Pattern formation in Faraday instability-experimental validation of theoretical models

Two types of resonance-derived interfacial instability are reviewed with a focus on recent work detailing the effect of side walls on interfacial mode discretization. The first type of resonance is the mechanical Faraday instability, and the second is electrostatic Faraday instability. Both types of resonance are discussed for the case of single-frequency forcing. In the case of mechanical Faraday instability, inviscid theory can forecast the modal forms that one might expect when viscosity is taken into account. Experiments show very favourable validation with theory for both modal forms and onset conditions. Lowering of gravity is predicted to shift smaller wavelengths or choppier modes to lower frequencies. This is also validated by experiments. Electrostatic resonant instability is shown to lead to a pillaring mode that occurs at low wavenumbers, which is akin to Rayleigh Taylor instability. As in the case of mechanical resonance, experiments show favourable validation with theoretical predictions of patterns. A stark difference between the two forms of resonance is the observation of a gradual rise in the negative detuning instability in the case of mechanical Faraday and a very sharp one in the case of electrostatic resonance. This article is part of the theme issue 'New trends in pattern formation and nonlinear dynamics of extended systems'.

Management strategies and outcomes in renal transplant recipients recovering from COVID-19: A retrospective, multicentre, cohort study

Background

There is an enormous knowledge gap on management strategies, clinical outcomes, and follow-up after kidney transplantation (KT) in recipients that have recovered from coronavirus disease (COVID-19).

Methods

We conducted a multi-center, retrospective analysis in 23 Indian transplant centres between June 26, 2020 to December 1, 2021 on KT recipients who recovered after COVID-19 infections. We analyzed clinical and biopsy-confirmed acute rejection (AR) incidence and used cox-proportional modeling to estimate multivariate-adjusted hazard ratios (HR) for predictors of AR. We also performed competing risk analysis. Additional outcome measures included graft loss, all-cause mortality, waiting time from a positive real-time polymerase test (RT-PCR) to KT, laboratory parameters, and quality of life in follow-up.

Findings

Among 372 KT which included 38(10·21%) ABO-incompatible, 12(3·22%) sensitized, 64(17·20%) coexisting donors with COVID-19 history and 20 (5·37%) recipients with residual radiographic abnormalities, the incidence of AR was 34 (9·1%) with 1(0·26%) death censored graft loss, and 4(1·07%) all-cause mortality over a median (interquartile range) follow-up of 241 (106-350) days. In our cox hazard proportional analysis, absence of oxygen requirement during COVID-19 compared to oxygen need [HR = 0·14(0·03-0·59); p-value = 0·0071], and use of thymoglobulin use compared to other induction strategies [HR = 0·17(0·03-0.95); p-value = 0·044] had a lower risk for AR. Degree of Human leukocyte antigen (HLA) DR mismatch had the highest risk of AR [HR = 10.2(1·74-65·83); p-value = 0·011]. With competing risk analysis, with death as a competing event, HLA DR mismatch, and oxygen requirement continued to be associated with AR. Age, gender, obesity, inflammatory markers, dialysis vintage, steroid use, sensitization and ABO-incompatibility have not been associated with a higher risk of AR. The median duration between COVID-19 real time polymerase test negativity to transplant was 88(40-145) days (overall), and ranged from 88(40-137), 65(42-120), 110(49-190), and 127(64-161) days in World Health Organization ordinal scale ≤ 3, 4, 5, and 6-7, respectively. There was no difference in quality of life, tacrolimus levels, blood counts, and mean serum creatinine assessed in patients with a past COVID-19 infection independent of severity.

Interpretation

Our findings support that the outcomes of KT after COVID-19 recovery are excellent with absence of COVID-19 sequelae during follow-up. Additionally, there does not seem to be a need for changes in the induction/immunosuppression regimen based on the severity of COVID-19.

Funding

Sanofi.

Technological advancements in jaggery-making processes and emission reduction potential via clean combustion for sustainable jaggery production: An overview

Jaggery is a kind of unrefined non-centrifugal sugar (NCS) used mainly in Asia, Africa, Latin America, and the Caribbean. Traditionally, jaggery is produced by concentrating sugarcane juice in open pans with the help of bagasse combustion. However, due to thermal energy loss with flue gases and an unscientific approach in plant construction, jaggery plants have a poor thermal efficiency of less than 25%, poor emission characteristics, and a high bagasse consumption rate. Advanced jaggery-making techniques use solar energy and heat pumps for jaggery production. However, these techniques are in the early stage of development, and the literature indicates that these techniques should be used in conjuction with traditional ones to improve the performance of jaggery making plants. This literature review describes advances in jaggery-making methods, critically analyzed them, and provides a qualitative comparison of these methods. Further, gaps in the existing literature are identified and reported for future research direction. In addition, efforts have been made to quantify and estimate the emissions reduction and bagasse consumption potentials from the traditional jaggery industry to make this rural industry a sustainable and profitable business for rural entrepreneurs. The comparison with the recently developed clean combustion device exhibits that the harmful emissions from the jaggery industry could be reduced drastically viz. 95%-98% of PM2.5; 92%-95% of CO, and 52-60% of CO2, while saving more than 35% of bagasse consumption. Implemented at a national scale, it may reduce nearly 3% of all harmful emissions in the country, which is equally applicable elsewhere.

