Neutrophils and Neutrophil Extracellular Traps Cause Vascular Occlusion and Delayed Cerebral Ischemia After Subarachnoid Hemorrhage in Mice

BACKGROUND

After subarachnoid hemorrhage (SAH), neutrophils are deleterious and contribute to poor outcomes. Neutrophils can produce neutrophil extracellular traps (NETs) after ischemic stroke. Our hypothesis was that, after SAH, neutrophils contribute to delayed cerebral ischemia (DCI) and worse outcomes via cerebrovascular occlusion by NETs.

METHODS

SAH was induced via endovascular perforation, and SAH mice were given either a neutrophil-depleting antibody, a PAD4 (peptidylarginine deiminase 4) inhibitor (to prevent NETosis), DNAse-I (to degrade NETs), or a vehicle control. Mice underwent daily neurological assessment until day 7 and then euthanized for quantification of intravascular brain NETs (iNETs). Subsets of mice were used to quantify neutrophil infiltration, NETosis potential, iNETs, cerebral perfusion, and infarction. In addition, NET markers were assessed in the blood of aneurysmal SAH patients.

RESULTS

In mice, SAH led to brain neutrophil infiltration within 24 hours, induced a pro-NETosis phenotype selectively in skull neutrophils, and caused a significant increase in iNETs by day 1, which persisted until at least day 7. Neutrophil depletion significantly reduced iNETs, improving cerebral perfusion, leading to less neurological deficits and less incidence of DCI (16% versus 51.9%). Similarly, PAD4 inhibition reduced iNETs, improved neurological outcome, and reduced incidence of DCI (5% versus 30%), whereas degrading NETs marginally improved outcomes. Patients with aneurysmal SAH who developed DCI had elevated markers of NETs compared with non-DCI patients.

CONCLUSIONS

After SAH, skull-derived neutrophils are primed for NETosis, and there are persistent brain iNETs, which correlated with delayed deficits. The findings from this study suggest that, after SAH, neutrophils and NETosis are therapeutic targets, which can prevent vascular occlusion by NETs in the brain, thereby lessening the risk of DCI. Finally, NET markers may be biomarkers, which can predict which patients with aneurysmal SAH are at risk for developing DCI.

Vanadium Chloro-Substituted Schiff Base Catecholate Complexes are Reducible, Lipophilic, Water Stable, and Have Anticancer Activities

A hydrophobic Schiff base catecholate vanadium complex was recently discovered to have anticancer properties superior to cisplatin and suited for intratumoral administration. This [VO(HSHED)(DTB)] complex, where HSHED is N-(salicylideneaminato)-N'-(2-hydroxyethyl)-1,2-ethanediamine and the non-innocent catecholato ligand is di-t-butylcatecholato (DTB), has higher stability compared to simpler catecholato complexes. Three new chloro-substituted Schiff base complexes of vanadium(V) with substituted catecholates as co-ligands were synthesized for comparison with their non-chlorinated Schiff base vanadium complexes, and their properties were characterized. Up to four geometric isomers for each complex were identified in organic solvents using ⁵¹V and ¹H NMR spectroscopies. Spectroscopy was used to characterize the structure of the major isomer in solution and to demonstrate that the observed isomers are exchanged in solution. All three chloro-substituted Schiff base vanadium(V) complexes with substituted catecholates were also characterized by UV-vis spectroscopy, mass spectrometry, and electrochemistry. Upon testing in human glioblastoma multiforme (T98g) cells as an in vitro model of brain gliomas, the most sterically hindered, hydrophobic, and stable compound [t_1/2 (298 K) = 15 min in cell medium] was better than the two other complexes (IC₅₀ = 4.1 ± 0.5 μM DTB, 34 ± 7 μM 3-MeCat, and 19 ± 2 μM Cat). Furthermore, upon aging, the complexes formed less toxic decomposition products (IC₅₀ = 9 ± 1 μM DTB, 18 ± 3 μM 3-MeCat, and 8.1 ± 0.6 μM Cat). The vanadium complexes with the chloro-substituted Schiff base were more hydrophobic, more hydrolytically stable, more easily reduced compared to their corresponding parent counterparts, and the most sterically hindered complex of this series is only the second non-innocent vanadium Schiff base complex with a potent in vitro anticancer activity that is an order of magnitude more potent than cisplatin under the same conditions.

Beliefs about Legality and Benefits for Mental Health

Research on mental health pays increasing attention to the influence of social institutions on subjective well-being over the life course. Yet little research has considered how belief in the promise of legal institutions may have beneficial effects for well-being. Through structural equation models of longitudinal data, our findings suggest that belief in the neutrality and fairness of legal institutions has salutary effects for mental health net of social and economic status and across individuals from a wide range of ethnic groups. By combining research in the sociology of mental health, cultural sociology, social psychology, and the sociology of law, we extend the emerging literature on the institutional determinants of mental health by including attention to law as one of the central organizing institutions of social life.

Association between intergenerational violence exposure and maternal age of menopause

OBJECTIVE

To investigate whether maternal violence exposure personally and through her child is associated with an earlier age of menopause, controlling for covariates.

METHODS

Analyses used merged data from two related sources. Although mothers (n = 1,466) were interviewed in 1995 and then 20 years later (2015-17), their children were interviewed in the National Longitudinal Study of Adolescent to Adult Health repeatedly (Waves 1-4, 1994/5 to 2008-2009). Mothers reported their own age of menopause, and mothers and adolescents each reported their own exposure to violence as children and adults.

