Fetal heart rate responses in chronic hypoxaemia with superimposed repeated hypoxaemia consistent with early labour: a controlled study in fetal sheep

OBJECTIVE

Deceleration area (DA) and capacity (DC) of the fetal heart rate can help predict risk of intrapartum fetal compromise. However, their predictive value in higher risk pregnancies is unclear. We investigated whether they can predict the onset of hypotension during brief hypoxaemia repeated at a rate consistent with early labour in fetal sheep with pre-existing hypoxaemia.

DESIGN

Prospective, controlled study.

SETTING

Laboratory.

SAMPLE

Chronically instrumented, unanaesthetised near-term fetal sheep.

METHODS

One-minute complete umbilical cord occlusions (UCOs) were performed every 5 minutes in fetal sheep with baseline p_a O₂ <17 mmHg (hypoxaemic, n = 8) and >17 mmHg (normoxic, n = 11) for 4 hours or until arterial pressure fell <20 mmHg.

MAIN OUTCOME MEASURES

DA, DC and arterial pressure.

RESULTS

Normoxic fetuses showed effective cardiovascular adaptation without hypotension and mild acidaemia (lowest arterial pressure 40.7 ± 2.8 mmHg, pH 7.35 ± 0.03). Hypoxaemic fetuses developed hypotension (lowest arterial pressure 20.8 ± 1.9 mmHg, P < 0.001) and acidaemia (final pH 7.07 ± 0.05). In hypoxaemic fetuses, decelerations showed faster falls in FHR over the first 40 seconds of UCOs but the final deceleration depth was not different to normoxic fetuses. DC was modestly higher in hypoxaemic fetuses during the penultimate (P = 0.04) and final (P = 0.012) 20 minutes of UCOs. DA was not different between groups.

CONCLUSION

Chronically hypoxaemic fetuses had early onset of cardiovascular compromise during labour-like brief repeated UCOs. DA was unable to identify developing hypotension in this setting, while DC only showed modest differences between groups. These findings highlight that DA and DC thresholds need to be adjusted for antenatal risk factors, potentially limiting their clinical utility.

The flavonoid fustin exerts anti-inflammatory effect in a model of carrageenan-induced paw oedema

Carrageenan-induced paw oedema is a widely used model of acute inflammation. The objective of this study was to assess the effect of the flavonoid fustin on carrageenan-induced acute paw inflammation in rats. Thirty male Wistar rats were distributed equally between three groups – control, F10, and F20. In the course of 1 week, animals were treated once daily by intragastric gavage as follows: control group – with distilled water (10 mL kg−1) containing 50 μL Tween 80; groups F10 and F20 – with 10 mL kg−1 suspensions containing fustin in two doses (10 mg kg−1 and 20 mg kg−1, respectively) and 50 μL Tween 80. After the treatment period, carrageenan was injected in the left hind paw and paw oedema was evaluated 0, 30, 60, 120, 180, 240, and 300 min after the injection using a plethysmometer. In the control group, paw oedema increased gradually and peaked at the 180th minute. Fustin treatment reduced the oedema in all time intervals and the effect was significant on the 30th and 60th minute after the injection. The present study indicated that fustin could suppress acute inflammation.

Circulating miRNA-16 in inflammatory bowel disease and some clinical correlations - a cohort study in Bulgarian patients

OBJECTIVE

The pathogenesis of the inflammatory bowel disease (IBD) includes chronic inflammation and altered immune reactions. There are several publications, reporting that micro ribonucleic acids (miRNAs) may serve as a diagnostic biomarker with a potential to assess inflammation severity and treatment response1,2 in IBD patients. The objective of the study is to assess and correlate the serum expression of circulating miR-16 in IBD patients with some clinical parameters, such as extent, activity and severity of the disease.

PATIENTS AND METHODS

70 IBD patients [35 with ulcerative colitis (UC) and 35 with Crohn's disease (CD)] were included in the study. Serum miR-16 expression in both IBD diseases was assessed using reverse transcription quantitative real time PCR (RT-qPCR). Circulating miR-16 levels were also correlated with disease extent, activity and severity indices [Crohn's Disease Activity Index (CDAI), Montreal classification, Partial Mayo score]. Serum expression of miR-16 in the 70 patients was also compared to miR-16 serum levels in 30 healthy control subjects.

RESULTS

The patients' group showed mean serum miR-16 expression of 3.07 for CD, 1.97 for UC and 1.61 for the control group of healthy subjects with a significant difference in the expression between groups. There is a significant correlation between increased serum expression of miR-16 and disease activity, extent and severity.

