Anomalous isomeric decays in 174Lu as a probe of K mixing and interactions in deformed nuclei

A K(pi)=13+, 280 ns four-quasiparticle isomer in the odd-odd nucleus 174Lu has been identified and characterized. The isomer decays to both K(pi)=7(+) and K(pi)=0(+) rotational bands obtained from the parallel and antiparallel coupling of the proton 7/2+[404] and neutron 7/2+[633] orbitals. K mixing caused by particle-rotation coupling explains the anomalously fast transition rates to the 7+ band but those to the 0+ band are caused by a chance degeneracy between the isomer and a collective state, allowing the mixing matrix element for a large K difference to be deduced.

Safety of iron polymaltose given as a total dose iron infusion

An audit of the in-hospital safety and tolerability of 401 infusions of iron polymaltose in 386 patients has shown no cases of anaphylaxis or other cardiorespiratory compromise. The infusion was terminated prematurely because of adverse events in six patients (1.6%). No adverse events occurred within the first 15 min of the infusion. Premedication (in 24%) was not associated with fewer adverse events. Fear of anaphylaxis should not inhibit the use of total dose iron infusion and the practices of premedication and of medical supervision during the first 15 min of the infusion should be abandoned.

K isomers in 254No: probing single-particle energies and pairing strengths in the heaviest nuclei

We have identified two isomers in 254No, built on two- and four-quasiparticle excitations, with quantum numbers K pi = 8- and (14+), as well as a low-energy 2-quasiparticle Kpi = 3+ state. The occurrence of isomers establishes that K is a good quantum number and therefore that the nucleus has an axial prolate shape. The 2-quasiparticle states probe the energies of the proton levels that govern the stability of superheavy nuclei, test 2-quasiparticle energies from theory, and thereby check their predictions of magic gaps.

A study on p53 gene alterations in esophageal squamous cell carcinoma and their correlation to common dietary risk factors among population of the Kashmir valley

AIM

To systematically examine the extent of correlation of risk factors, such as age, consumed dietary habit and familial predisposition with somatic Tp53 molecular lesion causal to elevate carcinogenesis severity of esophageal squamous cell carcinoma (ESCC) among the Kashmiri population of Northern India.

METHODS

All cases (n = 51) and controls (n = 150) were permanent residents of the Kashmir valley. Genetic alterations were determined in exons 5-8 of Tp53 tumor suppressor gene among 45 ESCC cases histologically confirmed by PCR-SSCP analysis. Data for individual cancer cases (n = 45) and inpatient controls (n = 150) with non-cancer disease included information on family history of cancer, thirty prevailing common dietary risk factors along with patient's age group. Correlation of genetic lesion in p53 exons to animistic data from these parameters was generated by Chi-square test to all 45 histologically confirmed ESCC cases along with healthy controls.

RESULTS

Thirty-five of 45 (77.8%) histologically characterized tumor samples had analogous somatic mutation as opposed to 1 of 45 normal sample obtained from adjacent region from the same patient showed germline mutation. The SSCP analysis demonstrated that most common p53 gene alterations were found in exon 6 (77.7%), that did not correlate with the age of the individual and clinicopathological parameters but showed significant concordance (P<0.05) with familial history of cancer (CD = 58), suggesting germline predisposition at an unknown locus, and dietary habit of consuming locally grown Brassica vegetable "Hakh" (CD = 19.5), red chillies (CD = 20.2), hot salty soda tea (CD = 2.37) and local baked bread (CD = 1.1).

CONCLUSION

Our study suggests that somatic chromosomal mutations, especially in exon 6 of Tp53 gene, among esophageal cancer patients of an ethnically homogenous population of Kashmir valley are closely related to continued exposure to various common dietary risk factors, especially hot salty tea, meat, baked bread and "Hakh", that are rich in nitrosoamines and familial cancer history.

Discordence of HER-2/neu overexpression and estrogen receptor between the primary breast cancer and axillary lymph node with metastasis

