Endoscopic ultrasound-guided fine needle aspiration of peritoneal nodules in patients with ascites of unknown cause

Ascites can pose a difficult diagnostic problem and in some patients, despite extensive work-up, diagnostic laparoscopy or laparotomy is required. We evaluated the usefulness of endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) of peritoneal nodules in 12  patients with undiagnosed ascites (9  men, 3 women; mean [SD] age 47.5 [11.8] years). On EUS, peritoneal deposits, noted as hyperechoic rounded lesions compared with surrounding anechoic ascitic fluid, were observed in 10/12  patients (83.3%). Cytological examination of EUS-FNA samples from these deposits revealed metastatic adenocarcinoma in four patients, poorly differentiated carcinoma in one patient and pseudomyxoma peritonei in one patient. It also revealed inflammatory cells without granulomas in four patients, and polymerase chain reaction (PCR) for Mycobacterium tuberculosis was positive in 2/4 patients (50%). Deposits were larger and clearly defined in malignant ascites in comparison with tubercular ascites. No complications of EUS-FNA were observed.

The first draft of the pigeonpea genome sequence

Pigeonpea (Cajanus cajan) is an important grain legume of the Indian subcontinent, South-East Asia and East Africa. More than eighty five percent of the world pigeonpea is produced and consumed in India where it is a key crop for food and nutritional security of the people. Here we present the first draft of the genome sequence of a popular pigeonpea variety 'Asha'. The genome was assembled using long sequence reads of 454 GS-FLX sequencing chemistry with mean read lengths of >550 bp and >10-fold genome coverage, resulting in 510,809,477 bp of high quality sequence. Total 47,004 protein coding genes and 12,511 transposable elements related genes were predicted. We identified 1,213 disease resistance/defense response genes and 152 abiotic stress tolerance genes in the pigeonpea genome that make it a hardy crop. In comparison to soybean, pigeonpea has relatively fewer number of genes for lipid biosynthesis and larger number of genes for cellulose synthesis. The sequence contigs were arranged in to 59,681 scaffolds, which were anchored to eleven chromosomes of pigeonpea with 347 genic-SNP markers of an intra-species reference genetic map. Eleven pigeonpea chromosomes showed low but significant synteny with the twenty chromosomes of soybean. The genome sequence was used to identify large number of hypervariable 'Arhar' simple sequence repeat (HASSR) markers, 437 of which were experimentally validated for PCR amplification and high rate of polymorphism among pigeonpea varieties. These markers will be useful for fingerprinting and diversity analysis of pigeonpea germplasm and molecular breeding applications. This is the first plant genome sequence completed entirely through a network of Indian institutions led by the Indian Council of Agricultural Research and provides a valuable resource for the pigeonpea variety improvement.

Splice variants of tissue factor promote monocyte-endothelial interactions by triggering the expression of cell adhesion molecules via integrin-mediated signaling

BACKGROUND

TF is highly expressed in cancerous and atherosclerotic lesions. Monocyte recruitment is a hallmark of disease progression in these pathological states.

OBJECTIVE

To examine the role of integrin signaling in TF-dependent recruitment of monocytes by endothelial cells.

METHODS

The expression of flTF and asTF in cervical cancer and atherosclerotic lesions was examined. Biologic effects of the exposure of primary microvascular endothelial cells (MVEC) to truncated flTF ectodomain (LZ-TF) and recombinant asTF were assessed.

RESULTS

flTF and asTF exhibited nearly identical expression patterns in cancer lesions and lipid-rich plaques. Tumor lesions, as well as stromal CD68(+)  monocytes/macrophages, expressed both TF forms. Primary MVEC rapidly adhered to asTF and LZ-TF, and this was completely blocked by anti-β1 integrin antibody. asTF- and LZ-TF-treatment of MVEC promoted adhesion of peripheral blood mononuclear cells (PBMCs) under orbital shear conditions and under laminar flow; asTF-elicited adhesion was more pronounced than that elicited by LZ-TF. Expression profiling and western blotting revealed a broad activation of cell adhesion molecules (CAMs) in MVEC following asTF treatment including E-selectin, ICAM-1 and VCAM-1. In transwell assays, asTF potentiated PMBC migration through MVEC monolayers by ∼3-fold under MCP-1 gradient.

