Development and characterization of polyethylene glycol–carbon nanotube hydrogel composite

Polyethylene–glycol–carbon nanotube composite was developed where carbon nanotubes altered the hydrogel mechanical and physical properties and aided neuronal cell viability.

Molecular-like hierarchical self-assembly of monolayers of mixtures of particles

We present a technique that uses an externally applied electric field to self-assemble monolayers of mixtures of particles into molecular-like hierarchical arrangements on fluid-liquid interfaces. The arrangements consist of composite particles (analogous to molecules) which are arranged in a pattern. The structure of a composite particle depends on factors such as the relative sizes of the particles and their polarizabilities, and the electric field intensity. If the particles sizes differ by a factor of two or more, the composite particle has a larger particle at its core and several smaller particles form a ring around it. The number of particles in the ring and the spacing between the composite particles depend on their polarizabilities and the electric field intensity. Approximately same sized particles form chains (analogous to polymeric molecules) in which positively and negatively polarized particles alternate.

The oral management of patients who have received radiotherapy to the head and neck region

Several thousand patients are diagnosed annually with head and neck cancer (HANC) in the United Kingdom. This represents a significant proportion of all cancers that are diagnosed and a common treatment modality for this is radiotherapy to the head and neck region. Radiotherapy can be highly successful in managing HANC but also has several side-effects in the oral cavity and associated structures. These sequelae present considerable short and long-term problems for dental professionals involved in the care of HANC suffers.

Appendicocalicostomy: A case of mistaken identity

Anatomical structures with similar appearance may at times be confused for each other. This situation can be compounded by lack of normal anatomical planes. We did ureterocalicostomy on a 32-year-female with secondary pelvi-ureteral junction obstruction. Post-operatively, it was discovered that she had a long appendix running parallel to ureter in retroperitoneum, which was misidentified as ureter and anastomosed to the lower pole of the kidney. She was re-explored, appendix was removed, ureter was identified and ureterocalicostomy was done. Patient is asymptomatic at 1 year follow-up.

Growth inhibitory and adjuvant therapeutic potential of aqueous extract of Triticum aestivum on MCF-7 and HeLa cells

AIM

The purpose of the present study is to evaluate the potent growth inhibitory effects of aqueous wheatgrass extract (AWE) alone and in combination with cisplatin on human breast and cervical cancer cells.

MATERIALS AND METHODS

The cytotoxic potential of AWE alone and in combination with cisplatin was evaluated on human breast and cervical cancer cells (MCF-7 and HeLa) by cell viability assay. Further, the mode of cell death induced by AWE was determined by nuclear morphological examination and cell cycle analysis. These effects were then correlated with the expression of genes involved in apoptosis and proliferation (cyclin D1 and Bax) by RT-PCR.

RESULTS

AWE showed dose- and time dependent selective cytotoxicity towards the cancer highlighting its safe profile. Lower dose combinations of AWE and cisplatin induced increased growth inhibition compared with the individual drugs on both cell lines (combination index < 1) indicating strong synergistic interactions. AWE was found to induce apoptosis and arrested the cells at G0-G1 phase of the cell cycle which correlated with the modulation of expression of bax and cyclin D1 in a time-dependent manner in MCF-7 and HeLa cells.

CONCLUSION

These results suggest that the anti-cancer potential of AWE may be due to apoptosis induction and its anti-proliferative properties. This study also provides the first evidence demonstrating synergism between AWE and cisplatin, which may enhance the therapeutic index of prevention and/or treatment of human breast and cervical cancer.

Changes in thigh muscle volume predict bone mineral density response to lifestyle therapy in frail, obese older adults

We studied the relationships among strength, muscle mass, and bone mineral density (BMD) with lifestyle change. Lifestyle therapy consisted of exercise, diet, and diet plus exercise. Diet was by caloric restriction to induce and maintain a weight loss of 10 % from baseline body weight. Exercise attenuated weight loss-induced muscle and bone losses. Exercise improved strength despite muscle loss in patients on diet and exercise. Changes in strength did not correlate with changes in BMD. However, changes in thigh muscle volume correlated with, and predicted changes in hip BMD.

