HCV cure: an appropriate moment to reduce cannabis use in people living with HIV? (ANRS CO13 HEPAVIH data)

BACKGROUND

Thanks to direct-acting antivirals, hepatitis C virus (HCV) infection can be cured, with similar rates in HCV-infected and HIV-HCV co-infected patients. HCV cure is likely to foster behavioral changes in psychoactive substance use, which is highly prevalent in people living with HIV (PLWH). Cannabis is one substance that is very commonly used by PLWH, sometimes for therapeutic purposes. We aimed to identify correlates of cannabis use reduction following HCV cure in HIV-HCV co-infected cannabis users and to characterize persons who reduced their use.

METHODS

We used data collected on HCV-cured cannabis users in a cross-sectional survey nested in the ANRS CO13 HEPAVIH cohort of HIV-HCV co-infected patients, to perform logistic regression, with post-HCV cure cannabis reduction as the outcome, and socio-behavioral characteristics as potential correlates. We also characterized the study sample by comparing post-cure substance use behaviors between those who reduced their cannabis use and those who did not.

RESULTS

Among 140 HIV-infected cannabis users, 50 and 5 had reduced and increased their use, respectively, while 85 had not changed their use since HCV cure. Cannabis use reduction was significantly associated with tobacco use reduction, a decrease in fatigue level, paying more attention to one's dietary habits since HCV cure, and pre-HCV cure alcohol abstinence (p = 0.063 for alcohol use reduction).

CONCLUSIONS

Among PLWH using cannabis, post-HCV cure cannabis reduction was associated with tobacco use reduction, improved well-being, and adoption of healthy behaviors. The management of addictive behaviors should therefore be encouraged during HCV treatment.

Microelimination or Not? The Changing Epidemiology of Human Immunodeficiency Virus-Hepatitis C Virus Coinfection in France 2012–2018

Background

The arrival of highly effective, well-tolerated, direct-acting antiviral agents (DAA) led to a dramatic decrease in hepatitis C virus (HCV) prevalence. Human immunodeficiency virus (HIV)-HCV–coinfected patients are deemed a priority population for HCV elimination, while a rise in recently acquired HCV infections in men who have sex with men (MSM) has been described. We describe the variations in HIV-HCV epidemiology in the French Dat’AIDS cohort.

Methods

This was a retrospective analysis of a prospective cohort of persons living with HIV (PLWH) from 2012 to 2018. We determined HCV prevalence, HCV incidence, proportion of viremic patients, treatment uptake, and mortality rate in the full cohort and by HIV risk factors.

Results

From 2012 to 2018, 50 861 PLWH with a known HCV status were followed up. During the period, HCV prevalence decreased from 15.4% to 13.5%. HCV prevalence among new HIV cases increased from 1.9% to 3.5% in MSM but remained stable in other groups. Recently acquired HCV incidence increased from 0.36/100 person-years to 1.25/100 person-years in MSM. The proportion of viremic patients decreased from 67.0% to 8.9%. MSM became the first group of viremic patients in 2018 (37.9%). Recently acquired hepatitis represented 59.2% of viremic MSM in 2018. DAA treatment uptake increased from 11.4% to 61.5%. More treatments were initiated in MSM in 2018 (41.2%) than in intravenous drug users (35.6%). In MSM, treatment at the acute phase represented 30.0% of treatments in 2018.

Conclusions

A major shift in HCV epidemiology was observed in PLWH in France from 2012 to 2018, leading to a unique situation in which the major group of HCV transmission in 2018 was MSM.

Clinical Trials Registration. NCT02898987.

Chemotherapeutic Response and Survival for Patients With an Anal Squamous Cell Carcinoma and Low Hemoglobin Levels

Purpose

Anemia is associated with poor treatment results for a variety of cancers. The effect of low hemoglobin levels on long-term outcomes after the treatment of patients with an anal squamous cell carcinoma (SCC) remains unclear. For that reason, this study aimed to investigate the effect of anemia on treatment outcomes following chemoradiation for an anal SCC.

