Patterns of antibiotic administration in patients with burn injuries: A TriNetX study

BACKGROUND

In the advent of increasing antibiotic resistance, several studies sought to determine antibiotic prescription trends; however, no pattern has been firmly identified particularly for the burned population. We performed a query of burned patients in a large established database to understand differences in antibiotic use related to patient-specific factors.

METHODS

Burned patients with systemic antibiotics given within 7 days of injury were identified on the TriNetX database. The patient population was stratified by age, 1-year time intervals of antibiotic prescription from 2004 to 2019, time of antibiotic prescription in 1-day intervals after injury, and % TBSA burned in 10% intervals ranging from < 10% to > 90%. Data were analyzed using χ2 with p < 0.05 considered significant. Pearson coefficients (r2) values were used to correlate differences in antibiotic prescription between age groups and to changes over time.

RESULTS

Stratification by age revealed higher use of antibiotics in older burned patients compared to younger patients. Surprisingly, 87.6% of burn patients of those who received antibiotic therapy was on the day of injury. Penicillins and beta-lactam antimicrobials were used most often at a frequency of 64%. No statistically significant differences in rates of antibiotic therapy were observed in burned patients when stratified by %TBSA burned.

CONCLUSIONS

The study elucidates current patterns of antibiotic use in burn care in the United States, allowing for improved understanding of both past and present patterns of antibiotic prescription.

[The feasibility study of objective evaluation of the severity of motion sickness by quantitative analysis of the facial skin color]

Objective: To explore the feasibility of applying quantitative analysis of the facial skin color to evaluate the severity of motion sickness objectively and to seek objective indicators that can reflect the severity of motion sickness. Methods: Motion sickness was induced in 51 male adult subjects recruited at the Air Force Medical University by Coriolis acceleration stimulation, and facial skin colorimetric values were acquired using a portable spectrophotometer at five time points: before stimulation and at 0 min, 10 min, 20 min and 30 min after the end of stimulation. The Graybiel rating scales were applied to assess the severity of motion sickness in subjects at each time point after stimulation, and the correlation between the magnitude of change in each colorimetric value and the maximum Graybiel's score was analyzed. The ROC curves were used to compare the evaluation performance of colorimetric value indicators which could reflect the severity of motion sickness. Results: Each colorimetric value in the CIE-L^*a^*b^* color system changed significantly after exposure to provocative motion stimuli, and the trend was consistent with the typical sign of pallor in motion sickness. The magnitudes of the increase in the colorimetric value CIE-L^*, the decrease in CIE-a^*, and the increase in CIE-b^* were all significantly and positively correlated with the maximum of Graybiel's scores (r=0.490 0, P=0.000 3; r=0.549 3, P<0.000 1; r=0.540 9, P<0.000 1). Comparing the performance of three colorimetric indicators to assess the severity of motion sickness, CIE-a^* had an area under the ROC curve of 0.875 0, a sensitivity of 85.71%, and a specificity of 87.50%, which was better than CIE-L^* and CIE-b^*. Conclusions: The CIE-L^*a^*b^* colorimeter values can be considered as objective indicators of the severity of motion sickness, among which the colorimetric indicator CIE-a^* has the most diagnostic significance, and the method of quantitative analysis of the facial skin color can provide a new reference for the objective evaluation of the severity of motion sickness.

82 Early Skin Excision Decreased the Risk of Skin Infection, Sepsis and Mortality Among Burn Patients

Introduction

In lieu of outdated and limited patient studies on excision for severe burns, a more comprehensive analysis is indicated to determine the effects of early skin excision following burn. This study aims to address the outcomes of early excision.

Methods

Data collection and analysis was performed using TriNetX, a national research database. The study population included patients ranging from 0 to 90 years old who underwent excision for burns. Groups were stratified by the number of days after injury in which they received a skin excision treatment. Five outcomes were analyzed: death, cardiac stress, wound infection, blood transfusion, and sepsis. Risk and incidence of various health outcomes were compared between groups after matching for age, gender and race, using a z-test with p< 0.05 considered significant.

