Late Urinary Toxicity and QoL with Curative Radiotherapy for High-Risk Prostate Cancer: Dose-Effect Relations in the POP-RT Randomized Phase III Trial

PURPOSE/OBJECTIVE(S)

Whole pelvic radiotherapy (WPRT) showed better biochemical failure-free survival and metastasis-free survival than prostate-only radiotherapy (PORT) in the phase III randomized POP-RT trial for high and very high-risk prostate cancer, albeit with higher RTOG grade 2 late urinary toxicity. We report updated long term, symptom-wise comparison and dose-effect relations from this trial.

MATERIALS/METHODS

Late urinary toxicity, and cumulative severity of each symptom over the follow-up period was graded using CTCAE v5.0. Grade 2+ toxicities were compared between the trial arms by chi square test. Bladder dosimetry in 5-Gy increments (V5, V10, V15...V65 Gy, V68 Gy) from the trial database of approved radiotherapy plans, was compared for each urinary symptom and overall late gr2+ toxicity by student t-test. Observed differences in dosimetric parameters were tested using multivariable logistic regression analysis, including age at diagnosis, known diabetes, tumor stage, trial arm, and prior transurethral resection of prostate (TURP). Urinary QOL scores were compared between arms using generalised linear mixed model.

RESULTS

Combined late symptom-wise toxicity and dose-volume data were available for analysis for 193/224 patients. At a median follow-up of 75 months, cumulative CTCAE gr2+ late urinary toxicity remained higher with WPRT than PORT, though not statistically significant (36.5% vs 26.8%, p = 0.15). Grade 3 toxicity was low and similar in both arms. Symptom-wise cumulative rates showed no significant difference between arms (Table 1). Dosimetric comparison showed significantly higher bladder V5-V15 in patients with gr2+ toxicity over those with

CONCLUSION

Compared to prostate-only radiotherapy, whole pelvic radiotherapy resulted similar Grade 3 urinary toxicity of about 5% with about 10% higher cumulative grade 2+ urinary toxicity over long term follow up. This difference was not reflected in patient-reported QOL. WPRT particularly increased urgency and hematuria. Larger bladder volume being irradiated with 5Gy to 15Gy dose range could contribute to increase in urinary symptoms.

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Affiliation(s)

G Maheshwari Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
P Maitre Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
J Sarkar Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
V Raveendran Department of Medical Physics, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
R Phurailatpam Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
P Singh Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
V Murthy Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India

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Epidemiological Profile of a Human Hepatitis E Virus Outbreak in 2018, Chattogram, Bangladesh

Hepatitis E virus (HEV) is a waterborne zoonotic disease that can result in a high fatality rate in pregnant women and infants. In 2018, a large HEV outbreak emerged in Chattogram, Bangladesh, resulting in 2800 cases and a significant public health response to mitigate the transmission. While the source of the outbreak remained poorly understood, authorities suggested that possible risk factors for HEV infection included contamination of water supply, exacerbated by concurrent severe flooding events in the community. A cross-sectional study was conducted to investigate the distribution and risk factors for HEV seroprevalence between January and December 2018 in the Chattogram city area. A total of 505 blood samples were collected from symptomatic patients of 10 hospitals who met the case definition for an HEV infection. Standard ELISA tests were performed in all patients to identify anti-HEV antibodies. The size and location of HEV seroprevalence clusters within Chattogram were investigated using SaTScan. We investigated the association between risk of HEV infection and individual and environmentally lagged risk factors using Bernoulli generalised linear regression models. Our results indicate an overall HEV seroprevalence of 35% with significant variation according to sex, source of drinking water, and boiling of drinking water. A positive cross-correlation was found between HEV exposure and precipitation, modified normalised difference water index (MNDWI), and normalised difference vegetation index (NDVI). Our model indicated that risk of infection was associated with sex, age, source of drinking water, boiling of water, increased precipitation, and increased MNDWI. The results from this study indicate that source and boiling of drinking water and increased precipitation were critical drivers of the 2018 HEV outbreak. The communities at highest risk identified in our analyses should be targeted for investments in safe water infrastructure to reduce the likelihood of future HEV outbreaks in Chattogram.

