Phase II study of induction chemotherapy with fixed dose rate (FDR) gemcitabine and cisplatin followed by concurrent chemoradiation with capecitabine for locally advanced pancreatic cancer (LAPC)

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Background: Despite the use of 5-FU based chemoradiotherapy (CRT) over the past decades, prognosis of patients with LAPC remains dismal. To deliver more efficient systemic treatment earlier and reduce toxicity of CRT, we designed a treatment protocol consisting of induction (IND) chemotherapy with FDR gemcitabine (GEM) and cisplatin (CDDP), followed by CRT with capecitabine (CAP) in LAPC. Methods: Eligible patients had unresectable, histologically confirmed adenocarcinoma of pancreas, ECOG PS of 0–2, and no prior chemo- or radiotherapy for this phase II study. Patients received FDR GEM 1000 mg/m2 (D1,8) and CDDP 60 mg/m2 (D1) every 3 weeks for 3 cycles. Patients without disease progression subsequently received CRT of 55.8 Gy in 31 fractions concurrently with CAP, 650 mg/m2 given twice daily without drug holidays. Four weeks after CRT, FDR GEM 1000 mg/m2 was given on day 1, 8 every 3 weeks for 3 cycles. Time to progression was the primary endpoint. Results: Between Jan 2005 and Nov 2006, 21 patients were enrolled (median age 59, M/F: 13/8, ECOG PS 0/1: 3/18). Two patients withdrew consent after 1st and 2nd cycle and remaining 19 patients completed all three cycles of IND chemotherapy, with three (15.8%) out of 19 evaluable patients achieving partial response (0 CR, 3 PR, 14 SD, 2 PD). All 17 patients completed CRT with mean radiation dose of 55.4 Gy. Further four patients progressed during CRT, while one additional patient achieved partial response. As of Jan 2007, 5 patients died and 12 patients showed tumor progression. Median TTP was 12.5 mo (95% CI: 4.2–20.8) and median survival was not reached with median follow up duration of 9.7 months. Grade III/IV toxicities included neutropenia (38.1%/9.5%), thrombocytopenia (4.8%/0%), and anemia (14.3%/0%) during IND phase. Toxicites were generally mild during CRT phase with grade III neutropenia and diarrhea occurring in one and two patients, respectively. One patient died of neutropenic sepsis after 3rd cycle of IND chemotherapy. Conclusions: FDR GEM-CDDP induction chemotherapy followed by CAP-RT and maintenance FDR GEM is feasible and active with promising TTP of 12.5 months. Enrollment continues till reaching target accrual of 37 patients.

No significant financial relationships to disclose.

Imaging of pericardial diseases

Traditionally echocardiography has been the method of choice for the evaluation of pericardial and cardiac lesions. However, computed tomography (CT) and magnetic resonance imaging (MRI) provide a large field of view and excellent images of anatomy not available with echocardiography. In addition, CT and MRI demonstrate high soft-tissue contrast as well as the exact localization of a lesion. Currently, CT and MRI are the preferred techniques for the recognition and characterization of pericardial disorders. In this review, the characteristic imaging appearances of a variety of pericardial diseases are discussed.

Utilization of an alternative Communication Device using the Anal Sphincter (CDAS)

The purpose of this study was to invent a new communication system for terminal amyotrophic lateral sclerosis (ALS) patients who are in a state of complete motor paralysis with intact sensory and cognitive functions whose speech are disrupted due to the weakness of muscles involved in speaking and/ or to tracheostomy and ventilator dependence.

Automated Individual Prescription of Exercise with an XML-based Expert System

Continuously motivating people to exercise regularly is more important than finding a barriers such as lack of time, cost of equipment or gym membership, lack of nearby facilities and poor weather or night-time lighting. Our proposed system presents practicable methods of motivation through a web-based exercise prescription service. Users are instructed to exercise according to their physical ability by means of an automated individual prescription of exercise checked and approved by a personal trainer or exercise specialist after being tested with the HIMS, fitness assessment system. Furthermore, utilizing BIOFIT exercise prescriptions scheduled by an expert system can help users exercise systematically. Automated individual prescriptions are built in XML based documents because the data needs to be flexible, expansible and convertible structures to process diverse exercise templates. Web-based exercise prescription service makes users stay interested in exercise even if they live in many different environments.

