Reducing Salivary Toxicity with Adaptive Radiotherapy (ReSTART): A Randomized Controlled Trial Comparing Conventional IMRT to Adaptive IMRT in Head and Neck Squamous Cell Carcinomas

BACKGROUND

The utility of Adaptive Radiotherapy (ART) in Head and Neck Squamous Cell Carcinoma (HNSCC) remains to be ascertained. While multiple retrospective and single-arm prospective studies have demonstrated its efficacy in decreasing parotid doses and reducing xerostomia, adequate randomized evidence is lacking.

METHODS AND ANALYSIS

ReSTART (Reducing Salivary Toxicity with Adaptive Radiotherapy) is an ongoing phase III randomized trial of patients with previously untreated, locally advanced HNSCC of the oropharynx, larynx, and hypopharynx. Patients are randomized in a 1:1 ratio to the standard Intensity Modulated Radiotherapy (IMRT) arm {Planning Target Volume (PTV) margin 5 mm} vs. Adaptive Radiotherapy arm (standard IMRT with a PTV margin 3 mm, two planned adaptive planning at 10th and 20th fractions). The stratification factors include the primary site and nodal stage. The RT dose prescribed is 66Gy in 30 fractions for high-risk PTV and 54Gy in 30 fractions for low-risk PTV over six weeks, along with concurrent chemotherapy. The primary endpoint is to compare salivary toxicity between arms using salivary scintigraphy 12 months' post-radiation. To detect a 25% improvement in the primary endpoint at 12 months in the ART arm with a two-sided 5% alpha value and a power of 80% (and 10% attrition ratio), a sample size of 130 patients is required (65 patients in each arm). The secondary endpoints include acute and late toxicities, locoregional control, disease-free survival, overall survival, quality of life, and xerostomia scores between the two arms.

DISCUSSION

The ReSTART trial aims to answer an important question in Radiation Therapy for HNSCC, particularly in a resource-limited setting. The uniqueness of this trial, compared to other ongoing randomized trials, includes the PTV margins and the xerostomia assessment by scintigraphy at 12 months as the primary endpoint.

Feasibility of loupe assisted subinguinal varicocelectomy in treatment of male infertility

OBJECTIVES

To study the impact of loupe assisted subinguinal varicocelectomy on semen quality, serum testosterone level, and spontaneous pregnancy rate.

METHODS

The data were prospectively collected for 102 infertile men with clinical varicocele. The preoperative values of semen analysis parameters and serum testosterone level were compared with postoperative values at 6 months. Spontaneous pregnancy was assessed at 6 months.

RESULTS

The mean age of patients was 31.56 ± 4.31 years. Primary infertility was reported in 86 patients, while 16 had secondary infertility. Bilateral varicocele was seen in 79 patients while 23 had a unilateral varicocele. The total sperm concentration (×10⁶/mL) before and after varicocelectomy was 12.82 ± 3.91 and 20.06 ± 2.13 respectively (P < .0001). The total sperm motility (%) before and after varicocelectomy was 37.67 ± 7.23 and 55.46 ± 4.51 respectively (P < .0001). The sperm morphology (Kruger/Strict morphology criteria, %) before and after varicocelectomy was 3.11 ± 0.80 and 3.70 ± 0.78 respectively (P < .0001). The serum testosterone level (ng/dL) before and after varicocelectomy was 323.90 ± 67.81 and 396.74 ± 40.88 respectively (P < .0001). The Spontaneous pregnancy rate in couples with primary and secondary infertility was 18.60% and 31.25% respectively. The difference in their rates was not significant (P = .251). The overall spontaneous pregnancy rate was 20.5%.

CONCLUSION

Loupe-assisted sub-inguinal varicocelectomy is a safe and effective modality for treating infertile men, particularly when provision for microscopic surgery is unavailable. However, only large size comparative studies or multi-centric trials can confirm this.

323 Carcinoma of Prostate Masquerading as Retroperitoneal Lymphoma

Prostate cancer is the fifth most common malignancy worldwide and the second most common in men. It usually metastasizes to the bony skeleton, followed by lung, liver, pleura, and adrenals. We report a 71-year-old male patient who initially presented only with retroperitoneal lymphadenopathy and constitutional symptoms, misleading the diagnosis of retroperitoneal lymphoma. Who later on was discovered to have carcinoma prostate.

