A Novel Method for Intracavitary Cervical HDR Brachytherapy: Express Finger-Guided Implant Insertion at Simulation Table without Speculum, Cervical Dilatation, Sleeve, Anesthesia, or Sedation

PURPOSE/OBJECTIVE(S)

Our purpose is to develop a fast, effective, and independent intracavitary brachytherapy implant insertion method that does not need sleeve insertion, anesthesia or conscious sedation, and that can be performed at the front edge of the simulation table (CT or MRI), using finger guidance without a need for speculum or cervical dilatation.

MATERIALS/METHODS

From February 2022 to January 2023, we treated 27 locally advanced cervical cancer patients. In the last week of EBRT, we assessed patients with MRI and pelvic exam to determine their eligibility: 89% (24 patients) met the two inclusion criteria for the express insertion which are: the ability to cover any residual disease with intracavitary brachytherapy, and the accessibility of cervix external os. Each patient had 3 HDR express insertions (8Gy x3). A total of 72 consecutive express implant insertions were performed. Each insertion is evaluated for the success of procedure, number of attempts, and time taken. Patients started on laxative 3 days prior to the procedure, and paracetamol & Ibuprofen taken at home 2 hours before the procedure. On arrival, patients used the bathroom, and IM/SC morphine given. Patients were prepared at the front edge of the simulation table and topical lidocaine applied to the cervix. The external os identified with the index finger of one hand which also guided the tandem insertion using the other hand. No cervical dilatation was used. CT simulation was performed to confirm adequate implant placement and to contour and plan CTV-HR and OARs as per GEC-ESTRO/ABS guidelines.

RESULTS

The success rate was 100% in all the 72 express insertions. >90% (66 insertions) were smooth and fast, i.e., completed in 1 attempt that took <20 minutes. <10% (6 insertions) were challenging but successful, in 2 patients: one patient had an acute anteverted uterus for which suprapubic abdominal pressure facilitated the procedure that took <3 attempts and completed in <40 minutes, the other patient had an acute retroverted uterus which was associated with the most challenging procedure that took >3 attempts and completed in >40 minutes. The success rate was not affected by the type of applicator used. 85% of our applications used multichannel tandem and cylinder, 10% used tandem and ovoids, and 5% used tandem and ring applicators.

CONCLUSION

Express finger-guided intracavitary brachytherapy implant insertion at the simulation table without speculum, cervical dilatation, sleeve, anesthesia, or sedation is fast, effective, and an independent method that can be used in most cervical cancer patients to complete their planned brachytherapy treatment regardless of limited resources. Practice and dissemination of this innovative method is important especially when operative rooms and anesthesia support are limited (e.g., epidemics and closures) and in centers lacking such support. Further studies are warranted to optimize the procedure and to highlight its significant medical and socioeconomic benefits.

Dendritic Mesoporous Organosilica Nanoparticles with Photosensitizers for Cell Imaging, siRNA Delivery and Protein Loading

Dendritic mesoporous organosilica nanoparticles (DMON) are a new class of biodegradable nanoparticles suitable for biomolecule delivery. We studied the photochemical internalization (PCI) and photodynamic therapy (PDT) of DMON to investigate new ways for DMON to escape from the endosomes-lysosomes and deliver biomolecules into the cytoplasm of cells. We added photosensitizers in the framework of DMON and found that DMON were loaded with siRNA or FVIII factor protein. We made four formulations with four different photosensitizers. The photosensitizers allowed us to perform imaging of DMON in cancer cells, but the presence of the tetrasulfide bond in the framework of DMON quenched the formation of singlet oxygen. Fortunately, one formulation allowed us to efficiently deliver proapoptotic siRNA in MCF-7 cancer cells leading to 31% of cancer cell death, without irradiation. As for FVIII protein, it was loaded in two formulations with drug-loading capacities (DLC) up to 25%. In conclusion, DMON are versatile nanoparticles capable of loading siRNA and delivering it into cancer cells, and also loading FVIII protein with good DLC. Due to the presence of tetrasulfide, it was not possible to perform PDT or PCI.

