CT coronary angiography as an alternative imaging method to ascertain cardiac output and its correlation with echocardiography

AIM

To assess the feasibility and accuracy of cardiac output (CO) obtained using a test bolus in patients scanned with single-source prospective-gated cardiac computed tomography (CT), and comparing it with CO obtained from unenhanced two-dimensional (2D) echocardiography using biplane Simpson's method.

MATERIALS AND METHODS

In the present study, 100 patients with a mean age of 55 ± 12 years who underwent coronary CT angiography with prospective electrocardiogram (ECG)-gated CT in which the scan delay was evaluated using a test bolus. The time-attenuation curves obtained from the test bolus were used to calculate the CO of the patients. The CO obtained was then compared with that obtained after follow-up 2D echocardiography using biplane modified Simpson method.

RESULTS

Linear regression was calculated between the CO and contrast enhancement: CO = -0.16(HUmax) + 7.65. The study showed good correlation between the two methods with r=0.77, p<0.001. On Bland-Altman analysis, no significant difference was noted between the two methods.

CONCLUSION

This less researched method for CO estimation appears feasible; however, the clinical usefulness of this parameter is uncertain in absence of further clinical and reference standard validation.

Turbulence suppression by cardiac-cycle-inspired driving of pipe flow

Flows through pipes and channels are, in practice, almost always turbulent, and the multiscale eddying motion is responsible for a major part of the encountered friction losses and pumping costs1. Conversely, for pulsatile flows, in particular for aortic blood flow, turbulence levels remain low despite relatively large peak velocities. For aortic blood flow, high turbulence levels are intolerable as they would damage the shear-sensitive endothelial cell layer2-5. Here we show that turbulence in ordinary pipe flow is diminished if the flow is driven in a pulsatile mode that incorporates all the key features of the cardiac waveform. At Reynolds numbers comparable to those of aortic blood flow, turbulence is largely inhibited, whereas at much higher speeds, the turbulent drag is reduced by more than 25%. This specific operation mode is more efficient when compared with steady driving, which is the present situation for virtually all fluid transport processes ranging from heating circuits to water, gas and oil pipelines.

A rare case of congenital ranula

Simple ranula is a cystic swelling confined to the floor of mouth while plunging ranula presents with extension to the neck. Congenital ranula presenting with symptoms of feeding difficulties is a very rare occurrence. There is paucity of literature regarding the management of large congenital ranula. Varied treatment options are described for the management of ranula with variable recurrence rate. In paediatric and adult patients, ranula is considered as a type of extravasation cyst and removal of sublingual gland is advocated to remove the sources of extravasation. Congenital ranula is usually a variant of retention cyst and should be treated with marsupialisation or simple excision of cyst while cyst excision with sublingual sialadenectomy should be reserved for recurrent cases.

Challenges in Sensors Technology for Industry 4.0 for Futuristic Metrological Applications

The current advances and innovations in sensor technologies attributed to Industry 4.0 serve as the backbone for the inclusive growth of industry and ramping up the economy of any country. Industry 4.0 was basically conceptualized by introducing the Internet of Things (IoT) and Information and Communication technologies (ICT) that serve as an interface between digital and physical world through the fusion of smart sensors. The role of smart sensors and IoT-enabled industrial infrastructure is pivotal for adapting to the advanced technologies based on fusion of smart sensors. Digital meteorological traceability and uses of intelligent sensors, instrumentation and machinery in Industry 4.0, Smart Cities, Digital India and AtmaNirbhar Bharat missions of the government of India, are not only highly important but also in huge demand, which is going to increase manifolds in the years to come. The present paper is an attempt to provide a terse review and perspectives related to the advanced technological developments in this field and the challenges therein.

BA3338, a surface layer homology domain possessing protein augments immune response and protection efficacy of protective antigen against Bacillus anthracis in mouse model

AIM

Category A classified Bacillus anthracis is highly fatal pathogen that causes anthrax and creates challenges for global security and public health. In this study, development of a safe and ideal next-generation subunit anthrax vaccine has been evaluated in mouse model.

