Health behaviour practices and expectations for a local cancer survivorship programme: a cross-sectional study of survivors of childhood cancer in Hong Kong.

INTRODUCTION: Lifestyle choices may influence health outcomes in cancer survivors. This study of childhood cancer survivors in Hong Kong investigated factors associated with health-protective and health-damaging behaviours; it also examined expectations of a survivorship programme. METHODS: This cross-sectional study recruited survivors of childhood cancer ≥2 years after treatment. Survivors completed a structured questionnaire to report their health practices and the perceived values of survivorship programme components. Multivariable logistic regression analysis was conducted to identify factors associated with health behaviours. RESULTS: Two hundred survivors were recruited (mean age=23.4 ± 8.8 years; mean duration since treatment, 13.4 ± 7.6 years). Comparatively few survivors exercised ≥4 days/week (16.0%), used sun protection (18.0%), and had a balanced diet (38.5%). Furthermore, comparatively few survivors reported that they had not undergone any immunisation (24.5%) or were unsure (18.5%) about their immunisation history. Most adult survivors were never-drinkers (71.0%) and never-smokers (93.0%). Brain tumour survivors were more likely to have unhealthy eating habits, compared with haematological malignancy survivors (odds ratio [OR]=2.45; 95% confidence interval [CI]=1.29-4.68). Lower socioeconomic status was associated with inadequate sun protection (OR=0.20; 95% CI=0.05-0.83), smoking (OR=5.13; 95% CI=1.48-17.75), and exposure to second-hand smoke (OR=3.52; 95% CI=1.42-8.69). Late-effects screening (78.5%) and psychosocial services to address psychological distress (77%) were considered essential components of a survivorship programme. CONCLUSIONS: Despite the low prevalences of health-damaging behaviours, local survivors of childhood cancer are not engaging in health-protective behaviours. A multidisciplinary programme addressing late effects and psychosocial aspects may address the multifaceted needs of this special population.

Multicentre study of hospitalised patients with sports- and recreational cycling-related traumatic brain injury in Hong Kong.

INTRODUCTION: Cycling is associated with a greater risk of traumatic brain injury (TBI) than other recreational activities. This study aimed to investigate the epidemiology of sports-related TBI in Hong Kong and to examine predictors for recreational cycling-induced intracranial haemorrhage. METHODS: This retrospective multicentre study included patients diagnosed with sports-related TBI in public hospitals in Hong Kong from 2015 to 2019. Computed tomography scans were reviewed by an independent assessor. The primary endpoint was traumatic intracranial haemorrhage. The secondary endpoint was an unfavourable Glasgow Outcome Scale (GOS) score at discharge from hospital. RESULTS: In total, 720 patients were hospitalised with sports-related TBI. The most common sport was cycling (59.2%). The crude incidence of cycling-related TBI was 1.1 per 100 000 population. Cyclists were more likely to exhibit intracranial haemorrhage and an unfavourable GOS score, compared with patients who had TBI because of other sports. Although 47% of cyclists had intracranial haemorrhage, only 15% wore a helmet. In multivariate analysis, significant predictors for intracranial haemorrhage were age ≥60 years, antiplatelet medication, moderate or severe TBI, and skull fracture. Among 426 cyclists, 375 (88%) had mild TBI, and helmet wearing was protective against intracranial haemorrhage, regardless of age, antiplatelet medication intake, and mechanism of injury. Of 426 cyclists, 31 (7.3%) had unfavourable outcomes on discharge from hospital. CONCLUSIONS: The incidence of sports-related TBI is low in Hong Kong. Although cycling-related head injuries carried greater risks of intracranial haemorrhage and unfavourable outcomes compared with other sports, most cyclists experienced good recovery. Helmet wearing among recreational cyclists with mild TBI was protective against intracranial haemorrhage and skull fracture.

Correction to: Recommendations for the nomenclature of enteroviruses and rhinoviruses.

