Seasonal Trends in Pediatric Respiratory Illnesses: Using Google Trends to Inform Precision Outreach

OBJECTIVES

Google Trends is an emerging tool that allows users to analyze search queries, showing when certain topics are searched most often. Multiple studies have compared Google Trends to epidemiological data of health conditions, but pediatric specific illnesses have not yet been investigated. An association between disease incidence and Google Trends data may help facilitate precision outreach in the form of digital resources and promotion. We sought to examine the relationship between Google Trends data and measured incidence of bronchiolitis and croup.

METHODS

We carried out a Google Trends search using the terms "bronchiolitis" and "croup" on July 24, 2019. The number of positive respiratory syncytial virus and parainfluenza tests published by the Public Health Agency of Canada was used to estimate incidence of bronchiolitis and croup, respectively. Emergency department discharge data were used to measure the number of patients with bronchiolitis and croup presenting to a Canadian pediatric hospital. Data from January 1, 2015, to December 31, 2018, were used for analysis.

RESULTS

Google Trends revealed clear seasonal variation in search volume for both bronchiolitis and croup in keeping with known epidemiological data for these conditions. For data on bronchiolitis, Google Trends correlated strongly with Canadian Public Health and our hospital data. A positive correlation was also found with croup.

CONCLUSIONS

Google Trends correlates with both laboratory-based and hospital incidence of respiratory viral diagnoses. This novel data source has implications for tracking disease epidemiology, tailoring health information, and providing precision outreach tools to patients and their families.

The GoodHope Exercise and Rehabilitation (GEAR) Program for People With Ehlers-Danlos Syndromes and Generalized Hypermobility Spectrum Disorders

Introduction: The Ehlers-Danlos Syndromes (EDS) and Generalized Hypermobility Spectrum Disorders (G-HSD) comprise a heterogeneous group of genetic disorders of abnormal synthesis and/or maturation of collagen and other matricellular proteins. EDS is commonly characterized by manifestations such as multi joint hypermobility that can lead to musculoskeletal pains, subluxations and dislocations, fragile skin, organ dysfunction, and chronic significant diffuse pain with fatigue, deconditioning eventuating to poor quality of life. Evidence suggests exercise and rehabilitation interventions may ameliorate symptoms of unstable joints, recurrent subluxations/dislocations, and chronic widespread musculoskeletal pain. To date, there have only been a few reports describing exercise and rehabilitation care strategies for people with EDS.

Methods: In this manuscript, we describe the GoodHope Exercise and Rehabilitation (GEAR) program, its overarching principles, as well as the program development and delivery model. The GEAR program aims to decrease functional impairment, reduce pain, increase confidence in symptom self-management, and provide a community of support for people with EDS/G-HSD. To achieve these goals, we detail the model of care that includes exercise and rehabilitation therapy, education for self-management, and support accessing relevant community resources.

Strengths and Limitations of the Study: GEAR represents a novel exercise and rehabilitation care model for people with G-HSD and various clinical EDS subtypes, beyond the commonly included hEDS subtype. Systematic collection of data via validated measurements is ongoing and will guide the refinement of GEAR and support the development of emerging exercise and rehabilitation programs for people with EDS.

The GoodHope Ehlers Danlos Syndrome Clinic: development and implementation of the first interdisciplinary program for multi-system issues in connective tissue disorders at the Toronto General Hospital

