Shining light on fluoride detection: a comprehensive study exploring the potential of coumarin precursors as selective turn-on fluorescent chemosensors

In this study, we report a fluoride chemosensor based on the use of a non-fluorescent pre-coumarin, compound 1. This compound undergoes selective fluoride-triggered formation of coumarin 2, with a concomitant turn-on fluorescence signal. Although compound 1 exists as a mixture of alkene isomers (2 : 1 in favor of the E isomer), only the minor Z-isomer undergoes cyclization. Nonetheless, comprehensive computational and experimental studies provide evidence that in situ isomerization of E-1 to Z-1, followed by fluoride-triggered phenolate evolution and intramolecular cyclization, facilitates the generation of coumarin 2 in high yield. Moreover, this system is an effective turn-on fluorescence sensor for fluoride anions, which displays outstanding selectivity (limited response to other commonly occurring analytes), sensitivity (lowest reported limits of detection for this sensor class), and practicality (works in solution and on paper to generate both fluorometric and colorimetric responses). Ongoing efforts are focused on expanding this paradigm to other pre-coumarin scaffolds, which also undergo analyte-specific coumarin formation accompanied by turn-on fluorescence.

Thioxobimanes

Dioxobimanes, colloquially known as bimanes, are a well-established family of N-heterobicyclic compounds that share a characteristic core structure, 1,5-diazabicyclo[3.3.0]octadienedione, bearing two endocyclic carbonyl groups. By sequentially thionating these carbonyls in the syn and anti isomers of the known (Me,Me)dioxobimane, we were able to synthesize a series of thioxobimanes, representing the first heavy-chalcogenide bimane variants. These new compounds were extensively characterized spectroscopically and crystallographically, and their aromaticity was probed computationally. Their potential role as ligands for transition metals was demonstrated by synthesizing a representative gold(I)-thioxobimane complex.

Assessing the Link between Diabetic Metabolic Dysregulation and Breast Cancer Progression

Diabetes mellitus is a burdensome disease that affects various cellular functions through altered glucose metabolism. Several reports have linked diabetes to cancer development; however, the exact molecular mechanism of how diabetes-related traits contribute to cancer progression is not fully understood. The current study aimed to explore the molecular mechanism underlying the potential effect of hyperglycemia combined with hyperinsulinemia on the progression of breast cancer cells. To this end, gene dysregulation induced by the exposure of MCF7 breast cancer cells to hyperglycemia (HG), or a combination of hyperglycemia and hyperinsulinemia (HGI), was analyzed using a microarray gene expression assay. Hyperglycemia combined with hyperinsulinemia induced differential expression of 45 genes (greater than or equal to two-fold), which were not shared by other treatments. On the other hand, in silico analysis performed using a publicly available dataset (GEO: GSE150586) revealed differential upregulation of 15 genes in the breast tumor tissues of diabetic patients with breast cancer when compared with breast cancer patients with no diabetes. SLC26A11, ALDH1A3, MED20, PABPC4 and SCP2 were among the top upregulated genes in both microarray data and the in silico analysis. In conclusion, hyperglycemia combined with hyperinsulinemia caused a likely unique signature that contributes to acquiring more carcinogenic traits. Indeed, these findings might potentially add emphasis on how monitoring diabetes-related metabolic alteration as an adjunct to diabetes therapy is important in improving breast cancer outcomes. However, further detailed studies are required to decipher the role of the highlighted genes, in this study, in the pathogenesis of breast cancer in patients with a different glycemic index.

Aneurysmal Bone Cyst (ABC), A Rare Diagnosis in Oral Pathology Based on Our 15-Year Institutional Experience

Introduction/Objective

Aneurysmal bone cyst (ABC) is a rare, benign bone lesion that was first described by Jaffe and Lichtenstein in 1942. Primary ABC usually affects vertebrae and metaphyseal regions of long bones, particularly femur and tibia. Only 2-3% of ABCs occur in the head and neck region, with the mandible and maxilla being the most common. It arises mostly in children and young adults, mean age 20 yo, with no gender predilection. ABC can manifest with pain, swelling, and pathological fractures. Radiographically, it appears as a metaphyseal expansile lesion that thins the cortex and has a sclerotic rim. Lesions containing “fluid-fluid” levels are best appreciated on MRI. Approximately 70% of primary ABCs have rearrangements of the USP6 gene. The most common translocation seen in primary ABCs is t(16;17) (q22;p13) leading to the fusion of the cadherin 11 gene with USP6 gene. The USP6 gene product inhibits the differentiation of osteoblasts and dysregulates bone morphogenetic protein signaling pathway.

Methods/Case Report

A retrospective chart review of all oral pathology cases referred to our institution between 1996 and 2022 was performed; three patients diagnosed with primary ABC were identified. Patient demographic data, clinical presentation, treatment, slides, and pathologic features were reviewed.

Results (if a Case Study Enter NA)

We report of three primary ABCs of the mandible and maxilla. The mean age was 39 yo (range, 26-59 years). The mandible was affected in two cases, and the maxilla involved in one. Female: Male ratio was 2:1. All lesions were primary ABC, with no other associated lesion - they showed pseudocystic structures with fibrous stroma and a variable numbers of multinucleated giant cells in relation to sinusoidal blood spaces, as well as irregular trabeculae of osteoid and reactive woven bone.

Conclusion

Primary ABC is a rare tumor in oral pathology. The importance of this study is to increase awareness of this neoplasm in the head and neck region, as well as delineate features that help differentiate ABCs from other fibro- osseous lesions of the mandible and maxilla.

P-658 NLRP3 Inflammasome and polycystic ovarian syndrome – a possible novel association

Study question

Is NLRP3 inflammasome expression in subcutaneous adipose tissue (SAT) and peripheral blood monocytes upregulated in women with polycystic ovarian syndrome (PCOS) compared to healthy controls?

Summary answer

NLRP3 expression was upregulated in subcutaneous adipose tissue but not in peripheral blood mononuclear cells (PBMCs) of women with PCOS compared to controls.

