Association of N-terminal pro-brain natriuretic peptide with cognitive function and depression in elderly people with type 2 diabetes

<p>Background: Type 2 diabetes mellitus is associated with risk of congestive heart failure (CHF), cognitive dysfunction and depression. CHF itself is linked both to poor cognition and depression. The ventricular N-terminal pro-brain natriuretic peptide (NT-proBNP) is a marker of CHF, suggesting potential as a marker for cognitive impairment and/or depression. This was tested in the Edinburgh Type 2 Diabetes Study (ET2DS).</p> <p>Methodology and Principal Findings: Cross-sectional analysis of 1066 men and women aged 60–75 with type 2 diabetes. Results from seven neuropsychological tests were combined in a standardised general cognitive ability factor, ‘g’. A vocabulary-based test estimated pre-morbid cognitive ability. The Hospital Anxiety and Depression Scale (HADS) assessed possible depression. After adjustment for age and sex, raised plasma NT-proBNP was weakly associated with lower ‘g’ and higher depression scores (ß −0.09, 95% CI −0.13 to −0.03, p = 0.004 and ß 0.08, 95% CI 0.04 to 0.12, p<0.001, respectively). Comparing extreme quintiles of NT-proBNP, subjects in the highest quintile were more likely to have reduced cognitive ability (within the lowest tertile of ‘g’) and ‘possible’ depression (HADS depression ≥8) (OR 1.80; 95% CI: 1.20, 2.70; p = 0.005 and OR 2.18; 95% CI: 1.28, 3.71; p = 0.004, respectively). Associations persisted when pre-morbid ability was adjusted for, but as expected were no longer statistically significant following the adjustment for diabetes-related and vascular co-variates (β −0.02, 95% CI −0.07 to 0.03, p>0.05 for ‘g’; β 0.03, 95% CI −0.02 to 0.07, p>0.05 for depression scores).</p> <p>Conclusion: Raised plasma NT-proBNP was weakly but statistically significantly associated with poorer cognitive function and depression. The prospective phases of the ET2DS will help determine whether or not NT-proBNP can be considered a risk marker for subsequent cognitive impairment and incident depression and whether it provides additional information over and above traditional risk factors for these conditions.</p&gt

The Poor and the Poorest, Fifty Years On

We re-explore Able-Smith and Townsend's landmark study of poverty in early post WW2 Britain. They found a large increase in poverty between 1953-4 and 1960, a period of relatively strong economic growth. Our re-examination is a first exploitation of the newly-digitised Board of Trade Household Expenditure Survey data set for 1953/4. Able-Smith and Townsend used only a small part of this data source. We find that Able-Smith and Townsend substantially over-estimated the rise in absolute poverty and also substantially under-estimated the rise in relative poverty. Their and our findings on poverty reflect a large rise inequality in the distribution of expenditure among British households. This rise is related to a rise in the preponderance of pensioner households, who, for instance, account for all the poor households in the 1961 Family Expenditure survey

The Nature of the UV/X-Ray Absorber in PG 2302+029

We present Chandra X-ray observations of the radio-quiet QSO PG 2302+029. This quasar has a rare system of ultra-high velocity (-56,000 km/s) UV absorption lines that form in an outflow from the active nucleus (Jannuzi et al. 2003). The Chandra data indicate that soft X-ray absorption is also present. We perform a joint UV and X-ray analysis, using photoionization calculations, to detemine the nature of the absorbing gas. The UV and X-ray datasets were not obtained simultaneously. Nonetheless, our analysis suggests that the X-ray absorption occurs at high velocities in the same general region as the UV absorber. There are not enough constraints to rule out multi-zone models. In fact, the distinct broad and narrow UV line profiles clearly indicate that multiple zones are present. Our preferred estimates of the ionization and total column density in the X-ray absorber (log U=1.6, N_H=10^22.4 cm^-2) over predict the O VI 1032, 1038 absorption unless the X-ray absorber is also outflowing at ~56,000 km/s, but they over predict the Ne VIII 770, 780 absorption at all velocities. If we assume that the X-ray absorbing gas is outflowing at the same velocity of the UV-absorbing wind and that the wind is radiatively accelerated, then the outflow must be launched at a radius of < 10^15 cm from the central continuum source. The smallness of this radius casts doubts on the assumption of radiative acceleration.Comment: Accepted for Publication in Ap

HERMIONE: a randomized Phase 2 trial of MM-302 plus trastuzumab versus chemotherapy of physician's choice plus trastuzumab in patients with previously treated, anthracycline-naïve, HER2-positive, locally advanced/metastatic breast cancer.

