The role of the cytopathologist in subtyping and epidermal growth factor receptor testing in non-small cell lung cancer: An institutional experience

OBJECTIVE

Approximately 10% of non-small-cell lung cancer (NSCLC) remains unclassifiable as NSCLC-not otherwise specified (NOS), after using a panel of immunomarkers. The present study was undertaken to assess sensitivity and specificity of immunomarkers in sub-typing NSCLC on fine needle aspiration cytology (FNAC). Epidermal growth factor receptor (EGFR) mutations were also detected in these samples.

METHODS

Sixty cases of NSCLC including 15 squamous cell carcinoma (SCC), 15 adenocarcinomas (ADC) and 30 NSCLC-NOS reported on FNAC were included in the study. A panel of CK7, CK5/6, TTF-1 and p63 was applied in these cases. DNA was extracted from 54 cases including 14 effusion samples, and EGFR mutations were detected.

RESULTS

Classic ADC cases (n=15) showed 73.3% TTF-1 positivity and 100% CK7 positivity. Two cases of ADC showed aberrant expression of p63 and 2 cases showed CK5/6 positivity. 80% of classic SCC cases (n=15) showed strong nuclear p63 positivity and 86.6% were positive for CK5/6. TTF-1 was seen exclusively in ADC cases. Immunohistochemistry (IHC) using two immunomarkers (TTF-1 and p63) helped in subtyping 24/30(80%) cases of NSCLC. EGFR mutations were detected in 9/54 (16.7%) cases, and the most common mutation was short in-frame deletion in Exon 19.

CONCLUSIONS

More than 90% of NSCLC can be sub-typed on cytology samples with the help of immunochemistry. The sensitivity of TTF-1, p63, CK5/6 and CK7 was 73.3%, 80%, 100% and 100%, respectively. The specificity of TTF-1, p63, CK5/6 and CK7 was 100%, 86.6%, 86.6% and 93.3%, respectively. TTF-1 is highly specific, and almost 80% of NSCLC-NOS cases can be sub-typed using TTF-1 and p63. EGFR mutations can be detected in cytology samples, and 16.7% samples were positive for EGFR mutations.

Evaluation of Mycotube, a modified version of Lowenstein-Jensen (LJ) medium, for efficient recovery of Mycobacterium tuberculosis (MTB)

Timely diagnosis of tuberculosis (TB), caused by Mycobacterium tuberculosis (MTB), is only achieved for ~58% cases. An improved, accurate, time- and cost-effective method for bacteriological confirmation of MTB is necessary. We evaluated Mycotube, a new variant of Lowenstein-Jensen (LJ) culture medium, by comparing it with Mycobacterium Growth Indicator Tube (MGIT) 960 (gold standard), local LJ, and bioMérieux LJ-T in terms of isolation rate and time-to-growth. Pulmonary and extra-pulmonary samples from treatment-naïve suspects (n = 207) were decontaminated by the N-acetyl-L-cysteine-sodium hydroxide method and used to inoculate the four media. Subjective and objective parameters were used for evaluation. Mycotube yielded 140 positive results, compared to 162, 69, and 141 from MGIT, local LJ, and LJ-T, respectively. Of these, 139 (67%) were true-positive results and 1 (0.5%) was false-positive. The mean time-to-growth detection was 17.4 days for Mycotube, compared to 14.5, 28.1, and 16.5 days for MGIT, local LJ, and LJ-T, respectively. The mean time-to-growth for local LJ significantly differed from that for MGIT, but not those for LJ-T and Mycotube. No contamination was observed. Mycotube had a sensitivity of 85.8% and a specificity of 97.8% as compared to MGIT. Mycotube offers good results, comparable with those observed for conventional LJ. It requires only basic laboratory infrastructure. The overall cost of the test should be nearly three times lower than that of MGIT. Mycotube helps with TB diagnosis and generates pure isolates for drug susceptibility testing.

Risk of cardiac pacemaker pocket infection in a tertiary care hospital

BACKGROUND

The risk of pacemaker pocket infections (PPIs) is rare with good antisepsis techniques and use of advanced antibiotics. However, injudicious antibiotic usage leads to the rise of multidrug-resistant bacteria, which may cause PPI. Few reports exist about the microbial spectrum of the PPI from our country, prompting us to study the same.

