Impact of pregnancy vaccine uptake and socio-demographic determinants on subsequent childhood Measles, Mumps and Rubella vaccine uptake: A UK birth cohort study

BACKGROUND

We examined the association between socio-demographic determinants and uptake of childhood Measles, Mumps & Rubella (MMR) vaccines and the association between pregnant women's pertussis vaccine uptake and their children's MMR vaccine uptake.

METHODS

We used nationally-representative linked mother-baby electronic records from the United Kingdom's Clinical-Practice-Research-Datalink. We created a birth cohort of children born between 01.01.2000 and 12.12.2020. We estimated the proportion vaccinated with first MMR vaccine by age 2 years and first and second MMR vaccines by age 5 years. We used survival-analysis and Cox proportional hazard models to examine the association between deprivation, ethnicity and maternal age and pertussis vaccination in pregnancy and children's MMR uptake.

RESULTS

Overall, 89.4 % (710,797/795,497) of children had first MMR by age 2 years and 92.6 % (736,495/795,497) by age 5 years. Among children still in the cohort when second MMR was due, 85.9 % (478,480/557,050) had two MMRs by age 5 years. Children from the most-deprived areas, children of Black ethnicity and children of mothers aged < 20 years had increased risk of being unvaccinated compared with children from the least-deprived areas, White children and children of mothers aged 31-40 years: first MMR by 5 years, adjusted Hazard Ratios (HR):0.86 (CI:0.85-0.87), HR:0.87 (CI:0.85-0.88) & HR:0.89 (CI:0.88-0.90) respectively. Deprivation was the determinant associated with the greatest risk of missed second MMR: adjusted HR:0.82 (CI:0.81-0.83). Children of mothers vaccinated in pregnancy were more likely than children of unvaccinated mothers to have MMR vaccines after adjusting for ethnicity, deprivation, and maternal age (First and Second MMRs adjusted HRs:1.43 (CI:1.41-1.45), 1.49 (CI:1.45-1.53).

CONCLUSION

Children from most-deprived areas are less likely to have MMR vaccines compared with children from least-deprived areas. Mothers who take up pregnancy vaccines are more likely to have their children vaccinated with MMR. Healthcare services should promote and facilitate access to both maternal and childhood vaccines during pregnancy.

Diagnostic performance of saliva RT-PCR test as a diagnostic tool and its utility in the detection of SARS-CoV-2 shedding with different patient characteristics: Prospective observational study

BACKGROUND

Salivary shedding of SARS-CoV-2 is a known entity and its role has been established in transmission of the disease. The present study was performed to evaluate the duration of viral shedding in saliva in COVID-19 patients and its variation among symptomatic and asymptomatic patients with or without co-morbidities.

METHODS

The present prospective observational study was conducted at the COVID-19 care hospital associated with primary to tertiary care in New Delhi, India. A total of 124 COVID-19 confirmed cases enrolled in two phases (January-March 2021; April-June 2021) who consented for 48hrly saliva and nasopharyngeal swab (NPS) specimens till discharge from the hospital for SARS-CoV-2 detection were included. The specimens obtained were tested for SARS-CoV-2 by Real-Time PCR.

RESULTS

The sensitivity and the specificity of RT-PCR on saliva were 81.7 ​% and 85.0 ​%, respectively. The sensitivity of saliva-based PCR was comparable in symptomatic and asymptomatic patients (81.6 ​% vs 82.1 ​%). The sensitivity of saliva-based PCR markedly increased in the second phase of enrollment as compared to the first phase (92.6 ​% vs 78.5 ​%) indicating higher level of salivary shedding by the delta variant of SARS-CoV-2. The sensitivity of PCR on saliva was the highest up to day seven of illness. The median duration of RNA shedding in saliva was comparable among the symptomatic and asymptomatic patients. The severity of the disease was not associated with the duration of SARS-CoV-2 shedding in saliva.

CONCLUSIONS

SARS-CoV-2 shedding in saliva continued till seven days in large number of patients including asymptomatic patients. Saliva is non-inferior to NPS specimen in the diagnosis of SARS-CoV-2. Saliva specimen is recommended as a good alternate to NPS for SARS-CoV-2 testing.

How did the covid-19 pandemic affect lower respiratory tract infections in young children in England?

Background

Social distancing policies to reduce transmission of covid-19 also reduced children's exposures to endemic respiratory viruses. We aimed to examine the impact of the covid-19 pandemic on lower respiratory tract infections in under 5s presenting to primary care in England.

Methods

Longitudinal trends analysis using electronic health records from a nationally representative primary care database. Our target population was children aged &lt;5 years registered with a primary care practice from January 2015 to March 2021.

Our main outcome was total weekly contacts with primary care for a lower respiratory tract infection (LRTI). We defined three pandemic phases from March 2020 - March 2021: i) first national lockdown (late March to early June 2020), ii) childcare settings reopened and second national lockdown with schools open (mid-June to mid-December 2020) and iii) third national lockdown with schools closed (late December 2020 to end of March 2021). We compared outcomes during each of the three phases with corresponding calendar weeks during pre-pandemic years 2015 to 2019.

Results

Our study population included 843 020 children &lt;5 years who had 1 076 181 contacts with primary care for LRTIs. During the first phase (first lockdown) there were falls of 79.3% (95% CI: 73.6 to 84.5) from an average of 28 547 primary care contacts for LRTI in 2015 - 2019 to 5915 in 2020; there was a 78.9% (95% CI: 73.7 to 83.9) fall in phase two (childcare settings reopened and second lockdown) from 107 873 to 22 792 contacts; and a 77.7% (95% CI: 73.5 to 81.4) fall in phase three (third lockdown) from 57 200 to 12 764 contacts.

Conclusions

Children under 5 in England had fewer contacts with primary care for LRTIs during the covid-19 pandemic. This change likely reflects lower prevalence of respiratory illness due to fewer social contacts. This may impact on future health service use as these children have had less exposure, and therefore may have less immunity, to respiratory diseases.

Key messages

• Children under 5 had fewer contacts with primary care for lower respiratory tract infections during the covid-19 pandemic in England likely due to the restrictions in place to reduce social contacts.

• The falls in lower respiratory tract infections during the covid-19 pandemic in under 5s may mean they have less immunity to respiratory viruses which may impact upon their future health service use.

The use of EPR spectroscopy to study transcription mechanisms

Electron paramagnetic resonance (EPR) spectroscopy has become a promising structural biology tool to resolve complex and dynamic biological mechanisms in-vitro and in-cell. Here, we focus on the advantages of continuous wave (CW) and pulsed EPR distance measurements to resolve transcription processes and protein-DNA interaction. The wide range of spin-labeling approaches that can be used to follow structural changes in both protein and DNA render EPR a powerful method to study protein-DNA interactions and structure-function relationships in other macromolecular complexes. EPR-derived data goes well beyond static structural information and thus serves as the method of choice if dynamic insight is needed. Herein, we describe the conceptual details of the theory and the methodology and illustrate the use of EPR to study the protein-DNA interaction of the copper-sensitive transcription factor, CueR.