What is known already

Emerging evidence strongly suggests that PCOS is a chronic inflammatory condition. Inflammasomes are multiprotein complexes, which act as intracellular regulators of inflammation. It is now well established that NLRP3 inflammasome plays a central role in obesity-induced inflammation and insulin resistance. Given the close link between obesity and PCOS, it is plausible to hypothesize that the NLRP3 inflammasome may play a role in PCOS-related chronic inflammation and insulin resistance. This hypothesis has never been investigated before.

Study design, size, duration

This lab-based study involved reproductive age women (age 18–45years; BMI≤40kg/m2) who were diagnosed with PCOS (n = 24) according to the Rotterdam criteria. A healthy control group of non-PCOS women (n = 13) of similar age and BMI was included. Ethics approval was obtained, and all participants signed a written, informed consent. SAT biopsies were obtained during routine gynaecological surgery through the abdominal skin incision. Blood samples were obtained during surgery or during clinic visits.

Participants/materials, setting, methods

Blood samples were processed to separate plasma and to isolate peripheral blood mononuclear cells (PBMCs). SAT and PBMCs were analysed using qPCR and Western Blot (WB) to measure the relative gene and protein expression levels of NLRP3, CYP17, Caspase-1, IL-1β and IL-18 in both groups. ELISA was used to measure concentrations of Caspase-1, IL-1β and IL-18 in the plasma.

Main results and the role of chance

NLRP3 gene expression in SAT was significantly (p = 0.038) higher in PCOS women (2.08±3.5 (n = 12)) compared to controls (0.77±2.9 (n = 8)). Both groups were matched for age (PCOS, 29.4±3.7 vs controls, 30.3±4.0) and BMI (PCOS, 25.4±3.2 vs controls, 26.9±4.3). CYP17 expression was significantly (p = 0.001) higher in PCOS women (4.8±0.1) versus controls (1.5±1.6). There was a moderate positive correlation (r²=0.576, P < 0.05) between SAT NLRP3 and CYP17 expressions.

NLRP3 gene expression in PBMCs were not significantly (p < 0.05) different between non-obese PCOS (-2.64±1.55 (n = 4)), obese PCOS (-2.847±1.85 (n = 8)) and non-PCOS women (0.000±2.67 (n = 5)).

Using WB in PBMCs, NLRP3 band had a mean molecular weight of 72.59±5.43kDa with no significant difference between groups, with a trend towards higher levels in PCOS. Using ELISA in PBMCs, NLRP3 levels were not significantly (p = 0.3) different between PCOS (1.53±1.32pg/ml (n = 12)) vs controls (1.03±0.583 (n = 5)).

Gene expression levels of Caspase-1, IL-1b and IL-18 in PBMCs were not significantly (P > 0.05) different between groups.

Plasma IL-1β levels were significantly (p < 0.05) higher in PCOS (51.64±91.00ng/ml) vs. controls (0.47±0.93ng/ml). Plasma IL-18 concentrations were not significantly different between PCOS (3.79±0.53μg/ml) vs. controls (4.08±0.21μg/ml).

Limitations, reasons for caution

One limitation of this study is the lack of data on the protein expression of NLRP3 in the adipose tissue. There was also no data on other inflammasome components in the SAT analysis e.g. Caspase-1. However, all these data were available for the PBMCs.

Wider implications of the findings

The novel and interesting finding of an increase in NLRP3 in adipose tissue of PCOS women suggests that this inflammasome may play a central role in this common condition. Our study may therefore pave the way to further research to help understand the role of inflammation in PCOS

Trial registration number

N/A

P–639 The role of chronic inflammation in polycystic ovarian syndrome – a systematic review and meta-analysis

Study question

Is polycystic ovarian syndrome (PCOS) associated with chronic inflammation as determined by elevated serum C-reactive protein (CRP) level independent of obesity? Summary answer: Circulating CRP is moderately elevated in women with PCOS (independent of obesity), which is indicative of low-grade chronic inflammation.

What is known already

Although current literature associates polycystic ovarian syndrome (PCOS) with chronic inflammation, the evidence for this link remains inconclusive and its causal nature remains unclear. A systematic review and meta-analysis involving 31 studies was published on this topic in 2011 providing evidence for increased circulating CRP (96% higher than controls). However, since that review there have been over 100 published studies assessing CRP in PCOS women utilising more advanced CRP assays.

Study design, size, duration

This systematic review involved an extensive search of electronic databases for studies investigating CRP and other inflammatory makers in PCOS women from January 2000 to March 2020. Searched databases included PUBMED, EMBASE and MEDLINE, SCOPUS, DynaMed plus, TRIP, ScienceDirect and Cochrane Library. Inclusion criteria were using Rotterdam criteria for PCOS diagnosis, measuring CRP with high-sensitivity assay, matching/adjusting participants for BMI, and including drug naïve participants who were free from conditions that could affect inflammatory markers.

Participants/materials, setting, methods

The review included all studies comparing circulating CRP between women with and without PCOS. Articles’ quality and risk of bias were assessed using modified Newcastle-Ottawa scale. CRP data were extracted from eligible studies and entered into RevMan software for calculation of standardized mean difference (SMD) and 95% Confidence Interval (CI). Sensitive analysis was performed for high-quality studies providing data for non-obese participants.

Main results and the role of chance

The systematic review included 95 eligible studies (n = 10,074), of which 68 (n = 7991) were included in a meta-analysis. Sixty-two of the 95 studies reported significantly higher circulating CRP in PCOS women (n = 5235) versus controls (n = 4839). The remaining studies showed no statistically significant differences between the two groups after adjusting for BMI. Pooled analysis of 68 studies revealed significantly higher circulating CRP in PCOS women (SMD 1.26, 95%CI, 1.01, 1.52; z = 9.60; p = 0.00001; I²=96%). Sensitivity meta-analysis for non-obese women in 37 high-quality studies showed significantly higher circulating CRP in PCOS women versus controls (SMD 1.84, 95%CI, 1.40, 2.28; z = 8.19; p < 0.00001; I²=97%). Circulating TNF- α was measured in 13 studies, of which seven reported higher levels in PCOS women versus controls and six showed no difference. Circulating IL–6 was measured in 19 articles, of which eight reported significantly higher levels in PCOS women versus controls and 11 found no difference. Four studies (n = 512) reported increased white cell count in PCOS women (n = 323) compared with healthy controls (n = 189).

