Evaluation of Gold’s nomogram for predicting recurrence-free survival in gastrointestinal stromal tumors in Indian patients

Gold described a nomogram for prediction of recurrence-free survival (RFS) after surgery for gastrointestinal stromal tumors (GIST). This retrospective study was intended to evaluate the utility of this nomogram for predicting a 2-year RFS in our patients. Twenty-eight consecutive eligible patients from January 2009 to January 2013 who underwent R0 resection and had histopathologically proven GIST were included in the study. Nomogram predicted RFS was compared with observed RFS in four groups as in the National Institutes of Health (NIH)-Fletcher classification. Calibration was assessed by plotting the predicted probabilities of RFS against the actual outcome. For validation of the nomogram, the graph obtained should be closer to the 45-degree line. The observed overall 2-year RFS was 85.7 % (24 patients). Four patients had recurrence within 2 years. The observed RFS was 87.5 %, 77.8 %, 90 %, and 100 % in the high, intermediate, low, and very low risk groups, respectively. The nomogram predicted the 2-year RFS was 40 %, 84.8 %, 88.6 %, and 90 % for high, intermediate, low, and very low risk groups, respectively. Thus, the predicted probabilities of the 2-year RFS in intermediate, low, and very low risk groups were similar to the observed outcomes. However, for the high risk group, the observed RFS was better than predicted RFS. This variation in the high risk group may be due to the use of adjuvant imatinib in our study.     

Development of remineralizing, antibacterial dental materials

Light curable methacrylate dental monomers containing reactive calcium phosphate filler (monocalcium phosphate monohydrate (MCPM) with particle diameter of 29 or 90 μm) and β-tricalcium phosphate (β-TCP) at 1:1 weight ratio in a powder:liquid ratio (PLR) of 1:1 or 3:1 and chlorhexidine diacetate (0 or 5 wt.%), were investigated. Upon light exposure, approximately 90% monomer conversion was gained irrespective of the formulation. Increasing the PLR promoted water sorption by the set material, induced expansion and enhanced calcium, phosphate and chlorhexidine release. Concomitantly, a decline in compressive and biaxial flexural strengths occurred. With a reduction in MCPM particle diameter, however, calcium and phosphate release was reduced and less deterioration in strength observed. After 24 h, the remaining MCPM had reacted with water and β-TCP, forming, within the set materials, brushite of lower solubility. This provided a novel means to control water sorption, component release and strength properties. Measurable chlorhexidine release was observed for 6 weeks. Both diffusion rate and total percentage of chlorhexidine release decreased with lowering PLR or by adding buffer to the storage solutions. Higher chlorhexidine release was associated with reduced bacterial growth on agar plates and in a biofilm fermenter. In cell growth media, brushite and hydroxyapatite crystals precipitated on the composite material surfaces. Cells spread on both these crystals and the exposed polymer composite surfaces, indicating their cell compatibility. These formulations could be suitable antibacterial, biocompatible and remineralizing dental adhesives/liners.     

Outcome of pregnancy in women treated with all-trans retinoic acid; A case report and review of literature

Abstract

All-trans-retinoic acid (ATRA) has been proved to be an effective treatment for acute promyelocytic leukemia (APL), inducing remission in more than 90% of cases. Treatment of APL in pregnancy is controversial as the use of ATRA has been questioned due to the teratogenic effect of retinoids. We report a case of pregnancy in a woman exposed to ATRA during the first trimester. The baby was born healthy, without any anomalies. Review of all reported cases of the use of ATRA in pregnancy revealed no serious adverse outcomes or congenital anomalies although only very few cases had exposure in the first trimester.     

Role of immunosuppressive therapy on clinical,immunological, and angiographic outcome in active Takayasu's arteritis

