Social Listening in Gout: Impact of Proactive vs. Reactive Management on Self-Reported Emotional States

INTRODUCTION

This study aimed to characterize patient-reported outcomes from social media conversations in the gout community. The impact of management strategy differences on the community's emotional states was explored.

METHODS

We analyzed two social media sources using a variety of natural language processing techniques. We isolated conversations with a high probability of discussing disease management (score > 0.99). These conversations were stratified by management type: proactive or reactive. The polarity (positivity/negativity) of language and emotions conveyed in statements shared by community members was assessed by management type.

RESULTS

Among the statements related to management, reactive management (e.g., urgent care) was mentioned in 0.5% of statements, and proactive management (e.g., primary care) was mentioned in 0.6% of statements. Reactive management statements had a significantly larger proportion of negative words (59%) than did proactive management statements (44%); "fear" occurred more frequently with reactive statements, whereas "trust" predominated in proactive statements. Allopurinol was the most common medication in proactive management statements, whereas reactive management had significantly higher counts of prednisone/steroid mentions.

CONCLUSIONS

A unique aspect of examining gout-related social media conversations is the ability to better understand the intersection of clinical management and emotional impacts in the gout community. The effect of social media statements was significantly stratified by management type for gout community members, where proactive management statements were characterized by more positive language than reactive management statements. These results suggest that proactive disease management may result in more positive mental and emotional experiences in patients with gout.

Health phenome of Parkinson's patients reveals prominent mood-sleep cluster

Background

Associations between phenotypic traits, environmental exposures, and Parkinson's disease have largely been evaluated one-by-one, piecemeal, and pre-selections. A comprehensive picture of comorbidities, phenotypes, exposures, and polypharmacy characterizing the complexity and heterogeneity of real-world patients presenting to academic movement disorders clinics in the US is missing.

Objectives

To portrait the complexity of features associated with patients with Parkinson's disease in a study of 933 cases and 291 controls enrolled in the Harvard Biomarkers Study.

Methods

The primary analysis evaluated 64 health features for associations with Parkinson's using logistic regression adjusting for age and sex. We adjusted for multiple testing using the false discovery rate (FDR) with £ 0.05 indicating statistical significance. Exploratory analyses examined feature correlation clusters and feature combinations.

Results

Depression (OR = 3.11, 95% CI 2.1 to 4.71), anxiety (OR = 3.31, 95% CI 2.01-5.75), sleep apnea (OR 2.58, 95% CI 1.47-4.92), and restless leg syndrome (RLS; OR 4.12, 95% CI 1.81-12.1) were significantly more common in patients with Parkinson's than in controls adjusting for age and sex with FDR £ 0.05. The prevalence of depression, anxiety, sleep apnea, and RLS were correlated, and these diseases formed part of a larger cluster of mood traits and sleep traits linked to PD. Exposures to pesticides (OR 1.87, 95% CI 1.37-2.6), head trauma (OR 2.33, 95% CI 1.51-3.73), and smoking (OR 0.57, 95% CI 0.43-0.75) were significantly associated with the disease consistent with previous studies. Vitamin supplementation with cholecalciferol (OR 2.18, 95% CI 1.4-3.45) and coenzyme Q10 (OR 2.98, 95% CI 1.89-4.92) was more commonly used by patients than controls. Cumulatively, 43% (398 of 933) of Parkinson's patients had at least one psychiatric or sleep disorder, compared to 21% (60 of 291) of healthy controls.

Conclusions

43% of Parkinson's patients seen at Harvard-affiliated teaching hospitals have depression, anxiety, and disordered sleep. This syndromic cluster of mood and sleep traits may be pathophysiologically linked and clinically important.

