Safety and Efficacy of Para-Aminohippurate Coinfusion for Renal Protection During Peptide Receptor Radiotherapy in Patients with Neuroendocrine Tumors

Para-aminohippurate, also known as p-aminohippuric acid (PAH), is used clinically to measure effective renal plasma flow. Preclinically, it was shown to reduce 177Lu-DOTATOC uptake in the kidneys while improving bioavailability compared with amino acid (AA) coinfusion. We report the safety and efficacy of PAH coinfusion during peptide receptor radiotherapy in patients with neuroendocrine tumors. Methods: Twelve patients with metastatic or unresectable gastroenteropancreatic neuroendocrine tumors received 177Lu-DOTATOC in 33 treatment cycles. Either 8 g of PAH or a mixture of 25 g of arginine and 25 g of lysine were coinfused. Safety was assessed by monitoring laboratory data, including hematologic and renal data, as well as electrolytes obtained before and 24 h after treatment. For radiation dosimetry, whole-body scans were performed at 1, 24, and 48 h and a SPECT/CT scan was performed at 48 h, along with blood sampling at 5 min and 0.5, 2, 4, 24, and 48 h after administration. Absorbed dose estimations for the kidneys and bone marrow were performed according to the MIRD concept. Results: In 15 treatment cycles, PAH was coinfused. No changes in mean creatinine level, glomerular filtration rate, and serum electrolytes were observed before or 24 h after treatment when using PAH protection (P ≥ 0.20), whereas serum chloride and serum phosphate increased significantly under AA (both P < 0.01). Kidney-absorbed dose coefficients were 0.60 ± 0.14 Gy/GBq with PAH and 0.53 ± 0.16 Gy/GBq with AA. Based on extrapolated cumulative kidney-absorbed doses for 4 cycles, 1 patient with PAH protection and 1 patient with AA protection in our patient group would exceed the 23-Gy conservative threshold. The bone marrow-absorbed dose coefficient was 0.012 ± 0.004 Gy/GBq with PAH and 0.012 ± 0.003 Gy/GBq with AA. Conclusion: PAH is a promising alternative to AA for renal protection during peptide receptor radiotherapy. Further research is required to systematically investigate the safety profile and radiation dosimetry at varying PAH plasma concentrations.

The genetic landscape of mitochondrial diseases in the next-generation sequencing era: a Portuguese cohort study

Introduction: Rare disorders that are genetically and clinically heterogeneous, such as mitochondrial diseases (MDs), have a challenging diagnosis. Nuclear genes codify most proteins involved in mitochondrial biogenesis, despite all mitochondria having their own DNA. The development of next-generation sequencing (NGS) technologies has revolutionized the understanding of many genes involved in the pathogenesis of MDs. In this new genetic era, using the NGS approach, we aimed to identify the genetic etiology for a suspected MD in a cohort of 450 Portuguese patients. Methods: We examined 450 patients using a combined NGS strategy, starting with the analysis of a targeted mitochondrial panel of 213 nuclear genes, and then proceeding to analyze the whole mitochondrial DNA. Results and Discussion: In this study, we identified disease-related variants in 134 (30%) analyzed patients, 88 with nuclear DNA (nDNA) and 46 with mitochondrial DNA (mtDNA) variants, most of them being pediatric patients (66%), of which 77% were identified in nDNA and 23% in mtDNA. The molecular analysis of this cohort revealed 72 already described pathogenic and 20 novel, probably pathogenic, variants, as well as 62 variants of unknown significance. For this cohort of patients with suspected MDs, the use of a customized gene panel provided a molecular diagnosis in a timely and cost-effective manner. Patients who cannot be diagnosed after this initial approach will be further selected for whole-exome sequencing. Conclusion: As a national laboratory for the study and research of MDs, we demonstrated the power of NGS to achieve a molecular etiology, expanding the mutational spectrum and proposing accurate genetic counseling in this group of heterogeneous diseases without therapeutic options.

Oral Health-Related Quality of Life in Celiac Portuguese Children: a cross-sectional study

PURPOSE

Celiac Disease (CD) presents a wide variety of clinical signs and symptoms, including oral manifestations. This study pretended to characterize Oral Health-Related Quality of Life (OHRQoL) and reported oral manifestations in children with CD.

METHODS

Target-population were children with CD. An online questionnaire, applied to children's parents, collected information about OHRQoL (using the Early Childhood Oral Health Impact Scale-ECOHIS), oral health behaviours, and history of oral manifestations. Data analysis included descriptive statistics, Mann-Whitney, Kruskall-Wallis, and Spearman correlation tests (α = 0.05).

RESULTS

The sample included 146 celiac patients, with a mean age of 10.5 years (sd = 4.1). Mean ECOHIS score was 5.2 (sd = 6.8). The most frequently reported oral manifestations were recurrent aphthous stomatitis (46.6%), dental caries (45.2%) and dental opacity (39%). About one third of the participants mentioned improvements in oral health when a gluten-free diet was introduced. Most of the reported oral manifestations had a significant association with the ECOHIS score (p < 0.05).