Prevention of mother-to-child transmission of hepatitis B virus: An observation of routine practice in a tertiary liver centre before and after the introduction of the global health sector strategy on viral hepatitis

INTRODUCTION

Worldwide, around 296 million people have hepatitis B virus (HBV) infection, most commonly transmitted from mother-to-child. Global Health Sector Strategy on Viral Hepatitis (GHSSVH) was introduced in May 2016, calling for elimination of viral hepatitis by 2030. This study aims to compare practice in a tertiary liver centre before and after GHSSVH introduction for prevention of mother-to-child transmission (MTCT).

MATERIALS AND METHODS

This retrospective cohort study was performed in a tertiary referral liver centre in Malaysia, using data from electronic medical record from January 2015 to December 2019. A total of 1457 medical records of female with HBV infection were screened. The inclusion criteria of the study were pregnant women with HBsAg positive or known to have HBV infection during the study period. We excluded patients with co-infections of other types of viral hepatitis or human immunodeficiency virus, concurrent liver diseases (e.g.: autoimmune hepatitis, Wilson’s disease), previous organ transplant and malignancy—except for hepatocellular carcinoma (HCC).

RESULTS

This study included 117 pregnancies and 21/117 (17.9%) were on antiviral therapy (AVT) for HBV. In 2017– 2019, 13/18 (72.2%) of those with HBV DNA >200,000IU/ml were on AVT, compared to 5/9 (55.6%) for 2015–2016, indicating 58% (95% CI −63% to 568%) higher odds of being on AVT in post GHSSVH group after accounting for HBV DNA.

CONCLUSION

Uptake of maternal AVT for the prevention of MTCT shows an increased trend since the introduction of GHSSVH, with room for improvement.

Insight into thermo-mechanical enhancement of polymer nanocomposites coated microsand proppants for hydraulic fracturing

The present work reports the fabrication of ultra-high strength microsand proppants (100 mesh) through a polymer nanocomposite dual coating approach and gives insight into their thermo-mechanical reinforcements. The dual coating can be of 3D-cross-linked poly(styrene-methyl methacrylate)/divinylbenzene) (PS-PMMA/DVB) porous network and thermally cross-linked epoxy with graphene nanosheets. The inner layer of PS-PMMA/DVB was prepared using bulk polymerization of styrene (S) and methyl methacrylate (MMA) at 70 °C with a free radical initiator azobisisobutyronitrile (AIBN). The outer layer was prepared by mixing epoxy resin, a cross-linker, and commercial graphene (CG) followed by thermally curing the mixture. The dual-coated microsand proppants exhibited enhanced mechanical characteristics of elastic modulus (E) as high as 7.78 GPa, hardness (H) of 0.35 GPa, and fracture toughness (K_c) of 3.19 MPa m^1/2 along with largely improved thermal properties. Moreover, the dual-coated microsand proppants exhibit a very high-stress resistance up to 14000 psi, and to the best of our knowledge, this is the highest stress resistance value attained for the modified sand-based proppants so far.

Enteral myiasis causing acute dysentery: A case report

Enteral myiasis or intestinal myiasis is acquired by ingesting food or water contaminated with dipteran fly eggs or larvae. Here, we describe a patient with intestinal myiasis presenting with acute dysentery caused by the larva of Hermetia illucens. The larva was identified morphologically, and its species confirmed through molecular analysis using polymerase chain reaction and sequencing based on mitochondrial cytochrome c oxidase subunit I gene (COI).

Brain responses to high frequencies (270 Hz-480 Hz) changes due to vibratory stimulation of human fingertips: An fMRI study

This fMRI study investigated the effects of vibratory stimulation on somatosensory areas during high-frequencies stimulation using a piezoelectric finger stimulation system during an fMRI scan. Twelve healthy right-handed subjects were stimulated at 270 Hz-480 Hz and the fMRI dataset was analysed to generate the activated regions due to the high-frequencies stimulation. The activated regions were identified and thresholded at Puncorrected<0.001 for multiple comparisons. The average effect of frequencies revealed significant activation in the left thalamus, right inferior parietal gyrus, right medial frontal gyrus, and right precuneus whereas the main effect of frequencies revealed significant activation in the left thalamus. The positive effect of frequencies displayed significant activation in the left pallidum, right amygdala, right superior temporal gyrus, right medial temporal gyrus. The vibratory stimulation at a frequency of 330 Hz and 360 Hz (330 Hz<360 Hz) revealed a significant difference in the left thalamus. Findings indicated the role of the secondary somatosensory areas processing and transporting sensory information to perform the perceptual and cognitive function.

