Gemcitabine in brief versus prolonged low-dose infusion, both combined with carboplatin for advanced non-small cell lung cancer

PURPOSE

Gemcitabine in low-dose prolonged infusion is a treatment with documented activity against a variety of tumors. The present study was conducted to evaluate the efficacy and safety of the combination of gemcitabine at a low-dose prolonged infusion in comparison with standard dose gemcitabine with carboplatin in chemonaive patients with advanced non-small cell lung cancer (NSCLC).

MATERIALS AND METHODS

Sixty chemonaive patients with stage IIIB or IV NSCLC were included. Patients were randomly assigned 1:1 to receive 350 mg/m 2 gemcitabine in a 6-h infusion on days 1 and 8 and carboplatin area under the serum concentration time curve (AUC) 5 on day 1 versus gemcitabine 1,000 mg/m 2 on days 1 and 8 and carboplatin AUC 5 on day 1 (3-week cycle both). A total of 118 chemotherapy cycles, with a median of 4 cycles per patient (range 2-6), and 134 chemotherapy cycles, with a median of 4.47 cycles per patient (range 3-6) were administered in standard and low infusional dose arm, respectively.

RESULTS

Among patients in the standard arm, 40% had overall response rate (ORR), 33.3% had stable disease and 26.6% had progressive disease, while in low-dose infusional arm, 36.6% had ORR, 36.3% had stable disease and 26.6% had progressive disease (P = 0.992). Median progression-free survival was 5.5 months and 5.4 months, median overall survival was 9.7 months and 10.7 months, and 1-year survival was 33.7% and 36.6% in standard arm and low-dose infusion arm, respectively. Grade 3/4 toxicity was rare.

CONCLUSION

In NSCLC, gemcitabine low-dose prolonged infusion with carboplatin has low toxicity, especially thrombocytopenia, and has an activity comparable with gemcitabine given in higher dose in standard infusion.

Processing fly ash stabilized hydrogen titanate nano-sheets for industrial dye-removal application

We report a new method for the processing of fly ash (FA) stabilized hydrogen titanate nano-sheets in the form of aggregated microspheres. The industrial silica-based FA has been utilized for this purpose which has been surface-modified by coating with the anatase-titania (TiO(2)) via sol-gel. The anatase-TiO(2) coated FA particles are subjected to the hydrothermal treatment in an autoclave under high temperature and pressure conditions in a highly alkaline solution. The hydrothermal conditions cause dissolution of silica resulting in the disintegration of other constituents of FA which are adsorbed in ionic and/or oxidized form on the surface of intermediate product of the hydrothermal treatment of anatase-TiO(2), specifically the hydrogen titanate. The adsorption of FA constituents has resulted in the stabilization of hydrogen titanate in the nano-sheet morphology instead of nanotubes. The FA stabilized hydrogen titanate nano-sheets exhibit higher specific surface-area than that of the hydrogen titanate nanotubes and have been successfully utilized for the removal of an organic synthetic-dye from an aqueous solution via surface-adsorption, involving the electrostatic-attraction and ion-exchange mechanisms operating, in the dark-condition.

Fictitious pseudo Meig’s syndrome: A medical emergency

The present case scenario deals with an acute on chronic symptomatology, and collapsed state of the patient with poor vitals on admission in casualty. Clinical work up pointing to an elevated serum CA 125 levels and USG pelvis suggesting peritoneal adhesions with cystic to firm mass in left ovary and minimal free fluid in abdomen and cul de sac, X Ray chest suggesting right sided Pleural effusion. It was after careful evaluation of the case, with past and present history along with signs, symptommatology and intraoperative findings that differentials like Chronic granulomatous lesions, endometriosis, Neoplastic lesions with metastasis and Meig’s syndrome or Pseudo Meig’s were evaluated. Finally, a diagnosis of genital tuberculosis with enodmetriosis was confirmed on histopathological evaluation. DOI: http://dx.doi.org/10.3126/jcmsn.v7i1.5975 JCMSN 2011; 7(1): 57-64

Synthesis, characterization and antiproliferative activity of 1,2-naphthoquinone and its derivatives

