The Role of MECP2 and CCR5 Polymorphisms on the Development and Course of Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is a chronic and systemic autoimmune disease. SLE is described by production of autoantibodies and causes damage of many organs. T-cells play a crucial role in SLE pathogenesis. T-cells intensify inflammation through a number of processes, which leads to autoimmunization. CCR5 and MECP2 genes are linked with T-cells and pathogenesis of SLE. Polymorphisms in these genes are related with the prognostic factors of risk of disease onset and disease severity. The aim of this study was to estimate the influence of polymorphisms in MECP2 and CCR5 genes on the development and course of systemic lupus erythematosus. We examined 137 SLE patients and 604 healthy controls. We studied polymorphisms for CCR5 gene: rs333 and for MECP2: rs2075596, rs1734787, rs17435, and rs2239464. We genotyped our MECP2 samples and we performed a restriction fragment length polymorphism (RFLP) analysis for CCR5 samples. We showed a risk factor for allele T in rs17435 and for allele A in rs2075596 in MECP2. We noticed that MECP2 rs2075596 G/A, rs1734787 C/A, rs17435 A/T, and rs2239464 G/A polymorphisms are more prevalent in SLE patients than in healthy controls. We believe that above-mentioned MECP2 polymorphisms can be considered as SLE susceptibility factor.

Assessment of tumour hypoxia, proliferation and glucose metabolism in head and neck cancer before and during treatment

OBJECTIVE

The aim of the study was to assess the feasibility of multitracer positron emission tomography (PET) imaging before and during chemoradiation and to evaluate the predictive value of image-based factors for outcome in locally advanced head and neck cancers treated with chemoradiation.

METHODS

In the week prior to the treatment [¹⁸F]-2-flu-2-deoxy-D-glucose (FDG), [¹⁸F]-3'-flu-3'deoxythymidine (FLT) and [¹⁸F]-flumisonidazole (FMISO) imaging was performed. FLT scans were repeated at 14 and 28 Gy and FMISO at 36 Gy. Overall survival, disease-free survival and local control were correlated with subvolume parameters, and with tumour-to-muscle ratio for FMISO. For every tracer, total metabolic tumour volume was calculated.

RESULTS

33 patients were included. No correlation was found between pre-treatment maximum standardised uptake value for FDG, FLT, FMISO and outcomes. Tumour volume measured on initial CT scans and initial FLT volume correlated with disease-free survivall (p = 0.007 and 0.04 respectively). FDG and FLT metabolic tumour volumes correlated significantly with local control (p = 0.005 and 0.02 respectively). In multivariate Cox analysis only individual initial TMRmax correlated with overall survival.

CONCLUSION

PET/CT imaging is a promising tool. However, various aspects of image analysis need further clinical validation in larger multicentre study employing uniform imaging protocol and standardisation, especially for hypoxia tracer.

ADVANCES IN KNOWLEDGE

Monitoring of biological features of the tumour using multitracer PET modality seems to be a feasible option in daily clinical practice.Evaluation of hypoxic subvolumes is more patient dependent; thus, exploration of individual parameters of hypoxia is needed. tumour-to-muscle ratio seems to be the most promising so far.

1028 Early response to a low- dose acubitril/valsartan (ARNI) therapy among stable symptomatic patients with HFrEF

Funding Acknowledgements

no financial support

Background

Sacubitril/valsartan (S/V) has shown to improve outcomes, that is related to reverse remodeling of the left ventricle (LV) with improved ejection fraction (LVEF) and mitral regurgitation (MR) during long-term therapy. There are limited data on early effects of S/V treatment with respect to the left ventricle function and echocardiographic evaluation of this phenomenon.

Aim of the study was to evaluate the early effect of a starting-dose of S/V administered in patients (pts) with stable symptoms of heart failure on clinical symptoms, laboratory tests and echocardiographic parameters using global longitudinal strain (GLS) as a sensitive parameter detecting improvement of LV function.

