Probiotic supplements prevented oxonic acid-induced hyperuricemia and renal damage

Hyperuricemia is highly prevalent and especially common in subjects with metabolic, cardiovascular and renal diseases. In chronic kidney disease, hyperuricemia is extremely common, and uric acid (UA) excretion relies on gut uricolysis by gut microbiota. Current therapy for lowering serum UA includes drugs that may produce undesired secondary effects. Therefore, this pilot study was designed to evaluate the potential of two probiotic supplements to reduce systemic uric acid concentrations. Secondary objectives were to assess whether the hypouricemic effect related to a therapeutic benefit on the hyperuricemia-induced renal damage and hypertension. Analysis of fecal microbiota was also performed. Groups of 6 rats each were followed for 5 weeks and allocated in the following treatment groups: C = Control; HU-ND = Oxonic acid-induced hyperuricemia (HU) +regular diet; HU-P = HU+placebo; HU-F1 = HU+ probiotics formula 1 and HU-F2 = HU+ probiotics formula 2. We confirmed that oxonic acid-induced hyperuricemia produced hypertension and renal functional and structural changes, along with modest changes in the overall composition of fecal microbiota. Both probiotic-containing diets prevented HU, elevated UA urinary excretion and intrarenal UA accumulation induced by oxonic acid. The hypouricemic effect conferred by probiotic supplementation also prevented the renal changes and hypertension caused by hyperuricemia. However, probiotic treatment did not restore the fecal microbiota. In conclusion, we demonstrated for the first time the ability of probiotics containing uricolytic bacteria to lower serum uric acid in hyperuricemic animals with beneficial consequences on blood pressure and renal disease. As probiotics supplements are innocuous for human health, we recommend clinical studies to test if probiotic supplements could benefit hyperuricemic individuals.

Metabolic profiling of a chronic kidney disease cohort reveals metabolic phenotype more likely to benefit from a probiotic

SCOPE

Persistent reduction in Glomerular Filtration Rate (GFR) is a hallmark of Chronic Kidney Disease (CKD) and is associated with an elevation of Blood Urea Nitrogen (BUN). This metabolomics pilot study sought to identify metabolites that differentiated patients with CKD whose BUN decreased on a probiotic and possible mechanisms.

METHODS AND RESULTS

Metabolomics was used to analyze baseline plasma samples previously diagnosed with CKD Stage III-IV. Patients had participated in a dose escalation study of the probiotic Renadyl™. A total of 24 samples were categorized depending on whether BUN increased or decreased from baseline after 4 months of probiotic use. Multivariate analysis was used to analyze the data and determine the metabolites that best differentiated the phenotypic groups. The sixteen patients who had a decrease in BUN were not significantly different based on demographic and clinical measures from those whose BUN increased or did not change with the exception of age. Eleven of the fourteen metabolites that differentiated the groups were known to be modulated by gut microflora, which may eventually provide a mechanistic link between probiotic and outcomes.

CONCLUSIONS

Metabolomics revealed metabolites at baseline that may predict individuals with CKD that would most benefit from a probiotics.

Design and characterization of a laterally mounted phased-array transducer breast-specific MRgHIFU device with integrated 11-channel receiver array

PURPOSE

This work presents the design and preliminary evaluation of a new laterally mounted phased-array MRI-guided high-intensity focused ultrasound (MRgHIFU) system with an integrated 11-channel phased-array radio frequency (RF) coil intended for breast cancer treatment. The design goals for the system included the ability to treat the majority of tumor locations, to increase the MR image's signal-to-noise ratio (SNR) throughout the treatment volume and to provide adequate comfort for the patient.

METHODS

In order to treat the majority of the breast volume, the device was designed such that the treated breast is suspended in a 17-cm diameter treatment cylinder. A laterally shooting 1-MHz, 256-element phased-array ultrasound transducer with flexible positioning is mounted outside the treatment cylinder. This configuration achieves a reduced water volume to minimize RF coil loading effects, to position the coils closer to the breast for increased signal sensitivity, and to reduce the MR image noise associated with using water as the coupling fluid. This design uses an 11-channel phased-array RF coil that is placed on the outer surface of the cylinder surrounding the breast. Mechanical positioning of the transducer and electronic steering of the focal spot enable placement of the ultrasound focus at arbitrary locations throughout the suspended breast. The treatment platform allows the patient to lie prone in a face-down position. The system was tested for comfort with 18 normal volunteers and SNR capabilities in one normal volunteer and for heating accuracy and stability in homogeneous phantom and inhomogeneous ex vivo porcine tissue.

RESULTS

There was a 61% increase in mean relative SNR achieved in a homogeneous phantom using the 11-channel RF coil when compared to using only a single-loop coil around the chest wall. The repeatability of the system's energy delivery in a single location was excellent, with less than 3% variability between repeated temperature measurements at the same location. The execution of a continuously sonicated, predefined 48-point, 8-min trajectory path resulted in an ablation volume of 8.17 cm(3), with one standard deviation of 0.35 cm(3) between inhomogeneous ex vivo tissue samples. Comfort testing resulted in negligible side effects for all volunteers.

CONCLUSIONS

The initial results suggest that this new device will potentially be suitable for MRgHIFU treatment in a wide range of breast sizes and tumor locations.

Methanol poisoning: predictors of visual outcomes

OBJECTIVE

To determine whether laboratory markers of methanol ingestion and subsequent toxicity can serve as predictors of visual outcomes in patients.

