Experience with 177Lu-Dotatate in Patients with Metastatic Gastroenteropancreatic Neuroendocrine Tumors at a Single Urban Cancer Center

PURPOSE/OBJECTIVE(S)

177Lu-Dotatate is an FDA approved peptide receptor radiotherapeutic (PRRT) agent for metastatic well differentiated midgut neuroendocrine tumors (NETs). Questions remain regarding tolerability in diverse subpopulations with higher grade disease, more than one prior line of treatment, and in non-ileal primaries.

MATERIALS/METHODS

In this retrospective analysis, we review the outcomes of patients with histologically proven metastatic GEP-NETs who received 177Lu-Dotatate at a single racially diverse urban cancer center. Treated patients had disease that progressed on systemic therapy. Uptake at disease sites was demonstrated in all patients using 68-Gallium-Dotate PET/CT. ECOG performance score (PS) was 0 to 2. 177Lu-Dotatate was administered in 200 mCi doses every 8 weeks for a total of 4 cycles and a maximum of 800 mCi. Patients were followed with serial CT scan and/or abdominal MRI with best objective response assessed per RECIST criteria.

RESULTS

Fifty-one patients were treated between December 2017 and September 2021. 42 patients completed a minimum 3-month follow-up imaging. Median age was 66 years, 59% were female, 66% identified as white, 26% as Black, 8% as other or chose not to specify. Most frequent primary site was small intestine (69%). All had metastatic disease involving the liver except for one. Median time from diagnosis to 177Lu-Dotatate was 51 months. Time from first line therapy to first 177Lu-Dotatate was 3.65 years CTCAE grade 3/4 hematologic toxicity was seen in 6 of 51 patients (12%) of patients. Grade 3/4 thrombocytopenia occurred in 3 pts, grade 3/4 leukopenia occurred in 2 pts and grade 3 anemia occurred in 1 patient. One patient developed myelodysplastic syndrome 1 year after first 177Lu-Dotatate. Patients who identified as non-white did not experience significantly higher rate of toxicity. Of the 42 patients who reached 3-month follow-up 29% had a partial response, 45% had a mixed or stable response, and 36% had progressive disease. Only gender demonstrated significant difference; with male gender associated with worse response categories (p = 0.001). Median overall survival (OS) was 2.13 years. Metastatic disease in the liver only (p = 0.013), tumor grade > 1 (p = 0.027), and no history of surgery (p = 0.011) were associated with significantly worse OS. The median progression free survival (PFS) was 1.56 years. Patients of male gender (p = 0.037), with liver only metastases (p = 0.013), and with higher grade tumors (p = 0.024) had worse PFS. There was no difference in PFS by race, primary tumor site (pancreatic vs small bowel), performance status, or prior treatment history.

CONCLUSION

In this retrospective study, investigating a racially and socioeconomically diverse patients, we report similar toxicity to prior studies investigating 177Lu-Dotatate. Despite similar toxicity, median PFS and OS were inferior to reported outcomes in NETTER-1 which we suspect may be partly due to timing of treatment and differences in patient populations.

382 Compliance With Current Excision Margin Guidelines for Non-Melanoma Skin Cancer: Do We Make the Cut?

Aim

Non-melanoma skin cancers (NMSC) are the most common malignancies worldwide, with basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) constituting an ever-growing clinical burden within Plastic & Reconstructive Surgery. In this 3-cycle Quality Improvement (QI) initiative we sought to evaluate and improve our unit’s compliance with British Association of Dermatology (BAD) guidance on excision margins for NMSCs.

Method

Following results from two Plan-Do-Study-Act (PDSA) cycles, a third retrospective review of clinic letters, operative notes and histopathology reports was undertaken to identify NMSCs that were excised during May 2021 and assess compliance with recommended excision margins according to risk stratification.

Results

The dissemination of cycle 1 findings at departmental meetings, as well as the implementation of guideline posters and operative note templates conferred a significant improvement in both clinical documentation (12% to 100%) and local compliance with excision margin guidelines for BCCs (53% to 71%) and SCCs (50% to 79%). Following the adoption of new BAD guidelines on SSC margins in early 2021, a third cycle comprising 42 lesions demonstrated a sustained improvement in clinical documentation (100%) after a 7-month period and similar guideline compliance rates for both BCC (67%) and SCC (78%).

