Pregnane X receptor knockout mitigates weight gain and hepatic metabolic dysregulation in female C57BL/6 J mice on a long-term high-fat diet

Obesity is a significant risk factor for several chronic diseases. However, pre-menopausal females are protected against high-fat diet (HFD)-induced obesity and its adverse effects. The pregnane X receptor (PXR, NR1I2), a xenobiotic-sensing nuclear receptor, promotes short-term obesity-associated liver disease only in male mice but not in females. Therefore, the current study investigated the metabolic and pathophysiological effects of a long-term 52-week HFD in female wild-type (WT) and PXR-KO mice and characterized the PXR-dependent molecular pathways involved. After 52 weeks of HFD ingestion, the body and liver weights and several markers of hepatotoxicity were significantly higher in WT mice than in their PXR-KO counterparts. The HFD-induced liver injury in WT female mice was also associated with upregulation of the hepatic mRNA levels of peroxisome proliferator-activated receptor gamma (Pparg), its target genes, fat-specific protein 27 (Fsp27), and the liver-specific Fsp27b involved in lipid accumulation, apoptosis, and inflammation. Notably, PXR-KO mice displayed elevated hepatic Cyp2a5 (anti-obesity gene), aldo-keto reductase 1b7 (Akr1b7), glutathione-S-transferase M3 (Gstm3) (antioxidant gene), and AMP-activated protein kinase (AMPK) levels, contributing to protection against long-term HFD-induced obesity and inflammation. RNA sequencing analysis revealed a general blunting of the transcriptomic response to HFD in PXR-KO compared to WT mice. Pathway enrichment analysis demonstrated enrichment by HFD for several pathways, including oxidative stress and redox pathway, cholesterol biosynthesis, and glycolysis/gluconeogenesis in WT but not PXR-KO mice. In conclusion, this study provides new insights into the molecular mechanisms by which PXR deficiency protects against long-term HFD-induced severe obesity and its adverse effects in female mice.

Utility of long-read sequencing for All of Us

The All of Us (AoU) initiative aims to sequence the genomes of over one million Americans from diverse ethnic backgrounds to improve personalized medical care. In a recent technical pilot, we compare the performance of traditional short-read sequencing with long-read sequencing in a small cohort of samples from the HapMap project and two AoU control samples representing eight datasets. Our analysis reveals substantial differences in the ability of these technologies to accurately sequence complex medically relevant genes, particularly in terms of gene coverage and pathogenic variant identification. We also consider the advantages and challenges of using low coverage sequencing to increase sample numbers in large cohort analysis. Our results show that HiFi reads produce the most accurate results for both small and large variants. Further, we present a cloud-based pipeline to optimize SNV, indel and SV calling at scale for long-reads analysis. These results lead to widespread improvements across AoU.

A randomized clinical trial evaluating the effects of administration of acidogenic boluses at dry-off on rumination and activity behavior in the 14 subsequent days

Elevated milk production at dry-off can lead to increased udder pressure and, in turn, increased stress due to pain and discomfort, affecting natural behaviors. Administering acidogenic boluses at dry-off acts by inducing temporary and mild decreases in blood pH. This decreases dry matter intake, reduces milk yield, and increases cow comfort by lessening udder pressure. The objective of this study was to assess the effect of oral administration of acidogenic boluses at dry-off on total daily activity (TDA) and total daily rumination (TDR) behaviors in the first 2 wk of the dry period. This randomized clinical trial was conducted on a single farm and cows were randomly assigned to either treatment (TRT; n = 30) or control (CON; n = 34). The TRT group received 2 acidogenic boluses at dry-off and the CON group received no intervention. All cows received dry-cow therapy (intramammary antibiotic and internal teat sealant). The TDA and TDR data from 7 d before to 14 d after dry-off were measured using ear-mounted activity monitors. Analyses were performed using linear mixed-effects models with repeated measures. We observed a similar TDA in both groups throughout the study follow-up period. Overall, cows in the TRT group spent 17 min/d less time active than cows in the CON group in the first 2 wk after dry-off with the greatest difference observed on the second day of the dry period (TRT = 395 min/d; 95% CI: 370 to 420 vs. CON = 428 min/d; 95% CI: 404 to 451). The TRT group had lower TDR in the first 24 h after bolus administration (TRT = 437 min/d; 95% CI: 414 to 461 vs. CON = 488 min/d; 95% CI: 466 to 510) when compared with the CON group, but no differences were observed when comparing both groups in the 13 subsequent days. Our results indicate that administering acidogenic boluses at dry-off slightly decreased TDA during the first 2 wk of the dry period and decreased TDR on the first day after administration.