P302 Disseminated histoplasmosis: Rare entity in immunocompromised individuals in India

 

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM

Invasive mycoses kill more than one million people every year. The disease burden of mycoses has increased over the last 20 years and the importance of fungal disease is expected to keep increasing in the years to come. One of these mycoses, histoplasmosis, a disease caused by species of dimorphic genera, Histoplasma and is endemic in the USA, Asia, and Africa with sporadic cases reported from India. In the United States alone, 3.4 cases/100 000 people occur yearly. In India, prevalence of histoplasmosis is seen in the eastern part of the country and few cases are reported from north India. Here, we present four cases of classic progressive disseminated histoplasmosis from non-endemic central and northern parts of India.

Cases I and II: Two cases, firstly a 51-year-old male resident of Delhi, came with complaints of fever, generalized weakness and weight loss for the past 6 months, and another a 55-year-old in an apparently immunocompetent female from a non-endemic state in central India. The disease was diagnosed by bone marrow aspirate incidentally.

Cases III and IV: A 25-year-old female and a 29-year-old HIV-infected female, with chief complaints of multiple skins colored swellings on her face, neck, chest, and back and also on both limbs. Physical examination revealed multiple skin-colored papules and nodules coalescing to form large plaques on the face, neck, upper back, and chest which had overlying yellowish-brown crusting (Fig.1). Her entire face was involved with depression of the nasal bridge and madarosis. Multiple discrete 0.1-0.5 mm papules and nodules on bilateral upper and lower limbs. Patient was started on the treatment of cutaneous histoplasmosis with injection of liposomal amphotericin-B 100 mg intravenous (around 3 mg/kg/day) after pre-medication for 10 days. For both cases, capsule itraconazole 200 mg BD started for 4 days. Patient responded well to the treatment and follow-up showed improvement in the condition of the patient.

Results

In all the cases, fine needle aspirate cytology of the lesions showed plenty of inflammatory cells and macrophages in pathological microscopic examination. Microscopic examination of skin tissue revealed that macrophages comprising of yeast forms of Histoplasma have pericellular halo around them. Moreover, on long incubation of biopsy sample on SDA media plate at 27˚C, white/buff colonies with yellow-tan on the back were observed. Furthermore, microscopic examination of grown fungal culture showed mycelial septate hyphae bearing round to pear-shaped, smooth-walled broadly elliptical microconidia, or tuberculate macroconidia. In all the cases, clinical suspicion, histopathological and mycological findings (microscopy, culture and post-culture sequencing) led to a confirmatory diagnosis of progressive disseminated Histoplasmosis by H. capsulatum var. capsulatum was made.

Conclusion

In all, 3 of these cases are of progressive disseminated histoplasmosis in apparently immunocompetent patients from the non-endemic states of north India. On the contrary, one of the cases was HIV positive with mucocutaneous lesions. Disseminated histoplasmosis in immunocompetent individuals is not a rare entity, in India. High clinical suspicion and awareness regarding the pathogen are required. From the point of good patient care, an accurate diagnosis, and timely management in cases of histoplasmosis are warranted.

Alien genome mobilization and fixation utilizing an apomixis mediated genome addition (AMGA) strategy in Pennisetum to improve domestication traits of P. squamulatum

An approach to release 'frozen' variability in apomictic species using sexuality of another species, eventually its utilization in crop improvement and de-novo domestication of crop wild relatives is presented. Pennisetum squamulatum, a secondary gene pool species of pearl millet (P. glaucum), harbours many desirable traits. However, it was neither utilized to improve pearl millet fodder traits nor improvement of its own domestication traits was attempted, due to the complexities of genomes and apomictic reproduction. To overcome this, we followed an Apomixis Mediated Genome Addition (AMGA) strategy and utilized the contrasting reproductive capacities (sexuality and apomixis) of both the species to access the otherwise un-available variability embedded in P. squamulatum. Segregating population of interspecific hybrids exhibited significant variability and heterosis for desired morphological, agronomical, and nutritional traits. Elite apomictic and perennial hybrids were evaluated in breeding trials, and eventually a novel grass cultivar was released for commercial cultivation in India. The performance of newly developed cultivar was superior to other adapted perennial grasses of arid and semi-arid rangelands. Through AMGA, the sexuality of one species was successfully utilized to 'release' the 'frozen' variability embedded in another species. Subsequently, the hybrids representing desirable trait combinations were again 'fixed' utilizing the apomixis alleles from the male parent in a back-and-forth apomixis-sexual-apomixis selection cycle. This study also demonstrated the potential of AMGA to improve crop relatives through genomes introgression as well as de novo domestication of new crops from wild species.

Screening Laboratory Testing in Asymptomatic Minor Pediatric Blunt Trauma Leads to Unnecessary Needle Sticks

OBJECTIVE

Screening blood work after minor injuries is common in pediatric trauma. The risk of missed injuries versus diagnostic necessity in an asymptomatic patient remains an ongoing debate. We evaluated the clinical utility of screening blood work in carefully selected asymptomatic children after minor trauma.

METHODS

Patients seen at a level 1 pediatric center with "minor trauma" for blunt trauma between 2010 and 2015 were retrospectively reviewed. Exclusion criteria were age <4 of >18 years, a Glasgow Coma Scale score of <15, penetrating trauma, nonaccidental trauma, hemodynamic instability, abdominal findings (pain, distension, bruising, tenderness), hematuria, pelvic/femur fracture, multiple fractures, and operative intervention. Data abstraction included demographics, blood work, interventions, and disposition.

RESULT

A total of 1308 patients were treated during the study period. Four hundred thirty-three (33%) met inclusion criteria. Mean ± SD age was 12.7 ± 4 years (range, 4-18 years), and 59% were male. Seventy-eight percent were discharged home from the emergency department. All patients had blood work. Twenty-eight percent had at least one abnormal laboratory value. The most common abnormal blood work was leukocytosis (16%). Thirty percent had an intervention, and none prompted by abnormal blood work. One patient had an intra-abdominal finding (psoas hematoma).

CONCLUSION

When appropriately selected, screening laboratory testing in asymptomatic minor pediatric blunt trauma patients leads to unnecessary needle sticks without significant advantage.

Are children at schools registered to The Daily Mile™ more physically active?

