Development of a rapid loop-mediated isothermal amplification (LAMP) assay for visual detection of porcine parvovirus (PPV) and its application

Porcine parvovirus (PPV) infection is one of the most important causes of reproductive failure in pigs impacting the piggery industry globally with huge economic losses. A cost-effective, simple, rapid, specific, and sensitive method is critical for monitoring PPV infection on pig farms. The main aim of the present study was to develop and evaluate a loop-mediated isothermal amplification (LAMP) assay for rapid visual detection of porcine parvovirus (PPV) in pigs. A set of six LAMP primers including two outer primers, two inner primers, and two loop primers were designed utilizing the conserved region of capsid protein VP2 gene sequences of PPV and was applied for detection of PPV from porcine samples. Time and temperature conditions for amplification of PPV genes were optimized to be 30 min at 63 °C. The developed assay was ten-fold more sensitive than conventional PCR with analytical sensitivity of 20 pg and 200 pg, respectively. This is the first report of detection of PPV by LAMP assay from India. The assay did not cross-react with porcine circovirus type 2 (PCV2), porcine reproductive and respiratory syndrome virus (PRRSV), or classical swine fever virus (CSFV). The LAMP assay was assembled into a LAMP assay kit of 20 reactions and was validated in different laboratories in India. The newly developed LAMP assay was proved to be a specific, sensitive, rapid, and simple method for visual detection of PPV which does not require even costly equipments for performing the test. It complements and extends previous methods for PPV detection and provides an alternative approach for detection of PPV.

Investigation of groundwater and soil quality near to a municipal waste disposal site in Silchar, Assam, India

Unscientific management of municipal solid waste is one of the direct sources of contamination in developing countries, such as India. The present investigation carried out during Oct–Dec 2019 attempts to assess the parameters, such as quality of groundwater and soil along three depths (0–5, 5–15 and 15–30 cm), in proximity to a dumping site in Silchar, a rapidly evolving city of North-East India. Standard protocols of soil and water quality assessments were carried out. The pH values of the surface soils were found to be slightly acidic. Decrease in acidity with increasing depth was observed in the study site. The relative abundance of the analyzed elements at all soil depths was Zn > Fe > Ni > Cu > Cr. Weak correlation between the concentration of Cu, Fe and Zn, and the bulk density of the soil highlighted the micronutrient status of the soil. The impact of the nearby dumpsite on trace element contamination is indicated by the ‘extremely contaminated’ status of the soils with respect to geo-accumulation index. Majority of the groundwater samples exhibited pH levels below the desired limits, making it unfit for consumption by local communities. While Fe, Cu and Ni levels in groundwater samples exceeded the guideline values, Cr and Zn concentrations were found to be within limits except one sample. Principal Component Analysis of the observed data was carried out to ascertain the predominant sources of contamination. The observations indicate the negative impacts of nearby dumpsite on environmental parameters, such as groundwater and soil quality, as highlighted in this research.

FRI0438 POST-CHIKUNGUNYA CHRONIC ARTHRITIS - SHARING OF BANGLADESH EXPERIENCE OVER ONE YEAR FOLLOW UP OF 60 PATIENTS

Background:

Chikungunya virus (CHIKV) infection is an emerging disease which is responsible for several epidemics around the world1. Systematic review and meta-analysis had shown that approximately 25% of cases of Chikungunya(CHIK) would develop CHIK-Chronic Inflammatory Rheumatism and 14% would develop persistent arthritis (or spondylitis)2.

Objectives:

To describe the frequency of the clinical patterns of chronic arthritis & to characterize the clinical symptoms in a Bangladeshi cohort of CHIK patients 12months post-infection.