CONCLUSIONS

TF splice variants ligate β1 integrins on MVEC, which induces the expression of CAMs in MVEC and leads to monocyte adhesion and transendothelial migration. asTF appears more potent than flTF in eliciting these effects. Our findings underscore the pathophysiologic significance of non-proteolytic, integrin-mediated signaling by the two naturally occurring TF variants in cancer and atherosclerosis.

First Report of Tomato chlorosis virus Infecting Tomato in Georgia

Tomato yellow leaf curl virus (TYLCV) and Tomato spotted wilt virus (TSWV) are prevalent in field-grown tomato (Solanum lycopersicum) production in Georgia. Typical TYLCV symptoms were observed during varietal trials in fall 2009 and 2010 to screen genotypes against TYLCV at the Coastal Plain Experiment Station, Tifton, GA. However, foliar symptoms atypical of TYLCV including interveinal chlorosis, purpling, brittleness, and mottling on upper and middle leaves and bronzing and intense interveinal chlorosis on lower leaves were also observed. Heavy whitefly (Bemisia tabaci (Gennadius), B biotype) infestation was also observed on all tomato genotypes. Preliminary tests (PCR and nucleic acid hybridization) in fall 2009 indicated the presence of TYLCV, TSWV, Cucumber mosaic virus, and Tomato chlorosis virus (ToCV); all with the exception of ToCV have been reported in Georgia. Sixteen additional symptomatic leaf samples were randomly collected in fall 2010 and the preliminary results from 2009 were used to guide testing. DNA and RNA were individually extracted using commercially available kits and used for PCR testing for ToCV, TYLCV, and TSWV. Reverse transcription (RT)-PCR with ToCV CP gene specific primers (4) produced approximately 750-bp amplicons from nine of the 16 leaf samples. Four of the nine CP gene amplicons were purified and directly sequenced in both directions. The sequences were 99.4 to 100.0% identical with each other (GenBank Accession Nos. HQ879840 to HQ879843). They were 99.3 to 99.5%, 97.2 to 97.5%, and 98.6 to 98.9% identical to ToCV CP sequences from Florida (Accession No. AY903448), Spain (Accession No. DQ136146), and Greece (Accession No. EU284744), respectively. The presence of ToCV was confirmed by amplifying a portion of the HSP70h gene using the primers HSP-1F and HSP-1R (1). RT-PCR produced approximately 900-bp amplicons in the same nine samples. Four HSP70h gene amplicons were purified and directly sequenced in both directions. The sequences were 99.4 to 99.7% identical to each other (Accession Nos. HQ879844 to HQ879847). They were 99.2 to 99.5%, 98.0 to 98.4%, and 98.9 to 99.3% identical to HSP70h sequences from Florida (Accession No. AY903448), Spain (Accession No. DQ136146), and Greece (Accession No. EU284744), respectively. TYLCV was also detected in all 16 samples by PCR using degenerate begomovirus primers PAL1v 1978 and PARIc 496 (3) followed by sequencing. TSWV was also detected in two of the ToCVinfected samples by RT-PCR with TSWV N gene specific primers (2) followed by sequencing. To our knowledge, this is the first report of the natural occurrence of ToCV in Georgia. Further studies are required to quantify the yield losses from ToCV alone and synergistic interactions between ToCV in combination with TSWV and/or TYLCV in tomato production in Georgia. References: (1) T. Hirota et al. J. Gen. Plant Pathol. 76:168, 2010. (2) R. K. Jain et al. Plant Dis. 82:900, 1998. (3) M. R. Rojas et al. Plant Dis. 77:340, 1993. (4) L. Segev et al. Plant Dis. 88:1160, 2004.

Novel mixed-mode phase transition involving a composition-dependent displacive component

Solid-solid displacive, structural phase transformations typically undergo a discrete structural change from a parent to a product phase. Coupling electron microscopy, three-dimensional atom probe, and first-principles computations, we present the first direct evidence of a novel mechanism for a coupled diffusional-displacive transformation in titanium-molybdenum alloys wherein the displacive component in the product phase changes continuously with changing composition. These results have implications for other transformations and cannot be explained by conventional theories.

