Molecular disruption of NBS1 with targeted gene delivery enhances chemosensitisation in head and neck cancer

BACKGROUND

a fibroblast growth factor 2 (FGF2)-targeted adenoviral system can alter viral tropism and allow for improved transduction and reduced systemic toxicity. This study is to investigate if the FGF2-targeted adenoviral mutant Nijmegen breakage syndrome 1 (FGF2-Ad-NBS1) gene transfer can enhance cisplatin chemosensitisation not only by targeting DNA repair, but also through the induction of antiangiogenesis, whereas at the same time reducing toxicities in treating head and neck squamous cell carcinoma (HNSCC).

METHODS

the human HNSCC cell line was treated in vitro and in a nude mouse xenograft model. We conducted verification of binding ability of mutant NBS1 and downregulation of MRN complex, evaluation of transduction efficiency and combined antitumour activities. The antiangiogenesis mechanism was also investigated. Finally, we estimated the distribution of adenoviral vector in the liver.

RESULTS

the mutant NBS1 protein retains the binding ability and effectively suppresses the expression level of the MRN in infected cells. Transduction efficiency in vitro and cisplatin chemosensitisation were upregulated. The FGF2-Ad-NBS1 also showed detargeting the viral vectors away from the liver. The downregulation of NF-κB expression was supposed to correlate with increased antiangiogenesis.

CONCLUSIONS

FGF2-targeted adenoviral system enhances the cisplatin chemosensitisation of mutant NBS1 and may avoid viral-associated liver toxicities.

Assessment of radiological hazards of clay bricks fabricated in the Punjab province of Pakistan

The Punjab is the most populous among the four provinces of Pakistan, which has around 72 million of people and 205 344 km(2) of land. The majority of the population of this province lives in houses made of clay bricks that contain variable amounts of naturally occurring radioactive material (NORM). The concentration level of NORM in clay bricks used to construct dwellings may pose health hazards to inhabitants if it exceeds the permissible limits. For radiological surveillance, activity concentrations of the primordial radionuclides (40)K, (226)Ra and (232)Th were measured in 140 brick samples collected from 35 districts of the Punjab province. A high-purity germanium gamma-ray detector coupled with a personal computer-based multichannel analyzer was employed for the measurement of activity concentrations of primordial radionuclides in the brick samples. The province-wide average activity concentrations and the range (given in parenthesis) of (40)K, (226)Ra and (232)Th were found to be 624 ± 133 (299-918), 35 ± 7 (21-47) and 42 ± 8 (22-58) Bq kg(-1), respectively. The values lie within the range of activity concentration values for clay bricks of some countries of Asia. Potential radiological constraint was checked in the form of hazard indices calculated from the measured activity concentrations; the indices were found to be less than their limiting values. Indoor external dose was calculated for a standard size room made of clay bricks, and the dose rate was 159 ± 30 (83-219) nGy h(-1). The average value of the dose rate is comparable to that of Asian countries and is about twice the worldwide average value. Annual effective dose E(ff) in the bricks-made room was calculated and the average value of the dose was 0.80 mSv y(-1), which is about twice the worldwide background value of 0.41 mSv y(-1).

Neovascular AMD: an overlooked risk factor for injurious falls

While those with neovascular age-related macular degeneration (NV-AMD) may be at increased risk of injurious falls risk due to poor central vision and suboptimal responses when falling, preserved peripheral vision and decreased activity levels may actually be protective. Compared with control participants, patients with NV-AMD had a significantly greater number of falls and almost twice the risk of injurious falls.

INTRODUCTION

Impaired vision, particularly peripheral visual function, is a key risk factor for injurious falls. NV-AMD is a leading cause of severely impaired vision among older adults but is associated with a profound central, rather than peripheral, deficit. The objective was to determine whether older women with NV-AMD are at an increased risk of falls or injurious falls.

METHODS

We conducted a 12-month prospective cohort study of community-dwelling older (>or=70 years) women, enrolling 114 with NV-AMD and 132 without from a retinal clinic in Vancouver, Canada. Fall incidence was determined through monthly telephone follow-up, with fall severity classified by a blinded reviewer. We compared mean injurious falls per person-year between groups using negative binomial regression.

RESULTS

A mean of 0.37 injurious falls per person-year were experienced among NV-AMD participants, compared to 0.16 injurious falls per person-year among non-NV-AMD participants (p = 0.006). The age-adjusted incidence rate ratio for injurious falls, for an individual with NV-AMD compared to without, was 1.77 (1.07-3.02).