RESULTS

A mother's own childhood physical abuse (b = -1.60, P < .05) and her child's sexual abuse (b = -1.39, P < .01) both were associated with an earlier age of menopause. Mothers who were physically abused in childhood and have a child who experienced regular sexual abuse reached menopause 8.78 years earlier than mothers without a history of personal abuse or abuse of their child.

CONCLUSIONS

Our study is the first to find that age of natural menopause is associated with intergenerational violence exposures.

O37 CONCOMITANT INTESTINAL RESECTION DOES NOT NEGATIVELY INFLUENCE LONG TERM OUTCOMES FOLLOWING COMPLEX ABDOMINAL WALL RECONSTRUCTION

Aim

Simultaneous intestinal resection increases infective risks following abdominal wall reconstruction. We investigated the frequency of those risks and its impact on long-term outcomes.

Material and Methods

Analysis of prospectively accrued data from patients undergoing AWR by a single surgeon (01/01/2014–31/12/2020). Comparison between AWR with (IR-AWR) and without (AWR) concomitant intestinal resection. Clinical review was undertaken 6 monthly for 24 months with ongoing telephone follow-up thereafter.

Results

101 repairs were performed within the study period (46 AWR,55 IR-AWR). IR-AWR patients underwent 129 gastrointestinal procedures including 30 gastrointestinal fistula,33 small bowel,19 colonic and 2 gastric resections.

Both groups were similar in terms of smoking status, diabetes, but obesity (BMI&gt;30) was more prevalent in AWR(23/46(50%)vs.16/55(29%); p=0.03). Hernia defects were the same for both groups; AWR median area (range) 511cm2(47–2171 cm2) and IR+AWR 471cm2(50–2827cm2) (p = 0.7).

Post-operative wound infection was more frequent following IR-AWR (20/55(36%) (Superficial incisional=13,deep incisional=6, cavity=1) vs. 6/46(13%)(N = 5,0,1 respectively);Odds ratio(OR)=3.8 (95% CI1.4-10.6); p=0.01). Patients undergoing IR-AWR were also more likely to experience ileus necessitating short-term postoperative parenteral nutrition (OR 3.3(1–10.8); p=0.05) and Clavien Dindo&gt;2 complications (OR4.4 (1.2–16.7); p=0.03). Within IR-AWR cohort there was a single anastomotic complication requiring re-laparotomy and one mesh infection treated with antibiotics.

Median follow-up= 25.2 months(range 1.2–88.8). 14 patients died during follow-up (AWR 7/46(15%), IR-AWR 7/55(13%); p=0.7). 5 were lost to follow-up (3AWR, 2 IR-AWR).

12(26%) AWR and 8(15%) IR-AWR reported either persistent or delayed onset chronic abdominal wall pain post repair(P = 0.14). Recurrent hernias occurred in 7/46(15%) AWR compared with 10/55(18%)IR-AWR(p = 0.5).

Conclusions

Despite more frequent short-term complications in IR-AWR patient outcomes are comparable at 2 years.

Economic analysis of prenatal fetoscopic vs open-hysterotomy repair of open neural tube defect

OBJECTIVE

Fetal repair of an open neural tube defect (ONTD) by open hysterotomy has been shown to reduce the need for ventriculoperitoneal shunting and improve motor outcomes for infants, but increases the risk of Cesarean section and prematurity. Fetoscopic repair is an alternative approach that may confer similar neurological benefits but allows for vaginal delivery and reduces the incidence of hysterotomy-related complications. We sought to compare the costs of care from fetal surgery until neonatal discharge, as well as the clinical outcomes, associated with each surgical approach.

METHODS

This was a retrospective cohort study of patients who underwent prenatal ONTD repair, using either the open-hysterotomy or the fetoscopic approach, at a single institution between 2012 and 2018. Clinical outcomes were collected by chart review. A cost-consequence analysis was conducted from the hospital perspective, and included all inpatient and ambulatory hospital and physician costs incurred for the care of mothers and their infants, from the time of maternal admission for fetal ONTD repair up to postnatal maternal and infant discharge. Costs were estimated using cost-to-charge ratios for hospital billing and the Medicare physician fee schedule for physician billing.

RESULTS

Seventy-eight patients were included in the analysis, of whom 47 underwent fetoscopic repair and 31 underwent open-hysterotomy repair. In the fetoscopic-repair group, compared with the open-repair group, fewer women underwent Cesarean section (53% vs 100%; P < 0.001) and the median gestational age at birth was significantly higher (38.1 weeks (interquartile range (IQR), 35.2-39.1 weeks) vs 35.7 weeks (IQR, 33.9-37.0 weeks); P < 0.001). No case of uterine dehiscence was observed in the fetoscopic-repair group, compared with an incidence of 16% in the open-repair group. After adjusting for baseline characteristics, there was no significant difference in the total cost of care between the fetoscopic-repair and the open-repair groups (median, $76 978 (IQR, $60 312-$115 386) vs $65 103 (IQR, $57 758-$108 103); P = 0.458).

