Therapeutic outcome of 6198 interferon-naïve Egyptian patients with chronic hepatitis C: a real-life experience and lessons to be learned in DAAs' era.

Antiviral therapy for HCV infection has been validated in randomized controlled clinical trials, but its value in the real world is less well studied. There is relatively little data on real-world responses to interferon-based therapies for patients with genotype 4 infection. We aimed to examine experience with large-scale access to antiviral therapy in chronic HCV in a real-life clinical setting in Egypt. Detailed pretreatment data of 6198 IFN-naïve chronic HCV patients who had received PEG-IFN/RBV therapy at Cairo-Fatemic Hospital, Egypt, between 2009 and 2012 were obtained from the HCV database. At week 12, 95.7% of patients had undetectable HCV RNA, and by week 24 and 48, breakthrough was 6% and 4%, respectively. However, 43.7% of patients discontinued treatment prematurely, and intent to treat end of treatment response was 44.6% (79.3% per protocol). Sustai-ned response data were available from only 1281 patients and was 84.9%. Haematological abnormalities were comparable in patients who did or did not comply with therapy. This is the first real-world, large-scale experience of antiviral therapy in chronic HCV in Egypt. Suboptimal response in HCV predominantly genotype 4 was mainly driven by noncompliance as well as gaps in the healthcare system leading to treatment discontinuation. These results need to be considered in the era of all oral antiviral regimes.

Handling the sequelae of breast cancer treatment: use of NPWT to enhance patient independence.

A cancer diagnosis can be an overwhelming experience and has devastating implications for an individual, their family and friends. Radical treatment, although often essential, can have its own health consequences. This case study describes the management of a 38-year-old woman with a portable, non-electrical negative pressure wound therapy device, suggesting benefits in terms of healing, patient independence and improved quality of life. The case study also highlights the importance of effective communication, patient involvement and empowerment in clinical decision-making, showing that an effective client-clinician relationship can help overcome the physical and emotional sequelae of this diagnosis.

Effect of surfactant surface coverage on formation of solid lipid nanoparticles (SLN).

The effect of surfactant surface coverage on formation and stability of Tween 20 stabilized tripalmitin solid lipid nanoparticles (SLN) was investigated. A lipid phase (10% w/w tripalmitin) and an aqueous phase (2% w/w Tween 20, 10 mM phosphate buffer, pH 7) were heated to 75 degrees C and then homogenized using a microfluidizer. The resulting oil-in-water emulsion was kept at a temperature (37 degrees C) above the crystallization temperature of the tripalmitin to prevent solidification of emulsion droplets, and additional surfactant at various concentrations (0-5% w/w Tween 20) was added. Droplets were then cooled to 5 degrees C to initiate crystallization and stored at 20 degrees C for 24 h. Particle size and/or aggregation were examined visually and by light scattering, and crystallization behavior was examined by differential scanning calorimetry (DSC). Excess Tween 20 concentration remaining in the aqueous phase was measured by surface tensiometry. Emulsion droplets after homogenization had a mean particle diameter of 134.1+/-2.0 nm and a polydispersity index of 0.08+/-0.01. After cooling to 5 degrees C at low Tween 20 concentrations, SLN dispersions rapidly gelled due to aggregation of particles driven by hydrophobic attraction between insufficiently covered lipid crystal surfaces. Upon addition of 1-5% w/w Tween 20, SLN dispersions became increasingly stable. At low added Tween 20 concentration (<1% w/w) the SLN formed gels but only increased slightly at higher surfactant concentrations (>1% w/w). The Tween 20 concentration in the aqueous phase decreased after tripalmitin crystallization suggesting additional surfactant adsorption onto solid surfaces. At higher Tween 20 concentrations, SLN had increasingly complex crystal structures as evidenced by the appearance of additional thermal transition peaks in the DSC. The results suggest that surfactant coverage at the interface may influence crystal structure and stability of solid lipid nanoparticles via surface-mediated crystal growth.

Study of the protective effect of ascorbic acid against the toxicity of stannous chloride on oxidative damage, antioxidant enzymes and biochemical parameters in rabbits.

