Gallyas Silver Impregnation of Myelinated Nerve Fibers

In the nervous system of vertebrates, nerve impulse propagation is accelerated by the ensheathment of neuronal axons with myelin. Myelin sheaths are molecularly specialized, lipid-rich plasma membrane extensions of Schwann cells in the peripheral nervous system and oligodendrocytes in the central nervous system (CNS). To visualize myelinated nerve fibers and to allow for the morphological analyses of myelin in the brain and the spinal cord, an efficient method for silver impregnation of myelin has originally been developed by Ferenc Gallyas in 1979, referred to as Gallyas silver impregnation. Gallyas' method is based on the agyrophilic characteristic of myelin to form and bind silver particles, while this process is suppressed in tissues other than myelin. The silver particles are finally enhanced in a developing step ("physical developer"). The main advantage of this method is that it efficiently visualizes both large myelinated fiber tracts and individual myelinated axons. Here we provide our laboratory protocol that is suitable for paraffin embedded sections and the use of light microscopy based on Gallyas' original protocol and subsequent modifications by Pistorio and colleagues.

Persistent collection of antibiotic ointment masquerading as a lipoma arising at a surgical site

Antibiotic ointments are often used to treat or prevent infections in surgical wounds. However, due to a dearth of reports on adverse effects, the complications of the use of such ointments, especially possible long-term effects, are largely unknown. We experienced a unique case of a cystic lesion that developed after surgical site infection treated with gentamicin ointment in a 62-year-old man who underwent subtotal glossectomy for tongue cancer. The antibiotic ointment that was applied following abscess drainage remained there, replacing the abscess cavity and forming an oval mass. The lesion was found incidentally on follow-up MR examination to monitor cancer recurrence. On both T1- and T2-weighted images, it showed high-intensity reflecting oily base material, constituting the ointment, which appeared to be a fat-containing tumor such as a lipoma that had arisen at the surgical site. Echo-guided drainage extracted the ointment, which was seemingly unaltered from the time it was applied 11 months before. We describe the clinical course and imaging findings to acknowledge this potential adverse effect associated with topical antibiotic treatment for surgical site infection.

Effectiveness of Paraffin and Sustained Stretch in Treatment of Shoulder Contractures Following a Burn Injury

OBJECTIVE

To examine if range of motion of the shoulder treated with paraffin will be better than that of the shoulder treated with sustained stretch alone.

DESIGN

Pilot randomized controlled trial.

SETTING

Regional burn center.

PARTICIPANTS

Patients (N=23) who sustained a burn injury, with a shoulder active abduction and/or flexion in the +70° to +150° degree range, who were 14 years or older, were receiving follow-up physical therapy after discharge from hospital, and provided a signed consent to participate.

INTERVENTIONS

Group A received sustained stretch and paraffin, and group B received sustained stretch only. Both groups had 6 sessions of treatment over 2 weeks.

MAIN OUTCOME MEASURES

Active range of motion (AROM) and active-assisted range of motion (AAROM) for shoulder flexion (SF) and shoulder abduction (SA) were measured before and after each treatment session.

RESULTS

For pretreatment measurements, only the results for SF AAROM had significant time effects. For posttreatment measurements, SF AROM and SF AAROM had significant effects for time. Session 1 was significantly lower than sessions 2, 3, 4, and 6 for both measures, and additionally, session 1 was significantly lower than session 5 for SF AAROM. For SA AROM, a group-by-time interaction effect was significant, with scores for the paraffin group relatively stable across sessions, and the nonparaffin group had peaks at sessions 3 and 6. There were no significant effects for (1) within-session changes to examine improvement during a session or (2) presession scores across the 6 sessions showing maintenance of motion. Total change from the first session presession measurement to the sixth session postsession measurement for the 2 treatment groups were nonsignificantly different.

CONCLUSIONS

As shown in this study, sustained stretching with paraffin may be a valuable adjunct to range of motion intervention for the shoulder after burn injury.

