Rare case of coexisting hepatic, splenic, and vertebral hemangiomas - A case report

Synchronous existence of hepatic, splenic, and skeletal hemangiomas has not been reported previously in the English literature to our knowledge. In this case report, we present a case of coexistence of hepatic, splenic, and skeletal hemangiomas in a 30-year-old woman with on and off bilateral lumbar region pain and no significant past medical history. Radiological investigations, including ultrasound and computed tomography and magnetic resonance imaging helped identify the synchronous existence of hepatic, splenic, and skeletal hemangiomas. The patient improved with conservative management and was kept on follow-ups. Although there have been reports of coexistence of splenic and hepatic hemangiomas in the literature, to our knowledge, this is the first report of synchronous existence of hepatic, splenic, and skeletal hemangiomas.

Unravelling the hidden power of esterases for biomanufacturing of short-chain esters

Microbial production of esters has recently garnered wide attention, but the current production metrics are low. Evidently, the ester precursors (organic acids and alcohols) can be accumulated at higher titers by microbes like Escherichia coli. Hence, we hypothesized that their 'direct esterification' using esterases will be efficient. We engineered esterases from various microorganisms into E. coli, along with overexpression of ethanol and lactate pathway genes. High cell density fermentation exhibited the strains possessing esterase-A (SSL76) and carbohydrate esterase (SSL74) as the potent candidates. Fed-batch fermentation at pH 7 resulted in 80 mg/L of ethyl acetate and 10 mg/L of ethyl lactate accumulation by SSL76. At pH 6, the total ester titer improved by 2.5-fold, with SSL76 producing 225 mg/L of ethyl acetate, and 18.2 mg/L of ethyl lactate, the highest reported titer in E. coli. To our knowledge, this is the first successful demonstration of short-chain ester production by engineering 'esterases' in E. coli.

Joint EANM/SNMMI guideline on radiomics in nuclear medicine : Jointly supported by the EANM Physics Committee and the SNMMI Physics, Instrumentation and Data Sciences Council

PURPOSE

The purpose of this guideline is to provide comprehensive information on best practices for robust radiomics analyses for both hand-crafted and deep learning-based approaches.

METHODS

In a cooperative effort between the EANM and SNMMI, we agreed upon current best practices and recommendations for relevant aspects of radiomics analyses, including study design, quality assurance, data collection, impact of acquisition and reconstruction, detection and segmentation, feature standardization and implementation, as well as appropriate modelling schemes, model evaluation, and interpretation. We also offer an outlook for future perspectives.

CONCLUSION

Radiomics is a very quickly evolving field of research. The present guideline focused on established findings as well as recommendations based on the state of the art. Though this guideline recognizes both hand-crafted and deep learning-based radiomics approaches, it primarily focuses on the former as this field is more mature. This guideline will be updated once more studies and results have contributed to improved consensus regarding the application of deep learning methods for radiomics. Although methodological recommendations in the present document are valid for most medical image modalities, we focus here on nuclear medicine, and specific recommendations when necessary are made for PET/CT, PET/MR, and quantitative SPECT.

Corrigendum: Corynebacterium glutamicum as an efficient omnivorous microbial host for the bioconversion of lignocellulosic biomass

[This corrects the article DOI: 10.3389/fbioe.2022.827386.].

Outside-in technique versus inside-out semitendinosus graft harvest technique in ACLR: a randomised control trial

Background

Paraesthesia after hamstring graft harvest is a ubiquitous complication in the early post-operative period, and its correlation with vertical versus horizontal skin incision are well documented. The purpose of the study is to evaluate the incidence and extent/area of sensory loss of saphenous nerve branches occurring with the outside-in (OI) versus inside-out technique (IO) of semitendinosus graft harvest from the sartorius fascia and to determine a better method of graft harvest.

Methods

Sixty patients who underwent isolated semitendinosus graft harvest during anterior cruciate ligament reconstruction (ACLR) between 2016 and 2017. Patients were randomised into two groups depending on the graft harvest technique: 30 in the OI group and 30 in the IO group. The area of sensory loss was mapped on the patients’ skin using tactile feedback from the patients at each follow-up (10 days, 1 month, 3 months, 6 months and 1 year). Then, the area of sensory changes for the infrapatellar branch (IPBSN) and sartorial branch (SBSN) of the saphenous nerve, incision length, graft harvest duration, and graft length were analysed statistically between the groups.

Results

In groups 1 and 2, 18/30 (60%) and 19/30 (63%) of patients, respectively, developed sensory changes, with no significant difference between the groups (p = 0.79). Isolated SBSN and IPBSN paraesthesia occurred in 2/60 (3%) and 19/60 (32%), respectively. Combined SBSN and IPBSN paraesthesia was present in 16/60 (27%) of patients. There was no significant difference in the area of the sensory deficit between OI and IO groups on the 10th post-operative day or at 1-month, 3-month or 1-year follow-up (p = 0.723, p = 0.308, p = 0.478, p = 0.128, respectively). However, at 6-month follow-up, the area of paraesthesia was significantly higher in the IO group (p = 0.009). The length of incision and duration of graft harvest was higher in the OI group than in the IO group (p = 0.002 and p = 0.007, respectively), and the total length of the graft was greater in the IO group (p = 0.04).

Conclusion

Incidence is equally distributed, area of iatrogenic saphenous nerve injury gradually decreases, and recovery is seen in the majority of the patients in both graft harvest techniques. IO graft harvesting technique is better in terms of graft harvest time and cosmetics and yields longer graft; however, area of paraesthesia, though not significant, was two-fold higher than the OI technique at 1-year follow-up.

Clinical relevance

IO graft harvest technique would enable the surgeon to adopt quicker graft harvest, smaller surgical scar and lengthier graft than the OI technique.

Level of evidence

Therapeutic randomised controlled prospective study, Level II.

