Surface dose rate variations in planar and curved geometries of 106Ru/106Rh plaque sources for ocular tumors

PURPOSE

Investigation of surface dose rate variation with respect to the source configuration of ¹⁰⁶Ru/¹⁰⁶Rh eye plaque. To explore an alternate way to determine activity of brachytherapy plaques.

METHODS

The surface dose rates of ¹⁰⁶Ru/¹⁰⁶Rh plaque developed indigenously were measured by extrapolation chamber. To rule out possibility of any error in the activity distribution and quantity, same source was used in two different configurations namely planar and curved. EBT3 Gafchromic film was used for determination of uniformity in activity. Monte Carlo-based Codes EGSnrc and FLUKA were used to calculate dose rate in tissue, percentage depth dose and for determination of activity. Parameters and correction factors were estimated using simulations.

RESULTS

The measured reference absorbed dose rates for planar and curved ¹⁰⁶Ru/¹⁰⁶Rh eye plaques are found to be 589 ± 29 mGy/h and 560 ± 28 mGy/h, respectively. The difference in the reference absorbed dose rate of curved eye plaque is about ~5% as compared to planar configuration. The FLUKA-calculated dose values are almost independent of cavity length of the extrapolation chamber for both eye plaques. The FLUKA-based dose rates per μCi ¹⁰⁶Ru/¹⁰⁶Rh are about 17.28 ± 0.08 mGy/h and 16.48 ± 0.06 mGy/h, respectively for planar and curved eye plaques which match well with the measurements. The calculated activities for planar and curved eye plaques are 34.08 μCi and 33.98 μCi, respectively.

CONCLUSIONS

Surface dose rates for a prototype ¹⁰⁶Ru/¹⁰⁶Rh eye plaque with different configurations were estimated using simulations and measured experimentally. An alternate way to determine activity of beta-gamma brachytherapy plaque has been proposed.

Symphytum officinale augments osteogenesis in human bone marrow-derived mesenchymal stem cells in vitro as they differentiate into osteoblasts

ETHNOPHARMACOLOGICAL RELEVANCE

Mesenchymal stem cells (MSCs) are multipotent stem cells possessing regenerative potential. Symphytum officinale (SO) is a medicinal plant and in homoeopathic literature, believed to accelerate bone healing.

AIM OF THE STUDY

This study aimed to determine if homoeopathic doses of SO could augment osteogenesis in MSCs as they differentiate into osteoblasts in vitro.

MATERIALS AND METHODS

Bone marrow samples were obtained from patients who underwent bone grafting procedures (n = 15). MSCs were isolated, expanded and characterized by flow cytometry (CD90, CD105). Cytotoxicity of SO was evaluated by MTT assay. Osteogenic differentiation was induced in MSCs with β-glycerophosphate, ascorbic acid and dexamethasone over 2 weeks. Different homoeopathic doses of SO (MT, 3C, 6C, 12C and 30C) were added to the basic differentiation medium (BDM) and efficiency of MSCs differentiating into osteoblasts were measured by evaluating expression of Osteocalcin using flow cytometry, and alkaline phosphatase activity using ELISA. Gene expression analyses for osteoblast markers (Runx-2, Osteopontin and Osteocalcin) were evaluated in differentiated osteoblasts using qPCR.

RESULTS

Flow cytometry (CD90, CD105) detected MSCs isolated from bone marrow (93-98%). MTT assay showed that the selected doses of SO did not induce any cytotoxicity in MSCs (24 hours). The efficiency of osteogenic differentiation (2 weeks) for different doses of Symphytum officinale was determined by flow cytometry (n = 10) for osteoblast marker, Osteocalcin, and most doses of Symphytum officinale enhanced osteogenesis. Interestingly, gene expression analysis for Runx-2 (n = 10), Osteopontin (n = 10), Osteocalcin (n = 10) and alkaline phosphatase activity (n = 8) also showed increased osteogenesis with the addition of Symphytum officinale to BDM, specially mother tincture.

