De-escalating radiotherapy in HPV-positive oropharyngeal squamous cell carcinoma: how much is too little?

Oropharyngeal squamous cell carcinoma (OPSCC) had a rapidly increasing incidence rate in high-income countries, with a significant increase in cases related to human papilloma virus (HPV). HPV-positive (HPV+) OPSCC has shown better survival rates compared with HPV-negative (HPV-) cases, prompting investigations into de-escalation strategies to reduce or change chemoradiotherapy protocols. We present a case of a patient with HPV+ OPSCC who discontinued chemoradiotherapy after 2 weeks, effectively receiving a de-escalated dose of 18 Gy over nine fractions and only one cycle of cisplatin, subsequently undergoing curative surgical resection with no residual disease in the radiotherapy field 14 years later. This case challenges the concept of standard radiotherapy dosing in HPV+ OPSCC and discusses the implications on future de-escalation trials.

Research Note: Effect of dietary xylo-oligosaccharide on growth performance, intestinal histomorphology, and specific cecal bacteria in broiler chickens

This study was conducted to evaluate the prebiotic effect of xylo-oligosaccharide (XOS) supplemented in a corn-soybean meal (SBM) based conventional diet on growth performance, intestinal histomorphology, and quantification of specific bacteria in the ceca of broilers. A total of 240 d of hatch Cobb 500 male broiler chicks were randomly assigned to 4 dietary treatments (corn-SBM-based control diet) containing 0, 0.05, 0.1, and 0.2% XOS. The broilers were raised for 21 d in 6 replicate cages, each containing 10 birds. Growth performance parameters were obtained weekly. Additionally, small intestinal tissues were collected to evaluate histomorphometry and whole ceca were collected to quantify bacterial populations on D21. The results showed that inclusion of XOS has similar body weight (BW), body weight gain (BWG), feed intake (FI), and feed conversion ratio (FCR) as the control group during the 21-day study. The results further indicate a tendency for the jejunum villus to crypt ratio (VH:CD) to increase in birds given 0.05 and 0.2% XOS (P = 0.08). Cecal bacteria quantification showed a linear increase in Bifidobacterium with increasing XOS levels (P < 0.0001) and a decrease Clostridium perfringens levels compared to birds fed the control diet (P < 0.0001). However, there were no differences in the total counts of Lactobacillus and E. coli. Together these results showed that while there were no differences in growth parameters up to 21 d, the histomorphology findings and the increase in Bifidobacterium, along with the reduction in C. perfringens observed in the XOS groups, suggest a beneficial impact of XOS inclusion on gut health. Further research with longer feeding periods and higher XOS levels should be conducted to explore potential positive effects on both growth and gut health parameters.

Short-term exposure to fumonisins and deoxynivalenol, on broiler growth performance and cecal Salmonella load during experimental Salmonella Enteritidis infection

Fumonisins (FUM) and deoxynivalenol (DON) are two common mycotoxins in poultry feed. Salmonella enterica ser. Enteritidis (S. Enteritidis) is a primary foodborne bacterium in broilers. This trial was conducted to evaluate the effects of naturally occurring FUM and DON and their combination at subclinical doses on broiler performance during a S. Enteritidis challenge. The experiment consisted of five treatments: NCC, no-challenge no-mycotoxin treatment; CC, Salmonella challenge + no-mycotoxin treatment; DON, DON 0.6 mg/kg + Salmonella challenge; FUM, FUM 14 mg/kg + Salmonella challenge; DON + FUM + T-2 + neosolaniol, DON 0.6 mg/kg + FUM 14 mg/kg + T-2 toxin 0.6 mg/kg + 0.8 mg/kg neosolaniol + Salmonella challenge. On d 4, birds were challenged with either 0 or 1 × 10⁹ CFU/mL S. Enteritidis orally. There were no significant effects on growth performance among treatments at 0, 3, 7, and 14 d of post-inoculation (dpi). On 14 dpi, the combined DON + FUM + T-2 + neosolaniol significantly increased the Salmonella load by 1.5 logs compared to the control groups (P < 0.05). FUM significantly increased the cecal tonsil IL-10 gene expression by 1.2-fold at 7 dpi (P < 0.05) and downregulated TNF-α by 1.8-fold on 14 dpi compared to the control, nonchallenge groups (P < 0.05). On 7 dpi, the combined DON + FUM + T-2 + neosolaniol reduced occludin by 4.4-fold (P < 0.05) when compared to the control groups. Similarly, combined DON + FUM+ T-2 + neosolaniol decreased zona-occluden transcription by 2.3 and 7.6-fold on 3 and 14 dpi, respectively (P < 0.05). Furthermore, combined DON + FUM + T-2 + neosolaniol decreased Claudin-1 by 2.2-fold and Claudin-4 by 5.1-fold on 14 dpi when compared to the control groups (P < 0.05). In conclusion, short-term exposure to a subclinical dose of combined DON + FUM + T-2 + neosolaniol had an impact on broiler intestinal tight junction proteins and cecal Salmonella abundance under experimental Salmonella challenge.

TORPEdO: A phase III trial of intensity-modulated proton beam therapy versus intensity-modulated radiotherapy for multi-toxicity reduction in oropharyngeal cancer

•There is a lack of prospective level I evidence for the use of PBT for most adult cancers including oropharyngeal squamous cell carcinoma (OPSCC).•TORPEdO is the UK's first PBT clinical trial and aims to determine the benefits of PBT for OPSCC.•Training and support has been provided before and during the trial to reduce variations of contouring and radiotherapy planning.•There is a strong translational component within TORPEdO. Imaging and physics data along with blood, tissue collection will inform future studies in refining patient selection for IMPT.