Unfortunately, one of the affiliations of author "A. E. Gorbalenya" was missed in original version. The affiliation is updated here.

Recommendations for the nomenclature of enteroviruses and rhinoviruses.

Enteroviruses (EVs) and rhinoviruses (RVs) are significant pathogens of humans and are the subject of intensive clinical and epidemiological research and public health measures, notably in the eradication of poliovirus and in the investigation and control of emerging pathogenic EV types worldwide. EVs and RVs are highly diverse in their antigenic properties, tissue tropism, disease associations and evolutionary relationships, but the latter often conflict with previously developed biologically defined terms, such as "coxsackieviruses", "polioviruses" and "echoviruses", which were used before their genetic interrelationships were understood. This has created widespread formatting problems and inconsistencies in the nomenclature for EV and RV types and species in the literature and public databases. As members of the International Committee for Taxonomy of Viruses (ICTV) Picornaviridae Study Group, we describe the correct use of taxon names for these viruses and have produced a series of recommendations for the nomenclature of EV and RV types and their abbreviations. We believe their adoption will promote greater clarity and consistency in the terminology used in the scientific and medical literature. The recommendations will additionally provide a useful reference guide for journals, other publications and public databases seeking to use standardised terms for the growing multitude of enteroviruses and rhinoviruses described worldwide.

Prospective evaluation of treatment response and disease reversibility of paediatric localized scleroderma (morphoea) to steroids and methotrexate using multi-modal imaging.

BACKGROUND: Paediatric localized scleroderma is a severe inflammatory disorder associated with tissue atrophy, often leading to disability. Assessing disease activity and response to treatment has always been challenging and remains an important difficulty in clinical practice. OBJECTIVES: To investigate prospectively the efficacy of systemic treatment with corticosteroids and methotrexate in children with localized scleroderma and the validity of infrared thermography, laser Doppler flowmetry and high-frequency ultrasound in assessing disease activity. METHODS: Children with localized scleroderma were prospectively treated with corticosteroids (initially pulsed IV methylprednisolone 30 mg/kg/day, maximum 500 mg/day and/or oral prednisolone 0.5-1 mg/kg/day) and methotrexate (15 mg/m2 weekly). Treatment response was evaluated using a clinical activity score. Skin temperature, blood flow, dermal thickness and dermal echogenicity of clinically active skin lesions were determined in relation to the unaffected contralateral site at baseline and after 3, 6, 12 and 18 months. Patient charts were later reviewed for long-term follow-up. RESULTS: Twenty-two patients were included [age 6.0 (0.2-14.4] years; female-to-male ratio 3.4 : 1) All responded well to therapy. Disease reversibility was demonstrated in the majority of children with partial resolution of skin sclerosis and regrowth of hair. Laser Doppler flowmetry and high-frequency ultrasound findings correlated with disease activity at baseline. Thermography had no added value in this cohort. The recurrence rate was 36% in the follow-up period. CONCLUSIONS: Corticosteroids and methotrexate are highly effective as first-line therapy in paediatric localized scleroderma, leading to partial reversal of skin manifestations. However, the recurrence rate is substantial and affected children require long-term follow-up. Laser Doppler flowmetry and high-frequency ultrasound correlate with disease activity in the acute phase and may assist decision-making in these patients.

Middle East respiratory syndrome: making the case for surveillance of transboundary coronaviruses in the Middle East.

