Emergency-related inpatient admissions in child and adolescent psychiatry: comparison of clinical characteristics of involuntary and voluntary admissions from a survey in Bavaria, Germany

Emergency inpatient admissions of children and adolescents are more difficult if the patient is admitted involuntarily and/or the caregivers or custodians of institutional care are absent. The present study aimed to clinically characterize involuntary versus voluntary admissions by examining the reasons for presentation and associated factors. We retrospectively analyzed patients who presented to the emergency department of a hospital for child and adolescent psychiatry in Bavaria, Germany, and were admitted as inpatients for crisis intervention in the 4th quarter of 2014-2018. Reasons for presentation, clinical and sociodemographic characteristics, and type of admission (voluntary versus involuntary) were analyzed for 431 emergency inpatient admissions. A total of 106 (24.6%) patients were involuntarily admitted. In a binominal logistic regression, presentation due to alcohol consumption, deviant social behavior, and psychosocial burden was positively associated, whereas difficulties at school and depression were negatively associated, with the likelihood of involuntary admission. 58.5% of the 123 unaccompanied patients were admitted involuntarily. Reasons for the presentation of unaccompanied and voluntary inpatient admissions were suicidal thoughts, psychosocial burden, and externalized aggression. A substantial number of child and adolescent psychiatric admissions represent emergency admissions. Involuntarily admitted patients and unaccompanied children/adolescents represent a non-negligible proportion of clinical routine and the clinical and legal background factors need to be further clarified in future studies. This study is registered in the German Clinical Trials Register (24 September 2019, DRKS00017689).

The synthetic food dye, Red 40, causes DNA damage, causes colonic inflammation, and impacts the microbiome in mice

The incidence of colorectal cancer (CRC) among young people has been on the rise for the past four decades and its underlying causes are only just starting to be uncovered. Recent studies suggest that consuming ultra-processed foods and pro-inflammatory diets may be contributing factors. The increase in the use of synthetic food colors in such foods over the past 40 years, including the common synthetic food dye Allura Red AC (Red 40), coincides with the rise of early-onset colorectal cancer (EOCRC). As these ultra-processed foods are particularly appealing to children, there is a growing concern about the impact of synthetic food dyes on the development of CRC. Our study aimed to investigate the effects of Red 40 on DNA damage, the microbiome, and colonic inflammation. Despite a lack of prior research, high levels of human exposure to pro-inflammatory foods containing Red 40 highlight the urgency of exploring this issue. Our results show that Red 40 damages DNA both in vitro and in vivo and that consumption of Red 40 in the presence of a high-fat diet for 10 months leads to dysbiosis and low-grade colonic inflammation in mice. This evidence supports the hypothesis that Red 40 is a dangerous compound that dysregulates key players involved in the development of EOCRC.

A Versatile Brij-Linker for One-Step Preparation of Targeted Nanoparticles

Background: Most frequently the functionalization of nanoparticles is hampered by time-consuming, sometimes harsh conjugation and purification procedures causing premature drug release and/or degradation. A strategy to circumvent multi-step protocols is to synthesize building blocks with different functionalities and to use mixtures thereof for nanoparticle preparation in one step. Methods: BrijS20 was converted into an amine derivative via a carbamate linkage. The Brij-amine readily reacts with pre-activated carboxyl-containing ligands such as folic acid. The structures of the building blocks were confirmed by different spectroscopic methods and their utility was assessed by one-step preparation and characterization of nanoparticles applying PLGA as a matrix polymer. Results: Nanoparticles were about 200 nm in diameter independent of the composition. Experiments with human folate expressing single cells and monolayer revealed that the nanoparticle building block Brij mediates a "stealth" effect and the Brij-amine-folate a "targeting" effect. As compared to plain nanoparticles, the stealth effect decreased the cell interaction by 13%, but the targeting effect increased the cell interaction by 45% in the monolayer. Moreover, the targeting ligand density and thus the cell association of the nanoparticles is easily fine-tuned by selection of the initial ratio of the building blocks. Conclusions: This strategy might be a first step towards the one-step preparation of nanoparticles with tailored functionalities. Relying on a non-ionic surfactant is a versatile approach as it might be extended to other hydrophobic matrix polymers and promising targeting ligands from the biotech pipeline.