Photobiomodulation in the management of oral mucositis for adult head and neck cancer patients receiving irradiation: the LiTEFORM RCT

BACKGROUND

Oral mucositis is a debilitating and painful complication of head and neck cancer irradiation that is characterised by inflammation of the mucous membranes, erythema and ulceration. Oral mucositis affects 6000 head and neck cancer patients per year in England and Wales. Current treatments have not proven to be effective. International studies suggest that low-level laser therapy may be an effective treatment.

OBJECTIVES

To assess the clinical effectiveness and cost-effectiveness of low-level laser therapy in the management of oral mucositis in head and neck cancer irradiation. To identify barriers to and facilitators of implementing low-level laser therapy in routine care.

DESIGN

Placebo-controlled, individually randomised, multicentre Phase III superiority trial, with an internal pilot and health economic and qualitative process evaluations. The participants, outcome assessors and therapists were blinded.

SETTING

Nine NHS head and neck cancer sites in England and Wales.

PARTICIPANTS

A total of 87 out of 380 participants were recruited who were aged ≥ 18 years and were undergoing head and neck cancer irradiation with ≥ 60 Gy.

INTERVENTION

Random allocation (1 : 1 ratio) to either low-level laser therapy or sham low-level laser therapy three times per week for the duration of irradiation. The diode laser had the following specifications: wavelength 660 nm, power output 75 mW, beam area 1.5 cm², irradiance 50 mW/cm², exposure time 60 seconds and fluence 3 J/cm². There were 20-30 spots per session. Sham low-level laser therapy was delivered in an identical manner.

MAIN OUTCOME MEASURE

The mean Oral Mucositis Weekly Questionnaire-Head and Neck Cancer score at 6 weeks following the start of irradiation. Higher scores indicate a worse outcome.

RESULTS

A total of 231 patients were screened and, of these, 87 were randomised (low-level laser therapy arm, n = 44; sham arm, n = 43). The mean age was 59.4 years (standard deviation 8.8 years) and 69 participants (79%) were male. The mean Oral Mucositis Weekly Questionnaire-Head and Neck Cancer score at 6 weeks was 33.2 (standard deviation 10) in the low-level laser therapy arm and 27.4 (standard deviation 13.8) in the sham arm.

LIMITATIONS

The trial lacked statistical power because it did not meet the recruitment target. Staff and patients willingly participated in the trial and worked hard to make the LiTEFORM trial succeed. However, the task of introducing, embedding and sustaining new low-level laser therapy services into a complex care pathway proved challenging. Sites could deliver low-level laser therapy to only a small number of patients at a time. The administration of low-level laser therapy was viewed as straightforward, but also time-consuming and sometimes uncomfortable for both patients and staff, particularly those staff who were not used to working in a patient's mouth.

CONCLUSIONS

This trial had a robust design but lacked power to be definitive. Low-level laser therapy is relatively inexpensive. In contrast with previous trials, some patients found low-level laser therapy sessions to be difficult. The duration of low-level laser therapy sessions is, therefore, an important consideration. Clinicians experienced in oral cavity work most readily adapt to delivering low-level laser therapy, although other allied health professionals can be trained. Blinding the clinicians delivering low-level laser therapy is feasible. There are important human resource, real estate and logistical considerations for those setting up low-level laser therapy services.

FUTURE WORK

Further well-designed randomised controlled trials investigating low-level laser therapy in head and neck cancer irradiation are needed, with similar powered recruitment targets but addressing the recruitment challenges and logistical findings from this research.

TRIAL REGISTRATION

This trial is registered as ISRCTN14224600.

FUNDING

This project was funded by the National Institute for Health and Care Research ( NIHR ) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 46. See the NIHR Journals Library website for further project information.

Subclinical Doses of Combined Fumonisins and Deoxynivalenol Predispose Clostridium perfringens–Inoculated Broilers to Necrotic Enteritis

Fumonisins (FB) and deoxynivalenol (DON) are mycotoxins which may predispose broiler chickens to necrotic enteritis (NE). The objective of this study was to identify the effects of subclinical doses of combined FB and DON on NE. A total of 480 day-old male broiler chicks were divided into four treatment groups; 1) control group (basal diet + Clostridium perfringens); 2) necrotic enteritis group (basal diet + Eimeria maxima + C. perfringens); 3) FB + DON group (basal diet + 3 mg/kg FB + 4 mg/kg DON + C. perfringens); and 4) FB + DON + NE group (basal diet + 3 mg/kg FB + 4 mg/kg DON + E. maxima + C. perfringens). Birds in NE and FB + DON + NE groups received 2.5 × 10³E. maxima on day 14. All birds were inoculated with C. perfringens on days 19, 20, and 21. On day 35, birds in the NE, FB + DON, and FB + DON + NE groups had 242, 84, and 339 g lower BWG and a 19-, 2-, and 22-point increase in FCR respectively, than in the control group. Subclinical doses of FB + DON increased (p < 0.05) the NE lesion scores compared to the control group on day 21. On day 21, birds in the NE, FB + DON, and FB + DON + NE groups had increased (p < 0.05) serum FITC-D, lower (p < 0.05) jejunal tight junction protein mRNA, and increased (p < 0.05) cecal tonsil IL-1 mRNA compared to control group. On day 21, birds in the NE group had decreased (p < 0.05) villi height to crypt depth ratio compared to the control group and the presence of FB + DON in NE-induced birds further decreased the villi height to crypt depth ratio. Birds in the NE, FB + DON, and FB + DON + NE groups had increased (p < 0.05) C. perfringens, lower (p < 0.05) Lactobacillus loads in the cecal content, and a lower (p < 0.05) CD8⁺: CD4⁺ cell ratio in the cecal tonsils compared to the control group. It can be concluded that subclinical doses of combined FB and DON predispose C. perfringens-inoculated birds to NE, and the presence of FB + DON in NE-induced birds exacerbated the severity of NE.