Methods

Twenty pts (mean age 60 years, 2 female), with HFrEF (NYHA class II-III) on optimal medical treatment with ICM (75%) or NICM (35%) were included to low-dose S/V treatment (24/26mg) after excluding contraindications. Clinical and echocardiographic evaluation was performed at baseline and after 30 days. The following parameters have been measured: 6-Minutes Walking Test (6MWT) and Minnesota Living with Heart Failure questionnaire, laboratory results and echocardiographic assessment with speckle tracking technique (STE).

Results

All pts completed 30 days treatment period without complications and no change to medication. During this period the mean values of RR decreased significantly (SBP 129,4mmHg vs 121,25mmHg and DBP 81,6mmHg vs 79,2mmHg respectively). Other clinical parameters did not change. There were no differences NT-pro BNP and TNT levels (respectively 1726 vs 1930 pg/ml and 26 vs 22 ng/ml). After 30days, the mean 6MWT distance increased by 50m (349,5 vs 401,5m p < 0.01), and a positive response was observed in Minnesota Living with Heart Failure Questionnaire (p < 0.001). Echocardiographic parameters revealed positive remodeling of LV and left atrium (LA). There was a significant improvement in LVEDd (67,9mm vs 64,9mm, p < 0.01), LVESd (61,6mm vs 58,8mm, p < 0.01) and stroke volume (40,5 to 45,8ml, p < 0.01). There was no significant increase in LVEF (30% vs 31,5%, p = 0.052). The diastolic parameters of LV function didn’t change during the study. The LA volumes significantly decreased (110 vs 92ml, p < 0.01) during the treatment period as well as the degree of MR (ERO 0.51 vs 0,37 p < 0.01). Out of several LV deformation parameters, only global longitudinal strain has changed significantly (GLS-6,1% vs -7,0%, p = 0,02). The improvement in symptoms and 6MWT correlated only with global systolic radial (RS) and longitudinal (GLS) strain correlated positively after 30 days treatment. Conclusion:Thirty days treatment with low-dose S/V in stable, symptomatic HFrEF patients leads to symptomatic and clinical improvement which correlates with positive remodeling of the left ventricle and reduces the degree of mitral regurgitation. The GLS is a sensitive indicator of LV function improvement after short time S/V treatment and may be used to assess early response.

P310 The role of the left ventricle deformation parameters determining reverse remodeling due to six months of spironolactone therapy

Introduction

Spironolactone is widely used in the pharmacotherapy of patients (pts) with HFrEF. However, there is still little information on the influence of spironolactone therapy on the global and regional left ventricular (LV) function.

Aim

Evaluation of the influence of regional deformation parameters on global LV systolic function as a result of six months of spironolactone therapy.

Methods

The study included 39 pts (mean age 64 years, with stable heart failure; NYHA class II-III, mean LVEF 37,4%, mean wall motion index score, WMSI 1,62). All pts received optimal standard treatment before entering the study. Then therapy of spironolactone 25mg daily was introduced. Clinical status, treadmill exercise test (compilation time and effort level), NT-pro-BNP and speckle tracking echocardiography (STE) assessment were analyzed. Two groups were created according to LV reverse remodeling (PRR -responders, 10% increase in LVEF and/or 15% decrease in LVESV; NRR- nonresponders). Differences between NRR I PRR, at the start point and after six months therapy of spironolactone for the above-mentioned parameters, were analyzed.

Results

Reverse remodeling was observed in 21 pts (PRR). There were no differences between PRR I NRR in: exercise test on the treadmill (compilation parameters: 27,86 vs 29,41), NYHA class, Nt-pro BNP levels (1071 vs 1172 pg/ml). WMSI in both groups was similar (respectively: 1,62 vs 1,61), however akinetic region in apical and septal regions of LV in NRR were more often represented (NRR 91,6% vs PRR 35% pts). PRR showed significantly better improvement of peak systolic longitudinal (LS) and circumferential (CS) strain in the apical (AP) and LV septal region of LV (SEP) depending on the post-infarction condition. (table 1)

Conclusions

Improvement of left ventricle systolic function depends on the regional contractility status of the myocardium. Longitudinal (LS) and circumferential (CS) peak systolic strain, regardless of ejection fraction and WMSI are the sensitive parameters determining improvements of the LV systolic function. The study showed that cut-off values to predict reverse LV remodeling must be lower than -10.08% for CS and -11.55% for LS.

