P-431 Functionally active microbiota in the receptive-phase endometria in women with recurrent implantation failure

Study question

Does the functionally active microbial composition at the receptive phase endometria differ between women with recurrent implantation failure (RIF) and healthy controls?

Summary answer

Women with RIF have different functionally active microbiota in the receptive-phase endometria that are involved in distinct metabolical pathways when compared to healthy women.

What is known already

Recurrent implantation failure (RIF) is a common and burdening diagnosis in infertility treatment. Despite scientific advances in the field, the cause of RIF remains unclear and the treatment options ambiguous. Microorganisms have important role in human physiology and pathophysiology, and their potential involvement in endometrial functions and health are gaining support. Our previous work of microbiota mapping of healthy endometrium identified over 5000 functionally active microorganisms (bacteria, viruses, fungi, archaea) that participate in key metabolic pathways for embryo implantation. In the present work we focus on microbiota mapping in RIF patients, where endometrial dysfunction is suspected.

Study design, size, duration

A case-control age-match study of 20 RIF and 20 healthy controls was performed. Endometrial samples were obtained at the mid-secretory phase (LH + 7/8) using Pipelle curette.

Participants/materials, setting, methods

Total RNA sequencing (RNA-seq) was performed. R package MetagenomeSeq was used for metataxonomic microorganismal analyses and HUMAnN2 algorithm was used for functional metagenome assessment. The microbial maps were created using Kraken metagenomic sequence classification. With this approach we were able to identify and map the ‘active’ microorganisms in samples.

Main results and the role of chance

We identified a total of 4175 microorganisms in the human endometrial samples including different bacteria, fungi, viruses, and archaea. At the taxonomic level, RIF patients demonstrated a total of 180 microorganism with differential abundance when compared to controls (FDR<0.05), where the biggest difference was in Streptomyces, Xanthomonas, Fusarium and Burkholderia that were significantly less detected in RIF. The metabolical functions analysis of the microbes differed significantly between the two groups, with a total of 150 different pathways, where fatty acid biosynthesis, mucin glycosylation, folate pathway and serotonin pathways were influenced in RIF.

Limitations, reasons for caution

Poly A enrichment could avoid the detection of some microorganism. However, the resolution power in microbial identification was comparable to previous metatranscriptomics published studies.

Wider implications of the findings

Our study findings are first to demonstrate that alive microbes are involved in the uterine pathology as is RIF, where different metabolic pathways could be dysregulated. This knowledge could help to develop pre-/probiotic strategies to modulate uterine environment for improving endometrial functions in RIF.

Trial registration number

not applicable

Disaccharide anthocyanin delphinidin 3-O-sambubioside from Hibiscus sabdariffa L.: Candida antarctica lipase B-catalyzed fatty acid acylation and study of its color properties

Enzymatic lipophilization is an important process to extend the use of anthocyanins in lipidic media. In this work delphinidin 3-O-sambubioside (Dp3sam) isolated from Hibiscus sabdariffa L. flower was esterified with octanoic acid using Candida antarctica lipase B. The physical-chemical properties of the new lipophilic pigment were studied by UV-vis spectroscopy. Dp3sam with chloride, acetate and formate as counter ions were employed to study the lipophilization reaction. The hydrolysis of the reagent was avoided with a formate counter ion and the expected product was achieved with a noteworthy change of solubility. 1D and 2D NMR characterization of Dp3sam-C8 confirmed that the lipophilization took place at the primary alcohol of the glucoside moiety. Overall, the Dp3sam-C8 ester presents a stabilization of the quinoidal base (blue color) at neutral or moderate alkaline pH, which foresees a potential use of this pigment as a broad kind of industries on lipo-soluble formulations.

Convergent synthesis and properties of photoactivable NADPH mimics targeting nitric oxide synthases

A new series of photoactivable NADPH mimics bearing one or two O-carboxymethyl groups on the adenosine moiety have been readily synthesized using click chemistry. These compounds display interesting one- or two-photon absorption properties. Their fluorescence emission wavelength and quantum yields (Φ) are dependent on the solvent polarity, with a red-shift in a more polar environment (λ_max,em = 460-467 nm, Φ > 0.53 in DMSO, and λ_max,em = 475-491 nm, Φ < 0.17 in Tris). These compounds show good binding affinity towards the constitutive nNOS and eNOS, confirming for the first time that the carboxymethyl group can be used as a surrogate of phosphate. Two-photon fluorescence imaging of nanotriggers in living cells showed that the presence of one carboxymethyl group (especially on the 3' position of the ribose) strongly favors the addressing of nanotriggers to eNOS in the cell context.