CONCLUSIONS

The OHRQoL of children was good, however oral manifestations had a negative impact on OHRQoL. The most reported oral manifestations were recurrent aphthous stomatitis, dental caries, and dental opacities. Oral health professionals must be aware about the heterogeneity of the disease, to recognize oral manifestations associated and their importance in the early diagnosis to reduce complications and to an improvement in the OHRQoL of these patients.

The impact of Covid-19 on the Mental Health of the Portuguese Population

Introduction

Covid-19 does not only have repercussions on the physical level, representing a new way of life, both individually and in society. The pandemic results in invisible consequences for the population’s mental health.

Objectives

This study aimed to explore the consequences of Covid-19 on mental health in Portugal with a view to understanding and promoting the well-being and happiness of the Portuguese.

Methods

The study included 111 young people and adults, aged between 18 and 58 years (M= 21.81, SD= 5.34), with 43.7% males and 52.7% females. A sociodemographic questionnaire was applied to all participants, as well as the Échelle de Mesure des Manifestations du Bien-Être Psychologique (ÈMMBEP; Massé et al., 1998 - Portuguese translation by Monteiro, Tavares & Pereira, 2012) which translates into a response scale 5-point Likert type, with five subscales, including happiness. In addition, a semistructured interview with data collection instruments was administered.

Results

The results obtained demonstrate the negative impact of Covid-19 on the level of well-being, regardless of the participant’s gender or age.

Conclusions

The data presented point to the need to sensitize individuals to the risk of the pandemic in terms of mental health, thus increasing society’s awareness of the psychological effects of this new global disease. Therefore, coping mechanisms are essential to promote well-being and successfully overcome the pandemic.

Disclosure

No significant relationships.

Depression among Endometrial Cancer hospitalizations - Preliminary results of a nationwide retrospective study

Introduction

Uterine cancer is the most common gynecologic malignant neoplasm in developed countries. While depression is up to 3-5 times more common in patients with cancer than in the general population, literature is still limited regarding the relation between Endometrial Cancer and depression.

Objectives

To analyze Depression among Endometrial Cancer hospitalizations in mainland Portuguese public hospitals (2008-2015).

Methods

A retrospective observational study was conducted using administrative data from all hospitalizations in Portuguese mainland public hospitals between 2008-2015. All women’s hospitalizations(≥18 years) with a primary diagnosis of Endometrial Cancer (ICD-9-CM 182.x) were selected. Secondary diagnosis of depression was identified with ICD-9-CM 296.2x, 296.3x and 311x codes. Surgical procedures codes 68.4x, 65.6x, 40.3x, 40.5x, 68.6x, 68.9x and 68.8x were used to divide the hospitalizations into surgical vs non-surgical. Groups were compared with Pearson Chi-square test and crude odds ratio(OR) was used to estimate the association between surgery and depression.

Results

From 10227 hospitalizations with a primary diagnosis of Endometrial Cancer, 533 had a registry of depression(5.2%). Annual depression frequency rose from 2.0% (2008) to 8.3% (2015). Among patients with a record of depression, 73.2% had surgery. Women who had surgery were significantly more likely to have registered depression (p<0.001). The OR for depression in surgical vs non-surgical patients was 1.73 (95%IC:1.42-2.10).

Conclusions

Patients hospitalized due to Endometrial Cancer and submitted to surgery had almost two-fold more risk of having a registry of depression. This trend reinforces the importance of early depression screening of these patients, enabling the implementation of timely therapeutic strategies before and after surgery.

Disclosure

No significant relationships.

Bioactivity and Bioaccessibility of Bioactive Compounds in Gastrointestinal Digestion of Tomato Bagasse Extracts

A nutrient-rich diet is a key to improving the chemical signals, such as antioxidants, which modulate pathogens’ resistance in the gut and prevent diseases. A current industrial problem is the generation of undervalued by-products, such as tomato bagasse, which are rich in bioactive compounds and of commercial interest (carotenoids and phenolic compounds). This work analyzed the effect of gastrointestinal digestion on the bioactivity and bioaccessibility of carotenoids and phenolic compounds from tomato bagasse extracts. Thus, the extraction by ohmic heating (OH) technology was compared with conventional (organic solvents). The results showed that the main phenolic compounds identified by UPLC-qTOF-MS were p-coumaric acid, naringenin, and luteolin. A higher recovery index for total phenolic compounds throughout the gastrointestinal digestion was observed for OH while for carotenoids, a strong reduction after stomach conditions was observed for both extracts. Furthermore, colon-available fraction exhibited a prebiotic effect upon different Bifidobacterium and Lactobacillus, but a strain-dependent and more accentuated effect on OH. Thus, the extraction technology highly influenced bioaccessibility, with OH demonstrating a positive impact on the recovery of bioactive compounds and related health benefits, such as antioxidant, anti-hypertensive, prebiotic, and anti-inflammatory properties. Of these properties, the last is demonstrated here for the first time.