NeuroBlu: a natural language processing (NLP) electronic health record (EHR) data analytic tool to generate real-world evidence in mental healthcare

Introduction

EHRs contain a rich source of real-world data that can support evidence generation to better understand mental disorders and improve treatment outcomes. However, EHR datasets are complex and include unstructured free text data that are time consuming to manually review and analyse. We present NeuroBlu, a secure, cloud-based analytic tool that includes bespoke NLP software to enable users to analyse large volumes of EHR data to generate real-world evidence in mental healthcare.

Objectives

(i) To assemble a large mental health EHR dataset in a secure, cloud-based environment.

(ii) To apply NLP software to extract data on clinical features as part of the Mental State Examination (MSE).

(iii) To analyse the distribution of NLP-derived MSE features by psychiatric diagnosis.

Methods

EHR data from 25 U.S. mental healthcare providers were de-identified and transformed into a common data model. NLP models were developed to extract 241 MSE features using a deep learning, long short-term memory (LSTM) approach. The NeuroBlu tool (https://www.neuroblu.ai/) was used to analyse the associations of MSE features in 543,849 patients.

Results

The figure below illustrates the percentage of patients in each diagnostic category with at least one recorded MSE feature.

Conclusions

Delusions and hallucinations were more likely to be recorded in people with schizophrenia and schizoaffective disorder, and cognitive features were more likely to be recorded in people with dementia. However, mood symptoms were frequently recorded across all diagnoses illustrating their importance as a transdiagnostic clinical feature. NLP-derived clinical information could enhance the potential of EHR data to generate real-world evidence in mental healthcare.

Disclosure

This study was funded in full by Holmusk.

Precision Oncology With Radiogenomics: Non-invasive Interrogation of Liver Cancer Genomics to Select Drug Therapy and Monitor Patient Response

Background: Significant intratumoral heterogeneity is present in hepatocellular carcinoma (HCC) and single biopsy samples severely underread the genomic profile of the tumor. This confounds drug development in HCC and makes it extremely challenging to stratify and prognosticate patients to select therapy on the basis of genomic biomarkers. Multiregion sampling of surgically resected HCC allows for these intratumoral heterogeneity to be unraveled and this is currently carried out in our prospective PLANET (Precision Medicine in Liver Cancer across an Asia-Pacific Network) program. However, multiregion sampling is not practical in unresectable HCC cases, which comprise 80% of the disease burden. Radiogenomics studies on liver, lung and head-and-neck cancers have established the capability of radiomics analysis in capturing intratumor heterogeneity with the identification of radiomics signatures that are representative of underlying gene expression patterns. Aim: On this basis, our PLANET program has adopted a radiogenomics approach to characterize the intratumoral heterogeneity in HCC. Methods: This approach will leverage on the correlation of distinctive imaging traits in CT scans against the gene expression profiles of surgically resected HCC patients. Our PLANET program and the data-science enterprise Holmusk have embarked on close collaborative efforts to develop an algorithm that characterizes intratumoral heterogeneity based on distinctive traits in the CT scans. Results and conclusion: The development of such an algorithm is potentially ground-breaking as it allows for the noninvasive interrogation of liver cancer genomics and prognostication of HCC patients. This allows the easy screening of patients for therapeutic targets in vivo and will significantly improve the selection of drug therapy and monitoring of therapeutic response in HCC.

Passive acoustic tracking using a library of nearby sources of opportunity

A method of localizing unknown acoustic sources using data derived replicas from ships of opportunity has been reported previously by Verlinden, Sarkar, Hodgkiss, Kuperman, and Sabra [J. Acoust. Soc. Am, 138(1), EL54-EL59 (2015)]. The method is similar to traditional matched field processing, but differs in that data-derived measured replicas are used in place of modeled replicas and, in order to account for differing source spectra between library and target vessels, cross-correlation functions are compared instead of comparing acoustic signals directly. The method is capable of localizing sources in positions where data derived replicas are available, such as locations previously transited by ships tracked using the Automatic Identification System, but is limited by the sparsity of ships of opportunity. This paper presents an extension of this localization method to regions where data derived replicas are not available by extrapolating the measured cross-correlation function replicas onto a larger search grid using waveguide invariant theory. This new augmentation provides a method for continuous tracking.

