Survival patterns and cancer determinants in families with myotonic dystrophy type 1.

BACKGROUND AND PURPOSE: Research indicates that patients with myotonic dystrophy type 1 (DM1) are at increased risk of cancer and early death. Family data may provide insights given DM1 phenotypic heterogeneity, the broad range of non-muscular manifestations and the usual delays in the diagnosis of DM1. METHOD: Family history data were collected from 397 genetically and/or clinically confirmed DM1 patients (respondents) enrolled in the US or UK myotonic dystrophy registries. Standardized mortality ratios were calculated for DM1 first-degree relatives (parents, siblings and offspring) by their reported DM1 status (affected, unaffected or unknown). For cancer-related analyses, mixed effects logistic regression models were used to evaluate factors associated with cancer development in DM1 families, including familial clustering. RESULTS: A total of 467 deaths and 337 cancers were reported amongst 1737 first-degree DM1 relatives. Mortality risk amongst relatives reported as DM1-unaffected was comparable to that of the general population [standardized mortality ratio (SMR) 0.82, P = 0.06], whilst significantly higher mortality risks were noted in DM1-affected relatives (SMR = 2.47, P < 0.0001) and in those whose DM1 status was unknown (SMR = 1.60, P < 0.0001). In cancer risk analyses, risk was higher amongst families in which the DM1 respondent had cancer (odds ratio 1.95, P = 0.0001). Unknown DM1 status in the siblings (odds ratio 2.59, P = 0.004) was associated with higher cancer risk. CONCLUSION: There is an increased risk of death, and probably cancer, in relatives with DM1 and in those whose DM1 status is unknown. This suggests a need to perform a careful history and physical examination, supplemented by genetic testing, to identify family members at risk for DM1 and who might benefit from disease-specific clinical care and surveillance.

Nutritional quality of heat-sensitive food materials in intermittent microwave convective drying.

BACKGROUND: The retention of health promoting components in nutrient-rich dried food is significantly affected by the dehydration method. Theoretical and experimental investigations reported in the literature have demonstrated that intermittent microwave convective drying (IMCD) can effectively improve the drying performance. However, the impact of this advanced drying method on the quality food has not been adequately investigated. DESIGN: A programmable NN-SD691S Panasonic inverter microwave oven (1100 W, 2450 MHz) was employed for the experiments. The microwave power level was set at 100 W and ran for 20 seconds at different power ratios and the constant hot air conditions was set to a temperature of 60°C and 0.86 m/s air velocity. OBJECTIVE: In this study, natural bioactive compounds (ascorbic acid and total polyphenol), water activity, colour and microstructure modifications which can occur in IMCD were investigated, taking kiwifruit as a sample. RESULTS AND DISCUSSION: The microwave (MW) power ratio (PR) had significant impact on different quality attributes of dried samples. The results demonstrate that applying optimum level MW power and intermittency could be an appropriate strategy to significantly improve the preservation of nutrient contents, microstructure and colour of the dried sample. The IMCD at PR 1:4 was found to be the ideal drying condition with the highest ascorbic acid retention (3.944 mg/g DM), lowest colour change (ΔERGB = 43.86) and a porous microstructure. However, the total polyphenol content was better maintained (3.701 mg GAE/g DM) at higher microwave density (PR 1:3). All samples attained a desirable level of water activity which is unsusceptible for microorganism growth and reproduction. CONCLUSION: Overall, IMCD significantly improved the drying performance and product quality compared to traditional convective drying.

Pigmentation phenotype, photosensitivity and skin neoplasms in patients with myotonic dystrophy.

