The CD11b-integrin (ITGAM) and systemic lupus erythematosus

Variations at the ITGAM gene, which encodes for the CD11b chain of the Mac-1 (alphaMbeta2; CD11b/CD18; complement receptor-3) integrin, is one of the strongest genetic risk factors for systemic lupus erythematosus (SLE). More specifically, a genetic variant (rs1143679) which results in an arginine to histidine substitution at position 77 in the extracellular portion of the integrin is associated with disease. It has recently been shown that this amino acid substitution results in a dysfunctional integrin, which is deficient in mediating cell adhesion to integrin ligands, phagocytosis and in addition cannot restrict inflammatory cytokine production in macrophages. In this review, we discuss immunological functions of the Mac-1 integrin and how defects in the genetic variant of Mac-1 may relate to SLE development.

Contact dermatitis in hairdressers

18 cases of hand dermatitis in hairdressers seen over a 5-year period are reviewed. The diagnoses in these patients are discussed with reference to other studies of hand dermatitis in hairdressers. Contact allergy due to paraphenylenediamine and related hair dyes was the presenting complaint in younger hairdressers, while formaldehyde allergy occurred in those who were older. The prognosis in the former group of workers with respect to continued employment in the trade tended to be poorer than the latter. Follow-up revealed that hand dermatitis often resulted in the worker not continuing to work in the hairdressing trade.

Platelet Behaviour in Normal Pregnancy, Pregnancy Complicated by Essential Hypertension and Pregnancy-Induced Hypertension

Platelet behaviour was studied throughout pregnancy in a group of women who remained normotensive and a group with essential hypertension (EHT). Women who developed pregnancy-induced hypertension (PIH) were also studied together with a group of non-pregnant female controls. We determined the sensitivity of platelets to arachidonic acid (AA) and determined the effects of dazoxiben, a thromboxane synthetase inhibitor, on AA-induced platelet behaviour.

A marked increase in platelet reactivity was evident in all three groups throughout pregnancy; platelets became more sensitive to AA and less sensitive to the inhibitory effects of dazoxiben. The change was apparent as early as 16 weeks gestation. In normotensive pregnancy and in EHT platelet behaviour had returned to normal six weeks after delivery. Platelets from women who developed PIH were more sensitive to AA than those from the other pregnant women and platelet reactivity had not returned to normal six weeks after delivery.

The results indicate that alterations in platelet behaviour may contribute to the vascular complications that are known to be associated with pregnancy and with PIH in particular.

A novel Drosophila alkaline phosphatase specific to the ellipsoid body of the adult brain and the lower Malpighian (renal) tubule

Two independent Drosophila melanogaster P(GAL4) enhancer-trap lines revealed identical GAL4-directed expression patterns in the ellipsoid body of the brain and in the Malpighian (renal) tubules in the abdomen. Both P-element insertions mapped to the same chromosomal site (100B2). The genomic locus, as characterized by plasmid rescue of flanking DNA, restriction mapping, and DNA sequencing, revealed the two P(GAL4) elements to be inserted in opposite orientations, only 46 bp apart. Three genes flanking the insertions have been identified. Calcineurin A1 (previously mapped to 21E-F) lies to one side, and two very closely linked genes lie to the other. The nearer encodes Aph-4, the first Drosophila alkaline phosphatase gene to be identified; the more distant gene [l(3)96601] is novel, with a head-elevated expression, and with distant similarity to transcription regulatory elements. Both in situ hybridization with Aph-4 probes and direct histochemical determination of alkaline phosphatase activity precisely matches the enhancer-trap pattern reported by the original lines. Although the P-element insertions are not recessive lethals, they display tubule phenotypes in both heterozygotes and homozygotes. Rates of fluid secretion in tubules from c507 homozygotes are reduced, both basally, and after stimulation by CAP(2b), cAMP, or Drosophila leucokinin. The P-element insertions also disrupt the expression of Aph-4, causing misexpression in the tubule main segment. This disruption extends to tubule pigmentation, with c507 homozygotes displaying white-like transparent main segments. These results suggest that Aph-4, while possessing a very narrow range of expression, nonetheless plays an important role in epithelial function.

