The Global Otolaryngology-Head and Neck Surgery Workforce

Importance

A core component of delivering care of head and neck diseases is an adequate workforce. The World Health Organization report, Multi-Country Assessment of National Capacity to Provide Hearing Care, captured primary workforce estimates from 68 member states in 2012, noting that response rates were a limitation and that updated more comprehensive data are needed.

Objective

To establish comprehensive workforce metrics for global otolaryngology-head and neck surgery (OHNS) with updated data from more countries/territories.

Design, Setting, and Participants

A cross-sectional electronic survey characterizing the OHNS workforce was disseminated from February 10 to June 22, 2022, to professional society leaders, medical licensing boards, public health officials, and practicing OHNS clinicians.

Main Outcome

The OHNS workforce per capita, stratified by income and region.

Results

Responses were collected from 121 of 195 countries/territories (62%). Survey responses specifically reported on OHNS workforce from 114 countries/territories representing 84% of the world's population. The global OHNS clinician density was 2.19 (range, 0-61.7) OHNS clinicians per 100 000 population. The OHNS clinician density varied by World Bank income group with higher-income countries associated with a higher density of clinicians. Regionally, Europe had the highest clinician density (5.70 clinicians per 100 000 population) whereas Africa (0.18 clinicians per 100 000 population) and Southeast Asia (1.12 clinicians per 100 000 population) had the lowest. The OHNS clinicians deliver most of the surgical management of ear diseases and hearing care, rhinologic and sinus diseases, laryngeal disorders, and upper aerodigestive mucosal cancer globally.

Conclusion and Relevance

This cross-sectional survey study provides a comprehensive assessment of the global OHNS workforce. These results can guide focused investment in training and policy development to address disparities in the availability of OHNS clinicians.

Exome Sequencing Expands the Genetic Diagnostic Spectrum for Pediatric Hearing Loss

OBJECTIVES

Genetic testing is the standard-of-care for diagnostic evaluation of bilateral, symmetric, sensorineural hearing loss (HL). We sought to determine the efficacy of a comprehensive genetic testing method, exome sequencing (ES), in a heterogeneous pediatric patient population with bilateral symmetric, bilateral asymmetric, and unilateral HL.

METHODS

Trio-based ES was performed for pediatric patients with confirmed HL including those with symmetric, asymmetric, and unilateral HL.

RESULTS

ES was completed for 218 probands. A genetic cause was identified for 31.2% of probands (n = 68). The diagnostic rate was 40.7% for bilateral HL, 23.1% for asymmetric HL, and 18.3% for unilateral HL, with syndromic diagnoses made in 20.8%, 33.3%, and 54.5% of cases in each group, respectively. Secondary or incidental findings were identified in 10 families (5.52%).

CONCLUSION

ES is an effective method for genetic diagnosis for HL including phenotypically diverse patients and allows the identification of secondary findings, discovery of deafness-causing genes, and the potential for efficient data re-analysis.

LEVEL OF EVIDENCE

4 Laryngoscope, 133:2417-2424, 2023.

Essential equipment and services for otolaryngology care: a proposal by the Global Otolaryngology-Head and Neck Surgery Initiative

PURPOSE OF REVIEW

To highlight the need for comprehensive resource lists to provide baseline care of otolaryngologic conditions; to present a proposed list of essential equipment and services that may be applied toward surgical systems research, policymaking, and charitable efforts in global otolaryngology-head and neck surgery.

RECENT FINDINGS

To provide effective and high-quality surgical care across care settings, there must be a global standard for equipment and ancillary services necessary to provide baseline care. Though there have been efforts to devise resource standards via equipment lists and appraisal tools, these have been limited in scope to general surgery, emergency care, and a few other subspecialty surgical contexts. Recent efforts have brought attention to the significant burden imposed by otolaryngologic conditions such as hearing loss, otitis media, head and neck cancer, head and neck trauma, and upper airway foreign bodies. Yet, there has not been a comprehensive list of resources necessary to provide baseline care for common otolaryngologic conditions.

SUMMARY

Through an internal survey of its members, the Global Otolaryngology-Head and Neck Surgery Initiative has compiled a list of essential equipment and services to provide baseline care of otolaryngologic conditions. Our efforts aimed to address common otolaryngologic conditions that have been previously identified as high-priority with respect to prevalence and burden of disease. This expert-driven list of essential resources functions as an initial framework to be adapted for internal quality assessment, implementation research, health policy development, and economic priority-setting.

Integrating Genomic Screening into Primary Care: Provider Experiences Caring for Latino Patients at a Community-Based Health Center

Introduction:

Minority communities have had limited access to advances in genomic medicine. Mayo Clinic and Mountain Park Health Center, a Federally Qualified Health Center in Phoenix, Arizona, partnered to assess the feasibility of offering genomic screening to Latino patients receiving care at a community-based health center. We examined primary care provider (PCP) experiences reporting genomic screening results and integrating those results into patient care.

