Preconception paternal stress in rats alters dendritic morphology and connectivity in the brain of developing male and female offspring

The goal of this research was to examine the effect of preconception paternal stress (PPS) on the subsequent neurodevelopment and behavior of male and female offspring. Prenatal (gestational) stress has been shown to alter brain morphology in the developing brain, and is presumed to be a factor in the development of some adult psychopathologies. Our hypothesis was that paternal stress in the preconception period could impact brain development in the offspring, leading to behavioral abnormalities later in life. The purpose of this study was to examine the effect of preconception paternal stress on developing male and female offspring brain morphology in five brain areas; medial prefrontal cortex (mPFC), orbitofrontal cortex (OFC), parietal cortex (Par1), hippocampus (CA1) and nucleus accumbens (NAc). Alterations in dendritic measures and spine density were observed in each brain area examined in paternal stress offspring. Our two main findings reveal; (1) PPS alters brain morphology and organization and these effects are different than the effects of stress observed at other ages; and, (2) the observed dendritic changes were sexually dimorphic. This study provides direct evidence that PPS modifies brain architecture in developing offspring, including dendritic length, cell complexity, and spine density. Alterations observed may contribute to the later development of psychopathologies and maladaptive behaviors in the offspring.

Robot-assisted surgical approach to bladder cancer: a decade of progress!

Robot-assisted radical cystectomy (RARC) has gained popularity and proven its efficacy, safety and reproducibility in the last decade. RARC has resulted in less blood loss, enhanced recovery, and shorter hospital stay. RARC has proven to have similar or better postoperative morbidity, mortality and equal oncologic, outcomes. Limiting factors to the acceptance of this surgical approach have included its steep learning curve and the lack of both long-term outcome data. This article systematically reviews the literature comparing the outcomes for RARC (comparisons with open radical cystectomy when performed at the same institution) with a focus on operative, complications, oncologic, functional and survival outcomes.

Tactile stimulation improves neuroanatomical pathology but not behavior in rats prenatally exposed to valproic acid

Autism is a severe neurodevelopmental disorder with a population prevalence of 1 in 68, and dramatically increasing. While no single pharmacologic intervention has successfully targeted the core symptoms of autism, emerging evidence suggests that postnatal environmental manipulations may offer greater therapeutic efficacy. Massage therapy, or tactile stimulation (TS), early in life has repeatedly been shown to be an effective, low-cost, therapeutic approach in ameliorating the cognitive, social, and emotional symptoms of autism. While early TS treatment attenuates many of the behavioral aberrations among children with autism, the neuroanatomical correlates driving such changes are unknown. The present study assessed the therapeutic effects of early TS treatment on behavior and neuroanatomy using the valproic acid (VPA) rodent model of autism. Rats were prenatally exposed to VPA on gestational day 12.5 and received TS shortly following birth. Whereas TS reversed almost all the VPA-induced alterations in neuroanatomy, it failed to do so behaviorally. The TS VPA animals, when compared to VPA animals, did not exhibit altered or improved behavior in the delayed non-match-to-sample T-maze, Whishaw tray reaching, activity box, or elevated plus maze tasks. Anatomically, however, there were significant increases in dendritic branching and spine density in the medial prefrontal cortex, orbital frontal cortex, and amygdala in VPA animals following early TS treatment, suggesting a complete reversal or remediation of the VPA-induced effects in these regions. The results suggest that postnatal TS, during a critical period in development, acts as a powerful reorganization tool that can ameliorate the neuroanatomical consequences of prenatal VPA exposure.

Microbiological analysis of isolates in Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal

BACKGROUND

Urinary tract infections (UTIs) are the common cause of bacterial infection. Recently UTI become more complicated and difficult to treat because of appearance of pathogen with increasing resistance to antimicrobial agents.

OBJECTIVE

To determine the etiology of the urinary tract infections and their susceptibility to antimicrobial agents.

