Greywater use in Israel and worldwide: standards and prospects

Water shortage around the world enhanced the search for alternative sources. Greywater (GW) can serve as a solution for water demands especially in arid and semi-arid zones. However, issues considered which include acceptability of GW segregation as a separate water treated stream, allowing its use onsite. Consequently, it is the one of next forthcoming water resources that will be used, primarily in the growing mega-cities. It will be even more rentable when combined with the roof runoff water harvesting and condensing water from air-conditioning systems. Reuse of GW is as well beneficial in the mega-cities subject to the high expenses associated with wastewater and fresh water conveyance in the opposite direction. The main problem associated with GW reuse is the quality of the water and the targeted reuse options. At least two main options can be identified: the public sector that is ready to reuse the GW and the private sector which raises extra issues related to the reuse risks. These risk stems from the on yard use of GW, relatively close to the household location. The main focus of the Israeli guidelines for GW use is on the private and single house. The problem is less rigorous in public facilities, where the amounts are relatively large and the raw GW is relatively diluted. The two main principles adopted for reuse are: (i) greywater can be minimally treated since it differs from the black wastes, and; (ii) no contact exists with the resident around. The aggravated standards are an indication of the sensitivity issues related to the problem.

Modeling Selective Local Interactions with Memory: Motion on a 2D Lattice

We consider a system of particles that simultaneously move on a two-dimensional periodic lattice at discrete times steps. Particles remember their last direction of movement and may either choose to continue moving in this direction, remain stationary, or move toward one of their neighbors. The form of motion is chosen based on predetermined stationary probabilities. Simulations of this model reveal a connection between these probabilities and the emerging patterns and size of aggregates. In addition, we develop a reaction diffusion master equation from which we derive a system of ODEs describing the dynamics of the particles on the lattice. Simulations demonstrate that solutions of the ODEs may replicate the aggregation patterns produced by the stochastic particle model. We investigate conditions on the parameters that influence the locations at which particles prefer to aggregate. This work is a two-dimensional generalization of [Galante & Levy, Physica D, http://dx.doi.org/10.1016/j.physd.2012.10.010], in which the corresponding one-dimensional problem was studied.

Human melanoma metastasis in NSG mice correlates with clinical outcome in patients

Studies of human cancer metastasis have been limited by a lack of experimental assays in which cancer cells from patients metastasize in vivo in a way that correlates with clinical outcome. This makes it impossible to study intrinsic differences in the metastatic properties of cancers from different patients. We recently developed an assay in which human melanomas readily engraft in nonobese diabetic/severe combined immunodeficient interleukin-2 receptor-γ chain null (NSG) mice. We show that melanomas from 25 patients exhibited reproducible differences in the rate of spontaneous metastasis after transplantation into NSG mice and that these differences correlated with clinical outcome in the patients. Stage IIIB/C melanomas that formed distant metastases within 22 months in patients also formed tumors that metastasized widely in NSG mice, whereas stage IIIB/C melanomas that did not form distant metastases within 22 to 50 months in patients metastasized more slowly in NSG mice. These differences in the efficiency of metastasis correlated with the presence of circulating melanoma cells in the blood of NSG mice, suggesting that the rate of entry into the blood is one factor that limits the rate of metastasis. The study of NSG mice can therefore yield information about the metastasis of human melanomas in vivo, in this case revealing intrinsic differences among stage III melanomas in their ability to circulate/survive in the blood and to metastasize.

Using peer-assisted learning to teach basic surgical skills: medical students' experiences

Standard medical curricula in the United Kingdom (UK) typically provide basic surgical-skills teaching before medical students are introduced into the clinical environment. However, these sessions are often led by clinical teaching fellows and/or consultants. Depending on the roles undertaken (e.g., session organizers, peer tutors), a peer-assisted learning (PAL) approach may afford many benefits to teaching surgical skills. At the University of Keele's School of Medicine, informal PAL is used by the Surgical Society to teach basic surgical skills to pre-clinical students. As medical students who assumed different roles within this peer-assisted model, we present our experiences and discuss the possible implications of incorporating such sessions into UK medical curricula. Our anecdotal evidence suggests that a combination of PAL sessions--used as an adjunct to faculty-led sessions--may provide optimal learning opportunities in delivering a basic surgical skills session for pre-clinical students.

