An Exploratory Statistical Analysis of the effect of Demographic risk factors on uterine Cervical squamous Intraepithelial Lesion

Pap Smear test (Pap test), a cytological screening test of the cervical squamous intraepithelial lesion (SIL) is a widely accepted screening technique for uterine cervical cancer (UCC). UCC is a major canter burden for Indian women. In this article, we present an in-depth exploratory analysis on various statistical relationships between the Pap test and a set of demographic risk factors, such as Age, Age at consummation of marriage [ACM], parity [PAR] etc. The data had been collected from the Calcutta Medical College Hospital (CMCH) on 308 subjects. Major statistical findings in this article include a possible Age dependent association between PAR and the SIL-status. It seems that a high value of parity at a relatively young age is an important risk factor for developing SIL in future. This finding may be useful in relating to overall female helath issues in developing and underdeveloped country-senario.

AMS (2000) Subject Classification: Primary 62-07, 62Pl0, 92C60, Secondary 92C50, 62F03, 62F10.

Multimodal characterization of radiologically detectable lung lesions

Diagnosing radiologically detectable lung lesions on the basis of cyto/histopathological staining often suffers from ambiguity, leading to faulty detection of lung diseases, especially cancer. Present study attempted to perform a multimodal characterzation of clinical samples from patients with radiologically detected lung lesions, in order to classify diseases with higher precision. The study included analysing nuclear morphometric and intensity based differences between benign and malignant lung lesions in a quantitative way. Simultaneous analysis of serum samples taken from similar sets of patients was performed by Fourier transform infra red (FTIR) spectroscopy which provided differential global biochemical insights of normal and diseased states. Both nuclear and serum biochemical features were helpful in accomplishing high classification accuracy in distinguishing benign and different malignant cases.

Elucidation of the bonding of a near infrared dye to hollow gold nanospheres - a chalcogen tripod

Determining how Raman labels orientate on the surface of HGNs to aid in future advancements of designing NIR nanosensors.

Infrared surface enhanced Raman scattering (SERS) is an attractive technique for the in situ detection of nanoprobes in biological samples due to the greater depth of penetration and reduced interference compared to SERS in the visible region. A key challenge is to understand the surface layer formed in suspension when a specific label is added to the SERS substrate in aqueous suspension. SERS taken at different wavelengths, theoretical calculations, and surface-selective sum frequency generation vibrational spectroscopy (SFG-VS) were used to define the surface orientation and manner of attachment of a new class of infrared SERS labels with a thiopyrylium core and four pendant 2-selenophenyl rings. Hollow gold nanospheres (HGNs) were used as the enhancing substrate and two distinct types of SERS spectra were obtained. With excitation close to resonance with both the near infrared electronic transition in the label (max 826 nm) and the plasmon resonance maximum (690 nm), surface enhanced resonance Raman scattering (SERRS) was obtained. SERRS indicates that the major axis of the core is near to perpendicular to the surface plane and SFG-VS obtained from a dried gold film gave a similar orientation with the major axis at an angle 64–85° from the surface plane. Longer excitation wavelengths give SERS with little or no molecular resonance contribution and new vibrations appeared with significant displacements between the thiopyrylium core and the pendant selenophene rings. Analysis using calculated spectra with one or two rings rotated indicates that two rings on one end are rotated towards the metal surface to give an arrangement of two selenium and one sulphur atoms directly facing the gold structure. The spectra, together with a space filled model, indicate that the molecule is strongly adsorbed to the surface through the selenium and sulphur atoms in an arrangement which will facilitate layer formation.

ID: 25: SOCIAL DETERMINANTS OF PATIENT ANTIBIOTIC MISUSE IN HARYANA, INDIA

Background

Antibiotic resistance is recognized globally as an urgent health crisis. Multidrug resistant organisms lead to deadly hospital and community acquired infections and complicate patients' underlying health issues. In the United States, antibiotic resistance causes 23,000 deaths and direct healthcare costs of $20 billion a year. In the developing world, the costs are estimated to be even higher. In India alone, antibiotic resistance is responsible for an estimated 58,000 infant deaths annually. While its severity is agreed upon, the causes and solutions to antibiotic misuse are complex. Antibiotic dispensing laws are poorly enforced in many developing nations, including India. Patient and provider contributions are intertwined, thus confronting the problem requires a better understanding of the motivations of several populations.

Methods

We conducted a mixed methods study in the northern state of Haryana, India, between June and August 2015. We qualitatively assessed the antibiotic knowledge and use practices of 20 local community members using semi-structured interviews. We also completed 64 surveys of community members and healthcare workers. Both populations were given the same survey, which focused on the participant's experience obtaining antibiotics as a patient. The interviews and surveys were conducted in English and Hindi, as applicable, by bilingual members of the research team. Interview data was coded for themes using NVivo software, and quantitative survey responses were analyzed in SAS. We used DAGitty software to construct a directed acyclic graph to determine the minimally sufficient adjustment sets needed to block confounders of the relationship between antibiotic knowledge and antibiotic misuse.