OBJECTIVE: To evaluate the role of an immunosuppressive regimen consisting of azathioprine and prednisolone on the clinical, immunological, and angiographic outcome in patients with active Takayasu's arteritis (TA). METHODS: Between January 1996 and January 2001, of 65 consecutive newly diagnosed patients with TA not previously treated by any immunosuppressive therapy, 15 fulfilled the criteria for disease activity. Detailed clinical and laboratory evaluation was carried out in these patients. They were treated with a combination of azathioprine and prednisolone for one year, and aortography was carried out in all patients before and after completion of the treatment. RESULTS: All patients had improvement in systemic symptoms and laboratory measures of disease activity within a period of 3 months of onset of treatment. Erythrocyte sedimentation rate decreased from a mean of 55.5 +/- 14.7 mm/h to 21.9 +/- 9.5 mm/h within 3 months (p < 0.001) and further to 20.8 +/- 15.2 at one year (p = NS). C-reactive protein concentrations fell from 4.8 +/- 5.2 mg/dl to 0.5 +/- 0.2 mg/dl at 3 months (p = 0.004) and remained at 0.5 +/- 0.3 mg/dl at one year (p = NS). No changes in the peripheral pulses or differences in limb blood pressures were noted. Repeat angiograms revealed no significant changes compared to baseline. No new lesion appeared in any patient. The immunosuppressive therapy was well tolerated with no notable side effects. CONCLUSION: An immunosuppressive regimen of azathioprine and prednisolone is safe, well tolerated, and effective in ameliorating systemic symptoms and laboratory measures of disease activity in TA, and at least halts progression in angiographic lesions at one year of followup, although it does not seem to lead to a regression of the arterial lesions.     

Sleep-disordered breathing as a mechanism for nocturia: preliminary findings

Nocturia is commonly associated with prostate or bladder problems but is also an important symptom of obstructive sleep apnea, a potentially lethal condition. The primary purpose of this study was to test the relationship between symptoms of sleep-disordered breathing and increased nocturnal urine production as described by the Sleep-Disordered Breathing--Nocturia Model. The purpose of the first phase of this three-phase study was to survey community-dwelling older adults (> 55 years) about nocturia and sleep-disturbance symptoms. A random sample of 1,000 older adults, balanced by ethnicity and gender, were surveyed via a mailed questionnaire. The brief questionnaire included characterizing poor sleep quality, obstructive sleep apnea symptoms, nocturia, lower urinary tract symptoms, naps, and self-rated health. The return rate was low (18%, n = 176), but respondents were equally represented by gender and ethnicity across the targeted age groups. Half of the respondents (n = 87) reported > or = 2 voids per night, two-thirds of whom reported nocturia as bothersome. The data showed that African-American women had significant associations between episodes of nocturia and symptoms of obstructive sleep apnea, poor sleep quality, naps, and lower urinary tract symptoms, thus failing to support the notion that nocturia or sleep-disordered breathing are prostate or gender related. As expected, subjects (n = 80) who volunteered for the later phases of the study, had significantly more problems. These preliminary data suggest that the relationship between obstructive sleep apnea and nocturia is important because older adults are at higher risk of injury due to falls that may occur while attempting to toilet in the dark. Also, older adults may also be at higher risk of receiving inappropriate urologic treatment if they are not screened for sleep disorders when reporting nocturia along with symptoms of excessive daytime sleepiness and sleep-disordered breathing. Phases II and III of the parent study will include a detailed examination of hormonal, biochemical, and physical variables to further test the proposed Sleep-Disordered Breathing--Nocturia Model.     

Effect of ternary phosphate-based glass compositions on osteoblast and osteoblast-like proliferation, differentiation and death in vitro

There is currently a need to expand the range of graft materials available to orthopaedic surgeons. This study investigated the effect of ternary phosphate-based glass (PBG) compositions on the behaviour of osteoblast and osteoblast-like cells. PBGs of the formula (in mol.%) P(2)O(5)(50)-CaO(50-X)-Na(2)O(X), where X is either 2, 4, 6, 8 or 10, were produced and their influence on the proliferation, differentiation and death in vitro of adult human bone marrow stromal cells (hBMSCs) and human fetal osteoblast 1.19 (HFOB 1.19) cells were assessed. Tissue culture plastic (TCP) and hydroxyapatite (HA) were used as controls. Exposure to PBGs in culture inhibited cell adhesion and proliferation and increased cell death in both cell types studied. There was no significant difference in percentage cell death between the PBGs, which was significantly greater than the controls. However, compared with other PBGs, a greater number of cells were found on the 48mol.% CaO which may have been due to either increased adherence or proliferation, or both. This composition was capable of supporting osteogenic proliferation and early differentiation, and supports the notion that chemical modification of the glass could lead to a more biologically compatible substrate with the potential to support osteogenic grafting. Realisation of this potential should lead to the development of novel grafting strategies for the treatment of problematic bone defects.