Titanium elastic nailing in femoral diaphyseal fractures in children of 6-14 years age

BACKGROUND

Traditionally conservative methods were used in managing paediatric femoral diaphyseal fractures. There has been a renewed interest for operative treatment with Titanium elastic nail system (TENS) in the age group of 6-14 years.

MATERIALS AND METHODS

This prospective study was done on 20 patients. Two titanium nails were used for stabilization. We followed them for maximum of two years. The results were evaluated using Flynn's scoring criteria.

RESULTS

In our study we had fifteen males and five females with average age 10.35 years. Average time for fracture union was 9.0 weeks, full weight bearing 9.2 weeks, hospital stay 8.6 days and return to school at 10 weeks. The results were excellent in 14, good in 5 and poor in 1 patient. Most common complication was irritation at nail entry site. No delayed union or nonunion seen.

CONCLUSION

Treatment of diaphyseal femoral fracture in selected pediatric patients by TENS is reasonably effective.

Abstract P6-13-16: Ropidoxuridine (IPdR) potentiates alisertib (MLN8237) activity in triple-negative breast cancer

Introduction and Background: An estimated 234,190 new cases of invasive breast cancer will be diagnosed in 2015 with 40,730 deaths (American Cancer Society, 2015). Triple-negative breast cancer (TNBC) has an overall poor prognosis due to aggressive and early pattern of metastasis and a relative lack of therapeutic targets. Chemotherapy remains the cornerstone of treatment albeit with a dismal response rate (∼25%) to monotherapy. Synergism between two drugs could provide a key advance to enhance effectiveness, decrease resistance and reduce toxicities. Here we focused on discovery of synergism of antiproliferative agents given TNBC is highly proliferative.

Experimental Methods: We assembled a library of antiproliferative agents with unique mechanisms and targets that have subtly different effects on cancer cell proliferation. We performed a novel synergy screen testing 105 unique two-drug combinations in MDA-MB-231 TNBC cells. Our screen was designed to distinguish between synergism and additivity through presence of an internal control and performed in sufficient replicates to identify changes in viability exceeding 5%. We validated hits through Chou Talalay Combination Index (CI), xenograft and mechanistic analyses.

Results: We discovered strong synergy between Ropidoxuridine (IPdR) and Alisertib (MLN8237). Ropidoxuridine is an orally bioavailable pro-drug of IUdR (5-iodo-2'-deoxyuridine), with an improved therapeutic index and with promising activity as a radiosensitizer, although it lacks single agent activity. Alisertib is an inhibitor of Aurora A kinase and acts by impairing assembly of a bipolar mitotic spindle, thereby activating the spindle assembly checkpoint leading to cancer cell death. Alisertib has demonstrated activity in breast cancer with a response rate of 18% in heavily pretreated patients (Melichar B et.al. Lancet Oncol 16:395-405, 2015). First, Ropidoxuridine and Alisertib combination was validated in cell culture using CI analysis with a mean CI of 0.14; range 0.01-0.67 suggesting strong synergism. A separately performed Live Dead Cell Assay also confirmed synergism (mean CI of 0.79; range: 0.53-1.76) suggesting enhanced anti-proliferative activity of Alisertib in presence of Ropidoxuridine. To assess generalizability, this combination was validated in two other TNBC cell lines, MDA-MB-468 and CAL-51. To confirm our hypothesis that in vitro activity of Ropidoxuridine is from its metabolism to IUdR in cancer cells, we demonstrated strong synergy of IUdR and Alisertib (mean CI of 0.12; range 0.01-0.74) at clinically relevant concentrations. To validate synergy in an orthotopic tumor model, Ropidoxuridine and Alisertib single agents and in combination were tested in mice treated with Ropidoxuridine (750 mg/kg/day) and Alisertib (30 mg/kg/day) by gavage. This in vivo model also demonstrated strong synergism. Mechanistically, Ropidoxuridine and IUdR enhance G2/M arrest in response to Alisertib, allowing low dose exposures of Alisertib to be effective.

Conclusions and Future Directions: This study identifies and validates a novel synergy between Ropidoxuridine and Alisertib with a potential for significant clinical implications. We propose evaluating this synergistic drug combination in an early phase clinical trial.

Citation Format: Rampurwala MM, Choudhary A, Burkard ME. Ropidoxuridine (IPdR) potentiates alisertib (MLN8237) activity in triple-negative breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-13-16.

