microRNA signatures associated with fetal growth restriction: a systematic review

Placental-origin microRNA (miRNA) profiles can be useful toward early diagnosis and management of fetal growth restriction (FGR) and associated complications. We conducted a systematic review to identify case-control studies that have examined miRNA signatures associated with human FGR. We systematically searched PubMed and ScienceDirect databases for relevant articles and manually searched reference lists of the relevant articles till May 18th, 2021. Of the 2133 studies identified, 21 were included. FGR-associated upregulation of miR-210 and miR-424 and downregulation of a placenta-specific miRNA cluster miRNA located on C19MC (miR-518b, miR-519d) and miR-221-3p was reported by >1 included studies. Analysis of the target genes of these miRNA as well as pathway analysis pointed to the involvement of angiogenesis and growth signaling pathways, such as the phosphatidylinositol 3-kinase- protein kinase B (PI3K-Akt) pathway. Only 3 out of the 21 included studies reported FGR-associated miRNAs in matched placental and maternal blood samples. We conclude that FGR-associated placental miRNAs could be utilized to inform clinical practice towards early diagnosis of FGR, provided enough evidence from studies on matched placental and maternal blood samples become available.Prospective Register of Systematic Reviews (PROSPERO) registration number: CRD42019136762.

EVALUATION OF INAPPROPRIATE PRESCRIPTIONS IN THE GERIATRIC POPULATION OF AN URBAN SLUM IN BANGALORE

Although the over 60 years age population constitutes approximately 8% of the total population, 30% of total medication is prescribed for this age group. Chronic diseases and polypharmacy in the elderly population increase the risk of inappropriate drug use. Some physicians prescribe medications without reviewing other supplements and medications used by the elder patient. This polypharmacy results in many adverse drug interactions and reactions. The purpose of this study was to identify older patients who were prescribed inappropriate drugs, according to START/STOPP criteria. To estimate the prevalence of inappropriate prescriptions amongst the elderly residing in an urban slum under the field practice area of Urban Health and Training Center (UHTC) of a tertiary medical college; to assess polypharmacy and morbidity pattern in these elderly. A cross-sectional study was conducted among the elderly, aged 65 years and above, residing in an urban slum under the field practice area of a tertiary medical college. A total of 215 elderly were chosen from the study area by simple random sampling. Data regarding socio-demographic profile and medication usage was collected using a pre-tested semistructured questionnaire through individual interview. START/STOPP criteria were used to identify potentially inappropriate prescriptions. The prevalence of PIPs was 43.3% and of PIOs was 20.9%. Polypharmacy was found in 36.7% of elderly population. Mean number of medications used by the study population was 6.19±2.43 (range was 1-10). The most common morbidity present in the study population was Arthritis in 34.9% followed by hypertension in 13% (28) of elderly. The faulty prescription commissions and omissions have created a significant issue of polypharmacy. This study only provides a baseline data about inappropriate prescriptions and polypharmacy. A multi-pronged approach, involving healthcare workers and policy makers is required to address this issue to optimize the elderly pharmacotherapy and thus health care.

Quality of life from cytoreductive surgery in advanced Ovarian cancer: investigating association with disease burden and surgical complexity in the international, prospective, SOCQER2 cohort study

OBJECTIVE

To investigate quality of life (QoL) and association with surgical complexity and disease burden after surgical resection for advanced ovarian cancer in centres with variation in surgical approach DESIGN: Prospective multicentre observational study SETTING: United Kingdom, Kolkata, India, and Melbourne, Australia gynaecological cancer surgery centres.

PARTICIPANTS

Patients undergoing surgical resection for late stage ovarian cancer. Exposure Low, intermediate or high Surgical Complexity Score (SCS) surgery MAIN OUTCOMES AND MEASURES: Primary: EORTC-QLQ-C30 Global score change. Secondary: EORTC OV28, progression free survival.

RESULTS

Patients' pre-operative disease burden and SCS varied between centres, confirming differences in surgical ethos. QoL response rates were 90% up to 18 months. Mean change from the pre-surgical baseline in the EORTC QLQ-C30 was 3.4 (SD 1.8, n=88) in the low, 4.0 (SD 2.1, n=55) in the intermediate and 4.3 (SD 2.1, n=52) in the high SCS group after 6 weeks (p=0.048) and 4.3 (SD 2.1, n=51), 5.1 (SD 2.2, n=41) and 5.1 (SD 2.2, n=35) respectively after 12 months (p=0.133). In a repeated measures model, there were no clinically or statistically meaningful differences in EORTC QLQ-C30 global scores between the three SCS groups, p= 0.840 but there was a small statistically significant improvement in all groups over time (p<0.001). The high SCS group experienced small to moderate decreases in physical (p=0.004), role (p=0.016) and emotional (p=0.001) function at 6 weeks post-surgery which resolved by 6-12 months.

CONCLUSIONS AND RELEVANCE

Global QoL of patients undergoing low, intermediate, and high SCS surgery improved at 12 months post operation and was no worse in patients undergoing extensive surgery.