Conclusions

Adequate excision margins in cutaneous malignant pathology are vital to ensure complete removal, thus minimising the risk of recurrence. Although improvement across the PDSA cycles has been sustained despite the introduction of new SCC margin guidelines, we aim to introduce further interventions such as a knowledge and practice survey to continue improving excision margin compliance.

1576 Safeguarding Tools in Paediatric Burns

Introduction

When assessing paediatric patients presenting with burns, non-accidental injury always has to be considered. In our department, local policy dictates that all patients aged 18 or below should have a child safeguarding tool completed on initial clerking.

Method

A retrospective audit of all paediatric burns seen over one month was performed. Primary outcome measures included completion of a safeguarding tool and documentation of referral outcome. These results were presented locally and implementing changes were carried out. This was then re-audited over a further monthly period.

Results

Initial data collection showed a safeguarding tool completion rate of 69% and referral outcome documentation rate of 50% (n = 16). Implement changes included dissemination of initial audit results to the department, changing the layout of our clerking proformas and introducing posters in the unit which provided more information on risk assessing paediatric patients. The re-audit results showed a safeguarding tool completion rate of 100% and a referral outcome documentation rate of 100% (n = 14).

Conclusions

There was a significant improvement in both the safeguarding tool completion and referral outcome documentation rates following our interventions. Simple measures just such education and strategic adjustments of clerking proformas have been shown to be effective measures for increasing documental compliance of child safeguarding tools.

1343 Post-Operative Outcomes of Circular External Fixation in The Treatment of Tibial Plafond Fractures: A Systematic Review

Introduction

Tibial plafond fractures (TPF) are uncommon but potentially devastating injuries to the ankle. Meticulous care of the associated soft tissue injury is imperative in managing these fractures. The reported benefits of circular external fixation (CEF) include the ability to affect fracture reduction and create stable fixation, while limiting further soft tissue insult. This article provides the systematic review of the clinical and functional outcomes of TPF treated definitively with CEF.

Method

A literature search from inception to 13th November 2020 was performed. Quality and risk of bias was assessed using standardised scoring tools.

Results

16 studies were included. 303 patients were analysed. Mean follow-up was 35 months. The mean time in CEF was 18 weeks and mean time to union was 21 weeks. Non-union and malunion occurred in 3.2% and 12.4% respectively. The overall complication rate was 12.3%. The rate of deep infection was 4.8%. No amputations were reported. Minor soft tissue infection (including pin site infections) accounted for 56.7% of complications. Almost two-thirds achieved good-to-anatomic reduction radiologically. Mean range of motion assessments were 11.8 and 24.8 degrees in dorsiflexion and plantarflexion, respectively. Approximately one-third reported excellent functional outcome scores. Quality of the studies was deemed satisfactory. A moderate risk of bias was acknowledged.

Conclusions

This systematic review provides an evidence-based summary, which highlights CEF as an acceptable treatment option with comparable complication rate and outcome scores to that of internal fixation. However, we acknowledge that high quality evidence is still lacking.

1632 Improving Excision Margins in Skin Oncology

Aim

There are 152,000 new non-melanoma skin cancer (NMSC) cases in the UK every year, and excision and reconstruction of basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) form a significant part of the clinical workload in plastic surgery. In this quality improvement project, we aimed to identify and improve our unit’s compliance of guidelines for excision margins for NMSCs.

Method

A retrospective audit was undertaken in June 2020 to determine compliance with British Association of Dermatology and local guidelines on excision margins for NMSCs. A repeat audit was undertaken in October 2020 following quality improvement interventions.

Results

The first audit cycle examined 66 lesions in total. Guidelines were met in 53% (BCCs) and 50% (SCCs) of lesions. 12% of lesions had unclear documentation of margins. 16 lesions had margins that were too small as according to the risk factors present. These findings were presented to the department, and a new operative note template specifically designed for skin oncology was launched. Key audit findings were displayed along with the guidelines on posters. A repeat cycle was undertaken in October 2020, which examined 52 lesions. Significant improvement was seen with 100% documentation, and excision margin guideline compliance rate of 71% (BCCs) and 79% (SCCs).

