Apigetrin ameliorates doxorubicin prompted testicular damage: biochemical, spermatological and histological based study

Doxorubicin (DOX) is a highly effective, commonly prescribed, potent anti-neoplastic drug that damages the testicular tissues and leads to infertility. Apigetrin (APG) is an important flavonoid that shows diverse biological activities. The present research was designed to evaluate the alleviative role of APG against DOX-induced testicular damages in rats. Forty-eight adult male albino rats were randomly distributed into 4 groups, control, DOX administered (3 mgkg-1), DOX + APG co-administered (3 mgkg-1 of DOX; 15 mgkg-1 of APG), and APG administered group (15 mgkg-1). Results of the current study indicated that DOX treatment significantly reduced the activities of superoxide dismutase (SOD), glutathione reductase (GSR), catalase (CAT) and glutathione peroxidase (GPx), while increasing the levels of malondialdehyde (MDA) and reactive oxygen species (ROS). DOX treatment also reduced the sperm count, viability, and motility. Moreover, DOX significantly increased the sperm morphological anomalies and reduced the levels of plasma testosterone, luteinizing hormone (LH) and follicle-stimulating hormone (FSH). The administration of DOX significantly increased the expressions of Bax and Caspase-3, as well as the levels of inflammatory markers. Additionally, DOX treatment significantly downregulated the expressions of steroidogenic enzymes (StAR, 3β-HSD and 17β-HSD) and Bcl-2. Furthermore, DOX administration provoked significant histopathological abnormalities in the testicular tissues. However, APG supplementation significantly reversed all the testicular damages due to its androgenic, anti-apoptotic, anti-oxidant and anti-inflammatory nature. Therefore, it is concluded that APG may prove a promising therapeutic agent to treat DOX-induced testicular damages.

Stereocontrol via Propeller Chirality in FLP-Catalyzed Asymmetric Hydrogenation

Utilization of chiral frustrated Lewis pairs as catalysts in enantioselective hydrogenation of unsaturated molecules represents a promising approach in asymmetric synthesis. In our effort to improve our current understanding of the factors governing the stereoselectivity in these catalytic processes, herein we examined the mechanism of direct hydrogenation of aromatic enamines catalyzed by a binaphthyl-based chiral amino-borane. Our computational analysis reveals that only one particular conformer of the key borohydride reaction intermediate can be regarded as a reactive form of this species. This borohydride conformer has a well-defined chiral propeller shape, which induces facial selectivity in the hydride transfer to pro-chiral iminium intermediates. The propeller chirality of the reactive borohydride conformer is generated by the axially chiral binaphthyl scaffold of the amino-borane catalyst through stabilizing π-π stacking interactions. This new computational insight can be readily used to interpret the high degree of stereoinduction observed for these reactions. We expect that the concept of chirality relay could be further exploited in catalyst design endeavors.

An incidentally diagnosed primary pancreatic body hydatid cyst: A case report and literature review

INTRODUCTION AND IMPORTANCE

Primary pancreatic hydatid cysts are exceptionally rare as they have an incidence rate ranging from 0.14 % to 2 %. Due to their extreme rarity, the patient's clinical manifestations are nonspecific. This leads to misdiagnosis and delay in treatment. Therefore, a multidisciplinary approach is necessary for the proper treatment of this pathology.

CASE PRESENTATION

Herewith, we present the rare case of a 46-year-old Middle Eastern female who sought medical attention at our surgical clinic complaining of an acute on-top-of chronic epigastric pain that radiated to the back. It was associated with a reported dark and pale discoloration of the urine and stool, respectively. The preoperative investigative radiological analysis identified a primary pancreatic body mass formation.

CLINICAL DISCUSSION

A meticulous surgical resection of the pancreatic body, tail, and the spleen was performed. Subsequent histopathological analysis of the excised specimens decisively established the diagnosis of a primary pancreatic body hydatid cyst.

CONCLUSION

Primary pancreatic hydatid cysts are profoundly rare, and their occurrence in the pancreatic body is even rarer. The profound scarcity of published literature on primary pancreatic body hydatid cysts highlights the imperative need for documentation, epidemiological studies, and the development of crucial interventional protocols. After a meticulous review of the published literature, we deduced that ours is the third documented case from our country of a primary pancreatic body hydatid cyst. Furthermore, no other cases beyond these three have been published from our country involving primary pancreatic hydatid cysts.

Curative effects of tectochrysin on paraquat-instigated testicular toxicity in rats: A biochemical and histopathological based study

Background

Paraquat (PQ) is a herbicide that is used globally in the agriculture sector to eradicate unwanted weeds, however it also induces significant damages in various organs of the body such as testes. Tectochrysin (TEC) is an important flavonoid that shows versatile therapeutic potentials. Currently, there is no established antidote to cure PQ-induced testicular toxicity.

Objective

The present study was conducted to evaluate the ameliorative effects of TEC against PQ prompted testicular damage.

Methods

Sprague-Dawley rats (n = 48) were used to conduct the trial. Rats were allocated in to 4 groups i.e., Control, PQ administrated group (5 mgkg-1), PQ + TEC co-administrated group (5 mgkg-1 + 2.5 mgkg-1) and TEC only administrated group (2.5 mgkg-1). The trial was conducted for 8 weeks. The activity of anti-oxidants and the levels of MDA and ROS were determined by spectrophotometric method. Steroidogenic enzymes as well as apoptotic markers expressions were evaluated by qRT-PCR. The level of hormones and inflammatory indices was quantified by enzyme-linked immunosorbent assay.

Results

PQ exposure markedly (P < 0.05) disturbed the biochemical, spermatogenic and histological profile in the rats. Nevertheless, TEC treatment considerably (P < 0.05) increased CAT, GPx GSR and SOD activity, besides decreasing MDA and ROS contents. TEC administration also increased sperm viability, count and motility. 17β-HSD, 3β-HSD, StAR and Bcl-2 expressions were also increased following TEC administration. The supplementation of TEC substantially (P < 0.05) decreased Bax, Caspase-3 expression and the levels of inflammatory markers i.e., interleukin-1β (IL-1β), interleukin-6 (IL-6), nuclear factor kappa-B (NF-κB), tumor necrosis factor-α (TNF-α) and cyclooxygenase-2 (COX-2) activity. Additionally, the levels of plasma testosterone, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) were increased following TEC supplementation. Furthermore, TEC supplementation considerably decreased sperm structural abnormalities and histomorphological damages of the testes. The mitigative role of TEC might be due to its anti-inflammatory, anti-apoptotic, androgenic and anti-oxidant potentials.

Conclusion

Taken together, it is concluded that TEC can be used as a potential candidate to treat testicular toxicity.

Achievement of Target Gain Larger than Unity in an Inertial Fusion Experiment

On December 5, 2022, an indirect drive fusion implosion on the National Ignition Facility (NIF) achieved a target gain G_{target} of 1.5. This is the first laboratory demonstration of exceeding "scientific breakeven" (or G_{target}>1) where 2.05 MJ of 351 nm laser light produced 3.1 MJ of total fusion yield, a result which significantly exceeds the Lawson criterion for fusion ignition as reported in a previous NIF implosion [H. Abu-Shawareb et al. (Indirect Drive ICF Collaboration), Phys. Rev. Lett. 129, 075001 (2022)PRLTAO0031-900710.1103/PhysRevLett.129.075001]. This achievement is the culmination of more than five decades of research and gives proof that laboratory fusion, based on fundamental physics principles, is possible. This Letter reports on the target, laser, design, and experimental advancements that led to this result.