ABO-incompatible transplantation without conventional induction immunosuppression (IL-2RB or depleting agents)

Transplantation across the ABO blood group (ABOI-Tx) has facilitated to increase in donor pool for living donor kidney transplantation. Increased risk of rejection despite augmented immunosuppression has been the concern for many transplant programs in initiating an ABOI-TX program. The benefits of induction immunosuppression on long-term graft survival in immunologically low-risk individuals are still not clear. Increased immunosuppression of ABOI-Tx recipients before transplantation could provide an opportunity to transplant without induction with IL2-R blockers or Lymphocyte depleting agents. The aim of our study is to analyze the outcome of our series of 25 consecutive ABOI-Tx patients who underwent transplantation without routine thymoglobulin or IL2R-blocker induction. Our study is a prospective observational study for the first 25 consecutive patients who had undergone ABOI-Tx from two tertiary care centers in Kerala, India, having the same IS protocol. Anti-A and anti-B titers ≤1:512 by Gel-method (Biorad) were accepted for desensitization. Patients underwent CDC-crossmatch, Flow-crossmatch, and Luminex-anti-HLA-antibody-screen. Desensitization regimen included- Rituximab 200 mg on Day-21, Triple IS Prednisolone 10 mg, mycophenolate mofetil 1000 mg, and Tacrolimus 0.06 mg/bodywt from Day-14 and Plasma-exchange (PLEX) 3-4 sessions from day -7 to attain titer of 1:8 before transplantation. Transplantation was done without induction IS. Twenty-five patients underwent ABOI-Tx from both centers. Twenty recipients were male. The average age was 34.5 ± 8 years with follow-up of 503 ± 120 days. Eight donors were spouse, 13 were parents and three siblings. The average age of the donor was 46.3 ± 10.5 years. Twenty-two patients have normal functioning transplant with creatinine 1.23 ± 0.2 mg/dL. Kaplan-Meier analysis showed patient survival of 91.2% and death censored graft survival of 95.6% at 36 months. Two patients were lost; one on the postoperative day (POD)-3 due to ACS and second on POD-22 due to sepsis. One graft loss occurred due to posttransplant HUS. Of the functioning 22 allograft-recipients, one had cellular rejection, which resolved with pulse steroids; one developed HUS due to CNI, which recovered with PLEX and switch to non-CNI based IS. One patient developed AMR on POD-4, which was completely reversed with PLEX, intravenous immunoglobulin (IVIG), and augmentation of IS. Three patients had CMV viremia and another three patients had BKV viremia, all resolved with treatment and tailoring of IS. Achieving acceptable anti-A/B titers prior to transplantation is the most critical step in ABOI-Tx. Avoidance of induction IS can reduce cost and infectious complications. Our data showed that there is no increased incidence of rejections in the first post-transplant year for immunologically low-risk individuals from histocompatibility standpoint undergoing ABOI-Tx without induction immunosuppression.

A comprehensive review of the recent development and challenges of a solar-assisted biodigester system

The extensive use of fossil fuels and the environmental effect of their combustion products have attracted researchers to look into renewable energy sources. In addition, global mass production of waste has motivated communities to recycle and reuse the waste in a sustainable way to lower landfill waste and associated problems. The development of waste to energy (WtE) technology including the production of bioenergy, e.g. biogas produced from various waste through Anaerobic Digestion (AD), is considered one of the potential measures to achieve the sustainable development goals of the United Nations (UN). Therefore, this study reviews the most recent studies from relevant academic literature on WtE technology (particularly AD technology) for biogas production and the application of a solar-assisted biodigester (SAB) system aimed at improving performance. In addition, socio-economic factors, challenges, and perspectives have been reported. From the analysis of different technologies, further work on effective low-cost technologies is recommended, especially using SAB system upgrading and leveraging the opportunities of this system. The study found that the performance of the AD system is affected by a variety of factors and that different approaches can be applied to improve performance. It has also been found that solar energy systems efficiently raise the biogas digester temperature and through this, they maximize the biogas yield under optimum conditions. The study revealed that the solar-assisted AD system produces less pollution and improves performance compared to the conventional AD system.

Clinical profile and outcome in long-term hemodialysis: A comparative study of hospital-based versus standalone units

Introduction:

Chronic hemodialysis (CHD) remains the most “resorted to“ renal-replacement option in India. Pursuit for accessible and affordable dialysis has resulted in setting up standalone centers (SACs). We need more Indian data on the profile of CHD population and outcome of SAC compared to hospital-based units (HBUs).

