Effect of postbiotic Lactiplantibacillus plantarum LRCC5314 supplemented in powdered milk on type 2 diabetes in mice

Type 2 diabetes (T2D) is a chronic multifactorial disease characterized by a combination of insulin resistance and impaired glucose regulation. The alleviative effects of probiotics on T2D have been widely studied. However, studies on the effects of postbiotics, known as inactivated probiotics, on dairy products are limited. This study aimed to evaluate the effectiveness of postbiotic Lactiplantibacillus plantarum LRCC5314 in milk powder (MP-LRCC5314) in a stress-T2D mouse model. Compared with probiotic MP-LRCC5314, postbiotic MP-LRCC5314 significantly influenced stress-T2D-related factors. The administration of heat-killed MP-LRCC5314 reduced corticosterone levels, increased short-chain fatty acid production by modulating gut microbiota, and regulated immune response, glucose metabolism, stress-T2D-related biomarkers in the brain, gut, and adipose tissues, as well as glucose and insulin sensitivity. Additionally, heat-killed MP-LRCC5314 treatment led to a decrease in pro-inflammatory cytokine levels and an increase in anti-inflammatory cytokine levels. Overall, these findings suggest that adding postbiotic MP-LRCC5314 to milk powder could serve as a potential supplement for stress-T2D mitigation.

For control of COVID-19: the development of regular mass testing of COVID-19 in old age psychiatry wards

Introduction

COVID-19, was declared a pandemic by World Health Organisation on March 11, 2020. Older people with dementia or those with multimorbidity are more vulnerable to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for the development of COVID-19. Given absence of a vaccine or treatment, prevention is the fundamental aspect of COVID-19 control. This requires early identification of contagious people with COVID-19 and isolation keeping them apart from non infected group of people. Early identification of infection in elderly with dementia or functional psychiatric condition is often difficult, due to difficulty in obtaining history or evaluating medical symptoms.

Objectives

1) To establish the current standards of interventions provided at the unit to control COVID-19, with current recommendation by Government guidance. 2) To address difficulties in early identification of people of COVID-19 in Old Age Psychiatry wards. 3) To introduce sustainable interventions aimed at controlling COVID-19 risk, targeted to this group.

Methods

Trust guidance for COVID-19 testing on the ward and guidance of isolation were reviewed. Literature review of currently available scientific evidence for testing for controlling COVID-19 was conducted.

Results

We have created a bi-weekly mass testing guidance for Old Age Psychiatry inpatient wards with clear guidane of when to start isolation and when to stop isolation.

Conclusions

There is no specific interventions to target older adult within our service currently and it was felt that it is necessary to develop a sustainable mass testing programme for this group of people for control of COVID-19.

PIN1 Attenuation Improves Midface Hypoplasia in a Mouse Model of Apert Syndrome

Premature fusion of the cranial suture and midface hypoplasia are common features of syndromic craniosynostosis caused by mutations in the FGFR2 gene. The only treatment for this condition involves a series of risky surgical procedures designed to correct defects in the craniofacial bones, which must be performed until brain growth has been completed. Several pharmacologic interventions directed at FGFR2 downstream signaling have been tested as potential treatments for premature coronal suture fusion in a mouse model of Apert syndrome. However, there are no published studies that have targeted for the pharmacologic treatment of midface hypoplasia. We used Fgfr2^S252W/+ knock-in mice as a model of Apert syndrome and morphometric analyses to identify causal hypoplastic sites in the midface region. Three-dimensional geometric and linear analyses of Fgfr2^S252W/+ mice at postnatal day 0 demonstrated distinct morphologic variance. The premature fusion of anterior facial bones, such as the maxilla, nasal, and frontal bones, rather than the cranium or cranial base, is the main contributing factor toward the anterior-posterior skull length shortening. The cranial base of the mouse model had a noticeable downward slant around the intersphenoid synchondrosis, which is related to distortion of the airway. Within a skull, the facial shape variance was highly correlated with the cranial base angle change along Fgfr2 S252W mutation-induced craniofacial anomalies. The inhibition of an FGFR2 downstream signaling enzyme, PIN1, via genetic knockdown or use of a PIN1 inhibitor, juglone, attenuated the aforementioned deformities in a mouse model of Apert syndrome. Overall, these results indicate that FGFR2 signaling is a key contributor toward abnormal anterior-posterior dimensional growth in the midface region. Our study suggests a novel therapeutic option for the prevention of craniofacial malformations induced by mutations in the FGFR2 gene.