Inactivation of the von Hippel-Lindau tumor suppressor leads to selective expression of a human endogenous retrovirus in kidney cancer

A human endogenous retrovirus type E was recently found to be selectively expressed in most renal cell carcinomas (RCC). Importantly, antigens derived from this provirus are immunogenic, stimulating cytotoxic T-cells that kill RCC cells in vitro and in vivo. Here we show HERV-E expression is restricted to the clear cell subtype of RCC (ccRCC) characterized by an inactivation of the von Hippel-Lindau (VHL) tumor suppressor gene with subsequent stabilization of hypoxia-inducible transcription factors HIF-1α and -2α. HERV-E expression in ccRCC linearly correlated with HIF-2α levels and could be silenced in tumor cells by either transfection of normal VHL or siRNA inhibition of HIF-2α. Using chromatin immunoprecipitation, we demonstrated that HIF-2α can serve as transcriptional factor for HERV-E by binding with HIF response elements (HRE) localized in the proviral 5′LTR. Remarkably, the LTR was found to be hypomethylated only in HERV-E-expressing ccRCC while other tumors and normal tissues possessed a hypermethylated LTR preventing proviral expression. Taken altogether, these findings provide the first evidence that inactivation of a tumor suppressor gene can result in aberrant proviral expression in a human tumor and give insights needed for translational research aimed at boosting human immunity against antigenic components of this HERV-E.

Comparative analysis of expressed sequence tags (ESTs) between drought-tolerant and -susceptible genotypes of chickpea under terminal drought stress

BACKGROUND

Chickpea (Cicer arietinum L.) is an important grain-legume crop that is mainly grown in rainfed areas, where terminal drought is a major constraint to its productivity. We generated expressed sequence tags (ESTs) by suppression subtraction hybridization (SSH) to identify differentially expressed genes in drought-tolerant and -susceptible genotypes in chickpea.

RESULTS

EST libraries were generated by SSH from root and shoot tissues of IC4958 (drought tolerant) and ICC 1882 (drought resistant) exposed to terminal drought conditions by the dry down method. SSH libraries were also constructed by using 2 sets of bulks prepared from the RNA of root tissues from selected recombinant inbred lines (RILs) (10 each) for the extreme high and low root biomass phenotype. A total of 3062 unigenes (638 contigs and 2424 singletons), 51.4% of which were novel in chickpea, were derived by cluster assembly and sequence alignment of 5949 ESTs. Only 2185 (71%) unigenes showed significant BLASTX similarity (<1E-06) in the NCBI non-redundant (nr) database. Gene ontology functional classification terms (BLASTX results and GO term), were retrieved for 2006 (92.0%) sequences, and 656 sequences were further annotated with 812 Enzyme Commission (EC) codes and were mapped to 108 different KEGG pathways. In addition, expression status of 830 unigenes in response to terminal drought stress was evaluated using macro-array (dot blots). The expression of few selected genes was validated by northern blotting and quantitative real-time PCR assay.

CONCLUSION

Our study compares not only genes that are up- and down-regulated in a drought-tolerant genotype under terminal drought stress and a drought susceptible genotype but also between the bulks of the selected RILs exhibiting extreme phenotypes. More than 50% of the genes identified have been shown to be associated with drought stress in chickpea for the first time. This study not only serves as resource for marker discovery, but can provide a better insight into the selection of candidate genes (both up- and downregulated) associated with drought tolerance. These results can be used to identify suitable targets for manipulating the drought-tolerance trait in chickpea.

CavinKare Private Limited (A)

Case A on CavinKare describes the entrepreneurial journey of the founder, C.K. Ranganathan. As the enterprise outperformed expectations, the organization set itself an incredible vision. This case traces the history of the entrepreneur and the growth story of the enterprise. The case describes the context of opportunity recognition and exploitation, and elucidates the significant decisions taken by the entrepreneur and the organization in order to sustain rapid growth amidst liberalization and stiff competition from multinational companies with deep pockets and significant stakes in the industry.

Description of a new species of sand fly Sergentomyia (Parrotomyia) vadhanurensis (Diptera: Psychodidae) from Puducherry Union Territory, India

A new species of phlebotomine sand fly, Sergentomyia (Parrotomyia) vadhanurensis, is described from Puducherry Union Territory, India, with illustrations of adult female and male specimens. This species was collected in tree holes, tree buttresses, termite mounds, cattle sheds, and human dwellings from rural areas.

CavinKare Private Limited (B)

Case B on CavinKare describes the incredible vision the organization has set for itself. This case is set at a time when the company had achieved significant progress towards its incredible vision, but needed a quantum jump in performance to sustain its growth. The case describes the FMCG industry and the firm’s capabilities, and evolves strategic challenges facing the company, including sustaining high growth, expanding the product focus to men’s range of products and investment in the services business.

