Inflammatory bowel disease and thromboembolism. Is inflammation at the centre of the clot?

Thromboembolic events are well recognised in patients with inflammatory bowel disease (IBD). We present three cases which highlight the need for vigilance with respect to this complication. We also propose that consideration be given to re-evaluating disease activity in those patients who develop thromboembolic complications.

Mathematical modeling demonstrates how multiple slow processes can provide adjustable control of islet bursting

Pancreatic islets exhibit bursting oscillations that give rise to oscillatory Ca (2+) entry and insulin secretion from β-cells. These oscillations are driven by a slowly activating K (+) current, Kslow, which is composed of two components: an ATP-sensitive K (+) current and a Ca (2+) -activated K (+) current through SK4 channels. Using a mathematical model of pancreatic β-cells, we analyze how the factors that comprise Kslow can contribute to bursting. We employ the dominance factor technique developed recently to do this and demonstrate that the contributions the slow processes make to bursting are non-obvious and often counterintuitive, and that their contributions vary with parameter values and are thus adjustable.

Service user involvement in mental health practitioner education in Ireland

In recent years, there is an ever increasing call to involve people who use mental health services in the development, delivery and evaluation of education programmes. Within Ireland, there is very little evidence of the degree of service user involvement in the educational preparation of mental health practitioners. This paper presents the findings on service user involvement in the education and training of professionals working in mental health services in Ireland. Findings from this study indicate that in the vast majority of courses curricula are planned and delivered without consultation or input from service users. Currently the scope of service user involvement is on teaching, with little involvement in curriculum development, student assessment and student selection. However, there is evidence that this is changing, with many respondents indicating an eagerness to move this agenda forward.

Laminar inflammatory gene expression in the carbohydrate overload model of equine laminitis

REASONS FOR PERFORMING STUDY

There is a need to assess the laminar inflammatory response in a laminitis model that more closely resembles clinical cases of sepsis-related laminitis than the black walnut extract (BWE) model.

OBJECTIVES

To determine if a similar pattern of laminar inflammation, characterised by proinflammatory cytokine expression, occurs in the CHO model of laminitis as has been previously reported for the BWE model.

METHODS

Sixteen horses administered 17.6 g of starch (85% corn starch/15% wood flour)/kg bwt via nasogastric (NG) tube were anaesthetised either after developing a temperature>38.9°C (DEV group, n=8) or at onset of Obel grade 1 lameness (OG1 group, n=8). Control horses (CON group, n=8) were anaesthetised 24 h after NG administration of 6 l of deionised water. Laminar tissue was collected from horses while under anaesthesia, followed by humane euthanasia. Real time-quantitative PCR was used to assess laminar mRNA concentrations of genes involved in inflammatory signalling.

RESULTS

Increased mRNA concentrations (P<0.05) for IL-1β, IL-6, IL-12p35, COX-2, E-selectin and ICAM-1 were present in laminae from horses with OG1 lameness but not at the DEV time, when compared to the CON horses. No differences between the groups were found for IL-2, IL-4, IL-10, TNF-α, IFN-γ or COX-1 at either the DEV or OG1 time points.

CONCLUSIONS

There was a notable difference in the temporal pattern of inflammatory events between the BWE and CHO models, with the majority of laminar inflammatory events appearing to occur at or near the onset of lameness in the CHO model, whereas many of these events peak earlier in the developmental stages in the BWE model. This suggests that, in addition to circulating inflammatory molecules, there may be a local phenomenon in the CHO model resulting in the simultaneous onset of multiple laminar events including endothelial activation, leucocyte emigration and proinflammatory cytokine expression.

POTENTIAL RELEVANCE

The similar (although somewhat delayed) inflammatory response in the CHO model of laminitis indicates that inflammatory signalling is a consistent entity in the pathophysiology of laminitis.

Slow variable dominance and phase resetting in phantom bursting

Bursting oscillations are common in neurons and endocrine cells. One type of bursting model with two slow variables has been called 'phantom bursting' since the burst period is a blend of the time constants of the slow variables. A phantom bursting model can produce bursting with a wide range of periods: fast (short period), medium, and slow (long period). We describe a measure, which we call the 'dominance factor', of the relative contributions of the two slow variables to the bursting produced by a simple phantom bursting model. Using this tool, we demonstrate how the control of different phases of the burst can be shifted from one slow variable to another by changing a model parameter. We then show that the dominance curves obtained as a parameter is varied can be useful in making predictions about the resetting properties of the model cells. Finally, we demonstrate two mechanisms by which phase-independent resetting of a burst can be achieved, as has been shown to occur in the electrical activity of pancreatic islets.

