Knowledge and Awareness about Systemic Effects of Periodontal Disease among Medical, Dental and Alternate Medical Practitioners and Their Referral Practice to Periodontists

In the past few decades, many medical professionals and dentists have paid close notice to their own fields, specializing in medicine pertaining to body and oral cavity respectively. Currently, this void is rapidly closing between all medical specialties, in presence of significant findings that supports association between periodontal disease and systemic conditions. Till now, some practitioners are not aware about the specialties of dentistry that results in improper referral practices. There are few studies on referral practice pertaining to periodontist, not with standing the fact that clear and effective communication between all health practitioners is essential for good practice. A cross-sectional study was carried out to assess the knowledge and awareness about systemic effects of periodontal disease among medical, dental and alternate medical practitioners and their referral practice to periodontist in Kanpur city. This cross-sectional study was carried out using self-reported questionnaire, distributed to 560 practitioners of various medical fields from January 2020 to August 2021. A total of 206(36.8%) Medical, 194(34.6%) Dentists and 160(28.6%) alternative practitioners participated in study. More than half participants agreed about relationship between periodontal diseases and Diabetes Mellitus, Cardio-VascularDisease and Adverse Pregnancy Outcomes. Among all 31.3% showed good knowledge level while 2.7% showed perfect level of practitioner's referral practice to periodontist. Dentists had statistically higher level of awareness compared to physicians. Referral practice to periodontist was deficit by medical and alternate medical practitioners despite of fact; they have good knowledge of relationship between periodontal disease and systemic health. Hence, interdisciplinary dental and medical training of practitioners is recommended.

P-203 Searching for the optimal timing of intracytoplasmic sperm injection post oocyte retrieval: a systematic review and meta-analysis

Study question

What is the optimal time post oocyte retrieval (POR) to undertake intracytoplasmic sperm injection (ICSI) in order to maximise subsequent pregnancy and live birth outcomes?

Summary answer

Delaying ICSI for 5 hours or more POR may compromise subsequent clinical pregnancy and live birth rates.

What is known already

It is often challenging to perform ICSI at a set timing POR, especially in ART clinics with a heavy workload. However, the degree of flexibility in ICSI timing remains unclear in the literature. Some articles have reported detrimental impacts by delaying ICSI on the subsequent treatment outcomes (Pujol et al 2018), while others reported no evidence of adverse effects caused by different ICSI timings (Vandenberghe et al 2021). Therefore, we aimed to explore a “safety time window” for ICSI procedures to enable flexibility in workflow arrangement without compromising pregnancy outcomes.

Study design, size, duration

A systematic review and meta-analysis were performed according to PRISMA guidelines, with protocol registered with PROSPERO (ID: CRD42022296838). The studies were searched for in PubMed, MEDLINE, EMBASE and the Cochrane Library on 16 December 2021, using (“subfertile” OR “sub-fertile” OR “infert*” OR “fertility treatment” OR “women” OR “female” OR “couple”) AND (“ICSI” OR “intracytoplasmic sperm injection” OR “intra-cytoplasmic sperm injection”) AND (“timing” OR “time interval”) AND (“pregnancy” OR “fertili*” OR “birth”) NOT (Review [Publication Type]).

Participants/materials, setting, methods

Two independent reviewers systematically evaluated each study on patient, intervention, comparison, and outcome (PICO). The Newcastle-Ottawa scale was used for risk of bias assessment in non-randomised trials and observational studies. Further screening was performed separately by the two independent reviewers, with differences mediated by the third reviewer. Data extraction was performed according to Cochrane methods. Clinical pregnancy or live birth data were synthesised from eligible studies depending on availability of raw data in corresponding subgroups.

Main results and the role of chance

A total of 605 records were hit in the search. After initial exclusion according to PICO, 30 articles were included for further screening for eligibility. For meta-analysis, 4 retrospective cohort studies were eventually included for clinical pregnancy rate assessment while 2 for live birth rate analysis. Due to different groupings in ICSI timing amongst these studies, a series of comparisons on ICSI timings with a cut-off at an hourly increment were set up to pool data from the 4 included studies where applicable. Clinical pregnancy rates were comparable when ICSI was performed (a) 2+ hours (n = 6448, Relative Risk or RR = 1.031, 95% CI 0.964-1.102) in reference to < 2 hours POR (n = 2336), (b) 3+ hours (n = 5101, RR = 1.005, 95% CI 0.945-1.069) in reference to < 3 hours POR (n = 3465), and (c) 4+ hours (n = 3192, RR = 1.017, 95% CI 0.956-1.082) in reference to < 4 hours POR (n = 5374). However, clinical pregnancy rates were significantly compromised when ICSI was performed at 5+ hours (n = 2335, RR = 1.103, 95% CI 1.036-1.175) in reference to < 5 hours POR (n = 7169). Similarly, live birth rate was also significantly reduced when ICSI was performed 5+ hours (n = 2335, RR = 1.155, 95% CI 1.070-1.246) in reference to < 5 hours POR (n = 7169).

Limitations, reasons for caution

All studies included for meta-analysis were retrospective with heterogeneity. There were various groupings amongst studies due to the wide range of ICSI timings POR, which limits data pooling and subsequent comparisons. A future well designed randomised controlled trial is warranted for further analysis based on better quality evidence.

