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  Molecular pathways elicited by Toll-like receptor 2 (TLR2) signaling during Staphylococcus aureus craniotomy infection

  Chinyere Agba, Cortney E. Heim, Christopher M. Horn, and Tammy Kielian

  A craniotomy is required to access the brain during neurosurgery for tumor resection or epilepsy treatment and despite extensive precautionary measures, infectious complications occur at a frequency of 1-3% (1-3). Approximately half of craniotomy infections are caused by S. aureus, which forms a biofilm on the bone flap. Our laboratory has developed a mouse model of S. aureus craniotomy-associated biofilm infection that shares important ultrastructural and MRI attributes with human disease (4). Toll-like receptor 2 (TLR2) is expressed by cells of the innate immune system and is critical for recognizing pathogen-associated molecular patterns (PAMPs) in the cell wall of gram-positive bacteria, such as S. aureus. Recent studies have shown that TLR2 is critical for S. aureus containment during craniotomy infection, in that TLR2 knockout (KO) mice displayed increased bacterial burden in the brain, galea, and bone flap during acute and chronic infection (days 3 and 14, respectively)(5). Cytokine and chemokine expression was dramatically reduced in TLR2 KO mice which did not coincide with a decrease in leukocyte infiltrates in the brain or galea. This suggested that S. aureus outgrowth in the context of TLR2 deficiency is not the result of altered leukocyte recruitment, but instead due to defects in their activation status. To determine this, RNA-sequencing (RNA-seq) was performed on microglia purified from the brain of WT and TLR2 KO mice at either day 3 or 7 post-infection by FACS with the goal of identifying microglial transcripts that are divergent between the two mouse strains (either increased or decreased). RNA-seq revealed Fibroblast Growth Factor Receptor (FGFR) 2 and 3 were upregulated in TLR2 KO microglia. This suggests a direct correlation between TLR2, FGFR2 and FGFR3. Since TLR2 KO animals have a bias toward an anti-inflammatory response to infection and the fact that FGFR2 and FGFR3 are upregulated during wound healing or infection, this could be a reason why higher levels are observed in TLR2 KO microglia. FGRF2 and FGRF3 are key regulators of neuronal protection and repair following brain injury/infection. Therefore, microglia may be increasing the expression of these receptors in an effort to control the damage that is occurring in response to the increased bacterial burden in TLR2 KO animals.

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  Using heuristic design methods to build a home kit for remote monitoring of Parkinson’s Disease progression

  Noha Algahimi and Bethany Lowndes

  Heuristic evaluation is a tool of usability engineering. It provides a determination of design error and possible issues with product use. This project applies the elements of Heuristic evaluation to a home kit carefully curated to older Parkinson’s patients with limited knowledge of technology. The home kit is carefully assembled to provide an easy method of monitoring the progression of Parkinson’s Disease, the goal of the kit is to collect data on the patient's ability to get up from a chair and walk 10 ft.

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  GlyKali : an efficient means of harnessing study-specific glycan and glycosylation data

  Ashdyn Anderson, Maia Kelly, and Rebekah Gundry

  Glycosylation is an enzyme directed form of secondary protein modification in eukaryotic and archaeal cell.Glycosylation plays a critical role in determining proteins three-dimensional configuration and structure, function, and stability.

  A glycan, or polysaccharide, is a chain like structure containing a number of monosaccharides. Glycans make up Glycoconjugates to makeup the glycoproteins that cover the cell and makeup a cell-surface glycome.

  The way these glycan chains are glycosylated has been known to change due to immune responses and disease. For example, Blood Type is known to be a result of differential cell-surface glycomes.

  The goal of this workflow is as follows. To simplify mass data retrieval of glycomic data Use already known data from databases in context of experimental data.