Ehlers-Danlos Syndrome (EDS) are a heterogeneous group of genetic connective tissue disorders, and typically manifests as weak joints that subluxate/dislocate, stretchy and/or fragile skin, organ/systems dysfunction, and significant widespread pain. Historically, this syndrome has been poorly understood and often overlooked. As a result, people living with EDS had difficulty obtaining an accurate diagnosis and appropriate treatment, leading to untold personal suffering as well as ineffective health care utilization. The GoodHope EDS clinic addresses systemic gaps in the diagnosis and treatment of EDS. This paper describes a leap forward—from lack of awareness, diagnosis, and treatment—to expert care that is tailored to meet the specific needs of patients with EDS. The GoodHope EDS clinic consists of experts from various medical specialties who work together to provide comprehensive care that addresses the multi-systemic nature of the syndrome. In addition, EDS-specific self-management programs have been developed that draw on exercise science, rehabilitation, and health psychology to improve physical and psychosocial wellbeing and overall quality of life. Embedded into the program are research initiatives to shed light on the clinical presentation, underlying mechanisms of pathophysiology, and syndrome management. We also lead regular educational activities for community health care providers to increase awareness and competence in the interprofessional management of EDS beyond our doors and throughout the province and country.

Abstract 4560: A cost-effective and rapid assay for profiling of immunobiology and the development of predictive signatures for response to immunotherapies

Introduction: Gene expression profiling is an important tool to monitor the human immune response to different antitumor agents for drug development and to identify predictive signatures for response to immunotherapies. We have developed and analytically validated a gene expression assay panel, namely the AdvantaTM Immuno-Oncology Gene Expression Assay (AdvantaTM I/O GE Assay), on the Fluidigm BiomarkTM HD system, a microfluidic real-time PCR system, for investigation of antitumor agent effects on immune inhibitory pathways. The assay panel consists of 170 unique gene targets in categories such as T cell subset markers (e.g., CD4), cytokines and chemokines (e.g., IFNg), immune regulation (e.g., PD-L1, PD-L2) and immune cell-fate markers (e.g., NK) associated with immune-checkpoint inhibitory pathways for cancer treatments. Method: The Assay consists of Fluidigm Dynamic Array™ IFCs, an assay panel and RT-PCR reagents. The assay panel is composed of TaqMan™ gene expression assays provided in two 96-well plates: 96 assays on one and 79 assays on another with 17 unused assay wells available for customization. Each plate contains five housekeeping genes for assay normalization. This assay configuration allows customers to test 96 samples on two Fluidigm 96.96 Dynamic Array™ IFCs. Two primer pools for preamplification, and a positive control have been developed along with a 24.192 Dynamic Array™ IFC which enables 24 samples and the complete panel, 170 genes to be run on a single IFC. The assay has been analytically validated by a third party (Q2/EA) on the 96.96 IFC. This study is to verify the assay and kit reagents on the 24.192 IFC. A universal RNA was reversely transcribed into cDNA and pre-amplified with the preamp primer pools for all 170 genes. Three tissue cDNAs (lymph node, brain and Jurkat cells) and the positive control, which contains all 170 targets, were used to evaluate amplification efficiency, linearity and reproducibility. Each sample was tested in three replicates on 24.192 IFCs in six independent runs. Results: The results show an average amplification efficiency across all assays of 98.2% and linearity (RSQ) 0.999 for universal RNA. The efficiency and linearity for the positive control are 0.999 and 0.998, respectively. The within-run replicate correlation (RSQ) is 0.997 for the universal RNA, 0.992 for Jurkat cDNA, 0.986 for brain cDNA, and 0.990 for lymph node cDNA. The between-IFC replicate correlation (RSQ) is 0.981 for universal RNA, 0.982 for Jurkat cDNA, 0.972 for brain cDNA and 0.977 for lymph node cDNA. Gene expression signatures for individual tissues were observed. Conclusions: The AdvantaTM I/O GE Assay on 24.192 IFC and the Fluidigm BiomarkTM HD system provides high amplification efficiency, excellent linearity and reproducibility and reduces the cost of routine laboratory testing for both immune checkpoint research and drug development.

Citation Format: Peilin Chen, Sandy Spurgeon, Jing Wang, Michael Gonzales, Lianne McLean, Tom Goralski. A cost-effective and rapid assay for profiling of immunobiology and the development of predictive signatures for response to immunotherapies [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4560.

