Associations between sleep and appetitive traits in higher-income preschoolers: A six-month study

BACKGROUND

Short sleep is consistently linked with childhood obesity, possibly via disrupting appetite hormones and increasing food responsiveness. Few studies have objectively examined this association in early childhood.

OBJECTIVE

To evaluate associations of sleep quantity and quality with child appetitive traits and eating in the absence of hunger (EAH) in a higher-income cohort of 86 preschool-age children (age 4.0 ± 0.8 years; 42% female; 93% non-Hispanic white, Northern New England, US).

METHODS

Children's sleep duration and quality were assessed via parent report (Children's Sleep Habits Questionnaire, CSHQ) at baseline and 6-month follow-up and via accelerometry at baseline. Parents also completed the Child Eating Behaviors Questionnaire to assess the child's appetitive traits. EAH, an objective measure of overeating, was observed at baseline during an in-person visit. Associations between sleep measures and appetitive traits were examined with linear mixed-effect or linear regression models, as appropriate, adjusting for child age, sex, and household income.

RESULTS

Shorter sleep duration per parent report was associated with less satiety responsiveness (standardized ß = 0.14, 95% CI: 0.01, 0.26; p = 0.03). Further, satiety responsiveness was inversely related to EAH (Pearson's r = -0.35, p = 0.02). No associations were found between accelerometer-measured sleep parameters and appetitive traits, and no sleep measures were related to EAH.

CONCLUSIONS

Shorter usual sleep, per the parent report, was cross-sectionally associated with reduced satiety responsiveness in this sample of higher-income preschoolers. Future studies should consider whether socioeconomic status may modify the impact of poor sleep on appetitive traits in early childhood.

Compact, ultrastable, high repetition-rate 2 μm and 3 μm fiber laser for seeding mid-IR OPCPA

We report a compact and reliable ultrafast fiber laser system optimized for seeding a high energy, 2 μm pumped, 3 μm wavelength optical parametric chirped pulse amplification to drive soft X-ray high harmonics. The system delivers 100 MHz narrowband 2 μm pulses with >1 nJ energy, synchronized with ultra-broadband optical pulses with a ∼1 μm FWHM spectrum centered at 3 μm with 39 pJ pulse energy. The 2 μm and 3 μm pulses are derived from a single 1.5 μm fiber oscillator, fully fiber integrated with free-space downconversion for the 3 μm. The system operates hands-off with power instabilities <0.2% over extended periods of time.

Numerical investigation of gas-filled multipass cells in the enhanced dispersion regime for clean spectral broadening and pulse compression

We show via numerical simulations that the regime of enhanced frequency chirp can be achieved in gas-filled multipass cells. Our results demonstrate that there exists a region of pulse and cell parameters for which a broad and flat spectrum with a smooth parabolic-like phase can be generated. This spectrum is compatible with clean ultrashort pulses, whose secondary structures are always below the 0.5% of its peak intensity such that the energy ratio (the energy contained within the main peak of the pulse) is above 98%. This regime makes multipass cell post-compression one of the most versatile schemes to sculpt a clean intense ultrashort optical pulse.

Attention to food cues following media multitasking is associated with cross-sectional BMI among adolescents

Purpose

To measure attention to food cues following a multitask or a sustained attention single task, and further, to examine the associations with current weight status and excess consumption.

Methods

Ninety-six 13-to 17-year-olds were fed a standardized meal and then had their attention to food cues measured following completion of a single sustained attention task, media multitask, or a passive viewing control task. Participants then completed an eating in the absence of hunger paradigm to measure their excess consumption. Adolescents completed each condition on separate visits in randomized order. Attention to food cues was measured by computing eye-tracking measures of attention, first fixation duration, and cumulative fixation duration to distractor images while participants played the video game, Tetris. Participants also had their height and weight measured.

Results

Although not statistically significant, attention to food cues was greatest following a media multitask and weakest following a task that engaged sustained attention when compared to a control. First fixation duration was positively and statistically significantly associated with BMI-Z when measured following a multitask. Cumulative fixation duration was not associated with BMI-Z. There were no associations between BMI-Z and attention to food cues after the attention or control task, nor any association between attention to food cues and eating in the absence of hunger.