Comparison of conventional, immunological and molecular techniques for the diagnosis of symptomatic congenital human cytomegalovirus infection in neonates and infants

PURPOSE

Human cytomegalovirus (HCMV) is the commonest pathogen causing congenital infection globally. The diagnosis of congenital infection is based either on viral isolation (in cell culture) or demonstration of HCMV DNA from the urine. Saliva is also being used as an alternative sample to urine for the same. The objective of this study was to compare the following assays-polymerase chain reaction (PCR) from urine, saliva and blood, serology (anti-HCMV IgM) and antigen detection (HCMV pp65 antigenaemia) for the diagnosis of congenital HCMV infection.

MATERIALS AND METHODS

Urine and blood samples were collected from 31 infants (median age: 13 weeks) with suspected HCMV infection. For 18 infants, additional saliva samples were collected and all the above assays were compared.

RESULTS

PCR for HCMV DNA from urine and anti-HCMV IgM were performed for all 31 infants. Of these, 22 (70.9%) were positive for both assays. In 18 (of the 22) infants positive by both assays, PCR for HCMV DNA from saliva was positive in all 18 (100%), PCR from blood in 7/18 (38.8%) and HCMV pp65 antigenaemia only in 1/18 (5.5%) of the infants.

CONCLUSION

Detection of HCMV DNA in urine combined with anti-HCMV IgM are suitable assays to diagnose HCMV infection in infants. Both PCR from the blood and HCMV pp65 antigenaemia lack sensitivity in infants. Salivary PCR combines convenience with high sensitivity and can substitute PCR from urine, especially in the outpatient and field settings. To the best of our knowledge, this is the first study from India to evaluate salivary PCR for the diagnosis of congenital HCMV infection.

Implementation of the INTERGROWTH-21st Project in India

The South Asian site in the INTERGROWTH-21(st) Project was the city of Nagpur, in Maharashtra State, India, with approximately 4500 births per year among the target population with middle to high socio-economic status. These deliveries are mainly concentrated in 20 small private hospitals, most of which are in the city centre. The sample for the Newborn Cross-Sectional Study (NCSS) was drawn from ten of these hospitals, covering 76% of the target low-risk pregnant population. The Fetal Growth Longitudinal Study (FGLS) sample was recruited from the largest of these institutions, Ketkar Hospital, as well as several ancillary antenatal care clinics. Special activities to encourage participation and raise awareness of the study at this site included translating patient information leaflets into local languages and securing local media interest. Among the unique challenges of the Indian site was the coordination of the large number of hospitals involved in NCSS, a task that required careful planning and organisation by the field teams.

Serological & molecular approaches for diagnosis of leptospirosis in a tertiary care hospital in north India: a 10-year study

BACKGROUND & OBJECTIVES

Leptospirosis, a spirochetal zoonosis, is underreported from the northern States of India. This study reports results of a 10-year retrospective sero-epidemiological survey of leptospirosis conducted in a tertiary care hospital in New Delhi, India.

METHOD

A total of 1453 patients clinically suspected for leptospirosis were included and investigated initially by IgM ELISA. A proportion of these were subjected to culture, microscopic agglutination test (MAT) and polymerase chain reaction (PCR).

RESULTS

Of the 1453 patients, 391 (26.90%) were positive serologically by IgM ELISA. Seropositive and seronegative patients revealed no significant difference in clinical features and laboratory parameters. Amongst the IgM seropositive cases, culture for leptospires was positive in 5 of 192 (2.6%), MAT in 50 of 138 (36.23%), PCR from blood and urine in 10 of 115 (8.7%) and 10 of 38 (26.31%) cases, respectively. In Leptospira spp. positive patients co-infections with viral hepatitis E, malaria and dengue fever were diagnosed in 27 cases.

INTERPRETATION & CONCLUSIONS

The overall seropositivity for leptospirosis was 26.9 per cent in our study. A decreasing trend in seropositivity was observed in recent years. Co-infections with malaria, dengue, hepatitis A and E were also seen. Since leptospirosis is a treatable disease, correct and rapid diagnosis may help in effective management of patients.