Placental expression of miR-21-5p, miR-210-3p and miR-141-3p: relation to human fetoplacental growth

BACKGROUND/OBJECTIVES

Dysregulation of microRNAs (miRNAs) and their target genes in placental tissue is associated with foetal growth restriction. We aimed to evaluate associations of placental miR-21-5p, miR-141-3p and miR-210-3p expression with maternal, placental and newborn parameters and with placental expression of their potential target genes PTEN, VEGF, FLT and ENG in a set of well-characterized small- (SGA) and appropriate- (AGA) for gestational age full-term singleton pregnancies.

SUBJECTS/METHODS

Placental samples (n = 80) from 26 SGA and 54 AGA were collected from full-term singleton pregnancies. Placental transcript abundances of miR-21-5p, miR-141-3p and miR-210-3p were assessed after normalization to a reference miRNA, mir-16-5p by real-time quantitative PCR. Placental transcript abundances of PTEN, VEGF, FLT and ENG were assessed after normalizing to a panel of reference genes.

RESULTS

Placental miR-21-5p transcript abundance was negatively associated with placental weight (n = 80, r = -0.222, P = 0.047) and this association was specific to the AGA births (n = 54, r = -0.292, P = 0.032). Placental transcript abundances of miR-210-3p and miR-141-3p were not associated with placental weight or birth weight in all 80 births. However, placental miR-210-3p transcript abundance was positively associated with birth weight specifically in the SGA births (n = 26, r = 0.449, P = 0.021). Placental transcript abundance of miR-21-5p was negatively associated with PTEN transcript abundance (Spearman's ρ = -0.245, P = 0.028) while that of miR-141-3p was positively associated with FLT (Spearman's ρ = 0.261, P = 0.019) and ENG (Spearman's ρ = 0.259, P = 0.020) transcript abundances in all 80 births.

CONCLUSION

We conclude that placental miR-21-5p and miR-210-3p may be involved in fetoplacental growth. However, this regulation is unlikely to be mediated through placental expression of PTEN, VEGF, FLT or ENG.

Placental expression of RNU44, RNU48 and miR-16-5p: stability and relations with fetoplacental growth

BACKGROUND/OBJECTIVES

The current study aimed to identify suitable reference miRNA for placental miRNA expression analysis in a set of well-characterized and fetal-sex balanced small- (SGA) and appropriate- (AGA) for gestational age full-term singleton pregnancies.

SUBJECTS/METHODS

In this retrospective study, placental samples (n = 106) from 35 SGA (19 male and 16 female) and 71 AGA (30 male and 41 female) full-term singleton pregnancies were utilized. Placental transcript abundance of three widely used reference miRNAs [miR-16-5p and Small nucleolar RNAs (snoRNAs) RNU44 and RNU48] were assessed by real-time quantitative PCR. Raw cycle threshold (C_t) analysis and RefFinder tool analysis were conducted for evaluating stability of expression of these miRNAs.

RESULTS

Raw C_t values of miR-16-5p were similar between SGA and AGA births (P = 0.140) and between male and female births within SGA (P = 0.159) and AGA (P = 0.060) births while that of RNU44 and RNU48 were higher in SGA births (P = 0.008 and 0.006 respectively) and in male births within the SGA group (P = 0.005) for RNU44 and in female births within the AGA group (P = 0.048) for RNU48. Across all 106 samples tested using the RefFinder tool, miR-16-5p and RNU44 were equally stable reference miRNAs.

CONCLUSION

We recommend miR-16-5p and RNU44 as suitable reference miRNAs for placental samples from settings similar to our study.

Anomalous magnetoresistance and magneto-thermal properties of the half-Heuslers,RPdSi (RY, Gd-Er)

Here, we present a detailed study on the magnetic, magneto-transport, and magneto-thermal properties of the equiatomic half-Heusler compounds with the general formula,RPdSi (R= Y and rare-earth, Gd-Er). These materials crystallize in two different superstructures of the TiNiSi-type orthorhombic unit cell with the space groupsPnmaandPmmn. Our magnetic and heat capacity measurements reveal the onset of an antiferromagnetic (AFM) ordering in the temperature range 3-16 K for all the local moments bearingRPdSi compounds, while the non-magnetic analog, YPdSi exhibits a Pauli-paramagnetic behaviour. The AFM state of these compounds can be tuned by magnetic field and temperature as demonstrated by the magnetic measurements below the Neel temperature (T_N). Most importantly, this tuning of the magnetic structure is well documented in the complex temperature and field dependence of magnetoresistance (MR) and magnetocaloric effect (MCE). Our study establishes a striking correlation of the commensurate/incommensurate AFM structure with that of positive/negative MR and MCE in this series of compounds. We emphasize that such a framework applies to a large number of AFM intermetallic systems.

Enrichment of laccase production by Phoma herbarum isolate KU4 under solid-state fermentation by optimizing RSM coefficients using genetic algorithm

The process parameters were optimized to obtain enhanced enzyme activity from the fungus Phoma herbarum isolate KU4 using rice straw and saw dust as substrate under solid-state fermentation using Response surface methodology (RSM). Genetic algorithm was used to validate the RSM for maximum laccase production. Six variables, viz., pH of the media, initial moisture content, copper sulphate concentration, concentration of tannic acid, inoculum concentration and incubation time were found to be effective and optimized for enhanced production. Maximum laccase production was achieved by RSM at pH 5·0 and 86% of initial moisture content of the culture medium, 150 µmol l^-1 of CuSO₄ , 1·5% tannic acid and 0·128 g inoculum g^-1 dry substrate inoculum size on the fourth day of fermentation. The highest laccase activity was observed as 79 008 U g^-1 , which is approximately sixfold enhanced production compared to the unoptimized condition (12 085·26 U g^-1 ).

