Plaque radiotherapy treatment with ruthenium-106 for iris malignant melanoma

PURPOSE

To report the results of ruthenium-106 plaque radiotherapy for iris malignant melanoma.

METHODS

A retrospective study of 15 patients with pure iris melanoma treated with ruthenium-106 plaque radiotherapy from June 1998 to June 2006. The main outcome measures were tumour control and ocular complications.

RESULTS

Of the 15 patients, 8 had biopsy-proven melanoma (6 incisional and 2 excisional biopsies). In the remaining seven patients enlargement of the lesion was documented. The median follow-up was 96 months (ranging from 14 months to 12 years). Common radiation-related complications included cataract in 9 (60%) patients, dry eyes in 3 (20%) patients and elevated intraocular pressure in 4 (27%) patients. Vision was preserved in 80% of patients. Local tumour control was obtained in all patients.

CONCLUSIONS

Ruthenium-106 plaque radiotherapy is an effective treatment for primary malignant iris melanoma, resulting in excellent local control with preservation of vision. Main complications included cataract, dry eyes, and glaucoma.

Approaches to normalization of spinal cord volume: application to multiple sclerosis

BACKGROUND AND PURPOSE

To determine the proper method for the normalization of spinal cord volume.

MATERIALS AND METHODS

A group of 34 multiple sclerosis (MS) patients (28 relapsing and 6 progressive) and 15 healthy controls had whole spinal cord 3-mm thick T2-weighted axial fast spin-echo magnetic resonance imaging (MRI) images obtained at 3T. For each participant, four volumes were measured (C2-3 volume, cervical cord volume, thoracic cord volume, and whole cord volume). The volumes were normalized by the number of slices and three potential measures of body size (intracranial volume [ICV], body mass index, and body surface area) using the proportional method.

RESULTS

All raw volumes and volumes normalized by number of slices or ICV were significantly lower in progressive MS patients compared to relapsing MS patients/healthy controls (P < .05). In addition, C2-3 volume and cervical cord volume were significantly correlated with Expanded Disability Status Scale score (P < .05). All regional volumes showed high intercorrelation, and normalization by the number of slices significantly increased some correlations. Regarding reliability, whole cord volume regardless of normalization technique had lower coefficient of variation than C2-3 volume.

CONCLUSIONS

Since normalization factor had limited impact on reliability and the ability to detect differences, normalization by the number of slices is recommended.

RD antigen based nanovaccine imparts long term protection by inducing memory response against experimental murine tuberculosis

BACKGROUND

The absence of certain genomic loci that are present in most of the virulent strains of Mycobacterium tuberculosis as well as lack of lasting memory responses are some of the major causes attributed to the non effectiveness of Bacille Calmette-Gue'rin (BCG) vaccine. Immunization schedules addressing these issues can offer better strategy for protection against tuberculosis.

METHODS

The immunological responses evoked upon administration of archaeosome based antigen delivery system comprising T cell antigen, Rv3619c (an ESAT-6 family protein), has been assessed against experimental murine tuberculosis in BALB/c mice.

RESULTS

Archaeosome based subunit vaccine has been found to elicit type-1 cytokines in the immunized mice. Besides effective T cell memory response, the Rv3619c based vaccine was able to reduce mycobacterial burden in the animals challenged with Mycobacterium tuberculosis infection.

CONCLUSION

The data of the present study suggest that archaeosome encapsulated RD gene products offer substantial protection against M. tuberculosis infection.

