Morphometric study of vocal fold of different sexes of Bangladeshi cadaver

The larynx is an organ of respiration and phonation. Larynx or Voice box is well developed in humans. The sound made by a human being using the vocal folds for talking, singing, laughing, crying, screaming etc. Pitch of the sound depends on the length, tension and mass of the vocal folds. This cross sectional descriptive type of study was done to see the length of the vocal folds and to establish the difference between sexes of adult Bangladeshi people. A total of 29 human larynges of adult age group ranging from 17 to 60 years in the both sexes were collected by purposive sampling during routine postmortem examination at the autopsy laboratory of Department of Forensic Medicine of Mymensingh Medical College, from October 2008 to March 2009. The mean length of vocal fold was measured and significance differences of the dimension between male and female were observed. In the present study observed finding was compared with those of other researchers. In male the mean(+/-SD) length of vocal fold was 23.12(+/-4.06) mm. In female the mean(+/-SD) length of vocal fold was 18.50(+/-2.39) mm. In statistical analysis, difference between male and female values was calculated by using Students (Unpaired) 't' test. The present study revealed that the value was greater in male than in female group and this difference was statistically significant (p<0.01).

Complexity analysis of the uterine electromyography

In respect to the main goal of our ongoing work for predicting preterm birth, we analyze in this paper the complexity of the uterine electromyography (EMG) by using the sample entropy (SampEn) algorithm. By considering recent methodological developments, we measure the SampEn over multiple scales using the wavelet packet decomposition method. The results obtained from the analyzed data indicate that SampEn decreases along pregnancy. Furthermore, we demonstrate that the computed SampEn parameter may discriminate between the two classes (pregnancy/labor). The results are supported by statistical analysis using t-test indicating good statistical significance with a confidence level of 95%. A surrogate data test is also performed to investigate the nature of the underlying dynamics of our experimental data. The results are very promising for monitoring pregnancy and detecting labor to help identify preterm labor.

Lymphedema-distichiasis syndrome without FOXC2 mutation: evidence for chromosome 16 duplication upstream of FOXC2

A patient with the classical phenotype of Lymphedema-Distichiasis syndrome (OMIM 153400) is described who showed no mutations in the sequence of FOXC2. Accordingly, a Gene Chip 250k array analysis was undertaken with dense SNP genotyping of the genomic region surrounding the FOXC2 locus on Chromosome 16 followed by copy number evaluation by real time PCR. The latter assay showed evidence of a duplicated region 5' of FOXC2 that could be causative for the patient's striking phenotype, which included both distichiasis and a hyperplastic refluxing lymphatic vascular and lymph node phenotype associated with pubertal onset lymphedema, scoliosis and strabismus.

Sexual attitudes and their relation to cervical intraepithelial neoplasia in Maiduguri, Nigeria

Five hundred randomly selected sexually active women attending antenatal, postnatal, family planning and gynaecological clinics in the Department of Obstetrics and Gynaecology, University of Maiduguri Teaching Hospital, had questionnaires administered on their sexual attitudes/ behaviour and their 'pap'smears taken for cytological assessment. The aim was to identify any significant association between sexual attitudes/behaviour and cervical intraepithelial neoplasia (CIN) for the purpose of targeting the population most at risk. Ninety-one women had varying degrees of CIN, a prevalence rate of 18.2%. However, multiple sexual partners was the only factor incriminated to significantly increase the risk of occurrence of CIN. Targeting women with multiple sexual partners may help in directing limited screening resources to those more likely to be positive.

Knowledge and attitude to cervical cancer screening among women in Maiduguri, Nigeria

Five hundred women were studied to determine their knowledge of cervical cancer. Less than 10% of the women were aware of the disease or its symptoms. Even fewer were aware of cytological screening, the good results obtained in the premalignant stage and early invasive stages of the disease. Simple explanation showed a good recall at 4-6 weeks. At that time women would accept screening and understood its importance. This study shows clearly that education must precede a screening programme if it is to succeed.