Material and Methods:

We analyzed the clinical profile of patients on CHD for >5 years, compared the outcome between HBU and SAC, and analyzed the factors associated with mortality. Patients initiated between January 1, 2006 and December 31, 2012 and who have survived 5 years on CHD at HBU or SAC were enrolled and followed up prospectively for 2 years. Their clinical and biochemical profile, comorbidities, long-term complications, and mortality were analyzed.

Results:

The study included 137 patients, 41 (30%) from HBU and 96 (70%) from SACs. In both groups, the patients were predominantly male, aged 51–70 yrs, diabetic, unplanned initiation through catheters, and had average-dialysis vintage between 83 and 85 months. SAC had more patients with hemoglobin (> 11 gm/dL) and hyperparathyroidism with elevated SAP levels (P < 0.05). Both groups had comparable iron stores, serum calcium, and phosphorus. Comparable between groups, infections, coronary artery disease, and access complications accounted for most hospitalizations and sudden cardiac death and sepsis accounted for most mortality. A trend of better survival was seen in SAC. Multivariate analysis showed anemia, DM and hospitalizations were associated with mortality.

Conclusion:

We conclude that the outcomes of long-term CHD at SACs are not inferior to HBUs. Anemia, diabetes, and hospitalizations were associated with overall mortality. Benefits of SACs in cost, QOL, and employment opportunities need to be studied in the Indian context.

Effect of spinning on the shape and stability of a pendent drop

Assuming that we wish to measure the surface tension between two liquids by running a pendent drop experiment, we present calculations supporting the case for spinning the drop. For bridges, jets, etc., spinning a heavy fluid surrounded by a lighter fluid is strictly destabilizing. But we find that spinning a drop may be stabilizing and, if this is so, it leads to larger critical volumes, volumes where stability is lost, and thus more accurate measurements of surface tension. There are two observable patterns, one symmetric and the other unsymmetric, at the point of instability. The symmetric pattern leads to larger critical volumes. Our aim is to show how spinning can be used to achieve the symmetric pattern.

Paying for Hemodialysis in Kerala, India: A Description of Household Financial Hardship in the Context of Medical Subsidy

INTRODUCTION

Many low- and middle-income countries are implementing strategies to increase dialysis availability as growing numbers of people reach end-stage renal disease. Despite efforts to subsidize care, the economic sustainability of chronic dialysis in these settings remains uncertain. We evaluated the association of medical subsidy with household financial hardship related to hemodialysis in Kerala, India, a state with high penetrance of procedure-based subsidies for patients on dialysis.

METHODS

Patients on maintenance hemodialysis at 15 facilities in Kerala were administered a questionnaire that ascertained demographics, dialysis details, and household finances. We estimated direct and indirect costs of hemodialysis, and described the use of medical subsidy. We evaluated whether presence of subsidy (private, charity, or government-sponsored) was associated with lower catastrophic health expenditure (defined as ≥40% of nonsubsistence expenditure spent on dialysis) or distress financing.

RESULTS

Of the 835 patients surveyed, 759 (91%) reported their households experienced catastrophic health expenditure, and 644 (77%) engaged in distress financing. Median dialysis-related expenditure was 80% (25th-75th percentile: 60%-90%) of household nonsubsistence expenditure. Government subsidies were used by 238 (29%) of households, 139 (58%) of which were in the lowest income category. Catastrophic health expenditure was present in 215 (90%) of households receiving government subsidy and 332 (93%) without subsidy.

CONCLUSIONS

Provision of medical subsidy in Kerala, India was not associated with lower rates of household financial hardship related to long-term hemodialysis therapy. Transparent counseling on impending costs and innovative strategies to mitigate household financial distress are necessary for persons with end-stage renal disease in resource-limited settings.

Spectrum of biopsy-proven renal diseases: A single center experience

Kidney biopsy is one of the most important tools in the assessment of kidney disease as histopathological diagnosis promotes evidence-based practice in Nephrology. This study included 271 consecutive percutaneous kidney biopsies (145 males and 126 females) performed at EMS Memorial Cooperative Hospital, Perinthalmanna, Kerala, India, from September 2009 to March 2016. Among the biopsy-proven renal diseases (BPRD), primary glomerular diseases (PGD) were the most common (77.78%) followed by secondary glomerular diseases (SGD) (12.22%) and tubulointerstitial diseases (10%). The IgA nephropathy (IgAN) was the most common PGD and majority had mesangial hypercellularity (M1) (93.54%), tubular atrophy (T1 or T2 68.25%), and the most common pattern was M1, E0, S0, and T1, suggesting that patients of Indian subcontinent have aggressive disease type, unlike western literature. The focal segmental glomerulosclerosis (FSGS) was the second most common PGD and the majority were of not otherwise specified type. FSGS, membranous nephropathy and minimal change disease were the three most common causes for PGD causing nephrotic syndrome. Diabetic nephropathy and lupus nephritis were the two most common biopsy-proven SGDs. Among the patients of diabetes mellitus who underwent renal biopsy with suspicion of nondiabetic renal disease (NDRD), 58.33% had NDRD, 16.67% had DN+ NDRD, and 26.67% had DN alone. This study shows the changing pattern BPRD in comparison to earlier studies. This study also confirms the aggressive nature of IgAN in Indian patients and underlines the importance of renal biopsy in patients of DM.

