Endoscopic implantation of autologous myoblasts for stress urinary incontinence and evaluation of its efficacy in sphincterotomized rabbits

INTRODUCTION

Stress urinary incontinence (SUI) is one of the health problems with more impact on patients' lives. The aim of the present work was to develop a therapy for SUI using tissue engineering by isolation and culture of autologous myoblasts (CAM) followed by endoscopic implantation. We also evaluated the efficacy of this therapy in a rabbit model of incontinence after sphincterotomy.

MATERIALS AND METHODS

We used healthy male New Zealand rabbits. The animals were first bled to obtain platelet-poor plasma (PPP) and biopsied for myoblast isolation. Post-sphincterotomy, they were divided into two groups: the treatment group (including animals that received CAM resuspended in PPP) and the control group (including animals receiving only PPP). The leak-point pressure (LPP) was used to measure continence in both groups at different time points. The results were evaluated with hierarchical linear regression models. Histological evaluation of the rabbits' sphincters was also performed at the end of follow-up.

RESULTS

No statistically significant differences were observed between the baseline LPP values of each group. The post-sphincterotomy values of both groups were below 50% of the baseline value, which was a mandatory condition for incontinence. The post-implantation values of the treatment group were higher than 50% of the baseline value, which led us to assume continence recovery. A statistically significant difference was observed in the LPP values between the two treatment groups (p=0.003). Histological study revealed interconnected islands formed by muscle fibers in the treatment group, and connective tissue surrounding the urethral lumen and inflammatory infiltrate in the control group.

DISCUSSION AND CONCLUSIONS

The implantation of CAM significantly improved LPP values in the treatment group, and the improvement remained throughout the evaluation period. It may be associated with the consistency of the implant and its stability at the injection site. Longer follow-up studies and human clinical investigations are required to consider CAM implantation as an alternative treatment for stress urinary incontinence.

Incidence of myocarditis among patients recovered from COVID-19 infection identified using cardiac magnetic resonance imaging

Funding Acknowledgements

Type of funding sources: None.

Introduction

Coronavirus disease 2019 (COVID-19) has caused significant morbidity and mortality worldwide and has been associated with several cardiac complications including myocarditis. COVID-19 patients with myocardial injury have worse clinical outcomes than those without cardiac involvement. Hence, early detection of myocardial involvement in those who have recovered would be helpful in risk stratification of these patients. Locally, there has been no literature regarding cardiac involvement detected by cardiac magnetic resonance (CMR) imaging among COVID-19 patients. This study aims to report the incidence of patients who developed myocarditis among those who recovered from COVID-19 infection and who underwent CMR imaging in our institution.

Methodology

A single-center retrospective cohort study was performed in our institution. Consecutive patients from January 1, 2020, to December 31, 2021, who were initially referred for cardiac CMR examination due to cardiac symptoms and who met the following inclusion criteria 1) 19 years old and above; 2) with a history of a previously confirmed diagnosis of COVID-19 using reverse transcription-polymerase chain reaction (RT-PCR) swab test; 3) patients were considered recovered by the discharging criteria and 4) underwent CMR imaging for evaluation to rule out myocarditis in our institution. The primary outcome was determining the number of patients with positive and negative conventional MRI findings based on late gadolinium enhancement and edema.

Results

Fifty-four percent (54%) of patients had positive conventional MRI findings indicative of myocarditis (myocardial edema or late gadolinium presence). The most common co-morbid condition remains to be Hypertension (55%), followed by Diabetes Mellitus (17%). Dyspnea, palpitations and chest discomfort were the most commonly reported symptoms in 29 (54%), 24 (44%) and 21 (39%) patients, respectively. Twenty-nine patients (54%) were observed with increased T2 signal or positive LGE. Myocardial edema was found in 9 (31%) patients. Among them, 8 (57%) patients were observed with positive LGE. There was no significant difference of LV and RV systolic function among patients with positive and negative conventional CMR findings.

Conclusion

Myocarditis is one of the cardiovascular complications among patients who recovered from COVID-19, as demonstrated by our cardiac MRI study. Evaluation of the cardiac status of recovered COVID-19 patients needs to be closely monitored, and cardiac MRI may be a sensitive imaging tool to investigate any cardiac involvement further. This study provided local data on those with potential structural changes and cardiac complications aligned with the clinical history, which may be unique in our population after recovering from the disease. Further research with a larger sample size, risk factors, and the intervention to prevent disease progression may need more attention.

Evidence of sheep and abattoir environment as important reservoirs of multidrug resistant Salmonella and extended-spectrum beta-lactamase Escherichia coli

The increase in antimicrobial-resistant (AMR) foodborne pathogens, including E. coli and Salmonella in animals, humans, and the environment, is a growing public health concern. Among animals, cattle, pigs, and chicken are reservoirs of these pathogens worldwide. There is a knowledge gap on the prevalence and AMR of foodborne pathogens in small ruminants (i.e., sheep and goats). This study investigates the prevalence and antimicrobial resistance of extended-spectrum beta-lactamase (ESBL) E. coli and Salmonella from sheep and their abattoir environment in North Carolina. We conducted a year-round serial cross-sectional study and collected a total of 1128 samples from sheep (n = 780) and their abattoir environment (n = 348). Sheep samples consisted of feces, cecal contents, carcass swabs, and abattoir resting area feces. Environmental samples consisted of soil samples, lairage swab, animal feed, and drinking water for animals. We used CHROMAgar EEC with 4 μg/ml of Cefotaxime for isolating ESBL E. coli, and ESBL production was confirmed by double-disk diffusion test. Salmonella was isolated and confirmed using standard methods. All of the confirmed isolates were tested against a panel of 14 antimicrobials to elucidate susceptibility profiles. The prevalence of ESBL E. coli and Salmonella was significantly higher in environmental samples (47.7% and 65.5%) compared to the sheep samples (19.5% and 17.9%), respectively (P < 0.0001). We recovered 318 ESBL E. coli and 368 Salmonella isolates from sheep and environmental samples. More than 97% (310/318) of ESBL E. coli were multidrug-resistant (MDR; resistant to ≥3 classes of antimicrobials). Most Salmonella isolates (77.2%, 284/368) were pansusceptible, and 10.1% (37/368) were MDR. We identified a total of 24 different Salmonella serotypes by whole genome sequencing (WGS). The most common serotypes were Agona (19.8%), Typhimurium (16.2%), Cannstatt (13.2%), Reading (13.2%), and Anatum (9.6%). Prevalence and percent resistance of ESBL E. coli and Salmonella isolates varied significantly by season and sample type (P < 0.0001). The co-existence of ESBL E. coli in the same sample was associated with increased percent resistance of Salmonella to Ampicillin, Chloramphenicol, Sulfisoxazole, Streptomycin, and Tetracycline. We presumed that the abattoir environment might have played a great role in the persistence and dissemination of resistant bacteria to sheep as they arrive at the abattoir. In conclusion, our study reaffirms that sheep and their abattoir environment act as important reservoirs of AMR ESBL E. coli and MDR Salmonella in the U.S. Further studies are required to determine associated public health risks.

