Factors associated with hookworm and Schistosoma mansoni infections among school-aged children in Mayuge district, Uganda.

BACKGROUND: Hookworm infection and schistosomiasis are two of sub-Saharan Africa's most common neglected tropical diseases. An annual mass drug administration (MDA) program against schistosomiasis and soil-transmitted helminths (STHs), including hookworm, has been implemented in Mayuge district, Uganda, since 2003 to date. However, hookworm and schistosomiasis remain prevalent in Mayuge district. Understanding the factors that predispose children to these infections in the context of MDA could inform interventions to reduce prevalence in Uganda and similar settings. METHOD: This cross-sectional study took place in 33 randomly selected primary schools in the Mayuge district from January to February 2022. Children in primary classes 4 or 5, in the selected schools provided single stool samples and completed questionnaires. Stool specimens were examined using the Kato-Katz method to determine the prevalence of hookworm and schistosomiasis. We performed univariable and multivariable logistic regression to assess the associations of each infection with potential risk factors. RESULT: A total of 1,617 students (mean age 12.1 years, 50.1% male) were enrolled. The prevalence of hookworm infection and schistosomiasis was 21.8% (95% confidence interval (CI): 19.8-23.9%) and 18.7% (95% CI: 16.8-20.7%), respectively. In multivariable analysis, longer water fetching time (over 30 min versus less than 30 min) and working daily in the soil were associated with increased odds of hookworm infection (adjusted odds ratio (AOR): 1.49, 95% CI: 1.13-1.96 and 1.37, 95% CI: 1.03-1.82, respectively). Higher odds of schistosomiasis were linked to proximity to water bodies within a one-hour walking distance (AOR: 1.84, 95% CI: 1.35-2.50), and not always washing hands before eating (AOR: 2.00, 95% CI: 1.50-2.67). Swimming, bathing, or washing in water bodies twice a week, compared to never, also increased schistosomiasis odds (AOR: 2.91, 95% CI: 1.66-5.13). CONCLUSION: Consistent with the mechanisms of acquisition, hookworm infection increased with exposure to soil, and schistosomiasis increased with exposure to unclean water. Our findings highlight the importance of Water, Sanitation, and Hygiene programs and strategies aimed at reducing exposure within the framework of Neglected Tropical Disease elimination programs.

The impact of dual- versus single-dosing and fatty food co-administration on albendazole efficacy against hookworm among children in Mayuge district, Uganda: Results from a 2x2 factorial randomised controlled trial.

BACKGROUND: Mass Drug Administration (MDA) is the main strategy for control of soil-transmitted helminth (STH) infections, with single-dose benzimidazole (albendazole or mebendazole) the principal MDA option. In Mayuge district, Uganda, an MDA programme has been in place for over fifteen years but hookworm infection remains common and there is concern that the effectiveness of single-dose albendazole as currently used for MDA may be sub-optimal. This study aims to assess the efficacy of dual- versus single-dose albendazole, with and without fatty food co-administration against hookworm, the dominant form of STHs in Mayuge district, Uganda. METHODOLOGY: This was a 2x2 factorial randomised controlled trial to investigate two interventions simultaneously; 1) dual-dose versus single-dose albendazole, 2) taking albendazole with or without fatty food (200 grams of avocado eaten directly after medication). School children with hookworm infection were randomised in a 1:1:1:1 ratio to the four possible treatment groups. Three weeks after the treatment, stool samples were collected from trial participants to evaluate trial outcomes: cure rate and egg reduction rate (ERR). PRINCIPAL FINDINGS: A total of 225 participants were enrolled, and 222 (98.7%) seen at 3 weeks. The cure rate in the dual-dose group was 96.4% (95% CI: 90.9-99%), higher than 83.9% (95% CI: 75.7-90.2%) in the single-dose group (OR: 5.07, 95% CI:1.61-15.96, p = 0.002). The ERR was 97.6% and 94.5% in the dual-dose group and single-dose drug group, respectively (ERR difference 3.1%, 95% CI: -3.89-16.39%, p = 0.553). The cure rates among participants taking albendazole with and without avocado were 90.1% and 89.1%, respectively, with no statistical difference between the two groups (OR: 1.24, 95% CI: 0.51-3.03, p = 0.622). The ERR was 97.0% and 94.2% in the group receiving albendazole with and without avocado, respectively, and the difference in ERR between the two groups was 2.8% (95% CI -8.63-14.3%, p = 0.629). CONCLUSIONS/SIGNIFICANCE: In Ugandan school children, dual-dose albendazole improves the cure rate of hookworm compared to single-dose albendazole. However, there was no significant improvement in cure rate or egg reduction rate of hookworm with fatty-food co-administration. Dual-dose albendazole is a feasible alternative for improving drug effectiveness against hookworm infection and minimising drug resistance. TRIAL REGISTRATION: PACTR202202738940158.

