A rare diagnosis of Langerhans cell histiocytosis made on thyroid histology with coexisting papillary thyroid cancer and AVP deficiency

Summary

A 48-year-old Asian male, presented to the hospital for an elective total thyroidectomy in the context of 6.3 cm thyroid nodule. The fine needle aspiration cytology of the nodule confirmed papillary thyroid cancer (PTC) with some atypical histiocytes. He has a history of idiopathic arginine vasopressin deficiency (AVP-D) and has been taking oral DDAVP 100 µg daily, self-adjusting the dose based on thirst and polyuria. Additionally, he also has a history of recurrent spontaneous pneumothorax. His total thyroidectomy was aborted due to significant intraoperative bleeding, and his admission was further complicated by post-operative hyponatraemic seizure. Thyroid histology revealed the diagnosis of Langerhans cell histiocytosis (LCH), and further investigation with contrast CT demonstrated multi-organ involvement of the thyroid, lungs, and bones.

Learning points

Langerhans cell histiocytosis (LCH) is a condition that can affect one or more organ systems, including the pituitary, where it can present as AVP deficiency. Strict monitoring of fluid balance, as well as serial monitoring of serum sodium, is essential in all patients with AVP-D in the perioperative setting. Iatrogenic hyponatraemic seizure is an uncommon but serious complication of DDAVP treatment in hospitalised patients with AVP-D. DDAVP dosing must be carefully monitored. LCH with multisystem involvement is an important mimic for metastatic conditions, and histological diagnosis is essential to guide treatment and prognosis. Although LCH without bone marrow involvement is unlikely to increase the risk of bleeding, its effect on tissue integrity may make surgery more challenging. BRAF-V600E mutation is an important driver mutation and a potential therapeutic target in the treatment of LCH.

Codesigning enhanced models of care for Northern Australian Aboriginal and Torres Strait Islander youth with type 2 diabetes: study protocol

INTRODUCTION

Premature onset of type 2 diabetes and excess mortality are critical issues internationally, particularly in Indigenous populations. There is an urgent need for developmentally appropriate and culturally safe models of care. We describe the methods for the codesign, implementation and evaluation of enhanced models of care with Aboriginal and Torres Strait Islander youth living with type 2 diabetes across Northern Australia.

METHODS AND ANALYSIS

Our mixed-methods approach is informed by the principles of codesign. Across eight sites in four regions, the project brings together the lived experience of Aboriginal and Torres Strait Islander young people (aged 10-25) with type 2 diabetes, their families and communities, and health professionals providing diabetes care through a structured yet flexible codesign process. Participants will help identify and collaborate in the development of a range of multifaceted improvements to current models of care. These may include addressing needs identified in our formative work such as the development of screening and management guidelines, referral pathways, peer support networks, diabetes information resources and training for health professionals in youth type 2 diabetes management. The codesign process will adopt a range of methods including qualitative interviews, focus group discussions, art-based methods and healthcare systems assessments. A developmental evaluation approach will be used to create and refine the components and principles of enhanced models of care. We anticipate that this codesign study will produce new theoretical insights and practice frameworks, resources and approaches for age-appropriate, culturally safe models of care.

ETHICS AND DISSEMINATION

The study design was developed in collaboration with Aboriginal and Torres Strait Islander and non-Indigenous researchers, health professionals and health service managers and has received ethical approval across all sites. A range of outputs will be produced to disseminate findings to participants, other stakeholders and the scholarly community using creative and traditional formats.

Temperature dependent structural properties of Mn1.90M0.10O3(M = Cr and Fe)

The polycrystalline samples of Mn1.90Cr0.10O3(MCO) and Mn1.90Fe0.10O3(MFO) have been investigated for their temperature dependent magnetic and structural properties. The Cr and Fe substitutions have significant effect on the magnetic and structural properties of Mn2O3. Like pristine Mn2O3, the Cr and Fe substituted samples MCO and MFO also exhibit two antiferromagnetic transitions; one at ∼77 K, ∼80 K, respectively and another at ∼40 K. Our room temperature synchrotron x-ray powder diffraction (SXRD) results confirm that both the MCO and MFO samples crystallize in cubic symmetry. The temperature dependent SXRD results demonstrate the cubic to orthorhombic structural transition for the studied samples. The pristine Mn2O3shows cubic to orthorhombic transition around 310 K, whereas this structural transition shifted towards lower temperature side with these substitutions i.e. around 240 K for MCO and 260 K for MFO. Interestingly, the centrosymmetricPcabto non-centrosymmetricPca21change in symmetry is also resolved at the ferroelectric ordering temperature for MCO.

Comparative study of the short-range structure of α-V2O5, α-TeO2 and xV2O5-(100 - x)TeO2 glasses using X-ray diffraction, Rietveld analysis and reverse Monte Carlo simulations

Vanadium-tellurite glasses, tetragonal TeO₂ and orthorhombic V₂O₅ crystalline samples were characterized for their atomic structure properties by synchrotron X-ray diffraction, pair distribution function analysis, reverse Monte Carlo simulations (RMC) and Rietveld analysis. The pair correlation function, G(r), of V₂O₅ shows the first peak at 1.61 Å. G(r) of TeO₂ shows three peaks at 1.57, 2.13 and 2.88 Å due to Te-O linkages of three different lengths, whereas the Te-Te atomic pair correlation shows a peak at 3.85 Å. The average coordination number of V with O in crystalline V₂O₅ is 4.39 while that of Te with O in crystalline TeO₂ is 3.71. G(r) of the vanadium tellurite glass shows the first peak at 1.90 Å due to overlapping Te-O and V-O atomic pair correlations. The RMC analysis on diffraction data of glasses found that the V-O coordination number is in the range 5.27-5.59 and the Te-O coordination number is 5.39-5.67. However, it is found that these coordination numbers cannot be clearly defined due to short-range disorder.

Perceived stigma among diabetic patients and their caregivers: a review

AIMS

Considerable number of studies in the existing literature indicate the existence of stigma related to many diseases, disabilities, and disorders, but less attention has been given to diabetes-related stigma. This narrative review of literature aims to explore the existence of stigma surrounding type 1 diabetes mellitus (T1DM).

METHODS

Literature were searched using search engines, Google Scholar, PubMed, and Scopus electronic databases published from year 2000 to 2020. Both qualitative and quantitative studies focusing on the stigma associated with T1DM were included. A total of 21 articles met the inclusion criteria. Thematic analysis of collected research material was done.

RESULTS

Results provided substantial evidence that stigma associated with T1DM was experienced by T1DM patients and their caregivers at some point in their lives and it had affected their lives in different domains such as difficulty finding a spouse, discrimination at employment opportunities, educational institutions, management of disease, being misjudged as a druggie, poor quality of life of the patient and caregiver, depressive symptoms among parents of patients, constant worrying of their child's disease management, and so on.