A systematic review of the indirect and social costs studies in fragility fractures

Fragility fractures (FF) are the main clinical consequence of osteoporosis. FF lead to a loss in quality of life (QL), increased dependency and higher costs due to loss of productivity. Despite this, very few studies have been performed about the indirect or social costs of FF. The objective of this review was to systematically synthesize published evidence regarding indirect costs of FF. We conducted a systematic literature review of empirical studies published as peer review papers between 1998 and 2019. A total of 295 papers were found about costs and osteoporosis. After an iterative process, only 16 papers fit the criteria of selection. Despite the important consequences for QL, only seven studies have included research of the issue and only one about dependency. Treatments are cost-effective, but adherence is low. Multiple fractures, older age and low socioeconomic profile imply higher costs. Most studies are performed using the human capital methodology. The main two variables are loss of productivity and absenteeism. Most of the people included in the samples are out of the active population. Those studies that include a follow-up period vary in a range between 3 months and 2 years. Depending on sample and methodology, the indirect costs (IC) are between 2 and 50%. The direct costs associated with FF generally far outweigh the IC. There is a lack of studies about the effects of treatments and adherence and about the dependency system. The changing role of women in coming generations will increase indirect costs.

Evaluation of Factors That Influence Dose Variability of Marek's Disease Vaccines

Marek's disease (MD) vaccines are cell-associated and require special handling and care during administration. Vaccine dose is evaluated by plaque assay and is indicated as the number of plaque-forming units (PFUs) per dose. The objectives of this study were to evaluate the dose variability within each vial of MD vaccines and to assess those factors (from both manufacturing and handling and administration of the vaccine) that could affect vaccine dose variability. Three experiments were conducted. Experiment 1 was to evaluate dose variability in 36 MD vaccine vials and the effect of manufacturing factors on dose variability. Vaccines were titrated 10 times. Dose variability was measured as the coefficient of variability (CV) calculated as standard deviation divided by average PFU and multiplied by 100. Our results showed that all evaluated vaccines had levels of CV ranging from 10% to 34%. Variability existed regardless of manufacturer, vaccine serotype, and batch. Experiment 2 was conducted to evaluate the effect of infectivity rate (IR) on CV. IR was artificially reduced by adding noninfected chicken embryo fibroblast to the reconstituted vaccine before titration. Our results showed that decreased IR results in higher CV. Experiment 3 was to evaluate the handling and administration factors (time and mixing during administration) on CV. Our results showed that CV tends to increase with time and that this effect is more remarkable if vaccines were not mixed. Our study emphasizes the relevance of proper handling of MD vaccines and shows that dose variability can jeopardize the uniformity of vaccination in a flock and therefore the success of vaccination.

Evidence of higher intramyocellular fat among normal and overweight Indians with prediabetes

BACKGROUND

The rise in prevalence rates of Type 2 Diabetes among Indians is well recognized. The research focus has been primarily to understand the changes in insulin sensitivity and beta cell dysfunction among Indians with Type 2 Diabetes. However, no data are available on the role of peripheral tissue, in particular intramyocellular lipid (IMCL) content and its impact on glucose homeostasis among Indians with prediabetes.

METHODS

28 male subjects (20-40 year) were studied. 13 with prediabetes (BMI ranging from 25.4 ± 2.9 kg/m²) and 15 controls (BMI ranging from 24.6 ± 2.8 kg/m²) were recruited. Body composition by dual energy X-ray absorptiometry (DXA), insulin sensitivity, insulin secretion rates were derived using the minimal model of C-peptide secretion and kinetics rates and skeletal muscle strength of the lower limb (quadriceps) was assessed using Isokinetic dynamometry. From muscle biopsy samples of the vastus lateralis, IMCL fat content (Oil red O staining) was determined.

RESULTS

The prediabetes group were older compared to controls (P < 0.01), but had similar BMI. The muscle to fat ratio, plasma Insulin, C peptide, HOMA-IR and HOMA % B were also comparable between the groups. IMCL fat content (%) was significantly higher in the prediabetes group compared to controls (7.0 ± 0.7% vs. 2.0 ± 0.3%, P < 0.01). This difference persisted even after controlling for age. Overall the IMCL fat content (%) was positively and significantly associated with HbA1c (r = 0.76, P < 0.01). HOMA-IR was significantly correlated with central (android, trunk) adiposity (kg) (r = 0.71, P < 0.01) but not with IMCL (%).

CONCLUSIONS

This is the first direct evidence of existence of significantly higher lipid levels within skeletal muscle cells among normal and overweight young Indians with prediabetes. However, there was no association between IMCL and HOMA-IR among the prediabetes group.

Stillbirth rates in 20 countries of Latin America: an ecological study

OBJECTIVE

To describe country-level stillbirth rates and their change over time in Latin America, and to measure the association of stillbirth rates with socio-economic and health coverage indicators in the region.

DESIGN

Ecological study.

SETTING

20 countries of Latin America.

POPULATION OR SAMPLE

Aggregated data from pregnant women with countries as units of analysis.

METHODS

We used stillbirth estimates, and socio-economic and healthcare coverage indicators reported from 2006 to 2016 from UNICEF, United Nations Development Programme and World Bank datasets. We calculated Spearman's correlation coefficients between stillbirths rates and socioeconomic and health coverage indicators.

