Effect of prophylactic granulocyte-colony stimulating factor (G-CSF) on acute hematological toxicity in medulloblastoma patients during craniospinal irradiation (CSI).

OBJECTIVES: Haematological toxicity and treatment breaks are common during cranio-spinal irradiation (CSI) due to irradiation of large volume of bone marrow. We conducted this study to see the effect of prophylactic granulocyte colony stimulating factor (GCSF) in reducing treatment breaks. PATIENTS AND METHODS: The study was conducted over a period of 15 months from August 2017 to November 2018. Histopathologically proven Medulloblastoma patients received prophylactic GCSF during CSI. Acute hematological toxicities and treatment breaks were noted and effect of age and pretreatment blood counts were analyzed by SPSS (Statistical Package for Social Sciences) version 23. RESULTS: A total of 28 patients were included in the study. During CSI, hematological toxicity leading to treatment breaks was observed in 11 (39.3 %) patients, of which grade 3 and 2 toxicities were seen in ten and one patients respectively. Younger age (<10 years) at diagnosis was significantly associated with the development of hematological toxicity (p = 0.028, Chi-Square). No correlation was found with pre-treatment blood counts. CONCLUSION: Prophylactic use of GCSF may be effective in preventing radiation induced hematological toxicity and treatment breaks.

Effect of surface modification and laser repetition rate on growth, structural, electronic and optical properties of GaN nanorods on flexible Ti metal foil.

The effect of flexible Ti metal foil surface modification and laser repetition rate in laser molecular beam epitaxy growth process on the evolution of GaN nanorods and their structural, electronic and optical properties has been investigated. The GaN nanostructures were grown on bare- and pre-nitridated Ti foil substrates at 700 °C for different laser repetition rates (10-30 Hz). It is found that the low repetition rate (10 Hz) promotes sparse growth of three-dimensional inverted-cone like GaN nanostructures on pre-nitridated Ti surface whereas the entire Ti foil substrate is nearly covered with film-like GaN consisting of large-sized grains for 30 Hz growth. In case of the GaN growth at 20 Hz, uniformly-aligned, dense (∼8 × 109 cm-2) GaN nanorods are successfully grown on pre-nitridated Ti foil whereas sparse vertical GaN nanorods have been obtained on bare Ti foil under similar growth conditions for both 20 and 30 Hz. X-ray photoemission spectroscopy (XPS) has been utilized to elucidate the electronic structure of GaN nanorods grown under various experimental conditions on Ti foil. It confirms Ga-N bonding in the grown structures, and the calculated chemical composition turns out to be Ga rich for the GaN nanorods grown on pre-nitridated Ti foil. For bare Ti substrates, a preferred reaction between Ti and N is noticed as compared to Ga and N leading to sparse growth of GaN nanorods. Hence, the nitridation of Ti foil is a prerequisite to achieve the growth of dense and aligned GaN nanorod arrays. The X-ray diffraction, high resolution transmission electron microscopy and Raman studies revealed the c-axis growth of wurtzite GaN nanorods on Ti metal foil with good crystallinity and structural quality. The photoluminescence spectroscopy showed that the dense GaN nanorod possesses a near band edge emission at 3.42 eV with a full width at half maximum of 98 meV at room temperature. The density-controlled growth of GaN nanorods on a flexible substrate with high structural and optical quality holds promise for potential applications in futuristic flexible GaN based optoelectronics and sensor devices.

Resistant starch content of conventionally boiled and pressure-cooked cereals, legumes and tubers.

Resistant starch (RS) content was determined in the conventionally boiled (H1) and pressure-cooked (H2) cereals, legumes and tubers using enzymatic method. Both H1 and H2 legumes contained higher amount of RS as compared to cereals and tubers. H1 and H2 lentils showed highest RS content of 5.0 and 4.9% (dwb), respectively. Higher RS content in legumes can be attributed to the presence of intact tissue/cell structures enclosing starch granules and high level of amylose (26-33%) and high content of viscous soluble dietary fiber components. The decrease in RS content of H2 foods in comparison to H1 counterparts (maximum decrease of 15% in pea) might have occurred due to changes in cell wall integrity of H2 foods and this could result in increased accessibility of starch to amylolytic enzymes.