Methods:

We conducted open-ended, semi-structured interviews with PCPs and other members of the health care team charged with supporting patients who received positive genomic screening results. Interviews were recorded, transcribed, and analyzed thematically.

Results:

Of the 500 patients who pursued genomic screening, 10 received results indicating a genetic variant that warranted clinical management. PCPs felt genomic screening was valuable to patients and their families, and that genomic research should strive to include underrepresented minorities. Providers identified multiple challenges integrating genomic sequencing into patient care, including difficulties maintaining patient contact over time; arranging follow-up medical care; and managing results in an environment with limited genetics expertise. Providers also reflected on the ethics of offering genomic sequencing to patients who may not be able to pursue diagnostic testing or follow-up care due to financial constraints.

Conclusions:

Our results highlight the potential benefits and challenges of bringing advances in precision medicine to community-based health centers serving under-resourced populations. By proactively considering patient support needs, and identifying financial assistance programs and patient-referral mechanisms to support patients who may need specialized medical care, PCPs and other health care providers can help to ensure that precision medicine lives up to its full potential as a tool for improving patient care.

Communicating unexpected pharmacogenomic results to biobank contributors: A focus group study

OBJECTIVES

The goals of this study were to explore 1) the impact of returning unexpected pharmacogenomic (PGx) results to biobank contributors, and 2) participant views about improving communication.

METHODS

We conducted a qualitative focus group study with biobank participants (N = 54) who were notified by mail of an individual research result indicating increased risk for adverse events associated with the common cancer drug 5-fluorouracil (5-FU). We employed a framework approach for analysis.

RESULTS

Our results revealed three themes illustrating participants' questions and uncertainty, especially regarding how to share results with health providers and family members, and remember them over time. Participants valued results for themselves and others, and for the future of medicine. Risk perception was framed by health identity. "Toxicity narratives," or familiarity with another's adverse reaction to chemotherapy, increased the sense of importance participants reported.

CONCLUSION

These focus group results highlight research participant remaining questions and high valuation of PGx results, even when unexpected.

PRACTICE IMPLICATIONS

We identify PGx research participants' needs for clear clinical translation messaging that attends to health identity, pragmatics of sharing information with family members, and patient perceptions of barriers to transferring research results to a clinical context.

Cellular Automata with Synthetic Image A Secure Image Communication with Transform Domain

    Image encryption has attained a great attention due to the necessity to safeguard confidential images. Digital documents, site images, battlefield photographs, etc. need a secure approach for sharing in an open channel. Hardware – software co-design is a better option for exploiting unique features to cipher the confidential images. Cellular automata (CA) and synthetic image influenced transform domain approach for image encryption is proposed in this paper. The digital image is initially divided into four subsections by applying integer wavelet transform. Confusion is accomplished on low – low section of the transformed image using CA rules 90 and 150. The first level of diffusion with consecutive XORing operation of image pixels is initiated by CA rule 42. A synthetic random key image is developed by extracting true random bits generated by Cyclone V field programmable gate array 5CSEMA5F31C6. This random image plays an important role in second level of diffusion. The proposed confusion and two level diffusion assisted image encryption approach has been validated through the entropy, correlation, histogram, number of pixels change rate, unified average change intensity, contrast and encryption quality analyses.

Electrical transport and gas sensing characteristics of dielectrophoretically aligned MBE grown catalyst free InAs nanowires

In this report, the precise alignment of catalyst free InAs nanowires (NWs) on pre-patterned Au microelectrodes by dielectrophoresis (DEP) technique for gas sensing applications is presented. The catalyst free InAs NWs have been grown on Si (111) substrate by molecular beam epitaxy (MBE) technique. The effect of dispersing solvents, electrode geometries and gaps, magnitude, frequency and duration of applied voltage etc, has been studied for aligning the InAs NWs by DEP technique. Current-voltage (I-V) measurements on the aligned NWs show linear behavior at room temperature (300 K), which changes to nonlinear at lower temperatures and higher voltages. The nonlinearity at lower temperatures and higher voltages is well explained by a space charge limited current contribution, which further gives a quantitative estimation of free charge carriers and trap density. The DEP aligned NWs exhibit good sensing response upon exposure to 10 ppm NO₂ gas.