Stannous chloride (SnCl2) is a reducing chemical agent used in several man-made products. SnCl2 can generate reactive oxygen species (ROS). Therefore, the present study has been carried out to investigate the antioxidant action of l-ascorbic acid (AA) in minimizing SnCl2 toxicity on lipid peroxidation, antioxidant enzyme, and biochemical parameters in male New Zealand white rabbits. Animals were assigned to one of four treatment groups: 0mg AA and 0mg SnCl2/kg BW (control); 40 mg AA/kg BW; 20mg SnCl2/kg BW; 20mg SnCl2 plus 40 mg AA/kg BW. Rabbits were orally administered the respective doses every other day for 12 weeks. Results obtained showed that SnCl2 significantly (P<0.05) induced thiobarbituric acid-reactive substances (TBARS; the marker of lipid peroxidation) in plasma, while the activities of glutathione S-transferase (GST), superoxide dismutase (SOD) and catalase (CAT), and the level of sulfhydryl groups (SH-group) were decreased (P<0.05) in blood plasma. Aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (AlP), acid phosphatase (AcP) and lactate dehydrogenase (LDH) activities were decreased (P<0.05). Stannous chloride significantly (P<0.05) increased the levels of plasma total lipid (TL), cholesterol, triglyceride (TG), low-density lipoprotein (LDL) and very low-density lipoprotein (VLDL), glucose, urea and total bilirubin. On the other hand, the level of plasma high-density lipoprotein (HDL), total protein (TP), albumin (A) and globulin (G) were significantly (P<0.05) decreased. Ascorbic acid alone significantly decreased the levels of TBARS, lipids and urea, and increased the activities of GST, SOD and CAT, and the levels of SH-group and proteins. While the rest of the tested parameters were not affected. Also, the presence of AA with SnCl2 alleviated its harmful effects on most of the tested parameters. Therefore, the present results revealed that treatment with AA could minimize the toxic effects of stannous chloride.

Altered gene expression in mice selected for high maternal aggression.

We previously applied selective breeding on outbred mice to increase maternal aggression (maternal defense). In this study, we compared gene expression within a continuous region of the central nervous system (CNS) involved in maternal aggression (hypothalamus and preoptic regions) between lactating selected (S) and nonselected control (C) mice (n= 6 per group). Using microarrays representing over 40,000 genes or expressed sequence tags, two statistical algorithms were used to identify significant differences in gene expression: robust multiarray and the probe logarithmic intensity error method. Approximately 200 genes were identified as significant using an intersection from both techniques. A subset of genes was examined for confirmation by real-time polymerase chain reaction (PCR). Significant decreases were found in S mice for neurotensin and neuropeptide Y receptor Y2 (both confirmed by PCR). Significant increases were found in S mice for neuronal nitric oxide synthase (confirmed by PCR), the K+ channel subunit, Kcna1 (confirmed by PCR), corticotrophin releasing factor binding protein (just above significance using PCR; P= 0.051) and GABA A receptor subunit 1A (not confirmed by PCR, but similar direction). S mice also exhibited significantly higher levels of the neurotransmitter receptor, adenosine A1 receptor and the transcription factors, c-Fos, and Egr-1. Interestingly, for 24 genes related to metabolism, all were significantly elevated in S mice, suggesting altered metabolism in these mice. Together, this study provides a list of candidate genes (some previously implicated in maternal aggression and some novel) that may play an important role in the production of this behavior.

The evolution of gene expression in mouse hippocampus in response to selective breeding for increased locomotor activity.

The evolution of behavior has been notoriously difficult to study at the molecular level, but mouse genetic technology offers new promise. We applied selective breeding to increase voluntary wheel running in four replicate lines of Mus domesticus (S mice) while maintaining four additional lines through random breeding to serve as controls (C mice). The goal of the study was to identify the gene expression profile of the hippocampus that may have evolved to facilitate the increased voluntary running. The hippocampus was of interest because it is known to display marked physiological responses in association with wheel running itself. We used high-density oligonucleotide arrays representing 11,904 genes. To control for the confounding influence of physical activity itself on gene expression, animals were housed individually without access to running wheels, and were sampled during the day when they are normally inactive. Two-month-old female mice in estrus were used (n = 16 total; two per line; 8 S and 8 C). After correcting for an acceptable false discovery rate (10%), 30 genes, primarily involved in transcription and translation, significantly increased expression whereas 23 genes, distributed among many categories including immune function and neuronal signaling, decreased expression in S versus C mice. These changes were relatively small in magnitude relative to the changes in gene expression that occur in the hippocampus in response to wheel running itself. A priori tests of dopamine receptor expression levels demonstrated an increase of approximately 20% in the expression of D2 and D4 receptors. These results suggest that relatively small changes in the expression patterns of hippocampal genes underlie large changes in phenotypic response to selection, and that the genetic architecture of running motivation likely involves the dopaminergic system as well as CNS signaling machinery.

