The support of matrix accumulation and the promotion of sheep articular cartilage defects repair in vivo by chitosan hydrogels

OBJECTIVE

Chitosan has been widely used as an injectable scaffold in cartilage tissue engineering due to its characteristic biocompatibility and biodegradability. In this study, chitosan was used in its hydrogel form as a scaffold for chondrocytes that act to reconstruct tissue-engineered cartilage and repair articular cartilage defects in the sheep model. This study aims to find a novel way to apply chitosan in cartilage tissue engineering.

METHODS

Temperature-responsive chitosan hydrogels were prepared by combining chitosan, beta-sodium glycerophosphate (GP) and hydroxyethyl cellulose (HEC). Tissue-engineered cartilage reconstructions were made in vitro by mixing sheep chondrocytes with a chitosan hydrogel. Cell survival and matrix accumulation were analyzed after 3 weeks in culture. To collect data for in vivo repair, reconstructions cultured for 1 day were transplanted to the freshly prepared defects of the articular cartilage of sheep. Then at both 12 and 24 weeks after transplantation, the grafts were extracted and analyzed histologically and immunohistochemically.

RESULTS

The results showed that the chondrocytes in the reconstructed cartilage survived and retained their ability to secrete matrix when cultured in vitro. Transplanted in vivo, the reconstructions repaired cartilage defects completely within 24 weeks. The implantation of chitosan hydrogels without chondrocytes also helps to repair cartilage defects.

CONCLUSIONS

The chitosan-based hydrogel could support matrix accumulation of chondrocytes and could repair sheep cartilage defects in 24 weeks. This study showcased the success of a new technique in its ability to repair articular cartilage defects.

Three types of defense-responsive genes are involved in resistance to bacterial blight and fungal blast diseases in rice

Bacterial blight and fungal blast diseases of rice, caused by Xanthomonas oryzae pv. oryzae and Pyricularia grisea Sacc., respectively, are two of the most devastating diseases in rice worldwide. To study the defense responses to infection with each of these pathogens, expression profiling of 12 defense-responsive genes was performed using near-isogenic rice lines that are resistant or susceptible to bacterial blight and fungal blast, respectively, and rice cultivars that are resistant or susceptible to both pathogens. All 12 genes showed constitutive expression, but expression levels increased in response to infection. Based on their expression patterns in 12 host-pathogen combinations, these genes could be classified into three types, pathogen non-specific (6), pathogen specific but race non-specific (4) and race specific (2). Most of the 12 genes were only responsive during incompatible interactions. These results suggest that bacterial blight and fungal blast resistances share common pathway(s), but are also regulated by different defense pathways in rice. Activation of the corresponding R gene is the key step that initiates the action of these genes in defense responses. The chromosomal locations and pathogen specificities of seven of the 12 genes were consistent with those of previously identified quantitative trait loci for rice disease resistance, which indicates that some of the 12 genes studied may have a phenotypic impact on disease resistance in rice.

Targeted modification of wheat grain protein to reduce the content of celiac causing epitopes

The prolamin peptides in wheat gluten and in the homologous storage proteins of barley and rye cause painful chronic erasure of microvilli of the small intestine epithelium in celiac patients. If untreated, it can lead to chronic diarrhea, abdominal distension, osteoporosis, weight-loss due to malabsorption of nutrients, and anemia. In addition to congenital cases, life-long exposure to gluten proteins in bread and pasta can also induce development of celiac sprue in adults. To date, the only effective treatment is life-long strict abstinence from the staple food grains. Complete exclusion of dietary gluten is, however, difficult due to use of wheat in many foods, incomplete labeling and social constraints. Thus, finding alternative therapies for this most common foodborne disease remained an active area of research, which has led to many suggestions in last few years. The pros and cons associated with these therapies were reviewed in the present communication. As different celiac patients are immunogenic to different members of the undigestible proline/glutamine rich peptides of ~149 gliadins and low molecular weight glutenin subunits as well as the six high molecular weight glutenin subunits, an exhaustive digestion of the immunogenic peptides in the stomach, duodenum, jejunum, and ileum of celiacs is required. In view of the above, we evaluated the capacity of cereal grains to synthesize and store the enzymes prolyl endopeptidase from Flavobacterium meningosepticum and the barley cysteine endoprotease B2, which in combination are capable of detoxifying immunogenic gluten peptides in a novel treatment of celiac disease.

Atherosclerosis of the carotid artery: evaluation by magnetic resonance angiography

Carotid artery atherosclerotic plaques (APs) can lead to brain ischemia, an event shown to correlate with both the degree of stenosis and the composition of the AP. Currently, accurate estimates of stenosis can be obtained by either x-ray angiography or three-dimensional time-of-flight (TOF) magnetic resonance angiography (MRA). Our purpose was to determine whether three-dimensional TOF MRA images could also provide information on plaque location, morphology, and composition. Seven pre-endarterectomy patients underwent three-dimensional TOF MRA. After endarterectomy, plaque histology was evaluated. Three-dimensional TOF MRA images contained sufficient soft tissue contrast to differentiate the plaques from the surrounding tissues in all cases. Estimation of plaque morphology had 80% correlation with histology. Finally, intraplaque hemorrhage and calcification were deplicted as regions of moderately high and very low intensity, respectively. These preliminary results suggest that three-dimensional TOF MRA may be useful in studying the development and progression of carotid atherosclerosis.

Technical Note: Evaluation of the systematic accuracy of a frameless, multiple image modality guided, linear accelerator based stereotactic radiosurgery system

PURPOSE

To evaluate the total systematic accuracy of a frameless, image guided stereotactic radiosurgery system.

