CDK4 in lung, and head and neck cancers in old age: evaluation as a biomarker

BACKGROUND

Cyclin dependent kinases (CDK) are key factors in promoting the initiation and development of tumors. These kinases are important for maintenance of mitochondrial biogenesis and imbalance in their expression in old age may lead to the oxidative stress. Lung cancer (LC), and head and neck squamous cell carcinoma (HNSCC) are two very prominent cancers in older Indians. Both the cancers are showing increasing trend in older population. The present study assessed serum concentration of one of the kinases; CDK4 in older LC and HNSCC patients.

METHODS

The study included 100 subjects each of LC and HNSCC; and older subjects without cancer or any major health problems as controls. Serum CDK4 concentration was estimated using real-time label-free Surface plasmon resonance (SPR) and was verified by western blot.

RESULTS

Significant elevation in serum CDK4 was observed in cases with LC and HNSCC compared to controls. HNSCC patients with higher CDK4 expression had distinctly shorter survival than patients with comparatively lower CDK4 expression. No such difference was observed in LC patients. The germ line mutation study of this gene in Exon-2 was performed and none was observed among cases and controls.

CONCLUSION

It can be concluded that older patients with HNSCC and lung cancer have raised serums CDK4 levels, which has the potential to emerge as a biomarker in clinical practice.

Dynamics of cancer progression and suppression: A novel evolutionary game theory based approach

In this paper, a novel mathematical approach is proposed for the dynamics of progression and suppression of cancer. We define mutant cell density, ρ(μ) (μ × ρ), as a primary factor in cancer dynamics, and use logistic growth model and replicator equation for defining the dynamics of total cell density (ρ) and mutant fraction (μ), respectively. Furthermore, in the proposed model, we introduce an analytical expression for a control parameter D (drug), to suppress the proliferation of mutants with extra fitness level σ. Lastly, we present a comparison of the proposed model with some existing models of tumour growth.

Blood transfusion in preterm infants improves intestinal tissue oxygenation without alteration in blood flow

BACKGROUND AND OBJECTIVE

The objective of the study was to investigate the splanchnic blood flow velocity and oximetry response to blood transfusion in preterm infants according to postnatal age.

MATERIALS AND METHODS

Preterm infants receiving blood transfusion were recruited to three groups: 1-7 (group 1; n = 20), 8-28 (group 2; n = 21) and ≥29 days of life (group 3; n = 18). Superior mesenteric artery (SMA) peak systolic (PSV) and diastolic velocities were measured 30-60 min pre- and post-transfusion using Doppler ultrasound scan. Splanchnic tissue haemoglobin index (sTHI), tissue oxygenation index (sTOI) and fractional tissue oxygen extraction (sFTOE) were measured from 15-20 min before to post-transfusion using near-infrared spectroscopy.

RESULTS

The mean pretransfusion Hb in group 1, 2 and 3 was 11, 10 and 9 g/dl, respectively. The mean (SD) pretransfusion SMA PSV in group 1, 2 and 3 was 0·63 (0·32), 0·81 (0·33) and 0·97 (0·40) m/s, respectively, and this did not change significantly following transfusion. The mean (SD) pretransfusion sTOI in group 1, 2 and 3 was 36·7 (19·3), 44·6 (10·4) and 41·3 (10·4)%, respectively. The sTHI and sTOI increased (P < 0·01), and sFTOE decreased (P < 0·01) following transfusion in all groups. On multivariate analysis, changes in SMA PSV and sTOI following blood transfusion were not associated with PDA, feeding, pretransfusion Hb and mean blood pressure.

CONCLUSION

Pretransfusion baseline splanchnic tissue oximetry and blood flow velocity varied with postnatal age. Blood transfusion improved intestinal tissue oxygenation without altering mesenteric blood flow velocity irrespective of postnatal ages.

