Evaluation of Peer Review Practice in Radiation Oncology Treatment Planning: Single Institution Experience

PURPOSE/OBJECTIVE(S)

Pretreatment Peer review meeting at our radiation oncology department is a weekly meeting, where the initial radiation treatment (RT) planning process for every patient is discussed including: Computed Tomography (CT) simulation and treatment planning. In this study, we are aiming to evaluate our peer review process and to report the compliance to the suggested modifications.

MATERIALS/METHODS

All RT plans for all patients indicated for radiotherapy accepted by the primary radiation oncology team then presented in our weekly peer review meeting for final approval. A minimum of two radiation oncologists reviewed each plan and their suggestions documented then suggested modifications are classified as changes in: field arrangement, clinical target volume (CTV), dose and fractionation. Compliance to suggested modification also recorded as: applied and not applied with or without documented justification.

RESULTS

Atotal of 1779 radiation treatment plans were discussed in our regular weekly peer review meetings for a period of 3 years. 67.5% of them were treated with radical intent while 32.5% treated with palliative intent. The most common technique used was three-dimensional conformal (3DCRT) followed by intensity modulated RT (IMRT) (70.6% and 29.4%, respectively). The most frequently reviewed sites were: breast (38%), Gastrointestinal (11.9%) and head and neck (9.3%).1592 plans (89.48%) were labeled as: approved, 162 (9.1%) labeled as: modified and only 25 (1.4%) plans labeled as: hold. The frequency of modifications was significantly greater in breast (39.5%) than Gastrointestinal (17.9%) followed by gynecological cancers (14.2%) (P value <0.001). Modifications were more predominant with radical plans (64.2%) than palliative ones (35.8%) (P value <0.001) and statistically greater using 3DCRT (64.2%) than IMRT (35.8%) (P value <0.001). CTV recorded as the most frequent variable suggested for modifications (34.6%), followed by dose and fractionation (24.7%) (P value = 0.035). 72.2% of recommended modifications were applied by the consultant of primary team and 22.2% of non-applied modifications were justified and documented. There was 100% compliance rate to all plans labeled as hold.

CONCLUSION

The practiceof peer review in radiation oncology specialty is very challenging. Its role in quality assurance of the radiotherapy process is highly accepted by radiation oncologists at our radiation oncology department. It is reflected in their high compliance rate to the suggested modifications. We recommend its implementation routinely at any radiation oncology department to enhance the quality of RT plans.

The Evolving Role of Advanced Endoscopic Techniques in Hepatology

The role of advanced endoscopy in the field of hepatology has evolved rapidly over the last decade. Several novel diagnostic and therapeutic interventions can now be accomplished endoscopically both easily and safely in patients with liver disease; these include endoscopic ultrasound (EUS)-guided liver biopsy, EUS-guided measurement of the portal pressure gradient, EUS-guided therapy for gastric varices, and EUS elastography. This article highlights advances in endoscopic tools and techniques that can be applied in the field of hepatology.

Knowledge and Perceptions of Hepatitis B and Hepatocellular Carcinoma Screening Guidelines Among Trainees: A Tale of Three Centers

BACKGROUND

Hepatitis B (HBV), the leading cause of hepatocellular carcinoma (HCC) worldwide, disproportionately affects minorities in the USA. Undiagnosed HBV precludes HCC screening and contributes to late-stage cancer presentation and decreased survival. Barriers to HBV and HCC screening include lack of insurance and limited diffusion of guidelines. We aimed to assess knowledge about HBV and HCC screening indications and explore barriers to screening.

METHODS

We surveyed trainees from the University of Miami/Jackson Memorial Hospitals, Palmetto General Hospital, and Mount Sinai Medical Center. We assessed knowledge using clinical vignettes. We performed bivariate and Chi-squared analyses.

RESULTS

There were 183 respondents; median age was 31 and 52% were male. The sample was 35% Hispanic, 29% White, 18% Asian, and 9% Black. Training department was Internal Medicine, 71%; Family Medicine, 11%; Infectious Diseases, 6%; or Gastroenterology, 7%. Only 59% correctly estimated national HBV prevalence; 25% correctly estimated global prevalence. In vignettes with behavioral risk factors, trainees correctly advised screening, 63-96%. However, when the risk factor was the birthplace, correct responses ranged from 33 to 53%. Overall, 45% chose an incorrect combination of HBV screening tests. Perceived barriers to screening included limited expertise in screening of immigrants and limited patient education. Respondents were more likely to recommend HCC screening in cirrhotic patients versus non-cirrhotic HBV patients. Key barriers to HCC screening included uncertainty about HCC guidelines and patient financial barriers.