318 Monopolar Versus Bipolar TURBT: Bradford Experience

Aim

To compare the safety and efficacy of monopolar vs bipolar TURBT.

Method

This was a randomized control trial done over 18 months with patients being allotted randomly into the bipolar and monopolar arms. The study was carried out in the department of urology at BRI and YC. All consecutive patients undergoing TURBT for suspected bladder tumors were eligible for the study. The diagnosis was based on imaging and/or cystoscopy. Exclusion criteria included refusal to participate, unfitness for spinal anesthesia, and lack of tumor in the lateral wall. The primary objective was to compare the incidence of obturator jerk in monopolar and bipolar TURBT. The secondary objective was to study and compare the quality of histopathology specimen, detrusor muscle identification, and bladder perforation.

Results

A total of 95 transurethral resections were done over the study period. All these patients were eligible for inclusion in the study, 50 in monopolar and 45 in the bipolar arms, were analyzed. Both the study groups were comparable for age, sex, and tumor size. The incidence of obturator jerk was greater in the bipolar arm (8.8 %% vs 2%, P- value=2.25). The difference in the incidence of obturator jerk in the two arms was not statistically significant (Chi-Square test). There was no significant difference in either of the secondary outcomes.

Conclusions

The bipolar transurethral resection of the bladder tumor was not superior to monopolar resection concerning the obturator jerk, bladder perforation, and histopathological quality of the resected specimen.

322 Feasibility of Loupe Assisted Subinguinal Varicocelectomy in Treatment of Male Infertility

Aim

To study the impact of loupe-assisted subinguinal varicocelectomy on semen quality, serum testosterone level, and spontaneous pregnancy rate.

Method

The data were prospectively collected for 102 infertile men with clinical varicocele. The preoperative values of semen analysis parameters and serum testosterone level were compared with postoperative values at 6 months. Spontaneous pregnancy was assessed at 6 months.

Results

The mean age of patients was 31.56 ± 4.31 years. Primary infertility was reported in 86 patients, while 16 had secondary infertility. Bilateral varicocele was seen in 79 patients while 23 had a unilateral varicocele. The total sperm concentration (x106/ml) before and after varicocelectomy was 12.82 ±3.91 and 20.06 ±2.13 respectively (p&lt;0.0001). The total sperm motility (%) before and after varicocelectomy was 37.67 ±7.23 and 55.46 ±4.51 respectively (p&lt;0.0001). The sperm morphology (Kruger/Strict morphology criteria, %) before and after varicocelectomy was 3.11 ±0.80 and 3.70 ±0.78 respectively (p&lt;0.0001). The serum testosterone level (ng/dl) before and after varicocelectomy was 323.90 ±67.81 and 396.74 ±40.88 respectively (p&lt;0.0001). The Spontaneous pregnancy rate in couples with primary and secondary infertility was 18.60% and 31.25% respectively. The difference in their rates was not significant (p = 0.251). The overall spontaneous pregnancy rate was 20.5 %.

Conclusions

Loupe-assisted sub-inguinal varicocelectomy is a safe and effective modality for treating infertile men, particularly when provision for microscopic surgery is unavailable. However, only large-size comparative studies or multi-centric trials can confirm this.

Outcomes of a conservative approach to management in amoebic liver abscess

Context:

Unfortunately, there is confusion among the medical community regarding the management of amoebic liver abscess (ALA). Therapeutic options range from simple pharmacotherapy to use of interventions like a needle or catheter aspiration under ultrasound guidance to surgical intervention. There is a plethora of thresholds for parameters such as the maximum diameter of the abscess and volume on ultrasound examination suggested by various authors to serve as a criterion to help to decide when to use which modality in these cases.

Aims:

To assess the outcome of patients with uncomplicated ALA treated using a conservative approach. Moreover, to identify factors associated with its failure.

Settings and Design:

A prospective, observational study was carried out at a large municipal urban health care center over a period of 3-year (2011–2014) in India.

