Prognostic value of angiogenic markers in pregnancies with fetal growth restriction

OBJECTIVE

Pregnancies with fetal growth restriction are at increased risk of preeclampsia. Angiogenic markers including soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) are altered in pregnancies complicated by fetal growth restriction (FGR). The utility of these markers as a predictor of preeclampsia in women with growth-restricted fetuses is still uncertain. This study aims to evaluate the prognostic value of angiogenic markers for predicting the development of preeclampsia in pregnancies with FGR and suspected preeclampsia.

METHODS

This study included 93 women with FGR, defined according to Delphi consensus criteria, who were assessed for angiogenic markers sFlt-1 and PlGF for suspicion of preeclampsia at the Department of Obstetrics and feto-maternal Medicine at the Medical University of Vienna between 2013 and 2020. Women with established diagnosis of preeclampsia at sampling were excluded. Cox regression analysis and logistic regression were performed to demonstrate the association of angiogenic markers with the outcome.

RESULTS

Within this cohort, 14 women (15.1%) developed preeclampsia within one week from sampling, 21 (22.6%) within two weeks, 38 (40.9%) at any time. The sFLT-1/PLGF ratio consistently showed a stronger association with development of preeclampsia compared to sFlt-1 or PlGF alone in pregnancies with fetal growth restriction (PE within a week, AUC 0.85 vs 0.82 and 0.72, respectively). Models including sFlt-1/PlGF were more strongly associated with preeclampsia hazard compared to sFlt-1 and PlGF alone models (C-index: 0.79±0.046 vs 0.76±0.048 and 0.75±0.047, respectively). Risk classification capabilities of sFlt-1/PlGF decreased after the two-week time point. The established cut-off value for ruling out preeclampsia (sFlt-1/PlGF ratio <38) was effective with a negative predictive value of 93.3% and sensitivity of 95.2%.

CONCLUSION

Combined use of sFlt-1/PlGF can be preferred to PlGF alone in pregnancies with fetal growth restriction. Moreover, established cut-offs for ruling-out development of preeclampsia seem to be effective in these patients. This article is protected by copyright. All rights reserved.

Antibacterial defense in bull and boar semen: A putative link to the microbiome and reproductive strategy?

Several domestic and wildlife species have been shown to possess antibacterial defenses in their ejaculate most probably in order to increase the fertilization success and protect against sexually transmitted pathogens. However, very little is known about the consequences and factors influencing the differences within and between species as far as ejaculate-associated immunity. In the present study, we have analyzed bacterial killing activity (BKA) against Escherichia (E.) coli and Staphylococcus (S.) aureus as well as lysozyme concentrations (LC) in seminal plasma from 60 Fleckvieh bulls. Further, sperm quality and its association with BKA and LC were determined. Twenty percent of the individuals displayed BKA against both bacteria, 78.3% against S. aureus only and 1.7% of the bulls did not indicate any BKA in seminal plasma. No bulls with seminal plasma BKA only against E. coli were identified; implying that 80.0% of the tested bulls had no ejaculate associated defense mechanisms against this gram-negative bacterial species in place. This is in striking contrast to results of Pietrain boars within our previous study, in which 42.8% of the 119 boars expressed an antibacterial activity against E. coli in seminal plasma, 10.9% amongst them with BKA against E. coli only. LC was higher in the bull group with BKA against both bacteria (1.2 ± 0.6 μg/mL) compared to the group with BKA against S. aureus only (0.7 ± 0.3 μg/mL), but - if calculated over all individuals - LC in bulls (0.8 ± 0.4 μg/mL) was lower compared to boars (2.4 ± 1.2 μg/mL). LC showed positive correlations to the age of the bulls and sperm quality as well as a negative relation to bacterial load in raw semen although the highest bacterial contamination was found in animals with seminal plasma BKA against both strains. We discuss the obtained results with regards to possible differences within the microbiome of female and male genital tracts and the reproductive strategies (vaginal vs. uterine depositors) in these two livestock species. Besides identifying the responsible molecules, future phylogenetically controlled comparative studies are needed for a better understanding of the evolution of species differences in ejaculate-associated antibacterial defenses.