Dust exposure and pulmonary inflammation in Standardbred racehorses fed dry hay or haylage: A pilot study

Respirable dust exposure is linked to airway inflammation in racehorses. Feeding haylage may reduce dust exposure by 60-70%. The objective of this study was to compare dust exposure, airway cytology, and inflammatory cytokine concentrations between horses fed haylage or hay over 6 weeks while in training. Seven healthy Standardbred horses were randomly assigned to be fed alfalfa hay (n = 3) or grass-alfalfa mix haylage (n = 4) for six weeks while training on a treadmill. Dust exposure was measured gravimetrically at the breathing zone. Endotoxin and β-glucan concentrations in respirable dust were measured. Bronchoalveolar lavage fluid (BALF) cytology was determined at baseline and after 2, 4, and 6 weeks. Cytokine concentrations (interferon-γ, tumor necrosis factor-α, and interleukin-4) were measured in BALF at baseline and week 6. The effect of forage on exposure, airway cytology and cytokines were evaluated using generalized linear mixed models. Respirable dust and β-glucan exposures were lower in horses fed haylage than hay (0.02 ± 0.001 mg/m³ vs. 0.06 ± 0.01 mg/m³; P = 0.03, and 69 ± 18 pg/m³ vs. 160 ± 21 pg/m³; P = 0.02, respectively). In horses eating haylage, BALF neutrophil proportion decreased between baseline (2.2 ± 0.5%), week 2 (0.8 ± 0.3%; P = 0.01) and week 6 (0.7 ± 0.2%; P = 0.03). By week 6, horses fed haylage had lower BALF neutrophilia than horses fed hay (4.0 ± 0.7 %; P = 0.0004). Interleukin-4 concentration in BALF was higher at week 6 (14.4 ± 4.6 pg/mL) in horses fed hay compared to baseline (2.9 ± 4.6 pg/mL; P = 0.007). In conclusion, feeding haylage instead of hay to horses in training can reduce exposure to respirable irritants and mitigate airway neutrophilia.

An overview of Kuwait’s water resources and a proposed plan to prevent the spread of the Novel Corona Virus (COVID-19) pandemic through Kuwait’s water supply facilities and groundwater system

Kuwait has been affected by the COVID-19 pandemic that is still raging in the country despite all precautionary measures adopted by the Government of Kuwait. The lack of definitive knowledge about of the occurrence, evolution and migration mechanisms of the Novel Corona Virus (NCV-19) makes it very difficult to develop a comprehensive and implementable plan to identify the possible contamination pathways of the virus and to prescribe effective mitigation measures to eliminate or, at least, reduce its potential negative effects. In an arid country such as Kuwait, water could potentially act as a “conduit” through which the Novel Corona Virus (NCV-19) could spread. Water pathways for the spread of the virus include a multitude of sources such as hospitals and quarantine facilities, input and output seawater of the desalination plants, surface and elevated freshwater reservoirs, freshwater distribution centers for water bowsers, freshwater distribution points for residential areas, booster pumping stations along the freshwater network, freshwater network at residential areas, fresh and brackish water in houses and residential units and the groundwater of the country’s water fields.A plan has been made to develop a better understanding of the possible pathways and the migration mechanisms of the Novel Corona Virus (NCV-19) in Kuwait’s water facilities and groundwater system in preparation for the development of a comprehensive and implementable plan to address and mitigate the challenges of the virus. This will involve investigating the effects of temperature and time on the survival of the virus in water by preserving the water samples to be collected in a temperature-controlled environment for specific time periods. Laboratory soil column tests using a combination of different types of soils and Corona Virus contaminated water will be conducted to assess the mobility of the virus through the soil. Lastly, laboratory treatment of water contaminated with the virus using ultraviolet (UV) light, ozonation and chlorination techniques will be carried out to assess the effectiveness of these methods for disinfection of water that is contaminated with the virus.

Social network analysis of COVID-19 transmission in Karnataka, India

We used social network analysis (SNA) to study the novel coronavirus (COVID-19) outbreak in Karnataka, India, and to assess the potential of SNA as a tool for outbreak monitoring and control. We analysed contact tracing data of 1147 COVID-19 positive cases (mean age 34.91 years, 61.99% aged 11-40, 742 males), anonymised and made public by the Karnataka government. Software tools, Cytoscape and Gephi, were used to create SNA graphics and determine network attributes of nodes (cases) and edges (directed links from source to target patients). Outdegree was 1-47 for 199 (17.35%) nodes, and betweenness, 0.5-87 for 89 (7.76%) nodes. Men had higher mean outdegree and women, higher mean betweenness. Delhi was the exogenous source of 17.44% cases. Bangalore city had the highest caseload in the state (229, 20%), but comparatively low cluster formation. Thirty-four (2.96%) 'super-spreaders' (outdegree ⩾ 5) caused 60% of the transmissions. Real-time social network visualisation can allow healthcare administrators to flag evolving hotspots and pinpoint key actors in transmission. Prioritising these areas and individuals for rigorous containment could help minimise resource outlay and potentially achieve a significant reduction in COVID-19 transmission.

