An ethnopharmacological survey of medicinal plants traditionally used for cancer treatment in the Ashanti region, Ghana

AIMS

Cancer represents a major health burden and drain on healthcare resources in the world. The majority of the people of Africa still patronize traditional medicine for their health needs, including various forms of cancer. The aim of the following study is the identification of medicinal plants used for cancer treatment by the traditional healers in the Ashanti area of Ghana and to cross-reference the identified plant species with published scientific literature.

METHODOLOGY

Validated questionnaires were administered to 85 traditional healers in 10 communities within Ashanti region. For cross-validation, also 7 healers located outside Ashanti region were investigated to evaluate regional differences. Interviews and structured conversations were used to administer the questionnaires. Selected herbal material dominantly used by the healers was collected and identified.

RESULTS

The ethnopharmacological survey revealed 151 plant species used for cancer treatment. Identified species were classified into different groups according to their frequency of use, resulting in the "top-22" plants. Interestingly group I (very frequent use) contained 5 plant species (Khaya senegalensis, Triplochiton scleroxylon, Azadirachta indica, Entandrophragma angolense, Terminalia superba), three of which belong to the plant family Meliaceae, phytochemically mainly characterized by the presence of limonoids. Cross-referencing of all plants identified by current scientific literature revealed species which have not been documented for cancer therapy until now. Special interest was laid on use of plants for cancer treatment of children.

CONCLUSION

A variety of traditionally used anti-cancer plants from Ghana have been identified and the widespread use within ethnotraditional medicine is obvious. Further in vitro and clinical studies will be performed in the near future to rationalize the phytochemical and functional scientific background of the respective extracts for cancer treatment.

Late normal tissue response in the rat spinal cord after carbon ion irradiation

Background

The present work summarizes the research activities on radiation-induced late effects in the rat spinal cord carried out within the “clinical research group ion beam therapy” funded by the German Research Foundation (DFG, KFO 214).

Methods and materials

Dose–response curves for the endpoint radiation-induced myelopathy were determined at 6 different positions (LET 16–99 keV/μm) within a 6 cm spread-out Bragg peak using either 1, 2 or 6 fractions of carbon ions. Based on the tolerance dose TD₅₀ of carbon ions and photons, the relative biological effectiveness (RBE) was determined and compared with predictions of the local effect model (LEM I and IV). Within a longitudinal magnetic resonance imaging (MRI)-based study the temporal development of radiation-induced changes in the spinal cord was characterized. To test the protective potential of the ACE (angiotensin converting enzyme)-inhibitor ramipril™, an additional dose–response experiment was performed.

Results

The RBE-values increased with LET and the increase was found to be larger for smaller fractional doses. Benchmarking the RBE-values as predicted by LEM I and LEM IV with the measured data revealed that LEM IV is more accurate in the high-LET, while LEM I is more accurate in the low-LET region. Characterization of the temporal development of radiation-induced changes with MRI demonstrated a shorter latency time for carbon ions, reflected on the histological level by an increased vessel perforation after carbon ion as compared to photon irradiations. For the ACE-inhibitor ramipril™, a mitigative rather than protective effect was found.

Conclusions

This comprehensive study established a large and consistent RBE data base for late effects in the rat spinal cord after carbon ion irradiation which will be further extended in ongoing studies. Using MRI, an extensive characterization of the temporal development of radiation-induced alterations was obtained. The reduced latency time for carbon ions is expected to originate from a dynamic interaction of various complex pathological processes. A dominant observation after carbon ion irradiation was an increase in vessel perforation preferentially in the white matter. To enable a targeted pharmacological intervention more details of the molecular pathways, responsible for the development of radiation-induced myelopathy are required.