Treatment of long bone infection by a biodegradable bone cement releasing antibiotics in human

Repair of methicillin-resistant Staphylococcal (MRSA) chronic osteomyelitis and resulting bone defect is one of the major challenges in orthopaedics. Previous study has shown the effectiveness of antibiotic loaded biodegradable composite bone cement with in vitro tests and in the treatment of experimental osteomyelitis. The cement is composed of poly(lactide-co-glycolide) encapsulated antibiotic-biphasic calcium phosphate granule complex and additive antibiotic powder in gypsum binder. In this study, the cement was studied further to evaluate its in vitro biological properties (cytocompatibility, platelet activation), anti-infective, and bone regenerative potential in comparison to poly(methyl methacrylate) (PMMA) cement and parenteral therapy in 43 patients (age 5-57 years) with chronic MRSA osteomyelitis by analyzing the results of histopathology, radiographs, magnetic resonance imaging, scanning electron microscopy, and serum drug concentrations for 1 year. The composite cement showed superior cytocompatibility and coagulant activity compared to PMMA cement. Moreover, the results of different postoperative clinical and radiological examinations also proved the supremacy of composite cement over the other treatment modalities in terms of success rate, faster sepsis control and bone regeneration. Low serum antibiotic concentrations and normal serum calcium levels indicate that the calcium-rich composite cement is safe for application in human. Therefore, we conclude that the composite bone cement is a promising candidate for the treatment of chronic osteomyelitis.

Corynebacterium glutamicum as an Efficient Omnivorous Microbial Host for the Bioconversion of Lignocellulosic Biomass

Corynebacterium glutamicum has been successfully employed for the industrial production of amino acids and other bioproducts, partially due to its native ability to utilize a wide range of carbon substrates. We demonstrated C. glutamicum as an efficient microbial host for utilizing diverse carbon substrates present in biomass hydrolysates, such as glucose, arabinose, and xylose, in addition to its natural ability to assimilate lignin-derived aromatics. As a case study to demonstrate its bioproduction capabilities, L-lactate was chosen as the primary fermentation end product along with acetate and succinate. C. glutamicum was found to grow well in different aromatics (benzoic acid, cinnamic acid, vanillic acid, and p-coumaric acid) up to a concentration of 40 mM. Besides, ¹³C-fingerprinting confirmed that carbon from aromatics enter the primary metabolism via TCA cycle confirming the presence of β-ketoadipate pathway in C. glutamicum. ¹³C-fingerprinting in the presence of both glucose and aromatics also revealed coumarate to be the most preferred aromatic by C. glutamicum contributing 74 and 59% of its carbon for the synthesis of glutamate and aspartate respectively. ¹³C-fingerprinting also confirmed the activity of ortho-cleavage pathway, anaplerotic pathway, and cataplerotic pathways. Finally, the engineered C. glutamicum strain grew well in biomass hydrolysate containing pentose and hexose sugars and produced L-lactate at a concentration of 47.9 g/L and a yield of 0.639 g/g from sugars with simultaneous utilization of aromatics. Succinate and acetate co-products were produced at concentrations of 8.9 g/L and 3.2 g/L, respectively. Our findings open the door to valorize all the major carbon components of biomass hydrolysate by using C. glutamicum as a microbial host for biomanufacturing.

Synthesis, molecular docking, and biological evaluation of Schiff base hybrids of 1,2,4-triazole-pyridine as dihydrofolate reductase inhibitors

In this study novel derivatives of 1,2,4-triazole pyridine coupled with Schiff base were obtained in altered aromatic aldehyde and 4-((5-(pyridin-3-yl)-4H-1,2,4-triazol-3-ylthio)methyl)benzenamine reactions. Thin layer chromatography and melting point determination were employed to verify the purity of hybrid derivatives. The structures of the hybrid derivatives were interpreted using methods comprising infrared, nuclear magnetic resonance, and mass spectroscopy. The in vitro anti-microbial properties and minimum inhibitory concentration were determined with Gram-positive and Gram-negative bacteria. Among the derivatives produced, two derivatives comprising (Z)-2-((4-((5-(pyridine-3-yl)-4H-1,2,4-triazol-3-ylthio)methyl)phenylimino)methyl)phenoland (Z)-2-methoxy-5-((4-((5-(pyridine-3-yl)-4H-1,2,4-triazol-3- ylthio)methyl)phenylimino)methyl)phenol obtained promising results as antibacterial agents. After synthesizing different derivatives, docking studies were performed and the scores range from −10.3154 to −12.962 ​kcal/mol.

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Synthesis and evaluation of Schiff Base Hybrids of 1, 2, 4-Triazole-Pyridine as DHFR Inhibitors.

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Schiff Base Hybrids shown promising antibacterial results.

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Docking studies reveals a good binding affinity in range of -10.3154 to -12.962 kcal/mol with DHFR.

Tubercular Osteomyelitis of Pubis with Labial Abscess: A Rare Presentation of a Common Disease

Introduction

Skeletal tuberculosis (TB) accounts for 10-15% of all cases of extra-pulmonary TB. The involvement of pubis is extremely rare with only 40 cases of pubic bone TB reported in the medical literature. The presentation of the disease with labial abscess is much rarer with only one case reported till now.

Case Report

A 23-year-old female presented with symptoms of pain and swelling in the right groin. The patient was evaluated with hematological and radiological investigations and the diagnosis of Tubercular osteomyelitis of pubis with labial abscess was confirmed using AFB staining and culture of the aspirate. The patient was subsequently managed with Anti-tubercular chemotherapy for 18 months and the lesion healed with excellent functional outcome.

Conclusion

Tubercular Osteomyelitis of the pubis is a rare disease with varied clinical presentation. Timely diagnosis and anti-tubercular chemotherapy usually result in complete recovery.

Arthroscopic reduction and internal fixation (ARIF) versus open reduction internal fixation (ORIF) to elucidate the difference for tibial side PCL avulsion fixation: a randomized controlled trial (RCT)

PURPOSE

To compare the clinical, radiological outcomes, economic and technical differences for ORIF by cancellous screw fixation versus ARIF by double-tunnel suture fixation for displaced tibial-side PCL avulsion fractures.

METHODS

Forty patients with displaced tibial-sided PCL avulsions were operated upon after randomizing them into two groups (20 patients each in the open and arthroscopic group) and followed up prospectively. Assessment included duration of surgery, cost involved, pre- and post-operative functional scores, radiological assessment of union, and posterior laxity using stress radiography and complications.