Multiscale design of cell-free biologically active architectural structures

Cell-free protein expression systems are here combined with 3D-printed structures to study the challenges and opportunities as biofabrication enters the spaces of architecture and design. Harnessing large-scale additive manufacturing of biological materials, we examined the addition of cell-free protein expression systems ("TXTL" i.e., biological transcription-translation machinery without the use of living cells) to printed structures. This allowed us to consider programmable, living-like, responsive systems for product design and indoor architectural applications. This emergent, pluripotent technology offers exciting potential in support of health, resource optimization, and reduction of energy use in the built environment, setting a new path to interactivity with mechanical, optical, and (bio) chemical properties throughout structures. We propose a roadmap towards creating healthier, functional and more durable systems by deploying a multiscale platform containing biologically-active components encapsulated within biopolymer lattices operating at three design scales: (i) supporting cell-free protein expression in a biopolymer matrix (microscale), (ii) varying material properties of porosity and strength within two-dimensional lattices to support biological and structural functions (mesoscale), and (iii) obtaining folded indoor surfaces that are structurally sound at the meter scale and biologically active (we label that regime macroscale). We embedded commercially available cell-free protein expression systems within silk fibroin and sodium alginate biopolymer matrices and used green fluorescent protein as the reporter to confirm their compatibility. We demonstrate mechanical attachment of freeze-dried bioactive pellets into printed foldable fibrous biopolymer lattices showing the first steps towards modular multiscale fabrication of large structures with biologically active zones. Our results discuss challenges to experimental setup affecting expression levels and show the potential of robust cell-free protein-expressing biosites within custom-printed structures at scales relevant to everyday consumer products and human habitats.

Hydroxychloroquine Dose per Ophthalmology Guidelines and the Risk of Systemic Lupus Erythematosus Flares

This study of an academic medical center patient cohort with systemic lupus erythematosus (SLE) investigates the association between hydroxychloroquine dose based on current guidelines and risk of lupus flares.

Evaluation of Immune Response and Disease Status in Systemic Lupus Erythematosus Patients Following SARS-CoV-2 Vaccination

OBJECTIVE

To evaluate seroreactivity and disease flares after COVID-19 vaccination in a multiethnic/multiracial cohort of patients with systemic lupus erythematosus (SLE).

METHODS

Ninety SLE patients and 20 healthy controls receiving a complete COVID-19 vaccine regimen were included. IgG seroreactivity to the SARS-CoV-2 spike receptor-binding domain (RBD) and SARS-CoV-2 microneutralization were used to evaluate B cell responses; interferon-γ (IFNγ) production was measured by enzyme-linked immunospot (ELISpot) assay in order to assess T cell responses. Disease activity was measured by the hybrid SLE Disease Activity Index (SLEDAI), and flares were identified according to the Safety of Estrogens in Lupus Erythematosus National Assessment-SLEDAI flare index.

RESULTS

Overall, fully vaccinated SLE patients produced significantly lower IgG antibodies against SARS-CoV-2 spike RBD compared to fully vaccinated controls. Twenty-six SLE patients (28.8%) generated an IgG response below that of the lowest control (<100 units/ml). In logistic regression analyses, the use of any immunosuppressant or prednisone and a normal anti-double-stranded DNA antibody level prior to vaccination were associated with decreased vaccine responses. IgG seroreactivity to the SARS-CoV-2 spike RBD strongly correlated with the SARS-CoV-2 microneutralization titers and correlated with antigen-specific IFNγ production determined by ELISpot. In a subset of patients with poor antibody responses, IFNγ production was similarly diminished. Pre- and postvaccination SLEDAI scores were similar in both groups. Postvaccination flares occurred in 11.4% of patients; 1.3% of these were severe.

CONCLUSION

In a multiethnic/multiracial study of SLE patients, 29% had a low response to the COVID-19 vaccine which was associated with receiving immunosuppressive therapy. Reassuringly, severe disease flares were rare. While minimal protective levels remain unknown, these data suggest that protocol development is needed to assess the efficacy of booster vaccination.

POS1150 ANATOMICAL LOCATIONS AND CORRELATES OF CALCIUM PYROPHOSPHATE CRYSTAL DEPOSITS OF THE SPINE – PATHOLOGIC EXAMINATION OF 77 SURGICAL CASES

Background:

Spinal involvement in calcium pyrophosphate deposition disease (CPPD) is thought to be a rare occurrence and is seen infrequently as crowned dens syndrome. Furthermore, data on anatomical locations and correlates of calcium pyrophosphate (CPP) deposits in spinal CPPD are scarce.

Objectives:

To describe the anatomical locations and correlates of pathologically confirmed CPPD of the spine.