Methods

This was a retrospective study of all patients who underwent curative treatment for an anal SCC between 2009 and 2015 at 2 trusts in the United Kingdom. Data were collated from prospectively collected cancer databases and were cross-checked with operating-room records and records in the hospitals’ patient management systems.

Results

We identified 103 patients with a median age of 63 years (range, 36–84 years). The median overall survival was 39 months (range, 9–90 months), and the disease-free survival was 36 months (range, 2–90 months). During the follow-up period, 16.5% patients died and 13.6% patients developed recurrence. Twenty-two people were anemic prior to treatment, with a female preponderance (20 of 22). No differences in disease-free survival (P = 0.74) and overall survival (P = 0.12) were noted between patients with anemia and those with normal hemoglobin levels. On regression the analysis, the combination of anemia, the presence of a defunctioning colostomy, lymph-node involvement and higher tumor stage correlated with poor overall survival.

Conclusion

In this study, anemia did not influence disease-free survival or overall survival. We suggest that the interaction between anemia and survival is more complex than previously demonstrated and potentially reliant on other coexisting factors.

Anastomosing hemangioma of the kidney: radiologic and pathologic distinctions of a kidney cancer mimic

Anastomosing hemangioma (ah) is a rare subtype of primary vascular tumour that can, clinically and radiologically, present similarly to malignant renal tumours such as renal cell carcinoma (rcc) and angiosarcoma. Rarely seen in the genitourinary system, the ah we report here occurred in a 40-year-old male patient diagnosed initially with rcc based on imaging and successfully treated by laparoscopic left radical nephrectomy, with adrenal sparing and perihilar lymph node dissection. The pathologic diagnosis of ah can be challenging on small biopsy specimens; we therefore opine that it is appropriate to excise these lesions to facilitate diagnosis and definitively exclude common renal cancers. However, in this review, we describe some radiologic and pathologic distinctions between ah and malignant tumours.

Efficacy, safety and patient-reported outcomes of ledipasvir/sofosbuvir in NS3/4A protease inhibitor-experienced individuals with hepatitis C virus genotype 1 and HIV coinfection with and without cirrhosis (ANRS HC31 SOFTRIH study)

OBJECTIVES

Studies evaluating the efficacy and safety of the fixed-dose combination ledipasvir (LDV)/sofosbuvir (SOF) in patients coinfected with HIV-1 and hepatitis C virus (HCV) have mainly included treatment-naïve patients without cirrhosis. We aimed to evaluate the efficacy and safety of this combination in treatment-experienced patients with and without cirrhosis.

METHODS

We conducted a multicentre, open-label, double-arm, nonrandomized study in patients coinfected with HIV-1 and HCV genotype 1 with and without cirrhosis, who had good viral suppression on their antiretroviral regimens. All patients were pretreated with a first-generation NS3/4A protease inhibitor (PI) plus pegylated interferon/ribavirin. Patients received a fixed-dose combination of LDV/SOF for 12 weeks, or for 24 weeks if cirrhosis was present. The primary endpoint was a sustained virological response (SVR) 12 weeks after the end of therapy. Secondary endpoints included safety, pharmacokinetics and patient-reported outcomes.

RESULTS

Of the 68 patients enrolled, 39.7% had cirrhosis. Sixty-five patients [95.6%; 95% confidence interval (CI): 87.6-99.1%; P < 0.0001] achieved an SVR, with similar rates of SVR in those with and without cirrhosis. Tolerance was satisfactory, with mainly grade 1 or 2 adverse events. Among patient-reported outcomes, only fatigue significantly decreased at the end of treatment compared with baseline [odds ratio (OR): 0.36; 95% CI: 0.14-0.96; P = 0.04]. Mean tenofovir area under the plasma concentration-time curve (AUC) at week 4 was high, with mean ± SD AUC variation between baseline and week 4 higher in cirrhotic than in noncirrhotic patients (3261.57 ± 1920.47 ng/mL vs. 1576.15 ± 911.97 ng/mL, respectively; P = 0.03). Mild proteinuria (54.4%), hypophosphataemia (50.0%), blood bicarbonate decrease (29.4%) and hypokalaemia (13.2%) were reported. The serum creatinine level was not modified.