Study of prenatal and postnatal development of spleen of Gallus Domesticus (deshi chicken)

Spleen is one of the secondary or peripheral lymphoid organs along with cecal tonsils in birds. The growth of the spleen of Gallus Domesticus (deshi chicken) from prenatal embryonic day fifteen (ED15) to postnatal day ninety (D90) were studied. In macroscopic study it was found that the shape of the spleen was rounded with slightly flattened from side to side at its middle part at prenatal period (ED15, ED18) and becomes rounded at postnatal stages of the deshi chicken (D90). Regarding position it lies close to the right side of the junction between proventriculus and gizzard and was similar in prenatal and postnatal stages. The result of the present study revealed that the mean diameter and weight of the spleen in deshi chicken gradually increases with increase of age, which were 2.00+/-0.136mm and 0.007+/-0.00gm respectively at ED15 stage and it reaches upto 10.40+/-0.331mm and .303+/-0.004gm respectively at day 90 (D90). It was observed that the differences of diameter & weight of the spleen between different ages were statistically significant (p<0.01). Histologically the spleen was surrounded by thin capsule in prenatal life, which gradually becomes thicker in postnatal life. The splenic pulps were not differentiated into white and red pulp on 15th day of embryonic life (ED15) but they were gradually differentiated into white and red pulp in the late prenatal (ED18) and postnatal period. The growth and development of spleen at each stage of the study period were found to be significantly high. Present study indicates that chicken splenic cell population, structure and function were similar to human spleen histologically. It was also found that the chicken embryo allows easy experimental access to all the stages of the splenic development, so the present study will be helpful for experimentation on lymphoid organs and to understand pathophysiology of immunological diseases of human.

Morphological study of levator glandulae thyroidea in Bangladeshi cadaver

The study was done to see the incidence of levator glandulae thyroidea including its association with pyramidal lobe and its morphological variation regarding its craniocaudal attachment in Bangladeshi people. Sixty postmortem tissue blocks containing thyroid gland and its neighbouring structures were collected from 48 male and 12 female cadavers of different age groups and fixed in 10% formol-saline solution. Gross and fine dissection was carried out to study the incidence of levator glandulae thyroidea, its attachment and its association with pyramidal lobe. In the present study, observed findings were compared with those of Western and Bangladeshi researchers. It was evident that, in the present study, in 43.33% cases levator glandulae thyroidea was present. Among them 84.65% was associated with the pyramidal lobe and in all of these cases it extended from the apex of the pyramidal lobe to hyoid bone. In most of the cases (92%) of this study the levator glandulae thyroideae were cranially found to attach with hyoid bone. Only four muscles those were not associated with pyramidal lobe arise from isthmus. Two of them cranially attached with hyoid bone and remaining two levator glandulae thyroideae cranially was found to be attached with the corresponding oblique line of thyroid cartilage.

Measurement of different external dimensions of the heart in adult Bangladeshi cadaver

The cross sectional descriptive study was carried out to determine the gross morphological parameters regarding heart to establish a racial characteristic of Bangladeshi adult population. To fulfill this aim, different external dimensions of the heart in Bangladeshi adult people of both sexes were measured and compared with the findings of other researchers of Bangladesh and western countries. A total fifty normal human hearts from both sexes were collected during routine postmortem examination in autopsy laboratory of Forensic medicine department of Mymensingh Medical College, Mymensingh on different dates from August 2003 to April 2004. The age at death of cadavers was ranged from 20 to 60 years. The mean weight, length, breadth and antero-posterior diameter were measured and the following values were found. In male the mean (+/-SD) weight was 247.92(+/-40.26) gm, mean (+/-SD) length was 10.5(+/-0.62) cm, mean (+/-SD) breadth was 8.51(+/-0.61) cm and mean (+/-SD) antero-posterior diameter was 5.86(+/-0.63) cm. In female the mean (+/-SD) weight was 164.29(+/-33.56) gm, mean (+/-SD) length was 9.2(+/-0.89) cm, mean (+/-SD) breadth was 7.67(+/-0.61) cm and mean (+/-SD) antero-posterior diameter was 5.47(+/-0.55) cm. In statistical analysis, difference between male and female values was calculated by using students 't' test. The present study revealed that the values were always greater in male than in female group, though statistically there was no significant difference (p>0.05) between them.

