Intermediate dose enoxaparin in hospitalized patients with moderate-severe COVID-19: a pilot phase II single-arm study, INHIXACOVID19

BACKGROUND

Randomized clinical trials in non-critically ill COVID-19 patients showed that therapeutic-dose heparin increased survival with reduced organ support as compared with usual-care thromboprophylaxis, albeit with increased bleeding risk. The purpose of the study is to assess the safety of intermediate dose enoxaparin in hospitalized patients with moderate to severe COVID-19.

METHODS

A phase II single-arm interventional prospective study including patients receiving intermediate dose enoxaparin once daily according to body weight: 60 mg for 45-60 kg, 80 mg for 61-100 kg or 100 mg for > 100 kg for 14 days, with dose adjustment according to anti-factor Xa activity (target range: 0.4-0.6 UI/ml); an observational cohort (OC) included patients receiving enoxaparin 40 mg day for comparison. Follow-up was 90 days. Primary outcome was major bleeding within 30 and 90 days after treatment onset. Secondary outcome was the composite of all-cause 30 and 90-day mortality rates, disease severity at the end of treatment, intensive care unit (ICU) admission and length of ICU stay, length of hospitalization. All outcomes were adjudicated by an independent committee and analyzed before and after propensity score matching (PSm).

RESULTS

Major bleeding was similar in IC (1/98 1.02%) and in the OC (none), with only one event observed in a patient receiving concomitantly anti-platelet therapy. The composite outcome was observed in 53/98 patients (54%) in the IC and 132/203 (65%) patients in the OC (p = 0.07) before PSm, while it was observed in 50/90 patients (55.6%) in the IC and in 56/90 patients (62.2%) in the OC after PSm (p = 0.45). Length of hospitalization was lower in the IC than in OC [median 13 (IQR 8-16) vs 14 (11-21) days, p = 0.001], however it lost statistical significance after PSm (p = 0.08). At 30 days, two patients had venous thrombosis and two pulmonary embolism in the OC. Time to first negative RT-PCR were similar in the two groups.

CONCLUSIONS

Weight adjusted intermediate dose heparin with anti-FXa monitoring is safe with potential positive impact on clinical course in COVID-19 non-critically ill patients.

TRIAL REGISTRATION

The study INHIXACOVID19 was registred on ClinicalTrials.gov with the trial registration number (TRN) NCT04427098 on 11/06/2020.

Cell-Free DNA Fragmentomics for Early Detection of Malignant Transformation in NF1 Patients Harboring Plexiform Neurofibromas

PURPOSE/OBJECTIVE(S)

Malignant peripheral nerve sheath tumors (MPNST) are aggressive soft tissue sarcomas that are resistant to radiotherapy and chemotherapy, and are associated with poor survival. MPNST typically arise from benign or atypical plexiform neurofibromas (PN) in the setting of neurofibromatosis type 1 (NF1). Unfortunately, early detection by imaging and clinical examination remains very challenging. We hypothesize that cell-free DNA fragmentomic analysis can be used to precisely detect the risk for developing MPNST in NF1 patients, which could significantly improve clinical outcomes in the future through early cancer detection.

MATERIALS/METHODS

We performed low-pass whole genome sequencing of plasma cell-free DNA samples from healthy controls (n = 21), patients with PN (n = 113), AN (n = 39) and MPNST (n = 71). Cell-free DNA was analyzed at a per-fragment level by tracking 4-nucleotide end motifs, and using a bin-wise fragmentomic machine learning approach called DELFI, which integrates across ratios of short (100-150 bp) versus long (151-220 bp) fragments in 5 megabase bins across the genome. End motif frequencies were compared between MPNST and PN patients, and receiver operating characteristic (ROC) analysis was used to classify disease states using DELFI fragmentomic scores.

RESULTS

Using DELFI for genome-wide fragmentomics, followed by ROC analysis, we obtained the following accuracies: MPNST vs. AN (acc 0.62), MPNST vs. PN (acc 0.83), MPNST vs. healthy (acc 0.86), AN vs. PN (acc 0.87), AN vs. healthy (acc 0.72) and PN vs. healthy (acc 0.88). DELFI-based cell-free DNA fragmentomics was superior to the ichor CNA-based copy number alteration classifier that we published previously (Szymanski et al. PLOS Medicine, 2021) for all the aforementioned group comparisons (p < 0.001 by McNemar's test). Strikingly, the two AN cases with DELFI scores most closely resembling MPNST were separately identified by independent clinical care teams to have very high-risk features and recent history warranting short-interval follow up. Specifically, one patient had a paraspinal AN exhibiting new onset pain and rapid growth on imaging, while the other had increased FDG uptake of multiple AN lesions in a supraclavicular field treated years earlier with radiotherapy. We also measured fragment end motifs across different patient groups, and found that the CTCA end motif was more commonly present in cell-free DNA from MPNST and PN patients compared to healthy donors (Bonferroni-corrected p-value < 0.001).

CONCLUSION

This study suggests that fragmentomic analysis of cell-free DNA can accurately risk-stratify NF1 patients with plexiform neurofibromas. Cell-free DNA fragmentomics outperformed our previously published copy number alteration method for distinguishing closely related patient subgroups with different malignancy risks. Atypical neurofibroma patients with cell-free DNA fragmentomic scores suggestive of MPNST were deemed clinically very high-risk for malignant transformation.

Microbiological surveillance post-reprocessing of flexible endoscopes used in digestive endoscopy: a national study

INTRODUCTION

Microbiological surveillance of endoscopes is a safety measure for verifying the quality of reprocessing procedures and identifying contaminated devices, but duodenoscope-related outbreaks are still reported.

