Physiological aspect of apoptosis-regulating microRNAs expressions during fasting

OBJECTIVE

Fasting is an activity that requires a certain calorie restriction without consuming food or drinks for a certain period of daytime. However, fasting triggers many complex events, including activating cellular stress response pathways, autophagy promotion, apoptosis pathways, and a change in hormonal balance. Among the many events affecting the regulation of apoptosis, the expression of microRNAs (miRNAs) plays an important role. Therefore, we aimed to investigate the levels and importance of miRNA expression in fasting.

PATIENTS AND METHODS

The expressions of 19 miRNAs regulating different pathways from saliva samples, isolated by matching healthy university students (n = 34) as group 1 (fasting for 17 consecutive hours) and group 2 (testing 70 minutes after meal consumption), were examined using the real-time PCR method.

RESULTS

In fasting, modulation of apoptotic pathways by miRNAs triggers anti-pathogenic effects, and the adaptation of abnormal cells in the body decreases. For this reason, vital diseases, such as cancer, can be treated by preventing the proliferation and growth of cancerous cells by increasing programmed cell death due to the downregulation expression mechanism of miRNAs.

CONCLUSIONS

Our study aims to improve the knowledge about the mechanisms and functions of miRNAs in various apoptosis pathways during fasting and may be a model for further future physiological and pathological studies.

P-508 Why I left my Fertility Clinic for Another ART provider – It’s Not What You Think: A RealTalk patient survey

Study question

To assess with a large number of patients why they chose to switch ART provider[s] before they had exhausted all of their treatment options.

Summary answer

The patient-provider relationship was the most common reason cited for leaving an ART provider, and also the most common reason for staying.

What is known already

A large number of patients drop out of treatment early in the ART treatment process, for many reasons. In previous studies, this was attributed to a negative patient experience. Also, ‘information’, ‘attitude of and relationship with staff’ and ‘competence of clinic and staff’ were noted by patients as three major points. Previous evidence suggests a ‘lack of empathy’, negative interactions with staff, and poorly formulated explanations of healthcare plans[5] are substantially causing discontinuation of treatment. Most research published on the topic available so far, either uses a small sample of patients or only indirectly assesses potential reasons for drop out.

Study design, size, duration

A 12-question online questionnaire was sent to 40 patient advocates of diverse age, race, sexual orientation, and treatment experiences. They were asked to disseminate it to members of their communities who met the criteria of having undergone at least one fertility treatment. In total, 1,060 patients were surveyed (February-April 2019). 89.6% came from the US, the remainder from 21 countries (six continents). Median age of respondents was 33.7. Median months trying to conceive was 48.

Participants/materials, setting, methods

The confidential online survey consisted of four demographic questions, four closed-ended treatment-history questions, and three open-ended questions about experiences with ART providers. The open-ended questions allowed answers of unlimited length.

Long form responses were modeled using Natural Language Processing (NLP) techniques, TF-IDF (Term Frequency-Inverse Document Frequency) combined with NMF (Non-negative Matrix Factorization) and grouped into topics, from which several “themes” emerged.

Methodology, results and conclusions were reviewed and endorsed by a committee of fertility specialists.

Main results and the role of chance

The reasons given for leaving their clinic fell into six clear themes: a treatment/approach not tailored to the patient and their needs (23%); poor bedside manner (communication style, the patient not feeling “heard”) (18%); logistical challenges e.g., doctor, clinic or patient had moved (14%); cost/access issues (9%); lack of efficacy e.g., treatment unsuccessful (8%); provider was “all business” e.g., patient felt like a number (8%). Taken together, 49% left a clinic because of a relationship issue. The remaining responses were too general to classify into a clear theme.

Four clear themes emerged in the reasons provided for staying with their clinic. Patients stayed because of good access/cost/insurance coverage (29%), they were already enrolled in next steps at the clinic (e.g., purchased IVF bundle, embryo storage, etc.) (26%), they had a connection with staff (25%), they were feeling optimistic (20%).

Relationships were also a major theme when respondents were asked to provide further comments about their experiences and/or what they value in a fertility doctor: a good fit (24%); provider has an interest in learning about them and/or exploring tailored treatment options (13%); feels connected and is being treated like a human being (11%); provider communicates and shows compassion (10%).

Limitations, reasons for caution

Respondents were invited to participate by other respondents, rather than recruited centrally.

Wider implications of the findings

This study demonstrates that, unlike patient access to funds or treatment success (over which they have little control), ART clinics can improve their patient retention rates by improving the one aspect of the patient experience over which providers have the most control: the patient-provider relationship.