Solution structure and dynamics of ADF from Toxoplasma gondii

Toxoplasma gondii ADF (TgADF) belongs to a functional subtype characterized by strong G-actin sequestering activity and low F-actin severing activity. Among the characterized ADF/cofilin proteins, TgADF has the shortest length and is missing a C-terminal helix implicated in F-actin binding. In order to understand its characteristic properties, we have determined the solution structure of TgADF and studied its backbone dynamics from ¹⁵N-relaxation measurements. TgADF has conserved ADF/cofilin fold consisting of a central mixed β-sheet comprised of six β-strands that are partially surrounded by three α-helices and a C-terminal helical turn. The high G-actin sequestering activity of TgADF relies on highly structurally and dynamically optimized interactions between G-actin and G-actin binding surface of TgADF. The equilibrium dissociation constant for TgADF and rabbit muscle G-actin was 23.81 nM, as measured by ITC, which reflects very strong affinity of TgADF and G-actin interactions. The F-actin binding site of TgADF is partially formed, with a shortened F-loop that does not project out of the ellipsoid structure and a C-terminal helical turn in place of the C-terminal helix α4. Yet, it is more rigid than the F-actin binding site of Leishmania donovani cofilin. Experimental observations and structural features do not support the interaction of PIP2 with TgADF, and PIP2 does not affect the interaction of TgADF with G-actin. Overall, this study suggests that conformational flexibility of G-actin binding sites enhances the affinity of TgADF for G-actin, while conformational rigidity of F-actin binding sites of conventional ADF/cofilins is necessary for stable binding to F-actin.

Brain MRI lesion load at 1.5T and 3T versus clinical status in multiple sclerosis

BACKGROUND/PURPOSE

To assess correlation between brain lesions and clinical status with 1.5T and 3T magnetic resonance imaging (MRI).

METHODS

Brain MRI fluid-attenuated inversion-recovery (FLAIR) sequences were performed in 32 multiple sclerosis (MS) patients. Expanded Disability Status Scale (EDSS) score (mean±standard deviation) was 2±2.0 (range 0-8), disease duration 9.3±8.0 (range .8-29) years.

RESULTS

FLAIR lesion volume (FLLV) at 3T was higher than at 1.5T (P=.01). Correlation between 1.5T FLLV and EDSS score was poor, while 3T FLLV correlated moderately and significantly (rs=.39, P=.03). When controlling for age and depression, correlations between FLLV and cognitive measures were significant at 1.5T for the Judgment of Line Orientation test (JLO) (rs=-.44, P=.05), the Symbol Digit Modalities Test (SDMT) (rs=-.49, P=.02), and the California Verbal Learning Test Delayed Free Recall (CVLT DR) (rs=-.44, P=.04). Correlations at 3T were also significant for these tests, but of greater magnitude: JLO (rs=-.70, P=.0005), SDMT (rs=-.73, P=.0001), CVLT DR (rs=-.061, P=.003). Additional significant correlations obtained only at 3T included the 2 second-paced auditory serial addition test (rs=-.55, P=.01), the Brief Visuospatial Memory Test-Delayed Free Recall (rs=-.56, P=.007), and the California Verbal Learning Test Total Recall (rs=-.42, P=.05).

CONCLUSION

MRI at 3T may boost sensitivity and improve validity in MS brain lesion assessment.

Approach to Chronic Hepatitis B Virus Infection

Hepatitis B virus (HBV) infection constitutes one of the major global public health problems. Not only India and Nepal, East Asia is ghting with the same. About 30 percent of the world’s population has serological evidence of current or past infection with HBV. By virtue of its different stage of presentation in different age groups of patients and the rapid mutation in the virus, the treatment of HBV requires thorough work-up and regular monitoring. Many new concepts have evolved in last decade in managing these patients, such as HBV Genotype, HBV DNA quanti cation and mutation analysis. The introduction of oral antivirals in the treatment of HBV infection has revolutionized the treatment.

Development of tool for the assessment of comprehension of informed consent form in healthy volunteers participating in first-in-human studies

Informed consent is a process that involves providing all pertinent study information to the potential study participant. The information imparted in the form gives all such information as would enable a potential participant to come to a decision regarding his/her participation in the study. Various study related aspects are outlined in the participant information leaflet including the background of the study, the benefits and risks, treatment alternatives; the methodology of the study, follow up schedules, confidentiality of the data, compensations and remunerations and right to not participate or withdraw from the study. We have continued a similar exercise for a phase I, first-in-human study, conducted by our center. Here, the volunteers were asked certain questions pertaining to the trial background, design, patients' rights and miscellaneous categories. They were then assessed and the scores compared to come up with certain conclusions. The median (range) for the entire comprehension score was calculated and statistically analyzed on various aspects. Readability of the ease of reading of the consent form was also analyzed on a Flesch-Kinkaid reading scale. A total of 69 volunteers were screened out of which 50 were enrolled in the study. The median (range) score was 27 (19 to 33) and the mean (S.D.) score was 28.9 (3.1). The maximum correct responses were observed for the questions falling under the volunteers' rights category. The Flesch reading ease score was 54 and the Flesch-Kincaid Grade level score was 9.8. Investigators may be encouraged to incorporate such tools in their informed consent process.