CONCLUSIONS

Our findings suggest that homoeopathic dose (specially mother tincture) of Symphytum officinale has the potential to enhance osteogenesis.

Serum and blister-fluid elevation and decreased epidermal content of high-mobility group box 1 protein in drug-induced Stevens-Johnson syndrome/toxic epidermal necrolysis

BACKGROUND

High-mobility group box 1 (HMGB1) is a damage-associated molecular-pattern protein. Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) are serious, immune-mediated skin-blistering conditions.

OBJECTIVES

To determine serum and/or blister-fluid total HMGB1 levels in SJS/TEN cohorts, and HMGB1 expression in formalin-fixed, paraffin-embedded (FFPE) SJS/TEN skin vs. healthy and maculopapular exanthema (MPE) skin. Methods Serum HMGB1 was quantified in Malawian nevirapine-induced hypersensitivity, Taiwanese SJS/TEN and Spanish SJS/TEN cohorts. FFPE skin (healthy skin, MPE, SJS/TEN) was stained and assessed for HMGB1 expression.

RESULTS

Serum total HMGB1 was not significantly elevated in patients with nevirapine-induced SJS/TEN (3·98 ± 2·17 ng mL^-1 ), MPE (3·92 ± 2·75 ng mL^-1 ) or drug reaction with eosinophilia and systemic symptoms (4·73 ± 3·00 ng mL^-1 ) vs. tolerant controls (2·97 ± 3·00 ng mL^-1 ). HMGB1 was significantly elevated in Taiwanese patients with SJS/TEN, highest during the acute phase (32·6 ± 26·6 ng mL^-1 ) vs. the maximal (19·7 ± 23·2 ng mL^-1 ; P = 0·007) and recovery (24·6 ± 25·3 ng mL^-1 ; P = 0·027) phases. In blister fluid from Spanish patients with SJS/TEN, HMGB1 (486·8 ± 687·9 ng mL^-1 ) was significantly higher than in serum (8·8 ± 7·6 ng mL^-1 ; P <0·001). Preblistered SJS/TEN skin showed decreased epidermal nuclear HMGB1 expression in upper epidermis vs. healthy or MPE skin but retained basal/suprabasal expression.

CONCLUSIONS

Epidermal HMGB1 expression was decreased in SJS/TEN skin. Retained basal/suprabasal epidermal HMGB1 expression may exacerbate localized injury in SJS/TEN.

Dosimetry of indigenously developed 177Lu patch source for surface brachytherapy-Experimental and Monte Carlo methods

This paper describes the evaluation of dosimetry characteristics of an in-house developed ¹⁷⁷Lu skin patch source for treatment of non-melanoma skin cancer. A ¹⁷⁷Lu skin patch source based on Nafion-115 membrane backbone containing 3.46 ± 0.01 mCi of activity was used. Activity measurement of the patch source was based on gamma ray spectrometry using a HPGe detector. The efficiencies of the HPGe detector were fitted using an orthogonal polynomial function. The absorbed dose rate to water at 5 μm depth in water was determined using an extrapolation chamber, EBT3 Gafchromic film and compared with Monte Carlo methods. The correction factors such as Bragg-Gray stopping power ratio of water-to-air and chamber wall material being different from water, needed to be applied on measurements for establishing the dose rate at 5 μm depth, were calculated using the Monte Carlo method. Absorbed dose rate at 5 μm depth in water (surface dose rate) measured using an extrapolation chamber and EBT3 Gafchromic film were 9.9 ± 0.7 and 8.2 ± 0.1 Gy h^-1 mCi^-1 respectively for the source activity of 3.46 ± 0.01 mCi. The surface dose rate calculated using the Monte Carlo method was 8.7 ± 0.2 Gy h^-1 mCi^-1, which agrees reasonably well with measurement. The measured dose rate per mCi offers scope for ascertaining treatment time required to deliver the dose for propitious therapeutic outcome. Additionally, on-axis depth dose and lateral dose profiles at 5 μm and 1 mm depth in water phantom were also calculated using the Monte Carlo method.