BACKGROUND AND PURPOSE: Recent studies have suggested a possible excess risk of skin neoplasms in patients with myotonic dystrophy (DM). Risk factors related to this observation have not been defined. METHOD: Information regarding personal history of skin tumors, pigmentation phenotype, and skin reaction to sun exposure were collected from 266 DM patients who were enrolled in the US National Institutes of Health National Registry of Myotonic Dystrophy and Facioscapulohumeral Muscular Dystrophy Patients and Family Members. RESULTS: Seventy-seven subjects reported having skin tumors that were either benign (n = 31), malignant (n = 32) or both (n = 14). Female gender [odds ratio (OR) = 2.27, 95% confidence interval (CI) 1.02-5.05, P = 0.04], older age (OR = 1.10, 95% CI 1.05-1.16, P < 0.001) and DM1 subtype (OR = 3.42, 95% CI 1.27-9.26, P = 0.02) were associated with a malignant skin tumor. The associations between malignant skin tumors and known risk factors [light eye color (OR = 1.62, 95% CI 0.78-3.39, P = 0.20), light skin complexion (OR = 1.31, 95% CI 0.63-2.73, P = 0.48) and moderate/extensive face freckles (OR = 1.47, 95% CI 0.50-4.34, P = 0.49)] were modest. Strong, but not statistically significant, associations were noted with sunburn reactions when exposed to sunlight (OR = 4.28, 95% CI 0.91-19.95, P = 0.06, and OR = 2.19, 95% CI 0.67-7.09, P = 0.19, for sunburn with and without blistering, respectively). CONCLUSIONS: Although our study was limited by small sample size, the risk factors for malignant skin tumors in DM strongly resemble the general population. It is recommended that DM patients adhere to sun exposure protective behavior.

Pro-angiogenic impact of dental stem cells in vitro and in vivo.

Within the field of dental tissue engineering, the establishment of adequate tissue vascularization is one of the most important burdens to overcome. As vascular access within the tooth is restricted by the apical foramen, it is of major importance to implement effective vascularization strategies in order to recreate viable components of teeth and periodontal tissues. However, while the current regenerative approaches focus on the use of dental stem cells (DSCs), little is known about these cells and their ability to promote angiogenesis. Therefore, the present study aimed to elucidate the paracrine angiogenic properties of postnatal DSCs, in particular dental pulp stem cells (DPSCs), stem cells from the apical papilla (SCAPs) and dental follicle precursor cells (FSCs). An antibody array, together with RT-PCR and ELISA, pointed out the differential expression of pro-angiogenic as well as anti-angiogenic factors by cultured DSCs and human gingival fibroblasts (HGF-1). Despite the secretion of proliferation-promoting factors, DSCs caused no notable increase in the proliferation of human microvascular endothelial cells (HMEC-1). With regard to other aspects of the angiogenic cascade, DPSCs, SCAPs and HGF-1 significantly promoted endothelial migration in a transwell migration assay. DPSCs also had a pronounced effect on endothelial tubulogenesis, as was shown by an in vitro Matrigel™ assay. In the last part of this study, a chorioallantoic membrane assay demonstrated a sustained pro-angiogenic impact of DPSCs and SCAPs in an in vivo setting. Collectively, these data indicate a predominant pro-angiogenic influence of DPSCs and SCAPS in vitro and in vivo in comparison to FSCs, suggesting that both stem cell populations could potentially promote the vascularization of regenerated dental tissues.

Dental stem cells and their promising role in neural regeneration: an update.

INTRODUCTION: Stem cell-based therapies are considered to be a promising treatment method for several clinical conditions such as Alzheimer's disease, Parkinson's disease, spinal cord injury, and many others. However, the ideal stem cell type for stem cell-based therapy remains to be elucidated. DISCUSSION: Stem cells are present in a variety of tissues in the embryonic and adult human body. Both embryonic and adult stem cells have their advantages and disadvantages concerning the isolation method, ethical issues, or differentiation potential. The most described adult stem cell population is the mesenchymal stem cells due to their multi-lineage (trans)differentiation potential, high proliferative capacity, and promising therapeutic values. Recently, five different cell populations with mesenchymal stem cell characteristics were identified in dental tissues: dental pulp stem cells, stem cells from human exfoliated deciduous teeth, periodontal ligament stem cells, dental follicle precursor cells, and stem cells from apical papilla. CONCLUSION: Each dental stem cell population possesses specific characteristics and advantages which will be summarized in this review. Furthermore, the neural characteristics of dental pulp stem cells and their potential role in (peripheral) neural regeneration will be discussed.

Effect of isolation methodology on stem cell properties and multilineage differentiation potential of human dental pulp stem cells.

