The effect of iron doping on the structural, optical, surface morphological, and temperature-dependent magnetic properties of ZnO nanoparticles.

This study reports the role of temperature on the magnetic properties of the Fe-doped (0, 1, 3, and 5 wt%) ZnO nanoparticles (NPs) synthesized using the facile co-precipitation procedure. Powder x-ray diffraction analysis revealed the crystallinity deterioration of the ZnO matrix on trivalent cationic doping and the shifting of peak position due to the mismatch in ionic radius between the Zn2+ and Fe3+. A clear redshift in the bandgap of the iron-doped ZnO samples is observed from the UV-vis diffused reflectance spectroscopic studies. The existence of lattice defects including the zinc interstitials, zinc vacancies, and oxygen vacancies are confirmed by the room temperature photoluminescence analysis. Scanning electron microscopic investigations showed the synthesized NPs possesses agglomerated spherical morphology. The role of temperature on the magnetization of the iron-doped ZnO nanoparticles has been examined at 300 and 100 K. A 3-fold enhancement of magnetization value perceived for the 5% iron-doped ZnO nanoparticles at 100 K compared to the magnetization value of such sample at 300 K.

A prospective gating method to acquire a diverse set of free-breathing CT images for model-based 4DCT.

Breathing motion modeling requires observation of tissues at sufficiently distinct respiratory states for proper 4D characterization. This work proposes a method to improve sampling of the breathing cycle with limited imaging dose. We designed and tested a prospective free-breathing acquisition protocol with a simulation using datasets from five patients imaged with a model-based 4DCT technique. Each dataset contained 25 free-breathing fast helical CT scans with simultaneous breathing surrogate measurements. Tissue displacements were measured using deformable image registration. A correspondence model related tissue displacement to the surrogate. Model residual was computed by comparing predicted displacements to image registration results. To determine a stopping criteria for the prospective protocol, i.e. when the breathing cycle had been sufficiently sampled, subsets of N scans where 5 ⩽ N ⩽ 9 were used to fit reduced models for each patient. A previously published metric was employed to describe the phase coverage, or 'spread', of the respiratory trajectories of each subset. Minimum phase coverage necessary to achieve mean model residual within 0.5 mm of the full 25-scan model was determined and used as the stopping criteria. Using the patient breathing traces, a prospective acquisition protocol was simulated. In all patients, phase coverage greater than the threshold necessary for model accuracy within 0.5 mm of the 25 scan model was achieved in six or fewer scans. The prospectively selected respiratory trajectories ranked in the (97.5 ± 4.2)th percentile among subsets of the originally sampled scans on average. Simulation results suggest that the proposed prospective method provides an effective means to sample the breathing cycle with limited free-breathing scans. One application of the method is to reduce the imaging dose of a previously published model-based 4DCT protocol to 25% of its original value while achieving mean model residual within 0.5 mm.

Analytical modeling and feasibility study of a multi-GPU cloud-based server (MGCS) framework for non-voxel-based dose calculations.

PURPOSE: In this paper, a multi-GPU cloud-based server (MGCS) framework is presented for dose calculations, exploring the feasibility of remote computing power for parallelization and acceleration of computationally and time intensive radiotherapy tasks in moving toward online adaptive therapies. METHODS: An analytical model was developed to estimate theoretical MGCS performance acceleration and intelligently determine workload distribution. Numerical studies were performed with a computing setup of 14 GPUs distributed over 4 servers interconnected by a 1 Gigabits per second (Gbps) network. Inter-process communication methods were optimized to facilitate resource distribution and minimize data transfers over the server interconnect. RESULTS: The analytically predicted computation time predicted matched experimentally observations within 1-5 %. MGCS performance approached a theoretical limit of acceleration proportional to the number of GPUs utilized when computational tasks far outweighed memory operations. The MGCS implementation reproduced ground-truth dose computations with negligible differences, by distributing the work among several processes and implemented optimization strategies. CONCLUSIONS: The results showed that a cloud-based computation engine was a feasible solution for enabling clinics to make use of fast dose calculations for advanced treatment planning and adaptive radiotherapy. The cloud-based system was able to exceed the performance of a local machine even for optimized calculations, and provided significant acceleration for computationally intensive tasks. Such a framework can provide access to advanced technology and computational methods to many clinics, providing an avenue for standardization across institutions without the requirements of purchasing, maintaining, and continually updating hardware.