Didymin protects against polystyrene nanoplastic-induced hepatic damage in male albino rats by modulation of Nrf-2/Keap-1 pathway

Polystyrene nanoplastics (PS-NPs) are ubiquitous environmental pollutants that can cause oxidative stress in various organs, including the liver. Didymin is a dietary flavanone that displays multiple pharmacological activities. Therefore, the present study evaluated the palliative role of didymin against PS-NPs-induced hepatic damage in rats. Albino rats (n=48) were randomly distributed into 4 groups: control, PS-NPs treated group, PS-NPs + didymin co-administered group, and didymin supplemented group. After 30 days, PS-NPs intoxication lowered the expression of Nrf-2 and anti-oxidant genes [catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GPx), glutathione reductase (GSR), glutathione-S-transferase (GST), and heme oxygenase-1 (HO-1)], whereas the expression of KEAP1 kelch like ECH associated protein 1 (Keap-1) was increased. PS-NPs exposure also reduced the activities of anti-oxidants enzymes (CAT, SOD, GPx, GSR, GST, GSH, and OH-1), while malondialdehyde (MDA) and reactive oxygen species (ROS) levels were increased. The levels of alanine transaminase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP) were increased in PS-NPs-exposed rats. Moreover, inflammatory indices [interleukin-1β (IL-1β), tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), nuclear factor-kappa B (NF-κB), and cyclooxygenase-2 (COX-2)] were increased in PS-NPs-exposed rats. Furthermore, PS-NPs intoxication increased the expressions of apoptotic markers including Bax and Caspase-3, as well as reducing Bcl-2 expression. The histopathological analysis showed significant damage in PS-NPs-treated rats. However, didymin supplementation ameliorated all the PS-NPs-induced damage in the liver of rats. Therefore, it was concluded that didymin can act as a remedy against PS-NPs-induced liver toxicity due to its anti-apoptotic, anti-oxidant, and anti-inflammatory activities.

Mitigative potential of kaempferide against polyethylene microplastics induced testicular damage by activating Nrf-2/Keap-1 pathway

Polyethylene microplastics (PE-MPs) are one of the environmental contaminants that instigate oxidative stress (OS) in various organs of the body, including testes. Kaempferide (KFD) is a plant-derived natural flavonol with potential neuroprotective, hepatoprotective, anti-cancer, anti-oxidant and anti-inflammatory properties. Therefore, the present study was designed to evaluate the alleviative effects of KFD against PE-MPs-prompted testicular toxicity in rats. Fourty eight adult male albino rats were randomly distributed into 4 groups: control, PE-MPs-administered (1.5 mgkg-1), PE-MPs (1.5 mgkg-1) + KFD (20 mgkg-1) co-treated and KFD (20 mgkg-1) only treated group. PE-MPs intoxication significantly (P < 0.05) lowered the expression of Nrf-2 and anti-oxidant enzymes, while increasing the expression of Keap-1. The activities of anti-oxidants i.e., catalase (CAT), glutathione reductase (GSR), superoxide dismutase (SOD), hemeoxygene-1 (HO-1) and glutathione peroxidase (GPx) were reduced, besides malondialdehyde (MDA) and reactive oxygen species (ROS) contents were increased significantly (P < 0.05) following the PE-MPs exposure. Moreover, PE-MPs exposure significantly (P < 0.05) reduced the sperm motility, viability and count, whereas considerably (P < 0.05) increased the dead sperm number and sperm structural anomalies. Furthermore, PE-MPs remarkably (P < 0.05) decreased steroidogenic enzymes and Bcl-2 expression, while increasing the expression of Caspase-3 and Bax. PE-MPs exposure significantly (P < 0.05) reduced the levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH) and testosterone, whereas inflammatory indices were increased. PE-MPs exposure also induced significant histopathological damages in the testes. Nevertheless, KFD supplementation significantly (P < 0.05) abrogated all the damages induced by PE-MPs. The findings of our study demonstrated that KFD could significantly attenuate PE-MPs-instigated OS and testicular toxicity, due to its anti-oxidant, anti-inflammatory, androgenic and anti-apoptotic potential.

Attenuative effects of tamarixetin against polystyrene microplastics-induced hepatotoxicity in rats by regulation of Nrf-2/Keap-1 pathway

Polystyrene microplastics (PS-MPs) are environmental contaminants due to their potential to induce damages in multiple organs specifically liver. Tamarixetin (TMT) is a naturally occurring flavonoid present in Tamarix ramosissima plant that exhibits multiple pharmacological properties. Therefore, the present research was designed to evaluate the palliative role of TMT against PS-MPs instigated liver dysfunction in rats. The exposure to PS-MPs reduced the expressions of nuclear factor erythroid 2-related factor 2 and antioxidant genes, while increasing the expression of Kelch-like ECH-associated protein 1. PS-MPs exposed rats exhibited considerably (p < .05) higher alkaline phosphatase (ALP), aspartate aminotransferase (AST) as well as alanine aminotransferase (ALT) contents. Additionally, PS-MPs treatment resulted in a notable decrease in anti-oxidants activity, that is, glutathione S-transferase (GST), superoxide dismutase (SOD), heme oxygenase-1 (HO-1), glutathione reductase (GSR), glutathione peroxidase (GPx), catalase (CAT) and glutathione (GSH) content, whereas upregulating reactive oxygen species (ROS) and malondialdehyde (MDA) contents. Moreover, PS-MPs intoxication noticeably increased (p < .05) the inflammatory indices (interleukin-1ß [IL-1ß], nuclear factor kappa B [NF-κB], interleukin-6 [IL-6], tumor necrosis factor-α [TNF-α] levels, and cyclooxygenase-2 [COX-2] activity). Besides, Caspase-3 and Bax expressions were upregulated and Bcl-2 expression was decreased after PS-MPs exposure. Additionally, the histomorphological examination revealed notable hepatic damage in PS-MPs treated group. However, TMT treatment substantially (p < .05) recovered all the PS-MPs-induced damages and histopathological changes. Taken together, it can be deduced that TMT might be used as a pharmacological agent to ameliorate hepatic damage.

Melanin pigmentation variations in the larval cuticle of almond moth, Ephestia cautella caused by gamma radiation

To determine the effects of gamma radiation on the melanization process and phenoloxidase activity, Ephestia cautella larvae were exposed to dosages of 200, 400, 600, 800, and 1000 Gy. After irradiation, the number of non melanized larvae and the number exhibiting a slight melanization usually increased. The degree of melanization in treated larvae differed significantly from untreated larvae. The amount of melanin usually decreases as the dosage increases and as time passes after the treatment. The results of the phenoloxidase assay indicate that the enzyme activity responds differently to radiation. For instance, at doses of 200, 400, and 800 Gy, the enzyme activity remained consistent in both control and irradiated larvae. However, at doses of 600 and 1000 Gy, the enzyme activity increased to 14.92 and 13.37 O.D. units, respectively, compared to 8.81 O.D. units in the control. In order to determine if irradiated larvae have been previously exposed to ionizing radiation, a quick and easy test based on phenoloxidase activity or the melanization response is presented for use in quarantine treatment. Histological changes, specifically in the pigment granules of melanin, were studied using a light microscope. Upon inspection of the unirradiated larvae, it was observed that brown melanin pigment granules were deposited in the epicuticle and exocuticle layers of the cuticle. When gamma radiation dosages were administered to larvae, it was observed that the melanin pigment gradually diminished until it vanished at the highest dose (1000 Gy).

Sciadopitysin mitigates spermatological and testicular damage instigated by paraquat administration in male albino rats

Paraquat (PQ) is a herbicide that has ability to induce testicular toxicity by producing reactive oxygen species (ROS). Sciadopitysin (SPS) is a promising flavonoid that displays multiple pharmacological properties i.e., anti-inflammatory, anti-oxidant and anti-apoptotic. Therefore, the present study was designed to evaluate the mitigative role of SPS against PQ induced testicular toxicity in male rats. The experiment was performed on male albino rats (n = 48) that were divided into 4 groups. The group-1 was control group. Group-2 was administrated orally with PQ (5 mg/kg). Group-3 was administrated orally with PQ (5 mg/kg) and SPS (2 mg/kg). Group-4 was supplemented with SPS (2 mg/kg) through oral gavage. The experiment was conducted for 56 days. The exposure to PQ significantly lowered the activities of catalase (CAT), glutathione reductase (GSR), superoxide dismutase (SOD) as well as glutathione peroxidase (GPx). Whereas, a substantial increase was observed in dead sperms number, abnormalities in the tail, head as well as midpiece of sperms in PQ intoxicated rats. Moreover, a significant increase in the level of ROS and malondialdehyde (MDA) was noticed in PQ administrated group. Furthermore, steroidogenic enzymes expression was significantly decreased in PQ-intoxicated group, whereas the level of inflammatory markers was increased in PQ administrated rats. Besides, the expression of apoptotic markers was significantly escalated in PQ exposed rats, whereas the expression of anti-apoptotic markers was considerably reduced. A significant reduction in hormonal level was also noticed in the rats that were administrated with PQ. Moreover, the histopathological examination revealed that PQ significantly damaged the testicles. However, the supplementation of SPS with PQ significantly reduced the adverse effects of PQ in the testes of albino rats. Therefore, the current investigation demonstrated that SPS possesses a significant potential to avert PQ-induced testicular dysfunction due to its anti-apoptotic, androgenic, anti-oxidant and anti-inflammatory nature.