Paraffin/red mud phase change energy storage composite incorporated gypsum-based and cement-based materials: Microstructures, thermal and mechanical properties

In this study, paraffin/red mud phase change energy storage composites were fabricated at 4 mix proportions with paraffin to red mud ratios of 0.4:0.6, 0.45:0.55, 0.5:0.5, and 0.55:0.45 by a mixed mill-heating method. Scanning electron microscopy (SEM) and Fourier transform infrared (FT-IR) results reveal that paraffin flows well into red mud pores and has good compatibility. The differential scanning calorimetry (DSC) results reveal that the melting temperatures of the paraffin/red mud phase change energy storage composite vary from 75℃ to 85℃, and the latent heat value is approximately 25-40J/g. High thermal stability is observed by the thermogravimetric analysis (TG) method. The Brunauer Emmett Teller (BET) isotherms, laser particle sizer, X-ray diffraction analysis (XRD), and laser Raman spectrograph (LRS) show that the phase change energy storage composite does not produce a new material from the raw materials and that the material has a stable performance. Furthermore, the paraffin/red mud phase change energy storage composite was incorporated into the cement-based and gypsum-based materials at 10%, 20%, and 30% weight. The heat storage performance can be improved remarkably with an increase in the addition of phase change energy storage composite replacement. The compressive strength change is minimal with the addition of 10% and 20%, and the compressive strength decreases by nearly 40% with the addition of 30%. The paraffin/red mud phase change energy storage composite has a large influence on the flexural strength.

Making Formalin-Fixed, Paraffin Embedded Blocks

Paraffin embedding is a standard technique used in clinical and research laboratories to create a formalin-fixed, paraffin-embedded (FFPE) block of tissue. Formalin-fixed tissue undergoes tissue processing and then is embedded in paraffin (wax) to create a FFPE block or paraffin block. The paraffin block can be cut using a microtome to generate thin sections of tissue contained in paraffin to be stained or paraffin tissue ribbons suitable for nucleic acid extraction. In addition, the FFPE blocks can be stored at room temperature for years. Herein, we provide a basic knowledge, and introduce common methods of the paraffin embedding process.

Reciprocal nerve staining (RNS) for the concurrent detection of choline acetyltransferase and myelin basic protein on paraffin-embedded sections

BACKGROUND

Objective of our work was to develop a sequential double nonfluorescent immunostaining method which allows the selective identification of myelinated motor fibers in paraffin-embedded samples of peripheral nerves. Motor recovery after a nerve gap-lesion repaired by artificial nerve-guides ("conduits") is often less complete and slower than sensory recovery. The mechanism for this is not fully understood.

NEW METHOD

Incubation in sheep polyclonal choline acetyltransferase antibody (Abcam 18,736) at dilution of 1:150 was followed by incubation in mouse monoclonal anti-myelin basic protein antibody (Abcam 62,631) at a dilution of 1:5000. Counterstaining was performed with hematoxylin QS (Vector Labs H-3404).

RESULTS

Immunostaining of choline acetyltransferase and myelin basic protein can be combined together and results show a good contrast between the light brown of the choline acetyltransferase reaction product and the green of myelin basic protein reaction product. Cell nuclei are stained blue. This new protocol retains the advantages of paraffin embedded sections such as (i) having a relatively simple methodology, (ii) years-long storage life, and (iii) easy sharing among laboratories. Comparison with existing method. This specific combinatorial protocol has never been used before on paraffin embedded sections. It has been named "reciprocal nerve staining" (RNS).

CONCLUSIONS

Routine combination of choline acetyltransferase and myelin basic protein immunostaining provides a highly specific, highly contrasted paraffin-embedded sections where optical differentiation of myelinated motor fibers is easy and straightforward. This method will likely simplify and speed-up the routine histological study of nerve regeneration and will contribute a better identification of the nerve motor component.

Diagnosis of T-cell-mediated kidney rejection in formalin-fixed, paraffin-embedded tissues using RNA-Seq-based machine learning algorithms

Molecular diagnosis is being increasingly used in transplant pathology to render more objective and quantitative determinations that also provide mechanistic and prognostic insights. This study performed RNA-Seq on biopsies from kidneys with stable function (STA) and biopsies with classical findings of T-cell-mediated rejection (TCMR). Machine learning tools were used to develop prediction models for distinguishing TCMR and STA samples using the top genes identified by DSeq2. The prediction models were tested on 703 biopsies with Affymetrix chip gene expression profiles available in the public domain. Linear discriminant analysis predicted TCMR in 55 of 67 biopsies labeled TCMR, and 65 of 105 biopsies designated as antibody-mediated rejection. The random forest and support vector machine models showed comparable performance. These data illustrate the feasibility of using RNA-Seq for molecular diagnosis of TCMR in formalin-fixed tissue. Application of the derived diagnostic algorithms to publicly available data sets demonstrates frequent coexistence of TCMR in biopsies designated as antibody-mediated rejection. This underrecognition of TCMR in renal allograft biopsies has significant implications with respect to patient care.