Rentabilitätsberechnung des Kaiserschnitts beim Schaf

Gegenstand: In der vorliegenden Studie wird eine Rentabilitätsberechnung zum Kaiserschnitt beim Schaf nach konservativ nicht korrigierbarer Schwergeburt erstellt. Material und Methode: Die Berechnungen stützen sich auf 119 durchgeführte Kaiserschnitte und das anschließende Schicksal der Mutterschafe und entwickelten Lämmer. Ergebnisse: Eine konservativ nicht korrigierbare Schwergeburt stellt für Schafhalter immer ein Verlustgeschäft dar. Werden die Tiere nicht behandelt, sondern euthanasiert, liegt der finanzielle Schaden bei 117,90 荤. Dieses Verlustgeschäft kann bei Tierhaltern mit mehr als 10 Mutterschafen durch eine Sectio caesarea um ca. 20% auf 95,08 荤 minimiert werden, weil diese Tierhalter mit der Mutterschaf-/ Grünlandprämie über eine zusätzliche Einnahmequelle pro Mutterschaf verfügen. Diese Berechung gilt nicht für Hobbyschafhalter mit weniger als 10 Mutterschafen, da hier die Einnahmen durch diese Prämien wegfallen. In diesen Fällen spielt jedoch meist nicht nur der ökonomische Aspekt für oder gegen die Operationsentscheidung eine Rolle. Schlussfolgerung: Die in dieser Studie dargestellten Berechnungen zeigen, dass der finanzielle Rahmen der Schafhaltung eng ist. Trotzdem stellt die Operation die ökonomisch überlegene Strategie gegenüber der Euthanasie dar, wenn Mutterschaf und Lämmer die Operation überleben. Mit 97,8%iger Wahrscheinlichkeit lohnt sich somit die operative Therapie.

Wound healing in rabbit corneas after flapless refractive lenticule extraction with a 345 nm ultraviolet femtosecond laser

PURPOSE

To characterize corneal wound healing in a rabbit model after flapless refractive lenticule extraction with a 345 nm ultraviolet femtosecond laser.

SETTING

Departments of Ophthalmology and Anatomy II, University of Erlangen-Nürnberg and Wavelight GmbH, Erlangen, Germany.

DESIGN

Experimental study.

METHODS

Flapless refractive lenticule extraction was performed in 1 eye each of 20 New Zealand white rabbits (-5.0 diopters). Groups of 4 animals were euthanized after 48 hours, 1 week, 2 weeks, 4 weeks, and 3 months, respectively. Corneal samples were prepared for histology and fluorescence microscopy. To assess corneal cell death, proliferation, and myofibroblastic transdifferentiation, terminal uridine deoxynucleotidyl nick end-labeling (TUNEL) assay as well as immunostaining for Ki67 and α-smooth muscle actin (αSMA) were performed on sagittal cryosections.

RESULTS

Histology revealed a zone of keratocyte depletion with a thickness of approximately 50 μm around the extraction site. At 48 hours, pronounced TUNEL staining of keratocytes was detected around the interface (159.9 cells/mm ± 18.4 [SD]), which steadily decreased to 74.9 ± 19.8 cells/mm at 1 week and 5.7 ± 4.8 cells/mm at 2 weeks. Ki67 staining of keratocytes was evident at 48 hours (10.0 ± 3.8 cells/mm), which then decreased at 1 week (5.2 ± 1.7 cells/mm) and 2 weeks (0.4 ± 0.5 cells/mm). From 4 weeks onward, no TUNEL or Ki67 staining was detected. The corneal stroma was αSMA-negative at all timepoints.

CONCLUSION

Application of the 345 nm laser showed no signs of problematic repair processes in the cornea, which supports the initiation of the clinical phase.

Relevance of liver-limited disease in metastatic colorectal cancer: Subgroup findings of the FIRE-3/AIO KRK0306 trial

In metastatic colorectal cancer (mCRC), liver-limited disease (LLD) is associated with a higher chance of metastectomy leading to long-term survival. However, limited data describes the prognostic and predictive relevance of initially unresectable LLD with regard to targeted first-line therapy. The present analysis investigated the relevance of initially unresectable LLD in mCRC patients treated with targeted therapy against either the epidermal growth factor receptor (EGFR) or vascular epithelial growth factor (VEGF). The analysis was performed based on FIRE-3, a randomized phase III trial comparing first-line chemotherapy with FOLFIRI plus either cetuximab (anti-EGFR) or bevacizumab (anti-VEGF) in RAS wild-type (WT) mCRC. Of 400 patients, 133 (33.3%) had LLD and 267 (66.8%) had non-LLD. Median overall survival (OS) was significantly longer in LLD compared to non-LLD patients (36.0 vs. 25.4 months; hazard ratio [HR] = 0.66; 95% confidence interval [CI]: 0.51-0.87; p = 0.002). In a multivariate analysis also including secondary hepatic resection as time-dependent variable, LLD status was independently prognostic for OS (HR = 0.67; 95% CI: 0.50-0.91; p = 0.01). As assessed by interaction tests, treatment benefit from FOLFIRI plus cetuximab compared to FOLFIRI plus bevacizumab was independent of LLD status with regard to objective response rate (ORR), early tumour shrinkage ≥20% (ETS), depth of response (DpR) and OS (all p > 0.05). In conclusion, LLD could be identified as a prognostic factor in RAS-WT mCRC, which was independent of hepatic resection in patients treated with targeted therapy. LLD had no predictive relevance since benefit from FOLFIRI plus cetuximab over bevacizumab was independent of LLD status.