1168 Radiotherapy Dose for HPV Driven Oropharyngeal Cancer: What Is Enough?

Aim

Squamous cell carcinoma of the oropharynx is associated with high-risk Human Papilloma Virus (HPV) infection. HPV positive oropharyngeal cancer is often more radiosensitive and first line treatment includes either radiotherapy or surgical resection. Trials are ongoing to establish situations in which radiation doses can be reduced with the aim of reducing late tissue toxicity (“de-escalation trials”) . We report a case in which a patient failed to complete his prescribed radiotherapy treatment, describe his clinical outcomes and the potential questions this situation raises.

Method

In 2009 a male patient presented with a right T2N0MO P16 positive tonsillar squamous cell carcinoma. He was scheduled to complete a course of chemoradiotherapy. However, he was only able to complete a third of the radiotherapy course. Due to unresolved symptoms, he underwent a right transoral laser extended tonsillectomy, however this showed only fibrous tissue.

Results

Despite not completing the radiotherapy course he has not experienced local recurrence of the tonsillar OPSCC 11 years post initial treatment.

Conclusions

This case illustrates that some patients with HPV driven oropharyngeal cancer can have a clinically significant tumour response to markedly lower doses of radiotherapy than is currently recommended. Further randomized controlled trials are required to establish the optimum dose in the management of HPV driven oropharyngeal squamous cell cancer.

Effects of cardiopulmonary bypass perfusion temperature on perioperative renal function in adult patients undergoing cardiac surgery

Aims and objective

The primary objective of this investigation was to study the effects of cardiopulmonary bypass (CPB) perfusion temperature on renal function parameters [serum creatinine, creatinine clearance, urine albumin, urine protein, and urine albumin/creatinine ratio (ACR)]. The secondary objective was to detect renal complications of CPB.

Materials and methods

This is a prospective longitudinal study of 30 adult patients (17 men, 13 women; mean age, 53.37 ± 16.02 years) who underwent valvular heart surgery [with or without coronary artery bypass grafting (CABG)]. Serum creatinine, creatinine clearance, urine protein, urine albumin, and urine ACR were collected during CPB (at 28 °C, 32 °C, and 37 °C) and postoperatively (at 12 hours, 24 hours, and 48 hours). Data were analyzed using one-way repeated-measures analysis of variance (ANOVA). A significant ANOVA was followed by a Bonferroni–Holm post hoc test.

Results

Although serum creatinine (p < 0.001) and creatinine clearance (p = 0.0016) underwent a significant ANOVA change (p < 0.001 and p = 0.0016, respectively) after CPB, there was no statistically significant change compared with their baseline values. Urine ACR showed a significant change at 28 °C (p < 0.01), 32 °C (p < 0.01), and 37 °C (p < 0.05) as compared with baseline values. No significant change in urine albumin was observed during CPB or up to 24 hours. A significant change occurred after 48 hours of CPB (p < 0.05). A significant increase in urine protein was noted after CPB at 12 hours (p < 0.01), 24 hours (p < 0.01), and 48 hours (p < 0.01). Overall, 12 (40%) patients had acute kidney injury (AKI). Ten (33.33%) patients had stage I AKI, one patient progressed to AKI stage II, and another to AKI stage III. Of the 10 patients who had stage I AKI, eight had complete recovery within 48 hours.

Conclusions

CPB with moderate hypothermia for valvular heart surgeries can be performed safely in patients with adequate renal functional reserve. The glomerular permeability across the Bowman’s capsule increases after CPB as evidenced by significant proteinuria at 12 hours and increased albuminuria at 48 hours after surgery. There is an increased risk of transient stage I AKI after CPB, from which patients recover within 48 hours.

Research Note: Effect of synbiotic supplementation on caecal Clostridium perfringens load in broiler chickens with different necrotic enteritis challenge models

Studies were conducted to determine the efficacy of synbiotic applications to combat the negative effects of necrotic enteritis (NE). An in vitro study was conducted to test the effect of probiotics species supernatants to decrease Clostridium perfringens (CP) proliferation. Lactobacillus reuteri, Enterococcus faecium, Bifidobacterium animalis, and Pediococcus acidilactici culture supernatants decreased the proliferation of CP at 1:1 supernatant-to-pathogen dilution in vitro. Two in vivo studies were conducted to determine the in vivo response of synbiotic supplementation containing the aforementioned probiotic strains on broiler production performance and caecal CP load in broilers induced with NE infection. In experiment 1, 75 broiler chicks were randomly allotted to 3 treatment groups, control (basal diet), ionophore (Salinomycin), and synbiotic (PoultryStar me), from day of hatch, and NE was induced in all birds. There were no significant treatment effects on BW, feed consumption, and feed gain ratio. However, at 35 D, ionophore or synbiotic supplementation increased (P < 0.05) villi height and decreased interleukin (IL)-1 mRNA abundance, while synbiotic supplementation increased (P < 0.05) IL-10 mRNA abundance compared with the control group, respectively. In experiment 2, 360 broiler chicks were randomly allotted to 3 treatments, an unchallenged negative control (control; basal diet), challenged positive control (NE; basal diet), or NE + synbiotic group (synbiotic). At both 21 and 42 D of age, NE birds had decreased (P < 0.05) BW, feed conversion, and jejunal villi height compared with control, while NE + synbiotic birds were not different from control groups. At 42 D of age, NE birds had 2.2 log/g increased CP in the ceca contents compared with control, while synbiotic birds had CP load that was not different than that of the control group. NE + synbiotic birds had significantly greater amounts of bile anti-CP IgA than the control and NE groups. It can be concluded that synbiotic supplementation decreased CP proliferation in vitro and caecal CP load in vivo while improving production parameters during an NE infection in broilers.

