Synchrotron X-ray phase contrast imaging of leaf venation in soybean (Glycine max) after exclusion of solar UV (280-400 nm) radiation

The hydraulic efficiency of a leaf depends on its vascular structure as this is responsible for transport activities. To investigate the effect of exclusion of UVAB and UVB radiation from the solar spectrum on the micro-structure of leaves of soybean (Glycine max, variety JS-335), a field experiment was conducted using synchrotron-based phase contrast imaging (PCI). Plants were grown in specially designed UV exclusion chambers, and wrapped with filters that excluded UVB (280-315 nm) or UVAB (280-400 nm), or transmitted all the ambient solar UV (280-400 nm) radiation (filter control). Qualitative observation of high-resolution X-ray PCI images obtained at 10 keV has shown the differences in major and minor vein structures of the leaves. The mid-rib width of the middle leaflet of third trifoliate leaves, for all treatments, were obtained using quantitative image analysis. The width of the mid-rib of the middle leaflet of third trifoliate leaves of UVB excluded plants was found to be more compared to leaves of filter control plants, which are exposed to ambient UV. The mid-rib or the main conducting vein transports water and sugars to the whole plant; therefore, mid-rib enhancement by the exclusion of solar UV radiation possibly implies enhancement in the leaf area which in turn causes an increased rate of photosynthesis.

Validity of nutrition risk index as a malnutrition screening tool compared with subjective global assessment in end-stage renal disease patients on peritoneal dialysis

We undertook this study to compare subjective global assessment (SGA) and nutrition risk index (NRI) as malnutrition screening tools in peritoneal dialysis (PD) patients. Nutrition status of the patients was categorized into low, moderate and high risk of malnutrition based on both NRI and SGA. The sensitivity, specificity and predictive values of NRI were compared with SGA, an already validated tool of nutrition status assessment in PD patients. Two hundred and eighty-three end-stage renal disease patients (age 50.02 ± 13.76 years; 204 males, 150 diabetic) were included. Based on SGA, 71/283 (25.08%) had normal nutrition, 192/283 (67.84%) mild-moderate and 20/283 (7.07%) severe malnutrition. Based on NRI, 38/283 (13.43%) patients had normal nutritional status, 193/283 (68.20%) mild-moderate and 52/283 (18.37%) severe malnutrition. Twenty-three of 283 (8.1%) were correctly classified as normal by NRI (true negative) and 197/283 (69.6%) as malnourished (true positive), 15/283 (5.3%) as false negative, 48/283 (16.96%) were misclassified as malnourished (false positive). NRI has sensitivity of 92.9% and specificity of 32.39%. Positive predictive value and Negative predictive values (NPVs) of NRI are 80.41% and 60.53%, respectively. Accuracy of the test is 78%. The receiver operating characteristic curve of NRI is 0.63. To conclude, NRI carries high sensitivity but low specificity as compared to SGA. It can be used as screening tool but not as a diagnostic tool for assessment of nutritional status in PD patients because of its low specificity and NPV.

Pericarditis with anaemia as a herald syndrome in a fatal presentation of cardiac lymphoma

Primary cardiac lymphoma (PCL) is rare, accounting for 2% of all primary cardiac malignancies. Diagnosis is sometimes slow due to the non-specific nature of symptoms, causing a delay to treatment with potentially curative anthracycline chemotherapy. We report an unusual presentation of primary cardiac lymphoma in an immunocompetent man presenting with subacute isolated right-sided heart failure with pericarditis on a background of chronic anaemia and constitutional upset. Echocardiography demonstrated a pericardial mass invading the right atrium and compressing the tricuspid annulus. Diffuse large B-cell lymphoma was diagnosed after biopsy. This case highlights the importance of early imaging and hospitalisation in pericarditis with high-risk features such as high inflammatory markers, myocardial involvement (with troponin elevation), fever, immunosuppression or evidence of heart failure. The differential and diagnostic pathway of an intracardiac mass, and the treatment and prognosis of PCL, are discussed.