RESULTS

The mean follow-up period was 33 months (27-42) (open group) and 30 months (26-44) (arthroscopic group). The duration of surgery was significantly larger in the arthroscopic group (47.8 ± 17.9 min) as compared to the open group (33.4 ± 10.1 min). The costs involved were significantly higher in the arthroscopic group (p- 0.01). At final follow-up, knee function in the form of IKDC (International Knee Documentation Committee) evaluation (89.9 ± 4.8-open and 89.3 ± 5.9-arthroscopic) and Lysholm scores (94.2 ± 4.1-open and 94.6 ± 4.1-arthroscopic) had improved significantly with the difference (n.s.) between the two groups. The mean posterior tibial displacement was 5.7 ± 1.8 mm in the open group and 6.3 ± 3.1 mm in the arthroscopic group which was (n.s.). There were two non-unions and one popliteal artery injury in the arthroscopic group.

CONCLUSION

Both ARIF and ORIF for PCL avulsion fractures yield good clinical and radiological outcomes. However, ORIF was better than ARIF in terms of cost, duration of surgery, and complications like non-union and iatrogenic vascular injury.

LEVEL OF EVIDENCE

II.

Does change in occupancy ratio and fatty infiltration of the supraspinatus influence functional outcome after single-row rotator cuff repair? A magnetic resonance imaging-based study

INTRODUCTION

The purpose of this study was to analyze the correlation of occupancy ratio (OR) and fatty infiltration (FI) to functional outcome and retear rate following rotator cuff repair by single-row technique.

MATERIAL AND METHODS

Retrospectively, all the patients (n = 100) with rotator cuff tear were evaluated preoperatively and postoperatively with functional scores (American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form [ASES], University of California-Los Angeles [UCLA] shoulder score, Constant score) and magnetic resonance imaging (MRI) for OR and FI. Two observers studied the MRI data separately. Statistical analysis was done using SPSS (version 16), paired t test, Pearson correlation, and intraclass correlation coefficients.

RESULTS

The mean (± standard deviation) follow-up was 16.24 ± 6.39 months, and the mean age was 56.18 ± 7.5 years. There was a significant increase in muscle atrophy (decreased OR) and FI (P < .01). The mean preoperative and postoperative ORs were 0.57 and 0.51, respectively. However, the mean functional scores improved significantly for ASES (55.78 to 82.09), UCLA (19.44 to 28.47), and Constant score (49.73 to 75.07) (P < .001). There was no significant difference in functional outcome among the different stages of FI (ASES P = .341, UCLA P = .839, Constant P = .376). Seven patients had asymptomatic retear during follow-up, of which 2 patients had grade 3, 4 patients had grade 2, and 1 patient had grade 1 FI, preoperatively.

CONCLUSION

Muscle atrophy and FI are irreversible phenomena and continue even after successful repair; however, they do not have a significant influence on the functional outcome at short-term follow-up after cuff repair. Repairing cuff with higher grades of FI can be performed as they achieve significantly improved functional outcomes.

Do coracohumeral interval and glenoid version play a role in subscapularis tears?

Purpose

To study the effect of the coracohumeral interval and orientation of the glenoid for causation of subscapularis tears and literature review for the need of coracoplasty.

Methods

This is a retrospective cohort study of patients who underwent arthroscopic shoulder surgery from January 2013 to December 2017. The coracohumeral interval and orientation of the glenoid in patients with arthroscopically diagnosed subscapularis tears (group A, n = 40) were compared with 2 control groups (group B, n = 38 [intact subscapularis with supraspinatus and infraspinatus cuff tears] and group C, n = 39 [intact rotator cuff]). Group A1 (n = 23) consisted of the isolated subscapularis and combined subscapularis + supraspinatus tears, and group A2 (n = 17) all the 3 rotator cuff tears. The measurements were made on preoperative axial magnetic resonance imaging. Statistical analysis was performed to compare the groups.

Results

The mean coracohumeral interval was 8.81 ± 2.69 mm in group A and 10.62 ± 2.21 and 10.39 ± 2.59 mm in control groups B and C, respectively; this difference was statistically significant (P = .002 and .01, respectively). The mean glenoid version in patients with subscapularis tears was -3.7°, whereas the mean version in patients with intact cuff was -3.4°, and this difference was not statistically significant (P = .74). The mean glenoid version was -4.69° ± 4.22° in group A1 and -3.28° ± 4.04° in group B, with no statistically significant difference (P = .07).

Conclusion

The coracohumeral interval was significantly decreased in patients with subscapularis tears. The glenoid was retroverted in the subscapularis group but was not statistically significant.

Towards continuous-to-continuous 3D imaging in the real world

Imaging systems are often modeled as continuous-to-discrete mappings that map the object (i.e. a function of continuous variables such as space, time, energy, wavelength, etc) to a finite set of measurements. When it comes to reconstruction, some discretized version of the object is almost always assumed, leading to a discrete-to-discrete representation of the imaging system. In this paper, we discuss a method for single-photon emission computed tomography (SPECT) imaging that avoids discrete representations of the object or the imaging system, thus allowing reconstruction on an arbitrarily fine set of points.

Detection of self-organized criticality behavior in an electronic circuit designed to solve a third order non-linear ODE (NL-ODE) for a damped KdV equation

In this work, we present an electronic implementation of a damped Korteweg-de Vries equation modeled as a third order nonlinear autonomous ordinary differential equation (jerk equation). The circuit has been realized using operational amplifiers, multipliers, and passive electronic components which provides the time series solution of the equation in agreement with the numerical simulation results. Using nonlinear time series analysis on the acquired waveform data, we have obtained different types of phase space portraits and further analysis reflected long range correlation in the chaotic time series. Important findings include hysteresis induced bifurcation and self-organized criticality behavior in the system which is mentioned in this work.

Performance of lemongrass (Cymbopogon citrates) oil as growth promoter in broiler

