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Acute myeloid leukemia (AML) is characterized by recurrent genetic events. The BCL6 corepressor (BCOR) and its homolog, the BCL6 corepressor-like 1 (BCORL1), have been reported to be rare but recurrent mutations in AML. Previously, smaller studies have reported conflicting results regarding impacts on outcomes. Here, we retrospectively analyzed a large cohort of 1529 patients with newly diagnosed and intensively treated AML. BCOR and BCORL1 mutations were found in 71 (4.6%) and 53 patients (3.5%), respectively. Frequently co-mutated genes were DNTM3A, TET2 and RUNX1. Mutated BCORL1 and loss-of-function mutations of BCOR were significantly more common in the ELN2017 intermediate-risk group. Patients harboring loss-of-function mutations of BCOR had a significantly reduced median event-free survival (HR = 1.464 (95%-Confidence Interval (CI): 1.005–2.134), p = 0.047), relapse-free survival (HR = 1.904 (95%-CI: 1.163–3.117), p = 0.01), and trend for reduced overall survival (HR = 1.495 (95%-CI: 0.990–2.258), p = 0.056) in multivariable analysis. Our study establishes a novel role for loss-of-function mutations of BCOR regarding risk stratification in AML, which may influence treatment allocation.
Killing the cMSSM softly
(2016)
We investigate the constrained Minimal Supersymmetric Standard Model (cMSSM) in the light of constraining experimental and observational data from precision measurements, astrophysics, direct supersymmetry searches at the LHC and measurements of the properties of the Higgs boson, by means of a global fit using the program Fittino. As in previous studies, we find rather poor agreement of the best fit point with the global data. We also investigate the stability of the electro-weak vacuum in the preferred region of parameter space around the best fit point. We find that the vacuum is metastable, with a lifetime significantly longer than the age of the Universe. For the first time in a global fit of supersymmetry, we employ a consistent methodology to evaluate the goodness-of-fit of the cMSSM in a frequentist approach by deriving p values from large sets of toy experiments. We analyse analytically and quantitatively the impact of the choice of the observable set on the p value, and in particular its dilution when confronting the model with a large number of barely constraining measurements. Finally, for the preferred sets of observables, we obtain p values for the cMSSM below 10 %, i.e. we exclude the cMSSM as a model at the 90 % confidence level.
Background: Diabetes mellitus type 2 (DM2) is highly associated with increased risk for chronic kidney disease (CKD), end stage renal disease (ESRD) and cardiovascular morbidity. Epidemiological and genetic studies generate hypotheses for innovative strategies in DM2 management by unravelling novel mechanisms of diabetes complications, which is essential for future intervention trials. We have thus initiated the DIAbetes COhoRtE study (DIACORE).
Methods: DIACORE is a prospective cohort study aiming to recruit 6000 patients of self-reported Caucasian ethnicity with prevalent DM2 for at least 10 years of follow-up. Study visits are performed in University-based recruiting clinics in Germany using standard operating procedures. All prevalent DM2 patients in outpatient clinics surrounding the recruiting centers are invited to participate. At baseline and at each 2-year follow-up examination, patients are subjected to a core phenotyping protocol. This includes a standardized online questionnaire and physical examination to determine incident micro-and macrovascular DM2 complications, malignancy and hospitalization, with a primary focus on renal events. Confirmatory outcome information is requested from patient records. Blood samples are obtained for a centrally analyzed standard laboratory panel and for biobanking of aliquots of serum, plasma, urine, mRNA and DNA for future scientific use. A subset of the cohort is subjected to extended phenotyping, e. g. sleep apnea screening, skin autofluorescence measurement, non-mydriatic retinal photography and non-invasive determination of arterial stiffness.
Discussion: DIACORE will enable the prospective evaluation of factors involved in DM2 complication pathogenesis using high-throughput technologies in biosamples and genetic epidemiological studies.