MAIN OUTCOME MEASURES

National estimates of stillbirth rates in each country.

RESULTS

The estimated stillbirth rate for Latin America for 2015 was 8.1 per 1000 births (range 3.1-24.9). Seven Latin America countries had rates higher than 10 stillbirths per 1000 births. The average annual reduction rate for the region was 2% (range 0.1-3.8%), with the majority of Latin America countries ranging between 1.5 and 2.5%. National stillbirth rates were correlated to: women's schooling (rS = -0.7910), gross domestic product per capita (rS = -0.8226), fertility rate (rS = 0.6055), urban population (rS = -0.6316), and deliveries at health facilities (rS = -0.6454).

CONCLUSIONS

Country-level estimated stillbirth rates in Latin America varied widely in 2015. The trend and magnitude of reduction in stillbirth rates between 2000 and 2015 was similar to the world average. Socio-economic and health coverage indicators were correlated to stillbirth rates in Latin America.

TWEETABLE ABSTRACT

Stillbirth rates decreased in Latin America but remain relatively high, with wide variations among countries.

Bartonella Seroepidemiology in Dogs from North America, 2008-2014

BACKGROUND

Improved understanding of Bartonella species seroepidemiology in dogs may aid clinical decision making and enhance current understanding of naturally occurring arthropod vector transmission of this pathogen.

OBJECTIVES

To identify demographic groups in which Bartonella exposure may be more likely, describe spatiotemporal variations in Bartonella seroreactivity, and examine co-exposures to other canine vector-borne diseases (CVBD).

ANIMALS

A total of 15,451 serology specimens from dogs in North America were submitted to the North Carolina State University, College of Veterinary Medicine Vector Borne Disease Diagnostic Laboratory between January 1, 2008, and December 31, 2014.

METHODS

Bartonella henselae, Bartonella koehlerae, and Bartonella vinsonii subspecies berkhoffii indirect fluorescent antibody (IFA) serology results, as well as results from a commercial assay kit screening for Dirofilaria immitis antigen and Ehrlichia species, Anaplasma phagocytophilum, and Borrelia burgdorferi antibodies, and Ehrlichia canis, Babesia canis, Babesia gibsoni, and Rickettsia species IFA results were reviewed retrospectively.

RESULTS

Overall, 3.26% of dogs were Bartonella spp. seroreactive; B. henselae (2.13%) and B. koehlerae (2.39%) were detected more frequently than B. vinsonii subsp. berkhoffii (1.42%, P < 0.0001). Intact males had higher seroreactivity (5.04%) than neutered males (2.87%, P < 0.0001) or intact or spayed females (3.22%, P = 0.0003). Mixed breed dogs had higher seroreactivity (4.45%) than purebred dogs (3.02%, P = 0.0002). There was no trend in seasonal seroreactivity; geographic patterns supported broad distribution of exposure, and co-exposure with other CVBD was common.

CONCLUSIONS AND CLINICAL IMPORTANCE

Bartonella spp. exposure was documented throughout North America and at any time of year. Male intact dogs, mixed breed dogs, and dogs exposed to other CVBD have higher seroreactivity to multiple Bartonella species.

Taxonomía y ecología del orden <i>Trichoptera</i> en el departamento de Antioquia en diferentes pisos altitudinales

De febrero de 1978 a agosto de 1979 se llevó a cabo el estudio ecológico y taxonómico del orden Trichoptera en el Departamento de Antioquia a diferentes pisos altitudinales. En total se estudiaron 18 estaciones ecosistemas acuáticos lóticos, correspondientes a cinco pisos altitudinales, de 500 m. a 2.800 m. de altura. Se hicieron mediciones fisicoquímicas como 02,CO2, pH, conductividad, temperatura del agua, nitratos y fosfatos. Se observó un incremento de 02 y una disminución de los valores de CO2, pH y conductividad con la altura.Además, se hizo un inventario de la fauna béntica en general y se sacaron valores de índice de diversidad por piso altitudinal para dichos organismos, observándose por ejempló, como algunos grupos taxonómicos tienden a disminuir con la altura.El estudio taxonómico y ecológico se centró en las larvas de los tricópteros encontrándose un total de 12 familias, 20 géneros y 3 especies reconfirmadas. De los cuales el género Mortoniella fue el más abundante y Wormaldia, Xiphocentron y Ochrotrichia los de más bajo porcentaje. Los géneros de mayor distribución en los diferentes pisos altitudinales fueron Leptomena y Smicridea. Se reportó por primera vez para el neotrópico Grumichella, Triplectides y Mortoniella. Se observó además, como a mayor altura se presentaba una mayor diversidad de los tricópteros.

Retrospective analysis of jaw biopsies in young adults. A study of 1599 cases in Southern Brazil

BACKGROUND

To evaluate the prevalence and the characteristics of jaw lesions diagnosed in young adults aged 20 to 30 years in a southern Brazil reference center, over a period of 25 years. And to analyze the concordance between clinical and histological diagnosis.

MATERIAL AND METHODS

In this cross-sectional retrospective study, the biopsies files from this center were retrieved and data regarding sex, age, bone localization, clinical and histological diagnosis were collected. The histological diagnosis were grouped into the categories Cystic lesions of odontogenic origin, Periapical inflammation, Odontogenic tumors, Bone diseases, Health tissue and Nonspecific diagnostic. Absolute and relative frequencies were estimated with descriptive analysis. The agreement between clinical and histological diagnosis was measured through Kappa statistic.

RESULTS

A total of 18,181 histopathological analysis were performed during the period of the study, registering 1,599 jaw lesions in young adults. The average age of individuals was 24,59 years (SD 3,1). Nine hundred ninety-one (62%) lesions were found in females and 608 (38%) in males. More than half of pathologies were cystic lesions of odontogenic origin (822/51.4%), followed by periapical inflammation (282/17.6%). Regarding the site of lesions, more than half occurred in posterior mandible (877/54.8%), followed by posterior maxilla (339/21.2%). The most frequent entities were periapical cyst, chronic periapical granuloma, dental follicle and paradental cyst, corresponding to a total of 1,202 (75.2%) evaluated cases. In relation to the analysis of concordance between clinical and histological diagnosis the general Kappa index was 0.5, which is considered moderate. Finally, the findings confirm data from literature about the most frequent jaw pathologies in young adults and serve as aid for preventive measures of some entities. Additionally, they can improve the formulation of differential diagnosis and the patient management.