METHOD AND RESULTS

Protective antigen (PA) and BA3338, a surface layer homology (SLH) domain possessing protein were cloned, expressed in heterologous system and purified by IMAC. Recombinant PA and BA3338 with alum were administered in mouse alone or in combination. The humoral and cell-mediated immune response was measured by ELISA and vaccinated animals were challenged with B. anthracis spores via intraperitoneal route. The circulating IgG antibody titre of anti-PA and anti-BA3338 was found significantly high in the first and second booster sera. A significant enhanced level of IL-4, IFN-γ and IL-12 was observed in antigens stimulated supernatant of splenocytes of PA + BA3338 vaccinated animals. A combination of PA and BA3338 provided 80% protection against 20 LD₅₀ lethal dose of B. anthracis spores.

CONCLUSION

Both antigens induced admirable humoral and cellular immune response as well as protective efficacy against B. anthracis spores.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study has been evaluated for the first time using BA3338 as a vaccine candidate alone or in combination with well-known anthrax vaccine candidate PA. The findings of this study demonstrated that BA3338 could be a co-vaccine candidate for development of dual subunit vaccine against anthrax.

Sharp Foreign Bodies of the Aero-Digestive Tract: Endoscopic Removal by the 'Kangaroo' Technique

Removal of sharp foreign bodies in the aero-digestive tract may inflict iatrogenic damage to the esophagus, trachea or other vital structures in case of impalement. We describe the 'Kangaroo' technique for safe and effective removal of sharp objects from the upper aero-digestive tracts. Index Case 1: 1-year old boy presented to us with an open (un)safety-pin lodged in the upper esophagus. The technique of removal of the pin by the Kangaroo technique, along-with the mechanics of en-pouching the (un)safety-pin has been described. Index Case 2: 8 years old boy presented with accidental aspiration of a razor blade. The removal of the blade from his trachea was executed by the Kangaroo technique. The Kangaroo technique is described for safe endoscopic extraction of sharp foreign body from the aero-digestive tract while protecting the surrounding tissues, to maintain control of the object during extraction and to avoid causing iatrogenic damage by enclosing the foreign body in a 'kangaroo pouch'. The advantages and limitations of the technique have been discussed. The Kangaroo technique is safe, effective and reproducible way to effect removal of sharp object from the aerodigestive tract while preventing iatrogenic injury to the surrounding organs.

Characterization of liver specific promoters in a foamy viral vector pMD09

Foamy viruses (FVs) or spumaviruses are retroviruses that are explored as vectors for gene therapy. The good feature of foamy viruses is its broad tropism; however, their infections result in non-targeted gene expression. Here, we attempted to design the liver targeted viral gene delivery by employing liver specific gene promoters like albumin (ALB), transthyretin (TTR) and hepatitis B virus (HBV) promoters. We compared the relative gene expression of liver specific promoters versus the U3 promoter in liver cell line (HepG2) and non-liver cell lines: human fibrosarcoma cell line (HT1080), baby hamster kidney cell line (BHK), human embryonic kidney cell line (HEK 293T) and cervical cancer cell line (HeLa). We have found that the promoter exchange didn't affect viral assembly. The ability to drive gene expression was best with TTR promoter which was followed by HBV and ALB promoter. The use of TTR, HBV and ALB promoters are helpful in achieving liver specific gene expression. Keywords: foamy virus; gene therapy; liver; albumin; transthyretin promoter; HBV promoter.

Abernethy malformation type 2: varied presentation, management and outcome

PURPOSE

To study the varied presentations and the outcomes in children with Type 2 Abernethy malformation following shunt ligation.

MATERIAL AND METHODS

Children with Type 2 Abernethy who had had been operated between 2013 and 2017 were included in the study. The diagnosis had been confirmed on ultrasonography, CECT or angiography. All patients underwent laparotomy. The shunt was identified, clamped and the bowel congestion was noted. The shunt was ligated if the bowel congestion was not significant or had improved. Relevant follow-up investigations were done to document the resolution or amelioration of symptoms and the patency of the shunt.