Dental pulp stem cells (DPSCs) are an attractive alternative mesenchymal stem cell (MSC) source because of their isolation simplicity compared with the more invasive methods associated with harvesting other MSC sources. However, the isolation method to be favored for obtaining DPSC cultures remains under discussion. This study compares the stem cell properties and multilineage differentiation potential of DPSCs obtained by the two most widely adapted isolation procedures. DPSCs were isolated either by enzymatic digestion of the pulp tissue (DPSC-EZ) or by the explant method (DPSC-OG), while keeping the culture media constant throughout all experiments and in both isolation methods. Assessment of the stem cell properties of DPSC-EZ and DPSC-OG showed no significant differences between the two groups with regard to proliferation rate and colony formation. Phenotype analysis indicated that DPSC-EZ and DPSC-OG were positive for CD29, CD44, CD90, CD105, CD117 and CD146 expression without any significant differences. The multilineage differentiation potential of both stem cell types was confirmed by using standard immuno(histo/cyto)chemical staining together with an in-depth ultrastructural analysis by means of transmission electron microscopy. Our results indicate that both DPSC-EZ and DPSC-OG could be successfully differentiated into adipogenic, chrondrogenic and osteogenic cell types, although the adipogenic differentiation of both stem cell populations was incomplete. The data suggest that both the enzymatic digestion and outgrowth method can be applied to obtain a suitable autologous DPSC resource for tissue replacement therapies of both bone and cartilage.

Magnetic resonance imaging of human dental pulp stem cells in vitro and in vivo.

Recent advances in stem cell research have shown the promising nature of mesenchymal stem cells as plausible candidates for cell-based regenerative medicine. Many studies reported the use of human dental pulp stem cells (hDPSCs), which possess self-renewal capacity, high proliferation potential, and the ability to undergo multilineage differentiation. Together with this therapeutic approach, development of effective, noninvasive and nontoxic imaging techniques for visualizing and tracking the cells in vivo is crucial for the evaluation and improvement of stem cell therapy. Magnetic resonance imaging (MRI) is one of the most powerful diagnostic imaging techniques currently available for in vivo diagnosis and has been proposed as the most attractive modality for monitoring stem cell migration. The aim of this study was to investigate the labeling efficiency of hDPSCs using superparamagnetic iron oxide (SPIO) particles in order to allow visualization using in vitro and in vivo MRI without influencing cellular metabolism. MRI and transmission electron microscopy (TEM) showed optimal uptake with low SPIO concentrations of 15 µg/ml in combination with 0.75 µg/ml poly-L-lysine (PLL) resulting in more than 13 pg iron/cell and an in vitro detection limit of 50 labeled cells/µl. Very low SPIO concentrations in the culture medium resulted in extremely high labeling efficiency not reported before. For these conditions, tetrazolium salt assays showed no adverse effects on cell viability. Furthermore, in vivo MRI was performed to detect labeled hDPSCs transplanted into the brain of Rag 2-γ C immune-deficient mice. Transplanted cells did not show any signs of tumorgenecity or teratoma formation during the studied time course. We have reported on a labeling and imaging strategy to visualize human dental pulp stem cells in vivo using MRI. These data provide a solid base to allow cell tracking in future regenerative studies in the brain longitudinally.

Expression pattern of basal markers in human dental pulp stem cells and tissue.

Dental pulp stem cells (DPSC) have been characterized as a multipotent stem cell population, with the ability to differentiate into mesodermal and neural cell lineages. Although 'de novo' expression of neural markers after differentiation is mostly considered as proof of differentiation, expression of these markers in undifferentiated DPSC is not well described. Therefore, an immunocytochemical analysis was performed to evaluate the neural marker expression of undifferentiated human DPSC (hDPSC) in in vitro cultures. Undifferentiated hDPSC uniformly expressed neural markers ß-III-tubulin, S100 protein and synaptophysin. A subset of the population showed a positive immune-reactivity for galactocerebroside, neurofilament and nerve growth factor receptor p75. Furthermore, the location of possible stem cell niches, present in young dental pulp tissue, was determined by means of immunohistochemistry based on mesenchymal and neural marker expression. The results demonstrated the presence of a perivascular niche and a second stem cell niche at the cervical area. In adult dental pulp, only a perivascular niche could be observed. Based on the expression of neural markers in naïve DPSC, it has to be taken into account that not only the marker expression upon neural differentiation must be analyzed, but an ultrastructural analysis of the morphological changes and functional studies must also be performed to confirm a successful differentiation.