Bowel Migration of Dormant Chronic Ambulatory Peritoneal Dialysis Catheter: A Vexed Problem Not Avoided by Flushing

Delayed bowel erosion by peritoneal dialysis catheter is rare with fewer than thirty cases having been reported in the literature. This complication is usually encountered when the catheter is kept dormant. Two cases have also been reported with catheters in active use. The risk factors for bowel erosion include immunosuppression, diverticulosis, and amyloidosis. An 80-year-old male with chronic kidney disease Stage 5 due to hypertensive nephrosclerosis underwent chronic ambulatory peritoneal dialysis catheter insertion. Due to improvement in the glomerular filtration rate and clinical parameters including extracellular fluid volume status, peritoneal dialysis was not initiated. Weekly catheter flushes were performed. After 5 months, he developed watery diarrhea after a regular flushing episode. Computed tomography scan revealed the catheter displaced into the sigmoid colon with the tip in the rectum. He was managed successfully with catheter removal alone and conservative treatment. He remains asymptomatic at 3-month follow-up. This case is presented to emphasize the fact that delayed bowel erosion can happen with dormant catheter even in the absence of risk factors. Periodic flushing has not prevented this complication in our patient. Perforations can be self-curing when diagnosed early and when patients present without features of peritonitis or sepsis. Such cases can be managed successfully with catheter removal alone.

Dimensionality-Dependent Electrochemical Kinetics at the Single-Layer Graphene-Electrolyte Interface

The theories to describe the rate at which electrochemical reactions proceed, to date, do not consider explicitly the dimensionality or the discreteness and occupancy of the energy levels of the electrodes. We show experimentally that such quantum mechanical aspects are important for dimensionally confined nanostructured materials and yield unusual variation of the kinetic rate constants with applied voltage in single-layer graphene. The observed divergence from conventional electrokinetics was ascribed to the linear energy dispersion as well as a nonzero density of states at the Dirac point in the graphene. The obtained results justify the use of density of states-based rate constants and considerably add to Marcus-Hush-Chidsey kinetics.

Endurance based personalized fitness planner

Endurance is an important factor of cardiovascular fitness indicating the capacity of an individual to perform exercise for a longer duration with increased intensity. Various subject specific and exercise related parameters affect endurance of an individual. In this work, we propose a statistical technique to model endurance as a function of these factors incorporating the serial dependence of observations generated by individuals over time. The proposed model provides a device to predict future endurance of a test subject following particular exercise regime. This facilitates a test user with a fitness planner with the provision to fix exercise regimes to reach a set fitness goal.

Cholecystokinin-2/gastrin antagonists: 5-hydroxy-5-aryl-pyrrol-2-ones as anti-inflammatory analgesics for the treatment of inflammatory bowel disease

Arylated 5-hydroxy-pyrrol-2-ones were prepared in 2 synthetic steps from mucochloric acid and optimised as CCK2-selective ligands using radiolabelled binding assays. CCK antagonism was confirmed for the ligands in isolated tissue preparations. DSS (dextran sulfate sodium)-induced inflammation was analysed for derivative 7 and PNB-001 with L-365,260 as a standard. The IC50 of PNB-001 was determined to be 10 nM. Subsequent in vivo evaluation confirmed anti-inflammatory activity with respect to IBD assays. The best molecule, PNB-001, showed analgesic activity in the formalin test and in the hotplate assay, in which the analgesic effect of 1.5 mg kg-1 PNB-001 was equivalent to 40 mg kg-1 tramadol. The CCK2-selective antagonist PNB-001 protected rats against indomethacin-induced ulceration at similar doses. The GI protection activity was found to be more potent than that of the 10 mg kg-1 dose of prednisolone, which served as a standard.

Abstract P6-12-06: Nonsteroidal, tissue selective androgen receptor modulator (SARM), enobosarm, reduces growth of androgen receptor-positive breast cancer in patient-derived preclinical models

Introduction: In breast cancer the androgen receptor (AR) is the most abundantly expressed steroid receptor with 75-95% of estrogen receptor (ER)-positive and 40-70% of ER-negative breast cancers expressing the AR. Historically, advanced breast cancer has been treated with androgens, resulting in significant clinical response. However, the use of steroidal androgens fell from favor as a result of their virilizing side effects. Nonsteroidal, tissue selective androgen receptor modulators (SARMs) will provide a novel targeted approach to exploit the therapeutic benefits of androgens in breast cancer.