Methods:

Consecutive patients with spinal CPPD were identified via retrospective chart review of individuals who underwent spine surgery for intractable chronic neck or back pain at Massachusetts General Hospital between 2009 and 2014. These deposits and surrounding anatomical structures were surgically resected and confirmed to have calcium pyrophosphate deposition upon pathologic review. We reviewed musculoskeletal imaging (CT, MRI, XR) and laboratory data from these pathologically confirmed cases.

Results:

From April 2009 to August 2014, we identified 77 individuals with pathologically confirmed CPPD of the spine. The mean age was 68 years; 41 (53%) were female; mean BMI was 28.7. Calcium pyrophosphate (CPP) was grossly identified intraoperatively by the surgeon in 38 cases (50%), typically as “chalky white deposits” (Figure 1). CPP deposits were seen most frequently in the ligamentum flavum (23%) and intervertebral disc (23%), followed by other less common locations (Table 1). Imaging findings in the soft tissue or intervertebral disc suggestive of CPPD were found in 5 cases (6%), whereas findings of spinal canal narrowing, facet arthropathy, or ligamentum flavum thickening were eventually correlative with CPP deposits in pathologic specimens. Only 7 (9%) experienced a prior episode of acute CPP arthritis (pseudogout). Chondrocalcinosis on x-ray was seen in 26 cases (34%), most commonly in the wrist and/or knees. Osteoarthritis was present in all spinal imaging, and 65% had comorbid scoliosis. Laboratory abnormalities associated with secondary causes of CPPD (hypercalcemia, hypomagnesemia, hyperparathyroidism) were not seen with spinal CPPD.

Conclusion:

Spinal CPPD may occur more frequently than previously perceived. The ligamentum flavum and intervertebral discs were common anatomical locations for spinal CPPD. Advanced imaging of the spine showed low sensitivity for detecting spinal CPPD. Only a small minority had typical peripheral joint involvement or imaging with peripheral joint chondrocalcinosis. Thus, without pathologic confirmation, the vast majority of cases would remain unidentified. These findings call for the need to seek pathologic confirmation to determine the robust epidemiology and also raise the potential role for preoperative CPPD treatment.

Table 1.

Spinal Anatomic Locations of Pathologically Confirmed CPPD

Spinal Anatomic LocationNo. of Sites (%)*ligamentum flavum29 (23)Intervetebral Disc28 (23)Other Location19 (15)Posterior Elements18 (15)Facet14 (11)Synovium8 (6)Interspinous Ligament3 (2)Subarticular/Lateral Recess2 (2)Fibrocartilaginous Tissue1 (1)Inner Spine1 (1)Other Ligament1 (1)

*Some patients had more than one anatomic location where CPP was isolated

Figure 1.

Gross visualization of calcium pyrophosphate deposition (black arrow)

Disclosure of Interests:

Jonathan Dau: None declared, Gary Ho: None declared, Hyon Choi Consultant of: Ironwood, Selecta, Horizon, Takeda, Kowa, Vaxart, Grant/research support from: Ironwood, Horizon, Joseph Schwab: None declared, Minna Kohler Speakers bureau: Eli Lily, Consultant of: Novartis.

SERENA: Particle Instrument Suite for Determining the Sun-Mercury Interaction from BepiColombo

The ESA-JAXA BepiColombo mission to Mercury will provide simultaneous measurements from two spacecraft, offering an unprecedented opportunity to investigate magnetospheric and exospheric particle dynamics at Mercury as well as their interactions with solar wind, solar radiation, and interplanetary dust. The particle instrument suite SERENA (Search for Exospheric Refilling and Emitted Natural Abundances) is flying in space on-board the BepiColombo Mercury Planetary Orbiter (MPO) and is the only instrument for ion and neutral particle detection aboard the MPO. It comprises four independent sensors: ELENA for neutral particle flow detection, Strofio for neutral gas detection, PICAM for planetary ions observations, and MIPA, mostly for solar wind ion measurements. SERENA is managed by a System Control Unit located inside the ELENA box. In the present paper the scientific goals of this suite are described, and then the four units are detailed, as well as their major features and calibration results. Finally, the SERENA operational activities are shown during the orbital path around Mercury, with also some reference to the activities planned during the long cruise phase.