BackgroundHuman epidermal growth factor receptor 2 (HER2)-positive breast cancer is a particularly aggressive form of the disease, and ultimately progresses in patients with metastases on standard therapies. Anthracyclines, such as doxorubicin, are an effective treatment for HER2-positive breast cancer, particularly when administered in combination with trastuzumab - however, doxorubicin-related cardiotoxicity has limited its use. Many patients are therefore never treated with anthracyclines, even upon disease progression, despite the potential for benefit. MM-302 is a novel, HER2-targeted antibody-liposomal doxorubicin conjugate that specifically targets HER2-overexpressing cells. Preclinical and Phase 1 data suggest that MM-302, as a monotherapy or in combination with trastuzumab, could be effective for managing previously treated, anthracycline-naïve, HER2-positive breast cancer, without the cardiotoxicity observed with free doxorubicin formulations.Methods/designHERMIONE is an open-label, multicenter, randomized (1:1) Phase 2 trial of MM-302 plus trastuzumab versus chemotherapy of physician's choice (gemcitabine, capecitabine, or vinorelbine) plus trastuzumab planned to enroll 250 anthracycline-naïve patients with locally advanced/metastatic HER2-positive breast cancer. Key inclusion criteria are: previous treatment with trastuzumab (with or without pertuzumab) in any setting; refractory or intolerant to pertuzumab (refractory to pertuzumab defined as progression in the locally advanced or metastatic setting, or disease recurrence during or within 12 months of completing pertuzumab-containing neoadjuvant and/or adjuvant therapy); and disease progression on, or intolerant to, ado-trastuzumab emtansine for locally advanced or metastatic disease. The trial is currently being conducted at sites in the USA, Canada, and Western Europe. Treatment will be administered in 21-day cycles, and will be continued until disease progression or unacceptable toxicity. The primary endpoint is independently assessed progression-free survival (PFS). Tumor response will be assessed every 6 weeks, and defined according to RECIST v1.1. Secondary endpoints include investigator-assessed PFS, overall survival (OS), OS rates at 6 months and 1 year, objective response rates, safety and tolerability, quality of life, and the pharmacokinetic profile of MM-302 plus trastuzumab.DiscussionThe HERMIONE study will evaluate the efficacy and safety of MM-302 plus trastuzumab in patients with refractory HER2-positive advanced/metastatic breast cancer for whom there are no standard of care therapies with a proven survival advantage.Trial registrationClinicaltrials.gov identifier: NCT02213744 . Registration date: 06AUG2014

FINITE H-DIMENSION DOES NOT IMPLY EXPRESSIVE COMPLETENESS

Accepted versio

Breaking Barriers to Successful Implementation of Day Case Laparoscopic Cholecystectomy.

Laparoscopic cholecystectomy is a common procedure performed in both emergency and elective settings. Our aim was to analyse the trends in laparoscopic surgery in Ireland in the public and private healthcare systems. In particular we studied the trend in day case laparoscopic cholecystectomy. National HIPE data for the years 2010-2012 was obtained. Similar datasets were obtained from the three main health insurers. 19,214 laparoscopic cholecystectomies were carried out in Ireland over the 3-year period. More procedures were performed in the public system than the private system from 2010-2012. There was a steady increase in surgeries performed in the public sector, while the private sector remained static. Although the ALOS was significantly higher in the public sector, there was an increase in the rate of day case procedures from 416 (13%) to 762 (21.9%). The day case rates in private hospitals increased only slightly from 29 (5.1%) in 2010 to 40 (5.9%) in 2012. Day case laparoscopic cholecystectomy has been shown to be a safe procedure, however significant barriers remain in place to the implementation of successful day case units nationwide

Differential effects of oilseed supplements on methane production and milk fatty acid concentrations in dairy cows

