PUF60-related developmental disorder: A case series and phenotypic analysis of 10 additional patients with monoallelic PUF60 variants

PUF60-related developmental disorder (also referred to as Verheij syndrome), resulting from haploinsufficiency of PUF60, is associated with multiple congenital anomalies affecting a wide range of body systems. These anomalies include ophthalmic coloboma, and congenital anomalies of the heart, kidney, and musculoskeletal system. Behavioral and intellectual difficulties are also observed. While less common than other features associated with PUF60-related developmental disorder, for instance hearing impairment and short stature, identification of specific anomalies such as ophthalmic coloboma can aid with diagnostic identification given the limited spectrum of genes linked with this feature. We describe 10 patients with PUF60 gene variants, bringing the total number reported in the literature, to varying levels of details, to 56 patients. Patients were recruited both via locally based exome sequencing from international sites and from the DDD study in the United Kingdom. Eight of the variants reported were novel PUF60 variants. The addition of a further patient with a reported c449-457del variant to the existing literature highlights this as a recurrent variant. One variant was inherited from an affected parent. This is the first example in the literature of an inherited variant resulting in PUF60-related developmental disorder. Two patients (20%) were reported to have a renal anomaly consistent with 22% of cases in previously reported literature. Two patients received specialist endocrine treatment. More commonly observed were clinical features such as: cardiac anomalies (40%), ocular abnormalities (70%), intellectual disability (60%), and skeletal abnormalities (80%). Facial features did not demonstrate a recognizable gestalt. Of note, but remaining of unclear causality, we describe a single pediatric patient with pineoblastoma. We recommend that stature and pubertal progress should be monitored in PUF60-related developmental disorder with a low threshold for endocrine investigations as hormone therapy may be indicated. Our study reports an inherited case with PUF60-related developmental disorder which has important genetic counseling implications for families.

Culturally adapted psychosocial interventions (CaPSI) for early psychosis in a low-resource setting: study protocol for a large multi-center RCT

BACKGROUND

Psychosis treatment guidelines recommend cognitive behaviour therapy (CBT) and family intervention (FI), for all patients with first episode psychosis (FEP), though guidance borrows heavily from literature in adults from high income countries. To our knowledge, there are few randomized controlled trials (RCTs) examining the comparative effect of these commonly endorsed psychosocial interventions in individuals with early psychosis from high-income countries and no such trials from low and middle-income countries (LMICs). The present study aims to confirm the clinical-efficacy and cost-effectiveness of delivering culturally adapted CBT (CaCBT) and culturally adapted FI (CulFI) to individuals with FEP in Pakistan.

METHOD

A multi-centre, three-arm RCT of CaCBT, CulFI, and treatment as usual (TAU) for individuals with FEP (n = 390), recruited from major centres across Pakistan. Reducing overall symptoms of FEP will be the primary outcome. Additional aims will include improving patient and carer outcomes and estimating the economic impact of delivering culturally appropriate psychosocial interventions in low-resource settings. This trial will assess the clinical-efficacy and cost-effectiveness of CaCBT and CulFI compared with TAU in improving patient (positive and negative symptoms of psychosis, general psychopathology, depressive symptoms, quality of life, cognition, general functioning, and insight) and carer related outcomes (carer experience, wellbeing, illness attitudes and symptoms of depression and anxiety).

CONCLUSIONS

A successful trial may inform the rapid scale up of these interventions not only in Pakistan but other low-resource settings, to improve clinical outcomes, social and occupational functioning, and quality of life in South Asian and other minority groups with FEP.

TRIAL REGISTRATION

NCT05814913.

In ovo injection of silver nanoparticles modulates some productive traits and hepatic gene expression of broilers exposed to lipopolysaccharide challenge

This study aimed to evaluate the effectiveness of the embryonic injection of silver nanoparticles (SilNPs) on some productive traits and hepatic gene expression of lipopolysaccharide (LPS)-challenged broilers after a 42 d rearing period. 560 fertile eggs were randomly allocated to four groups and received either of the following treatments at d 7 of incubation, control (no injection), placebo (1 mL saline), SilNP20 (20 mg/kg silver nanoparticles), or SilNP40 (40 mg/kg silver nanoparticles). After the incubation, 320 hatchlings experienced a 42 d standard rearing period. Live body weight (LBW), feed intake (FI), and feed conversion ratio (FCR) were weekly recorded. At the end of the experiment, two birds from each replicate (n = 8 per treatment) were exposed to LPS intraperitoneal injection at 48, 24, and 12 h before slaughter time. They were also used for blood, intestinal, and microbial evaluations. The hepatic mRNA levels of tumor necrosis factor-alpha (TNF-α), interleukin 6 (IL-6), transforming growth factor beta (TGF-β), and insulin-like growth factor I (IGF-I) were assessed at d 1 and 42 of the experiment. Adminstration of SiLNPs improved LBW, FI, and FCR and also enhanced liver and spleen weights (P < 0.05). SilNP20 birds had significantly lower bursa of Fabricius weight (P < 0.05). SilNP20 had lower total cholesterol levels than others. There was a significant difference (P < 0.05) between SliNP40 and SilNP20 in the ratio of villus height to crypt width. Compared to control groups, chicks of SilNP20, but not SilNP40, showed a significant increase in the relative expression of TNF-α, IL-6, TGF-β, and IFG-I genes at d 1. On d 42, however, both SilNP20 and SilNP40 had significantly higher TNF-α and TGF-β levels than both controls. Silver nanoparticles did not significantly affect the microflora of the ileum and cecum in the current study. In summary, SilNPs administration to chick embryos showed a long-term positive effect on their productive performance.