Comparative evaluation of 0.2% Chlorhexidine Mouthwash, Xylitol Chewing Gum, and Combination of 0.2% Chlorhexidine Mouthwash and Xylitol Chewing Gum on Salivary Streptococcus mutans and Biofilm Levels in 8- to 12-Year-Old Children

AIM

To assess the effect of combining 0.2% chlorhexidine (CHX) mouthwash with xylitol (XYL) chewing gum on Streptococcus mutans and biofilm levels among 8- to 12-year-old children.

MATERIALS AND METHODS

Sixty children aged 8 to 12 years were selected with moderate and high salivary S. mutans levels. They were divided into three groups of 20 children each: (1) XYL group where the subjects chewed XYL twice daily; (2) CHX where rinsing was done twice daily; and (3) combination of XYL and CHX group (XYL+CHX) where both the agents were used once daily. The S. mutans colony-forming units (CFUs) were counted by using the mitis salivarius agar plate at the beginning of the study and at 15 days, 1, 2, and 6 months from the start of the study.

RESULTS

The XYL+CHX group showed the maximum reduction in both the biofilm and S. mutans scores throughout the study period.

CONCLUSION

The XYL+CHX combination reduced both the biofilm and S. mutans score significantly better than either XYL chewing gums or CHX mouthwash used alone.

HOW TO CITE THIS ARTICLE

Syed M, Chopra R, Shrivastava V, Sachdev V. Comparative evaluation of 0.2% Chlorhexidine Mouthwash, Xylitol Chewing Gum, and Combination of 0.2% Chlorhexidine Mouthwash and Xylitol Chewing Gum on Salivary Streptococcus mutans and Biofilm Levels in 8- to 12-Year-Old Children. Int J Clin Pediatr Dent 2016;9(4):313-319.

Hemophagocytosis on bone marrow aspirate cytology: single center experience in north himalayan region of India

BACKGROUND

The differentiation of hemophagocytic lymphohistiocytosis (HLH) with other causes of hemophagocytosis is essential as HLH is life-threatening condition and requires definite clinical and biochemical criteria for its diagnosis.

AIM

The present study was conducted to study hemophagocytosis on bone marrow aspirates and to observe if there is any difference on bone marrow examination between HLH and non HLH cases showing hemophagocytosis.

MATERIALS AND METHODS

The study reviewed all the cases of bone marrow aspirate for evidence of hemophagocytosis in which at least three smears and 500 nucleated cells were observed for every case. The cases were provisionally diagnosed as HLH according to the proposed HLH diagnostic criteria, 2009.

RESULTS

A total of 80 cases showed hemophagocytosis in the present study with infections followed by HLH being the most common cause. Pancytopenia and erythroid hyperplasis were common hematological presentation. Moderate to severe hemophagocytosis was observed in HLH cases while mild grade in non HLH cases.

CONCLUSION

The study concludes that hemophagocytosis even if observed in single cell should always be documented in the bone marrow reports. It may be the only indicator of subtle infection in the marrow. Pancytopenia and higher grade of hemophagocytosis on bone marrow examination may be helpful in establishing an early differentiation of HLH and non HLH cases.

Ultrasound measurement for abdominal aortic aneurysm screening: a direct comparison of the three leading methods

OBJECTIVES

Ultrasound (US) is non-invasive and cost-effective for screening abdominal aortic aneurysms (AAAs) but there is no universally accepted method to measure the aortic diameter. This study evaluates the accuracy, reproducibility, and repeatability of three methods: inner-to-inner (ITI), leading-to-leading edge (LTL), and outer-to-outer (OTO). The secondary objective of this study was to determine whether aneurysm size or grade of operator had any effect on either intra- or inter-observer variability.

