Drudgery, accidents and injuries in Indian agriculture

The Indian farming employs 225 million workforce to cover 140 million hectares of total cultivated land. In spite of rapid farm mechanization (e.g., 149 million farm machinery), the vast resource-poor family farming has primary dependence on traditional methods (e.g., 520 million hand tools and 37 million animal-drawn implements are in operation). The work drudgery, the traumatic accidents and injuries are the major concerns to examine options for ergonomics intervention and betterment of work in crop production activities. This review summarizes human energy expenditure in crop production activities, to assess the job severity, tools and machinery, and formulate the basis to reorganize work and work methods. While the farm mechanization is more in the northern India, the accidents were more in the villages in southern India. On average of the four regions, the tractor incidents (overturning, falling from the tractor, etc.) were highest (27.7%), followed by thresher (14.6%), sprayer/duster (12.2%), sugarcane crusher (8.1%) and chaff cutter (7.8%) accidents. Most of the fatal accidents resulted from the powered machinery, with the annual fatality rate estimated as 22 per 100,000 farmers. The hand tools related injuries (8% of the total accidents) were non-fatal in nature. In spite of the enactment of legislation, the shortcomings in production and monitoring of the machinery in field use may be responsible for the high rate of accidents (e.g., 42 thresher accidents/1,000 mechanical threshers/year in southern India). Due to the lack of technical capability of the local artisans, adhering to safety and design standards is impractical to the implements fabricated in the rural areas. The analysis emphasizes that the effective safety and health management may be possible through legislative enabling of the local infra-structure, such as block development authority and primary health services, to permeate occupational health and safe work practices in the farming sector.     

High dose rate brachytherapy: its clinical applications and treatment guidelines

Brachytherapy has the advantage of delivering a high dose to the tumor while sparing the surrounding normal tissues. With proper case selection and delivery technique, high-dose-rate (HDR) brachytherapy has great promise, because it eliminates radiation exposure, allows short treatment times, and can be performed on an outpatient basis. Additionally, use of a single-stepping source, allows optimization of dose distribution by varying the dwell time at each dwell position. However, when HDR brachytherapy is used, the treatments must be executed carefully, because the short treatment times do not allow any time for correction of errors, and mistakes can result in harm to patients. Hence, it is very important that all personnel involved in HDR brachytherapy be well trained and be constantly alert. It is expected that the use of HDR brachytherapy will greatly expand over the next decade and that refinements will occur primarily in the integration of imaging (computed tomography, magnetic resonance imaging, intraoperative ultrasonography) and optimization of dose distribution. It is anticipated that better tumor localization and normal tissue definition will help to optimize dose distribution to the tumor and reduce normal tissue exposure. The development of well-controlled randomized trials addressing issues of efficacy, toxicity, quality of life, and costs-versus-benefits will ultimately define the role of HDR brachytherapy in the therapeutic armamentarium.     

Intraoperative electron beam treatment for pediatric malignancies: The Ohio State University experience

PURPOSE: To report the result of intraoperative electron beam radiation therapy (IOERT) in patients with extensive pediatric tumors. METHOD: From October 1989 through June 2000, 13 children were treated with chemotherapy, maximal surgery, and 10-15 Gy IOERT at a total of 18 sites. IOERT was used for palliative purposes in 5 children with metastatic disease and in 3 others who were previously treated with external beam radiation (EBRT). The remaining five patients received definitive IOERT. Postoperative EBRT of 35.4-45 Gy was given in 5 patients. RESULTS: After a median follow-up of 42 months (range = 18-63 months), 4 patients were alive and without evidence of disease. Overall and 3 year actuarial survival rates were 31% (4/13) and 26%, respectively. Local control was achieved at 13/18 sites (72%). Poor prognostic factors included metastatic disease, recurrent disease, and the absence of adjuvant EBRT. Two children with Wilms tumors had 100% local control, disease-free survival, and overall survival without the addition of EBRT. CONCLUSION: A boost dose of IOERT allows for reduction in the dose of EBRT, thereby limiting growth-related morbidity without compromising local control or disease-free survival. Except for Wilms tumors, which achieved 100% local control and disease-free survival, adjuvant EBRT is necessary for successful local control and survival in children with soft tissue sarcomas. Based on this study and others, intraoperative irradiation should be considered for inclusion in prospective, multi-institutional trials designed to treat localized malignancies in young children.     