20106

Background: Adjuvant hormonal therapy and trastuzumab are known to be associated with a significant reduction in cancer-related mortality in a subset of women with breast cancer. The treatment decision is usually based on immunohistochemistry (IHC) staining of the primary tumor. We reported here a case of discordance of HER-2/neu overexpression and estrogen receptor status between the primary breast cancer and axillary lymph node with metastasis. Methods: IHC and fluorescence in situ hybridization (FISH) analysis was perfromed for the assessment of HER-2/neu. E-cadherin staining was done on the primary tumor and lymph node with metastasis. Results: A 52 year old woman presented with right breast lump. The imaging studies showed a 5 × 5 cm speculated mass. No other abnormalities were noted. An excision biopsy revealed 3 cm moderately differentiated invasive lobular carcinoma. Subsequently a wider excision and axillary lymph node dissection was done. 2/20 lymph nodes were involved by the cancer. IHC was done in the primary tumor and the lymph node with metastasis. IHC of the primary tumor revealed less than 1% nuclei positive for estrogen receptor (ER), 0% nuclei positive for progesterone receptor (PR), and no HER-2/neu overexpression. IHC of the lymph nodes with metastasis revealed 80% nuclei positive for ER, less than 1% nuclei positive for PR, and equivocal HER-2/neu overexpression. FISH analysis for HER-2/neu gene was done on the primary tumor which revealed no amplification in the tumor nuclei (Her2/CEP17 ratio was 3.6/2.7 = 1.3) whereas FISH analysis on the lymph node section revealed amplification in tumor nuclei (Her2/CEP 17 ratio of 7.3/1.9 = 3.9). E-cadherin staining of the primary breast tumor as well as the lymph node with metastasis revealed no membrane staining of the malignant cells in either section. Conclusions: The unusual occurrence of a divergent IHC profile and FISH analysis results between the primary carcinoma and metastatic carcinoma may be due to a subselection of a malignant clone which were not represented in the section of primary tumor chosen for IHC. Future studies are required to determine the utility of IHC staining of metastatic cells involving the lymph nodes if primary tumor is negative for HER-2/neu & ER.

No significant financial relationships to disclose.

Malignant hemangiopericytoma: A study of long-term outcomes

9560

Background: Malignant hemangiopericytoma (MH) is a rare disease with limited data on long term clinical outcomes. We presented a poster at ASCO 2005 annual meeting, outlining the long term follow up of 14 patients. We reviewed the data from 10 additional patients from our affiliated center and present here a combined analysis. Methods: Clinical characteristics, pathologic and treatment data of 24 patients diagnosed with MH between 1972 and 1995 was reviewed. All cases were histologically proven. Survival was determined by using Kaplan-Meier curve. Results: The median age was 52 yrs. (range 28 - 74). Male: female ratio was 1: 2.4. Patients presented with involvement of following primary sites: cranial/meningeal 8 (33.34%), extremities 4 (16.7%), uterus 3 (12.5%), metastatic 2 (8.3%), retroperitoneal 2 (8.3%), pelvis 2 (8.3%), sinonasal, middle ear and thyroid 1 each (4.2% each). 20 patients had definitive surgical resection at initial presentation. 4 patients received post operative radiation therapy (RT). No patient received adjuvant chemotherapy. 7 out of 8 patients who recurred died of disease. One patient who was alive 5 years after recurrence got stereotactic RT to localized recurrence. At disease recurrence, 2 patients received chemotherapy and RT, while 5 were treated with surgery and/or RT. 4 out of 8 patients with cranial/meningeal disease at diagnosis recurred. Two of them recurred after 6 years. Only one of the 4 recurred patients had post operative adjuvant RT. Median recurrence free survival was 5.25 years. Median survival after recurrence was 3.28 years. Fourteen year cause specific survival was 55%. Conclusions: Combined analysis of 24 patients shows that complete surgical resection is the main treatment with 55% of patients living at 14 years (median is not reached). Compared to our prior report, female preponderance was less marked. Radiation may play some part in adjuvant setting, but its role is not clearly defined. Role of systemic treatment is not clear. In our series 40% recurred after definitive treatment. Recurrences can occur several years after the initial diagnosis and definitive treatment. There is a need to develop effective adjuvant systemic treatments.

No significant financial relationships to disclose.

Gemcitabine-related thrombocytosis: Does it increase the risk of thrombosis?

