New Zealand COPD Guidelines: Quick Reference Guide

The purpose of the Asthma and Respiratory Foundation of New Zealand's COPD Guidelines: Quick Reference Guide is to provide simple, practical, evidence-based recommendations for the diagnosis, assessment, and management of chronic obstructive pulmonary disease (COPD) in clinical practice. The intended users are health professionals responsible for delivering acute and chronic COPD care in community and hospital settings, and those responsible for the training of such health professionals.

Quality of Life After Bladder Cancer: A Cross-sectional Survey of Patient-reported Outcomes

BACKGROUND

Little is known about health-related quality of life (HRQOL) following treatment for bladder cancer (BC).

OBJECTIVE

To determine this, we undertook a cross-sectional survey covering 10% of the English population.

DESIGN, SETTING, AND PARTICIPANTS

Participants 1-10 yr from diagnosis were identified through national cancer registration data.

INTERVENTION

A postal survey was administered containing generic HRQOL and BC-specific outcome measures. Findings were compared with those of the general population and other pelvic cancer patients.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Generic HRQOL was measured using five-level EQ-5D (EQ-5D-5L) and European Organization for Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ)-C30. BC-specific outcomes were derived from EORTC QLQ-BLM30 and EORTC QLQ-NMIBC24.

RESULTS AND LIMITATIONS

A total of 1796 surveys were completed (response rate 55%), including 868 (48%) patients with non-muscle-invasive BC, 893 (50%) patients who received radiotherapy or radical cystectomy, and 35 (1.9%) patients for whom treatment was unknown. Most (69%) of the participants reported at least one problem in any EQ-5D dimension. Age/sex-adjusted generic HRQOL outcomes were similar across all stages and treatment groups, whilst problems increased with age (problems in one or more EQ-5D dimensions: <65 yr [67% {95% confidence interval or CI: 61-74}] vs 85+ yr [84% {95% CI: 81-89}], p =  0.016) and long-term conditions (no conditions [53% {95% CI: 48-58}] vs more than four conditions [94% {95% CI: 90-97}], p < 0.001). Sexual problems were reported commonly in men, increasing with younger age and radical treatment. Younger participants (under 65 yr) reported more financial difficulties (mean score 20 [95% CI: 16-25]) than those aged 85+ yr (6.8 [4.5-9.2], p <  0.001). HRQOL for BC patients (for comparison, males with problems in one or more EQ-5D dimensions 69% [95% CI: 66-72]) was significantly worse than what has been found after colorectal and prostate cancers and in the general population (51% [95% CI: 48-53], all p <  0.05).

CONCLUSIONS

HRQOL following BC appears to be relatively independent of disease stage, treatment, and multimodal care. Issues are reported with sexual function and financial toxicity. HRQOL after BC is worse than that after other pelvic cancers.

PATIENT SUMMARY

Patients living with bladder cancer often have reduced quality of life, which may be worse than that for other common pelvic cancer patients. Age and other illnesses appear to be more important in determining this quality of life than the treatments received. Many men complain of sexual problems. Younger patients have financial worries.

Swept Langmuir probe investigation of a time varying DC discharge

The paper reports on the development and application of a swept Langmuir probe to characterize plasma between two disc-like electrodes. A battery was added to a probe circuit to offset against the cathode fall voltage, and to make the sweep voltage effective at the probe tip. This arrangement allowed the collection of the electron and ion parts of the probe current and the subsequent construction of time-resolved current–voltage IP(V) characteristics with a time resolution of about one millisecond. The probe collected electron current in the lower voltage region of the discharge waveform where it surmounted the cathode fall voltage, whereas the ion current was collected continuously due to an accelerating field for the ions. The results highlighted how the cathode fall voltage limits the collection of the electron and ion parts of the probe current and how to handle the problem with a series battery in the probe circuit. In addition to the swept single-probe, a triple-probe was used simultaneously to compare and validate the results.

Phytochemical management of root knot nematode (Meloidogyne incognita) kofoid and white chitwood by Artemisia spp. in tomato (Lycopersicon esculentum L.)