Brain responses to frequency changes due to vibratory stimulation of human fingertips: An fMRI study

Vibratory (e.g., piezoelectric) devices can stimulate cortical responses from the somatosensory area during functional magnetic resonance imaging. Twelve healthy, right-handed subjects (7 males and 5 females) were scanned with a 3.0 T magnetic resonance imaging scanner and stimulated at 30-240 Hz using a piezoelectric vibrator attached to the subjects’ index fingers. The functional images were analysed to determine the brain activation region by performing random effects analyses at the group level. One-way analysis of variance was used to measure changes in frequency on brain activity. The activated regions were identified with WFU PickAtlas software, and the images were thresholded at Puncorrected < 0.001 for multiple comparisons. The average effect of frequency revealed significant activations in the right insula and right middle frontal gyrus; the corresponding region in the somatosensory area may act as a top-down control signal to improve sensory targets. Results revealed significant differences between frequencies; 90 Hz > 120 Hz activated right inferior parietal gyrus, 120 Hz > 150 Hz activated right cerebellum, and 60 Hz > 90 Hz activated right supramarginal gyrus and bilateral inferior frontal gyrus pars triangularis. Findings indicated the role of secondary somatosensory areas and the cerebellum in performing higher-order functions and discriminating various frequencies during vibratory stimulation. Increasing the patient sample size and testing higher frequencies in future experiments will contribute to furthering brain mapping of somatosensory areas.

Impact of Pore-Walls Ligand Assembly on the Biodegradation of Mesoporous Organosilica Nanoparticles for Controlled Drug Delivery

Porous materials with molecular-scale ordering have attracted major attention mainly because of the possibility to engineer their pores for selective applications. Periodic mesoporous organosilica is a class of hybrid materials where self-assembly of the organic linkers provides a crystal-like pore wall. However, unlike metal coordination, specific geometries cannot be predicted because of the competitive and dynamic nature of noncovalent interactions. Herein, we study the influence of competing noncovalent interactions in the pore walls on the biodegradation of organosilica frameworks for drug delivery application. These results support the importance of studying self-assembly patterns in hybrid frameworks to better engineer the next generation of dynamic or "soft" porous materials.

Generic daclatasvir plus sofosbuvir, with or without ribavirin, in treatment of chronic hepatitis C: real-world results from 18 378 patients in Egypt

BACKGROUND

Treatment of chronic hepatitis C using combination of sofosbuvir (SOF) and daclatasvir (DCV) was used in several clinical trials and multicentre studies, which were somewhat limited to genotypes 1-3. The national program in Egypt is using SOF-DCV combination for large scale treatment.

AIM

To assess the efficacy and safety of combined SOF-DCV in treating patients with HCV-G4 in a real-world setting.

METHODS

Data and outcome of chronic HCV patients who were treated for 12 weeks with generic medications: DCV 60 mg plus SOF 400 mg ± ribavirin (RBV) within the national hepatitis C treatment program in Egypt are presented. Treatment-naïve patients without cirrhosis were treated without RBV, and those who had cirrhosis or were treatment-experienced (interferon experienced or SOF experienced) received RBV. Efficacy and safety were assessed, and baseline factors associated with sustained virological response at post-treatment week 12 (SVR12) were explored.

RESULTS

During the first 2 months of the programme, 18 378 patients with HCV-G4 started treatment with SOF-DCV with or without RBV. Overall, 95.1% achieved SVR12 (95.4% among patients treated without RBV and 94.7% for patients treated with RBV, P = .32). Treatment was prematurely discontinued in only 1.5% of patients. The most common events leading to discontinuation were patient withdrawal (n = 76) and pregnancy (n = 5). Five deaths occurred within this group.

CONCLUSIONS

Real-world experience of generic SOF-DCV in patients with chronic HCV-G4 proved to be safe and associated with a high SVR12 rate, in patients with different stages of fibrosis.

Thermoresponsive pegylated bubble liposome nanovectors for efficient siRNA delivery via endosomal escape

AIM

Improving the delivery of siRNA into cancer cells via bubble liposomes. Designing a thermoresponsive pegylated liposome through the introduction of ammonium bicarbonate salt into liposomes so as to control their endosomal escape for gene therapy.

METHODS

A sub-200 nm nanovector was fully characterized and examined for cellular uptake, cytotoxicity, endosomal escape and gene silencing.

