Effects of systemic oxytocin administration on ultraviolet B-induced nociceptive hypersensitivity and tactile hyposensitivity in mice

Ultraviolet B (UVB) radiation induces cutaneous inflammation, leading to thermal and mechanical hypersensitivity. Here, we examine the mechanical properties and profile of tactile and nociceptive peripheral afferents functionally disrupted by this injury and the role of oxytocin (OXT) as a modulator of this disruption. We recorded intracellularly from L4 afferents innervating the irradiated area (5.1 J/cm2) in 4-6 old week male mice (C57BL/6J) after administering OXT intraperitoneally, 6 mg/Kg. The distribution of recorded neurons was shifted by UVB radiation to a pattern observed after acute and chronic injuries and reduced mechanical thresholds of A and C- high threshold mechanoreceptors while reducing tactile sensitivity. UVB radiation did not change somatic membrane electrical properties or fiber conduction velocity. OXT systemic administration rapidly reversed these peripheral changes toward normal in both low and high-threshold mechanoreceptors and shifted recorded neuron distribution toward normal. OXT and V1aR receptors were present on the terminals of myelinated and unmyelinated afferents innervating the skin. We conclude that UVB radiation, similar to local tissue surgical injury, cancer metastasis, and peripheral nerve injury, alters the distribution of low and high threshold mechanoreceptors afferents and sensitizes nociceptors while desensitizing tactile units. Acute systemic OXT administration partially returns all of those effects to normal.

Lactated Ringers Use in the First 24 Hours of Hospitalization Is Associated With Improved Outcomes in 999 Patients With Acute Pancreatitis

INTRODUCTION

Recent pilot trials in acute pancreatitis (AP) found that lactated ringers (LR) usage may result in decreased risk of moderately severe/severe AP compared with normal saline, but their small sample sizes limit statistical power. We investigated whether LR usage is associated with improved outcomes in AP in an international multicenter prospective study.

METHODS

Patients directly admitted with the diagnosis of AP were prospectively enrolled at 22 international sites between 2015 and 2018. Demographics, fluid administration, and AP severity data were collected in a standardized prospective manner to examine the association between LR and AP severity outcomes. Mixed-effects logistic regression analysis was performed to determine the direction and magnitude of the relationship between the type of fluid administered during the first 24 hours and the development of moderately severe/severe AP.

RESULTS

Data from 999 patients were analyzed (mean age 51 years, female 52%, moderately severe/severe AP 24%). Usage of LR during the first 24 hours was associated with reduced odds of moderately severe/severe AP (adjusted odds ratio 0.52; P = 0.014) compared with normal saline after adjusting for region of enrollment, etiology, body mass index, and fluid volume and accounting for the variation across centers. Similar results were observed in sensitivity analyses eliminating the effects of admission organ failure, etiology, and excessive total fluid volume.

DISCUSSION

LR administration in the first 24 hours of hospitalization was associated with improved AP severity. A large-scale randomized clinical trial is needed to confirm these findings.

Managing RT Schedules of Early-Stage Breast Cancer Patients with a Genetic-Dosimetric Validated Model for Late Fibrosis

PURPOSE/OBJECTIVE(S)

Define a multifactorial risk prediction model for RT-induced fibrosis and investigate the benefit of a personalized approach for breast cancer (BC) patients (pts) treated with whole breast RT.

MATERIALS/METHODS

In a previous study, we confirmed the predictive role of 30 SNPs from the literature and built an interaction aware Polygenic Risk Score (PRS, following the methods from Franco RO 2021) for Late Fibrosis (FG2+) on a cohort of 1500 pts from the REQUITE EU/USA prospective observational study. The PRS weights the radiosensitive (RS) and radioresistant (RR) genetic components and can be included in NTCP models. In a subgroup from the same cohort (390 pts), we have also confirmed an NTCP model based on biologically Equivalent Uniform Dose (BEUD) from PTV DVHs for pts treated at 40-50 Gy and no RT boost. Here, we combine PRS and BEUD into a sigmoid model allowing PRS to modulate BEUD50 (BEUD leading to 50% FG2+), i.e., we permitted a personalized BEUD50. We can also consider this as translating the PRS into a personalized equivalent BEUD, which is added/subtracted to the treatment BEUD. We evaluated model performances through ROC-AUC, calibration plot and Precision-Recall AUC.

RESULTS

A total of 381 pts had complete dosimetric/genetic data, prescribed dose 40-50 Gy, and no fibrotic alteration at RT start. We scored FG2+ in 87 pts (23%). PRS ranged from -13 (more RR pts) to 7 (more RS), and a unit in PRS corresponds to 5.3 Gy BEUD or 3 Gy in EQ EUD2 Gy. Table 1 summarizes model performances, with details for subgroups below/above the quartiles I/III of the BEUD distribution. The PRS-only model correctly describes the toxicity rates in the whole population (calibration slope/offset = 0/1). Still, it overestimates/underestimates the absolute risks in the low/high dose ranges. The integrated model improves AUC-ROC and AUC-PRC by 5% and 10% and guarantees a better calibration in pts receiving low/high BEUD to the PTV.

CONCLUSION

We developed a multifactorial model for FG2+ based on two previously validated models and reported the improvement against single-factor models. The BEUD+PRS model is suitable for assisting clinicians in managing early-stage BC pts. The number of fractions or the daily dose could be reduced for RS pts. The integrated model resulted in a possible quantitative tool for driving the planning decision process. Also, it showed a better performance in the high BEUD region, suggesting the potential value of its extension toward RT including boost or ultra hypofractionation. We are testing this extension in the whole REQUITE cohort.

