Recent Advances and Changing Face of Anatomy Teaching and Learning in Medical Education

Background A sound knowledge of human anatomy is a major requirement for being a good physician or a practicing surgeon. Despite digitalization and modernization of education sector, traditional cadaveric dissection still occupies the leadership of anatomy education. It is becoming an untold truth that no modern technologies such as virtual dissection or 3D model printing could replace cadaveric dissection in its way of teaching students.

Methods Recent research studies on modern anatomical teaching methods for medical and non-medical students and their influences are reviewed.

Results Despite new technologies, traditional cadaveric dissection helps students to acquire more practical knowledge and still occupies prior position on its way.

Consensus statement from the International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury : Consensus statement

BACKGROUND

Two randomised trials assessing the effectiveness of decompressive craniectomy (DC) following traumatic brain injury (TBI) were published in recent years: DECRA in 2011 and RESCUEicp in 2016. As the results have generated debate amongst clinicians and researchers working in the field of TBI worldwide, it was felt necessary to provide general guidance on the use of DC following TBI and identify areas of ongoing uncertainty via a consensus-based approach.

METHODS

The International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury took place in Cambridge, UK, on the 28th and 29th September 2017. The meeting was jointly organised by the World Federation of Neurosurgical Societies (WFNS), AO/Global Neuro and the NIHR Global Health Research Group on Neurotrauma. Discussions and voting were organised around six pre-specified themes: (1) primary DC for mass lesions, (2) secondary DC for intracranial hypertension, (3) peri-operative care, (4) surgical technique, (5) cranial reconstruction and (6) DC in low- and middle-income countries.

RESULTS

The invited participants discussed existing published evidence and proposed consensus statements. Statements required an agreement threshold of more than 70% by blinded voting for approval.

CONCLUSIONS

In this manuscript, we present the final consensus-based recommendations. We have also identified areas of uncertainty, where further research is required, including the role of primary DC, the role of hinge craniotomy and the optimal timing and material for skull reconstruction.

Health Outcomes of Youth in Clinical Pediatric Weight Management Programs in POWER

OBJECTIVE

To describe treatment outcomes of children and adolescents enrolled in the Pediatric Obesity Weight Evaluation Registry, a consortium of multicomponent pediatric weight management programs in the US.

STUDY DESIGN

This multicenter prospective observational cohort study, established in 2013, includes youth (2-18 years of age) with obesity enrolled from 31 Pediatric Obesity Weight Evaluation Registry (POWER) sites over a 2-year period and followed up to 12 months. Weight status was evaluated by the percentage of the 95th percentile for body mass index (%BMIp95). Associations of weight status outcomes with patient characteristics and program exposure were analyzed with multivariable mixed effects modeling.

RESULTS

We included 6454 children and adolescents (median age, 11 years; IQR, 9-14 years; 53% white, 32% Hispanic; 73% with severe obesity) who were enrolled in POWER. Median changes in %BMIp95 for this cohort were -1.88 (IQR, -5.8 to 1.4), -2.50 (IQR, -7.4 to 1.8), -2.86 (IQR, -8.7 to 1.9), at 4-6, 7-9, and 10-12 of months follow-up, respectively (all P < .05). Older age (≥12 years), greater severity of obesity, and Hispanic race/ethnicity were associated with better improvement in %BMIp95. A 5-percentage point decrease in %BMIp95 was associated with improvement in cardiometabolic risk factors.

CONCLUSIONS

Overall, treatment in pediatric weight management programs is associated with a modest median decrease in BMI as measured by change in %BMIp95. Further studies are needed to confirm these findings, as well as to identify additional strategies to enhance the effectiveness of these multicomponent interventions for youth with severe obesity.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT02121132.