Results

Over a third of survey participants reported antibiotic misuse, defined as purchasing medication from a pharmacy without a doctor's prescription (36.5%). Furthermore, none of the 20 community member interviewees were able to correctly define antibiotics without prompting. The interviews also revealed that limited health education, inadequate access to a doctor, and poverty all influence patients' antibiotic decision making. Participants with these characteristics were more likely to bypass doctors and seek medical care directly from a pharmacist.

The effect of antibiotic knowledge on antibiotic misuse was significant in our pilot survey data, even after adjusting for the variables in the minimally sufficient adjustment set: first vs. fourth quartile of knowledge, OR=72.09, p=0.014; second vs. fourth quartile, OR=44.09, p=0.006. The covariates in the model include age, income, healthcare occupation, education, having a doctor in the family, and having access to a doctor in your local community.

Discussion

This study highlights the need for public health education regarding antibiotics and the extensive health implications of their misuse. Local and national governments should consider social factors when enacting future antibiotic policies.

Effectiveness of Paliperidone Depot in Seriously Violent Men With Comorbid Schizophrenia and Dissocial Personality Disorder in a Uk High-Security Hospital

Introduction

High-security hospital patients are often complex in presentation characterised by treatment resistance, medication non-concordance and history of violence. Paliperidone is licensed as both an oral and depot antipsychotic for the treatment of schizophrenia. Whilst there is data for the effectiveness of paliperidone palmitate (PP), there are no studies involving patients in forensic settings or those with comorbid personality disorder.

Objective

To determine the effects of PP on violence, aggression and personality pathology.

Aim

To evaluate the clinical effectiveness of PP.

Methods

This was a retrospective service evaluation involving 11 patients. Medical records and interviews with the treating psychiatrist were used to formulate clinical global impression (CGI) and to identify incidents of violence. The effect on personality symptom domains; cognitive-perceptual, impulsive-behavioural dyscontrol and affective dysregulation was ascertained, as well as engagement with occupational and psychological therapies.

Results

Six patients were being prescribed PP. All 6 showed improvement in the CGI score with benefits in the symptom domains. Two patients demonstrated a reduction in violence risk and 2 remained incident-free. There was improvement in engagement with therapies. Benefits were also seen in aspects of personality for those who had discontinued PP.

Conclusions

This pragmatic study of a small but complex patient group demonstrated that PP was effective in reducing symptoms of schizophrenia. Additionally and for the first time, it was shown that PP was also effective in reducing violence as well as improving personality pathology dimensions in a comorbid patient. This could have significant implications for management of high-security patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Abstract P3-05-11: The evolution of the estrogen receptor (ER) complex conformation governs estrogen-induced apoptosis in antihormone-resistant breast cancer cells

Over the past decade new insights have been gained into the acquired resistance to tamoxifen and the Aromatase Inhibitors (AIs) with the discovery of the new biology of estrogen-induced apoptosis. However, it has also been learned that estrogens can be classified into planar class I and angular class II estrogens. Using model systems of long-term estrogen-deprived breast cancer cells in vitro (MCF-7:5C), it was previously shown that class I estrogens cause immediate apoptosis over a 3-4 day period. Paradoxically, class II estrogens actually block apoptosis caused by planar class I estrogens. To gain insight into this paradox we have successfully crystallized an angular class II triphenylethylene (TPE) estrogen bound to the ligand binding domain (LBD) of the ER and derived a new conformation for the TPE:ER complex (code 3Q97 in the PDB). Surprisingly, Helix 12 seals the LBD with the class II estrogen, but not the same conformation is observed with the planar class I estrogen 17β-estradiol (E2). There would seem to be no reason why the 3Q97 complex would not cause immediate apoptosis. To address this issue we have used Western blot analysis for protein and qRT-PCR for mRNA levels for the ER. ER parameters were monitored for up to 72 hours and results compared and contrasted between E2, the Class II estrogens, 4-hydroxytamoxifen (4OHT) and endoxifen (Endox). ER protein and mRNA levels with 4OHT or Endox accumulated and remained high throughout the study period. In contrast, the planar estrogen E2 produced a rapid decline in the protein and mRNA levels for the ER complex. The angular class II estrogens initially produced an accumulation of the ER protein complex, which decreased with time. Using a chromatin immunoprecipitation (ChIP) technique we demonstrated that the class II estrogens recruit only half of the ER to the estrogen-responsive genes promoters (TFF1 And BREB1) and less than half co-activator binding compared to E2. The TPEs were only partial agonists compared to planar estrogen. These results explain why the Class II estrogens induce delayed apoptosis. We conclude that, for the first time, we have observed the binding of a ligand to a receptor that changes conformation against time and evolves from an antagonist to an agonist conformation to trigger apoptosis. These observations have current relevance to the decryption of the protective effects of estrogen alone therapy against breast cancer incidence in the Women's Health Initiative (WHI) trial. This work was supported by the Susan G. Komen for the Cure Foundation award SAC100009.