CONCLUSION

Stigma related to T1DM is experienced by individuals suffering from it, and it is widespread. It not only affects the sufferers but their loved ones also. To reduce and cope-up with stigma, there is a need to increase public education and awareness at a mass level. Further research and awareness will serve to build our understanding of the experience of diabetes-related stigma.

Angiomatoid Fibrous Histiocytoma with EWSR1 Rearrangement in an Unusual Location

Introduction/Objective

Angiomatoid fibrous histiocytoma (AFH) is a rare mesenchymal neoplasm most often arising in the superficial extremities of children and young adults. AFH can mimic clinical, histologic, and radiologic presentation of several different tumors, therefore diagnosis can be quite challenging.

Methods/Case Report

We report the case of a 32-year-old woman with no significant medical history who presented with three days of right upper quadrant pain. Radiologic studies showed a 2.3 centimeter right lower lobe soft tissue nodule abutting the right lower lobe bronchus.

Results (if a Case Study enter NA)

Subsequent lobectomy with mediastinal lymph node dissection was performed. Histopathologic examination of the right middle and lower lobes revealed a fibrohistiocytic appearing neoplasm with bland nuclear features and brisk associated lymphoplasmacytic and histiocytic infiltrate. Given the suspicion for AFH, fluorescent in situ hybridization for EWSR1 and FUS were performed at an outside facility with detection of EWSR1 gene rearrangement supporting the diagnosis of AFH.

Conclusion

AFH is a rare soft tissue neoplasm that is often indolent but intermediate in potential given the rare possibility of metastasis. While most common in superficial extremities, increasing unusual anatomic sites are being reported. Histologically, the tumor can show a spectrum of morphologic patterns including nodules to sheets of often monomorphic bland, spindle or ovoid cells in an inflammatory background and with associated fibrous pseudocapsule. Three characteristic chromosomal translocations have been identified: EWSR1-CREB1, EWSR1-ATF1 and FUS- ATF1. Treatment is wide surgical excision or radiotherapy if unresectable. The differential diagnosis can be broad with a spectrum from reactive, benign lesions to malignant neoplasms, including a variety of sarcomas.

Structural correlations in the enhancement of ferroelectric property of Sr doped BaTiO3

The effect of Sr doping in BaTiO3(BTO) with nominal compositions Ba0.80Sr0.20TiO3(BSTO) have been explored on its structural, lattice vibration, dielectric, ferroelectric and electrocaloric properties. The temperature dependent dielectric results elucidate the enhancement in dielectric constant and exhibit three frequency independent transitions around 335, 250 and 185 K, which are related to different structural transitions. All these transitions occur at lower temperature as compared with pristine BTO, however; remnant electric polarization (Pr) of BSTO is much higher than in BTO. The value ofPris ∼5μC cm-2at room temperature and the maximumPr∼ 8μC cm-2is observed at tetragonal to orthorhombic and orthorhombic to rhombohedral transitions. The electro-caloric effect shows the maximum adiabatic change in temperature ΔT∼ 0.24 K at cubic to tetragonal transition. The temperature dependent synchrotron x-ray diffraction and Raman results show correlations betweenPr, crystal structure and lattice vibrations. Our results demonstrate the enhancement in ferroelectric properties of BTO with Sr doping. The origin of the enhancement in ferroelectric property is also discussed in correlations with the appearance of superlattice peak around room temperature due to TiO6octahedral distortion. These enhanced properties would be useful to design lead free high quality ferroelectric and piezoelectric materials.

Direct hybridization gap from intersite and onsite electronic interactions in CeAg2Ge2

Electronic and crystal structure studies are presented to describe the role of intersite and onsite interactions for antiferromagnetic ordering in CeAg2Ge2. The crystal structure showed a prominent magnetovolume effect with anomalous negative thermal expansion at low temperature as a consequence of itinerant electron magnetism. The direct hybridization gap with a V-shaped band observed in the angle resolved photoemission data at room temperature, indicates that spin polarized quasiparticle states exist in the gapped region. Valence band broadening and enhanced localization effects at low temperature indicate strong hybridization of the valence orbitals of Ce atoms with the near neighbor Ge atoms. We find that the intersite interaction between the Ce atoms at high temperature stabilizes the onsite interaction at low temperature that leads to the spin density wave type antiferromagnetism in CeAg2Ge2.

Combined pathologic-genomic algorithm for early-stage breast cancer improves cost-effective use of the 21-gene recurrence score assay

Background

The 21-gene recurrence score (RS) (Oncotype DX®; Genomic Health, Redwood City, CA) partitions hormone receptor positive, node negative breast cancers into three risk groups for recurrence. The Anne Arundel Medical Center (AAMC) model has previously been shown to accurately predict RS risk categories using standard pathology data. A pathologic-genomic (P-G) algorithm then is presented using the AAMC model and reserving the RS assay only for AAMC intermediate-risk patients.

Patients and methods

A survival analysis was done using a prospectively collected institutional database of newly diagnosed invasive breast cancers that underwent RS assay testing from February 2005 to May 2015. Patients were assigned to risk categories based on the AAMC model. Using Kaplan-Meier methods, 5-year distant recurrence rates (DRR) were evaluated within each risk group and compared between AAMC and RS-defined risk groups. Five-year DRR were calculated for the P-G algorithm and compared with DRR for RS risk groups and the AAMC model's risk groups.

Results

A total of 1268 cases were included. Five-year DRR were similar between the AAMC low-risk group (2.7%, n = 322) and the RS < 18 low-risk group (3.4%, n = 703), as well as between the AAMC high-risk group (22.8%, n = 230) and the RS > 30 high-risk group (23.0%, n = 141). Using the P-G algorithm, more patients were categorized as either low or high risk and the distant metastasis rate was 3.3% for the low-risk group (n = 739) and 24.2% for the high-risk group (n = 272). Using the P-G algorithm, 44% (552/1268) of patients would have avoided RS testing.

Conclusions

AAMC model is capable of predicting 5-year recurrences in high- and low-risk groups similar to RS. Further, using the P-G algorithm, reserving RS for AAMC intermediate cases, results in larger low- and high-risk groups with similar prognostic accuracy. Thus, the P-G algorithm reliably identifies a significant portion of patients unlikely to benefit from RS assay and with improved ability to categorize risk.