Methods:

In 2017, a Chikungunya outbreak occurred in Dhaka, Bangladesh, during which a prospective cohort of CHIK patients with confirmed diagnosis was constituted. A longitudinal follow up of 60 patients from an initial cohort of 142 patients, attending the out-patient department of Rheumatology, BSMMU, was done. Patients having arthritis/ arthralgia or both lasting more than 3 months were considered as chronic cases. Their baseline and follow-up symptoms at 3m, 6m and 12months were evaluated. Functional status was assessed with the Bengali Version Health Assessment Questionnaire (HAQ).

Results:

Of the initial 142 patients enrolled in the study, 135(95.1%) had CHIKV-IgM and 29(20.4%) had IgG positive. Patients that followed up in-person were predominantly adult (age 43.73 ± 11.09 years) and female 34 (56.7%). The majority of the patients 35 (58.3%) had undifferentiated arthritis. After three months, 8 (16.3%) had oligoarthralgia, 26 (53.1%) had polyarthralgia and 8 (16.3%) had polyarthralgia with oligoarthritis. At the end of one year, 13 (21.7%) patients underwent complete remission. Among the 47 patients, 21 had joint involvement where 11(52.4%) had polyarthralgia, 5(23.8%) had polyarthralgia with oligoarthritis, 5 (23%) had oligoarthralgia and 4 (19%) had monoarthralgia. Among the 47 patients, mild, moderate and severe functional disability was present in 89.4%, 6.4% and 4.3% patients respectively.

Conclusion:

After one year of follow up, one-third of the patients remained symptomatic. Polyarthralgia was the predominant clinical feature. Mild functional disability was also observed in a significant number of patients.

References:

[1]Ali Ou Alla S, Combe B. Arthritis after infection with Chikungunya virus. Best Pract Res Clin Rheumatol. 2011;25(3):337-46.

[2]Rodríguez-Morales AJet al.Prevalence of Post-Chikungunya Infection Chronic Inflammatory Arthritis: A Systematic Review and Meta-Analysis.Arthritis. Care. Res. 68(12), 1849-1858 (2016).

Table 1.

Socio-demographic and clinical pattern of patients with Chronic CHK arthritis (n=60)

Variablesn(%)Age (in years)Mean ±SD43.73 ±11.1SexFemale34 (56.7)Male26 (43.3)First joint involvementGeneralized34 (56.7)Ankle12 (20.0)Knee6 (10.0)Wrist5 (8.3)Others (MTP, shoulder, neck and axial plane)3 (5.0)Clinical patternUndifferentiated35(58.3)Spondyloarthritis10 (16.7)Rheumatoid Arthritis7 (11.7)Pre-existing Spondyloarthritis6(10.2)Pre-existing Rheumatoid Arthritis1(1.7)Pre-existing Osteo-arthritis Arthritis1(1.7)Table 2.

Joint involvement of patients with Chronic CHIK arthritis

Joint characteristics3 m (n=49)6 m (n=36)1yr (n=21)f(%)f(%)f(%)Type of involvement in persistent painJoint only33 (55.0)28 (46.7)20 (33.3)Both joint & soft-tissue16 (26.7)8 (13.3)1 (1.7)Joint involvementMonoarthralgia1 (2.0)5 (13.9)4 (19.0)Oligoarthralgia8 (16.3)6 (16.7)5 (23.0)Polyarthralgia26 (53.1)18 (50.0)11 (52.4)Monoarthritis1 (2.0)0(0.0)0(0.0)Oligoarthritis6 (12.2)3 (8.3)0(0.0)Polyarthritis7 (14.3)9 (11.1)1 (4.8)Oligoarthralgia & monoarthritis1 (2.0)0 (0.0)0 (0.0)Polyarthralgia & monoarthritis0 (0.0)1 (2.8)0 (0.0)Polyarthralgia & oligoarthritis8 (16.3)4 (11.1)5 (23.8)Polyarthralgia & Polyarthritis1 (2.0)0 (0.0)0 (0)

Disclosure of Interests:

None declared

Association between HbA1c and the development of cystic fibrosis-related diabetes

AIMS

To examine HbA_1c as a predictor of risk for future development of cystic fibrosis-related diabetes and to assess the association with the development of retinopathy in people with cystic fibrosis-related diabetes.