Catheter ablation of atrial fibrillation in patients with heart failure with preserved ejection fraction: a systematic review and meta-analysis

Background

Catheter ablation improves clinical outcomes in symptomatic atrial fibrillation (AF) patients with heart failure (HF) with reduced ejection fraction (HFrEF). However, the role of catheter ablation in HF patients with a preserved ejection fraction (HFpEF) is less clear.

Purpose

To determine the efficacy of catheter ablation of AF in patients with HFpEF relative to those with HFrEF.

Methods

We performed an extensive literature search and systematic review of studies that compared AF recurrence at one year after catheter ablation of AF in patients with HFpEF versus those with HFrEF. Risk ratio (RR) 95% confidence intervals were measured using the Mantel-Haenszel method for dichotomous variables, where a RR&lt;1.0 favors the HFpEF group.

Results

Four studies with a total of 563 patients were included, of which 312 had HFpEF and 251 had HFrEF. All patients included were undergoing first time catheter ablation of AF. Patients with HFpEF experienced similar recurrence of AF one year after ablation on or off antiarrhythmic drugs compared to those with HFrEF (RR 0.87; 95% CI 0.69–1.10, p=0.24), as shown in Figure 1. Recurrence of AF was assessed with electrocardiography, Holter monitoring, and/or event monitoring at scheduled follow-up visits and final follow-up.

Conclusion

Based on the results of this meta-analysis, catheter ablation of AF in patients with HFpEF appears as efficacious in maintaining sinus rhythm as in those with HFrEF.

Funding Acknowledgement

Type of funding source: None

Biofilter for generation of concentrated sulphuric acid from H2S

Biofilters are used for the conversion of odorous hydrogen sulphide to odourless sulphate in wastewater treatment plants under the right conditions of moisture and pH. One of the consequences of maintaining the suitable pH and moisture content is the production of large volumes of weakly acidic leachate. This paper presents a biofilter with a maximum H2S elimination capacity of 16.3 g m(-3) h(-1) and removal efficiency greater than 95 % which produces small volumes (1 mL of solution L(-1) of reactor day(-1)) of sulphuric acid with a concentration greater than 5.5 M after 150 days of continuous operation. The concentrated sulphuric acid was produced by intermittently trickling a minimum amount of nutrient solution down the upflow biofilter which created a moisture and pH gradient within the biofilter resulting in an environment at the top for the bacterial conversion of H2S, while sulphuric acid was accumulated at the base. Genetic diversity profiling of samples taken from different sections of the biofilter confirms that the upper sections of the biofilter had the best environment for the bacteria to convert H2S to sulphate. The formation of concentrated sulphuric acid presents an opportunity for the recovery of sulphur from the waste stream as a usable product.

[Clinical case of the month. Amoebic liver abscess contracted in India with diagnosis confirmed by PCR]

Amoebiasis is a disease of parasitic origin responsible for dysentery and extra-intestinal complications. The infection is by Entamoeba histolytica, an amoeba whose geographical distribution is cosmopolitan, but that is more prevalent in tropical areas. Only a few infections are symptomatic and some of them may cause extra-intestinal complications. Hepatic amoebiasis is the most frequently observed. We report the case of a Belgian woman who developed an amoebic liver abscess after returning from a trip to India. The diagnosis was confirmed by PCR detection of E. histolytica DNA performed on the abscess fluid. The epidemiological, diagnosis and treatment aspects are discussed.

Enhancement of waste activated sludge anaerobic digestion by a novel chemical free acid/alkaline pretreatment using electrolysis

Anaerobic digestion of waste activated sludge (WAS) is relatively poor due to hydrolysis limitations. Acid and alkaline pretreatments are effective in enhancing hydrolysis leading to higher methane yields. However, chemical costs often prohibit full-scale application. In this study, 12 V two-chamber electrolysis using an anion exchange membrane alters sludge pH without chemical dosing. pH dropped from 6.9 to 2.5 in the anode chamber and increased to 10.1 in the cathode chamber within 15 h. The volatile suspended solids solubilisation of WAS was 31.1% in the anode chamber and 34.0% in the cathode chamber. As a result, dissolved chemical oxygen demand increased from 164 to 1,787 mg/L and 1,256 mg/L in the anode and cathode chambers, respectively. Remixing of sludge from the two chambers brought the pH back to 6.5, hence no chemical neutralisation was required prior to anaerobic digestion. Methane yield during anaerobic digestion at 20 d retention time was 31% higher than that of untreated sludge. An energy balance assessment indicated that the non-optimised process could approximately recover the energy (electricity) expended in the electrolysis process. With suitable optimisation of treatment time and voltages, significant energy savings would be expected in addition to the benefit of decreased sludge volume.

