Reprogramming Chromosome Ends by Functional Histone Acetylation

Cancers harness embryonic programs to evade aging and promote survival. Normally, sequences at chromosome ends called telomeres shorten with cell division, serving as a countdown clock to limit cell replication. Therefore, a crucial aspect of cancerous transformation is avoiding replicative aging by activation of telomere repair programs. Mouse embryonic stem cells (mESCs) activate a transient expression of the gene Zscan4, which correlates with chromatin de-condensation and telomere extension. Head and neck squamous cell carcinoma (HNSCC) cancers reactivate ZSCAN4, which in turn regulates the phenotype of cancer stem cells (CSCs). Our study reveals a new role for human ZSCAN4 in facilitating functional histone H3 acetylation at telomere chromatin. Next-generation sequencing indicates ZSCAN4 enrichment at telomere chromatin. These changes correlate with ZSCAN4-induced histone H3 acetylation and telomere elongation, while CRISPR/Cas9 knockout of ZSCAN4 leads to reduced H3 acetylation and telomere shortening. Our study elucidates the intricate involvement of ZSCAN4 and its significant contribution to telomere chromatin remodeling. These findings suggest that ZSCAN4 induction serves as a novel link between 'stemness' and telomere maintenance. Targeting ZSCAN4 may offer new therapeutic approaches to effectively limit or enhance the replicative lifespan of stem cells and cancer cells.

Lipidomics Profiles in Hepatocytes from Nonalcoholic Steatohepatitis Patients Differ Markedly from In Vitro-Induced Steatotic Hepatocytes

Nonalcoholic steatohepatitis (NASH) is a severe form of liver injury that can be caused by a variety of stimuli and has a significant mortality rate. A common technique to induce in vitro steatosis involves culturing primary human hepatocytes (PHH) in fatty acid-enriched media. This study compared the lipidome of PHH cultured in fatty acid-enriched media to hepatocytes from patients with NASH and healthy controls. Hepatocytes from NASH patients displayed increased total cellular abundance of glycerolipids and phospholipids compared to healthy control hepatocytes. PHH cultured in fatty acid-enriched media demonstrated increased glycerolipids. However, these culture conditions did not induce elevated phospholipid levels. Thus, culturing PHH in fatty acid-enriched media has limited capacity to emulate the environment of hepatocytes in NASH patients.

Direct differentiation of tonsillar biopsy-derived stem cells to the neuronal lineage

BACKGROUND

Neurological disorders are considered one of the greatest burdens to global public health and a leading cause of death. Stem cell therapies hold great promise for the cure of neurological disorders, as stem cells can serve as cell replacement, while also secreting factors to enhance endogenous tissue regeneration. Adult human multipotent stem cells (MSCs) reside on blood vessels, and therefore can be found in many tissues throughout the body, including palatine tonsils. Several studies have reported the capacity of MSCs to differentiate into, among other cell types, the neuronal lineage. However, unlike the case with embryonic stem cells, it is unclear whether MSCs can develop into mature neurons.

METHODS

Human tonsillar MSCs (T-MSCs) were isolated from a small, 0.6-g sample, of tonsillar biopsies with high viability and yield as we recently reported. Then, these cells were differentiated by a rapid, multi-stage procedure, into committed, post-mitotic, neuron-like cells using defined conditions.

RESULTS

Here we describe for the first time the derivation and differentiation of tonsillar biopsy-derived MSCs (T-MSCs), by a rapid, multi-step protocol, into post-mitotic, neuron-like cells using defined conditions without genetic manipulation. We characterized our T-MSC-derived neuronal cells and demonstrate their robust differentiation in vitro.

CONCLUSIONS

Our procedure leads to a rapid neuronal lineage commitment and loss of stemness markers, as early as three days following neurogenic differentiation. Our studies identify biopsy-derived T-MSCs as a potential source for generating neuron-like cells which may have potential use for in vitro modeling of neurodegenerative diseases or cell replacement therapies.