CONCLUSIONS

The increased miR-16 serum expression correlates with disease activity, intestinal localization of CD, stenotic and penetrating phenotype. MiR-16 could serve as a potential biomarker to assess inflammation.

Rates of latent and active tuberculosis in BGC vaccinated, immunosuppressed Crohn's disease patients form Bulgaria before and during anti-tumor necrosis factor therapy

OBJECTIVE

Although the use of anti-tumor necrosis factor-alpha (anti-TNF-α) agents is highly effective in achieving and maintaining remission in patients with moderate-to-severe IBD, they place the patient at increased risk of developing opportunistic infections, including new cases of tuberculosis infection (TBI) and/or reactivation of latent tuberculosis infection (LTBI). Our study aims to determine the incidence of TBI [active tuberculosis (ATBI) and LTBI] among patients with Crohn's disease (CD) receiving anti-TNF-α therapy.

PATIENTS AND METHODS

We performed a retrospective analysis of consecutive CD patients undergoing anti-TNF-α (infliximab, adalimumab) treatment for a minimum of 6 months, in the period between June 2010 and December 2019, followed-up at a reference IBD center. All patients were HIV negative, and BCG vaccinated. In all patients, ATBI was excluded and all were tested for LTBI prior to initiating a biological treatment.

RESULTS

Before starting the biological treatment, we established LTBI in 11/109 (10.1%): 8/11 (72.7%) patients were TST positive, 2/11 (18.2%) were IGRA positive and TST negative, 1/11 (9.1%) were both IGRA and TST positive. In patients undergoing biological therapy with previous negative screening test for tuberculosis, a total of 16/74 (21.6%) patients were newly diagnosed with LTBI. The median induration (not erythema) diameter of TST is 8 (IQR 5-17) mm. Active pulmonary tuberculosis infection, developed in 3/74 (4.1%) patients. One patient developed ATBI on the background of chemoprophylaxis with INH for LTBI.

CONCLUSIONS

Specialists should thoroughly analyse all patient clinical data, chest X-ray results, epidemiological and BCG status, as well as perform a LTBI screening before initiating immunosuppressive and/or biological treatment. IBD patients have a higher risk of developing TBI in the first 12 months.

Cytotoxicity of the Fusarium mycotoxin deoxynivalenol on mammalian and avian cell lines

Trichothecenes are mycotoxins that occur in grains and can lead to acute and chronic poisoning in animals and humans. Deoxynivalenol (DON) is a type B trichothecene affecting protein synthesis, immune system, leading to brain, blood and kidney disorders. The aim of this work was to evaluate in vitro the cytotoxicity and the pathological effects of DON in short-term experiments on cells from non-tumour and tumour permanent cell lines and to compare their sensitivity. Cell cultivation of BALB/c 3T3, DEC 99, MDA-MB-231, MCF-7 and Hela cells was performed. Quantitative and qualitative methods evaluating cytotoxicity on the base of statistical and morphological analyses for determining the impact on the viability and proliferative activity were used: Neutral Red Uptake (NRU) cytotoxicity test, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) test and fluorescence microscopy. The cytotoxic effect of DON was assessed after an exposure period of 24 h. DON treatment induced significant alterations in the growth and morphology of the cells, involving early and late apoptosis and necrosis signs. Statistically significant decrease of the viability of all cell lines was established at concentrations of DON starting from 1.9 µg/mL to 3.7 µg/mL, the mean IC50 concentrations were calculated. According to the IC50 values the hierarchical order of cell lines’ sensitivity was determined.

Deceleration area and capacity during labour-like umbilical cord occlusions identify evolving hypotension: a controlled study in fetal sheep

OBJECTIVE

Cardiotocography is widely used to assess fetal well-being during labour. The positive predictive value of current clinical algorithms to identify hypoxia-ischaemia is poor. In experimental studies, fetal hypotension is the strongest predictor of hypoxic-ischaemic injury. Cohort studies suggest that deceleration area and deceleration capacity of the fetal heart rate trace correlate with fetal acidaemia, but it is not known whether they are indices of fetal arterial hypotension.

DESIGN

Prospective, controlled study.

SETTING

Laboratory.

SAMPLE

Near-term fetal sheep.

METHODS

One minute of complete umbilical cord occlusions (UCOs) every 5 minutes (1:5 min, n = 6) or every 2.5 minutes (1:2.5 min, n = 12) for 4 hours or until fetal mean arterial blood pressure fell <20 mmHg.

MAIN OUTCOME MEASURES

Deceleration area and capacity during the UCO series were related to evolving hypotension.