Conclusion

Among adolescents, we found that current adiposity was related to attention to food cues following a multitask. Multitasking may perturb the cognitive system to increase attention to food cues.

Nonlinear post-compression in multi-pass cells in the mid-IR region using bulk materials

We numerically investigate the regime of nonlinear pulse compression at mid-IR wavelengths in a multi-pass cell (MPC) containing a dielectric plate. This post-compression setup allows for ionization-free spectral broadening and self-compression while mitigating self-focusing effects. We find that self-compression occurs for a wide range of MPC and pulse parameters and derive scaling rules that enable its optimization. We also reveal the solitonic dynamics of the pulse propagation in the MPC and its limitations and show that spatiotemporal/spectral couplings can be mitigated for appropriately chosen parameters. In addition, we reveal the formation of spectral features akin to quasi-phase matched degenerate four-wave mixing. Finally, we present two case studies of self-compression at 3-μm and 6-μm wavelengths using pulse parameters compatible with driving high-field physics experiments. The simulations presented in this paper set a framework for future experimental work using few-cycle pulses at mid-IR wavelengths.

Photonic crystal resonators for inverse-designed multi-dimensional optical interconnects

We experimentally demonstrate a 400 Gbit/s optical communication link utilizing wavelength-division multiplexing and mode-division multiplexing for a total of 40 channels. This link utilizes a novel, to the best of our knowledge, 400 GHz frequency comb source based on a chip-scale photonic crystal resonator. Silicon-on-insulator photonic inverse-designed 4 × 4 mode-division multiplexer structures enable a fourfold increase in data capacity. We show less than -10 dBm of optical receiver power for error-free data transmission in 34 out of a total of 40 channels using a PRBS31 pattern.

0012 Disordered sleep and emotional self-regulation in a prospective cohort of preschool-age children

Introduction

Disrupted sleep has been associated with poor emotional self-regulation among preschool-age children cross-sectionally, with few studies examining change over time. Our goal was to examine the prospective association between disrupted sleep and emotional self-regulation over six months among preschool-age children.

Methods

Analyses included 54 children, age 3-5 years old, who completed their participation in a currently ongoing, 6-month prospective study conducted in a rural area of New England to examine early-life predictors of obesity. Parents completed the 35-item Children’s Sleep Habits Questionnaire (CSHQ), a validated scale to measure problematic sleep, reflecting both reduced sleep quantity and quality. Total scores greater than 41 reflect a clinically-meaningful sleep disorder. Parents also completed the 5-item emotional self-regulation subscale of the validated Child Social Behavior questionnaire. A final score was computed as the average across the 5 items (range 1-7), with higher scores indicating poorer emotional self-regulation. A series of linear regression models were used to examine associations between sleep and emotional self-regulation at baseline, as well as change in self-regulation over six months. Each model was adjusted for child age, sex, and parental education level.

Results

The sample was largely white, non-Hispanic (87.0%), with 61.1% of male children, 90.7% of accompanying parents as mothers, and 79.6% of parents with a Bachelor’s degree or greater. One-fourth (n=14, 25.9%) of children met the criteria for disordered sleep at baseline. In an adjusted linear regression model, children with disordered sleep at baseline, on average, had worse self-regulation at baseline (beta coefficient=0.90, SE=0.33; p&lt;0.01) and, separately, a greater decrease in self-regulation over six months (beta=0.78, SE=0.30; p=0.01). When further adjusting for disordered sleep at month 6, disordered sleep at baseline remained predictive of a greater decrease in self-regulation over time (beta=1.12; SE=0.41; p&lt;0.01).

Conclusion

In this preliminary analysis, disordered sleep was associated with poor emotional self-regulation cross-sectionally and a decline in emotional self-regulation over six months. Generalizability is limited because of the high socioeconomic status of the sample. Yet findings suggest that the effects of disordered sleep on emotional self-regulation may manifest within in the preschool-years.