AIM

To assess the effectiveness of duodenoscope reprocessing procedures in Italy.

METHODS

Between December 2019 and April 2020, data obtained from microbiological surveillance post-reprocessing in 15 Italian endoscopy units were collected. Sampling was carried out after reprocessing or during storage in a cabinet. In keeping with international guidelines and the Italian position paper, the micro-organisms were classified as high-concern organisms (HCOs) and low-concern organisms (LCOs).

FINDINGS

In total, 144 samples were collected from 51 duodenoscopes. Of these, 36.81% were contaminated: 22.92% were contaminated with HCOs and 13.89% were contaminated with LCOs [2.08% with an LCO load of 11-100 colony-forming units (CFU)/device and 0.69% with an LCO load of >100 CFU/device]. The contamination rate was 27.5% in samples collected after reprocessing, 40% in samples collected during storage in a cabinet that was compliant with EN 16442:2015 (C-I), and 100% in samples collected during storage in a cabinet that was not compliant with EN 16442:2015 (NC-I). The respective HCO rates were 15.00%, 27.27% and 66.67%. Correlation between LCO contamination and storage time was demonstrated (Spearman's rho=0.3701; P=0.0026). The Olympus duodenoscope TJFQ180V demonstrated the lowest rate of contamination (29.82%), although the contamination rate was 100% for duodenoscopes stored in an NC-I cabinet.

CONCLUSION

Microbiological surveillance, along with strict adherence to reprocessing protocols, may help to detect endoscope contamination at an early stage, and reduce the risk of duodenoscope-associated infections.

Lipopolysaccharide-induced murine lung injury results in long-term pulmonary changes and downregulation of angiogenic pathways

Acute respiratory distress syndrome is the most severe form of acute lung injury (ALI) and is associated with significant mortality. Lipopolysaccharide (LPS)-induced injury is a valuable murine model of ALI but there is a paucity of data on lung regeneration and the role of angiogenic signaling involving vascular endothelial growth factor (VEGF). Eight-week-old male C57BL/6J mice were randomized to receive intratracheal instillation of either LPS or isovolumetric phosphate buffered saline as a vehicle control. Mice were observed at a single follow-up time-point that was either short-term (24 h or 4 days) or long-term (7 days or 4 weeks). On pulmonary function testing, LPS-treated mice had increased compliance at 4 weeks post-instillation, which correlated with decreased vascularization and with time-dependent, progressive decrease in alveolarization. Treadmill exercise tolerance testing demonstrated impaired performance at 24 h, 4 days and 4 weeks following LPS exposure. On lung protein analysis, LPS instillation decreased VEGF expression at up to 4 weeks, and decreased activation of its key receptor, VEGFR2 at 7 days and 4 weeks post-instillation. Together, these data provide insight on long-term pulmonary functional outcomes 4 weeks after ALI and identify angiogenic proteins as possible therapeutic targets following lung injury.

An in-line digestive cartridge increases enteral fat and vitamin absorption in a porcine model of short bowel syndrome

BACKGROUND & AIMS

Short bowel syndrome (SBS) occurs after intestinal loss resulting in parenteral nutrition dependence and micronutrient deficiencies, which may lead to life-limiting complications. ALC-078 is a cartridge containing immobilized lipase that connects in-line with enteral feeding sets and digests fats in enteral nutrition (EN). In this study, we evaluate the efficacy of ALC-078 to improve fat and nutrient absorption in a porcine SBS model.

METHODS

Fifteen male Yorkshire piglets were assessed. Animals were randomized to no intestinal resection (n = 5), 75% resection (n = 5), or 75% resection + ALC-078 (n = 5). After recovery, animals were treated for 14 days. Piglets received 60% of nutrition from continuous EN and 40% from chow. The degree of fat malabsorption was determined by the coefficient of fat absorption (CFA) following a 72-h stool collection. Body weight, fat-soluble vitamins, and nutritional markers were assessed.

RESULTS

Adverse events were similar across the three groups (P = 1.00). ALC-078-treated animals had similar weight gain compared to resected piglets. Resected animals had a lower CFA compared to unresected controls (79.3% vs. 95.2%, P = 0.01) while there was no significant difference in the ALC-078 animals (87.1% vs. 95.2%, P = 0.19). Between Study Days 1 and 15, ALC-078 animals had increased concentrations of vitamin D (12.2 vs. 8.7 ng/mL, P = 0.0006), and vitamin E (4.3 vs. 2.5 mg/L, P = 0.03). These markers did not significantly change in untreated resected animals.

CONCLUSION

ALC-078 increases the absorption of fat-soluble vitamins and may improve fat malabsorption. Future studies should determine whether ALC-078 can reduce PN dependence and if these findings translate to human patients with SBS.

[Consumption of sugar-sweetened beverages and artificially sweetened beverages and risk of cardiovascular disease: a meta-analysis]