CONCLUSIONS

LDV/SOF provided a high SVR rate in PI-experienced subjects coinfected with HCV genotype 1 and HIV-1, including patients with cirrhosis.

Direct-acting antiviral treatment against hepatitis C virus infection in HIV-Infected patients - "En route for eradication"?

OBJECTIVES

Direct-Acting Antivirals (DAAs) opened a new era in HCV treatment. We report the impact of HCV treatment in French HIV-HCV coinfected patients.

METHODS

All HIV-HCV patients from the Dat'AIDS cohort followed between 2012 and 2015 were included. HCV status was defined yearly as naive, spontaneous cure, sustained virological response (SVR12), failure or reinfection.

RESULTS

Among 32,945 HIV-infected patients, 15.2% were positive for anti-HCV antibodies. From 2012 to 2015, HCV incidence rate increased from 0.35%PY to 0.69%PY in MSM, while median incidence was 0.08%PY in other patients. Median reinfection rate was 2.56%PY in MSM and 0.22%PY in other patients. HCV treatment initiation rate rose from 8.2% in 2012 to 29.6% (48.0% in pre-treated patients vs 22.6% in naïve patients). SVR12 rate increased from 68.7% to 95.2%. By the end of 2015, 62.7% of the patients were cured either spontaneously or following SVR.

CONCLUSIONS

HCV treatment dramatically increased in HIV-HCV patients in France from 2012 to 2015 resulting in HCV cure in nearly two-thirds of the patients in this cohort. Combined with a declining HCV prevalence, the prevalence of active HCV infection among HIV patients will drastically decrease in the forthcoming years.

Moisture effect in prompt gamma measurements from soil samples

The variation in intensity of 1.78MeV silicon, 6.13MeV oxygen, and 2.22MeV hydrogen prompt gamma rays from soil samples due to the addition of 5.1, 7.4, 9.7, 11.9 and 14.0wt% water was studied for 14MeV incident neutron beams utilizing a LaBr3:Ce gamma ray detector. The intensities of 1.78MeV and 6.13MeV gamma rays from silicon and oxygen, respectively, decreased with increasing sample moisture. The intensity of 2.22MeV hydrogen gamma rays increases with moisture. The decrease in intensity of silicon and oxygen gamma rays with moisture concentration indicates a loss of 14MeV neutron flux, while the increase in intensity of 2.22MeV gamma rays with moisture indicates an increase in thermal neutron flux due to increasing concentration of moisture. The experimental intensities of silicon, oxygen and hydrogen prompt gamma rays, measured as a function of moisture concentration in the soil samples, are in good agreement with the theoretical results obtained through Monte Carlo calculations.

Performance tests of a large volume cerium tribromide (CeBr3) scintillation detector

The response of a large cylindrical 76mm×76mm (height×diameter) cerium tribromide (CeBr3) detector was measured for prompt gamma rays. The total intrinsic activity of the CeBr3 detector, which was measured over 0.33-3.33MeV range, was found to be 0.022±0.001 counts/s/cm(3). The partial intrinsic activity ( due to (227)Ac contamination), was measured over a energy range of 1.22-2.20MeV energy, was found to be 0.007±0.001 counts/s/cm(3). Compared to intrinsic activities of LaBr3:Ce and LaCl3:Ce detectors of equivalent volume, the CeBr3 detector has 7-8 times less total intrinsic activity. The detector response for low energy prompt gamma rays was measured over 0.3-0.6MeVgamma energy range using a portable neutron generator-based Prompt Gamma Neutron Activation Analysis (PGNAA) setup. The experimental yield of boron, cadmium and mercury prompt gamma-rays was measured from water samples contaminated with 0.75-2.5wt% mercury, 0.31-2.50wt% boron, and 0.0625-0.500wt% cadmium, respectively. An excellent agreement has been observed between the calculated and experimental yields of the gamma rays. Also minimum detection limit (MDC) of the CeBr3 detector was measured for boron, cadmium and mercury samples. The CeBr3 detector has 23% smaller value of MDCB and 18% larger value of MDCCd than those of a LaBr3:Ce detector of equivalent size. This study has shown that CeBr3 detector has an excellent response for the low energy prompt gamma-rays with almost an order of magnitude low intrinsic activity as compared to LaCl3:Ce and LaBr3:Ce detectors of equivalent volume.