Mitigating ammonia inhibition of thermophilic anaerobic treatment of digested piggery wastewater: use of pH reduction, zeolite, biomass and humic acid

High free ammonia released during anaerobic digestion of livestock wastes is widely known to inhibit methanogenic microorganisms and result in low methane production. This was encountered during our earlier thermophilic semi-continuously fed continuously-stirred tank reactor (CSTR) treatment of piggery wastewater. This study explored chemical and biological means to mitigate ammonia inhibition on thermophilic anaerobic treatment of piggery wastewater with the aim to increase organic volatile carbon reduction and methane production. A series of thermophilic anaerobic batch experiments were conducted on the digested piggery effluent to investigate the effects of pH reduction (pH 8.3 to 7.5, 7.0 and 6.5) and additions of biomass (10% v/v and 19% v/v anaerobic digested piggery biomass and aerobic-anaerobic digested municipal biomass), natural zeolite (10, 15 and 20 g/L) and humic acid (1, 5 and 10 g/L) on methane production at 55 °C for 9-11 days. Reduction of the wastewater pH from its initial pH of 8.3 to 6.5 produced the greatest stimulation of methane production (3.4 fold) coupled with reductions in free ammonia (38 fold) and total volatile fatty acids (58% TVFA), particularly acetate and propionate. Addition of 10-20 g/L zeolite to piggery wastewater with and without pH reduction to 6.5 further enhanced total VFA reduction and methane production over their respective controls, with 20 g/L zeolite producing the highest enhancement effect despite the ammonia-nitrogen concentrations of the treated wastewaters remaining high. Without pH reduction, zeolite concentration up to 20 g/L was required to achieve comparable methane enhancement as the pH-reduced wastewater at pH 6.5. Although biomass (10% v/v piggery and municipal wastes) and low humic acid (1 and 5 g/L) additions enhanced total VFA reduction and methane production, they elevated the residual effluent total COD concentrations over the control wastewaters (pH-unadjusted and pH-reduced) unlike zeolite treatment. The outcomes from these batch experiments support the use of pH reduction to 6.5 and zeolite treatment (10-20 g/L) as effective strategies to mitigate ammonia inhibition of the thermophilic anaerobic treatment of piggery wastewater.

Ruptured abdominal aortic aneurysm: endovascular or open approach in a Dutch general hospital

AIM

We compared the outcomes of 56 patients with a ruptured abdominal aortic aneurysm (RAAA) who underwent either open repair or emergency endovascular aneurysm repair (eEVAR) in a general hospital. It seems feasible that the availability of eEVAR for treatment of RAAA could lead to a decrease in hospital mortality.

METHODS

We analyzed all admitted patients with a RAAA, between January 2006 and April 2008, eEVAR is compared to open repair. We studied 30 days mortality, intensive care unit stay, hospital stay, total blood loss and complications.

RESULTS

Fifteen eEVAR procedures (26.8%) were performed. Mortality in the eEVAR-group was 26%, in the open repair-group 46%. Mean intensive care unit stay was 3.9 days and 4.8 days in the eEVAR-group and open repair-group, respectively. Mean hospital stay was 13 days and 10.5 days. The average blood loss was 210cc and 2760cc. The amount of blood products for transfusion was significantly higher in the open repair. Overall complication rate was not significantly different in both treatment groups.

CONCLUSION

Treatment in a Dutch general hospital of a RAAA with an eEVAR procedure has a lower mortality in comparison to the open repair. Therefore, whenever possible the eEVAR is the preferred treatment method.