Mathematical Modelling of Indian Regional Navigation Satellite System Receiver

<p class="p1">At present the armoured fighting vehicles are equipped with either global positioning system (GPS) receivers or integrated inertial navigation system (INS)/GPS navigation systems. During hostile situations, the denial/degradation of the GPS satellite signals may happen. This results in the requirement of an indigenous satellite based navigation system. Indian Space Research Organisation has developed an indigenous Indian regional navigation satellite system (IRNSS), with a seven satellite constellation to provide independent position, navigation and timing services over India and its neighbouring regions. In this paper, the development of IRNSS receiver using MATLAB as per IRNSS signal in space interface control document for standard positioning service is discussed. A method for faster IRNSS signal acquisition in frequency domain and delay locked loop code tracking for the acquired satellite signals are used. Models for navigation message decoding and pseudo range/user position calculations are developed using the algorithms provided in IRNSS ICD.</p>

Microstructural and Compositional Characterisation of Electronic Materials

<p class="p1"> </p><p class="p2"><span class="s1"> </span>Microstructural and compositional characterisation of electronic materials in support of the development of GaAs, GaN, and GaSb based multilayer device structures is described. Electron microscopy techniques employing nanometer and sub-nanometer scale imaging capability of structure and chemistry have been widely used to characterise various aspects of electronic and optoelectronic device structures such as InGaAs quantum dots, InGaAs pseudomorphic (pHEMT), and metamorphic (mHEMT) layers and the ohmic metallisation of GaAs and GaN high electron mobility transistors, nichrome thin film resistors, GaN heteroepitaxy on sapphire and silicon substrates, as well as InAs and GaN nanowires. They also established convergent beam electron diffraction techniques for determination of lattice distortions in III-V compound semiconductors, EBSD for crystalline misorientation studies of GaN epilayers and high-angle annular dark field techniques coupled with digital image analysis for the mapping of composition and strain in the nanometric layered structures. Also, <em>in-situ </em>SEM experiments were performed on ohmic metallisation of pHEMT device structures. The established electron microscopy expertise for electronic materials with demonstrated examples is presented.</p>

Theoretical investigation, biological evaluation and VEGFR2 kinase studies of metal(II) complexes derived from hydrotris(methimazolyl)borate

The reaction of soft tripodal scorpionate ligand, sodium hydrotris(methimazolyl)borate with M(ClO4)2·6H2O [MMn(II), Ni(II), Cu(II) or Zn(II)] in methanol leads to the cleavage of B-N bond followed by the formation of complexes of the type [M(MeimzH)4](ClO4)2·H2O (1-4), where MeimzH=methimazole. All the complexes were fully characterized by spectro-analytical techniques. The molecular structure of the zinc(II) complex (4) was determined by X-ray crystallography, which supports the observed deboronation reaction in the scorpionate ligand with tetrahedral geometry around zinc(II) ion. The electronic spectra of complexes suggested tetrahedral geometry for manganese(II) and nickel(II) complexes, and square-planar geometry for copper(II) complex. Frontier molecular orbital analysis (HOMO-LUMO) was carried out by B3LYP/6-31G(d) to understand the charge transfer occurring in the molecules. All the complexes exhibit significant antimicrobial activity against Gram (-ve) and Gram (+ve) bacterial as well as fungal strains, which are quite comparable to standard drugs streptomycin and clotrimazole. The copper(II) complex (3) showed excellent free radical scavenging activity against DPPH in all concentration with IC50 value of 30μg/mL, when compared to the other complexes. In the molecular docking studies, all the complexes showed hydrophobic, π-π and hydrogen bonding interactions with BSA. The cytotoxic activity of the complexes against human hepatocellular liver carcinoma (HepG2) cells was assessed by MTT assay, which showed exponential responses toward increasing concentration of complexes.

Studies on the growth and characterization of a non linear optical crystal: 3 Hydroxy Pyridinium Tartrate Mono Hydrate (3HPTMH)

Single crystals of 3 Hydroxy Pyridinium Tartrate Mono Hydrate (3HPTMH) was synthesised and successfully grown in mixed solvent of ethanol and water by slow evaporation technique at room temperature. 3HPTMH belongs to the orthorhombic crystal system with space group P212121. The lattice parameters of 3HPTMH are a=7.4597(2)Å, b=8.7012(3)Å, c=17.8786(5)Å, V=1160.47(6)Å(3), obtained by single crystal X ray diffraction studies. Hyperpolarizability and HOMO-LUMO analysis were performed for grown crystal using DFT calculations using Gaussian 03 software. Functional groups were identified by FT-IR studies. The lower cut-off wavelength of the 3HPTMH has been identified by UV-Vis study. The thermal behavior has been studied by thermal gravimetric analysis and differential thermal analysis. The powder second harmonic generation efficiency of 3HPTMH was compared with KDP.