RESULTS

Five patients were included in the study with a median age of 6 years. Hepatopulmonary syndrome was the presentation in 4 patients while one patient presented with liver tumor. Ultrasonography and CECT were able to diagnose Type 2 malformation in 4 patients whereas in 1 patient the distal portal vein was not seen. The postoperative period was complicated in 3 patients. At the median follow up at 14 months, good intrahepatic portal flow in all patients. All patients demonstrated improvement/ resolution of symptoms.

CONCLUSION

Abernethy is rare malformation which can have a varied presentation. Additional investigations may be needed to confirm the diagnosis of Type 2 variety. Most patients have gradual improvement of symptoms.

LEVEL OF EVIDENCE

Level IV/ Treatment study.

Whipple's Pancreaticoduodenectomy in Pediatric Patients: An Experience from a Tertiary Care Center

Purpose:

Whipple's pancreaticoduodenectomy (WPD) is rarely required in children. However, WPD is the only option with pathologies involving the head of the pancreas requiring surgical excision. The objective of our study was to review our experience with WPD performed on children.

Materials and Methods:

A retrospective analysis of case records was conducted on all patients <18 years of age, who underwent WPD at our center over the last 20 years. Data regarding demographics, signs, and symptoms at presentation, diagnostic imaging and procedures, pathologic reports, surgical and medical treatment, and follow-up were collected to study the indications and safety and outcomes of WPD in children.

Results:

Five patients had been planned for a WPD during the study (1995–2015); but in one patient, the procedure was abandoned, the rest four patients formed the study group. Male to female ratio was 3:1. Median age at the time of surgery was 9 years (11 months–12 years). The most common presentation was obstructive jaundice (50%, 2/4). Radiological imaging was able to accurately predict the surgical procedure required in all except one case. The mean operating time was 205 min (180–240 min). There were no intraoperative complications. The mean intraoperative blood loss was 85 mL (20–150 mL). The youngest patient requiring WPD was an 11-month-old child. Oral feeding was established by the 7^th postoperative day (range 5–7 days) in all cases. There were no cases of anastomotic leak or pancreatic or jejunal fistulae. One patient developed features of subacute intestinal obstruction after discharge and required re-exploration. There was no intra- or post-operative mortality.

Conclusion:

WPD is safe and efficacious procedure in a selected group of children. The overall efficacy of surgical treatment combined with the relatively low severity of complications leads us to recommend WPD in children when indicated.

Transverse testicular ectopia with a blind ending vas deferens

Transverse testicular ectopia (TTE) is an uncommon anomaly of testicular descent. Herein, we describe a case of TTE with blindly ending vas and persistent Mόllerian duct syndrome in a 2-year-old child. Orchidopexy could be done through the normal orthotopic route after separating it from the Mόllerian structure and dividing the peritoneal fold just distal to the blindly ending vas. The report highlights that laparoscopy is useful for identifying subtle anomalies in addition to its therapeutic role.

Malignant systemic hypertension, encephalopathy and bradycardia following splenectomy for hereditary spherocytosis

An 8-year-old girl suffering from hereditary spherocytosis underwent splenectomy for chronic severe anaemia. Surgery was uneventful and the patient had a good early postoperative recovery. On the third postoperative day, however, she developed severe headache with associated abnormal movements of upper limbs and nystagmus. She had a heart rate of 50 bpm and a blood pressure of 180/110 mm Hg. She was managed with triple antihypertensives, antiepileptics and sedatives. She recovered slowly over 2 weeks and is fine at 5 months follow-up.

School eye survey in rural population in UP, India

OBJECTIVE

To find out the prevalence of refractive errors and pattern of ocular morbidity amongst the school children of a rural village.

MATERIALS AND METHODS

A cross sectional study was carried out in children of age group 3 - 12 years in a rural village of Hathras, Uttar Pradesh, India. All the children were examined including visual acuity measurement using Snellen's E chart, retinoscopy and refraction under cycloplegia. Examination of the anterior segment, media, and fundii was also done. Myopia was defined as spherical/cylindrical equivalent refractive error of at least -0.50 D and hypermetropia as +0.50 D or more (Dandona et al 2002).