Use of heparin in aortic dissection: beware the misdiagnosis of acute pulmonary embolism

We present a case which highlights the diagnostic difficulties between a Stanford type A aortic dissection (AD) and a pulmonary embolism (PE) and the impact it has on subsequent management. A 75-year-old man presenting with chest pain, shortness of breath and dizziness was initially suspected of having a PE and started on low-molecular-weight-heparin (LMWH). The patient was correctly diagnosed afterwards with CT of the chest to have an aortic dissection. The detrimental use of LMWH may have caused a propagation of the dissection and delayed surgical intervention of an acutely life-threatening condition. When the diagnosis is unclear, the early use of CT can help differentiate AD from PE. This in-turn can guide the management as well as the use of LMWH, which should be avoided until the correct diagnosis is confirmed.

Patterns of Aedes aegypti (Diptera: Culicidae) infestation and container productivity measured using pupal and Stegomyia indices in northern Argentina

A citywide control program of Aedes aegypti (L.) (Diptera: Culicidae) mainly based on the use of larvicides reduced infestations but failed to achieve the desired target levels in Clorinda, northeastern Argentina, over 5 yr of interventions. To understand the underlying causes of persistent infestations and to develop new control tactics adapted to the local context, we conducted two pupal surveys in a large neighborhood with approximately 2,500 houses and recorded several variables for every container inspected in fall and spring 2007. In total, 4,076 lots and 4,267 containers were inspected over both surveys, and 8,391 Ae. aegypti pupae were collected. Large tanks used for potable water storage were the most abundant and the most productive type of container, accounting for 65-84% of all the pupae collected. Therefore, large tanks were key containers and candidates for improved targeted interventions. Multivariate analysis showed that containers located in the yard, at low sun exposure, unlidded, filled with rain water, and holding polluted water were all more likely to be infested by larvae or pupae. When only infested containers were considered, productivity of pupae was most closely associated with large tanks and rain water. A stochastic simulation model was developed to calculate the expected correlations between pupal and Stegomyia indices according to the characteristics of the distribution of larvae and pupae per container and the spatial scale at which the indices were computed. The correlation between pupal and Stegomyia indices is expected to increase as infestation levels decline.

Breast cancer treatment in clinical practice compared to best evidence and practice guidelines

There is sparse evidence on community practice patterns in treating women with breast cancer. This study compared care of women with breast cancer with evidence from meta-analyses and US National Comprehensive Cancer Network (NCCN) clinical guidelines. Records of 4395 women with breast cancer were abstracted from practices of 19 surgeon oncologists in six specialty practices in the Philadelphia region during 1995–1999. Patients were followed through December 2001. Low-frequency data were obtained on all patients. All other data were from a random sample of 464 women, minimum of 50 patients per practice. Actual care provided was compared to NCCN guidelines and results of meta-analyses. Fewer than half the women received treatments reflecting meta-analysis results or NCCN guidelines, by disease stage/TNM status. Adherence to either standard varied from 0% for LCIS to 87% for stages IIA or IIB node positive. There are multiple interactive reasons for low adherence to guidelines or meta-analyses results, including insufficient health system supports to clinicians, inadequate organisation and delivery systems and ineffective continuing medical education. The paucity of written information from patient records on physician/patient interactions limits the understanding of treatment decisions.

Extensive structure-activity studies of lactam derivatives of MT-II and SHU-9119: their activity and selectivity at human melanocortin receptors 3, 4, and 5

The melanocortin system is involved in the regulation of several diverse physiologic pathways. Recently we have demonstrated that replacing His6 by Pro6 in the well-known antagonist SHU-9119 resulted in a potent agonist at the hMC5R (EC50 = 0.072 nm) with full antagonist activity at the hMC3R and the hMC4R. We have designed, synthesized, and pharmacologically characterized a series of peptide analogs of MT-II and SHU-9119 at the human melanocortin receptors MC3R, MC4R and MC5R. All these peptides were modified at position 6 with a Pro instead of a His residue. In this study, we have identified new scaffolds which are antagonists at the hMC4R and hMC3R. Additionally, we have discovered a new selective agonist at the hMC4R, Ac-Nle-c[Asp-Pro-D-Phe-Arg-Trp-Lys]-Pro-Val-NH2 (6, PG-931) which will be useful in further biologic investigations of the hMC4R. PG-931 was about 100-fold more selective for the hMC4R vs. the hMC3R (IC50 = 0.58 and 55 nm, respectively). Some of these new analogs have exceptional biologic potencies at the hMC5R and will be useful in further efforts to differentiate the substructural features responsible for selectivity at the hMC3R, hMC4R, and hMC5R.