Calcifications are potential surrogates for prostate localization in image-guided radiotherapy

PURPOSE

To investigate the feasibility of using calcifications as surrogates for the prostate position during cone-beam computed tomography (CBCT) image-guided radiotherapy.

METHODS AND MATERIALS

The twice-weekly CBCT images taken during the treatment course of 4 patients were retrospectively studied for the stability of the calcifications. The geometric center of three fiducial markers was used as the reference. The planning CT images of 131 prostate patients recently treated with external beam radiotherapy at our center were reviewed to estimate the calcification occurrence rate. Analysis was conducted using the Varian Eclipse treatment planning system. Two patients were treated using prostate calcifications as the landmark in on-line registration. Both the Varian standard and the low-dose CBCT modes were used for imaging.

RESULTS

The calcifications were found to be stable during the treatment course. At the 95% confidence interval, the difference between the distance from an identified calcification to the fiducial markers on CBCT and the distance on the planning CT scans was 0.2 +/- 2.0 mm, 0.8 +/- 2.2 mm, and 0.4 +/- 2.4 mm in the left-right, anteroposterior, and superoinferior direction, respectively. Of the 131 patients, 46 (35%) had well-defined calcifications either inside the prostate or near the borders. Our experience in treating the first 2 patients demonstrated that the calcifications are easily distinguished on low-dose scans and that calcification registration can be precisely performed.

CONCLUSION

The results of our study have shown that calcifications can be reliable markers of prostate position and allow for precise image guidance with a low-imaging dose. With this approach, potentially about one-third of prostate patients could benefit from precise image guidance without the invasive use of markers.

Cardiorespiratory fitness and accelerometer-determined physical activity following one year of free-living high-intensity interval training and moderate-intensity continuous training: a randomized trial

Background

Free-living adherence to high-intensity interval training (HIIT) has not been adequately tested. This randomized trial examined changes in cardiorespiratory fitness (CRF) and accelerometer-measured purposeful physical activity over 12 months of free-living HIIT versus moderate-intensity continuous training (MICT).

Methods

Ninety-nine previously low-active participants with overweight/obesity were randomly assigned to HIIT (n = 47) or MICT (n = 52). Both interventions were combined with evidence-based behaviour change counselling consisting of 7 sessions over 2 weeks. Individuals in HIIT were prescribed 10 X 1-min interval-based exercise 3 times per week (totalling 75 min) whereas individuals in MICT were prescribed 150 min of steady-state exercise per week (50 mins 3 times per week). Using a maximal cycling test to exhaustion with expired gas analyses, CRF was assessed at baseline and after 6 and 12 months of free-living exercise. Moderate-to-vigorous physical activity of 10+ minutes (MVPA10+) was assessed by 7-day accelerometry at baseline, 3, 6, 9, and 12 months. Intention to treat analyses were conducted using linear mixed models.

Results

CRF was improved over the 12 months relative to baseline in both HIIT (+ 0.15 l/min, 95% CI 0.08 to 0.23) and MICT (+ 0.11 l/min, 95% CI 0.05 to 0.18). Both groups improved 12-month MVPA10+ above baseline (HIIT: + 36 min/week, 95% CI 17 to 54; MICT: + 69 min/week, 95% CI 49 to 89) with the increase being greater (by 33 min, 95% CI 6 to 60) in MICT (between group difference, P = 0.018).

Conclusion

Despite being prescribed twice as many minutes of exercise and accumulating significantly more purposeful exercise, CRF improvements were similar across 12 months of free-living HIIT and MICT in previously low-active individuals with overweight/obesity.

