Versican maintains the homeostasis of adipose tissues and regulates energy metabolism

Versican is a large chondroitin sulfate proteoglycan in the extracellular matrix. It plays a pivotal role in the formation of the provisional matrix. S100a4, previously known as fibroblast-specific protein, functions as a calcium channel-binding protein. To investigate the role of versican expressed in fibroblasts, we generated conditional knockout mice in which versican expression is deleted in cells expressing S100a4. We found that S100a4 is expressed in adipose tissues, and these mice exhibit obesity under a normal diet, which becomes apparent as early as five months. The white adipose tissues of these mice exhibited decreased expression levels of S100a4 and versican and hypertrophy of adipocytes. qRT-PCR showed a reduced level of UCP1 in their white adipose tissues, indicating that the basic energy metabolism is diminished. These results suggest that versican in adipose tissues maintains the homeostasis of adipose tissues and regulates energy metabolism.

Continuous quality improvement in a community-wide TB screening and prevention programme in Papua New Guinea

SETTING

Daru Island in Papua New Guinea (PNG) has a high prevalence of TB and multidrug-resistant TB (MDR-TB).

OBJECTIVE

To evaluate the early implementation of a community-wide project to detect and treat TB disease and infection, outline the decision-making processes, and change the model of care.

DESIGN

A continuous quality improvement (CQI) initiative used a plan-do-study-act (PDSA) framework for prospective implementation. Care cascades were analysed for case detection, treatment, and TB preventive treatment (TPT) initiation.

RESULTS

Of 3,263 people screened for TB between June and December 2023, 13.7% (447/3,263) screened positive (CAD4TB or symptoms), 77.9% (348/447) had Xpert Ultra testing, 6.9% (24/348) were diagnosed with TB and all initiated treatment. For 5-34-year-olds without active TB (n = 1,928), 82.0% (1,581/1,928) had tuberculin skin testing (TST), 96.1% (1,519/1,581) had TST read, 23.0% (350/1,519) were TST-positive, 95.4% (334/350) were TPT eligible, and 78.7% (263/334) initiated TPT. Three PDSA review cycles informed adjustments to the model of care, including CAD4TB threshold and TPT criteria. Key challenges identified were meeting screening targets, sputum unavailability from asymptomatic individuals with high CAD4TB scores, and consumable stock-outs.

CONCLUSION

CQI improved project implementation by increasing the detection of TB disease and infection and accelerating the pace of screening needed to achieve timely community-wide coverage.

An insight into the role of branched-chain α-keto acid dehydrogenase (BKD) complex in branched-chain fatty acid biosynthesis and virulence of Listeria monocytogenes

Listeria monocytogenes is a foodborne bacterial pathogen that causes listeriosis. Positive regulatory factor A (PrfA) is a pleiotropic master activator of virulence genes of L. monocytogenes that becomes active upon the entry of the bacterium into the cytosol of infected cells. L. monocytogenes can survive and multiply at low temperatures; this is accomplished through the maintenance of appropriate membrane fluidity via branched-chain fatty acid (BCFA) synthesis. Branched-chain α-keto acid dehydrogenase (BKD), which is composed of four polypeptides encoded by lpd, bkdA1, bkdA2, and bkdB, is known to play a vital role in BCFA biosynthesis. Here, we constructed BKD-deficient Listeria strains by in-frame deletion of lpd, bkdA1, bkdA2, and bkdB genes. To determine the role in in vivo and in vitro, mouse model challenges, plaque assay in murine L2 fibroblast, and intracellular replication in J744A.1 macrophage were conducted. BKD-deficient strains exhibited defects in BCFA composition, virulence, and PrfA-regulon function within the host cells. Transcriptomics analysis revealed that the transcript level of the PrfA-regulon was lower in ΔbkdA1 strain than those in the wild-type. This study demonstrates that L. monocytogenes strains lacking BKD complex components were defective in PrfA-regulon function, and full activation of wild-type prfA may not occur within host cells in the absence of BKD. Further study will investigate the consequences of BKD deletion on PrfA function through altering BCFA catabolism.IMPORTANCEListeria monocytogenes is the causative agent of listeriosis, a disease with a high mortality rate. In this study, we have shown that the deletion of BKD can impact the function of PrfA and the PrfA-regulon. The production of virulence proteins within host cells is necessary for L. monocytogenes to promote its intracellular survival and is likely dependent on membrane integrity. We thus report a link between L. monocytogenes membrane integrity and the function of PrfA. This knowledge will increase our understanding of L. monocytogenes pathogenesis, which may provide insight into the development of antimicrobial agents.

Anatomical Study of Bicipital Groove of Dry Adult Human Cadaveric Humerus in Bangladesh

The bicipital groove is a groove on the anterior aspect of the proximal end of the humerus. It lies between the greater and lesser tubercles. The variations of this groove may lead to various pathologies of the biceps brachii tendon, one of the most common causes of shoulder pain. Hence, this study examines the various osteometric parameters of bicipital groove in the Bangladeshi population. This cross-sectional descriptive study was done on 100 dry adult human cadaveric humeri (43 right sides and 57 left sides) in the Department of Anatomy, Mymensingh Medical College, Bangladesh from July 2021 to June 2022. The length, maximum width and depth of the bicipital groove and the length of this groove's medial and lateral walls were measured using a digital Vernier slide caliper. Data were recorded in a predesigned data sheet separately and analyzed statistically using Microsoft Excel and SPSS. According to the present study, the mean±SD length of the bicipital groove of the right humeri was 66.646±11.563mm and the left humeri were 66.002±13.025mm. The mean±SD maximum width of the bicipital groove of the right humeri was 10.870±1.799mm and the left humeri were 11.480±1.402mm. The mean±SD depth of the bicipital groove of the right humeri was 4.242±0.655mm and the left humeri were 4.452±0.854mm. The mean±SD medial wall length of the bicipital groove of the right humeri was 60.671±12.360mm and the left humeri were 59.161±13.660mm. The mean±SD lateral wall length of the bicipital groove of the right-sided humeri was 64.996±11.611mm and the left humeri were 64.074±13.115mm. It is expected that this osteometric study of bicipital groove among the Bangladeshi population will be very helpful for clinical anatomists, orthopaedic surgeons, anthropologists and radiologists.

