A Phase I Trial of Focal Salvage Stereotactic Body Radiation Therapy for Radiorecurrent Prostate Cancer

PURPOSE/OBJECTIVE(S)

Locally recurrent prostate cancer after radiotherapy (RT) is an increasingly recognized entity with no standard management. NCT03253744 was a phase I trial with a primary objective of identifying the maximally tolerated dose (MTD) of a course of image-guided, focal, salvage stereotactic body radiotherapy (SBRT) for patients with local recurrence after prior definitive RT. Additional objectives included biochemical control and imaging response on mpMRI and 18F-DCFPyL (PSMA) PET/CT.

MATERIALS/METHODS

SBRT was prescribed to three dose levels (DLs): 40Gy (DL1), 42.5Gy (DL2), and 45Gy (DL3) in 5 fractions. The prescription dose was delivered to a PTV defined by mpMRI and PSMA imaging and biopsy confirmed tumor volume. Dose escalation followed a 3+3 design with a 3-patient expansion at the MTD. Toxicities above baseline were scored using CTCAE v5.0 criteria for two years after completion of SBRT. Escalation was halted if 2 dose limiting toxicities (DLTs) were observed. DLTs were defined as any persistent (>4 days) grade 3 toxicity occurring within the first 3 weeks after SBRT, and any grade 3 GU or grade 4 GI toxicity thereafter. Imaging response was compared between baseline and 6-months by the Wilcoxon signed rank test.

RESULTS

Between 08/2018 and 05/2022, 8 patients underwent salvage SBRT to 11 intraprostatic lesions with a median follow-up of 27 months. No DLTs were observed on DL1. Two patients were enrolled on DL2 and both experienced grade 3 GU toxicities, prompting de-escalation and expansion (n = 6) on DL1, the MTD. The most common toxicities were grade 2 GU toxicities: acute urinary urgency/frequency, acute weak urinary stream, and noninfective cystitis. One patient at DL1 had a self-limited episode of grade 2 GI toxicity (proctitis). No grade 3 GI toxicities were observed. All but two patients achieved an undetectable PSA nadir. Only one of these experienced biochemical failure (nadir + 2.0) at 33 months with suspicion of distant metastatic failure on restaging PET/CT. Imaging response was demonstrated by MRI in all lesions with heterogeneity in volumetric response (6% to 100%). A significant (p<0.01) response on PSMA PET/CT was observed for all measured parameters (SUVMax, SUVMean, GTVPSMA, Total Lesion PSMA [SUVMean × GTVPSMA]). Of the 11 lesions, 1 (9%) demonstrated a complete response (CR) by MRI and 9 (82%) by PSMA PET/CT. A single lesion increased in volume by 0.06 cc (16%) at 6-month PSMA PET/CT compared to baseline in the only patient who did not achieve an undetectable PSA nadir and did not have imaging suggestive of distant failure.

CONCLUSION

On this phase I dose escalation study of salvage SBRT for isolated intraprostatic local failure after definitive RT, the MTD was 40Gy in 5 fractions. producing a 100% 24-month bPFS, with one late failure at 33 months occurring after the 24-month study period. The most frequent clinically significant toxicity was late grade 2 GU toxicity. Imaging response was demonstrated in all lesions on MRI and PSMA PET/CT with exception of a single lesion.

Integrated full-scale solar CPC/UV-LED–filtration system as a tertiary treatment in a conventional WWTP for agricultural reuse purposes

Today, the emergence of increasingly restrictive treatment and reuse policies make the implementation of full-scale tertiary treatment, capable of improving the quality of water, a priority. Full-scale TiO2 photocatalysis systems are resulting in a promising option, since TiO2 is commercially available. However, questions such as how to work continuously during day/night irradiation cycle, or the removing of TiO2 in outlet flow are still unresolved. In this work, a full-scale system integrating a solar CPC/UV-LED step combined with commercial microfiltration membranes was installed in a conventional WWTP for agricultural reuse purposes. After optimization, 0.5 g/L of catalyst and combined SOLAR + UV-LED showing the highest pharmaceutical removal percentages, while a self-designed UV-LED included in the own reaction tank resulting in higher efficiencies compared with commercial lamps. Longer membrane surface area decreased fouling problems in the system. However, 60 min of irradiation time was necessary to reach the most restrictive water quality values according with (EU 2020/741). After optimization step, total costs were reduced by 45%. However, it was shown that a reduction in operating and maintenance costs, along with the development of more effective and economical commercial filtration membranes is a key factor; therefore, working on these aspects is essential in the treated water cost reduction.