Nine studies (n = 922) assessed circulating adiponectin, with seven showing significantly lower levels in PCOS women (n = 368) versus controls and one showing no difference. Meta-analysis of four of these studies (n = 355) revealed a SMD –1.48 (95% CI; –2.48,-.14).

Limitations, reasons for caution

High heterogeneity between studies and the small size of several studies are the main limitations. Heterogeneity is due to variation in laboratory methods used to measure CRP and variations between participants e.g. age, BMI and PCOS phenotypes. Sensitivity and sub-group analysis were performed to address this heterogeneity.

Wider implications of the findings: Further research is required to understand the underlying molecular mechanisms and the pathophysiological role of chronic inflammation in PCOS. This could potentially identify targets for new treatments that could improve short- and long-term health problems associated with PCOS.

Trial registration number

N/A

Evaluation of tuberculosis diagnostic tools, with extending MODS assay use to second line susceptibility testing

Tuberculosis diagnosis and drug susceptibility testing (DST) are considered a priority for prompt initiation of effective therapy, increasing the chance of cure, decreasing the development of resistance, and reducing transmission.

AIM

Our objective was to evaluate currently applied diagnostic tools for tuberculosis including microscopic examination, GeneXpert, culture, and microscopic observation drug susceptibility (MODS) assay, investigating MODS assay usage for second line DST against culture based methods.

MATERIAL AND METHODS

In this study the 120 sputum samples collected from suspected cases were over one year duration from December 2018 to January 2020. The samples were subjected to ZN microscopic examination, GeneXpert, MODS assay, and culture for detection of mycobacteria. Moreover, resistance to 5 drugs: isoniazid, rifampicin, ofloxacin, levofloxacin, and amikacin were tested using MODS against the proportion method.

RESULTS

The sensitivity and specificity of the MODS assay were similar culture method with the advantage of obtaining the results in a median time of 10.7 days. Whereas the specificity of ZN and GeneXpert was high among untreated cases and decreased in subjects with a history of treatment. Monoresistance was the most common form of resistance detected among new cases followed by multidrug resistance, with a categorical agreement between the two methods above 90% for all tested drugs.

CONCLUSIONS

MODS assay is an attractive option once standardized for second line susceptibility testing and GeneXpert assay is of high sensitivity for rapid detection of MTB and RIF resistance especially in treatment naive cases.

A retrospective analysis of emergency referrals and admissions to a regional neurosurgical centre 2016-2018

BACKGROUND AND OBJECTIVES

Emergencies account for 60% of UK neurosurgical workload. We analysed the emergency referrals made to the on-call neurosurgical registrar in a regional centre over three years, aiming to identify temporal trends in volume of referrals, admission practices and major diagnostic categories contributing to referrals and admissions.

METHODS

Individual referrals recorded in on-call databases were processed to extract basic demographics, call timing, diagnosis category and whether the patient was admitted under neurosurgery. Linear regression analysis was used to identify temporal trends across the three years.

RESULTS

A total of 18128 calls were made to the on-call registrar between 2016 and 2018, with a significant increase in monthly calls. On average, one call was received every 88 minutes. An increasing proportion of these calls were taken out of office hours. Diagnostic categories accounting for the largest percentage of calls were traumatic brain injury (17.7%) and cauda equina syndrome (13%). Significant increases in referral volume were seen in cauda equina syndrome, traumatic brain injury, spinal trauma and spinal tumours, while no category had a significant decrease. The admission rate was 17.1% - no change was seen in this across the study period, resulting in increasing numbers of admissions, reflecting increasing referrals. Categories most likely to result in admission were hydrocephalus (41.1%), spontaneous subarachnoid haemorrhage (39.4%), intracranial infection (32.6%) and chronic subdural haematoma (CSDH, 32.2%). A change in admission rate was seen only for CSDH, with a significant increase in the percentage of referrals across the study period.

CONCLUSION

Emergency neurosurgical referrals continue to rise in the UK at a rate exceeding population growth. This implies a decreasing referral threshold. However, the constant admission rate suggests either an increasing amount of neurosurgical pathology, the threshold for admission/intervention has decreased, or a combination. Neurosurgical services need to adapt in order to meet increasing demands.

Dilute-and-shoot-based direct nano-electrospray ionization tandem mass spectrometry as screening methodology for multivitamins in dietary supplement and human urine

INTRODUCTION

In recent years, analytical screening methods for simultaneous detection of multivitamins have gained substantial attention to ensure quality and public confidence in dietary supplements. Even so, few analytical methods have been proposed for simultaneous analysis of multivitamin constituents due to the large divergence in chemical characteristics.

OBJECTIVES

In the present study, the objective was to develop a simple and rapid direct nano-electrospray ionization-tandem mass spectrometry (DI-nano-ESI-MS/MS) method for targeted detection of water soluble vitamins, fat soluble vitamins, amino acids, royal jelly, ginkgo biloba, and ginseng in a dietary supplement. The applicability of dilute-and-shoot-based DI-nano-ESI-MS/MS to analyze the same tested compounds and their related metabolites in clinical samples was also examined.

METHODS

Intact urine mixed with the ionization solvent was loaded (4-μL aliquot) into a nanospray (NS) capillary of 1-μm tip diameter. The NS capillary was then fitted into an off-line ion source at a distance of 5 mm from MS aperture. The sample was directly injected by applying a voltage of 1.1 kV, producing a numerous of m/z peaks for analysis in mere minutes.