METHODS

We conducted this retrospective observational study for 3 years (January 2013-February 2016) from all the patients with PPI. We collected the relevant clinical samples (blood and pus) for the microbial culture using a standard protocol. We included 100 samples collected from the medical staff and the hospital environment as a control sample. The data were analyzed using appropriate statistical methods and a P< 0.05 was considered statistically significant.

RESULTS

Our data showed that 17 out of 160 (10.6%) patients had PPI. Coagulase negative Staphylococcus sp. was isolated in 7 (41.2%) patients, followed by Staphylococcus aureus in 4 patients (23.5%). Other isolated bacteria include multidrug-resistant Burkholderia cepacia (n = 3), Mycobacterium abscessus (n = 2) and polymicrobial infection in a single patient. One out of hundred surveillance samples grew B. cepacia.

CONCLUSION

Our data revealed a high incidence of Gram-positive cocci causing PPI. Every hospital should formulate their antibiotic policy based on the pattern of the hospital flora and their drug sensitivity.

Ultrafast demagnetization in bulk versus thin films: an ab initio study

We report ab initio simulations of the quantum dynamics of electronic charge and spins when subjected to intense laser pulses. By performing these purely electron-dynamics calculations for a thin film and for the bulk of Ni, we conclude that formation of surfaces has a dramatic influence of amplifying the laser induced demagnetization. The reason for this amplification is enhanced spin-currents on the surface of the thin films. We show that the underlying physics of demagnetization for bulk is dominated by spin-flips induced by spin-orbit coupling. In the case of thin films, the dominant cause of demagnetization is a combination of the flow of spin-currents and spin-flips. Furthermore, a comparison of our results with experimental data shows that below  ∼120 fs processes of demagnetization are entirely dominated by purely electronic processes followed by which dissipative effects like the Elliott-Yafet mechanism start to contribute significantly.

Subungual Glomus Tumours: Is Magnetic Resonance Imaging or Ultrasound Necessary for Diagnosis?

INTRODUCTION

Diagnosis of subungual glomus tumour is mostly based on detailed history and clinical examination. Recently, Magnetic Resonance Imaging (MRI) and Ultrasound have been proposed as the imaging modality to confirm the clinical diagnosis and in planning the surgical management of these tumours. However, these imaging modalities are not routinely available in rural setting and also are expensive. Due to these limitations, we set out to establish that diagnosis and management of these rare tumours can be based solely on a battery of clinical tests and history taking.

MATERIALS AND METHODS

Retrospectively, we reviewed nine cases of glomus tumour. A clinical evaluation proforma was developed on the basis of clinical history and specific clinical test for diagnosis of these tumours. All the cases were evaluated and treated surgically by a single surgeon with a specific technique. Post-operatively, diagnosis was confirmed by histopathological examination.

RESULTS

Females (77.78%) were predominantly affected in this series and the tumours commonly occurred in the right hand (66.66%). Spontaneous pain, cold sensitivity test and Love's Pin test was positive in all cases (100%). Hildreth's test was positive in 88.89%. In none of the cases the tumours recurred during minimum follow-up of one year. In all cases, histopathological examination confirmed the preoperative diagnosis of glomus tumours.

CONCLUSION

Diagnosis of glomus tumours can be made clinically based on history taking and clinical examination. Magnetic Resonance Imaging and Ultrasound are not necessary for diagnosis and management of typical subungual tumours.

A cohort study of vulvar cancer over a period of 10 years and review of literature

OBJECTIVE

The objective of this study was to study the risk factors, management protocols, and the outcome of vulvar cancer cases over a period of 10 years in a tertiary care hospital.

METHODOLOGY

It is a retrospective cohort study. The hospital records of 41 patients with histologically proven vulvar cancer were studied from the Department of Obstetrics and Gynaecology and the Department of Radiotherapy (RT). The presence of risk factors, stage of disease, treatment modalities used, and disease outcomes in terms of survival were studied. The data collected were analyzed and compared with the published literature.