Spectrophotometric determination of trifluoperazine HCl and isopropamide iodide in binary mixture using second derivative and second derivative of the ratio spectra methods.

Two methods are presented for the simultaneous determination of trifluoperazine hydrochloride and isopropamide iodide in binary mixture. The first method depends on second derivative ((2)D) ultraviolet spectrophotometry, with zero crossing and peak to base measurement. The second derivative amplitudes at 270.4 and 230.2 nm were selected for the assay of trifluoperazine hydrochloride and isopropamide iodide, respectively. The second method depends on second derivative of the ratio spectra by division of the absorption spectrum of the binary mixture by a normalized spectrum of one of the components and then calculating the second derivative of the ratio spectrum. The second derivative of the ratio amplitudes at 257 and 228 nm were selected for the determination of trifluoperazine hydrochloride and isopropamide iodide, respectively. The two proposed methods were successfully applied to the determination of the two drugs in laboratory prepared mixtures and in commercial tablets.

Spectrophotometric, spectrofluorimetric and LC determination of trazodone hydrochloride.

Three methods are described for the determination of trazodone hydrochloride in pharmaceutical tablets. The spectrophotometric method was based on the formation of yellow ion pair complex between the basic nitrogen of the drug and bromophenol blue at pH 3.4. The formed complex was extracted with chloroform and measured at 414 nm. The spectrofluorimetric method was based on measurement of the native fluorescence of the drug in 50% acetic acid upon excitation at a maximum of 320 nm and the emission wavelength is 435 nm. The third method was based on the high performance liquid chromatographic determination of trazodone hydrochloride using a reversed phase, ODS column, with a mobile phase of acetonitrile--phosphate buffer at pH 4.5 (60:40, v/v). Quantization was achieved with UV detection at 250 nm based on peak area. The three methods were simple, accurate and suitable for quality control application.

Effects of early angiotensin-converting enzyme inhibition on cardiac gene expression after acute myocardial infarction.

BACKGROUND: ACE inhibition after myocardial infarction (MI) has been shown to have beneficial effects on cardiac anatomy and function. The purpose of this study was to examine the effects of ACE inhibition on cardiac gene expression after MI. METHODS AND RESULTS: Rats were randomized to receive captopril or no treatment 1 day after MI. Eight weeks later, cardiac function and hemodynamics were measured by use of indwelling catheters and perivascular flow probes. Myocardial gene expression was assessed with DNA microarrays and real-time reverse transcription-polymerase chain reaction. The ratios of heart and left ventricular weights to body weight were significantly increased by MI and normalized by captopril. Cardiac index and stroke volume index were lower in the untreated MI group than in sham controls but were normal in the MI+captopril group. Thirty-seven genes were found to be differentially expressed between the untreated MI group and sham controls; 31 were induced and 6 repressed. Captopril partially or completely inhibited changes in 10 of the genes. The 37 genes clustered into 11 functional groups, and 6 had >/=1 genes whose expression was modified by ACE inhibition. CONCLUSIONS: ACE inhibition after MI inhibits cardiac hypertrophy, preserves cardiac function, and attenuates changes in myocardial gene expression. Gene expression profiling reveals, however, that some elements of the pathophysiology may be unaffected by the treatment and be targets for new therapies.

Negative transcriptional regulation mediated by thyroid hormone response element 144 requires binding of the multivalent factor CTCF to a novel target DNA sequence.