A GPU based high-resolution multilevel biomechanical head and neck model for validating deformable image registration.

PURPOSE: Validating the usage of deformable image registration (dir) for daily patient positioning is critical for adaptive radiotherapy (RT) applications pertaining to head and neck (HN) radiotherapy. The authors present a methodology for generating biomechanically realistic ground-truth data for validating dir algorithms for HN anatomy by (a) developing a high-resolution deformable biomechanical HN model from a planning CT, (b) simulating deformations for a range of interfraction posture changes and physiological regression, and (c) generating subsequent CT images representing the deformed anatomy. METHODS: The biomechanical model was developed using HN kVCT datasets and the corresponding structure contours. The voxels inside a given 3D contour boundary were clustered using a graphics processing unit (GPU) based algorithm that accounted for inconsistencies and gaps in the boundary to form a volumetric structure. While the bony anatomy was modeled as rigid body, the muscle and soft tissue structures were modeled as mass-spring-damper models with elastic material properties that corresponded to the underlying contoured anatomies. Within a given muscle structure, the voxels were classified using a uniform grid and a normalized mass was assigned to each voxel based on its Hounsfield number. The soft tissue deformation for a given skeletal actuation was performed using an implicit Euler integration with each iteration split into two substeps: one for the muscle structures and the other for the remaining soft tissues. Posture changes were simulated by articulating the skeletal structure and enabling the soft structures to deform accordingly. Physiological changes representing tumor regression were simulated by reducing the target volume and enabling the surrounding soft structures to deform accordingly. Finally, the authors also discuss a new approach to generate kVCT images representing the deformed anatomy that accounts for gaps and antialiasing artifacts that may be caused by the biomechanical deformation process. Accuracy and stability of the model response were validated using ground-truth simulations representing soft tissue behavior under local and global deformations. Numerical accuracy of the HN deformations was analyzed by applying nonrigid skeletal transformations acquired from interfraction kVCT images to the model's skeletal structures and comparing the subsequent soft tissue deformations of the model with the clinical anatomy. RESULTS: The GPU based framework enabled the model deformation to be performed at 60 frames/s, facilitating simulations of posture changes and physiological regressions at interactive speeds. The soft tissue response was accurate with a R(2) value of >0.98 when compared to ground-truth global and local force deformation analysis. The deformation of the HN anatomy by the model agreed with the clinically observed deformations with an average correlation coefficient of 0.956. For a clinically relevant range of posture and physiological changes, the model deformations stabilized with an uncertainty of less than 0.01 mm. CONCLUSIONS: Documenting dose delivery for HN radiotherapy is essential accounting for posture and physiological changes. The biomechanical model discussed in this paper was able to deform in real-time, allowing interactive simulations and visualization of such changes. The model would allow patient specific validations of the dir method and has the potential to be a significant aid in adaptive radiotherapy techniques.

A nonvoxel-based dose convolution/superposition algorithm optimized for scalable GPU architectures.