Quantitative assessment of brain iron by R2* relaxometry in patients with clinically isolated syndrome and relapsing–remitting multiple sclerosis

Background

Increased iron deposition has been implicated in the pathophysiology of multiple sclerosis (MS), based on visual analysis of signal reduction on T2-weighted images. R2* relaxometry allows to assess brain iron accumulation quantitatively.

Objective

To investigate regional brain iron deposition in patients with a clinically isolated syndrome (CIS) or relapsing–remitting MS (RRMS) and its associations with demographical, clinical, and conventional magnetic resonance imaging (MRI) parameters.

Methods

We studied 69 patients (CIS, n = 32; RRMS, n = 37) with 3T MRI and analyzed regional R2* relaxation rates and their correlations with age, disease duration, disability, T2 lesion load, and normalized brain volumes.

Results

Basal ganglia R2* relaxation rates increased in parallel with age ( r = 0.3–0.6; P < 0.01) and were significantly higher in RRMS than in CIS ( P < 0.05). Using multivariate linear regression analysis, the rate of putaminal iron deposition was independently predicted by the patients’ age, disease duration, and gray matter atrophy.

Conclusions

Quantitative assessment by R2* relaxometry suggests increased iron deposition in the basal ganglia of MS patients, which is associated with disease duration and brain atrophy. This technique together with long-term follow-up thus appears suited to clarify whether regional iron accumulation contributes to MS morbidity or merely reflects an epiphenomenon.

Tremelimumab in combination with exemestane as novel immunotherapy for patients with advanced breast cancer

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Background: Tremelimumab (CP-675, 206) is a fully human IgG2 anti-CTLA4 monoclonal antibody (mAb) with single-agent antitumor activity presumed to be related to immune stimulation following blockade of CTLA4. Here, we conducted a phase I, open-label, dose-escalation trial of the combination of tremelimumab and exemestane in patients (pts) with advanced hormone receptor (or unknown receptor status if prior response with hormone therapy) breast cancer. Methods: Twenty-five pts with ER+ and/or PR+ breast cancer and 1 pt with unknown receptor status who had relapsed after treatment for advanced disease were enrolled. Pts received escalating doses of tremelimumab (3 to 10 mg/kg) delivered either every 28 days (Q28D) or every 90 days (Q90D) in combination with continuous exemestane (25 mg/day). Primary endpoints were assessment of safety and determination of recommended phase II dose. Tumor response evaluation per RECIST was a secondary endpoint. Results: Overall, 65 cycles of tremelimumab were administered in combination with exemestane. Pts received 3 mg/kg tremelimumab Q28D (n=6), 6 mg/kg tremelimumab Q28D (n=1), 6 mg/kg tremelimumab Q90D (n=13), or 10 mg/kg Q90D (n=6). No pharmacokinetic interaction between tremelimumab and exemestane was observed. Dose-limiting toxicities included transient serum transaminase elevation in cycle 1 (grade 3 in 1 pt) and diarrhea in cycle 1 (grade 3 in 3 pts, 1 of whom was hospitalized with steroid-refractory diarrhea and given anti-tumor necrosis factor-α mAb, infliximab) and cycle 2 (grade 3 in 1 pt). One pt developed grade 2 autoimmune thyroiditis requiring chronic hormone replacement. Other toxicities included constipation (n=6), fatigue (n=8), and rash (n=9). The MTD was 6 mg/kg Q90D. For pts receiving ≥2 cycles of therapy, best response was stable disease in 8 pts lasting 3 to 14 months (median 8 months); no pts had objective responses. Conclusions: MTD of tremelimumab in combination with exemestane is estimated at 6 mg/kg Q90D, which is lower than the single-agent dose of 15 mg/kg Q90D used in phase II and III trials in pts with melanoma or colorectal cancer. This may suggest that there is a biological interaction between tremelimumab and exemestane.