Two souls in one breast--a case report of the rock star double.

A case report is presented and analyzed of a patient who was a double for and imitator of the late Freddy Mercury, lead singer for the rock group Queen. The patient was socially excluded, rejected by his peers, and neglected by his parents. As a consequence he experienced self-hate, shame, low self-esteem, and serious identity problems. Although impressive Freddy Mercury imago appeared to benefit the patient, mainly though social acceptance and enhanced opportunities for relationships, in the long-term it could not cover up his deep-rooted and repressed identity problems. The struggle to cope with these problems is illustrated here.

Ultrastructural and immunocytochemical analysis of multilineage differentiated human dental pulp- and umbilical cord-derived mesenchymal stem cells.

Mesenchymal stem cells (MSCs) are one of the most promising stem cell types due to their availability and relatively simple requirements for in vitro expansion and genetic manipulation. Besides the well-characterized MSCs derived from bone marrow, there is growing evidence suggesting that dental pulp and the umbilical cord matrix both contain a substantial amount of cells having properties similar to those of MSCs. In order to assess the potential of dental pulp-derived MSCs (DPSC) and umbilical cord-derived MSCs (UCSC) in future clinical applications, it is essential to gain more insight into their differentiation capacity and to evaluate the tissues formed by these cells. In the present study, the morphological and ultrastructural characteristics of DPSC and UCSC induced towards osteogenic, adipogenic, and chondrogenic lineages were investigated. Cultured DPSC and UCSC showed a similar expression pattern of antigens characteristic of MSCs including CD105, CD29, CD44, CD146, and STRO-1. Under appropriate culture conditions, both DPSC and UCSC showed chondrogenic and osteogenic potential. Adipogenesis could be only partially induced in DPSC resulting in the de novo expression of fatty acid binding protein (FABP), whereas UCSC expressed FABP combined with a very high accumulation of lipid droplets in the cytoplasm. Our results demonstrate, at the biochemical and ultrastructural level, that DPSC display at least bilineage potential, whereas UCSC, which are developmentally more primitive cells, show trilineage potential. We emphasize that transmission electron microscopical analysis is useful to elucidate detailed structural information and provides indisputable evidence of differentiation. These findings highlight their potential therapeutic value for cell-based tissue engineering.

Mexiletine is an effective antimyotonia treatment in myotonic dystrophy type 1.

OBJECTIVE: To determine if mexiletine is safe and effective in reducing myotonia in myotonic dystrophy type 1 (DM1). BACKGROUND: Myotonia is an early, prominent symptom in DM1 and contributes to decreased dexterity, gait instability, difficulty with speech/swallowing, and muscle pain. A few preliminary trials have suggested that the antiarrhythmic drug mexiletine is useful, symptomatic treatment for nondystrophic myotonic disorders and DM1. METHODS: We performed 2 randomized, double-blind, placebo-controlled crossover trials, each involving 20 ambulatory DM1 participants with grip or percussion myotonia on examination. The initial trial compared 150 mg of mexiletine 3 times daily to placebo, and the second trial compared 200 mg of mexiletine 3 times daily to placebo. Treatment periods were 7 weeks in duration separated by a 4- to 8-week washout period. The primary measure of myotonia was time for isometric grip force to relax from 90% to 5% of peak force after a 3-second maximum grip contraction. EKG measurements and adverse events were monitored in both trials. RESULTS: There was a significant reduction in grip relaxation time with both 150 and 200 mg dosages of mexiletine. Treatment with mexiletine at either dosage was not associated with any serious adverse events, or with prolongation of the PR or QTc intervals or of QRS duration. Mild adverse events were observed with both placebo and mexiletine treatment. CONCLUSIONS: Mexiletine at dosages of 150 and 200 mg 3 times daily is effective, safe, and well-tolerated over 7 weeks as an antimyotonia treatment in DM1. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that mexiletine at dosages of 150 and 200 mg 3 times daily over 7 weeks is well-tolerated and effective in reducing handgrip relaxation time in DM1.

