Endocrine regulation in asymmetric intrauterine fetal growth retardation

OBJECTIVE

The ponderal index (PI) is a widely accepted measure of disproportionate growth or asymmetrical growth retardation by pediatricians worldwide. Identification of disproportionately grown small for gestational age (SGA) neonates by using the ponderal index as a measure of the nutritional status at birth, is important because they constitute a high-risk group among SGA neonates. Poor nutritional status of the mother could have a direct effect on the organs of the developing fetus and/or affect the endocrine milieu in the maternal feto-placental unit resulting in an increased incidence of intrauterine growth-retarded (IUGR)/SGA births. IUGR is a significant risk factor for adult disease. In this study, we have investigated the endocrine adaptation by the fetus to overcome the growth disadvantage caused due to poor nutritional status of the mother.

MATERIALS AND METHODS

We examined the quantitative variations in hormonal and growth factor profiles in paired maternal and cord blood samples obtained from mothers and their neonates who were classified based on their growth status into SGA and appropriate for gestational age (AGA).

RESULTS

(1) A total of 24.7% neonates had a PI < 2, indicating a high incidence of asymmetric IUGR in the population studied. (2) Anthropometric parameters measured in the mothers indicate that the mothers giving birth to neonates with a PI < 2 had poor nutritional status, both prior to and during pregnancy. (3) We observed increased levels of placental lactogen and prolactin and decreased levels of insulin in the cord blood of neonates with PI < 2, while lower levels of insulin-like growth factor 1 (IGF-1) and higher levels of epidermal growth factor (EGF) were observed in their mothers.

CONCLUSION

Poor maternal nutritional status results in fetal adaptation to a growth restricted environment via the modulation of the pituitary-thyroid axis thereby altering the endocrine milieu, thus affecting fetal growth.

Impact of a simple intervention that improves colon cancer lymph node yield and assessement

e15058

Background: The National Quality Forum has endorsed the 12 lymph node (LN) benchmark as a quality metric. Currently, less than 40% of institutions meet this requirement. The purpose of this study was to determine whether implementation of a simple pathology template with dedicated fields for LN reporting led to an increase in the number of colon cancer resections where >12 LNs were reported. Methods: A simple pathology template, derived from the College of American Pathology, using standardized terminology and dedicated fields for LN reporting was implemented in August 2007. Using a pre and post- test design, all consecutive pathology cases were retrospectively reviewed. Inclusion criteria consisted of all stage 0-IV colon cancer patients who underwent surgical resection at a single Veterans Affairs Medical Center. The primary outcome was the percentage of cases in which >12 LNs were assessed between the pre and post-template group. Age, gender, anatomic location, and stage were also collected. Statistical comparisons were made using chi-square and Fisher's exact t-test. Results: 111 pre-template and 71 post-template cases were analyzed. The majority of patients were Caucasian (74%) males (97%). There were no significant differences between the two groups (see Table 1 ), however there was a trend towards more right-sided colon cancers in the pre-template group. 51% of all pre-template pathology reports evaluated >12 LNs compared to 68% of post-template reports (33% improvement in LN yield; p=0.03). Conclusions: Examination of >12 LNs has important therapeutic and prognostic implications in colon cancer patients. Use of a standardized pathology template with dedicated fields for LN reporting is a simple intervention that can increase yield of LN reporting. This can have a significant impact for institutions striving to reach the 12 LN quality metric.

[Table: see text]

No significant financial relationships to disclose.

Radiation dose-benefit analysis of hematopoietic stem cell grafting for tolerence induction across MHC barriers in living related donor renal allograft recipients

3044

Background: Donor specific immunologic tolerance protects an allograft from chronic rejection and allows discontinuation of chronic immunosuppressive therapy. Ahmedabad-tolerance induction protocol (A-TIP) allows grafting in living related donor (LRD) renal allograft recipients with persistent low-level MLHC. Present study aims to define of the ideal radiation dose needed for tolerance induction in patients undergoing A-TIP. Methods: 210 consecutive end stage renal disease patients recruited between May '05 through Mar '07 underwent renal transplantation (RTx) following A-TIP and negative Lymphocytotoxicity cross match (LCM). A-TIP includes (a) 2 DLI's (b) low intensity conditioning, and (c) HSC grafting.The conditioning regimen included fractionated low dose target specific radiation, cyclosporine, cyclophosphamide, anti T-cell a.b and treosulfan. All patients underwent subtotal lymphoid irradiation (STLI) targeting spleen, abdominal, iliac and inguinal lymph nodes, thoraco-lumbar vertebra and 75% of pelvis. Patients were randomized into 3 groups of 70 each: STLI 600, STLI 800, STLI 1000, corresponding to doses of 600cgy, 800cgy and 1000cgy delivered conventionally using 6MV/15MV photons. Unfractionated HSC procured from donor BM was administered into portal circulation, within 24 hours of achieving CD4+/CD8+ T cell count ≤ 10% of baseline. Donor specific cytotoxic antibodies were eliminated before RTx. Immunosuppression (ISp) was withdrawn 3–6 mo after RTx for patients with consistently positive chimerism. Tolerance - Robust (R), Prope (P) and Metastable (M) is defined as RT: Stable allograft function (fn.) for >100 days without ISp; PT: Early adequate, stable grafts fn. with no rejection episodes on minimum ISp; MT: Adequate graft fn. on ISp with single episode of steroid responsive ac. rejection. Results: See Table. Conclusions: The safe and effective dose for tolerance induction in LRD renal transplantation is 1000 cGy.