Aims: To test the effects of enobosarm (a first-in-class SARM) and enzalutamide (AR antagonist) on the growth of patient-derived breast cancer xenografts (PDX) and to discern the mechanism of action of AR-targeted therapies in AR-positive breast cancer.

Materials and Methods: AR-positive PDXs with varying receptor expression (ER, progesterone receptor (PR), and HER2) were implanted in immunecompromised mice. Mice carrying PDXs were treated with vehicle, 10 mg/kg/day (mpk) enobosarm (GTx, Inc., Memphis, TN), or 20 mpk enzalutamide (Medivation Inc.), orally. Tumor volume was measured twice or thrice weekly. Tumors that received enobosarm were further analyzed to determine the mechanism of action.

Results: Enobosarm significantly (p&lt;0.01) inhibited the growth of ER-, PR-, and HER2- positive HCI-7 and ER- and PR- negative and HER2-positive HCI-12 PDX. While enobosarm inhibited the growth of HCI-12 by ~80% and HCI-7 by ~60%, enzalutamide failed to inhibit the growth of the HCI-7 PDX. In contrast, neither enobosarm nor enzalutamide inhibited the growth of ER- and PR-negative and HER2-positive HCI-9 PDX, consistent with the heterogeneity of AR-positive breast cancers. Growth of two triple-negative breast cancer (TNBC) PDXs were inhibited by 30-40% by enobosarm, but not by enzalutamide. These results were reproduced in xenografts developed with breast cancer cell lines, MCF-7 and MDA-MB-231 expressing the AR. Gene expression studies conducted with the HCI-12 tumors indicated that enobosarm inhibited the expression of various proliferative genes (MUC2, IL10RA, IGSF1, SLC6A4, and others) and increased the expression of growth inhibitory genes (CYP4F8, MYBPC1, and others). Ingenuity pathway analysis demonstrated that enobosarm inhibited genes that are downstream of HER2 signaling. Interestingly, miR-21-3p, which has been implicated in chemo-resistance, was consistently expressed at approximately 10-50-fold higher than miR-21-5p in PDXs. This imbalance was partially reversed by enobosarm.

Conclusion: These results indicate that AR-positive breast cancers are highly heterogeneous and that enobosarm has promise as novel targeted therapy to treat AR-positive breast cancer. Enobosarm is currently in phase II clinical trial in both ER-positive breast cancer and in TNBC patients.

Citation Format: Narayanan R, Ponnusamy S, Fan M, Yang CH, Grimes BL, Fleming MD, Pritchard EF, Berry MP, Oswaks RM, Fine RE, Loiseau J-C, Schwartzberg LS, Pfeffer LM. Nonsteroidal, tissue selective androgen receptor modulator (SARM), enobosarm, reduces growth of androgen receptor-positive breast cancer in patient-derived preclinical models [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-12-06.

Case Report: Application of whole exome sequencing for accurate diagnosis of rare syndromes of mineralocorticoid excess

Syndromes of mineralocorticoid excess (SME) are closely related clinical manifestations occurring within a specific set of diseases. Overlapping clinical manifestations of such syndromes often create a dilemma in accurate diagnosis, which is crucial for disease surveillance and management especially in rare genetic disorders. Here we demonstrate the use of whole exome sequencing (WES) for accurate diagnosis of rare SME and report that p.R337C variation in the HSD11B2 gene causes progressive apparent mineralocorticoid excess (AME) syndrome in a South Indian family of Mappila origin.

Cholecystokinin-1 receptor antagonists: 5-hydroxy-5-aryl-pyrrol-2-ones as anticancer agents

Hydroxy-pyrrolones, which were potent CCK1R antagonists, showed nanomolar in vitro activity and anticancer activity in vivo for colon and pancreatic cancer.

Modulation of the Electrostatic and Quantum Capacitances of Few Layered Graphenes through Plasma Processing

It is shown that charged defect generation, through argon ion-based plasma processing, in few layer graphene, could substantially enhance the electrical capacitance for electrochemical energy storage. Detailed consideration of the constituent space charge and quantum capacitances were used to delineate a new length scale, correlated to electrically active defects contributing to the capacitance, and was found to be smaller than a structural correlation length determined through Raman spectroscopy. The study offers insights into an industrially viable method (i.e., plasma processing) for modifying and enhancing the energy density of graphene-based electrochemical capacitors.