RESULTS

The siRNA-liposomes were internalized into cancer cells within 5 min and then released siRNAs in the cytosol prior to lysosomal degradation upon external temperature elevation. This was confirmed by confocal bioimaging and gene silencing reaching up to 90% and further demonstrated by the protein inhibition of both target genes.

CONCLUSION

The thermoresponsiveness of ammonium bicarbonate containing liposomes enabled the rapid endosomal escape of the particles and resulted in an efficient gene silencing.

Biodegradable Magnetic Silica@Iron Oxide Nanovectors with Ultra-Large Mesopores for High Protein Loading, Magnetothermal Release, and Delivery

The delivery of large cargos of diameter above 15nm for biomedical applications has proved challenging since it requires biocompatible, stably-loaded, and biodegradable nanomaterials. In this study, we describe the design of biodegradable silica-iron oxide hybrid nanovectors with large mesopores for large protein delivery in cancer cells. The mesopores of the nanomaterials spanned from 20 to 60nm in diameter and post-functionalization allowed the electrostatic immobilization of large proteins (e.g. mTFP-Ferritin, ~534kDa). Half of the content of the nanovectors was based with iron oxide nanophases which allowed the rapid biodegradation of the carrier in fetal bovine serum and a magnetic responsiveness. The nanovectors released large protein cargos in aqueous solution under acidic pH or magnetic stimuli. The delivery of large proteins was then autonomously achieved in cancer cells via the silica-iron oxide nanovectors, which is thus a promising for biomedical applications.

Patient characteristics infected with Middle East respiratory syndrome coronavirus infection in a tertiary hospital

BACKGROUND:

In April 2014, a surge in cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection was seen in Jeddah, Saudi Arabia. The aim of this study is to describe the demographic and clinical features, laboratory and radiological findings of MERS-CoV patients identified during this outbreak in a single tertiary hospital.

METHODS:

All laboratory-confirmed MERS-CoV cases who presented to King Faisal Specialist Hospital from March 1, 2014, to May 30, 2014, were identified. Patients' charts were reviewed for demographic information, comorbidities, clinical presentations, and outcomes.

RESULTS:

A total of 39 patients with confirmed MERS-CoV infection were identified. Twenty-one were male (54%), aged 40 ± 19 years and included 3 (8%) pediatric patients (<18-year-old). 16 (41%) patients were health care workers. Twenty-one (53%) patients were previously healthy whereas eighteen (47%) had at least one comorbidity. The predominant comorbidities included hypertension (31%), diabetes (26%), respiratory (23%), and renal disease (18%). Thirty patients (81%) were symptomatic at presentation, fever (69%) being the most common complaint. The overall mortality rate was 28%. In univariate analysis, older age, hypertension, and chronic kidney disease were associated with mortality.

CONCLUSIONS:

MERS-CoV presentation varies from asymptomatic infection to severe respiratory disease causing death. Future studies to identify the risk factors for worse outcome are needed.

Hybrid Iron Oxide-Graphene Oxide-Polysaccharides Microcapsule: A Micro-Matryoshka for On-Demand Drug Release and Antitumor Therapy In Vivo

Premature drug release is a common drawback in stimuli-responsive drug delivery systems (DDS), especially if it depends on internal triggers, which are hard to control, or a single external stimulus, which can only have one function. Thus, many DDS systems have been reported that combined different triggers; however, limited success has been established in fine-tuning the release process, mainly due to the poor bioavailability and complexity of the reported designs. This paper reports the design of a hybrid microcapsule (h-MC) by a simple layer-by-layer technique comprising polysaccharides (sodium alginate, chitosan, and hyaluronic acid), iron oxide, and graphene oxide (GO). Electrostatic assembly of the oppositely charged polysaccharides and graphene sheets provided a robust structure in which to load drugs through pH control. The polysaccharide component ensured high biocompatibility, bioavailability, and tumor cells targeting. The alternative magnetic field and near-infrared laser triggerable Fe3O4@GO component provided for dual high-energy and high-penetration hyperthermia therapy. On-demand drug release from h-MC can be achieved by synchronizing these external triggers, making the release highly controllable. The synergistic effect of hyperthermia and chemotherapy was successfully confirmed in vitro and in vivo.