P3521Predicting 30-day mortality and 30-day re-hospitalization risks in patients with heart failure

Background

Heart failure (HF) is the leading cause of hospitalization among persons aged ≥65 years. In the USA, nearly one-quarter of these patients are discharged to skilled nursing facilities (SNFs). These patients are typically older, and have greater mortality and re-hospitalization risks compared with those discharged home. Despite the importance of SNFs as a post-acute care setting for patients with HF, little is known about factors that predict short-term mortality and re-hospitalization in these high risk patients.

Purpose

To develop and validate separate predictive models for 30-day all-cause mortality and 30-day all-cause re-hospitalization among HF patients discharged from acute care hospitals to SNF.

Methods

Using a nationwide dataset including Medicare claims data cross-linked with Minimum Data Set 3.0 (2011–2013), we identified 77,670 hospitalized patients with HF discharged to 11,529 SNFs; we randomly split the patients into development (2/3 of the sample) and validation (1/3 of the sample) cohorts. Using data on patient sociodemographic and clinical characteristics, health service use, functional status, and facility-level factors, we developed separate prediction models for 30-day mortality and 30-day re-hospitalization using logistic regression models in the development cohort.

Results

In the development cohort, the median age of patients was 84 years, 39.6% were men, 83.4% were Caucasian whites. The median Charlson index was 4 and the median length of hospital stay was 6 days. Functional disabilities were prevalent: 80.0% had moderate-to-severe physical limitations and 35.9% moderate or severe cognitive impairment. After admission to SNF, 6.8% died and 24.2% were re-hospitalized within 30 days in the development cohort. Of those who died, 56.1% were re-hospitalized and 13.6% were discharged to home or self-care before their death. Of those who were re-hospitalized, 18.5% were discharged to home or self-care before their readmission. Of 48 potential predictors, 13 patient-level factors remained in the final model for 30-day mortality and 10 patient-level factors for re-hospitalization with good calibration. Among the selected predictors, developing symptoms of dyspnea, having physical limitations, depression severity, BMI, Charlson index, number of hospitalizations in past 6 months and length of hospital stay contributed most. The area under receiver operating characteristic curves were 0.71 for 30-day mortality and 0.63 for re-hospitalization in the validation cohort.

Conclusions

Among HF patients discharged to SNFs, our predictive model based on administrative data may be used to identify those at risk for death within 30 days, which could aid clinicians in improving care during this vulnerable period. Further work identifying factors for re-hospitalization remains needed.

Acknowledgement/Funding

None

Clinical characteristics of pediatric cutaneous lupus erythematosus: experience from a tertiary referral center in Korea

The clinical characteristics of cutaneous lupus erythematosus (CLE) are well delineated in adults, but pediatric data, particularly in Asian populations, are limited. Therefore, we evaluated the characteristics of pediatric cases by retrospectively reviewing the medical records of children with CLE during a 15-year period in a tertiary care dermatology clinic in South Korea. The study included 21 children (8 males and 13 females), 4 of whom had neonatal lupus erythematosus (NLE). Among 17 patients with CLE, discoid lupus erythematosus (DLE) was most common (47.1%), followed by acute CLE (ACLE, 35.3%). All ACLE cases had systemic lupus erythematosus (SLE). Female predominance was conspicuous in ACLE/SLE (6/11 females versus 0/6 males), as was older age, whereas DLE and NLE showed near-equal sex distributions. The median age at the diagnosis of CLE was significantly higher in females than in males (15 years versus 4.5 years, p = 0.02). All patients with ACLE/SLE simultaneously showed skin and systemic symptoms from onset. The kidney was the most commonly involved organ. This study revealed unique characteristics of pediatric CLE, further warranting a comprehensive review among various ethnicities to understand the wide spectrum of CLE in the pediatric population.