Association between Gallbladder Ultrasound Findings and Bacterial Culture of Bile in 70 Cats and 202 Dogs

Background

Bacterial cholecystitis often is diagnosed by combination of gallbladder ultrasound (US) findings and positive results of bile culture. The value of gallbladder US in determining the likelihood of bile bacterial infection in cats and dogs with suspected biliary disease is unknown.

Hypothesis/Objectives

To determine the value of gallbladder US in predicting bile bacterial culture results, identify most common bacterial isolates from bile, and describe complications after cholecystocentesis in cats and dogs with suspected hepatobiliary disease.

Animals

Cats (70) and dogs (202) that underwent an abdominal US and submission of bile for culture were included in the study.

Methods

A cross‐sectional study design was used to determine the association of gallbladder US abnormalities and the results of bile cultures, and complications of cholecystocentesis.

Results

Abnormal gallbladder US had high sensitivity (96%) but low specificity (49%) in cats with positive and negative results of bile bacterial culture, respectively. Cats with normal gallbladder US findings were unlikely to have positive bile bacterial culture (negative predictive value of 96%). Gallbladder US had lower sensitivity (81%), specificity (31%), positive predictive value (20%), and negative predictive value (88%) in dogs. The most common bacterial isolates were of enteric origin, the prevalence being higher in cats. Incidence of complications after cholecystocentesis was 3.4%.

Conclusions and clinical importance

Gallbladder US has a high negative predictive value for bile culture results in cats. This modality is less predictive of infection in dogs. Percutaneous US‐guided cholecystocentesis has a low complication rate.

Genetic diversity of armored scales (Hemiptera: Diaspididae) and soft scales (Hemiptera: Coccidae) in Chile

Scale insects (Sternorrhyncha: Coccoidea) are one of the most invasive and agriculturally damaging insect groups. Their management and the development of new control methods are currently jeopardized by the scarcity of identification data, in particular in regions where no large survey coupling morphological and DNA analyses have been performed. In this study, we sampled 116 populations of armored scales (Hemiptera: Diaspididae) and 112 populations of soft scales (Hemiptera: Coccidae) in Chile, over a latitudinal gradient ranging from 18°S to 41°S, on fruit crops, ornamental plants and trees. We sequenced the COI and 28S genes in each population. In total, 19 Diaspididae species and 11 Coccidae species were identified morphologically. From the 63 COI haplotypes and the 54 28S haplotypes uncovered, and using several DNA data analysis methods (Automatic Barcode Gap Discovery, K2P distance, NJ trees), up to 36 genetic clusters were detected. Morphological and DNA data were congruent, except for three species (Aspidiotus nerii, Hemiberlesia rapax and Coccus hesperidum) in which DNA data revealed highly differentiated lineages. More than 50% of the haplotypes obtained had no high-scoring matches with any of the sequences in the GenBank database. This study provides 63 COI and 54 28S barcode sequences for the identification of Coccoidea from Chile.

Abstract P4-07-10: Epithelial mesenchymal transition associated with high miR-221 and integrin β6 leads to poor prognosis in hormone receptor positive HER2 negative breast cancers

Background: MicroRNA mediated molecular alterations are involved in the initiation and progression of cancer. Altered expression of multiple microRNAs is associated with endocrine resistance in hormone receptor positive HER2 negative (HR+/HER2-ve) cancer. The role of miR-221 in inducing epithelial to mesenchymal transition (EMT) is well documented especially in cell line model systems. However, the detailed mechanism of specific microRNAs in intrinsic and acquired resistance to endocrine therapy needs to be worked out. In addition, more needs to be done in the documentation of these mechanisms in human breast cancer specimens with complete clinical documentation and long-term follow-up. In this study, we have evaluated the clinical significance of miR-221 and its mechanistic role in EMT using human specimens and cell line models.

Materials and Methods: Formalin fixed paraffin embedded tumor from 129 HR+/HER2-ve breast cancer patients with a median follow up of 63 months were used for estimation of miR-221 by quantitative real time PCR. Expression levels of genes which are direct targets of miR-221 and related genes in EMT were analysed from these tumors. Survival between miR-221 high and low groups was compared by Kaplan Meier survival curves and prognostic relevance was estimated by Cox proportional hazard model.

Cell line experiments to investigate the role of miR-221 in inducing EMT through integrin β6 are underway in both wild type and tamoxifen resistant MCF-7 cell lines (A gift from Prof Ben Ho Park, Johns Hopkins University School of Medicine).

Results: A significant elevated level of miR-221 was observed in small proportion (14%) of HR+/HER2-ve tumors. miR-221 expression had an inverse correlation with both ER protein and ESR1 mRNA levels within HR+/HER2-ve tumors. Tumors with high levels of miR-221 showed significantly higher expression of integrin β6 which is a robust marker of EMT. Patients with high expression of miR-221 had a poorer survival in Kaplan Meier analysis.

Results of interrogation of EMT mediated through integrin related pathways involving miR-221 in cell line models will be presented.

Discussion: The association between miR-221 and integrin β6 in HR+/HER2-ve breast cancer with endocrine resistance suggests a potential link between an epigenetic regulator and a mediator of tumor-stromal interaction. The other mediators involved in this pathway are being investigated. miR-221 could be potentially used as a marker for identification of a poor prognostic subtype within HR+/HER2-ve breast cancers.

Citation Format: Prabhu JS, Kaul R, Korlimarla A, Desai K, Gangadharan C, Rajarajan S, Nair MG, Alexander A, Kaluve R, Manjunath S, Correa M, Prasad MSN, Patil S, Srinath BS, Sridhar TS. Epithelial mesenchymal transition associated with high miR-221 and integrin β6 leads to poor prognosis in hormone receptor positive HER2 negative breast cancers [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-07-10.