Diode-pumped femtosecond solid-state waveguide laser with a 4.9 GHz pulse repetition rate

We report on the first demonstration of a passively mode-locked, diode-pumped, monolithic Yb:glass channel waveguide laser that incorporates a semiconductor saturable absorber mirror. Stable and self-starting mode-locking is achieved in a Fabry-Perot cavity configuration producing a pulse repetition rate up to 4.9 GHz. The shortest pulse duration of 740 fs is generated with 30 mW of average output power at a center wavelength of 1058 nm. A maximum output power of 81 mW is produced during mode-locking with corresponding pulse duration of 800 fs.

Serum hepatitis B surface antigen levels correlate with high serum HBV DNA levels in patients with chronic hepatitis B: a cross-sectional study

PURPOSE

The hallmark of chronic hepatitis B (CHB) infection is the presence of hepatitis B surface antigen (HBsAg) positivity for at least 6 months. Recently, serum levels of HBsAg have been compared with serum HBV DNA as a surrogate marker to monitor CHB patients. However, data correlating these two markers are scarce. Hence, the present study was done to correlate HBV DNA with HBsAg in CHB patients.

MATERIALS AND METHODS

Consecutive patients of CHB were included. HBV DNA was measured by real-time polymerase chain reaction (PCR). Serum HBsAg was measured by Architect HBsAg.

RESULTS

Of the 198 patients enrolled, 166 fulfilled the inclusion criteria (mean age 43 ± 14 years, 87% males) and the median HBV DNA was 1.7 × 10 3 (range 6.0-1.1 × 10 8 ) IU/ml. Median HBsAg was 8.7 × 10 3 (range 5.0-3.2 × 10 5) IU/ml. Overall correlation between HBV DNA and HBsAg was weak but significant (Spearman ρ = 0.443, P < 0.01). Correlation in HBe antigen-positive group was better (ρ = 0.402, P < 0.01) in comparison to HBe antigen-negative group (ρ = 0.193 P = 0.05). Good correlation existed in treatment-naïve group (ρ = 0.538, P < 0.01) .Correlation was regardless of normal or raised alanine transaminase (ALT). Eighty (48%) patients had high HBV DNA (≥ 2000 IU/ml). Correlation in high DNA group was significant (P < 0.01). The best cut-off of HBsAg for diagnosing high DNA is 3.36 ×10 3 IU/ml.

CONCLUSIONS

Serum HBsAg correlates with HBV DNA in CHB patients, especially in high serum HBV DNA, HBe antigen-positive and treatment-naïve group. HBsAg levels can be used for predicting high serum HBV DNA levels.

Anisotropic behavior of water in ferroelectric liquid crystals

The outcome of water addition in ferroelectric liquid crystal (FLC) has been investigated in uniform and defect-free homogeneous and homeotropically aligned monodomain sample cells from electro-optical and dielectric spectroscopic measurements. The lagging in optical response between nonconducting (spatially variable switching) and conducting (conventional switching) portions of water added FLC sample cell has been observed by frequency-dependent electro-optical studies. The bias-dependent water related new relaxation peak near the conventional Goldstone mode relaxation process has been observed only in the homogeneous alignment and not in the homeotropic one. Further, the significant increment in dielectric anisotropy as well as faster diffusion of water along long molecular axis than short molecular axis has also been monitored. These studies strongly suggest that the distribution of water is anisotropic in FLC medium and could be the reason for new relaxation peak in the water added FLC sample.

Effect of carbon nanotubes on response time of ferroelectric liquid crystals

We present the results of the fast electro-optic response of multiwalled carbon nanotubes (MWCNTs)-doped deformed helix ferroelectric liquid crystal (DHFLC). The fastening of the response in MWCNTs-doped DHFLC has been attributed to the decrease in rotational viscosity and increase in anchoring energy. The decrease in the former is due to the experience of the torque both by MWCNTs and DHFLC and perturbation of order parameter of the DHFLC while the increase in the latter is due to the pi-pi electrons stacking between the MWCNTs, DHFLC molecules, and alignment layers. The increase in conductance in doped cells has also been observed.

Variable stiffness colonoscope versus regular adult colonoscope: meta-analysis of randomized controlled trials

BACKGROUND AND STUDY AIMS

The variable stiffness colonoscope (VSC) may have theoretical advantages over standard adult colonoscopes (SACs), though data are conflicting. We conducted a meta-analysis to compare the efficacies of the VSC and SAC.

