Flavonoid intake and risk of pancreatic cancer in the National Institutes of Health-AARP Diet and Health Study Cohort

Background:

Limited epidemiological studies show inverse associations between dietary flavonoid intake and pancreatic cancer risk, but results are inconsistent and are based on few cases. We examined the association between intake of flavonoids and pancreatic cancer risk in the large, prospective National Institutes of Health-AARP Diet and Health Study Cohort.

Methods:

During follow-up through 2006 (median follow-up 10.6 years), 2379 pancreatic cancer cases were identified. We used Cox proportional hazards modelling to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).

Results:

We found no association between total flavonoid intake (Q5 vs Q1 HR=1.09, 95% CI: 0.96–1.24) or any flavonoid subtypes and pancreatic cancer risk. Significant interactions were not observed by age, sex, smoking status, BMI or diabetes.

Conclusion:

Our results do not support the hypothesis that flavonoids have a protective role in pancreatic cancer carcinogenesis.

Effect of statins on the clinical outcomes of patients with sepsis

Despite numerous attempts at novel intervention and tests to aid in earlier diagnosis and improved treatment, there has been an increased incidence of overall mortality related to sepsis, despite improvements in in-hospital mortality. Statins have emerged as potential immunomodulatory and antioxidant agents that might impact on sepsis outcomes. Definitive evidence to support the routine use of statins in patients with sepsis has not yet been elicited. We retrospectively analysed data from patients who presented with sepsis, severe sepsis or septic shock, stratifiying them according to statin use into two groups (statin and no statin). Sequential Organ Failure Assessment was used to evaluate severity of illness. The primary outcome was hospital mortality. Secondary outcomes included intensive care unit (ICU) mortality, hospital and ICU length of stay, and mechanical ventilation and vasopressor therapy duration. Five hundred and sixty-eight patients were included. Patients with prior statin use (statin group) were older; more obese and had higher prevalence of smoking, diabetes and ischaemic heart disease. There was no difference in Sequential Organ Failure Assessment scores and mortality did not vary between the two groups (19.6 vs. 16.9%). Furthermore, secondary outcomes including ICU mortality, hospital and ICU length of stay, mechanical ventilation and vasopressor duration did not differ Multivariate analysis revealed age and Sequential Organ Failure Assessment score were independent predictors of survival, while history of statin use was not (p = 0.403). This current retrospective study did not find any benefit of statin use on primary and secondary outcomes of the patients admitted to an academic hospital with sepsis.

Alternative approaches to ventilator-associated pneumonia prevention

Ventilator-associated pneumonia (VAP), which develops in patients receiving mechanical ventilation, is the most common nosocomial infection in patients with acute respiratory failure. The major mechanism of lower respiratory tract colonization is aspiration of bacteria-colonized secretions from the oropharynx into the lower airways. The hydrostatic pressure of the secretions that collect in the subglottic space, which is the area above the endotracheal tube (ETT) cuff, or aerosolization of bacteria from the secretions collected within the respiratory tubing may facilitate the leakage into the lower airways. Ideally, the elimination of the mechanisms responsible for aspiration would decrease the incidence of VAP. Several preventive measures have been tested in clinical trials with little success.Here we present the results of our efforts to develop novel approaches for the prevention of VAP. Specifically, we found that keeping ventilated patients in a lateral position, which eliminates gravitational forces, is feasible and possibly advantageous. Additionally, several novel medical devices have been recently developed to prevent bacterial biofilm formation from the ETT and breathing tubing. These devices include coated ETTs, mucus shavers and mucus slurpers. Prevention of ETT bacterial colonization showed decreased bacterial colonization of the respiratory circuit and of the lower respiratory tract in laboratory studies and clinical trials. Future large studies should be designed to test the hypothesis that VAP can be prevented with these novel strategies. While there is a current focus on the use of respiratory devices to prevent biofilm formation and microaspiration, it is important to remember that lower respiratory tract colonization is multifactorial. Prevention of VAP cannot be achieved solely by eliminating bacterial biofilm on respiratory devices, and more comprehensive care of the intubated patient needs to be implemented.

Methods and mortality results of a health survey of purebred dogs in the UK

OBJECTIVES

To collect information on the cause of death and longevity of dogs owned by members of the numerically largest breed clubs of 169 UK Kennel Club-recognised breeds.

METHODS

A cross-sectional study was carried out. Approximately 58,363 questionnaires were sent out to breed club members in 2004 (nine clubs failed to report the exact number of questionnaires sent out). Owners reported age at death and cause(s) of death for all dogs that had died within the previous 10 years.

RESULTS

A total of 13,741 questionnaires (24% response rate) containing information on 15,881 deaths were included in the analysis. Breed-specific response rates ranged from 64·7 to 4·5%. The median age at death was 11 years and 3 months (minimum=2 months, maximum=23 years and 5 months) and it varied by breed. The most common causes of death were cancer (n=4282, 27%), "old age" (n=2830, 18%) and cardiac conditions (n=1770, 11%).