Effect of a post-hatch lipopolysaccharide challenge in Turkey poults and ducklings after a primary embryonic heat stress

The effect of embryonic thermal manipulation on the post-hatch immune response to a lipopolysaccharide (LPS) challenge was studied in Pekin ducklings and turkey poults. Commercial duck and turkey eggs were distributed among four treatments: SS-Control (37.5 °C from embryonic day [ED] 1 to 25); SS-LPS (37.5 °C from ED1 to 25 + LPS at D0 [hatch]); HH-LPS (38 °C from ED1 to 25 + LPS at D0; SH-LPS (37.5 °C from ED1 to 10 and 38 °C from ED 11 to 25 + LPS at D0). At ED16 and ED24, the egg shell temperature of the duck and turkey eggs in the HH and SH treatments were higher (P ≤ 0.01) than the SS treatment. Ducklings and poults in the HH treatment had the lowest yolk free body weight at hatch (P ≤ 0.05). At 24, 48, and 72 h post-LPS injection, ducklings and poults in the HH-LPS treatment had significantly reduced BW compared with the SS-Con treatments (P ≤ 0.05). Ducklings and poults in the SH-LPS and HH-LPS treatments had increased plasma heat shock protein 70 (HSP70) and lower splenic HSP70 mRNA amounts than the SS-LPS treatments at 24, and 48 h post-challenge (P ≤ 0.05). At 48 and 72 h, macrophage nitric oxide (NO) production in ducklings and poults in the SH-LPS and HH-LPS treatments was lower than in the SS-LPS treatments (P ≤ 0.05). Ducklings and poults in the SH-LPS treatment had increased thymocyte proliferation compared to the SS-LPS treatment at 24, 48 and 72 h (P ≤ 0.05). At 24 h, ducklings in the SH-LPS treatment had increased splenic IL-10 and reduced IFNγ and IL-6 mRNA abundance. However, both ducklings and poults in the HH-LPS treatment had increased IFNγ, and IL-10 mRNA abundance compared to the SS-LPS treatment (P ≤ 0.05). At 48 h, SH-LPS ducklings and poults had lower splenic IL-10 mRNA abundance (P ≤ 0.05) while the HH-LPS treatment resulted in comparable splenic IL-10 mRNA compared to the SS-LPS treatment (P ≥ 0.05). Ducklings and poults in the SH-LPS treatment had increased thymic and splenic CD8⁺/CD4⁺ ratios at 24 h versus the SS-LPS treatment (P ≤ 0.05). In conclusion, embryonic thermal manipulation from ED11-25 increased extracellular HSP70 release, thymocyte proliferation and IL-10 but decreased splenic HSP70 and IFNγ mRNA amounts at 24 h post-LPS injection. This suggests that mild heat stress during the later stages of incubation could potentially prime the embryonic immune system thereby enhances the immune response as earlier than 24 h to eliminate the inflammatory response without affecting the growth performance by increase the extracellular release of HSP70 in both ducklings and poults. Continuous exposure to the small increase in temperature from ED 1-25 (HH) caused an imbalance between pro (IFNγ)- and anti-inflammatory cytokines(IL-10) which affects hatchling responses to an inflammatory challenge and increased mortality. The amount of extracellular HSP70 could potentially play an important role in modulating the immune response against inflammatory challenges.

Synbiotic supplementation to decrease Salmonella colonization in the intestine and carcass contamination in broiler birds

In vitro and in vivo experiments were conducted to study the effects of synbiotic supplementation on Salmonella enterica ser. Enteritidis (SE) proliferation, cecal content load, and broiler carcass contamination. Lactobacillus reuteri, Enterococcus faecium, Bifidobacterium animalis, and Pediococcus acidilactici culture supernatants decreased (P < 0.05) the in vitro proliferation of SE at 1:1 supernatant: pathogen dilution. A total of 240 Cobb-500 broiler chicks were randomly allotted to three treatment groups (8 replicates/group with 10 birds/replicate): control (basal diet), antibiotic (Virginiamycin at 20 mg/kg feed), synbiotic (PoultryStar® ME at 0.5 g/kg feed containing L. reuteri, E. faecium, B. animalis, P. acidilactici and a Fructooligosaccharide) from day of hatch. At 21 d of age, all birds in experimental groups were orally inoculated with 250 μl of 1 X 109 CFU SE. Antibiotic supplementation increased (P < 0.05) body weight and feed consumption, compared to the control group. Birds in the synbiotic supplementation had intermediate body weight and feed consumption that were not significantly different from both the control and antibiotic group at 42 d of age in SE infected birds. No significant effects were observed in feed efficiency at 42 d of age among the groups. Antibiotic and synbiotic supplementation decreased (P < 0.05) SE load in cecal contents by 0.90 and 0.85 log units/ g and carcass SE load by 1.4 and 1.5 log units/mL of rinsate compared to the control group at 42 d of age (21 dpi). The relative abundance of IL-10, IL-1, TLR-4, and IFNγ mRNA was decreased (P < 0.05) in the antibiotic and synbiotic supplementation groups compared to the control birds at 42 d of age (21 dpi). It can be concluded that synbiotic supplementation decreased SE proliferation in vitro and decreased SE load in the cecal contents and broiler carcass.