Background

The Daily Mile (TDM) is among the most popular school-based running programmes recommended globally by governments and the WHO to meet the shortfalls in children's physical activity. In England, it has been adopted by 1 in 5 primary schools. However, its impact on children's physical activity has not been assessed at scale. We aimed to compare a)minutes (mins) of moderate to vigorous physical activity (MVPA) in and outside school hours and b)meeting physical activity guidelines in primary school children in England, comparing those in schools registered with TDM with those that were not.

Methods

This was a cross-sectional study. We used self-reported data of 49,561 English primary school children(5-11 years) from the Active Lives Children and Young People Survey and TDM registration data of their school. We compared mins of MVPA in and outside school hours between children in TDM-registered and non-registered schools using a multilevel zero-inflated negative binomial model; and the differences in the likelihood of meeting physical activity guidelines based on TDM registration with a multilevel logistic regression model. All models included a random effect for school and adjusted for potential confounders.

Results

Children attending TDM-registered schools reported an extra 36 mins of MVPA a week overall, including 10 additional mins (95%CI:3,16) MVPA/week during school hours and 26 additional (95%CI:4,44) mins MVPA/week outside school hours. Children in TDM-registered schools were 6% more likely to meet physical activity guidelines compared to those who were not(RR:1.06 (95%CI:1.02,1.11)).

Conclusions

Children in primary schools registered to TDM report more physical activity that is not compensated for outside school hours. However, the absolute differences fall considerably short of international guidelines across the whole child population. Therefore, a whole school and systems-based approach is required, embedding school-based running programmes.

Key messages

Children in schools registered to TDM report more MVPA overall, inside, and outside school hours; suggesting no compensation of activity in those who are registered. TDM is a potential solution to increase children’s physical activity during the school day.

Internalized weight bias in the relationship between mental health and obesity in UK adolescents

Background

It is crucial to promote mental and physical health during adolescence to protect against lifetime risks of mental health problems and obesity. Internalized weight bias (self-directed stigmatizing attitudes about perceived weight status) and bullying are implicated as potential mechanisms in the relationship between mental health and obesity in adolescence. We examined internalized weight bias and bullying as potential mediators of the relationship between mental health and weight status across adolescence in the United Kingdom (UK).

Methods

We analysed data on 8,688 adolescents from the UK Millennium Cohort Study. Weight status was defined using sex and age specific International Obesity Taskforce cut points for body-mass index (not overweight/obese; overweight; obese) at 11 and 17 years. Mental health was defined using parental reported emotional (anxiety and depression), and externalizing (aggression and impulsivity) symptoms at 11 and 17 years (low; moderate; high). Self-reported measures of internalized weight bias captured via body-dissatisfaction and self-esteem and bullying at 14 years were tested as mediators. We used Generalized Structural Equation Models to examine longitudinal pathways between weight status and mental health across 11 and 17 years, whilst accounting for concurrent associations and potential confounders.

Results

Adolescents with high emotional (relative risk (RR) 1.98, 95% CI 1.28 to 3.07) or externalizing symptoms (RR 2.07, 95% CI 1.23 to 3.48) at 11 years were twice as likely to be obese at 17 years compared with those who had low symptoms. The impact of emotional and externalizing symptoms on weight status was found to be partially attributable to internalized weight bias, but not bullying, with significant mediation for body-dissatisfaction and low self-esteem.

Conclusions

Internalized weight bias partially explains the relationship between mental health and weight status across adolescence.

Key messages

There is a need for a holistic, early prevention strategy to focus on reducing weight stigma to encourage healthy mental and physical development of children. The relationship between mental health and weight status across adolescence is partly attributable to internalized weight bias.

A core outcome set for school-based physical activity interventions: an international consensus

Background

Studies of school-based physical activity interventions vary in the outcomes they measure. This prevents comparisons of results to establish impacts. We aimed to develop a core outcome set agreed by key stakeholders for future studies of school-based physical activity interventions.

Methods

We used a modified-Delphi consensus method. First, we conducted a systematic review to identify outcomes measured in relevant studies and listed these in a Delphi survey. Next, we recruited key stakeholders to complete 2 survey rounds: Round 1 was to rate each outcome from ‘not important' to ‘critical', and Round 2 was to re-rate the outcomes based on feedback from Round 1. Outcomes rated ‘critical' by 70% of stakeholders (i.e., reaching consensus) were highlighted. Then, using the full list of outcomes, we conducted a children's workshop to include their views. Finally, we held a stakeholder meeting to discuss results and agree consensus.

Results

We identified 50 outcomes from the systematic review. Sixty-five stakeholders (16 educators, 13 health professionals, 12 parents, 24 researchers) representing 9 countries completed both survey rounds; 13/50 outcomes reached consensus. Children (n = 16) identified 8 outcomes of importance; 3 were consistent with the survey results. Stakeholders attending the meeting (n = 13) reached consensus on 14 outcomes to be included in the core outcome set: fitness, physical activity intensity, energy, sleep, diet, happiness, stress, depression, anxiety, wellbeing, self-esteem, enjoyment, concentration, and focus. These core outcomes were reviewed and agreed by all 65 stakeholders.

Conclusions

Our core outcome set agreed by international stakeholders includes physical and mental health, and cognitive function. We recommend its use in future studies of school-based physical activity interventions. Findings from future studies can be compared and combined which will be relevant to public health policy makers and educators.

Key messages

School-based physical activity interventions should measure physical and mental health, and cognitive function. Wide use of this core outcome set will enable findings to be compared and combined.

Implementation of The Daily Mile™: survey of primary schools in Greater London

Background

The Daily Mile™ is a free school-based active mile intervention. Its main features include that children run or jog for 15 minutes at least 3 times a week (3x/wk) during school hours. The Daily Mile Foundation recommends 10 principles for successful implementation. These are it is (1) quick (15 minutes), (2) fun, (3) whole school participates, (4) it takes place in all weathers, (5) 3x/wk in addition to curricular lessons (not during PE, breaks, before/after school), (6) ideally in the school playground, (7) safe, (8) simple (no equipment), (9) children go at their own pace and (10) no change of clothes or shoes is needed. The aim of this study was to identify how many Greater London primary schools adopting The Daily Mile implement its 10 principles.

Methods

In September 2020, we sent all state-funded primary schools (n = 1721) in every Greater London borough (n = 32) a survey to find out if and how they implemented The Daily Mile.

Results

By June 2021, 368 (21%) schools responded to our survey (at least one from every London borough). Of these, 195 (53%) schools adopted The Daily Mile of which only 7 (4%) reported implementing all 10 principles; a median 7 (IQR: 6,8) principles were reported implemented. Whole school participation was reported by 93 (48%) Daily Mile schools, 104 (53%) reported implementing The Daily Mile for 15 minutes, 127 (65%) implemented it at least 3x/wk, and 149 (76%) schools reported that the children ran or jogged during The Daily Mile. A large proportion of schools reported implementing The Daily Mile in the school playground and that it was done simply (both n = 171, 88%), but only 85 (44%) schools reported implementing it during lessons.