Studies on purification of 89Sr from irradiated yttria target by multi-column extraction chromatography using DtBuCH18-C-6/XAD-7 resin

89Sr is being produced using yttria target via the nuclear reaction 89Y(n,p)89Sr in Fast Breeder Test Reactor (FBTR), Kalpakkam. The isotope 89Sr is a pure beta emitter with a half-life of 50.53 days which is useful mainly for bone pain palliation in patients with bone metastases. The existing method for processing the irradiated yttria target to obtain the pure 89Sr source involves separation of the bulk yttrium target by solvent extraction using TBP-HNO3 followed by purification of 89Sr source by cation exchange chromatography technique using Dowex resin. The study described here involves the selective extraction and purification of 89Sr by multi-column extraction chromatography technique using the Sr-specific crown ether, DtBuCH18C6 (CE) coated onto an XAD-7 resin matrix for superior separation and increased yield compared to single column technique. The 89Sr source thus purified from the irradiated yttria target is free from other radionuclidic impurities produced during the target irradiation i.e. 88Y, 65Zn, 139,141Ce, 154Eu and 160Tb.

Prehospital Factors Associated with Discharge Outcomes: Baseline Data from the Andhra Pradesh Traumatic Brain Injury Project

Objective

Strategies to improve traumatic brain injury (TBI) outcomes in India are ill defined. The objective of this study was to examine baseline prehospital (PH) factors associated with outcomes from the Andhra Pradesh Traumatic Brain Injury Project.

Methods

We conducted a prospective observational cohort study of adult patients with TBI admitted to the primary referral hospital. Modes of injury, prehospital care and transport, and factors associated with increased in-hospital mortality were evaluated. Poisson regression with robust error variance and adjusted attributable risk percent estimates determined factors associated with outcomes.

Results

A total of 447 adults (38% with mild TBI, 30% with moderate TBI, and 32% with severe TBI; 81% men) with isolated TBI (89%) from road traffic accidents (48.1%) or falls (46.5%) were enrolled. Of the patients, 45.7% were transported by ambulance, 61% had scalp/facial bleeding, 11% had respiratory distress, and 7% had cervical spine stabilization. Of these, 25.3% died and 34% had unfavorable outcomes. Among 335 direct admits, 45% traveled more than 50 km and nearly 20% traveled more than 100 km. Bleeding was associated with higher mortality (adjusted relative risk [aRR], 1.56; 95% confidence interval [CI], 1.05–2.31) and unfavorable outcome (aRR, 1.60; 95% CI, 1.18–2.17). Of the patients, 45 (31%) with severe TBI received PH airway management prior to definitive treatment, and respiratory distress was associated with unfavorable discharge outcomes (aRR, 1.23; 95% CI, 1.00–1.51).

Conclusions

Patients with TBI often received treatment far away from injury, bypassing closer hospitals. Scalp/facial bleeding was common and associated with unfavorable outcomes. Ambulance use was infrequent, and few patients received PH airway management, hemorrhage control, or cervical spine stabilization when needed.

Investigating different options in course delivery – traditional vs online: is there another option?

Purpose

The purpose of this paper is to examine students’ perceptions of online vs traditional (face-to-face) course offerings at the business school of a liberal arts university in southwest USA. The research compares perceptions of students who have been subjected to online education along with those who have not been exposed to online education and examines likelihood to take online courses.

Design/methodology/approach

Paper and pencil surveys were distributed in different classes in business classes at a university in southwest USA. The target group was undergraduate students.

Findings

The results indicate that overall, students have neutral perceptions about online courses, while favorable perceptions are strongly associated with likelihood to take online courses. Moreover, prior exposure with online courses is not a significant factor in forming favorable perceptions about online courses.

Research limitations/implications

The present research is limited in generalizability and the institution surveyed in the southwest region is new to online courses offering in their curriculum and not all the participants had prior experience with online courses.

Originality/value

Although this paper compares online education with traditional, another option for methods of education include hybrid models incorporating both. A possible third option not discussed through this research is a hybrid or blended learning course, a combination of both online and traditional courses. This opens the options for the student, as hybrid courses can be built with many different options. One includes using technology for “screencasts” or lectures online.

