Dynamics of blaOXA-23 gene transmission in Acinetobacter spp. from contaminated veterinary environmental surfaces: an emerging One Health threat?

BACKGROUND

Carbapenem-resistant Acinetobacter baumannii is a common pathogen associated with healthcare-acquired infections, and robust infection prevention and control protocols exist in human healthcare settings. In contrast, infection prevention and control (IPC) standards are limited in veterinary medicine, necessitating further investigation.

AIM

Examine the possible transmission of carbapenem-resistant Acinetobacter spp. in a veterinary practice where a cat was diagnosed with an OXA-23-producing A. baumannii ST2 strain.

METHODS

Environmental samples together with nasal and hand swabs from the veterinary personnel were collected. All swabs were screened for the presence of extended-spectrum-β-lactamase- and carbapenemase-producing Enterobacterales, meticillin-resistant staphylococcus and multi-drug-resistant Acinetobacter spp. Whole-genome sequencing was performed for carbapenemase-producing strains.

RESULTS

Of the veterinary staff, 60% carried meticillin-resistant Staphylococcus epidermidis. Environmental evaluation showed that 40% (N=6/15) of the surfaces analysed by contact plates and 40% (N=8/20) by swabs failed the hygiene criteria. Assessment of the surfaces revealed contamination with five OXA-23-producing Acinetobacter spp. strains: an OXA-23-producing Acinetobacter schindleri on the weight scale in the waiting room; and four OXA-23-producing Acinetobacter lwoffii strains, on different surfaces of the treatment room. The blaOXA-23 gene was located on the same plasmid-carrying Tn2008 across the different Acinetobacter spp. strains. These plasmids closely resemble a previously described OXA-23-encoding plasmid from a human Portuguese nosocomial Acinetobacter pittii isolate. Distinctly, the OXA-23-producing A. baumannii ST2 clinical strain had the resistant gene located on Tn2006, possibly inserted on the chromosome.

CONCLUSION

The detection of an OXA-23-producing A. baumannii ST2 veterinary clinical strain is of concern for companion animal health and infection, prevention and control. This study established the dynamic of transmission of the plasmid-mediated blaOXA-23 gene on critical surfaces of a small animal veterinary practice. The genetic resemblance to a plasmid found in human nosocomial settings suggests a potential One Health link.

Consumption of legumes in children from 3 to 6 years – evaluation of an intervention program

Introduction

Eating habits are a key aspect of a healthy lifestyle. This study focuses on the importance of consuming legumes - rich and accessible source of protein, and a healthy and sustainable option, in environmental terms - contributing to increment health literacy levels at the population level.

Objectives

To design, implement and evaluate a program to promote the consumption of legumes - Beans4Life. Specifically, to assess its impact on the knowledge and frequency of consumption of the eight legumes (beans, grain, peas, beans, beans, lentils, chickpeas and lupins).

Methods

Pre-test post-test analytical study, with three evaluation moments: 1) before the intervention; 2) after the intervention with the children and 3) after the intervention with the guardians (end of the intervention). Participants: 90 children from 3 to 6 years old (54.4% male) and their guardians. Instruments: questionnaire to assess knowledge and food preferences, questionnaire on eating habits and a questionnaire to evaluate sessions. The intervention had two components, the first with the children (4 food education sessions) and the second with the families (activities that facilitate the inclusion of recipes with legumes in the family's daily life).

Results

Before the intervention, the results obtained show low levels of knowledge and frequency of consumption of legumes, influencing low health literacy. Peas and beans are the best known legumes (81.1% and 55.6%) and also preferred (77.8% and 73.3%). The results obtained in the second and third assessments show that there was a significant increase (p < 0.05) in the knowledge and frequency of consumption of most legumes.

Conclusions

The objectives initially proposed were achieved and it will be pertinent to continue the present study, with larger samples, in order to increase health literacy awareness and the consumption of this food group in childhood, and provide more robust results that help to clarify the relationships found.

Choosing wisely in burn care

BACKGROUND

The Choosing Wisely Campaign was launched in 2012 and has been applied to a broad spectrum of disciplines in almost thirty countries, with the objective of reducing unnecessary or potentially harmful investigations and procedures, thus limiting costs and improving outcomes. In Canada, patients with burn injuries are usually initially assessed by primary care and emergency providers, while plastic or general surgeons provide ongoing management. We sought to develop a series of Choosing Wisely statements for burn care to guide these practitioners and inform suitable, cost-effective investigations and treatment choices.

METHODS

The Choosing Wisely Canada list for Burns was developed by members of the Canadian Special Interest Group of the American Burn Association. Eleven recommendations were generated from an initial list of 29 statements using a modified Delphi process and SurveyMonkey™.

RESULTS

Recommendations included statements on avoidance of prophylactic antibiotics, restriction of blood products, use of adjunctive analgesic medications, monitoring and titration of opioid analgesics, and minimizing 'routine' bloodwork, microbiology or radiological investigations.

