New Anti-Infective Preparations of Naphthyloxypropargylpiperidine Series

1-alkyl-4-(3-naphthyloxyprop-1-ynyl)piperidine-4-ols have been obtained by the condensation of 1-alkyl-pipieridin-4-ones with 1- and 2-naphthoxypropines by the Favorsky method in absolute diethylether, in the presence of powered technical KОН, under atmospheric pressure. Acylation of tertiary naphthoxypropynyl piperidols by cyclopropanecarbonylchloride has been carried out in order to introduce a cyclopropanecarbonyl fragment into the structures of naphthoxypropargylpiperidines. The obtained esters of cyclopropanecarboxylic acid represent crystalline substances with the definite melting temperature, very soluble in water, ethanol, acetone. The composition and structure of the synthesized compounds have been confirmed by the data of elemental analysis, IR-spectroscopy, NMR-spectroscopy, the identity has been confirmed by thin-layer chromatography. The compounds under the code AIP (anti-infective preparation) have been studied for an antimicrobial activity in relation to museum microbial strains. The effects of these preparations have been assessed in vitro in relation to Bacillus subtilis ATCC 6633, Escherichia coli ATCC 25922, Salmonella enterica ATCC 14028 and Staphylococcus aureus ATCC 6538- P. It has been found that the compounds AIP-30 and AIP-31 possess an antimicrobial activity in relation to all strains of microorganisms, engaged in the experiment. AIP- 30 and AIP-31 have antimicrobial effects to different extents, AIP-30 has displayed the highest activity in relation to the museum strain Bacillus subtilis ATCC 6633 in the concentration of 250 μg/ml. It has been established that AIP-32 displays a selective antimicrobial activity towards one type, and AIP-33 ‒ towards two types of the museum strains, engaged in the experiment.

Greatly reduced risk of EBV reactivation in rituximab-experienced recipients of alemtuzumab-conditioned allogeneic HSCT

EBV-associated post-transplant lymphoproliferative disease (PTLD) remains an important complication of allogeneic haematopoietic stem cell transplantation (allo-HSCT). We retrospectively analysed the incidence and risk factors for EBV reactivation in 186 adult patients undergoing consecutive allo-HSCT with alemtuzumab T-cell depletion at a single centre. The cumulative incidence of EBV reactivation was 48% (confidence interval (CI) 41-55%) by 1 year, with an incidence of high-level EBV reactivation of 18% (CI 13-24%); 8 patients were concurrently diagnosed with PTLD. Amongst patients with high-level reactivation 31/38 (82%) developed this within only 2 weeks of first EBV qPCR positivity. In univariate analysis age⩾50 years was associated with significantly increased risk of EBV reactivation (hazard ratio (HR) 1.54, CI 1.02-2.31; P=0.039). Furthermore, a diagnosis of non-Hodgkin lymphoma (NHL) was associated with greatly reduced risk of reactivation (HR 0.10, CI 0.03-0.33; P=0.0001) and this was confirmed in multivariate testing. Importantly, rituximab therapy within 6 months prior to allo-HSCT was also highly predictive for lack of EBV reactivation (HR 0.18, CI 0.07-0.48; P=0.001) although confounding with NHL was apparent. Our data emphasise the risk of PTLD associated with alemtuzumab. Furthermore, we report the clinically important observation that rituximab, administered in the peri-transplant period, may provide effective prophylaxis for PTLD.

Potent sirtuin inhibition with 1,2,5-trisubstituted benzimidazoles

Benzimidazole analogs were previously shown to inhibit sirtuin activity. Novel compound 5i was found to be a potent SIRT2 inhibitor with an IC50 value of 2.92 μM.

Transfusion in CMV seronegative T-depleted allogeneic stem cell transplant recipients with CMV-unselected blood components results in zero CMV transmissions in the era of universal leukocyte reduction: a U.K. dual centre experience

OBJECTIVES

To establish rates of cytomegalovirus (CMV) transmission with use of CMV-unselected (CMV-U), leukocyte-reduced blood components transfused to CMV-seronegative patient/CMV-seronegative donor (CMV neg/neg) allogeneic stem cell transplantation (SCT) recipients including those receiving T-depleted grafts.

