Unintended intrapleural insertion of an epidural catheter in thoracic surgery: regional analgesia game over, or is there another way out?

In thoracic surgery, optimized pain control is crucial to prevent dysfunction in cardiorespiratory mechanics. Epidural anesthesia (EA) and paravertebral block (PVB) are the most popular techniques for analgesia. Unintended intrapleural insertion of an epidural catheter is a rare complication. Our report presents a case of a patient submitted to pulmonary tumor resection by video-assisted thoracoscopic surgery (VATS). There was difficulty in epidural insertion related to patient's obesity, but after general anesthesia induction, no additional intravenous analgesia was needed after epidural injection. Surgery required conversion to thoracotomy, with intrapleural identification of epidural catheter. At the end of surgery, surgeons reoriented catheter to paravertebral space, with leak absence confirmation after local anesthetic injection through the catheter. In postoperative period, pain control was efficient, with no complications. It was a successful case that shows that when we find unexpected complications, we can look for alternative solutions to give our patient the best treatment.

POS0100 ACTIVATION OF THE CELLULAR INTEGRATED STRESS RESPONSE IN LABIAL SALIVARY GLANDS FROM SJÖGREN’S SYNDROME PATIENTS

Background

Sjögren’s syndrome (SS) is a chronic autoimmune disease characterized by inflammation of the exocrine glands and severe symptoms of eye and mouth dryness. Disorders in the saliva secretion process have been associated with oxidative and endoplasmic reticulum (ER) stress in combination with inflammatory responses. The integrated stress response (ISR) is a mechanism that allows cells to modify their gene expression program to restore homeostasis and promote their survival against various extrinsic and intrinsic stress signals, such as hypoxia, nutrient deprivation, viral infections, inflammatory factors (cytokines, chemokines, inflammasomes), and accumulation of unfolded proteins in the ER, among others (1). The ISR is regulated by four kinases: PERK, PKR, HRI and GCN2, that dimerize and autophosphorylate to become active and each one responds to different stress stimuli. The signaling pathways that are activated in response to stress factors stimulate the phosphorylation of eIF2α, which causes a transient inhibition of global protein synthesis and induction of synthesis of some specific genes like ATF4 and NRF2. ATF4 induces the transcription of genes involved in metabolism and nutrient uptake, redox status, and regulation of apoptosis. Dephosphorylation of eIF2α is the ISR termination signal to restore protein synthesis and is mediated by the PP1 complex, which recruits the catalytic subunit PP1c and one of its two regulatory subunits: GADD34 or CREP.

Objectives

To evaluate the presence and functional state (phosphorylation) of the ISR sensing kinases: PERK, PKR, HRI and GCN2; the levels of eIF2α /p-eIF2α and the key ISR transcription factors ATF4 and NRF2, as well as subunits of the complex involved in the ISR termination: PP1c, GADD34 and CREP in labial salivary glands (LSG) of SS-patients.

Methods

Biopsies of LSG from 12 SS-patients and 11 control subjects were studied. The levels of mRNA, protein and phospho (p)-protein of the ISR components were determined by RT-qPCR and Western blotting.

Results

Our results show increased levels of p-PERK/PERK ratio (11/11), PKR (7/11), p-PKR (7/11), p-PKR/PKR ratio (7/11), eIF2α (5/11), p-eIF2α (5/11) and ATF4 (11/11) in LSG from SS-patients compared to control subjects. No significant changes were found in mRNA levels of HRI, GCN2, and GADD34 between LSG from SS-patients and control subjects. Decreased protein levels of HRI (8/12), p-GCN2 (6/11), eIF2α (6/11), p-eIF2α (6/11), NRF2 (11/12), and p-NRF2 (12/12) were found in LSG showing scarce parenchyma and high fibrosis and fat infiltration. On the other hand, PP1c and CREP showed decreased mRNA and protein levels in all SS-patients LSG. Interestingly, Ro autoantibodies and focus score were negatively correlated with PP1c and NRF2 mRNA and protein levels whereas positively correlated with PKR mRNA levels.

Conclusion

The overexpression and activation of some ISR kinases together with the decrease in the PP1c/CREP phosphatase complex suggests a continuous activation of ISR, resulting in p-eIF2α to remain activated in LSG from SS-patients. This would explain the high protein levels of ATF4 and of target genes involved in the antioxidant response in LSG from SS patients suggesting that ISR activation plays a key role in pro-survival response to cellular stress.

References

[1]Pakos-Zebrucka K, Koryga I, Mnich K, Ljujic M, Samali A, Gorman AM. The integrated stress response. EMBO Rep. 2016;17(10):1374-95.

Acknowledgements

This work was supported by Fondecyt-Chile 1210055; Enlace-VID Universidad de Chile [ENL04/20 to MJG]; Fondecyt Iniciacion 11201058 and PhD fellowship Conicyt Chile.

Disclosure of Interests

None declared

POS0455 TOFACITINIB DECREASES INFLAMMATORY MARKERS AND MITOCHONDRIAL MORPHOLOGICAL DAMAGE IN SALIVARY GLANDS OF A MURINE MODEL OF SJÖGREN’S SYNDROME

Background

Altered homeostasis of salivary gland (SG) epithelial cells in Sjögren’s syndrome (SS) patients could be the initiating factor that leads to inflammation, as well as secretory dysfunction. Mitochondria are important organelles involved in cellular metabolism and their dysfunction can induce a loss of homeostasis and inflammation. Altered mitochondrion can release mitochondrial components that can act as damage-associated molecular patterns (DAMPs) and induce an inflammatory response via pattern recognition receptors (PRRs) such as the NLRP3 inflammasome, TLR9, cGAS/STING, and ZBP1 (1). Previously we determined that SG from SS patients showed and altered autophagy, which is associated to an increased pro-inflammatory cytokines expression. Interestingly, increased expression of pro-inflammatory markers such as IL-6, was reversed by JAK inhibitor tofacitinib in three-dimensional (3D)-acini deficient in autophagy (2). It is not clear whether the alterations in autophagy found in SG patients include alterations in mitochondrial clearance (mitophagy) that may lead to the accumulation of damaged mitochondria and enhanced inflammation. In this context, recent results of our laboratory showed, for the first time, severe ultrastructural alterations of mitochondria in SG cells from SS patients (1). However, it remains to be determined if these alterations are related to inflammation and if an anti-inflammatory agent could regulate these processes.