We perform global fits to the parameters of the Constrained Minimal Super-symmetric Standard Model (CMSSM) and to a variant with non-universal Higgs masses (NUHM1). In addition to constraints from low-energy precision observables and the cosmological dark matter density, we take into account the LHC exclusions from searches in jets plus missing transverse energy signatures with about 5 fb\(^{−1}\) of integrated luminosity. We also include the most recent upper bound on the branching ratio B\(_s\) → μμ from LHCb. Furthermore, constraints from and implications for direct and indirect dark matter searches are discussed. The best fit of the CMSSM prefers a light Higgs boson just above the experimentally excluded mass. We find that the description of the low-energy observables, (g − 2)\(_μ\) in particular, and the non-observation of SUSY at the LHC become more and more incompatible within the CMSSM. A potential SM-like Higgs boson with mass around 126 GeV can barely be accommodated. Values for B(B\(_s\)→μμ) just around the Standard Model prediction are naturally expected in the best fit region. The most-preferred region is not yet affected by limits on direct WIMP searches, but the next generation of experiments will probe this region. Finally, we discuss implications from fine-tuning for the best fit regions.
Family studies suggest a genetic component to the etiology of chronic kidney disease (CKD) and end stage renal disease (ESRD). Previously, we identified 16 loci for eGFR in genome-wide association studies, but the associations of these single nucleotide polymorphisms (SNPs) for incident CKD or ESRD are unknown. We thus investigated the association of these loci with incident CKD in 26,308 individuals of European ancestry free of CKD at baseline drawn from eight population-based cohorts followed for a median of 7.2 years (including 2,122 incident CKD cases defined as eGFR < 60ml/min/1.73m(2) at follow-up) and with ESRD in four case-control studies in subjects of European ancestry (3,775 cases, 4,577 controls). SNPs at 11 of the 16 loci (UMOD, PRKAG2, ANXA9, DAB2, SHROOM3, DACH1, STC1, SLC34A1, ALMS1/NAT8, UBE2Q2, and GCKR) were associated with incident CKD; p-values ranged from p = 4.1e-9 in UMOD to p = 0.03 in GCKR. After adjusting for baseline eGFR, six of these loci remained significantly associated with incident CKD (UMOD, PRKAG2, ANXA9, DAB2, DACH1, and STC1). SNPs in UMOD (OR = 0.92, p = 0.04) and GCKR (OR = 0.93, p = 0.03) were nominally associated with ESRD. In summary, the majority of eGFR-related loci are either associated or show a strong trend towards association with incident CKD, but have modest associations with ESRD in individuals of European descent. Additional work is required to characterize the association of genetic determinants of CKD and ESRD at different stages of disease progression.
Das VEP ist eine Methode, die schon lange im klinischen Alltag genutzt wird, im Gegensatz zum relativ neuen, noch nicht etablierten mfVEP. Beide erfassen Potenziale, die in der Sehrinde im Occipitallappen erzeugt werden. Um Normalwerte des VEP und mfVEP zu erlangen bedarf es der Funktion des gesamten Sehsystems. Funktionsstörungen des Sehsystems führen zu Veränderungen im VEP und mfVEP. Dadurch können Ausfälle, wie z.B. beim Glaukom, auch mittels mfVEP erkannt werden. Für unsere Experimente wurden bei 30 Normalpersonen sowohl VEP als auch mfVEP abgeleitet. Dies erfolgte neben monokularer Messung auch binokular. Das VEP zeigte die in der Literatur beschriebenen Werte. Jedoch konnte nur eine geringe, nicht signifikante Steigerung binokularer Messungen gefunden werden. Es konnten bei den Messungen keine Unterschiede zwischen den monokularen und binokularen Latenzen ermittelt werden. Der erstmalige Vergleich binokularer und monokularer mfVEP lieferte eine Steigerung der Binokularantwort, wie sie in der Literatur beim VEP ähnlich beschrieben ist. Die durchgeführten Vergleiche des Faktors R in unterschiedlichen topographischen Regionen ergaben ein einheitliches Verhalten des gesamten Gesichtsfeldes auf binokulare Reizung. Die Latenzen der binokularen Messungen waren kürzer. Es konnte aber bezüglich der Latenzen keine Signifikanz im Vergleich mit monokularer Messung erzielt werden, anders als in der Literatur beschrieben. Der Vergleich zwischen beiden elektrophysiologischen Methoden VEP und mfVEP ergab eine ca. drei mal höhere Amplitude des VEP. Das mfVEP zeigte dabei kürzere Latenzen. Erklärbar könnte dieses Phänomen durch die Adaptation des Sehsystems beim mfVEP sein, es können jedoch auch retinale Mechanismen eine