Proposed classification of adenomyosis in Infertile women to simplify management options undergoing ART

OBJECTIVE

Adenomyosis associated with subfertility is a situation of a dilemma for the treating clinician as the treatment is highly controversial and there remains an overall lack of consensus regarding the value of conservative surgery with or without medical management to improve reproductive out-comes. Hence we proposed this classification based on mapping of the size of adenomyoma, its location, distance from the endometrial cavity, and any associated endometriosis by studying 100 women with adenomyosis undergoing IVF.

METHODS

We did a prospective study over 2 years in 100 women with adenomyosis who underwent IVF. They were classified into 4 categories based on our management-based proposed classification and the pregnancy outcomes were studied in each group.

RESULTS

According to our classification, 56% of women belonged to grade 1, 24% to grade 2, 8% to grade 3, and 12% to Grade 4 Adenomyosis. The Pregnancy rates were 71% in Grade 1, 66% with Medical management, and 33% with surgical management in Grade 2, Grade 3 were offered surrogacy, and 66% in Grade 4 Adenomyosis.

CONCLUSIONS

Our classification is simple and allows cost-effective management based on the location and ex-tent of the disease with the help of ultrasonography.

Evaluation of Pelvic Floor Muscle Strength in Nulliparous, Parous and Postmenopausal Women and its Association with Various Factors

Objective

To evaluate pelvic floor muscle strength (PFMS) in nulliparous, parous and postmenopausal women using vaginal digital palpation and perineometer.

Material and Methods

It was a cross-sectional study, conducted in department of Obstetrics and Gynecology, VMMC & Safdarjung hospital. A total of 300 women were recruited from Gynaecology and Family welfare outpatient departments and divided into 3 equal groups-nulliparous women, premenopausal parous women and postmenopausal women. PFMS was measured by modified Oxford Scale with vaginal digital palpation and by perineometer. Linear regression analysis was performed to evaluate and compare mean PFMS and identify its associated factors.

Results

Median age was 21 years in nulliparous, 27 years in parous and 58 years in postmenopausal group. The average body mass index was 27.45, 28.01 and 34.63 kg/m2 in nulliparous, parous and postmenopausal group. The mean MOS by digital vaginal palpation was 4.66 in nulliparous, 3.9 in parous and 2.54 in postmenopausal women. The difference was statistically significant. The mean PFMS by perineometer was 40.04 cm H2O, 37.69 cm H2O and 34.93 cm H2O in nulliparous, parous and postmenopausal group, respectively. The difference was statistically significant (p < 0.001). Majority (50%) of nulliparous women had PFMs between 41 and 50 cm H2O and parous (81%) had PFMS between 21 and 30 cm H2O. There was a statistical significance between the groups.

Conclusions

The PFMS of nulliparous women was significantly higher than multiparous women, and difference was statically significant (p < 0.001). Age had an important influence on pelvic floor muscle before menopause, but after menopause, it is years of menopause which has significant negative impact on PFMS and not age.

Identification of plant beneficial Bacillus spp. for Resilient agricultural ecosystem

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The plant beneficial microbes from rhizosphere soils in cauliflower fields were characterized for plants beneficial attributes such as phosphorus solubilization, siderophore, chitinase and protease activity, and indole acetic acid type of growth regulator.

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The antagonistic behavior of these isolates against fusarium oxysporum and sclerotinia sclerotiorum revealed their potential in combating the biotic stresses.

The use of synthetic pesticides and chemicals to continuously increase agricultural productivity is causing severe damage to our ecosystem. Therefore, there is need to enhance our understanding about the factors which can contribute to soil processes and play key role in developing sustainable agricultural ecosystem. In this context, the bacteria from cauliflower rhizosphere were isolated and characterized for different plants beneficial attributes. The relationship of soil bacteria and its elemental composition was examined using canonical correspondence analysis. The elemental composition analysis of soil samples revealed presence of Mg, Al, Si, P, K, Ca, Fe and their oxides. In addition, the isolates were found positive for phosphorus solubilization, siderophore, chitinase and protease activity, and indole acetic acid type of growth regulator. The direct confrontation assay revealed antagonistic behavior of these isolates against Fusarium oxysporum and Sclerotinia sclerotiorum. The promising isolates were identified and affiliated to closely related species of genus Bacillus in phylogenetic relationship. The canonical correspondence analysis revealed distribution of elements and their relationship with the identified species in particular area. The characteristics of these isolates revealed their potential in alleviating the biotic and abiotic stresses and hence enhancing crops yield without the usage of synthetic fertilizers and pesticides. The present study is first of its kind and will open new avenues to explore microbial community structure across different farmlands soils to develop resilience agricultural ecosystem.