Adenosine-loaded dissolving microneedle patches to improve skin wrinkles, dermal density, elasticity and hydration

OBJECTIVE

Although dissolving microneedle patches have been widely studied in the cosmetics field, no comparisons have been drawn with the topical applications available for routine use. In this study, two wrinkle-improving products, adenosine-loaded dissolving microneedle patches and an adenosine cream, were evaluated for efficacy, with respect to skin wrinkling, dermal density, elasticity, and hydration, and safety in a clinical test on the crow's feet area.

METHODS

Clinical efficacy and safety tests were performed for 10 weeks on 22 female subjects with wrinkles around their eyes. The adenosine-loaded dissolving microneedle patch was applied once every 3 days, in the evening, for 8 weeks to the designated crow's feet area. The adenosine cream was applied two times per day, in the morning and evening, for 8 weeks to the other crow's feet area. Skin wrinkling, dermal density, elasticity, and hydration were measured by using PRIMOS^® premium, Dermascan^® C, Cutometer^® MPA580, and Corneometer^® CM 825, respectively. In addition, subjective skin irritation was evaluated by self-observation, and objective skin irritation was assessed through expert interviews.

RESULTS

The adenosine-loaded dissolving microneedle patches had a similar or better efficacy than the adenosine cream. Both groups showed statistically significant efficacy for almost all parameters (P < 0.05). The dissolving microneedle patches had a long-lasting effect on the average wrinkle depth (P < 0.05), only showed efficacy in dermal density (P < 0.05), had an early improving effect on elasticity (P < 0.05), and demonstrated better hydration efficacy (P < 0.001). No adverse effects were observed in either group during the test period.

CONCLUSIONS

In the clinical efficacy test of four skin-improvement parameters, adenosine-loaded dissolving microneedle patches showed the same or better effect than the adenosine cream, although the weekly adenosine dose was 140 times lower. The dissolving microneedle patches caused no adverse reactions. These adenosine-loaded dissolving microneedle patches are expected to be safe, effective, and novel cosmetics for skin improvement.

Direct Gingival Fibroblast/Osteoblast Transdifferentiation via Epigenetics

Alveolar bone resorption caused by trauma or periodontal diseases has represented a challenge for both dental clinicians and researchers. In this study, we evaluate the osteogenic potential of human gingival fibroblasts (HGFs) through a direct transdifferentiation from HGFs to functional osteoblasts via epigenetic modification and osteogenic signaling with bone morphogenetic protein 2 (BMP2) in vitro and in vivo. HGF treatment with 5-aza-2'-deoxycytidine (5-aza-dC) induced demethylation in the hypermethylated CpG islands of the osteogenic lineage marker genes RUNX2 and ALP, and subsequent BMP2 treatment successfully drove the fibroblasts to the osteoblasts' lineage. Cell morphological changes viewed under microscopy and alkaline phosphatase (ALP) and alizarin red S (ARS) staining confirmed the osteoblastic change mediated by epigenetic modification as did real-time polymerase chain reaction (PCR), methylation-specific PCR (MSP), and chromatin immunoprecipitation (ChIP) assay, which demonstrated the altered methylation patterns in the RUNX2 and ALP promoter regions and their effect on gene expression. Furthermore, micro-computed tomography (CT) analysis of in vivo mouse cell transplantation experiments showed high-density signal in the epigenetically modified HGF group; in addition, a significant amount of bone formation was observed in the transplanted material using hematoxylin and eosin (H&E) staining as well. Collectively, our results indicate that epigenetic modification permits the direct programming of HGFs into functional osteoblasts, suggesting that this approach might open a novel therapeutic avenue in alveolar bone regeneration.

