Development of a new reproductive tissue cryopreservation clinical service for children: the Oxford programme

PURPOSE

This article describes the development of a new reproductive tissue cryopreservation clinical service for children at high risk of infertility in the NHS during times of severe financial constraints in the health service.

METHOD

A development plan with two phases was drawn up. Phase 1 restricted the service to childhood cancer patients referred to the Oxford Paediatric Oncology and Haematology Principle Treatment Centre. It was estimated that there would be 10 patients/year and used existing staff and facilities from paediatric oncology, surgery, anaesthetics radiology, pathology, psychology, teenage-young adult gynaecology, and an existing Human Tissue Authority tissue bank with a licence for storage of tissue under a Human Sector Licence. Phase 2 extended the service to include children and young adults across England, Wales and Ireland-patients from Scotland having access to a research programme in Edinburgh. The main challenge in phase 2 being resources and the need for patients to be able to be treated as close to home as safely as possible.

RESULTS

The Oxford team developed information resources and eligibility criteria based on published best practice, referral and treatment pathways, multidisciplinary team meetings, a network of third party sites, and a dedicated case management and database. As the programme expanded, the Oxford team was able to justify to management the need for a dedicated theatre list. Patient feedback through questionnaires, qualitative work conducted as part of a Ph.D. thesis as well as direct patient stories and interviews in TV, and radio features underpins the positive impact the programme has on patients and their families.

CONCLUSION

The Oxford Reproductive Cryopreservation programme delivers fertility preservation treatment to children and young adults at high risk of infertility safely, effectively and as close to home as possible. The onward view is to apply for national funding for this programme for recognition and sustainability.

A Phase I/II Study of Stereotactic Hypofractionated Once-weekly Radiation Therapy (SHORT) for Prostate Cancer

AIMS

Stereotactic radiation therapy has been investigated predominantly in patients with low-intermediate-risk disease. We conducted a clinical trial of stereotactic hypofractionated radiation therapy delivered in once-weekly fractions on patients with all-risk non-metastatic disease to test feasibility, acute toxicities and patient-reported outcomes.

MATERIALS AND METHODS

In this phase I/II study, 30 patients with prostatic adenocarcinoma, any Gleason score, T1-4N0 and prostate-specific antigen ≤60 ng/ml were treated with volumetric intensity modulated arc radiation therapy to a dose of 35 Gy in five fractions delivered once weekly. Patients with high-risk disease also received elective nodal irradiation to a dose of 25 Gy in five fractions simultaneously. Androgen deprivation was offered to intermediate- and high-risk patients. The primary outcome was acute toxicity. Secondary outcome measures included biochemical control and late toxicity. Patient-reported outcomes were measured using the International Prostate Symptom Score and European Organization for Research and Treatment of Cancer (EORTC) Quality-of-Life Questionnaire (QLQ).

RESULTS

All 30 patients completed treatment per-protocol. Most patients had T3 (60%) and Gleason 7 (50%) tumours. The median prostate-specific antigen was 17 ng/ml. High-risk disease was present in 20 patients (66.7%). There was a low incidence of acute toxicities (grade 2 + urinary 3.3%, grade 2 rectal 0%). Within the EORTC QLQ framework, only the urinary symptom score showed a clinically meaningful worsening from a mean of 20/100 at baseline to 34/100 at the end of treatment (P < 0.001), but reduced to 24/100 at 6 months (P = 0.08). With a median follow-up of 41.5 months, two patients each reported grade 2 late urinary and rectal toxicity. The 3- and 4-year biochemical control rates were 96.7 and 87.9%, respectively.

CONCLUSION

In a cohort of mainly high-risk cancers, stereotactic once-weekly radiation therapy was easy to implement and well tolerated, with a low incidence of acute and late toxicity and excellent biochemical control.

B-09 Cerebral Grey Matter After Out-Of-Hospital Cardiac Arrest In Good Outcome Survivors

Objective

The purpose of this study was to evaluate the impact of out-of-hospital cardiac arrest (OHCA) on cognitive functioning and brain volumes, in good outcome survivors.

Method

Participants were medically stable OHCA survivors. Two control groups were also recruited: patients who experienced myocardial infarction (MI), and healthy controls (HC) with no history of cardiovascular disease. Neuropsychological assessment was conducted using the Neuropsychological Assessment Battery (NAB). Imaging was performed on a 3T Siemens Trio MRI scanner. Cerebral grey matter volume (GM; measured by voxel-based morphometry in SPM12) results are presented.

Results

Participants (nOHCA = 9, nMI = 19, nHC = 13) ranged in age from 30 to 85 years. When controlling for age, whole-brain analyses revealed decreased GM in anterior cingulate cortex, bilateral hippocampus in the OHCA and in the MI group compared to the HC group. In addition, the MI group had decreased GM compared to the HC in the thalamus and the right dorsolateral prefrontal cortex (p < .001). No significant differences in GM were observed between the MI and OHCA groups. The hippocampus was selected as a region-of-interest for further analyses. The Total NAB Index was correlated with hippocampal GM in the OHCA group but not in the MI group (rOHCA = .78, p = .014).