Implementation of a transcutaneous charger for fully implantable middle ear hearing device

A transcutaneous charger for the fully implantable middle ear hearing device (F-IMEHD), which can monitor the charging level of battery, has been designed and implemented. In order to recharge the battery of F-IMEHD, the electromagnetic coupling between primary coil at outer body and secondary coil at inner body has been used. Considering the implant condition of the F-IMEHD, the primary coil and the secondary coil have been designed. Using the resonance of LC tank circuit at each coil, transmission efficiency was increased. Since the primary and the secondary coil are magnetically coupled, the current variation of the primary coil is related with the impedance of internal resonant circuit. Using the principle mentioned above, the implanted module could transmit outward the information about charging state of battery or coupling between two coils by the changing internal impedance. As in the demonstrated results of experiment, the implemented charger has supplied the sufficient operating voltage for the implanted battery within about 10 mm distance. And also, it has been confirmed that the implanted module can transmit information outward by control of internal impedance.

Analysis of relation between coronary perfusion pressure and the extracted parameters from a ventricular fibrillation ECG signal

This work presents an alternative return of spontaneous circulation (ROSC) estimate using indirectly induced presumption that coronary perfusion pressure (CPP) correlates with the extracted parameter from the ventricular fibrillation (VF) ECG signal. In past studies, it is revealed that successful cardiopulmonary resuscitation (CPR) needs at least 30 approximately 40 mmHg CPP during the aortic diastolic period. In 360 segments derived from 18 test dogs with experimental cardiac arrest of cardiac cause, we analyzed the ability of 4 spectral features of VF before countershock to discriminate or not between segments that correspond to CPP. The median frequency (MF), peak frequency (PF), average segment amplitude (ASA) and maximum segment amplitude (MSA) were studied. After preprocessing the raw data acquired from the specific experimental setup and protocol, we verified CPP is a serious estimate of ROSC, and then we analyzed the extracted parameters corresponding to CPP by multiple regression. In the specific conditional frequency domain (MF: 9.42 approximately 12.42 Hz, PF: 8.71 approximately 13.08 Hz, ASA: > 0.19 mV), CPP is correlated to the extracted parameter with 0.71 +/- 0.05 coefficient of multiple determination (R(2)). The combination of MF, PF, and ASA achieved a 79.47 +/- 3% sensitivity and 41.67 +/- 4% specificity in testing.

Reduction of Listeria monocytogenes populations during exposure to a simulated gastric fluid following storage of inoculated frankfurters formulated and treated with preservatives

The effect of a simulated gastric fluid (adjusted to pH 1.0 with HCl) on Listeria monocytogenes, inoculated postprocessing on pork frankfurters formulated with sodium lactate (SL) and sodium diacetate (SD) and not dipped or dipped in solutions of lactic acid or acetic acid, was evaluated during storage of the frankfurters at 10 degrees C for 40 days. Pork frankfurters containing 1.8% SL, 0.25% SD, 1.8% SL+0.125% SD, or 1.8% SL+0.25% SD were inoculated with 10(2)-10(3) CFU/cm2 of a 10-strain preparation of L. monocytogenes and were not dipped or dipped for 2 min in solutions of 2.5% lactic or acetic acid before they were vacuum-packaged and stored. Survival of L. monocytogenes was determined after exposure of frankfurters for 0, 20, 40, and 60 min to the simulated gastric fluid after storage for 0, 10, 20, 30, or 40 days. Growth of L. monocytogenes on frankfurters formulated with antimicrobials was inhibited in the order control <SL<0.25% SD<SL+0.125% SD<SL+0.25% SD. Survival of L. monocytogenes during exposure to simulated gastric fluid was higher on those frankfurters on which there had been extensive growth of the pathogen than on frankfurters on which growth had been inhibited. Inclusion of single antimicrobials in the formulation of not dipped frankfurters appeared to increase resistance of L. monocytogenes to simulated gastric fluid provided the initial level of the pathogen exposed to the simulated gastric fluid was higher than 5 log CFU/cm2. Although the combinations of SL and SD used in the formulation of not dipped frankfurters inhibited growth of L. monocytogenes, prolonged (40 days) storage of such frankfurters induced slight resistance to simulated gastric fluid. The frankfurter formulation of 0.25% SD and dipping in 2.5% lactic acid appeared to increase resistance of L. monocytogenes to simulated gastric fluid following growth during prolonged (days 20 to 40) storage. Use of 2.5% acetic acid dipping combined with antimicrobials in the formulation inhibited growth of L. monocytogenes on frankfurters and subsequent detectable survival after exposure to simulated gastric fluid.