Support (If Any)

This study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases, grant number K01DK117971.

199 Efficient Knock-out of Ovine β-Lactoglobulin (BLG) Gene and Knock-in of Recombinant Human Factor IX (rhFIX) Under BLG Native Regulatory Sequences in Somatic Cells and Zygotes Using TALEN Nuclease

Site-specific genetic engineering is a valuable tool for pharmaceutical research and development of biomedical models. Despite engineered nucleases allow targeted gene edition in a rather simple fashion; few reports are available so far on specific gene knock-in (KI) combined with engineered nucleases in domestic species. Here, we evaluated the possibility of inducing specific KI of cDNAs coding for proteins of pharmaceutical interest under the control of milk native promoter sequences, taking advantage of the TALEN system, both in ovine somatic cells and in zygotes. We designed 2 TALENs, targeting exons 1 and 5 of ovine β-lactoglobulin gene (BLG), respectively, and a homologous recombination vector (pHR), carrying recombinant human factor IX (rhFIX) flanked by homology arms contiguous to the TALEN target sites. In an initial set of experiments, 5 × 105 to 1 × 106 ovine fibroblasts were transfected with 1 μg of each TALEN mRNA, with or without 50 ng μL−1 pHR. The feasibility of inducing knock-out (KO) was confirmed by Cel1 assay. The deletion of the genomic region between TALEN target sites and the occurrence of HR in cell lysates were assessed by PCR. Also, 576 individual colonies were picked up and analyzed by PCR. The deletion of the region between TALEN target sites was achieved with 7.8% efficiency (45/576). The incidence of HR in cells was 0.5% (3/576), as detected by PCR. In order to evaluate the system in zygotes, laparoscopic AI was performed on synchronized and superovulated ewes. Zygotes were recovered 16 h after AI and cytoplasmically injected with (1) 5 ng μL−1 TALEN mix (2.5 ng μL−1 oaBLG T1.1 + 2.5 ng μL−1 oaBLG T5.1) (5TM); (2) 5 ng μL−1 TALEN mix + 25 ng μL−1 pHR-hFIX plasmid (5TM+25pRH); or (3) 15 ng μL−1 TALEN mix (7.5 ng μL−1 oaBLG T1.1 + 7.5 ng μL−1 oaBLG T5.1) + 50 ng μL−1 pHR-hFIX (15TM+50pRH). A non-injected control (NIC) was also included. Embryo analysis was conducted on whole-genome amplified DNA from blastocysts, followed by PCR and sequencing. Non-parametric Fisher test was applied to detect significant differences among treatments. Although blastocyst rates for NIC and 5TM did not statistically differ, 5TM+25pRH and 15TM+50pRH groups resulted in lower blastocysts rates than the NIC [P < 0.05; 13/17 (76%), 6/15 (40%), 4/15 (26%) and 2/14 (14%) for NIC, 5TM, 5TM+25pRH and 15TM+50pRH respectively]. It was possible to detect the PCR product compatible with deletion of the entire region among TALEN target sites in 6/6 blastocysts (100%) from the group 5TM, 3/4 blastocysts (75%) from the group 5TM+25pRH and 2/2 (100%) blastocysts from the group 15TM+50pRH. HR was detected in 1/2 (50%) blastocysts injected with 15TM+50pRH and in 1/4 (25%) blastocysts injected with 5TM+25pRH, by PCR and sequencing of the PCR products. Our results indicate that TALEN combined with homologous recombination constitutes a powerful platform for the production of proteins of pharmaceutical interest under native regulatory sequences in the milk of genetically modified animals.