Abstract 4651: Development of a targeted NGS panel for solid tumor actionable gene targets using multiplex PCR-based enrichment in an integrated fluidic circuit

Introduction: Next-generation sequencing (NGS) has been being rapidly adopted in clinical research to align actionable variants in tumors to targeted therapies or clinical trials. Comprehensive NGS-based tumor profiling assays are an efficient and effective method to characterize a variety of clinically relevant somatic mutations. We have developed a targeted NGS cancer gene panel that focuses on actionable gene mutations and employs a NGS library preparation method based on multiplex PCR enrichment in an integrated fluidic circuit (IFC) and the automated JunoTM System. Methods: 53 actionable cancer genes were selected based on both clinical and research knowledge that covers 15 solid tumor types. Assays for the selected regions of the 53 genes were designed by an internal assay design pipeline. Multiplex PCR using target-specific primers is conducted in an LP—48.48 IFC on the Fluidigm Juno™ system, where up to 48 DNA samples can be processed simultaneously. A unique barcode is incorporated in one of the PCR primers to distinguish individual samples. To evaluate the assay performance, three sets of cell line gDNA samples were identified from commercial sources: set 1: 22 commercial reference samples, set 2: 12 samples for single nucleotide variants (SNVs) and indels, and set 3: 12 samples for copy number variations (CNVs). Each sample was tested on the IFC in 4 replicates. PCR products harvested from the IFC were pooled and purified with Agencourt® AMPure® XP magnetic beads. A second PCR step using a universal primer pair was performed to add sequencing adapters. After a second purification, the DNA library was sequenced on a NextSeq™ 500 system. The data analysis was performed by a service provider partner (GenomOncology). Results: A total of 1,508 primer pairs with an average insert size of 155 bp were selected to cover SNVs, indels, and CNVs. The assays were separated into 44 pools to minimize the interaction between assay primers and improve performance. The percentage of reads mapped to the genome was 98.9%, and the percentage of reads that mapped to amplicons was 96.8%. Mutation detection sensitivity was 4% variant allele frequency (VAF.) In 47 selected samples, the total SNVs, CNVs and indels represented are 182, 154 and 28, respectively. For SNVs, the positive percent agreement (PPA) is 1.0 and positive predictive value (PPV) is 0.974. For CNVs, the PPA is 1.0 and PPV is 0.969 and for indels, the PPA and PPV are 1.0 and 0.966, respectively. Overall concordance is 0.99. Conclusions: A targeted NGS cancer panel employing PCR-based enrichment on an IFC has been developed and yielded high quality of libraries generated on the JunoTM system for detecting SNVs, indels and CNV in solid tumor samples. This panel covers actionable targets in 53 cancer genes and utilizes a microfluidic device to provide a simple streamlined workflow for library preparation of up to 48 DNA samples per IFC.

Citation Format: Peilin Chen, Jaibiao Gong, David Wang, Devin Do, Lianne McLean, Tom Goralski. Development of a targeted NGS panel for solid tumor actionable gene targets using multiplex PCR-based enrichment in an integrated fluidic circuit [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4651.

Age and the risk of All-Terrain Vehicle-related injuries in children and adolescents: a cross sectional study

BACKGROUND

The study was designed to determine if youth <16 years are at a greater risk of serious injuries related to all-terrain vehicle (ATV) use compared to older adolescents and adults.

METHODS

We performed cross sectional study of children and adults presenting to pediatric and adult emergency departments between 1990 and 2009 in Canada. The primary exposure variable was age <16 years and the primary outcome measure was moderate to serious injury determined from physician report of type and severity of injury.