Identification of unique gene expression signatures in colon cancer stroma using microarray technology

447

Background: Microarrays are widely used to study gene expression patterns in cancer. In colorectal cancer, it has proven useful to predict recurrence. The majority of expression profiles are generated from the cancer itself. Given the increasing evidence of importance of the microenvironment for tumor invasion, progression and metastasis, we explored tumor stroma gene signature using microarrays.

Methods: Four formalin-fixed paraffin embedded (FFPE) colon cancer specimen carrying a pathological stage of T3-4/N0-2 were retrieved. Tumor stroma and normal stroma were separated using microdissection technology. Random sampling was used to minimize sampling bias. Total RNA was extracted, amplified, and labeled using Nugene FFPE kit, with array analysis using Affymetrix Human Gene 1.0. Eight samples, four normal stroma and four tumor stroma, were analyzed and compared. Array data were balanced and analyzed using standard software. To identify gene signature differences in tumor vs normal stroma, ComparativeMarker analysis and unsupervised cluster analysis were carried out.

Results: We identified a 969 Affymetrix probe set as a signature that is highly expressed in tumor stroma. The top 117 genes were further analyzed to carry out a pathway analysis. We found a strong signature evident in tumor stroma, and much of this signature comprised the genes of the extracellular matrix. The pathway analysis revealed evidence of the generalized IGF1/TGFbeta/CTGF/activin mediated effect on the stroma, raising the possibility that some of this derives from, or is accompanied by, angiotensin receptor signaling. Through literature search, we found that several upregulated genes (e.g., FAP) were reported to be associated with stroma activation in vitro and in vivo.

Conclusions: In this study, we successfully applied microarrays to study reactive colon tumor stroma in FFPE samples. We identified a specific gene signature reflecting stromal reaction to tumor invasion. We further identified the potential pathway that was activated in the reactive tumor stroma. We provide evidence that microarrays are useful in stroma analysis and may help identify new stromal pathways with potential diagnostic and therapeutic value.

No significant financial relationships to disclose.

Quantification of hypoxia-inducible factor-1α, vascular endothelial growth factor, and angiopoietin-2 expression in hepatocellular carcinoma using a real-time quantitative reverse transcription polymerase chain reaction

223

Background: Hepatocellular carcinoma (HCC) is characteristically a hypervascular tumor and its progression is closely related to angiogenesis. Hypoxia inducible factor-1α (HIF-1 α), vascular endothelial growth factor (VEGF), and angiopioetin-2 (Ang-2) are key angiogenic factors in HCC. In this study, expression of HIF-1α, VEGF, and Ang-2 were analyzed and correlated with clinicopathologic features of HCC.

Methods: Expression of HIF-1α, VEGF, and Ang-2 were analyzed by real-time quantitative reverse transcription polymerase chain reaction in 67 HCC patients (23HBV, 22HCV, 22NBNC) with mean age 59.09 ± 11.13 years (60 M: 7 F), 9 cirrhosis patients (2HBV, 2HCV, 5ALD) with mean age 48.33 ± 11.31 years (8 M:1 F), and 14 chronic hepatitis patients (7HBV, 7HCV) with mean age 48.33 ± 7.17 years (10 M: 4 F), respectively. HCC was diagnosed on the basis of EASL (European Association for the Study of the Liver) criteria.

Results: Expression of HIF-1α and VEGF were found to be significantly higher in patients with HCC compared with cirrhosis and chronic hepatitis. Although Ang-2 expression was higher in HCC compared to cirrhosis and chronic hepatitis but the difference was not statistically significant. The difference in the expression of HIF-1α, VEGF, and Ang-2 in cirrhosis and chronic hepatitis were not significant. Tumor size was positively correlated with HIF-1 α(p = 0.268, p = 0.030)and VEGF (p = 0.546, p = 0.0001). A positive correlation was also seen between the HIF-1α and VEGF expression (p = 0.347, p = 0.0001). However no correlation of HIF-1α, VEGF and Ang-2 was seen with portal vein thrombosis, cirrhosis, etiology, AST, ALT, and platelets.

Conclusions: HIF-1α and VEGF were highly expressed in HCC patients and may be responsible for the HCC growth. Further studies with a larger number of patients need to be done.

No significant financial relationships to disclose.