Inflammatory dysregulation in women with an eating disorder: Relationships with altered emotional reactivity

BACKGROUND

Some studies suggest that inflammatory signaling dysregulation may contribute to eating disorder (ED) pathophysiology. However, little is known about the influence of inflammatory response on altered processes seen among patients with ED, such as emotional processing and reactivity.

OBJECTIVES

The objectives were: (a) to investigate the systemic inflammatory response in ED women; and (b) to analyze the role of inflammatory markers in emotional reactivity.

METHOD

Concentrations of several intercellular and intracellular inflammatory mediators (cytokines, prostaglandin by-products and enzymes, TBARS, and MAPK proteins) were quantified in plasma and PBMCs from 68 women with an ED (m = 22.01 years, SD = 9.15) and 35 healthy controls (m = 18.54 years, SD = 4.21). Moreover, emotional reactivity to affective pictures (those without either food or thinness content) was studied using the adult (>18 years old) sample (n = 41).

RESULTS

Between-group differences were revealed for most markers (TNF-α, PGE₂ , COX2, and ratio of activated MAPK proteins), pointing to increased inflammatory response in patients (p < .01). Women with ED showed heightened emotional reactivity, regardless of picture valence. Principal components derived from inflammatory markers showed an explanatory loading on patient's emotional reaction, in terms of valence and arousal.

CONCLUSION

This study corroborates the altered systemic inflammatory response in patients with ED. The inflammatory dysregulation may contribute to ED phenotype, as seen by its relationship with heightened emotional reactivity, even though the inflammatory markers were not evaluated throughout the emotional reactivity protocol.

Seeding of breast cancer cell line (MDA-MB-231LUC+) to the mandible induces overexpression of substance P and CGRP throughout the trigeminal ganglion and widespread peripheral sensory neuropathy throughout all three of its divisions

Some types of cancer are commonly associated with intense pain even at the early stages of the disease. The mandible is particularly vulnerable to metastasis from breast cancer, and this process has been studied using a bioluminescent human breast cancer cell line (MDA-MB-231^LUC+). Using this cell line and anatomic and neurophysiologic methods in the trigeminal ganglion (TG), we examined the impact of cancer seeding in the mandible on behavioral evidence of hypersensitivity and on trigeminal sensory neurons. Growth of cancer cells seeded to the mandible after arterial injection of the breast cancer cell line in Foxn1 animals (allogeneic model) induced behavioral hypersensitivity to mechanical stimulation of the whisker pad and desensitization of tactile and sensitization of nociceptive mechanically sensitive afferents. These changes were not restricted to the site of metastasis but extended to sensory afferents in all three divisions of the TG, accompanied by widespread overexpression of substance P and CGRP in neurons through the ganglion. Subcutaneous injection of supernatant from the MDA-MB-231^LUC+ cell culture in normal animals mimicked some of the changes in mechanically responsive afferents observed with mandibular metastasis. We conclude that released products from these cancer cells in the mandible are critical for the development of cancer-induced pain and that the overall response of the system greatly surpasses these local effects, consistent with the widespread distribution of pain in patients. The mechanisms of neuronal plasticity likely occur in the TG itself and are not restricted to afferents exposed to the metastatic cancer microenvironment.

IRE1α-XBP1 signaling in leukocytes controls prostaglandin biosynthesis and pain

Inositol-requiring enzyme 1[α] (IRE1[α])-X-box binding protein spliced (XBP1) signaling maintains endoplasmic reticulum (ER) homeostasis while controlling immunometabolic processes. Yet, the physiological consequences of IRE1α-XBP1 activation in leukocytes remain unexplored. We found that induction of prostaglandin-endoperoxide synthase 2 (Ptgs2/Cox-2) and prostaglandin E synthase (Ptges/mPGES-1) was compromised in IRE1α-deficient myeloid cells undergoing ER stress or stimulated through pattern recognition receptors. Inducible biosynthesis of prostaglandins, including the pro-algesic mediator prostaglandin E2 (PGE₂), was decreased in myeloid cells that lack IRE1α or XBP1 but not other ER stress sensors. Functional XBP1 transactivated the human PTGS2 and PTGES genes to enable optimal PGE₂ production. Mice that lack IRE1α-XBP1 in leukocytes, or that were treated with IRE1α inhibitors, demonstrated reduced pain behaviors in PGE₂-dependent models of pain. Thus, IRE1α-XBP1 is a mediator of prostaglandin biosynthesis and a potential target to control pain.

Multi-walled carbon nanotubes functionalized with bathocuproinedisulfonic acid: analytical applications for the quantification of Cu(II)

This work reports the successful non-covalent functionalization of multi-walled carbon nanotubes (MWCNTs) with bathocuproinedisulfonic acid (BCS) and the analytical application of the resulting dispersion (MWCNTs-BCS) to develop an electrochemical sensor for Cu(II) quantification. The sensor was obtained by casting glassy carbon electrodes (GCEs) with MWCNTs-BCS. The sensing mechanism was based on the open circuit preconcentration of Cu(II) at the electrode surface by complexation of Cu(II) through the phenanthroline ring nitrogen of the BCS that supports the MWCNTs, the reduction of the preconcentrated Cu(II), and final differential pulse voltammetry-anodic stripping in 0.020 M acetate buffer, pH 5.00. The sensitivity of the sensor was (2.73 ± 0.08) μA μM^-1, with a linear range between 5.0 × 10^-7 M and 6.0 × 10^-6 M, a detection limit of 0.15 μM (9.5 μg L^-1), and reproducibility of 6.2% using the same dispersion and 7.1% using three different MWCNTs-BCS dispersions. The quantification of Cu(II) was highly selective even in the presence of As³⁺, Cr³⁺, Cd²⁺, Ni²⁺, Pb²⁺, Co²⁺, Zn²⁺, Fe²⁺, Hg²⁺, Rh, Ir, and Ru. The proposed sensor was successfully used for quantifying Cu(II) in tap water. Graphical abstract.