Effect of embryonic thermal manipulation on heat shock protein 70 (HSP70) expression and subsequent immune response to post-hatch lipopolysaccharide challenge in Pekin ducklings

During the course of multi-stage incubation, small locational differences in incubation temperature within a machine are not uncommon and so the goal of this study was to study the immune response of ducklings exposed to thermal manipulation during incubation. Commercial Pekin duck eggs (n = 200) were distributed among four treatment: SS-Control (37.5°C from embryonic day [ED] 1 to 25); SS-LPS (37.5°C from ED1 to 25 + LPS at D0 [hatch]); HH-LPS (38°C from ED1 to 25+ LPS at D0); SH-LPS (37.5°C from ED1 to 10 and 38°C from ED 11 to 25 + LPS at D0). At D0, ducklings received a lipopolysaccharide (LPS) injection. At D1 and D5, the HH-LPS treatment significantly reduced body weight (P ≤ 0.05). At D1 and D3 post-LPS injection, the SH-LPS and HH-LPS treatments significantly reduced splenic and bursal heat shock protein 70 (HSP70), mRNA abundance, and macrophage nitric oxide production compared with the SS-LPS treatment (P ≤ 0.05). At D1, the HH-LPS and SH-LPS treatments had increased splenic IL-10 mRNA and lower MHC I mRNA compared with the SS-LPS treatment (P ≤ 0.05). At D1, the HH-LPS treatment increased splenic IL-6 mRNA and bursal IFNγ mRNA transcription while the SH-LPS treatment reduced splenic IL-6 mRNA compared with the SS-LPS treatment (P ≤ 0.05). The HH-LPS treatment reduced thymocyte proliferation efficiency, while at D1, D3, and D5, the SH-LPS treatment increased thymocyte proliferation efficiency compared with the SS-LPS treatment (P ≤ 0.05). Ducklings in the HH-LPS treatment had a higher splenic CD8+/CD4+ ratio compared to the SS-LPS treatment at D3 post-LPS injection (P ≤ 0.05). In summary, the HH-LPS treatment compromised immunocompetence via decreased NO production and thymocyte proliferation efficiency, while the SH-LPS treatment increased body weight and thymocyte proliferation and reduced IL-6 mRNA abundance. This suggests that an embryonic temperature stress during the latter half of incubation may prime the immune system which may be beneficial during secondary post-hatch inflammatory challenges.

Effect of synbiotic supplementation on layer production and cecal Salmonella load during a Salmonella challenge

This study analyzed the inhibitory effects of a synbiotic product (PoultryStar® me) on production parameters, intestinal microflora profile, and immune parameters in laying hens with and without a Salmonella challenge. The synbiotic product contained 4 probiotic bacterial strains (Lactobacillus reuteri, Enterococcus faecium, Bifidobacterium animalis, and Pediococcus acidilactici) and a prebiotic fructooligosaccharide. Layers were supplemented with the synbiotic from d of hatch to 28 wk of age. At 16 wk of age, birds were either vaccinated with Salmonella enterica Enteritidis (SE) vaccine or left unvaccinated. At 24 wk of age, a portion of the birds was challenged with 1 × 109 CFU of SE or left unchallenged, resulting in a 3 (vaccinated, challenged, or both vaccinated and challenged) X 2 (control and synbiotics) factorial arrangement of treatments. At 18 and 20 wk of age, birds fed synbiotics in both vaccinated and unvaccinated groups had increased (P < 0.05) BW more than those in the un-supplemented groups. Birds fed synbiotics had 0.7, 17.8, 21.7, 3, and 4.2% higher (P < 0.05) hen d egg production (HDEP) at 19, 20, 21, 22, and 23 wk of age, compared to the birds without supplementation, respectively. After administering the SE challenge, supplemented birds had 3, 6.7, 4.3, 12.5, and 14.4% higher (P < 0.05) HDEP at 24, 25, 26, 27, and 28 wk of age, compared to the birds not supplemented, respectively. Irrespective of the vaccination status, birds fed synbiotics and challenged with SE had a lower (P < 0.05) SE cecal load compared to the un-supplemented groups. At 22 d post Salmonella challenge, birds supplemented, vaccinated, and challenged had the highest bile IgA content. It can be concluded that supplementation of the synbiotic product could be beneficial to layer diets as a growth promoter, performance enhancer, and for protection against SE infection.

Comparison of Carotid Intima Media Thickness in Children of Patients with and without Premature Coronary Artery Disease

INTRODUCTION

Increased Carotid Intima Medial Thickness (CIMT) is associated with cardiovascular risk factors and vascular events like Coronary Artery Disease (CAD) and stroke.

AIM

This study was designed to identify whether CIMT is increased in the children of parents with premature coronary artery disease and compare it with age and sex matched controls who are children of normal individuals. We also tried to compare and correlate the changes in CIMT if any, among the study group with relation to family history of diabetes and hypertension.

MATERIALS AND METHODS

It was an observational prospective case control study. Twenty five cases (children of parents with premature coronary artery disease) were recruited as per the inclusion and exclusion criteria. Age and sex matched controls were recruited from the paediatric Outpatient Department (OPD). The CIMT was measured using ultrasound Doppler as per the protocol by the Mannheim intima media thickness consensus statement.

RESULTS

Ten children out of 25 controls had CIMT of 0.05 cm and 5 out of 25 cases had CIMT of 0.07 cm. The association between cases and controls was not statistically significant. Even though the CIMT increases after 10 years, there is no statistically significant association between cases and controls in the different age groups. Out of the total 48% of the children among the case group had family history of hypertension whereas 28% in the control group. A 33% of children in the case group with family history of hypertension had CIMT of 0.07 cm; 46% of children in case group without family history of hypertension had CIMT of 0.05 cm. This difference was statistically significant (p=0.005). There was no significant association between family history of diabetes mellitus and CIMT in both groups.