Synthesis and biological evaluation on hMC3, hMC4 and hMC5 receptors of gamma-MSH analogs substituted with L-alanine

To elucidate the molecular basis of the interaction of the native dodecapeptide gamma-MSH with the melanocortin receptors, we performed a structure-activity study in which we systematically replaced l-Ala in each position of this peptide. Here we report the binding affinity and agonist potency on human MC3R, MC4R and MC5R. Intracellular cAMP concentration was measured on CHO cells, and binding assays were carried out using membranes prepared from these cell lines which stably express hMC3R, hMC4R and hMC5R. Our results indicate that the last four amino acids in the C-terminal region of gamma-MSH are not important determinants of biological activity and selectivity at human melanocortin receptors. Interesting results were obtained when l-Ala was substituted for His6, Phe7, Arg8 and Trp9. For these peptides, the affinity and activity at all three human receptors (MC3R, MC4R and MC5R) decreased significantly, demonstrating that the His-Phe-Arg-Trp sequence in gamma-MSH is important for activity at these three melanocortin receptors. Similar results were obtained when Met3 was replaced with l-Ala, suggesting the importance of this position in the interaction with all three receptors. This study highlights the role played by the His-Phe-Arg-Trp sequence in receptor binding and in agonist activity of gamma-MSH.

Complete diagnostic evaluation in colorectal cancer screening: research design and baseline findings

BACKGROUND

While indicated by guidelines, complete diagnostic evaluation, or CDE (i.e., colonoscopy or combined flexible sigmoidoscopy plus barium enema X ray), is often not recommended and performed for persons with an abnormal screening fecal occult blood test (FOBT) result. We initiated a randomized trial to assess the impact of a physician-oriented intervention on CDE rates in primary care practices.

METHODS

In 1998, we identified 1,184 primary care physicians (PCPs) in 584 practices whose patients received FOBTs that are mailed annually by a managed care organization screening program. A total of 470 PCPs in 318 practices completed a baseline survey. Practices were randomly assigned either to a Control Group (N = 198) or to an Intervention Group (N = 120). Control Group practices received the screening program. Intervention Group practices received the screening program and the intervention (i.e., CDE reminder-feedback plus educational outreach). Practice CDE recommendation and performance rates are the primary outcomes to be measured in the study.

RESULTS

Baseline CDE recommendation and performance rates were low and were comparable in Control and Intervention Group practices (54 to 57% and 39 to 40%, respectively). PCPs in the practices tended to view FOBT screening and CDE favorably, but had concerns about screening efficacy, time involved in CDE, and patient discomfort and adherence. Control Group physicians were more likely than Intervention Group physicians to believe that a mail-out FOBT screening program helps in the practice of medicine.

CONCLUSIONS

We were able to enroll a high proportion of targeted primary care practices, measure practice characteristics and CDE rates at baseline, and develop and implement the intervention. Study outcome analyses will take into account baseline differences in practice characteristics.

Ectopic expression of guanylyl cyclase C in CD34+ progenitor cells in peripheral blood

PURPOSE

To examine the utility of guanylyl cyclase C (GC-C)-specific nested reverse transcriptase polymerase chain reaction (RT-PCR) to detect circulating tumor cells in patients with colorectal cancer.

PATIENTS AND METHODS

Peripheral-blood mononuclear cells from 24 patients with Dukes' stage D colorectal cancer were analyzed by GC-C-specific nested RT-PCR using 1 microg of total RNA. Peripheral-blood mononuclear cells from 20 healthy volunteers served as controls. Additionally, peripheral-blood CD34+ progenitor cells were assayed for the expression of both GC-C and other epithelial cell-specific markers.

RESULTS

GC-C mRNA was detected in blood mononuclear cells from all 24 patients with colorectal cancer and all healthy volunteers. These unexpected positive results reflected low-level ectopic transcription of GC-C in CD34+ progenitor cells. Moreover, CD34+ progenitor cells expressed other epithelial cell-specific markers, including prostate-specific antigen, prostate-specific membrane antigen, carcinoembryonic antigen, CK-19, CK-20, mucin 1, and GA733.2. Limiting the quantity of mononuclear cell total RNA analyzed to < or = 0.8 microg eliminated detection of GC-C and other tissue-specific transcripts in blood of healthy volunteers. However, under the same conditions, GC-C mRNA was detected in mononuclear cells from all 24 patients with metastatic colorectal cancer. Using 0.5 microg of total RNA and GC-C-specific primers, nested RT-PCR detected a single human colon carcinoma cell (approximately 20 to 200 GC-C transcripts/cell) in 10(6) to 10(7) mononuclear blood cells.