6091

Background: Gemcitabine is an antimetabolite agent that has demonstrated activity in various solid and hematological malignancies. Although thrombocytopenia is a known side effect, gemcitabine-related thrombocytosis has been uncommonly reported. Chemotherapy increases the risk of thrombo-embolism in patients with cancer. The study aimed to identify the incidence of gemcitabine-related thrombocytosis and to determine whether it has been associated with an increased risk of thrombo-embolism. Methods: Medical records of 175 consecutive adults patients with a malignant disease who received gemcitabine at Saskatoon Cancer Center were reviewed. Patients with history of prior thrombo-embolism or with baseline thrombocytosis were excluded. Fisher’s Exact test was done for statistical analysis. Results: 149 eligible patients with median age of 62 (26–83) and M:F of 1.01:1 were identified. 141 (95%) patients had advanced malignancy and 61 (41%) had received prior chemotherapy. 106 (71%) patients received combination of chemotherapy and 95% of those patients received gemcitabine in combination with a platinum compound. Median number of cycle was 3 (1–8). Median platelets count prior to commencement of gemcitabine was 285 × 109 (44–449). 83 (56%) patients experienced thrombocytopenia whereas 69 (46%) patients experienced thrombocytosis within 3 weeks of treatment with gemcitabine. Median post-gemcitabine platelet count in patients with thrombocytosis was 622 × 109 (457–1385). 15 (10%) patients experienced thrombocytosis with each cycle of gemcitabine. Median duration of thrombocytosis was 2 weeks (0.5−5). 13 (9%) of 149 patients experienced a vascular event (venous, n=9; arterial, n=4) within 6 weeks of treatment with gemcitabine. Median platelet count prior to the vascular event was 268 × 109 (79–669). All except one patient had advanced malignancy and 85% had received combination of chemotherapy. 5 of 69 (7%) patients with thrombocytosis experienced a vascular event compared with 8 of 80 (10%) patients without thrombocytosis (p=0.77). Conclusions: Gemcitabine has been associated with an increased incidence of thrombocytosis. However gemcitabine-related thrombocytosis is a transient phenomenon and has not been associated with an increased risk of a vascular event.

No significant financial relationships to disclose.

Management of iron deficiency in patients admitted to hospital: time for a rethink of treatment principles

BACKGROUND

Iron deficiency is very common in patients admitted to hospital. Its management is changing with new insights into iron absorption and therapeutic options.

AIMS

The aims of this study were to develop guidelines for the correction of iron deficiency in patients admitted to hospital and to compare these with current practice.

METHODS

Based on current published evidence, guidelines were developed. All patients in whom iron deficiency was detected during hospital admission over a 2.5 year period were retrospectively studied. Their management was compared with that of the guidelines developed.

RESULTS

Three clinical scenarios were identified--(A) urgent attention to haemoglobin required: blood transfusion followed by i.v. iron recommended, (B) Semiurgent iron repletion: i.v. iron recommended and (C) non-urgent iron repletion: oral or i.v. repletion recommended. A total of 119 patients was identified, age 18-99 (median 77) years, 29% men, and haemoglobin 33-130 (87) g/L. Of 66 given blood transfusion, 17 had subsequent i.v. iron, 25 oral iron and 24 no other form of iron repletion. Of the other 53, nine had i.v. iron, 32 oral iron and 12 had no treatment. Fifty-five per cent of patients were managed according to the proposed guidelines and this occurred less frequently (9%) in those presenting with cardiovascular problems than in those with anaemia, gastrointestinal bleeding or other medical problems (all >60%; P < 0.0001, Fisher's exact test).

CONCLUSION

Current management is haphazard, with underutilization of i.v. iron and failure to initiate any regimen for iron repletion being common. It may be time for a change in approach to repletion of iron in ill patients.

Responses of European eel (Anguilla anguilla L.) circulating phagocytes to an in situ closed pulp mill effluent exposure and its association with organ-specific peroxidative damage

The effect of bleached kraft pulp mill effluent (BKPME) persistent compounds on phagocyte activities and its organ-specific influence in gill, kidney and liver was studied in European eel (Anguilla anguilla L.). Eels were caged and plunged at 3 different sites-50 m (site 1), 100 m (site 2) and 2,000 m (site 3) away from the end of the closed BKPME discharging channel for 8 and 48 h. Gill, head kidney and peritoneum phagocytes oxidative burst activity (OBA) was measured by the nitroblue tetrazolium reduction assay whereas lipid peroxidation (LPO) in eel gill, kidney and liver was measured by thiobarbituric acid reaction. A significant gill OBA induction was found at 8h on site 2, and on sites 1, 2 and 3 at 48 h exposure. However, in head kidney and peritoneal exudate phagocytes, OBA induction was significant only at sites 2 and 3 after 48 h exposure. In those particular sites, a significant increase in gill, kidney and liver LPO was measured that is assumed to result from OBA induction. Considering OBA and LPO, gill is the most affected tissue compared to kidney and liver. Gill vulnerability towards peroxidative damage was demonstrated at 8h on site 2 and at 48 h on sites 1, 2 and 3, whereas in kidney was observed at sites 2 and 3 only at 48 h. Liver LPO increased at site 2 only after 48 h exposure. Our results demonstrate that the OBA activation pattern in gill and kidney is associated with the induced peroxidative damage extent in those organ, together with water pollution the exposure route, resulting from previous BKPME effluent sediment contamination which may affect the activation pattern of circulating fish phagocytes.