NADPH Oxidase 3 Deficiency Protects From Noise-Induced Sensorineural Hearing Loss

The reactive oxygen species (ROS)-generating NADPH oxidase NOX3 isoform is highly and specifically expressed in the inner ear. NOX3 is needed for normal vestibular development but NOX-derived ROS have also been implicated in the pathophysiology of sensorineural hearing loss. The role of NOX-derived ROS in noise-induced hearing loss, however, remains unclear and was addressed with the present study. Two different mouse strains, deficient in NOX3 or its critical subunit p22phox, were subjected to a single noise exposure of 2 h using an 8-16 kHz band noise at an intensity of 116-120 decibel sound pressure level. In the hours following noise exposure, there was a significant increase in cochlear mRNA expression of NOX3 in wild type animals. By using RNAscope in situ hybridization, NOX3 expression was primarily found in the Rosenthal canal area, colocalizing with auditory neurons. One day after the noise trauma, we observed a high frequency hearing loss in both knock-out mice, as well as their wild type littermates. At day seven after noise trauma however, NOX3 and p22phox knockout mice showed a significantly improved hearing recovery and a marked preservation of neurosensory cochlear structures compared to their wild type littermates. Based on these findings, an active role of NOX3 in the pathophysiology of noise-induced hearing loss can be demonstrated, in line with recent evidence obtained in other forms of acquired hearing loss. The present data demonstrates that the absence of functional NOX3 enhances the hearing recovery phase following noise trauma. This opens an interesting clinical window for pharmacological or molecular intervention aiming at post prevention of noise-induced hearing loss.

Local Cisplatin Delivery in Mouse Reliably Models Sensorineural Ototoxicity Without Systemic Adverse Effects

Cisplatin is a lifesaving chemotherapeutic drug with marked ototoxic adverse effects. Cisplatin-induced hearing loss affects a significant part of cancer-surviving patients and is an unmet clinical need with important socioeconomic consequences. Unfortunately, in current preclinical animal models of cisplatin ototoxicity, which are mainly based on systemic delivery, important morbidity is observed, leading to premature death. This methodology not only raises obvious animal welfare concerns but also increases the number of animals used in ototoxicity studies to compensate for dropouts related to early death. To overcome these important limitations, we developed a local delivery model based on the application of a cisplatin solution directly into the otic bulla through a retroauricular approach. The local delivery model reliably induced significant hearing loss with a mean threshold shift ranging from 10 to 30 dB, strongly affecting the high frequencies (22 and 32 kHz). Importantly, mice did not show visible stress or distress indicators and no significant morbidity in comparison with a traditional systemic delivery control group of mice injected intraperitoneally with 10 mg/kg cisplatin, where significant weight loss >10% in all treated animals (without any recovery) led to premature abortion of experiments on day 3. Mass spectrometry confirmed the absence of relevant systemic uptake after local delivery, with platinum accumulation restricted to the cochlea, whereas important platinum concentrations were detected in the liver and kidney of the systemic cisplatin group. A clear correlation between the cochlear platinum concentration and the auditory threshold shift was observed. Immunohistochemistry revealed statistically significant loss of outer hair cells in the basal and apical turns of the cochlea and an important and statistically significant loss of auditory neurons and synapses in all cochlear regions. In conclusion, local cisplatin delivery induces robust hearing loss with minimal morbidity, thereby offering a reliable rodent model for human cisplatin ototoxicity, reducing the number of animals required and showing improved animal welfare compared with traditional systemic models.

CARDIOGENIC SHOCK DUE TO VENTRICULAR SEPTAL DEFECT (VSD) AFTER MYOCARDIAL INFARCTION

62 year-old man admitted in ICU post myocardial infarction with ventricular septal defect (VSD) and cardiogenic shock due to anterior descending artery stenosis. VSD corrected percutaneously after intra-aortic Figure 1 Transthoracic echocardiography with Doppler showing VSD after myocardial infarction due to anterior descendent stenosis. balloon pump insertion, resulting in iatrogenic tricuspid regurgitation. Tricuspid valvuloplasty, VSD correction and CABG performed after patient stabilization. Discharge after 26 days.

Anthocyanin Recovery from Grape by-Products by Combining Ohmic Heating with Food-Grade Solvents: Phenolic Composition, Antioxidant, and Antimicrobial Properties

Usually, wine-making by-products are discarded, presenting a significant environmental impact. However, they can be used as a source of bioactive compounds. Moreover, consumers’ increasing demand for naturally nutritious and healthy products requires new formulations and food product improvement, together with sustainable, environmentally friendly extraction methods. Thus, this work aimed to compare ohmic heating (OH) with conventional methodology (CONV), using food-grade solvents, mainly water, compared to standard methanol extraction of anthocyanins. No significant differences were found between the CONV and OH for total phenolic compounds, which were 2.84 ± 0.037 and 3.28 ± 0.46 mg/g DW gallic acid equivalent, respectively. The same tendency was found for antioxidant capacity, where CONV and OH presented values of 2.02 ± 0.007 g/100 g and 2.34 ± 0.066 g/100 g ascorbic acid equivalent, respectively. The major anthocyanins identified were malvidin-3-O-acetylglucoside, delphinidin-3-O-glucoside, petunidine-3-O-glucoside, cyanidin-3-O-glucoside, and peonidine-3-O-glucoside. These extracts displayed antimicrobial potential against microorganisms such as Yersinia enterocolitica, Pseudomonas aeruginosa, Salmonella enteritidis, methicillin-sensitive Staphylococcus aureus, a methicillin-resistant Staph. aureus (MRSA), and Bacillus cereus. In conclusion, OH provides similar recovery yields with reduced treatment times, less energy consumption, and no need for organic solvents (green extraction routes). Thus, OH combined with water and citric acid allows a safe anthocyanin extraction from grape by-products, thus avoiding the use of toxic solvents such as methanol, and with high biological potential, including antimicrobial and antioxidant activity.