Materials and Methods:

Patients with uncomplicated ALA were recruited. All patients were managed with pharmacotherapy initially for a period of 72 h. Response to treatment was assessed by resolution of symptoms within the given time frame. Failure to respond was considered an indication for intervention. Needle aspiration was offered to these patients and response assessed within 72 h. Failure to respond to aspiration was considered an indication for catheter drainage. Statistical Analysis Used: Data recorded were entered in a Microsoft Office Excel Sheet and analyzed using the SPSS version 16.0 (IBM).

Results:

Sixty patients with ALA were included in the study over its duration. Forty-nine (81.67%) patients were managed conservatively, while 11 (18.33%) patients needed an intervention for relief. Patients who required intervention had deranged liver function at presentation, a larger abscess diameter (10.09 ± 2.23 vs. 6.33 ± 1.69 cm P < 0.001) and volume (399.73 ± 244.46 vs. 138.34 ± 117.85 ml, P < 0.001) compared to those who did not need it. Patients that required intervention had a longer length of hospital stay (7.1 ± 2.4 vs. 4.8 ± 0.9 days, P < 0.001). On post hoc analysis, a maximum diameter of >7.7 cm was found to be the optimal criterion to predict the need of intervention in cases of ALA.

Conclusions:

A conservative approach is effective in the management of ALA for a majority of patients. Failure of conservative management was predicted by the size of the abscess (maximum diameter >7.7 cm). Even in the cases of failure, a gradual step-up with interventions was found to be safe and effective.

Fluidized glass beads reduce fouling in a novel anaerobic membrane bioreactor

This study focuses on the use of fluidized glass beads as turbulence promoters in a laboratory-scale anaerobic membrane bioreactor treating municipal wastewater at 20 °C. The addition of fluidized glass beads into an external tubular ceramic membrane enabled the operation at low crossflow velocities of 0.053-0.073 m/s (mean fluxes between 5.5 and 9.7 L/(m²·h)) with runtimes >300 h. Glass beads with a diameter of 1.5 mm were more effective than smaller ones with a diameter of 0.8-1.2 mm. Increasing the bed voidage from 74 to 80% did not show any beneficial effect. As scanning electron microscope examination showed, the fluidized glass beads damaged the used membrane by abrasion. The overall total chemical oxygen demand (COD) removal was between 77 and 83%, although mean hydraulic retention times were only between 1.3 and 2.3 h. The production of total methane was increased about 30% in comparison to the bioreactor without membrane. The increased methane production is presumably attributed to biological conversion of rejected, dissolved and particulate organic matter. The total required electrical energy was predicted to be about 0.3 kWh/m³.

Congenital kyphosis in thoracic spine secondary to absence of two thoracic vertebral bodies

Congenital thoracic kyphosis at D6-D7 vertebral body level has been encountered in an 18-month-old boy without neurological deficit. The constellation of the spine malformation complex such as incomplete development of the vertebral bodies associated with defective ossification of the thoracic pedicles causing effectively the development of spinal cord injury at the kyphotic level of D6-D7 were present. Congenital kyphosis in thoracic spine secondary to absence of two thoracic vertebral bodies has been reported in a few studies. It is the absence and asymmetry of growth plates that may contribute to a congenital defect. Congenital Kyphosis refers to the normal convex curvature of the spine as it occurs in the thoracic and sacral regions since birth. Congenital kyphosis is an uncommon, but potentially devastating anomaly of the spine. It is one of the important aetiology for spinal cord compression leading to further neurological complications. Congenital kyphosis although rare, is more associated with neurological complication. Early identification not only helps in understanding its natural history but also helps in deciding its management.

An experience with 156 patients attending a newly organized pain and palliative care clinic in a tertiary hospital

CONTEXT

Pain and palliative care clinic (PCC).

AIMS

The primary object of this study was to enumerate the demographic characteristics of patients attending a newly organized PCC. The secondary purpose was to detect symptom prevalence and frequency of different cancers in these patients.

SETTINGS AND DESIGN

Prospective cross-sectional descriptive study.

MATERIALS AND METHODS

A prospective cross-sectional descriptive study was done on patients referred to the PCC of a tertiary hospital in North India. Comprehensive details of all patients were recorded systematically on the first visit on a proforma specially prepared for the newly established palliative care clinic.