A new method for quantifiable and controlled dosage of particulate matter for in vitro studies: the electrostatic particulate dosage and exposure system (EPDExS)

An exposure chamber is described for the quantifiable addition of fine and ultrafine aerosol particulate matter directly to cells and used to demonstrate the in vitro cytotoxicity of fine 1,4-naphthoquinone particles to murine lung epithelial cells. The electrostatic particulate dosage and exposure system (EPDExS) operates on the principle of electrostatic precipitation and is shown to deposit fine and ultrafine aerosol particles directly to cells with 100% efficiency for particle diameters in the range of 40-530nm. This range is not limited by the EPDExS, but rather by the aerosolization method used for this study. Numbers of particles deposited onto the cells are counted with a condensation particle counter, negating any need to calculate or estimate particle exposure. The process of particle introduction, assessed using Trypan blue dye exclusion, had no effect on cell viability. In combination with a differential mobility classifier, the EPDExS can deliver select particle diameters to cells. The ability to control the diameter and number of particles deposited permits in vitro toxicity studies of particulate matter using different particle dosage metrics, i.e., particle number and size, surface area and mass. Finally, because EPDExS introduces particles directly from the aerosol, it can be used to expose cells grown at air/liquid interfaces.

Dose distributions and dose rate constants for new ytterbium-169 brachytherapy seeds

Relative dose distributions in the vicinities of two new prototypes of ytterbium-169 brachytherapy sources have been measured using lithium fluoride thermoluminescent dosimeters (TLD) placed in a solid water phantom. The type 6 seed consists of four Yb2O3 spheres contained in a 0.075-mm thick titanium tube, with overall dimensions of 4.5 mm in length and 0.8 mm in diameter. The type 8 seed contains a cylindrical segment of Yb wire, 2.5 mm long, sealed in a 0.075-mm thick titanium tube 4 mm in length and 0.5 mm in diameter. The relative dose distributions, measured with TLD, were compared with those predicted by Monte Carlo simulations (MCNP code). Experimental and theoretical dose distributions were generally in agreement within 5% of the local dose value. Source strength was determined from activity measurements using a high purity germanium (HPGe) spectrometer. With source strengths established, thermoluminescence was then used to measure the dose rate constant, lambda 0, for the type 8 seed. The measured lambda 0 of 1.34 +/- 0.10 cGy U-1 for the type 8 seed agrees, within statistical uncertainty, with the value of 1.25 +/- 0.05 cGy U-1 predicted through Monte Carlo simulation. Comparisons are made with experimental data reported by other investigators.

Explaining trends in alcohol-related harms in Scotland, 1991-2011 (I): the role of incomes, effects of socio-economic and political adversity and demographic change

OBJECTIVE

This paper tests the extent to which differing trends in income, demographic change and the consequences of an earlier period of social, economic and political change might explain differences in the magnitude and trends in alcohol-related mortality between 1991 and 2011 in Scotland compared to England & Wales (E&W).

STUDY DESIGN

Comparative time trend analyses and arithmetic modelling.

METHODS

Three approaches were utilised to compare Scotland with E&W: 1. We modelled the impact of changes in income on alcohol-related deaths between 1991-2001 and 2001-2011 by applying plausible assumptions of the effect size through an arithmetic model. 2. We used contour plots, graphical exploration of age-period-cohort interactions and calculation of Intrinsic Estimator coefficients to investigate the effect of earlier exposure to social, economic and political adversity on alcohol-related mortality. 3. We recalculated the trends in alcohol-related deaths using the white population only to make a crude approximation of the maximal impact of changes in ethnic diversity.

RESULTS

Real incomes increased during the 1990s but declined from around 2004 in the poorest 30% of the population of Great Britain. The decline in incomes for the poorest decile, the proportion of the population in the most deprived decile, and the inequality in alcohol-related deaths, were all greater in Scotland than in E&W. The model predicted less of the observed rise in Scotland (18% of the rise in men and 29% of the rise in women) than that in E&W (where 60% and 68% of the rise in men and women respectively was explained). One-third of the decline observed in alcohol-related mortality in Scottish men between 2001 and 2011 was predicted by the model, and the model was broadly consistent with the observed trends in E&W and amongst women in Scotland. An age-period interaction in alcohol-related mortality was evident for men and women during the 1990s and 2000s who were aged 40-70 years and who experienced rapidly increasing alcohol-related mortality rates. Ethnicity is unlikely to be important in explaining the trends or differences between Scotland and E&W.

