Quality assessment of expert answers to lay questions about cystic fibrosis from various language zones in Europe: the ECORN-CF project
Kris De Boeck
Thomas Otto Friedrich Wagner
Helge Uwe Hebestreit
- Background: The European Centres of Reference Network for Cystic Fibrosis (ECORN-CF) established an Internet forum which provides the opportunity for CF patients and other interested people to ask experts questions about CF in their mother language. The objectives of this study were to: 1. develop a detailed quality assessment tool to analyze quality of expert answers, 2. evaluate the intra- and inter-rater agreement of this tool, and 3. explore changes in the quality of expert answers over the time frame of the project.
Methods: The quality assessment tool was developed by an expert panel. Five experts within the ECORN-CF project used the quality assessment tool to analyze the quality of 108 expert answers published on ECORN-CF from six language zones. 25 expert answers were scored at two time points, one year apart. Quality of answers was also assessed at an early and later period of the project. Individual rater scores and group mean scores were analyzed for each expert answer.
Results: A scoring system and training manual were developed analyzing two quality categories of answers: content and formal quality. For content quality, the grades based on group mean scores for all raters showed substantial agreement between two time points, however this was not the case for the grades based on individual rater scores. For formal quality the grades based on group mean scores showed only slight agreement between two time points and there was also poor agreement between time points for the individual grades. The inter-rater agreement for content quality was fair (mean kappa value 0.232+/-0.036, p<0.001) while only slight agreement was observed for the grades of the formal quality (mean kappa value 0.105+/-0.024, p<0.001). The quality of expert answers was rated high (four language zones) or satisfactory (two language zones) and did not change over time.
Conclusions: The quality assessment tool described in this study was feasible and reliable when content quality was assessed by a group of raters. Within ECORN-CF, the tool will help ensure that CF patients all over Europe have equal possibility of access to high quality expert advice on their illness.
Descending aortic calcification increases renal dysfunction and in-hospital mortality in cardiac surgery patients with intraaortic balloon pump counterpulsation placed perioperatively: a case control study
James D. Rawn
Prem S. Shekar
Tobias Michael Bingold
Holger K. Eltzschig
Stanton K Shernan
- Introduction: Acute kidney injury (AKI) after cardiac surgery increases length of hospital stay and in-hospital mortality. A significant number of patients undergoing cardiac surgical procedures require perioperative intra-aortic balloon pump (IABP) support. Use of an IABP has been linked to an increased incidence of perioperative renal dysfunction and death. This might be due to dislodgement of atherosclerotic material in the descending thoracic aorta (DTA). Therefore, we retrospectively studied the correlation between DTA atheroma, AKI and in-hospital mortality.
Methods: A total of 454 patients were retrospectively matched to one of four groups: -IABP/-DTA atheroma, +IABP/-DTA atheroma, -IABP/+DTA atheroma, +IABP/+DTA atheroma. Patients were then matched according to presence/absence of DTA atheroma, presence/absence of IABP, performed surgical procedure, age, gender and left ventricular ejection fraction (LVEF). DTA atheroma was assessed through standard transesophageal echocardiography (TEE) imaging studies of the descending thoracic aorta.
Results: Basic patient characteristics, except for age and gender, did not differ between groups. Perioperative AKI in patients with -DTA atheroma/+IABP was 5.1% versus 1.7% in patients with -DTA atheroma/-IABP. In patients with +DTA atheroma/+IABP the incidence of AKI was 12.6% versus 5.1% in patients with +DTA atheroma/-IABP. In-hospital mortality in patients with +DTA atheroma/-IABP was 3.4% versus 8.4% with +DTA atheroma/+IABP. In patients with +DTA atheroma/+IABP in hospital mortality was 20.2% versus 6.4% with +DTA atheroma/-IABP. Multivariate logistic regression identified DTA atheroma > 1 mm (P = *0.002, odds ratio (OR) = 4.13, confidence interval (CI) = 1.66 to 10.30), as well as IABP support (P = *0.015, OR = 3.04, CI = 1.24 to 7.45) as independent predictors of perioperative AKI and increased in-hospital mortality. DTA atheroma in conjunction with IABP significantly increased the risk of developing acute kidney injury (P = 0.0016) and in-hospital mortality (P = 0.0001) when compared to control subjects without IABP and without DTA atheroma.