In the present study substituted 1,2-naphthoquinones were synthesized, purified and characterized by spectroscopic studies (UV, FT-IR, ¹H NMR, ¹³ C NMR and elemental analysis). These compounds were evaluated for cytotoxicity against a panel of human cancer cell lines (Hep-G₂ for liver sarcoma, MG-63 for osteosarcoma and MCF-7 for human breast cancer). The cells were dosed with these ortho-naphthoquinone derivatives at varying concentrations, and cell viability was measured by a 3-(4,5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay with doxorubicin as positive control. Significant anticancer activities were observed in vitro for some members of the series, and compounds 1,2-naphthoquinone 2-thiosemicarbazone, 1,2-naphthoquinone-2-semicarbazone, 4-amino-1,2-naphthoquinone 2-thiosemicarbazone and 4-amino-1,2-naphthoquinone-2-semicarbazone are active cytotoxic agents against different cancer cell lines with IC₅₀ values in the range of 5.73-17.67 μM. The obtained data suggested that better anticancer activity was linked with introduction of thiosemicarbazone and semicarbazone moiety in 1,2-naphthoquinone ring system. Outcomes of experimentation also reveal that incorporation of amino group in 1,2-naphthoquinone moiety contributes positively for cytotoxic action of compounds. Docking experiments showed a good correlation between their calculated interaction energies with the topoisomerase-II and the observed IC₅₀ values of all these compounds.

Improving cancer chemotherapy with modulators of ABC drug transporters

ATP-binding cassette (ABC) transporters, P-glycoprotein (P-gp, ABCB1) and ABCG2, are membrane proteins that couple the energy derived from ATP hydrolysis to efflux many chemically diverse compounds across the plasma membrane, thereby playing a critical and important physiological role in protecting cells from xenobiotics. These transporters are also implicated in the development of multidrug resistance (MDR) in cancer cells that have been treated with chemotherapeutics. One approach to blocking the efflux capability of an ABC transporter in a cell or tissue is inhibiting the activity of the transporters with a modulator. Since ABC transporter modulators can be used in combination with chemotherapeutics to increase the effective intracellular concentration of anticancer drugs, the possible impact of modulators of ABC drug transporters is of great clinical interest. Another possible clinical use of modulators that has recently attracted attention is their ability to increase oral bioavailability or increase tissue penetration of drugs transported by the transporters. Several preclinical and clinical studies have been performed to evaluate the feasibility and the safety of this approach. The primary focus of this review is to discuss progress made in recent years in the identification and applicability of compounds that may serve as ABC transporter modulators and the possible role of these compounds in altering the pharmacokinetics and pharmacodynamics of therapeutic drugs used in the clinic.

Bilateral symmetrical facial swelling owing to tuberculous gummas

Metastatic tuberculous abscesses and gummas are unusual forms of cutaneous tuberculosis. They result from haematogeneous spread of the mycobacterium from a primary focus during a period of impaired immunity. A 5-year-old boy is reported who presented with spinal tuberculosis and bilateral subcutaneous swelling of the cheeks owing to tuberculous gummas.

Virulence attributes of Helicobacter pylori isolates & their association with gastroduodenal disease

BACKGROUND & OBJECTIVES

Certain genotype(s) of Helicobacter pylori strains may play important role in the development of gastric cancer (GC) and peptic ulcer disease (PUD). This study was undertaken to investigate the association of cagA, cagA3/ region subtypes, babA2 and vacA genotypes of H. pylori with GC, PUD and non-ulcer dyspepsia (NUD) as there are no such studies from India.

METHODS

A total of 348 consecutive adult patients (NUD 241, PUD 45, GC 62) undergoing upper gastrointestinal endoscopy between September 2002 and May 2007 in a tertiary referral centre at Lucknow, north India, were enrolled. H. pylori infection was diagnosed by rapid urease test, culture, histopathology and PCR. Genotyping for cagA, cagA3/ subtypes, babA2 and vacA was performed by PCR using sequence specific primers.