Pulse height tests of a large diameter fast LaBr₃:Ce scintillation detector

The pulse height response of a large diameter fast 100 mm × 100 mm LaBr3:Ce detector was measured for 0.1-10 MeV gamma-rays. The detector has a claimed time resolution of 608 ps for 511 keV gamma rays, but has relatively poor energy resolution due to the characteristics of its fast photomultiplier. The detector pulse height response was measured for gamma rays from cobalt, cesium, and bismuth radioisotope sources as well as prompt gamma rays from thermal neutron capture in water samples contaminated with mercury (3.1 wt%), boron (2.5 wt%), cadmium (0.25 wt%), chromium (52 wt%), and nickel (22 wt%) compounds. The energy resolution of the detector was determined from full width at half maximum (FWHM) of element-characteristic gamma ray peaks in the pulse height spectrum associated with the element present in the contaminated water sample. The measured energy resolution of the 100 mm × 100 mm detector varies from 12.7±0.2% to 1.9±0.1% for 0.1 to 10 MeV gamma rays, respectively. The graph showing the energy resolution ΔE/E(%) versus 1/√Eγ was fitted with a linear function to study the detector light collection from the slope of the curve. The slope of the present 100 mm × 100 mm detector is almost twice as large as the slope of a similar curve of previously published data for a 89 mm × 203 mm LaBr3:Ce detector. This indicates almost two times poorer light collection in the 100 mm × 100 mm detector as compared to the other detector.

Prompt gamma ray evaluation for chlorine analysis in blended cement concrete

Single prompt gamma ray energy has been evaluated to measure chlorine concentration in fly ash (FA), Super-Pozz (SPZ) and blast furnace slag (BFS) cement concrete specimens using a portable neutron generator-based Prompt Gamma Neutron Activation (PGNAA) setup. The gamma ray yield data from chloride concentration measurement in FA, SPZ and BFS cement concretes for 2.86-3.10, 5.72 and 6.11MeV chlorine gamma rays were analyzed to identify a gamma ray with common slope (gamma ray yield/Cl conc. wt%) for the FA, BFS and SPZ cement concretes. The gamma ray yield data for FA and SPZ cement concretes with varying chloride concentration were measured previously using a portable neutron generator-based PGNAA setup. In the current study, new data have been measured for chlorine detection in the BFS cement concrete using a portable neutron generator-based PGNAA setup for 2.86-3.10, 5.72, and 6.11MeV chlorine gamma rays. The minimum detection limit of chlorine in BFS cement concrete (MDC) was found to be 0.034±0.010, 0.032±0.010, 0.033±0.010 for 2.86-3.10, 5.72 and 6.11MeV gamma ray, respectively. The new BFS cement concrete data, along with the previous measurements for FA and SPZ cement concretes, have been utilized to identify a gamma ray with a common slope to analyze the Cl concentration in all of these blended cement concretes. It has been observed that the 6.11MeV chlorine gamma ray has a common slope of 5295±265 gamma rays/wt % Cl concentration for the portable neutron generator-based PGNAA setup. The minimum detectable concentration (MDC) of chlorine in blended cement concrete was measured to be 0.033±0.010wt % for the portable neutron generator-based PGNAA. Thus, the 6.11MeV chlorine gamma ray can be used for chlorine analysis of blended cement concretes.

Detection of carcinogenic chromium in synthetic hair dyes using laser induced breakdown spectroscopy

A laser induced breakdown spectroscopic (LIBS) system, consisting of a pulsed 266 nm laser radiation, in conjunction with a high-resolution spectrograph, a gated intensified charge coupled device camera, and a built-in delay generator were used to develop a sensitive detector to quantify the concentration of toxic substances such as chromium in synthetic hair dyes available on the local market. The strong atomic transition line of chromium (Cr I) at 427.5 nm wavelength was used as a fingerprint wavelength to calibrate the detection system and also to quantify the levels of chromium in the hair dye samples. The limit of detection achieved by our LIBS detection system for chromium was 1.2 ppm, which enabled us to detect chromium concentration in the range of 5-11 ppm in the commercial hair dyes available on the local market. The concentrations of chromium in the hair dyes measured using our system were validated using a standard analytical technique such as inductively coupled plasma mass spectrometry (ICPMS), and acceptable agreement (nearly 8%) was found between the results obtained by the two methods (LIBS and ICPMS). This study is highly significant for human health, specifically for people using synthetic hair dyes for changing the color of their hair.

