Clinical and immunohistochemical assessment of vulval intraepithelial neoplasia following photodynamic therapy using a novel bioadhesive patch-type system loaded with 5-aminolevulinic acid

Background: The work in this study appraised photodynamic treatment (PDT) as a treatment method for vulval intraepithelial neoplasia (VIN) using a novel bioadhesive patch to deliver aminolevulinic acid. An analysis of changes in expression of apoptotic and cell cycle proteins (p53, p21, Mdm2, Blc-2, Bax, Ki-67) in response to PDT was evaluated. Methods: PDT was performed using non-laser light, either as a one or two-cycle treatment, with clinical and pathological assessment following after 6 weeks. Twenty-three patients with 25 VIN lesions underwent 49 cycles of PDT Patches were designed to conform to uneven vulval skin and contained 38 mg cm(-2) aminolevulinic acid. Assessment was carried out at 6 weeks post-treatment. Patient-based treatment assessment, along with clinical and pathological changes, were monitored. Immunohistochemical staining was used to elucidate a possible biomolecular basis for induced cellular changes. Results: Most patients (52%) reported a symptomatic response, with normal pathology restored in 38% of lesions. The patch was easy to apply and remove, causing minimal discomfort. Fluorescence inspection confirmed protoporphyrin accumulation. Pain during implementation of PDT was problematic, necessitating some form of local analgesia. Changes in expression of cell cycle and apoptotic-related proteins suggested involvement of apoptotic pathways. Down regulation of p21 and inverse changes in Bcl-2 and Bax were key findings. Conclusion: Treatment of VIN lesions using a novel bioadhesive patch induced changes in cell cycle and apoptotic proteins in response to PDT with possible utilisation of apoptotic pathways. The efficacy of PDT in treating VIN could be improved by a better understanding of these apoptotic mechanisms, the influence of factors, such as HPV status, and of the need for effective pain management.

‘Dealing with the Leftovers: Post Conflict Imprisonment in Northern Ireland’

The criminal justice system in Northern Ireland is experiencing a period of transition from dealing with intense political violence to a situation of relative peace. Although this period has witnessed incredible changes to the justice systemit is evident that many challenges still lay ahead, particularly in regards to the penal system. This article explores the penal system in Northern Ireland since the signing of the peace agreement.

Gaze and power. A post-structuralist interpretation on Perseus’ myth

Gaze hierarchizes, manages and labels reality. Then, according to Foucault, gaze can be understood as a practice of power. This paper is inspired by his theories, and it applies them to one of the most powerful symbolic spheres of Western culture: Greek Myths. Notions such as visibility, invisibility and panopticism bring new light into the story of Perseus and Medusa, and they enable a re-reading of this Myth focused on the different ways of power that emerge from the gaze.

Developing NGO competencies in post-disaster reconstruction: a theoretical framework

In the aftermath of recent natural disasters, NGOs have become increasingly involved in the permanent reconstruction of affected communities. These organizations, often operating well outside their expertise, encounter significant barriers as they implement reconstruction programmes. This paper presents the theoretical bedrock of a current research project, the overall goal of which is to design a competency-based framework model that can be used by NGOs in post-disaster reconstruction projects. Drawing on established theories of management, a unique perspective has been developed from which a competency-based reconstruction theory emerges. This theoretical framework brings together three distinct fields; Disaster Management, Strategic Management and Project Management, each vital to the success of the model. This theoretical study will incorporate a critical review of literature within each field. It is imperative that NGOs involved in post-disaster reconstruction familiarize themselves with concepts and strategies. It is hoped that the competence-based frame-work model that is produced on the basis of this theory will help define the standard of best practice to which future NGO projects might align themselves.