Wider implications of the findings

Our results indicate 5 hours POR should be considered the maximum time limit to perform ICSI. This finding, supported by statistics with improved power through meta-analysis, offers valuable guidance to busy clinics. This information could both improve pregnancy outcomes and allow better workflow arrangements without compromising them.

Trial registration number

not applicable

O03 ST97 Staphylococcus aureus and oxacillin resistance: an emerging challenge for microbiologists?

Background

The presence of cefoxitin and oxacillin resistance in Staphylococcus aureus isolates is suggestive of methicillin resistance (MRSA) with molecular detection of the mecA or mecC genes providing confirmation. The UK SMI and EUCAST guidelines for MRSA detection describe a subset of strains that exhibit reduced susceptibility to oxacillin and cefoxitin, though negative for mecA and mecC genes—frequently named borderline oxacillin-resistant S. aureus (BORSA). Local data noted a number of S. aureus isolates that matched the above phenotype leading to laboratory, clinical and epidemiological questions.

Methods

Routine samples were collected between August 2020 and April 2021 at West Midlands Health Security Agency Laboratory, Birmingham. If provisional results suggested an MRSA isolate, the following confirmatory tests were undertaken. Locally, clinical samples underwent susceptibility testing with cefoxitin disc diffusion and oxacillin gradient diffusion (MRSA screens) or Vitek 2 (non-MRSA screens). Isolates with discrepant results [susceptible to cefoxitin; resistant to oxacillin (MIC >2 mg/L) or vice versa] were sent to the reference laboratory at Colindale, UK for further testing, which included mecA or mecC gene detection by PCR and serotyping with Illumina sequencing for all isolates.

Results

In total, 53 isolates were sent to the reference lab of which 22 were confirmed to have an ST97 serotype. All 53 were negative by PCR for mecA and mecC genes. For the 22 isolates of ST97, local oxacillin MIC values ranged from 2 to 6 mg/L. Cefoxitin susceptibility was confirmed locally in all isolates. The 22 isolates were from 15 patients; wound swabs (n = 18); blood culture (n = 1), sputum (n = 1) and MRSA screen (n = 2). Median patient age was 48 years (IQR 38–59) with 5 being female and 10 male. A history of injecting drug use was documented in 53% (8/15).

Conclusions

BORSA remains a problem from a laboratory, clinical and infection control perspective. This work raises two important questions: what is the most appropriate local laboratory testing pathway and what is the clinical relevance of these isolates (i.e. can flucloxacillin be relied upon in treatment)? The ST97 serotype appears to be associated with skin and soft tissue infection and may be linked to people who inject drugs.

E-Cigarettes and myocardial Infarction: a systemic review and meta-analysis

Funding Acknowledgements

Type of funding sources: None.

Introduction

With widespread awareness about the harmful effects of traditional smoking, many people are considering the use of an e-cigarette. However, there are many studies which have shown  e-cigarettes is not entirely harmless and it’s use has been implication in causing major adverse cardiovascular events.

Methodology

This systemic review strictly adhered to the PRISMA checklist. An electronic search was conducted comprehensively through five databases to find the relevant articles. The odds ratio (OR) was used for comparing groups. Meta-analysis was conducted using R statistical software version 3.4.3. A random-effect model was used.

Results

A total of 4 studies were included in the analysis incorporating data on 585,306 subjects. In these, 19,435 were e-cigarettes users, while 1693 used only traditional cigarette users, and 553,095 were non-e-cigarette users. A total of 7.0% of e-cigarette users suffered an MI in their lifetime, while only 6.5% of non-e-cigarette users have had MI. The OR of getting an MI in e-cigarettes users was 1.30 (95% CI = 1.23-1.38, p-value < 0.01) in comparison to non e-cigarette users. While it is 0.61 (95% CI = 0.40 – 0.93, p-value 0.02) when compared with traditional smoking.

Conclusion

Those using e-cigarettes have a higher odds of suffering from an MI in comparison to not using e-cigarettes. However, using e-cigarettes reduces the risk of MI by half in comparison to traditional smoking.

Abstract Figure. Forest plot

A Preliminary Study on the Evaluation of In-vitro Inhibition Potential of Antimicrobial Efficacy of Raw and Commercial Honey on Escherichia coli: An Emerging Periodontal Pathogen

