Expanded Characterization of a Hemi-Body Shielded Göttingen Minipig Model of Radiation-induced Gastrointestinal Injury Incorporating Oral Dosing Procedures.

In collaboration with the Biomedical Advanced Research and Development Authority (BARDA), the authors recently conducted a pilot study in a hemi-body shielded model of radiation-induced gastrointestinal (GI) injury in Göttingen minipigs following exposure to radiation dose levels between 8-16 Gy. Herein, the impact of oral dosing procedures is assessed, as well as the specific causes of death in animals exposed to radiation doses of 14 and 16 Gy (n = 64; 32 male, 32 female, between 6 and 8 mo of age). Oral dosing using a 2-tablet placebo system comprised of both immediate release and enteric-coated tablets starting 24 h post-irradiation resulted in inhibited gastric emptying of the enteric-coated tablets, which were found to be retained in the stomach and/or regurgitated. This finding appears to be species-specific, as similar findings have not been reported for other large animal species (e.g., non-human primates). Mortality was primarily dictated by decreased activity, body weight loss (>35%), and/or respiratory distress, despite shielding of the lung. The cause of respiratory distress in animals that were pre-terminally euthanized varied according to the timing of death, with interstitial inflammation and extensive fibrosis observed >20 days post-irradiation. Kidney damage was also identified in most animals after day 10. Changes in the GI tract were consistent with previous studies and included collagen deposition/fibrosis. Observations of inflammatory infiltrates and interstitial inflammation/fibrosis in both shielded and unshielded organs support a strong secondary inflammatory syndrome post-irradiation.

Pilot Study of Radiation-induced Gastrointestinal Injury in a Hemi-body Shielded Göttingen Minipig Model.

Development of medical countermeasures (MCMs) for gastrointestinal (GI) injury following acute radiation exposure requires well-characterized models that can assess not only survival but also secondary endpoints, including structural and functional characteristics of GI damage and recovery that ultimately contribute to long-term survival. The authors conducted a pilot study in a hemi-body shielded Göttingen minipig model of radiation-induced GI injury that enables radiation damage to the GI tract to be evaluated and reduces the potential for hemorrhage and/or damage in other more sensitive organ systems. With shielding of the head, chest, and front legs, radiation dose levels of 14 Gy were required to see significant GI-related morbidity, while dose levels of 16 Gy resulted in significant mortality by day 45 post-irradiation. Periodic scheduled necropsies showed significant reduction in and slow recovery of intestinal crypt count at 14 and 16 Gy. Intestinal proliferative activity was initially increased and then gradually decreased over the course of the study. Histological evidence of marked inflammatory infiltrates was noted in the GI tract at day 5, while collagen deposition, indicative of fibrosis, was observed as early as day 15, peaking at day 30. The radiation dose-responsive indicators of GI damage identified in this model (i.e., intestinal crypt count and proliferative activity) may serve as useful endpoints for evaluation of the efficacy of potential MCMs.

Patient-specific compensation for Co-60 TBI treatments based on Monte Carlo design: A feasibility study.

PURPOSE: To develop an AP-PA treatment technique for the delivery of total body irradiation (TBI) at extended SSD using a modified Co-60 unit equipped with flattening filter and patient-specific compensators supported by Monte Carlo (MC) simulations and measurements. METHODS: An existing Eldorado-78 Co-60 teletherapy unit was stripped of its original collimator and equipped with two beam-defining cerrobend blocks. An acrylic flattening filter was numerically designed based on detailed mapping of the dose distribution of the large open field at a 10 cm depth in water using a primary radiation attenuation calculation. An EGSnrc/BEAMnrc MC model of the resulting unit was developed and experimentally validated and was used to calculate MC dose distributions in whole-body supine and prone CT images of a patient. AP-PA patient-specific compensators were designed based on the supine and prone mid-plane dose distributions. RESULTS: The designed flattening filter flattens the beam to within ±2% over a 200 cm × 70 cm area at 10 cm depth in water. Experimental validation of the calculated dose profiles in the open and flattened beams shows agreement of better than 2% and 1%, respectively. Patient MC dose calculations in the flattened, uncompensated beam showed dose deviations from prescription dose most notably in lung, neck and extremities ranging from -5% to +25%. The use of patient-specific compensators reduced inhomogeneities to within -5% to +10%. CONCLUSIONS: This work demonstrates that a Co-60 TBI setup upgraded with patient-specific compensators, numerically designed using MC patient dose calculations, is feasible and considerably improves the dose homogeneity.

Poster - Thur Eve - 52: Clinical use of nanoDots: In-vivo dosimetry and treatment validation for stereotactic targets with VMAT techniques.

