Gut microbiome in children with enthesitis-related arthritis in a developing country and the effect of probiotic administration

In Asia, enthesitis-related arthritis (ERA) is the most frequent category of juvenile idiopathic arthritis. ERA has a strong association with human leucocyte antigen (HLA)-B27 and subclinical gut inflammation. In an HLA-B27 transgenic rat model, the presence of Bacteroides bacteria in the gut appears to cause spondyloarthropathy (SpA). Thus, we studied gut microbiota in children with ERA. Stool specimens from 33 patients with ERA and 14 age-matched healthy controls were studied; none had any gastrointestinal symptom, or had received a drug known to affect gut motility or microbiota in the preceding 6 weeks. From each specimen, a cDNA library for the V3 region of bacterial 16S rRNA was subjected to high-throughput, massively parallel sequencing. Relationship of the specimens was studied using principal co-ordinate analysis (PCoA), and abundances of various bacterial taxa and alpha diversity were compared between groups. In eight patients, a repeat faecal specimen was studied after 12 weeks of probiotic therapy. The 55 specimens yielded a median (range) of 397 315 (102 093-1 502 380) high-quality reads each. In PCoA, gut microbiota from ERA showed a wider dispersion than those from controls. In patients, families Bacteroidaceae and Enterobacteriaceae were more abundant and Prevotellaceae were less abundant than in controls. Also, genera Bacteroides, Entercoccus and Klebsiella were over-represented and genus Prevotella was under-represented in ERA patients. Probiotic therapy led to a non-significant increase in Prevotellaceae. Patients with ERA have a dysbiosis in the gut, with increased abundance of Bacteroides and reduction of Prevotella. Probiotic supplementation in a subset of patients did not reverse these changes significantly.

Pancreatic trauma

Pancreatic trauma is relatively uncommon and although the surgical management is in many cases comparatively simple, occasionally complex technical surgery is required. Early diagnosis is paramount, although this remains difficult. The challenge of pancreatic trauma is compounded by a high incidence of associated injuries to adjoining organs and major vascular structures that may require damage control surgery and delayed definitive repair and add to the high frequency of postoperative complications, morbidity and mortality.

Investigation in W/O developed microemulsions with DMSO as a cosurfactant

In this study the effect of dimethylsulfoxide (DMSO) radii on the droplets and on the required non-ionic surfactant volume for preparing water-in-oil microemulsions (MEs) was investigated. Five series of MEs were prepared either with the aid of isopropylpalmitate or medium chain triglycerides (MCTG) as continuous phases. The MEs were stabilized via either Tween80 or Span20 or a mixture of both. A mixture of water:DMSO (W:DMSO) with different ratios formed the colloidal phase of the first four MEs series. Only DMSO was used as colloidal phase of the fifth series. Dynamic light scattering (DLS) was used for measuring the radii of the droplets of MEs. The results showed that the consumed volumes of the surfactants were related to the W:DMSO ratio and the surfactant type. Moreover, the consumed surfactant volumes increased with decreasing radii of the droplets of the MEs. The MEs stabilized with Span20 had lower radii of the droplets (4-15 nm) than MEs stabilized by Tween80 (25-65 nm). It was evident that DMSO changed the interfacial tension which is reflected by changing the the volume of the surfactant consumed and by altering the droplets sizes. Consequently, DMSO acted as co-surfactant in stabilizing the MEs by reducing the required volumes of the surfactant which is important for reducing their toxicity.

A homozygous nonsense variant in IFT52 is associated with a human skeletal ciliopathy

Intraflagellar transport (IFT) is vital for the functioning of primary cilia. Defects in several components of IFT complexes cause a spectrum of ciliopathies with variable involvement of skeleton, brain, eyes, ectoderm and kidneys. We examined a child from a consanguineous family who had short stature, narrow thorax, short hands and feet, postaxial polydactyly of hands, pigmentary retinopathy, small teeth and skeletal dysplasia. The clinical phenotype of the child shows significant overlap with cranioectodermal dysplasia type I (Sensenbrenner syndrome). Whole-exome sequencing revealed a homozygous nonsense variant p.R142* in IFT52 encoding an IFT-B core complex protein as the probable cause of her condition. This is the first report of a human disease associated with IFT52.