A framework for expanding aqueous chemistry in the Community Multiscale Air Quality (CMAQ) model version 5.1

This paper describes the development and implementation of an extendable aqueous-phase chemistry option (AQCHEM -KMT(I)) for the Community Multiscale Air Quality (CMAQ) modeling system, version 5.1. Here, the Kinetic PreProcessor (KPP), version 2.2.3, is used to generate a Rosenbrock solver (Rodas3) to integrate the stiff system of ordinary differential equations (ODEs) that describe the mass transfer, chemical kinetics, and scavenging processes of CMAQ clouds. CMAQ's standard cloud chemistry module (AQCHEM) is structurally limited to the treatment of a simple chemical mechanism. This work advances our ability to test and implement more sophisticated aqueous chemical mechanisms in CMAQ and further investigate the impacts of microphysical parameters on cloud chemistry. Box model cloud chemistry simulations were performed to choose efficient solver and tolerance settings, evaluate the implementation of the KPP solver, and assess the direct impacts of alternative solver and kinetic mass transfer on predicted concentrations for a range of scenarios. Month-long CMAQ simulations for winter and summer periods over the US reveal the changes in model predictions due to these cloud module updates within the full chemical transport model. While monthly average CMAQ predictions are not drastically altered between AQCHEM and AQCHEM-KMT, hourly concentration differences can be significant. With added in-cloud secondary organic aerosol (SOA) formation from biogenic epoxides (AQCHEM-KMTI), normalized mean error and bias statistics are slightly improved for 2-methyltetrols and 2-methylglyceric acid at the Research Triangle Park measurement site in North Carolina during the Southern Oxidant and Aerosol Study (SOAS) period. The added in-cloud chemistry leads to a monthly average increase of 11-18 % in "cloud" SOA at the surface in the eastern United States for June 2013.

Differences between magnitudes and health impacts of BC emissions across the United States using 12 km scale seasonal source apportionment

Recent assessments have analyzed the health impacts of PM2.5 from emissions from different locations and sectors using simplified or reduced-form air quality models. Here we present an alternative approach using the adjoint of the Community Multiscale Air Quality (CMAQ) model, which provides source-receptor relationships at highly resolved sectoral, spatial, and temporal scales. While damage resulting from anthropogenic emissions of BC is strongly correlated with population and premature death, we found little correlation between damage and emission magnitude, suggesting that controls on the largest emissions may not be the most efficient means of reducing damage resulting from anthropogenic BC emissions. Rather, the best proxy for locations with damaging BC emissions is locations where premature deaths occur. Onroad diesel and nonroad vehicle emissions are the largest contributors to premature deaths attributed to exposure to BC, while onroad gasoline emissions cause the highest deaths per amount emitted. Emissions in fall and winter contribute to more premature deaths (and more per amount emitted) than emissions in spring and summer. Overall, these results show the value of the high-resolution source attribution for determining the locations, seasons, and sectors for which BC emission controls have the most effective health benefits.

Association between the extent of urinary albumin excretion and glycaemic variability indices measured by continuous glucose monitoring

AIMS

The contribution of glycaemic variability to the microvascular complication of diabetes has not been established. We examined whether there is an independent association between indices of glycaemic variability in continuous glucose monitoring and extent of albuminuria.

METHODS

A total of 173 patients with Type 2 diabetes (without insulin therapy, n = 96; with insulin therapy, n = 77) who had unexplained large fluctuations in blood glucose values underwent three-day continuous glucose monitoring. We used a multinomial logistic regression model to determine whether the indices of glycaemic variability independently affected the odds of having a spot urine albumin/creatinine ratio of 30-299 mg/g and ≥ 300 mg/g.

RESULTS

Higher standard deviation (P = 0.002), mean of daily differences (P = 0.023) and mean amplitude of glycaemic excursion (P = 0.043) significantly increased the odds of having a urine albumin/creatinine ratio of ≥ 300 mg/g. In multivariable analysis, only higher standard deviation, but not mean amplitude of glycaemic excursion and mean of daily differences, independently increased the odds of having a urine albumin/creatinine ratio of ≥ 300 mg/g (P = 0.025). Coefficient of variation (sd/mean) was not associated with the odds of having a urine albumin/creatinine ratio of 30-299 or ≥ 300 mg/g.

CONCLUSIONS

The independent association between standard deviation and the extent of albuminuria was lost when the measures were normalized by mean glucose level. At least in terms of relative measures of glycaemic variability, we failed to demonstrate an independent association between glycaemic variability and albuminuria extent in patients with inadequately controlled Type 2 diabetes.