Conclusions

Adequate excision margins in skin oncology is vital to ensure complete excision and to minimise the risk of recurrence. Our project demonstrates significant improvement in excision margin compliance through the launch of a specific operative note template and information posters.

Optimization of RBF-SVM hyperparameters using genetic algorithm for face recognit

Manual grid-search tuning of machine learning hyperparameters is very time-consuming. Hence, to curb this problem, we propose the use of a genetic algorithm (GA) for the selection of optimal radial-basis-function based support vector machine (RBF-SVM) hyperparameters; regularization parameter C and cost-factor γ. The resulting optimal parameters were used during the training of face recognition models. To train the models, we independently extracted features from the ORL face image dataset using local binary patterns (handcrafted) and deep learning architectures (pretrained variants of VGGNet). The resulting features were passed as input to either linear-SVM or optimized RBF-SVM. The results show that the models from optimized RBFSVM combined with deep learning or hand-crafted features yielded performances that surpass models obtained from Linear-SVM combined with the aforementioned features in most of the data splits. The study demonstrated that it is profitable to optimize the hyperparameters of an SVM to obtain the best classification performance. Keywords: Face Recognition, Feature Extraction, Local Binary Patterns, Transfer Learning, Genetic Algorithm and Support Vector  Machines.

Synthesis of eco-friendly silver nanoparticles using Allium sp. and their antimicrobial potential on selected vaginal bacteria

Allium cepa and garlic Allium sativa plants were used to evaluate their potential synthesis of silver nanoparticles and their antibacterial effect on Streptococcus pneumoniae and Pseudomonas aeruginosa. Transmission electron microscopy (SEM) was used to distinguish the morphology of the nanoparticles attained from plant extracts. Energy dispersive X-ray (EDX) spectrometer established the existence of elemental sign of the silver and homogenous allocation of silver nanoparticles. Diffraction by using X ray (XRD) analysis for the formed AgNPs revealed spherical plus cubical shapes structure with different planes ranged between 111 and 311 planes. The antibacterial action of AgNPs against vaginal pathogens, Streptococcus pneumoniae and Pseudomonas aeruginosa was recognized. Our work showed a rapid, eco-safety and suitable method for the synthesis of AgNPs from Allium cepa and garlic Allium sativa extracts and can be used in biomedical applications.

Identification of Tissue-Specific DNA Methylation Signatures for Thyroid Nodule Diagnostics

PURPOSE

Thyroid cancer is frequently difficult to diagnose due to an overlap of cytologic features between malignant and benign nodules. This overlap leads to unnecessary removal of the thyroid in patients without cancer. While providing some improvement over cytopathologic diagnostics, molecular methods frequently fail to provide a correct diagnosis for thyroid nodules. These approaches are based on the difference between cancer and adjacent thyroid tissue and assume that adjacent tissues are the same as benign nodules. However, in contrast to adjacent tissues, benign thyroid nodules can contain genetic alterations that can be found in cancer.Experimental Design: For the development of a new molecular diagnostic test for thyroid cancer, we evaluated DNA methylation in 109 thyroid tissues by using genome-wide single-base resolution DNA methylation analysis. The test was validated in a retrospective cohort containing 65 thyroid nodules.

RESULTS

By conducting reduced representation bisulfite sequencing in 109 thyroid specimens, we found significant differences between adjacent tissue, benign nodules, and cancer. These tissue-specific signatures are strongly linked to active enhancers and cancer-associated genes. Based on these signatures, we developed a new epigenetic approach for thyroid diagnostics. According to the validation cohort, our test has an estimated specificity of 97% [95% confidence interval (CI), 81-100], sensitivity of 100% (95% CI, 87-100), positive predictive value of 97% (95% CI, 83-100), and negative predictive value of 100% (95% CI, 86-100).

CONCLUSIONS

These data show that epigenetic testing can provide outstanding diagnostic accuracy for thyroid nodules.See related commentary by Mitmaker et al., p. 457.

User perception of endocervical sampling: A randomized comparison of endocervical evaluation with the curette vs cytobrush

Objectives

To evaluate whether the endocervical brush (ECB) is better accepted by patients and health care providers for endocervical evaluation when compared to the endocervical curette (ECC), without a decrease in the quality of sampling.