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  Racial and Gender Disparities in Pediatric Clinical Trials

  Albrea Barnwell and Arika L. Hoffman

  Racial and gender disparities are issues in the medical field that go unnoticed. In order to reduce the large number of disparities, it is essential to encourage diversity in clinical trials. Minorities are underrepresented in clinical trials happening in America. This does not allow an equal chance at great healthcare. The lack of transportation and knowledge about clinical trials contributes to the lack of minority representation in clinical trials. Women are another group of individuals who are underrepresented in clinical trials. Studies have shown that females are less likely to receive a renal transplant than males. Pediatric female patients with ESRD are 14% less likely to be listed on a transplant list with males. Adult women with ESRD are 18% less likely to be activated on a transplant list with males. Female patients of all ages with ESRD must deal with the challenges of being activated for a renal transplant. These disparities are real. Minorities and women go through unfair obstacles that no one should have to face. In order to fight against these disparities, it is essential to spread the word about clinical trials to make them more diverse. Clinical trials need to be promoted so that more minorities and female patients can be represented for all.

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  Engagement with Case Management Reduces Emergency Department Visits for Asthma

  Bethany Baumgartner, Danielle Jakopovic, Toni Blazek, Tricia LeVan, and Hana Niebur

  Rationale: Millions of children utilize the Emergency Department (ED) for asthma exacerbations annually, increasing healthcare utilization and costs. Patients with a low socio-economic status are more likely to utilize the ED for asthma exacerbations due to long work hours, lack of transportation, and low health literacy.22,24 Long-term involvement with case management can address these issues and bridge gaps in access to preventative care, potentially improving overall asthma outcomes. This study investigated the effects of engagement with case management on asthma outcomes in patients with frequent ED utilization for asthma exacerbations by facilitating access to asthma specialty care.

  Methods: Subjects who presented to the ED at Children’s Hospital and Medical Center in Omaha, NE for an asthma exacerbation with two previous visits for asthma exacerbations in the previous 12 months were identified through a Best Practice Alert (BPA) in the Electronic Health Record (EHR). The BPA created a referral to case management. The case manager approached subjects either during the ED visit or afterwards through a phone call to refer and facilitate evaluation with asthma specialty care. The intervention group consisted of subjects who engaged with case managers over time and attended at least one appointment with an asthma specialist, while the control group did not engage with case management after the initial contact. Demographic data, asthma control measures, pulmonary function tests, the number of new prescriptions for oral and inhaled corticosteroids (OCS/ICS) and number of ED visits were collected for the 12 months after the BPA notification. This study followed a prospective cohort design. Chi square test and anova were utilized for the descriptive data, and a non-parametric KWallace test was used on non-normal continuous variables. While a McNemars test was implemented on the paired analysis.

  Results: The intervention group was significantly more likely to experience passive smoke exposure. There were no significant differences in the day of the week and time of day of the ED visit, number of new OCS/ICS prescriptions, sex, ethnicity, ZIP code, insurance coverage, or age between the intervention and control groups. Face-to-face case management significantly increased the enrollment of subjects in the intervention compared to remote case management. Engagement with case management including asthma specialty care decreased the number of ED visits due to asthma 12 months after the BPA notification. The intervention group was significantly more likely to experience passive smoke exposure.

  Conclusions: Asthma case management can decrease the number of ED visits in patients with uncontrolled asthma and could improve health care costs. Face-to-face case management is more effective than remote case management in engaging patients. Increased involvement of case management in the ED could improve access to specialty care for chronic disease management.

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  Addiction in American Indian Adults and the Role of Early Social Context

  Sarah Budz and Nicholas Guenzel

  Background/Intro:

  Substance abuse and addiction plague much of the United States, especially in the American Indian population. Substance abuse in the American Indian community is higher than any other ethnic group (American Addiction Centers, 2020). According to the Substance Abuse and Mental Health Services Administration, in 2013, American Indians 12 years and older had one of the highest rates of illicit drug use and heavy drinking in the U.S (Dickerson et al., 2016). Addiction and substance abuse typically stem from the experiences and traumas in a person's life. Some risk factors among the American Indian population include socioeconomic inequality, discrimination, racism, historical trauma, and violence (American Addiction Centers, 2020). These factors play a significant role in the development of substance abuse disorders.