RESULTS

The 1:5 min group developed only mild metabolic acidaemia, without hypotension. By contrast, 10/12 fetuses in the 1:2.5-min group progressively developed severe metabolic acidaemia and hypotension, reaching 16.8 ± 0.9 mmHg after 71.2 ± 6.7 UCOs. Deceleration area and capacity remained unchanged throughout the UCO series in the 1:5-min group, but progressively increased in the 1:2.5-min group. The severity of hypotension was closely correlated with both deceleration area (P < 0.001, R²  = 0.66, n = 18) and capacity (P < 0.001, R²  = 0.67, n = 18). Deceleration area and capacity predicted development of hypotension at a median of 103 and 123 minutes before the final occlusion, respectively.

CONCLUSIONS

Both deceleration area and capacity were strongly associated with developing fetal hypotension, supporting their potential to improve identification of fetuses at risk of hypotension leading to hypoxic-ischaemic injury during labour.

TWEETABLE ABSTRACT

Deceleration area and capacity of fetal heart rate identify developing hypotension during labour-like hypoxia.

EXPLORATION OF THE IMPACT OF THE EXTRACTION PARAMETERS ON BIOLOGICAL ACTIVE SUBSTANCES IN THE EXTRACTS FROM DRIED FRUIT BLACK BLUEBERRY (VACCINIUM MYRTILLUS L.)

The optimal parameters of the extraction process for the extraction of biologically active substances from the dried fruits of black blueberry have been established and experimentally confirmed. The phenolic complex of the extracts obtained at different parameters of the extraction process was investigated - selection of the extractant; extraction temperature; extraction time and hydromodule. Studied are the extracts obtained at the optimals extraction parameters for total phenols 7,34 g gallic acid / 100 g dry substance, phenolcarboxylic acids 0,61%, flavonoid phenolic compounds 194 mg%, sum anthocyanins 115 mg% and tannins 8,76 g catechin / 100g dry substance. On the basis of the experimental data, the technological regimes of the extraction process were selected. The use of 70% C2H5OH as an extractant is technologically warranted to produce extracts of dried fruits black blueberry with maximum content of phenols, flavonoids, anthocyanins and tannins. Technologically justified extraction temperature is 65-80оС. By increasing the extraction temperature to 80°C, the quantity of anthocyanins in the extracts increases, which positively affects the organoleptic evaluation of the final products. The optimum extraction time is 3-4 hours. During this extraction period, a maximum content of the phenolic complex is obtained. The results obtained suggest that the most advantageous hydromodul for extraction is 1:30

Resistance of native honey bees from Rhodope Mountains and lowland regions of Bulgaria to Nosema ceranae and viral pathogens

The Western honey bee (Apis mellifera L., Hymenoptera: Apidae) is a species of fundamental economic, agricultural and environmental importance. The aim of this study was to compare the prevalence of some parasitic and viral pathogens in local honey bees from the Rodope Mountains and plain regions. To achieve this goal, molecular screening for two of the most distributed Nosema spp. and molecular identification of six honey bee viruses – Deformed wing virus (DWV), Acute bee paralysis virus (ABPV), Chronic bee paralysis virus (CBPV), Sacbrood virus (SBV), Kashmir bee virus (KBV), and Black queen cell virus (BQCV) was performed. Molecular analysis was carried out on 168 honey bee samples from apiaries situated in three different parts of the country where a mix of different honey bee subspecies were reared. In South Bulgaria (the Rhodope Mountains), a local honey bee called Apis mellifera rodopica (a local ecotype of A. m. macedonica) was bred, while in the other two regions (plains) different introduced subspecies existed. The results showed that the samples from the lowland regions in the country were outlined with the highest prevalence (70.5%) of N. ceranae, while those from the mountainous parts had the lowest rate (5.2%). Four of the honey bee viruses were identified – DWV (10/5.9%), followed by SBV (6/3.6%) and ABPV (2/1.2%), and one case of BQCV. In conclusion, the local honey bee A. m. rodopica (despite the higher number of samples) has shown lower prevalence of both nosemosis and viral infections. Therefore, this honey bee has to be preserved as a part of the national biodiversity.