Validation of a score to identify inpatients at risk of a drug-related problem during a 4-year period

Objective

Drug-related problems (DRP) produce high morbidity and mortality. It is therefore essential to identify patients at higher risk of these events. This study aimed to validate a DRP risk score in a large number of inpatients.

Material and methods

Validation of a previously designed score to identify inpatients at risk of experiencing at least one DRP in a tertiary university hospital from 2010 to 2013. DRP were detected by a pharmacy warning system integrated in the electronic medical record. The score included the following variables associated with a higher risk of DRP: prescription of a higher number of drugs, greater comorbidity, advanced age, specific ATC groups and certain major diagnostic categories.

Results

The study included a total of 52,987 admissions; of these, at least one DRP occurred in 14.9%. After validation of the score (period range, 2010–2013: 0.746–0.764), the area under the curve (AUC) was 0.751 (95% CI: 0.745–0.756).

Conclusions

This value is higher than those reported in other studies describing validation of risk scores. The score showed good capacity to identify those patients at higher risk of DRP in a much larger sample of inpatients than previously described in the literature. This tool allows optimization of drug therapy monitoring in admitted patients.

State-of-science: situation awareness in individuals, teams and systems

Our review addresses one of the most used, but debated, topics in Ergonomics: Situation Awareness (SA). We examine and elaborate upon key SA models. These models are divided into individual SA, team SA and systems SA categories. Despite, or perhaps because of, the debates surrounding SA it remains an enduring theme for research and practice in the domain of Ergonomics, now for over two decades. A contingent approach, which seeks to match different models of SA to different types of ergonomics problem, enables the differences between positions to be revealed and reconciled, and the practitioner guided towards optimum methodological solutions. Practitioner Summary: Measuring SA in individuals, teams and systems has become a key objective in Ergonomics. One single approach to SA does not fit all problems encountered. This review shows the importance of considering all three types of models and achieving a match between them and the problem at hand.

Computerized pharmacy surveillance and alert system for drug-related problems

WHAT IS KNOWN AND OBJECTIVE

Because of the impact of drug-related problems (DRPs) on morbidity and mortality, there is a need for computerized strategies to increase drug safety. The detection and identification of the causes of potential DRPs can be facilitated by the incorporation of a pharmacy warning system (PWS) in the computerized prescriber order entry (CPOE) and its application in the routine validation of inpatient drug therapy. A limited number of studies have evaluated a clinical decision support system to monitor drug treatment. Most of these applications have utilized a small range of drugs with alerts and/or types of alert. The objective of this study was to describe the implementation of a PWS integrated in the electronic medical record (EMR).

METHODS

The PWS was developed in 2003-2004. Pharmacological information to generate drug alerts was entered on demographic data, drug dosage, laboratory tests related to the prescribed drug and drug combinations (interactions, duplications and necessary combinations). The PWS was applied in the prescription reviews conducted in patients admitted to the hospital in 2012.

RESULTS AND DISCUSSION

Information on 83% of the drugs included in the pharmacopeia was introduced into the PWS, allowing detection of 2808 potential DRPs, representing 79·1% of all potential DRPs detected during the study period. Twenty per cent of PWS DRPs were clinically relevant, requiring pharmacist intervention.

WHAT IS NEW AND CONCLUSION

The PWS detected most potential DRPs, thus increasing inpatient safety. The detection ability of the PWS was higher than that reported for other tools described in the literature.

Oxidative pentose phosphate pathway inhibition is a key determinant of antimalarial induced cancer cell death

Despite immense interest in using antimalarials as autophagy inhibitors to treat cancer, it remains unclear whether these agents act predominantly via autophagy inhibition or whether other pathways direct their anti-cancer properties. By comparing the treatment effects of the antimalarials chloroquine (CQ) and quinacrine (Q) on KRAS mutant lung cancer cells, we demonstrate that inhibition of the oxidative arm of the pentose phosphate pathway (oxPPP) is required for antimalarial induced apoptosis. Despite inhibiting autophagy, neither CQ treatment nor RNAi against autophagy regulators (ATGs) promote cell death. In contrast, Q triggers high levels of apoptosis, both in vitro and in vivo, and this phenotype requires both autophagy inhibition and p53-dependent inhibition of the oxPPP. Simultaneous genetic targeting of the oxPPP and autophagy is sufficient to trigger apoptosis in lung cancer cells, including cells lacking p53. Thus, in addition to reduced autophagy, oxPPP inhibition serves as an important determinant of antimalarial cytotoxicity in cancer cells.