Iodine-125 brachytherapy in the treatment of colorectal adenocarcinoma metastatic to the liver

BACKGROUND: The liver is the site of distant failure in > 33% of patients with colorectal adenocarcinoma. Liver resection is the only potentially curative option in these patients. Patients with incompletely resected liver lesions (due to the proximity to critical vascular structures) are at high risk of dying of progressive disease in the liver. This pilot study was performed to determine whether the intraoperative implantation of iodine-125 (I-125) seeds could reduce the recurrence and improve the survival of patients with incompletely resected liver metastases. METHODS: Fifty-six patients with unresectable or residual disease after surgical resection of liver metastases from colorectal carcinoma underwent permanent implantation with I-125 seeds to deliver 160 gray to the periphery of the target volume. RESULTS: The 1-, 3-, and 5-year actuarial control rates of liver disease were 41%, 23%, and 23%, respectively. The 5-year actuarial control of liver disease was better for patients with a solitary metastasis (39%) than for those with multiple metastases (9%) (P = 0.04). The 1-, 3-, and 5-year actuarial overall survival rates were 71%, 25%, and 8%, respectively (median, 20 months; 95% confidence interval, 17-23). The radiation-related complications were minimal. CONCLUSIONS: I-125 liver brachytherapy is feasible with minimal radiation-related morbidity. Good prognostic factors for long term liver control and survival are the presence of a solitary metastasis, postresection minimal residual disease requiring smaller volume implants, and no prior liver resections. Future prospective trials should be directed toward this patient population, which has the highest probability of obtaining improved results from the local dose escalation provided by brachytherapy. Adjuvant regional chemotherapy clearly is needed due to the high rate of liver recurrence and ultimate death from liver failure observed in spite of liver resection and brachytherapy.     

The effect of age on the response of the rat brains to continuous β-amyloid infusion

Young (3 months old) and aging (18–21 months old) rats were infused intracerebroventricularly with β-amyloid (1–40; 4.2 nmol) for 14 days. In both age groups, β-amyloid led to deficits in water-maze and decreased choline acetyltransferase activity and somatostatin levels. Cortical substance P levels also decreased whereas neuropeptide Y levels remained unaltered. There were no significant age dependent differences among these neurochemicals except a decrease in hippocampal neuropeptide Y levels in the aging group. It is concluded that young and aging rat brains respond similarly to β-amyloid infusion.     

Expression of endothelial phosphorylated caveolin-1 is increased in brain injury

Aims: Increased endothelial caveolae leading to transcytosis of plasma proteins is associated with blood–brain barrier (BBB) breakdown and cerebral oedema in brain injury. Increased expression of caveolin-1α (Cav-1), an integral caveolar membrane protein, was reported in endothelium of arterioles and veins with BBB breakdown to fibronectin post injury. In this study the phosphorylation state of Cav-1 and its association with BBB breakdown was determined in the rat cortical cold injury model over a period of days 0.5–6 post lesion. Methods: Expression of phosphorylated Cav-1 was determined by immunoblotting and dual labelling immunofluorescence for phosphorylated caveolin-1 and fibronectin, a marker of BBB breakdown. A phospho-specific monoclonal antibody that selectively recognizes only tyrosine 14-phosphorylated Cav-1 (PY14Cav-1) was used. Results: Immunoblots showed constitutive expression of PY14Cav-1 in cortex of control rats and a significant increase in PY14Cav-1 expression at the lesion site up to day 4 post lesion. PY14Cav-1 immunostaining was observed in the endothelium of lesion vessels at days 0.5–4 post lesion, in neutrophils at days 0.5 and 2 and in macrophages at day 6 post lesion. Dual labelling showed that 100% of vessels with BBB breakdown to fibronectin showed endothelial PY14Cav-1 on day 0.5, the percentage decreasing to 62% on day 4. On day 6, none of the vessels showed endothelial phosphorylated Cav-1. Conclusions: The presence of phosphorylated Cav-1 in endothelium of vessels showing BBB breakdown suggests that phosphorylated Cav-1 signalling may be one of the factors associated with early BBB breakdown and brain oedema in brain injury.