InGaN islands and thin films grown on epitaxial graphene

In this work, the growth of InGaN on epitaxial graphene by molecular beam epitaxy is studied. The nucleation of the alloy follows a three-dimensional (3D) growth mode in the observed temperature range of 515 °C-765 °C, leading to the formation of dendrite-like islands. Careful Raman scattering experiments show that the graphene underneath is not degraded by the InGaN growth. Moreover, lateral displacement of the nuclei during an atomic force microscopy (AFM) scan demonstrates weak bonding interactions between the InGaN and the graphene. Finally, a longer growth time of the alloy gives rise to a compact thin film in a partial epitaxial relationship with the SiC underneath the graphene.

Electromagnetic character of the competitive γγ/γ-decay from 137mBa

Second-order processes in physics is a research topic focusing attention from several fields worldwide including, for example, non-linear quantum electrodynamics with high-power lasers, neutrinoless double-β decay, and stimulated atomic two-photon transitions. For the electromagnetic nuclear interaction, the observation of the competitive double-γ decay from ^137mBa has opened up the nuclear structure field for detailed investigation of second-order processes through the manifestation of off-diagonal nuclear polarisability. Here, we confirm this observation with an 8.7σ significance, and an improved value on the double-photon versus single-photon branching ratio as 2.62 × 10^-6(30). Our results, however, contradict the conclusions from the original experiment, where the decay was interpreted to be dominated by a quadrupole-quadrupole component. Here, we find a substantial enhancement in the energy distribution consistent with a dominating octupole-dipole character and a rather small quadrupole-quadrupole component in the decay, hindered due to an evolution of the internal nuclear structure. The implied strongly hindered double-photon branching in ^137mBa opens up the possibility of the double-photon branching as a feasible tool for nuclear-structure studies on off-diagonal polarisability in nuclei where this hindrance is not present.

Preliminary results for the 19F(ρ,α)16O reaction cross section measured at INFN-LNS

The 19F(ρ,α)16O reaction is an important fluorine destruction chan- nel in the proton-rich outer layers of asymptotic giant branch (AGB) stars and it might also play a role in hydrogen-deficient post-AGB star nucleosynthesis. At present, theoretical models overproduce F abundances in AGB stars with re-spect to the observed values, thus calling for further investigation of the nuclear reaction rates involved in the production and destruction of fluorine. In the last years, new direct and indirect measurements improved significantly the knowl- edge of 19F(ρ,α)16O cross section at deeply sub-Coulomb energies (below 0.8 MeV). However, those data are larger by a factor of 1.4 with respect the previ- ous data reported in the NACRE compilation in the energy region 0.6-0.8 MeV. Using the Large High resolution Array of Silicons for Astrophysics (LHASA), we performed a new direct measurement of the 19F(ρ,α)16O. The goal of this experiment is to reduce the uncertainties in the nuclear reaction rate of the 19F(ρ,α)16O reaction. Here, experimental details, the calibration procedure and angular distributions are presented.

The Association Between Six Surrogate Insulin Resistance Indexes and Hypertension: A Population-Based Study

Background: The relationship between insulin resistance and hypertension is well established, but the association of different surrogate insulin resistance indexes with the presence of hypertension is still under debate. The aim of this study was to compare the strength of the association between the presence of hypertension and six indexes: triglyceride/HDL cholesterol ratio (TG/HDL-C), Triglyceride Glucose (TyG) Index, Visceral adiposity index (VAI), Lipid accumulation product (LAP), TyG-Body mass index (TyG-BMI), and TyG-Waist circumference (TyG-WC). Methods: Data from a cross-sectional epidemiological study enrolling a sample representative for the Romanian population aged 18-80 years, excluding those with diabetes or requiring treatment for hypertriglyceridemia, were used to calculate the six indexes. The association with the presence of hypertension was examined with binomial and multinomial logistic regression. Results: In multinomial logistic models, which included age, gender, smoking, drinking, sedentary lifestyle, estimated glomerular filtration rate, urinary sodium, urinary albumin creatinine ratio, and use of medications known to influence insulin resistance as covariates, all individual components and surrogate insulin resistance indexes were independently associated with the presence of hypertension. Values of pseudo R square ranged from 0.342 for the multivariate model including TG/HDL-C to 0.357 for the model including TyG-WC, but with no clear superiority of any of the tested indexes over all others. Models including BMI and WC had a similar ability to predict the presence of hypertension as most of the surrogate indexes and they were slightly superior to TG/HDL-C and TyG. Conclusions: Although TG/HDL-C, VAI, LAP, TyG, TyG-BMI, and TyG-WC were independently associated with the presence of hypertension, no superiority could be demonstrated over the use of BMI and WC as predictors of hypertension in this cross-sectional study.

