Genetic variation in alcohol dehydrogenase is associated with neurocognition in men with HIV and history of alcohol use disorder: preliminary findings

The co-occurrence of HIV and alcohol use disorder (AUD) amplifies risk for neural injury and neurocognitive deficits. However, the substantial neurocognitive heterogeneity across HIV+/AUD+ individuals suggests inter-individual differences in vulnerability to the neurotoxicity of comorbid HIV/AUD. Genetic variation in alcohol dehydrogenase (ADH), which metabolizes ethanol, may contribute to inter-individual neurocognitive variability. We evaluated associations between five ADH single-nucleotide polymorphisms (SNPs) and neurocognition in men stratified by HIV and lifetime AUD status. Neurobehavioral assessments were administered to 153 men. Three-way ANOVAs examined the interaction of HIV, AUD, and ADH SNPs on global and domain-specific demographically corrected T scores. Follow-up ANCOVAs adjusted for age, estimated verbal IQ, depression, and remote non-alcohol substance use disorders. HIV/AUD groups differed globally and for verbal fluency, working memory, executive function, and processing speed T scores specifically, with HIV+/AUD+ exhibiting the poorest performance. ADH4 (rs1126671) was associated with large effects on working memory (d?=???1.16, p?=?.001) and executive function (d?=???0.77, p?=?.028) selectively in HIV+/AUD+, which remained significant in ANCOVA models. ADH1A (rs3819197) moderated the deleterious effects of HIV+/AUD+ on processing speed such that HIV+/AUD+ related to slower information processing in A allele carriers but not GG homozygotes (ps?<?0.03). Preliminary findings suggest genetic variation in the ADH pathway moderates the deleterious neurocognitive effects of comorbid HIV/AUD. Differential metabolism of heavy ethanol exposure may compromise neurocognition under conditions of neurobiological stress, such as in HIV infection. The functional effects on ethanol metabolism of ADH SNPs examined in this study remain poorly understood, warranting further examination of pharmacokinetic mechanisms mediating ADH gene-neurobehavior relationships in HIV.

     

MR shoulder arthrography in patients younger than 40 years of age: Frequency of rotator cuff tear versus labroligamentous pathology

The purpose of this study was to compare the frequency of rotator cuff pathology versus labroligamentous pathology in patients younger than 40 years and to determine whether routine MR arthrography is justified in all patients in this age group, regardless of the clinical symptoms. The MR arthrography was carried out on 332 patients 40 years of age and younger. Two hundred and forty‐three patients had clinical history of instability and possible labroligamentous pathology. Eighty‐nine patients had no history or physical signs of instability and were referred for reasons other than instability, such as assessment for rotator cuff tear. In the 243 patients younger than 40 years with clinical history of potential labral pathology, 39% (95/243) showed a labral tear and 2.1% (5/243) had a full‐thickness rotator cuff tendon tear. In the 89 patients with no history suggesting labral pathology, 19% (17/89) showed an unsuspected labral tear and 4.5% (4/89) had a full‐thickness rotator cuff tear. These findings suggest that, regardless of the clinical indication for referral, patients aged 40 and less referred for shoulder MRI should be imaged using MR arthrography because of the significant risk that symptoms are related to unsuspected labral pathology.     

Palliation und Frakturprävention

Sind Skelettmetastasen nachweisbar, so ist dies ein untrügliches Zeichen dafür, dass sich die Tumorerkrankung im gesamten Organismus ausgebreitet hat. Eine Heilung ist nur in seltenen F?llen zu erwarten. Die Therapie ist in diesem Stadium eher palliativ. Bei konservativer Therapiestrategie sollte wegen des Risikos von pathologischen Frakturen eine Abstimmung mit dem Chirurgen und Orthop?den erfolgen, um ggf. rechtzeitig operativ zu intervenieren. W?hrend eine pr?ventive operative Stabilisierung im Bereich der langen R?hrenknochen relativ unproblematisch ist, kann sie im Becken- und Wirbels?ulenbereich Komplikationen mit sich bringen.     