METHODS

A 7-year retrospective longitudinal study was conducted in 50 adults with cystic fibrosis, comparing oral glucose tolerance test results with HbA_1c values in predicting the development of cystic fibrosis-related diabetes. Retinal screening data were also compared with HbA_1c measurements to assess microvascular outcome.

RESULTS

An HbA_1c value ≥37 mmol/mol (5.5%; hazard ratio 3.49, CI 1.5-8.1) was significantly associated with the development of dysglycaemia, as defined by the oral glucose tolerance test over a 7-year period. Severity of diabetic retinopathy was associated with a higher HbA_1c and longer duration of cystic fibrosis-related diabetes.

CONCLUSION

There is a link between HbA_1c level and the future development of dysglycaemia in cystic fibrosis based on oral glucose tolerance test, as well as microvascular outcomes. Although current guidance does not advocate the use of HbA_1c as a diagnostic tool in cystic fibrosis-related diabetes, it may be of clinical use in determining individuals at risk of future development of cystic fibrosis-related diabetes.

TBX18 overexpression enhances pacemaker function in a rat subsidiary atrial pacemaker model of sick sinus syndrome

KEY POINTS

The sinoatrial node (SAN) is the primary pacemaker of the heart. SAN dysfunction, or 'sick sinus syndrome', can cause excessively slow heart rates and pauses, leading to exercise limitation and syncope, currently treated by implantation of an electronic pacemaker. 'Biopacemaking' utilises gene therapy to restore pacemaker activity by manipulating gene expression. Overexpressing the HCN pacemaker ion channel has been widely used with limited success. We utilised bradycardic rat subsidiary atrial pacemaker tissue to evaluate alternative gene targets: the Na+ /Ca2+ exchanger NCX1, and the transcription factors TBX3 and TBX18 known to be involved in SAN embryonic development. TBX18 overexpression restored normal SAN function, as assessed by increased rate, improved heart rate stability and restoration of isoprenaline response. TBX3 and NCX1 were not effective in accelerating the rate of subsidiary atrial pacemaker tissue. Gene therapy targeting TBX18 could therefore have the potential to restore pacemaker function in human sick sinus syndrome obviating electronic pacemakers.

ABSTRACT

The sinoatrial node (SAN) is the primary pacemaker of the heart. Disease of the SAN, sick sinus syndrome, causes heart rate instability in the form of bradycardia and pauses, leading to exercise limitation and syncope. Biopacemaking aims to restore pacemaker activity by manipulating gene expression, and approaches utilising HCN channel overexpression have been widely used. We evaluated alternative gene targets for biopacemaking to restore normal SAN pacemaker physiology within bradycardic subsidiary atrial pacemaker (SAP) tissue, using the Na+ /Ca2+ exchanger NCX1, and the transcription factors TBX3 and TBX18. TBX18 expression in SAP tissue restored normal SAN function, as assessed by increased rate (SAN 267.5 ± 13.6 bpm, SAP 144.1 ± 8.6 bpm, SAP-TBX18 214.4 ± 14.4 bpm; P < 0.001), improved heart rate stability (standard deviation of RR intervals fell from 39.3 ± 7.2 ms to 6.9 ± 0.8 ms, P < 0.01; root mean square of successive differences of RR intervals fell from 41.7 ± 8.2 ms to 6.1 ± 1.2 ms, P < 0.01; standard deviation of points perpendicular to the line of identity of Poincaré plots (SD1) fell from 29.5 ± 5.8 ms to 7.9 ± 2.0 ms, P < 0.05) and restoration of isoprenaline response (increases in rates of SAN 65.5 ± 1.3%, SAP 28.4 ± 3.4% and SAP-TBX18 103.3 ± 10.2%; P < 0.001). These changes were driven by a TBX18-induced switch in the dominant HCN isoform in SAP tissue, with a significant upregulation of HCN2 (from 1.01 × 10-5  ± 2.2 × 10-6 to 2.8 × 10-5  ± 4.3 × 10-6 arbitrary units, P < 0.001). Biophysically detailed computer modelling incorporating isoform-specific HCN channel electrophysiology confirmed that the measured changes in HCN abundance could account for the observed changes in beating rates. TBX3 and NCX1 were not effective in accelerating the rate of SAP tissue.