Citation Format: Maximov PY, Sengupta S, Fernandes DJ, Fan P, Curpan RF, Rajan SS, Greene GL, Jordan VC. The evolution of the estrogen receptor (ER) complex conformation governs estrogen-induced apoptosis in antihormone-resistant breast cancer cells. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-05-11.

Abstract P5-03-03: Designing a novel platinum chemotherapeutic (IO-125) for treatment of breast cancer

Triple-negative breast cancer (TNBC) is an aggressive form of cancer occurring in 15-20% of breast cancer patients, with most patients relapsing on currently approved therapy. Recent studies have shown activity of platinum chemotherapy in this class of patients. IO-125 is a novel platinum (II) chemotherapeutic agent with an unique coordination environment. In this study, we investigated the anti-tumor activity of IO-125 in pre-clinical models of TNBC.

The coordination environment in IO-125 facilitates supramolecular assembly and releases diaminocyclohexane (DACH)-platinum in a sustained pH-dependent manner. In vitro cell viability studies using an array of breast cancer cell lines shows IO-125 exerts increased potency compared to carboplatin or oxaliplatin. The maximum tolerated (platinum-equivalent) dose (MTD) of IO-125 in mice was 8-fold higher than the MTD (platinum-equivalent) dose of oxaliplatin. The biodistribution and pharmacokinetic profile of IO-125 in plasma and tumor revealed preferential tumor accumulation, significantly increased area-under-the-curve (AUC), a reduction in clearance (CL) and a longer terminal half-life (42 hours) in comparison to oxaliplatin (18 hours). In addition, DNA-Pt adduct formation in tumors was significantly higher for IO-125. When administered at their respective MTDs, IO-125 led to sustained regression of the tumor in a 4T1 syngeneic breast cancer model. Based on these observations, we conclude that IO-125 may emerge as a novel therapeutic against triple negative breast cancer.

Citation Format: Sengupta A, Roy M, Sarkar A, Mylavarapu S, Modi S, Gupta N, B H, Hossain S, Ansari A, Pandey M, Yadav Y, Sengupta S. Designing a novel platinum chemotherapeutic (IO-125) for treatment of breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-03-03.

Legal Aspects in Obstetric Anesthesia

Obstetric anesthesia is a particularly high-risk sub-specialty of anesthesia and may lead to serious morbidities and even mortality. Good doctor-patient relation from the time of admission till discharge is the most important factor to avert future litigations. Any procedure done or planned should be clearly documented. Documentation should start with a valid consent in the patient’s own language, and have all three components of voluntariness, capacity and knowledge. A ‘Surgical Safety’ checklist is particularly helpful in documentation and decreasing errors. Safety of the mother (and her child) is paramount. Both regional as well as general anesthesia, either inadvertently or if not administered properly may be associated with morbidities like headache, pain and emotional distress. However, deaths do occur and general anesthesia is associated with care should be routine practice and inculcated by everyone involved in patient care.

Epithelial mesenchymal transition in lung cancer cells: A quantitative analysis

Cellular auto-fluorescence along with morphological and cytoskeletal features were assessed in lung cancer cells undergoing induced epithelial mesenchymal transition (EMT). During EMT progression, significant increase was observed in cellular aspect ratio (AR), filamentous (F)-actin and green auto-fluorescence intensities while blue intensity decreased. These features were provided to a kernel classification framework. The classification accuracy were impressive, thus these features along with the classification technique can be considered as suitable tools for automated grading of lung cancer cells undergoing EMT progression.

B CHROMOSOMES IN ANGIOSPERM--A REVIEW

A review article on B chromosomes (Bs) in angiosperms is documented considering occurrence, morphology, polymorphic B forms, divisional phase heterogeneity, chromatin organization and gene content, sequence composition, origin, evolutionary aspects and significant role on host with an objective to foresee the evolutionary perspectives as it still remains an enigma. Irrespective of the origin of Bs, it seems that they have attained the following modifications, namely, insertion of centromeric and telomeric sequences, structural reorganization and procuring mitotic and meiotic drives but shows genetic inertness and present in the host as selfish DNA. In the context, few questions are raised. Further, scientific quest may unravel the unexplored information about Bs to ascertain its evolutionary perspectives, if any.