RESULTS

The DI-nano-ESI-MS/MS method successfully identified almost all dietary supplement components, as well as a plethora of component-related metabolites in clinical samples. In addition, a new merit of the proposed method for the detection of index marker and chemical contaminants as well as subspecies identification was investigated for further quality evaluation of the dietary supplement.

CONCLUSIONS

The previous findings illustrated that DI-nano-ESI-MS/MS approach can emerge as a powerful, high throughput, and promising analytical tool for screening and accurate detection of various pharmaceuticals and ingredient in dietary supplements as well as biological fluids.

Highly sensitive detection of cobalt through fluorescence changes in β-cyclodextrin-bimane complexes

A supramolecular complex of syn-(methyl,methyl)bimane (1) and β-cyclodextrin demonstrates a sensitive (limit of detection = 0.60 nM) and selective fluorescence turn-off response in the presence of cobalt in aqueous media, with calibration curves enabling quantitation in solution and using filter papers on which bimane and cyclodextrin were adsorbed. 1H NMR spectroscopy provides insight into interactions underlying the sensor performance.

Assessing the Knowledge of Environmental Risk Factors for Cancer among the UAE Population: A Pilot Study

The incidence of cancer is increasing worldwide as well as in the United Arab Emirates (UAE). Currently, researchers are advocating not only for prevention programs but also for early detection. In this study, we aimed to assess the general awareness of cancer among the UAE population, with a focus on environmental risk factors. A descriptive cross-sectional design was employed, and a structured questionnaire was used to collect data from 385 participants. A total of 91.2% of the study population identified cancer as the leading cause of death, while 64.6% of the subjects were able to identify the key causes of cancer. A total of 87.3% and 70.5% of the participants were able to define tobacco and alcohol, respectively, as cancer-causing agents. Most of the study population failed to identify cancer-related infectious agents and incense smoke as carcinogens. Respondents in the medical professions had the highest knowledge score when compared with respondents with a non-medical profession and unemployed participants (p < 0.0005). To fill the gaps in cancer-related knowledge, participants were asked about their preferred method for cancer education, and 83.9% of the participants favored the media as a source of information. Conclusively, our findings indicated a gap in cancer knowledge among UAE residents, which highlights the importance of educational campaigns by health authorities; a follow-up study evaluating the success of educational campaigns is also warranted.

Direct nano-electrospray ionization tandem mass spectrometry for the quantification and identification of metronidazole in its dosage form and human urine

A rapid, sensitive and direct nano-electrospray ionization-tandem mass spectrometry (NS-ESI-MS/MS) method, using an offline nanospray (NS) capillary, has been developed and validated for the analysis of metronidazole (MTZ). A mixture of 2 µl MTZ sample solution prepared in an ionization solvent consisting of methanol : water : formic acid in a ratio of 80 : 20 : 0.3, together with 2 µl of an internal standard (IS), 1,3,6-polytyrosine, is loaded into the back of the NS capillary. The NS capillary was fitted into the ion source at a distance of 3 mm between the NS tip and MS orifice. The sample is then analysed and acquired a sustainable signal that allowed for data compilation across various data points for MTZ identification and quantification. The quantification relied on the ratio of the [M + H]+ peaks of MTZ and IS with m/z values of 172.0717 and 182.0812, respectively, while the identification relied on the MS/MS of the precursor ions [M + H]+ of both compounds and their fragments at 128.05 for MTZ and 165.1 and 136.07 for the IS. The NS-ESI-MS/MS method was accurate and precise for the quantification of MTZ over the concentration range from 2.5 to 25 000 ng ml-1. The applicability of the method was confirmed by MTZ analysis in its pharmaceutical dosage form and detection of the analyte in clinical human urine samples without any sample treatment procedure.

Role of TGF‑β in the motility of ShcD‑overexpressing 293 cells

The newly identified Src homology and collagen (Shc) family member ShcD was observed to be upregulated in 50% of vertical growth phase and metastatic melanomas. The aim of the present study was to investigate the mechanism by which ShcD mediates cell motility. 293 cell lines were altered to stably express GFP (GF) or GFP‑ShcD (G5). Treatment of the cells with transforming growth factor (TGF)β2 promoted extracellular signal‑regulated kinase (ERK) phosphorylation and, to a lesser extent, Smad2 phosphorylation in GFP‑ShcD‑expressing cells but not in GFP‑overexpressing cells. GFP‑ShcD‑expressing cells exhibited upregulated expression of certain epithelial‑mesenchymal transition‑related genes, such as snail family transcriptional repressor 1 and SLUG, than GFP‑expressing cells. Higher levels of ERK were found in the nuclear fraction of GFP‑ShcD‑expressing cells than that of GFP‑expressing cells. Overall, GFP‑ShcD‑expressing cells demonstrated enhanced migration compared with GFP‑expressing cells. A slight increase in cell migration was observed in both cell lines (GF and G5) when the cells were allowed to migrate towards conditioned medium derived from TGFβ2‑treated GFP‑ShcD expressing cells. Collectively, ShcD upregulation was proposed to induce cell migration by affecting the expression of certain epithelial‑mesenchymal transition‑related genes. Thus, our findings may improve understanding of the role of ShcD in cell migration.

Studying the ShcD and ERK interaction under acute oxidative stress conditions in melanoma cells

