Studies on the effect of preservatives on physico-chemical, microbiological and sensory quality of kunda

Kunda, an indigenous heat desiccated sweet product prepared from milk and added sugar, has a shelf-life of a few days under market conditions. In this study, effect of preservatives viz. potassium sorbate and nisin on the shelf-life of kunda stored at 30° and 5 °C was investigated. During storage, several changes took place in physico-chemical and sensory characteristics, the changes being faster at 30° than at 5 °C. There was little effect of preservatives per se on the quality of kunda, but changes were slower in kunda preserved with nisin. Kunda packaged in LDPE pouches or tin cans and stored at 30° and 5 °C, irrespective of the presence or absence of preservatives, was stable for 42 and 90 days respectively. Increase in osmotic pressure due to high levels of sugar in kunda might be responsible for containing the growth of microbes in the product.

Limb lengthening over plate

BACKGROUND

The limb lengthening over plate eliminates the associated risk of infection with limb lengthening over intramedullary nail. We present our experience of limb lengthening in 15 patients with a plate fixed on the proximal segment, followed by corticotomy and application of external fixator.

MATERIALS AND METHODS

15 patients (7 females, 8 males) were included in this consecutive series. The average age was 18.1 years (range 8-35 years). Fifteen tibiae and one femur were lengthened in 15 patients. Lengthening was achieved at 1 mm/day followed by distal segment fixation with three or four screws on reaching the target length.

RESULTS

The preoperative target length was successfully achieved in all patients at a mean of 4.1 cm (range 1.8-6.5 cm). The mean duration of external fixation was 75.3 days (range 33-116 days) with the mean external fixation index at 19.2 days/cm (range 10.0-38.3 days/cm). One patient suffered deep infection up to the plate, three patients had mild procurvatum deformities, and one patient developed mild tendo achilles contracture.

CONCLUSION

Lengthening over a plate allows early removal of external fixator and eliminates the risk of creating deep intramedullary infection as with lengthening over nail. Lengthening over plate is also applicable to children with open physis.

OT1-03-03: Effect of Tamoxifen Therapy on Inhibition of Tumor Suppressor p53 by Estrogen Receptor

Background: A large number of patients with estrogen receptor (ER)-positive tumors are resistant to tamoxifen (TAM). Although several plausible reasons for such resistance have been suggested, the mechanisms remain unclear. ER mediates effects of estrogen by promoting proliferation of breast cancer cells. Tumor suppressor protein p53 guards against tumorigenesis by preventing proliferation of cells with genomic damage. Dr. Das's laboratory previously reported that ER binds and functionally suppresses wild type p53 in human breast cancer cells and xenograft tumor tissue, and TAM is capable of inhibiting this interaction. We hypothesize that relieving suppression of wild type p53 by ER could be an important mechanism underlying TAM action in breast cancer. To test this hypothesis, we have initiated a pilot randomized clinical trial of 50 women with newly diagnosed ERa-positive breast cancer.

Specific Aims: 1) To investigate the effect of a short pre-surgical intervention with TAM on the ER-p53 interaction in ER-positive, p53 wild type breast tumors and 2) To confirm the wild type status of p53 and analyze the functional status of the p53 pathway by monitoring expression of selected p53 target genes in tumors that have and have not been treated with TAM.

Trial design: A randomized clinical trial in the pre-surgical setting was proposed with either TAM 20mg for four weeks vs. no intervention. Patients randomized to the TAM arm will undergo multiple pharmacokinetic and phamacodynamic measurements of TAM metabolites and genotyping for common polymorphisms of TAM metabolism genes, CYP2D6 and CYP3A4/5. Fresh tumor tissue will be harvested from all patients at the time of surgery for analysis of ER-p53 protein interaction using tissue chromatin immunoprecipitation (tissue ChIP) assay. p53 gene status will be determined by sequencing. RNA and protein expression of ER, p53, and a selected group of ER and p53 target genes in the diagnostic core biopsy and surgical specimens will be analyzed by quantitative real-time PCR (qRTPCR) and immunohistochemistry (IHC). TAM metabolites will also be measured in the tumor and the surrounding benign tissue.

Eligibility criteria: Women greater or equal to eighteen years of age diagnosed with ER-positive invasive breast cancer (approximately 1cm in size) who will undergo primary surgical excision for their initial therapy are eligible. Women must not be pregnant, be on current hormonal therapy, or have a history of hypercoagulable syndrome or prior arterial or venous thrombosis.