THORACIC SYMPATHECTOMY: SEDATION EXPERIENCE

Introduction/Study Goals: Thoracic sympathectomy is considered to be the most effective treatment for hyperhidrosis, a procedure traditionally performed under general anesthesia. Nowadays it's a minimally invasive procedure, which makes it possible to perform under sedation with local anesthesia. The goal in this study was to assess the efficacy and safety of this anesthetic technique in video-assisted thoracic sympathectomy.

MATERIAL AND METHODS

The study took place in Centro Hospitalar Universitário Lisboa Norte, between June 2017 and September 2019. The anesthetic technique consisted in a propofol infusion titrated to achieve a moderate to deep sedation, in addition to local anesthesia with lidocaine 2% and ropivacaine 0,75% on surgical incisions. All patients were assessed subsequently for pain and anesthetic or surgical complications, with a 30-day follow-up.

RESULTS

From a final sample of 63 patients, most were female (70%), with age ranging between 15 and 57 years old. There were no intra-operative complications. On the immediate postoperative period there were only two cases of poorly controlled pain.

CONCLUSION

Results showed efficiency and safety with sedation associated with local anaesthesia as an anaesthetic technique for video-assisted thoracic sympathectomy. This anaesthetic approach avoids possible complications associated with general anaesthesia and one lung ventilation, with good analgesic efficacy. However, there is still the need for a bigger sample to confirm the obtained results and to strengthen sedation as an anesthetic approach in thoracic sympathectomy.

Are olive pomace powders a safe source of bioactives and nutrients?

BACKGROUND

The olive oil industry generates significant amounts of semi-solid wastes, namely olive pomace. Olive pomace is a by-product rich in high-value compounds (e.g. dietary fibre, unsaturated fatty acids, polyphenols) widely explored to obtain new food ingredients. However, conventional extraction methods frequently use organic solvents, while novel eco-friendly techniques have high operational costs. The development of powdered products without any extraction step has been proposed as a more feasible and sustainable approach.

RESULTS

The present study fractionated and valorized the liquid and pulp fraction of olive pomace obtaining two stable and safe powdered ingredients, namely a liquid-enriched powder (LOPP) and a pulp-enriched powder (POPP). These powders were characterized chemically, and their bioactivity was assessed. LOPP exhibited a significant amount of mannitol (141 g kg^-1 ), potassium (54 g kg^-1 ) and hydroxytyrosol derivatives (5 mg g^-1 ). POPP exhibited a high amount of dietary fibre (620 g kg^-1 ) associated with a significant amount of bound phenolics (7.41 mg GAE g^-1 fibre DW) with substantial antioxidant activity. POPP also contained an unsaturated fatty acid composition similar to that of olive oil (76% of total fatty acids) and showed potential as a reasonable source of protein (12%). Their functional properties (solubility, water-holding and oil-holding capacity), antioxidant capacity and antimicrobial activity were also assessed, and their biological safety was verified.

CONCLUSIONS

The development of olive pomace powders for application in the food industry could be a suitable strategy to add value to olive pomace and obtain safe multifunctional ingredients with higher health-promoting effects than dietary fibre and polyphenols. © 2020 Society of Chemical Industry.

Intrinsically Self-renewing Neuroprogenitors From the A/J Mouse Spiral Ganglion as Virtually Unlimited Source of Mature Auditory Neurons

Nearly 460 million individuals are affected by sensorineural hearing loss (SNHL), one of the most common human sensory disorders. In mammals, hearing loss is permanent due to the lack of efficient regenerative capacity of the sensory epithelia and spiral ganglion neurons (SGN). Sphere-forming progenitor cells can be isolated from the mammalian inner ear and give rise to inner ear specific cell types in vitro. However, the self-renewing capacities of auditory progenitor cells from the sensory and neuronal compartment are limited to few passages, even after adding powerful growth factor cocktails. Here, we provide phenotypical and functional characterization of a new pool of auditory progenitors as sustainable source for sphere-derived auditory neurons. The so-called phoenix auditory neuroprogenitors, isolated from the A/J mouse spiral ganglion, exhibit robust intrinsic self-renewal properties beyond 40 passages. At any passage or freezing-thawing cycle, phoenix spheres can be efficiently differentiated into mature spiral ganglion cells by withdrawing growth factors. The differentiated cells express both neuronal and glial cell phenotypic markers and exhibit similar functional properties as mouse spiral ganglion primary explants and human sphere-derived spiral ganglion cells. In contrast to other rodent models aiming at sustained production of auditory neurons, no genetic transformation of the progenitors is needed. Phoenix spheres therefore represent an interesting starting point to further investigate self-renewal in the mammalian inner ear, which is still far from any clinical application. In the meantime, phoenix spheres already offer an unlimited source of mammalian auditory neurons for high-throughput screens while substantially reducing the numbers of animals needed.

