Methanol extraction revealed anticancer compounds Quinic Acid, 2(5H)‑Furanone and Phytol in Andrographis paniculata

Andrographis paniculata (Ap) has been a part of traditional medicine for its anti-inflammatory effects, treatment of snake bites and liver abnormalities. Several investigations have revealed its bioactive components to be andrographolides. The methanolic extracts of leaves from Ap were characterized, the non-andrographolides were identified and screened for anti-proliferative activity. The extracts showed significant toxicity against numerous cancer cells including HeLa, MCF7, BT549, 293 and A549 cells. Anti-proliferative activity and effect on cancer cell invasion (metastatic potential) and cell migration were examined. The extracts revealed significant inhibition of the ability of HeLa cells in repairing the gap created by a vertical wound made on a confluent cell monolayer. Similarly, a 40% reduction in cell migration was observed in presence of the extracts. Significant anti-angiogenic activity in terms of reduced blood capillary formation was observed on the Chorioallantoic membranes of embryonated hen eggs co-inoculated with HeLa cells and the extracts. Analysis of HeLa cells treated with the extracts using flow cytometry indicated the arrest of cell cycle progression at the G2/M phase. Variation in the Bax/Bcl-2 ratio and elevated caspase-3 levels by immunoblotting confirmed cell death induction via the apoptotic pathway. Investigation of the extracts by gas chromatography-mass spectrometry displayed the predominant components to be 2(5H)-Furanone (14.73%), Quinic acid (17.32%), and Phytol (11.43%). These components have been previously known to have anticancer activity, while being studied individually in other plants. This is the first study, to the best of our knowledge, on the anti-proliferative and anti-angiogenic activity of the non-andrographolide components from Ap.

CD8+ T cells contribute to survival in patients with COVID-19 and hematologic cancer

Patients with cancer have high mortality from coronavirus disease 2019 (COVID-19), and the immune parameters that dictate clinical outcomes remain unknown. In a cohort of 100 patients with cancer who were hospitalized for COVID-19, patients with hematologic cancer had higher mortality relative to patients with solid cancer. In two additional cohorts, flow cytometric and serologic analyses demonstrated that patients with solid cancer and patients without cancer had a similar immune phenotype during acute COVID-19, whereas patients with hematologic cancer had impairment of B cells and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific antibody responses. Despite the impaired humoral immunity and high mortality in patients with hematologic cancer who also have COVID-19, those with a greater number of CD8 T cells had improved survival, including those treated with anti-CD20 therapy. Furthermore, 77% of patients with hematologic cancer had detectable SARS-CoV-2-specific T cell responses. Thus, CD8 T cells might influence recovery from COVID-19 when humoral immunity is deficient. These observations suggest that CD8 T cell responses to vaccination might provide protection in patients with hematologic cancer even in the setting of limited humoral responses.

CD8 T cells compensate for impaired humoral immunity in COVID-19 patients with hematologic cancer

Cancer patients have increased morbidity and mortality from Coronavirus Disease 2019 (COVID-19), but the underlying immune mechanisms are unknown. In a cohort of 100 cancer patients hospitalized for COVID-19 at the University of Pennsylvania Health System, we found that patients with hematologic cancers had a significantly higher mortality relative to patients with solid cancers after accounting for confounders including ECOG performance status and active cancer status. We performed flow cytometric and serologic analyses of 106 cancer patients and 113 non-cancer controls from two additional cohorts at Penn and Memorial Sloan Kettering Cancer Center. Patients with solid cancers exhibited an immune phenotype similar to non-cancer patients during acute COVID-19 whereas patients with hematologic cancers had significant impairment of B cells and SARS-CoV-2-specific antibody responses. High dimensional analysis of flow cytometric data revealed 5 distinct immune phenotypes. An immune phenotype characterized by CD8 T cell depletion was associated with a high viral load and the highest mortality of 71%, among all cancer patients. In contrast, despite impaired B cell responses, patients with hematologic cancers and preserved CD8 T cells had a lower viral load and mortality. These data highlight the importance of CD8 T cells in acute COVID-19, particularly in the setting of impaired humoral immunity. Further, depletion of B cells with anti-CD20 therapy resulted in almost complete abrogation of SARS-CoV-2-specific IgG and IgM antibodies, but was not associated with increased mortality compared to other hematologic cancers, when adequate CD8 T cells were present. Finally, higher CD8 T cell counts were associated with improved overall survival in patients with hematologic cancers. Thus, CD8 T cells likely compensate for deficient humoral immunity and influence clinical recovery of COVID-19. These observations have important implications for cancer and COVID-19-directed treatments, immunosuppressive therapies, and for understanding the role of B and T cells in acute COVID-19.