Pregnancy-Related Hormones Increase UGT1A1-Mediated Labetalol Metabolism in Human Hepatocytes

Pregnancy-related hormones (PRH) are recognized as important regulators of hepatic cytochrome P450 enzyme expression and function. However, the impact of PRH on the hepatic expression and function of uridine diphosphate glucuronosyltransferases (UGTs) remains unclear. Using primary human hepatocytes, we evaluated the effect of PRH exposure on mRNA levels and protein concentrations of UGT1A1, UGT2B7, and other key UGT enzymes, and on the metabolism of labetalol (a UGT1A1 and UGT2B7 substrate commonly prescribed to treat hypertensive disorders of pregnancy). Sandwich-cultured human hepatocytes (SCHH) from female donors were exposed to the PRH estradiol, estriol, estetrol, progesterone, and cortisol individually or in combination. We quantified protein concentrations of UGT1A1, UGT2B7, and four additional UGT1A isoforms in SCHH membrane fractions and evaluated the metabolism of labetalol to its glucuronide metabolites in SCHH. PRH exposure increased mRNA levels and protein concentrations of UGT1A1 and UGT1A4 in SCHH. PRH exposure also significantly increased labetalol metabolism to its UGT1A1-derived glucuronide metabolite in a concentration-dependent manner, which positively correlated with PRH-induced changes in UGT1A1 protein concentrations. In contrast, PRH did not alter UGT2B7 mRNA levels or protein concentrations in SCHH, and formation of the UGT2B7-derived labetalol glucuronide metabolite was decreased following PRH exposure. Our findings demonstrate that PRH alter expression and function of UGT proteins in an isoform-specific manner and increase UGT1A1-mediated labetalol metabolism in human hepatocytes by inducing UGT1A1 protein concentrations. These results provide mechanistic insight into the increases in labetalol clearance observed in pregnant individuals.

Transradial Access Results in Faster Skin Puncture to Reperfusion Time than Transfemoral Access in Posterior Circulation Mechanical Thrombectomy

BACKGROUND

Successful mechanical embolectomy for acute embolic arterial occlusion in the posterior cerebral circulation can potentially result in less neurologic disability and mortality. The transradial approach can potentially offer more direct navigation into the posterior circulation than the transfemoral approach and can result in faster recanalization time.

OBJECTIVE

To compare procedural metrics and the technical and clinical outcomes of transradial versus transfemoral access for mechanical embolectomy in the posterior cerebral circulation.

MATERIAL AND METHODS

Single-center retrospective review of a prospectively maintained neurointerventional database from a large volume neurointerventional service in a tertiary academic center. Patients presenting with acute disabling symptoms due to embolic occlusion of a large intracranial artery in the posterior that underwent to endovascular treatment in our institution from January 2017 to January 2019 were included in the present study.

RESULTS

Between January 2018 and January 2019 a total of 10 subjects underwent a mechanical embolectomy for acute embolic occlusion on the posterior circulation via transradial access; and between January 2017 and January 2018 a total of 10 subjects underwent a mechanical embolectomy for acute embolic occlusion on the posterior circulation via transfemoral access. Subjects in the transradial access group had a shorter skin puncture to recanalization time compared to the transfemoral group (29.2 ± 17.6 in the transradial group vs. 63.9 ± 56.7 in the transfemoral group respectively).

CONCLUSIONS

This is the first study comparing transradial versus transfemoral access for mechanical embolectomy in patients with acute embolic occlusion in the posterior cerebral circulation. Transradial access resulted in a safe, effective, and faster endovascular route for recanalization in the acute embolic occlusion of the posterior circulation.

ZSCAN4 is negatively regulated by the ubiquitin-proteasome system and the E3 ubiquitin ligase RNF20

Zscan4 is an early embryonic gene cluster expressed in mouse embryonic stem and induced pluripotent stem cells where it plays critical roles in genomic stability, telomere maintenance, and pluripotency. Zscan4 expression is transient, and characterized by infrequent high expression peaks that are quickly down-regulated, suggesting its expression is tightly controlled. However, little is known about the protein degradation pathway responsible for regulating the human ZSCAN4 protein levels. In this study we determine for the first time the ZSCAN4 protein half-life and degradation pathway, including key factors involved in the process, responsible for the regulation of ZSCAN4 stability. We demonstrate lysine 48 specific polyubiquitination and subsequent proteasome dependent degradation of ZSCAN4, which may explain how this key factor is efficiently cleared from the cells. Importantly, our data indicate an interaction between ZSCAN4 and the E3 ubiquitin ligase RNF20. Moreover, our results show that RNF20 depletion by gene knockdown does not affect ZSCAN4 transcription levels, but instead results in increased ZSCAN4 protein levels. Further, RNF20 depletion stabilizes the ZSCAN4 protein half-life, suggesting that RNF20 negatively regulates ZSCAN4 stability. Due to the significant cellular functions of ZSCAN4, our results have important implications in telomere regulation, stem cell biology, and cancer.