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Functional pathway mapping of human glioblastoma multiforme and brain metastases for patient tailored therapy

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Background: Genome scanning analysis of human glioblastoma multiforme (GBM) has suggested that this form of cancer is a protein pathway disease. Since genomic analysis cannot directly predict protein activation, analysis of protein pathway activation is required. With the current focus on targeted translational therapeutic modalities, a functional understanding of the GBM signaling repertoire is critical, and yet largely unknown. Methods: Twelve tumors were included in this study: 10 GBMs (9 primary, 1 recurrent) and two brain metastases (1 breast and 1 lung). Pure tumor cell populations were obtained from fixed frozen tissue sections using Laser Capture Microdissection. Protein pathway mapping was performed using Reverse Phase Protein Microarrays (RPMA) whereby the activation of 85 key signaling proteins was quantitatively measured at once. Unsupervised and supervised analysis was used to explore pathway activation. Results: Unsupervised hierarchical clustering of all tumors in the study set revealed largely patient-specific signaling portraits yet also identified distinct pathway subsets. The two metastatic tumors clustered separately and distinctly from the GBMs. The GBM specimens clustered according to pathway activity. Statistical analysis demonstrated significant correlations between certain phosphorylated endpoints detected and overall survival. Phosphorylation of cofilin (S3) was associated with shorter survival time, while Stat1 (Y701) and Shc (Y317) phosphorylation were both positively correlated with longer overall survival. Conclusions: This study represents the most comprehensive proteomic analysis of human GBM pathway mapping to date. Since certain pathway biomarkers are themselves being targeted by current investigational therapies, the ability to map pathway activation and identify critical pathway biomarkers can lead to targeted therapeutics tailored to each patient's tumor. The ability to segregate short from long-term survivors according to protein pathway activation is promising.

[Table: see text]

Morphology of sighs and their role in the control of breathing in preterm infants, term infants and adults

BACKGROUND

Although there is evidence that sighs are important to restore lung volume, the factors responsible for inducing a sigh and the effects of sighs on the stability of the respiratory system remain unclear.

OBJECTIVE

To compare newborn with adult sigh morphology in order to better understand the physiological mechanisms that induce sighs and the role sighs play on the control of breathing in infants.

DESIGN/METHODS

We measured respiratory variables during control, the pre-sigh, the sigh, and the post-sigh period during quiet and REM sleep in 10 preterm infants, 10 term infants and 10 adults using a flow-through system.

RESULTS

No significant differences were observed in any of the respiratory variables between the pre-sigh and the control breaths in any of the subjects in any of the two sleep states, suggesting that indices of respiratory drive are not predictive of an impending sigh. Sighs were relatively larger in infants than in adults and had a characteristic biphasic inspiratory flow observed almost exclusively in infants. While post-sigh ventilation was usually increased in adults, it was usually decreased in infants due to the presence of apneas.

CONCLUSIONS

The established indexes of respiratory drive are not predictive of an impeding sigh. When compared with control breaths, sighs are much larger in preterm and term infants than in adults. These big augmented breaths in infants are often followed by apnea and hypoventilation likely secondary to the increased activity of the peripheral chemoreceptors present in neonates.

Selenium intoxication with selenite broth resulting in acute renal failure and severe gastritis

Selenium (Se) is an essential trace element in human and animal nutrition. It is also widely utilized in industrial processes. Reports of acute selenium toxicity in humans are rare. We report a case of a 23-year-old female who consumed about 100 mL of liquid selenite broth and presented with severe nausea, vomiting, abdominal pain, hematemesis and acute renal failure (ARF). The serum selenium level was significantly increased. Gastro-duodenoscopy revealed severe corrosive gastritis. Renal biopsy showed features of acute tubular necrosis (ATN), affecting primarily the proximal tubules. The patient was managed with gastric lavage, blood transfusions, infusion of fresh frozen plasma (FFP) and platelet concentrates and hemo-dialysis. The patient was discharged five weeks after admission and her renal functions recovered completely by eight weeks after admission. She continues to be on regular follow-up for any possible sequelae of mucosal corrosive damage. This case highlights a case of selenium intoxication from selenite broth resulting in ARF and corrosive gastritis. The recovery was complete.