Methods

Two hundred patients with cervical dysplasia were randomized at the colposcopy clinic of the University Hospital of Geneva into two groups according to technique. Patients and physicians’ preference regarding the technique as well as the quality of samples were assessed. ECB samples were analyzed using both cytological (cell block) and histologic analysis, while ECC samples were analyzed using standard histologic analysis.

Results

Of the 200 patients, 89 were randomized to ECC, 101 to ECB and 10 were excluded due to incomplete information or cervical stenosis. Physicians preferred ECB against ECC, classifying it more frequently as an easy technique (94.1% vs.61.4%, p<0.001). Physicians more frequently evaluated the ECB as little or not uncomfortable for patients (28.7% vs.10.2%, p<0.001), though patients themselves didn’t express a preference for either technique. From a quality standpoint, the brush allowed for a better quality of samples, with a lower rate of inadequate samples (2.0% vs 14.3%, p = 0.002) and greater amount of material.

Conclusion

Endocervical sampling using ECB seems to be easier to perform and provides better quality samples. ECB can therefore be an acceptable alternative to ECC in standard practice.

Trial registration

ClinicalTrials.gov NCT01435590

Effects of first-line anti-retroviral therapy on blood coagulation parameters of HIV-infected patients attending a tertiary hospital at Abuja, Nigeria

BACKGROUND

Blood coagulation abnormalities are common in persons infected with the human immunodeficiency virus (HIV). However, few studies showed the association of these abnormalities with anti-retroviral therapy (ART).

OBJECTIVE

This cross-sectional study investigated the effects of ART on blood coagulation parameters of patients infected with HIV attending HIV special clinics of the University of Abuja Teaching Hospital (UATH), Gwagwalada, Abuja, Nigeria.

MATERIAL AND METHODS

A total of 191 patients comprising 128 HIV subjects on ART (test subjects) and 63 other HIV patients not on ART (control subjects) were included in the study. CD4+ lymphocyte counts, platelet counts, prothrombin time (PT) and partial thromboplastin time with kaolin (PTTK) of subjects were determined using flow cytometry, automated hematology analyser and Quick one-stage methods respectively.

RESULTS

Of the total test subjects, 21 (16.4%) were CD4 lymphopaenic, and the mean CD4+ cell count for the test subjects was statistically higher than that of the control subjects (578 versus 322 cells/ mm(3)) (p = 0.014). Eight (6.3%) of test subjects had prolong PTTK, and the mean values of PT and PTTK were statistically not significant between test subjects and control subjects (p = 0.358 and p= 0.141 respectively). Eight (6.3%) of test subjects had thrombocytopaenia, the mean platelet count was significantly lower than that of the control subjects (238 versus 278.6 x 10(9)/L, p = 0.001), and also varied significantly with the duration of ART (p = 0.0086).

CONCLUSION

Findings from this study revealed ART decreased platelet counts of HIV-infected individuals, but did not affect the PT and PTTK results.

Developing a digital data collection platform to measure the prevalence of sepsis in Wales

OBJECTIVE

To develop a secure, efficient, and easy-to-use data collection platform to measure the prevalence of sepsis in Wales over 24 hours.

MATERIALS AND METHODS

Open Data Kit was used on Android devices with Google App Engine and a digital data collection form.

RESULTS

A total of 184 students participated in the study using 59 devices across 16 hospitals, 1198 datasets were submitted, and 97% of participants found the Open Data Kit form easy to use.

DISCUSSION

We successfully demonstrated that by combining a reliable Android device, a free open-source data collection framework, a scalable cloud-based server, and a team of 184 medical students, we can deliver a low-cost, highly reliable platform that requires little training or maintenance, providing results immediately on completion of data collection.

CONCLUSION

Our platform allowed us to measure, for the first time, the prevalence of sepsis in Wales over 24 hours.