CONCLUSIONS

Older women with NV-AMD are at almost twice the risk of injurious falls compared to those without. Clinicians caring for older adults should recognise NV-AMD as an important risk factor for injurious falls.

Introduction of Portable Computed Tomography Scanners, in the Treatment of Acute Stroke Patients via Telemedicine in Remote Communities

Background

Thrombolysis is an established treatment in selected patients who present early to hospital after symptoms of acute ischaemic stroke. Treatment can only be offered after the patient has been assessed by highly trained physicians and imaging studies have ruled out a brain haemorrhage. This limits the wider availability of thrombolysis to patients in remote communities, especially in countries with limited resources. There has been considerable success with the use of TeleStroke to overcome such barriers. TeleStroke is feasible in remote hospitals provided there is an available computed tomography scanner, a fundamental prerequisite in the assessment of acute stroke and thrombolysis. This is a luxury not widely available, especially in remote sites. Recently, Neurologica introduced a portable computed tomography scanner that can be operated after minimal training.

Methods

We report our preliminary experience with the portable computed tomography scanner in a remote community where Telemedicine was successfully used to evaluate and treat patients presenting with symptoms suggestive of an acute ischaemic stroke. The University of Alberta Hospital in Edmonton, Canada was the ‘hub’ site and Wainwright Community Hospital was the ‘spoke’ site.

Results

Over a 3-month period, 18 patients were evaluated in the emergency department of the remote hospital where the referring physician felt that symptoms indicated potential for thrombolysis. All patients were evaluated remotely by a stroke neurologist in a TeleStroke service situated 207 km from the rural site. After clinical examination, cranial computed tomography scans were obtained with the portable scanner and evaluated by the stroke neurologist. In three patients, thrombolysis was not offered because the computed tomography showed evidence of brain haemorrhage: two intracerebral haemorrhage and one subarachnoid haemorrhage. Three patients meeting the standard criteria received thrombolysis within 4·5 h from onset of symptoms. There was a significant improvement in two patients. One patient did not make a good recovery. Repeat computed tomography scans showed a small haemorrhagic transformation in one patient. In the remaining 12 subjects, symptoms improved rapidly, were outside the window for thrombolysis, or were not consistent with an acute ischaemic stroke.

Interpretations

Our preliminary study shows that the portable scanner can be used successfully in the evaluation of patients in remote regions that are not within timely reach of stroke experts or do not have available conventional imaging with computed tomography scans. Telemedicine, in combination with the use of portable scanners, offers hope to a large remote population base that would otherwise not have access to appropriate acute stroke treatment.

Radon monitoring in water sources of Balakot and Mansehra cities lying on a geological fault line

This paper relates to a series of systematic studies regarding measurement of radon concentration in the earthquake-affected areas of northern Pakistan. Radon is a radioactive alpha-particle-emitting gas originating from the decay series of uranium and thorium and is found anywhere in soil, air and water. The nature of water does not matter with regard to the presence of radon, however, the level of radon concentration varies in different types of water. The present survey is carried out in water samples from the fault zone of Balakot and Mansehra regions, North West Frontier Province, Pakistan, which is important for geological consideration and protection from radiation hazards. The measurements were made on a Pylon system that is based on the radon gas measurement with a Lucas cell. In 72 water samples in the equilibrium state between radon and its progeny, the concentration level of radon is measured. The results show that the radon concentrations are in the range of 4.99-24.52 kBq/m(3), with an average value of 15.52 kBq/m(3) for all types of water taken in this survey.

Hip protectors: recommendations for conducting clinical trials--an international consensus statement (part II)

INTRODUCTION

While hip protectors are effective in some clinical trials, many, including all in community settings, have been unable to demonstrate effectiveness. This is due partly to differences in the design and analysis. The aim of this report is to develop recommendations for subsequent clinical research.

METHODS

In November of 2007, the International Hip Protector Research Group met to address barriers to the clinical effectiveness of hip protectors. This paper represents a consensus statement from the group on recommended methods for conducting future clinical trials of hip protectors.

RESULTS AND CONCLUSIONS

Consensus recommendations include the following: the use of a hip protector that has undergone adequate biomechanical testing, the use of sham hip protectors, the conduct of clinical trials in populations with annual hip fracture incidence of at least 3%, a run-in period with demonstration of adequate adherence, surveillance of falls and adherence, and the inclusion of economic analyses. Larger and more costly clinical trials are required to definitively investigate effectiveness of hip protectors.

Hip protectors: recommendations for biomechanical testing--an international consensus statement (part I)

INTRODUCTION

Hip protectors represent a promising strategy for preventing fall-related hip fractures. However, clinical trials have yielded conflicting results due, in part, to lack of agreement on techniques for measuring and optimizing the biomechanical performance of hip protectors as a prerequisite to clinical trials.