Molecular signature of extended spectrum β-lactamase producing Klebsiella pneumoniae isolated from bovine milk in eastern and north-eastern India

The present study reports on 23 extended spectrum β-lactamase producing Klebsiella pneumoniae (KP), isolated from milk samples (n=340) of healthy cows (n=129) and cows with subclinical (n=159) and clinical (n=52) mastitis, from three different states of India viz. West Bengal, Jharkhand and Mizoram. Seven of them were AmpC type β-lactamase producers, as well. The ESBL producing KP were significantly (P=0.006, χ2=10.04, df=2) and more frequently detected in milk samples of mastitic cows than healthy ones. The β-lactamase genes - blaCTX-M, blaTEM and blaSHV were detected in 19, 8 and 3 isolates, respectively. In all but one CTX-M positive isolates, the genetic platform - ISEcp1-blaCTX-M-orf477 was detected. Ten of the isolates carried plasmid mediated quinolone resistance gene - qnrS and 1 isolate possessed qnrB. Again 11 of them were found to have sulfonamide resistance gene - sul1 and 12 possessed class I integron. Sequencing of the class 1 integron revealed the presence of dfrA12/dfrA17 and aadA2/aadA5 gene cassettes conferring resistance to trimethoprim and aminoglycosides, respectively. All the isolates, characterized by enterobacterial repetitive intergenic consensus (ERIC) PCR, yielded distinct fingerprinting profile. However, most of the isolates from Jharkhand were clustered along with two isolates each from West Bengal and Mizoram indicating their clonal relatedness even though isolated from geographically different areas. Isolation of ESBL producing KP from bovine milk samples implies its public health significance; as such pathogens may enter the human food chain causing severe health hazards.

Cerebral blood flow and oximetry response to blood transfusion in relation to chronological age in preterm infants

OBJECTIVE

Preterm infants frequently receive blood transfusion (BT) and the aim of this study was to measure the effect of BT on cerebral blood flow and oxygenation in preterm infants in relation to chronological age.

PATIENTS

Preterm infants undergoing intensive care recruited to three chronological age groups: 1 to 7 (Group 1; n=20), 8 to 28 (Group 2; n=21) & ≥29days of life (Group 3; n=18).

METHODS

Pre and post-BT anterior cerebral artery (ACA) time averaged mean velocity (TAMV) and superior vena cava (SVC) flow were measured. Cerebral Tissue Haemoglobin Index (cTHI) and Oxygenation Index (cTOI) were measured from 15-20min before to 15-20min post-BT using NIRS. Vital parameters and blood pressure were measured continuously.

RESULTS

Mean BP increased significantly, and there was no significant change in vital parameters following BT. Pre-BT ACA TAMV was higher in Group 2 and 3 compared to Group 1 (p<0.001). Pre-BT ACA TAMV decreased significantly (p≤0.04) in all 3 groups; pre-BT SVC flow decreased significantly in Group 1 (p=0.03) and Group 3 (p<0.001) following BT. Pre-BT cTOI was significantly lower in Group 3 compared to Group 1 (p=0.02). cTHI (p<0.001) and cTOI (p<0.05) increased significantly post-BT in all three groups. PDA had no effect on these measurements.

CONCLUSION

Baseline cTOI decreases and ACA TAMV increases with increasing chronological age. Blood transfusion increased cTOI and cTHI and decreased ACA TAMV in all groups. PDA had no impact on the baseline cerebral oximetry and blood flow as well as changes following blood transfusion.

Impact Modification of Isotactic Polypropylene with Ethylene-Propylene Diene Monomer Rubber

The present work was done to improve the impact property of isotactic polypropylene (PP), especially at low temperatures, by incorporating ethylene propylene diene monomers (EPDM). This was done by ensuring compatibility between the two polymers with phase modifiers polyethylene grafted with maleic anhydride (PE-g-MA) and initiator dicumyl peroxide (DCP). In addition, attempts were also made to understand the fundamentals of impact toughening as well as fracture toughness, and to correlate the results with that of morphological evidences obtained from scanning electron microscopy (SEM) and X-ray diffraction (XRD) methods. Varying the ratios of all blend composition, mechanical properties were studied. It was observed that as the rubber fraction increased, the impact property as well as fracture toughness increased. All these tests also showed promising results when PE-g-MA was added, leading to more improvement in all the mechanical properties including increase in crystallite size. It had shown plasticization effect on the compositions, which could be further confirmed by differential scanning calorimetry (DSC) compared to the uncompatibilized ones. But when DCP was added, it behaved like an initiator which directly reacted with the PP matrix, decreasing the molecular weight of the blend with decreasing size of the crystallites.

What drives junior doctors to use clinical practice guidelines? A national cross-sectional survey of foundation doctors in England & Wales

BACKGROUND

Clinical practice guidelines (CPGs) aim to improve patient care, but their use remains variable. We explored attitudes that influence CPG use amongst newly qualified doctors.

METHODS

A self-completed, anonymous questionnaire was sent to all Foundation Doctors in England and Wales between December 2012 and May 2013. We included questions designed to measure the 11 domains of the validated Theoretical Domains Framework (TDF). We correlated these responses to questions assessing current and future intention to use CPGs.