BACKGROUND

CMV infection remains a major cause of morbidity following SCT. CMV-seronegative SCT recipients are particularly at risk of transfusion transmitted CMV (TT-CMV) and until recently they have received blood components from CMV-seronegative donors with significant resource implications. Although leukocyte reduction of blood components is reported to minimise risk of TT-CMV, its efficacy in high-risk situations, such as in T-depleted transplant recipients, is unknown.

METHODS

We retrospectively analysed the incidence of TT-CMV in CMV neg/neg allogeneic SCT recipients transfused with CMV-U, leukocyte-reduced blood components in two transplantation centres in the UK. Patients were monitored for CMV infection by weekly CMV polymerase chain reaction testing. Leukocyte reduction of blood components was in accordance with current UK standards.

RESULTS

Among 76 patients, including 59 receiving in vivo T-depletion, no episodes of CMV infection were detected. Patients were transfused with 1442 CMV-unselected, leukocyte-reduced components, equating to 1862 donor exposures.

CONCLUSIONS

Our findings confirm the safety of leukocyte reduction as a strategy in preventing TT-CMV in high-risk allogeneic SCT recipients.

Evaluation of occupational and patient radiation doses in orthopedic surgery

This study intends to measure the radiation dose to patients and staff during (i) Dynamic Hip Screw (DHS) and (ii) Dynamic Cannula Screw (DCS) and to evaluate entrance surface Air kerma (ESAK) dose and organ doses and effective doses. Calibrated Thermoluminescence dosimeters (TLD-GR200A) were used. The mean patients' doses were 0.46mGy and 0.07mGy for DHS and DCS procedures, respectively. The mean staff doses at the thyroid and chest were 4.69mGy and 1.21mGy per procedure. The mean organ and effective dose for patients and staff were higher in DHS compared to DCS. Orthopedic surgeons were exposed to unnecessary radiation doses due to the lack of protection measures. The radiation dose per hip procedure is within the safety limit and less than the previous studies.

Atypical blood and bone marrow lymphocytes in ALK-positive anaplastic T-cell lymphoma: important lessons

A 42-year-old man presented with a short history of fever, significant weight loss and bilateral neck swelling. A CT scan revealed widespread lymphadenopathy and hepatosplenomegaly. Lymph node morphology and immunohistochemistry confirmed a diagnosis of anaplastic lymphoma kinase (ALK)-positive anaplastic T-cell non-Hodgkin's lymphoma. Both the peripheral blood (PB) and bone marrow (BM) revealed atypical lymphocytes with cleaved nuclei, vacuolation and granulation, suggestive of disease involvement at both sites. However, BM and PB immunophenotyping and immunohistochemistry did not reveal typical markers (ALK and CD30) at either site. All features resolved with a short remission after conventional chemotherapy. Despite salvage chemotherapy and an autologous stem cell transplant, a relapse of the PB and BM features with stable radiological findings was noted. Rapid decline followed with pancytopenia resulting in death 12 months after the initial diagnosis.

Structure–electrical conductivity of polyvinylidene fluoride/graphite composites

Graphite powder was introduced into polyvinylidene fluoride via the solution mixing technique. The composites were then subjected to hot compression molding. The effect of dispersion of graphite particles and electrical conductivity of the composites were investigated. Solution mixing enabled homogeneous dispersion of graphite powder within the polyvinylidene fluoride matrix as revealed by transmission electron microscopy. X-ray diffraction and Fourier transform infrared spectroscopy analysis revealed that graphite incorporation induced the α-phase of polyvinylidene fluoride. The DC conductivity results showed that the conductivity increased with an increase in graphite content. Beyond a critical concentration of graphite, percolation threshold, (Φ c = 2.3 vol%) the conductivity increases by five orders of magnitude at 3.9 vol% of graphite powder composite. The electrical conductivity was approximately constant for the composites with the higher graphite loading. Consequently, adding more graphite powder did not significantly alter the electrical conductivity. The correlation between the dispersion of graphite particles and electrical conductivity was discussed. The AC conductivity of composites was investigated in a wide range of frequencies from 50 Hz to 5 MHz and at temperatures ranging from room temperature to 180°C. The conductivity of the composites exhibited strong frequency dependence particularly in the vicinity of the electrical percolation threshold. σAC obeyed the power law of the form: [Formula: see text], where ω is the angular frequency and s and A the characteristic parameters. The values of the exponent ( s) were found to decrease with increasing temperature which is consistent with the correlated barrier-hopping model.