In vitro and screen house experiments were conducted to investigate the effectiveness of thirteen phytochemicals from Artemisia elegantissimia and A. incisa on root knot nematode, Meloidogyne incognita in tomato (Lycopersicon esculentum L.) cv. Rio Grande. A positive control (Carbofuran) and negative control (H2O) were also used for comparison. Effectiveness of phytochemicals against juveniles (J2s) mortality and egg hatch inhibition were evaluated after 24, 48 and 72 hours of incubation at three concentrations viz; 0.1, 0.2 and 0.3 mg/mL in vitro conditions. Amongst thirteen phytochemicals, Isoscopletin (Coumarin), Carbofuran and Apigenin (Flavonoid) showed the highest mortality and egg hatch inhibition of M. incognita at all intervals. Inhibition of eggs and J2s mortality were the greatest (90.0%) and (96.0%) at 0.3 mg/mL concentration. Application of phytochemicals caused reduction in number of galls, galling index, and egg masses on tomato plant and enhanced plant growth parameters under screen house conditions. Gall numbers (1.50), galling index (1.00), number of juveniles (4.83) and egg masses (4.00) were greatly reduced and plant growth parameters such as; plant height (28.48 cm), fresh (72.13 g) and dry shoot weights (35.99 g), and root fresh (6.58 g) and dry weights (1.43 g) were increased significantly by using Isoscopletin. In structure activity relationship, juveniles of M. incognita, exhibited variations in their shape and postures upon death when exposed to different concentrations of phytochemicals of Artemisia spp. The present study suggests that Artemisia based phytochemicals possess strong nematicidal effects and can be used effectively in an integrated disease management program against root knot nematodes.

miR-673/menin/JunD axis modulates hyperglycemia-induced oxidative stress and inflammation in the diabetic heart

Background

Hyperglycemia-induced reactive oxygen species generation in diabetic heart contributes to myocardial dysfunction. JunD, a member of the activated protein 1 (AP-1) family of transcription factors, is emerging as a major gatekeeper against oxidative stress. Previous studies have shown that downregulation of AP-1 transcription factor JunD is involved in vascular aging and heart failure. However, the role of JunD in diabetes-induced myocardial dysfunction is unknown.

Purpose

The present study was designed to investigate whether hyperglycemia-driven epigenetic regulation of JunD contributes to oxidative stress, inflammation and myocardial dysfunction in the diabetic heart.

Methods

Diabetes (DB) was induced in C57BL/6 wild-type (WT) mice by streptozotocin. After four weeks of DB, left ventricular (LV) function was assessed by standard and 2D speckle-tracking echocardiography in both groups (n=10). Then, the animals were euthanized and LV specimens were collected to determine JunD mRNA and protein expression as well as superoxide anion production by ESR spectroscopy. Chromatin modifications of JunD gene promoter were assessed by chromatin immunoprecipitation. Isolated DNA was analyzed for promoter methylation following Methylminer kit. Cardiac biopsies were collected from age-matched patients with and without diabetes.

Results

DB mice showed LV dysfunction with reduced ejection fraction and fractional shortening. JunD mRNA and protein expression were reduced in the myocardium of DB as compared to control mice. JunD downregulation was associated with oxidative stress, increased NF-kB binding activity and expression of inflammatory mediators. Accordingly, expression of free radical scavenger superoxide dismutase 1 and aldehyde dehydrogenase 2 was reduced, whereas nicotinamide adenine dinucleotide phosphate oxidase subunits NOX2 and NOX4 were upregulated in DB. A reduction of JunD mRNA and protein expression was confirmed in LV specimens obtained from patients with diabetes. The downregulation of JunD was epigenetically regulated by promoter hypermethylation and histone modifications. Post-translational repression by tumor suppressor menin also contributed to JunD downregulation. Indeed, menin was significantly upregulated in DB hearts and co-immunoprecipitation experiments confirmed the binding of menin to JunD. Furthermore, rat ventricular myocytes exposed to high glucose (HG) showed increased menin expression. We found that miR-673 targeting menin was downregulated in hearts of DB mice. Reprogramming miR-673 in HG-treated myocytes was able to restore both menin and JunD expression to control levels.

Conclusions

Our findings show that downregulation of AP-1 transcription factor JunD contributes to diabetes-induced myocardial dysfunction and miR-673/menin/JunD represents a novel molecular axis involved in hyperglycemia-induced ROS-driven cardiac damage.

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): European Society of Cardiology (ESC) Research Grant 2017

Occupational bladder cancer: A cross section survey of previous employments, tasks and exposures matched to cancer phenotypes

Objectives

Up to 10% of Bladder Cancers may arise following occupational exposure to carcinogens. We hypothesised that different cancer phenotypes reflected different patterns of occupational exposure.