CONCLUSION

There was significant association between CIMT in children with family history of premature CAD and family history of hypertension when compared with no family history of hypertension with premature CAD. There was no significant association between CIMT of children with and without family history of premature CAD.

Uterine Arteriovenous Malformation: Case Series and Literature Review

BACKGROUND

Uterine AV malformation is a rare cause of torrential post-abortal hemorrhage, which can present with varying grades of severity. Diagnosis requires a high degree of suspicion and is done with ultrasound and Doppler.

CASE SERIES

In our institution, during the period 2008-2013, five cases of symptomatic uterine AVMs have been reported. All of them were in the reproductive age group (22-36 years), presenting with a history of miscarriage or termination of pregnancy for which curettage was done. The presentation was with recurrent bouts of torrential bleeding, some triggered by second curettage, and not controllable with regular measures. Diagnosis was by ultrasound-gray scale, color Doppler, and spectral Doppler. The time interval between the onset of symptoms and the primary curettage was 8-89 days; four patients underwent selective arterial embolization, and one patient opted for hysterectomy. On follow-up, all the four patients are presently free of symptoms; two of them conceived within 2 years of the procedure and carried the pregnancy to term-one resulting in a live-birth and the other intrauterine death.

CONCLUSION

Uterine AV malformation should be thought of as a differential diagnosis in all cases presenting with bleeding after miscarriage or curettage, since diagnosis is simple and treatment by selective arterial embolization saves morbidity of surgery and anesthesia, and more importantly reduces hospital stay and the absence from work.

Fly ash based Bacillus thuringiensis var. israelensis formulation for use against Culex quinquefasciatus, the vector of filariasis in natural ecosystems

BACKGROUND & OBJECTIVES

Fly ash is produced in huge quantities by the various thermal power stations in India. This thermal waste has been employed as a carrier material in the preparation of a biopesticidal water dispersible powder (WDP) formulation for use against mosquitoes. In the present investigation, this newly developed fly ash based WDP formulation was evaluated in natural breeding habitats of mosquito.

METHODS

Fly ash based WDP formulation of Bacillus thuringiensis var. israelensis (VCRC B17) was evaluated for its efficacy and residual activity in aquatic habitats supporting breeding of Culex quinquefasciatus, the vector of lymphatic filariasis in Neyveli Township, Neyveli Lignite Corporation, India for a period of one month.

RESULTS

At an application rate of 10 kg/ha, the WDP was effective for five days regardless of the habitat, and provided 80-100% reduction in larval abundance of Cx. quinquefasciatus.

INTERPRETATION & CONCLUSION

The study indicates that for continued control of immature density and prevention of adult emergence, a weekly application of this formulation is necessary. This study also showed that fly ash based formulations can be used for immediate control of mosquitoes in different types of habitats and has also brought out a new avenue for the utilization of coal ash.

Regulatory T cell properties of thymic CD4+CD25+ cells in turkeys

Thymic CD4+CD25+ cells from turkeys were analyzed for T regulatory cell suppressive properties and cytokine production profile. Thymocytes treated with concanavalin-A and interleukin-2 upregulated CD25 at 72 h of culture. The mean CD4+CD25+ cell percentage in the blood was 1.1%, in the thymus was 2.7%, in the spleen was 9.6%, in the lung was 18.6%, in cecal tonsils was 9.2%, and in bone marrow was 14.9%. The CD4+CD25+ cells were not detectable in the bursa. Turkey thymic CD4+CD25+ cells had approximately 158-fold higher interleukin-10 mRNA, 7-fold higher transforming growth factor β, 24-fold higher cytotoxic T lymphocyte antigen 4, and 11-fold higher lymphocyte-activation gene 3 mRNA amounts than thymic CD4+CD25- cells. Thymic CD4+CD25+ cells had no detectable levels of interleukin-2 mRNA. Turkey CD4+CD25+ cells suppressed naïve cell proliferation in vitro. It could be concluded that thymic CD4+CD25+ cells in turkeys are likely the counterpart of mammalian T regulatory cells.

Evaluation of certain insecticides on nettings for their efficacy and wash resistance against mosquito species

Five insecticides (Bifenthrin, Deltamethrin, Etofenprox, Permethrin and Lamda cyhalothrin) recommended by WHO, at their recommended dose were compared for their efficacy and wash resistance through bioassay against mosquito vectors, Culex quinquefasciatus, Aedes aegypti and Anopheles stephensi. Etofenprox treated nettings exhibited better knockdown and mortality than the other insecticides. The order of efficacy of the insecticides treated nettings was Etofenprox > or = Deltamethrin > Lambda cyhalothrin > Permethrin > Bifenthrin.

Effect of killed whole yeast cell prebiotic supplementation on broiler performance and intestinal immune cell parameters

Two experiments were conducted to study the effect of CitriStim, a commercial killed whole yeast cell prebiotic, on broiler performance, regulatory T cells, CD4(+) and CD8(+) percentages, and IL-10 and IL-1 mRNA contents of the spleen and cecal tonsils. No immune challenges were imposed in either of the 2 experiments. One-day-old broiler chicks were fed a corn- and soybean meal-based diet supplemented with 0, 0.1, or 0.2% CitriStim (ADM, Decatur, IL) for 35 d. At 21 (P = 0.03) and 35 d (P = 0.02) of age, CitriStim supplementation at 0.2% increased regulatory T cell percentage in the cecal tonsil compared with that of the 0% CitriStim-supplemented group. At 21 (P = 0.08) and 35 d (P = 0.01) of age, CitriStim supplementation at 0.2% increased IL-10 mRNA content of the cecal tonsil compared with that of the 0% CitriStim-supplemented group. At 21 (P = 0.13) and 35 d (P < 0.01) of age, CitriStim supplementation at 0.2% decreased IL-1 mRNA content compared with that of the 0% CitriStim supplemented group. CitriStim supplementation did not (P > 0.05) alter the IL-10 and IL-1 mRNA contents in the spleen. CitriStim supplementation did not (P > 0.05) alter the CD4(+) and CD8(+) cell percentages in the spleen and cecal tonsil at 21 and 35 d of the experiment. CitriStim supplementation increased regulatory T cell percentage and IL-10 mRNA content and decreased IL-1 mRNA content in the cecal tonsil to produce a net antiinflammatory milieu. The immunomodulatory effect of CitriStim supplementation was a local effect rather than a systemic effect.