Easy and cost-efficient method for tumour localization in patients with breast cancer undergoing neoadjuvant chemotherapy followed by breast conservation therapy

This article describes placement of a radio-opaque clip for tumour localization to facilitate resection in patients undergoing neoadjuvant chemotherapy followed by breast conservation therapy. Use of a radio-opaque marker made of stainless steel K-wire and use of a Trucut® needle with a blunt stylet for wire placement in the breast tumour bed is a safe, indigenous, and cost-effective method for tumour localization.

Prevalence of TEM, SHV, and CTX-M Beta-Lactamase genes in the urinary isolates of a tertiary care hospital

Introduction:

Extended-spectrum beta-lactamases (ESBLs) are the major cause of resistance to beta-lactam antibiotics such as penicillins, cephalosporins, and monobactams. They are derived from the narrow-spectrum beta-lactamases (TEM-1, TEM-2, or SHV-1) by mutations that alter the amino acid configuration around the enzyme active site.

Aim:

To determine the prevalence of ESBL (bla_TEM, bla_CTX-M, and bla_SHV) genes among the members of Enterobacteriaceae.

Methodology:

The present prospective study was carried out from January 2015 to June 2015 in the Department of Microbiology and Molecular Medicine of a Teaching Tertiary Care Hospital. A total of 526 urine samples were studied. Seventy-eight isolates were subjected to polymerase chain reaction for detection of ESBL genes.

Results:

In our study, ESBL genes were detected among 18 (45%) phenotypically confirmed ESBL producers and 20 (52.5%) phenotypically confirmed non-ESBL producers. The gene that predominated was bla_TEM (48.7%), followed by bla_CTX-M (7.6%) and bla_SHV (5.1%).

Conclusion:

Definitive identification of ESBL genes is only possible by molecular detection methods. Phenotypic tests need to be evaluated periodically as their performance may change with the introduction of new enzymes.

Relationship of Imported Fire Ant (Hymenoptera: Formicidae) Integument Coloration to Cuticular Hydrocarbon and Venom Alkaloid Profiles

Red imported fire ant (Solenopsis invicta Buren; RIFA) and black imported fire ant (Solenopsis richteri Forel (Hymenoptera: Formicidae); BIFA) are considered distinct species with introgression via a reproductively functional hybrid (HIFA). The RIFA and BIFA common names are based on relative coloration. Due to human color perception variation, using color to identify RIFA, BIFA or HIFA is challenging. Fire ant identification traditionally involves molecular or chemical techniques, but a colorimetric test could allow rapid and low-cost identification. In this study, ant integument coloration was measured by spectrophotometer, and color attributes were compared to a combined gas chromatography (GC) index derived from cuticular hydrocarbon and venom alkaloid indices. Significant Pearson Correlation coefficients were found for colony GC index versus color attributes red to green (a*), blue to yellow (b*), chroma (C*), and hue (h*), but not lightness (L*). The RIFA colonies were distinct from BIFA for four of five color attributes and plots of the a*b* and C*h* horizontal axis of the L*a*b* and L*C*h* color spaces. Color attributes for HIFA indices were not distinct from BIFA and RIFA parental species, but HIFA a*b* and C*h* plots were distinct from RIFA and a*b* plots from BIFA. Color attributes a*, b*, and C* increased and h* decreased with GC index in a sinusoidal pattern. In conclusion, most RIFA and BIFA color attributes were distinct and a*b* and C*h* color axes plots had potential to distinguish HIFA from parental species, but coloration of HIFA indices was variable and complicated identifications among HIFA phenotypes, RIFA and BIFA.

Molecular and Genetic Characterization of Natural Variants of HIV-1 Nef Gene from North India and its Functional Implication in Down-Regulation of MHC-I and CD-4

BACKGROUND

HIV-1 Nef is an important accessory protein with multiple effector functions. Genetic studies of the HIV-1 Nef gene show extensive genetic diversity and the functional studies have been carried out mostly with Nef derived from regions dominated by subtype B (North America & Europe).