Hydroxymethylglutaryl-coenzyme a synthase 2 expression is associated with chemoradiotherapy responses in colorectal cancer.

BACKGROUND: Preoperative chemoradiotherapy has become a standard treatment modality for locally advanced rectal cancer. Favorable long-term outcomes have been reported for patients with good responses to chemoradiotherapy. Therefore, predictive factors for chemoradiotherapy responses can be useful for their applicability to risk-adaptive therapy in patients with colorectal cancer. OBJECTIVE: The aim of this study was to investigate whether hydroxymethylglutaryl-coenzyme A synthase 2, a key enzyme in ketogenesis, is associated with the responses of colorectal cancer cells to chemoradiotherapy. DESIGN: Hydroxymethylglutaryl-coenzyme A synthase 2 was identified by a 2-dimensional gel electrophoresis -based proteome analysis. It was analyzed in 12 colorectal cancer cells for associations with radiation or 5-fluorouracil susceptibility by Western blotting, 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium Bromide assay, and small interfering RNA transfection. Then, tumor tissues obtained from 45 patients with rectal cancer before chemoradiotherapy were analyzed by Western blotting for associations with chemoradiotherapy responses. RESULTS: Expression of hydroxymethylglutaryl-coenzyme A synthase 2 was significantly correlated with intrinsic radiation resistance of 12 cancer cells. Hydroxymethylglutaryl-coenzyme A synthase 2 expression was significantly affected by treatment with either 5-fluorouracil or radiation depending on cell types. The artificial suppression of hydroxymethylglutaryl-coenzyme A synthase 2 did not result in the change of chemoradiation susceptibility in colorectal cancer cells. Nevertheless, in multivariate analyses, hydroxymethylglutaryl-coenzyme A synthase 2 expression in rectal cancer tissues was shown to be a significant predictive factor for chemoradiotherapy responses, as evaluated in terms of tumor regression grade and downstaging. LIMITATIONS: Overall findings in vitro showed that the expression level of hydroxymethylglutaryl-coenzyme A synthase 2 was highly variable depending on colon cancer cell types, and it cannot directly affect on chemoradiotherapy responses. The molecular mechanism underpinning the association between hydroxymethylglutaryl-coenzyme A synthase expression and chemoradiotherapy responses needs to be elucidated through future research. CONCLUSIONS: Hydroxymethylglutaryl-coenzyme A synthase 2 was associated with the effects of chemoradiotherapy on human colorectal cancer cells. Pretreatment levels of hydroxymethylglutaryl-coenzyme A synthase 2 in rectal cancer may be useful in predicting the responses to chemoradiotherapy.

Multi-Agent-Based Urban Vegetation Design.