Objective: Using Meta-analysis to evaluate the relation of sugar-sweetened beverages (SSBs) intakes and artificially sweetened beverages (ASBs) intakes with risk of incident cardiovascular disease. Methods: "Sugar-sweetened beverages"(SSBs),"artificially sweetened beverages"(ASBs),"coronary heart disease"(CHD),"stroke","cardiovascular disease"(CVD), and related terms (both in English and in Chinese) were searched in Pubmed, EMBASE, Web of Science, Cochrane library, ProQuest, China National Knowledge Infrastructure (CNKI), Wanfang databases, and VIP Chinese Science and Technology Journal. Besides, it searched for additional references in websites including Clinical Tirals.gov and International Clinical Trials Registry Platform. The time was up to May 31st 2020. Stata 13 software was used to calculate pooled RR, perform heterogeneity test, and assess publication bias. Results: A total of 14 articles were included from the 40 804 articles retrieved, including 12 articles from European and American countries and 2 articles from Asian countries. The baseline mean age of the participants ranged from 52 to 69 years, and the mean follow-up time was from 6 to 26 years. Meta-analysis showed that compared with those in the lowest group, the RR (95%CI) for those in the highest group of SSBs consumption was 1.11 (1.04-1.08) for CHD, 1.10 (1.01-1.19) for stroke, and 1.09 (0.96-1.24) for CVD events. The corresponding RR (95%CI) comparing extreme groups of ASBs consumption was 1.10 (0.98-1.23) for CHD, 1.19 (1.09-1.29) for stroke, and 1.32 (1.15-1.52) for CVD events. Further analysis for subtypes of stroke showed that compared with the lowest group, the RR (95%CI) for those in the highest groups of SSBs consumption was 1.10 (0.99-1.22) for ischemic stroke and 0.86 (0.71-1.04) for hemorrhagic stroke. The corresponding RR (95%CI) comparing extreme consumption of ASBs was 1.23 (1.04-1.46) for ischemic stroke and 1.33 (1.03-1.72) for hemorrhagic stroke. Conclusion: Higher consumption of SSBs or ASBs may lead to increased risk of incident CHD and stroke (particularly ischemic stroke).

Interaction between sodium dodecylsulfate (SDS) and pluronic L61 in aqueous medium: assessment of the nature and morphology of the formed mixed aggregates by NMR, EPR, SANS and FF-TEM measurements

The interaction of copolymer L61 i.e., (EO)2(PO)32(EO)2 (where EO and PO are ethylene and propylene oxides, respectively) with surfactant SDS (sodium dodecylsulfate) in relation to their self-aggregation, dynamics and microstructures has been physicochemically studied in detail employing the Nuclear Magnetic Resonance (NMR), Electron Paramagnetic Resonance (EPR), Small-Angle Neutron Scattering (SANS), and Freeze-Fracture Transmission Electron Microscopy (FF-TEM) methods. The NMR self-diffusion study indicated a synergistic interaction between SDS and L61 forming L61-SDS mixed complex aggregates, and deuterium (2H) NMR pointed out the nonspherical nature of these aggregates with increasing [L61]. EPR spectral analysis of the motional parameters of 5-doxyl steraric acid (5-DSA) as a spin probe provided information on the microviscosity of the local environment of the L61-SDS complex aggregates. SANS probed the geometrical aspects of the SDS-L61 assemblies as a function of both [L61] and [SDS]. Progressive evolution of the mixed-aggregate geometries from globular to prolate ellipsoids with axial ratios ranging from 2 to 10 with increasing [L61] was found. Such morphological changes were further corroborated with the results of 2H NMR and FF-TEM measurements. The strategy of the measurements, and data analysis for a concerted conclusion have been presented.

[Self-rated health measures and their relations to all-cause and cardiovascular mortality in adults from 10 regions of China]

Objective: To examine the association between self-rated health status (SRH) and all-cause and cardiovascular mortality. Methods: A total of 512 713 adults aged 30-79 years from 10 areas of China were followed from baseline (2004-2008) until 31 December 2016 in the China Kadoorie Biobank study. Global and age-comparative SRH [general self-rated health status (GSRH) and age-comparative self-rated health status (ASRH), respectively] were asked in baseline questionnaires. Causes for mortality were monitored through linkage with established Disease Surveillance Point system and health insurance records. Multivariable Cox proportional regression models were used to estimate the HRs and 95%CIs for the association between SRH measures and all-cause or cardiovascular mortality. Results: During an average of 9.9 years' follow-up, 44 065 deaths were recorded, among which 17 648 were from cardiovascular disease. Compared with excellent GSRH, the HR(95%CI) for all-cause and cardiovascular mortality associated with poor GSRH was 1.84(1.78-1.91) and 1.94(1.82-2.06), respectively. Relative to better ASRH, the HR(95%CI) for all-cause and cardiovascular mortality associated with worse ASRH was 1.75(1.70-1.81) and 1.83(1.73-1.92), respectively. Conclusion: In this large prospective cohort study in China, participants reporting poor GSRH or worse ASRH had significantly higher risk of all-cause and cardiovascular mortality.

Early identification and optimal management of carbapenem-resistant Gram-negative infection

BACKGROUND

Carbapenem resistance in Gram-negative bacteria is associated with severe infections in the hospital setting. No uniform screening policy or agreed set of criteria exists within the EU to inform treatment decisions for infections caused by carbapenem-resistant Gram-negative bacteria.

AIM

To develop a range of consensus statements to survey experts in carbapenem resistance, to identify potential similarities and differences across the EU and across specialties.

METHODS

The survey contained 43 statements, covering six key topics relating to carbapenem-resistant organisms: microbiological screening; diagnosis; infection control implementation; antibiotic stewardship; use of resources; and influencing policy.

FINDINGS

In total, 136 survey responses were received (66% infectious disease specialists, 18% microbiologists, 11% intensive care specialists, 4% other/unknown) from France, Germany, Greece, Italy, Spain, and the UK. High, or very high, levels of agreement were seen for all 43 consensus statements, indicating good alignment concerning early identification and optimal management of infection due to carbapenem-resistant organisms.

CONCLUSION

We offer the following recommendations: (1) screening is required when a patient may have been exposed to the healthcare system in countries/hospitals where carbapenem-resistant organisms are endemic; (2) rapid diagnostic tools should be available in every institution; (3) all institutions should have a specific policy for the control of carbapenem-resistant organisms, which is routinely audited; (4) clear strategies are required to define both appropriate and inappropriate use of carbapenems; (5) priority funding should be allocated to the management of infections due to carbapenem-resistant organisms; and (6) international co-operation is required to reduce country-to-country transmission of carbapenem-resistant organisms.