The Histopathology of Oral Cancer Pain in a Mouse Model and a Human Cohort

Oral cancer patients often have severe, chronic, and mechanically induced pain at the site of the primary cancer. Oral cancer pain is initiated and maintained in the cancer microenvironment and attributed to release of mediators that sensitize primary sensory nerves. This study was designed to investigate the histopathology associated with painful oral cancers in a preclinical model. The relationship of pain scores with pathologic variables was also investigated in a cohort of 72 oral cancer patients. Wild-type mice were exposed to the carcinogen, 4-nitroquinoline 1-oxide (4NQO). Nociceptive (pain) behavior was measured with the dolognawmeter, an operant device and assay for measuring functional and mechanical allodynia. Lesions developed on the tongues and esophagi of the 4NQO-treated animals and included hyperkeratoses, papillomas, dysplasias, and cancers. Papillomas included lesions with benign and dysplastic pathological features. Two histologic subtypes of squamous cell carcinomas (SCCs) were identified-SCCs with exophytic and invasive components associated with papillary lesions (pSCCs) and invasive SCCs without exophytic histology (iSCCs). Only the pSCC subtype of tongue cancer was associated with nociceptive behavior. Increased tumor size was associated with greater nociceptive behavior in the mouse model and more pain experienced by oral cancer patients. In addition, depth of invasion was associated with patient-reported pain. The pSCC histology identifies 4NQO-induced tongue cancers that are expected to be enriched for expression and release of nociceptive mediators.

Society of pediatric liver transplantation: Current registry status 2011-2018

BACKGROUND

SPLIT was founded in 1995 in order to collect comprehensive prospective data on pediatric liver transplantation, including waiting list data, transplant, and early and late outcomes. Since 2011, data collection of the current registry has been refined to focus on prospective data and outcomes only after transplant to serve as a foundation for the future development of targeted clinical studies.

OBJECTIVE

To report the outcomes of the SPLIT registry from 2011 to 2018.

METHODS

This is a multicenter, cross-sectional analysis characterizing patients transplanted and enrolled in the SPLIT registry between 2011 and 2018. All patients, <18 years of age, received a first liver-only, a combined liver-kidney, or a combined liver-pancreas transplant during this study period.

RESULTS

A total of 1911 recipients from 39 participating centers in North America were registered. Indications included biliary atresia (38.5%), metabolic disease (19.1%), tumors (11.7%), and fulminant liver failure (11.5%). Greater than 50% of recipients were transplanted as either Status 1A/1B or with a MELD/PELD exception score. Incompatible transplants were performed in 4.1%. Kaplan-Meier estimates of 1-year patient and graft survival were 97.3% and 96.6%. First 30 days of surgical complications included reoperation (31.7%), hepatic artery thrombosis (6.3%), and portal vein thrombosis (3.2%). In the first 90 days, biliary tract complications were reported in 13.6%. Acute cellular rejection during first year was 34.7%. At 1 and 2 years of follow-up, 39.2% and 50.6% had normal liver tests on monotherapy (tacrolimus or sirolimus). Further surgical, survival, allograft function, and complications are detailed.

Primary lymphoma of CNS, mycophenolate mofetil and lupus

Lymphoproliferative disorders are known to complicate immunosuppressive therapy and two cases of primary lymphoma of CNS (PCNSL) have previously been described in association with mycophenolate mofetil (MMF) treatment. We report the third case of PCNSL in a patient with lupus nephropathy while on MMF treatment. PCNSL may be seen more frequently considering the increased use of MMF in immunosuppressant responsive conditions.