Transport of target anions, chromate (Cr (VI)), arsenate (As (V)), and perchlorate (ClO4-), through RO, NF, and UF membranes

Rejection and transport of chromate (Cr (VI)), arsenate (As (V)), and perchlorate (ClO4-) by and through reverse osmosis, nanofiltration, and ultrafiltration were found to be affected by solution pH and ionic strength. In this study, the rejection of these target ionic contaminants increased with increasing pH at the same conductivity (ionic strength) for the tested membranes, regardless of salt type. General trends showed that the rejection followed the order: CaCl2 < KCl < or = K2SO4, at the same pH and conductivity condition. The rejection also significantly decreased as conductivity was increased regardless of the salt type. These results support the notion that a more negative surface charge due to increasing pH and/or decreasing ionic strength (conductivity) enhances rejection; lower molecular weight cut-off also enhances rejection. Measured values of hindered diffusion coefficient through the membrane pores (Dp) for the target contaminants significantly decreased as pH was increased, regardless of salt type at the same conductivity. At the same pH and conductivity, the Dp of the target contaminants follows the order: CaCl2 > KCl > K2SO4, in the presence of different types of salts. The Dp of the target contaminants significantly increased as conductivity was increased regardless of the salt type. The rejection data were modeled by application of a non-equilibrium thermodynamic model. The rejection model has five transport parameters: the molecular transport coefficient (omega), osmotic pressure gradient (deltaII), molecular reflection coefficient (sigma), the average bulk fluid interfacial concentration between the feed and permeate side (C(avg)), and the solvent flux (Jv). The transport parameters were determined by independent measurements (and calculation with minimum assumptions.) Measurements and predictions of the target contaminant transport were in good agreement.

Effect of simulated spray chilling with chemical solutions on acid-habituated and non-acid-habituated Escherichia coli O157:H7 cells attached to beef carcass tissue

Samples (10 by 20 by 2.5 cm) of beef carcass tissue were inoculated (10(4) to 10(5) CFU/cm2) with Escherichia coli O157: H7 that was either non-acid habituated (prepared by incubating at 15 degrees C for 48 h in inoculated filter-sterilized composite [1:1] of hot and cold water meat decontamination runoff fluids, pH 6.05) or acid habituated (prepared in inoculated water fluids mixed with filter-sterilized 2% lactic acid [LA] runoff fluids in a proportion of 1/99 [vol/vol], pH 4.12). The inoculated surfaces were exposed to conditions simulating carcass chilling (- 3 degrees C for 10 h followed by 38 h at 1 degree C). Treatments applied to samples (between 0 and 10 h) during chilling included the following: (i) no spraying (NT) or spraying (for 30 s every 30 min) with (ii) water, (iii) cetylpyridinium chloride (CPC; 0.1 or 0.5%), (iv) ammonium hydroxide (AH; 0.05%), (v) lactic acid (LA; 2%), (vi) acidified sodium chlorite (ASC; 0.12%), (vii) peroxyacetic acid (PAA; 0.02%), (viii) sodium hydroxide (SH; 0.01%), or (ix) sodium hypochlorite (SC; 0.005%) solutions of 4 degrees C. Samples were taken at 0, 10, 24, 36, and 48 h of the chilling process to determine changes in E. coli O157:H7 populations. Phase 1 tested water, SH, PAA, LA, and 0.5% CPC on meat inoculated with non-acid-habituated pathogen populations, whereas phase 2 tested water, SC, AH, ASC, LA, and 0.1% CPC on meat inoculated with acid- and non-acid-habituated populations. Reductions in non-acid-habituated E. coli O157:H7 populations from phase 1 increased in the order NT = water = SH < PAA < LA < CPC. Reductions from phase 2 for acid-habituated cells increased in the order NT = water = SC < ASC = LA = AH < CPC, whereas on non-acid-habituated cells the order observed was NT = water = SC < AH = ASC < LA < CPC. Previous acid habituation of E. coli O157:H7 inocula rendered the cells more resistant to the effects of spray chilling, especially with acid; however, the trend of reduction remained spray chilling with water = non-spray chilling < spray chilling with chemical solutions.

