The urotensin-II receptor: A marker for staging and steroid outcome prediction in ulcerative colitis

BACKGROUND

Urotensin-II receptor- (UTR) related pathway exerts a key-role in promoting inflammation. The aim was to assess the relationship between UTR expression and clinical, endoscopic and biochemical severity of ulcerative colitis (UC), exploring its predictivity of intravenous (iv) steroid administration therapeutic outcome.

METHODS

One-hundred patients with first diagnosis of UC and 44 healthy subjects were enrolled. UTR expression was assessed by qPCR, Western Blot (WB) and immunohistochemistry (IHC). Clinical, endoscopic and histological activity of UC were evaluated by using Truelove and Witts (T&W) severity index, Mayo Endoscopic Score (MES), and Truelove and Richards Index (TRI). The partial and full Mayo scores (PMS and FMS) were assessed to stage the disease.

RESULTS

The UTR expression, resulted higher in the lesioned mucosa of UC patients in comparison to healthy subjects (p < .0001 all). Direct relationship between UTR (mRNA and protein) expression and disease severity assessment (T&W, PMS, MES and TRI) was highlighted (p < .0001 all). UTR expression resulted also higher in the 72 patients requiring iv steroids administration compared to those who underwent alternative medications, (p < .0001). The 32 steroid-non-responders showed an increased UTR expression (WB, IHC and qPCR from lesioned mucosa), compared to 40 steroid-responders (p: .0002, .0001, p < .0001 respectively). The predictive role of UTR expression (p < .05) on the negative iv steroids administration therapeutic outcome was highlighted and ROC curves identified the thresholds expressing the better predictive performance.

CONCLUSIONS

UTR represents a promising inflammatory marker related to clinical, endoscopic, and histological disease activity as well as a predictive marker of steroid administration therapeutic outcome in the UC context.

TRPM8 indicates poor prognosis in colorectal cancer patients and its pharmacological targeting reduces tumour growth in mice by inhibiting Wnt/β-catenin signalling

BACKGROUND AND PURPOSE

Transient receptor potential melastatin type-8 (TRPM8) is a cold-sensitive cation channel protein belonging to the TRP superfamily of ion channels. Here, we reveal the molecular mechanism of TRPM8 and its clinical relevance in colorectal cancer (CRC).

EXPERIMENTAL APPROACH

TRPM8 expression and its correlation with the survival rate of CRC patients was analysed. To identify the key pathways and genes related to TRPM8 high expression, Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyses were conducted in CRC patients. TRPM8 functional role was assessed by using Trpm8^-/- mice in models of sporadic and colitis-associated colon cancer. TRPM8 pharmacological targeting by WS12 was evaluated in murine models of CRC.

KEY RESULTS

TRPM8 is overexpressed in colon primary tumours and in CD326⁺ tumour cell fraction. TRPM8 high expression was related to lower survival rate of CRC patients, Wnt-Frizzled signalling hyperactivation and adenomatous polyposis coli down-regulation. In sporadic and colitis-associated models of colon cancer, either absence or pharmacological desensitization of TRPM8 reduced tumour development via inhibition of the oncogenic Wnt/β-catenin signalling. TRPM8 pharmacological blockade reduced tumour growth in CRC xenograft mice by reducing the transcription of Wnt signalling regulators and the activation of β-catenin and its target oncogenes such as C-Myc and Cyclin D1.

CONCLUSION AND IMPLICATIONS

Human data provide valuable insights to propose TRPM8 as a prognostic marker with a negative predictive value for CRC patient survival. Animal experiments demonstrate TRPM8 involvement in colon cancer pathophysiology and its potential as a drug target for CRC.

Polydatin Incorporated in Polycaprolactone Nanofibers Improves Osteogenic Differentiation

Polycaprolactone nanofibers are used as scaffolds in the field of tissue engineering for tissue regeneration or drug delivery. Polycaprolactone (PCL) is a biodegradable hydrophobic polyester used to obtain implantable nanostructures, which are clinically applicable due to their biological safety. Polydatin (PD), a glycosidic precursor of resveratrol, is known for its antioxidant, antitumor, antiosteoporotic, and bone regeneration activities. We aimed to use the osteogenic capacity of polydatin to create a biomimetic innovative and patented scaffold consisting of PCL-PD for bone tissue engineering. Both osteosarcoma cells (Saos-2) and mesenchymal stem cells (MSCs) were used to test the in vitro cytocompatibility of the PD-PCL scaffold. Reverse-phase (RP) HPLC was used to evaluate the timing release of PD from the PCL-PD nanofibers and the MTT assay, scanning electron microscopy, and alkaline phosphatase (ALP) activity were used to evaluate the proliferation, adhesion, and cellular differentiation in both osteosarcoma and human mesenchymal stem cells (MSCs) seeded on PD-PCL nanofibers. The proliferation of osteosarcoma cells (Saos-2) on the PD-PCL scaffold decreased when compared to cells grown on PLC nanofibers, whereas the proliferation of MSCs was comparable in both PCL and PD-PCL nanofibers. Noteworthy, after 14 days, the ALP activity was higher in both Saos-2 cells and MSCs cultivated on PD-PCL than on empty scaffolds. Moreover, the same cells showed a spindle-shaped morphology after 14 days when grown on PD-PCL as shown by SEM. In conclusion, we provide evidence that nanofibers appropriately coated with PD support the adhesion and promote the osteogenic differentiation of both human osteosarcoma cells and MSCs.

Altered activity of pain processing brain regions in association with hip osteoarthritis

Hip osteoarthritis (OA) is characterized by chronic pain, but there remains a mismatch between symptoms and radiological findings. Recently, brain connectivity has been implicated in the modulation of chronic peripheral pain, however its association with perceived pain in hip OA is not understood. We used resting-state functional magnetic resonance imaging (fMRI) to examine functional connectivity associated with pain in hip OA patients. Thirty participants with hip OA and 10 non-OA controls were recruited. Using the visual analogue scale (VAS), pain scores were obtained before and after performing a painful hip activity. All participants underwent 3.0 T resting-state fMRI, and functional connectivity of brain regions associated with pain was determined and compared between participants, and before and after hip activity. Relative to controls, functional connectivity between the secondary somatosensory cortex and left posterior insula was increased, and functional connectivity between the bilateral posterior insula and motor cortices was significantly decreased in hip OA participants. In response to painful hip activity, functional connectivity increased between the thalamus, periaqueductal grey matter and brainstem. Functional connections between brain regions associated with pain are altered in hip OA patients, and several connections are modulated by performing painful activity. Unique lateralization of left posterior insula and linked brain functional connectivity patterns allows assessment of pain perception in hip OA providing an unbiased method to evaluate pain perception and pain modulation strategies.