Spanish validation of the Eating Disorder Examination Questionnaire for Adolescents (EDE-Q-A): confirmatory factor analyses among a clinical sample

Most studies of eating disorders (ED) among adolescents have relied on the use of self-report questionnaires given its cost-effectiveness compared to interviews approaches. The Eating Disorders Examination Questionnaire (EDE-Q) is one of the most commonly used self-report measures of eating psychopathology, despite issues regarding the underlying latent structure and its validity in this population. Given the lack of validated measures among Hispanic clinical samples, the current study aimed to validate previously suggested models for the adolescent version (EDE-Q-A) among female teenage patients with ED in Spain (M_age = 15.45, SD = 1.59). Results failed to replicate the theoretical 4-factor structure, and a 2-factor model previously validated in a Hispanic-American community sample showed best fit over a 3-factor and a single-factor model. Excellent levels of internal consistency were observed for the two dimensions of the retained model and for the Global Score of the EDE-Q-A. Significant correlations with well-established measures of ED (Eating Disorders Inventory; EDI-2) and self-esteem are presented as evidence for convergent and concurrent validity. Sensitivity analyses showed a similar pattern of association between the retained model of the EDE-Q-A and the EDI-2. Current findings may contribute to development of evidence-based knowledge on ED among Hispanic clinical populations.

Abstract P1-09-02: Prevalence of genetic mutations in patients with second primary breast cancers

Background: Women newly diagnosed with primary breast cancer (PBC) often undergo multi-gene panel testing to determine their contralateral breast cancer (BC) risk and whether a contralateral prophylactic mastectomy is warranted. However, with the exception of BRCA1/2, gene-specific associations with contralateral or second PBC (SPBC) have not been established. Methods: The study sample was comprised of 83,278 women with BC referred to a single diagnostic laboratory for multi-gene panel testing. The frequency of pathogenic/likely pathogenic variants in clinically-actionable genes (CAG), including highly penetrant genes (HPG: BRCA1, BRCA2, TP53, PTEN) and moderately penetrant genes (MPG: ATM, CHEK2, PALB2, CDH1, NBN, NF1) was compared between women with a PBC and SPBC. Women with a SPBC &lt;1 year from their first diagnosis were excluded. Logistic regression burden tests were used to test for associations between mutated genes and SPBC adjusting for age at diagnosis of first BC, histology, presence of first- or second-degree relative with BC, and race/ethnicity. Results: The study included 75,550 women with PBC and 7,728 with SPBC. The median (IQR) time between primaries for the SPBC group was 11 (6,17) years . Women with SPBC were slightly more likely to be Caucasian (67.8% vs. 63.4%; p&lt;0.001), older when referred for genetic testing (mean difference 9.7 years, p&lt;0.001), slightly younger at first BC diagnosis (mean difference 2.1 years, p&lt;0.001) and slightly more likely to have &gt;1 first or second degree relative with BC (62.2% vs. 60.8%; p=0.004) than PBC. Among women tested for all CAGs, 4,883 (8.1%) were carriers of pathogenic/likely pathogenic variants (11.1% SPBC vs. 7.8% PBC). CHEK2 was the most frequently mutated gene (3.4% SPBC vs. 2.3% PBC), followed by BRCA1 (2.7% SPBC vs.1.6% PBC), BRCA2 (2.2% SPBC vs. 1.8% PBC), and PALB2 (1.4% SPBC vs. 0.9% PBC). In fully adjusted models, women with SPBC were 1.38 times as likely (p=&lt;0.0001) as women with PBC to test positive for a CAG (OR=1.35 for HPG and 1.34 for MPG). BRCA1 (OR=1.49; p&lt;0.0001), followed by CHEK2 (OR=1.36; p&lt;0.0001) and PALB2 (OR=1.53; p&lt;0.001) were most significantly associated with SPBC. TP53, BARD1, ATM and BRCA2 were marginally associated with SPBC (p=0.01 to 0.06). When results were stratified by race/ethnicity, ORs among Caucasians were similar to those observed overall. Among African Americans, women with SPBC were 1.76 times as likely to carry a CAG (p&lt;0.001) than their PBC counterparts. PALB2 (OR=2.69; p=0.002), BRCA2 (OR=1.85; p=.004), and TP53 (OR=3.88; p=.009) were most significantly associated with SPBC followed by BRCA1 (OR=1.63; p=.002). Analysis of gene associations for other racial/ethnic groups was limited by small sample size. Conclusions: There is a significantly higher prevalence of CAG mutations among women with SPBC, even after adjusting for age at diagnosis and family history. These findings support SPBC as a standalone indication for multigene panel testing. Additional studies aimed to assess cumulative risk of SPBC for CAG beyond BRCA1/2 are needed to help guide clinical management decisions for mutation carriers.

Citation Format: Yao K, Clifford J, Li S, LaDuca H, Hulick PJ, Xu J, Gutierrez S, Black MH. Prevalence of genetic mutations in patients with second primary breast cancers [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-09-02.

Tachykinins modulate nociceptive responsiveness and sensitization: In vivo electrical characterization of primary sensory neurons in tachykinin knockout (Tac1 KO) mice

Since the failure of specific substance P antagonists to induce analgesia, the role of tachykinins in the development of neuropathic pain states has been discounted. This conclusion was reached without studies on the role of tachykinins in normal patterns of primary afferents response and sensitization or the consequences of their absence on the modulation of primary mechanonociceptive afferents after injury. Nociceptive afferents from animals lacking tachykinins (Tac1 knockout) showed a disrupted pattern of activation to tonic suprathreshold mechanical stimulation. These nociceptors failed to encode the duration and magnitude of natural pronociceptive stimuli or to develop mechanical sensitization as consequence of this stimulation. Moreover, paw edema, hypersensitivity, and weight bearing were also reduced in Tac1 knockout mice 24 h after paw incision surgery. At this time, nociceptive afferents from these animals did not show the normal sensitization to mechanical stimulation or altered membrane electrical hyperexcitability as observed in wild-type animals. These changes occurred despite a similar increase in calcitonin gene-related peptide immunoreactivity in sensory neurons in Tac1 knockout and normal mice. Based on these observations, we conclude that tachykinins are critical modulators of primary nociceptive afferents, with a preeminent role in the electrical control of their excitability with sustained activation or injury.