INTRODUCTION

Losses of hip BMD and lean body mass are major complications of lifestyle therapy in frail, obese older adults; however, the contribution of mechanical strain loss from muscle loss is poorly defined. We determined the effect of changes in thigh muscle volume and muscle strength on BMD in frail, obese older adults undergoing lifestyle therapy aimed at intentional weight loss with or without exercise.

METHODS

One hundred seven obese older adults were randomized to control, diet, exercise, and diet-exercise groups for 1 year. Thigh muscle volume was measured by magnetic resonance imaging, BMD by DXA, knee strength by dynamometry, total strength by one-repetition maximum (1-RM), and bone markers by immunoassay.

RESULTS

Thigh muscle volume decreased in the diet group (-6.2 ± 4.8 %) and increased in the exercise group (2.7 ± 3.1 %), while it was not significantly different from the control in the diet-exercise group. Changes in hip BMD followed similar pattern as those in thigh muscle volume. Knee extension and flexion increased in the exercise group (23 ± 20 %; 25 ± 19 %) and diet-exercise group (20 ± 19 %; 20.6 ± 27 %) but were unchanged in the control and diet groups. Changes in thigh muscle volume correlated with changes in hip BMD (r = 0.55, P = <0.001) and were an independent predictor of changes in hip BMD (β = 0.12, P = 0.03) in the multiple regression analyses after accounting for demographic factors and changes in weight and physical activity. There were no correlations between BMD changes and knee strength, 1-RM, and sclerostin changes.

CONCLUSIONS

Changes in thigh muscle volume predict hip BMD changes in obese older patients undergoing lifestyle therapy. The effect of exercise in attenuating thigh muscle loss when added to diet may in part account for the reduction in weight loss-induced bone loss in the diet-exercise group.

Can γH2AX be used to personalise cancer treatment?

Many cancer therapeutics, including radiation therapy, damage DNA eliciting the DNA damage response (DDR). Clinical assays that characterise the DDR could be used to personalise cancer treatment by indicating the extent of damage to tumour and normal tissues and the nature of the cellular response to that damage. The phosphorylated histone γH2AX is generated early in the response to DNA double-strand breaks, the most deleterious form of DNA damage. Translational researchers are developing tissue sampling and assay strategies to apply the measurement of γH2AX to a range of clinical questions, including that of tumour response. The presence of γH2AX is also associated with other cell states including replication stress, hypoxia and apoptosis, which could influence the relationship between γH2AX and clinical endpoints. This review aims to assess the potential of γH2AX as a practical and clinically useful biomarker of tumour and normal tissue responses to therapy.

CT imaging correlates of genomic expression for oral cavity squamous cell carcinoma

BACKGROUND AND PURPOSE

Imaging correlates of genetic expression have been found for prognostic and predictive biomarkers of some malignant diseases, including breast and brain tumors. This study tests the hypothesis that imaging findings correlate with relevant genomic biomarkers in oral cavity squamous cell carcinoma.

MATERIALS AND METHODS

Surplus frozen tissue from 27 untreated patients with oral cavity squamous cell carcinoma who underwent preoperative CT imaging was analyzed for gene expression. A team of neuroradiologists blinded to the genomic analysis results reviewed an extensive list of CT findings. The imaging correlated with genomic expression for cyclin D1, angiogenesis-related genes (vascular endothelial growth factor receptors and ligands), which relate to enhancement on the basis of other tumor types; and epidermal growth factor receptor, which may relate to proliferation and mass effect.

RESULTS

Expression of vascular endothelial growth factor receptors 1 and 2 correlated with the enhancement of the primary tumor (P = .018 and P = .025, respectively), whereas the epidermal growth factor receptor correlated with mass effect (P = .03). Other exploratory correlations included epidermal growth factor receptor to perineural invasion (P = .05), and certain vascular endothelial growth factor receptors and ligands to mass effect (P = .03) and increased (P = .01) or decreased (P = .02) primary tumor size.