Determination of Drinking Water Quality: A Case Study on Saline Prone South-West Coastal Belt of Bangladesh

This research integrates quantitative data of underground and sub-surface sources of drinking water from two coastal union Gabura and Munshiganj of Shyamnagur upazila of Satkhira district. Four drinking water sources have been selected and sampled during dry season when the salinity rate is generally high. A total of 22 water samples have been collected of which 6 from protected pond, 6 from tube well, 6 from rainwater and 4 from pond sand filter (PSF). The average pH of tube well water, protected pond water, pond sand filter water and rain water were 6.59 (±.05), 6.46 (±1.03), 6.60 (±.52), 5.95 (±.87), respectively. The average EC (μs cm-1) range of tube well water, protected pond water, pond sand filter water and rain water were 2059.16 (±49.43), 1756 (±14), 769 (±94.27), 64.33(±59.91) while the TDS (ppm) range were 1319.97 (±31.69), 1125.64 (±913.46), 492.94 (±60.43) and 15.38 (±118.59) respectively. The maximum concentration of salinity was found in tube well water which was 1.37 (±53) ppt. Most of the protected ponds were highly contaminated with sulphate and it ranges from 84.64 to 218.25 ppm. The average number of fecal Coliform in protected ponds were 1650 100 m l-1 of water while in PSF source pond 2350 100ml-1 and collection point 1.5 100ml-1.J. Environ. Sci. & Natural Resources, 10(1): 101-108 2017

Serum zinc, copper and iron status of children with coeliac disease on three months of gluten-free diet with or without four weeks of zinc supplements: a randomised controlled trial

Data about the effect of zinc supplementation with gluten-free diet on normalisation of plasma zinc, copper and iron in patients with coeliac disease are scanty. We evaluated the effect of zinc supplementation on serum zinc, copper and iron levels in patients with coeliac disease, by randomising 71 children newly diagnosed with coeliac disease into two groups: Group A = gluten-free diet (GFD); and Group B = gluten-free diet with zinc supplements (GFD +Zn). The rise in iron and zinc was significantly higher in the latter, but the mean rise of copper levels was slightly higher in the former, but the difference was not significant.

Highly immunoreactive antibodies against the rHup-F2 fragment (aa 63-161) of the iron-regulated HupB protein of Mycobacterium tuberculosis and its potential for the serodiagnosis of extrapulmonary and recurrent tuberculosis

HupB is an iron-regulated protein in Mycobacterium tuberculosis that functions as a positive regulator of mycobactin biosynthesis. It is essential for the growth and survival of the pathogen inside macrophages. Previously, using the full-length rHupB of M. tuberculosis, we demonstrated high levels of anti-HupB antibodies in the serum of pulmonary tuberculosis (TB) and, interestingly, extrapulmonary TB patients with negligible levels in household contacts and healthy controls. Here, we used three antigenic fragments of HupB, namely the recombinant HupB-F1 (aa 1-71), HupB-F2 (aa 63-161) and HupB-F3 (aa 164-214), as antigens in enzyme-linked immunosorbent assay (ELISA) to screen serum from TB patients. HupB-F2 showed enhanced immunoreactivity with serum from patients with pulmonary TB (three groups consisting of new cases, defaulters and recurrent cases) and extrapulmonary TB, with negligible levels in normal healthy controls. The negative correlation of the anti-(HupB-F2) antibodies with serum iron was maximal, with a Pearson's correlation coefficient value of -0.415. The study, in addition to strengthening the diagnostic potential of HupB, reflected the superior performance of HupB-F2 as an antigen in screening pulmonary and extrapulmonary TB.