Identification of allele-specific KIV-2 repeats and impact on Lp(a) measurements for cardiovascular disease risk

The abundance of Lp(a) protein holds significant implications for the risk of cardiovascular disease (CVD), which is directly impacted by the copy number (CN) of KIV-2, a 5.5 kbp sub-region. KIV-2 is highly polymorphic in the population and accurate analysis is challenging. In this study, we present the DRAGEN KIV-2 CN caller, which utilizes short reads. Data across 166 WGS show that the caller has high accuracy, compared to optical mapping and can further phase ~50% of the samples. We compared KIV-2 CN numbers to 24 previously postulated KIV-2 relevant SNVs, revealing that many are ineffective predictors of KIV-2 copy number. Population studies, including USA-based cohorts, showed distinct KIV-2 CN, distributions for European-, African-, and Hispanic-American populations and further underscored the limitations of SNV predictors. We demonstrate that the CN estimates correlate significantly with the available Lp(a) protein levels and that phasing is highly important.

P204 FRACTIONAL EXCRETION OF ALBUMIN DURING ACS AS A PREDICTOR OF THE VERY LONG–TERM MORTALITY AND CAUSES OF DEATH. RESULTS FROM 22 YEARS OF FOLLOW–UP OF THE ABC STUDY ON HEART DISEASE

Introduction

Several clinical risk predictors have been used to stratify risk in acute coronary syndromes (ACS) patients. Yet, few have been tested or demonstrated usefulness in the very long–term follow–up.

Purpose

To investigate the association between baseline albumin fractional excretion (AlbFE) and the long–term mortality and causes of death after ACS.

Methods

This prospective analysis included 579 patients admitted with ACS to 3 hospitals and discharged alive. Clinical and laboratory data were gathered within the first 7 days of hospitalization. Baseline AlbFE calculated as ((Serum Cr*Urine Alb) / (Serum Alb*UCr)) %, Patients were followed–up for 22 years.

Results

All except three patients completed the follow–up, and by its end 449(78%) patients were dead. Causes of death were sudden cardiac death (SCD) in 85(15%), non–sudden cardiac death (non–SCD) in 176(30%), non–cardiac death (non–CD) in 166 (29%). Baseline AlbFE median (IQR) values were: 4.1% (1.5–12.4), 1.7% (0.8–5.3), 1.3% (0.6–3.5) at 1st,3rd, and 7th hospitalization, respectively. At cox regression analysis, 3rd day AlbFE was associated to all–cause mortality: (HR = 1.4, 95%CI=1.3–1.5; p < 0.0001). It was also associated to the risk of non–SCD (HR = 1.6, 95%CI=1.4–1.7; p < 0.0001), SCD (HR = 1.3, 95%CI=1.2–1.5; p < 0.0001), and to non–CD (HR = 1.3, 95%CI=1.1–1.4; p < 0.0001). Using a cox regression model adjusted for age, gender diabetes and baseline left ventricular ejection fraction: the 3rd day AlbFE was associated to all–cause mortality (HR = 1.1, 95%CI=1.1–1.2; p < 0.0001), and to non–SCD risk (HR = 1.2, 95%CI=1.1–1.4; p < 0.0001) but not to the risk of SCD or non–CD (HR = 1.1, 95%CI=0.9–1.2; p = 0.45), and (HR = 1.1, 95% CI=1.0–1.2; p = 0.06), respectively. Same results were obtained with 1st an 7th day AlbFE values. Of relevance, a sub–analysis showed that the association between the 3rd day AlbFE and all–cause mortality kept true both in the 1st (1–11 years) and the 2nd (12–22 years) half of follow up period; (HR = 1.5, 95%CI=1.4–1.6; p < 0.0001) and (HR = 1.2, 95%CI=1.1–1.4; p = 0.001) in the unadjusted model and (HR = 1.3, 95%CI=1.2–1.4; p < 0.0001) and (HR = 1.1, 95%CI=1.0–1.3; p = 0.02) in age and gender–adjusted model for the 1st and the second half respectively.

