Multistrain influenza protection induced by a nanoparticulate mucosal immunotherapeutic

All commercial influenza vaccines elicit antibody responses that protect against seasonal infection, but this approach is limited by the need for annual vaccine reformulation that precludes efficient responses against epidemic and pandemic disease. In this study we describe a novel vaccination approach in which a nanoparticulate, liposome-based agent containing short, highly conserved influenza-derived peptides is delivered to the respiratory tract to elicit potent innate and selective T cell-based adaptive immune responses. Prepared without virus-specific peptides, mucosal immunostimulatory therapeutic (MIT) provided robust, but short-lived, protection against multiple, highly lethal strains of influenza in mice of diverse genetic backgrounds. MIT prepared with three highly conserved epitopes that elicited virus-specific memory T-cell responses but not neutralizing antibodies, termed MITpep, provided equivalent, but more durable, protection relative to MIT. Alveolar macrophages were more important than dendritic cells in determining the protective efficacy of MIT, which induced both canonical and non-canonical antiviral immune pathways. Through activation of airway mucosal innate and highly specific T-cell responses, MIT and MITpep represent novel approaches to antiviral protection that offer the possibility of universal protection against epidemic and pandemic influenza.

Abnormalities of the corpus callosum in non-psychotic high-risk offspring of schizophrenia patients

Alterations in the structure of the corpus callosum (CC) have been observed in schizophrenia. Offspring of schizophrenia parents have 10-15 times higher risk for developing schizophrenia. We examined CC volume in offspring at genetic high-risk (HR) subjects. Since the sub-regions of the CC are topographically mapped to cortical brain regions, we hypothesized that HR subjects may show a decrement in total volume and differential volume decreases in sub-regions of the CC. The offspring of schizophrenia parents (HR; n=70; 36 males) and healthy volunteers with no family or personal history of psychotic disorders (healthy controls (HC); n=73; 37 males) matched for age, gender and education were selected for the study. Magnetic resonance images were collected using a GE 1.5 T scanner and processed using FreeSurfer image analysis software. The CC was divided into five neuroanatomically based partitions. The volume of total CC and the five sub-regions were measured blind to clinical information. With covariation for intracranial volume, HR subjects had significantly reduced total CC, more prominently observed in the anterior splenium. An age-related increase in CC volume was found in the anterior and posterior splenium of healthy controls but not in HR subjects. The volume reduction was greater in male than female HR subjects. The volume reduction in the CC may reflect a reduction in axonal fibers crossing the hemispheres and/or myelination between the left and right temporo-parietal cortices. The absence of an age-related volume increase suggests an abnormal developmental trajectory that may underlie susceptibility to schizophrenia.

Dental health behaviour in relation to caries status among medical and dental undergraduate students of Udaipur district, India

OBJECTIVE

To compare the caries status and oral hygiene behaviour of dental and medical students and to assess the influence of oral hygiene behaviour on the caries status.

METHODS

A questionnaire survey was conducted to assess the knowledge, attitudes and behaviour along with clinical examination to asses the caries status. A total of 403 dental and medical students enrolled with Rajasthan University of Health Sciences of Udaipur district, India were recruited in the study.

RESULTS

56.4% of dental students brushed their teeth twice daily compared to 38.5% of medical students. There was no significant difference between the mean decayed components of males and females of dental stream, whereas among medical subjects, males had a higher decayed score than females (P = 0.012). The mean behaviour score obtained by dental students (19.38) was greater than that of medical students (18.34). Moreover, medical students presented a higher decayed, missing and filled teeth (DMFT) score (1.96) than dental students (1.16). Subjects who had a habit of brushing after every meal showed lower DMFT score (1.4) than those who brushed only once a day (1.64). Step-wise linear regression analysis revealed that course of education and final behaviour score were the best predictors for the DMFT status.

CONCLUSION

This study revealed significant differences between the oral hygiene behaviour and caries status of dental and medical students; furthermore, caries status was significantly influenced by the oral hygiene behaviour.

Asymptomatic, isolated tubercular splenic abscess, in an immunocompetent person

Tubercular splenic abscess in an immunocompetent person, especially when the patient is without any symptoms, is a rare clinical entity. We report a case of isolated tubercular splenic abscess in a 38-year-old asymptomatic healthy female and emphasize the importance of careful smear examination. The patient had come to the hospital for repair of vaginal vault prolapse. Her abdominal ultra sonography showed normal sized spleen with hypoechoic areas suggesting abscess. Fine needle aspiration of splenic lesion revealed tubercle bacilli on Ziehl Neelsen stain. The organisms also grew on culture. The splenic lesions cleared after six months of treatment with anti tubercular drugs at our Directly Observed Treatment centre under Revised National TB Control Programme. The patient was operated successfully for vault prolapse one year later.

Pregnancy-associated breast cancer: spectrum of imaging appearances

Delay in diagnosis of pregnancy-associated breast cancer (PABC) is common, often attributed to the difficulty in evaluating tumours in the gravid breast, low awareness among physicians and reluctance of patients and physicians to perform imaging or invasive procedures during pregnancy. Familiarity with imaging features of PABC is crucial for prompt diagnosis. This article illustrates imaging findings of PABC and provides an approach for the evaluation of pregnant and lactating women with palpable abnormalities.