Bile acid receptor agonist GW4064 regulates PPARγ coactivator-1α expression through estrogen receptor-related receptor α

Peroxisome proliferator-activated receptor γ coactivator-1α (PGC-1α) is induced in energy-starved conditions and is a key regulator of energy homeostasis. This makes PGC-1α an attractive therapeutic target for metabolic syndrome and diabetes. In our effort to identify new regulators of PGC-1α expression, we found that GW4064, a widely used synthetic agonist for the nuclear bile acid receptor [farnesoid X receptor (FXR)] strongly enhances PGC-1α promoter reporter activity, mRNA, and protein expression. This induction in PGC-1α concomitantly enhances mitochondrial mass and expression of several PGC-1α target genes involved in mitochondrial function. Using FXR-rich or FXR-nonexpressing cell lines and tissues, we found that this effect of GW4064 is not mediated directly by FXR but occurs via activation of estrogen receptor-related receptor α (ERRα). Cell-based, biochemical and biophysical assays indicate GW4064 as an agonist of ERR proteins. Interestingly, FXR disruption alters GW4064 induction of PGC-1α mRNA in a tissue-dependent manner. Using FXR-null [FXR knockout (FXRKO)] mice, we determined that GW4064 induction of PGC-1α expression is not affected in oxidative soleus muscles of FXRKO mice but is compromised in the FXRKO liver. Mechanistic studies to explain these differences revealed that FXR physically interacts with ERR and protects them from repression by the atypical corepressor, small heterodimer partner in liver. Together, this interplay between ERRα-FXR-PGC-1α and small heterodimer partner offers new insights into the biological functions of ERRα and FXR, thus providing a knowledge base for therapeutics in energy balance-related pathophysiology.

A 3T MR imaging investigation of the topography of whole spinal cord atrophy in multiple sclerosis

BACKGROUND AND PURPOSE

Spinal cord atrophy is a common feature of MS. However, it is unknown which cord levels are most susceptible to atrophy. We performed whole cord imaging to identify the levels most susceptible to atrophy in patients with MS versus controls and also tested for differences among MS clinical phenotypes.

MATERIALS AND METHODS

Thirty-five patients with MS (2 with CIS, 27 with RRMS, 2 with SPMS, and 4 with PPMS phenotypes) and 27 healthy controls underwent whole cord 3T MR imaging. The spinal cord contour was segmented and assigned to bins representing each C1 to T12 vertebral level. Volumes were normalized, and group comparisons were age-adjusted.

RESULTS

There was a trend toward decreased spinal cord volume at the upper cervical levels in PPMS/SPMS versus controls. A trend toward increased spinal cord volume throughout the cervical and thoracic cord in RRMS/CIS versus controls reached statistical significance at the T10 vertebral level. A statistically significant decrease was found in spinal cord volume at the upper cervical levels in PPMS/SPMS versus RRMS/CIS.

CONCLUSIONS

Opposing pathologic factors impact spinal cord volume measures in MS. Patients with PPMS demonstrated a trend toward upper cervical cord atrophy. However patients with RRMS showed a trend toward increased volume at the cervical and thoracic levels, which most likely reflects inflammation or edema-related cord expansion. With the disease causing both expansion and contraction of the cord, the specificity of spinal cord volume measures for neuroprotective therapeutic effect may be limited.

Approach to chronic hepatitis B virus infection

Hepatitis B virus (HBV) infection constitutes one of the major global public health problems. Not only India and Nepal, East Asia is fighting with the same. About 30 percent of the world's population has serological evidence of current or past infection with HBV. By virtue of its different stage of presentation in different age groups of patients and the rapid mutation in the virus, the treatment of HBV requires thorough work-up and regular monitoring. Many new concepts have evolved in last decade in managing these patients, such as HBV Genotype, HBV DNA quantification and mutation analysis. The introduction of oral antivirals in the treatment of HBV infection has revolutionized the treatment.