Abstract P4-10-09: Relapse-free survival of triple negative breast cancer long term survivors and characterization of late events in MD Anderson experience

Background:

Stage I-III TNBC patients have a high risk of disease relapse during the first 5 years after diagnosis. However, there is limited data on the risk of late relapse in TNBC survivors who are disease free at 5 years or more from diagnosis. We sought to characterize this risk in a cohort of TNBC long-term survivors from a large institutional database.

Methods:

The MD Anderson Breast Cancer Management System database was queried for TNBC survivors who were disease free 5 years or more from diagnosis. Demographic, tumor, and treatment data was extracted. Electronic medical records were searched to confirm pathology reports for invasive breast cancer diagnosis, triple negative receptor status, and hormone receptor percentage (%). The primary and secondary outcomes of interest were relapse free survival (RFS) and distant relapse free survival (DRFS). Patients were censored at time of developing a second primary breast cancer or at last follow-up time for those who were alive during the study. We used ACP-ASCO definition of ER and PR <1% and HER2/neu negative (IHC 0-1 or ratio <2 and average copy number <4) but also included patients with low ER/PR(1-9%) and HER2 normal. Kaplan-Meier analysis was performed to compare RFS and DRFS for the overall population and categorized by ER/PR <1%, and ER/PR 1-9%.

Results:

We identified 1038 patients who had a median follow-up of 8.0 years. Receptor % information was available on 69% of patients, with 78% of them meeting current TNBC definition. From the total cohort of 130, 12.5% suffered event(s) that occurred after 5 years from diagnosis, with 86.2% of them occurring within 5-10 years of diagnosis. The event rate was 16.4% among patients with ER/PR 1-9% versus 11.3% among patients with ER/PR <1%. Table 1 shows RFS and DRFS by year from diagnosis for the entire cohort and categorized by % receptor. 18 patients developed second primary breast cancer as first event and were censored. Of total events recorded, 53(40.8%) were deaths and 77(59.2%) were recurrences, of which 51(66%) were distant and 26(34%) local, of whom 12(46.2%) subsequently developed distant metastases. Among patients who initially presented with distant recurrence, frequencies of initial sites of metastases are shown in Table 2.

Conclusions:

TNBC long term survivors are still at risk for relapse events after 5 years from diagnosis, and it is important to quantity this risk when counseling our patients. Frequency of late events was higher among patients with low hormone receptor positivity. Multivariate modeling of predictors of late recurrence is ongoing.

Table 1: RFS and DRFS by Year from Diagnosis All PatientsER/PR <1%ER/PR 1-9%Year From DiagnosisRFSDRFSRFSDRFSRFSDRFS4-51.01.01.01.01.01.05-60.950.960.940.950.940.956-70.930.940.930.940.910.927-80.900.920.900.920.870.898-90.860.880.870.890.810.849-100.840.870.840.860.800.8310-120.810.840.810.830.800.8312-150.730.780.730.750.670.74

Table 2: Site of Initial Distant RecurrenceSiteN (%)Lung/Pleura28 (54.9)Bone19 (37.3)Distant Lymph Nodes19 (37.3)Liver11 (21.6)Brain/Spinal Cord8 (15.7)Colorectal/Pancreas/Kidney/Adrenal6 (11.7)Other2 (3.9)*Patients presenting with multiple sites of distant recurrence are counted in each category.

Citation Format: Reddy SM, Sinha A, Syed M, Barcenas C, Valero V. Relapse-free survival of triple negative breast cancer long term survivors and characterization of late events in MD Anderson experience. [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 P4-10-09.