CONCLUSIONS

The Choosing Wisely recommendations aim to encourage greater discussion between those involved in burn care, other health care professionals, and their patients, with a view to reduce the cost and adverse effects associated with unnecessary therapeutic and diagnostic procedures, while still maintaining high standards of evidence-based burn care.

P-534 Noninvasive preimplantation genetic testing for aneuploidies (NIPGT-A) x Preimplantation genetic testing for aneuploidies (PGT-A): NIPGT-A is more reliable than PGT-A

Study question

Does NIPGT-A have lower false-positive rates (FPR) than PGT-A?

Summary answer

When DNA from whole embryo cells was used as the gold-standard, the FPR of NIPGT-A was 3.57-times smaller than that obtained with PGT-A.

What is known already

After many years of using PGT-A, there are still many concerns, such as risks of invasive action and difficulties in the correct interpretation of mosaicism, which could lead to errors in the interpretation of false-positive and false-negative results. Recently, a new technology (NIPGT-A) has arisen using cell-free DNA present in the spent culture media of human blastocysts. Unlike PGT-A that uses only trophoblastic cells, NIPGT-A reflects the ploidy status of trophoblastic cells and inner cell mass, suggesting that this new technology could be less prone to errors and thus more reliable than invasive tests.

Study design, size, duration

This multicentric cohort study included a total of 56 blastocysts vitrified on day/5 that were previously biopsied for PGT-A(all these embryos presented a diagnosis of aneuploidy). The embryos were donated under informed consent by patients following the Human Medical Authority regulations. Blastocysts were thawed and cultured in 15μl drops of culture medium under oil. After their expansion(4-8hours), the blastocysts and their corresponding spent media were transferred to PCR tubes and stored at -20ºC until analysis.

Participants/materials, setting, methods

The DNA of all samples (spent culture medium and whole embryo) was amplified by the MALBAC® technology(Yikon Genomics). The DNA concentration of the amplified product was measured using Qubit 3.0 Fluorometer(Thermo Fisher Scientific). The samples were subjected to next-generation sequencing(NGS) using Illumina MiSeq® System. The ploidy status results obtained from ChromGo™ software(Yikon Genomics) for spent culture medium and whole embryo were compared to determine the accuracy of NIPGT-A for screening chromosomal abnormalities in each embryo.

Main results and the role of chance

DNA from all 56 spent media samples and whole embryos were successfully amplified. Comparing the results of NIPGT-A and whole embryos sequencing, the positive predictive value (PPV) was 93.5% and the FPR was 6.5% (Table 1). On the other hand, comparing the whole embryo and PGT-A results, the PPV was 76.8%, and the FPR was 23.2% (Table 2). NIPGT-A had a negative predictive value (NPV) of 100% and a false negative rate (FNR) of 0%.

Limitations, reasons for caution

Despite the sample size could be considered small, comparative analyses between the results of invasive/noninvasive PGT-A with whole embryo are rare. All donated embryos were classified as aneuploidy. Additionally, the cut-off for aneuploidy in cases of PGT-A could be variable(multicentre-study). Euploid embryos have not been donated for research to date.

Wider implications of the findings

NIPGT-A has a lower FPR than PGT-A and does not require micromanipulation skills, avoiding trophectoderm biopsy trauma and seems to provide more accurate results corresponding to the ploidy status of the whole embryo. Thereby NIPGT-A should be considered as the test of choice for genetic evaluation of the embryo.

Trial registration number

Not Applicable

CRISPR-Cas9 In Vivo Gene Editing for Transthyretin Amyloidosis

BACKGROUND

Transthyretin amyloidosis, also called ATTR amyloidosis, is a life-threatening disease characterized by progressive accumulation of misfolded transthyretin (TTR) protein in tissues, predominantly the nerves and heart. NTLA-2001 is an in vivo gene-editing therapeutic agent that is designed to treat ATTR amyloidosis by reducing the concentration of TTR in serum. It is based on the clustered regularly interspaced short palindromic repeats and associated Cas9 endonuclease (CRISPR-Cas9) system and comprises a lipid nanoparticle encapsulating messenger RNA for Cas9 protein and a single guide RNA targeting TTR.

METHODS

After conducting preclinical in vitro and in vivo studies, we evaluated the safety and pharmacodynamic effects of single escalating doses of NTLA-2001 in six patients with hereditary ATTR amyloidosis with polyneuropathy, three in each of the two initial dose groups (0.1 mg per kilogram and 0.3 mg per kilogram), within an ongoing phase 1 clinical study.