Respiratory viral infections during the 2009-2010 winter season in Central England, UK: incidence and patterns of multiple virus co-infections

Acute viral respiratory infections are the most common infections in humans. Co-infection with different respiratory viruses is well documented but not necessarily well understood. The aim of this study was to utilise laboratory data from the winter season following the 2009 influenza A(H1N1) outbreak to investigate rates of respiratory virus co-infections, virus prevalence in different age groups and temporal variations in virus detection. The Health Protection Agency Public Health Laboratory (HPA PHL) Birmingham, UK, routinely uses polymerase chain reaction (PCR) to detect common respiratory viruses. The results from specimens received for respiratory virus investigations from late September 2009 to April 2010 were analysed. A total of 4,821 specimen results were analysed. Of these, 323 (13.2 %) had co-detections of two viruses, 22 (0.9 %) had three viruses and four (0.2 %) had four viruses. Reciprocal patterns of positive or negative associations between different virus pairs were found. Statistical analysis confirmed the significance of negative associations between influenza A and human metapneumovirus (HMPV), and influenza A and rhinovirus. Positive associations between parainfluenza with rhinovirus, rhinovirus with respiratory syncytial virus (RSV) and adenovirus with rhinovirus, parainfluenza and RSV were also significant. Age and temporal distributions of the different viruses were typical. This study found that the co-detection of different respiratory viruses is not random and most associations are reciprocal, either positively or negatively. The pandemic strain of influenza A(H1N1) was notable in that it was the least likely to be co-detected with another respiratory virus.

Surgical excision for B3 breast lesions diagnosed by vacuum-assisted core biopsy

The aim of this retrospective study was to assess whether open surgical excision is required following a B3 diagnosis on 11-gauge vacuum-assisted core biopsy (VACB) of radiologically indeterminate breast lesions.

PATIENTS AND METHODS

Twenty-four women with a histological diagnosis of the B3 category on VACB of radiologically indeterminate breast lesions were identified over a 3-year period. The VACB procedure was performed under stereotactic (n=21), ultrasound (n=2) or magnetic resonance imaging (MRI) (n=1) guidance using the Suros system. Nineteen patients underwent open surgical excision. The remaining 5 patients who had 'complete' removal of the radiological abnormality using VACB under ultrasound (n=2, papilloma) or stereotactic (n=4, atypical ductal hyperplasia) guidance were followed up clinically and radiologically.

RESULTS

The median patient age was 49 years. The disease status in three patients was upgraded to ductal carcinoma in situ at open surgical excision. The VACB showed atypical lobular hyperplasia in these 3 patients, associated with microcalcification (n=2) or mass lesion (n=1). No single case of upgrading to invasive breast cancer was identified in our series. The remaining patients (16 out of 19) had a benign biopsy. The upgrade to malignancy was significantly associated with the presence of atypical lobular hyperplasia, a BI-RADS category of 4 and incomplete removal of the radiological abnormality by VACB. After a mean follow-up of 18 months, no malignancy was detected in the 5 patients who did not undergo open surgical biopsy.

CONCLUSION

Open surgical excision is strongly recommended for atypical lobular hyperplasia identified in VACB specimens. VACB can be a safe alternative to surgery in the treatment of B3 lesions in selected cases, providing thorough multidisciplinary discussion has taken place.