Economic analysis of thrombo inCode, a clinical-genetic function for assessing the risk of venous thromboembolism

BACKGROUND

Patients with venous thromboembolism (VTE) commonly have an underlying genetic predisposition. However, genetic tests nowadays in use have very low sensitivity for identifying subjects at risk of VTE. Thrombo inCode(®) is a new genetic tool that has demonstrated very good sensitivity, thanks to very good coverage of the genetic variants that modify the function of the coagulation pathway.

OBJECTIVE

To conduct an economic analysis of risk assessment of VTE from the perspective of the Spanish National Health System with Thrombo inCode(®) (a clinical-genetic function for assessing the risk of VTE) versus the conventional/standard method used to date (factor V Leiden and prothrombin G20210A).

METHODS

An economic model was created from the National Health System perspective, using a decision tree in patients aged 45 years with a life expectancy of 81 years. The predictive capacity of VTE, based on identification of thrombophilia using Thrombo inCode(®) and using the standard method, was obtained from two case-control studies conducted in two different populations (S. PAU and MARTHA; 1,451 patients in all). Although this is not always the case, patients who were identified as suffering from thrombophilia were subject to preventive treatment of VTE with warfarin, leading to a reduction in the number of VTE events and an increased risk of severe bleeding. The health state utilities (quality-adjusted life-years [QALYs]) and costs (in 2013 EUR values) were obtained from the literature and Spanish sources.

RESULTS

On the basis of a price of EUR 180 for Thrombo inCode(®), this would be the dominant option (more effective and with lower costs than the standard method) in both populations. The Monte Carlo probabilistic analyses indicate that the dominance would occur in 100 % of the simulations in both populations. The threshold price of Thrombo inCode(®) needed to reach the incremental cost-effectiveness ratio (ICER) generally accepted in Spain (EUR 30,000 per QALY gained) would be between EUR 3,950 (in the MARTHA population) and EUR 11,993 (in the S. PAU population).

CONCLUSION

According to the economic model, Thrombo inCode(®) is the dominant option in assessing the risk of VTE, compared with the standard method currently used.

Economic evaluation of Cardio inCode®, a clinical-genetic function for coronary heart disease risk assessment

BACKGROUND

A clinical–genetic function (Cardio inCode®) was generated using genetic variants associated with coronary heart disease (CHD), but not with classical CHD risk factors, to achieve a more precise estimation of the CHD risk of individuals by incorporating genetics into risk equations [Framingham and REGICOR (Registre Gironí del Cor)].

OBJECTIVE

The objective of this study was to conduct an economic analysis of the CHD risk assessment with Cardio inCode®, which incorporates the patient’s genetic risk into the functions of REGICOR and Framingham, compared with the standard method (using only the functions).

METHODS

A Markov model was developed with seven states of health (low CHD risk, moderate CHD risk, high CHD risk, CHD event, recurrent CHD, chronic CHD, and death). The reclassification of CHD risk derived from genetic information and transition probabilities between states was obtained from a validation study conducted in cohorts of REGICOR (Spain) and Framingham (USA). It was assumed that patients classified as at moderate risk by the standard method were the best candidates to test the risk reclassification with Cardio inCode®. The utilities and costs (€; year 2011 values) of Markov states were obtained from the literature and Spanish sources. The analysis was performed from the perspective of the Spanish National Health System, for a life expectancy of 82 years in Spain. An annual discount rate of 3.5 % for costs and benefits was applied.

RESULTS

For a Cardio inCode® price of €400, the cost per QALY gained compared with the standard method [incremental cost-effectiveness ratio (ICER)] would be €12,969 and €21,385 in REGICOR and Framingham cohorts, respectively. The threshold price of Cardio inCode® to reach the ICER threshold generally accepted in Spain (€30,000/QALY) would range between €668 and €836. The greatest benefit occurred in the subgroup of patients with moderate–high risk, with a high-risk reclassification of 22.8 % and 12 % of patients and an ICER of €1,652/QALY and €5,884/QALY in the REGICOR and Framingham cohorts, respectively. Sensitivity analyses confirmed the stability of the study results.

CONCLUSIONS

Cardio inCode® is a cost-effective risk score option in CHD risk assessment compared with the standard method.