Trial registration number

NA

Frequency of eosinophilic esophagitis in patients with esophageal symptoms: a single-center Turkish experience

Eosinophilic esophagitis (EoE) is a chronic, immune/antigen-mediated esophageal disease characterized with symptoms related to esophageal dysfunction and eosinophil-predominant inflammation. There has been a dramatic increase in the diagnosis of this disease in recent years. The primary objective of this study was to determine the frequency of EoE in adult patients who were evaluated by gastroenterologists in our clinic with esophageal symptoms. Between November 2010 and May 2011, 311 adult patients who were evaluated in our clinic with esophageal symptoms were enrolled prospectively. All patients underwent endoscopy and had biopsies taken. Gastroesophageal reflux disease was excluded by either proton pump inhibitory treatment or 24-hour ambulatory pH monitorization. The diagnosis was confirmed by one independent pathologist. Frequency of EoE in patients with esophageal symptoms was 2.6% (n = 8; four men and four women). Mean age at diagnosis was 40.2 ± 8 years. Heartburn was the predominant symptom in patients (75% of the patients), and 87.5% (n = 7) of patients had more than one symptom at diagnosis. Nearly 38% of the patients (n = 3) had a history of allergic disease. Endoscopic findings were as follows: transient/fixed esophageal rings (25%), white exudates (25%), and normal appearance (50%). Median number of circulating eosinophils was 208 (93-659)/mm(3) . Median number of intraepithelial eosinophils in proximal-middle 1/3 part and distal 1/3 part of esophagus were 0 (0-50)/hpf and 37 (16-50)/hpf, respectively. In conclusion, EoE is not rare in Turkey, and it should be considered in the differential diagnosis of patients with esophageal symptoms.

A severely mental and motor retarded boy with monosomy 9pter-->p22 trisomy 10q26-->qter due to paternal reciprocal translocation 46,XY,t(9;10)(p23;q26)

We report on a twenty-two months old male patient with hypotonia, mental and motor retardation and trigonocephaly. Standard GTG banding chromosomal analysis (from metaphyses of a periferal blood lymphocyte culture) showed 46,XY, der(9) monosomy 9pter-->p22, trisomy 10q26--> qter karyotype. This unbalanced translocation resulted from the father's t(9,10) (p22;p26) karyotype. Deletions of the terminal part of 9p and partial trisomy of chromosome 10q are rare chromosomal disorders. To our knowledge, this is the first case report in the literature of a deletion of 9pter-->p22.3 and a duplication of 10q26-->qter. We assume that the clinical anomalies are due to der(9) monosomy 9pter-->p22, trisomy 10q-->26qter.

Turner syndrome and 45,X/47,XXX mosaicism

The occurrence of double aneuploidy is a relatively rare phenomenon. We report on a 17-year-old woman with short stature, minimal pubic and axillar hair and short hands. In cultured lymphocyte a double aneuploidy mosaicism was detected, consisting of a cell line with trisomy for X chromosome and a cell line with monosomy for the X-chromosome and no cell line with a normal karyotype. To our knowledge, this is the first case of mosaic 45,X/47,XXX in Turkey.

Analysis of the SRY gene in a girl with 45,X/46,XY genotype

Analysis of the SRY gene in a girl with 45,X/46,XY genotype: We present a Turner syndrome patient with a 45, X/46, XY mosaicism. A seven-year-old patient was admitted to our laboratory for evaluation of Turner Syndrome. On physical examination, short stature, a webbed neck, a broad chest with widely spaced nipples, syndactyly on toes, horse shoe kidney and typical findings of aortic coarctation were present. The chromosome karyotype of the patient was 45 X/46 XY. Molecular analysis of the blood lymphocytes confirmed the presence of the SRY gene of the patient. We report here the clinical and cytogenetic findings in a patient with an unusual sex chromosome mosaicism.

A male case with double aneuploidy (48,XXY,+21)

The co-occurrence of two numerical chromosomal abnormalities in same individual (double aneuploidy) is relatively rare and the clinical presentations are variable depending on the predominating aneuploidy or a combination effect of both. Furthermore, double aneuploidy involving both autosomal and sex chromosomes is seldom described. We describe a male patient with typical clinical features of Down Syndrome and his karyotype revealed 48,XXY,+21. The phenotypic characteristics of this child have been discussed in the light of the published reports on double aneuploidies of XXY and trisomy 21.