RESULTS

The mean age for the diagnosis of vulvar cancer was 52 years and the peak incidence was seen in the age group of 50-70 years. Incidence was significantly more in multiparous (P = 0.001) and postmenopausal women (P = 0.007). An average of 4.1 cases were seen per year. Nearly, 97.56% of the cases were squamous cell carcinomas. Twenty cases belonged to the early stage of the disease (Stage I and II) whereas 21 cases had advanced disease (Stage III and IV). Nearly, 48.78% of the cases were primarily treated with surgery, 26.83% with RT, 7.3% with chemotherapy, and 17.07% with combined chemoradiation. Seventy-eight percent of the surgically treated cases had a mean survival of 5 years. Mean survival of 1 year was recorded in advanced disease cases. Limitation of the study was poor follow-up after treatment.

CONCLUSION

Incidence of vulvar cancer is significantly high in multiparous and postmenopausal women. Conservative surgical treatment is the best option in the early stage of the disease (Stage I and II) and gives high survival rates whereas advanced disease treated with chemoradiation has a poor survival.

Chemical characterization of rainwater at a high-altitude site "Nainital" in the central Himalayas, India

The present study investigates the chemical composition of rainwater (RW) from a high-altitude site "Nainital" (1958 m above msl) in the central Himalaya region, to understand the influence of local, regional, and long-range transport of pollutants. A total of 55 (2 in pre-monsoon and 53 in monsoon) RW samples were collected during the study period (June-September 2012) and were analyzed for major anions and cations using an ion chromatograph. The pH of precipitation events ranged from 4.95 to 6.50 (average 5.6 ± 0.3) was observed during the monsoon period (near to the acidic), whereas during the pre-monsoon, the pH was 6.25 ± 0.49 (alkaline) over the study region; it is due the mixture of anthropogenic as well as the natural chemical constituents. The average ionic concentration (sum of measured chemical constituents) was ∼3 times higher during the pre-monsoon (986 ± 101 μeq/1) compared to that in the monsoon season (373 ± 37 μeq/1). This is mainly due to the presence of more natural aerosols in the pre-monsoon season which is also reflected in the pH of rainwater (average 6.25 ± 0.50) as well as ionic concentration. The chemical composition suggests that Ca²⁺ was the major contributor (34%) among cations, followed by Na⁺ (10%), K⁺ (8%), and Mg²⁺ (9%), whereas Cl^-, NO₃^-, and SO₄^2- contributed ∼13, 11, and 9%, respectively, among anions. The average ratio of acidic species (SO₄^2-/NO₃^-) is 1.56, suggesting 61 and 39% contribution of SO₄^2- and NO₃^-, respectively, which is very close to the estimated contribution of H₂SO₄ (60-70%) and HNO₃ (30-40%) in the precipitation samples. Neutralization factors for Ca²⁺, Mg²⁺, and NH₄⁺ in RW at Nainital are 4.94, 1.21, and 0.37, respectively, indicating their crucial role in neutralization of acidic species. The non-sea-salt (NSS) contribution to total Ca²⁺, K⁺, and Mg²⁺ is estimated to be ∼98, 97, and 74%, respectively, suggesting the dominance of crustal sources for cations. In contrast, the NSS contribution to the total Cl^- and SO₄^2- is 16 and 69% indicating their anthropogenic origin, respectively. Principle component analysis also suggests that the first factor (i.e., natural sources, mainly dust, and sea-salts) accounts for ∼33% variance, whereas the second factor (i.e., fossil fuel and biomass burning) accounts for ∼18% variance of the measured ionic composition. The remaining contributions are attributed to the mixed emission sources and transport of pollutants from Indo-Gangetic Plain (IGP) and western parts of India. The results of the present study reveal a significant contribution of crustal and anthropogenic sources in the RW and neutralization processes in the central Himalaya.