Urban vegetation is an essential element of the urban city pedestrian walkway. Despite city forest regulations and urban planning best practices, vegetation planning lacks clear comprehension and compatibility with other urban elements surrounding it. Urban planners and academic researchers currently devote vital attention to include most of the urban elements and their impact on the occupants and the environment in the planning stage of urban development. With the advancement in computational design, they have developed various algorithms to generate design alternatives and measure their impact on the environment that meets occupants' needs and perceptions of their city. In particular, multi-agent-based simulations show great promise in developing rule compliance with urban vegetation design tools. This paper proposed an automatic urban vegetation city rule compliance approach for pedestrian pathway vegetation, leveraging multi-agent system and algorithmic modeling tools. This approach comprises three modules: rule compliance (T-Rule), street vegetation design tool (T-Design), and multi-agent alternative generation (T-Agent). Notably, the scope of the paper is limited to trees, shrubbery, and seating area configurations in the urban pathway context. To validate the developed design tool, a case study was tested, and the vegetation design tool generated the expected results successfully. A questionnaire was conducted to give feedback on the use of the developed tool for enhancing positive experience of the developed tool. It is anticipated that the proposed tool has the potential to aid urban planners in decision-making and develop more practical vegetation planting plans compared with the conventional Two-Dimensional (2D) plans, and give the city occupants the chance to take part in shaping their city by merely selecting from predefined parameters in a user interface to generate their neighborhood pathway vegetation plans. Moreover, this approach can be extended to be embedded in an interactive map where city occupants can shape their neighborhood greenery and give feedback to urban planners for decision-making.

Improved bone healing by angiogenic factor-enriched platelet-rich plasma and its synergistic enhancement by bone morphogenetic protein-2.

PURPOSE: The purpose of this study was to modify the method of platelet-rich plasma (PRP) preparation for obtaining optimal angiogenic potential and accelerate bone healing. Also, the potential synergistic effect of a suboptimal concentration of bone morphogenic protein-2 (BMP-2) and modified PRP (mPRP) on bone healing was evaluated in vivo. MATERIALS AND METHODS: The angiogenic factor-enriched PRP, which included peripheral blood mononuclear cells (mostly lymphocytes and monocytes, excluding polymorphonuclear leukocytes [PMNs], was achieved by lowering concentrations of thrombin and CaCl2, after pre-activation with shear stress using a table-top vortex machine and collagen. In vitro, endothelial cell migration activity in the mPRP group was compared to conventional PRP preparation using a modified Boyden chamber assay. In an animal study, PGA scaffold, PGA scaffold + mPRP, PGA scaffold + mPRP + rhBMP-2, and PGA scaffold + rhBMP-2 were applied to critical-sized calvarial defects in 28 nude rats. At 2 weeks, periosteal blood flow was measured using laser Doppler perfusion imaging, and bone formation was evaluated at 8 weeks by histology, dual energy x-ray absorptiometry, and micro-computed tomography. RESULTS: mPRP induced faster migration of cord blood-derived outgrowth endothelial-like cells. In vivo, the group with mPRP with a low dose of rhBMP-2 showed significantly increased numbers of blood vessels at 2 weeks and notable synergistic effect on bone healing at 8 weeks as evaluated with histology, bone mineral density and bone mineral content, and muCT. CONCLUSION: The mPRP used in this study improved vascular perfusion around the defect and resulted in enhanced bone healing. Also, combining mPRP with a suboptimal dosage of rhBMP-2 improved bone formation and enhanced bone density.

Antidepressant-like Effects of p-Coumaric Acid on LPS-induced Depressive and Inflammatory Changes in Rats.

Depression causes mental and physical changes which affect quality of life. It is estimated to become the second most prevalent disease, but despite its commonness, the pathophysiology of depression remains unclear and medicine is not sufficiently protective. p-Coumaric acid (p-CA) is a dietary phenolic acid which has been proven to have antifungal, anti-HIV, anti-melanogenic, antioxidant and anti-inflammatory effects. Considering these effects, we investigated whether p-CA can prevent depressive symptoms by reducing inflammatory cytokines in animals injected with lipopolysaccharide (LPS). Changes in despair-related behaviors, inflammatory cytokines, neurotrophic factors and synaptic activity were measured. In these animals, p-CA improved despair-related behavioral symptoms induced by LPS in the forced swim test (FST), tail suspension test (TST) and sucrose splash test (SST). p-CA also prevented the increase of inflammatory cytokines in the hippocampus such as cycloxigenase-2 and tumor necrosis factor-α due to LPS. Similarly, it prevented the reduction of brain-derived neurotrophic factor (BDNF) by LPS. Electrophysiologically, p-CA blocked the reduction of long-term depression in LPS-treated organotypic tissue slices. In conclusion, p-CA prevented LPS-induced depressive symptoms in animals, as determined by behavioral, biochemical and electrophysiological measures. These findings suggest the potential use of p-CA as a preventive and therapeutic medicine for depression.