Results

We identified 2,522 patients who underwent excision between 0-3 days, 825 between 4-7 days, and 419 between 8-14 days following burn. We found a significant decrease in risk of skin infection and sepsis for skin excision 0-3 days after burn compared to 4-7 days (p< 0.05). Additionally, the frequency of blood transfusion significantly increased for those with excision 0-3 days after burn when compared to 4-7 days (p< 0.05). There was a significant increase in the risk of mortality for patients who received skin excision 8-14 days after injury as compared to both 0-3 days (p< 0.05) and 4-7 days (p< 0.05). However, we found no statistical difference in cardiac stress, skin infection, blood transfusion or sepsis between 0-3 and 8-14 days nor 4-7 and 8-14 days.

Conclusions

Skin excision 0-3 days after burn injury results in a significantly lowered risk of skin infection and sepsis as compared to skin excision 4-7 days and 8-14 days after burn. Skin excision within the first 7 days after burn decreased the risk of mortality as compared to excision 8-14 days after burn. The risk of blood transfusion increased with early excision, which may be explained by the severity of the injury.

12 The Influence of Female Sex Hormones on Outcomes After Burn Injury

Introduction

The pathophysiological response to major trauma has gender dimorphism in outcomes associated with sex hormones levels. However, little is known of the effects of female hormones on outcomes in burn patients. Previous studies demonstrated exogenous estrogen alleviates hyper-inflammation after burn. We thus posit that female patients have fewer comorbidities depending on female hormone levels. We had two objectives: to investigate the role of female hormones on outcomes after burn and to investigate potential protective properties of exogenous hormone treatment on burned post-menopausal women.

Methods

This study obtained data from the TriNetX research network with electronic medical records of de-identified patients. Both male and female patients who suffered burns were included from 2002-2020. The population was stratified to only include women over 45 on estrogen or progestin hormones taken within 6 months prior to injury and 1 month after injury to assure a menopausal state which occurs at age 45-55. Outcomes for mortality, sepsis, acute myocardial infarction, and acute kidney injury were measured within one day of injury to one month following injury. Odds ratios, risk difference, and risk ratios were calculated for outcome analysis after propensity-matched for race and ethnicity. A z-test for risk difference was performed. Statistical significance was defined at p &lt; 0.05.

Results

Compared to males, females grossly had a 28% risk reduction of 30-day mortality and a relative risk reduction for sepsis (26%), acute kidney failure (30), and myocardial infarction (29%) (p&lt; .05). Additionally, female burns younger than the age 45 had risk reductions for mortality 5.4-fold within 3 months, 2.9-fold lower for sepsis, 17.5-fold lower for myocardial infarction, and 7.7-fold lower for acute kidney injury (p&lt; .001). TriNetX identified 169,566 female burn patients, of which 2,683 were on estrogen and progestin and above 45 years old. Women over 45 on exogenous hormones had a 37% significant risk reduction in acute kidney failure when compared to the women over 45 not prescribed estrogen or progestin (p&lt; .05).

Conclusions

Female burn patients had better outcomes, while women over 45 had worse outcomes indicating the role of female sex hormone correlated to burn patient progress. The administration of estrogen and progestins for females above age 45 resulted in reduced risks for acute kidney failure after burn injury.

4 Risk Association Between Race and Complications Following Burn

Introduction

Racial minorities have been recognized to experience worse health outcomes for many medical conditions. However, it is not clear if these outcomes are associated with pre-existing conditions or the quality of care those patients receive. In burns, little information on the relationship between race and burn comorbidities is available. This study examines the risk association between race and burn complications, such as pneumonia, sepsis, and ARDS while controlling for common comorbidities that affect burn recovery such as diabetes and hypertension.

Methods

Burn patient cohorts were identified by ICD10 codes for burn injury using TriNetX, a federated network of real-world data. The cohorts were stratified by race and balanced in terms of age at index, gender, BMI, and pre-existing comorbidities such as diabetes and hypertension. The following post burn outcomes were selected for analysis: renal failure, cardiovascular disease, sepsis, ARDS, graft complication, pneumonia, ICU admit, respiratory failure, hypertrophic scarring (HTS), hyperglycemia, and mortality. A measure of association analysis was performed to compare risk outcomes in black vs. white burn patients. Statistical significance was set at p< 0.05. The same cohorts were analyzed for treatment pathways to compare critical care billing CPT codes for the amount of time seen by a physician: Critical Care and Evaluation, first 30-74 minutes, and Critical Care and Evaluation, each additional 30 minutes.