A newly acquired nanoDot In-Light system was compared with TLD-100 dosimeters to confirm the treatment dose in the multiple cases: an electron eye treatment, H&N IMRT and VMAT validation for small targets. Eye tumour treatment with 9 MeV electrons A dose of 1.8 Gy per fraction was prescribed to the 85% isodose. The average dose measured by three TLDs and three Dots was 1.90 and 1.97 Gy. Both detectors overestimated dose, by 2.9% and 6.7% respectively. H&N IMRT treatment of skin cancer with 6 MV photons Dose per fraction is 2.5 Gy. The average doses measured by two TLDs and two Dots were 2.48 and 2.56 Gy, which represent errors of -0.8% and 2.2%, respectively. VMAT validation for small targets using an Agarose phantom, dose 15 Gy A single-tumour brain treatment was delivered using two coplanar arcs to an Agarise phantom containing a large plastic insert holding 3 nanoDots and 4 TLDs. The difference between the average Pinnacle dose and the average dose of the corresponding detectors was -0.6% for Dots and -1.7% for TLDs. A two-tumour brain treatment was delivered using three non-coplanar arcs. Small and large plastic inserts separated by 5 cm were used to validate the dose. The difference between the average Pinnacle dose and the average dose of the corresponding detectors was the following; small phantom 0.7% for Dots and 0.3% for TLDs, large phantom-1.9% for Dots and -0.6% for TLDs. In conclusion, nanoDot detectors are suitable for in-vivo dosimetry with photon and electron beams.

Helicobacter pylori, Chlamydia pneumoniae, and cytomegalovirus: chronic infections and coronary heart disease.

We conducted a MEDLINE search of the English-language literature from 1966-1999 on the association of chronic infections with Helicobacter pylori, Chlamydia pneumoniae, and cytomegalovirus (CMV) with coronary heart disease (CHD); additional literature was retrieved from references of selected articles. All human studies were included. Abstracts were excluded because of limited data. Chronic infections in CHD are speculated to be due to serum antibody concentrations of one or more of the three organisms. Data for H. pylori and CMV are difficult to interpret due to the confounding factor of childhood poverty and studies conducted in transplant recipients, respectively. Chlamydia pneumoniae data appear stronger with elevated IgG antibody titers (> or = 64) as a risk factor. Larger prospective studies are warranted to determine an association with CHD before universal prophylaxis or treatment of these chronic infections.

Trimmed radiosurgical fields.

Radiosurgery aims to deliver a high radiation dose to a small target volume while sparing surrounding healthy tissues. However, since the target volume is often large and irregularly-shaped, a significant amount of healthy tissue is irradiated. To improve conformity of the dose volume to the target volume, we propose to optimize the field shape by trimming the field described by the radiosurgery cone with the accelerator jaws for a given arc. We have measured output factors (OF), tissue-maximum ratios (TMR), off-axis ratios (OAR) and penumbrae for 40, 32.5 and 24 mm cone fields trimmed by the lower (i.e., X jaws) and /or upper (i.e., Y jaws) collimator jaws. The smallest field was 8 mm large, and length was limited by the cone size. The average penumbra due to the cone field is 2.8 mm, and 4.1 and 6.1 mm for those due to the X and Y jaws, respectively. Moreover, the penumbrae due to the X and Y jaws are independent of jaw position within the radiosurgical field. Because of the large penumbra involved with the Y jaws, radiosurgical fields should be trimmed by the X1 and/or X2 jaws only. The measured OF's have been fitted with a hyperbolic function. All of the fitted OF's fall within +/- 0.5% of the measured OF's. The TMR values obtained with trimmed fields do not change much, except for the smallest fields (up to 10% at a depth of 20 cm). Therefore, using trimmed radiosurgical fields requires straightforward dosimetric changes and provides a level of beam shaping for large cone fields (> 20 mm in diameter) without introducing additional hardware.

An analytical expression for electron beam central axis depth doses.

An analytical expression based on four fitting parameters is proposed for a mathematical description of electron beam central axis depth dose distributions. The expression approximates well the measured electron beam data in the field size range from 4 x 4 cm2 to 25 x 25 cm2 and in the energy range from 6 to 20 MeV in all four regions of the electron depth dose curve: build-up, dose maximum, dose fall-off, and bremsstrahlung contamination.

The amino-terminal segment of the catalytic subunit of kidney Na,K-ATPase regulates the potassium deocclusion pathway of the reaction cycle.