Rolle spielen. Das mfVEP lieferte die in der Literatur beschriebenen Asymmetrien von oberem und unterem Halbfeld und anderen Besonderheiten bei Normalpersonen, wie die unterschiedlichen geschlechtsabhängigen Amplitudenhöhen der weiblichen und männlichen Probanden. Zur besseren Auswertung der 60 Felder des mfVEP bot sich eine Sechs-Sektoren-Mittelung an, da so einheitliche Kurven miteinander verrechnet wurden. Es zeigten sich spiegelbildliche aber auch in der Form unterschiedliche Kurven mit Latenzunterschieden vor allem in den beiden mittleren Sektoren (oben und unten), aber auch zwischen den mittleren und lateralen Sektoren, was durch die Faltung der Gehirnrinde erklärbar ist. Anhand des Signal-Rausch-Verhältnisses (SNR) konnten die Einzelantworten des mfVEP auf statistische Signifikanz geprüft und zusammen mit Mehrkanal-Messung und 20-Felder-Mittelung Normalwerte errechnet werden, bei denen bis zu 94 % der Einzelantworten des monokularen mfVEP als signifikant erkannt wurden. Zusätzlich erreichte man mit dieser Auswertungstechnik ein EEG-skaliertes mfVEP. Geschlechtsspezifische Unterschiede des mfVEP konnten damit ausgeglichen werden. Unsere Versuche zeigen das große Potential des mfVEP auf. Vor allem die Mehrkanal-Messungen bieten einen großen Informationsgewinn. Eine Mittelung des mfVEP zu weniger Feldern (z.B. 20) bietet als Vereinfachung einen Kompromiss aus geringerer Auflösung aber höheren Antworten. Eine zukünftige Kombination der Objektivierung von Einzelantworten mit größeren Reizfeldern (Sektoren oder 20 Felder) oder dem Nutzen von Muster-gepulstem mfVEP kann zu weiteren Verbesserungen beim Erreichen eines objektiven Standards für Normalpersonen führen, welcher gut als Basis für die klinische Etablierung des mfVEP dienen könnte.
Background
Telemedicine improves the quality of acute stroke care in rural regions with limited access to specialized stroke care. We report the first 2 years' experience of implementing a comprehensive telemedical stroke network comprising all levels of stroke care in a defined region.
Methods
The TRANSIT-Stroke network covers a mainly rural region in north-western Bavaria (Germany). All hospitals providing acute stroke care in this region participate in TRANSIT-Stroke, including four hospitals with a supra-regional certified stroke unit (SU) care (level III), three of those providing teleconsultation to two hospitals with a regional certified SU (level II) and five hospitals without specialized SU care (level I). For a two-year-period (01/2015 to 12/2016), data of eight of these hospitals were available; 13 evidence-based quality indicators (QIs) related to processes during hospitalisation were evaluated quarterly and compared according to predefined target values between level-I- and level-II/III-hospitals.
Results
Overall, 7881 patients were included (mean age 74.6 years +/- 12.8; 48.4% female). In level-II/III-hospitals adherence of all QIs to predefined targets was high ab initio. In level-I-hospitals, three patterns of QI-development were observed: a) high adherence ab initio (31%), mainly in secondary stroke prevention; b) improvement over time (44%), predominantly related to stroke specific diagnosis and in-hospital organization; c) no clear time trends (25%). Overall, 10 out of 13 QIs reached predefined target values of quality of care at the end of the observation period.
Conclusion
The implementation of the comprehensive TRANSIT-Stroke network resulted in an improvement of quality of care in level-I-hospitals.
Meiotic chromosome movement is important for the pairwise alignment of homologous chromosomes, which is required for correct chromosome segregation. Movement is driven by cytoplasmic forces, transmitted to chromosome ends by nuclear membrane-spanning proteins. In animal cells, lamins form a prominent scaffold at the nuclear periphery, yet the role lamins play in meiotic chromosome movement is unclear. We show that chromosome movement correlates with reduced lamin association with the nuclear rim, which requires lamin phosphorylation at sites analogous to those that open lamina network crosslinks in mitosis. Failure to remodel the lamina results in delayed meiotic entry, altered chromatin organization, unpaired or interlocked chromosomes, and slowed chromosome movement. The remodeling kinases are delivered to lamins via chromosome ends coupled to the nuclear envelope, potentially enabling crosstalk between the lamina and chromosomal events. Thus, opening the lamina network plays a role in modulating contacts between chromosomes and the nuclear periphery during meiosis.