Application of XANES in gamma dosimetry

The thermoluminescence material, CaSO₄:Dy, is widely used for the dosimetry of ionizing radiation due to its high sensitivity, low fading and wide dose range from μGy to few tens of gray. However, its application is limited at high doses due to non-linear and saturation effects. In this paper, X-ray Absorption Near Edge Structure (XANES) studies at the Dy L₃-edge have been carried out on CaSO₄:Dy discs exposed to gamma doses in the range 0-1000 Gy. The results show an increase in white line in XANES spectra with gamma dose. Structural change in CaSO₄:Dy also has been studied using X-Ray Diffraction (XRD) and has found no structural change up to 1000 Gy. The study indicates that XANES can be used as an alternative dosimetry technique and is useful in the evaluation of absorbed dose in the case of accidental exposure to high radiation in a radiation facility or during a radiological accident.

Experimental setup to measure thermal waves generated by X-ray absorption using pyroelectric sensor

Pyroelectric detectors are widely used for infrared radiation detection, whereas these can also be used in the X-ray region. They have multiple advantages when used at synchrotron radiation sources, such as (a) can be used with a white beam (high flux), (b) have a flat spectral response, and (c) can be used both as a detector and as a sample. However, when used in the hard X-ray region, absorption in the detector plays an important role depending upon the thickness of the detector. Hence, the estimation of the responsivity of the detector is important. In this paper, we report an improved experimental setup for the measurement of a pyroelectric signal in the hard X-ray region. The responsivity (V/W) of a pyroelectric detector for absorbed radiation in the hard x-ray region is measured. Measurements of the K-edge x-ray absorption fine structure of 10-μm copper and nickel foils are carried out using a LiTaO₃ pyroelectric detector and compared with the measurements carried out using an ionization chamber as a sensor for the same foils. Absorption spectra near the Ta L_III and L_II edges in LiTaO₃, measured using a LiTaO₃ crystal both as a sample and as a sensor, are also reported in this paper.

Free radical scavenging potential of sericin obtained from various ecoraces of tasar cocoons and its cosmeceuticals implication

Tropical tasar silkworm Antheraea mylitta is a wild sericigenous insect which is distributed in different geographical regions and named as different ecoraces. In the present study, we investigated the molecular characterisation and cosmeceutical properties of sericin extracted from different ecoraces of tasar cocoons. The surface morphology and molecular weight of cocoons were determined by scanning electron microscope (SEM) and SDS-PAGE, respectively. Characterisation of sericin was performed by various methods such as FTIR, CHNS, TGA and amino acid analyzer. The anti-tyrosinase, anti-elastase, glutathione-S-transferase inhibition, free radical scavenging potential and inhibition of oxidative damages were measured in tasar ecoraces sericin. SEM images have revealed the removal of sericin from the surface of cocoons. SDS-PAGE of sericin depicted the presence of diverse molecular weight of proteins. Structural determination by FTIR revealed the presence of both α-helical and β-sheet structures. Thermal properties of sericin were studied by TGA which showed a 50% weight loss at temperature 410 °C-430 °C. Additionally, ecoraces sericin contains 17 amino acids in which serine, aspartic acid and glycine are predominantly present (55.68-59.61%). Further, anti-tyrosinase, anti-elastase, inhibition of glutathione-S-transferase activity, free radical scavenging potential and inhibition of lipid peroxidation were also observed in ecoraces sericin. Our findings suggest that the present study appear to be helpful in exploiting sericin as potential biomaterial in cosmeceutical and allied field.

Tasar silk fiber waste sericin: New source for anti-elastase, anti-tyrosinase and anti-oxidant compounds

The present study investigates the properties of sericin extracted from tasar silk fiber waste (TSFW). The surface morphology of TSFW was observed by scanning electron microscope (SEM). SEM images revealed the removal of residual sericin over the surface of TSFW. The molecular weight distribution of sericin was examined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). The results suggested that TSFW sericin represented a family of proteins with wide-ranging molecular weight distribution (11-245 kDa). Structural determination by FTIR revealed the presence of both α-helical and β-sheet structures. The colour was studied by colorimeter indicating less brightness, more red and yellow colour intensities. The carbon: nitrogen ratio (C:N) was studied by CHNS element analyzer and the ratio is 5.15-7.85. Thermal properties of TSFW sericin have been studied by thermogravimetric analysis (TGA) method. TGA curve showed higher thermal stability and variable degradation profiles. Furthermore, TSFW sericin contains 17 amino acids where serine, aspartic acid and glycine are the more significant compounds (54.34-60.49%). In addition, sericin was found to inhibit tyrosinase, elastase and glutathione-S-transferase activity, and had apparent radical scavenging impacts on 2.2‑diphenyl‑1‑picryl‑hydrazil (DPPH), hydrogen peroxide and inhibition of lipid peroxidation. Result suggested that TSFW sericins might be a valuable ingredient for cosmoceutical products.

Long-term survival outcomes of triple-receptor negative breast cancer survivors who are disease free at 5 years and relationship with low hormone receptor positivity

Background:

We counsel our triple-negative breast cancer (TNBC) patients that the risk of recurrence is highest in the first 5 years after diagnosis. However, there are limited data with extended follow-up on the frequency, characteristics, and predictors of late events.

Methods:

We queried the MD Anderson Breast Cancer Management System database to identify patients with stage I–III TNBC who were disease free at 5 years from diagnosis. The Kaplan–Meier method was used to estimate yearly recurrence-free interval (RFI), recurrence-free survival (RFS), and distant relapse-free survival (DRFS), as defined by the STEEP criteria. Cox proportional hazards model was used to compute hazard ratios (HRs) and 95% confidence intervals (CIs).

Results:

We identified 873 patients who were disease free at least 5 years from diagnosis with median follow-up of 8.3 years. The 10-year RFI was 97%, RFS 91%, and DRFS 92% the 15-year RFI was 95%, RFS 83%, and DRFS 84%. On a subset of patients with oestrogen receptor and progesterone receptor percentage recorded, low hormone receptor positivity conferred higher risk of late events on multivariable analysis for RFS only (RFI: HR=1.98, 95% CI=0.70–5.62, P-value=0.200; RFS: HR=1.94, 95% CI=1.05–3.56, P-value=0.034; DRFS: HR=1.72, 95% CI=0.92–3.24, P-value=0.091).

Conclusions:

The TNBC survivors who have been disease free for 5 years have a low probability of experiencing recurrence over the subsequent 10 years. Patients with low hormone receptor-positive cancers may have a higher risk of late events as measured by RFS but not by RFI or DRFS.