Point Prevalence Study (PPS) of Antibiotic Usage and Bacterial Culture Rate (BCR) among Secondary Care Hospitals of Small Cities in Central India: Consolidating Indian Evidence

Objective Indian hospitals (especially government-run public sector hospitals) have a nonexistent antimicrobial stewardship program (AMSP). After successfully initiating AMSPs in tertiary care hospitals of India, the Indian Council of Medical Research envisages implementing AMSP in secondary care hospitals. This study is about the baseline data on antibiotic consumption in secondary care hospitals.

Materials and Methods It was a prospective longitudinal observational chart review type of study. Baseline data on antibiotic consumption was captured by a 24-hour point prevalence study of antibiotic usage and bacterial culture rate. The prescribed antibiotics were classified according to the World Health Organization (WHO) Access, Watch, and Reserve classification. All data were collated in Microsoft Excel and summarized as percentages.

Results Out of the 864 patients surveyed, overall antibiotic usage was 78.9% (71.5% in low-priority areas vs. 92.2% in high-priority areas). Most of the antibiotic usage was empirical with an extremely low bacterial culture rate (21.9%). Out of the prescribed drugs, 53.1% were from the WHO watch category and 5.5% from the reserve category.

Conclusion Even after 5 years of the launch of the national action plan on AMR (NAP-AMR) of India, AMSP is still non-existent in small- and medium-level hospitals in urban cities. The importance of trained microbiologists in the health care system is identified as a fulcrum in combating antimicrobial resistance (AMR); however, their absence in government-run district hospitals is a matter of grave concern and needs to be addressed sooner than later.

On the application of sound radiation force for focusing of powder stream in directed energy deposition

One of the challenges in directed energy deposition via powder feeding (DED-PF) is the powder stream divergence that results in low catchment efficiency (i.e., the fraction of particles added to the melt pool). This article introduces a new ultrasound-based powder focusing method referred to as ultrasound particle lensing (UPL), tailored for powder used in DED-PF. The method uses an ultrasound phased array to produce a small volume of high-intensity ultrasound with the required period averaged sound intensity profile. UPL was used to acoustically focus streams of Ti64 and SS 316L particles with an average size of 89μm and a particle speed of 0.6 m/s, exiting from a DED-PF nozzle analog. The e^-1 powder stream widths downstream of the resulting force fields for both materials were reduced by 30%. The experimental results closely match Lagrangian and Eulerian simulations of the process. This novel setup offers the possibility of fast control of the powder stream divergence angle and effective diameter in the process zone during the DED-PF process. This will in turn improve the feature resolution and catchment efficiency of the process.

Potential benefits of early-life supplementation of liquid feed with fennel (Foeniculum vulgare) seeds or oregano (Origanum vulgare) leaves on growth, health, and blood metabolites in Holstein dairy calves

This study was performed to determine the early-life (first month of age) supplementation of liquid feed with fennel seed powder (FSP) or oregano leaf powder (OLP) on growth performance, health, and blood biochemical attributes in preweaning dairy calves. Holstein female calves (n = 57; 1 d of age; 34.1 ± 0.97 kg of BW; mean ± SE) were assigned randomly to receive liquid feed (colostrum and milk) with no added herbal plants (CON) or supplemented with FSP (3 g/d) or OLP (30 g/d) during the first month of age. The calves received pooled colostrum (4.5 kg/d on the first 2 d of life; total solids = 25.0% ± 1.24; mean ± SD) and then pooled waste milk (6 kg/d from d 3 to 44, 5 kg/d from d 45 to 46, 4 kg/d from d 47 to 48, and 3 kg/d from d 49 to 50 of the trial; total solids = 12.54% ± 0.50) to ensure they receive same mixed liquid feed daily. The calves had unlimited access to the starter feed and fresh water and remained in the study until weaning on d 51 of age. The average mean temperature-humidity index was 70.1 units (ranging between 61.9 to 78.2) during the experiment, indicating a borderline degree of environmental heat-load. The amount of starter feed offered and refused was recorded daily. The calves were weighed immediately after birth and every 10 d thereafter, before the morning feeding. Jugular blood samples were taken immediately before and 24 h after colostrum feeding, at first month of age, and at weaning to quantify serum concentrations of glucose, urea N, cholesterol, triglycerides, total proteins, albumin, globulin, aspartate transferase, alanine transferase, total antioxidant status, and malondialdehyde. Health checks including rectal temperature, general appearance (on a 1-5 score system), fecal score (on a 1-5 score system), and bovine respiratory disease (BRD; scored using the University of Wisconsin Calf Health Chart) were performed daily, by a veterinarian who was unaware of the calf treatment allocations, for all calves over the study period. A repeated-measures ANOVA was used to compare growth performance and blood metabolites among treatment groups, and a logistic regression model using a binomial distribution (PROC GLIMMIX, SAS v. 9.4, SAS Institute Inc.) was used to assess the chance of elevated rectal temperature (≥39.4°C), general appearance (≥2), diarrhea (≥3), and BRD. A Poisson regression model (PROC GENMOD) was also used to test group differences in the experience of days with elevated rectal temperature and general appearance, and frequency and duration of diarrhea or BRD. Total nutrient intake (DM, CP, and ME, but not ether extract) originating from milk and starter feed was greater in OLP- (but not FSP-) supplemented calves compared with CON group, being partially associated with difference in milk refusal. Calves receiving FSP and OLP had greater average daily gain, BW gain, skeletal gain (withers height or heart girth, respectively), and feed efficiency compared with CON animals with no difference between FSP and OLP. Rectal temperature was lower in FSP- (but not OLP-) supplemented calves compared with CON animals. The CON animals had a greater chance of experiencing higher rectal temperature (≥39.4°C; odds ratio = 1.55 and confidence interval = 1.12-2.15 and odds ratio = 1.33 and confidence interval = 0.92-1.90, respectively, compared with FSP and OLP) and general appearance (≥2; odds ratio = 1.99 and confidence interval = 1.45-2.74 and odds ratio = 1.45 and confidence interval = 1.03-2.05), and diarrhea (odds ratio = 1.47 and confidence interval = 1.11-1.97 and odds ratio = 1.49 and confidence interval = 1.07-2.08) compared with those receiving FSP or OLP; with the chance of BRD being lower in FSP- (but not OLP-) supplemented versus CON animals (odds ratio = 1.59 and confidence interval = 1.13-2.23). As compared with OLP and CON groups, FSP treatment resulted in shorter days with elevated rectal temperature and general appearance. Supplementing FSP or OLP decreased the duration of diarrhea and BRD but not their frequency compared with CON. Duration of diarrhea was not different between FSP- or OLP-supplemented calves but calves supplemented with FSP had shorter days with BRD compared with OLP-supplemented calves. Of the blood constituents measured on d 30, concentration of aspartate transferase was higher in FSP- (but not CON) versus OLP-supplemented calves, indicating a transient liver tissue damage or dysfunction which was subsequently ameliorated. At weaning, blood concentration of triglycerides was higher in FSP and OLP groups compared with CON group. Supplementation of the liquid feed with FSP or OLP, especially FSP, had beneficial effects on calf growth performance and health. Further experiments are warranted for optimizing the dosage and duration of feeding FSP or OLP as feed additives for dairy calves.