CONCLUSIONS

Knowledge of HBV and HCC screening recommendations is suboptimal among trainees. Efforts to broadly disseminate HBV and HCC guidelines through targeted educational interventions are needed.

Diagnosis and Treatment of Metastatic Disease to the Pancreas

Introduction: Metastatic disease to the pancreas is a rare entity from all malignant pancreatic masses. Its diagnosis is very challenging, but with the introduction of endoscopic ultrasound (EUS)-fine needle aspiration (FNA), now there is a feasible way to make an accurate histopathological and definitive diagnosis. Materials and Methods: This is a retrospective review of 11 patients with metastasis to the pancreas diagnosed with EUS-FNA in a tertiary referral center over a period of 3 years. We describe our institutional experience in diagnosing metastatic disease to the pancreas through EUS-FNA. Results: Between January 2015 and June 2018, 115 patients were diagnosed with pancreatic malignancy by EUS-FNA and only 11 (10%) with metastatic disease to the pancreas. Most common primary malignancy was renal cell carcinoma, followed by colon carcinoma, squamous/small cell carcinoma of the lung, and urothelial carcinoma. Five of 11 patients presented as a solitary pancreatic mass on initial imaging without any evidence of primary or metastatic disease elsewhere. Conclusions: In our experience, metastatic disease to the pancreas can represent up to 10% of solid pancreatic masses, which is lower compared to the reported incidence in previous literature. Our findings reveal that early identification and diagnosis help patient management and limit surgical morbidity and mortality.

Abstract B002: Improving knowledge and identifying barriers to screening for hepatitis B and hepatocellular carcinoma in trainees

Background: Hepatitis B (HBV), a leading cause of hepatocellular carcinoma (HCC) worldwide, disproportionately affects minorities in the United States. Undiagnosed HBV infection precludes HCC screening and contributes to late-stage presentation and decreased survival. Previously, we reported low HBV screening rates in persons from endemic countries. Barriers to screening include lack of insurance, limited diffusion of guidelines, and provider uncertainty. We aimed to assess knowledge about HBV and HCC screening and to explore barriers to HCC screening among trainees from three unique institutions.

Methods: We administered a survey to trainees from the University of Miami/Jackson Memorial Hospitals, Palmetto General Hospital, and Mount Sinai Medical Center. We used univariate, bivariate, and Pearson's chi-squared analyses to assess knowledge and barriers using clinical vignettes.

Results: There were 183 respondents born in 36 countries. Median age was 31 years. The sample was 35% Hispanic, 29% White, 18% Asian, 9% Black, 7% other, 2% multiracial and 52% male. Training department was Internal Medicine, 71%, Family Medicine, 11%, Infectious Diseases (ID), 6%, or Gastroenterology (GI), 7%. The perceived burden of HBV was low; 2/3 stated HBV affects &lt;5% of the patient population, 59% correctly estimated national HBV prevalence and 25% correctly estimated global prevalence. In vignettes with behavioral risk factors (e.g., intravenous drug use), trainees correctly advised screening, 63-96%. However, when birthplace was the only risk factor, correct responses ranged from 33-53%. Overall, 48% chose an incorrect combination of HBV screening tests. Respondents from HBV-endemic countries were no more likely to screen for HBV. Knowledge of HBV treatment indications was poor. More fellows (ID/GI) correctly recommended treatment than residents, p &lt;0.01. Barriers to HBV screening were lack of education among health care workers, limited expertise in screening of immigrants, and limited patient education. Barriers to treatment were cost, knowledge about HBV regimens, and provider comfort. Respondents were more likely to recommend HCC screening in cirrhotic patients vs. noncirrhotic HBV patients, even when indicated. Only 43% of participants recognized that HCC screening is unnecessary in patients with acute HBV and 53% either recommended HCC screening or indicated uncertainty in noncirrhotic patients with resolved HBV infection. Respondents indicated they would screen for HCC if strong evidence suggested a mortality benefit or if recommended by a national organization. Key barriers to screening were uncertainty or lack of awareness about HCC guidelines and patient financial barriers.