The lethal and sterile doses of gamma radiation on the museums pest, varied carpet beetle, Anthrenus verbasci (Coleoptera: Dermestidae)

Museums preserve historical cultural artifacts and serve as an essential resource for current and future generations seeking first-hand knowledge about the diversity of life on Earth. However, significant changes in climate from temperature and humidity cause serious biotic degradation. Despite ongoing insect control treatments, insect pests are still a major problem for museums due to the lack of suitable and unsafe environments that are provided for the storage and display of the collection. The varied carpet beetle, Anthrenus verbasci (Coleoptera: Dermestidae) is one of the major stored product pests whose larvae cause serious damage to household items and museum specimens. Therefore, this research aims to study the effect of gamma radiation on the larval, pupal and adult stages. The effects of gamma radiation have been studied on 3rd instar larvae (100, 200, 300, 400 and 500 Gy). The results showed that mortality in the larval stage significantly increased with increasing gamma radiation dose, which was reflected in the eclosion of the adult stage. The exposure of one-day-old pupae to 200, 400, 600, 800 and 1000 Gy of gamma radiation showed that the higher the dose, the lower the percentage of adult emergence. Additionally, there was a significant increase in the percentage of mortality in A. verbasci adults with increasing radiation doses when the newly emerged adults were irradiated with 200, 400, 600, 800 and 1000 Gy. The LD50 and LD90 of gamma radiation doses on larvae, pupae and adults were calculated, and the malformations in all stages were photographed. The fecundity and fertility of A. verbasci adults that were exposed to radiation as one-day-old pupae decreased gradually with increasing doses of gamma radiation and reached 100% sterility when exposed to a dose of 150 Gy. Among all the treatments, the sterile dose (150 Gy) or lethal dose (1000 Gy) showed superior performance over other treatments and was adjudged as the best treatments, which prevented the subsequent development and complete mortality of the pest.

Evaluation of possible attenuative role of chrysoeriol against polyethylene microplastics instigated testicular damage: A biochemical, spermatogenic and histological study

The current study was designed to evaluate the protective role of chrysoeriol against polyethylene microplastics (PE-MP) induced testicular damage. Forty eight male rats were distributed into 4 equal groups: vehicle control, PE-MP administrated, PE-MP + chrysoeriol co-administrated and only chrysoeriol supplemented group. The administration of PE-MP significantly reduced the activities of anti-oxidant enzymes, i.e., glutathione peroxidase, catalase, glutathione reductase and superoxide dismutase, whereas the levels of reactive oxygen species and malondialdehyde were increased. PE-MP exposure increased the levels of inflammatory markers (TNF-α, 1L-1β, NF-κβ, IL-6 & COX-2). Additionally, a considerable increase was observed in dead sperms number, abnormality of sperms (tail, midpiece and head), while a potential decrease was noticed in sperm motility in PE-MP treated rats. The expressions of steroidogenic enzymes were also decreased in PE-MP administrated group. The levels of plasma testosterone, luteinizing & follicle stimulating hormone were decreased in PE-MP treated group. Moreover, Bax and Caspase-3 expressions were increased, whereas Bcl-2 expressions were reduced. Furthermore, histopathological analysis showed that PE-MP exposure considerably damaged the testicular tissues. However, chrysoeriol supplementation potentially decreased all the adverse effects induced by PE-MP. Taken together, our findings indicate that chrysoeriol holds significant potential to avert PE-MP-induced testicular damage due to its androgenic, anti-apoptotic, anti-oxidant and anti-inflammatory nature.

Evaluation Of Interdepartmental Calls Generated In 8 Tertiary Care Hospitals Of Northern Pakistan

Objectives

To assess the quality of medical call writing in multiple tertiary care hospitals based on a variety of parameters.

METHODS

The cross-sectional study was conducted in 8 tertiary care hospitals across Pakistan from May 27 to June 27, 2021, and comprised residents and consultants aged 25-60 years regardless of gender and specialty. Data was collected using questionnaires related to demographic and professional characteristics, quality of calls received, quality of calls sent, and opinion regarding improvements to the existing system. Data ws analysed using SPSS 22.

RESULTS

Of the105 participants, 65(62%) were residents and 40(38%) were consultants. General surgery team received referrals most frequently 26(24.7%). History of the patient along with relevant examination findings were mentioned in 4(3%) and 6(5%), respectively (p=0.6 vs p=0.5). The timeline was mentioned by 10(9.5%), (p=0.09), and it was inconsistent with the clinical relevancy in 13(12.3%) cases (p=0.5). The working diagnosis for which the patient was admitted in a particular service was mentioned in 35(33.3%) of the generated calls (p=0.01).

CONCLUSIONS

The call referral system deserved more attention in order to improve communication among the physicians. Analysis of the quality of referral letters should be part of initial and continuing medical education.

Mitigative potential of rhoifolin against cisplatin prompted testicular toxicity: biochemical, spermatogenic and histological based analysis

Rhoifolin (ROF) is a naturally occurring flavonoid compound with diverse pharmacological and therapeutic benefits. The current investigation was designed to evaluate the curative potential of Rhoifolin (ROF) against Cisplatin (CP) induced testicular damage. Mature male albino rats (n = 48) were randomly distributed into 4 equal groups: control, CP (10 mg/kg), CP + ROF (10 mg/kg + 20 mg/kg) and ROF (20 mg/kg) supplemented group. Following 56 days of the trial, biochemical, inflammatory markers, spermatogenic, steroidogenic, hormonal, apoptotic, anti-apoptotic, and histopathological parameters were evaluated. The exposure to CP markedly (p < 0.05) lowered the activities of anti-oxidant enzymes, glutathione reductase (GSR), catalase (CAT), and glutathione peroxidase (GPx) as well as superoxide dismutase (SOD) in testicular tissues of male albino rats. Besides the levels of reactive oxygen species (ROS) and thiobarbituric acid reactive substances (TBARS) were considerably augmented in CP exposed rats. The administration of CP also increased the level of inflammatory cytokines i.e. IL-6, TNF-α, 1L-1β and NF-κβ as well as COX-2 activity. Additionally, a notable (p < 0.05) upsurge was observed in dead sperms count, abnormality in the tail, midpiece as well as head of sperms along with a notable decline in sperm motility in CP treated rats. Moreover, the expressions of steroidogenic enzymes were also lowered in CP administered group. The levels of follicle stimulating hormone (FSH) and plasma testosterone as well as luteinizing hormone (LH) were decreased in CP treated group. Moreover, the expression of Bax as well as Caspase-3 (apoptotic markers) were increased. On the other hand, Bcl-2 expression (anti-apoptotic marker) was reduced. Furthermore, the histopathological analysis showed that CP considerably (p < 0.05) damaged the testicular tissues. However, the administration of ROF significantly reduced the damaging effects of CP in testicular tissues. The results of our study suggested that ROF can potentially alleviate CP-induced testicular damages due to its androgenic, anti-oxidant and anti-inflammatory as well as anti-apoptotic nature.