Graphical abstract

Why should gender-sensitive health reports be intersectional?

Background

A key focus of both epidemiology and PHMR is the identification of health inequity between population groups and its determinants. However, scholars in the social sciences have criticised prevalent approaches of describing health differences according to single social categories like sex/gender or race/ethnicity, glossing over significant heterogeneity within and relations between presumed population groups. Applying these critiques to the field of PHMR, we would argue that intersectionality scholarship offers vital impulses for the study of health inequity by focusing on several, interrelated social categories and emphasising the structural determinants affecting unique population subgroups differently.

Methods

We mapped existing approaches to describing population differences in health. We also conducted a literature review on intersectionality scholarship in public health and then synthesised results to develop a conceptual framework for deploying intersectionality to epidemiology and PHMR.

Findings

We identified four key principles through which the reporting on subgroup differences could be strengthened: addressing the internal heterogeneity of population groups; contextualising inequities and focusing on societal power relations rather than individual characteristics; deploying novel multivariable modelling approaches in data analysis; and aiming towards the empowerment of population groups rather than deploying deficit-oriented and paternalistic models.

Discussion

To be discussed are the unique contributions of intersectionality to PHMR compared to other approaches, for example from social epidemiology or medical anthropology.

Suggestions for a gender-sensitive and intersectional practice of health monitoring and reporting

Background

Health reports summarize the evidence basis on disease burden and its causes and are intended to inform decisions of policy makers. By focusing on health needs of social groupings according to sex/gender or race/ethnicity, PHMR crucially contributes to achieving health equity. In order to realise its aims, PHMR relies on the availability of high-quality data, appropriate analysis methods and intuitive presentation of results.

Methods

The joint project AdvanceGender used mixed methods to translate principles of intersectionality into new methods for recruitment, data analysis and health reporting. A review of descriptions of representativeness in epidemiological studies was conducted to investigate how an intersectional perspective can inform recruitment. To evaluate intersectional and gender-sensitive data analysis, we reviewed and applied recently developed methods such as classification and regression tree analysis (CART) and multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA).

Findings

An intersectional perspective on representativeness unravelled that study participation of women and men might be differential according to further social categories such as civil status or educational level. CART analysis might help to identify intersectional groupings differing in health behaviours or outcomes by exploring a multitude of social dimensions without facing the risk of stereotyping with predefined categories. MAIHDA depicts an alternative method that is suited for descriptive analyses of health-related outcomes among intersectional strata. In contrast to analysing supposedly static features such as sex, a focus on solution-linked variables like social support might be a fertile ground to identify areas for public health action.

Discussion

Principles of intersectionality open up new perspectives for recruitment and data analysis that might be fruitful for population health research and ultimately for PHMR.

 

Greta Bauer

Schulich School of Medicine & Dentistry, Western University, London, Canada

Contact: gbauer@uwo.ca

Olena Hankivsky

University of Melbourne, Centre for Health Equity, Melbourne, Australia Institute for Intersectionality Research, School of Public Policy, Simon Fraser University, Burnaby, Canada

Contact: o.hankivsky@unimelb.edu.au

Nicole Rosenkötter

NRW Centre for Health, Division of Health Reporting, Bielefeld, Germany

Contact: Nicole.Rosenkoetter@lzg.nrw.de

An integral approach to sludge handling in a WWTP operated for EBPR aiming phosphorus recovery: Simulation of alternatives, LCA and LCC analyses

As phosphorus is a non-renewable resource mainly used to produce fertilizers and helps to provide food all over the world, the proper management of its reserves is a global concern since it is expected to become scarcer in the near future. In this work we assessed two different sludge line configurations aiming for P extraction and recovery before anaerobic digestion and compared them with the classical configuration. This study has been performed by simulation with the model BNRM2 integrated in the software package DESASS 7.1. Configuration 1 was based on the production of a PO₄-enriched stream from sludge via elutriation in the primary thickeners, while Configuration 2 was based on the WASSTRIP® process and its PO₄-enriched stream was mechanically obtained with dynamic thickeners. In both alternatives recovery was enhanced by promoting poly-phosphate (poly-P) extraction under anaerobic conditions, for which both configurations were fully evaluated in a full-scale WWTP. Both were also optimized to maximize phosphorus extraction. Their costs and life cycles were also analysed. The novelty of this research lies in the lack of literature about the integral evaluation of pre-anaerobic digestion P recovery from wastewaters. This study included a holistic approach and an optimization study of both alternatives plus their economic and environmental aspects. In Configuration 1, the PO₄-P load in the recovery stream reached 43.1% of the total influent P load and reduced uncontrolled P-precipitation in the sludge line up to 52.9%. In Configuration 2, extraction was 48.2% of the influent P load and it reduced precipitation by up to 60.0%. Despite Configuration 1's lower phosphorus recovery efficiency, it had a 23.0% lower life cycle cost and a 14.2% lower global warming impact per hm³ of treated influent than Configuration 2. Configuration 1 also reduced the TAEC by 17.6% and global warming impact by 2.0% less than Configuration 0.