Characterization of Nutty Flavor in Cheddar Cheese

The objectives of this study were to determine the volatile components responsible for the sensory perception of nutty flavor in Cheddar cheese. Cheddar cheeses with and without nutty flavors were selected by descriptive sensory analysis. Volatile aroma components from Cheddar cheeses with and without nutty flavors were isolated and characterized using solvent extraction with high vacuum distillation, dynamic headspace analysis, gas chromatography-olfactometry, and gas chromatography-mass spectrometry. More than 50 aroma-active compounds were detected in Cheddar cheeses. Consistent differences were observed between nutty and not nutty Cheddar cheeses. Strecker aldehydes were detected in higher amounts in Cheddar cheeses with nutty flavors compared with Cheddar cheeses without nutty flavors. Strecker aldehydes, dimethyl sulfide, and propionic acid were evaluated in young and aged Cheddar cheese models for nutty flavor by descriptive sensory analysis. Dimethyl sulfide and propionic acid did not contribute to nutty flavor in Cheddar cheese. The addition of Strecker aldehydes to young (<4 mo old) Cheddar cheese models resulted in nutty/malty flavor perceived by sensory analysis. When Strecker aldehydes were incorporated into aged (>9 mo old) Cheddar cheese models, nutty flavor perception increased. Strecker aldehydes contribute to nutty flavor in aged Cheddar cheese.

Agricultural recycling of the by-product concentrate of livestock wastewater treatment plant processed with VSEP RO and bio-ceramic SBR

One of the problems in a reverse osmosis process for livestock wastewater treatment is disposal of the by-product concentrate. The agricultural recycling of the concentrate is more cost saving than a further treatment. Application of the concentrate reduces the chemical fertilizer amendment. The agricultural recycling of the concentrate from the Kimhae livestock wastewater treatment plant, processed with the VSEP RO and bio-ceramic SBR, was studied. The concentrate includes non-biodegradable humic ubstance and residual inorganic ions (NH4+, NO3-, PO4(3-), K+, etc.). The contents of N, P and K were 1,650, 382 and 2,059 mg L(-1), respectively. The total acidity of humic acids extracted from the concentrate was 5.17 cmol(+) g(-1), composed of 2.38 cmol(+) g(-1) of carboxylic group and 2.79 cmol(+) g(-1) of phenolic hydroxyl group. Coliforms and E. coli were not detected in the concentrate. The yield of rice plant with the concentrate applied to it resulted in similar production to that with chemical fertilizer applied. The water extractable nitrate content of the concentrate-applied land did not exceed that of chemical fertilizer applied, at soil depths of 30 and 60 cm. The percolated amount of nitrate into the water table in arable land with the concentrate applied showed a similar level to that treated with the chemical fertilizer.

A Web-based interactive education programme on vaccination for public health officials

Health and Welfare Training Center of Korean National Institute of Health (KNIH) has developed various education curricula for officials who are involved in the public health or welfare sectors. Still almost all education programmes are off-line based. In off-line settings, both the lecturers and the students should come to NIH from their counties to join the education programmes, and it is impossible for the students to review or to re-practice the education contents. We developed a prototype on-line setting education programmes to provide a more convenient and more effective service to the officials. This web-based interactive education programme consisted of the specific objectives on vaccination for the public health officials who were working for the national immunization programmes. It became a prototype of web-based education and was evaluated by the participants in April, 2001. From the evaluation, we improved the contents and tried to develop more subjects for the officials' training.