Economic evaluation of treatment for acute lymphoblastic leukaemia in childhood

Berlin-Frankfurt-Munster (BFM) and Dana-Farber Cancer Institute (DFCI) consortia's treatment strategies for acute lymphoblastic leukaemia (ALL) in children are widely used. We compared the health effects and monetary costs of hospital treatments for these two strategies. Parents of children treated at seven centres in Canada, Italy and the USA completed health-related quality of life (HRQL) assessments during four active treatment phases and at 2 years after treatment. Mean HRQL scores were used to calculate quality-adjusted life years (QALYs) for a period of 5 years following diagnosis. Total costs of treatment were determined from variables in administrative databases in a universally accessible and publicly funded healthcare system. Valid HRQL assessments (n = 1200) were collected for 307 BFM and 317 DFCI patients, with costs measured for 66 BFM and 28 DFCI patients. QALYs per patient were <1.0% greater for BFM than DFCI. Median HRQL scores revealed no difference in QALYs. The difference in mean total costs for BFM (US$88 480) and DFCI (US$93 026) was not significant (P = 0.600). This study provides no evidence of superiority for one treatment strategy over the other. Current BFM or DFCI strategies should represent conventional management for the next economic evaluation of treatments for ALL in childhood.

Bioequivalence of fixed-dose combination Myrin®-P Forte and reference drugs in loose combination

BACKGROUND

Myrin®-P Forte is a fixed-dose combination (FDC) tablet containing rifampicin (RMP, 150 mg), isoniazid (INH, 75 mg), ethambutol (EMB) hydrochloride (275 mg) and pyrazinamide (PZA, 400 mg) developed for the treatment of tuberculosis (TB).

SETTING

This study was conducted at a single centre--the Pfizer Clinical Research Unit in Singapore.

OBJECTIVE

To demonstrate the bioequivalence of each drug component of the Myrin-P Forte FDC and the individual product in loose combination.

DESIGN

In a randomized, open-label, single-dose, two-way, crossover study, subjects received single doses of Myrin-P Forte or four individual products under fasting conditions in a crossover fashion with at least 7 days washout between doses. The primary measures for comparison were peak plasma concentration (C(max)) and the area under plasma concentration-time curve (AUC).

RESULTS

Of 36 subjects enrolled, 35 completed the study. The adjusted geometric mean ratios and 90% confidence intervals for C(max) and AUC values were completely contained within bioequivalence limits (80%, 125%) for all four drugs in both formulations. Both treatments were generally well tolerated in the study.

CONCLUSION

The Myrin-P Forte FDC tablet formulation is bioequivalent to the four single-drug references for RMP, INH, EMB hydrochloride and PZA at equivalent doses.

Hydrogen, carbon and oxygen determination in proxy material samples using a LaBr3:Ce detector

Hydrogen, carbon and oxygen concentrations were measured in caffeine, urea, ammonium acetate and melamine bulk samples via 14 MeV neutron inelastic scattering using a LaBr3:Ce detector. The samples tested herein represent drugs, explosives and benign materials, respectively. Despite its intrinsic activity, the LaBr3:Ce detector performed well in detecting the hydrogen, carbon and oxygen elements. Because 5.1 MeV nitrogen gamma rays interfere with silicon and calcium prompt gamma rays from the room background, the nitrogen peak was not detected in the samples. An excellent agreement was observed between the experimental and theoretical yields of 2.22, 4.43 and 6.13 MeV gamma rays from the analyzed samples as a function of H, C and O concentrations, respectively. Within statistical errors, the minimum detectable concentration (MDC) of hydrogen, carbon and oxygen elements in the tested materials were consistent with previously reported MDC values for these elements measured in hydrocarbon samples.