Relationship of uterine artery with ureter

The study was done to see the relationship of right and left uterine artery with corresponding ureter. Their distance from lateral border of uterus and site of crossing in relation to internal os in Bangladeshi female were observed. Sixty post mortem specimens containing uterus, uterine tube, ureter and surrounding structures were collected from cadavers of different age groups and fixed in 10% formol saline solution. Gross and fine dissections were carried out to study the relationship and distance of uterine artery where it crosses the corresponding ureter and the site of crossing in relation to internal os. In the present study our findings were compared with those of the standard text books. In this study, there were no variations regarding relations of right and left uterine artery with corresponding ureter. In all cases of all age groups, ureters were found to cross the uterine artery anteriorly on both sides. Site of crossing of uterine artery of both sides with ureter at the level of internal os was 50% in 2-12 years (Group A) 20.45% in 13-45 years (Group B) and 12.50% in 46-80 years (Group C) age group. Below the level of the os was found in remaining cases except one which crosses above the level of the os in group B. In this study mean distance of uterine artery where it crosses the ureter from lateral border of uterus was more on right side in all age groups, which was 1.67 cm, 2.30 cm and 2.11 cm in age Group A, B & C respectively.

Histomorphological study of lymphoid follicle of vermiform appendix

The study was done to find out the number of lymphoid follicle of vermiform appendix in Bangladeshi people and to increase the knowledge regarding variational anatomy in our population. Total 40 fresh appendixes were collected for histological study of different age and sex during postmortem examination in the autopsy laboratory of Forensic department of Mymensingh Medical College. This cross sectional descriptive study was done by convenient sampling technique. For convenience of differentiating the number of lymphoid follicle of vermiform appendix in relation to age and sex, findings were classified in four groups, up to 20 years, 21 to 35 years, 36 to 55 years and 56 to 70 years. In the present study the number of lymphoid follicle were highest in group A, mean were (5.40+/-1.30) and lowest in group D where mean were (1.05+/-0.35). In male mean were 3.16 and in female mean were 2.86. Diameter of the lymphoid follicle in group A was highest (40.14+/-2.66) and lowest in group D (0.24+/-1.35). Number of germinal centre are highest in group B (2.20 +/- 0.45) and lowest in group D (0.00 +/- 0.00).

Stem cells in pediatric heart failure

Pediatric heart failure could be a target for regenerative therapy. Stem cell-based therapy has the potential to provide functional cardiomyocytes. Whereas adult stem cells have shown no or only minimal therapeutic benefit in adults with no evidence of transdifferentiation, embryonic stem cells can differentiate to any cell type, including cardiomyocytes. However, ethical concerns and immunological problems are associated with embryonic stem cells derived from the inner cell mass of blastocysts. Recently, somatic cells could be reprogrammed to a pluripotent state (i.e. induced pluripotent stem cells) with the help of transcription factors. This technique removes ethical and probably also immunological concerns. Nevertheless extensive experimental research will be necessary before cell replacement strategies become clinically applicable. Because the underlying pathophysiology differs significantly with age, caution is warranted extrapolating data obtained in experimental models of cardiac ischemia and clinical studies in adults to the pediatric population. Pediatric heart failure has a good prognosis if causal therapy is possible. However, some forms of congenital heart disease and especially dilated cardiomyopathy still have limited therapeutic options. Almost half of children with symptomatic cardiomyopathy receive a transplant or die within two years. The authors will review the relevant stem cell sources for cell-based treatments. And, given the differences of the underlying diseases between adult and pediatric patients with heart failure, it is contemplated which condition of pediatric patients with heart failure is most likely to benefit and which cell type would be appropriate.