The extreme light infrastructure-nuclear physics (ELI-NP) facility: new horizons in physics with 10 PW ultra-intense lasers and 20 MeV brilliant gamma beams

The European Strategy Forum on Research Infrastructures (ESFRI) has selected in 2006 a proposal based on ultra-intense laser fields with intensities reaching up to 10²²-10²³ W cm^-2 called 'ELI' for Extreme Light Infrastructure. The construction of a large-scale laser-centred, distributed pan-European research infrastructure, involving beyond the state-of-the-art ultra-short and ultra-intense laser technologies, received the approval for funding in 2011-2012. The three pillars of the ELI facility are being built in Czech Republic, Hungary and Romania. The Romanian pillar is ELI-Nuclear Physics (ELI-NP). The new facility is intended to serve a broad national, European and International science community. Its mission covers scientific research at the frontier of knowledge involving two domains. The first one is laser-driven experiments related to nuclear physics, strong-field quantum electrodynamics and associated vacuum effects. The second is based on a Compton backscattering high-brilliance and intense low-energy gamma beam (<20 MeV), a marriage of laser and accelerator technology which will allow us to investigate nuclear structure and reactions as well as nuclear astrophysics with unprecedented resolution and accuracy. In addition to fundamental themes, a large number of applications with significant societal impact are being developed. The ELI-NP research centre will be located in Măgurele near Bucharest, Romania. The project is implemented by 'Horia Hulubei' National Institute for Physics and Nuclear Engineering (IFIN-HH). The project started in January 2013 and the new facility will be fully operational by the end of 2019. After a short introduction to multi-PW lasers and multi-MeV brilliant gamma beam scientific and technical description of the future ELI-NP facility as well as the present status of its implementation of ELI-NP, will be presented. The science and examples of societal applications at reach with these electromagnetic probes with much improved performances provided at this new facility will be discussed with a special focus on day-one experiments and associated novel instrumentation.

Development of the ELISSA array: prototype testing at Laboratori Nazionali del Sud

The Extreme Light Infrastructure-Nuclear Physics (ELI-NP) facility, underconstruction in Magurele near Bucharest in Romania, will provide high-intensity andhigh-resolution gamma ray beams that can be used to address hotly debated problems in nuclear astrophysics, such as the accurate measurements of the cross sections of the24Mg(γ,α)20Ne reaction

For this purpose, a silicon strip detector array (named ELISSA) will be realized in acommon effort by ELI-NP and Laboratori Nazionali del Sud (INFN-LNS), in order to measure excitation functions and angular distributions over a wide energy and angular range. A prototype of ELISSA was built and tested at INFN-LNS in Catania (Italy) with the support of ELI-NP. In this occasion, we have carried out experiments with alpha sources and with a 11 MeV 7Li beam that show up a very good energy resolution (better than 1%) and very good position resolution, of the order of 1 mm. Moreover, a threshold of 150 keV can be easily achieved with no cooling.

A Geant4-based Monte Carlo Tool for Nuclear Astrophysics

Present and future gamma-beam facilities represent a great opportunity to validate and evaluate the cross-sections of many photonuclear reactions at near-threshold energies, whose data mostly come from theoretical calculations. We developed a Monte Carlo (MC) software that makes use of the validatedtracking Geant4 libraries and the n-body event generator of ROOT libraries in order to provide a fast, realiable and complete MC tool to be used for nuclear physics experiments, with a particular focus on photo-nuclear processes. We discuss the results of the MC simulations performed in order to evaluate the effects of the electromagnetic background, the straggling of the emitted particles due to the target thickness and the resolution of the silicon detectors. Finally we present the preliminary results on some nuclear reactions involved in the p-process, which will be studied with ELISSA and the GBS at ELI-NP.

Capture and photonuclear reaction rates involving charged-particles: Impacts of nuclear ingredients and future measurement on ELI-NP

The astrophysical p-process is an important way of nucleosynthesis to produce the stable and proton-rich nuclei beyond Fe which can not be reached by the s- and r-processes. In the present study, the impact of nuclear ingredients, especially the nuclear potential, level density and strength function, to the astrophysical re-action rates of (p,γ), (α,γ), (γ,p), and (γ,α) reactions are systematically studied. The calculations are performed basad on the modern reaction code TALYS for about 3000 stable and proton-rich nuclei with 12≤Z≤110. In particular, both of the Wood-Saxon potential and the microscopic folding potential are taken into account. It is found that both the capture and photonuclear reaction rates are very sensitive to the nuclear potential, thus the better determination of nuclear potential would be important to reduce the uncertainties of reaction rates. Meanwhile, the Extreme Light Infrastructure-Nuclear Physics (ELI-NP) facility is being developed, which will provide the great opportunity to experimentally study the photonuclear reactions in p-process. Simulations of the experimental setup for the measurements of the photonuclear reactions 96Ru(γ,p) and 96Ru(γ,α) are performed. It is shown that the experiments of photonuclear reactions in p-process based on ELI-NP are quite promising.

HYDROCEPHALY, SCHIZENCEPHALY, SPONDYLOCOSTAL DYSPLASIA, AND HYPOPARATHYROIDISM IN AN INFANT OF A DIABETIC MOTHER

CONTEXT

Diabetes mellitus is the most frequent chronic complication in pregnancy and continues to contribute to increased perinatal morbidity and mortality in newborns. Macrosomia, respiratory distress syndrome, metabolic and electrolytic disturbances, and increased rates of congenital structural defects are well-known neonatal complications associated with maternal diabetes, even if well-controlled.

CASE REPORT

A macrosomic infant born from an insulin-dependent mother, with uncontrolled diabetes and lack of adequate prenatal care, prenatally diagnosed with hydrocephaly showed a complicated postnatal course. Initial respiratory distress syndrome and transient hypoglycemia, rapidly corrected under treatment, were followed by persistent hypocalcemia and hyperphosphatemia due to hypoparathyroidism and evolving hydrocephaly. Ventriculoperitoneal shunting was followed by resolution of hypocalcemia, but seizures associated with schizencephaly and recurrent respiratory tract infections, aggravated by spondylocostal dysplasia, concurred to infant's demise at the age of 5 months.