Synthesis, characterization, computational calculation and biological studies of some 2,6-diaryl-1-(prop-2-yn-1-yl)piperidin-4-one oxime derivatives

A new series of 2,6-diaryl-1-(prop-2-yn-1-yl)piperidin-4-one oximes (17-24) were designed and synthesized from 2,6-diarylpiperidin-4-one oximes (9-16) with propargyl bromide. Unambiguous structural elucidation has been carried out by investigating IR, NMR ((1)H, (13)C, (1)H-(1)H COSY and HSQC), mass spectral techniques and theoretical (DFT) calculations. Further, crystal structure of compound 17 was evaluated by single crystal X-ray diffraction analysis. Single crystal X-ray structural analysis of compound 17 evidenced that the configuration about CN double bond is syn to C-5 carbon (E-form). The existence of chair conformation was further confirmed by theoretical DFT calculation. All the synthesized compounds were screened for in vitro antimicrobial activity against a panel of selected bacterial and fungal strains using Ciprofloxacin and Ketoconazole as standards. The minimum inhibition concentration (MIC) results revealed that most of the 2,6-diaryl-1-(prop-2-yn-1-yl)piperidin-4-one oximes (17, 19, 20 and 23) exhibited better activity against the selected bacterial and fungal strains.

Isolation and Screening of <i>Lactobacillus</i> Bacteria for Ability to Produce Antibiotics

Antibiotic is one of the important commercially exploited secondary metabolites produced by bacteria and used in a wide range. Most of the antibiotics used today are isolated from the microbes. Bacteria are easy to culture, isolate, maintain and to improve their strain. Isolation of lactic acid bacteria (LAB) from soil, yoghurt and cheese was carried out. LAB were cultivated on De Man Rogosa Sharpe (MRS) agar and were characterized based on colony morphology, cell shape and biochemical tests. Out of eight samples analyzed, 96 isolates were identified as LAB. The bacterial isolates were identified as Lactococcus Lactis, Lactobacillus Brevis, Lactobacillus casei, Pediococcus damnosus, Lactobaciilus rhamnosus, Lactobacillus Plantarum, Lactobacillus pentosus, Enterococcus feacalis, Staphylococcus Simulans.Using MRS broth, the isolated LAB were screened for production of bacteriocins. Further, 96 LAB screened for bacteriocin production, 12 LAB were identified as bacteriocin producers. Out of 12 LAB, Enterococcus faecium (CST-1) was identified as potential bacteriocin producer against Bacillus subtlis MTCC-10403 Pseudomonas aureginosa MTCC-4676 microorganisms used while Pediococcus damnosus had the least bacteriocin activity against Staphylococcus aureus and Bacillus subtilis.

Isolation and Screening of <i>Lactobacillus</i> Bacteria for Ability to Produce Antibiotics

Antibiotic is one of the important commercially exploited secondary metabolites produced by bacteria and used in a wide range. Most of the antibiotics used today are isolated from the microbes. Bacteria are easy to culture, isolate, maintain and to improve their strain. Isolation of lactic acid bacteria (LAB) from soil, yoghurt and cheese was carried out. LAB were cultivated on De Man Rogosa Sharpe (MRS) agar and were characterized based on colony morphology, cell shape and biochemical tests. Out of eight samples analyzed, 96 isolates were identified as LAB. The bacterial isolates were identified as Lactococcus Lactis, Lactobacillus Brevis, Lactobacillus casei, Pediococcus damnosus, Lactobaciilus rhamnosus, Lactobacillus Plantarum, Lactobacillus pentosus, Enterococcus feacalis, Staphylococcus Simulans.Using MRS broth, the isolated LAB were screened for production of bacteriocins. Further, 96 LAB screened for bacteriocin production, 12 LAB were identified as bacteriocin producers. Out of 12 LAB, Enterococcus faecium (CST-1) was identified as potential bacteriocin producer against Bacillus subtlis MTCC-10403 Pseudomonas aureginosa MTCC-4676 microorganisms used while Pediococcus damnosus had the least bacteriocin activity against Staphylococcus aureus and Bacillus subtilis.

A bluish-green emitting organic compound methyl 3-[(E)-(2-hydroxy-1-naphthyl)methylidene]carbazate: spectroscopic, thermal, fluorescence, antimicrobial and molecular docking studies

The present paper describes the physicochemical properties and biological activities of a Schiff base compound which was grown by the slow evaporation solution growth technique.

(E)-3-Isopropyl-1-methyl-2,6-di-phenyl-piperidin-4-one O-nicotinoyl oxime

In the title compound, C₂₇H₂₉N₃O₂, the piperidine ring exists in a chair conformation with an equatorial orientation of the phenyl and methyl substituents. The C—C=N bond angles are significantly different [119.1 (2) and 127.2 (2)°]. The phenyl rings are inclined to one another by 44.90 (14)°, and by 80.85 (13) and 79.62 (12)° to the mean plane of the piperidine ring. The terminal pyridine ring is inclined to the piperidine ring mean plane by 74.79 (15)°. In the crystal, mol­ecules are linked by C—H⋯π inter­actions, forming a three-dimensional network.