Definitive high-dose radiotherapy with concurrent chemotherapy for locally advanced rectal cancer: A case report and literature review.

BACKGROUND: Standard management for locally advanced rectal cancer (LARC) involves preoperative chemoradiotherapy (CRT) and radical surgery. However, this level of treatment may be unnecessary for a subgroup of LARC patients. Previous reports have shown that approximately 20% of LARC patients experience a complete tumor response to preoperative CRT. Post-CRT nonoperative management of these patients may prevent morbidities associated with radical surgery. To our knowledge, this case report firstly presents the favorable long-term outcomes of a LARC patient who underwent definitive aim CRT. METHODS: The patient was 73 years' old, and staging workups revealed T3N2bM0 rectal adenocarcinoma. He agreed to receive CRT, but refused surgery. A radiotherapy (RT) dose of 64.8 Gy was prescribed, which was higher than conventional (50.4 Gy) preoperative aim RT. The regimen of concurrent chemotherapy was the same as that used in preoperative aim CRT: 2 cycles of 5-fluorouracil and leucovorin. RESULTS: Three months after CRT completion, a complete tumor response was identified clinically. Colonoscopic biopsy after 1 year showed no tumor cells. This patient is alive after 4 years with no evidence of recurrence or severe toxicity. CONCLUSION: The long-term outcomes of this case indicate the feasibility of definitive high-dose RT with concurrent chemotherapy for LARC.

Autogenous fresh demineralized tooth graft prepared at chairside for dental implant.

BACKGROUND: This study aimed to evaluate the clinical usefulness of autogenous fresh demineralized tooth (auto-FDT) graft prepared at the chairside for alveolar bone grafting during dental implant surgery. METHODS: In total, 38 patients requiring both tooth extraction (for endodontic or periodontal reasons or third molar extraction) and alveolar bone regeneration for dental implant placement were included. Within 2 h after clean extraction, the teeth were prepared at the chairside to serve as bone graft material. In the same sitting, blocks or chips of this graft material were used to reconstruct defects at the osteotomy site simultaneously with or before implant placement. Twelve months after prosthesis fabrication and placement, the clinical findings and implant success rates were evaluated. Histological studies were randomly conducted for selected cases. RESULTS: Clinical evaluation showed favorable wound healing with minimal complications and good bone support for the implants. No implant was lost after 12 months of function following prosthetic rehabilitation. Histological examination revealed new bone formation induced by the graft material. CONCLUSIONS: Chairside preparation of autogenous fresh demineralized teeth after extraction can be a useful alternative to the use of autogenous bone or other graft materials for the immediate reconstruction of alveolar bone defects to facilitate subsequent implant placement.

Fabrication and characterization of hydrophilic poly(lactic-co-glycolic acid)/poly(vinyl alcohol) blend cell scaffolds by melt-molding particulate-leaching method.