Fast burn-up measurement in simulated nuclear fuel using ICP-MS

A double focusing ICP-MS with pulsed laser deposition (PLD) of thin films as sampling tool has been used in simulated spent fuels for a quick measurement on burn-up of nuclear reactor fuels by measuring the atom ratio of U (representing total heavy elements of mass >225) to selected lanthanide fission monitors. A linear correlation is established between the measured intensity ratios of 238U/143Nd, 238U/(145Nd+146Nd) and 238U/139La against the actual atom ratios present in the samples. The samples in the form of solution are obtained by dissolving different concentrations of U, Nd and La in nitric acid medium, representing a wide burn-up range (0.19 to 19.98 at.%). In addition, PLD films were deposited using 1064 nm, 100 ps Nd:YAG laser pulses on solid targets of U and Nd mixed oxide, corresponding to different burn-ups. ICP-MS analysis of these films after dissolving in nitric acid showed values close to that of the solid target composition. Burn-up data obtained with films deposited at a high laser power density of 1.67×1011 W/cm2 agrees well with the values of the respective target compositions compared to the films deposited at 3.3×109 W/cm2. Present analytical method requires only a very small sample quantity, typically a few nanograms and generally does not require any chemical separation in comparison to the conventional mass spectrometry method, which is traditionally employed to determine the burn-up of a nuclear fuel.

Development of an orthotopic canine prostate cancer model expressing human GRPr

BACKGROUND

Ace-1 canine prostate cancer cells grow orthotopically in cyclosporine immunosuppressed laboratory beagles. We previously transfected (human Gastrin-Releasing Peptide Receptor, huGRPr) into Ace-1 cells and demonstrated receptor-targeted NIRF imaging with IR800-G-Abz4-t-BBN, an agonist to huGRPr. Herein, we used the new cell line to develop the first canine prostate cancer model expressing a human growth factor receptor.

METHODS

Dogs were immunosuppressed with cyclosporine, azathioprine, prednisolone, and methylprednisolone. Their prostate glands were implanted with Ace-1huGRPr cells. The implantation wounds were sealed with a cyanoacrylic adhesive to prevent extraprostatic tumor growth. Intraprostatic tumors grew in 4-5 week. A lobar prostatic artery was then catheterized via the carotid artery and 25-100 nmol IR800-Abz4-t-BBN was infused in 2 mL followed by euthanasia in dogs 1-2, and recovery for 24 h before euthanasia in dogs 3-6. Excised tissues were imaged optically imaged, and histopathology performed.

RESULTS

Dog1 grew no tumors with cyclosporine alone. Using the four drug protocol, Dogs 2-6 grew abundant 1-2 mm intracapsular and 1-2 cm intraglandular tumors. Tumors grew >5 cm when the prostate cancer cells became extracapsular. Dogs 4-6 with sealed prostatic capsule implantation sites had growth of intracapsular and intraglandular tumors and LN metastases at 5 weeks. High tumor to background BPH signal in the NIRF images of sectioned prostate glands resulted from the 100 nmol dose (∼8 nmol/kg) in dogs 2-4 and 50 nmol dose in dog 5, but not from the 25 nmol dose in Dog 6. Imaging of mouse Ace-1huGRPr tumors required an intravenous dose of 500 nmol/kg body wt. A lymph node that drained the prostate gland was detectable in Dog 4. Histologic findings confirmed the imaging data.

CONCLUSION

Ace-1huGRPr cells created viable, huGRPr-expressing tumors when implanted orthotopically into immune-suppressed dogs. Local delivery of an imaging agent through the prostatic artery allowed a very low imaging dose, suggesting that therapeutic agents could be used safely for treatment of early localized intraglandular prostate cancer as adjuvant therapy for active surveillance or focal ablation therapies, or for treating multifocal intraglandular disease where focal ablation therapies are not indicated or ineffective.

Utility of Transcranial Doppler in Estimating Cerebral Perfusion Pressure in Traumatic Brain Injury: A Prospective Observational Trial

Title Utility of transcranial Doppler (TCD) in estimating cerebral perfusion pressure (eCPP) in traumatic brain injury—a prospective observational trial.

Aim To validate the utility of a noninvasive technique of eCPP estimation using transcranial Doppler (TCD).