Conclusions: Perioperative IABP and DTA atheroma are independent predictors of perioperative AKI and in-hospital mortality. Whether adding an IABP in patients with severe DTA calcification increases their risk of developing AKI and mortality postoperatively cannot be clearly answered in this study. Nevertheless, when IABP and DTA are combined, patients are more likely to develop AKI and to die postoperatively in comparison to patients without IABP and DTA atheroma.
Prospective evaluation of artemether-lumefantrine for the treatment of non-falciparum and mixed-species malaria in Gabon
Daisy A. Diop
Ayola A. Adegnika
Peter G. Kremsner
- Background: The recommendation of artemisinin combination therapy (ACT) as first-line treatment for uncomplicated falciparum malaria is supported by a plethora of high quality clinical trials. However, their recommendation for the treatment of mixed-species malaria and the large-scale use for the treatment of non-falciparum malaria in endemic regions is based on anecdotal rather than systematic clinical evidence.
Methods: This study prospectively observed the efficacy of artemether-lumefantrine for the treatment of uncomplicated non-falciparum or mixed-species malaria in two routine district hospitals in the Central African country of Gabon.
Results: Forty patients suffering from uncomplicated Plasmodium malariae, Plasmodium ovale or mixed-species malaria (including Plasmodium falciparum) presenting at the hospital received artemether-lumefantrine treatment and were followed up. All evaluable patients (n = 38) showed an adequate clinical and parasitological response on Day 28 after oral treatment with artemether-lumefantrine (95% confidence interval: 0.91,1). All adverse events were of mild to moderate intensity and completely resolved by the end of study.
Conclusions: This first systematic assessment of artemether-lumefantrine treatment for P. malariae, P. ovale and mixed-species malaria demonstrated a high cure rate of 100% and a favourable tolerability profile, and thus lends support to the practice of treating non-falciparum or mixed-species malaria, or all cases of malaria without definite species differentiation, with artemether-lumefantrine in Gabon.
Trial Registration: ClinicalTrials.gov Identifier: NCT00725777
Biglycan: a multivalent proteoglycan providing structure and signals
Madalina V. Nastase
Marian F. Young
- Research over the past few years has provided fascinating results indicating that biglycan, besides being a ubiquitous structural component of the extracellular matrix (ECM), may act as a signaling molecule. Proteolytically released from the ECM, biglycan acts as a danger signal signifying tissue stress or injury. As a ligand of innate immunity receptors and activator of the inflammasome, biglycan stimulates multifunctional proinflammatory signaling linking the innate to the adaptive immune response. By clustering several types of receptors on the cell surface and orchestrating their downstream signaling events, biglycan is capable to autonomously trigger sterile inflammation and to potentiate the inflammatory response to microbial invasion. Besides operating in a broad biological context, biglycan also displays tissue-specific affinities to certain receptors and structural components, thereby playing a crucial role in bone formation, muscle integrity, and synapse stability at the neuromuscular junction. This review attempts to provide a concise summary of recent data regarding the involvement of biglycan in the regulation of inflammation and the musculoskeletal system, pointing out both a signaling and a structural role for this proteoglycan. The potential of biglycan as a novel therapeutic target or agent for the treatment of inflammatory diseases and skeletal muscular dystrophies is also addressed.
Untersuchungen zur Bedeutung der mitochondrialen Proteinqualitätskontrolle für Alterungsprozesse bei dem Ascomyceten Podospora anserina
- Ziel dieser Arbeit war die Untersuchung der Rolle der i-AAA Protease in P. anserina, besonders während des Alterns des Ascomyceten. Die dazu durchgeführten Untersuchungen führten zu folgenden Ergebnissen:
1. Unter Standardbedingungen ist der PaIap-Deletionsstamm langlebiger als der Wildstamm, ohne feststellbare physiologische Beeinträchtigungen aufzuweisen. Dass dies auf den Verlust von PaIap zurückzuführen ist, bestätigen die PaIap-Revertantenstämme, in denen das Gen wieder eingeführt wurde, wodurch deren Lebensspanne wieder Wildtyp-artig ist. Dies zeigt, dass PaIAP zelluläre Prozesse beeinflusst, die die Lebensspanne kontrollieren.
2. Bei Hitzestress weist der PaIap-Deletionsstamm dagegen eine höhere Hitzesensitivität auf als der Wildstamm, was sich in einer verkürzten Lebensspanne und der Störung vitaler Funktionen äußert. Dies deutet auf eine mögliche Rolle von PaIAP bei der Hitzestressantwort hin.