METHODS

Fifty static US images were measured by six assessors (2 vascular radiologists, 2 interventional radiology trainees, and 2 sonographers) on two separate occasions 6 weeks apart. Repeatability and reproducibility were calculated and compared with computed tomography (CT) as the gold standard.

RESULTS

All three methods have high repeatability and reproducibility when static images are used. The inter-observer reproducibility coefficients between assessors were 0.48 cm, 0.35 cm, and 0.34 cm for ITI, LTL and OTO, respectively. The intra-observer repeatability coefficients between assessors were 0.30 cm, 0.20 cm, and 0.19 cm for ITI, LTL and OTO, respectively. The mean difference between CT and OTO, LTL, and ITI was 1 mm, 3 mm, and 5 mm, respectively (all underestimations) (p < .0001).

CONCLUSIONS

US consistently underestimates aortic size when compared with CT, with ITI demonstrating the greatest underestimation (on average 5 mm). In the UK, this underestimation by the NHS Abdominal Aortic Aneurysm screening programme reduces the sensitivity of the screening test and may impact on the way in which vascular specialists interpret the findings of the screening programme.

Monte Carlo-based revised values of dose rate constants at discrete photon energies

Absorbed dose rate to water at 0.2 cm and 1 cm due to a point isotropic photon source as a function of photon energy is calculated using the EDKnrc user-code of the EGSnrc Monte Carlo system. This code system utilized widely used XCOM photon cross-section dataset for the calculation of absorbed dose to water. Using the above dose rates, dose rate constants are calculated. Air-kerma strength Sk needed for deriving dose rate constant is based on the mass-energy absorption coefficient compilations of Hubbell and Seltzer published in the year 1995. A comparison of absorbed dose rates in water at the above distances to the published values reflects the differences in photon cross-section dataset in the low-energy region (difference is up to 2% in dose rate values at 1 cm in the energy range 30-50 keV and up to 4% at 0.2 cm at 30 keV). A maximum difference of about 8% is observed in the dose rate value at 0.2 cm at 1.75 MeV when compared to the published value. Sk calculations based on the compilation of Hubbell and Seltzer show a difference of up to 2.5% in the low-energy region (20-50 keV) when compared to the published values. The deviations observed in the values of dose rate and Sk affect the values of dose rate constants up to 3%.

Penetrating atherosclerotic ulcer of the aorta: a continuing debate

Aortic penetrating atherosclerotic ulcer (PAU) is a relatively common incidental finding on thoracic computed tomography (CT) examinations. This is likely to relate to the steady increase in the number of CT examinations performed and also due, in part, to the increasing age of the general population. There is as yet no consensus on the management of incidental PAUs in asymptomatic patients. This article aims to review the literature and discuss the natural history, prognosis, and management of incidental PAU.

Primary infrarenal aortic stenting with or without iliac stenting for isolated and aortoiliac stenoses: single-centre experience with long-term follow-up

PURPOSE

The purpose of this study was to evaluate the technical success, complications, long-term clinical outcome, and patency after primary infrarenal aortic stenting for aortic and aortoiliac stenosis. Between January 1999 and January 2006, 22 consecutive patients underwent endovascular treatment because of infrarenal aortic stenosis with and without common iliac stenosis (10 men; mean age 64 ± 14 years). Eleven (11 of 22) patients had an isolated aortic stenosis, whereas 11 of 22 had aortic stenosis that extended into the common iliac arteries (CIAs). Thirteen patients were Rutherford classification type 3, and 9 patients were type 4. Statistical analysis included paired Student t test and Kaplan-Meier life table analysis; p < 0.05 was considered significant. Technical and initial clinical success was achieved in all patients. There were three (14 %) procedure-related complications, which included two access-point pseudoaneurysms and one non-flow-limiting left external iliac dissection. Patients were followed-up for a mean period of 88 months (range 60-132). Mean preprocedure ankle brachial pressure indexes (ABPI) were 0.60 ± -0.15 (right) and 0.61 ± -0.16 (left). After the procedure they were 0.86 ± -0.07 (right) and 0.90 ± -0.09 (left). The increase in ABPI was significant (p < 0.05), and this continued throughout follow-up. Four (18 %) patients had recurrence of symptoms during follow-up. These occurred at 36, 48, 48, and 50 months after the original procedure. All four patients were successfully treated with repeat angioplasty procedures. There was a significant difference in primary patency between isolated aortic stenosis (100 %) and aortoiliac stenosis (60 %) (p = 0.031). Cumulative follow-up was 1920 months yielding a reintervention rate of 0.025/events/year.