Fluoride, boron and nitrate toxicity in ground water of northwest Rajasthan, India.

The study was carried out to access the fluoride, boron, and nitrate concentrations in ground water samples of different villages in Indira Gandhi, Bhakra, and Gang canal catchment area of northwest Rajasthan, India. Rural population, in the study site, is using groundwater for drinking and irrigation purposes, without any quality test of water. All water samples (including canal water) were contaminated with fluoride. Fluoride, boron, and nitrate were observed in the ranges of 0.50-8.50, 0.0-7.73, and 0.0-278.68 mg/l, respectively. Most of the water samples were in the categories of fluoride 1.50 mg/l, of boron 2.0-4.0 mg/l, and of nitrate < 45 mg/l. There was no industrial pollution in the study site; hence, availability of these compounds in groundwater was due to natural reasons and by the use of chemical fertilizers.

Radiation therapy for intractable bleeding in extremity arteriovenous malformation: considerations on a clinical case.

Arteriovenous malformations are rare clinicopathological entities with varied distribution and a constellation of symptoms. In the extremities they are usually associated with dermatological manifestations, such as angiodermatitis with a potential risk of torrential haemorrhage. Surgical resection is a morbid procedure. Transcatheter embolization and sclerotherapy is an attractive alternative to surgical resection. However, proper case selection is a prerequisite and may not be possible in all the cases. The case reported here is a paradigm of a complex and extensive vascular malformation with torrential haemorrhage where a unique therapeutic approach of radiation therapy was used as an alternative to morbid surgery after embolization and sclerotherapy failure.

Orbital lymphoma: role of radiation.

The purpose of this article is to review the literature for clinical presentation, treatment, outcome and complications of using radiotherapy for the treatment of orbital lymphoma. For this, MEDLINE, EMBASE, and the Cochrane Library were searched through January 2007 for published data on primary non-Hodgkin's lymphoma (NHL) of the orbit. The search was conducted in all document types, using the following terms "Non-Hodgkin's lymphoma, MALT (mucosa associated lymphoid tissue) and orbit". Data extracted were based on age, sex, therapeutic methods and outcome of treatment. When full articles were not available, abstracts were used as a source of information. Only those articles whose abstracts or full text were available in English were included in table. The review of reports of NHL of the orbit, in general, served as a source of information about its clinical behavior, treatment and overall prognosis. Fifty-six publications were identified, including six in languages other than English. There was no randomized trial. All the studies were retrospective. The studies were heterogeneous in patient number (3 to 112), histology, disease stage (IE to IV), radiotherapy doses used (4 to 53.8Gy), local control rates (65 to 100%), distant relapse rates (0 to 67%, from low grade to high grade) and five-year survival rates (33 to 100%). Three of the studies with a good number of patients also demonstrated clinical benefit with radiotherapy in terms of superior efficacy or less toxicity. Available data support the acceptance of radiotherapy as a standard therapeutic option in patients with low to intermediate grade orbital lymphoma. Toxicity of radiotherapy is mild if delivered precisely.

Outcome following radical cystectomy and bladder-preservation therapy in patients with invasive carcinoma of urinary bladder.