Pathological autoantibody internalisation in myositis

OBJECTIVES

Autoantibodies targeting intracellular proteins are common in various autoimmune diseases. In the context of myositis, the pathologic significance of these autoantibodies has been questioned due to the assumption that autoantibodies cannot enter living muscle cells. This study aims to investigate the validity of this assumption.

METHODS

Confocal immunofluorescence microscopy was employed to localise antibodies and other proteins of interest in myositis muscle biopsies. Bulk RNA sequencing was used to examine the transcriptomic profiles of 669 samples, including those from patients with myositis, disease controls and healthy controls. Additionally, antibodies from myositis patients were introduced into cultured myoblasts through electroporation, and their transcriptomic profiles were analysed using RNA sequencing.

RESULTS

In patients with myositis autoantibodies, antibodies accumulated inside myofibres in the same subcellular compartment as the autoantigen. Bulk RNA sequencing revealed that muscle biopsies from patients with autoantibodies targeting transcriptional regulators exhibited transcriptomic patterns consistent with dysfunction of the autoantigen. For instance, in muscle biopsies from patients with anti-PM/Scl autoantibodies recognising components of the nuclear RNA exosome complex, an accumulation of divergent transcripts and long non-coding RNAs was observed; these RNA forms are typically degraded by the nuclear RNA exosome complex. Introducing patient antibodies into cultured muscle cells recapitulated the transcriptomic effects observed in human disease. Further supporting evidence suggested that myositis autoantibodies recognising other autoantigens may also disrupt the function of their targets.

CONCLUSIONS

This study demonstrates that, in myositis, autoantibodies are internalised into living cells, causing biological effects consistent with the disrupted function of their autoantigen.

Catabolite control protein C contributes to virulence and hydrogen peroxide-induced oxidative stress responses in Listeria monocytogenes

Listeria monocytogenes causes listeriosis, an infectious and potentially fatal disease of animals and humans. A diverse network of transcriptional regulators, including LysR-type catabolite control protein C (CcpC), is critical for the survival of L. monocytogenes and its ability to transition into the host environment. In this study, we explored the physiological and genetic consequences of deleting ccpC and the effects of such deletion on the ability of L. monocytogenes to cause disease. We found that ccpC deletion did not impact hemolytic activity, whereas it resulted in significant reductions in phospholipase activities. Western blotting revealed that the ΔccpC strain produced significantly reduced levels of the cholesterol-dependent cytolysin LLO relative to the wildtype F2365 strain. However, the ΔccpC mutant displayed no significant intracellular growth defect in macrophages. Furthermore, ΔccpC strain exhibited reduction in plaque numbers in fibroblasts compared to F2365, but plaque size was not significantly affected by ccpC deletion. In a murine model system, the ΔccpC strain exhibited a significantly reduced bacterial burden in the liver and spleen compared to the wildtype F2365 strain. Interestingly, the deletion of this gene also enhanced the survival of L. monocytogenes under conditions of H2O2-induced oxidative stress. Transcriptomic analyses performed under H2O2-induced oxidative stress conditions revealed that DNA repair, cellular responses to DNA damage and stress, metalloregulatory proteins, and genes involved in the biosynthesis of peptidoglycan and teichoic acids were significantly induced in the ccpC deletion strain relative to F2365. In contrast, genes encoding internalin, 1-phosphatidylinositol phosphodiesterase, and genes associated with sugar-specific phosphotransferase system components, porphyrin, branched-chain amino acids, and pentose phosphate pathway were significantly downregulated in the ccpC deletion strain relative to F2365. This finding highlights CcpC as a key factor that regulates L. monocytogenes physiology and responses to oxidative stress by controlling the expression of important metabolic pathways.

Evaluation of Antimicrobial Efficacy and Clinical Outcomes of Triphala and 2.5% Sodium Hypochlorite as Intraradicular Irrigants in Pulpectomy of Primary Teeth

A natural irrigation solution with a broad spectrum of antimicrobial coverage, triphala was selected for the pulpectomy procedure. Because of its natural ingredients, it is well-known for promoting tissue healing. It also supposedly has certain additional qualities as compared to usual irrigation solutions that are made chemically. Although 2.5% NaOCl is thought to be perfect since it meets most of the requirements for an irrigation solution but it cannot be optimized for pulpectomy procedure. Primary teeth that were recommended for pulpectomy underwent this randomized controlled experiment. Two groups of eighty-four primary teeth were randomly assigned to receive irrigations: triphala in Group A; 2.5% Sodium hypochlorite in Group B. Sample were taken from infected primary root canals. A sterile test tube with bhi broth as the transport media was used to collect pre- and post-irrigation samples using sterile absorbent paper tips. On agar media, microorganisms were cultivated and their mean colony count was assessed. Following the procedure, the patient's follow-up visits at one, two and three months were used to evaluate the clinical result. The post-microbial colony count was dramatically reduced (p<0.001) by both irrigation treatments. Triphala in Group A is demonstrating desirable efficacy. Clinical success was found satisfactory in both the groups studied (p<0.001). But statistically significant difference was not found (p=0.175). Considering undesirable properties of sodium hypochlorite triphala can be a better alternative as a root canal irrigants in pulpectomy of primary teeth.