Middle East respiratory syndrome (MERS) is a zoonotic viral disease identified in both animals and human beings. More than 2,200 laboratory-confirmed cases have been reported in humans from 27 countries, with a crude case fatality rate of 35% since the disease's emergence in the Middle East in 2012. In the coming years, MERS will continue to pose a severe threat to economic development as well as to the elimination of poverty and advances in food security. An important gap in the effort to keep MERS at bay is the lack of surveillance of animals in the Middle East. The authors identify the need for international collaboration to conduct MERS coronavirus (CoV) surveillance in animals in the Middle East, since the emergence of new MERS-CoV variants with the ability to sustain efficient person-to-person transmission is a genuine threat. However, effective surveillance will be very difficult, if not impossible, to achieve. There are multiple obstacles in the region to overcome, including a lack of transparency as governments in the Middle East generally do not disclose detailed information on animal diseases. In addition, there is minimal collaboration between local and international agencies in both the human and animal health sectors and a limited number of readily available qualified laboratories to screen animals for MERS- CoV. Last, but not least, there is a lack of adequate active communication between all relevant laboratories, local and abroad. However, with the support of the Food and Agriculture Organization of the United Nations (FAO), the World Organisation for Animal Health (OIE), and other partners, the responsibility of the Mediterranean Zoonosis Control Centre in Athens, Greece, could be widened to include the countries of the Middle East. This would foster a stronger alliance and far more effective collaboration in the spirit of One Health.

Le syndrome respiratoire du Moyen-Orient (MERS) est une maladie virale zoonotique qui affecte à la fois l'homme et les animaux. Plus de 2 200 cas humains confirmés au laboratoire ont été notifiés dans 27 pays depuis l'apparition de la maladie au Moyen-Orient en 2012, avec un taux brut de létalité de 35 %. Dans les années à venir, le MERS continuera à représenter une menace aussi bien pour le développement économique que pour la réussite des objectifs d'élimination de la pauvreté et de sécurisation de l'approvisionnement alimentaire. L'un des principaux obstacles empêchant de tenir le MERS en échec est l'absence de surveillance sanitaire exercée sur les populations animales au Moyen-Orient. Les auteurs soulignent la nécessité d'une collaboration internationale en matière de surveillance du coronavirus responsable du MERS (MERS-Cov) chez les animaux au Moyen-Orient, d'autant que l'émergence de nouveaux variants du MERS-CoV qui entretiennent l'infection en favorisant la transmission de personne à personne constitue un véritable danger. Toutefois, il sera extrêmement difficile, voire impossible de mettre en place une surveillance efficace. En effet les obstacles sont nombreux dans la région, en particulier l'absence de transparence puisque les gouvernements du Moyen-Orient ne publient généralement pas d'informations détaillées sur les maladies animales présentes sur leur territoire. En outre, la collaboration entre les agences locales et internationales des secteurs de la santé publique et animale est réduite au minimum et rares sont à ce jour les laboratoires possédant les compétences requises pour procéder au dépistage de l'infection par le MERS-CoV chez les animaux. Dernière difficulté mais non la moindre, les laboratoires compétents dans les pays et à l'étranger ne communiquent pas entre eux de manière proactive. Dans ce contexte, il est envisagé d'élargir la portée du Centre méditerranéen de lutte contre les zoonoses, situé à Athènes (Grèce) afin d'y intégrer les pays du Moyen-Orient, avec le soutien de l'Organisation des Nations Unies pour l'alimentation et l'agriculture (FAO), de l'Organisation mondiale de la santé animale (OIE) et d'autres partenaires. Cette initiative permettrait de renforcer les alliances et de déployer une collaboration bien plus efficace, dans une perspective Une seule santé.