CONCLUSIONS

Fetoscopic repair of ONTD, when compared with the open-hysterotomy approach, reduces the incidence of Cesarean section and preterm delivery with no significant difference in total costs of care from surgery to infant discharge. This novel approach may represent a cost-effective alternative to improve maternal and neonatal outcomes for this high-risk population. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Cumulative diagnostic imaging radiation exposure in premature neonates

BACKGROUND

To date, there has been limited work evaluating the total cumulative effective radiation dose received by infants in the neonatal intensive care unit. Most previous publications report that the total radiation dose received falls within the safe limits but does not include all types of ionizing radiation studies typically performed on this vulnerable patient population. We aimed to provide an estimate of the cumulative effective ionizing radiation dose (cED) in microSieverts (μSv) received by premature infants ≤32 weeks from diagnostic studies performed throughout their NICU stay, and predictors of exposures.

METHODS

Retrospective chart review from 2004-2011. Data included demographics, gestational age (GA), birth weight (BW), length of stay (LOS), clinical diagnosis, and radiological studies.

RESULTS

1045 charts were reviewed. Median GA = 30.0 weeks (SD 2.7, range 22.0-32.6). Median BW = 1340.0 grams (SD 445.4, range 420-2470). Median number of radiographic studies = 9 (SD 28.5, range 0-210). Median cED = 162μSv (range 0-9248). The cED was positively associated with LOS (p <  0.001) and inversely correlated with GA (p <  0.001) and BW (p <  0.001). Infants with intestinal perforation had the highest median cED 1661μSv compared to 162μSv for others (p <  0.001).

CONCLUSION

Our results provide an estimate of the cumulative effective radiation dose received by premature infants in a level 4 neonatal intensive care unit from all radiological studies involving ionizing radiation and identifies risk factors and predictors of such exposure. Radiation exposure in NICU is highest among the most premature and among infants who suffer from intestinal perforation.

Elevated Urine Leukotriene E4 Is Associated With Worse Objective Markers in Nasal Polyposis Patients

OBJECTIVES

Urine leukotriene E4 (uLTE4) is a biomarker of leukotriene synthesis and is elevated in patients with aspirin-exacerbated respiratory disease (AERD). It can also be useful to help delineate aspirin-tolerant chronic rhinosinusitis with nasal polyposis (CRSwNP) patients from AERD patients. The purpose of this study is to determine if uLTE4 biomarker levels are associated with objective and subjective markers of disease severity in patients with CRSwNP.

METHODS

A retrospective analysis of CRSwNP patients who underwent uLTE4 testing was completed to determine the association of uLTE4 levels to markers of disease severity. uLTE4 levels, as well as presenting subjective (Sinonasal Outcome Test 22 [SNOT22] scores, asthma control test [ACT] scores) and objective data (Lund-Mackay CT score, spirometry and lab values) were collected.

RESULTS

Among the 157 CRSwNP patients who met inclusion criteria, uLTE4 levels were associated with history of asthma (P < .001), aspirin sensitivity (P < .001), worse Lund-Mackay CT scores (P = .002) and other objective markers of disease severity including serum IgE (P = .05), presenting blood eosinophil level (P < .001), and the highest recorded eosinophil level (P < .001). In subgroup analysis, associations of uLTE4 to disease markers had stronger correlations in the aspirin sensitive CRSwNP group (R range 0.31-0.52) than the aspirin tolerant CRSwNP group (R range -0.30-0.24). uLTE4 levels were not associated with subjective symptom scores (SNOT22 and ACT scores).

CONCLUSION

Elevated uLTE4 biomarker levels are associated with worsened objective markers of disease severity in CRSwNP patients but not patient-reported symptom measures.

LEVEL OF EVIDENCE

3 Laryngoscope, 131:961-966, 2021.

A tale half told: State exclusionary and inclusionary regimes, incarceration of fathers, and the educational attainment of children

Paternal incarceration leads to educational disparities among children who are innocent of their fathers' crimes. The scale and concentration of mass paternal incarceration thus harms millions of innocent American children. Current individuallevel analyses neglect the contribution of macro-level variation in responses of punitive state regimes to this social problem. We hypothesize that state as well as individual level investment in exclusionary paternal incarceration diminishes the educational attainment of children, although state inclusionary investment in welfare and education can offset some - and could potentially offset more - of this harm. Understanding intergenerational educational attainment therefore requires individual- and contextuallevel analyses. We use Hierarchical Generalized Linear Models to analyze the National Longitudinal Survey of Adolescent to Adult Health. Disparities in postsecondary educational outcomes are especially detrimental for children of incarcerated fathers located in state regimes with high levels of paternal incarceration and concentrated disadvantage. This has important implications for intergenerational occupational and status attainment.

Imprisonment, opioids and health care reform: The failure to reach a high-risk population

The 2014 National Research Council report on American incarceration optimistically anticipated the Affordable Care Act (ACA) would be "a turning point in the nation's health care, and … will provide unprecedented access to care for many people being released from correctional facilities." However, the ACA was not designed to proactively respond to risks associated with prisoner re-entry into society. Our overarching hypothesis is that unmet health needs among previously incarcerated adults can be more fully understood by analyzing how un-prescribed use of drugs, such as opioids, is associated with economic and health problems and health care un-insurance that in turn results in exclusion from needed health care services. Using several waves of the National Longitudinal Study of Adolescent to Adult Health conducted before and after passage and implementation of ACA, our analysis indicates that the above risk factors nearly fully mediate the association between previous incarceration and failure to receive needed health care. We argue that these factors are likely intensified by a reactive approach to health care reform that not only fails to cover many former prisoners, but also is lacking in sufficient outreach programming, and as such is insufficient for adults with health problems and limited economic resources - especially those using un-prescribed opioids. Future work should address the capacity of more proactively organized public health programs to expand coverage to previously incarcerated populations - including un-prescribed opioid users - and thereby reduce their health risks and vulnerability to repeated exposure to law enforcement surveillance and criminal punishment.