RESULTS

Among 5005 individuals with complete data, 58% were <16 years and 35% were admitted to hospital. The odds of a moderate to serious injury versus minor injury among ATV users <16 years of age was not different compared with those ≥16 years of age (OR: 0.94; 95% CI: 0.84, 1.06). After adjusting for era, helmet use, sex and driver status, youth <16 years were more likely to present with a head injury (aOR: 1.45; 95% CI: 1.19-1.77) or fractures (aOR: 1.60; 95% CI: 1.43-1.81), compared with those ≥16 years. Male participants (aOR: 1.21; 95% CI: 1.06-1.38) and drivers (aOR: 1.30, 95% CI: 1.12-1.51) were more likely to experience moderate or serious injuries than females and passengers. Helmet use was associated with significant protection from head injuries (aOR: 0.59; 95% CI: 0.44-0.78).

CONCLUSIONS

Youth under 16 years are at an increased risk of head injuries and fractures. For youth and adults presenting to emergency departments with an ATV-related injury, moderate to serious injuries associated with ATV use are more common among drivers and males. Helmet use protected against head injuries, suggesting minimum age limits for ATV use and helmet use are warranted.

Using chlamydia positivity to estimate prevalence: evidence from the Chlamydia Screening Pilot in England

Studies have suggested that positivity can be used to estimate the prevalence of Chlamydia trachomatis in large-scale chlamydia screening programmes. A recent pilot of opportunistic screening in England estimated that the prevalence among 16–24-year-old women in Portsmouth and Wirral was 9.8% and 11.2%, respectively. This study assessed the continued validity of positivity as an approximate for prevalence. We re-analysed data from the Chlamydia Screening Pilot to estimate positivity, calculated as total positive tests divided by total tests, and compared these estimates with the previously reported prevalence, measured as the number of women testing positive divided by the total number of women screened. Overall positivity was 9.4% in Portsmouth and 11.0% in the Wirral; these estimates were not statistically different from prevalence, regardless of health-care setting, age group or symptoms. We conclude that positivity can be used as a proxy for prevalence.

A systematic review of the main mechanisms of heart failure disease management interventions

OBJECTIVE

To identify the main mechanisms of heart failure (HF) disease management programmes based in hospitals, homes or the community.

METHODS

Systematic review of qualitative and quantitative studies using realist synthesis. The search strategy incorporated general and specific terms relevant to the research question: HF, self-care and programmes/interventions for HF patients. To be included, papers had to be published in English after 1995 (due to changes in HF care over recent years) to May 2014 and contain specific data related to mechanisms of effect of HF programmes. 10 databases were searched; grey literature was located via Proquest Dissertations and Theses, Google and publications from organisations focused on HF or self-care.

RESULTS

33 studies (n=3355 participants, mean age: 65 years, 35% women) were identified (18 randomised controlled trials, three mixed methods studies, six pre-test post-test studies and six qualitative studies). The main mechanisms identified in the studies were associated with increased patient understanding of HF and its links to self-care, greater involvement of other people in this self-care, increased psychosocial well-being and support from health professionals to use technology.

CONCLUSION

Future HF disease management programmes should seek to harness the main mechanisms through which programmes actually work to improve HF self-care and outcomes, rather than simply replicating components from other programmes. The most promising mechanisms to harness are associated with increased patient understanding and self-efficacy, involvement of other caregivers and health professionals and improving psychosocial well-being and technology use.

Rigorous, robust and systematic: Qualitative research and its contribution to burn care. An integrative review

Qualitative methods are progressively being implemented by researchers for exploration within healthcare. However, there has been a longstanding and wide-ranging debate concerning the relative merits of qualitative research within the health care literature. This integrative review aimed to exam the contribution of qualitative research in burns care and subsequent rehabilitation. Studies were identified using an electronic search strategy using the databases PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Excerpta Medica database (EMBASE) and Scopus of peer reviewed primary research in English between 2009 to April 2014 using Whittemore and Knafl's integrative review method as a guide for analysis. From the 298 papers identified, 26 research papers met the inclusion criteria. Across all studies there was an average of 22 participants involved in each study with a range of 6-53 participants conducted across 12 nations that focussed on burns prevention, paediatric burns, appropriate acquisition and delivery of burns care, pain and psychosocial implications of burns trauma. Careful and rigorous application of qualitative methodologies promotes and enriches the development of burns knowledge. In particular, the key elements in qualitative methodological process and its publication are critical in disseminating credible and methodologically sound qualitative research.