Materials and Methods Eighteen patients with severe traumatic brain injury (TBI) requiring intracranial pressure (ICP) monitoring as per the Brain Trauma Foundation guidelines were prospectively recruited for the study. ICP was measured in all patients using an intraventricular catheter. Mean arterial pressure (MAP) was recorded from an intra-arterial catheter. Cerebral perfusion pressure (CPP) was calculated as the difference between MAP and ICP. Middle cerebral blood flow velocities were recorded using TCD, and CPP was estimated from the middle cerebral artery (MCA) flow velocities (eCPP) using the formula eCPP = (MAP × end diastolic velocity [EDV]/mean velocity [MV]) + 14. Total 185 simultaneous readings of CPP and eCPP were available for analysis. Reliability statistics between CPP and eCPP were computed to calculate the intraclass correlation (ICC).

Results The average CPP measured using intraventricular catheter was 73.2 (+/−12.4), and the mean estimated eCPP was 76.7 (+/−10.9). We found a very good Pearson's correlation between CPP and eCPP (r = 0.743) with a Cronbach's α of 0.843. In 86.2% of examinations, the estimation error of measuring CPP was within 10 mm Hg, and in 93.1% examinations, it was within 15 mm Hg.

Conclusion eCPP estimated using TCD can serve as reliable noninvasive alternative in situations in which ICP monitoring is not available, even in moderate or mild head injury.

Study of the factors at admission predicting the outcome in patients with attempted suicidal hanging

Our study sought to identify factors at presentation which can predict the outcome after an attempted hanging. A retrospective analysis of patients over a 12-year period was carried out. A poor outcome was found in 17.8% and this could be predicted by the presence of myoclonus, a Glasgow coma motor score of ≤3 or an abnormal chest radiograph.

A Phase-2 Trial of Single Agent Axitinib as Maintenance Therapy Following First-Line Treatment With Modified FOLFOX/Bevacizumab in Patients With Metastatic Colorectal Cancer

This phase-2 trial evaluated the efficacy of axitinib as maintenance therapy for patients with metastatic colorectal cancer (mCRC) following first-line treatment with FOLFOX/bevacizumab. Patients with mCRC received mFOLFOX/bevacizumab followed by axitinib maintenance after four cycles. The primary endpoint was progression-free survival (PFS). Seventy patients were enrolled. Common treatment-related toxicities were fatigue, nausea, diarrhea, and peripheral neuropathy during FOLFOX/bevacizumab treatment; and fatigue, hypertension, diarrhea, and peripheral neuropathy during axitinib treatment. Median PFS was 8.3 months. Treatment with FOLFOX/bevacizumab followed by maintenance axitinib as first-line treatment for mCRC produced a median PFS consistent with historical controls of other first-line regimens.

Abstract P4-22-09: A phase 2 open label study of everolimus in combination with endocrine therapy in resistant hormone receptor-positive HER2-negative advanced breast cancer

Background: Therapies targeting estrogen receptor (ER) signaling are standard for patients (pts) with hormone receptor positive (HR+) (ER and/or progesterone receptor [PR] positive) metastatic breast cancer (MBC). Dysregulation of the mammalian target of rapamycin (mTOR) pathway has been associated with endocrine therapy (ET) resistance. BOLERO-2 demonstrated that the addition of the mTOR inhibitor, everolimus (EVE), to exemestane doubled the PFS in HR+ HER2- MBC pts who previously progressed on nonsteroidal aromatase inhibitor therapy.The premise of this phase 2 trial in HR+ MBC is that the addition of EVE to the last ET on which the disease progressed may restore sensitivity to ET and extend the benefit of the anti-estrogen therapy.