Familial Syndromes Involving Meningiomas Provide Mechanistic Insight Into Sporadic Disease

Currently, there is an incomplete understanding of the molecular pathogenesis of meningiomas, the most common primary brain tumor. Several familial syndromes are characterized by increased meningioma risk, and the genetics of these syndromes provides mechanistic insight into sporadic disease. The best defined of these syndromes is neurofibromatosis type 2, which is caused by a mutation in the NF2 gene and has a meningioma incidence of approximately 50%. This finding led to the subsequent discovery that NF2 loss-of-function occurs in up to 60% of sporadic tumors. Other important familial diseases with increased meningioma risk include nevoid basal cell carcinoma syndrome, multiple endocrine neoplasia 1 (MEN1), Cowden syndrome, Werner syndrome, BAP1 tumor predisposition syndrome, Rubinstein-Taybi syndrome, and familial meningiomatosis caused by germline mutations in the SMARCB1 and SMARCE1 genes. For each of these syndromes, the diagnostic criteria, incidence in the population, and frequency of meningioma are presented to review the relevant clinical information for these conditions. The genetic mutations, molecular pathway derangements, and relationship to sporadic disease for each syndrome are described in detail to identify targets for further investigation. Familial syndromes characterized by meningiomas often affect genes and pathways that are also implicated in a subset of sporadic cases, suggesting key molecular targets for therapeutic intervention. Further studies are needed to resolve the functional relevance of specific genes whose significance in sporadic disease remains to be elucidated.

Infusion of 5-Azacytidine (5-AZA) into the fourth ventricle or resection cavity in children with recurrent posterior Fossa Ependymoma: a pilot clinical trial

BACKGROUND

DNA methylation inhibitors are logical therapeutic candidates for ependymomas originating in the posterior fossa of the brain. Our objective was to test the safety of infusing 5-Azacytidine (5-AZA), a DNA methylation inhibitor, directly into cerebrospinal fluid (CSF) spaces of the fourth ventricle or tumor resection cavity in children with recurrent ependymoma originating in the posterior fossa.

MATERIALS AND METHODS

In patients with recurrent ependymoma whose disease originated in the posterior fossa, a maximal safe subtotal tumor resection was performed. At the conclusion of the tumor resection, a catheter was surgically placed into the fourth ventricle or tumor resection cavity and attached to a ventricular access device. CSF flow from the posterior fossa to the sacrum was confirmed by CINE phase contrast magnetic resonance imaging (MRI) postoperatively. 12 consecutive weekly 10 milligram (mg) infusions of 5-Azacytidine (AZA) were planned. Disease response was monitored with MRI scans and CSF cytology.

RESULTS

Six patients were enrolled. One patient was withdrawn prior to planned 5-AZA infusions due to surgical complications after tumor resection. The remaining five patients received 8, 12, 12, 12, and 12 infusions, respectively. There were no serious adverse events or new neurological deficits attributed to 5-AZA infusions. All five patients with ependymoma who received 5-AZA infusions had progressive disease. Two of the five patients, however, were noted to have decrease in the size of at least one intraventricular lesion.

CONCLUSION

5-AZA can be infused into the fourth ventricle or posterior fossa tumor resection cavity without causing neurological toxicity. Future studies with higher doses and/or increased dosing frequency are warranted.

Dual-process theory of racial isolation, legal cynicism, and reported crime

Why is neighborhood racial composition linked so strongly to police-reported crime? Common explanations include over-policing and negative interactions with police, but police reports of crime are heavily dependent on resident 911 calls. Using Sampson's concept of legal cynicism and Vaisey's dual-process theory, we theorize that racial concentration and isolation consciously and nonconsciously influence neighborhood variation in 911 calls for protection and prevention. The data we analyze are consistent with this thesis. Independent of police reports of crime, we find that neighborhood racial segregation in 1990 and the legal cynicism about crime prevention and protection it engenders have lasting effects on 911 calls more than a decade later, in 2006-2008. Our theory explains this persistent predictive influence through continuity and change in intervening factors. A source of cumulative continuity, the intensification of neighborhood racial concentration and isolation between 1990 and 2000, predicts 911 calls. Likewise, sources of change-heightened neighborhood incarceration and home foreclosures during the financial crisis in 2006-2008-also predict these calls. Our findings are consistent with legal cynicism theory's focus on neighborhood disadvantage, racial isolation, and concerns about police protection and crime prevention; they correspond less with the emphasis of procedural justice theory on police legitimacy.

Maternal imprisonment, economic marginality, and unmet health needs in early adulthood

There is relatively little research on access to the health care needed by children whose mothers have been incarcerated, and even fewer studies of how effects of lack of access continue and cumulate as these children transition from living with parents, parent surrogates, or foster care into adulthood. We find in a nationally representative U.S. panel study (n=9418 participants from 1995 to 2007-2008 in the National Longitudinal Study of Adolescent and Adult Health) that young adult children of incarcerated mothers are less likely to receive the health care they need. These effects hold in models that take into account covariates and receipt of health care in the past, a useful control for unmeasured heterogeneity. In this analysis for 2007-2008, economic marginality mediates maternal incarceration on young adult unmet health care needs. Health insurance mediates a smaller portion of this effect. The findings of this research provide important bench marks for assessing the effects of the 2010 passage and the 2013 implementation of the Affordable Care Act [ACA], as well as prospective efforts to change or repeal the ACA.