Neuropeptide-induced modulation of carcinogenesis in a metastatic breast cancer cell line (MDA-MB-231LUC+)

Background

Metastatic cancer to bone is well-known to produce extreme pain. It has been suggested that the magnitude of this perceived pain is associated with disease progression and poor prognosis. These data suggest a potential cross-talk between cancer cells and nociceptors that contribute not only to pain, but also to cancer aggressiveness although the underlying mechanisms are yet to be stablished.

Methods

The in vitro dose dependent effect of neuropeptides (NPs) (substance P [SP], calcitonin gene-related peptide and neurokinin A [NKA]) and/or its combination, on the migration and invasion of MDA-MB-231^LUC+ were assessed by wound healing and collagen-based cell invasion assays, respectively. The effect of NPs on the expression of its receptors (SP [NK1] and neurokinin A receptors [NK2], CALCRL and RAMP1) and kininogen (high-molecular-weight kininogen) release to the cell culture supernatant of MDA-MB-231^LUC+, were measured using western-blot analysis and an ELISA assay, respectively. Statistical significance was tested using one-way ANOVA, repeated measures ANOVA, or the paired t-test. Post-hoc testing was performed with correction for multiple comparisons as appropriate.

Results

Our data show that NPs strongly modify the chemokinetic capabilities of a cellular line commonly used as a model of metastatic cancer to bone (MDA-MB-231^LUC+) and increased the expression of their receptors (NK1R, NK2R, RAMP1, and CALCRL) on these cells. Finally, we demonstrate that NPs also trigger the acute release of HMWK (Bradykinin precursor) by MDA-MB-231^LUC+, a molecule with both tumorigenic and pro-nociceptive activity.

Conclusions

Based on these observations we conclude that NPs exposure modulates this breast cancer cellular line aggressiveness by increasing its ability to migrate and invade new tissues. Furthermore, these results also support the pro nociceptive and cancer promoter role of the peripheral nervous system, during the initial stages of the disease.

Participation of membrane progesterone receptor α in the inhibitory effect of progesterone on prolactin secretion

The membrane progesterone receptors (mPRα, mPRβ, mPRγ, mPRδ and mPRε) are known to mediate rapid nongenomic progesterone functions in different cell types. However, the functions of these receptors in the pituitary have not been reported to date. In the present study, we show that the expression of mPRα was the highest among the mPRs in the rat anterior pituitary gland. Immunostaining of mPRα was detected in somatotrophs, gonadotrophs and lactotrophs. Interestingly, 63% of mPRα-positive cells within the pituitary were lactotrophs, suggesting that mPRα is involved in controlling prolactin (PRL) secretion in the pituitary. To test this hypothesis, rat pituitaries were incubated (1 hour) with either progesterone (P4) or the mPRα-specific agonist Org OD 02-0. PRL secretion was then measured by radioimmunoassay. The results of this experiment revealed that both P4 and Org OD 02-0 decreased PRL secretion. Moreover, the results from the GH3 cell line (CCL-82.1) showed that P4 and Org OD 02-0 inhibited PRL release, although the nuclear PR agonist R5020 was ineffective. Our investigation of the cellular mechanisms behind mPRα activity indicated that both P4 and Org OD 02-0 decreased cAMP accumulation, whereas R5020 was ineffective. In addition, the Org OD 02-0-effect on PRL release was blocked by pretreatment with pertussis toxin, an inhibitor of Go/Gi proteins. Because transforming growth factor (TGF)β1 is a potent inhibitor of PRL secretion in lactotrophs, we lastly evaluated whether TGFβ1 was activated by progesterone and whether this effect was mediated by mPRα. Our results showed that P4 and Org OD 02-0, but not R5020, increased active TGFβ1 levels. This effect was not observed when cells were transfected with mPRα-small interfering RNA. Taken together, these data provide new evidence suggesting that mPRα mediates the progesterone inhibitory effect on PRL secretion through both decreases in cAMP levels and activation of TGFβ1 in the lactotroph population.

Plasticity and Function of Spinal Oxytocin and Vasopressin Signaling during Recovery from Surgery with Nerve Injury

WHAT WE ALREADY KNOW ABOUT THIS TOPIC

WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Recovery from pain after surgery is faster after cesarean delivery than after other abdominal procedures. The authors hypothesized that recovery in rats after surgery could be reversed by antagonism of spinal oxytocin or vasopressin receptors, that there may be a sex difference, and that spinal oxytocin innervation could change after surgery.

METHODS

Male and female rats underwent partial spinal nerve ligation surgery. Effects of nonselective and selective oxytocin and vasopressin 1A receptor antagonists on mechanical hypersensitivity during partial recovery were assessed (n = 8 to 14/group). Oxytocin immunoreactivity in the dorsal horn of the spinal cord (n = 7 to 8/group) and messenger RNA (mRNA) expression for oxytocin-binding receptors in dorsal root ganglia and spinal cord (n = 8/group) were measured.

