Trends of Gaps Between Health-Adjusted Life Expectancy and Life Expectancy at the Regional Level in Korea Using a Group-Based Multi-Trajectory Modeling Approach (2008-2019)

BACKGROUND

Health-adjusted life expectancy (HALE) is an indicator of the average lifespan in good health. Through this study, we aimed to identify regional disparities in the gap between HALE and life expectancy, considering the trends that have changed over time in Korea.

METHODS

We employed a group-based multi-trajectory modeling approach to capture trends in the gap between HALE and life expectancy at the regional level from 2008 to 2019. HALE was calculated using incidence-based "years lived with disability." This methodology was also employed in the Korean National Burden of Disease Study.

RESULTS

Based on five different information criteria, the most fitted number of trajectory groups was seven, with at least 11 regions in each group. Among the seven groups, one had an exceptionally large gap between HALE and life expectancy compared to that of the others. This group was assigned to 17 regions, of which six were metropolitan cities.

CONCLUSION

Based on the results of this study, we identified regions in which health levels have deteriorated over time, particularly within specific areas of metropolitan cities. These findings can be used to design comprehensive policy interventions for community health promotion and urban regeneration projects in the future.

Measuring the Burden of Disease in Korea Using Disability-Adjusted Life Years (2008-2020)

BACKGROUND

The measurement of health levels and monitoring of characteristics and trends among populations and subgroups are essential for informing evidence-based policy decisions. This study aimed to examine the burden of disease in Korea for both the total population and subgroups in 2020, as well as analyze changes in disease burden from 2008 to 2020.

METHODS

We employed the methodology developed in the Korean National Burden of Disease and Injuries Study to calculate disability-adjusted life years (DALYs) by sex, causes, region, and income level from 2008 to 2020. DALYs were derived by combining years of life lost and years lived with disability.

RESULTS

In 2020, the burden of disease for the Korean population was estimated to be 25,439 DALYs per 100,000 population, reflecting a 13.8% increase since 2008. The leading causes of DALYs were diabetes mellitus, followed by low back pain and ischemic stroke. A sex-specific gap reversal was observed, with the disease burden for men surpassing that of women starting in 2017. Furthermore, variations in disease burden were identified across 250 regions and income quintiles.

CONCLUSION

It is imperative to establish appropriate health policies that prioritize the diseases with significantly increasing burdens and subgroups experiencing high disease burdens. The findings of this study are expected to serve as a foundation for developing healthcare policies aimed at improving the health levels of Koreans and achieving health equity.

Trends in Healthy Life Expectancy (HALE) and Disparities by Income and Region in Korea (2008-2020): Analysis of a Nationwide Claims Database

BACKGROUND

Healthy life expectancy is a well-recognized indicator for establishing health policy goals used in Korea's Health Plan. This study aimed to explore Koreans' healthy life expectancy and its gender, income, and regional disparities from 2008 to 2020.

METHODS

This study was conducted on the entire population covered by health insurance and medical aid program in Korea. The incidence-based "years lived with disability" for 260 disease groups by gender, income level, and region was calculated employing the methodology developed in the Korean National Burden of Disease Study, and it was used as the number of healthy years lost to calculate health-adjusted life expectancy (HALE).

RESULTS

Koreans' HALE increased from 68.89 years in 2008 to 71.82 years in 2020. Although the gender disparity in HALE had been decreasing, it increased to 4.55 years in 2020. As of 2020, 5.90 years out of 8.67 years of the income disparity (Q5-Q1) in HALE were due to the disparity between Q1 and Q2, the low-income groups. Income and regional disparities in HALE exhibited an increasing trend, and these disparities were higher in men than in women.

CONCLUSION

A subgroup with a low health level was identified through the HALE results, and it was confirmed that improving the health level of this population can reduce health inequalities and improve health at the national level. Further exploration of the HALE calculation methodology may help in the development of effective policies such as prioritizing interventions for health risk factors.

Updating Korean Disability Weights for Causes of Disease: Adopting an Add-on Study Method

OBJECTIVES

Disability weights require regular updates, as they are influenced by both diseases and societal perceptions. Consequently, it is necessary to develop an up-to-date list of the causes of diseases and establish a survey panel for estimating disability weights. Accordingly, this study was conducted to calculate, assess, modify, and validate disability weights suitable for Korea, accounting for its cultural and social characteristics.

METHODS

The 380 causes of disease used in the survey were derived from the 2019 Global Burden of Disease Collaborative Network and from 2019 and 2020 Korean studies on disability weights for causes of disease. Disability weights were reanalyzed by integrating the findings of an earlier survey on disability weights in Korea with those of the additional survey conducted in this study. The responses were transformed into paired comparisons and analyzed using probit regression analysis. Coefficients for the causes of disease were converted into predicted probabilities, and disability weights in 2 models (model 1 and 2) were rescaled using a normal distribution and the natural logarithm, respectively.

RESULTS

The mean values for the 380 causes of disease in models 1 and 2 were 0.488 and 0.369, respectively. Both models exhibited the same order of disability weights. The disability weights for the 300 causes of disease present in both the current and 2019 studies demonstrated a Pearson correlation coefficient of 0.994 (p=0.001 for both models). This study presents a detailed add-on approach for calculating disability weights.

CONCLUSIONS

This method can be employed in other countries to obtain timely disability weight estimations.

The gaps in health-adjusted life Expectancy (HALE) by income and region in Korea

 

This study aims to calculate the health-adjusted life expectancy (HALE) by using years lived with disability (YLD) from the national claims data, as well as to identify the differences and inequalities in sex, income level and region. The study was carried out on total population receiving national health insurance and medical benefits. We calculated incidence-based YLD for 260 disease groups, and used it as the number of healthy years lost to calculate HALE. We adopted the insurance premium to calculate the income as a proxy indicator. For the region classification, we chose 250 Korean municipal-level administrative districts. The primary outcome was HALE in the Korean population. The second outcome was the HALE’s gap in terms of sex, income, and region. Our results revealed that HALE increased from 2008 (68.89 years) to 2019 (70.58 years). HALE in males increased faster than that in females. HALE was higher in higher income levels. In 2019, the gap in HALE between Q1 and Q2, the lower income group, was about 5.70 years. The gap in females by income level was smaller than that in males. Moreover, the gap in HALE by region was found to increase. Results suggest that there is an inequality in YLD in terms of income level in Korea. Therefore, we need intensive management for the low-income group to increase HALE at the national level.

Key messages

• Males’ health level may be more sensitive to the socioeconomic level than females’ health level.

• In the 5th National Health Plan (HP2030), it was decided to set a target value for the overall goals based on this result.

Trends and Patterns of Cancer Burdens by Region and Income Level in Korea: A National Representative Big Data Analysis

PURPOSE

This study aimed to elucidate the trends and characteristics of the cancer burden in Korea by cancer site, region, and income level.

Materials and Methods

Korean National Burden of Disease research methodology was applied to measure the cancer burden in Korea from 2008 to 2018. The cause of death and national health insurance claims data were obtained from Statistics Korea and the National Health Insurance Service, respectively. An incidence-based approach was applied to calculate the disability-adjusted life-years, which is a summary measure of population health.

RESULTS

In the past decade, the cancer burden in Korea increased from 2,088 to 2,457 person-years per 100,000 population. Among the cancer burden, the years of life lost decreased, and the years lived with disabilities increased. Cancers of the trachea, bronchus, and lung had the highest disease burden, followed by those of the stomach, colon and rectum, liver, and breast.

CONCLUSION

The findings of this study can provide valuable quantitative data for prioritizing and evaluating cancer prevention strategies and implementing cancer policies. Estimating the difference in cancer burden according to region and income level within a country can yield useful data to understand the nature of the cancer burden and scale of the problem. In addition, the results of this study provide a better understanding of the causes of cancer patterns, thereby generating new hypotheses regarding its pathogenesis.