An attempt was taken to study the growth performance of lemongrass oil (Cymbopogon citraturs) as a growth promoter on the broiler production. A total of 180day-old broiler chicks were procured from private hatchery (Shivam Hatchery Birgung, Parsa, Nepal) and were allocated following Completely Randomized Design (CRD) into four treatment groups (each treatment with 3 replications and each replication with 15 birds); T1= control, T2= containing lemongrass oil 200 ml/100 kg feed, T3= containing lemongrass oil 400 ml/100 kg feed and, T4= containing lemongrass oil 600 ml/100 kg feed. The study was carried out for 36 days at Avian Research Unit, Regional Agriculture Research Station, Parwanipur, Bara, Nepal. Concentrate mixture and lemongrass oil were procured from Shakti Feed Industry, Birgung; Herbs Processing Plant of Ministry of Forest and Soil Conservation, Jadibuti, Kathmandu, respectively. Experimental birds were provided ad libitum amount of starter feed from 0 to 21 days and finisher feed from 22 to 36 days. Feed intake was recorded daily and body weight gain was measured in 7 days interval. The study revealed that the cumulative feed intake per bird was found higher in T3 (3443.17g) followed by T4 (3377.33g) and T2 (3354.04g), respectively, and were statistically non-significant among the diet groups. The FCR was highest in T3 (1:1.44 kg) and lowest in T4 (1:1.51 kg), and differed insignificantly among the diet groups. Similarly, the total weight gain of the experimental bird was found to be higher in T3 (2385.13g) followed by T1 (2279.46g) and T2 (2271.86g), respectively.  The average daily gain of experimental birds noted higher in T3 (66.25g) followed by T1 and T2 (63.31g) and (63.1g), respectively. The experiment suggested that inclusion of lemongrass oil could be considered as an alternative to antibiotic growth promoter in broiler diet to enhance the production performance. Bang. J. Anim. Sci. 2018. 47 (2): 85-91

Masson's Hemangioma of the Cheek: A Case Report

We report a rare case of intravascular papillary endothelial hyperplasia (IPEH) of the cheek. This neoplasm, known as Masson's tumor, is an unusual vascular lesion of proliferating endothelial cells. It is usually confined to the lumen of preexisting vessels or vascular malformations. The principal significance of IPEH is its resemblance to a variety of benign and malignant diseases and possible misdiagnosis as such. Achieving a correct diagnosis is essential to avoid subjecting a patient to either unnecessarily aggressive or inadequate therapy. For this reason, awareness of this lesion is very important.

Video Endoscopic Inguinal Lymphadenectomy vs Open Inguinal Lymphadenectomy for Carcinoma Penis: Expanding Role and Comparison of Outcomes

OBJECTIVE

To compare differences of morbidity profile, oncological yield, and efficacy between video endoscopic inguinal lymphadenectomy and open inguinal lymphadenectomy cases.

MATERIALS AND METHODS

A total of 29 patients with proven squamous cell carcinoma of the penis were selected for inguinal lymphadenectomy from August 2013 to January 2017. Video endoscopic lymphadenectomy was performed on 1 limb and open inguinal lymphadenectomy was performed on the contralateral side. Relevant outcome data such as operative time, complication rate, number of lymph nodes removed, number of positive nodes, and recurrence during the follow-up period were collected, analyzed, and compared.

RESULTS

The mean operative time was significantly longer for the video endoscopic inguinal lymphadenectomy group (mean = 162.83 minutes) as compared with the open group (mean = 92.35 minutes). However, the mean numbers of lymph nodes removed were 7.6 in the endoscopic group and 8.3 in the open group. Postoperative complications occurred in 10 limbs (34.48%) in the open group and in 3 limbs (10.34%) in the endoscopic group. In the follow-up period ranging from 7 to 28 (mean 14) months, 2 patients died because of either distant or visceral metastasis.

CONCLUSION

The present study clearly outlines the fact that video endoscopic inguinal lymphadenectomy can deliver an equivalent lymph node yield similar to open inguinal lymphadenectomy with significantly less morbidity and is not affected by either the palpability or the number of palpable nodes. Thus, we believe that this minimally invasive technique can provide a prudent alternative for the management of the inguinal region in carcinoma of the penis.

Aberrant promoter hypermethylation of selected apoptotic genes in childhood acute lymphoblastic leukemia among North Indian population

Promoter hypermethylation mediates gene silencing in many neoplasms. Acute leukemia has been reported to harbor multiple genes aberrantly silenced by hypermethylation.

AIM

In present study, we investigated the prevalence of hypermethylation of caspase-8 (CASP8), TMS1 and DAPK genes in correlation with clinicopathological factors in childhood acute lymphoblastic leukemia (ALL).

MATERIALS AND METHODS

A case-control study has been conducted based on bone marrow and peripheral blood samples from 125 ALL patients and 100 sex-age matched healthy controls. Methylation specific polymerase chain reaction (PCR) and bisulfite sequencing PCR was performed to analyze the methylation status of these genes. Reverse transcription PCR and real time PCR was carried out to determine changes in the mRNA expression level of the genes due to hypermethylation.

RESULTS

Hypermethylation of the 5´CpG islands of the CASP8, TMS1 and DAPK gene promoters was found in 3.2, 6.4, and 13.6% of 125 childhood ALL samples from north Indian population, respectively. There were significant differences in pattern of hypermethylation of TMS1 (p = 0.045) and DAPK (p &lt; 0.001) between patients and healthy controls. Down-regulation of mRNA expression was found in cases in which CASP8, TMS1 and DAPK were hypermethylated.

CONCLUSIONS

The present study indicated the impact of hypermethylation-mediated inactivation of CASP8, TMS1 and DAPK genes, which is associated with risk of childhood ALL. This abnormality occurs in leukemogenesis and it may be used as a biomarker and for predicting the prognosis of ALL.

Prediction of histological stage based on cystoscopic appearances of newly diagnosed bladder tumours

INTRODUCTION In the 75-80% of urothelial bladder cancers (UBC) presenting as non-muscle invasive bladder cancer (NMIBC), transurethral resection of bladder tumour (TURBT) is the key treatment and staging procedure. In the 20-25% of patients with muscle invasive bladder cancer (MIBC), further cross-sectional imaging is required to complete the staging process before considering radical treatment. Given the adverse effects of ionising radiation, clinicians identify patients believed to have MIBC, and so requiring further imaging pre-TURBT, at the tumour histology/stage based on the tumour's visual characteristics. There is minimal evidence describing the accuracy of such predictions in newly-diagnosed patients. METHODS Over a 6-year period, a database of patients undergoing resection of newly-diagnosed bladder lesions in a single UK centre was prospectively established. Predictions based on histology were simultaneously recorded, and the accuracy of these predictions of histology/stage subsequently assessed. RESULTS One hundred and twenty two (73.1%) patients with histologically confirmed NMIBC had predictions recorded versus 45 (26.9%) patients with MIBC. Visual assessment predictions of MIBC had a sensitivity of 88.9% (95% confidence interval [CI] 76.5%-95.2%) and a specificity of 91.0% (95% CI 84.6%-94.9%), giving a positive predictive value of 78.4% (95% CI 65.4%-87.5%) and a negative predictive value of 95.7% (95% CI 90.3%-98.1%). CONCLUSIONS We find that visual assessment is accurate in predicting the presence of MIBC. This supports the practice of stratifying patients at the time of initial cystoscopy for those requiring further radiological staging pre-TURBT.