Determination of acoustic waveguide invariant using ships as sources of opportunity in a shallow water marine environment

The waveguide invariant (WGI) is a property that can be used to localize acoustic radiators and extract information about the environment. Here the WGI is determined using ships as sources of opportunity, tracked using the Automatic Identification System (AIS). The relationship between range, acoustic intensity, and frequency for a ship in a known position is used to determine the WGI parameter β. These β values are interpolated and a map of β is generated. The method is demonstrated using data collected in a field experiment on a single hydrophone in a shallow water environment off the coast of Southern California.

Toward ocean attenuation tomography: Determining acoustic volume attenuation coefficients in seawater using eigenray amplitudes

A deep-water experiment in the Pacific made in situ measurements of the volume attenuation coefficients of sea water in the mid-frequency range. The frequency, temperature, salinity, pH, and pressure dependent seawater attenuation coefficients were determined using a vertical line array that received and identified over 2000 unique paths from 1200 mid-frequency 3-9 kHz LFM source transmissions at a convergence zone range and depth up to 400 m. The results show no change in attenuation coefficients in this band compared to estimates from 30-year-old models previously determined from a combination of long-range ocean acoustic and laboratory experiments. The inversion also explores the feasibility of ocean acoustic attenuation tomography to further separate the depth-dependent chemical components responsible for the total attenuation loss through by isolating a group of deep-water refracting acoustic paths.

Thermo-responsive polymer aided spheroid culture in cryogel based platform for high throughput drug screening

A versatile and widely applicable cryogel-based high throughput platform for spheroid culture in the presence of a thermo-responsive polymer and drug screening.

α-Solanine induces ROS-mediated autophagy through activation of endoplasmic reticulum stress and inhibition of Akt/mTOR pathway

α-Solanine is a glycoalkaloid found in species of the nightshade family including potato. It was primarily reported to have toxic effects in humans. However, there is a growing body of literature demonstrating in vitro and in vivo anticancer activity of α-solanine. Most of these studies have shown activation of apoptosis as the underlying mechanism in antitumor activity of α-solanine. In this study, we report α-solanine as a potential inducer of autophagy, which may act synergistically or in parallel with apoptosis to exert its cytotoxic effect. Induction of autophagy was demonstrated by several assays including electron microscopy, immunoblotting of autophagy markers and immunofluorescence for LC3 (microtubule-associated protein 1 (MAP1) light chain-3) puncta. α-Solanine-induced autophagic flux was demonstrated by additionally enhanced – turnover of LC3-II and – accumulation of LC3-specific puncta after co-incubation of cells with either of the autophagolysosome inhibitors – chloroquine and – bafilomycin A1. We also demonstrated α-solanine-induced oxidative damage in regulating autophagy where pre-incubation of cells with reactive oxygen species (ROS) scavenger resulted in suppression of CM-H₂DCFDA (5 (and 6)-chloromethyl-2′,7′-dichlorodihydrofluorescein diacetate acetyl ester) fluorescence as well as decrease in LC3-II turnover. α-Solanine treatment caused an increase in the expression of endoplasmic reticulum (ER) stress proteins (BiP, activating transcription factor 6 (ATF6), X-box-binding protein 1, PERK, inositol-requiring transmembrane kinase/endonuclease 1, ATF4 and CCAAT-enhancer-binding protein (C/EBP)-homologous protein) suggesting activation of unfolded protein response pathway. Moreover, we found downregulation of phosphorylated Akt (Thr³⁰⁸ and Ser⁴⁷³), mammalian target of rapamycin (mTOR; Ser²⁴⁴⁸ and Ser²⁴⁸¹) and 4E-BP1 (Thr^37/46) by α-solanine implying suppression of the Akt/mTOR pathway. Collectively, our results signify that α-solanine induces autophagy to exert anti-proliferative activity by triggering ER stress and inhibiting Akt/mTOR signaling pathway.