Objectives

To analyze the effect of tofacitinib on the mitochondrial ultrastructure in submandibular glands of a murine model of SS. In addition, to evaluate the effect of tofacitinib on the expression and activation of some PRRs involved in the recognition of mitochondrial DAMPs in the same murine model.

Methods

Six-month-old female NOD.B10Sn-H2b/J mice (Jackson Laboratories, USA) were used with 4-5 mice per group. Procedures were approved by the Universidad de Chile Animal Care and Use Committee. 30 mg/kg/day tofacitinib citrate was administered by oral gavage. After 28 days of tofacitinib or vehicle administration, their submandibular glands were obtained, which were processed to evaluate the mitochondrial ultrastructure by electron microscopy or lysed in RIPA buffer to obtain proteins. The protein levels of PRRs: NLRP3, TLR9, ZBP-1, and cGAs, as well as molecules activated downstream of cGAS and ZBP-1 such as TBK1, pTBK1, pSTING, and STING were determined by Western blotting.

Results

The results show that the mitochondria of the glandular epithelial cells of NOD.B10Sn-H2b/J mice treated with vehicle (control) present alterations such as swelling, disruption of membranes and crest disorganization that previously were reported in patients with SS (1). Interestingly, tofacitinib treatment improves the architecture of mitochondria. On the other hand, the protein levels of PRRs such as NLRP3 and cGAS decreased in mice treated with tofacitinib, as well as pTBK1.

Conclusion

The altered morphology of mitochondria together with the increased protein levels of PRRs and downstream markers of these PRRs suggests release of mitochondrial DAMPs in submandibular glands of NOD.B10Sn-H2b/J mice. The improvement in mitochondrial morphology as well as the decrease in PRRs activation under tofacitinib treatment suggest a potential use of this anti-inflammatory agent in mitochondrial alterations associated with inflammation. Many questions remain to be addressed, such as determining which mitochondrial DAMP might be being released and whether this is associated with impaired mitochondrial function in SS.

References

[1]Barrera, M. J., et al (2021). Dysfunctional mitochondria as critical players in the inflammation of autoimmune diseases: Potential role in Sjögren’s syndrome. Autoimmunity reviews, 20(8), 102867.

[2]Barrera, M. J., et al (2021). Tofacitinib counteracts IL-6 overexpression induced by deficient autophagy: implications in Sjögren’s syndrome. Rheumatology (Oxford, England), 60(4), 1951–1962.

Acknowledgements

This work was supported by Fondecyt Iniciación 11201058 and Fondecyt-Chile 1210055.

Disclosure of Interests

None declared.

POS0180 TYPE I INTERFERON DEPENDENT HSA-MIR-145-5P DOWNREGULATION MODULATES MUC1 AND TLR4 OVEREXPRESSION IN SALIVARY GLANDS FROM PRIMARY SJÖGREN’S SYNDROME PATIENTS

Background:

Primary Sjögren’s syndrome (pSS) is an autoimmune and inflammatory disease that mainly affects the salivary glands (SG) and is characterized by an overactivation of the type I interferon pathway (IFNs I). IFNs I are known to regulate the levels of microRNAs (miRNAs), non-coding RNAs whose levels are altered in pSS. IFNs I can decrease the levels of miR-145-5p, a miRNA with anti-inflammatory roles that has been reported downregulated in SG of from pSS patients [1]. This miRNA has TLR4 and MUC1 transcripts as predicted targets. MUC1 and TLR4 are two proteins overexpressed in SG of pSS patients that contribute, through various mechanisms, to the inflammatory state and glandular dysfunction [2-3]. Thus, we propose that IFNs I may contribute to a self-perpetuating inflammation loop through a hsa-miR-145-5p dependent MUC1 and TLR4 overexpression in the SG of pSS patients.

Objectives:

to evaluate whether mRNA levels of MUC1 and TLR4 are modulated by hsa-miR-145-5p in a IFNs I dependent manner.

Methods:

13 pSS patients and 9 controls SG biopsies were analyzed. hsa-miR-145-5p levels were determined by TaqMan assays and MUC1, TLR4, IFN-α and IFN-β mRNA levels by RT-qPCR. Additionally, in vitro assays using type I IFNs and chemically synthesized hsa-miR-145-5p mimics and inhibitors were performed to study its effect on MUC1 and TLR4 expression. JAK1 and STAT1 mRNA levels were also measured.

Results:

By Taqman assays we validated the decreased hsa-miR-145-5p levels (p=0.0001) in SG of pSS patients compared to controls. The decreased hsa-miR-145-5p levels correlated inversely with the increased mRNA levels of IFN-β (p=0.0192) in SG of pSS-patients. The hsa-miR-145-5p downregulation also correlated inversely with the overexpression of its predicted targets MUC1 (p=0.010) and TLR4 (p=0.0004). In vitro assays showed that IFN-β induces the overexpression of JAK1 (<p=0.0001) and STAT1 (p=<0.0001) leading to the downregulation of hsa-mir-145-5p (p=<0.0001) and increased MUC1 (p=<0.0001) and TLR4 mRNA levels (p=<0.0001). Functional assays suggest a regulation of hsa-miR-145-5p on MUC1 and TLR4 expression as MUC1 and TLR4 mRNA levels were decreased in HSG cells transfected with hsa-miR-513c-3p mimic and increased in HSG cells transfected with the miRNA inhibitor.

Conclusion:

Our findings suggest that IFNs I could induce the downregulation of hsa-miR-145-5p leading to the overexpression of MUC1 and TLR4 in SG from pSS patients. TLR4 is activated by ectopic mucins in the SG extracellular matrix from pSS patients which induces pro-inflammatory cytokines secretion [3]. Furthermore, the high levels of the MUC1-SEC and MUC1-Y isoforms observed in SG from pSS patients may favor cytokine synthesis through the immuno-enhancing peptide of MUC1-SEC or through the formation of a MUC1-SEC/MUC1-Y complex [4]. Therefore, IFNs I may contribute to the development of SS through amplification and perpetuation of inflammation due to a hsa-miR-145-5p dependent MUC1 and TLR4 overexpression.