ERYTHROCYTE OXIDATIVE STATUS AFTER MAXIMAL AEROBIC TEST IN WRESTLERS

Aim. The aim of this study was to determine the changes in the erythrocyte oxidative status of the wrestlers after performing the maximal aerobic test, by registering in erythrocytes the levels of lipid peroxidation (LPO), total glutathione (tGSH) and activities of catalase (CAT), superoxide dismutase (SOD), and glutathione peroxidase (GPx). Materials and methods. A group of 12 healthy wrestlers conducted a treadmill maximal aerobic test, and venous blood samples were obtained before and immediately after the exercise. Erythrocytes were separated from plasma and used for spectrophotometric determination of LPO, tGSH and enzyme activities. Plasma was used for determination of hemoglobin concentration (Hb) as an index of hemolysis. Results. The performance of the maximal aerobic test resulted in a significant increase of Hb in blood plasma, a decrease of LPO, and no changes of the tGSH level in erythrocytes. In regards to antioxidant enzymes, our results showed an increase in the activity of GPx, while the CAT and SOD activity remain unchanged. Conclusions. It can be concluded that in active athletes, predominate erythrocytes that are more resistant to oxidative stress, because of the accelerated hemolysis induced by physical exercise, lead to the elimination of the old and oxidative modified cells.

Phase-rectified signal averaging for intrapartum electronic fetal heart rate monitoring is related to acidaemia at birth

OBJECTIVE

Recent studies suggest that phase-rectified signal averaging (PRSA), measured in antepartum fetal heart rate (FHR) traces, may sensitively indicate fetal status; however, its value has not been assessed during labour. We determined whether PRSA relates to acidaemia in labour, and compare its performance to short-term variation (STV), a related computerised FHR feature.

DESIGN

Historical cohort.

SETTING

Large UK teaching hospital.

POPULATION

All 7568 Oxford deliveries that met the study criteria from April 1993 to February 2008.

METHODS

We analysed the last 30 minutes of the FHR and associated outcomes of infants. We used computerised analysis to calculate PRSA decelerative capacity (DC(PRSA)), and its ability to predict umbilical arterial blood pH ≤ 7.05 using receiver operator characteristic (ROC) curves and event rate estimates (EveREst). We compared DC(PRSA) with STV calculated on the same traces.

MAIN OUTCOME MEASURE

Umbilical arterial blood pH ≤ 7.05.

RESULTS

We found that PRSA could be measured in all cases. DC(PRSA) predicted acidaemia significantly better than STV: the area under the ROC curve was 0.665 (95% CI 0.632-0.699) for DC(PRSA), and 0.606 (0.573-0.639) for STV (P = 0.007). EveREst plots showed that in the worst fifth centile of cases, the incidence of low pH was 17.75% for DC(PRSA) but 11.00% for STV (P < 0.001). DC(PRSA) was not highly correlated with STV.

CONCLUSIONS

DC(PRSA) of the FHR can be measured in labour, and appears to predict acidaemia more accurately than STV. Further prospective evaluation is warranted to assess whether this could be clinically useful. The weak correlation between DC(PRSA) and STV suggests that they could be combined in multivariate FHR analyses.

[Surgical hygroscopic bandages for amputations, secreting wounds and diabetes foot]

The authors adopt in clinical practice using of sterile hygroscopic wound dressings 'pampers type'. They use these dressings in 113 patients. The appropriate patients are these with limbs amputations, diabetic foot, suppurative and plenty secreting deep wounds, atonite and decubital wounds. The dressings are sterilised using paraformaldehyde sterilization which do not injure the synthetic materials. The hygroscopic dressings are non- allergic and are well tolerated by the patients. Using these dressings facilitate the medical team work and help to reduce the contamination of the hospital linen and the patients coverlet. They help for accelerating the wound healing process. They are also economic effective by reducing the amount of used dressing material.

Inference of imatinib (IM) effects on leukemic stem cell (SC) compartment via mathematical modeling of IRIS treatment response data

7056

Background: Continuous treatment of chronic phase CML (CML-CP) patients with imatinib (IM) induces durable responses in majority of patients with a decreasing rate of relapse (Hochhaus et al, Blood. 2007;110). We present a mechanistic mathematical model which uses 6-year follow up data from the International Randomized Study of Interferon Versus STI571 (IRIS) trial (O'Brien et al, N Engl J Med. 2003;348:994) to explore IM effects on leukemic stem cells (SCs) across the patient population. Methods: The model approximates hemopoiesis as a 4-stage process in which only the first stage, corresponding to the SC compartment, is capable of self-renewal. Leukemic SCs, early and late progenitors were assumed to have higher self-renewal and expansion/differentiation rates than their normal counterparts. Model parameters describing the patient population distributions of leukemic/total SC ratio at diagnosis and sensitivity of leukemic cells to IM, were then fitted to individual cytogenetic and molecular response (CR/MR) data from 200 randomly selected newly-diagnosed CML-CP patients with 6-year follow-up. Results: Based on our analysis, successful characterization of the wide range of clinically observed treatment responses requires the inhibition of the leukemic SC compartment by IM. The median predicted inhibition of the leukemic SC proliferation rate was 79%. The model further predicted that after 6 years of IM treatment, 45% of patients would achieve a leukemic/total SC ratio below 0.1. Conclusions: We have developed a mathematical model of IM effects on CML-CP based on 6-year CR and MR data from the IRIS trial. In contrast to prior reports (Michor et al, Nature. 2005;435), our modeling predicts that IM reduces the leukemic SC compartment in most CML-CP patients, which could provide a mechanistic rationale for the decreasing rate of relapse observed in the study population.