The newly identified melanoma-associated adaptor ShcD was found to translocate to the nucleus upon hydrogen peroxide treatment. Therefore, the aim of this study was to identify the ShcD network in melanoma cells under oxidative stress. LC-MS/MS and GFP-trap were performed to study the ShcD phosphorylation status during acute severe oxidative stress. ShcD was found to be phosphorylated at threonine-159 (Thr159) in response to 5 mM H₂O₂ treatment. The GPS 2.1 phosphorylation prediction program predicted that the Thr159Pro motif, housed in the N-terminus of the ShcD-CH2 domain, is a potential phosphorylation site for MAPKs (ERK, JNK or p38). Co-immunoprecipitation experiments revealed that ShcD mainly interacts with ERK in B16 and MM138 melanoma cells under both hydrogen peroxide-untreated and -treated conditions. Moreover, ShcD interacts with both phosphorylated and un-phosphorylated ERK, although the interaction between ShcD and phospho-ERK was primarily observed after H₂O₂ treatment. A MEK inhibitor (U0126) enhanced the interaction between ShcD and unphosphorylated ERK under oxidative stress conditions. Furthermore, Thr159 was mutated to either alanine (A) or glutamic acid (E) to study whether the threonine phosphorylation state influences the ShcD/ERK interaction. Introducing the T159E mutation obliterated the ShcD/ERK interaction. To identify the functional impact of the ShcD/ERK interaction on cell survival signalling under oxidative stress conditions, caspase 3/7 assays and 7AAD cell death assays were used. The ShcD/ERK interaction promoted anti-survival signalling upon exposure to hydrogen peroxide, while U0126 treatment reduced death signalling. Our data also showed that the death signalling initiated by the ShcD/ERK interaction was accompanied by p21 phosphorylation. In summary, these data identified ShcD, via its interaction with ERK, as a proapoptotic protein under oxidative stress conditions.

Schistosomiasis mansoni incidence data in Rwanda can improve prevalence assessments, by providing high-resolution hotspot and risk factors identification

Background

Schistosomiasis mansoni constitutes a significant public health problem in Rwanda. The nationwide prevalence mapping conducted in 2007–2008 revealed that prevalence per district ranges from 0 to 69.5% among school children. In response, mass drug administration campaigns were initiated. However, a few years later some additional small-scale studies revealed the existence of areas of high transmission in districts formerly classified as low endemic suggesting the need for a more accurate methodology for identification of hotspots. This study investigated if confirmed cases of schistosomiasis recorded at health facility level can be used to, next to existing prevalence data, detect geographically more accurate hotspots of the disease and its associated risk factors.

Methods

A GIS-based spatial and statistical analysis was carried out. Confirmed cases, recorded at primary health facilities level, were combined with demographic data to calculate incidence rates for each of 367 health facility service area. Empirical Bayesian smoothing was used to deal with rate instability. Incidence rates were compared with prevalence data to identify their level of agreement. Spatial autocorrelation of the incidence rates was analyzed using Moran’s Index, to check if spatial clustering occurs. Finally, the spatial relationship between schistosomiasis distribution and potential risk factors was assessed using multiple regression.

Results

Incidence rates for 2007–2008 were highly correlated with prevalence values (R² = 0.79), indicating that in the case of Rwanda incidence data can be used as a proxy for prevalence data. We observed a focal distribution of schistosomiasis with a significant spatial autocorrelation (Moran’s I > 0: 0,05–0.20 and p ≤ 0,05), indicating the occurrence of hotspots. Regarding risk factors, it was identified that the spatial pattern of schistosomiasis is significantly associated with wetland conditions and rice cultivation.

Conclusion

In Rwanda the high density of health facilities and the standardized microscopic laboratory diagnostic allow the derived data to be used to complement prevalence studies to identify hotspots of schistosomiasis and its associated risk factors. This type of information, in turn, can support disease control interventions and monitoring.

Gene expression of inflammatory markers in adipose tissue between obese women with polycystic ovary and normal obese women

OBJECTIVE

The pathogenesis of polycystic ovary syndrome (PCOS), a common endocrine disease and metabolic disturbance, is still unknown. The aim of the study was to investigate whether patients with PCOS display increased expression of inflammatory markers in adipose tissue.

PATIENTS AND METHODS

Two groups of women were investigated, those diagnosed with PCOS (n = 8) and age and BMI-matched normal women (n = 12). Their age was between 20-45 years and all subjects were apparently healthy and did not take any medications. Adipose tissue levels of mRNA of inflammatory markers were determined by use of real-time PCR.

RESULTS

There were no differences between obese patients and obese PCOS in levels of adipocytokines.

CONCLUSIONS

There were no effects of PCOS on the expression of any of the adipocytokines genes measured in subcutaneous adipose tissue.

Development and preclinical evaluation of new (124)I-folate conjugates for PET imaging of folate receptor-positive tumors

In an attempt to develop new folate radiotracers with favorable biochemical properties for detecting folate receptor-positive cancers, we have synthesized [(124)I]-SIB- and [(124)I]-SIP-folate conjugates using a straightforward and two-step simple reactions. Radiochemical yields for [(124)I]-SIB- and [(124)I]-SIP-folate conjugates were greater than 90 and 60% respectively, with total synthesis time of 30-40min. Radiochemical purities were always greater than 98% without HPLC purification. These synthetic approaches hold considerable promise as rapid and simple method for (124)I-folate conjugate preparation with high radiochemical yield in short synthesis time. In vitro tests on KB cell line showed that the significant amounts of the radioconjugates were associated with cell fractions. In vivo characterization in normal Balb/c mice revealed rapid blood clearance of these radioconjugates and favorable biodistribution profile for [(124)I]-SIP-folate conjugate over [(124)I]-SIB-folate conjugate. Biodistribution studies of [(124)I]-SIP-folate conjugate in nude mice bearing human KB cell line xenografts, demonstrated significant tumor uptake. The uptake in the tumors was blocked by excess injection of folic acid, suggesting a receptor-mediated process. These results demonstrate that [(124)I]-SIP-folate conjugate may be useful as a molecular probe for detecting and staging of folate receptor-positive cancers, such as ovarian cancer and their metastasis as well as monitoring tumor response to treatment.

Currently recommended BK virus (BKV) plasma viral load cutoff of ≥4 log10/mL underestimates the diagnosis of BKV-associated nephropathy: a single transplant center experience

BACKGROUND

BK virus (BKV)-associated nephropathy (BKVAN) is a major cause of renal dysfunction and graft loss in renal transplant recipients. Monitoring plasma BK viral load (BKVL) is the recommended screening tool to predict BKVAN. American Society of Transplantation (AST) guidelines define a BKVL of ≥4 log10/mL (10,000 copies) as presumptive BKVAN and recommend reduction in immunosuppression. We evaluated the clinical sensitivity of the quantitative BKV DNA assay in predicting risk for BKVAN using the AST-recommended BKVL cutoff.