Health and finance in the post-austerity context: the Portuguese experience

In March 2018, a Mission Structure (EMSPOS) was created in Portugal, under supervision of both Ministries of Health and Finance, to analyze the economic situation of the National Health Service (NHS), and propose recommendations to ensure its financial sustainability. The main concern was the recurrent cycles of overdue debt of NHS hospitals, which reached, in September 2018, more than 1.3 billion euros. These debts cycles, mainly to the pharmaceutical industry, were viewed as a combination of (i) under-budgeting during and following the Great Recession; (ii) expenditure growth related to population aging and new technologies; and (iii) a hospital financing and governance model that provided few incentives towards adequate management.

Hospitals' overdue debts limit their autonomy to assume investment compromises, while they deteriorate the NHS negotiation power vis-à-vis suppliers/creditors. Also, these debts were paid through financial bailouts, which shifted from punctual to predictable and regular, constituting an “indebtment reward” that destroyed any incentive towards efficiency and cost containment.

The challenge faced by EMSPOS was to ensure better budgets and autonomy to hospitals, both indispensable to face growing needs (the health sector claim), while providing the right monitoring and incentives to avoid new cycles of debt, inefficiencies, and unsustainable expenditure growth (the Ministry of Finance claim). This last request was reinforced by the Post-Program Surveillance (PPS), by the European Commission and Central Bank, that “measure Portugal's capacity to repay its outstanding loans”.

The EMSPOS proposed a new governance model that included better budgets with an efficiency-related performance component, a new management contract for hospitals' executive boards, and a path towards more investment autonomy, through the approval of “Activity and Budget Plans”. We will discuss the details of this new models and the challenges of its implementation.

Key messages

Portuguese NHS hospitals have been facing regular cycles of overdue debt, related to under-budgeting and inadequate governance models. Better budgets and hospital autonomy are needed to face growing needs (MoH claim), and right incentives are needed, to avoid inefficiencies and unsustainable expenditure growth (MoF claim).

Aberrant Trajectory Of A Central Venous Catheter

During placement of a central venous catheter into the right subclavian vein it was found to be impossible to extract the guidewire. An Angio-Computed Tomography was performed, showing an aberrant guidewire path, as the image shows. An urgent mini-sternotomy was performed to extract both catheter and guidewire under direct visualization.

Assessing Soybean Genotypes for Resistance to Helicoverpa armigera (Lepidoptera: Noctuidae)

Helicoverpa armigera (Hübner) (Lepidoptera: Noctuidae) is an important pest capable of colonizing several species of cultivated plants, including soybean [Glycine max (L.) Merrill]. The primary management strategy for this insect is chemical control and adoption of Bt plants. However, alternative environmentally friendly strategies should be investigated and adopted as available for sustainable management of this insect pest. One potential underutilized method for insect control is plant resistance. The objective of this study was to categorize resistance (antixenosis and antibiosis) of 22 soybean genotypes on H. armigera in a laboratory setting. A preliminary experiment was conducted using soybean leaves and pods to determine the most promising genotypes for resistance. For each selected genotype, we collected biological parameters, leaf intake, and performed confinement tests. The genotypes PI 227687, PI 274453, PI 274454, PI 229358, PI 171451, 'IAC 17', and 'IAC 19' expressed resistance against H. armigera. Each genotype lowered larval survivorship. The genotypes PI 229358, PI 227687, PI 274453, and PI 274454 expressed resistance by prolonging larval development and reducing fifth-instar larvae weight. 'IAC 19' reduced leaf consumption and lowered the weight of fifth-instar larvae. Antixenosis was found in genotypes PI 227687, PI 274454, and 'IAC 19'. These genotypes might be used in breeding programs focusing on soybean resistance to lepidopterans.

Redox activation of excitatory pathways in auditory neurons as mechanism of age-related hearing loss

Age-related hearing (ARHL) loss affects a large part of the human population with a major impact on our aging societies. Yet, underlying mechanisms are not understood, and no validated therapy or prevention exists. NADPH oxidases (NOX), are important sources of reactive oxygen species (ROS) in the cochlea and might therefore be involved in the pathogenesis of ARHL. Here we investigate ARHL in a mouse model. Wild type mice showed early loss of hearing and cochlear integrity, while animals deficient in the NOX subunit p22^phox remained unaffected up to six months. Genes of the excitatory pathway were down-regulated in p22^phox-deficient auditory neurons. Our results demonstrate that NOX activity leads to upregulation of genes of the excitatory pathway, to excitotoxic cochlear damage, and ultimately to ARHL. In the absence of functional NOXs, aging mice conserve hearing and cochlear morphology. Our study offers new insights into pathomechanisms and future therapeutic targets of ARHL.

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Mice devoid of NADPH oxidase (NOX) activity are protected from age-related hearing loss.

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Cochlear NOX expression shows a similar pattern in mouse and human.

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NOX3, the predominant NOX isoform in the cochlea, is mostly expressed in auditory neurons.

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NOX-deficient auditory neurons show decreased transcription of glutamatergic pathway and are protected from excitotoxicity.

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NOX-mediated gene regulation within auditory neurons contributes to age-related hearing loss.