Standardized standing pelvis-to-floor photographs for the assessment of lower-extremity alignment

OBJECTIVES

The objective of this cross-sectional study was to assess the intra-rater, inter-rater and test-retest reliability and concurrent validity of lower-extremity alignment estimated from a photograph [photographic alignment (PA) angle].

METHODS

A convenience sample of participants was recruited from the community. Radiopaque stickers were placed over participants' anterior superior iliac spines. One radiograph and one photograph were taken with the participant standing in a standardized position. The stickers were removed. After 30 min they were reapplied and a second photograph was taken. The hip-knee-ankle (HKA) angle was measured from each radiograph using customized imaging analysis software. The same software was used by three readers to measure the PA angle from each photograph from the first set twice, at least 2 weeks apart. One reader measured the PA angle from the second set of photographs. Reliability was tested using intraclass correlation coefficients (ICC(2,1)), Bland-Altman analyses and the minimal detectable change (MDC95). Concurrent validity was tested using a Pearson's correlation coefficient and Bland-Altman analysis.

RESULTS

Fifty adults participated (mean age 41.8 years; mean body mass index 24.7 kg/m(2)). The PA angle was 4.5° more varus than the HKA angle; these measures were highly correlated (r = 0.92). Intra-rater (ICC(2,1) > 0.985), inter-rater (ICC(2,1) = 0.988) and test-retest reliability (ICC(2,1) = 0.903) showed negligible bias (<0.20°). The MDC95 was 2.69°.

CONCLUSIONS

The PA angle may be used in place of the HKA angle if a bias of 4.5° is added. A difference of 3° between baseline and follow-up would be considered a true difference.

Adult burn survivors' personal experiences of rehabilitation: an integrative review

Burn rehabilitation is a lengthy process associated with physical and psychosocial problems. As a critical area in burn care, the aim was to systematically synthesise the literature focussing on personal perceptions and experiences of adult burn survivors' rehabilitation and to identify factors that influence their rehabilitation. Studies were identified through an electronic search using the databases: PubMed, CINAHL, EMBASE, Scopus, PsycINFO and Trove of peer reviewed research published between 2002 and 2012 limited to English-language research with search terms developed to reflect burn rehabilitation. From the 378 papers identified, 14 research papers met the inclusion criteria. Across all studies, there were 184 participants conducted in eight different countries. The reported mean age was 41 years with a mean total body surface area (TBSA) burn of 34% and the length of stay ranging from one day to 68 months. Significant factors identified as influential in burn rehabilitation were the impact of support, coping and acceptance, the importance of work, physical changes and limitations. This review suggests there is a necessity for appropriate knowledge and education based programmes for burn survivors with consideration given to the timing and delivery of education to facilitate the rehabilitation journey.

Getting depression clinical practice guidelines right: time for change?

OBJECTIVE

As part of a series of papers ['Chronobiology of mood disorders' Malhi & Kuiper. Acta Psychiatr Scand 2013;128(Suppl. 444):2-15; and 'It's time we managed depression: The emerging role of chronobiology' Malhi et al. Acta Psychiatr Scand 2013;128(Suppl. 444):1] examining chronobiology in the context of depression, this article examines recent western clinical practice guidelines (CPGs) for the treatment of depression with respect to the recommendations they make, in particular as regards chronobiological treatments, and briefly considers the implications of their methodology and approach.

METHOD

Five international treatment guidelines, which had been published in the past 5 years, were identified, representing North American and European views. Chosen guidelines were reviewed by the authors, and the relevant recommendations were distributed for discussion and subsequent synthesis.