Statistical methods: Descriptive statistics such as frequencies and relative frequencies will be computed for all categorical variables. Numeric variables will be summarized using simple descriptive statistics such as mean, standard deviation, and quartiles. Ninety-five percent confidence intervals will be computed. ChIP data will be subjected to Fisher's Exact Test. IHC date will be analyzed by Wilcoxon-Mann-Whitney test.

Present accrual and target accrual: We have accrued 17 patients to date and plan to accrue a total of 50 patients, 25 in each arm.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr OT1-03-03.

A single-centre chart review exploring the adjusted association between breast cancer phenotype and prognosis

PURPOSE AND METHODS

Using a retrospective chart review, we investigated the differences in survival and prognostic factors between patients with triple-negative breast cancer (tnbc) and those with non-tnbc. The review included 1018 breast cancer patients who were diagnosed between 2000 and 2005 in Essex, Kent, and Lambton counties in Ontario, Canada.

RESULTS

Our findings indicate that, although the unadjusted results suggested that patients with tnbc were more likely than patients with non-tnbc to die [hazard ratio (hr): 2.29; 95% confidence interval (ci): 1.33 to 2.93], an adjusted survival analysis revealed no significant difference in overall survival between the groups (hr: 1.22; 95% ci: 0.63 to 2.39). The significant predictors of survival in the adjusted analysis were age, stage of cancer, and size of cancer.

CONCLUSIONS

Our findings support those of earlier reports, which suggest that presenting tumour size is the most important prognostic factor in tnbc. Investigations into unique screening methods to identify these tumours at an earlier stage and to prevent advanced-stage cancer in this patient subpopulation are necessary.

Oral health related quality of life among children with parents and those with no parents

OBJECTIVES

To compare the oral health related quality of life (OHRQoL) and caries status between school children living with their parents and orphan children, and to assess the factors that influence the oral health related quality of life.

METHODS

Study sample consisted of 279 school children living with their parents and 257 orphan children thus making a total sample of 536 school children. Sampling frame comprised of 12-15 year old children attending two upper primary public schools and two special schools for orphan children at Udaipur city, India. Clinical examination for caries status and personal interviews for oral health related quality of life were conducted by a single investigator.

RESULTS

Children without parents presented poor scores for OHRQoL compared to those having parents. Caries status was significantly related to OHRQoL and its domains. Subjects with no caries reported good OHRQoL which deteriorated as the caries score increased. Children who never visited dentist reported poorer OHRQoL than regular visitors and males experienced better oral health quality of life than females. All the four variables (gender, group, dental visits and DMFT) entered the step wise linear regression analysis when the effect of each independent variable was adjusted for all others and were responsible for a variance of 21.6% for OHRQoL; however DMFT constituted the first best predictor which solely explained a variance 15.8%.

CONCLUSIONS

Oral health related quality of life along with its domains differed significantly between children with and without parents. Furthermore, gender, dental visiting habits and caries status significantly influenced the OHRQoL.

Combined liver kidney transplantation: critical analysis of a single-center experience

Combined liver kidney transplantation (LKT) can be successfully performed on patients with liver and renal failure; however, outcomes are inferior to liver transplantation alone (OLT). Our aim was to determine the indications for and outcome of LKT and whether patients with longer wait times required more frequent LKT versus OLT alone. We included 18/93 adults who underwent LKT from August 2007 to August 2010 for hepatitis C virus (HCV, n = 7), alcohol (n = 5), nonalcoholic steatohepatitis (n = 2), primary biliary sclerosis, polycystic kidney disease with liver involvement, hepatic adenomatosis, and ischemic hepatitis. Eleven were originally listed for LKT and 7 required listing for-kidney transplantation while awaiting OLT. Eight were on dialysis when first listed and 10 had a low glomerular filtration rate or known kidney disease. The mean calculated Model for End-Stage Liver Disease (MELD) score for LKT was 31.2 ± 3.54. Seven had hepatocellular carcinoma in explants. Two patients had acute cellular kidney rejection that responded to treatment. Recurrence of HCV was documented in 5 patients within 6 months of LKT; 2/5 received HCV therapy (interferon and ribavirin) without renal allograft rejection. One-year liver graft/patient survival was 94% after LKT. One patient died at 6 months post LKT due to severe HCV recurrence. Last mean serum creatinine level was 1.35 ± 0.28 mg/dL for LKT patients. LKT is a safe procedure with favorable outcomes even in patients with a high MELD score. Transplantation of patients with a high MELD score due to regional variations in organ allocation results in additional use of kidneys by OLT patients. Improved organ allocation algorithms in OLT would help to reduce combined transplants, sparing more kidneys.