Species-diagnostic polymerase chain reaction assays for Phlebotomus argentipes and Phlebotomus papatasi, vectors of Leishmania

Species-specific differences encountered in the nucleotide sequences of a highly variable region of the 18S rRNA gene were used to design a multiplex polymerase chain reaction (PCR) assay for the identification of Phlebotomus papatasi Scopoli and Phlebotomus argentipes An-nandale & Brunetti, vectors of Leishmania. This multiplex PCR assay uses a common forward primer and two reverse primers, which are specific for the two species. Amplification of a PCR product of size 788 bp indicates the presence of P. papatasi, whereas a product of size 677 bp indicates the presence of P. argentipes. The assay was found to be highly specific and sensitive.

Atypical squamous cells and low-grade squamous intraepithelial lesion in cervical cytology: cytohistological correlation and implication for management in a low-resource setting

OBJECTIVES

To perform an audit of all cervical smears reported as atypical squamous cells (ASC) and low-grade squamous intraepithelial lesion (LSIL) as in the Bethesda system (TBS) 2001, and determine their histological follow-up and outcome when available, in order to define the threshold for colposcopic referral.

MATERIAL AND METHODS

A total of 25,203 cervical smears were screened over a period of 3 years (January 2006 - December 2008) and all ASC and LSIL smears were reviewed with the corresponding histological follow-up. All cervical intraepithelial neoplasia (CIN) grade 2 lesions and above (CIN2+) were considered as clinically significant lesions for analysis.

RESULTS

Out of 25,203 cervical smears, 424 (1.7%) were reported as ASC and 113 (0.4%) as LSIL. Additionally, three were reported as atypical cells, not otherwise specified. The ASC : SIL ratio was 2.18 : 1. Follow-up histology was available in 153 (36.8%) of the ASC cases and revealed CIN2+ lesions in 22 (14.4%). Follow-up histology was available in 50 (44.2%) of LSIL cases and revealed clinically significant abnormalities in five (10%), all of which were CIN2. CIN3 and invasive squamous carcinomas were seen in 5.9% and 1.4%, respectively, of cases of ASC, and not seen in LSIL. Reclassification of ASC smears into ASC-US (ASC-undetermined significance) and ASC-H (ASC- high grade SIL not excluded) revealed ASC-H in 2.6% of all ASC smears, with a clinically significant outcome in 45.4%.

CONCLUSION

In a low-resource setting where human papillomavirus testing is unaffordable, the threshold for colposcopic referral and follow-up histology should be ASC rather than SIL.

Invasion of toxic marine cyanobacteria in to the tsunami affected coastal villages of southern India

This documentation explores the facts about the invasion of marine cyanobacteria in to the tsunami affected coastal villages of Nagapattinam district of Tamilnadu and Karaikkal district of Pondicherry Union Territory (UT) in southern India. Water samples were collected from eight tsunami-hit coastal villages in different open water sources. The collected samples were processed for detecting marine cyanobacterial growth. Totally 110 water samples were processed, three samples were positive for the toxic cyanobacteria, Lyngbya sp., and nine for nontoxic species such as Epithemia sp.,, Johannesbaptistia pellucida, Oscillatoria princeps, Phormidium fragile, Synechocystis sp. Besides posing a public health risk because of the toxic cyanobacteria, the bloom formation by the cyanobacterial species such as Anabaena, Microcystis, Lyngbya, Plectonema, Phormidium contaminated the water bodies and deteriorated the water quality in the tsunami affected villages. The study revealed that another kind of public health risk from the invasion of toxic cyanobacteria to the costal ecosystem during the tsunami. It is necessary, in this context, that the surveillance mechanism, which is geared up during or after natural disasters, should have a provision to monitor the transportation of toxic elements/organisms from marine system to coastal/inland ecosystems and to control such organisms.

Assessing the susceptibility of cruciferous Lepidoptera to Cry1Ba2 and Cry1Ca4 for future transgenic cruciferous vegetables