A randomised phase II trial of hydroxychloroquine and imatinib versus imatinib alone for patients with chronic myeloid leukaemia in major cytogenetic response with residual disease

In chronic-phase chronic myeloid leukaemia (CP-CML), residual BCR-ABL1+ leukaemia stem cells are responsible for disease persistence despite TKI. Based on in vitro data, CHOICES (CHlorOquine and Imatinib Combination to Eliminate Stem cells) was an international, randomised phase II trial designed to study the safety and efficacy of imatinib (IM) and hydroxychloroquine (HCQ) compared with IM alone in CP-CML patients in major cytogenetic remission with residual disease detectable by qPCR. Sixty-two patients were randomly assigned to either arm. Treatment 'successes' was the primary end point, defined as ≥0.5 log reduction in 12-month qPCR level from trial entry. Selected secondary study end points were 24-month treatment 'successes', molecular response and progression at 12 and 24 months, comparison of IM levels, and achievement of blood HCQ levels >2000 ng/ml. At 12 months, there was no difference in 'success' rate (p = 0.58); MMR was achieved in 80% (IM) vs 92% (IM/HCQ) (p = 0.21). At 24 months, the 'success' rate was 20.8% higher with IM/HCQ (p = 0.059). No patients progressed. Seventeen serious adverse events, including four serious adverse reactions, were reported; diarrhoea occurred more frequently with combination. IM/HCQ is tolerable in CP-CML, with modest improvement in qPCR levels at 12 and 24 months, suggesting autophagy inhibition maybe of clinical value in CP-CML.

Placental expression of leptin: fetal sex-independent relation with human placental growth

OBJECTIVES

Leptin (LEP) is a vital placental hormone that is known to affect different aspects of placental function and fetal development. The present study aimed to determine the association of placental LEP transcript abundance with maternal, placental, and newborn parameters.

SUBJECTS/METHODS

In this retrospective case-control study, placental samples (n = 105) were collected from small (SGA) and appropriate (AGA) for gestational age full-term singleton pregnancies (n = 44 SGA and n = 61 AGA). Placental transcript abundance of LEP was assessed by real-time quantitative PCR after normalization to a reference gene panel. LEP methylation was measured using a quantitative MethyLight assay in a subset of samples (n = 54).

RESULTS

Placental LEP transcript abundance was negatively and significantly associated with placental weight (β = -3.883, P = 0.015). This association continued to be significant in the SGA group (β = -10.332, P = 0.001), both in female (β = -15.423, P = 0.021) and male births (β = -10.029, P = 0.007). LEP transcript abundance was not associated with LEP methylation levels (Spearman's ρ = 0.148, P = 0.287).

CONCLUSION

We conclude that placental upregulation of LEP is an integral and fetal sex-independent component of placental growth restriction, which can be potentially targeted through maternal dietary modifications to improve fetoplacental growth.

Clinical practice guidelines 2019: Indian consensus-based recommendations on influenza vaccination in adults

Influenza, a common cause of acute respiratory infections, is an important health problem worldwide, including in India. Influenza is associated with several complications; people with comorbidities and the elderly are at a higher risk for such complications. Moreover, the influenza virus constantly changes genetically, thereby worsening therapeutic outcomes. Vaccination is an effective measure for the prevention of influenza. Despite the availability of global guidelines on influenza vaccination in adults, country-specific guidelines based on regional variation in disease burden are required for better disease management in India. With this aim, the Indian Chest Society and National College of Chest Physicians of India jointly conducted an expert meeting in January 2019. The discussion was aimed at delineating evidence-based recommendations on adult influenza vaccination in India. The present article discusses expert recommendations on clinical practice guidelines to be followed in India for adult influenza vaccination, for better management of the disease burden.

Clinical practice guidelines 2019: Indian consensus-based recommendations on pneumococcal vaccination for adults

Similar to the global scenario, pneumococcal diseases are a significant health concern in India. Pneumococcal diseases occur frequently among adults and are largely preventable through vaccines. Globally, several guidelines and recommendations are available for pneumococcal vaccination in adults. However, owing to wide variations in the disease burden, regulatory landscape, and health-care system in India, such global guidelines cannot be unconditionally implemented throughout the country. To address these gaps, the Indian Chest Society and National College of Chest Physicians of India jointly conducted an expert meeting in January 2019. The aim of the discussion was to lay down specific evidence-based recommendations on adult pneumococcal vaccination for the country, with a view to further ameliorate the disease burden in the country. This article presents an overview of the closed-door discussion by the expert members on clinical practice guidelines to be followed for adult pneumococcal vaccination in India.

Placental expression of ENG, VEGF, and FLT: Gender-specific associations with maternal vitamin B12 status

OBJECTIVES

Adequate vitamin B₁₂ is a requisite during pregnancy and its deficiency is linked with increased risk for adverse outcomes, likely mediated by impaired placental angiogenesis. Thus, we aimed to test associations of maternal vitamin B₁₂ status with the placental expression of angiogenesis-associated genes ENG, VEGF, and FLT.