Genetic contribution to factor VII levels in families of patients undergoing coronary arteriography

An elevated plasma level of factor VII is a risk factor for coronary artery disease. We investigated environmental, familial, and genetic influences on factor VII activity in 508 family members of 87 probands who underwent elective coronary arteriography. Maximum likelihood methods were used to fit several genetic and non-genetic models of inheritance to these data to determine whether an unobserved Mendelian major gene could explain the familial distribution of factor VII. Factor VII activities were adjusted for age, gender, body mass index, smoking, alcohol consumption, menopause status, and triglycerides prior to this segregation analysis (this model accounted for 33.5% of the total variation). Adjusted factor VII activities showed strong familial aggregation with an estimated parent-offspring correlation of 0.34, sibling correlation of 0.36 and a smaller spouse correlation of 0.16. Regressive models were used to test genetic and non-genetic models in these 87 families. Mendelian single-locus models with either two or three underlying genotypic distributions of factor VII activities were best supported by these data. Essentially, these Mendelian models suggest most individuals come from a low distribution (mean, 116%), with a few individuals homozygous for a high allele drawn from a distribution with a mean of 166%. Future linkage studies may be worthwhile to further clarify the mechanisms controlling factor VII activity.

Ultrasonographic observation of intestinal mobility of dogs after acupunctural stimulation on acupoints ST-36 and BL-27

objectives of this study were to observe normal peristalsis and mixing (or segmental movements) and to evaluate an acupuncture stimulation (ST-36 and BL-27) on the intestinal (duodenum) motility in normal dogs using duplex Doppler sonography. Fifteen healthy Beagle dogs were used for this experiment after the administration of warm saline and pellet feeding. The duodenal motility was examined using duplex Doppler sonography. Six hours after the pellet feeding, an electroacupuncture stimulation at ST-36 and BL-27 was applied and the duodenal motility was examined using duplex Doppler sonography pre-stimulation, during the stimulation and post-stimulation. After saline and pellet administration, the duplex Doppler sonograms showed 3 types of peristalsis and a mixing type (or segmental movement) of duodenum motility. In the peristalsis types, most yielded high-amplitude signals which had one high peak (type-1), two high peaks (type-2), and three high peaks (type-3) and lasted more than 1.3 seconds. Mixing type of duodenum motility had weak signals and were lasted more than 1.5 seconds. Among the peristalsis types, the type 1 and type 2 were predominant and the type 3 was rarely observed. The frequency of intestinal motility stimulated by ST-36 acupoint was increased during the acupuncture stimulation (20% increase compared to the basal value) and decreased (7% decrease compared to the basal value) after stimulation. The frequency of intestinal motility stimulated by BL-27 acupoint was decreased during the acupuncture stimulation (31% decrease compared to the basal value) and increased (18% increase compared to the basal value) after stimulation. There was a significant increase between the value found in during and the post-stimulation tests. We conclude that duplex Doppler studies permit a graphic visualization of intestinal movements which can be qualitatively and quantitatively analyzed using this technique, it is possible to evaluate the gastrointestinal motility after an acupuncture

Prevalence of hepatitis E virus antibodies in Canadian swine herds and identification of a novel variant of swine hepatitis E virus

Swine hepatitis E virus is a newly identified potentially zoonotic virus from pigs of particular concern for possible direct transmission to a human xenotransplant recipient by organ transplantation. In the present study, prevalence of serum antibodies to hepatitis E virus was examined in Canadian swine herds. A total of 998 serum samples collected from 6-month-old healthy slaughter hogs were examined by enzyme immunoassay and Western blot analysis for antibodies to the recombinant open reading frame 3 (ORF3) protein of hepatitis E virus expressed in Escherichia coli. These samples represented more than 80 different swine production units from five major swine-producing provinces across Canada. From this study, 594 samples (59.4%) were found to be positive for hepatitis E virus antibody. The seroprevalence was higher in Quebec (88.8%) and Ontario (80.1%) than in Alberta and Saskatchewan (38.3%). By PCR using a pair of oligonucleotide primers deduced from the ORF2 sequence of human hepatitis E virus, a specific hepatitis E virus sequence was recovered from feces of pigs. The nucleotide sequence identity between the U.S. swine hepatitis E virus and the Canadian isolate (SK3) was only 85.8%, suggesting that genotypic variations may exist in swine hepatitis E virus in North America. Among 165 serum samples collected from humans in Saskatchewan, 2.4% were found to be positive for antibodies to the hepatitis E virus ORF3 protein. Our data indicate that hepatitis E virus is highly prevalent in commercial swine populations in Canada and support the suggestion that the swine hepatitis E virus may be an important zoonotic agent for humans.