METHODS

In a retrospective, single-center study, all patients who underwent renal transplant at Henry Ford Hospital from January 2008 to August 2011 were analyzed (n = 490). Plasma BKVL Assay A (commercial large T antigen-based polymerase chain reaction [PCR]) was done in all patients. Renal biopsy was done if there was a rise in serum creatinine ≥0.5 mg from baseline. BKVAN was confirmed by biopsy. As a subset to this study, from the same cohort, data for a set of 20 consecutive Assays A and B (in-house VP1-based PCR assay) from 15 patients over a period of 3 months were collected. Differences in physicians' clinical decision-making (CDM) were analyzed between the 2 assays using chi-square test.

RESULTS

A total of 413 patients met the inclusion criteria, of which 222 patients had BK viremia. Among the 248 patients who had a renal biopsy done, 31 (12.5%) were found to have BKVAN. Eleven of the 31 (35%) patients had BKVL consistently <4 log10/mL, and thus were not diagnosed to have BKVAN using the AST-recommended BKVL cutoff of ≥4 log10/mL. A total of 8 patients lost their graft owing to BKVAN, including 3 patients with BKVL <4 log10/mL. Using a cutoff point of plasma BKVL of ≥4 log10/mL, the sensitivity, specificity, positive predictive value, and negative predicative value of the PCR Assay A for the diagnosis of biopsy-proven BKVAN were 64.5%, 98.4%, 87.0%, and 94.5%, respectively, and for the diagnosis of presumptive nephropathy were found to be 76.6%, 99.4%, 95.8%, and 96.4%, respectively. In the second part of the study, presumptive nephropathy was detected in 8 samples using Assay A and 14 samples using Assay B. Six samples in Assay A would have led to no changes in the CDM in terms of reduction in immunosuppression. Kidney biopsy was carried out in 5 patients, 4 of whom had BKVAN and had Assay B log count of ≥5. If Assay A had been used in CDM, BKVAN would have been missed in 1 patient.

CONCLUSION

Utilizing the current AST guideline cutoff of ≥4 log10 /mL, the PCR Assay A underestimated the diagnosis of BKVAN. Urgent standardization of the various BKVL assays and establishment of universal cutoff points is imperative to avoid BKVAN-related graft loss.

Molecular identification of Fasciola spp. (Digenea: Fasciolidae) in Egypt

A total of 134 Egyptian liver flukes were collected from different definitive hosts (cattle, sheep, and buffaloes) to identify them via the use of PCR-RFLP and sequence analysis of the first nuclear ribosomal internal transcribed spacer (ITS1). Specimens of F. hepatica from France, as well as F. gigantica from Cameroon were included in the study for comparison. PCR products of ITS1 were subjected for digestion by RsaI restriction enzyme and visualized on agarose gel. According to RFLP pattern, Egyptian flukes were allocated into two categories. The first was identical to that of French hepatica flukes to have a pattern of 360, 100, and 60 (bp) band size, whereas the second resembled to that of Cameroonian gigantica worms to have a profile of 360, 170, and 60 bp in size. Results of RFLP analysis were confirmed by sequence analysis of representative ITS1 amplicons. No hybrid forms were detected in the present study. Taken together, this study concluded that both species of Fasciola are present in Egypt, whereas the hybrid form may be not very common.

Molecular identification of Fasciola spp. (Digenea: Platyhelminthes) in cattle from Vietnam

Fasciola spp. were collected from naturally infected cattle at a local abattoir of Khanh Hoa province, Vietnam, for morphological and genetic investigations. Microscopic examination detected no sperm cells in the seminal vesicles, suggesting a parthenogenetic reproduction of the flukes. Analyses of sequences from the first and second internal transcribed spacers (ITS1 and ITS2) of the ribosomal RNA revealed that 13 out of 16 isolates were of Fasciola gigantica type, whereas three isolates presented a hybrid sequence from F. gigantica and Fasciola hepatica. Interestingly, all the mitochondrial sequences (partial COI and NDI) were of F. gigantica type, suggesting that the maternal lineage of the hybrid form is from F. gigantica. No intra-sequence variation was detected.

The relationship of ethnicity, maternal height and shoe size, and method of delivery

In a bid to determine the relationship of ethnicity, maternal height and shoe size as predictors of cephalopelvic disproportion, we conducted a prospective comparative study of primigravidas at term with singleton pregnancies, who had undergone spontaneous labour. A total of 208 primigravidas were studied; 151 (62.9%) achieved vaginal delivery and 57 (37.1%) had emergency caesarean section for failure-to-progress. We found a statistically significant positive correlation between maternal height and vaginal delivery (p = 0.04), but no correlation with maternal shoe size was found (p = 0.24). This study also showed that Caucasian women were significantly more than twice as likely to achieve vaginal delivery compared with Africans (p = 0.02). Maternal height of at least 162.5 cm, has a sensitivity of 74% and a specificity of 43% for predicting vaginal delivery. We concluded that the most predictive anthropometric measurement for vaginal delivery is maternal height.

Drug resistance evaluation of some commonly used anti-coccidial drugs in broiler chickens

The study investigated some anticoccidial resistance for Amprol, Toltrazuril and sulfaclozine in experimental infected broiler. Eimeria identification depended on necropsy and coproscopic examination. 140 day-old chicks allotted into 7 groups and infected with Eimeria in 2nd day of age. G1: neither infected nor treated (negative control), G2: infected but not treated (positive control), Infected and treated with toltrazuril (G3), or with Amprol+Allicin (G4), or with Amprol+ethobabate (G5), or with Amprol (G6) or with Sulfaclozine (G7). Eimeria infection caused decrease in body gain, total protein, albumin but increase in FCR, ALT, AST, Uric acid, Creatinine. Treatment decreased the harmful effect of infection but some significant differences were between infected treated groups and non infected non-treated one.