Conclusion

The present results showed that baseline AlbFE is an independent predictor of mortality up to 22 years after ACS, chiefly for non–SCD.

P137 GEOGRAPHIC DIFFERENCES IN CANCER RISK LONG AFTER ACS. THE ABC 7–7A* STUDY ON HEART DISEASE

Background

Increased risk of cancer and cancer death has been reported in patients with Acute Coronary Syndrome (ACS). We investigated the long–term geographic differences in those risks.

Methods

In this prospective study, we enrolled 586 ACS patients admitted to hospitals in three provinces in the Veneto region of Italy. The patients were classified as residing in urban or rural areas in each province.

Results

With 3 exceptions, all patients completed the 22–year follow–up or were followed until death. Urban (46%) and rural (54%) residents shared most of their baseline demographic and clinical characteristics. Pre–existing malignancy was noted in 16 patients, whereas 106 patients developed cancer during follow–up and 99 patients died due to the malignancy. The urban/rural incidence rate of new malignancy per 1000 person–years was (9/32 in the north, 19/21 in the middle, and 18/13 in the southern province) and the urban/rural incidence rate of neoplastic death per 1000 person–years was (10/23 in the north, 16/17 in the middle, and 17/11 in the southern province). Unadjusted Cox regression analysis revealed increasing hazards ratios (HRs) for malignancy onset from urban to rural areas (HR = 3.0; 95%CI=1.5–6.2; p = 0.02). Also, we found a strong positive interaction between urban/rural areas and provinces with risk increasing from the urban to rural areas from southern to northern provinces (HR 2.1; 95% CI 1.3–3.5; p = 0.002), even with a fully adjusted model. Geographic areas, additionally, showed a strong positive interaction for the risk of cancer death, with risk increasing from the urban to rural areas from southern to northern provinces (HR = 1.9; 95%CI=1.1–3.0; p = 0.01) with the unadjusted Cox regression analysis. The fully adjusted Cox regression and Fine–Gray competing risk regression models provided similar results. We did not observe an urban/rural difference or an interaction between the geographic areas in non–neoplastic death risk.

Conclusion

This analysis reveals the significant urban/rural difference in the long–term risk of cancer onset and cancer death among unselected ACS patients. These results highlight the importance of implementing a preventive policy based on area–specific knowledge.

Development of a recombinant oncolytic poliovirus type 3 strain with altered cell tropism

Diffuse gliomas are incurable, prevalent, and aggressive central nervous system tumors. Therefore, the development of selective oncolytic viral strains for malignant neoplasms is highly relevant. This study aimed to create an oncolytic virus based on a vaccine strain of poliovirus type 3 with natural antitumor activity. To achieve this goal, we replaced the internal ribosome entry site (IRES) of poliovirus with the corresponding fragment of human rhinovirus 30. The resulting recombinant oncolytic strain RVP3 retained the serotype of poliovirus type 3, as confirmed by virus neutralization micro-test with specific antiserum. In addition, the oncolytic efficacy of RVP3 was assessed in vitro on a broad panel of cell cultures. According to the results, RVP3 has changed its tropism, losing the ability to replicate in conditionally normal cell lines of embryonic astrocytes and embryonic fibroblasts while retaining the ability to replicate in tumor cells.