SUBJECTS/METHODS

In this retrospective case-control study, placental and maternal trimester 1 blood samples (n = 104) were collected from small for gestational age (SGA) and appropriate for gestational age (AGA) full-term singleton pregnancies. Maternal trimester 1 vitamin B₁₂ status was measured. Placentae and neonates were weighed at birth. Realtime quantitative PCR was performed to assess placental transcript abundance of ENG, VEGF, and FLT normalized to a panel of reference genes. Associations of placental transcript abundance of the genes with maternal trimester 1 vitamin B₁₂ status were evaluated.

RESULTS

Placental ENG transcript abundance associated negatively with maternal trimester 1 vitamin B₁₂ status (β = -0.461, P = 0.017, n = 104). This association was specific to the female births (β = -0.590, P = 0.014, n = 60). Placental VEGF transcript levels were negatively associated with maternal trimester 1 vitamin B₁₂ status only in the female births (β = -1.995, P = 0.029). Placental FLT transcript levels were not associated with maternal trimester 1 vitamin B₁₂ status.

CONCLUSION

Maternal trimester 1 vitamin B₁₂ status was associated negatively with placental ENG and VEGF expression predominantly in the female births. Therefore, we hypothesize that the placenta adapts to low maternal vitamin B₁₂ status by up-regulating angiogenic pathways in a gender-specific manner.

Effectiveness of an advanced practice nurse-led delirium education and training programme

AIM

To develop an education and training programme to enhance bedside nurses' knowledge, competency and compliance in accurately performing delirium screening in intensive care units.

BACKGROUND

Delirium in intensive care units is associated with several poor patient outcomes. Delirium detection can be improved by enhancing nurses' knowledge, competency and compliance in accurately performing delirium screening.

METHODS

A descriptive quantitative study with pretest-post-test design was adopted. There were 245 nurses from five intensive care units who participated in the study. Multiple-choice questions were used to assess nurses' knowledge change before and after the education programme. Competency was assessed before and 2 months after the programme by simulation with a standardized patient, followed by real patients at the bedside. Compliance data on screening were collected from the documentation of the Richmond Agitation-Sedation Scale and the Confusion Assessment Method for the ICU before and 3 and 10 months after the programme. Data collection took 1 year, from June 2014 to May 2015.

RESULTS

Despite nurses' improved knowledge and good competency, delirium screening documentations after 3 months were poor. However, screening documentations subsequently improved when measured at 10 months, following further emphasis by the senior nursing staff.

IMPLICATIONS FOR NURSING PRACTICE AND POLICY

Nursing administrators and bedside nurses need to be involved in the policy-making process and plan a training programme for the new nursing staff in the high-risk areas. A short refreshment course should be offered to the nursing staff 3 months after the initial training programme.

CONCLUSIONS

Improved knowledge and competency in assessment did not improve compliance and documentation of delirium screening. Therefore, it is important to reinforce nurses' compliance of delirium screening over time.

Abstract P2-06-10: Withdrawn

This abstract was withdrawn by the authors.

Citation Format: Sood AK, Mukhopadhyay A, Wang J. Withdrawn [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 P2-06-10.

A new family of transcriptional regulators of tungstoenzymes and molybdate/tungstate transport

Bacterial genes for molybdenum-containing and tungsten-containing enzymes are often differentially regulated depending on the metal availability in the environment. Here, we describe a new family of transcription factors with an unusual DNA-binding domain related to excisionases of bacteriophages. These transcription factors are associated with genes for various molybdate and tungstate-specific transporting systems as well as molybdo/tungsto-enzymes in a wide range of bacterial genomes. We used a combination of computational and experimental techniques to study a member of the TF family, named TaoR (for tungsten-containing aldehyde oxidoreductase regulator). In Desulfovibrio vulgaris Hildenborough, a model bacterium for sulfate reduction studies, TaoR activates expression of aldehyde oxidoreductase aor and represses tungsten-specific ABC-type transporter tupABC genes under tungsten-replete conditions. TaoR binding sites at aor promoter were identified by electrophoretic mobility shift assay and DNase I footprinting. We also reconstructed TaoR regulons in 45 Deltaproteobacteria by comparative genomics approach and predicted target genes for TaoR family members in other Proteobacteria and Firmicutes.

Fetal sex modifies the effect of maternal macronutrient intake on the incidence of small-for-gestational-age births: a prospective observational cohort study

Background

Maternal macronutrient intake is likely to play a pivotal role in fetoplacental growth. Male fetuses grow faster and their growth is more responsive to maternal size.

Objective

We assessed the role of fetal sex in modifying the effect of maternal macronutrient intake on the risk of small-for-gestational-age (SGA) birth.

Design

This was a prospective, observational cohort study of 2035 births from an urban South Asian Indian population. Maternal intakes of total energy and macronutrients were recorded by validated food-frequency questionnaires. The interaction of trimester 1 macronutrient intake with fetal sex was tested on the outcome of SGA births.