A Morphometric Study of Olecranon Fossa of Adult Human Humerus of Bangladeshi Population

Olecranon fossa is the largest fossa among the three fossae of the humerus. It is present in the lower end of the posterior surface just above the trochlea. Osteometry of olecranon fossa is important since their fractures occur in 10.0% of upper limb fractures. The aim of this study was to measure different parameters of olecranon fossa. This study was taken from 100 (right=43 and left=57) samples were selected through the purposive sampling technique for this cross-sectional descriptive study which was carried out in the Department of Anatomy, Mymensingh Medical College, Mymensingh, Bangladesh from July 2021 to June 2022. Any damaged, unossified bones or fractured bones were excluded. Data were tabulated and statistically analyzed using Microsoft Excel and SPSS software. The mean ±SD vertical diameter of the olecranon fossa of the right humeri was 16.858±2.623mm and the left humeri were 17.071±2.905mm. The mean ±SD width of the olecranon fossa of the right humeri was 24.239±2.520mm and the left humeri were 24.509±2.692mm. The mean ±SD maximum depth of the olecranon fossa of the right humeri was 13.442±1.688mm and the left humeri were 13.124±1.733mm. The anatomical knowledge of the olecranon fossa is beneficial for anthropologists, orthopedic surgeons and radiologists in cases of olecranon fractures of the humerus.

Pathogenic autoantibody internalization in myositis

Objectives

Myositis is a heterogeneous family of autoimmune muscle diseases. As myositis autoantibodies recognize intracellular proteins, their role in disease pathogenesis has been unclear. This study aimed to determine whether myositis autoantibodies reach their autoantigen targets within muscle cells and disrupt the normal function of these proteins.

Methods

Confocal immunofluorescence microscopy was used to localize antibodies and other proteins of interest in myositis muscle biopsies. Bulk RNA sequencing was used to study the transcriptomic profiles of 668 samples from patients with myositis, disease controls, and healthy controls. Antibodies from myositis patients were introduced into cultured myoblasts by electroporation and the transcriptomic profiles of the treated myoblasts were studied by bulk RNA sequencing.

Results

In patients with myositis autoantibodies, antibodies accumulated inside myofibers in the same subcellular compartment as the autoantigen. Each autoantibody was associated with effects consistent with dysfunction of its autoantigen, such as the derepression of genes normally repressed by Mi2/NuRD in patients with anti-Mi2 autoantibodies, the accumulation of RNAs degraded by the nuclear RNA exosome complex in patients with anti-PM/Scl autoantibodies targeting this complex, and the accumulation of lipids within myofibers of anti-HMGCR-positive patients. Internalization of patient immunoglobulin into cultured myoblasts recapitulated the transcriptomic phenotypes observed in human disease, including the derepression of Mi2/NuRD-regulated genes in anti-Mi2-positive dermatomyositis and the increased expression of genes normally degraded by the nuclear RNA exosome complex in anti-PM/Scl-positive myositis.

Conclusions

In myositis, autoantibodies are internalized into muscle fibers, disrupt the biological function of their autoantigen, and mediate the pathophysiology of the disease.

Variation of Acromiocoracoid and Acromioglenoid Distance in Bangladeshi People

This cross-sectional descriptive purposive study was done on 150 (70 right and 80 left) fully ossified dry human scapulae of Bangladeshi people to find out the variation in length of acromiocoracoid and acromioglenoid distance. Sample collection was carried out in the Department of Anatomy, Mymensingh Medical College, Bangladesh from January to December 2019. Any kind of damaged or broken scapulae were excluded to maintain standard measurement. Length of these distances was measured with the help of digital Vernier slide calipers. The mean±SD acromiocoracoid distance were 35.8±4.64 mm and 36.32±5.55 mm on right and left sided scapulae respectively and the mean±SD acromioglenoid distance were 27.69±3.43 mm on right sided scapulae and 28.18±3.26 mm on left sided scapulae. These data are important to compare Bangladeshi scapulae to those from various other races that could contribute to demographic studies of shoulder disease probability and management in Bangladeshi population.

Study of Nutrient Foramina of Dry Adult Human Clavicle

As a modified long bone, the clavicle is most important bone for transmission of body weight from upper limb to the axial skeleton, for attachment of muscles and is a significant source of bone grafting. This descriptive cross-sectional study was conducted among 150 (65 right and 85 left) fully ossified dry human clavicle in Mymensingh Medical College, Mymensingh, Bangladesh from January 2020 to December 2020. Sample was collected by the help of nonrandom purposive sampling technique from Anatomy department of Mymensingh Medical College and Community Based Medical College, Bangladesh, Mymensingh. In this study, nutrient foramen was present in 86.67% (130) cases. On the right side, 87.69% (57) cases and on the left side, 85.88% (73) cases were found present. Out of 130 clavicles where nutrient foramen were present, 52.31% (68) nutrient foramina were on inferior surface, 46.92% (61) on posterior surface and 0.77% (1) on superior surface. On the right side, 49.12% (28) cases were found on inferior surface and 49.12% (28) were on posterior surface and remaining 1.75% (1) was on superior surface. On the left side, 54.79% (40) cases were found on inferior surface and 45.21% were on posterior surface whereas none was found on superior surface. Among the present 130 cases, 1 nutrient foramen was found in total 80% (104) cases and 2 in 20% (26) cases. In right side, the numbers of cases were 75.44% (43) for 1 and 24.56% (14) for 2 nutrient foramina. In left side, the number of cases of 1 was 83.56% (61) and 16.44% (12) for 2 foramina. The nutrient foraminal direction was 98.46% (128) towards acromial end and 1.54% (2) to sternal end. In the right side, the direction was 100% (57) towards acromial end. In the left side, the direction was 97.26% (71) towards acromial end and 2.74% (2) to sternal end. In the current study, the mean ±SD nutrient foramina of 65 clavicles of right side were 71.04±13.91 and 67.13±16.30 in 85 left sided clavicles. The purpose for undertaking this study was to obtain baseline data on nutrient foramen to help to predict the success rate and different surgical interventions regarding fractures and grafting.

