A196 CROHN’S DISEASE PATIENT DERIVED MACROPHAGES ARE MORE SUSCEPTIBLE TO HYDROGEN PEROXIDE INDUCED CELL DEATH

Background

Crohn’s disease (CD) is characterized by intestinal inflammation due to the interplay between immunity, genetics, and environmental factors such as diet. Selenium (Se) deficiency is common in patients with CD due to malabsorption or high enteric losses. Selenium is used in the synthesis of selenoproteins that have antioxidant properties (e.g. glutathione peroxidases (GPx)) and are highly expressed in macrophages. However, how Se deficiency affects immune system function in patients with CD is unknown. We hypothesize that characterizing Se status, selenoprotein expression and subsequently macrophage function will advance knowledge of mucosal immunity and provide novel insight into CD.

Purpose

To determine if patients with active CD and healthy controls differ in Se dietary intake and status, oxidative stress, and macrophage cytotoxicity in response to oxidative stress.

Method

Blood was collected from healthy volunteers and patients diagnosed with ileal, ileocolonic or colonic CD (age ≥18 years, with mild or moderate endoscopic disease activity or fecal calprotectin ≥250 µg/g, and Harvey Bradshaw index <16, stable medications including biologics for at least 8-weeks prior to recruitment). Serum was analyzed for GPx activity, malondialdehyde (MDA) and C-reactive protein (CRP) concentrations. Monocytes were isolated by plastic adherence and treated with M-CSF (10 ng/ml, 7d) to derive macrophages. mRNA expression of GPx1, GPx4 and SelenoP was determined by qPCR. Lactate dehydrogenase release was measured in macrophages treated with 500 µM H₂O₂ for 2h.

Result(s)

Samples and/or dietary intake data were collected from 9 patients with CD (3 female, 6 male, mean age=36.8 years) and 13 controls (7 female, 6 male, mean age=27.7 years). Dietary Se intake did not differ between patients with CD and controls (126.1 ± 23.2 vs. 123.3 ± 19.8 µg/day). GPx activity was greater in the serum of patients with CD compared to controls (369 ± 49 vs. 169 ± 27 mU/mL, n=6-8, p<0.005). Patients with CD and controls did not differ in serum MDA concentration (7.80 ± 0.57 vs. 6.53 ± 1.1 µM). CRP levels correlated with serum MDA concentration in patients with CD (r=0.95, n=5, p<0.05) but not GPx activity. Macrophages from patients with CD (n=6) and controls (n=7) did not differ in expression of GPx1 and GPx4 mRNA, whereas SelenoP mRNA was ~200-fold lower in macrophages from patients with CD. Macrophages derived from patients with CD were more susceptible to H₂O₂-evoked cell death (10.3 ± 1.1 vs. 4.7 ± 0.7 % n=2-3 p<0.05).

Conclusion(s)

Despite adequate dietary Se intake our findings suggest altered Se metabolism in patients with active CD, with increases in serum GPx potentially indicative of the need for antioxidant activity to counter oxidative stress. The increased sensitivity of macrophages from patients with CD to H₂O₂ emphasizes the role of oxidative stress and redox balance in IBD. Defining how micronutrients, in this instance Se, impacts innate immunity may provide new approaches to the management of CD.

Disclosure of Interest

None Declared

Yoga participation associated with changes in dietary patterns and stress: A pilot study in stressed adults with poor diet

BACKGROUND AND PURPOSE

Stress contributes to dietary patterns that impede health. Yoga is an integrative stress management approach associated with improved dietary patterns in burgeoning research. Yet, no research has examined change in dietary patterns, body mass index (BMI), and stress during a yoga intervention among stressed adults with poor diet.

MATERIALS AND METHODS

Objectively-measured BMI and a battery of self-report questionnaires were collected at four time points during and following a 12-week yoga intervention (N = 78, 71% women, mean BMI = 25.69 kg/m2±4.59) - pre-treatment (T1), mid-treatment (6 weeks; T2), post-treatment (12 weeks; T3), and at 3-month follow-up (24 weeks; T4).