OBJECTIVE

This study was carried out to characterize genetic variations of the Nef gene from HIV-1 infected individuals from North India and to find out their functional implications.

METHODS

The unique representative variants were sub-cloned in a eukaryotic expression vector and further characterized with respect to their ability to downregulate cell surface expression of CD4 and MHC-1 molecules.

RESULTS

The phylogenetic analysis of Nef variants revealed sequence similarity with either consensus subtype B or B/C recombinants. Boot scan analysis of some of our variants showed homology to B/C recombinant and some to wild type Nef B. Extensive variations were observed in most of the variants. The dN/dS ratio revealed 80% purifying selection and 20% diversifying selection implying the importance of mutations in Nef variants. Intracellular stability of Nef variants differed greatly when compared with wild type Nef B and C. There were some variants that possessed mutations in the functional domains of Nef and responsible for its differential CD4 and MHC-1 downregulation activity.

CONCLUSION

We observed enhanced biological activities in some of the variants, perhaps arising from amino acid substitutions in their functional domains. The CD4 and MHC-1 down-regulation activity of Nef is likely to confer immense survival advantage allowing the most rare genotype in a population to become the most abundant after a single selection event.

Increased tracheostomy rates in head and neck cancer surgery during the COVID-19 pandemic

Surgical practice during the coronavirus disease 2019 (COVID-19) pandemic has changed significantly, without supporting data. With increasing experience, a dichotomy of practice is emerging, challenging existing consensus guidelines. One such practice is elective tracheostomy. Here, we share our initial experience of head and neck cancer surgery in a COVID-19 tertiary care centre, emphasizing the evolved protocol of perioperative care when compared to pre-COVID-19 times. This was a prospective study of 21 patients with head and neck cancers undergoing surgery during the COVID-19 pandemic, compared to 193 historical controls. Changes in anaesthesia, surgery, and operating room practices were evaluated. A strict protocol was followed. One patient tested positive for COVID-19 preoperatively. There was a significant increase in pre-induction tracheostomies (28.6% vs 6.7%, P = 0.005), median hospital stay (10 vs 7 days, P = 0.001), and postponements of surgery (57.1% vs 27.5%, P = 0.01), along with a significant decrease in flap reconstructions (33.3% vs 59.6%, P = 0.03). There was no mortality and no difference in postoperative morbidity. No healthcare personnel became symptomatic for COVID-19 during this period. Tracheostomy is safe during the COVID-19 pandemic and rates have increased. Despite increased rescheduling of surgeries and longer hospital stays, definitive cancer care surgery has not been deferred and maximum patient and healthcare worker safety has been ensured.

AB0713 PERIODONTAL DISEASES AND ITS ASSOCIATION WITH ANKYLOSING SPONDYLITIS/SPA: A SYSTEMATIC REVIEW

Background:

A close association between periodontal disease and Ankylosing spondylitis (AS) has long been specualted. Both diseases are characterized by dysregulation of the host inflammatory response, leading to further destruction of soft and hard connective tissue with there being evidence of increased levels of TNF-α and various interleukins in both patients of AS and periodontitis.

Objectives:

The aim of this systematic review was to appraise the available literature exploring the relationship between AS and periodontal disease.

Methods:

We searched Medline & Embase databases (from their inception till October 2019) using appropriate combinations of following search items with limits ‘(English, Human)’; Ankylosing spondylitis, spondyloarthritis, spondyloarthropathies, spondyloarthritides, spinal disease, musculoskeletal disease, Rheumatic disease AND periodontitis, periodontal disease, periodontoses, parodontoses, chronic periodontitis, gum disease, gingivitis, oral health, dental health, plaque index, bleeding on probing, probing pocket depth, clinical attachment loss. This search was supplemented by the manual search of bibliographies of articles selected and conferences proceedings of EULAR. Only be reviews, observational study of cross-sectional, cohort or case control type on adult patients with AS were selected. Data was extracted from a predesigned proforma. A close association between periodontal disease and Ankylosing spondylitis (AS) has long been specualted. Both diseases are characterized by dysregulation of the host inflammatory response, leading to further destruction of soft and hard connective tissue with there being evidence of increased levels of TNF-α and various interleukins in both patients of AS and periodontitis.