  Methods:

  Design: Secondary Data Analysis

  Sample: Self-identifying American Indian adults (19+ years) living within 30 miles outside of Omaha or Lincoln that have used a drug or alcohol at least once. Procedure: A booth set up at local pow-wows and AI events, research assistants (RA) contacted people they knew who might qualify, and word-of-mouth were the main methods of finding participants. From here, RAs ensured they met inclusion/exclusion criteria; 41 participants were chosen for the “Substance Use Disorder” group and 41 were chosen for the “Non-Substance Use Disorder” group. A survey was administered by trained community members either over the phone or in person, and answers were entered into REDCap by RAs. A licensed drug and alcohol counselor (LDAC) called 8 random participants from each group and conducted an assessment determining if they likely had a drug/alcohol problem in the past.

  Analysis:

  We will use chi-square analysis for categorical variables and t-tests for continuous variables.

  Results:

  Results are pending

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  Immune Cell Expression Signatures in B cell Lymphoma

  Ramiah Caine, Tyler Herek, and Javeed Iqbal

  Intro: B-cell lymphomas are a group of diseases that originate from the B cell compartment of your white blood cells. B-cell lymphoma and High-Grade Lymphoma are difficult to distinguish by pathologists based on morphology but have been shown to have very different expression profiles by suggesting these lymphomas come from different stages of B-cell development. M&M: xCell is an analytical tool to impute gene expression profiles and provide an estimation of the abundances of member cell types in a mixed cell population, using gene expression data. Results: A program called xCell was utilized to see that High-Grade Lymphoma cases were enhanced for memory B-cell marks while Burkitt Lymphoma cases were improved for plasma cell signatures suggesting a potential difference in the normal cell counterpart. For immune-cell signatures in the microenvironment, I observed that High Grade Lymphoma samples had a statistically significant increase in T-regulatory cell signatures Conclusions: I observed that High Grade Lymphoma samples had a statistically significant increase in T-regulatory cell signatures while Burkitt Lymphoma samples had a statistically significant increase in T-helper 1 signatures. Taken together, these results suggest differential microenvironments in these malignancies which could be exploited in therapeutic strategies as T-regulatory and T-helper 1 subsets can influence anti-tumor responses.

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  Targeting NF-kB Signaling using a Novel Inhibitor in DLBCL

  Julia Ceniceros, Alexandria Eiken, and Dalia Elgamal

  Diffuse large B-cell lymphoma (DLBCL) is an aggressive B-cell malignancy that can be categorized by cell of origin, molecular features and reoccurring mutations. The transcription factor “NF-κB” plays a key role in cell survival, inflammation and immune responses; in cancer it promotes malignant cell proliferation.Targeting pathways such as the NF-κB is a viable option to treat B-cell malignancies. A novel NF-κB inhibitor was evaluated in DLBCL cell lines (OCI-LY3, RI-1, and Pfeiffer). The NF-κB inhibitor showed cytotoxic effects in DLBCL cells, especially those dependent on NF-κB.

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  Obesity Interventions in Hispanic Americans Across the Lifespan: a systematic review using the RE-AIM framework

  Caitlin Gerdes, Diego Renteria, Tzeyu Michaud, Fabiana Silva, and Paul Estabrooks

  To determine the number and success of obesity treatment interventions for Hispanic populations that have been implemented in the past and examine the effectiveness of the interventions by looking at weight and or BMI change in the participants from the beginning to the end of the individual programs using a systematic review with the RE-AIM framework.

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  Does Heparin Cause Essential Fatty Acid Loss During Therapeutic Plasma Exchange?