Conceptual framework for intersectionality-based gender sensitivity in multivariable analysis

Background

Intersectionality-based gender sensitivity in multivariable analysis might advance simultaneous consideration of intersecting social positions and identities. Identification and implementation of quantitative statistical approaches that adequately operationalise the concept of intersectionality are currently scarce.

Methods

An intersectionality-based framework for evaluation of gender sensitivity in multivariable analysis and for future study design was developed. The framework comprises operationalisation of sex/gender, definition of solution-linked variables from a gender mainstreaming perspective, definition and function of intersectional variables and consideration of central gender theoretical concepts. For evaluation of current practice regarding sex/gender sensitivity in intersectionality-informed analyses, a scoping review within selected thematic fields relevant for heath reporting has been conducted.

Findings

Based on 16 identified intersectionality-informed studies, sex/gender shows to be exclusively operationalised as binary. Solution-linked variables from a gender mainstreaming perspective are rarely taken into account. Sex/gender and race/ethnicity are the only intersectional variables considered in almost all studies, predominantly for stratification or as part of interaction terms. Income, education and employment status as proxies for social position as well as age are mainly used for adjustment in multivariable analyses.

Conclusions

The framework allows for comparison of gender sensitivity in intersectionality-based multivariable analysis. The project AdvanceDataAnalysis at the Institute of Public Health and Nursing Research, University of Bremen, Germany, will contribute to the detection and analysis of complex interactions from an intersectionality perspective, including the consideration of gender theoretical concepts in multivariable analyses.

First-in-human phase 0 study of 111In-CHX-A"-DTPA trastuzumab for HER2 tumor imaging

Introduction:

Tumors over-expressing the human epithelial receptor 2 (HER2) or exhibiting amplification or mutation of its proto-oncogene have a poorer prognosis. Using trastuzumab and/or other HER2 targeted therapies can increase overall survival in patients with HER2(+) tumors making it critical to accurately identify patients who may benefit. We report on a Phase 0 study of the imaging agent, ¹¹¹In-CHX-A”-DTPA trastuzumab, in patients with known HER2 status to evaluate its safety and biodistribution and to obtain preliminary data regarding its ability to provide an accurate, whole-body, non-invasive means to determine HER2 status.

Methods:

¹¹¹In-CHX-A”-DTPA trastuzumab was radiolabeled on-site and slowly infused into 11 patients who underwent single (n=5) or multiple (n=6) ɣ-camera (n=6) and/or SPECT (n=8) imaging sessions.

Results:

No safety issues were identified. Visual and semi-quantitative imaging data were concordant with tissue HER2 expression profiling in all but 1 patient. The biodistribution showed intense peak liver activity at the initial imaging timepoint (3.3h) and a single-phase clearance fit of the average time-activity curve (TAC) estimated t_1/2=46.9h (R²=0.97; 95%CI 41.8 to 53h). This was followed by high gastrointestinal (GI) tract activity peaking by 52h. Linear regression predicted GI clearance by 201.2h (R² =0.96; 95%CI 188.5 to 216.9h). Blood pool had lower activity with its maximum on the initial images. Non-linear regression fit projected a t_1/2=34.2h (R² =0.96; 95%CI 25.3 to 46.3h). Assuming linear whole-body clearance, linear regression projected complete elimination (x-intercept) at 256.5hr (R²=0.96; 95%CI 186.1 to 489.2h).