Results:

A total number of 984 articles were identified and 12 were selcted for detailed appraisal (Figure 1, PRISMA flow chart). They were all case control studies. The prevalence of periodontitis ranged from 38% to 88% in patients with AS whereas in the control group from 26% to 71 % in controls. Out of 12 studies, two showed significant changes in Plaque Index (PI), two studies showed altered Pocket Probing Depth (PPD), three showed significant increased in Clinical Attachment Loss (CAL) and increased Bleeding On Probing (BOP) was seen in 2 studies. In 7 studies, periodontitis was seen in a significant number of patients with AS (P<0.05). All studies reported that the prevalence of periodontal disease in AS patients was higher as compared to non-AS patients.

Conclusion:

Our systematic review found an association between AS and periodontal disease. Patients with AS show higher prevalence of periodontitis and a poor oral hygiene as compared to healthy controls. At practice level, this systematic review underscores the need for a collaboration between dentists and rheumatologist.

Disclosure of Interests:

None declared

Worker Size, Geographical Distribution, and Introgressive Hybridization of Invasive Solenopsis invicta and Solenopsis richteri (Hymenoptera: Formicidae) in Tennessee

Worker size and geographical distribution of red imported fire ants (Solenopsis invicta Buren), black imported fire ants (Solenopsis richteri Forel), and their hybrid (S. invicta × S. richteri) (Hymenoptera: Formicidae) were evaluated from colonies sampled across Tennessee. The fire ant species and hybrid status were determined using cuticular hydrocarbon and venom alkaloid indices obtained from gas chromatography and mass spectrometry. Hybrids were the most common fire ant throughout Tennessee. With the exception of a few isolated S. invicta samples, only hybrids were found in east Tennessee, and hybrids predominated in middle Tennessee. In west Tennessee, mixed populations of S. richteri and hybrids were found. Hybrids were more common in west Tennessee than a survey performed a decade earlier. No statistical differences were detected in the average inter-colonial worker size of S. richteri and hybrids. Likewise, average worker size was not related to geographic location in Tennessee. The similarity in average worker size among hybrid colonies with a wide range of cuticular hydrocarbon and venom alkaloid values suggests introgression was not impacting ant size in colonies sampled throughout Tennessee.

Salt responsive physiological, photosynthetic and biochemical attributes at early seedling stage for screening soybean genotypes

Salt stress affects all the stages of plant growth however seed germination and early seedling growth phases are more sensitive and can be used for screening of crop germplasm. In this study, we aimed to find the most effective indicators of salt tolerance for screening ten genotypes of soybean (SL-295, Gujosoya-2, PS-1042, PK-1029, ADT-1, RKS-18, KDS-344, MAUS-47, Bragg and PK-416). The principal component analysis (PCA) resulted in the formation of three different clusters, salt sensitive (SL-295, Gujosoya-2, PS-1042 and ADT-1), salt tolerant (MAUS-47, Bragg and PK-416) and moderately tolerant/sensitive (RKS-18, PK-1029 and KDS-344) suggesting that there was considerable genetic variability for salt tolerance in the soybean genotypes. Subsequently, genotypes contrasting in salt tolerance were analyzed for their physiological traits, photosynthetic efficiency and mitochondrial respiration at seedling and early germination stages under different salt (NaCl) treatments. It was found that salt mediated increase in AOX-respiration, root and shoot K+/Na+ ratio, improved leaf area and water use efficiency were the key determinants of salinity tolerance, which could modulate the net photosynthesis (carbon assimilation) and growth parameters (carbon allocation). The results suggest that these biomarkers could be can be useful for screening soybean genotypes for salt tolerance.