Methods: Pts ≥18 yrs with HR+, HER2- unresectable, locally recurrent, or MBC refractory to ET in either the adjuvant or advanced/metastatic setting. 0-1 chemotherapy (chemo) regimens for MBC were permitted. Post-/ pre-/peri-menopausal women were eligible with ovarian function suppression permitted. Additional eligibility requirements include: no prior mTOR inhibitor therapy, measurable or evaluable disease, ECOG ≤2, adequate bone marrow and organ function. EVE (10 mg PO daily) was administered on a 4-wk cycle in combination with the same dose and schedule of the last ET to which their disease became resistant. Disease assessments were performed every 2 cycles and treatment continued until disease progression or unacceptable toxicity. Blood samples and archival tumor were collected respectively for the VeriStrat Assay and for the Foundation One molecular profiling platform.

Results: 48 pts were enrolled; data from 26 pts is presented. Median age 63.5 yrs (range, 36-81) with 46% ≥ 65 yrs. 14 (54%) pts had received chemo in the adjuvant setting, 9 pts (35%) received chemo for MBC, and 4 pts (15%) received chemo in both settings. All pts had at least 1 prior hormonal therapy; 9 pts received ≥ 3 hormonal agents. EVE was combined with tamoxifen (27%), AIs (61%), and fulvestrant (12%). Median time on treatment was 18.6 wks (range 1-48.9 weeks). 5 pts (19%) remain on treatment and 21 (81%) have discontinued therapy due to: disease progression - 17, toxicity -2, and other causes - 2. 23 pts were evaluable for response. 1 pt on fulvestrant plus EVE had a PR and 18 pts (78%) had SD as best response, with SD &gt; 6 mos in 7 pts, for a clinical benefit rate (CR+PR+ SD ≥ 6 months) of 35%. With a median follow up of 11 mos (range 2-16 mos), the median PFS was 6.6 months (range 3.6-9.4); the median OS has not been reached. Treatment-related adverse events consisted mostly of stomatitis, rash and fatigue with few G3 events: stomatitis 3 pts, rash 2 pts, and 1 each of fatigue, edema, and neutropenia. G1 pneumonitis was present in 2 pts. There were no G4 events or treatment related deaths.

Conclusions: In HR+ HER2- advanced/MBC patients who progressed on prior ET, the addition of EVE to the ET to which their disease became resistant, resulted in 1 PR and 7 pts with SD &gt; 6 mos. The results of the full study population will be presented. Modulation of the mTOR/AKT/PI3K pathway with EVE may extend the benefit of ET, even after tumor progression on ET alone.

Citation Format: Yardley DA, Blakely L, Hemphill B, Joseph M, Liggett W, Daniel B, Castrellon A, Shastry M, Finney L, DeBusk L, Hainsworth JD, Burris III HA. A phase 2 open label study of everolimus in combination with endocrine therapy in resistant hormone receptor-positive HER2-negative advanced breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-22-09.

Physicochemical properties and radiolytic degradation studies on tri-iso-amyl phosphate (TiAP)

The solvent composed of tri-iso-amyl phosphate (TiAP) in n-dodecane (n-DD) is regarded as a promising candidate for reprocessing of spent fuel. In this context, the radiolytic degradation of a solution of TiAP in n-dodecane was investigated by irradiating the solvent to various absorbed dose levels of γ-radiation. The neat extractant or a solution of extractant in n-dodecane was irradiated in the presence of nitric acid. Physicochemical properties such as density, viscosity and interfacial tension (IFT) were measured for unirradiated and irradiated solutions. The extent of degradation was determined by measuring the variation in extraction behavior of U(VI) and Pu(IV) with irradiated solvent systems. Uranium and plutonium retention with irradiated solvents was also measured. The distribution ratio of uranium and plutonium increased with increase in absorbed dose. Effect of alpha degradation was studied by plutonium retention as a function of time using 1.1 M TiAP/n-DD. Laser desorption/ionization mass spectrometric technique was employed to identify the possible radiolytic degradation products. Similar studies were also carried out with tri-n-butyl phosphate (TBP) based solvent system under identical experimental conditions and the results are compared.

Importance of fibrinogen in dilutional coagulopathy after neurosurgical procedures: A descriptive study

BACKGROUND AND AIMS

The routine management of coagulopathy during surgery involves assessing haemoglobin, prothrombin time (PT), activated partial thromboplastin time (aPTT) and platelets. Correction of these parameters involves administration of blood, fresh frozen plasma and platelet concentrates. The study was aimed at identifying the most common coagulation abnormality during neurosurgical procedures and the treatment of dilutional coagulopathy with blood components.

