Exploring the Relationship between Mediterranean Diet Adherence and Subjective Well-Being among Greek and Cypriot Adults

Associations between subjective well-being (SWB) and dietary habits, employment status, and habitual activities are increasingly capturing the focus of researchers as well as policymakers worldwide. This study aimed to explore these associations in a sample of the population in Greece and Cyprus via an online survey. In total, 936 questionnaires (470: Cyprus, 466: Greece) were analyzed to study the associations between the Mediterranean Diet (MD) (using the 14-item MEDAS score, (14-MEDAS)), subjective well-being (SWB), and several socioeconomic factors. Key remarks of this survey highlight the positive impact of MD adherence on some well-being items. Namely, statistically significant differences were found on the following items: Satisfied with life (p < 0.001), Life worthwhile (p < 0.001), Feeling happy (p < 0.001), worried (p = 0.005), and depressed (p = 0.001), when comparing Low MD adherence (14-MEDAS < 5) to High MD adherence (14-MEDAS > 10). Other lifestyle habits such as spending time with friends and family, spending time in nature, and habitual physical activity were associated with aspects of SWB such as Life satisfaction, Life worthwhile, Feeling happy, and energetic. The findings support adherence to the MD, since it is associated with higher life satisfaction and self-reported happiness in this sample and should be considered when developing health policies on well-being.

Sweet Basil between the Soul and the Table-Transformation of Traditional Knowledge on Ocimum basilicum L. in Bulgaria

The study tracks the utilization of Ocimum basilicum L. (sweet basil)-a garden plant popular for its ritual and ornamental value in the past, that is currently applied in various forms and ways as medicine, food, insect repellent, etc.-in Bulgaria. Previous data for Bulgarian rural home gardens showed a significant number of preserved local landraces; however, it remained unclear how people perceive the large varietal diversity of this species and how the traditions related to its use are preserved. We combined a literature review on the cultural value of sweet basil and the breeding of local genetic resources with an online questionnaire, directed to adult laypeople, that sought to access different aspects of past (recalled) and present use and related knowledge. The identification skills of the participants were tested using images of local plant landraces and foreign varieties. Responses from 220 participants showed that potted "Genovese"-type individual was most frequently identified as sweet basil (89.9%), followed by two examples of local landraces in flower. Participants who grow sweet basil or used it in more varied ways had significantly better identification skills. Ocimum basilicum was most frequently reported as food, while ritual/symbolic use was preserved while devalued during the Communism regime (1945-1989). Food and religious uses were negatively associated in the past, but presently, the tendency is completely reversed. Preferences for the informal exchange of seeds and seed-saving practices were discussed.

Hypomorphic RAG deficiency: impact of disease burden on survival and thymic recovery argues for early diagnosis and HSCT

Patients with hypomorphic mutations in the RAG1 or RAG2 gene present with either Omenn syndrome or atypical combined immunodeficiency with a wide phenotypic range. Hematopoietic stem cell transplantation (HSCT) is potentially curative, but data are scarce. We report on a worldwide cohort of 60 patients with hypomorphic RAG variants who underwent HSCT, 78% of whom experienced infections (29% active at HSCT), 72% had autoimmunity, and 18% had granulomas pretransplant. These complications are frequently associated with organ damage. Eight individuals (13%) were diagnosed by newborn screening or family history. HSCT was performed at a median of 3.4 years (range 0.3-42.9 years) from matched unrelated donors, matched sibling or matched family donors, or mismatched donors in 48%, 22%, and 30% of the patients, respectively. Grafts were T-cell depleted in 15 cases (25%). Overall survival at 1 and 4 years was 77.5% and 67.5% (median follow-up of 39 months). Infection was the main cause of death. In univariable analysis, active infection, organ damage pre-HSCT, T-cell depletion of the graft, and transplant from a mismatched family donor were predictive of worse outcome, whereas organ damage and T-cell depletion remained significant in multivariable analysis (hazard ratio [HR] = 6.01, HR = 8.46, respectively). All patients diagnosed by newborn screening or family history survived. Cumulative incidences of acute and chronic graft-versus-host disease were 35% and 22%, respectively. Cumulative incidences of new-onset autoimmunity was 15%. Immune reconstitution, particularly recovery of naïve CD4+ T cells, was faster and more robust in patients transplanted before 3.5 years of age, and without organ damage. These findings support the indication for early transplantation.

Risk factors and outcomes associated with type of uterine rupture

PURPOSE

To identify risk factors associated with the occurrence of complete uterine rupture (CUR) in comparison to partial uterine rupture (PUR) to further investigate to what extent a standardized definition is needed and what clinical implications can be drawn.

METHODS

Between 2005 and 2017 cases with CUR and PUR at Charité University Berlin, Germany were retrospectively identified. Demographic, obstetric and outcome variables were analyzed regarding the type of rupture. Binary multivariate regression analysis was conducted to identify risk factors associated with CUR. In addition, the intended route of delivery (trial of labor after cesarean delivery (TOLAC) and elective repeat cesarean delivery (ERCD)), divided according to the type of rupture, was compared.