RESULTS

T1 to T3 fruit and vegetable intake, BMI, and stress significantly declined in the overall sample. Reduction in vegetable intake was no longer significant after accounting for reductions in caloric intake, and reduction in caloric intake remained significant after accounting for reductions in stress.

CONCLUSION

Findings may be interpreted as yoga either encouraging or adversely impacting healthy dietary patterns (i.e., minimizing likelihood of future weight gain vs. decreasing vegetable intake and overall caloric intake among individuals who may not need to lose weight, respectively). Continued research is warranted, utilizing causal designs.

Efficacy of C.E.R.A. in Routine Clinical Practice for Correction of Anaemia and Maintenance of the Haemoglobin Levels in CKD Patients not on Dialysis

INTRODUCTION

C.E.R.A. reported effective correction of anaemia and was well tolerated in International studies on CKD patients not on dialysis.

OBJECTIVE

The study aimed to describe the management of renal anaemia in CKD patients not on dialysis with C.E.R.A. in routine clinical practice in India.

METHODS

This was a prospective, single-arm, open-label, multi-centre, non-interventional, Phase IV study which followed 108 CKD Stage III-IV patients, not on dialysis with Hb < 10 g/dL for correction of anaemia with C.E.R.A.

RESULTS

Of the 108 patients with Hb < 10 g/dL at baseline, 83 (90.2%) patients achieved target Hb of 10-12 g/dL and the time taken to achieve correction of anaemia was 9.6 weeks ± 6.13 weeks in the Intent-to-treat population. Haemoglobin concentration increased from 8.59 ± 0.808 g/dL pre-therapy to 10.91 ± 0.634 g/dL post-therapy. The change in mean ± SD Hb value was 2.32 ± 0.174 g/dL. Maintenance of Hb levels within the target range of Hb 10 - 12 g/dL was observed in 78.2% of ITT and 80.8% of the PP population for mean duration of 16.69 weeks. Four patients (3.7%) experienced 5 AEs and 2 patients (1.9%) experienced 3 SAEs in the safety population. As per the treating physician none of the AEs or SAEs was considered related to study drug. There were no deaths reported.

CONCLUSIONS

This study demonstrated successful correction of anaemia in Indian patients with C.E.R.A. treatment as well as maintenance of Hb levels within the target range. C.E.R.A. was well tolerated with no new safety concerns specific to the Indian population. The less frequent up to monthly dosing schedule of C.E.R.A. may offer clinicians and patients a simplified regimen of anaemia management as compared to traditional frequently administered (thrice weekly to once weekly) ESAs.

A comparison of diagnostic imaging modalities for colorectal liver metastases

AIMS

The aims of this study were to compare the diagnostic performance of CT scan, MR liver, PET-CT and intra-operative ultrasound (IOUS) for the detection of liver metastases against the histopathological findings, and to compare PET-CT with CT for the detection of distant disease in metastatic colorectal cancer patients eligible for surgical treatment.

METHODS

A prospective study was performed that measured concordance between the number and stage of metastatic lesions identified with various preoperative imaging modalities and histology of patients undergoing surgical treatment for CRLM.

RESULTS

Compared with histopathology, concordance for the number of metastatic liver lesions was moderate for CT scan (K = 0.477, 95% CI: 0.28-0.66), moderate for MR scan (K = 0.574, 95% CI: 0.39-0.75), good for FDG PET-CT (K = 0.703, 95% CI: 0.52-0.87) and very good for IOUS (K = 0.904, 95% CI: 0.81-0.99). Additional CRLM were identified intraoperatively in six patients (9.1%) with IOUS and in 7.5% of the cases surgical strategy was changed according to the new intraoperative findings. The diagnosis of intra abdominal lymph node metastatic disease was made with PET-CT only in nine patients (13.6%)

DISCUSSION

Our study supports the recent recommendations of the Oncosurg Multidisciplinary International Consensus regarding the importance of high quality CT and MR in the staging of CRLM but provides further evidence for the added value of PET-CT, especially in detecting extrahepatic intra-abdominal metastatic disease that may be amenable to potentially curative resection. Despite these advances in preoperative staging, there still remains a role for IOUS in detecting additional metastases at the time of surgery.