First Report of Bacterial Spot Caused by Xanthomonas campestris pv. vesicatoria on Sweet Pepper (Capsicum annuum L.) in Saudi Arabia

In the summer of 2009 and 2010, 18 sweet pepper fruit with blister-like, raised, rough lesions were collected from four greenhouses (total of 0.1 ha) in the Al-Kharj region of Saudi Arabia. All samples were collected from commercial crops of the sweet pepper cv. California Wonder. Disease incidence was ≤5%. Isolations were made from all diseased fruits. A small piece (3 mm²) of symptomatic tissue from pepper fruit was placed in a sterile mortar and macerated in sterile distilled water with a pestle. A loopful of bacterial suspension from each sample was streaked onto Tween B agar medium (3). Plates were incubated at 28°C for 48 h. Single yellow, circular, butyrous, shiny colonies were picked from the plates and transferred to nutrient agar plates containing 5% D+ glucose agar (NGA). Gram-negative, rod-shaped bacteria were consistently isolated from the fruit and 10 of the isolates were identified as Xanthomonas campestris pv. vesicatoria on the basis of morphological, physiological, and biochemical tests (1,2). The isolates were oxidase positive and levan negative, arginine-dihydrolase positive, and did not macerate potato discs. The isolates were also non-fluorescent, grew at 37 and 4°C but not at 40°C, did not liquefy gelatine or starch, but did produce H₂S. The identity of the 10 bacterial strains was confirmed by PCR assay using primers RST65 and RST69 (4). Four-week old pepper plants (cv. California Wonder) were inoculated by spraying five potted plants with each isolate using a bacterial suspension (10⁸ CFU/ml). Sterile distilled water was sprayed on an additional five plants as a negative control treatment. The bacterial isolates caused necrotic lesions, each with a yellow halo, on leaves of inoculated plants. Bacteria reisolated from the necrotic lesions using the technique previously described were identical to the original strains according to the morphological, cultural, and biochemical tests described above. Negative control plants inoculated with sterile distilled water did not show symptoms and no bacterial colonies were recovered from them. To our knowledge, this is the first report of bacterial spot on pepper fruits in Saudi Arabia. References: (2) R. F. Bradbury. Genus II Xanthomonas Dowson 1939. In: Bergey's Manual of Systematic Bacteriology, Vol. 1, Krieg, R., Holt, J. G. (Eds.), Williams & Wilkins Co., Baltimore, MD, 1987. (3) R. A. Lelliott and D. E. Stead. Methods for the Diagnosis of Bacterial Diseases of Plants. Blackwell Scientific Publications, Oxford, UK. (1) R. G. McGuire et al. Plant Dis 70:887, 1986. (4) A. Obradovic et al. Eur. J. Plant Pathol. 110:285, 2004.

IGF-Induced Gene Profiles Are Dependent on IRS Expression and Convey Prognostic Value in Human Breast Cancer

The insulin-like growth factor (IGF) pathway mediates aberrant function during the initiation and progression of primary tumors and secondary metastases in cancer. As a result, a host of tyrosine kinase inhibitors and monoclonal antibodies directed against the type 1 IGF receptor (IGF-1R) have entered clinical trials with early positive results. However, no predictive biomarkers have yet emerged from these initial studies. We propose that expanding IGF biomarkers beyond IGF-1R alone may identify the most appropriate candidates for anti-IGF therapy. Previous work has shown that the insulin receptor substrate (IRS) proteins serve as the functional link between IGF-I-induced IGF-1R phosphorylation and downstream signaling linked to cellular behavior. Our work has demonstrated that IRS isoforms differentially mediate IGF-I action, whereby IRS-1 drives proliferation and IRS-2 triggers motility. Here we employed the T47D-YA (IRS null) breast cancer cell line and T47D-YA/IRS clones stably transfected with IRS-1 or IRS-2. In response to acute (4h) and chronic (24h) IGF-I stimulation, global gene expression patterns were assessed by Affymetrix U133 Plus 2.0 microarray analysis. Analysis revealed that IGF-1R activation alone was insufficient to affect gene expression as no genes were regulated by IGF-I in T47D-YA cells. Conversely, ligand stimulation of IRS-1 and IRS-2 clones induced or repressed hundreds of transcripts in both overlapping and distinct fashions. Direct comparison of IRS-1 to IRS-2 clones revealed a number of early (4h) IRS-2 genes linked to metastasis and late (24h) IRS-1 proliferative genes. Interestingly, a 10-fold upregulation in the transforming growth factor beta 2 (TGFβ2) gene by IGF-I in IRS-2 cells suggested a link between the IRS-derived gene signatures and the TGFβ pathway known to regulate breast cancer metastasis. We then compared our arrays with published IGF-I (MCF-7) and TGFβ-derived (MCF10A, MDA-231, HaCaT, HPL1) microarrays to find a list of commonly regulated genes and performed cluster analysis to reveal consistent patterns of gene expression (Creighton el al 2008 & Padua et al 2008). We found 75 genes that were regulated in common between these signatures. To explore the clinical relevance of the signatures we developed, we examined the NKI-295 dataset used to establish the 70-gene profile of prognosis and found 71 genes regulated in common between all four datasets (van de Vijver et al 2002). Strikingly, we discovered that patient survival was heavily influenced by the degree to which tumor expression correlated to the conserved signatures. A high degree of correlation resulted in the poorest disease free survival and an inverse correlation resulted in an improved disease free survival. Our data suggest that IGF stimulation of breast cancer cells results in distinct profiles of gene expression that are dependent on IRS adaptor protein expression. In addition, some of the “IRS-regulated” genes are shared in common with other gene signatures of poor prognosis. With the use of anti-IGF therapies in breast cancer, attention should focus on the use of these profiles as prognostic and predictive biomarkers.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3031.