Conclusions

Daily Mile schools in Greater London implement 7/10 principles on average. Whether implementing all the principles limits the success of its desired effect is unclear. Studies assessing effects of The Daily Mile should consider its implementation when reporting results.

Key messages

Of The Daily Mile’s 10 principles, an average of 7 are implemented in London schools. Studies examining The Daily Mile should consider implementation which may impact its desired effect.

Prevalence and knowledge of hypertension among students of medical college of central Uttar Pradesh, India

Background: Hypertension is one of the biggest health challenges, which is continuously increasing among young adults, especially students. The aim of the present study was to find out the prevalence, associated factors and knowledge of hypertension among undergraduate students of a medical college of a rural area in central Uttar Pradesh, India. Methodology:  A cross-sectional study was conducted in one of the medical college of central Uttar Pradesh, India. Data were collected on socio-demographic and behavioral factors, and anthropometric assessments were carried out using standard equipment and procedures. Results: The present research involved 147 undergraduate medical students with a mean age of 21.9±2.2 years. Knowledge about hypertension was poor, average and good among19.7% (n=29), 76.8% (n=113) and 3.4% (n=5) students, respectively. Mean systolic blood pressure (mean SBP) was 127.07 ± 10.109 mm of Hg with a range 110 to 154mm of Hg, and mean diastolic blood pressure (mean DBP) was 80.5 ± 6.587 mm Hg with a range 68 to 94 mm of Hg. Conclusions: Smoking, alcoholism, non-vegetarian diet, body weight over 60 kgs and waist-hip ratio over 0.9 were recognized as risk factors of hypertension. Hence it needs a powerful surveillance program to find the exact problem.

Efficacy and tolerability of eslicarbazepine acetate as monotherapy in patients of newly diagnosed focal epilepsy

Introduction

Eslicarbazepine Acetate, a novel anti-epileptic drug has been approved as monotherapy in focal onset seizures, with/without secondary generalization in adults. Eslicarbazepine has many advantages over older anti-epileptic drugs and is useful in patients of new onset focal epilepsy.

Objectives

Aim of our study was to determine the efficacy and safety of Eslicarbazepine Acetate, observe its well-tolerated use and monitor adverse effects in newly diagnosed patients of focal epilepsy.

Methods

Study was done at Department of Psychiatry, Teerthanker Mahaveer University, Moradabad. A total of 30 newly diagnosed cases of focal epilepsy between 18-60 years of age were studied for 6 months, using a Semi-structured Interview and Liverpool Adverse Events Profile.

Results

Majority of patients were males (58%), between 21-30 years. Patients with partial/focal seizures (63%) were more common than those of generalized seizures (37%). Majority of the participants had 1-2 episodes of focal seizures weekly(48%), while some had almost daily(32%). Majority were on Eslicarbazepine Acetate 800 mg in two divided doses daily (64%), while the others received 1200 mg in three divided doses(32%). The mean Liverpool Adverse Events Profile score initially was 28.34 ± 6.28 which significantly improved after 4 weeks treatment to 22.80 ± 4.35 (p < 0.05). The improvement in newly diagnosed focal seizures patients was significantly more than other patients (p < 0.05). No major side effects were observed.

Conclusions

Eslicarbazepine Acetate as a monotherapy is effective in treating focal epilepsy. Better results of this drug are found in newly diagnosed focal epilepsy patients.

Disclosure

No significant relationships.

Epigenetic Modifiers and Their Potential Application in Colorectal Cancer Diagnosis and Therapy

Colorectal cancer (CRC) is the second leading cause of mortality in western countries. Delayed diagnosis of CRC is among the major reasons for its high mortality rate and progression to advanced stages. Early diagnosis of CRC is considered very important for timely treatment. Therefore, identification of accurate biomarkers holds the potential of laying a structural foundation for successful clinical management. A multistep process including genetic and epigenetic alterations, drives the development of early premalignant lesions to advanced metastatic CRC. These genetic and epi-genetic alterations accumulated over the course of malignant transformation favor the growth of neoplastic cells and an aggressive phenotype of malignant cells. Several epigenetic modifications have been shown to play a critical role in regulating gene expression, not only causing belligerent malignant cells but also impelling the initial stages of oncogenesis. The present review discusses the diagnostic, prognostic, and predictive applications of epigenetic biomarkers along with therapeutic strategies targeting such epigenetic alterations.

Dynamics of noise-induced wave-number selection in the stabilized Kuramoto-Sivashinsky equation

We revisit the question of wave-number selection in pattern-forming systems by studying the one-dimensional stabilized Kuramoto-Sivashinsky equation with additive noise. In earlier work, we found that a particular periodic state is more probable than all others at very long times, establishing the critical role of noise in the selection process. However, the detailed mechanism by which the noise picked out the selected wave number was not understood. Here, we address this issue by analyzing the noise-averaged time evolution of each unstable mode from the spatially homogeneous state, with and without noise. We find drastic differences between the nonlinear dynamics in the two cases. In particular, we find that noise opposes the growth of Eckhaus modes close to the critical wave number and boosts the growth of Eckhaus modes with wave numbers smaller than the critical wave number. We then hypothesize that the main factor responsible for this behavior is the excitation of long-wavelength (q→0) modes by the noise. This hypothesis is confirmed by extensive numerical simulations. We also examine the significance of the magnitude of the noise.

Ten-year fracture risk predicted by proximal femur Hounsfield units

Colon cancer screening occurs at younger ages than osteoporosis screening. Bone density measurements using virtual colonoscopy performed for colon cancer screening can provide an early warning sign of patients at potential risk for osteoporosis-related fractures. Earlier identification may improve treatment and potentially fracture prevention.

INTRODUCTION

Opportunistic osteoporosis screening with computed tomography colonography (CTC) offers an opportunity to capitalize on earlier colorectal cancer screening to identify patients at risk of future fractures. The purpose of this study is to evaluate 10-year fracture and specifically hip fracture risk based on Hounsfield units (HU) obtained from CTC.

METHODS

We identified all CTC scans between 2004 and 2007 of patients 40 years and older with 10 years minimum follow-up. Hounsfield units were measured within the proximal femur and fractures identified via worldwide military records. Patients were stratified into two cohorts based on the presence or lack of a fracture in the wrist, spine, hip, or proximal humerus. Hounsfield unit measurements were compared between groups using Student's t test and the HU threshold was calculated that best approximated an 80% sensitivity to optimally screen patients for fracture risk. The odds ratio, negative predictive value, 10-year incidence of fracture, and survival curves were calculated.