References:

[1]I. Alevizos, et al,. Arthritis Rheum, 2011;63:535-44.

[2]HH. Sung, et al,. Oral Dis. 2015;21(6):730-8.

[3]MJ. Barrera, et al,. Rheumatology (Oxford). 2015;54(8):1518-27

[4]LM. Herbert, et al,. Cancer Res. 2004;64(21):8077-84.

Acknowledgements:

Fondecyt 1210055, Fondecyt 1160015, Fondecyt Iniciación 11170049, Fondecyt Iniciación 11201058, CONICYT fellowship (DJ, PC)

Disclosure of Interests:

None declared

THU0229 HSA-MIR-513C-3P OVEREXPRESSION DECREASES XBP-1S CORRELATING WITH INCREASED INFLAMMATION AND AUTOANTIBODIES IN SALIVARY GLANDS FROM SJÖGREN’S SYNDROME PATIENTS

Background:

Endoplasmic reticulum (ER) stress and the Unfolded Protein Response (UPR) are linked to inflammation in a variety of human pathologies including autoimmune diseases. Salivary glands (SG) from Sjögren’s syndrome (SS) patients have high levels of IFN-gamma among other cytokines, which trigger or exacerbate protein unfolding or misfolding, inducing ER stress. In this study, we focused on the IRE1α/XBP-1 pathway of the UPR, whose transcription factor is XBP-1s, which induces genes linked to regulation of the secretory pathway. We recently found that SG of SS patients have reduced levels of XBP-1s transcripts associated with an increased DNA methylation of XBP-1 promoter [1]. We postulate that other epigenetic mechanisms, such as miRNAs, could coexist with promoter DNA hyper-methylation to regulate XBP-1s expression.

Objectives:

Due to hsa-miR-513c-3p overexpression has been reported in SG from SS patients [2] and that XBP-1 is a predicted target of hsa-miR-513c-3p, the aim of this study was to evaluate whether mRNA levels of XBP-1s is modulated by hsa-miR-513c-3p and also if IFN-gamma modify the expression hsa-miR-513c-3p and XBP-1s.

Methods:

SG biopsies from 16 SS-patients with low and high focus score and 5 controls were analyzed. hsa-miR-513c-3p levels were measured by Taqman miRNA assays, whereas XBP-1s mRNA levels were determined by qRT-PCR. Additionally,in vitroassays using IFN-gamma and chemically synthesized hsa-miR-513c-3p mimics and inhibitors were performed to study its effect on XBP-1s expression.

Results:

By Taqman assays we validated the overexpression of hsa-miR-513c-3p in SG from 8 SS patients with low (p=0.03) and 8 SS-patients with high (p=0.003) focus score, compared with SG from 5 controls. In the same samples, a decrease of XBP-1s transcript levels was observed in SG from SS-patients with low (p=0.002) and high (p=0.026) focus score. XBP1s transcript levels were negatively correlated with hsa-miR-513c-3p (r=-0.47, p=0.014), Ro (r=-0.73, p=0.0009), ANA (r=-0.7, p=0.0033) and focus score (r=-0.72, p=0.001). Stimulation of 3D-acini with 1 ng/mL IFN-gamma increase the hsa-miR-513c-3p levels (p=0.014) and decrease the XBP-1s transcript levels (p=0.027). A negative correlation was found between hsa-miR-513c-3p and XBP-1s transcript levels in 3D-acini stimulated with IFN-gamma (r=-0.87, p=0.0001). The XBP-1s transcript levels were decreased in HSG cells transfected with hsa-miR-513c-3p mimic and increased in HSG cells transfected with the miRNA inhibitor.

Conclusion:

IFN-gamma-induced upregulation of hsa-miR-513c-3p is consistent with the presence of STAT1-binding elements in its promoter region. Our findings suggest that the combined action of miRNAs and DNA methylation modulated by IFN-gamma could explain the altered expression of XBP-1s, a key transcription factor involved in cellular proteostasis, affecting secretory function in LSG from SS-patients. Our results confirm previous correlations found between XBP-1s protein levels and clinical parameters of SS-patients, suggesting an association of XBP-1s with inflammation and impaired SG function.

References:

[1]D. Sepúlveda,et al, Rheumatology (Oxford), 2018;57:1021-32.

[2]I. Alevizos,et al,. Arthritis Rheum, 2011;63:535-44.

Acknowledgments :

Fondecyt 1160015, Fondecyt Iniciación 11170049, Fondecyt Postdoctorado 3170023, CONICYT fellowship (PC, DJ).

Disclosure of Interests: :

None declared

Optimising adjacent membrane segmentation and parameterisation in multicellular aggregates by piecewise active contours

In fluorescence microscopy imaging, the segmentation of adjacent cell membranes within cell aggregates, multicellular samples, tissue, organs, or whole organisms remains a challenging task. The lipid bilayer is a very thin membrane when compared to the wavelength of photons in the visual spectra. Fluorescent molecules or proteins used for labelling membranes provide a limited signal intensity, and light scattering in combination with sample dynamics during in vivo imaging lead to poor or ambivalent signal patterns that hinder precise localisation of the membrane sheets. In the proximity of cells, membranes approach and distance each other. Here, the presence of membrane protrusions such as blebs; filopodia and lamellipodia; microvilli; or membrane vesicle trafficking, lead to a plurality of signal patterns, and the accurate localisation of two adjacent membranes becomes difficult. Several computational methods for membrane segmentation have been introduced. However, few of them specifically consider the accurate detection of adjacent membranes. In this article we present ALPACA (ALgorithm for Piecewise Adjacent Contour Adjustment), a novel method based on 2D piecewise parametric active contours that allows: (i) a definition of proximity for adjacent contours, (ii) a precise detection of adjacent, nonadjacent, and overlapping contour sections, (iii) the definition of a polyline for an optimised shared contour within adjacent sections and (iv) a solution for connecting adjacent and nonadjacent sections under the constraint of preserving the inherent cell morphology. We show that ALPACA leads to a precise quantification of adjacent and nonadjacent membrane zones in regular hexagons and live image sequences of cells of the parapineal organ during zebrafish embryo development. The algorithm detects and corrects adjacent, nonadjacent, and overlapping contour sections within a selected adjacency distance d, calculates shared contour sections for neighbouring cells with minimum alterations of the contour characteristics, and presents piecewise active contour solutions, preserving the contour shape and the overall cell morphology. ALPACA quantifies adjacent contours and can improve the meshing of 3D surfaces, the determination of forces, or tracking of contours in combination with previously published algorithms. We discuss pitfalls, strengths, and limits of our approach, and present a guideline to take the best decision for varying experimental conditions for in vivo microscopy.

