Directly observed therapy of sofosbuvir/ribavirin +/- peginterferon with minimal monitoring for the treatment of chronic hepatitis C in people with a history of drug use in Chennai, India (C-DOT)

We assessed the feasibility of field-based directly observed therapy (DOT) with minimal monitoring to deliver HCV treatment to people with a history of drug use in Chennai, India. Fifty participants were randomized 1:1 to sofosbuvir+peginterferon alfa 2a+ribavirin (SOF+PR) for 12 weeks (Arm 1) vs sofosbuvir+ribavirin (SOF+R) for 24 weeks (Arm 2). SOF+R was delivered daily at participant chosen venues and weekly peginterferon injections at the study clinic. HCV RNA testing was performed to confirm active HCV infection and sustained virologic response 12 weeks after treatment completion (SVR12). No baseline genotyping or on-treatment viral loads were performed. Median age was 46 years. All were male and 20% had significant fibrosis/cirrhosis. All self-reported history of injection drug use, 18% recent noninjection drug use and 38% alcohol dependence. Six discontinued treatment (88% completed treatment in each arm). Of 22 who completed SOF+PR, all achieved SVR12 (22/25=88%); 15 of 22 who completed SOF+R achieved SVR12 (15/25=60%; P=.05). Among those completing SOF+R, SVR12 was significantly less common in participants reporting ongoing substance use (36% vs 100%) and missed doses. Active substance use and missed doses did not impact SVR with SOF+PR. Field-based DOT of HCV therapy without real-time HCV RNA monitoring was feasible; however, achieving 100% adherence was challenging. SOF+PR appeared superior to SOF+R in achieving SVR12, even when doses were missed with no discontinuations due to side effects. Further exploration of short duration treatment with peginterferon plus direct-acting antivirals is warranted.

Making gametes from alternate sources of stem cells: past, present and future

Infertile couples including cancer survivors stand to benefit from gametes differentiated from embryonic or induced pluripotent stem (ES/iPS) cells. It remains challenging to convert human ES/iPS cells into primordial germ-like cells (PGCLCs) en route to obtaining gametes. Considerable success was achieved in 2016 to obtain fertile offspring starting with mouse ES/iPS cells, however the specification of human ES/iPS cells into PGCLCs in vitro is still not achieved. Human ES cells will not yield patient-specific gametes unless and until hES cells are derived by somatic cell nuclear transfer (therapeutic cloning) whereas iPS cells retain the residual epigenetic memory of the somatic cells from which they are derived and also harbor genomic and mitochondrial DNA mutations. Thus, they may not be ideal starting material to produce autologus gametes, especially for aged couples. Pluripotent, very small embryonic-like stem cells (VSELs) have been reported in adult tissues including gonads, are relatively quiescent in nature, survive oncotherapy and can be detected in aged, non-functional gonads. Being developmentally equivalent to PGCs (natural precursors to gametes), VSELs spontaneously differentiate into gametes in vitro. It is also being understood that gonadal stem cells niche is compromised by oncotherapy and with age. Improving the gonadal somatic niche could regenerate non-functional gonads from endogenous VSELs to restore fertility. Niche cells (Sertoli/mesenchymal cells) can be directly transplanted and restore gonadal function by providing paracrine support to endogenous VSELs. This strategy has been successful in several mice studies already and resulted in live birth in a woman with pre-mature ovarian failure.

Deranged regulatory T-cells and transforming growth factor-β1 levels in type 1 diabetes patients with associated autoimmune diseases

Aim:

This study was designed to enumerate regulatory T-cells (Tregs) and estimate transforming growth factor-β1 (TGF-β1) levels in type 1 diabetic (T1D) patients with respect to disease duration and associated autoimmune diseases.

Methods:

One hundred and fifty patients and twenty healthy controls were recruited in the study. The patients were subcategorized into eight categories on the basis of disease duration (new onset [NO] and long standing [LS]) and associated diseases, i.e., celiac disease (CD) and autoimmune thyroid disease (AiTD). Treg cells were assessed as CD4⁺ CD25^hi+, FOXP3⁺ cells and serum TGF-β1 levels were assessed by ELISA.

Results:

The frequency of Tregs and levels of TGF-β1 were significantly increased in the patients compared to the healthy controls. Among the different categories of the patients, no significant differences were seen for TGF- β1 levels, but for Tregs in patients with T1D and AiTD (P = 0.035). A significant correlation was also found between percentage count of Tregs and TGF-β1 levels in NO cases in all disease subcategories, but not in LS patients.

Conclusion:

Thus, there was an increased percentage of Tregs and serum levels of TGF-β1 in T1D patients, irrespective of the disease duration and associated autoimmune diseases. The significant correlation in these two parameters at the onset of the disease, but not in LS disease, indicates that the immunological milieu in LS autoimmune diseases is more complicated with disease-associated conditions such as prolonged hyperglycemia, insulin therapy, and/or continued gluten in diet. Treatment and modulation of these long-term complications for improving immunological parameters require further research.

