Abstract P5-09-01: Plasma osteoprotegerin and the risk of breast cancer in BRCA1 and BRCA2 mutation carriers

This abstract was withdrawn by the authors.

Lack of adherence to SHEA-IDSA treatment guidelines for Clostridium difficile infection is associated with increased mortality

OBJECTIVES

The objective of this study was to determine our institution's compliance with 2010 Society for Healthcare Epidemiology of America and IDSA Clostridium difficile infection (CDI) treatment guidelines and their respective outcomes.

METHODS

We collected clinical parameters, laboratory values, antibiotic therapy and clinical outcomes from the electronic medical records for all patients hospitalized at our institution with a diagnosis of CDI from December 2012 to November 2013. We specifically evaluated whether SHEA-IDSA treatment guidelines were followed and evaluated the associations between guideline adherence and severe outcomes including mortality.

RESULTS

We identified 230 patients with CDI meeting inclusion criteria during the study period. Of these, 124 (54%) were appropriately treated, 46 (20%) were under-treated and 60 (26%) were over-treated. All-cause 90 day mortality was 17.4% overall; 43.5% in the under-treated group versus 12.9% in those appropriately treated (P < 0.0001) and 10.9% in those appropriately treated plus over-treated (P < 0.0001). Similarly, 90 day mortality attributed to CDI was 21.7% in those under-treated versus 8.9% in those appropriately treated (P = 0.03) and 8.2% in those either appropriately treated or over-treated (P = 0.015). Severe-complicated CDI occurred in 46 patients. In this subgroup, there was a non-significant trend towards increased mortality in under-treated patients (56.7%) compared with appropriately treated patients (37.5%, P = 0.35). Under-treatment was also associated with a higher rate of CDI-related ICU transfer (17.4% versus 4.8% in those appropriately treated, P = 0.023).

CONCLUSIONS

Adherence to CDI treatment guidelines is associated with improved outcomes especially in those with severe disease. Increased emphasis on provision of appropriate, guideline-based CDI treatment appears warranted.

Does at-home bleaching induce systemic oxidative stress in healthy subjects?

BACKGROUND

At-home bleaching is a technique characterized by the use of carbamide peroxide or hydrogen peroxide as a tooth-whitening agent. However, no data exist regarding systemic safety of this technique. The aim of this study was to investigate the effect of at-home bleaching on serum redox homeostasis.

METHODS

Twenty-nine healthy volunteers who requested tooth-whitening participated in this study. Specified bleaching trays were fabricated for the maxilla and mandible arches. Each participant was given two syringes containing 9% hydrogen peroxide gel to use for 30 min/night for 14 nights consecutively. To evaluate the redox status, the serum concentrations of malondialdehyde (MDA), total antioxidant capacity (TAC) and pro-oxidant-antioxidant balance (PAB) were measured. Blood samples were obtained in the morning prior to initiation of study and the morning after expiration of the bleaching period. The collected data were analyzed using Student's t-test with 95% confidence interval.

RESULTS

Twenty-three subjects completed the study. MDA, PAB and TAC were significantly increased after the bleaching period (P = 0.001, 0.001 and 0.002, respectively).

CONCLUSIONS

At-home bleaching revealed the potential to disturb oxidant-antioxidant balance and induce oxidative stress. Its clinical relevance is unfavourable and potential side-effects of at-home bleaching should be considered.

Ginger extract and aerobic training reduces lipid profile in high-fat fed diet rats

OBJECTIVE

Obesity, hyperglycemia and dyslipidemia, are major risk factors. However, natural therapies, dietary components, and physical activity may effect on these concerns. The aim of this study was to examine the effect of aerobic exercise and consumption of liquid ginger extract on lipid profile of Male rats with a high-fat fed diet.

MATERIALS AND METHODS

32 rats were randomly divided into 4 groups: 1) aerobic exercise, 2) Ginger extract, 3) combined aerobic exercise and Ginger extract, and 4) the control. Subjects of the first three groups received ginger extract via gavage feeding of 250 mg/kg. The exercise program was 3 sessions per week on 3 different days over 4 weeks. Total cholesterol (TC), Triglyceride (TG), HDL and LDL were measured 24-h before the first session and 24-h after the final training session.