Undernutrition upregulates fumarate hydratase in the rat nucleus accumbens

Previous comparative studies of fumarate hydratase (FH) protein density revealed that the enzyme was overexpressed in the striatum of rodents that are less influenced by rewarding stimuli, from cocaine to food. Therefore, we recently proposed FH as a potential striatal biomarker of brain reward deficiency and addiction vulnerability. This work has been focused to investigate FH activity in the Nucleus Accumbens (NAc) of undernourished rats, taking into account that malnutrition has been related to increased responsiveness to food and drug reward. To this end, we have studied adult female Wistar rats severely food restricted from the 16th day of intrauterine life until adulthood. Animals were sacrificed to dissect the NAc and obtain mitochondrial and cytosolic fractions after homogenisation and centrifugation. FH activity was measured by conversion of malate to fumarate, and protein levels were compared by Western blot analysis when fractions showed differences in activity. Undernutrition did not change cytosolic FH activity but led to a marked increase of mitochondrial FH activity (72 %) and protein content (50 %) in the NAc. This change was in the opposite direction that one would predict if it was related to addiction vulnerability of some kind, but strongly suggests that mitochondrial FH needs to be at some optimal level for normal reward responsiveness.

[Epidemiological profile of late mortality in severe polytraumatisms]

OBJECTIVE

A study is made of the epidemiology, chronogramand causes of late mortality in traumatized patients.

DESIGN

A prospective, observational cohort study of adult trauma patients was carried out.

SETTINGS

Province of Guipúzcoa (Basque Country, Spain). Intensive care unit of a tertiary hospital.

PATIENTS

Patients with severe trauma (Injury Severity Score > 15), admitted to the ICU from January 1995 to December 2009, with late death (> 7 days).

VARIABLES

Epidemiological, laboratory test, hemodynamic and transfusional data were collected. Severity scores: Abbreviated Injury Scale (AIS) and ISS.

RESULTS

Patients: 2003; ISS: 24.3±14.2. Total deaths: 405 (20%). Late mortality (>7 days): 102 (25.2%) patients, 9 years older and with a lower (18 points) ISS score than the patients who died early (48 hours). Most frequent injuries: AIS-Head-Cervical spine ≥ 4 (52%); AIS-Abdomen ≥ 4 (19.6%); AIS-Chest ≥ 4 (11.7%); AIS-Extremities ≥ 4 (4.9%). Causes of death: 1) brain death (14.7%); 2) multiorgan failure (67.6%), in two injury contexts: a) severe brain trauma in the vegetative state and high spinal cord injuries with tetraplegia (35.3%); and b) non-neurological injuries (32.3%) with a high prevalence of hypovolemic shock, multiple transfusion and coagulopathy; 3) miscellaneous (10.7%): post-resuscitation anoxic-ischemic encephalopathy, pulmonary embolism and massive stroke; 4) non-evaluable (7%).

CONCLUSIONS

Age, severity and type of injuries have an influence upon the time distribution and causality of late mortality. Brain death remains predominant, with multiorgan failure as the most frequent cause. This knowledge should contribute to the identification of problems, and to better organization of the structural and educational resources, thereby reducing the likely factors leading to death from trauma.

Factors associated with adherence to guidelines for the use of tigecycline in a tertiary care hospital

We assessed the adherence to the prescribing hospital protocol for tigecycline and factors associated with noncompliance. A total of 103 patients were included in the study. In 23 (22.3%) patients, tigecycline was not administered according to the protocol, mostly because of the availability of other therapeutic alternatives and prescription for indications that were not included in the guidelines. factors independently associated with nonadherence to the protocol were community-acquired infection (OR, 14.01; 95% CI, 1.54-127.12; P=0.019), and empirical tigecycline treatment (OR, 6.97; 95% CI, 0.88-55.40; P=0.066). penicillin allergy (OR, 0.004; 95% CI, 0.000-0.071; P=0.001) and previous antibiotic treatment (OR, 0.025; 95% CI, 0.003-0.233; P=0.001) were factors associated with adherence to the hospital protocol. A positive time trend between total number of prescriptions and non-compliant prescriptions with the protocol was observed (Spearman's rho coefficient 0.971; P=0.001). Adherence to tigecycline protocol could be improved by focusing on protocols for community-acquired infections, mainly skin and soft tissue infections.

Potentially modifiable risk factors for adverse pregnancy outcomes in women with psoriasis

BACKGROUND

Data on pregnancy outcomes among women with psoriasis are lacking. However, there are several known comorbidities of psoriasis, including obesity, smoking and depression, each of which increases the risk for negative birth outcomes.

OBJECTIVES

To determine if pregnant women with psoriasis have an excess of potentially modifiable risk factors for adverse pregnancy outcomes.

METHODS

Prospectively collected data from the Organization of Teratology Information Specialists (OTIS) Autoimmune Diseases in Pregnancy Project were analysed to compare the prevalence of selected risk factors between 170 pregnant women with psoriasis and 158 nondiseased controls.

