The effect of microbiome therapy on COVID-19-induced gut dysbiosis: A narrative and systematic review

AIMS

Emerging evidence highlights the role of COVID-19 in instigating gut dysbiosis, with repercussions on disease severity and bidirectional gut-organ communication involving the lung, heart, brain, and liver. This study aims to evaluate the efficacy of probiotics, prebiotics, synbiotics, and fecal microbiota transplantation (FMT) in addressing gut dysbiosis associated with COVID-19, as well as their impact on related disease severity and clinical outcomes.

MATERIALS AND METHODS

We systematically review 27 studies exploring the efficacy of different microbiome-modulating therapies: probiotics, prebiotics, synbiotics, and fecal microbiota transplantation as potential interventions for COVID-19.

KEY FINDINGS

The probiotics and synbiotics investigated encompassed a spectrum of eight bacterial and fungal genera, namely Lactobacillus, Bifidobacterium, Streptococcus, Enterococcus, Pediococcus, Bacillus, Saccharomyces, and Kluyveromyces. Noteworthy prebiotics employed in these studies included chestnut tannin, galactooligosaccharides, fructooligosaccharides, xylooligosaccharide, and resistant dextrin. The majority of the investigated biotics exhibited positive effects on COVID-19 patients, manifesting in symptom alleviation, inflammation reduction, and notable decreases in mortality rates. Five studies reported death rates, showing an average mortality ranging from 0 % to 11 % in the intervention groups, as compared to 3 % to 30 % in the control groups. Specifically, probiotics, prebiotics, and synbiotics demonstrated efficacy in diminishing the duration and severity of symptoms while significantly accelerating viral and symptomatic remission. FMT emerged as a particularly effective strategy, successfully restoring gut microbiota and ameliorating gastrointestinal disorders.

SIGNIFICANCE

The insights gleaned from this review significantly contribute to our broader comprehension of the therapeutic potential of biotics in addressing COVID-19-related gut dysbiosis and mitigating secondary multi-organ complications.

Serum Tumor Markers and Outcomes in Patients With Appendiceal Adenocarcinoma

Importance

Serum tumor markers carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), and cancer antigen 125 (CA125) have been useful in the management of gastrointestinal and gynecological cancers; however, there is limited information regarding their utility in patients with appendiceal adenocarcinoma.

Objective

To assess the association of serum tumor markers (CEA, CA19-9, and CA125) with clinical outcomes and pathologic and molecular features in patients with appendiceal adenocarcinoma.

Design, Setting, and Participants

This is a retrospective cohort study at a single tertiary care comprehensive cancer center. The median (IQR) follow-up time was 52 (21-101) months. Software was used to query the MD Anderson internal patient database to identify patients with a diagnosis of appendiceal adenocarcinoma and at least 1 tumor marker measured at MD Anderson between March 2016 and May 2023. Data were analyzed from January to December 2023.

Main Outcomes and Measures

Association of serum tumor markers with survival in patients with appendiceal adenocarcinoma. Cox proportional hazards regression analyses were also performed to assess associations between clinical factors (serum tumor marker levels, demographics, and patient and disease characteristics) and patient outcomes (overall survival).

Results

A total of 1338 patients with appendiceal adenocarcinoma were included, with a median (range) age at diagnosis of 56.5 (22.3-89.6) years. The majority of the patients had metastatic disease (1080 patients [80.7%]). CEA was elevated in 742 of the patients tested (56%), while CA19-9 and CA125 were elevated in 381 patients (34%) and 312 patients (27%), respectively. Individually, elevation of CEA, CA19-9, or CA125 were associated with worse 5-year survival; elevated vs normal was 81% vs 95% for CEA (hazard ratio [HR], 4.0; 95% CI, 2.9-5.6), 84% vs 92% for CA19-9 (HR, 2.2; 95% CI, 1.4-3.4), and 69% vs 93% for CA125 (HR, 4.6; 95% CI, 2.7-7.8) (P < .001 for all). Quantitative evaluation of tumor markers was associated with outcomes. Patients with highly elevated (top 10th percentile) CEA, CA19-9, or CA125 had markedly worse survival, with 5-year survival rates of 59% for CEA (HR, 9.8; 95% CI, 5.3-18.0), 64% for CA19-9 (HR, 6.0; 95% CI, 3.0-11.7), and 57% for CA125 (HR, 7.6; 95% CI, 3.5-16.5) (P < .001 for all). Although metastatic tumors had higher levels of all tumor markers, when restricting survival analysis to 1080 patients with metastatic disease, elevated CEA, CA19-9, or CA125 were all still associated worse survival (HR for CEA, 3.4; 95% CI, 2.5-4.8; P < .001; HR for CA19-9, 1.8; 95% CI, 1.2-2.7; P = .002; and HR for CA125, 3.9; 95% CI, 2.4-6.4; P < .001). Interestingly, tumor grade was not associated with CEA or CA19-9 level, while CA-125 was slightly higher in high-grade tumors relative to low-grade tumors (mean value, 18.3 vs 15.0; difference, 3.3; 95% CI, 0.9-3.7; P < .001). Multivariable analysis identified an incremental increase in the risk of death with an increase in the number of elevated tumor markers, with an 11-fold increased risk of death in patients with all 3 tumor markers elevated relative to those with none elevated. Somatic mutations in KRAS and GNAS were associated with significantly higher levels of CEA and CA19-9.