Porous PLGA/PVA scaffolds were fabricated by blending poly(lactic-co-glycolic acid) (PLGA) with polyvinyl alcohol (PVA) to improve the hydrophilicity and cell compatibility of the scaffolds for tissue engineering applications. PLGA/PVA blend scaffolds with different PVA compositions up to 20wt% were fabricated by a melt-molding particulate-leaching method (non-solvent method). The prepared scaffolds were investigated by scanning electron microscopy (SEM), mercury intrusion porosimetry, the measurements of water contact angles and bi-axial tensile strengths, etc. for their surface and bulk characterizations. The scaffolds exhibited highly porous and open-cellular pore structures with almost same surface and interior porosities (pore size, 200-300 microm; porosity, about 90%). The PLGA/PVA blend scaffolds with PVA compositions more than 5% were easily wetted in cell culture medium without any prewetting treatments, which is highly desirable for tissue engineering applications. In vitro cell compatibility of the control hydrophobic PLGA and hydrophilized PLGA/PVA (5wt%) blend scaffolds was compared by the culture of human chondrocytes in the scaffolds and the following analyses by MTT assay and SEM observation. It was observed that the PLGA/PVA blend scaffold had better cell adhesion and growth than the control PLGA scaffold. For in vivo evaluation of tissue compatibility, the scaffolds were implanted into the skull defects of rabbits. The results were evaluated by histology examinations. The PLGA/PVA (5wt%) blend scaffold showed better bone ingrowth into the scaffold and new bone formation inside the scaffold than the PLGA scaffold. It seems that 5% addition of PVA to PLGA to fabricate PLGA/PVA blend scaffolds is enough for improving the hydrophilicity and cell compatibility of the scaffolds.

Ex vivo expansion of human umbilical cord blood CD34+ cells in a collagen bead-containing 3-dimensional culture system.

Self-renewal of stem cells depends on several critical factors, including the hematopoietic microenvironment, interactions with supporting stromal cells, features of the extracellular matrix, hematopoietic growth factors, and cytokines. Our study investigated the role of artificial 3-dimensional microenvironments as a means of replicating a more physiologic milieu in expansion of cord blood CD34+ cells. In the 3-dimensional model, hematopoietic cells inside collagen beads are exposed to cytokines added to a culture medium. We found that amplification of CD34+ cells with a clonogenic assay, fluorescence-activated cell sorter analysis, and bone marrow repopulation of NOD/SCID mice showed greater clonogenic ability of cells cultured by the 3-dimensional method compared with the 2-dimensional method. The present study demonstrated that 3-dimensional matrix support may be useful for extended periods in expansion and preservation of stem cells or progenitor cells in vitro.

Determination of specific interactions between glucose ligand carrying polymer and glucose transporter type-1 (GLUT-1) using different cell types.

In order to develop a biomimetic polymer for cell recognition, poly [3-O-(4'-vinylbenzyl)-D-glucose] (PVG) and different types of glucose transport (GLUT)-carrying cells, namely, HepG2 cells (GLUT-1), 3T3-L1 fibroblast cells (GLUT-1 and GLUT-4), and MIN6 cells (GLUT-2), were tested for specific interaction. To clarify the nature of interaction between PVG and the different cell types, rhodamine-B isothiocyanate (RITC)-labeled polymers were used to prove and visualize the interactions. In this study, we found that labeled polymer strongly binds to HepG2 cells. The fluorescence intensity of PVG with in the presence of HepG2 cells was found to be stronger than that of 3T3-L1 fibroblast cells (0.11 +/- 0.05) and MIN6 cells, which carry GLUT-2 (0.028 +/- 0.01); a confocal laser microscopic study confirmed this interaction. To confirm the specificity of the interaction mediated by GLUT, the cells were pretreated with phloretin, an inhibitor of GLUT-1, before adding RITC-labeled PVG polymer to the cell culture medium. This treatment suppressed the interaction of PVG with HepG2 cells and partially suppressed its interaction with 3T3-L1 fibroblast cells.

Volumetric modulated arc radiotherapy sparing the thyroid gland for early-stage glottic cancer: A dosimetrical analysis.