RESULTS

The concentration of TG in the control group was significantly higher than other groups. In addition, the mean concentration of TG in the aerobic exercise group was significantly lower than Ginger extract group but there was no significant difference as compared to combined aerobic exercise and ginger extract group. The combination of aerobic exercise and ginger consumption significantly reduced the TG level compared to ginger group. TC and LDL concentrations were significantly decreased in all groups compare to control. The combination of aerobic exercise and ginger extract feeding caused a significant increase in HDL levels.

CONCLUSIONS

The finding of this study suggests that the combination of aerobic exercise and liquid ginger extract consumption might be an effective method of reducing lipid profiles, which will reduce the risk of cardiovascular diseases caused by high-fat diets.

A novel inorganic–organic nanohybrid material H4SiW12O40/pyridino-MCM-41 as efficient catalyst for the preparation of 1-amidoalkyl-2-naphthols under solvent-free conditions

A new inorganic–organic nanohybrid material was prepared and performed as an efficient catalyst for the one-pot multi-component synthesis of different substituted 1-amidoalkyl-2-naphthols under solvent-free conditions.

Flt3 ligand treatment modulates parasitemia during infection with rodent malaria parasites via MyD88- and IFN-γ-dependent mechanisms

We previously showed that treatment of mice with the Flt3 ligand (Flt3L) prevents development of lethal experimental cerebral malaria and inhibits parasitemia during Plasmodium berghei ANKA (PbA) infection. In this study, we investigated the mechanisms underlying the reduction of parasitemia in Flt3L-treated mice. Studies using gene knockout mice and antibody treatment indicated that the anti-parasitemia effect of Flt3L was mediated by innate immune system and was dependent on MyD88, IFN-γ, IL-12 and natural killer (NK) cells. The number of NK cells and their ability to produce IFN-γ was enhanced in Flt3L-treated mice. Phagocytic activity of splenocytes was increased in Flt3L-treated mice after PbA infection when compared with that in untreated mice, and this activity was mainly mediated by the accumulation of F4/80(mid) CD11b(+) cells in the spleen. In both MyD88(-/-) and IFN-γ(-/-) mice, the proportion of F4/80(mid) CD11b(+) cells was not increased in the spleen of Flt3L-treated mice after infection. These correlations suggest that NK cells produce IFN-γ in Flt3L-treated mice, and accumulation of F4/80(mid) CD11b(+) cells in the spleen is promoted by an IFN-γ -dependent manner, culminating in the inhibition of parasitemia. These findings imply that Flt3L promotes effective innate immunity against malaria infection mediated by interplay among varieties of innate immune cells.

Cerebral and non-cerebral coenurosis in small ruminants

Cerebral coenurosis is caused by Coenurus cerebralis, the larval stage of Taenia multiceps. The metacestode causes severe lesions in the brain and spinal cord of the intermediate host, so-called "gid" or "stagger" disease. Whereas, the non-cerebral coenurosis caused by Coenurus gaigeri, the larval stage of Taenia gaigeri, particularly affects goats. The cyst form of the Taenia gaigeri is found in intramuscular and subcutaneous tissues. The difference in the sequence of mitochondrial genes of cox1 and nadI and also other variations reported for clinical, morphological and pathological aspects in coenurosis lead to the hypothesis that there is genetic intraspecific variability within this species, such as in other members of the genus Taenia. Nevertheless, it has been shown that sheep and goats have been infected by both cerebral and non-cerebral coenurosis and it has been suggested that such cerebral and non-cerebral metacestodes may belong to different species of Taenia which are host specific for these hosts.

A pilot study of a modified radiographic technique for detecting early proximal cavities

Diagnosing the necessity of cavity preparation in demineralized proximal areas has been considered as a challenge in restorative treatment planning. The purpose of this study was to investigate the clinical performance of a modified radiographic technique for the detection of proximal cavities. The sample consisted of 44 proximal surfaces in 38 dental students. The patients had radiolucent proximal lesions restricted to the inner half of enamel or the outer third of dentine in bitewing radiographs, and there was doubt regarding the presence or absence of cavities in the approximal areas. The suspected surfaces were then examined by secondary bitewing radiographs which were taken after pressing radiopaque material into the proximal areas. Finally, orthodontic elastic separators were placed in the contact areas to provide enough space for direct visual and tactile examination, thus detecting any proximal cavity (reference standard). The sensitivity, specificity and accuracy of the modified bitewing radiography were calculated against the reference standard. Overall, 7 surfaces presented caries cavities according to the reference standard. All proximal radiolucencies observed in the inner half of enamel and 46% of those extended to the outer third of dentine were not cavitated when evaluated by direct visual and tactile examination. The sensitivity, specificity and accuracy of bitewing radiography with opaque material for detecting proximal cavities (n = 7) were 86, 100 and 98%, respectively. The tested radiographic technique displayed good validity in this pilot study for detecting proximal cavities in posterior teeth and should be further investigated.