Giant Rashba effect at the topological surface of PrGe revealing antiferromagnetic spintronics

Rashba spin-orbit splitting in the magnetic materials opens up a new perspective in the field of spintronics. Here, we report a giant Rashba spin-orbit splitting on the PrGe [010] surface in the paramagnetic phase with Rashba coefficient α R  = 5 eVÅ. We find that α R can be tuned in this system as a function of temperature at different magnetic phases. Rashba type spin polarized surface states originates due to the strong hybridization between Pr 4f states with the conduction electrons. Significant changes observed in the spin polarized surface states across the magnetic transitions are due to the competition between Dzyaloshinsky-Moriya interaction and exchange interaction present in this system. Presence of Dzyaloshinsky-Moriya interaction on the topological surface give rise to Saddle point singularity which leads to electron-like and hole-like Rashba spin split bands in the [Formula: see text] and [Formula: see text] directions, respectively. Supporting evidences of Dzyaloshinsky-Moriya interaction have been obtained as anisotropic magnetoresistance with respect to field direction and first-order type hysteresis in the X-ray diffraction measurements. A giant negative magnetoresistance of 43% in the antiferromagnetic phase and tunable Rashba parameter with temperature makes this material a suitable candidate for application in the antiferromagnetic spintronic devices.

Grading, staging and Nottingham prognostic index scoring of breast carcinoma

Background: Breast carcinoma is the most frequent malignant tumor in women accounting for approximately 15% of female cancer deaths. It is the second most common malignancy among women in Nepal. Our objectives were to study the extent and spread of different histological types breast carcinoma in the eastern region of Nepal, to grade and stage the tumors, score the prognosis.Materials and Methods: A cross-sectional descriptive study of mastectomy specimens with axillary lymph node sampling was done for a period of two years. Diagnosis was done using WHO classification. Modified Bloom Richardson score and TNM system was used to grade and stage the tumors. Nottingham Prognostic index was applied to score the prognosis.Results: Out of 31 total cases, the most common histologic type was Invasive Carcinoma of No Special Type (67.74%). The largest tumor size was of 12cm which had poor NPI score. Most tumors were of grade II and T2. Out of 30 cases with lymph nodes, 13 were negative for metastasis pN0, 10 were pN1 and 7 were pN2. Extranodal spread was observed in 6 out of 17 cases with lymph node metastasis and was associated with higher grades and poor prognosis.Conclusion: Higher grade tumors, lymph node metastasis and extranodal extension are associated with higher Nottingham Prognostic Index score. 

Comparison of semen analysis by manual and automated method

Background: Semen analysis is used to evaluate male fertility. The aim of this study was to compare the results of semen analysis using manual method and automated sperm analyzer.Materials and Methods: This was a comparative study of 50 cases of semen analysis done in the Department of Pathology at the B.P. Koirala Institute of Health Sciences from March 2009 to March 2010. The automated sperm analyzer did not show the WHO parameters of patients who had functional sperm count (FSC) less than five hundred thousand (500,000). Semen analysis of each of the case included in the study was done by manual and automated method (using SQAII-P analyzer).Results: Out of 31 patients, the mean age of the patients was 28.56 years with youngest patient of 20 years and eldest of 45 year. Sensitivity and specificity was 100% in analysis of sperm concentration by both the methods. Sperm motility analysis showed 100% sensitivity and 81.81% specificity. Sperm morphology analysis showed 100% sensitivity and 34.48% specificity.Conclusion: It was observed that the automated method is much quicker and precise than the conventional, manual method for semen analysis.

Externally limited defect generation in multiwalled carbon nanotubes upon thermal annealing, and possible mechanism

Structural defects in multiwalled carbon nanotubes (MWCNTs) are found to increase upon moderate thermal annealing below 1400 K in an argon atmosphere. The defects are estimated using the ID/IG ratio in Raman spectroscopy of MWCNTs and confirmed by a direct observation using high-resolution transmission electron microscopy (HRTEM). HRTEM shows that the structural defects are created due to large damage to the outer walls of the nanotubes, while inner walls do not sustain any damage. The generation of defects on MWCNTs is attibuted to mechanical abrasion between the MWCNTs in contact, augmented by the momentum transfer from the flow of hot gas. A possible mechanism is proposed and experimentally validated by means of modulating the chemical environment of annealing from argon to hydrogen.

Progression of Kidney Disease in Indigenous Australians: The eGFR Follow-up Study

BACKGROUND AND OBJECTIVES

Indigenous Australians experience a heavy burden of CKD. To address this burden, the eGFR Follow-Up Study recruited and followed an Indigenous Australian cohort from regions of Australia with the greatest ESRD burden. We sought to better understand factors contributing to the progression of kidney disease. Specific objectives were to assess rates of progression of eGFR in Indigenous Australians with and without CKD and identify factors associated with a decline in eGFR.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

This observational longitudinal study of Indigenous Australian adults was conducted in >20 sites. The baseline cohort was recruited from community and primary care clinic sites across five strata of health, diabetes status, and kidney function. Participants were then invited to follow up at 2-4 years; if unavailable, vital status, progression to RRT, and serum creatinine were obtained from medical records. Primary outcomes were annual eGFR change and combined renal outcome (first of ≥30% eGFR decline with follow-up eGFR<60 ml/min per 1.73 m(2), progression to RRT, or renal death).

RESULTS

Participants (n=550) were followed for a median of 3.0 years. Baseline and follow-up eGFR (geometric mean [95% confidence interval], 83.9 (80.7 to 87.3) and 70.1 (65.9 to 74.5) ml/min per 1.73 m(2), respectively. Overall mean annual eGFR change was -3.1 (-3.6 to -2.5) ml/min per 1.73 m(2). Stratified by baseline eGFR (≥90, 60-89, <60 ml/min per 1.73 m(2)), annual eGFR changes were -3.0 (-3.6 to -2.4), -1.9 (-3.3 to -0.5), and -5.0 (-6.5 to -3.6) ml/min per 1.73 m(2). Across baseline eGFR categories, annual eGFR decline was greatest among adults with baseline albumin-to-creatinine ratio (ACR) >265 mg/g (30 mg/mmol). Baseline determinants of the combined renal outcome (experienced by 66 participants) were higher urine ACR, diabetes, lower measured GFR, and higher C-reactive protein.

CONCLUSIONS

The observed eGFR decline was three times higher than described in nonindigenous populations. ACR was confirmed as a powerful predictor for eGFR decline across diverse geographic regions.