Increasing phenolic and aromatic compounds extraction and maximizing liking of lemon verbena (Aloysia triphylla) infusions through the optimization of steeping temperature and time

Herbal infusions are a new emerging trend among consumers, appearing in the market in many different forms. Due to intense competition, the commercial success of herbal infusions largely depends on flavour. The identification of the best combinations of steeping time and water temperature for the preparation of Aloysia triphylla infusions using a central composite design and response surface methodology was performed. The procedure aimed to maximize its antioxidant activity, phenolic and aromatic compounds, and consumers' liking of the infusions. The antioxidant activity and phenolic content were evaluated using the 2,2'-azinobis-(3-ethylbenzothiazoline-6-sulfonic acid radical cation) method and the Folin-Ciocalteu procedure. The analysis of aromatic compounds was performed based on the method of terpenic compounds. Sensory evaluation encompassed overall liking using a 9-point hedonic scale. Antioxidant activity and extraction of most phenolic compounds was higher for longer steeping times and higher temperatures, with some presenting a contrasting effect due to degradation at higher temperatures for longer steeping times. Results for terpenic compounds showed similar contrasting patterns. Based on the quadratic response surface, it was possible to predict the maximum overall liking for lemon verbena infusions prepared by brewing for 6 min at 96 ℃. Under such conditions, extraction of bioactive compounds was kept at a high level, close to the maximum attainable, while reducing the extraction of bitter compounds. These results are considered of great importance for the development of premium infusions from organic lemon verbena leaves.

Optimizing Synthetic miRNA Minigene Architecture for Efficient miRNA Hairpin Concatenation and Multi-target Gene Knockdown

Synthetic microRNA (miRNA) minigenes (SMIGs) have a major potential for molecular therapy; however, their optimal architecture still needs to be determined. We have previously optimized the stem structure of miRNA hairpins for efficient gene knockdown. Here, we investigate the overall architecture of SMIGs driven by polymerase II-dependent promoters. When miRNA hairpins were placed directly behind the promoter, gene knockdown was inefficient as compared with constructs containing an intercalated sequence (“spacer”). Spacer sequence was relevant for knockdown efficiency and concatenation potential: GFP-based sequences (even when truncated or including stop codons) were particularly efficient. In contrast, a spacer of similar length based on a CD4 intronic sequence was entirely inefficient. Spacer sequences influenced miRNA steady-state levels without affecting transcript stability. We demonstrate that with an optimized spacer, up to five concatenated hairpins targeting two different genes are efficiently expressed and able to knock down their respective targets. Transplantation of hematopoietic stem cells containing a CCR5 knockdown SMIG demonstrated a sustained in vivo efficacy of our approach. In summary, we have defined features that optimize SMIG efficiency. Based on these results, optimized knockdown of genes of interest, such as the HIV co-receptor CCR5 and the NADPH oxidase subunit p22^phox, was achieved.

Induction of resistance of corn plants to Spodoptera frugiperda (J. E. Smith, 1797) (Lepidoptera: Noctuidae) by application of silicon and gibberellic acid

The aim of this study was to evaluate the effects of silicon application and administration of the phytohormone gibberellic acid on resistance of the corn plants to the fall armyworm (FAW), Spodoptera frugiperda, and their vegetative characteristics. We evaluated larval and pupal duration, survival and biomass, and adult longevity, malformation and fecundity of S. frugiperda after feeding on plant matter treated with silicon and/or gibberellic acid. The feeding preference of FAW first-instar larvae, the total leaf area consumed by the insects, and the vegetative parameters of corn plants were also evaluated. No significant differences were observed in the measured parameters of larval and pupal stages of S. frugiperda in response to silicon or gibberellic acid. In adult stage insects, the number of eggs per female was significantly reduced in insects derived from larvae fed plants treated with silicon or gibberellic acid. In a non-preference test, 48 h after release, caterpillars preferred control untreated plants and consumed less matter from plants that had received hormonal treatment (gibberellic acid). Gibberellic acid also altered the vegetative characteristics of plants, by increasing their height, shoot fresh and dry mass, and silicon content. We conclude that gibberellic acid can alter the vegetative characteristics and silicon uptake of corn plants, leading to a reduction in their consumption by S. frugiperda larvae and a decrease in female insect oviposition.

Integrated indicator to evaluate vehicle performance across: Safety, fuel efficiency and green domains