[Research progress of relationship between vitamin K and type 2 diabetes]

Objective: To systematically review research on the association between vitamin K and type 2 diabetes and diabetes-related biomarkers in humans, and evaluate the role of vitamin K in the prevention of type 2 diabetes. Methods: "Vitamin K", "type 2 diabetes" and related terms were searched in PubMed, EMBASE, China National Knowledge Infrastructure (CNKI) and Wanfang Med Online up to November 2018. Results: A total of 1 Chinese and 12 English articles were included. Among 6 observational studies, 5 of them showed that higher dietary vitamin K intake and plasma vitamin K level were associated with the decrease of the risk of type 2 diabetes. Among 6 clinical intervention studies, 5 of them indicated that the supplementation of vitamin K(1) or K2 could have positive influence on insulin metabolism. One Mendelian randomization study showed higher circulation vitamin K level might reduce the risk of type 2 diabetes. Conclusion: Vitamin K plays an important role in the prevention and control of type 2 diabetes, which may be related to the improvement of insulin metabolism and blood glucose level.

[Association between self-rated health and risk of cardiovascular disease among middle-aged and elderly Chinese]

Objective: To analyze the association between the self-rated health (SRH) status and risk of cardiovascular disease (CVD) among the middle-aged and eldly Chinese. Methods: Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS), which enrolled 21 133 participants by using the probability proportional to size (PPS) sampling from 150 counties/districts of 28 provinces in China from 2011 to 2012. A total of 11 701 participants were included in the study. Basic information and SRH were obtained in the baseline survey via questionnaires. Information of CVD was self-reported during the follow-up. Cox proportional hazards modeling was used to analyze the association between the baseline SRH and risk of CVD. Subgroup analyses were performed by age, sex and body mass index (BMI), and their interactions with SRH for risk of CVD were examined by using the likelihood ratio test. A sensitivity analysis was conducted to test the robustness of the association. Results: Participants were (57.9±9.7) years old, and men accounted for 48.1% (5 626). SRH was reported as the excellent, very good, good, fair and poor among 4.2% (n=487), 13.5% (n=1 583), 33.6% (n=3 932), 35.4% (n=4 147) and 13.3% (n=1 552), respectively. During 42 104 person-years of followed up, 590 cases of CVD were identified. Cox regression analyses showed that compared with the excellent/very good SRH, the HR (95%CI) of CVD risk for the good, fair and poor SRH was 1.36 (1.02-1.80), 1.66 (1.26-2.19) and 1.89 (1.38-2.59), respectively. Subgroup analyses showed that compared with the excellent/very good SRH, HR (95%CI) of CVD risk for poor SRH in the group of 45-59 years old, equal to or over 75 years old, men, women and normal BMI were 2.00 (1.32-3.04), 3.87 (1.04-14.46), 1.76 (1.07-2.91), 1.92 (1.27-2.91) and 2.30 (1.42-3.72), respectively. There were no interactions between age, sex, BMI and SRH (P>0.05). Conclusion: SRH is associated with risk of CVD among middle-aged and elderly Chinese. The CVD risk for good, fair and poor SRH is higher than that for excellent/very good SRH.

[The application of energy adjustment models in nutritional epidemiology]

The energy adjustment models in nutritional epidemiological studies could substantially reduce the confounding effect of total energy intake from the intake of dietary components, and it could explore the real relationship between the intake of dietary component and research outcomes. Four energy adjustment models were introduced in this article, including the standard multivariate model, multivariate nutrient residual model, energy partition model, and multivariate nutrient density model. The four energy adjustment models were applied to analyze the association between the intake of saturated fatty acids and the risk of all-cause mortality based on the data of the US National Health and Nutrition Examination Survey. The consistent results of different energy adjustment models could indicate that the four models could better control the confounding effect of total energy intake.

[Sugar-sweetened beverages consumption in midlife and risk of late-life cognitive impairment in Chinese adults]

Objective: To evaluate whether midlife consumption of sugar-sweetened beverages (SSBs), including juices and soft drinks, were associated with late-life cognitive impairment in Chinese adults. Methods: Follow up was conducted for participants from Singapore Chinese Health Study, a population-based prospective cohort, for 16-23 (mean 20) years. The information about their SSBs consumption were collected at baseline survey from 1993 to 1998 by using a validated food frequency questionnaire and their cognition status were evaluated by using a Singapore-modified Mini-Mental State Examination Scale in the 3(rd) follow-up visit during 2014- 2016. Multivariable logistic regression models were used to estimate the ORs and 95%CIs. Results: A total of 16 948 participants were included in the analysis and 2 443 of them were identified as cognitive impairment using education-specific cutoffs. Sex, age, ancestral home, education level, physical activity level, total diet fiber intake level, BMI, alcohol drinking were significantly associated with cognitive impairment (P<0.05). After adjusted the above variables, potential dietary variables and disease status, no significant association was observed between SSBs consumption and cognitive impairment (P>0.05). Compared with those who never or hardly ever drank soft drinks, no significant differences in cognitive impairment risk were observed for those who drank soft drinks 2 or more times a week (OR=0.91, 95%CI: 0.77-1.08), those who drank 1 time a week (OR=1.00, 95%CI:0.82-1.23) and those who drank 1-3 times a month (OR=0.94, 95%CI: 0.80-1.09) (trend P=0.306). Compared with those who never or hardly ever drank juices, no significant differences in cognitive impairment risk were observed for those who drank juices 2 or more times a week (OR=1.03, 95%CI:0.88-1.20), those who drank 1 time a week (OR=0.96, 95%CI: 0.82-1.12) and those who drank 1-3 times a month (OR=0.94, 95%CI: 0.82-1.08) (trend P=0.930). No significant interactions were found with age, sex, and BMI status. Conclusion: SSBs consumption in midlife was not significantly associated with risk of late-life cognitive impairment in Singaporean Chinese adults with relatively low consumption levels. Further researches are needed to verify the results.