Microvascular Outcomes after Metabolic Surgery (MOMS) in patients with type 2 diabetes mellitus and class I obesity: rationale and design for a randomised controlled trial

INTRODUCTION

There are several randomised controlled trials (RCTs) that have already shown that metabolic/bariatric surgery achieves short-term and long-term glycaemic control while there are no level 1A of evidence data regarding the effects of surgery on the microvascular complications of type 2 diabetes mellitus (T2DM).

PURPOSE

The aim of this trial is to investigate the long-term efficacy and safety of the Roux-en-Y gastric bypass (RYGB) plus the best medical treatment (BMT) versus the BMT alone to improve microvascular outcomes in patients with T2DM with a body mass index (BMI) of 30-34.9 kg/m².

METHODS AND ANALYSIS

This study design includes a unicentric randomised unblinded controlled trial. 100 patients (BMI from 30 to 34.9 kg/m²) will be randomly allocated to receive either RYGB plus BMT or BMT alone. The primary outcome is the change in the urine albumin-to-creatinine ratio (uACR) captured as the proportion of patients who achieved nephropathy remission (uACR<30 mg/g of albumin/mg of creatinine) in an isolated urine sample over 12, 24 and 60 months.

ETHICS AND DISSEMINATION

The study was approved by the local Institutional Review Board. This study represents the first RCT comparing RYGB plus BMT versus BMT alone for patients with T2DM with a BMI below 35 kg/m².

TRIAL REGISTRATION NUMBER

NCT01821508; Pre-results.

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15-18 March 2016

[This corrects the article DOI: 10.1186/s13054-016-1208-6.].

Phytochemical, antioxidant and anticancer activities of extracts of seven fruits found in the Southern Brazilian flora

Methanol extracts of seven edible fruits found in southern Brazil: Garcinia achachairu, Rubus imperialis, Rubus rosaefolius, Solanum quitoense, Solanum sessiliflorun, Diospyros inconstans and Plinia glomerata, were evaluated for their total phenol content and antioxidant activity in different in vitro free radical scavenging models. In addition, studies were performed on cell viability of extracts of the seeds of G. achachairu against murine melanoma cells. The fruits peel and seeds of G. achachairu were very promising in terms of total phenol content (data in gallic acid equivalent per gram), as assessed by the Folin-Ciocalteu method, with values of 9.70±3.2 and 8.40±1.1, respectively. On the other hand, antioxidant activity using the 2,2-diphenyl-1-picrylhydrazyl scavenging assay showed that the fruit pulp and peel of P. glomerata presented the best profile, with values of the 16.3±1.8 and 15.9±2.4 μg/ml, respectively. Regarding the cytotoxic effect of methanol extract and guttiferone A from G. achachairu, we have observed that both inhibit the growth of B16F10 tumor cells, with calculated IC₅₀ values of 49.6±2.1 mg/ml and 48.6±5.4 mM, respectively.

Should the first blood pressure reading be discarded?

We evaluated the consequences of excluding the first of three blood pressure (BP) readings in different settings: a random population sample (POS, n=1525), a general practice office (GPO, n=942) and a specialized hypertension center (SHC, n=462). Differences between systolic and diastolic BP (SBP and DBP) estimates obtained including and excluding the first reading were compared and their correlation with ambulatory BP monitoring (ABPM) was estimated. The samples were divided into quartiles according to the difference between the third and the first SBP (3-1ΔSBP). SBP decreased through sequential readings, 3-1ΔSBP was -5.5 ± 9.7 mm Hg (P<0.001), -5.1 ± 10.4 mm Hg (P<0.001) and -6.1 ± 9.3 mm Hg (P<0.001) for POS, GPO and SHC, respectively. However, individuals included in the top quartile of 3-1ΔSBP showed their highest values on the third reading. The mean SBP estimate was significantly higher excluding the first reading (P<0.001), but the differences among both approaches were small (1.5-1.6 mm g). Moreover, the correlation between SBP values including and excluding the first reading and daytime ABPM were comparable (r = 0.69 and 0.68, respectively). Similar results were observed for DBP. In conclusion, our study does not support the notion of discarding the first BP measurement and suggests that it should be measured repeatedly, regardless the first value.

Randomized Phase III Trial Exploring the Use of Long-Acting Release Octreotide in the Prevention of Chemotherapy-Induced Diarrhea in Patients With Colorectal Cancer: The LARCID Trial

Purpose

Chemotherapy-induced diarrhea (CID) is a relatively common adverse event in the treatment of patients with colorectal cancer. The LAR for Chemotherapy-Induced Diarrhea (LARCID) trial evaluated the efficacy and safety of long-acting release octreotide (octreotide LAR) for the prevention of CID in this population.

Patients and Methods

Patients with colorectal cancer starting adjuvant or first-line treatment with a chemotherapy combination containing fluorouracil, capecitabine, and/or irinotecan were randomly assigned to receive octreotide LAR 30 mg intramuscularly every 4 weeks (experimental arm) or the physician's treatment of choice in case of diarrhea (control arm).

Results

A total of 139 patients were randomly assigned, most of whom received fluorouracil- and oxaliplatin-containing chemotherapy regimens. The rate of diarrhea was 76.1% in the experimental group (n = 68) and 78.9% in the control group (n = 71). Treatment with octreotide LAR did not prevent or reduce the severity of CID. Treatment choices for diarrhea management included loperamide in the majority of patients. No benefit from octreotide LAR was identified in terms of need for diarrhea treatment, opioids, or intravenous hydration or in the rate of hospitalization or quality of life.

Conclusion

This study could not prove the efficacy of octreotide LAR in the prevention of CID.

Brazilian consensus in gastric cancer: guidelines for gastric cancer in Brazil

BACKGROUND

In Brazil, gastric cancer is the fourth most common malignancy among men and sixth among women. The cause is multivariate and the risks are well known. It has prognosis and treatment defined by the location and staging of the tumor and number of lymph nodes resected and involved.

AIM

The Brazilian Consensus on Gastric Cancer promoted by ABCG was designed with the intention to issue guidelines that can guide medical professionals to care for patients with this disease.