Visible upconversion in Er3+/Yb3+ co-doped LaAlO3 phosphors

The Er³⁺ doped and Er³⁺/Yb³⁺ co-doped LaAlO₃ phosphors have been synthesized by the combustion method and characterized their structural, morphological, elemental, vibrational and optical properties. The optical absorption and upconversion properties of the synthesized phosphors have been studied. Upon co-doping Yb³⁺ ions into Er³⁺:LaAlO₃, the blue, green and red upconversion emissions of Er³⁺ ions have been enhanced about ~20, ~54 and ~22 times, under 978nm laser excitation. The observed upconversion emissions could be due to excited state absorption in Er³⁺:LaAlO_3, whereas energy transfer is dominant mechanism in Er³⁺/Yb³⁺:LaAlO₃ phosphors. The tuning in the color emitted from the synthesized phosphors towards the green region has been found due to incorporation of the Yb³⁺ ions. With increase in the pump power, the color emitted from the co-doped phosphor is not tuned significantly, showing its applicability in making the green display devices.

Impact of forest vegetation on soil characteristics: a correlation between soil biological and physico-chemical properties

Temperate and dry deciduous forest covers major portion of terrestrial ecosystem in India. The two forest types with different dominant tree species differ in litter quality and root exudates, thereby exerting species-specific impact on soil properties and microbial activity. This study aims to examine the influence of forest type or dominant tree species on soil physico-chemical properties and its relationship with microbial characters in temperate and dry deciduous forest types. We assessed soil physico-chemical properties among five different sites located within the selected forest stand covered by different dominant species. The soil microbial biomass carbon (MBC), nitrogen (MBN) and phosphorous (MBP) were recorded high in oak soil, i.e., the MBC/TOC ratio was significantly higher in dry deciduous forest. Basal respiration was recorded highest at oak-mixed soil while qCO2 was comparatively high in oak soil. Temperate forest displayed the highest MBC/MBN ratio, while dry deciduous forest had the highest MBC/MBP ratio. Moreover, the MBN/TN ratio was found high in dry deciduous forest, whereas MBP/TP ratio was high in temperate forest. Additionally, the enzyme activities were significantly higher in an oak-mixed soil among all the sites. The results displayed that the soil microbial characters and soil physico-chemical uniqueness are interrelated, and were significantly influenced by specific forest type and climatic variables.

Estimation of Photon Specific Absorbed Fractions in Digimouse Voxel Phantom using Monte Carlo Simulation Code FLUKA

BACKGROUND

Most preclinical studies are carried out on mice. For internal dose assessment of a mouse, specific absorbed fraction (SAF) values play an important role. In most studies, SAF values are estimated using older standard human organ compositions and values for limited source target pairs.

OBJECTIVE

SAF values for monoenergetic photons of energies 15, 50, 100, 500, 1000 and 4000 keV were evaluated for the Digimouse voxel phantom incorporated in Monte Carlo code FLUKA. The organ sources considered in this study were lungs, skeleton, heart, bladder, testis, stomach, spleen, pancreas, liver, kidney, adrenal, eye and brain. The considered target organs were lungs, skeleton, heart, bladder, testis, stomach, spleen, pancreas, liver, kidney, adrenal and brain. Eye was considered as a target organ only for eye as a source organ. Organ compositions and densities were adopted from International Commission on Radiological Protection (ICRP) publication number 110.

RESULTS

Evaluated organ masses and SAF values are presented in tabular form. It is observed that SAF values decrease with increasing the source-to-target distance. The SAF value for self-irradiation decreases with increasing photon energy. The SAF values are also found to be dependent on the mass of target in such a way that higher values are obtained for lower masses. The effect of composition is highest in case of target organ lungs where mass and estimated SAF values are found to have larger differences.

CONCLUSION

These SAF values are very important for absorbed dose calculation for various organs of a mouse.