METHODS

In November 2007, the International Hip Protector Research Group met in Copenhagen to address barriers to the clinical effectiveness of hip protectors. This paper represents an evidence-based consensus statement from the group on recommended methods for evaluating the biomechanical performance of hip protectors.

RESULTS AND CONCLUSIONS

The primary outcome of testing should be the percent reduction (compared with the unpadded condition) in peak value of the axial compressive force applied to the femoral neck during a simulated fall on the greater trochanter. To provide reasonable results, the test system should accurately simulate the pelvic anatomy, and the impact velocity (3.4 m/s), pelvic stiffness (acceptable range: 39-55 kN/m), and effective mass of the body (acceptable range: 22-33 kg) during impact. Given the current lack of clear evidence regarding the clinical efficacy of specific hip protectors, the primary value of biomechanical testing at present is to compare the protective value of different products, as opposed to rejecting or accepting specific devices for market use.

Prognosis in isolated gastroschisis with bowel dilatation: a systematic review

OBJECTIVES

To investigate prognosis of the fetus with isolated gastroschisis and bowel dilatation from a systematic review of the literature. We aimed to compare the incidence of (a) intrauterine death, (b) death within 4 weeks of delivery, (c) bowel resection, (d) length of time to oral feeds and (e) time as inpatient in fetuses with gastroschisis with and without evidence of bowel dilatation.

METHODS

Literature was identified by searching two bibliographical databases between 1980 and 2007. Studies were assessed for quality and stratified according to the definition of bowel dilatation. The data extracted were inspected for clinical and methodological heterogeneity.

RESULTS

The search strategy yielded 1335 potentially relevant citations. Full manuscripts were retrieved for 92 citations. 10 studies (273 patients) were finally included in the systematic review. No difference was found between groups for death within 4 weeks of delivery (OR = 0.62 (95% CI 0.11 to 3.32); heterogeneity p = 0.39) or bowel resection (OR = 3.35 (95% CI 0.82 to 13.74); heterogeneity p = 0.39). There were insufficient data to compare the risk of intrauterine death and length of time to oral feeds. The mean inpatient stay was not significantly different between groups (OR = 16.63 (95% CI 0.98 to 32.28); heterogeneity p = 0.23).

CONCLUSION

Current available evidence suggests that fetuses with isolated gastroschisis and bowel dilatation are not at increased risk of adverse perinatal outcome compared to those without bowel dilatation. However, there is a paucity of studies, and a randomised controlled trial is urgently needed.

Factors affecting the stability of L-glutamine in solution

The degradation rate of L-glutamine in water, various buffers, and intravenous solutions was assessed over a period of 2 weeks. Measurements were made at various temperatures (22-24 degrees C, and 4 degrees C and -80 degrees C) and pH, and also in the presence and absence of light and oxygen (intravenous solutions only). At 22-24 degrees C, the degradation rate of glutamine was variable depending on the type of solution used (0.23% in water pH 6.5; 0.22% in dextrose/water [15% w/v]; 0.8% in mixed total parenteral nutrition (TPN) solution), and on the pH, molarity and type of buffer used. The degradation rate was essentially unaffected by light and O(2). The degradation rate of L-glutamine in the intravenous solutions was less than 0.15%/day at 4 degrees C, minimal at -20 degrees C (<0.03%/day), and undetectable at -80 degrees C. Glutamine degradation resulted in the equimolar formation of ammonia and no associated formation of glutamate. It is concluded that (a) glutamine degradation in solution is variable due to the effect of physico-chemical factors, and (b) glutamine degradation in TPN solutions is sufficiently slow, especially during storage at 4 degrees C or below, to consider its inclusion in such solutions, for clinical use.

Expression of somatostatin and dopamine 2 receptors in neuroendocrine tumours and the potential role for new biotherapies

INTRODUCTION

Somatostatin and dopamine receptors are both G-protein-coupled receptors. Somatostatin receptor (SSTR) expression in neuroendocrine tumours has been well characterised, and there is evidence of dopamine receptor expression in neuroendocrine tumours. In this study, we examined expression of D2R, SSTR-2 and SSTR-5 using immunohistochemistry in patients with neuroendocrine tumours.

METHODS

Consecutive samples of formalin-fixed paraffin-embedded tumour tissue were available from 56 patients with a histologically confirmed diagnosis of neuroendocrine tumour (NET). The study population was divided into low-grade (n = 29), intermediate-grade (n = 18) and high-grade NET (n = 9). Immunohistochemical evaluation was performed for the expression of SSTR-2a, SSTR-5 and D2 receptors (D2R).