Periodontitis, a multiple pathogen disease has the latest addition to the family i.e. Escherichia coli as a potential and emerging periodontal pathogen owing to its lipopolysaccharide more potent than Porphyromonas gingivalis, which makes it an emerging threat in periodontal disease. The role of antimicrobial agents in the management of periodontal diseases is of utmost importance. However, in the present scenario, antibiotic resistance is a public health concern now and there are very few options left for treatment. So, honey, a pioneer in traditional medicine was tried in the treatment against Escherichia coli to evaluate and compare the "in-vitro" antibacterial activity and efficacy of raw and commercial honey at different concentrations in comparison to tetracycline as a control on patient-isolated Escherichia coli and the American Type Culture Collection (ATCC) Escherichia coli 25922 strain from 5th Aug 2018 to 15th Feb 2019 at the Department of Microbiology, Rama Medical College, Kanpur (UP), India. In the in-vitro study different concentrations (100%, 75%, 50% and 25% v/v) of raw and commercial honey were studied and sensitivity tests were used to evaluate their antibacterial effect on patient-isolated Escherichia coli and the ATCC Escherichia coli 25922 strain. Minimum inhibitory concentration (MIC) and Minimum bactericidal concentration (MBC) were also determined for raw honey, and commercial honey in comparison to tetracycline. In case of raw honey, zone of inhibition was seen at 100%, 75% and 50% concentration, with maximum inhibition being 27±1.154mm and 23±0.666mm for patient-isolated Escherichia coli and ATCC Escherichia coli 25922 strain respectively at 100% concentration, whereas, the commercial honey was effective only at 100% and 75% concentration, with maximum inhibition zone of 13±1.054mm and 17±0.942mm at 100% concentration on patient-isolated Escherichia coli and ATCC Escherichia coli 25922 strain respectively. However, no effect was observed at 25% concentration for both raw and commercial honey. The MIC and MBC of raw and commercial honey were determined by the broth dilution method, where raw honey exhibited both MIC and MBC at 512 mg/ml whereas, and commercial honey exhibited MIC at 512mg/ml and MBC at 1024 mg/ml respectively. While comparing the zone of inhibition of raw and commercial honey, it was observed that the raw honey showed almost equivalent potency and efficacy as compared to a positive control tetracycline (2.5%). There was statistically significant difference (p≤0.01) in zone of inhibition of raw and commercial honey at 100% concentration on patient-isolated Escherichia coli and ATCC Escherichia coli 25922 strain. Antimicrobial activity of raw honey at 100% concentration was equivalent to that of tetracycline and was significantly better than commercial honey.

Recent advances on mycotic keratitis caused by dematiaceous hyphomycetes

Dematiaceous hyphomycetes (DH) are darkly pigmented fungi ubiquitously found all over the world as plant pathogens and saprophytes, and many of the members of this group have emerged as opportunistic pathogens. These fungi are responsible for a wide variety of infections including mycotic keratitis, which is considered as one of the major causes of corneal blindness, particularly in tropical and subtropical countries with an annual global burden of about 1 000 000 patients. The infection is more common in workers working in an outdoor environment. Moreover, trauma is found to be the most important predisposing cause of mycotic keratitis. Considerable delay in diagnosis and scarcity of effective pharmacological drugs are the major factors responsible for increased morbidity and visual impairment. Considering the crucial role of DH in mycotic keratitis, in the present review, we have focused on major DH with special emphasis on their pathogenicity, diagnosis and treatment strategies.

Rpb4 and Puf3 imprint and post-transcriptionally control the stability of a common set of mRNAs in yeast

Gene expression involving RNA polymerase II is regulated by the concerted interplay between mRNA synthesis and degradation, crosstalk in which mRNA decay machinery and transcription machinery respectively impact transcription and mRNA stability. Rpb4, and likely dimer Rpb4/7, seem the central components of the RNA pol II governing these processes. In this work we unravel the molecular mechanisms participated by Rpb4 that mediate the posttranscriptional events regulating mRNA imprinting and stability. By RIP-Seq, we analysed genome-wide the association of Rpb4 with mRNAs and demonstrated that it targeted a large population of more than 1400 transcripts. A group of these mRNAs was also the target of the RNA binding protein, Puf3. We demonstrated that Rpb4 and Puf3 physically, genetically, and functionally interact and also affect mRNA stability, and likely the imprinting, of a common group of mRNAs. Furthermore, the Rpb4 and Puf3 association with mRNAs depends on one another. We also demonstrated, for the first time, that Puf3 associates with chromatin in an Rpb4-dependent manner. Our data also suggest that Rpb4 could be a key element of the RNA pol II that coordinates mRNA synthesis, imprinting and stability in cooperation with RBPs.

Transrectal Subharmonic Ultrasound Imaging for Prostate Cancer Detection

OBJECTIVE

To assess the prostate cancer (CaP) detection rates of contrast-enhanced, transrectal subharmonic ultrasound imaging (SHI).

MATERIALS AND METHODS

This IRB-approved study enrolled 55 subjects. The initial 5 subjects were studied for SHI optimization, while the remaining 50 were evaluated with contrast-enhanced sonography using continuous SHI, color, and power Doppler as well as conventional grayscale, continuous color, and power Doppler and SHI combined with maximum flash replenishment. A maximum of 6 directed biopsy cores were obtained from sites of greatest asymmetrical enhancement, followed by spatially distributed cores in a double sextant distribution. Subharmonic time-intensity parameters, including time to peak intensity, peak intensity, and estimated perfusion were also evaluated for each directed biopsy core. Receiver operating characteristic curve analysis and conditional logistic regression were employed to assess the benefit of each modality and the quantitative SHI parameters.

RESULTS

Cancer was detected in 22 of 50 subjects. Among subjects with clinically significant CaP (n = 11), targeted cores were more likely to be positive (odds ratio 1.39, P = .02). The majority of patients detected by SHI demonstrated significant CaP (5/8); SHI remained an independent marker of malignancy in a multivariate logistic regression model (P = .027). Receiver operating characteristic curve analysis of imaging findings compared to biopsy results yielded diagnostic accuracies ranging from 0.59 to 0.80 for all imaging modalities with the highest being for quantitative subharmonic perfusion estimates.