Spectral studies of 2-pyrazoline derivatives: structural elucidation through single crystal XRD and DFT calculations

A series of biologically active N-thiocarbamoyl pyrazoline derivatives have been synthesized using anhydrous potassium carbonate as the catalyst. All the synthesized compounds were characterized by FT-IR, (1)H NMR, (13)C NMR spectral studies, LCMS, CHN Analysis and X-ray diffraction analysis (compound 7). In order to supplement the XRD parameters, molecular modelling was carried out by Gaussian 03W. From the optimized structure, the energy, dipolemoment and HOMO-LUMO energies of all the systems were calculated.

Use of ABO-incompatible grafts in living donor liver transplantation--first report from India

ABO incompatibility is the commonest reason for rejection of donors in living donor liver transplantation (LDLT). The donor pool could be expanded by 25 % to 35 % if the ABO barrier is overcome. In the absence of pre-conditioning, transplantation across the blood groups is fraught with the almost universal risk of antibody-mediated rejection (AMR) that rapidly leads to graft loss. However, AMR can be prevented by removal of preformed antibodies and reducing their production by B cells. We describe our initial experience of three cases of ABO-incompatible (ABO-i) LDLT: a 42-year-old male, an 8-month-old male and a 28-month-old female, all of blood group O+ who received blood group B + right lobe, B + left lateral segment, and A + left lateral segment liver grafts, respectively. Pre-LDLT conditioning included administration of anti-CD20 antibody (Rituximab(®)) to the adult 4 weeks prior, and four to seven sessions of double-filtration plasmapheresis to all, to remove preformed antibodies and achieve anti-donor blood group antibody (ADA) titers of ≤ 1:16 IgG and ≤ 1:8 IgM, respectively. In addition, cases 1 and 3 received mycophenolate mofetil for 7 days prior to LDLT. After LDLT, all three patients achieved normal graft function over 8-17 days with no evidence of AMR and without the need for further plasmapheresis. Postoperative complications included portal vein thrombosis (one successfully re-explored), CMV (one), Pseudomonas and Klebsiella sepsis (one each), and abdominal collection (one treated with percutaneous drainage). All are currently well with normal graft function and low ADA titers at 8, 16, and 19 months after ABO-i LDLT.

1-[2-Hy-droxy-4-(prop-2-yn-1-yl-oxy)phen-yl]ethanone

In the title compound, C11H10O3, there is an intra-molecular O-H⋯O hydrogen bond generating an S(6) ring motif. The O atom of the hy-droxy group deviates by 0.0200 (1) Å from the benzene ring to which it is attached. The propyne group is almost linear, the C-C C angle being 177.83 (15)°, and is almost coplanar with the benzene ring; the C-C-O-C torsion angle being only -1.1 (2)°. In the crystal, mol-ecules are linked via C-H⋯O hydrogen bonds, forming infinite C(11) chains running parallel to [103]. These chains are linked by a pair of C-H⋯O hydrogen bonds, enclosing R 2 (2)(8) inversion dimers, forming a corrugated two-dimensional network lying parallel to (103).

[(4E)-1-Methyl-2,6-diphenyl-3-(propan-2-yl)piperidin-4-yl-idene]amino 3-methyl-benzoate

In the title compound, C₂₉H₃₂N₂O₂, the piperidine ring exists in a chair conformation (the bond-angle sum at the sp²-hybridized C atom is 359.79°). The phenyl rings and the methyl group substituted on the heterocyclic ring are in equatorial orientations. In the crystal, pairs of C—H⋯π inter­actions result in the formation of inversion dimers.

[(4E)-3-Ethyl-1-methyl-2,6-di-phenyl-piperidin-4-yl-idene]amino 3-methyl-benzoate

In the title compound, C₂₈H₃₀N₂O₂, the piperidine ring exists in a chair conformation with an equatorial orientation of the phenyl rings and methyl group substituted on the heterocycle. In the crystal, C—H⋯π inter­actions result in chains of mol­ecules running parallel to the a-axis direction.

3-Hy-droxy-1-[(morpholin-4-yl)meth-yl]pyridazin-6(1H)-one

In the title compound, C₉H₁₃N₃O₃, the morpholine ring adopts a chair conformation and its mean plane makes a dihedral angle of 68.00 (11)° with the pyridazine ring. The carbonyl O atom deviates from the plane of the pyridazine ring by 0.0482 (12) Å. An intra­molecular C—H⋯O hydrogen bond occurs. In the crystal, mol­ecules are linked by O—H⋯O and C—H⋯O hydrogen bonds, forming chains along [1-10].