RESULTS

In the survey 220 eyes of 110 children were examined, majority of them were in 5-10 year age group. The prevalence of uncorrected visual acuity of 6/6 was 85.40%. Refractive error was the cause in 6.81% of eyes with vision impairment, out of which myopia and hypermetropia were present in 26.67% of eyes. Blepharo-conjunctivitis was present in 15.45% of children and Bitot's spots were present in 0.90% of them. Colour blindness was found in one child.

CONCLUSION

The prevalence of refractive error in rural school is 6.81 %. Blepharitis is the commonest cause of ocular morbidity.

Hierarchical Exploration of Volumes Using Multilevel Segmentation of the Intensity-Gradient Histograms

Visual exploration of volumetric datasets to discover the embedded features and spatial structures is a challenging and tedious task. In this paper we present a semi-automatic approach to this problem that works by visually segmenting the intensity-gradient 2D histogram of a volumetric dataset into an exploration hierarchy. Our approach mimics user exploration behavior by analyzing the histogram with the normalized-cut multilevel segmentation technique. Unlike previous work in this area, our technique segments the histogram into a reasonable set of intuitive components that are mutually exclusive and collectively exhaustive. We use information-theoretic measures of the volumetric data segments to guide the exploration. This provides a data-driven coarse-to-fine hierarchy for a user to interactively navigate the volume in a meaningful manner.

Phosphorous magnetic resonance spectroscopy-based skeletal muscle bioenergetic studies in subclinical hypothyroidism

BACKGROUND

Subclinical hypothyroidism (sHT) is considered to be a milder form of thyroid dysfunction. Few earlier studies have reported neuromuscular symptoms as well as impaired muscle metabolism in sHT patients.

AIM/OBJECTIVE

In this study we report our findings on muscle bioenergetics in sHT patients using phosphorous magnetic resonance spectroscopy (31P MRS) and look upon the possibility to use 31P MRS technique as a clinical marker for monitoring muscle function in subclinical thyroid dysfunction.

SUBJECTS AND METHODS

Seventeen normal subjects, 15 patients with sHT, and 9 patients with hypothyroidism performed plantar flexion exercise while lying supine in 1.5 T magnetic resonance scanner using custom built exercise device. MR Spectroscopy measurements of inorganic phosphate (Pi), phosphocreatine (PCr), and ATP of the calf muscle were taken during rest, at the end of exercise and in the recovery phase. PCr recovery rate constant (kPCr) and oxidative capacity were calculated by monoexponential fit of PCr vs time (t) at the beginning of recovery.

RESULTS

We observed that changes in some of the phosphometabolites (increased phosphodiester levels and Pi concentration) in sHT patients which were similar to those detected in patients with hypothyroidism. However, our results do not demonstrate impaired muscle oxidative metabolism in sHT patients based upon PCr dynamics as observed in hypothyroid patients.

CONCLUSIONS

31P MRS-based PCr recovery rate could be used as a marker for monitoring muscle oxidative metabolism in sub clinical thyroid dysfunction.

Social snapshot: a system for temporally coupled social photography

Social Snapshot actively acquires and reconstructs temporally dynamic data. The system enables spatiotemporal 3D photography using commodity devices, assisted by their auxiliary sensors and network functionality. It engages users, making them active rather than passive participants in data acquisition.

pH-Dependent urea-induced unfolding of stem bromelain: unusual stability against urea at neutral pH

Equilibrium unfolding of stem bromelain (SB) with urea as a denaturant has been monitored as a function of pH using circular dichroism and fluorescence emission spectroscopy. Urea-induced denaturation studies at pH 4.5 showed that SB unfolds through a two-state mechanism and yields DeltaG (free energy difference between the fully folded and unfolded forms) of approximately 5.0 kcal/mol and C(m) (midpoint of the unfolding transition) of approximately 6.5 M at 25 degrees C. Very high concentration of urea (9.5 M) provides unusual stability to the protein with no more structural loss and transition to a completely unfolded state.