CONCLUSION

This first-in-humans study provides a preliminary estimate of the diagnostic accuracy of SHI for detection of clinically significant CaP (up to 80%).

Hemin, a heme oxygenase-1 inducer, restores the attenuated cardioprotective effect of ischemic preconditioning in isolated diabetic rat heart

BACKGROUND

Attenuated cardioprotective effect of ischemic preconditioning (IPC) by reduced nitric oxide (NO) is a hallmark during diabetes mellitus (DM). Recently, we reported that the formation of caveolin-endothelial nitric oxide synthase (eNOS) complex decreases the release of NO, which is responsible for attenuation of IPC-induced cardioprotection in DM rat heart. Heme oxygenase-1 (HO-1) facilitates release of NO by disrupting caveolin-eNOS complex. The activity of HO-1 is decreased during DM. This study was designed to investigate the role of hemin (HO-1 inducer) in attenuated cardioprotective effect of IPC in isolated diabetic rat heart.

METHODS

DM was induced in male Wistar rat by single dose of streptozotocin. Cardioprotective effect was assessed in terms of myocardial infarct size and release of lactate dehydrogenase and creatine kinase in coronary effluent. The release of NO was estimated indirectly by measuring the release of nitrite in coronary effluent. Perfusion of sodium nitrite, a precursor of NO, was used as a positive control.

RESULT

IPC-induced cardioprotection and increased release of nitrite were significantly attenuated in a diabetic rat as compared to a normal rat. Pretreatment with hemin and daidzein, a caveolin inhibitor, alone or in combination significantly restored the attenuated cardioprotection and increased the release of nitrite in diabetic rat heart. Zinc protoporphyrin, a HO-1 inhibitor, significantly abolished the observed cardioprotection and decreased the release of nitrite in hemin pretreated DM rat heart.

CONCLUSION

Thus, it is suggested that hemin restores the attenuated cardioprotective effect in diabetic rat heart by increasing the activity of HO-1 and subsequently release of NO.

X-ray spectromicroscopy investigation of soft and hard breakdown in RRAM devices

Resistive random access memory (RRAM) is considered an attractive candidate for next generation memory devices due to its competitive scalability, low-power operation and high switching speed. The technology however, still faces several challenges that overall prohibit its industrial translation, such as low yields, large switching variability and ultimately hard breakdown due to long-term operation or high-voltage biasing. The latter issue is of particular interest, because it ultimately leads to device failure. In this work, we have investigated the physicochemical changes that occur within RRAM devices as a consequence of soft and hard breakdown by combining full-field transmission x-ray microscopy with soft x-ray spectroscopic analysis performed on lamella samples. The high lateral resolution of this technique (down to 25 nm) allows the investigation of localized nanometric areas underneath permanent damage of the metal top electrode. Results show that devices after hard breakdown present discontinuity in the active layer, Pt inclusions and the formation of crystalline phases such as rutile, which indicates that the temperature increased locally up to 1000 K.

The Clinical and Histological Effects of Ethanolamine in Varicose Veins

Objective:

To study the histological changes in varicosities after injection of 5% ethanolamine.

Design:

A prospective study in nine groups of six patients awaiting bilateral varicose vein surgery.

Patients:

Each patient had a below-knee incompetent perforating vein injected with either 0.5, 1.0 or 2.0 ml 5% ethanolamine. The contralateral varicosity received a similar volume of normal saline.

Intervention:

The patients wore elasticated stockings until admitted for operation at 2, 4 or 8 weeks after the injections. The injected varicosity was then dissected out.

Main outcome measures:

Each vein was reported on by a histologist who did not know which had received ethanolamine or saline. The histologist graded each vein according to the severity of change from 0 (no effect) to 5 (total obliteration of vein).

Results:

Ethanolamine at 0.5, 1.0 and 2.0 ml caused extensive histological damage to the varicosity. After 8 weeks most varicosities had been destroyed.

Conclusion:

Ethanolamine, unlike sodium tetradecyl sulphate, causes complete destruction of a varicosity. A dose of 0.5 ml is just as effective as 2.0 ml.

Meticillin-resistant Staphylococcus aureus and meticillin-susceptible Staphylococcus aureus screening in a cohort of haemodialysis patients: carriage, demographics and outcomes

BACKGROUND

Patients on haemodialysis are vulnerable to colonization with Staphylococcus aureus due to frequent hospital contact, indwelling devices, and impaired immunity. Additionally colonization is associated with increased risk of infection.

AIM

To determine the prevalence of both meticillin-resistant S. aureus (MRSA) and meticillin-susceptible S. aureus (MSSA) carriage in our haemodialysis cohort and to identify any risk factors predisposing to carriage, recolonization, or persistent carriage following a decolonization programme.

METHODS

All haemodialysis patients screened for S. aureus carriage between June 2009 and May 2011 were retrospectively followed up for 18 months using hospital electronic records. Statistical analysis was performed using IBM SPSS version 19.