CONCLUSIONS

The decline in alcohol-related mortality in Scotland since the early 2000s and the differing trend to E&W were partly described by a model predicting the impact of declining incomes. Lagged effects from historical social, economic and political change remain plausible from the available data.

Physiological bases of genetic differences in cannibalism behavior of the confused flour beetle Tribolium confusum

Physiological causes of genetic differences in cannibalism were examined to gain a better understanding of constraints on behavior evolution. Cannibalism has complex population level consequences in Tribolium confusum, including dramatic effects on population size. Laboratory strains with low and high cannibalism rates, obtained through inbreeding, have maintained distinct levels of cannibalism for over two decades even in the absence of artificial selection to maintain the differences. Why strains differ in their cannibalism rates was examined by measuring: (1) the nutritional benefit from cannibalism in both nutritionally good and poor environments, and (2) the possibility that eggs are an important source of water. How strains achieve differences in cannibalism was examined by testing for differences between strains in their ability to find eggs and in their tendency to eat eggs. Beetles from both strains survive equally well in a nutritionally good environment, but they accomplish this in different ways. The low cannibalism strain has high survivorship with and without cannibalism. The high cannibalism strain has low survivorship when not fed eggs and survivorship equivalent to the low cannibalism strain when fed eggs, suggesting it compensates for poor nutritional adaptation by eating eggs. The strains also differ in feeding behavior; beetles from the high cannibalism strain have a higher appetite for eggs. Beetles from the two strains did not differ in locomotor activity, search efficiency, or need for water. The observed behavioral and nutritional differences may contribute to the maintenance of different levels of cannibalism.

Current practice in total-body irradiation: results of a Canada-wide survey

BACKGROUND

Total-body irradiation (tbi) is used to condition patients before bone marrow transplant. A variety of tbi treatment strategies have been described and implemented, but no consensus on best practice has been reached. We report on the results of a survey created to assess the current state of tbi delivery in Canada.

RESULTS

A 19-question survey was distributed to 49 radiation oncology programs in Canada. Responses were received from 20 centres, including 12 centres that perform tbi. A variety of tbi dose prescriptions was reported, although 12 Gy in 6 fractions was used in 11 of the 12 centres performing tbi. Half of the centres also reported using a dose prescription unique to their facility. Most centres use an extended-distance parallel-opposed-pair technique, with the patient standing or lying on a stretcher against a wall. Others translate the patient under the beam, sweep the beam over the patient, or use a more complicated multi-field technique. All but 1 centre indicated that they attenuate the lung dose; only 3 centres indicated attenuating the dose for other organs at risk. The survey also highlighted the considerable resources used for tbi, including extra staff, prolonged planning and treatment times, and use of locally developed hardware or software.

CONCLUSIONS

At transplant centres, tbi is commonly used, but there is no commonly accepted approach to planning and treatment delivery. The important discrepancies in practice between centres in Canada creates an opportunity to prompt more discussion and collaboration between centres, improving consistency and uniformity of practice.