[Table: see text]

Computational inference of gene expression signatures differentiating between breast cancers responsive or resistant to letrozole

Abstract #3024

Introduction:Genes which have been shown either to be differentially expressed or differentially changed between responders and non-responders to the neoadjuvant treatment with the aromatase inhibitor letrozole have been described. However, their network structure and interconnectivity have not been formally analysed.Bayesian network (BN) inference algorithms have demonstrated promise in the analysis of genomics data to recover fragments of biological pathways due to their ability to capture many types of relationships between variables and to handle noisy data.An inference score (4), normalized to be between -1 and 1, is a measure of the strength of the interaction (either positive or negative) between different nodes in the recovered network.&#x2028; Materials and methods:This computational study uses BN methodology to elucidate any possible network structure and refine a gene expression signature distinguishing responders from non-responders groups to letrozole treatment. It has been applied to 205 covariables (69 baseline expression, 45 day 14 expression and 91 changes in expression with treatment), identified via Random Forests as being differentially expressed between 37 tumours responding to neoadjuvant letrozole and 15 non-responders. The number of false positive relationships was limited by considering 4 different sub-sets of the original data 1) all 205 variables, but allowing for limited connectivity between them; 2) only the baseline variables 3) only the change variables with treatment and 4) only day 14 post-treatment variables. It was conjectured that the variables linking significantly to response status would appear in the overlap between lists 1) and 2), lists 1) and 3) and lists 1) and 4).&#x2028; Results:The analysis of the overall dataset highlighted the importance and the interconnectivity of ribosomal proteins. More specifically, the BN algorithm found two connected networks of 20 genes each with 13 and 14 ribosomal proteins and an average inference score of 0.65. In addition, BN links patient type (responder vs. non-responder) directly to genes that have been implicated in the natural history of breast cancer such as BCL-2 and KIAA0101 with inference scores of 0.4 and 0.45, respectively. The inferred network also contained a link with inference score of 0.4 between patient type and phosphatidylinositol glycan, whose oncogenic role has been suggested by others. The preliminary network analysis of the baseline covariables did not yield any meaningful pattern that differentiates the two patient types, except for the involvement of the cyclin E2 pathway with a “composite” inference score of 0.33.&#x2028; Conclusions: With initial encouraging results, further refinement of the BN analysis, as well as enrichment of the data should facilitate the discovery of a predictive baseline gene expression pattern.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 3024.

Potential antioxidant activity of celecoxib and amtolmetin guacyl: in vitro studies

1. In vitro studies of the potential antioxidant activity of the selective cyclo-oxygenase-2 inhibitor celecoxib and the non-steroid anti-inflammatory drug amtolmetin guacyl (AMG) were carried out. The study included experiments on the ability of these drugs to affect some indices of the oxidative stress [lipid peroxidation (LP), activity of antioxidant enzymes, glutathione (GSH) level] in rat stomach and colon mucosa and in liver. 2. Celecoxib and AMG did not change the activity of the enzymes GSH-peroxidase, oxidased glutathione (GSSG)-reductase and glucose-6-phosphate-dehydrogenase, as well as the GSH level in all tissue preparations. An increased superoxide dismutase (SOD) activity and a tendency to a decreased Fe/ascorbic acid-induced LP in stomach and colon mucosa were found, but only in the presence of AMG. 3. In the liver, both celecoxib and AMG decreased spontaneous and Fe/ascorbic acid-induced LP. SOD activity was enhanced only in the presence of AMG. 4. Experiments aimed at studying celecoxib and AMG in free oxygen radical-generating systems were also carried out. AMG and tolmetin (the main metabolite of AMG) inhibited OH*-provoked deoxyribose degradation in a Fenton system. Celecoxib had no effect on free radicals when tested in the same system. 5. In conclusion, the results of the present in vitro studies suggest that AMG and celecoxib possess antioxidant and metal-chelating abilities, which might contribute to their beneficial effects.