CONCLUSIONS

The reported case is rare due to multiple aspects: persistent hypoparathyroidism, uncommon association of schizencephaly, and even rarely association with spondylocostal dysplasia, all these conditions requiring a multidisciplinary therapeutic approach. Also, the reported case is evocative for challenges associated with infants born from diabetic mothers.

Original research. Regional Wall Motion Abnormalities and Ventricular Function in Acute Peri-Myocarditis

Introduction: Myocardial involvement in pericardial diseases and the effect of pericardial inflammation and effusion on the function of the left ventricle (LV) is still a controversial issue. The present study aimed to evaluate LV regional wall abnormalities in patients with acute peri-myocarditis, using 3D echocardiographic assessment of LV contractility. Material and methods: The study included 56 subjects divided into two groups: Group 1 - 28 subjects with acute peri-myocarditis and Group 2 - 28 healthy controls. All subjects underwent a complete clinical examination, including laboratory tests. 3D echocardiography was performed to assess the left ventricular end-diastolic (EDV) and end-systolic volumes (ESV), and to calculate specific indexes for global and regional ventricular contractility, such as the index of contraction amplitude (ICA) and the regional index of contraction amplitude (RICA) for each segment corresponding to the region affected by peri- myocarditis. Results: 3D echocardiography showed no differences between the groups regarding the EDV (p = 0.2), the LV ejection fraction (Group 1: 55.82% ± 3.36% vs. Group 2: 57.21% ± 4.69%, p = 0.2). The ESV however, was significantly higher in Group 1 compared to Group 2 (55.78 ± 5.45 ml vs. 52.20 ± 6.43 ml, p = 0.04). ICA was similar between the groups (p = 0.2). However, the RICA was significantly lower in Group 1 compared to Group 2 (2.27 ± 0.63 vs. 5.16 ± 0.54, p <0.0001). Conclusions: The extension of the inflammatory process from the pericardium to the adjacent myocardial layer may affect the contractility of the LV. A good association exists between peri-myocarditis and the regional contractility abnormalities of the LV.

THE ROLE OF ESTROGENS AND ESTROGEN RECEPTORS IN MELANOMA DEVELOPMENT AND PROGRESSION

Melanoma has a significant mortality and its growing incidence is associated with important social and health care costs. Thus, investigation of the complex mechanisms contributing to emergence and development of melanoma are of real interest both in scientific research and clinical practice. Estrogens play an important role in the emergence and development of certain types of cancer, such as breast cancer, endometrial cancer and ovarian cancer, but their role in development of cutaneous melanoma is still a matter of debate. Various data suggest that increased levels of endogenous estrogens during pregnancy or exposure to exogenous estrogens by use of oral contraceptives (OCs) and hormone replacement therapy (HRT) may have a potential role in melanoma development and progression. Moreover, there were revealed several intracellular pathways which can support the connection between estrogens, estrogen receptors (ER) and melanoma. While ER-β plays an antiproliferative role, ER-α promotes cell growth and cellular atypia. Thus, inhibition of ER-β activity in the skin can increase the risk for development of cutaneous melanoma and spread of metastatic cells. However, despite recent advances in this area, the exact role and clinical implications of estrogens and estrogen receptors in melanoma are still not entirely understood and require further investigations.

Mesostructured silica and aluminosilicate carriers for oxytetracycline delivery systems

Oxytetracycline delivery systems containing various MCM-type silica and aluminosilicate with different antibiotic content were developed in order to establish the influence of the support structural and textural properties and aluminum content on the drug release profile. The antibiotic molecules were loaded into the support mesochannels by incipient wetness impregnation method using a drug concentrated aqueous solution. The carriers and drug-loaded materials were investigated by small- and wide-angle XRD, FTIR spectroscopy, TEM and N2 adsorption-desorption isotherms. Faster release kinetics of oxytetracycline from uncalcined silica and aluminosilicate supports was observed, whereas higher drug content led to lower delivery rate. The presence of aluminum into the silica network also slowed down the release rate. The antimicrobial assays performed on Staphylococcus aureus clinical isolates showed that the oxytetracycline-loaded materials containing MCM-41-type mesoporous silica or aluminosilicate carriers inhibited the bacterial development.

Correlation Between Acute Impairment of Regional Contractility and Left Ventricular Remodeling after Revascularized Acute Myocardial Infarction

Introduction: The present study aims to demonstrate the role of acute impairment of regional contractility, as assessed by 3D echocardiography, in predicting LV remodeling in post acute myocardial infarction (AMI) patients.

Methods: We enrolled in the study a number of 48 subjects with AMI who underwent primary PCI followed by optimum medical therapy. In all these cases we followed the correlation between the amplitude of ventricular remodeling at 6 months postinfarction and regional contractility in the immediate postinfarction period, as assessed by 3D echo parameters at baseline: regional index of contraction amplitude (RICA) and the index of contraction amplitude (ICA). Positive remodeling (PR) was defined as an increase in LV end-diastolic global volume with >15% compared with baseline.

Results: Patients with positive remodeling (PR) presented at baseline a significantly lower ejection fraction (44.75% versus 49.95%, p = 0.009), associated with a higher end-systolic volume (80.34 ml vs. 70.63 ml, p = 0.02) and lower values for index of contraction amplitude — ICA (3.05 vs. 3.53, p = 0.01) and for regional index of contraction amplitude — RICA (1.38 vs. 2.78, p <0.0001), in comparison with the patients who did not experience ventricular remodeling. RICA achieved the best statistical significance for predicting the development of LV remodeling during the evolution of the disease. For RICA, the ROC curve using logistic analysis showed an area under the curve (AUC) of 0.88, highly significant (p = 0.0001).