METHODS

During 2 years period, all adult patients undergoing neurosurgical procedures who were transfused two or more units of red cells were prospectively evaluated for the presence of a coagulopathy. PT, aPTT, platelet count and fibrinogen levels were estimated before starting a component therapy.

RESULTS

After assessing PT, aPTT, platelet count and fibrinogen levels following two or more blood transfusions, thirty patients were found to have at least one abnormal parameter that required administration of a blood product. The most common abnormality was a low fibrinogen level, seen in 26 patients; this was the only abnormality in three patients. No patient was found to have an abnormal PT or aPTT without either the fibrinogen concentration or platelet count or both being low.

CONCLUSION

Low fibrinogen concentration was the most common coagulation abnormality found after blood transfusions for neurosurgical procedures.

Effects of replacing marine fishmeal with graded levels of Tra Catfish by-product protein hydrolysate on the performance and meat quality of pigs

A feeding trial was carried out to evaluate the effects of replacing fish meal (FM) with Tra Catfish (Pangasius hypophthalmus) by-product protein hydrolysate (TPH) on performance and carcass quality in pigs. Forty crossbred castrated (Yorkshire x Landrace) male pigs with an initial average bodyweight of 22.8 ± 1.5 kg were allocated to 40 individual pens in a randomized complete block design with eight replications. The pigs were fed a control diet (TPH0) with FM as sole protein supplement. In the experimental diets, 100% (TPH100), 75% (TPH75), 50% (TPH50) and 25% (TPH25) of the crude protein (CP) from FM was replaced by the CP from TPH. The results showed no significant differences in average daily feed intake (ADFI) in all treatments during the growing and finishing phases. However, daily weight gain (ADG) was higher in TPH75 (655 g/day) and TPH100 (663 g/day) than in TPH0 (639 g/day). Feed conversion ratio (FCR) was improved with higher inclusion of TPH in the diets. Carcass yield and dressing percentage were not affected by treatments, but abdominal fat and backfat thickness were higher and in the loin-eye area lower in TPH100 compared with TPH0. Polyunsaturated fatty acids (PUFA), ether extract (EE) contents and meat colour values a* (redness) in the longissimus dorsi muscle increased with TPH replacement level. Feed costs were 10% lower in TPH100 compared with TPH0. In conclusion, replacing FM with TPH improved the performance, but resulted in an increase in backfat thickness and fat content of meat. However, because of reduced feed costs, complete replacement of FM would still be profitable for pig producers in Vietnam.Keywords: Backfat thickness, longissimus dorsi muscle, fatty acid, Pangasius hypophthalmus

The incidence of deep venous thrombosis in high-risk Indian neurosurgical patients: Need for early chemoprophylaxis?

INTRODUCTION

Deep venous thrombosis (DVT) is thought to be less common in Asians than in Caucasian population. The incidence of DVT in high-risk groups, especially the neurosurgical (NS) patients, has not been well studied. This leaves no firm basis for the start of early prophylactic anticoagulation within first 5 postoperative days in Indian NS patients. This is a prospective observational study to determine the early occurrence of DVT in the NS patients.

PATIENTS AND METHODS

We screened 137 consecutive high-risk NS patients based on inclusion and exclusion criteria. The femoral veins were screened using Doppler ultrasound on day 1, 3, and 5 of admission into the NS Intensive Care Unit (ICU) at tertiary center from South India.

RESULTS

Among 2887 admissions to NICU 147 patients met inclusion criteria. One hundred thirty seven were screened for DVT. There was a 4.3% (6/137) incidence of DVT with none of the six patients having signs or symptoms of pulmonary embolism. Among the risk factors studied, there was a significant association with femoral catheterization and a probable association with weakness/paraparesis/paraplegia. The mortality in the study group was 10.8% with none attributable to DVT or pulmonary embolism.

