A Study of Microalbuminuria (MAU) and Advanced Glycation End Products (AGEs) Levels in Diabetic and Hypertensive Subjects

The prevalence of non-communicable diseases like diabetes mellitus (DM) and hypertension (HTN) is growing worldwide. Both lead to nephropathy if not controlled effectively. Microalbuminuria (MAU) is recognized as an early predictor for nephropathy. Additionally, the timely detection of advanced glycation end products (AGEs) is also considered to be an important prognostic factor for diabetic nephropathies. Hence, screening for the early detection of MAU and AGEs would be an useful and relatively inexpensive laboratory test for early clinical diagnosis for the incidence of nephropathy in these diseases. This study was conducted in DM, HTN and pregnancy induced hypertensive (PIH) subjects. MAU and N^ε-Carboxymethyllysine (CML) levels were estimated by in-house RIA kits in the patient groups and controls, while the total AGEs level in serum was determined by ELISA. The levels of MAU, CML and AGE-BSA were observed to be significantly higher in DM, HTN and PIH subjects compared to controls (p < 0.001). Increased serum CML and AGEs levels in DM, HTN and PIH subjects indicated ongoing glycemic damage and their susceptibility to develop renal complications.

The Long-Term Follow-up and Support for Living Organ Donors: A Center-Based Initiative Founded on Developing a Community of Living Donors

Transplant professionals recognize that the long-term follow-up of living organ donors is a priority, yet there has been no implemented solution to this problem. This critical gap is essential, because the transplant field is now emphasizing living donation as a means to address the organ shortage. We detail our living donor initiative, which sets several priorities we recognize as fundamental to persons who have donated organs at our transplant center. This intervention attempts to mitigate the donor and center factors that are known to contribute to the lack of long-term follow-up. Beyond that, our goals are aimed at providing ongoing engagement, wellness, clinical data accrual, laboratory follow-up, and social support for our living donors, in continuity. Our ultimate goal is to nurture the development of local living donor community networks by providing social engagement for current and past donors, which also serves as a platform for greater population education on the societal importance of living donation. This initiative is based on joint recognition by our transplant team and our hospital leadership that supporting the long-term welfare of living donors is essential to accomplishing the goal of expanding living donor transplantation. The transplant team and hospital missions are aligned, and both contribute resources to the initiative.

De Novo Belatacept in a Human Immunodeficiency Virus-Positive Kidney Transplant Recipient

Benefits of belatacept-based immunosuppressive regimens in human immunodeficiency virus (HIV)-positive renal transplant recipients include avoidance of drug interactions between calcineurin inhibitors and highly active antiretroviral agents and decreased likelihood or severity of nonimmune toxicities such as new-onset diabetes after transplant, hyperlipidemia and hypertension. We report a successful case of de novo belatacept at >18 mo from transplant in an HIV-positive black man aged 50 years who received his first transplant from a living related kidney donor. To our knowledge, this case is the first reported of belatacept use in an HIV-positive renal transplant recipient.

Effect of Plug Temperature on the Strain and Thickness Distribution of Components Made by Plug Assist Thermoforming

Plug temperature is a key parameter affecting the thickness distribution of thermoplastic components made by plug assist thermoforming. For a specified pair of plug and plastic sheet, the variation in plug temperature can alter the coefficient of friction (COF) between the pair. We show here how the temperature dependence of COF influences the nature and extent of biaxial stretching of the sheet and consequently the thickness distribution of the thermoformed component. In the present study, high impact polystyrene (HIPS) sheets were thermoformed into axisymmetric cups using a plug-assist process in which the aluminum plug temperature (Tplug) was varied from ambient to above the glass transition temperature of HIPS (∼100 °C). Biaxial strain maps on the surfaces of the formed cups were measured and quantified using Grid Strain Analysis (GSA). Thickness distributions of the cups were also measured. Temperature dependent COF between HIPS and aluminum was determined independently using a rotational rheometer. The measured COF was low for T < 100 °C, whereas it increased appreciably at and above 100 °C. We conclude that when Tplug < 100 °C the HIPS sheet slips on the plug during forming, and this results in biaxial stretching of the base and walls of the formed cup. In contrast for Tplug > 100 °C, a significant reduction in the magnitude of slip is expected. Here the sheet is gripped at the clamp and by the plug during forming which causes reduced biaxial stretching of the base and increased uniaxial stretching of the walls of the cup. Simulations of plug-assist thermoforming using a temperature dependent COF showed qualitative agreement with the GSA data thereby supporting our inferences.