Cosmic Ray Energy Spectrum derived from the Data of EAS Cherenkov Light Arrays in the Tunka Valley

The extensive air shower Cherenkov light array Tunka-133 collected data during 7 winter seasons from 2009 to 2017. From 2175 hours of data taking, we derived the differential energy spectrum of cosmic rays in the energy range 6 · 1015 2 · 1018 eV. The TAIGA-HiSCORE array is in the process of continuous expansion and modernization. Here we present the results obtained with 28 stations of the first HiSCORE stage from 35 clear moonless nights in the winter of 2017-2018. The combined spectrum of two arrays covers a range of 2 · 1014 – 2 · 1018 eV.

TAIGA: results and perspectives

In this talk, we describe the status and the perspectives of the hybrid Air Shower Array TAIGA (Tunka Advanced Instrument for cosmic rays and Gamma Astronomy) which is currently under construction in the Tunka Valley close to Lake Baikal and is taking data in its initial configurations. TAIGA is designed for the study of gamma rays and charged cosmic rays in the energy range of 1013 eV - 1018 eV. It has the potential to play an important role in the search for Galactic Pevatrons and within a multi-messenger approach to explore the high-energy sky.

[The relationship between smoking and hyperuricemia in Chinese residents]

Objective: To explore the relationship between smoking and hyperuricemia in Chinese residents. Methods: Based on data from the China Health and Nutrition Survey (CHNS), residents with blood samples provided in the 2009 round (including information of socio-demographic factors, lifestyle behaviors, medical history, and laboratory examinations etc.) were selected as the participants in the current analysis. Unconditional logistic regression models were utilized to compute the ORs and corresponding 95%CIs for assessing the relationship between smoking and hyperuricemia. Results: Among the 8 785 subjects, 1 435 had hyperuricemia with a prevalence rate of 16.3%, consisting of 886 men and 549 women with prevalence rates of 21.6% (886/4 110) and 11.7% (549/4 675) , respectively. Compared with never smokers, the adjusted OR (95%CI) for hyperuricemia was 0.83 (0.70-0.98) among current smokers, 0.77 (0.63-0.94) among current smokers with 20-39 years of smoking, and 0.79 (0.65-0.97) among current smokers with 11-20 cigarettes per day. When stratified by gender and compared with non-smoker, the adjusted OR (95%CI) for hyperuricemia among current smokers compared with never smokers was 0.83 (0.70-0.98) among men, while no significant association was found in female current smokers (OR=0.73, 95%CI: 0.42-1.26, P=0.260). Conclusion: In Chinese residents, there is an inverse association between smoking and hyperuricemia prevalence, and this association may be related to duration and intensity of smoking among current smokers. The findings need to be validated in large prospective cohort studies.

Genome-wide association study confirms that the chromosome Z harbours a region responsible for rumplessness in Hongshan chickens

Rumplessness in Hongshan chickens has been reported as a novel sex-linked characteristic. Re-sequencing data suggest that a pseudogene on the Z chromosome, LOC431648, is affiliated with this phenotype. In this study, we chose 23 rumpless and 25 normal Hongshan chickens to localize the potential variation by means of a genome-wide association study using a high density microarray. A region on the Z chromosome was found to be closely associated with rumplessness in Hongshan chickens. The region, located in gene LINGO2, was approximately 3 Mb away from pseudogene LOC431648. The function of this gene has not yet been studied in birds. Differential expression of the candidate genes in the tail feather follicles was not detected by q-PCR, which suggests that the rumplessness trait could be attributed to other genetic mechanisms.

Vesicle to micelle transition in the ternary mixture of L121/SDS/D2O: NMR, EPR and SANS studies

Proposed model depicting vesicle to mixed micelle transformation in a ternary mixture of L121/SDS/D₂O.

Status of glucose metabolism including insulin resistance and beta cell function in overtly iron loaded Thalassemia patients

BACKGROUND Abnormality of glucose metabolism is a frequent complication in Thalassemia patients. Both insulin deficiency and insulin resistance has been proposed in its pathogenesis. Some form of abnormality in glucose metabolism is expected at an earlier age in these patients in developing countries like India and Nepal where iron overload is excessive due to lack of chelation therapy.MATERIALS AND METHODS Fasting serum glucose and fasting serum insulin (FSI) were measured in 40 beta-thalassemia major patients, 40 Ebeta- thalassemia patients and 40 controls, all aged between 5 and 12 years. 2 hours after an appropriate dose of oral glucose feed (Children ingested 1.75 g/kg body weight maximum 75 gram dissolved in 250 to 300 ml water) blood samples were drawn again to measure post prandial serum glucose. Iron overload was assessed by measuring liver size, spleen size, total amount of packed cells transfused and serum ferritin. Insulin resistance (IR), insulin sensitivity (%S) and beta cell functions (%B) were derived from the measured laboratory parameters using the latest version of Homeostatic Model Assessment (HOMA) calculator software.RESULTS No one had impaired glucose metabolism or diabetes mellitus beta-thalassemia major patients showed evidence of insulin resistance in the form of significantly higher fasting serum insulin (p value 0.002), IR (p value 0.003), %B (p value 0.017) and significantly lower %S (0.002) when compared with controls. FSI showed positive correlation with total amount of packed cells received (r=0.372, p=0.018), serum ferritin (r=0.345, p=0.029) and spleen size (r=0.427, p=0.006). Similarly, IR also showed positive correlation with total amount of packed cells received (r=0.388, p=0.013), serum ferritin (r=0.336, p=0.034) and spleen size (r=0.425, p=0.005). %S showed negative correlation with all these parameters. %B didn’t show any statistically significant correlation with these parameters.Ebeta- thalassemia patients didn’t have any statistically significant difference in FSI, IR, %S and %B than controls.CONCLUSION Insulin resistance develops as the earliest abnormality in glucose metabolism in overtly iron loaded beta thalassemia major patients at an early age. Ebeta- thalassemia patients with milder phenotype do not develop dysfunction of glucose metabolism at such an early age.Journal of College of Medical Sciences-Nepal, 2014, Vol-10, No-3, 29-36