Human serum albumin nanoparticles as a versatile vehicle for targeted delivery of antibiotics to combat bacterial infections

Urinary tract infections (UTIs) are among the most common bacterial infections. Despite a wide range of therapeutic options, treatment success is compromised by the efficient mechanism of tissue colonization of uropathogenic Escherichia coli. In advanced drug delivery systems, a similar, glycan-mediated targeting mechanism may be realized by conjugating the drug to a plant lectin, like wheat germ agglutinin (WGA). We introduce a drug delivery vehicle consisting of human serum albumin as nanoparticle shell, olive oil as core component, the active pharmaceutical ingredients (API) trimethoprim and rifampicin as well as WGA to facilitate cellular internalization. When WGA was embedded into the proteinaceous particle shell, cell binding studies revealed up to 60 % higher cell binding potential. Additionally, nanoparticles showed a good efficacy against gram-negative just as against gram-positive bacteria. The combination of the promising cell-associative properties and the proven antimicrobial potential might lead to an improved efficacy of advanced treatment of UTIs.

How well do polygenic risk scores identify men at high risk for prostate cancer? Systematic review and meta-analysis

OBJECTIVES

Genome-wide association studies have revealed over 200 genetic susceptibility loci for prostate cancer (PCa). By combining them, polygenic risk scores (PRS) can be generated to predict risk of PCa. We summarize the published evidence and conduct meta-analyses of PRS as a predictor of PCa risk in Caucasian men.

PATIENTS AND METHODS

Data were extracted from 59 studies, with 16 studies including 17 separate analyses used in the main meta-analysis with a total of 20,786 cases and 69,106 controls identified through a systematic search of ten databases. Random effects meta-analysis was used to obtain pooled estimates of area under the receiver-operating characteristic curve (AUC). Meta-regression was used to assess the impact of number of single-nucleotide polymorphisms (SNPs) incorporated in PRS on AUC. Heterogeneity is expressed as I² scores. Publication bias was evaluated using funnel plots and Egger tests.

RESULTS

The ability of PRS to identify men with PCa was modest (pooled AUC 0.63, 95% CI 0.62-0.64) with moderate consistency (I² 64%). Combining PRS with clinical variables increased the pooled AUC to 0.74 (0.68-0.81). Meta-regression showed only negligible increase in AUC for adding incremental SNPs. Despite moderate heterogeneity, publication bias was not evident.

CONCLUSION

Typically, PRS accuracy is comparable to PSA or family history with a pooled AUC value 0.63 indicating mediocre performance for PRS alone.

Lecithin-based nanoemulsions of traditional herbal wound healing agents and their effect on human skin cells

In previous studies, lecithin-based nanoemulsions (NEs) have been shown to be skin friendly drug carrier systems. Due to their nontoxic properties, NEs might also be suitable as wound healing agents. Hence, different O/W NEs based on lecithin Lipoid® S 75 and plant oils or medium chain triglycerides were produced and characterised. Two lipophilic natural wound healing agents, a betulin-enriched extract from birch bark (BET) and a purified spruce balm (PSB), were successfully incorporated and their effects on primary human skin cells were studied in vitro. MTT, BrdU and scratch assays uncovered the positive influence of the drug-loaded NEs on cell viability, proliferation and potential wound closure. Compared to control formulations, the NEs loaded with either BET or PSB led to higher cell viability rates of fibroblasts and keratinocytes. Higher proliferative activity of keratinocytes and fibroblasts was observed after the treatment, which is a prerequisite for wound closure. Indeed, in scratch assays NEs with PSB and notably BET showed significantly ameliorated wound closure rates than the negative control (unloaded NEs) and the positive control (NEs with dexpanthenol). Our findings suggest that BET and PSB are outstanding wound healing drugs and their incorporation into lecithin-based NEs may represent a valid strategy for wound care.

Characterization of sonochemically prepared human serum albumin nanocapsules using different plant oils as core component for targeted drug delivery

The focus of this study is the preparation of proteinaceous human serum albumin (HSA) nanocapsules with biocompatible plant oil cores avoiding toxic cross-linker and noxious non-aqueous liquids. The sonochemical preparation of HSA capsules with different plant oils yields particles with narrow size distribution forming suspensions stable for at least 14 days and enabling long-term storage by freezing. Furthermore, wheat germ agglutinin (WGA) as a targeting molecule was successfully embedded into the proteinaceous particle shell at a molar ratio of 7:1 (HSA/WGA). As urothelial cell binding studies revealed up to 55% higher cell binding potential of WGA-grafted particles than those without a targeter, targeted protein nanocapsules represent the first step towards new and innovative formulations.

Resistance Training as Therapeutic Management in Women with PCOS: What is the Evidence?