RESULTS

Intrathecal injection of oxytocin and vasopressin receptor antagonists were similarly effective at reducing withdrawal threshold (in all experiments from 22 [19, 26] median [first quartile, third quartile]) g to 8.3 [6.4, 12] g after injection) in both sexes, while having no or minimal effects in animals without surgery. Oxytocin fiber immunoreactivity was 3- to 5-fold greater in lumbar than other regions of the spinal cord and was increased more than 2-fold in lumbar cord ipsilateral to surgery. Injury was also associated with a 6.5-fold increase in oxytocin receptor and a 2-fold increase in vasopressin 1A receptor messenger RNA expression in the L4 dorsal root ganglion ipsilateral to surgery.

CONCLUSIONS

These findings suggest that the capacity for oxytocin signaling in the spinal cord increases after surgery and that spinal oxytocin signaling plays ongoing roles in both sexes in recovery from mechanical hypersensitivity after surgery with known nerve injury.

Randomized trial of omega-3 for autism spectrum disorders: Effect on cell membrane composition and behavior

A high ω6/ω3 ratio [fatty acid (FA) index] in the cell membrane has been associated with inadequate brain development. It has started to be used as a biomarker of treatment efficacy in human diseases. The aim of this study was to investigate if omega-3 supplementation improves erythrocyte membrane ω6/ω3, plasma antioxidant status (TAS) and autistic behaviors. A randomized, crossover, placebo-controlled study was designed to investigate the effect of 8 weeks of supplementation with ω3 (962mg/d and 1155mg/d for children and adolescents, respectively). Sixty-eight children and adolescents with Autism Spectrum Disorders (ASD) completed the full protocol. Primary outcome measures were erythrocyte membrane FA composition and TAS. Secondary outcome measures were Social Responsiveness Scale and Clinical Global Impression-Severity. Treatment with ω3 improved the erythrocyte membrane ω6/ω3 ratio (treatment effect p<0.008, d=0.66; within subjects effect p<0.007, d=0.5) without changing TAS. There was a within subjects significant improvement in Social Motivation and Social Communication subscales scores, with a moderate to large effect size (p=0.004, d=0.73 and p=0.025, d=0.79 respectively), but no treatment effect (treatment-placebo order). Carryover effects cannot be discarded as responsible for the results in behavioral measures. In conclusion, supplementation with ω3 FA might be studied as an add-on to behavioral therapies in ASD. Optimal duration of treatment requires further investigation. With regard to side effects, the effect of this supplementation on the lipid profile needs monitoring.

Umbilical cord and preeclampsia

INTRODUCTION

Preeclampsia is associated with abnormalities in the umbilical cord in several ways: morphological, biochemical and functional. Alteration in blood vessels of the placenta, decidua and circulatory system of the fetus might be related to factors that cause preeclampsia and may be associated with alterations of the umbilical cord.

OBJECTIVES

This study aimed to analyze the relationship between each type of umbilical cord abnormality and the different subtypes of hypertensive gestational disorders.

METHODS

We conducted a prospective study on consecutive autopsies and its placentas, looking for abnormalities in the umbilical cord's features and their clinical associations.

RESULTS

Umbilical cord abnormalities including length, diameter, insertion, entanglements, knots and coils were associated with maternal gestational hypertension.

CONCLUSION

In women with gestational hypertension, umbilical cord abnormalities are associated with fetal and neonatal consequences.

An international survey of screening and management of hypothyroidism during pregnancy in Latin America

Objective To determine how endocrinologists in Latin America deal with clinical case scenarios related to hypothyroidism and pregnancy. Materials and methods In January 2013, we sent an electronic questionnaire on current practice relating to management of hypothyroidism in pregnancy to 856 members of the Latin American Thyroid Society (LATS) who manage pregnant patients with thyroid disease. Subsequently, we have analyzed responses from physician members. Results Two hundred and ninety-three responders represent clinicians from 13 countries. All were directly involved in the management of maternal hypothyroidism and 90.7% were endocrinologists. The recommendation of a starting dose of L-thyoxine for a woman diagnosed with overt hypothyroidism in pregnancy, preconception management of euthyroid women with known thyroid autoimmunity and approach related to ovarian hyperstimulation in women with thyroid peroxidase antibodies were widely variable. For women with known hypothyroidism, 34.6% of responders would increase L-thyroxine dose by 30-50% as soon as pregnancy is confirmed. With regard to screening, 42.7% of responders perform universal evaluation and 70% recommend TSH < 2.5 mUI/L in the first trimester and TSH < 3 mUI/L in the second and third trimester as target results in known hypothyroid pregnant women. Conclusion Deficiencies in diagnosis and management of hypothyroidism during pregnancy were observed in our survey, highlighting the need for improvement of specialist education and quality of care offered to patients with thyroid disease during pregnancy in Latin America. Arq Bras Endocrinol Metab. 2014;58(9):906-11

Nerve injury induces a new profile of tactile and mechanical nociceptor input from undamaged peripheral afferents

Chronic pain after nerve injury is often accompanied by hypersensitivity to mechanical stimuli, yet whether this reflects altered input, altered processing, or both remains unclear. Spinal nerve ligation or transection results in hypersensitivity to mechanical stimuli in skin innervated by adjacent dorsal root ganglia, but no previous study has quantified the changes in receptive field properties of these neurons in vivo. To address this, we recorded intracellularly from L4 dorsal root ganglion neurons of anesthetized young adult rats, 1 wk after L5 partial spinal nerve ligation (pSNL) or sham surgery. One week after pSNL, hindpaw mechanical withdrawal threshold in awake, freely behaving animals was decreased in the L4 distribution on the nerve-injured side compared with sham controls. Electrophysiology revealed that high-threshold mechanoreceptive cells of A-fiber conduction velocity in L4 were sensitized, with a seven-fold reduction in mechanical threshold, a seven-fold increase in receptive field area, and doubling of maximum instantaneous frequency in response to peripheral stimuli, accompanied by reductions in after-hyperpolarization amplitude and duration. Only a reduction in mechanical threshold (minimum von Frey hair producing neuronal activity) was observed in C-fiber conduction velocity high-threshold mechanoreceptive cells. In contrast, low-threshold mechanoreceptive cells were desensitized, with a 13-fold increase in mechanical threshold, a 60% reduction in receptive field area, and a 40% reduction in instantaneous frequency to stimulation. No spontaneous activity was observed in L4 ganglia, and the likelihood of recording from neurons without a mechanical receptive field was increased after pSNL. These data suggest massively altered input from undamaged sensory afferents innervating areas of hypersensitivity after nerve injury, with reduced tactile and increased nociceptive afferent response. These findings differ importantly from previous preclinical studies, but are consistent with clinical findings in most patients with chronic neuropathic pain.