Application of zeolites for biological treatment processes of solid wastes and wastewaters - A review

This review reports the use of zeolites in biological processes such as anaerobic digestion, nitrification, denitrification and composting, review that has not been proposed yet. It was found that aerobic processes (activated sludge, nitrification, Anammox) use zeolites as ion-exchanger and biomass carriers in order to improve the seattlebility, the biomass growth on zeolite surface and the phosphorous removal. In the case of anaerobic digestion and composting, zeolites are mainly used with the aim of retaining inhibitors such as ammonia and heavy metals through ion-exchange. The inclusion of zeolite effect on mathematical models applied in biological processes is still an area that should be improved, including also the life cycle analysis of the processes that include zeolites. At the same time, the application of zeolites at industrial or full-scale is still very scarce in anaerobic digestion, being more common in nitrogen removal processes.

Abstract P1-08-32: Treatment delivery waiting times for stage I-III breast cancer patients in Switzerland : A pooled analysis of 7 cancer registries over the 2003-2008 period

Background: To examine time intervals between needle/core biopsy, breast cancer diagnosis, surgery and radiotherapy (RT) as quality metrics in the management of stage I-III breast cancer in a representative Swiss population sample.

Methods: Based on seven regional cancer registries covering 45% of the Swiss population, we identified 2628 women which underwent surgery for stage I-III breast cancer without receiving (neo)-adjuvant chemotherapy between January 1, 2003 and December 31, 2005.

Four different time intervals were defined: a) time between needle/core biopsy and diagnosis of breast cancer, b) time between diagnosis of breast cancer and surgery, c) time between needle/core biopsy and surgery, d) time between surgery and adjuvant RT.

These four time intervals were analyzed according to age, nationality, health insurance status, public vs. private hospitals and geography. We also investigated whether case discussion at tumor board delayed patient management.

A one-way analysis of variance (ANOVA) and multiple comparison tests were used to assess differences between groups. All tests were performed using STATA v.15.

Results: 2628 women were identified, median age was 67 years (IQR: 58-77). Breast-conserving surgery was performed in 1899 cases (72.3%), mastectomy in 539 cases (20.5%), unspecified surgery /missing data in 190 cases (7.2%). Adjuvant RT was delivered in 1546/2628 patients (58.8 %).

Time interval between biopsy and surgery was age-dependent, ranging from 22 days (95% CI: 19.6 - 25.2) for women &lt; 60 years to 39 days (95% CI: 27.0-50.3) for women 80+ years old (p&lt;0.001). After biopsy, women waited on average 19 days until surgery in private clinics (95% CI: 16.4-21.6) and 30 days in public hospitals (95% CI: 26.6-33.3) (p&lt;0.001). Women with private insurance were operated 24 days after biopsy (95% CI: 17.0-31.1), compared with 30 days (95% CI: 27.1-33.2) (p&lt;0.01)for women with basic state insurance. After biopsy, time interval for foreign nationals was significantly longer than for Swiss citizen (30 vs 24 days, p&lt;0.01). Tumor board presentation postponed surgery by 10 days (31 vs 22 days, p&lt;0.01).

Time between surgery and RT did not correlate with age (p=0.83); the interval was 33% longer in tertiary teaching hospitals than in private clinics (61 vs. 46 days, p&lt;0.001), and 8 days longer for patients with private insurance than for those without (61 vs 53 days, p&lt;0.01). There was a trend for foreign nationals to receive adjuvant RT later than Swiss citizen (58 vs 55 days, p=0.09). RT started later in larger metropolitan areas compared to more rural regions (59 vs 53 days, p&lt;0.01). Presenting patients at a tumor board after surgery had no impact on RT start (p=0.12).

Conclusions: Major differences in treatment waiting times were observed between patients with stage I-III breast cancer. Elderly and foreign patients were at risk for delayed surgery after biopsy. Data from patients with longer timelines need to be analyzed to identify further reasons for delays.

Citation Format: Zwahlen DR, Herrmann C, Mousavi M, Bordoni A, Bouchardy C, Konzelmann I, Staehlin K, Rohrmann S, Oehler C, Zimmermann M. Treatment delivery waiting times for stage I-III breast cancer patients in Switzerland : A pooled analysis of 7 cancer registries over the 2003-2008 period [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-08-32.