Polycystic ovary syndrome (PCOS), the most common chronic endocrinopathy and the leading cause of infertility in women, has significant clinical consequences, including cardiovascular, endocrinological, oncological, and psychological co-morbidities. Endocrine Society Clinical Practice Guidelines on the Diagnosis and Treatment of PCOS recommend exercise and physical activity as first-line treatment to combat chronic disease risk. However, details about what type of exercise are not provided. Given the known beneficial effects of resistance training on the management of other chronic diseases, the purpose of this scoping review was to evaluate the scientific evidence about the physical and psychosocial effects of resistance training among women with PCOS. Studies were identified through a systematic search of PubMed, SPORTDiscus, and CINAHL databases. Peer-reviewed research studies published between January 2011 and January 2021 that evaluated a resistance training intervention for premenopausal women with PCOS were included. Studies that offered multi-component programs were excluded. Nine articles met the inclusion criteria of which seven were sub-studies of one larger clinical trial. One article reported findings from a small randomized controlled trial and the last article reported feasibility study findings. Each intervention yielded positive results across a wide range of outcome variables; however, the studies had small sample sizes and assessed different outcome variables. Evidence regarding the effects of resistance training on health outcomes for women with PCOS is positive but preliminary. Adequately powered clinical trials are required to confirm health benefits, answer research questions as to therapeutic dose, and discover behavioral strategies to promote resistance training for therapeutic management.

Oscillatory Correlates of Selective Restudy

Prior behavioral work has shown that selective restudy of some studied items leaves recall of the other studied items unaffected when lag between study and restudy is short, but improves recall of the other items when lag is prolonged. The beneficial effect has been attributed to context retrieval, assuming that selective restudy reactivates the context at study and thus provides a retrieval cue for the other items (Bäuml, 2019). Here the results of two experiments are reported, in each of which subjects studied a list of items and then, after a short 2-min or a prolonged 10-min lag, restudied some of the list items. Participants' electroencephalography (EEG) was recorded during both the study and restudy phases. In Experiment 2, but not in Experiment 1, subjects engaged in a mental context reinstatement task immediately before the restudy phase started, trying to mentally reinstate the study context. Results of Experiment 1 revealed a theta/alpha power increase from study to restudy after short lag and an alpha/beta power decrease after long lag. Engagement in the mental context reinstatement task in Experiment 2 eliminated the decrease in alpha/beta power. The results are consistent with the view that the observed alpha/beta decrease reflects context retrieval, which became obsolete when there was preceding mental context reinstatement.

Associations of the Dietary Inflammatory Index With Total Adiposity and Ectopic Fat and the Mediating Effect of the Gut Microbiota

Objectives

To assess, in a large multiethnic cross-sectional study, associations between the Dietary Inflammatory Index (DII®) and total adiposity and ectopic fat, and whether these associations are mediated by gut microbiota (GM).

Methods

Analyses used data from 1,655 participants (812 men, 843 women, 60–77 y) in the Adiposity Phenotype Study. At clinic visit (2013–2015), DXA-based total fat mass, MRI-based visceral adipose tissue (VAT) area at L1-L5 (cm2), and liver fat (% volume) were measured. Participants provided a stool sample and completed a validated food frequency questionnaire (FFQ). Stool bacterial DNA was amplified and the V1-V3 region of the 16S rRNA gene was sequenced. As ratios, GM data were centered log-ratio transformed. DII score was computed from FFQ data, with a higher DII representing a more inflammatory diet. The relationships between DII, GM and adiposity phenotypes were examined using linear regression and mediation analyses. Bootstrap 95% CI were calculated for the indirect effect (IE).

Results

DII was positively associated with total fat mass (β = 0.71 kg), VAT (β = 4.73 cm2), and liver fat (β = 0.40%) (P-values < 0.001). DII was negatively associated with Eubacterium xylanophilum (β = −2.86), and alpha diversity (β = −0.04), and positively associated with Tyzzerella (β = 5.78) (P-values < 0.001). An inverse relationship was found between E. xylanophilum, VAT (β = −0.11 cm2), and liver fat (β = −0.01%), and between alpha diversity and liver fat (β = −0.93%) (P-values < 0.001). Tyzzerella was positively associated with VAT (β = 0.04 cm2) (P < 0.001). The total effect of DII on VAT was partially mediated by E. xylanophilum (IE = 0.30) and Tyzzerella (IE = 0.26). The association between DII and liver fat was partially mediated by E. xylanophilum (IE = 0.02) and alpha diversity (IE = 0.04). GM did not mediate the total effect between DII and total fat mass.

Conclusions

The total effect of DII on ectopic fat was partially mediated by lower bacterial diversity and E. xylanophilum, a butyrate-producing genera often inversely associated with inflammation. The association between DII and ectopic fat was also mediated by an abundance of Tyzzerella, a genus previously found to be associated with low-quality diets. Following an anti-inflammatory diet may minimize intra-abdominal fat, in part through the indirect effect of the gut microbiota.

Funding Sources

NIH, NCI.