4-Methyl-6-(piperidin-1-yl)pyrimidin-2-amine

The title compound, C₁₀H₁₆N₄, crystalizes with two mol­ecules (A and B) in the asymmetric unit in which the dihedral angles between the piperidine and pyrimidine rings are 47.5 (1) and 10.3 (1)°. The four C atoms of the pyrimidine ring in one of the mol­ecules are disordered over two sets of sites with occupancy factors 0.508 (11):0.492 (11). In the crystal, the A mol­ecules are linked to one another through N—H⋯N hydrogen bonds, generating R₂²(8) ring patterns and forming inversion dimers. These dimers are further connected on either side to a B molecule through pairs of N—H⋯N hydrogen bonds, resulting in a tetra­meric unit.

6-(4-Methoxyphenyl)naphtho[2,3-b][1]benzothiophene

The asymmetric unit of the title compound, C₂₃H₁₆OS, contains two independent mol­ecules with opposite orientations of the meth­oxy groups bonded to the benzene rings. The napthobenzothiophene group in the two molecules is separated by an average distance of 3.912 Å. In both mol­ecules, the napthobenzothio­phene unit is almost planar, with r.m.s deviations of 0.0522 and 0.0143 Å. The meth­oxy­phenyl ring makes dihedral angles of 67.0 (6)° and 70.4 (6)° with respect to the napthobenzothio­phene ring system in the two mol­ecules. The crystal packing features C—H⋯S, π–π [centroid–centroid distances = 3.666 (10) and 3.658 (10) Å] and C–H⋯π inter­actions, forming a sheet running along the b-axis direction.

6-[4-Chloro-2-(trifluoromethyl)phenyl]-3-fluoro-2-methylpyridine

In the title compound, C₁₃H₈ClF₄N, the dihedral angle between the benzene and pyridine rings is 59.8 (3)°. In the crystal, mol­ecules are stacked in columns along the b axis through weak C—H⋯π inter­actions.

6-Phenyl-benzo[d]naphtho-[2,3-b]thio-phene

In the title compound, C22H14S, the r.m.s. deviation from the mean plane of the four-fused-ring naphtho-thio-phene unit is 0.056 Å. The dihedral angle between the naphtho-thio-phene plane and the pendant phenyl ring is 67.24 (6)°. In the crystal, weak C-H⋯π and π-π stacking [minimum centroid-centroid separation = 3.7466 (10) Å] inter-actions are observed, which together lead to (010) sheets.

1-(2-Amino-6-methyl-pyrimidin-4-yl)-N,N-dimethyl-piperidin-4-aminium chloride

In the title mol-ecular salt, C12H22N5(+)·Cl(-), the cation is protonated at the dimethyl-substituted tertiary N atom. The piperidine ring adopts a chair conformation with the exocyclic N-C bond in an equatorial orientation. The dihedral angle between the piperidine ring (all atoms) and the pyrimidine ring is 14.00 (1)°. In the crystal, the ions are connected by N-H⋯N hydrogen bonds, forming inversion dimers, which are further connected by N-H⋯Cl hydrogen bonds. Aromatic π-π stacking inter-actions [centroid-centroid separation = 3.4790 (9) Å] are also observed in the structure.

9-(4-Meth-oxy-phen-yl)anthracene

In the title compound, C21H16O, the dihedral angle between the anthracene ring system and the benzene ring is 74.3 (5)°. The anthracene ring system is essentially planar (r.m.s. deviation = 0.0257 Å) and the meth-oxy group lies in the plane of the benzene ring [C1-O1-C2-C7 torsion angle = 0.5 (2)°]. The crystal structure features π-π [centroid-centroid distance = 3.9487 (12) Å] and C-H⋯π inter-actions, forming a sheet running along the a-axis direction.

3'-Ferrocenylcarbon-yl-1'-methyl-4'-phenyl-spiro-[indeno-[2,3-b]quinoxaline-11,2'-pyrrolidine]

In the title compound, [Fe(C₅H₅)(C₃₁H₂₄N₃O)], the pyrrolidine ring makes a dihedral angle of 86.3 (3)° with the mean plane [r.m.s deviation = 0.074 (2) Å] of the indeno-quinoxaline ring system. The central pyrrolidine ring adopts a twist conformation and the two cyclopentadienyl rings adopt an eclipsed conformation. In the crystal, mol­ecules are linked by weak C—H⋯N and C—H⋯π inter­actions, propagating along the c and a axes, respectively.