PURPOSE: Real-time adaptive planning and treatment has been infeasible due in part to its high computational complexity. There have been many recent efforts to utilize graphics processing units (GPUs) to accelerate the computational performance and dose accuracy in radiation therapy. Data structure and memory access patterns are the key GPU factors that determine the computational performance and accuracy. In this paper, the authors present a nonvoxel-based (NVB) approach to maximize computational and memory access efficiency and throughput on the GPU. METHODS: The proposed algorithm employs a ray-tracing mechanism to restructure the 3D data sets computed from the CT anatomy into a nonvoxel-based framework. In a process that takes only a few milliseconds of computing time, the algorithm restructured the data sets by ray-tracing through precalculated CT volumes to realign the coordinate system along the convolution direction, as defined by zenithal and azimuthal angles. During the ray-tracing step, the data were resampled according to radial sampling and parallel ray-spacing parameters making the algorithm independent of the original CT resolution. The nonvoxel-based algorithm presented in this paper also demonstrated a trade-off in computational performance and dose accuracy for different coordinate system configurations. In order to find the best balance between the computed speedup and the accuracy, the authors employed an exhaustive parameter search on all sampling parameters that defined the coordinate system configuration: zenithal, azimuthal, and radial sampling of the convolution algorithm, as well as the parallel ray spacing during ray tracing. The angular sampling parameters were varied between 4 and 48 discrete angles, while both radial sampling and parallel ray spacing were varied from 0.5 to 10 mm. The gamma distribution analysis method (γ) was used to compare the dose distributions using 2% and 2 mm dose difference and distance-to-agreement criteria, respectively. Accuracy was investigated using three distinct phantoms with varied geometries and heterogeneities and on a series of 14 segmented lung CT data sets. Performance gains were calculated using three 256 mm cube homogenous water phantoms, with isotropic voxel dimensions of 1, 2, and 4 mm. RESULTS: The nonvoxel-based GPU algorithm was independent of the data size and provided significant computational gains over the CPU algorithm for large CT data sizes. The parameter search analysis also showed that the ray combination of 8 zenithal and 8 azimuthal angles along with 1 mm radial sampling and 2 mm parallel ray spacing maintained dose accuracy with greater than 99% of voxels passing the γ test. Combining the acceleration obtained from GPU parallelization with the sampling optimization, the authors achieved a total performance improvement factor of >175 000 when compared to our voxel-based ground truth CPU benchmark and a factor of 20 compared with a voxel-based GPU dose convolution method. CONCLUSIONS: The nonvoxel-based convolution method yielded substantial performance improvements over a generic GPU implementation, while maintaining accuracy as compared to a CPU computed ground truth dose distribution. Such an algorithm can be a key contribution toward developing tools for adaptive radiation therapy systems.

Shielding implications for secondary neutrons and photons produced within the patient during IMPT.

PURPOSE: Intensity modulated proton therapy (IMPT) uses a combination of computer controlled spot scanning and spot-weight optimized planning to irradiate the tumor volume uniformly. In contrast to passive scattering systems, secondary neutrons and photons produced from inelastic proton interactions within the patient represent the major source of emitted radiation during IMPT delivery. Various published studies evaluated the shielding considerations for passive scattering systems but did not directly address secondary neutron production from IMPT and the ambient dose equivalent on surrounding occupational and nonoccupational work areas. Thus, the purpose of this study was to utilize Monte Carlo simulations to evaluate the energy and angular distributions of secondary neutrons and photons following inelastic proton interactions within a tissue-equivalent phantom for incident proton spot energies between 70 and 250 MeV. METHODS: Monte Carlo simulation methods were used to calculate the ambient dose equivalent of secondary neutrons and photons produced from inelastic proton interactions in a tissue-equivalent phantom. The angular distribution of emitted neutrons and photons were scored as a function of incident proton energy throughout a spherical annulus at 1, 2, 3, 4, and 5 m from the phantom center. Appropriate dose equivalent conversion factors were applied to estimate the total ambient dose equivalent from secondary neutrons and photons. RESULTS: A reference distance of 1 m from the center of the patient was used to evaluate the mean energy distribution of secondary neutrons and photons and the resulting ambient dose equivalent. For an incident proton spot energy of 250 MeV, the total ambient dose equivalent (3.6 × 10(-3) mSv per proton Gy) was greatest along the direction of the incident proton spot (0°-10°) with a mean secondary neutron energy of 71.3 MeV. The dose equivalent decreased by a factor of 5 in the backward direction (170°-180°) with a mean energy of 4.4 MeV. An 8 × 8 × 8 cm(3) volumetric spot distribution (5 mm FWHM spot size, 4 mm spot spacing) optimized to produce a uniform dose distribution results in an ambient dose equivalent of 4.5 × 10(-2) mSv per proton Gy in the forward direction. CONCLUSIONS: This work evaluated the secondary neutron and photon emission due to monoenergetic proton spots between 70 and 250 MeV, incident on a tissue equivalent phantom. Example calculations were performed to estimate concrete shield thickness based upon appropriate workload and shielding design assumptions. Although lower than traditional passive scattered proton therapy systems, the ambient dose equivalent from secondary neutrons produced by the patient during IMPT can be significant relative to occupational and nonoccupational workers in the vicinity of the treatment vault. This work demonstrates that Monte Carlo simulations are useful as an initial planning tool for studying the impact of the treatment room and maze design on surrounding occupational and nonoccupational work areas.