DALY Estimation Approaches: Understanding and Using the Incidence-based Approach and the Prevalence-based Approach

Disability-adjusted life-year (DALY) estimates may vary according to factors such as the standard life expectancy, age weighting, time preference and discount rate, calculation of disability weights, and selection of the estimation method. DALY estimation methods are divided into the following 3 approaches: the incidence-based approach, the pure prevalence-based approach, and the hybrid approach. These 3 DALY estimation approaches each reflect different perspectives on the burden of disease using unique characteristics, based on which the selection of a suitable approach may vary by the purpose of the study. The Global Burden of Disease studies, which previously estimated DALYs using the incidence-based approach, switched to using the hybrid approach in 2010, while the National Burden of Disease studies in Korea still mainly apply the incidence-based approach. In order to increase comparability with other international burden of disease studies, more DALY studies using the prevalence-based approach need to be conducted in Korea. However, with the limitations of the hybrid approach in mind, it is necessary to conduct more research using a disease classification system suitable for Korea. Furthermore, more detailed and valid data sources should be established before conducting studies using a broader variety of DALY estimation approaches. This review study will help researchers on burden of disease use an appropriate DALY estimation approach and will contribute to enhancing researchers’ ability to critically interpret burden of disease studies.

A Review of the Types and Characteristics of Healthy Life Expectancy and Methodological Issues

An index that evaluates the health level of a population group considering both death and loss of function due to disease is called a summary measure of population health (SMPH). SMPHs are broadly divided into life year indices and life expectancy indices, the latter of which comprise healthy life expectancy (HLE). HLE is included as a policy target in various national and regional level healthcare plans, and the term “HLE” is commonly used in academia and by the public. However, the overall level of understanding of HLE—such as the precise definition of HLE and methods of calculating HLE—still seems to be low. As discussed in this study, the types of HLE are classified into disability-free life expectancy, disease-free life expectancy, quality-adjusted life expectancy, self-rated HLE, and disability-adjusted life expectancy. Their characteristics are examined to facilitate a correct understanding and appropriate utilization of HLE. In addition, the Sullivan method, as a representative method for calculating HLE, is presented in detail, and major issues in the process of calculating HLE, such as selection of the population group and age group, estimation of death probability, calculation of life years, and incorporation of health weights, are reviewed. This study will help researchers to select an appropriate HLE type and evaluate the validity of HLE research results, and it is expected to contribute to the vitalization of HLE research.

Measuring the Burden of Disease in Korea, 2008-2018

The study aims to examine the current status and differences in the burden of disease in Korea during 2008-2018. We calculated the burden of disease for Koreans from 2008 to 2018 using an incidence-based approach. Disability adjusted life years (DALYs) were expressed in units per 100 000 population by adding years of life lost (YLLs) and years lived with disability (YLDs). DALY calculation results were presented by gender, age group, disease, region, and income level. To explore differences in DALYs by region and income level, we used administrative district and insurance premium information from the National Health Insurance Service claims data. The burden of disease among Koreans showed an increasing trend from 2008 to 2018. By 2017, the burden of disease among men was higher than that among women. Diabetes mellitus, low back pain, and chronic lower respiratory disease were ranked high in the burden of disease; the sum of DALY rates for these diseases accounted for 18.4% of the total burden of disease among Koreans in 2018. The top leading causes associated with a high burden of disease differed slightly according to gender, age group, and income level. In this study, we measured the health status of Koreans and differences in the population health level according to gender, age group, region, and income level. This data can be used as an indicator of health equity, and the results derived from this study can be used to guide community-centered (or customized) health promotion policies and projects, and for setting national health policy goals.

Estimation of Years Lived with Disability Using a Prevalence-Based Approach: Application to Major Psychiatric Disease in Korea

To help develop policies concerning the prevention of psychiatric disease in Korea, we reviewed the literature on this topic in different countries and used a prevalence-based approach to estimate the years lived with disability (YLDs) in Korean patients with major psychiatric diseases. We calculated YLDs by extracting data on the number of patients with mild, moderate, and severe cases of schizophrenia, bipolar disorder, and major depressive disorder, as classified by International Statistical Classification of Disease (ICD) codes. YLDs were highest for patients with major depressive disorder (1190.6; 73.9%), schizophrenia (303.3; 18.8%) and bipolar disorder (117.9; 7.3%). Men had higher YLDs for schizophrenia, 2502 (20-24 years); bipolar disorder, 477 (40-44 years); and major depressive disorder, 2034 (75-79 years). Women had higher YLDs for schizophrenia, 484 (45-49 years); bipolar disorder, 214 (≥80 years); and major depressive disorder, 3541 (75-79 years). The prevalence-based approach and severity distribution is useful for estimating long-term psychiatric disease burden and YLDs. However, YLD-estimation studies must compensate for the shortcomings of the ICD-10 by referencing the Diagnostic and Statistical Manual of Mental Disorders 5th edition, as well as updating the disability weight score according to disease severity.

The prevalence, incidence, and admission rate of diagnosed schizophrenia spectrum disorders in Korea, 2008-2017: A nationwide population-based study using claims big data analysis

This study estimated the prevalence and incidence rate of schizophrenia, schizotypal, and delusional disorders (SSDD) in Korea from 2008 to 2017 and analyzed the hospital admission rate, re-admission rate, and hospitalization period. It used the Korean nationwide National Health Insurance Service claims database. SSDD patients who had at least one visit to Korea's primary, secondary, or tertiary referral hospitals with a diagnosis of SSDD, according to the International Classification of Diseases, 10th Revision (ICD-10), were identified as SSDD cases if coded as F20-F29. Data were analyzed using frequency statistics. Results showed that the 12-month prevalence rate of SSDD increased steadily from 0.40% in 2008 to 0.45% in 2017. Analysis of the three-year cumulative prevalence rate of SSDD showed an increase from 0.51% in 2011 to 0.54% in 2017. In 2017, the five-year cumulative prevalence rate was 0.61%, and the 10-year cumulative prevalence rate was 0.75%. The hospital admission rate among SSDD patients decreased from 2008 (30.04%) to 2017 (28.53%). The incidence of SSDD was 0.05% and no yearly change was observed. The proportion of SSDD inpatients whose first hospital visit resulted in immediate hospitalization was 22.4% in 2017. Epidemiological indicators such as prevalence, incidence, and hospitalization rate play an important role in planning social and financial resource allocation. Therefore, efforts to produce more accurate epidemiological indicators are very important and this study's findings could have a significant social impact.

Association of Health Insurance Status with Outcomes of Sepsis in Adult Patients: A Retrospective Cohort Study

(1) Background: Sepsis is a life-threatening disease, and various demographic and socioeconomic factors affect outcomes in sepsis. However, little is known regarding the potential association between health insurance status and outcomes of sepsis in Korea. We evaluated the association of health insurance and clinical outcomes in patients with sepsis. (2) Methods: Prospective cohort data of adult patients with sepsis and septic shock from March 2016 to December 2018 in three hospitals were retrospectively analyzed. We categorized patients into two groups according to their health insurance status: National Health Insurance (NHI) and Medical Aid (MA). The primary end point was in-hospital mortality. The multivariate logistic regression model and propensity score matching were used. (3) Results: Of a total of 2526 eligible patients, 2329 (92.2%) were covered by NHI, and 197 (7.8%) were covered by MA. The MA group had fewer males, more chronic kidney disease, more multiple sources of infection, and more patients with initial lactate > 2 mmol/L. In-hospital, 28-day, and 90-day mortality were not significantly different between the two groups and in-hospital mortality was not different in the subgroup analysis. Furthermore, health insurance status was not independently associated with in-hospital mortality in multivariate analysis and was not associated with survival outcomes in the propensity score-matched cohort. (4) Conclusions: Our propensity score-matched cohort analysis demonstrated that there was no significant difference in in-hospital mortality by health insurance status in patients with sepsis.