Predictors of objective cough frequency in pulmonary sarcoidosis

Cough is a common symptom of pulmonary sarcoidosis. This study aimed to quantify cough frequency, and investigate its relationship with cough reflex sensitivity, pulmonary function and health status.32 patients with pulmonary sarcoidosis were compared with 40 healthy controls. Cough reflex sensitivity to capsaicin, objective 24-h cough counts, cough-specific health status, cough severity and cough triggers were measured. The predictors of cough frequency in sarcoidosis were determined in a multivariate analysis.Objective cough frequency was significantly raised in patients with sarcoidosis compared with healthy controls (p<0.001) and patients with cough had an impaired health status. Patients with pulmonary sarcoidosis had a heightened cough reflex sensitivity compared with healthy controls (p<0.001). Only cough reflex sensitivity was significantly associated with objective cough frequency in multivariate analysis, explaining 42% of the variance (p<0.001). There was no association between cough frequency, lung function, number of organs involved, chest radiograph stage or serum angiotensin-converting enzyme levels.Cough is a common and significant symptom in patients with sarcoidosis. Ambulatory objective cough monitoring provides novel insights into the determinants of cough in sarcoidosis, suggesting that cough reflex sensitivity may be more important than lung function and other measures of disease severity, and this should be investigated further.

Rosai-Dorfman disease and the heart

Rosai-Dorfman disease (RDD) is a non-malignant pathology of histiocyte proliferation. The classical clinical presentation is with painless cervical lymphadenopathy, but extranodal involvement is frequent, occurring in approximately 40% of cases. The literature was systematically reviewed to identify reported cases of RDD with cardiac involvement. Eighteen cases were identified (3 pediatric and 15 adult). In adult cardiac RDD (cRDD), three patterns of disease were noted: an intra-cardiac mass, epicardial involvement, and pulmonary artery involvement. Reported cases suggest that surgical excision of intra-cardiac masses confers a good prognosis.

Endoscopic-CT: Learning-Based Photometric Reconstruction for Endoscopic Sinus Surgery

In this work we present a method for dense reconstruction of anatomical structures using white light endoscopic imagery based on a learning process that estimates a mapping between light reflectance and surface geometry. Our method is unique in that few unrealistic assumptions are considered (i.e., we do not assume a Lambertian reflectance model nor do we assume a point light source) and we learn a model on a per-patient basis, thus increasing the accuracy and extensibility to different endoscopic sequences. The proposed method assumes accurate video-CT registration through a combination of Structure-from-Motion (SfM) and Trimmed-ICP, and then uses the registered 3D structure and motion to generate training data with which to learn a multivariate regression of observed pixel values to known 3D surface geometry. We demonstrate with a non-linear regression technique using a neural network towards estimating depth images and surface normal maps, resulting in high-resolution spatial 3D reconstructions to an average error of 0.53mm (on the low side, when anatomy matches the CT precisely) to 1.12mm (on the high side, when the presence of liquids causes scene geometry that is not present in the CT for evaluation). Our results are exhibited on patient data and validated with associated CT scans. In total, we processed 206 total endoscopic images from patient data, where each image yields approximately 1 million reconstructed 3D points per image.

Readmission rates and financial penalties after ear, nose and throat surgery: how can we improve?

INTRODUCTION

Since April 2011, all patient readmissions within 30 days have resulted in a financial penalty to the hospital trust, and therefore the responsible department. These costs may be substantial and potentially preventable.

METHODS

A service evaluation of readmissions within 30 days of discharge, over a 12-month period (January-December 2012), was performed in the ear, nose and throat department of a district general hospital, and findings were used as a basis to suggest areas for potential quality improvement.

AIMS

To determine the number of readmissions, causes of readmission and resulting costs, and to explore how these readmissions may be prevented.

RESULTS

The departmental 30-day readmission rate over the study period was 3.12% (81/2606). The commonest causes of readmission (33.3%) were complications following tonsillectomy (27/81) such as pain, infection or bleeding. Over a third of these patients (30/81) were readmitted for less than 24 hours, with the average length of stay being less than 2.5 days. Financial implications: In 2011 the trust had 7526 emergency readmissions which were eligible for penalty within the 30-day time frame. This resulted in a loss of income of more than £60 000 to the ear, nose and throat department.