STUDY DESIGN

We searched Medline (1966 - 2008) and abstracts of gastroenterology scientific meetings in the 5 years to February 2008, only for randomized clinical trials (RCTs) of adult patients. Trial quality was assessed using the Delphi list. In a meta-analysis with a fixed effects model, cecal intubation rates, cecal intubation times, abdominal pain scores, sedation used, and use of ancillary maneuvers, were compared in separate analyses, using weighted mean differences (WMDs), standardized mean differences (SMDs), or odds ratios (ORs).

RESULTS

Seven RCTs satisfied the inclusion criteria (1923 patients), four comparing VSC with SAC procedures in adults, and three evaluating the pediatric VSC. There was no significant heterogeneity among the studies. The overall trial quality was adequate. Cecal intubation rate was higher with the use of VSC (OR = 2.08, 95 % confidence interval [CI] 1.29 to 3.36). The VSC was associated with lower abdominal pain scores and a decreased need for sedation during colonoscopy. Cecal intubation time was similar for the two colonscope types (WMD = - 0.21 minutes, 95 % CI - 0.85 to 0.43). Because of the nature of the intervention no studies were blinded. There was no universal method for using the VSC.

CONCLUSIONS

Compared with the SAC, VSC use was associated with a higher cecal intubation rate, less abdominal pain, and decreased need for sedation. However, cecal intubation times were similar for the two colonoscope types.

Memory effect in weakly anchored surfaces of deformed helix ferroelectric liquid crystals

A wide-range memory effect in deformed helix ferroelectric liquid crystals (DHFLCs) has been investigated by electro-optical and textural methods. A comparative study has been performed on strongly and weakly anchored surfaces of DHFLC cells. The saturation voltage has been compared in both types of cells by studying the variation of tilt angle and spontaneous polarization with applied voltage. The long-lasting memory effect has been observed in untreated (weakly anchored) cells. It has been proposed that perfect memory in DHFLC cells without any surface treatment is due to the possibility of the absence of depolarization and ionic charges over the surfaces of the cells.

Modified laser DCR for paediatric nasolacrimal duct obstruction

AIMS

To evaluate the efficacy, safety, and long-term outcome of modified laser dacryocystorhinostomy (DCR) for primary nasolacrimal duct obstruction, unresponsive to probing.

METHODS

Retrospective, noncomparative case-note review of all paediatric cases operated between September 2000 and November 2003.

PROCEDURE

A fibre optic light, inserted through the canaliculi into the lacrimal sac was visualized endonasally. Nasal mucosa was incised using a keratome and a bony ostium was created with the Holmium : YAG laser. Bicanalicular silicone tubes were inserted.

RESULTS

Five children with a mean follow-up of 25.6 months (range 21-48 months) and a mean age of 7 years were reviewed. Silicone tubes were used in four patients and were removed at a mean 6.5 months (range 3-9 months). One patient developed a mucocele 6 months after the procedure requiring excision of the membrane covering the ostium. There were no other immediate or late postoperative complications. Complete cure of symptoms was achieved in all patients and was maintained at final follow up.

CONCLUSION

Modified paediatric laser DCR appears to be an encouraging technique for primary nasolacrimal duct obstruction unresponsive to probing. This may be attributable to the modification of excision of mucous membrane, which may prevent regrowth.

Influence of electric field on the hydrogen bond network of water

Understanding the inherent response of water to an external electric (E)-field is useful towards decoupling the role of E-field and surface in several practically encountered situations, such as that near an ion, near a charged surface, or within a biological nanopore. While this problem has been studied in some detail through simulations in the past, it has not been very amenable for theoretical analysis owing to the complexities presented by the hydrogen (H) bond interactions in water. It is also difficult to perform experiments with water in externally imposed, high E-fields owing to dielectric breakdown problems; it is hence all the more important that theoretical progress in this area complements the progress achieved through simulations. In an attempt to fill this lacuna, we develop a theory based on relatively simple concepts of reaction equilibria and Boltzmann distribution. The results are discussed in three parts: one pertaining to a comparison of the key features of the theory vis a vis published simulation/experimental results; second pertaining to insights into the H-bond stoichiometry and molecular orientations at different field strengths and temperatures; and the third relating to a surprising but explainable finding that H-bonds can stabilize molecules whose dipoles are oriented perpendicular to the direction of field (in addition to the E-field and H-bonds both stabilizing molecules with dipoles aligned in the direction of the field).