Influence of forage inclusion in the diet on ileal and total tract digestibility

The present investigation aimed to study the ileal and total tract digestibility of 3 forages (clover-grass, clover-grass silage, and field pea (Pisum sativum)-barley (Hordeum vulgare) silage) supplemented to a basal diet. A total of 24 pigs, adapted to eating forages by supplementing a basal feed with clover-grass silage from weaning, were fitted with a T-cannula at the terminal ileum at approximate 30 kg BW. For each of the 3 types of forage, 2 balance trials with a 4 wk interval were carried out. Two pigs in each test were fed the basal diet and 6 others were fed the basal diet plus forage throughout the whole experiment. The intake of forages was low and quite variable and on average accounted for only 10 to 12% of the DMI. Ileal digestibility of protein estimated by collection from the T-cannula was higher (P = 0.031) than the digestibility estimated by the slaughter technique indicating some separation of the digesta collected from the T-cannula. The forages had, as expected, a lower total tract DM and energy digestibility than the basal diet (P < 0.05). The fresh clover-grass had a higher energy digestibility than the 2 silages (60 vs. 48%; P < 0.05). Inclusion of 10% of GE in the diet as forage reduced (P < 0.05) the energy digestibility of the ration by 2.2% for clover-grass, 3.4% for clover-grass silage, and 5.0% for pea-barley silage. In organic slaughter pig production, the overall energy supply from these forages is limited, but they may play an important role in satiety and rooting behavior.

Technological Development for Commercialization of Amorphous Silicon Based Multijunction Modules

Some of the significant steps in technological development for large-scale commercialization of amorphous silicon (a-Si:H) based multijunction photovoltaic modules are presented. These developments are establishing a high quality baseline process for manufacturing large-area ( ˜ 8 ft2) a-Si:H/a-SiGe:H tandem junction modules with improved stabilized conversion efficiency, throughput, yield, and reduced materials usage.

Efficiency Limitations of Multicrystalline Silicon Solar Cells Due to Defect Clusters

Multicrystalline Si wafers used in commercial solar cell fabrication exhibit a tendency to form large “clusters” of defects, which remain laterally separated from each other. Defect clusters are also sites of impurity precipitation. Because precipitated impurities cannot be gettered by the conventional processes used in Si solar cell fabrication, defect clusters constitute low-performing regions in the cell. They shunt the device and constitute the primary efficiency limiting mechanism in current solar cells. We show that the efficiency loss caused by defect clusters can exceed 3–4 absolute points.

ABT-869 in Combination with Paclitaxel (P) as First-Line Treatment in Patients (Pts) with Advanced Breast Cancer

Background: ABT-869 is a novel orally active, potent and selective inhibitor of VEGF and PDGF receptor tyrosine kinases. ABT-869 potentiates the action of P in a number of preclinical tumor models including breast carcinoma (BC). This study was conducted to assess pharmacokinetic (PK) interaction and safety of ABT-869 combined with weekly P, and to guide ABT-869 dosing in the randomized portion of the trial.Methods: Pts with measurable chemotherapy naïve metastatic or unresectable locally advanced BC were eligible for this trial. Treatment consisted of weekly P (90 mg/m2) on Day (D) 1, 8 and 15 of every 28-day cycle (C) and ABT-869 0.20 orally once daily (QD) starting on D3 of C1. Treatment continued until progressive disease (PD) or unacceptable toxicity was observed. CT scans were conducted at baseline (within 21 days prior to C1 D1) and at the end of every 3 cycles. Adverse events (AE) were graded by NCI CTCAE V3.0; efficacy was evaluated by RECIST.Results: As of May 2009, 8 pts have enrolled in this study: 5 at 0.20 mg/kg and, based on the frequent need for dose reductions in this and other ongoing trials, a second cohort has enrolled 3 out of 6 planned pts at 0.15 mg/kg. Preliminary safety and efficacy results are shown (table). Of the 5 pts dosed at 0.20 mg/kg, 2 pts had confirmed partial responses (PR) and continued on drug at reduced dose for 12 and 10 cycles, and 3 discontinued (DC); 1 due to PD, 1 withdrew consent, and 1 for AE (pulmonary embolism, cycle 2). Three pts have been dosed at 0.15 mg/kg; one is early and two have PR. The most common AEs were neutropenia (n=3), stomatitis, vomiting, ALT increased, hyperglycemia, hypokalemia and hypertension (n=2 each). These events were generally grade 1 or 2 except for neutropenia.Conclusion: The combination of ABT-869 0.20 mg/kg QD with P weekly resulted in antitumor activity (2 PR) but required frequent dose reductions due to AEs. A reduced dose of 0.15 mg/kg with weekly P is being evaluated (2 PR). Updated results of this ongoing study will be presented.Pt #Initial ABT-869 Dose (mg)Current ABT-869 Dose (mg)Cycle of Dose ReductionReason for Dose ReductionEnd Cycle 3 AssessmentsEnd Cycle 6 AssessmentsCurrent status   0.20 mg/kg    1001107.54G3 hand-footPRPRCycle 121041105.03,5G3 fatiguePRPRCycle 1010022020----DC in Cycle 2 (PD)102112.512.5--SD-DC in Cycle 4 (withdrew consent due to headaches)10221515----DC in Cycle 2 (Pulmonary embolism)   0.15 mg/kg    10231052,4G2 hand painPR-Cycle 510247.57.5--PR-Cycle 410251010----Cycle 1G= grade