Ascites alone as the presentation of Congenital Tuberculosis

Congenital tuberculosis is a rare disease. It usually presents with respiratory distress, fever and organomegaly. We report a case of congenital tuberculosis presenting with ascites only.DOI: http://dx.doi.org/10.3126/jcmsn.v10i1.12766 Journal of College of Medical Sciences-Nepal, 2014, Vol.10(1); 37-40

Congenital cystic adenomatoid malformation of lung: A case report

A term neonate developed respiratory distress after 12 hours of birth which was diagnosed as a case of congenital cystic adenomatoid malformation (CCAM) of the right lung by computerized tomography scan. CCAM of the lung is rare congenital cystic lung lesion. DOI: http://dx.doi.org/10.3126/jcmsn.v10i1.12767 Journal of College of Medical Sciences-Nepal, 2014, Vol.10(1); 41-42

Physicochemical perspectives (aggregation, structure and dynamics) of interaction between pluronic (L31) and surfactant (SDS)

The influence of the water soluble non-ionic tri-block copolymer L31 on the microstructure and self-aggregation dynamics of the anionic surfactant sodium dodecylsulfate (SDS) in aqueous solution was investigated.

Outbreak of extrapulmonary tuberculosis infection associated with acupuncture point injection

Mycobacterium tuberculosis infection is rarely reported to be associated with acupuncture practices. We performed a retrospective outbreak investigation of a unique outbreak of 33 extrapulmonary M. tuberculosis infections related to acupuncture point injection therapy (AIT) among clients who visited a private traditional Chinese medicine clinical centre in China. The lumps, abscesses and ulcers occurred mostly on the neck, shoulders, waist, knees and hips, localized at acupuncture point meridian sites. These symptoms appeared from January to November 2011, with a peak cluster of infections in September 2011 (nine cases). M. tuberculosis Beijing strain was isolated and confirmed by DNA sequencing. All diagnosed patients were treated empirically with appropriate antibiotic treatment, and their condition improved. Our study indicated that this outbreak was most likely resulted from contaminated AIT. Drafting standard guidelines for AIT is urgently needed, and routine medical supervision should be provided, including obligating health providers to perform routine physical examinations that include testing for infectious diseases.

Control of carbapenemase-producing Klebsiella pneumoniae: a region-wide intervention

Starting in 2010, there was a sharp increase in infections caused by Klebsiella pneumoniae resistant to carbapenems in the Emilia-Romagna region in Italy. A region-wide intervention to control the spread of carbapenemase-producing K. pneumoniae (CPKP) in Emilia-Romagna was carried out, based on a regional guideline issued in July 2011. The infection control measures recommended to the Health Trusts (HTs) were: phenotypic confirmation of carbapenemase production, active surveillance of asymptomatic carriers and contact isolation precautions for carriers. A specific surveillance system was activated and the implementation of control measures in HTs was followed up. A significant linear increase of incident CPKP cases over time (p<0.001) was observed at regional level in Emilia-Romagna in the pre-intervention period, while the number of cases remained stable after the launch of the intervention (p=0.48). Considering the patients hospitalised in five HTs that provided detailed data on incident cases, a downward trend was observed in incidence after the release of the regional guidelines (from 32 to 15 cases per 100,000 hospital patient days). The spread of CPKP in Emilia-Romagna was contained by a centrally-coordinated intervention. A further reduction in CPKP rates might be achieved by increased compliance with guidelines and specific activities of antibiotic stewardship.

Micellization and related behavior of sodium dodecylsulfate in mixed binary solvent media of tetrahydrofuran (Tf) and formamide (Fa) with water: a detailed physicochemical investigation

The detailed aggregation behavior of sodiumdodecyl sulfate (SDS) in tetrahydrofuran (Tf)-water (W) and formamide (Fa)-water (W) media at varied volume percent compositions has been investigated. Surface tension (ST), conductance (Cond), viscosity (Visc), isothermal titration calorimetry (ITC), nuclear magnetic resonance (NMR) and small angle neutron scattering (SANS) were used in this study. The presence of nonaqueous solvents affected the critical micelle concentration (CMC) of SDS, the counter-ion binding of the micelle, the energetics of the air/water interfacial adsorption and micellization of the amphiphiles in the bulk, the ion-association (ion-pair, triple-ion, quadruple, etc. between Na(+) and DS(-) ions) as well as the weakly soluble (aggregation less) amphiphile solution. Tf has been observed to produce a "dead zone" or "non-micelle formation zone" in the mixed Tf-W domain of 10-40 vol%. Fa influenced the SDS aggregation up to 70 vol%, at higher proportions (below the Krafft temperature (K(T))), instead of the micelle, "randomly arranged globular assembly" (RAGA) was formed. The correlation of the standard free energy of micellization (ΔG(m)(0)) with different solvent parameters (1) dielectric constant (ε), (2) viscosity (η0), (3) Reichardt parameter (E(T)(30)), (4) Gordon parameter (G), and (5) Hansen-Hildebrand hydrogen bonding parameter (δ(h)) has been attempted. It has been found that δ(h) produced a master correlation between ΔG(m)(0) and δ(h) for different binary mixtures such as Tf-W, Fa-W, Ml-W and Dn-W.