Results

The balanced patient cohorts comprised 78,974 patients per cohort. Black patients experience a positive relative risk ratio (RR) to renal failure (p < 0.0001, RR = 1.372, 95% CI: 1.314-1.435), cardiovascular disease (p < 0.0001, RR = 1.115, CI: 1.08-1.15), sepsis (p < 0.0071 RR = 1.081, CI: 1.021-1.144), and ARDS (p < 0.0010, RR = 1.287 CI: 1.107-1.496) following burn injury. However, black patients experience a negative risk ratio to mortality (p < 0.0006, RR = 0.935, CI: 0.89-0.982) and pneumonia (p < 0.0014, RR = 0.937, CI: 0.901-0.975). The risk ratio was not significant for outcomes between black and white burn patients for respiratory failure, HTS, hyperglycemia, and ICU admit. Analysis of treatment pathways did not show significant differences in Critical Care and Evaluation billing between the two races.

Conclusions

Black burn patients are more likely to experience renal failure, cardiovascular disease, sepsis, and ARDS compared to white burn patients despite controlling for common comorbidities. They are less likely to experience pneumonia and mortality.

115 Analyzing Temporal Trends and Outcomes Associated with High Prevalence Bacterial Infections in Burn Patients

Introduction

Bacterial infections are a leading cause of complications in burn patients. However, ambiguity remains around the most common infectious etiologies and their resulting complications. Our study identifies which bacterial infections will lead to specific complications and tracks infection rates of these bacteria over time.

Methods

Burn patients diagnosed with a bacterial infection within 6 months of burn were identified in the TriNetX database using ICD-10 codes; those with bacterial infections prior to injury were excluded. Occurrence of the following outcomes within 12 months of injury were compared for those with bacterial infections and those without, including acute kidney injury (AKI), congestive heart failure (CHF), hypertrophic scarring, sepsis, and death. The top 4 bacterial infections, by incidence, were then identified and analyzed for the outcomes. Lastly, infection rates were stratified by year from 2010-2020. Data was analyzed using chi-square with p < .05 considered significant, and regressions.

Results

We identified 457,383 burn patients, of whom 4,688 (1.0%) were diagnosed with a bacterial infection within 6 months of injury. The bacteria that constituted the highest proportion of infected patients were Staph aureus (51.1%), E. Coli (20.2%), Pseudomonas (17.6%), and Enterococcus (9.6%). When outcomes were stratified by bacteria, Enterococcus infection was associated with the highest incidence of AKI (23.1%), sepsis (25.2%), and mortality (16.03%). E. Coli was associated with the highest incidence of CHF (17.7%) and Pseudomonas was associated with the highest incidence of hypertrophic scarring (13.3%). All data was found to be statistically significant (p< .05). Time trend data from 2010 to 2020 stratified by bacterial infection is displayed in Figure 1. Of note, Pseudomonas infection rates increased by 90% (r² = 0.6717) while E. Coli infection rates increased by 33%. (r² = 0.7223). In contrast, Staph Aureus infection rates have decreased since 2013. Lastly, Enterococcus infection rates displayed a fluctuating pattern with an increasing trend since 2017.

Conclusions

Species identification of a post-burn bacterial infection is an important step in outcome management. Despite its low incidence, Enterococcus infection was associated with the highest incidence of AKI, sepsis, and mortality, and has displayed recent increases in infection rates. Pseudomonas has shown a similar increasing trend and is notable for hypertrophic scar formation.

118 Burn Injury Vandalizes Cancer Survival with Increased Risk of Complications

Introduction

Burn injuries place patients in a compromised state, especially those with pre-existing comorbidities. The presence of cancer complicates care and worsens outcomes for patients suffering from illnesses unrelated to burns, such as sepsis. Therefore, we posit the incidence of burn injury on patients with preexisting cancer diagnoses results in an increased risk of complications.