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5076.

Phase II study of bevacizumab (B) plus cisplatin (C) plus intensity-modulated radiation therapy (IMRT) for locoregionally advanced head and neck squamous cell cancer (HNSCC): Preliminary results

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Background: For patients with locoregionally advanced HNSCC, concurrent high-dose cisplatin + radiation therapy is a historical standard of care. HNSCC tumors expressing high levels of VEGF have been associated with worse prognosis, and bevacizumab may sensitize tumors to cisplatin and radiation. Methods: Percutaneous gastrostomy (PEG) tube was placed pre-treatment for all patients. Planned treatment consisted of definitive IMRT (total, 70 Gy) with concurrent C (50 mg/m2 days 1, 2, 22, 23, 43, 44) and B (15 mg/kg days 1, 15, and 43). The initial version of the protocol called for an additional 6 months of maintenance B, but this was discontinued in an amendment after a G4 pulmonary hemorrhage event in subject 1 during maintenance treatment. 1o endpoint was 2-year PFS. Results: 42 previously untreated patients (34 M, 8 F), median age 55 (27–75), with stage III/IV, M0 HNSCC (oropharynx 39, larynx 3) enrolled. HPV status by ISH: 16 pos, 14 neg, 12 unknown). All patients have completed treatment. CTCAE v3.0 toxicities (% patients) have included: functional mucositis G3 (76 %); nausea G3 (24%); vomiting G3 (17%); neutropenia G3 (31%), G4 (10%); hemoglobin G3 (17%); hyponatremia G3 (14%). Median weight loss during treatment was 8.9 kg (2.1–26 kg). There were two deaths within 90 days of last treatment: 1 aspiration pneumonia, 1 sudden death. Median follow up is approximately 9 months (range, <3 to 24 months). Locoregional control rate is 100%. Three patients have developed distant metastasis. Estimated one-year PFS is 83% (± 10%) and estimated 1 year OS is 88% (± 6%). At a median of 8 months after completion of radiation therapy, PSS-HN scores were 100 for eating, speech, and diet in respectively 88%, 76%, and 53% of surveyed patients (n = 17). Conclusions: The addition of B to C + IMRT did not appear to increase toxicity to unacceptable levels, and preliminary efficacy results are encouraging.

[Table: see text]

Phase I study of everolimus (E; RAD001) + low-dose weekly cisplatin (C) for patients with advanced solid tumors: Preliminary results