Six-Minute Walk Test demonstrates motor fatigue in spinal muscular atrophy.

BACKGROUND: In spinal muscular atrophy (SMA), weakness, decreased endurance, and fatigue limit mobility. Scales have been developed to measure function across the wide spectrum of disease severity. However, these scales typically are observer dependent, and scores are based on sums across Likert-scaled items. The Six-Minute Walk Test (6MWT) is an objective, easily administered, and standardized evaluation of functional exercise capacity that has been proven reliable in other neurologic disorders and in children. METHODS: To study the performance of the 6MWT in SMA, 18 ambulatory participants were evaluated in a cross-sectional study. Clinical measures were 6MWT, 10-m walk/run, Hammersmith Functional Motor Scale-Expanded (HFMSE), forced vital capacity, and handheld dynamometry. Associations between the 6MWT total distance and other outcomes were analyzed using Spearman correlation coefficients. A paired t test was used to compare the mean distance walked in the first and sixth minutes. RESULTS: The 6MWT was associated with the HFMSE score (r = 0.83, p < 0.0001), 10-m walk/run (r = -0.87, p < 0.0001), and knee flexor strength (r = 0.62, p = 0.01). Gait velocity decreased during successive minutes in nearly all participants. The average first minute distance (57.5 m) was significantly more than the sixth minute distance (48 m) (p = 0.0003). CONCLUSION: The Six-Minute Walk Test (6MWT) can be safely performed in ambulatory patients with spinal muscular atrophy (SMA), correlates with established outcome measures, and is sensitive to fatigue-related changes. The 6MWT is a promising candidate outcome measure for clinical trials in ambulatory subjects with SMA.

Overview of the ability of different treatment methods for liquid and solid manure to inactivate pathogens.

The use of manure as a fertilizer in agriculture includes the risk of spreading pathogenic infectious agents to the environment, to animals and humans. The treatment of manure can help avoid or reduce these risks. Even if the treatment is dominated by economic considerations such as biogas production, ammonia stripping or phosphorous precipitation, the hygienic aspect should be kept in mind. Otherwise, new infection chains may be established by the use of insufficiently treated manure by-products such as fertilizers still containing infective pathogens. Treatment plants should use a concept according to HACCP principles that includes hazard analysis, risk assessment, the determination of process relevant CCPs and the validation of the process by determining the hygienizing efficiency using representative test organisms as well as microbial end product supervision. Treatment methods can be divided into physical, chemical and microbiological treatment, sometimes used in combination. For economical reasons, only composting or anaerobic treatment (biogas) or, to a minor extent, aerobic thermophilic stabilization (ATS) are used as routine preventive measures on a farm level. In cases of outbreaks of notifiable diseases both physical and chemical treatment of manure can lead to reliable disinfected/pasteurised end products which can be used in agriculture without long-lasting risks for soil fertility or the environment.

Enforced dismissal of Dutch patients who are not motivated to leave forensic psychiatric settings and treatment--is it ethically acceptable?

The ethical issues surrounding enforced release of forensic psychiatric patients are discussed in this article. Some patients disagree with their discharge because they are convinced that they need the continued structure of the hospital setting and the social relationships with fellow patients and therapists. They fear that without this structure they will unable to cope with the challenges of life in society and the consequence could be relapse and recidivism. Suggestions for guidelines on a practical approach to this category of forensic patients are presented.

Thermal decomposition studies of the polyhedral oligomeric silsesquioxane, POSSh, and when it is impregnated with the metallocene bis(eta5-cyclopentadienyl)zirconium (IV) dichloride or immobilized on silica.

Thermal decomposition studies of the free polyhedral oligomeric silsesquioxane, POSSh, and when this compound has been impregnated with Cp2ZrCl2 (Cp = eta5-C5H5) or immobilized on SiO2 were conducted using infrared emission spectroscopy (IES) over a 100-1000 degrees C temperature range and by thermogravimetric analysis (TGA). The organic groups in POSS(h) apparently decompose thermally into Si-CH3, Si-H and other fragments. Upon impregnation with Cp2ZrCl2, however, a different thermal decomposition pathway was followed and new infrared emission bands appeared in the 1000-900 cm(-1) region suggesting the formation of Si-O-Zr moieties. When immobilized on SiO2 and subjected to thermal decomposition, the POSSh compound lost its organic groups and the inorganic structure remaining was incorporated into the SiO2 framework.