Methods

Burned patients were identified using the TriNetX database, a global federated health research network. Fifty-one thousand patients with a diagnosis of cancer prior to experiencing a burn injury were identified. Control groups included 1) patients who had a previous cancer diagnosis and no incidence of burn, and 2) patients who experienced a burn with no history of cancer. Outcomes analyzed included sepsis, nutritional deficiency, eating disorder, immunodeficiency, and depression within 5 years. Cancer diagnoses were categorized into 5 of the 13 most common cancer reported in the US. Data was analyzed using a chi-square analysis with p&lt; 0.05 considered significant, and presented odds ratio are with 95% confidence intervals.

Results

The majority of cancer survivors with burns were White (70%) and female (62%). Compared to cancer patients without burn injury, patients experiencing a burn after a diagnosis of cancer were more likely to develop sepsis (1.718, 1.612-1.83), nutritional deficiency (1.963, 1.593-2.418), immunodeficiency (1.265, 1.098-1.459), eating disorders (2.569, 2.077-3.177), and depression (1.538,1.468-1.611). When compared to burn patients with no history of cancer, burned patients with cancer diagnosis had increased odds of developing sepsis (3.806, 3.502-4.137), nutritional deficiency (3.529, 2.725-4.571), immunodeficiency (6.657, 5.126,8.645), eating disorder (2.184, 1.787-2.67), and depression (2.147, 2.041-2.259). Further, burned patients with a history of lung cancer experienced a uniquely high risk of sepsis. Additionally, burn patients with histories of either lung or breast cancers were also at increased risk ratios of experiencing depression (p&lt; 0.05).

Conclusions

Burned patients with a history of a cancer demonstrated considerable increases in complications when compared to those with only a burn injury. Categorization of the broad “neoplasm” label uncovers patterns or trends for specific cancer types to inform the current healthcare system more accurately.

123 Sleep Disorder Is Associated with Neuropsychological Disturbances in Burn Survivals

Introduction

Prior studies explored neuropsychological disorders in the context of burn severity; however, the relationship between occurrence after burn and sleep has not been investigated. This study aims to determine if patients that developed a first-time sleep disorder after burn injury are more likely to develop a psychological or nervous system disorder within 10 years after injury.

Methods

We identified burn patients on the TriNetX database, a federated research network of de-identified patient data. We formed two groups, those with first time sleep disorder diagnosis on or after the incidence of burn injury and those with no first-time sleep disorder diagnosis on or after burn. Groups were propensity matched to evaluate incidence of nervous system and mental disorders and characteristics, defined as bipolar disorder, epilepsy, neuropathy disorders, and 52 other neuropsychological disorders. Diagnoses of nervous system disorder and mental disorder were limited to after the burn injury and within the 10-year time frame. We analyzed data using a z-test with a p &lt; 0.05 considered significant.

Results

We found 7.83% of patients developed a first-time sleep disorder after burn injury. The population was older (43.9 ± 20.8 vs. 31.7 ± 22.4 yrs), female (51.13% vs. 46.10%), and White (70.02% vs 60.24%) when compared to those without sleep disorders (p&lt; 0.05). Those who experienced a first-time sleep disorder after burn presented a greater risk of developing the mental, central nervous system, and peripheral nervous system disorders when compared to those who did not. Eating disorders, persistent mood disorders, and obsessive-compulsive disorders were 4.54, 95% CI [3.65, 5.65]; 3.84, 95% CI [3.49, 4.22], and 3.94, 95% CI [3.13, 4.97] times higher, respectively, in patients who developed a first-time sleep disorder (p&lt; 0.05). Anxiety-related disorders were also more than 3 times more likely in those who developed a sleep disorder after burn (p&lt; 0.05).Central nervous system disorders were related to sleep disorder post burn. Extrapyramidal and movement disorders were more than 3 times more likely to occur in sleep disorder patients (Extrapyramidal and movement disorder, unspecified 95% CI [2.48, 4.63] and Other extrapyramidal and movement disorders 95% CI [3.17, 3.78]. In regard to peripheral nervous system disturbances, restless leg syndrome was more than 4 times more likely to occur in patients that developed a first time sleep disorder after burn injury 95% CI [3.70, 4.65]. Polyneuropathy was also 2.28 more times likely to occur 95% CI [2.12, 2.47].

Conclusions

Mental disorders and various central nervous system and peripheral nervous system disturbances are highly associated with identification of sleep disorders after burn. This finding suggests close monitoring for sleep in those who were burned to optimize outcomes.