Association between ABO blood group and COVID-19 infection: an updated systematic review and meta-analysis

The relationship between ABO blood group and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 - coronavirus disease 19 [COVID-19]) infection has been investigated, and several studies have reported discordant findings. This systematic review and meta-analysis study were conducted to investigate the relationship between ABO blood group and COVID-19 infection. The international databases Institute for Scientific Information (ISI)/Web of Science, PubMed, and Scopus were systematically searched from 1 January 2020 through 14 June 2021. Twenty-seven studies met the inclusion criteria for meta-analysis including 23,285 COVID-19 case subjects and 590,593 control subjects. The odds of having each blood group among COVID-19 patients compared with control subjects were calculated. The random effects model was used to obtain the overall pooled odds ratio (OR). Publication bias and subgroup and sensitivity analyses were performed to explore the source of heterogeneity. According to the random effects model, the results indicated that the pooled estimates of OR (95% confidence interval) for blood groups A, O, B, and AB were 1.26 (1.13-1.40), 0.77 (0.71-0.82), 1.05 (0.99-1.12), and 1.11 (0.99-1.25), respectively. Therefore, individuals infected with COVID-19 have higher odds of having blood group A and lower odds of having blood group O. In conclusion, this study indicated that individuals with blood group A are more susceptible to COVID-19 infection, whereas those with blood group O are less susceptible to COVID-19 infection. However, further studies are warranted to support these findings.

A micro-jet array for economic intensification of gas transfer in bioreactors

Bioreactors are of interest for gas-to-liquid conversion of stranded or waste industrial gases, such as CO, CH₄ , or syngas. Process economics requires reduction of bioreactor cost and size while maintaining intense production via rapid delivery of gases to the liquid phase (i.e., high k_L a). Here, we show a novel bioreactor design that outperforms all known technology in terms of gas transfer energy efficiency (k_L a per power density) while operating at high k_L a (i.e., near 0.8 s^-1 ). The reactor design uses a micro-jet array to break feedstock gas into a downward microbubble flow. Hydrodynamic and surfactant measurements show the reactor's advanced performance arises from its bubble breakage mechanism, which limits fluid shear to a thin plane located at an optimal location for bubble breakage. Power dissipation and k_L are shown to scale with micro-jet diameter rather than reactor diameter, and the micro-jet array achieves improved performance compared to classical impinging-jets, ejector, or U-loop reactors. The hydrodynamic mechanism by which the micro-jets break bubbles apart is shown to be shearing the bubbles into filaments then fragmentation by surface tension rather than "cutting in half" of bubbles. Guided by these hydrodynamic insights, strategies for industrial design are given. © 2018 American Institute of Chemical Engineers Biotechnol. Prog., 35: e2710, 2019.

Effects of plasma transfusions on antithrombin levels after paediatric liver transplantation

BACKGROUND AND OBJECTIVES

Thrombotic complications affect 3-10% of patients after liver transplantation (LT), leading to potentially life-threatening complications. In the days following LT, antithrombin (AT) is decreased longer than pro-coagulant factors, thus favouring a pro-thrombotic profile. Plasma transfusions are given empirically in some centres to correct AT levels following LT. We assessed the effect of plasma transfusion on AT levels after paediatric LT.