Effect of recycled litter on immune cells in the cecal tonsils of chickens

This experiment was conducted to study selected aspects of the gut immune response in broiler chicks reared on fresh or recycled litter that were fed diets with and without subtherapeutic antibiotic supplementation. All of the chicks were reared in pens that contained either fresh pine shavings (fresh litter) or litter that was recycled for 3 consecutive flocks (recycled litter). The experiment was a 2 × 2 factorial arrangement of treatments with 4 replicate pens (n = 4) per treatment. At 10 and 35 d of age, the cecal tonsils were analyzed for intestinal immune measurements. The cecal tonsils of birds reared on recycled litter had increased IL-1 mRNA (P < 0.01) and a lower percentage of CD4(+)CD25(+) cells at 10 and 35 d of age when compared with those of chicks reared on fresh litter. Birds fed diets supplemented with bacitracin had a reduction in CD4(+) cells (P = 0.01) at 10 d of age when compared with that of chicks that were not fed the antibiotic. The combination of bacitracin supplementation and fresh litter resulted in an approximate 10-fold increase in IL-10 mRNA (P = 0.01) at 10 d of age when compared with that of the unsupplemented chicks in fresh litter. Among those chicks that were not supplemented with bacitracin, the recycled-litter treatment resulted in 25-fold (P = 0.01) and 39-fold (P = 0.02) higher IL-4 mRNA levels at 10 and 35 d of age, respectively, when compared with those of the chicks reared on fresh litter. In conclusion, the intestinal immune response of birds reared on recycled litter is skewed toward an inflammatory response, whereas the fresh litter treatment was skewed toward an anti-inflammatory response. Bacitracin supplementation did not interact with the litter type to alter IL-1 mRNA levels in cecal tonsils, suggesting the low efficiency of bacitracin in alleviating the inflammatory response induced by recycled litter.

Testicular microlithiasis: Is there an agreed protocol?

This review addresses the issues on etiopathogenesis of testicular microlithiasis (TM), associated clinical entities, evaluation and follow-up of patients with TM. A literature search of Medline/PubMed was carried out using the keywords 'testicular microlithiasis' and 'testicular calcifications' for published data in English language on TM from 1970 to 2006. TM is an uncommon entity among adult males, resulting from intratubular calcifications. The reported incidence of TM is highly variable. With the increasing frequency of ultrasound examination in scrotal and testicular conditions and with the advent of high frequency transducers, TM is increasingly being reported. TM is associated with many benign and malignant conditions of testes but the possible association of TM with testicular cancer has been a matter of concern. Though a few sporadic cases of testicular malignancies have been reported, it is believed that a conservative approach is warranted in the absence of high risk factors, in view of the low risks for invasive cancers. There is no uniform protocol for the evaluation and follow-up of the patients with TM. Those with high risk factors like contralateral testicular tumour, chromosomal anomalies, gonadal dysgenesis, cryptorchidism and definite ultrasound pattern of TM should be advised to have further evaluation. Incidentally detected asymptomatic TM during ultrasound examination does not warrant aggressive measures and it can be followed with self examination.

Youssef's syndrome: Is there a better way to diagnose?

Vesicouterine fistula (VUF) the least common of the urogynecological fistulae. Hysterosalphingography is the gold standard investigation in demonstrating the fistulous track. It is an invasive investigation. We report a case of VUF where magnetic resonance imaging was useful to diagnose the condition in a non-invasive manner especially when the clinical picture was confusing.

Lutein supplementation alters inflammatory cytokine production and antioxidant status in F-line turkeys

Effect of dietary lutein supplementation on turkey production parameters, cytokine production, and oxidative status during an acute phase response following lipopolysaccharide (LPS) injection was studied. One-day-old chicks were fed a basal diet supplemented with 3 levels (0, 25, or 50 mg/kg of feed) of lutein. At 50 d of dietary lutein supplementation, turkeys were injected or not injected with LPS. Increasing dietary lutein increased the liver and plasma lutein content in both LPS injected and uninjected groups. In the groups fed 50 mg of lutein, LPS treatment decreased the lutein content of both the liver and the plasma at 48 h post-LPS injection. In the groups fed 0 mg of lutein, LPS treatment decreased the BW gain and feed consumption at 24 and 48 h post-LPS injection. The feed intake and BW gain of the group fed 50 mg of lutein in the LPS injected groups were comparable to those of the group with no LPS injection at both 24 and 48 h post-LPS injection. Treatment with LPS increased IL-1β mRNA content (P = 0.01) in the group fed 0 mg of lutein. In the LPS injected groups, increasing dietary lutein to 50 mg decreased the IL-1β mRNA amount compared with the group fed 0 mg of lutein. In the LPS injected groups, increasing dietary lutein to 50 mg increased IL-10 mRNA content compared with the group fed 0 mg of lutein. Injection of LPS increased the thiobarbituric reactive substances content of the liver in the group fed 0 mg of lutein. Increasing dietary lutein to 50 mg decreased the thiobarbituric reactive substances content of the liver in the LPS injected groups. Dietary lutein supplementation decreased oxidative damage and inflammatory responses post-LPS injection by decreasing IL-1β production and increasing IL-10 production in turkeys.

