Identification and validation of immunogenic potential of India specific HPV-16 variant constructs: In-silico &in-vivo insight to vaccine development

Cervical cancer is one of the most common gynecological cancers in the world but in India, it is the top most cancer among women. Persistent infection with high-risk human papillomaviruses (HR-HPVs) is the most important risk factor. The sequence variation(s) in the most common HR-HPV i.e. HPV type 16 leads to altered biological functions with possible clinical significance in the different geographical locations. Sixteen major variants (V1-V16) in full length L1 gene of HPV-16 were identified following analysis of 250 prospectively collected cervical cancer tissue biopsies and their effect on immunogenicity was studied. The effect of these major variations on the epitopes were predicted by in silico methods and the immunogenicity of variants and respective reference DNA vaccine constructs were evaluated by administration of prepared DNA vaccine constructs in female BALB/c mice to evaluate antibody titer. In the present study, L500F (V16) variation showed a significant ~2.7 fold (p < 0.002) increase in antibody titer, whereas T379P (V8) showed ~0.4 fold (p < 0.328) decrease after final injection. These results showed a promising roadmap for the development of DNA based vaccine and for the generation of effective response, though there is a need to study more prevalent variants of HPV in the Indian population.

Rasmussen's aneurysm: A rare and forgotten cause of hemoptysis

Hemoptysis as a sequelae of past tubercular infection of lungs is a known occurrence. Hemoptysis in such a patient can result from a number of etiologies like tubercular reactivation, bronchiectasis, aspergiloma and vascular complications like hypervascularity from bronchial arteries, arteriovenous fistula formation, pseudoaneurysms, etc. Massive hemoptysis in such a patient is usually treated by bronchial artery embolization and occasionally by surgical lobectomy. A rare source of bleeding in such a patient is from Rasmussen's aneurysm arising from the pulmonary arteries. We report a young patient of treated pulmonary tuberculosis who had recurrent hemoptysis. He was treated earlier with bronchial artery embolization. On recurrence of hemoptysis, he was reevaluated and was found to have multiple Rasmussen's aneurysms arising from the pulmonary arteries, which were successfully treated by coil embolization.

The association between lesion location and functional outcome after ischemic stroke

BACKGROUND

Infarct location has a critical effect on patient outcome after ischemic stroke, but the study of its role independent of overall lesion volume is challenging. We performed a retrospective, hypothesis-generating study of the effect of infarct location on three-month functional outcome in a pooled analysis of the EPITHET and DEFUSE studies.

METHODS

Posttreatment MRI diffusion lesions were manually segmented and transformed into standard-space. A novel composite brain atlas derived from three standard brain atlases and encompassing 132 cortical and sub-cortical structures was used to segment the transformed lesion into different brain regions, and calculate the percentage of each region infarcted. Classification and Regression Tree (CART) analysis was performed to determine the important regions in each hemisphere associated with nonfavorable outcome at day 90 (modified Rankin score [mRS] > 1).

RESULTS

Overall, 152 patients (82 left hemisphere) were included. Median diffusion lesion volume was 37·0 ml, and median baseline National Institutes of Health Stroke Score was 13. In the left hemisphere, the strongest determinants of nonfavorable outcome were infarction of the uncinate fasciculus, followed by precuneus, angular gyrus and total diffusion lesion volume. In the right hemisphere, the strongest determinants of nonfavorable outcome were infarction of the parietal lobe followed by the putamen.

CONCLUSIONS

Assessment of infarct location using CART demonstrates regional characteristics associated with poor outcome. Prognostically important locations include limbic, default-mode and language areas in the left hemisphere, and visuospatial and motor regions in the right hemisphere.

Storage stability of bevacizumab in polycarbonate and polypropylene syringes

PURPOSE

To compare and examine the storage stability of compounded bevacizumab in polycarbonate (PC) and polypropylene (PP) syringes over a 6-month period. PC syringes have been used in a recent clinical study and bevacizumab stability has not been reported for this type of syringe.

METHODS

Repackaged bevacizumab was obtained from Moorfields Pharmaceuticals in PC and PP syringes. Bevacizumab from the stored syringes was analysed at monthly time points for a 6-month period and compared with bevacizumab from a freshly opened vial at each time point. SDS-PAGE electrophoresis and size-exclusion chromatography (SEC) was used to observe aggregation and degradation. Dynamic light scattering (DLS) provided information about the hydrodynamic size and particle size distribution of bevacizumab in solution. VEGF binding and the active concentration of bevacizumab was determined by surface plasmon resonance (SPR) using Biacore.