Chemically modified inulin for intestinal drug delivery - A new dual bioactivity concept for inflammatory bowel disease treatment

This study investigates a novel preparation technique for pellets made from acetylated inulin and their characterization focusing on specific intestinal delivery of 5-aminosalicylic acid. By means of acetylation the hydrophobicity of four native inulins was increased yielding materials with selected degrees of acetylation. The acetylated inulins were insoluble in water, which was confirmed by the log P-values ranging from 1.30 to 1.58. 5-Aminosalicylic acid loading capacity of the pellets was up to 60 % and high enough to match the therapeutic range of the anti-inflammatory drug. Depending on the 5-aminosalicylic acid content and the type of acetylated inulin, up to 80 % of the entrapped drug was released within 24 h in intestinal environment under in-vitro conditions. Here we successfully prepared chemically modified and profoundly characterized inulin to provide innovative formulations and to open up a promising new strategy for treatment of Morbus Crohn and ulcerative colitis.

Suicidality Presented to a Child and Adolescent Psychiatry Emergency Service: Increasing Rate and Changing Characteristics

Background: Children and adolescents who present to child and adolescent psychiatric emergency departments show a variety of reasons for their presentations. Suicidality, in particular suicidal thoughts and suicide attempts, as well as non-suicidal self-injury (NSSI) play a large and important role. In this context, inpatient admissions frequently serve as crisis intervention. Methods: In this study, face-to-face emergency presentations to the emergency department at our Clinic of Child and Adolescent Psychiatry (CAP) were analyzed over the years 2014-2018, the 4th quarter (October-December) of each year. Data from 902 emergency presentations were evaluated, primarily with regard to suicidal thoughts, suicide attempts, and NSSI as reasons for presentation. Results: Data demonstrated that the number of emergency presentations increased in general and especially for suicidal thoughts and NSSI as reasons for presentation. In addition, suicidal thoughts, suicide attempts, and NSSI as reasons for emergency presentation were more likely to result in crisis-related inpatient admissions. Furthermore, reporting suicide attempts at emergency presentation was associated with longer inpatient stays. Finally, cases with multiple diagnoses increased independent of the general increase in emergency presentations. Conclusion: The increase of utilization of clinics with CAP outpatient emergency patients and following admissions to the inpatient units for crisis intervention poses a major challenge for the future. It is important to prepare for the assessment and treatment of suicidality, which is of extraordinary importance in the care of emergency patients.

Trimethoprim-Loaded PLGA Nanoparticles Grafted with WGA as Potential Intravesical Therapy of Urinary Tract Infections-Studies on Adhesion to SV-HUCs Under Varying Time, pH, and Drug-Loading Conditions

Intravesical therapy, already used to treat bladder cancer, is a potential treatment option for urinary tract infections. However, short dwelling time and washout proved to be challenging obstacles. To circumvent these issues, PLGA 503H and PLGA 2300 nanoparticles were prepared and surface modified with wheat germ agglutinin (WGA). Nanoparticles of both poly(d,l-lactic-co-glycolic acid) (PLGA) types exhibited high inherent adhesion to human uroepithelial cells. Although surface-bound WGA could be easily increased, adhesion did not. Loading the nanoparticles with trimethoprim did not counteract cell adhesion. Varying the medium for instillation revealed highest adhesion in sodium bicarbonate buffer (pH 5). To evaluate dwelling time, nanoparticles were incubated with the cell monolayer for increasing time intervals. A contact time of 15 min seems to be too short for adhesion to the cells as less than 50% particles remained bound after washing. However, after 30 min 70% of the particles added were bound, and afterward, no further increase was observed. WGA only slightly increased the adhesion of the PLGA nanoparticles, but this approach might not be economically viable. However, PLGA nanoparticles displayed a high inherent adhesion to cells that might substantially foster intravesical therapy.

Trimethoprim-Loaded Microspheres Prepared from Low-Molecular-Weight PLGA as a Potential Drug Delivery System for the Treatment of Urinary Tract Infections

Commonly, therapy of urinary tract infections suffers from increasing resistance to antibiotics and the ability of uropathogenic Escherichia coli (UPEC) to invade bladder cells and cause recurring infections. As an alternative strategy for instillation into the bladder, trimethoprim-loaded microparticles with poly(d,l-lactic-co-glycolic acid) (PLGA) as a matrix were prepared. To reduce particle loss by washout, their surface was grafted with bioadhesive wheat germ agglutinin, providing biomimicry akin to UPEC. Since PLGA 503H has shown a slow drug release profile, the low-molecular-weight PLGA 2300 was studied. Whereas the drug loading of PLGA 503H particles amounted to 2.8%, the drug content of PLGA 2300 particles was twice as high. Although the drug release pattern started with an initial burst of 30% after 24 h for both PLGA types, half of the trimethoprim content was released after 4 days from PLGA 503H microparticles as opposed to 2 days in the case of PLGA 2300. Higher drug loading and accelerated release render PLGA 2300 a viable alternative to PLGA 503H.