CONCLUSION

These data suggest that GC-C may be useful for detecting circulating colorectal cancer cells. They also demonstrate that CD34+ cells are a source of ectopically expressed epithelial cell-specific markers and that CD34+ cells may contribute to the high false-positive rate generally observed when those markers are used to detect rare circulating metastatic cancer cells by RT-PCR.

D-Amino acid scan of gamma-melanocyte-stimulating hormone: importance of Trp(8) on human MC3 receptor selectivity

In our search for potent and receptor-selective agonists and antagonists, we report here the results of D-amino acid substitution at each position of the short peptide gamma-melanocyte-stimulating hormone (gamma-MSH). The native gamma-MSH shows weak binding at all three receptors (i.e., the human MC3, MC4, and MC5) and a selectivity of 1-2 orders of magnitude at the MC3R over the MC4R and MC5R. Sequential replacement of each residue in the gamma-MSH sequence with the corresponding D-isomer results in analogues which mostly have weaker binding affinity than the native peptide, except for two analogues. For the DTrp(8) analogue, there is an increase in binding affinity by about 1 order of magnitude (IC(50) = 6 nM) at the MC3R compared with that of the natural molecule and an increase in selectivity for the MC3R by 2 orders of magnitude compared with the activity at the MC4R and MC5R. The DPhe(6) analogue is about 10-fold more potent (IC(50) = 8.8 nM) at the MC3R compared with the native peptide but lacks subtype selectivity. Measurement of the intracellular cAMP accumulation in human MC3R, MC4R, and MC5R revealed that the native peptide shows potent activity at the MC3R (EC(50) = 5.9 nM) and is about 50-100-fold selective at this receptor compared with the MC4R and MC5R. The DArg(10) (EC(50) = 35 nM) and DPhe(11) (EC(50) = 11 nM) analogues are selective for the MC3R by 1 and 2 orders of magnitude compared with the MC4R and MC5R, respectively. The DTrp(8) compound (EC(50) = 0.33 nM) shows about 300- and 250-fold increase in selectivity at the MC3R compared with the MC4R and MC5R, respectively. Finally, the DTyr(1) peptide is selective for the MC3R (EC(50) = 12 nM) by 40-200-fold compared with the MC4R and MC5R. In general, the trend is that D-amino acid substitutions of the aromatic residues 1, 6, 8, and 11 and the basic residue Arg(10), but not Arg(7), result in an increase in MC3R selectivity over the MC4R and MC5R and only agonist activity is observed. Thus, the key residues of gamma-MSH identified in this study include the aromatic residues 1, 6, 8, and 11 and the basic residue Arg(10) (but not Arg(7)), as important for MC3 selectivity over the MC4 and MC5 subtypes. Further, the study reveals the extreme importance of DTrp at position 8 in imparting potency and selectivity since this is the most selective analogue for the human MC3R reported thus far.

Colorectal cancer staging and adjuvant chemotherapy

Colorectal cancer is a significant cause of morbidity and mortality in Western populations. The standard of care for staging patients with colorectal cancer to determine prognosis and identify patients who will receive adjuvant therapy continues to be histopathology of regional lymph nodes. However, the significant variability in survival within each staging category likely reflects the heterogeneity of detecting micrometastatic disease employing this technique. Novel molecular markers of micrometastases currently in development will permit more accurate staging of patients with colorectal cancer. These advances in staging will distinguish patients who will maximally benefit from adjuvant therapy from those who have an especially good prognosis in whom chemotherapy can be avoided. In addition, new adjuvant chemotherapeutic agents, novel combinations of those agents and creative dosing schedules currently being investigated will offer considerable advantages with respect to ease of administration, safety and tolerability, quality of life and efficacy. Ultimately, it is anticipated that advances in molecular diagnostics will define unique biochemical characteristics of patients' tumours, permitting individualization of chemotherapeutic regimens employing novel agents that specifically exploit those characteristics.