RESULTS

H. pylori infection was higher in patients with PUD than with GC (80 vs. 56.5%, P < 0.01) and NUD (80 vs. 55.2%, P= 0.002). cagA positive H. pylori isolates were detected in 80 per cent in GC, 83.3 per cent in PUD and 76.7 per cent in NUD with no significant difference among them. Only A subtype of cagA3/ was detected and its distribution in GC, PUD and NUD was 68.8, 69.4 and 52.6 per cent respectively. Presence of babA2 genotype was 31.4 per cent and it had significant association with PUD when compared with NUD (52.8 vs. 26.3%, P<0.003). On univariate regression analysis, s1a allele was associated with GC (P<0.050) and s1a/m2 vacA genotype with both GC (P=0.014) and PUD (P=0.016).

INTERPRETATION & CONCLUSIONS

H. pylori infection was strongly associated with PUD with a very high proportion of patients with GC have s1a allele and s1a/m2 vacA genotype. Both s1a/m2 vacA genotype and babA2 are associated with PUD. The study shows that different virulence attributes of H. pylori are involved in different gastroduodenal disorders.

Meta-analysis: the effects of gut flora modulation using prebiotics, probiotics and synbiotics on minimal hepatic encephalopathy

BACKGROUND

Minimal hepatic encephalopathy (MHE) is characterised by subtle neurocognitive deficits without overt clinical manifestations. Although several trials have individually evaluated the role of prebiotics, probiotics and synbiotics, there is yet no consensus on the management of MHE.

AIM

To estimate the efficacy of prebiotics, probiotics and synbiotics in MHE in randomised controlled trials.

METHODS

MEDLINE, EMBASE, CINAHL and the Cochrane Database of Systematic Reviews were searched for published studies in all languages. Inclusion and exclusion criteria were defined a priori. Pooled relative risk and heterogeneity were estimated as the measures of association.

RESULTS

Nine studies met our inclusion criteria. Use of prebiotics, probiotics and synbiotics significantly reduced the pooled relative risk (RR) of no improvement of MHE (RR 0.40, 95% CI 0.32-0.50; P<0.001). Upon subgroup analysis, five studies with lactulose showed significant reduction of risk of no improvement of MHE (RR 0.34, 95% CI 0.24-0.47; P<0.0001) with no inter-trial heterogeneity. In two trials each of probiotics and synbiotics, their use was associated with significant beneficial effects (RR 0.41, 95% CI 0.26-0.65; P<0.0001 and RR of 0.51, 95% CI 0.32-0.80; P=0.004 respectively). There were no major adverse events though probiotics and synbiotics were better tolerated than lactulose.

CONCLUSIONS

The use of prebiotics, probiotics and synbiotics was associated with significant improvement in minimal hepatic encephalopathy. Among individual agents, lactulose appears to have the most beneficial effect, followed closely by probiotics and synbiotics.

Meta-analysis: the effects of gut flora modulation using prebiotics, probiotics and synbiotics on minimal hepatic encephalopathy

BACKGROUND

Minimal hepatic encephalopathy (MHE) is characterised by subtle neurocognitive deficits without overt clinical manifestations. Although several trials have individually evaluated the role of prebiotics, probiotics and synbiotics, there is yet no consensus on the management of MHE.

AIM

To estimate the efficacy of prebiotics, probiotics and synbiotics in MHE in randomised controlled trials.

METHODS

MEDLINE, EMBASE, CINAHL and the Cochrane Database of Systematic Reviews were searched for published studies in all languages. Inclusion and exclusion criteria were defined a priori. Pooled relative risk and heterogeneity were estimated as the measures of association.

RESULTS

Nine studies met our inclusion criteria. Use of prebiotics, probiotics and synbiotics significantly reduced the pooled relative risk (RR) of no improvement of MHE (RR 0.40, 95% CI 0.32-0.50; P<0.001). Upon subgroup analysis, five studies with lactulose showed significant reduction of risk of no improvement of MHE (RR 0.34, 95% CI 0.24-0.47; P<0.0001) with no inter-trial heterogeneity. In two trials each of probiotics and synbiotics, their use was associated with significant beneficial effects (RR 0.41, 95% CI 0.26-0.65; P<0.0001 and RR of 0.51, 95% CI 0.32-0.80; P=0.004 respectively). There were no major adverse events though probiotics and synbiotics were better tolerated than lactulose.