RESULTS

Preclinical studies showed durable knockout of TTR after a single dose. Serial assessments of safety during the first 28 days after infusion in patients revealed few adverse events, and those that did occur were mild in grade. Dose-dependent pharmacodynamic effects were observed. At day 28, the mean reduction from baseline in serum TTR protein concentration was 52% (range, 47 to 56) in the group that received a dose of 0.1 mg per kilogram and was 87% (range, 80 to 96) in the group that received a dose of 0.3 mg per kilogram.

CONCLUSIONS

In a small group of patients with hereditary ATTR amyloidosis with polyneuropathy, administration of NTLA-2001 was associated with only mild adverse events and led to decreases in serum TTR protein concentrations through targeted knockout of TTR. (Funded by Intellia Therapeutics and Regeneron Pharmaceuticals; ClinicalTrials.gov number, NCT04601051.).

Follie a deux: Psychopathology in a pandemic

Introduction

Follie a deux is a rare syndrome characterized by the transference of delusions from a primary subject to a secondary one. This rare condition, and frequently forgotten in psychiatry pratice, is more frequent in feedlots, particularly in situations alike we face nowadays because of the pandemic.

Objectives

To describe a clinical case and to discuss and highlight some clinical aspects of this entity.

Methods

Present a clinical case report and respective non systematic literature review

Results

This clinical vignete describes a case of shared delusion between a mother and a son. The son suffers from an intelectual disability and shared with his mother a persecutory and prejudice delusion. Both live in the same house and because of the pandemic they spend all the time together. This situation was probably the main factor influencing the course of the symptoms.

Conclusions

It is highlighted the importance of a social isolation and close contact between the pair mother/son, more important in context of a global pandemic, viewed as an obstacle to promote the separation of both.

A combined digital and organizational approach dramatically improves access to outpatient care in cardiology

 

We have previously shown that digital preconsultation saves medical time and may improve outcome. But waiting times for a cardiology consultation are still growing mainly due to chronic diseases, aging and a growing demand for prevention.

Purpose

We aimed to evaluate the impact of a combined approach using digital tools and a novel outpatient team organization on access to care, in real life

Methods

We implemented a full digital solution and a dedicated team in a new outpatient cardiology center (Figure). The organization was schematically divided in five parts: (1) digital PRECONSULTATION completed by the patient with an assistant and nurse support if necessary; (2) digital AI-NALYSIS of this data with a trained nurse validation to define the risk level; (3) Medical CONSULTATION either physical or using teleconsultation; (4) RESULTS: directly accessible to the patient and his GP; (5) FOLLOW-UP if relevant mainly based on digital tools and trained nurses. Activity was monitored for 9 months. The following parameters were measured: waiting time (from demand to consultation); medical efficiency (number of consultations/hour of work); patient overall satisfaction

Results

2867 consultations were performed between April and December 2019, with a waiting time of 4.3±1.6 days (compared to a national average of 61 days). Efficiency averaged 2.3 patients/hour. Patient satisfaction averaged 4.84 over 5.

In addition, 160 possible consultations in the emergency room were avoided (mainly mild palpitations and non-cardiac chest pain)

Conclusion

A specific digital platform and a dedicated medical team and organization improved the access to care and the medical efficiency. We believe this is a promising way to decrease the demand burden in the emergency room, to decrease the professional burnout risk and to improve prevention.

Figure 1. A Phygital care path

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Cardioparc, Izycardio

Health tourism and public health: when novelty crosses the added value of multilateralism

Background

Of the EU citizens, 5% get medical treatment in another EU country (MTT), 33% are willing to travel to get MTT and 53% willing to travel for better quality MTT (Statista 2018). In Portugal between 2017 and 2018 almost 1000 patients were treated in another EU country (cost/mean of 10 thousand Euros). Portugal has increase hindrances in disease care at the NHS. The private sector increased its market share (attracting specialists out of the NHS). While waiting lists, as shortness of human resources prevails, have no sign of changing in the near future, European regulations create expectations to receive appropriate timely MTT. To deal with the complexity of the topic a study case based on cataract disease, will be used. As national strategies try to fill precise gaps to answer specific disease conditions, Medical Tourism (MT) demand can be seen as a strategy to decrease inequalities of access?

Methods

A tracer methodology, looking at cataracts treatment in the population, is used to understand how demand increase can be mitigated with a European answer of MTT.

Results

Although Portugal has the highest rate of cataract operations in the EU28 (14 operations per thousand inhabitants (2015)) demand is not answered by the NHS, with a wating list of 194 days for the first consultation and about 100 days of waiting lists to get operated (and increasing over recent years). Regional municipalities have tried to overcome this NHS failure by offering its populations treatment vouchers in another countries. Nevertheless, the National Audit Office ruled as illegal such initiatives and moreover, at the NHS, cataract operations are not allowed in another country.

Conclusions

Although very rare and specific disease conditions have been allowed to be answered by MTT, common and increasingly debilitated conditions, e.g. cataracts, remain inaccessible for citizens in proper and due time while MT stands as an open option.