First Report of Bacterial Leaf Spot of Lettuce (Lactuca sativa) Caused by Xanthomonas campestris pv. vitians in Saudi Arabia

In April of 2008, lettuce (Lactuca sativa L. cv. Darkland) plants grown in the Al-Ouunia Region of Saudi Arabia were observed with numerous lesions typical of bacterial leaf spot. Leaf lesions were irregular, small, pale green to black, and 2 to 5 mm in diameter. Bacteria were isolated from diseased leaf tissues by cutting leaves into small pieces (0.5 mm) and soaking them in 2 ml of sterile distilled water. The resulting suspension was streaked onto yeast dextrose calcium carbonate agar (YDC) (1) and plates were incubated at 28°C. Large, round, butyrus, bright yellow colonies typical of Xanthomonas spp. formed after 48 h and five strains were selected for further tests. A yellow, mucoid bacterium was consistently isolated from lettuce samples with typical bacterial leaf spot symptoms. All five strains tested in this study were gram negative, oxidase negative, nitrate reduction negative, catalase and esculin hydrolysis positive, motile, and strictly aerobic. All were slightly pectolytic but not amylolytic. All were identified as Xanthomonas campestris pv. vitians. The bacterium was identified with specific oligonucleotide primers (2). This primer pair directed the amplification of an approximately 700-bp DNA fragment from total genomic DNA of all X. campestris pv. vitians strains tested. Pathogenicity tests were performed by using bacterial cultures grown on YDC for 48 h at 28°C. Each strain was suspended in sterile distilled water and the bacterial concentration was adjusted to 10⁶ CFU/ml. Leaves of 5-week-old lettuce plants (cv. Darkland) were sprayed with the bacterial suspension. The inoculated and sterile-water-sprayed control plants were covered with polyethylene bags for 48 h at 25°C, after which the bags were removed and plants were transferred to a greenhouse at 25 to 28°C (1). All strains were pathogenic on the lettuce cv. Darkland, causing typical bacterial leaf spot symptoms by 2 weeks after inoculation. All inoculated plants showed typical symptoms of bacterial leaf spot and symptoms similar to those observed on the samples collected. No symptoms developed on the control plants. The bacterium was reisolated from inoculated plants and identified as X. campestris pv. vitians by morphological, physiological, and biochemical tests as described above. To our knowledge, this is the first report of bacterial leaf spot of lettuce by X. campestris pv. vitians in Saudi Arabia. References: (1) F. Sahin and A. Miller. Plant Dis.81:1443, 1997. (2) J. D. Barak. Plant Dis.85:169, 2001.