26 Opioid Prescription in Burns: A Large Database Analysis from 1990 to 2021

Introduction

The use of opioids in the medical field has contributed to the growing opioid epidemic. Nonetheless, opioids remain imperative in the treatment for pain management in burns. While some studies have addressed the use of opioids in surgery, a comprehensive analysis of the pattern of opioids use in burns has not been investigated. This study aims to identify trends of opioid use and investigate the risk of opioid related disorders in burn patients.

Methods

Data was obtained from TriNetX, a national research database that provides medical records of de-identified patients. The study population includes patients that were prescribed an opioid, ICD-10 code CN101, on or after any instance of burn between January 1^st, 1990 and September 19^th, 2021. Patient population was further stratified by the decade in which patients received opioids for pain following burn injury: 1990-1999, 2000-2009, 2010-2019, and 2020-September 19^th, 2021. Five outcomes were investigated: opioid related disorders, opioid dependence, opioid abuse, intentional self-harm, and mental and behavioral disorders due to psychoactive substance use. Cohorts were matched for age at index, sex, and race. Statistical analysis used risk ratios with a 95% confidence interval, and p< 0.05 was considered significant.

Results

We identified 8,421 patients that were prescribed an opioid between 1990-1999, 30,846 patients from 2000-2009, 169,991 patients from 2010-2019, and 30,966 patients from 2020-present. When compared to the 2000s cohorts, the 1990s patients had a 47% decrease in risk of opioid related disorders, with a 53% decrease in risk of opioid dependence, 45% decrease in risk in opioid abuse, 11% decrease in risk of mental and behavioral disorders due to psychoactive substance use, and 63% reduced risk of intentional self-harm.

Comparison of the 2000-2009 to 2010-2019 cohorts showed increased risk of opioid related disorders (RR= 1.912), opioid dependence (RR=1.569), opioid abuse (RR=1.677), mental and behavioral disorders (RR =1.733), and intentional self-harm (RR=2.027). When compared to 2020-present, the 2010-2019 patient cohort had 10 times the risk of developing opioid-related disorders, with 3 times the risk for opioid dependence and behavioral disorders, and 5 times the risk for opioid abuse and intentional self-harm.

Conclusions

The risk of opioid related disorders in the 1990s was lower compared to the 2000s. Since 2000, the risk of opioid related disorders has significantly increased. Recognizing the risks of opioid prescriptions in burn patients is imperative when addressing the role of physicians in controlling the constantly growing opioid epidemic.

735 Early Treatment with NSAIDs Improves Blood Clotting Function in Severely Burned Patients

Introduction

The risk of coagulopathy is increased in severe burns. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed in burn patients to relieve pain and reduce inflammation. This study investigates the impact of NSAIDs on burn induced coagulopathy in severely burned patients.

Methods

Severe burn patients (total body surface area [TBSA] >20%) were identified with TriNetX, a North American federated health research network from 51 health-care organizations (HCOs) and categorized for those receiving NSAIDs during the first week following injury; those with NSAID use prior to injury were excluded. NSAIDs included in this study were ibuprofen, oxaprozin, indomethacin, aspirin, diclofenac, celecoxib, and naproxen. Burn induced coagulopathy was defined as international normalized ratio (INR) levels ≥1.5. Statistical significance of the rate of burn-induced coagulopathy in the week following injury among the two groups was analyzed with measures of association using chi-squared tests.

Results

We identified 709 severely burned patients receiving NSAIDS during the week after burn and 1,032 severely burned patients without NSAID use. Among those receiving NSAIDs, ibuprofen and aspirin were the most prescribed at rates of 80% and 36%, respectively. After cohort matching, the risk of burn induced coagulopathy was significantly decreased in patients taking NSAIDs (17.7%) compared to patients not receiving NSAIDs (32.3%) (p< 0.0001). The protective nature of NSAIDs was greatest on the same day (p=0.0002) and first day following burn injury (p=0.0026). On average, those not taking NSAIDs had an elevated risk of developing coagulopathy compared to those who did as %TBSA increased in 10% intervals. This observation was confirmed in a linear regression analysis with slopes of 0.0453 and 0.0293, respectively. Furthermore, patients taking NSAIDs were less likely to develop sepsis (p=0.0046) and thrombocytopenia (p=0.0003) and die the first week following injury (p< 0.0001).