METHODS

This study was carried out in Kathmandu Medical College, at department of microbiology. Total 3,460 urine samples were tested microbiologically by standard procedure. Antibiotic susceptibility test was performed for all the isolates by Kirby Bauer disc diffusion method and result was interpreted according to National Committee for Clinical Laboratory Standards (NCCLS) guide line.

RESULTS

Out of 3,460 urine samples 680 (19.7%) showed the significant bacteriuria. The most common pathogens isolated were Escherichia coli 75.7% followed by Klebsiella pneumoniae 10.7%, Acinetobacter spp 5.5%, Proteus spp 3.5% and Pseudomonas aeruginosa 1.2%. Most susceptible antibiotic was Amikacin, Ceftriaxone and Ciprofloxacin for most of the isolates. E. coli which was the main isolate was found to be most susceptible to Amikacin 96.1%, Nitrofurantoin 91.3% and Gentamicin 77.7% followed by Ceftriaxone 65.8% and Ciprofloxacin 64.1%.

CONCLUSION

Regular surveillance of the resistance rate among uro-pathogens is needed to ensure the appropriate therapy of UTI.

Antimicrobial susceptibility patterns of Salmonella typhi and Salmonella paratyphi A in a tertiary care hospital

BACKGROUND

Enteric fever is still an important public health problem in developing countries including Nepal. A changing antibiotic susceptibility pattern of Salmonella typhi and Salmonella paratyphi A and emergence of multi drug resistance has increased to a great concern. Aim of the study was to investigate the antibiotic susceptibility pattern of Salmonella typhi and Salmonella paratyphi A.

METHODS

Study was carried out at the department of microbiology in Kathmandu Medical College. Blood culture samples were collected from suspected enteric fever patient and tested microbiologically by standard procedure. Antibiotic susceptibility test was performed by Kirby-Bauer disc diffusion method and results were interpreted by National Committee for Clinical Laboratory (NCCLS) guideline.

RESULTS

Of total 78 (2.0%) Salmonella serotype isolated from 3,980 blood culture samples, in which 47 (60.3%) were S. typhi and 31 (39.7%) were S. paratyphi A. Isolates were from all age group median age being the 25 years. Among the tested antibiotics S. typhi was susceptible towards Ciprofloxacin (100%) followed by Gentamicin (97.9%), Ofloxacine (95.7%), Ceftriaxone (95.7%) and Chloramphenicol (93.6%). In case of S. paratyphi A most of the tested antibiotics showed high percentage of susceptibility and least susceptible antibiotic for S. paratyphi A was Ampicillin (25.8%). Three isolates of S. typhi showed multidrug resistance.

CONCLUSIONS

A considerable variation was observed in the antimicrobial susceptibility pattern of S.typhi and S. paratyphi A. Hence antibiotic susceptibility test must be sought before instituting appropriate therapy to prevent from further emergence of drug resistance.

Surface-enhanced Raman spectroscopy: nonlocal limitations

Giant field enhancement and field singularities are a natural consequence of the commonly employed local-response framework. We show that a more general nonlocal treatment of the plasmonic response leads to new and possibly fundamental limitations on field enhancement with important consequences for our understanding of surface-enhanced Raman spectroscopy (SERS). The intrinsic length scale of the electron gas serves to smear out assumed field singularities, leaving the SERS enhancement factor finite, even for geometries with infinitely sharp features. For silver nanogroove structures, mimicked by periodic arrays of half-cylinders (up to 120 nm in radius), we find no enhancement factors exceeding 10 orders of magnitude (10(10)).

Relative dose intensity delivered to patients with early breast cancer: Canadian experience

Adjuvant chemotherapy for early breast cancer improves disease-free and overall survival in pre- and postmenopausal women. The importance of maintaining relative dose intensity (rdi) is well-known; however, little information is available from routine clinical practice regarding how well dose intensity is maintained with modern chemotherapy regimens.