An evidence-based bundle improves the quality of care and outcomes of patients with candidaemia

Background

Candidaemia is a leading cause of bloodstream infections in hospitalized patients all over the world. It remains associated with high mortality.

Objectives

To assess the impact of implementing an evidence-based package of measures (bundle) on the quality of care and outcomes of candidaemia.

Methods

A systematic review of the literature was performed to identify measures related to better outcomes in candidaemia. Eight quality-of-care indicators (QCIs) were identified and a set of written recommendations (early treatment, echinocandins in septic shock, source control, follow-up blood culture, ophthalmoscopy, echocardiography, de-escalation, length of treatment) was prospectively implemented. The study was performed in 11 tertiary hospitals in Spain. A quasi-experimental design before and during bundle implementation (September 2016 to February 2018) was used. For the pre-intervention period, data from the prospective national surveillance were used (May 2010 to April 2011).

Results

A total of 385 and 263 episodes were included in the pre-intervention and intervention groups, respectively. Adherence to all QCIs improved in the intervention group. The intervention group had a decrease in early (OR 0.46; 95% CI 0.23–0.89; P = 0.022) and overall (OR 0.61; 95% CI 0.4–0.94; P = 0.023) mortality after controlling for potential confounders.

Conclusions

Implementing a structured, evidence-based intervention bundle significantly improved patient care and early and overall mortality in patients with candidaemia. Institutions should embrace this objective strategy and use the bundle as a means to measure high-quality medical care of patients.

Presence and diversity of mixed avian Plasmodium spp. infections in introduced birds whose distribution overlapped with threatened New Zealand endemic birds

Aims: To determine the presence of infection and co-infection of Plasmodium lineages in introduced birds at translocation sites for the North Island saddleback (Philesturnus rufusater), to investigate their role as Plasmodium spp. reservoirs.Methods: Blood samples were collected from introduced bird species, with a special focus on blackbirds (Turdus merula) and song thrushes (Turdus philomelos), at six locations in the North Island of New Zealand that were the origin, or translocation sites, for North Island saddleback. Where available, blood smears were examined, and blood samples were tested using nested PCR with subsequent sequence analysis, for the presence of Plasmodium spp.Results: Of the 55 samples tested using PCR analysis, 39 (71%) were positive for Plasmodium spp., and 28/40 (62%) blood smears were positive for Plasmodium spp. Overall, 31 blood samples were from blackbirds with 28/31 (90%) samples positive for Plasmodium spp. Six distinct avian Plasmodium lineages were identified, including three cosmopolitan lineages; Plasmodium vaughani SYAT05 was detected in 16 samples, Plasmodium matutinum Linn1 in 10 samples and Plasmodium elongatum GRW6 in eight samples. Mixed infections with more than one lineage were detected in 12 samples. Samples from two Australian magpies (Gymnorhina tibicen) were positive for Plasmodium. sp. lineage MYNA02, previously not identified in New Zealand.Conclusions and clinical relevance: This is the first report from New Zealand in which specific Plasmodium spp. mixed infections have been found in introduced birds. Co-infections with several cosmopolitan Plasmodium lineages were identified, as well as the first report in New Zealand of an exotic avian Plasmodium sp. lineage, in Australian magpies. Whilst the role of introduced birds in maintaining and spreading pathogenic avian malaria in New Zealand is unclear, there is a potential infection risk to native birds, especially where distributions overlap.

Melissa officinalis L. ethanolic extract inhibits the growth of a lung cancer cell line by interfering with the cell cycle and inducing apoptosis

Melissa officinalis is a plant from the family Lamiaceae, native in Europe particularly in the Mediterranean region. Given our interest in identifying extracts and compounds capable of inhibiting tumor cell growth, and given the antioxidant content and the high consumption of Melissa officinalis in Portugal, this study aimed to test the tumor cell growth inhibitory activity of five different extracts of this plant (aqueous, methanolic, ethanolic, hydromethanolic and hydroethanolic) in three human tumor cell lines: MCF-7, AGS and NCI-H460. All extracts decreased cell growth in all cell lines in a concentration-dependent manner. The ethanolic extract was the most potent one, presenting a GI50 concentration of approximately 100.9 μg mL-1 in the NCI-H460 lung cancer cells. This extract was characterized by LC-DAD-ESI/MS regarding its phenolic composition, revealing rosmarinic acid as the most abundant compound. The GI75 concentration of this extract affected the cell cycle profile of these cells. In addition, both the GI50 and the GI75 concentrations of the extract induced cellular apoptosis. Moreover, treatment of NCI-H460 cells with this extract caused a decrease in pro-caspase 3 and an increase in p53 levels. This study emphasizes the relevance of the study of natural products as inhibitors of tumor cell growth.

Study of major genetic factors involved in pituitary tumorigenesis and their impact on clinical and biological characteristics of sporadic somatotropinomas and non-functioning pituitary adenomas

Genetic and functional aberrations of guanine nucleotide-binding protein, alpha stimulating (GNAS), aryl hydrocarbon receptor interacting protein (AIP), and pituitary tumor transforming gene (PTTG) are among the most prominent events in pituitary tumorigenesis. A cohort of Brazilian patients with somatotropinomas (n=41) and non-functioning pituitary adenomas (NFPA, n=21) from a single tertiary-referral center were evaluated for GNAS and AIP mutations and gene expression of AIP and PTTG. Results were compared to the clinical and biological (Ki67 and p53 expression) characteristics of tumors and their response to therapy, if applicable. Genetic analysis revealed that 27% of somatotropinomas and 4.8% of NFPA harbored GNAS mutations (P=0.05). However, no differences were observed in clinical characteristics, tumor extension, response to somatostatin analog therapy, hormonal/surgical remission rates, Ki67 index, and p53 expression between mutated and non-mutated somatotropinomas patients. PTTG overexpression (RQ mean=10.6, min=4.39, max=11.9) and AIP underexpression (RQ mean=0.56, min=0.46-max=0.92) were found in virtually all cases without a statistically significant relationship with clinical and biological tumor features. No patients exhibited somatic or germline pathogenic AIP mutations. In conclusion, mutations in GNAS and abnormal PTTG and AIP expression had no impact on tumor features and treatment outcomes in this cohort. Our data support some previous studies and point to the need for further investigations, probably involving epigenetic and transcriptome analysis, to improve our understanding of pituitary tumor behavior.