Metabolite Profile and In Vitro Beneficial Effects of Black Garlic (Allium sativum L.) Polar Extract

Over the centuries, humans have traditionally used garlic (Allium sativum L.) as a food ingredient (spice) and remedy for many diseases. To confirm this, many extensive studies recognized the therapeutic effects of garlic bulbs. More recently, black garlic (BG), made by heat-ageing white garlic bulbs, has increased its popularity in cuisine and traditional medicine around the world, but there is still limited information on its composition and potential beneficial effects. In this study, the metabolite profile of methanol extract of BG (BGE) was determined by high-performance liquid chromatography coupled to tandem mass spectrometry in high-resolution mode. Results allowed to establish that BGE major components were sulfur derivatives, saccharides, peptides, organic acids, a phenylpropanoid derivative, saponins, and compounds typical of glycerophospholipid metabolism. Characterization of the BGE action in cancer cells revealed that antioxidant, metabolic, and hepatoprotective effects occur upon treatment as well as induction of maturation of acute myeloid leukemia cells. These results are interesting from the impact point of view of BG consumption as a functional food for potential prevention of metabolic and tumor diseases.

Ultrasound Guided Stellate Ganglion Block with Dexmedetomidine as an Adjuvant in Complex Regional Pain Syndrome (CRPS)

This is a case report of successful use of ultrasound for stellate ganglion (SG) blocks in CRPS I in 11 patients using local anesthetic bupivacaine with injection dexmedetomidine as an adjunct. Ultrasound helped us to deposit Local anesthetics in target area without any noticeable side effects and trauma to adjacent structures.

OP0035 EXAMINATION OF INTERSTITIAL LUNG DISEASE IN PATIENTS WITH RHEUMATOID ARTHRITIS – PREVALENCE, TIME TO ONSET, AND CLINICAL CHARACTERISTICS

Background:

Interstitial lung disease (ILD) is a known extraarticular manifestation of rheumatoid arthritis (RA). Previous studies have shown variability in the prevalence of RA-ILD, as well as clinical characteristics and risk factors of RA-ILD.

Objectives:

To evaluate the prevalence and time to onset of ILD and compare the clinical characteristics between RA patients (pts) with or without ILD using a large US electronic medical record (EMR)-based dataset.

Methods:

Pts with an initial RA diagnosis (ICD-9-CM code: 714.0; ICD-10-CM codes: M05 & M06) during the study period (01JAN2009-20SEP2019) were included from the Discus Analytics JointMan database. The initial RA diagnosis date was defined as the index date. Pts with ILD were identified by ICD diagnosis codes or by provider indication in the JointMan record. Pts who developed ILD before RA were excluded from this analysis. The prevalence and time to onset of ILD were reported. Pt demographics, comorbidities, RA characteristics and disease activity scores were compared for 6 months prior to or on the index date (baseline period) for selected adult RA pts with available information.

Results:

Among 8,963 identified RA pts, 337 (3.8%) were diagnosed with ILD on or after RA diagnosis. The median time to ILD onset post-RA was 2.3 years, and 47% had ILD within 2 years after RA diagnosis. RA-ILD pts were significantly older than those without ILD (65.8 years vs. 59.1 years; p<0.001; Table 1). At baseline, a higher percentage of RA-ILD pts had history of chronic obstructive pulmonary disease, positive rheumatoid factor, rheumatoid nodules, erosive joint disease, positive anti-cyclic citrullinated peptide antibody, and joint swelling compared to RA-only pts (Table 2). The mean ESR and RA disease activity scores were also significantly higher for RA-ILD pts.

Table 1.

Patient Demographics

Patient demographicsRA-ONLY COhort(N = 5,612)RA-ild coHORT(N = 205)P-valueAge, Mean ± SD, years59.1 ± 14.265.8 ± 11.8<.001Male, N (%)1,375 (24.5%)72 (35.1%)0.001Race, N (%) White4,014 (71.5%)165 (80.5%)0.005 African American365 (6.5%)9 (4.4%)0.226 Other/Missing1,233 (22.0%)31 (15.1%)0.020Table 2.

Baseline Clinical Characteristics

Clinical CharacteristicsRA-ONLY COhort(N = 3,846)RA-ild coHORT(N = 115)P-valueHistory of Chronic Obstructive Pulmonary Disease, N (%)102 (2.7%)8 (7.0%)0.006Hypertension, N (%)900 (23.4%)23 (20.0%)0.395Serious Infection, N (%)38 (1.0%)3 (2.6%)0.091Rheumatoid Factor Positive, N (%)1,388 (36.1%)69 (60.0%)<.001Joint Stiffness, N (%)1,092 (28.4%)39 (33.9%)0.197Rheumatoid Nodules, N (%)153 (4.0%)17 (14.8%)<.001Erosive Joint Disease, N (%)459 (11.9%)23 (20.0%)0.009Anti-CCP Antibody Positive, N (%)858 (22.3%)45 (39.1%)<.001Joint Swelling*, N (%)2,861 (58.0%)123 (68.0%)0.008Joint Tenderness*, N (%)3,728 (75.6%)138 (76.2%)0.851ESR**, Mean ± SD, mm/hr22.0 ± 22.630.1 ± 25.5<.001CRP**, Mean ± SD, mg/L22.5 ± 13.060.6 ± 25.00.086CDAI, Mean ± SD16.4 ± 12.318.9 ± 15.70.044DAS28-CRP, Mean ± SD2.6 ± 1.23.1 ± 1.4<.001DAS28-ESR, Mean ± SD3.3 ± 1.43.9 ± 1.5<.001SDAI, Mean ± SD20.2 ± 29.328.6 ± 40.20.048

* A total of 4,929 non-ILD and 181 ILD patients had joint swelling and tenderness data.

** Variables were calculated among patients who had available information.

Conclusion:

This large real-world RA population provides insight into the burden of ILD in RA pts. Pts with ILD had a higher proportion of comorbidities and RA-related conditions and higher RA activity. Further analysis is warranted to assess the risk factors of ILD and its prognosis.