STATISTICAL ANALYSIS USED

The descriptive statistics of palliative care data was presented in terms of frequencies and percentages (%) for categorical variables.

RESULTS

The data collected at our PCC showed that out of 156 patients, 87 were males and 69 were females. Patients of all ages varying from 6 to 85 years were seen. Most patients (82.1%) lived with their families, and 28 (17.1%) patients lived alone and had no financial support. The most common primary diagnoses were head and neck cancers (38.5%), carcinoma cervix (15.4%), breast cancer (10.3%), colorectal cancer (6.4%), and lung cancer (4.5%). Frequency of seven most common symptoms was pain (100%), insomnia (64.1%), loss of appetite (34.6%), nausea (32.7%), vomiting (32.1%), constipation (31.4%) and sore mouth (28.8%).

CONCLUSIONS

Population-based studies determine the actual magnitude of sufferers and suffering and show that palliative care services should be included as an essential component in a tertiary care hospital. The objective should be to reach out to the patient and help in improving the patent's quality of life in every way possible.

Osteopontin signaling upregulates cyclooxygenase-2 expression in tumor-associated macrophages leading to enhanced angiogenesis and melanoma growth via α9β1 integrin

Tumor-associated macrophages (TAMs) have multifaceted roles in tumor development, particularly linked with tumor angiogenesis and invasion, but the molecular mechanism underlying this association remains unclear. In this study, we report that lack of osteopontin (OPN) suppresses melanoma growth in opn(-/-) mice and macrophages are the crucial component responsible for OPN-regulated melanoma growth. In tumor microenvironment, OPN activates macrophages and influences angiogenesis by enhancing cyclooxygenase-2 (COX-2)-dependent prostaglandin E2 (PGE2) production in an autocrine manner. Furthermore, we identify α9β1 integrin as a functional receptor for OPN that mediates its effect and activates ERK and p38 signaling, which ultimately leads to COX-2 expression in macrophages. The major role played by OPN and PGE2 in angiogenesis are further amplified by upregulation of MMP-9. OPN-activated macrophages promote the migration of endothelial and cancer cells via PGE2. These findings provide evidence that TAMs serve as source of key components such as OPN and COX-2-derived PGE2 and MMP-9 in melanoma microenvironment. Clinical specimens analyses revealed that increased infiltration of OPN-positive TAMs correlate with melanoma growth and angiogenesis. These data provide compelling evidence that OPN and COX-2 expressing macrophages are obligatory factors in melanoma growth. We conclude that OPN signaling is involved in macrophage recruitment into tumor, and our results emphasize the potential role of macrophage in modulation of tumor microenvironment via secretion of OPN, PGE2 and MMP-9, which trigger angiogenesis and melanoma growth. Thus, blockade of OPN and its regulated signaling network provides unique strategy to eradicate melanoma by manipulating TAMs.

Hypoxia-driven osteopontin contributes to breast tumor growth through modulation of HIF1α-mediated VEGF-dependent angiogenesis

Hypoxia is a salient feature of most solid tumors, and hypoxic adaptation of cancer cells has crucial implications in propagation of malignant clonal cell population. Osteopontin (OPN) has been identified as a hypoxia-responsive gene, but the mechanistic and regulatory role of OPN under hypoxia is less characterized. The present study identifies the existence of a positive inter-regulatory loop between hypoxia and OPN. We have shown that hypoxia induces OPN expression in breast cancer cells; however, the expression was found to be HIF1α independent. OPN enabled transcriptional upregulation of HIF1α expression both under normoxia and hypoxia, whereas stability of HIF1α protein in breast cancer cells remained unaffected. Moreover, we have shown that OPN induces integrin-linked kinase (ILK)/Akt-mediated nuclear factor (NF)-κB p65 activation leading to HIF1α-dependent vascular endothelial growth factor (VEGF) expression and angiogenesis in response to hypoxia. These in vitro data are biologically important as OPN expressing cells induce greater tumor growth and angiogenesis through enhanced expressions of proangiogenic molecules as compared with control. Immunohistochemical analysis of human breast cancer specimens revealed significant correlation between OPN and HIF1α but not HIF2α. Elevated expression of HIF1α and OPN was observed in pre-neoplastic and early stage infiltrating ductal carcinoma implicating the role of these proteins in neoplastic progression of breast cancer. Together, our results substantiate the prime role of OPN in cellular adaptation through ILK and NF-κB-mediated HIF1α-dependent VEGF expression in response to hypoxia that ultimately controls breast cancer progression and angiogenesis. Our study reinforces the fact that targeting OPN and its regulated signaling network hold important therapeutic implications.