Conclusions: Impairment of regional contractility is associated with development of LV remodeling to a more significant extent than the global impairment of ventricular contractility.

Constraint of the astrophysical ^{26g}Al(p,γ)^{27}Si destruction rate at stellar temperatures

The Galactic 1.809-MeV γ-ray signature from the β decay of ^{26g}Al is a dominant target of γ-ray astronomy, of which a significant component is understood to originate from massive stars. The ^{26g}Al(p,γ)^{27}Si reaction is a major destruction pathway for ^{26g}Al at stellar temperatures, but the reaction rate is poorly constrained due to uncertainties in the strengths of low-lying resonances in ^{27}Si. The ^{26g}Al(d,p)^{27}Al reaction has been employed in inverse kinematics to determine the spectroscopic factors, and hence resonance strengths, of proton resonances in ^{27}Si via mirror symmetry. The strength of the 127-keV resonance is found to be a factor of 4 higher than the previously adopted upper limit, and the upper limit for the 68-keV resonance has been reduced by an order of magnitude, considerably constraining the ^{26g}Al destruction rate at stellar temperatures.

Brief history of syphilis

Before the discovery of Treponema pallidum as the etiologic agent, the origins of syphilis have been the subject of several debates. Diverse therapeutic agents were employed in an attempt to cure the disease. Examining the milestones in the history of syphilis, the present article reviews the existing theories that tried to explain the origins of the disease, the approach in art, the cultural and the evolution of the treatments from the empiric means to the discovery of penicillin.

Photodynamic therapy in the treatment of basal cell carcinoma

Photodynamic therapy (PDT) is a medical procedure based on the activation of the molecules of various exogenous or endogenous chemical substances called photosensitizers by a light source emitting radiation of an adequate wavelength, usually situated in the visible spectrum; photosensitizers are chemical compounds bearing the capacity to selectively concentrate in the neoplastic cells. The energy captured by the molecules of these substances pervaded in the tumor cells is subsequently discharged in the surrounding tissue, triggering certain photodynamic reactions that result in the destruction of the tumor. The procedure is applicable in numerous medical fields. Skin basal cell carcinoma (BCC), the most frequent type of cancer of the human species, is a cutaneous tumor that responds very well to this innovative treatment method. By reviewing numerous recent studies in the field, this article aims to present the role and the indications of photodynamic therapy in the management of basal cell carcinoma, as well as the most important results achieved so far by this therapy in the field of dermato-oncology.

Neutron single particle structure in 131Sn and direct neutron capture cross sections

Recent calculations suggest that the rate of neutron capture by (130)Sn has a significant impact on late-time nucleosynthesis in the r process. Direct capture into low-lying bound states is expected to be significant in neutron capture near the N=82 closed shell, so r-process reaction rates may be strongly impacted by the properties of neutron single particle states in this region. In order to investigate these properties, the (d,p) reaction has been studied in inverse kinematics using a 630 MeV beam of (130)Sn (4.8 MeV/u) and a (CD(2))(n) target. An array of Si strip detectors, including the Silicon Detector Array and an early implementation of the Oak Ridge Rutgers University Barrel Array, was used to detect reaction products. Results for the (130)Sn(d, p)(131)Sn reaction are found to be very similar to those from the previously reported (132)Sn(d, p)(133)Sn reaction. Direct-semidirect (n,γ) cross section calculations, based for the first time on experimental data, are presented. The uncertainties in these cross sections are thus reduced by orders of magnitude from previous estimates.

Halo nucleus 11Be: a spectroscopic study via neutron transfer

The best examples of halo nuclei, exotic systems with a diffuse nuclear cloud surrounding a tightly bound core, are found in the light, neutron-rich region, where the halo neutrons experience only weak binding and a weak, or no, potential barrier. Modern direct-reaction measurement techniques provide powerful probes of the structure of exotic nuclei. Despite more than four decades of these studies on the benchmark one-neutron halo nucleus 11Be, the spectroscopic factors for the two bound states remain poorly constrained. In the present work, the 10Be(d,​p) reaction has been used in inverse kinematics at four beam energies to study the structure of 11Be. The spectroscopic factors extracted using the adiabatic model were found to be consistent across the four measurements and were largely insensitive to the optical potential used. The extracted spectroscopic factor for a neutron in an nℓj=2s(1/2) state coupled to the ground state of 10Be is 0.71(5). For the first excited state at 0.32 MeV, a spectroscopic factor of 0.62(4) is found for the halo neutron in a 1p(1/2) state.

[Multiple splenic abscesses associated with normotensive hydrocephaly]

The paper contains a concise review of the current literature on the splenic abscesses and presents an unusual association of multiple splenic abscesses with normotensive hydrocephaly to an elderly patient, treated by ventriculo-cardiac shunting and splenectomy as an one stage procedure performed by a combined surgical team (neurosurgeon, vascular surgeon and general surgeon), with a favourable outcome. As far as the authors know, this is the first communication of multiple splenic abscesses associated with adult hydrocephaly treated by a simultaneous surgical approach.