Distribution of extended spectrum beta-lactamase resistance genes among nosocomial imipenem resistant A. Baumannii strains harboring BLAoxa-23 carbapenemases isolated from Ilam and Tehran

Antimicrobial susceptibility and ESBLs genes of 42 imipenem resistant A. baumannii carried out by DDST and PCR. The most antimicrobial agents against A. baumannii strains, harboring blaOXA-23-like carbapenemases, were meropenem (33.4 percent), piperacillin-tazobactam (23.9 percent), ceftazidime (14.3 percent) and gatifoxacin (19.1 percent), respectively. All the 42 isolates harbored the blaTEM gene, but the bla SHV and VEB genes were not present among all the isolates. With the exception of seven isolates, all the A. baumannii strains harbor blaTEM showed ESBL positivity in DDST. The result of this study show that resistance against antimicrobial agents, especially carbapenems, has increased and that blaTEM harboring A. baumannii strains can be help the blaOXA-like carbapenemase genes to code for resistance against carbapenem antibiotics.

Systematic review: the quality of the scientific evidence and conflicts of interest in international inflammatory bowel disease practice guidelines

BACKGROUND

Guidelines published by the international gastroenterology societies establish standards of care and seek to improve patient outcomes.

AIM

We examined inflammatory bowel disease guidelines (IBD) for quality of evidence, methods of grading evidence and conflicts of interest (COI).

METHODS

All 182 guidelines published by the American College of Gastroenterology, American Gastroenterological Association, British Society of Gastroenterology, Canadian Association of Gastroenterology, Crohn's and Colitis Foundation of America and European Crohn's and Colitis Organisation as of 27 September 2012 were reviewed. Nineteen IBD guidelines were found.

RESULTS

Eighty-nine per cent (n = 17/19) of the guidelines graded the levels of evidence using seven different systems. Of the 1070 recommendations reviewed, 23% (n = 249) cited level A evidence; 28% (n = 302) level B; 36% (n = 383) level C and 13% (n = 136) level D. The mean age of the guidelines was 4.2 years. In addition, 61% (n = 11/19) of the guidelines failed to comment on COI. All eight articles commenting on COI had conflicts with 81% (n = 92/113) of authors reported an average 11.7 COI. Lastly, there were variations in the recommendations between societies.

CONCLUSIONS

Nearly half the IBD guideline recommendations are based on expert opinion or no evidence. Majority of the guidelines fail to disclose any COI, and when commenting, all have numerous COI. Furthermore, the guidelines are not updated frequently and there is a lack of consensus between societal guidelines. This study highlights the critical need to centralize and redesign the guidelines development process.

The Crohn's disease activity index (CDAI) is similarly elevated in patients with Crohn's disease and in patients with irritable bowel syndrome

BACKGROUND

While the Crohn's disease activity index (CDAI) is the gold standard for defining clinical endpoints in Crohn's disease (Crohn's) clinical trials, its ability to distinguish symptoms due to inflammation from those that are non-inflammatory has been questioned.

AIM

To compare CDAI scores in patients with Crohn's and those with Irritable Bowel Syndrome (IBS).

METHODS

This was a prospective, cross-sectional cohort study of 91 patients with either Crohn's (n = 44) or IBS (n = 47). Total CDAI and individual component scores were recorded and comparisons were made between Crohn's and IBS patients.