Conclusions: In a diverse sample of trainees, knowledge of HBV and HCC screening recommendations is suboptimal. Efforts to broadly disseminate guidelines through targeted educational interventions are needed as responses confirm that HCC screening indications, especially in HBV, are not universally known.

Citation Format: Patricia D. Jones, Mahmoud Mahfouz, Harry Nguyen, Jonathan Tu, Carlos R. Diaz, Shweta Anjan, Stefanie Brown, Kassandra Bosire, Paul M. Martin, Olveen Carrasquillo. Improving knowledge and identifying barriers to screening for hepatitis B and hepatocellular carcinoma in trainees [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B002.

Hepatic Complications of Inflammatory Bowel Disease

Hepatobiliary disorders are commonly encountered in patients with inflammatory bowel disease (IBD). Although primary sclerosing cholangitis is the stereotypical hepatobiliary disorder associated with IBD, other diseases, including autoimmune hepatitis and nonalcoholic fatty liver disease, also are encountered in this population. Several agents used for treatment of IBD may cause drug-induced liver injury, although severe hepatotoxicity occurs infrequently. Furthermore, reactivation of hepatitis B virus infection may occur in patients with IBD treated with systemic corticosteroids and biologic agents.

Effect of Curcumin on LDL Oxidation in Vitro, and Lipid Peroxidation and Antioxidant Enzymes in Cholesterol Fed Rabbits

In this study we examined the antioxidant effect of curcumin on lipid oxidation in vitro and in vivo. In vitro, curcumin at 5 microgM concentration completely prevented low-density lipoprotein (LDL) oxidation by CuS04, indicating that curcumin is an effective antioxidant in vitro. In vivo, feeding a pure cholesterol (PC)-rich diet to rabbits significantly increased the plasma and liver lipids as well as thiobarbituric acid reactive substances (TBARS) levels. Addition of curcumin to the PC diet did not show any effect on either plasma lipid and TBARS or liver lipids. Liver TBARS tended to decrease but that decrease was not significant. Erythrocyte glutathione peroxidase (GSH-Px) activity was significantly decreased while catalase activity was significantly increased in rabbits fed a PC diet. The addition of curcumin to a PC diet did not show any significant effect on erythrocyte enzyme activities compared to the rabbits fed a PC diet. The liver GSH-Px and catalase activities were significantly decreased in rabbits fed a PC diet, but the addition of curcumin to the PC diet enhanced the liver GSH-Px activity, which became nonsignificantly different from the control group. These results were discussed considering that curcumin may not be well absorbed and it did not reach a level high enough in vivo to overcome the severe hypercholesterolemia and oxidative stress produced by the PC-rich diet.

Biogenic cements from rice hull ash doped with aluminum and iron

This work describes the use of rice hull as starting material for the synthesis of cements doped with iron and aluminum. Rice hull contains about 10-20% of silica along with organic material. In many countries rice hull represents an environmental problem since this material is merely burned at rice fields, rendering suspended silica particles in the air. Dicalcium silicate (beta-Ca(2)SiO(4)) is the second most important component of Portland cement and presents many environmental advantages over commercial cement. It can be prepared at lower temperatures saving energy and raw-materials. In this work we describe the synthesis beta-Ca(2)SiO(4) using silica derived from rice hull ash. Silica was obtained from heating rice hull at 600 degrees C. Starting materials (silica, calcium oxide, barium chloride, iron or aluminum oxide) were weighed in stoichiometric proportions and aqueous dispersions having water:solid ratio of approximately 20:1 were prepared and treated in an ultrasonic bath for 60 min. After this, an intermediate silicate and the excess of calcium hydroxide were obtained. Finally solids were dried, grounded and heated up to 800 degrees C. It was observed that beta-Ca(2)SiO(4) was obtained when dopant concentration was limited to 1%.