Macroscopic technique for the evaluation of oral tongue tumour thickness: a reliable intraoperative method

There is no reliable method to assess tumour thickness preoperatively or intraoperatively in cases of oral tongue squamous cell carcinoma (SCC). The purpose of this study was to evaluate the efficacy of a macroscopic technique to measure tumour thickness. This was a prospective study of 51 consecutive patients with T1/T2 primary SCC of the oral tongue. All patients underwent primary resection with ipsilateral neck dissection. Thickness measurements were obtained using Vernier calipers on the fresh specimen. The technique was correlated with the microscopic evaluation statistically using (1) Pearson's correlation coefficient, (2) intra-class correlation, and (3) Bland-Altman plot with 95% confidence intervals. On comparing the macroscopic technique to the microscopic evaluation, Pearson's correlation (r) was 0.915 (P<0.001). The inter-rater reliability using the intra-class correlation coefficient was 0.955. The Bland-Altman plot to test the agreement between the techniques showed the average difference between macroscopic thickness and microscopic thickness (bias) to be -0.421, with 95% limits of agreement of -3.166 and 2.82. There was a significant correlation and agreement between the macroscopic and microscopic measures of tumour thickness. The macroscopic technique could be used as a reliable tool to measure tumour thickness intraoperatively, prior to neck dissection.

Abstract P5-03-03: Designing a novel platinum chemotherapeutic (IO-125) for treatment of breast cancer

Triple-negative breast cancer (TNBC) is an aggressive form of cancer occurring in 15-20% of breast cancer patients, with most patients relapsing on currently approved therapy. Recent studies have shown activity of platinum chemotherapy in this class of patients. IO-125 is a novel platinum (II) chemotherapeutic agent with an unique coordination environment. In this study, we investigated the anti-tumor activity of IO-125 in pre-clinical models of TNBC.

The coordination environment in IO-125 facilitates supramolecular assembly and releases diaminocyclohexane (DACH)-platinum in a sustained pH-dependent manner. In vitro cell viability studies using an array of breast cancer cell lines shows IO-125 exerts increased potency compared to carboplatin or oxaliplatin. The maximum tolerated (platinum-equivalent) dose (MTD) of IO-125 in mice was 8-fold higher than the MTD (platinum-equivalent) dose of oxaliplatin. The biodistribution and pharmacokinetic profile of IO-125 in plasma and tumor revealed preferential tumor accumulation, significantly increased area-under-the-curve (AUC), a reduction in clearance (CL) and a longer terminal half-life (42 hours) in comparison to oxaliplatin (18 hours). In addition, DNA-Pt adduct formation in tumors was significantly higher for IO-125. When administered at their respective MTDs, IO-125 led to sustained regression of the tumor in a 4T1 syngeneic breast cancer model. Based on these observations, we conclude that IO-125 may emerge as a novel therapeutic against triple negative breast cancer.

Citation Format: Sengupta A, Roy M, Sarkar A, Mylavarapu S, Modi S, Gupta N, B H, Hossain S, Ansari A, Pandey M, Yadav Y, Sengupta S. Designing a novel platinum chemotherapeutic (IO-125) for treatment of breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-03-03.

Homology and enzymatic requirements of microhomology-dependent alternative end joining

Nonhomologous DNA end joining (NHEJ) is one of the major double-strand break (DSB) repair pathways in higher eukaryotes. Recently, it has been shown that alternative NHEJ (A-NHEJ) occurs in the absence of classical NHEJ and is implicated in chromosomal translocations leading to cancer. In the present study, we have developed a novel biochemical assay system utilizing DSBs flanked by varying lengths of microhomology to study microhomology-mediated alternative end joining (MMEJ). We show that MMEJ can operate in normal cells, when microhomology is present, irrespective of occurrence of robust classical NHEJ. Length of the microhomology determines the efficiency of MMEJ, 5 nt being obligatory. Using this biochemical approach, we show that products obtained are due to MMEJ, which is dependent on MRE11, NBS1, LIGASE III, XRCC1, FEN1 and PARP1. Thus, we define the enzymatic machinery and microhomology requirements of alternative NHEJ using a well-defined biochemical system.

Preinduction incentive spirometry versus deep breathing to improve apnea tolerance during induction of anesthesia in patients of abdominal sepsis: A randomized trial

BACKGROUND

Abdominal sepsis is associated with varied degree of hypoxemia and atelactasis in the lung and can enhance the onset of desaturation of arterial blood during apnea.

AIMS

This study looked at methods to improve safety margin of apnea during induction of anesthesia in these high-risk patients.

SETTINGS AND DESIGN

It was a randomized, single blind study on adult patients presenting for emergency laparotomy due to peritonitis in a university teaching hospital setting.