Methods

Consecutive participants, with bladder cancer, self-completed a structured questionnaire detailing employment, tasks, exposures, smoking, lifestyle and family history. Our primary outcome was association between cancer phenotype and occupational details.

Results

We collected questionnaires from 536 patients, of whom 454 (85%) participants (352 men and 102 women) were included. Women were less likely to be smokers (68% vs. 81% Chi sq. p<0.001), but more likely than men to inhale environmental tobacco smoke at home (82% vs. 74% p = 0.08) and use hair dye (56% vs. 3%, p<0.001). Contact with potential carcinogens occurred in 282 (62%) participants (mean 3.1 per worker (range 0–14)). High-grade cancer was more common than low-grade disease in workers from the steel, foundry, metal, engineering and transport industries (p<0.05), and in workers exposed to crack detection dyes, chromium, coal/oil/gas by-products, diesel fumes/fuel/aircraft fuel and solvents (such as trichloroethylene). Higher staged cancers were frequent in workers exposed to Chromium, coal products and diesel exhaust fumes/fuel (p<0.05). Various workers (e.g. exposed to diesel fuels or fumes (Cox, HR 1.97 (95% CI 1.31–2.98) p = 0.001), employed in a garage (HR 2.19 (95% CI 1.31–3.63) p = 0.001), undertaking plumbing/gas fitting/ventilation (HR 2.15 (95% CI 1.15–4.01) p = 0.017), undertaking welding (HR 1.85 (95% CI 1.24–2.77) p = 0.003) and exposed to welding materials (HR 1.92 (95% CI 1.27–2.91) p = 0.002)) were more likely to have disease progression and receive radical treatment than others. Fewer than expected deaths were seen in healthcare workers (HR 0.17 (95% CI 0.04–0.70) p = 0.014).

Conclusions

We identified multiple occupational tasks and contacts associated with bladder cancer. There were some associations with phenotype, although our study design precludes robust assessment.

Analysis of pressure-driven membrane preconcentration for point-of-care assays

Point-of-care diagnostic devices for both physicians and patients themselves are now ubiquitous, but often not sensitive enough for highly dilute analytes (e.g., pre-symptomatic viral detection). Two primary methods to address this challenge include (1) increasing the sensitivity of molecular recognition elements with greater binding affinity to the analyte or (2) increasing the concentration of the analyte being detected in the sample itself (preconcentration). The latter approach, preconcentration, is arguably more attractive if it can be made universally applicable to a wide range of analytes. In this study, pressure-driven membrane preconcentration devices were developed, and their performance was analyzed for detecting target analytes in biofluids in the form of point-of-care lateral-flow assays (LFAs). The demonstrated prototypes utilize negative or positive pressure gradients to move both water and small interferents (salt, pH) through a membrane filter, thereby concentrating the analyte of interest in the remaining sample fluid. Preconcentration up to 33× is demonstrated for influenza A nucleoprotein with a 5 kDa pore polyethersulfone membrane filter. LFA results are obtained within as short as several minutes and device operation is simple (very few user steps), suggesting that membrane preconcentration can be preferable to more complex and slow conventional preconcentration techniques used in laboratory practice.

Analysis of Gastrointestinal and Hepatic Manifestations of SARS-CoV-2 Infection in 892 Patients in Queens, NY

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an RNA virus responsible for coronavirus disease 2019 (COVID-19).^1,2 The virus enters cells via the angiotensin-converting enzyme 2 receptor, which is present in enterocytes in the ileum and colon.³ Gastrointestinal (GI) manifestations include diarrhea, nausea, vomiting, and abdominal pain, and the prevalence of GI symptoms varies greatly, with a range between 2% and 57%.⁴ In addition, abnormal liver chemistries are reported commonly.⁴ As a medical center at the forefront of the early epidemic in the United States, we seek to contribute to the growing body of literature that outlines the gastrointestinal and hepatic manifestations of COVID-19.