Impact of the United Kingdom national bowel cancer awareness campaigns 2012 on colorectal cancer services and patient survival

AIM

The UK national bowel cancer awareness campaigns in 2012 were intended to improve survival of patients with colorectal cancer (CRC) by raising public awareness and prompting symptomatic individuals to seek medical attention early. The aim of the present study was to compare the number of CRCs diagnosed, tumour stage at diagnosis, survival and number of investigations performed during the campaigns compared with a similar time period in 2011.

METHOD

A retrospective study was carried out of 1439 consecutive referrals through the 2-week wait pathway (2WW) to our colorectal unit during the February and September 2012 campaigns. Patient demographics, number of referrals, investigations performed and newly diagnosed cases of CRC with their respective staging were determined and compared with a group in 2011. Two-year survival was evaluated by Kaplan-Meier statistics.

RESULTS

Referrals through the 2WW increased by 55-60% and endoscopic and the number of radiological investigations performed increased by over 70% during the awareness campaigns. Although new diagnoses of CRC nearly doubled, the increase in the patients referred meant the diagnostic yield remained low at 6%. The bowel cancer awareness campaigns did not alter the tumour stage at presentation, as over 50% of patients were diagnosed with Stage 3 and 4 CRC and there was no significant difference in 2-year survival.

CONCLUSION

The UK bowel cancer awareness campaigns appear to have improved public awareness of CRC and encouraged symptomatic individuals to seek urgent medical attention. The increase in 2WW referrals has not translated into better survival for symptomatic patients, partly due to the proportion presenting with advanced disease.

The role of CT and staging laparoscopy in the staging of gastric cancer

AIM

To assess the relative roles of computed tomography (CT) and diagnostic laparoscopy in the staging process of patients with potentially curable gastric cancer.

MATERIALS AND METHODS

Fifty-two patients underwent laparoscopy and CT as part of staging; 36 patients underwent surgery without laparoscopy. Pathological findings at laparoscopy or surgery were compared with initial CT reports, and analysis of the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) was performed.

RESULTS

Of the patients who underwent laparoscopy and CT, six were staged as positive for peritoneal disease (PD), of which five (83%) were positive for PD at laparoscopy. Forty-six patients were reported at CT as negative for PD, of which 40 (87%) were negative at laparoscopy. Of 36 patients with no advanced disease at CT, who had surgery without diagnostic laparoscopy, nine (25%) were positive at surgery for PD. The overall sensitivity of CT for PD was therefore 25%, the specificity was 99%, the PPV was 86%, and the NPV was 83%.

CONCLUSION

CT is not sufficiently sensitive to detect or exclude PD in patients with gastric cancer, although is highly specific. Staging laparoscopy is an essential adjunct to imaging in all patients being considered for curative surgery for gastric cancer.

Indoor resting density pattern of mosquito species in Fingeswar block of Raipur district in Chhattisgarh, central India

Anopheline mosquitoes are vectors of human malaria and hence they are of greatest concern. Around 40% of the world's population resides in malaria affected areas. Malaria affects poor communities and causes enormous economic losses. The deadly disease annually causes clinical illness in 400-600 million people and kills 2-3 millions annually (WHO 2008). Faunistic survey was conducted in Fingeswar block in Raipur district of Chhattisgarh state of India during January 2003 to March 2004 to asses the prevalence of different species of mosquitoes and their seasonal variations.Indoor resting mosquitoes were collected from selected houses in 5 villages using aspirator tube and torch light in the morning between 06:00-08:00. Adult mosquitoes were identified using standard morphological and pictorial keys following Rao (1984), Das et al. (1991) and Reuben et al. (1994) and assessed as person hour density.A total of 13,248 mosquitoes were collected during the study period. Nine species of mosquitoes comprising of 4 genera with 5 Anopheles, two Culex and one each Armigeres and Aedes were recorded. The malaria vectors constituted 14.09% of the total mosquito collections. Anopheles subpictus (25.81%) showed the dominance followed by A. annularis (8.68%), A. barbirostris (6.76%), A. culicifacies (5.41%) and A. pallidus (4.11%). The other genus recorded included Culex quinquefasciatus (38.38%), C. vishnui (3.32%), Armigeres subalbatus (6.92%) and Aedes albopictus (0.29%). The density of all the species were high in months of August, September and October, decreased in month of May and June 2003. There was a significant (p < 0.01) positive correlation between temperature and density of A. culicifacies and A. annularis. The seasonal distribution pattern of A. culicifacies (primary) and A. annularis (secondary) malaria vectors along with other mosquito species was studied which is an important component of epidemiological study of malaria. This information will help in formulating a baseline structure for control program in the study region.