DNA target sites for a "multivalent" 11-zinc-finger CCTC-binding factor (CTCF) are unusually long ( approximately 50 base pairs) and remarkably different. In conjunction with the thyroid receptor (TR), CTCF binding to the lysozyme gene transcriptional silencer mediates the thyroid hormone response element (TRE)-dependent transcriptional repression. We tested whether other TREs, which in addition to the presence of a TR binding site require neighboring sequences for transcriptional function, might also contain a previously unrecognized binding site(s) for CTCF. One such candidate DNA region, previously isolated by Bigler and Eisenman (Bigler, J., and Eisenman, R. N. (1995) EMBO J. 14, 5710-5723), is the TRE-containing genomic element 144. We have identified a new CTCF target sequence that is adjacent to the TR binding site within the 144 fragment. Comparison of CTCF recognition nucleotides in the lysozyme silencer and in the 144 sequences revealed both similarities and differences. Several C-terminal CTCF zinc fingers contribute differently to binding each of these sequences. Mutations that eliminate CTCF binding impair 144-mediated negative transcriptional regulation. Thus, the 144 element provides an additional example of a functionally significant composite "TRE plus CTCF binding site" regulatory element suggesting an important role for CTCF in cooperation with the steroid/thyroid superfamily of nuclear receptors to mediate TRE-dependent transcriptional repression.

Postembryonic development of the midline glia in the CNS of Drosophila: proliferation, programmed cell death, and endocrine regulation.

The development of Drosophila midline glia during larval and pupal stages was characterized by localizing beta-gal expression in enhancer trap lines, as well as with BrdU incorporation and pulse-chase experiments. At hatching about 40 to 50 glial cells are present along the midline of the ventral nerve cord (2 to 3 dorsal and 1 to 2 ventral cells per neuromere). The cells proliferate during the third larval instar and spread dorsoventrally within the midline, increasing in number to about 230 or more (around 20 cells per neuromere). Cell divisions cease shortly after pupariation, and the cells persist for the first half of pupal life with no apparent changes in numbers or positions. Between 50 and 80% of metamorphosis, however, virtually all of the midline glia undergo programmed cell death. Tissue culture experiments indicate that the peak of ecdysteroids occurring at pupariation is required for the cessation of proliferation of midline glia and their subsequent degeneration. Midline glia in central nervous systems (CNS) cultured with low or no ecdysteroids survive and continue to divide, whereas they cease proliferating and later degenerate with high ecdysteroids levels. The midline glial may play a role during CNS metamorphosis similar to that of their progenitors in the embryo, in stabilizing outgrowing neurites that cross or run along the midline.

Development of the two-part pattern during regeneration of the head in hydra.

The head of a hydra is composed of two parts, a domed hypostome with a mouth at the top and a ring of tentacles below. When animals are decapitated a new head regenerates. During the process of regeneration the apical tip passes through a transient stage in which it exhibits tentacle-like characteristics before becoming a hypostome. This was determined from markers which appeared before morphogenesis took place. The first was a monoclonal antibody, TS-19, that specifically binds to the ectodermal epithelial cells of the tentacles. The second was an antiserum against the peptide Arg-Phe-amide (RFamide), which in the head of hydra is specific to the sensory cells of the hypostomal apex and the ganglion cells of the lower hypostome and tentacles. The TS-19 expression and the ganglion cells with RFamide-like immunoreactivity (RLI) arose first at the apex and spread radially. Once the tentacles began evaginating in a ring, both the TS-19 antigen and RLI+ ganglion cells gradually disappeared from the presumptive hypostome area and RLI+ sensory cells appeared at the apex. By tracking tissue movements during morphogenesis it became clear that the apical cap, in which these changes took place, did not undergo tissue turnover. The implications of this tentacle-like stage for patterning the two-part head are discussed.

Effect of dietary fats on the lipid composition and enzyme activities of rat cardiac sarcolemma.

The effect of dietary lipids on the lipid composition and the activities of some enzymes of cardiac sarcolemma were studied. Feeding rats coconut oil--rich diet for 4 weeks resulted in a significant decrease in 5'-nucleotidase, phosphodiesterase I and p-nitrophenylphosphatase activity of cardiac sarcolemma as compared with feeding rats safflower oil. Sarcolemma from animals fed coconut oil diet contained a significantly lower concentration of total polyunsaturated fatty acids and a higher concentration of total monounsaturated fatty acids than that from rats fed safflower oil. Most of the alterations in polyunsaturated fatty acids were found in 20:4, whereas those of the monounsaturates were found in 18:1. Among all the phosphoglycerides, the fatty acid composition of the phosphatidylcholine exhibited the largest alterations as a result of coconut oil feeding. No dietary effect was observed in the sarcolemma content of cholesterol and phospholipid. These studies clearly indicate that manipulation of dietary lipids influences both the fatty acid composition and some functional properties of the sarcolemma membranes.