Conclusions and Relevance

In this retrospective study of serum tumor markers in patients with appendiceal adenocarcinoma, CEA, CA19-9, and CA125 were associated with overall survival in appendiceal adenocarcinoma. Given their value, all 3 biomarkers should be included in the initial workup of patients with a diagnosis of appendiceal adenocarcinoma.

Impact of KRAS mutations and co-mutations on clinical outcomes in pancreatic ductal adenocarcinoma

The relevance of KRAS mutation alleles to clinical outcome remains inconclusive in pancreatic adenocarcinoma (PDAC). We conducted a retrospective study of 803 patients with PDAC (42% with metastatic disease) at MD Anderson Cancer Center. Overall survival (OS) analysis demonstrated that KRAS mutation status and subtypes were prognostic (p < 0.001). Relative to patients with KRAS wildtype tumors (median OS 38 months), patients with KRASG12R had a similar OS (median 34 months), while patients with KRASQ61 and KRASG12D mutated tumors had shorter OS (median 20 months [HR: 1.9, 95% CI 1.2-3.0, p = 0.006] and 22 months [HR: 1.7, 95% CI 1.3-2.3, p < 0.001], respectively). There was enrichment of KRASG12D mutation in metastatic tumors (34% vs 24%, OR: 1.7, 95% CI 1.2-2.4, p = 0.001) and enrichment of KRASG12R in well and moderately differentiated tumors (14% vs 9%, OR: 1.7, 95% CI 1.05-2.99, p = 0.04). Similar findings were observed in the external validation cohort (PanCAN's Know Your Tumor® dataset, n = 408).

The relative prevalence of the Omicron variant within SARS-CoV-2 infected cohorts in different countries: A systematic review

The Omicron variant of SARS-CoV-2 was detected in October 2021 and exhibited high transmissibility, immune evasion, and reduced severity when compared to the earlier variants. The lesser vaccine effectiveness against Omicron and its reduced severity created vaccination hesitancy among the public. This review compiled data reporting the relative prevalence of Omicron as compared to the early variants to give an insight into the existing variants, which may shape the decisions regarding the targets of the newly developed vaccines. Complied data revealed more than 90% prevalence within the infected cohorts in some countries. The BA.1 subvariant predominated over the BA.2 during the early stages of the Omicron wave. Moreover, BA.4/BA.5 subvariants were detected in South Africa, USA and Italy between October 2021 and April 2022. It is therefore important to develop vaccines that protect against Omicron as well as the early variants, which are known to cause more severe complications.

Statistically learning the functional landscape of microbial communities

Microbial consortia exhibit complex functional properties in contexts ranging from soils to bioreactors to human hosts. Understanding how community composition determines function is a major goal of microbial ecology. Here we address this challenge using the concept of community-function landscapes-analogues to fitness landscapes-that capture how changes in community composition alter collective function. Using datasets that represent a broad set of community functions, from production/degradation of specific compounds to biomass generation, we show that statistically inferred landscapes quantitatively predict community functions from knowledge of species presence or absence. Crucially, community-function landscapes allow prediction without explicit knowledge of abundance dynamics or interactions between species and can be accurately trained using measurements from a small subset of all possible community compositions. The success of our approach arises from the fact that empirical community-function landscapes appear to be not rugged, meaning that they largely lack high-order epistatic contributions that would be difficult to fit with limited data. Finally, we show that this observation holds across a wide class of ecological models, suggesting community-function landscapes can be efficiently inferred across a broad range of ecological regimes. Our results open the door to the rational design of consortia without detailed knowledge of abundance dynamics or interactions.

The Clinical Significance of CEA, CA19-9, and CA125 in Management of Appendiceal Adenocarcinoma

Importance

Serum tumor markers CEA, CA19-9, & CA125 have been useful in the management of gastrointestinal and gynecological cancers, however there is limited information regarding their utility in patients with appendiceal adenocarcinoma.

Objective

Assessing the association of serum tumor markers (CEA, CA19-9, and CA125) with clinical outcomes, pathologic, and molecular features in patients with appendiceal adenocarcinoma.