El síndrome respiratorio de Oriente Medio (MERS, por su acrónimo inglés) es una enfermedad viral zoonótica que se ha descrito tanto en animales como en personas. Desde que en 2012 surgió en el Oriente Medio, se han notificado más de 2 200 casos confirmados en laboratorio que afectan a personas de 27 países, con una tasa bruta de letalidad del 35%. En los próximos años, el MERS seguirá constituyendo una grave amenaza para el desarrollo económico y también para el avance hacia la eliminación de la pobreza y la seguridad alimentaria. A la hora de poner coto a la enfermedad, un importante problema es la deficiente vigilancia zoosanitaria en el Oriente Medio. Los autores señalan la necesidad de colaboración internacional para hacer efectiva en la región la vigilancia del coronavirus (CoV) del MERS en los animales, pues la aparición de nuevas variantes de este virus capaces de transmitirse eficaz y sostenidamente entre las personas constituye un verdadero peligro. Sin embargo, resultará difícil, si no imposible, efectuar una vigilancia eficaz, habida cuenta de la multitud de obstáculos que hay que superar en el Oriente Medio, incluida la falta de transparencia de los gobiernos, que no acostumbran a revelar información detallada sobre las enfermedades animales. Además, la colaboración entre instancias locales y organismos internacionales en los sectores de la salud humana y la sanidad animal es mínima, y hay contados laboratorios cualificados para la detección del MERS­CoV en animales que estén en condiciones de intervenir con presteza. Por último, pero no menos importante, no hay una adecuada comunicación activa entre todos los laboratorios competentes, ya sean de los propios países o del extranjero. No obstante, con apoyo de la Organización de las Naciones Unidas para la Alimentación y la Agricultura (FAO), la Organización Mundial de Sanidad Animal (OIE) y otros colaboradores, sería posible extender a los países del Oriente Medio el ámbito de responsabilidad y actuación del Centro de Control de Zoonosis del Mediterráneo, sito en Atenas (Grecia), cosa que favorecería alianzas más sólidas y mucho más eficaces, conforme al espíritu de Una sola salud.

Interventions for hidradenitis suppurativa: a Cochrane systematic review incorporating GRADE assessment of evidence quality.

More than 50 interventions have been used to treat hidradenitis suppurativa (HS), and so therapy decisions can be challenging. Our objective was to summarize and appraise randomized controlled trial (RCT) evidence for HS interventions in adults. Searches were conducted in Medline, Embase, CENTRAL, LILACS, five trials registers and abstracts from eight dermatology conferences until 13 August 2015. Two review authors independently assessed study eligibility, extracted data and assessed methodological quality. Primary outcomes were quality of life and adverse effects of the interventions. Twelve trials, from 1983 to 2015, investigating 15 different interventions met our inclusion criteria. The median trial duration was 16 weeks and the median number of participants was 27. Adalimumab 40 mg weekly improved the Dermatology Life Quality Index (DLQI) by 4·0 points, which equates to the minimal clinically important difference for the scale, compared with placebo (95% confidence interval -6·5 to -1·5 points). Evidence quality was reduced to 'moderate' because the results are based on only a single study. Adalimumab 40 mg every other week was ineffective in a meta-analysis of two studies comprising 124 participants. Infliximab 5 mg kg(-1) improved the DLQI score by 8·4 points after 8 weeks in a moderate-quality study completed by 33 of 38 participants. Etanercept 50 mg twice weekly was ineffective. Inclusion of a gentamicin sponge prior to primary closure did not improve outcomes. Other interventions, including topical and oral antibiotics, were investigated by relatively small studies, preventing treatment recommendations due to imprecision. More, larger RCTs are required to investigate most HS interventions, particularly oral treatments and surgical therapy. Moderate-quality evidence suggests that adalimumab given weekly and infliximab are effective, whereas adalimumab every other week is ineffective.

Genomics and zoonotic infections: Middle East respiratory syndrome.

The emergence of Middle East respiratory syndrome (MERS) and the discovery of MERS coronavirus (MERS-CoV) in 2012 suggests that another SARS-like epidemic is occurring. Unlike the severe acute respiratory syndrome (SARS) epidemic, which rapidly disappeared in less than one year, MERS has persisted for over three years. More than 1,600 cases of MERS have been reported worldwide, and the disease carries a worryingly high fatality rate of >30%. A total of 182 MERS-CoV genomes have been sequenced, including 94 from humans and 88 from dromedary camels. The 182 genomes all share >99% identity, indicating minimal variation among MERS-CoV genomes. MERS-CoV is a lineage C Betacoronavirus (ßCoV). MERS-CoV genomes can be roughly divided into two clades: clade A, which contains only a few strains, and clade B, to which most strains belong. In contrast to ORF1ab and structural proteins, the putative proteins encoded by ORF3, ORF4a, ORF4b, ORF5 and ORF8b in the MERS-CoV genome do not share homology with any known host or virus protein, other than those of its closely related lineage C ßCoVs. Human and dromedary viral genomes have intermingled, indicating that multiple camel-to-human transmission events have occurred. The multiple origins of MERS-CoV suggest that the virus has been resident in dromedaries for many years. This is consistent with the detection of anti-MERS-CoV antibodies in dromedary camels as early as the 1980s.