Spiradenoma causing longitudinal splitting of the nail

Longitudinal splitting of the nails can occur as a result of any growth arising in the nail matrix. We present a case of a 50-year-old woman who presented with an 18-month history of longitudinal splitting of the nail on her right little finger, along with pain in the proximal nail fold region, which was extremely tender to touch. Magnetic resonance imaging revealed an intensely enhancing lesion, while colour Doppler imaging revealed hypervascularity within the mass. A provisional diagnosis of glomus tumour was considered. Histopathology demonstrated presence of a well-circumscribed tumour comprising a dual population of cells, which stained negatively with periodic-acid-Schiff. The histopathological features were consistent with those of eccrine spiradenoma (ES). In this case, glomus tumour was considered as the first differential diagnosis, but histopathology confirmed it as an ES.

Land-use and land-cover change in Western Ghats of India

The Western Ghats (WG) of India, one of the hottest biodiversity hotspots in the world, has witnessed major land-use and land-cover (LULC) change in recent times. The present research was aimed at studying the patterns of LULC change in WG during 1985-1995-2005, understanding the major drivers that caused such change, and projecting the future (2025) spatial distribution of forest using coupled logistic regression and Markov model. The International Geosphere Biosphere Program (IGBP) classification scheme was mainly followed in LULC characterization and change analysis. The single-step Markov model was used to project the forest demand. The spatial allocation of such forest demand was based on the predicted probabilities derived through logistic regression model. The R statistical package was used to set the allocation rules. The projection model was selected based on Akaike information criterion (AIC) and area under receiver operating characteristic (ROC) curve. The actual and projected areas of forest in 2005 were compared before making projection for 2025. It was observed that forest degradation has reduced from 1985-1995 to 1995-2005. The study obtained important insights about the drivers and their impacts on LULC simulations. To the best of our knowledge, this is the first attempt where projection of future state of forest in entire WG is made based on decadal LULC and socio-economic datasets at the Taluka (sub-district) level.

Complete sequencing of an IncX3 plasmid carrying blaNDM-5 allele reveals an early stage in the dissemination of the blaNDM gene

PURPOSE

The aim of the present study was to perform molecular characterisation of the blaNDM plasmids and to understand the mechanism of its spread among pathogenic bacteria.

MATERIALS AND METHODS

Seventy-six non-repetitive carbapenem-resistant isolates which were collected during Nov 2011 to April 2013 from four hospitals in Chennai were analyzed for the presence of the blaNDM gene by PCR. Further, the genetic context of the blaNDM gene was analyzed by PCR specific to ISAba125 and bleMBL gene. One of the blaNDM plasmid was completely sequenced in the Illumina HiSeq platform.

RESULTS

Twenty-three isolates consisting of 8 Escherichia coli, 8 Klebsiella pneumoniae, 3 Klebsiella oxytoca, 3 Acinetobacter baumanii and 1 Pseudomonas aeruginosa were found to carry the blaNDM gene. In 18 isolates the blaNDM gene was associated with a bleMBL gene and the ISAba125 element. The complete sequencing of pNDM-MGR194 revealed an IncX3 replication type plasmid, with a length of 46,253 bp, an average GC content of 47% and 59 putative ORFs. The iteron region contained the blaNDM5 gene and the bleMBL , trpF and dsbC genes downstream and an IS5 inserted within the ISAba125 element upstream.

CONCLUSION

This is the first report where the blaNDM gene insertion in a plasmid is not accompanied by other resistance gene determinants. These observations suggest that the IncX3 plasmid pNDM-MGR194 is an early stage in the dissemination of the blaNDM .

A COMPARATIVE ANALYSIS OF METHYLATION STATUS OF TUMOR SUPPRESSOR GENES IN PAIRED BIOPSY AND SERUM SAMPLES FROM CERVICAL CANCER PATIENTS AMONG NORTH INDIAN POPULATION

Tumor-specific genetic or epigenetic alterations have been detected in serum DNA in case of various types of cancers. In breast cancer, the detection of tumor suppressor gene hypermethylation has been reported in several body fluids. Promoter hypermethylation of some genes like MYOD1, CALCA, hTERT etc. has also been detected in serum samples from cervical cancer. The present study is the first report on the comparison of promoter hypermethylation of tumor suppressor genes likep14, p15, p16, p21, p27, p57, p53, p73, RARβ2, FHIT, DAPK, STAT1 and-RB1 genes in paired biopsy and serum samples from cervical cancer patients among north Indian population. This is also the first report on the hypermethylation of these genes in serum samples from cervical cancer patients among north Indian population. According to the results of the present study, promoter hypermethylation of these genes can also be detected in serum samples of cervical cancer patients. The sensitivity of detection of promoter hypermethylation in serum samples of cervical cancer patients as compared to paired biopsy samples was found to be around 83.3%. It was observed that promoter hypermethylation was mainly observed in the serum samples in the higher stages and very rarely in the lower stages. The present study clearly showed that serum of patients with cervical cancer can also be used to study methylated genes as biomarkers.

Switching antibiotics production on and off in actinomycetes by an IclR family transcriptional regulator from Streptomyces peucetius ATCC 27952

Doxorubicin, produced by Streptomyces peucetius ATCC 27952, is tightly regulated by dnrO, dnrN, and dnrI regulators. Genome mining of S. peucetius revealed the presence of the IclR (doxR) type family of transcription regulator mediating the signal-dependent expression of operons at the nonribosomal peptide synthetase gene cluster. Overexpression of doxR in native strain strongly repressed the drug production. Furthermore, it also had a negative effect on the regulatory system of doxorubicin, wherein the transcript of dnrI was reduced to the maximum level in comparision with the other two. Interestingly, the overexpression of the same gene also had strong inhibitory effects on the production of actinorhodin (blue pigment) and undecylprodigiosin (red pigment) in Streptomyces coelicolor M145, herboxidiene production in Streptomyces chromofuscus ATCC 49982, and spinosyn production in Saccharopolyspora spinosa NRRL 18395, respectively. Moreover, DoxR exhibited pleiotropic effects on the production of blue and red pigments in S. coelicolor when grown in different agar media, wherein the production of blue pigment was inhibited in R2YE medium and the red pigment was inhibited in YEME medium. However, the production of both blue and red pigments from S. coelicolor harboring doxR was halted in ISP2 medium, whereas S. coelicolor produced both pigmented antibiotics in the same plate. These consequences demonstrate that the on and off production of these antibiotics was not due to salt stress or media compositions, but was selectively controlled in actinomycetes.