MATERIALS AND METHODS

Prospective single-centre observational study in 20 consecutive paediatric LT recipients over a 24-month period. Plasma was administered twice daily (10 ml/kg/dose) according to an existing protocol. AT levels were measured once daily, immediately prior to and one hour after the morning plasma transfusion. Sample size was calculated based on a non-inferiority hypothesis.

RESULTS

The median age and weight were 11.6 years (IQR 2.8; 14.7) and 40 kg (IQR 12.75; 44.8), respectively. We collected 85-paired blood samples. The median AT level prior to plasma transfusion was 58%. The median difference in AT levels before and after plasma transfusion was 4.2% (P = 0.001). Changes in AT levels after plasma transfusion were not correlated with baseline AT levels (R = 0.19) or patient weight (R = 0.18).

CONCLUSION

Plasma transfusions only marginally increase AT levels in children after LT. Therefore, prophylactic plasma transfusions probably do not seem to confer an advantage in the routine management of paediatric LT patients. Randomized controlled trials are needed to identify the optimal anticoagulation strategy in this specific population.

Diagnosis and severity criteria for sinusoidal obstruction syndrome/veno-occlusive disease in pediatric patients: a new classification from the European society for blood and marrow transplantation

The advances in hematopoietic cell transplantation (HCT) over the last decade have led to a transplant-related mortality below 15%. Hepatic sinusoidal obstruction syndrome/veno-occlusive disease (SOS/VOD) is a life-threatening complication of HCT that belongs to a group of diseases increasingly identified as transplant-related, systemic endothelial diseases. In most cases, SOS/VOD resolves within weeks; however, severe SOS/VOD results in multi-organ dysfunction/failure with a mortality rate >80%. A timely diagnosis of SOS/VOD is of critical importance, given the availability of therapeutic options with favorable tolerability. Current diagnostic criteria are used for adults and children. However, over the last decade it has become clear that SOS/VOD is significantly different between the age groups in terms of incidence, genetic predisposition, clinical presentation, prevention, treatment and outcome. Improved understanding of SOS/VOD and the availability of effective treatment questions the use of the Baltimore and Seattle criteria for diagnosing SOS/VOD in children. The aim of this position paper is to propose new diagnostic and severity criteria for SOS/VOD in children on behalf of the European Society for Blood and Marrow Transplantation.

Fertility preservation issues in pediatric hematopoietic stem cell transplantation: practical approaches from the consensus of the Pediatric Diseases Working Party of the EBMT and the International BFM Study Group

Fertility preservation is an urgent challenge in the transplant setting. A panel of transplanters and fertility specialists within the Pediatric Diseases Working Party of the European Society for Blood and Marrow Transplantation (EBMT) and the International BFM Study Group provides specific guidelines. Patients and families should be informed of possible gender- and age-specific cryopreservation strategies that should be tailored according to the underlying disease, clinical condition and previous exposure to chemotherapy. Semen collection should be routinely offered to all postpubertal boys at the diagnosis of any disease requiring therapy that could potentially impair fertility. Testicular tissue collection might be offered to postpubertal boys; nevertheless, its use has been unsuccessful to date. Oocyte collection after hormonal hyperstimulation should be offered to postpubertal girls facing gonadotoxic therapies that could be delayed for the 2 weeks required for the procedure. Ovarian tissue collection could be offered to pre-/post-pubertal girls. Pregnancies have been reported after postpubertal ovarian tissue reimplantation; however, to date, no pregnancy has been reported after the reimplantation of prepubertal ovarian tissue or in vitro maturation of pre-/post-pubertal ovarian tissue. Possible future advances in reproductive medicine could change this scenario. Health authorities should prioritize fertility preservation projects in pediatric transplantation to improve patient care and quality of life.

Extrudate Swell of High Density Polyethylenes in Slit (Flat) Dies

Extrudate swell of industrial-grade high-molecular mass high-density polyethylenes (HDPEs) in flat/slit dies is studied using both experiments and simulations. The experimental set-up consists of an optical micrometer to measure the extrudate dimensions and a pair of radiation heaters to control the extrudate temperature outside the die attached to the capillary rheometer. The simulation of extrudate swell phenomenon is carried out by using a well-known integral K-BKZ model. The effects of several rheological characteristics, die characteristics, and processing conditions on swell measurements are studied systematically, and the corresponding two-dimensional, steady-state numerical predictions are presented in this paper. This study includes the effects of polymer molecular characteristics, apparent shear rate, die geometrical characteristics (length to die gap (L/H) and width to die gap (W/H)), and distance from the die exit. It is found that the integral K-BKZ model predicts well both the width and thickness extrudate swells. Extrudate swell measurements demonstrate that the thickness swell is predominant in comparison with width swell.

An update on radiation absorbed dose to patients from diagnostic nuclear medicine procedures in Tehran: A study on four academic centers

Purpose:

Use of radiopharmaceuticals for diagnostic nuclear medicine procedures is one of the main sources of radiation exposure. We performed this study with respect to the rapid growth in nuclear medicine in Iran and lack of updated statistics.

Materials and Methods:

The data were obtained for all active Nuclear Medicine Centers affiliated to Shahid Beheshti University of Medical Sciences during 2009 and 2010.

Results:

The most frequently performed procedures were bone (30.16%), cardiac (28.96%), renal (17.97%), and thyroid (7.93%) scans. There was a significant decrease in the number of thyroid scintigraphies with ¹³¹I and ^99mTc-sulfur colloid liver/spleen scans and tremendous increase in the frequencies of cardiac and bone scintigraphies compared to one decade ago.

