A comparative study of complications and long term outcomes of Surgical Tracheostomy and two techniques of Percutaneous Tracheostomy

Context:

The operative technique for surgical tracheostomy has remained unchanged, but different techniques for percutaneous tracheostomy have evolved due to interest in minimally invasive procedures for the critically ill patient.

Aims:

To compare the periprocedural complications and long term outcomes of bedside surgical tracheostomy (ST) with two percutaneous tracheostomy (PCT) techniques, namely serial guide wire dilating forceps (GWDF) and PercuTwist (PT).

Settings and Design:

This prospective observational study was carried out in ICU of a tertiary referral centre over three year period on adult intubated patients needing elective tracheostomy.

Materials and Methods:

Patients with anticipated difficult neck anatomy were assigned for ST based on discretion of intensivist. Patients included for PCT were randomly assigned to the GWDT and PT technique. 90 patients underwent either bedside ST (n = 30), PCT by GWDF technique (n = 30) or PCT with PercuTwist (n = 30) and were followed up with fibreoptic bronchoscopy monthly for 06 months.

Statistical Analysis Used:

Data was analyzed by applying chi square tests for categorical variables.

Results:

Periprocedural complications during PCT included major bleeding (>100ml) in two patients in GWDF group which required conversion to ST. Periprocedural bleeding was also the main complication in ST. Increased incidence of granulation tissue and tracheal narrowing in long term was seen in both ST and PCT groups. All of the P values analysed for the intra operative, post operative complications or long term outcomes were >0.05.

Conclusions:

There was no statistically significant difference in incidence of complications of ST and two techniques of PCT. Proper case selection makes PCT as safe as ST.

Abstract P1-04-16: Multi-center experience with CELLSEARCH® circulating tumor cell kit on patients with metastatic breast cancer

Background: Clinical studies have shown that circulating tumor cell (CTC) detection via the CELLSEARCH® assay is a validated prognostic marker for the prediction of progression-free survival (PFS) and overall survival (OS) in metastatic breast cancer (mBC) patients. We evaluated the impact of CTC testing on OS using real-world observational data from multiple centers.

Material and Methods: Electronic medical records (EMR) were used to identify patients who were: (i) women > 18 years diagnosed with mBC on or after their date of registration, (ii) registered to the EMR system on or after 4/1/2010, and (iii) followed for at least 2 months from the time of metastases. Patients who had CTC testing were required to have at least 1 valid CTC test result. OS among mBC patients with CTC testing was compared to a cohort of patients without CTC testing (non-CTC) using a Cox model controlling for age, race, hormone receptor status, and scanning frequency.

Results: CTC patients were treated in 43 centers and grouped into two main sites based on region (N1 = 123, N2 = 240); non-CTC patients were treated in 58 different centers (N = 1,115). Mean (SD) ages of CTC and non-CTC patients were 66 (13) and 65 (14) years, respectively. ER or PR+ patients comprised 77% of the CTC tested and 72% of the non-CTC samples. The majority of patients in both cohorts were Caucasian (83% - CTC, 57% - non-CTC). A Cox model comparing OS between CTC and non-CTC patients did not show a survival benefit due to CTC testing. Comparing CTC testing frequency between the two sites showed that, on average, the 123 patients from site 1 were tested more frequently than the 240 patients in site 2 (0.6 vs. 0.3 CTC tests/month, p-value<0.001). The model that compared OS between CTC patients from site 1 showed a 43% reduction in risk of death (HR = 0.58, p-value = 0.005) compared to the overall cohort of non-CTC patients. Patients from site 2 did not show a reduction in risk of death compared to non-CTC patients, but a significant interaction between CTC testing and race (Caucasian vs. non-Caucasian) (p-value = 0.005) was observed. For Caucasians, CTC patients exhibited a 37% reduction in risk of death compared to non-CTC patients; reduction in risk of death was not observed for non-Caucasians CTC patients. This interaction (p-value = 0.005) was consistent among the subset of ER or PR+ Caucasian patients relative to non-CTC ER or PR+ Caucasian patients (HR = 0.55). For site 1, the subset of ER or PR+ CTC also had a lower risk of dying compared to ER or PR+ non-CTC (HR = 0.47, p-value = 0.004).