RESULTS

Women with psoriasis were more likely to be overweight/obese prior to pregnancy (P < 0.0001), to smoke (P < 0.0001), or to have a diagnosis of depression (P = 0.03), and were less likely to have been taking preconceptional vitamin supplements (P = 0.004). After controlling for race/ethnicity and socioeconomic status, women with psoriasis were 2.37 (95% confidence interval 1.45-3.87) times more likely to be overweight/obese as women without psoriasis. Duration of disease, age at onset, measures of disease impact during pregnancy, or use of biologics in pregnancy were not significant predictors of overweight/obesity in the subset of psoriatic women.

CONCLUSIONS

Pregnant women with psoriasis may be at increased risk for adverse pregnancy outcomes due to comorbidities or other health behaviours associated with the disease. These should be taken into consideration during clinical treatment of women with psoriasis who are in their childbearing years.

Matrix superhighways configurations: new concepts for complex organ regeneration

New ideas and experimental models for tissue and organ regeneration are urgently needed. There are several exciting challenges in the field of organogenesis that need to be defined. The integrated signals and molecular repertoires that shape the particular architecture of specific organs like the kidney or the liver are not completely understood yet. To develop a new scientific platform to be able to build up complex organs we have established a research program using basically Acellular Xenogeneic Isomorphic Matrices (AXIMs) and mesenchymal stem cells (MSCs) generating the necessary concepts for the definition, production, and application of the specific configurations of these matrices for organ regeneration. New and interesting pathways for MSC differentiation were identified. We believe that all extracellular matrices were created fundamentally equal or at least very similar in nature. We also believe that there are true "matrix superhighway configurations" with different three-dimensional geometrical architectures as well as biochemical, electrical, and molecular properties that are tissue and organ specific that influence cell differentiation and organogenesis and will be fundamental for the in vitro regeneration of complex organs for transplantation.

A novel anti-ischemic nitric oxide donor (LA419) reduces thrombogenesis in healthy human subjects

BACKGROUND

Platelet and endothelial production of nitric oxide (NO) is known to be impaired in coronary artery disease patients. Compounds that release NO (e.g. nitrates) have antiplatelet effects, but at supratherapeutic doses with hypotensive side effects.

OBJECTIVES

To investigate the antithrombotic effect on human blood of a novel NO donor (LA419) with known anti-ischemic properties but without hypotensive side effects and to compare with abciximab.

PATIENTS/METHODS

Healthy subjects (n = 8; 32 +/- 3 years) received daily aspirin starting three days prior to the study day. Treatments (LA419 10 and 20 microm, and abciximab 4 microm) were added ex vivo to non-anticoagulated blood, and the antithrombotic properties were assessed by measuring changes in thrombus size from pretreatment baseline in the Badimon perfusion chamber at low and high shear rates. Platelet surface adhesion using a Cone and Platelet Analyzer (CPA) and platelet fibrinogen-receptor activation with flow cytometry were also evaluated.

RESULTS

At low shear rates, LA419 displayed a reduction in thrombus area of 43% +/- 8% (10 microm) and 56% +/- 6% (20 microm), whereas at high shear rates the reductions were 44% +/- 3% (10 microm) and 62% +/- 6% (20 microm). Platelet surface adhesion with the CPA was also reduced. Abciximab exhibited a strong inhibitory effect on thrombus formation, platelet surface adhesion and fibrinogen receptor activation.

CONCLUSIONS

The novel NO donor, LA419, shows a strong antithrombotic effect in human blood, which is comparable to abciximab, especially under high shear rate conditions. Our observations suggest that the availability of an NO donor could prove beneficial in the prevention of thrombotic complications of cardiovascular disease. Further clinical studies are warranted.

Ischemic Preconditioning and Kidney Transplantation: In Vivo Nitric Oxide Monitoring in a Rat Ischemia-Reperfusion Experimental Model

Direct nitric oxide measurement in live tissue would help us to understand its role in ischemia-reperfusion injury and its relationship to ischemic preconditioning (IP). We constructed four experimental groups of ischemia-reperfusion in the rat kidney: G1 were controls; G2, 1 hour of renal ischemia; G3 and G4: one or two 15/10 minute cycles, respectively, of IP prior to 1 hour of ischemia. Real-time in vivo nitric oxide measurements were compared with functional parameters of kidney damage at 24 hours. The peaks of nitric oxide production in the IP periods increased less in the rising curve of nitric oxide production during the 1 hour ischemia time. No improvement in the IP groups was observed based on serum creatinine levels at 24 hours.