Medical physics staffing for radiation oncology: a decade of experience in Ontario, Canada

The January 2010 articles in The New York Times generated intense focus on patient safety in radiation treatment, with physics staffing identified frequently as a critical factor for consistent quality assurance. The purpose of this work is to review our experience with medical physics staffing, and to propose a transparent and flexible staffing algorithm for general use. Guided by documented times required per routine procedure, we have developed a robust algorithm to estimate physics staffing needs according to center‐specific workload for medical physicists and associated support staff, in a manner we believe is adaptable to an evolving radiotherapy practice. We calculate requirements for each staffing type based on caseload, equipment inventory, quality assurance, educational programs, and administration. Average per‐case staffing ratios were also determined for larger‐scale human resource planning and used to model staffing needs for Ontario, Canada over the next 10 years. The workload specific algorithm was tested through a survey of Canadian cancer centers. For center‐specific human resource planning, we propose a grid of coefficients addressing specific workload factors for each staff group. For larger scale forecasting of human resource requirements, values of 260, 700, 300, 600, 1200, and 2000 treated cases per full‐time equivalent (FTE) were determined for medical physicists, physics assistants, dosimetrists, electronics technologists, mechanical technologists, and information technology specialists, respectively.

PACS numbers: 87.55.N‐, 87.55.Qr

Long-term percutaneous endoscopic gastrostomy feeding in young adults with multiple disabilities

AIM

To study the outcomes from initiation of percutaneous endoscopic gastrostomy (PEG) feeding in young people with profound multiple disabilities.

METHODS

Observations were made on 40 adults with lifelong intellectual disability (mental retardation) and quadriplegia, in whom PEG feeding was initiated during 1990-2008. There were 20 men and 20 women aged 15-40 years at the time of the audit, living in settings with 24 h registered nurse staffing.

RESULTS

Undernutrition and recurrent aspiration with frequent infections were cited as reasons for PEG feeding. The positive outcomes were that some were said to be more alert for a time following the procedure; and these young adults lived with PEG feeding for an average of 8.5 years, some up to 18 years. In that time, however, they all experienced complications of the PEG insertion, and of the PEG feeding process. There were no measurable improvements in cognition. There were no reductions in prescription of medications. They all required frequent daily interventions by nurses to maintain medical stability. Ten people died during this review period, from continued deterioration in neurological status, with pneumonia cited as the terminal event.

CONCLUSIONS

Unlike other people with neurological deterioration, young adults with lifelong multiple disabilities may live for many years with PEG feeding. There is little gain in quality of life.

Evaluation of a thermoplastic immobilization system for breast and chest wall radiation therapy

We report on the impact of a thermoplastic immobilization system on intra- and interfraction motion for patients undergoing breast or chest wall radiation therapy. Patients for this study were treated using helical tomotherapy. All patients were immobilized using a thermoplastic shell extending from the shoulders to the ribcage. Intrafraction motion was assessed by measuring maximum displacement of the skin, heart, and chest wall on a pretreatment 4D computed tomography, while inter-fraction motion was inferred from patient shift data arising from daily image guidance procedures on tomotherapy. Using thermoplastic immobilization, the average maximum motion of the external contour was 1.3 ± 1.6 mm, whereas the chest wall was found to be 1.6 ± 1.9 mm. The day-to-day setup variation was found to be large, with random errors of 4.0, 12.0, and 4.5 mm in the left-right, superior-inferior, and anterior-posterior directions, respectively, and the standard deviations of the systematic errors were found to be 2.7, 9.8, and 4.1 mm. These errors would be expected to dominate any respiratory motion but can be mitigated by daily online image guidance. Using thermoplastic immobilization can effectively reduce respiratory motion of the chest wall and external contour, but these gains can only be realized if daily image guidance is used.

Explaining trends in alcohol-related harms in Scotland 1991-2011 (II): policy, social norms, the alcohol market, clinical changes and a synthesis

OBJECTIVE

To provide a basis for evaluating post-2007 alcohol policy in Scotland, this paper tests the extent to which pre-2007 policy, the alcohol market, culture or clinical changes might explain differences in the magnitude and trends in alcohol-related mortality outcomes in Scotland compared to England & Wales (E&W).

STUDY DESIGN

Rapid literature reviews, descriptive analysis of routine data and narrative synthesis.