Changes in rat olfactory detection performance induced by orexin and leptin mimicking fasting and satiation

Numerous peripheral and hypothalamic peptides control food intake. Among these signals are orexin, an orexigenic molecule released into the olfactory bulb by centrifugal hypothalamic fibres and leptin, an anorexigenic molecule that is released peripherally and can pass through the blood-brain barrier. In the present study, we injected either orexin or leptin, intracerebroventricularly, and their effect on olfactory performance was evaluated in two groups of rats, using a behavioral paradigm based on conditioned olfactory aversion. Rats were made aversive to water odorized with isoamyl acetate (ISO) at 10(-5) (1microl in 100ml of water). One group was injected with orexin versus saline and the other with leptin versus saline. They were then presented with different concentrations (lower than 10(-5)) of ISO-odorized water to compare their ability to avoid the ISO-drink. Orexin decreased ISO-drink consumption, showing increased avoidance of the ISO concentrations tested which ranged from 10(-9) to 10(-7). Conversely, the administration of leptin resulted in a dose dependant increase in the odorized-drink consumption for ISO 10(-10). Orexin therefore increases and leptin decreases olfactory sensitivity. Orexin and leptin modulate the olfactory performance in a similar way as do physiological induced fasting and satiation and appear to be important factors in the interdependency of olfaction and food intake.

[Laparoscopic appendectomy as training procedure for all stages of appendicitis]

Appendectomy is one of the most common procedures in general surgery. Appendectomy is routinely performed in our department laparoscopically and as a training procedure for all stages of appendicitis. Between 1.1.2003 till 31.7.2005 642 patients underwent appendectomy. 613 of them were performed laparoscopically with a conversion rate of 0,6% in uncomplicated findings and 8,1% in complicated findings (perforated, abscess and gangrenous appendicitis). The postoperative recovery after laparoscopic appendectomy was without any significant complication in 98.2% of the patients with acute appendicitis and 89% of the patients with complicated findings. The overall morbidity rate in both situations (uncomplicated and complicated findings) did not differ from that described in literature. This supports impressively our thesis that laparoscopic appendectomy is feasible in all situations, with a high value for training young surgeons.

Fasting increases and satiation decreases olfactory detection for a neutral odor in rats

Olfaction plays a fundamental role in feeding behavior, but changes in olfactory acuity according to feeding states have never been precisely demonstrated in animals. The present study assesses the olfactory detection performance of fasted or satiated rats placed under a strictly controlled food-intake regimen. We did this using a conditioned odor aversion (COA) protocol which induced in rats an almost total aversion to an ISO-odorized drink at 10(-5) (1 microl in 100 ml of water). The rats (either fasted or satiated) were then presented with different concentrations of ISO-odorized water to compare their ability to detect and so avoid the ISO drink. In both states, the rats consumed significantly larger volumes of ISO at 10(-10), 10(-9) and 10(-8) than at 10(-5), suggesting lower detection at these three concentrations, although the fasted rats consumed significantly less ISO drink than did the satiated ones, showing better ISO detection at these concentrations. These experiments provide original data demonstrating the expected fact that olfactory sensitivity increases in fasted animals. Since these results were obtained using a neutral odor, we suggest that olfactory acuity increases during fasting, enabling animals to more easily detect both food and environmental odors such as those of predators. This would have an obvious eco-ethological role by increasing the relevance of olfactory inputs when seeking food.

Inhibition of prostacyclin release by cigarette smoke extract in endothelial cells is not related to enhanced superoxide generation and NADPH-oxidase activation

Exposure of human umbilical endothelial cells (ECs) to cigarette smoke extract (CSE) activated the NADPH-oxidase enzyme and increased the production of superoxide (O-2) as well as reactive oxygen species (ROS). CSE also inhibited the prostacyclin (PGI2) formation by ECs. Preincubation of ECs with diphenylene iodonium (DPI), the inhibitor of NADPH oxidase, blocked the increase of O-2 production, but neither lowered the ROS level nor prevented the inhibition of PGI2 formation in CSE-treated cells. Preincubation of ECs with a medium supplemented with 1 mM vitamin C did not decrease, but rather increased the O-2 production in CSE-treated cells. However, adding 1 mM glutathione (GSH) to vitamin C decreased the O-2 production, indicating that vitamin C was overwhelmed by the prooxidant in CS, and GSH enhanced the recycling process and spared vitamin C. The ROS level remained high in CSE-treated cells even after preincubation with vitamin C or vitamin C + GSH compared to the control cells. These results are discussed in light of the possible decrease of antioxidant enzyme activities in CSE-treated cells and the increase of cellular hydrogen peroxide (H2O2) generated from the CSE, which cause an imbalance between oxidizing species and the antioxidants producing oxidative stress in CSE-treated cells. These results demonstrate that CSE has a direct inhibitory effect on PGI2 formation and enhances the level of ROS in CSE-treated ECs, regardless of the activation of NADPH-oxidase.