Abstract P4-03-05: Wide-field optical coherence tomography (WF-OCT) for near real-time, point-of-care assessment of margin status in breast-conserving surgery specimens: Results of a feasibility study at a high-volume single-centre

Wide-Field Optical Coherence Tomography (WF-OCT) is a non-destructive, non-contact light imaging modality capable of label-free visualization of the internal microscopic architecture of breast tissue specimens. Its unique combination of high-resolution imaging in near real-time with tissue penetration depths approaching 2-mm makes it a promising imaging modality for obtaining detailed surgical margin status in breast-conserving surgery (BCS) specimens. A prototype WF-OCT imaging platform developed by Perimeter Medical Imaging, Inc. (Toronto, Canada) has permitted fully-automated, dynamically-focused visualization of margin widths around the intact surfaces of freshly excised BCS specimens. Herein are reported the results of a feasibility study at a high-volume single-centre evaluating the routine use of WF-OCT for sampling of surgical margin status in BCS specimens at the point-of-care.

Methods: Women with biopsy confirmed breast cancer and scheduled for primary BCS were recruited at Princess Margaret Cancer Centre (Toronto, Canada). Standard medical care was not altered. Freshly excised BCS specimens including all lumpectomy samples were imaged by WF-OCT immediately prior to standard histological processing. The system acquired dynamically-focused, hemispherical coverage over two contra-lateral surfaces of the intact BCS specimen within the time constraints of the cold ischemic time window. High-resolution (10 μm) images of the tissue surface down to a 1 to 2-mm depth were obtained. Blinded assessments were performed on image data sets by two clinical readers (surgeon and radiologist) trained on a validated and unrelated data set correlating OCT images with histology slides. The readers were first asked to independently assess margin status using only blinded pre- and intra-operative knowledge (without OCT). Upon completion, the readers were provided OCT images of all scanned surface and similarly asked to assess the margin status with the additional OCT information. These assessments were subsequently evaluated by a breast pathologist comparing the OCT images and corresponding histopathology sections. The added utility of WF-OCT imaging information for margin prediction was studied.

Results: [Pending study completion in August 2015]. Through accurate correlation with the histopathologic gold standard, OCT demonstrated capability to differentiate tissue microstructures, including: distinctive patterns for adipose tissue, fibrous stroma, breast lobules and ducts, cysts and microcysts, as well as in-situ and invasive carcinomas.

Implications: The fully-automated WF-OCT imaging platform can integrate conveniently into standard pathological processing workflows to provide comprehensive sampling of surgical margin status in BCS specimens at the point-of-care. Clinical readers from surgical and radiological backgrounds can be trained to competently interpret WF-OCT images of BCS specimens for accurate prediction margin status. The implementation of WF-OCT at the point-of-care for routine surgical margin assessments will be further explored in future clinical trials.

Citation Format: Valic MS, Leong WL, Done SJ, Wilson BC, Kulkarni S, McCready DR, Niu CJ, Atachia Y, Munro EA, Rempel D. Wide-field optical coherence tomography (WF-OCT) for near real-time, point-of-care assessment of margin status in breast-conserving surgery specimens: Results of a feasibility study at a high-volume single-centre. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-03-05.

Knowledge, Attitude and Practice Regarding Organ Donation among Indian Dental Students

BACKGROUND

Of the overall 9.5 million deaths annually in India, nearly 100,000 are due to organ failure. To save and extend lives, organ donation and organ transplantation have become the only hope. Health care professionals (HCPs) are a key element in facilitating cadaveric organ donation process.

OBJECTIVE

To assess and compare the knowledge, attitude, and practice regarding organ donation among undergraduate dental students.

METHODS

A cross-sectional study was conducted among 298 undergraduate dental students of the Panineeya Institute of Dental Sciences and Hospital, Hyderabad, India. A 27-item self-administered questionnaire, which assessed the levels of knowledge (Q1-13), positive attitude (Q14-24) and practice habits (Q25-27) regarding organ donation with dichotomous scale (Yes/No).

RESULTS

As compared to males, females reported better mean±SD scores in knowledge (8.22±1.51) and practice (0.91±0.8); higher mean±SD attitude scores (8.55±1.56) were reported among males (p<0.001). While second year dental students had higher scores for their knowledge (8.55±1.56) and practice (1.02±0.44) compared to other year of training, third year students showed a significant higher mean attitude score (1.73±1.17) (p=0.02). Hindus and Muslims scored significantly lower mean knowledge, attitude and practice habits compared to others (Christians, Jains and Athesists) (p<0.001). There was a positive correlation between mean knowledge, attitude, and practice habits.