Finite Element Analysis and Experimental Study on the Effect of Extrusion Ratio during Hot Extrusion Process of Aluminium Matrix Composites

The finite element (FE) analysis on the effect of extrusion process parameter namely, extrusion ratio at different billet temperatures on the plastic strain and strain rate of aluminium matrix composite during hot extrusion process has been dealt. The dynamic explicit FE code in ANSYS 15.0 workbench was used for simulation. The FE analysis was carried out on the SiC reinforced aluminium matrix composites for three extrusion ratios 4:1, 8:1 and 15:1, for the billet temperatures in the range 350 °C - 450 °C in steps of 50 °C. The plastic strain and strain rate were found to increase with increase in the extrusion ratio. A minimum strain and strain rate was found to occur at the billet temperature of 450 °C. The silicon carbide particles reinforced aluminium matrix composites were then extruded at the optimised temperature of 450 °C for various extrusion ratios as mentioned above. The effect of extrusion ratio on the microstructure and surface quality of extruded rod was studied.

Refractive index sensing in the visible/NIR spectrum using silicon nanopillar arrays

Si nanopillar (NP) arrays are investigated as refractive index sensors in the visible/NIR wavelength range, suitable for Si photodetector responsivity. The NP arrays are fabricated by nanoimprint lithography and dry etching, and coated with thin dielectric layers. The reflectivity peaks obtained by finite-difference time-domain (FDTD) simulations show a linear shift with coating layer thickness. At 730 nm wavelength, sensitivities of ~0.3 and ~0.9 nm/nm of SiO₂ and Si₃N₄, respectively, are obtained; and the optical thicknesses of the deposited surface coatings are determined by comparing the experimental and simulated data. The results show that NP arrays can be used for sensing surface bio-layers. The proposed method could be useful to determine the optical thickness of surface coatings, conformal and non-conformal, in NP-based optical devices.

A novel signalling screen demonstrates that CALR mutations activate essential MAPK signalling and facilitate megakaryocyte differentiation

Most myeloproliferative neoplasm (MPN) patients lacking JAK2 mutations harbour somatic CALR mutations that are thought to activate cytokine signalling although the mechanism is unclear. To identify kinases important for survival of CALR-mutant cells, we developed a novel strategy (KISMET) that utilizes the full range of kinase selectivity data available from each inhibitor and thus takes advantage of off-target noise that limits conventional small-interfering RNA or inhibitor screens. KISMET successfully identified known essential kinases in haematopoietic and non-haematopoietic cell lines and identified the mitogen activated protein kinase (MAPK) pathway as required for growth of the CALR-mutated MARIMO cells. Expression of mutant CALR in murine or human haematopoietic cell lines was accompanied by myeloproliferative leukemia protein (MPL)-dependent activation of MAPK signalling, and MPN patients with CALR mutations showed increased MAPK activity in CD34 cells, platelets and megakaryocytes. Although CALR mutations resulted in protein instability and proteosomal degradation, mutant CALR was able to enhance megakaryopoiesis and pro-platelet production from human CD34+ progenitors. These data link aberrant MAPK activation to the MPN phenotype and identify it as a potential therapeutic target in CALR-mutant positive MPNs.

Improving medication safety and diabetes management in Hong Kong: a multidisciplinary approach

INTRODUCTION

Patients with diabetes often require complex medication regimens. The positive impact of pharmacists on improving diabetes management or its co-morbidities has been recognised worldwide. This study aimed to characterise drug-related problems among diabetic patients in Hong Kong and their clinical significance, and to explore the role of pharmacists in the multidisciplinary diabetes management team by evaluating the outcome of their clinical interventions.

METHODS

An observational study was conducted at the Diabetes Clinic of a public hospital in Hong Kong from October 2012 to March 2014. Following weekly screening, and prior to the doctor's consultation, selected high-risk patients were interviewed by a pharmacist for medication reconciliation and review. Drug-related problems were identified and documented by the pharmacist who presented clinical recommendations to doctors to optimise a patient's drug regimen and resolve or prevent potential drug-related problems.

RESULTS

A total of 522 patients were analysed and 417 drug-related problems were identified. The incidence of patients with drug-related problems was 62.8% with a mean of 0.9 (standard deviation, 0.6) drug-related problems per patient. The most common categories of drug-related problems were associated with dosing (43.9%), drug choice (17.3%), and non-allergic adverse reactions (15.6%). Drugs most frequently involved targeted the endocrine or cardiovascular system. The majority (71.9%) of drug-related problems were of moderate clinical significance and 28.1% were considered minor problems. Drug-related problems were totally solved (50.1%) and partially solved (11.0%) by doctors' acceptance of pharmacist recommendations, or received acknowledgement from doctors (5.5%).

CONCLUSIONS

Pharmacists, in collaboration with the multidisciplinary team, demonstrated a positive impact by identifying, resolving, and preventing drug-related problems in patients with diabetes. Further plans for sustaining pharmacy service in the Diabetes Clinic would enable further studies to explore the long-term impact of pharmacists in improving patients' clinical outcomes in diabetes management.