Novel red fluorescence protein based microplate assay for drug screening against dormant Mycobacterium tuberculosis by using paraffin

The hypoxia model of dormancy is widely used in drug screening programs to identify novel inhibitors against latent Mycobacterium tuberculosis disease. In earlier reported microplate assays, hypoxia was maintained by either sealing the microplate or shifting in an anaerobic chamber to develop dormant phenotype. In these assays, inhibitors were added during inoculation, which mainly represents the active stage inhibitors instead of the dormant ones. Herein, the culture was covered with paraffin to develop hypoxia condition and consequently providing the advantage of adding compounds at any stage during incubation of 96-well plate. The stable expression of the red fluorescent protein in the bacilli under both actively growing as well as dormant conditions also facilitate the reliable estimation of growth and inhibition kinetics of bacilli in medium. Furthermore, S/N ratio and Z' factor of this assay were found to be > 27 and 0.91-0.94 respectively, which confirm the robustness of the protocol. This newly developed drug-screening assay offers an easy, inexpensive, safe and high throughput-screening tool to search novel antitubercular inhibitors against both active and dormant bacilli. The red fluorescent H37Ra strain is a suitable surrogate for the more virulent H37Rv strain, and thus this effort will help in combating latent tuberculosis.

Mesangial C4d Deposits in Early IgA Nephropathy

BACKGROUND AND OBJECTIVES

The prognostic value of mesangial C4d deposits in IgA nephropathy has been analyzed in patients with reduced GFR but has not been analyzed in those with normal kidney function. The main objective of the study was to analyze the prognostic value of C4d deposits and association with response to treatment in patients with IgA nephropathy and normal GFR.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

This retrospective cohort study included 190 patients with idiopathic IgA nephropathy diagnosed by kidney biopsy between 1988 and 2005. The patients had GFR≥80 ml/min per 1.73 m2 at the time of diagnosis, and they had a paraffin-embedded kidney biopsy with eight glomeruli available.

RESULTS

In total, 170 (89%) and 20 (11%) patients were >18 and <18 years old, respectively; median (interquartile range) follow-up was 15 (12-22) years. Mesangial C4d deposit prevalence was 20% (38 of 190). At diagnosis, C4d-positive versus -negative patients had higher protein-to-creatinine ratio (median [interquartile range]: 1.94 g/g [0.9-3.1] versus 1.45 g/g [0.9-2.2]; P=0.04). During follow-up, C4d-positive patients showed a higher number of nephritic flares (median [range]: 1.4 [0-5] versus 0.9 [0-2]; P=0.04), had a higher protein-to-creatinine ratio (median [interquartile range]: 1.32 g/g [0.7-1.7] versus 0.89 g/g [0.1-1.3]; P<0.01), were more prone to receive repeated treatment with corticosteroids (45% versus 24%; P<0.01), and showed a larger reduction in eGFR (-1.6 versus -0.8 ml/min per 1.73 m2 per year; P=0.04). Furthermore, the presence of mesangial C4d deposits was an independent predictor of long-term kidney survival.

CONCLUSIONS

C4d deposits may be one of the earliest poor prognostic variables available for patients with idiopathic IgA nephropathy and normal kidney function at the time of diagnosis. However, Cd4 deposits alone are not associated with the response to angiotensin blockers or corticosteroid treatment.

Carbon nanotube/paraffin/montmorillonite composite phase change material for thermal energy storage

A composite phase change material (PCM) comprised of organic montmorillonite (OMMT)/paraffin/grafted multi-walled nanotube (MWNT) is synthesized via ultrasonic dispersion and liquid intercalation. The microstructure of the composite PCM has been characterized to determine the phase distribution, and thermal properties (latent heat and thermal conductivity) have been measured by differential scanning calorimetry (DSC) and a thermal constant analyzer. The results show that paraffin molecules are intercalated in the montmorillonite layers and the grafted MWNTs are dispersed in the montmorillonite layers. The latent heat is 47.1 J/g, and the thermal conductivity of the OMMT/paraffin/grafted MWNT composites is 34% higher than that of the OMMT/paraffin composites and 65% higher than that of paraffin.