Non-small cell lung cancer with distal cutaneous metastases in a patient with a previously treated colorectal carcinoma

Cutaneous manifestations of visceral carcinomas are scarce, occurring in around 0.7-12% of internal malignancies. Lung cancer is one of the most common sources of skin metastasis, particularly in male patients. We present a case of cutaneous metastasis in a man with concurrent lung lesions and a previously treated colorectal carcinoma. Immunohistochemistry markers for both skin and lung lesions were strongly positive for carcinoembryonic antigen and cytokeratin 20, suggesting an intestinal primary tumour. However, colonoscopy excluded new and metastatic bowel lesions. After multidisciplinary team meetings, which reviewed the clinical, radiological and immunohistochemistry findings, it was concluded to be a non-small cell lung cancer with skin metastasis. This case presented an interesting diagnostic challenge, and highlighted the importance of cross-specialty liaison and investigation to reach the correct diagnosis.

Iatrogenic watering-can perineum and osteomyelitis of pubic ramus as a complication of post-urethral calculus removal UTI

We present a case of a 55-year-old male with a history of urethroscopic calculus removal who later developed urinary tract infection (UTI), complicated by periurethral abscess formation with osteomyelitis of the inferior pubic ramus and a urethrocutaneous fistula after surgical drainage of the abscess. UTI with periurethral abscess and urethrocutaneous fistula (watering-can perineum) is a rare complication of UTI. A periurethral abscess with pubic osteomyelitis has not been previously reported.

EVALUATION OF MULTIPLEX LIGATION DEPENDENT PROBE AMPLIFICATION AS A TOOL FOR DIAGNOSIS AND CARRIER DETECTION IN FAMILIES WITH A DYSTROPHINOPATHY

We set out to evaluate multiplex ligation dependent probe amplification (MLPA) as a tool for diagnosis and carrier detection in families with a dystrophinopathy. Fifty three Indian families with provisional diagnosis of Duchene muscular dystrophy or Becker muscular dystrophy were evaluated by MLPA and multiplex polymerase chain reaction (PCR). Sanger sequencing was used to analyze the entire gene in one patient. Mothers were tested for carrier status whenever possible. Molecular analysis of DMD gene by combining MLPA and multiplex PCR yielded a mutation detection rate of 62% (33/53). Deletions were detected in 27/53 (51%) cases, duplications in 5/53 (9%) cases, a small deletion one case and Sanger sequencing detected a nonsense mutation in one case. Mutation was not detected in 36% (19/53) cases. Fifty six percent of mothers (9/16) were found to be carriers. MLPA helped to refine the results of multiplex PCR testing in 22 patients (5 duplications, 16 deletions and one small deletion). We also describe a situation where a deletion of single exon on MLPA (but not detected by multiplex PCR) was actually due to a deletion of two nucleotides in the probe ligation site. MLPA appears to score over multiplex PCR in diagnosis and carrier detection, specifically by detecting deletions and duplications that are not detected by traditional multiplex PCR.

Geomorphic and geologic controls of geohazards induced by Nepal's 2015 Gorkha earthquake

The Gorkha earthquake (magnitude 7.8) on 25 April 2015 and later aftershocks struck South Asia, killing ~9000 people and damaging a large region. Supported by a large campaign of responsive satellite data acquisitions over the earthquake disaster zone, our team undertook a satellite image survey of the earthquakes' induced geohazards in Nepal and China and an assessment of the geomorphic, tectonic, and lithologic controls on quake-induced landslides. Timely analysis and communication aided response and recovery and informed decision-makers. We mapped 4312 coseismic and postseismic landslides. We also surveyed 491 glacier lakes for earthquake damage but found only nine landslide-impacted lakes and no visible satellite evidence of outbursts. Landslide densities correlate with slope, peak ground acceleration, surface downdrop, and specific metamorphic lithologies and large plutonic intrusions.

Sacrococcygeal Teratoma: Experience with 36 Patients in a Teritiary Care Hospital

Introduction: Sacrococcygeal teratomas (SCT) are the most common solid tumours in the neonatal period, originate from embryonic totipotent cells. Most of them are benign however some that present later in life and have major intra-pelvic component have greater malignant potential. Complete surgical excision provides an excellent prognosis. The aim of this study was to describe the clinical profile, age of presentation, sex distribution, diagnostic evaluation and management of children with a histological confirmed diagnosis of sacrococcygeal teratoma.Material and Methods: Patients with histological diagnosis of sacrococcygeal teratoma during a period from January 2011 to December 2012 were included in this retrospective study. Data collected included age of presentation, sex distribution, symptoms, associated anomalies, diagnostic evaluation, operative approach technique employed, tumour histology, operative complications and outcome.Results: Thirty six patients with diagnosis of sacrococcygeal teratoma were included in the study. Of these children, 58.33% were females and 41.66% were males. The median age at presentation was four days. 69.44% of patients presented during the neonatal period. 77.77% of patients presented with sacrococcygeal mass followed by lower abdominal mass in 11.11%. The tumour was resected by sacral approach in 27 patients and abdomino sacral approach in nine patients. Tumour was resectable in 34 patients and two had incomplete resection. Follow up duration varied from six months to 24 months.Conclusion: Sacrococcygeal teratomas represent a group of benign and malignant lesions of children. Neonates present with benign disease and aggressive lesions are seen as age progresses. Overall survival of SCT is high.J Nepal Paediatr Soc 2015;35(1):89-93