Blood, urine, and hair kinetic analysis following an acute lead intoxication

A case of lead exposure resulting from the accidental ingestion of a lead-containing solution is reported. Because of clinical management rapidly performed through chelation therapy by 2,3-dimercaptopropane sulfonate sodium and meso-2,3-dimercaptosuccinic acid, blood lead levels of this 51-year-old patient were moderate (412.9 μg/L) and no clinical symptoms were observed. Numerous blood and urine samples were collected for kinetic analysis of lead elimination. However, we report the first case in which hair samples were analyzed to determine the excretion level of lead after acute intoxication.

Reliability and reproducibility of a clinical application of a simple technique for repeated circumferential leg measurements

Objective

The aim of this study is to determine the reliability and reproducibility of repeated tape measurements to assess the leg circumference during a long period.

Methods

A tape measure is a simple instrument that is applicable in the presence of oedema. Measurements were performed by four observers on 11 volunteers. Four measurements were done in the first week (short term), a fifth measurement at two weeks (medium term) and a sixth measurement was done at 12 weeks (long term).

Results

The short-, medium- and long-term intra-class correlation coefficients for repeated measurements were 0.90, 0.89 and 0.78, respectively. The short-term and long-term reproducibility indices equalled 4.4% and 6.5%. If only a single observer would be involved, the short-term intra-class correlation coefficients would improve to 0.94 (reproducibility index 3.3%).

Conclusion

Tape measurements have been proved to be a reliable and reproducible method to asses the lower limb circumference.

In vivo imaging of retinal gliosis: a platform for diagnosis of PD and Screening of anti-PD compounds

Parkinson's disease (PD) is the second most frequent degenerative disorder after Alzheimer's disease. It is characterized by the depletion of mesenchephalic dopaminergic (DA) neurons in the substantia nigra pars compacta (SNpc) and striatal dopamine. Oxidative stress plays a major role in the pathogenesis of Parkinson's disease where DA neurons are especially vulnerable to excessive production of the H2O2 reactive oxygen species. Unfortunately, the first clinical symptoms of PD occur after at least 60-80% of nigro-striatal dopaminergic neurons have lost their function. Therefore, early detection of PD is critical in slowing down the progression of the disease and enabling the development of therapeutic compounds which could intervene at an earlier stage. Here, we employ in vivo molecular imaging of astrocytic retinal gliosis in a transgenic mice to longitudinally monitor the progression of MPTP-induced PD. We have quantitatively evaluated, via this imaging platform, the efficacy of a synthetic antioxidant, 1,3- bisbenzylimidazolium bromide (DBZIM), in protecting the DA neurons and scavenging the ROS. We show here that MPTPinduced PD results in an upregulation of glial fibrillary acidic protein (GFAP), a marker for gliosis, by 36% relative to saline whereas gliosis is normalized in MPTP-induced PD mice treated with DBZIM.

Updating the profile of C-terminal MECP2 deletions in Rett syndrome

OBJECTIVES

This study aimed to compare the phenotype of Rett syndrome cases with C-terminal deletions to that of cases with different MECP2 mutations and to examine the phenotypic variation within C-terminal deletions.

METHODS

Cases were selected from InterRett, an international database and from the population-based Australian Rett Syndrome Database. Cases (n=832) were included if they had a pathogenic MECP2 mutation in which the nature of the amino acid change was known. Three severity scale systems were used, and individual aspects of the phenotype were also compared.

RESULTS

Lower severity was associated with C-terminal deletions (n=79) compared to all other MECP2 mutations (e.g. Pineda scale C-terminals mean 15.0 (95% CI 14.0-16.0) vs 16.2 (15.9-16.5). Cases with C-terminal deletions were more likely to have a normal head circumference (odds ratio 3.22, 95% CI 1.53 - 6.79) and weight (odds ratio 2.97, 95% CI 1.25-5.76). Onset of stereotypies tended to be later (median age 2.5 years vs 2 years, p<0.001 from survival analysis), and age of learning to walk tended to be earlier (median age 1.6 years vs 2 years, p=0.002 from survival analysis). Those with C-terminal deletions occurring later in the region had lower average severity scores than those occurring earlier in the region.

CONCLUSION

In terms of overall severity C-terminal deletion cases would appear to be in the middle of the range. In terms of individual aspects of phenotype growth and ability to ambulate appear to be particular strengths. By pooling data internationally this study has achieved the case numbers to provide a phenotypic profile of C-terminal deletions in Rett syndrome.