Passive acoustic source localization using sources of opportunity

The feasibility of using data derived replicas from ships of opportunity for implementing matched field processing is demonstrated. The Automatic Identification System (AIS) is used to provide the library coordinates for the replica library and a correlation based processing procedure is used to overcome the impediment that the replica library is constructed from sources with different spectra and will further be used to locate another source with its own unique spectral structure. The method is illustrated with simulation and then verified using acoustic data from a 2009 experiment for which AIS information was retrieved from the United States Coast Guard Navigation Center Nationwide AIS database.

Long-term benefits of full-day kindergarten: a longitudinal population-based study

In the first longitudinal, population-based study of full-day kindergarten (FDK) outcomes beyond primary school in Canada, we used linked administrative data to follow 15 kindergarten cohorts (n ranging from 112 to 736) up to grade 9. Provincial assessments conducted in grades 3, 7, and 8 and course marks and credits earned in grade 9 were compared between FDK and half-day kindergarten (HDK) students in both targeted and universal FDK programmes. Propensity score matched cohort and stepped-wedge designs allowed for stronger causal inferences than previous research on FDK. We found limited long-term benefits of FDK, specific to the type of programme, outcomes examined, and subpopulations. FDK programmes targeted at low-income areas showed long-term improvements in numeracy for lower income girls. Our results suggest that expectations for wide-ranging long-term academic benefits of FDK are unwarranted.

The Treponema denticola AtcR LytTR domain-containing response regulator interacts with three architecturally distinct promoter elements: implications for understanding the molecular signaling mechanisms that drive the progression of periodontal disease

Treponema denticola is an oral spirochete and periopathogen that transitions from low abundance in healthy subgingival crevices to high abundance in periodontal pockets. The T. denticola response regulator AtcR harbors the relatively rare, LytTR DNA-binding domain. LytTR domain containing response regulators control critical transcriptional responses required for environmental adaptation. Using a multi-step bioinformatics approach, 26 strong lytTR recognition motifs were identified in the genome of T. denticola strain 35405. Electrophoretic mobility shift assays demonstrated that AtcR binds to these recognition motifs. High specificity-high affinity complexes formed with phosphorylated AtcR. The LytTR recognition sequences were found to exist in three distinct promoter architectures designated as LytTR1, LytTR2 and LytTR3 promoters. LytTR1 and LytTR2 promoters harbor σ(54) binding sites. The functional diversity of the proteins encoded by the putative AtcR regulon suggests that AtcR sits at the top of a regulatory cascade that plays a central role in facilitating T. denticola's ability to adapt to changing environmental conditions and thrive in periodontal pockets.

Detection of subclinical peste des petits ruminants virus infection in experimental cattle

The present study was undertaken to investigate the possible involvement of cattle in the epidemiology of peste des petits ruminants (PPR) as subclinical carriers. Cattle were exposed experimentally to PPR virus (PPRV) infection or placed in contact with PPR infected goats. Clinical samples including heparinized/EDTA blood, plasma, peripheral blood monocyte cells (PBMCs) and clotted blood (for serum) were collected periodically from 21 days post infection (dpi) to 397 dpi (21, 45, 50, 57, 65, 95, 111, 119, 148, 190, 203 and 397 dpi) and tested for PPRV antigen, nucleic acid and antibody. Exposed cattle seroconverted and maintained PPRV specific haemagglutinin antibodies and detectable PPRV antigen/nucleic acid in blood, plasma and PBMCs from 21 to 397 dpi. PPRV was recovered from blood and PBMC collected from experimental animals at 21 dpi, initially in B95a cells and then adapted to Vero cells. The study indicated that PPRV can infect cattle subclinically and PPRV antigen/nucleic acid persist in cattle for at least 397 days.

Synthesis, characterization and antimicrobial activity of dextran stabilized silver nanoparticles in aqueous medium

A simple one-step rapid synthetic route is described for the preparation of silver nanoparticles by reduction of silver nitrate (AgNO3) using aqueous dextran solution which acts as both reducing and capping agent. The formation of silver nanoparticles is assured by characterization with UV-vis spectroscopy, atomic force microscopy (AFM), transmission electron microscopy (TEM) and X-ray diffraction (XRD). The absorbance of the silver nanoparticles is observed at 423 nm. The AFM image clearly shows the surface morphology of the well-dispersed silver nanoparticles with size range of 10-60 nm. TEM images show that the nanoparticles are spherical in shape with ∼5-10 nm dimensions. The crystallinity of Ag nanoparticles is assured by XRD analysis. The antimicrobial activity of as synthesized silver nanoparticles is tested against the bacteria, Bacillus subtilis, Bacillus cereus, Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa. The bacterial growth is inhibited by gradual reduction of the concentration of the silver nanoparticles.