Legionnaire's disease: a nosocomial outbreak in Turkey

Six nosocomial cases of Legionella pneumophila occurred over a two-week period, with one further case being diagnosed retrospectively after 30 days. Strains isolated from the hospital water system were clonally related to a single sputum isolate. A sero-epidemiological investigation into legionella exposure amongst staff and inpatients was undertaken at the eight-year-old Inonu University Medical Centre in Turkey, which has 600 beds and central air conditioning. There is no disinfection programme for the hospital water system. A total of 500 serum samples (400 hospital staff and 100 inpatients) were screened for antibody to L. pneumophila by enzyme-linked immunosorbent assay (ELISA). Seroreactive cases were confirmed by a four-fold antibody rise in ELISA, a high indirect immunofluorescent assay (IFA) antibody titre or a positive urinary antigen test. ELISA showed that 24 (6%) of the 400 hospital staff and seven (7%) of the 100 inpatients had antibody titres higher than the cut-off value. ELISA-seroreactive cases were followed for two to four weeks. Of these subjects, seven (three patients and four staff) showed a four-fold rise in antibody titre by ELISA, six (three patients and three staff) had a high IFA titre, three patients with pneumonia had a positive urinary antigen test, and one of these patients also had a positive sputum culture. In addition, 22 water distribution systems were screened for the presence of L. pneumophila by culture. L. pneumophila was isolated from 15 sites. Pulsed-field gel electrophoresis typing indicated that all strains isolated from water systems were identical and clonally related to the strain isolated from sputum. Superheating and flushing of water systems were undertaken with legionella being re-isolated from four sites. Repeated superheating and flushing eliminated legionella completely. This study demonstrated that rapid detection of L. pneumophila and adequate superheating and flushing of water systems are effective for elimination and reduction of spread of this organism.

Legionella as a cause of severe pneumonia

Legionella pneumophila has been found to be a common cause of community-acquired pneumonia in patients who required intensive care unit (ICU) admission. In many studies, the clinical manifestations for Legionnaires' disease were more severe and the mortality was higher when compared with pneumonias of other etiology. However, this may be due to delay in diagnosis and suboptimal antibiotic therapy, rather than enhanced virulence of L. pneumophila. A syndromic approach using high fever, diarrhea, mental status changes, hyponatremia, etc., may be useful in suggesting the correct diagnosis in patients with severe pneumonia, but this remains to be validated. The availability of Legionella diagnostic microbiology testing in-house (rather than being sent to an outside reference laboratory) maximizes the ability to correctly diagnose Legionnaires' disease. All patients with community-acquired pneumonia admitted to an ICU should undergo Legionella testing using the urinary antigen and culture on selective media. Moreover, we recommend routine cultures of the hospital water supply once a year (regardless of whether a case of nosocomial Legionnaires' disease has ever been diagnosed). If Legionella is found in the water supply, all patients with nosocomial pneumonia should undergo diagnostic tests for Legionella; empiric anti-Legionella antibiotics should be administered pending definitive diagnosis.

Legionnaires' disease and pneumonia. Beware the temptation to underestimate this "exotic" cause of infection

Legionnaires' disease is an often overlooked but common cause of community-acquired pneumonia. The clinical presentation is nonspecific, although fever higher than 39 degrees C (102.2 degrees F), gastrointestinal symptoms, and hyponatremia should raise the index of suspicion. In this article, Drs Akbas and Yu describe specialized laboratory tests needed for definitive diagnosis and discuss therapeutic options.

A quantitative study of genital skin flora and urinary colonization in spinal cord injured patients

This study was performed to define the relation between colonization of genital skin flora and bacteriuria in spinal cord injured patients with neurogenic bladder dysfunction. Twenty-seven female and 23 male spinal cord injured patients were included in the study. Patients were evaluated regarding their type of bladder management, educational status, level and degree of the spinal cord lesion. Quantitative cultures were obtained from the perineum labium/dorsum of penis, external meatus of urethra, and urine. We investigated whether the organisms isolated from urine were also present in one or more skin sites in every patient. In total 54 identical bacterial isolates were observed both from urine and one or more skin sites in 43 of the patients. Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae, and Proteus stuartii were the most common bacterial isolates. The distribution of identical colonization of genital skin flora with urine were as follows: 30 in urethra, one in perineum, four in urethra and perineum, nine in urethra and labium/dorsum of penis, and 10 in both three skin sites. Identical colonization of both perineum and labium/dorsum of penis with urine were significantly higher in female patients than those of males (P = 0.037, P = 0.003, respectively). No significant difference was found in the presence/distribution of colonization with respect to type of bladder management, educational status, and neurologic status. These results demonstrate the importance of the urethra, perineum, and labium/dorsum of penis as a source of bacteria causing urinary infection in spinal cord injured patients.