Tab.1. CS nad LS value at the end point Region of LV NRR mean strain % PRR mean strain% p value (NRRvs PRR) CS AP -11,42 -15,47 0.03 CS SEP -12,3 -17,04 0.02 LV 3CH -13,42 -16,30 0.04 CA AP-circumferential strain in apical LV region, CS SEP- circumferential strain in septal LV region, LV 3CH- longitudinal strain in three-chamber view of LV

Which positive factors give general practitioners job satisfaction and make general practice a rewarding career? A European multicentric qualitative research by the European general practice research network

BACKGROUND

General Practice (GP) seems to be perceived as less attractive throughout Europe. Most of the policies on the subject focused on negative factors. An EGPRN research team from eight participating countries was created in order to clarify the positive factors involved in appeals and retention in GP throughout Europe. The objective was to explore the positive factors supporting the satisfaction of General Practitioners (GPs) in clinical practice throughout Europe.

METHOD

Qualitative study, employing face-to-face interviews and focus groups using a phenomenological approach. The setting was primary care in eight European countries: France, Belgium, Germany, Slovenia, Bulgaria, Finland, Poland and Israel. A thematic qualitative analysis was performed following the process described by Braun and Clarke. Codebooks were generated in each country. After translation and back translation of these codebooks, the team clarified and compared the codes and constructed one international codebook used for further coding.

RESULTS

A purposive sample of 183 GPs, providing primary care to patients in their daily clinical practice, was interviewed across eight countries. The international codebook included 31 interpretative codes and six themes. Five positive themes were common among all the countries involved across Europe: the GP as a person, special skills needed in practice, doctor-patient relationship, freedom in the practice and supportive factors for work-life balance. One theme was not found in Poland or Slovenia: teaching and learning.

CONCLUSION

This study identified positive factors which give GPs job satisfaction in their clinical practice. This description focused on the human needs of a GP. They need to have freedom to choose their working environment and to organize their practice to suit themselves. In addition, they need to have access to professional education so they can develop specific skills for General Practice, and also strengthen doctor-patient relationships. Stakeholders should consider these factors when seeking to increase the GP workforce.

One consensual depression diagnosis tool to serve many countries: a challenge! A RAND/UCLA methodology

OBJECTIVE

From a systematic literature review (SLR), it became clear that a consensually validated tool was needed by European General Practitioner (GP) researchers in order to allow multi-centred collaborative research, in daily practice, throughout Europe. Which diagnostic tool for depression, validated against psychiatric examination according to the DSM, would GPs select as the best for use in clinical research, taking into account the combination of effectiveness, reliability and ergonomics? A RAND/UCLA, which combines the qualities of the Delphi process and of the nominal group, was used. GP researchers from different European countries were selected. The SLR extracted tools were validated against the DSM. The Youden index was used as an effectiveness criterion and Cronbach's alpha as a reliability criterion. Ergonomics data were extracted from the literature. Ergonomics were tested face-to-face.

RESULTS

The SLR extracted 7 tools. Two instruments were considered sufficiently effective and reliable for use: the Hospital Anxiety and Depression Scale and the Hopkins Symptoms Checklist-25 (HSCL-25). After testing face-to-face, HSCL-25 was selected. A multicultural consensus on one diagnostic tool for depression was obtained for the HSCL-25. This tool will provide the opportunity to select homogeneous populations for European collaborative research in daily practice.