BACKGROUND: Invasive bladder cancer is a lethal disease with a 50% cancer-related mortality even in the best healthcare systems. Optimum combination of surgery, external beam radiotherapy and platinum-based chemotherapy has yet to be determined. PURPOSE: To audit the outcome of multi-modality treatment and compare this with the existing literature in order to set future priorities and re-audit in patients with invasive carcinoma of urinary bladder. MATERIALS AND METHODS: Between January 2001 and December 2004, 97 patients with invasive carcinoma of urinary bladder were analyzed. Radical surgery was done in 18(18%) patients and adjuvant radiation was given to 20(21%) patients. Radical radiation alone, (>/=50 Gy) was given to 26(27%) and chemoradiation to 33(34%) patients respectively. Patients in the chemoradiation arm were given the same dose of radiation with weekly concomitant cisplatin at 40 mg/ m(2) one hour before radiation during the first phase only. At a median follow-up of 32 months the outcome studied included locoregional failure, distant failure, disease-free survival (DFS) and overall survival (OS) using univariate and multivariate analyses. The OS and DFS were calculated according to Kaplan-Meier. Log rank test was used for statistical significance. RESULTS: Median age of the patients was 58 years. Males comprised 93% of the total patients. Most (93%) of the patients had transitional cell histology. In patients treated with radiation alone overall response rate was 60%, with a complete response (CR) rate of 42%. The CR in patients treated with chemoradiation was 51%. Bladder was preserved in 61% of patients who received chemoradiation as compared to 42% in patients treated with radical radiation. With radical radiation local recurrence rate was 19% as compared to 22% with surgery and 6% with chemoradiation, respectively. Local recurrence rate was only 5% in patients treated with adjuvant radiation. Distant metastasis rate was least with chemoradiation (9%) as compared to 11.5% in radical radiation: curable dose of radiation and 33% with surgery alone, respectively. Patients with adjuvant radiation had a distant metastases rate of 15%. Median OS was 36 months. Factors affecting OS were histology (P = 0.023) and nodal involvement (P = 0.034). Median DFS was 26 months. Significant factors affecting DFS on univariate analysis were histology (P = 0.046) and nodal involvement (P = 0.004). On multivariate analysis the only factor affecting DFS and OS was nodal involvement (P = 0.01; Hazard Ratio, 0.085-0.719). CONCLUSION: In patients with invasive bladder cancer, combined modality in the form of radical cystectomy followed by radiation give best local control. Radiation alone is not effective to control muscle-invasive local disease; however, Chemoradiation is an effective alternative to radical cystectomy to preserve bladder function.

Fungating scrotal mass: A rare clinical presentation of testicular tumor.

A 20-year-old male patient presented with fungating scrotal mass. Investigations revealed yolk sac tumor with lung metastasis. The patient was treated with systemic chemotherapy. There was complete disappearance of the scrotal mass as well as metastatic disease from the lung. Fungating scrotal mass is a rare presentation of testicular tumor. This rare presentation is reported here. This is second such case in the English literature.

Results of letrozole in postmenopausal women after tamoxifen treatment for advanced breast cancer.

AIM: To analyze overall and progression-free survival after letrozole in postmenopausal women with advanced breast cancer who failed after tamoxifen therapy. MATERIALS AND METHODS: This is a retrospective analysis of 95 patients with breast cancer who were postmenopausal and had failed after tamoxifen therapy. Dose of letrozole was 2.5 mg daily until disease progressed. Patients had estrogen receptor- and/or progesterone receptor-positive tumors or both receptors were unknown. One complete course of (6 cycles) chemotherapy for metastatic disease was allowed. The primary end point was time to progression (TTP). Secondary end points included overall objective response rate (ORR), its duration, time to treatment failure (TTF), overall survival and tolerability. RESULTS: Median TTP was 10 months. ORR was 21% with complete response rate of 9%. Nine patients died of disease during treatment. Median overall survival was 36 months. Median time to response was three months and median duration of response was 13 months. Time to chemotherapy was 13.5 months and TTF was 9.3 months. Treatment failure was seen in 76% of patients. Disease progression was the main cause for treatment failure. Treatment was well-tolerated by all patients. CONCLUSION: This retrospective analysis shows that letrozole is quite effective as second line therapy in postmenopausal patients with advanced breast cancer who had failed after tamoxifen therapy.

Patterns of relapse in locally advanced breast cancer treated with neoadjuvant chemotherapy followed by surgery and radiotherapy.