Anatomical Study of Number, Location and Position of Nutrient Foramina of Fully Ossified Dry Human Humerus

The nutrient foramen is the natural opening present in the shaft of the humerus. It passes the nutrient artery to the medullary cavity. The nutrient artery is the chief artery that enters the bone through a nutrient foramen to provide nutrition for its growth. It plays an important role in healing during fracture and trauma and is also important for bone grafting. This study aimed to determine the common location, position and number of nutrient foramina of fully ossified dry human humerus. One hundred samples (right- 43 and left- 57) were selected through the purposive sampling technique for this cross-sectional descriptive study carried out in the Department of Anatomy, Mymensingh Medical College, Bangladesh from July 2021 to June 2022. Any damaged, unossified bones or fractured bones were excluded. Data were tabulated and statistically analyzed using Microsoft Excel and SPSS software. Among 43 right humeri, 37(75.51%) have single-nutrient foramen and 06(24.49%) have double-nutrient foramina. Among 57 left humeri, 53(92.98%) have single nutrient foramen, 03(5.27%) have double nutrient foramina and 01(1.75%) has triple nutrient foramina. In case of location of nutrient foramina, among 49 right nutrient foramina, 45(91.84%) were found on the anteromedial surface, 02(4.08%) were found on the anterolateral surface and 02(4.08%) were on the posterior surface of the shaft of the humerus. In case of 62 left nutrient foramina, 57(91.94%) were found on the anteromedial surface and 05(8.06%) were found on the posterior surface of the shaft of the humerus. Among 49 right nutrient foramina, 01(2.04%) was found on the upper third, 46(93.88%) on the middle third and 02(4.08%) on the lower third of the shaft of the humerus. In case of 62 left nutrient foramina, 01(1.60%) was on the upper third, 57(91.95%) were on the middle third and 04(6.45%) were on the lower third of the shaft of the humerus.

Radiation Therapy Sensitizes Head-and-Neck Cancer Cells to Killing by Chimeric Antigen Receptor (CAR)-NK Cells Targeting CD70

PURPOSE/OBJECTIVE(S)

CAR-T cell therapy is limited by toxicity, high cost, logistical manufacturing issues in the autologous setting and risk of GVHD in the allogeneic setting. Substitution of T cells with NK cells opens the possibility for an allogeneic off-the-shelf product with a better safety profile. However, the inadequate efficacy of CAR-NK cells against solid tumors can be extrapolated from experience with CAR-T cells. There is limited but promising preclinical evidence that radiation therapy (RT) enhances CAR-T cell tumoricidal activity against solid tumors. However, there is no data examining the potential synergy between RT and CAR-NK cell therapy.

MATERIALS/METHODS

We engineered CAR-NK cells with CD27 receptor as extracellular domain to target its natural ligand CD70, which is overexpressed in head-and-neck cancers (HNSCC). CAR-NK cell killing was assessed real-time through xCELLigence cytotoxicity assays. CD70+ OQ01 human HNSCCs were used for most experiments. FaDu is a CD70- HNSCC (negative ctrl). UMRC3 is a CD70+ kidney cancer cell line (positive ctrl). CD70 expression pre- and post-RT was assessed by flow cytometry and Western blot. Ionizing RT was compared at 5 doses: 0, 1.75, 3.5, 7, and 14 Gy. A single dose of 3.5 Gy was used for most experiments. Post-radiation effects were generally assessed at 3 days or 9 days post-RT. Intracellular staining was used to assess NK cell expression of IFN-γ, CD107a, and TNF-α by flow cytometry. CD27/CD70 interaction blockade was through α-CD27 pre-treatment of CAR-NK cells.

RESULTS

OQ01 HNSCCs heterogeneously express CD70 and are killed by CD70 CAR-NK cells in vitro. Pre-conditioning low-dose RT of 3.5 Gy applied to OQ01 HNSCCs 3 days prior to coculture with NK cells enhances CD70 CAR-NK cell killing, with ∼30% increased cytotoxicity against the tumor cells. Low-dose RT by itself did not induce acute cytolysis. As a possible mechanism for the increased sensitivity of irradiated OQ01 cells to CD70 CAR-NK cells, we found that RT enhances CD70 expression among HNSCCs in a dose-dependent manner. There was no increase in NK cell expression of IFN-γ, CD107a, and TNF-α with exposure to irradiated target cells. CD27/CD70 blockade does not solely abrogate RT-induced sensitization toward CAR-NK cell killing. Despite RT induction of transient increased expression of CD70, which normalizes by 9 days post-RT, there is persistent increase in RT-synergized target cell killing even at this later timepoint. Thus, altogether, RT sensitizes CD70-expressing HNSCC cells to CAR-NK cell killing in vitro.

CONCLUSION

This work represents the first preclinical study to identify the synergy of RT and CAR-NK cell therapy in solid tumors and is the first demonstration of CAR-NK cell activity against human HNSCCs. We show significantly enhanced potency of CAR-NK cells against irradiated tumor cells in vitro. Collectively, this research will be vital to guide efforts expanding into other target antigens and tumor types.