First Direct Measurement of the 17F(p,gamma)18Ne Cross Section

The rate of the (17)F(p,gamma)(18)Ne reaction is important in various astrophysical events. A previous (17)F(p,p)(17)F measurement identified a 3;{+} state providing the strongest resonance contribution, but the resonance strength was unknown. We have directly measured the (17)F(p,gamma)(18)Ne reaction using a mixed beam of (17)F and (17)O at ORNL. The resonance strength for the 3;{+} resonance in (18)Ne was found to be omegagamma = 33 +/- 14(stat) +/-1 7(syst) meV, corresponding to a gamma width of Gamma_{gamma} = 56 +/- 24(stat) +/- 30(syst) meV. An upper limit on the direct capture of S(E) <or= 65 keV b was determined at an energy of 800 keV.

99mTc-HMPAO labelled white blood cell scintigraphy in patients with osteoarticular infection: the value of late images for diagnostic accuracy and interobserver reproducibility

The objectives of this study were to evaluate the diagnostic value of 99mTc-HMPAO labelled white blood cell scintigraphy (WBCS) in patients with suspected osteomyelitis using late images and to study interobserver reproducibility. This study prospectively included 120 patients, and after a follow-up of one year, only 70 patients (n = 49 with implants, n = 21 without implants) were selected. The final diagnosis of infection was based either on microbiological data (n = 54) or follow-up (n = 16). We performed WBCS with 4 h and 24 h scans. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 77%, 72%, 83%, 64%, and 75% at 4 h, and 74%, 87%, 91%, 59%, and 79% at 24 h, respectively. The interobserver reproducibility shows a 63% prevalence of agreement between results (kappa = 0.5) at 4 h and 80% (kappa = 0.74) at 24 h, respectively. WBCS with 24-h images improves specificity and interobserver reproducibility in patients with suspected osteoarticular sepsis.

Measurement of the cascade transition via the first excited state of 16O in the 12C(alpha,gamma)16O reaction, and its S factor in stellar helium burning

Radiative alpha-particle capture into the first excited, J(pi)=0+ state of 16O at 6.049 MeV excitation energy has rarely been discussed as contributing to the 12C(alpha,gamma)16O reaction cross section due to experimental difficulties in observing this transition. We report here measurements of this radiative capture in 12C(alpha,gamma)16O for center-of-mass energies of E=2.22 MeV to 5.42 MeV at the DRAGON recoil separator. To determine cross sections, the acceptance of the recoil separator has been simulated in GEANT as well as measured directly. The transition strength between resonances has been identified in R-matrix fits as resulting both from E2 contributions as well as E1 radiative capture. Details of the extrapolation of the total cross section to low energies are then discussed [S6.0(300)=25(-15)(+16) keV b] showing that this transition is likely the most important cascade contribution for 12C(alpha,gamma)16O.

In vivo multiple-mouse imaging at 1.5 T

A multiple-mouse solenoidal MR coil was developed for in vivo imaging of up to 13 mice simultaneously to screen for tumors on a 1.5 T clinical scanner. For the coil to be effective as a screening tool, it should permit acquisition of MRIs in which orthotopic tumors with diameters >2 mm are detectable in a reasonable period of time (<1 hr magnet time) and their sizes accurately measured. Using a spin echo sequence, we demonstrated that this coil provides sufficient sensitivity for moderately high resolution images (156-176 microm in plane-resolution, 1.5 mm slice thickness). This spatial resolution permitted detection of primary brain tumors in transgenic/knockout mice and orthotopic xenografts. Brain tumor size as measured by MRI was correlated with size measured by histopathology (P < 0.001). Metastatic tumors in the mouse lung were also successfully imaged in a screening setting. The multiple mouse coil is simple in construction and may be implemented without any significant modification to the hardware or software on a clinical scanner.

[Off-pump beating heart coronary artery bypass. Technical points of view and surgical results]

A consecutive series of 746 patients undergoing heart beating myocardial revascularization was reviewed. An average of 2.30 grafts/patients was performed. The rate of mortality in the first 30 postoperative days was 0.28%. Two cases had to be terminated on-pump. We used the inotropic drugs in 0.6% of cases. The postoperative events were: atrial fibrillation (12.6%), myocardial infarction (0.3%). The rate of transfusion was 7.4%. The extubation was performed in the first 24 h postoperatively in 94.7% of cases. The majority of patients (91.3%) left the hospital in the first 8 d postoperatively. Off pump coronary artery bypass grafting gives good result for the most of the patients even for those with multiple vessel disease and high operating risk.

Cross-sectional association of soluble thrombomodulin with mild peripheral artery disease; the ARIC study. Atherosclerosis Risk in Communities

Thrombomodulin, an endothelial membrane glycoprotein, is an essential part of the protein C anti-coagulant pathway. It may also have a role in the regulation of fibrinolysis. We carried out a cross-sectional study to assess the association of soluble thrombomodulin (sTM) with peripheral artery disease (PAD) in a stratified random sample (n=863) of otherwise healthy black and white participants of the Atherosclerosis Risk in Communities (ARIC) Study. PAD was more common in black than in white participants and associated with classical risk factors in an expected manner; positively with age, smoking, hypertension, diabetes (P=0.05), and LDL-cholesterol, and inversely with HDL-cholesterol. Significant positive associations were observed also with fibrinogen and white blood cell count. Overall, the sTM concentration was not a significant predictor of PAD. The association was, however, modified by the level of factor VIII:C in whites (P=0.002 for the interaction), but not in blacks. Protein C was inversely associated with PAD prevalence (odds ratio 0.33, 95% CI 0.18--0.61, P=0.0004). sTM was inversely associated with plasminogen, but no associations with t-PA, PAI-1, or D-dimer were seen. In conclusion, the present results provide some additional evidence on the role of thrombomodulin-protein C pathway in atherosclerotic disease and support our earlier observation on interaction between sTM and factor VIII:C.