The fraction of recombinant factor VIII:Ag unable to bind von Willebrand factor has no FVIII coagulant activity: studies in vitro

A fraction of FVIII:Ag in commercial recombinant FVIII (rFVIII) cannot bind VWF whereas all the FVIII:Ag in plasma-derived FVIII (pd-FVIII) concentrates does. To compare the FVIII:C activities of the fractions of rFVIII:Ag that can and cannot bind VWF. The FVIII:Ag contents of the rFVIII Kogenate, and Advate and a pd-FVIII-pd-VWF (Fanhdi) were measured by ELISA. The FX activation was initiated by adding 1.0 IU of FVIII:C of each FVIII-containing product to a coagulant phospholipids suspension containing 1.0 nm FIXa, 100 nm FX, 1 μm hirudin and 2 mm calcium chloride and measured after 1, 5 and 10 min. The same approach was followed after adding 2.0 IU of pd-VWF to 1.0 IU of FVIII:C of Kogenate or Advate. The FVIII:Ag content/IU of FVIII:C of Kogenate, Advate and Fanhdi were 1.80 ± 0.05, 1.31 ± 0.9 and 0.84 ± 1.5 IU respectively. Only Kogenate and Advate effectively enhanced FX activation 1 min after adding each FVIII:C to the coagulant suspension containing FIXa and FX. Thus, the FXa initially generated by FIXa readily activated FVIII:C in control Kogenate and Advate to thereby effectively enhance FX activation while the VWF in Fanhdi continued to suppress FX activation for up to 10 min. Addition of pd-VWF to Kogenate or Advate effectively decreased their enhancements of FX activation to the same level as Fanhdi over 10 min. The FVIII:Ag fraction in Kogenate and Advate that cannot bind VWF appears to be inactive as it has no measureable FVIII:C activity in the presence of added VWF in vitro.

Response tests of a LaCl(3):Ce scintillation detector with low energy prompt gamma rays from boron and cadmium

The yield of 478 and 558 keV gamma-rays have been measured from water samples containing 0.031-0.500 wt. % boron and 0.0625-0.500 wt. % cadmium, respectively, using a cylindrical 76 mm × 76 mm (height × diameter) LaCl(3):Ce detector. Inspite of interferences between detector-associated and the sample-associated prompt gamma rays, the LaCl(3):Ce detector has excellent resolution for the low energy prompt gamma-rays. An excellent agreement has been observed between the experimental and calculated yield of boron and cadmium prompt gamma ray from water samples.

[Bacterial resistance and antibiotic prescription: a survey of hospital physician perception, attitude, and knowledge]

OBJECTIVE

The authors' goal was to assess physicians' perception of antibiotic prescribing practice and of bacterial resistance.

DESIGN

We questioned 503 interns and senior physicians in the Nice University Hospital.

RESULTS

Three hundred and twenty-two out of five hundred and three (64 %) physicians answered the questionnaire. Antibiotic resistance was perceived as a national problem by 98 % of physicians, but only 74 % rated the problem as important in their own daily practice. Fifty-nine percent of interns and 34 % of senior physicians respectively had received some training on antibiotic prescribing in the past 12 months. Only 33 % of physicians knew the exact prevalence of MRSA in their hospital. Senior physicians were more confident than interns when prescribing an antibiotic. The three issues they were the less confident with were: indications of antibiotic combinations, reassessment, and duration of antibiotic treatment. They were aware that antibiotic overuse, prescription of broad-spectrum molecules, or subtherapeutic doses of antibiotics were the three major causes of antibiotic resistance. They believed that the most useful measures to improve antibiotic prescription were: availability of guidelines, specific courses, readily accessible advice from an infectious diseases specialist, and audit plus feedback.

CONCLUSIONS

The collected data provides useful information for the implementation of strategies to optimize adherence to good antimicrobial stewardship.

[Bacterial resistance and antibiotic prescriptions: perceptions, attitudes and knowledge of a sample of French GPs]

OBJECTIVE

The study's objective was to assess General Practitioners' (GPs) perceptions of their antibiotic prescribing practice and of bacterial resistance.