Structural analysis of lead magnesium niobate using synchrotron powder X-ray diffraction and the Rietveld method

The room-temperature synchrotron powder X-ray diffraction pattern of the single phase perovskite lead magnesium niobate (PMN) has shown significant broadening in the q range ∼ 5-7 Å(-1) compared with standard LaB6 synchrotron powder X-ray diffraction data, taken under similar conditions. This broadening/asymmetry lies mainly towards the lower 2θ side of the Bragg peaks. Attempts to fit this data with the paraelectric cubic phase (Pm\bar 3m) and the local rhombohedral phase (R3m) corresponding to polar nanoregions (PNRs) are made using the Rietveld method. Rietveld refinements show that neither cubic (Pm\bar 3m) nor rhombohedral (R3m) symmetry can fit this XRD pattern satisfactorily. The two-phase refinement fits the experimental data satisfactorily and suggests that the weight percentage of the PNRs is approximately 12-16% at room temperature. The unit-cell volume of these rhombohedral PNRs is approximately 0.15% larger than that of the unit cell volume of the paraelectric cubic phase.

Mask-less deposition of Au-SnO2 nanocomposites on CMOS MEMS platform for ethanol detection

Here we report on the mask-less deposition of Au-SnO2 nanocomposites with a silicon-on-insulator (SOI) complementary metal oxide semiconductor (CMOS) micro electro mechanical system (MEMS) platform through the use of dip pen nanolithography (DPN) to create a low-cost ethanol sensor. MEMS technology is used in order to achieve low power consumption, by the employment of a membrane structure formed using deep reactive ion etching technique. The device consists of an embedded tungsten micro-heater with gold interdigitated electrodes on top of the SOI membrane. The tungsten micro-heater is used to raise the membrane temperature up to its operating temperature and the electrodes are used to measure the resistance of the nanocomposite sensing layer. The CMOS MEMS devices have high electro-thermal efficiency, with 8.2 °C temperature increase per mW power of consumption. The sensing material (Au-SnO2 nanocomposite) was synthesised starting from SnO nanoplates, then Au nanoparticles were attached chemically to the surface of SnO nanoplates, finally the mixture was heated at 700 °C in an oven in air for 4 h. This composite material was sonicated for 2 h in terpineol to make a viscous homogeneous slurry and then 'written' directly across the electrode area using the DPN technique without any mask. The devices were characterised by exposure to ethanol vapour in humid air in the concentration range of 100-1000 ppm. The sensitivity varied from 1.2 to 0.27 ppm(-1) for 100-1000 ppm of ethanol at 10% relative humid air. Selectivity measurements showed that the sensors were selective towards ethanol when they were exposed to acetone and toluene.

A clinico-histopathological study on skin appendageal tumors

Background: Skin Appendageal tumors are a large and diverse group of tumors that are commonly classified according to their state of appendageal differentiation: follicular, sebaceous, eccrine and apocrine. Objectives of this study were to study the clinic-epidemiological profile of skin appendageal tumors and to correlate the clinico-histopathological diagnosis.Materials and Methods: This was a retrospective and prospective study which included all cases of skin adnexal tumours diagnosed histologically during the period of f

Microvessel density in Prostatic Lesions : Relevance to prognosis

Background:  Angiogenesis is required for growth and metastasis of tumor tissue. Quantization of angiogenesis by calculating the microvessel density can be done in histopathology specimens with the help of immunochemistry. In this study we used anti CD 34 antibody to highlight the endothelial cells and thus calculate microvessel density. Most studies have shown a positive correlation of microvessel density with increasing pathological grade and have also shown microvessel density as an independent predictor of cancer progression and survival. The present study was to find out the microvessel density in benign and malignant lesions of prostate and also to correlate the vascularity with increasing grade of cancer.Materials and methods:  Sixty five prostatic biopsies were evaluated for microvessel density using CD34 monoclonal antibody. Comparison was done between BPH and Carcinoma Prostate. MVD was correlated with Gleason’s score, weight of specimen and increasing age of patient. Effect of prostatitis on Microvessel density was studied.Results: Microvessel density was significantly higher in carcinoma prostate than in Benign Prostatic Hyperplasia. There was positive correlation of Microvessel density with increasing Gleason’s score. Microvessel was significantly increased in patients having symptoms for more than a year and also with biopsies revealing prostatitis. However, there was no significant correlation between Microvessel density and weight of specimen or increasing age.Conclusion: Since Microvessel density was found to be significantly higher in Prostatic Carcinoma and it showed positive correlation with Gleason’s score it can be added as one of the indicators for predicting the disease outcome. 

Study of the microstructure information of GaAs epilayers grown on silicon substrate using synchrotron radiation

Williamson-Hall (WH) analysis is a well established method for studying the microstructural properties of epilayers grown on foreign substrates. However, the method becomes inapplicable in specific cases where the structure factor considerations and the presence of anti-phase domains forbid the data acquisition for certain reflections in conventional high-resolution X-ray diffraction (HRXRD) measurements. Here, this limitation is overcome by exploiting the large intensity (25 µW mm(-2)) and high photon energy (15.5 keV) of the X-ray beam obtained from a synchrotron radiation source. The lateral coherence length, vertical coherence length, tilt and micro-strain of GaAs epilayers grown on Si substrate have been successfully measured using the conventional WH analysis. The microstructure information obtained from the conventional WH analysis based on the data acquired at the synchrotron radiation source is in reasonable agreement with the results obtained from atomic force microscope and surface profiler measurements. Such information cannot be obtained on a laboratory-based HRXRD system where modification of the WH method by involving a set of parallel asymmetric crystallographic planes is found to be essential. However, the information obtained from the modified WH method is along a different crystallographic orientation.

Anesthetic management of Wolff-Parkinson-White syndrome in a pregnant patient posted for emergency caesarean section

The most common arrhythmia seen during pregnancy is paroxysmal supraventricular tachycardia and Wolff-Parkinson-White syndrome accounts for majority of this in such population. The presence of pre-disposing factors may facilitate the onset of tachyarrhythmias in previously asymptomatic parturients with the WPW syndrome such as increased hemodynamic, hormonal, autonomic, and emotional changes. Therefore, meticulous monitoring is essential perioperatively. Epidural anesthesia providing added advantage of hemodynamic stability and post-operative analgesia is preferred in such pregnant patients undergoing emergency cesarean section.