The puerperium alters spinal cord plasticity following peripheral nerve injury

Tissue and nerve damage can result in chronic pain. Yet, chronic pain after cesarean delivery is remarkably rare in women and hypersensitivity from peripheral nerve injury in rats resolves rapidly if the injury occurs in the puerperium. Little is known regarding the mechanisms of this protection except for a reliance on central nervous system oxytocin signaling. Here we show that the density of inhibitory noradrenergic fibers in the spinal cord is greater when nerve injury is performed in rats during the puerperium, whereas the expression of the excitatory regulators dynorphin A and neuregulin-1 in the spinal cord is reduced. The puerperium did not alter spinal cord microgial and astrocyte activation. Astrocyte activation, as measured by glial fibrillary acidic protein (GFAP) expression, was not evident in female rats with injury, regardless of delivery status suggesting sex differences in spinal astrocyte activation after injury. These results suggest a change in the descending inhibitory/facilitating balance on spinal nociception neurotransmission during the puerperium, as mechanisms for its protective effect against injury-induced hypersensitivity.

Skin incision-induced receptive field responses of mechanosensitive peripheral neurons are developmentally regulated in the rat

Maturation of the nervous system results in changes in both central and peripheral processing. To better understand responses to injury in the young, developmental differences in the acute response to incision were investigated in both tactile and nociceptive myelinated peripheral mechanosensitive afferent neurons in vivo. Neuronal intrasomal recordings were performed in juvenile and infant rats in 34 L5 dorsal root ganglia, and each neuron was phenotypically defined. Neurons had a mechanosensitive receptive field in the glabrous skin on the plantar surface of the hind paw, which was characterized at baseline and for up to 45 min after incision. Fundamental maturational differences in the effect of incision were clear: in high-threshold nociceptive mechanoreceptors, the mechanical threshold decreased immediately and the receptive field size increased rapidly in juvenile rats but not in infant rats. Additionally, a divergence in changes in the instantaneous response frequency of tactile afferents occurred between the two ages. These differences may help explain maturational differences in responses to peripheral injury and suggest that differences in central nervous system responses may be partially mitigated by spatially confined and frequency-dependent differences resulting from tactile and nociceptive mechanosensitive input.

Strategies to defeat ketamine-induced neonatal brain injury

Studies using animal models have shown that general anesthetics such as ketamine trigger widespread and robust apoptosis in the infant rodent brain. Recent clinical evidence suggests that the use of general anesthetics on young children (at ages equivalent to those used in rodent studies) can promote learning deficits as they mature. Thus, there is a growing need to develop strategies to prevent this injury. In this study, we describe a number of independent approaches to address therapeutic intervention. Postnatal day 7 (P7) rats were injected with vehicle (sterile PBS) or the NMDAR antagonist ketamine (20 mg/kg). After 8 h, we prepared brains for immunohistochemical detection of the pro-apoptotic enzyme activated caspase-3 (AC3). Focusing on the somatosensory cortex, AC3-positive cells were then counted in a non-biased stereological manner. We found AC3 levels were markedly increased in ketamine-treated animals. In one study, microarray analysis of the somatosensory cortex from ketamine-treated P7 pups revealed that expression of activity dependent neuroprotective protein (ADNP) was enhanced. Thus, we injected P7 animals with the ADNP peptide fragment NAPVSIPQ (NAP) 15 min before ketamine administration and found we could dose-dependently reverse the injury. In separate studies, pretreatment of P6 animals with 20 mg/kg vitamin D(3) or a nontoxic dose of ketamine (5 mg/kg) also prevented ketamine-induced apoptosis at P7. In contrast, pretreatment of P7 animals with aspirin (30 mg/kg) 15 min before ketamine administration actually increased AC3 counts in some regions. These data show that a number of unique approaches can be taken to address anesthesia-induced neurotoxicity in the infant brain, thus providing MDs with a variety of alternative strategies that enhance therapeutic flexibility.

Depletion of endogenous noradrenaline does not prevent spinal cord plasticity following peripheral nerve injury

The present study examined the role of endogenous noradrenaline on glial and neuronal plasticity in the spinal cord in rats after peripheral nerve injury. An intrathecal injection of dopamine-β-hydroxylase antibody conjugated to saporin (DβH-saporin) completely depleted noradrenergic axons in the spinal cord and also reduced noradrenergic neurons in the locus coeruleus (A6) and A5 noradrenergic nucleus in the brainstem and noradrenergic axons in the paraventricular nucleus of the hypothalamus. DβH-saporin treatment itself did not alter mechanical withdrawal threshold, but enhanced mechanical hypersensitivity and intrathecal clonidine analgesia after L5-L6 spinal nerve ligation. In the spinal dorsal horn of spinal nerve ligation rats, DβH-saporin treatment increased choline acetyltransferase immunoreactivity as well as immunoreactivity in microglia of ionized calcium binding adaptor molecule 1[IBA1] and in astrocytes of glial fibrillary acidic protein, and brain-derived nerve growth factor content. DβH-saporin treatment did not, however, alter the fractional release of acetylcholine from terminals by dexmedetomidine after nerve injury. These results suggest that endogenous tone of noradrenergic fibers is not necessary for the plasticity of α2-adrenoceptor analgesia and glial activation after nerve injury, but might play an inhibitory role on glial activation.