Extracorporeal Irradiation in Malignant Bone Tumors

Extracorporeal irradiation (ECI) is relatively a rare method used in the management of malignant bone tumors (MBT). It consists of en block removal of the tumor bearing bone segment, removal of the tumor from the bone, irradiation and re implantation back in the body.

Linear trichilemmoma following a blaschkoid pattern: a clinical dilemma

BACKGROUND

Trichilemmoma are benign adnexal neoplasm with follicular outer sheath differentiation. It usually appears as single or multiple papules that resembles colour of the surrounding skin. They are most commonly seen on the face particularly on the nose and cheek.

OBJECTIVES

We report a case of linear trichilemmoma following blaschkoid pattern.

METHODS

A 13 year old boy presenting with asymptomatic plaque on the right side of the nose was fully evaluated for possible cause.

RESULTS

On histopathology, a diagnosis of trichilemmoma was made.

CONCLUSION

This is the first case report where linear trichilemmoma following a blaschkoid pattern is seen.

Enhanced production of nargenicin A(1) and generation of novel glycosylated derivatives

Nargenicin A1, an antibacterial polyketide macrolide produced by Nocardia sp. CS682, was enhanced by increasing the pool of precursors using different sources. Furthermore, by using engineered strain Nocardia sp. ACC18 and supplementation of glucose and glycerol, enhancement was ~7.1 fold in comparison to Nocardia sp. CS682 without supplementation of any precursors. The overproduced compound was validated by mass spectrometry and nuclear magnetic resonance analyses. The novel glycosylated derivatives of purified nargenicin A1 were generated by efficient one-pot reaction systems in which the syntheses of uridine diphosphate (UDP)-α-D-glucose and UDP-α-D-2-deoxyglucose were modified and combined with glycosyltransferase (GT) from Bacillus licheniformis. Nargenicin A1 11-O-β- D-glucopyranoside, nargenicin A1 18-O-β-D-glucopyranoside, nargenicin A111 18-O-β-D- diglucopyranoside, and nargenicin 11-O-β-D-2-deoxyglucopyranoside were generated. Nargenicin A1 11-O-β-D-glucopyranoside was structurally elucidated by ultra-high performance liquid chromatography-photodiode array (UPLC-PDA) conjugated with high-resolution quantitative time-of-flight-electrospray ionization mass spectroscopy (HR-QTOF ESI-MS/MS), supported by one- and two-dimensional nuclear magnetic resonance studies, whereas other nargenicin A1 glycosides were characterized by UPLC-PDA and HR-QTOF ESI-MS/MS analyses. The overall conversion studies indicated that the one-pot synthesis system is a highly efficient strategy for production of glycosylated derivatives of compounds like macrolides as well. Furthermore, assessment of solubility indicated that there was enhanced solubility in the case of glycoside, although a substantial increase in activity was not observed.

Comparative evaluation of surgical modalities for coverage of gingival recession: An Armed Forces Medical College perspective

BACKGROUND

Esthetics represents an inseparable part of today's oral therapy, and several procedures have been proposed to preserve or enhance it. Gingival recessions may cause hypersensitivity, impaired esthetics and root caries. Keeping in mind patient's desire for improved esthetics and other related problems, every effort should be made to achieve complete root coverage.

METHODS

Different types of modalities have been introduced to treat gingival recession including displaced flaps, free gingival graft, connective tissue graft, different type of barrier membranes and combination of different techniques. The aim of this study was to compare the commonly used techniques for gingival recession coverage and evaluate the results obtained. 73 subjects were selected for the present study who were randomly divided into four groups and were followed at baseline and 180 days where following parameters were recorded: (a) Assessment of gingival recession depth (RD); (b) Assessment of pocket depth (PD); (c) Assessment of clinical attachment level (CAL) and (d) Assessment of width of attached gingiva (WAG).

RESULTS

Results of this study showed statistically significant reduction of gingival recession, with concomitant attachment gain, following treatment with all tested surgical techniques. However, SCTG with CAF technique showed the highest percentage gain in coverage of recession depth as well as gain in keratinized gingiva. Similar results were obtained with CAF alone. The use of GTR and other techniques showed less predictable coverage and gain in keratinized gingiva.

CONCLUSION

Connective tissue grafts were statistically significantly superior to guided tissue regeneration for improvement in gingival recession reduction.

Curcumin-Mediated Reversal of p15 Gene Promoter Methylation: Implication in Anti-Neoplastic Action against Acute Lymphoid Leukaemia Cell Line

Curcumin has been documented to exert anticancer effects by interacting with altered proliferative and apoptotic pathways in cancer models. In this study, we evaluated the potential of curcumin to reverse promoter methylation of the p15 gene in Raji cells and its ability to induce apoptosis and genomic instability. Anti-neoplastic action of curcumin showed an augmentation in reactive oxygen species (ROS) and cell cycle arrest in G1 phase. Subsequently, curcumin- exposed Raji cells showed structural abnormalities in chromosomes. These observations suggest that curcumin also causes ROS-mediated apoptosis and genomic instability. The treatment of Raji cell line with 10 μM curcumin caused hypomethylation of the p15 promoter after six days. Hypomethylation of p15 was further found to be favoured by downregulation of DNA methyltransferase 1 after 10 μM curcumin treatment for six days. Methylation-specific PCR suggested demethylation of the p15 promoter. Demethylation was further validated by DNA sequencing. Reverse-transcription PCR demonstrated that treatment with curcumin (10 μM) for six days led to the up-regulation of p15 and down-regulation of DNA methyltransferase 1. Furthermore, curcumin- mediated reversal of p15 promoter methylation might be potentiated by down-regulation of DNA methyltransferase 1 expression, which was supported by cell cycle analysis. Furthermore, curcumin acts as a double-pronged agent, as it caused apoptosis and promoter hypomethylation in Raji cells.