Modeling Radiation Effects of Ultrasoft X Rays on the Basis of Amorphous Track Structure

There is experimental evidence that ultrasoft X rays (0.1-5 keV) show a higher biological effectiveness than high-energy photons. Similar to high-LET radiation, this is attributed to a rather localized dose distribution associated with a considerably smaller range of secondary electrons, which results in an increasing yield of double-strand breaks (DSBs) and potentially more complex lesions. We previously reported on the application of the Giant LOop Binary LEsion (GLOBLE) model to ultrasoft X rays, in which experimental values of the relative biological effectiveness (RBE) for DSB induction were used to show that this increasing DSB yield was sufficient to explain the enhanced effectiveness in the cell inactivation potential of ultrasoft X rays. Complementary to GLOBLE, we report here on a modeling approach to predict the increased DSB yield of ultrasoft X rays on the basis of amorphous track structure formed by secondary electrons, which was derived from Monte Carlo track structure simulations. This procedure is associated with increased production of single-strand break (SSB) clusters, which are caused by the highly localized energy deposition pattern induced by low-energy photons. From this, the RBE of ultrasoft X rays can be determined and compared to experimental data, showing that the inhomogeneity of the energy deposition pattern represents the key variable to describe the increased biological effectiveness of ultrasoft X rays. Thus, this work demonstrates an extended applicability of the amorphous track structure concept and tests its limits with respect to its predictive power. The employed model mechanism offers a possible explanation for how the cellular response to ultrasoft X rays is directly linked to the energy deposition properties on the nanometric scale.

Hot carrier relaxation in CdTe via phonon-plasmon modes

Carrier and lattice dynamics of laser excited CdTe was studied by time-resolved reflectivity for excitation fluences spanning about three orders of magnitude, from 0.064 to 6.14 mJ cm^-2. At fluences below 1 mJ cm^-2 the transient reflectivity is dominated by the dynamics of hybrid phonon-plasmon modes. At fluences above 1 mJ cm^-2 the time-dependent reflectivity curves show a complex interplay between band-gap renormalization, band filling, carrier dynamics and recombination. A framework that accounts for such complex dynamics is presented and used to model the time-dependent reflectivity data. This model suggests that the excess energy of the laser-excited hot carriers is reduced much more efficiently by emitting hybrid phonon-plasmon modes rather than bare longitudinal optical phonons.

Alteration of Multiple Leukocyte Gene Expression Networks is Linked with Magnetic Resonance Markers of Prognosis After Acute ST-Elevation Myocardial Infarction

Prognostic relevant pathways of leukocyte involvement in human myocardial ischemic-reperfusion injury are largely unknown. We enrolled 136 patients with ST-elevation myocardial infarction (STEMI) after primary angioplasty within 12 h after onset of symptoms. Following reperfusion, whole blood was collected within a median time interval of 20 h (interquartile range: 15-25 h) for genome-wide gene expression analysis. Subsequent CMR scans were performed using a standard protocol to determine infarct size (IS), area at risk (AAR), myocardial salvage index (MSI) and the extent of late microvascular obstruction (lateMO). We found 398 genes associated with lateMO and two genes with IS. Neither AAR, nor MSI showed significant correlations with gene expression. Genes correlating with lateMO were strongly related to several canonical pathways, including positive regulation of T-cell activation (p = 3.44 × 10^-5), and regulation of inflammatory response (p = 1.86 × 10^-3). Network analysis of multiple gene expression alterations associated with larger lateMO identified the following functional consequences: facilitated utilisation and decreased concentration of free fatty acid, repressed cell differentiation, enhanced phagocyte movement, increased cell death, vascular disease and compensatory vasculogenesis. In conclusion, the extent of lateMO after acute, reperfused STEMI correlated with altered activation of multiple genes related to fatty acid utilisation, lymphocyte differentiation, phagocyte mobilisation, cell survival, and vascular dysfunction.