Enhanced wound healing using a 3D printed VEGF-mimicking peptide incorporated hydrogel patch in a pig model

There is a need for effective wound healing through rapid wound closure, reduction of scar formation, and acceleration of angiogenesis. Hydrogel is widely used in tissue engineering, but it is not an ideal solution because of its low vascularization capability and poor mechanical properties. In this study, gelatin methacrylate (GelMA) was tested as a viable option with tunable physical properties. GelMA hydrogel incorporating a vascular endothelial growth factor (VEGF) mimicking peptide was successfully printed using a three-dimensional (3D) bio-printer owing to the shear-thinning properties of hydrogel inks. The 3D structure of the hydrogel patch had high porosity and water absorption properties. Furthermore, the bioactive characterization was confirmed by cell culture with mouse fibroblasts cell lines (NIH 3T3) and human umbilical vein endothelial cells. VEGF peptide, which is slowly released from hydrogel patches, can promote cell viability, proliferation, and tubular structure formation. In addition, a pig skin wound model was used to evaluate the wound-healing efficacy of GelMA-VEGF hydrogel patches; the results suggest that the GelMA-VEGF hydrogel patch can be used for wound dressing.

Projecting the prevalence of obesity in South Korea through 2040: a microsimulation modelling approach

OBJECTIVE

To project the prevalence of obesity in 2040 among individuals 19 years and older in South Korea.

DESIGN, SETTING, AND PARTICIPANTS

Using the 'Population Health Model-body mass index' (BMI) microsimulation model, the prevalence of obesity in Korean adults 19 years and older was projected until 2040. The model integrated individual survey data from the Korea Health Panel Survey of 2011 and 2012, population statistics based on resident registration, population projections and complete life tables categorised by sex and age. Birth rate, life expectancy and international migration were based on a medium growth scenario. The base population of Korean adults in 2012, devised through data aggregation, was 39 842 730. The prediction equations were formulated using BMI as the dependent variable; the individual's sex, age, smoking status, physical activity and preceding year's BMI were used as predictive factors.

OUTCOME MEASURE

BMI categorised by sex.

RESULTS

The median BMI for Korean adults in 2040 was expected to be 23.55 kg/m² (23.97 and 23.17 kg/m² for men and women, respectively). According to the Korean BMI classification, 70.05% of all adults were expected to be 'preobese' (ie, have BMIs 23-24.9 kg/m²) by 2040 (81.23% of men and 59.07% of women) and 24.88% to be 'normal'.

CONCLUSIONS

We explored the possibility of applying and expanding on the concept of microsimulation in the field of healthcare by combining data sources available in Korea and found that more than half of the adults in this study population will be preobese, and the proportions of 'obesity' and 'normal' will decrease compared with those in 2012. The results of our study will aid in devising healthy strategies and spreading public awareness for preventing this condition.

Associations Between Private Health Insurance and Medical Care Utilization for Musculoskeletal Disorders: Using the Korea Health Panel Survey Data for 2014 to 2015

In South Korea, people may increase their medical coverage by purchasing private health insurance to augment low coverage provided by the National Health Insurance (NHI). Frequent and excessive use of medical care by those with private health insurance is an issue, especially for musculoskeletal disorders that require excessive care and contribute to moral hazard. In South Korea, since private health insurance is structurally linked to the scope of coverage with public health insurance, this increased use of medical care may adversely affect public health insurance finances. This study aimed to analyze the effects of private health insurance on medical care use for patients with musculoskeletal disorders. We used the Korea Health Panel 2014 to 2015 data that included 5622 participants who used medical care for musculoskeletal disorders in 2015. Two groups were created: those who purchased private health insurance (n = 3588) and those without private insurance (n = 2034). We compared their medical utilization using logistic regression, negative binomial regression, and multiple linear regression to determine the associations of private health insurance with medical care use. Medical expenditures by private health insurance purchasers were higher than those of non-purchasers for outpatient care (P < .001), but no differences were found for inpatient care. Our findings suggest that the expansion of private health insurance further burdened the NHI financially, ultimately increasing the burden of medical expenses for the population. Research should implement demonstration studies with different groups of diseases.

Trends in the prevalence and treatment of bipolar affective disorder in South Korea

This study aimed to assess trends in the prevalence of bipolar disorder (BP). We also analyzed patterns of medical use by Korean patients with BP, defined as those diagnosed with the International Classification of Diseases (ICD) F31 code who used at least one inpatient or outpatient medical service in a year. We analyzed yearly BP prevalence and inpatient hospitalization periods per year from 2008 to 2017 using National Health Insurance Service (NHIS) claims data for 52.43 million people. Overall, the BP prevalence was 0.2 %, as of 2017, with consistently higher rates in women. The BP prevalence was highest among those aged ≥60 years (0.27 %) and was lowest among those aged 0-29 years (0.12 %), as of 2017. The average annual rate of increase among those aged 0-29 years and ≥60 years was 8.48 % and 7.39 %, respectively, which exceeded the overall mean of 6.58 %. The average annual rate of increase in BP prevalence for those aged 30-59 years was 4.67 %. The proportion of inpatients who were hospitalized for longer than 180 days decreased, while the proportion of those hospitalized for 0-14 days increased. The estimated BP prevalence was higher when using the most recent NHIS data rather than in the surveys. These prevalence rates can be used to support the development of future mental health policies.

Effects of anti-resorptive drugs on implant survival and peri-implantitis in patients with existing osseointegrated dental implants: a retrospective cohort study

The effect of anti-resorptive drug (ARD) usage among patients with successful dental implant osseointegration is controversial. This study showed an increased risk of implant failure in ARD users. Risk factors included pre-existing marginal bone loss, overdenture, diabetes, and a short interval between implant placement and ARD administration.

INTRODUCTION

This retrospective study aimed to determine whether anti-resorptive drug (ARD) usage increased risk of implant failure among patients with successful implant osseointegration. Additionally, the study investigated risk factors that affected implant survival rate in ARD users.

METHODS

Eighty ARD users with 344 implants who had more than 12 months of follow-up from the initiation of ARD treatment during the period between 2008 and 2017 were included, along with 80 non-ARD users from the same period. The primary outcome was dental implant survival. Kaplan-Meier survival curves and Cox proportional hazard models were used for survival analysis.

RESULTS

Average follow-up was 85.3 months. Implant survival rates were 89.83% in ARD users and 96.03% in non-ARD users. In the univariate Cox proportional hazard model, risk of implant failure was significantly higher in patients with pre-existing marginal bone loss (MBL), diabetes, and concurrent bone augmentation. However, risk of implant failure was significantly lower when the interval between implant placement and ARD administration was < 36 months. Compared with overdenture, single crown and fixed splinted users had lower risk of implant failure. In multivariate analysis, variables including pre-existing MBL, diabetes, < 36-month interval between implant placement and ARD treatment, and usage of fixed splinted prosthesis were significantly associated with increased risk of implant failure.

CONCLUSIONS

ARD administration after implant osseointegration was correlated with a reduced implant survival rate. Pre-existing MBL, diabetes, type of final prosthesis, and the interval between implant placement and initiation of ARD administration influenced risk of implant failure.

Abstract P4-14-04: Time course changes in serum FSH, estradiol, and menstruation restoration in premenopausal patients with breast cancer taking adjuvant tamoxifen after completing chemotherapy: A report from the ASTRRA study

BACKGROUND

Assessment of restoration of ovarian function after chemotherapy is critical with respect to the initiation of different types of endocrine treatment in young high risk breast cancer patients

METHODS

In total, 1289 women who remained premenopausal or resumed premenopausal status after chemotherapy were randomized to receive 5 years of tamoxifen or 5 years of tamoxifen plus 2 years of ovarian suppression. The patients who did not resume menstruation were followed up for 2 years with tamoxifen treatment after finishing chemotherapy. Prospectively collected consecutive post-chemotherapy hormone and menstruation data were available for 705 breast cancer patients who enrolled tamoxifen-only treatment group or did not resume menstruation during follow up. This analysis evaluated the proportion of patients with pre-menopausal FSH levels (&lt;30 mIU/ml), E2 levels (340 pg/ml), and menstruation at any time point during treatment with tamoxifen.