Silicon is a frequent component of atmospheric nanoparticles

Nanoparticles are the largest fraction of aerosol loading by number. Knowledge of the chemical components present in nanoparticulate matter is needed to understand nanoparticle health and climatic impacts. In this work, we present field measurements using the Nano Aerosol Mass Spectrometer (NAMS), which provides quantitative elemental composition of nanoparticles around 20 nm diameter. NAMS measurements indicate that the element silicon (Si) is a frequent component of nanoparticles. Nanoparticulate Si is most abundant in locations heavily impacted by anthropogenic activities. Wind direction correlations suggest the sources of Si are diffuse, and diurnal trends suggest nanoparticulate Si may result from photochemical processing of gas phase Si-containing compounds, such as cyclic siloxanes. Atmospheric modeling of oxidized cyclic siloxanes is consistent with a diffuse photochemical source of aerosol Si. More broadly, these observations indicate a previously overlooked anthropogenic source of nanoaerosol mass. Further investigation is needed to fully resolve its atmospheric role.

SU-E-T-421: 6MV Radiation Small Field Dose: Off Axis and Penumbra Effects, a Study with Radiochromic Film

PURPOSE

To accurately determine relative dose factor scaling, tissue depth relation, and penumbra details of small 6MV radiation fields with an emphasis on far-off-central-axis fields for various MLC designs -subject matter important in the context of SRS, FSRT, SBRT, and IMRT.

METHODS

Radiochromic film designed for quantitative dosimetry, EBT3™ film (Ashland Inc.) can be reliably used as a relative dosimeter to within 1% accuracy if one controls for both film and flatbed scanner variation. This enabled a study of the fine detail of small radiation fields and the impact upon these small dose profiles by different MLC designs both on central axis and off. In particular, the impact of leaf-end penumbra from bifocal MLC Optifocus (Siemens) and Synergy Beam Modulator (Elekta) is examined.EBT3 films were placed at 100cm SAD in solid water phantom and irradiated to 200 MU at various depths 1.5cm - 20cm and for various off-axis locations. The films were analysed to give the detailed dosimetric profile of each small field and relate them to both a standard reference field (10 × 10)cm² and to a broadfield flatness/symmetry irradiation (20 × 20)cm² . Films were scanned at ∼20 hours post irradiation on an Epson 2000 flatbed scanner and analysed using FilmQAPro and in-house methods.

RESULTS

As small field size decreases, the field center falls within the penumbra of each MLC edge for megavoltage photon energies. The penumbral effects cause the conventional dosimetric quantity SP to sharply depart from the smooth fieldsize dependence for larger conventional fields.

CONCLUSIONS

Careful characterization of small field dose and leaf end modeling within a TPS is crucial in both predicting accurate small field dosimetry and off-axis dosimetry.

Retinyl retinoate, a novel hybrid vitamin derivative, improves photoaged skin: a double-blind, randomized-controlled trial

BACKGROUND

All-trans-retinoic acid (RA) and all-trans-retinol (ROL) are not widely used as anti-wrinkle agents due to their irritancy and photo-stability, respectively. Therefore, the safety and photo-stability in the development of RA or ROL derivatives have been an important issue.

AIM

To identify the efficacy of retinyl retinoate as an anti-aging agent of cosmetics in treating females over 30 years old with periorbital wrinkles.

METHODS

The clinical study was a prospective, double-blind, randomized, and controlled study with a total of 11 Korean women. At every 4 weeks, the effectiveness was assessed with a global photodamage score, photographs, and image analysis using replicas and visiometers. The dermal distance and intensity was also evaluated using Dermascan C.

RESULTS

A statistically significant improvement in facial wrinkles (P<0.05) in eleven volunteers was observed in a clinical trial. The successive application of 0.06% retinyl retinoate cream for 3 months showed decreased depth and area of wrinkles in comparison with 0.075% retinol cream. The visual wrinkle improvement and the maximum roughness improvement rate (R2) for retinyl retinoate cream were 22% higher than that of retinol cream after 12 weeks. A statistically significant increase was observed after 8 and 4 weeks for dermal distance and dermal intensity, respectively (P<0.05).