METHODS

Were summarized and answered 43 questions reflecting consensus or not on diagnosis and treatment that may be used as guidance for its multidisciplinary approach. The method involved three steps. Initially, 56 digestive surgeons and related medical specialties met to formulate the questions that were sent to participants for answers on scientific evidence and personal experience. Summaries were presented, discussed and voted in plenary in two other meetings. They covered 53 questions involving: diagnosis and staging (six questions); surgical treatment (35 questions); chemotherapy and radiotherapy (seven questions) and anatomopathology, immunohistochemistry and perspective (five questions). It was considered consensus agreement on more than 70% of the votes in each item.

RESULTS

All the answers were presented and voted upon, and in 42 there was consensus.

CONCLUSION

It could be developed consensus on most issues that come with the care of patients with gastric cancer and they can be transformed in guidelines.

Prevalence of in vitro susceptibility to carbapenems among clinical isolates of the Bacteroides fragilis group from a Colombian tertiary hospital

Clinical isolates of the Bacteroides fragilis group (n=29) were collected from patients attending a tertiary care hospital in Medellin, Colombia, during 2012 and were tested for susceptibility to four carbapenems using the Clinical and Laboratory Standards Institute (CLSI) Etest method. Overall rates of percent susceptibility were as follows: meropenem, 93.1%; imipenem, 100%; ertapenem, 96.6%; and doripenem, 93.1%. This is the first study to show rates of resistance of Bacteroides spp. to carbapenems in Colombia among a species formerly thought to be fully susceptible to this type of antimicrobial.

Abstract P4-07-09: An approach to the identification of tumors driven by HER2 using the integrated activity of oncomiR miR-21 along with HER2 enriched genes

Introduction: The initial identification of HER2 as a driver in a subset of breast cancers was at the level of DNA (amplification), and subsequently noted at the level of transcripts and protein as well. However, the clinical selection of patients for treatment with Trastuzumab, has been through either IHC (protein) or FISH (DNA amplification) and not through transcript abundance. Interestingly, in most studies that have estimated transcript abundance in primary tumors, the proportion of patients that demonstrate increased transcript levels (termed HER2 Enriched) have tended to be slightly larger than the clinical HER2+ category.

A more clinically useful measure might be proof of HER2 downstream activity that might help separate tumors being driven significantly by HER2 from ones where its role is supportive. One of the many consequences of HER2 over-expression is activation of the oncomiR, miR-21 via the MAPK pathway. miR-21 in turn is known to epigenetically regulate multiple targets including the tumor suppressors PTEN and PDCD4. While these molecular mechanisms have been demonstrated convincingly in breast cancer cell lines, clinical studies of these alterations in large numbers are yet to be reported. In this study we have examined the relationship between clinical HER2 positivity and miR-21 levels in 124 surgically excised breast cancer specimens.

Methods: We selected 124 surgically excised specimens of primary breast cancers from our cohort that by HER2 immunohistochemistry (IHC) comprised 42 positive, 62 negative and 20 equivocal. Relative abundance of miR-21 was assessed using a TaqMan qRT-PCR, with normalization by RNU48. Relative transcript abundance of a set of 6 genes (HER2, GRB7, MLN64 and 3 reference genes) were evaluated by SYBR Green real time qPCR.

Results: The majority of tumors that were clinically HER2+ over expressed miR-21. A concordance with an AUC of 96% at 100% sensitivity and 85% specificity was noted. There is a highly significant differential expression of miR-21 between HER2 positive, negative and equivocal samples (P &lt; 0.0001).

HER2 enriched score determined by using the expression levels of 3 genes (HER2, GRB7, MLN64) identified 35% (44/124) of the samples to be HER2 enriched. 72% of these (32/44) were also clinical HER2 positive by IHC. As expected, miR-21 was significantly over expressed in these tumors as well (P&lt;0.0001).

To identify all samples which might show HER2 downstream activity, a logistic regression model was built using expression of miR-21, HER2, MLN64 and GRB7 as the determinants of HER2 status. The best fitting model classified 91% (38/42) of HER2 +, 95% (59/62) of the HER2 negative accurately with 94% specificity and an AUC of 0.96. The model helped identify 10% of clinical HER2 negative samples (6/20 equivocal & 3/62 HER-2 negative) to have a high probability of being HER2+.

Conclusion: Identification of HER2+ tumors with evidence of downstream activity may help identify patients with tumors being driven significantly by HER2 from ones where its role is supportive. The possibility of targeting miR-21 raises the tantalizing prospect of effecting change by altering the epigenetic regulation of multiple targets including tumor-suppressors.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-07-09.

Abstract P6-08-12: Gains in women’s education has not led to commensurate gains in seeking health-care early in breast cancer patients in urban India

Introduction:

Breast cancer is the leading cancer diagnosed in urban Indian women. Historically the proportion of women presenting with advanced disease has been in excess of 50% at most regional cancer centres. The past 20 years has witnessed rapid economic growth and urbanization with significant gains in women's education and access to health. However, it is not clear if this has translated to earlier seeking of care in the educated.

The aim of this study was to examine if higher education (College) was a determinant in the time of seeking first medical consultation, and whether there were significant differences between women under the age of 40 versus women over 60 years old at the time of diagnosis.

Methods:

The data for analysis were obtained from a prospective longitudinal observational study conducted between 2008-2013 at a medical teaching hospital and a tertiary specialized cancer care centre. A total of 460 patients have been enrolled so far. All patients provided informed consent and the study has been reviewed and approved by the institutional ethics committees at these institutions. We have collected from the patients and their medical records information about their age at diagnosis, educational level, stage of disease, histopathology reports and clinical details.

Results:

Data from 194 patients have been used for the analysis. Patients were divided into one group of &lt; = 40Y of age (Group I, N = 58) and the second of &gt; = 60 years of age (Group II, N = 136). Mean age at presentation for the groups was 35 and 68 years respectively. As expected almost 1.5 times as many women under the age of 40 (36%) were college educated compared to the women over 60 (22%) (p = 0.05). The proportion of LABC in the two groups was not different with group I having 27% and group II 25%. The proportion of older women with LABC and a college degree was 20%. However, rather than the expected decrease in proportion of women with high education and LABC, 31% of young women with LABC had a college degree. LABC in the college educated was not different in the group I when compared to group II. (p = 0.39).

