Shoulder-Mounted Robot for MRI-guided arthrography: Accuracy and mounting study

A new version of our compact and lightweight patient-mounted MRI-compatible 4 degree-of-freedom (DOF) robot for MRI-guided arthrography procedures is introduced. This robot could convert the traditional two-stage arthrography procedure (fluoroscopy-guided needle insertion followed by a diagnostic MRI scan) to a one-stage procedure, all in the MRI suite. The results of a recent accuracy study are reported. A new mounting technique is proposed and the mounting stability is investigated using optical and electromagnetic tracking on an anthropomorphic phantom. Five volunteer subjects including 2 radiologists were asked to conduct needle insertion in 4 different random positions and orientations within the robot's workspace and the displacement of the base of the robot was investigated during robot motion and needle insertion. Experimental results show that the proposed mounting method is stable and promising for clinical application.

Heteroleptic Cu(ii)–polypyridyl complexes as photonucleases

Four new copper(ii)–polypyridyl complexes having tail groups with increasing aromaticity, hydrophobicity and planarity are synthesized. These complexes are found to be avid DNA binders and show efficient nuclease activity under either chemical stimulus or UV-A light irradiation.

Localisation of 11β-Hydroxysteroid Dehydrogenase Type 2 in Mineralocorticoid Receptor Expressing Magnocellular Neurosecretory Neurones of the Rat Supraoptic and Paraventricular Nuclei

An accumulating body of evidence suggests that the activity of the mineralocorticoid, aldosterone, in the brain via the mineralocorticoid receptor (MR) plays an important role in the regulation of blood pressure. MR was recently found in vasopressin and oxytocin synthesising magnocellular neurosecretory cells (MNCs) in both the paraventricular (PVN) and supraoptic (SON) nuclei in the hypothalamus. Considering the physiological effects of these hormones, MR in these neurones may be an important site mediating the action of aldosterone in blood pressure regulation within the brain. However, aldosterone activation of MR in the hypothalamus remains controversial as a result of the high binding affinity of glucocorticoids to MR at substantially higher concentrations compared to aldosterone. In aldosterone-sensitive epithelia, the enzyme 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2) prevents glucocorticoids from binding to MR by converting glucocorticoids into inactive metabolites. The present study aimed to determine whether 11β-HSD2, which increases aldosterone selectivity, is expressed in MNCs. Specific 11β-HSD2 immunoreactivity was found in the cytoplasm of the MNCs in both the SON and PVN. In addition, double-fluorescence confocal microscopy demonstrated that MR-immunoreactivity and 11β-HSD2-in situ hybridised products are colocalised in MNCs. Lastly, single-cell reverse transcriptase-polymerase chain reaction detected MR and 11β-HSD2 mRNAs from cDNA libraries derived from single identified MNCs. These findings strongly suggest that MNCs in the SON and PVN are aldosterone-sensitive neurones.

Multiplex PCR in diagnosis of M. tuberculosis and M. avium co-infection from lymph node in an AIDS patient

A 35-year-old, HIV-seropositive male (CD4 count 41 cells/mm3) on highly active antiretroviral ( HAART) presented with fever and weight loss for 3 months and new skin lesions. He was earlier diagnosed of TB and was on anti-tubercular therapy (ATT). The retroperitoneal lymph node aspirate showed acid-fast bacilli and epithelioid cell granulomas; however, cultures remained sterile. A dual infection with Mycobacterium tuberculosis and Mycobacterium avium was diagnosed with multiplex polymerase chain reaction (MPCR). Clarithromycin was added to ATT, and on follow-up at 1 and 3 months, the patient responded well. Molecular methods like MPCR should be exploited for routine diagnosis of high-risk patients.