RESULTS

92 cases with uterine rupture were identified out of a total of 64.063 births (0.14%). Puerperal complications were more frequent in CUR (67.9 versus 41.1%, p = 0.021). Multiparity ≥ 3 was more frequent in CUR (31 versus 10.7%, p = 0.020). Factors increasing the risk for CUR were parity ≥ 3 (OR = 3.8, p = 0.025), previous vaginal birth (OR = 4.4, p = 0.011), TOLAC (OR = 6.5, p < 0.001) and the use of oxytocin (OR = 2.9, p = 0.036). After multivariate analysis, the only independent risk factor associated with CUR was TOLAC (OR = 7.4, p = 0.017).

CONCLUSION

TOLAC is the only independent risk factor for CUR. After optimized antenatal counselling TOLAC and ERCD had comparable short-term maternal and fetal outcomes in a high resource setting. A high number of previous vaginal births does not eliminate the risk of uterine rupture. A clear distinction between CUR and PUR is essential to ensure comparability among studies.

Enough to Feed Ourselves!-Food Plants in Bulgarian Rural Home Gardens

The home garden is a unique human-nature interspace that accommodates a diverse spectrum of plant species and provides multiple services to households. One of the most important roles of home gardens is to shelter the agricultural plant diversity that provides for diverse and healthy nutrition, especially in rural communities. While tropical home gardens have received wide recognition due to their provisional function for the local communities, temperate and especially European home gardens have been discussed less frequently as a source of subsistence. The main objectives of the current study were to document plant species grown in Bulgarian rural home gardens and to explore related local knowledge and cultural practices that influence food plant diversity, its selection and preservation. Field work was focused on settlements situated in eight provinces in South and North-West Bulgaria. Participants representing 65 home gardens were approached through semi-structured interviews. Home gardens were found to harbor 145 cultivated and semi-cultivated plant taxa, used as food, medicinal and aromatic plants and as animal fodder. Members of the Rosaceae family were most numerous. The largest part of the garden area was occupied by vegetable crops of Solanaceae and Cucurbitaceae. In 63.1% of the studied households, the food growing area comprised more than 2/3 of the total size of the garden. Most preferred crops reflected the social and cultural importance of food self-provisioning, especially in the rural areas. The provisional role of the home gardens in regard to preparation of traditional foods and the driving forces for seed saving are discussed.

Impact of COVID-19 on gynaecological patient care: results of patient's survey with 327 patients

Purpose

The pandemic SARS-CoV-2 poses new and unprecedented challenges for health care systems on a national and global level. Although the current situation has been going on for more than 1 year, there is limited data on the impact of the pandemic on general hospital and medical practice care. This survey captures the perspective of patients with gynaecological diseases of this impact.

Methods

Using a paper-based questionnaire, 327 patients were asked about medical care and their experiences during the pandemic at the University Hospital Bonn and the University Hospital Charité Berlin. The study was performed from the 1st June to 30th September 2020.

Results

A total of 327 patients participated in the study: 156 stated to have been tested for coronavirus, and 1 patient reported a positive test. 41.3% of the patients felt insecure about the current situation, 30.4% were concerned about the risk of infection during the hospital stay. The pandemic-specific measures in hospitals and medical practices unsettled 6.8% of patients. 18.1% of patients feared that their gynaecological disease would not be treated adequately due to the pandemic. 55.7% of patients reported that their confidence in their physicians has increased during the pandemic.

Conclusion

The results show that patients’ confidence in the healthcare system and the physicians acting significantly increased during the COVID-19 crisis. Transparent and comprehensive information policy regarding actions and restrictions within the COVID-19 crisis eases patients concerns and improves patients’ confidence in their physicians, which is crucial for a successful treatment’s outcome.

The women in situation of gaslighting – risk identification in the work environment

Background

As a contemporary form of “workplace harassment' (WH) is reported gaslighting. Preston Ni, defines it as ‘A form of constant manipulation and brainwashing…' The phenomenon is presented as mainly affecting the woman in the workplace. The aim of the study is to determine and identify the risk of subjecting a woman in the workplace in Bulgaria to this form of psychological pressure gaslighting, in favor of building a risk reduction program cause.

Methods

Empirical sociological research (ESR) among working women for period of 10 years in Sofia (around 2 million citizens), Bulgaria. An anonymous survey of 2,000 working women between the ages of 30 and 65 was conducted. The questionnaire of the respondents with only more than 5 years of work experience are included.

Results

Of the surveyed 25% are between 30-40 years, about 47% are 41-50 years, about 25% are 51-60 years and about 3% are 61-65 years. The result of the study indicates that mostly women between 41 and 50 years are subjected to psychological pressure by a man at work (about 45%), about 15% - are 51-60 years, only about 5% of women 31-40 years, and less 2% over 61. All of them are described as introverted. Mostly women with a high level of education have remained mentally resistant to gaslighting - about 35% of respondents, and less than 5% of them have shown higher creativity against the background of psychological pressure. In almost 1/3 of those subjected to prolonged mental harassment, were diagnosed for the first time, including: Hashimoto's thyroiditis (5%); arterial hypertension (about 10%); ischemic disease (about 15%). Half of them are presented with depression.