Density of states in graphene with vacancies: midgap power law and frozen multifractality

The density of states ϱ(E) of graphene is investigated numerically and within the self-consistent T-matrix approximation in the presence of vacancies within the tight binding model. The focus is on compensated disorder, where the concentration of vacancies n(A) and n(B) in both sublattices is the same. Formally, this model belongs to the chiral symmetry class BDI. The onlinear sigma model predicts for BDI a Gade-type singularity ϱ(E)∼|E|(-1)exp[-|log(E)|(-1/x)]. Our numerical data are comparable to this result in a preasymptotic regime that gives way, however, at even lower energies to ϱ(E)∼E(-1)|log(E)|(-x̃), 1≤x̃<2. We take this finding as evidence that, similar to the case of dirty d-wave superconductors, generic bipartite random hopping models may also exhibit unconventional (strong-coupling) fixed points for certain kinds of randomly placed scatterers if these are strong enough. Our research suggests that graphene with (effective) vacancy disorder is a physical representative of such systems.

Abstract P5-09-21: Selective androgen receptor modulators (SARMs): Enobosarm as targeted therapy for the treatment of androgen receptor-positive breast cancer

Background: The androgen receptor (AR) is the most highly expressed steroid receptor in breast cancer with 75-95% of estrogen receptor (ER)-positive and 40-70% of ER-negative breast cancers expressing AR. Prior studies have shown that women with metastatic breast cancer who have been previously treated with tamoxifen and progress have responded to non-tissue-selective androgens like fluoxymesterone, medroxyprogesterone and danazol, with overall response rates ranging from 20 to 60%. Although these non-tissue-selective androgens have been used to treat breast cancer, the unwanted virilizing side effects, including facial and body hair, enlargement of voice box, acne, and edema, have limited their widespread clinical use. Nonsteroidal, tissue- selective androgen receptor modulators (SARMs) like enobosarm and GTx-027 may provide a novel targeted approach to exploit the therapeutic benefits of androgen therapy in breast cancer without the unwanted virilizing side effects or concerns related to their conversion by aromatase to estrogens.

Methods: MDA-MB-231 triple-negative and MCF-7 triple-positive breast cancer cells stably expressing AR (MDA-MB-231-AR and MCF-7-AR, respectively) were used to evaluate the in vitro and in vivo anti-proliferative and gene expression effects of bicalutamide (an AR antagonist), dihydrotestosterone (DHT), enobosarm, and GTx-027. Phase II clinical studies examined the pharmacologic effects (lean body mass and muscle strength), tissue selectivity (skin, endometrium, and hair growth) and safety of enobosarm, a first-in-class SARM, in postmenopausal women.

Results: DHT and SARMs, but not bicalutamide, inhibited the proliferation of MDA-MB-231-AR and MCF-7-AR cells. DHT and the SARMs functioned as AR agonists in transactivation assays in MDA-MB-231 cells, indicating that AR agonists, but not antagonists, elicit anti-proliferative effects in breast cancer. MDA-MB-231-AR and MCF-7-AR cells were implanted subcutaneously in nude mice and were treated orally with vehicle or 30 mg/kg/day GTx-027. GTx-027 reduced the tumor growth significantly with greater than 75% tumor growth inhibition observed in MDA-MB-231-AR tumors and greater than 50% tumor growth inhibition observed in MCF-7-AR tumors, compared to vehicle-treated tumors. GTx-027 also inhibited tumor weights by greater than 50% concurring with the tumor volume observation. GTx-027 inhibited the intratumoral expression of genes and pathways that promote breast cancer development through its actions on the AR. Interestingly, GTx-027 and other AR agonists elicited opposite effects on various AR target genes in ER-positive versus ER-negative breast cancer cells, indicating a potential cross talk between AR and ER signaling pathways on the promoter of these genes. Phase II clinical studies showed that enobosarm was generally well tolerated in postmenopausal women. Statistically significant improvements in lean body mass and physical function were observed after 12 weeks of treatment with 3 mg enobosarm, with no significant changes in sebaceous gland volume (biopsy), hair growth, endometrial stripe thickness (transvaginal ultrasound) or bleeding (medroxyprogesterone challenge).

Dual role of gravity on the Faraday threshold for immiscible viscous layers

This work discusses the role of gravity on the Faraday instability, and the differences one can expect to observe in a low-gravity experiment when compared to an earth-based system. These differences are discussed in the context of the viscous linear theory for laterally infinite systems, and a surprising result of the analysis is the existence of a crossover frequency where an interface in low gravity switches from being less to more stable than an earth-based system. We propose this crossover exists in all Faraday systems, and the frequency at which it occurs is shown to be strongly influenced by layer height. In presenting these results physical explanations are provided for the behavior of the predicted forcing amplitude thresholds and wave number selection.