Attenuative effect of astilbin on polystyrene microplastics induced testicular damage: Biochemical, spermatological and histopathological-based evidences

Polystyrene microplastics (PS-MPs) are the potential environmental pollutants that possess the ability to induce testicular damage. Astilbin (ASB) is a dihydroflavonol, abundantly reported in multiple plants that has various pharmacological properties. This research elucidated the mitigative potential of ASB against PS-MPs-instigated testicular toxicity. 48 adult male rats (200 ± 10 g) were distributed into 4 groups (n = 12): control, PS-MPs received (0.01 mg/kg), PS-MPs + ASB received (0.01 mg/kg + 20 mg/kg) and ASB supplemented group (20 mg/kg). After 56th day of the trial, animals were sacrificed and testes were harvested for the estimation of biochemical, hormonal, spermatogenic, steroidogenic, apoptotic and histological profiles. PS-MPs intoxication significantly (P < 0.05) lowered glutathione peroxidase (GPx), superoxide dismutase (SOD), glutathione reductase (GSR) as well as catalase (CAT) activities, whereas elevated MDA as well as ROS levels. Besides, the levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), nuclear factor kappa-B (NF-κB) along with cyclooxygenase-2 (COX-2) activity were raised. PS-MPs treatment reduced luteinizing hormone (LH), plasma testosterone and follicle-stimulating hormone (FSH) level besides decreased epididymal sperm number, viability, motility as well as the count of HOS coil-tailed spermatozoa and increased sperm morphological irregularities. PS-MPs exposure lowered steroidogenic enzymes (17β-HSD, 3β-HSD and StAR protein along with Bcl-2 expression, besides increasing Caspase-3 and Bax expressions and histopathological alterations in testicular tissues. However, ASB treatment significantly reversed PS-MPs mediated damage. In conclusion, ASB administration is protective against PS-MPs-instigated testicular damage owing to its anti-inflammatory, anti-apoptotic, antioxidant and androgenic nature.

Navigated Transcranial Magnetic Stimulation (nTMS) based Preoperative Planning for Brain Tumor Treatment

Transcranial Magnetic Stimulation (TMS) is a non-invasive technique for analyzing the central and peripheral nervous system. TMS could be a powerful therapeutic technique for neurological disorders. TMS has also shown potential in treating various neurophysiological complications, such as depression, anxiety, and obsessive-compulsive disorders, without pain and analgesics. Despite advancements in diagnosis and treatment, there has been an increase in the prevalence of brain cancer globally. For surgical planning, mapping brain tumors has proven challenging, particularly those localized in expressive regions. Preoperative brain tumor mapping may lower the possibility of postoperative morbidity in surrounding areas. A navigated TMS (nTMS) uses magnetic resonance imaging (MRI) to enable precise mapping during navigated brain stimulation. The resulting magnetic impulses can be precisely applied to the target spot in the cortical region by employing nTMS. This review focuses on nTMS for preoperative planning for brain cancer. This study reviews several studies on TMS and its subtypes in treating cancer and surgical planning. nTMS gives wider and improved dimensions of preoperative planning of the motor-eloquent areas in brain tumor patients. nTMS also predicts postoperative neurological deficits, which might be helpful in counseling patients. nTMS have the potential for finding possible abnormalities in the motor cortex areas.

Alleviative effects of pinostrobin against cadmium-induced renal toxicity in rats by reducing oxidative stress, apoptosis, inflammation, and mitochondrial dysfunction

Introduction

Cadmium (Cd) is a highly toxic heavy metal that can be found everywhere in the environment and can have harmful effects on both human and animal health. Pinostrobin (PSB) is a bioactive natural flavonoid isolated from Boesenbergia rotunda with several pharmacological properties, such as antiinflammatory, anticancer, antioxidant, and antiviral. This investigation was intended to assess the therapeutic potential of PSB against Cd-induced kidney damage in rats.

Methods

In total, 48 Sprague Dawley rats were divided into four groups: a control, a Cd (5 mg/kg), a Cd + PSB group (5 mg/kg Cd and 10 mg/kg PSB), and a PSB group (10 mg/kg) that received supplementation for 30 days.

Results

Exposure to Cd led to a decrease in the activities of catalase (CAT), glutathione reductase (GSR), superoxide dismutase (SOD), and glutathione peroxidase (GSH-PX), whereas levels of reactive oxygen species (ROS) and malondialdehyde (MDA) increased. Cd exposure also caused a substantial increase in urea, kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), and creatinine levels. Moreover, a noticeable decline was noticed in creatinine clearance. Moreover, Cd exposure considerably increased the levels of inflammatory indices, including interleukin-1b (IL-1b), tumor necrosis factor-a (TNF-a), interleukin-6 (IL-6), nuclear factor kappa-B (NF-kB), inducible nitric oxide synthase (iNOS), and cyclooxygenase-2 (COX-2) activity. Cd treatment decreased the expression of the antiapoptotic markers (Bcl-2) while increasing the expression of apoptotic markers (Bax and Caspase-3). Furthermore, Cd treatment substantially reduced the TCA cycle enzyme activity, such as alpha-ketoglutarate dehydrogenase, succinate dehydrogenase, malate dehydrogenase, and isocitrate dehydrogenase. Moreover, mitochondrial electron transport chain enzymes, succinatedehydrogenase, NADH dehydrogenase, cytochrome c-oxidase, and coenzyme Q-cytochrome reductase activities were also decreased following Cd exposure. PSB administration substantially reduced the mitochondrial membrane potential while inducing significant histological damage. However, PSB treatment significantly reduced Cd-mediated renal damage in rats.

Conclusion

Thus, the present investigation discovered that PSB has ameliorative potential against Cd-induced renal dysfunction in rats.

Eriodictyol attenuates Furan induced testicular toxicity in Rats: Role of oxidative stress, steroidogenic enzymes and apoptosis

Furan (C₄H₄O) is a naturally occurring organic compound. It develops as a result of the thermal processing of food and stimulates critical impairments in male reproductive tract. Eriodictyol (Etyol) is a natural dietary flavonoid possessing diverse pharmacological potentials. The recent investigation was proposed to ascertain the ameliorative potential of eriodictyol against furan-instigated reproductive dysfunctions. Male rats (n = 48) were classified into 4 groups: untreated/control, furan (10 mg/kg), furan+ eriodictyol (10 mg/kg + 20 mg/kg) and eriodictyol (20 mg/kg). At the 56th day of the trial, the protective effects of eriodictyol were evaluated by assessing various parameters. Results of the study revealed that eriodictyol attenuated furan-induced testicular toxicity in the biochemical profile by increasing catalase (CAT), glutathione peroxidase (GPx), superoxide dismutase (SOD) along with glutathione reductase (GSR) activities, whereas reduced the reactive oxygen species (ROS) along with malondialdehyde (MDA) levels. It also restored the normal state of sperm motility, viability, the count of hypo-osmotic tail swelled sperm as well as epididymal sperm number along with reduced sperm anomalies (morphological) tail, mid-piece and head. Furthermore, it elevated the decreased levels of luteinizing hormone (LH), plasma testosterone and follicle-stimulating hormone (FSH) as well steroidogenic enzymes (17β-HSD, StAR protein & 3β-HSD) and testicular anti-apoptotic marker (Bcl-2) expression, whereas, down-regulating apoptotic markers (Bax & Caspase-3) expression. Eriodictyol treatment also effectively mitigated the histopathological damages. The outcomes of the current study provide fundamental insights into the ameliorative potential of eriodictyol against furan-instigated testicular toxicity.

Pinostrobin alleviates testicular and spermatological damage induced by polystyrene microplastics in adult albino rats

BACKGROUND

Polystyrene microplastics (PS-MPs) have become major environmental pollutants that adversely effects multiple organs specifically testicles. Pinostrobin (PN) is an important flavonoid which, shows several pharmacological potentials.

PURPOSE

The current study was designed to elucidate the mitigative effects of PN against PS-MPs induced testicular toxicities in rats.

METHODS

48 male albino rats were randomly distributed into 4 groups, control, PS-MPs group (0.01 mg/kg), PS-MPs + PN group (0.01 mg/kg of PS-MPs; 40 mg/kg of PN) and PN group (40 mg/kg).

RESULTS

PS-MPs intoxication substantially lessened the activities of glutathione peroxidase (GPx), glutathione reductase (GSR), superoxide dismutase (SOD) along with catalase (CAT) while, raised the level of malondialdehyde (MDA) as well as reactive oxygen species (ROS). Additionally, PS-MPs reduced luteinizing hormone (LH), plasma testosterone, follicle-stimulating hormone (FSH) concentration, sperm motility, sperm count, expression of steroidogenic enzymes and Bcl-2 (anti-apoptotic protein) along with the count of spermatogenic cells. While, dead sperm count, sperm abnormalities (tail, neck and head), Bax and caspase-3 (apoptotic proteins) expression along with histopathological anomalies were elevated. Moreover, PS-MPs exposure increased the level of inflammatory markers. However, PN treatment considerably decreased oxidative stress (OS) by reducing ROS as well as increased sperm motility and alleviated all the damages induced by the PS-MPs.