Linagliptin as add-on therapy for type 2 diabetes - an overview

The pathogenesis of type 2 diabetes (T2D) can result in decreased levels of glucagon-like peptide 1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), which under normal circumstances increase insulin secretion and suppress glucagon release. A new form of drug therapy known as dipeptidyl peptidase 4 (DPP IV) inhibitors has focused on increasing the circulating levels of these "incretin" hormones in order to improve glycemic control in patients with T2D. The DPP IV inhibitors saxagliptin, vildagliptin, linagliptin, alogliptin and sitagliptin function by inhibiting the enzyme DPP IV, which breaks down GLP-1 and GIP, and have had significant success. However, with most DPP IV inhibitors being extensively excreted renally, this is a significant issue, as a large proportion of diabetic patients suffer from renal complications. Linagliptin is a novel DPP IV inhibitor that is excreted primarily by the hepatic route, with little need for dose adjustment in patients with renal impairment. It therefore represents a major advancement in the pharmacotherapy of patients with T2D.

Fibrous variant of rhinophyma

Rhinophyma is a rare disease which causes disfiguring soft tissue hypertrophy of the nose. The fibrous variant of rhinophyma is still rare which mimics fibrous papule of nose and lupus pernio. We report an unusual fibrous variant which was surgically managed with the good results. The use of scalpel for sculpting and the use of split thickness skin graft is being highlighted.

Pleuropulmonary blastoma with cervical lymph node metastasis at presentation

Pleuropulmonary blastoma is a rare childhood neoplasm accounting for less than one percent of all primary malignant lung tumors of children less than six years of age. Metastasis to CNS, orbit and iris, bone, contralateral lung and rarely adrenal glands, liver, kidney and pancreas has been described. This report presents a rare case of pleuropulmonary blastoma with cervical lymph node metastasis at the time of presentation.

Preoperative ultrasound-guided fine-needle aspiration cytology for axillary staging in breast carcinoma

Axillary lymph node (ALN) status is considered to be the single most important prognostic indicator in patients with breast cancer. It can be assessed by various radiological, pathological and surgical techniques, the most accurate being histological examination of lymph nodes after axillary lymph node dissection (ALND). This prospective study was conducted to assess the feasibility and diagnostic accuracy of preoperative ultrasound (US) and ultrasound-guided fine-needle aspiration cytology (USG-FNAC) of ALN in patients with breast cancer. Thirty patients with FNAC-proven breast cancer, planned for definitive surgery with axillary clearance, were included in this study. Ultrasonographic evaluation of the axillae of these patients was conducted for alterations in size, shape, contour and cortical morphology of lymph nodes that could reflect presence of underlying metastases. Ultrasound-guided fine-needle aspiration cytology of the ALN was done in 24 of these patients. These findings were evaluated, with the ALN status determined by histological examination after ALND. Out of the 30 patients, eight had T(1), 16 had T(2), five had T(3), and one had T(4) lesions. Ultrasound evaluation of the ALN had a sensitivity of 86.3%, a specificity of 41.6%, a positive predictive value of 79%, a negative predictive value of 50% and a diagnostic accuracy of 73.3%. Sensitivity of USG-FNAC was 78.95%, specificity was 100%, positive predictive value was 100%, negative predictive value was 55.56% and diagnostic accuracy was 83.33%. Our study concludes that preoperative USG-FNAC of ALN is a simple, minimally invasive, easily available and reliable technique for the initial determination of ALN status in patients with breast cancer. Those who are USG-FNAC positive can be directed towards ALND straight away, and only those who are USG-FNAC negative should be considered for sentinel lymph node biopsy. This will save considerable operating time, especially where facilities for sentinel lymph node biopsy (costly dye, gamma camera, nuclear medicine facilities) are restricted or not available.