Molecular signaling mechanisms of the periopathogen, Treponema denticola

In the healthy subgingiva, oral treponemes account for a small percentage of the total bacteria. However, in diseased periodontal pockets, treponemes thrive and become a dominant component of the bacterial population. Oral treponemes are uniquely adept at capitalizing on the environmental conditions that develop with periodontal disease. The molecular basis of adaptive responses of oral treponemes is just beginning to be investigated and defined. The completion of several treponeme genome sequences and the characterization of global regulatory systems provide an important starting point in the analysis of signaling and adaptive responses. In this review, we discuss existing literature focused on the genetic regulatory mechanisms of Treponema denticola and present an overview of the possible roles of regulatory proteins identified through genome analyses. This information provides insight into the possible molecular mechanisms utilized by oral spirochetes to survive in the periodontal pocket and transition from a minor to a dominant organism.

The Hpk2-Rrp2 two-component regulatory system of Treponema denticola: a potential regulator of environmental and adaptive responses

Treponema denticola levels in the gingival crevice become elevated as periodontal disease develops. Oral treponemes may account for as much as 40% of the total bacterial population in the periodontal pocket. The stimuli that trigger enhanced growth of T. denticola, and the mechanisms associated with the transmission of these signals, remain to be defined. We hypothesize that the T. denticola open reading frames tde1970 (histidine kinase) and tde1969 (response regulator) constitute a functional two-component regulatory system that regulates, at least in part, responses to the changing environmental conditions associated with the development of periodontal disease. The results presented demonstrate that tde1970 and tde1969 are conserved, universal among T. denticola isolates and transcribed as part of a seven-gene operon in a growth-phase-dependent manner. tde1970 undergoes autophosphorylation and transfers phosphate to tde1969. Henceforth, the proteins encoded by these open reading frames are designated as Hpk2 and Rrp2 respectively. Hpk2 autophosphorylation kinetics were influenced by environmental conditions and by the presence or absence of a PAS domain. It can be concluded that Hpk2 and Rrp2 constitute a functional two-component system that contributes to environmental sensing.

An unprecedented biogenetic-type chemical synthesis of 1(15-->11) abeotaxanes from normal taxanes

A one-pot chemical process using BF(3).Et(2)O for the synthesis of a new class of 1(15-->11) abeotaxanes from normal taxanes has been developed. The chemical structures of rearranged 1(15-->11) abeotaxane were established by extensive 2D NMR spectroscopic data.

Sequence analysis of morbillivirus CD150 receptor-Signaling Lymphocyte Activation Molecule (SLAM) of different animal species

Signaling Lymphocyte Activation Molecule-SLAM (CD150) molecule has been reported as a putative receptor for most morbilliviruses for their respective host species. In this study, we determined the complete nucleotide sequence of the gene coding for the morbillivirus receptor-SLAM from the four species, namely, goat (Capra hircus), sheep (Ovis aries), Indian cattle (Bos indicus), and buffalo (Bubalus bubalis). The nucleotide (nt) open reading frame sequence of SLAM gene in all the four species studied was 1017 nucleotides in length encoding a polypeptide of 339 amino acids (aa), similar to Bos taurus, but different from canine, human, marmoset, and mouse SLAM, which were 1029, 1008, 1011, and 1032 nts, respectively, in length, and coding for 343, 336, 337, and 344 aa, respectively. Sequence analysis revealed 96.3-98.5% and 92.9-96.8% identities among the four species at the nt and aa level, respectively. Sequence diversity at aa level between various species revealed that the critical functional region of SLAM protein among different species is relatively conserved, thereby facilitating this molecule to act as a receptor for morbillivirus. Phylogenetic relationship based on the aa sequences of SLAM protein revealed that caprine, ovine, cattle, and buffalo fall under a defined cluster but caprine SLAM is more closely related to ovine, followed by bovine.