PERSPECTIVE

This study demonstrates that endogenous noradrenaline modulates plasticity of glia and cholinergic neurons in the spinal cord after peripheral nerve injury and hence influences the pathophysiology of spinal cord changes associated with neuropathic pain.

CHD6 chromatin remodeler is a negative modulator of influenza virus replication that relocates to inactive chromatin upon infection

The influenza virus establishes close functional and structural connections with the nucleus of the infected cell. Thus, viral ribonucleoproteins (RNPs) are closely bound to chromatin components and the main constituent of viral RNPs, the nucleoprotein (NP) protein, interacts with histone tails. Using a yeast two-hybrid screening, we previously found that the PA influenza virus polymerase subunit interacts with the CHD6 protein, a member of the CHD family of chromatin remodelers. Here we show that CHD6 also interacts with the viral polymerase complex and colocalizes with viral RNPs in the infected cells. To study the relationships between RNPs, chromatin and CHD6, we have analysed whether NP and CHD6 binds to peptides representing trimethylated lysines of histone 3 tails that mark transcriptionally active or inactive chromatin. Upon infection, NP binds to marks of repressed chromatin and, interestingly an important recruitment of CHD6 to these heterochromatin marks occurs in this situation. Silencing experiments indicate that CHD6 acts as a negative modulator of influenza virus replication. Hence, the CHD6 association with inactive chromatin could be part of a process where the influenza virus triggers modifications of chromatin-associated proteins that could contribute to the pathogenic events used by the virus to induce host cell shut-off.

Developmental differences in peripheral glabrous skin mechanosensory nerve receptive field and intracellular electrophysiologic properties: phenotypic characterization in infant and juvenile rats

Developmental differences in peripheral neuron characteristics and functionality exist. Direct measurement of active and passive electrophysiologic and receptive field characteristics of single mechanosensitive neurons in glabrous skin was performed and phenotypic characterization of fiber subtypes was applied to analyze developmental differences in peripheral mechanosensitive afferents. After Institutional approval, male Sprague-Dawley infant (P7: postnatal day 7) and juvenile (P28) rats were anesthetized and single cell intracellular electrophysiology was performed in the dorsal root ganglion (DRG) soma of mechanosensitive cells with receptive field (RF) in the glabrous skin of the hindpaw. Passive and active electrical properties of the cells and RF size and characteristics determined. Fiber subtype classification was performed and developmental differences in fiber subtype properties analyzed. RF size was smaller at P7 for both low and high threshold mechanoreceptor (LTMR and HTMR) with no differences between A- and C-HTMR (AHTMR and CHTMR). The RF size was also correlated to anatomic location on glabrous skin, toes having smaller RF. Conduction velocity (CV) was adequate at P28 for AHTMR and CHTMR classification, but not at P7. Only width of the action potential at half height (D50) was significantly different between HTMR at P7, while D50, CV and amplitude of the AP were significant for HTMR at P28. RF size is determined in part by the RF distribution of the peripheral neuron. Developmental differences in RF size occur with larger RF sizes occurring in younger animals. This is consistent with RF size differences determined by measuring RF in the spinal cord, except the peripheral RF is much smaller, more refined, and in some cases pinpoint. Developmental differences make CV alone unreliable for neuron classification. Utilizing integration of all measured parameters allows classification of neurons into subtypes even at the younger ages. This will prove important in understanding changes that occur in the peripheral sensory afferents in the face of ongoing development and injury early in life.

The relationship of preconception thyrotropin levels to requirements for increasing the levothyroxine dose during pregnancy in women with primary hypothyroidism

BACKGROUND

Most women with hypothyroidism require an increase in their dose of levothyroxine (LT4) after conception. To minimize fetal and maternal complications of maternal hypothyroidism, it is thought that women should be rapidly restored to the euthyroid state. The objectives of this study was to determine the percentage of hypothyroid women who would need to increase their dose of LT4 dose even if they had a preconception (pre-C) serum thyrotropin (TSH) of <2.5 mIU/L as recommended by the Endocrine Society's guidelines and to ascertain whether there was a relationship between the pre-C TSH value and the need to increase the LT4 dose during pregnancy.

METHODS

Fifty-three pregnant women with hypothyroidism on LT4 treatment in whom the pre-C serum TSH was <2.5 mIU/L, but which was within the normal range, within the 6 months before pregnancy were retrospectively studied. An additional selection criterion was that their LT4 dose at the time of their first prenatal visit was the same as that received pre-C.

RESULTS

Seventeen patients had to increase their LT4 dose during pregnancy, because their serum TSH was increased at the time of the first prenatal visit (Group 1); and 36 patients did not have to increase their dose of LT4 during pregnancy (Group 2). The pre-C TSH was significantly higher in Group 1 (1.55 ± 0.62 mIU/L) than in Group 2 (0.98 ± 0.67 mIU/L). When pre-C TSH range was 1.2-2.4 mIU/L, 50% of the patients required an increase in the LT4 dose during pregnancy. In contrast, when the pre-C TSH was <1.2 mIU/L, only 17.2% (p< 0.02) had to increase the LT4 dose during pregnancy.

CONCLUSIONS

We suggest that in women with hypothyroidism who are planning to become pregnant, serum TSH levels should be in the normal range but should not be greater than about 1.2 mIU/mL.

Is age-dependent, ketamine-induced apoptosis in the rat somatosensory cortex influenced by temperature?