CONCLUSION

There are an average level of knowledge and low levels of positive attitude and practice habits among studied dental students towards organ donation and transplantation.

Acute Neurological Illness in a Kidney Transplant Recipient Following Infection With Enterovirus-D68: An Emerging Infection?

We report the first case of enterovirus-D68 infection in an adult living-donor kidney transplant recipient who developed rapidly progressive bulbar weakness and acute flaccid limb paralysis following an upper respiratory infection. We present a 45-year-old gentleman who underwent pre-emptive living-donor kidney transplantation for IgA nephropathy. Eight weeks following transplantation, he developed an acute respiratory illness from enterovirus/rhinovirus that was detectable in nasopharyngeal (NP) swabs. Within 24 h of onset of respiratory symptoms, the patient developed binocular diplopia which rapidly progressed to multiple cranial nerve dysfunctions (acute bulbar syndrome) over the next 24 h. Within the next 48 h, asymmetric flaccid paralysis of the left arm and urinary retention developed. While his neurological symptoms were evolving, the Centers for Disease Control reported that the enterovirus strain from the NP swabs was, in fact, Enterovirus-D68 (EV-D68). Magnetic resonance imaging of the brain demonstrated unique gray matter and anterior horn cell changes in the midbrain and spinal cord, respectively. Constellation of these neurological symptoms and signs was suggestive for postinfectious encephalomyelitis (acute disseminated encephalomyelitis [ADEM]) from EV-D68. Treatment based on the principles of ADEM included intensive physical therapy and other supportive measures, which resulted in a steady albeit slow improvement in his left arm and bulbar weakness, while maintaining stable allograft function.

Inhibition of enamel demineralisation using "Nd-YAG and diode laser assisted fluoride therapy"

AIM

This in vitro study was to evaluate the irradiation efficacy of the Diode laser and the Nd-YAG laser either un-assisted or assisted by acidulated phosphate fluoride (APF) treatment on enamel's acid resistance.

METHODS

Seventy-two enamel samples, obtained from 12 extracted human molars, were randomly assigned to 6 groups as follows: (1) Control (C); (2) Exposed to APF gel (F); (3) Diode laser (DL); (4) Irradiated with Diode laser through APF gel (DL/F); (5) Nd-YAG laser (NL) and (6) Irradiated with Nd-YAG laser through APF gel (NL/F). The specimens were individually demineralised in an acidified hydroxyethylcellulose system, and the acid resistance was evaluated by determining the calcium ion dissolution using atomic absorption spectrometry.

RESULTS

The average concentration of the calcium ion determined in groups 1 to 6 was 901, 757, 736, 592, 497 and 416 parts per million micrograms/gram, respectively. The results showed that demineralisation in the NL/F group was significantly less than the other groups and the control group was significantly greater than the other groups (P < 0.001).

CONCLUSION

The effect of Nd-YAG laser irradiation, used alone or in combination with APF, in decreasing the enamel demineralisation was greater than all the other groups.

Development of a Donor-Centered Approach to Risk Assessment: Rebalancing Nonmaleficence and Autonomy

Living kidney donors are often excluded from the shared decision making and patient-centered models that are advocated in medical practice. Thresholds for acceptable risk vary between transplant centers, and between clinicians and donors. Although donor selection committees commonly focus on medical risks, potential donors also consider nonmedical risks and burdens, which may alter their assessment of an acceptable level of medical risk. Thus, transplant centers may encounter ethical tensions between nonmaleficence and respect for donor autonomy. A donor-centered model of risk assessment and risk reconciliation would integrate the donor's values and preferences in a shared decision about their eligibility to donate. This paper argues for shifting to a donor-centered model of risk assessment, and presents a research agenda to facilitate the greater participation of donors in their own evaluation and approval processes.