FINDINGS

Out of 578 patients screened, 288 patients (49%) had at least one positive swab (10% MRSA, 90% MSSA). Of these patients, 265 completed a course of decolonization therapy following which 36% successfully eradicated (eradicators) and 64% did not (non-eradicators). There was no statistically significant difference in patient demography, type of vascular access, 18-month patient mortality, or number of hospital admissions between the two groups. Those who failed to eradicate were more likely to have had an episode of S. aureus bacteraemia within the study period compared to those who successfully decolonized (P = 0.003).

CONCLUSION

Half of our haemodialysis cohort was colonized with S. aureus at any one time over an 18-month period. Following decolonization, one-third of patients remained successfully eradicated for 18 months. Non-eradicators have an increased risk of bacteraemia, which is associated with poor mortality. We would recommend routine screening and aggressive attempts to decolonize.

Abstract P6-04-16: TGF-b2, a novel target of CD44-promoted breast cancer invasion

Hyaluronan (HA) mediates communication between cancer cells and the environment via interactions with the cell surface receptor CD44. We have previously shown that CD44-HA interaction in BC cells promotes adhesion to bone marrow endothelial cells. This suggests that HA/CD44 signalling may be correlated with breast cancer (BC) metastasis. The long-term objective of this study is to increase our understanding of the mechanisms by which CD44-HA interaction promotes BC metastasis, and further identify and validate CD44-downstream transcriptional targets for anti-metastatic therapy.

Pursuant to this goal, we have developed a tetracycline (tet)-regulated expression of CD44 gene in the BC cell line MCF-7 (B5 clone) and identified TGF-beta2 (Transforming Growth Factor beta-2; 3 fold induction) as a potential CD44s-downstream transcriptional target by microarray analysis. To further validate this finding, the same RNA samples, used for microarray analysis and their corresponding protein lysates collected from the BC cell line MCF-7-B5, were examined for CD44 expression in the presence of HA for 18, 24, and 48 hr post-tet withdrawal. Expression of TGF-beta 2 was examined using RT-PCR and western-Blot analyses.

Our results showed that TGF-beta2 mRNA levels were significantly elevated following the removal of tet at 18, 24, and 48 h post-HA stimulation compared to the parental cells. Furthermore, the TGF-beta2 precursor protein increased in a time-dependent pattern upon HA-stimulation and in the absence of tet. More interestingly, inhibition of CD44 gene by RNAi method decreased TGF-beta2 expression upon HA-stimulation and in the absence of tet.

Our data strongly support the hypothesis that TGF-beta2 is a potential target of HA/CD44- downstream-signaling mediating BC cell invasion. Ongoing investigation aims to elucidate the signal transduction pathways coupling CD44 to the regulation of TGF-beta2 expression, and further validate CD44/TGF-beta2 axes in breast tumor invasion and metastasis.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-04-16.

Abstract P4-06-16: TGF-β2, A Novel Target of CD44-Promoted Breast Cancer Invasion

Background: Hyaluronan (HA) mediates communication between cancer cells and the environment via interactions with the cell surface receptor CD44. We have previously shown that CD44-HA interaction in BC cells promotes adhesion to bone marrow endothelial cells. This suggests that HA/CD44 signalling may be correlated with breast cancer (BC) metastasis. The long-term objective of this study is to increase our understanding of the mechanisms by which CD44-HA interaction promotes BC metastasis, and further identify and validate CD44-downstream transcriptional targets for anti-metastatic therapy.

Materials & Methods: Pursuant to this goal, we have developed a tetracycline (tet)-regulated expression of CD44 gene in the BC cell line MCF-7 (B5 clone) and identified TGF-β2 (Transforming Growth Factor beta-2; 3 fold induction) as a potential CD44s-downstream transcriptional target by microarray analysis. To further validate this finding, the same RNA samples, used for microarray analysis and their corresponding protein lysates collected from the BC cell line MCF-7-B5, were examined for CD44 expression in the presence of HA for 18, 24, and 48 hr post-tet withdrawal. Expression of TGF-β2 was examined using RT-PCR and western-Blot analyses.

Results: Our results showed that TGF-β2 mRNA levels were significantly elevated following the removal of tet at 18, 24, and 48 h post-HA stimulation compared to the parental cells. Furthermore, the TGF-β2 precursor protein increased in a time-dependent pattern upon HA-stimulation and in the absence of tet. More interestingly, inhibition of CD44 gene by RNAi method decreased TGF-β2 expression upon HA-stimulation and in the absence of tet.

Conclusion: Our data strongly support the hypothesis that TGF-β2 is a potential target of HA/CD44- downstream-signaling mediating BC cell invasion. Ongoing investigation aims to elucidate the signal transduction pathways coupling CD44 to the regulation of TGF-β2 expression, and further validate CD44/TGF-β2 axes in breast tumor invasion and metastasis.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-06-16.

Abstract P4-06-14: CD146-suppresses breast tumor invasion via a novel transcription target TIMPv

The function of the cell adhesion receptor CD146, a recently discovered marker of endothelial cells and a tumor promoter of melanoma and other cancers, is controversial in breast cancer (BC). However several lines of evidence supports its role as a tumor suppressor in BC. Further, the molecular mechanisms underpinning this suppression are unknown, neither has the ligand for CD146 been identified. Using a novel validated Enhanced Green Fluorescent Protein (EGFP)-inducible systems of CD146 expression both in vitro and in vivo, we provide here molecular and functional evidence of CD146 and its novel transcriptional target TIMPv (a variant of tissue inhibitor of metallo-proteinases) in underpinning the suppression of BC invasion.