Development and validation of CAPS and AFLP markers for white rust resistance gene in Brassica juncea

White rust, caused by Albugo candida, is a very serious disease in crucifers. In Indian mustard (Brassica juncea), it can cause a yield loss to the extent of 89.9%. The locus Ac2(t) controlling resistance to white rust in BEC-144, an exotic accession of mustard, was mapped using RAPD markers. In the present study, we developed: (1) a more tightly linked marker for the white rust resistance gene, using AFLP in conjunction with bulk segregant analysis, and (2) a PCR-based cleaved amplified polymorphic sequence (CAPS) marker for the closely linked RAPD marker, OPB06(1000). The data obtained on 94 RILs revealed that the CAPS marker for OPB06(1000) and the AFLP marker E-ACC/M-CAA(350) flank the Ac2(t) gene at 3.8 cM and 6.7 cM, respectively. Validation of the CAPS marker in two different F(2) populations of crosses Varuna x BEC-144 and Varuna x BEC-286 was also undertaken, which established its utility in marker-assisted selection (MAS) for white rust resistance. The use of both flanking markers in MAS would allow only 0.25% misclassification and thus provide greater efficiency to selection.

Symptomatic small non-obstructing lower ureteric calculi: comparison of ureteroscopy and extra corporeal shock wave lithotripsy

OBJECTIVE

To compare the success, efficacy and complications of ureteroscopy (URS) and extra corporeal shock wave lithotripsy (ESWL) for the treatment of symptomatic small non obstructing lower ureteric calculi.

SUBJECTS AND METHODS

This prospective non-randomised study was conducted simultaneously at two urological referral centres, included 280 patients with symptomatic small (4-10 mm) lower ureteric calculi (situated below the sacroiliac joint), with good renal function on intravenous urography. Patients were offered both the treatment options. One hundred and sixty patients chose ureteroscopy, whereas 120 patients were treated by ESWL. Standard techniques of ureteroscopy and ESWL were employed. Patients were followed-up to assess the success rates and complications of the two procedures.

RESULTS

Ureteroscopy achieved complete stone clearance in one session in 95% of patients. In six patients ureteroscopy had failed initially and was later accomplished in second session improving the success rate to 98.7%. Two patients had a proximal migration of calculus that needed ESWL. Of the 120 patients treated by ESWL, 90% achieved stone free status at three months. Ureteroscopy was needed for twelve patients (10%) where ESWL failed to achieve stone clearance. There were no significant ESWL related complications. ESWL was administered on outpatient basis, while patients needed hospitalisation and anaesthesia for ureteroscopy.

CONCLUSION

ESWL can be the primary mode of treatment for symptomatic small non-obstructing lower ureteric calculi as it is minimally invasive and safe. Ureteroscopy can be offered to patients who demand immediate relief or when ESWL fails.

Resting membrane potential as a marker of apoptosis: studies on Xenopus oocytes microinjected with cytochrome c

Observation of the electrical potential difference across the cell membrane is described as a new method for monitoring apoptosis of a single cell. The resting membrane potential (DeltaPsi) of Xenopus oocytes has been recorded in real time following microinjection of cytochrome c. Soon after microinjection, DeltaPsi becomes less negative and attains a new constant value with a half time, t(m), of about 35 (+ /- 5) min at all cytochrome c concentrations greater than 1 microM. The cytosol extract of cytochrome c-injected oocytes shows DEVD proteolytic activity characteristic of aspartate specific proteases, implicating an apoptotic death pathway. In response to the delivery of cytochrome c into the cytosol, caspases are activated within 7 min while the changes in DeltaPsi begin to occur after about 30 min. The method described here will be potentially useful to assess the effectiveness of cell death regulators and modulators of synthetic and biological origin, and the results presented shed light on the currently debated issue of the importance of the redox state of cytochrome c in the initiation of apoptosis.