Cytogenetic and array-CGH characterization of a complex de novo rearrangement involving duplication and deletion of 9p and clinical findings in a 4-month-old female

Approximately 15 patients with partial trisomy 9p involving de novo duplications have been previously described. Here, we present clinical, cytogenetic, FISH and aCGH findings in a patient with a de novo complex rearrangement in the short arm of chromosome 9 involving an inverted duplication at 9p24→p21.3 and a deletion at 9pter→p24.2. FISH probes generated from BACs selected from the UCSC genome browser were utilized to verify this rearrangement. It is likely that some previously described duplications of 9p may also be products of complex chromosomal aberrations. This report in which FISH and aCGH were used to more comprehensively characterize the genomic rearrangement in a patient with clinical manifestations of 9p duplication syndrome underscores the importance of further characterizing cytogenetically detected rearrangements.

Genetic Susceptibility as a Possible Risk Factor for Breast Cancer

Background: Established risk factors for breast cancer (BC) only explain 25% to 47% of BC incidence. The Gail model is commonly used to assess BC risk and determine eligibility for prevention trials. Unfortunately, it has a discriminatory accuracy of 58% at the individual level. A greater understanding of BC risk factors is needed to offer improved risk stratification and prevention. It is plausible that BC risk may be related to deficiencies or abnormalities in DNA repair and cell cycle checkpoints because of their importance in maintaining genomic integrity. Recent epidemiologic studies support this hypothesis. In this pilot project, the bleomycin mutagen sensitivity assay (MSS), a measure of genetic susceptibility was performed on women of low, intermediate, and high risk based on commonly used risk models to determine if there was any correlation between MSS and established BC risk factors.Methods: Women in the Prevention Clinic at RPCI consented to donate blood for this study as part of the Data Bank and BioRepository (DBBR). Gail and Claus Models were calculated using CancerGene. Women were stratified into three groups low (<20%), intermediate (20%-35%), and high (> 35%) lifetime BC risk. For logistic regression analysis, women were grouped into low risk (<20%) and high risk (≥20%). MSS in blood lymphocytes were performed at LCCC using fresh blood samples. The mean values of MSS were compared between low, intermediate, and high risk groups using Wilcoxon-Mann-Whitney tests. Multivariate logistic regression was used to analyze the relationship between BC risk groups and MSS.Results: A total of 78 women were enrolled in the study. MSS were performed on 70 blood samples and 67 had evaluable slides. There were 30, 26 and 11 women in the low, intermediate, and high risk groups respectively. The mean age was 49.1 years. There was no statistical difference between the three groups with respect to age, race, menopausal status, proportion of patients with a family history of BC or another cancer, and smoking status (never, former, or current). The mean MSS score was not significantly different among the three risk groups: mean ±SD = 0.86±0.37, 0.84±0.37 (p=0.565), and 0.76+0.44 (0.361) for low, intermediate and high risk groups respectively. Spearman correlation revealed that MSS score did not correlate with Gail lifetime BC risk score (r=-0.054, p=0.668) or Claus model-10 year risk score (r=-0.057, p=0.722). Using the median in low risk women as a cut point, when women who had higher MSS score were compared with women had lower MSS score, the adjusted OR was 1.16 (95% CI, 0.29 to 4.57), adjusted for age, race, smoking status, BMI and menopausal status. When the MSS score were categorized into quartiles, no significant dose-response relationship was observed.Conclusions: In this pilot study, there was no correlation between commonly used breast cancer risk assessment models based on hormonal, family and biopsy history and the MSS in our study population. Previous case-control studies have consistently shown that MSS is significantly associated with BC risk. The lack of correlation between mutagen sensitivity and Gail or Claus risk score suggests that mutagen sensitivity may measure the host susceptibility factors that are not considered by Gail or Claus risk models.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6067.