An Ectopic Pelvic Kidney

Background

If a kidney does not ascend as it should in normal fetal development, it remains in the pelvic area and is called a pelvic kidney. Often a person with a pelvic kidney will go through his/her whole life unaware of this condition, unless it is discovered during neonatal kidney ultrasound screening or if complications arise later in life due to this or a completely different reason and the condition is noted during investigations. Generally, this is not a harmful condition but it can lead to complications like in our case. With appropriate testing and treatment, if needed, an ectopic kidney should cause no serious long-term health complications and all that may be required for the patient is reassurance with advice to follow up at regular intervals.

Case Report

A 28-year-old male presented with recurrent pain in his lower left abdomen for one month and an episode of hematuria 3 days earlier accompanied by an attack of acute pain lasting for 3–4 hours. He gave a history of passing 2 small (about 5 mm each) calculi in his urine after the occurrence of hematuria, following which pain decreased in intensity. No history of fever was present.

Conclusions

Although a simple ectopic kidney seldom causes symptoms, the association of malrotation of the renal pelvis with calculus increases the risk of hematuria and/or hydronephrosis, presenting with colicky pain as in the present case. The clinician should be aware of these in such a case.

If asymptomatic, no treatment is required. However, the patient should be advised to have follow-up ultrasounds at regular intervals to detect complications like calculus, hydronephrosis, etc. With appropriate testing and treatment, if required, an ectopic kidney should not cause serious long-term health complications.

Abstract 38: ERK5 inhibitor XMD8-92 for malignant mesothelioma treatment: A preclinical study

Malignant mesothelioma (MM) is an aggressive cancer in dire need of successful treatment. We are first to demonstrate that Extracellular signal regulated kinase 5 (ERK5) plays an important role in MM pathogenesis (Clinical Cancer Research, 19, 2013). In this study we used genetically manipulated (ERK5 inhibited) MM cell lines to show that MM tumorigenesis is influenced by ERK5. In the present study we used recently discovered specific ERK5 inhibitor (XMD8-92) to show that it regulates MM tumor growth both in vitro and in vivo. First, we show that XMD8-92 inhibits ERK5 phosphorylation in 3 out of 4 MM cell lines showing constitutive activation of ERK5. Next, time and dose dependent study demonstrated significant cytotoxicity of XMD8-92 on 3 different MM cell lines. We also showed that soft agar colony forming efficiency of H2373 MM cells was significantly reduced in response to XMD8-92 treatment. Furthermore, in vivo studies using syngeneic mouse model of intraperitoneal mesothelioma showed that XMD8-92 treatment (50 mg/kg, ip, 1x daily for 3 weeks) resulted in significant decreases in tumor weights as compared to vehicle treated mice. Total and differential cell counts in peritoneal lavage fluid (PLF) were also inhibited by XMD8-92 suggesting the role of inflammation in MM tumor growth and their inhibition by ERK5 inhibitor. Cytokine profile assessment in PLF demonstrated the reduced levels of VEGF and IL-6 in XMD8-92 treated animals as compared to control animals receiving saline. FGF2, MCP-1, G-CSF, KC and RAGE levels were, however, not significantly impacted by the ERK5 inhibition. Taken together these data suggest that ERK5 inhibitor/ERK5 inhibition could be used for inhibiting the growth of MM tumors. Currently we are exploring the role of XMD8-92 alone as well as in combination with chemotherapeutic drugs for the treatment of MM using various mouse models. We are also exploring the role(s) of ERK5 inhibitor in inflammasome regulation by chemotherapeutics. This work is supported by NIEHS RO1 ES021110 and VCC/LCCRO grants.