RESULTS

A total of 13,138 doctors were invited of which 1693 [corrected] (13 %) responded. 1,035 (62.5 %) reported regular CPG use with 575 (34.4 %) applying CPGs 2-3 times per week. A significant minority of 606 (36.6 %) declared an inability to critically appraise evidence. Despite efforts to design a questionnaire that captured the domains of the TDF, the domain scales created had low internal reliability. Using previously published studies and input from an expert statistical group, an alternative model was sought using exploratory factor analysis. Five alternative domains were identified. These were judged to represent: "confidence", "familiarity", "commitment and duty", "time" and "perceived benefits". Using regression analyses, the first three were noted as consistent predictors of both current and future intentions to use CPGs in decreasing strength order.

CONCLUSIONS

In this large survey of newly qualified doctors, "confidence", "familiarity" and "commitment and duty" were identified as domains that influence use of CPGs in frontline practice. Additionally, a significant minority were not confident in critically appraising evidence. Our findings suggest a number of approaches that may be taken to improve junior doctors' commitment to CPGs through processes that increase their confidence and familiarity in using CPGs. Despite limitations of a self-reported survey and potential non-response bias, these findings are from a large representative sample and a review of existing implementation strategies may be warranted based on these findings.

Effect of malachite green toxicity on non target soil organisms

Although malachite green (MG), is banned in Europe and US for its carcinogenic and teratogenic effect, the dye being cheap, is persistently used in various countries for fish farming, silk, dye, leather and textile industries. Current research, however, fails to elucidate adequate knowledge concerning the effects of MG in our ecosystem. In the present investigation, for the first time, an attempt has been made to study the effects of MG on soil biota by testing Bacillus subtilis, Azotobacter chroococcum, Saccharomyces cerevisiae, Penicillium roqueforti, Eisenia fetida and seeds of three crop plants of different families. Various tests were conducted for determining cytotoxicity, genotoxicity, acute toxicity, morphological and germination effect. Our data confirmed MG toxicity on fungi and bacteria (gram positive and gram negative organisms) showing elevated level of ROS. Genotoxicity caused in the microorganisms was detected by DNA polymorphism and fragmentation. Also, scanning electron microscopy data suggests that the inhibitory effect of MG to these beneficial microbes in the ecosystem might be due to pore formation in the cell and its eventual disruption. Filter paper and artificial soil test conducted on earthworms demonstrated a LC 50 of 2.6 mg cm(-2) and 1.45 mg kg(-1) respectively with severe morphological damage. However, seed germination of Mung bean, Wheat and Mustard was found to be unaffected in presence of MG up to 100 mL(-1) concentration. Thus, understanding MG toxicity in non target soil organisms and emphasis on its toxicological effects would potentially explicate its role as an environmental contaminant.

Symptomatic first urinary tract infection in children and underlying kidney and urinary ttract abnormalities from a tertiary care hospital in India

Objective The aim of this study was to describe the characteristics and the clinical evolution of first documented symptomatic Urinary Tract Infection and to detect underlying abnormalities of the kidney and urinary tract if any. Methods Prospective observational study on 102 patients (6 months to 5 yrs) with first documented symptomatic Urinary Tract Infection diagnosed by positive urine culture in the department of Paediatrics, G.S.V.M Medical College, Kanpur, India between January 2008 and June 2009. Antibiotics were given according to the sensitivity pattern. All children were evaluated with renal bladder ultrasonogram and voiding cystourethrography. Results Out of 102 patients 62 (60.78%) girls and 40 (39.21%) boys, most of the patients (62.7%) within 6 months to 2 years old. The commonest presentation was fever (84.3%).The commonest organism was E.Coli (80.37%). Overall most common underlying abnormality was VUR, found in 31(30.31%) children. Other abnormalities were urolithiasis(4.9%), ureteropelvic junction obstruction (3.92%),Mild hydronephrosis (2.9%), ureteric duplex(0.98%), posterior urethral valve(0.98%), renal duplex (0.98%). Conclusion In our study 45.09% children had underlying abnormalities which may be a potential risk factor for urinary tract infection. Better recognition of risk factors, prompt diagnosis and early intervention are sufficient enough to maintain normal renal function and healthy lifestyle.   Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-3, 45-53 DOI: http://dx.doi.org/10.3126/jcmsn.v9i3.10222  