CONCLUSION

Therefore, it is concluded that PN may prove a potential therapeutic candidate to restore all the PS-MPs-induced testicular toxicities.

Accuracy of Whole Blood Cardiac Troponin I in the Diagnosis of Childhood Heart Failure at the University College Hospital, Ibadan

OBJECTIVE

To determine the accuracy of cardiac troponin I (cTnI), a marker of myocardial cell injury or necrosis, in correctly identifying heart failure in children.

PATIENTS, MATERIALS, AND METHODS

This was a crosssectional study in which 45 children aged 12 years or below admitted into the paediatric wards of the University College Hospital, Ibadan, who, on evaluation with the Ibadan Childhood Heart Failure Index (ICHFI) had a score of ≥ 3, were consecutively recruited. Forty-five age- and sex-matched apparently healthy children with ICHFI score of <3 were similarly evaluated as controls. Demographic, clinical data and cTnI values were documented. Statistical analysis was done using IBM SPSS version 23.

RESULTS

There was a strong positive correlation (0.592) between the whole blood cTnI values and ICHFI scores (rs = 0.592, P = 0.000). At a cut-off value of 0.07ng/ml, the whole blood cTnI had a sensitivity of 26.7%, specificity of 97.8%, a positive predictive value of 92.8% and a negative predictive value of 57.1%. The receiver operating characteristic curve plotted had an AUC of 0.800 at the 95% CI, 0.704 - 0.896; P < 0.001.

CONCLUSION

Whole blood cTnI level is elevated in children in heart failure and may predict severity of the condition. Whole blood cTnI was found to be an accurate tool for the exclusion of heart failure in children and is therefore recommended for use in children with suspected heart failure for its rapid diagnosis.

Rhamnetin alleviates polystyrene microplastics-induced testicular damage by restoring biochemical, steroidogenic, hormonal, apoptotic, inflammatory, spermatogenic and histological profile in male albino rats

The current research was performed to evaluate the ameliorative effects of Rhamnetin (RHM) on polystyrene microplastics (PS-MPs)-instigated testicular dysfunction in male albino rats. 48 albino rats were distributed in four groups, i.e., control, PS-MPs treated, PS-MPs + RHM co-treated and RHM only supplemented group. PS-MPs exposure considerably reduced anti-oxidant enzymes i.e., catalase (CAT), glutathione peroxidase (GSR), superoxide dismutase (SOD) and glutathione reductase (GPx) activities. Whereas, reactive oxygen species (ROS) level along with malondialdehyde (MDA) was considerably escalated in PS-MPs treated rats as well as a potential decline was observed in sperm progressive motility. Additionally, a substantial upsurge was noticed in the count of dead sperms, deformity in the tail, mid-piece and head of sperms in PS-MPs treated rats. PS-MPs exposure also decreased steroidogenic enzymes, 17β-hydroxysteroid dehydrogenase (17β-HSD), steroidogenic acute regulatory protein (StAR) and 3β-hydroxysteroid dehydrogenase (3β-HSD) expressions. Moreover, the levels of inflammatory indices i.e., Interleukin-6 (IL-6), Nuclear factor kappa-B (NF-κB), Interleukin-1β (IL-1β), tumour necrosis factor-α (TNF-α) and cyclooxygenase-2 (COX-2) activity were also increased in PS-MPs administrated group. Besides it increased the expression of apoptotic markers (Bax and caspase-3) expression. Whereas, anti-apoptotic marker i.e., Bcl-2 expression was reduced. Moreover, luteinizing hormone (LH), follicle-stimulating hormone (FSH) as well as plasma testosterone levels were also decreased. PS-MPs exposure also led to a substantial histopathological damage in testicular tissues. However, RHM supplementation potentially reduced the damaging effects of PS-MPs in the reproductive tissues of male albino rats. Thus, the current study revealed, RHM possesses potential to prevent PS-MPs-induced testicular damage due to its anti-oxidant anti-apoptotic, anti-inflammatory as well as androgenic properties.

Rhamnazin ameliorates 2, 3, 7, 8-tetrachlorodibenzo-p-dioxin-evoked testicular toxicity by restoring biochemical, spermatogenic and histological profile in male albino rats

2,3,7,8 tetrachlorodibenzo-p-dioxin (TCDD) is a potential environmental toxin that has the ability to affect male reproductive tract. Rhamnazin is a naturally present flavone that displays multiple medicinal properties. Therefore, the current study was designed to determine the mitigative role of rhamnazin against TCDD induced reproductive damage. 48 adult male albino rats were randomly separated into four groups: control, TCDD (10 µgkg-1), TCDD + rhamnazin (10 µgkg-1 + 5 mgkg-1 respectively) and rhamnazin (5 mgkg-1). The trial was conducted for 56 days. TCDD intoxication notably affected superoxide dismutase (SOD), glutathione peroxidase (GPx), glutathione reductase (GSR) and catalase (CAT) activities, besides reactive oxygen species (ROS) and malondialdehyde (MDA) concentrations were augmented. TCDD administration also lowered sperm motility, viability, sperm number, while it augmented the sperm morphological (tail, neck/midpiece and head) anomalies. Moreover, it decreased the levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH) and plasma testosterone. Moreover, TCDD reduced steroidogenic enzymes i.e., 17-beta hydroxysteroid dehydrogenase (17β-HSD), steroidogenic acute regulatory protein (StAR) and 3-beta hydroxysteroid dehydrogenase (3β-HSD) as well as B-cell lymphoma 2 (Bcl-2) expressions, but increased the expressions of Bcl-2-associated X protein (Bax) and cysteine-aspartic acid protease (Caspase-3). Furthermore, TCDD exposure also induced histopathological anomalies in testicular tissues. However, the supplementation of rhamnazin recovered all the mentioned damages in the testicles. The outcomes revealed that rhamnazin can ameliorate TCDD induced reproductive toxicity due to its anti-oxidant, anti-apoptotic and androgenic nature.

Cryptococcus Infection Mimicking Lipoid Pneumonia in a Lung Biopsy

Introduction/Objective

Lipoid pneumonia is a non-infectious, rare entity which results from accumulation of exogenous or endogenous lipids in the lungs. It appears as intraalveolar macrophages filled with lipids in the form of fine spherical vacuoles. Cryptococcosis can also appear as vacuolated macrophages filled with yeasts. At low magnification, the distinction is very difficult. The co-existence of the two entities is noted in literature but is exceedingly rare.

Methods/Case Report

A 33-year-old male, status post renal and pancreatic transplant, on chronic immunosuppression therapy presented with dysphagia. Imaging studies showed cavitary and non-cavitary nodules, patchy, confluent consolidations in the bilateral lungs, and a patulous, debris filled esophagus. This raised the possibility of atypical infections as well as aspiration. Biopsy of a right lower lobe lung lesion was performed. Histology demonstrated fibrotic lung parenchyma with vacuolated histiocytes containing small spherical substances. The differential diagnosis included Cryptococcus infection versus exogenous lipoid pneumonia, both of which were consistent with clinical and radiologic findings. Few, scattered foreign body giant cells were found. Additionally, GMS and mucicarmine stains were positive in the small spheres within the macrophages. The final diagnosis of lung parenchyma with numerous yeast forms, morphologically consistent with cryptococcus species was rendered. The patient was additionally found to have esophageal candidiasis. Concurrent lipoid pneumonia was considered unlikely based on the patient's history of immunosuppression (which made infection a much more likely etiology) and paucity of foreign body giant cell reaction.

Results (if a Case Study enter NA)

NA

Conclusion

This case highlights the importance of knowledge of rare entities and correlation with clinical and radiologic findings in arriving at an accurate diagnosis.

Rare Urinary Bladder Tumor with Unusual Morphology: A Potential Diagnostic Pitfall

Introduction/Objective

Transurethral resection of bladder tumor (TURBT) is a common surgical pathology specimen. The purpose of this report is to describe an unusual case encountered on a TURBT specimen with discussion of the differential diagnoses to avoid potential diagnostic pitfall.