RESULTS

During 5 years of tamoxifen treatment after chemotherapy for premenopausal breast cancer patients, 62% of patients resumed menstruation. Menstruation returned in 92% of patients under 35 years old but only in 31% of patients over 45 years old. Ovarian function, defined by serum FSH and E2 levels, resumed in 94% and 65% of patients, respectively, over 5 years. Most patients achieved ovarian function restoration during the first 2 years after chemotherapy, with 47.1% resuming menstruation and 86.2% and 50.3% achieving pre-menopausal FSH and E2 levels, respectively, in the first 2 years. Clinical factors related to menstruation restoration were younger age (HR = 6.38, 95% CI 1.33-3.47), 6 month hormone profile after chemotherapy (FSH&lt;30: HR=1.67, 95% CI 1.28-2.17; E2 &gt;40: HR=2.96, 95% CI 2.25-3.89), and anthracycline without taxane chemotherapy (HR=1.63, 95% CI 1.25-2.13).

CONCLUSIONS

During 5 years of tamoxifen treatment after chemotherapy, half of patients experienced menstruation restoration, including most very young patients under 35 years. The majority of patients experienced menstruation restoration in the first 2 years of tamoxifen treatment.

Citation Format: Kim HJ, Noh WC, Nam SJ, Park B-w, Lee ES, Im SA, Jung YS, Yoon JH, Kang SS, Park KH, Lee S-J, Jung J, Lee MH, Cho SH, Kim SY, Kim H-A, Han S-H, Han W, Hur MH, Ahn SH. Time course changes in serum FSH, estradiol, and menstruation restoration in premenopausal patients with breast cancer taking adjuvant tamoxifen after completing chemotherapy: A report from the ASTRRA study [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-14-04.

Clinical Characteristics of Patients with Pseudo-Subarachnoid Haemorrhage who were Successfully Resuscitated from Out-of-Hospital Cardiopulmonary Arrest

Introduction

Pseudo-subarachnoid haemorrhage (PSAH) is a rare neuroradiological finding seen in patients with diffuse cerebral edemas. We investigated clinical characteristics and risk factors for the development of PSAH.

Method

The successfully resuscitated patients in emergency department were classified into two groups: those with pseudo-SAH [PSAH (+)] and those without pseudo-SAH [PSAH (-)]. Clinical variables were analysed.

Results

Pseudo-SAH was found in 31.6% of patients. PSAH was more common in males (p=0.042). The mean age was 39.9±10.3 years in the PSAH (+) group and 54.4±22.0 years in the PSAH (-) group (p=0.038). Outcomes measured by Cerebral Performance Category score were also significantly different between the two groups (p=0.037). Logistic regression analysis found that serum lactate concentration and duration of anoxia were associated with the development of PSAH (with odds ratios and p values of 1.92, p=0.01 and 1.13, p=0.02, respectively).

Conclusions

PSAH itself is a phenomenon that could be seen in post-resuscitation encephalopathy as a consequence of severe anoxic insult.

Systematic review with meta-analysis: the efficacy of vonoprazan-based triple therapy on Helicobacter pylori eradication

BACKGROUND

In order to increase eradication rates, vonoprazan, a novel potassium-competitive acid blocker, has been used in Helicobacter pylori eradication therapy.

AIM

To summarise the results of the efficacy of vonoprazan-based triple therapy, helping clinicians to better understand the benefit of vonoprazan in the treatment of H. pylori infection.

METHODS

We conducted a systematic literature search on MEDLINE, EMBASE, and the Cochrane Library using the primary keywords "vonoprazan," "takecab", "TAK-438," "potassium," "competitive," "potassium-competitive," "Helicobacter," and "pylori." Studies were included if they evaluated the eradication rate between the vonoprazan-based and proton pump inhibitor (PPI)-based triple therapies.

RESULTS

Ten studies and 10 644 patients were evaluated. The crude H. pylori eradication rate determined by intention-to-treat analysis was 87.9% and 72.8% in the vonoprazan-based triple therapy and PPI-based triple therapy respectively. The eradication rate of the vonoprazan-based triple therapy was superior to that of the PPI-based triple therapy (pooled risk ratio [RR] [95% confidence interval (CI)]=1.19 [1.15-1.24]) In addition, there was no significant difference in dropout rate due to adverse event between the regimens (pooled RR of the vonoprazan-based triple therapy [95% CI]=0.69 [0.23-2.03]). The incidence of any adverse events also did not differ between the regimens (pooled RR [95% CI]=1.02 [0.78-1.34]).

CONCLUSIONS

The vonoprazan-based triple therapy showed superior efficacy in terms of H. pylori eradication as compared to the PPI-based triple therapy. In addition, the vonoprazan-based triple therapy showed comparable tolerability and incidence of adverse events.

Mandibular step osteotomy using CAD/CAM-derived surgical splint: case report

Mandibular step osteotomy is a useful technique for large mandibular setbacks. We report a case of a patient who had a mandibular step osteotomy using a CAD/CAM-derived wafer for mandibular setback with reduction of the arch.

Periorbital melasma: Hierarchical cluster analysis of clinical features in Asian patients

BACKGROUND

Studies have shown melasma lesions to be distributed across the face in centrofacial, malar, and mandibular patterns. Meanwhile, however, melasma lesions of the periorbital area have yet to be thoroughly described.

METHODS

We analyzed normal and ultraviolet light-exposed photographs of patients with melasma. The periorbital melasma lesions were measured according to anatomical reference points and a hierarchical cluster analysis was performed.

RESULTS

The periorbital melasma lesions showed clinical features of fine and homogenous melasma pigmentation, involving both the upper and lower eyelids that extended to other anatomical sites with a darker and coarser appearance. The hierarchical cluster analysis indicated that patients with periorbital melasma can be categorized into two clusters according to the surface anatomy of the face. Significant differences between cluster 1 and cluster 2 were found in lateral distance and inferolateral distance, but not in medial distance and superior distance. Comparing the two clusters, patients in cluster 2 were found to be significantly older and more commonly accompanied by melasma lesions of the temple and medial cheek.

CONCLUSION

Our hierarchical cluster analysis of periorbital melasma lesions demonstrated that Asian patients with periorbital melasma can be categorized into two clusters according to the surface anatomy of the face.

Abstract P5-12-08: Time course of changes in serum FSH, serum estradiol, and menstruation in premenopausal patients with breast cancer taking tamoxifen after completing chemotherapy: A report from the ASTRRA study

BACKGROUND

Ovarian suppression with tamoxifen after chemotherapy is a promising therapeutic approach, particularly in young, high-risk breast cancer patients. Assessment of restoration of ovarian function is important with respect to the initiation of ovarian suppression.

METHODS

In total, 1289 women who remained or resumed premenopausal status after chemotherapy were randomized to receive 5 years of tamoxifen or 5 years of tamoxifen plus 2 years of ovarian suppression. Prospectively collected hormone data were available for 24 months after completing chemotherapy for 267 breast cancer patients without ovarian suppression.

RESULTS

At 6 months, a premenopausal status was identified in 56.6%, 36%, and 16.2% of patients using serum FSH, E2, and with menstruation bleeding, respectively, and about 30% more women achieved ovarian restoration using all three parameters during the 24-month follow-up. Ovarian function restoration differed significantly according to age group (log-rank, P&lt;0.001 for all definitions). At 6 months, the distribution of patients according to hormone levels was as follows: group 1 (FSH &lt;30 mIU/ml, E2 &gt;20 pg/ml), 28.0%; group 2 (FSH &lt;30 mIU/ml, E2 ≤20 pg/ml), 28.4%; group 3 (FSH ≥30 mIU/ml, E2 &gt;20 pg/ml), 8.0%; and group 4 (FSH ≥30 mIU/ml, E2 ≤20 pg/ml), 35.6%. During the 24-month follow-up, the prevalence of menstruation restoration was higher in group 1 (71.6%) than in the other three groups. Restoration of serum E2 and menstrual bleeding occurred in 44% and 33% of patients in group 2, respectively; the corresponding percentages in group 4 were 40.6% and 28.7% (P&lt;0.001).

CONCLUSIONS

Ovarian function should be monitored using serum FSH, serum E2, and menstruation history for at least 24 months after completing chemotherapy during tamoxifen treatment to establish eligibility for ovarian suppression.