Plastic pollution on the Baltic beaches of Kaliningrad region, Russia

Contamination of sandy beaches of the Baltic Sea in Kaliningrad region is evaluated on the base of surveys carried out from June 2015 to January 2016. Quantity of macro/meso/microplastic objects in the upper 2cm of the sandy sediments of the wrack zone at 13 sampling sites all along the Russian coast is reported. Occurrence of paraffin and amber pieces at the same sites is pointed out. Special attention is paid to microplastics (range 0.5-5mm): its content ranges between 1.3 and 36.3 items per kg dry sediment. The prevailing found type is foamed plastic. No sound differences in contamination are discovered between beaches with high and low anthropogenic load. Mean level of contamination is of the same order of magnitude as has been reported by other authors for the Baltic Sea beaches.

Sudan Black B, The Specific Histochemical Stain for Lipofuscin: A Novel Method to Detect Senescent Cells

The Sudan-Black-B (SBB) histochemical stain is well known to specifically react against lipofuscin, an aggregate of oxidized proteins, lipids, and metals. Lipofuscin is related to many ageing processes. It is also known to accumulate in senescent cells. We recently proved that lipofuscin detection, when applying the SBB staining, is highly specific for the visualization of senescent cells. Here, we present in detail this SBB method that can detect senescent cells in any material, irrespective of its preparation. This provides unique advantages not only in understanding physiological processes and the pathophysiology of various diseases but also in estimating the response to therapeutic interventions.

Paraffin Granuloma Associated with Buried Glans Penis-Induced Sexual and Voiding Dysfunction

A paraffinoma is a type of inflammatory lipogranuloma that develops after the injection of an artificial mineral oil, such as paraffin or silicon, into the foreskin or the subcutaneous tissue of the penis for the purpose of penis enlargement, cosmetics, or prosthesis. The authors experienced a case of macro-paraffinoma associated with sexual dysfunction, voiding dysfunction, and pain caused by a buried glans penis after a paraffin injection for penis enlargement that had been performed 35 years previously. Herein, this case is presented with a literature review.

Combined treatment with paraffin, manual therapy, pegboard and splinting in a patient with post-traumatic stiff hand

Background

The stiff hand is a still common, severe complication of hand injuries.

Case presentation

We report here the case of a 56 year-old woman, professional goldsmith, who suffered a distal radius fracture of her right hand. The patient was treated with surgery followed by four weeks of immobilization, and developed a stiff hand. Physical examination showed mild inflammatory signs, pain and a major limitation in the extension and supination of the wrist, and in the mobility of the II, III, IV and V metacarpophalangeal (-5° and 32° of average passive extension and flexion, respectively) and interphalangeal (-35° and 73° of average passive extension and flexion, respectively) joints. There was a lack of slip of the flexor tendons. The diagnosis of complex regional pain syndrome was considered although it could not be definitely established. After five months of adverse evolution the patient was referred to our center where a combined intervention with paraffin, manual therapy, prolonged active and passive stretch on a pegboard, and splinting was applied. After initiation of this therapy, a marked change in the evolution of the pain, the mobility and functionality of the hand was observed. At the end of the rehabilitation program the patient was able to fully resume her job.

Conclusion

The present case illustrates the need of intensive treatment for post-traumatic hand stiffness, and describes, as an original contribution, a combined intervention therapy including paraffin, manual therapy, pegboard and splinting.

A case of lipoid pneumonia caused by inhalation of vaporized paraffin from burning candles

A 66-year-old woman was referred to our hospital for investigation of interstitial lung disease. She had spent most of her time in a shrine, and had always been exposed to vaporized paraffin from burning candles. Chest High-resolution computed tomography (HRCT)showed ground-glass attenuation with thickening of septal lines, wh create the so-called "crazy-paving appearance". Although bronchoalveolar lavage(BAL) and transbronchial biopsy were performed to aid in diagnosis, the findings did not reveal any conclusive information. Improvements on chest radiographs and in the patient's symptoms were observed without any therapeutic intervention; however, one year later, her chest X-ray showed deteriorative changes. Surgical lung biopsy was performed, and the pathological findings were consistent with those of lipoid pneumonia. The patient showed spontaneous remission of the disease. The cause of exogenous lipoid pneumonia was attributed to inhalation of vaporized paraffin from burning candles in the shrine. This is the first case of lipoid pneumonia that was found to develop from exposure to vaporized paraffin.