CONCLUSION

Primary stenting of infrarenal stenosis is safe and successful with a low reintervention rate. It should be considered as first-line treatment for patients with infrarenal aortic stenotic disease.

Surgical abortion in second trimester: initial experiences in Nepal

INTRODUCTION

In spite of legalising abortion and making safe abortion available at affordable price at accessible distance to almost everyone, unsafe abortion especially second trimester abortion is still a big health problem in Nepal.

OBJECTIVE

The objective of the study is to fi nd the demographic profile, reasons for seeking abortion and to see the effectiveness of Misoprostol in preparing the cervix.

MATERIALS AND METHODS

A prospective study was done in the two second trimester abortion trainings conducted in Maternity hospital, Kathmandu. Total 57 clients had second trimester abortion performed. Information was collected from structured questionnaire and then data was analysed.

RESULTS

Commonest reason for seeking abortion was, multiparity (61.4%). Common reasons for second trimester abortion were, completed family size with unwanted pregnancy (61.4%), unwanted pregnancy in married (10.52%) unwanted pregnancy in unmarried (5.26%).

CONCLUSIONS

Second trimester abortion is one of the most common procedures performed in reproductive-aged women and when performed by a skilled provider in the appropriate setting, it is one of the safest surgeries, if it is well supported by change in policy of the country and acceptability of the people.

Use of pretreatment serum CA9 (carbonic anhydrase 9) to predict PFS and survival in trastuzumab-treated metastatic breast cancer

11092

Background: Approximately half of HER2-positive breast cancer patients will respond to first-line trastuzumab-containing therapy. However, in those patients with an initial trastuzumab response, most will progress within a year with acquired resistance. Since trastuzumab treatment is also now used in the HER2-positive adjuvant breast cancer setting, trastuzumab resistance will continue to be a vexing clinical problem, and better predictive and prognostic biomarkers are urgently needed. Methods: Serum HER2, tissue inhibitor of metalloproteinase-1 (TIMP-1), urokinase-type plasminogen activator (uPA), CA9, VEGF-165, and endoglin were measured using ELISA assays in 66 metastatic breast cancer patients before starting first-line trastuzumab-containing therapy. The HER2, TIMP-1, uPA, CA9, and VEGF-165 ELISAs were from Oncogene Science/Siemens Healthcare Diagnostics, Cambridge, MA; and the endoglin ELISA was from R&D Systems, Minneapolis, MN. Progression-free (PFS) and overall survival (OS) were analyzed using the Kaplan-Meier method and Cox modeling with continuous pretreatment serum biomarker variables. Results: Pretreatment serum HER2 (p= 0.005), TIMP-1 (p< 0.0001), uPA (p= 0.006), endoglin (p= 0.008), and CA9 (p <0.0001) were all significant as univariate continuous biomarkers for predicting PFS to first-line trastuzumab-containing therapy, but VEGF was not. In multivariate analysis for PFS with all six biomarkers, only serum CA9 (p= 0.002) was a significant independent covariate. For OS, pretreatment serum HER2 (p= 0.018), TIMP-1 (p< 0.0001), uPA (p< 0.0001), endoglin (p= 0.002), and CA9 (p< 0.0001) were all significant as univariate continuous biomarkers for prognosis, but serum VEGF was not. In multivariate analysis for OS with all six biomarkers, only serum CA9 was a significant independent prognostic covariate (p= 0.001). Conclusions: Elevated pretreatment serum CA9 (a marker of hypoxia) predicts reduced progression-free survival and overall survival in metastatic breast cancer patients treated with first-line trastuzumab-containing therapy. These serum biomarkers deserve further study in larger trials of HER2-targeted breast cancer treatment. Supported by a grant from Komen for the Cure.