CONCLUSIONS

Retinyl retinoate had characteristic features of new anti-aging agents, and effectively improved facial wrinkle conditions.

Phase II study of fixed-dose-rate infusion of gemcitabine and UFT combination chemotherapy in patients with advanced bile duct cancer: Daegu Gyeoungbuk Oncology Group

280

Background: This phase II study evaluated efficacy of fixed dose rate (FDR) infusion of gemcitabine (10mg/m2/min) and UFT combination in chemo-naïve patients with advanced bile duct cancer.

Methods: This was an open-label, single-arm, multicenter, phase II study with a Simon two-stage minimax design. Patients received the FDR gemcitabine 1,000mg/m2 for 3 consecutive weeks and UFT 400 mg/m2 on days 1-21. The cycle was repeated every 28 days. The primary end point was Response Evaluation Criteria in Solid Tumors (RECIST) -defined objective response rate. Secondary end points included clinical benefit response (CBR), safety, progression-free survival (PFS), and overall survival (OS). Clinical characteristics including four single nucleotide polymorphisms in DNA repair genes (RecQ1, RAD54L, XRCC1, ATM) were evaluated whether these influence the overall survival.

Results: Between December 2006 and February 2008, fifty-one patients were enrolled, with a median age of 58 years. The majority of patients (76%) had intra-hepatic disease. Fourteen patients (27%) had a RECIST investigator-assessed, partial response (PR); disease control rate (PR + stable disease) was 55%. CBR was 14% among 37 evaluable patients. Hematologic toxicity was main grade 3 or 4 treatment-related adverse events. Median PFS was 4.0 months (95% CI, 2.9 to 5.1 months). Median OS was 7.0 months (95% CI, 3.5 to 10.5 months). Intrahepatic disease, poor performance, and, XRCC1 R194W C/C type were predictive markers of poor overall survival.

Conclusions: FDR gemcitabine and UFT demonstrated apparent activity in patients with advanced bile duct cancer. However, this activity did not translate to prolong survival. The location of disease, performance status, and, polymorphic variants of DNA repair genes may affect clinical outcome of patients with advanced bile duct cancer.

No significant financial relationships to disclose.

Predictors of survival in patients with refractory metastatic colorectal cancer

583

Background: The survival of patients (pts) with metastatic colorectal cancer (mCRC) refractory to three active drugs including fluoropyrimidine, oxaliplatin and irinotecan is very limited but highly variable. Since estimating life expectancy is important for palliative intervention and advanced care planning, we aimed to suggest a model for improved prognostication of pts with mCRC.

Methods: We retrospectively reviewed 185 pts with mCRC who had been treated with fluoropyrimidine, oxaliplatin and irinotecan with no response to treatment since 2008.

Results: Of 185 pts, there were 104 (56.2%) males and 81 (43.8%) females. The median age was 58 years (range, 23-84 years). Additional cetuximab treatment was given in 43 (23.2%) pts. The median overall survival was 4.82 months. There were seven independent variables with a relationship to survival: performance status (hazard ratio [HR], 1.78; 95% confidence interval [CI], 1.31 to 2.42; p<0.001), resection of primary tumor (HR, 1.55; 95% CI, 1.04 to 2.31; p=0.033), histologic type (HR, 2.54; 95% CI, 1.59 to 4.06; p<0.001), neutrophil/lymphocyte ratio (HR, 1.62; 95% CI, 1.14 to 2.30; p=0.007), serum hemoglobin level (HR, 1.42; 95% CI, 1.02 to 1.96; p=0.035), serum albumin level (HR, 2.33; 95% CI, 1.38 to 3.92; p=0.001) and sum of metastasis site (HR, 2.00; 95% CI, 1.39 to 2.86; p<0.001). By combining these risk factors, pts with mCRC could be categorized into three different groups (Table). There was a significant difference in survival duration between the groups. (p<0.001).

Conclusions: Seven prognostic factors predicting survival were identified and used to categorize mCRC Pts who had been treated with fluoropyrimidine, oxaliplatin and irinotecan into three prognostic groups.

[Table: see text]

No significant financial relationships to disclose.