Citation Format: Arti Shukla, Joyce Thompson, Anurag Shukla, Alan Leggett, Maximilian MacPherson, Stacie Beuschel. ERK5 inhibitor XMD8-92 for malignant mesothelioma treatment: A preclinical study. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 38. doi:10.1158/1538-7445.AM2015-38

Religious/spiritual characteristics of indian and indonesian physicians and their acceptance of spirituality in health care: a cross-cultural comparison

Religious/spiritual (r/s) characteristics of physicians influence their attitude toward integrative medicine and spiritual care. Indonesia physicians collaborate with traditional, complementary, and alternative medicine (TCAM) professionals within modern healthcare system, while Indian physicians are not reported to do so. The aim of the study was to understand the r/s characteristics and their influence on Indian and Indonesian physicians' acceptance of TCAM/spirituality in modern healthcare system. An exploratory, pilot, cross-cultural, cross-sectional study, using Religion and Spirituality in Medicine, and Physician Perspectives (RSMPP) survey questionnaire, compared r/s characteristics and perspectives on integrative medicine of 169 physicians from two allopathic, Sweekar-Osmania University (Sweekar-OU), India, University of Airlanga (UNAIR), Indonesia, and a TCAM/Central Research Institute of Unani Medicine (CRIUM) institute from India. More physicians from UNAIR and CRIUM (89.1 %) described themselves as "very"/"moderately" religious, compared to 63.5 % Sweekar-OU (p = 0.0000). Greater number of (84.6 %) UNAIR physicians described themselves as "very" spiritual and also significantly high (p < 0.05) in intrinsic religiosity as compared to Sweekar-OU and TCAM physicians; 38.6 % of UNAIR and 32.6 % of CRIUM participants reported life-changing spiritual experiences in clinical settings as against 19.7 % of Sweekar-OU; 92.3 % of UNAIR, compared to CRIUM (78.3 %) and Sweekar-OU (62 %), felt comfortable attending to patients' spiritual needs, (p = 0.0001). Clinical comfort and not r/s characteristics of participants was the significant (p = 0.05) variable in full regression models, predictive of primary outcome criteria; "TCAM or r/s healing as complementary to allopathic treatment." In conclusion, mainstreaming TCAM into healthcare system may be an initial step toward both integrative medicine and also improving r/s care interventions by allopathic physicians.

p53 Expression in Oral cancer: A study of 50 cases

Background: Oral cancer is the sixth most common cancer in the world. P53 mutations are associated with the development of oral squamous cell carcinomas. This study is to determine the presence of p53 oncogene expression in cases of oral malignant, premalignant and benign lesions and to show association of p53 oncogene and lymph node enlargement in malignant lesion.Materials and Methods: Four to five micron-thick sections of formalin fixed, paraffin embedded biopsy material from various intra-oral sites of 50 patients were collected, in the series of 50 cases, 35 oral squamous cell carcinoma, 10 dysplastic lesions and 05 hyperplastic lesions were assessed for p53 expression. The tissue sections were immunohistochemically analyzed for the expression of p53 gene.Results: Out of 50; 22/35 (63%) cases of squamous cell carcinoma, 02/10 (20%) cases of dysplasia (20%), were positive for p53. Five hyperplastic lesions were negative for p53. The P53 protein was not identified in benign lesion.Conclusion: Results indicate that p53 over-expression is seen in oral squamous cell carcinomas. It is a significant marker of carcinogenesis and can be considered as an important marker for clinical evaluation, diagnosis as well as prognosis of disease.Journal of Pathology of Nepal (2015) Vol. 5, 747-751

Monitoring minute ventilation versus respiratory rate to measure the adequacy of ventilation in patients undergoing upper endoscopic procedures

Endoscopic procedures performed under conscious sedation require careful monitoring of respiratory status to prevent adverse outcomes. This study utilizes a non-invasive respiratory volume monitor (RVM) that provides continuous real-time measurements of minute ventilation (MV), tidal volume and respiratory rate (RR) to assess the adequacy of ventilation during endoscopy. Digital respiratory traces were collected from 51 patients undergoing upper endoscopy with propofol sedation using an impedance-based RVM. Baseline MV for each patient was derived from a 30 s period of quiet breathing prior to sedation (MVBASELINE). Capnography data were also collected. Because RR from capnography was frequently unavailable, the RVM RR's were used for analysis. RR rate values were compared the MV measurements and sensitivity and specificity of RR to predict inadequate ventilation (MV <40 % MVBASELINE) were calculated. Initial analysis revealed that there is a weak correlation between an MV measurement and its corresponding RR measurement (r = 0.05). If MV is an actual indictor of respiratory performance, using RR as a proxy is grossly inadequate. Simulating a variety of RR alarm conditions [4-8 breaths/min (bpm)] showed that a substantial fraction of low MV measurements (MV <40 % MVBASELINE) went undetected (at 8 bpm, >70 % low MV measurements were missed; at 6 bpm, >82 % were missed; and at 4 bpm, >90 % were missed). A cut-off of 6 bpm had a sensitivity of only 18.2 %; while <40 % of all RR alarms would have coincided with a low MV (39.4 % PPV). Low RR measurements alone do not reflect episodes of low MV and are not sufficient for accurate assessment of respiratory status. RVM provides a new way to collect MV measurements which provide more comprehensive data than RR alone. Further work is ongoing to evaluate the use of MV data during procedural sedation.

