Major sources of sinking particulate organic matter in the western Bay of Bengal

Impacts of river discharge on coastal ocean processes are multi-dimensional. Studies on sinking particle fluxes, composition and their seasonal variability in coastal oceans are very limited. In this study, we investigated the impact of river discharge on seasonal variability in sinking fluxes of total mass, biogenic and lithogenic material in a river-dominated continental margin, western coastal Bay of Bengal. Higher POC, lithogenic and total mass fluxes were found during early southwest monsoon, and are decoupled with peak river discharge and elevated primary production. It is attributed to cross-shelf transport of re-suspended surface sediments from shelf region. Peak river discharge followed by elevated chlorophyll-a suggest nutrients supply though river discharge support primary production. Elemental C:N ratios, δ13C and δ15N results likely suggest that both marine and terrestrial sources contributed to sinking POM, . Overall, higher sinking fluxes during southwest monsoon than rest of the year suggest that seasonal river discharge exerts considerable impact on sinking fluxes in the western coastal Bay of Bengal.

Export of particulate organic carbon and nitrogen to the northern Indian Ocean by the monsoonal rivers of India

This study analyses particulate organic carbon (POC) and particulate nitrogen (PN) export from Indian monsoonal rivers to the north Indian Ocean. Indian monsoonal rivers export approximately 1.2 Tg yr-1 (1Tg = 1012 g) of POC and 0.14 Tg yr-1 of PN, with about two-thirds entering the Bay of Bengal (0.8 and 0.1 Tg yr-1, respectively) and the remaining reaches to the Arabian Sea (0.4 and 0.04 Tg yr-1, respectively). Remarkably, just four rivers from northwest India's black soil-dominated regions contribute about half of the total POC and PN exports (0.64 and 0.06 Tg yr-1, respectively). This is due to substantial erosion in these catchments, resulting in suspended matter concentrations averaging 596 ± 252 mg L-1, significantly higher than catchments dominated by red sandy, red loamy and alluvial soils (54 ± 56 mg l-1). In contrast, rivers originating from catchments with heavy precipitation, a tropical wet climate, red loamy soils (with peaty and marshy characteristics), rich tropical wet evergreen and moist deciduous forests, and higher soil organic carbon content yield more POC and PN (1704 ± 383 kgC km-2 yr-1 and 261 ± 56 kgN km-2 yr-1, respectively) than the other rivers of India (951 ± 508 kgC km-2 yr-1 and 120 ± 57 kgN km-2 yr-1, respectively). These findings stress that the export flux and yield of POC and PN from the Indian monsoonal rivers are primarily influenced by the interplay of hydrological, lithological, environmental, and climatic conditions within the catchment, rather than river size. Moreover, this study highlights the significant impact of incorporating POC data from medium-sized rivers worldwide, as it reveals that yield is independent of river size. This calls for a re-evaluation of global POC export fluxes, taking into account hydrological, lithological, environmental, and climatic factors.

Intelligent system for leaf disease detection using capsule networks for horticulture

Horticulture crops take a crucial part of the Indian economy by creating employment, supplying raw materials to different food processing industries. Mangoes are one of the major crops in horticulture. General Infections in Mango trees are common by various climatic and fungal infections, which became a cause for reducing the quality and quantity of the mangos. The most common diseases with bacterial infection are anthracnose and Powdery Mildew. In recent years, it has been perceived that different variants of deep learning architectures are proposed for detecting and classifying the problems in the agricultural domain. The Convolutional Neural Network (CNN) based architectures have performed amazingly well for disease detection in plants but at the same time lacks rotational or spatial invariance. A relatively new neural organization called Capsule Network (CapsNet) addresses these limitations of CNN architectures. Hence, in this work, a variant of CapsNet called Multilevel CapsNet is introduced to characterize the mango leaves tainted by the anthracnose and powdery mildew diseases. The proposed architecture of this work is validated on a dataset of mango leaves collected in the natural environment. The dataset comprises both healthy and contaminated leaf pictures. The test results approved the undeniable level of exactness of the proposed framework for the characterization of mango leaf diseases with an accuracy of 98.5%. The outcomes conceive the higher-order precision of the proposed Multi-level CapsNet model when contrasted with the other classification algorithms such as Support Vector Machine (SVM) and CNNs.

IgG4-related retroperitoneal fibrosis: a rare cause of obstructive uropathy

Immunoglobulin G4 (IgG4)-related disease was described in 2003 and is known to affect almost all organ systems. Rarely, this disease can manifest in the retroperitoneum, which can lead to sequalae such as obstructive uropathy. Here we describe a case of IgG4-related retroperitoneal fibrosis leading to obstructive uropathy. The patient was managed with bilateral Double J (DJ) stenting and oral steroids. Following remission of the disease, the DJ stents were removed and the patient remained asymptomatic over the follow-up period. A high index of suspicion is required for diagnosis of this rare disease and timely management can lead to a positive outcome.