[Triclosan-coated sutures in colorectal surgery : Assessment and meta-analysis of the recommendations of the WHO guideline]

BACKGROUND

In the global guidelines for the prevention of surgical site infections (SSI), the World Health Organization (WHO) recommends the general use of triclosan-coated sutures irrespective of the type of surgical intervention.

OBJECTIVE

Can this recommendation on the use of triclosan-coated sutures be confirmed by a meta-analysis specifically for colorectal surgery?

METHODS

Randomized and non-randomized clinical trials comparing triclosan-coated and uncoated sutures for the efficacy in reducing the SSI rate in colorectal surgery were identified by a systematic literature review. In addition, various quality criteria were set for the studies to be included: SSI definition according to the Centers for Disease Control and Prevention (CDC), a priori sample size calculation and a maximum SSI rate of 20%. The odds ratios were pooled using a fixed and random effects model, the 95% confidence intervals (CI) were calculated and subgroup analyses were carried out.

RESULTS

Included in the meta-analysis were 3 prospective randomized trials (RCT) and 3 non-randomized trials involving a total of 2957 subjects. The average SSI rate was 6.90% (76/1101) in the triclosan group and 9.11% (169/1856) in the control group, resulting in an odds ratio of 0.62 (95% CI: 0.29-1.31). Subgroup analysis showed a decreased risk for SSI in monocentric trials (OR = 0.39, 95% CI: 0.25-0.60) but an increased SSI risk in multicenter trials (OR = 1.75, 95% CI: 1.11-2.77).

CONCLUSION

Against the background of a moderate to high risk of bias and the partially contradictory findings of the studies, the general recommendation of the WHO on the use of triclosan-coated sutures for colorectal surgery could not be confirmed.

Bimetallic nickel complexes for selective CO2 carbon capture and sequestration

Herein we report on the selective CO₂ uptake from air by a dinickel azacryptand complex and its capability to act as a reversible CO₂ storage system.

Survival in patients with primary liver cancer, gallbladder and extrahepatic biliary tract cancer and pancreatic cancer in Europe 1999-2007: Results of EUROCARE-5

BACKGROUND

The EUROCARE study collects and analyses survival data from population-based cancer registries (CRs) in Europe in order to provide data on between-country differences in survival and time trends in survival.

METHODS

This study analyses data on liver cancer, gallbladder and extrahepatic biliary tract cancers ("biliary tract cancers"), and pancreatic cancer diagnosed in 2000-2007 from 88 CRs in 29 countries. Relative survival (RS) was estimated overall, by region, sex, age and period of diagnosis using the complete approach. Time trends in 5-year RS over 1999-2007 were also analysed using the period approach.

RESULTS

The prognosis of the studied cancers was poor. Age-standardised 5-year RS was 12% for liver cancer, 17% for biliary tract cancers and 7% for pancreatic cancer. There were some between-country differences in survival. In general, RS was low in Eastern Europe and high in Central and Southern Europe. For all sites, 5-year RS was similar in men and women and decreased with advancing age. No substantial changes in survival were reported for pancreatic cancer over the period 1999-2007. On average, there was a crude increase in 5-year RS of 3 percentage points between the periods 1999-2001 and 2005-2007 for liver cancer and biliary tract cancers.

CONCLUSIONS

The major changes in imaging techniques over the study period for the diagnosis of the three studied cancers did not result in an improvement in the prognosis of these cancers. In the near future, new innovative treatments might be the best way to improve the prognosis in these cancers.

Investigation of effect of particle size and rumen fluid addition on specific methane yields of high lignocellulose grass silage

This work examines the digestion of advanced growth stage grass silage. Two variables were investigated: particle size (greater than 3 cm and less than 1cm) and rumen fluid addition. Batch studies indicated particle size and rumen fluid addition had little effect on specific methane yields (SMYs). In continuous digestion of 3 cm silage the SMY was 342 and 343 L CH4 kg(-1)VS, respectively, with and without rumen fluid addition. However, digester operation was significantly affected through silage floating on the liquor surface and its entanglement in the mixing system. Digestion of 1cm silage with no rumen fluid addition struggled; volatile fatty acid concentrations rose and SMYs dropped. The best case was 1cm silage with rumen fluid addition, offering higher SMYs of 371 L CH4 kg(-1)VS and stable operation throughout. Thus, physical and biological treatments benefited continuous digestion of high fibre grass silage.