Study of Glycerol and Sweet Water as a Carbon Source for Production of Rhamnolipids by Naturally Occurring Strains of Pseudomonas aeruginosa (ATCC 10145 and ATCC 9027)

The interest in biosurfactant has increased considerably due to their large potential for industrial applications. Rhamnolipid is a simplest class of biosurfactants with well defined structure. The main obstacle in commercialization of biosurfactant especially rhamnolipids is the higher cost of the production. Glycerol is readily available from commercial fat-splitting process in the form of sweet water (up to 20% w/v) at very low cost. Two natural strains of Pseudomonas aeruginosa (ATCC 10145 and ATCC 9027) were compared for rhamnolipid production. The neotype strain of Pseudomonas aeruginosa (ATCC 10145) was found to produce more amounts of rhamnolipids than Pseudomonas aeruginosa (ATCC 9027) on glucose and glycerol as carbon source. The microbial growth (0.94 g/L) and formation of rhamnolipids (2.75 g/L) was maximum at 5% (w/v) glycerol concentration by Pseudomonas aeruginosa (ATCC 10145). The fermentation was monitored for 8 days on shake flask and magnetically stirred batch culture. In magnetically stirred batch culture, microbial growth was 0.69 g/L and 2.73 g/L of rhamnolipid was formed. Sweet water was also used as a source of glycerol.

Screening of protease producing fungi for microbial digestion of seed proteins and synthesis of amino acids-metalnutrient chelates

The problem of metalnutrient deficiency is becoming more serious with the introduction of modern agricultural practices. As a result, metalnutrient deficiency is recognized as one of the critical yield limiting factors. Metalnutrients are generally offered in their sulphate or oxide forms. However, it is reported that organically bound minerals generally have a higher bioavailability than inorganic minerals. Chelation makes otherwise unavailable metalnutrients plant available. Amino acids are well known among various chelating agents. In present investigation the fungus Paecilomyces variotii PR-4 was isolated from soil and was used for production of protease and determination of its activity. Proteins from germinating seeds of chick pea, mung bean, soybean and cowpea were hydrolyzed for the production of amino acids. Amino acids were recovered, estimated and utilized for chelation of metalnutrients viz., Zn, Cu, Fe, Mn, Mg, B and Mo. The resultant chelates were employed to detect with Fourier Transform Infra-Red Spectrophotometer (FTIR) analysis. The peaks of most intensive bands in the IR spectra of ligands recorded were present in the intervals of the wave numbers 3500-3300 and 1720-1700 cm(-1). Chelation of metalnutrients led to the broadening of peak and changes of the peak position of hydroxyl groups, which indicated the binding of the carboxylic groups and primary amine groups of amino acids to the metalnutrients. The resultant amino acids-metalnutrient chelates can be utilized as organic fertilizer.

A hypothesis to explain how LaeA specifically regulates certain secondary metabolite biosynthesis gene clusters

Biosynthesis of mycotoxins involves transcriptional co-regulation of sets of clustered genes. We hypothesise that specific control of transcription of genes in these clusters by LaeA, a global regulator of secondary metabolite production and development in many filamentous fungi, results from its interaction with a Cys6Zn2 DNA-binding protein unique to the gene cluster.