  Drew Hedstrom and Nathan Bills

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  Statistical analysis and visualization of mass spectrometry data using R

  Joseph Hennessey, Linda Berg Luecke, and Rebekah Gundry

  Mass spectrometry (MS) identifies the mass-to-charge ratio of ions. In proteomic research, MS can be used to identify proteins in a sample by digesting proteins into peptides, ionizing the peptides, then detecting the peptides and fragments of peptides via a mass spectrometer. However, most proteomic experiments identify large numbers of proteins and at times it can be difficult to efficiency communicate results of large datasets. Therefore, we sought to apply various visualization techniques in R to allow for fast and effective processing of large MS datasets.

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  Nurse Practitioner Survey on Cardiorespiratory Fitness Testing

  Ashtyn Keezer and Sheri Rowland

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  Breastfeeding initiation and duration in depressed and non-depressed women who gave birth during COVID-19

  Kara Lemkau and Elizabeth Mollard

  Breastfeeding is crucial to the development of a strong maternal-infant bond and for maternal and infant health. Previous studies have determined that maternal depression may have an impact on breastfeeding initiation and duration. The purpose of this study was to explore the relationship between depression and breastfeeding initiation and duration in women who have given birth during the Coronavirus Disease 2019 (COVID-19) pandemic. This study is a secondary analysis of a retrospective mixed methods study on women who gave birth during the COVID-19 pandemic. Women were recruited for the parent study if they spoke English and gave birth in the United States on or after March 1st, 2020. The measures of this study were taken from the parent study. The evaluation tools are the 10 item Birth Satisfaction Scale Revised (BSS-R), the 2 item Connor Davidson Resilience Scale (CD-RISC2), the 10 item Perceived Stress Scale (PSS10), the 7 item Pearlin Mastery (PM) scale, demographic questions, birth and pregnancy related questions, and a narrative text box where the participant can describe in their own words their birth and postpartum experience. This study will focus on depression and breastfeeding initiation and duration. This study will offer insight into the possible relationship of depression and breastfeeding initiation and duration in women who gave birth during the COVID-19 pandemic. Results and data analysis are pending. The relationship between depression and breastfeeding initiation and duration in women who gave birth during COVID-19 remains uncertain. The results from this study may be used to develop future research or to advance healthcare practices.

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  Systematic Review of Telehealth Survey Instruments to Assess Patient and Family Caregiver Communication Experience

  Joe Lukowski, Brittany Wichman, and Meaghann Weaver

  The COVID19 pandemic has resulted in rapid upsurge in telehealth use without clear knowledge of patient or family caregiver communication experiences using telehealth. This poster reports on a systematic review of quantitative and qualitative research inclusive of telehealth survey instruments following PRISMA guidelines using a PROSPERO registered protocol . 13 well-designed telehealth communication surveys were included in the final analysis. The findings from this systematic review reveal the need for development of survey instruments inclusive of communication experience in addition to current emphasis on technology interface and survey instruments relevant to pediatric family cohorts.

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  Impact of brain-death-induced transient myocardial dysfunction on long-term health of heart transplant recipients

  Matthew Muellner and Marian Urban

  Despite the many years that brain-dead donors have been a source for heart transplants, some uncertainty remains as to the impact of brain-death on the long-term outcome of the heart transplant recipients. Cardiac dysfunction may occur in up to 42% of adults with brain death, affecting a highly significant proportion of hearts that are transplanted[1,2]. Records of 246 donor hearts matched to recipients at UNMC between 2010 and 2017 were examined to determine long-term effect of brain-death-induced transient myocardial dysfunction (BDIMC). Data was also assessed to determine correlation between donor characteristics of age, gender, and cause of death and exhibition of BDIMC in donor hearts. It was found that 1-year and 5-year survival rates of recipients of donor hearts with BDIMC within the sample were on average lower than those seen in recipients of non-BDIMC donor hearts. While this result was not statistically significant (p = 0.18), the trend demonstrated in the data merits additional study into the effects of BDIMC in larger and more diverse sample sizes. No association between BDIMC and donor characteristics was found. Conclusions made by further study may aid health care workers in selection of hearts with highest survival rates for those in need.