Discussion: These results suggest that frequent serial testing for CTC may be associated with better prognosis compared to no CTC testing or even infrequent CTC testing. By more frequent monitoring, the assessment of serial CTCs provide clinicians with more frequent information, which in turn can provide a clearer understanding of a patient's cancer progression in a metastatic setting. One limitation of these results is the difficulty in ruling out other potential drivers. Particularly, results regarding the racial differences in outcomes where race might serve as a proxy for a number of factors such as severity of disease which is difficult to derive from a retrospective observational database.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-04-16.

Enhanced Production of the Polysaccharide Arabinogalactan Using Immobilized Cultures of Tinospora cordifolia by Elicitation and In Situ Adsorption

Immobilized callus cultures of Tinospora cordifolia (Willd) Miers ex Hooks and Thoms were investigated to find out the combined effect of elicitation, cell permeabilization with chitosan and in situ product recovery by polymeric neutral resin-like Diaion HP 20. In this study, callus cultures of T. cordifolia were immobilized using sodium alginate and calcium chloride and the beads were cultured in Murashige and Skoog's basal medium along with benzyl adenine (BA), 2,4-dichlorophenoxy acetic acid (2,4-D) and 3% sucrose. The immobilized cultures, when subjected to elicitation and cell permeabilization with chitosan and in situ removal of the secondary metabolites by addition of resin, showed a 10-fold increase in production of arabinogalactan (0.490% dry weight) as compared to respective controls devoid of resin and chitosan. This indicates that in situ adsorption may have reduced the feedback inhibition caused by accumulation of secondary metabolites in the media, while the dual effect of elicitation and cell permeabilization by chitosan may have released the intracellular (secreted) berberine and the polysaccharide arabinogalactan, respectively.

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

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

The behavioral spectrum of tic disorders: a community-based study

BACKGROUND

Tourette syndrome (TS) and related tic disorders are commonly associated with obsessive-compulsive disorder (OCD) and attention deficit hyperactivity disorder (ADHD). It has been argued, however, that any observed association between TS and these and other psychopathologies may be due to ascertainment bias in that individuals with multiple problems are more likely to be referred for medical evaluation.

METHODS

In order to overcome the potential confounding by ascertainment bias, the authors conducted a community-based study of school children using direct interviews to determine the prevalence of tic disorders and any comorbid psychopathology. A standard psychiatric interview and standardized rating scales were utilized to diagnose childhood behavioral disorders.

RESULTS

Of the 1,596 children interviewed, 339 were identified as having tics. The following psychopathologies were found more commonly (p < 0.05) in the children with tics: OCD, ADHD, separation anxiety, overanxious disorder, simple phobia, social phobia, agoraphobia, mania, major depression, and oppositional defiant behavior.

CONCLUSION

The behavioral spectrum of tic disorders includes OCD, other anxiety disorders, a mood disorder, and attention-deficit and disruptive behavior disorders.

Inheritance of disease lesion mimic leaf trait in groundnut

In groundnut, two identical mutants with disease lesion mimic leaf trait were isolated independently from two different parents through induced mutagenesis and in vitro culture technique. The leaf chlorophyll content in both the mutants was found to be drastically reduced. The segregation pattern in the F(2) and F(3) generations for normal and mutant traits fitted a 13:3 ratio, indicating that the disease lesion mimic trait in the mutants was due to suppressive gene action. Both mutants were allelic for the disease mimic trait.

Prevalence of tics in schoolchildren and association with placement in special education

BACKGROUND

Based on the knowledge that Tourette's syndrome (TS) is associated with several clinical features that can impair school function and growing evidence that the disorder is much more common than previously thought, the authors hypothesized that TS and related tic disorders would be associated with school problems in the childhood population at large.