Conclusion:

The determinants of seeking health care are complex and influenced by a variety of factors including socio-economic status, access to health care, education, cultural beliefs, and personal preferences. While urban India's steady economic growth has been highlighted by the scholarly as well as the lay press, the data presented here suggest that there is not an automatic and linear transfer between education, economics and healthcare seeking behaviours. We suggest that while a lot of attention has been paid to awareness and screening, we may need to focus on local cultural factors, and perhaps provide support from female counsellors and care providers as critical components of attempting to bring our women to the hospital at the earliest.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-08-12.

Effect of subtype-selective adenosine receptor antagonists on basal or haloperidol-regulated striatal function: studies of exploratory locomotion and c-Fos immunoreactivity in outbred and A(2A)R KO mice

Behavioral activation is regulated by dopamine (DA) in striatal areas. At low doses, while typical antipsychotic drugs produce psychomotor slowing, psychostimulants promote exploration. Minor stimulants such as caffeine, which act as adenosine receptor antagonists, can also potentiate behavioral activation. Striatal areas are rich in adenosine and DA receptors, and adenosine A2A receptors are mainly expressed in the striatum where they are co-localized with DA D2 receptors. Adenosine antagonists with different receptor-selectivity profiles were used to study spontaneous or haloperidol-impaired exploration and c-Fos expression in different striatal areas. Because A2A antagonists were expected to be more selective for reversing the effects of the D2 antagonist haloperidol, A2A receptor knockout (A2ARKO) mice were also assessed. CD1 and A2ARKO male mice were tested in an open field and in a running wheel. Only the A1/A2A receptor antagonist theophylline (5.0-15.0 mg/kg) and the A2A antagonist MSX-3 (2.0 mg/kg) increased spontaneous locomotion and rearing. Co-administration of theophylline (10.0-15.0 mg/kg), and MSX-3 (1.0-3.0 mg/kg) reversed haloperidol-induced suppression of locomotion. The A1 antagonist CPT was only marginally effective in reversing the effects of haloperidol. Although adenosine antagonists did not affect c-Fos expression on their own, theophylline and MSX-3, but not CPT, attenuated haloperidol induction of c-Fos expression. A2ARKO mice were resistant to the behavioral effects of haloperidol at intermediate doses (0.1 mg/kg) in the open field and in the running wheel. A2A receptors are important for regulating behavioral activation, and interact with D2 receptors in striatal areas to regulate neural processes involved in exploratory activity.

A randomized phase III trial exploring the use of long-acting release octreotide in the prevention of chemotherapy-induced diarrhea in patients with colorectal cancer: The LARCID trial

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Background: Chemotherapy-induced diarrhea (CID) is a relatively common adverse event in the treatment of colorectal cancer patients. The LARCID trial evaluated the efficacy and safety of long-acting release octreotide (octreotide LAR) for the prevention of CID in this population.

Methods: Colorectal cancer patients starting adjuvant or first-line treatment with a chemotherapy combination containing fluorouracil (5-FU), capecitabine and/or irinotecan were randomized to receive octreotide LAR, 30 mg intramuscularly every 4 weeks, (experimental arm) or the physician’s treatment of choice in case of diarrhea (control arm).

Results: A total of 139 patients were randomized, most of which received 5-FU- and oxaliplatin-containing chemotherapy regimens. The rate of diarrhea was 76.1% in the experimental group (n=68) and 78.9% in the control group (n=71). Treatment with octreotide LAR did not prevent nor reduced the severity of CID. Treatment choices for diarrhea management included loperamide in the majority of cases. No benefit from octreotide LAR was identified in terms of need for diarrhea treatment, opioids, or intravenous hydration, nor in the rate of hospitalization, or quality-of-life.

Conclusions: Octreotide LAR is not indicated for the prevention of CID.

Adenosine A2A receptor antagonism and genetic deletion attenuate the effects of dopamine D2 antagonism on effort-based decision making in mice

Brain dopamine (DA) and adenosine interact in the regulation of behavioral activation and effort-related processes. In the present studies, a T-maze task was developed in mice for the assessment of effort-related decision making. With this task, the two arms of the maze have different reinforcement densities, and a vertical barrier is positioned in the arm with the higher density (HD), presenting the animal with an effort-related challenge. Under control conditions mice prefer the HD arm, and climb the barrier to obtain the larger amount of food. The DA D(2) receptor antagonist haloperidol decreased selection of the HD arm and increased selection of the arm with the low density of reinforcement. However, the HD arm was still the preferred choice in haloperidol-treated mice trained with barriers in both arms. Pre-feeding the mice to reduce food motivation dramatically increased omissions, an effect that was distinct from the actions of haloperidol. Co-administration of theophylline, a nonselective adenosine receptor antagonist, partially reversed the effects of haloperidol. This effect seems to be mediated by the A(2A) receptor but not the A(1) receptor, since the A(2A) antagonist MSX-3, but not the A(1) antagonist CPT, dose dependently reversed the effects of haloperidol on effort-related choice and on c-Fos expression in the dorsal striatum and nucleus accumbens. In addition, adenosine A(2A) receptor knockout mice were resistant to the effects of haloperidol on effort-related choice in the maze. These results indicate that DA D(2) and adenosine A(2A) receptors interact to regulate effort-related decision making and effort expenditure in mice.

Slow phasic changes in nucleus accumbens dopamine release during fixed ratio acquisition: a microdialysis study

Nucleus accumbens dopamine (DA) is a critical component of the brain circuitry regulating behavioral output during reinforcement-seeking behavior. Several studies have investigated the characteristics of accumbens DA release during the performance of well-learned operant behaviors, but relatively few have focused on the initial acquisition of particular instrumental behaviors or operant schedules. The present experiments focused on the initial acquisition of operant performance on a reinforcement schedule by studying the transition from a fixed ratio 1 (FR1) schedule to another operant schedule with a higher ratio requirement (i.e. fixed ratio 5 [FR5]). Microdialysis sessions were conducted in different groups of rats that were tested on either the FR1 schedule; the first, second, or third day of FR5 training; or after weeks of FR5 training. Consistent with previous studies, well-trained rats performing on the FR5 schedule after weeks of training showed significant increases in extracellular DA in both core and shell subregions of nucleus accumbens during the behavioral session. On the first day of FR5 training, there was a substantial increase in DA release in nucleus accumbens shell (i.e. approximately 300% of baseline). In contrast, accumbens core DA release was greatest on the second day of FR5 training. In parallel experiments, DA release in core and shell subregions did not significantly increase during free consumption of the same high carbohydrate food pellets that were used in the operant experiments, despite the very high levels of food intake in experienced rats. However, in rats exposed to the high-carbohydrate food for the first time, there was a tendency for extracellular DA to show a small increase. These results demonstrate that transient increases in accumbens DA release occur during the initial acquisition of ratio performance, and suggest that core and shell subregions show different temporal patterns during acquisition of instrumental behavior.