A multi-GPU real-time dose simulation software framework for lung radiotherapy.

PURPOSE: Medical simulation frameworks facilitate both the preoperative and postoperative analysis of the patient's pathophysical condition. Of particular importance is the simulation of radiation dose delivery for real-time radiotherapy monitoring and retrospective analyses of the patient's treatment. METHODS: In this paper, a software framework tailored for the development of simulation-based real-time radiation dose monitoring medical applications is discussed. A multi-GPU-based computational framework coupled with inter-process communication methods is introduced for simulating the radiation dose delivery on a deformable 3D volumetric lung model and its real-time visualization. The model deformation and the corresponding dose calculation are allocated among the GPUs in a task-specific manner and is performed in a pipelined manner. Radiation dose calculations are computed on two different GPU hardware architectures. The integration of this computational framework with a front-end software layer and back-end patient database repository is also discussed. RESULTS: Real-time simulation of the dose delivered is achieved at once every 120 ms using the proposed framework. With a linear increase in the number of GPU cores, the computational time of the simulation was linearly decreased. The inter-process communication time also improved with an increase in the hardware memory. Variations in the delivered dose and computational speedup for variations in the data dimensions are investigated using D70 and D90 as well as gEUD as metrics for a set of 14 patients. Computational speed-up increased with an increase in the beam dimensions when compared with a CPU-based commercial software while the error in the dose calculation was <1%. CONCLUSION: Our analyses show that the framework applied to deformable lung model-based radiotherapy is an effective tool for performing both real-time and retrospective analyses.

SU-E-J-98: 3D Tracking of Interfraction Patient Setup Uncertainties Using Multiple Kinect Sensors.

PURPOSE: On-board optical 3D imaging enables measuring daily setup patient uncertainties without involving any additional imaging-induced radiation dose to critical structures. We hypothesize that the tumor and normal organ deformation caused by routine patient head and neck misalignments can be determined by coupling a quantitative patient-specific biomechanical model with quantitative skin surface 3D imaging. METHODS: A set of 3D cameras are used to track the patient anatomy externally. One of the cameras employed a marker less face recognition and tracking for delineating the region of the patient's face. The location of the face was then shared among the camera controllers in real-time and the anatomical contour that closely matches the face region is selected and integrated to form a single 3D anatomical representation. Patient surface aligning was performed between the patient's external surface obtained from a reference 3D anatomy (simulation CT, MRI, patient surface map from previous fraction) and the above-mentioned camera system to quantify the daily patient setup variations. For each of the 3D patient surface, a point feature histogram (PFH) was first generated. Once the PFH descriptors were generated, a non-rigid iterative closest point registration algorithm that minimizes the difference in the PFH descriptor aligns the patient surface to the reference 3D anatomy. RESULTS: The proposed tracking system was able to track both the patient surface setup uncertainty and the internal anatomy when coupledwith a patient specific biomechanical head and neck model. CONCLUSIONS: A 3D head and neck tracking system that monitors the interfraction patient setup uncertainties in the head and neck cancer patient is presented. The aligning process was shown to perform for cases with and without the head immobilization system. The external patient surface manifold and the motion vectors will be coupled to align the biomechanical model using model-guided techniques.

SU-E-J-58: Patient-Specific Biomechanical Head and Neck Models for Interfraction Dose Accumulation.