Oxidized low density lipoprotein inhibits prostacyclin generation by rat aorta in vitro: a key role of lysolecithin

The objective of this study was to examine the effect of oxLDL on prostacyclin (PGI2) generation by rat aortic segments and to see whether the lipid fraction of oxLDL or its components are responsible for that effect. We also tested if antioxidants have any protective role. LDL oxidized by copper was characterized by higher TBARS, conjugated diene, lysophosphatidylcholine (lyso PC), oxysterols and less polyunsaturated fatty acids (PUFA) than nLDL. Preincubation of aortas with oxLDL caused a significant inhibition of PGI2 generation compared to aortas preincubated with nLDL or buffer only. The percent inhibition was dependent on the concentration of oxLDL. Most of the inhibitory effect of oxLDL resided in its lipid moiety while the lipid fraction of nLDL, as well as native LDL had no effect. Preincubation of aortas with 10 microg/ml of 7-ketocholesterol the major oxysterol in oxLDL reduced the amount of PGI2 generated by aorta at all times tested; however that decrease did not reach a significant level. Aortas preincubated with 10 microg/ml of lyso PC showed a 21-36% inhibition of PGI2 generation which was comparable to the inhibition produced by preincubating the aortas with 50 microg protein/ml of oxLDL (containing about 7.5 microg lyso PC). This indicated that most of the inhibitory effect of oxLDL was due to its lyso PC. The small molecular weight fraction (< 10 kDa) with a high level of TBARS (TBARS solution) also significantly decreased the PGI2 generation by aorta. Addition of superoxide dismutase (SOD) + catalase or vitamin E simultaneously with oxLDL or TBARS solution in the preincubation medium did not reverse their inhibitory effects. This indicated that oxygen free radicals are not a contributing factor to the inhibitory effect of oxLDL but lyso PC and the lipid peroxides and probably other components already present within oxLDL are the important inhibitors.

Cholesterol metabolism in human umbilical arterial endothelial cells cultured in low magnesium media

Epidemiological and experimental studies have shown that magnesium is closely related to regulation of lipid metabolism, membrane structure and permeability, ion migration through cellular membranes, endocrine hormone and platelet function. The cause of atherosclerosis induced by magnesium deficiency has been suggested to be due to abnormal lipid metabolism, lipid peroxidation, a decrease of prostacycline produced by endothelial cells, and an increase of platelet aggregation. We found that the plasma from cardiac catheterized patients suffering from chest pains contained higher levels of oxysterols than age and sex matched patients free of chest pain. Studies with cultured arterial cells in media deficient in magnesium or containing oxysterols indicated that both magnesium and oxysterols have an important role in lipid metabolism in patients with coronary heart disease.

Parkinson's disease, cognition and aging. Clinical, neuropsychological, electrophysiological and cranial computerized tomographic assessment

Forty-three patients with Parkinson's disease (PD) and thirty-seven normal volunteers were subjected to clinical, neuropsychological, neurophysiological (P300 component of the event-related potentials ERP) and radiological (cranial computerized tomographic scanning CCT) evaluation. Intentional memory was more impaired in PD than in normal controls, more so in the demented group of patients, and was related to enlargement of third ventricular size in CCT. While intentional memory was age related in PD patients, perception was age-related in normal controls. Neither global nor specific cognitive functions were related to duration, severity of parkinsonian motor disability, or depression. However, depression in PD was significantly related to parkinsonian motor disability. P300 latency was more prolonged in PD patients than normal controls. P300 parameters of PD patients were not influenced by age, cognitive functions, duration or severity of motor disability, or depression. The reaction time was the only P300 parameter that was age-related in normal controls. Subcortical atrophy as indicated by CCT was more marked in PD and correlated with age in both patients and controls. Subcortical atrophy was significantly related to cognitive functions in PD but not in normal controls. It was concluded that cognitive impairment in PD could be attributed to complex cognitive changes rather than age. It is a disease process, though not directly related to parkinsonian motor disability or depression. PD differed from normal aging as regards the effect of age on the specific cognitive functions, where in PD patients, age was related to intentional memory, yet in normal controls, it was related to perception. Intentional memory deterioration was found to be specific of PD, being related to subcortical atrophy as well as being more pronounced in the demented group of patients.