Nondestructive identification of arsenic and cobalt minerals from Cobalt city, Ontario, Canada: arsenolite, erythrite, and spherocobaltite on pararammelsbergite.

A Ni-Co-As ore sample from Cobalt City, Ontario, Canada, was examined with scanning electron microscopy and energy dispersive X-ray analysis. In addition to cobaltian pararammelsbergite with variable cobalt content, for which Cobalt City is the type locality, and erythrite, one new mineral was observed for this locality. Well-formed crystals of arsenolite, As(2)O(3), were found embedded in what appears to be fibrous spherocobaltite, CoCO(3). Additional information was obtained by Raman microscopy, confirming the identification of the arsenolite. Both are considered to be secondary minerals formed by exposure to air resulting in oxidation and the formation of secondary carbonates.

Electron paramagnetic resonance, optical absorption and IR spectroscopic studies of the sulphate mineral apjohnite.

Apjohnite, a naturally occurring Mn-bearing pseudo-alum from Terlano, Bolzano, Italy, has been characterized by EPR, optical, IR and Raman spectroscopy. The optical spectrum exhibits a number of electronic bands around 400 nm due to Mn(II) ion in apjohnite. From EPR studies, the parameters derived, g=2.0 and A=8.82 mT, confirm MnO(H(2)O)(5) distorted octahedra. The presence of iron impurity in the mineral is reflected by a broad band centered around 8400 cm(-1) in the NIR spectrum. A complex band profile appears strongly both in IR and Raman spectra with four component bands around 1100 cm(-1) due to the reduction of symmetry for sulphate ion in the mineral. A strong pair of IR bands at 1681 and 1619 cm(-1) with variable intensity is a proof for the presence of water in two states in the structure of apjohnite.

Determinants of increased risk of schizophrenia in immigrants. What could be done by our western governments?

Some categories of immigrants run an increased risk of suffering from schizophrenia Such vulnerability might be determined by virus infections, diabetes mellitus and obesity during pregnancy, racism, socio-economic disadvantage, a lack of social support/network, stressful events and alienating environments, culture shock (as in the cases of immigrants and refugees), technological dominance, lack of coping skills (wrong coping strategies), social-emotional adjustment and acculturation problems. The governments and mental health services of our civilized countries should prepare prevention and intervention programs that are geared to deal with the correlates and causes of schizophrenia in immigrants.

Quantitative analysis of the "warm-up" phenomenon in myotonic dystrophy type 1.

To quantitate improvement in hand-grip myotonia and muscle strength (i.e., the "warm-up" phenomenon) in myotonic dystrophy type 1 (DM1), six successive, standardized maximum voluntary isometric contractions (MVICs) were recorded on 2 separate days using a computerized isometric hand-grip myometer in 25 genetically confirmed DM1 patients and in 17 normal controls. An automated computer program placed cursors along the declining (relaxation) phase of the MVICs at 90%, 50%, and 5% of peak force (PF) and calculated relaxation times (RTs) between these points. Mean 90% to 5% RT (a measure of myotonia) rapidly declined from 2.5 s in MVIC 1 to 0.8 s in MVIC 6 (warm-up = 1.7 s) in DM1; in controls, it remained 0.4 s for all six MVICs (warm-up = 0). In DM1, 70% of warm-up occurred between MVIC 1 and 2, almost exclusively in the terminal 50% to 5% phase of muscle relaxation. Day 1 warm-up was highly correlated with the severity of myotonia, and with day 2 warm-up. Improvement in myotonia was not accompanied by either transient paresis or improvement in PF. We conclude that, with this testing paradigm: warm-up of myotonia in DM1 can be reliably measured; is proportional to severity of myotonia; occurs rapidly, being most prominent between the first and second grips; mainly results from shortening of the terminal phase of muscle relaxation; and is not accompanied by significant warm-up in force output.