Abnormal thymic maturation and lymphoproliferation in MRL-Fas lpr/lpr mice can be partially reversed by synthetic oligonucleotides: implications for systemic lupus erythematosus and autoimmune lymphoproliferative syndrome

MRL-Fas ^lpr/lpr mice represent an excellent animal model for studying non-malignant lymphoproliferation, regeneration and systemic autoimmunity. Retro-transposon insertion into the second intron of the pro-apoptotic Fas gene appears to be responsible for both lymphoproliferation and autoimmunity, while other genes are more likely to contribute to the regenerative healing characteristic of this mouse strain. Previous studies have shown that neonatal thymectomy can halt the development of abnormal lymphoproliferation. Whereas at four weeks of age primary and secondary lymphoid organs appear to be grossly intact, vigorous lymphoproliferation and autoantibody production subsequently ensues. This is first noticeable at six weeks of age, at which time lymph nodes, spleens and thymuses, but not the bone marrow, become infiltrated with abnormal B220⁺CD3⁺CD4^-CD8^- T cells. Around the same time, thymuses show a significant drop in CD4⁺CD8⁺double-positive T cells generating an abnormal ratio between double-positive and single-positive thymocytes. The objective of current study was to evaluate the effect of synthetic oligonucleotides-toll-like receptor antagonists on early lymphoid development in this strain of mice. Herein, we demonstrate the ability of synthetic oligonucleotides made with the nuclease-resistant phosphorothioate backbone to partially reverse abnormal lymphoproliferation and thymic involution in pre-diseased MRL-Fas ^lpr/lpr mice when administered intraperitoneally starting from week four of age. This curative effect of oligonucleotides was primary sequence/secondary oligonucleotide structure-independent, suggesting an effect through the toll-like receptor 7. A similar approach may potentially benefit patients with autoimmune lymphoproliferative syndrome who, like MRL-Fas ^lpr/lpr mice, carry a mutation in the Fas gene.

Dual-Source Computed Tomography for Chronic Total Occlusion of Coronary Arteries

OBJECTIVES

We compared dual-source CT (DSCT) and conventional angiography (CA) in evaluation of chronic total occlusion (CTO) of coronary arteries.

BACKGROUND

Percutaneous coronary intervention (PCI) in CTO is technically difficult and has comparatively lower success rate than intervention in non-occluded artery. Accurate assessment of lesion morphology is an important determinant of PCI success in CTO.

METHODS

Nineteen symptomatic patients (18 men, age: 58.6 ± 10.6 years) with a CTO on CA were subjected to a DSCT (Definition, Siemens, Germany). Heart rate (HR) control was not performed. Dedicated post-processing software was used for lesion analysis on both modalities. Presence of bridging collaterals, stump morphology, calcification, side branch, proximal tortuosity, occlusion length, distal vessel interpretability, and distal lesions were statistically compared.

RESULTS

There were 20 CTOs. HR during DSCT ranged from 53 to 131 bpm. Bridging collaterals were seen in 3/20 (15%) lesions on CA and in none on DSCT. Stump anatomy and side branch were identified equally well. Plaque calcification was identified in 5/20 (25%) lesions on CA and in 12/20 (60%) lesions on DSCT (P = 0.025). Nature and extent of calcification were better visualized on DSCT. No proximal tortuosity was noted. Distal vessel was better interpretable on DSCT (15/20; 75%) compared to CA (9/20; 45%) (P = 0.05). No significant difference in lesion length was noted.

CONCLUSION

DSCT performs as well as CA for most features of CTO. Avoidance of need to control HR, ability to better detect and characterize calcium and to interpret distal vessels make it a useful pre-intervention investigation. © 2014 Wiley Periodicals, Inc.

Performance Evaluation of Algorithms in Lung IMRT: A comparison of Monte Carlo, Pencil Beam, Superposition, Fast Superposition and Convolution Algorithms

BACKGROUND

Inclusion of inhomogeneity corrections in intensity modulated small fields always makes conformal irradiation of lung tumor very complicated in accurate dose delivery.

OBJECTIVE

In the present study, the performance of five algorithms via Monte Carlo, Pencil Beam, Convolution, Fast Superposition and Superposition were evaluated in lung cancer Intensity Modulated Radiotherapy planning.

MATERIALS AND METHODS

Treatment plans for ten lung cancer patients previously planned on Monte Carlo algorithm were re-planned using same treatment planning indices (gantry angel, rank, power etc.) in other four algorithms.