Results

The prevalence of SGA was 28%. Trimester 1 macronutrient composition was high in carbohydrate and low in fat (means ± SDs-carbohydrate: 64.6% ± 5.1%; protein: 11.5% ± 1.1%; and fat: 23.9% ± 4.4% of energy). Higher carbohydrate and lower fat consumption were each associated with an increased risk of SGA [adjusted OR (AOR) per 5% of energy (95% CI): carbohydrate: 1.15 (1.01, 1.32); fat: 0.83 (0.71, 0.97)] specifically among male births (males: n = 1047; females: n = 988). Dietary intake of >70% of energy from carbohydrate was also associated with increased risk (AOR: 1.67; 95% CI: 1.00, 2.78), whereas >25% of energy from fat intake was associated with decreased risk (AOR: 0.61; 95% CI: 0.41, 0.90) of SGA in male births.

Conclusions

Higher carbohydrate and lower fat intakes early in pregnancy were associated with increased risk of male SGA births. Therefore, we speculate that fetal sex acts as a modifier of the role of maternal periconceptional nutrition in optimal fetoplacental growth.

Role of Gynaecology Oncology Specialist Nurses in Improving Patient Follow-Up and Integration With the Health Care Team

Background: All advanced gynecologic cancers treated initially with a curative intent should also be referred to palliative care at the outset for symptom management. Specialist nurses can play an integral role in this process as patients feel more comfortable to relay their symptoms to nurses rather than busy clinicians. The concept of specialist nurses has been introduced in June 2016 in the Gynecologic Oncology Department in Tata Medical Center. We aim evaluate our services through this prospective audit. Aim: i: To assess whether pre and posttreatment counseling and follow-up by gynecologic oncology specialist nurses lead to better patient care in the following areas. Increased patient participation in self-reporting of PROM (patient reported outcome monitoring) and uptake of follow-up methods via e-mail, telephone etc. ii: Coordinate administration of intraperitoneal chemotherapy and follow-up. iii: Detection of posttreatment complications and symptoms by telephonic follow up and coordination with the treating team including quality of life data collection. iv: Communicating MDT decisions to patients and arrange appropriate follow-up. v: Reduction of patient follow-up appointments and distress by coordinating with other departments i.e., palliative care team and gynae/medical oncology at same visit. vi: Develop patient information leaflets and providing preoperative education Methods: Prospective audit for service evaluation. Patients follow-up was done by face to face, telephone, e-mail in the pre and postoperative period, during chemotherapy and follow-up visits by 4 specialist nurses. Results: Between June 2016 and December 2017, specialist nurses conducted follow-up of 225 patients both in preoperative and postoperative period and collected 30 day morbidity data. Preoperative health education was given to all. 36 patients were coordinated with palliative care team on same day with gynecologic visit to reduce harassment/repeat appointments. Postchemotherapy follow-up was done for 80 patients after each cycle of chemotherapy. Coordination for 19 intraperitoneal chemotherapy was done by nurses during a 9 month period. As a result of regular follow-up visits, women were more comfortable in self-reporting of symptoms to the nurse including sensitive issues like body image and sexuality even by nonface to face methods including telephone calls/e-mails and postal mails. This has led to early detection of recurrences in 4 women, participation in multicentric national/international quality of life studies (SOCQER2/ SOCQER IND) and successful organization of survivorship programs in gynecologic oncology. Conclusion: Counseling, education and building up of interpersonal relationship with specialist nurses can improve patient participation. The role of CNS is vital to the advancement of nursing practice.

Strategies to Motivate Cancer-Affected Individuals and Their Families to Mobilize Their Kith and Kin, Neighbours and Community to Assess Their Awareness Level to Accept and Attend Screening Clinic to Prevent Cervical Cancer

Background and context: Cervical cancer is second most common cancer among women across the world. It is a public health problem especially in a developing country like India, as it alone accounts for one-quarter of the worldwide burden of cervical cancer. It is estimated by ICMR that a total of 100,000 new cases were diagnosed in 2016. This figure is expected to touch 1,04,000 during 2020. If treated in early stages more than 90% 5-year survival may be expected. However, less than 10% of our patients are diagnosed early resulting in an overall poor outcome. We do not have any organized national program for cervical cancer screening that might help in reducing the incidence of and death from cervical cancer. Aim: The aim of this study was to evaluate the efficacy of establishing a hospital-based opportunistic screening clinic with the underlying intention of disseminating awareness and knowledge by empowering cancer affected women to mobilize women folks or relatives known to them for voluntary participation in screening clinic. Strategy/Tactics: We have initiated the following measures: 1. Enlisting the phone numbers of female cancer patients from hospital records and contacting their families for participating in the screening clinic. 2. One to one counseling of patients suffering from any other cancer and involving their accompanying family members to avail the facility. 3. Encouraging them to bring their neighbors, relatives, friends to participate. 4. To identify patient representatives involved in community work like NGOs, clubs, religious institutes etc. and empower them with knowledge for motivating others to participate. 5. Development of IC (information and communication) materials like standees, leaflets, audio visuals for people waiting in hospital lobby. 6. Involving the male members of the family in encouraging the women to participate in the screening. 7. Assess the awareness level of women participating in the screening clinic. Program/Policy process: To create awareness and empower the affected cancer people and their relatives/attendants to participate and to mobilize the community for voluntary participation in screening clinic for prevention of cervical cancer. Outcomes: The outcome measure is assessed by the number of healthy women of any age coming forward to attend the screening/vaccination/awareness clinic per one cancer affected women. We have already registered 270 participants and screened 268 women for cervical cancer. Seventeen women were detected with HPV infection and underwent colposcopy. Interest in vaccination of young girl in the family was generated by people visiting our hospital. What was learned: The strategy to establish “screening clinic” for women with help of cancer patients has proved to be effective in reaching out to the community through the involvement of their kith and kin.