Conclusions

Results revealed select areas of GM reduction in OHCA and MI groups, suggesting a contribution of cardiovascular disease to observed atrophy. Reductions are related to cognitive performance only in the cardiac arrest group which may suggest that these volume losses represent clinically meaningful changes.

FNAC and Its Utility in Solitary Thyroid Nodule and Its Correlation with Histopathological Examination

Discrete swelling in one lobe of thyroid gland with no palpable abnormality elsewhere is termed as a solitary thyroid nodule. FNAC is the investigation of choice in solitary nodule for selection of surgical cases due to compliance, simple and quick to perform. The aim of this study was to evaluate the utility of FNAC in solitary thyroid nodule with the relation of histopathological findings. In this prospective observational study fifty (50) patients of solitary thyroid nodule without multinodular goitre, diffuse goitre, dominant nodule and clinically hypothyroidism or hyperthyroidism were included from admitted patients of different institutes of Comilla both private and government Medical College Hospital, Bangladesh. All patients were clinically examined and investigation findings from thyroid scan, ultrasonogram of thyroid gland, FNAC of thyroid nodule, histopathological report of excised thyroid were collected and posted into data collection sheet. The data were analysed with simple statistical table. The result showed that among 50 patients 41 patients were detected as benign nodule after FNAC which is about 82%. Malignant lesions were 12% (6 patients) and 6% (3 patients) of the case was indeterminate as because the specimen were unsatisfactory. The sensitivity, specificity, and accuracy of FNAC diagnosis in relation to histopathological findings were 100%, 83.33% and 97.87%. So FNAC is sensitive and accurate method for evaluation of solitary thyroid nodules.

Diurnal and seasonal patterns of soil CO2 efflux from the Pichavaram mangroves, India

The diurnal and seasonal variation of soil carbon dioxide (CO₂) flux was measured in the Pichavaram mangrove forest, the Southeast coast of India from February 2016 to October 2016 using an automated soil CO₂ flux chamber system. Maximum soil CO₂ efflux reached at 14:00 h and minimum at 00:00 h. The surface soil CO₂ concentration ranged from 375 to 532 ppm with the mean 405 ± 18 ppm. The daily soil CO₂ flux varied from near zero to about 7 μmol m^-2 s^-1 with a mean value of 2.4 ± 1.3 μmol m^-2 s^-1. The highest seasonal CO₂ efflux from soil was during the summer and premonsoon seasons, whereas low flux values were recorded during the monsoon season. Soil CO₂ efflux values were highly correlated with soil temperature. Tidal inundation during monsoon season, extreme drought condition in summer, and unusual precipitation are the major factors controlling the soil CO₂ flux.

Modern rain-isotope data from Indian island and the mainland on the daily scale for the summer monsoon season

The atmospheric stable isotopes in rainwater are measured as the ratio of heavy to the lighter (e.g., ¹⁸O/¹⁶O). This data article describes two datasets of daily rain isotopic variations during the Indian Summer Monsoon (ISM) season. Firstly, an island site (namely Port Blair) dataset for four years (2012-2015) and another dataset of Indian mainland sites (namely Nagpur, Tezpur, and Kolkata) for the year 2015. Port Blair is strategically situated in the Bay of Bengal (BoB), which is known to be a significant moisture source to ISM rainfall over the Indian landmass. On the other hand, sites in the mainland are receivers of the BoB moisture. This dataset includes 1030 isotopic analyses made on daily water samples as well as rainfall amount (24 hours) during ISM. The data is related to "Isotopic investigation of the moisture transport processes over the Bay of Bengal" [1].

Historical Expansion of Kyasanur Forest Disease in India From 1957 to 2017: A Retrospective Analysis

A highly infectious tick-borne virus causes Kyasanur Forest disease (KFD), which has been expanding in recent decades in India. Current studies do not provide an updated understanding of the disease trends and its expansion in India. We address this gap in the literature through a detailed review to reveal the annual historic expansion of KFD cases across the span of years from 1957 to 2017. In addition, we explore the factors that may have led to the geographic expansion of KFD. The annual numbers of cases of KFD among humans are estimated using peer-reviewed journal articles, Pro-MED database, historical and archived newspapers, and government reports, technical reports, publications, and medical websites. From 1957 to 2017, there were an estimated 9,594 cases of KFD within 16 districts in India. The most significant human outbreaks of the disease were in the years 1957-1958 (681 cases), 1983-1984 (2,589 cases), 2002-2003 (1,562 cases), and 2016-2017 (809 cases). In 2015, KFD appeared in Goa. In 2016, new cases emerged in Belgaum, a district in Karnataka state, and in the Sindhudurg district in Maharashtra state. The processes by which KFD persists and spreads are not clear, but demographic, socioeconomic, political, and environmental factors seem to play a role.