In a retrospective review of patients undergoing chemotherapy for early breast cancer at a single institution in Canada from January 2006 to November 2007, a total of 263 patients received one of the following regimens:

ac-t [doxorubicin (Adriamycin: Pharmacia, Kalamazoo, MI, U.S.A.)–cyclophosphamide, paclitaxel (Taxol: Bristol–Myers Squibb, Princeton, NJ, U.S.A.)]

fec-100 (5-fluorouracil–epirubicin–cyclophosphamide)

fec-d (5-fluorouracil–epirubicin–cyclophosphamide, docetaxel)

Overall, only 14.4% of patients had a rdi less than 85%. Dose delay or reduction (or both) occurred in 46%, 37%, and 20% of patients receiving fec-100, ac-t, and fec-d respectively. Optimal rdi was delivered to 96%, 95%, and 70.7% of patients for ac-t, fec-d and fec-100 regimens respectively. Patients over 65 years of age accounted for 14% of the total cohort and were more likely to receive a suboptimal rdi than were patients younger than 65 years of age (35% vs. 6.6%).

Optimal chemotherapy rdi (>85%) for early breast cancer can be achieved at an academic cancer centre. This goal is less often accomplished in elderly patients, and thus a proactive approach is required for managing toxicity in that population.

Automated classification of renal cell carcinoma subtypes using scale invariant feature transform

The task of analyzing tissue biopsies performed by a pathologist is challenging and time consuming. It suffers from intra- and inter-user variability. Computer assisted diagnosis (CAD) helps to reduce such variations and speed up the diagnostic process. In this paper, we propose an automatic computer assisted diagnostic system for renal cell carcinoma subtype classification using scale invariant features. We capture the morphological distinctness of various subtypes and we have used them to classify a heterogeneous data set of renal cell carcinoma biopsy images. Our technique does not require color segmentation and minimizes human intervention. We circumvent user subjectivity using automated analysis and cater for intra-class heterogeneities using multiple class templates. We achieve a classification accuracy of 83% using a Bayesian classifier.

Outcomes of Stereotactic Radiosurgery in the Management of Brain Metastasis in Patients with HER2 Positive Metastatic Breast Cancer

Background:We present single institution experience on the effect of Her 2 status on results of Gamma knife radiosurgery (SRS) for brain metastases (BM) as to local control, pattern of relapse and survival.Material and Methods:From 2004 to 2008, 65 patients with metastatic breast cancer (MBC) were treated with GK-SRS at our center, 52 had documented Her 2 status. We performed analysis based on Her 2 status of the original tumor defined as positive by 3+ DAKO or FISH. SRS was delivered using cobalt leksell GKS to a median dose of 20Gy (range 16-20 Gy) at 50% isodose line. Responses were evaluated by gadolinium enhanced MRI. We analyzed the data as to: objective response (OR) defined as radiologic response or stable disease, and local progression –free survival (PFS) defined as freedom from progression of treated BM, appearance of new brain metastases and/or leptomeningeal progression, as well as overall survival (OS) measured from the time of SRS .ResultsTwenty-eight patients were identified as HER2 positive (Group A) and 24 patients were HER2 negative (Group B). Median time to develop BM in group A was 60 months (4 -240 months) versus 48 months (4-156) in group B. Median follow-up was 12 months (1-48) from the time of onset of BM. 66% patients in group A and 82% patients in group B have no more than 2 BM at the time of SRS.In group A, OR was 78.6% (22 pts)and 21.4%(6 pts) had progressive disease (PD) where as in group B the OR was 83% (20 pts) and 17%(4 pts) had PD. Median time to local recurrence of the treated lesion in group A was 13 months (95% CI 5.84 to 20.15) compared to 8 months (95%CI 6.75 to 9.25) in group B. Local PFS at 1 year for Group A vs. B was: control of the treated lesions 69% versus 41.2% respectively, p= 0.97 by log rank test; and development of new BM 67% compared to 86% (p=0.2).Out of all CNS relapses, almost a quarter of patients in both groups received second SRS whereas 25% patients in group A and 31% patients in group B received whole brain irradiation respectively. Interestingly, 28% (9 pts) failed as leptomeningeal disease following SRS, 7 of them with Her 2 positive tumors. Leptomeningeal relapses were seen both as only pattern of recurrence (4 pts) or associated with other types of CNS progression: local re-growth or new BM (5pts).ConclusionsSRS provides high rate of objective response and local control for BM from both Her 2 positive and Her 2 negative breast cancer. No statistically significant difference in local PFS was seen. More frequent pattern of relapse as leptomeningeal disease was seen in Her 2 positive after SRS. Evaluation of novel systemic targeted therapies in conjunction with local therapies is needed for effective management of BM from breast cancer.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6152.