Incidental Enterobius Vermicularis infestation in surgically removed appendices with a clinical diagnosis of acute appendicitis: A retrospective analysis

Background: Appendiceal parasites can cause symptoms of appendicitis. Although the symptomatology imitates acute appendicitis clinically, the true nature of disease is diagnosed through histological examination. The aim of this study is to therefore determine the prevalence of E. Vermicularis in appendicectomy specimens to relate this to acute inflammation histologically.Materials & Methods: Histological data on all appendectomy specimens with a clinical diagnosis of acute appendicitis were retrieved from the archives of department of pathology, B.P.K.I.H.S, over the period of  five years (January 2004- December 2008) and was analyzed retrospectively.Results: There were a total of 1528 patients. M:F ratio being 1.2:1.Inflamed appendix constituted for 94.24% of all cases. There were a total of six (0.39%) appendicectomy specimens  which showed presence of oxyuriasis appendix. Though all patients with oxyuriasis presented with appendicial colic only one (1) out of the six cases of oxyuriasis showed histologic evidence of inflammation. Conclusion: We conclude that enterobius does not frequently cause inflammation of appendix though it may clinically mimic acute appendicitis. Since it represents a disease curable without necessitating surgery, symptomatology awareness is stressed upon.Journal of Pathology of Nepal (2015) Vol. 5, 720-722

Transverse wobbling in ^{135}pr

A pair of transverse wobbling bands is observed in the nucleus ^{135}Pr. The wobbling is characterized by ΔI=1, E2 transitions between the bands, and a decrease in the wobbling energy confirms its transverse nature. Additionally, a transition from transverse wobbling to a three-quasiparticle band comprised of strong magnetic dipole transitions is observed. These observations conform well to results from calculations with the tilted axis cranking model and the quasiparticle rotor model.

Lower treatment targets for gestational diabetes: is lower really better?

Proposed lower diagnostic thresholds and lower treatment targets for gestational diabetes have been controversial internationally. Intervention trials for the recently revised lower Australian treatment targets are currently lacking. While there may be benefits, lowering treatment targets may cause a number of harms including increased risk of hypoglycaemia in pregnant women, greater medicolegal risk for health practitioners, and heavier economic costs for the health system. Regional and remote care providers in particular will have greater costs, and may be overwhelmed in attempts to implement new treatment targets. An excessively glucose-centric focus may divert attention and resources from identifying and addressing other important and growing contributors to adverse pregnancy outcomes, such as obesity. Important groups such as Aboriginal and Torres Strait Islander Australians may not gain overall benefit from lowering treatment targets for gestational diabetes because of current low birthweights and the effect of social costs. It has not yet been established whether implementing lower treatment targets for gestational diabetes will create more benefit than harm. Implementation at this stage is premature.

Comparative study of glycated hemoglobin by ion exchange chromatography and affinity binding nycocard reader in type 2 diabetes mellitus

The aim of this study was to compare the level of glycated hemoglobin (HbA1c) in type 2 Diabetes Mellitus (DM) patients by two different methods namely Ion Exchange Chromatography and Affinity Binding Nycocard Reader. This is a cross-sectional study conducted on confirmed type 2 diabetes mellitus patients (n = 100) who visited Out Patients Department of the Universal College of Medical Sciences Teaching hospital, Bhairahawa, Nepal from November 2012 to March 2013. The diagnosis of diabetes mellitus was done on the basis of their fasting (164.46 ± 45.33 mg/dl) and random (187.93 ± 78.02 mg/dl) serum glucose level along with clinical history highly suggestive of type 2 DM. The HbA1c values of (7.8 ± 1.9%) and (8.0 ± 2.2%) were found in DM patients as estimated by those two different methods respectively. The highest frequency was observed in HbA1c > 8.0% indicating maximum cases were under very poor glycemic control. However, there were no significant differences observed in HbA1c value showing both methods are comparable in nature and can be used in lab for ease of estimation. The significant raised in HbA1c indicates complications associated with DM and monitoring of therapy become hard for those patients. Despite having standard reference method for HbA1c determination, the availability of report at the time of the patient visit can be made easy by using Nycocard Reader and Ion Exchange Chromatography techniques without any delay in communicating glycemic control, clinical decision-making and changes in treatment regimen.

Structural, magnetic, and dielectric studies on Gd0.7Y0.3MnO3

Structural, magnetic, specific heat, and dielectric studies were carried out on Y substituted (30 at. %) GdMnO(3) compound as a function of temperature. Anomalies occur at ~41 and 18 K, in the specific heat measurements and are ascribed to paramagnetic, to sinusoidal incommensurate antiferromagnetic transition (ICAFM) and ICAFM to commensurate antiferromagnetic transitions, respectively. Changes in the lattice parameters across these temperatures indicate magneto-elastic coupling present in the compound. However, in the dielectric measurements, an anomaly at 18 K alone is observed and is ascribed to a ferroelectric transition, giving rise to spontaneous ferroelectric ordering at low temperatures. This observation is supported by an anomaly in lattice parameters, across the transition temperature. From the frequency dependent dielectric studies, a strong coupling between Gd(3+) and Mn(3+) magnetic sublattices is inferred and Y substitution results in substantial changes in the relaxation process compared to that of GdMnO(3).

Dermcidin isoform-2 induced nullification of the effect of acetyl salicylic acid in platelet aggregation in acute myocardial infarction

The aggregation of platelets on the plaque rupture site on the coronary artery is reported to cause both acute coronary syndromes (ACS) and acute myocardial infarction (AMI). While the inhibition of platelet aggregation by acetyl salicylic acid was reported to produce beneficial effects in ACS, it failed to do in AMI. The concentration of a stress induced protein (dermcidin isoform-2) was much higher in AMI than that in ACS. Incubation of normal platelet rich plasma (PRP) with dermcidin showed one high affinity (K_d = 40 nM) and one low affinity binding sites (K_d = 333 nM). When normal PRP was incubated with 0.4 μM dermcidin, the platelets became resistant to the inhibitory effect of aspirin similar to that in the case of AMI. Incubation of PRP from AMI with dermcidin antibody restored the sensitivity of the platelets to the aspirin effect. Incubation of AMI PRP pretreated with 15 μM aspirin, a stimulator of the NO synthesis, resulted in the increased production of NO in the platelets that removed the bound dermcidin by 40% from the high affinity binding sites of AMI platelets. When the same AMI PRP was retreated with 10 μM aspirin, the aggregation of platelets was completely inhibited by NO synthesis.