A fuzzy approach for modelling radionuclide in lake system

Radioactive liquid waste is generated during operation and maintenance of Pressurised Heavy Water Reactors (PHWRs). Generally low level liquid waste is diluted and then discharged into the near by water-body through blowdown water discharge line as per the standard waste management practice. The effluents from nuclear installations are treated adequately and then released in a controlled manner under strict compliance of discharge criteria. An attempt was made to predict the concentration of (3)H released from Kakrapar Atomic Power Station at Ratania Regulator, about 2.5 km away from the discharge point, where human exposure is expected. Scarcity of data and complex geometry of the lake prompted the use of Heuristic approach. Under this condition, Fuzzy rule based approach was adopted to develop a model, which could predict (3)H concentration at Ratania Regulator. Three hundred data were generated for developing the fuzzy rules, in which input parameters were water flow from lake and (3)H concentration at discharge point. The Output was (3)H concentration at Ratania Regulator. These data points were generated by multiple regression analysis of the original data. Again by using same methodology hundred data were generated for the validation of the model, which were compared against the predicted output generated by using Fuzzy Rule based approach. Root Mean Square Error of the model came out to be 1.95, which showed good agreement by Fuzzy model of natural ecosystem.

Excitation of weakly bound molecules to trilobitelike Rydberg states

We observe "trilobitelike" states of ultracold (85)Rb(2) molecules, in which a ground-state atom is bound by the electronic wave function of its Rydberg-atom partner. We populate these states through the ultraviolet excitation of weakly bound molecules, and access a regime of trilobitelike states at low principal quantum numbers and with vibrational turning points around 35 Bohr radii. This demonstrates that, unlike previous studies that used free-to-bound transitions, trilobitelike states can also be excited through bound-to-bound transitions. This approach provides high excitation probabilities without requiring high-density samples, and affords the ability to control the excitation radius by selection of the initial-state vibrational level.

Potentially avoidable emergency department attendance: interview study of patients' reasons for attendance

OBJECTIVES

To explore the reasons for attendance at the emergency department (ED) by patients who could have been managed in an alternative service and the rate of acute admissions to one acute hospital.

DESIGN

Interview study.

SETTING

One acute hospital (University Hospitals of Leicester) in the East Midlands.

PARTICIPANTS

23 patients and/or their carers.

METHODS

A purposive sample of patients attending the ED and the linked urgent care centre was identified and recruited. Patients in the sample were approached by a clinician and a researcher and invited to take part in an interview. Patients of different ethnicities and from different age groups, arriving at the ED via different referral routes (self-referral, emergency ambulance, GP referral, out-of-hours services) and attending at different times of the day and night were included. The interviews were recorded and transcribed with the individuals' permission and analysed using the framework analysis approach.

RESULTS

Patients' anxiety or concern about the presenting problem, the range of services available to the ED and the perceived efficacy of these services, patients' perceptions of access to alternative services including general practice and lack of alternative pathways were factors that influenced the decision to use the ED.

CONCLUSIONS

Access to general practice, anxiety about the presenting problem, awareness and perceptions of the efficacy of the services available in the ED and lack of alternative pathways are important predictors of attendance rates.

Formation of ultracold Rb2 molecules in the v'' = 0 level of the a(3)Σ+(u) state via blue-detuned photoassociation to the 1(3)Π(g) state

We report on the observation of blue-detuned photoassociation in Rb(2), in which vibrational levels are energetically above the corresponding excited atomic asymptote. (85)Rb atoms in a MOT were photoassociated at short internuclear distance to levels of the 1(3)Π(g) state at a rate of approximately 5 × 10(4) molecules s(-1). We have observed most of the predicted vibrational levels for all four spin-orbit components; 0(+)(g), 0(-)(g), 1(g), and 2(g), including levels of the 0(+)(g) outer well. These molecules decay to the metastable a(3)Σ(+)(u) state, some preferentially to the v'' = 0 level, as we have observed for photoassociation to the v' = 8 level of the 1(g) component.

Characteristics of general practices associated with emergency-department attendance rates: a cross-sectional study

BACKGROUND

Strategies are needed to contain emergency-department attendance. Quality of care in general practice might influence the use of emergency departments, including management of patients with chronic conditions and access to consultations.

AIM

The aim was to determine whether emergency-department attendance rates are lower for practices with higher quality and outcomes framework performance and lower for practices with better patient reported access.

DESIGN

A cross-sectional study.

SETTING

Two English primary-care trusts, Leicester City and Leicestershire County and Rutland, with 145 general practices.