Consensus on definition and severity grading of lymphatic complications after kidney transplantation

BACKGROUND

The incidence of lymphatic complications after kidney transplantation varies considerably in the literature. This is partly because a universally accepted definition has not been established. This study aimed to propose an acceptable definition and severity grading system for lymphatic complications based on their management strategy.

METHODS

Relevant literature published in MEDLINE and Web of Science was searched systematically. A consensus for definition and a severity grading was then sought between 20 high-volume transplant centres.

RESULTS

Lymphorrhoea/lymphocele was defined in 32 of 87 included studies. Sixty-three articles explained how lymphatic complications were managed, but none graded their severity. The proposed definition of lymphorrhoea was leakage of more than 50 ml fluid (not urine, blood or pus) per day from the drain, or the drain site after removal of the drain, for more than 1 week after kidney transplantation. The proposed definition of lymphocele was a fluid collection of any size near to the transplanted kidney, after urinoma, haematoma and abscess have been excluded. Grade A lymphatic complications have a minor and/or non-invasive impact on the clinical management of the patient; grade B complications require non-surgical intervention; and grade C complications require invasive surgical intervention.

CONCLUSION

A clear definition and severity grading for lymphatic complications after kidney transplantation was agreed. The proposed definitions should allow better comparisons between studies.

Effects of lecithin-based nanoemulsions on skin: Short-time cytotoxicity MTT and BrdU studies, skin penetration of surfactants and additives and the delivery of curcumin

Surfactants are important ingredients in pharmaceutical and cosmetic formulations, as in creams, shampoos or shower gels. As conventional emulsifiers such as sodium dodecyl sulfate (SDS) have fallen into disrepute due to their skin irritation potential, the naturally occurring lecithins are being investigated as a potential alternative. Thus, lecithin-based nanoemulsions with and without the drug curcumin, known for its wound healing properties, were produced and characterised in terms of their particle size, polydispersity index (PDI) and zeta potential and compared to SDS-based formulations. In vitro toxicity of the produced blank nanoemulsions was assessed with primary human keratinocytes and fibroblasts using two different cell viability assays (BrdU and EZ4U). Further, we investigated the penetration profiles of the deployed surfactants and oil components using combined ATR-FTIR/tape stripping experiments and confirmed the ability of the lecithin-based nanoemulsions to deliver curcumin into the stratum corneum in tape stripping-UV/Vis experiments. All manufactured nanoemulsions showed droplet sizes under 250 nm with satisfying PDI and zeta potential values. Viability assays with human skin cells clearly indicated that lecithin-based nanoemulsions were superior to SDS-based formulations. ATR-FTIR tests showed that lecithin and oil components remained in the superficial layers of the stratum corneum, suggesting a low risk for skin irritation. Ex vivo tape stripping experiments revealed that the kind of oil used in the nanoemulsion seemed to influence the depth of curcumin penetration into the stratum corneum.

Micro vs. nano: PLGA particles loaded with trimethoprim for instillative treatment of urinary tract infections

Recurring infections and increasing resistances continue to complicate treatment of urinary tract infections. To investigate alternative treatment options, trimethoprim loaded micro- (D[4;3] of 1-9 µm) and nanoparticles (Z-Avg of 200-400 nm) were prepared from two types of poly(d,l-lactic-co-glycolic acid) (PLGA) for instillative therapy. While PLGA 503H microparticles could not be loaded with more than 2.6% trimethoprim, PLGA 2300 entrapped 22%. When preparing nanoparticles, both types displayed an even higher drug load of up to 29% using PLGA 2300, while PLGA 503H drug load stagnated at 10%. After eight hours, drug release from microparticles amounted to 55% (503H) and 35% (2300) whereas total drug release occurred after 8 (503H) and 9 days (2300). In case of nanoparticles, trimethoprim was liberated much faster with 60% after 2 h and a complete release after 24 h from both polymers. PLGA 2300 seems to be the better choice for entrapment of trimethoprim in microparticles considering the drug load. Both polymers, however, seem to be viable options for nanoparticles. Due to the higher overall drug load, nanoparticles seem to be advantageous over microparticles for instillative therapy, especially when prepared with PLGA 2300.