AIMS: To define the clinical and pathological predictors of locoregional recurrence (LRR) in locally advanced breast cancer (LABC) patients treated with neoadjuvant chemotherapy (NACT). MATERIALS AND METHODS: We retrospectively reviewed the outcome of 141 patients with stage II to stage III carcinoma breast treated at Department of Radiotherapy, PGIMER, Chandigarh from 1998-2002. Mean age of the patients was 46 years, 49% of patients were premenopausal and 51% were postmenopausal. The tumor stage was T2 in 18%; T3 in 61% and T4 in 26% of the patients. NACT regimen given was FAC (5-fluorouracil, adriamycin and cyclophosphamide) in 85% and CMF (cyclophosphamide, methotrexate and 5-Fu) in 15% patients. RESULTS: After NACT, surgery was possible in 95% patients. Conservative surgery was possible in 23% patients and mastectomy was done in 72% of patients. Pathological complete response (pCR) was seen in 18% patients and pathological partial response (pPR) in 69% of patients. Stable and progressive disease was seen in 6% and 7% of patients respectively. Adjuvant radiation therapy was given to 86% patients. Six percent patients developed progressive disease and 4% of patients did not turn up for radiation. Five year LRR was 6% and relapse free survival (RFS) was 94%. Thirty-two (23%) patients developed distant metastasis resulting in distant metastasis free survival of 77%. The factors that correlated positively with LRR on univariate analysis included tumor stage, stage and pathological nodal stage. However, on multivariate analysis, tumor stage and pathological nodal stage were significant. Factors that correlated for distant relapse were tumor stage, response to chemotherapy, type of surgery, extracapsular extension (ECE) and tamoxifen therapy. On multivariate analysis only ECE was the significant factor that correlated with distant relapse free survival. CONCLUSION: Thus, tumor stage and pathological nodal stage remains the most important predictor of LRR in LABC. Factors that correlated for distant relapse were tumor stage, response to chemotherapy, type of surgery and ECE and tamoxifen therapy.

Postmastectomy radiation and survival in patients with breast cancer.

PURPOSE: To analyze the impact of postmastectomy radiotherapy on locoregional control and overall survival in patients with carcinoma breast. MATERIALS AND METHODS: Between 1995 and 2000, 688 patients of carcinoma breast were analyzed. Out of these, 608 received postmastectomy radiotherapy and 80 patients were not given any radiation therapy. At a median follow-up of 67 months, the outcomes studied were locoregional recurrence (LRR), distant metastases, disease-free survival (DFS) and overall survival (OS) using univariate and multivariate analyses. RESULTS: The frequency of LRR with or without distant metastases was 8.5%, and distant metastases was seen in 18.7% of patients. On univariate analyses, factors affecting LRR were age < 40 years (0.019), tumor stage ( P = 0.001 ), grade ( P = 0.027 ), pathological nodal status ( P ), deep resection plane (0.041), ER/PR status ( P = 0.032 ) and postmastectomy radiation therapy (PMRT) ( P ). DFS rate was 69% at 5 years. Factors affecting distant metastases were age < 40 years (0.005), tumor stage ( P ), grade ( P = 0.0007 ), pathological nodal status ( P ), extra capsular extension (ECE) ( P = 0.002 ), hormonal therapy ( P ) and PMRT ( P ). The OS rate was 81% at 5 years. Factors affecting OS were tumor stage ( P ), grade ( P = 0.0001 ), pathological nodal status ( P ), ECE ( P = 0.002 ) ER/PR status ( P = 0.008 ), hormonal therapy ( P = 0.001 ) and PMRT ( P = 0.004 ). On multivariate analysis, factors affecting LRR were age ( P = 0.001 ), tumor stage ( P = 0.021 ), deep resection plane (0.003), ECE ( P = 0.022 ) and PMRT ( P = 0.047 ). Factors affecting distant metastases were menopause ( P = 0.044 ), grade ( P = 0.012 ), ECE ( P = 0.017 ) and PMRT ( P = 0.012 ). Factors affecting OS were menopausal status ( P = 0.017 ), tumor stage ( P = 0.029 ), pathological nodal status ( P = 0.011 ) and PMRT ( P = 0.002 ). CONCLUSION: PMRT improves LRR as well as OS in patients with carcinoma breast. Other factors of prognostic importance were menopausal status, tumor stage and pathological nodal status.