Management of stab wounds of the heart: analysis of 73 cases in 10 years

BACKGROUND

Stab wounds of the heart still cause a significant number of traumatic deaths every year. The aim of this study was to assess the outcome of patients with cardiac stab wounds requiring emergency thoracotomy.

PATIENTS AND METHODS

Preoperative and operative variables were reviewed for all patients treated at the Mansoura Emergency Hospital between August 1998 and July 2008.

RESULTS

Seventy-three patients were treated for stab wounds of the heart. Of these 69 were male (94.5 %) and only 4 were female (5.5 %). Mean patient age was 28.5 +/- 5.8 years. The clinical status was stable in 22 patients (30.1 %) and unstable in 26 patients (35.6 %), while 10 patients were in shock (13.7 %), and 15 patients had suffered cardiac arrest prior to thoracotomy (20.6 %). Emergency room (ER) thoracotomy was performed in 18 patients (24.7 %) and operative room (OR) thoracotomy was carried out in 55 patients (75.3 %). The commonest location of stab wounds to the heart was the right ventricle in 28 patients (38.4 %) followed by the left ventricle in 25 patients (34.2 %). Mortality was 23.3 % (17 patients), and morbidity was 21.4 % (12 patients out of 56 surviving patients). Prognostic factors included clinical status (patients in shock or cardiac arrest had a mortality rate of 50 % and 60 %, respectively), cardiopulmonary resuscitation (CPR; mortality rate: 68.2 %) and ER thoracotomy (mortality rate: 66.7 %).

CONCLUSION

Clinical status as shock, CPR and ER thoracotomy were prognostic of a poor outcome and associated with high mortality rates.

An RCT of metformin versus orlistat for the management of obese anovulatory women

BACKGROUND

Treatment of obesity-related anovulation poses a significant clinical challenge. Occasionally, the use of antiobesity medications such as orlistat or insulin sensitizing agents such as metformin is sometimes indicated in these patients. This study aimed to compare the effects of metformin and orlistat for improving ovulation in obese anovulatory women.

METHODS

This was an open-label RCT. A total of 40 women were randomized to receive either metformin (n = 20) or orlistat (n = 20). BMI as well as the androgen profile and the ovulatory status were assessed at baseline and at four weekly intervals for 3 months. Different anthropometric and endocrine parameters were also assessed as possible predictors of ovulation.

RESULTS

There was no significant difference between the two study arms regarding the ovulation rate for metformin and orlistat [40% (n = 8/20) and 25% (n = 5/20), respectively, P = 0.31]. Both arms showed a significant drop in the BMI, testosterone and androstendione concentrations (P < 0.05), but there was no difference between the two arms. Patients who ovulated had significantly lower concentrations of baseline LH, androstendione, dehydroepiandrosterone and free androgen index (P < 0.05). Among these factors, a low baseline LH was found to be the only independent predictor of ovulation (area under curve, 0.85).

CONCLUSIONS

Both metformin and orlistat show a similar effect on weight loss, ovulation rates and androgen concentrations. However, the effects on ovulation rates need to be confirmed in larger studies. The presence of a low baseline serum LH was found to be the most important predictor of ovulation. The study was registered at clinicaltrials.gov. NCT00292799.

An integrated platform for bio-analysis and drug delivery

The advances in the microelectronics fabrication allow the strong appearance of micro-electro-mechanical systems known as MEMS. MEMS enable the fabrication of smaller devices that are manufactured using standard micro-fabrication techniques similar to the ones that are used to create computer silicon chips. Several MEMS devices including micro-reservoirs, micro-pumps, cantilevers, rotors, channels, valves, sensors, and other structures have been designed, fabricated and tested from using materials that have been demonstrated to be biocompatible. This paper reviews the status of Micro-electronic and MEMS systems that can be used for adaptive drug administration. It presents different components and describes a possible implementation. Finally it presents a prototype that is termed ipill which stands intelligent pill.

Salivary glucose concentrations in patients with diabetes mellitus--a minimally invasive technique for monitoring blood glucose levels

Salivary and blood glucose concentrations were determined in non-diabetic healthy individuals and patients with diabetes mellitus (type II). Glycosylated haemoglobin A1c was also determined in some of the patients (n = 25) and a significant correlation (r = 0.82) was found between HbAlc and serum glucose concentrations in these patients, indicating that these patients had average elevated blood glucose concentration over an extended time period. Glucose was only found in the saliva of patients with diabetes mellitus (n = 135), while the salivary samples of age matched non-diabetic subjects (n = 25) did not show the presence of glucose. A significant correlation (r = 0.78) was found between salivary and blood concentrations in the diabetics. This finding suggests that saliva can be used reliably for reflecting and monitoring the blood glucose concentration in the patients of diabetes mellitus.

Evidence for an intrarenal renin-angiotensin system in the rainbow trout, Oncorhynchus mykiss

Physiological and molecular approaches were used to investigate the existence of an intrarenal renin-angiotensin system (RAS) in rainbow trout. Inhibition of angiotensin-converting enzyme by captopril (5 x 10(-4 )M) rapidly decreased vascular resistance of the trunk of the trout, perfused at 19 mmHg, resulting in an increased perfusate flow rate and a decreased intrarenal dorsal aortic pressure. A profound diuresis occurred in the in situ perfused kidney and reflected both increased glomerular filtration rates and decreased water reabsorption (osmolyte reabsorption was unchanged). Renal and vascular parameters recovered once captopril treatment was stopped. Diuretic and vascular effects of captopril on the in situ trout kidney concur with an inhibition of known vasoconstrictor and antidiuretic actions of angiotensin II. However, at a higher perfusion pressure (28 mmHg), captopril had no effect on intrarenal aortic pressure or perfusate and urine flow rates, suggesting that the trout intrarenal RAS is activated by low perfusion pressures/flows. Existence of the renal RAS in trout was further supported by evidence for angiotensinogen gene expression in kidney as well as liver.