Female gonadal hormones, mild restraint, and male preference

The partner preference paradigm was used to test the hypothesis that mild restraint reduced sexual motivation of female rats. Ovariectomized rats were primed with 10 pg estradiol benzoate or estradiol benzoate and 500 microg progesterone. Additional rats were injected with sesame seed oil. These three groups of rats (oil-oil, estradiol benzoate-oil, or estradiol benzoate-progesterone; OO, EO, EP) were placed for 10 min in an arena, the ends of which enclosed either a sexually active male or an ovariectomized, unprimed female. Time spent near the sexually active male relative to time spent near either stimulus animal was used as the index of male preference. As expected, hormonal treatment significantly increased male preference. After this first 10 min interval, females were returned to the home cage or restrained for 5 min in a Decapicone. Thereafter, male preference was recorded for another 10 min. Consistent with the first 10 min period, EP rats spent significantly more time near the male than did OO rats while EO rats were intermediate. There was no effect of restraint, but there was a significant increase in self-grooming. These findings contrast with previous studies and allow the suggestion that a brief, mild restraint fails to influence the female's sexual motivation. The implications of these findings are discussed.

Development of an Indirect ELISA for the Detection of Antibodies against Peste-des-petits-ruminants Virus in Small Ruminants

Peste des petits ruminants (PPR) is an acute, febrile, highly contagious and economically important viral disease of small ruminants. A polyclonal antibody based indirect ELISA was developed for detection of antibodies to PPR virus in the serum samples of goats and sheep using purified PPR viral antigen propagated in Vero cell culture. A threshold (cut-off) value was set as twice the mean of the negative population based on the distribution of known negative serum samples in respect of PPR virus antibodies in the test. A total of 1544 serum samples from goats and sheep were screened by indirect ELISA and competitive ELISA. The indirect ELISA compared very well with competitive ELISA, with a high degree of specificity (95.09%) and sensitivity (90.81%). When compared with virus neutralization test, the present assay had 100% specificity and 80% sensitivity. With serum samples, the assay could clearly differentiate animals from the infected population from uninfected ones. These results suggest that the indirect ELISA may be a good alternative tool to competitive ELISA for seroepidemiological surveys.

Confinement-induced instability and adhesive failure between dissimilar thin elastic films

When two thin soft elastomeric films are separated from each other, an elastic instability develops at the interface. Although similar instability develops for the case of a soft film separating from a rigid adherent, there are important differences in the two cases. For the single-film case, the wavelength of instability is independent of any material properties of the system, and it scales only with thickness of the film. For the two-film case, a co-operative instability mode develops, which is a non-linear function of the thicknesses and the elastic moduli of both films. We investigate the development of such instability by energy minimization procedures. Understanding the nature of this instability is important, as it affects the adhesive compliance of the system and thus the energy release rate in the debonding of soft interfaces.

Comparative nucleotide sequence analysis of the phosphoprotein gene of peste des petits ruminants vaccine virus of Indian origin

The nucleotide sequences of the phosphoprotein (P) gene of peste des petits ruminants (PPRV) vaccine virus (PPRV Sungri/96) belongs to Asian lineage have been determined and the deduced amino acid sequences were compared with another vaccine strain PPRV/Nigeria75/1 and with those of the other morbilliviruses. The 1652 nucleotides of the P gene encode a phosphoprotein of 509 amino acid residues (from nucleotide numbers 60 to 1587), which is 91% identical to that of PPRV/Nigeria75/1. The C protein consists of 177 amino acid residues and is 91% identical with that of PPRV/Nigeria75/1. The conserved mRNA editing site (5'TTAAAAGGGCACAG) was present at positions 742-756 in the P gene, which is conserved in all other morbilliviruses. The CTT trinucleotide sequence is present at the N/P and P/M intergenic region, which is totally conserved in morbilliviruses. This will be the third sequence for the P gene of PPRV since that of the vaccine strain and a wild-type Turkish isolate has been published already.