Identification of cryptolepine metabolites in rat and human hepatocytes and metabolism and pharmacokinetics of cryptolepine in Sprague Dawley rats

BACKGROUND

This study aims at characterizing the in vitro metabolism of cryptolepine using human and rat hepatocytes, identifying metabolites in rat plasma and urine after a single cryptolepine dose, and evaluating the single-dose oral and intravenous pharmacokinetics of cryptolepine in male Sprague Dawley (SD) rats.

METHODS

The in vitro metabolic profiles of cryptolepine were determined by LC-MS/MS following incubation with rat and human hepatocytes. The in vivo metabolic profile of cryptolepine was determined in plasma and urine samples from Sprague Dawley rats following single-dose oral administration of cryptolepine. Pharmacokinetic parameters of cryptolepine were determined in plasma and urine from Sprague Dawley rats after single-dose intravenous and oral administration.

RESULTS

Nine metabolites were identified in human and rat hepatocytes, resulting from metabolic pathways involving oxidation (M2-M9) and glucuronidation (M1, M2, M4, M8, M9). All human metabolites were found in rat hepatocyte incubations except glucuronide M1. Several metabolites (M2, M6, M9) were also identified in the urine and plasma of rats following oral administration of cryptolepine. Unchanged cryptolepine detected in urine was negligible. The Pharmacokinetic profile of cryptolepine showed a very high plasma clearance and volume of distribution (Vss) resulting in a moderate average plasma half-life of 4.5 h. Oral absorption was fast and plasma exposure and oral bioavailability were low.

CONCLUSIONS

Cryptolepine metabolism is similar in rat and human in vitro with the exception of direct glucuronidation in human. Clearance in rat and human is likely to include a significant metabolic contribution, with proposed primary human metabolism pathways hydroxylation, dihydrodiol formation and glucuronidation. Cryptolepine showed extensive distribution with a moderate half-life.

Ovarian steroids, oxytocin, and tumor necrosis factor modulate equine oviduct function

The oviduct plays important roles in the early reproductive process. The aim of this study was to evaluate gene transcription and protein expression of progesterone receptor (PGR), estrogen receptors 1 (ESR1) and 2 (ESR2); oxytocin receptor (OXTR); prostaglandin F2α synthase (AKR1C3), and prostaglandin E2 synthase (Ptges) in mare oviduct in different estrous cycle stages. Estradiol (E₂), progesterone (P₄), oxytocin (OXT), and tumor necrosis factor α (TNF) effect on in vitro PGE₂ and prostaglandin F2α (PGF_2α) secretion by equine oviduct explants or by oviductal epithelial cells (OECs) were also assessed. During the breeding season, oviduct tissue was obtained post mortem from cyclic mares. Protein of ESR1, ESR2, PGR, AKR1C3, and Ptges was present in OECs, whereas OXTR was shown in oviduct stroma. In follicular phase, protein expression of ESR1, ESR2, PGR, and OXTR increased in oviduct explants (P < 0.05), whereas no estrous cycle effect was noted for AKR1C3 or Ptges. In follicular phase, mRNA transcription was upregulated for Pgr but downregulated for Oxtr, Ptges, and Akr1c3 (P < 0.05). Nevertheless, Esr1 and Esr2 mRNA levels did not change with the estrous cycle. In the ampulla, Esr1, Esr2, and Oxtr mRNA transcription increased, but not for Pgr or Ptges. In contrast, Akr1c3 mRNA level was upregulated in the infundibulum (P < 0.05). In follicular phase, E₂, P₄, and OXT downregulated PGE₂ production by OEC (P < 0.05), but no difference was observed in mid-luteal phase. Explants production of PGE₂ rose when treated with OXT in follicular phase; with TNF or OXT in early luteal phase; or with TNF, OXT, or P₄ in mid-luteal phase. PGF_2α production by OEC was downregulated by all treatments in follicular phase but upregulated in mid-luteal phase (P < 0.05). Oviduct explants PGF_2α production was stimulated by TNF or OXT in all estrous cycle phases. In conclusion, this work has shown that ESR1, ESR2, OXTR, Ptges, and AKRLC3 gene transcription and/or translation is estrous cycle dependent and varies with oviduct portion (infundibulum vs ampulla) and cell type. Ovarian steroid hormones, OXT and TNF stimulation of PGF_2α and/or PGE₂ production is also estrous cycle dependent and varies in the different portions of mare oviduct. Differential transcription level and protein localization in various portions of the oviduct throughout the estrous cycle, as well as PG production, suggest coordinated physiologic actions and mechanisms of steroid hormones, OXT, and TNF in the equine oviduct.