Design

This is a retrospective study with results reported in 2023. The median follow-up time was 43 months.

Setting

Single tertiary care comprehensive cancer center.

Participants

Under an approved Institutional Review Board protocol, the Palantir Foundry software system was used to query the MD Anderson internal patient database to identify patients with a diagnosis of appendiceal adenocarcinoma and at least one tumor marker measured at MD Anderson between 2016 and 2023.

Results

A total of 1,338 patients with appendiceal adenocarcinoma were included, with a median age of 56.5 years. The majority of the patients had metastatic disease (80.7%). CEA was elevated in more than half of the patients tested (56%), while CA19-9 and CA125 were elevated in 34% and 27%, respectively. Individually, elevation of CEA, CA19-9, or CA125 were associated with worse 5-year survival; 82% vs 95%, 84% vs 92%, and 69% vs 93% elevated vs normal for CEA, CA19-9, and CA125 respectively (all p<0.0001). Quantitative evaluation of tumor markers increased prognostic ability. Patients with highly elevated (top 10th percentile) CEA, CA19-9 or CA125 had markedly worse survival with 5-year survival rates of 59%, 64%, and 57%, respectively (HR vs. normal : 9.8, 6.0, 7.6, all p<0.0001). Although metastatic tumors had higher levels of all tumor markers, when restricting survival analysis to 1080 patients with metastatic disease elevated CEA, CA19-9 or CA125 were all still associated worse survival (HR vs. normal : 3.4, 1.8, 3.9, p<0.0001 for CEA and CA125, p=0.0019 for CA19-9). Interestingly tumor grade was not associated with CEA or CA19-9 level, while CA-125 was slightly higher in high relative to low-grade tumors (18.3 vs. 15.0, p=0.0009). Multivariable analysis identified an incremental increase in the risk of death with an increase in the number of elevated tumor markers, with a 11-fold increased risk of death in patients with all three tumor markers elevated relative to those with none elevated. Mutation in KRAS and GNAS were associated with significantly higher levels of CEA and CA19-9.

Conclusions

These findings demonstrate the utility of measuring CEA, CA19-9, and CA125 in the management of appendiceal adenocarcinoma. Given their prognostic value, all three biomarkers should be included in the initial workup of patients diagnosed with appendiceal adenocarcinoma.

Impact of KRAS Mutations and Co-mutations on Clinical Outcomes in Pancreatic Ductal Adenocarcinoma

The relevance of KRAS mutation alleles to clinical outcome remains inconclusive in pancreatic adenocarcinoma (PDAC). We conducted a retrospective study of 803 PDAC patients (42% with metastatic disease) at MD Anderson Cancer Center. Overall survival (OS) analysis demonstrated that KRAS mutation status and subtypes were prognostic (p<0.001). Relative to patients with KRAS wildtype tumors (median OS 38 months), patients with KRASG12R had a similar OS (median 34 months), while patients with KRASQ61 and KRASG12D mutated tumors had shorter OS (median 20 months [HR: 1.9, 95% CI 1.2-3.0, p=0.006] and 22 months [HR: 1.7, 95% CI 1.3-2.3, p<0.001], respectively). There was enrichment of KRASG12D mutation in metastatic tumors (34% vs 24%, OR: 1.7, 95% CI 1.2-2.4, p=0.001) and enrichment of KRASG12R in well and moderately differentiated tumors (14% vs 9%, OR: 1.7, 95% CI 1.05-2.99, p=0.04). Similar findings were observed in the external validation cohort (PanCAN's Know Your Tumor® dataset, n=408).

Sentinel lymph node biopsy in a resourcelimited setting: a retrospective comparison of sentinel lymph node biopsy before and after the introduction of Sentimag at an academic breast unit

BACKGROUND

Sentinel lymph node biopsy (SLNB) is performed for staging and prognostication of breast cancer (BC) in cases with a clinically and radiologically negative axilla. Using blue dye and a radioactive colloid injection is considered the gold standard for SLNB. This study aims to evaluate the SLNB outcomes before and after the introduction of Sentimag at an academic breast unit. Sentimag uses an injection of superparamagnetic iron oxide which is then detected in the sentinal lymph node using a magnetometer.

METHODS

A retrospective cohort study was performed comparing SLNBs done from 1 January 2017 to 31 December 2018. During 2017, a nuclear medicine technique was used for all SLNBs, while the Sentimag system was used in 2018.

RESULTS

There was no difference between the two groups comparing age, T-stage, size of tumour, and molecular status. The only statistically significant difference found was more higher-grade tumours in the group where a nuclear medicine technique was used in 2017 (p = 0.04). There was no difference in the type of surgery performed comparing mastectomy and breast-conserving surgery rates between the two groups. There was an 11% increase in the number of patients who had an SLNB done with the Sentimag technique (2018). In 2017, 42% (58/139) had an SLNB and in 2018, 53% (59/112) had an SLNB.