Poor outcome of adenovirus infections in adult hematopoietic stem cell transplant patients with sustained adenovirus viremia

The outcome of adenovirus (ADV) infections in adult hematopoietic stem cell transplant (HSCT) patients remains poorly characterized. We studied 14 adults and 3 children, who had undergone HSCT and had developed ADV viremia. Peak ADV DNA levels were significantly higher in patients with ADV diseases than in those without (P=0.03). All children survived the ADV infections. Among the 14 adult HSCT patients, 11 were treated with cidofovir, 2 with ribavirin, and 1 did not receive antiviral treatment. Six of the 13 (46%) treated patients developed ADV diseases and 3 of them (23%) died of ADV infections. Sustained viremia (≥3 positive polymerase chain reaction assays during follow-up) was detected in all patients who finally died of ADV infections. However, 2 adults having had transient ADV viremia either survived or died of diseases other than ADV infections. Our study indicates that the outcome of adult HSCT patients with sustained ADV viremia may be poor, even for those who have received anti-ADV treatment.

Colorimetric peroxidase mimetic assay for uranyl detection in sea water

Uranyl (UO2(2+)) is a form of uranium in aqueous solution that represents the greatest risk to human health because of its bioavailability. Different sensing techniques have been used with very sensitive detection limits especially the recently reported uranyl-specific DNAzymes systems. However, to the best of our knowledge, few efficient detection methods have been reported for uranyl sensing in seawater. Herein, gold nanoclusters (AuNCs) are employed in an efficient spectroscopic method to detect uranyl ion (UO2(2+)) with a detection limit of 1.86 μM. In the absence of UO2(2+), the BSA-stabilized AuNCs (BSA-AuNCs) showed an intrinsic peroxidase-like activity. In the presence of UO2(2+), this activity can be efficiently restrained. The preliminary quenching mechanism and selectivity of UO2(2+) was also investigated and compared with other ions. This design strategy could be useful in understanding the binding affinity of protein-stabilized AuNCs to UO2(2+) and consequently prompt the recycling of UO2(2+) from seawater.

Study the effect of beryllium reflector poisoning on the Syrian MNSR

Neutron interactions with beryllium lead to formation of (3)H and strong neutron absorbers (3)He and (6)Li in the reflector (so called beryllium poisoning). After the reactor shutdown, the concentration of (3)He increases in time due to tritium decay. This paper illustrates the impact of poisoning accumulation in the beryllium reflectors on reactivity for the Syrian MNSR research reactor. The prediction of (6)Li and (3)He poison concentrations, initiated by the 9Be(n,α) reaction, in the beryllium reflectors of the MNSR was also presented. The results were based on MCNP Monte Carlo calculations and solutions to the differential equations which describe the time dependent poison concentrations as a function of reactor operation time and shutdown periods. The whole reactor history was taken into account to predict reliable values of parasitic isotope concentrations. It was found that the (3)He and (6)Li accumulations in the beryllium reflectors during the actual working history decreased the excess reactivity by about 28%. While, the effect became more significant at the reactor life's end and the reactor became subcritical after 25,000 h operation. The results contained in this paper could be used in assess the safety analysis of the MNSR reactor.

Allogeneic haematopoietic stem-cell transplantation with reduced intensity conditioning for advanced stage Hodgkin's lymphoma in Sweden: high incidence of post transplant lymphoproliferative disorder

Allogeneic transplantation after reduced intensity conditioning (allo-RIC) is a treatment option for patients with Hodgkin's lymphoma (HL) relapsing after autologous transplantation. In all, 23 adult patients with HL underwent allo-RIC in Sweden between 2000 and 2007. The median number of previous treatment lines was five and 20 patients (87%) were previously autografted. TRM at 100 days and at 1 year was 13 and 22% respectively. Acute GVHD grades II-IV developed in 7 out of 23 patients (30%) and chronic GVHD in 10 out of 20 patients at risk (50%). The OS and EFS at three years was 59 and 27%, respectively. Four patients (17%) developed post transplant lymphoproliferative disease (PTLD) after a median time of 55 days (range 38-95); two of these patients later died. The study confirmed that allo-RIC is feasible, but associated with a substantial relapse rate: only 20% of the patients were still alive 7 years after the transplant. A finding of high incidence of PTLD needs to be confirmed in a larger trial that includes patients with non-HL and CLL.

