A Novel Lactic Acid Bacteria Mixture: Macrophage-Targeted Prophylactic Intervention in Colorectal Cancer Management

Colorectal cancer (CRC) is one of the most common forms of cancer. Its onset from chronic inflammation is widely accepted. Moreover, dysbiosis plays an undeniable role, thus the use of probiotics in CRC has been suggested. They exhibit both anti- and pro-inflammatory properties and restore balance in the microbiota. The aim of this study was to investigate the immunomodulatory properties of six lactobacilli with probiotic features in an in vitro model of macrophage-like cells and to test these pooled probiotics for their anti-tumour properties in a chemically induced CRC model using Wistar male rats. Upon co-culture of M1- and M2-like macrophages with lactobacilli, cytokine release (TNF-α, IL-1β, IL-18, IL-23) and phagocytic activity using fluorescent-labelled bacteria were tested. The effects of orally administered probiotics on basic cancer and immune parameters and cytokine concentration (TNF-α, IL-1β, IL-18) in colon tumours were studied. Tested lactobacilli exhibited both pro- and anti-inflammatory properties in in vitro conditions. In vivo study showed that the administration of probiotics was able to decrease multiplicity, volume and total tumour numbers, restore colon length (p < 0.05) and increase IL-18 production (p < 0.05) in tumour tissue. These data indicate both an immunomodulatory effect of probiotics on distinct macrophage subsets and a protective effect against chemically-induced CRC.

Macrophage subsets exhibit distinct E. coli-LPS tolerisable cytokines associated with the negative regulators, IRAK-M and Tollip

Macrophages (Mϕs) play a central role in mucosal immunity by pathogen sensing and instruction of adaptive immune responses. Prior challenge to endotoxin can render Mφs refractory to secondary exposure, suppressing the inflammatory response. Previous studies demonstrated a differential subset-specific sensitivity to endotoxin tolerance (ET), mediated by LPS from the oral pathogen, Porphyromonas gingivalis (PG). The aim of this study was to investigate ET mechanisms associated with Mφ subsets responding to entropathogenic E. coli K12-LPS. M1- and M2-like Mφs were generated in vitro from the THP-1 cell line by differentiation with PMA and Vitamin D3, respectively. This study investigated ET mechanisms induced in M1 and M2 Mφ subsets, by measuring modulation of expression by RT-PCR, secretion of cytokines by sandwich ELISA, LPS receptor, TLR4, as well as endogenous TLR inhibitors, IRAK-M and Tollip by Western blotting. In contrast to PG-LPS tolerisation, E. coli K12-LPS induced ET failed to exhibit a subset-specific response with respect to the pro-inflammatory cytokine, TNFα, whereas exhibited a differential response for IL-10 and IL-6. TNFα expression and secretion was significantly suppressed in both M1- and M2-like Mφs. IL-10 and IL-6, on the other hand, were suppressed in M1s and refractory to suppression in M2s. ET suppressed TLR4 mRNA, but not TLR4 protein, yet induced differential augmentation of the negative regulatory molecules, Tollip in M1 and IRAK-M in M2 Mφs. In conclusion, E. coli K12-LPS differentially tolerises Mφ subsets at the level of anti-inflammatory cytokines, associated with a subset-specific divergence in negative regulators and independent of TLR4 down-regulation.

Use of Whole Genome Sequencing and Patient Interviews To Link a Case of Sporadic Listeriosis to Consumption of Prepackaged Lettuce

We report on a case of listeriosis in a patient who probably consumed a prepackaged romaine lettuce-containing product recalled for Listeria monocytogenes contamination. Although definitive epidemiological information demonstrating exposure to the specific recalled product was lacking, the patient reported consumption of a prepackaged romaine lettuce-containing product of either the recalled brand or a different brand. A multinational investigation found that patient and food isolates from the recalled product were indistinguishable by pulsed-field gel electrophoresis and were highly related by whole genome sequencing, differing by four alleles by whole genome multilocus sequence typing and by five high-quality single nucleotide polymorphisms, suggesting a common source. To our knowledge, this is the first time prepackaged lettuce has been identified as a likely source for listeriosis. This investigation highlights the power of whole genome sequencing, as well as the continued need for timely and thorough epidemiological exposure data to identify sources of foodborne infections.