CONCLUSION

There is a low incidence of DVT among the high risk neurosurgical population evaluated within the first 5 days of admission to NICU, limiting the need for early chemical thrombo-prophylaxis in these patients. With strict protocols for mechanical prophylaxis with passive leg exercise, early mobilization and serial femoral Doppler screening, heparin anticoagulation can be restricted within the first 5 days of ICU admission in high risk patients.

A Phase 2 Study of the Hsp90 Inhibitor AUY922 as Treatment for Patients with Refractory Gastrointestinal Stromal Tumors

BACKGROUND

AUY922 is an inhibitor of heat shock protein 90 (Hsp90). Hsp90 inhibitors induce kit degradation in preclinical gastrointestinal stromal tumor (GIST) models. This trial was designed to determine the progression-free survival (PFS) of patients with GIST refractory to or intolerant of imatinib and sunitinib.

METHODS

Eligible patients received AUY922 70 mg/mg(2) by intravenous (IV) infusion on days 1, 8, and 15 of 21-day cycles. Treatment continued until progression or unacceptable toxicity.

RESULTS

Between December 2011 and January 2015, 25 patients were enrolled (median age, 63 years; 56% male) and received a median of 2 cycles (range: 1-12) of AUY922 treatment. Thirty-four patients were planned, but enrollment was stopped early due to slow accrual. Median PFS was 3.9 months (95% CI: 2.5, 5.3) and median OS was 8.5 months (95% CI: 5.2, 16.7). Radiographic response was evaluated in 21 patients; one patient achieved PR (4%) with another 15 having best response of stable disease (60%). The most common treatment-related adverse event was diarrhea (60% all grades). Reversible ocular toxicities that resulted in drug hold (24%) or reduction (8%) were also observed.

CONCLUSION

AUY922 produced a median PFS which compares favorably to historical controls of placebo (6 weeks) for patients refractory to treatment with imatinib. While diarrhea and ocular toxicities were common, the majority of patients received treatment until disease progression.

Cervical spine injuries in 64 attempted suicidal hangings in India

This report describes the outcome of 64 attempted suicidal hangings, 81% of whom made a full recovery.

Complexation Behavior of the Tri-n-butyl Phosphate Ligand with Pu(IV) and Zr(IV): A Computational Study

Tri-n-butyl phosphate (TBP), used as the extractant in nuclear fuel reprocessing, shows superior extraction abilities for Pu(IV) over a large number of fission products including Zr(IV). We have applied density functional theory (DFT) calculations to explain this selectivity by investigating differences in electronic structures of Pu(NO3)4·2TBP and Zr(NO3)4·2TBP complexes. On the basis of our quantum chemical calculations, we have established the lowest energy electronic states for both complexes; the quintet is the ground state for the former, whereas the latter exists in the singlet spin state. The calculated structural parameters for the optimized geometry of the plutonium complex are in agreement with the experimental results. Atoms in Molecules analysis revealed a considerable amount of ionic character to M-O{TBP} and M-O{NO3} bonds. Additionally, we have also investigated the extraction behavior of TBP for metal nitrates and have estimated the extraction energies to be -73.1 and -57.6 kcal/mol for Pu(IV) and Zr(IV), respectively. The large extraction energy of Pu(IV) system is in agreement with the observed selectivity in the extraction of Pu.

Gender Differences in HIV-Related Neurological Progression in a Cohort of Injecting Drug Users Followed for 3.5 Years

We evaluated potential gender differences in the development of HIV related neurologic impairment, by matching 38 pairs of HIV positive male and female injecting drug users on their baseline age, education, disease stage and CD4 counts, and following them for 3.5 years. Adjusting for age, education, drug use, history of head injury and baseline CD4 count, more women had sensory abnormalities and symptoms than men at baseline, but the odds of having neurological impairment, particularly extrapyramidal signs and sensory abnormalities were increased over time in men but not in women. Men with ARC or AIDS had more neurological impairment than women in similar stages of illness. This study suggests further investigations of gender differences in HIV disease progression.