Conclusions

Gaslighting is a hidden psychological violence against a female person based on hate speech and demonstration of power. Gaslighting is defined as a real risk among women, mostly of the introverted type. Emotional plasticity based on knowledge and smart has a positive effect in situation of gaslighting.

Key messages

Gaslighting can lead to lack of confidence, clinical depression, distress and related physical illnesses. Early risk detection provides advantages for early reduction and optimization of the corporate culture of the department and the institution and in favor of building a risk reduction program.

Workplace mobbing and organizational intelligence - healthcare risk management in a crisis

Issue

Mobbing is the old syndrome of the new age. A phenomenon of invisible systemic group pressure on a selected dissident victim and a visible harassment that sticks strongly in a crisis. A victim with a strong character, a person competent and leadership skills to a degree that exceeds another placed leader, as an expression of his fear and frustration. The presence of mobbing is always an expression of a bad organizational culture. The opportunities for risk reduction are based in the creation of a highly effective, tactical-strategic flexibility and creative program of control, mediation and modeling of the risk factors leading to mobbing.

Description of the problem

A particularly interesting scene for the manifestation of mobbing is the academic environment. The manifestation of mobbing leads to serious losses, social isolation and has health consequences on the attacked and subjected to emotional pressure member of the team. A creative scientist and charismatic teacher, a wonderful and eroded specialist does not go unnoticed by the more mediocre. Circles are formed with different scope and degrees of trust in the initiator of the mobbing, who generates and manages directly several with the role of accomplices and indirectly dozens to hundreds of cowardly and sufficiently obedient performers.

Results

Basic human rights are violated and the organizational culture of the institution is compromised through mobbing. A process of a cyclical nature in which only the victim changes. The implementation of a policy of zero tolerance for mobbing is a starting point, but it is not enough for a lasting solution to a problem with the volume and nature of a socio-economic disaster.

Lessons

Mobbing is a conflict of interest in which the better prepared fall victim to the more mediocre. Insufficiently good level of management at all levels in the institution leads to mobbing when a competent and eroded member of the team appears.

Key messages

No one is protected from mobbing in bad and destructive management. A mobbing risk reduction program is applicable to each prevention indication at each level.

Psychological assistance at disaster in Bulgaria - contemporary policies for health risk management

Issue

Health risk management (HRM) in Bulgaria is provided to citizens in emergencies, disasters, accidents and catastrophes (E&DAC). According to the legislation in the country, this is a part of the mandatory package of medical provision for the injured population (MPIP) and concerns any acute life-threatening condition (LTC). In the dynamically changing environment of E&DAC, a special form of health consequences among survivors are related to mental health (MeH).

Description of the problem

In practice, any serious E&DAC has a direct or indirect psychological impact. It can manifest itself acutely or remotely over time, puts the victims in temporary or permanent disability and is followed by serious social effects. A strategy has been proposed for inclusion in the obligatory package of MPIP in case of significant E&DAC and primary psychological assistance (PPA) for every citizen who has survived.

Results

In the country, PPАs to citizens for decades is an on-demand service provided mainly by the private sector. Within the BRC, a group has been formed to provide PPA with a modest resource capacity. The emotional citizens culture in the country is far from active demand for PPA in general and severely limited in resources and the MeH is not a priority. This system of public health care, based on withdrawal from the MeH, also exposes to increased risk of psycho-somatic and distress-provoked physical illnesses (PSDPPhI).

Lessons

Carrying out timely PPA for those in need changes the range of adverse mental effects, reducing them. Provides a better adaptive response to reduced risk of PTSD and PSDPPhI. A volume of preventive measures organized in stages over time gives a greater chance to a larger number of victims.

Key messages

The health of the nation is a complex program for controlling both the acute health problems at E&DAC and the protection of MeH. To provide modern sustainable policies for the implication of PPA in everyone who has seriously experienced E&DAC is resulted in good health practices.

Influence of migrant background on patient preference and expectations in breast and gynecological malignancies (NOGGO-expression V study): results of a prospective multicentre study in 606 patients in Germany

Background

An effective cross-cultural doctor-patient communication is vital for health literacy and patient compliance. Building a good relationship with medical staff is also relevant for the treatment decision-making process for cancer patients. Studies about the role of a specific migrant background regarding patient preferences and expectations are lacking. We therefore conducted a multicentre prospective survey to explore the needs and preferences of patients with a migrant background (PMB) suffering from gynecological malignancies and breast cancer to evaluate the quality of doctor-patient communication and cancer management compared to non-migrants (NM).

Methods

This multicentre survey recruited patients with primary or recurrence of breast, ovarian, peritoneal, or fallopian tube cancer. The patients either filled out a paper form, participated via an online survey, or were interviewed by trained staff. A 58-item questionnaire was primarily developed in German and then translated into three different languages to reach non-German-speaking patients.