[Table: see text]

Pretreatment serum TIMP-1 levels and survival in advanced pancreatic cancer

e15568

Background: Tissue inhibitor of metalloproteinase-1 (TIMP-1) has been shown to have diverse multifunctional roles in tumorigenesis such as inhibition of the catalytic activity of MMPs, growth promotion, inhibition of apoptosis and regulation of angiogenesis. Elevated TIMP-1 has been associated with an unfavorable prognosis in many cancers including breast, colorectal, gastric, head and neck, lung, and lymphoma. VEGF is also intimately associated with angiogenesis. Methods: This study determined serum TIMP-1 and VEGF levels in a phase III clinical trial of 157 patients with advanced pancreatic cancer. ELISAs for TIMP-1 and VEGF (Oncogene Science / Siemens HealthCare Diagnostics, Cambridge, MA) were employed to measure pretreatment serum TIMP-1 levels in 157 pancreatic cancer patients enrolled in a randomized, double-blind, placebo-controlled phase III trial. Statistical analysis was performed with TIMP-1 and VEGF on a continuous and cutpoint basis. Serum biomarker levels were then correlated with patient survival using Kaplan -Meier life table analysis. Results: Serum TIMP-1 levels in 157 pancreatic patients had a median of 409.9 ng/mL, and ranged from 144 to 1078 ng/mL. Patients with higher serum TIMP-1 had significantly shorter survival on a continuous basis (p = 0.001), on quartile analysis (p = 0.004), and on a dichotomous cutpoint analysis of upper 25 % vs lower 75 % (median survival 101 days vs. 197 days)(p< 0.001). Serum VEGF level was not associated with survival on a continuous (p = 0.57) or cutpoint analysis (p= 0.93). Conclusions: Pancreatic cancer patients with higher serum TIMP-1 levels had significantly shorter overall survival. Serum TIMP-1 level should be evaluated as a predictive factor for response to novel treatment regimens.

[Table: see text]

Prospective Study of 100 cases of Pap Smear

Abstract

Subfascial endoscopic perforator surgery: a review

Approximately 1-2% of the UK population suffers from venous ulcers. Incompetent perforator leg veins are thought to be a major contributory factor. Subfascial endoscopic perforator surgery treats incompetent perforators in a minimally invasive fashion with significant improvement in wound healing and reduction in ulcer recurrence rates.

Coronary artery aneurysm with a fistulous connection to the right atrium mimicking a sinus of Valsalva aneurysm

Coronary artery aneurysms are uncommon and may be complicated by rupture, thromboembolic phenomenon, and more rarely fistulation into one of the cardiac chambers. This case report highlights the difficulty in making a preoperative diagnosis of a coronary artery aneurysm that has fistulated into the right atrium, and lists possible differential diagnoses.

Evaluation of Norpalnt in Nepalese Women

This was a prospective study done in Marie Stope clinic, Chabhill, Kathmandu. One hundredwomen who had Norplant insertion between May 1996 to April 1997 were followed upfor a year for its side effects. The age, ethnic group, number of living children, literacy,socioeconomic status of the women who has Norplant insertion were also analyzed. Norplantwas found to be most popular in age group of 21-30 years (68%). Maximum number ofacceptors were in Chetri community (32%). It was a popular contraceptive in women whohad two or more children and those who came from low socioeconomic group and wereilliterate. Among side effects, menstrual irregularity was commonest (67%) headachewas present in 12%, weight gain and depressive symptoms each was present in 10% ofwomen. 2% had local infection at insertion site and 1% of woman had allergic reaction.Key words: Norplant, Contraceptives, Side effects.