Surviving on the Street

This article documents the living conditions of a sample of adolescents (N = 390) who had left home and were living on the street in Toronto, Canada The majority of these youth had spenta considerable amount of time without adequate shelter, food, or income; furthermore, many were involved in a variety of illegal activities and had been incarcerated or suicidal Multiple regression analyses revealed that the most consistent predictors of hunger, criminal activity, and incarceration were conditions of street life itself: thelack of secure shelter and the length of time on the street. Overal4 the living conditions of these youth closely parallel those of homeless adults. Although there are differences between adults and adolescents who live on the street, the similarities suggest that it may be inappropriate to label the latter runaways and to consistently separate adults and adolescents into two completely distinct homeless populations.

Asthma Status and Risk of Incident Myocardial Infarction: A Population-Based Case-Control Study

BACKGROUND

The role of asthma status and characteristics of asthma in the risk of myocardial infarction (MI) are poorly understood.

OBJECTIVE

We determined whether asthma and its characteristics are associated with risk of MI.

METHODS

The study was designed as a population-based retrospective case-control study, which included all eligible incident MI cases between November 1, 2002, and May 31, 2006, and their matched controls. Asthma was ascertained using predetermined criteria. Active (current) asthma was defined as the occurrence of asthma-related episodes (asthma symptoms, use of asthma medications, unscheduled medical or emergency department visit, or hospitalization for asthma) within 1 year before MI index date.

RESULTS

There were 543 eligible incident MI cases during the study period. Of the 543 MI cases, 81 (15%) had a history of asthma before index date of MI, whereas 52 of 543 controls (10%) had such a history (adjusted odds ratio [OR]: 1.68; 95% CI: 1.06-2.66) adjusting for risk factors for MI and comorbid conditions (excluding chronic obstructive lung disease). Although inactive asthma did not increase the risk of MI, individuals with active asthma had a higher odds of MI, compared with those without asthma (adjusted OR: 3.18; 95% CI: 1.57-6.44) without controlling for chronic obstructive pulmonary disease (COPD). After adjusting for COPD, although asthma overall was no longer statistically significant (adjusted OR: 1.34, 95% CI: 0.84-2.15), active asthma still was associated (adjusted OR: 2.33, 95% CI: 1.12-4.82).

CONCLUSION

Active asthma is an unrecognized risk factor for MI. Further studies are needed to assess the role of asthma control and medications in the risk of MI.

Diagnostic Utility of Urinary LTE4 in Asthma, Allergic Rhinitis, Chronic Rhinosinusitis, Nasal Polyps, and Aspirin Sensitivity

BACKGROUND

Urinary leukotriene E4 (LTE4) is a well-validated marker of the cysteinyl leukotriene pathway, and LTE4 elevation has been described in conditions such as asthma, aspirin sensitivity, and chronic rhinosinusitis (CRS). There have been a number of reports investigating the role of spot urine LTE4 to predict aspirin sensitivity; however, variability in urinary LTE4 may affect the accuracy of this approach.

OBJECTIVE

Here, we explored the utility of 24-hour urinary LTE4 in 5 clinical diagnoses of allergic rhinitis, asthma, chronic rhinosinusitis with nasal polyps (CRSwNP), CRS without nasal polyps, and aspirin sensitivity.

METHODS

This was a retrospective review of patients who had 24-hour quantification of urinary LTE4 by a clinically validated liquid chromatography tandem mass spectrometry method and their assigned diagnoses after assessment and clinical care.

RESULTS

Twenty-four-hour urinary LTE4 elevations were seen in those with asthma and those with CRSwNP but influenced by underlying aspirin sensitivity. Elevation in LTE4 was significant in those with CRSwNP after adjusting for aspirin sensitivity. Allergic rhinitis was not associated with elevated LTE4 excretion. Receiver operator characteristic analysis of 24-hour urinary LTE4 showed that a cutoff value of 166 pg/mg Cr suggested the presence of history of aspirin sensitivity with 89% specificity, whereas a cutoff value of 241 pg/mg Cr discriminated "challenge-confirmed" aspirin-sensitive subjects with 92% specificity.

CONCLUSIONS

Elevated 24-hour excretion of urinary LTE4 is a reliable and simple test to identify aspirin sensitivity in patients with respiratory diagnoses.

Immunological profiling in chronic rhinosinusitis with nasal polyps reveals distinct VEGF and GM-CSF signatures during symptomatic exacerbations

BACKGROUND

The mechanisms and immune pathways associated with chronic rhinosinusitis (CRS) are not fully understood. Immunological changes during acute exacerbation of CRS may provide valuable clues to the pathogenesis and perpetuation of the disease.

OBJECTIVE

To characterize local and systemic immune responses associated with acute worsening of sinonasal symptoms during exacerbation in CRS with nasal polyps (CRSwNP) compared to controls.

METHODS

This was a non-interventional prospective study of individuals with CRSwNP and normal controls. Subjects underwent a baseline visit with collection of nasal secretions, nasal washes, and serum specimens. Within 3 days of acute worsening of sinonasal symptoms, subjects underwent a study visit, followed by a post-visit 2 weeks later. The sinonasal outcome test-22 (SNOT-22) scores and immunological parameters in the specimens were analysed using a novel, unsupervised learning method and by conventional univariate analysis.