The relationships among MRI-defined spinal cord involvement, brain involvement, and disability in multiple sclerosis

OBJECTIVE

To determine the interrelationships between MRI-defined lesion and atrophy measures of spinal cord involvement and brain involvement and their relationships to disability in a small cohort of patients with multiple sclerosis (MS).

BACKGROUND

Although it is known that cervical spinal cord atrophy correlates with disability in MS, it is unknown whether it is the most important determinant when compared to other regions of the central nervous system (CNS). Furthermore, it is not clear to what extent brain and cord lesions and atrophy are related.

DESIGN AND METHODS

3T MRI of the whole brain and whole spinal cord was obtained in 21 patients with MS, including 18 with relapsing-remitting, one with secondary progressive, one with primary progressive, and one with a clinically isolated syndrome. Brain global gray and white matter volumes were segmented with Statistical Parametric Mapping 8. Spinal cord contour volume was segmented in whole by a semi-automated method with bins assigned to either the cervical or thoracic regions. All CNS volumes were normalized by the intracranial volume. Brain and cord T2 hyperintense lesions were segmented using a semi-automated edge finding tool.

RESULTS

Among all MRI measures, only upper cervical spinal cord volume significantly correlated with Expanded Disability Status Scale score (r =-.515, P = .020). The brain cord relationships between whole or regional spinal cord volume or lesions and gray matter, white matter, or whole brain volume or whole brain lesions were generally weak and all nonsignificant.

CONCLUSIONS AND RELEVANCE

In this preliminary study of mildly disabled, treated MS patients, cervical spinal cord atrophy most strongly correlates with physical disability in MS when accounting for a wide range of other CNS measures of lesions and atrophy, including thoracic or whole spinal cord volume, and cerebral gray, white or whole brain volume. The weak relationship between spinal cord and brain lesions and atrophy may suggest that they progress rather independently in patients with MS.

Phantom vibration syndrome among medical staff: a cross sectional survey

OBJECTIVE

To describe the prevalence of and risk factors for experiencing "phantom vibrations," the sensory hallucination sometimes experienced by people carrying pagers or cell phones when the device is not vibrating.

DESIGN

Cross sectional survey.

SETTING

Academic medical centre.

PARTICIPANTS

176 medical staff who responded to questionnaire (76% of the 232 people invited). Measurements Electronic survey consisting of 17 questions about demographics, device use, phantom vibrations experienced, and attempts to stop them.

RESULTS

Of the 169 participants who answered the question, 115 (68%, 95% confidence interval 61% to 75%) reported having experienced phantom vibrations. Most (68/112) who experienced phantom vibrations did so after carrying the device between 1 month and 1 year, and 13% experienced them daily. Four factors were independently associated with phantom vibrations: occupation (resident v attending physician, prevalence ratio 1.47, 95% confidence interval 1.10 to 1.97), device location (breast pocket v belt, prevalence ratio 1.66, 1.29 to 2.14), hours carried (per 6 hour increment, prevalence ratio 1.30, 1.07 to 1.58), and more frequent use in vibrate mode (per frequency category, prevalence ratio 1.18, 1.03 to 1.34). Of those who experienced phantom vibrations, 43 (39%, 30% to 48%) were able to stop them. Strategies for stopping phantom vibrations included taking the device off vibrate mode, changing the location of the device, and using a different device (success rates 75% v 63% v 50%, respectively, P=0.217). However, 39% (30% to 49%) of respondents did not attempt any strategies.

CONCLUSIONS

Phantom vibration syndrome is common among those who use electronic devices.