Correlation between Depth of Medial and Lateral Curvatures of Clavicle

Having the first bone to ossify clavicle is a bone of pectoral girdle. It is the only bony attachment between the trunk and upper limb. To obtain the precise data that is required to investigate the range in size and morphological features of the human clavicle, a study was undertaken on dry human clavicles which had been sourced from the Department of Anatomy. The purpose for undertaking this study was to obtain baseline data on the clavicular bow in the transverse plane. This cross-sectional descriptive study having some analytical components was done among 150 (65 right and 85 left) fully ossified dry clavicles in Mymensingh Medical College, Bangladesh from January 2020 to December 2020. Sample which met the inclusion criteria was collected through non random sampling technique, from Anatomy department of Mymensingh Medical College and Community Based Medical College Bangladesh. The parameters (the depth of medial and lateral curvatures) were measured with the help of rigid osteometry board and were expressed in millimeter. In the current study, the mean±SD depth of medial curvature of 65 clavicles of right side was 15.54±3.54mm and 15.45±3.24mm of 85 left clavicles. The mean±SD depth of lateral curvature of right side was 11.71±2.54mm and of left side was 9.21±2.31mm. Correlation was done in between depth of medial and lateral curvatures on both sides and the regression line showed positive correlation but these differences were statistically non-significant on both sides.

Haematohidrosis: A Case Series of Five Patients

Haematohidrosisis manifested by sweating mixed with blood. It is a rare disease and there are scarce literature regarding case report. We are describing five cases of haematohidrosis in different age group here in this case series. In case 1- a 20 year old woman was admitted with history of recurrent haemorrhage from various sites without any trauma or anticoagulant or antipletlet medication. There was no evidence of local trauma. Physical examination was unremarkable. Her blood workup came out insignificant. In case 2- a 10 year old boy was admitted with epistaxis, conjunctival bleeding, haematuria and per rectal bleeding without any history of injury. He had no history of medicine which would cause bleeding. Physical examination and laboratory profile were insignificant. In case 3- a 15 year old boy presented with recurrent haematuria and conjunctival haemorrhage without any trauma. No history of medication that would cause the bleeding. His systemic examination and laboratory profile was unremarkable. In case 4- a 25 year old woman presented with bleeding from ear, nose and eyes without any local trauma. She was not on any medication that would cause bleeding. Her systemic inquiry and laboratory profile was unremarkable. In case 5- a 20 year old woman presented with bleeding from eyes, ears and umbilicus. There was no evidence of self-inflicted injury. She had features of anxiety disorder. Other systemic examination and laboratory profile was unremarkable. All the cases were labelled as haematohidrosis and treated with propranolol with successful outcome. We report this case series to build up awareness and disseminate clinical knowledge.

Bcl11b sustains multipotency and restricts effector programs of intestinal-resident memory CD8+ T cells

The networks of transcription factors (TFs) that control intestinal-resident memory CD8⁺ T (T_RM) cells, including multipotency and effector programs, are poorly understood. In this work, we investigated the role of the TF Bcl11b in T_RM cells during infection with Listeria monocytogenes using mice with post-activation, conditional deletion of Bcl11b in CD8⁺ T cells. Conditional deletion of Bcl11b resulted in increased numbers of intestinal T_RM cells and their precursors as well as decreased splenic effector and circulating memory cells and precursors. Loss of circulating memory cells was in part due to increased intestinal homing of Bcl11b^-/- circulating precursors, with no major alterations in their programs. Bcl11b^-/- T_RM cells had altered transcriptional programs, with diminished expression of multipotent/multifunctional (MP/MF) program genes, including Tcf7, and up-regulation of the effector program genes, including Prdm1. Bcl11b also limits the expression of Ahr, another TF with a role in intestinal CD8⁺ T_RM cell differentiation. Deregulation of T_RM programs translated into a poor recall response despite T_RM cell accumulation in the intestine. Reduced expression of MP/MF program genes in Bcl11b^-/- T_RM cells was linked to decreased chromatin accessibility and a reduction in activating histone marks at these loci. In contrast, the effector program genes displayed increased activating epigenetic status. These findings demonstrate that Bcl11b is a frontrunner in the tissue residency program of intestinal memory cells upstream of Tcf1 and Blimp1, promoting multipotency and restricting the effector program.

Clinical Profile of Pediatric Cases of Dengue during the 2019 Epidemic in Bangladesh: A Multicenter Cross-Sectional Study

Bangladesh experienced the largest dengue epidemic during 2019, with more than 100,000 confirmed cases and 164 deaths. Almost one-third of these cases were children. The present study aimed to investigate the clinical and hematological manifestations of pediatric dengue cases during the epidemic. This was a multicenter cross-sectional study conducted in Dhaka Medical College Hospital, Dhaka, Dr. Sirajul Islam Medical College Hospital and Tangail Sadar Hospital, Tangail, Bangladesh between the period of June 2019 and September 2019. The study included 208 pediatric patients (age <18 years) with confirmed dengue fever. Patient's demographics, clinical and laboratory features of dengue were collected through patients' interview, clinical examination and laboratory investigations. Descriptive statistics were used to represent the patients' socio-demographic information, clinical presentations and hematological parameters. The majority of the patients were aged between 6 and 17 years with male predominance. The most commonly presented clinical manifestations were fever (100.0%), headache (59.0%), myalgia (42.0%), rash (36.0%), retro-orbital pain (28.0%) and diarrhea (24.0%). Warning signs abdominal pain (40.0%) and persistent vomiting (29.0%), bleeding manifestations such as melena (17.0%), gum bleeding (7.0%) and epistaxis (6.0%) and evidence of plasma leakage such as oliguria (3.4%), ascites (2.4%), pleural effusion (1.4%), and shock (1.0%) were also present in the patients. Raised HCT levels, leucopenia and thrombocytopenia were present in almost 23.0%, 43.0% and 28.0% of children, respectively. Warning signs and plasma leakage were present in a substantial number of patients indicating potential risk of severe dengue. Prompt diagnosis and management based on best clinical judgment might prevent severe dengue at an early stage.