RESULTS

We identified 3711 patients with 183 fractures over 10 years. The HU threshold that corresponded with an 80% sensitivity to identify fractures was 112 HU. The negative predictive value (NPV) for overall fractures and hip fractures was over 97%. The 10-year fracture incidence was higher in patients below 112 HU compared to those above for both overall fractures (6.3% vs 1.7%) and hip fractures (2.7% vs 0.07%). The 112 HU threshold corresponds with an odds ratio for overall fracture and hip fractures of 2.5 (95% confidence interval (CI), 1.7-3.6) and 24.5 (95% CI, 3.3-175.5), respectively.

CONCLUSION

In the 10 years following CTC, patients who experienced a fracture had lower hip HU. Decreasing HU on CTC may be an early warning sign of fracture potential.

Impact of school-based physical activity interventions in primary schools: measuring what matters

Background

A growing number of small studies suggest that school-based physical activity initiatives can help children achieve the recommended 60 minutes of physical activity per day. However, the heterogeneity of outcomes and measures used in small studies prevents pooling of results to demonstrate whether short-term health benefits are sustained. Qualitative studies suggest many benefits that are not represented by outcomes in trials to date. The aim of this study was to generate a list of outcomes that have been studied to develop a core outcome set (COS) acceptable to key stakeholders for future studies evaluating school-based physical activity initiatives.

Methods

We searched six databases (MEDLINE, EMBASE, PsycINFO, CINAHL, CENTRAL and Cochrane Database of Systematic Reviews) systematically for reviews of school-based physical activity interventions, and extracted relevant studies to identify the outcomes and measures used in each paper. A long list was generated from the literature and a previous workshop with stakeholders. This study is registered with COMET (#1322), and with PROSPERO (CRD42019146621).

Results

75/121 cited studies drawn from 53/2409 reviews met our inclusion criteria. We grouped 65 outcomes into 3 domains: (i) physical activity and health (ii) social and emotional health, and (iii) educational attainment. We will conduct two Delphi survey rounds with four stakeholder groups (health professionals, researchers, educators and parents) to rate the importance of each outcome. A core outcome set will be generated from a consensus process.

Conclusions

There is currently a large variation of outcomes and measures studied that precludes evidence synthesis of the impact of school-based physical activity interventions. Consensus methods are needed to focus research on the outcomes that matter the most to key stakeholders and to provide tools for future studies to assess long-term impact.

Key messages

Variations in outcomes studied precludes evidence synthesis of SBPA intervention impacts. A core outcome set is needed to ensure future SBPA interventions measure outcomes that matter the most.

Early years pathways to inequalities in childhood asthma? A causal mediation analysis

Background

Asthma affects one in five children in the United Kingdom (UK). Children in deprived areas have twice as many unplanned admissions for wheeze but mediating pathways between socioeconomic circumstances and asthma remain unclear. We aimed to quantify which early years pathways explain inequalities in childhood asthma in the UK.

Methods

We analysed data on 10650 children from the Millennium Cohort Study (MCS), a nationally representative sample of the UK population. Early life socioeconomic circumstance (SEC) was measured by maternal education at birth. Our outcome was parent-reported asthma at 5 years of age categorised as none, diagnosed asthma and diagnosed asthma with wheeze symptoms in the preceding year. Mediators were grouped into perinatal characteristics (maternal BMI, breastfeeding duration, birthweight, gestation, maternal smoking and alcohol use during pregnancy), neighbourhood features (pollution, grime and environment issues, traffic volume, housing quality) and the home environment (damp/condensation, tenure, pets, tobacco smoke). We used multinomial regression to examine the total effect of SEC on childhood asthma, then adjusted for all potential mediators. Using causal mediation analysis, we will estimate the proportion mediated by blocks of mediators and the natural indirect effect (NIE) via each block of mediators.

Results

Children whose mothers had no qualifications were more than twice as likely to have asthma by the age of 5 years with a wheeze episode in the preceding year compared with those whose mothers had degree-level qualifications (relative risk (RR) 2.21, 95% CI 1.44 to 3.40). After adjustment for all mediators, there was a 69% reduction to aRR 1.38 (95% CI 0.89 to 2.14).

Conclusions

Perinatal characteristics and early years neighbourhood features and measures of the home environment partially contribute to inequalities in childhood asthma.

Key messages

The antenatal period and early years of development are important for targeting interventions to reduce inequalities in asthma. About two-thirds of the social inequality in childhood asthma was explained by perinatal characteristics, early years neighbourhood features and the home environment.

Impact of financial incentives for primary care to give long acting reversible contraceptive advice

Background

Long acting reversible contraceptives (LARC) are cost-effective but uptake remains poor even in high income settings. In 2009/10, a pay-for-performance (P4P) scheme in the United Kingdom was introduced for primary care physicians to offer advice about LARC to women attending for contraceptive care. We examined the equity and impact of this scheme on LARC uptake and abortions

Methods

We examined records of women aged 13 to 54 years registered with a primary care practice in the UK Clinical Practice Research Datalink from 2004/05 to 2013/14. We used interrupted time series analysis to examine trends in annual LARC and non-LARC hormonal contraception (NLHC) uptake and abortion rates, stratified by age, region and deprivation groups, before and after P4P was introduced in 2009/10.

Results

LARC uptake among women of all ages increased immediately after P4P with step change of 5.36 per 1,000 women (95% CI 5.26 to 5.45). Largest increase was in women aged 20 to 24 years (8.40, 8.34 to 8.47). NLHC uptake fell in all women with a step change of -22.9 (-24.5 to -21.2). Among LARC methods, contraceptive injection and implant had the greatest increase after P4P; step changes were 1.68 (1.67 to 1.70) and 1.64 (1.63 to 1.65) respectively. Abortion rates fell across all 12 regions in UK and in all women immediately after P4P with a step change of -2.28 (-2.99 to -1.57). The largest falls occurred in women aged 13 to 19 years (step change -5.04, -7.56 to -2.51) and women from the most deprived group (step change -4.40, -6.89 to -1.91).

Conclusions

Pay-for-performance scheme for primary care physicians to give LARC advice to women attending for contraception was associated with desirable impact and equity of LARC prescriptions and abortion.

LARC uptake increased in women of all ages, especially 13-19 and 20-24 years. Abortion rates fell in all UK regions and age groups, particularly 13-19 and 20-24 years and those from deprived quintile.

Key messages

Pay-for-performance scheme for primary care practitioners to give LARC advice to women attending for contraception was associated with desirable impact and equity of LARC prescriptions and abortion. LARC uptake increased in women of all ages, especially 13-19 and 20-24 years. Abortion rates fell in all UK regions and age groups, particularly 13-19 and 20-24 years and those from deprived quintile.