Brain aging in normal Egyptians: neuropsychological, electrophysiological and cranial tomographic assessment

Eighty-eight normal Egyptian volunteers above the age of 40 years were studied for brain aging and subjected to neuropsychological (the Paced Auditory Serial Addition Test; the Trailmaking test A, B; the Digit Symbol Substitution Test; sensory and secondary memory tests), electrophysiological (computerized EEG, P300 and reaction time measures), and Computerized Cranial Tomography (CCT) assessment. A significant correlation was found between age and both perception (Digit Symbol Substitution Test (DDST) and psychomotor performance (Trailmaking B test (TMb)), reaction time (RT) and the size of the third ventricle. Whereas females were worse in attention (Paced Auditory Serial Addition Test (PASAT)), males had worse performance in secondary memory test. Elderly subjects with vascular risk factors did worse in psychomotor performance (TMa) than subjects with no risk factors. Non-educated subjects showed worse perception (DSST) than educated subjects. A significant decrease in upper and lower limit percent power of the alpha band was found in subjects above 60 years, males, and non-educated subjects. A significant increase in theta activity was found only in non-educated subjects. It is concluded that decline in specific cognitive functions occurs with advancing age. Vascular risk factors and lack of education early in life enhance these changes. Moreover, the EEG slowing in the elderly was linked to lack of education early in life.

Changes in linoleic acid metabolism and membrane fatty acids of LLC-PK cells in culture induced by 5 alpha-cholestane-3 beta,5,6 beta-triol

The aim of this study was to investigate the effect of the oxysterol 5 alpha-cholestane-3 beta,5,6 beta-triol (triol) on the metabolism of linoleic acid (18:2n-6) to arachidonic acid (20:4n-6) and on the cell membrane fatty acid composition. Porcine kidney cells were incubated in medium with or without 10 microgram(s)/mL of triol for 24 h, then incubated for 1, 6, or 12 h in a medium which contained 50 muM of either [14C] linoleic acid or unlabeled linoleic acid. The cellular uptake of [14C] linoleic acid was significantly higher in the triol-treated cells than in control cells. After 1- and 6-h incubations despite the increase of [14C] linoleic acid pool size in the triol-treated cells, neither total n-6 polyunsaturated fatty acids (PUFA) metabolites nor arachidonic acid were increased in the triol-treated cells as compared to the control cells, but trienoic acids accumulated to a greater extent in the triol-treated cells. Therefore, the ratios of n-6 PUFA metabolites vs. pool size of linoleic acid and of tetraenoic acids vs. dienoic acids were significantly decreased in triol-treated cells as compared to the control cells. The cellular fatty acid composition also showed that linoleic acid percentage was significantly increased while arachidonic acid percentage was significantly decreased in the triol-treated cells, and that the accumulation of trienoic acids (18:3n-6 + 20:3n-6) observed from the [14C] linoleic acid experiment was due solely to increased 20:3n-6 content. This latter finding indicates that a decrease of elongase activity by triol is unlikely. Our results also showed that the triol-treated cells had a lower level of free cholesterol but higher levels of phospholipid and triol in their membranes, suggesting that triol displaced free cholesterol from the cell membrane.