Methods/Case Report

A 68-year-old male presented with history of urinary frequency, urgency and nocturia. Cystoscopy showed nodular, pedunculated lesion at the bladder trigone. Transurethral resection was performed. Histologic section showed a 4 mm polypoid lesion with classical appearance of cystitis glandularis and an adjacent area of relatively more atypical yet bland cells in tubular growth pattern. This elicited a differential diagnosis of nephrogenic adenoma / metaplasia, prostate type polyp / ectopic prostatic tissue and urothelial carcinoma with tubule formation. Immunohistochemical stains showed the lesional cells to be positive for high molecular weight cytokeratin and racemase (AMACR) and negative for GATA3, NKX 3.1, PAX-8, CK 7, CK 20, p63, PSA and PSAP. Literature review suggested that racemase is frequently positive in neuroendocrine tumors. Additional immunohistochemical stains performed showed the lesional cells to be positive for synaptophysin and chromogranin and negative for TTF-1 and CDX-2. Ki-67 proliferation index was less than 1%. Therefore, final diagnosis of well-differentiated neuroendocrine tumor, grade 1 involving urothelial mucosa was rendered. Patient did not have any history of prior malignancies. A subsequent PET / CT did not demonstrate any evidence of metastatic disease. Additional work up was also negative for carcinoid tumor of lung and well differentiated neuroendocrine tumor of gastrointestinal and pancreaticobiliary tracts. Multidisciplinary discussion recommended cystoscopy every 3 months for a year, then every 6 months for 2 more years and annually thereafter.

Results (if a Case Study enter NA)

n/a.

Conclusion

This case reminds pathologists that although rare, well differentiated neuroendocrine tumors can occur in the urinary bladder, they can show unusual histology with tubular growth, and can be racemase positive.

The eyes don't see, what the mind doesn't know

Introduction/Objective

Calcifying fibrous tumor is a rare benign mesenchymal neoplasm. The etiology and pathogenesis of this tumor are uncertain. It has wide anatomical distribution. The tumor is most commonly found in the soft tissues of the extremities in younger individuals. However, in middle aged patients it tends to affect the visceral locations more commonly. In visceral location it can mimic aggressive lesions clinically. The purpose of this report is to describe a case of calcifying fibrous tumor in a 71-year-old female with a history of breast carcinoma who was found to have an incidental small bowel mass on her follow up. Clinically and radiologically and the main diagnostic consideration were metastatic disease and gastrointestinal stromal tumor.

Methods/Case Report

The patient underwent an open small bowel resection, and a 6.5 cm segment of small bowel was sent to pathology. Grossly, a 2.0 cm tan-pink smooth round submucosal polyploid mass protruding into the lumen, mimicking gastrointestinal stromal tumor was identified. The tumor was hard and serially sectioned to reveal a white, calcified cut surface. Microscopically, the tumor appeared hypocellular and composed of scant spindle cells embedded in a dense, hyalinized and calcified, collagenous stroma. Immunohistochemical stains for pan cytokeratin, DOG1, desmin, S100, CD34, and MUC4 were negative, and diagnosis of calcifying fibrous tumor was rendered.

Results (if a Case Study enter NA)

NA.

Conclusion

This case highlights the importance of knowledge of rare entities in providing accurate diagnosis for lesions that can clinically mimic common tumors.

Paraneoplastic Nephropathy with Peculiar Immunofluorescence Pattern: Report of a Rare Case

Introduction/Objective

Hematolymphoid neoplasms are commonly associated with medical renal disease; however, association of renal cell carcinoma and nephrotic/nephritic syndrome is exceedingly rare. Paraneoplastic nephropathy in setting of renal cell carcinoma can manifest as membranous nephropathy, IgA nephropathy, or minimal change disease. The purpose of this report is to describe a rare case of clear cell renal cell carcinoma with associated membranous nephropathy with concurrent glomerular IgG and IgA deposition.

Methods/Case Report

A 68-year-old male presented with a penile mass. Diagnostic work up reveled an 11cm renal mass. Urinalysis demonstrated nephrotic range proteinuria (&gt;5 g/d). Subsequently, the patient underwent nephrectomy and penectomy. Pathologic evaluation showed clear cell renal carcinoma with sarcomatoid component and metastasis to penis. Nonneoplastic kidney workup revealed membranous glomerulopathy, with 3+ granular IgG predominantly within glomerular capillaries and 2+ IgA and 1+ C3 in a similar pattern. Electron microscopy demonstrated numerous subepithelial and intramembranous immune deposits, and few small mesangial deposits. Concurrent membranous and IgA nephropathy has been reported, but the IgA in that case is typically mesangial. The peculiar pattern of IgG and IgA deposition in this case can be seen with membranous nephropathy secondary to lupus or neoplasia. Lupus was excluded based on patient’s history, serology, and absence of significant C1q staining. Therefore, the findings were consistent with membranous glomerulopathy secondary to patient’s cancer. Patient’s proteinuria improved after nephrectomy. He is alive and disease-free 10months after nephrectomy, with proteinuria in 0.1-0.6 g/d range.

Results (if a Case Study enter NA)

NA

Conclusion

This case highlights the importance of thorough evaluation of non-neoplastic kidney in nephrectomy specimens for cancer, thus guiding the type of surgical intervention. Non-orthodox presentation of immunoglobulin deposition may be the herald of neoplasia in select cases.

Undifferentiated Melanoma: A Rare Phenomenon and a Challenging Diagnosis

Introduction/Objective

Undifferentiated melanoma is defined as a primary or metastatic melanoma lacking histologic and immunophenotypic features of melanoma. Dedifferentiated melanoma shows transition between undifferentiated and conventional melanoma components. Dedifferentiation and transdifferentiation (implying dedifferentiation with heterologous elements) in melanoma are exceedingly rare and occur mostly in metastatic deposits. The purpose of this report is to describe a case of undifferentiated melanoma that proved to be a diagnostic challenge and to highlight the importance of the multimodality approach and utilization of advanced diagnostic tools in reaching an accurate diagnosis.

Methods/Case Report

Methods: A 43-year-old white male who was diagnosed with metastatic melanoma on the right axillary biopsy at a local hospital presented to our institution with a rapidly enlarging 30 cm peritoneal mass. He underwent debulking surgery to lower his tumor burden. On pathologic evaluation, the tumor showed a heterogeneous appearance ranging from highly cellular fascicles of spindle cells to sheets of primitive round cells and epithelioid cells with abundant eosinophilic cytoplasm. One metastatic focus showed heterologous cartilaginous differentiation. This morphologic appearance elicited the differential diagnosis of metastatic melanoma, primitive neuroectodermal tumor, synovial sarcoma, and metastatic germ cell tumor with somatic transformation. Immunochemical staining showed the tumor cells to be positive for SALL4, CD99 (patchy), and TLE1 (patchy) and negative for pan-cytokeratin, S100, SOX- 10, HMB-45, desmin, myogenin, DOG1, CD 117, CDX2, TTF-1, PAX-8, CK7, CK20, chromogranin, CD30, and OCT4. Fluorescence in situ hybridization for EWSR1, SS18(SYT), and isochromosome 12p were negative. BRAF gene mutation analysis detected p.V600E / p.V600D. Subsequently, a diagnosis of undifferentiated melanoma was rendered after expert consultation. Unfortunately, the patient passed away 1 month after surgery.

Results (if a Case Study enter NA)

NA.

Conclusion

Diagnosis of undifferentiated melanoma by the conventional H&E and immunohistochemical profile is extremely challenging. Multimodality approach and utilization of advanced diagnostic tools such as molecular studies are helpful in this regard.

Hypertension in Young Adults: Think Juxtaglomerular Cell Tumor!

Introduction/Objective

Juxtaglomerular cell tumor is a benign, renin-secreting neoplasm. The tumor arises from the juxtaglomerular apparatus cells of the kidney. Because the tumor is hormonally active, patients usually suffer from hypokalemia, hyperaldosteronism, and hypertension. The typical patient population is adolescents and young adults with slight female predominance. Herein, we describe a case of a 19-year-old Asian female with a somewhat atypical presentation.