METHODS

Direct, blinded (to educational placement) interviews of 1,596 schoolchildren in Monroe County, Rochester, NY, were conducted.

RESULTS

Twenty-seven percent of 341 students classified as receiving special education (SpEd) had tics compared with 19.7% (p = 0.008) of 1,255 students in regular classroom programs (RegEd). The weighted prevalence estimates for tics were 23.4% in SpEd and 18.5% in RegEd. A higher percentage of students in SpEd (7.0%) met diagnostic criteria for TS than students in RegEd (3.8%; p = 0.01).

CONCLUSIONS

Although possibly influenced by selection bias, our results indicate that tic disorders are common in children and are highly associated with school dysfunction. Tics may represent an identifiable sign of an underlying brain developmental disorder that contributes to academic difficulties.

Syntheses, structural determination, and electrochemistry of Ru(2)(Fap)(4)Cl and Ru(2)(Fap)(4)(NO)Cl

Ru(2)(Fap)(4)Cl and Ru(2)(Fap)(4)(NO)Cl, where Fap is the 2-(2-fluoroanilino)pyridinate anion, were synthesized, and their structural, electrochemical, and spectroscopic properties were characterized. Ru(2)(Fap)(4)Cl, which was obtained by reaction between Ru(2)(O(2)CCH(3))(4)Cl and molten HFap, crystallizes in the monoclinic space group P2(1)/c, with a = 11.2365(4) A, b = 19.9298(8) A, c = 19.0368(7) A, beta = 90.905(1) degrees, and Z = 4. The presence of three unpaired electrons on the Ru(2)(5+) core and the 2.2862(3) A Ru-Ru bond length for Ru(2)(Fap)(4)Cl are consistent with the electronic configuration (sigma)(2)(pi)(4)(delta)(2)(pi*)(2)(delta*)(1). The reaction between Ru(2)(Fap)(4)Cl and NO gas yields Ru(2)(Fap)(4)(NO)Cl, which crystallizes in the orthorhombic space group Pbca, with a = 10.0468(6) A, b = 18.8091(10) A, c = 41.7615(23) A, and Z = 8. The Ru-Ru bond length of Ru(2)(Fap)(4)(NO)Cl is 2.4203(8) A, while its N-O bond length and Ru-N-O bond angle are 1.164(8) A and 155.8(6) degrees, respectively. Ru(2)(Fap)(4)(NO)Cl can be formulated as a formal Ru(2)(II,II)(NO(+)) complex with a linear Ru-N-O group, and the proposed electronic configuration for this compound is (sigma)(2)(pi)(4)(delta)(2)(pi*)(3)(delta*)(1). The binding of NO to Ru(2)(Fap)(4)Cl leads to some structural changes of the Ru(2)(Fap)(4) framework and a stabilization of the lower oxidation states of the diruthenium unit. Also, IR spectroelectrochemical studies of Ru(2)(Fap)(4)(NO)Cl show that NO remains bound to the complex upon reduction and that the first reduction involves the addition of an electron on the diruthenium core and not on the NO axial ligand.

Familial infantile myaesthenia

We report a family of two brothers with familial infantile myaesthenia which is an autosomal recessive congenital myaesthenic syndrome. It is a presynaptic neuro muscular junction disorder, responsive to treatment and has got good prognosis.

Covalent coupling of immunoglobulin G to a poly(vinyl)alcohol-poly(acrylic acid) graft polymer as a method for fabricating the interfacial-recognition layer of a surface plasmon resonance immunosensor

The synthesis of a terminally thiolated poly(vinyl)alcohol (PVA) grafted with Poly (acrylic acid) (PAA) side chains is described. The PVA-PAA graft polymer (PVAg) was end-tethered to silver surfaces via the terminal thiol functionality and the resultant mobile, hydrophilic polymer matrix exploited for the covalent immobilization of large quantities of polyclonal goat (anti-hIgG) antibody (IgG) with low levels of non-specific adsorption. An SPR immunosensor, fabricated with an IgG-PVA-silver interfacial layer proved capable of performing a sensitive label-free assay of human IgG antigen (hIgG) with minimal non-specific binding interference. A detection limit (DL) for hIgG from serum of 0.8 microgram/ml (5 nM) and an assay sensitivity of 0.66 ng hIgG/mm2/nM are reported.