Correlation of the Glomerular Filtration Rate Measured With the Use of DTPA-Tc99m in Live Kidney Donors With Equations Based on Creatinine and Cystatin C

BACKGROUND

Renal donation leads to a risk of developing chronic kidney disease, with an incidence of 0.47%. To evaluate for its presence, formulas based on serum creatinine are used, but up to 80% of these formulas underestimate the glomerular filtration rate (GFR) in donors. The aim of this work was to confirm the highest correlation of the GFR as measured with the use of DTPA-Tc99m with the GFR as estimated by means of the formula based on serum cystatin C (CKD-EPI creatinine-cystatin C) in healthy kidney donors.

METHODS

In this observational, analytic, cross-sectional study, the GFR of kidney donors was determined ≥1 year after donation by means of DTPA gammagram and estimation with the use of conventional formulations and with cystatin C.

RESULTS

Of 112 donors, 38 (34%) were included, 20 (60%) were female, with an overall average age of 40 years, 36.5 months after donation, and body mass index of 25.5 kg/m². Correlation with the GFR as measured by means of DTPA gammagram was better with the use of CKD-EPI cystatin C (0.402; P = .020) and CKD-EPI creatinine-cystatin (0.549; P < .001) than the conventional formulas. Linear correlation with serum cystatin C was 0.825 (P < .001; 95% confidence interval, -105.3 to -63.2) for the CKD-EPI cystatin C formula, 0.77 (P < .001; -89.9 to -48.1) for the CKD-EPI creatinine-cystatin formula, and 0.525 (P = .002; -91.1 to -23.2) for DTPA-Tc99m scintigraphy.

CONCLUSIONS

There is a strong correlation between estimate the GFR by equations based on cystatin C and the measurement of the GFR by DTPA-Tc99m gammagram.

Correlation of the Renal Cortex Volume With the Glomerular Filtration Rate in Live Donors for Renal Transplantation

INTRODUCTION

As a pretransplantation evaluation, renal function is determined by the glomerular filtration rate (GFR) with the use of renal scintigraphy (RS) and the estimated glomerular filtration rate (eGFR). To date, there are few studies that correlate renal cortex volume with eGFR determined with renal gammagram (GR) and eGFR by equations (Cockroft-Gault, Modification of Diet in Renal Disease, and Chronic Kidney Disease Epidemiology Collaboration equation) in Latin American living donors.

AIM

This study sought to determine whether there is correlation of the volume of the renal cortex by Herts equation with the GFR determined with renal gammagram (GFR-GR).

PATIENTS AND METHODS

This was an analytical, observational, and cross-sectional study. A review of the donor charts from January 1, 2014, to December 1, 2014, with a complete clinical file, kidney measurements, predonation tomography volume, and eGFR by different formulas and by renal scintigraphy.

RESULTS

Thirty-three donors were included, 51.5% male and 48.5% female. The mean age was 38.58 ± 10 years, with an average volume of 127.83 ± 28.30 mL, with diethylenetriamine-pentaacetate (DTPA) of 54.80 ± 7.13 mL/min/1.73 m² in the donated kidney. Spearman correlation showed the best association with the Herts equation (r = 0.346) reaching significance (P = .049) when comparing the different equations against the GFR with DTPA. Using the Bland-Altman method, the lowest variability and best significance was verified with the same equation compared to the other formulas (P = .0002).

CONCLUSIONS

There is no consensus regarding which is the best formula for calculating the GFR of both kidneys. Of the different formulas, the one that best correlated with the GFR was the Herts method, which uses the volume of the kidney.

Non-antibiotic treatment for infectious diseases

The abuse and uncontrolled use of antibiotics has resulted in the emergence and spread of resistant bacteria. The utility of conventional antibiotics for the treatment of bacterial infections has become increasingly strained due to increased rates of resistance coupled with reduced rates of development of new agents. As a result, multidrug-resistant, extensively drug-resistant, and pan-drug-resistant bacterial strains are now frequently encountered. This has led to fears of a "post-antibiotic era" in which many bacterial infections could be untreatable. Alternative non-antibiotic treatment strategies need to be explored to ensure that a robust pipeline of effective therapies is available to clinicians. The new therapeutic approaches for bacterial infections (beyond antibiotics) may provide a way to extend the usefulness of current antibiotics in an era of multidrug-resistant (MDR) bacterial infections.

Safety and tolerance of three probiotic strains in healthy infants: a multi-centre randomized, double-blind, placebo-controlled trial

Some strains of species belonging to the genera Bifidobacterium and Lactobacillus are used in order to maintain health. Although these organisms have a long record of safe use, it is important to assess their safety and tolerance in potentially vulnerable populations, such as infants. The objective of this study was to evaluate the safety and tolerance of three probiotic strains (Bifidobacterium longum subsp. infantis R0033, Bifidobacterium bifidum R0071 and Lactobacillus helveticus R0052) in healthy infants aged 3 to 12 months. A multi-centre randomized, double-blind, placebo-controlled intervention study with 221 healthy full-term infants was conducted. Infants received either a placebo or one of the 3 probiotic strains (3×109 cfu) daily during an 8 week intervention period. Growth (weight, height and head circumference), adverse events (AEs)/serious adverse events (SAEs), concentrations of D-lactic acid in urine samples, characteristics of the stools and use of medication were collected for safety evaluation. All 4 groups were homogeneous with respect to age, gender, feeding type, ethnicity, height, weight and head circumference at the start of the study. The results showed that changes in growth (weight, height and head circumference) were equivalent in all 4 groups. No SAEs were reported. Total number of AEs recorded was equivalent in all groups. Thus, the use of B. infantis R0033, L. helveticus R0052 and B. bifidum R0071 in infancy is safe, and well tolerated.