General anesthetics have long been thought to be relatively safe but recent clinical studies have revealed that exposure of very young children (4 years or less) to agents that act by blocking the N-methyl-D-aspartate receptor (NMDAR) can lead to cognitive deficits as they mature. In rodent and non-human primate studies, blockade of this receptor during the perinatal period leads to a number of molecular, cellular and behavioral pathologies. Despite the overwhelming evidence from such studies, doubt remains as to their clinical relevance. A key issue is whether the primary injury (apoptotic cell death) is specific to receptor blockade or due to non-specific, patho-physiological changes. Principal to this argument is that loss of core body temperature following NMDAR blockade could explain why injury is observed hours later. We therefore examined the neurotoxicity of the general anesthetic ketamine in P7, P14 and P21 rats while monitoring core body temperature. We found that, at P7, ketamine induced the pro-apoptotic enzyme activated caspase-3 in a dose-dependent manner. As expected, injury was greatly diminished by P14 and absent by P21. However, contrary to expectations, we found that core body temperature was not a factor in determining injury. Our data imply that injury is directly related to receptor blockade and is unlikely to be overcome by artificially changing core body temperature.

The effect of low-cost modification of the home environment on the development of respiratory symptoms in the first year of life

BACKGROUND

Previous studies have suggested that environmental exposures may be related to the development of respiratory symptoms in early life. Intervention studies, however, have not produced consistent findings.

OBJECTIVE

The Peer Education in Pregnancy Study examined the effect of home environment intervention with pregnant women at risk for having children with asthma on the development of respiratory symptoms in their infants.

METHODS

A total of 383 pregnant women whose unborn child had a first-degree relative with an allergic history were randomized to 1 of 2 intervention groups, both of whom received general health education, smoking cessation advice, and encouragement to breastfeed. In addition, the intensive education group received 3 home visits focused on home environment modification. Home assessment was performed at baseline and after 1 year of follow-up. Respiratory symptoms were identified during the first year of life.

RESULTS

Families in both intervention groups showed significant changes in several environmental factors, with significant differences between the 2 groups in insects other than cockroaches, use of mattress covers, and washing in hot water. Children in the intensive education group had slightly lower incidence rates of respiratory symptoms, but few differences were statistically significant.

CONCLUSIONS

The results of this study do not provide strong support for a primary intervention focused on general modification of the home environment during pregnancy for high-risk children. It does not address the effects of more aggressive approaches or of interventions targeting individual environmental factors.

Prenatal exposure to acetaminophen and respiratory symptoms in the first year of life

BACKGROUND

Prevalence of asthma in developed countries increased between the 1970s and the 1990s. One factor that might contribute to the trends in asthma is the increased use of acetaminophen vs aspirin in children and pregnant women.

OBJECTIVE

To examine relationships between in utero exposure to acetaminophen and incidence of respiratory symptoms in the first year of life.

METHODS

A total of 345 women were recruited in the first trimester of pregnancy and followed up with their children through the first year of life. Use of acetaminophen in pregnancy was determined by questionnaire and related to incidence of respiratory symptoms.

RESULTS

Use of acetaminophen in middle to late but not early pregnancy was significantly related to wheezing (odd ratio, 1.8; 95% confidence interval, 1.1-3.0) and to wheezing that disturbed sleep (odds ratio, 2.1; 95% confidence interval, 1.1-3.8) in the first year of life after control for potential confounders.

CONCLUSION

This study suggests that use of acetaminophen in middle to late but not early pregnancy may be related to respiratory symptoms in the first year of life. Additional follow-up will examine relationships of maternal and early childhood use of acetaminophen with incidence of asthma at ages 3 to 5 years, when asthma diagnosis is more firmly established.

Resources for health: a primary-care-based diet and physical activity intervention targeting urban Latinos with multiple chronic conditions

OBJECTIVE

The Resources for Health trial evaluates a social-ecologically based lifestyle (physical activity and diet) intervention targeting low-income, largely Spanish-speaking patients with multiple chronic conditions.

DESIGN

A randomized controlled trial was conducted with 200 patients recruited from an urban community health center and assigned to intervention and usual care conditions. Intervention involved 2 face-to-face, self-management support and community linkage sessions with a health educator, 3 follow-up phone calls, and 3 tailored newsletters.

MAIN OUTCOME MEASURES

Primary outcomes measured at 6-months were changes in dietary behavior and physical activity. Changes in multilevel support for healthy living were evaluated as a secondary outcome.

RESULTS

After adjustment for age, sex, language, and number of chronic conditions, significant intervention effects were observed for dietary behavior and multilevel support for healthy lifestyles but not for physical activity.

CONCLUSION

The Resources for Health intervention provides an effective and practical model for improving health behavior among low-income, Spanish-speaking patients with multiple chronic conditions.

Recruitment and retention of Latinos in a primary care-based physical activity and diet trial: The Resources for Health study

Mandates to include women and minority populations in research have heightened the need to identify successful recruitment strategies. This paper describes the recruitment and retention strategies used as part of a randomized controlled trial (RCT) of a physical activity and dietary intervention targeting low-income, predominantly Latino patients in a primary health care clinic. Data on the recruitment and retention rates and the representativeness of participants are presented. Strategies included hiring bilingual staff, translating and culturally adapting intervention materials and soliciting ongoing consultation from patients, clinicians and organizations providing services to the Latino community. The primary recruitment procedure involved letters from physicians followed by phone calls from project staff to patients identified from electronic medical records. Two hundred patients were recruited into the RCT (78% of those reached and eligible), with 69 and 81% reached for the 6-week and 6-month follow-ups, respectively. Women were more likely to both participate and remain in the trial, and there was a trend toward greater recruitment and retention of Spanish speakers. By engaging the community, clinicians and patients, this study was able to successfully recruit and retain a large proportion of this often difficult to reach Latino sub-population of patients with multiple chronic conditions.