Immunohistochemical techniques for the human inner ear

In this review, we provide a description of the recent methods used for immunohistochemical staining of the human inner ear using formalin-fixed frozen, paraffin and celloidin-embedded sections. We also show the application of these immunohistochemical methods in auditory and vestibular endorgans microdissected from the human temporal bone. We compare the advantages and disadvantages of immunohistochemistry (IHC) in the different types of embedding media. IHC in frozen and paraffin-embedded sections yields a robust immunoreactive signal. Both frozen and paraffin sections would be the best alternative in the case where celloidin-embedding technique is not available. IHC in whole endorgans yields excellent results and can be used when desiring to detect regional variations of protein expression in the sensory epithelia. One advantage of microdissection is that the tissue is processed immediately and IHC can be made within 1 week of temporal bone collection. A second advantage of microdissection is the excellent preservation of both morphology and antigenicity. Using celloidin-embedded inner ear sections, we were able to detect several antigens by IHC and immunofluorescence using antigen retrieval methods. These techniques, previously applied only in animal models, allow for the study of numerous important proteins expressed in the human temporal bone potentially opening up a new field for future human inner ear research.

Post-mortem Reperfusion of a Pig: a First Step to a New Surgical Training Model?

The purpose of this experimental study was to establish a short-term post-mortem circulation in a pig model using liquid paraffin. This study also investigated the quality of vascular perfusion in the peripheral tissues. This is the first step in the development of a new revascularized human surgical training model. This first experience was performed on the hind leg of a pig. Initial cannulation of the external iliac artery and vein was followed by connection of the arterial inflow to a heart-lung machine and using the venous outflow to flush post-mortem clots and blood. Subsequently, after connecting the venous outflow to the heart-lung machine, circulation was initiated. Circulation was established during 27 min, during which the flow was constantly 130 mL/min. A steady increase in inlet pressure was observed during the experiment, which finally reached a minimum value of 124 mmHg. Perfusion was interrupted early due to an uncontrollable fluid leak. Afterwards, the distal hind leg was incised showing an equal distribution of paraffin. A short-term revascularization was successfully re-established under excellent conditions. Although the results are promising, further experiments are necessary to eventually perform a wide range of surgical procedures on revascularized human cadavers.

Temperature-Responsive Tensile Actuator Based on Multi-walled Carbon Nanotube Yarn

Many temperature indicators or sensors show color changes for materials used in food and medical fields. However, they are not helpful for a color-blind person or children who lack judgment. In this paper, we introduce simply fabricated and more useful low-temperature indicator (~30 °C) for devices that actuates using paraffin-infiltrated multi-walled carbon nanotube (MWCNT) coiled yarn. The density difference of MWCNT yarn provides large strain (~330 %) when heat causes the melted polymer to move. Furthermore, the MWCNT yarn decreases the melting point of paraffin. These properties allow control of the actuating temperature. In addition, mechanical strength was enhanced by MWCNT than previously reported temperature-responsive actuators based on shape memory polymers. This simply fabricated temperature indicator can be applied in latching devices for medical and biological fields.

Petroleomics by Direct Analysis in Real Time-Mass Spectrometry

The analysis of crude oil and its fractions by applying ambient ionization techniques remains underexplored in mass spectrometry (MS). Direct analysis in real time (DART) in the positive-ion mode was coupled to a linear quadrupole ion trap Orbitrap mass spectrometer (LTQ Orbitrap) to analyze crude oil, paraffin samples, and porphyrin standard compounds. The ionization parameters of DART-MS were optimized for crude oil analysis. DART-MS rendered the optimum conditions of the operation using paper as the substrate, T = 400°C, helium as the carrier gas, and a sample concentration ≥6 mg mL(-1). In the crude oils analysis, the DART(+)-Orbitrap mass spectra detected the typical N, NO, and O-containing compounds. In the paraffin samples, oxidized hydrocarbon species (Ox classes, where x = 1-4) with double-bond equivalent of 1-4 were detected, and their structures and connectivity were confirmed by collision-induced dissociation (CID) experiments. DART(+)-MS has identified the porphyrin standard compounds as [M + H](+) ions of m/z 615.2502 and 680.1763, where M = C44H30N4 and C44H28N4OV, respectively, based on the formula assignment and by phenyl losses observed on CID experiments.