RESULTS

Both CRSwNP patients and control subjects showed a significant increase in SNOT-22 scores during acute exacerbation. Increased nasal levels of IL-6, IL-5, and eosinophil major basic protein were observed in CRSwNP patients. A network analysis of serum specimens revealed changes in a set of immunological parameters, which are distinctly associated with CRSwNP but not with controls. In particular, systemic increases in VEGF and GM-CSF levels were notable and were validated by a conventional analysis.

CONCLUSIONS

CRSwNP patients demonstrate distinct immunological changes locally and systemically during acute exacerbation. Growth factors VEGF and GM-CSF may be involved in the immunopathogenesis of subjects with CRS and nasal polyps experiencing exacerbation.

MAKING PUNISHMENT PAY: The Political Economy of Revenue, Race and Regime in the California Prison Boom

Sociologists have neglected the politically channeled and racially connected role of leveraged debt in mass incarceration. We use qualitative and quantitative data from California, circa 1960-2000, to assess how Republican entrepreneurial leveraging of debt overcame contradictions between parochial preferences for punishment and resistance to paying taxes for building prisons. The leveraging of bond debt deferred and externalized the costs of building prisons, while repurposed lease revenue bonds massively enlarged and extended this debt and dispensed with the requirement for direct voter approval. A Republican-dominated punishment regime capitalized debt to build prisons in selected exurban Republican California counties with growing visible minority populations. We demonstrate that the innovative use of lease revenue bonds was the essential element that enlarged and extended funding of California prison construction by an order of magnitude that made this expansion a boom. With what Robert Merton called the consequences of imperious interest, this prison expansion enabled the imprisonment of an inordinately large and racially disproportionate inmate population.

Three-dimensional volumetric computed tomographic scoring as an objective outcome measure for chronic rhinosinusitis: clinical correlations and comparison to Lund-Mackay scoring

BACKGROUND

We aimed to test the hypothesis that three-dimensional (3D) volume-based scoring of computed tomography (CT) images of the paranasal sinuses was superior to Lund-Mackay CT scoring of disease severity in chronic rhinosinusitis (CRS). We determined correlation between changes in CT scores (using each scoring system) with changes in other measures of disease severity (symptoms, endoscopic scoring, and quality of life) in patients with CRS treated with triamcinolone.

METHODS

The study group comprised 48 adult subjects with CRS. Baseline symptoms and quality of life were assessed. Endoscopy and CT scans were performed. Patients received a single systemic dose of intramuscular triamcinolone and were reevaluated 1 month later. Strengths of the correlations between changes in CT scores and changes in CRS signs and symptoms and quality of life were determined.

RESULTS

We observed some variability in degree of improvement for the different symptom, endoscopic, and quality-of-life parameters after treatment. Improvement of parameters was significantly correlated with improvement in CT disease score using both CT scoring methods. However, volumetric CT scoring had greater correlation with these parameters than Lund-Mackay scoring.

CONCLUSION

Volumetric scoring exhibited higher degree of correlation than Lund-Mackay scoring when comparing improvement in CT score with improvement in score for symptoms, endoscopic exam, and quality of life in this group of patients who received beneficial medical treatment for CRS.

Conditional inactivation of the mouse Wwox tumor suppressor gene recapitulates the null phenotype

WW domain-containing oxidoreductase (WWOX) is highly conserved in both human and murine. WWOX spans the second most common human chromosomal fragile site, FRA16D, and is commonly inactivated in multiple human cancers. Modeling WWOX inactivation in mice revealed a complex phenotype including postnatal lethality, defects in bone metabolism and steroidogenesis and tumor suppressor function resulting in osteosarcomas. For better understanding of WWOX roles in different tissues at distinct stages of development and in pathological conditions, Wwox conditional knockout mice were generated in which loxp sites flank exon 1 in the Wwox allele. We demonstrated that Cre-mediated recombination using EIIA-Cre, a Cre line expressed in germline, results in postnatal lethality by age of 3 weeks and decreased bone mineralization resembling total ablation of WWOX as in conventional null mice. This animal model will be useful to study distinct roles of WWOX in multiple tissues at different ages.

Asthma and risk of selective IgA deficiency or common variable immunodeficiency: a population-based case-control study

OBJECTIVE

To determine the association between a history of asthma and a diagnosis of selective IgA deficiency (sIgAD)/common variable immunodeficiency (CVID).

PATIENTS AND METHODS

This population-based case-control study included residents of Olmsted County, Minnesota, who met the Pan-American Group for Immunodeficiency/European Society for Immunodeficiencies diagnostic criteria for sIgAD/CVID between January 1, 1964, through December 31, 2008. Each case had 4 age- and sex-matched controls (2 from the community and 2 from a list of individuals who had undergone an immune work-up). We ascertained asthma status by applying predetermined criteria for asthma.

RESULTS

We identified 39 cases: 26 (66.7%) had sIgAD and 13 (33.3%) had CVID. Of the 39 cases, 51.3% were men (n=20) and 97.1% were white (33 of 34 patients). The mean age at the index date (the time when criteria were met) of sIgAD/CVID was 34.2 years. Of the 39 cases, 9 (23.1%) had a history of asthma before the index date of sIgAD/CVID; of the 156 controls, 16 (10.3%) had a history of asthma before the index date (odds ratio, 2.77; 95% CI, 1.09-7.06; P=.03). A history of asthma (before or after the index date of sIgAD/CVID) was more prevalent in sIgAD/CVID cases (30.8%; n=12) than in matched controls (11.5%; n=18) (odds ratio, 3.57; 95% CI, 1.50-8.51; P=.01).