Reservoir Formation Damage; Reasons and Mitigation: A Case Study of the Cambrian–Ordovician Nubian ‘C’ Sandstone Gas and Oil Reservoir from the Gulf of Suez Rift Basin

Reservoir formation damage is a major problem that the oil and gas industry has to mitigate in order to maintain the oil and gas supply. A case study is presented that identifies the impacts of formation damage and their causes in the Nubian ‘C’ hydrocarbon reservoir within Sidki field located in the Southern Gulf of Suez, Egypt. In addition, a formation damage mitigation program was designed and implemented involving an effective stimulation treatment for each well experiencing reservoir damage. The data available for this study include core analysis to provide rock mineralogy and lithology; analysis of production fluid data; water chemistry; drilling fluid composition; perforations and well completion details; workover operations; and stimulation history. The diagnosis of formation damage based on the integrated assessment of the available data is associated with several benefits, (1) The integration of the data available helps provide a robust analysis of formation damage causes and in establishing suitable remediation actions, (2) Workover fluid is confirmed as the primary cause of reservoir damage in the studied well, (3) Several reservoir damage mechanisms were identified including water blockage, solids and filtrate invasion, fluid/rock interaction (deflocculation of kaolinite clay), salinity shock and/or high-sulfate content of the invaded fluid, (4) Irrespective of the potential causes of formation damage, the primary objective of a gas production company is to mitigate its effects and the integrated dataset helps to design appropriate and effective stimulation treatments to overcome formation damage, and (5) In gas reservoirs, especially low permeability ones, extra precautions are necessary to avoid potential reservoir damage due to workover fluid invasion.

The Effect of Pentosan Polysulphate (SP54) on the Fibrinolytic Enzyme System - A Human Volunteer and Experimental Animal Study

Pentosan polysulphate causes an increase in plasminogen activator activity in plasma both after oral ingestion and after subcutaneous injection. The effect is greatest after 3 h and has disappeared by 6 h. Repeat doses by mouth over 5 days elicit a similar response. The recorded increase in activity is due largely to the release of tissue-type plasminogen activator (tPA) from the endothelium according to the antigen assay although there could be a small contribution from Factor XH-related “intrinsic” fibrinolysis induced in vitro. SP54 enhances activity ex vivo by a non-specific surface effect, and this phenomenon may contribute the increased levels of activity seen in vitro. Administration of SP54 to animals elicits a similar increase in activator activity, the intramuscular route being slightly more effective. Results with an inferior vena cava thrombosis model in the rat suggest that pentosan polysulphate may induce a thrombolytic effect.

Bioimmunoassay (BIA) of Tissue Plasminogen Activator (t-PA) and Its Specific Inhibitor (t-PA/INH)

A bioimmunoassay (BIA) for tissue plasminogen activator (t-PA) is described which depends on the binding of t-PA and its inhibitor complexes to an immobilised IgG to t-PA and the subsequent assessment of the bound t-PA using glutamic acid- plasminogen (glu-plgn) and the chromogenic substrate, S-2251. This assay indicated that neither normal plasma nor its euglobulin precipitate contain any measurable free and functionally active t-PA. The BIA was also used to measure the level of the fast acting specific t-PA inhibitor (t-PA/INH) in plasma by assessing the residual t-PA activity in the plasma euglobulin fraction (pH 5.9), following the addition of a known amount of t-PA to the plasma.

Genome-wide pleiotropy and shared biological pathways for resistance to bovine pathogens

Host genetic architecture is a major factor in resistance to pathogens and parasites. The collection and analysis of sufficient data on both disease resistance and host genetics has, however, been a major obstacle to dissection the genetics of resistance to single or multiple pathogens. A severe challenge in the estimation of heritabilities and genetic correlations from pedigree-based studies has been the confounding effects of the common environment shared among relatives which are difficult to model in pedigree analyses, especially for health traits with low incidence rates. To circumvent this problem we used genome-wide single-nucleotide polymorphism data and implemented the Genomic-Restricted Maximum Likelihood (G-REML) method to estimate the heritabilities and genetic correlations for resistance to 23 different infectious pathogens in calves and cows in populations undergoing natural pathogen challenge. Furthermore, we conducted gene-based analysis and generalized gene-set analysis to understand the biological background of resistance to infectious diseases. The results showed relatively higher heritabilities of resistance in calves than in cows and significant pleiotropy (both positive and negative) among some calf and cow resistance traits. We also found significant pleiotropy between resistance and performance in both calves and cows. Finally, we confirmed the role of the B-lymphocyte pathway as one of the most important biological pathways associated with resistance to all pathogens. These results both illustrate the potential power of these approaches to illuminate the genetics of pathogen resistance in cattle and provide foundational information for future genomic selection aimed at improving the overall production fitness of cattle.