3-(Ferrocen-1-ylcarbon-yl)-1-methyl-4-(4-methyl-phen-yl)spiro-[pyrrolidine-2,11'-indeno-[1,2-b]quinoxaline]

In the title compound, [Fe(C(5)H(5))(C(32)H(26)N(3)O)], the pyrrolidine ring adopts a twist conformation. The indeno-quinoxaline ring system [86.44 (5)°], the methyl-phenyl ring [86.06 (7)°] and the ferrocene rings [82.00 (7) and 83.95 (9)°] are almost perpendicular to the pyrrolidine ring. The two cyclopentadienyl rings adopt an eclipsed conformation. The crystal structure features C-H⋯N inter-actions.

1-Ethoxy-2-methoxy-4-[2-(4-nitrophenyl)ethenyl]benzene

In the title mol­ecule, C₁₇H₁₇NO₄, the dihedral angle between the two aromatic rings is 42.47 (7)°. The nitro group is twisted by 7.44 (11)° out of the plane of the ring to which it is attached. The methoxy and ethoxy group O atoms deviate significantly from the phenyl ring [by 0.0108 (11) and 0.0449 (11) Å, respectively]. The crystal structure is stabilized by C—H⋯π inter­actions.

{1'-Phenyl-1',2',5',6',7',7a'-hexa-hydro-spiro-[indeno-[1,2-b]quinoxaline-11,3'-pyrrolizin]-2'-yl}(p-tol-yl)methanone

In the title compound, C(35)H(29)N(3)O, the quinoxaline and indene systems are essentially planar, with maximum deviations of 0.047 (2) and 0.032 (2) Å for C atoms, respectively. The quinoxaline system forms a dihedral angle of 4.75 (3)° with the indene system. The pyrrolizine system is folded. The substituted five-membered ring adopts an envelope conformation. In the other five-membered ring, one C atom is disordered with a site-occupancy ratio of 0.676 (12):0.324 (12). In the crystal, mol-ecules are linked via C-H⋯O hydrogen bonds involving the bifurcated carbonyl O atom.

3'-(4-Chloro-benzo-yl)-4'-(4-chloro-phen-yl)-1'-methyl-spiro-[indoline-3,2'-pyrrolidin]-2-one

In the title compound, C₂₅H₂₀Cl₂N₂O₂, the pyrrolidine ring adopts an envelope conformation and the best plane through the five ring atoms makes a dihedral angle of 87.03 (8)° with the indoline ring. Mol­ecules are connected by pairs of N—H⋯O hydrogen bonds into centrosymmetric dimers with an R₂²(8) graph-set ring motif. C—H⋯O hydrogen bonds stabilize the crystal structure.

3-(4-Bromo-phen-yl)quinazolin-4(3H)-one

In the title compound, C₁₄H₉BrN₂O, the quinazoline unit is essentially planar, with a mean deviation of 0.058 (2) Å from the least-squares plane defined by the ten constituent ring atoms. The dihedral angle between the mean plane of the quinazoline ring system and the 4-bromo­phenyl ring is 47.6 (1)°. In the crystal, mol­ecules are linked by inter­molecular C—H⋯N and C—H⋯O hydrogen bonds, forming infinite chains of alternating R₂²(6) dimers and R₂²(14) ring motifs.

(Biphenyl-4-yl)[2-(4-methylbenzoyl)phenyl]methanone

In the title compound, C₂₇H₂₀O₂, the central benzene ring makes dihedral angles of 64.86 (7) and 70.35 (7)° with the methyl-substituted ring and the biphenyl ring system, respectively. The crystal packing is stabilized by inter­molecular C—H⋯O inter­actions, which link the mol­ecules into chains parallel to the b axis.

Autologous Immune Enhancement Therapy for cancer using NK cells and CTLs without feeder layers; our six year experience in India

BACKGROUND

Autologous Natural Killer (NK) cells and Cytotoxic T Lymphocytes (CTLs) based immune-cell therapy, otherwise called as Autologous Immune enhancement therapy (AIET), though has been in clinical practice in several developed nations since early 90s, in India it is in infancy due to lack of technological knowhow. Our institute has been providing the AIET cell expansion services since 2005 and we here in report our experience in 30 such patients of both solid tumours and hematological malignancies.

MATERIALS & METHODS

The number of AIET transfusions in each patient ranged from one to six. All the patients included had Stage III to IV malignancy. AIET was either given along with the chemotherapy or after the completion of a minimum of six cycles of chemotherapy in all the patients. 70 ml of Peripheral Blood was collected each time. The protocol followed was as per Terunuma et al (Breast Cancer 2010) which uses only the patients' autologous plasma for expansion of the Natural Killer Cells and Cytotoxic T lymphocytes from the peripheral blood. The cells were cultured for a period of 10 to 16 days and then transfused to the patients intravenously. The cells were subjected to Flow cytometry before and after the in vitro expansion. Feeder layers were not used in the procedure of in vitro expansion at any stage.