Radionuclide study of the blood ocular barrier

The purpose of this study was to investigate the permeability and clinical significance of the blood-ocular barrier. A new technique using systemic, subtenon, and retrobulbar injections was applied to the study of intraocular penetration of labelled steroid compound. The study was carried out in normal rabbits and in animals with artificially induced intraventional inflammation. It is concluded that there is no blood-vitreous barrier, a vague concept in any case, in the anterior region of the vitreous where free diffusion was observed between the anterior and posterior segments of the eye. High concentration of the labelled steroids was found in the cornea with the peak of activity usually at 30 minutes. However, traces of activity were detectable for up to 4 hours. This indicates the need for a depot long term respiratory form of corticosteroid that would deliver a high concentration of the medication. Local subtenon's and retrobulbar injections resulted in a relatively higher ocular I-125 Cortisol concentration than obtained by systemic route. It is concluded therefore that a high concentration of steroids applied locally will give better and less deletrious effects than systemic administration. Subtenon injection resulted in higher activity in various ocular tissues especially aqueous and vitreous. However, the I-125 Cortisol was rapidly cleared regardless of the route of administration.

Biochemical changes induced in human plasma by its lipoprotein lipase

1. Incubation of human citrated plasma with a concentrate of lipoprotein lipase (separated from the same plasma pool), for 6 hr at 37 degree C and pH 7.0, caused a marked decrease in the concentrations of calcium, triglycerides, total phosphorus, lipid phosphorus and total fatty acids. 2. There was a concomitant increase in the concentrations of non-esterified fatty acids and inorganic phosphorus which were presumably formed by enzymatic hydrolysis of triglycerides and lipid phosphorus. 3. These changes in human plasma, induced by its lipoprotein lipase, were quantitatively comparable to the same changes which have been previously reported in liquid plasma between the 1st and 2nd months of storage at room temperature.

Multielement analysis of fingernail, scalp hair and water samples from Egypt (a preliminary study)

Scalp hair, fingernail and water samples collected from different parts of Egypt are analysed by atomic absorption spectrophotometry and neutron activation analysis. The results for hair show minimum variation of Zn among different regions; a relatively well-controlled dispersion of values (maximum to minimum less than 2) for Co, Fe, Mn and Se; an overall inter-regional variation of factors of 7, 10, 6, 4 and 6 for the elements Ag, Cd, Cs, Sc and W, respectively; a steady decline in the concentration of Sc from south (Aswan) to north (Alexandria). The findings for nail show a steady decline in the concentration of Fe and Sc from south (Aswan) to north (Alexandria); elevated levels of Cd in samples from Aswan area; and regional variations extending up to factors of 6.5, 3.6, 4.7, 5.9, 4.4, 4.5 and 1.9 for Co, Cr, Cs, Mn, Mo, W and Zn, respectively. No unified relationship is observed between the elemental compositions of hair and nail. For Cr, Cs, Fe, Sb and Sc mean values for hair are lower than in nails. Among the remaining elements the ratio nail/hair is less than 1 for Ag in Assiut, El Kharga and Alexandria, for Cd in all of the areas with the exception of Aswan, for Co, Mn and Mo in Cairo, for Zn in Cairo and Alexandria, and for W in Alexandria. The data for water samples reflect highest concentration of all the measured elements in the Mediterranean sea; a steady increase of the concentration of Cu in drinking water from south to north and for Nile water a similar trend for Ca and Mg; and elevated concentrations of Sb and Mn in river water. No distinct trend for the interrelationship between water and tissue elemental concentrations could be established for the regions around Cairo, Aswan and Alexandria.

Inhibition of desaturation of palmitic, linoleic and eicosa-8,11,14-trienoic acids in vitro by isomeric cis-octadecenoic acids

The effects of the positional isomers of cis-18 : 1 acids on the desaturation of 18 : 2 omega 6 leads to 18 : 3 omega 6 (delta 6 desaturase), 20 : 3 omega 6 leads to 20 : 4 omega 6 (delta 5 desaturase) and 16 : 0 leads to 16 : 1 (delta 9 desaturase) were investigated using essential fatty acid deficient rat liver microsomes. The isomeric cis-18 : 1 acids were found to be inhibitory for the delta 6, delta 5 and delta 9 desaturases, and the position of the double bond is important in determining the degree of inhibition. The effects of the several cis-18 : 1 isomers on delta 6 and delta 5 desaturases were parallel in magnitude exept for the cis-delta isomer which gave 17.5% inhibition for delta 6 desaturase and no inhibition for delta 5 desaturase. The strongest inhibitor for delta 6 desaturase (cis-delta 8 18 : 1) was also the most potent inhibitor for delta 5 desaturase, and the weakest inhibitor for delta 6 desaturase (cis-delta 3 18 : 1) was the least effective inhibitor on delta 5 desaturase. The delta 9 desaturase was maximally inhibited by cis-delta 10 and delta 11 18 : 1 isomers. The cis-18 : 1 acid isomers in partially hydrogenated edible fats may have effects on the lipid metabolism through their inhibitory effects on the desaturases.