Uptake and degradation of DDT by hairy root cultures of Cichorium intybus and Brassica juncea

Hairy root cultures of Cichorium intybus and Brassica juncea were used for their ability to uptake and degrade DDT (1,1,1-trichloro-2,2-bis-(4'-chlorophenyl)ethane). After 24 h of 14C DDT treatment, only 12-13% of the total applied radioactivity was detected in the culture media, indicating the efficient uptake of DDT by the hairy roots. The majority of the applied radioactivity was associated with the roots. DDT was degraded to various other products such as DDD, DDE and DDMU, along with some unknown compounds by hairy root cultures, which were detected by thin layer chromatography (TLC) and autoradiography. The rate of in situ degradation was found to be higher during the initial stages of culture and the residual 14C DDT in the roots was found to decrease from 77% to 61% over a period of 10-days. There was no spontaneous degradation of 14C DDT in media lacking hairy root cultures or in media with autoclaved hairy roots. This suggests that endogenous root enzymes play a role in the breakdown of 14C DDT. These results suggest the potential applicability and advantage of using these plant species for phytoremediation of persistent xenobiotics such as DDT in an eco-friendly and efficient manner for environmental clean up.

Serous fluid leakage following modified Blalock-Taussig operation using PTFE grafts

BACKGROUND

Serous fluid leakage is an unusual but often devastating complication following the placement of a modified Blalock-Taussig shunt using a polytetrafluoroethylene graft.

METHOD AND RESULTS

Between September 1994 and September 1999, out of 268 patients undergoing a modified Blalock-Taussig shunt using polytetrafluoroethylene grafts, 10 developed massive pleural effusion or seroma due to a leak from the surface of the shunt. The age of the patients ranged from 9 days to 7 years. There were 7 males and 3 females. Nine patients presented with respiratory distress between 2 and 12 weeks of shunt surgery and one presented with sudden cardiac arrest. The shunt was patent in all the patients. Initial management was conservative. i.e. by pharmacological means and tube thoracostomy. Reoperation was undertaken in 9 patients when conservative treatment failed. All patients survived except one who had a cardiac arrest before any intervention could be carried out.

CONCLUSIONS

Patients with serous effusion have significant morbidity and mortality and often require reoperation. The initial management remains conservative but, if unsuccessful, re-exploration can be undertaken as it proved to be uniformly successful in our experience.

Osteopoiesis: the early development of bone cells

An understanding of the disorders of bone formation clearly requires insights into the complex regulatory events occurring during the evolution of bone precursor cells into osteoblasts. Moreover, a rational approach to therapeutic interventions that might alter the clinical course of bone disorders must take into consideration the exact nature of the developmental control mechanism(s) being affected during the disease process. The process of osteopoiesis involves the proliferation and maturation of primitive precursor cells into functional osteoblasts. The bone cell lineage originates from mesenchymal stem cells that commit to the osteogenic cell lineage becoming osteoprogenitor cells, preosteoblasts, osteoblasts, and osteocytes. In order to understand how different regulatory signals coordinate bone cell development, it is important to study the responses of bone progenitor cells to different microenviromental signals. This requires that lineage markers be identified for the various populations of bone cells and their precursors, that cell separation techniques be established so that cells of the osteogenic lineage can be purified at different stages of differentiation, and that these isolated cells are studied under serum-free, chemically defined conditions. This review focuses on the current understanding of bone progenitor cell development, examining the various types of precursor cells, their responses to cytokines and other extracellular influences, and recent observations on the biochemical and molecular control of lineage-specific gene expression. Although the emphasis is on human cells, the importance of work using rodent cells goes without saying, and is addressed where relevant.

Three-dimensional cellular development is essential for ex vivo formation of human bone

Tissue engineering of human bone is a complex process, as the functional development of bone cells requires that regulatory signals be temporally and spatially ordered. The role of three-dimensional cellular interactions is well understood in embryonic osteogenesis, but in vitro correlates are lacking. Here we report that in vitro serum-free transforming growth factor (TGF)-beta1 stimulation of osteogenic cells immediately after passage results in the formation of three-dimensional cellular condensations (bone cell spheroids) within 24 to 48 hours. In turn, bone cell spheroid formation results in the up-regulation of several bone-related proteins (e.g., alkaline phosphatase, type I collagen, osteonectin) during days 3-7, and the concomitant formation of micro-crystalline bone. This system of ex vivo bone formation should provide important information on the physiological, biological and molecular basis of osteogenesis.

Bone marrow accessory cells regulate human bone precursor cell development

OBJECTIVE

Much remains to be learned about the intimate relationship between bone marrow and its surrounding tissue: the bone. We hypothesized that bone marrow accessory cell populations might regulate the development of human bone precursor cells.