RESULTS

SDS-PAGE and SEC analysis did not show any changes in the presence of higher molecular weight species (HMWS) or degradation products in PC and PP syringes from T0 to T6 compared with bevacizumab sampled from a freshly opened vial. The hydrodynamic diameter of bevacizumab in the PC syringe after 6 months of storage was not significantly different to bevacizumab taken from a freshly opened vial. Using SPR, the VEGF binding activity of bevacizumab in the PC syringe was comparable to bevacizumab taken from a freshly opened vial.

CONCLUSION

No significant difference over a 6-month period was observed in the quality of bevacizumab repackaged into prefilled polycarbonate and polypropylene syringes when compared with bevacizumab that is supplied from the vial.

L1014F-kdr Mutation in Indian Anopheles subpictus (Diptera: Culicidae) Arising From Two Alternative Transversions in the Voltage-Gated Sodium Channel and a Single PIRA-PCR for Their Detection

Leucine-to-phenylalanine substitution at residue L1014 in the voltage-gated sodium channel, target site of action for dichlorodiphenyltrichloroethane (DDT) and pyrethroids, is the most common knockdown resistance (kdr) mutation reported in several insects conferring resistance against DDT and pyrethroids. Here, we report presence of two coexisting alternative transversions, A>T and A>C, on the third codon position of L1014 residue in malaria vector Anopheles subpictus Grassi (species A) from Jamshedpur (India), both leading to the same amino acid substitution of Leu-to-Phe with allelic frequencies of 19 and 67%, respectively. A single primer-introduced restriction analysis-polymerase chain reaction (PIRA-PCR) was devised for the identification of L1014F-kdr mutation in An. subpictus resulting from either type of point mutation. Genotyping of samples with PIRA-PCR revealed high frequency (82%) of L1014F-kdr mutation in the study area.

Imaging Selection in Ischemic Stroke: Feasibility of Automated CT-Perfusion Analysis

Background

Advanced imaging may refine patient selection for ischemic stroke treatment but delays to acquire and process the imaging have limited implementation.

Aims

We examined the feasibility of imaging selection in clinical practice using fully automated software in the EXTEND trial program.

Methods

CTP and perfusion-diffusion MRI data were processed using fully-automated software to generate a yes/no ‘mismatch’ classification that determined eligibility for trial therapies. The technical failure/mismatch classification error rate and time to image and treat with CT vs. MR-based selection were examined.

Results

In a consecutive series of 776 patients from five sites over six-months the technical failure rate of CTP acquisition/processing (uninterpretable maps) was 3·4% (26/776, 95%CI 2·2–4·9%). Mismatch classification was overruled by expert review in an additional 9·0% (70/776, 95%CI 7·1–11·3%) due to artifactual ‘perfusion lesion’. In 154 consecutive patients at one site, median additional time to acquire CTP after noncontrast CT was 6·5 min. Subsequent RAPID processing time varied from 3–10 min across 20 trial centers (median 5 min 20 s). In the EXTEND trial, door-to-needle times in patients randomized on the basis of CTP ( n = 47) were median 78 min shorter than MRI-selected ( n = 16) patients ( P < 0·001).

Conclusions

Automated CTP-based mismatch selection is rapid, robust in clinical practice, and associated with faster treatment decisions than MRI. This technological advance has the potential to improve the standardization and reproducibility of interpretation of advanced imaging and extend use to practice settings beyond highly specialized academic centers.

Potentiometric Studies on Stepwise Mixed Ligand Complex Formation

Stepwise mixed ligand complex formation is observed in the systems containing metal ion, iminodiacetic acid (IMDA) as primary ligand and one of the diamines, such as ethylenediamine (en), 1,2-propanediamine (1,2-pn) and 1,3-propanediamine (1,3-pn) as secondary ligands. Potentionmetric titrations indicate the formation of ternary complexes having a 1:1:1 molar ratio of metal ion to iminodiacetic acid to the secondary ligand. Initially, metal-IMDA (1:1) complex is formed in the lower buffer region prior to the formation of the ternary complex and the addition of the secondary ligand takes place only after the combination with the primary ligand is complete. Formation constants (log KMAB) of the ternary complexes have been calculated and the probable reaction mechanism is suggested. The order of stability in terms of metal ion has been found to be Cu (II) > Ni (II) >Zn (II) >Cd (II) and in terms of secondary ligand as 1,2-pn>en>1,3-pn.