Heat-killed probiotic bacteria differentially regulate colonic epithelial cell production of human β-defensin-2: dependence on inflammatory cytokines

The inducible antimicrobial peptide human β-defensin-2 (hBD-2) stimulated by pro-inflammatory cytokines and bacterial products is essential to antipathogen responses of gut epithelial cells. Commensal and probiotic bacteria can augment such mucosal defences. Probiotic use in the treatment of inflammatory bowel disease, however, may have adverse effects, boosting inflammatory responses. The aim of this investigation was to determine the effect of selected probiotic strains on hBD-2 production by epithelial cells induced by pathologically relevant pro-inflammatory cytokines and the role of cytokine modulators in controlling hBD-2. Caco-2 colonic intestinal epithelial cells were pre-incubated with heat-killed probiotics, i.e. Lactobacillus casei strain Shirota (LcS) or Lactobacillus fermentum strain MS15 (LF), followed by stimulation of hBD-2 by interleukin (IL)-1β and tumour necrosis factor alpha (TNF-α) in the absence or presence of exogenous IL-10 or anti-IL-10 neutralising antibody. Cytokines and hBD-2 mRNA and protein were analysed by real-time quantitative polymerase chain reaction and enzyme-linked immunosorbent assay. LcS augmented IL-1β-induced hBD-2, whereas LF enhanced TNF-α- and suppressed IL-1β-induced hBD-2. LF enhanced TNF-α-induced TNF-α and suppressed IL-10, whereas augmented IL-1β-induced IL-10. LcS upregulated IL-1β-induced TNF-α mRNA and suppressed IL-10. Endogenous IL-10 differentially regulated hBD-2; neutralisation of IL-10 augmented TNF-α- and suppressed IL-1β-induced hBD-2. Exogenous IL-10, however, suppressed both TNF-α- and IL-1β-induced hBD-2; LcS partially rescued suppression in TNF-α- and IL-1β-stimulation, whereas LF further suppressed IL-1β-induced hBD-2. It can be concluded that probiotic strains differentially regulate hBD-2 mRNA expression and protein secretion, modulation being dictated by inflammatory stimulus and resulting cytokine environment.

Evaluation of the microbial community, acidity and proximate composition of akamu, a fermented maize food

BACKGROUND

Akamu is a lactic acid-fermented cereal-based food that constitutes a major infant complementary food in most West African countries. The identities of LAB populations from DGGE analysis and conventionally isolated LAB and yeasts from traditionally fermented akamu were confirmed by PCR sequencing analysis. The relationships between pH, acidity and lactic acid levels and proximate composition of the akamu samples were investigated.

RESULTS

The LAB communities in the akamu samples comprised mainly Lactobacillus species, including Lb. fermentum, Lb. plantarum, Lb. delbrueckii ssp. bulgaricus and Lb. helveticus, as well as Lactococcus lactis ssp. cremoris. Identified yeasts were Candida tropicalis, Candida albicans, Clavispora lusitaniae and Saccharomyces paradoxus. Low pH (3.22-3.95) was accompanied by high lactic acid concentrations (43.10-84.29 mmol kg⁻¹). Protein (31.88-74.32 g kg⁻¹) and lipid (17.74-36.83 g kg⁻¹ contents were negatively correlated with carbohydrate content (897.48-926.20 g kg⁻¹, of which ≤1 g kg⁻¹ was sugars). Ash was either not detected or present only in trace amounts (≤4 g kg⁻¹). Energy levels ranged from 17.29 to 18.37 kJ g⁻¹.

CONCLUSION

The akamu samples were predominantly starchy foods and had pH < 4.0 owing to the activities of fermentative LAB.

Probiotic bacterial strains differentially modulate macrophage cytokine production in a strain-dependent and cell subset-specific manner

Gut mucosal macrophages play a pivotal role in driving mucosal immune responses, resulting in either activation of inflammatory immune responses to pathogenic challenge or tolerance to beneficial luminal contents such as food and commensal bacteria. Macrophage responses elicited are dependent on tissue environment and the resulting cell subset, where homeostatic macrophages resemble the M2 macrophage subset and inflammatory macrophages resemble M1s. Probiotics can modulate macrophage function with outcome dependent on subset present. Using a THP-1 monocyte cell line-derived model of CD14high/low M1 and M2 macrophages, the aim of this study was to investigate the immunomodulatory effects of a panel of heat-killed probiotic bacteria and their secreted proteins on the subset-specific inflammatory marker profile of TNFα, IL-6 and NFκB. M1 and M2 cells were generated by differentiation of monocyte stable transfectants for high and low CD14 expression with phorbol 12-myristate 13-acetate and vitamin D3, respectively, where the resulting CD14lo M2 and CD14hi M1s mimicked homeostatic and inflammatory mucosal macrophages. Subsets were stimulated by enteropathic lipopolysaccharides in the presence or absence of heat-killed (HK) or secreted proteins (SP) from a panel of probiotic bacteria. Regulation of cytokine expression was measured by ELISA and NFκB activity by reporter assay. HK probiotics suppress CD14lo and augment CD14hi M1 and M2 production of TNFα whereas SPs augmented CD14hi M1 TNFα and were generally suppressive in the other subtypes. M2 macrophage IL-6 production was suppressed by both HK and SPs and differentially regulated in CD14lo and CD14hi M1s. NFκB activation failed to parallel the regulatory profiles for TNFα and IL-6 which is suggestive of probiotic bacteria exerting their regulatory effects on these cytokines in an NFκB-independent manner. In conclusion, HK and SP probiotics differentially regulate macrophage cytokines and NFκB activation in a subset-dependent manner and suggest a cautionary approach to probiotic treatment of mucosal inflammation.