MATERIALS AND METHODS

In group 1 (IS) (n = 32), three sessions of incentive spirometry (IS) were performed within one hour before induction of anesthesia. In group 2 (DB) (n = 34), patients were subjected to deep breathing sessions in a similar manner. All patients received preoxygenation (100%) by mask for 3 min, followed by rapid-sequence induction of anesthesia using fentanyl, thiopental, and suxamethonium and endotracheal intubation. Patients were subjected to a period of apnea by keeping the end of the endotracheal tube open to air till they developed 95% hemoglobin saturation (SpO 2) by pulse oxymetry. Positive pressure ventilation was resumed at the end. We observed for hemodynamic changes, apnea time, and SpO 2 (100%) recovery time on resuming ventilation. Arterial blood gas samples were taken before intervention, after IS or DB, after preoxygenation, and at the end of apnea.

STATISTICAL ANALYSIS USED

One-way analysis of variance (ANOVA), X 2 test, Kaplan-Meier graph, and log-rank tests were applied to compare the two study groups.

RESULTS

Oxygenation level in group 1 (265 ± 76.7 mmHg) patients was significantly (P < 0.001) higher than in group 2 (221 ± 61.8 mmHg)at the end of preoxygenation. The apnea time (median: lower bound - upper bound Confidence Interval apnea time) (272:240-279 s) in group 1 (IS) patients was significantly higher P < 0.05) than in group 2 (180:163-209 s) patients. Saturation recovery time (35:34-46 s) in group 1 (IS) patients was also quicker than in group 2 patients (48:44-58 s).

CONCLUSIONS

IS in the preoperative period is superior to deep breathing sessions for improving apnea tolerance during induction of anesthesia in abdominal sepsis patients.

Biological behavior and disease pattern of carcinoma gallbladder shown on 64-slice CT scanner: a hospital-based retrospective observational study and our experience

PURPOSE

The aim of this diagnostic observational study was to assess the spread and biological behavior of gallbladder cancer using 64-slice computerized tomography (CT) scanner in this particular geographic belt (eastern Uttar Pradesh, western Bihar, and northern Madhya Pradesh provinces of North India). Indians are ethnically and culturally different from their Western counterparts among whom the incidence of this disease is comparatively low.

SUBJECTS AND METHODS

After systemic examination, all patients (87) were subjected to ultrasonographic examination. All cases were histopathologically proven. Confirmed cases were subjected to volumetric CT examination of abdomen and pelvis, plain, post contrast and delayed phase.

RESULTS

Majority of the cases were adenocarcinoma. There was female preponderance with majority belonging to fifth and sixth decades. Commonest presentation was diffuse, irregular, enhancing wall thickening in 49.4%. Majority had invasion of liver parenchyma (74.7%). Cholelithiasis was seen in 48.3% cases. Invasion of biliary radicals was high (13.8-18.4%). Eleven cases had invasion of portal vein and tumor thrombus, with hepatic artery invasion in one case. In two cases, both hepatic artery and portal vein invasion was seen. Portal and peripancreatic nodal metastasis was seen in 58.5%. Distant metastasis was reported.

CONCLUSION

Few studies involving the Indian population have attempted to use multi-row detector CT to define the biological behavior of carcinoma gallbladder. The opinion whether the pathology is operable or non-operable can reasonably be given. This large-scale, single-center study gives insight about the epidemiology and biological behavior of carcinoma gallbladder.

Estimation of factors from natural and anthropogenic radioactivity present in the surface soil and comparison with DCF values

A study was conducted to evaluate the absorbed rate coefficient of (238)U, (232)Th, (40)K and (137)Cs present in soil. A total of 31 soil samples and the corresponding terrestrial dose rates at 1 m from different locations were taken around the Anushaktinagar region, where the litho-logy is dominated by red soil. A linear regression model was developed for the estimation of these factors. The estimated coefficients (nGy h(-1) Bq(-1) kg(-1)) were 0.454, 0.586, 0.035 and 0.392, respectively. The factors calculated were in good agreement with the literature values.