Tetracycline (tet-on) CD146 system was developed in both MCF-7 and MDA-231 BC founder cell lines, and validated using time course RT-PCR and western blot analyses, and fluorescent microscopy. In functional experiments, induction of CD146 inhibited BC cell migration and invasion. TIMPv, the only endogenous protein inhibitor known for metallocarboxypeptidases, was identified by expression profiling as a novel transcriptional target of CD146-signaling, an association validated by quantitative PCR and immunoblotting experiments in a range of breast and melanoma cancer cells. However, siRNA inhibition of CD146 in the SKMel-28 melanoma cell line increased TIMPv expression, suggesting that while TIMPv is a positive transcriptional target of CD146 in BC cells, it is negatively regulated in melanoma cells. Furthermore, using invasion assay, the functional relevance of TIMPv to CD146-suppressed metastasis was demonstrated by selective suppression of TIMPv in CD146-expressing BC inducible cells using RNAi. More interestingly, induction of CD146 expression in vivo, using the tet-on CD146 expression system in BC Xenograft model resulted in suppression of breast tumor growth. Further, Clinical analysis of breast tissue samples by Immunohistochemistry showed that TIMPv expression patterns paralleled those of CD44s during breast tumor progression. Pharmacological and molecular approaches revealed that the activation of NFκB via Akt pathway couples CD146 to the transcription of TIMPv in BC cells.

Our study is the first report to provide a functional molecular link of a novel transcriptional target of CD146, TIMPv, to cancer via a unique axis that underpin CD146-suppressed BC progression; TIMPv is a potential target for guiding the development of novel therapeutic strategies for BC.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-06-14.

Establishment of prenatal diagnosis for β-thalassaemia: A step towards its control in a developing country

Beta-thalassaemia constitutes a major health burden on the limited health resources of India and prenatal diagnosis is seen as an important preventive measure to reduce the burden of the disease. Prenatal diagnosis has been offered to 99 women in 112 pregnancies by fetal DNA analysis, using a PCR-based Amplification Refractory Mutation System (ARMS) for the common and uncommon Indian mutations. Restriction fragment length polymorphism (RFLP) for the beta-globin gene was used when the mutation remained unidentified in one of the parents or to complement the ARMS result. In 53 cases the fetus tested had beta-thalassaemia trait (betaTT) (47.3%), 22 were normal (19.6%) and 31 had thalassaemia major (27.6%). In five cases (4.5%), a definitive report could not be given due to maternal contamination. In one case (0.9%), there was a misdiagnosis. Pitfalls encountered in the diagnosis were maternal contamination and occasional non-amplification of the primers. Having established a regional centre for the prenatal diagnosis for thalassaemia, the screening programmes will be enlarged both to identify carriers and prevent the birth of further homozygous children, even during the first pregnancy.

Adherence to antiretroviral therapy & its determinants amongst HIV patients in India

BACKGROUND & OBJECTIVE

Very high levels of adherence are required for ART to be effective. There is limited information available from India on adherence to ART and its predictors. We carried out this study to examine adherence levels and to explore the factors associated with adherence among PLHA receiving ART in India.

METHODS

Using a cross-sectional study design 310 HIV+ patients receiving ART (252 paying out-of-pocket; 58 free via employee-insurance programme) were interviewed from Pune and Delhi health facilities, using a semi-structural questionnaire.

RESULTS

The median age for patients was 36 yr. The median time from diagnosis of HIV-infection was 34.5 months, median time on ART was 16 months and median CD4 cell count at start of ART was 110 cells/microl. 98 per cent of the respondents were using a non protease inhibitor (PI) treatment regimen. Mean 4-day adherence was 93 per cent. Adherence was lower over longer periods of recall: 20 per cent reported missed does over the past 7 days; 33 per cent reported ever missing a full day's medications and 16 per cent had a treatment interruption of more than 7-days at least once. On univariate analysis less than university education, being unemployed, obtaining free treatment, severe depression, baseline CD4 count>200/microl, hospitalization >2 times, having moderate to severe side-effects and taking 4 or more medicines were associated with lower adherence (<90%). However, only obtaining free treatment (adjusted OR, 4.05, 95% CI 1.42-11.54, P=0.009) and severe depression (adjusted OR 4.48, 95% CI 1.64-12.27, P=0.003) were associated with lower adherence in multivariate analysis.

INTERPRETATION & CONCLUSION

Although the overall adherence was high, lower levels of adherence were documented among patients receiving free ART. Provision of free treatment without adequate patient preparation and adherence support may compromise the success of ART scale up programmes. Early diagnosis and management of depression need special focus.