Characterization and mobilization of an IncA/C plasmid-mediated antibiotic resistance in Edwardsiella ictaluri

OBJECTIVES

Edwardsiella ictaluri is an important pathogen of farmed raised catfish. Recently, we showed that resistance to tetracycline and florfenicol in the E. ictaluri MS 17-156 strain isolated from channel catfish was facilitated by acquisition of a 135 kb-sized plasmid (named pEIMS-171561).

METHODS

In this study, we describe the genetic structure of pEIMS-171561. Plasmid copy number and stability within E. ictaluri strain MS-17-156 was determined. We also investigated the in vitro and in vivo transferability of pEIMS-171561 using catfish as a model for in vivo transfer.

RESULTS

pEIMS-171561 belongs to the IncA/C group and contains florfenicol efflux major facilitator superfamily (MFS) (floR), sulfonamides (sul2), and tetracycline efflux MFS (tetD) genes. The plasmid contains two conjugative transfer-associated regions and encodes six transposases and insertion sequences. In vitro conjugation experiments demonstrated that the IncA/C plasmid can transfer from E. ictaluri to Escherichia coli. The plasmid is stable in E. ictaluri without selection pressure for 33 days. We showed that pEIMS-171561 did not transfer from E. ictaluri MS 17-156 to endogenous microbiota in catfish. Moreover, we could not detect in vivo conjugal transfer of pEIMS-171561 from E. ictaluri to E. coli. Results from real-time PCR revealed upregulation of floR gene in catfish intestine when receiving florfenicol medicated feed compared to fish receiving unmedicated feed.

CONCLUSIONS

This study demonstrated that pEIMS-171561 did not disseminate from E. ictaluri to gut microbiota under selective pressure. This result suggests a limited role of the fish microbiota as a reservoir for this plasmid and for spread of resistance.

A176 ASSOCIATIONS OF ANTIBIOTICS, HORMONAL THERAPIES, ORAL CONTRACEPTIVES, AND LONG-TERM NSAIDS WITH INFLAMMATORY BOWEL DISEASE: RESULTS FROM THE PROSPECTIVE URBAN RURAL EPIDEMIOLOGY (PURE) STUDY

Background

The pathogenesis of inflammatory bowel disease (IBD) which includes Crohn’s disease (CD) and ulcerative colitis (UC), is believed to involve activation of the intestinal immune system in response to the gut microbiome among genetically susceptible hosts. IBD has been historically regarded as a disease of developed nations, though in the past two decades there has been a reported shift in the epidemiological pattern of disease. High-income nations with known high prevalence of disease are seeing a stabilization of incident cases, while a rapid rise of incident IBD is being observed in developing nations. This suggests that environmental exposures may play a role in mediating the risk of developing IBD. The potential environmental determinants of IBD across various regions is vast, though medications have been increasingly recognized as one broad category of risk factors.

Purpose

Several medications have been considered to contribute to the etiology of IBD. This study assessed the association between medication use and risk of developing IBD using the Prospective Urban Rural Epidemiology (PURE) cohort.

Method

This was a prospective cohort study of 133,137 individuals between the ages of 20-80 from 24 countries. Country-specific validated questionnaires documented baseline and follow-up medication use. Participants were followed prospectively at least every 3 years. The main outcome was development of IBD, including CD and UC. Short-term (baseline but not follow-up use) and long-term use (baseline and subsequent follow-up use) was evaluated. Results are presented as adjusted odds ratios (aOR) with 95% confidence intervals (CI).

Result(s)

During the median follow-up of 11.0 years [interquartile range (IQR) 9.2-12.2], we recorded 571 incident cases of IBD (143 CD and 428 UC). Higher risk of incident IBD was associated with baseline antibiotic use [aOR: 2.81 (95% CI: 1.67-4.73), p=0.0001] and hormonal medication use [aOR: 4.43 (95% CI: 1.78-11.01), p=0.001]. Among females, previous or current oral contraceptive use was also associated with IBD development [aOR: 2.17 (95% CI: 1.70-2.77), p=5.02E-10]. NSAID users were also observed to have increased risk of IBD [aOR: 1.80 (95% CI: 1.23-2.64), p=0.002], which was driven by long-term users [aOR: 5.58 (95% CI: 2.26-13.80), p<0.001]. All significant results were consistent in direction for CD and UC with low heterogeneity.

Conclusion(s)

Antibiotics, hormonal medications, oral contraceptives, and long-term NSAID use were associated with increased odds of incident IBD after adjustment for covariates.