Citation Format: Kim HJ, Ahn SH, Nam SJ, Park SH, Ro JS, Im SA, Jung YS, Noh WC. Time course of changes in serum FSH, serum estradiol, and menstruation in premenopausal patients with breast cancer taking tamoxifen after completing chemotherapy: A report from the ASTRRA study. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-12-08.

Inhibition of breast cancer invasion by TIS21/BTG2/Pc3-Akt1-Sp1-Nox4 pathway targeting actin nucleators, mDia genes

The mammalian homolog of Drosophila diaphanous (mDia), actin nucleator, has been known to participate in the process of invasion and metastasis of cancer cells via regulating a number of actin-related biological processes. We have previously reported that tumor suppressor TIS21(/BTG2/Pc3) (TIS21) inhibits invadopodia formation by downregulating reactive oxygen species (ROS) in MDA-MB-231 cells. We herein report that TIS21(/BTG2/Pc3) downregulates diaphanous-related formin (DRF) expression via reducing NADPH oxidase 4 (Nox4)-derived ROS generation by Akt1 activation and subsequently impairs invasion activity of the highly invasive breast cancer cells. Knockdown of Akt1 by RNA interference recovered the TIS21(/BTG2/Pc3)-inhibited F-actin remodeling and ROS generation by recovering Nox4 expression. Furthermore, Sp1-mediated Nox4 transcription was downregulated by TIS21(/BTG2/Pc3)-Akt1 signals, leading to the inhibition of cancer cell invasion via F-actin remodeling by mDia genes. To our best knowledge, this is the first study to show that TIS21(/BTG2/Pc3)-Akt1 inhibited Sp1-Nox4-ROS cascade, subsequently reducing invasion activity via inhibition of mDia family genes.

Evaluation of lymph node status after neoadjuvant chemotherapy in breast cancer patients: comparison of diagnostic performance of ultrasound, MRI and ¹⁸F-FDG PET/CT

Objective:

To evaluate the diagnostic performance of ultrasound, MRI and fluorine-18 fludeoxyglucose positron emission tomography (¹⁸F-FDG PET)/CT for the diagnosis of metastatic axillary lymph node (ALN) after neoadjuvant chemotherapy (NAC) and to find out histopathological factors affecting the diagnostic performance of these imaging modalities.

Methods:

From January 2012 to November 2014, 191 consecutive patients with breast cancer who underwent NAC before surgery were retrospectively reviewed. We included 139 patients with ALN metastasis that was confirmed on fine needle aspiration or core needle biopsy at initial diagnosis.

Results:

After NAC, 39 (28%) patients showed negative conversion of ALN on surgical specimens of sentinel lymph node (LN) or ALN. The sensitivity of ultrasound, MRI and PET/CT was 50% (48/96), 72% (70/97) and 22% (16/73), respectively. The specificity of ultrasound, MRI and PET/CT was 77% (30/39), 54% (21/39) and 85% (22/26), respectively. The Az value of combination of ultrasound and PET/CT was the highest (0.634) followed by ultrasound (0.626) and combination of ultrasound, MRI and PET/CT (0.617). The size of tumour deposit in LN and oestrogen receptor was significantly associated with the diagnostic performance of ultrasound (p < 0.001 and p = 0.009, respectively) and MRI (p = 0.045 and p = 0.036, respectively). The percentage diameter decrease, size of tumour deposit in LN, progesterone receptor, HER2 and histological grade were significantly associated with the diagnostic performance of PET/CT (p = 0.023, p = 0.002, p = 0.036, p = 0.044 and p = 0.008, respectively). On multivariate logistic regression analysis, size of tumour deposit within LN was identified as being independently associated with diagnostic performance of ultrasound [odds ratio, 13.07; 95% confidence interval (CI), 2.95–57.96] and PET/CT (odds ratio, 6.47; 95% CI, 1.407–29.737).

Conclusion:

Combination of three imaging modalities showed the highest sensitivity, and PET/CT showed the highest specificity for the evaluation of ALN metastasis after NAC. Ultrasound alone or combination of ultrasound and PET/CT showed the highest positive-predictive value. The size of tumour deposit within ALN was significantly associated with diagnostic performance of ultrasound and PET/CT.

Advances in knowledge:

This study is about the diagnostic performance of ultrasound, MRI, PET/CT and combination of each imaging modality for the evaluation of metastatic ALN after NAC. Of many histopathological factors, only the size of tumour deposit within ALN was an independent factor associated with the diagnostic performance of ultrasound and PET/CT.

Development of inorganic and organic hybrid nanocoating based on carbon nanotubes for corrosion resistance

In this study, we report the synthesis and characterization of novel hybrid nanocoating based on carbon nanotubes (CNTs) on anodized aluminum surfaces (AAO). The hybrid nanocoating was deposited by number of methods which include spray coating, spin coating and dip coating. The bonding of nanocoating with metal surface is an important parameter for successful modification of the metal surfaces. The improved adhesion of nanocoating on metal surfaces could be attributed to chemical bonding of sol-gel nanocoating with anodized surfaces. The nanocoated anodized aluminum surfaces showed superior adhesion and excellent anticorrosive properties. The nanocoated panels showed enhanced galvanic protection comparable to 80% of titanium metal as determined by galvanic corrosion measurements. It also showed higher thermal conductivities than stainless steel and bare anodized surfaces.

Diagnostic performance of 18F-FDG PET/CT, ultrasonography and MRI. Detection of axillary lymph node metastasis in breast cancer patients

The aim of this study was to evaluate the diagnostic abilities of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography(PET/CT) compared with those of ultrasonography and magnetic resonance imaging (MRI) for axillary lymph node staging in breast cancer patients.

PATIENTS, METHODS

Preoperative 18F-FDG PET/non-contrast CT, ultrasonography and MRI were performed in 215 women with breast cancer. Axillary lymph node dissection was performed in all patients and the diagnostic performance of each modality was evaluated using histopathologic assessments as the reference standard. ROC curves were compared to evaluate the diagnostic ability of several imaging modalities (i. e., ultrasonography, MRI and 18F-FDG PET/CT).

RESULTS

In total, 132 patients (61.4%) had axillary lymph node metastasis. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for the detection of axillary lymph node metastasis were 72.3%, 77.3%, 66.7%, 81.6%, 75.3% for ultrasonography, 67.5%, 78.0%, 65.9%, 79.2%, 74.0% for MRI, and 62.7%, 88.6%, 77.6%, 79.1%, 78.6% for 18F-FDG PET/CT, respectively. There was no significant difference in diagnostic ability among the imaging modalities (i.e., ultrasonography, MRI and 18F-FDG PET/CT). The diagnostic ability of 18F-FDG PET/CT was significantly improved by combination with MRI (p = 0.0002) or ultrasonography (p < 0.0001). The combination of 18F-FDG PET/CT with ultrasonography had a similar diagnostic ability to that of all three modalities combined (18F-FDG PET/CT+ultrasonography+MRI, p = 0.05).

CONCLUSION

The diagnostic performance of 18F-FDG PET/CT for detection of axillary node metastasis was not significantly different from that of ultrasonography or MRI in breast cancer patients. Combining 18F-FDG PET/CT with ultrasonography or MRI could improve the diagnostic performance compared to 18F-FDG PET/CT alone.

Antitumor effect of novel small chemical inhibitors of Snail-p53 binding in K-Ras-mutated cancer cells

p53 is frequently mutated by genetic alternation or suppressed by various kinds of cellular signaling pathways in human cancers. Recently, we have revealed that p53 is suppressed and eliminated from cells by direct binding with oncogenic K-Ras-induced Snail. On the basis of the fact, we generated specific inhibitors against p53-Snail binding (GN25 and GN29). These chemicals can induce p53 expression and functions in K-Ras-mutated cells. However, it does not show cytotoxic effect on normal cells or K-Ras-wild-type cells. Moreover, GN25 can selectively activate wild-type p53 in p53(WT/MT) cancer cells. But single allelic mt p53 containing cell line, Panc-1, does not respond to our chemical. In vivo xenograft test also supports the antitumor effect of GN25 in K-Ras-mutated cell lines. These results suggest that our compounds are strong candidate for anticancer drug against K-Ras-initiated human cancers including pancreatic and lung cancers.