PURPOSE: In this abstract, we discuss a biomechanical head and neck model that will be able to represent patient setup variations as well as physiologic changes and subsequently enable dose calculations on the deformed anatomy. METHODS: We selected Multi Pose MRI as the imaging modality to aid in model development and validation. The MRI data allowed us to build a biomechanically predictive model that will enable accurate estimation of tumor position when seeded with CT data alone. The soft tissue contrast and lack of ionizing radiation when using MRI enabled us to acquire extensive imaging datasets with a suitable variety of head pose variations. These poses were selected to encompass the clinical positioning variations so that the resulting model will accurately reflect internal organ motion and deformation. All images were acquired using an 8-channel, 1.5T research MRI system in radiology. The imaging volume extended from about T3(upper thoracic vertebrae) to the top of the head, thereby covering the entire head and neck. Model components included: muscles, skeletal bones, lymph nodes, fat tissues, and organs such as salivary glands, tendons, andligaments. At first, one MRI image dataset was selected as the reference image. The biometric properties (length, volume, mass, shape), hinge constraints of the bones, and the biomechanical properties of each of the anatomies were estimated using MRIs acquired at different head and neck poses. RESULTS: The model's ability to represent different head and neck postures can be illustrated by observing the internal tissue deformations andthe model's ability to represent different postures. CONCLUSIONS: Results show that the biomechanical model was able to simulate different poses that may be exhibited during interfraction patient setup variations and intrafraction patient motion. Future work would focus on integrating dose calculations on the deforming model and validating the model deformations.

Phenotypic and genotypic analysis of multidrug-resistant tuberculosis in Ethiopia.

SETTING: National Tuberculosis Reference Laboratory, Addis Ababa, Ethiopia. OBJECTIVES: To determine the drug susceptibility pattern of Mycobacterium tuberculosis isolates and to genetically characterise multidrug-resistant tuberculosis (MDR-TB) isolates. DESIGN: A total of 107 M. tuberculosis isolates recovered during the period December 2005-August 2006 were tested for drug susceptibility against streptomycin, isoniazid, rifampicin and ethambutol (SHRE) using the proportion method on Löwenstein-Jensen medium. The MDR-TB isolates were tested against kanamycin, ciprofloxacin, capreomycin, D-cycloserine and ethionamide. Genotyping was performed using spoligotyping. RESULTS: MDR-TB was observed in one of the 44 new cases (2.3%) and 45/63 previously treated patients (71.4%). Drug susceptibility testing against second-line drugs (SLDs) showed that 26.1% of all MDR-TB isolates were susceptible to all SLDs tested and 73.9% were resistant to one or more classes of SLD. Extensively drug-resistant (XDR) TB was detected in two isolates (4.4%). T3_ETH was the predominant spoligotype, followed by CAS_KILI. In this African setting, no Beijing spoligotype was identified. CONCLUSION: Both MDR- and XDR-TB are present in Ethiopian patients. MDR-TB was found to be associated with T3 and Central Asian genotypes.

Pdcd4 repression of lysyl oxidase inhibits hypoxia-induced breast cancer cell invasion.

Metastasis to bone, liver and lungs is the primary cause of death in breast cancer patients. Our studies have revealed that the novel tumor suppressor Pdcd4 inhibits breast cancer cell migration and invasion in vitro. Loss of Pdcd4 in human nonmetastatic breast cancer cells increased the expression of lysyl oxidase (LOX) mRNA. LOX is a hypoxia-inducible amine oxidase, the activity of which enhances breast cancer cell invasion in vitro and in vivo. Specific inhibition of LOX activity by beta-aminopropionitrile or small interfering RNA decreased the invasiveness of T47D and MCF7 breast cancer cells attenuated for Pdcd4 function. Most significantly, loss of Pdcd4 augments hypoxia induction of LOX as well. Conversely, overexpression of Pdcd4 significantly reversed the hypoxia induction of LOX expression in T47D cells attenuated for Pdcd4. However, Pdcd4 did not affect hypoxia-inducible factor-1 (HIF-1) protein expression or HIF-1-responsive element-luciferase activity in response to hypoxia, suggesting that Pdcd4 regulation of LOX occurs through an HIF-independent mechanism. Nevertheless, the loss of Pdcd4 early in cancer progression may have an important role in the increased sensitivity of cancer cells to hypoxia through increased LOX activity and concomitant enhanced invasiveness.