Harvesting multipotent progenitor cells from a small sample of tonsillar biopsy for clinical applications

Background

Human adult stem cells hold the potential for the cure of numerous conditions and degenerative diseases. They possess major advantages over pluripotent stem cells as they can be derived from donors at any age, and therefore pose no ethical concerns or risk of teratoma tumor formation in vivo. Furthermore, they have a natural ability to differentiate and secrete factors that promote tissue healing without genetic manipulation. However, at present, clinical applications of adult stem cells are limited by a shortage of a reliable, standardized, and easily accessible tissue source which does not rely on specimens discarded from unrelated surgical procedures.

Method

Human tonsil-derived mesenchymal progenitor cells (MPCs) were isolated from a small sample of tonsillar tissue (average 0.88 cm³). Our novel procedure poses a minimal mechanical and enzymatic insult to the tissue, and therefore leads to high cell viability and yield. We characterized these MPCs and demonstrated robust multipotency in vitro. We further show that these cells can be propagated and maintained in xeno-free conditions.

Results

We have generated tonsillar biopsy-derived MPC (T-MPC) lines from multiple donors across a spectrum of age, sex, and race, and successfully expanded them in culture. We characterized them by cell surface markers, as well as in vitro expansion and differentiation potential. Our procedure provides a robust yield of tonsillar biopsy-derived T-MPCs.

Conclusions

Millions of MPCs can be harvested from a sample smaller than 1 g, which can be collected from a fully awake donor in an outpatient setting without the need for general anesthesia or hospitalization. Our study identifies tonsillar biopsy as an abundant source of adult MPCs for regenerative medicine.

Electronic supplementary material

The online version of this article (doi:10.1186/s13287-017-0619-x) contains supplementary material, which is available to authorized users.

Aromatase Inhibitor-Mediated Downregulation of INrf2 (Keap1) Leads to Increased Nrf2 and Resistance in Breast Cancer

Aromatase inhibitors are effective drugs that reduce or eliminate hormone-sensitive breast cancer. However, despite their efficacy, resistance to these drugs can occur in some patients. The INrf2 (Keap1):Nrf2 complex serves as a sensor of drug/radiation-induced oxidative/electrophilic stress. INrf2 constitutively suppresses Nrf2 by functioning as an adapter protein for the Cul3/Rbx1-mediated ubiquitination/degradation of Nrf2. Upon stress, Nrf2 dissociates from INrf2, is stabilized, translocates to the nucleus, and coordinately induces a battery of cytoprotective gene expression. Current studies investigated the role of Nrf2 in aromatase inhibitor resistance. RT-PCR and immunoblot assays showed that aromatase inhibitor-resistant breast cancer LTLTCa and AnaR cells express lower INrf2 and higher Nrf2 protein levels, as compared with drug-sensitive MCF-7Ca and AC1 cells, respectively. The increase in Nrf2 was due to lower ubiquitination/degradation of Nrf2 in aromatase inhibitor-resistant cells. Higher Nrf2-mediated levels of biotransformation enzymes, drug transporters, and antiapoptotic proteins contributed to reduced efficacy of drugs and aversion to apoptosis that led to drug resistance. shRNA inhibition of Nrf2 in LTLTCa (LTLTCa-Nrf2KD) cells reduced resistance and sensitized cells to aromatase inhibitor exemestane. Interestingly, LTLTCa-Nrf2KD cells also showed reduced levels of aldehyde dehydrogenase, a marker of tumor-initiating cells and significantly decreased mammosphere formation, as compared with LTLTCa-Vector control cells. The results together suggest that persistent aromatase inhibitor treatment downregulated INrf2 leading to higher expression of Nrf2 and Nrf2-regulated cytoprotective proteins that resulted in increased aromatase inhibitor drug resistance. These findings provide a rationale for the development of Nrf2 inhibitors to overcome resistance and increase efficacy of aromatase inhibitors.