Use of C-banding for identifying radiation induced micronuclei

Differentiation of micronuclei (MN) caused by ionizing radiation from those caused by chemicals is a crucial step for managing treatment of individuals exposed to radiation. MN in binucleated lymphocytes in peripheral blood are widely used as biomarkers for estimating dose of radiation, but they are not specific for ionizing radiation. MN induced by ionizing radiation originate predominantly as a result of chromosome breaks (clastogenic action), whereas MN caused by chemical agents are derived from the loss of entire chromosomes (aneugenic action). C-banding highlights centromeres, which might make it possible to distinguish radiation induced MN, i.e., as a byproduct of acentric fragments, from those caused by the loss of entire chromosomes. To test the use of C-banding for identifying radiation induced MN, a blood sample from a healthy donor was irradiated with 3 Gy of Co-60 gamma rays and cultured. Cells were harvested and dropped onto slides, divided into a group stained directly with Giemsa and another processed for C banding, then stained with Giemsa. The frequency of MN in 500 binucleated cells was scored for each method. In preparations stained with Giemsa directly, the MN appeared as uniformly stained structures, whereas after C banding, some MN exhibited darker regions corresponding to centromeres that indicated that they were not derived from acentric fragments. The C-banding technique enables differentiation of MN from acentric chromosomal material. This distinction is useful for improving the specificity of the MN assay as a biomarker for ionizing radiation.

Residential Unit for the Elderly: Cases Study and Reflections on the First 18 Months of Functioning

Introduction

The Residential Unit for the Elderly (RUE) was established in August 2015 and has capacity for 8 inpatients. It is intended to behavioral reorganization and caregiver rest of elderly patients with behavioral changes, particularly in cases of cognitive impairment.

Aim

We intend to describe the hospitalized population in the first 18 months and discuss the unit functioning and its impact on clinical stability of patients.

Methods

Socio-demographic and clinical data were analyzed using the STATA v13.1 software, using multivariate regression model with a 0.05 significance level.

Results

We present preliminary results from the first twelve months. Twenty-six patients admitted, 18 (69.2%) were female, with an average age of 76.7 years-old (IQR 71–86-years-old). The main reasons for referral were: caregiver rest (38.4%), psychopathological stabilization (30.7%) and autonomy training/cognitive stimulation (15.4%). Most patients had dementia (65.4%). Patients were hospitalized on average 78 days (IQR 30–98 days). Complications occurred in 18 patients (69.2%). There was an 85.7% reduction in the number of hospitalizations for any cause within 6 months after hospitalization in the RUE (P < 0.001) and a 75% reduction in hospitalizations from psychiatric cause (P = 0.001). Regarding visits to the emergency room (ER), we found a decrease of 87.1% in visits for psychiatric motive (P < 0.001) and 85.4% in visits for any cause (P < 0.001).

Conclusion

Inpatient care in RUE has contributed to the clinical stability of patients with consequent reduced use of health services. Although the results still concern a short operating period, they appear to be promising.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Compound Property Optimization in Drug Discovery Using Quantitative Surface Sampling Micro Liquid Chromatography with Tandem Mass Spectrometry

Surface sampling micro liquid chromatography tandem mass spectrometry (SSμLC-MS/MS) was explored as a quantitative tissue distribution technique for probing compound properties in drug discovery. A method was developed for creating standard curves using surrogate tissue sections from blank tissue homogenate spiked with compounds. The resulting standard curves showed good linearity and high sensitivity. The accuracy and precision of standards met acceptance criteria of ±30%. A new approach was proposed based on an experimental and mathematical method for tissue extraction efficiency evaluation by means of consecutively sampling a location on tissue twice by SSμLC-MS/MS. The observed extraction efficiency ranged from 69% to 82% with acceptable variation for the test compounds. Good agreement in extraction efficiency was observed between surrogate tissue sections and incurred tissue sections. This method was successfully applied to two case studies in which tissue distribution was instrumental in advancing project teams' understanding of compound properties.

Serum protein concentration in low-dose total body irradiation of normal and malnourished rats

Among the radiotherapeutics' modalities, total body irradiation (TBI) is used as treatment for certain hematological, oncological and immunological diseases. The aim of this study was to evaluate the long-term effects of low-dose TBI on plasma concentration of total protein and albumin using prematurely and undernourished rats as animal model. For this, four groups with 9 animals each were formed: Normal nourished (N); Malnourished (M); Irradiated Normal nourished (IN); Irradiated Malnourished (IM). At the age of 28 days, rats of the IN and IM groups underwent total body gamma irradiation with a source of cobalt-60. Total protein and Albumin in the blood serum was quantified by colorimetry. This research indicates that procedures involving low-dose total body irradiation in children have repercussions in the reduction in body-mass as well as in the plasma levels of total protein and albumin. Our findings reinforce the periodic monitoring of total serum protein and albumin levels as an important tool in long-term follow-up of pediatric patients in treatments associated to total body irradiation.

Anxiety Among Hiv-Infected Patients – When Anxiety Is A Disorder and not Simply A Natural Reaction to a Life-Threatening IIIness

Introduction

HIV infection is a chronic disease characterized by a great deal of uncertainty and unpredictability, being anxiety disorders a frequent psychiatric problem.