Pancreatic fistulae--rare complication of cholecystectomy

Pancreaticocutaneous fistula after cholecystetactimy is a very rare condition. A 40 year male patient presented with a drain tube on the right lateral abdominal wall with drainage of 200 ml turbid fluid daily for about 2 months following cholecystectomy. After through investigation and operation it was diagnosed as external pancreatic fistula. It is treat by fistulojejunal anastomosis with Roux-En-Y loop of Jejurum in Bangabandhu Sheikh Mujib Medical University Hospital, Dhaka.

Total intravenous anaesthesia for tracheobronchial stenting in children

Stenosis and malacia of the tracheobronchial tree, most often secondary to prolonged intubation, tracheostomy or following correction of a congenital cardiac lesion, present a significant therapeutic problem, especially when the lesions are extensive. The utilization of self-expanding tracheobronchial stents is a useful addition to the medical armamentarium for maintenance of airways in these patients with major airway stenosis and collapse. The majority of previous reported cases of tracheobronchial stenting have been performed under general anaesthesia with the help of rigid bronchoscopy under direct vision. We conducted two cases of tracheobronchial stenting in postoperative cardiosurgical babies under continuous propofol infusion taking advantage of cardiovascular stability during continuous infusion and rapid emergence after its discontinuation.

Lactating adenoma--cytomorphologic study with review of literature

Lactating adenoma is an uncommon well-differentiated benign tumor of secretory mammary epithelium that occurs in pregnant and lactating women. Three percent of all breast cancers are diagnosed during pregnancy and need to be differentiated from other breast masses occurring in pregnancy and lactational states. Its origin, though controversial, is believed to be de novo or a variant of pre-existing tubular adenoma or fibroadenoma, that reflects the morphologic changes resulting from the physiologic state of pregnancy. Four pregnant/lactating women presenting with solitary breast masses were aspirated. Spontaneous regression of the mass was observed in two of the four cases, one underwent excision biopsy and one case was lost to follow up. All four cases were diagnosed as lactating adenoma on fine needle aspiration cytology. Cytomorphologic features included cellular aspirates comprising of epithelial cells, scattered and in small groups. The acinar cells had foamy to vacuolated cytoplasm. The nucleus had prominent nucleoli. Background showed abundant foamy material. Biopsy confirmed lactating adenoma in one of the cases. Lactating adenoma needs to be differentiated from other breast masses, including carcinoma, in pregnant or lactating women. Sonographic studies are not diagnostic and surgical biopsies are not recommended as a majority of the lesions are known to regress spontaneously.

Systemic and local antimicrobial use in periodontal therapy in England and Wales

BACKGROUND/AIMS

The aim of this study was to investigate antimicrobial use during periodontal therapy in dental practice in England & Wales.

METHOD

This was a postal questionnaire survey of 800 dentists, 400 general dental practitioners (GDP) in National Health Service practice and 400 members of the British Society of Periodontology (Periodontal Society) primarily in dental practice. We designed and piloted a questionnaire to evaluate both systemic and local antibiotic use with periodontal therapy as well as factors affecting their prescription. In addition, we also investigated the potential use of antibiotic sensitivity testing, since this has been recommended prior to prescribing antibiotics. Two follow-up mailings were used to encourage non-responders.

RESULTS

The useable return rate for the questionnaires was 587/800 (73%). Systemic antibiotics were used by 7.4% Periodontal Society members and 18.4% GDP for untreated adult periodontitis patients (p<0.001). Antimicrobials were prescribed more frequently by Periodontal Society members in early onset (52.7%) and refractory periodontitis patients (49.6%), and this was highly statistically significantly greater usage than GDP (p<0.001). Regarding local antimicrobials, usage for untreated adult periodontitis was Periodontal Society 8.9% and GDP 5.4%. Higher usage of local antimicrobials was found both for the treatment of recurrent pocketing in adult periodontitis (Periodontal Society 26.3%, GDP 14.8%, p<0.014) and refractory periodontitis (Periodontal Society 30.8%, GDP 15.2%, p<0.001). As reasons for using local antimicrobials, more than 80% of all respondents stated superiority over root debridement alone. Barriers to use included cost, no perceived need and lack of supporting research data. The percentage of responders considering diagnostic microbiology either theoretically or at a cost of pound 60 were by group, Periodontal Society 83% & 70.4% and GDP 76% & 51.2%. 33% of Periodontal Society members and 3.8% of GDP spent at least 45 min per quadrant on root planing and Periodontal Society members had a greater exposure to lectures on both systemic and local drug therapy compared with GDP (p<0.001).