Methods/Case Report

A 19-year-old Asian female presented with upper extremity weakness, numbness, and tingling. On physical examination, the only notable finding was hypertension. Extensive work up reveled an aldosterone level of 71 nanograms per deciliter and plasma renin activity of 6.25 nanograms per milliliter per hour. A CT scan of the abdomen revealed a 2.4cm mass in the lower pole of the left kidney. The mass was resected by partial nephrectomy. Sectioning of the specimen revealed a 2.4cm well-circumscribed, encapsulated tumor. On microscopic evaluation, the tumor had glomoid appearance with sheets of uniform, round to polygonal cells with clear to eosinophilic cytoplasm. The stroma was scanty, mitoses were rare, and necrosis was not identified. Immunohistochemical stains showed the tumor cells to be positive for CD117, CD34, Cathepsin K, Synaptophysin, and CD10 and negative for ER, PR, CK7, PAX-8, pancytokeratin, EMA, S100, Melan-A, HMB45, SMA and CAIX. Diagnosis of Juxtaglomerular cell tumor was rendered. The patient was alive and well and without signs of recurrence 14 months after surgery.

Results (if a Case Study enter NA)

NA.

Conclusion

This case highlights the importance of a regular physical exam and having a high index of suspicion in patients presenting with unusual complaints.

Langerhans’ Cell Histiocytosis Masquerading as Metastatic Melanoma on Frozen Section

Introduction/Objective

Langerhans’ cell histiocytosis (LCH) involving the lungs usually presents as multiple interstitial, bilateral, peribronchiolar pulmonary nodules. As lungs are a common site of metastatic involvement LHC can masquerade as a metastatic lesion. The distinction can be challenging, especially on a frozen section.

Methods/Case Report

We present a case of a 35-year-old male with history of metastatic melanoma who presented with pulmonary nodules and underwent lung wedge resection. Frozen section was requested at the time of surgery. Grossly there was a 2.8 cm tan-grey irregular lesion abutting the pleura. Frozen section of a representative piece showed a discohesive lesion composed of large cells with prominent nuclei resembling melanocytes. The eosinophilic infiltrate in the frozen slide was extremely scant, and presence of anthracotic macrophages resembled the melanin pigment frequently seen with melanoma. CT imaging prior to the surgery had raised the differential of LCH and metastatic disease. The frozen section was favored to be negative for carcinoma and metastatic melanoma and final diagnosis was deferred to permanent sections. Permanent tissue sections showed classic features of LCH and positivity for CD1a confirming the diagnosis.

Results (if a Case Study enter NA)

NA

Conclusion

This case emphasizes the importance of multidisciplinary approach and knowledge of imaging impression during a frozen section.

Every TURP Is not Just BPH

Introduction/Objective

Transurethral resection of prostate is a common specimen in surgical pathology practice. These specimens usually demonstrate benign prostatic hyperplasia. However, occasionally incidental prostate cancer is identified. Finding a true mesenchymal tumor in these specimens is exceedingly rare. We present a unique case of prostatic adenocarcinoma Gleason score 3 + 4 =7 and concurrent solitary fibrous tumor identified on a TURP specimen. Solitary fibrous tumor in this anatomical location is rare with approximately 50 cases reported in the English language literature.

Methods/Case Report

An 86-year-old male presented with symptoms and signs of urinary retention. On clinical evaluation the prostatae was profoundly enlarged with a calculated volume of 283cc; firm in consistency. He was given trial of medical management including finasteride, tamsulosin and Foley catheter placement. Subsequently, the patient underwent transurethral resection of prostate. Complete morcellation was not possible at the initial surgery due to hard consistency of the gland. Pathologic evaluation showed prostatic adenocarcinoma Gleason grade 3 + 4=Score 7 (Grade group 2) involving 10% of submitted tissue in addition to the changes of benign prostatic hyperplasia. Additionally, the background stroma demonstrated short plump oval to spindle cells with inconspicuous nucleoli and collagenous background, arranged in a haphazard (‘‘patternless’’) pattern. Immunohistochemical stains showed these lesional cells to be positive for STAT6 and CD34 and negative for desmin, S100, SOX-10, CD 117, DOG-1 and NKX 3.1. Morphology and immunohistochemical profile were compatible with solitary fibrous tumor involving the prostate. The patient is alive and symptom-free 9 months after the procedure.

Results (if a Case Study enter NA)

NA.

Conclusion

This case highlights the value of thorough evaluation of prostatic tissue in TURP specimens not only for prostate cancer but other tumors as well. It also reminds the practising pathologist to keep an eye out for the stromal lesions of the prostate gland. Also finding one lesion should not dissuade one from looking for additional concurrent lesions.

Concurrent Prostatic Adenocarcinoma and Lymphoma: Clinicopathologic Study of 10 Cases

Introduction/Objective

Synchronous and meta-synchronous hematolymphoid neoplasms and prostatic adenocarcinomas are known to occur, albeit rarely. The purpose of this study is to identify the clinicopathologic features of patients with coexisting prostatic adenocarcinoma and a lymphoma diagnosis.

Methods/Case Report

The institutional pathology archive was searched from 2016 to 2021. Data such as patient age, Gleason score, pathologic tumor stage, type of lymphoma and follow up data were collected.

Results (if a Case Study enter NA)

Ten patients were identified. Mean patient age was 65.4 ± 5.7 years. Nine specimens were prostatectomies and 1 was a needle core biopsy. Four patients had previous lymphoma diagnoses while 6 were diagnosed with lymphoma on lymph node dissection for prostatectomies. Seven patients had Gleason grade 3 + 4=7 disease, two had Gleason grade 4 + 3=7 and one had Gleason grade 4 + 5=9. Seven patients had small lymphocytic lymphoma/chronic lymphocytic leukemia, one had follicular lymphoma, one had mantle cell lymphoma and one had peripheral T-cell lymphoma. The patient with peripheral T-cell lymphoma died 18 months after lymphoma diagnosis and 11 months after prostate cancer diagnosis. The remaining 9 patients were alive for a mean of 27.7 ± 22.6 months after prostate cancer diagnosis.

Conclusion

There is minimal literature on patients with synchronous/meta-synchronous hematolymphoid neoplasms and prostatic adenocarcinoma. Our data provides one of the largest institutional series in this regard. Additional data and follow up is needed to evaluate if the concurrent low grade hematolymphoid malignancy, specifically small lymphocytic lymphoma/chronic lymphocytic leukemia, affects the survival outcome in these patients.

Piercing and sucking mouth parts sensilla of irradiated mosquito, Culex pipiens (Diptera: Culicidae) with gamma radiation

Morphology, distribution and function of the sensilla associated with mouthparts of female mosquito, Culex pipiens (Diptera: Culicidae) were studied by using the scanning electron microscope. The female mosquito mouthpart is a piercing and sucking type and carrying many sensory organs which plays major role in host seeking, and oviposition behaviour of mosquitoes. Six types of mouthpart sensilla have been identified and described, Sensilla trichoidea, chaetica, basiconica, Capitate peg, campaniformia and squamiformia. Females mosquito were irradiated as pupae with 20, 40 and 80 Gy of gamma radiation to investigate their effect on mouthparts sensilla. Dose of 20 Gy had slight effect on the different types of the sensilla as compared with the control. Features of malformation observed in the maxillary palp segments at this radiation dose include falling of some scales (sensilla squamiformia) at certain parts of the 1st segment leaving vacuoles. At 40 Gy, the maxillary palp segments were liquefied in some areas leaving undistinguished shape. At the highest dose 80 Gy, the tip of labial palps had many tears and showed were most affected, especially, at the trichoid, basiconic and chateica sensilla. All these malformations may lead the mosquitoes to not reaching the host, impeding their ability to transmit diseases or killing the mosquitoes, and this is the main objective of this study.

P01.18.B Structural abnormalities related to chemotherapy in cancer survivors: an ALE meta-analysis of neuroimaging studies

Background

Chemotherapy induced cognitive impairment (CICI) is a term used for the cognitive dysfunction reported with non-central nervous system cancer patients during or after chemotherapy. Recent neuroimaging studies have shown decreased activation in cancer patients during cognitive tasks post-chemotherapy. Structural changes are sought to be associated with cognitive decline in cancer survivors after chemotherapy. Here we aim to investigate the neuroimaging findings of structural abnormalities and gray matter alterations associated with chemotherapy in cancer survivors.