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Salim Yusuf is supported by the Heart & Stroke Foundation/Marion W. Burke Chair in Cardiovascular Disease. The PURE Study is an investigator-initiated study funded by the Population Health Research Institute, the Canadian Institutes of Health Research (CIHR), Heart and Stroke Foundation of Ontario, support from CIHR’s Strategy for Patient Oriented Research (SPOR) through the Ontario SPOR Support Unit, as well as the Ontario Ministry of Health and Long-Term Care and through unrestricted grants from several pharmaceutical companies, with major contributions from AstraZeneca (Canada), Sanofi-Aventis (France and Canada), Boehringer Ingelheim (Germany and Canada), Servier, and GlaxoSmithkline, and additional contributions from Novartis and King Pharma and from various national or local organisations in participating countries; these include: Argentina: Fundacion ECLA; Bangladesh: Independent University, Bangladesh and Mitra and Associates; Brazil: Unilever Health Institute, Brazil; Canada: Public Health Agency of Canada and Champlain Cardiovascular Disease Prevention Network; Chile: Universidad de la Frontera; China: National Center for Cardiovascular Diseases; Colombia: Colciencias, grant number 6566-04-18062; India: Indian Council of Medical Research; Malaysia: Ministry of Science, Technology and Innovation of Malaysia, grant numbers 100 -IRDC/BIOTEK 16/6/21 (13/2007) and 07-05-IFN-BPH 010, Ministry of Higher Education of Malaysia grant number 600 -RMI/LRGS/5/3 (2/2011), Universiti Teknologi MARA, Universiti Kebangsaan Malaysia (UKM-Hejim-Komuniti-15-2010); occupied Palestinian territory: the UN Relief and Works Agency for Palestine Refugees in the Near East, occupied Palestinian territory; International Development Research Centre, Canada; Philippines: Philippine Council for Health Research & Development; Poland: Polish Ministry of Science and Higher Education grant number 290/W-PURE/2008/0, Wroclaw Medical University; Saudi Arabia: the Deanship of Scientific Research at King Saud University, Riyadh, Saudi Arabia (research group number RG -1436-013); South Africa: the North-West University, SANPAD (SA and Netherlands Programme for Alternative Development), National Research Foundation, Medical Research Council of SA, The SA Sugar Association (SASA), Faculty of Community and Health Sciences (UWC); Sweden: grants from the Swedish state under the Agreement concerning research and education of doctors; the Swedish Heart and Lung Foundation; the Swedish Research Council; the Swedish Council for Health, Working Life and Welfare, King Gustaf V’s and Queen Victoria Freemasons Foundation, AFA Insurance, Swedish Council for Working Life and Social Research, Swedish Research Council for Environment, Agricultural Sciences and Spatial Planning, grant from the Swedish State under the Läkar Utbildnings Avtalet agreement, and grant from the Västra Götaland Region; Turkey: Metabolic Syndrome Society, AstraZeneca, Turkey, Sanofi Aventis, Turkey; United Arab Emirates (UAE): Sheikh Hamdan Bin Rashid Al Maktoum Award For Medical Sciences and Dubai Health Authority, Dubai UAE.

Disclosure of Interest

C. Pray: None Declared, N. Narula Grant / Research support from: Neeraj Narula holds a McMaster University Department of Medicine Internal Career Award. Neeraj Narula has received honoraria from Janssen, Abbvie, Takeda, Pfizer, Merck, and Ferring, E. C. Wong: None Declared, J. K. Marshall Grant / Research support from: John K. Marshall has received honoraria from Janssen, AbbVie, Allergan, Bristol-Meyer-Squibb, Ferring, Janssen, Lilly, Lupin, Merck, Pfizer, Pharmascience, Roche, Shire, Takeda and Teva., S. Rangarajan: None Declared, S. Islam: None Declared, A. Bahonar: None Declared, K. F. Alhabib: None Declared, A. Kontsevaya: None Declared, F. Ariffin: None Declared, H. U. Co: None Declared, W. Al Sharief: None Declared, A. Szuba: None Declared, A. Wielgosz: None Declared, M. L. Diaz: None Declared, R. Yusuf: None Declared, L. Kruger: None Declared, B. Soman: None Declared, Y. Li: None Declared, C. Wang: None Declared, L. Yin: None Declared, M. Erkin: None Declared, F. Lanas: None Declared, K. Davletov: None Declared, A. Rosengren: None Declared, P. Lopez-Jaramillo: None Declared, R. Khatib: None Declared, A. Oguz: None Declared, R. Iqbal: None Declared, K. Yeates: None Declared, Á. Avezum: None Declared, W. Reinisch Consultant of: Speaker for Abbott Laboratories, Abbvie, Aesca, Aptalis, Astellas, Centocor, Celltrion, Danone Austria, Elan, Falk Pharma GmbH, Ferring, Immundiagnostik, Mitsubishi Tanabe Pharma Corporation, MSD, Otsuka, PDL, Pharmacosmos, PLS Education, Schering-Plough, Shire, Takeda, Therakos, Vifor, Yakult, Consultant for Abbott Laboratories, Abbvie, Aesca, Algernon, Amgen, AM Pharma, AMT, AOP Orphan, Arena Pharmaceuticals, Astellas, Astra Zeneca, Avaxia, Roland Berger GmBH, Bioclinica, Biogen IDEC, Boehringer-Ingelheim, Bristol-Myers Squibb, Cellerix, Chemocentryx, Celgene, Centocor, Celltrion, Covance, Danone Austria, DSM, Elan, Eli Lilly, Ernest & Young, Falk Pharma GmbH, Ferring, Galapagos, Genentech, Gilead, Grünenthal, ICON, Index Pharma, Inova, Janssen, Johnson & Johnson, Kyowa Hakko Kirin Pharma, Lipid Therapeutics, LivaNova, Mallinckrodt, Medahead, MedImmune, Millenium, Mitsubishi Tanabe Pharma Corporation, MSD, Nash Pharmaceuticals, Nestle, Nippon Kayaku, Novartis, Ocera, Omass, Otsuka, Parexel, PDL, Periconsulting, Pharmacosmos, Philip Morris Institute, Pfizer, Procter & Gamble, Prometheus, Protagonist, Provention, Robarts Clinical Trial, Sandoz, Schering-Plough, Second Genome, Seres Therapeutics, Setpointmedical, Sigmoid, Sublimity, Takeda, Therakos, Theravance, Tigenix, UCB, Vifor, Zealand, Zyngenia, and 4SC, Advisory board member for Abbott Laboratories, Abbvie, Aesca, Amgen, AM Pharma, Astellas, Astra Zeneca, Avaxia, Biogen IDEC, Boehringer-Ingelheim, Bristol-Myers Squibb, Cellerix, Chemocentryx, Celgene, Centocor, Celltrion, Danone Austria, DSM, Elan, Ferring, Galapagos, Genentech, Grünenthal, Inova, Janssen, Johnson & Johnson, Kyowa Hakko Kirin Pharma, Lipid Therapeutics, MedImmune, Millenium, Mitsubishi Tanabe Pharma Corporation, MSD, Nestle, Novartis, Ocera, Otsuka, PDL, Pharmacosmos, Pfizer, Procter & Gamble, Prometheus, Sandoz, Schering-Plough, Second Genome, Setpointmedical, Takeda, Therakos, Tigenix, UCB, Zealand, Zyngenia, and 4SC, P. Moayyedi: None Declared, S. Yusuf: None Declared