Retained foreign bodies: a serious threat in the Indian operation room

Retained foreign bodies (RFBs) are a surgical complication resulting from foreign materials accidently left in a patient's body. This review attempts to give an overview of different types of RFBs, problems related to them and their management after the surgical operation. The internet was searched using the Google and Google scholar. In addition, relevant electronic journals from the University's library such as Entrez (including PubMed and PubMed central), Since Direct, Scirus, NIH.gov, Medknow.com, Medscape.com, Scopus, MedHelp.org, Cochrane library, WebMD.com, and World Health Organization Hinari. It shows that the major reasons of RFBs are emergency surgical operation with unplanned changes, patient high body mass index, and poor communication. To prevent this textile material should be radiopaque marked and must be counted once at the start and twice at the conclusion of all surgical procedures. If the count is incorrect, then radiography or manually re-exploration should be performed. Ultrasonography, computerized tomography, magnetic resonance imaging and radio frequency identification are also used in the proper identification of RFBs. Safety practice should be robust and simple enough to protect patient under the most chaotic of circumstances. Proper communication among the personnel participating in surgery aimed at preventing this medical negligence would help in mitigating such errors. Finally, the surgeon should not only follow the standard recommended procedure, but also report cases of RFBs.

Protective effects of quercetin during influenza virus-induced oxidative stress

Oxidative stress was found to have a role in many viral diseases including AIDS, hepatitis and influenza. In the present study the pathology of influenza viral infection in the lungs, which may lead to oxidative stress, was investigated and an attempt was made to study the efficacy of anti-oxidants as therapeutic agents. Adult male mice of Swiss albino type were infected with influenza virus (A/Hong Kong/8/68) and studied for the antioxidant status in the lungs by evaluating the lung enzymatic anti-oxidant system including superoxide dismutase and catalase. Superoxide radical generation, which might increase by the activated alveolar macrophages, was estimated by nitroblue-tetrazolium reduction assay. We have also estimated lipid peroxidation levels in lung through thiobarbutiric acid reactive substances assay. We also examined the ability of flavonoid quercetin in protecting from influenza virus-induced oxidative stress. The influenza-infected group showed decreased levels of superoxide dismutase and catalase; however, anti-oxidant supplemented groups showed these activities to be the same as in the control group. The lipid peroxide levels were increased in virus-infected mice. Administration of quercetin lowered the lipid peroxide levels significantly. Formazan positive cells were increased by 80% in the virus-infected group and supplementation with quercetin reduced their number to 44%.

Burn injury caused by laptop computers

Laptop burn is a real condition and medical reports indicate that using a laptop across the legs can indeed cause it. in very rare cases, the condition can cause damage leading to skin cancer. A 24-year-old man presented with an asymptomatic reddish brown pigmentation on the thighs. After an extensive work-up, burning caused by use of a laptop was observed. Burning was induced in 3 days by using laptop for 4 h daily. Laptop should be used in properly ventilated and air-conditioned rooms. The most effective way of preventing erythema is to use the laptop on the table or desk.

Abstract P1-09-03: The use of MRI in the evaluation of breast cancer

Background: The availability of Magnet Resonance Imaging (MRI) has increased in the United States over the last decade. Its use for the diagnosis and staging of breast cancer remains undetermined. We examined the trends and frequency of MRI use in women with newly diagnosed breast cancer in Texas and evaluated the factors associated with a receipt of an MRI.

Methods: The Texas Cancer Registry (TCR) Medicare linked data were used to identify incident breast cancer cases between 1/1/2003-12/30/2007. We included female patients, 65 and older enrolled in both Medicare Parts A and B for 3 months prior to diagnosis and 12 months after diagnosis, and not enrolled in an HMO plan during the same period. Patients diagnosed at autopsy were excluded. Bivariate and multivariate logistic regression analysis was performed to determine the factors associated with receipt of MRI. A Cochran-Armitage trend test was performed to examine the trends in use of MRI over study period. A p-value &lt;0.05 was considered statistically significant.

Results: Of the 292,297 patients diagnosed with breast cancer between 2003 and 2007, 18, 856 patients met the inclusion criteria. Of these, 1268 (6.72%) received an MRI. The overall use of breast MRI has increased significantly in Texas from 2.25% of women diagnosed in 2003 to 13.9% of women diagnosed in 2007 (p&lt;0.001). In the bivariate analysis we found that age, race, number of comorbidities, poverty level, education level, and region were associated with the receipt of MRI at the time of breast cancer diagnosis. In the multivariate analysis after adjusting for those covariates, we found that women of advancing age, black race (34%) and presence of any comorbidity (29%) to be significantly less likely to get an MRI, while those with regional disease and higher level of education were more likely to receive MRI (table 1).