Disclosure of Interests:

Joe Zhuo Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Qisu Zhang Consultant of: I am a paid employee of STATinMED Research which is a paid consultant to Bristol-Myers Squibb Company., Keith Knapp Consultant of: In the last year, I was a paid consultant to Bristol Myers-Squibb Company., Employee of: I am a paid employee of Discus Analytics., Yuexi Wang Consultant of: I am a paid employee of STATinMED Research which is a paid consultant to Bristol-Myers Squibb Company., Cynthia Gutierrez Consultant of: I am a paid employee of STATinMED Research which is a paid consultant to Bristol-Myers Squibb Company., Ding He Consultant of: I am a paid employee of STATinMED Research which is a paid consultant to Bristol-Myers Squibb Company., Lin Xie Consultant of: I am a paid employee of STATinMED Research which is a paid consultant to Bristol-Myers Squibb Company., Sonie Lama Shareholder of: I own shares of Bristol-Myers Squibb Company., Employee of: I am a paid employee of Bristol-Myers Squibb Company., Gary Craig Consultant of: I have served as a consultant to Bristol-Myers Squibb Company., Employee of: I am a paid employee of Arthritis Northwest and VP of Discus Analytics., Speakers bureau: I am a member of the speakers bureau for Bristol-Myers Squibb Company.

SAT0129 ROLE OF SHARED EPITOPE ON THE EFFECTIVENESS OF TNFI TREATMENT FOR PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

Rheumatoid arthritis (RA) has been shown a strong genetic association with particularHLA–DRB1alleles containing shared epitope (SE). However, whether SE is clinically useful in treatment choices is insufficiently investigated1and previous studies have presented mixed findings in the role of SE in the response of TNFi therapies2,3.

Objectives:

To assess the role of SE in response to TNFi treatment in real-world RA patients (pts).

Methods:

Pts enrolled in a large RA registry, Brigham and Women’s Hospital RA Sequential Study, with known SE and received TNFi therapies were included for the analysis. TNFi pts were identified by the first-time use of the drugs between March 2003 to June 2018. For this analysis, all pts were followed up to 1 year. Summary statistics are reported for demographics, serostatus and disease activity (DA) at baseline and follow-up, stratified by SE status. Given the strong association of SE and anti-citrullinated protein antibody (ACPA), the analysis was further stratified by ACPA status. The effect of SE on change in DA was assessed using linear regression model with age, gender, RA disease duration, baseline DA, smoking status, SE, ACPA and ACPA-SE interaction as covariates.

Results:

Of the 484 TNFi pts included in the study, 68.8% were SE+. SE+ pts (vs SE-) were more likely to be rheumatoid factor positive, have erosive disease and a higher disease duration, irrespective of ACPA status. No difference in the change of DA was observed by SE. In SE- pts, ACPA+ pts had a greater reduction of DA than ACPA- pts (Table 1). After accounting for baseline differences, there was no significant effect of SE status on the mean change from baseline in any of the 3 DA measures.(Figure 1) The change in DA was not associated with ACPA but was significantly affected by disease duration and baseline DA.

Table 1.

Disease Activity in TNFi Patients, Stratified by SE and ACPA Status

ParameterSE+ (1 & 2 alleles, n=333)SE- (n=151)ACPA+ACPA–OverallACPA+ACPA-Overall(n=264)(n=69)(n=333)(n=90)(n=61)(n=151)Baseline, Mean (SD)DAS28 CRP3.94 (1.69)3.57 (1.61)3.86 (1.67)3.85 (1.49)3.45 (1.65)3.69 (1.57)CDAI23.06 (18.13)18.95 (15.96)22.25 (17.78)21.91 (15.96)17.72 (17.06)20.26 (16.48)SDAI24.08 (18.82)19.96 (16.59)23.27 (18.45)22.58 (16.34)18.55 (17.87)20.99 (17.01)Follow-up, Mean (SD)DAS28 CRP3.42 (1.55)2.69 (1.32)3.27 (1.53)3.19 (1.43)3.11 (1.53)3.16 (1.47)CDAI17.61 (15.53)12.11 (12.65)16.51 (15.14)15.15 (13.35)14.94 (14.73)15.07 (13.84)SDAI18.35 (15.73)12.45 (12.78)17.15 (15.34)15.31 (13.81)15.71 (15.45)15.46 (14.38)Change, Mean (SD)DAS28 CRP-0.48 (1.31)-0.65 (1.53)-0.52 (1.36)-0.52 (1.50)-0.24 (0.93)-0.42 (1.34)CDAI-4.29 (13.16)-4.79 (13.13)-4.39 (13.12)-6.45 (13.56)-2.63 (9.58)-4.99 (12.28)SDAI-4.74 (14.13)-5.07 (13.90)-4.80 (14.05)-6.87 (14.21)-2.97 (10.32)-5.41 (12.98)Figure 1.

Linear Regression Model for Change in Disease Activity*Estimates, p-values are shown as data labels on the graphs; The above model is adjusted for age, gender, RA duration, smoking status, SE status, baseline DA, ACPA and ACPA*SE status

Conclusion:

This real-world study validates the finding from previous studies conducted in clinical settings that SE does not differentiate treatment response for TNFi therapies.

References:

[1]Saruhan-Direskeneli G, et al.Rheumatology (Oxford) 2007;46(12):1842-44

[2]Skapenko A, et al.Clin Exp Rheumatol2019;37(5):783-790

[3]Rigby W, et al.Annals of the Rheumatic Diseases2019;78(2):263-264

Disclosure of Interests:

Joe Zhuo Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Joshua Bryson Shareholder of: I own shares of Bristol-Myers Squibb Company, Employee of: I am a paid employee of Bristol-Myers Squibb Company, Qian Xia Shareholder of: I own shares of Bristol-Myers Squibb Company, Employee of: I am a paid employee of Bristol-Myers Squibb Company, Niyati Sharma Consultant of: I work as a consultant for Bristol-Myers Squibb Company, Chidananda Samal Consultant of: I work as a consultant for Bristol-Myers Squibb Company, Sonie Lama Shareholder of: I own shares of Bristol-Myers Squibb Company., Employee of: I am a paid employee of Bristol-Myers Squibb Company., Michael E. Weinblatt Grant/research support from: BMS, Amgen, Lilly, Crescendo and Sonofi-Regeneron, Consultant of: Horizon Therapeutics, Bristol-Myers Squibb, Amgen, Abbvie, Crescendo, Lilly, Pfizer, Roche, Gilead, Nancy Shadick Grant/research support from: Mallinckrodt, BMS, Lilly, Amgen, Crescendo Biosciences, and Sanofi-Regeneron, Consultant of: BMS