Utility of prospective step sections in diagnostic skin histopathology for small biopsies

Background: Small skin biopsies have a cosmetic advantage and prospective step sections could potentially improve turnaround time without compromising diagnostic information. The study aimed to examine the use of prospective step sections of small skin biopsies and its effect on histopathological diagnosis and turnaround time. Materials and Methods: This was a hospital based cross-sectional study at Department of Pathology and Department of Dermatology, BPKIHS from June 2011- June 2012. Diagnoses /comment on three levels of prospectively taken 3mm biopsies were compared with those of 5mm biopsies taken from the same/similar lesion from 100 patients. Additional sections from 5mm biopsies were taken retrospectively. Percentage, proportion, mean, standard deviation, diagnostic sensitivity, kappa statistics and paired sample t- test were used as statistical tools. Results: Of 100 cases, 80 were diagnosed using 5mm biopsies while 73 were diagnosed using 3mm biopsies. On additional step sections of 3mm biopsies, 3 more cases were diagnosed. When compared with 5mm biopsies, the sensitivity of the 3mm biopsy rose from 90% to 93.8% after additional sections while the measure of agreement rose from 0.751 to 0.826.Mean turnaround time for prospectively sectioned 3mm biopsies was 2.56 days and that of retrospectively sectioned 5 mm biopsies was 4.64 days with their difference being statistically significant. Conclusion: A statistically significant decrease in turnaround time and an increase in sensitivity and agreement after step sections elucidates the utility of prospective step sectioned 3 mm biopsies in diagnostic skin histopathology. DOI: http://dx.doi.org/10.3126/jpn.v4i7.10298 Journal of Pathology of Nepal (2014) Vol. 4, 552-559  

Mycotoxin production by some IndianAlternaria species

A total of seven species ofAlternaria: A. alternata (Fr.) Keissler;A. capsici-annui Savul & Sandu;A. citri Ellis & Pierce;A. porri (Ellis) Clfferi;A. radicina Meler, Drechsler & Eddy;A. tenuissima (Kunze: Pers) Wiltshire andA. tomato (Cooke) Jones were screened on rice culture medium for their ability to elaborate five majorAlternaria mycotoxins viz. tenuazonlc acid (TA), alternariol (AOH), alternariol methyl ether (AME), altenuene (ALT) and altertoxin-l (ATX-I). All the species produced mycotoxins in varying concentrations. A.capsici-annul was recorded as the mycotoxin producer for the first time. ALT byA. citri andA. tomato; ALT, and ATX-I byA. tenuissima; ALT, TA and AME byA. porri and TA byA. radicina are the new additions to the list of mycotoxins produced by the respective species ofAlternaria.

A threefold increase in gestational diabetes over two years: review of screening practices and pregnancy outcomes in Indigenous women of Cape York, Australia

BACKGROUND

Australian Aboriginal women have a high prevalence of type 2 diabetes (T2DM) in pregnancy and gestational diabetes (GDM).

AIMS

To review how screening practice affects the pregnancy data of all Indigenous women and their newborns living in Cape York, Queensland.

METHODS

All medical charts of mothers and their neonates delivered in the regional hospital over two-one-year periods (2006 and 2008) were reviewed. Universal testing with an oral glucose tolerance test (OGTT) was introduced in 2007.

RESULTS

Gestational diabetes (GDM) increased from 4.7 to 14.2%, and T2DM was similar (2.4 and 2.3%). There were 127 deliveries in 2006 and 134 in 2008. Testing rates with OGTT improved from 31.4% in 2006 to 65.6% in 2008. Mothers with diabetes in pregnancy (DIP) were older and heavier than non-DIP mothers. Caesarean section rates were significantly higher in the DIP group compared with the non-DIP group (66 vs 25%) in both time periods. The booking weight of DIP mothers decreased 16 kg, their babies normalised their weight, length and head circumference; respiratory distress and Apgar scores improved comparing the two periods. In DIP, infants >40% had hypoglycaemia; however, rates of serious complications were low. Rates of breastfeeding were similar between groups. Follow-up rates for GDM improved from 16.6% in 2006 to 31.6% in 2008. Of those tested one-third were diagnosed with T2DM.

CONCLUSION

The rate of GDM tripled after implementation of universal testing. Outcomes improved. There is still need for improvement in testing and follow-up practices in relation to DIP.

Pattern of head and neck malignancies in eastern part of Nepal

The term head and neck refers to the upper aerodigestive tract, the salivary glands, the thyroid, parathyroid glands, the sino-nasal tract and the skin of the head and neck region. Malignancies at these sites are important due to the divergence in their behaviors and prognosis. A retrospective, cross sectional, series of cases were studied to determine the pattern of head and neck malignancies in our department from January, 2005 to July, 2006. A total of 90 cases of head and neck malignancies proven on histopathology were studied. Pharynx 25 (27.78%) was the commonest site involved by cancer. In the pharynx, malignancies at the nasopharyngeal region contributed to the bulk of the tumor constituting 12 (48.00%). Histopathologically, squamous cell carcinoma was seen in 61, (67.77%) subjects. Most of the patients presented in IIIrd or IVth stage of disease. The commonest treatment strategy adopted was surgery with post operative radiotherapy. Nasopharyngeal carcinoma is a major concern in this part of the region.

A microfocus X-ray fluorescence beamline at Indus-2 synchrotron radiation facility

A microfocus X-ray fluorescence spectroscopy beamline (BL-16) at the Indian synchrotron radiation facility Indus-2 has been constructed with an experimental emphasis on environmental, archaeological, biomedical and material science applications involving heavy metal speciation and their localization. The beamline offers a combination of different analytical probes, e.g. X-ray fluorescence mapping, X-ray microspectroscopy and total-external-reflection fluorescence characterization. The beamline is installed on a bending-magnet source with a working X-ray energy range of 4-20 keV, enabling it to excite K-edges of all elements from S to Nb and L-edges from Ag to U. The optics of the beamline comprises of a double-crystal monochromator with Si(111) symmetric and asymmetric crystals and a pair of Kirkpatrick-Baez focusing mirrors. This paper describes the performance of the beamline and its capabilities with examples of measured results.

Australian Diabetes Foot Network: practical guideline on the provision of footwear for people with diabetes

Trauma, in the form of pressure and/or friction from footwear, is a common cause of foot ulceration in people with diabetes. These practical recommendations regarding the provision of footwear for people with diabetes were agreed upon following review of existing position statements and clinical guidelines. The aim of this process was not to re-invent existing guidelines but to provide practical guidance for health professionals on how they can best deliver these recommendations within the Australian health system. Where information was lacking or inconsistent, a consensus was reached following discussion by all authors. Appropriately prescribed footwear, used alone or in conjunction with custom-made foot orthoses, can reduce pedal pressures and reduce the risk of foot ulceration. It is important for all health professionals involved in the care of people with diabetes to both assess and make recommendations on the footwear needs of their clients or to refer to health professionals with such skills and knowledge. Individuals with more complex footwear needs (for example those who require custom-made medical grade footwear and orthoses) should be referred to health professionals with experience in the prescription of these modalities and who are able to provide appropriate and timely follow-up. Where financial disadvantage is a barrier to individuals acquiring appropriate footwear, health care professionals should be aware of state and territory based equipment funding schemes that can provide financial assistance. Aboriginal and Torres Strait Islanders and people living in rural and remote areas are likely to have limited access to a broad range of footwear. Provision of appropriate footwear to people with diabetes in these communities needs be addressed as part of a comprehensive national strategy to reduce the burden of diabetes and its complications on the health system.