Cysteine proteinase 30 (CP30) and antibody response to CP30 in serum and vaginal washes of symptomatic and asymptomatic Trichomonas vaginalis-infected women

Infection with Trichomonas vaginalis may be asymptomatic or with symptoms suggestive of vaginitis. Because cysteine proteinase 30 (CP30) of T. vaginalis is known to be a virulence marker that plays a role in cytoadherence, the aim of this study was to analyse the presence of CP30 and antibody to CP30 in clinical samples of symptomatic and asymptomatic infected women. CP30 was detected in all the serum and vaginal washes (VWs) of symptomatic women and in 65% of the serum and 80% of the VWs of asymptomatic women. This suggested that the majority of asymptomatic women also exhibit CP30 in the serum and VWs. Antibody to CP30 was detected in all the serum samples of symptomatic and asymptomatic women and in the VWs of only 54.5% of the symptomatic and 35% of the asymptomatic women. Antibody to CP30 was also detected in 3/20 of the serum samples and in none of the VWs from uninfected women. Significantly higher amounts of antibody (mean OD values) were observed in serum and VWs of symptomatic as compared to asymptomatic and healthy women (P<0.001). These results indicate that besides CP30, other factors may also be playing a role in leading to symptomatic infection, because CP30 was detected in clinical samples from all the symptomatic and the majority of the asymptomatic women. Although anti-CP30 antibodies do not appear to be protective, detection of antibody to CP30 antigen in serum samples may be used as a diagnostic tool.

Kinetics of serum and local cytokine profile in experimental intravaginal trichomoniasis induced with Trichomonas vaginalis isolates from symptomatic and asymptomatic women

Trichomoniasis, the most common non-viral sexually transmitted disease, is caused by infection with the protist Trichomonas vaginalis. The clinical spectrum varies from an asymptomatic to a severe symptomatic state. However, the exact factors leading to varied symptomatology have not been well elucidated. The role of cytokines in the pathogenesis of many microbial diseases has been reported. The present study reports the cytokine levels (IL-2, IL-4, IFN-gamma) on different days post infection (3rd, 7th, 14th, 21st and 28th d.p.i.) in serum and vaginal washes (VWs) of mice infected intravaginally with T. vaginalis isolates from 15 symptomatic and 15 asymptomatic women. Significantly higher production of IL-2 and IFN-gamma was observed on the 3rd to 28th d.p.i., and IL-4 on the 7th to 21st d.p.i., in infected as compared to uninfected mice. A significant increase in cytokine IL-2 and IFN-gamma was observed on the 3rd to 28th d.p.i. in serum and VWs of mice infected with T. vaginalis isolates from asymptomatic as compared to symptomatic women. IL-2 (P < 0.001) and IFN-gamma (P < 0.05) concentrations were significantly higher on the 14th d.p.i. in serum samples as compared to VWs of mice infected with T. vaginalis isolates from asymptomatic and symptomatic women, while no significant difference was observed in IL-4 concentration between the two groups of mice. The study indicates the involvement of a Th-1 (IL-2 and IFN-gamma) like response in mice infected with isolates from asymptomatic women as compared to symptomatic women and suggests that Th-1 type cytokines might be playing a role in maintaining low levels of infection.

The release dynamics of model drugs from the psyllium and N-hydroxymethylacrylamide based hydrogels

In order to utilize the psyllium husk, a medicinally important natural polysaccharide, for developing the novel hydrogels for the controlled drug delivery device, we have prepared psyllium and N-hydroxymethylacrylamide based polymeric networks by using N,N'-methylenebisacrylamide (N,N'-MBAAm) as crosslinker. The polymeric networks thus formed were characterized with scanning electron micrography (SEM), FTIR and thermogravimetric analysis (TGA) techniques to study various structural aspects of the networks and also with the swelling response of the polymeric networks as a function of time, temperature, pH and [NaCl]. Equilibrium swelling has been observed to depend on both structural aspects of the polymers and environmental factors. Maximum P(s) 748.3 was observed at 13.0 x 10(-3)mol/L of [N,N'-MBAAm] in 0.5M NaOH solution. The release dynamics of model drugs (salicylic acid and tetracycline hydrochloride) from hydrogels has also been discussed, for the evaluation of the release mechanism and diffusion coefficients. The effect of pH on the release pattern of tetracycline has been studied by varying the pH of the release medium. In release medium of pH 7.4 buffer the release pattern of tetracycline drastically changes to the extent that mechanism of drug diffusion shifted from non-Fickian diffusion to Fickian diffusion. It has been observed that diffusion exponent "n" have 0.71, 0.67 and 0.52 values and gel characteristic constant 'k' have 1.552 x 10(-2), 2.291 x 10(-2) and 5.309 x 10(-2) values in distilled water, pH 2.2 buffer and pH 7.4 buffer, respectively, for tetracycline release. In solution of pH 7.4 buffer, the rate of polymer chain relaxation was more as compare to the rate of drug diffusion from these hydrogels and it follows Fick's law of diffusion. The value of the initial diffusion coefficient for the release of tetracycline hydrochloride was higher than the value of late time diffusion coefficient in each release medium indicating that in the start, the diffusion of drug from the polymeric matrix was fast as compare to the latter stages.