Effects of Omega-3 Fatty Acids on Resting Cerebral Perfusion in Patients with Mild Cognitive Impairment: A Randomized Controlled Trial

Alteration of cerebral perfusion can be considered as a possible therapeutic target in mild cognitive impairment. This randomized, placebo-controlled, double-blind proof-of-concept study assessed effects of omega-3 fatty acids on cerebral perfusion in patients with mild cognitive impairment. In thirteen patients (omega:n=5; placebo:n=8) cerebral perfusion was measured before and after 26-weeks intervention within posterior cortical regions using magnetic resonance imaging. There was a medium effect of intervention on cerebral blood flow (η2=0.122) and blood volume (η2=0.098). The omega group showed an increase in blood flow (mean difference: 0.02 [corresponds to 26.1%], 95% confidence interval:0.00-0.05) and blood volume (mean difference: 0.08 [corresponds to 18.5%], 95% confidence interval:0.01-0.15), which was not observed in the placebo group. These preliminary findings suggest that omega-3 fatty acids supplementation may improve perfusion in cerebral regions typically affected in mild cognitive impairment.Regulation of perfusion may help to maintain brain structure and function and potentially delay conversion to dementia.

Algorithm for predicting threshold retinopathy of prematurity is insufficient and fundus examinations are still needed before 31 weeks

AIM

We evaluated the weight, insulin-like growth factor-1, neonatal, retinopathy of prematurity (WINROP) algorithm for very premature infants.

METHOD

Infants born before 32 weeks who had undergone fundus examinations in the neonatal intensive care unit at the University Hospital of Nancy were included in this French retrospective cohort study from July 2012 to July 2016. We evaluated how well the WINROP software predicted threshold retinopathy of prematurity (ROP).

RESULTS

We studied 570 infants with a mean gestational age of 28.7 ± 1.8 weeks and a mean birth weight of 1110 ± 297 g: 28.1% had ROP and 1.2% had threshold ROP. The overall WINROP sensitivity was 57.1%, specificity was 46.0%, predictive positive value was 1.3% and predictive negative value was 98.9%. At more than 30 weeks of gestation or 1250 g, these figures rose to a respective specificity of 100% and 95.7% and respective predictive negative value of 100% and 100%. There were independent associations between the severity of ROP and the Apgar score at five minutes, the duration of oxygen therapy and non-invasive ventilation.

CONCLUSION

WINROP worked better on preterm infants born from 31 weeks onwards or weighing over 1250 g. Fundus examinations remain necessary for infants born earlier or lighter.

Abstract C45: Development and validation of Children Dietary Inflammatory Index (CDII)

Introduction: Chronic inflammation is a risk factor for many chronic diseases. The Dietary Inflammatory Index (DII) is a literature-derived index developed to measure the inflammatory potential of diet. A Children's Dietary Inflammatory Index (CDII) was developed to understand the association between diet and chronic inflammation-related health outcomes in children.

Methods: Food parameters that comprise the CDII include several nutrients like carbohydrates, various vitamins, minerals, and whole foods. To develop a reliable CDII scoring algorithm, aggregate data on children ages 6-14 were obtained from 16 different countries. This forms the basis for a world standard database to which all individuals' intakes can be standardized. Using this global database, CDII scores were calculated using dietary data from children between 6 and 14 years of age (n=3300) who participated in the U.S. National Health and Nutrition Examination Survey (NHANES) from 2005 to 2010. Construct validation was performed using linear regression models with CDII as the independent variable and C-reactive protein (CRP) as the outcome.

Results: Positive associations were observed between the CDII and CRP (mg/l) (p-value<0.01) among all children. For each one-point increase in CDII (i.e., corresponding to a 12.5% increase in inflammatory potential of the diet as observed in NHANES) CRP increased by 0.053 mg/dl (standard error = 0.01).

Conclusion: Results indicate that the CDII predicts CRP among children aged 6-14 years. Further validation and analyses using NHANES, as well as other data sets, are required to deepen understanding of inflammation in child health and the CDII in predicting inflammation levels in children.

Learning Objectives:

Describe how the CDII was created

Describe the process of construct validation

Discuss the use of CDII as a means for informing primary prevention and for educating physician, parents, and children on the importance of healthy diet to reduce chronic disease rates and to enhance feels of well-being and to improve quality of life.

Acknowledgment: All authors received funding from USDA 2016-01022.

Citation Format: Samira Khan, Christian Alvarado, Michael Wirth, Nitin Shivappa, James R. Hebert. Development and validation of Children Dietary Inflammatory Index (CDII) [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C45.

[Switching Therapy from Ranibizumab and/or Bevacizumab to Aflibercept in Neovascular Age-Related Macular Degeneration (AMD): One-Year Results]

BACKGROUND

The presented study is a retrospective evaluation of switching therapy from ranibizumab and/or bevacizumab to aflibercept in neovascular age-related macular degeneration in patients who had previously given an insufficient response to therapy with ranibizumab and/or bevacizumab.