Acute medical assessment units: an efficient alternative to in-hospital acute medical care

Acute Medical Assessment Units (AMAUs) are being proposed as an alternative to congested Emergency Departments (EDs for the assessment of patients with a range of acute medical problems. We retrospectively reviewed the discharge destination of patients referred to a newly established AMAU during a six-month period. During the same period we contrasted activity in the ED for a similar group of patients. 1,562 patients were assessed in the AMAU. 196 (12.5%) were admitted to an in-patient bed and 1,148 (73.5%) were entered into specific diagnosis-driven out-patient pathways. 1,465 patients attended the ED and 635 (43.3%) were admitted. Out-patient alternatives to expensive in-patient care need to be provided at the 'coal face" of acute referral. The AMAU provides this, and as a consequence admission rates are relatively low. This is achieved by directly communicating with GPs, accessing senior clinical decision makers, and providing immediate access to diagnostically driven outpatient pathways.

Abstract P4-11-18: CT Simulation Alone Appears To Be Appropriate for Pre-Operative Partial Breast Radiation

Introduction: Pre-operative radiotherapy is being evaluated at several centers as a method to potentially increase patient eligibility for partialbreast radiotherapy. Theoretically pre-operative radiotherapy will decrease the volume of normal tissue irradiated which could decrease the morbidity. This study was performed to determine whether CT based imaging could be used for radiotherapy planning.

Material and Methods: Between December 2008 and February 2010, 204 breast cancer patients were seen in the breast evaluation and treatment program clinic at the University of Maryland Marlene and Stewart Greenebaum Cancer Center. Patients with a new diagnosis of breast cancer and no prior treatment were included in the study if they underwent MRI of the breast and a CT, including the breast, within 30 days of each other, and images were available for review. Measurements of maximum tumor dimension obtained from CT and MRI were compared. These measurements were also compared to the maximum pathologic tumor dimension, when pathology was available. Measurements were compared using correlative paired t-tests. Associations between these measurements and T stage, tumor diameter, nodal involvement, receptor status and histologic subtype were explored. Specifically, the risk of CT underestimating the size of the tumor in the pre-operative setting was also evaluated, with a 3 mm underestimation of size chosen as significant. Results: CT and MRI images were available for 40 patients. Twelve patients who underwent imaging after receiving induction chemotherapy were excluded, leaving 28 patients for analysis. In 25 patients, CT images were obtained as part of a staging PET/CT. Pathology was available in 19 patients; nine patients received neo-adjuvant chemotherapy after imaging was obtained. The average maximum tumor dimension was 10% smaller on CT than MRI (4.25 cm (range 1.1 — 9.1 cm) versus 4.72 cm (range 1.3 — 9.0 cm)), but this difference was not statistically significant. Tumor measurements obtained by CT and MRI were only statistically different in the presence of lobular carcinoma (p=0.049). The CT underestimated the MRI measurement by greater than 3 mm in 9 out of 28 (32.14%) patients, six of whom had extensive calcifications on mammogram. When the maximum tumor dimension obtained from CT was compared to pathological size, CT underestimated the pathologic tumor size by greater than 3 mm in only 4 out of 19 (21.1%) patients. All 4 patients had pathologic T3 tumors and were node positive. For comparison, the MRI similarly underestimated the tumor size in 3 of these 4 cases. Limiting our analysis to tumors less than 3 cm in diameter, only 1 out of 7 patients had a pathologic tumor size that was 3 mm greater than the maximum tumor dimension obtained from CT imaging.

Conclusions: Measurements of maximum tumor dimension on CT are on average 10% smaller than measurements obtained from MRI, although not statistically different. The risk of underestimating pathologic maximum tumor dimension was similar for CT and MRI. The risk appeared to be less for infiltrating ductal carcinoma and tumors &lt; 3 cm. CT based treatment planning for pre-operative partial breast radiotherapy seems appropriate although additional data is needed to confirm these findings.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P4-11-18.

Conserving biodiversity in production landscapes

Alternative land uses make different contributions to the conservation of biodiversity and have different implementation and management costs. Conservation planning analyses to date have generally assumed that land is either protected or unprotected, and that the unprotected portion does not contribute to conservation goals. We develop and apply a new planning approach that explicitly accounts for the contribution of a diverse range of land uses to achieving conservation goals. Using East Kalimantan (Indonesian Borneo) as a case study, we prioritize investments in alternative conservation strategies and account for the relative contribution of land uses ranging from production forest to well-managed protected areas. We employ data on the distribution of mammals and assign species-specific conservation targets to achieve equitable protection by accounting for life history characteristics and home range sizes. The relative sensitivity of each species to forest degradation determines the contribution of each land use to achieving targets. We compare the cost effectiveness of our approach to a plan that considers only the contribution of protected areas to biodiversity conservation, and to a plan that assumes that the cost of conservation is represented by only the opportunity costs of conservation to the timber industry. Our preliminary results will require further development and substantial stakeholder engagement prior to implementation; nonetheless we reveal that, by accounting for the contribution of unprotected land, we can obtain more refined estimates of the costs of conservation. Using traditional planning approaches would overestimate the cost of achieving the conservation targets by an order of magnitude. Our approach reveals not only where to invest, but which strategies to invest in, in order to effectively and efficiently conserve biodiversity.