CONCLUSION

Asthmatic patients are more likely to have a diagnosis of sIgAD/CVID than nonasthmatic individuals. This association may potentially account for the increased risks of bacterial infections in some individuals with asthma.

Maternal and paternal imprisonment in the stress process

Parental incarceration is now prevalent in community samples (e.g., with 11% of children reporting paternal imprisonment and 3% reporting maternal imprisonment in a national sample), pointing to a potentially important childhood trauma that should be included in work on contemporary childhood stressors in this era of mass incarceration. This paper investigates the influences of maternal and paternal imprisonment on changes in young adult mental health using a nationally representative sample. We assess four perspectives-gendered loss, same-sex role model, intergenerational stress, and maternal salience - on the joint influences of maternal and paternal incarceration within the broader stress process paradigm. The results generalize support for a gendered loss perspective developed in work on parental death and an early small study of parental incarceration. This pattern reveals maternal incarceration increases depressive symptoms while paternal incarceration increases substance role problems. Chronicity of parental imprisonment and its timing are also influential. Analyses further specify a vulnerability of male and minority young adults to high levels of mental health problems following maternal and paternal incarceration in adolescence.

Perceived danger and offending: exploring the links between violent victimization and street crime

Perceptions of the danger of crime are typically discussed in the context of people's fear that they will be harmed by offenders. We shift the focus and examine the association between perceived danger and offending and the contribution of these perceptions to the well-established relationship between violent victimization and crime. We hypothesize that violence may embolden some victims and contribute to their perception that offending is not dangerous. We examine the mediating effects of these perceptions alongside two other potential links between violent victimization and crime: deviant definitions and risk seeking. Our analyses of data from a sample of homeless youth find that violent victimization is strongly associated with four types of offending--theft, drug use, drug selling, and prostitution--and that perceived danger significantly mediates several of these relationships. Our results suggest that perceived danger may be an important mechanism connecting victimization and crime.

Evaluation of correlation between dose and clinical outcomes in subcutaneous immunoglobulin replacement therapy

The importance of serum immunoglobulin (Ig)G concentration in IgG replacement therapy for primary immunodeficiency diseases is established in certain settings. Generally, IgG is infused via the intravenous (IVIG) or subcutaneous (SCIG) route. For IVIG infusion, published data demonstrate that higher IgG doses and trough levels provide patients with improved protection from infection. The same conclusions are not yet accepted for SCIG; data from two recent Phase III studies and a recent post-hoc analysis, however, suggest the same correlation between higher SCIG dose and serum IgG concentration and decreased incidence of infection seen with IVIG. Other measures of clinical efficacy have not been considered similarly. Thus, combined analyses of these and other published SCIG studies were performed; a full comparison of the 13 studies was, however, limited by non-standardized definitions and reporting. Despite these limitations, our analyses indicate that certain clinical outcomes improve at higher SCIG doses and associated higher serum IgG concentrations, and suggest that there might be opportunity to improve patient outcomes via SCIG dose adjustment.

Abstract 276: Role of AP1 elements and TCL1 protein in regulation of the gene encoding PTPROt (protein tyrosine phosphatase receptor-type O) in chronic lymphocytic leukemia

The gene for protein tyrosine phosphatase receptor-type O encodes two functional isoforms in a tissue-specific manner. The full-length form is expressed in epithelial cells, particularly in the brain and kidney, whereas the truncated form (PTPROt) is primarily expressed in hematopoietic cells. We have previously demonstrated that PTPROt is a bona fide tumor suppressor (J Biol Chem. 2009 Jan 2;284(1):455-64) and is down-regulated in primary CLL samples (Clin Cancer Res. 2007 Jun 1;13(11):3174-81). Further, studies from two laboratories including ours have shown that Syk and Lyn, two key protein tyrosine kinases involved in B-cell receptor signaling, are substrates of PTPROt, igniting interest in understanding deregulation of this tyrosine phosphatase in CLL. While the PTPRO promoter is methylated, the mechanism of its silencing in the pathogenesis of CLL is unexplored. Here, we utilized the Tcl1 transgenic (Tg) mouse model of CLL and a cell line with TPA-inducible expression of PTPROt to elucidate the mechanism of PTPROt silencing. This study demonstrates that PTPROt is transcriptionally silenced in CD19+ spleen B cells from Tcl1 transgenic (Tg) mouse when compared to wild type mice. As observed with primary human CLL, the methylation of PTPRO CGI (CpG island) is significantly higher in Tcl1 Tg CLL B-lymphocytes than in normal B lymphocytes. Significant suppression of PTPROt is also observed at very early time-point (∼7 wks) in CD19+ spleen B-cells from Tcl1 Tg mice compared to normal spleen B-lymphocytes from age-matched WT mice in the absence of detectable methylation at CGI. This data suggests that transcriptional silencing occurs prior to methylation. To understand further the potential transcriptional mechanism of PTPROt suppression in CLL, the role of AP1 in the expression of this gene was explored. We first demonstrate that AP-1 activation by TPA in U937 cells induces PTPROt expression with concurrent recruitment of c-fos and c-jun to its promoter. PTPROt promoter is also responsive to over- and under-expression of AP-1 confirming the role of AP-1 in PTPROt expression. Next, we demonstrate that Tcl1 can repress PTPROt promoter by altering c-fos expression and c-jun activation state. These findings further substantiate the importance of TCL1 in the pathogenesis of CLL.