METHODS

Retrospective medical record review of 122 patients in a cluster outbreak of methanol poisoning. Data collected included history, complete ocular and systemic examination details, time to presentation, amount of alcohol ingested, and results of laboratory investigations, such as hemogram, glucose levels, hematocrit level, arterial pH, methanol levels, potassium and bicarbonate levels, and anion and osmolar gap determination, as well as hepatic and renal function tests. Therapy administered consisted of ethyl alcohol, sodium bicarbonate, and nutritional supplements, with hemodialysis in severe cases. Visual acuity (VA), pupillary reaction, and optic disc findings were assessed at presentation and 3 months after discharge. Patients were classified according to their visual disturbance: transient (group 1) or permanent (group 2). Appropriate statistical analysis was performed. Outcome measures included determining the association between biochemical markers of methanol poisoning and final VA.

RESULTS

A total of 122 patients (1 female and 121 male) were admitted for treatment; of these, 10 died. Only 1 patient showed a 2-line drop in VA. pH was the strongest predictor of final VA and improvement in VA among all markers. The odds that a patient with an initial pH greater than 7.2 would have only transient visual disturbances were high (odds ratio, 31; 95% CI, 6-149).

CONCLUSIONS

The degree of acidosis at presentation appears to determine final VA; early presentation and treatment did not seem to significantly alter the visual outcome, especially in severe poisoning.

An analytical solution for improved HIFU SAR estimation

Accurate determination of the specific absorption rates (SARs) present during high intensity focused ultrasound (HIFU) experiments and treatments provides a solid physical basis for scientific comparison of results among HIFU studies and is necessary to validate and improve SAR predictive software, which will improve patient treatment planning, control and evaluation. This study develops and tests an analytical solution that significantly improves the accuracy of SAR values obtained from HIFU temperature data. SAR estimates are obtained by fitting the analytical temperature solution for a one-dimensional radial Gaussian heating pattern to the temperature versus time data following a step in applied power and evaluating the initial slope of the analytical solution. The analytical method is evaluated in multiple parametric simulations for which it consistently (except at high perfusions) yields maximum errors of less than 10% at the center of the focal zone compared with errors up to 90% and 55% for the commonly used linear method and an exponential method, respectively. For high perfusion, an extension of the analytical method estimates SAR with less than 10% error. The analytical method is validated experimentally by showing that the temperature elevations predicted using the analytical method's SAR values determined for the entire 3D focal region agree well with the experimental temperature elevations in a HIFU-heated tissue-mimicking phantom.

Magnitude and determinants of ocular morbidities among persons with diabetes in a project in Ahmedabad, India

BACKGROUND

Visual disabilities due to diabetes are on the rise, especially in urban areas of developing countries. Proper health planning will need evidence-based information.

STUDY DESIGN AND METHODS

We estimated the prevalence and identified the determinants of eye complications among persons with diabetes screened in Ahmedabad, India, during 2007-2008. This was a review of the data from a health institution-based project. Physicians collected information on diabetes, and ophthalmologists examined the patients for visual acuity, diabetic retinopathy (DR), glaucoma, and cataracts. World Health Organization-recommended grading of DR was used. Frequencies, prevalence, and 95% confidence interval (CI) values were calculated.

RESULTS

Of 40,919 persons who we examined for diabetes, 9,246 (66.6%) persons knew that they had diabetes, whereas 4,641 (33.4%) persons were detected with diabetes for the first time. The prevalence of DR, early cataract, and glaucoma among those who knew that they had diabetes was 14.6% (95% CI 13.9-15.3), 44.4% (95% CI 43.4-45.4), and 5.4% (95% CI 4.9-5.9), respectively. The prevalence of DR among persons with diabetes (new and old) was 10.1% (95% CI 9.6-10.6). Although poor vision was positively associated with DR (chi2 = 706), 40% of those with DR had vision better than 20/60. Male sex (odds ratio [OR] = 1.31), longer duration of diabetes (chi2 = 1,808), hypertension (OR = 1.13), good sugar control (OR = 0.09), and nephropathy (OR = 2.16) were the factors associated with DR. Regression analysis suggested that longer duration of diabetes and poor control of diabetes were the predictors of DR.

CONCLUSIONS

The prevalence of DR was low. Long duration of diabetes, poor control of blood sugar, presence of nephropathy, and hypertension were associated with DR. Good vision could mislead about the severity of DR.

Evaluation of sparfloxacin eye drop in the management of conjunctival and corneal infection

Sparfloxacin 03% eye drop was evaluated in consecutive culture proven cases of conjunctivitis and corneal infection. Sparfloxacin 03% eye drop was found to provide 100% cure rate clInIcally as well as bacteriologically. This can be due to better ocular penetration and higher therapeutic index of sparfloxacin 03% eye drops. Sparfloxacin seems to be a better antibiotic for topical application for themanagement of external ocular Infections like conjunctivitis, keratitis and corneal ulcers.

Feeding, illness and nutritional status of young children in rural Gujarat

Eighty children, aged 0-18 months, were studied over a period of 6 months. Information was obtained from monthly interviews with mothers, when the children were also weighed. Feeding practices, incidence of illness and weight gain were described. The children who were nutritionally most at risk were identified. The average weight of the children was 1 kg less than the NCHS international reference by 3 months, 1.7 kg by 9 months. The majority of mothers did not introduce foods other than breast milk before 9 months. The children from labourers' households gained less weight between 3 and 6 months, had a higher prevalence of malnutrition and more reports of illness than children from non-labourers' households. The implications of these results for workers in child health and nutrition programmes are discussed.