The EIF4EBP3 translational repressor is a marker of CDC73 tumor suppressor haploinsufficiency in a parathyroid cancer syndrome

Germline mutation of the tumor suppressor gene CDC73 confers susceptibility to the hyperparathyroidism-jaw tumor syndrome associated with a high risk of parathyroid malignancy. Inactivating CDC73 mutations have also been implicated in sporadic parathyroid cancer, but are rare in sporadic benign parathyroid tumors. The molecular pathways that distinguish malignant from benign parathyroid transformation remain elusive. We previously showed that a hypomorphic allele of hyrax (hyx), the Drosophila homolog of CDC73, rescues the loss-of-ventral-eye phenotype of lobe, encoding the fly homolog of Akt1s1/ PRAS40. We report now an interaction between hyx and Tor, a central regulator of cell growth and autophagy, and show that eukaryotic translation initiation factor 4E-binding protein (EIF4EBP), a translational repressor and effector of mammalian target of rapamycin (mTOR), is a conserved target of hyx/CDC73. Flies heterozygous for Tor and hyx, but not Mnn1, the homolog of the multiple endocrine neoplasia type 1 (MEN1) tumor suppressor associated with benign parathyroid tumors, are starvation resistant with reduced basal levels of Thor/4E-BP. Human peripheral blood cell levels of EIF4EBP3 were reduced in patients with CDC73, but not MEN1, heterozygosity. Chromatin immunoprecipitation demonstrated occupancy of EIF4EBP3 by endogenous parafibromin. These results show that EIF4EBP3 is a peripheral marker of CDC73 function distinct from MEN1-regulated pathways, and suggest a model whereby starvation resistance and/or translational de-repression contributes to parathyroid malignant transformation.

Transplacentally acquired organophosphorus poisoning in a newborn: case report

A term neonate was born to a mother who had consumed an organophosphorus compound with suicidal intent 50 hours before delivery. At birth, the infant showed signs and symptoms of organophosphorus poisoning and was treated with atropine and pralidoxime to which she responded well. Unfortunately, the mother died despite appropriate treatment. This is only the second report documenting transplacental organophosphate poisoning.

Screening for distress can predict loss of follow-up and treatment in cancer patients: results of development and validation of the Distress Inventory for Cancer Version 2

INTRODUCTION

The evidence suggests that in most instances distress from cancer goes unrecognised. There has been substantial work in screening for distress leading to development in practice guidelines recommending screening for distress. There is a need to identify distress early in the continuum, where suitable and timely interventions will benefit the patient. The Distress Inventory for Cancer (DIC) was designed for this.

METHODS

The present study reports the improved psychometric properties of the second version of the DIC (DIC 2). A standardisation sample of 520 patients was administered the 73-item draft questionnaire as well as the Functional Assessment of Cancer Therapy-General (FACT-G). Additional 240 patients were administered Hospital Anxiety and Depression Scale (HADS) besides the final DIC 2 and FACT-G. Internal consistency was measured with the Cronbach's alpha. Chi-square, odds ratio, and binary logistic regression were used to compare the results of three tools and to establish validity.

RESULTS

A principal factor analysis of the 73-item draft questionnaire with varimax rotation in a six-factor structure resulted in 33 items. Activity of daily living emerged as a single item domain. The FACT-G scores negatively correlated with DIC 2 scores, while emotional distress of DIC 2 overlapped with anxiety in HADS. DIC 2 significantly predicted patient non-compliance to treatment and follow-up.

CONCLUSION

The results show a suitable internal consistency, construct, and convergent/divergent validity of the global distress measure (DIC 2). The DIC 2 also demonstrates a predictive function for future negative clinical behaviour, the knowledge of which may facilitate better intervention triage.

Non-smokers are more prone to pulmonary oedema than smokers during acute coronary syndrome

OBJECTIVES

Acute coronary syndrome (ACS) patients are prone to develop pulmonary oedema with varied degree of hypoxaemia. The aim was to compare the risk for pulmonary oedema and related complications during ACS amongst non-smokers vs. smokers.

METHODS

Prospective, observational study was performed in consecutive 68 patients presenting with ACS. They were divided into two groups; group 1 (n = 33) non-smokers and group 2 (n = 35) chronic smokers. Standard conservative treatment was given to maintain mean arterial pressure >or= 60 mmHg, oxygen saturation > 95%. The bedside chest x-ray was graded for Battler grading (0-4) for pulmonary oedema. All patients were evaluated for troponin, serial creatinine kinase, echocardiography, arterial blood gas, renal function and correlated with inotropes requirement, active respiratory support, coronary care unit (CCU) stay and hospital outcome.