Tryptic cleavage of the catalytic subunit of kidney Na,K-ATPase in the E1 conformation effects a change in kinetic behavior apparent at low ATP concentration. Thus, at < or = 10 microM ATP, K+ inhibits Na(+)-dependent ATPase activity of the undigested enzyme but activates activity of the digested enzyme. With time of trypsinolysis, a transient increase followed by a decrease in activity is observed at low [ATP], whereas at high [ATP] (1 mM), activity is progressively reduced. At low [ATP], the trypsin-treated/control activity ratio was > or = 3-fold higher with K+ compared to the ratio observed with the K+ congener Li+. Also, the relative Na/K exchange activity (22Na+ influx into K(+)-loaded inside-out vesicles from erythrocytes) with either 0.01 mM ATP or 1 mM CTP compared to 1 mM ATP was greater for the trypsin-treated than for the control enzyme. The kinetic change is correlated with the initial rapid cleavage of the N-terminal tryptic fragment (< or = 30 residues) from the catalytic subunit. It is concluded that this segment regulates the K+ deocclusion pathway of the reaction; removal of this fragment produces a modified active species having an increased rate of K+ deocclusion.

Membrane transport models with fast and slow reactions: general analytical solution for a single relaxation.

Membrane transport models are usually expressed on the basis of chemical kinetics. The states of a transporter are related by rate constants, and the time-dependent changes of these states are given by linear differential equations of first order. To calculate the time-dependent transport equation, it is necessary to solve a system of differential equations which does not have a general analytical solution if there are more than five states. Since transport measurements in a complex system rarely provide all the time constants because some of them are too rapid, it is more appropriate to obtain approximate analytical solutions, assuming that there are fast and slow reaction steps. The states of the fast steps are related by equilibrium constants, thus permitting the elimination of their differential equations and leaving only those for the slow steps. With a system having only two slow steps, a single differential equation is obtained and the state equations have a single relaxation. Initial conditions for the slow reactions are determined after the perturbation which redistribute the states related by fast reactions. Current and zero-trans uptake equations are calculated. Curve fitting programs can be used to implement the general procedure and obtain the model parameters.

Presteady-state kinetics and carrier-mediated transport: a theoretical analysis.

Kinetic studies of cotransport mechanisms have so far been limited to the conventional steady-state approach which does not allow in general to resolve either isomerization or rate-limiting steps and to determine the values of the individual rate constants for the elementary reactions involved along a given transport pathway. Such questions can only be answered using presteady-state or relaxation experiments which, for technical reasons, have not yet been introduced into the field of cotransport kinetics. However, since two recent reports seem compatible with the observation of such transient kinetics, it would appear that theoretical studies are needed to evaluate the validity of such claims and to critically evaluate the expectations from a presteady-state approach. We thus report such a study which was performed on a simple four-state mechanism of carrier-mediated transport. The time-dependent equation for zero-trans substrate uptake was thus derived and then extended to models with p intermediary steps. It is concluded that (p-1) exponential terms will describe the approach to the steady state but that such equations have low analytical value since the parameters of the flux equation cannot be expressed in terms of the individual rate constants of the elementary reactions for models with p greater than 5. We thus propose realistic simplifications based on the time-scale separation hypothesis which allows replacement of the rate constants of the rapid steps by their equilibrium constants, thereby reducing the complexity of the kinetic system. Assuming that only one relaxation can be observed, this treatment generates approximate models for which analytical expressions can easily be derived and simulated through computer modeling. When performed on the four-state mechanism of carrier-mediated transport, the simulations demonstrate the validity of the approximate solutions derived according to this hypothesis. Moreover, our approach clearly shows that presteady-state kinetics, should they become applicable to (co)transport kinetics, could be invaluable in determining more precise transport mechanisms.

Locomotion of granulocytes on an inclined plane.

The paper presents a quantitative study of the trajectories of rat granulocytes (PMNs) migrating on a glass surface inclined at various angles, i.e. under the action of gravitational force component parallel to the plane. The action of the force of the order of 5 X 10(-13) N (component parallel to the plane inclined at 80 degrees) accompanied by the decrease of a gravitational component perpendicular to the surface does not disrupt the adhesion contact of migrating PMNs with the serum coated glass surface. Under the action of the external force parallel to the surface, the PMNs exhibit a tendency to migrate in the direction of the force vector and the angles between elementary segments (steps) of cell trajectories are smaller in comparison with migration on a horizontal plane (0 degrees inclination). It has been found that the mean velocity of motion of PMNs locomoting on a steep slope (70 degrees and 80 degrees) is greater in comparison with the migration velocity on a horizontal surface. The increase of velocity concerns not only cells migrating in the downward direction, but also those which move upwards. Possible mechanisms of the influence of external force on direction and rate of migration of granulocytes are discussed, namely modification of adhesion force, stimulation of cell motile activity, individual variability of cell adhesive and migration properties, shortening of transient locomotory adhesions.