An in vitro antimicrobial comparison of miswak extract with commercially available non-alcohol mouthrinses

The aim of this study was to assess the antimicrobial activity of eight commercially available mouthrinses and 50% miswak extract against seven microorganisms. Corsodyl, Alprox, Oral-B advantage, Florosept, Sensodyne, Aquafresh Mint, Betadine and Emoform mouthrinses were used while 50% aqueous extract of miswak (Salvadora persica) was used against Streptococcus faecalis, Streptococcus pyogenis, Streptococcus mutans, Candida albicans, Staphylococcus aureus and Staphylococcus epidermidis. The ditch plate method was used to test the antimicrobial activity. Inhibition zones of microorganisms around ditches were measured in millimetres. Range, mean and standard deviations were used for comparison of antimicrobial activity. Mouthrinses containing chlorhexidine was with maximum antibacterial activity, while cetylpyridinium chloride mouthrinses were with moderate and miswak extract was with low antibacterial activity. Further research is needed for the substantivity of these mouthrinses and further in vivo/in vitro studies are needed using Biofilm model to substantiate present findings. Dental professionals must exercise caution and provide guidance in assisting their patients in making informed choices regarding their use of mouthrinses for clinical efficacy.

MUDPY ontology: a tool for multimedia project planning, design and development

Purpose

This paper seeks to describe the process used to develop the multimedia design and planning pyramid (MUDPY) ontology, and the role played by the MUDPY ontology as a planning, design and development tool in multimedia projects.

Design/methodology/approach

The MUDPY model was implemented for the semantic web by developing an ontology for it. This ontology facilitates defining the concepts existing in that domain, their attributes and the relationships between them.

Findings

The MUDPY ontology can guide developers through the various phases of a multimedia project in a systematic fashion by allowing them to create a project proposal, specify the functional requirements, decide on the navigational structure and create a storyboard, and thus create high‐quality projects.

Research limitations/implications

The current system is a prototype. This MUDPY ontology can be extended by adding more classes in order to increase its functionality; for example, one can develop special plug‐in widgets to generate project reports required during multimedia project planning and design.

Practical implications

By using the MUDPY ontology, developers can follow a systematic process for project development, and better manage the complexity of multimedia projects.

Originality/value

The paper introduces the MUDPY model and its ontology, and shows a multimedia author the pathway to manage a multitude of concepts and assets required in a multimedia project.

40Ca(alpha, gamma)44Ti reaction in the energy regime of supernova nucleosynthesis

The 44Ti(t1/2=59 yr) nuclide, an important signature of supernova nucleosynthesis, has recently been observed as live radioactivity by gamma-ray astronomy from the Cas A remnant. We investigate in the laboratory the major 44Ti production reaction 40Ca(alpha, gamma)44Ti (Ec.m. approximately 0.6-1.2 MeV/u by direct off-line counting of 44Ti nuclei. The yield, significantly higher than inferred from previous experiments, is analyzed in terms of a statistical model using microscopic nuclear inputs. The associated stellar rate has important astrophysical consequences, increasing the calculated supernova 44Ti yield by a factor approximately 2 over previous estimates and bringing it closer to Cas A observations.

Major ion and heavy metal chemistry of Pachin river (Itanagar) - levels and sources

The Pachin river is an upland tributary of the Brahmaputra river, originating in the foot-hills of the lesser Himalayas. A systematic study of major ions and heavy metals in the surface water of the river was carried out at peak, intermediate and low flow conditions during an one-year interval to assess the relative contributions from weathering and pollution. The major ion chemistry indicates that silicate weathering and precipitation are the major contributing factors to the river's chemical composition. The Pachin river is characterized by a low overall conductivity, even during times of evaporative concentrations during low flow. This corresponds to the fact that the catchment area is still relatively pristine, i.e., well forested and without significant industry. However, heavy metal patterns clearly reflect source input from agricultural activity and urban development. The levels of Fe and Co were amongst the highest of any rivers of the Indian sub-continent, while these and Cr, Mn, Cu and Se each exceeded the world average value. These results clearly indicate that rivers draining pristine areas can be significantly modified by human activities, and consequently, these must be monitored to ensure that useable water supplies meet the prescribed safety standards.