Variation of Carrying Angle With Age, Sex, Height and Special Reference to Side

Background The carrying angle is defined as the acute angle made by the median axis of arm and median axis of forearm in full extension and supination. This angle permits the forearms to clear the hips in swinging movements during walking and is important when carrying objects.Objective The purpose of this study was to determine the values of carrying angle in both the sexes according to the age group in relation with height and special reference to side.Methods To evaluate the elbow carrying angle in normal children between 5-15 years by a manual goniometer, measurements were performed in 532 children (Male- 335, Female- 197), with the elbow in full extension and forearm in supination. Carrying angle was measured on right and left upper limbs to find out the difference on both the limbs. Their height, ages and sexes are also recorded. Bicipital groove, biceps brachii tendon at its insertion and palmaris longus tendon at the wrist were palpated and marked as anatomical landmarks to demarcate the median axes of arm and forearm respectively.Results The mean carrying angle of male on the left limb was 7.0359O and the female was 7.8030O and the mean carrying angle of male on the right limb was 4.5509O and the female was 4.9545O. We observed the greater carrying angle in non-dominant limb than the dominant limbs. There was significant positive correlation between height of students and carrying angle left (r =0.0866, p= 0.048<0.05), negative correlation between height and carrying angle right (r= -0.082, p= 0.058 >0.05).Conclusion The present study showed that the carrying angle was greater in female than in male and was greater in non-dominant arm than in dominant arm and the carrying angle was not inversely related to the height of the person.Kathmandu Univ Med J 2013; 11(4): 315-318

Anticancer Effects of Extracts from the Fruit of Morinda Citrifolia (Noni) in Breast Cancer Cell Lines

Morinda citrifolia L. (NONI) fruits have been used for thousands of years for the treatment of many health problems including cancer, cold, diabetes, flu, hypertension, and pain. Plant extracts have reported several therapeutic benefits, but extraction of individual compound from the extract often exhibits limited clinical utility as the synergistic effect of various natural ingredients gets lost. They generally constitute polyphenols and flavonoids. Studies have suggested that these phytochemicals, especially polyphenols, display high antioxidant properties, which help to reduce the risk of degenerative diseases, such as cancer and cardiovascular diseases. Several in-vitro and in-vivo studies have shown that Noni fruits have antioxidant, anti-inflammatory, anti-dementia, liver-protective, anticancer, analgesic, and immunomodulatory effects. Till date about 7 in vitro cancer studies have been done, but a detailed in vitro study including cell cycle and caspase activation assay on breast cancer cell line has not been done. In the present study different Noni fruit fractions have tested on cancer cell lines MCF-7, MDA-MB-231 (breast adenocarcinoma) and one non-cancer cell line HEK-293 (Human embryonic kidney). Out of which ethylacetate extract showed a higher order of in vitro anticancer activity profile. The ethylacetate extract strongly inhibited the proliferation of MCF-7, MDA-MB-231 and HEK-293 cell lines with IC50 values of 25, 35, 60 µg/ml respectively. The extract showed increase in apoptotic cells in MCF-7 and MDA-MB-231 cells and arrested the cell cycle in the G1/S phase in MCF-7 and G0/G1 phase in MDA-MB-231 cells. Noni extract also decreases the intracellular ROS generation and mitochondrial membrane potential.

Evaluation of multiplex polymerase chain reaction utilising multiple targets in Mycobacterium tuberculosis direct test negative but culture positive cases: a potential method for enhancing the diagnosis of tuberculosis

PURPOSE

To evaluate multiplex Polymerase Chain Reaction (MPCR) utilising multiple targets (IS6110, Protein b [Pab] and MPB64 genes) in Mycobacterium tuberculosis Direct Test (MTD) negative but culture positive cases and comparison of MPCR with Real-Time polymerase chain reaction (RT-PCR) for diagnosis of tuberculosis.

MATERIALS AND METHODS

MPCR was carried out on 28 culture positive sputum samples. Out of 28 culture positive samples, 17 were originally reported, as MTD test negative and 11 were MTD test positive, respectively. The results of MPCR were compared with RT-PCR. To check the specificity of the tests, MPCR and RT-PCR were also evaluated with 16 non-tuberculous mycobacterial (NTM) isolates.

RESULTS

Out of 28 culture positive sputum samples, MPCR was positive in all 28/28 samples, whereas RT-PCR was positive in 27/28 samples and MTD test was originally tested positive in six sputum samples and on repeating MTD testing, five more sputum samples were positive and thus total number of MTD positive were 11/28 sputum samples, respectively. All the tests were negative on evaluation with all the 16 NTMs, thus giving specificity of 100% to all the tests; sensitivity of MPCR, RT-PCR and MTD tests were 100%, 96.42% and 39.28%, respectively, in these specifically selected samples.

CONCLUSIONS

MPCR may be an important tool in the rapid diagnosis of tuberculosis especially in disease endemic, resource limited countries.