Circadian rhythms of melatonin and cortisol in manifest Huntington's disease and in acute cortical ischemic stroke

Recent studies indicate disruptions to the circadian system in brain injury and neurodegeneration. The results, however, are often not consistent and limited by measurement of only one circadian marker and by infrequent sampling rates. In this study, we examined diurnal rhythmicity in different stages of Huntington (HD) disease and in patients with acute moderate ischemic stroke (AIS) outside the retinohypothalamic pathway by evaluating serum concentrations of melatonin and cortisol at twelve timepoints. All study participants were subjected to the same study protocol of 12-hour light/dark cycle and controlled room conditions. Using cosinor analysis of data and comparing the results with the controls we found melatonin phase delay with lowered amplitude and mesor in stage III HD patients. These changes coexisted with phase advanced rhythm and elevated values of mesor and amplitude for cortisol. Early and mid-stages of HD showed only a phase advance in cortisol secretion. In AIS the circadian rhythm of serum melatonin was sustained without any phase shift and exhibited more flattened profile (lowered mesor and amplitude values), while advanced rhythm with higher mesor for cortisol was present. In conclusion, 1) abnormal pattern of melatonin release in the late stages of HD and in moderate AIS occurs in conjunction with phase-advanced rhythm of cortisol; 2) changes observed in late stages of HD are similar to those that occur with ageing; 3) brain regions other than the presumptive retinopineal neural pathway may play an important role in the pineal production of melatonin in humans; 4) lesion in extrahypothalamic region is related to the strong adrenal stimulation in response to AIS.

FLT-1 gene polymorphisms and protein expression profile in rheumatoid arthritis

OBJECTIVES

Inflammation and angiogenesis are a significant element of pathogenesis in rheumatoid arthritis (RA). The FLT-1- triggering factor for production of proinflammatory cytokines-might contributes to inflammation in patients with RA. Association of the FLT-1 polymorphisms with different "angiogenic diseases" suggests that it may be a novel genetic risk factor also for RA. The aim of the study was to identify FLT-1 genetic variants and their possible association with sFLT-1 levels, susceptibility to and severity of RA.

METHODS

The FLT-1 gene polymorphisms were genotyped for 471 RA patients and 684 healthy individuals. Correlation analysis was performed with clinical parameters, cardiovascular disease (CVD) and anti-citrullinated peptide/protein antibody (ACPA) presence. The sFLT-1 serum levels were evaluated.

RESULTS

The FLT-1 gene polymorphisms showed no significant differences in the proportion of cases and controls. Furthermore, the FLT-1 rs2296188 T/C polymorphism was associated with ACPA-positive RA. Overall, rs9943922 T/C and rs2296283 G/A are in almost completed linkage disequilibrium (LD) with D' = 0.97 and r2 = 0.83. The FLT-1 rs7324510 A allele has shown association with VAS score (p = 0.035), DAS-28 score (p = 0.013) and ExRA presence (p = 0.027). Moreover, other clinical parameters were also higher in RA patients with this allele. In addition, FLT-1 genetic variants conferred higher sFLT-1 levels in RA patients compared to controls.

CONCLUSION

FLT-1 rs7324510 C/A variant may be a new genetic risk factor for severity of RA. Examined factor highly predispose to more severe disease activity as well as higher sFLT-1 levels in RA.

Genetic Variants in IL-12B and IL-27 in the Polish Patients with Systemic Lupus Erythematosus