Measurement of fetal fat in utero in normal and diabetic pregnancies using magnetic resonance imaging

OBJECTIVES

To assess the reliability of magnetic resonance imaging (MRI) to measure fetal fat volume in utero, and to study fetal growth in women with and without diabetes in view of the increased prevalence of macrosomia in the former.

METHODS

We studied 26 pregnant women, 14 with pre-gestational diabetes and 12 non-diabetic controls. Fetal assessment took place at 24 weeks' gestation and again at 34 weeks by standard ultrasound biometry followed by MRI at 1.5 T. Fetal fat volume was determined from T1-weighted water-suppressed images using a semi-automated approach based on pixel intensity and taking into account partial volume effects. Fetal volume was also determined from the MRI images. Fetal weight was calculated using published fat and lean tissue densities.

RESULTS

There was little fetal fat at 24 weeks' gestation, but at 34 weeks the fetal fat content was considerably higher in the women with diabetes, with a mean fat content of 1090 ± 417 cm(3) compared with 541 ± 348 cm(3) in the controls (P = 0.006). Measurements of fetal fat volume showed low intra- and interobserver variability at 34 weeks, with intraclass correlation coefficients consistently above 0.99. Birth-weight centile correlated with fetal fat volume (R(2)  = 0.496, P < 0.001), percentage of fetal fat (R(2)  = 0.362, P = 0.008) and calculated fetal weight (R(2)  = 0.492, P < 0.001) at 34 weeks.

CONCLUSIONS

MRI appears to be a promising tool for the determination of fetal fat, body composition and weight in utero during the third trimester of pregnancy.

Rarer in a rare

Though moya moya disease is a disease of Asian origin, it is one of the very rare causes of stroke in India. It is a rare disease mainly characterized by progressive cerebrovascular episode due to the slowly progressive stenosis of supraclinoid segment of bilateral internal carotid arteries, the anterior and the middle cerebral arteries, and very rarely, posterior cerebral arteries. We hereby report a case of a young female who presented to us with the psychiatric complaints and refractory headache since her childhood. Therefore, we are reporting rarer (headache and neuropsychiatric) manifestations in the rare (moya moya) disease.

Influence of γ-radiation on the structure and function of soybean trypsin inhibitor

Soybean trypsin inhibitor (STI) is a known antinutrient and food allergen present in soybean. γ-Radiation has the potential to inactivate the TI protein. However, a systematic study on the influence of different moisture levels during γ radiation on structure and function of the molecule has not been reported. Pure STI was irradiated up to 200 kGy, in dry state, with 50% moisture and in aqueous solution. The radiation damage in molecular structure was assessed using, SDS-PAGE, size exclusion chromatography, fluorescence measurement, and circular dichroism, while functional damage was assessed by the TI assay. In aqueous solution, both the structure and function of TI were almost destroyed at the 10 kGy dose. While with 50% moisture and in dry state, the loss in functional and structural attributes was discernible only at 30 and 100 kGy, respectively. The TI activity was found to be unaffected in dry and soaked seeds of soybean as well as other legumes up to irradiation doses of 100 and 50 kGy, respectively.

P2-08-11: Correlation of Mammography, Ultrasound and MRI in Patients with Nipple Discharge

BACKGROUND: Breast cancer mainly originates in the epithelial lining of milk ducts or lobules. Once early pre-malignant or malignant changes occur in the ductal lining there is a long latent period before they manifest symptoms or are detected on imaging. Symptomatic nipple discharge (SND) is a common symptom noted in approximately 5% of patients. Although, usually benign it may be the earliest sign of cancer. The current standard evaluation of patients with nipple discharge includes clinical examination (CE), mammography (MMG) and ultrasound (US). Contrast enhanced MRI is considered the most sensitive imaging modality for the breast and reports suggest it may be of benefit in the evaluation of nipple discharge. We have combined MRI with standard evaluation in an ongoing prospective study to determine its utility in patients with SND.