Conclusion:

¹¹¹In-CHX-A”-DTPA trastuzumab can be safely imaged in humans. The biodistribution allowed for visual and semiquantitative analysis with results concordant with tissue expression profiling in 10 of 11 patients. Advances in Knowledge and Implications for Patient Care Using readily available components and on-site radiolabeling ¹¹¹In-CHX-A”-DTPA trastuzumab SPECT imaging may provide an economical, non-invasive means to detect HER2 over-expression.

Effect of electric field on the performance of soil electro-bioremediation with a periodic polarity reversal strategy

In this work, it is studied the effect of the electric fields (within the range 0.0-1.5 V cm(-1)) on the performance of electrobioremediation with polarity reversal, using a bench scale plant with diesel-spiked kaolinite with 14-d long tests. Results obtained show that the periodic changes in the polarity of the electric field results in a more efficient treatment as compared with the single electro-bioremediation process, and it does not require the addition of a buffer to keep the pH within a suitable range. The soil heating was not very important and it did not cause a change in the temperature of the soil up to values incompatible with the life of microorganisms. Low values of water transported by the electro-osmosis process were attained with this strategy. After only 14 d of treatment, by using the highest electric field studied in this work (1.5 V cm(-1)), up to 35.40% of the diesel added at the beginning of the test was removed, value much higher than the 10.5% obtained by the single bioremediation technology in the same period.

Abstract P4-01-09: 18F-FLT-PET/CT for the prediction of response to ANG-1005 therapy in patients with brain metastases from breast cancer

Background: ANG1005 (formerly called GRN1005) is a peptide-drug conjugate being developed for targeted treatment of brain metastases. It consists of 3 molecules of paclitaxel covalently linked to Angiopep-2 designed to cross the blood brain barrier (BBB) via the low density lipoprotein (LDL) receptor-related protein-1 (LRP1)-mediated trancytosis. This drug was evaluated in a multi-center, open-label single-arm study (GRABMB study). An interim analysis determined that the agent met the futility endpoint based on MRI assessment (SABC 2012). However, centrally confirmed responses were achieved in the study, and a biomarker substudy enrolling patients (pts) to evaluate the utility of FLT-PET in assessing response to treatment with ANG1005 suggested sufficient activity of the agent to allow continuation of the study. 18F-FLT (3’-Fluoro-3’ deoxythymidine)-PET imaging is a novel imaging modality which provides a tool for measuring in vivo tumor cell proliferation. FLT is an analog of thymidine; cellular retention of FLT reflects DNA synthesis.

Methods: Adult pts with measurable BMBC were eligible with or without history of prior WBRT. We compared 18F-FLT-PET/CT with MRI-gadolinium contrast images for brain metastases detection and for assessment of whether treatment with ANG1005 was associated with significant change in intracranial tumor uptake of 18F-FLT.

ANG1005 therapy was administered intravenously at 550 mg/m2 q 21d until progression of intra-cranial disease or unacceptable toxicity. All pts underwent 18F-FLT PET/CT imaging before and after 1 cycle of therapy with ANG1005. Pts were scanned dynamically over 30 min followed by a static whole body PET image at 1 hour post-injection. We calculated the% of change before and after therapy, with change &gt; 20% considered significant.

Results: 5/10 planned pts have been accrued to the substudy to date, and 12 metastatic brain lesions have been analyzed. The maximum standard uptake value (SUVmax) ranged from 0.8 to 4.0, mean 1.8 for baseline scans. Tumor to normal brain background ratios ranged from 3.2 to 22.3, mean 9.4. 7/12 lesions showed &gt;20% change between pre and post therapy. The average% change was (-) 42.39% ± 12.77, range: 29.2 to 66.8% (using SUVmax), and (-) 38.7% ± 14.3, range: 20.12 to 57.10% (using tumor to normal ratios). Based on brain MRI evaluation per RECIST 1.1 criteria, 1 pt had intra-cranial partial response (PR) and 3 patients had stable disease (SD). These pts remained on therapy for an average of 7 cycles, range: 5 to 9 cycles. 1 pt withdrew consent after 2 cycles of therapy and opted to receive whole brain radiation therapy. 5/42 pts achieved a confirmed investigator-assessed PR by MRI at 550 mg/m2, and 4/13 pts achieved a PR at 650 mg/m2, a dose not progressed due to toxicity.

Conclusion: This pilot study using 18F-FLT-PET imaging of brain metastases suggests that it is a promising tool for detection and measurement of CNS disease. Given that contrast-enhanced MRI detection of brain metastases represent gadolinium leakage through the BBB rather than actual tumor volume measurements, better approaches are needed to assess efficacy of therapies. Accrual to this study is ongoing. Updated results with ANG1005 will be presented during the meeting.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-01-09.