RESULTS

The values of radiotherapy planning parameters such as Mean dose, volume of 95% isodose line, Conformity Index, Homogeneity Index for target, Maximum dose, Mean dose; %Volume receiving 20Gy or more by contralateral lung; % volume receiving 30 Gy or more; % volume receiving 25 Gy or more, Mean dose received by heart; %volume receiving 35Gy or more; %volume receiving 50Gy or more, Mean dose to Easophagous; % Volume receiving 45Gy or more, Maximum dose received by Spinal cord and Total monitor unit, Volume of 50 % isodose lines were recorded for all ten patients. Performance of different algorithms was also evaluated statistically.

CONCLUSION

MC and PB algorithms found better as for tumor coverage, dose distribution homogeneity in Planning Target Volume and minimal dose to organ at risks are concerned. Superposition algorithms found to be better than convolution and fast superposition. In the case of tumors located centrally, it is recommended to use Monte Carlo algorithms for the optimal use of radiotherapy.

Cytomegalovirus Infection in Patients with Sepsis Due to Bloodstream Infections: Lower Risk and Better Outcomes in New versus Already Hospitalised Intensive Care Unit Admissions

Few studies have examined cytomegalovirus (CMV) reactivation exclusively in immunocompetent patients with sepsis due to bloodstream infections. In a cohort of CMV-seropositive critically ill otherwise non-immunosuppressed patients with sepsis due to bloodstream infection, weekly testing for CMV viraemia was performed. Outcomes were assessed at 30 days or until death/discharge from the intensive care unit (ICU). CMV viraemia developed in 20% (20/100) of the patients. Age ( P=0.044) and blood transfusions ( P=0.022) were significantly associated with CMV viraemia. There was no difference in the primary endpoint (mortality and/or multi-organ failure) between patients with and without CMV viraemia ( P=0.49). However, CMV viraemia was associated with significantly fewer ICU-free days ( P=0.023) and fewer ventilator-free days ( P=0.031). Patients hospitalised in the ICU for more than 48 hours prior to the onset of bloodstream infection were more likely to develop CMV viraemia ( P=0.006), have high-grade viraemia ( P=0.010), and fewer ICU-free days ( P=0.018) and ventilator-free days ( P=0.029) than those admitted within 48 hours of bloodstream infection. Thus, CMV reactivation was associated with fewer ICU- and ventilator-free days, however overall mortality was not affected. Patients already in the ICU at the onset of sepsis had higher risk of CMV reactivation and worse outcomes than new ICU-bound patients suggesting that a targeted approach for interventions for CMV could conceivably be directed towards those with a more protracted course of illness.

Statin-induced changes in mitochondrial respiration in blood platelets in rats and human with dyslipidemia

3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) are widely used drugs for lowering blood lipid levels and preventing cardiovascular diseases. However, statins can have serious adverse effects, which may be related to development of mitochondrial dysfunctions. The aim of study was to demonstrate the in vivo effect of high and therapeutic doses of statins on mitochondrial respiration in blood platelets. Model approach was used in the study. Simvastatin was administered to rats at a high dose for 4 weeks. Humans were treated with therapeutic doses of rosuvastatin or atorvastatin for 6 weeks. Platelet mitochondrial respiration was measured using high-resolution respirometry. In rats, a significantly lower physiological respiratory rate was found in intact platelets of simvastatin-treated rats compared to controls. In humans, no significant changes in mitochondrial respiration were detected in intact platelets; however, decreased complex I-linked respiration was observed after statin treatment in permeabilized platelets. We propose that the small in vivo effect of statins on platelet energy metabolism can be attributed to drug effects on complex I of the electron transport system. Both intact and permeabilized platelets can be used as a readily available biological model to study changes in cellular energy metabolism in patients treated with statins.