Conclusions

The early protective effects of NSAIDs at reducing the risk of coagulopathy occurs during the acute phase of burns, though selection bias cannot be excluded. The potential risk of burn induced coagulopathy increased more with %TBSA in patients without NASIDs.

[The study of the rational use of antibiotics after nasal surgery]

Objective:To study whether the antibiotics should be used in the patients with or without chronic nasal sinusitis after the nasal surgery,and how to rationally use it.Method：Study design:prospective stratified randomized controlled study.Patients with sinusitis were divided into three groups.A group was without antibiotics,B group was with standard antibiotics using ,and C group was with prolonged antibiotics using.Patients without sinusitis were divided into D group without antibiotics,E group with standard antibiotics using,and F group with prolonged antibiotics using. Observe the postoperative infection rate in each group and compare them.Result：The infection rates were 3.53%,2.67%,0.00% in A,B and C group, and there was no significant differences between three groups. The infection rates were 1.22%,0.00%,1.39% in D,E and F group,and there was no significant differences between them.Conclusion： There was no influence in patients with or without using antibiotics,standard or prolonged using antibiotics after nasal surgery. Recommend not to use antibiotics after nasal surgery,and appropriately use antibioctics within 48 hours.Prolonged using is not recommended.

Leptin promotes apoptosis and inhibits autophagy of chondrocytes through upregulating lysyl oxidase-like 3 during osteoarthritis pathogenesis

OBJECTIVE

Leptin has been found highly expressed in human osteoarthritis. We aimed to explore the possible effects and mechanisms of leptin on the apoptosis and autophagy of chondrocytes during osteoarthritis pathogenesis.

METHODS

Gene expression profile from osteoarthritis affected and preserved cartilage were downloaded from NCBI's Gene Expression Omnibus database (GSE57218). Lysyl oxidase-like 3 (LOXL3) mRNA expression in cartilage tissues and leptin concentration in joint synovial fluid (SF) was measured in samples from 45 osteoarthritis patients and 25 healthy donors by real-time PCR and radioimmunoassay, respectively. Rat osteoarthritis model was induced by anterior cruciate ligament transection (ACLT). The expression of apoptosis regulators and autophagy markers were detected by Western blot. Cell survival and cell apoptosis were identified by CCK-8 and flow cytometry, respectively.

RESULTS

Re-analysis on GSE57218 indicated that LOXL3 mRNA was upregulated in osteoarthritis affected cartilage. LOXL3 mRNA was upregulated in osteoarthritis patients, which was positively correlated with SF leptin concentration. Similar results were obtained in rat osteoarthritis model. Moreover, ACLT surgery led to a significant increase in the protein levels of cleaved caspase 3, and a notable decrease in the protein levels of Bcl-2, LC3 II/LC3 I and Beclin1. Silencing of LOXL3 in ACLT and leptin treated primary chondrocytes significantly inhibited cell apoptosis, and promoted cell proliferation and autophagy. Moreover, overexpression of LOXL3 remarkably inhibited autophagy of chondrocytes via activating mTORC1.

CONCLUSIONS

LOXL3, a downstream of leptin, stimulated the apoptosis, but inhibited the autophagy of chondrocytes. LOXL3 is a potential therapy target for osteoarthritis.

Protective effects of bifidobacteria on intestines in newborn rats with necrotizing enterocolitis and its regulation on TLR2 and TLR4

We established a necrotizing enterocolitis (NEC) rat model and explored the role of bifidobacteria in the intestines of the rats and its regulation on intestinal Toll-like receptors (TLRs). Seventy-five newborn Sprague-Dawley rats were randomly divided into 5 groups (15 rats/group): group A, artificial feeding group (formula-fed); group B, NEC model (LPS + formula-fed); group C, bifidobacterium (LPS + formula-fed + bifidobacterium microcapsules, intragastric administration); group D, artificial feeding + bifidobacterium (formula-fed + bifidobacterium microcapsules gavage); group E, rat breast-feeding group (rat breast-feeding). After 3 days of feeding, rats were placed in incubators, fasted for 12 h, and killed by decapitation. The ileocecal proximal segment ileum was fixed and sliced; pathological examination was conducted, and TLR2, TLR4, and nuclear factor-kB p65 protein expression in the intestinal tissue was detected by immunohistochemistry. There was a statistically significant difference in pathological scores between groups C and B (H = 21.789, P = 0.000), and the former was lower than the latter. TLR2, TLR4, and nuclear factor-kB p65 expression in intestinal tissue was determined in groups A-E. There were statistically significant differences between groups C and B (P = 0.001; P = 0.000; P = 0.000). Bifidobacteria had a protective effect on the intestines of newborn rats with NEC, which showed reduced NEC and intestinal damage severity. This observation may be related to the reduced levels of TLR2, TLR4, and nuclear factor-kB P65 observed during the inflammatory response.