The Italian national surgical site infection surveillance programme and its positive impact, 2009 to 2011

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Symptomatic first urinary tract infection in children and underlying kidney and urinary ttract abnormalities from a tertiary care hospital in India

Objective The aim of this study was to describe the characteristics and the clinical evolution of first documented symptomatic Urinary Tract Infection and to detect underlying abnormalities of the kidney and urinary tract if any. Methods Prospective observational study on 102 patients (6 months to 5 yrs) with first documented symptomatic Urinary Tract Infection diagnosed by positive urine culture in the department of Paediatrics, G.S.V.M Medical College, Kanpur, India between January 2008 and June 2009. Antibiotics were given according to the sensitivity pattern. All children were evaluated with renal bladder ultrasonogram and voiding cystourethrography. Results Out of 102 patients 62 (60.78%) girls and 40 (39.21%) boys, most of the patients (62.7%) within 6 months to 2 years old. The commonest presentation was fever (84.3%).The commonest organism was E.Coli (80.37%). Overall most common underlying abnormality was VUR, found in 31(30.31%) children. Other abnormalities were urolithiasis(4.9%), ureteropelvic junction obstruction (3.92%),Mild hydronephrosis (2.9%), ureteric duplex(0.98%), posterior urethral valve(0.98%), renal duplex (0.98%). Conclusion In our study 45.09% children had underlying abnormalities which may be a potential risk factor for urinary tract infection. Better recognition of risk factors, prompt diagnosis and early intervention are sufficient enough to maintain normal renal function and healthy lifestyle.   Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-3, 45-53 DOI: http://dx.doi.org/10.3126/jcmsn.v9i3.10222  

Seizure and unilateral facial nerve paralysis in a newborn with Dandy-Walker malformation – A case report

The Dandy-Walker syndrome (DWS) is a rare posterior fossa malformation. It can have a varied presentation depending on the age. A newborn presenting with neonatal seizure along with unilateral facial nerve palsy is rather a rare presentation of DWS and very few such cases were reported in the past. We are reporting a case of a newborn male baby presenting with neonatal seizure within 48 hrs of birth along with right sided LMN type facial nerve palsy which on due course of investigation revealed as a case of Dandy–Walker malformation. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-1, 48-51 DOI: http://dx.doi.org/10.3126/jcmsn.v9i1.9673

Infections in acute leukemia in Indian Children

Aims: In the present study acute leukemic children were studied to determine the incidence and principal site of infection, correlation with absolute neutrophil count, causative organisms and to standardize the initial empirical anti microbial therapy. Materials and methods: A total 40 children in the age group 6 month to 12 year with acute leukemia relapse were included in this study. A total 82 infectious episodes including 61 febrile episodes were investigated for infectious etiology. Results: We found that the frequency of infections increased significantly with the degree of immunocompromisation specially neutropenia (ANC < 500/cmm). The skin and soft tissue was the commonest site of infection (26.83%), followed by respiratory tract (21.95%). Staphylococcus nonhemolytic coagulase-negative (34%), followed by Klebsiella (17%) were the most common organisms isolated from blood. Staphylococcus non-hemolytic coagulase-negative was also the commonest isolate (26%) from other sites of infection. Most strains were sensitive to Cloxacillin, cephalosporin and aminoglycosides. Conclusion: For the treatment of febrile episodes, empirical use of beta-lactamase resistant penicillin e.g. Cloxacillin or cephalosporin combined with an aminoglycosides with a broad spectrum antifungal like fluconazole in selective cases at the first sign of infection is recommended. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-1, 40-47 DOI: http://dx.doi.org/10.3126/jcmsn.v9i1.9672

Olfactory experience modulates immature neuron development in postnatal and adult guinea pig piriform cortex

Immature neurons expressing doublecortin (DCX+) are present around cortical layer II in various mammals including guinea pigs and humans, especially enriched in the paleocortex. However, little is known whether and how functional experience affects the development of this population of neurons. We attempted to explore a modulation by experience to layer II DCX+ cells in the primary olfactory cortex in postnatal and adult guinea pigs. Neonatal and 1-year-old guinea pigs were subjected to unilateral naris-occlusion, followed 1 and 2months later by morphometry of DCX+ cells in the piriform cortex. DCX+ somata and processes were reduced in the deprived relative to the non-deprived piriform cortex in both age groups at the two surviving time points. The number of DCX+ cells was decreased in the deprived side relative to internal control at 1 and 2months in the youths and at 2months in the adults post-occlusion. The mean somal area of DCX+ cells showed a trend of decrease in the deprived side relative to the internal control in the youths. In addition, DCX+ cells in the deprived side exhibited a lower frequency of colocalization with the neuron-specific nuclear antigen (NeuN) relative to counterparts. These results suggest that normal olfactory experience is required for the maintenance and development of DCX+ immature neurons in postnatal and adult guinea pig piriform cortex.