Previous studies on advanced radiotherapy (RT) techniques for early stage glottic cancer have focused on sparing the carotid artery. However, the aim of the present study was to evaluate the dosimetric advantages of volumetric modulated arc therapy (VMAT) in terms of sparing the thyroid gland in early-stage glottic cancer patients. In total, 15 cT1N0M0 glottic cancer patients treated with definitive RT using VMAT were selected, and for dosimetric comparison, a conventional RT plan comprising opposed-lateral wedged fields was generated for each patient. The carotid artery, thyroid gland and spinal cord were considered organs at risk. The prescription dose was 63 Gy at 2.25 Gy per fraction. For the thyroid gland and carotid artery, all compared parameters were significantly lower with VMAT compared with conventional RT. For the thyroid gland, the median reduction rates of the mean dose (Dmean), the volume receiving ≥30% of the prescription dose (V30) and the V50 were 32.6, 40.9 and 46.0%, respectively. The Dmean was 14.7±2.6 Gy when using VMAT compared with 22.2±3.9 Gy when using conventional RT. The differences between the techniques in terms of planning target volume coverage and dose homogeneity were not significant. When considering a recent normal tissue complication probability model, which indicated the mean thyroid gland dose as the most significant predictor of radiation-induced hypothyroidism, the dosimetric advantage shown in this study may be valuable in reducing hypothyroidism following RT for early stage glottic cancer patients.

Intensity-modulated stereotactic body radiotherapy for stage I non-small cell lung cancer.

This study aimed to investigate the clinical outcomes of intensity-modulated radiotherapy (IMRT)-based stereotactic body radiotherapy (SBRT) for patients with stage I non-small cell lung cancer (NSCLC). A prospective database of 16 consecutive patients receiving SBRT for pathologically-proven and peripherally-located stage I NSCLC was reviewed. Fifteen patients were medically inoperable and one patient refused to undergo surgery. The median age of the patients was 76 years (range, 69-86). Treatment planning used four-dimensional computed tomography and fixed-field IMRT (n=11) or volumetric-modulated arc therapy (VMAT; n=5). The SBRT scheme was 48 Gy in four fractions (n=9) or 55 Gy in five fractions (n=7), delivered on consecutive days. The overall response rate at 6 months was 78.6%, including a complete response in three (21.4%) patients and a partial response in eight (57.1%). Three patients (21.4%) demonstrated a stable disease status. The median follow-up time was 14 months (range, 6-20) for the surviving patients. One patient developed local failure at 11 months, while another suffered from regional failure in a subcarinal lymph node at 4 months. Two patients did not survive within the first 6 months; one patient died during salvage chemotherapy for mediastinal lymph node metastasis and the other succumbed to a cause unrelated to lung cancer. The Kaplan-Meier estimates of local failure-free, progression-free and overall survival rates at 18 months were 91.0, 85.2 and 87.5%, respectively. The toxicity was mild; no severe (grade ≥3) toxicity was identified. IMRT-based (including VMAT) delivery of SBRT for patients with stage I NSCLC demonstrated favorable responses and local control without severe toxicity.

Resistive index as a predictor of acute kidney injury caused by an angiotensin converting enzyme inhibitor or angiotensin II receptor blocker in chronic kidney disease patients.

BACKGROUND: Angiotensin converting enzyme (ACE) inhibitor and angiotensin receptor blocker (ARB) may induce acute kidney injury (AKI). The aim of this study was to evaluate the role of the resistive index (RI), which reflects renal artery resistance on renal duplex ultrasonography, as a predictor of AKI in chronic kidney disease (CKD) patients who are prescribed an ACE inhibitor or ARB. METHODS: We screened 105 CKD patients evaluated with renal duplex ultrasonography from 2008 to 2012. We excluded patients not treated with ACE inhibitor or ARB and diagnosed with renal artery stenosis. Finally, we retrospectively analyzed the medical records of 54 patients. AKI was defined as increased serum creatinine by >30% compared with baseline after starting ACE inhibitor or ARB treatment. RESULTS: The mean age of the patients was 60.5±13.0 years, serum creatinine level was 1.85±0.85 mg/dL and 22.2% of the patients had AKI after the use of an ACE inhibitor or ARB. The RI (P=0.006) and the percentages of patients with diabetes (P=0.008) and using diuretics (P=0.046) were higher in the AKI group. The area under the receiver operating characteristics curve for the prediction of AKI was 0.736 (95% confidence interval=0.587-0.885, P=0.013), and RI≥0.80 predicted AKI with 83.3% sensitivity and 61.9% specificity. In the multivariate analysis, RI≥0.80 was an independent prognostic factor [Exp (B)=8.03, 95% confidence interval=1.14-56.74, P=0.037] for AKI. CONCLUSION: RI≥0.80 on the renal duplex ultrasonography may be a helpful predictor for AKI in CKD patients who are prescribed an ACE inhibitor or ARB.