RESULTS

Patients in both the groups had similar cardiac involvement for cardiothoracic ratio, troponin, ejection fraction and creatinine kinase muscle and brain (CK-MB). The bedside chest x-ray revealed significant (p < 0.05) lung oedema grades (3 and 4) in 60% non-smokers (group 1) vs. smokers (11%). These patients (group 1) also presented with significant (p < 0.001) hypoxaemia (lower PaO(2)/FiO(2)-201 +/- 44), metabolic acidosis (higher lactate; 2.1 +/- 0.72 mmol/l, base deficit; -5.1 +/- 4.8) and hypocarbia (28 +/- 2.9 mmHg) than smokers (group 2). The risk estimates for active respiratory support (OR =1.716) and inotrope use (OR = 1.836) was three times higher in non-smokers than smokers.

CONCLUSIONS

The higher degree of pulmonary oedema and hypoxemia probably contributed to poor short-term outcome in non-smokers than smokers. It would be important to recognise and treat hypoxaemia in non-smokers during ACS.

Raman spectroscopic investigations of nanoparticles of Sn(x)Ti(1-x)O2 solid solution

SnO2 nanoparticles dispersed in TiO2 matrix are prepared at a relatively low temperature of approximately 185 degrees C. Nanoparticles of Sn(x)Ti(1-x)O2 solid solution without significant aggregation have been prepared by annealing them at approximately 500 and 900 degrees C. X-ray diffraction and high-resolution transmission electron microscopy studies have clearly established the nano-size nature of the samples. Raman spectroscopic investigations of these samples show mixed vibrational modes, some of them being similar to TiO2 (A(1g), E(g)), while some of them are similar to SnO2 (B(2g)). The E(g) mode shows significant red shift and B(2g) mode shows significant blue shift. Unlike this A(1g) mode remains unaffected. These results are explained based on the combined effects of random alloy formation and the nano-size nature of samples.

A hernia in the inguinal region is not always an inguinal hernia

A male patient of 60 years presented with a swelling in the left groin of 10 months duration. Past records showed bilateral lumbar sympathectomy and omentopexy done 20 and 6 years back, respectively, for Buerger's disease. Abdominal examination revealed a huge hernial swelling in the left groin extending from the symphysis pubis to anterior superior iliac spine measuring 25 x 18 cm. On exploration, the contents were intestines and omentum, which were coming out through a defect of 5 x 3 cm in the lower fibers of the conjoint muscle 4 cm cephalad to the deep ring, a finding which made the final diagnosis as an incisional hernia. We present this interesting case as a very rare complication of omentopexy, probably not reported previously, and an unusual case of an incisional hernia presenting as an inguinal hernia which is very difficult to diagnose unless encountered before. Its rarity and clinical challenge is highlighted.

Taurine fails to protect against 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-induced striatal dopamine depletion in mice

Taurine, a known antioxidant and neuroprotector has been investigated for its free radical scavenging action in vitro in isolated mitochondria, and tested whether it protects against 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced dopaminergic neurodegeneration in mice. Taurine (0.1-10 mM) did not affect 1-methyl-4-phenyl pyridinium-induced hydroxyl radical production in isolated mitochondria. Systemic administration of taurine (250 mg/kg, i.p.) caused a small, but significant loss of dopamine levels in the striatum of mice. Taurine failed to reverse MPTP-induced striatal dopamine depletion, but caused significant increase in dopamine turnover in these animals. In the light of the present study it may be suggested that consumption of taurine may neither help in scavenging of neurotoxic hydroxyl radicals in the brain mitochondria, nor would it help in blocking the process of neurodegeneration.

Seed mucilage from Ipomoea dasysperma

A non-ionic water-soluble galactomannan, having galactose and mannose in 1:6 molar ratio, was isolated from endosperm of the seeds of Ipomoea dasysperma. The seed mucilage was found to have a structure having a linear chain of beta (1-->4) linked mannopyranosyl units with D-galactose side chains attached through alpha (1-->6) linkage to the main chain. I. dasysperma seed gum possesses non-ionic characteristics of commercial seed gums and has potential to be used in food and pharmaceutical industries.