CONCLUSIONS

Optimizing postoperative care and improving patient understanding of common complications may reduce readmission rates, thus limiting the financial burden on the trust. These areas could serve as a basis for future quality improvement projects.

Application of X-ray micro-CT for micro-structural characterization of APCVD deposited SiC coatings on graphite conduit

SiC coatings are commonly used as oxidation protective materials in high-temperature applications. The operational performance of the coating depends on its microstructure and uniformity. This study explores the feasibility of applying tabletop X-ray micro-CT for the micro-structural characterization of SiC coating. The coating is deposited over the internal surface of pipe structured graphite fuel tube, which is a prototype of potential components of compact high-temperature reactor (CHTR). The coating is deposited using atmospheric pressure chemical vapor deposition (APCVD) and properties such as morphology, porosity, thickness variation are evaluated. Micro-structural differences in the coating caused by substrate distance from precursor inlet in a CVD reactor are also studied. The study finds micro-CT a potential tool for characterization of SiC coating during its future course of engineering. We show that depletion of reactants at larger distances causes development of larger pores in the coating, which affects its morphology, density and thickness.

Non-destructive evaluation of teeth restored with different composite resins using synchrotron based micro-imaging

BACKGROUND

Application of high resolution synchrotron micro-imaging in microdefects studies of restored dental samples.

OBJECTIVE

The purpose of this study was to identify and compare the defects in restorations done by two different resin systems on teeth samples using synchrotron based micro-imaging techniques namely Phase Contrast Imaging (PCI) and micro-computed tomography (MCT). With this aim acquired image quality was also compared with routinely used RVG (Radiovisiograph).

METHODS

Crowns of human teeth samples were fractured mechanically involving only enamel and dentin, without exposure of pulp chamber and were divided into two groups depending on the restorative composite materials used. Group A samples were restored using a submicron Hybrid composite material and Group B samples were restored using a Nano-Hybrid restorative composite material. Synchrotron based PCI and MCT was performed with the aim of visualization of tooth structure, composite resin and their interface.

RESULTS

The quantitative and qualitative comparison of phase contrast and absorption contrast images along with MCT on the restored teeth samples shows comparatively large number of voids in Group A samples.

CONCLUSIONS

Quality assessment of dental restorations using synchrotron based micro-imaging suggests Nano-Hybrid resin restorations (Group B) are better than Group A.

Healthcare professional requirements for the care of adult diabetes patients managed with insulin pumps in Australia

BACKGROUND

Healthcare professional (HCP) time supporting insulin pump therapy (IPT) has not been documented, yet it is important in planning and allocating resources for effective care.

AIM

This study aims to determine HCP time spent in IPT patient care to inform resource planning for optimal IPT delivery.

METHODS

Twenty-four Australian adult IPT-experienced institutions (14 government funded, seven private, three both) collected data between April 2012 and January 2013 prospectively, including: patient demographics, HCP classification, purpose of HCP-patient interaction, interaction mode and HCP time with the patient. A subset of patients was tracked from pre-pump education until stable on IPT.

RESULTS

Data on 2577 HCP-adult patient interactions (62% face-to-face, 29% remote, 9% administrative) were collected over 12.2 ± 6.4 weeks for 895 patients; age 35.4 ± 14.2 years; 67% female; 99% type 1 diabetes, representing 25% of all IPT patients of the institutions. Time (hours) spent on IPT interactions per centre per week were: nurses 5.4 ± 2.8, dietitians 0.4 ± 0.2 and doctors 1.0 ± 0.5. IPT starts accounted for 48% of IPT interaction time. The percentage of available diabetes clinic time spent on outpatient IPT interactions was 20.4%, 4.6% and 2.7% for nurses, dietitians and doctors respectively. Fifteen patients tracked from pre-pump to stabilisation over 11.8 ± 4.5 weeks, required a median (range) of 9.2 (3.0-20.9), 2.4 (0.5-6.0) and 1.8 (0.5-5.4) hours per patient from nurses, dietitians and doctors respectively.