In general, car manufacturers face trade-offs between safety, efficiency and environmental performance when choosing between mass, length, engine power, and fuel efficiency. Moreover, the information available to the consumers makes difficult to assess all these components at once, especially when aiming to compare vehicles across different categories and/or to compare vehicles in the same category but across different model years. The main objective of this research was to develop an integrated tool able to assess vehicle's performance simultaneously for safety and environmental domains, leading to the research output of a Safety, Fuel Efficiency and Green Emissions (SEG) indicator able to evaluate and rank vehicle's performance across those three domains. For this purpose, crash data was gathered in Porto (Portugal) for the period 2006-2010 (N=1374). The crash database was analyzed and crash severity prediction models were developed using advanced logistic regression models. Following, the methodology for the SEG indicator was established combining the vehicle's safety and the environmental evaluation into an integrated analysis. The obtained results for the SEG indicator do not show any trade-off between vehicle's safety, fuel consumption and emissions. The best performance was achieved for newer gasoline passenger vehicles (<5year) with a smaller engine size (<1400cm(3)). According to the SEG indicator, a vehicle with these characteristics can be recommended for a safety-conscious profile user, as well as for a user more interested in fuel economy and/or in green performance. On the other hand, for larger engine size vehicles (>2000cm(3)) the combined score for safety user profile was in average more satisfactory than for vehicles in the smaller engine size group (<1400cm(3)), which suggests that in general, larger vehicles may offer extra protection. The achieved results demonstrate that the developed SEG integrated methodology can be a helpful tool for consumers to evaluate their vehicle selection through different domains (safety, fuel efficiency and green emissions). Furthermore, SEG indicator allows the comparison of vehicles across different categories and vehicle model years. Hence, this research is intended to support the decision-making process for transportation policy, safety and sustainable mobility, providing insights not only to policy makers, but also for general public guidance.

Abstract P3-12-18: Radiation-induced CD8 T-lymphocyte apoptosis as a predictor of late toxicity after radiotherapy: Results of the prospective multicenter French trial

Purpose/Objective(s): We and others showed in retrospective and monocentric studies that radiation-induced CD8-lymphocyte apoptosis (RILA) can significantly predict differences in late toxicity between individuals and can be used as a rapid screening for potential hyper-reactive patients to radiation therapy (RT). We present here the clinical results of the prospective multicenter French trial (NCT00893035) evaluating the predictive role of RILA as a predictor of late effects after RT.

Materials/Methods: A total of 502 consenting breast-cancer patients (pts) treated by conservative surgery and adjuvant RT were included by 10 French centers. Lymphocytes apoptosis was assessed before RT by associated condensation of DNA. The incidence of late toxicities was obtained using CTCAEv3.0 grading scale. Complication-free survival (CFS) and complication-relapse-free survival (CRFS) curves were estimated by the Kaplan-Meier method. The log-rank test was used to identify significant categorical variables for each of the survival curves. Cox model was used for multivariate analysis.

Results: Four hundred and fifty-four pts (90.4%) were included in the final analysis (clinical, biological and dosimetric data available). One hundred and eight pts (24%) received both whole breast (WB) and nodal irradiation (NI). A boost dose of 10-16 Gy was given in 448 pts (99%). Adjuvant hormonotherapy (tamoxifen or aromatase inhibitor) was delivered to 346 pts (76%). Three categories of absolute change in the percent CD8 cells in apoptosis before and after exposure to 8-Gy in vitro RT were constructed around the 33 percent quantiles, &lt;12%, 12-20%, and &gt;20%. In a median follow-up period of 38.5 months, grade 2 and 3 late fibrosis was observed in 54 (12%) and 3 (0.7%) pts, respectively. A decreased percentage of grade 2 or more late toxicity was observed for increasing values of CD8 apoptosis (p=0.001). No grade 3 late toxicity was observed for patients with RILA ≥12%. The 3-year CFS rates were significantly lower for patients with low levels of CD8 radiation-induced apoptosis, 79% (95% confidence interval [CI]: 72–85%), 90% (95% CI: 84–94%), and 93% (95% CI: 87–96%) for CD8 &lt;12%, 12–20%, and &gt;20%, respectively (p=0.001). Similar results were observed for the CRFS rates (p&lt;0.001). In multivariate analyses, prognostic factors for CFS were RILA&lt;12% (p=0.001), smoking history (p&lt;0.001), and adjuvant hormonal treatment (p=0.008). Negative predictive value for grade 2 or more toxicity was equal to 83% for CD8 &gt;20% and positive predictive value was equal to 22% for CD8 &lt;12% where the overall prevalence of grade 2 or more late side effects was estimated at 14%.

Conclusion: RILA significantly predicts differences in radiation-induced late toxicity between individuals. This study validates the use of RILA as a rapid screening for potential hyper-reactive pts to radiotherapy.

Citation Format: Hennequin C, Azria D, Riou O, Castan F, Coelho M, Nguyen TD, Peignaux K, Lemanski C, Lagrange J-L, Kirova Y, Lartigau E, Belkacemi Y, Bourgier C, Noel G, Clippe S, Mornex F, Kramar A, Pèlegrin A, Ozsahin M. Radiation-induced CD8 T-lymphocyte apoptosis as a predictor of late toxicity after radiotherapy: Results of the prospective multicenter French trial. [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 P3-12-18.