Regulation of Nrf2-an update

Nrf2:INrf2 (Keap1) are cellular sensors of oxidative and electrophilic stress. Nrf2 is a nuclear factor that controls the expression and coordinated induction of a battery of genes that encode detoxifying enzymes, drug transporters, antiapoptotic proteins, and proteasomes. In the basal state, Nrf2 is constantly degraded in the cytoplasm by its inhibitor, INrf2. INrf2 functions as an adapter for Cul3/Rbx1 E3 ubiquitin ligase-mediated degradation of Nrf2. Chemicals, including antioxidants, tocopherols including α-tocopherol (vitamin E), and phytochemicals, and radiation antagonize the Nrf2:INrf2 interaction and lead to the stabilization and activation of Nrf2. The signaling events involve preinduction, induction, and postinduction responses that tightly control Nrf2 activation and repression back to the basal state. Oxidative/electrophilic signals activate unknown tyrosine kinases in a preinduction response that phosphorylates specific residues on Nrf2 negative regulators, INrf2, Fyn, and Bach1, leading to their nuclear export, ubiquitination, and degradation. This prepares nuclei for unhindered import of Nrf2. Oxidative/electrophilic modification of INrf2 cysteine 151 followed by PKC phosphorylation of Nrf2 serine 40 in the induction response results in the escape or release of Nrf2 from INrf2. Nrf2 is thus stabilized and translocates to the nucleus, resulting in a coordinated activation of gene expression. This is followed by a postinduction response that controls the "switching off" of Nrf2-activated gene expression. GSK3β, under the control of AKT and PI3K, phosphorylates Fyn, leading to Fyn nuclear localization. Fyn phosphorylates Nrf2 Y568, resulting in nuclear export and degradation of Nrf2. The activation and repression of Nrf2 provide protection against oxidative/electrophilic stress and associated diseases, including cancer. However, deregulation of INrf2 and Nrf2 due to mutations may lead to nuclear accumulation of Nrf2 that reduces apoptosis and promotes oncogenesis and drug resistance.

Basic sciences: an alternative career?

Career selection is a crucial and a complex process which is also true for the medical profession. In the context of our country, due to the limited opportunity and proper guidance, migration of medical graduates to foreign countries is increasing. Though, clinical subjects have a huge attraction, basic science field has failed to impress our medical graduates. In current scenario, basic science field seems to be a dumping site for the incompetent as the candidates who have failed trying their luck elsewhere stumble upon basic science careers though it is not true for all. Moreover, a very few medical graduates are interested in developing their career as a basic scientist. Therefore, to motivate today's young medical graduates, there is a need of a good mentor along with a proper career guidance which can help them to understand the basic science field as an alternative career.

Lambda Light Chain Myeloma with Oliguric Cast Nephropathy and Remission with Bortezomib, Doxorubicin and Dexamethasone

Cast nephropathy is one of the major causes of renal failure in patients with multiple myeloma resulting from precipitation of free light chains inside the tubules. Timely diagnosis and treatment confers a better prognosis though around 10% of patients with cast nephropathy remain dialysis dependent in spite of treatment.We report the clinical course and outcome of a patient presenting with acute kidney injury and oliguria, preceded by acute gastroenteritis and intake of Chinese medications and dialysis dependent state for eight weeks. Kidney biopsy revealed cast nephropathy with lambda light chain restriction and severe tubular injury. Serum protein electrophoresis was normal with no “M spike” but serum free light chain ratio was altered with very high lambda and normal kappa light chain levels. Bone marrow biopsy showed >85% atypical plasma cells. Haemodialysis was continued and chemotherapy with bortezomib, doxorubicin and dexamethasone was started. Kidney function gradually improved with discontinuation of dialysis after 1 month and complete remission of acute kidney injury and myeloma in 4 months of chemotherapy.   Keywords: acute kidney injury; bortezomib; cast nephropathy; multiple myeloma.