Primary disseminated extrapulmonary multidrug resistant tuberculosis

Disseminated tuberculosis is a common mode of presentation of tuberculosis in patients both with and without HIV/AIDS in India. However, primary multidrug resistance in disseminated tuberculosis involving only the extrapulmonary sites in an immunocompetent adult is rare. Here, we report a case of a 19-year-old man who had disseminated tuberculosis involving left pleura, pericardium, peritoneum and intraabdominal lymph nodes. He was initially taking WHO category I antituberculous drugs, but was not responding in spite of 5 months of chemotherapy. Culture of the pleural biopsy specimen grew Mycobacterium tuberculosis which was resistant to isoniazid and rifampicin. He was put on therapy for multidrug resistant tuberculosis,following 24 months of chemotherapyhe had an uneventful recovery.

Histopathological study of endometrium in abnormal uterine bleeding

Background: Histopathological evaluation of endometrial samples is essential in the workup of abnormal uterine bleeding. This study was carried out to evaluate patterns of endometrial histological findings in women with abnormal uterine bleeding and to correlate histopathological findings with clinical features.Materials and Methods: One hundred and twenty two patients with diagnosis of abnormal uterine bleeding underwent endometrial sampling. The slides stained with Hematoxylin and Eosin stain were studied.Results: The predominant endometrial histopathological finding was proliferative endometrium 32 cases (26.23%) followed by simple hyperplasia without atypia 22 cases (18.03%). Malignant lesions were more common in patients more than 40 years of age and comprised of 7 cases (5.74%) of all cases. Atrophic endometrium was most common finding in postmenopausal bleeding 8 cases (28.6%) followed by endometrial carcinoma 5 cases (17.9%).Conclusion: Histopathological examination of endometrium should be done generously in women presenting with abnormal uterine bleeding especially after the age of 40 years to rule out malignant pathology.Journal of Pathology of Nepal (2012) Vol. 2, 297-300DOI: http://dx.doi.org/10.3126/jpn.v2i4.6882

Type 2 diabetes in young Indigenous Australians in rural and remote areas: diagnosis, screening, management and prevention

The burden of type 2 diabetes mellitus (T2DM) among Indigenous children and adolescents is much greater than in non-Indigenous young people and appears to be rising, although data on epidemiology and complications are limited. Young Indigenous people living in remote areas appear to be at excess risk of T2DM. Most young Indigenous people with T2DM are asymptomatic at diagnosis and typically have a family history of T2DM, are overweight or obese and may have signs of hyperinsulinism such as acanthosis nigricans. Onset is usually during early adolescence. Barriers to addressing T2DM in young Indigenous people living in rural and remote settings relate to health service access, demographics, socioeconomic factors, cultural factors, and limited resources at individual and health service levels. We recommend screening for T2DM for any Aboriginal or Torres Strait Islander person aged > 10 years (or past the onset of puberty) who is overweight or obese, has a positive family history of diabetes, has signs of insulin resistance, has dyslipidaemia, has received psychotropic therapy, or has been exposed to diabetes in utero. Individualised management plans should include identification of risk factors, complications, behavioural factors and treatment targets, and should take into account psychosocial factors which may influence health care interaction, treatment success and clinical outcomes. Preventive strategies, including lifestyle modification, need to play a dominant role in tackling T2DM in young Indigenous people.

Histopathological patterns of ovarian tumors at BPKIHS

Introduction: Ovarian tumors account for fifth most common cause of cancer related death in females involving a variety of histological diagnosis. It accounts for 6% of all cancers. Though it is one of the treatable cancers due to its sensitivity to anticancer therapies, it frequently does not result in symptoms until the cancer has spread extensively.Objectives: To study the incidence, histopathological spectrum and clinical correlates of ovarian tumours at B.P. Koirala Institute of Health Sciences (BPKIHS).Methods: A cross-sectional study was undertaken during a period of one year (1st Jan. 31st Dec 2006). The tumors were classified according to WHO classification after thorough examination of H&E slides under light microscope. Data on clinical presentation and physical findings were also recorded in each case.Results: There were a total of 83 cases. Surface epithelial tumors emerged as the commonest variety accounting for 47%, followed by Germ cell tumors (45.8%). Sex . cord stromal tumors and metastatic tumors accounted 3.6% each. The age range was 10 . 86 years. Metastatic tumors involved younger age groups. Abdominal mass was the commonest clinical presentation followed by pain abdomen.Conclusion: At BPKIHS, ovarian tumors were found to occur in wide range of age (10-86years) with abdominal mass and pain abdomen being the commonest mode of clinical presentation .Histology revealed that surface epithelial tumors and germ cell tumors together constitute the large majority of the case (92.8%). An accurate histological diagnosis and staging is therapeutically and prognostically important.DOI: http://dx.doi.org/10.3126/hren.v10i2.6570 Health Renaissance 2012; Vol 10 (No.2); 87-97 

The control of hyperglycemia in alloxan treated diabetic mice through the stimulation of hepatic insulin synthesis due to the production of nitric oxide

OBJECTIVE

The hepatocytes from the adult mice when stimulated by glucose had been reported to synthesize and secrete insulin. The feasibility of controlling hyperglycemia in alloxan induced diabetic mice through hepatic synthesis of insulin was studied.

MATERIALS AND METHODS

Insulin synthesis was determined by in vitro translation of mRNA and by immunohistochemistry of the hepatocytes and assayed by enzyme linked immunosorbent assay (ELISA). Dermcidin isoform 2 (dermcidin) was measured by ELISA. Nitric oxide was measured by methemoglobin method. Insulin synthesis was quantitated by immunoblot technique and the expression of proinsulin genes I and II in the hepatocytes was quantitated by cDNA synthesis.

RESULTS

It was found that in contrast to normal hepatocytes, the hepatocytes from the diabetic mice showed impaired insulin synthesis in the presence of glucose that was related to the inhibition of nitric oxide synthesis through the synthesis of dermcidin, a potent competitive inhibitor of nitric oxide synthase. The increase of systemic NO synthesis either by oral use of 0.7 mM acetyl salicylic acid (aspirin) or by dermal application of 0.28 mmol sodium nitroprusside in saline soaked in cotton pad was found to decrease blood glucose level from 600 mg/dL to 120 mg/dL with concomitant increase of plasma insulin level from 5 µunits/dL to 38 µunits/dL. And subsequently normalized dermcidin level from 80 nM to 4.5 nM within 24 h (p<0.001; n=10).

CONCLUSION

Our studies suggested the possibility of controlling hyperglycemia in alloxan induced diabetic mice by the stimulation of the hepatic insulin synthesis through the systemic stimulation of NO production in the hepatocytes.