Abstract 115: Correlation between homocysteine concentration in serum and response to anti-hormonal treatment in breast tumor patients

Background: Breast tumors are today the most incident tumor in women. One of the widely used markers for breast cancer is the estrogen receptor (ER), which is member of the nuclear receptor superfamily of transcription factors. Almost 70% of the breast cancer patients are ER positive and can be beneficiated with hormonal therapy. Patients with ER+ tumors are candidates for anti-hormonal therapy, including tamoxifen and anastrozol. Many studies proposed that elevated levels of total homocysteine (tHcy) in the blood can be a risk factor for cancer. It is also known that estrogen status is associated with tHcy concentration. One important epigenetic mechanism which is a well-described for carcinogenesis, and seems to be related to homocysteine pathways, is the DNA methylation. In tumors, it is well documented a decrease in total DNA methylation and a hipermethylation of specific gene promoters. There are no studies showing the impact of anti-hormonal treatment in the tHcy concentration and in the DNA methylation pattern of the breast tumor patients. Objectives: In this study we aimed to verify which is the impact of the anti-hormonal treatment in the tHcy concentration and its correlation with the clinical data. Samples and Methods: To investigate the effect of anti-hormonal therapy on homocysteine metabolism, 50 breast tumor patients were randomly assigned to therapy with anastrozol or tamoxifen or placebo. Sera from the patients were obtained before and after the treatment with anti-hormonal drugs. Homocysteine levels were determined by HPLC. Total DNA methylation was evaluated in the tumor biopsies before the treatment by restriction enzyme method. Pearson's correlation test and t test were performed for statistical analysis. Results: We observed that the tHcy before the anti-hormonal treatment increase in the patients with a high agressive tumor (p=0,0401), and with positive lifonodes (p=0,0379). After the treatment with tamoxifen, the tHcy level decreases (p=0,0263). We could observe that the decrease was significant in the patients with positive linfonodes (p=0,0400). No significant correlations were observed when the patients were treated with anastrozol or placebo and also no correlation were observed in these patients when we correlated the tHcy variation with the clinical data set. We observed a total DNA hypomethylation in the tumors before treatment when compared with adjacent tissue (p=0,0157). Conclusions and perspectives: We could observe that the higher tHcy levels are related to aggressive tumors. Our results also show that the treatment with tamoxifen, mainly in aggressive tumors, decreases the tHcy levels showing that this treatment can have a role in the tHcy level. Other clinical data and new studies should be done to evaluate the tamoxifen impact in tHcy and also its relation with the tumor DNA methylation.

Financial support: Fapesp, CAPES, CNPq.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 115. doi:10.1158/1538-7445.AM2011-115

Abstract P5-03-03: DNA Methylation of the Estrogen Receptor (alpha) Promoter Is Higher in Triple Negative Breast Cancers Compared to the ER Negative Sub-Type

Background: The incidence of Estrogen Receptor alpha (ER) negative breast cancer and triple negative cases in India is twice that of Western Caucasians. The underlying causes for this two fold difference are unclear. DNA methylation of the ER promoter is one of the mechanisms of gene silencing. Recent data from the West indicate that the ER promoter is weakly methylated in a majority of patients independent of ER status. Data from an Indian cohort found 66% of ER negative breast tumors to be methylated at the ER gene. However, the technique used, Methylation specific PCR (MSP) suffers from a number of disadvantages such as false priming and low specificity. We have checked the methylation status of ER promoter A by a quantitative method and correlated it with clinicopathological parameters such as ER, progesterone receptor (PR) and Her2 protein status.

Materials and Methods: Tumor sections from 51 cases of primary invasive carcinomas were used for DNA extraction and bisulphite conversion. We adopted a quantitative method, Methylight assay for estimating the methylation status of the ER gene. Percentage Methylation Ratio (PMR) was computed and graded according to previously published standards. Methylation specific PCR was done for all these samples for comparison. Grade and Lymph node (LN) status were assessed. Immunohistochemistry was done to examine the status of ER, PR and Her2 protein.

Results: 16.6% of the ER negative tumors were moderately methylated (PMR score 5-50) at the ER promoter while none of the ER positive tumors were methylated to the same extent. Among the Triple Negative (TN) tumors in our cohort, 25% were moderately methylated. MSP tends to overestimate the methylated tumors and indicated that 43.5% of the ER negative tumors and19.2% of ER positive tumors were methylated. Discussion: A subgroup of ER negative and triple negative Indian patients have enhanced methylation of the ER gene. However this does not account for the doubling of ER negative incidence. Our demographics of a large pre-menopausal population might explain some part of this increase. Methylation of ER promoter was highest in TN tumors. This finding hints towards epigenetic dysregulation being a trait of TN tumors. The possibility of reversing the ER status from negative to positive in the clinic has raised an interest in the mechanism by which ER is lost.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-03-03.

Reutilization of thermostable polyester wastes by means of agglomeration with phenolic resins

We report on the possibility of obtaining organic polymeric matrixes allowing the development of new high performance fire-resistant products by recycling downsized thermostable waste materials. Phenolic resins have been used as binders for recycled waste. Furthermore, considering that reinforced plastic triturations have superior properties (chemical, mechanical, water resistance, etc.) to wood agglomerates, significant advantages over conventional materials are anticipated. In summary, we propose a viable solution to some of the known problems caused by the consumption of wood and to the needs of strengthened plastic processing engineering. Using resins as a binder, several fire-resistant prototypes were prepared from polyester waste, and their mechanical properties, thermal stability, and fire-resistant properties were analyzed.