SAT0061 ROLE OF SHARED EPITOPE IN THE PROGNOSIS OF RHEUMATOID ARTHRITIS IN RELATION TO ACPA POSITIVITY

Background:

The mechanistic association ofHLA-DRB1alleles that code a “shared epitope” (SE) with rheumatoid arthritis (RA) is not yet clear. Previous data has suggested the carriage of SE is associated with the production of cyclic citrullinated peptide antibodies (anti-CCP)1and severe RA2-4. The interrelationship among SE, anti-citrullinated protein antibody (ACPA) positivity and disease outcomes is not fully understood.

Objectives:

To assess the RA prognosis associated with the carriage of SE, in relation to ACPA positivity.

Methods:

Pts enrolled in a large RA registry, Brigham and Women’s Hospital RA Sequential Study between March 2003 to June 2018, with known SE and ACPA status were included in the analysis. HLA-DRB1 SE status was determined by allele-specific polymerase chain reaction and DNA sequencing for most of the subjects and by GWAS-based imputation for the rest. Disease activity (DA) was measured at baseline (BL) and 1-year follow-up by DAS28(CRP), CDAI and SDAI. Pts were stratified by SE+ (1 or 2 SE alleles) and SE- (0 alleles) and ACPA status. We analyzed the relationship of SE with ACPA positivity and change in DA by a linear regression model separately. A mediation analysis was used to examine the mediating effect of ACPA on association between SE and change in DA.

Results:

Out of 926 pts included in the analysis, 65.1% were SE+, of whom 75.6% were ACPA+. In comparison, 51.7% were ACPA+ in SE- pts. SE+ pts were similar with SE- pts in age, gender, BMI and smoking status, but had longer disease duration, were more likely to be rheumatoid factor positive, have erosive disease and higher comorbidity burden irrespective of ACPA status. The differences were more pronounced if the pts were also ACPA+. Adjusting for BL differences, pts with SE 1 and 2 alleles (vs 0) had an odd ratio of 1.97 (95% CI:1.36-2.84; p=0.0003) and 3.82 (95% CI: 2.44-5.98; p<.0001) to be ACPA +, respectively. The regression analysis suggests that SE+ (vs SE-) pts had an average increase in DAS28 (CRP) of 0.22 (p=0.033), CDAI of 2.07 (p=0.045) and SDAI of 2.43 (p=0.029) over a year (Fig 1). Using a mediation analysis, the direct effect of SE+ account for 78.8% to 81.0% of total effect in the increase in DAS28 (CRP), CDAI and SDAI, and the indirect effect mediated by ACPA account for 19.0% to 21.2% (Table 1).

Table 1.

Mediation Analysis for SE and ACPA Association with Change in DA

ParameterChange in DAS28 CRP (N=666)Change in CDAI (N=653)Change in SDAI (N=629)EstimateP-valueEstimateP-valueEstimateP-valueTotal Effect of SE on DA change0.220.0342.050.0472.400.030Direct effect of SE on DA change excluding mediation of ACPA0.170.1011.570.1401.890.098Indirect effect of SE on DA change due to ACPA mediation and interaction0.040.1830.480.1330.510.143

The model is adjusted with other covariates: Age, Gender, Charlson comorbidity score; baseline biologic use, Smoking status, baseline DA, Interaction term (ACPA*SE)

Figure 1.

Linear Regression Model for SE Association with Change in Disease Activity *Estimates, p-values are shown as data labels on the graphs; Change in disease activity (DA) = (follow-up DA- baseline DA); The above model is adjusted for age, gender, CCI, baseline DA, baseline biologic use, SE status and smoking status

Conclusion:

SE is strongly related to ACPA and a greater burden of disease in RA pts. In pts receiving standard treatments including biologics, SE is predictive of a greater increase in DA, which is partially mediated by the presence of ACPA.

References:

[1] Dayan I, et al.,Arch of Rheumatology, 2010;25:012-018.

[2] Gregerson PK, et al,Arthritis Rheum. 1987;30:1205-1213.

[3] Turesson C, et al.Arthritis Res Ther. 2005;7:R1386-1393.

[4] Moreno I, et al.J Rheumatol. 1996;23:6-9.

Disclosure of Interests:

Joe Zhuo Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Joshua Bryson Shareholder of: I own shares of Bristol-Myers Squibb Company, Employee of: I am a paid employee of Bristol-Myers Squibb Company, Qian Xia Shareholder of: I own shares of Bristol-Myers Squibb Company, Employee of: I am a paid employee of Bristol-Myers Squibb Company, Niyati Sharma Consultant of: I work as a consultant for Bristol-Myers Squibb Company, Sheng Gao Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Sonie Lama Shareholder of: I own shares of Bristol-Myers Squibb Company., Employee of: I am a paid employee of Bristol-Myers Squibb Company., Michael E. Weinblatt Grant/research support from: BMS, Amgen, Lilly, Crescendo and Sonofi-Regeneron, Consultant of: Horizon Therapeutics, Bristol-Myers Squibb, Amgen, Abbvie, Crescendo, Lilly, Pfizer, Roche, Gilead, Nancy Shadick Grant/research support from: Mallinckrodt, BMS, Lilly, Amgen, Crescendo Biosciences, and Sanofi-Regeneron, Consultant of: BMS

Urotensin II receptor expression in patients with ulcerative colitis: a pilot study

BACKGROUND

Urotensin II (U-II) is a vasoactive peptide that interacts with a specific receptor named UTR. Recently, our group has demonstrated increased UTR expression in both human colon adenocarcinoma cell lines and adenomatous polyps, as well as in colon carcinoma samples if compared to healthy colon samples of the same patients. We also showed that an UTR agonist induced an increase in colon adenocarcinoma cell growth in vitro, whereas the UTR block with a specific antagonist caused an inhibition of their growth and an inhibition of about 50% of both motility and cell invasion. Ulcerative colitis (UC) is an inflammatory bowel disease (IBD) associated with an increased baseline risk for colon cancer compared with the general population, and this risk is mostly attributed to chronic inflammation and immune dysregulation. This risk increases along with the duration of the disease, as demonstrated by many studies. There are no UTR expression data related to UC, and we therefore evaluated UTR expression in ill colon biopsies and in healthy colon ones of patients with UC and colon biopsies of healthy patients.