The risk of sodium toxicity from bed accumulation to key species in the vermifiltration wastewater treatment process

This study was undertaken to assess the toxicological risks from sodium accumulation in a vermifiltration wastewater treatment system to the key worm species, Eisenia fetida. The study found that sodium chloride (NaCl) is the more toxic of the common sodium salts found in wastewater to the worms. The research further found that the worms have an ability to detoxify NaCl although reproduction will be impaired if the worms are exposed to moderate concentrations of NaCl for a long period of time. The actual risk from NaCl toxicity in the vermifiltration process was low however. The low risk was due to the low solid-water partitioning constant of NaCl, which led to a very low predicted environmental concentration (PEC) for NaCl.

Influence of high gas production during thermophilic anaerobic digestion in pilot-scale and lab-scale reactors on survival of the thermotolerant pathogens Clostridium perfringens and Campylobacter jejuni in piggery wastewater

Safe reuse of animal wastes to capture energy and nutrients, through anaerobic digestion processes, is becoming an increasingly desirable solution to environmental pollution. Pathogen decay is the most important safety consideration and is in general, improved at elevated temperatures and longer hydraulic residence times. During routine sampling to assess pathogen decay in thermophilic digestion, an inversely proportional relationship between levels of Clostridium perfringens and gas production was observed. Further samples were collected from pilot-scale, bench-scale thermophilic reactors and batch scale vials to assess whether gas production (predominantly methane) could be a useful indicator of decay of the thermotolerant pathogens C. perfringens and Campylobacter jejuni. Pathogen levels did appear to be lower where gas production and levels of methanogens were higher. This was evident at each operating temperature (50, 57, 65 degrees C) in the pilot-scale thermophilic digesters, although higher temperatures also reduced the numbers of pathogens detected. When methane production was higher, either when feed rate was increased, or pH was lowered from 8.2 (piggery wastewater) to 6.5, lower numbers of pathogens were detected. Although a number of related factors are known to influence the amount and rate of methane production, it may be a useful indicator of the removal of the pathogens C. perfringens and C. jejuni.

The common BDNF polymorphism may be a modifier of disease severity in Rett syndrome

BACKGROUND

Rett syndrome (RTT) is caused by mutations in the transcriptional repressor methyl CpG-binding protein 2 (MECP2). Brain-derived neurotrophic factor (BDNF) is a neurotrophic factor playing a major role in neuronal survival, neurogenesis, and plasticity, and it has been shown that BDNF expression is regulated by MeCP2 through a complex interaction. A common polymorphism of BDNF (Val66Met [p.V66M]) has been found to correlate with severity and course of several neuropsychiatric disorders.

METHODS

We examined the association between disease severity score, assessed by the modified Percy score, and BDNF polymorphism, using regression methods, in 125 mutation-positive patients with RTT from the Australian Rett Syndrome Database and an Israeli cohort.

RESULTS

Those who were heterozygous (Val/Met) had slightly more severe disease than those who were homozygous for the wild-type (Val/Val) BDNF polymorphism (increased severity score 2.1, p = 0.09). In those with p.R168X, a commonly occurring MECP2 mutation in RTT, there was a 6-point increase in severity score for those who were heterozygous for the BDNF polymorphism, both unadjusted (p = 0.02) and adjusted for age (p = 0.03). Individuals with the p.R168X mutation and heterozygous for the BDNF polymorphism were also at an increased risk of seizure onset (hazard ratio 5.3, 95% confidence interval 1.6-17.7) compared with those homozygous for the wild-type BDNF allele.

CONCLUSIONS

In addition to mutation type and degree of X-chromosome skewing, the common brain-derived neurotrophic factor (BDNF) polymorphism appears to be another genetic modifier of Rett syndrome (RTT) severity. This suggests that BDNF function may play a significant role in the pathogenesis of RTT.