CONCLUSION

This result demonstrates the feasibility of the magnetic technique for SLNB in a resource-limited setting. This new method shows promise as a safe and effective technique for SLNB - it is a valuable alternative in the absence of nuclear medicine (N.Med) facilities.

Early-Life Microbial Restitution Reduces Colitis Risk Promoted by Antibiotic-Induced Gut Dysbiosis in Interleukin 10-/- Mice

BACKGROUND & AIMS

Perturbations in the early-life gut microbiome are associated with increased risk for complex immune disorders like inflammatory bowel diseases. We previously showed that maternal antibiotic-induced gut dysbiosis vertically transmitted to offspring increases experimental colitis risk in interleukin (IL) 10 gene deficient (IL10-/-) mice, a finding that may result from the loss/lack of essential microbes needed for appropriate immunologic education early in life. Here, we aimed to identify key microbes required for proper development of the early-life gut microbiome that decrease colitis risk in genetically susceptible animals.

METHODS

Metagenomic sequencing followed by reconstruction of metagenome-assembled genomes was performed on fecal samples of IL10-/- mice with and without antibiotic-induced dysbiosis to identify potential missing microbial members needed for immunologic education. One high-value target strain was then engrafted early and/or late into the gut microbiomes of IL10-/- mice with antibiotic-induced dysbiosis.

RESULTS

Early-, but not late-, life engraftment of a single dominant Bacteroides strain of non-antibiotic-treated IL10-/- mice was sufficient to restore the development of the gut microbiome, promote immune tolerance, and prevent colitis in IL10-/- mice that had antibiotic-induced dysbiosis.

CONCLUSIONS

Restitution of a keystone microbial strain missing in the early-life antibiotic-induced gut dysbiosis results in recovery of the microbiome, proper development of immune tolerance, and reduced risk for colitis in genetically prone hosts.

Functional and genetic markers of niche partitioning among enigmatic members of the human oral microbiome

INTRODUCTION

Microbial residents of the human oral cavity have long been a major focus of microbiology due to their influence on host health and intriguing patterns of site specificity amidst the lack of dispersal limitation. However, the determinants of niche partitioning in this habitat are yet to be fully understood, especially among taxa that belong to recently discovered branches of microbial life.

RESULTS

Here, we assemble metagenomes from tongue and dental plaque samples from multiple individuals and reconstruct 790 non-redundant genomes, 43 of which resolve to TM7, a member of the Candidate Phyla Radiation, forming six monophyletic clades that distinctly associate with either plaque or tongue. Both pangenomic and phylogenomic analyses group tongue-specific clades with other host-associated TM7 genomes. In contrast, plaque-specific TM7 group with environmental TM7 genomes. Besides offering deeper insights into the ecology, evolution, and mobilome of cryptic members of the oral microbiome, our study reveals an intriguing resemblance between dental plaque and non-host environments indicated by the TM7 evolution, suggesting that plaque may have served as a stepping stone for environmental microbes to adapt to host environments for some clades of microbes. Additionally, we report that prophages are widespread among oral-associated TM7, while absent from environmental TM7, suggesting that prophages may have played a role in adaptation of TM7 to the host environment.

CONCLUSIONS

Our data illuminate niche partitioning of enigmatic members of the oral cavity, including TM7, SR1, and GN02, and provide genomes for poorly characterized yet prevalent members of this biome, such as uncultivated Flavobacteriaceae.

Long-term outcome after endoscopic ligation of acute esophageal variceal bleeding in patients with liver cirrhosis

Endoscopic variceal ligation (EVL) has been the standard treatment for acute variceal bleeding (AVB). However, reports of long-term prognosis after EVL are scarce. Therefore, the current work aimed to investigate the long-term outcome and prognostic modifiers of cirrhotic cases presented with acute esophageal variceal bleeding and managed with EVL. The current prospective work comprised primarily 276 consecutive grown-up cirrhotic cases presenting with AVB and managed with EVL. Two-hundred patients who completed the study till death or 3-year follow-up were enrolled in final analysis. The primary outcome measure was occurrence of rebleeding and all-cause mortality. By the end of follow up 56 patients (28%) developed rebleeding and 78 (39%) died. The independent factors associated with rebleeding were lacking follow up EVL (OR: 4.8, 95%CI: 1.9-12.2), BMI > 30 kg/m2 (OR: 0.-, 95%CI: 0.2-0.9), Child class C (OR: 3.8, 95%CI: 1.8-7.8), and grade IV varices (OR: 2.6, 95%CI: 1.3-5.3). The independent factors associated with mortality were: Age > 65 years (OR: 32.4, 95%CI: 8.7-120.3), rebleeding (OR: 98.4, 95%CI: 27.9-347.0), coexistence of HCC (OR: 7.4, 95%CI: 2.0-27.4), and lacking follow up EVL (OR: 6.1, 95%CI: 1.2-31.1). Recurrent bleeding after emergency endoscopic ligation of acute esophageal variceal bleeding in cirrhotic cases is a rather common complication that significantly increases the mortality rate. The liver condition, lack of follow up endoscopy, old age, and severity of esophageal varices are independent prognostic indicator of rebleeding and morality.