Functional and molecular imaging: applications for diagnosis and staging of localised prostate cancer

Prostate cancer is currently the most common solid organ cancer type among men in the Western world. Currently, all decision-making algorithms and nomograms rely on demographics, clinicopathological data and symptoms. Such an approach can easily miss significant cancers while detecting many insignificant cancers. In this review, novel functional and molecular imaging techniques used in the diagnosis and staging of localised prostate cancer and their effect on treatment decisions are discussed.

Parastomal hernia repair: laparoscopic ventral hernia meshplasty with stoma relocation. The current state and a clinical case presentation

BACKGROUND

Parastomal hernia is a frequent complication after performing an ostomy, and although different technical options have been described, it lacks an ideal intervention to resolve it. The use of meshes and the laparoscopic approach, has led to a significant advance in resolving this condition. However, the ideal technique should guarantee must ensure integral repair of the abdominal wall, taking into account the functionality of the stoma. In large parastomal eventrations the repairing of the ventral hernia with a mesh and relocating the stoma in another quadrant may be an intervention that fulfills both principles, and open approach being described.

METHODS

We review the current state of surgical management of this condition and analyze the different technical options. Present the first description for using a laparoscopic technique with meshplasty and stoma relocation in an obese patient with a complex parastomal hernia, with results in the 18 month follow up.

CONCLUSIONS

Surgical technique repair of the parastomal hernia is sometimes a complex issue, which possibly requires different solutions according to the characteristics of the hernia and patient. The technique described of meshplasty with stoma relocation by laparoscopic approach has been revealed as an affordable technique, with minor inconvenience to the patient, absence of complications and good functional results in the long term, benefiting from the advantages of minimally invasive surgery itself.

[Giant cell tumor of the tendon sheath: characteristic findings of the bone scintigraphy and correlation with MRI]

We report 3 cases of an unusual tumor, that is, the giant cell tumor of the tendon sheath. The patients consulted due to the appearance of a well-defined, painless, soft tissue mass with mild-to-moderate inflammation located in the thumbs or toes. These clinical data, together with the bone scan findings, oriented the diagnostic suspicion that was confirmed by a pathology study of the tumor after resection. This work has aimed to review the characteristics of the bone scan (BS) image of this tumor and its correlation with the conventional X-ray imaging and magnetic resonance imaging (MRI).

[Latin-American Dialysis and Kidney Transplantation Registry: data on the treatment of end-stage renal disease in Latin America]

Latin America, a region composed of a series of neighboring countries that share their history, Latin ancestry and language (Spanish or Portuguese), includes Mexico, Central America, the Spanish Caribbean islands, and South America. The Latin-American Dialysis and Kidney Transplantation Registry, which has been operative since 1991, collects data from 20 countries (Argentina, Brazil, Bolivia, Chile, Colombia, Costa Rica, Cuba, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Puerto Rico, Dominican Republic, Venezuela and Uruguay), where 97% of Latin Americans live. The prevalence of renal replacement therapy (RRT) has increased from 119 patients per million (pmp) in 1991 to 478.2 in 2005 (147,158 patients [57%] on chronic hemodialysis, 58,251 [23%] on peritoneal dialysis and 52,565 [20%] living with a functioning kidney graft). The incidence rate also increased from 27.8 pmp in 1992 to 167 in 2005. The increment in prevalence and incidence occurred in all Latin- American countries. The transplantation rate increased from 3,7 pmp in 1987 to 15 pmp in 2005 (7,968 kidney transplants performed this year, the cumulative number being 98,415). Access to RRT was available for every patient diagnosed with end-stage renal disease only in Argentina, Brazil, Chile, Cuba, Puerto Rico, Venezuela and Uruguay. In Latin America, the incidence and prevalence of RRT increased year by year. Only in some countries is access to RRT available to 100% of diagnosed patients. Detection and prevention programs for chronic kidney disease are needed in the region. Meanwhile, access to RRT has to be improved for everybody who needs it.