Advances in transgenic plants expressing Bacillus thuringiensis (Bt) insecticidal gene(s) offer a promising alternative to traditional insecticides for control of lepidopteran pests on important cruciferous vegetable crops such as cabbage and cauliflower. A public-private partnership, the Collaboration on Insect Management for Brassicas in Asia and Africa (CIMBAA), was formed in 2005 with the goal of developing dual-gene Bt cauliflower and cabbage, initially for India, to replace the use of broad spectrum, traditional insecticides. As a first step in this effort, the major lepidopteran pests of cruciferous vegetable crops [Plutella xylostella (L.), Pieris rapae (L.), Pieris brassicae (L.), Crocidolomia binotalis (L.), Hellula undalis (F.), Diacrisia obliqua Walker, Spodoptera litura F., and Helicoverpa armigera (Hübner)] were collected over a large geographic area (India, Indonesia, Taiwan, China, Australia, and the United States) and tested against purified Cry1Ba2 and Cry1Ca4 toxins, the toxins proposed to be expressed in the CIMBAA plants. Our results demonstrate that Cry1Ba2 and Cry1Ca4 were effective against the primary target of the CIMBAA plants, P. xylostella, regardless of geographic location, and had LC50 values <1.3 ppm. Furthermore, one or both toxins were effective against the other major pest Lepidoptera, except for S. litura or H. armigera which were less susceptible. No cross-resistance has been found between Cry1Ba2 and Cry1Ca4, suggesting cry1Ba2+cry1Ca4 cauliflower and cabbage could be an effective and sustainable tool to control, P. xylostella, the key lepidopteran pest on cruciferous vegetable crops, as well as most other Lepidoptera. As the CIMBAA plants are being developed, further tests are needed to determine whether they will express these proteins at sufficient levels to control all the Lepidoptera. Sustainable use of the dual-gene plants also is discussed.

Development of a phosphomannose isomerase-based Agrobacterium-mediated transformation system for chickpea (Cicer arietinum L.)

To develop an alternative genetic transformation system that is not dependent on an antibiotic selection strategy, the phosphomannose isomerase gene (pmi) system was evaluated for producing transgenic plants of chickpea (Cicer arietinum L.). A shoot morphogenesis protocol based on the thidiazuron (TDZ)-induced shoot morphogenesis system was combined with Agrobacterium-mediated transformation of the pmi gene and selection of transgenic plants on mannose. Embryo axis explants of chickpea cv. C-235 were grown on a TDZ-supplemented medium for shoot proliferation. Embryo axis explants from which the first and second flush of shoots were removed were transformed using Agrobacterium carrying the pmi gene, and emerging shoots were allowed to regenerate on a zeatin-supplemented medium with an initial selection pressure of 20 g l(-1) mannose. Rooting was induced in the selected shoots on an indole-3-butyric acid (IBA)-supplemented medium with a selection pressure of 15 g l(-1) mannose. PCR with marker gene-specific primers and chlorophenol red (CPR) assay of the shoots indicated that shoots had been transformed. RT-PCR and Southern analysis of selected regenerated plants further confirmed integration of the transgene into the chickpea genome. These positive results suggest that the pmi/mannose selection system can be used to produce transgenic plants of chickpea that are free from antibiotic resistance marker genes.

Implantable devices: challenges and opportunities

Breakthroughs in technology are progressing at a phenomenal pace, but bringing them to the patient in the form of a device remains a challenge.The technical issues involved in designing an implantable device are outlined together with some potential solutions.

Differential free radical scavenging activity and radioprotection of caesalpinia digyna extracts and its active constituent

Two extracts E1and E2 were prepared from the dried root of the plant Caesalpinia digyna by extracting with solvents of different polarity. The extracts were standardized with respect to a polyphenol, bergenin, by LC- MS analysis and they were subjected to free radical scavenging activity and in vitro radioprotection studies. Free radical reactions were carried out with superoxide, hydroxyl, and peroxyl radicals and DPPH. In vitro radioprotecting activity was studied by following their effect on gamma-radiation induced lipid peroxidation, protein carbonylation and DNA damage. The results indicated that E1 with higher free radical scavenging ability is also a more potent inhibitor of radiation induced damage to proteins, DNA and liposomes than E2. Comparing the results with those for bergenin indicated that bergenin alone is not responsible for the free radical scavenging ability and in vitro radioprotection. The studies also confirmed that the extracts enriched with bergenin are more effective than the isolated polyphenol, bergenin.