Mapping the Brain's electric fields with Magnetoelectric nanoparticles

Background

Neurodegenerative diseases are devastating diagnoses. Examining local electric fields in response to neural activity in real time could shed light on understanding the origins of these diseases. To date, there has not been found a way to directly map these fields without interfering with the electric circuitry of the brain. This theoretical study is focused on a nanotechnology concept to overcome the challenge of brain electric field mapping in real time. The paper shows that coupling the magnetoelectric effect of multiferroic nanoparticles, known as magnetoelectric nanoparticles (MENs), with the ultra-fast and high-sensitivity imaging capability of the recently emerged magnetic particle imaging (MPI) can enable wirelessly conducted electric-field mapping with specifications to meet the requirements for monitoring neural activity in real time.

Methods

The MPI signal is numerically simulated on a realistic human brain template obtained from BrainWeb, while brain segmentation was performed with BrainSuite software. The finite element mesh is generated with Computer Geometry Algorithm Library. The effect of MENs is modeled through local point magnetization changes according to the magnetoelectric effect.

Results

It is shown that, unlike traditional magnetic nanoparticles, MENs, when coupled with MPI, provide information containing electric field's spatial and temporal patterns due to local neural activity with signal sensitivities adequate for detection of minute changes at the sub-cellular level corresponding to early stage disease processes.

Conclusions

Like no other nanoparticles known to date, MENs coupled with MPI can be used for mapping electric field activity of the brain at the sub-neuronal level in real time. The potential applications span from prevention and treatment of neurodegenerative diseases to paving the way to fundamental understanding and reverse engineering the brain.

One Metarhizium brunneum Strain, Two Uses to Control Ceratitis capitata (Diptera: Tephritidae)

We determined the virulence and insecticidal activity of the hypocrealean fungus Metarhizium brunneum (Petch) strain EAMb 09/01-Su and its crude extract against Mediterranean fruit fly Ceratitis capitata Wiedemann (Diptera: Tephritidae) and we evaluated the combined use of the fungus with its crude extract. We also determined the effect of fermentation time, temperature, and initial pH of the M. brunneum culture medium on the insecticidal activity of the crude extract. When C. capitata adults were sprayed with a conidial suspension, the strain EAMb 09/01-Su caused 100% mortality with a mean lethal time (LT50) of 5.6 d and mean lethal concentration (LC50) of 2.84 f#x2013; 10(7) conidia per milliliter. Fermentation time significantly affected the lethality of the crude extract when it was provided to C. capitata per os. The highest level of mortality (73.3%) and the shortest median survival time (25.5 h) was obtained from 15-d-old cultures. The crude extract was demonstrated to be thermostable, given that the mortality was >50% at 48 h when the extract had been heated to 100°C for 3 h. Lastly, the optimum initial pH for maximum crude extract activity in terms of mortality ranged between 7 and 9. Additivity was observed for all M. brunneum EAMb 09/01-Su strain crude extract combinations tested, indicating compatibility between products. We concluded that the M. brunneum EAMb 09/01-Su strain is a promising tool for medfly control alone or in combination with its crude extract.

Beauveria bassiana (Ascomycota: Hypocreales) wound dressing for the control of Euzophera pinguis (Lepidoptera: Pyralidae)

Injury to olive tree trunks and branches because of biotic and abiotic factors, such as pruning and mechanical harvesting, attracts the olive pyralid moth Euzophera pinguis Haworth (Lepidoptera: Pyralidae). This moth has become increasingly important in the Mediterranean region during recent years. The use of an entomopathogenic fungus for wound dressing for pest control is reported for the first time in this study. Beauveria bassiana (Ascomycota: Hypocreales) strain EABb 08/04-Ep was originally obtained from a diseased E. pinguis larva and has shown effective E. pinguis control in an olive crop in Jaén, Andalusia, Spain, under field conditions during the spring and fall of 2008 and 2009 and the spring of 2011. Experimental artificial 30 by 30-mm square wound cages were large enough to allow the E. pinguis females to oviposit. Approximately 80 and 40-60% of the control wounds contained live larvae in the experiments that occurred during the spring and fall, respectively. The B. hassiana wound dressing gave similar results as the chlorpyrifos wound dressing throughout the experiment, with efficacies reaching 80-85% in the spring and 90-95% in the autumn. The B. bassiana fungus was recovered from 60-90% of the wounds at the completion of the experiments and after 60 d of treatment. These data indicate that strain EABb 08/04-Ep applied to the pruning wounds can be an effective tool for the microbial control of E. pinguis in olive crops. Moreover, B. bassiana may be used within integrated pest management strategies to minimize chemicals, depending on the population density of the pyralid moth.