L'émergence du syndrome respiratoire du Moyen-Orient (SRMO, ou MERS d'après son sigle anglais) et l'identification en 2012 du coronavirus responsable de cette maladie (MERS-CoV) indiquent que nous sommes en présence d'une épidémie semblable à celle du syndrome respiratoire aigu sévère (SRAS). Toutefois, contrairement à l'épidémie du SRAS qui avait rapidement disparu en moins d'un an, le MERS persiste depuis plus de trois ans. Plus de 1 600 cas de MERS ont été notifiés dans le monde ; la maladie présente un taux de létalité particulièrement préoccupant, s'élevant à plus de 30 %. Au total, 182 génomes du MERS-CoV ont été séquencés jusqu'à présent, dont 94 provenaient de virus isolés chez l'homme et 88 chez des dromadaires. Ces 182 génomes ont en commun un pourcentage d'identité de 99 %, dénotant une très faible variabilité des génomes viraux. Le MERS-CoV appartient à la lignée C du genre Betacoronavirus (ßCoV). Les génomes du MERSCoV se répartissent, dans leurs grandes lignes, en deux clades : le clade A, qui ne contient que quelques souches, et le clade B regroupant l'immense majorité des souches. Contrairement à ce qui se produit avec la protéine ORF1ab et les protéines structurales, les protéines potentiellement codées par les gènes ORF3, ORF4a, ORF4b, ORF5 et ORF8b du génome du MERS-CoV ne présentent aucune homologie avec des protéines virales ou de l'hôte autres que celles d'autres bêtacoronavirus de la lignée C, qui lui sont étroitement apparentés. Les génomes des virus affectant l'homme et le dromadaire se sont entremêlés, ce qui montre que le virus a connu de multiples épisodes de transmission des camélidés à l'homme. Les origines multiples du MERS-CoV témoignent d'une présence prolongée du virus (plusieurs années) chez les dromadaires. Ce constat est corroboré par le fait que des anticorps anti-MERS-CoV ont été détectés chez des dromadaires dès le début des années 80.

La aparición del síndrome respiratorio de Oriente Medio (MERS, por sus siglas en inglés) y el descubrimiento del coronavirus que lo causa (MERS-CoV) en 2012 parecen apuntar al advenimiento de una nueva epidemia análoga a la del síndrome respiratorio agudo severo (SRAS). Pero a diferencia de lo ocurrido con la epidemia de SRAS, que en menos de un año había desaparecido, el MERS lleva más de tres años presente. En el mundo se han notificado más de 1.600 casos de MERS, y la enfermedad presenta una tasa de letalidad muy alta y preocupante, superior al 30%. Hasta ahora se han secuenciado un total de 182 genomas del MERS-CoV, 94 de ellos obtenidos a partir de personas y 88 a partir de dromedarios. Estos 182 genomas comparten identidad en más de un 99%, lo que pone de manifiesto un nivel mínimo de variación entre los genomas coronavíricos. El coronavirus del MERS pertenece al linaje C del género Betacoronavirus (ßCoV). Los genomas de este virus pueden ser divididos, a grandes rasgos, en dos clados: el clado A, que agrupa unas pocas cepas; y el clado B, al que pertenecen la gran mayoría de las cepas. A diferencia de lo que ocurre con la proteína ORF1ab y las proteínas estructurales, las proteínas que supuestamente codifican los genes ORF3, ORF4a, ORF4b, ORF5 y ORF8b del genoma del MERS-CoV no comparten homología con ninguna proteína conocida de otros virus o anfitriones, salvo con proteínas de otros betacoronavirus del linaje C estrechamente emparentados con él. Los genomas de los virus que afectan a personas y dromedarios se han entremezclado, lo que indica que se han producido numerosos episodios de transmisión de camélidos a humanos. De los múltiples orígenes del MERS-CoV se deduce que el virus lleva muchos años siendo residente en dromedarios, lo que concuerda con el hecho de que ya en los años ochenta se detectaran anticuerpos anti-MERS-CoV en dromedarios.