Imaging of adipose tissue

Adipose tissue is an endocrine organ that specializes in lipid metabolism and is distributed throughout the body in distinct white adipose tissue (WAT) and brown adipose tissue (BAT) depots. These tissues have opposing roles in lipid metabolism with WAT storing excessive caloric intake in the form of lipid, and BAT burning lipid through nonshivering thermogenesis. As accumulation of lipid in mature adipocytes of WAT leads to obesity and increased risk of comorbidity (Pi-Sunyer et al., 1998), detailed understanding of the mechanisms of BAT activation and WAT accumulation could produce therapeutic strategies for combatting metabolic pathologies. As morphological changes accompany alterations in adipose function, imaging of adipose tissue is one of the most important tools for understanding how adipose tissue mass fluctuates in response to various physiological contexts. Therefore, this chapter details several methods of processing and imaging adipose tissue, including bright-field colorimetric imaging of paraffin-sectioned adipose tissue with a detailed protocol for automated adipocyte size analysis; fluorescent imaging of paraffin and frozen-sectioned adipose tissue; and confocal fluorescent microscopy of whole mounted adipose tissue. We have also provided many example images showing results produced using each protocol, as well as commentary on the strengths and limitations of each approach.

High expression of epidermal growth factor-like domain 7 is correlated with poor differentiation and poor prognosis in patients with epithelial ovarian cancer

Objective

The purpose of this study was to evaluate the expression of epidermal growth factor-like domain 7 (EGFL7) in epithelial ovarian cancer, and to assess its relevance to clinicopathological characteristics and patients' survival.

Methods

A total of 177 patients with epithelial ovarian cancer were enrolled in the current study. For each patient, a retrospective review of medical records was conducted. Immunohistochemical staining for EGFL7 was performed using tissue microarrays made with paraffin-embedded tissue block. EGFL7 expression levels were graded on a grade of 0 to 3 based on the percentage of positive cancer cells. We analyzed the correlations between the expression of EGFL7 and various clinical parameters, and also analyzed the survival outcome according to the EGFL7 expression.

Results

The expression of EGFL7 in ovarian cancer tissues was observed in 98 patients (55.4%). High expression of EGFL7 (grade 2 or 3) was significantly correlated with pathologic type, differentiation, stage, residual tumor after debulking surgery, lymphovascular space involvement, lymph node metastasis, high cancer antigen 125, peritoneal cytology, and ascites. Among these clinicopathologic factors, differentiation was significantly correlated with EGFL7 expression in multivariate analysis (p<0.05). Survival analysis showed that the patients with high EGFL7 expression had a poorer disease free survival than those with low EGFL7 expression (p=0.002).

Conclusion

Our data suggest that EGFL7 expression is a novel predictive factor for the clinical progression of epithelial ovarian cancer, and may constitute a therapeutic target for antiangiogenesis therapy in patients with epithelial ovarian cancer.

B, Budhooram S, Ramsewak S, Ramdass MJ, Naraynsingh V. Topical "soft candle" applications for infected diabetic foot wounds: a cause for concern?

AIMS

There is a cultural barrier to early medical intervention for diabetic foot infections in Trinidad & Tobago, stemming from the strong cultural belief in "soft candle" as effective treatment. We carried out a case-control study to evaluate the outcomes of "soft candle" to treat diabetic foot infections.

METHODS

ALL CONSECUTIVE PATIENTS ADMITTED WITH DIABETIC FOOT INFECTIONS WERE INTERVIEWED TO COLLECT DATA ON: demographics, medical history, unhealthy lifestyle markers (exposure to risk factors for chronic diseases), chosen treatment and details of "soft candle" use. The hospital records were accessed on discharge to records the main outcome measures: HbA1c readings, duration of hospitalization, amputation and in-hospital mortality. Two groups were defined: The control group included patients who sought medical attention after detecting a foot infection. The study group included patients who recognized their infection but voluntarily chose to utilize "soft candle" regimens. We excluded patients who voluntarily chose to use other forms of non-traditional treatment or sought no treatment at all. Outcomes were compared using SPSS ver 19. A two-tailed P value was calculated for variables of interest in each group using Fisher's exact test. The duration of hospitalization between the groups was compared using paired T-Test. A P value <0.05 was considered statistically significant.