Reversible solvatomagnetic switching in a single-ion magnet from an entatic state

A vast impact on molecular nanoscience can be achieved using simple transition metal complexes as dynamic chemical systems to perform specific and selective tasks under the control of an external stimulus that switches "ON" and "OFF" their electronic properties. While the interest in single-ion magnets (SIMs) lies in their potential applications in information storage and quantum computing, the switching of their slow magnetic relaxation associated with host-guest processes is insufficiently explored. Herein, we report a unique example of a mononuclear cobalt(ii) complex in which geometrical constraints are the cause of easy and reversible water coordination and its release. As a result, a reversible and selective colour and SIM behaviour switch occurs between a "slow-relaxing" deep red anhydrous material (compound 1) and its "fast-relaxing" orange hydrated form (compound 2). The combination of this optical and magnetic switching in this new class of vapochromic and thermochromic SIMs offers fascinating possibilities for designing multifunctional molecular materials.

Abstract P1-10-27: Self-reported symptoms and interference issues in breast cancer patients

BACKGROUND: Breast cancer and its treatments produce multiple symptoms that significantly impact patient quality of life (QOL). Distress and impaired function are the most commonly referred symptoms [Cleeland CS, 2007]. Routine cancer care assessment of patient-reported outcomes (PROs), including symptoms, function, and QOL, has been shown to improve symptom management, identification of psychosocial problems, and patient-provider communication. The Symptom Inventory Tool (SIT) is an assessment tool that captures the patients' perceived symptom burden for real-time clinical intervention, taken at the point of no intervention (baseline) and every 21 days or greater. The SIT is comprised of 27 questions utilizing the M.D. Anderson Symptom Inventory tool (MDASI) [Cleeland CS, Cancer 2013], and validated assessment instrument with 8 questions added and a free text box by Cancer Treatment Centers of America (CTCA). CTCA is a national network of five hospitals that specialize in cancer treatment and integrative oncology.

PATIENTS & METHODS: Patients reported symptoms intensity using 19-item MD Anderson Symptom Inventory (MDASI) and 8 additional questions created by CTCA (constipation, swelling, mouth soreness, bleeding, sexual interest, family, hope & QOL). Symptoms were rated "at the worst" on an 11-point numeric scale ranging from 0 ('no present") to 10 ("as bad as you can imagine") in the previous 24 hours. SIT became an integral part of patient care at CTCA beginning in 2012.

RESULTS: From July 2012 to February 2015, a total of 3,740 outpatients with breast cancer were evaluated at CTCA.

A total of 13,852 assessments were analyzed. The assessments consisted of 3,513 completed at baseline, 2,237 completed at the 2nd follow up (FU), and 8,014 completed at 3rd FU or greater. Median age was 50 (range, 17-88), 60% of patients were ER+. Race: White (68%), Black (29%), and other (3%). Disease extension: locoregional (86%) and metastatic (13.6%). The average time since cancer was diagnosed were 35 months, and 50.7% of the patients received prior systemic therapy: chemotherapy (55%), hormone-therapy (41%), and immunotherapy (4%). Mean, standard deviation and inter quartile ranges at baseline assessment are depicted in.

Table 1.Patient Reported SymptomBaseline assessment statisticsPercentage of patients with severe symptoms at baseline and reporting a clinically significant change (2 points) at 2nd SIT assessment Mean +/- STDInterquartile range (IQR)Significant decreaseNo changeDistress3.0 +/- 3.0[0.5]695 (31.3%)594 (26.8%)414 (18.7%)Sadness2.5 +/- 2.9[0.4]622 (28%)718 (32.3%)358 (16.1%)Disturbed Sleep3.3 +/- 3.2[0.6]550 (24.8%)517 (23.3%)642 (28.9%)Mood2.6 +/- 2.7[0.4]549 (24.7%)678 (30.5%)447 (20.1%)Pain2.7 +/- 3.0[0.5]523 (23.9%)675 (30.8%)519 (23.7%)*IQR is a measure of variability, based on dividing a data set into quartiles. Quartiles divide a rank-ordered data set into four equal parts

CONCLUSIONS: The SIT was successful in identifying symptoms burden and interference with life issues in breast cancer patients. Distress, sadness, disturbed sleep, mood and pain were the most common reported symptoms. Early identification of patient burden symptoms allowed immediate intervention and improvement in approximately a quarter of patients.

Citation Format: Alvarez RH, Hartman S, Bosch B, Kendrick D, Cohen L, Fridman J, Ottersen D, Walcott K, Ware S, Castro I, Thomas J, Niu J, Ahn E, Denny D, Markman M. Self-reported symptoms and interference issues in breast cancer patients. [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 P1-10-27.

MUC1/SEC and MUC1/Y overexpression is associated with inflammation in Sjögren's syndrome

OBJECTIVES

To evaluate the expression and localization of MUC1/SEC and MUC1/Y isoforms in labial salivary glands (LSG) from Sjögren's syndrome patients (SS patients), as well as their in vitro expression induced by cytokines.

SUBJECTS AND METHODS

Labial salivary gland from 27 primary SS patients and 22 non-SS sicca subjects were studied. Relative MUC1/SEC and MUC1/Y mRNA levels were determined by qPCR and protein levels by Western blotting. Induction of mucin mRNAs was assayed in vitro. Immunohistochemistry was used for localization.

RESULTS

Relative MUC1/SEC and MUC1/Y mRNA and protein levels were significantly higher in LSG from SS patients. These mRNAs were induced by cytokines. MUC1/SEC and MUC1/Y were detected in acini apical region of control LSGs, and significant cytoplasmic accumulation was observed in acini of SS patients. MUC1/Y localized in acinar nuclei and cytoplasm of inflammatory cells of LSG from SS patients. A strong positive correlation was observed between cellular MUC1/SEC levels and glandular function determined by scintigraphy.

CONCLUSIONS

We show for the first time that MUC1/SEC and MUC1/Y are expressed in LSG of both SS patients and non-SS sicca subjects. The observed overexpression and aberrant localization of MUC1/SEC and MUC1/Y and their induction by pro-inflammatory cytokines may favor the perpetuation of the inflammatory environment that disrupts the salivary glandular homeostasis in SS patients.