Prospective control trial of cancer ultrastaging in the left colon with sentinel lymph node

14547

Background: The use of the sentinel node lymph (SNL) in connection with colorectal cancer is a subject in which there has been some controversy. Methods: Prospective control trial of 60 patients with left colon cancer stage II. Methylene Blue® or Nanocoll® had been used to identify the SNL. The standard pathologic examination with hematoxylin and eosin (H&E) had been compared with the study of SNL with H&E and Cytokeratine CAM 5.2. Results: Identification of the SNL: 100%, 2.4 SNL detected in each patient. Nodal disease (N+) was found in 19 patients (31.7%), and 41 patients (68.3%) were classified as node-negative (N0). Hidden micrometastasis in the SNL were found in 9.7% (4/41) patients considered as N0 by conventional histopathology. However, in 17.7% (7/41) patients considered as N0 we found large cell clusters, contatining up to 10 tumor cells, falling short of the AJCC on cancer criteria, and were considered to have high- risk disease. Having applied both the SNL study and the standard pathologic examination the number of patients N+ has increased to 38.3% (23 patients), ultrastaging: 6.6% (p= ns). If the patients with large cell clusters in the SNL had been considered as N+ the number of N+ patients would have increased to 50%(30 patients), ultrastaging 18,3%(p=0,001). Conclusions: The combined nodal study (H&E + SNL) increased 6.6% the staging in our group, and it let to identify a group of patietnts N0 with high-risk tumor progression. If the large cell clusters in the SNL were considered as micrometastases disease the ultrastaging would have been 18.3%.The implications of large cell clusters prognosis is yet, unknown.

No significant financial relationships to disclose.

[Evaluation of renal lesions using 99mTc-DMSA in children with urinary tract infection and the relation with vesicoureteral reflux]

OBJECTIVE

Paediatric patients with urinary tract infection (UTI) have risk of developing renal scarrings. Although it is known that vesicoureteral reflux (VUR) predisposes to UTIs and it seems to have an important role in the development of renal lesions, some recent published studies question that relation. The aim of the study was to evaluate renal scarring by using renal scintigraphy 99mTc-DMSA and see the relation with or without the presence of VUR.

MATERIAL AND METHODS

We evaluated retrospectively a total of 230 patients (460 renal units), mean age: 11 months (range: 12d-5y), with UTI probed by urinoculture. All were studied with voiding cistourethrography (MCU) to evaluate the presence or absence of VUR. Patients were evaluated with 99mTc-DMSA scan 6 months after UTI to determine if UTI caused renal scarring.

RESULTS

Renal scans with 99mTc-DMSA 6 months post-infection were abnormal in 62 renal units, affecting 54 patients (23 %). From all patients studied, 110 were diagnosis of VUR being affected 161 renal units, 43 of them (27 %) presented renal scarrings. From the remaining 120 patients without VUR that is 240 renal units, 19 of them (8 %) presented parenchymatous damage.

CONCLUSION

Renal scarring resulting from UTI are in some cases related to VUR, but sometimes are caused by the infection itself. Not all patients with VUR develop renal lesions, and neither the presence of VUR always predispose children to renal lesions. MCU and direct isotopic cystography are useful for diagnosis of VUR but we shouldn't avoid 99mTc-DMSA scan in the management of children with UTI.

Influence of the stabilisation of organic materials on their biopesticide effect in soils

Some organic materials have shown a suppressive effect on several diseases induced by soilborne plant pathogens. We have carried out a laboratory experiment (microcosm) to ascertain the influence of the stabilisation process of sewage sludge on it biopesticide effect when Pythium ultimum or Phytophthora sp. were introduced to soil as pathogens for pea or pepper. When P. ultimum was introduced there was a 63.8% reduction in the weight of the stems grown in the control, 47.6% in the presence of sewage sludge, but only 24.7% with compost. The same biopesticide effect was evident from the weight of the roots. The biopesticide effect was also strong when compost was used as organic amendment in the presence of Phytophthora, as could be seen from stem and shoot weight and length. The data showed that the degree of stabilisation of the organic material (compost) had a positive influence on it biopesticide effect. The changes undergone by a soil after the addition of organic materials helped to explain the biopesticide effect of the amendment. The organic treatments reduced P. ultimum and Phytophthora sp. populations.

DMSA study performed during febrile urinary tract infection: a predictor of patient outcome?