The impact of hearing loss in older adults: a tertiary care hospital based study

Hearing loss is the most common sensory deficit in the elderly, and is becoming a severe social and health problem. Presbycusis is the result of aging which can lead to communication problems compromising the quality of life (QoL).Since the elderly population is increasing worldwide, presbycusis is showing a similar trend. This study intended to identify the impact of hearing loss in the social life of the elderly. A total of 70 elderly patients attending Nepal Medical College Teaching Hospital who were found to have sensorineural hearing loss (SNHL) on pure tone audiometry (PTA) were recruited for this study.None of the patients had used hearing aids in the past. To assess their handicap due to hearing impairment a Hearing Handicap Inventory for the Elderly (HHIE) questionnaire was used and patients were graded as: no handicap, mild to moderate handicap and significant handicap. Pure-tone averages (PTA) were calculated for the thresholds at 0.5, 1 and 2 kHz in each ear. Patients with their PTA values between 26 to 40 dBHL were interpreted as having mild SNHL, those between 41 to 55dBHL as moderate SNHL and those above 55 dBHL as severe SNHL. Out of 70 patients, 65 had some degree of handicap ranging from mild to severe. The severity of handicap was significantly associated with the degree of hearing loss in both ears.

Metabolic engineering of rational screened Saccharopolyspora spinosa for the enhancement of spinosyns A and D production

Spinosyns A and D are potent ingredient for insect control with exceptional safety to non-target organisms. It consists of a 21-carbon tetracyclic lactone with forosamine and tri-O-methylated rhamnose which are derived from S-adenosylmethionine. Although previous studies have revealed the involvement of metK1 (S-adenosylmethionine synthetase), rmbA (glucose-1-phosphate thymidylyltransferase), and rmbB (TDP-D-glucose-4, 6-dehydratase) in the biosynthesis of spinosad, expression of these genes into rational screened Saccharopolyspora spinosa (S. spinosa MUV) has not been elucidated till date. In the present study, S. spinosa MUV was developed to utilize for metabolic engineering. The yield of spinosyns A and D in S. spinosa MUV was 244 mg L(-1) and 129 mg L(-1), which was 4.88-fold and 4.77-fold higher than that in the wild-type (50 mg L(-1) and 27 mg L(-1)), respectively. To achieve the better production; positive regulator metK1-sp, rmbA and rmbB genes from Streptomyces peucetius, were expressed and co-expressed in S. spinosa MUV under the control of strong ermE* promoter, using an integration vector pSET152 and expression vector pIBR25, respectively. Herewith, the genetically engineered strain of S. spinosa MUV, produce spinosyns A and D up to 372/217 mg L(-1) that is 7.44/8.03-fold greater than that of wild type. This result demonstrates the use of metabolic engineering on rationally developed high producing natural variants for the production.

An open label study to compare the efficacy of topical mometasone furoate with topical placental extract versus topical mometasone furoate with topical tacrolimus in patients with vitiligo involving less than 10% body surface area

Vitiligo is a common skin disorder affecting about 1 to 2% of the world population. The prevalence in Nepal is 2-3%. This disease is associated with profound psychological distress. Though many treatment options are available none of these are universally effective. The main objective of the study is to compare the efficacy and rate of repigmentation with use of topical steroid and topical placental extract versus topical steroid and topical tacrolimus 0.1% in treating patients with localized vitiligo. One hundred patients visiting the dermatology outpatient department of Nepal Medical College and Teaching Hospital with the diagnosis of vitiligo involving less than 10% of body surface area were taken. 50 of these patients (Category A) were randomly selected and treated with topical steroid (Mometasone furoate 0.1% cream) and Topical placental extract gel. Other 50 patients (Category B) were given the same topical steroid with Topical Tacrolimus 0.1% cream. The patients were examined every month and final outcome was seen at the end of 3 months. Of the total 100 patients 51% were male and 49% were female. Seventeen percent of patients had lesions over face and neck, 49% had lesions over the extremities and 34% had lesions over trunk. At the end of 3 months the rate of repigmentation was better in patients of Category B than Category A and the result was statistically significant. Topical Tacrolimus 0.1% ointment could be better option for the treatment of localized vitiligo when compared to topical placental extract but in combination with a steroid cream.

Post Kala azar dermal leishmaniasis (PKDL) presenting with ulcerated chronic paronychia like lesion

A 50-year-old lady, resident of urban Bihar, presented with inflamed proximal nail fold of a single digit for one and half months. The lesion on distal finger was remarkable for ulceration. Mucocutaneous examination revealed multiple hypopigmented macules and patches, notable for absence of scaling. The presence of ulceration was not consistent with chronic paronychia, hence, she was asked for biopsy. She declined and opted for trial of antibiotic and anti-fungal treatment. At two weeks of follow up, no improvement was noted at all. At the same time, she developed multiple juicy papules in perioral area and on neck. She tested positive by rK 39 tests. Histopathology from periungual area showed LD body. She was diagnosed as Post Kala-azar dermal leishmaniasis and was treated with miltefosine 50 mg twice daily for three months, resulting in complete resolution of all lesions.

Laparoscopic management of double gallbladder

Double gall bladder is a rare congenital anomaly and is challenging to the surgeons due to increased risk of post-operative complications. We present a case of double gall bladder that was successfully managed laparoscopically. Preoperative ultrasonography showed one vesicle of the gall bladder had thick wall with multiple calculi while the other had normal thickness without calculus. Both the gallbladders were connected to the common bile duct with a single cystic duct.

Review of radiation therapy in benign ocular diseases

Radiotherapy is a modality used for the treatment of malignant diseases. However it is also used as an effective modality in the treatment of many benign disorders. It is generally not the first choice of therapy in non malignant conditions but usually used when other modalities have failed or may induce more side effects. Benign disorders of the eye can cause severe morbidity in terms of inflammatory symptoms, loss of vision, pain and diplopia. Radiotherapy in such conditions is given in very low doses and the goals are controlling the condition and at the same time minimizing late tissue sequelae, if any. Here we highlight the use of radiotherapy in most common benign conditions of the eye; mainly Pterygium, Haemangioma, Graves' Orbitopathy and Pseudotumour Orbitae.