A Population Based Patterns of Care Study for Male Breast Cancer in Ontario

Background: Tamoxifen has been the standard endocrine treatment for both early breast cancer (EBC) and metastatic breast cancer (MBC) in women for over 30 years(y). Over the last decade the third generation aromatase inhibitors (AIs) have proven effective in the treatment of MBC and are incorporated into adjuvant therapy for EBC. Due to the rarity of male breast cancer there are no trials to guide therapy and treatment decisions in men are made by extrapolation from the existing published data for women. We set out to conduct a population based cohort study in the most populous Canadian province to describe contemporary patterns of Tamoxifen and AI use for male breast cancer from 1992-2007.Methods: In the province of Ontario cancer reporting is mandatory and date of diagnosis (Dx) and death are collected by the Ontario Cancer Registry (OCR), but stage information is not uniformly available. The government of Ontario subsidizes drugs for individuals >65y through the Ontario Drug Benefits (ODB) program and maintains electronic prescription records for all eligible citizens. Linkage of these administrative databases allowed us to assemble a cohort of male breast cancer cases in order to describe patterns of endocrine therapy and outcomes.Results: Through OCR we identified 845 cases of invasive male breast cancer (ICD9 175) with a date of Dx between 03Jan1992 and 27Dec2007. Mean age at the time of Dx was 66.9 ±12.6y, median age was 68y, range 16-97y respectively. A total of 490 men were ≥66y at Dx. Using ODB prescription records between 01Jan1992 and 31Dec2008 we looked for a first prescription for any of the following drugs: Tamoxifen(T), Anastrozole(A), Letrozole(L), or Exemestane(E). As stage information is not uniformly available in OCR, prescription <12 months from Dx was used as a surrogate for therapy with adjuvant intent (EBC group) and those with a first prescription for T or an AI >12 months from Dx were classified as MBC. Using these criteria, 172 cases received no prescription for endocrine therapy (35.0% stage unknown), 297 cases were EBC (271 prescribed T (55.3%) and 26 prescribed an AI (5.3%) < 1 y of Dx and 21 (4.3%) were MBC being prescribed either T or an AI > 1 y post Dx. Prescription of endocrine therapy increased over time: 60% (92-99) vs. 68% in (00-08) At a median follow up of 46.3 months overall survival(OS) is 64.96% for the entire group, 53.27% for stage unknown, 72.17% for EBC and 60.53% for MBC and has not changed significantly over time; 66.33% for 92-99 and 64% for 00-08 for the group as a whole.Conclusions: In this provincial cohort of male breast cancer spanning a 15 y period we observed that: 1) most men are prescribed some form of adjuvant endocrine therapy and in keeping with the paucity of data for AIs in male breast cancer, Tamoxifen was the most commonly prescribed agent; 2) use of endocrine therapy increased over time; 3) overall survival has not changed significantly over time. This study is limited by its use of administrative data, retrospective nature, and by the surrogate assignation of stage. That said, it does represent the largest cohort of male breast cancer and describes trends in modern endocrine therapy.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2108.

Quality of life of parents of children with newly diagnosed specific learning disability

BACKGROUND

Poor school performance in children causes significant stress to parents.

AIMS

To analyze the quality of life (QOL) of parents having a child with newly diagnosed specific learning disability (SpLD) and to evaluate the impact of clinical and socio-demographic characteristics on their QOL.

DESIGN

Cross-sectional questionnaire-based study.

SETTING

Learning disability clinic in tertiary care hospital.

MATERIALS AND METHODS

From June 2006 to February 2007, 150 parents (either mother or father) of children consecutively diagnosed as having SpLD were enrolled. Parent's QOL was measured by the WHOQOL-100 instrument which is a generic instrument containing 25 facets of QOL organized in six domains.

STATISTICAL ANALYSIS USED

Independent samples t-test, one-way analysis of variance, and multiple regression analysis were carried out for statistical significance.

RESULTS

Mean age of parents was 42.6 years (SD 5.5); mothers to fathers ratio 1.3:1; and 19 (12.7%) were currently ill. Only four WHOQOL-100 domains (psychological > social relationships > environment > spiritual) and five WHOQOL-100 facets (leisure > feel > energy > esteem > sex) contributed significantly to their "overall" QOL. Female gender, being currently ill, being in paid work, and having a male child were characteristics that independently predicted a poor domain/facet QOL score.

CONCLUSIONS

The present study has identified domains and facets that need to be addressed by counselors for improving overall QOL of these parents. Initiating these measures would also improve the home environment and help in the rehabilitation of children with SpLD.

Functional and fibrinogen receptor studies in platelets in pre-eclamptic toxaemia of pregnancy

It is believed that platelets play a key role in the production of pre-eclamptic toxaemia and toxaemia of pregnancy. Toxaemia of pregnancy is described as a condition of chronic DIC where there is thrombocytopenia as well as raised fibrin degradation products. Since fibrinogen receptors are involved in the final stage of the platelet aggregation reaction, we wanted to investigate the platelet receptors for fibrinogen in normal and abnormal pregnancy. Thirty-six normal pregnant women (12 in their 2nd trimester, 24 in their 3rd trimester), 24 pregnant pre-eclamptic toxaemia cases and 16 non-pregnant controls were included in the present study. All patients with pre-eclamptic toxaemia had oedema, proteinuria and hypertension. Flow cytometric study of platelets was undertaken utilizing fluorescein isothiocyanate (FITC)-labelled anti-human fibrinogen antibody in unstimulated and ADP-stimulated (final concentration 0.02 M) platelets. The intensity of platelet fluorescence was classified into three groups and expressed in arbitrary units. The results indicate that there are a higher number of stimulated platelets expressing fibrinogen receptors in the circulation of patients with pre-eclampsia. Thus, it is possible to hypothesize that platelets showing increased fibrinogen receptors aggregate and form microthrombi in smaller vessels in women with pre-eclamptic toxaemia.

Determinants for oral hygiene and periodontal status among mentally disabled children and adolescents

AIM

To assess the impact of socio-demographic and clinical variables on the oral hygiene and periodontal status in a sample of mentally disabled subjects.