Integrative design of a poly(ethylene glycol)-poly(propylene glycol)-alginate hydrogel to control three dimensional biomineralization.

A mineralized polymeric matrix has been extensively studied to understand biomineralization processes and to further regulate phenotypic functions of various cells involved in osteogenesis and physiological homeostasis. It has been often proposed that several matrix variables including charge density, hydrophobicity, and pore size play vital roles in modulating composition and morphology of minerals formed within a three dimensional (3D) matrix. However, the aspects have not yet been systematically examined because a tool enabling the independent control of the matrix variables is lacking. This study presents an advanced integrative strategy to control morphology and composition of biominerals with matrix properties, by using a hydrogel formulated to independently control charge density, hydrophobicity, and porosity. The hydrogel consists of poly(ethylene glycol) monomethacrylate (PEGmM), poly(propylene glycol) monomethacrylate (PPGmM), and methacrylic alginate (MA), so the charge density and hydrophobicity of the hydrogel can be separately controlled with mass fractions of MA and PPGmM. Also, hydrogels which present only nano-sized pores, termed nanoporous hydrogels, are lyophilized and rehydrated to prepare the hydrogels containing micro-sized pores, termed microporous hydrogels. We find that increasing the mass fractions of MA and PPGmM of the microporous hydrogel promotes the growth of apatite layers because of the increases in the charge density, hydrophobicity and pore size. In contrast, increasing mass fractions of MA and PPGmM of the nanoporous hydrogel enhances the formation of calcium carbonate minerals. The dependency of the mineralization on hydrogel variables is related to the change in supersaturation of mineral ions. Overall, the results of this study will be highly useful to better understand the interplay of matrix variables in biomineralization and to design a wide array of mineralized matrix potentially used in cell therapies and tissue engineering.

Angiogenic factor-enriched platelet-rich plasma enhances in vivo bone formation around alloplastic graft material.

PURPOSE: Although most researchers agree that platelet-rich plasma (PRP) is a good source of autogenous growth factors, its effect on bone regeneration is still controversial. The purpose of this study was to evaluate whether increasing angiogenic factors in the human PRP to enhance new bone formation through rapid angiogenesis. MATERIAL AND METHODS: In vitro, the human platelets were activated with application of shear stress, 20 µg/ml collagen, 2 mM CaCl(2) and 10U thrombin/1 × 10(9) platelets. Level of vascular endothelial growth factor (VEGF) and platelet microparticle (PMP) in the activated platelets were checked. In the animal study, human angiogenic factors-enriched PRP was tested in 28 athymic rat's cranial critical bone defects with ß-TCP. Angiogenesis and osteogenesis were evaluated by laser Doppler perfusion imaging, histology, dual energy X-ray densinometry, and micro-computed tomography. RESULTS: In vitro, this human angiogenic factors-enriched PRP resulted in better cellular proliferation and osteogenic differentiation. In vivo, increasing angiogenic potential of the PRP showed significantly higher blood perfusion around the defect and enhanced new bone formation around acellular bone graft material. CONCLUSION: Angiogenic factor-enriched PRP leads to faster and more extensive new bone formation in the critical size bone defect. The results implicate that rapid angiogenesis in the initial healing period by PRP could be supposed as a way to overcome short term effect of the rapid angiogenesis.

Accelerated partial breast irradiation using multicatheter brachytherapy for select early-stage breast cancer: local control and toxicity.