RESULTS

There were 442 patients who met inclusion criteria: There were 60 patients in the study group at an average age of 55.2 years (SD ± 11.4; range 43-88): 63% had HBA1c readings >7.0% at presentation and 95% had unhealthy lifestyle habits. There were 382 patients in the control group at an average age of 59.1 years (SD ± 12.6, Range 37-89): 74% with HBA1c readings >7.0% at presentation and 48% with unhealthy lifestyle habits. Patients who used "soft candle" had significantly longer duration of hospitalization (15.5 ± 10.2 vs 9.2 ± 3.9 days; P<0.001) and major amputations (13.3% vs 5.6%; P=0.048) that was considered clinically significant. There was no difference in minor amputations (31.7% vs 34.3%; P=0.770) or in-hospital mortality (1.7% vs 0.52%; P=0.355) between the groups.

CONCLUSION

In its current form, the traditional practice of topical "soft candle" application to diabetic foot wounds may be potentially harmful. Persons with diabetes should be warned about these effects. We have identified the target population for educational campaigns.

Acute unintentional intoxication with paraffin in a 25-year old patient - clinical case report

"Fire-breathing" or "fire-eating" is a special kind of street art where the acts are always stunning, spectacular and amazing. People exhibiting this kind of show are professionals, not rare amateurs, who use different kind of fuels, usually hydrocarbons, in order to produce a pillar of fire. Intoxications caused by ingestion or inhalation of liquid paraffin, used as a fuel while performing, are numerous and various. We present a clinical case report of a 25-year old, previously healthy, amateur "fire-breather". During October, 2010 this young men arrived at the Emergency Unit of the University Clinic for toxicology and Urgent Internal Medicine in a severe clinical condition, after his unsuccessful attempt to perform real "fire-breathing". He had fever, strong headaches, mild abdominal and chest pain and he also had difficulties breathing and persistent dry cough. The patient was extremely dyspneic with peripheral cyanosis and shortness of breath. "Fire-breathers" must be viewed as a population at risk of paraffin-induced pneumonia, which has low mortality rate, but still is related with numerous and various chronic complications. Our patient was first in a life threatening, extremely serious clinical condition which was urgently treated with appropriate vigorous and effective therapy. This therapeutic protocol led to successful full recovery of these young men, who luckily didn't exhibit any chronic complications.

A study of energy-related injuries from hospital admissions among children and adults in South Africa

INTRODUCTION

Burn and ingestion injuries are common in developing countries because of poor access to safe energy sources, crowded living conditions, and insufficient knowledge of potential risks. The purpose of this study is to understand the scope of burn and ingestion injuries due to various energy source usages in South Africa.

METHODS

Patients at 16 regional hospitals throughout South Africa presenting with an energy-related injury between 2006 and 2012 were interviewed to obtain demographics and injury characteristics.

RESULTS

A total of 12,443 patients were included in this study. Children aged 1-2 years predominantly experienced burn and ingestion injuries (21%). Liquid burns (30%) were more common than flame burns (14%). Chi-squared tests show that age was significantly related to degree of burn, type of burn, and severity of burn (p<0.001). Non-intentional injuries (45%) were more frequent than self-inflicted or assault injuries. Temporal and seasonal injury trends reflect usage patterns. Burn injuries result in longer hospital length of stay than ingestion injuries.

CONCLUSION

Non-intentional liquid burns and ingestions to infants and babies were most common in this study, with many injuries also occurring among young adults. It is advised that interventions targeting low-income communities be conducted to increase awareness of burn and ingestion injuries.

Microbial treatment for prevention and removal of paraffin deposition on the walls of crude pipelines

Two bacterial strains, paraffin removal strain and biosurfactant-producing strain, named BHJ-1 and QFL-1, were isolated from oil production wells in Daqing oilfield of China. They were subsequently identified as Bacillus cereus QAU68 and Bacillus subtilis XCCX, respectively. As an indicator of the degradation paraffin, the inoculum concentration of BHJ-1 and QFL-1 were added in different proportions, the optimum proportion was 5:2. In this proportion the degradation rate of paraffin could reach 64 %, the prevention rate of paraffin could reach 55 %.