Idea Cellular’s Acquisition of Spice Telecom

The case discusses the antecedents before the merger between Idea Cellular Ltd and Spice Telecom. It describes the evolution, fast growth and structure of the Indian mobile telecommunications industry; provides a brief profile of the firms involved; describes the merger/deal and highlights the issues involved (especially regulatory) in completing the merger. Idea Cellular Ltd., part of the diversified Aditya V. Birla Group, had announced its intent to acquire Spice Telecom, an independent mobile services company that was operating in two circles—Punjab and Karnataka, but held licenses in multiple circles. As part of the deal, TMI (a subsidiary of Telekom Malaysia) swapped its stake in Spice Telecom to acquire stake in Idea Cellular. However, the regulator, Department of Telecommunications (DOT) raised objections on the merger citing the revised M&A guidelines that restricted a company from owning more than a 10 per cent stake in two licenses in the same circles. This case provides learners with opportunities to (a) appreciate the complementarities of the M&A intent of all the firms involved and (b) analyze the deal structure and critically evaluate the options before the two companies in addressing the DOT objections.

Abundance & distribution of muscoid flies in tsunami-hit coastal villages of southern India during post-disaster management period

BACKGROUND & OBJECTIVE

In the tsunami (December 2004) affected coastal villages located on southern parts of Coramandel Coast of India, seawater intrusion has created serious problems for the people. In order to assess the risk of outbreak of fly-borne diseases, a longitudinal study for one year was carried out to investigate muscoid fly abundance and their distribution in relation to various phases of relief measures in disaster-hit villages.

METHODS

Muscoid fly density was monitored in devastated human settlements, temporary shelters, garbage dumping yards and open defaecation yards in seawater intrusion and indoors and outdoors of seawater non intrusion areas using scudder grill and sweep net at monthly intervals from February 2005 to January 2006.

RESULTS

Muscoid fly density recorded in the seawater incursion area was significantly higher, compared to that observed in the seawater non incursion area with scudder grill sampling (F= 57.896, df = 1, P<0.01) or sweep net sampling (F= 63.6, df = 1, P<0.01). Fly density in seawater non incursion area was higher during hotter months (June-July 2005) and lower during cooler months. On the contrary, the fly density in the seawater incursion areas was higher during the cooler months than in hotter months, indicating that the normal trend was upset by the tsunami.

INTERPRETATION & CONCLUSION

Seawater incursion, crowding of tsunami victims at relief camps, accumulation of solid waste at centralized relief kitchen and temporary shelters were responsible for the sudden increase in the number of flies. However, the post-disaster relief efforts kept the situation under control, without outbreak of any vector-borne diseases.

Combined tumor necrosis factor-α (TNF–α) and interleukin-2 (IL-2) blockade in acute steroid refractory graft-versus-host disease (SR-GVHD) following allogeneic hematopoietic stem cell transplantation (HCT)

7023

Background: SR-GVHD is a frequent and often fatal complication of HCT. A variety of inflammatory cytokines have been implicated in the pathogenesis of GVHD; single agent therapy against targets such as the IL-2 receptor α chain (daclizumab) or TNF-α (infliximab) has modest activity in SR-GVHD. We hypothesized that concomitant blockade of both TNF-α and IL-2 pathways would be more effective in controlling SR-GVHD than inhibition of either cytokine alone. Methods: The incidence of and outcome following SR-GVHD in 141 pts undergoing nonmyeloablative HCT from an HLA-matched family donor at our institution between February 2001 and November 2008 were analyzed. All SR-GVHD pts were treated with a combination of daclizumab (1 mg/kg, days1, 4, 8, 15, 22) and infliximab (10 mg/kg, days1, 8, 15, 22); in addition, aspergillus prophylaxis, empiric broad-spectrum antibiotics, and a rapid reduction in the dose of corticosteroids was initiated in order to minimize the risk of opportunistic infections associated with immunosuppression. Results: Twenty-three pts (23/141, 16%) developed SR-GVHD (median age 35 y, range 17–65 y); involved organs included the GI tract (n = 23), liver (n = 3), and skin (n = 8). We observed a remarkably high response rate following therapy, with 20/23 (87%) pts experiencing complete resolution of GVHD. Responses were usually delayed (median onset 2 weeks) but durable. The most notable complication associated with therapy was the development of opportunistic infections (invasive fungal infections in 3 pts); in 2/3 of these cases, prophylactic antifungal therapy had been discontinued prematurely due to drug toxicity. The median survival for the SR-GVHD cohort was 255 days (range 67–2,148 days), with 10/23 pts surviving at the time of this analysis. Causes of death included underlying cancer (5 pts), CMV disease (2 pts), and infectious complications (5 pts). Conclusions: These data suggest combined TNF-α /IL-2 blockade is a highly effective therapeutic option for pts with SR-GVHD and highlight the need for aggressive antimicrobial prophylaxis in the management of this condition.