It is known that supplementing dairy cow diets with full-fat oilseeds can be used as a strategy to mitigate methane emissions, through their action on rumen fermentation. However, direct comparisons of the effect of different oil sources are very few, as are studies implementing supplementation levels that reflect what is commonly fed on commercial farms. The objective was to investigate the effect of feeding different forms of supplemental plant oils on both methane emissions and milk fatty acid (FA) profile. Four multiparous, Holstein-Friesian cows in mid-lactation were randomly allocated to one of four treatment diets in a 4 x 4 Latin square design with 28-day periods. Diets were fed as a TMR with a 50:50 forage:concentrate ratio (dry matter, DM basis) with the forage consisting of 75:25 maize silage:grass silage (DM). Dietary treatments were a control diet containing no supplemental fat, and three treatment diets containing extruded linseed (EL), calcium salts of palm and linseed oil (CPLO) or milled rapeseed (MR) formulated to provide each cow with an estimated 500 g additional oil/d (22 g oil/kg diet DM). Dry matter intake (DMI), milk yield, milk composition and methane production were measured at the end of each experimental period when cows were housed in respiration chambers for 4 days. There was no effect of treatment diet on DMI or milk protein or lactose concentration, but oilseed-based supplements increased milk yield compared with the control diet and milk fat concentration relative to control was reduced by 4 g/kg by supplemental EL. Feeding CPLO reduced methane production, and both linseed-based supplements decreased methane yield (by 1.8 L/kg DMI) and intensity (by 2.7 L/kg milk yield) compared with the control diet, but feeding MR had no effect on methane emission. All the fat supplements decreased milk total saturated fatty acid (SFA) concentration compared with the control, and SFA were replaced with mainly cis-9 18:1 but also trans FA (and in the case of EL and CPLO there were increases in polyunsaturated FA concentration). Supplementing dairy cow diets with these oilseed-based preparations affected milk FA profile and increased milk yield. However, only the linseed-based supplements reduced methane production, yield, or intensity, whilst feeding MR had no effect

The Intermediate Luminosity Optical Transient SN 2010da: The Progenitor, Eruption and Aftermath of a Peculiar Supergiant High-mass X-ray Binary

We present optical spectroscopy, ultraviolet to infrared imaging and X-ray observations of the intermediate luminosity optical transient (ILOT) SN 2010da in NGC 300 (d=1.86 Mpc) spanning from -6 to +6 years relative to the time of outburst in 2010. Based on the light curve and multi-epoch SEDs of SN 2010da, we conclude that the progenitor of SN 2010da is a ~10-12 Msol yellow supergiant possibly transitioning into a blue loop phase. During outburst, SN 2010da had a peak absolute magnitude of M<-10.4 mag, dimmer than other ILOTs and supernova impostors. We detect multi-component hydrogen Balmer, Paschen, and Ca II emission lines in our high-resolution spectra, which indicate a dusty and complex circumstellar environment. Since the 2010 eruption, the star has brightened by a factor of ~5 and remains highly variable in the optical. Furthermore, we detect SN 2010da in archival Swift and Chandra observations as an ultraluminous X-ray source (L~6x10^{39} erg/s). We additionally attribute He II 4686 Angstrom and coronal Fe emission lines in addition to a steady X-ray luminosity of ~10^{37} erg/s to the presence of a compact companion.Comment: published; updated citations and other minor edit

Inhibition of the mitochondrial pyruvate carrier protects from excitotoxic neuronal death.

Glutamate is the dominant excitatory neurotransmitter in the brain, but under conditions of metabolic stress it can accumulate to excitotoxic levels. Although pharmacologic modulation of excitatory amino acid receptors is well studied, minimal consideration has been given to targeting mitochondrial glutamate metabolism to control neurotransmitter levels. Here we demonstrate that chemical inhibition of the mitochondrial pyruvate carrier (MPC) protects primary cortical neurons from excitotoxic death. Reductions in mitochondrial pyruvate uptake do not compromise cellular energy metabolism, suggesting neuronal metabolic flexibility. Rather, MPC inhibition rewires mitochondrial substrate metabolism to preferentially increase reliance on glutamate to fuel energetics and anaplerosis. Mobilizing the neuronal glutamate pool for oxidation decreases the quantity of glutamate released upon depolarization and, in turn, limits the positive-feedback cascade of excitotoxic neuronal injury. The finding links mitochondrial pyruvate metabolism to glutamatergic neurotransmission and establishes the MPC as a therapeutic target to treat neurodegenerative diseases characterized by excitotoxicity

Self-assembling peptide and protein amyloids: from structure to tailored function in nanotechnology

Self-assembled peptide and protein amyloid nanostructures have traditionally been considered only as pathological aggregates implicated in human neurodegenerative diseases. In more recent times, these nanostructures have found interesting applications as advanced materials in biomedicine, tissue engineering, renewable energy, environmental science, nanotechnology and material science, to name only a few fields. In all these applications, the final function depends on: (i) the specific mechanisms of protein aggregation, (ii) the hierarchical structure of the protein and peptide amyloids from the atomistic to mesoscopic length scales and (iii) the physical properties of the amyloids in the context of their surrounding environment (biological or artificial). In this review, we will discuss recent progress made in the field of functional and artificial amyloids and highlight connections between protein/peptide folding, unfolding and aggregation mechanisms, with the resulting amyloid structure and functionality. We also highlight current advances in the design and synthesis of amyloid-based biological and functional materials and identify new potential fields in which amyloid-based structures promise new breakthroughs