Medical Image Enhancement Using Edge Information-Based Methods

Medical image enhancement improves the quality and facilitates diagnosis. This chapter investigates three methods of medical image enhancement by exploiting useful edge information. Since edges have higher perceptual importance, the edge information based enhancement process is always of interest. But determination of edge information is not an easy job. The edge information is obtained from various approaches such as differential hyperbolic function, Haar filters and morphological functions. The effectively determined edge information is used for enhancement process. The retinal image enhancement method given in this chapter improves the visual quality of the vessels in the optic region. X-ray image enhancement method presented here is to increase the visibility of the bones. These algorithms are used to enhance the computer tomography, chest x-ray, retinal, and mammogram images. These images are obtained from standard datasets and experimented. The performance of these enhancement methods are quantitatively evaluated.

Retraction notice to "Management of liver hydatid cysts - Current perspectives" [Medical Journal Armed forces India 68 (2012) 304-309]

[This retracts the article DOI: 10.1016/j.mjafi.2012.04.010.].

ZnO nanowire-enabled light funneling effect for antireflection and light convergence applications

We present a new light trapping technique to reduce reflection loss, as well as for light, focusing at submicron scales for solar cell and image sensing applications. We have fabricated hexagonal arrays of ZnO funnel-like structures on Si substrate by the patterned growth of ZnO nanowires in a hydrothermal growth process. The funnels are optimized so that the effective refractive index along the vertical direction decreases gradually from the Si surface to the top of funnel to reduce Fresnel reflection at a device-air interface. Finite difference time domain simulation is used for optimization of the minimum reflectivity and to analyze optical properties such as angle dependency, polarization dependency, and funneling effect. The structures function similar to a GRIN lens in light trapping and convergence. An optimized structure reduces the average reflectivity close to 3% in the wavelength range of 300-1200 nm with the possibility of confining incident light to a few hundreds of nanometers.

Probiotic and functional characterization of bifidobacteria of Indian human origin

AIMS

To identify and characterize the probiotic and functional attributes of bifidobacteria isolated from human sources by in vitro methods.

METHODS AND RESULTS

Twelve isolates of bifidobacteria were obtained from different human sources viz; human milk, infant and adult faeces. The preliminary identification of isolates was done using genus-specific PCR followed by species level identification using 16S rRNA sequencing. All the isolates invariably showed potential probiotic characteristics. Finally, three most promising isolates were subjected to safety evaluation and were found to be safe. These were further evaluated for their potential functional characteristics like, antioxidative, antimutagenic and cholesterol assimilation. The isolates viz; NBIF-5 (73·55 ± 0·03%) and NBIF-7 (64·06 ± 0·03%) assimilated significantly higher cholesterol than NBIF-2. The maximum antioxidative activity was observed in NBIF-2 (56·56 ± 0·28% of radical inhibition). High percentage antimutagenicity scores of 52·41 ± 2·25% and 53·68 ± 1·98% against sodium azide (NaN3) were shown by NBIF-2 and NBIF-7 respectively.

CONCLUSIONS

Three strains (NBIF-2, NBIF-5 and NBIF-7) were found to be endowed with appreciable probiotic and functional activities.

SIGNIFICANCE AND IMPACT OF THE STUDY

With growing demands for probioitcs and bifidobacteria being prominent ones, new strains of diversified origin have the potential to be explored for commercial and functional applications and thus can be added to the existing commercially available strains of this genera.

Anti-inflammatory effect of dikaempferol rhamnopyranoside, a diflavonoid from Eugenia jambolana Lam. Leaves

Traditionally, the Indian Blackberry or locally called Jamun, Eugenia jambolana Lam. (Syn.: Syzygium cumini), is well known for its pharmacological potential, particularly anti-inflammatory. Here, we studied kaempferol-7-O-α-L-rhamnopyranoside]-4'-O-4'- [kaempferol-7-O-α-L-rhamnopyranoside (EJ-01) isolated from the E. jambolana leaves for possible anti-inflammatory activity. EJ-01 (3, 10 and 30 mg/kg, p.o.) was assessed for anti-inflammatory activity using carrageenan-induced paw edema model in mice by determining edema volume, myeloperoxidase (MPO), nitrite plus nitrate (NOx) and cytokine levels in paw edema tissue. EJ-01 significantly attenuated the edema, MPO levels, tumor necrosis factor-alpha (TNF-α) and interleukin-1beta (IL-1β) levels in the edema of paw at the 5th hour after carrageenan injection at all doses. EJ-01 (30 mg/kg) decreased the nitric oxide (NO) levels of the edema of paw at the 5th hour after carrageenan injection. The anti-inflammatory mechanisms of EJ-01 might be related to the decrease in the level of edema paw by reduced activities of NO and MPO. It probably exerts anti-inflammatory effects through the suppression of TNF-α and IL-1β. Therefore, we conclude that EJ-01 could be positively exploited for itspotential benefits against inflammatory diseases and support the pharmacological basis of E. jambolana as traditional herbal medicine for the treatment of inflammatory diseases.