The Effect of Germinated Sorghum Extract on the Pasting Properties and Swelling Power of Different Annealed Starches

Starches were extracted from chickpea (C.P.), corn (C.S.), Turkish bean (T.B.), sweet potato (S.P.S.), and wheat starches (W.S.). These starches exhibited different amylose contents. The extracted starches were annealed in excess water and in germinated sorghum extract (GSE) (1.0 g starch/9 mL water). The α-amylase concentration in the GSE was 5.0 mg/10 mL. Annealing was done at 40, 50, and 60 °C for 30 or 60 min. The pasting properties of annealed starches were studied using Rapid Visco-Analyzer (RVA), in addition to the swelling power. These starches exhibited diverse pasting properties as evidenced by increased peak viscosity with annealing, where native starches exhibited peak viscosity as: 2828, 2438, 1943, 2250, and 4601 cP for the C.P., C.S., T.B., W.S., and S.P.S., respectively, which increased to 3580, 2482, 2504, 2514, and 4787 cP, respectively. High amylose content did not play a major role on the pasting properties of the tested starches because sweet potato starch (S.P.S.) (22.4% amylose) exhibited the highest viscosity, whereas wheat starch (W.S.) (25% amylose) had the least. Therefore, the dual effects of granule structure and packing density, especially in the amorphous region, are determinant factors of the enzymatic digestion rate and product. Swelling power was found to be a valuable predictive tool of amylose content and pasting characteristics of the tested starches. The studied starches varied in their digestibility and displayed structural differences in the course of α-amylase digestion. Based on these findings, W.S. was designated the most susceptible among the starches and S.P.S. was the least. The most starch gel setback was observed for the legume starches, chickpeas, and Turkish beans (C.P. 2553 cP and T.B. 1172 cP). These results were discussed with regard to the underlying principles of swelling tests and pasting behavior of the tested starches. Therefore, GSE is an effortless economic technique that can be used for starch digestion (modification) at industrial scale.

ATLANTIS: a randomised multi-arm phase II biomarker-directed umbrella screening trial of maintenance targeted therapy after chemotherapy in patients with advanced or metastatic urothelial cancer

BACKGROUND

Metastatic urothelial cancer (UC) is the eighth most common cause of cancer death in the UK. Standard first-line treatment, for most patients, is cytotoxic chemotherapy. Although UC is initially sensitive to chemotherapy, relapse is almost inevitable and outcomes are poor; median overall survival is 8 months. Therefore, there is an urgent need for novel therapies to improve outcomes for this patient group.

METHODS

ATLANTIS is a randomised phase II umbrella-design screening trial of maintenance therapy in biomarker-defined subgroups of patients with advanced UC. The primary end point is progression-free survival, and the study involves over 30 UK cancer centres.

DISCUSSION

ATLANTIS is the first study in the UK to employ a precision-medicine approach to patients with UC for maintenance treatment. Agents with a positive efficacy signal will proceed to randomised phase III trials to confirm the activity of novel, biologically stratified therapies in UC.

REGISTRATION

ATLANTIS trial EudraCT number 2015-003249-25. ISRCTN25859465.

Current concepts in the management of ankle arthritis

Ankle arthritis is a common condition. It causes a significant socioeconomic burden, and is associated with significant morbidity. Patients with ankle arthritis are either elderly with significant co-morbidities, or young adults who have previously suffered with ankle injuries, resulting in post-traumatic arthritis. There is a wide variation in the management of these patients with ankle arthritis. We therefore present an overview of the current evidence based management of patients with symptomatic ankle arthritis.

Wheat-millet flour cookies: Physical, textural, sensory attributes and antioxidant potential

Millet flour (water washed or alkali washed) was replaced with wheat flour (WF) at 0, 25, 50, 75, and 100% levels. Objectives of the research were to characterize the flour blends for their technical properties and to produce cookies with less or no gluten contents. All types of flour blends were evaluated for their pasting properties. The cookies were baked and evaluated for their textural and physical attributes. Inclusion of millet flour (both types) in wheat flour resulted in significant reduction in peak and final viscosities while setback viscosities were affected non-significantly. Pasting temperature was increased from 65 ℃ (100% wheat flour) to 91 ℃ (100% millet flour). The hardness of cookies was reduced in the presence of millet flour. Fracturability values of cookies with higher millet flour were higher as compared to control cookies (prepared from 100% wheat flour). Cookies prepared from blends having more that 50% millet flour were not much liked by sensory panelists. The phenolic contents of cookies containing higher levels of either water washed or alkali washed millet flour were found to be higher when compared to cookies prepared from plain WF (1.90 ± 0.14 mg gallic acid/g sample). The 2,2-diphenyl-1-picrylhydrazyl activity (%) of cookies ranged from 16.39 ± 0.34 (100% water washed millet flour) to 10.39 ± 0.26 (100% WF; control). The study will help the non-coeliac people to consume low gluten (≈1.6-6.5%) or gluten intolerant people to consume gluten-free cookies (0%) from millet flour having abundant of antioxidants and health-promoting polyphenols.