Investigation of an outbreak of infectious pustular balanoposthitis in cattle breeding bulls at a frozen semen bank

Infectious pustular balanoposthitis (IPB) is one of the reproductive disorders caused by bovine herpesvirus 1 (BoHV1) that can be transmitted through artificial insemination. A herd of 63 breeding bulls at a frozen semen bank in Odisha state in India experienced a suspected outbreak of IPB, with 11 bulls showing clinical signs of the infection. Clinical signs were noticed in two bulls initially and a few days after in the other nine animals. Serum samples from 53 bulls were examined for anti-BoHV1 antibodies using a virus neutralisation test (VNT) and a competitive enzyme-linked immunosorbent assay (cELISA); the remaining ten bulls were not included in the study because it was difficult to restrain them at that time. Paired serum samples were collected 21 days apart from ten clinically affected bulls (the eleventh clinically affected bull was not included in the study for the reason stated above). In the neutralisation test, the paired serum samples showed a two- to fourfold increase in anti-BoHV1 antibody titre; in the cELISA, the paired samples were also found positive for anti-BoHV1 antibodies. Serum samples from 43 in-contact bulls were collected about day 22 after the first observation of clinical infection in the herd. Among these serum samples, a total of 30 were found positive for anti-BoHV1 antibodies in the VNT and a total of 30 were found positive in cELISA. Ten samples were positive in one test but not the other and 25 tested positive in both tests. In all, 35 serum samples from in-contact bulls tested positive in either one or both of the two types of test. An overall agreement of 76.74% was found in detection of anti-BoHV1 antibodies in the two tests. Sensitivity was higher than specificity in detection of anti-BoHV1 antibodies in the serum samples. The glycoprotein C region of the genomic DNA of BoHV1 was amplified from semen samples by polymerase chain reaction. The findings from the outbreak indicate that continuous monitoring of breeding bulls at frozen semen banks is warranted to avoid the risks associated with artificial insemination.

Transport of ions in mesoporous carbon electrodes during capacitive deionization of high-salinity solutions

Desalination of high-salinity solutions has been studied using a novel experimental technique and a theoretical model. Neutron imaging has been employed to visualize lithium ions in mesoporous carbon materials, which are used as electrodes in capacitive deionization (CDI) for water desalination. Experiments were conducted with a flow-through CDI cell designed for neutron imaging and with lithium-6 chloride ((6)LiCl) as the electrolyte. Sequences of neutron images have been obtained at a relatively high concentration of (6)LiCl solution to provide information on the transport of ions within the electrodes. A new model that computes the individual ionic concentration profiles inside mesoporous carbon electrodes has been used to simulate the CDI process. Modifications have also been introduced into the simulation model to calculate results at high electrolyte concentrations. Experimental data and simulation results provide insight into why CDI is not effective for desalination of high ionic-strength solutions. The combination of experimental information, obtained through neutron imaging, with the theoretical model will help in the design of CDI devices, which can improve the process for high ionic-strength solutions.

Ossifying fibromyxoid tumor (OFMT) - A rare cause of a painful thumb

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Ossifying fibromyxoid tumors (OFMT) is a rare but possible cause of a painful digit.

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These are part of the spectrum of sarcomas.

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They should be managed in a multidisciplinary environment with adequate follow up to detect recurrences.

INTRODUCTION

Ossifying fibromyxoid tumor (OFMT) is an uncommon soft tissue and bone neoplasm with just over 100 cases being reported in the literature. They present as small, slow-growing asymptomatic subcutaneous nodules in the soft tissues of the trunk and extremities.

PRESENTATION OF CASE

We present a case of a 25-year-old, right hand dominant gentleman who complained of a seven-year history of pain and discomfort in the dorsal aspect of the right thumb. He was unable to move his interphalangeal joint (IPJ) but had good function otherwise. Examination revealed a localized tender swelling over the dorsal aspect of the IPJ. The thumb was fixed in extension. X-ray revealed marked abnormal soft tissue swelling around the interphalangeal joint, cystic abnormalities and new bone formation. Biopsy showed fibrous tissue containing nodules of tumor with cells in a myxoid background, rounded and histiocytoid to elongated and spindle shaped. CD57, type IV collagen, smooth muscle actin were found and CD56 and EMA were focally positive.