CLINICAL SIGNIFICANCE

This survey shows breed differences in lifespan and causes of death, and the results support previous evidence that smaller breeds tend to have longer lifespan compared with larger breeds. Although many of the breeds in the study may not be representative of the general pedigree dog population in the UK, the results do contribute to the limited information currently available.

Pseudomonas aeruginosa: acute lung injury or ventilator-associated pneumonia?

Pseudomonas aeruginosa (P. aeruginosa) is a Gram-negative, aerobic, rod-shaped and polar-flagella bacterium with unipolar motility. Furthermore, it is an opportunistic pathogen responsible for ventilator-acquired pneumonia (VAP). VAP due to P. aeruginosa is usually multidrug-resistant and associated with severe infection and increased mortality. The goals of this review are as follows: (I) to present selected recent epidemiological literature characterizing the population at risk of P. aeruginosa pneumonia, (II) to describe some of the virulence factors of P. aeruginosa that are related to infection, and (III) to illustrate clinical outcomes of ventilated patients with large burdens of P. aeruginosa as well as the mechanism by which this bacterium may evade the host immune response.

Design, synthesis, and crystal structures of 6-alkylidene-2'-substituted penicillanic acid sulfones as potent inhibitors of Acinetobacter baumannii OXA-24 carbapenemase

Class D β-lactamases represent a growing and diverse class of penicillin-inactivating enzymes that are usually resistant to commercial β-lactamase inhibitors. As many such enzymes are found in multi-drug resistant (MDR) Acinetobacter baumannii and Pseudomonas aeruginosa, novel β-lactamase inhibitors are urgently needed. Five unique 6-alkylidene-2'-substituted penicillanic acid sulfones (1-5) were synthesized and tested against OXA-24, a clinically important β-lactamase that inactivates carbapenems and is found in A. baumannii. Based upon the roles Tyr112 and Met223 play in the OXA-24 β-lactamase, we also engineered two variants (Tyr112Ala and Tyr112Ala,Met223Ala) to test the hypothesis that the hydrophobic tunnel formed by these residues influences inhibitor recognition. IC(50) values against OXA-24 and two OXA-24 β-lactamase variants ranged from 10 ± 1 (4 vs WT) to 338 ± 20 nM (5 vs Tyr112Ala, Met223Ala). Compound 4 possessed the lowest K(i) (500 ± 80 nM vs WT), and 1 possessed the highest inactivation efficiency (k(inact)/K(i) = 0.21 ± 0.02 μM(-1)  s(-1)). Electrospray ionization mass spectrometry revealed a single covalent adduct, suggesting the formation of an acyl-enzyme intermediate. X-ray structures of OXA-24 complexed to four inhibitors (2.0-2.6 Å) reveal the formation of stable bicyclic aromatic intermediates with their carbonyl oxygen in the oxyanion hole. These data provide the first structural evidence that 6-alkylidene-2'-substituted penicillin sulfones are effective mechanism-based inactivators of class D β-lactamases. Their unique chemistry makes them developmental candidates. Mechanisms for class D hydrolysis and inhibition are discussed, and a pathway for the evolution of the BlaR1 sensor of Staphylococcus aureus to the class D β-lactamases is proposed.

Platinum-group elements in sewage sludge and incinerator ash in the United Kingdom: assessment of PGE sources and mobility in cities

Platinum-group element (PGE) concentrations in sewage sludge and incinerator ash compared with average PGE concentrations in road dust show a common pattern, characterized by a negative Rh anomaly. This similarity, found at 9 UK incinerators, suggests that there is a universal characteristic PGE pattern produced by common processes of dispersal of Pt, Pd and Rh derived from automobile catalytic converters. Ninety-one sewage sludge and incinerator ash samples from the sewage treatment facilities in Sheffield, Birmingham and 7 other UK cities were analyzed for PGE. The highest concentrations are 602ppb Pt and 710ppb Pd with lower maximum concentrations of 65ppb Rh, 100ppb Ru, 33ppb Ir and 12ppb Os. Ash from incinerated sewage was found to have higher PGE concentrations compared to the original sludge and the PGE ratios are preserved during incineration. Rh is more mobilized and dispersed than the other PGE as it is transported from roads into the drainage system and into sewage. Pt/Pd ratios of 1.0 in road dust and 0.9 in sewage and incinerator ash suggest that Pd is more mobile than Pt during dispersal. PGE abundances in stored incinerator ash of varying ages appear to have been affected by the variation in use of Pt, Pd and Rh in catalytic converters due to variation in their market prices. Concentrations of Os, Ir and Ru in ashes are greater in Sheffield and London than all the other city sites and may be derived from point industrial sources.