MATERIALS AND METHODS

Study sample comprised of 171 mentally disabled subjects attending a special school in Udaipur, India. Oral hygiene status was assessed by Simplified Oral Hygiene Index (OHI-S) and periodontal status by Community Periodontal Index.

RESULTS

Stepwise linear regression analysis revealed that the best predictors in the descending order for oral hygiene index were disabled sibling, medical diagnosis, IQ level, education of mother and father. Having Down syndrome, less educated parents, poor economic status and a disabled sibling were the most important predictors for poor periodontal status.

CONCLUSIONS

The present study highlighted that the oral hygiene and periodontal status of the present study population is poor and was influenced by medical diagnosis, IQ level, disabled sibling, parent's level of education and economic status.

Perceived sources of stress amongst Indian dental students

INTRODUCTION

Dental students have to face the additional stress of their studies in addition to the stresses related to dentistry as a profession. Furthermore, increasing stress may result in declining student performance. The aim of the present study was to assess perceived sources of stress amongst dental undergraduate students at a private dental institution in India.

MATERIALS AND METHODS

A modified dental environment stress (DES) questionnaire which consisted of 38 questions was used to assess the levels of stress.

RESULTS

The first major stressor for all the students was examination and grades with a mean score of 2.86 (SD 1.06) followed by full working day, receiving criticism from supervisors about academic or clinical work, amount of cheating in dental faculty, rules and regulations of the faculty and fear of unemployment after graduation. Amongst the six highest stressors in each year, at least three were dental faculty related. There was a significant difference in stress perception between genders with a predilection for males. Twelve of the 38 questionnaire items had significant differences across the year groups including clinical DES items.

CONCLUSION

The primary sources of stress as perceived by nearly 275 students at one private dental school in India were examinations and grades followed by full working day and receiving criticism from supervisors about academic or clinical work. It appears there is a need for the establishment of student advisors and counsellors combined with a faculty advising system in addition to student-oriented programmes.

Studies on the ABH-Iso-Agglutinins in serum, saliva and milk from mothers with "Bombay" (Oh) phenotype

Background:

ABO blood group iso-antibodies are naturally occurring antibodies found in serum and other body fluids.

Methods:

Serum, saliva and milk samples from 5 mothers identified as “Bombay” phenotype were tested for ABH-iso-antibodies by routine serological techniques.

Results:

All the five mothers showed presence of iso-antibodies in the samples tested. Higher titer values in milk than their serum were observed on subjects whose samples were collected in immediate post-partum phase as compared to those whose samples were collected after a lapse of a few months.

Conclusion:

High titer iso-agglutinins against ABH antigens were detected in milk samples besides their presence in saliva as well as serum.

Transrectal ultrasound-guided biopsy of recurrent cervical carcinoma

The objective of this study was to evaluate the feasibility, safety and diagnostic accuracy of transrectal ultrasound (TRUS)-guided core biopsy for recurrent carcinoma of the uterine cervix in patients with non-diagnostic vaginal cytology and transvaginal punch biopsy.17 patients with clinical and imaging suspicion of recurrent carcinoma of the cervix, and with negative cytology and punch biopsy, were referred for TRUS-guided biopsy of a recurrent mass. Data were collected with respect to demography, previous diagnosis, treatment received, size and location of the recurrent lesion, and biopsy results. Adequate samples were obtained for all patients. TRUS-guided biopsy was technically successful in all of the patients and provided histological diagnosis of recurrence in 16 patients. One of the patients had post-radiation fibrosis. There were no procedure-related complications. In conclusion, TRUS-guided biopsy for recurrent cervical cancer is a feasible, safe and accurate method for establishing a histopathological diagnosis. It should be considered in patients with non-diagnostic vaginal cytology and punch biopsy.

Hemifacial microsomia: a case report

Hemifacial microsomia is a congenital malformation in which there is a deficiency in the amount of hard and soft tissue on one side of the face. It is primarily a syndrome of the first branchial arch, involving underdevelopment of the temporomandibular joint, mandibular ramus, masticatory muscles and the ear. The affected ear may have an external soft-tissue malformation in addition to being lower set than on the contra lateral side. Hearing loss may result from underdevelopment of the osseous components of the auditory system and a diminished or absent external auditory meatus. Occasionally, second branchial arch defects involving the facial nerve and facial muscles coexist with Hemifacial microsomia. Radiographic examination in case of Hemifacial microsomia is of limited value because of superimposition of normal and abnormal bony structures. The skeletal and soft-tissue findings of a patient with Hemifacial microsomia who underwent three-dimensional computerized tomography is presented here to improve our knowledge and diagnostic skill of this uncommon entity.

An open, randomized, controlled, phase II, single centre, two-period cross-over study to compare the quality of life and toxicity experienced on PEG interferon with interferon-α2b in patients with multiple myeloma maintained on a steady dose of interferon-α2b

PURPOSE

To compare the effects of pegylated interferon-alpha2b (P-IFN) and interferon-alpha2b (IFN) on quality of life (QoL) and toxicity in patients with multiple myeloma maintained on a steady dose of IFN.