These were in keeping with ossifying fibromyxoid tumor with an atypical immunophenotype.

DISCUSSION

The tumor was formally excised with the flexor pollicis longus tendon. A two-month review revealed his pain had settled. As the tumor had an atypical immunophenotype he was referred to the regional sarcoma team.

CONCLUSION

OMFT can present with atypical clinical, radiological and histological features. It is managed in a multidisciplinary setting and often requires lifetime follow up to detect a recurrence given the uncertain nature of these lesions.

Variations in total facial index among students of Kathmandu University School of Medical Sciences

The total facial index exhibits sexual differences and different shapes of face. Facial anthropometry has its well known implications for forensic scientists, anatomists, human biologists, criminologists and physical anthropologists. Facial index is the ratio of the morphological facial height to facial width and multiplied by 100. The present study aimed to examine the facial length, facial width, facial index and to find out the facial type in students of Kathmandu University School of Medical Sciences. The present study was conducted on 300 medical, dental and human biology students of Kathmandu University School of Medical Sciences, Dhulikhel, Nepal. Of the total 300 students 150 students were male and 150 students were female and were between the age group 18-25 years. The study had been approved by the Institutional review committee of Kathmandu University School of Medical Sciences, Dhulikhel, Nepal. The study result showed that the mean facial index of Nepalese students was 87.01. The mean facial index of Nepalese male was found to be 87.20 and female was found to be 86.81. The dominant facial type in students of Kathmandu University School of Medical Sciences was found to be mesoproscopic and least common was hyperleptoproscopic. The dominant facial type in male was euriproscopic and the dominant type in female face was mesoproscopic.

K.s. Micro-implant placement guide

A one of the greatest concerns with orthodontic mini-implants is risk of injury to dental roots during placement is, especially when they are inserted between teeth. Many techniques have been used to facilitate safe placement of interradicular miniscrews. Brass Wires or metallic markers are easy to place in the interproximal spaces, but because their relative positions may be inconsistent in different radio -graphic views, they are not always accurate. K.S. micro implant placement guide suggested in this article is simple design and easy in fabrication, required minimal equipment for fabrication and does not disturb the existing appliance system, clearly located in the radiograph and the mini-screw can be easily inserted through the guide reducing the chance of implant misplacement.

Estimates of Genetic Variance for Some Selected Morphometric Characters: A Twin Study

Results on genetic variability in some of the morphometric characters on head and face, body girths and skin folds, based on 45 MZ and 67 like-sex DZ twin pairs, are presented. The data were subjected to a method which eliminated possible biases in the estimated genetic variances that could result from heterogeneity of total variances between zygosities of the 17 head and face measurements, heterogeneity was observed for only bizygomatic diameter. Head breadth means differed between MZ and DZ twins, indicating bias in the trait's genetic variance analysis. The results indicated a significant genetic component in these morphometric traits. For 11 girth and skinfold measurements, the t'-test based on hierarchical structure of twin data, also failed to reveal any appreciable difference between the mean values of MZ and DZ twins. Heterogeneity of total variance between zygosities was observed for three skinfold measurements, ie, biceps, triceps and suprailiac. The girth measurements, however, did not reveal any heterogeneity of total variances between the zygosities. The estimates of genetic variance revealed stronger genetic component for the girths than for the skinfolds.

A Prototype Body-Mounted MRI-Compatible Robot for Needle Guidance in Shoulder Arthrography

A novel compact and lightweight patient-mounted MRI-compatible robot has been designed for MRI image-guided interventions. This robot is intended to enable MRI-guided needle placement as done in shoulder arthrography. The robot could make needle placement more accurate and simplify the current workflow by converting the traditional two-stage arthrography procedure (fluoroscopy-guided needle insertion followed by a diagnostic MRI scan) to a one-stage procedure (streamlined workflow all in MRI suite). The robot has 4 degrees of freedom (DOF), two for orientation of the needle and two for needle positioning. The mechanical design was based on several criteria including rigidity, MRI compatibility, compact design, sterilizability, and adjustability. The proposed workflow is discussed and initial MRI compatibility experiments are presented. The results show that artifacts in the region of interest are minimal and that MRI images of the shoulder were not adversely affected by placing the robot on a human volunteer.