Comparative efficacy of various chemical stabilizers on the thermostability of a live-attenuated peste des petits ruminants (PPR) vaccine

Thermostability of a live-attenuated peste des petits ruminants (PPR) vaccine recently developed at Indian Veterinary Research Institute was studied using conventional lyophilization conditions. A total of four stabilizers viz., lactalbumin hydrolysate-sucrose (LS), Weybridge medium (WBM), buffered gelatin-sorbitol (BUGS) and trehalose dihydrate (TD) were used to prepare the lyophilized vaccine. The study revealed that the PPR vaccine lyophilized with either LS or TD is more stable than rest of the stabilizers having an expiry period of at least 45 days (so far studied) at 4 degrees C, 15-19 days at 25 degrees C and 1-2 days at 37 degrees C. However, at a temperature of 45 degrees C, BUGS had a marginal superiority, although lasted for few hours, followed by TD and LS with respect to shelf-life, LS and TD with respect to half-life. On the basis of half-life also LS followed by TD appeared superior at a temperature of 4, 25 and 37 degrees C. Reconstitution of vaccine with distilled water or 1M MgSO(4) or 0.85% NaCl maintained the required virus titre (2.5log(10)TCID(50) per dose) up to 8h at 37 degrees C and 7h at 45 degrees C. Among the three diluents, 1M MgSO(4) appeared to be the better diluent for reconstitution of lyophilized PPR vaccine, as the loss on dilution was lowest and maintain the required virus titre for a longer period. Investigation suggests for using LS as stabilizer for lyophilization and 1M MgSO(4) as vaccine diluent for the newly developed PPR vaccine.

A case of depersonalization-derealization syndrome during treatment with quetiapine

A case who schizophrenia developed patient male of a 65-year-old is reported depersonalization-derealization syndrome following treatment with quetiapine, an atypical antipsychotic. The literature is reviewed for possible biological mechanisms that may account for this phenomenon.

Long-term induction of immune tolerance after blockade of CD40-CD40L interaction in a mouse model of hemophilia A

A factor VIII-deficient knockout mouse was used as a model for severe hemophilia A to characterize the immune response to recombinant human factor VIII (fVIII) and to study new approaches for induction of immune tolerance to fVIII. Mice initially received periodic injections of fVIII in doses similar to those used for the treatment of human hemophilia A. To induce immune tolerance, a hamster monoclonal antibody specific for murine CD40 ligand (CD40L or CD154) was injected with fVIII. Control mice received fVIII alone or fVIII and hamster immunoglobulin G. After treatment, humoral and cellular immune responses were evaluated. Ninety-five percent of anti-CD40L-treated mice had lower titers of anti-fVIII antibody (less than 1 microg/mL) compared with fVIII-injected control mice (mean, 18 microg/mL). To determine whether anti-CD40L treatment induces long-term immune tolerance, mice were rechallenged 3 times with fVIII alone. At 150 days after treatment, 12 of 22 anti-CD40L-treated mice remained tolerant to fVIII (anti-fVIII antibody titers less than 1 microg/mL). However, tolerant mice immunized with tetanus toxoid (TT) developed high anti-TT antibody, demonstrating that tolerance is fVIII specific. T cells from tolerant mice showed impaired proliferative responses after stimulation with fVIII in vitro and lack of production of the cytokines interleukin-2 (IL-2), IL-4, interferon gamma, and IL-10. These results demonstrate that long-term immune tolerance to fVIII was effectively induced after early blockade of CD40-CD40L interaction. In addition, the lack of tolerance in this model was associated with the expression of a Th2 phenotype.

Contemporary treatment strategies for external pancreatic fistulas

BACKGROUND

Optimal treatment strategies for patients with external pancreatic fistulas have evolved with improved radiographic imaging and the development of transpapillary pancreatic duct stents. The aim of this study was to examine factors affecting fistula closure and develop a classification scheme to guide therapeutic interventions.

METHODS

Retrospective chart review was made of all patients with external pancreatic fistulas treated at our institution from January 1991 to January 1997. Side (partial) fistulas maintained continuity with the gastrointestinal tract; end (complete) fistulas had no continuity with the gastrointestinal tract.