Treatment of congenital clasped thumb in arthrogryposis

We report the result of treatment of 69 complex clasped thumbs in 39 patients with distal arthrogryposis. The mean age at surgery was 30 months. Surgical reconstruction included skin augmentation of the first web using modified dorsal rotation advancement flap (Abdel-Ghani flap), a la Carte release of tight structures of the first web, and chondrodesis of the thumb metacarpophalangeal joint. The mean follow-up was 4 years. We prefer chondrodesis because of the presence of global instability, abnormal joint structure, abnormal articular surfaces, and inefficient muscles for transfer. Also, chondrodesis shortens the thumb and may alleviate the need for release of deficient palmar skin and lengthening of a short flexor pollicis longus. The Abdel-Ghani flap provides ample skin that gives a wide rounded web. It is a simple procedure with minimal donor site morbidity. Surgical reconstruction significantly improved the cosmetic appearance and function of the thumb.

LEVEL OF EVIDENCE

IV.

A patient with pleuritic chest pain and abnormal blood clotting tests

We present the case of a 58 year old man who developed pleuritic chest while an in-patient; investigations revealed pulmonary embolism, despite a significantly raised Activated Partial Thromboplastin Time (APTT), which was subsequently attributed to Antiphospholipid syndrome (APS). The diagnosis and initial management of APS in the acute setting is discussed.

Endovascular treatment of a large venous pouch direct carotid cavernous fistula

Endovascular treatment of direct carotid cavernous fistula (CCF) can be performed by either arterial or venous approaches. The aim is to disconnect the fistula with or without preservation of the internal carotid artery (ICA). The aim of this article is to describe a technique for embolization of the cavernous sinus and the ICA in direct CCF using coils. Trapping the distal aspect of the fistula using a retrograde navigation via the vertebrobasilar system and the posterior communicating artery was performed in two cases. Clinical and radiological evolutions are described.

Rescue stenting in endovascular treatment of acutely ruptured cerebral aneurysms

Thromboembolic events and major artery occlusion following cerebral aneurysm coiling may lead to serious complications and even death if not treated. The use of an intracranial stent in the setting of subarachnoid hemorrhage (SAH) is risky due to the need for antiplatelet therapy. However in some conditions it could be an effective solution for this major problem. This study describes a revascularization technique using a Solitaire stent for treatment of anterior cerebral artery (ACA) occlusion following coiling of anterior communicating artery (Acom) aneurysms. Three cases of ruptured Acom aneurysms treated during the course of SAH underwent unplanned deployment of an intracranial stent. Complete occlusion of the ACA at the origin of the A2 segment developed during or shortly after coiling. Emergent CT brain scan was done in two cases to exclude rebleeding. Follow-up CT or MRI scans were performed 24 hours after stenting. Technical success was achieved in all cases. Complete revascularization of the Acom was achieved post stent deployment (TIMI grade 3). Time from onset of symptoms to full revascularization in the three cases was 35 minutes, one hour 50 minutes and two hours 40 minutes respectively. No intracranial bleeding occurred in any case following the procedure. No neurological changes occurred in case 1; mild neurological and radiological changes occurred in cases 2 and 3. Deployment of an intracranial stent achieved complete revascularization of the occluded Acom. Its use in a context of SAH is relatively risky but the technique resulted in a significant improvement of symptoms following flow restoration and probably helped prevent symptoms worsening, major disability or even death. A study on a larger patient sample with long-term follow-up will be of value.