A Retrospective Study to Determine Whether accessing Frequency Affects the Incidence of Microbial Colonisation in Peripheral Arterial Catheters

Peripheral arterial catheters are used for the continuous monitoring of blood pressure and repeated blood sampling in critically ill patients, but can be a source of catheter-related bloodstream infection. A common assumption is that the more frequently an arterial catheter is accessed, the greater the likelihood of contamination and colonisation to occur. We sought to determine whether the accessing frequency has an influence on the rate of colonisation in a peripheral arterial catheter.

A retrospective, unmatched, nested case control study was conducted in our intensive care unit. The intensive care unit charts of 96 arterial catheters from 83 patients were examined to measure the number of times each respective arterial catheter was accessed. Multivariate Cox proportional hazards regression was used to compare the rate of accessing of arterial catheters and account for varying arterial catheter in situ duration. Arterial catheters which had a high access rate of 8.1 or more times/day (five colonised of 32 patients: hazards ratio 1.69, 95% confidence interval 0.52 to 5.49; P=0.77), or a medium access rate of 6.7 to 8.0 times/day (six colonised of 32 patients: hazards ratio, 1.35, 95% confidence interval, 0.37 to 4.92: P=0.65) were not significantly more colonised when compared to arterial catheters which had a low access rate of 0 to 6.6 times/day (six colonised of 32 patients), adjusted for arterial catheter insertion site and place in hospital where the arterial catheter insertion was performed.

We were unable to demonstrate that the accessing frequency of an arterial catheter was a major predisposing factor for the likelihood of colonisation. Other mechanisms other than hub colonisation should be investigated further.

[Anti-inflammatory effect of enoxolone in an ex-vivo human gingival mucosa model]

INTRODUCTION

Our aim was to assess the modalities of use and the anti-inflammatory activity of enoxolone included in toothpaste and in a mouthwash solution.

MATERIAL AND METHODS

We used gingival fragments kept alive during 3 days at 37 degrees C. To induce inflammation, inflammatory mediators (SP and LPS) were applied to culture medium on contact with corium. The toothpaste versus placebo was applied on epithelium, in double blind. Histological analysis was then performed on hematoxylin and eosin stained slides. Edema was evaluated with semi-quantitative scores. Vasodilatation was studied by counting the percentage of dilated vessels according to scores and the surface of these dilated vessels by morphometrical image analysis. An inflammatory cytokine, IL8, was measured in culture supernatants. Dosing IL1alpha tested the mouth solution.

RESULTS

The toothpaste induced a significant decrease of edema, vasodilatation, and IL8 excretion. The enoxolone solution induced a decrease of IL1alpha.

DISCUSSION

Enoxolone demonstrated an anti-inflammatory property whatever the carrier was.

TLR2 sensing of F. nucleatum and S. sanguinis distinctly triggered gingival innate response

Gingival tissue faces constant exposure to micro-organisms. It functions as part of the host response, an anti-microbial barrier that recognizes and discriminates between commensal and pathogenic bacteria. This study aimed to evaluate and compare the effects of cell wall extracts from different periodontal bacteria, commensals Streptococcus sanguinis and Fusobacterium nucleatum and the pathogen Porphyromonas gingivalis, on the innate immune response of gingival keratinocytes and the role of TLR2 in regulating this. We assayed mRNA levels to determine the expression of human beta-defensins (hbetaD2, hbetaD3), interleukin-1alpha, -1beta, 6 and 8 and matrix metalloproteinase-9. F. nucleatum extracts induced beta-defensin and inflammatory marker mRNA expression at higher levels than P. gingivalis. Extracts from the Gram-positive commensal S. sanguinis did not upregulate the host response. TLR2 extinction inhibited the upregulation of beta-defensin and cytokine transcripts by F. nucleatum extracts but, in contrast, led to a weak induction of hbetaD3 after challenge with S. sanguinis extracts. Although F. nucleatum strongly induces innate immune and inflammatory mediators, S. sanguinis limits their expression through TLR2. Together, our data demonstrate that gingival keratinocytes recognize and discriminate between Gram-positive and Gram-negative commensal extracts, in part through TLR2, to activate different signaling pathways of the innate immune host response.