An essential role of Ffar2 (Gpr43) in dietary fibre-mediated promotion of healthy composition of gut microbiota and suppression of intestinal carcinogenesis

Composition of the gut microbiota has profound effects on intestinal carcinogenesis. Diet and host genetics play critical roles in shaping the composition of gut microbiota. Whether diet and host genes interact with each other to bring specific changes in gut microbiota that affect intestinal carcinogenesis is unknown. Ability of dietary fibre to specifically increase beneficial gut microbiota at the expense of pathogenic bacteria in vivo via unknown mechanism is an important process that suppresses intestinal inflammation and carcinogenesis. Free fatty acid receptor 2 (FFAR2 or GPR43) is a receptor for short-chain fatty acids (acetate, propionate and butyrate), metabolites of dietary fibre fermentation by gut microbiota. Here, we show FFAR2 is down modulated in human colon cancers than matched adjacent healthy tissue. Consistent with this, Ffar2(-/-) mice are hypersusceptible to development of intestinal carcinogenesis. Dietary fibre suppressed colon carcinogenesis in an Ffar2-dependent manner. Ffar2 played an essential role in dietary fibre-mediated promotion of beneficial gut microbiota, Bifidobacterium species (spp) and suppression of Helicobacter hepaticus and Prevotellaceae. Moreover, numbers of Bifidobacterium is reduced, whereas those of Prevotellaceae are increased in human colon cancers than matched adjacent normal tissue. Administration of Bifidobacterium mitigated intestinal inflammation and carcinogenesis in Ffar2(-/-) mice. Taken together, these findings suggest that interplay between dietary fibre and Ffar2 play a key role in promoting healthy composition of gut microbiota that stimulates intestinal health.

An unusual differential diagnosis of penile warts: metastases from rectal carcinoma

Patients with penile lesions, such as virally induced papillomata, frequently present to genitourinary medicine clinics and general practitioners. Their diagnosis is usually based on clinical observation and biopsy is not generally undertaken. Penile lesions may rarely have a more sinister aetiology and represent metastatic spread from solid tumours arising at distant sites. Penile metastases arise most frequently from genitourinary cancers (prostate, bladder and kidney), but may also arise from tumours of the large bowel; other primary sites are extremely uncommon. We report the case of a patient presenting with penile metastases from rectal carcinoma arising during third-line chemotherapy for metastatic disease.

It's not inside, it's on top! - An unusual cause of right iliac fossa pain

Rectus sheath haematoma (RSH) is an uncommon cause of acute abdominal pain, but can mimic a variety of acute surgical conditions. Computed tomography (CT) provides the diagnosis and avoids unnecessary procedures.

Slow and fast development in two aphidophagous ladybirds on scarce and abundant prey supply

Developmental rates are highly variable, both within and between genotypes and populations. But the rationale for two differential (slow and fast) developmental rates within same cohort under varying prey supply has yet not been explored. For this purpose, we investigated the effect of scarce and abundant prey supply on slow and fast development at 27°C in two aphidophagous ladybirds, Menochilus sexmaculatus (Fabricius) and Propylea dissecta (Mulsant) and its effect on their body mass and reproductive attributes. The ladybirds were provided with scarce and abundant supply of Aphis craccivora Koch under standardized abiotic conditions in the laboratory. A clear bimodal (two peaks, where the first peak represented the fast developing individuals and the second peak slow developing individuals) pattern of distribution for both prey supplies was obtained, which got skewed with change in prey supply. On abundant prey supply, more fast developing individuals (139 M. sexmaculatus and 123 P. dissecta) were found and less (46 M. sexmaculatus and 36 P. dissecta) on scarce prey supply. Slow developing individuals had female biased sex ratio, higher longevity and lower body mass. Fast developing females laid higher number of eggs with higher egg viability. Results of the study are indicative of occurrence and constancy of the slow and fast developing individuals in the egg batch.

Collapsing glomerulopathy in a case of anti-neutrophil cytoplasmic antibody associated vasculitis

Collapsing glomerulopathy (CG) is a pathological entity characterized by collapse and wrinkling of glomerular tuft, podocyte dedifferentiation and hyperplasia. CG may be idiopathic or secondary to other diseases. CG has been described with IgA nephropathy, membranous glomerulopathy, diabetic nephropathy, and lupus nephritis. However, till date there is no report of CG in association with the anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV). Here, we present a case of CG that developed during follow-up in a case of AAV with biopsy proven pauci-immune glomerulonephritis.