CONCLUSIONS

The use of prebiotics, probiotics and synbiotics was associated with significant improvement in minimal hepatic encephalopathy. Among individual agents, lactulose appears to have the most beneficial effect, followed closely by probiotics and synbiotics.

Effect of silver and palladium on dye-removal characteristics of anatase-titania nanotubes

Anatase-titania nanotubes have been synthesized via hydrothermal and surface-modified by depositing silver and palladium via ultraviolet-reduction method. The pure and surface-modified anatase-titania nanotubes have been characterized using the transmission electron microscope, selected-area electron diffraction, X-ray diffraction, diffuse reflectance, photoluminescence, and Fourier transform infrared spectroscope to reveal their average size, structure, and surface-chemistry. The nanotubes have been utilized for the dye-removal application involving the surface-adsorption mechanism under the dark-condition and photocatalytic degradation mechanism under the ultraviolet-radiation exposure. The variation in the dye-concentration during the dye-adsorption and photocatalysis processes has been determined using the ultraviolet-visible absorption spectrophotometer with methylene blue as a model catalytic dye-agent. It has been shown that silver-deposited anatase-titania nanotubes are more effective in enhancing the kinetics of the dye-removal via surface-adsorption and photocatalytic degradation mechanisms relative to the palladium-deposited anatase-titania nanotubes, which has been attributed to the differences in the surface-chemistry of anatase-titania nanotubes induced by the respective metal-deposition.

Hydrothermal processing of hydrogen titanate/anatase-titania nanotubes and their application as strong dye-adsorbents

The nanotubes of pure hydrogen titanate and anatase-titania have been synthesized via hydrothermal treatment of as-received anatase-titania particles. The formation mechanism of anatase-titania nanotubes via hydrothermal has been discussed in detail in view of the finger-prints produced by characterizing the intermediate and end products using various microscopic and spectroscopic techniques such as scanning electron microscope, high-resolution transmission electron microscope, X-ray diffraction, Brunauer, Emmett, and Teller specific surface-area measurement, Fourier transform infrared spectroscope, diffuse reflectance, photoluminescence, thermal gravimetric and differential thermal analyses. The obtained results strongly support the rollup mechanism, involving multiple nanosheets, for the formation of anatase-titania nanotubes with the formation of different intermediate hydrothermal products having various morphologies such as sodium titanate having aggregated rectangular block-like structures, hydrogen sodium titanate and pure hydrogen titanate having highly aggregated unresolved fine-structures containing nanotubes, and finally, the pure anatase-TiO2 nanotubes. It is demonstrated that, during the hydrothermal treatment, the nanotubes of pure hydrogen titanate are formed first coinciding with the stable solution-pH during washing, indicating the completion of ion-exchange process, and a drastic increase in the specific surface-area of the hydrothermal product. The anatase-titania nanotubes are then derived from the pure hydrogen titanate nanotubes via thermal treatment. The use of pure hydrogen titanate and anatase-titania nanotubes for an organic textile dye-removal, from an aqueous solution under the dark condition, via surface-adsorption mechanism has been demonstrated. It is shown that, the specific surface-area and the surface-charge govern the maximum dye-absorption capacity of the anatase-TiO2 nanotubes under the dark condition.

Bone densitometry using x-ray spectra

In contrast to the two distinct energy regions that are involved in dual-energy x-ray absorptiometry for bone densitometry, the complete spectrum of a beam transmitted through two layers of different materials is utilized in this study to calculate the areal density of each material. Test objects constructed from aluminum and Plexiglas were used to simulate cortical bone and soft tissue, respectively. Solid-state HPGe (high-purity germanium) detectors provided high-resolution x-ray spectra over an energy range of approximately 20-80 keV. Areal densities were obtained from spectra using two methods: a system of equations for two spectral regions and a nonlinear fit of the entire spectrum. Good agreement with the known areal densities of aluminum was obtained over a wide range of PMMA thicknesses. The spectral method presented here can be used to decrease beam hardening at a small number of bodily points selected for examination.