  References include:

  1. Dujardin KS, McCully RB, Wijdicks EF, et al. Myocardial dysfunction associated with brain death: clinical, echocardiographic, and pathologic features. J Heart Lung Transplant. 2001;20(3):350-357. doi:10.1016/s1053-2498(00)00193-52.
  2. Fyfe, B., et al. (1996). Heart TransplantationAssociated Perioperative Ischemic Myocardial Injury. Circulation 93(6): 1133-1140.

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  Multi-Criteria Optimization – Improved Knowledge for Knowledge-Based Planning

  Meredith Ollerich, Shuo Wang, and Chi Lin

  Multi-Criteria Optimization (MCO) is a new and upcoming way to quickly create and assign radiotherapy treatment plans to patients. How does it compare clinical treatment plans? MCO allows the user to adjust various treatment plans that the computer has created based on upper and lower dose limits. Varian, the program that houses MCO treatment plans, has an easy to use interface to determine the best individualized plans for each cancer patient. Clinical treatment planning may take longer than MCO-generated plans, with possible inconsistent and suboptimal quality.

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  Comparing the Use and Survival Outcome of Stereotactic Radiosurgery and Stereotactic Radiation Therapy

  Garrett Ostdiek-Wille and Saber A. Amin

  Brain metastases are common in many types of cancer. Treatment for this condition is usually through surgical resection, whole brain radiation treatment (WBRT), stereotactic radiosurgery (SRS), or stereotactic radiation therapy (SRT). SRS (15 to 24 Gy in 1 fraction) and SRT (21, 24 or 30 Gy in 3 fractions or 25, 30 Gy in 5 fractions) have similar biological equivalent doses but differ in the number of treatments the radiation is delivered over. The objective of this study is to use national cancer database (NCDB) to examine the factors associated with receiving SRS as compared to SRT, and to compare overall survival between patients who received SRS to those who received SRT after adjusting for all potential prognostic factors. The two treatments were not found to have a significant difference in survival.

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  Uncertainty Analysis of Radiomic Features for Lung Cancer

  Konpal Rafique, Shuo Wang, and Chi Lin

  Medical imaging has been an essential component in clinical cancer care. Computer Tomography (CT) is the most used medical imaging modality for diagnosis and treatment response monitoring of a variety of cancer types, including pancreatic cancer. However, the current practice of medical imaging analysis is still mainly intended for visual interpretation and lesion size determination. Recent success in quantitative imaging analysis is redefining the role of medical imaging as a new data source of novel biomarkers, in the form of imaging-based phenotyping. Radiomics is a method of high-throughput extraction of hundreds of features encrypted in the medical images based on a segmentation (delineation of boundary of a three-dimensional volume of interest, i.e. VOI). These Radiomics features typically include the shape, first-, or second- (or textual), and higher-order statistics of a 3D volume of interest, and can provide a far more comprehensive, quantitative, and nuanced representation of the radiographic phenotype of a tumor or an organ, in comparison to the semantic or qualitative descriptors from human experts. Due to its distinct advantages for biomarker development, it becomes an active area of research focusing on risk assessment and treatment response prediction of cancer as well as relationship between image feature and genomics. As previously stated, the inconsistency and variability of target volume delineation and radiomics feature extraction will affect, in a negative way, the robustness of the predictive model and its ability to generate on a different dataset. Patient positioning and image acquisition also affect each feature to varying degrees by introducing different types of imaging perturbations such as image rotation. In this study, we aim at evaluating the uncertainties introduced by the image rotation.

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  Pilot Study of Interventional Radiologist vs. Nephrologist in Renal Biopsy Procedures

  Israel Ramos and Arika L. Hoffman

  The purpose of this study is to investigate the difference in surgical practice between Interventional Radiology (IR) and Nephrology when performing renal biopsies. More research is needed for this project, but this pilot study’s conclusions can serve as future guidance in research. This study focuses on the quantity of cores and glomeruli collected during renal biopsy procedures. A study was published in 2009 from the Department of Pathology and Internal Medicine IV at the University of Erlangen-Nurnberg, Germany explaining “~10-15 glomeruli is optimal for a renal biopsy.” (1) A larger collection of cores/glomeruli can ensure an accurate biopsy diagnosis but may pose future risk for the patient.