Study of Auditory function in Rheumatoid Arthritis

Rheumatoid Arthritis may affect the auditory function and is a subject of debate. The exact etiopathogenesis is not known. However there is evidence of rt of synovial joints of ossicles. Rheumatoid Arthritis may involve the Aoditory system by producing conductive hearing loss, abnormal otoadmittance and sensorineural hearing loss. Patients with pre-existing ear disease were not included in the study. In the present study, effcet of Rheumatoid Arthritis on auditory function is observed. The Study was carried out on 25 patients of classical or definite Rheumatoid Arthritis and 16 controls at M.Y. Hospital, Indore.

Management of tracheocutaneous fistula

We describe a simple technique that utilises local skin flaps of closure of a large tracheocutaneous-fistula with a adequate support to the tracheal wall by double breasting of local flaps, thus avoiding the post-operative respiratory problems that can occur due to a single flap projecting into the tracheal lumen during inspiration.This technique avoids the complications associated with primary closure of fistulae & also the morbidity of waiting for secondary closure to occur. It also precludes the need for a more extensive operation in the form of muscle flap rotation. The fistulous tract does not need to be excised but forms a component of the repair.

Lambda light chain myeloma with oliguric cast nephropathy and remission with bortezomib, doxorubicin and dexamethasone

Cast nephropathy is one of the major causes of renal failure in patients with multiple myeloma resulting from precipitation of free light chains inside the tubules. Timely diagnosis and treatment confers a better prognosis though around 10% of patients with cast nephropathy remain dialysis dependent in spite of treatment. We report the clinical course and outcome of a patient presenting with acute kidney injury and oliguria, preceded by acute gastroenteritis and intake of Chinese medications and dialysis dependent state for eight weeks. Kidney biopsy revealed cast nephropathy with lambda light chain restriction and severe tubular injury. Serum protein electrophoresis was normal with no "M spike" but serum free light chain ratio was altered with very high lambda and normal kappa light chain levels. Bone marrow biopsy showed >85% atypical plasma cells. Haemodialysis was continued and chemotherapy with bortezomib, doxorubicin and dexamethasone was started. Kidney function gradually improved with discontinuation of dialysis after 1 month and complete remission of acute kidney injury and myeloma in 4 months of chemotherapy.

Microcatheter to recanalization (procedure time) predicts outcomes in endovascular treatment in patients with acute ischemic stroke: when do we stop?

BACKGROUND AND PURPOSE

Endovascular treatment for acute ischemic stroke consists of various mechanical and pharmacologic modalities used for recanalization of arterial occlusions. We performed this study to determine the relationship among procedure time, recanalization, and clinical outcomes in patients with acute ischemic stroke undergoing endovascular treatment.

MATERIALS AND METHODS

We analyzed data from consecutive patients with acute ischemic stroke who underwent endovascular treatment during a 6-year period. Demographic characteristics, NIHSS score before and 24 hours after the procedure, and discharge mRS score were ascertained. Procedure time was defined by the time interval between microcatheter placement and recanalization or completion of the procedure. We estimated the procedure time after which favorable clinical outcome was unlikely, even after adjustment for age, time from symptom onset, and admission NIHSS scores.

RESULTS

We analyzed 209 patients undergoing endovascular treatment (mean age, 65 ± 16 years; 109 [52%] men; mean admission/preprocedural NIHSS score, 15.3 ± 6.8). Complete or partial recanalization was observed in 176 (84.2%) patients, while unfavorable outcome (mRS 3-6) was observed in 138 (66%) patients at discharge. In univariate analysis, patients with procedure time ≤30 minutes had lower rates of unfavorable outcome at discharge compared with patients with procedure time ≥30 minutes (52.3% versus 72.2%, P = .0049). In our analysis, the rates of favorable outcomes in endovascularly treated patients after 60 minutes were lower than rates observed with placebo treatment in the Prourokinase for Acute Ischemic Stroke Trial. In logistic regression analysis, unfavorable outcome was positively associated with age (P = .0012), admission NIHSS strata (P = .0017), and longer procedure times (P = .0379).

CONCLUSIONS

Procedure time in patients with acute ischemic stroke appears to be a critical determinant of outcomes following endovascular treatment. This highlights the need for procedure time guidelines for patients being considered for endovascular treatment in acute ischemic stroke.