Sending out an S.O.S. Key insights identify how to keep your neonatal NPs from slipping away

Review results of a retention study that targets 16 neonatal nurse practitioners employed by five level II/III neonatal intensive care units.

Current role of beta-adrenergic blockers in the treatment of chronic congestive heart failure

Recent findings on the use of beta-adrenergic blockers in patients with congestive heart failure (CHF) are reviewed. CHF is a progressive, debilitating disease that afflicts 4.6 million patients in the United States. Treatment has traditionally consisted of a diuretic, an angiotensin-converting-enzyme (ACE) inhibitor, and digoxin. Despite advances in ACE-inhibitor therapy, the five-year mortality rate remains nearly 50%. Overstimulation of the sympathetic nervous system is believed to contribute to mortality. Beta-blockers have recently been added to the standard of care for patients with New York Heart Association functional class II or III heart failure. Four randomized, double-blind, placebo-controlled clinical trials were recently completed that addressed the benefits of beta-blockers in CHF. The overall mortality rate was reduced 65% by carvedilol, 34% by metoprolol, and 33% by bisoprolol; all these reductions were significant compared with placebo, and the trials were ended early. Bucindolol, however, did not have a significant effect on mortality. These drugs are hepatically metabolized and may require dosage adjustment in hepatically impaired patients. Decompensation of heart failure is another consideration; a beta-blocker should be added only for patients with stable CHF. Dosages must be slowly adjusted to targeted levels. Adverse effects do not differ significantly among beta-blockers. In addition to their effect on mortality, beta-blockers reduce CHF-related morbidity, such as all-cause hospitalization. Carvedilol, metoprolol, and bisoprolol decrease the mortality and morbidity associated with CHF and can be used with limited adverse effects. The choice among these agents does not affect clinical outcomes; bucindolol, however, has proven ineffective.

Receptor modeling for elemental source contributions to fine aerosols in New York State

Fine atmospheric particulate material was collected at five sites in upstate New York and analyzed for its trace element composition by instrumental neutron activation analysis. Of the 3700 daily samples collected over a 2-yr period, 1459 were analyzed for 39 elements, providing a large and detailed data set. Factor analysis (FA) was used to identify potential pollution sources or source regions and to construct inorganic source profiles for each. Following FA, the method of absolute factor scores-multiple linear regression was used to estimate the absolute elemental contribution of each of the identified sources. Factor analysis identified nine sources impacting the sampling region. Seven of these were found to be present in varying degrees among of the sampling sites. The other two sources had more localized impacts and were observed at only one of the sites each. Regional sources (such as the midwestern United States and eastern Canada) and crustal/soil material accounted for the greatest amount of the trace elements measured in the collected material.

Preoperative small-dose ketamine has no preemptive analgesic effect in patients undergoing total mastectomy

We evaluated the preemptive analgesic effect of a small dose of ketamine given before or immediately after surgery in a randomized, double-blinded study performed in 128 women undergoing total mastectomy. Group 1 patients received ketamine 0.15 mg/kg as a 5-mL i.v. injection 5 min before surgery and isotonic saline 5 mL i.v. at the time of skin closure. Group 2 received 5 mL i.v. of isotonic saline, then 0.15 mg/kg i.v. ketamine. A standard general anesthesia procedure including sufentanil was used. In the recovery room, patient-controlled analgesia i.v. morphine was used for postoperative analgesia. Postoperative pain was assessed by measuring morphine consumption and visual analog scale pain scores. No significant intergroup differences were seen in the pain scores. Patient-controlled analgesia morphine consumption was lower during the first 2 h after surgery in patients given ketamine at the time of skin closure. No patient complained of hallucinations or nightmares. The incidence of adverse effects was not different between the two groups. In conclusion, administering ketamine at the end of surgery is more effective in reducing morphine consumption than it is when given before surgery.

IMPLICATIONS

We administered the same small dose of ketamine before or after surgery. The preoperative administration of 0.15 mg/kg ketamine in patients undergoing total mastectomy did not elicit a preemptive analgesic effect. Ketamine given at closure reduced the patient-controlled analgesia morphine requirement in the first 2 h after surgery.

Attitudes of female college students toward over-the-counter availability of oral contraceptives

STUDY OBJECTIVE

To determine female college students' beliefs about oral contraceptive pill (OCP) availability and use, and to examine significant factors associated with these beliefs.

DESIGN

Cross-sectional survey.