Imaging and dosimetric errors in 4D PET/CT-guided radiotherapy from patient-specific respiratory patterns: a dynamic motion phantom end-to-end study

Effective positron emission tomography / computed tomography (PET/CT) guidance in radiotherapy of lung cancer requires estimation and mitigation of errors due to respiratory motion. An end-to-end workflow was developed to measure patient-specific motion-induced uncertainties in imaging, treatment planning, and radiation delivery with respiratory motion phantoms and dosimeters. A custom torso phantom with inserts mimicking normal lung tissue and lung lesion was filled with [(18)F]FDG. The lung lesion insert was driven by six different patient-specific respiratory patterns or kept stationary. PET/CT images were acquired under motionless ground truth, tidal breathing motion-averaged (3D), and respiratory phase-correlated (4D) conditions. Target volumes were estimated by standardized uptake value (SUV) thresholds that accurately defined the ground-truth lesion volume. Non-uniform dose-painting plans using volumetrically modulated arc therapy were optimized for fixed normal lung and spinal cord objectives and variable PET-based target objectives. Resulting plans were delivered to a cylindrical diode array at rest, in motion on a platform driven by the same respiratory patterns (3D), or motion-compensated by a robotic couch with an infrared camera tracking system (4D). Errors were estimated relative to the static ground truth condition for mean target-to-background (T/Bmean) ratios, target volumes, planned equivalent uniform target doses, and 2%-2 mm gamma delivery passing rates. Relative to motionless ground truth conditions, PET/CT imaging errors were on the order of 10-20%, treatment planning errors were 5-10%, and treatment delivery errors were 5-30% without motion compensation. Errors from residual motion following compensation methods were reduced to 5-10% in PET/CT imaging, <5% in treatment planning, and <2% in treatment delivery. We have demonstrated that estimation of respiratory motion uncertainty and its propagation from PET/CT imaging to RT planning, and RT delivery under a dose painting paradigm is feasible within an integrated respiratory motion phantom workflow. For a limited set of cases, the magnitude of errors was comparable during PET/CT imaging and treatment delivery without motion compensation. Errors were moderately mitigated during PET/CT imaging and significantly mitigated during RT delivery with motion compensation. This dynamic motion phantom end-to-end workflow provides a method for quality assurance of 4D PET/CT-guided radiotherapy, including evaluation of respiratory motion compensation methods during imaging and treatment delivery.

Ixodes ricinus ticks infected with the causative agent of Lyme disease, Borrelia burgdorferi sensu lato, have higher energy reserves

Ticks use their energy reserves to maintain their water balance, search for hosts and transmit tick-borne pathogens. However, the influence of tick-borne pathogens on the energy reserves of the tick vector has not been well studied. The relationship between Borrelia burgdorferi sensu lato (s.l.) infection status and fat content in questing Ixodes ricinus nymphs was examined. Nymphs were sampled from the field. Their body mass and fat content were measured, and their Borrelia genospecies infection status (using reverse line blot analysis), and spirochete load (using quantitative PCR) were analysed. Of the 900 nymphs tested, 21.2% were infected with a variety of Borrelia genospecies. Borrelia-infected nymphs had 12.1% higher fat content than uninfected ticks after correcting for body size. For the subset of Borrelia-infected nymphs, no relationship was found between spirochete load and fat content and bioenergetics calculations suggest that Borrelia spirochetes consume a negligible fraction of the tick energy reserves. While the mechanism that causes the association between Borrelia infection and higher fat content in I. ricinus nymphs remains unknown, the present study complements our previous findings that Borrelia-infected nymphs had higher survival times under desiccating conditions and walked less within a humidity gradient.