Conclusion:

Compared to previous studies, there were striking changes in trends of diagnostic nuclear medicine procedures in Tehran. This field is still evolving in the country, and this trend will further change with the introduction of positron emission tomography scanners in future.

Evaluation of Serum and Urinary Neopterin Levels as a Biomarker for Occupational Exposure to Crystalline Silica

Background:

Crystalline silica is a commonly used mineral in various industries and construction activities, and it is so important introducing potential biomarkers to identify early indicators of biological effects in its high-risk occupational exposures.

Aim:

The present study was aimed to assess the blood and urinary neopterin as an early biomarker of exposure in the workers of an insulator manufacturing plant who are exposed to crystalline silica.

Subjects and Methods:

This analytical descriptive study was done among two groups of exposed workers (n = 55) and unexposed office workers (n = 38) of an insulator manufacturing plant. Statistical software R was used to determine sample size and select the participants by random sampling among nonsmoker workers. Sampling of airborne silica in breathing zone of participants was done based on the National Institute for Occupational Safety and Health method 7601. The urinary and blood samples were collected and prepared for analysis by high-performance liquid chromatography to determine the level of urinary and serum neopterin. All of the statistical analyses were carried out using SPSS 22.

Results:

The airborne silica concentration was significantly different between two exposed and unexposed groups (P < 0.001, 0.27 [0.11] vs. 0.0028 [0.0006] mg/m³, respectively). The urinary neopterin in exposed group is significantly higher than the unexposed one (P < 0.001, 97.67 [30.24] vs. 55.52 [2.18] μmol/mol creatinine, respectively). Neopterin level of serum in exposed group is higher than the unexposed group, and there is a significant difference between them (P < 0.001, 6.90 [2.70] vs. 2.20 [1.20] nmol/l, respectively). The positive significant correlations were found between silica exposure concentration with urinary and serum neopterin (P < 0.001, r = 0.36 and 0.59, respectively).

Conclusions:

Considering the sensitively and easily measurement of neopterin in biological fluid and also the statistically significant positive relationships which were found between the airborne silica concentration and neopterin levels in the present study, the serum and urinary neopterin levels can be considered the potential biomarkers of silica exposure for doing further comprehensive studies in this area.

Influence of glutathione S-transferase gene polymorphisms on busulfan pharmacokinetics and outcome of hematopoietic stem-cell transplantation in thalassemia pediatric patients

Hematopoietic stem-cell transplantation (HSCT) is currently the only curative therapeutic option for the treatment of thalassemia. In spite of the high cure rate, HSCT can lead to life-threatening adverse events in some patients. Busulfan (Bu) is a key component of the conditioning regimen prior to HSCT. Inter-individual differences in Bu pharmacokinetics (PK) are hypothesized to influence Bu efficacy and toxicity. Since Bu is mainly metabolized by glutathione S-transferase (GST), we investigated the relationship of GSTA1 and GSTM1 genotypes with first-dose PK and HSCT outcomes in 44 children with thalassemia intermedia and thalassemia major. All children received a myeloablative conditioning regimen with IV Bu. Association analysis revealed a relationship between GSTA169C>T (or haplotype *A/*B) and first Bu dose PK that was dependent on sex and Pesaro risk classification (PRC). Among female patients and patients with PRC I-II, homozygous individuals for the GSTA1T-69 allele defining haplotype *B, had higher Bu exposure and lower clearance (P⩽0.01). Association with HSCT outcomes showed that patients with the GSTM1 null genotypes had higher occurrence of regimen-related toxicity (P=0.01). These results suggest that GST genotypes could be useful to tailor the first Bu dose accordingly to improve HSCT outcome.

Paste Extrusion and Mechanical Properties of PTFE

The paste extrusion process of two types of PTFE has been studied in capillary extrusion using dies having different reduction ratio (RR) and die entrance angles. The extrusion pressure shows a weak increase with shear rate over a wide range of flow rates and a more significant increase with reduction ratio. Moreover, the extrusion pressure exhibits a minimum for entrance angle at around 30°. A simple analytical model based on the radial flow hypothesis (previously developed) has been found to represent the extrusion pressure adequately as a function of flow rate (shear rate) and geometrical characteristics of the capillary dies. The extrudates collected at different processing conditions were dried and tested in uniaxial extension to assess their effect on mechanical properties. The tensile modulus, yield stress and ultimate tensile strength of the obtained extrudates were found to be increasing functions of reduction ratio, although the opposite effect was found for the ultimate elongational strain. These mechanical properties are also found to be insensitive to changes in the die entrance angle although the ultimate tensile strength has shown a maximum at the entrance angle of about 60°. The PTFE paste extrudates show a Poisson's ratio equal to zero in tensile experiments, thus exhibiting expansion (significant density reduction with stretching). Finally, a simple model was derived for the density change in tensile deformation by taking into the account the Poisson's ratio and the strain recovery (recovery of the elastic energy stored upon removal of the tensile stress).

Sleeping Pattern of Medical Students Preceding Viva Examination and Their Performance

INTRODUCTION

Sleep is an important determinant of keeping healthy physically and mentally. Deviation in sleep is a common problem among students during examinations. The purpose of this study is to determine students' sleep pattern during night preceding viva examination and its correlation with performance.