To investigate the potential association between IL-12B and IL-27 gene polymorphisms and systemic lupus erythematosus (SLE), we performed a case-control study based on the Polish population. Patients with SLE and healthy individuals were examined for -6415 CTCTAA/GC (rs17860508) and +1188A/C (rs3212227) in IL-12B and -924A/G (rs153109) and 4730T/C (rs181206) in IL-27 gene polymorphisms using the high-resolution melting method, PCR-RFLP method and TaqMan SNP genotyping assay, respectively. An increased frequency of GC/GC genotype as well as GC allele of the IL-12B rs17860508 was found in patients with SLE, as compared with healthy subjects (P < 0.001). We did not find differences in genotype and allele frequencies of the IL-12B rs3212227 and IL-27 rs153109 and rs181206 variants between patients with SLE and controls. IL-27 haplotype rs181206C/rs153109G indicated higher risk for SLE (P = 0.002), whereas haplotype rs181206T/rs153109G indicated reduced risk for SLE (P = 0.005). The IL-12B rs3212227 A/C polymorphism was associated with the mean value of the platelets (PLT), urea and complement C3 level. Furthermore, IL-12B rs17860508 genetic variant showed correlation with PLT, prothrombin time, international normalized ratio and alkaline phosphatase. Our results revealed that IL-12B rs17860508 and IL-27 haplotype CG are genetic risk factors for SLE and that both IL-12B rs17860508 and rs3212227 predict disease phenotype.

Which positive factors determine the GP satisfaction in clinical practice? A systematic literature review

Background

Looking at what makes General Practitioners (GPs) happy in their profession, may be important in increasing the GP workforce in the future. The European General Practice Research Network (EGPRN) created a research team (eight national groups) in order to clarify the factors involved in GP job satisfaction throughout Europe. The first step of this study was a literature review to explore how the satisfaction of GPs had been studied before. The research question was “Which factors are related to GP satisfaction in Clinical Practice?”

Methods

Systematic literature review according to the PRISMA statement. The databases searched were Pubmed, Embase and Cochrane. All articles were identified, screened and included by two separate research teams, according to inclusion or exclusion criteria. Then, a qualitative appraisal was undertaken. Next, a thematic analysis process was undertaken to capture any issue relevant to the research question.

Results

The number of records screened was 458. One hundred four were eligible. Finally, 17 articles were included. The data revealed 13 subthemes, which were grouped into three major themes for GP satisfaction. First there were general profession-related themes, applicable to many professions. A second group of issues related specifically to a GP setting. Finally, a third group was related to professional life and personal issues.

Conclusions

A number of factors leading to GP job satisfaction, exist in literature They should be used by policy makers within Europe to increase the GP workforce. The research team needs to undertake qualitative studies to confirm or enhance those results.

Electronic supplementary material

The online version of this article (doi:10.1186/s12875-016-0524-x) contains supplementary material, which is available to authorized users.

What research agenda could be generated from the European General Practice Research Network concept of Multimorbidity in Family Practice?

Background

Multimorbidity is an intuitively appealing, yet challenging, concept for Family Medicine (FM). An EGPRN working group has published a comprehensive definition of the concept based on a systematic review of the literature which is closely linked to patient complexity and to the biopsychosocial model. This concept was identified by European Family Physicians (FPs) throughout Europe using 13 qualitative surveys. To further our understanding of the issues around multimorbidity, we needed to do innovative research to clarify this concept. The research question for this survey was: what research agenda could be generated for Family Medicine from the EGPRN concept of Multimorbidity?

Methods

Nominal group design with a purposive panel of experts in the field of multimorbidity. The nominal group worked through four phases: ideas generation phase, ideas recording phase, evaluation and analysis phase and a prioritization phase.

Results

Fifteen international experts participated. A research agenda was established, featuring 6 topics and 11 themes with their corresponding study designs. The highest priorities were given to the following topics: measuring multimorbidity and the impact of multimorbidity. In addition the experts stressed that the concept should be simplified. This would be best achieved by working in reverse: starting with the outcomes and working back to find the useful variables within the concept.

Conclusion

The highest priority for future research on multimorbidity should be given to measuring multimorbidity and to simplifying the EGPRN model, using a pragmatic approach to determine the useful variables within the concept from its outcomes.

Evaluation of deciduous-tooth wear in children living in the middle ages

PURPOSE

To investigate the importance and range of tooth wear in deciduous teeth from the 14th century based on the examination of child skeletons from the Cedynia cemetery in Poland. As mechanical wear was widespread in early human populations, this study recorded symptoms of attrition and abrasion (facets and scoops), relating them to possible causative factors.