Prevalence of and risk factors for coccidiosis in kiwi between 1977 and 2011

AIMS

To identify risk factors associated with coccidiosis in kiwi (Apteryx spp.) using a retrospective analysis of historical data from kiwi examined post-mortem, and to determine the prevalence of coccidial oocysts in the droppings of wild and captive kiwi.

METHODS

Necropsy reports were examined from kiwi submitted to the National Wildlife Mortality Database of New Zealand (Huia) between February 1977 and May 2011. All cases that reported histological examination of one or more hepatic, intestinal or renal tissues were included in the study (n=372). Data collated for analysis included the presence or absence of coccidiosis in one or more tissues, age, host species, habitat, and season of submission. Fisher's exact test was used to determine the association between each independent variable and the prevalence of coccidiosis. Droppings opportunistically collected from wild and captive kiwi between January 2008 and June 2010 were also examined for the presence of coccidial oocysts.

RESULTS

Coccidiosis was evident in 47/372 (12.6%) kiwi examined post-mortem and was considered the primary cause of death in 12/47 (26%) infected cases. Examination of 412 droppings from wild and captive kiwi collected over a 29-month period revealed that 98 (23.8%) samples contained coccidia at the time of sampling. Enteric (n=27) coccidiosis was the most common form diagnosed using histology, followed by renal (n=19) and hepatic (n=11), with splenic (n=2) and pulmonary (n=1) infections infrequently seen. Many kiwi demonstrated infections in multiple tissues. The prevalence of coccidiosis was greater in juvenile kiwi (36/148, 24.3%) than adults (8/133, 6.0%) or chicks (2/83, 2.4%) (p<0.001), although there was no difference in mortality between age groups. Season of year was also associated with overall prevalence (p=0.05), with most cases being diagnosed in the autumn and winter. Coccidiosis was histologically evident in four of five species of kiwi examined, and in all host species upon analysis of droppings. Host species or habitat (captive vs. wild) did not influence the prevalence of disease detected histologically.

CONCLUSIONS

Age and season were the only factors that influenced the prevalence of coccidiosis in kiwi in this study. Coccidiosis was present in all species of kiwi, and this is the first report of coccidiosis in rowi (Apteryx rowi).

Cyst infection in hospital-admitted autosomal dominant polycystic kidney disease patients is predominantly multifocal and associated with kidney and liver volume

Positron-emission tomography/computed tomography (PET/CT) has improved cyst infection (CI) management in autosomal dominant polycystic kidney disease (ADPKD). The determinants of kidney and/or liver involvement, however, remain uncertain. In this study, we evaluated clinical and imaging factors associated with CI in kidney (KCI) and liver (LCI) in ADPKD. A retrospective cohort study was performed in hospital-admitted ADPKD patients with suspected CI. Clinical, imaging and surgical data were analyzed. Features of infected cysts were evaluated by PET/CT. Total kidney (TKV) and liver (TLV) volumes were measured by CT-derived multiplanar reconstruction. CI was detected in 18 patients who experienced 24 episodes during an interval of 30 months (LCI in 12, KCI in 10 and concomitant infection in 2). Sensitivities of CT, magnetic resonance imaging and PET/CT were 25.0, 71.4, and 95.0%. Dysuria (P<0.05), positive urine culture (P<0.01), and previous hematuria (P<0.05) were associated with KCI. Weight loss (P<0.01) and increased C-reactive protein levels (P<0.05) were associated with LCI. PET/CT revealed that three or more infected cysts were present in 70% of the episodes. TKV was higher in kidney-affected than in LCI patients (AUC=0.91, P<0.05), with a cut-off of 2502 mL (72.7% sensitivity, 100.0% specificity). TLV was higher in liver-affected than in KCI patients (AUC=0.89, P<0.01) with a cut-off of 2815 mL (80.0% sensitivity, 87.5% specificity). A greater need for invasive procedures was observed in LCI (P<0.01), and the overall mortality was 20.8%. This study supports PET/CT as the most sensitive imaging method for diagnosis of cyst infection, confirms the multifocal nature of most hospital-admitted episodes, and reveals an association of kidney and liver volumes with this complication.

Factors associated with complete endoscopic resection of an invasive adenocarcinoma in a colorectal adenoma

BACKGROUND AND OBJECTIVE

endoscopic polypectomy may allow curative resection of invasive adenocarcinoma on colorectal adenoma. Our goal was to determine the factors associated with complete endoscopic resection of invasive adenocarcinoma.

METHODS

retrospective observational study. We included 151 patients with invasive adenocarcinoma on adenomas endoscopically resected between 1999 and 2009. We determined those variables independently related to incomplete resection by a logistic regression. Relation was expressed as Odds Ratio (OR) and its 95% confidence interval (95% CI).

RESULTS

patients were predominantly male (66.2%) and their mean age was 68.03 ± 10.65 years. Colonoscopy was completein 84% of the patients and 60.3% had synchronous adenomas. Invasive adenocarcinoma was mainly located in distal colon (90.7%) and morphology was pedunculated in 75.5%. The endoscopic averagesize was 22.61 ± 10.86 mm. Submucosal injection was required in 32.5%. Finally, the resection was in one piece in 73.5% and incomplete in 8.6% of the adenocarcinomas. Factors independently associated with incomplete endoscopic resection were size (mm) (OR 1.08, 95% CI 1.03-1.14, p = 0.002), sessile or flat morphology (OR 8.78, 95% CI 2.24-34.38, p = 0.002) and incomplete colonoscopy (OR 4.73, 95% CI 1.15-19.34, p = 0.03).

CONCLUSIONS

endoscopic polypectomy allows complete resection of 91.4% of invasive adenocarcinomas on colorrectal adenoma in our series. Factors associated with incomplete resection were the size of the lesion, sessile or flat morphology and incomplete colonoscopy.

Coccidiosis in hihi/stitchbirds (Notiomystis cincta) due to coccidia of the Eimeriidae

AIM

To describe the pathology of coccidiosis in hihi and to provide preliminary data on the taxonomy of the coccidia involved using molecular methods.