PATIENTS AND METHODS

Consenting, eligible myeloma patients on IFN maintenance therapy for at least 6 weeks were randomly (1:1) allocated to receive P-IFN for 3 months followed by IFN for 3 months, or to continue with IFN for 3 months followed by P-IFN for 3 months (cross-over design). Patients were assessed for toxicity and QoL. Dose of P-IFN was equivalent to IFN.

RESULTS

The study enrolled 60 patients. At enrollment, 35 patients were in complete remission, 20 in partial remission and 5 were minimal responders. P-IFN was associated with significantly better global QoL score (mean difference 8.4; P = 0.0002). There was a significant improvement in functional scales--physical (P = 0.03), emotional (P = 0.04), social (P = 0.0008) with P-IFN. Fatigue (P = 0.0003), pain (P = 0.02) and appetite loss (P = 0.003) symptom scales were less in patients while on P-IFN. There were no statistically significant differences between treatment arms in QoL as measured by QLQ-MY24.

CONCLUSION

These data suggest that patients on P-IFN have a better QoL. Dose escalation studies are warranted to investigate potential impact on survival.

A phase 1 study of the selective cyclin dependent kinase inhibitor P276–00 in patients with advanced refractory neoplasms

14117

Background: In human cancers, genetic and epigenetic events result in over-expression of cyclins or absence or diminished levels of Cdk inhibitors, providing tumor cells with selective growth advantage. This has prompted the development of pharmacological Cdk inhibitors that could potentially produce anti-tumor effect. P276–00 is a selective Cdk4-D1 and Cdk1-B inhibitor. This study was designed to determine the maximum tolerated dose (MTD), toxicity profile, pharmacokinetics, and antitumour activity of P276–00 given intravenously to patients with advanced refractory solid tumours. Methods: P276–00 was administered in escalating doses to cohorts of eligible patients (pts), starting with a dose of 9 mg/m2 as a 30 minute iv infusion day 1 to 5, and day 8 to 12, q 3 weekly. To date 22 pts have been entered on the study (cohort 1 - 4 pts at 9 mg/m2, cohort 2 - 4 pts at 12.6 mg/m2, cohort 3 - 6 pts at 17.6 mg/m2, cohort 4 - 8 pts at 24.6 mg/m2) with PS 0–2, and mean age of 56 years. Pharmacokinetic profiles were obtained on cycle 1 days 1 and 5. Skin biopsies were obtained immediately prior to starting study treatment and on day 21 of cycle 2 and will be analyzed for Ki67, cleaved caspase 3, phospho-Rb, cyclin D1 and cdk4, and microarray. Results: To date dose limiting toxicity has occurred in one pt. Grade 3 fatigue occurred in 1 pt at 17.6 mg/m2. The most common drug-related adverse events, which were all grade 1 or 2, were fatigue, nausea, hypotension, sweating, and dry mouth. No Grade 3 biochemical toxicities have been reported so far. There have been no responses noted to date. 4 pts have stable disease after 2 cycles. Pharmacokinetic results: The Cmax, t1/2, and AUC0–8 on day 1 were as follows: 9 mg/m2- 315 ng/mL, 6.6 hr, 883 ng.h/mL; 12.6 mg/m2- 402 ng/mL, 5.5 hr, 848 ng.h/mL; 17.6 mg/m2- 589 ng/mL, 5.3 hr, 1289 ng.h/mL; 24.6 mg/m2- 621 ng/mL, 5.6 hr, 1286 ng.h/mL. Conclusions: P276–00 is well tolerated, but grade 3 fatigue has been noted in 1 pt at 17.6 mg/m2 dose level. We have observed confirmed stable disease in one patient. PK results indicate that at 9 mg/m2,12.6 mg/m2, 17.6 mg/m2 and 24.6 mg/m2 we are able to cross the cdk4 enzyme IC50 approximately 10, 13, 19 and 20 times and cross the anti-proliferative IC50 1.1, 1.4, 2.1 and 2.2 times respectively. Accrual continues at the 34.4 mg/m2 dose level.

No significant financial relationships to disclose.

A channelized Hotelling observer study of lesion detection in SPECT MAP reconstruction using anatomical priors

In emission tomography, anatomical side information, in the form of organ and lesion boundaries, derived from intra-patient coregistered CT or MR scans can be incorporated into the reconstruction. Our interest is in exploring the efficacy of such side information for lesion detectability. To assess detectability we used the SNR of a channelized Hotelling observer and a signal-known exactly/background-known exactly detection task. In simulation studies, we incorporated anatomical side information into a SPECT MAP (maximum a posteriori) reconstruction by smoothing within but not across organ or lesion boundaries. A non-anatomical prior was applied by uniform smoothing across the entire image. We investigated whether the use of anatomical priors with organ boundaries alone or with perfect lesion boundaries alone would change lesion detectability relative to the case of a prior with no anatomical information. Furthermore, we investigated whether any such detectability changes for the organ-boundary case would be a function of the distance of the lesion to the organ boundary. We also investigated whether any detectability changes for the lesion-boundary case would be a function of the degree of proximity, i.e. a difference in the radius of the true functional lesion and the radius of the anatomical lesion boundary. Our results showed almost no detectability difference with versus without organ boundaries at any lesion-to-organ boundary distance. Our results also showed no difference in lesion detectability with and without lesion boundaries, and no variation of lesion detectability with degree of proximity.