METHODS

This was a cross-sectional prospective study conducted between January and February 2014 among 1st and 2nd year MBBS students of National Medical College, Birgunj, Nepal who appeared in University's final practical examinations. Based on simple random sampling approach, each of the 280 participants was allowed to pick out five pieces of lottery papers and they were asked the five questions resembling the number in the list of questions.

RESULTS

Among the total 280 students, 74.6% were from India and 25.4% were from Nepal, and majorities (63%) of them were males. Fifty two percent of the students either could not sleep at all or slept just for 1 to 1.5 hours while 12% slept for 5 to 6.5 hours. Two-third (66%) of the students was able enough to achieve one to two scores, and only 1.8% could succeed to get the maximum score of five. The correlation between hours of sleep preceding examination and the score achieved was positively (r=0.701) and statistically significantly correlated (p<0.001).

CONCLUSIONS

There is a trend among the medical students either not to sleep or sleep only for few hours preceding viva examination that result in poor performance in examinations.

Pathological evaluation of differentiated thyroid cancer in patients with positive serum thyroglobulin and negative iodine scan

OBJECTIVE

There is no investigation that emphasizes the pathology of DTC (differentiated thyroid cancer) patients with positive Tg and negative iodine scan. The present study was performed to assess the pathology of these patients.

MATERIALS AND METHODS

In this retrospective study, the records of 500 patients with differentiated thyroid cancer between June 2005 and November 2011 were assessed, and those patients who had elevated serum thyroglobulin (Tg) with a negative whole body I-131 scan (Tg+/WBS-) were included in the study. Patients were followed for clinical and pathological findings of thyroid cancer, including type, variant, local invasion and cervical lymph node metastasis, and serum Tg, TgAb, and TSH levels.

RESULTS

A total of 38 patients, including 31 (81.6%) females and 7 (18.4) males with a mean age of 44.2 ± 15.6 years (range, 14 to 77 yrs) took part in the study. All 38 patients had the papillary type of differentiated thyroid cancer (PCDTC), and none had the follicular type of differentiated thyroid cancer (FCDTC). For the variant type of PTC in 16 patients, it was found that 7 were classic type (43.8%), 7 were follicular type (43.8%), and 2 were tall cell (12.4%) for papillary thyroid cancer. In 22 patients no distinct variant had been reported.

CONCLUSIONS

This report demonstrated that all of the 38 patients were PTC (100%), which is different from other previous studies. It may be concluded that the overall pathologic subtypes changes of DTC could mainly be due to the iodine fortification program in various geographic regions. The relationship between DTC pathologic subtypes and frequency of Tg+/WBS- condition was difficult to assess in this work. Therefore, further studies are required to evaluate this issue.

Treatment of an acute promyelocytic leukemia relapse using arsenic trioxide and all-trans-retinoic in a 6-year-old child

In adult therapy, arsenic trioxide (ATO) and all-trans-retinoic acid (ATRA) are recognized as active treatment of relapsed acute promyelocytic leukemia (APL). The efficacy of this combination in pediatric APL has not yet been well established. We report the case of a 6-year-old girl with relapsed APL, with a PML-RARα mutation, treated with a combination of ATO and ATRA. Over a period of 5 months, she received in total, 75 doses of intravenous ATO and 40 doses of oral ATRA. Currently, 22 months after relapse, she is still in complete remission. Here, we describe treatment of a relapsed APL in a child with limited treatment of ATO and ATRA and review the literature.

Fallopian tube papilloma--case report of a rare tumor

Fallopian tube neoplasms are rare. We report a rare case of fallopian tube papilloma discovered incidentally in a 45 year old female, operated for procidentia. Right tube was dilated at the infundibular region, with friable grey white tissue in the lumen. Microscopy showed delicate branching papillae lined by a single layer of epithelium resembling tubal lining. There were no features to suggest a reactive hyperplasia in response to inflammation or of aggressive behaviour.

The association of cytochrome P450 genetic polymorphisms with sulfolane formation and the efficacy of a busulfan-based conditioning regimen in pediatric patients undergoing hematopoietic stem cell transplantation

Cytochrome P450 enzymes (CYPs) and flavin-containing monooxygenases (FMOs) likely have a role in the oxidation of intermediate metabolites of busulfan (Bu). In vitro studies to investigate the involvement of these enzymes are cumbersome because of the volatile nature of the intermediate metabolite tetrahydrothiophene (THT) and the lack of sensitive quantitation methods. This study explored the association between the CYP2C9, CYP2C19, CYP2B6 and FMO3 genotypes and sulfolane (Su, a water soluble metabolite of Bu) plasma levels in children undergoing hematopoietic stem cell transplantation (HSCT). The relationship between these genotypes and the effectiveness of myeloablative conditioning was also analyzed. Sixty-six children receiving an intravenous Bu-based myeloablative conditioning regimen were genotyped for common functional variant alleles in CYP2C9 (*2 and *3), CYP2C19 (*2 and *17), FMO3 (rs2266780, rs2266782 and rs1736557) and CYP2B6 (*5 and *9). The plasma levels of Bu and its metabolite Su were measured after the ninth Bu dose in a subset of 44 patients for whom plasma samples were available. The ratio of Bu to Su was considered the metabolic ratio (MR) and was compared across the genotype groups. Higher MRs were observed in CYP2C9*2 and *3 allele carriers (mean±s.d.: 7.8±3.6 in carriers vs 4.4±2.2 in non-carriers; P=0.003). An increased incidence of graft failure was observed among patients with an MR>5 compared with those with MR values <5 (20% vs 0%; P=0.02). In contrast, a significantly higher incidence of relapse and graft failure (evaluated as event-free survival) was observed in patients with malignant disease who carried CYP2B6 alleles with reduced function on both chromosomes compared with carriers of at least one normal allele (100% vs 40%; P=0.0001). These results suggest that CYP2C9 has a role in the oxidation reactions of THT and indicate that it may be possible to predict the efficacy of Bu-based myeloablative conditioning before HSCT on the basis of CYP genotypes and Bu MRs.