Technetium-99m dimercaptosuccinic acid (DMSA) study has been advocated as a method for the assessment of renal sequelae after acute febrile urinary tract infection (UTI). However, it is not known whether DMSA scintigraphy performed during acute UTI has any prognostic value for outcome assessment. The objective of this study was to evaluate the usefulness of DMSA scintigraphy performed during UTI as a predictor of patient outcome, to identify children at risk of events [vesico-ureteral reflux (VUR) or recurrent UTI] that may lead to the development of progressive renal damage. One hundred and fifty-two children (including 78 girls) with a mean age of 20 months (range 1 month to 12 years) with first febrile UTI were evaluated by DMSA scintigraphy during acute UTI. After acute UTI, children were explored by voiding cysto-urethrography. Children who presented an abnormal DMSA study, or a normal DMSA study but VUR or recurrent UTI, underwent a DMSA control study 6 months after UTI. Children with VUR were followed up by direct radionuclide cystography. DMSA scintigraphy performed during acute UTI was normal in 112 children (74%). In 95 of these children, follow-up DMSA scintigraphy was not performed owing to a good clinical outcome. In the remaining 17 children, follow-up scintigraphy was normal. Forty children (26%) presented abnormal DMSA study during acute UTI. Twenty-five of them presented a normal follow-up DMSA, and 15 presented cortical lesions. Children with abnormal DMSA had a higher frequency of VUR than children with normal DMSA (48% vs 12%). It is concluded that children with normal DMSA during acute UTI have a low risk of renal damage. Children with normal follow-up DMSA and low-grade VUR have more frequent spontaneous resolution of VUR.

Translocation of Enterococcus in jaundiced and anergic rats

Background

Translocation of bacteria from the gut to other organs is one cause of systemic complications in obstructive jaundice. Furthermore, hyperbilirubinaemia appears to cause anergy. This study investigated whether these responses (translocation of gut bacteria and anergy) increase the postoperative mortality rate in rats in which obstructive jaundice is induced surgically by ligature of the bile duct.

Methods

Some 88 male Wistar rats were divided into six groups. All rats except those in group 1 received gentamicin by the oral route (0·7 mg in 1 ml water, daily for 6 days) to ensure intestinal decontamination. On day 7, all rats except those in groups 1 and 2, which had vehicle only, received Enterococcus. Statistical analysis was by Student's test and Fishers's exact test.

All animals underwent standard blood testing, delayed hypersensitivity tests, haematimetry and serum endotoxin determinations. Flow cytometry was used to count CD3-, CD4- and CD8-positive lymphocytes. On the day 5 after surgery, these assays were repeated and, in addition, the rats were killed for microbiological analysis of gut and viscera contents (liver, spleen, mesentery and lung).

Results

Five days after surgery, mean bilirubin levels in groups 5 and 6 were greater than 14 mg dl−1. In addition, all rats in groups 5 and 6 showed absence of the delayed hypersensitivity response, indicating anergy. Lymphocyte counts in each group are shown in the Table.

The mean proportion of CD8-positive lymphocytes in rats that had received Enterococcus (groups 3–6) was 16 per cent compared with 25 per cent in groups 1 and 2 (P &lt; 0·05). The mean percentage of CD3-positive lymphocytes in groups 5 and 6 was 51 per cent, but 71 per cent in all other groups (P &lt; 0·05). Likewise, the mean percentage of CD4-positive lymphocytes in groups 5 and 6 was 32 per cent, but 47 per cent in all other groups (P &lt; 0·05). The postoperative mortality rate in group 4 (17 per cent) was significantly lower than that in the obstructive jaundice groups 5 and 6 (62 per cent) (P &lt; 0·01). Post-mortem microbiological analyses revealed translocation of Enterococcus only in groups 5 (80 per cent) and 6 (70 per cent). Enterococci were most frequently present in the mesentery (80 and 70 per cent respectively), followed by the liver (40 and 40 per cent), spleen (20 and 20 per cent) and lungs (10 and 10 per cent).

Conclusion

(1) Obstructive jaundice in rats leads to immunological alterations including anergy. (2) Obstructive jaundice in rats favours translocation of enterococci from the gut to other organs. (3) The postoperative mortality rate in jaundiced rats was much higher than that in sham-operated rats.

Expression of costimulatory molecules on peripheral blood mononuclear cells in multiple sclerosis

OBJECTIVE

To determine whether there was aberrant expression of costimulatory molecules and their receptors on peripheral blood mononuclear cells of MS patients and healthy individuals and whether expression correlated with disease status.

METHODS

Forty-six patients with MS and 29 healthy individuals were analyzed by direct 2-color immunofluorescence flow cytometry for expression of CD80, CD86, CD28 and CTLA-4 on T and B cells and monocytes.