Biocontrol of Bactrocera oleae (Diptera: Tephritidae) with Metarhizium brunneum and its extracts

The susceptibility of preimaginal and adult olive fruit fly, Bactrocera oleae (Gmelin) (Diptera: Tephritidae), to a strain of the mitosporic ascomycete Metarhizium brunneum (Petch) (Hypocreales: Clavicipitaceae) and the insecticidal activity of its crude extract to olive fruit fly adults were investigated. Strain EAMb 09/01-Su caused 60% mortality to B. oleae adults, with average survival time (AST) of 8.8 d. In soil treatments against pupariating third-instar larvae, preimaginal B. oleae mortality reached 82.3%, whereas preimaginal mortality targeting puparia was 33.3%. The crude extract of EAMb 09/01-Su strain caused 80.0% adult mortality when administered per os, with AST of 27.7 h. The crude extract was demonstrated to be quite thermostable and photoresistant. These results indicate that M. brunneum EAMb 09/01-Su strain and its crude extract show potential to be used in an integrated pest management olive fruit fly management strategy targeting both adults and preimaginals.

Comparison the effects of metoclopramide and dropridol associated with dexamethasone on post operative nausea and vomiting

The aim of study was, comparison of effects of Metoclopramide and Dropridol associated with Dexamethasone on prevalence of nausea and vomiting after operation was considered. In this study 160 patients ASA physical status I were divided into two groups. In both groups, premedication and induction of anesthesia were given equally according to weight. To the first group, Metoclopramide associated with Dexamethasone and to the second group, Dropridol associated with Dexamethasone was ordered. At the end of the operation, after removing tracheal tube, prevalence of nausea and vomiting in both groups was considered after 2 h and results were analyzed with t-test and Chi-square. Ratio of nausea and vomiting after operation in the first group was 24% and in the second 8%. So results show that prevalence of nausea and vomiting in the second group was considerably lower than the first group (p < 0.004). According to the results of this study our conclusion, Dropridol with dexamethasone given at the before of general anesthesia was more effective in decreasing the prevalence of nausea and vomiting in patients compared with metoclopramide with dexamethasone.

Targeted metabolomics and mass spectrometry

While a great emphasis has been placed on global metabolomic analysis in recent years, the application of metabolomic style analyses to specific subsets of compounds (targeted metabolomics) also has merits in addressing biological questions in a more hypothesis-driven manner. These analyses are designed to selectively extract information regarding a group of related metabolites from the complex mixture of biomolecules present in most metabolomic samples. Furthermore, targeted metabolomics can also be applied to metabolism within macromolecules, hence furthering the systems biology impact of the analysis. This chapter describes the difference between the global metabolomics approach and the undertaking of metabolomics in a targeted manner and describes the application of this type of analysis in a number of biologically and medically relevant fields.

Determinants of deforestation in Nepal's Central Development Region

The process of deforestation in the Central Development Region (CDR) of Nepal is diverse in space and time, with rapid deforestation still occurring in areas outside the national parks and wildlife reserves. This paper identifies the spatial driving forces (SDFs) of deforestation in the CDR for 1975-2000 using satellite data of 1975 (MSS), 1990 (TM), and 2000 (ETM+) along with socio-demographic and socioeconomic variables. Radiometrically calibrated satellite images are individually classified into seven distinct classes and merged together to cover the entire CDR. Classification accuracies are also assessed. Areas of land use and cover within the areas of each Village Development Committee (VDC) and municipality represented by GIS polygons are calculated from the classified images by overlaying vector files of 1845 polygons representing sections of VDCs and municipalities in 30-1199 m, 1200-2399 m, 2400-4999 m and >5000 m elevation levels. These elevation levels were estimated from the DEM compiled from 24 ASTER scenes taken on different dates. Only the first three elevation levels are used in the analysis because area >5000 m is under permanent snow cover where human related forestry activities are almost negligible. A transition matrix is generated for 1975-1990 using classified images of 1975 and 1990 and then this product is used to further develop another transition matrix for 1990-2000 with the classified ETM+ 2000 images as the final stage. The GIS polygon layer is overlaid on the transition matrices to calculate deforestation areas for 1975-1990 and 1990-2000. Biophysical and socioeconomic information collected from various sources is then brought into a GIS platform for statistical analyses. Six linear regression models are estimated using SAS; in effect, two models for each elevation range representing the 1975-1990 and 1990-2000 periods of change to identify SDF influences on deforestation. These regression analyses reveal that deforestation in the CDR is related to multiple factors, such as farming population, genders of various ages, migration, elevation, road, distance from road to forest, meandering and erosion of river, and most importantly the conversion of forestland into farmland.