Systematics of relative biological effectiveness measurements for proton radiation along the spread out Bragg peak: experimental validation of the local effect model

The purpose of this study is to compare the predictions of the local effect model (LEM) in an extensive analysis to proton relative biological effectiveness (RBE) experiments found in the literature, and demonstrate the capabilities of the model as well as to discuss potential limitations. 19 publications with in vitro experiments and 10 publications with in vivo experiments focusing on proton RBE along the spread out Bragg peak (SOBP) were considered. In total the RBE values of over 100 depth positions were compared to LEM predictions. The treatment planning software TRiP98 was used to reconstruct the proton depth dose profile, and, together with the physical dose distribution, the RBE prediction was conducted based on the LEM. Only parameters from photon dose response curves are used as input for the LEM, and no free parameters are introduced, thus allowing us to demonstrate the predictive power of the LEM for protons. The LEM describes the RBE adequately well within the SOBP region with a relative deviation of typically less than 10% up to 10 keV µm^-1. In accordance with previous publications a clear dependence of RBE on the dose-averaged linear energy transfer (LET_D) was observed. The RBE in the experiments tends to increase above 1.1 for LET_D values above 2 keV µm^-1 and above 1.5 for LET_D values higher than 10 keV µm^-1 (distal part of the SOBP). The dose dependence is most pronounced for doses lower than 3 Gy (RBE). However, both the LEM predictions and experimental data show only a weak dependence of RBE on the tissue type, as characterized by the α/β ratio, which is considered insignificant with regard to the general uncertainties of RBE. The RBE predicted by the LEM shows overall very good agreement with the experimental data within the SOBP region and is in better agreement with the experimental data than the constant RBE of 1.1 that is currently applied in the clinics. All RBE trends deduced from the experiments were also reflected by the LEM predictions, which are purely based on input parameters derived from low-LET photon radiation.

On-scene treatment of spinal injuries in motor sports

Because spinal cord injuries can have fatal consequences for injured race car drivers, prehospital treatment of spinal injuries is a major concern in motor sports. A structured procedure for assessing trauma patients and their treatment should follow established ABCDE principles. Only then, a stable patient could be further examined and appropriate measures can be undertaken. For patients in an acute life-threatening condition, rapid transport must be initiated and should not be delayed by measures that are not indicated. If a competitor must first be extricated from the racing vehicle, the correct method of extrication must be chosen. To avoid secondary injury to the spine after a racing accident, in-line extrication from the vehicle and immobilization of the patient are standard procedures in motor sports and have been used for decades. Since immobilization can be associated with disadvantages and complications, the need for immobilization of trauma patients outside of motor sports medicine has become the subject of an increasing number of reports in the scientific literature. Even in motor sports, where specific safety systems that offer spinal protection are present, the indications for spinal immobilization need to be carefully considered rather than being blindly adopted as a matter of course. The aim of this article is to use recent literature to present an overview about the treatment of spinal injuries in motor sports. Further, we present a new protocol for indications for immobilizing the spine in motor sports that is based on the ABCDE principles and takes into account the condition of the patient.

Effects of perceptual body image distortion and early weight gain on long-term outcome of adolescent anorexia nervosa

Anorexia nervosa (AN), a severe mental disorder with an onset during adolescence, has been found to be difficult to treat. Identifying variables that predict long-term outcome may help to develop better treatment strategies. Since body image distortion and weight gain are central elements of diagnosis and treatment of AN, the current study investigated perceptual body image distortion, defined as the accuracy of evaluating one's own perceived body size in relation to the actual body size, as well as total and early weight gain during inpatient treatment as predictors for long-term outcome in a sample of 76 female adolescent AN patients. Long-term outcome was defined by physical, psychological and psychosocial adjustment using the Morgan-Russell outcome assessment schedule as well as by the mere physical outcome consisting of menses and/or BMI approximately 3 years after treatment. Perceptual body image distortion and early weight gain predicted long-term outcome (explained variance 13.3 %), but not the physical outcome alone. This study provides first evidence for an association of perceptual body image distortion with long-term outcome of adolescent anorexia nervosa and underlines the importance of sufficient early weight gain.