RESULTS

Postoperative side fistulas resolved with medical treatment in 13 (86%) of 15 patients after a mean of 11 weeks of conservative management. Inflammatory side fistulas resolved with medical treatment in only 8 (53%) of 15 patients after a mean of 22 weeks; those that did not close initially did so with transpapillary stenting. End pancreatic fistulas never closed with medical treatment and were unable to be stented; therefore internal drainage or pancreatic resection was necessary to achieve closure. There were no differences in sepsis rates, Acute Physiology and Chronic Health Evaluation II scores, fistula site, total parenteral nutrition, somatostatin treatment, or initial fistula output between groups.

CONCLUSIONS

Classifying external pancreatic fistulas as to their pancreatic duct relationship and cause provides important prognostic and therapeutic information.

Vitamin A is required for regulation of polymeric immunoglobulin receptor (pIgR) expression by interleukin-4 and interferon-gamma in a human intestinal epithelial cell line

The secretory immunoglobulin A (IgA) antibody response to infections of mucosal surfaces requires transport of IgA from the basal to apical surface of mucosal epithelial cells by a specific transport protein, the polymeric immunoglobulin receptor (pIgR). We have tested the hypothesis that the vitamin A metabolite all-trans retinoic acid (RA) is required for the regulation of pIgR expression by the cytokines interleukin-4 (IL-4) and interferon-gamma (IFN-gamma) in HT-29 cells, a well-differentiated human epithelial cell line derived from a colonic carcinoma. pIgR expression is upregulated by IFN-gamma and IL-4 when HT-29 cells are grown in normal media, but this upregulation was significantly lower when cells were grown in vitamin A-depleted media. Treatment with RA at concentrations from 10(-9) to 10(-5) mol/L restored normal levels of pIgR expression. The percentages of cells expressing cell-surface pIgR after 24, 48 and 72 h of treatment with RA, IL-4 and IFN-gamma were 66 +/- 10, 90 +/- 5 and 92 +/- 1, respectively, significantly higher than the percentages seen without RA treatment, which were 32 +/- 2.3, 72 +/- 1.2 and 30 +/- 7, respectively. In addition, the intensity of fluorescence of pIgR-positive cells was significantly higher in the RA-treated cultures than in the cultures without RA treatment. Similarly, pIgR mRNA levels (adjusted for beta-actin mRNA levels) in RA-supplemented cultures were 404, 105 and 949% higher at 24, 48 and 72 h, respectively, than were pIgR mRNA levels in identical cultures grown in the absence of RA. These data indicate that RA strongly interacts with IL-4 and IFN-gamma to regulate pIgR expression in HT-29 cells, suggesting that vitamin A may be required for proper in vivo regulation of IgA transport in response to mucosal infections.

Effect of amines on fibrinogen synthesis

L-Epinephrine, serotonin, and isoproterenol stimulate the incorporation of [14C]leucine into thrombin-induced clottable protein; this stimulation was abolished by actinomycin D. The incorporation of 32P into total RNA of rat liver, the site of fibrinogen synthesis, was stimulated by epinephrine and was highest at 2 h after 32P administration. [14C]Orotic acid incorporation into polysomal RNA of liver was also increased significantly by epinephrine and serotonin. The immunoprecipitation of newly synthesized protein by monospecific antibody raised against pure rat fibrinogen clearly demonstrates that L-epinephrine increased fibrinogen formation in vivo under the experimental condition. Translation of poly (A)-containing RNA from total polysomal RNA clearly indicates that L-epinephrine increased mRNA specific for fibrinogen.

Effect of some monoamine oxidase inhibitors and cyclic-AMP on plasma fibrinogen level of rats

In vivo administration of short acting or long acting inhibitor of monoamine oxidase elevates plasma fibrinogen level in rats. These inhibitors cannot elevate plasma fibrinogen level in rats pretreated with p-chlorophenyl alanine and alpha-methyl-meta-tyrosine, inhibitors of catecholamine and serotonin formation respectively. However, administration of epinephrine or serotonin under the above experimental condition elevates fibrinogen level indicating rise of biogenic monoamine, even for a short period, is a good stimulus for increase of plasma fibrinogen. Dibutyryl cyclic-AMP (c-AMP) also elevates fibrinogen level and shows additive effect with theophylline or serotonin.