Objective

To provide an overview of anxiety in HIV-infected patients.

Methods

Literature review based on PubMed/Medline, using the keywords “HIV” and “anxiety disorders”.

Results

HIV-infected individuals can experience symptoms of anxiety across the spectrum of anxiety disorders. Adjustment disorder with anxious mood is the most common diagnosis, followed by generalized anxiety disorder and panic disorder. Some patients present with these disorders prior to notification, others develop them during the course of their illness, mainly at key moments. In HIV-infected patients, anxiety can be a manifestation of side effects of medication; a symptom of an illness associated with HIV disease; or, most commonly, the psychological response to the stressors of the illness. In fact, many issues are responsible for the anxiety experienced by people living with HIV. The authors will analyze them. Besides the distress of anxiety disorders, these lead to a decrease in adherence to antiretroviral treatments, resulting in adverse progression of HIV disease and increased risk of mortality. Importantly, however, appropriate psychiatric intervention can do it over.

Conclusions

Careful diagnosis and treatment of anxiety disorders in the context of HIV disease is even important, given the serious effects if untreated. Thus, anxiety should never be seen simply as a natural reaction to a life-threatening illness.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

A journey across perversions history – from Middle Age to DSM

Introduction

Psychiatry's viewpoint of sexual deviance has waved between the normal and the pathological. “Normal” is not determined by nature but by the values of a specific society.

Aims

To review the main landmarks in paraphilias history and the importance of social and cultural dimensions to it.

Methods

PubMed database was searched using the keywords perversion, sexual deviance, paraphilia, culture and society.

Results

Throughout Middle Age and Renaissance any sexual act that differed from the natural/divine law was considered a vice. Unnatural vices (masturbation, sodomy, bestiality) were the most severely punished, as they could not result in conception. In 1886, Krafft-Ebing stated perversions were functional diseases of the sexual instinct caused by “hereditary taintedness” in the family pedigree and worsened by excessive masturbation. Proper perversions were sadism, masochism, antipathic sexuality (homosexuality, transvestism, transsexuality) and fetishism. Later, Havelock Ellis and Hirschfeld claimed sexual interest in the population followed a statistical norm, opposed the idea that masturbation led to diseases and demanded the decriminalization of homosexuality. Freud believed the “perverse disposition” to be universal in the childhood giving rise to healthy and pathological adult behaviors. In 1950's, Albert Kinsey surprised America when he proved many supposedly deviant sexual practices were quite common. The first Diagnostic and Statistical Manual (1952) was mainly psychoanalytic. Later, by 1973, homosexuality was removed from classifications. Recently, DSM-5 distinguishes between paraphilias and paraphilic disorders.

Conclusion

A progress in the paraphilic instincts’ acceptance has occurred. We hypothesize, in the future, paraphilias will follow homosexuality out of the diseases’ classifications.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

A Comparison of LC-MS/MS and a Fully Integrated Autosampler/Solid-Phase Extraction System for the Analysis of Protein Binding Samples

A new analysis approach was evaluated for measuring plasma protein binding (PPB) of small molecules using the Agilent RapidFire high-throughput system coupled with a Sciex API 4000 mass spectrometer (RF-MS/MS). Thirty-three proprietary and 12 literature compounds were subjected to rapid equilibrium dialysis (RED) and evaluated in parallel using RF-MS/MS at 16.4 s/sample and traditional liquid chromatography–tandem mass spectrometry (LC-MS/MS) at 3.5 min/sample, thus making the RF-MS/MS analysis over 12 times faster than LC-MS/MS. The high-throughput analysis method that was developed demonstrated excellent correlation with the traditional LC-MS/MS analysis method with an r2 value of 0.96. The RF-MS/MS analysis method was implemented to increase sample throughput, decrease turnaround time for PPB data, and decrease time burden on existing LC-MS/MS instruments.

Detailed off-gas measurements for improved modelling of the aeration performance at the WWTP of Eindhoven

At wastewater treatment plants (WWTPs), the aerobic conversion processes in the bioreactor are driven by the presence of dissolved oxygen (DO). Within these conversion processes, the oxygen transfer is a rate limiting step as well as being the largest energy consumer. Despite this high importance, WWTP models often lack detail on the aeration part. An extensive measurement campaign with off-gas tests was performed at the WWTP of Eindhoven to provide more information on the performance and behaviour of the aeration system. A high spatial and temporal variability in the oxygen transfer efficiency was observed. Applying this gathered system knowledge in the aeration model resulted in an improved prediction of the DO concentrations. Moreover, an important consequence of this was that ammonium predictions could be improved by resetting the ammonium half-saturation index for autotrophs to its default value. This again proves the importance of balancing sub-models with respect to the need for model calibration as well as model predictive power.