Energy efficient acquisition and reconstruction of EEG signals

In Wireless Body Area Networks (WBAN) the energy consumption is dominated by sensing and communication. Previous Compressed Sensing (CS) based solutions to EEG tele-monitoring over WBAN's could only reduce the communication cost. In this work, we propose a matrix completion based formulation that can also reduce the energy consumption for sensing. We test our method with state-of-the-art CS based techniques and find that the reconstruction accuracy from our method is significantly better and that too at considerably less energy consumption. Our method is also tested for post-reconstruction signal classification where it outperforms previous CS based techniques. At the heart of the system is an Analog to Information Converter (AIC) implemented in 65nm CMOS technology. The pseudorandom clock generator enables random under-sampling and subsequent conversion by the 12-bit Successive Approximation Register Analog to Digital Converter (SAR ADC). AIC achieves a sample rate of 0.5 KS/s, an ENOB 9.54 bits, and consumes 108 nW from 1 V power supply.

ALOBAR HOLOPROSENCEPHALY, CLEFT LIP/PALATE, URORECTAL SEPTUM MALFORMATION SEQUENCE AND CONGENITAL PERINEAL HERNIA IN A FETUS

We report on a fetus with alobar holoprosencephaly, complete cleft lip and palate, urorectal septum malformation sequence and perineal hernia. To our knowledge this appears to be a novel fetal malformation syndrome.

The GALAXIES beamline at the SOLEIL synchrotron: inelastic X-ray scattering and photoelectron spectroscopy in the hard X-ray range

The GALAXIES beamline at the SOLEIL synchrotron is dedicated to inelastic X-ray scattering (IXS) and photoelectron spectroscopy (HAXPES) in the 2.3-12 keV hard X-ray range. These two techniques offer powerful complementary methods of characterization of materials with bulk sensitivity, chemical and orbital selectivity, resonant enhancement and high resolving power. After a description of the beamline components and endstations, the beamline capabilities are demonstrated through a selection of recent works both in the solid and gas phases and using either IXS or HAXPES approaches. Prospects for studies on liquids are discussed.

Indian health care professionals' attitude towards spiritual healing and its role in alleviating stigma of psychiatric services

Persons with mental illnesses in India and rest of developing world continue to consult religious/spiritual (R/S) healers or traditional, complementary and alternative medicine (TCAM) professionals prior to seeking psychiatric services that are devoid of spiritual components of care. We aim to understand TCAM and allopathic professionals' perspectives on patients' R/S needs within mental health services, cross-sectional study was conducted at five TCAM and two allopathic tertiary care hospitals in three different Indian states; 393 participants completed RSMPP, a self-administered, semi-structured survey questionnaire. Perspectives of TCAM and allopathic health professionals on role of spirituality in mental health care were compared. Substantial percentage, 43.7 % TCAM and 41.3 % allopathic, of participants believe that their patients approach R/S or TCAM practitioners for severe mental illness; 91.2 % of TCAM and 69.7 % of allopaths were satisfied with R/S healers (p = 0.0019). Furthermore, 91.1 % TCAM and 73.1 % allopaths (p = 0.000) believe that mental health stigma can be minimized by integrating with spiritual care services. Overall, 87 % of TCAM and 73 % of allopaths agreed to primary criterion variable: 'spiritual healing is beneficial and complementary to psychiatric care.' A quarter of allopaths (24.4 %) and 38 % of TCAM physicians reportedly cross-refer their grieving patients to religious/TCAM healer and psychiatrist/psychologist, respectively; on logistic regression, significant (p < 0.05) predictors were clinical interactions/references to r/s healers. Providing spiritual care within the setup of psychiatric institution will not only complement psychiatric care but also alleviate stigma against mental health services. Implications on developing spiritual care services like clinical chaplaincy are discussed.