RESULTS

The percentage of NK cells and CTLs after expansion by flow cytometry ranged from 60 to 82 %. There were no adverse reactions in any of the patients following transfusion. The mean prolonged survival time was 15 months and 27% of the patients had Static non-progressive disease after the therapy. Two patients reported significant decrease in Cancer marker levels after AIET and among the terminally ill, two had more than two years survival. All the patients reported improvement in quality of life and resumption of appetite following AIET.

CONCLUSION

Optimal in vitro expansion of NK cells and CTLs of patients with stage III-IV cancer either concurrently or after chemotherapy could be accomplished using autologous serum without use of feeder layers. The In vitro expanded NK cells and CTLs when given intravenously decrease the tumor size and prolong the survival without any adverse effect in our experience.

3-(4-Chloro-phen-yl)quinazolin-4(3H)-one

In the title compound, C₁₄H₉ClN₂O, the quinazoline unit is essentially planar, with a mean deviation from the least-squares plane defined by the ten constituent ring atoms of 0.027 (2) Å. The dihedral angle between the mean plane of the quinazoline ring system and the 4-chloro­phenyl ring is 44.63 (5)°. In the crystal, mol­ecules are linked by inter­molecular C—H⋯N and C—H⋯O hydrogen bonds, forming infinite chains of alternating R₂²(6) dimers and R₂²(14) ring motifs.

Heterologous expression of Arabidopsis NPR1 (AtNPR1) enhances oxidative stress tolerance in transgenic tobacco plants

In Arabidopsis, NPR1 (non-expressor of pathogenesis related genes 1, AtNPR1) functions downstream of salicylic acid (SA) and modulates the SA mediated systemic acquired resistance. It is also involved in a cross talk with the jasmonate pathway that is essential for resistance against herbivores and necrotrophic pathogens. Overexpression of AtNPR1 in transgenic plants resulted in enhanced disease resistance. Recently, tobacco transgenic plants expressing AtNPR1 were shown to be tolerant to the early instars of Spodoptera litura (Meur et al., Physiol Plant 133:765-775, 2008). In this communication, we show that the heterologous expression of AtNPR1 in tobacco has also enhanced the oxidative stress tolerance. The transgenic plants exhibited enhanced tolerance to the treatment with methyl viologen. This tolerance was associated with the constitutive upregulation of PR1, PR2 (glucanase), PR5 (thaumatin like protein), ascorbate peroxidase (APX) and Cu(2+)/Zn(2+) superoxide dismutase (SOD). This is the first demonstration of the novel function of heterologous expression of AtNPR1 in oxidative stress tolerance in transgenic tobacco.

Treatment of synthetic glucose media by an integrated process of anaerobic digestion and reverse osmosis

A bio-kinetic study was conducted on a laboratory scale to evaluate the performance of an indigenously fabricated fixed film anaerobic reactor operated in upward flow mode for the treatment of synthetic glucose medium. The feasibility of using a combination of anaerobic treatment and reverse osmosis (RO) for generation of recyclable water from the effluent formed the basis of the study. The reactor was operated under different organic loading rates (OLR) and hydraulic residence times (HRT) at a constant feed pH of 7.0. The chemical oxygen demand (COD), biochemical oxygen demand (BOD), total alkalinity, pH and total volatile acids (TVA) were monitored in the samples drawn from different sampling ports provided in the reactor. Pilot-scale experiments using a spiral-wound thin-film composite (TFC) polyamide commercial membrane were carried out to investigate the potential of RO for processing the composite effluent emanating from the anaerobic process. Separation performance was evaluated at varying feed pressure (11-41 bar) and found to improve with increasing pressure. High rejection of dissolved solids (approximately 98%), COD, BOD and almost complete removal of color were achieved with reasonable flux and water recovery.

Raman and AFM studies of swift heavy ion irradiated InGaAs/GaAs heterostructures

The effect of swift heavy ion (SHI) irradiation on InGaAs/GaAs heterostructures is studied using Raman spectroscopy and atomic force microscopy (AFM). The structures consist of molecular beam epitaxy (MBE) grown InGaAs layers on GaAs(001), having layer thicknesses of 12, 36, 60 and 96 nm. After irradiation, the GaAs type longitudinal optical (LO) mode blue shifted to higher frequency in thin samples and red shifted towards lower frequency in thick samples. These results are discussed invoking the penetration depth of the probe radiation (λ = 514.5 nm) in InGaAs. Deconvoluting the Raman spectra of thin samples indicates a compressive strain developed in the substrate, close to the interface upon irradiation. This modification and diffusion of indium across the interface results in an increase of strain and reduction of the defect densities in the InGaAs layer. The variations in FWHM of the Raman modes are discussed in detail. The surface morphology of these heterostructures has been studied by AFM before and after SHI irradiation. These studies, combined with Raman results, help to identify different relaxation regimes.