MATERIALS AND METHODS

We used immunologic phenotyping, and isolation methods to fractionate subpopulations of nonadherent, low-density (NALD) human bone marrow cells. These cells were examined for their ability to support the serum-free survival, proliferation, and expression of bone proteins by highly purified populations of human bone precursor cells. Quantitative assessment of the accessory cell populations as well as human bone precursor cells phenotype was performed using multiparameter flow cytometry. Bone protein expression was evaluated by immunocytochemistry, Western analysis, and enzymatic analysis (for alkaline phosphatase activity).

RESULTS

Human bone marrow contains a cell population that stimulates the development of purified bone precursor cells. Feeder-layer studies demonstrate that these osteopoietic accessory cells (OACs) do not require cell-cell interaction to promote bone precursor cell development but, rather, produce soluble molecules responsible for their effects. Flow cytometric analyses reveal that bone marrow derived B cells, T cells, macrophages, natural killer cells, and endothelial cells do not produce this stimulatory factor. The (growth) factor cannot be replaced by addition of exogenous cytokines. The isolation of human transforming growth factor beta receptor type II (TGF-betaRII)-positive cells increases OAC-specific activity in bone cell ex vivo expansion cultures. Moreover, isolation of OAC bone marrow cells characterized by high TGF-betaRII expression, relatively low cellular complexity, and small size yields a population that is highly enriched for OACs.

CONCLUSION

We conclude that human bone marrow contains a population of OACs that are an obligate requirement for the early phases of bone cell development ex vivo.

Effect of whole-body vibration on the low back. A study of tractor-driving farmers in north India

STUDY DESIGN

A retrospective cohort study of tractor-driving farmers (study group) and non-tractor-driving farmers (control group) matched for age, gender, generic/ethnic group, land-holding, and work routines.

OBJECTIVES

To determine, using magnetic resonance imaging and clinical investigations, the effect of whole-body vibrations on the back in tractor-driving farmers.

SUMMARY OF BACKGROUND DATA

Low back pain and pathologic changes in the lower backs of tractor drivers have been reported. However, no study with a control group matched for work-related risk factors has been reported.

METHODS

Fifty tractor-driving farmers were compared with 50 non-tractor-driving farmers matched for age, gender, ethnic group, land-holding, and work routine. Both groups were interviewed for details of work routine, assets held, family profile, and vibration exposure to assess the influence of these parameters on signs and symptoms of backache. Magnetic resonance imaging was done to assess the effect of exposure on whole-body vibration and degenerative changes in the back. Vibration measurements also were done on tractors to observe the actual severity of the vibrations.

RESULTS

Regular work-related backache was more common among tractor-driving farmers (40%) than among non-tractor-driving farmers (18%, P = 0.015). Anthropometric evaluation showed abdominal girth and weight to be significantly higher in tractor-driving farmers (P = 0.006 and 0.046, respectively), whereas while height and arm span were similar between the two groups. Clinical examination for evidence of disc or facet degeneration showed no difference between the two groups. Evaluation of magnetic resonance images of tractor-driving farmers and non-tractor-driving farmers by an orthopedic surgeon, radiologist, and neurosurgeon showed degenerative changes to be similar between the two groups (P > 0.050).

CONCLUSIONS

Tractor-driving farmers report backache more often than non-tractor-driving farmers, but no significant objective differences on clinical or magnetic resonance imaging evaluation were found between the two groups.

LAG2, a gene that determines yeast longevity

Saccharomyces cerevisiae has a limited life span, measured by the reproductive capacity of the individual cell. Several genes that are differentially expressed during the yeast life span have been isolated. One of these genes, LAG2, has been characterized for its role in longevity. LAG2 is preferentially expressed in young cells. It encodes a predicted 680 amino acid protein with a putative transmembrane helix. The sequences does not show significant similarity to any other DNA or protein sequences in the databases. Deletion of LAG2 in a haploid strain did not affect growth, but it resulted in a 50% decrease in the mean and maximum life span. When LAG2 was overexpressed, the mean and maximum life span of the yeasts was extended by about 36% and 54%, respectively. These results indicate that this is a longevity-assurance gene in yeast.