Use of physiological doses of human growth hormone in haematological patients receiving intensive chemotherapy promotes haematopoietic recovery: a double-blind randomized, placebo-controlled study

In vivo and in vitro studies suggest human growth hormone (hGH) receptors on bone marrow stem cells may be biologically active and could be exploited to promote haemopoetic recovery after intensive chemotherapy. Patients with haematological malignancies receiving intensive chemotherapy and requiring hospitalization were randomized in a double-blind, placebo-controlled single-centre trial. Patients were randomly assigned to receive either hGH 500 microg/day or placebo, for 6 weeks. There was no significant difference in patient characteristics at baseline between the placebo and treatment arms. Patients treated with hGH showed significantly faster recovery of platelets to 25 x 10(9)/l (median of 16 versus 19 days; P = 0.03) compared to the placebo-controlled arm (hazard ratio 1.47 favouring hGH, 95% confidence interval (CI), 1.03-2.08). Time to relapse did not differ significantly between arms. There was no change in the anthropometric parameters at the start and end of hGH/placebo therapy. The study drug was well tolerated. Treatment with hGH in physiological doses improves platelet recovery, but is not associated with a lower relapse rate or improved anthropometric parameters in patients receiving intensive chemotherapy.

Flow cytometric quantification of antigen D sites on red blood cells of partial D and weak D variants in India

The D antigenic sites are diminished in weak D and partial D variants. The aim of this study was to estimate D antigen on RBC in weak D and partial D variants in Indian population by using flow cytometric method. Blood samples of 42 cases of partial D, eight cases of weak D and 123 normal Rh phenotypes identified by serological methods were used in the study. An indirect immunofluorescence method was employed using 29 monoclonal anti-D as primary antibody. The D antigenic sites were calculated using control RBC as internal standard. The D antigenic sites in weak D and partial D variants are less than that found in normal Rh phenotypes. In weak D, the D antigenic sites were between 1500 and 7000 D antigens per cell. Among partial D variants, DVI had minimum and DVa had maximum number of D sites. Flow cytometry is a very good tool for demonstrating minor variation in D antigen when serological methods are inconclusive. The D antigenic sites per RBC in partial D variants identified in Indian population are reported for the first time.

Lymphatic filariasis: possible pathophysiological nexus with oxidative stress

Wuchereria bancrofti-mediated lymphatic filariasis is widely prevalent. Diversity in immune response presumably may lead to myriad clinical presentations, such as overt chronic filariasis, occult filariasis with atypical systemic manifestation and asymptomatic microfilariae carrier state. Anticipated oxidative stress during inflammatory response to infective conditions might complicate the immune response and thus might alter the disease outcome. The present study was carried out to assess the status of oxidative stress in different clinical presentations of bancroftian filariasis. Twenty-five microfilariae carriers and 30 cases each of chronic filariasis and occult filariasis were compared to 30 endemic normal individuals. Serum malondialdehyde level and superoxide dismutase enzyme activity were measured by spectrophotometric methods and levels of filarial antigen were measured by ELISA. In the filarial cases, the levels of these parameters were assayed again after treatment with diethylcarbamazine citrate (DEC). Results showed significant (P<0.05) association of oxidative stress with chronic and occult filariasis but not with microfilarial carriers. DEC therapy in both clinical cases and carriers resulted in a significant reduction of oxidative stress associated with decreased antigen level (P<0.01). These findings suggest the possible involvement of oxidative stress in filarial disease pathology.

Study of association between p53 mutation and tamoxifen therapy in women with hormone receptor positive invasive ductal cancer

10630

Background: ERα promotes cell proliferation in breast tumors whereas p53 impedes cell cycle progression. We have reported direct link between these two opposing pathways. Our preclinical studies have demonstrated that ERα binds directly to p53 and negatively regulates its function and that anti estrogens disrupted the ERα- p53 interaction. Previous retrospective studies by us and others in advanced breast cancer patients had shown presence of wild type p53 in ER+ve breast tumors is associated with better response to endocrine therapy. Objective: To demonstrate women with hormonal receptor(ER) +ve non-metastatic invasive ductal cancer (IDC) with wild type p53 in the tumor tissue will have better DFS and/or OS with tamoxifen compared to those with abnormal p53. Methods: Tissue micro array (TMA) from archival tumor tissue of patients with IDC seen at Roswell Park Cancer Institute (RPCI) between 1992 and 2001 was made. The p53 status was assessed by IHC staining of the TMA, was considered positive (abnormal) if ≥10% nuclear staining was noted. Only those patients in TMA with the following criteria were included for this report; non-metastatic IDC treated at RPCI, patients who received adjuvant tamoxifen (for ER+ve tumors), p53 IHC data available. Results: 83 patients in the TMA with ER+ve tumors who were treated with tamoxifen met the study criteria to test our hypothesis. 35 patients with ER-ve tumors were analyzed to evaluate p53 effect unrelated to p53-ER interaction. Median follow up was 5 years. 16/83 (19%) ER+ve tumors and 11/35 (31%) ER-ve tumors had abnormal p53. 14 (17%) ER+ve and 11(31%) ER-ve patients experienced recurrence. 16(19%) ER+ve and 6(17%) ER-ve patients died (all causes) during the follow up period. Univariate analysis with respect to p53 for OS and DFS were undertaken. No significant OS or DFS difference were noted between patients with tumor tissue wild type and abnormal p53, for both ER+ve or ER-ve tumors. Conclusions: This study does not show any difference in outcome with tamoxifen therapy between tumors with wild type and abnormal p53. A Study with larger sample size involving sequence analysis and IHC is required to conclusively demonstrate the effect of the two common occurrences (ER+ve and abnormal p53) and tamoxifen.