3. Im Einklang mit dem hitzesensitiven Phänotyp des PaIap-Deletionsstamms konnte in mitochondrialen Extrakten des Wildtyps gezeigt werden, dass die Proteinmenge von PaIAP durch Hitzestress signifikant zunimmt. Gleichzeitig weisen mitochondriale Proteinextrakte von PaIap-Deletionsstämmen nach Hitzestress signifikant geringere Mengen an PaHSP60 und PaCLPP auf, zwei weiteren Komponenten der mitochondrialen Proteinqualitätskontrolle. Dies unterstreicht die Beteiligung von PaIAP an der Hitzestressantwort von P. anserina.
4. Darüber hinaus beeinflusst der Verlust von PaIap die Zusammensetzung der mitochondrialen Atmungskette und führt bei 27°C zu einer vermehrten Organisation der Komplexe in stabilere Superkomplexe. Dieser Mechanismus wird beim Wildstamm erst nach Hitzestress beobachtet, wogegen der PaIap-Deletionsstamm die Superkomplexmenge nicht mehr weiter steigern kann.
5. Die Genexpression von proteolytisch inaktiven Varianten von PaIAP (PaIAPE540Q bzw. PaIAPE540QG) kann den Phänotyp des PaIap-Deletionsstamms bei 27°C nicht komplementieren und führt ebenfalls zu einer Verlängerung der Lebensspanne von P. anserina. Dies liefert wichtige Informationen über den Mechanismus wie PaIAP die Lebensspanne von P. anserina beeinflusst, da dazu die proteolytische Aktivität von PaIAP benötigt wird.
6. Darüber hinaus zeigt die Analyse des PaIap/PaClpP-Deletionsstamms, dass sich die Mechanismen, wie PaIAP und PaCLPP die Lebensspanne von P. anserina beeinflussen, unterscheiden. Die unterschiedlichen zellulären Aufgaben werden auch bei Hitzestress deutlich, wovon der PaIap/PaClpP-Deletionsstamm noch stärker betroffen ist als durch die Deletion von PaIap bzw. PaClpP. Dies verdeutlicht, dass sich die Effekte der Deletionen der beiden Gene addieren.
Insgesamt konnte in dieser Arbeit gezeigt werden, dass die i-AAA Protease PaIAP auch bei P. anserina wichtige zelluläre Funktionen besitzt, die sich auf den Alterungsprozess des Ascomyceten auswirken. Dabei war es möglich verschiedene neue Mechanismen zu identifizieren, wie die i-AAA Protease diese Funktionen ausübt. Dazu gehören z.B. der Einfluss der proteolytischen Aktivität auf die Lebensspanne, die durch die Abwesenheit der i-AAA Protease ausgelöste Reorganisation der Atmungskettenkomplexe in stabile Superkomplexe, und die Induktion der Hitzestressantwort durch PaIAP. Diese Befunde tragen zum besseren Verständnis der zellulären Funktion der i-AAA Protease bei und stellen einen entscheidenden Ausgangspunkt für weiterführende Analysen der bislang wenig verstandenen Aufgaben der Protease dar.
Do non-genomically encoded fusion transcripts cause recurrent chromosomal translocations?
- We among others have recently demonstrated that normal cells produce “fusion mRNAs”. These fusion mRNAs do not derive from rearranged genomic loci, but rather they are derived from “early-terminated transcripts” (ETTs). Premature transcriptional termination takes place in intronic sequences that belong to “breakpoint cluster regions”. One important property of ETTs is that they exhibit an unsaturated splice donor site. This results in: (1) splicing to “cryptic exons” present in the final intron; (2) Splicing to another transcript of the same gene (intragenic trans-splicing), resulting in “exon repetitions”; (3) splicing to a transcript of another gene (intergenic trans-splicing), leading to “non-genomically encoded fusion transcripts” (NGEFTs). These NGEFTs bear the potential risk to influence DNA repair processes, since they share identical nucleotides with their DNA of origin, and thus, could be used as “guidance RNA” for DNA repair processes. Here, we present experimental data about four other genes. Three of them are associated with hemato-malignancies (ETV6, NUP98 and RUNX1), while one is associated with solid tumors (EWSR1). Our results demonstrate that all genes investigated so far (MLL, AF4, AF9, ENL, ELL, ETV6, NUP98, RUNX1 and EWSR1) display ETTs and produce transpliced mRNA species, indicating that this is a genuine property of translocating genes.