METHODS

The localization accuracy and intermodality difference was determined by delivering radiation to an end-to-end prototype phantom, in which the targets were localized using optical surface monitoring system (OSMS), electromagnetic beacon-based tracking (Calypso®), cone-beam CT, "snap-shot" planar x-ray imaging, and a robotic couch. Six IMRT plans with jaw tracking and a flattening filter free beam were used to study the dosimetric accuracy for intracranial and spinal stereotactic radiosurgery treatment.

RESULTS

End-to-end localization accuracy of the system evaluated with the end-to-end phantom was 0.5 ± 0.2 mm with a maximum deviation of 0.9 mm over 90 measurements (including jaw, MLC, and cone measurements for both auto and manual fusion) for single isocenter, single target treatment, 0.6 ± 0.4 mm for multitarget treatment with shared isocenter. Residual setup errors were within 0.1 mm for OSMS, and 0.3 mm for Calypso. Dosimetric evaluation based on absolute film dosimetry showed greater than 90% pass rate for all cases using a gamma criteria of 3%/1 mm.

CONCLUSIONS

The authors' experience demonstrates that the localization accuracy of the frameless image-guided system is comparable to robotic or invasive frame based radiosurgery systems.

Successful application of tissue-engineered skin to refractory ulcers

In this study, the effectiveness of a tissue-engineered skin (Activskin; Aierfu, Xi'an, China) was evaluated for the treatment of various refractory ulcers. These ulcers were treated with Activskin after debridement and irrigation with saline. A second application of Activskin was essential if the first application failed to persist on the wounds. Clinical efficacy and safety were assessed at regular clinic visits during 6 months of follow-up. All 11 treated patients improved with Activskin. The ulcers healed by inward migration from the wound edge. The average healing time was 27.8 days. No recurrent ulceration or other adverse events were observed during follow-up. These results provide preliminary evidence that Activskin is safe and effective in the management of refractory ulcers.

SU-E-J-45: Validation of the ExacTrac Virtual Isocenter Based Target Localization Method

PURPOSE

With no stable landmarks available for localization, a 'virtual isocenter' "'or surrogate landmark near the target'" can be used for image guidance. However, using a virtual isocenter in ExacTrac has not been thoroughly validated. This study evaluates its target localization accuracy and investigates the impact of two different couch correction sequences.

METHODS

A CT scan was acquired on an anthropomorphic thoracic phantom with a 2mm-diameter ball bearing (BB) marker implanted in thelung region. A treatment plan was created with isocenter placed at the BB center, and exported to ExacTrac. In ExacTrac, a virtual isocenter wasplaced on a spine vertebral body where three translational shifts (8.8cm laterally, 1.5cm longitudinally and 6cm vertically) were present. A series ofcouch rotations (+/-3 degrees, 1 degree increment) was intentionally applied to simulate angular setup variations. For each rotation, two stereoscopic x-rayimages were acquired and fused using the ExacTrac 6D registrationalgorithm. Calculated shifts were applied using two sequences: (1)automatic 5D corrections (three translations/two robotic couch rotations) followed by manual couch rotation; (2) manual couch rotation then automatic 5D corrections. After each ExacTrac localization, orthogonal (anterior-posterior and right-lateral) portal images were acquired to quantify BB center deviations from the radiation isocenter as an indicator of residual error.

RESULTS

Minimal difference between investigated table correction sequences was observed. Average translational deviations between the BB and radiation isocenter (mean+/-1SD) were 0.3+/-0.3mm and 1.0+/-0.2mm for lateral and vertical axis respectively. Longitudinally, the deviations were 0.8+/-0.4mm from the anterior-posterior image and 0.1+/-0.3mm from the right-lateral image. The systematic difference (0.7+/-0.1 mm) between thetwo may have been attributed to gantry sagging during rotation.

CONCLUSIONS

ExacTrac system successfully corrected angular shifts using the virtual isocenter method in a rigid phantom setup. The sequence ofcouch correction did not influence the localization accuracy. Further patient study is warranted.

SU-E-T-197: A Comprehensive Variance Reporting System and an Analysis of Variances Reported at Our Institution

PURPOSE

It is essential for radiation oncology departments to have comprehensive patient safety and quality programs. Two years ago we undertook a systematic review of our safety/QA program. Existing policies were updated and new policies created where necessary. One crucial component of any safety/QA program is continually updating it based on current information, the 'check' and 'act' portions of the Deming Cycle. We accomplished this with a transparent variance reporting system and a safety/QA committee reviewing and acting on reported variances.

METHODS

With 5 radiation oncology centers in our institution, we needed to devise a system that would allow anyone to report a variance and provide our QA committee the ability to review variances system-wide. We developed the system using web-based tools. The system allows individuals to report variances, anonymously or named, specify the nature of the variance and indicate the tools used to identify the variance.

RESULTS

In 2011, 285 variances were reported, 102 were reported by physicists, 86 anonymously, 71 by therapists and 26 by dosimetrists. We realized the need to develop clear classifications for variances. We added a high priority category, defined as variances which resulted in or had the potential to result in harm to a patient or when a policy is purposely overridden. Of the 285 variances reported, 5 were high priority. We created a process variance category, defined as variances where a specific clinical process is not followed. Of the 285 reported variances 155 were process variances.

CONCLUSIONS

Reporting of variances through a centralized database is central toward developing a robust patient safety/quality assurance program. Anonymous reporting fosters a non-punitive environment, and promotes the 'safety culture'. The goal of such a system is to review trends in clinical processes and ultimately to improve safety/quality by reducing variances associated with these processes.