The prevalence of abnormal ECG in trained sportsmen

BACKGROUND

Competitive sports training causes structural and conductive system changes manifesting by various electrocardiographic alterations. We undertook this study to assess the prevalence of abnormal ECG in trained Indian athletes and correlate it with the nature of sports training, that is endurance or strength training.

METHODS

We evaluated a standard resting, lying 12 lead Electrocardiogram (ECG) in 66 actively training Indian athletes. Standard diagnostic criteria were used to define various morphological ECG abnormalities.

RESULTS

33/66 (50%) of the athletes were undertaking endurance training while the other 33 (50%) were involved in a strength-training regimen. Overall 54/66 (81%) sportsmen had significant ECG changes. 68% of these changes were considered as normal training related features, while the remaining 32% were considered abnormal. There were seven common training related ECG changes-Sinus Bradycardia (21%), Sinus Arrhythmia (16%), 1st degree Atrioventricular Heart Block (6%), Type 1 2nd-degree Atrioventicular Heart Block (3%), Incomplete Right bundle branch block (RBBB) (24%), Early Repolarization (42%), Left Ventricular Hypertrophy (LVH) (14%); while three abnormal ECG changes--T-wave inversion (13%), RBBB(4%), Right ventricular hypertrophy (RVH) with strain (29%) were noted. Early repolarization (commonest change), sinus bradycardia, and incomplete RBBB were the commoner features noticed, with a significantly higher presence in the endurance trained athletes.

CONCLUSION

A high proportion of athletes undergoing competitive level sports training are likely to have abnormal ECG recordings. Majority of these are benign, and related to the physiological adaptation to the extreme levels of exertion. These changes are commoner during endurance training (running) than strength training (weightlifting).

Ultra-broadband quantum cascade laser, tunable over 760 cm(-1), with balanced gain

A heterogeneous quantum cascade laser, consisting of multiple stacks of discrete wavelength quantum cascade stages, emitting in 5.9-10.9 µm, wavelength range is reported. The broadband characteristics are demonstrated with a distributed-feedback laser array, emitting at fixed frequencies at room temperature, covering an emission range of ~760 cm(-1), which is ~59% relative to the center frequency. By appropriate choice of a strained AlInAs/GaInAs material system, quantum cascade stage design and spatial arrangement of stages, the distributed-feedback array has been engineered to exhibit a flat threshold current density across the demonstrated range.

CPT-11/bevacizumab for the treatment of refractory brain metastases in patients with HER2-neu-positive breast cancer

Nervous system relapse of patients with advanced HER2-neu-positive breast cancer is an increasing problem, with one-third of women developing brain metastases. Standard therapies using steroids, surgery and radiotherapy do not provide a lasting response. We evaluated CPT-11 and bevacizumab, which can both cross the blood-brain barrier, as combination therapy to treat HER2-neu-positive breast cancer with brain metastases.

Molecular mechanism of action of bisphenol and bisphenol A mediated by oestrogen receptor alpha in growth and apoptosis of breast cancer cells

BACKGROUND AND PURPOSE

Oestrogen receptor alpha (ERα) binds to different ligand which can function as complete/partial oestrogen-agonist or antagonist. This depends on the chemical structure of the ligands which modulates the transcriptional activity of the oestrogen-responsive genes by altering the conformation of the liganded-ERα complex. This study determined the molecular mechanism of oestrogen-agonistic/antagonistic action of structurally similar ligands, bisphenol (BP) and bisphenol A (BPA) on cell proliferation and apoptosis of ERα + ve breast cancer cells.

EXPERIMENTAL APPROACH

DNA was measured to assess the proliferation and apoptosis of breast cancer cells. RT-PCR and ChIP assays were performed to quantify the transcripts of TFF1 gene and recruitment of ERα and SRC3 at the promoter of TFF1 gene respectively. Molecular docking was used to delineate the binding modes of BP and BPA with the ERα. PCR-based arrays were used to study the regulation of the apoptotic genes.

KEY RESULTS

BP and BPA induced the proliferation of breast cancer cells; however, unlike BPA, BP failed to induce apoptosis. BPA consistently acted as an agonist in our studies but BP exhibited mixed agonistic/antagonistic properties. Molecular docking revealed agonistic and antagonistic mode of binding for BPA and BP respectively. BPA treatment resembled E2 treatment in terms of PCR-based regulation of apoptotic genes whereas BP was similar to 4OHT treatment.

CONCLUSIONS AND IMPLICATIONS

The chemical structure of ERα ligand determines the agonistic or antagonistic biological responses by the virtue of their binding mode, conformation of the liganded-ERα complex and the context of the cellular function.