A comparison of two systems of patient immobilization for prostate radiotherapy.

BACKGROUND: Reproducibility of different immobilization systems, which may affect set-up errors, remains uncertain. Immobilization systems and their corresponding set-up errors influence the clinical target volume to planning target volume (CTV-PTV) margins and thus may result in undesirable treatment outcomes. This study compared the reproducibility of patient positioning with Hipfix system and whole body alpha cradle with respect to localized prostate cancer and investigated the existing CTV-PTV margins in the clinical oncology departments of two hospitals. METHODS: Forty sets of data of patients with localized T1-T3 prostate cancer were randomly selected from two regional hospitals, with 20 patients immobilized by a whole-body alpha cradle system and 20 by a thermoplastic Hipfix system. Seven sets of the anterior-posterior (AP), cranial-caudal (CC) and medial-lateral (ML) deviations were collected from each patient. The reproducibility of patient positioning within the two hospitals was compared using a total vector error (TVE) parameter. In addition, CTV-PTV margins were computed using van Herk's formula. The resulting values were compared to the current CTV-PTV margins in both hospitals. RESULTS: The TVE values were 5.1 and 2.8 mm for the Hipfix and the whole-body alpha cradle systems respectively. TVE associated with the whole-body alpha cradle system was found to be significantly less than the Hipfix system (p < 0.05). The CC axis in the Hipfix system attained the highest frequency of large (23.6%) and serious (7.9%) set-up errors. The calculated CTV to PTV margin was 8.3, 1.9 and 2.3 mm for the Hipfix system, and 2.1, 3.4 and 1.8 mm for the whole body alpha cradle in CC, ML and AP axes respectively. All but one (CC axis using Hipfix) margin calculated did not exceed the corresponding hospital protocol. The whole body alpha cradle system was found to be significantly better than the Hipfix system in terms of reproducibility (p < 0.05), especially in the CC axis. CONCLUSIONS: The whole body alpha cradle system was more reproducible than the Hipfix system. In particular, the difference in CC axis contributed most to the results and the current CC margin for the Hipfix system might be considered as inadequate.

Radical SAM-dependent carbon insertion into the nitrogenase M-cluster.

The active site of nitrogenase, the M-cluster, is a metal-sulfur cluster containing a carbide at its core. Using radiolabeling experiments, we show that this carbide originates from the methyl group of S-adenosylmethionine (SAM) and that it is inserted into the M-cluster by the assembly protein NifB. Our SAM cleavage and deuterium substitution analyses suggest a similarity between the mechanism of carbon insertion by NifB and the proposed mechanism of RNA methylation by the radical SAM enzymes RlmN and Cfr, which involves methyl transfer from one SAM equivalent, followed by hydrogen atom abstraction from the methyl group by a 5'-deoxyadenosyl radical generated from a second SAM equivalent. This work is an initial step toward unraveling the importance of the interstitial carbide and providing insights into the nitrogenase mechanism.

In vitro generation of functional insulin-producing cells from lipoaspirated human adipose tissue-derived stem cells.

BACKGROUND AND AIMS: Tissue engineering strategy has been considered as an alternative treatment for diabetes mellitus due to lack of permanent pharmaceutical treatment and islet donors for transplantation. Various cell lines have been used to generate functional insulin-producing cells (IPCs) including progenitor pancreatic cell lines, embryonic stem cells (ESCs), umbilical cord blood stem cells (UCB-SCs), adult bone marrow stem cells (BMSCs), and adipose tissue-derived stem cells (ADSCs). METHODS: Human ADSCs from lipoaspirated abdominal fat tissue was differentiated into IPCs following a two-step induction protocol based on a combination of alternating high and low glucose, nicotinamide, activin A and glucagon-like peptide 1 (GLP-1) for a duration of 3 weeks. During differentiation, histomorphological changes of the stem cells towards pancreatic ß-islet characteristics were observed via light microscope and transmission electron microscope (TEM). Dithizone (DTZ) staining, which is selective towards IPCs, was used to stain the new islet-like cells. Production of insulin hormone by the cells was analyzed via enzyme-linked immunosorbent assay (ELISA), whereas its hormonal regulation was tested via a glucose challenge test. RESULTS: Histomorphological changes of the differentiated cells were noted to resemble pancreatic ß-cells, whereas DTZ staining positively stained the cells. The differentiated cells significantly produced human insulin as compared to the undifferentiated ADSCs, and its production was increased with an increase of glucose concentration in the culture medium. CONCLUSIONS: These initial data indicate that human lipoaspirated ADSCs have the potential to differentiate into functional IPCs, and could be used as a therapy to treat diabetes mellitus in the future.

Awareness of cervical cancer and HPV vaccination and its affordability among rural folks in Penang Malaysia.

INTRODUCTION: As the second most common cancer in women worldwide, cervical cancer causes major health and economic burdens. Recent introduction of HPV immunization program locally has been encouraging but vaccine uptake remains poor. In addition, no study has been conducted to explore the people' s awareness and knowledge on cervical cancer, HPV and its vaccine in a rural setting in Malaysia after the inception of the HPV vaccination program. OBJECTIVE: This study was conducted to determine the awareness of cervical cancer, HPV vaccination and its affordability among people in a rural area in Malaysia. METHOD: A cross-sectional study was conducted among 116 participants in a village in Penang. All consenting female villagers aged 13 years and above, and males who were married were interviewed using a questionnaire. RESULTS: Most participants (88.8%) had heard of cervical cancer, however only 29.3% and 42.2% of them had heard of HPV and HPV vaccination respectively. Only 5.2% knew the actual market price for the vaccine. They were willing to pay an average of RM 96.7 (USD $27.7) for the full course of vaccination if it is not given to them for free, whereas the market price is RM1200 (USD $342.85). CONCLUSION: Awareness among the Malaysian population in a rural setting on HPV and HPV vaccination is low. Educating the public on the infection can help control the illness. Cost of the HPV vaccine is a serious barrier to the success of the vaccination program in Malaysia.