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  Using LC-MS/MS Metabolomics to Study Cancer Metabolism

  Troy Robertson, Marshall Dawkins, Nick Mullen, and Pankaj Singh

  Using LC-MS/MS, we found that pancreatic cancer proliferation can be slowed down using the drug Brequinar as a DHODH inhibitor, which reduces the number of metabolites necessary to create pyrimidines and allow proliferation.

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  In Silico Prediction of Changes in Intrinsic Network Functional Connectivity Following Repetitive Transcranial Magnetic Stimulation

  Breanna Shen, Connor Phipps, and David Warren

  Targeted transcranial magnetic stimulation (TMS) is a non-invasive brain stimulation technique that can influence brain activity, psychiatric features, and cognitive performance. While TMS has been reported to affect cognitive performance across a variety of domains, substantial gaps in knowledge remain regarding the association of these TMS-based cognitive changes and functional connectivity in the brain. In this project, we aim to build a computational model to simulate the effects of TMS on functional associations between a stimulated brain region and the brain networks connected to that brain region. Using data from the Human Connectome Project as the basis for the brain’s functional connectivity, we built a prototypical matrix that models all cortical brain regions (“parcels”) and the functional connections between them. From this starting point, our computational model predicts the effects of stimulating a specific parcel with TMS. Further, our model includes variable parameters to support estimation of functional effects associated with differences in TMS delivery (applying excitatory or inhibitory stimulation), stimulation intensity, stimulation duration (days of TMS), etc. Finally, the model supports estimation of not only local results, but also whole-brain changes in functional connectivity. Based on the quantitative changes in the model estimates associated with different parameter settings, we were able to predict the effects on functional connectivity both within the parcel’s network as well as across the entire cortex. Our approach is an important first step toward individualized in silico computation of how TMS affects the brain, and our work may have implications for developing more effective treatment with TMS.

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  Bioenergetic and Proteomic Analysis of Striatal Synaptosomes from PINK1/Parkin Double Knockout Rats

  Jacob Shomali, Steven Totusek, and Kelly Stauch

  Parkinson’s disease (PD) patients exhibit dopaminergic (DA) neuron degeneration in the substantia nigra pars compacta (SNpc) and loss of associated terminals in the striatum, which results in motor deficits. Loss-of-function gene mutations in PINK1 and Parkin (proteins relevant to mitochondrial quality control) have been identified in hereditary PD patients and show promise for PD animal models. Without a reproducible PD mammalian model, previous studies have failed to observe the mechanisms of progressive neurodegeneration. Therefore, we created and characterized a PINK1/Parkin double knockout (DKO) rat that reproducibly (100% of males) exhibits PD-relevant pathology, including striatal nerve terminal bioenergetic deficits prior to significant motor impairments and DA neuron loss in the SNpc. With mass spectrometry-based proteomics, we identified the differentially expressed proteins in the striatal synaptosomes (a portion of which originate from the SNpc) of DKO rats. Our results indicate decreased expression of mitochondrial and neurotransmitter release proteins. Thus, the DKO rats exhibit deficient neuronal communication.