Rosiglitazone reduces angiotensin II and advanced glycation end product-dependent sustained nuclear factor-kappaB activation in cultured human proximal tubular epithelial cells

Tubular damage is a major feature in the development of diabetic nephropathy. This study investigates the effects of the thiazolidindione rosiglitazone on angiotensin II and advanced glycation end product-induced tubular activation in human proximal tubular epithelial cells IN VITRO. Angiotensin II and advanced glycation end products, both induced a dose-dependent sustained activation of the redox-sensitive transcription factor, Nuclear Factor KAPPA B (NF-kappaB). Nuclear translocation of NF-kappaB was evident already after one hour and persistent for more than four days. Co-incubation of proximal tubular epithelial cells with rosiglitazone significantly reduced angiotensin II and advanced glycation end product-mediated generation of reactive oxygen species, angiotensin II-dependent advanced glycation end product formation, NF-kappaB activation, and NF-kappaB-dependent pro inflammatory gene expression. Most importantly, rosiglitazone effects on NFkappaB activation were maximal at later time points, indicating that rosiglitazone treatment confers long lasting renoprotective effects.

[Evaluation of the quality of screening and management of infant malnutrition in Cotonou, Benin]

The purpose of this study was to evaluate the quality of screening and management of infant-juvenile malnutrition in medical/social centres in Cotonou, Benin, the nation's capital and largest city. Study was carried out in 19 public and private medical/social centres selected on the basis of their nutritional activity. Data was collected using 5 methods, i.e., retrospective review of the each centre's records, evaluation of physical resources available at each centre, observation of care providers (n=90), questionnaire concerning nutritional activities for the person in charge of each centre (n=19), and questionnaire about care for the mothers of children consulting at the centres (n=43). The overall prevalence of malnourished children identified by screening at the medical/social centres was low (2.2 %) in comparison with the prevalence of malnutrition in Cotonou (20.3 %). Less than half of the centres (47.4 %) used growth charts. None of the centres had a "thinness chart". Many centres (28.6 %) used material intended for cooking demonstrations. Most centres (75 %) conducted effective Information Education and Communication (IEC) sessions and all authorized centres had required essential medications on hand. Observation of care providers showed that 35% could not perform basic anthropometric measurements. Use of growth charts was lowest among physicians and medical assistants. No doctor provided nutritional counselling. Based on responses to the questionnaire the general knowledge of care providers was good despite the lack of supervision and continuous education. Analysis of the responses of the mothers who brought their children to the centres indicated that malnutrition was never the initial reason for seeking medical attention and only 39 % understood that their child was malnourished upon leaving the centre. These findings indicate that the quality of screening and management of infant-juvenile malnutrition in Cotonou is poor. There is a need to develop a program to fight malnutrition which is a major health problem in the city. Special measures will be necessary for the urban setting.

First Report of Tomato (Lycopersicon esculentum) Pith Necrosis Caused by Pseudomonas fluorescens and P. corrugata in the Kingdom of Saudi Arabia

From 2002 to 2004, tomato (Lycopersicon esculentum) plants with external stem lesions, adventitious roots, and necrotic pith that was hollowed or chambered were received by the Clinical Lab of the Plant Protection Department from eight greenhouses in the Riyadh, Abha, and El-Kharj regions of Saudi Arabia. Bacteria were isolated on nutrient agar or King's medium B (KMB) from the stems of tomato plants cv. Red Gold, the cultivar most commonly grown in greenhouses. Gram-negative, rod-shaped bacteria were consistently isolated from stems with symptoms of pith necrosis. They were identified as Pseudomonas fluorescens (biotype I) and P. corrugata on the basis of morphological, physiological, and biochemical tests (2). Isolates of P. fluorescens isolated from Abha and El-Kharj were fluorescent on KMB, aerobic, and positive for oxidase, arginine dihydrolase, and gelatin liquefaction. Furthermore, all isolates produced levan-type colonies on sucrose nutrient agar and utilized glucose, 2-ketogluconate, sucrose, and sorbitol. They were negative for tobacco hypersensitivity and nitrate reduction. The strains of P. corrugata isolated from Riyadh were nonfluorescent, aerobic, and positive for oxidase, nitrate reductase, arginine dihydrolase, and utilization of malonate, alanine, trehalose, arginine, mannitol, and m-inositol. They were negative for levan, pectinase, tobacco hypersensitivity, and utilization of cellobiose and sorbitol. The identity of bacterial species was confirmed by Biolog analysis (carbon source utilization at 37°C), with a similarity index of 0.75 for P. corrugata and 0.71 for P. fluorescens. Four-week-old tomato plants (cv. Red Gold) were inoculated by injecting 50 μl of a bacterial suspension into the axils of the first true leaves. The bacterial suspension was prepared from 24-h-old cultures with sterile distilled water. Sterile distilled water was used as the negative control. After inoculation, plants were covered with polyethylene bags for 24 h to maintain high humidity at 25°C (1). Necrotic lesions surrounding injection points were observed 14 days after inoculation. At 4 weeks after inoculation, all inoculated plants showed symptoms of necrotic pith similar to those observed on the samples received. Control plants injected with water remained healthy throughout the experiments. Isolates of P. fluorescens (biotype I) and P. corrugata were reisolated from inoculated plants and were identical to the original strains on the basis of Biolog analysis. To our knowledge, this is the first report of tomato pith necrosis in Saudi Arabia. References: (1) G. Demir. J. Turk. Phytopathol. 19:63, 1990. (2) R. A. Lelliott and D. E. Stead. Methods for the Diagnosis of Bacterial Diseases of Plants. Blackwell Scientific Publications. Oxford, UK, 1987.