Role of CK1 in GSK3beta-mediated phosphorylation and degradation of snail

The epithelial to mesenchymal transition (EMT) that occurs during embryonic development has begun to attract attention as a potential mechanism for tumor cell metastasis. Snail is a well-known Zn-finger transcription factor that promotes EMT by repressing E-cadherin expression. It is known that Snail is phosphorylated by GSK3beta and degraded by beta-TrCP-mediated ubiquitination. Here we described another protein kinase, CK1, whose phosphorylation of Snail is required for the subsequent GSK3beta phosphorylation. Specific inhibition or depletion of CK1varepsilon inhibits the phosphorylation and degradation of Snail and promotes cell migration, suggesting a central role of CK1varepsilon in the EMT process. Furthermore, our study uncovered distinct roles and steps of Snail phosphorylation by CK1varepsilon and GSK3beta. Taken together, we identified CK1varepsilon as a new component of the Snail-mediated EMT process, providing insight into the mechanism of human cancer metastasis.

Pharmacokinetics of oltipraz in diabetic rats with liver cirrhosis

BACKGROUND AND PURPOSE

The incidence of diabetes mellitus is increased in patients with liver cirrhosis. Oltipraz is currently in trials to treat patients with liver fibrosis and cirrhosis induced by chronic hepatitis types B and C and is primarily metabolized via hepatic cytochrome P450 isozymes CYP1A1/2, 2B1/2, 2C11, 2D1 and 3A1/2 in rats. We have studied the influence of diabetes mellitus on pharmacokinetics of oltipraz and on expression of hepatic, CYP1A, 2B1/2, 2C11, 2D and 3A in rats with experimental liver cirrhosis.

EXPERIMENTAL APPROACH

Oltipraz was given intravenously (10 mg x kg(-1)) or orally (30 mg x kg(-1)) to rats with liver cirrhosis induced by N-dimethylnitrosamine (LC rats) or with diabetes, induced by streptozotocin (DM rats) or to rats with both liver cirrhosis and diabetes (LCD rats) and to control rats, and pharmacokinetic variables measured. Protein expression of hepatic CYP1A, 2B1/2, 2C11, 2D and 3A was measured using Western blot analysis.

KEY RESULTS

After i.v. or p.o. administration of oltipraz to LC and DM rats, the AUC was significantly greater and smaller, respectively, than that in control rats. In LCD rats, the AUC was that of LC and DM rats (partially restored towards control rats). Compared with control rats, the protein expression of hepatic CYP1A increased, that of CYP2C11 and 3A decreased, but that of CYP2B1/2 and 2D was not altered in LCD rats.

CONCLUSIONS AND IMPLICATIONS

In rats with diabetes and liver cirrhosis, the AUC of oltipraz was partially restored towards that of control rats.

Antimicrobial effect of water-soluble muscadine seed extracts on Escherichia coli O157:H7

Water-soluble extracts were prepared from purple (cultivar Ison) and bronze (cultivar Carlos) muscadine seeds with or without heating. The Ison extracts had strong antimicrobial activity against a cocktail of three strains of Escherichia coli O157: H7. This extract had higher acidity (pH 3.39 to 3.43), total phenolics (2.21 to 3.49 mg/ml), tartaric acid (5.6 to 10.7 mg/ml), tannic acid (5.7 to 8.1 mg/ml), and gallic acid (0.33 to 0.59 mg/ml) than did the Carlos extracts. Heat treatment on both extracts increased antimicrobial activity, possibly because of increased acidity, tartaric acid, total phenolics, and individual phenolics. Heating of Ison extracts increased ellagic acid up to 83%. Up to 10.7 mg/ml tartaric acid alone was not as effective against E. coli O157:H7 as were water-soluble seed extracts. This finding suggests the involvement of other factors, such as tannic and gallic acids, in inactivation of this pathogen. Water-soluble muscadine seed extracts may be useful for incorporation into juice and other beverage products as natural preservatives.

Cyclooxygenase-2 expression in human thyroid disease

OBJECTIVES

Cyclooxygenase (COX)-2, which is the inducible form of the COX enzyme for prostaglandin synthesis and a key mediator of epithelial cell growth, has been shown to be up-regulated in gastrointestinal cancers. Additionally, regular intake of other non-steroidal anti-inflammatory drugs (NSAID) is known to decrease the incidence of these cancers. Therefore, the goals of the present study were to determine the possible involvement of COX-2 in human thyroid diseases.

METHODS

We used immunohistochemical staining and Western blot analysis to characterize the expression of COX-2 proteins in thyroid tissues from 64 patients with thyroiditis, benign tumors, and malignant tumors with or without metastasis. Immunoreactivity scores were calculated by multiplication of the determined grades.

RESULTS

COX-2 proteins were not expressed in normal thyroid tissues. However, each type of tumor tissue showed intense bands of COX-2 protein expression in Western blot analyses, and the immunoreactivity scores were 7.67+/-1.17 (SD) for thyroiditis, 7.87+/-0.9 for benign tumors, 7.53+/-1.53 for follicular cancer, 7.63+/-1.11 for papillary cancer without metastasis, and 7.17+/-1.55 for papillary cancer with metastasis. No significant differences were found in the levels of COX-2 expression between different tumor tissue types.

CONCLUSION

No significant correlations were observed between clinical and/or pathological characteristics of thyroid tumors and the intensity of COX-2 protein expression. In addition, we found no difference in COX-2 protein expression between thyroiditis and thyroid tumors. Thus, up-regulation of COX-2 protein synthesis in human thyroid diseases does not appear to be of clinical significance.

[Synthesis of reactivators of phosphorylated acetylcholinesterase of bis-pyridiniumdialdoxime type with a 3-oxapentane connecting chain and their testing in vitro on a model of the enzyme inhibited by chlorpyrifos and methylchlorpyrifos]

Insecticides (e.g., parathion, chlorpyrifos, methylchlorpyrifos) and nerve agents (e.g.. soman, sarin, tabun, VX) belong to the group of organophosphates. They are able to irreversibly inhibit the enzyme acetylcholinesterase (AChE). Three new reactivators with a 3-oxapentane connecting chain were prepared. The ability of the new compounds to reactivate AChE inhibited by pesticides was tested in vitro and compared to known oxime 10(-3) M which is unfortunately not applicable to in vivo experiments. All tested compounds are practically ineffective for methylchlorpyrifos-inhibited AChE at the physiological concentration (10(-5) M). On the other hand, the known reactivators surpass new substances in the case of chlorpyrifos-inhibited AChE at both concentrations.

Inhibitory effect of select nitrocompounds on growth and survivability of Listeria monocytogenes in vitro

We report the effects of 2-nitro-1-propanol (2NPOH), 2-nitroethanol (2NEOH), and nitroethane (NE) on growth and survivability of Listeria monocytogenes. In all cases, inhibition was greatest with 2NPOH and least with NE. For example, specific growth rates of L. monocytogenes strain 18 declined (P < 0.05) 76, 60, and 29% from controls during aerobic culture at 37 degrees C in brain heart infusion broth containing 10 mM 2NPOH, 2NEOH, or NE, respectively. Mean specific growth rate for the controls incubated likewise without added nitrocompound was 0.62 +/- 0.02 h(-1). Specific growth rates of L. monocytogenes Scott A decreased (P < 0.05) 67, 45, and 11%, respectively, from controls (0.67 +/- 0.02 h(-1)) when cultured similarly. Specific growth rates for L. monocytogenes strain 18 incubated similarly except at 30 degrees C were reduced (P < 0.05) 76, 60, and 30%, respectively, and were reduced (P < 0.05) 78, 23, and 23% during anaerobic culture at 30 degrees C in brain heart infusion broth containing 15 mM 2NPOH, 2NEOH, or NE (control rates ranged from 0.37 +/- 0.07 to 0.74 +/- 0.05 h(-1)). Survivability of L. monocytogenes strain 18 was reduced (P < 0.05) during aerobic storage (4 months at 4 degrees C) in brain heart infusion broth containing 2NPOH or 2NEOH (by 7.8 and 1.9 log units, respectively) but not NE. The inhibitory effect of 2NPOH was approximately 20% greater during growth at pH 7.0 than at pH 5.6 or 8.0. These results demonstrate the differential inhibitory activity of 2NPOH, 2NEOH, and NE against L. monocytogenes in vitro.