Role of amino acids as additives on sperm motility, plasma membrane integrity and lipid peroxidation levels at pre-freeze and post-thawed ram semen

The possibility of including amino acids for cryopreservation of ram semen to improve the quality of frozen semen was explored in this study in sheep model. 24 samples were collected in triplicate from 8 rams of 2-3 year old Bannur cross bred rams maintained at the Institute Experimental Livestock Unit. Semen was diluted in tris-egg yolk glycerol diluent and made into 7 aliquots as follows: aliquot 1 served as control, "l-alanine" was added at 100 and 135mM in the aliquots 2 and 3, "l-glutamine" was added at 20 and 25mM in the aliquots 4 and 5 and "l-proline" was added at 25 and 50mM in the aliquots 6 and 7, respectively. Diluted semen was filled in 0.25ml French straws and frozen in LN2. Inclusion of "l-proline" and "l-glutamine" in the diluent increased the percent live sperm (P<0.001), total motility (P<0.05) and maintained higher functional membrane and acrosomal integrity (P<0.001) by decreasing lipid peroxidation (P<0.001) compared to the control group. In contrast, "l-alanine" decreased the percentage of total motility, fast progressive spermatozoa and increased (P<0.01) the percentage of immotile spermatozoa. It can be concluded that 20mM "l-glutamine" and 25mM "l-proline" can be used as semen additive to freeze ram semen as they prevented cryoinjuries to sperm and improved the pre-freeze and post-thaw semen characteristics.

TBX6 null variants and a common hypomorphic allele in congenital scoliosis

BACKGROUND

Congenital scoliosis is a common type of vertebral malformation. Genetic susceptibility has been implicated in congenital scoliosis.

METHODS

We evaluated 161 Han Chinese persons with sporadic congenital scoliosis, 166 Han Chinese controls, and 2 pedigrees, family members of which had a 16p11.2 deletion, using comparative genomic hybridization, quantitative polymerase-chain-reaction analysis, and DNA sequencing. We carried out tests of replication using an additional series of 76 Han Chinese persons with congenital scoliosis and a multicenter series of 42 persons with 16p11.2 deletions.

RESULTS

We identified a total of 17 heterozygous TBX6 null mutations in the 161 persons with sporadic congenital scoliosis (11%); we did not observe any null mutations in TBX6 in 166 controls (P<3.8×10(-6)). These null alleles include copy-number variants (12 instances of a 16p11.2 deletion affecting TBX6) and single-nucleotide variants (1 nonsense and 4 frame-shift mutations). However, the discordant intrafamilial phenotypes of 16p11.2 deletion carriers suggest that heterozygous TBX6 null mutation is insufficient to cause congenital scoliosis. We went on to identify a common TBX6 haplotype as the second risk allele in all 17 carriers of TBX6 null mutations (P<1.1×10(-6)). Replication studies involving additional persons with congenital scoliosis who carried a deletion affecting TBX6 confirmed this compound inheritance model. In vitro functional assays suggested that the risk haplotype is a hypomorphic allele. Hemivertebrae are characteristic of TBX6-associated congenital scoliosis.

CONCLUSIONS

Compound inheritance of a rare null mutation and a hypomorphic allele of TBX6 accounted for up to 11% of congenital scoliosis cases in the series that we analyzed. (Funded by the National Basic Research Program of China and others.).

Study on the effect of packaging materials on the physico-chemical, microbiological and sensory quality of kunda

Kunda, an indigenous heat desiccated sweet product prepared from milk and sugar, has a shelf-life of a few days under market conditions. In this study, shelf-life of kunda packed in select packaging materials viz. LDPE, metallised polyester and tin cans and stored at 30° and 5 °C was investigated. During storage, several changes took place in physico-chemical and sensory characteristics, the changes being faster at 30 °C than at 5 °C. The storage study indicated that kunda was acceptable throughout the storage period of 42 days at 30 °C and 90 days at 5 °C, irrespective of packaging material. However, the rate of changes in characteristics of the product packaged in tin cans and metalized polyester was slower. Hence, it was recommended that kunda be packed in tin cans and metallised polyester pouches which possess high barrier properties for achieving long shelf-life.

Study on validity of a rapid diagnostic test kit versus light microscopy for malaria diagnosis in Ahmedabad city, India

Light microscopy of blood smears for diagnosis of malaria in the field has several limitations, notably delays in diagnosis. This study in Ahmedabad in Gujarat State, India, evaluated the diagnostic performance of a rapid diagnostic test for malaria (SD Bioline Malaria Ag P.f/Pan) versus blood smear examination as the gold standard. All fever cases presenting at 13 urban health centres were subjected to rapid diagnostic testing and thick and thin blood smears. A total of 677 cases with fever were examined; 135 (20.0%) tested positive by rapid diagnostic test and 86 (12.7%) by blood smear. The sensitivity of the rapid diagnostic test for malaria was 98.8%, specificity was 91.5%, positive predictive value 63.0% and negative predictive value 99.8%. For detection of Plasmodium falciparum the sensitivity of rapid diagnostic test was 100% and specificity was 97.3%. The results show the acceptability of the rapid test as an alternative to light microscopy in the field setting.