PATIENTS AND METHODS

96 eyes with neovascular age-related macular degeneration (AMD) were included, which had been pretreated with ranibizumab and/or bevacizumab (T&E), but had responded insufficiently. An injection interval of less than six weeks or permanently persisting intra- and/or subretinal fluid or persistent pigment epithelial detachments (PED) were defined as an insufficient response. The patients were followed for 12 months after switching therapy to aflibercept. The change in central retinal thickness (CRT) was defined as the primary endpoint. Other endpoints were the axial height of PEDs and the injection interval.

RESULTS

The primary endpoint, the average CRT, was significantly decreased twelve months after switching therapy to aflibercept (Wilcoxon Nemenyi-McDonald-Thompson post-hoc analysis - 31.36 µm; SD ± 70.64 µm; p < 0.001). Another morphological endpoint, the average axial height of PEDs, also decreased significantly (- 34.10 µm; SD ± 91.90 µm, p < 0.001) from 207.82 µm (SD ± 148.12 µm) at baseline to 173.72 µm (SD ± 132.30 µm) at month 12. Moreover, the average injection interval increased significantly (p < 0.001; Friedman test) from 1.30 months (SD ± 0.19 months) before switching therapy to 1.67 months (SD ± 0.19 months) at month 12 after switching therapy to aflibercept. However, the best corrected visual acuity (BCVA) as a functional endpoint did not significantly improve (+ 0.36 ETDRS letters = 0.0972 p; SD ± 16.94 ETDRS letters).

CONCLUSION

In patients with neovascular AMD, who had initially exhibited an inadequate response to ranibizumab and/or bevacizumab, switching therapy to aflibercept improves clinical outcome measures. Besides morphological improvements, such as the decrease of the CRT and the axial height of PEDs, the average injection interval was prolonged. However, visual acuity did not improve.

Abstract A69: The dietary inflammatory index is associated with inflammatory biomarkers among a population of African Americans from South Carolina

Chronic, systemic inflammation is mechanistically involved in processes associated with most major chronic diseases. The Dietary Inflammatory Index (DII) was developed to measure diet-based inflammatory potential, a strong risk factor for systemic inflammation. Participants included those attending baseline measurement clinics for the Healthy Eating and Active Living in the Spirit (HEALS) educational and behavioral intervention (2009-2012). HEALS, a randomized control trial set in faith-based communities, enrolled African Americans (AA) at high risk of chronic inflammation and related diseases. Baseline data were utilized for these analyses. Prior to each clinic visit, participants completed a questionnaire packet to assess demographic characteristics, physical activity, sleep habits (Pittsburgh Sleep Quality Index), health history, depression/stress, and social desirability, approval, and support. Dietary data were collected using a 144-item food frequency questionnaire (FFQ) which was modified based on the Block/NCI instrument. Dietary data from this FFQ, processed using the Nutrient Data System for Research (version 2012, Nutrition Coordinating Center, University of Minnesota, Minneapolis, Minnesota) was used to compute the DII. The DII is comprised of various micro and macronutrients, as well as several individual food items (collectively termed ‘food parameters’); each of which has an inflammatory effect score based on research from 1,943 diet and inflammation research articles. A “world” database (11 populations from around the world) consisting of means and standard deviations for the food parameters was subtracted from an individual's actual dietary intake and divided by its standard deviation, creating a z-score, which were centered around 0 and multiplied by the inflammatory effect score. These were summed across all parameters to create the overall DII score, which were categorized into quartiles. During clinic visits, participants had their blood pressure, height, weight, and percent body fat (via bioelectrical impedance assessment) measured. Physical activity levels were measured using Bodymedia's SenseWear® physical activity armband monitors. Blood samples were collected to characterize inflammatory biomarkers (i.e., high-sensitivity c-reactive protein [CRP] and interleukin-6 [IL-6]). In addition to using quantile regression for the main analyses, logistic regression was utilized when CRP was categorized as ≤3.0mg/L vs. &gt;3.0mg/L. The population was middle-aged (average = 56.9±11.3 years), obese (mean BMI=32.6±6.9kg/m2) and primarily female (80%). Various population characteristics were described according to DII quartiles. Higher DII values were associated with younger age, being married or living with a partner, being employed fulltime, and having a higher BMI. Quantile regression was used to estimate the adjusted 25th, 75th, and 90th percentiles of both CRP and IL-6. The 75th and 90th percentiles of CRP for the fourth quartile of the DII were significantly greater than for the first DII quartile (β0.75=3.95, 95% confidence interval [95%CI]=1.71-6.19; β0.90=6.83, 95%CI=1.11-12.55). No significant findings were observed for IL-6. Logistic regression analyses agreed with the quantile regression results for CRP. Those in DII quartile 4 had 3.17 times (95%CI=1.52-6.62) the odds of having CRP values greater than 3.0mg/L compared to those in DII quartile 1. This is the first construct validation of the DII in an all AA population. Chronic inflammation is a risk factor for many major chronic diseases, diseases that AA suffer from disproportionately. Therefore, the DII may serve as a useful tool to track dietary inflammatory potential among AA populations, which, in turn, may reduce risk of chronic disease among these populations.