[Supported, in part, by grants CA101956 and CA086978].

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 276. doi:10.1158/1538-7445.AM2011-276

The displaced and dispossessed of Darfur: explaining the sources of a continuing state-led genocide

The millions of survivors who fled from attacks to Sudanese-controlled displacement camps and the refugee camps in Chad are the living ghosts of the Darfur genocide. The 1948 Genocide Convention incorporates extermination by mass killing and elimination through forced migration as two distinct elements of genocide. Genocide scholars and public discourse emphasize extermination by killing, but they give far less explanatory attention to the elimination processes that the Genocide Convention describes as 'deliberately inflicting on the group conditions of life calculated to bring about its physical destruction'. (Article II United Nations 1948.) In Darfur, understanding the latter processes requires theoretical attention to the history of food, water, and famine and detailed methodological attention to temporal processes of displacement. We demonstrate how intentional state-led attacks on food and water massively dislodged Black Africans in Darfur from February 2003 to August 2004. The political leadership of the Sudanese state dehumanized and forcibly displaced Black Africans from their homes in Darfur to camps where they largely remain, not only through mass killings and rapes, but also by destroying life-sustaining access to food and water, leading to the genocidal elimination of group life in this region.

Abstract LB-352: B-CLL phenotype in Eµ-miR-29 transgenic mice

B-cell chronic lymphocytic leukemia (B-CLL) is the most common leukemia in the western world. Human B-CLL occurs in two forms: aggressive (showing high ZAP-70 expression and unmutated IgH VH) and indolent (showing low ZAP-70 expression and mutated IgH VH). We found that miR-29a is upregulated in indolent human B-CLL compared to aggressive B-CLL and normal CD19+ B-cells. To study the role of miR-29 in B-CLL, we generated Eµ-miR-29 transgenic mice overexpressing miR-29 in mouse B-cells. Flow cytometric analysis revealed a markedly expanded CD5+ population in the spleen of these mice starting at 2 months of age. Over 80% of miR-29 transgenic mice exhibited an expanded population of CD5+ B-cells, a characteristic of the B-CLL phenotype. An average of 56% of the B-cell population in these transgenics were CD5 positive. At the age of 2 years these mice showed significantly enlarged spleens and an increase in CD5+ B-cell population of up to 100% of B-cells. Over 8% (3/36) of Eµ-miR-29 transgenic mice developed frank leukemia and prematurely died from the disease at the age of 24-26 months. The expanded CD5+ B-cell population was found to be proliferative, with an increased number of cells in the S-phase of the cell cycle, compared to wild type CD19+ B-cells. These results suggest that deregulation of miR-29 can cause, or at least significantly contribute to the pathogenesis of indolent B-CLL.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr LB-352.

Racial targeting of sexual violence in Darfur

OBJECTIVES

We used the Atrocities Documentation Survey to determine whether Sudanese government forces were involved in racially targeting sexual victimization toward ethnically African women in the Darfur region of western Sudan.

METHODS

The US State Department conducted the survey by interviewing a randomized multistage probability sample of 1136 Darfur refugees at 20 sites in Chad in 2004. For a subset of 932 respondents who had fled from village clusters that accounted for 15 or more respondents per cluster, we used hierarchical linear models to analyze village-level patterns of reported sexual violence. We statistically controlled for individual sexual victimization to remove bias.

RESULTS

Respondents reported being subjected to racial epithets associated with sexual victimization significantly more often during combined attacks by Sudanese government forces and Janjaweed militia forces than during separate attacks by either force.

CONCLUSIONS

Combined attacks by Sudanese government forces and Janjaweed militia forces led to racial epithets being used more often during sexual victimization in Darfur. Our results suggest that the Sudanese government is participating in the use of sexual assault as a racially targeted weapon against ethnically African civilians.

UCbase & miRfunc: a database of ultraconserved sequences and microRNA function

Four hundred and eighty-one ultraconserved sequences (UCRs) longer than 200 bases were discovered in the genomes of human, mouse and rat. These are DNA sequences showing 100% identity among the three species. UCRs are frequently located at genomic regions involved in cancer, differentially expressed in human leukemias and carcinomas and in some instances regulated by microRNAs (miRNAs). Here we present UCbase & miRfunc, the first database which provides ultraconserved sequences data and shows miRNA function. Also, it links UCRs and miRNAs with the related human disorders and genomic properties. The current release contains over 2000 sequences from three species (human, mouse and rat). As a web application, UCbase & miRfunc is platform independent and it is accessible at http://microrna.osu.edu/.UCbase4.

Age, puberty, and exposure to intimate partner violence in adolescence

This paper links sociological and epidemiologic research on violence and the life course to biosocial perspectives on pubertal maturation to examine risk factors associated with exposure to intimate partner violence in adolescence. While prior research has established early puberty as a risk factor for delinquent behavior, studies to date have not yet investigated whether early puberty is also linked to intimate partner violence in adolescence. Prior epidemiologic research has found that increasing age in adolescence is a risk factor for dating violence, but this work has not yet incorporated the element of pubertal maturation. The present study examines the relative effects of chronological age and maturational age in a biosocial model predicting risk for intimate partner violence among adolescent females, net of established control variables, using three waves of data from the National Longitudinal Study of Adolescent Health. These findings indicate that early maturation in females is an additional risk factor for exposure to intimate partner violence in adolescence. The importance of disentangling types of age effects as raised in the developmental literature and as supported by these findings is discussed in relation to the prevention of youth violence.