Results

A total of 606 patients were included in the study: 54.1% (328) were interviewed directly, 9.1% (55) participated via an online survey, and 36.8% (223) used the paper print version. More than one quarter, 27.4% (166) of the participants, had a migrant background. The majority of migrants and NM were highly satisfied with the communication with their doctors.

First-generation migrants (FGM) and patients with breast cancer were less often informed about participation in clinical trials (p < 0.05) and 24.5% of them suggested the help of an interpreter to improve the medical consultation. Second and third-generation migrants (SGM and TGM) experienced more fatigue and nausea than expected.

Conclusions

Our results allow the hypothesis that training medical staff in intercultural competence and using disease-related patient information in different languages can improve best supportive care management and quality of life in cancer patients with migrant status.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-021-08731-6.

Persistent Moderate-to-Weak Mediterranean Diet Adherence and Low Scoring for Plant-Based Foods across Several Southern European Countries: Are We Overlooking the Mediterranean Diet Recommendations?

The Mediterranean diet (MD) has been sponsored worldwide as a healthy and sustainable diet. Our aim was to update and compare MD adherence and food choices across several Southern European countries: Spain (SP), Portugal (PT), Italy (IT), Greece (GR), and Cyprus (CY) (MED, Mediterranean), and Bulgaria (BG) and the Republic of North Macedonia (NMK) (non-MED, non-Mediterranean). Participants (N = 3145, ≥18 y) completed a survey (MeDiWeB) with sociodemographic, anthropometric, and food questions (14-item Mediterranean Diet Adherence Screener, 14-MEDAS). The MED and non-MED populations showed moderate (7.08 ± 1.96) and weak (5.58 ± 1.82) MD adherence, respectively, with significant yet small differences across countries (SP > PT > GR > IT > CY > BG > NMK, p-value < 0.001). The MED participants scored higher than the non-MED ones for most of the Mediterranean-typical foods, with the greatest differences found for olive oil (OO) and white meat preference. In most countries, ≥70% of the participants reported quantities of red meat, butter, sweet drinks, and desserts below the recommended cutoff points, whereas <50% achieved the targets for plant-based foods, OO, fish, and wine. Being a woman and increasing age were associated with superior adherence (p-value < 0.001), but differences were rather small. Our results suggest that the campaigns carried out to support and reinforce the MD and to promote plant-based foods have limited success across Southern Europe, and that more hard-hitting strategies are needed.

“The Green Sea Yard of Varna” – the innovative project in the focus of early child development

We present an innovative approach to early child development (ECD), designated as a priority for all societies. Traditional ECD services of the Bulgarian health system are predominantly medical or pedagogical provided by GPs and nurseries. This leaves space for interdisciplinary services based on the ideas of Françoise Dolto focused on child-parent relationships. The Green Sea Yard of Varna, Bulgaria, aims at providing accessible space for early socialization of children and preventive psychosocial services by experts in ECD.

The process oriented work combines: psychosocial accompaniment, social group & community work, psychoanalytic consultation with medical expertise. Specialists use direct observation, interviews, analysis of available information, hypothesis development. Questions to be answered: is there a recognized need for a space enhancing and stimulating the interaction between the three main subject in ECD child-parents-specialists; is there a need for a transitional space between the home and kindergarten enabling early child socialization; which are the most prevalent mental and behavioral problems and their earliest symptoms.

For 104 working days (December 2018-February 2020), 2 000 visits of 257 children have been performed, including 400 individual consultations of 51 children at risk. Smooth adaptation to nursery was experienced by 15,5% of children. The most prevalent problems are: insufficient to lacking parent-child verbal communication; delayed speech development; aggressive behavior towards peers.

The main lessons are: (1) There is a recognized by specialists, families and the community need for transitional spaces enabling children to experience first social encounters and concepts of social rules and norms; (2) the space stimulates both formal and informal quality communication between specialist and parents and mutual informal support between parents; (3) leading to a new view for the child as an autonomous person.

Key messages

The Green Sea Yard of Varna is the first innovative space for interdisciplinary approach to ECD, early socialization, care & prevention in our community fully applicable to other places and cultures. The project is in line with SDGs, contemporary scientific visions for the first 1000 days of a child's life and the WHO strategy for the prevention of child’s health in the family and in society.

Prevalence of depression among three cohorts of medical students

Background

Medical education is often related to serious distress for students, that affects negatively their mental well-being. Depression, poor academic performance, increased alcohol consumption, suicidal thoughts, are some of the detrimental effects of diminished mental health. Studies on depression in medical students reveal a higher prevalence (1.4-73.5%) than in the general population. This study aimed to assess and compare depression prevalence and severity in three cohorts of medical students in Bulgaria and Turkey.

Methods

We conducted a cross-sectional online survey with 257 Bulgarian and 288 foreign medical students from Medical University-Sofia, Bulgaria, and with 270 Turkish medical students from Ankara in the winter semester of 2019-2020 academic year. We used the Beck depression inventory (BDI) as valid and reliable instrument to assess depression. The students were categorised according to BDI scores in three groups: with mild depression (10- 18 points); moderate depression (19-29); severe depression (30- 63). Data were analysed with program product Python 3 (v3.6.9) with Pandas v0.25.3 and Scipy v1.4.1.