CONCLUSIONS

We report that CT imaging correlates with gene expression in untreated oral cavity squamous cell carcinoma. Enhancement of the primary tumor and degree of mass effect correlate with relevant genomic biomarkers, which are also potential drug targets. Eventually, treatment decisions may be aided by combining imaging findings into meaningful phenotypes that relate directly to genomic biomarkers.

Using patient-reported outcome measures to estimate cost-effectiveness of hip replacements in English hospitals

OBJECTIVE

To estimate the average cost per quality adjusted life year (QALY) gained from hip surgery, and to examine the variation in that between hospitals.

DESIGN

The transformation of patient-reported outcome measures (EQ-5D data) into QALYs, covering 25,463 NHS patient episodes between April 2009 and August 2010 from hospitals in England, using a model of future health change arising from a hip operation compared to a counterfactual of no operation. Hospital-level costs for hip procedures from the National Reference Costs data-set was used to calculate the hospitals' cost per QALY.

SETTING

English hospitals treating NHS-funded patients undergoing hip replacement.

PARTICIPANTS

NHS-funded patients undergoing primary hip replacement.

MAIN OUTCOME MEASURE

Cost per QALY.

RESULTS

Assuming some degradation in patients' health over the lifetime of the hip prosthesis, average health gain arising from a hip operation was 2.77 QALYs. For procedures paid for by the NHS but carried out in the independent sector the average gain was 2.97 QALYs. Average NHS hospital hip procedure costs were estimated to be £5844. The unweighted average cost per QALY for NHS hospitals was £2128. There were significant variations in cost per QALY between hospitals; most of this variation appears to be driven by variations in cost, not QALYs.

CONCLUSIONS

Using the new patient-assessed health-related quality of life data combined with routine hospital-level cost data it is possible to estimate a procedure-based measure of efficiency for hospitals. The fact that variations in cost per QALY are strongly driven by variations in cost suggests that further work is needed to investigate the causes of cost variations per se--especially the quality of routine NHS cost data.

A comparison of alternative variants of the lead and lag time TTO

'Lead Time' TTO improves upon conventional TTO by providing a uniform method for eliciting positive and negative values. This research investigates (i) the values generated from different combinations of time in poor health and in full health; and the order in which these appear (lead vs. lag); (ii) whether values concur with participants' views about states; (iii) methods for handling extreme preferences. n = 208 participants valued five EQ-5D states, using two of four variants. Combinations of lead time and health state duration were: 10 years and 20 years; 5 years and 1 year; 5 years and 10 years; and a health state duration of 5 years with a lag time of 10 years. Longer lead times capture more preferences, but may involve a framing effect. Lag time results in less non-trading for mild states, and less time being traded for severe states. Negative values broadly agree with participants' stated opinion that the state is worse than dead. The values are sensitive to the ratio of lead time to duration of poor health, and the order in which these appear (lead vs. lag). It is feasible to handle extreme preferences though challenges remain.

Synchronous colorectal liver metastases: the "surgeon as oncologist" perspective

Colon cancer presenting with synchronous metastatic disease to the liver creates challenging clinical scenarios. Traditionally, patients with resectable synchronous colorectal liver metastases (CRLM) were treated initially by resection of the primary tumor followed by an arbitrary but often prolonged duration of postoperative chemotherapy. In patients without progression of disease while receiving this postoperative chemotherapy, surgery for CRLM was then offered. In recent years this algorithm has been questioned, and in this review we describe the rationale for this classic approach as well as data that suggests that this model should be reconsidered. Evolving definitions of resectability of CRLM as well as technical advances in liver surgery have increased the number of patients eligible for potentially curative resections. There still exists controversies regarding the role of chemotherapy, its timing, the feasibility of simultaneous CRLM and primary tumor resection, and how to treat the asymptomatic primary in the context of CRLM. While it is a valuable treatment in unresectable CRLM, the role of prehepatectomy chemotherapy in resectable CRLM should be reconsidered as its survival benefits have not been well established and there are reports of chemotherapy related morbidity following hepatic resection. Although simultaneous primary tumor and CRLM resection has been traditionally viewed as prohibitively morbid, recent data suggests that it may be safe in carefully selected patients with limited volume of metastatic disease. The traditional paradigm of treating synchronous CRLM (SCRLM) should be reconsidered. Randomized controlled trials are necessary to help clarify the role and timing of chemotherapy in the treatment of SCRLM.