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Background: Preclinical studies demonstrate synergistic anti-tumor activity with the combination of E + C. Methods: Patients received E per oral for days 1–21 of a 28 day cycle. E was dose escalated though 4 planned dose levels (DLs): 2.5 mg/day, 5 mg/day, 7.5 mg/day, and 10 mg/day. Cisplatin dose was fixed at 20 mg/m2 intravenously on days 1, 8, 15. A standard 3 + 3 dose escalation scheme was used. Blood samples for pharmacokinetics were collected on Day 1 and Day 8 of Cycle 1. Response was assessed by RECIST after 2 cycles. Results: 24 patients enrolled: 13 M, 11F; median age 62 (32–77); median number of prior cytotoxic chemotherapy regimens 1 (0–3; 75% with prior RT). At DL1, 3 patients were inevaluable (1 withdrawal of consent prior to treatment, 1 disease progression during cycle 1, 1 recurrent diverticulitis during cycle 1) and were replaced. DL 1 was expanded after a patient with melanoma metastatic to liver had sudden death of unclear cause, and the protocol was amended to exclude patients with hepatic dysfunction. At DL2, one patient experienced grade 3 small bowel obstruction of uncertain etiology, and the dose level was expanded to 6 evaluable patients without additional DLT. No DLTs occurred at DL3. No DLTs have occurred to date among 6 patients enrolled at DL 4. Adverse events per cycle (total n = 63 cycles; 20 patients evaluable for toxicity) include: lymphopenia G3 (19%), AST G3 (3.2%), alkaline phosphatase G3 (3.2%), ALT G3 (1.6%), hyponatremia (1.6%). Median cycles per patient, 2 (range <1 to 10+). Minor response seen in pulmonary carcinoid (n = 1); prolonged SD ≥ 6 cycles seen in pulmonary carcinoid (n=2), basal cell carcinoma (n=1), and esthesioneuroblastoma (n=1). Conclusions: Pending safety analysis at the final planned dose level, the phase II recommended dose is E 10 mg/day (days 1 - 21) + C 20 mg/m2 (days 1, 8, and 15) on a 28-day cycle.

[Table: see text]

Serosal zinc attenuate serotonin and vasoactive intestinal peptide induced secretion in piglet small intestinal epithelium in vitro

This study addressed the mechanisms by which dietary zinc affects diarrhoea and aimed to study possible interactions between zinc status and the presence of zinc in vitro on secretagogue-induced secretion from piglet intestinal epithelium in Ussing chambers. In addition, it was studied from which side of the epithelium zinc would perform an effect and if copper caused similar effects. Twenty-four piglets (28 days of age) were weaned and fed diets containing 100 or 2500 mg zinc/kg (as ZnO) for 5 or 6 days (12 piglets per group). Intestinal epithelium underwent the following 5 treatments: zinc at the mucosal side (M(Zn)), zinc at the serosal side (S(Zn)), zinc at both sides (MS(Zn)), copper at both sides (MS(Cu)) or water at both sides (control). Provoked secretion in terms of short circuit responses to serotonin (5-HT) and vasoactive intestinal peptide (VIP) were measured. Zinc at the serosal or both sides of the epithelium reduced the 5-HT induced secretion (P<0.001); however, due to interactions (P=0.05) the effect of zinc in vitro was only present in the ZnO(100) group. The secretion caused by VIP was not affected by the diet (P=0.33), but zinc at the serosal side or both sides reduced the response to VIP (P<0.001). Copper reduced the 5-HT and VIP induced secretion to a larger extent than zinc. However, copper also disturbed intestinal barrier function as demonstrated by increased transepithelial conductance and increased short circuit current, which was unaffected by zinc. In conclusion, zinc at the serosal side of piglet small intestinal epithelium attenuated 5-HT and VIP induced secretion in vitro. These in vitro studies indicate that in vivo there will be no positive acute effect of increasing luminal Zn concentration on secretagogue-induced chloride secretion and that zinc status at the serosal side of the epithelium has to be increased to reduce secretagogue-induced chloride secretion and thereby diarrhoea.

Assessment of zinc and copper status in weaned piglets in relation to dietary zinc and copper supply