SETTING

Urban women's liberal arts college.

PARTICIPANTS

Two hundred ninety female undergraduates who completed surveys.

INTERVENTION

An anonymous survey was placed in all undergraduate mailboxes. Surveys were returned to a locked collection box in the mailroom. Within 4 weeks after distribution. 290 surveys were completed.

MAIN OUTCOME MEASURES

Sexual and contraceptive practices and students' beliefs regarding whether OCPs should be made available without prescription.

RESULTS

The respondents' average age was 20.9 +/- 3.3 years; 84% reported previous sexual intercourse with the mean age of first intercourse at 16.6 +/- 2.2 years. Seventy-five percent of the sexually active women reported use of OCPs and 52% had used OCPs at their last intercourse. Sixty-five percent of all respondents felt OCPs should not be available without prescription. The two most commonly cited reasons for not wanting OCPs to be available over the counter (OTC) were that (1) side effects might occur that a health care provider could have prevented (59%), and (2) people would not go to their providers for regular check ups (56%). The most commonly cited reason for believing that OCPs should be available OTC was that there would be fewer unwanted pregnancies (74%). Race, previous OCP use, previous sexual activity, and perceived risk of pregnancy were not significant predictors of believing OCPs should be available OTC. Having had a previous pregnancy was a significant predictor of believing OCPs should be available OTC (p = 0.047). Those who believed OCPs should be available only with a prescription were willing to pay more for OCPs (p = 0.033). Logistic regression controlling for race revealed that both younger age (p = 0.03) and previous pregnancy (p = 0.002) were independent predictors of believing OCPs should be available OTC.

CONCLUSIONS

The majority of our sample believe that OCPs should remain as a prescription medication. Previous pregnancy and younger age are important factors in determining beliefs regarding OCP availability. Further studies in a more diverse population are needed to explore the relationship between age, previous pregnancy, and desire for contraceptive availability without prescription.

Use of nursing models in pediatric nursing research: a decade of review

Systematic analysis of published nursing research is not new, but the incorporation of theory into research has not been separately evaluated, and pediatric nursing research has not been evaluated in its entirety for nearly two decades. A review of the use of nursing models in 302 pediatric nursing research articles published between 1980 and 1989 was conducted. Criteria developed by Silva (1986) to examine the theoretical basis of nursing practice research were used for this analysis. Nursing models were used as the theoretical framework in 17 investigations. According to Silva's criteria, the use of nursing models in these studies could be classified as follows: 6 minimal, 8 insufficient, and 3 adequate. This analysis produced results similar to those of previous analyses, finding that scant numbers of studies actually test nursing theory.

The interconnectedness of nurses' lives. Implications for nursing management

OBJECTIVE

This study extends knowledge of how nurses' careers interact with their personal lives and professional development.

BACKGROUND

Extant research suggests that nurses' career patterns are unstable or unplanned. However, these images may be a reflection of the models that are applied. Such models are overwhelmingly normative and do not reflect the actual life experience of nurses.

METHODS

A series of interviews explored how nurses make changes in their lives. Questions focused on the stimulus for change and the resources used, problems associated with changes, and the effects of changes on the nurses themselves and others.

RESULTS

The results show that nurses' careers, professional development, and personal lives are interconnected.

CONCLUSIONS

The concept of interconnectedness reflects the confluence of events or people and their contemplation and integration by the nurses into their lives and relationships. The results contradict normative admonitions about career planning and have implications for the development of theories on nursing careers and for nurse managers.

Histopathological and clinical correlations of cystosarcoma phyllodes

We performed a detailed retrospective analysis of 25 patients treated primarily at Northwestern Memorial Hospital, Chicago, for cystosarcoma phyllodes. Histopathological evaluation correlated well with malignancy, but clinical suspicion did not. Pathological studies indicated that high-grade tumors, necrosis, infiltrating margin, and the presence of more than one mesenchymal element were often associated with aggressive behavior. Flow-cytometric analyses of DNA aneuploidy and proliferative index supported the grading system we used, since all four malignant cases examined showed high proliferative index, and three of the four cases showed aneuploidy. None of the low-grade cases, including the recurrent ones, showed increased proliferative index or aneuploidy. We believe that flow-cytometric analysis ought to be performed on cases in which there is doubt regarding the potential malignancy.

[Chemical Constituents of the Convolvulaceae-Resins IV1.]

From the roots and upper parts of the Convolvulaceae IPOMOEA QUAMOCLIT, I. LACUNOSA, I. PANDURATA and CONVOLVULUS AL-SIRENSIS by ether-, petrolether and ethanol extraction respectively a resin material could be isolated, which yielded after alcaline hydrolysis glycosidic acids with jalapinolic acid as the common hydroxy fatty acid and the sugars rhamnose, glucose and xylose in different molar ratios.