Primary ventriculoperitoneal shunting outcomes: a multicentre clinical audit for shunt infection and its risk factors.

OBJECTIVES: To determine the frequency of primary ventriculoperitoneal shunt infection among patients treated at neurosurgical centres of the Hospital Authority and to identify underlying risk factors. METHODS: This multicentre historical cohort study included consecutive patients who underwent primary ventriculoperitoneal shunting at a Hospital Authority neurosurgery centre from 1 January 2009 to 31 December 2011. The primary endpoint was shunt infection, defined as: (1) the presence of cerebrospinal fluid or shunt hardware culture that yielded the pathogenic micro-organism with associated compatible symptoms and signs of central nervous system infection or shunt malfunction; or (2) surgical incision site infection requiring shunt reinsertion (even in the absence of positive culture); or (3) intraperitoneal pseudocyst formation (even in the absence of positive culture). Secondary endpoints were shunt malfunction, defined as unsatisfactory cerebrospinal fluid drainage that required shunt reinsertion, and 30-day mortality. RESULTS: A primary ventriculoperitoneal shunt was inserted in 538 patients during the study period. The mean age of patients was 48 years (range, 13-88 years) with a male-to-female ratio of 1:1. Aneurysmal subarachnoid haemorrhage was the most common aetiology (n=169, 31%) followed by intracranial tumour (n=164, 30%), central nervous system infection (n=42, 8%), and traumatic brain injury (n=27, 5%). The mean operating time was 75 (standard deviation, 29) minutes. Shunt reinsertion and infection rates were 16% (n=87) and 7% (n=36), respectively. The most common cause for shunt reinsertion was malfunction followed by shunt infection. Independent predictors for shunt infection were: traumatic brain injury (adjusted odds ratio=6.2; 95% confidence interval, 2.3-16.8), emergency shunting (2.3; 1.0-5.1), and prophylactic vancomycin as the sole antibiotic (3.4; 1.1-11.0). The 30-day all-cause mortality was 6% and none were directly procedure-related. CONCLUSIONS: This is the first Hong Kong territory-wide review of infection in primary ventriculoperitoneal shunts. Although the ventriculoperitoneal shunt infection rate met international standards, there are areas of improvement such as vancomycin administration and the avoidance of scheduling the procedure as an emergency.

Phenotypic and genotypic characteristics of cryopyrin-associated periodic syndrome: a series of 136 patients from the Eurofever Registry.