Citation Format: Michael Wirth, Nitin Shivappa, Lisa Davis, Thomas Hurley, Andrew Ortaglia, Ruby Drayton, Steven Blair, James Hebert. The dietary inflammatory index is associated with inflammatory biomarkers among a population of African Americans from South Carolina. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A69.

Biomimickry of UPEC Cytoinvasion: A Novel Concept for Improved Drug Delivery in UTI

Urinary tract infections (UTIs) are among the most common bacterial infections. In an increasing number of cases, pathogen (multi-)resistance hampers durable treatment success via the standard therapies. On the functional level, the activity of urinary excreted antibiotics is compromized by the efficient tissue colonization mechanism of uropathogenic Escherichia coli (UPEC). Advanced drug delivery systems aim at exploiting a glycan-mediated targeting mechanism, similar to the UPEC invasion pathway, to increase bioavailability. This may be realized by conjugation of intravesically applied drugs or drug carriers to chosen plant lectins. Higher local drug concentrations in or nearby bacterial reservoirs may be gained, with higher chances for complete eradication. In this study, preliminary parameters to clarify the potential of this biorecognitive approach were evaluated. Glycan-triggered interaction cascades and uptake processes of several plant lectins with distinct carbohydrate specificities were characterized, and wheat germ agglutinin (WGA) could be identified as the most promising targeter for crossing the urothelial membrane barrier. In partially differentiated primary cells, intracellular accumulation sites were largely identical for GlcNAc- and Mannose-specific lectins. This indicates that WGA-mediated delivery may also enter host cells via the FimH-dependent uptake pathway.

[Sandifer's syndrome in a 5-month-old child with suspicion of infantile spasms]

Sandifer's syndrome is a dystonic movement disorder in infants with gastroesophageal reflux (GER). It is probably misdiagnosed as epileptic seizures. We report the case of a 5-month-old infant with no past medical history admitted to a pediatric unit for suspicion of infantile spasms. She presented with dystonic movements of the upper left limb with left blepharospasm and an occasional dystonic head posture. Physical examination, EEG, brain MRI, and blood analysis were normal. Since the baby experienced regurgitations, Sandifer's syndrome was suspected and confirmed by 24-h esophageal pH monitoring that documented pathological GER. The dystonic symptoms quickly disappeared under treatment with thickened infant formula and sodium alginate. Infantile spasms remain the first diagnosis to explore with axial or para-axial dystonic postural events. Sandifer's syndrome should be retained when neurological investigations are normal and abnormal movements disappear under treatment of proven GER. Prognosis is excellent.

Determination of the glycosylation-pattern of the middle ear mucosa in guinea pigs

In the present study the glycosylation pattern of the middle ear mucosa (MEM) of guinea pigs, an approved model for middle ear research, was characterized with the purpose to identify bioadhesive ligands which might prolong the contact time of drug delivery systems with the middle ear mucosa (MEM). To assess the utility of five fluorescein labeled plant lectins with different carbohydrate specificities as bioadhesive ligands, viable MEM specimens were incubated at 4°C and the lectin binding capacities were calculated from the MEM-associated relative fluorescence intensities. Among all lectins under investigation, fluorescein-labeled wheat germ agglutinin (F-WGA) emerged as the highest bioadhesive lectin. In general, the accessibility of carbohydrate moieties of the MEM followed the order: sialic acid and N-acetyl-d-glucosamine (WGA)>>mannose and galactosamine (Lensculinaris agglutinin)>N-acetyl-d-glucosamine (Solanumtuberosum agglutinin)>fucose (Ulexeuropaeus isoagglutinin I)>>terminal mannose α-(1,3)-mannose (Galanthusnivalis agglutinin). Competitive inhibition studies with the corresponding carbohydrate revealed that F-WGA-binding was inhibited up to 90% confirming specificity of the F-WGA-MEM interaction. The cilia of the MEM were identified as F-WGA binding sites by fluorescence imaging as well as a z-stack of overlays of transmission, F-WGA- and nuclei-stained images of the MEM. Additionally, co-localisation experiments revealed that F-WGA bound to acidic mucopolysaccharides of the MEM. All in all, lectin-mediated bioadhesion to the MEM is proposed as a new concept for drug delivery to prolong the residence time of the drug in the tympanic cavity especially for successful therapy for difficult-to-treat diseases such as otitis media.