The aim of the study was to determine the effect of weaning and the effect of increasing dietary zinc concentrations on the zinc and copper status of weaned piglets (study 1) and to study the effect of high concentrations of dietary zinc and/or copper on zinc and copper status of weaned piglets (study 2). Study 1 included 54 piglets (six litters of nine piglets). One piglet from every litter was killed 1 day before weaning. The remaining 48 piglets were allocated at weaning (28 days) to four dietary zinc treatments (100, 250, 1000 or 2500 ppm) and subsequently killed 1-2, 5-6 or 14-15 days after weaning. Study 2 included 48 piglets (six litters of eight piglets) allocated to four dietary treatments, consisting of low or high dietary zinc (100 or 2500 ppm) in combination with low or high dietary copper (20 or 175 ppm). All piglets in study 2 were killed 5-7 days after weaning. In both studies, the trace mineral status was assessed by zinc and copper concentrations and alkaline phosphatase (AP) activity in plasma and mucosal tissue. In study 2, lymphocyte metallothionein (MT) mRNA and intestinal mucosa MT mRNA concentrations were included as zinc status markers. The results showed that the zinc status, measured as zinc in plasma and mucosa, was not affected by weaning of the piglets. Plasma copper concentrations decreased during the first 2 weeks after weaning. High dietary copper concentrations did not affect the concentration of copper in plasma, but increased the concentration of copper in mucosa and the concentration of zinc in plasma. The dietary zinc treatments increased the zinc concentration in plasma as well as the zinc and MT mRNA concentration in mucosa. Lymphocyte MT mRNA concentrations did not reflect the differences in dietary zinc supplementation.

High-intensity, short-term biofeedback in children with Hinman's syndrome (non-neuropathic voiding dyssynergia)

OBJECTIVE

To evaluate the long-term response to high-intensity, short-term biofeedback in children with severe voiding dysfunction.

PATIENTS AND METHODS

We retrospectively reviewed patients who underwent short-term, high-intensity biofeedback therapy from 1996 to 2004. Improvement was classified based on clinical and radiographic findings. Patients were categorized as having Hinman's syndrome when, in addition to urinary incontinence, at least four of the following categories were present: sphincter dyssynergia, bladder trabeculation, large post-void residual (PVR), hydronephrosis, vesicoureteral reflux (VUR) and urinary tract infections. There were 14 patients (eight males and six females), 13 of whom had Hinman's syndrome. Age when biofeedback was initiated varied from 5.6 to 12.9 years (mu=8.9+/-2.2). Before biofeedback, all had large PVRs, bladder trabeculation and sphincter dyssynergia. Nine had hydronephrosis and five had VUR. One patient had renal failure.

RESULTS

Before biofeedback, the mean PVR was 109 ml (25-270 ml); after biofeedback, this decreased to 21 ml (0-150 ml), including two patients who eventually failed treatment. All 14 patients were able to relax their external sphincter and reduce the PVR during biofeedback and on short-term follow up. Long-term follow up (mu=59.4 months) in 12 patients established that seven had a durable response with remission of symptoms, reduced PVR and radiographic improvement. In three, symptoms partially recurred over time and two failed treatment completely.

CONCLUSION

Short-term, high-intensity biofeedback achieves a durable response in the majority of children with Hinman's syndrome. Long-term follow up is needed to assure compliance.

Gliosarcoma cell death after radiosurgery in a rat model

Therapeutic radiation and subsequent detection of tumor cell death has been performed mainly in vitro systems, making it difficult to accurately characterize the mechanisms of tumor cell death after radiosurgery. To better characterize what occurs to glioma cells after radiation therapy, we developed a rat model using the 9L gliosarcoma cell line implanted reproducibly to the caudate nucleus in rats. After 1 Gy radiation, 9L tumors in vivo induced mainly necrosis (determined by trypan blue exclusion) of 10 - 74 % at 6 - 72 hours post-radiation. This is in contrast to a previous in vitro study which demonstrated that 18 Gy of radiation induces considerably less cell death as determined by trypan blue exclusion (approximately 20 - 25 % at 6 - 72 hours post-radiation). However, significant amounts of apoptosis were detected as early as 6 hours after radiation. Apoptosis determination was by annexin V (marker of early apoptosis) and propidium iodide (marker of membrane stability) staining followed by flow cytometry detection. When caspase 3 and caspase 8 enzymatic activities (mediators of apoptosis) were measured from freshly explanted tumor cells, peak activity was found 6 hours after 1 Gy radiation (p < 0.01). Taken together, these data indicate the presence of apoptosis early after radiation therapy (1 Gy) which progressed to necrosis in a unique in vivo model of gliosarcoma that may prove useful in determining new therapeutic approaches to radiation therapy and tumor cell biology.