PATIENTS AND METHODS: Between July 2004 and 31st May 2011, 75 women underwent surgery for SND. All were initially evaluated by CE, MMG and US following which a contrast enhanced breast MRI was requested. MRI was performed on a 1.5T MR unit using a dedicated breast coil. A STIR sequence in the coronal and sagittal planes along with an unenhanced fat-suppressed T1 W sequence was used to evaluate the ducts. The imaging findings were used to direct surgical excision. All specimens were oriented and evaluated by the pathologist by sectioning at 1 cm interval, from the ductal end to the periphery. The results of preoperative MMG, US and MRI findings were compared with pathology.

RESULTS: The incidence of cancer in this series was 29% and high risk lesions were noted in 43%. MMG and US were performed in 75 patients. MRI was requested in all 75 patients but could be performed in 64. MRI proved to be the most sensitive technique for detection of an abnormality in the breast (92%) compared to MMG 25%, and US 63%. MMG, US and MRI were suggestive of benign change in 64 (85%), 65 (87%) and 43 (67%) patients respectively, of which 14 (22%), 15 (23%) and 7 (16%) were malignant on pathology. MMG, US and MRI reported suspicious change in 11(15%), 10 (13%) and 21(33%) patients respectively of which 8 (73%), 7 (70%) and 9 (43%) patients had cancer on pathology. MRI had the highest sensitivity for malignancy (54%) compared to MMG (36%) and US (32%) but MRI had a low specificity (74%) (MMG 94%; US 94%). However, MRI had a high negative predictive value (86%) (MMG 78%; US 73%). Of the 22 patients with cancers, 12 were deemed to be normal on CE, MMG and US examination. Thus standard evaluation would have missed 54% of the cancers detected in this series.

CONCLUSIONS: Nipple discharge is associated with significant incidence of cancer and high risk changes. The majority of these are missed on standard evaluation (CE, MMG, US). MRI is the most sensitive method for the detection of an abnormality in these patients. It defines the location and extent of the abnormality and can guide surgical excision. However, MRI is unable to accurately differentiate malignant from benign lesions. Hence, excision of an identified abnormality and pathological evaluation remains essential.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-08-11.

Cricket ball trauma causing temporal space abscess: report of a case

A 9-year-old boy reported with swelling on right side of the face after injury by a cricket ball while fielding. There was a history of hot fermentation after which the swelling increased in size leading to a temporal space abscess. The patient underwent incision and drainage with uneventful healing and was followed-up for a period of 7 years.

Splenic torsion: a case report

INTRODUCTION

Torsion of the spleen is a rare cause of abdominal pain. Predisposition occurs following abnormal development of splenic suspensory ligaments. We report a case of splenic torsion in a spleen sited in a normal anatomical position and discuss the latest treatment options. To the best of our knowledge, this has not been reported in the literature to date.

CASE PRESENTATION

A 73-year-old Caucasian woman presented to our department with sudden onset, severe, left-upper abdominal pain. An enhanced computed tomography revealed an unenhancing spleen. She underwent an urgent laparotomy and splenectomy for 360 degrees torsion of her spleen.

CONCLUSIONS

Splenic torsion in a wandering spleen has been described with an incidence of < 0.2%. Symptoms vary from asymptomatic to an acute surgical abdomen. Diagnosis is commonly made using colour Doppler sonography or enhanced computed tomography. Surgery is guided by clinical setting, with preservation of the spleen as the goal.