Prevalence and duration of gastrointestinal symptoms before diagnosis of Inflammatory Bowel Disease and predictors of timely specialist review: a population-based study

BACKGROUND AND AIMS

Lack of timely referral and significant waits for specialist review amongst individuals with unresolved gastrointestinal (GI) symptoms can result in delayed diagnosis of Inflammatory Bowel Disease (IBD).

AIMS

To determine the frequency and duration of GI symptoms and predictors of timely specialist review before the diagnosis of both Crohn's Disease (CD) and ulcerative colitis (UC).

METHODS

Case-control study of IBD matched 1:4 for age and sex to controls without IBD using the Clinical Practice Research Datalink from 1998-2016.

RESULTS

We identified 19,555 cases of IBD, and 78,114 controls. 1 in 4 cases of IBD reported gastrointestinal symptoms to their primary care physician more than 6 months before receiving a diagnosis. There is a significant excess prevalence of GI symptoms in each of the 10 years before IBD diagnosis. GI symptoms were reported by 9.6% and 10.4% at 5 years before CD and UC diagnosis respectively compared to 5.8% of controls. Amongst patients later diagnosed with IBD, <50% received specialist review within 18 months from presenting with chronic GI symptoms. Patients with a previous diagnosis of irritable bowel syndrome or depression were less likely to receive timely specialist review (IBS: HR=0.77, 95%CI 0.60-0.99, depression: HR=0.77, 95%CI 0.60-0.98).

CONCLUSIONS

There is an excess of GI symptoms 5 years before diagnosis of IBD compared to the background population which are likely attributable to undiagnosed disease. Previous diagnoses of IBS and depression are associated with delays in specialist review. Enhanced pathways are needed to accelerate specialist referral and timely IBD diagnosis.

Utilization of Reproductive and Child Health Services and Client Satisfaction under Different Level of Health Facilities

Background: The utilization of any social services, including health services, has never been equitably distributed throughout society. People with access to the facilities are generally found to make greater use of them than people who have neither knowledge nor access to the facilities. Objective: To study the utilization pattern of RCH services, to identify factors influencing the utilization of RCH services in district Etawah and to describe level of client satisfaction about the various RCH services provided by Health Facility. Methods: This was a cross sectional study conducted in two blocks of Etawah i.e., Basrehar and Jaswant Nagar. Purposive sampling method was used and 260 participants were interviewed during the study period i.e., from May 2018 to April 2019.All the antenatal mothers and mothers with child up to 24 months attending OPD of selected health facility were included in the study. Result: Mean age of participants was found to be 24.9 ± 3.6 years. The proportion of previous delivery that was institutional was found to be 71.7% where as 28.3% had previous home delivery. Most common place for institutional delivery was found to be CHC. Conclusion: Utilization of RCH services were found to be not adequate in the study.

Pharmacotherapy to gene editing: potential therapeutic approaches for Hutchinson-Gilford progeria syndrome

Hutchinson-Gilford progeria syndrome (HGPS), commonly called progeria, is an extremely rare disorder that affects only one child per four million births. It is characterized by accelerated aging in affected individuals leading to premature death at an average age of 14.5 years due to cardiovascular complications. The main cause of HGPS is a sporadic autosomal dominant point mutation in LMNA gene resulting in differently spliced lamin A protein known as progerin. Accumulation of progerin under nuclear lamina and activation of its downstream effectors cause perturbation in cellular morphology and physiology which leads to a systemic disorder that mainly impairs the cardiovascular system, bones, skin, and overall growth. Till now, no cure has been found for this catastrophic disorder; however, several therapeutic strategies are under development. The current review focuses on the overall progress in the field of therapeutic approaches for the management/cure of HGPS. We have also discussed the new disease models that have been developed for the study of this rare disorder. Moreover, we have highlighted the therapeutic application of extracellular vesicles derived from stem cells against aging and aging-related disorders and, therefore, suggest the same for the treatment of HGPS.

A Comprehensive Review of Diagnostic and Therapeutic Strategies for the Management of Pancreatic Cancer

Pancreatic cancer is one of the fastest-growing fatal solid tumors across the world. The challenges with pancreatic cancer are delayed diagnosis and lack of effective treatment strategies. Pancreatic cancer is expected to become the third leading cause of cancer-related mortality in high-income countries in the coming decade. In most cases, patients are diagnosed at advanced stages, due to a lack of early symptoms, whereby the tumor is unresectable. Imaging, histopathology, and biomarker approaches are currently used for pancreatic cancer diagnosis. Imaging modalities for pancreatic cancer diagnosis include endoscopy, ultrasound, computed tomography, magnetic resonance imaging, and positron emission tomography scanning. Along with imaging, histopathology helps in the identification of cancer stages and in therapeutic decisions. The multidisciplinary treatment option is the most common choice for pancreatic cancer and includes surgery, chemotherapy, chemoradiotherapy, and supportive care. Immunotherapy is the emerging approach for the treatment of pancreatic cancers. The present review summarizes the current literature and provides an overview of both the diagnostic and therapeutic options for the effective management of pancreatic carcinoma.

Laparoscopic Peritoneal Dialysis Catheter Placement with Chest Wall Exit Site for Neonate with Stoma

Neonates requiring peritoneal dialysis (PD) catheters have been shown to have complication rates up to 70%. The presence of a concurrent stoma significantly increases the risk of peritonitis, exit-site infection, and catheter failure. As such, multiple techniques have been proposed to reduce these risks, including a chest wall exit site. In this case, the patient was born with bilateral hypoplastic kidneys and an anorectal malformation, requiring a colostomy soon after birth. At 4 weeks of life, he required placement of a PD catheter for dialysis. Given the high risk of infection, a laparoscopic-assisted PD catheter placement with a chest wall exit remote from the colostomy was performed. This report describes the operative technique including omentectomy, placement of a percutaneous stitch between the catheter cuffs, and fibrin glue injection around the catheter. The patient had no catheter-related infections. Laparoscopic-assisted PD catheter placement with chest wall exit site is a safe alternative in patients with any type of abdominal stoma.

Wave-number selection in pattern-forming systems

Wave-number selection in pattern-forming systems remains a long-standing puzzle in physics. Previous studies have shown that external noise is a possible mechanism for wave-number selection. We conduct an extensive numerical study of the noisy stabilized Kuramoto-Sivashinsky equation. We use a fast spectral method of integration, which enables us to investigate long-time behavior for large system sizes that could not be investigated by earlier work. We find that a state with a unique wave number has the highest probability of occurring at very long times. We also find that this state is independent of the strength of the noise and initial conditions, thus making a convincing case for the role of noise as a mechanism of state selection.

Neuroinflammation is a putative target for the prevention and treatment of perioperative neurocognitive disorders

INTRODUCTION

The demographics of aging of the surgical population has increased the risk for perioperative neurocognitive disorders in which trauma-induced neuroinflammation plays a pivotal role.