Novel preharvest strategies involving the use of experimental chlorate preparations and nitro-based compounds to prevent colonization of food-producing animals by foodborne pathogens

Foodborne diseases caused by enterohemorrhagic Escherichia coli, Salmonella, and Campylobacter species are of public health and economic significance. Shedding of these pathogens during production and slaughter are risks for contamination of products for human consumption. Consequently, strategies are sought to prevent or reduce the carriage of these pathogens in food animals before slaughter. Experimental products containing chlorate salts have been proven efficacious in reducing concentrations of E. coli and Salmonella Typhimurium in the gut of cattle, sheep, swine, and poultry when administered as feed or water additives. Mechanistically, chlorate selectively targets bacteria expressing respiratory nitrate reductase activity, such as most members of the family Enterobacteriaceae, as this enzyme catalyzes the reduction of chlorate to lethal chlorite. Most beneficial gut bacteria lack respiratory nitrate reductase activity, and thus the technology appears compatible with many bacteria exhibiting competitive exclusion capabilities. More recently, select nitrocompounds have been investigated as potential feed additives, and although these nitrocompounds significantly reduce pathogens on their own, evidence indicates that they may most effectively be used to complement the bactericidal activity of chlorate. A particularly attractive aspect of the nitrocompound technology is that, as potent inhibitors of ruminal methanogenesis, they may allow producers the opportunity to recoup costs associated with their use. At present, neither chlorate nor the nitrocompounds have been approved as feed additives by the US Food and Drug Administration, and consequently they are not yet available for commercial use.

Inhibitory activity of 2-nitropropanol against select food-borne pathogens in vitro*

AIMS

To test the inhibitory activity of 2-nitro-1-propanol (2NPOH) against Salmonella Typhimurium, Escherichia coli O157:H7 and Enterococcus faecalis.

METHODS AND RESULTS

Specific growth rates (h(-1)) of S. Typhimurium, E. coli O157:H7 and Ent. faecalis were determined during culture in tryptic soya broth (TSB) supplemented with 0-10 mm 2NPOH. Growth rates were inhibited by 2NPOH, with nearly complete inhibition observed with 10 mm. Studies with S. Typhimurium revealed that its survivability during culture in TSB containing 5 or 10 mm 2NPOH was lower (P < 0.05) under aerobic than anaerobic conditions. The survivability of Salmonella during anaerobic culture in TSB containing 2.5 mm 2NPOH was less at pH 5.6 than at pH 7.0 and 8.0. No Salmonella survived anaerobic incubation in TSB supplemented with 10 mm 2NPOH regardless of pH. When incubated in suspensions of freshly collected populations of ruminal and faecal bacteria, Salmonella concentrations were lower (P < 0.05) in suspensions containing 10 mm 2NPOH than in suspensions containing no 2NPOH.

CONCLUSIONS

2NPOH inhibited S. Typhimurium, E. coli O157:H7 and Ent. faecalis.

SIGNIFICANCE AND IMPACT OF THE STUDY

Results suggest that 2NPOH may be a useful antimicrobial supplement to reduce carriage of certain food-borne pathogens in food animals.

Effect of Drinking-Water Administration of Experimental Chlorate Ion Preparations on Salmonella enterica serovar Typhimurium Colonization in Weaned and Finished Pigs

Foodborne disease caused by Salmonella is of public health and economic significance. In order to assess the practical effectiveness of a new intervention strategy, experimental chlorate preparations (ECP) were administered via the drinking water to weaned and finished pigs that had been orally challenged the previous day with 10(9)-10(10) colony-forming units of Salmonella serovar Typhimurium. After 24 or 36 h ad libitum access to 0X, 1X or 2X ECP treatment (where X is the concentration estimated to deliver a minimal daily effective dose), the pigs were euthanized and gut contents and lymph tissue collected at necropsy were cultured for the challenge Salmonella. Drinking water administration of ECP effectively reduced (p < 0.05) caecal Salmonella concentrations and, with the weaned pigs, tended (p < or = 0.10) to reduce rectal Salmonella concentrations. No negative effects of ECP treatment on water intake and animal wellbeing were observed and only marginal effects on gut fermentation characteristics occurred. The bactericidal effect of administering ECP in drinking water was relatively rapid, with reductions in caecal Salmonella concentrations occurring within 24 h. These results suggest that ECP administered to pigs just days before slaughter may reduce gut concentrations of Salmonella; however, the impacts of such reductions on slaughter hygiene have yet to be determined.

Alterations in hepatic metabolism of sulfur-containing amino acids induced by ethanol in rats

Alterations in hepatic metabolism of S-amino acids were monitored over one week in male rats treated with a single dose of ethanol (3 g/kg, ip). Methionine and S-adenosylhomocysteine concentrations were increased rapidly, but S-adenosylmethionine, cysteine, and glutathione (GSH) decreased following ethanol administration. Activities of methionine adenosyltransferase, cystathionine gamma-lyase and cystathionine beta-synthase were all inhibited. gamma-Glutamylcysteine synthetase activity was increased from t = 8 hr, but GSH level did not return to control for 24 hr. Hepatic hypotaurine and taurine levels were elevated immediately, but reduced below control in 18 hr. Changes in serum and urinary taurine levels were consistent with results observed in liver. Cysteine dioxygenase activity was increased rapidly, but declined from t = 24 hr. The results show that a single dose of ethanol induces profound changes in hepatic S-amino acid metabolism, some of which persist for several days. Ethanol not only inhibits the cysteine synthesis but suppresses the cysteine availability further by enhancing its irreversible catabolism to taurine, which would play a significant role in the depletion of hepatic GSH.

Effects of sodium chlorate on toxin production by Escherichia coli O157:H7

Chlorate kills E. coli O157:H7 and has been proposed as a feed additive to be included in cattle rations immediately prior to slaughter to reduce E. coli O157: H7 populations in the gut. Antibiotic usage is not recommended in cases of E. coil O157:H7-induced hemorrhagic colitis because some antibiotics stimulate increased toxin production. This study was undertaken to determine if chlorate treatment affected toxin production. Pure cultures of E. coil O157:H7 were treated with 1/4 MIC of antibiotics (ampicillin, tetracycline, ceftiofur, gentamicin, monensin, tylosin, penicillin, ciprofloxacin, and novobiocin); toxin production was significantly increased by some antibiotics, but not by chlorate. Studies with mixed fecal bacteria demonstrated that chlorate killed E. coli O157:H7, but again did not stimulate toxin production. Chlorate appears to be an effective method to reduce shiga toxin-producing E. coil (STEC) populations in food animals, but additional studies are warranted before it is used to control infections.

Antimicrobial Resistance and Serotype Prevalence of Salmonella Isolated from Dairy Cattle in the Southwestern United States

Mature dairy cattle were sampled over a 2-year period (2001-2002) on six farms in New Mexico and Texas. Fecal samples (n = 1560) were collected via rectal palpation and cultured for Salmonella, and one isolate from each positive sample was serotyped. Three isolates of each serotype, with the exception of Salmonella Newport (n = 12), were examined for susceptibility to 17 antimicrobial agents. Twenty-two different serotypes were identified from a total of 393 Salmonella isolates. Montevideo was the predominant serotype (27%) followed by Mbandaka (15%), Senftenberg (11.4%), Newport (6.4%), Anatum (4.8%), and Give (4.8%). Salmonella Typhimurium and Dublin, two frequently reported serotypes, accounted for only 1% of the observed serotypes in this study. Sixty-four percent of the serotypes were susceptible to all 17 antimicrobials, 14% were resistant to a single agent, and 22% were multiresistant (2-11 types of resistance). All isolates tested were susceptible to amikacin, apramycin, imipenem, ceftriaxone, nalidixic acid, and ciprofloxacin. The most frequent types of resistance were to sulfamethoxazole, tetracycline, streptomycin, kanamycin, chloramphenicol, and ampicillin (ranging from 8.9 to 22.4%). Serotypes demonstrating multiple resistance included Dublin and Give (resistant to three or more antibiotics), Typhimurium (resistant to five antibiotics), and Newport (four and two isolates resistant to six and nine antibiotics, respectively). Class 1 integrons were present in only two Salmonella Dublin isolates and one Salmonella Newport isolate. The most prevalent resistance patterns observed in this study were toward antimicrobial agents commonly used in cattle, while all Salmonella isolates were susceptible to ceftriaxone and ciprofloxacin, antibiotics used in human medicine.