RESULTS

Expression of CD80 on CD4+ T cells was upregulated in progressing MS patients compared to stable MS patients and controls. Marked increase in the expression of CD80 and CD86 was seen on both CD4+ and CD8+ T cells from an MS patient with rapidly progressing disease. No difference in the expression of the costimulatory molecules or their ligands was seen between IFN-beta treated and non-treated MS patients.

CONCLUSIONS

Aberrant expression of costimulatory molecules occurs on T lymphocytes in MS patients with progressing disease.

Preservation of surface-dependent properties of viral antigens following immobilization on particulate ceramic delivery vehicles

B-cell stimulation for the purpose of evoking an effective neutralizing humoral immune response is a surface phenomenon that is exquisitely specific to antigen conformation. Consequently, successful delivery of antigen, such as would be desired in a vaccine, entails preservation of an antigen's apparent native surface (conformational) properties. Prior to testing the actual vaccinating efficacy of delivered antigens, the surface properties could be assessed through a variety of in vitro and in vivo assays in which the measurement standard would be the properties of the antigens in their native state (whole virus). Using surface modified nanocrystalline carbon and calcium-phosphate ceramic particulates (carbon ceramics and brushite), we evaluated the surface activity of immobilized non-nuclear material extracted from HIV-1. Physical characterization showed that the particles with immobilized antigen ("HIV decoys") measured 50 nm in diameter (HIV = 50-100 nm) and exhibited the same zeta potentials as whole (live) HIV. In vitro testing showed that the HIV decoys were recognized by both conformationally nonspecific and specific monoclonal antibodies, were recognized by human IgG from HIV antibody-positive patients, and could promote surface agglomeration among malignant T-cells similar to live HIV. Last, in vivo testing in three vaccinated animal species showed that the HIV decoys elicited humoral and cellular immune responses similar to that evoked by whole (live) HIV.

Evaluation of Port-A-Cul transport system for protection of anaerobic bacteria

The protection of anaerobes in Port-A-Cul (PAC) transport system (Bioquest, Div. of Becton, Dickinson &Co., Cockeysville, Md.) tubes and vials was studied. Ten species of obligately anaerobic bacteria commonly isolated from clinical specimens were used to prepare simulated swab and fluid specimens in high and low concentrations. Samples in PAC tubes and vials were held for 2, 24, and 48 h at ambient temperature and in a refrigerator. In addition, samples of the simulated specimens were exposed to controlled anaerobic and aerobic conditions in vented tubes and vials, with and without PAC medium, at ambient and refrigerator temperatures. Viable bacterial colony counts from specimens in PAC tubes and vials used as recommended by the manufacturer were consistently greater than those from specimens exposed to the different controlled conditions. The protection in PAC was about equal for specimens with either high or low concentrations of bacteria. Protection of the anaerobes in PAC was more obvious with swab than with fluid specimens. Quantitative recovery of anaerobes from refrigerated PAC samples, with few exceptions, was comparable to that from PAC samples held at ambient temperature.

Calcitonin treatment in hereditary bone dysplasia with hyperphosphatasemia: a radiographic and histologic study of bone

Two children with bone dysplasia with hyperphosphatasemia (juvenile Paget's disease) were treated with synthetic human calcitonin. The progress of bone disease was monitored radiographically and histologically. Pretreatment radiographs showed markedly abnormal bone, characterized by lack of discrete cortex and absence of normal modeling. During treatment a discrete cortex was formed composed of compact bone, and more normal modeling occurred. This coincided with a histologic change from woven bone before treatment to a more lamellar type during treatment.

Hereditary bone dysplasia with hyperphosphatasaemia: response to synthetic human calcitonin

Four cases of familial bone dysplasia with hyperphosphatasaemia were treated with synthetic human calcitonin. Prior to therapy, all four cases were characterized by marked bone deformity, pain, tenderness and elevated levels of serum alkaline phosphatase and urinary hydroxyproline. Treatment with calcitonin produced in each case a striking clinical, biochemical and radiographic remission. Pain and tenderness was greatly diminished and urinary hydroxyproline and serum alkaline phosphatase levels were significantly decreased. Radiographic regression of the bony abnormalities was apparent as early as 4 1/2 months after the start of treatment. Prior to therapy bones exhibit no real organization. After calcitonin treatment, the radiographic appearance of a normal cortex and medullary cavity was clearly evident for the first time.