OBJECTIVE: To evaluate genetic, demographic and clinical features in patients with cryopyrin-associated periodic syndrome (CAPS) from the Eurofever Registry, with a focus on genotype-phenotype correlations and predictive disease severity markers. METHODS: A web-based registry retrospectively collected data on patients with CAPS. Experts in the disease independently validated all cases. Patients carrying NLRP3 variants and germline-mutation-negative patients were included. RESULTS: 136 patients were analysed. The median age at disease onset was 9 months, and the median duration of follow-up was 15 years. Skin rash, musculoskeletal involvement and fever were the most prevalent features. Neurological involvement (including severe complications) was noted in 40% and 12% of the patients, respectively, with ophthalmological involvement in 71%, and neurosensory hearing loss in 42%. 133 patients carried a heterozygous, germline mutation, and 3 patients were mutation-negative (despite complete NLRP3 gene screening). Thirty-one different NLRP3 mutations were recorded; 7 accounted for 78% of the patients, whereas 24 rare variants were found in 27 cases. The latter were significantly associated with early disease onset, neurological complications (including severe complications) and severe musculoskeletal involvement. The T348M variant was associated with early disease onset, chronic course and hearing loss. Neurological involvement was less strongly associated with V198M, E311 K and A439 V alleles. Early onset was predictive of severe neurological complications and hearing loss. CONCLUSIONS: Patients carrying rare NLRP3 variants are at risk of severe CAPS; onset before the age of 6 months is associated with more severe neurological involvement and hearing loss. These findings may have an impact on treatment decisions.

The phenotype of TNF receptor-associated autoinflammatory syndrome (TRAPS) at presentation: a series of 158 cases from the Eurofever/EUROTRAPS international registry.

OBJECTIVE: To evaluate the genetic findings, demographic features and clinical presentation of tumour necrosis factor receptor-associated autoinflammatory syndrome (TRAPS) in patients from the Eurofever/EUROTRAPS international registry. METHODS: A web-based registry collected retrospective data on patients with TNFRSF1A sequence variants and inflammatory symptoms. Participating hospitals included paediatric rheumatology centres and adult centres with a specific interest in autoinflammatory diseases. Cases were independently validated by experts in the disease. RESULTS: Complete information on 158 validated patients was available. The most common TNFRSF1A variant was R92Q (34% of cases), followed by T50M (10%). Cysteine residues were disrupted in 27% of cases, accounting for 39% of sequence variants. A family history was present in 19% of patients with R92Q and 64% of those with other variants. The median age at which symptoms began was 4.3 years but 9.1% of patients presented after 30 years of age. Attacks were recurrent in 88% and the commonest features associated with the pathogenic variants were fever (88%), limb pain (85%), abdominal pain (74%), rash (63%) and eye manifestations (45%). Disease associated with R92Q presented slightly later at a median of 5.7 years with significantly less rash or eye signs and more headaches. Children were more likely than adults to present with lymphadenopathy, periorbital oedema and abdominal pains. AA amyloidosis has developed in 16 (10%) patients at a median age of 43 years. CONCLUSIONS: In this, the largest reported case series to date, the genetic heterogeneity of TRAPS is accompanied by a variable phenotype at presentation. Patients had a median 70 symptomatic days a year, with fever, limb and abdominal pain and rash the commonest symptoms. Overall, there is little evidence of a significant effect of age or genotype on disease features at presentation.

HNRNPA1 interacts with a 5'-flanking distal element of interleukin-6 and upregulates its basal transcription.

Interleukin-6 (IL-6) is an important pro-inflammatory cytokine involved in many autoimmune and inflammatory diseases. We have shown previously that a region from -5307 to -5202 bp upstream of the IL-6 transcriptional start site is responsible for basal IL-6 gene expression, and that there were DNA-binding proteins involved from electrophoretic mobility shift assay (EMSA) and transient expression experiments. Here we have combined surface plasmon resonance technology with mass spectrometry analysis and have identified nuclear proteins bound to this region. HNRNPA1 and HNRNPA2B1 were found consistently. EMSA supershift and chromatin immunoprecipitation assays confirmed the involvement of HNRNPA1, but not of HNRNPA2B1. Knocking down the HNRNPA1 expression by small interfering RNA resulted in reduced IL-6 transcriptional activity as assessed from transfection experiments using reporter constructs, mRNA and protein measurements. Overexpression of HNRNPA1 cDNA increased IL-6 mRNA expression. This regulation was dependent on the presence of the sequence from -5307 to -5202 bp of the IL-6 gene. Thus, HNRNPA1 is a novel transcriptional regulator of IL-6 expression, acting via the 5'-flanking sequence of the gene.