Effects of Motexafin gadolinium on tumor metabolism and radiation sensitivity

PURPOSE

Experiments were undertaken to determine if metabolic changes induced by Motexafin gadolinium (Gd-Tex(+2), XCYTRIN) predict time intervals between drug and radiation wherein there is enhancement of radiation efficacy.

METHODS AND MATERIALS

We evaluated the effect of Gd-Tex(+2) on tumor metabolism and on tumor growth using a mouse mammary carcinoma model and (31)P nuclear magnetic resonance (NMR) experiments. Response to therapy was evaluated based on time for the tumor to regrow to pretreatment size and also tumor doubling time.

RESULTS

(31)P NMR experiments indicated that Gd-Tex(+2) effected tumor energy metabolism during the first 24 hours postadministration. A decrease in phosphocreatine was noted at 2 (p < 0.04), 6 (p < 0.006), and 24 (p < 0.001) hours post Gd-Tex(+2). A decrease in nucleoside triphosphates was noted only at 2 hours (p < 0.02), with subsequent recovery at 6 hours. Phosphocreatine in control (saline treated) tumors showed a significant decrease only at 24 hours (p < 0.01). Irradiation at 2 and 6 hours post Gd-Tex(+2) induced an enhanced effect compared to radiation alone as measured by analyzing the growth curves, maximum tumor volumes, and the time for the tumors to regrow to their initial volumes. Irradiation at 24 hours post Gd-Tex(+2) induced a modest enhancement in tumor growth delay compared to radiation alone.

DISCUSSION

NMR spectroscopy may be useful for monitoring tumor metabolism after treatment with Gd-Tex(+2) and administering radiation during the time of maximal efficacy of Gd-Tex(+2).

Use of phosphorous-31 nuclear magnetic resonance spectroscopy to determine safe timing of chemotherapy after hepatic resection

Liver resection induces accelerated growth of residual hepatic micrometastases. Adjuvant chemotherapy may improve outcome if administered early after resection but may prove lethal if initiated prior to completion of DNA synthesis in regenerating liver. This study investigates phosphorus-31 nuclear magnetic resonance ((31)P-NMR) as a noninvasive tool for measuring energy changes reflective of hepatic DNA synthesis and for predicting safe timing of chemotherapy after 70% hepatectomy. To evaluate metabolic changes in regenerating liver, quantitative three-dimensional (31)P-NMR was performed, using the technique of chemical shift imaging at various time points after 70% hepatectomy in adult male Fischer rats. Animals receiving a course of 2'-deoxy-5-fluorouridine (FUDR; 100 mg/kg, i.p. four times per day x 5), initiated at the time of operation, were also evaluated to observe the effects of chemotherapy on liver regeneration. Forty-eight hours after resection, hepatic nucleoside triphosphate (NTP), which reflects ATP content, fell 37% (P < 0.03) in animals undergoing hepatectomy alone. By contrast, animals receiving FUDR after hepatectomy demonstrated a mitigated NTP response, with a drop of only 17% (P = not significant), suggesting that interruption of DNA synthesis leads to a reduced consumption of ATP. Direct measures of DNA synthesis and nuclear proliferation were correlated with NMR findings. [(3)H]Thymidine incorporation and Ki67 immunohistochemistry were performed on liver samples from rats undergoing 70% hepatectomy with and without FUDR. Both [(3)H]thymidine incorporation and Ki67 expression were inhibited significantly at 48 h in animals receiving hepatectomy and FUDR, compared with those not treated with FUDR. To determine whether NMR changes could be used to identify safe timing of chemotherapy after hepatectomy, rats were treated with a 5-day course of FUDR initiated either prior to or after NMR changes normalized. Animals treated with FUDR at the point of NTP normalization (72 h) showed significantly improved survival over those that began treatment at operation (75 % versus 17 %; P = 0.0005, log rank test). FUDR inhibits hepatic DNA synthesis and influences mortality if administered too early after hepatectomy. Chemical shift imaging is a noninvasive tool that can identify metabolic changes coinciding with DNA synthesis and nuclear proliferation after hepatectomy. (31)P-NMR may be useful for determining safe timing of chemotherapy after liver resection.

The in vivo effect of bryostatin-1 on paclitaxel-induced tumor growth, mitotic entry, and blood flow