METHOD

Using data on attendances at emergency departments in 2006/2007 and 2007/2008, a practice attendance rate was calculated for each practice. In a hierarchical negative binomial regression model, practice population characteristics (deprivation, proportion of patients aged 65 or over, ethnicity, gender) and practice characteristics (total list size, distance from the emergency department, quality and outcomes framework points, and variables measuring satisfaction with access) were included as potential explanatory variables.

RESULTS

In both years, greater deprivation, shorter distance from the central emergency department, lower practice list size, white ethnicity and lower satisfaction with practice telephone access were associated with higher emergency-department attendance rates.

CONCLUSIONS

Performance as indicated by the quality and outcomes framework did not predict rates of attendance at emergency departments, but satisfaction with telephone access did. Consideration should be given to improving access to some general practices to contain the use of emergency departments.

Characteristics of general practices associated with emergency admission rates to hospital: a cross-sectional study

OBJECTIVES

To identify characteristics of general practices associated with emergency hospital admission rates, and determine whether levels of performance and patient reports of access are associated with admission rates.

DESIGN

A cross-sectional study.

SETTING

Two primary care trusts (Leicester City and Leicestershire County and Rutland) in the East Midlands of England.

PARTICIPANTS

145 general practices.

METHODS

Hospital admission data were used to calculate the rate of emergency admissions from 145 practices, for two consecutive years (2006/7 and 2007/8). Practice characteristics (size, distance from principal hospital, quality and outcomes framework performance data, patient reports of access to their practices) and patient characteristics (deprivation, ethnicity, gender and age), were used as predictors in a two-level hierarchical model, developed with data for 2007/8, and evaluated against data for 2006/7.

RESULTS

Practice characteristics (shorter distance from hospital, smaller list size) and patient characteristics (higher proportion of older people, white ethnicity, increasing deprivation, female gender) were associated with higher admission rates. There was no association with quality and outcomes framework domains (clinical or organisation), but there was an association between patients reporting being able to see a particular general practitioner (GP) and admission rates. As the proportion of patients able to consult a particular GP increased, emergency admission rates declined.

CONCLUSIONS

The patient characteristics of deprivation, age, ethnicity and gender are important predictors of admission rates. Larger practices and greater distance from a hospital have lower admission rates. Being able to consult a particular GP, an aspect of continuity, is associated with lower emergency admission rates.

Epithelial Hic-5/ARA55 expression contributes to prostate tumorigenesis and castrate responsiveness

Stromal–epithelial interactions dictate prostate tumorigenesis and response to castration. Hydrogen peroxide-inducible clone 5 (Hic-5/ARA55) is a transforming growth factor-beta (TGF-β)-induced coactivator of androgen receptor (AR) expressed in the prostate stroma. Interestingly, following castration, we identified epithelial expression of Hic-5/ARA55 in mouse and human prostate tissues. To determine the role of epithelial Hic-5 in prostate cancer progression and castration responsiveness, we compared LNCaP cells having Hic-5 stably expressed with the parental LNCaP cells following tissue recombination xenografts with mouse prostate stromal cells. We previously identified knocking out prostate stromal TGF-β signaling potentiated castrate-resistant prostate tumors, in a Wnt-dependent manner. The LNCaP chimeric tumors containing prostate fibroblasts conditionally knocked out for the TGF-β type II receptor (Tgfbr2-KO) resulted in larger, more invasive, and castration-resistant tumors compared those with floxed (control) stromal cells. However, the LNCaP-Hic5 associated with Tgfbr2-KO fibroblasts generated chimeric tumors with reduced tumor volume, lack of invasion and restored castration dependence. Neutralization of canonical Wnt signaling is shown to reduce prostate tumor size and restore regression following castration. Thus, we hypothesized that epithelial Hic-5/ARA55 expression negatively regulated Wnt signaling. The mechanism of the Hic-5/ARA55 effects on castration was determined by analysis of the c-myc promoter. C-myc luciferase reporter activity suggested Hic-5/ARA55 expression inhibited c-myc activity by β-catenin. Sequential ChIP analysis indicated β-catenin and T-cell-specific 4 (TCF4) bound the endogenous c-myc promoter in the absence of Hic-5 expression. However, the formation of a TCF4/Hic-5 repressor complex inhibited c-myc promoter activity, by excluding β-catenin binding with TCF4 on the promoter. The data indicate Hic-5/ARA55 expression in response to castration-enabled epithelial regression through the repression of c-myc gene at the chromatin level.