Additional dietary zinc for weaning piglets is associated with elevated concentrations of serum IGF-I

Two experiments were performed in order to study how weaning and post-weaning dietary zinc level affect serum IGF-I. Further, whether the growth-enhancing effect of 2500 ppm of dietary zinc (Zn2500) and/or 175 ppm of dietary copper (Cu175) in post-weaning diets is associated with elevated serum IGF-I levels in piglets was studied. Experiment 1 included 54 piglets (six litters of nine piglets). One piglet from every litter was assigned to a control group (blood sampled 1 day before weaning). At weaning the remaining eight piglets from every litter were allocated randomly to four dietary treatments with increasing zinc inclusions (Zn100, Zn250, Zn1000, Zn2500). In exp. 2, 48 piglets (six litters of eight piglets) were allocated to four dietary treatments (Zn100, Zn100Cu175, Zn2500, Zn2500Cu175). All piglets in exp. 1 were blood sampled at -1, 1-2, 5-6 or 14-15 days after weaning and in exp. 2 blood samples were taken from all pigs 5-7 days after weaning. Feed intake was recorded per pen (two piglets) and weight gain was recorded for every piglet. Just after weaning feed intake was very low, piglets lost weight and serum IGF-I decreased in exp. 1. However, the piglets fed 2500 ppm of zinc reached pre-weaning levels of serum IGF-I at 14-15 days post-weaning, whereas piglets receiving lower zinc levels showed no changes in serum IGF-I. In exp. 2, additional dietary zinc in weaning diets for piglets was found to be associated with increased feed intake, improved growth rate and increased serum IGF-I. High levels of dietary copper did not affect any of these measurements. Zinc-induced rise in serum IGF-I was partly due to increased feed intake. After correcting for differences in feed intake, zinc significantly increased serum IGF-I. However, to completely separate effects of feed intake from effects of zinc status, pair-feeding should be considered in future studies.

IMRT: high-definition radiation therapy in a community hospital

A multileaf collimator (MLC)-based intensity-modulated radiation therapy (IMRT) program was implemented successfully at Monmouth Medical Center, a community hospital at Long Branch, New Jersey. Our clinical experience gained in the treatment of over 80 patients using IMRT for prostate, head and neck, and brain is reviewed, and some of the clinical issues are also, discussed. Implementation of the IMRT requires a treatment planning system, computer-controlled beam-shaping aperture, electronic record and verify system, and a good physics quality assurance program. These components, by grouping them efficiently, have created a seamless workflow for our complete radiotherapy process of IMRT. Each of these radiotherapy processes are discussed for clarity and the clinical importance is also evaluated. Of particular interest is inverse treatment planning that will impact treatment delivery such as beam orientation, treatment ports, and organ motion of IMRT. A checklist for physics and departmental quality assurance is suggested, with the intention of providing systematic workflow, making IMRT feasible at a community medical center setting. This is especially important because most of our cancer patients received radiation therapy locally. Lastly, the reimbursement issue affecting the implementation of IMRT at our medical center is also discussed to justify this new treatment protocol for future clinical outcomes.

Intensity modulation using multileaf collimators: current status

Intensity-modulated radiation therapy (IMRT) extends the capability of 3D conformal methods (3D-CRT). Studies show that these methods can clinically reduce complications and can allow a larger safety margin for dose escalation. The ultimate goal is improved survival and improved quality of life. IMRT methods typically require more fields, or segments, and more monitor units for a given dose, as compared to conventional CRT methods. Because of this, some multileaf collimator (MLC) parameters take on more importance. A review of current standard MLC configurations are discussed, along with the concept of integral dose. An effective quality assurance (QA) program for IMRT involves more than dose modeling of the MLC. Integrity of data flowing from 3D radiograph databases to treatment planning to delivery sequencing files to verify-and-record function is required. End users need to be aware of differences in commercial availability vs. in-house developments for configuring a system. Great strides have been made in streamlining the whole process. This is evidenced by the first major symposium on community-based IMRT. Research continues to improve accuracy and productivity.