Single-incision laparoscopic appendectomy: prospective case series at a single centre in Singapore.

PURPOSE: Laparoscopic appendectomy is widely accepted as a standard of care for acute appendicitis. Aim of our study is to assess the safety and feasibility of single-incision laparoscopic appendectomy (SILA) in our hospital setting. METHODS: From March to August 2010, 30 patients (21 male, 9 female) with mean age 30.4 years (range, 17 to 64 y) with clinical diagnosis of acute appendicitis underwent SILA. RESULTS: The procedure was successful in 28 of 30 patients. Mean operative time was 80.4 minutes (range, 31 to 136 min). There was no mortality or major postoperative complication. The median hospital stay was 1.9 days (range, 1 to 5 d). The mean visual analogue scale score at the time of discharge was 2.2 (range, 1 to 4). CONCLUSIONS: In our early experience, SILA is safe and feasible, with acceptable operative time, short learning curve, and good cosmetic result.

[Expression and significance of clusterin in normal prostate, benign prostate hyperplasia and prostate cancer].

OBJECTIVE: To investigate the expression and significance of Clusterin in normal prostate, benign prostate hyperplasia (BPH) and prostate cancer. METHODS: Clusterin expression in samples of 12 normal prostate, 15 BPH, and 56 prostate cancer were studied by immunohistochemical stain. RESULTS: Of 83 cases, 67 are positive or weak positive (81%). The rate of positive or weak positive for normal prostate, BPH and prostate cancer was 17% (2/12), 73% (11/15), and 96% (54/56) respectively. The expression level of Clusterin in prostate cancer was much higher than in normal prostate (t = 8.82, P < 0.01). BPH (t = 7.63, P < 0.01) was related positively with pathological grade (r = 0.649, P < 0.01) and stage (r = 0.609, P < 0.01) of prostate cancer. CONCLUSION: Clusterin may play an important role in the biological characteristics of prostate cancer by the anti-apoptosis pathway.

The anti-anginal drug fendiline increases intracellular Ca(2+) levels in MG63 human osteosarcoma cells.

The effect of fendiline, an anti-anginal drug, on cytosolic free Ca(2+) levels ([Ca(2+)](i)) in MG63 human osteosarcoma cells was explored by using fura-2 as a Ca(2+) indicator. Fendiline at concentrations between 1 and 200 microM increased [Ca(2+)](i) in a concentration-dependent manner and the signal saturated at 100 microM. The Ca(2+) signal was inhibited by 65+/-5% by Ca(2+) removal and by 38+/-5% by 10 microM nifedipine, but was unchanged by 10 microM La(3+) or verapamil. In Ca(2+)-free medium, pre-treatment with 1 microM thapsigargin (an endoplasmic reticulum Ca(2+) pump inhibitor) to deplete the endoplasmic reticulum Ca(2+) store inhibited fendiline-induced intracellular Ca(2+) release. The Ca(2+) release induced by 50 microM fendiline appeared to be independent of IP(3) because the [Ca(2+)](i) increase was unaltered by inhibiting phospholipase C with 2 microM U73122. Collectively, the results suggest that in MG63 cells fendiline caused an increase in [Ca(2+)](i) by inducing Ca(2+) influx and Ca(2+) release in an IP(3)-independent manner.

A prospective study of foreign-body ingestion in 311 children.

OBJECTIVE: To determine the preferable management protocol of foreign body ingestion in pediatric patients. METHODS: All pediatric patients aged less than 12 years who presented with suspected foreign body ingestion in a hospital setting over a period of 3 years were prospectively studied. The usefulness of symptoms and various diagnostic procedures to identify the impacted foreign bodies were analyzed. RESULTS: Of 311 children aged 4 months to 12 years, 115 foreign bodies were encountered. The presentations in children aged younger than 5 years were markedly different from the older children, who behaved more like adults. All sharp foreign bodies (107 cases or 93%), mostly fish bones (90.4%), were found in the oropharynx under direct vision using either tongue depressor (57%), Macintosh laryngoscope (6%), indirect laryngeal mirror (2%) or transnasal flexible endoscopy (28%). Coins (eight cases or 7%) were the only foreign body impacted at or below the level of cricopharyngeus. A plain cervical X-ray has a low sensitivity (15.9%) and a high specificity (99.5%) in identifying the foreign bodies. CONCLUSIONS: As the majority of the foreign bodies were sharp bones and situated in the oropharynx, a management protocol involving examination with a tongue depressor, transnasal laryngoscope, selective lateral soft tissue neck X-ray, chest X-ray and watchful observation is usually adequate. Removal of these foreign bodies can be accomplished using a tongue depressor and Macintosh laryngoscope. Patients with a suspected coin ingestion have to be evaluated by X-ray, and a rigid pharyngo-oesophagoscopy should be the mainstay of treatment.