Developing Interinstitutional Multimodality Model for Translational Studies for Cervical Cancer Screening and Treatment: Pragmatic Issues Pertaining to Logistics, Infrastructure and Solutions

Background and context: Cervical cancer claims the life of 67,500 women every year in India. Persistence of HPV leads to the development of high grade CIN which may progress to invasive cancer. Almost 80% of women are infected with the virus in their lifetime but only a small proportion of women progress to develop cervical cancer. In early cervical cancer patients despite surgery about 25% recur and in advanced cervical cancer about 50%-60% women respond to radiotherapy while the rest progress or recur with disease after standard treatment. The risk to progression and failure to treatment is dependent on both viral/tumor and host factors; therefore an integrated approach should be adopted in developing predictive and prognostic biomarkers to address these clinical questions. Aim: Establishing a clinical and translational research model to provide an infrastructure that will facilitate targeted screening and targeted therapeutics in cervical precancer and cancer. Strategy/Tactics: Integration of various premium institutions in the city with their infrastructure to form a “Systems Medicine Cluster” was established to conduct this research. We have adopted a primary HPV screening (HC2 DNA and genotyping) strategy as a clinical protocol and devised SOPS to enable sample collection strategies for several research usage from the same sample including cytology testing, genomics, metabolomics, microbiome, proteomics. Similarly a translational pathway has been created for seamless tissue collection from cancer patients for multidimensional research usage. Collaboration was established between clinicians, scientists, clinical trial coordinators, research nurses, data managers and biobank personnel to orchestrate this working model. Program/Policy process: Collaboration of various institutions to form a “Systems Medicine Cluster” to effectively implement research strategies for cervical cancer screening and treatment. Outcomes: With the help of translation work we intend to identify of viral and host factors which determine the persistence of the HPV in screened women, thereby risk stratifying them for colposcopic evaluation. In women with cervical cancer who are treated with standard care, we expect to identify modifiable tumor or host factors and drug targets that can be used to reduce the risk of recurrence and improve survival. In 3 months of implementation we have screened 260 women in the cervical cancer screening clinic and obtained samples from 190 cervical cancer patients for translational research. All women have also contributed to the collection of vaginal fluid and blood samples for various research protocols associated with cervical cancer. What was learned: These translational studies conducted hand in hand with clinical pathways requires meticulous planning and teamed approach. The formation of the “Systems Medicine Cluster” with different expertise to address clinical strategies has been a successful model.

Knee menisci segmentation using convolutional neural networks: data from the Osteoarthritis Initiative

OBJECTIVE

To present a novel method for automated segmentation of knee menisci from MRIs. To evaluate quantitative meniscal biomarkers for osteoarthritis (OA) estimated thereof.

METHOD

A segmentation method employing convolutional neural networks in combination with statistical shape models was developed. Accuracy was evaluated on 88 manual segmentations. Meniscal volume, tibial coverage, and meniscal extrusion were computed and tested for differences between groups of OA, joint space narrowing (JSN), and WOMAC pain. Correlation between computed meniscal extrusion and MRI Osteoarthritis Knee Score (MOAKS) experts' readings was evaluated for 600 subjects. Suitability of biomarkers for predicting incident radiographic OA from baseline to 24 months was tested on a group of 552 patients (184 incident OA, 386 controls) by performing conditional logistic regression.

RESULTS

Segmentation accuracy measured as dice similarity coefficient was 83.8% for medial menisci (MM) and 88.9% for lateral menisci (LM) at baseline, and 83.1% and 88.3% at 12-month follow-up. Medial tibial coverage was significantly lower for arthritic cases compared to non-arthritic ones. Medial meniscal extrusion was significantly higher for arthritic knees. A moderate correlation between automatically computed medial meniscal extrusion and experts' readings was found (ρ = 0.44). Mean medial meniscal extrusion was significantly greater for incident OA cases compared to controls (1.16 ± 0.93 mm vs 0.83 ± 0.92 mm; P < 0.05).

CONCLUSION

Especially for medial menisci an excellent segmentation accuracy was achieved. Our meniscal biomarkers were validated by comparison to experts' readings as well as analysis of differences w.r.t groups of OA, JSN, and WOMAC pain. It was confirmed that medial meniscal extrusion is a predictor for incident OA.

Maternal intake of milk and milk proteins is positively associated with birth weight: A prospective observational cohort study

BACKGROUND

A striking number of low birth weight (LBW) Indian babies are born annually. Previous studies have confirmed the positive association between milk intake and birth weight. However, the relations between protein and vitamin B₁₂ from milk and birth weight have not been systematically explored.