Imaging and Timing Performance of 1cm × 1cm Position-sensitive Solid-state Photomultiplier

We have designed and built a large-area 1cm × 1cm position-sensitive solid-state photomultiplier (PS-SSPM) for use in detector design for medical imaging applications. Our new large-area PS-SSPM concept implements resistive network between the micro-pixels, which are photodiodes operated in Geiger mode, called Geiger Photodiodes (GPDs), to provide continuous position sensitivity. Here we present imaging and timing performance of the large-area PS-SSPM for different temperatures and operating biases to find the optimum operating parameters for the device in imaging applications. A detector module was built by coupling a polished 8×8 LYSO array, with 1×1×20 mm³ elements, to a 1×1 cm² PS-SSPM. Flood images recorded at room temperature show good crystal separation as all 64 elements were separated from each other. Cooling the device at 10 °C showed significant improvement. The device optimum bias voltage was ~4.5V over breakdown voltage. The coincidence timing resolution was improved significantly by increasing the operating bias, as well as by lowering the temperature to 0 °C. Results show excellent imaging performance and good timing response with a large-area PS-SSPM device.

Managing chondrosarcoma of the epiglottis: a case report

Laryngeal chondrosarcomas are a very rare malignancy with less than 150 cases reported in the literature. Of these, the epiglottis is the most unusual primary neoplastic subsite. Uncertainties arise owing to the extremely rare nature of the condition with regard to treatment and investigation for metastases in overtly low grade cases. We present the case of a 62-year-old woman with a low grade chondrosarcoma, arising from the tip of the epiglottis, presenting with dysphagia but no other symptoms.

Contemporary management and outcomes for infants born with oesophageal atresia

Background

Reports on the management and outcome of rare conditions, such as oesophageal atresia, are frequently limited to case series reporting single-centre experience over many years. The aim of this study was to identify all infants born with oesophageal atresia in the UK and Ireland to describe current clinical practice and outcomes.

Methods

This was a prospective multicentre cohort study of all infants born with oesophageal atresia and/or tracheo-oesophageal fistula in 2008–2009 in the UK and Ireland to record current clinical management and early outcomes.

Results

A total of 151 infants admitted to 28 paediatric surgical units were identified. Some aspects of perioperative management were universal, including oesophageal decompression, operative technique and the use of transanastomotic tubes. However, there were a number of areas where clinical practice varied considerably, including the routine use of perioperative chest drains, postoperative contrast studies and antireflux medication, with each of these being employed in 30–50 per cent of patients. There was a trend towards routine postoperative ventilation.

Conclusion

The prospective methodology used in this study can help identify practices that all surgeons employ and also those that few surgeons use. Areas of clinical equipoise can be recognized and avenues for further research identified.

Tel Hashomer camptodactyly syndrome: a case report

Tel Hashomer camptodactyly syndrome (THCS) is a rare autosomal recessive camptodactyly with muscular involvement. The manifestations of THCS other than camptodactyly are clubbed feet, thenar and hypothenar hypoplasia, abnormal palmar creases and dermatoglyphic ridges, spina bifida and mitral valve prolapse. The syndrome was first described by Goodman et al in 1972 and thereafter two further cases with similar phenotype were seen. Herein, we present another case report and review of the literature of other syndromes associated with camptodactyly and mitral valve prolapse. Further cases with this syndrome need to be reported for mapping of the candidate loci. This will help in planning management and genetic counselling.