High resolution array comparative genomic hybridization identifies copy number alterations in diffuse large B-cell lymphoma that predict response to immuno-chemotherapy

Despite recent attempts at sub-categorization, including gene expression profiling into prognostically different groups of "germinal center B-cell type" and "activated B-cell type," diffuse large B-cell lymphoma (DLBCL) remains a biologically heterogenous tumor with no clear prognostic biomarkers to guide therapy. Whole genome, high resolution array comparative genomic hybridization (aCGH) was performed on four cases of chemoresistant DLBCL and four cases of chemo-responsive DLBCL to identify genetic differences that may correlate with response to rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) therapy. Array CGH analysis identified seven DNA copy number alteration (CNA) regions exclusive to the chemoresistant group, consisting of amplifications at 1p36.13, 1q42.3, 3p21.31, 7q11.23, and 16p13.3, as well as loss at 9p21.3 and 14p21.31. Copy number loss of the tumor suppressor genes CDKN2A (p16, p14) and CDKN2B (p15) at 9p21.3 was validated by fluorescence in situ hybridization and immunohistochemistry as independent techniques. In the chemo-sensitive group, 12 CNAs were detected consisting of segment gains on 1p36.11, 1p36.22, 2q11.2, 8q24.3, 12p13.33, and 22q13.2, as well as segment loss on 6p21.32. RUNX3, a tumor suppressor gene located on 1p36.11 and MTHFR, which encodes for the enzyme methylenetetrahydrofolate reductase, located on 1p36.22, are the only known genes in this group associated with lymphoma. Whole genome aCGH analysis has detected copy number alterations exclusive to either chemoresistant or chemoresponsive DLBCL that may represent consistent clonal changes predictive for prognosis and outcome of chemotherapy.

Tooth cleaning frequency in relation to socio-demographic variables and personal hygiene measures among school children of Udaipur district, India

OBJECTIVE

The aim of the study was to determine if frequency of tooth cleaning varies with social group, family size, bedtime and other personal hygiene habits among school children.

METHODS

Target population comprised schoolchildren aged 8-16 years of Udaipur district attending public schools. A two stage cluster random sampling procedure was executed to collect the representative sample, consequently final sample size accounted to 852 children. Data were collected by means of structured questionnaires which consisted of questions related to oral hygiene habits including a few general hygiene habits, bed time, family size, family income and dental visiting habits.

RESULTS

The results show that 30.5% of the total sample cleaned their teeth twice or more daily and there was no significant difference between the genders for tooth cleaning frequency. Logistic regression analysis revealed that older children and those having less than two siblings were more likely to clean their teeth twice a day than the younger ones and children with more than two siblings. Furthermore, frequency of tooth cleaning was significantly lower among children of parents with low level of education and less annual income as compared with those of high education and more annual income. In addition, tooth cleaning habits were more regular in children using tooth paste and regularly visiting to the dentist.

CONCLUSIONS

This study observed that tooth cleaning is not an isolated behaviour, but is a part of multifarious pattern of various social and behavioural factors.

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.

Management of thromboangiitis obliterans using distraction osteogenesis: A retrospective study

BACKGROUND

Thromboangiitis obliterans (TAO), also known as Buerger disease, is characterized by thrombosis in medium-sized arteries and veins along with a marked inflammatory response. TAO can be managed by using the principle of distraction osteogenesis to induce neoangiogenesis. We report thirty patients of TAO in the age-group of 20-50 years were treated with the Ilizarov method.

MATERIALS AND METHODS

Patients with severe rest pain (n=30), absent distal pulsation (n=30) and ulcer (n=6) and/or gangrene of the toes (n=4), who had failed the conservative pharmacological modalities of treatment were included. A lateral tibial corticotomy was performed and distraction applied by use of olive wire. A two-ring frame was used for all cases.

RESULTS

Of the 30 cases, 25 patients became pain free while 1 had partial relief of pain. The four patients worsened on treatment and developed frank infection were amputed. The average distraction was 1.8±0.3 mm (range: 1.5-2.2 cm). The mean consolidation period was 98±11 days, after which the fixator was removed. The total duration of treatment was 122±23 days. There were two cases of osteomyelitis in our series; both healed after debridement and both patients had good result, with relief of pain. The ulcers started healing by 4-6 weeks.

CONCLUSION

The principle of the distraction osteogenesis including neoangiogenesis can be used for treatment of TAO and has an acceptable complication rate.

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

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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.