CONCLUSIONS

Systemic antimicrobial use was infrequent for adult periodontitis and generally in line with current recommendations for other disease types. Whilst local antimicrobial therapy for periodontitis was not widespread, a substantial minority of dentists use this form of therapy and most believe that it is more effective than root debridement alone.

Malakoplakia of bone. A case report

BACKGROUND

Malakoplakia is an uncommon but distinctive granulomatous disease, characterized by an accumulation of histiocytes or Von Hansemann cells containing intracytoplasmic, laminated Michaelis-Gutmann bodies.

CASE

A 3-year-old male presented with a tender swelling in the left gluteal region that had been present for one month. Smears made from a fine needle aspirate showed large histiocytic cells containing intracytoplasmic, basophilic, laminated, targetoid Michaelis-Gutmann bodies resembling Von Hansemann cells in malakoplakia. Histopathology confirmed the diagnosis of malakoplakia of bone.

CONCLUSION

This case, histologically proven to be malakoplakia, demonstrated regression of the lesion following therapy. The characteristic cytologic features and presence of Von Hansemann cells may in themselves be diagnostic and obviate the need for biopsy.

ClC-2 contributes to native chloride secretion by a human intestinal cell line, Caco-2

It has been previously determined that ClC-2, a member of the ClC chloride channel superfamily, is expressed in certain epithelial tissues. These findings fueled speculation that ClC-2 can compensate for impaired chloride transport in epithelial tissues affected by cystic fibrosis and lacking the cystic fibrosis transmembrane conductance regulator. However, direct evidence linking ClC-2 channel expression to epithelial chloride secretion was lacking. In the present studies, we show that ClC-2 transcripts and protein are present endogenously in the Caco-2 cell line, a cell line that models the human small intestine. Using an antisense strategy we show that ClC-2 contributes to native chloride currents in Caco-2 cells measured by patch clamp electrophysiology. Antisense ClC-2-transfected monolayers of Caco-2 cells exhibited less chloride secretion (monitored as iodide efflux) than did mock transfected monolayers, providing the first direct molecular evidence that ClC-2 can contribute to chloride secretion by the human intestinal epithelium. Further, examination of ClC-2 localization by confocal microscopy revealed that ClC-2 contributes to secretion from a unique location in this epithelium, from the apical aspect of the tight junction complex. Hence, these studies provide the necessary rationale for considering ClC-2 as a possible therapeutic target for diseases affecting intestinal chloride secretion such as cystic fibrosis.

Primary diagnosis of ameloblastoma by fine-needle aspiration: a report of two cases

Ameloblastoma is the most common epithelial odontogenic tumor, comprising 1% of tumors and cysts arising in the jaws. We describe two cases of ameloblastoma of the jaw diagnosed by fine-needle aspiration cytology. The patients presented with swelling in the parotid region. Cytological examination of the particulate and sticky bloodstained fluid obtained on aspiration showed tightly packed groups of basaloid cells arranged in nests with rounded edges. Palisading epithelial cells and squamous cells with spherical keratinized bodies were the distinctive cytological features. Histologic examination confirmed the presence of ameloblastoma.

Localized tenosynovial giant cell tumor of tendon sheath. A case report

BACKGROUND

Localized tenosynovial giant cell tumor of tendon sheath (TGCT-L) is a benign, slowly growing lesion with a peak incidence in the third to fifth decade of life. It is thought to arise from the synovium of tendon sheaths, frequently affecting interphalangeal joints of the hands, feet, ankles and knees. Although the histopathologic appearances are well established, only a few reports describe the cytomorphology of this lesion.