Early otic development depends on autophagy for apoptotic cell clearance and neural differentiation
Maria Rodriguez Aburto
Juan M. Hurlé
- Autophagy is a highly regulated program of self-degradation of the cytosolic constituents that has key roles during early development and in adult cell growth and homeostasis. To investigate the role of autophagy in otic neurogenesis, we studied the expression of autophagy genes in early stages of chicken (Gallus gallus) inner ear development and the consequences of inhibiting the autophagic pathway in organotypic cultures of explanted chicken otic vesicles (OVs). Here we show the expression of autophagy-related genes (Atg) Beclin-1 (Atg6), Atg5 and LC3B (Atg8) in the otocyst and the presence of autophagic vesicles by using transmission electron microscopy in the otic neurogenic zone. The inhibition of the transcription of LC3B by using antisense morpholinos and of class III phosphatidylinositol 3-kinase with 3-methyladenine causes an aberrant morphology of the OV with accumulation of apoptotic cells. Moreover, inhibition of autophagy provokes the misregulation of the cell cycle in the otic epithelium, impaired neurogenesis and poor axonal outgrowth. Finally, our results indicate that autophagy provides the energy required for the clearing of neuroepithelial dying cells and suggest that it is required for the migration of otic neuronal precursors. Taken together, our results show for the first time that autophagy is an active and essential process during early inner ear development.
Does social interaction destablise financial markets?
- With this paper, I propose a simple asset pricing model that accounts for the influence from social interaction. Investors are assumed to make up their mind about an asset’s price based on a forecasting strategy and its past profitability as well as on the contemporaneous expectations of other market participants. Empirically analysing stocks of the DAX30 index, I provide evidence that social interaction rather destabilises financial markets. Based on my results, I state that at least, it does not have a stabilising effect.
Fluctuations of social influence: evidence from the behaviour of mutual fund managers during the economic crisis 2008/09
- In this paper, I analyse the reciprocal social influence on investment decisions within an international group of roughly 2000 mutual fund managers that invested in companies of the DAX30. Using a robust estimation procedure, I provide empirical evidence that in the average a fund manager puts 0.69% more portfolio weight on a particular stock, if other fund managers increase the corresponding position by 1%. The dynamics of this influence on portfolio weights suggest that fund managers adjust their behaviour according to the prevailing market situation and are more strongly influenced by others in times of an economic downturn. Analysing the working locations of the fund managers, I conclude that more than 90% of the magnitude of influence is due to pure observation. While this form of influence varies much in time, the magnitude of influence resulting from the exchange of opinion is more or less constant.
Tumor angiogenesis and anti-angiogenic therapy in malignant gliomas revisited
Karl H. Plate
Daniel J. Dumont
- The cellular and molecular mechanisms of tumor angiogenesis and its prospects for anti-angiogenic cancer therapy are major issues in almost all current concepts of both cancer biology and targeted cancer therapy. Currently, (1) sprouting angiogenesis, (2) vascular co-option, (3) vascular intussusception, (4) vasculogenic mimicry, (5) bone marrow-derived vasculogenesis, (6) cancer stem-like cell-derived vasculogenesis and (7) myeloid cell-driven angiogenesis are all considered to contribute to tumor angiogenesis. Many of these processes have been described in developmental angiogenesis; however, the relative contribution and relevance of these in human brain cancer remain unclear. Preclinical tumor models support a role for sprouting angiogenesis, vascular co-option and myeloid cell-derived angiogenesis in glioma vascularization, whereas a role for the other four mechanisms remains controversial and rather enigmatic. The anti-angiogenesis drug Avastin (Bevacizumab), which targets VEGF, has become one of the most popular cancer drugs in the world. Anti-angiogenic therapy may lead to vascular normalization and as such facilitate conventional cytotoxic chemotherapy. However, preclinical and clinical studies suggest that anti-VEGF therapy using bevacizumab may also lead to a pro-migratory phenotype in therapy resistant glioblastomas and thus actively promote tumor invasion and recurrent tumor growth. This review focusses on (1) mechanisms of tumor angiogenesis in human malignant glioma that are of particular relevance for targeted therapy and (2) controversial issues in tumor angiogenesis such as cancer stem-like cell-derived vasculogenesis and bone-marrow-derived vasculogenesis.