Prevalence of mosquito species in Chhura block of Raipur district of Chhattisgarh state

Mosquitoes act as vectors for several diseases including malaria and filaria. In Indian scenario, Chhattisgarh is endemic for both the diseases. The present study on prevalence of mosquito population in block Chhura of Raipur district of Chhattisgarh state was undertaken between August 2002 and March 2004 to asses the distribution pattern of various species of mosquitoes and their seasonal variations. Indoor resting mosquitoes were collected from five villages by aspirator tube in the morning (06:00-08:00 hr) using torchlight. Adult mosquitoes were identified using standard morphological and pictorial keys. Altogether 11 species belonging to three genera viz., Anopheles (7 species), Armigeres (1 species) and Culex (3 species) were recorded during study period. Average man-hour mosquito density was high in February 2003 (62.15) & March 2003 (69.35) and declined gradually till June 2003. From July 2003, it started rising again and reached a peak in August (94.10)-September (91.60) 2003. The vector species i.e. Anopheles culicifacies and Anopheles annularis were recorded high in rainy and winter seasons.

Is brain SPECT a suitable modality for evaluation of postradiotherapy posterior fossa brain tumours? A comparative evaluation with contrast enhanced computed tomography

Single photon emission computed tomography (SPECT) of the brain is exquisitely sensitive in detecting viable tumour tissue in the supratentorial region, but its efficacy has not been properly evaluated till date in case of infratentorial posterior fossa tumours. Twenty-four patients with primary posterior fossa brain tumour were included in this study. In each case brain SPECT with 99mTc-glucoheptonate (GHA) was performed for the evaluation of disease status. Contrast enhanced computerised tomography of brain was also performed in all the patients. Brain SPECT was positive in four patients with recurrence of tumour as compared to fifteen cases with computed tomography with a mean GHA retention index 5.26 +/- 1.64. Patients with postradiation gliosis (n=9) showed lower GHA retention index of 1.24 +/- 0.27. This study demonstrates that brain SPECT is not sensitive in detecting recurrence of tumour tissue in infratentorial region, as it is in the supratentorial region, with a sensitivity of 20%, accuracy of 45.83% and negative predictive value of 40% and the chance of any single study coming as false negative is about 80%.

Not everything acid-fast is Mycobacterium tuberculosis--a case of Nocardia

We report a case of a 47 year old woman who presented with a history of motor convulsions and a three month history of an increasingly painful and progressively enlarging mass on the right side of her back. Neurological examination revealed generalised wasting and a right sided hemiplegia. A biopsy of the mass was taken for microbiology which reported growing branching gram positive rods after three days of incubation. A mycological diagnosis of Nocardia asteroides was made. An MRI scan revealed extensive infiltration of the fungal mass into extending from the base of the skull to fifth cervical vertebra.

Images in cardiovascular medicine: ruptured aneurysm of the sinus of Valsava

A 27 year old woman presented with a two year history of cardiac symptoms. Echocardiographic examination revealed a ruptured aneurysm of the sinus of Valsava. Of note the patient was known to be HIV positive.

Extracorporeal shock wave lithotripsy for lower calyceal stones: can clearance be predicted?

OBJECTIVE

To determine the influence of pelvicalyceal angle, size of the lower calyx infundibulum and lowerpole calyceal anatomy in predicting the clearance of fragments after extracorporeal shock wave lithotripsy (ESWL) for lower calyceal stones.