Bevacizumab in combination with radiotherapy plus concomitant and adjuvant temozolomide for newly diagnosed glioblastoma: Update progression-free survival, overall survival, and toxicity

2017

Background: Prognosis of glioblastoma (GBM) is very poor. Standard treatment includes surgical resection (SR), radiation (RT), concomitant and adjuvant chemotherapy with temozolomide (TMZ). Our objective is to assess the treatment efficacy, safety and survival in patients with newly-diagnosed GBM treated with RT, TMZ, and bevacizumab in the upfront management. Methods: From 2006–2008, 51 eligible patients (age >18, KPS >70) with newly-diagnosed GBM divided into two groups. Group A (n = 20) was treated with RT (60Gy) and concomitant TMZ (75mg/m2 daily for 42 days) with bevacizumab (10mg/kg every 2 weeks), 29 days following surgery, followed by up to six cycles of adjuvant TMZ (150mg/m2,daily x 7d, q28 with bevacizumab at 10mg/kg days 8 and 22 of each 28 day cycle. Group B (n = 31) received similar treatment without bevacizumab. Both groups were followed up until tumor progression (PFS). Recurrence was defined according to MacDonald Criteria. The end points were PFS, overall survival (OS) and toxicity. Results: Median bevacizumab infusions were 12 (4–32). Median follow-up was14 months for both groups. 6 months PFS survival in Group A was 77.5% and in Group B was 51.6%. Median PFS in Group A was 17 months compared to 7 months in Group B (p < 0.0001, HR = 0.26). Median OS has not been reached in Group A and was 17 months in Group B. One and 2 year OS were 83% and 57% in Group A compared to 72% and 6.5% in Group B (p = 0.02) ). Post-RT and temodar toxicities include thrombocytopenia (1 patient; Gr 3 and fatigue (3 patient;1 Gr 3), bevacizumab related toxicities with RT include leg ulcer with cellulites (1 patient; Gr 3) and pulmonary embolism with thrombocytopenia (1 patient; Gr 4), hypertension (2 patients; Gr 1), and asymptomatic blood products on MRI (2 patients). Conclusions: Bevacizumab has demonstrated efficacy, acceptable toxicity, improved PFS and OS in the upfront management of GBM.

No significant financial relationships to disclose.

Simulation of atmospheric dispersion of radionuclides using an Eulerian-Lagrangian modelling system

In this paper we present an atmospheric dispersion scenario for a proposed nuclear power plant in Pakistan involving the hypothetical accidental release of radionuclides. For this, a concept involving a Lagrangian stochastic particle model (LSPM) coupled with an Eulerian regional atmospheric modelling system (RAMS) is used. The atmospheric turbulent dispersion of radionuclides (represented by non-buoyant particles/neutral traces) in the LSPM is modelled by applying non-homogeneous turbulence conditions. The mean wind velocities governed by the topography of the region and the surface fluxes of momentum and heat are calculated by the RAMS code. A moving least squares (MLS) technique is introduced to calculate the concentration of radionuclides at ground level. The numerically calculated vertical profiles of wind velocity and temperature are compared with observed data. The results obtained demonstrate that in regions of complex terrain it is not sufficient to model the atmospheric dispersion of particles using a straight-line Gaussian plume model, and that by utilising a Lagrangian stochastic particle model and regional atmospheric modelling system a much more realistic estimation of the dispersion in such a hypothetical scenario was ascertained. The particle dispersion results for a 12 h ground release show that a triangular area of about 400 km(2) situated in the north-west quadrant of release is under radiological threat. The particle distribution shows that the use of a Gaussian plume model (GPM) in such situations will yield quite misleading results.