Electrocardiographic changes in obstructive sleep apnea syndrome

The acute electrocardiographic changes during apneic episodes in patients with sleep apnea are well known. Long-term electro-cardiographic changes in these patients are not well studied. We conducted a retrospective case-control study to assess the electrocardiographic changes in African-American patients with established obstructive sleep apnea syndrome (OSA). A significant percentage of patients with OSA had abnormal EKGs as compared to the control group. The effect of sleep apnea on the cardiovascular system is more complex in African-Americans due to higher prevalence of co-morbid conditions. Seventy-three percent of our patients with OSA had metabolic syndrome.

Severe febrile systemic reaction to pneumococcal vaccine

Polyvalent pneumococcal polysaccharide vaccine (Pneumovax, PPV) has been shown to substantially reduce the risk of Streptococcus pneumoniae infections in susceptible individuals. Side effects, such as mild local erythema, induration, pain and fever, have been reported with various frequencies. Rarely, systemic symptoms, including high fever, headache, nausea and photophobia, have been reported in the literature. This case report describes a 38-year-old male who developed severe and prolonged local and systemic symptoms necessitating hospitalization following a dose of pneumovax.

Bronchioloalveolar carcinoma in African Americans

PURPOSE

To review the clinical and pathophysiologicol features of bronchioloalveolar carcinoma (BAC) in African Americans.

PATIENTS AND METHODS

This is a retrospective review of 19 cases of BAC at Howard University Hospital between 1984 and 1999. Twenty-seven cases were identified. Medical records of 19 patients (15 men and four women) were available for review. The pathological reports were reviewed. The clinical and pathological features of this disease were compared with another study by Feldman et al. from the Mayo Clinic reporting 25 Send patients (predominantly Caucasians) with metastatic BAC.

RESULTS

Of 835 cases of lung cancers diagnosed at our institution between 1984 and 1999, 27 cases of BAC were identified. Only 19 charts were available for review from the Howard University (HU) tumor registry. These were not consecutive cases. Four of 19 (21%) HU cases were nonsmokers compared to eight of 25 (32%) Mayo cases p = 0.51). Productive cough was the most common symptom in both HU and Mayo patients, and was less common in HU patients than Mayo patients (26% versus 68%: P = 0.008). In contrast, hemoptysis occurred in 16% of patients in both institutions (p = 1.00). Other studies have reported cough to be mostly nonproductive. Pathological review showed mucinous BAC accounting for 21% (four cases), nonmucinous for 68% (13 cases), and sclerotic for 10% (two) of cases. Earlier studies have reported 50% incidence of mucinous BAC. Sixteen had surgical resections (eight wedge, seven lobectomy, one segmentectomy). Eight patients received radiotherapy. Response to chemotherapy was poor, with average survival of nine months. Overall, average survival was 23 months (seven days to seven years). Eight out of nine patients who presented with stage-1 disease underwent wedge resection were noted to have the best five-year survival (75%). Five patients presented with stage-2, and three patients with stage-3 disease. Two patients who presented with stage-4 diease and received chemotherapy alone had the worst survival (mean seven months). Further subclassification into stages A and B were not available from the chart.

CONCLUSION

Our study is the first published review of clinical and pathophysiological features of BAC in African Americans. The study showed differences in the clinical features, histopathology, and radiological features among Caucasians and African Americans.

Effect of Total Abdominal Hysterectomy on Pelvic Floor Function

Historically, hysterectomy is one of the oldest gynecologic operations, dating back to the 1840s. Currently, it is the most common gynecologic operation performed and is associated with marked improvement in the patients' quality of life. It is widely considered a safe procedure with an extremely low mortality rate (<0.1%). The majority of hysterectomies are done abdominally, with the vast majority being total abdominal hysterectomies. The effect of hysterectomy on pelvic floor function has been a subject of long debate. Various studies have reached different and rather contradictory results. Most of these studies lack stringent methodologic standards, being retrospective, observational, or uncontrolled. A recent excellent study assessed the effect of abdominal hysterectomy on pelvic floor function as 1 functional unit and concluded that both total and subtotal abdominal hysterectomies have no detrimental effect on the pelvic floor function up to 1 year postoperatively.