Clinicopathological Analysis of Ovarian Tumours at Birendra Military Hospital

Introduction: Ovarian cancer is the second most common genital tract malignancy accounting for 25% gynaecological malignancy. This study was conducted to determine the incidence, epidemiological factors and clinical presentation of different types of ovarian tumours their correlation with histopathology. Methods: This is a descriptive study conducted in Birendra Military Hospital over a period of 2 years. The case records of all the patients with ovarian tumur was analyzed. Results: Of the total of 135 adnexal masses cases 100 (74.07%) were found to be histologically proven ovarian tumour out of which 35 were non neoplastic conditions. Benign tumours comprised of 68 (68%) and 32 (32%) were malignant and borderline.Mature cystic teratoma 28 (75%) was the commonest benign tumour, whereas serous cystadenocarcinoma 13 (64.3%) were commonest malignancy. Age varying from 2.5 yrs. To 70 yrs. Smallest tumour size was 2.5 cm. largest was 40 cm. Commonest symptom was abdominal discomfort and most common sign was abdominal lump. Malignancy usually presented with ascites especially epithelial ovarian tumours. Germ cell tumour was observed in younger age group in earlier stage. Conclusion: The commonest ovarian tumor was epithelial followed by germcell. Mature cystic teratoma was the most common benign tumour and malignant was serous cyst adenocarcinoma. Epithelial ovarian tumour prevalent in perimenopausal and postmenopausal age group whereas germ cell in earlier age. DOI: http://dx.doi.org/10.3126/mjsbh.v10i1.6446 Medical Journal of Shree Birendra Hospital Jan-June 2011 10(1) 26-31

Prevalence of HIV/AIDS in Nepal Army and its Dependants

Introduction: The Asia Pacific Region is currently at the “tip of iceberg” phase of the HIV/AIDS epidemic after African countries causing irreparable economic damage and undermining national and regional security if left unattended. HIV/AIDS remains a serious national concern and potential for epidemic relapse is high1. Continued vigilance is important. Study of the Prevalence of HIV/AIDS in Nepal Army (NA) and its dependants is based on the data collected from various sources to highlight the importance of ongoing measures plus the need of effective programs against HIV/AIDS control. Methods: This is a descriptive study and data are derived from February 1996 to March 2011 from the different sources. National Guideline for testing of HIV in Nepal, developed in 2003 was used for the diagnosis of the cases by blood tests in Birendra Hospital, Chhauni. Results: Total of 116 cases was diagnosed HIV positive. Maximum number of HIV positive cases was diagnosed in the year 2010 as compared to other years since 1996 and for the year 2011 till the month of March. The positive cases diagnosed from army personnel in UN Mission and blood donation programs accounted for 0.02% and 0.09% respectively. And from the surgical patients in the army hospital, 0.18% cases were diagnosed positive. From the year 2006 to 2010, 0.38% cases were diagnosed as positive among the voluntary counselling and testing (VCT) volunteers. Conclusion: HIV is a threat to the army, behaviour change and prevention is the key and it needs to be adapted to the best. Intensive training, massive awareness programs and behavioural issues start at the recruit level and need to be reinforced prior and during deployment with regular monitoring of the soldiers activities. DOI: http://dx.doi.org/10.3126/mjsbh.v10i1.6445 Medical Journal of Shree Birendra Hospital Jan-June 2011 10(1) 20-25

Triiodothyronin, thyroxine and thyrotropin in vitiligo

BACKGROUND

Vitiligo is a common pigmentary disorder of the skin, affecting individuals globally. Not only is this ailment psychologically incapacitating, it also has a high incidence of autoimmunity, signifying that its manifestations may be the portrayal of dysfunction of immune system.

OBJECTIVE

The aim of this study is to find out the situations of abnormal thyroid function test (TFT) in vitiligo patients.

METHODS

A prospective cross sectional study was conducted at the Dhulikhel Hospital, KUTH, Dhulikhel during November 2008 to January 2011 with the objective to assess the thyroid function tests in vitiligo patients.