Caregiver burden among nocturnal home hemodialysis patients

Recent studies have suggested improvements in quality of life (QOL) in patients on quotidian dialysis compared with conventional hemodialysis. Few studies have focused on the burden and QOL in caregivers of patients with end-stage renal disease (ESRD) on nocturnal home hemodialysis (NHD). We aim to assess the caregivers' burden, QOL, and depressive symptoms and to compare these parameters with their patients' counterparts. Cross-sectional surveys were sent to 61 prevalent NHD patients and their caregivers. Surveys assessed demographics, general self-perceived health using the 12-Item Short Form Health Survey (SF-12) and the presence of depression using the Beck Depression Inventory. Subjective burden on caregivers was assessed by the Caregiver Burden scale and was compared with perceived burden by the patients. Thirty-six patients and 31 caregivers completed the survey. The majority of caregivers were female (66%), spouse (81%) with no comorbid illness (72%). Their mean age was 51 ± 11 years. Patients were mostly male (64%) with a median ESRD vintage of 60 months (interquartile range [IQR], 18-136 months) and a mean age of 52 ± 10 years. Compared to caregivers, patients had lower perceived physical health score but had similar mental health score. Depression criteria were present in 47% of patients and 25% of caregivers. Total global burden perceived by either caregivers or patients is relatively low. Although there is a relatively low global burden perceived by caregivers and patients undergoing NHD, a significant proportion of both groups fulfilled criteria for depression. Further innovative approaches are needed to support caregivers and patients performing NHD to reduce the intrusion of caring for a chronic illness and the risk of developing depression.

Rapid diagnosis of leptospirosis in patients with different clinical manifestations by 16S rRNA gene based nested PCR

Leptospirosis, a zoonosis of global importance and it is underreported in India and more than 50,000 severe cases are reported each year. Here we present the evaluation of 16S rRNA based nested PCR assay for the rapid identification of human leptospires using serum and urine samples. The study includes 261 suspected cases for leptospirosis with different clinical manifestations. 16S rRNA based nested PCR assay was compared and evaluated against the conventional serological methods such as MAT and ELISA. The technique enabled amplification of a 289 bp product with notable percentage of positivity in all sample groups including 94.8 in pediatric cases, 93 in pregnant women, 94.2 in renal failure, 87.8 in jaundice and 94.6 in common febrile cases. The sensitivity and specificity was 94.4% and 100%, respectively. The technique proved to be prompt and effective for the diagnosis of leptospiral infection at the acute phase of the disease. PCR based approach detects leptospiral DNA from the clinical samples both at the acute and leptospiruria phase on comparison with its counter parts where detection is made possible only after 7 days or 7-30 days post-infection. In this regard PCR based diagnosis of leptospirosis should be made available for clinicians for the early diagnosis and prompt treatment of the disease.

Delayed graft function and the risk of death with graft function in living donor kidney transplant recipients

BACKGROUND

The link between delayed graft function (DGF) and death with graft function (DWGF) in living donor kidney transplant recipients presently is unknown.

STUDY DESIGN

Retrospective cohort study.

SETTING & PARTICIPANTS

44,630 adult living donor kidney recipients (first transplants only) in the US Renal Data System from January 1, 1994, to December 31, 2004.

PREDICTOR

DGF, defined as the need for dialysis therapy in the first week after transplant.

OUTCOME

Time to DWGF.

MEASUREMENTS

Kaplan-Meier curves were constructed to assess the impact of DGF on DWGF. Recipients with DGF were 1:1 propensity score matched to those without DGF, and time-dependent Cox proportional hazards models were used to examine factors associated with DWGF. Subgroup and sensitivity analyses also were conducted.

RESULTS

DWGF occurred in 3,878 patients during 3.9 years' (median) follow-up. In patients with DGF, survival with graft function at 1, 3, 5, and 10 years was 91.9%, 86.8%, 81.6%, and 61.7%, respectively (in patients without DGF, these values were 98.0%, 95.2%, 91.6%, and 80.1%, respectively; P < 0.001 compared with the DGF group). In a fully adjusted time-dependent Cox model, HRs for DWGF in patients with DGF (vs without DGF) were 6.55 (95% CI, 4.78-8.97), 3.55 (95% CI, 2.46-5.11), 2.07 (95% CI, 1.53-2.81), and 1.48 (95% CI, 1.26-1.73) at 0-1, 1-3, 3-12, and longer than 12 months posttransplant, respectively. Propensity score analysis showed similar results. Inferences were unchanged after adjustment for kidney function and acute rejection at 6 months and 1 year posttransplant. Cardiovascular and infectious causes of DWGF were more prevalent in patients with DGF. The association was more marked in female recipients and robust to various sensitivity analyses.

LIMITATIONS

The impact of lesser decreases in early graft function could not be evaluated.

CONCLUSIONS

DGF is associated with an increased risk of DWGF in living donor kidney recipients. The mechanisms underlying this relation require further study.