METHODS

We enrolled, prior to informed consent, 11 patients (5 males and 6 females, age range 29-75 years, median age 52 years) with first UC diagnosis compared to 11 healthy controls (6 males and 5 females, age range 30-78 years, median age 55 years). We have therefore sampled inflammatory and healthy tissue in UC patients. We have also taken colic tissue samples in healthy subjects. Evaluation of receptor expression was performed by reverse transcription-polymerase chain reaction (RT-PCR), Western Blot analysis. The ANOVA Test (P<0.05) was used for statistical analysis.

RESULTS

We found: 1) increased expression of UTR in 11/11 UC patients with ill mucosa biopsies compared to healthy controls in RT-PCR and in Western Blot analysis; 2) increased UTR expression in 11/11 UC patients with ill colon biopsies compared to the results obtained from healthy colon biopsies of the same patients both in RT-PCR and in Western Blot analysis; 3) increased UTR expression in 9/11 UC patients healthy colon biopsy specimens compared to healthy controls.

CONCLUSIONS

UTR could be considered as an inflammatory UC disease marker because its expression is greater in the mucosa of ill colon than in the healthy colon of the same patients and compared to healthy controls.

Silybin-Induced Apoptosis Occurs in Parallel to the Increase of Ceramides Synthesis and miRNAs Secretion in Human Hepatocarcinoma Cells

Silybin is a flavonolignan extracted from Silybum marianum (milk thistle) with hepatoprotective, antioxidant, and anti-inflammatory activity. Several studies have shown that silybin is highly effective to prevent and treat different types of cancer and that its antitumor mechanisms involve the arrest of the cell cycle and/or apoptosis. An MTT assay was performed to study cell viability, lipid peroxidation, extracellular NO production, and scavenger enzyme activity were studied by Thiobarbituric Acid-Reactive Species (TBARS) assay, NO assay, and MnSOD assay, respectively. Cell cycle and apoptosis analysis were performed by FACS. miRNA profiling were evaluated by real time PCR. In this study, we demonstrated that Silybin induced growth inhibition blocking the Hepg2 cells in G1 phase of cell cycle and activating the process of programmed cell death. Moreover, the antiproliferative effects of silybin were paralleled by a strong increase of the number of ceramides involved in the modulation of miRNA secretion. In particular, after treatment with silybin, miR223-3p and miR16-5p were upregulated, while miR-92-3p was downregulated (p < 0.05). In conclusion, our results suggest that silybin-Induced apoptosis occurs in parallel to the increase of ceramides synthesis and miRNAs secretion in HepG2 cells.

Effect of restriction vegan diet's on muscle mass, oxidative status, and myocytes differentiation: A pilot study

This study was conceived to evaluate the effects of three different diets on body composition, metabolic parameters, and serum oxidative status. We enrolled three groups of healthy men (omnivores, vegetarians, and vegans) with similar age, weight and BMI, and we observed a significant decrease in muscle mass index and lean body mass in vegan compared to vegetarian and omnivore groups, and higher serum homocysteine levels in vegetarians and vegans compared to omnivores. We studied whether serum from omnivore, vegetarian, and vegan subjects affected oxidative stress, growth and differentiation of both cardiomyoblast cell line H9c2 and H-H9c2 (H9c2 treated with H₂ O₂ to induce oxidative damage). We demonstrated that vegan sera treatment of both H9c2 and H-H9c2 cells induced an increase of TBARS values and cell death and a decrease of free NO^2- compared to vegetarian and omnivorous sera. Afterwards, we investigated the protective effects of vegan, vegetarian, and omnivore sera on the morphological changes induced by H₂ O₂ in H9c2 cell line. We showed that the omnivorous sera had major antioxidant and differentiation properties compared to vegetarian and vegan sera. Finally, we evaluated the influence of the three different groups of sera on MAPKs pathway and our data suggested that ERK expression increased in H-H9c2 cells treated with vegetarian and vegan sera and could promote cell death. The results obtained in this study demonstrated that restrictive vegan diet could not prevent the onset of metabolic and cardiovascular diseases nor protect by oxidative damage.

Epidemiology of Work-Related Musculoskeletal Symptoms and Illnesses among Brick Kiln Workers in Kathmandu Valley, Nepal

Background Workers in the brick manufacturing industries require to carry heavy loads, do repetitive work and remain in awkward postures for extended periods of time. These activities may cause them to develop work-related musculoskeletal symptoms and disorders. Objective To investigate the epidemiology of musculoskeletal symptoms and disorders among brick manufacturing workers as well as similar exposure groups among brick kiln workers. Method An analytical cross-sectional study was conducted during February - March 2015 in the Kathmandu Valley. From 16 brick kilns, 400 interviewees involving green brick molding, green brick stacking/carrying, red brick loading/carrying, coal crushing/ carrying and firing were recruited. An unmatched equal size of reference group of grocery workers was maintained for comparison. Prevalence of all musculoskeletal symptoms and disorders were computed and compared among brick workers and grocery workers as well as similar exposure groups among brick kiln workers. Result The musculoskeletal symptoms and disorders were prevalent in 90.5% of the exposed and 82.2% of the reference group. Brick kiln workers were about two times more likely to experience musculoskeletal symptoms and disorders compared to the reference group. When the associations among similar exposure groups were evaluated, there were significantly high prevalence of musculoskeletal symptoms and disorders among green brick molders, red brick loaders/carriers and coal crushers/ carriers in comparison to firemen. Conclusion This study showed a high prevalence of musculoskeletal symptoms and disorders among brick kilns workers. Among all similar exposure groups, coal crushing/carrying task significantly elevated with all types of musculoskeletal symptoms and disorders.