Pretreatment of tumor cells with the protein kinase C (PKC) inhibitor bryostatin-1 enhances the cytotoxicity of most chemotherapeutic agents. However, in the case of paclitaxel, this effect has been shown in vitro to be best achieved when bryostatin-1 follows (rather than precedes) paclitaxel treatment. With combination trials of bryostatin-1 and paclitaxel planned for clinical trials and with only in vitro data available regarding drug sequence, we elected to undertake an in vivo study evaluating the effect of sequential bryostatin-1 and paclitaxel in a tumor-bearing mouse model and to correlate this effect to cell cycle events, tumor metabolism, and tumor blood flow. At the maximum tolerated i.p. dose, bryostatin-1 at 80 microg/kg resulted in a small but significant increase in tumor doubling time (4.2 +/- 0.3 days) compared with control tumors (3.0 +/- 0.3 days; P < 0.01). Mice treated with i.v. paclitaxel, administered at a dose of 12 mg/kg every 12 h for three doses, weekly for 3 weeks, had a tumor doubling time of 23.4 +/- 1.7 days. Mice pretreated with i.p. bryostatin-1 (80 microg/kg) followed 12 h later by i.v. paclitaxel (12 mg/kg every 12h for three doses) weekly for 3 weeks had a tumor doubling time of 9.7 +/- 1.1 days. This was significantly less (P < .001) than paclitaxel alone, which indicated an inhibitory effect by bryostatin-1 on paclitaxel therapy. In comparison, tumor-bearing mice that were treated with the same dose but with the sequence of paclitaxel followed by bryostatin-1 had a tumor doubling time of 29.6 +/- 0.6 days. This was significantly greater than the tumor doubling times for any condition tested (P < 0.01), demonstrating the sequence dependence of this combination. The efficacy of paclitaxel is dependent on mitotic entry, a step that requires activation of p34cdc2 kinase activity. Treatment with paclitaxel in vivo increased p34 cdc2 kinase activity in the mouse mammary tumors, whereas administration of bryostatin-1 before paclitaxel prevented the p34cdc2 kinase activation by paclitaxel. This was further evaluated in vitro by flow cytometry in MKN-74 human gastric cancer cells. As determined by MPM-2 labeling, which identifies cells in mitosis, pretreatment with bryostatin-1 prevented paclitaxel-treated cells from entering mitosis. Bryostatin-1 has been reported to induce changes in muscle metabolism and to decrease muscle blood flow. These events could impact on the interaction of bryostatin-1 with paclitaxel. Using proton-decoupled phosphorus nuclear magnetic resonance (31P-NMR) spectroscopy in vivo, bryostatin-1 at 80 micro1g/kg induced a decrease in both intratumoral pH and high-energy phosphates. In vivo perfusion studies, using dynamic enhanced NMR imaging with gadolinium diethylenetriamine pentaacetic acid, also demonstrated decreased tumor blood flow. These studies suggest that the inhibition of tumor response to paclitaxel by bryostatin-1 is multifactorial and includes such diverse factors as inhibition of cell entry into mitosis, a decrease in pH and energy metabolism, and a decrease in tumor blood flow. These results indicate that, as this combination enters Phase I clinical trials, the sequence of paclitaxel followed by bryostatin-1 will be critical in the clinical trial design.

A quantitative assessment of liver metabolites during jaundice using three dimensional phosphorus chemical shift imaging

Phosphorus metabolites in the jaundiced rat liver were studied by three-dimensional phosphorus chemical shift imaging (CSI). Animals were studied at 1, 2, and 3 weeks post-ligation of the common bile duct. Quantitation of metabolites was performed using an external standard. Metabolite T(1) values were assessed in CSI experiments on normal untreated animals. High-performance liquid chromatography (HPLC) was used to measure adenine nucleotides in a separate group of jaundiced rats. 3D-CSI did not detect significant changes in NTP in jaundiced animals relative to baseline controls. At two and three weeks post bile duct ligation, pH was significantly elevated. HPLC data comparing ATP levels to baseline controls also detected no change except for elevated ATP detected on Day 21. (31)P NMR chemical shift imaging may be used to assess liver metabolites under conditions of stress such as jaundice. However, absolute quantitation requires careful attention to many factors including point spread function, correct T(1) values, and adequate signal-to-noise ratio.

Soluble thrombomodulin as a predictor of incident coronary heart disease and symptomless carotid artery atherosclerosis in the Atherosclerosis Risk in Communities (ARIC) Study: a case-cohort study

BACKGROUND

Small amounts of soluble thrombomodulin in plasma are thought to reflect endothelial damage. In a case-cohort study, we examined whether soluble thrombomodulin is a predictor of incident coronary heart disease and carotid artery atherosclerosis.

METHODS

The study population consisted of 14,170 black and white participants from the Atherosclerosis Risk in Communities (ARIC) study, who did not have cardiovascular disease at the start of the study and who we followed up for 6 years. After appropriate exclusions, we analysed 258 cases of incident coronary heart disease and 449 cases of carotid atherosclerosis. A stratified random sample of 753 individuals from the ARIC cohort was used as the comparison group. We used EIA to measure soluble thrombomodulin in plasma samples from both groups. For the analysis, we used quintiles of soluble thrombomodulin concentrations (< 24.7, 24.8-30.6, 30.7-40.2, 40.3-55.2, and > or = 55.3 ng/mL).

FINDINGS

Soluble thrombomodulin showed a strong, graded, inverse association with incident coronary heart disease (p=0.005). The adjusted rate ratio of the highest quintile of soluble thrombomodulin compared with the lowest quintile was 0.29 (95% CI 0.15-0.57). The association with carotid atherosclerosis, however, tended to be positive, especially among white participants (odds ratio 2.94 [1.15-7.51] for highest vs lowest quintile). The relation of soluble thrombomodulin to incident coronary heart disease and carotid atherosclerosis was dependent on factor VIII coagulant activity (p=0.06 and 0.003, respectively).

INTERPRETATION

The prospective association of soluble thrombomodulin with incident coronary heart disease differs from its cross-sectional association with carotid atherosclerosis. In healthy people, plasma concentrations of soluble thrombomodulin may reflect endothelial expression of thrombomodulin. High concentration of soluble thrombomodulin may be associated with decreased risk of coronary heart disease.

Octreotide induced remission of a refractory small cell carcinoma of the endometrium

This is the first report of remission obtained with octreotide in a woman diagnosed with recurrent small cell carcinoma of the endometrium with neuroendocrine features, refractory to a combination of etoposide, cisplatin, and radiation therapy. Stabilization of disease was obtained with a combination of tamoxifen and leuprolide depot. Regression of disease was then achieved by the addition of octreotide. The use of octreotide as an antitumor agent is reviewed.