Disparate effects of antibiotics on hypertension

Gut microbiota are associated with a variety of complex polygenic diseases. The usage of broad-spectrum antibiotics by patients affected by such diseases is an important environmental factor to consider, because antibiotics, which are widely prescribed to curb pathological bacterial infections, also indiscriminately eliminate gut commensal microbiota. However, the extent to which antibiotics reshape gut microbiota and per se contribute to these complex diseases is understudied. Because genetics play an important role in predisposing individuals to these modern diseases, we hypothesize that the extent to which antibiotics influence complex diseases depends on the host genome and metagenome. The current study tests this hypothesis in the context of hypertension, which is a serious risk factor for cardiovascular diseases. A 3 × 2 factorial design was used to test the blood pressure (BP) and microbiotal effects of three different antibiotics, neomycin, minocycline, and vancomycin, on two well-known, preclinical, genetic models of hypertension, the Dahl salt-sensitive (S) rat and the spontaneously hypertensive rat (SHR), both of which develop hypertension, but for different genetic reasons. Regardless of the class, oral administration of antibiotics increased systolic blood pressure of the S rat, while minocycline and vancomycin, but not neomycin, lowered systolic blood pressure in the SHR. These disparate BP effects were accompanied by significant alterations in gut microbiota. Our study highlights the need to consider an individualized approach for the usage of antibiotics among hypertensives, as their BP could be affected differentially based on their individual genetic and microbiotal communities.

Removal of fluoride from wastewater using HCl-treated activated alumina in a ribbed hydrocyclone separator

Excessive fluoride concentration in wastewater is a major health concern worldwide. The main objective of wastewater treatment is to allow industrial effluents to be disposed of without danger to the human health and the natural environment. In this current study, experiments have been conducted to remove fluoride from aqueous solution using alumina and HCl (Hydrochloric acid) treated activated alumina in a continuous mode. A spiral rib was introduced in the cylindrical part of the conventional hydrocyclone to increase the performance, and the new hydrocyclone is dubbed as ribbed hydrocyclone. Experiments were carried out to analyze the performance of the ribbed hydrocyclone and compared the results with the conventional hydrocyclone of the same dimension. The efficiency of conventional and ribbed hydrocyclone at a slurry flow rate of 50 LPM (liter per minute) for the solid concentration of 1.4 wt% were 80% and 93.5% respectively. The cut size d₅₀ of the conventional and ribbed hydrocyclone was 18 µm and 13 µm respectively at a slurry velocity of 50 LPM. Fluoride removal efficiency using alumina and HCl-treated alumina was also investigated in a continuous mode by the ribbed hydrocyclone. Maximum fluoride removal efficiency was 49.5%, and 80% for alumina and HCl-treated alumina for the initial concentration of 10 mg/L at a slurry flow rate of 50 LPM.

Isotopic study of intraseasonal variations of plant transpiration: an alternative means to characterise the dry phases of monsoon

The isotopic characteristics of plant transpired water are strongly controlled by soil evaporation process, primarily by relative humidity. The monsoon system is characterised by large variability of several atmospheric parameters; the primary one being the rainfall, which in turn, modulates the relative humidity. Due to the strong dependency of transpiration on relative humidity, it is expected that this process would vary in accordance with the active and break periods of the monsoon season, which are known to produce cycles of humid and relatively dry phases during a monsoon season. To study the transpiration process, an experiment was conducted wherein rainwater and transpired water were collected from a few plants and analyzed for their isotopic ratios during the summer monsoon seasons of 2016 and 2017. The difference between the isotopic characteristics of the transpired water and rain water is expected to be nominally positive, however, a large variability was observed. This difference is found to be high (low) during the reduced (enhanced) humidity conditions and varies in tandem with the break and active phases of the monsoon season. This characteristic feature may thus be used to delineate the dry and wet phases of monsoon on local to regional scale.

Reduced graphene oxide-loaded nanocomposite scaffolds for enhancing angiogenesis in tissue engineering applications

Tissue engineering combines cells, scaffolds and signalling molecules to synthesize tissues in vitro. However, the lack of a functioning vascular network severely limits the effective size of a tissue-engineered construct. In this work, we have assessed the potential of reduced graphene oxide (rGO), a non-protein pro-angiogenic moiety, for enhancing angiogenesis in tissue engineering applications. Polyvinyl alcohol/carboxymethyl cellulose (PVA/CMC) scaffolds loaded with different concentrations of rGO nanoparticles were synthesized via lyophilization. Characterization of these scaffolds showed that the rGO-loaded scaffolds retained the thermal and physical properties (swelling, porosity and in vitro biodegradation) of pure PVA/CMC scaffolds. In vitro cytotoxicity studies, using three different cell lines, confirmed that the scaffolds are biocompatible. The scaffolds containing 0.005 and 0.0075% rGO enhanced the proliferation of endothelial cells (EA.hy926) in vitro. In vivo studies using the chick chorioallantoic membrane model showed that the presence of rGO in the PVA/CMC scaffolds significantly enhanced angiogenesis and arteriogenesis.