Hand washing and use of gloves while managing patients receiving mechanical ventilation in the ICU

STUDY OBJECTIVE

To evaluate the effectiveness of warning labels permanently attached to mechanical ventilators in improving the practice of hand washing and use of gloves by respiratory care practitioners (RCPs) in the ICU.

DESIGN

The study consisted of two 4-week periods. Daily observations of hand washing and use of gloves by RCPs were made over four 1-h observation periods. Prior to the first 4-week period, the importance of hand washing and use of gloves was presented to all staff. At the end of the first period, "Wash Hands Use Gloves" labels were permanently placed on all ventilators in the ICU. The RCPs were not aware they were being observed for hand washing and use of gloves in either period.

MEASUREMENTS AND RESULTS

The total number of encounters between the RCPs and patients as well as the rates of hand washing and use of gloves were obtained during the study. The rates of hand washing and use of gloves were significantly higher during the second period when labels were attached to the ventilators, as compared to the rates during the first period: hand washing, 92% vs 46% (p < 0.05); use of gloves, 92% vs 43% (p < 0.05), respectively. During the first period, the rates of pre-encounter hand washing (78%, 48%, 27%, and 29% in weeks 1 through 4, respectively) and the use of gloves (56%, 37%, 32%, and 45% in weeks 1 through 4, respectively) were primarily declining. This was not observed during the second period of the study (94%, 88%, 95%, and 92% in weeks 1 through 4, respectively) for the rates of pre-encounter hand washing and the use of gloves.

CONCLUSIONS

Simple measures such as the placement of warning labels on mechanical ventilators can significantly improve hand washing and use of gloves by RCPs in the ICU.

Use of the computer for interpretation of fetal heart tracings

OBJECTIVE

To compare the interpretations of antepartum fetal heart tracing by computer and by three experts.

METHOD

One hundred and forty-eight patients with high risk pregnancies were included. Their fetal heart tracing was interpreted by each of the three experts and the computer. The interpretation of whether it was reactive or nonreactive, by each of the experts with that of the computer controlling for the outcome, were cross-tabulated using the chi 2-test with a control variable. To define the abnormal outcome the odds ratio and 95% confidence interval were used.

RESULTS

The computer defined 14 tracings as nonreactive and the experts, respectively, 19, 18 and 17. The gestation age ranged from 34 to 42 weeks with a mean of 38.26 and standard deviation of 2.31. The common reasons for monitoring were diabetes (20.9%), hypertension (20.3%) and post-date (11.9%). Out of 148, 16 had an abnormal fetal outcome. There were no statistically significant differences between any of the experts and the computer in determining the normal outcome. However, to determine the abnormal outcome, there was a statistically significant difference between two of the experts and the computer with P < 0.025. It was found that the computer was superior to any of the experts in defining the abnormal outcome with an odds ratio of 55.9 and experts odds ratio and 95% computer interpretation were 1.6 (0.4-6.5), 1.0 (0.2-4.9) and 1.1 (0.2-5.3), respectively.

CONCLUSION

There was no difference between the experts and the computer in defining the normal outcome, but it appears that the computer was better in defining the abnormal outcome.