A dose-response curve for biodosimetry from a 6 MV electron linear accelerator

Biological dosimetry (biodosimetry) is based on the investigation of radiation-induced biological effects (biomarkers), mainly dicentric chromosomes, in order to correlate them with radiation dose. To interpret the dicentric score in terms of absorbed dose, a calibration curve is needed. Each curve should be constructed with respect to basic physical parameters, such as the type of ionizing radiation characterized by low or high linear energy transfer (LET) and dose rate. This study was designed to obtain dose calibration curves by scoring of dicentric chromosomes in peripheral blood lymphocytes irradiated in vitro with a 6 MV electron linear accelerator (Mevatron M, Siemens, USA). Two software programs, CABAS (Chromosomal Aberration Calculation Software) and Dose Estimate, were used to generate the curve. The two software programs are discussed; the results obtained were compared with each other and with other published low LET radiation curves. Both software programs resulted in identical linear and quadratic terms for the curve presented here, which was in good agreement with published curves for similar radiation quality and dose rates.

Physiopathologic mechanisms involved in mare endometrosis

Endometrosis is a degenerative chronic process, characterized by paramount fibrosis development in mare endometrium. This condition is one of the major causes of subfertility/infertility in mares. As in other organs, fibrosis might be a pathologic sequel of many chronic inflammatory diseases. However, aetiology and physiopathologic mechanisms involved in endometrial fibrosis are still controversial. This review presents new hypotheses based on our newest data. As the first line of innate immune defence, systemic neutrophils arrive in the uterus at mating or in the presence of pathogens. A novel paradigm is that neutrophils cast out their DNA in response to infectious stimuli and form neutrophil extracellular traps (NETs). We have shown that bacterial strains of Streptococcus zooepidemicus, Escherichia coli or Staphylococcus capitis, known to cause endometritis in mares were able to induce NETs release in vitro by equine PMN to different extents. An intriguing dilemma is the dual action of NETs. While NETs play a desirable role fighting micro-organisms in mare uterus, they may also contribute to endometrial fibrosis. A long-term in vitro exposure of mare endometrium explants to NETs components (myeloperoxidase, elastase and cathepsin G) up-regulated fibrosis markers TGFβ and Tissue inhibitor of metalloproteinase (TIMP-1). Also, pro-fibrotic cytokines regulated collagen deposition and fibrosis. Changes in expression of connective tissue growth factor (CTGF), interleukins (IL)1-α, IL-1β, IL-6 and receptors in endometrium with different degrees of fibrosis and/or inflammation were observed. A putative role of CTGF, IL and NETs components in endometrosis development should be considered. Additionally, we speculate that in sustained endometritis in mares, prostaglandins may not only cause early luteolysis or early pregnancy loss, but may also be related to endometrial fibrosis pathogenesis by stimulating collagen deposition.

Englerin A Agonizes the TRPC4/C5 Cation Channels to Inhibit Tumor Cell Line Proliferation

Englerin A is a structurally unique natural product reported to selectively inhibit growth of renal cell carcinoma cell lines. A large scale phenotypic cell profiling experiment (CLiP) of englerin A on ¬over 500 well characterized cancer cell lines showed that englerin A inhibits growth of a subset of tumor cell lines from many lineages, not just renal cell carcinomas. Expression of the TRPC4 cation channel was the cell line feature that best correlated with sensitivity to englerin A, suggesting the hypothesis that TRPC4 is the efficacy target for englerin A. Genetic experiments demonstrate that TRPC4 expression is both necessary and sufficient for englerin A induced growth inhibition. Englerin A induces calcium influx and membrane depolarization in cells expressing high levels of TRPC4 or its close ortholog TRPC5. Electrophysiology experiments confirmed that englerin A is a TRPC4 agonist. Both the englerin A induced current and the englerin A induced growth inhibition can be blocked by the TRPC4/C5 inhibitor ML204. These experiments confirm that activation of TRPC4/C5 channels inhibits tumor cell line proliferation and confirms the TRPC4 target hypothesis generated by the cell line profiling. In selectivity assays englerin A weakly inhibits TRPA1, TRPV3/V4, and TRPM8 which suggests that englerin A may bind a common feature of TRP ion channels. In vivo experiments show that englerin A is lethal in rodents near doses needed to activate the TRPC4 channel. This toxicity suggests that englerin A itself is probably unsuitable for further drug development. However, since englerin A can be synthesized in the laboratory, it may be a useful chemical starting point to identify novel modulators of other TRP family channels.