Cytoplasmic residues influence the voltage-dependence of the gating of human K+ channels

Shaker type potassium channels are strongly voltage dependent and potassium selective. Kv1.4 channels from a variety of sources exhibit a much shallower voltage-dependence of activation than other members of the family. We have made a chimeric construct consisting of the N-terminal chain of hKv1.1 spliced onto the transmembrane portion of hKv1.4 (IN/4). When expressed in Xenopus oocytes, the chimeric channel exhibits a voltage dependence that is similar to hKv1.1 although the voltage sensing and transduction machinery presumably reside in the transmembrane portion of the channel. Loss of the N-terminal ball and chain from hKv1.4 is not responsible for this as a truncation construct, starting close to the splice junction, has the same voltage-dependence as full length hKv1.4. We suggest that residues from the N-terminal chain of hKv1.1 interact with the machinery that transduces movement of the voltage sensor into channel opening. If so, this chimeric construct could provide a handle to the identification of elements of this transduction machinery.

Exploring the architecture of potassium channels using chimaeras to reveal signal transduction

The chimeric channel, 4N/1, generated from two outwardly rectifying K+ channels by linking the N-terminal cytoplasmic domain of hKv1.4 with the transmembrane body of hKv1.1, functions as an inward rectifier. The operating range of the channel is shifted to hyperpolarizing potentials and it is inactivated at resting membrane potentials. Co-expression of a truncated form of hKv1.1 with the N-terminal domain of hKv1.4 results in the same physiology as the chimaera implying specific interactions between the two segments.

Transplanting the N-terminus from Kv1.4 to Kv1.1 generates an inwardly rectifying K+ channel

A chimeric channel, 4N/1, was generated from two outwardly rectifying K+ channels by linking the N-terminal cytoplasmic domain of hKv1.4 (N terminus ball and chain of hKv1.4) with the transmembrane body of hKv1.1 (delta78N1 construct of hKv1.1). The recombinant channel has properties similar to the six transmembrane inward rectifiers and opens on hyperpolarization with a threshold of activation at -90 mV. Outward currents are seen on depolarization provided the channel is first exposed to a hyperpolarizing pulse of -100 mV or more. Hyperpolarization at and beyond -130 mV provides evidence of channel deactivation. Delta78N1 does not show inward currents on hyperpolarization but does open on depolarizing from -80 mV with characteristics similar to native hKv1.1. The outward currents seen in both delta78N1 and 4N/1 inactivate slowly at rates consistent with C-type inactivation. The inward rectification of the 4N/1 chimera is consistent with the inactivation gating mechanism. This implies that the addition of the N-terminus from hKv1.4 to hKv1.1 shifts channel activation to hyperpolarizing potentials. These results suggest a mechanism involving the N-terminal cytoplasmic domain for conversion of outward rectifiers to inward rectifiers.

Electroacupuncture, morphine and clonidine: a comparative study of analgesic effects

This is a comparative study of the analgesic effects of the modified traditional method of analgesia, electroacupuncture (EA), a standard analgesic drug, morphine, a potential analgesic drug, clonidine and the combination of EA + morphine and EA + clonidine. In each case, the index of analgesia (IA) was determined by recording the tail flick latency (TFL) in 60 rats divided into 6 groups of 10 rats each. Group I rats served as control group while Group II-VI were subjected to EA for 20 min (at Zusanli and Kunlun points), morphine (5 mg/kg bw i.p.), clonidine (150 micrograms/kg bw i.p.), EA + morphine and EA + clonidine respectively. TFLs were recorded after the procedure and at 10 min intervals for 150 min or til the TFL returned to¿ the baseline. The IA, analyzed using the Kruskal-Wallis test and its significance determined by multiple comparison test (at 5% level), was found to be significantly different, at various time intervals, in the 6 groups studied.

Comparison of developmental stages of inflorescence for high frequency plant regeneration in Triticum aestivum L. and T. durum Desf

Whole immature inflorescences at 4 different developmental stages (0.5, 1.0, 1.5, 2.0 cm in size) of different genotypes of Triticum aestivum and T. durum were cultured to see the morphogenetic responses on Murashige and Skoog's (MS) medium supplemented with 2,4-dichlorophenoxyacetic acid (2,4-D) (2.5 mg/l). Very young inflorescences 0.5 and 1.0cm long formed embryogenic callus from their entire surface while 1.5 and 2.0 cm long inflorescences formed embryogenic callus from the basal spikelets and rachis only. This embryogenic callus was maintained by regular subcultures on MS medium with 2,4-D (2.5 mg/l) for more than a year. Plantlets were regenerated by transferring the embryogenic callus on hormone-free MS medium. Inflorescences (0.5 and 1.0 cm long) responded best in forming callus as well as plantlets at a very high frequency. Variation in response was observed amongst the genotypes but the qualitative response of formation of embryogenic callus and later regeneration of plantlets was observed from all the genotypes. Immature young inflorescence explants could provide a suitable material for particle gun mediated genetic transformation in wheat.