[Table: see text]

No significant financial relationships to disclose.

Diagnosis, Classification and Treament of Psychopathology in Infants and Toddlers: Incorporating an Infant Mental Health Approach

Aims:

This workshop will present a theoretical framework to conceptualize early childhood behavior problems in the context of the early parent-child relationship, and will demonstrate how this relational framework can be used to diagnose, classify, and treat child behavior concerns in children under the age of five.

Background:

There is increasing evidence to suggest that a significant number of very young children manifest signs of early psychopathology, and that behavioral problems that emerge early are likely to persist, and warrant further assessment and intervention. One of the challenges to identifying early psychopathology in young children is how to diagnose and classify early behavioral disturbances using a developmental and relational framework.

Methods:

This presentation will describe an “infant mental health approach” to diagnose and intervene with young children with behavioral concerns. This comprehensive model of behavioral assessment incorporates an assessment of the parent's perceptions of the child, observations of dyadic interactions, and utilizes a developmental context to diagnose, classify and treat early behavioral concerns in children under the age of five. Using the DC 0-3R, this model will highlight how an understanding of child behavior in the context of the parent-child relationship can be a helpful framework to diagnose and treat early behavioral disturbances in children under the age of 5. Participants will learn how to identify vulnerabilities in the parent-child relationship, how to diagnose and conceptualize early psychopathology in young children, and how to formulate interventions to support dyads at risk.

Strain improvement and up scaling of phytase production by Aspergillus niger NCIM 563 under submerged fermentation conditions

Combination of physical and chemical mutagenesis was used to isolate hyper secretory strains of Aspergillus niger NCIM 563 for phytase production. Phytase activity of mutant N-1 and N-79 was about 17 and 47% higher than the parent strain. In shake flask the productivity of phytase in parent, mutant N-1 and N-79 was 6,181, 7,619 and 9,523 IU/L per day, respectively. Up scaling of the fermentation from shake flask to 3 and 14 L New Brunswick fermenter was studied. After optimizing various fermentation parameters like aeration, agitation and carbon source in fermentation medium the fermentation time to achieve highest phytase activity was reduced considerably from 14 days in shake flask to 8 days in 14 L fermenter. Highest phytase activity of 80 IU/ml was obtained in 1% rice bran-3.5% glucose containing medium with aeration 0.2 vvm and agitation 550 rpm at room temperature on 8th day of fermentation. Addition of either bavistin (0.1%), penicillin (0.1%), formalin (0.2%) and sodium chloride (10%) in fermented broth were effective in retaining 100% phytase activity for 8 days at room temperature while these reagents along with methanol (50%) and ethanol (50%) confer 100% stability of phytase activity at 4 degrees C till 20 days. Among various carriers used for application of phytase in feed, wheat bran and rice bran were superior to silica and calcium carbonate. Thermo stabilization studies indicate 100% protection of phytase activity in presence of 12% skim milk at 70 degrees C, which will be useful for its spray drying.

Effects of pioglitazone and metformin on NEFA-induced insulin resistance in type 2 diabetes

AIMS/HYPOTHESIS

We sought to determine whether pioglitazone and metformin alter NEFA-induced insulin resistance in type 2 diabetes and, if so, the mechanism whereby this is effected.

METHODS

Euglycaemic-hyperinsulinaemic clamps (glucose approximately 5.3 mmol/l, insulin approximately 200 pmol/l) were performed in the presence of Intralipid-heparin (IL/H) or glycerol before and after 4 months of treatment with pioglitazone (n = 11) or metformin (n = 9) in diabetic participants. Hormone secretion was inhibited with somatostatin in all participants.

RESULTS

Pioglitazone increased insulin-stimulated glucose disappearance (p < 0.01) and increased insulin-induced suppression of glucose production (p < 0.01), gluconeogenesis (p < 0.05) and glycogenolysis (p < 0.05) during IL/H. However, glucose disappearance remained lower (p < 0.05) whereas glucose production (p < 0.01), gluconeogenesis (p < 0.05) and glycogenolysis (p < 0.05) were higher on the IL/H study day than on the glycerol study day, indicating persistence of NEFA-induced insulin resistance. Metformin increased (p < 0.001) glucose disappearance during IL/H to rates present during glycerol treatment, indicating protection against NEFA-induced insulin resistance in extrahepatic tissues. However, glucose production and gluconeogenesis (but not glycogenolysis) were higher (p < 0.01) during IL/H than during glycerol treatment with metformin, indicating persistence of NEFA-induced hepatic insulin resistance.

CONCLUSIONS/INTERPRETATION

We conclude that pioglitazone improves both the hepatic and the extrahepatic action of insulin but does not prevent NEFA-induced insulin resistance. In contrast, whereas metformin prevents NEFA-induced extrahepatic insulin resistance, it does not protect against NEFA-induced hepatic insulin resistance.