Results

Depressive symptoms reported 71.5% of Turkish students, 47.1% of Bulgarian and 48.7% of foreign medical students. The depression frequency among Turkish and Bulgarian medical students was significantly different (chi2 = 35.31; p = 0,001). Mean BDI scores were similar for Bulgarian medical students (11.0) and foreign medical students, studying in Bulgaria (11.6). Turkish medical students scored highest on BDI (15.3). Severe depression was detected in 5.6% of foreign, 4.3% of Bulgarian and 6.3% of Turkish students.

Conclusions

Depression prevalence was high in all studied medical students cohorts, with Turkish cohort affected most, probably because of cultural and curriculum differences.

Key messages

Support of student’s mental health should be an integral part of the educational policies of all Medical Universities worldwide. Depression among medical students has to be prevented by comprehensive approach.

Evaluation of Cardiovascular Disease Risk in HIV-1-Infected Patients Treated with Darunavir

Introduction

We evaluated cardiovascular disease (CVD) risk associated with darunavir treatment and examined the demographic/clinical characteristics of darunavir users based on data from Janssen-sponsored clinical trials, post-marketing pharmacovigilance databases, and administrative claims databases.

Methods

First, selected CVD events [myocardial infarction, stroke, sudden death, invasive cardiovascular procedures (coronary artery angioplasty or bypass, or carotid endarterectomy)] were analyzed in 19 Janssen-sponsored phase 2–4 studies (incidence rates estimated from pooled data; 95% confidence intervals derived from Poisson distribution). Second, analyses were conducted to identify spontaneously reported CVD events in post-marketing pharmacovigilance databases and evaluate disproportional reporting of CVD events for darunavir (using Empirical Bayesian Geometric Mean scores). Third, baseline demographic/clinical characteristics of human immunodeficiency virus-1 (HIV-1)–infected patients in general and new users of darunavir and atazanavir were explored using three US administrative claims databases.

Results

Among 19 Janssen-sponsored clinical trials (treatment durations ≤ 6 years), the CVD event rate (95% CI) per 1000 person-years (pooled population; n = 5713) was 6.15 (2.91–11.89), and was lower for patients who used once-daily darunavir/ritonavir 800/100 mg [0.71 (0.16–3.05); n = 1326] versus twice-daily darunavir/ritonavir 600/100 mg [9.21 (4.94–16.04); n = 3058]. Trend analysis of post-marketing pharmacovigilance data showed that cumulative CVD event reporting rates for darunavir users (any dose) generally declined over time. Spontaneously reported CVD events were not disproportionately reported with darunavir versus other protease inhibitors. Compared with the general HIV-1–infected population and atazanavir users, higher proportions of darunavir users were male, older, and had comorbidities associated with CVD risk based on results from US administrative claims databases.

Conclusions

This comprehensive review of Janssen-sponsored clinical trial, post-marketing, and epidemiological data does not suggest that CVD should be considered an important risk for users of darunavir.

Electronic supplementary material

The online version of this article (10.1007/s40268-018-0238-8) contains supplementary material, which is available to authorized users.

Suínos dos Balcãs de Leste – uma raça suína autóctone Búlgara

O porco dos Balcãs de Leste (EBS) é a última raça suína indígena da Bulgária que resta. É um porco “tipo banha” fenotipicamente similar ao javali com uma excelente capacidade de adaptação a condições extensivas. Atualmente (2016) a população da raça é de 1114 porcas e 48 varrascos e por essa razão o EBS é considerado como “em perigo”. Esta raça habita partes florestais do país nas encostas do leste de Stara Planina Mt. (Os Balcãs) e Strandzha Mt. Da mesma forma que o porco selvagem, o porco EBS caracteriza-se pela sua maturidade tardia – a idade ao primeiro parto ulatrapassa os 500 dias. Durante a sua vida reprodutiva esta raça local tem, em média, 5,2 ninhadas. A prolificidade varia de 6 a 8 leitões nascidos vivos e 5-6 leitões desmamados. Os animais EBS atingem um peso corporal de 100kg com cerca de 14 meses. Os valores médios caracterizadores da qualidade da carcaça aos 100kg de peso são os seguintes: carcaça – 56,7kg (determinada após a remoção da pele, cabeça, pernas pelo curvilhão e chispe e todas as vísceras), total de carne com ossos – 41,8kg (73,4% da carcaça) e gordura – 15,08kg (26,6% da carcaça).