RESULTS

Most current guidelines do not address chronobiology in detail. Chronotherapeutic recommendations are tentative, although agomelatine is considered as an option for major depression and bright light therapy for seasonal affective disorder. Sleep deprivation is not routinely recommended.

CONCLUSION

Recommendations are limited by the lack of reliable therapeutic markers for chronotherapeutics. Current evidence supports use of light therapy in seasonal depression, but in non-seasonal depression there is insufficient evidence to support reliance on chronotherapeutics over existing treatment modalities.

Canine breed predispositions for marked hypocobalaminaemia or decreased folate concentration assessed by a laboratory survey

OBJECTIVE

The aim of this study was to determine canine breed predispositions for decreased serum folate or markedly decreased cobalamin concentrations.

METHODS

Retrospective analysis of samples from dogs that had serum folate and cobalamin concentrations measured, from 1990 to 2002 at the Comparative Gastroenterology Laboratory of Liverpool, were enrolled. A total of 13,069 samples were analysed. Those with trypsin-like immunoreactivity < 5·0 lg/L were excluded, and only breeds with at least 30 individuals tested were further analyzed. Breed predisposition was determined by calculating odds ratios and 95% confidence intervals for hypocobalaminaemia or decreased folate concentration. Significance was tested with a two-sided Fisher's exact test, and the level of statistical significance was set at P<0·05.

RESULTS

A total of 9960 dogs fulfilled the inclusion criteria. Forty breeds contained at least 30 individuals. Predispositions for hypocobalaminaemia were identified in shar peis, Staffordshire bull terriers, German shepherd dogs and mixed breeds. Predispositions for decreased folate concentration were found in golden retrievers and boxers.

CLINICAL SIGNIFICANCE

Predisposition for marked hypocobalaminaemia and decreased folate concentration differed between breeds. The shar peis had a markedly increased odds ratio for hypocobalaminaemia, as previously reported in North America, but other at-risk breeds were also identified.

The association of depression with platelet activation: evidence for a treatment effect

BACKGROUND

Depression is associated with an increased risk of cardiovascular disease (CVD). Although the mechanism is uncertain, prothrombotic and inflammatory factors may play a role.

OBJECTIVES

As platelets play a key role in CVD, we determined first, whether depressed individuals had more activated platelets than non-depressed individuals and second, whether treatment of depression reduced platelet activation levels.

PATIENTS/METHODS

We recruited 108 depressed outpatients and 45 control subjects all without a history of CVD. After psychological assessment, the depressed patients were offered treatment with medication and/or psychotherapy. Flow cytometric markers of platelet activation and level of depression were assessed at baseline and at 4 weeks and 6 months after treatment.

RESULTS

Depression was associated with increased platelet activation with a higher number of circulating CD62p (0.76x10(9) L(-1) vs. 0.46, P=0.019) and CD63 (P=0.05) positive platelets compared with controls. Patients with depression also had more circulating platelet-leukocyte aggregates than controls (P<0.001). There was a positive correlation between the severity of depression and the level of platelet activation. Platelets from depressed patients were also hyperreactive to adenosine 5 -diphosphate (ADP) stimulation with increased CD62p and CD63 exposure (P=0.003 and 0.019, respectively). Six months of treatment resulted in a reduced number of circulating CD62p and CD63 positive platelets (29.84% and 53.38% decrease) and a 20.9% reduction in CD63 exposure after ADP activation.

CONCLUSIONS

Depression is associated with increased in vivo platelet activation and resolution of depression using psychotherapy and/or medication reduces platelet activation. These findings provide insights into the link between depression and cardiovascular risk.