Elevated serum glycosaminoglycans with hypomagnesemia in patients with coronary artery disease & thrombotic stroke

Elevated levels of serum glycosaminoglycans (GAG), associated with hypomagnesemia were observed in patients of proven CAD and thrombotic stroke in Kerala. Serum lipid profile was normal in the majority of these patients, indicating that elevated serum GAG may be an even more reliable indicator of atherosclerosis than elevated serum total cholesterol or LDL cholesterol. Autopsy samples of carotid artery and aorta which had atheroma showed significantly higher GAG when compared to samples which showed no atheroma. Serum Mg levels were significantly lower in CAD and thrombotic stroke patients as compared to controls. Mg deficiency may be one of the factors involved in the increased level of GAG.

Agrobacterium tumefaciens mediated gene transfer in peanut (Arachis hypogaea L.)

Transgenic peanut plants were produced using Agrobacterium mediated gene transfer. Primary leaf explants of peanut were co-cultivated with Agrobacterium tumefaciens LBA 4404 harbouring the binary plasmid pBI 121 (conferring β-glucuronidase activity and resistance to kanamycin) and cultured on regeneration medium supplemented with kanamycin to select putatively transformed shoots. They were rooted and plants were transferred to soil. Stable integration and expression of the transgenes were confirmed by NPT II assay, Southern blot hybridization and GUS assay.

Organogenesis and embryogenesis from diverse explants in pigeonpea (Cajanus cajan L.)

Seed and seedling expiants of pigeonpea were evaluated for organogenesis and somatic embryogenesis. De novo plant regeneration through organogenesis was obtained from mature cotyledons, primary leaves and roots of seedlings. Production of multiple shoots from the cotyledonary node was observed in cultures of whole seeds on 6-benzylaminopurine enriched medium. Somatic embryos were induced from immature cotyledons and embryonal axes, however, well-developed plants could not be derived from these embryos. The regenerants obtained through organogenesis were transferred to the field and grown to maturity.

New developments in affinity chromatography

The design, synthesis and chromatographic operation of a new range of stable and selective immobilized dye affinity adsorbents for potential application in the purification of pharmaceutical proteins is described. Computer aided molecular design has been exploited to design novel dye ligands which show a predictable selectivity for the target protein and which, when coupled to stable perfluoropolymer supports, yield high capacity, low leakage adsorbents for affinity chromatography. It is anticipated that these new materials will withstand the rigorous conditions required for sanitization and cleaning in situ of industrial scale processes.

Stable transformation of moth bean Vigna aconitifolia via direct gene transfer

Direct gene transfer proved to be an efficient transformation method for Vigna aconitifolia, a member of the legume family. Kanamycin resistant calli and plants were regenerated from heat shocked protoplasts treated with PEG and plasmid DNA containing the coding region for aminoglycoside phosphotransferase gene (NPT II). The plant cultivar used was an important factor in attaining higher transformation frequencies. Transformation was confirmed by Southern blot analysis using a non-radioactive detection system. Attempts to transform mesophyll and suspension cultured cells by this method were unsuccessful. Protoplasts electroporated with the plasmid pCAP212, which codes for chloramphenicol acetyltransferase, exhibited transient expression of this gene two days after treatment while electroporated cells did not show this enzyme activity. It is therefore assumed that the DNA uptake is prevented by the cell wall.