No significant financial relationships to disclose.

Prognostic significance of leptin (L) and leptin receptor (OB-R) expression in human breast cancer (BC)

20054

Background: L is a cytokine-like hormone that controls adipocyte mass and energy balance by binding to OB-R. Both L and OB-R have been implicated in carcinogenesis and were recently identified in human BC. The clinical significance of increased expression of L and OB-R in human BC is unclear. Methods: The anti-L rabbit (A-20) and anti-OB-R goat (M-18) polyclonal antibodies (ABs) from Santa Cruz Biotechnology were applied in indirect immunohistochemical (IHC) assays. Following antigen retrieval, ABs were reacted with 5 μm paraffin sections of tissue microarrays (TMAs). TMAs included 1mm cores of 316 women with operable BC and contained invasive cancer (IC), ductal carcinoma insitu (DCIS), surrounding histologically normal tissue (N) and nodal metastases (M). For L, nuclear (LN) and cytoplasmic (LC) staining were evaluated separately. For OB-R, one qualitative score (0, +1, +2, +3) was applied to each case. For analysis, 0, +1 were considered low and +2, +3 were considered high expression. Expression of LN, LC, and OB-R were evaluated with respect to clinicopathologic variables; disease free survival (DFS) and survival (S) were evaluated using Cox regression. Results: Median S and DFS were 11.4 and 10.1 years. Tissue from 113 patients with IC, 93 patients with N, 49 patients with M, and 36 patients with DCIS were evaluable for LC, LN and OB-R. OB-R expression was significantly higher in lobular vs. ductal carcinomas (p < .001). Increased expression of LC, LN, or OB-R was not associated with aggressive pathologic features studied in IC and DCIS. On multivariate analysis, highest expression of LN (+3) in IC was significantly associated with poor survival, p = .038, HR 3.51 (1.07–11.51 95% CI). Strong expression of LN in N was also associated with decreased survival, p = .043, HR 8.43 (1.07, 66.30 95% CI). Strong expression of OB-R expression in N was significantly associated with increased DFS and S, p = .004, HR 0.21 (.07–0.61 95% CI) and p = .007, HR .29 (.11–.71 95% CI). Conclusions: In this limited study, LN appears to have a negative impact on survival in women with invasive BC when elevated in IC and N. Elevated levels of LR appear to have a protective effect when elevated in N. Larger studies are needed to confirm our findings and elucidate the mechanisms responsible for these observations.

No significant financial relationships to disclose.

Raised Plasma Soluble P-Selectin in Peripheral Arterial Occlusive Disease Enhances Leukocyte Adhesion

Raised levels of soluble P-selectin (sP-selectin) have been reported in the plasma of patients with vascular diseases; however, the functional importance of this ligand remains unclear. In this study we have examined a potential role for plasma sP-selectin in regulating neutrophil adhesion in patients with peripheral arterial occlusive disease (PAOD). Patients with PAOD had significantly higher levels of sP-selectin (mean±SD: 73.3±13.0 versus 16.7±6.4 ng/mL) and enhanced whole blood leukocyte adhesion to platelets under shear. To examine whether the raised sP-selectin levels can directly influence leukocyte adhesion, isolated neutrophils were incubated with plasma from PAOD patients before and after immunodepletion of sP-selectin. Neutrophil adhesion to fibrinogen increased 2-fold following incubation with PAOD plasma, which was abrogated on sP-selectin immunodepletion. We subsequently demonstrated that recombinant sP-selectin dose-dependently (75 to 250 ng/mL) increased leukocyte adhesion to fibrinogen and platelet monolayers. This increase was PSGL-1 and Src kinase-dependent and correlated with an increase in sP-selectin-mediated Mac-1 activation. sP-selectin–stimulated neutrophil adhesion to platelet monolayers was inversely correlated with shear, such that at low shear (50 s −1 ) a 92.7%±15.7 increase in adhesion was observed decreasing to 38.5%±11.9 at 150 s −1 and 10.1%±7.4 at 300 s −1 . These studies suggest a potentially important role for sP-selectin in modulating neutrophil adhesion in patients with PAOD, particularly at sites of low shear, where it raises the possibility that raised plasma sP-selectin levels may enhance leukocyte recruitment to vascular injury and promote disease progression.