CONCLUSIONS

IPT patient care represents a substantial investment in HCP time, particularly for nurses. Funding models for IPT care need urgent review to ensure this now mainstream therapy integrates well into healthcare resources.

Progressive wheeze: atrial myxoma masquerading as chronic obstructive pulmonary disease

Atrial myxoma, the commonest primary cardiac neoplasm, presents with symptoms of heart failure, embolic phenomena or constitutional upset. We present an atypical case, with wheeze and symptomatic exacerbations typical of chronic obstructive pulmonary disease. With no early clinical evidence of heart failure, the patient was managed with inhaled steroids and bronchodilators, with little relief. Only when the patient was in extremis requiring intubation, due to respiratory failure, did clinical evidence of left heart failure become apparent, with echocardiography demonstrating a massive left atrial myxoma obstructing the mitral valve annulus. Following successful surgical resection, the patient's symptoms fully abated. This case highlights the importance of considering cardiac wheeze in those initially managed as obstructive airway disease not responding in a typical fashion to initial bronchodilator therapy, and particularly in those with rapidly progressive symptoms. Such patients should be referred early for cardiac imaging. The excellent prognosis and quick recovery after timely surgical resection of a myxoma are also highlighted.

A prospective comparative study of channel photoselective vaporization of prostate vs. channel transurethral resection of prostate in patients with advanced carcinoma prostate

OBJECTIVE

To compare short term efficacy and safety of channel photoselective vaporization of prostate (PVP) and channel transurethral resection of prostate (TURP) in patients with bladder outlet obstruction (BOO) secondary to advanced carcinoma prostate.

METHODS

This prospective, non-randomized comparative study was conducted between April 2012 and December 2014. Patients with locally advanced/metastatic carcinoma prostate, who underwent either channel PVP or channel TURP for troublesome LUTS/ acute retention of urine were included in the study. Preoperative, intraoperative, postoperative and follow up data at 1,3 and 6 months was recorded for analysis.

RESULTS

Data analysis of 34 and 37 patients, who underwent channel PVP and channel TURP respectively, were done. Baseline characteristics of the two groups were similar with no statistical difference noted between them. Though the operative duration was significantly higher in channel PVP group; perioperative blood loss, need for postoperative irrigation, duration of postoperative irrigation and catheterization were significantly lesser compared to channel TURP group. Clot retention rates were significantly higher in channel TURP group. The efficacy parameters were comparable between the two groups at 6 month follow up.

CONCLUSION

Channel KTP-PVP is an efficacious alternative to channel TURP in the management of BOO secondary to advanced carcinoma prostate with the added advantages of significantly less perioperative blood loss, no requirement for blood transfusion and a short catheterization time.

Phase I and biomarker study of OPB-51602, a novel signal transducer and activator of transcription (STAT) 3 inhibitor, in patients with refractory solid malignancies

BACKGROUND

The aim of this study was to determine the maximum-tolerated dose (MTD), safety, pharmacokinetics, and pharmacodynamics of OPB-51602, an oral, direct signal transduction activator of transcription 3 (STAT3) inhibitor, in patients with refractory solid tumors.

PATIENTS AND METHODS

Three cohorts were studied: cohort A, a sequential dose escalation of OPB-51602 administered intermittently (days 1-14 every 21 days); cohort B, an expansion cohort evaluating the dose lower than the MTD; cohort C, evaluating continuous daily dosing.