Maternal and Fetal Outcomes of Adolescent Pregnancies at Patan Hospital

Aims: This study aims to review obstetric and neonatal outcome and risk factors in adolescent pregnant women and to compare perinatal outcomes with the adult group.Methods: This is a retrospective comparative study in between primiparous pregnant teenager women aged 15-19 years and   20-24 years from April 2012 to April 2013 in Patan Hospital Lalitpur, Nepal. The data was retrieved from the hospital records. Frequency of prenatal care, perinatal outcome (newborn’s weight and gestational age at delivery), mode of delivery and maternal complications if any were recorded.  Results: Neonates with normal birth weight (>2.5-4 kg) was seen in 70% (n=248) of the adolescent age group and 85% (n=1797) of adult age group. Neonates with low birth weight (<2.5 kg) was significantly higher in the adolescent age group with 29% (n=102) than the adult age group with only 13% (n=287). The occurrence of premature rupture of membrane and preterm premature rupture of membrane also show statistically significant association (Chi-square test p-value 0.000) on mother’s age having 18% and 2% respectively in adolescent pregnancy.Conclusions: There was significant association of neonatal complications like still birth, fetal distress, and meconium aspiration with the adolescent pregnancy. There was no significant association between neonatal death and age of mother. 

Optimizing gDNA extraction from fresh frozen meningioma tissue for downstream genetic analysis

OBJECTIVE

Meningioma is the most common brain tumor. Genetic mutations in meningioma that include deletion of the neurofibromatosis type 2 gene, (NF2), offer diagnostic information on tumor behavior, recurrence and potential response to treatment. Obtaining high-grade genetic material is critical for accurate, sensitive and robust molecular testing. Currently, no standardized procedure exists for extracting gDNA from meningioma, and this problem was addressed in this report.

METHOD

This study compared the yield and quality of extracted gDNA from patient meningioma specimens using an optimized phenol chloroform method and two commercial silica column-based extractions kits and tested respective performances as template in qPCR tests and multiplex ligation-dependent probe amplification (MLPA) NF2 screening.

RESULTS

Mean gDNA yields were comparable for each method tested; however, phenol chloroform extraction outperformed column-based kits in all other quality assurance metrics examined. Phenol chloroform extracted gDNA was highly pure, and of a higher fragment size species when compared to column prepared gDNA. qPCR of GAPDH, B2MG, and RPL37A housekeeping genes demonstrated variance in cycle thresholds between patient samples was much lower in the phenol chloroform group. Similarly, primer efficiencies were significantly improved in this sample group which translated to a broader qPCR linear dynamic range and much improved qPCR performance at low concentrations of template. MLPA screening identified NF2 gene deletions in 6 of 12 meningioma samples. Inconsistencies in copy number data for NF2 and reference regions of the genome were observed between gDNA sample extraction groups that included both false negative and positive errors in silica column derived gDNA samples.

CONCLUSIONS

This study outlines a highly robust phenol chloroform extraction method for obtaining high-quality gDNA from frozen meningioma tissue and highlights the significance of performing adequate quality assurance when using gDNA for downstream genetic analysis. Most importantly, we demonstrate using gDNA extracted with silica column based kits can lead to diagnostic errors when screening NF2 deletions in meningiomas with MLPA.

Hopelessness and Suicidal Ideation among Patients with Depression and Neurotic Disorders Attending a Tertiary Care Centre at Eastern Nepal

BACKGROUND

Hopelessness is thought to result from a negative appraisal system and interacts with, and worsens, appraisals of defeat and trap which in turn interact with suicide schema and lead to suicidal behaviour. This study was intended to assess hopelessness and suicidal ideation among patients with depression and neurotic disorders at tertiary care centre of eastern Nepal.

METHODS

A cross sectional design included 70 respondents by purposive sampling technique. Beck Hopelessness Scale and Scale of Suicidal Ideation were used to measure hopelessness and suicidal ideation, respectively. Data were analyzed using SPSS statistical software. Pearson chi-square, binary logistic regression and Spearmans' rho, test were applied at 95% confidence interval.

RESULTS

Mean ± SD age was 32.8 ± 13.5 years. Most (62.8%) of the patients were female and with the diagnosis of depression. Majority (66%) of the patients had hopelessness. There was no significant difference in hopelessness among patients with depression and neurotic disorders. About 17% respondents had suicidal ideation, among them 82.4% were female. There was no significant difference of suicidal ideation among patients with depression and neurotic disorders (p=0.013). Significant positive correlation between hopelessness and suicidal ideation was found (p=0.001). Binary logistic regression revealed hopelessness was independently related to income and family history of mental illness. Similarly, suicidal ideation was independently related to depression and family history of mental illness.

CONCLUSIONS

Female respondents, people living under poverty and positive family history of mental illness had more hopelessness and suicidal ideation.

Barriers in Utilization of Maternal Health Care Services: Perceptions of Rural Women in Eastern Nepal

BACKGROUND

Nepal is promoting safe motherhood through maternity incentives schemes. Still about two-thirds of births take place at home. Inadequate access to health care and under utilization of services is the major reasons for poor health of women and children.

OBJECTIVES

The study aim to explore the barriers in utilization of maternal health care services in eastern Nepal specifically to explore the reasons for not availing the services and to assess the indigenous practices regarding maternal health.

METHODS

An exploratory study design was adopted to elicit the information from the selected respondents from different villages. Focus group discussions and in-depth interviews were conducted. Data was transcribed and analyzed manually to identify themes.

RESULTS

The barriers to maternal health care service utilization were identified as social factors like family pressure, superstition, shyness, misconception, negligence, illiteracy, alcoholism. Likewise, large family size, jobless, unnecessary expenditure on health services was identified as economic barrier. Some cultural practices were also found as barrier for not availing the health services.

CONCLUSION

The study explored factors that are contributing in not availing the maternal health care services. The elimination of these barriers will facilitate quality of care and health outcomes. Therefore, the interventions should be developed and implemented to improve the health status of women and children. The result of this study can be utilized to draw the attention of local government, in strategic planning related to maternal health interventions.