RESULTS

Mean CDAI scores were higher in the IBS patients (183 vs. 157, P = 0.1). Sixty-two per cent (n = 29) of IBS patients had CDAI scores greater than 150. Mean CDAI haematocrit score (35.9 vs. 23.0, P = 0.02) and CRP level (6.8 vs. 2.0, P = 0.002) were higher in the Crohn's group. Analysis of CDAI sub-scores demonstrated that IBS patients had significantly higher pain (mean 1.7 vs. 0.8, P = 0.0007) and well-being scores (mean 1.2 vs. 0.8, P = 0.04) relative to patients with Crohn's. Specifically evaluating patients with CDAI greater than 150 (n = 51), IBS patients had higher pain sub-scores (mean 2.4 vs. 1.4, P = 0.002), whereas patients with Crohn's had higher CRP (mean 8.4 vs. 1.8, P = 0.001).

CONCLUSIONS

Our study demonstrates that the CDAI does not discriminate patients with symptoms due to active Crohn's from patients with IBS. Patients with IBS can have CDAI scores in the clinically meaningful range. Objective measures, such as CDAI haematocrit score and CRP, are more specific markers of inflammation.

Prevalence of Linguatula serrata Nymphs in Mesenteric Lymph Nodes of Cattle and Buffaloes Slaughtered in Ahvaz Abattoir, Iran

BACKGROUND

Linguatula serrata, one of the parasitic zoonoses, inhabits the canine respiratory system (final hosts). The objective of this study was to determine the prevalence rate of L. serrata nymphs in mesenteric lymph nodes (MLNs) of cattle and buffaloes (intermediate hosts) that were processed in the Ahvaz, Iran abattoir.

METHODS

During November 2010 to March 2011, 223 animals (119 cattle and 104 buffaloes), in different sex and three age groups (<2, 2-< 3 and 3-> 3 years old) were sampled randomly at Ahvaz abattoir. Up to 35 grams of their mesenteric lymph nodes were examined separately for nymphal stages of L. serrata by digesting the samples with acid- pepsin method, collected the nymphs and counted under stereomicroscope.

RESULTS

Overall 37(16.6%) of 223 animals were infected with L. serrata nymphs in their mesenteric lymph nodes. Prevalence of the infection in cattle and buffaloes were 16.8% and 16.3% respectively. The number of collected nymphs of MLNs was ranged from 1 to 16. No significant differences were seen in the infection rates between males and females (sexes) and age groups in the cattle and buffaloes (P <0.05).

CONCLUSION

Linguatula serrata has an active life cycle in the studied area and a zoonotic potential for transmission between animal and human. Avoiding use of raw MLNs to dogs can help reduce the infection.

Enzymatic modification of regenerated cellulosic fabrics to improve bacteria sorption properties

This research investigates the effect of enzymatic treatment of two different regenerated cellulosic fibers (Lyocell and viscose) on their ability of bacteria sorption from an aqueous suspension. The sorption of Escherichia coli (E. coli, Gram negative) and Staphylococcus aureus (S. aureus, Gram positive) cells by treated Lyocell and viscose fabrics were determined by measuring the optical density (OD) of the remaining bacteria suspension after removal of the fabric samples using spectrometry. Fourier transform infrared spectroscopy and scanning electron microscopy (SEM) were utilized to investigate structural and morphological changes of the enzyme treated samples. The result showed that the moisture content and crystallinity of both viscose and Lyocell samples increased after enzymatic treatment. Comparing the results of OD measurements indicated that enzymatic treatment of cellulosic samples significantly increased the bacteria absorption properties compared to those untreated samples. However, treated samples showed different ranges of sorption ability with different kinds of bacteria. The maximum bacteria sorption of 38% and 37% of E. coli bacteria from an aqueous suspension was found for the treated viscose and Lyocell samples compared with only 20% and 10% of the untreated viscose and Lyocell samples, respectively. It was also found that S. aureus sorption of cellulose-treated viscose and Lyocell fabrics from a bacterial suspension could significantly improve up to 33% compared with only 5% of untreated samples. Furthermore, SEM micrographs confirmed that bacterial sorption of the cellulose-treated samples were effectively improved in terms of their uniform sorption on the fibers surface.

Study of promoter methylation pattern of 14-3-3 sigma gene in normal and cancerous tissue of breast: A potential biomarker for detection of breast cancer in patients

Background:

In recent years, DNA methylation as a main epigenetic modification in human cancer is found as a promising biomarker in early detection of breast cancer. Possible applications of numerous hypermethylated genes have been reported in diagnosis of breast cancer but there has been a little comprehensive study on the clinical usefulness of these genes in breast cancer. The aim of the present study was to investigate the promoter methylation status of 14-3-3 sigma gene with the goal of developing a diagnostic application in breast cancer.