Cleaning strategies for flux recovery of an ultrafiltration membrane fouled by natural organic matter

One of the most common problems encountered in water treatment applications of membranes is fouling. Natural organic matter (NOM) represents a particularly problematic foulant. Membranes may be fouled by relatively hydrophilic and/or hydrophobic NOM components, depending on NOM characteristics, membrane properties, and operating conditions. To maximize flux recovery for an NOM-fouled ultrafiltration membrane (NTR 7410), chemical cleaning and hydraulic rinsing with a relatively high cross-flow velocity were investigated as cleaning strategies. The modification of the membrane surface with either an anionic or a cationic surfactant was also evaluated to minimize membrane fouling and to enhance NOM rejection. Foulants from a hydrophobic NOM source (Orange County ground water (OC-GW)) were cleaned more effectively in terms of permeate flux by acid and caustic cleanings than foulants from a relatively hydrophilic NOM source (Horsetooth surface water (HT-SW)). An anionic surfactant (sodium dodecyl sulfate (SDS)) was not effective as a cleaning agent for foulants from either hydrophobic or hydrophilic NOM sources. High ionic strength cleaning with 0.1 M NaCl was comparatively effective in providing flux recovery for NOM-fouled membranes compared to other chemical cleaning agents. Increased cross-flow velocity and longer cleaning time influenced the efficiency of caustic cleaning, but not high ionic strength cleaning. The membrane was successfully modified only with the cationic surfactant; however, enhanced NOM rejection was accompanied by a significant flux reduction.

Mammalian dynamin-like protein DLP1 tubulates membranes

Dynamins are large GTPases with mechanochemical properties that are known to constrict and tubulate membranes. A recently identified mammalian dynamin-like protein (DLP1) is essential for the proper cellular distribution of mitochondria and the endoplasmic reticulum in cultured cells. In this study, we investigated the ability of DLP1 to remodel membranes similar to conventional dynamin. We found that the expression of a GTPase-defective mutant, DLP1-K38A, in cultured cells led to the formation of large cytoplasmic aggregates. Electron microscopy (EM) of cells expressing DLP1-K38A revealed that these aggregates were comprised of membrane tubules of a consistent diameter. High-magnification EM revealed the presence of many regular striations along individual membrane tubules, and immunogold labeling confirmed the association of DLP1 with these structures. Biochemical experiments with the use of recombinant DLP1 and labeled GTP demonstrated that DLP1-K38A binds but does not hydrolyze or release GTP. Furthermore, the affinity of DLP1-K38A for membrane is increased compared with wild-type DLP1. To test whether DLP1 could tubulate membrane in vitro, recombinant DLP1 was combined with synthetic liposomes and nucleotides. We found that DLP1 protein alone assembled into sedimentable macromolecular structures in the presence of guanosine-5'-O-(3-thio)triphosphate (GTPgammaS) but not GTP. EM of the GTPgammaS-treated DLP1 revealed clusters of stacked helical ring structures. When liposomes were included with DLP1, formation of long membrane tubules similar in size to those formed in vivo was observed. Addition of GTPgammaS greatly enhanced membrane tubule formation, suggesting the GTP-bound form of DLP1 deforms liposomes into tubules as the DLP1-K38A does in vivo. These results provide the first evidence that the dynamin family member, DLP1, is able to tubulate membranes both in living cells and in vitro. Furthermore, these findings also indicate that despite the limited homology to conventional dynamins (35%) these proteins remodel membranes in a similar manner.