Outcome of Medical versus Surgical Methods in Second Trimester Abortion

Aims: This study aimed to assess the effectiveness of medical versus the surgical methods and to determine the outcome of both the methods with respect to complications like incomplete abortion, bleeding and sepsis.Methods:  This study was conducted at BP Koirala Institue of Health Sciences.  Total of 80 patients, 40 in each group were enrolled in the study.  For medical abortion group, Mifepristone 200mg orally followed by Misoprostol 400 mcg vaginally were given until the patient expelled the fetus.  In surgical group, cervical priming was done with Misoprostol followed by dilatation and evacuation.  The outcome of both medical and surgical abortions were compared in terms of amount of blood loss and associated complications like retained placenta and sepsis.Results: The overall complications were more in the medical group with 11.25% vs 2.5% in the surgical group (p value=0.02), with higher incidence of retained placenta (8 vs 0) and a higher amount of blood loss (129.20 +/- 20.4 ml vs 70.89 +/- 11.2 ml, p value <0.001) requiring blood transfusion.Conclusions: This study demonstrated that the surgical method is a more effective and safer procedure as compared to medical method.  The complication rates were lower and it was also more cost effective.

Relationship of Oxygen Saturation with Neonatal and Maternal factors in Vaginal and Cesarean Deliveries

INTRODUCTION

Hypoxemia is the major cause of neonatal morbidity and mortality. The study aims to determine the influence of birth weight, Apgar score, gestation age, body mass index and hemoglobin of mother on levels of SpO2 in healthy newborns born vaginally and through cesarean section.

METHODS

A hospital Based, observational study conducted in Department of Pediatrics, Universal College of Medical Sciences-Teaching Hospital, Bhairahawa, Lumbini, Nepal; on 49 vaginal and 49 cesarean deliveries with Apgar Score ≥ 6. SpO2 was estimated by pulse oximeter post-ductally between 1 to 30 minutes of birth. The observed SpO2 values were correlated with neonatal and maternal factors.

RESULTS

Vaginal and Cesarean deliveries SpO2 were comparable for birth weight, gestational age, Apgar score of neonates, body mass index and hemoglobin of the mother. Birth weight in vaginally delivered babies and Apgar score in cesarean births showed significant change in SpO2 (P<0.05). At all points of time the SpO2 values were higher in neonates, born by cesarean than those born out of spontaneous vaginal deliveries (P<0.001).

CONCLUSIONS

SpO2 levels in neonates born through cesarean section were higher in comparison to thoseborn by vaginal route. Birth weight and Apgar score had correlation with SpO2 in vaginal and cesarean births, respectively.

Polydatin administration improves serum biochemical parameters and oxidative stress markers during chronic alcoholism: a pilot study

AIM

Polydatin, a hydroxystilbene derived from the rhizome of Polygonum cuspidatum, elicits hepatoprotective and neuroprotective effects through its anti-oxidant properties. The present study aimed to determine the effects of oral administration of polydatin in alcoholic patients in order to improve liver biochemical parameters, serum oxidative stress and mental state. We enrolled 20 chronic alcoholic patients hospitalized for rehabilitative therapy. The patients were divided into two groups receiving the following treatment regimes for two weeks: administration of an anti-oxidant nutritional supplement containing glutathione and vitamin C (group 1), or glutathione, vitamin C and polydatin (group 2).

RESULTS

The results of the present study show that elevated plasma aspartate aminotransferase and alanine aminotransferase levels in patients after two weeks of alcohol withdrawal were significantly reduced by polydatin (group 2), when compared to group 1. Polydatin also significantly reduced lipid peroxidation levels. Finally, our preliminary data resulting from the analysis of the Mini-Mental Status suggest that polydatin improves cognitive performance.

CONCLUSION

Daily dietary administration of polydatin should be considered for prevention and treatment of liver disease and cognitive impairment in alcoholic patients.

Pegylated liposomal doxorubicin in the management of ovarian cancer: a systematic review and metaanalysis of randomized trials

Ovarian cancer is the leading cause of death among gynecological tumors. Carboplatin/paclitaxel represents the cornerstone of front-line treatment. Instead, there is no consensus for management of recurrent/progressive disease, in which pegylated liposomal doxorubicin (PLD) ± carboplatin is widely used. We performed a systematic review and metaanalysis to evaluate impact of PLD-based compared with no-PLD-based regimens in the ovarian cancer treatment. Data were extracted from randomized trials comparing PLD-based treatment to any other regimens in the January 2000-January 2013 time-frame. Study end-points were overall survival (OS), progression free survival (PFS), response rate (RR), CA125 response, and toxicity. Hazard ratios (HRs) of OS and PFS, with 95% CI, odds ratios (ORs) of RR and risk ratios of CA125 response and grade 3-4 toxicity, were extracted. Data were pooled using fixed and random effect models for selected endpoints. Fourteen randomized trials for a total of 5760 patients were selected and included for the final analysis, which showed no OS differences for PLD-based compared with other regimens (pooled HR: 0.94; 95% CI: 0.88-1.02; P = 0.132) and a significant PFS benefit of PLD-based schedule (HR: 0.91; 95% CI: 0.86-0.96; P = 0.001), particularly in second-line (HR: 0.85; 95% CI: 0.75-0.91) and in platinum-sensitive (HR: 0.83; 95% CI: 0.74-0.94) subgroups. This work confirmed the peculiar tolerability profile of this drug, moreover no difference was observed for common hematological toxicities and for RR, CA125 response. PLD-containing regimens do not improve OS when compared with any other schedule in all phases of disease. A marginal PFS advantage is observed only in platinum-sensitive setting and second-line treatment.

Histopathological pattern of abnormal uterine bleeding in endometrial biopsies

Abnormal uterine bleeding is a common presenting complaint in gyanecology out patient department. Histopathological evaluation of the endometrial samples plays a significant role in the diagnosis of abnormal uterine bleeding. This study was carried out to determine the histopathological pattern of the endometrium in women of various age groups presenting with abnormal uterine bleeding. Endometrial biopsies and curettings of patients presenting with abnormal uterine bleeding was retrospectively studied. A total of 403 endometrial biopsies and curettings were analyzed. The age of the patients ranged from 18 to 70 years. Normal cyclical endometrium was seen in 165 (40.94%) cases, followed by 54 (13.40%) cases of disordered proliferative endometrium and 44 (10.92%) cases of hyperplasia. Malignancy was seen in 10 (2.48%) cases. Hyperplasia and malignancy were more common in the perimenopausal and postmenopausal age groups. Histopathological examination of endometrial biopsies and curettings in patients presenting with abnormal uterine bleeding showed a wide spectrum of changes ranging from normal endometrium to malignancy. Endometrial evaluation is specially recommended in women of perimenopausal and postmenopausal age groups presenting with AUB, to rule out a possibility of any preneoplastic condition or malignancy.