Conclusion: Breast MRI in newly diagnosed breast cancer in the state of Texas increased six fold during the study period. While use has increased in Texas, receipt of MRI does not appear to be uniform. To identify the group of women who would benefit most from MRI, more in depth analyses of the role of socio-economic components on receipt of MRI and patient outcomes is needed.

Multivariate analysis: Odds of receiving an MRI at the time of breast cancer diagnosisVariableOdds of MRI (95% CI)P-valueAge Group &lt;.000165-691 70-740.784 (0.672-0.913) 75-790.518 (0.433-0.620) 80-840.415 (0.335-0.514) 85-890.215 (0.145-0.319) &gt;900.098 (0.044-0.223) Race 0.0463White1 Black0.658 (0.492-0.880) Hispanic0.967 (0.587-1.592) Others0.931 (0.545-1.592) Comorbidity &lt;.000101 10.713 (0.607-0.839) 20.712 (0.545-0.931) &gt;20.304 (0.192-0.479) Education Level 0.00011st Quartile (highest)1 2nd Quartile0.743 (0.617-0.896) 3rd Quartile0.594 (0.464-0.760) 4th Quartile (lowest)0.544 (0.404-0.733) Urban/Rural &lt;.0001Big Metro1 Metro0.467 (0.389-0.560) Urban0.558 (0.405-0.768) Less Urban0.882 (0.706-1.101) Rural1.022 (0.642-1.628) Stage 0.01710/In situ1 Localized1.135 (0.932-1.381) Regional1.334 (1.067-1.667) Distant1.166 (0.775-1.755) Unknown0.663 (0.414-1.063) 

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-09-03.

Abstract WP33: Reduced Cerebral Blood Flow on Acute Whole Brain CT Perfusion Best Predicts Hemorrhagic Transformation

Objective: Hemorrhagic transformation in ischemic stroke is a potentially life threatening complication of thrombolysis. Using perfusion MRI, very low cerebral blood volume (VLCBV) strongly predicts hemorrhagic transformation after reperfusion. CT perfusion (CTP) is currently more widely accessible than MRI and recent data have shown that CT relative cerebral blood flow (relCBF) provides a better estimate of infarct core than CBV. We aimed to determine the optimal parameter to predict hemorrhagic transformation using whole brain CTP.

Methods: Patients with ischemic stroke were imaged with whole brain CTP within 6hrs of symptom onset. Hemorrhagic transformation was assessed on CT/MRI within 7 days of stroke using ECASS grade. CBF and CBV were analyzed within a relative time to peak >4sec region of interest. Results were expressed as volumes below a given percentile relative to the contralateral hemisphere (relCBF and relCBV). Receiver operating characteristic (ROC) and logistic regression analysis were performed to determine the optimal parameter and percentile threshold correlating with parenchymal hemorrhage (PH).

Results: 128 patients with acute CTP were analyzed, median age 76yr (IQR 66-83), median NIHSS 13 (IQR 9-16), 59% received IV thrombolysis. 11 patients had PH on follow-up. On ROC analysis, the optimal threshold for very low CBF (VLCBF) was at the <0 th centile. VLCBF was significantly associated with PH in ROC analysis (AUC=0.760, p<0.01) whereas VLCBV (AUC 0.638 at <5 th centile, 0.618 at <2.5 th centile, 0.440 at <0 th centile) was not significant. Using VLCBF, the optimal lesion volume to predict PH was >3mL with OR 12.0 (95%CI 2.4-58), sensitivity 0.82 (95%CI 0.48-0.98), specificity 0.73 (95%CI 0.64-0.80), negative predictive value 0.98 (95%CI 0.92-1.0) and positive predictive value 0.22 (95%CI 0.11-0.38). In logistic regression, PH was associated with increased VLCBF (p<0.01) but not with VLCBV (p=0.08). The Bayesian information criterion for VLCBF compared to VLCBV was +5 indicating improved model fit.

Conclusions: VLCBF appears to be more reliably associated with hemorrhagic transformation than VLCBV when CT perfusion is used. This may be due to reduced ability of VLCBV to distinguish regions of ischemia from normal white matter.