To study hypoactive sexual desire disorder in a fragile X carrier female successfully treated with local testosterone application

There is still considerable controversy concerning the role of androgen therapy for hypoactive sexual desire disorder in females. Clinical trials have shown that exogenous testosterone therapy improves arousability, sexual desire and fantasy, frequency of sexual activity and orgasm, and satisfaction and pleasure from the sexual act. We report our experience of 36-year-old fragile X carrier female presented to our department with low sex drive and subjectively poor arousal for the past 1 year. We decided to treat her with local testosterone in a pump form (1% 5 g twice a week). She responded very well to the treatment, and in 3 weeks her libido and sexual functions improved dramatically. We decided to continue the same treatment for almost 1 year following up her free and total testosterone, complete lipid profiles, liver functions and complete blood picture every 3 months. During the whole course of treatment, she had mild facial acne, which was resolved in 2 months after completing treatment with testosterone. This is our first and only case of this syndrome with low sexual desire disorder treated with local testosterone in a pump form. Based upon our 1 year follow-up, low-dose testosterone is a safe and effective approach in treating hypoactive sexual desire disorder in a fragile X carrier female, provided the patient is monitored every 3 months for blood counts, lipid profiles, liver functions and free and total testosterone levels.

Calculation of immersion doses from external exposure to a plume of radioactive material

The immersion doses from external exposure to a Gaussian plume of noble gases accidentally released into the atmosphere have been calculated. A numerical integration procedure employing Gauss-Legendre of 64th order has been used. The numerical procedure allows calculating the dose rate at any downwind horizontal or vertical distance. The dose rates were calculated using various forms of gamma dose build-up factors, including Linear, Berger and Geometric Progression (GP). The GP form, having an extraordinarily precise formulation, is a favored choice because the build-up factor levels off for large distances and does not increase exponentially as does the Berger form. The Linear form much under predicts the build-up and subsequently the dose rates for large distances from the source. The dose predictions using a simple uniform cloud model (that does not use any form of build-up factor) is also presented for comparison purposes. The comparison of dose rates with the already reported results indicated that the numerical procedure could be used for dose calculations from a Gaussian plume for all downwind and crosswind distances. The comparison of dose rates obtained using different forms of the build-up factors indicated that the Geometric Progression form was a favored choice and has a wider range of applicability as compared to the Linear or Berger form. The simple uniform cloud model for dose calculations is only suitable for plume centerline doses and should be used with caution for off-center distances.

Patient expectations and costs of immediate reporting of screening mammography: talk isn't cheap

OBJECTIVE

Our purpose was to determine whether patients prefer immediate or delayed results of screening mammography and to determine the cost of immediate reporting at our institution.

MATERIALS AND METHODS

A survey was anonymously and randomly distributed to 129 women who were 35-70 years old during a visit to their primary care physician, asking the women's preference for receiving mammography results by one of two systems: by letter with a return visit for any additional tests; or by speaking at once with the radiologist, with the option of additional tests being performed during the same visit. Patients' willingness to pay for the latter service was also determined. A cost identification model was constructed using commercially available software. We considered the impact on radiologists' and technologists' time and the need for additional equipment and space, and we analyzed the effect on the cost of immediate reporting.

RESULTS

One hundred twenty (93%) surveys were completed. Eighty women (67%) preferred immediate reporting, and 62 (78%) of these 80 patients would wait 30-60 min. The additional cost of immediate reporting is $28.22 per patient. Only 11% of patients were willing to pay this additional cost. When new equipment and space were not required, the cost would increase by $4.38. This cost was most influenced by the time required to give patients normal results.

CONCLUSION

Most surveyed patients preferred speaking with a radiologist immediately but were unwilling to pay additional fees. Radiologists, hospital administrators, and health care planners must be aware of the costs of immediate reporting and must factor these costs into any change in hospital or national policy.