Angiofibroma, a rare cardiac tumour in children

Angiofibromas, located in any other sites than nasopharynx are unusual. Cardiac angiofibromas are a very rare cardiac tumours in comparison to rhabdomyomas which are the commonest in the children. We report a right ventricular tumour in a10 year old girl which was excised under cardiopulmonary bypass successfully and diagnosed as angiofibroma on histopathology. Journal of College of Medical Sciences-Nepal, 2012, Vol-8, No-4, 51-54 DOI: http://dx.doi.org/10.3126/jcmsn.v8i4.8702  

Risk Factors for Acute Respiratory Infections in Hospitalized Under Five Children in Central Nepal

Introduction: Acute respiratory infection is a leading cause of morbidity and mortality in under 5 children in developing countries. There are various modifiable risk factors associated with Acute Respiratory Tract Infection (ARI). Hence, identification of associated risk factors for ARI may be helpful to reduce the burden of disease. The aims of this study were to study the risk factors for ARI in under five hospitalized children and to correlate risk factors with ARI related morbidity. It was a hospital- based prospective study. Materials and Methods: Children of less than 5 years admitted in ward with diagnosis of ARI were enrolled in the study as cases. Control included children under 5 years of age attending to Well Baby Clinic, Immunization Clinic and siblings or relatives under 5 years who came with patients in the Paediatric outpatient department of the same institution during the same period. Various risk factors, demographic and clinical data of each child were recorded in a pre-designed proforma of both groups. Results: A total of 200 cases and 200 controls were enrolled. The various risk factors associated with ARI on stepwise logistic regression were male gender, rural residency, overcrowding, history of ARI in any family member within two weeks and undernutrition. The statistically insignificant risk factors were infancy, economic status, illiterate parents, cooking fuel other than LPG, low birth weight, prematurity, lack of exclusive breast feeding, vitamin A deficiency and incomplete immunization. Conclusion: The various risk factors for ARI identified in this study were male gender, rural residency, overcrowding, history of ARI in any family member within two weeks and undernutrition. DOI: http://dx.doi.org/10.3126/jnps.v33i1.7358 J Nepal Paediatr Soc. 2013;33(1):39-44

A survey of methicillin-resistant Staphylococcus aureus control strategies in Italy

PURPOSE

Data regarding the implementation of state-of-the-art methicillin-resistant Staphylococcus aureus (MRSA) control procedures in Italy are lacking. There is a need to evaluate compliance with MRSA recommendations (CR) in Italian hospitals.

METHODS

A 67-question closed-answer survey was sent to all Italian hospitals, in order to analyze and evaluate program consistency with CR [hand hygiene (HH), contact precautions, screening of high-risk patients, decolonization, feedback on surveillance data, and antimicrobial guidelines and education programs].

RESULTS

205 hospitals, which account for 42 % of national admissions, returned questionnaires. 131 hospitals (64 %) did not have written MRSA control guidelines. Hospitals reported the following levels of compliance with CR: (1) HH: 67 hospitals (33 %); (2) contact precautions: 33 (16 %); (3) MRSA screening: 66 (32 %); (4) MRSA decolonization: 42 (20 %); (5) surveillance data feedback: 87 (43 %); and (6) antimicrobial guidelines and education programs: 41 (20 %). One hospital (0.5 % of responses) had implemented all recommendations and 28 hospitals (14 %) had implemented four or five recommendations. 31 % of hospitals surveyed had implemented none. Multivariate analysis showed that the only factor identified as being associated with the implementation of MRSA control recommendations was the number of meetings/year of the infection control team (ICT) (p = 0.004).

CONCLUSIONS

Written MRSA control guidelines are available in only one-third of Italian facilities. An organized system, with ≥4 interventions, has been implemented in just 1 out of 7 hospitals. HH programs and ICT activity are related to better MRSA control. In Italy, there is significant opportunity for improvement in MRSA control.

Changes in water and beverage intake and long-term weight changes: results from three prospective cohort studies

OBJECTIVE

To examine the long-term relationship between changes in water and beverage intake and weight change.

SUBJECTS

Prospective cohort studies of 50013 women aged 40-64 years in the Nurses' Health Study (NHS, 1986-2006), 52987 women aged 27-44 years in the NHS II (1991-2007) and 21988 men aged 40-64 years in the Health Professionals Follow-up Study (1986-2006) without obesity and chronic diseases at baseline.

MEASURES

We assessed the association of weight change within each 4-year interval, with changes in beverage intakes and other lifestyle behaviors during the same period. Multivariate linear regression with robust variance and accounting for within-person repeated measures were used to evaluate the association. Results across the three cohorts were pooled by an inverse-variance-weighted meta-analysis.

RESULTS

Participants gained an average of 1.45 kg (5th to 95th percentile: -1.87 to 5.46) within each 4-year period. After controlling for age, baseline body mass index and changes in other lifestyle behaviors (diet, smoking habits, exercise, alcohol, sleep duration, TV watching), each 1 cup per day increment of water intake was inversely associated with weight gain within each 4-year period (-0.13 kg; 95% confidence interval (CI): -0.17 to -0.08). The associations for other beverages were: sugar-sweetened beverages (SSBs) (0.36 kg; 95% CI: 0.24-0.48), fruit juice (0.22 kg; 95% CI: 0.15-0.28), coffee (-0.14 kg; 95% CI: -0.19 to -0.09), tea (-0.03 kg; 95% CI: -0.05 to -0.01), diet beverages (-0.10 kg; 95% CI: -0.14 to -0.06), low-fat milk (0.02 kg; 95% CI: -0.04 to 0.09) and whole milk (0.02 kg; 95% CI: -0.06 to 0.10). We estimated that replacement of 1 serving per day of SSBs by 1 cup per day of water was associated with 0.49 kg (95% CI: 0.32-0.65) less weight gain over each 4-year period, and the replacement estimate of fruit juices by water was 0.35 kg (95% CI: 0.23-0.46). Substitution of SSBs or fruit juices by other beverages (coffee, tea, diet beverages, low-fat and whole milk) were all significantly and inversely associated with weight gain.

CONCLUSION

Our results suggest that increasing water intake in place of SSBs or fruit juices is associated with lower long-term weight gain.