Evaluation of a surveillance strategy for early detection of adenovirus by PCR of peripheral blood in hematopoietic SCT recipients: incidence and outcome

Adenoviruses (AdV) have emerged as important causes of morbidity and mortality in patients after hematopoietic SCT (HSCT). Early diagnosis of the infection by detection of viral DNA may improve the prognosis. A surveillance strategy was evaluated for detection of AdV DNA by PCR in a prospective study of unselected allogeneic HSCT recipients. In parallel with a routine CMV surveillance program, plasma from 20 children and 77 adults was analyzed by quantitative PCR for detection of AdV DNA. In addition, in 12 unselected patients, the presence of AdV-specific T cells were analyzed by enzyme-linked immunosorbent spot (ELISPOT) at 1 to 3 months after transplantation. A total of 5 of 97 (5%) patients had detectable AdV DNA in peripheral blood. Only one patient had high titers and none developed AdV disease. BM as a source of stem cells and myelodysplastic syndrome as the indication for transplantation were independently associated with higher risk of acquiring AdV infection. AdV-specific T cells were detected in 7 (58%) of 12 patients. Although AdV DNA was found in peripheral blood by quantitative PCR in 5% of patients undergoing allogeneic HSCT, the present surveillance program did not have a significant effect on the clinical outcome.

Targeted monitoring of patients at high risk of post-transplant lymphoproliferative disease by quantitative Epstein-Barr virus polymerase chain reaction

BACKGROUND

Epstein-Barr virus (EBV)-associated post-transplantation lymphoproliferative disease (PTLD) is a serious complication after allogeneic stem cell transplantation (SCT). The likelihood of PTLD is increased in the presence of specific risk factors. Monitoring of EBV DNA load and early administration of rituximab in patients with high EBV loads is recommended for high-risk patients.

METHODS

Patients at high risk of EBV-associated PTLD were defined as those showing an EBV serological mismatch between donor and recipient, those with lymphoma, those given cord blood grafts, and those with primary EBV disease before SCT. High-risk patients were prospectively monitored by weekly measurement of EBV DNA by quantitative polymerase chain reaction assay, and rituximab was given when the EBV load reached 10,000 copies/mL or symptoms were suggestive of EBV disease. During the study period (July 2005 to the end of June 2007) 131 patients underwent SCT, of whom 53 had high risk factors. A historical control group transplanted between January 2003 to the end of June 2005 was retrospectively used to evaluate the effect of the prospective monitoring strategy.

RESULTS

Of the patients, 30% were positive for EBV DNA at least once; 10% of patients with EBV DNAemia developed PTLD. Risk factors of EBV DNAemia were younger age (P=0.04), receiving transplants from mismatched family or unrelated donors (P=0.01), and acute graft-versus-host disease grades II-IV (P=0.001). The overall frequency of PTLD was 3%; 5.7% in the high-risk group and 1.3% in the standard-risk group. Previous splenectomy (P=0.046) was the only significant risk factor associated with PTLD. In the control group, 6 of 150 patients (4%) developed PTLD; 5/53 (9.4%) in the high-risk group and 1/97 (1%) in the standard-risk group. Human leukocyte antigen-mismatched donors (P<0.01) and EBV-positive donors/EBV-negative recipients (P=0.01) had a significant impact on the risk of PTLD.

CONCLUSION

A targeted monitoring strategy among patients at a high risk of EBV-associated PTLD might be helpful to decrease the risk of development of PTLD. However, larger prospective studies are needed to verify this hypothesis.

Multimodal sensory testing of the rectum and rectosigmoid: development and reproducibility of a new method

Evaluation of rectal and rectosigmoid sensation is important in basic, clinical and pharmacological studies. New methods to evoke and assess multimodal (electrical, thermal and mechanical) experimental pain of the upper gut activate distinct pathways and mimics clinical pain. The aims of the current study were to characterize the sensory response and reproducibility to multimodal stimulation of rectum and the rectosigmoid. A multimodal rectal probe was developed. Mucosal electrostimulation was delivered at the recto-sigmoid junction. In Rectum, impedance planimetry was used for measurement of cross-sectional area (CSA) during distension. Circulation of water within the bag at either 4 or 60 degrees C was applied for thermal stimulation. The method was tested in 12 healthy volunteers (six men mean age 32 years) on two subsequent days. Mechanical and sensory responses and referred pain areas were assessed. Stimulation with electrical, thermal and mechanical modalities resulted in different sensory perceptions. The relationship between stimulus intensity and sensory response was linear for all modalities. Sensory response to different modalities did not differ between investigation days (all P-values > 0.1). Approximately 75% of subjects felt referred pain in distinct skin locations. Between-days reproducibility was good for all modalities [intra-class correlation (ICC) > or = 0.6]. At sensory threshold, CSA showed best reproducibility (ICC > or = 0.9). At pain detection threshold stretch ratio, CSA and electrostimulation showed best reproducibility (ICC = 1.0; 0.9; 0.9). The present model was easily implemented, robust and showed good reproducibility. It can be used to study pathophysiology or pharmacological interventions in healthy controls and in patients with diseases involving the distal hindgut.