Anabolic steroids in COPD: a review and preliminary results of a randomized trial

Patients with severe chronic obstructive pulmonary disease (COPD) commonly develop weight loss, muscle wasting, and consequently poor survival. Nutritional supplementation and anabolic steroids increase lean body mass, improve muscle strength, and survival in patients enrolled in comprehensive rehabilitation programs. Whether anabolic steroids are effective outside an intensive rehabilitation program is not known. We conducted a prospective, double-blind, placebo-controlled, 16-week trial to study the benefits of anabolic steroids in patients with severe COPD who did not participate in a structured rehabilitation program. Biweekly intramuscular injections of either the drug (nandrolone decanoate) or placebo were administered. Sixteen patients with severe COPD were randomized to either placebo or nandrolone decanoate. The placebo group weighed 55.32 ± 11.33 kg at baseline and 54.15 ± 10.80 kg at 16 weeks; the treatment group weighed 68.80 ± 6.58 at baseline and 67.92 ± 6.73 at 16 weeks. Lean body mass remained unchanged, 71 ± 6 vs. 71 ± 7 kg in placebo group and 67 ± 7 vs. 67 ± 7 in treatment group, at baseline and 16 weeks respectively. The distance walked on 6 min was unchanged at baseline, 8 weeks, and 16 weeks in placebo (291.17 ± 134.83, 282.42 ± 115.39, 286.00 ± 82.63 m) and treatment groups (336.13 ± 127.59, 364.83 ± 146.99, 327.00 ± 173.73 m). No improvement occurred in forced expiratory volume in one second, forced vital capacity, maximal inspiratory pressure, maximal expiratory pressure, VO2 max or 6-min walk distance or health related quality of life. Administration of anabolic steroids (nandrolone decanoate) outside a dedicated rehabilitation program did not lead to either weight gain, improvement in physiological function, or better quality of life in patients with severe COPD.

Evidence for an influence of chemokine ligand 3-like 1 (CCL3L1) gene copy number on susceptibility to rheumatoid arthritis

OBJECTIVE

There is increasing evidence that gene copy-number variation influences phenotypic variation. Chemokine ligand 3-like 1 (CCL3L1) is encoded by a variable copy-number gene, and binds to several pro-inflammatory cytokine receptors, including chemokine receptor 5 (CCR5). Considering lymphocyte recruitment by beta-chemokines is a feature of autoimmunity, and that the CCR5Delta32 variant is associated with protection to rheumatoid arthritis (RA), we hypothesised that CCL3L1 copy-number influences susceptibility to RA and type 1 diabetes (T1D).

METHODS

We measured CCL3L1 copy-number in 1136 RA cases from New Zealand (NZ) and the UK, 252 NZ T1D cases and a total of 1470 controls. All subjects were ancestrally Caucasian.

RESULTS

A copy-number higher than 2 (the most common copy number) was a risk factor for RA in the NZ cohort (odds ratio (OR) 1.34, 95% CI 1.08-1.66, p = 0.009) but not the smaller UK RA cohort (OR 1.09, 95% CI 0.75-1.60, p = 0.643). There was evidence for association in the T1D cohort (OR 1.46, 95% CI 0.98-2.20, p = 0.064) and in the combined RA/T1D cohort (OR 1.30, 95% CI 1.00-1.54, p = 0.003). Genetic interaction between CCL3L1 dosage and CCR5 genotype was found; the increased genetic risk conferred by higher CCL3L1 copy-number was ablated by a dysfunctional CCR5 (CCR5Delta32).

CONCLUSIONS

These data suggest that increased CCL3L1 expression may enhance inflammatory responses and increase the chance of autoimmune disease. Genetic interaction data were consistent with a biologically plausible model; CCR5Delta32 protects against RA and T1D by blocking signalling through the CCR5 pathway, mitigating the pro-inflammatory effects of excess CCL3L1.