BACKGROUND: To investigate the efficacy and safety of accelerated partial breast irradiation (APBI) via high-dose-rate (HDR) multicatheter interstitial brachytherapy for early-stage breast cancer. METHODS: Between 2002 and 2006, 48 prospectively selected patients with early-stage breast cancer received APBI using multicatheter brachytherapy following breast-conserving surgery. Their median age was 52 years (range 36-78). A median of 34 Gy (range 30-34) in 10 fractions given twice daily within 5 days was delivered to the tumor bed plus a 1-2 cm margin. Most (92%) patients received adjuvant systemic treatments. The median follow-up was 53 months (range 36-95). Actuarial local control rate was estimated from surgery using Kaplan-Meier method. RESULTS: Local recurrence occurred in two patients. Both were true recurrence/marginal miss and developed in patients with close (< 0.2 cm) surgical margin after 33 and 40 months. The 5-year actuarial local recurrence rate was 4.6%. No regional or distant relapse and death has occurred to date. Late Grade 1 or 2 late skin and subcutaneous toxicity was seen in 11 (22.9%) and 26 (54.2%) patients, respectively. The volumes receiving 100% and 150% of the prescribed dose were significantly higher in the patients with late subcutaneous toxicity (p = 0.018 and 0.034, respectively). Cosmesis was excellent to good in 89.6%. CONCLUSIONS: APBI using HDR multicatheter brachytherapy yielded local control, toxicity, and cosmesis comparable to those of conventional whole breast irradiation for select early-stage breast cancer. Patients with close resection margins may be ineligible for APBI.

Ultrasound assisted parascalene brachial plexus block for performing arthroscopic shoulder surgery: report on 8 cases: A case report.

Performing a brachial plexus block is very useful for shoulder arthroscopic surgery. Several techniques for blocking the brachial plexus have been described with the purpose of improving the efficacy and minimizing the risk. The parascalene approach was introduced in 1979. This block approaches at the lateral border of the anterior scalene muscle and superior to the clavicle. At this level, the incidences of phrenic nerve paralysis and spinal or epidural anesthesia should be minimized. Previous studies have reported on ultrasound-assisted brachial plexus blocks, but few studies have applied this imaging technology to the parascalene region. We report here on 8 cases of parascalene brachial plexus block with using ultrasound guidance to show the clinical usefulness of this technology for conducting arthroscopic shoulder surgery. Ultrasound technology is valuable to anesthesiologists to localize nerves and the needle placement during the parascalene approach to block the brachial plexus for conducting arthroscopic shoulder surgery.

What is the optimal effect-site concentration of remifentanil for minimizing the cardiovascular changes to endotracheal intubation during induction with propofol in elderly patients?.

BACKGROUND: The addition of remifentanil during propofol TCI (target controlled infusion) attenuates the hemodynamic changes induced by endotracheal intubation. This study examined the optimal effect-site concentration of remifentanil to minimize the cardiovascular changes to endotracheal intubation in elderly patients. METHODS: Fifty ASA 1 or 2 elderly patients scheduled for elective surgery under general anesthesia were assigned randomly to one of two groups according to the effect-site concentration of remifentanil. Each group was administered 4 microgram/ml of propofol TCI with 1 ng/ml (group R1) or 3 ng/ml (group R3) of remifentanil. The heart rate (HR), systolic (SAP), mean (MAP) and diastolic arterial pressure (DAP) were measured at pre-induction, before and after endotracheal intubation. RESULTS: After intubation, the HR, SAP, MAP and DAP increased significantly in the two groups compared with the pre-intubation values. However, the HR, SAP, MAP and DAP for group R3 were lower than group R1 for 5 min after intubation. CONCLUSIONS: In elderly patients administered 4 microg/ml of propofol TCI, we suggest that the optimal effect-site concentration of remifentanil to minimize the cardiovascular changes to endotracheal intubation is 3 ng/ml rather than 1 ng/ml.