Costeff optic atrophy syndrome: new clinical case and novel molecular findings

3-Methylglutaconic aciduria (MGA) encompasses a heterogeneous group of disorders, often coinciding with elevated levels of urinary 3-methylglutaric acid. Type I MGA is a disorder of leucine metabolism, while the biological basis for the MGA is unclear for the other types (MGA types II-V). MGA type III (Costeff optic atrophy syndrome, autosomal recessive optic atrophy-3 or optic atrophy plus syndrome, OMIM 258501) is distinguished by early bilateral optic atrophy, later-onset spasticity, extrapyramidal dysfunction, ataxia, and occasional cognitive deficits. It is caused by homozygous mutations in the optic atrophy 3 gene (OPA3). We present a case of a patient with MGA who has infantile-onset optic atrophy, ataxia, extrapyramidal movements and spasticity, but with normal intellect. Sequencing of the patient's DNA revealed a homozygous nonsense mutation c.415C>T (p.Q139X) in exon 2 of transcript 2 of the OPA3 gene, as well as a common silent polymorphism c.231T>C in the same exon. This is the first nonsense mutation found in OPA3. The molecular findings in OPA3 are also reviewed, including mutations in OPA3 that result in autosomal dominant optic atrophy and cataract (ADOAC). The recessive mode of inheritance of MGA type III as a result of the p.Q139X mutation is supported by the carrier status of the unaffected father.

Achieving cellular resolution for in vivo retinal images of transgenic GFAP-GFP mice via image processing

In vivo retinal images of transgenic mice, expressing GFP under the control of the GFAP (glial fibrillary acidic protein) promoter, have very poor signal-to-noise ratio (SNR) and cellular resolution such that the analysis of GFAP-GFP expressing retinal cells from these images can be a very challenging task. We report an image averaging method based on a pixel rank matching criterion which significantly enhances both these image attributes. We also show that it compares favorably against direct image averaging and a commercial averaging routine available from the Heidelberg Retinal Angiograph 2 software.

The toxicity of ammonia/ammonium to the vermifiltration wastewater treatment process

This study was undertaken to assess the toxicity of ammonia/ammonium to key species within the vermifiltration process. The key species, the earthworm Eisenia fetida, was subjected to a series of tests in solid phase mesocosms and full-scale units. The solid phase tests showed a relatively low toxicity to ammonium with ammonium chloride having an LC50 for ammonium of 1.49 g/kg. Ammonium sulfate did not show an effect on mortality at 2 g/kg ammonium. The full-scale units showed that ammonia hydroxide can change the pH and concentration of ammonia in wastewater and while it caused some mortality to the worms its overall affect on system functioning was minimal with no significant difference in terms of worm survival found between treatments. The affect on nitrifying bacteria was also minimal with no linear trend shown with ammonia concentration.

MRI: imaging of stomach

The study is to determine the optimal MRI bowel preparation regime for visualization of the stomach anatomy. Eight healthy volunteers were asked to take water, 75% barium and blueberry juice. The image quality and tolerance of different stomach distension regime were evaluated. Blueberry juice gave the best distension, but the signal intensity was not very homogeneous. Taking into account the image quality, tolerability and adverse effects, it is concluded that water is the most desirable oral contrast for MR stomach imaging.

Transient multiple acyl-CoA dehydrogenation deficiency in a newborn female caused by maternal riboflavin deficiency

A newborn female presented on the first day of life with clinical and biochemical findings consistent with multiple acyl-CoA dehydrogenase deficiency (MADD). Riboflavin supplementation corrected the biochemical abnormalities 24 h after commencing the vitamin. In vitro acylcarnitine profiling in intact fibroblasts both in normal and riboflavin depleted media showed normal oxidation of fatty acids excluding defects in electron transfer flavoprotein (ETF), or ETF ubiquinone oxidoreductase (ETF:QO), or a genetic abnormality in flavin metabolism. In addition, sequencing of the genes encoding ETF and ETF:QO in the proband did not reveal any pathogenic mutations. Determination of the maternal riboflavin status after delivery showed that the mother was riboflavin deficient. Repeat testing done two years after the infant's birth and while on a normal diet showed that the mother was persistently riboflavin deficient and showed a typical MADD profile on plasma acylcarnitine testing. A possible genetic defect in riboflavin transport of metabolism in the mother is postulated to be the cause of the transient MADD seen in the infant. Sequencing of the SLC16A12, RFK and FLAD1 genes encoding key enzymes in riboflavin transport of metabolism in the mother did not identify any pathogenic mutations. The underlying molecular basis of the mother's defect in riboflavin metabolism remains to be established.