An elective single autograft with high-dose melphalan: single-center study of 451 patients

In all, 451 myeloma patients, 51% previously untreated, underwent elective single autotransplantation after 200 mg/m(2) melphalan between 1985 and 2001 at the Royal Marsden Hospital. The therapy sequence was: Induction (vincristine, doxorubicin, methylprednisolone+/-cyclophosphamide), marrow or filgrastim-mobilized blood stem cell harvest, autograft, and interferon-alpha2b maintenance. A total of 27 (6%) died of transplant-related toxicity, all within 3 months. Complete or near-complete remission was seen in 59% with an overall response rate of 91%. Subsequent disease progression was seen in 285, and 17 died of unrelated causes. In all, 206 patients were alive at the last follow-up, 6 months to 17.7 years post-transplant (median 65 months); 122 without disease progression at 6 months to 17.7 years (median 58 months). The median overall (OS) and event-free (EFS) survivals were 5.9 and 2.4 years, with 10-year OS and EFS probabilities of 31.4 and 16.5%, respectively. In Cox analysis, it was seen that significantly longer OS occurred for patients who had beta-2-microglobulin <3.5 mg/l (P<0.0001), age <60 years (P=0.001) and albumin > or =35 g/l (P=0.009). EFS was also longer if beta-2-microglobulin was <3.5 mg/l (P=0.0056) and patients were <60 years of age (P=0.033). We conclude that with a single planned autograft, patients with myeloma have an excellent outcome.

Non-dilated obstructed pelvicalyceal system

Renal insufficiency because of obstruction may not always be represented by dilated pelvicalyceal system. This may make diagnosis and thence the management very difficult with the present available investigative armamentarium. Experience and clinical acumen may help with a decision of empirical treatment in the form of stenting or nephrostomy in these cases. This may be diagnostic as well as curative of the renal failure. We present herewith three such challenging cases managed by us. We also have reviewed the literature as to the diagnosis and management of such cases.

Fungal contamination of air conditioning units in operating theatres in India

Postoperative fungal infections may be caused by discharge of spores from contaminated air conditioning (AC) units. The filters of such units may act as a nidus for the growth of fungi. In this survey, filters of AC units in 25 operating theatres in India were evaluated quarterly over two years. The overall rate of fungal colonization of the AC filters was 26%. In addition, window-mounted AC units had higher fungal counts than wall-mounted AC units. We conclude that although the exact load of fungal spores necessary to initiate infections is unknown, AC units in operating theatres should be meticulously maintained and frequently monitored to minimize the chances of growth and proliferation of potentially pathogenic fungi. Data from this study also suggest that the design of the AC unit may play an important role in reducing fungal spore counts in the air of operating theatres in developing countries.

Misplaced Macroplastique injection presenting as a vaginal nodule and a bladder mass

We describe a very unusual presentation of misplaced Macroplastique injection. This incidentally showed up as bladder lesion and vaginal nodule during a tension-free vaginal tape surgery.

"Minimal intervention management" for gastroschisis: a preliminary report

The replacement of eviscerated bowel, without anaesthesia, has been performed safely in stable neonates with gastroschisis. This technique, termed "minimal intervention management", was used in three infants treated at the Newborn Special Care Nursery of the University Hospital of the West Indies. Two infants had excellent results but one had bowel perforation during the procedure, necessitating conversion to formal laparotomy under general anaesthesia. In selected patients, advantages of this technique include the ability to be guided by patient response during the procedure in order to avoid excessive intra-abdominal tension, the avoidance of anaesthesia and minimal cost. This technique is proposed for wider use in developing countries.

Thrombolysis with percutaneous transluminal balloon angioplasty of a blocked modified Blalock-Taussig shunt

Transcatheter balloon recanalization of occluded Blalock-Taussig shunts in the early post-operative period has been reported in the past but there are issues regarding the role of thrombolysis in this situation. We present our experience with such a procedure in an infant with blocked modified Blalock-Taussig shunt.

Correlation between transvaginal ultrasound measured endometrial thickness and histopathological findings in Afro-Caribbean Jamaican women with postmenopausal bleeding

Postmenopausal bleeding is traditionally investigated with invasive procedures. Recent studies in white populations have suggested that these procedures can be avoided, as ultrasonographic endometrial thickness of < 5 mm is not associated with malignancy. We performed a prospective study in 75 Jamaican Afro-Caribbean women with postmenopausal bleeding to determine whether an endometrial thickness of < 5 mm excluded endometrial cancer. We also examined the aetiology of postmenopausal bleeding and looked for possible risk factors. Double-layer transvaginal ultrasonographic measurement of the endometrial thickness was followed by hysteroscopy, suction curettage and histopathological confirmation. Correlation between imaging and pathology was not reliable. Half the patients with endometrial cancer had an endometrial thickness of between 3 mm and 4 mm. Seventy per cent of the women with endometrial thickness of greater than 5 mm had benign pathology. Additionally, the following characteristics were found to be more strongly associated with women with endometrial cancer: age over 65 years and 5 or more years since menopause. However parity < 2 appeared not to have a significant effect.