DESIGN

We surveyed a random sample of 102 GPs out of the 1242 working in the Alpes-Maritimes area (France).

RESULTS

The response rate was 69%. More than 80% of the GPs felt confident when prescribing an antibiotic. The two main factors thought to influence their antibiotic prescriptions were their previous experience (97%) and guidelines (81%), advice from a colleague was quoted by only 13% of the GPs. Antibiotic resistance was perceived as a national problem by 91% of the respondents, but only 65% rated the problem as important in their own daily practice. Widespread and inappropriate antibiotic use, prescription of broad spectrum antibiotics or too low antibiotic doses were rated as important causes of resistance, but excessive duration of antibiotic treatment or poor hand hygiene practices were cited less often. The three measures perceived to be helpful or very helpful to improve antibiotic prescribing by more than 80% of the GPs were training sessions, availability of guidelines and of resistance data.

CONCLUSIONS

These perceptions must be taken into account to maximize adherence of GPs to the measures intended to limit bacterial resistance.

Dose calculation from a D-D-reaction-based BSA for boron neutron capture synovectomy

Monte Carlo simulations were carried out to calculate dose in a knee phantom from a D-D-reaction-based Beam Shaping Assembly (BSA) for Boron Neutron Capture Synovectomy (BNCS). The BSA consists of a D(d,n)-reaction-based neutron source enclosed inside a polyethylene moderator and graphite reflector. The polyethylene moderator and graphite reflector sizes were optimized to deliver the highest ratio of thermal to fast neutron yield at the knee phantom. Then neutron dose was calculated at various depths in a knee phantom loaded with boron and therapeutic ratios of synovium dose/skin dose and synovium dose/bone dose were determined. Normalized to same boron loading in synovium, the values of the therapeutic ratios obtained in the present study are 12-30 times higher than the published values.

Overview of the use of implantable venous access devices in the management of children with inherited bleeding disorders

Frequent infusion of factor concentrates may be challenging in young boys with haemophilia, especially if their disease is complicated by inhibitors. A central venous access device (CVAD) is often placed in young patients in need of repeated infusions for prophylaxis or immune tolerance induction. Although user friendly and capable of providing reliable venous access, these devices are associated with a high complication rate over time. In the haemophilia population, major complications include CVAD-associated infections and deep venous thrombosis, which is most often silent. Established risk factors for catheter-related infection include age less than 6 years at the time of CVAD placement and use of an external CVAD when compared with a totally implantable device such as a port. Avoidance of CVAD-related infections is facilitated by strict adherence to aseptic technique. The risk of deep venous thrombosis appears related to the duration for which the catheter is in place, with the risk increasing beyond 4 years. The promotion of a strict clinic policy in which CVADs are left in place for as short a time as possible should decrease the risk of complications. In rare cases where a totally implantable CVAD cannot be placed for technical reasons, an arteriovenous fistula may provide reliable venous access. In all cases, however, venous access via peripheral veins is preferred over CVADs.

Antagonism of p66shc by melanoma inhibitory activity

The p66shc protein governs oxidant stress and mammalian lifespan. Here, we identify melanoma inhibitory activity (MIA), a protein secreted by melanoma cells, as a novel binding partner and antagonist of p66shc. The N-terminal collagen homology-2 (CH2) domain of p66shc binds to the Src Homology-3 (SH3)-like domain of MIA in vitro. In cells, ectopically expressed MIA and p66shc colocalize and co-precipitate. MIA also co-precipitates with the CH2 domain of p66shc in vivo. MIA expression in vivo suppresses p66shc-stimulated increase in endogenous hydrogen peroxide (H(2)O(2)), and inhibits basal and H(2)O(2)-induced phosphorylation of p66shc on serine 36 and H(2)O(2)-induced death. In human melanoma cells expressing MIA, endogenous MIA and p66shc co-precipitate. Downregulation of MIA in melanoma cells increases basal and ultraviolet radiation (UVR)-induced phosphorylation of p66shc on serine 36, augments endogenous H(2)O(2) levels, and increases their susceptibility to UVR-induced death. These findings show that MIA binds to p66shc, and suggest that this interaction antagonizes phosphorylation and function of p66shc.