The bear in Eurasian plant names: motivations and models

Ethnolinguistic studies are important for understanding an ethnic group's ideas on the world, expressed in its language. Comparing corresponding aspects of such knowledge might help clarify problems of origin for certain concepts and words, e.g. whether they form common heritage, have an independent origin, are borrowings, or calques. The current study was conducted on the material in Slavonic, Baltic, Germanic, Romance, Finno-Ugrian, Turkic and Albanian languages. The bear was chosen as being a large, dangerous animal, important in traditional culture, whose name is widely reflected in folk plant names. The phytonyms for comparison were mostly obtained from dictionaries and other publications, and supplemented with data from databases, the co-authors' field data, and archival sources (dialect and folklore materials). More than 1200 phytonym use records (combinations of a local name and a meaning) for 364 plant and fungal taxa were recorded to help find out the reasoning behind bear-nomination in various languages, as well as differences and similarities between the patterns among them. Among the most common taxa with bear-related phytonyms were Arctostaphylos uva-ursi (L.) Spreng., Heracleum sphondylium L., Acanthus mollis L., and Allium ursinum L., with Latin loan translation contributing a high proportion of the phytonyms. Some plants have many and various bear-related phytonyms, while others have only one or two bear names. Features like form and/or surface generated the richest pool of names, while such features as colour seemed to provoke rather few associations with bears. The unevenness of bear phytonyms in the chosen languages was not related to the size of the language nor the present occurence of the Brown Bear in the region. However, this may, at least to certain extent, be related to the amount of the historical ethnolinguistic research done on the selected languages.

Peginterferon Lambda-1a Is Associated with a Low Incidence of Autoimmune Thyroid Disease in Chronic Hepatitis C

Peginterferon alfa (alfa) increases the risk of autoimmune disease. Peginterferon lambda-1a (Lambda) acts through a receptor with a more liver-specific distribution compared to the alfa receptor. In a phase-2b study, 525 treatment-naive patients with chronic hepatitis C virus (HCV) infection received ribavirin and Lambda interferon (120, 180, or 240 μg) or alfa interferon (180 μg) for 24 (genotypes 2 and 3) or 48 (genotypes 1 and 4) weeks. Retrospective analysis found that adverse events of MedDRA-coded thyroid dysfunction and abnormal levels of thyroid-stimulating hormone (TSH) were significantly more frequent with alfa versus Lambda (12% versus 2.6% and 15.2% versus 3.4%, respectively, both P<0.0001). Most Lambda recipients with abnormal TSH had levels below the lower limit of normal; the frequency of low and high TSH was similar in alfa recipients with abnormal TSH. Blinded review by an endocrinologist found that new-onset primary hypothyroidism or painless thyroiditis was less frequent with Lambda versus alfa (0.5% and 1.8% versus 5.3% and 7.5%, respectively, P<0.0001). Most TSH elevations reflected new-onset hypothyroidism requiring treatment, while most markedly suppressed TSH values reflected probable painless thyroiditis and resolved without sequelae. In conclusion, HCV-infected patients treated with Lambda/ribavirin experienced fewer adverse events of thyroid dysfunction compared with patients treated with alfa/ribavirin.

Cardiac dysfunction associated with a nucleotide polymerase inhibitor for treatment of hepatitis C

Treatment for chronic hepatitis C virus (HCV) infection is evolving from interferon (IFN)-based therapy to direct-acting antiviral (DAA) agents, yet some safety concerns have arisen involving cardiac toxicity. In this study, we sought to better understand the potential off-target toxicities of new DAAs. We retrospectively evaluated the clinical and pathological findings of the sentinel case in a phase II study that led to clinical development discontinuation for BMS-986094, an HCV nucleotide polymerase (nonstructural 5B) inhibitor. We also report on outcomes from other patients in the same study, including electrocardiogram changes, cardiovascular biomarkers, and transthoracic echocardiograms. Thirty-four patients received IFN-free BMS-986094 regimens. Six patients had left ventricular ejection fractions (LVEFs) <30%, 8 had LVEFs 30%-50%, and 11 required hospitalization for suspected cardiotoxicity. Of the patients with LVEF <50%, 6 had normalization of systolic function after a median of 20 days. T-wave inversions were the most sensitive predictor of LVEF dysfunction. B-type natriuretic peptide levels increased over time and correlated with the degree of LVEF dysfunction. Pathological analysis of cardiac tissue revealed severe myocyte damage with elongated myofibrils without gross necrosis. These findings were consistent with some results of recent primate studies that were conducted to further investigate the potential mechanisms of BMS-986094 toxicity.

CONCLUSION

A novel nucleotide analog polymerase inhibitor developed for HCV treatment may cause a toxic cardiomyopathy. Ongoing surveillance of DAAs for cardiotoxicities may be beneficial, especially among patients at higher risk for cardiovascular disease.

Ex situ conservation of Ruscus aculeatus L. - ruscogenin biosynthesis, genome-size stability and propagation traits of tissue-cultured clones

Ruscus aculeatus L. is a perennial semi-shrub with distinctive leaf-like branches (cladodes). Rhizomes and roots contain steroidal saponins (ruscogenins) that are used in medicine and cosmetics for their anti-inflammatory, venotonic and antihaemorroidal activity. Problematic cultivation of the species causes in many countries unsustainable over-collection from the wild. Tissue culture propagation of R. aculeatus was carried out for conservation and propagation purposes. The impact of the clonal origin (genotype) on the ruscogenin biosynthesis, genome-size stability and propagation traits and morpho-physiological response to long-term cultivation in vitro was studied. Production of ruscogenins in fully developed regenerants was quantified by high-performance liquid chromatography (HPLC). Genome-size stability of the clones was assessed by flow cytometry. Slow growth and prolonged lag-phase were characteristic for the whole propagation cycle. Produced plantlets with well-defined organs were suitable for direct ex vitro planting. Genome DNA content of all clones was stable and comparable to native plants. Ruscogenin biosynthesis was clone-specific, presenting distinctive profiles of the cultures. Our results imply that clone origin and culture type might influence saponin biosynthesis in Ruscus. These traits should be considered in the ex situ conservation of the genetic diversity of this species and by production of planting material as well.