European guidelines for quality assurance in colorectal cancer screening and diagnosis: overview and introduction to the full supplement publication

Population-based screening for early detection and treatment of colorectal cancer (CRC) and precursor lesions, using evidence-based methods, can be effective in populations with a significant burden of the disease provided the services are of high quality. Multidisciplinary, evidence-based guidelines for quality assurance in CRC screening and diagnosis have been developed by experts in a project co-financed by the European Union. The 450-page guidelines were published in book format by the European Commission in 2010.  They include 10 chapters and over 250 recommendations, individually graded according to the strength of the recommendation and the supporting evidence. Adoption of the recommendations can improve and maintain the quality and effectiveness of an entire screening process, including identification and invitation of the target population, diagnosis and management of the disease and appropriate surveillance in people with detected lesions. To make the principles, recommendations and standards in the guidelines known to a wider professional and scientific community and to facilitate their use in the scientific literature, the original content is presented in journal format in an open-access Supplement of Endoscopy. The editors have prepared the present overview to inform readers of the comprehensive scope and content of the guidelines.

Biochemical properties of Xenopus laevis p53

The p53 gene has evolutionarily highly conserved boxes from rainbow trout to man whereas other regions are divergent in different species. In order to define conserved and species specific properties of p53 we analyzed frog p53. Since the commonly available monoclonal antibodies do not react with Xenopus p53 we expressed a recently cloned Xenopus laevis cDNA in bacteria and this protein was used to generate polyclonal antibodies. This antibody recognizes p53 from Xenopus laevis oocytes, baculovirus infected insect cells and p53 from an in vitro transcription/translation reaction but not from somatic Xenopus tissue cells. In contrast to p53 from other species Xenopus p53 is mainly found in the cytoplasm. Xenopus p53 forms mainly tetramers as p53 from other species. Like p53 from other species Xenopus p53 is tightly associated with a protein kinase activity and phosphorylated by this associated enzyme. Xenopus p53 binds strongly to its own RNA without any influence on the translation of p53 mRNA. Thus, Xenopus p53 seems to have some properties in common with p53 from other species and some additional species specific features.

Phosphorylation of wild-type and mutant phenotypes of p53 by an associated protein-kinase

Immunopurified mutant mouse p53 from transformed cells is known to be tightly associated with a protein kinase which phosphorylates p53 in an in vitro kinase reaction. Wild-type p53 from a non-transformed cell line was not associated with a protein kinase whereas immunopurified wild-type p53 from a transformed cell line was tightly associated with a protein kinase which phosphorylated p53. In order to compare wild-type and mutant p53 in the same cellular environment both forms were cloned in a baculovirus expression system and in in vitro transcription/translation vectors and both p53 proteins were expressed in the two systems. Wild-type and mutant p53 from baculovirus infected insect cells were tightly associated with a protein kinase which phosphorylates p53. In contrast, immunopurified wild-type and mutant p53 from an in vitro transcription/translation reaction were not associated with a protein kinase but could be phosphorylated by added casein kinase II. Thus, in the present paper we demonstrate that the association of p53 with a protein kinase and the in vitro phosphorylation of p53 seems to depend on the surrounding cellular environment.

[Botulinum toxin in the treatment of adult spasticity. An interdisciplinary German 10-point consensus 2010]

Spasticity is one of the major causes of functional impairment in adults with lesions of the central nervous system. For instance, approximately 30% of post-stroke patients suffer from different degrees of spasticity with possible consecutive impairments. Numerous studies or meta-analyses showed that local injections of botulinum toxin in spastic muscles lead to dose-dependent reduction in muscle tone and improvement of passive movements (e. g. facilitated care), especially following repeated injections.However, country-specific regulations and patient-remote administration in German health care often do not allow adequate provision of this therapy. Thus, the present consensus statement based on the EBM analyses of the published international literature tries to highlight recent advances and the standard in the field of local spasticity treatment, aiming to facilitate communication between the decision makers and German reimbursement institutions in health care. Prior to initiation of BoNT-A injections, patient-oriented goals should be identified in a multiprofessional context to assure realistic goals for this specific treatment and patient expectations. In Germany for the treatment of focal spasticity following stroke three products have been approved: Botox® (Pharm Allergan, Ettlingen), Dysport® (Ipsen Pharma, Ettlingen) and Xeomin® (Merz Pharma, Frankfurt/Main). For all preparations safety has been repeatedly shown. Functional improvements have also been illustrated for selected patients concerning hand/arm function and gait. The dose per muscle and the selection of muscles to be injected have to be individualized according to the patient's symptoms and should be accompanied by modern neurorehabilitative therapies such as redression or repetitive activation of the injected and antagonistic muscles.