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  The Effects of Ethanol on the Pancreatic Cell Line Transcriptomes

  Shea Thompson, Emalie Clement, and Nicholas Woods

  Pancreatic Ductal Adenocarcinoma (PDAC) is a highly aggressive cancer that develops from cells in the pancreas. Currently, PDAC has a 5-year survival rate of only 10% and it makes up about 7% of all cancer deaths (1). Certain risk factors are associated with PDAC development, including family history of cancer, obesity, diabetes, pancreatitis, alcohol consumption, and smoking. While several studies have assessed alcohol consumption and its contribution to PDAC development, there is conflicting evidence to whether or not alcohol actually promotes PDAC. Work from our lab indicates that specific subtypes of pancreatic cancer are associated with a patient’s drinking status, which may influence treatment strategies and patient outcomes (2). This raises the question; How does alcohol affect cancerous and pre-cancerous pancreatic cells? In this study, we performed RNA-Sequencing on ethanol treated pancreatic cells in different stages of cancer progression may provide insight to the effects of ethanol on the etiology of this disease. We analyzed the protein coding genes that were differentially expressed between non-treated and ethanol treated cells and performed functional analysis to better understand the impact of ethanol on the biological processes in pancreatic cells.

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  Roles of Extracellular Vesicles in Opioid Addiction: Potential Applications

  Sydney Wheeler, Katherine Odegaard, and Sowmya V. Yelamanchili

  Extracellular Vesicles (EVs) are lipid-bilayer membranous vesicles that facilitate intercellular communication via their secretion. EVs contain a variety of cargoes that reflect the intracellular environment of their host cells, and these cargoes can induce functional changes in recipient cells. A wide body of previous research has demonstrated that EVs play a role in a diverse range of disease pathologies as well as regular function and have emerged as promising vehicles for therapeutics and drug-delivery systems. Unsurprisingly, some work has recently been published implicating EVs in drug addiction pathways and therapeutics. Given the pressing scope of the opioid misuse and abuse in the U.S., it is necessary to consider the role of EVs in the development of opioid dependence and tolerance, as well as their role in potential therapeutics. The current review seeks to identify work investigating the role of EVs in opioid addiction and identify gaps and future directions in the literature.

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  Quantifying Breast Milk Retinol Inadequacy and the Impact on Neonatal Outcomes in a Midwestern United States Population of Postpartum Women

  Julia Wickman, Allison Zetterman, Lauren Wegner, Jaden Hattery, Rebecca Slotkowski, Matthew VanOrmer, Melissa Thoene, Maranda Thompson, Corrine Hanson, and Ann Anderson-Berry

  Background: Low serum antioxidant concentrations at birth can lead to oxidative stress, bronchopulmonary dysplasia, retinopathy, and necrotizing colitis in infants. Specifically, low retinol (Vitamin A1) levels can cause night blindness and impaired immune system function. Retinol inadequacy is a well-documented nutritional issue in developing countries. According to World Health Organization survey data, low Vitamin A serum levels (less than 300 mcg/L) impact approximately one third of pre-school aged children and more than 15% of pregnant woman in at-risk populations. However, there is a lack of understanding about the prevalence of breast milk retinol inadequacy in developed countries. For vitamin A deficiency to constitute a moderate public health problem by WHO biochemical standards, population retinol must reach between 10-25% for breast milk inadequacy or 10-20% for maternal serum deficiency. Objective: The purpose of this study is to quantify the prevalence of breast milk retinol adequacy (greater than 300 mcg/L), insufficiency (between 200 – 300 mcg/L) and deficiency (less than 200 mcg/L) in a Midwestern United States population of postpartum women. A secondary aim is to identify the relationship amongst breast milk retinol concentrations and birth outcomes. Experimental Design: An IRB approved study enrolled 24 infant-mother pairs. Data analysis was performed on subjects with breast milk nutrient analyses available. Descriptive statistics were run for all variables, including maternal retinol activity equivalents. Spearman correlation coefficients were used to assess the relationship between maternal blood retinol and breast milk retinol, cord blood retinol and breast milk retinol, and breast milk retinol and birth outcomes. Median corrected gestational age statistics and breast milk retinol levels were compared amongst maternal serum retinol groups. Results: In our population of postpartum mothers, only 56% of participants had breast milk retinol adequacy, with 36.4% of participants achieving maternal serum retinol adequacy. Retinol category results are summed up in Table 1. Median maternal retinol activity equivalents was 1740 mcg/L (range=651mcg/L - 3436mcg/L). There was no significant correlation between maternal serum retinol level and breast milk retinol levels (R=0.24, p=0.915). Additionally, there was no significant correlation between maternal retinol activity equivalents and maternal serum retinol level (R=.008, p=0.973) or breast milk retinol level (R=-.192, p=0.381). There was a significant negative correlation between breast milk retinol level and the number of oxygen therapy days during infant admission (R=-0.483, p=0.017).