PATIENTS AND METHODS

The study comprised a retrospective analysis of 133 patients, divided into 92 who were considered to be completely clear of fragments 6 months after ESWL and 41 who had residual stones. The pelvicalyceal angle, diameter of the lower calyx infundibulum and lower-pole calyceal pattern were determined from intravenous urograms.

RESULTS

There were residual stones in 64% of the patients with a pelvicalyceal angle < 90 degrees, in 12% of those with an angle > 90 degrees, in 70% of patients with an infundibular diameter < 4 mm, in 16% of those with a diameter > 4 mm, in 78% with a complex calyceal pattern and 12% with a simple calyceal pattern.

CONCLUSIONS

These three anatomical factors play a key role in predicting the clearance of stone and they should be assessed during intravenous urography to facilitate the planning of treatment for lower calyceal stones.

Monocyte chemoattractant protein-2 is a potent agonist of CCR2B

The binding and functional activity of the CC chemokines monocyte chemoattractant protein-1 (MCP-1), MCP-2, and MCP-3 have been characterized using Chinese hamster ovary DXB-11 cells transfected with the chemokine receptor CCR2B. Receptor binding studies demonstrated that 125I-labeled MCP-1 bound to a single class of high-affinity receptors with a Kd of 0.14 (0.07-0.32) nM. In competition studies MCP-1, MCP-2, and MCP-3 completely inhibited 125I-labeled MCP-1 binding with Ki values of 0.3 (0.16-0.46), 8.8 (3.4-26), and 12.2 (0.6-22) nM, respectively. In calcium mobilization studies, MCP-1 and MCP-3 induced robust elevations in intracellular calcium concentrations, whereas MCP-2 was only weakly active. In contrast, using changes in extracellular acidification rate as a functional readout, all three chemokines were identified as potent agonists of CCR2B. These data demonstrate that MCP-2, in addition to MCP-1 and MCP-3, is a potent agonist of CCR2B and furthermore that MCP-2 activates either different or a subset of the signaling pathways activated by MCP-1 and MCP-3.

Hypolipidaemic properties of a potent and bioavailable alkylsulphinyl-diphenylimidazole ACAT inhibitor (RP 73163) in animals fed diets low in cholesterol

RP 73163 ((S)-2-[5-(3,5-dimethyl-l-pyrazolyl)pent-l-yl)-sulphinyl]-5, 6-diphenylimidazole) has been shown to be a potent and specific inhibitor of acyl-CoA:cholesterol acyltransferase (EC 2.3.1.26; ACAT) in vitro using the tissues of experimental animals as sources of the enzyme. The concentrations of RP 73163 required to produce 50% inhibition of ACAT activity (IC50 values) in microsomal preparations ranged from 86 nM for rat liver to 370 nM for rabbit intestine. In whole cell assays using human hepatic (HepG2), intestinal (Caco2), and monocytic (THP-1) cell lines, RP 73163 inhibited ACAT activity with IC50 values of 266, 158, and 314 nM, respectively. The addition of RP 73163 (0.03-1.0 microM) to the medium of cultured HepG2 cells produced a concentration-dependent decrease in apolipoprotein B (apoB) secretion. The compound has high systemic bioavailability. Using a bioassay, a concentration of active inhibitor equivalent to 29 microM of parent compound was present in plasma 1 hr after oral administration of RP 73163 (50 mg.kg-1). In rats that had been fed a basal diet ad libitum or starved for 18 hr prior to blood sampling, the administration of RP 73163 (50 mg.kg-1 b.i.d. for 7 days) reduced plasma triglyceride levels by 50% without affecting the concentration of cholesterol. This hypotriglyceridaemic effect was associated with reductions in plasma very-low-density-lipoprotein (VLDL) and low-density-lipoprotein (LDL) levels. RP 73163 decreased the rate of VLDL secretion by 24% in Triton WR-1339-treated rats that had been fasted overnight but did not affect the secretion rate in animals fed ad libitum, indicating that ACAT was only important in regulating VLDL secretion under certain nutritional conditions. RP 73163 reduced the accumulation of intraperitoneally administered [3H]leucine into the plasma VLDL-apoB pool in both fed and fasted states. The results suggest that, in fed animals at least, an increase in the clearance of VLDL from the bloodstream may contribute to the hypolipidaemic activity of the compound. In rabbits with casein-induced endogenous hypercholesterolaemia, RP 73163 specifically reduced the levels of cholesterol carried by LDL. In conclusion, the hypolipidaemic actions of RP 73163, a potent and systemically bioavailable ACAT inhibitor, are consistent with a reduction in the secretion of apoB containing lipoproteins by hepatic tissue and possibly with an increase in the clearance of these particles.