The hypolipidaemic effect of gum tragacanth in diet induced hyperlipidaemia in rats

Previous research indicated that fiber in the diet of men lowers plasma lipid and LDL cholesterol concentration. To further study the lipid lowering effect of fibre, we conducted an animal study using rats with diet induced hyperlipidaemia. Rats were randomly assigned to one of the three experimental diets. Two of the diets contained cholesterol and choice acid to induce hyperlipidaemia, the fiber source in the hyperlipidaemic diet was gum tragacanth (5%). The rats consumed one of the three diets ad libitum for 4 weeks before they were killed. Plasma LDL cholesterol and total cholesterol concentrations were significantly higher in the hyperlipidaemic group than in the non hyperlipidaemic control group. A marked improvement in the plasma LDL cholesterol and total cholesterol concentration was observed in the rats that were fed hyperlipidaemic diet containing grum tragacanth. No significant difference in the plasma triglyceride concentration was detected in the three groups. Plasma HDL concentration was significantly higher in the non-hyperlipidaemic group than in the hyperlipidaemic group than. Addition of gum tragacanth to the hyperlipidaemic diet significantly improved the plasma HDL concentration in the hyperlipidaemic rats. These results suggest that fiber from gum tragacanth lowers plasma cholesterol and LDL in hyperlipidaemia. Gum tragacanth could be useful adjunct to the dietary management of hyperlipidaemia.

Glomerular actions of arginine vasotocin in the in situ perfused trout kidney

Recent measurements of plasma arginine vasotocin (AVT) in teleost fish suggest circulating concentrations of 10(-10)-10(-12)M. Previous studies of the renal actions of AVT in vivo suggest both diuretic and antidiuretic effects, but at unknown circulating concentrations. We have investigated the renal actions of 10(-9) and 10(-11) M AVT in vitro using an in situ perfused kidney preparation of rainbow trout (oncorhynchus mykiss). AVT increased vascular resistance (56%), reduced perfusate flow (P < 0.001), and increased interrenal aortic pressure (P < 0.001). AVT resulted in dose-dependent decreases in urine flow rates, glomerular filtration rates, and tubular transport maxima for glucose. AVT at 10(-11) M reduced relative free water clearances (P < 0.01), but urine/plasma inulin ratios were unchanged, whereas 10(-9)M AVT reduced urine/plasma inulin ratios (P < 0.01) and increased relative free water clearances (P < 0.05). The filtering population of glomeruli was reduced by both 10(-11) and 10(-9)M AVT to approximately one-third of the glomeruli, and a similar population of arterially perfused but nonfiltering glomeruli emerged. These results demonstrate that physiological concentrations of AVT have potent glomerular antidiuretic action in the trout, reducing the number of functional glomeruli, and imply reduced individual nephron filtration rates.

Enzyme-linked immunosorbent assay for diagnosis of acute sporadic hepatitis E in Egyptian children

Hepatitis E virus (HEV) is thought to be a cause of enterically transmitted non-A, non-B (ET-NANB) hepatitis. Waterborne epidemics have been recorded in many developing countries, mainly affecting young-to-middle-aged adults; sporadic infection and overt illness in children are rare. However, a convenient and sensitive diagnostic test for HEV infection is not yet available. We now report the use of a solid-phase enzyme-linked immunoassay (ELISA) that detects IgM and IgG antibody to HEV. In a prospective study of endemic acute hepatitis during 1986 in rural Benha, Egypt, 15 (42%) of 36 children with NANB hepatitis (from whom convalescent-phase sera were available every 3 months to 9 or 12 months) were positive for anti-HEV-IgG by ELISA. Of 20 sera from healthy Benha children (controls), 5 (25%) were also positive for anti-HEV-IgG. When evaluated for anti-HEV-IgM, 6 of the 15 IgG-positive children, but none of the controls, were IgM positive and were thus regarded as having confirmed acute HEV infections. These 6 cases together with 2 presumptive cases (IgM negative, IgG seroconversion from positive to negative) presented sporadically over 9 months. This ELISA is a convenient method for the diagnosis of HEV infection; we have shown that the disease is present in Egypt, that it can occur endemically as sporadic cases, and that children do have overt infection.

The molluscicidal properties of Ambrosia maritima L. (Compositae). 4. Temporal and spatial distribution of Biomphalaria alexandrina in Egyptian village irrigation systems with reference to schistosomiasis transmission control

Data on the temporal and spatial distribution of Biomphalaria alexandrina were collected throughout one year in two village irrigation systems near Alexandria, Egypt. Snails bearing Schistosoma mansoni cercariae were found from May to December but about 80% of annual transmission potential was confined from June to August. Although snail infection rates were generally 0-2%, higher rates were recorded and tended to be associated with smaller number snail collections. Infected snails were found in most canal and drain types and were judged to be present across most of the irrigated area of each village. In view of the dispersed nature of both infected snails and human-water contact in the area, it is suggested that schistosomiasis transmission is more widespread than focal. Effective transmission control using molluscicides should therefore require application to all village irrigation water-courses. The difficulties these various findings might impose on the use of commercial molluscicides are discussed and some possible advantages of the alternative plant molluscicide, Ambrosia maritima are noted.

Effect of subdermal levonorgestrel contraceptive implants on vaginal candidiasis

A total of 150 women in 3 equal groups, each using a different contraceptive method (group I used Norplant, group II used the IUD and group III used combined OC pills) were investigated for the presence of vaginal candidiasis before and at various time intervals (3, 6 and 12 months) after starting to use the particular contraceptive method. The incidence of vaginal Candida albicans infection increased significantly among pill and IUD users, but with a much lower intensity among the latter cases. In Norplant users the increase was slight and insignificant. The explanation of these findings within the context of changes in local vaginal milieu is discussed.

Mononeuritis multiplex in a patient with macroglobulinaemia

A case is described of a 73 year old male with Waldenström's macroglobulinaemia and hyperviscosity in association with neurological abnormalities, the Bing-Neel syndrome. The relationship of the clinical features to changes in serum viscosity and the response to therapy with plasmapheresis and chlorambucil are discussed.