synthesized from alternative initiation codons (M1 and M87). We now show that spastin-M1 can sort from the endoplasmic reticulum (ER) to pre- and mature lipid droplets (LDs). A hydrophobic motif comprised of amino acids 57 through 86 of spastin was sufficient to direct a reporter protein to LDs, while mutation of arginine 65 to glycine abolished LD targeting. Increased levels of spastin-M1 expression reduced the number but increased the size of LDs. Expression of a mutant unable to bind and sever MTs caused clustering of LDs. Consistent with these findings, ubiquitous overexpression of Dspastin in Drosophila led to bigger and less numerous LDs in the fat bodies and increased triacylglycerol levels. In contrast, Dspastin overexpression increased LD number when expressed specifically in skeletal muscles or nerves. Downregulation of Dspastin and expression of a dominant-negative variant decreased LD number in Drosophila nerves, skeletal muscle and fat bodies, and reduced triacylglycerol levels in the larvae. Moreover, we found reduced amount of fat stores in intestinal cells of worms in which the spas-1 homologue was either depleted by RNA interference or deleted. Taken together, our data uncovers an evolutionarily conserved role of spastin as a positive regulator of LD metabolism and open up the possibility that dysfunction of LDs in axons may contribute to the pathogenesis of HSP.

Hereditary spastic paraplegia (HSP) is a genetically heterogeneous neurological disease characterized by weakness and spasticity of the lower limbs, caused by progressive retrograde degeneration of the corticospinal axons, the longest in the central nervous system. The most commonly mutated gene in autosomal dominant forms of HSP, SPAST, encodes for spastin, a microtubule-severing protein. Spastin has been implicated in several processes involving remodeling of membrane structures. We now show that the longest spastin form, spastin-M1, harbors a lipid droplet targeting sequence, which allows targeting of the protein to the surface of lipid droplets, the organelles where cells store neutral lipids. Furthermore, we demonstrate that depletion of the homologous spastin proteins in both flies and worms affects lipid droplet number and triacylglycerol content. Our study adds to recent discoveries that implicate other HSP proteins in lipid droplet and lipid metabolism, and strongly suggests that lipid droplet dysfunction in neurons should be investigated to understand pathogenesis of HSP.

Public stigma towards mental illness in the Greek culture

Mental illness stigma negatively affects the lives of individuals with mental health disorders. Studies have indicated that the type and degree of stigma significantly varies across cultures. This study aimed to add to this body of knowledge by examining the prevalence and the type of mental illness stigma among individuals who identified themselves as Greek. It also examined the influence of a range of potential within-culture stigma moderating factors, including levels of previous experience with mental illness and mental illness knowledge. A cross-sectional quantitative design was employed, and 111 participants living in England and Greece were sampled through the snowball sampling technique. Stigma prevalence was measured using the 'Community Attitudes to Mental Illness' questionnaire. The findings revealed that participants showed a high degree of sympathy for people with mental illness but also considered them to be inferior and of a lower social class, and needing strict societal control. Higher stigma was significantly associated with being educated in England (instead of Greece), higher religiosity, lower knowledge levels and lower levels personal experience of mental illness. Targeted antistigma campaigns specifically tailored for the Greek culture are required in order to help reduce stigmatizing attitudes.

The evaluation of various restoration techniques on internal adaptation of composites in class v cavities

Aim. The aim of this study was to evaluate the effect of different restoration techniques on the formation of internal microgaps between materials and dentin in class V restorations. Materials and Methods. Twenty-five extracted human premolars were prepared with standardized class V cavity outlines (3 mm × 2 mm × 2 mm). The cavities were randomly divided into 5 groups of 10 cavities each and restored according to manufacturer's instructions: Group 1: preheating (55°C) conventional composite (Filtek Z250), Group 2: flowable composite (Filtek Flow), Group 3: Filtek Flow + Filtek Z250 light-cured separately, Group 4: Filtek Flow + Filtek Z250 light-cured simultaneously, and Group 5 (control): Filtek Z250 at room temperature (23°C). The specimens were then thermocycled and cross-sectioned through the center of the restoration. Subsequently, impressions were taken, and epoxy resin replicas were made. The internal adaptation of the materials to the axial wall was analyzed under SEM. Results. The preheated Filtek Z250 (Group 1) showed better internal adaptation than the room temperature groups (P < 0.05). The combination of Filtek Flow with Filtek Z250 which was light-cured separately (Group 3) exhibited better internal adaptation than control group (P < 0.05). Conclusion. Different restoration techniques exhibit different behavior regarding internal adaptation to dentin after photopolymerization.

Safewards: the empirical basis of the model and a critical appraisal

ACCESSIBLE SUMMARY

In the previous paper we described a model explaining differences in rates of conflict and containment between wards, grouping causal factors into six domains: the staff team, the physical environment, outside hospital, the patient community, patient characteristics and the regulatory framework. This paper reviews and evaluates the evidence for the model from previously published research. The model is supported, but the evidence is not very strong. More research using more rigorous methods is required in order to confirm or improve this model.

ABSTRACT

In a previous paper, we described a proposed model explaining differences in rates of conflict (aggression, absconding, self-harm, etc.) and containment (seclusion, special observation, manual restraint, etc.). The Safewards Model identified six originating domains as sources of conflict and containment: the patient community, patient characteristics, the regulatory framework, the staff team, the physical environment, and outside hospital. In this paper, we assemble the evidence underpinning the inclusion of these six domains, drawing upon a wide ranging review of the literature across all conflict and containment items; our own programme of research; and reasoned thinking. There is good evidence that the six domains are important in conflict and containment generation. Specific claims about single items within those domains are more difficult to support with convincing evidence, although the weight of evidence does vary between items and between different types of conflict behaviour or containment method. The Safewards Model is supported by the evidence, but that evidence is not particularly strong. There is a dearth of rigorous outcome studies and trials in this area, and an excess of descriptive studies. The model allows the generation of a number of different interventions in order to reduce rates of conflict and containment, and properly conducted trials are now needed to test its validity.

Highlighting intrafamilial clinical heterogeneity in late-onset Pompe disease

BACKGROUND/AIMS

Pompe disease is a rare metabolic disorder caused by deficiency of the lysosomal enzyme acid alpha-glycosidase (GAA). The late onset form of the disease is characterized by muscle weakness and respiratory involvement of variable severity. The aim of this short communication is to highlight the clinical variability of Pompe disease within siblings suffering from the disease.

CASE REPORTS

We report three pairs of siblings with late-onset Pompe disease presenting with different clinical phenotypes within the spectrum of disease phenotypes.

CONCLUSION

Clinical manifestations in Pompe disease within the same family can be very different. Clinicians should investigate patients' siblings for symptoms throughout the entire spectrum of the disease in order to avoid delays in the diagnosis and to pick-up mildly affected persons as early as possible, when they can benefit the most from enzyme replacement therapy.