Paraneoplastic leukocytoclastic vasculitis in chronic lymphoid leukemia.

A 50-year-old female who was a known case of chronic lymphoid leukemia (CLL) developed ecchymoses, purpuric spots with papules, some nodules (1-3 mm) and crusts all over the body associated with severe burning and itching along with exaggeration of CLL. The lesions were more prominent on lower limbs and face. Skin biopsy was reported as leukocytoclastic vasculitis. These lesions regressed after treatment with leukeran and glucocorticoids.

Cardiovascular changes in thyroid disorder.

Thyroid hormones have a profound effect on the metabolism. The cardiovascular system is particularly sensitive to this metabolic alteration. Therefore it is not surprising that thyroid dysfunction can produce dramatic cardiovascular effects, often mimicking primary cardiac disease. Both hypothyroidsm and hyperthyroidsm produce a clinical syndrome causing a diagnostic and therapeutic dilemma to the endocrinologist and cardiologist. Furthermore, cardiac disease and amiodarone therapy can also produce thyroid abnormality.

A study of psychiatric comorbidity in alcohol dependence.

The diagnosis of comorbid psychiatric conditions have important clinical ramifications as the outcome is poorer with multiple disorders. Various studies have shown that alcohol abuse has severe adverse effects on the course of metal illness and vice versa. Only a little data on the subject are available from our country. We interviewed 30 patients suffering from alcohol dependence using SCID - I & SCID - II. Seventy six percent of the sample had axis - I comorbid diagnosis and 40% had an axis -II diagnoses. Depressive disorder and cluster B personality disorders were the most common comorbid diagnosis.

Cloning and characterization of a cDNA encoding topoisomerase II in pea and analysis of its expression in relation to cell proliferation.

We have isolated and sequenced four overlapping cDNA clones to identify the full-length cDNA for topoisomerase II (PsTopII) from pea. Using degenerate primers, based on the conserved amino acid sequences of other eukaryotic type II topoisomerases, a 680 bp fragment was PCR-amplified with pea cDNA as template. This fragment was used as a probe to screen an oligo-dT-primed pea cDNA library. A partial cDNA clone was isolated that was truncated at the 3' end. RACE-PCR was employed to isolate the remaining portion of the gene. The total size of PsTopII is 4639 bp with an open reading frame of 4392 bp. The deduced amino acid sequence shows a strong homology to other eukaryotic topoisomerase II (topo II) at the N-terminus end. The topo II transcript was abundant in proliferative tissues. We also show that the level of topo II transcripts could be stimulated by exogenous application of growth factors that induced proliferation in vitro cultures. Light irradiation to etiolated tissue strongly stimulated the expression of topo II. These results suggest that topo II gene expression is up-regulated in response to light and hormones and correlates with cell proliferation. Besides, we have also isolated and analysed the 5'-flanking region of the pea TopII gene. This is first report on the isolation of a putative promoter for topoisomerase II from plants.

Continuous ethanol production from sugarcane molasses using a column reactor of immobilized Saccharomyces cerevisiae HAU-1.

A fermentation system for the continuous ethanol production from sucrose and molasses using calcium alginate immobilized Saccharomyces cerevisiae strain HAU-1 has been optimised. Immobilization of active yeast cells (30%, w/v) was accomplished in 1.5% calcium alginate and these yeast-beads were employed for ethanol production in a vertical column reactor. High ethanol productivity was achieved with a medium containing 10%, w/v sucrose at a dilution rate of 0.20 h-1. Alginate beads containing 30-50% yeast cell--mass resulted in high productivity 60.4 g l-1 h-1). Sugarcane molasses containing 15% total sugars was fermented in column reactor to produce 6.0%, v/v ethanol in continuous system. These yields could be improved to 7.0% with overall 11% increase in fermentation--efficiency with the use of acid-clarified sugar cane molasses medium.