Antiproliferative effects of β-blockers on human colorectal cancer cells

Colon cancer is the fourth and third most common cancer, respectively in men and women worldwide and its incidence is on the increase. Stress response has been associated with the incidence and development of cancer. The catecholamines (CA), adrenaline (AD) and noradrenaline (NA), are crucial mediators of stress response, exerting their effects through interaction with α- and β-adrenergic receptors (AR). Colon cancer cells express β-AR, and their activation has been implicated in carcinogenesis and tumor progression. Interest concerning the efficacy of β-AR blockers as possible additions to cancer treatment has increased. The aim of this study was to investigate the effect of several AR agonists and β-blockers following cell proliferation of HT-29 cells, a human colon adenocarcinoma cell line. For this purpose, HT-29 cells were incubated in the absence (control) or in the presence of the AR-agonists, AD, NA and isoprenaline (ISO) (0.1-100 µM) for 12 or 24 h. The tested AR agonists revealed proliferative effects on HT-29 cells. In order to study the effect of several β-blockers following proliferation induced by AR activation, the cells were treated with propranolol (PRO; 50 µM), carvedilol (CAR; 5 µM), atenolol (ATE; 50 µM), or ICI 118,551 (ICI; 5 µM) for 45 min prior, and simultaneously, to incubation with each of the AR agonists, AD and ISO, both at 1 and 10 µM. The results suggested that adrenergic activation plays an important role in colon cancer cell proliferation, most probably through β-AR. The β-blockers under study were able to reverse the proliferation induced by AD and ISO, and some of these blockers significantly decreased the proliferation of HT-29 cells. The elucidation of the intracellular pathways involved in CA-induced proliferation of colon cancer cells, and in the reversion of this effect by β-blockers, may contribute to identifying promising strategies in cancer treatment.

Substantia nigra neuromelanin magnetic resonance imaging in de novo Parkinson's disease patients

BACKGROUND

Depigmentation of the substantia nigra (SN) and locus coeruleus (LC) is a conspicuous pathological feature of Parkinson's disease (PD) and is related to the loss of neuromelanin, whose paramagnetic properties result in high signal on specific T1-weighted magnetic resonance imaging (MRI). Recent studies have suggested that neuromelanin decrease in the SN and LC of PD patients may emerge as a possible diagnostic biomarker. The SN neuromelanin signal in de novo and early stage PD patients was studied to assess its diagnostic accuracy. This is the first study based on a semi-automated MRI analysis of the neuromelanin signal in de novo PD patients.

METHODS

The inclusion criteria were untreated de novo PD and a 2-5 year disease duration; in addition, age matched healthy controls were enrolled. These were studied with a high-resolution T1-weighted MRI sequence at 3 T to visualize neuromelanin. The primary outcome was SN high signal area, length and neuromelanin/midbrain ratio obtained with semi-automated methods.

RESULTS

A total of 12 de novo PD patients and 10 PD patients with a 2-5 year disease duration were evaluated. The area, length of the SN T1 high signal and the SN neuromelanin/midbrain ratio were markedly decreased in the PD groups compared with age-matched controls, with a substantial overlap between the two PD groups.

CONCLUSIONS

Neuromelanin-sensitive MRI techniques can discriminate PD patients from healthy individuals with high sensitivity and specificity. Our findings are consistent with recent findings showing that PD neuromelanin changes remain stable during the course of the disease.

Outbreak of Clostridium difficile PCR ribotype 027--the recent experience of a regional hospital

Background

Clostridium difficile infection (CDI) is the leading cause of healthcare-associated diarrhea, and several outbreaks with increased severity and mortality have been reported. In this study we report a C. difficile PCR ribotype 027 outbreak in Portugal, aiming to contribute to a better knowledge of the epidemiology of this agent in Europe.

Methods

Outbreak report with retrospective study of medical records and active surveillance data of all inpatients with the diagnosis of CDI, from 1^st January to 31^th December 2012, in a Portuguese hospital. C. difficile isolates were characterized regarding ribotype, toxin genes and moxifloxin resistance. Outbreak control measures were taken, concerning communication, education, reinforcement of infection control measures, optimization of diagnosis and treatment of CDI, and antibiotic stewardship.

Results

Fifty-three inpatients met the case definition of C. difficile-associated infection: 55% males, median age was 78.0 years (interquartile range: 71.0-86.0), 75% had co-morbidities, only 15% had a nonfatal condition, 68% had at least one criteria of severe disease at diagnosis, 89% received prior antibiotherapy, 79% of episodes were nosocomial. CDI rate peak was 13.89/10,000 bed days. Crude mortality rate at 6 months was 64.2% while CDI attributable cause was 11.3%. Worse outcome was related to older age (P = 0.022), severity criteria at diagnosis (leukocytosis (P = 0.008) and renal failure), and presence of fatal underlying condition (P = 0.025). PCR ribotype 027 was identified in 16 of 22 studied samples.

Conclusions

This is the first report of a 027-CDI outbreak in Portugal. We emphasize the relevance of the measures taken to control the outbreak and highlight the importance of implementing a close and active surveillance of CDI.

Subthalamic deep brain stimulation effects on odor identification in Parkinson's disease

BACKGROUND AND PURPOSE

Olfactory dysfunction is common in Parkinson's disease (PD) and it is one of the earliest non-motor symptoms. A few studies have suggested that deep brain stimulation of the subthalamic nucleus (STN-DBS) could improve olfactory function. Our aim was to evaluate the acute effect of bilateral STN-DBS on a commonly used smell test in PD patients.

METHODS

Fifteen PD patients who underwent bilateral STN-DBS and 15 controls were recruited. Patients and controls were tested for odor identification.

RESULTS

No statistical differences were documented between ON and OFF STN-DBS acute stimulation concerning olfaction. Controls presented a better performance for olfactory identification than patients.

CONCLUSIONS

Our exploratory study did not support that bilateral STN-DBS could have an acute effect on olfactory function in PD patients.