BRCA1 gene promoter methylation status in high-grade serous ovarian cancer patients--a study of the tumour Bank ovarian cancer (TOC) and ovarian cancer diagnosis consortium (OVCAD)

BACKGROUND

Mutations in BRCA1/2 genes are involved in the pathogenesis of breast and ovarian cancer. Inactivation of these genes can also be mediated by hypermethylation of CpGs in the promoter regions. Aim of this study was to analyse the clinical impact of BRCA1 promoter gene methylation status in a homogenous cohort of high-grade serous ovarian cancer (HGSOC) patients.

METHODS

The cohort included 257 primary HGSOC patients treated by cytoreduction and platinum-based chemotherapy. DNA was extracted from fresh frozen tissue samples. BRCA1 gene promoter methylation rate was assessed using polymerase chain reaction (PCR).

RESULTS

14.8% of patients presented hypermethylation within a selected region of the BRCA1 promoter. The rate of hypermethylation was significantly higher in younger patients (20.8% hypermethylation in the age group ⩽ 58 years versus 8.7% hypermethylation in the age group >58 years; p = 0.008). Optimal tumour debulking could be reached in 63% of patients, without significant differences in the extent of residual disease with respect to the methylation status. No impact of BRCA1 gene promoter methylation status on progression free- and overall-survival rates was found. No significant differences within BRCA1 promoter methylation status between primary and metastatic tissue could be observed. These results on BRCA1 promoter methylation status were also confirmed in a subgroup of 107 patients found negative for BRCA1 exon 11 mutations.

CONCLUSIONS

Our data suggest that BRCA1 methylation determines the earlier onset of HGSOC. Furthermore our study supports the idea that BRCAness is not only due to mutations but also to epigenetic changes in BRCA1 promoter gene.

Sofosbuvir and daclatasvir combination therapy in a liver transplant recipient with severe recurrent cholestatic hepatitis C

Recurrent HCV infection following liver transplantation can lead to accelerated allograft injury that is difficult to treat with interferon. The aim of this study is to describe the first ever use of an interferon-free, all oral regimen in a liver transplant recipient with severe recurrent HCV. A 54-year-old male with HCV genotype 1b developed severe cholestatic HCV at 6 months posttransplant with ascites, AST 503 IU/mL, alkaline phosphatase of 298 IU/mL, HCV RNA of 12 000 000 IU/mL, and histological cholestasis with pericellular fibrosis. Sofosbuvir, an HCV polymerase inhibitor (400 mg/day), and daclatasvir, an HCV NS5A replication complex inhibitor (60 mg/day), were co-administered for 24 weeks. Within 4 weeks of initiating treatment, serum HCV RNA levels became undetectable and liver biochemistries normalized with concomitant resolution of ascites. The patient achieved a sustained virological response with undetectable HCV RNA at 9 months posttreatment. During and following treatment, the daily dose and blood level of tacrolimus remained stable and unchanged. The rapid and sustained suppression of HCV replication in this liver transplant recipient provides great promise for the use of combination oral antiviral regimens in other immunosuppressed and interferon refractory HCV patients.

Case report of successful peginterferon, ribavirin, and daclatasvir therapy for recurrent cholestatic hepatitis C after liver retransplantation

A recurrent hepatitis C virus (HCV) infection after liver transplantation (LT) can lead to accelerated allograft injury and fibrosis. The aim of this article is to report the first ever use of daclatasvir (DCV; also known as BMS-790052), a potent orally administered nonstructural 5A replication complex inhibitor, in combination with peginterferon α (PEG-IFNα) and ribavirin in an LT recipient. A 49-year-old female developed a severe recurrent HCV genotype 1b infection 4 months after transplantation with severe cholestasis on biopsy, an HCV RNA level of 10,000,000 IU/mL, an alkaline phosphatase level of 1525 IU/mL, and a total bilirubin level of 8.4 mg/dL. Despite partial virological suppression with PEG-IFNα and ribavirin, progressive allograft failure ensued and culminated in retransplantation at 9 months. Three months after the second transplant, DCV (20 mg/day), PEG-IFNα2a (180 μg/week), and ribavirin (800 mg/day) were prescribed for early recurrent cholestatic HCV. Serum HCV RNA became undetectable at week 3 of treatment and remained undetectable during 24 weeks of triple therapy and during the posttreatment follow-up. DCV was well tolerated, and the trough drug levels were within the targeted range throughout the treatment. The cyclosporine trough levels were also stable during and after therapy. In conclusion, the lack of anticipated drug-drug interactions between DCV and calcineurin inhibitors and the potent antiviral efficacy of DCV make this agent (in combination with PEG-IFN and ribavirin) an attractive antiviral regimen worthy of further study in LT recipients with recurrent HCV.