Nitric oxide radicals in leucocytes and vaginal washes of Trichomonas vaginalis -infected symptomatic and asymptomatic women

The clinical spectrum of Trichomonas vaginalis infection varies from asymptomatic to mild, moderate or severe vaginitis. Nitric oxide and other reactive nitrogen radicals produced by immune effector cells are important cytotoxic and cytostatic mediators against several microorganisms including parasites. In the present study, inducible nitric oxide synthase (iNOS) and reactive nitrogen intermediates (RNI) were determined in leucocyte cultures (stimulated with T. vaginalis in vitro) and vaginal washes (VWs) of 22 symptomatic and 20 asymptomatic T. vaginalis-infected and 20 healthy women by immunoblotting and Griess method respectively. The iNOS protein was detected in leucocytes and VWs of all the symptomatic and asymptomatic women, but was not detected in any of the samples from healthy women. Mean iNOS protein band intensity was significantly higher in leucocytes as compared to VWs (P<0.001) of both symptomatic and asymptomatic women and was also higher in leucocytes of asymptomatic as compared to symptomatic women (P<0.05). Mean RNI concentration was also significantly higher in leucocytes (P<0.01) and VWs (P<0.05) of asymptomatic as compared to symptomatic women, and was also higher in samples of infected as compared to healthy women (P<0.001). These results suggest that reactive nitrogen radicals may have a role in limiting T. vaginalis infection in asymptomatic women.

Marine water quality assessment at Mumbai West Coast

In recent past, Mumbai Municipal corporation was not able to keep pace with required infrastructural facilities due to unprecedented population growth. Sewage disposal is one of the major issues, which needed immediate attention because huge quantity of sewage with only preliminary treatment is disposed into the nearby coastal areas and has deteriorated the water quality of the near coastal region. World Bank assisted Bombay Sewage Disposal Project (BSDP) undertaken by the Municipal Corporation of Bruhan Mumbai (MCBM) envisaged sewage discharges through marine outfalls at Worli and Bandra and treatment by aerated lagoons for other areas before disposal in creeks. During BSDP programme, studies were undertaken on water quality assessment along the west coast of Mumbai before and after commissioning of the Worli outfall. A pre- and post-commissioning water quality database for selected parameters was generated for near shore as well as west coast region up to 5 km seaward distance to assess the efficacy of the Worli outfall and delineate the areas affected around diffuser location of the outfall due to sewage disposal. This paper presents observations of the coastal studies at Mumbai and the impact zone of Worli outfall.

Kinetics of immunoglobulin G, M, A and IgG subclass responses in experimental intravaginal trichomoniasis: prominence of IgG1 response

Trichomoniasis, the most common nonviral sexually transmitted disease, is caused by infection with the protist Trichomonas vaginalis. The clinical spectrum varies from an asymptomatic state to mild, moderate or severe symptoms. However, the exact factors leading to varied symptomatology have not been well elucidated. The mouse is a useful experimental model for intravaginal trichomoniasis, for understanding the role of local immune responses in the pathogenesis and varied symptomatology of this disease. The present study reports anti-Trichomonas IgG, IgM, IgA and IgG subclass antibody responses on different post-infection days (3rd, 7th, 14th, 21st and 28th) in serum and vaginal washes of mice infected intravaginally with T. vaginalis isolates from 15 symptomatic and 15 asymptomatic women. Successful intravaginal infection was established by inoculating T. vaginalis in BALB/c mice pre-inoculated with Lactobacillus acidophilus and pretreated with oestradiol. A significant increase in parasite load was observed on the 14th post-infection day (p.i.d.) in mice inoculated with T. vaginalis isolates from symptomatic women as compared to asymptomatic women (P < 0.001), followed by reduction until the 28th p.i.d. (P < 0.05). A significant increase in specific IgG (P < 0.001) and in particular IgG1 (P < 0.001) and IgM (P < 0.01) responses was observed on the 14th p.i.d. in serum and vaginal washes of mice infected with T. vaginalis isolates from symptomatic women as compared to asymptomatic women. Significant increases in specific IgG, IgM and IgG1 responses was observed on the 14th p.i.d. in serum samples as compared with vaginal washes of mice infected with T. vaginalis isolates from symptomatic and asymptomatic women (P < 0.01), whereas no significant difference was observed in IgA, IgG2a, IgG2b and IgG3 antibody responses. The study indicates that specific IgG, particularly IgG1 and IgM, may be playing a role in establishing symptomatic infection.

Tocolytic therapy in conservative management of symptomatic placenta previa

OBJECTIVES

To study the effect of ritodrine therapy on maternal and perinatal outcome in cases of symptomatic placenta previa being managed conservatively.

METHODS

A prospective, randomized controlled clinical trial was made of a total of 60 women whose pregnancies ranged from 28 through 34 menstrual weeks who were randomly allocated to the two study groups using Tippet's random number table. Of these women, 30 were included in the study group where tocolysis with ritodrine was given whereas the other 30 in the control group did not receive tocolysis. Prolongation of pregnancy and birth weight of the newborn were evaluated. The unpaired t-test and chi-square test were used for statistical analysis.

RESULTS

Use of tocolysis in symptomatic placenta previa was associated with significant prolongation of pregnancy (25.33 vs. 14.47 days, P<0.05) and difference in birth weight (2270 g vs. 1950 g, P<0.05). There was no observed statistical difference between the two groups with regard to number of episodes of hemorrhage after admission, total amount of blood loss during stay in hospital, number of blood transfusions and maternal complications due to tocolysis in the study group.

CONCLUSIONS

The present prospective study suggests that ritodrine hydrochloride in patients with symptomatic placenta previa tends to prolong the pregnancy and result in an increase in birth weight of the babies without causing any adverse effect on the mother and fetus.