Degradation of bleaching gels in vivo as a function of tray design and carbamide peroxide concentration

This study determined the degradation of nine bleaching agents with different concentrations after two hours in vivo following the manufacturers' recommendations. The nine carbamide peroxide products are 10%, 15% and 20% Opalescence, 10%, 15% and 22% Rembrandt and 10%, 16% and 22% Nite White Excel 2. Each subject wore the tray with the bleaching agent for two hours on three separate occasions. The amount of remaining carbamide peroxide was determined after each use. Evaluation of remaining amount of carbamide peroxide was calculated by the US Pharmacopeia method. The study showed that the total carbamide peroxide percent recovered was significantly higher for Opalescence products (47% to 54%) compared to Nite White (22% to 25%) and Rembrandt bleaching gels (15% to 16%). It concluded that this difference was mostly due to the use of facial reservoirs with Opalescence products, and also that whitening gel in trays with reservoirs and trays without reservoirs degraded at the same rate.

In vivo biocompatibility evaluation of Cibacron blue-agarose

This study investigated the biocompatibility of Cibacron blue-agarose as a biomaterial for microencapsulation. Cibacron blue-agarose is known to have an affinity for albumin under certain pH conditions and in the proper steric environment. Thus it was postulated that the material's high affinity for host albumin might reduce a secondary immune response and reduce the fibrotic overgrowth that often accompanies transplanted foreign materials. In vivo tests were performed using the Lewis rat model. Both Cibacron blue-agarose and plain agarose disks were prepared, with some disks from each group being pre-exposed to sera from Lewis rats. The disks were transplanted into the peritoneal cavities of Lewis rats. After 115 days the disks were excised. Fibrotic overgrowth was analyzed using light microscopy, and a blind study was used to measure the average growth thickness on each disk. The results demonstrated that all disks developed some fibrotic encapsulation and that the presence of Cibacron blue was not significant in reducing fibrotic overgrowth (p = 0.62). Agarose disks pre-exposed to sera had significantly less average overgrowth than any other group (p = 0. 06).

Spontaneous closure of acquired tracheo-oesophageal fistula

Acquired tracheo-oesophageal fistulae are uncommon in the paediatric age group. A case of such a fistula secondary to impaction of a button battery is reported below. Prompt management is essential to reduce morbidity and mortality in these cases.

Effects of lead and cadmium on adrenal and thyroid functions in rats

Seventy sexually mature male rats were injected with lead (50 and 250 mcg), cadmium, (50 and 250 mcg) and a mixture of lead (25 mcg) and cadmium (25 mcg) for 70 days. TSR results show that 250 mcg cadmium had a stimulating effect but 1/10 of the dose of cadmium plus 25 mcg lead had the opposite effect. Plasma thyroid hormones indicated that 50 mcg lead had a stimulating effect on T4 but cadmium and a mixture of lead and cadmium had a suppressing effect on both T4 and T3. Plasma corticosterone and adrenal cortical histology showed increased adrenal function in animals treated with 50 mcg lead, 50 mcg and 250 mcg cadmium and a mixture of lead and cadmium. The data indicated that cadmium had more deleterious effects on thyroid and adrenal function than lead.

Effects of cadium on growth, sexual development, and metabolism in female rats

Female rats were exposed to cadmium by multiple intramuscular injections of 250 mug CaCl2 for 54 days. Activity and haircoat were affected, sores on the sites of injection and persistent diestrus were observed in the treated rats. Morphological examination of organs revealed a smaller weight and size in reproductive organs and pituitary, but enlargement of liver, spleen, and kidney. The ratic enzymatic demethylation activity.

Environmental interaction of lead and cadmium on reproduction and metabolism of male rats

To study the environmental interaction of lead and cadmium on reproduction and metabolism 70 male sprague Dawley rats were divided equally into 7 goups. Goups 1 and 2 served as controls, 3 and 4 were injected daily with 50 and 250 ug of lead respectively, 5 and 6 with 50 and 250 ug of cadmium respectively and group 7 with 25 ug of both lead and cadmium. After 70 days of injections rats were sacrificed. In group 6 cadmium injection caused enlargement of adrenal, liver, kidney and spleen but retarded growth, reduction in size of prostate, testes, epididymis and hepatic enzyme activity. Groups 4 and6 had the highest and most significant mineral concentration in blood and liver. Testes histology of group 7 showed an absence of spermatogenesis in some seminiferous tubules indicating that low levels of lead and cadmium together have a more synergetic damaging effect on rat testes than higher levels of lead or cadmium alone. This study suggests that blood mineral levels should be used with other more sensitive clinical tests to assess the toxicity picture in humans.