Urinary tract infection in nephrotic syndrome

BACKGROUND

The aim was to study the frequency, etiology and predisposing factors of urinary tract infection (UTI) in children with nephrotic syndrome.

METHODS

A retrospective analysis of all children with nephrotic syndrome was made to determine the occurrence of infectious complications.

RESULTS

UTI was found to be the most common infection (40.26%); 49 episodes of culture-positive UTI were observed in 37 children. All 49 episodes occurred in patients who were initially considered to be steroid nonresponders or in relapse. Fourteen of the 49 episodes (28.6%) were asymptomatic. One child had Grade IV reflux and another had a ureteric calculus. The majority of the children had no underlying urinary tract malformations. The children with UTI had significantly lower serum albumin (P < 0.05) and higher serum cholesterol (P < 0.001) concentrations than the group of 206 children without infections. Non-Escherichia coli organisms accounted for 39% of the culture isolates.

CONCLUSIONS

We believe that UTI is an important but often underdiagnosed infection in children with nephrotic syndrome.

Is McMurray's osteotomy obsolete?

A review of the method of performing, advantages, disadvantages of McMurray's displacement osteotomy with regard to treatment of nonunion of transcervical fracture neck femur with viable femoral head was carried out in this study of ten cases, in view of the abandonment of the procedure in favour of angulation osteotomy. Good results obtained in the series attest to the usefulness of McMurray's osteotomy in the difficult problem of nonunion of transcervical fracture neck femur in well selected cases with certain advantages over the angulation osteotomy due to the 'Armchair effect'.

Effect of Beconase nasal spray on olfactory function in post-nasal polypectomy patients: a prospective controlled trial

Numerous studies have postulated the possible benefit of corticosteroids on olfaction in patients with nasal/sinus disease. Twenty-nine patients with bilateral nasal polyps were included in our study using strict selection criteria to reduce other aetiologies of olfactory dysfunction. The University of Pennsylvania Smell Identification Test (UPSIT) was performed pre-operatively on the right and left nostrils separately. Following intranasal polypectomy the patients received a six-week course of beclomethasone nasal spray (Beconase) to one nostril only, with the other acting as a control. The UPSIT scores were again obtained for each nostril separately. Wilcoxon Signed Rank test revealed no statistically significant difference in UPSIT scores between treated and untreated nostrils (p = 0.31; power 70 per cent; ES = 0.47). We conclude that topical beclomethasone does not improve olfaction following nasal polypectomy.

Adaptive speckle reduction for improving the differential diagnosis of breast lesions

Adaptive speckle reduction could mask diagnostic features and adversely affect diagnosis of focal breast lesions. Four radiologists assessed focal breast lesions (29 malignant and 31 benign) by blind review of representative static B-mode scans before and after adaptive speckle reduction processing, scoring 14 diagnostic features for breast cancer and recording their opinions on the diagnosis and on how adaptive speckle reduction affected interpretation of each feature. No adverse affect on diagnosis of malignant (P = 0.756) or benign (P = 1.000) breast lesions was found, despite some differences in scoring of the diagnostic features after adaptive speckle reduction. Observer recognition of most diagnostic features was easier after adaptive speckle reduction (e.g., edge definition [50% of cases], edge regularity [40%], lesion texture [44%], and lesion echogenicity [35%]).

Dual role of calmodulin in excitable cells

Consideration of the enzymatic reactions governing calcium channel phosphorylation and dephosphorylation leads one to deduce that there exist separate groups of enzymes, membrane-bound and cytoplasmic that are activated by a common mediator, calmodulin (CaM), whose time-dependent appearance (via diffusion) at both locales is controlled by both intracellular calcium levels and electrostatic interaction with the membrane. In brief, the change in the sign and extent of the electrical charge borne by the modulator in the presence of calcium (Ca) brings about the electrostatic attraction that enables the transport of [Ca-CaM] to the membrane. This translocation of Ca-CaM makes possible a sequential activation of cellular enzymes whose locations differ. The sequence, both spatial and temporal, of the activation of various cellular enzymes by Ca-CaM appears to be a control network shared in common by excitable cells containing a stimulus-response pathway mediated by second messengers.