Material and Methods

A systematic search through PubMed database for peer-reviewed English-language studies yielded a total of 302 studies. Eligible studies were included in the activation likelihood estimation (ALE) meta-analysis if they reported coordinates in a stereotactic format (MNI or Talairach space) for voxel-based morphometric (VBM) studies on gray matter volume and post-chemotherapy cancer survivors compared to matched healthy controls. GingerALE (3.0.2) software from Brainmap.org was used to perform the ALE meta-analysis with threshold settings of uncorrected P-value &lt; 0.001 for multiple comparisons.

Results

The study sample included 299 patients comprised of breast cancer survivors (BCS), childhood acute lymphocytic leukemia (ALL) survivors, ovarian cancer survivors (OCS) and lung cancer with 279 matched healthy controls from 12 studies and 21 experiments. ALE-maps for post-chemotherapy cancer survivors showed reduced gray matter volume in comparison to healthy controls in the left inferior frontal gyrus, right thalamus, right superior frontal gyrus, right medial frontal gyrus and right cerebellum (peak coordinates: [-43,40,-6], [23,-29,2], [14,30,55], [9,57,-16], [9,-78,-41] respectively, and cluster size of 544 mm3, 312 mm3 and 257 mm3, 296 mm3, 297 mm3 respectively).

Conclusion

This is the first ALE meta-analysis that studied the converged areas of reduced gray matter volume in post-chemotherapy cancer survivors. Our findings of reduced gray matter volume in frontal regions and cerebellum might be responsible for the cognitive dysfunction in executive function, attention, and memory observed in cancer survivors. Further studies are needed to assess the impact of different chemotherapeutic regimens related to CICI .

Lawson Criterion for Ignition Exceeded in an Inertial Fusion Experiment

For more than half a century, researchers around the world have been engaged in attempts to achieve fusion ignition as a proof of principle of various fusion concepts. Following the Lawson criterion, an ignited plasma is one where the fusion heating power is high enough to overcome all the physical processes that cool the fusion plasma, creating a positive thermodynamic feedback loop with rapidly increasing temperature. In inertially confined fusion, ignition is a state where the fusion plasma can begin "burn propagation" into surrounding cold fuel, enabling the possibility of high energy gain. While "scientific breakeven" (i.e., unity target gain) has not yet been achieved (here target gain is 0.72, 1.37 MJ of fusion for 1.92 MJ of laser energy), this Letter reports the first controlled fusion experiment, using laser indirect drive, on the National Ignition Facility to produce capsule gain (here 5.8) and reach ignition by nine different formulations of the Lawson criterion.

Vagal Paraganglioma: A Rare Finding in a 31-Year-Old Male

Vagal paraganglioma is a rare finding that develops from paraganglionic tissue found around the vagus nerve; it has a prevalence of 0.012% of all tumors. It is the third most common paraganglioma of the head and neck but still accounts for less than 5% of these tumors, and it has a well-established female prevalence. It is a difficult tumor to identify early based on its symptoms alone and only a thorough investigation can help solidify its diagnosis. In this report, we discuss a presentation of this phenomenon that is not only unique in its manifestation but also a very difficult diagnosis due to its deceptive presentation and multiple extensions. These masses need a good surgical regime to be removed properly and postoperative complications are very frequent in most of these cases.

A Rare Case of Homocysteinemia Presenting With Multiple Aneurysms in an Adolescent Boy

Thoracoabdominal aortic aneurysm (TAAA) is primarily a disorder of the elderly; the condition, however, is rare in children, for whom the misdiagnosis is not uncommon. It is one of the leading causes of death in the older age group worldwide, with a 4:1 male to female ratio. There are no real data about the incidence of aortic aneurysms in childhood. Although rare, an aortic aneurysm can be an important cause of mortality in children and adolescents. We present a case of an adolescent boy with a left coronary artery aneurysm, left axillary artery aneurysm, and TAAA type-IV caused by the metabolic disease homocysteinemia. He was referred to our facility when the complicated picture of the disease was discovered.

Fuzzy logic and Lyapunov-based non-linear controllers for HCV infection

Hepatitis C is the liver disease caused by the Hepatitis C virus (HCV) which can lead to serious health problems such as liver cancer. In this research work, the non‐linear model of HCV having three state variables (uninfected hepatocytes, infected hepatocytes and virions) and two control inputs has been taken into account, and four non‐linear controllers namely non‐linear PID controller, Lyapunov Redesign controller, Synergetic controller and Fuzzy Logic‐Based controller have been proposed to control HCV infection inside the human body. The controllers have been designed for the anti‐viral therapy in order to control the amount of uninfected hepatocytes to the desired safe limit and to track the amount of infected hepatocytes and virions to their reference value which is zero. One control input is the Pegylated interferon (peg‐IFN‐α) which acts in reducing the infected hepatocytes and the other input is ribavirin which blocks the production of virions. By doing so, the uninfected hepatocytes increase and achieve the required safe limit. Lyapunov stability analysis has been used to prove the stability of the whole system. The comparative analysis of the proposed nonlinear controllers using MATLAB/Simulink have been done with each other and with linear PID. These results depict that the infected hepatocytes and virions are reduced to the desired level, enhancing the rate of sustained virologic response (SVR) and reducing the treatment period as compared with previous strategies introduced in the literature.

Teaching breast ultrasound skills including core-needle biopsies on a phantom enhances undergraduate student's knowledge and learning satisfaction

Purpose

To investigate whether a training program on breast ultrasound skills including core-needle biopsies to undergraduate students can improve medical knowledge and learning satisfaction.

Methods

Medical students attending mandatory classes at the Medical School of the University of Saarland received a supplemental theoretical and hands-on training program on ultrasound (US) breast screening and on US-guided core-needle biopsy using an agar–agar phantom. Experienced breast specialists and ultrasound examiners served as trainers applying Peyton’s 4-step training approach. The students’ theoretical knowledge and hands-on skills were tested before and after the training program, using a multiple-choice questionnaire (MCQ), the Objective Structured Clinical Examination (OSCE) and a student curriculum evaluation.

Results

The MCQ results showed a significant increase of the student’s theoretical knowledge (50.2–75.2%, p < 0.001). After the course, the OSCE showed a mean total of 17.3/20 points (86.5%), confirming the practical implementation of the new skills. The student curriculum evaluation in general was very positive. A total of 16/20 questions were rated between 1.2 and 1.7 (very good) and 3 questions were rated as 2.1 (good).

Conclusion

Undergraduate student’s medical education can be enhanced by teaching breast US skills.

Perspective of Covid-19 pandemic in South Asian countries

COVID-19 is rapidly spreading throughout the world since December 2019. It has hit South Asian countries with faded impact, which can be attributed to (a) availability of kits, (b) number of people tested for COVID-19, (c) immunity, (d) environmental conditions and (e) vaccination.

ACTUALITIES IN ENDOCRINE PHARMACOLOGY: ADVANCES IN THE DEVELOPMENT OF ORAL FORMULATIONS FOR CALCITONIN AND SEMAGLUTIDE

As the medical utility of injectable therapeutic peptides is expanding, so is the challenge of developing technologies that allow the administration of such molecules via alternative routes, considering that chronic patients requiring treatment with parenteral formulations are less adherent and compliant to the therapeutic regimens. Hence, substantial efforts have been made to develop technologies that allow the oral formulation of peptides. Due to their importance in the field of pharmaceutical technology, we describe the latest advancements made in the development of oral salmon calcitonin and oral semaglutide, in co-formulation with absorption enhancers such as 8-[(5-chloro-2-hydroxybenzoyl) amino] octanoic acid (or 5-CNAC) and N-[8-(2-hydroxybenzoyl) amino] caprylate (or SNAC). Oral semaglutide is considered to be a landmark for oral peptide delivery technology, as it is one of the very few successful examples of peptides that can be administered orally. Unlike semaglutide, oral calcitonin is still not approved by the regulatory authorities because it failed to demonstrate the anticipated effects in phase III clinical trials conducted so far. However, the efforts for obtaining an oral form of calcitonin have significantly contributed to the development of technologies that facilitate the absorption of peptide-structure macromolecules.