METHODS

In an initial study from 1994 to 1997, gross and histopathological examinations were performed on 12 dead juvenile hihi from the National Wildlife Centre (NWC) at Mt. Bruce. In a second study during 2008-2010 DNA from sporulated oocysts and liver tissue was used for PCR analysis and sequencing. Faecal samples were also obtained from infected hihi from the NWC and examined for coccidial oocysts, which were then sporulated in the laboratory in 1994-1997 and 2007-2009. In addition, a post mortem was performed on a dead adult hihi from the NWC in 2008, and 18 archived hihi tissues from 11 individual birds stored at the Institute of Veterinary, Animal and Biomedical Sciences (IVABS) were used for DNA extraction.

RESULTS

Severe gross and histopathological changes in the intestine and occasionally in the liver were found in the 12 dead birds examined. The morphological characteristics of the sporulated oocysts suggested that two types of coccidia were present. PCR analysis and sequencing of extracted DNA supported the existence of at least two different coccidia species in hihi. These were genetically more closely related to the genus Eimeria than to the morphologically similar genus Cystisospora (formerly Isospora) of mammals. In addition, one liver tissue sample that was examined post mortem was positive for at least two different coccidia species of the family Eimeriidae according to sequencing results, and the presence of extraintestinal coccidian stages was confirmed.

CONCLUSIONS

Preliminary morphological and sequencing results suggest that two types of eimeriid coccidia are present and at least one of these commonly has extraintestinal stages.

CLINICAL RELEVANCE

Coccidiosis in hihi is a serious disease capable of causing mortalities in juvenile and adult birds in captive situations. Treatment and control of the disease will be difficult as the extraintestinal stages of the organism are likely to be refractile to oral treatment.

Avipoxvirus infections in brown kiwi (Apteryx mantelli)

CASE HISTORY

Nodular lesions were found on the skin of two immature brown kiwi (Apteryx mantelli) less than 6 months of age living freely on Ponui Island off the North Island of New Zealand. The lesions were observed during routine external examination undertaken as a part of the management of other research projects, one in 2006 and the other in 2011. Apart from the skin lesions, both birds showed no signs of illness and the lesions resolved spontaneously over a 2-month period.

PATHOLOGICAL FINDINGS

The first case showed several 3-mm diameter firm, brown nodules located on the skin below the hock of both legs. The second case had a single multinodular mass that measured 7×20 mm, on the base of the bill. A portion of the mass and scab samples were collected for diagnosis. Histological examination of the nodules revealed severe ballooning degeneration of keratinocytes and epithelial hyperplasia. Round eosinophilic structures resembling avipoxvirus (APV) intracytoplasmic inclusion bodies (Bollinger bodies) were observed in the layers of keratinocytes. In deeper layers of the epidermis, there was evidence of secondary bacterial growth and inflammation.

DIAGNOSIS

DNA was extracted from tissue samples and subjected to PCR analysis. Avipoxvirus 4b core protein gene was detected in both samples by PCR. Bootstrap analysis of APV 4b core protein gene revealed that APV isolates from two kiwi comprised two different subclades. One isolate displayed 100% sequence homology to subclade B1, and the other presented 100% sequence homology to subclade A3.

CLINICAL RELEVANCE

This study confirmed that kiwi are susceptible to APV infection and that at least two different strains of APV are present in the population examined. Since there is no information on the origin, virulence, or prevalence of APV in kiwi, a seroprevalence study would be useful to elucidate the degree of exposure and immune response to the disease. This would allow a more informed approach to risk management of the disease in wild and captive populations.

Peroxisome morphology in pathology

Peroxisomes are remarkably dynamic and versatile organelles that are essential for human health and development. They respond to physiological changes in the cellular environment by adapting their morphology, number, enzyme content and metabolic functions accordingly. With the discovery of the first key peroxisomal morphology proteins, the investigation of peroxisomal shape, distribution and dynamics has become an exciting new field in cell biology and biomedical sciences because of its relation to organelle functionality and its impact on developmental and physiological processes. In this review, we summarize recent findings on peroxisome biology, dynamics and the modulation of peroxisome morphology, especially in mammals. Furthermore, we discuss the roles of peroxisome dynamics and morphology in cell pathology and present recent examples for alterations in peroxisome morphology under disease conditions. Besides defects in the peroxisomal morphology machinery, we also address peroxisome biogenesis disorders, alterations of peroxisome number during carcinogenesis and liver cirrhosis, and morphological alterations of peroxisomes during viral infection.

Enteric coccidiosis in the brown kiwi (Apteryx mantelli)

Enteric coccidiosis may cause significant morbidity and mortality in juvenile brown kiwi (Apteryx mantelli). Morphology of sporulated oocysts indicates that at least two Eimeria species are able to infect the brown kiwi. A histological study of the endogenous stages of coccidia was undertaken in the intestinal tracts of ten naturally infected young kiwi. Sequential sectioning of the entire intestinal tract allowed identification and recording of the distribution of the various coccidial life stages. Macromeronts measuring 268 × 162 μm when mature were found mainly within the lamina propria of the proximal one third of the small intestine. A smaller form of lamina propria meront was also identified (8.7 × 6.4 μm) with a similar distribution to the macromeronts. Small meronts (4.4 × 3.8 μm) were also identified in mucosal epithelial cells, with the overall peak in distribution within the intestinal tract being distal to the lamina propria meronts. Three morphologically distinctive gametocytes were identified. Type A gametocytes contained within epithelial cells shared the same distribution as the epithelial meronts. Polyps containing large numbers of type B gametocytes within the distal intestinal tract were found in two cases, and type C gametocytes were identified throughout the entire intestinal tract in one case only. The observational nature of this study precludes complete knowledge of the parasite life cycles using histology alone. However, it is likely that each of the three morphologically distinct gametocytes represents a separate species of enteric coccidia.

Use of raptors for biomonitoring of heavy metals: gender, age and tissue selection

The concentrations of cadmium, mercury and lead were determined in liver, kidney and feathers of Accipiter gentilis, Buteo buteo and Strix aluco. No significant differences in the concentrations of metals were observed in relation to either age or gender. Cadmium levels in feathers and in kidney were significantly correlated (p < 0.01 or p < 0.05) in all species. In B. buteo, cadmium concentrations in feathers and in liver were also correlated (p < 0.01), as were the concentrations of lead in feathers and in liver (p < 0.05). The low correlation coefficients let to reject the possibility of predicting metals concentrations in viscera from the concentrations in feathers.