Callus induction from protoplasts of V. unguiculata, V. sublobata and V. mungo

Protoplasts were isolated from hypocotyl of V. mungo (L.) Hepper or hypocotyl-derived callus of V. sublobata (Phaseolus sublobata Roxb.) and V. unguiculata (L.) Walp (syn. V. sinensis (L.) Saviex Hassk) using an enzyme solution comprising Cellulase 2.5%, Macerozyme, Hemicellulase and Driselase each at a 0.5% level in 0.5 M sorbitol. Isolated protoplasts were cultured in Murashige and Skoog's (1962) basal liquid medium supplemented with BA, NAA, 2,4-D (1 mg/l each) and sucrose (14%). After four weeks, protoplast colonies were transferred to the same medium with a reduced level of sucrose (7%). Colonies proliferated into actively growing calli. Further attempts to regenerate plants from such calli were not successful. However, protoclones of V. unguiculata differentiated roots on auxin/cytokinin supplemented media. Alternative methods for shoot differentiation from protoplastderived cultures were tried by the use of Agrobacterium tumefaciens "shooter" strains pGV 2215 or pGV 2298 or wild type strain B6S3.

Regeneration of plants from cultured root explants of mothbean (Vigna aconitifolia L. Jacq. Marechal)

Decapitated seedling root explants of seven cultivars of mothbean (Vigna aconitifolia) cultured on Murashige and Skoog's basal medium without any phytohormone gave rise to plantlets at the end of 4-5 weeks. Addition of cytokinins such as BA, Z, Kn and 2,i-P enhanced the frequency of plant regeneration and also the average number of shoot buds/culture. The buds originated directly from cortical cells or through callussing and subsequent differentiation from the surface. The plantlets obtained were successfully transferred to the field.

Kinetic studies on the diaqua form of cis-platin and various nucleobases

Kinetic studies on cis-[Pt(NH3)2(OH2)2]2+ and various nucleobases show that this ion reacts more quickly with guanosine than with adenosine, cytidine, and thymidine, and that a monophosphoric acid unit considerably enhances the rate of reaction of guanosine; the kinetic preference of 5'-GMP over 5'-AMP may point to a greater thermodynamic selectivity.

Plant regeneration from callus cultures of Durum and emmer wheat

Callus cultures were initiated from isolated mature embryos of Triticum turgidum L. Thell ssps durum and dicoccum on a basal medium supplemented with 2,4-D, 2,4,5-Cl3POP or 2,4-D+CM. Shoot bud regeneration was observed on 2,4,5-Cl3POP medium. In both the cultivars of durum, further development of shoot buds occurred on transfer of tissues to basal medium whereas in dicoccum basal medium supplemented with coconut milk or coconut milk with NAA (0.2 mg/l) was necessary. The regenerated shoot buds were induced to root on basal medium supplemented with NAA. The in vitro obtained plants were transferred to soil and successfully grown to maturity. Chlorophyll variants were observed among the regenerated plants of dicoccum.

Two NAD-dependent alcohol dehydrogenases (E.C. 1.1.1.1) in callus cultures of wheat, rye and triticale

Two NAD-dependent alcohol dehydrogenases ADH-1 and ADH-2, under independent genetic control of genes designated as Adh-1 and Adh-2 located on chromosomes 4A, 4B and 4D, have been reported in aestivum wheat (Hart 1980). Only ADH-1 is expressed in developing seeds, dry seeds, pollen and germinating seedlings. ADH-2 can be induced in seedling roots or shoots under conditions of partial anaerobiosis or by certain chemicals. Expression of ADH-1 and ADH-2 isoenzymes was investigated in undifferentiated calli from aestivum and durum wheats, rye, triticale and also in in vitro regenerated roots and leaves from aestivum cultures. Wheat callus cultures originating from seed, mature and immature embryos, mesocotyl and root, as well as cultures grown on media containing different supplements did not show any variation in the overall expression of ADH-1 or ADH-2, although differences in the band intensities were observed. The callus isoenzyme pattern was similar to that observed in roots under anaerobic conditions. Both ADH-1 and ADH-2 were expressed in in vitro regenerated roots but were absent in regenerated leaves. Expression of ADH-1 and ADH-2 in wheat calli seems to be related to the type of differentiation.