Psychological Problems Among Nursing Staff in a Hospital

Introduction: A high prevalence of psychological/ mental disorders has frequently been reported among nursing staff. However, there is a scarcity of data about ‘psychological, mental and behavioural problems’ among Nepalese nurses. Current study aimed to measure the prevalence of psychiatric problems among nursing staff in a tertiary care hosital. Methods: All nursing staffs working in the hospital during one year were the subjects of this study. With the informed written consent, the responses to semi-structured proforma and the questionnaire General Health Questionnaire 28 were collected. A semi-structured proforma was used to record socio-demographic, clinical profiles and other information. The GHQ 28 was used to screen major psychiatric disorders. The GHQ 28 gives ‘psychiatric caseness’ to the subjects with score of 4 or more. Results: Overwhelming majority of nursing staff in BPKIHS is female certificate level staff nurses. Majority were from urban and semi urban settings. Some had job and institute related stressors. Most common among the reported health complaints were low back pain and headache. Few staff revealed psychiatric diagnosis. Among the enrolled 337 subjects, ‘psychiatric caseness’ was present in 34.72%. Some departments (e.g. dialysis, eye, medical, gynecology ward) had proportionately higher ‘psychiatric caseness’ rates than other (e.g. ENT, psychiatry ward, emergency OT, CSSD). Conclusions: A great proportion of nursing staff suffer from mental and behavioral problems. Keywords: hospital; GHQ 28; mental illness; nursing staff; psychology.

Level of compliance and factors associated with non-compliance to treatment among the mentally ill patients

Background: Mental illnesses are treatable and need medication and other therapies i.e. counseling, psychotherapy etc for the better outcome. Poor adherence to psychiatric medication regimens is a major obstacle to the effective care of persons who have chronic mental illness.Objectives: The study aims to identify the level of compliance and factors associated with non-compliance to treatment regimen.Methods: This was a hospital based cross sectional study carried out in psychiatric ward and OPD at B.P.Koirala Institute of Health Sciences, Dharan Nepal. A total of 150 patients were included as study samples using purposive sampling technique. Data was collected using self developed, pre tested, semi structured Pro forma by interview method.Results: Half of the patients showed average compliance. Thirty seven percentages of patients had good compliance and only 13% showed poor compliance. There was no association between drug compliance and demographic variables (p> 0.05). Drug compliance was significantly associated with factors such as drug related aspects, treatment access related factors, quality of interaction with treating team, family support, attitude towards mental illness and relatives' insight towards mental illness (p<0.05 ).Conclusion: The findings of the study highlighted the various factors such as drug related, social support, and treatment access related factors are influencing the drug compliance among the mentally ill patients.DOI: http://dx.doi.org/10.3126/hren.v10i2.6577 Health Renaissance 2012; Vol 10 (No.2); 113-117 

Psychological problems among nursing staff in a hospital

INTRODUCTION

A high prevalence of psychological/ mental disorders has frequently been reported among nursing staff. However, there is a scarcity of data about 'psychological, mental and behavioural problems' among Nepalese nurses. Current study aimed to measure the prevalence of psychiatric problems among nursing staff in a tertiary care hosital.

METHODS

All nursing staffs working in the hospital during one year were the subjects of this study. With the informed written consent, the responses to semi-structured proforma and the questionnaire General Health Questionnaire 28 were collected. A semi-structured proforma was used to record socio-demographic, clinical profiles and other information. The GHQ 28 was used to screen major psychiatric disorders. The GHQ 28 gives 'psychiatric caseness' to the subjects with score of 4 or more.

RESULTS

Overwhelming majority of nursing staff in BPKIHS is female certificate level staff nurses. Majority were from urban and semi urban settings. Some had job and institute related stressors. Most common among the reported health complaints were low back pain and headache. Few staff revealed psychiatric diagnosis. Among the enrolled 337 subjects, 'psychiatric caseness' was present in 34.72%. Some departments (e.g. dialysis, eye, medical, gynecology ward) had proportionately higher 'psychiatric caseness' rates than other (e.g. ENT, psychiatry ward, emergency OT, CSSD).

CONCLUSIONS

A great proportion of nursing staff suffer from mental and behavioral problems.

Histopathologic study of chronic antral gastritis

BACKGROUND

Gastritis has a broad histopathologic and topographical spectrum and leads to different patterns of disease. The introduction of the Sydney system made it possible to grade histological parameters, identify topographic distribution and provide etiological information which would help to generate reproducible and clincally useful diagnoses. The aim of this study was to determine the prevalence of Helicobacter pylori in non-ulcer dyspepsia, duodenal ulcer and gastric ulcer; and to assess the histopathologic features associated with chronic gastritis.

METHODS

Gastric antral biopsy specimens from 200 patients were examined for the prevalence of H. pylori, and were classified and graded histologically.

RESULTS

The overall colonization rate of H. pylori was 44%. The colonization rates were 85%, 67% and 41% in patients with duodenal ulcer, gastric ulcer and non-ulcer dyspepsia respectively. There was not much difference between the degree of atrophy and intestinal metaplasia in H. pylori positive and negative cases.

CONCLUSIONS

Helicobacter gastritis is the commonest type of gastritis present in patients presenting with dyspeptic symptoms. It is more common in patients presenting with duodenal ulcer. Adequate sampling is a must for accurate diagnosis of H. pylori colonization.

American National Red Cross experience with hepatitis-B antibody (HBAb or anti-HBAg) testing

Blood collected by 11 Red Cross Regional Blood Centers were screened by the method of agar gel diffusion (AGD) for the presence of hepatitis-B antibody. Of the 185,134 units tested, 114 were found to be positive for HBAb by the Regional Centers and were forwarded to National Special Projects Laboratory for confirmation. Only five out of 114 samples revealed lines of identity with a control anti-HBAg when reacted with a pool of plasma positive for hepatitis-B antigen that was different from that which was provided to the Centers. Apparently, the precipitation reactions observed by the Centers were largely due to the antithrombin antibodies in the donors' sera reacting with the residual thrombin used by the manufacturer to convert HBAg positive plasma to serum. We conclude that the incidence of hepatitis-B antibody as measured by agar gel diffusion in the Red Cross Blood donor population was extremely low.