Molecular characterization of secretory proteins Rv3619c and Rv3620c from Mycobacterium tuberculosis H37Rv

Rv3619c and Rv3620c are the secretory, antigenic proteins of the ESAT-6/CFP-10 family of Mycobacterium tuberculosis H37Rv. In this article, we show that Rv3619c interacts with Rv3620c to form a 1 : 1 heterodimeric complex with a dissociation constant (K(d)) of 4.8 × 10(-7) M. The thermal unfolding of the heterodimer was completely reversible, with a T(m) of 48 °C. The comparative thermodynamics and thermal unfolding analysis of the Rv3619c-Rv3620c dimer, the ESAT-6-CFP-10 dimer and another ESAT family heterodimer, Rv0287-Rv0288, revealed that the binding strength and stability of Rv3619c-Rv3620c are relatively lower than those of the other two pairs. Molecular modeling and docking studies predict the structure of Rv3619c-Rv3620c to be similar to that of ESAT-6-CFP-10. Spectroscopic studies revealed that, in an acidic environment, Rv3619c and Rv3620c lose their secondary structure and interact weakly to form a complex with a lower helical content, indicating that Rv3619c-Rv3620c is destabilized at low pH. These results, combined with those of previous studies, suggest that unfolding of the proteins is required for dissociation of the complex and membrane binding. In the presence of membrane mimetics, the α-helical contents of Rv3619c and Rv3620 increased by 42% and 35%, respectively. In mice, the immune response against Rv3619c protein is characterized by increased levels of interferon-γ, interleukin-12 and IgG(2a) , indicating a dominant Th1 response, which is mandatory for protection against mycobacterial infection. This study therefore emphasizes the potential of Rv3619c as a subunit vaccine candidate.

A twisted periscope arrangement for transporting elliptically polarized light without change in its polarization state

The authors describe a dual-mirror 90(∘) twisted periscope arrangement for transporting polarized light in air, wherein a general elliptic polarization state of the light is preserved at all wavelengths. It is experimentally demonstrated that in the wavelength range 400-1000 nm, this arrangement preserves the polarization state fairly well when using either metallic or dielectric mirrors.

Randomised, controlled trial of concomitant pneumococcal and meningococcal conjugate vaccines

A randomised, open-label study compared the immunogenicity and safety of 7-valent pneumococcal conjugate vaccine (PCV7) and meningococcal C conjugate vaccine (MnCC vaccine) administered concomitantly and individually. Infants received PCV7+MnCC vaccine (n=265), PCV7 alone (n=268) or MnCC vaccine alone (n=178). PCV7 was administered at 2, 3½, 6 and 12 months, and MnCC vaccine at 2, 6 and 12 months. For the 7 pneumococcal serotypes tested (4, 6B, 9V, 14, 18C, 19F and 23F), proportions of subjects with pneumococcal serotype-specific immunoglobulin G (IgG) antibody concentrations ≥0.35 μg/mL post-infant series were non-inferior for the PCV7+MnCC vaccine (91.5-99.6%) and PCV7 (89.0-99.6%) groups. Proportions of subjects achieving serogroup C meningococcal serum bactericidal assay titres ≥1:8 post-infant series were non-inferior for the PCV7+MnCC vaccine (99.6%) and MnCC vaccine groups (98.8%). Pneumococcal IgG antibody levels were similar in the PCV7+MnCC vaccine and PCV7 groups at each time point. Post-infant and post-toddler meningococcus C serum bactericidal assay titres and IgG levels were similar in the PCV7+MnCC vaccine and MnCC groups, although pre-toddler, the levels were lower in the PCV7+MnCC vaccine group than the MnCC vaccine group. Immune response rates to diphtheria antigen approached 100% for all vaccine groups. Local reactions were mostly similar among the treatment groups. The MnCC vaccine group had lower rates of some systemic events than the PCV7+MnCC vaccine group. Immune responses to PCV7+MnCC vaccine were non-inferior compared with those seen with each vaccine administered alone.

Fiber optic based system for polarization sensitive spectroscopy of semiconductor quantum structures

We describe an optical fiber based setup for performing polarization resolved magneto-optical spectroscopy measurements under low temperatures ( approximately 4 K) and high magnetic fields ( approximately 8 T). The measurements are performed in a windowless helium Dewar. Circularly polarized light is produced inside the Dewar by inserting the polarizing elements between the fiber end and the sample. Photoconductivity spectra of a GaAs/AlGaAs multiquantum-well sample have been measured over the photon energy range of 1.5-1.7 eV in left and right circularly polarized light under crossed magnetic and electric fields. It is shown that reversing the direction of magnetic field produces the same spectral changes as caused by changing the direction of circular polarization with the optical components.