A comprehensive photovoltaic study on tungsten disulfide (WS2) buffer layer based CdTe solar cell

Transition metal di-chalcogenides (TMCDs)-Tungsten disulfide (WS₂) exhibit excellent optoelectronic properties such as suitable bandgap, high absorption coefficient, good conductivity, high carrier mobility, etc. to be used as a photovoltaic material for thin-film solar cells. In the present work, we have replaced the traditional buffer CdS and ITO/ZnO window layer in CdTe solar cells with the non-toxic, earth-abundant WS₂ buffer and SnO₂ window layer, respectively. The SCAPS-1D solar simulator is used to investigate the potentiality of WS₂ as buffer material in CdTe solar cells. This numerical study provides a comparison of the performances between the proposed structure: SnO₂/WS₂/CdTe/Au and the baseline structure: ITO/ZnO/CdS/CdTe/Au. The impacts of the charge carrier generation rate, spectral response, current-voltage characteristics, bulk defect density, defect density at buffer/absorber interface, operating temperature, and capacitance-voltage characteristics on the solar cell performance parameters have also been analyzed. The tolerance level of defect density in WS₂ bulk and WS₂/CdTe interface are found to be 10¹⁷ cm^-3 and 10¹² cm^-3, respectively. The temperature study reveals the poor structural robustness and thermal stability of the proposed cell. The conversion efficiency of the proposed cell has found to be 20.55% at the optimized device structure. Nevertheles, these findings may provide an insight to fabricate viable, environment friendly, and inexpensive CdTe thin-film solar cells.

Do farmers use waterlogged wastelands efficiently? An economic study on water chestnut farming in Bangladesh

Waterlogging due to rain-fed floods is considered a natural calamity worldwide that causes lands in the north region of Bangladesh to remain underwater and uncultivable for most crops during the rainy season. This unused wasteland has immense potential for additional earnings for the marginal farmer by converting it to cultivable land through proper utilization by cultivating water chestnuts. Increasing the productivity and efficiency of water chestnut farming in these wastelands would facilitate higher food production for the growing populations. Therefore, this study estimates the farmers' profitability of water chestnut production along with technical efficiency (TE) and land use efficiency (LUE). Primary data from 150 farmers of Natore, Naogaon, and Jamalpur districts were used and stochastic frontier analysis was employed. Results reveal that no farmers had any training in water chestnut farming. Human labor and land use costs incur more than 80% of the total cost and laborers shortage was found due to skin problems working in the water. However, water chestnut farming was profitable in all districts and the average benefit-cost ratio was 1.37. TE results indicate that there was an opportunity to increase the water chestnut production by 20.2% using the same amount of inputs. LUE by the water chestnut farmers was found to be very low; hence, they were using their land inefficiently and this inefficiency was positively affected by farm size and number of family members and negatively affected by age, year of schooling, and income. The study suggests research focusing on improved management of water chestnut without affecting laborers and training to facilitate higher productivity and LUE.

Association between body mass index (BMI) and severity of coronary artery disease in young onset acute coronary syndrome (ACS)

Funding Acknowledgements

Type of funding sources: None.

Background

A high body mass index (BMI) is seems to be associated with an increased incidence of coronary artery disease. If the affected person is young, the consequences are more tragic. There are variable information on the relation of incidence and severity of coronary artery disease in high BMI populations. We have examined the association between BMI and severity of coronary artery disease in young onset Acute Coronary Syndrome (ACS).

Methods

In this prospective observational study a total number of 150 patients, aged ≤45 years presented with acute coronary syndrome were enrolled to analyze association between Body Mass Index (BMI) and severity of coronary artery disease.

Results

The mean BMI in male was 24.6±3.6 and the mean BMI in female was 25.4±3.3. Among the 150 patients, 2(1.3%) was underweight, 78(52%) was normal, 60(40%) was overweight & 10(6.7%) was obese. All underweighted patients were diagnosed as STEMI. Among the normal BMI patients, 18(23.1%) had UA, 12(15.4%) had NSTEMI & 48 (61.5%) had STEMI. Among the overweight patients, 23(38.3%) had UA, 9(15%) had NSTEMI & 28(46.7%) had STEMI. And among the obese patients, 4(40%) had UA, 1 (10%) had NSTEMI & 5(50%) had STEMI. Considering involving coronary artery, left main coronary artery involvement was 0(0%), 6 (7.7%), 5 (8.3%) & 0(0%) in underweight, normal, overweight & obese patients respectively. Left anterior descending coronary artery involvement was 2(100%), 54 (69%), 45 (75%) & 7 (70%) in underweight, normal, overweight & obese patients respectively. Left circumflex coronary artery involvement was 1(50%), 33 (42%), 25 (41.7%) & 1 (9%) in underweight, normal, overweight & obese patients respectively. And right coronary artery involvement was 1(50%), 35 (44.9%), 31 (51.7%) & 5 (50%) in underweight, normal, overweight & obese patients respectively. In underweight patients 1(50%) had SVD and 1 (50%) had TVD. In normal BMI patients 40 (51.3%) had SVD, 11(14.1%) had DVD and 19 (24.4%) had TVD. In overweight patients 27 (45%) had SVD, 15 (25%) had DVD and 13 (21.7%) had TVD. And in obese patients 5 (50%) had SVD, 3(30%) had DVD and 0 (0%) had TVD. In all BMI group SVD was more common.

Conclusion

There is no statistically significant differences in severity of coronary artery in respect to body mass index (BMI), in patients presented with acute coronary syndrome.