Efficacy of Isoniazid Prophylaxis in Renal Allograft Recipients

The efficacy of isoniazid (INH) prophylaxis in renal allograft recipients who are on long-term immunosuppression in a region highly prevalent for tuberculosis (TB) was studied. INH (300 mg/d in patients weighing more than 35 kg and 5 mg/kg/d in patients with <35 kg body weight) together with Pyridoxine 50 mg/d for 1 year was started in randomly assigned renal allograft recipients. Occurrence of clinical tuberculosis during the initial 2 years posttransplantation was observed in the risk group and patients at no risk. Risks were defined as acute rejection episodes and exposure to antirejection therapy, past history of TB completely or incompletely treated, radiological evidence of past tuberculosis, history of tuberculosis in close contacts. Among 480 patients registered in the study, INH prophylaxis was given to 219 randomly assigned renal allograft recipients. Results were compared among patients developing TB during the initial 2 years posttransplantation in both the groups. Risk factors were analyzed for comparison in both groups. No significant difference was observed in terms of past history of TB, TB in close contacts, episodes of acute rejection during the initial 3 months, and comorbidities such as cytomegalovirus infection, hepatitis C virus infection, and posttransplant diabetes. One patient from the INH group and 10 patients from the non-INH group developed TB during the initial 2 years posttransplantation (P < .0001). None of patients required discontinuation of INH. INH was observed to be safe and effective as a chemoprophylactic agent in renal allograft recipients.

Outcome of Pregnancy in Renal Allograft Recipients: SIUT Experience

The course of pregnancy and its outcome was studied in renal allograft recipients. Between November 1985 and November 2005, a total of 1481 renal transplants were carried out at the Sindh Institute of Urology and Transplantation (SIUT); among them were 348 females, with 73 potential females for pregnancy. All patients received cyclosporine and prednisolone, with 82% also receiving azathioprine and 4 patients mycophenolate mofetil as a third immunosuppressant drug. We evaluated incidence of hypertension, diabetes, pre-eclampsia, urinary tract infection (UTI), rejection during pregnancy and during 3 months' postdelivery as well as outcomes of pregnancy. Among 73 potential candidates, 31 had 47 pregnancies, after an average of 31 months (8-86 months). Of 31 subjects, 21 subjects were hypertensive on one or two drugs prior to conception. A rise in blood pressure during pregnancy was noticed in 7 patients. Albuminuria from trace to 3+ appeared in 13 patients and glycosuria in one other. Blood sugar levels remained within normal range in all subjects. UTIs occurred during pregnancy in 7 patients. Among 47 pregnancies, 9 had abortions (7 spontaneous, 2 therapeutic) and 6 had preterm deliveries. The others were full-term deliveries: 12 via a lower segment caesarean section and 20 were normal vaginal deliveries. Average birth weight was 4.8 lbs. At an average follow-up of 38 months the serum creatinine values ranged from 0.94 to 2.3 mg %. One patient developed acute irreversible graft dysfunction soon after delivery. Our study demonstrated that pregnancy did not reduce renal graft survival, but newborns are at greater risk of premature birth and low birth weight.

Performance improvement of keV Neutrons-based PGNAA setups

The performance of keV neutrons based Prompt Gamma Ray Neutron Activation Analysis (PGNAA) setups have been observed to improve by enclosing its neutron source inside the moderator. The keV neutrons were produced via (7)Li(p,n) reaction and (3)H(p,n) reactions. For the two PGNAA setups, the maximum intensity of the prompt gamma-ray yield was observed for a 5cm long moderator with the neutron source positioned at a distance of 0.5cm from the moderator-end facing the sample. Due to enclosing the source inside the moderator, the prompt gamma-ray yield from the (7)Li(p,n) reaction and (3)H(p,n) reaction based PGNAA setups have increased by a factor of three as compared to that achieved from these setups with the source outside the moderator. This study provides a theoretical basis for the measurement of performance of (7)Li(p,n) reaction and the (3)H(p,n) reaction based PGNAA setups.