Effect of hypoxia and acidosis on the cytotoxicity of mitoxantrone, bisantrene and amsacrine and their platinum complexes at normal and hyperthermic temperatures

In an effort to synthesize drugs which would become much more cytotoxic at clinically achievable hyperthermic temperatures, complexes of the tetrachloro-platinum(II) dianion were made with two anthracene dye derivatives, MITOX and BISANT, and the acridine dye derivative m-AMSA. As compared with the parent drug, PtCl4(MITOX)2 was less cytotoxic at 37 degrees C and more cytotoxic at 42 degrees C and 43 degrees C especially at pH 6.45. In contrast, the PtCl4(BISANT)2 was more cytotoxic than BISANT under all conditions. M-AMSA was again shown to be less cytotoxic at elevated temperatures but PtCl4(m-AMSA)2 was more cytotoxic especially at 43 degrees C and pH 6.45. Platinum levels in cells treated for 1 hr with 25 microM at 37 degrees C, 42 degrees C and at pH 7.40 versus pH 6.45 demonstrated no significant differences depending on temperature or pH except for PtCl4(MITOX)2 where approximately 4 times higher intracellular platinum levels were present at pH 6.45 versus pH 7.40, although this finding did not correlate with cytotoxicity. These results suggest that PtCl4(MITOX)2 and PtCl4(m-AMSA)2 may be highly interactive drugs with local hyperthermia.

Multiple modality treatment of carcinoma cells with Pt(Rh-123)2 plus x-ray plus light

A complex of platinum tetrachloride with two molecules of rhodamine-123 (Rh-123), Pt(Rh-123)2, has been reported to act as hypoxic cell radiosensitizer of carcinoma cells in vitro and in vivo. In the present paper we report that Pt(Rh-123)2 photosensitizes human mammary carcinoma (MCF-7) cells and cis-platinum resistant human mammary carcinoma (MCF-7/CP) cells to 400-800 nm light in vitro. The efficiency of photosensitization by Pt(Rh-123)2 was 10 times greater than for Rh-123. Combination therapy using Pt(Rh-123)2 plus x-ray plus light was also much more effective compared to the combination therapy using Rh-123 plus x-ray plus light. After 15 microM of Rh-123 plus x-ray (0-8 Gy) plus light (5 J/cm2) treatment, cell survival curve was parallel to the x-ray cell survival curve with an initial decrease in the surviving fraction corresponding to the drug plus light mediated killing. Cell killing caused by Rh-123 (15 microM) plus x-ray (0-8 Gy) plus light (5 J/cm2) was additive as determined by the product of the surviving fraction after Rh-123 plus light and x-ray. In contrast, for 15 microM of Pt(Rh-123)2 plus x-ray (8 Gy) plus light (5 J/cm2) treatment, whereas additive killing predicts a survival fraction of approximately 0.024, in reality, the combination therapy caused the survival fraction to decrease to 0.0012, implying that the cell killing was enhanced by a factor of 20. Using Pt(Rh-123)2 plus x-ray plus light, supra-additive cell killing was also observed under hypoxic conditions, although compared to normally oxygenated conditions the degree of cytotoxicity was significantly reduced.(ABSTRACT TRUNCATED AT 250 WORDS)