Identification of endogenous metabolites in human sperm cells using proton nuclear magnetic resonance ((1) H-NMR) spectroscopy and gas chromatography-mass spectrometry (GC-MS)

The objective of this study was to contribute to the first comprehensive metabolomic characterization of the human sperm cell through the application of two untargeted platforms based on proton nuclear magnetic resonance ((1) H-NMR) spectroscopy and gas chromatography coupled to mass spectrometry (GC-MS). Using these two complementary strategies, we were able to identify a total of 69 metabolites, of which 42 were identified using NMR, 27 using GC-MS and 4 by both techniques. The identity of some of these metabolites was further confirmed by two-dimensional (1) H-(1) H homonuclear correlation spectroscopy (COSY) and (1) H-(13) C heteronuclear single-quantum correlation (HSQC) spectroscopy. Most of the metabolites identified are reported here for the first time in mature human spermatozoa. The relationship between the metabolites identified and the previously reported sperm proteome was also explored. Interestingly, overrepresented pathways included not only the metabolism of carbohydrates, but also of lipids and lipoproteins. Of note, a large number of the metabolites identified belonged to the amino acids, peptides and analogues super class. The identification of this initial set of metabolites represents an important first step to further study their function in male gamete physiology and to explore potential reasons for dysfunction in future studies. We also demonstrate that the application of NMR and MS provides complementary results, thus constituting a promising strategy towards the completion of the human sperm cell metabolome.

Sperm nuclear proteome and its epigenetic potential

The main function of the sperm cell is to transmit the paternal genetic message and epigenetic information to the embryo. Importantly, the majority of the genes in the sperm chromatin are highly condensed by protamines, whereas genes potentially needed in the initial stages of development are associated with histones, representing a form of epigenetic marking. However, so far little attention has been devoted to other sperm chromatin-associated proteins that, in addition to histones and protamines, may also have an epigenetic role. Therefore, with the goal of contributing to cover this subject we have compiled, reviewed and report a list of 581 chromatin or nuclear proteins described in the human sperm cell. Furthermore, we have analysed their Gene Ontology Biological Process enriched terms and have grouped them into different functional categories. Remarkably, we show that 56% of the sperm nuclear proteins have a potential epigenetic activity, being involved in at least one of the following functions: chromosome organization, chromatin organization, protein-DNA complex assembly, DNA packaging, gene expression, transcription, chromatin modification and histone modification. In addition, we have also included and compared the sperm cell proteomes of different model species, demonstrating the existence of common trends in the chromatin composition in the mammalian mature male gamete. Taken together, our analyses suggest that the mammalian sperm cell delivers to the offspring a rich combination of histone variants, transcription factors, chromatin-associated and chromatin-modifying proteins which have the potential to encode and transmit an extremely complex epigenetic information.

P-type Cuox thin films by rf-plasma enhanced reactive thermal evaporation: influence of rf-power density

Copper oxide is a well known p-type semiconductor material, usually obtained by thermal oxidation of copper thin-films within few minutes, at atmospheric pressure. In this paper, thin films of copper oxide that were deposited by radio-frequency plasma enhanced reactive thermal evaporation of copper at room temperature, without any post-deposition annealing treatment, are studied. The deposition of good quality p-type semiconductor oxide to be used in the fabrication of p-TFTs is the purpose of this work. The thickness of the films varies from 97 up to 160 nm. The influence of rf power density on chemical, electrical and optical properties of the films was studied. Samples present conductivity within the range of 6 x 10(-5) to 4 x 10(2) omega(-1) x cm(-1) (thermal activation energy in the interval 0.46 to 0.01 eV). The p-type conductivity of the films was confirmed by Seebeck effect in the more conductive samples. Surface composition obtained by XPS analysis was correlated with optical and electrical properties, showing that rf-power plays a main role in changes of material characteristics.

Discovery of LFF571: an investigational agent for Clostridium difficile infection

Clostridium difficile (C. difficile) is a Gram positive, anaerobic bacterium that infects the lumen of the large intestine and produces toxins. This results in a range of syndromes from mild diarrhea to severe toxic megacolon and death. Alarmingly, the prevalence and severity of C. difficile infection are increasing; thus, associated morbidity and mortality rates are rising. 4-Aminothiazolyl analogues of the antibiotic natural product GE2270 A (1) were designed, synthesized, and optimized for the treatment of C. difficile infection. The medicinal chemistry effort focused on enhancing aqueous solubility relative to that of the natural product and previous development candidates (2, 3) and improving antibacterial activity. Structure-activity relationships, cocrystallographic interactions, pharmacokinetics, and efficacy in animal models of infection were characterized. These studies identified a series of dicarboxylic acid derivatives, which enhanced solubility/efficacy profile by several orders of magnitude compared to previously studied compounds and led to the selection of LFF571 (4) as an investigational new drug for treating C. difficile infection.

The future of testis research is turning 6! Six years of international network for young researchers in male fertility

The 'International Network for Young Researchers in Male Fertility' has now turned 6 years old and offers a platform that stimulates scientific exchange as well as the development of international cooperation for young researchers. We report on our scope and the exciting achievements, amongst others, the continually increasing number of participants and the growing success of our annual meetings.