RESULTS

Total 66 vitiligo patients with male 30 (45%) and female 36 (55%). Total 26 (39.39%) vitiligo patients have been found to have abnormal thyroid function test. Among them 10 had abnormal T3, seven had abnormal T4 and 12 had abnormal TSH level. Thyroid function test were normal in other vitiligo patients. Total seven vitiligo had high level of T3 than normal value, four male and three female. Two had higher level of T4 above 2.0 ng/dl and all were male, while five had abnormally low level of T4 with three male and two female. There were seven vitiligo patient with increased T3 level and three with decreased T3 level, among them six were males and four were females, the age group was ranged from seven to 68 years old. The T4 level were found abnormal in seven vitiligo patients among which five were males and two were females with the age group ranging from 7 to 51 years.

CONCLUSIONS

There has been significant association of thyroid disorder in the patient with vitiligo. Therefore, patient with vitiligo need to undergo thyroid function test to rule out the thyroid disorder and prevent from long-term complications.

Requirements for emergent neurosurgical procedures among patients undergoing neuroendovascular procedures in contemporary practice

BACKGROUND AND PURPOSE

Provisions for an emergent neurosurgical procedure have been a mandatory component of centers that perform neuroendovascular procedures. We sought to determine the need for emergent neurosurgical procedures following neuroendovascular interventions in 2 comprehensive stroke centers in settings with such provisions.

MATERIALS AND METHODS

Analysis of retrospectively collected data from procedure logs and patient charts was performed to identify patients who required immediate (before the termination of the intervention) or adjunctive (within 24 hours of the intervention) neurosurgical procedures related to a neuroendovascular intervention complication. The types of neurosurgical procedures and in-hospital outcomes of identified patients are reported as an aggregate and per endovascular procedure-type analyses.

RESULTS

We reviewed a total of 933 neuroendovascular procedures performed during 3.5 years (2006-2010). A total of 759 intracranial procedures were performed. There was a need for emergent neurosurgical procedures in 8 patients (0.85% cumulative incidence and 1.05% for major intracranial procedures) (mean age, 46 years; 7 were women); the procedures were categorized as 3 immediate and 5 adjunctive procedures. There were 5 in-hospital deaths (62.5%) among these 8 patients. Neurosurgical procedures performed were external ventricular drainage placement in 6 (6 of 8, 75%) patients, decompressive craniectomy in 1 (12.5%) patient, and both surgical procedures in 1 (12.5%) patient.

CONCLUSIONS

The need for emergent neurosurgical procedures is very low among patients undergoing intracranial neuroendovascular procedures. Survival in such patients despite emergent neurosurgical procedures is quite low.

Knowledge, behavior and attitude towards sexually transmitted infections and acquired immunodeficiency syndrome of adolescent students

BACKGROUND

Adolescence is a period of great physical, mental and emotional turmoil within teenagers. The objective of the study was to assess the knowledge of, attitude to and behaviour towards STI and AIDS among adolescence.

METHODS

Four randomly selected higher secondary school from students of class XI and XII were included after taking their verbal consent. A pre-designed and pre-tested questionnaire was given to all the participants of the school. In order to get correct answers, specific questions were explained to the students with the help of their class teachers.

RESULTS

The results were encouraging with the majority (94.16%) have heard about STIs and HIV/AIDS. Teachers (100%), Newspaper/magazine (90%) and Television (78.33%) were the main informational source about disease. Respondents correctly identified that unsafe sexual contact (86.66%) as major mode of transmission of AIDS and more than 90% of students regarded the use of condoms as the true preventive method for the disease. Among those respondents 6% were sexually active and their partners were either sex worker (71%) or friends (29%).

CONCLUSIONS

The student's attitude towards disease was positive and most of the adolescent wished inclusion of sex education in their text book from secondary level school's curriculum.

Allergic fungal rhinosinusitis in chronic rhinosinusitis

BACKGROUND

Rhinosinusitis is the inflammation of nasal and paranasal sinus mucosa and is associated with mucosal alteration ranging from inflammatory thickening or gross nasal polyp formation.The main objective of this study is to determine the prevalence of allergic fungal rhino sinusitis among the patients having chronic rhino sinusitis with or without polyps who under goes functional endoscopic sinus surgery.

METHODS

The patient with chronic rhinosinusitis with or without polyp who FESS were studied. Surgical specimens were sent for mycology and histopathological analysis for identification of fungus.