Quantification of adenovirus DNA in unrelated donor hematopoietic stem cell transplant recipients

BACKGROUND

Adenovirus (AdV) infection is a life threatening condition in immunosuppressed patients. Quantitative AdV assays can improve the clinical management of these patients.

OBJECTIVES

To evaluate quantitative measurement of AdV DNA with PCR in blood from hematopoietic stem cell transplant (HSCT) recipients.

STUDY DESIGN

Quantitative PCR was used to measure viral DNA levels of AdV in consecutive blood samples from 40 HSCT recipients (27 adults and 13 children) during a 1-year post-engraftment period. All patients received grafts from unrelated donors and were given anti-T-cell antibodies in the conditioning regimen.

RESULTS

In the group of 40 patients, six (15%) had detectable AdV DNA in blood for different lengths of time. None of these six patients suffered from severe graft-versus-host disease. In three of the patients a high AdV viral load (>10,000 copies/mL) was detected, one of whom also had high viral load of EBV and CMV and one of EBV only. These three patients died within 2 months after detection of ADV viremia. A low AdV viral load (<500 copies/mL) was detected in three surviving patients and they did not have concomitant high viral load of neither CMV nor EBV.

CONCLUSIONS

AdV viremia was present in 15% of the HSCT recipients and a high AdV viral load was associated with fatal outcome. Screening for AdV DNA with quantitative PCR in blood may be of clinical importance in allogeneic HSCT recipients in order to prevent severe clinical virological complications.

Kinetics of cell growth and cyclosporin A production by Tolypocladium inflatum when scaling up from shake flask to bioreactor

The kinetics of cell growth and Cyclosporin A (Cyc A) production by Tolypocladium inflatum were studied in shake flasks and bioreactors under controlled and uncontrolled pH conditions. In the case of the shake flask, the production time was extended to 226 h and the maximal antibiotic concentration was 76 mg/l. When scaling up the cultivation process to a bioreactor level, the production time was reduced to only 70 h with a significant increase in both the cell growth and the antibiotic production. The maximal dry cell weights in the case of the controlled pH and uncontrolled pH cultures in the bioreactor were 22.4 g/l and 14.2 g/l, respectively. The corresponding maximal dry cell weight values did not exceed 7.25 g/l with the shake flask cultures. The maximal values for Cyc A production were 144.72 and 131.4 mg/l for the controlled and uncontrolled pH cultures, respectively. It is also worth noting that a significant reduction was observed in both the dry cell mass and the antibiotic concentration after the Cyc A production phase, whereas the highest rate of antibiotic degradation was observed in the stirred tank bioreactor with an uncontrolled pH. Morphological characterization of the micromorphological cell growth (mycelial/pellet forms) was also performed during cultivation in the bioreactor.

Detecting and treating depression among adolescents presenting for reproductive care: realizing opportunities

This article reviews typical symptoms of depression presented by adolescents in the reproductive care practice setting, provides an overview of the assessment process, and offers options for referral and/or treatment of this common, yet often unrecognized, mood disorder. Because females have a two-fold higher prevalence rate of depressive disorders as compared to males of the same age and because reproductive care providers have exceptional access to females during the early reproductive years, these physicians have a unique, but often unrealized, opportunity to detect and initiate treatment and/or referrals for depression in adolescent patients. Indeed, adolescents often discuss symptoms of depression with their reproductive care provider with an expectation that they will serve as a "first responder" in terms of assisting in the management of the depression. Thus, it is important that the provider have an understanding of the disorder, its symptoms, and possible treatment modalities. Reproductive care providers are uniquely qualified to identify, assess, and treat many types of mood disorders in adolescent females.