Ascorbate-mediated enhancement of reactive oxygen species generation from polymorphonuclear leukocytes: modulatory effect of nitric oxide.

Recent studies from our laboratory have demonstrated that ascorbate potentiated enzymatic synthesis of nitric oxide (NO) from polymorphonuclear leukocytes (PMNs). NO is known to modulate various function of PMNs such as chemotaxis, adherence, aggregation, and generation of reactive oxygen species (ROS). The role of ascorbate in the PMN phagocytosis, ROS generation, and apoptosis was thus evaluated in the present study. Ascorbate and its oxidized and cell-permeable analog, dehydroascorbate (DHA), did not affect the phagocytosis but enhanced ROS generation and apoptosis following treatment with Escherichia coli or arachidonic acid. A detailed investigation on the DHA-mediated response indicated that inhibitors of DHA uptake, reduced nicotinamide adenine dinucleotide phosphate oxidase, NO synthase, or ROS scavengers attenuated ROS generation. In DHA-treated cells, enhanced generation of peroxynitrite was also observed; thus, ascorbate-mediated ROS and reactive nitrogen species generation might mediate cytotoxicity toward the ingested microbes and subsequently, augmented PMN apoptosis. Results of the present study have helped in delineating the role of ascorbate in the modulation of NO-mediated ROS generation from PMNs.

Vascular regulation by the L-arginine metabolites, nitric oxide and agmatine.

Research on the biochemistry and physiology of l-arginine has remained an attractive area for scientists over the last 100 years due to its diverse physiological functions in mammals. Research on l-arginine was boosted after the identification of nitric oxide (NO) and agmatine and their physiological importance. NO directly modulates ion channels, activates soluble guanylyl cyclase and other important proteins by ADP ribosylation and nitrosylation and binding to heme or iron-sulfur clusters. These modifications and interaction with heme might activate or inhibit various protein kinases, phosphatases and modulate transcription of various nuclear factors to possibly cause cardiovascular diseases like hypertension, ischemia, diabetes, atherosclerosis and angiogenesis. Agmatine holds the key to prevent the toxic effects associated with induction of NO synthesis by its ability to inhibit inducible nitric oxide synthase (iNOS). Agmatine is also synthesized from l-arginine by the enzyme arginine decarboxylase and displays a significant potential in cardiovascular system. Agmatine, with the myriad of effects on calcium homeostasis, seems to modulate various functions in the heart, brain and vasculature. The present review compiles the recent development to improve the understanding the role played by l-arginine-metabolic pathways in cardiovascular system. Though l-arginine and its metabolites are well known to affect various cardiovascular physiologies, the currently available literature is still not sufficient to validate the prophylactic/therapeutic efficacy of l-arginine. l-Arginine and its metabolites, NO and agmatine still hold the key for future research in cardiovascular system.

Role of ascorbate in the regulation of nitric oxide generation by polymorphonuclear leukocytes.

We have recently demonstrated that NO-mediated polymorphonuclear (PMN)-dependent inhibition of rat platelet aggregation is significantly enhanced in the presence of ascorbate. Consequently, the present study was undertaken to elucidate the underlying mechanisms involved in ascorbate-mediated potentiation of NO synthesis in PMNs. We observed that ascorbate or its oxidized product, dehydroascorbate (DHA), enhanced NOS activity, as measured by nitrite content, diaminofluorescein fluorescence or conversion of L-[3H]arginine to L-[3H]citrulline in rat, monkey, and human PMNs. The increase in NO generation following ascorbate treatment was due to the intracellular ascorbate as iodoacetamide-mediated inhibition of DHA to ascorbate conversion attenuated the DHA-mediated increase in NO synthesis. The augmentation of NOS activity in the PMN homogenate by tetrahydrobiopterin was significantly enhanced by ascorbate, while ascorbate alone did not influence the NOS activity. Ascorbate-mediated enhancement of NOS activity in the cultured PMNs was significantly reduced in the presence of biopterin synthesis inhibitors. Ascorbate, thus, seems to regulate the NOS activity in the PMNs through tetrahydrobiopterin.