Spinal angiolipoma mimicking extradural lipomatosis

Spinal angiolipoma is a rare, benign tumour. More than 90% of cases arise extradurally. The authors report an extradural spinal angiolipoma in a 54-year-old man. Conventional T1-weighted and T2-weighted magnetic resonance imaging (MRI) demonstrated an excessive amount of extradural adipose tissue posteriorly, extending from the level of the third to the ninth thoracic vertebra. The signal intensity within the spinal cord was normal. These findings were initially misinterpreted as being of little clinical significance. When the patient's condition deteriorated, myelography was performed, and extradural compression of the thecal sac was demonstrated. At surgery spinal angiolipoma was confirmed. The ease with which the MRI features of this lesion can be overlooked, as well as imaging strategies to avoid this pitfall, are discussed.

Early pregnancy factor as a marker for assessing embryonic viability in threatened and missed abortions

It is now well recognized that the presence of early pregnancy factor (EPF) can signify the occurrence of fertilization, continuation of pregnancy and the existence of a viable embryo. With this in view, a study was undertaken to observe the potential of EPF as a marker in assessing embryo viability in cases complicated with vaginal bleeding during early pregnancy. The results indicated that the sensitivity of EPF as a marker in predicting threatened or missed abortion was 78.9% and the specificity 95.6%. The positive predictive value was observed to be 93.8% and the negative predictive value 84.6%. Our studies have shown that since EPF is present in viable but absent in non-viable pregnancies, it could be a useful marker of prognostic value in threatened abortions.

U2AF homolog required for splicing in vivo

Several fission yeast temperature-sensitive mutants defective in pre-mRNA processing (prp- mutants) at the nonpermissive temperature have been identified. Here, the prp2+ gene has been cloned by its ability to complement the temperature-sensitive growth defect of a prp2- mutant. The gene also corrects the pre-mRNA splicing defect of prp2- mutants and encodes a 59-kilodalton polypeptide (PRP2). A molecular characterization indicates that PRP2 is a previously uncharacterized yeast splicing factor with extensive similarity to the mammalian splicing factor U2AF65. Thus, this study provides evidence that a U2AF homolog participates in RNA processing in vivo.

Amputation of the fine guidewire tip during atherectomy using the Simpson "over-the-wire" peripheral atherectomy catheter

After successful treatment of a localized eccentric atheromatous deposit in the distal superficial femoral artery using the Simpson "over-the-wire" atherectomy catheter, a short segment of guidewire tip was noted in the proximal peroneal artery. A digital angiogram of the distal vessels showed satisfactory run-off. There were no immediate clinical sequelae and none after 2 months follow-up.

The appearances on ultrasound of the female urethral sphincter

A rounded or ovoid midline structure with mean measurements of 1.30 cm x 1.33 cm x 0.96 cm in longitudinal, transverse and antero-posterior dimensions was routinely imaged at the bladder base in 97 female patients on pelvic ultrasound examination. Its position and appearance are reminiscent of a smaller version of the male prostate, and it has been dubbed the "female pseudoprostate". It appears to correspond with the external rhabdo-sphincter of the bladder. Its rounded shape may be confusing but it should not be misread as pathological.

The incidence of fetomaternal haemorrhage following elective termination of first-trimester pregnancy

Alphafetoprotein (AFP) levels were determined in 62 patients undergoing termination of first-trimester pregnancy in order to ascertain the incidence of fetomaternal haemorrhage. The apparent frequency of this phenomenon (58%) was higher than that previously reported. There was no evidence of fetomaternal haemorrhage associated with simple bimanual examination.