Materials and Methods:

Totally 40 cases of cancerous and noncancerous tissues were studied. DNA was extracted from tissue samples, and promoter methylation pattern was determined by using methylation-specific polymerase chain reaction.

Results:

Methylation pattern of 14-3-3 sigma promoter significantly differed between control and malignant breast tissues (P = 0.001), and there was no remarkable correlation between methylation and age (P > 0.05).

Conclusion:

The relationship of promoter methylation of 14-3-3 sigma with development of breast cancer found in this study and confirmed the results of previous reports suggests that we can provide the foundation for possible application of 14-3-3 sigma as a potential biomarker for early detection and monitoring disease status.

Noise-induced Outer Hair Cells' Dysfunction and Cochlear Damage in Rabbits

BACKGROUND

Outer hair cells' (OHCs') dysfunctions as the extent of temporary and permanent threshold shifts (TTS and PTS) and cochlear damage were assessed in rabbits exposed to continuous noise

METHODS

Twelve New Zealand white rabbits were studied in noise (N) (n=6; exposed to continuous noise; 95 dB SPL, 500-8000 Hz for 8 h per day during 5 consecutive days) and control (C) (n=6; not exposed to noise). OHCs' functions were assessed by distortion product otoacoustic emission (DPOAE) level (Ldp) measurements in different periods and comparing TTS and PTS. Animals were anaesthetized by CO2; cochleae were extracted, fixed in 10% formaldehyde for 48 hours, decalcified by 10% nitric acid for 24 hours, and dehydrated, embedded, sectioned 5 µm thickness and stained by Hematoxylin and Eosin for light microscopy.

RESULTS

The most and least Ldp or TTS or PTS were related to 5888.50 Hz and 588.00 Hz respectively in noise subjected rabbits (P<0.05). TTS and PTS were decreased up to 17.79 dB and to 16.01 dB respectively. TTS were more than PTS over all test frequencies, especially at 5888.50 Hz (P<0.05). Ldp or TTS or PTS were found to be equal across ears (P>0.05). Severely vacuolated OHCs, pyknotic IHCs, swollen SC, and slightly thickened BM were found.

CONCLUSION

Continuous noise extensively led to OHCs' dysfunctions as decreased Ldp (both TTS and PTS) and highly damage to cochlea.

Temporary and permanent level shifts in distortion product otoacoustic emissions following noise exposure in an animal model

BACKGROUND

Noise-induced hearing loss (NIHL) is one of the most common occupational illnesses. Most of the studies on NIHL were conducted at high noise levels that people are rarely exposed to but in industries. The function of the outer hair cells (OHCs) is impaired after exposure to industrial noise. Distortion product otoacoustic emissions (DPOAEs) are useful in examination of noise-induced level shifts.

OBJECTIVE

To assess the function of OHCs by DPOAE temporary and permanent level shifts (TLSdp and PLSdp) in rabbits exposed to white noise at realistic levels typically found in industrial settings over a broad range of frequencies.

METHODS

12 albino rabbits were divided into two groups: the experimental group rabbits which were exposed to 95 dB SPL white noise at 500-8000 Hz for 8 hrs/day for 5 consecutive days, and the control group rabbits with no exposure to noise. The function of OHCs was examined by DPOAE level (Ldp) in different occasions. The study groups were compared for DPOAE temporary and permanent level shifts (TLSdp and PLSdp) to assess the effect of noise on OHCs function.

RESULTS

Noise-induced DPOAE levels (Ldp) were decreased up to 20.65 dB (on day 8) and 18.93 dB (on day 11) at 5888.50 Hz (p = 0.081). TLSdp and PLSdp were significantly decreased up to 17.99 dB and 16.27 dB, respectively in the experimental group. The most and least Ldp were significantly different (p<0.05); they occurred at 5888.50 and 588.00 Hz, respectively. There were significant differences between temporary and permanent threshold shift at various frequencies (p<0.05). These differences were mainly related to 5888.50 Hz compared to other frequencies in each ear (p<0.05).

CONCLUSION

DPOAEs are an attractive tool for obtaining information about small temporary or permanent threshold shifts, even when the pure tone audiogram is normal.