Supplementation of microbial levan in the diet of Cyprinus carpio fry (Linnaeus, 1758) exposed to sublethal toxicity of fipronil: effect on growth and metabolic responses

A 60-day feeding trial was conducted to study the effect of dietary microbial levan on growth performance and metabolic responses of Cyprinus carpio fry exposed to sublethal dose (1/10th LC₅₀) of fipronil [(±)-5-amino-1-(2,6-dichloro-α,α,α-trifluoro-p-tolyl)-4-trifluoromethylsulfinylpyrazole-3-carbonitrile]. Two hundred and twenty five fry were randomly distributed in five treatments in triplicates. Four purified diets were prepared with graded levels of microbial levan. Five different treatment groups were levan control L₀P₀ (basal feed + 0 % levan without exposure to pesticide); pesticide control L₀P₁ (basal feed + 0 % levan with exposure to pesticide); L₀.₂₅P₁ (basal feed + 0.25 % levan with exposure to pesticide); L₀.₅₀P₁ (basal feed + 0.50 % levan with exposure to pesticide); and L₀.₇₅P₁ (basal feed + 0.75 % levan with exposure to pesticide). Weight gain% and specific growth rate were significantly higher (p < 0.05) in levan fed groups compared to their non-levan fed counterpart. Highest (p < 0.05) content of ascorbic acid in muscle, liver and brain tissues was observed with higher level of dietary levan. Glucose-6-phosphate dehydrogenase activity decreased with the increasing level of dietary levan in the liver and muscle. Aspartate aminotransferase activity exhibited a second order polynomial relationship with the dietary levan, both in liver (Y = -1.001x² + 5.366x + 5.812, r² = 0.887) and muscle (Y = -0.566x² + 2.833x + 6.506, r² = 0.858) while alanine aminotransferase activity showed third order polynomial relationship both in liver (Y = 1.195x³ - 12.30x² + 35.23x + 9.874, r² = 0.879) and muscle (Y = 0.527x³ - 8.429x² + 31.80x + 8.718, r² = 0.990). Highest (p < 0.05) superoxide dismutase activity in gill was observed in the group fed with 0.75 % levan supplemented diet. Overall results indicated that dietary microbial levan at 0.75 % in C. carpio fry ameliorated the negative effects of fipronil and augmented the growth.

Views of the chairs of Scottish health boards on engagement with quality management and comparisons with English trusts

OBJECTIVE

To describe the views of the chairs of Scottish health boards on the engagement of their boards with healthcare quality and to compare them with the views of the chairs of boards of English acute trusts. The focus of the Scottish Health Boards is on providing and commissioning care, while in England the acute trusts only provide care.

METHODS

We mailed a questionnaire, based on one used in England, to the 14 health board chairs in NHS Scotland in January 2011. The results were compared with the results of a similar questionnaire given to English acute trust chairs in 2009.

RESULTS

Most chairs in Scotland (67%) prioritised oversight of quality. Quality is considered at most Board meetings (92%), taking over 20% of time for 69% of chairs. Most boards have local quality targets and feedback quality data to staff. Compared with England, boards in Scotland meet less frequently and focus less on quality (shorter discussions, less frequent data review, fewer local targets) but they are more optimistic about their board's performance.

CONCLUSIONS

Although most chairs of Scottish boards view quality as a priority, they pay less attention to it than chairs in England, possibly due to their additional role in commissioning care.

Oral and dental complications of head and neck radiotherapy and their management

Cancer patients who are diagnosed early and or receive effective anti tumour therapy can expect to live for many years after treatment and therefore preservation of normal tissue function is crucial to ensure long term quality of life. Oral complications affect hundred per cent of patients who receive radiotherapy to fields involving the oral cavity and combined modality treatment with chemotherapy may compound these effects. Oral cavity is highly susceptible to side effects as radiotherapy targets cells that divide rapidly and the cells of the mucosal lining of the mouth are rapidly dividing cells and they are thus injured. All patients who are to receive radiotherapy to the head and neck region should be sent for a dental consultation prior to the initiation of their treatment in order to decrease the acute and chronic post treatment sequelae.

KEYWORDS

Dental management;head and neck cancers;radiotherapy.

Ketoconazole or clotrimazole solution wash as a prophylaxis in management and prevention of fungal infection: a comparative study

The incidence of fungal infections has increased at an alarming rate in the past two decades. Topical Ketoconazole and Clotrimazole solutions are used to stop growth of fungus like Dermatophytes, Candidiasis and Pityrosporum. The objective of this study is to assess the effectiveness of prophylactic Ketoconazole or Clotrimazole solution wash in patients with fungal infections. Hundred patients (aged 10-60 yrs) with different fungal infections (Candida, Tinea, Pityriasis) were included. The study groups were divided into intervention group and control group. The Intervention group was given 5 weeks prophylactic Ketoconazole/Clotrimazole shampoo wash along with antifungal treatment whereas the control group was given only antifungal treatment without prophylaxis. All the patients were assessed at 1, 3 and 6 months interval to find out the response and recurrence. After one month of treatment 96% of patients in the intervention group and 60% of patients in the control group were completely cured. The recurrence rate after 3 mths of treatment was 4% in the intervention group and 40% in the control group. After 6 months the recurrence rate was 4% in the intervention group and 60% in the control group. The most common problem with fungal infections is the recurrence. Use of prophylactic antifungal (Ketoconazole/Clotrimazole) wash for some period of time along with antifungal treatment minimizes the chances of recurrence.

Antioxidant potential and protection of pancreatic β- cells by Calotropis gigantea in streptozocin induced diabetic rats

This study was designed to examine the antioxidant defense by chloroform extract of Calotropis gigantea on streptozotocin-(40mg/kg, intraperitonial, single-injection) induced diabetes in wistar albino rats. The extract significantly (P < .05) decreased the pancreatic thiobarbituric acid-reactive substances (TBARS) levels and significantly (P < .05) increased the superoxide dismutase, catalase, and glutathione levels as compared to above levels in pancreatic tissue of pathogenic diabetic rats. The results of test drug were comparable to Glibenclamide (5mg/kg, daily), a standard antihyperglycemic agent. The study concludes that Calotropis gigantea enhances the antioxidant defense against reactive oxygen species produced under hyperglycemic condition and this protects β-cells against loss, and exhibit antidiabetic property.

Gingival cyst of adult: A rare case

Gingival cyst of adult is an uncommon cyst of gingival soft tissue occurring in either the free or attached gingiva. This odontogenic epithelial cyst is most frequently seen near mandibular canine and premolar region, believed to represent the soft tissue counter part of the lateral periodontal cyst. This article presents a case of gingival cyst treated with exicisional biopsy followed by histopathological confirmation and an emphasis on the clinical aspects of this lesion.