SOURCES OF DATA

After determining the scope of the review, the authors used PubMed with select phrases encompassing the words in the scope. Both preclinical and clinical reports were considered.

AREAS OF AGREEMENT

Neuroinflammation is a sine qua non for development of perioperative neurocognitive disorders.

AREAS OF CONTROVERSY

What is the best method for ameliorating trauma-induced neuroinflammation while preserving inflammation-based wound healing.

GROWING POINTS

This review considers how to prepare for and manage the vulnerable elderly surgical patient through the entire spectrum, from preoperative assessment to postoperative period.

AREAS TIMELY FOR DEVELOPING RESEARCH

What are the most effective and safest interventions for preventing and/or reversing Perioperative Neurocognitive Disorders.

CXCR1/2 Chemokine Network Regulates Melanoma Resistance to Chemotherapies Mediated by NF-κB

BACKGROUND

Cancer-related inflammation is recognized as a driver for tumor progression and chemokines are important players in both inflammation and the progression of many cancer types. CXC chemokines, especially CXCL8, have been implicated in melanoma growth and metastasis, while less is known for their roles in drug resistance.

METHODS

We generated drug-resistant cells by continuous exposure to chemotherapeutic drugs and analyzed the mechanism(s) of therapy resistance in malignant melanoma.

RESULTS

We report chemotherapies induced upregulation of a variety of chemokines in the CXCR1/CXCR2 network by an NF-κB-dependent mechanism. Notably, analysis of the drug-resistant melanoma cell line selected after prolonged exposure to chemotherapeutic drug dacarbazine revealed higher levels of CXCL8 and CXCR2 compared with parent cells as a signature of drug resistance. CXCR2 neutralization markedly improved sensitivity to dacarbazine in melanoma cells.

CONCLUSION

These data provide insights into what drives melanoma cells to survive after chemotherapy treatment, thus pointing to strategies for developing combined drug therapies for combating the problem of chemotherapy resistance in melanoma.

Ophthalmological manifestation in patients of tuberculous meningitis

BACKGROUND

Vision impairment, blindness in particular is a devastating complication in patients with tuberculous meningitis. However, information regarding ophthalmological manifestation and its impact on vision is sparse in the literature. This study evaluated the spectrum of ophthalmological manifestations in tuberculous meningitis, including retinal nerve fiber layer thickness assessment by optic coherence tomography and its correlation with visual and clinical outcome.

METHODS

This was a prospective observational study done from October 2015 to March 2017. Consecutive patients of tuberculous meningitis, diagnosed as per consensus case definition were included in the study. The patients were divided into two categories: uncomplicated and complicated tuberculous meningitis. Clinical evaluation, cerebrospinal fluid examination and contrast enhanced MRI of brain was done. Detailed ophthalmological evaluation including optic coherence tomography was done in all patients. All the patients were followed for 6 months. The primary outcome was blindness or low vision after 6 months. The secondary outcome was death or severe disability after 6 months. It was defined as modified Barthel index (MBI) ≤ 12 at 6 months (including disability plus death). Appropriate statistical analysis was done.

RESULTS

Out of 101 patients of tuberculous meningitis, 47 patients of TBM belonged to uncomplicated category, while 54 patients were of complicated group. The visual impairment was present in 24 out of 101 (23.76%) patients out of which 20 (19.8%) patients had low vision while 4 (3.96%) had blindness. The visual impairment was more evident in complicated group, low vision 0.03 (1.2-31.5). The most common abnormality on fundus examination was papilledema (22.8%). The complicated group had more incidence <0.0001 (19.6-48). Optic atrophy was found in three patients while choroid tubercles were found in eight patients (all complicated TBM group). RNFL thinning was noted in 10 patients in both the eyes. On univariate analysis, presence of diplopia at baseline, impairment of color vision at baseline, visual impairment at baseline, cranial nerve VIth involvement, optic atrophy and papilledema at baseline, RNFL thinning, abnormal VEP and baseline MBI were associated with poor visual outcome. On multivariate analysis, none of the factors were found to be independently associated with poor visual outcome. On univariate analysis, many factors including baseline MRC staging, altered sensorium, seizure, hemiparesis, basal exudates, infarcts, optochiasmaticarachnoiditis, visual impairment at baseline were found to be associated with poor clinical outcome at 6 months. On multivariate analysis, presence of seizure (P = 0.047, odds ratio = 78.59, 95% confidence interval (1.07-578.72)) was the only factor found to be independently associated with poor outcome.

CONCLUSION

Wide spectrum of ophthalmological manifestation was observed in patients of tuberculous meningitis. The visual impairment was more evident in complicated tuberculous meningitis. Ophthalmological findings like optic atrophy, papilledema and RNFL thinning were associated with poor visual outcome on univariate but not multivariate analysis. Visual impairment at baseline, among other factors was associated with poor clinical outcome on univariate analysis, whereas seizure was the only factor independently associated with poor outcome on multivariate analysis.

Peritoneal Nodules in a Pediatric Patient with Benign Teratoma. A Case Report and Review of Literature

BACKGROUND

Mature ovarian teratomas are common in children. These well differentiated tumors are typically confined to the ovary. In rare cases, they can rupture leading to granulomatous peritonitis that mimics carcinomatosis. Ovarian tumors with peritoneal/omental implants suggest malignant pathology with a different prognosis.

CASE

A 15-year-old girl presented with 5 months of abdominal pain, and weight loss. Computed tomography (CT) imaging of the abdomen revealed a large mass filling the abdomen. Slightly elevated lactate dehydrogenase (LDH) and carcinoma antigen 125 (CA125). On laparotomy an ovarian tumor with peritoneal and omental implants was identified. Left salpingo-oophorectomy, omentectomy, and peritoneal washing were performed. Pathology revealed a benign cystic teratoma.

SUMMARY AND CONCLUSION

Although ovarian teratomas are typically benign, they might mimic carcinomatosis. In patients with unexpected finding of peritoneal implants, histologic diagnosis is recommended before proceeding with a full oncologic ovarian resection.

Gibberellin-induced perturbation of source-sink communication promotes sucrose accumulation in sugarcane

Constant removal of sugars from the site of synthesis (i.e., leaves), in response to elevated sink (culm) demand, may perhaps prevent damping of photosynthesis, by sugar, and hence promote further sucrose accumulation in the culm. In this study, gibberellic acid (GA₃) induced nearly 42.3% enlargement in cell size and about 39.3% increase in internodal length (sink capacity), 177% escalation in reducing sugar level (sink strength), amplified the expression of sucrose-metabolizing enzymes (sink demand), viz., 7.5-fold for SAI, 4.5-fold for CWI, sixfold for SPS, all demonstrating facilitation of augmented sucrose accumulation in the culm. The GA₃-treated BO 91 cane (late maturing sugarcane variety) exhibited an elevated final sucrose concentration (40.54-41.6%) as compared to control (30.44-38.8%). The GA₃-sprayed cane of early maturing Co J64 also showed such a boost, but it was lost by the end of maturity, perhaps due to inversion and/or the less effective GA₃ treatment. Thus, results demonstrated the role of GA₃ in augmenting sucrose content of cane culm, possibly by influencing source-sink dynamics in sugarcane.