Pharmacokinetics and whole-blood bactericidal activity against Mycobacterium tuberculosis of single doses of PNU-100480 in healthy volunteers

BACKGROUND

The oxazolidinone PNU-100480 is superior to linezolid against experimental murine tuberculosis. Two metabolites contribute to but do not fully account for its superiority. This study examined the safety, tolerability, pharmacokinetics, and mycobactericidal activity of single ascending doses of PNU-100480.

METHODS

Nineteen healthy volunteers received 2 escalating single oral doses (35-1500 mg) of PNU-100480 or placebo. Eight subjects received 4 daily doses of 300 mg of linezolid. Drug concentrations and bactericidal activity against Mycobacterium tuberculosis in whole-blood bactericidal culture were measured.

RESULTS

All doses were safe and well tolerated. PNU-100480 doses to 1000 mg were well absorbed and showed approximately proportional increases in exposures of parent and metabolites. The geometric mean maximal concentrations of PNU-100480, PNU-101603, and PNU-101244 (sulfoxide and sulfone metabolites) at 1000 mg were 839, 3558, and 54 ng/mL, respectively. The maximal whole-blood bactericidal activity (-0.37 +/- .06 log/day) occurred at combined PNU levels > or =2 times the minimum inhibitory concentration. The observed geometric mean maximal concentration for linezolid was 6425 ng/mL. Its maximal whole-blood bactericidal activity also occurred at > or =2 times the minimum inhibitory concentration, but it was only -0.16 +/- .05 log/day (P< .001) Neither drug showed enhanced activity at higher concentrations.

CONCLUSIONS

Single doses of PNU-100480 to 1000 mg were well tolerated and exhibited antimycobacterial activity superior to 300 mg of linezolid at steady state. Additional studies are warranted to define its role in drug-resistant tuberculosis.

[Expression of activating and inhibitory receptors on peripheral blood natural killer cell subsets of women with reproductive failures]

It is now apparent that immunologic implantation failure and recurrent abortions are more than likely mediated through activation of natural killer (NK) cells. The NK cell activity is mediated by a balance between activating and inhibitory receptors upon recognition of MHC class I molecules. In this study, we investigated by flow cytometry the expression of activating and inhibitory receptors on NK cells of women with reproductive failures- recurrent spontaneous abortion (RSA) and implantation failures (IF). In women with implantation failures CD56+CD16+ NK cell subset was significantly increased (p = 0.017) and CD158a expressing NK cells was significantly decreased (p = 0.027). CD161-activating receptor expressing CD56+ NK cells were significantly decreased in women with RSA (p = 0.033). These data further support an imbalance in NK cell subsets in women with reproductive failures.

Serum sperm antibodies unrelated to mumps orchitis

In order to determine whether there is an association between mumps orchitis and serum sperm antibodies, we tested patients at the time orchitis was diagnosed (n = 7) and individuals who had had orchitis at least 1 month previously (n = 14). Data were compared with the results for a control group of blood donors (n = 20). Sperm antibodies were detected by the gelatin agglutination test of Kibrick, the tray agglutination test of Friberg and the ELISA. Clinically significant sperm antibody levels were not found in patients in the early stages of the disease. Four subjects tested post-disease were positive in the Friberg test and one was positive in the ELISA. One control serum was also positive in the latter test. Significant differences were not found between levels in patients in the early stages of the disease and levels in individuals post-disease, although the results of the Friberg test differed significantly between controls and former mumps orchitis cases. These data do not support the assumption of an involvement of humoral immunity against spermatozoa in mumps orchitis patients.

Nucleolin inhibits Hdm2 by multiple pathways leading to p53 stabilization

Nucleolin is a c-Myc-induced gene product with defined roles in ribosomal RNA processing and the inhibition of chromosomal DNA replication following stress. Here we find that changes in nucleolin protein levels in unstressed cells cause parallel changes in the amount of p53 protein. Alterations in p53 levels arise from nucleolin binding to the p53 antagonist Hdm2, resulting in the inhibition of both p53 ubiquitination and Hdm2 auto-ubiquitination. Nucleolin does not alter p53 ubiquitination by human papillomavirus E6, indicating that the effect is specific for Hdm2. Although the inhibition of ligase activity would be expected to stabilize Hdm2, we instead find that nucleolin also reduces Hdm2 protein levels, demonstrating that nucleolin inhibits Hdm2 using multiple mechanisms. Increases in nucleolin levels in unstressed cells led to higher expression of p21(cip1/waf1), a reduced rate of cellular proliferation, and an increase in apoptosis. Thus, nucleolin has a number of properties in common with the tumor suppressor ARF (alternate reading frame). We propose that nucleolin, like ARF, responds to hyperproliferative signals by upregulation of p53 through Hdm2 inhibition.