MATERIALS AND METHODS

The study material comprised 84 child skulls (458 teeth) categorised into two age groups: 1. up to 7 years; 2. from 8 to 14 years. The degree of tooth wear was determined on the basis of a modified Smith and Knight's classification. Significant differences between examined features were determined by the chi-square and Fisher Freeman Halton non-parametric tests with the significance level set al p < 0.05.

RESULTS

Statistically significant differences between age groups in the canines and molars were found (p < 0.05). More advanced wear of deciduous teeth was noticed in the older group. There was no difference in distribution of tooth wear between the maxilla and the mandible.

CONCLUSION

Examination of children's dentition showed that wear of deciduous teeth rose with the age of individuals, which agrees with the referenced literature data. This study confirms the relationship between dietary patterns and tooth wear and corroborates a role of tooth wear in determining developmental age and growth of the masticatory system.

Impairment of antioxidant defenses as a contributor to arsenite-induced cell transformation

Arsenite (As) causes transformation of human osteogenic sarcoma cells (HOS) when applied continuously at low doses (0.1-0.5 μM) during 8-weeks of exposure. However, the mechanisms by which As transforms human cells are not known. We investigated whether alterations occurred in gene expression and protein levels of antioxidant defense proteins, such as superoxide dismutase 1 (SOD1) and ferritin. In comparison to control HOS cells, 0.1 μM As induced greater cell proliferation and decreased anti-oxidant defenses. The tumor suppressor protein p53 was also decreased at both mRNA and protein levels. Further, pig3 (p53-induced-gene 3), a homolog of NQO1 (NADPH quinone oxidoreductase 1), was also down-regulated after 8 weeks of As challenge. The treatment of HOS cells with dicumarol, a NQO1 inhibitor, caused a dose-dependent decline in p53 protein levels, proving the effect of an antioxidant enzyme on p53 expression and, potentially, down-stream processes. Caffeic acid phenethyl ester, an antioxidant, prevented the As-induced decreases in SOD1, p53, and ferritin mRNA and protein levels. SOD1, p53 and ferritin levels were inversely related to As-induced cell proliferation. Cumulatively, these results strongly suggest that impairment in antioxidant defenses contributes to As-induced human cell transformation and that the p53 pathway is involved in the process.

Microstructure and biocompatibility of titanium oxides produced on nitrided surface layer under glow discharge conditions

The disadvantages of titanium implants are their low wear resistance and the release of titanium elements into surrounding tissue. These can be eliminated by modifying the surface by surface engineering methods, among them nitriding under glow discharge conditions which allow to produce diffusive surface layers. Their combining with an oxide layer might be valuable for biological events occurring at the bone implant interface. The aim of this study was to enhance the titanium biomaterial performance via combining nitriding and oxidizing treatments in one process under glow discharge conditions. The oxynitrided surface layers were produced at 680 degrees C. The obtained layer was TiO + TiN + Ti2N + alphaTi(N) type and about 4-microm thick and was of diffusive character. This layer significantly increased wear resistance and slightly corrosion resistance compared to that of the reference titanium alloy. The produced titanium oxide was about 400-nm thick and built from fine crystallites. This oxide exhibits bioactivity in SBF (simulated body fluid). Osteoblasts of Saos-2 line incubated on this surface exhibited good adhesion and proliferation and ALP release comparable with cells cultured on the reference titanium alloy and TiN + Ti2N + alphaTi(N) surface layers. A quantitative analysis of blood platelets adhering to this layer revealed their highest amount in comparison to that on both the nitrided surface layer and titanium alloy. The presented study provided a simple and reproducible method of combining oxidizing and nitriding under glow discharge in one process. Experimental data in vitro suggests that titanium alloy oxynitriding under low temperatures at glow discharge conditions improves titanium alloy properties and biocompatibility and tissue healing. Therefore, the layer of TiO + TiN +Ti2N + alphaTi(N) type could be valuable for long-term bone implants.