Anti-neoplastic properties of human corticotropin releasing factor: involvement of the nitric oxide pathway

We report a series of the in vivo and in vitro studies that evaluate the anti-neoplastic potential of hCRF in W256 rat mammary carcinoma. Using magnetic resonance imaging (MRI) and direct measurements of tumor and peritumoral brain water content we found that hCRF treatment (100 micrograms/kg subcutaneously twice a day for 3 days) caused significant inhibition of growth and vascular permeability of the i.c. W256 tumors. hCRF also exhibited antiproliferative and differentiation-inducing effects in W256 cells in vitro. The calculated IC50 values were 70 nM and 100 nM of hCRF, as measured by digital videomicroscopic quantitation of tumor cell population growth rate and by [3H]-thymidine incorporation assay, respectively. The observed effects in W256 cells were CRF receptor mediated. This was shown in two ways: by the presence of relatively high levels of CRF1 receptor mRNA in W256 cells, and by the fact that the tumor growth inhibitory and differentiation inducing effects of hCRF in vitro were abolished by the CRF receptor antagonist a-helical CRF (9-41). Antiproliferative and differentiation inducing effects of hCRF in W256 cells involve activation of nitric oxide synthase (NOS) and L-arginine-NO pathway. This was shown by using the inhibitor of NOS, the L-nitro-arginine methyl esther (L-NAME), which prevented the antiproliferative and differentiation inducing effects of hCRF in vitro. The cytotoxicity of NO in W256 cells was assessed by the addition of sodium nitroprusside (SNP) to the media. SPN exhibited dose-dependent cytotoxicity in W256 cells with IC50 of 100 muM SNP as measured by [3H]-thymidine incorporation assay. We conclude, that hCRF has substantial anti-neoplastic effects which include inhibition of proliferation and induction of differentiation of the tumor cells in vitro, and a decrease in tumor vascular permeability (and possibly neo-angiogenesis) in vivo.

Radiation enhancement by biochemical modulation and 5-fluorouracil

PURPOSE

To evaluate the effects of biochemical modulation by N-(phosphonacetyl)-L-aspartate (PALA), 6-methylmercaptopurine riboside (MMPR), and 6-aminonicotinamide (6AN), (PALA + MMPR + 6AN is referred to as PMA) on tumor radiosensitivity, and evaluate the efficacy of the addition of 5-FU to the PMA + XRT regimen for enhancement of tumor response to radiation without exceeding normal tissue tolerance.

METHODS AND MATERIALS

A first generation transplant of the CD8F1 spontaneous murine tumor was studied. 31P nuclear magnetic resonance spectroscopy was used to determine the interval between chemotherapy and radiation based on energy depletion. PMA was administered three times with fractionated XRT (15 Gy x 3 = 45 Gy) on days 1, 10, or 11, and 21. The addition of 5-fluorouracil (5-FU) at maximum tolerated doses was evaluated and intergroup comparisons were made for tumor growth delay, local control, and disproportionate normal tissue damage.

RESULTS

The combination of 5-FU + XRT induced a tumor doubling time of 75.4 days (67.4-84.4) (p < 0.0001 compared to XRT), validating that in this tumor model, pretreatment with bolus i.p. 5-FU enhanced XRT. In comparison, mice treated with PMA + XRT had a tumor doubling time (TDT) > 123.2 days (109.4-138.7), (p < 0.0001 compared to 5-FU + XRT). The addition of 5-FU to PMA + XRT induced a doubling time of > 170.8 days (150.7-193.7) (p = 0.0002 compared to PMA + XRT). The doubling time for the PMA + XRT cohort and the PMA + 5-FU + XRT cohorts are underestimates since some of the tumor bearing mice continue to have a complete regression (CR). The CR rate (measured on day 250) for the PMA + 5-FU + XRT cohort was 31.7% compared to 0% for 5-FU + XRT and 10% for PMA + XRT (p < 0.05). Mortality and local effects induced by radiation in the PMA + XRT group were comparable to the toxicity for the PMA + 5-FU + XRT group indicating that the addition of 5-FU at 75 mg/kg to PMA + XRT was tolerated and induced both greater CR and tumor doubling times than XRT alone, 5-FU (150 mg/kg) + XRT, or PMA + XRT.

CONCLUSIONS

PMA is superior to 5-FU as a radiosensitizer in the schedule studied. The combination of PMA + 5-FU further enhanced XRT without exceeding normal tissue tolerance.

Study of the metabolism of choline and phosphatidylcholine in tumors in vivo using phosphonium-choline

The results of an initial study on the feasibility of using the phosphonium analog of choline to follow the metabolism of phosphatidylcholine in tumors in vivo using 31P NMR are reported. C3H/He mice bearing a mammary carcinoma tumor on the foot pad were fed a choline-free diet supplemented with the phosphonium analog of choline. Metabolites of this compound, including the phosphonium analogs of phosphatidylcholine, phosphocholine, glycerophosphocholine, and betaine were observed noninvasively in vivo in tumors by 31P NMR after 2-3 weeks of feeding. Clearance of these phosphonium-labeled metabolites from tumors was measured after a change to a choline-containing diet. Significant decreases were seen in the levels of the analogs of betaine (P < 0.003) and phosphatidylcholine (P < 0.004) by Day 4. A significant increase in the level of authentic phosphocholine (P < 0.003) occurred over the same time period.