No significant financial relationships to disclose.

A phase II study of two dosing regimens of GSK 1363089 (GSK089), a dual MET/VEGFR2 inhibitor, in patients (pts) with papillary renal carcinoma (PRC)

5103

Background: GSK089 is a potent, orally available small molecule inhibitor of MET and VEGFR2. Activating mutations and/or amplifications in MET have been described in pts with PRC. Two of 4 PRC pts treated with intermittent dosing of GSK089 on a Phase I study sustained partial responses (PR) for 1 and > 3 years respectively. The aim of the current study is to evaluate the efficacy, safety and tolerability of 2 dosing regimens of GSK089 as a single agent in pts with advanced sporadic PRC (SPRC) or hereditary PRC (HPRC). Methods: Adults with advanced PRC are enrolled in 2 cohorts with different dosing schedules of GSK089: cohort 1) 240 mg/day on days 1–5 of every 14 days (5-on/9-off); cohort 2) 80 mg daily. Pts are stratified based on status of MET-pathway activation (activating MET mutation, MET [7q31] amplification, or trisomy 7). The primary endpoint is RECIST response rate, assessed every 8 weeks. Plasma markers reflecting potential effects of MET inhibition and anti-VEGF therapy are analyzed. Results: As of December 15, 2008, 37 pts were enrolled in the 5-on/9-off cohort (19 with MET activation including 5 HPRC, 18 SPRC without MET activation or unknown MET status), and 16 pts in the daily dosing cohort (2 with HPRC, 14 SPRC with unknown MET status). Enrollment is ongoing in cohort 2. In cohort 1, of the 35 evaluable pts, 4 pts (2 HPRC and 2 SPRC) had confirmed PRs and 27 had stable disease (SD) as best response with 6 ≥12mo, 3 ≥ 9mo and 3 ≥ 6mo. Four of 5 HPRC pts (1 not evaluated) had shrinkage (15–53%) in all measurable tumors. Twenty-three SPRC pts had shrinkage (2–58%) in the sum of measurable tumors. In cohort 2, of the 9 evaluable pts, 2 (both SPRC) had confirmed PRs, and 7 had SD. The most frequent adverse events (AEs) associated with GSK089 were fatigue, hypertension, nausea, vomiting, diarrhea, and increased ALT/AST, primarily grades 1 and 2. Preliminary results from cohort 1 indicated that plasma shed Met (sMET) and VEGF increased and sVEGFR2 decreased after 2 cycles with changes maintained after 4 cycles. Conclusions: GSK089 is well tolerated and demonstrates anti-tumor activity in pts with PRC with both 5-on/9-off and daily dosing. VEGF, sVEGFR2, and sMET are promising pharmacodynamic markers for biological activity of GSK089.

[Table: see text]

Phase I study of E7389/gemcitabine combination in patients with advanced solid tumors

e13509

Background: E7389 (E) is a synthetic analogue of halichondrin B, an investigational tubulin-based antimitotic drug. Gemcitabine (G) is a nucleoside analogue clinically active in several human tumours. These two drugs exhibit synergistic cytotoxic effects against the H522 non-small cell lung cancer (NSCLC) xenografts. Methods: A phase I study of these two drugs in combination was initiated in patients with advanced solid tumours. Two prior chemotherapy regimens for metastatic disease were allowed. Results: Patient characteristics: male 11/female 10; median age 59 (range 28–84); performance status 0 /1/2: n=1/13/7; prior chemotherapy 21, prior radiotherapy 7, prior immunotherapy 1; tumour types: ovarian cancer 3, endometrial cancer 3, NSCLC 3, gastric/esophageal adenocarcinoma 3, miscellaneous 9. Total number of cycles given 52, median cycles/patient (range) 2 (1, 8). Cohort (CT) 1: E/G given days 1,8,15 q28 days. Due to DLT, regimen changed in CT 2 with E/G given days 1, 8 q21 days. Cycles (C) given: median 2 range 1–8, total 52. Response: partial response 1 (ovarian cancer), stable 8 [minor response 4 (NSCLC 2, endometrial cancer 1, head and neck cancer 1)], progression 8, inevaluable 4. Conclusions: Further phase II investigation of this regimen should be considered at a dose of E 1.0 g/m2/G 1000 mg/m2 q 3 weeks.

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No significant financial relationships to disclose.