METHODS

We assessed the impact of pre-2007 Scottish policy and policy in the comparison areas in relation to the literature on effective alcohol policy. Rapid literature reviews were conducted to assess cultural changes and the potential role of substitution effects between alcohol and illicit drugs. The availability of alcohol was assessed by examining the trends in the number of alcohol outlets over time. The impact of clinical changes was assessed in consultation with key informants. The impact of all the identified factors were then summarised and synthesised narratively.

RESULTS

The companion paper showed that part of the rise and fall in alcohol-related mortality in Scotland, and part of the differing trend to E&W, were predicted by a model linking income trends and alcohol-related mortality. Lagged effects from historical deindustrialisation and socio-economic changes exposures also remain plausible from the available data. This paper shows that policy differences or changes prior to 2007 are unlikely to have been important in explaining the trends. There is some evidence that aspects of alcohol culture in Scotland may be different (more concentrated and home drinking) but it seems unlikely that this has been an important driver of the trends or the differences with E&W other than through interaction with changing incomes and lagged socio-economic effects. Substitution effects with illicit drugs and clinical changes are unlikely to have substantially changed alcohol-related harms: however, the increase in alcohol availability across the UK is likely to partly explain the rise in alcohol-related mortality during the 1990s.

CONCLUSIONS

Future policy should ensure that alcohol affordability and availability, as well as socio-economic inequality, are reduced, in order to maintain downward trends in alcohol-related mortality in Scotland.

Simulation of a medical linear accelerator for teaching purposes

Simulation software for medical linear accelerators that can be used in a teaching environment was developed. The components of linear accelerators were modeled to first order accuracy using analytical expressions taken from the literature. The expressions used constants that were empirically set such that realistic response could be expected. These expressions were programmed in a MATLAB environment with a graphical user interface in order to produce an environment similar to that of linear accelerator service mode. The program was evaluated in a systematic fashion, where parameters affecting the clinical properties of medical linear accelerator beams were adjusted independently, and the effects on beam energy and dose rate recorded. These results confirmed that beam tuning adjustments could be simulated in a simple environment. Further, adjustment of service parameters over a large range was possible, and this allows the demonstration of linear accelerator physics in an environment accessible to both medical physicists and linear accelerator service engineers. In conclusion, a software tool, named SIMAC, was developed to improve the teaching of linear accelerator physics in a simulated environment. SIMAC performed in a similar manner to medical linear accelerators. The authors hope that this tool will be valuable as a teaching tool for medical physicists and linear accelerator service engineers.

PACS number: 87.55Gh, 87.56bd

Sci-Fri PM: Planning-05: Saving trees and improving workflow

Patient treatment preparation is a multi-step process requiring inputs from a range of disciplines and technologies. Our centre generates just over 4500 treatment plans annually and operates from two main campuses. A large, split program presents unique challenges during treatment preparation and has provided the impetus for a completely electronic treatment process. Throughout 2006 and 2007, we migrated our external beam treatment planning to the Computerized Medical Systems (CMS) product line. Utilizing a thin-client architecture, CMS supports distributed (multi-site) planning. Coincident with the treatment planning upgrade, IMPAC Multi-Access was configured to provide a paperless and filmless treatment record and electronic patient workflow. Standardized treatment objectives were also implemented in the form of site-group approved care plans. Details of the pretreatment process and the CMS / IMPAC implementation will be presented as well as a workflow time analysis. To date, treatment preparation times have been reduced by 25% (2.5 days) as a result of workflow improvements, representing a clear benefit to both staff and patients.

Vitamin supplementation in pregnancy

The aim of the study was to investigate the extent and determinants of vitamin supplementation in early pregnancy. Some 246 women were recruited in the antenatal clinics of a major teaching hospital and asked to complete a brief questionnaire relating to sources of advice and details of diet and vitamin supplementation during the index pregnancy. Further information was abstracted from routine antenatal records. A total of fifty-seven women (23%) took some form of vitamin supplement during the index pregnancy. Factors which affected supplementation included advice received from diverse sources and whether or not the women took iron supplements. Somewhat surprisingly, supplementation was not affected by age, social class or reproductive history.