Inhibition of platelet aggregation by rat globin.

This study was undertaken to identify and characterize the anti-aggregatory protein factor present in rat polymorphonuclear leukocytes (PMNs) supernatant. Since the purified protein exhibited sequence homology to beta globin, globin was also isolated from rat blood by acid-acetone precipitation and was purified on Superdex-75 column in FPLC. Elution of rat globin on the gel filtration column yielded two peaks of approximately 60 and 30 kDa as observed in the PMNs supernatant. Purity of globin and eluted fractions was further evaluated by SDS-PAGE. Platelet aggregation induced by agonists viz. adenosine-5'-diphosphate (ADP; 2-5 microM), arachidonic acid (AA; 10 microM), A23187 (2.50 microg/ml) was inhibited by globin and the purified fractions. ADP-induced rise in intracellular calcium levels and expression of CD62 on the platelets were reduced by both globin and active fraction of PMNs supernatant. Results obtained suggest that globin or globin-related protein present in the PMNs supernatant inhibits platelet aggregation response.

Abdominal rectopexy for complete prolapse: prospective study evaluating changes in symptoms and anorectal function.

The effect of abdominal rectopexy on bowel function is difficult to assess in retrospective studies because preoperative bowel habit cannot be determined accurately. This study examined bowel symptoms and physiologic tests of anorectal function prospectively in 23 patients before and at three months after rectopexy. Rectopexy eliminated complete prolapse in all and stopped bleeding in 16 of 18 patients. Incontinence improved significantly. Constipation (less than 3 bowel actions per week or straining for more than 25 percent of defecation time) was relieved in 4 of 11 affected patients but developed in 5 of the 12 who were not constipated preoperatively. Since the median bowel frequency was 21 motions per week before surgery and 17 afterward, the main determinant of constipation was straining. Abdominal pain was relieved after rectopexy in 6 of 12 patients but developed in 3 of 13 who were pain-free before surgery. Three patients (13 percent) had a first-degree relative with rectal prolapse. Perineal descent decreased significantly. Maximal anal resting pressure increased significantly, but this did not correlate significantly with improved continence. Twenty-one patients (91 percent) could expel a 50-ml balloon preoperatively; 18 of those 21 could still do so postoperatively. The two patients who could not expel the balloon preoperatively were able to do so postoperative. This study shows that rectal prolapse is associated with profoundly abnormal defecation and abdominal pain. While abdominal rectopexy improved continence, it may improve or worsen other bowel symptoms, including constipation.

Regulation of IgA secretion in polyclonally induced in vitro human lymphocyte cultures: the function of T and B cells from mesenteric lymph nodes and peripheral blood.

Human gut-associated immunoregulatory events were studied in a pokeweed mitogen (PWM)-stimulated culture system using lymphocytes obtained from the mesenteric lymph nodes (MLN) of female subjects undergoing gastroplasty for obesity. Compared with peripheral blood lymphocytes, lymphocytes obtained from MLN secreted IgG, IgA and IgM isotypes that differ in pattern and distribution despite similar proportions of T cells and B cells expressing isotype-specific surface membrane immunoglobulin (SmIg). Among the isotypes secreted, IgA appeared to be increased relatively to other isotypes in MLN cultures. Crossover coculture experiments using T and B cells isolated from both MLN and blood by E-rosetting and cell panning procedures demonstrated that IgA was particularly sensitive to help and suppression exerted by MLN T cells and T cell subsets defined by monoclonal antibodies OKT4 and OKT8 respectively, when compared with similar subsets isolated from blood. The results presented provide a basis for study of gut handling of ingested antigen in man, and of disturbed immunoregulatory events in inflammatory and neoplastic disease of the human gut.