The impact of T-cell depletion techniques on the outcome after haploidentical hematopoietic SCT

Several T-cell depletion (TCD) techniques are used for haploidentical hematopoietic SCT (HSCT), but direct comparisons are rare. We therefore studied the effect of in vitro TCD with graft engineering (CD34 selection or CD3/CD19 depletion, 74%) or in vivo TCD using alemtuzumab (26%) on outcome, immune reconstitution and infections after haploidentical HSCT. We performed a retrospective multicenter analysis of 72 haploidentical HSCT in Switzerland. Sixty-seven patients (93%) had neutrophil engraftment. The 1-year OS, TRM and relapse incidence were 48 (36-60)%, 20 (11-33)% and 42 (31-57)%, respectively, without differences among the TCD groups. In vivo TCD caused more profound lymphocyte suppression early after HSCT, whereas immune recovery beyond the second month was comparable between the two groups. Despite anti-infective prophylaxis, most patients experienced post-transplant infectious complications (94%). Patients with in vivo TCD had a higher incidence of CMV reactivations (54% vs 28%, P=0.015), but this did not result in a higher TRM. In conclusion, TCD by graft engineering or alemtuzumab are equally effective for haploidentical HSCT.

Klossiella equi in a donkey--a first case report from Iran

Klossiella equi is the only known and rarely reported coccidian parasite of the renal paranchyma of equids. An aged male donkey (Equus asinus asinus) was submitted to necropsy department of veterinary hospital. In histopathological study of renal sections different developmental stages of parasite were observed. These stages were as follow: Trophozoites, microgametes, macrogametes, sporont, budding sporont, sporoblasts, free sporoblasts, mature sporoblast and sporocyst. Parasitic infection with K. equi was encountered in the donkey. According to literature review this is the first report of donkey klossiellosis in Iran.

Entry Flow of Polyethylene Melts in Tapered Dies

The excess pressure losses due to end effects (mainly entrance) in the capillary flow of several types of polyethylenes were studied both experimentally and numerically under slip and no-slip conditions. These losses were first measured as a function of the contraction angle ranging from 15° to 90°. It was found that the excess pressure loss attains a local minimum at a contraction angle of about 30° for all types of polyethylenes examined. This was found to be independent of the apparent shear rate. This minimum becomes more dominant under slip conditions that were imposed by adding a significant amount of fluoropolymer into the polymer. Numerical simulations using a multimode K-BKZ viscoelastic model have shown that the entrance pressure drops can be predicted fairly well for all cases either under slip or no-slip boundary conditions. The clear experimental minimum at about 30° can only slightly be seen in numerical simulations, and at this point its origin is unknown. Further simulations with a viscous (Cross) model have shown that they severely under-predict the entrance pressure by an order of magnitude for the more elastic melts. Thus, the viscoelastic spectrum together with the extensional viscosity play a significant role in predicting the pressure drop in contraction flows, as no viscous model could. The larger the average relaxation time and the extensional viscosity are, the higher the differences in the predictions between the K-KBZ and Cross models are.

Acute calcineurin inhibitor overdose: analysis of cases reported to a national poison center between 1995 and 2011

Transplant recipients and other patients requiring immunosuppression with calcineurin inhibitors or their household contacts may be exposed to overdose. This study investigated the circumstances, pharmacokinetics and outcomes of overdose with cyclosporine and tacrolimus reported to the Swiss Toxicological Information Centre between 1995 and 2011. Of 145,396 reports by healthcare professionals, 28 (0.02%) concerned enteral or parenteral overdose with these calcineurin inhibitors. Thirteen (46%) were iatrogenic errors, 12 (43%) were with suicidal intent and 3 (11%) were accidental. Iatrogenic overdoses usually involved noncapsule drug formulations. Acute enteral overdoses caused symptoms in a dose-dependent fashion but were generally well tolerated; the mean multiple of patient's usual dose was 20.8 ± 28.8 for symptomatic versus 4.4 ± 3.4 for asymptomatic cases (p = 0.037). The most common symptoms were nausea, headache, somnolence, confusion, hypertension and renal impairment. In contrast, acute intravenous overdoses were often poorly tolerated and resulted in one fatality due to cerebral edema after a cyclosporine overdose. Enteral decontamination measures were performed in six cases involving oral ingestion and appeared to reduce drug absorption, as shown by pharmacokinetic calculations. In the one case where it was used, pharmacoenhancement appeared to accelerate tacrolimus clearance after intravenous overdose.

Sentinel node biopsy in endometrial cancer: systematic review and meta-analysis of the literature

PURPOSE

Sentinel lymph node biopsy is a fairly new approach for staging of gynecological malignancies. In the current study, the authors comprehensively reviewed the available reports on sentinel node biopsy of endometrial cancer.