Larvicidal activity of neem and karanja oil cakes against mosquito vectors, Culex quinquefasciatus (say), Aedes aegypti (L.) and Anopheles stephensi (L.)

Larvicidal effect of neem (Azadirachta indica) and karanja (Pongamia glabra) oil cakes (individuals and combination) was studied against mosquito species. Both the oil cakes showed larvicidal activity against the mosquito species tested. The combination of neem and karanja oil cakes in equal proportion proved to have better effect than the individual treatments. The combination of the two oil cakes recorded an LC95 of 0.93, 0.54 and 0.77% against the mosquitoes, Culex quinquefasciatus, Aedes aegypti and Anopheles stephensi respectively The increase in efficacy of the combination treatment over individuals in all the mosquito larvae tested was found to range about 4 to 10 fold in terms of LC50 and 2 to 6 fold in terms of LC95.

Pericardial tamponade in neonate following migration of a sialastic central venous catheter

Central venous catheters constitute an essential part of most neonatal intensive care units (NICU). However, they are known to be associated with several complications. We here with report a rare lethal complication of pericardial effusion with cardiac tamponade occurred in a term neonate following central venous line.

Comparative efficacy and persistency of permethrin in Olyset net and conventionally treated net against Aedes aegypti and Anopheles stephensi

The efficacy of the Olyset net was compared to a net treated conventionally with permethrin 10% emulsifiable concentrate at the World Health Organization recommended dose. The nets were assessed under laboratory conditions against the mosquito vectors Aedes aegypti and Anopheles stephensi. Knockdown efficacy for the Olyset net was assessed after the first 10 washings and then after the 15th and 20th washings. Data were not collected for the conventionally treated netting after 5 washings because the conventional treatment was no longer effective. The results of the study indicate permethrin effectively persisted on Olyset net for at least 20 washings, confirming the regeneration of pesticide after each wash.

Rotational application of bioinsecticide with deltamethrin-An antilarval measure for the control of filarial vector, Culex quinquefasciatus (Culicidae: Diptera)

A laboratory investigation was undertaken to study the cyclic usage of field recommended doses of Bacillus thuringiensis israelensis (Bti), Bacillus sphaericus (Bsp) and combination of Bti and Bsp (half the recommended dose of each) with deltamethrin 2.8 EC to attain better control of mosquito larvae. To understand the susceptibility status of the Culex quinquefasciatus larvae in the field, early fourth instar field collected larvae were exposed to the above treatments of biopesticides and were monitored for their persistency till 50% mortality was obtained. The larvae those survived in each treatment were transferred to the concentration of deltamethrin that gave 50% mortality. Observations on larval mortality after the treatment with deltamethrin were recorded after 24 h. The results revealed that Bti excels Bsp, as it recorded 54% mortality only on 17th day after application. The other salient finding of this study is LC50 of deltamethrin is sufficient to follow the biopesticides application for an effective control of Culex larvae.

180 Degrees rotated intestinal anastomosis for jejunoileal atresia in neonates - a preliminary study

The authors report the results of a preliminary study of a new technique of 180 degrees rotated anastomosis carried out as a primary anastomosis for ten neonates with jejunoileal atresia. The details of the technique are illustrated. The advantages of this technique over the conventional end-to-back anastomosis are discussed. A comparative analysis shows improved results compared to the conventional anastomosis.

Cost of neonatal intensive care

Neonates are among those patients generating the highest hospital costs in recent years. There are no published data on the costs of neonatal intensive care in our country. The aim of our study was to analyse the cost of neonatal intensive care in a tertiary care unit. The average hospital charges per day were higher among non-survivors (Rs. 1857) compared to survivors (Rs. 727). Care of more than 1250 gms infant is cost beneficial in our set up.

Treatment of threshold retinopathy of prematurity

This report deals with our experience in the management of threshold retinopathy of prematurity (ROP). A total of 45 eyes of 23 infants were subjected to treatment of threshold ROP. 26.1% of these infants had a birth weight of > 1,500 gm. The preferred modality of treatment was laser indirect photocoagulation, which was facilitated by scleral depression. Cryopexy was done in cases with nondilating pupils or medial haze and was always under general anaesthesia. Retreatment with either modality was needed in 42.2% eyes; in this the skip areas were covered. Total regression of diseases was achieved in 91.1% eyes with no sequelae. All the 4 eyes that progressed to stage 5 despite treatment had zone 1 disease. Major treatment-induced complications did not occur in this series. This study underscores the importance of routine screening of infants upto 2,000 gm birth weight for ROP and the excellent response that is achieved with laser photocoagulation in inducing regression of threshold ROP. Laser is the preferred method of treatment in view of the absence of treatment-related morbidity to the premature infants.

Retinopathy of prematurity: a study

A total of 50 infants of less than 2000 gm birth weight were screened for retinopathy of prematurity (ROP) by binocular indirect ophthalmoscopy. The incidence of ROP was found in 19 patients (38%). Of these, 8 patients (16 eyes) had threshold disease. Significantly, occurrence of threshold ROP was seen in both 1600 gm birth weight in one infant and in the absence of oxygen administration in 2 infants. Ten of the 16 eyes underwent therapeutic intervention while 6 eyes did not receive treatment for lack of consent from the parents. The treatment consisted of indirect laser photocoagulation (8 eyes) and transconjunctival cryopexy (2 eyes). Good regression of the disease (favourable outcome) was noted in all the treated eyes.

Isolation of 5-amino-4-ribitylaminouracil from a riboflavineless mutant of Aspergillus nidulans

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