The GSTP1 A1578G polymorphism and the risk of childhood acute lymphoblastic leukemia: results from an updated meta-analysis

Studies investigating the association between the glutathione S-transferase P1 (GSTP1) A1578G polymorphism and the risk of childhood acute lymphoblastic leukemia (ALL) report conflicting results. The aim of this study was to quantitatively summarize the evidence for such a relationship. Two investigators independently searched the Medline, Embase, China National Knowledge Infrastructure, and Wangfang databases for studies of the polymorphism and ALL. Summary odds ratios (ORs) and 95% confidence intervals (CIs) for the GSTP1 polymorphism and childhood ALL were calculated in a fixed-effect model. Pooled ORs were calculated for a co-dominant model (GG vs AA, AG vs AA), a dominant model (GG + AG vs AA), and a recessive model (GG vs AA + AG). Analyses were also performed in subgroups stratified by race, study design, genotyping methods, and study sample size. This meta-analysis included 8 case-control studies with 1384 childhood ALL cases and 1755 controls. Overall, the variant genotypes (GG and AG) of A1578G were not associated with childhood ALL risk, when compared with the wild-type homozygote AA genotype (GG vs AA, OR = 1.09, 95%CI = 0.84-1.43; AG vs AA, OR = 1.05, 95%CI = 0.91-1.23). Similarly, no associations were found in the dominant and recessive models (dominant model, OR = 1.06, 95%CI = 0.92-1.23; recessive model, OR = 1.09, 95%CI = 0.84-1.43). Stratified analyses did not detect significant association in any subgroup. No heterogeneity or publication bias was observed in the present study. This updated meta-analysis indicates that the GSTP1 A1578G polymorphism is not associated with the risk of childhood ALL. In the future, additional studies in Asian and African-American patients should be performed to re-evaluate the association in these populations.

Calcium function in affective disorders and healthy controls

Calcium metabolism has been reported to be disturbed in some forms of affective disorder. We studied concurrently a battery of calcium measures in 29 unipolar, 14 bipolar depressed, 11 manic, and 10 healthy control subjects. In addition to measures of extracellular calcium, we studied intracellular calcium concentration in platelets and measures that reflect cellular capability to maintain a low intracellular Ca++ concentration in red blood cells (RBCs) and platelets. Plasma calcium was lower in unipolar and manic patients than in control subjects. Platelet calcium concentration was lower in unipolar than bipolar depressed patients. RBC Ca++ adenosine triphosphatase (ATPase) was lower in unipolar and control subjects than in bipolar depressed and manic patients. Platelet Ca++ ATPase and Ca++ uptake were inversely correlated with severity of illness in unipolar patients. In bipolar depressed patients, RBC Ca++ ATPase and platelet Ca++ uptake were inversely correlated with severity. In addition to indicating abnormalities in calcium activity in affective disorders, the data suggest that unipolar and bipolar patients differ in several measures and may have different pathophysiological disturbances in calcium metabolism.

Platelet monoamine oxidase response to lithium treatment in psychiatric patients

Platelet monoamine oxidase (MAO) activity was studied in bipolar and schizophrenic patients treated with lithium and was found to be increased as a nonspecific drug effect. Greater MAO increase in manic patients was correlated with lesser clinical improvement. There was no correlation of MAO activity with short-term outcome in schizophrenic patients. Change in MAO was not correlated with lithium dosage or plasma levels. Patients with baseline MAO values below the median had the largest activity increases. Platelet MAO might thus be characterized as a state variable, increased by lithium as a nonspecific pharmacologic effect, with the increase associated with poor clinical outcome in manic patients.