A novel cationic cardiolipin analogue for gene delivery

The optically active R and S isomers of cationic cardiolipin analogues (CCA) were synthesized and evaluated as a liposome based transfection reagent. Both isomers form stable liposomes with mean diameters of about 120 nm without any additional lipid ingredients. No significant change in particle size distribution profile was observed over one-month storage at room temperature (20-25 degrees C). The gel to liquid crystalline phase transition temperature (Tm) of cationic liposomes comprised of both R and S isomers was approximately 2 degrees C, as measured by differential scanning calorimetry (DSC). Both isomers also formed stable liposomes when combined with DOPE. In vitro transfection efficiency of the CCA/DOPE liposomes complexed to plasmid DNA was evaluated using a luciferase reporter gene. Both liposomes composed of R and S isomers of the cationic cardiolipin displayed higher transfection efficiency than commercially available Lipofectin. Further in vivo studies are warranted.

Peyronie's disease with erectile dysfunction: penile modeling over inflatable penile prostheses

OBJECTIVES

To evaluate, retrospectively, the impact of penile correction by modeling of the penis over an inflatable penile prosthesis and the subsequent improvement in erectile function. Advanced Peyronie's disease with severe penile curvature and poor quality erections presents a challenge to the urologist.

METHODS

In our series, 46 patients with advanced Peyronie's disease and associated erectile dysfunction underwent insertion of an inflatable penile prosthesis between 1998 and 2003. Of the 46 patients, 28 (61%) underwent a standard modeling procedure; the other 18 patients (39%) did not need additional modeling, because their curvature was corrected by inflation of the prosthesis alone. Patients were evaluated postoperatively in the clinic, as well as by a postal questionnaire.

RESULTS

Of the 46 patients, 44 were satisfied with the penile correction and 2 (4.4%) underwent removal of their prosthesis because of infection. These 2 patients underwent revision surgery; subsequently both prostheses had to be removed, one for severe pain and the other for urethral erosion. None of the patients underwent reoperation for additional straightening. Of the 44 patients with intact prostheses, erectile function significantly improved in 41 (93%).

CONCLUSIONS

The results of our study have indicated that patients with severe Peyronie's disease and erectile dysfunction should be offered the choice of penile modeling over an inflatable penile implant to correct the curvature, as well as improve erectile function.

Retrospective observational case-control study comparing prehospital thrombolytic therapy for ST-elevation myocardial infarction with in-hospital thrombolytic therapy for patients from same area

OBJECTIVES

To compare a system of prehospital thrombolytic therapy, delivered by paramedics under medical guidance, with in-hospital thrombolytic therapy in meeting National Service Framework (NSF) targets for treatment of acute myocardial infarction at a District General Hospital setting in England.

DESIGN

Retrospective observational case-control study comparing patients with suspected acute myocardial infarction (AMI) treated with thrombolytic therapy in the prehospital environment with patients treated in hospital.

SETTING

Wyre Forest District and Worcestershire Royal Hospital, UK.

PARTICIPANTS

(A) All patients who received prehospital thrombolytic therapy for suspected AMI accompanied by electrocardiographic features considered diagnostic.(B) Patients who received thrombolytic therapy after arrival at hospital for the same indication, matched with group A by age, gender and postcode.

MAIN OUTCOME MEASURES

1. Call to needle time. 2. Percentage of patients treated within one hour of calling for medical help. 3. Appropriateness of thrombolytic therapy. 4. Safety of thrombolytic therapy

RESULTS

1. The median call to needle time for patients treated before arriving in hospital (n = 27) was 40 minutes with an inter-quartile range 25-112 (mean 43 minutes). Patients from the same area who were treated in hospital (n = 27) had a median time of 106 minutes with an inter-quartile range 50-285 (mean 126 minutes). This represents a median time saved by prehospital treatment of 66 minutes. 2. 60 minutes after medical contact, 96 % of patients treated before arrival in hospital had received thrombolytic therapy; this compares with 4% of patients from similar areas treated in hospital. 3. Myocardial infarction was confirmed in 92% (25/27) of patients who received prehospital thrombolytic therapy and similarly 92% (25/27) of those given in-hospital thrombolytic therapy. 4. No major bleeding occurred in either group. Group A suffered fewer in-hospital deaths than group B (1 versus 4). Cardiogenic shock (3 patients) and ventricular arrhythmia (5 patients) were seen only in group B.

CONCLUSION

Paramedic-delivered thrombolytic therapy can be delivered appropriately, safely, and effectively. Time gains are substantial and can meet the national targets for early thrombolytic therapy in the majority of patients.

Anterior dental aesthetics: Gingival perspective

The purpose of this series is to convey the principles governing our aesthetic senses. Usually meaning visual perception, aesthetics is not merely limited to the ocular apparatus. The concept of aesthetics encompasses both the time-arts such as music, theatre, literature and film, as well as space-arts such as paintings, sculpture and architecture.