RESULTS

Both SSTR-2 and SSTR-5 were expressed in 100% of low-grade, 94.4% of intermediate-grade and 66.7% of high-grade NET. D2R was expressed in 93.1% of low-grade, 77.8% of intermediate-grade and 44.4% of high-grade tumours. Co-expression of all 3 receptors was present in 93.1% of low-grade tumours. There was an inverse correlation of SSTR-2 (r = -0.380, p < 0.005) and SSTR-5 (r = -0.472, p < 0.0001) with tumour grade. D2R was positively correlated with SSTR-2 (r = 0.269, p = 0.041) and SSTR-5 (r = 0.267, p = 0.045). Also, D2R expression was inversely correlated with grade of tumour (r = 0.395, p = 0.006). Octreoscan correlated with SSTR-2, SSTR-5 and D2R expression.

CONCLUSION

D2R is expressed in the majority of low and intermediate grade tumours. It is co-expressed with SSTR-2 and SSTR-5 in the majority of cases. The advent of new chimeric molecules that bind both somatostatin and dopamine receptors may provide a new therapeutic option in the management of neuroendocrine patients.

Environmental gamma radiation measurement in district Swat, Pakistan

External exposure to environmental gamma ray sources is an important component of exposure to the public. A survey was carried out to determine activity concentration levels and associated doses from (226)Ra, (232)Th, (40)K and (137)Cs by means of high-resolution gamma ray spectrometry in the Swat district, famous for tourism. The mean concentrations for (226)Ra, (232)Th and (40)K were found to be 50.4 +/- 0.7, 34.8 +/- 0.7 and 434.5 +/- 7.4 Bq kg(-1), respectively, in soil samples, which are slightly more than the world average values. However, (137)Cs was only found in the soil sample of Barikot with an activity concentration of 34 +/- 1.2 Bq kg(-1). Only (40)K was determined in vegetation samples with an average activity of 172.2 +/- 1.7 Bq kg(-1), whereas in water samples, all radionuclides were found below lower limits of detection. The radium equivalent activity in all soil samples is lower than the limit set in the Organisation for Economic Cooperation and Development report (370 Bq kg(-1)). The value of the external exposure dose has been determined from the content of these radionuclides in soil. The average terrestrial gamma air absorbed dose rate was observed to be 62.4 nGy h(-1), which yields an annual effective dose of 0.08 mSv. The average value of the annual effective dose lies close to the global range of outdoor radiation exposure given in United Nations Scientific Committee on the Effects of Atomic Radiation. However, the main component of the radiation dose to the population residing in the study area arises from cosmic ray due to high altitude.

An open-label pilot study of infliximab therapy in diffuse cutaneous systemic sclerosis

AIM

The safety and potential efficacy of a chimaeric anti-tumour necrosis factor alpha monoclonal antibody (infliximab) were examined in diffuse cutaneous systemic sclerosis (dcSSc).

METHODS

A 26-week open-label pilot study in which 16 cases of dcSSc received five infusions of infliximab (5 mg/kg). Clinical assessment included skin sclerosis score, scleroderma health assessment questionnaire, self-reported functional score and physician global visual analogue scale. Collagen turnover, skin biopsy analysis and full safety evaluation were performed.

RESULTS

There was no significant change in skin score at 26 weeks but a trend for lower modified Rodnan skin score at 22 weeks (OR 17, 95% CI 6 to 46) compared with peak value (OR 29, 95% CI 11 to 44; p = 0.10). Serum aminoterminal propeptide of type III collagen level was significantly lower at week 26 compared with baseline (p = 0.03). Secretion of type I collagen by dermal fibroblasts was reduced at 26 weeks compared with baseline (p = 0.02). There were no deaths during the study and no suspected unexpected serious adverse reactions. 21 serious adverse events (AE) occurred in seven subjects, mostly attributable to dcSSc. 127 distinct AE occurred in 16 subjects. Of these, 19 AE (15%) were probably or definitely related to infliximab treatment. Eight (50%) patients prematurely discontinued infliximab. Anti-infliximab antibodies developed during the study in five subjects and were significantly associated with suspected infusion reactions (p = 0.025).

CONCLUSION

In dcSSc infliximab did not show clear benefit at 26 weeks but was associated with clinical stabilisation and a fall in two laboratory markers of collagen synthesis. The frequency of suspected infusion reactions may warrant additional immunosuppression in any future studies in systemic sclerosis.