RESULTS

Headache 41(82%) and nasal block 45(90%) were the commonest clinical presentation. Out of 50 patients, fungal elements were detected by KOH in 8(16%) of cases and histopathological examination in 11(22%) of cases.

CONCLUSIONS

Allergic Fungal Rhinosinusitisis a common disorder in patients with chronic rhinosinusitis, it need different specific tests for the diagnosis, a more specific diagnostic tests are fungus culture, and IgE to fungal antigen and skin test are needed for definite diagnosis.

Histomorphological spetrum of breast lesions

BACKGROUND

Cancer of the breast is the second most common cause of cancer in women. Mass in the breast, whether benign or malignant is a cause of anxiety to the patients and the family members. All breast lumps are considered to be carcinomas until proved otherwise and are the causes of concern both for the patient and surgeon.

METHODS

This is a retrospective study conducted in Kathmandu Model Hospital for a total duration of three years from August 2007 to August 2010.

RESULTS

114 sample of breast tissue sent for histopathology were studied. Peak incidence of benign lesion was in between 21-30 years and malignant lesions in between 31-50 years. No breast lesions were seen in the first decade of life. Cancer of the breast was seen in 12.28% of cases. Fibroadenoma and fibrocystic disease were the commonest benign lesion and infiltrating ductal carcinoma was the commonest malignant lesion. Specimens from 10 male breasts were received. Gynaecomastia was the most common lesion encountered in males. Infiltrating ductal carcinoma was seen in a 70 year old male.

CONCLUSIONS

Breast cancer is one of the commonest causes of breast lump particularly in women and is growing public health problem in Nepal.

Abstract 4131: Activation of PKC-delta inhibits apoptosis leading to mitomycin C resistance

Antioxidant-induced protein kinase C delta (PKCdelta) is known to phosphorylate cell survival transcription factor Nrf2. Phosphorylated Nrf2 translocates to the nucleus leading to coordinated activation of detoxifying enzyme gene expression. This mechanism is critical for protection against chemical and radiation stress and cell survival. Human breast cancer MCF-7 cells expressing endogenous PKCdelta, human breast cancer BT549 cells deficient in PKCdelta expression (PKCdelta-null) and BT549-C1 cells expressing cDNA derived PKCdelta demonstrated differential survival and apoptotic death responses to anti-tumor drug mitomycin C. MCF-7 and BT549-C1 cells expressing PKCdelta showed increased survival and decreased apoptotic cell death as compared with PKCdelta-null BT549 cells. The studies also demonstrated that mitomycin C induced serine40 phosphorylation and nuclear translocation of Nrf2. Further studies determined that Nrf2 translocation in the nucleus led to an increase in Bcl2 and BclXL expression that contributed to the inhibition of apoptosis, increased cell survival and mitomycin C resistance. Interestingly, inclusion of antioxidant tert-butyl hydroquinone with mitomycin C further enhanced the PKCdelta effect on cell survival and apoptotic cell death. These results led to the conclusion that PKCdelta is endogenous factor in drug resistance and could serve as a therapeutic target.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 4131.

A simple new technique of performing myomectomy for a predominantly subserosal myoma quickly within few minutes

Removing a degenerated myoma located around the uterine cornu by an innovative technique shelling the myoma a little away from the base by choice of a low placed incision, advantageous in terms of no requirement of blood transfusion because of the reduction in the surgical time is described in a 24 years old lady demanding a fertility conserving surgery.

Human Immune Deficiency Virus-1: Diagnosis and Treatment in Adults and Adolescents

Human Immune Deficiency Virus-1: Diagnosis and Treatment in Adults and Adolescents

Chorioangioma of Placenta

We report a case of Chrioangima of placenta resulting to hydropsfetalis. A 24 yrs old primigravida with polyhydramnios and large placental chorioangioma at 24 wks of gestation expelled a nonimmune hydropic male baby weighing 900gms. The baby expired after 5 minutes of expulsion. Keywords: Placental chorioangioma; Hydropsfetalis; Polyhydraamnios DOI: http://dx.doi.org/10.3126/mjsbh.v9i2.5026 Medical Journal of Shree Birendra Hospital Vol.9(2) 2010: 44-46