AIMS

We examined the relations between birth weight and maternal intake of milk, protein from milk and vitamin B₁₂ from milk.

METHODS

This prospective, observational cohort study was conducted in an urban South Indian hospital. The dietary intakes of milk and milk products were assessed using validated food frequency questionnaire and at delivery birth outcomes were measured. The relations between milk products, milk protein, and vitamin B₁₂ from milk with birth weight and gestational weight gain were assessed in 2036 births with first trimester dietary and delivery data.

RESULTS

Median consumption of milk products in the first trimester was 310 g·day^-1 and average birth weight was 2876 g. Birth weight was positively associated with intake of milk products and of % protein from milk products (%milk protein) in the first trimester [β = 86.8, 95% confidence interval (CI): 29.1, 144.6; β = 63.1, 95% CI: 10.8, 115.5; P < 0.001 for both]. Intake of milk products and of %milk protein in the third trimester was positively associated with gestational weight gain (GWG) between the second and third trimester (One-way ANOVA, P < 0.001 and = 0.001, respectively). Neither birth weight nor GWG were associated with %vitamin B₁₂ from milk products.

CONCLUSIONS

These findings indicate that intake of milk products in the first trimester and especially, protein from milk products is positively associated with birth weight in this South Asian Indian population.

Optimization of lithium content in LiFePO4 for superior electrochemical performance: the role of impurities

Carbon coated Li_xFePO₄ samples with systematically varying Li-content (x = 1, 1.02, 1.05, 1.10) have been synthesized via a sol–gel route. The Li : Fe ratios for the as-synthesized samples is found to vary from ∼0.96 : 1 to 1.16 : 1 as determined by the proton induced gamma emission (PIGE) technique (for Li) and ICP-OES (for Fe). According to Mössbauer spectroscopy, sample Li_1.05FePO₄ has the highest content (i.e., ∼91.5%) of the actual electroactive phase (viz., crystalline LiFePO₄), followed by samples Li_1.02FePO₄, Li_1.1FePO₄ and LiFePO₄; with the remaining content being primarily Fe-containing impurities, including a conducting FeP phase in samples Li_1.02FePO₄ and Li_1.05FePO₄. Electrodes based on sample Li_1.05FePO₄ show the best electrochemical performance in all aspects, retaining ∼150 mA h g⁻¹ after 100 charge/discharge cycles at C/2, followed by sample Li_1.02FePO₄ (∼140 mA h g⁻¹), LiFePO₄ (∼120 mA h g⁻¹) and Li_1.10FePO₄ (∼115 mA h g⁻¹). Furthermore, the electrodes based on sample Li_1.05FePO₄ retain ∼107 mA h g⁻¹ even at a high current density of 5C. Impedance spectra indicate that electrodes based on sample Li_1.05FePO₄ possess the least charge transfer resistance, plausibly having influence from the compositional aspects. This low charge transfer resistance is partially responsible for the superior electrochemical behavior of that specific composition.

Extensive information regarding the Li : Fe stoichiometry in the LiFePO₄ cathode and the formation of concomitant impurities and their impact on the various electrochemical performances have been reported.

Abstract P3-07-13: Prostate derived Ets factor, a novel driver of breast cancer independent of estrogen signaling axis and a target for immunotherapy of breast cancer

This abstract was withdrawn by the authors.

Mathematical modeling to predict the sub-bandage pressure on a conical limb for multi-layer bandaging

The effectiveness of the compression treatment by a medical compression bandage is dependent on the pressure generated at the interface between the bandage and the skin. This pressure is called interface pressure or sub-bandage pressure. The performance of a bandage depends upon the level of interface pressure applied by the bandage and the sustenance of this pressure over time. The interface pressure exerted by the bandage depends on several other factors like limb shape or size, application technique, physical and structural properties of the bandage, physical activities taken by the patient, etc. The current understanding of how bandages apply pressure to a limb is based on the Law of Laplace, which states that tension in the walls of a container is dependent on both the pressure of the container's content and its radius. This concept was translated mathematically into equation relating pressure to tension and radius by Thomas. In addition, a modified equation was generated by multiplying the model with a constant that represents the number of bandage layers in order to use the model to estimate the pressure applied by multi-layer bandages. This simple multiplication adjustment was questioned by researchers. They had doubts about the model validity and whether it can be used to predict the sub-bandage pressure applied by pressure garments. One of the questions that were raised regarding the bandage thickness affecting the sub-bandage pressure has been recently explored by Al Khaburi where he used the thin and thick cylinder shell theory to study the effect of Multi Component Bandage's (MCB) thickness on the sub-bandage pressure. The model by Al Khaburi and the earlier models developed for pressure prediction are all based on calculations considering the cylindrical limb shapes although the human limb normally is wider at the calf and reduces in circumference towards the ankle. So in our approach, the bandage is assumed to take a conical shape during application and membrane shell theory is used for developing pressure prediction model for multi-layers of bandage. Both analytical and experimental work showed that the effect of bandage thickness and the geometry of the limb on pressure produced by multi-layers of bandage are significant. The model developed when compared to the data obtained using experimental setup confirmed the validity of the mathematical model for multi-layers of bandage based on conical geometry of the limb.