CASE

A 37-year-old female presented with a slowly growing, nontender mass located near the left ankle joint. The cytologic features of localized tenosynovial giant cell tumor of tendon sheath (TGCT-L) include abundant mononuclear histiocytic cells occurring singly and in three-dimensional tissue fragments, hemosiderin within histiocytes and a few multinucleated giant cells. Subsequently, the histopathologic examination of the surgical specimen was proven to be TGCT-L.

CONCLUSION

Fine needle aspiration cytology can be used as a diagnostic tool for early and accurate detection of TGCT-L since the cytologic features combined with clinical details are sufficiently distinctive.

Sevoflurane as a sole anaesthetic for thymectomy in myasthenia gravis

Myasthenia gravis is a challenging situation for anaesthesiologists due to its neuromuscular involvement. The main concerns are respiratory muscle weakness and side effects due to a heavy dose of anticholinesterases. This limits the use of sedatives, hypnotics and muscle relaxants. Inhalational anaesthetics are best suited. We describe our experience with sevoflurane as a sole anaesthetic in a child having juvenile-type myasthenia gravis with thymoma, who underwent thymectomy by midsternal incision. Very smooth and short duration of induction (35 s) and easy intubation within 60 s without use of muscle relaxant were the remarkable features. Sevoflurane in oxygen and nitrous oxide (MAC=0.5-0.7) was used for maintenance of anaesthesia. Recovery was smooth and fast with no residual respiratory insufficiency. Hence we found sevoflurane to be a highly suitable agent for thymectomy in mysthenia gravis.

Stabilization of slow troponin C polypeptide compensates for its reduced synthesis in antisense oligodeoxynucleotide-treated cells

The expression of genes for contractile proteins during myogenesis is coordinately regulated. Uncoupling the expression of the slow/cardiac troponin C (sTnC) gene from this process with an antisense phosphorothioate oligodeoxynucleotide (ODN) was used to examine the presence of any post-transcriptional mechanisms for regulating muscle protein synthesis. Approximately 70 and 50% decreases in sTnC polypeptide synthesis and mRNA levels, respectively, were achieved after 4 days antisense treatment. This decrease in sTnC polypeptide synthesis was not reflected in a similar decline in the steady-state level of this polypeptide. Extension of the ODN treatment to 7 days was required to produce a substantial decrease in the steady-state level of sTnC polypeptide. Our investigation suggests that during the 4-day treatment, the affected cells stabilized the sTnC polypeptide level by increasing its half-life. However, the stabilizing effect appears to be overridden during prolonged (7 days) antisense ODN treatment. Measurement of the polypeptide synthesis and mRNA levels of several contractile proteins showed no evidence of cross-regulation among the genes to coordinately regulate their expression levels.

Malignant renal tumor with extension to the inferior vena cava

BACKGROUND

Management of malignant renal tumors involving the inferior vena cava (IVC) depends on tumor extension within the cava.

METHODS

Of 295 patients treated for renal cancer, propagation of tumor mass through the renal vein to IVC was seen in 22 (7%) patients. Cephalad extension of the tumor was suprarenal: infrahepatic in 12, retrohepatic in 6, and within the right atrium in 4 patients. All patients had radical nephrectomy, cavotomy, and complete resection of tumors except 1 with diffuse peritoneal metastasis.

RESULTS

Twenty-one patients had curative resections. No operative deaths and no instances of pulmonary embolism or exsanguination occurred. Seventeen patients were alive at 2 years and 12 at 5 years, resulting in 77% and 55% survival rates, respectively.

CONCLUSIONS

An aggressive approach for vena cava involvement from malignant renal neoplasms resulted in prevention of tumor embolus, minimization of blood loss, and maintenance of venous return to the heart.