Prediction of skin sensitization potential using D-optimal design and GA-kNN classification methods

Modelling of skin sensitization data of 255 diverse compounds and 450 calculated descriptors was performed to develop global predictive classification models that are applicable to whole chemical space. With this aim, we employed two automated procedures, (a) D-optimal design to select optimal members of the training and test sets and (b) k-Nearest Neighbour classification (kNN) method along with Genetic Algorithms (GA-kNN Classification) to select significant and independent descriptors in order to build the models. This methodology helped us to derive multiple models, M1-M5, that are stable and robust. The best among them, model M1 (CCR(train) = 84.3%, CCR(test) = 87.2% and CCR(ext) = 80.4%), is based on six neighbours and nine descriptors and further suggests that: (a) it is stable and robust and performs better than the reported models in literature, and (b) the combination of D-optimal design and GA-kNN classification approach is a very promising approach. Consensus prediction based on the models M1-M5 improved the CCR of training, test and external validation datasets by 3.8%, 4.45% and 3.85%, respectively, over M1. From the analysis of the physical meaning of the selected descriptors, it is inferred that the skin sensitization potential of small organic compounds can be accurately predicted using calculated descriptors that code for the following fundamental properties: (i) lipophilicity, (ii) atomic polarizability, (iii) shape, (iii) electrostatic interactions, and (iv) chemical reactivity.

Nanocrystalline hydroxyapatite coatings from ultrasonated electrolyte: preparation, characterization, and osteoblast responses

An electrochemical method of producing nanograined hydroxyapatite coatings on titanium surface is reported in this article. The electrolyte contained Ca(NO(3))(2) and NH(4)H(2)PO(4) in the molar ratio of 1.67:1. The electrolyte had physiological pH and was ultrasonically agitated throughout the time of electrolysis. Coatings were deposited for 30 minutes at 10 and 15 mA/cm(2) and contained monohydroxyapatite phase whose grain sizes were 18 and 25 nm, respectively. These sizes are comparable with the grain size of bone. Small globules of hydroxyapatite covered the coating surface completely. Cell viability and total protein assay studies were carried out using SaOS-2 human osteoblast-like cell line. Of the two, the coating produced at 10 mA/cm(2) showed higher viability and protein activity and seems to be a promising material for osseointegration.

A two-stage process for simultaneous thermophilic sludge digestion, pathogen control and metal leaching

A consortium of aerobic sulphur oxidizing microorganisms native to municipal sewage sludge has been developed that is capable of reducing the pH of sludge from 7.0 to 2.0 under mild-thermophilic (45 degrees C) temperatures. This mild-thermophilic, acidophilic acclimatized consortium has then been used to develop a thermophilic acidophilic culture capable of reducing the pH of municipal sewage sludge from 7.0 to 4.8 at 60 degrees C. Furthermore, these two cultures have been used to develop a novel two-stage aerobic process functioning under thermophilic and mild-thermophilic conditions capable of simultaneous sludge digestion, pathogen control and metal leaching. Studies with 1.5 L reactors indicate that at the end of the process, concentration of volatile suspended solids has stabilized, no coliforms are present, and 90-98% copper, 90-94% manganese and 95-100% zinc has been leached.

Adaptation of a 3D prostate cancer atlas for transrectal ultrasound guided target-specific biopsy

Due to lack of imaging modalities to identify prostate cancer in vivo, current TRUS guided prostate biopsies are taken randomly. Consequently, many important cancers are missed during initial biopsies. The purpose of this study was to determine the potential clinical utility of a high-speed registration algorithm for a 3D prostate cancer atlas. This 3D prostate cancer atlas provides voxel-level likelihood of cancer and optimized biopsy locations on a template space (Zhan et al 2007). The atlas was constructed from 158 expert annotated, 3D reconstructed radical prostatectomy specimens outlined for cancers (Shen et al 2004). For successful clinical implementation, the prostate atlas needs to be registered to each patient's TRUS image with high registration accuracy in a time-efficient manner. This is implemented in a two-step procedure, the segmentation of the prostate gland from a patient's TRUS image followed by the registration of the prostate atlas. We have developed a fast registration algorithm suitable for clinical applications of this prostate cancer atlas. The registration algorithm was implemented on a graphical processing unit (GPU) to meet the critical processing speed requirements for atlas guided biopsy. A color overlay of the atlas superposed on the TRUS image was presented to help pick statistically likely regions known to harbor cancer. We validated our fast registration algorithm using computer simulations of two optimized 7- and 12-core biopsy protocols to maximize the overall detection rate. Using a GPU, patient's TRUS image segmentation and atlas registration took less than 12 s. The prostate cancer atlas guided 7- and 12-core biopsy protocols had cancer detection rates of 84.81% and 89.87% respectively when validated on the same set of data. Whereas the sextant biopsy approach without the utility of 3D cancer atlas detected only 70.5% of the cancers using the same histology data. We estimate 10-20% increase in prostate cancer detection rates when TRUS guided biopsies are assisted by the 3D prostate cancer atlas compared to the current standard of care. The fast registration algorithm we have developed can easily be adapted for clinical applications for the improved diagnosis of prostate cancer.