Clinical facilitators: a new way of working

AIM: To improve the quality and quantity of student clinical placements in an NHS trust. METHOD: When nurse training was under review, a 12-month pilot study was undertaken to introduce 12 clinical facilitators to acute and surgical wards at six trust sites on a supernumerary basis. As well as guiding the student, each facilitator liaised with a link tutor and ward staff, thereby maintaining continuity. The project team worked closely with the trust audit department and collected data using a variety of methods. The project leader developed an audit questionnaire for students, ward staff and college tutors. The initial answers were used as a baseline, then the same questionnaire was redistributed so the data could be analysed and compared. RESULTS: Most of the students felt more supported and confident to practise. The clinical facilitators were able to help ground the tutors' practice knowledge in reality, and the tutors built up the clinical facilitators' confidence in curricular issues and skills, such as presentation and teaching strategies. CONCLUSION: The clinical facilitator can strengthen partnerships between education and service and offer a model for practical facilitation.     

Early spatial memory deficit induced by 2,5-hexanedione in the rat

2,5-Hexanedione (2,5-HD), the major common neurotoxic metabolite of n-hexane and methyl n-butyl ketone, causes a delayed neuropathy with associated sensorimotor impairments. The question arises as to whether specific cognitive deficits occur even prior to changes in sensorimotor ability. The present experiments examined the effects of 2,5-HD on spatial navigation of rats in a water maze at levels/times that did not affect spontaneous exploratory motor activity in an open field holeboard apparatus. Exposure to 1% 2,5-HD in the drinking water for 2 weeks did not significantly affect escape learning, as measured by latency to find a hidden platform. However, 2,5-HD treated animals were impaired in the use of a spatial strategy during a recall test. A similar impairment in spatial memory was observed after i.p. injection of 500 mg/kg/day 2,5-HD for 4 days, in the absence of significant changes in sensorimotor ability or weight loss. Thus 2,5-HD may mediate some of the cognitive effects of hexacarbons and these changes can occur prior to the development of motor symptoms.     

Inhibition of furin-like enzymes blocks interleukin-1alpha/oncostatin M-stimulated cartilage degradation

OBJECTIVE: To investigate the role of furin-like enzymes in the proteolytic cascades leading to cartilage breakdown and to examine which collagenase(s) contribute to collagen degradation. METHODS: Bovine nasal cartilage was stimulated to resorb with the addition of interleukin-1alpha (IL-1alpha)/oncostatin M (OSM) in the presence or absence of a furin inhibitor, Dec-RVKR-CH(2)Cl, or selective matrix metalloproteinase 1 (MMP-1) inhibitors. Collagen and proteoglycan levels were determined by assay of hydroxyproline and sulfated glycosaminoglycan, respectively. Collagenase and gelatinase activity were measured using (3)H-acetylated collagen and gelatin zymography, respectively. RESULTS: The addition of Dec-RVKR-CH(2)Cl to stimulated cartilage reduced the release of collagen fragments and the levels of active collagenase and MMP-2, suggesting that furin-like enzymes are involved in the cascades leading to activation of procollagenases. At MMP inhibitor concentrations that selectively inhibit MMP-1, no inhibition of collagen release was observed, but increasing the concentration to the 50% inhibition concentration for MMP-13 resulted in a 50% blockage of collagen release. The addition of Dec-RVKR-CH(2)Cl to resorbing cartilage also partially blocked proteoglycan release, thus demonstrating a role for furin-activated enzymes in the pathways leading to proteoglycan degradation. CONCLUSION: Furin-like enzymes are involved in cascades leading to activation of procollagenases and degradation of collagen. MMP-13, which can be activated by furin-processed membrane-type 1 MMP-1, appears to be a major collagenase involved in collagen degradation induced by IL-1alpha/OSM. Furin-like enzymes also appear to play a role in the pathways leading to proteoglycan degradation. These findings are of importance when considering proteinase inhibition as a target for therapeutic intervention in arthritic diseases.