MATERIALS AND METHODS

The authors searched Medline, SCOPUS, ISI web of knowledge, Science Direct, Springer, OVID SP, and Google Scholar with the following search terms: "endometrium OR endometrial OR uterine OR uterus AND sentinel". The outcomes of interest were detection rate and sensitivity.

RESULTS

Overall, 35 studies had enough information for false negative rate evaluation and 51 studies (including the sub-groups of individual studies) for detection rate evaluation (2,071 patients overall). Pooled detection rate was 77.8% (95% CI: 73.5-81.5%) and pooled sensitivity was 89% (95% CI: 83-93%). Cervical injection, as well as using both blue dye and radiotracer, results in higher detection rate and sensitivity. New techniques such as fluorescent dye injection and robotic-assisted surgery showed high detection rate and sensitivity.

CONCLUSION

Sentinel node mapping is feasible in endometrial cancer. Using both blue dye and radiotracer and cervical injection of the mapping material can optimize the sensitivity and detection rate of this technique. Larger studies are still needed to evaluate the false negative rate and the factors influencing the sensitivity before considering this method safe.

The association of rate pressure product (RPP) and myocardial perfusion imaging (MPI) findings: a preliminary study

Introduction: The product of heart rate and systolic blood pressure, termed as rate-pressure product (RPP), is a very reliable indicator of myocardial oxygen demand and is widely used clinically. There have been previous attempts to describe the relationship between RPP and the onset of pain in angina pectoris. The current study aimed to evaluate the association between RPP results and scan findings.

Materials and methods: In total, 497 patients with suspected coronary artery disease (CAD) underwent gated, single-photon emission computed tomography (SPECT) imaging with dipyridamole, exercise, or dobutamine stress, and were included in this study. Baseline and maximum heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and electrocardiogram (ECG) results were recorded. The rate-pressure product (RPP) was calculated as the product of heart rate and systolic arterial pressure for both baseline and maximum measures. The difference between the RPP max and the basal RPP is known as the RPP reserve. Researchers also obtained semi-quantitative analyses of myocardial perfusion imaging (MPI), using gated software, demographic information, risk factors of CAD, and pretest likelihoods of CAD using nomograms.

Result: Four hundred and ninety-seven cases, including 426 patients with dipyridamole stress, 59 with exercise stress, and 12 with dobutamine stress, underwent myocardial perfusion imaging. Scan results were positive in 194 (45.5%) and negative in 232 (54.5%) patients with dipyridamole stress. In patients with exercise stress, the scan was positive in 24 (40.7%) cases and negative in 35 (59.3%) cases. In dobutamine stressed patients, the scan was positive in 6 (50%) cases and negative in the 6 remaining cases. Dipyridamole stress resulted in a significant difference between HR at rest and at maximum (28.95 ± 24.53, p-value<0.0001), between systolic BP at rest and maximum (6.75 ± 12.50, p-value<0.0001) and between diastolic BP at rest and maximum (1.45 ± 5.80; p-value<0.0001). There was a significant correlation between sum stress scores (SSS) and reserved RPP (r= −0.12, p-value<0.001) which, in dipyridamole patients, was r=−0.18, p-value=0.0001). In addition, there was a significant association between reserved RPP and risk of CAD (p-value<0.001). In the patients with dipyridamole stress, the ejection fraction (EF) change (odds ratio =0.92; 95% CI: 0.86-0.98; p=0.01), reserve RPP (odds ratio =1.00; 95% CI: 1.00-1.00; p=0.04), risk of CAD (odds ratio =5.80; 95% CI: 3.21-10.50; p<0.0001) and age (odds ratio =0.94; 95% CI: 0.89-0.98; p=0.01) were associated significantly with MPI results, using multiple logistic regressions.

Conclusion. The study demonstrated that RPP is associated with MPI findings using gated SPECT imaging with dipyridamole stress. However, to confirm this preliminary result, further studies are mandatory.

Parasites of Some Freshwater Fish from Armand River, Chaharmahal va Bakhtyari Province, Iran

BACKGROUND

The aim of this study was to detect the occurrence of parasites in fish in Armand River, Chaharmahal va Bakhtyari Province regarding the importance of native fish population in the river.

METHODS

The occurrence of parasites was investigated in 6 native fish (Capoeta capoeta, C. damascina, C. aculeta, Barbus barbulus, B. grypus and Glyptothorax silviae) collected from the current main channel of the river from autumn 2009 to summer 2010.

RESULTS

63.7% of the studied fishes were infected with 19 parasite species including Ichthyophthirius multifiliis, Myxobolus musayevi, Dactylogyrus lenkorani, D. gracilis, D. pulcher, D. chramuli, D. akaraicus, D. skrjabiensis, two species of Gyrodactylus, Paradiplozoon sp., Lamproglena compacta, Copepodid of Lernaea cyprinacea, Ergasilus sp., Allocreadium isoporum, Allocreadium pseudaspii, Kawia sp., Bothriocephalus gowkongensis and Rhabdochona denudata. The infection rate was significantly higher (P<0.05) in C.aculeata while the maximum parasite diversity was found in C.damascina. The infection rate was also significantly different in four seasons (P<0.05) but no significant differences were found among fishes with different weight and length.

CONCLUSION

High prevalence of Ichthyophthirius multifiliis and Rhabdochona denudata may affect native fish population. Monogenean parasites Dactylogyrus akaraicus and D. skrjabiensis collected from B. barbulus and C. capoeta are reported for the first time in Iran. B. barbulus is also reported as a new host for aforementioned parasites.