Immune deficiency in Hodgkin and non-Hodgkin lymphoma

Forty-three previously untreated Egyptian patients with Hodgkin's disease and thirty-five patients with non-Hodgkin lymphoma were studied with several readily available tests of immune function, number of peripheral blood lymphocytes, delayed hypersensitivity to two recall antigens, in vitro blastoid transformation by PHA, the capacity of E-rosette formation and surface marker criteria. The results were correlated to the histology, stage of disease and to the presence of general symptoms and signs.

Effect of some central nervous system acting drugs on rat brain and liver monoamine oxidase activity

A number of central nervous system acting drugs were administered to male rats. At certain time intervals after the administration of these drugs, the rats were sacrificed. Liver and brain monoamine oxidase (MAO) activities were determined. The drugs employed were: ethyl alcohol, cognac, hexobarbital, diazepam, imipramine and chloralose. Results obtained indicated that the liver MAO activity was not altered by any of these drugs. Brain MAO activity, contrary to in vitro studies, was increased by alcohol and cognac. The increase was not due to a direct effect of alcohol on the enzyme activity, since the in vitro addition of equivalent concentrations of alcohol, as those calculated to be present in vivo, to brain homogenates resulted in a decrease rather than an increase in activity.

Birth weight in relation to maternal socio-economic status

On an attempt to illustrate the influence of maternal socio-economic status on birth weight, this study was carried out on 689 full term new borns. The weight, age, parity, income and occupation of their mothers were compared to the birth weight. A correlation was also performed between birth weight and the presentation of the babies and the ante-natal care offered to their mothers. A positive correlation was only found to be present between birth weight and family income below 10 pounds/month. A similar correlation was noticed between birth weight and the interpregnancy interval up to 30 months. The presentation of the foetus might be of influence on birth weight only in cephalic and breeck presentation. The age of the mother, occupation, weight were negatively correlated with birth weight.

Value of serum copper measurement in acute leukaemia of childhood

Serum copper level (SCL) determination was carried out on sixteen normal children and on 16 with acute leukaemia. A significant increase in SCL was observed in cases of leukaemia than in normal controls. Drop of SCL occurs in cases who respond to quadruple chemotherapy, while those who failed to respond showed persistantly high serum copper level.

Effect of hashish on brain gamma aminobutyric acid system, blood fibrinolytic activity and glucose and some serum enzymes in the rat

Adult male rats were exposed to Hashish smoke for 15 min. Certain biochemical parameters were determined. This treatment did not change the brain glutamic acid level, whereas it significantly decreased brain gamma aminobutyric acid level. There was a significant increase in the activity of the brain enzyme forming gamma aminobutyric acid, namely glutamate decarboxylase, as well as in that enzyme metabolizing gamma aminobutyric acid, namely aminobutyrate aminotransferase. However, the increase was much more marked in the case of aminobutyrate aminotransferase, a finding that might explain the decrease observed in brain gamma aminobutyric acid upon exposure to Hashish. Blood glucose and fibrinolytic activity were significantly increased. It was concluded that these changes might be due to an adrenaline releasing effect of Hashish smoke inhalation. Serum lactate dehydrogenase and serum glutamate oxalacetate transaminase activities were significantly increased, whereas serum glutamate pyruvate transaminase activity was unaffected. From these data it was suggested that the source of leakage of these enzyme activities into the blood is probably the skeletal muscles rather than the liver.

Intra-hepatic vascular response to sodium nitrite

1. In the perfused liver of the dog, sodium nitrite produced vasoconstriction in the hepatic arterial bed and, particularly, in the portal venous vascular bed.2. These effects on the hepatic vasculature may account in part for the reduction of venous return and diminution in cardiac output recorded by other workers, and may therefore be a factor in the clinical efficacy of the nitrites in angina pectoris.