  Conclusion: Based on these results, breast milk and maternal serum retinol inadequacies may constitute a serious and moderate public health problem, respectively, for postpartum mothers in the Midwestern United States. These results suggest that breast milk retinol adequacy promotes healthy lung development in neonates. Further, breast milk retinol levels may be independent of maternal serum retinol levels and maternal retinol activity equivalents. Limitations of this study include a small sample size of mothers whose preterm skewed infants were all admitted to the NICU. Future studies should focus on replicating these results with a larger heterogenous sample size.

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  Comparing Intrauterine Transfer Rates and Maternal Plasma Levels of Carotenoids In Maternal-Infant Pairs Between Gestational Age Groups

  Allison Zetterman, Jaden Hattery, Lauren Wegner, Julia Wickman, Rebecca Slotkowski, Melissa K. Thoene, Matthew Van Ormer, Maranda Thompson, Corrine K. Hanson, and Ann Anderson-Berry

  Background: Carotenoids are recognized as potential antioxidants with a wide range of functions in humans, such as protecting eye health. Carotenoid levels in infant cord blood are generally lower than in maternal serum. Still, little research has assessed on the intrauterine transfer rate of carotenoids between mothers and infants at varying gestational ages.

  Objective: This study aimed to identify differences in intrauterine transfer rates of carotenoids between five gestational age groups.

  Experimental Design: An IRB-approved study enrolled 308 maternal-infant pairs at delivery. Gestational age was categorized into five groups: extremely preterm (<28 >weeks), very preterm (28 to <32 >weeks), moderately to late preterm (32 to <37 >weeks), early term (37 to <39 >weeks), and term (>39 weeks). Maternal blood and umbilical cord samples were collected at birth and analyzed for carotenoid nutrient levels using high-performance liquid chromatography. Demographic and clinical outcome data were collected from the electronic health record. Intrauterine transfer rates were calculated as [(umbilical cord blood nutrient level/maternal serum level)*100]. Descriptive statistics were generated. The Kruskal-Wallis test was used to compare the intrauterine transfer rates of carotenoids between the gestational age groups. Post-hoc pairwise comparisons were used to assess specific inter-group differences. A p-value of <0.05 was considered significant.

  Results: Median birth gestational age was 39 2/7 weeks with 3 (1%) infants in the extremely preterm group, 9 (2.9%) in very preterm, 33 (10.7%) in moderately to late preterm, 70 (22.7%) in early term, and 193 (62.7%) born term. There was a significant difference in intrauterine transfer rate between gestational age groups for lutein + zeaxanthin (L+Z), a-carotene, and total B-carotene (Table 1). Post-hoc pairwise comparisons showed significant differences between term and moderately preterm for L+Z (p=0.016), term and extremely preterm for L+Z (p=0.041), and term and moderately preterm for a-carotene (p=0.003).

  Table 1. Comparison of Median Intrauterine Transfer Rates in Maternal-Infant Pairs Between Gestational Age Groups Transfer Rate p-value between all groups lutein + zeaxanthin 15.6% 0.001 total lycopene 4.4% 0.070 β-cryptoxanthin 11.0% 0.112 ⍺-carotene 8.6% 0.03 β-carotene 6.1% 0.037

  Conclusion: There may be a relationship between intrauterine transfer rates of carotenoids and gestational age groups. Further research is needed to fully understand the clinical significance of this observed relationship and ascertain what interventions, if any, are ideal for maternal-fetal health. This study is limited by the low number of participants in the extremely preterm and very preterm groups.