RESULTS

Fifty-one patients were studied at 2, 4, and 5 mg per day dosing. The MTD was 5 mg; first-cycle dose-limiting toxicities (DLTs) were grade 3 hyponatremia in one patient, and grade 3 dehydration in another. Intermittent dosing of both 2 and 4 mg doses were tolerable, and the recommended phase II dose was 4 mg. Cohort B investigated 4 mg intermittently, whereas cohort C investigated 4 mg continuously. Common toxicities included fatigue, nausea/vomiting, diarrhea, anorexia, and early-onset peripheral neuropathy. Drug-induced pneumonitis occurred in two patients in cohort C. Continuous dosing was associated with a higher incidence of peripheral neuropathy and a lower mean relative dose intensity, compared with intermittent dosing. Steady-state pharmacokinetics was characterized by high oral clearance, mean elimination half-life ranging from 44 to 61 h, and a large terminal-phase volume of distribution. An active metabolite, OPB-51822, accumulated to a greater extent than OPB-51602. Flow cytometry of peripheral blood mononuclear cells demonstrated pSTAT3 (Tyr(705)) inhibition following exposure. Two patients achieved partial responses at 5 mg intermittently and 4 mg continuously; both had epidermal growth factor receptor (EGFR) mutation-positive non-small-cell lung cancer (NSCLC) with prior EGFR tyrosine kinase inhibitor exposure.

CONCLUSION

OPB-51602 demonstrates promising antitumor activity, particularly in NSCLC. Its long half-life and poorer tolerability of continuous dosing, compared with intermittent dosing, suggest that less frequent dosing should be explored.

CLINICALTRIALSGOV IDENTIFIER

NCT01184807.

Oscillatory blood flow through a capillary in presence of thermal radiation

This paper deals with the theoretical investigation of a fundamental problem of magnetohydrodynamic (MHD) flow of blood in a capillary in the presence of thermal radiation and chemical reaction. The unsteadiness in the flow and temperature fields is caused by the time-dependence of the stretching velocity and the surface temperature. The fluid is considered to be non-Newtonian, whose flow is governed by the equation of a third-order fluid. The problem is first reduced to solving a system of coupled nonlinear differential equations involving several parameters. Considering blood as an electrically conducting fluid and using the present analysis, an attempt is made to compute some parameters of the blood flow by developing a suitable numerical method and by devising an appropriate finite difference scheme. The computational results are presented in graphical form, and thereby some theoretical predictions are made with respect to the hemodynamical flow of the blood in a hyperthermal state under the action of a magnetic field. Computational results for the variation in velocity, temperature, concentration, skin-friction coefficient, Nusselt number and Sherwood number are presented in graphical/tabular form. Since the study takes care of thermal radiation in blood flow, the results reported here are likely to have an important bearing on the therapeutic procedure of hyperthermia, particularly in understanding blood flow and heat transfer in capillaries.

Comparison between Single Dose Azithromycin and Six Doses, 3 Day Norfloxacin for Treatment of Cholera in Adult

AIM

To evaluate the efficacy of single dose Azithromycin (1 gram) in treatment of cholera in adults. A randomized, controlled clinical trial on 120 adults with acute watery diarrhoea and moderate to severe dehydration compared the efficacy of azithromycin (1 gram) single dose and Norfloxacin (400 mg) twice daily for three days in treating cholera. Data were analysed for 64 patients who were stool culture positive for Vibrio cholerae. In conjunction with rehydration therapy, 32 patients received Azithromycin and 32 patients received Norfloxacin. Patients in the two treatment groups had comparable clinical characteristics on admission.

CONCLUSIONS

Result shows Azithromycin and Norfloxacin has got almost similar efficacy in reducing stool output, duration of diarrhoea and fluid requirement in cholera positive cases.

Relapses in patients treated with fingolimod after previous exposure to natalizumab

In post hoc analyses of an open-label, phase 3b study (FIRST), relapse rates during 4 months of fingolimod therapy were compared in patients with and without previous natalizumab exposure. Reductions in the proportion of patients experiencing relapses and annualized relapse rates (ARRs) from years 1 and 1-2 pre-study were evident between months 1 and 2 of fingolimod treatment, and were most pronounced in natalizumab-naïve patients and those who discontinued natalizumab >6 months pre-study. Patients who discontinued natalizumab 3-6 months pre-study had a peak ARR during month 1 of fingolimod treatment, followed by a decrease during months 2-4. These data indicate that fingolimod has the potential to reduce disease reactivation but that timing of treatment initiation may be critical for achieving an optimal effect.