Ionophores: their use as ruminant growth promotants and impact on food safety

Ionophores (such as monensin, lasalocid, laidlomycin, salinomycin and narasin) are antimicrobial compounds that are commonly fed to ruminant animals to improve feed efficiency. These antimicrobials specifically target the ruminal bacterial population and alter the microbial ecology of the intestinal microbial consortium, resulting in increased carbon and nitrogen retention by the animal, increasing production efficiency. Ionophores transport ions across cell membranes of susceptible bacteria, dissipating ion gradients and uncoupling energy expenditures from growth, killing these bacteria. Not all bacteria are susceptible to ionophores, and several species have been shown to develop several mechanisms of ionophore resistance. The prophylactic use of antimicrobials as growth promotants in food animals has fallen under greater scrutiny due to fears of the spread of antibiotic resistance. Because of the complexity and high degree of specificity of ionophore resistance, it appears that ionophores do not contribute to the development of antibiotic resistance to important human drugs. Therefore it appears that ionophores will continue to play a significant role in improving the efficiency of animal production in the future.

Effects of the antibiotic ionophores monensin, lasalocid, laidlomycin propionate and bambermycin on Salmonella and E. coli O157:H7 in vitro

AIMS

To examine the effects of ionophores on Salmonella and Escherichia coli O157:H7 in pure and mixed ruminal fluid cultures.

METHODS AND RESULTS

Four Salmonella serotypes (Dublin, Derby, Typhimurium, and Enteriditis) and two strains of E. coli O157:H7 (ATCC 43895 and FDIU 6058) were cultured in the presence of varying concentrations of ionophores (monensin, lasalocid, laidlomycin propionate, and bambermycin) in pure and mixed ruminal fluid cultures. Bacterial growth rates in pure culture were not affected (P > 0.10) by ionophores at concentrations up to 10 times the approximate rumen ionophore concentration under normal feeding regimens. Likewise, ionophores had no effect (P > 0.10) on Salmonella or E. coli CFU plated from 24-h ruminal fluid incubations. Ionophore treatment decreased (P < 0.01) the acetate : propionate ratio in ruminal fluid cultures as expected.

CONCLUSIONS

Ionophores had no effect on the foodborne pathogens Salmonella and E. coli O157:H7 in vitro.

SIGNIFICANCE AND IMPACT OF THE STUDY

The results suggest that ionophore feeding would have little or no effect on Salmonella or E. coli populations in the ruminant.

Identification of structural domains affecting transactivation potential of Nm23

The strong transactivation activity of the C-terminal half (amino acids 76-152) of Nm23 was reported previously. Here we examined a structural domain preventing or necessary to its transactivation activity. The C-terminal 1/4 (amino acids 109-152) was sufficient for transactivation, but the C-terminal half with a longer N-terminal extension (amino acids 58-152) caused the loss of the transactivation ability. Furthermore, coexpression of the N-terminal half with the C-terminus of Nm23-H1 blocked the transactivation activity of the C-terminal half, where direct interaction of both truncated proteins was demonstrated in vitro. Transactivation activities in the C-terminal halves of the known mutants (P96S, H118F, S120G, and S120A) exhibiting differential antimetastasis effects were also tested. Significant reduction of transactivation activity was observed only in H118F, indicating that NPD kinase active-site histidine is required. This suggests that transactivation potential of Nm23 is related to NDP kinase activity but not to metastasis suppressor activity.

Apoptosis-linked gene 2 binds to the death domain of Fas and dissociates from Fas during Fas-mediated apoptosis in Jurkat cells

Apoptosis-linked gene 2 (ALG-2) is a member of the family of Ca(2+)-binding proteins with penta-EF-hand and is essential for the execution of apoptosis by various signals including Fas activation. We studied the regulation of ALG-2 during Fas-mediated apoptosis in Jurkat cells. The 22-kDa ALG-2 protein is cleaved and becomes a 19-kDa protein after Fas activation. The appearance of 19-kDa ALG-2 protein increases for 4 h after treatment with 200 ng/ml of anti-Fas Ab treatment and gradually degrades afterward. Confocal microscopic analysis showed that ALG-2 translocated from the plasma membrane to the cytosol during Fas-mediated apoptosis. Therefore, we examined if ALG-2 interacts with Fas. The protein-protein interaction of ALG-2 with Fas was demonstrated using yeast two-hybrid assays as well as in vitro GST pull-down assay. Endogenous ALG-2 was immunoprecipitated with anti-Fas Ab in Jurkat cells without Fas activation. However, the endogenous ALG-2 was no longer immunoprecipitated with anti-Fas Ab 2 h after anti-Fas Ab treatment. This study, for the first time, presents a direct molecular connection of ALG-2 to apoptosis by its direct interaction with Fas, and enlists ALG-2 as a new member of posttranslationally modified proteins during Fas-mediated apoptotic process.

Rutaecarpine, a quinazolinocarboline alkaloid, inhibits prostaglandin production in RAW264.7 macrophages

In order to delineate the mechanism involved in the anti-inflammatory activity of rutaecarpine, its effects on the production of prostaglandin (PG) and therein involved enzymes were examined. Rutaecarpine reduced the production of PGE(2) in RAW264.7 cells treated with lipopolysaccharide (LPS) in a dose dependent manner when added to the culture media at the time of stimulation. However, the inhibition of total cellular cyclooxygenase (COX) activity under the same experimental condition was observed only at high concentrations of rutaecarpine. Rutaecarpine did not affected the levels of COX-2 mRNA and protein in macrophages stimulated with LPS. Calcium ionophore A23187 induced-PG production and [(3)H]-arachidonic acid release were significantly decreased by the pretreatment of rutaecarpine for 30 minutes. With the same treatment schedule, however, rutaecarpine failed to alter the activities of cellular COX-1 and COX-2. Collectively, our data suggest that anti-inflammatory effect of rutaecarpine is, at least in part, ascribed to the diminution of PG production through inhibition of arachidonic acid release albeit the nature of its effects on PLA(2) activity remains to be elaborated.

Behavior of murine renal carcinoma cells grown in ectopic or orthotopic sites in syngeneic mice

We examined whether the organ microenvironment modulates the metastatic behavior and the response to doxorubicin (DXR) in murine renal carcinoma (RENCA) cells. Tumor cells were injected into kidney (orthotopic) and subcutis (ectopic) of syngeneic mice. Lung metastases developed in up to 57% (17/30) of animals having kidney tumors but not in those with skin tumors. Tumors growing in the kidney were more resistant to DXR than tumors growing in the subcutis when mice were given intravenous injections of DXR (8 mg/kg) on days 8 and 15 after implantation. In addition, tumor cells cultured from kidney tumors were initially more resistant to DXR than tumor cells cultured from subcutis tumors. After tumor cells were passaged in vitro, all cells exhibited a similar sensitivity to DXR. Additionally, we examined the expression levels of mdr1, EGFR and type IV collagenase by an in situ mRNA hybridization technique. A higher mRNA expression for type IV collagenase and EGFR was found in kidney tumors than in subcutis tumors. These results demonstrate that the organ environment influences the drug responsiveness and the expression of metastasis-related genes in murine renal carcinoma cells.