Pulmonary hyalinizing granuloma with ureteric fibrosis: A case report and review of relevant literature

A 52-year-old, asymptomatic patient presented with bilateral lung nodules on chest radiograph. She was diagnosed to have "pulmonary hyalinizing granuloma" on an open lung biopsy. We review the clinical features of this rare disease.

Evaluation of a pyroelectric detector with a carbon multiwalled nanotube black coating in the infrared

The performance of a pyroelectric detector with a carbon multiwalled nanotube coating was evaluated in the 0.9-14 microm wavelength range. The relative spectral responsivity of this detector was shown to be flat over most of the wavelength range examined, and the spectral flatness was shown to be comparable to the best infrared black coatings currently available. This finding is promising because black coatings with spectrally flat absorbance profiles are usually associated with the highest absorbance values. The performance of the detector (in terms of noise equivalent power and specific detectivity) was limited by the very thick (250 microm thick) LiNbO3 pyroelectric crystal onto which the coating was deposited. The responsivity of this detector was shown to be linear in the 0.06-2.8 mW radiant power range, and its spatial uniformity was comparable to that of other pyroelectric detectors that use different types of black coating. The carbon nanotube coatings were reported to be much more durable than other infrared black coatings, such as metal blacks, that are commonly used to coat thermal detectors in the infrared. This, in combination with their excellent spectral flatness, suggests that carbon nanotube coatings appear extremely promising for thermal detection applications in the infrared.

A preliminary investigation into maximal expiratory pressures in some village children

A clinical mercury sphygmomanometer was used to measure Maximal Expiratory Pressure (MEP) in 29 boys (mean age 8 +/- 1.4 yr) and 21 girls (mean age 7.6 +/- 1.5 yr) of a village in interior Maharashtra. The values of 70.6 +/- 13.4 mmHg SD for the boys and 61.9 +/- 18.9 mmHg for the girls were quite comparable to the respiratory pressures reported elsewhere in literature, even though the subjects were apparently poorly nourished. There was no statistical difference between the MEPs of boys and girls. The MEP was positively and significantly (P<0.01) correlated to height (r=0.51) and weight (r=0.05) in the boys. The MEP denoting respiratory muscle strength also correlated positively with handgrip power used to represent non-respiratory muscle strength (r=0.34) (P>0.05). The simple, reproducible method of measuring MEP as described may be useful for measuring this important physiological parameter at the bedside in children whose respiratory muscle function needs to be evaluated.

Modified technique for rapid atraumatic radial artery harvesting

The radial artery is currently enjoying a resurgence in popularity as a conduit for coronary artery bypass grafting. We have introduced a modification of the standard technique of radial artery harvesting, which we have evaluated in a prospective randomized control study. Our modified technique was significantly quicker (p < 0.001) than the standard technique and required the use of fewer hemostatic clips (p < 0.001). Spasm of the radial artery did not occur in either group and there was no histological evidence of thermal injury to the radial artery. There was no incidence of postoperative hematoma, forearm dysesthesia, impaired wound healing, or hand complications in either group. We conclude that our technique allows rapid, inexpensive, and atraumatic harvesting of the radial artery.

The impact of cyclosporine on the development of immunosuppressive therapy: perspective from a transplant nephrologist involved with the development of C2

The availability of Neoral in place of Sandimmun offered better pharmacokinetics and improved results but emphasized the poor accuracy of trough levels as a tool for monitoring drug exposure and dosage adjustment. Subsequent studies confirmed that Neoral exposure correlated with clinical events and it was found that C2 was the single point that correlated best with exposure as determined by AUC(0-4h). Single and multicenter studies have now shown that C2 monitoring is practically feasible and that its use resulted in very low rates of acute rejection with excellent renal function. One retrospective comparison suggested that rates of acute rejection were lower with C2 than with C0 monitoring. This tool has now been shown to be effective in managing African-American renal transplants and those with delayed graft function. A very recent international randomized trial has shown equivalent rates of acute rejection in liver transplant recipients treated with both Neoral and Prograf. Studies now in progress will permit further refinement of target levels with the potential to improve long-term results.