Avian proteomics: advances, challenges and new technologies

Proteomics is defined as an analysis of the full complement of proteins of a cell or tissue under given conditions. Avian proteomics, or more specifically chicken proteomics, has focussed on the study of individual tissues and organs of interest to specific researchers. Researchers have looked at skeletal muscle and growth, and embryonic development and have performed initial studies in avian disease. Traditional proteomics involves identifying and cataloguing proteins in a cell and identifying relative changes in populations between two or more states, be that physiological or disease-induced states. Recent advances in proteomic technologies have included absolute quantification, proteome simplification and the ability to determine the turnover of individual proteins in a global context. This review discusses the current developments in this relatively new field, new technologies and how they may be applied to biological questions, and the challenges faced by researchers in this ever-expanding and exciting field.

Using myoelectric signal parameters to distinguish between computer workers with and without trapezius myalgia

Complaints of chronic trapezius muscle pain among computer workers have increased in prevalence during the last decade. Currently there is no clear understanding of the pathophysiological mechanisms involved in affected muscles. The major objective of this work was to determine if measurable electrophysiological differences exist between the trapezius muscles in individuals suffering from trapezius myalgia (TM) and occupation-matched pain-free control subjects. Myoelectric signal (MES) data were recorded from the upper trapezius muscle while subjects with and without myalgia performed a standardized series of postural and arm-holding tasks. MES variables reflecting muscle fatigue, muscle tension and motor control strategies were analyzed to determine their potential ability to distinguish between the two groups. One variable, RestTime, was found to be significantly different between the groups but it was not specific enough to predict group association. A multivariate logistic regression analysis yielded a model that separated the two groups with better than 70% sensitivity and 70% specificity. The variables included in the model reflect differences in trapezius muscle activity between the groups, particularly related to motor control and/or active muscle tension, but not fatigue. The model was tested using a small sample of new data, which again produced a good sensitivity (85.7%) but not specificity (42.9%). To the authors' knowledge, this is the first objective MES-based model that has successfully classified subjects with or without TM based on a simple clinical test. Further work with this model might result in understanding the pathophysiology of TM, assisting with clinical diagnosis, and testing the effect of various treatment interventions.

Haematological cancers in the breast and axilla: a drop in an ocean of breast malignancy

We have reviewed imaging findings of 32 female patients with a proven haematological malignancy in the breast and axilla presenting to two breast units over a 13-year period. Nineteen patients had screen-detected lesions, and 13 presented to symptomatic services. The most common histological diagnosis was of non-Hodgkins lymphoma. Of the 12 patients who presented with disease in the breast, six (all with primary breast lymphoma) presented with a well-defined mass on mammography. The range of radiological appearances is, however, highly variable.

8-oxo-7,8-dihydroguanine is removed by a nucleotide excision repair-like mechanism in Porphyromonas gingivalis W83

A consequence of oxidative stress is DNA damage. The survival of Porphyromonas gingivalis in the inflammatory microenvironment of the periodontal pocket requires an ability to overcome oxidative stress caused by reactive oxygen species (ROS). 8-oxo-7,8-dihydroguanine (8-oxoG) is typical of oxidative damage induced by ROS. There is no information on the presence of 8-oxoG in P. gingivalis under oxidative stress conditions or on a putative mechanism for its repair. High-pressure liquid chromatography with electrochemical detection analysis of chromosomal DNA revealed higher levels of 8-oxoG in P. gingivalis FLL92, a nonpigmented isogenic mutant, than in the wild-type strain. 8-oxoG repair activity was also increased in cell extracts from P. gingivalis FLL92 compared to those from the parent strain. Enzymatic removal of 8-oxoG was catalyzed by a nucleotide excision repair (NER)-like mechanism rather than the base excision repair (BER) observed in Escherichia coli. In addition, in comparison with other anaerobic periodontal pathogens, the removal of 8-oxoG was unique to P. gingivalis. Taken together, the increased 8-oxoG levels in P. gingivalis FLL92 could further support a role for the hemin layer as a unique mechanism in oxidative stress resistance in this organism. In addition, this is the first observation of an NER-like mechanism as the major mechanism for removal of 8-oxoG in P. gingivalis.