Developing a Novel Ambulatory Total Parenteral Nutrition-Dependent Short Bowel Syndrome Animal Model

BACKGROUND

Short bowel syndrome (SBS) results from extensive bowel resection. Patients with SBS require total parenteral nutrition (TPN) for survival. Understanding mechanisms contributing to TPN-associated liver injury and gut atrophy are critical in developing SBS therapies. Existing SBS models using tethered animals have significant limitations and are unlike ambulatory human SBS patients. We hypothesized that we could induce SBS in piglets and develop an ambulatory TPN-SBS model.

MATERIAL AND METHODS

Eighteen neonatal pigs received duodenal and jugular catheters. They were fitted with a jacket holding TPN and a miniaturized pump. Six piglets had 90% small bowel resection and catheter placement (SBS group). Non-SBS piglets were randomized into enteral nutrition (EN) or TPN.

RESULTS

Bowel resection was successfully accomplished in SBS animals. Weight gain was similar in all groups. SBS animals had increased serum bilirubin compared to EN. Mean conjugated bilirubin ± SD was 0.045 ± 0.01 for EN, (P = 0.03 EN versus TPN and P = 0.03 SBS versus EN) and 1.09 ± 1.25 for TPN, (P = 0.62 TPN versus SBS). Gut density was reduced in the TPN group compared to EN and SBS groups. Mean gut density ± SD was 0.11 ± 0.04 for TPN (P = 0.0004 TPN versus SBS and P = 0.00007 TPN versus EN) and not statistically different for EN versus SBS (P = 0.32).

CONCLUSIONS

We created a novel, ambulatory TPN-SBS model using piglets, mimicking long-term TPN delivery in human SBS patients. Our model demonstrated TPN-related conjugated hyperbilirubinemia and compensatory gut hypertrophy, as noted in humans with SBS. This model holds great potential for future research.

Laparoscopic-assisted divided colostomy for anorectal malformation case series: a description of technique, clinical outcomes and a review of the literature

OBJECTIVE

To present a case series of pediatric patients who underwent a laparoscopic-assisted divided colostomy for anorectal malformations, describe our technique, and provide a review of the literature on laparoscopic-assisted colostomy in pediatric patients.

METHODS

We performed a retrospective review of six patients born with anorectal malformations, who received a laparoscopic-assisted colostomy from 2012 to 2016 at Cardinal Glennon Children's Medical Center.

RESULTS

The average operating time was 74.5 min. Laparoscopic colostomy types included divided (n = 5) and end colostomy with Hartmann's (n = 1). Location of the colostomy was selected just distal to the descending colon (n = 5) or at the sigmoid flexure (n = 1). Feeds and stoma production was achieved within 24 h from surgery in most patients. There were no major complications except one patient having a mucosal fistula prolapse that was easily reduced.

CONCLUSIONS

Laparoscopic-assisted colostomy in the management of anorectal malformations is a safe and effective technique. It offers similar advantages of the open technique, with the added benefits of avoiding wound-related complications and improved cosmetic results.

No Gut No Gain! Enteral Bile Acid Treatment Preserves Gut Growth but Not Parenteral Nutrition-Associated Liver Injury in a Novel Extensive Short Bowel Animal Model

BACKGROUND

Parenteral nutrition (PN) provides nutrition intravenously; however, this life-saving therapy is associated with significant liver disease. Recent evidence indicates improvement in PN-associated injury in animals with intact gut treated with enteral bile acid (BA), chenodeoxycholic acid (CDCA), and a gut farnesoid X receptor (FXR) agonist, which drives the gut-liver cross talk (GLCT). We hypothesized that similar improvement could be translated in animals with short bowel syndrome (SBS).

METHODS

Using piglets, we developed a novel 90% gut-resected SBS model. Fifteen SBS piglets receiving PN were given CDCA or control (vehicle control) for 2 weeks. Tissue and serum were analyzed posteuthanasia.

RESULTS

CDCA increased gut FXR (quantitative polymerase chain reaction; P = .008), but not downstream FXR targets. No difference in gut fibroblast growth factor 19 (FGF19; P = .28) or hepatic FXR (P = .75), FGF19 (P = .86), FGFR4 (P = .53), or Cholesterol 7 α-hydroxylase (P = .61) was noted. PN resulted in cholestasis; however, no improvement was noted with CDCA. Hepatic fibrosis or immunostaining for Ki67, CD3, or Cytokeratin 7 was not different with CDCA. PN resulted in gut atrophy. CDCA preserved (P = .04 vs control) gut mass and villous/crypt ratio. The median (interquartile range) for gut mass for control was 0.28 (0.17-0.34) and for CDCA was 0.33 (0.26-0.46).

CONCLUSIONS

We note that, unlike in animals with intact gut, in an SBS animal model there is inadequate CDCA-induced activation of gut-derived signaling to cause liver improvement. Thus, it appears that activation of GLCT is critically dependent on the presence of adequate gut. This is clinically relevant because it suggests that BA therapy may not be as effective for patients with SBS.

Evaluating the Role of Immunological Cells (Tissue Eosinophils and Mast Cells) in Progression of Oral Squamous Cell Carcinoma

Mast cells and eosinophils are increased in oral squamous cell carcinoma. The significance of such an association has been variably thought to be either a potential diagnostic tool for stromal invasion or as a prognostic indicator. The aim of the study was to study the mast cells and eosinophils between normal oral mucosa, leukoplakia and oral squamous cell carcinoma and to study the significance of mast cells in the progression of the lesion. A retrospective study was done on archival tissue received from January 2015 to December 2015, in the Department of Oral Pathology, RUHS College of Dental Sciences, Jaipur, Rajasthan, India. Seventy (70) cases were studied (30 cases each of leukoplakia and carcinoma and 10 cases of control group), sections were stained with toluidine blue solution to reveal mast cells. Eosinophils were studied in Haematoxylin & Eosin stained sections. Mast cell density significantly increased from: normal mucosa to oral leukoplakia to carcinoma, suggesting a role of the mast cells in the development of these lesions. The higher eosinophil counts in carcinoma group compared to dysplasia group proved that they might have a role in stromal invasion. The assessment of these could become, in the future, useful for therapeutic approaches in this subset of the patient.