Interaction of D,L- and D-tetraplatin with hyperthermia in vitro and in vivo

The cytotoxicities of D,L-tetraplatin and D-tetraplatin were evaluated at 37 degrees C, 42 degrees C and 43 degrees C at normal pH, at pH 6.45 and under normally oxygenated and hypoxic conditions in EMT-6 cells in vitro. The D-isomer was also tested in FSaIIC cells in vitro. Under these various conditions the pure D-isomer was very similar in cytotoxicity with the racemic mixture. Like cisplatin, both D,L- and D-tetraplatin were selectively cytotoxic toward normally oxygenated cells under acidic pH (6.45) conditions at 37 degrees C. In both cell lines the cytotoxicity of D,L- and D-tetraplatin was markedly increased at hyperthermic temperatures. Under the same conditions platinum levels in EMT-6 cells exposed to D,L- or D-tetraplatin were higher than in cells exposed to cisplatin, and unlike cisplatin there was an increase in intracellular platinum levels when the cells were exposed to D,L- or D-tetraplatin at 42 degrees C compared with 37 degrees C. The tumour growth delay of the FSaIIC fibrosarcoma was the same for D,L- and D-tetraplatin. A dose of 10 mg/kg intraperitoneally of tetraplatin produced a tumour growth delay of about 4.3 days which was increased to about 6 days with the addition of local hyperthermia (43 degrees C, 30 min) to the drug treatment. The tumour cell survival assay also showed no difference between D,L- and D-tetraplatin and a log-linear increase in tumour cell killing with increasing drug dose which was increased 1.5-3-fold with local hyperthermia. D,L- and D-tetraplatin were relatively much more cytotoxic toward bone marrow colony forming units of granulocyte-macrophage progenitors (CFU-GM) than was cisplatin and this cytotoxicity was increased about 5-10-fold under hyperthermic conditions. There was an increase in DNA crosslink formation in tumours when hyperthermia accompanied tetraplatin treatment. Overall, D,L- and D-tetraplatin produced very similar responses under hyperthermic conditions in both tumour and normal tissues, and may be a useful agent in combination with local hyperthermia.

Effect of hypoxia and acidosis on the cytotoxicity of six metal(ligand)4(rhodamine-123)2 complexes at normal and hyperthermic temperatures

Several analogues of PtCl4(Rh-123)2 in which the metal may be Pt or Pd and the coordinated ligand may be -Cl, -CN or -NO2 were prepared and tested in cell culture with EMT-6 cells at normal (37 degrees C) and hyperthermic (42 degrees C and 43 degrees C) temperatures and various environmental conditions (normally oxygenated vs. hypoxic and pH 7.40 vs. pH 6.45). Pd is a much more reactive metal than Pt, while -CN and -NO2 are more tightly bound ligands than is -Cl. The goal of these studies was to define the complex with the least cytotoxicity at 37 degrees C and the greatest enhancement in cytotoxicity under hyperthermic conditions. The Pt complexes Pt(CN)4(Rh-123)2 and Pt(NO2)4(Rh-123)2 were much less cytotoxic than PtCl4(Rh-123)2 under both normothermic and hyperthermic conditions. The Pd complexes were, in general, more cytotoxic than the corresponding Pt complexes. The level of metal (Pt or Pd) in the cells did not appear to be a major factor in the level of cytotoxicity obtained. Complexes which were not cytotoxic at 37 degrees C regardless of oxygenation level or pH did not become cytotoxic at hyperthermic temperatures. In conclusion, the optimal members of this series were the complexes with chloro ligands, indicating that aquation is probably a necessary step in the cytotoxic mechanism and cytotoxicity at 37 degrees C was necessary to obtain cytotoxicity at higher temperatures.

A report on a rare case of Kearns Sayre-like syndrome

Purpose: To report the presentation of a rare case of Kearns-Sayre-like syndrome (KSS) Case: A 14-year-old boy presented with progressive drooping of both upper eyelids for 10 years. Past history of right sided hemi-plegia and left facial nerve palsy was present. Examination (OU) showed total external ophthalmoplegia, ptosis and pigmentary retinopathy. The patient also had a short stature (height 121.9 cm) for his age. Keywords: Kearns Sayre syndrome; total external ophthalmoplegia; ptosis DOI: 10.3126/nepjoph.v2i2.3725 Nep J Oph 2010;2(2) 160-163