A Low-Prevalence Single-Nucleotide Polymorphism in the Sensor Kinase PhoR in Mycobacterium tuberculosis Suppresses Its Autophosphatase Activity and Reduces Pathogenic Fitness: Implications in Evolutionary Selection

The genome sequencing of Mycobacterium tuberculosis, the causative organism of tuberculosis, has significantly improved our understanding of the mechanisms that drive the establishment of infection and disease progression. Several clinical strains of M. tuberculosis exhibit single-nucleotide polymorphisms (SNPs), the implications of which are only beginning to be understood. Here, we examined the impact of a specific polymorphism in PhoR, the sensor kinase of the PhoPR two-component system. Biochemical analysis revealed reduced autophosphatase/ATPase activity, which led to enhanced downstream gene expression. We complemented M. tuberculosis H37Ra with the wild-type and mutant phoPR genes and characterized the strains in a cell line infection model. We provide an explanation for the low prevalence of the SNP in clinical strains (∼1%), as the mutation causes a survival disadvantage in the host cells. The study provides a rare example of selection of a signaling node under competing evolutionary forces, wherein a biochemically superior mutation aids bacterial adaptation within-host but has low fitness for infection and hence is not selected. Our study highlights the importance of accounting for such SNPs to test therapeutic and co-therapeutic methods to combat TB.

Sources of organic matter and tracing of nutrient pollution in the coastal Bay of Bengal

Stable isotopic composition of carbon (δ¹³C_POM) and nitrogen (δ¹⁵N_POM) in the particulate organic matter (POM) is used to identify sources of organic carbon and nutrients using monthly time-series observation in the coastal Bay of Bengal (BoB). The hydrographic structure indicates that the coastal BoB is influenced by coastal upwelling during March-May, advection of peninsular river discharge during June to September and glacial (Ganges) river discharge during October to December due to reversing of East India Coastal Currents (EICC). C/N ratios in POM were mostly higher values than Redfield ratio in the study region indicating possible contribution of terrestrial origin. Enriched δ¹³C_POM were found during March-May associated with coastal upwelling indicating major contribution of POM from the in situ production while lower values were noticed during June to September followed by October to December indicating influence of terrestrial sources. δ¹⁵N_POM displayed strong inverse relation with salinity and linear relation with Chl-a suggesting that anthropogenic nutrients from the land increased coastal phytoplankton biomass. δ¹⁵N_POM linearly decreased with increase in distance from the coast and reached to the typical offshore value of 6-6.5‰ indicating that terrestrial nutrients influence was spread up to a distance of 15 to 20 km from the coast in the study region. Our study suggested that coastal waters are influenced by terrestrial/anthropogenic nutrients and its impact can be noticed up to 15 to 20 km from the coast and its impact on Biodiversity Beyond National Jurisdiction may be negligible than hitherto hypothesized.

FRI0475 STEROID SPARING AGENTS IN POLYMYALGIA RHEUMATICA: A SYSTEMATIC REVIEW

Background:

Polymyalgia rheumatica (PMR) is the commonest chronic inflammatory musculoskeletal disease of the elderly. The mainstay of treatment for PMR is long term systemic glucocorticoid (GC), which is associated with significant systemic toxicity. There is a need for steroid sparing drugs in PMR to reduce GC cumulative dose and GC induced adverse effects.(1)

Objectives:

To evaluate the role of steroid sparing agents in PMR.

Primary outcomes:

Secondary outcomes:

Methods:

Electronic databases including Medline, Embase and Cochrane databases (CENTRAL) were searched since inception for prospective randomized control trials comparing disease modifying anti rheumatic drugs (DMARDs) and biologics with systemic GC in PMR, published in English with more than 20 patients and a minimum study duration of 24 weeks. As different classification criteria for PMR exist, studies were included if they used any accepted classification criteria for PMR. Case series, case reports, retrospective, non-randomized trials, abstracts, systematic reviews and non English language trials were not included. Patients with Giant cell arteritis (GCA) were excluded. Risk of bias and quality was assessed using the Cochrane tool.

The studies were assessed for cumulative GC dose, proportion of patients in remission, proportion of patients with relapse, reduction in inflammatory markers, adverse events and mortality.

Results:

5 studies were selected for final review-- 3 studies involving Methotrexate, one study on azathioprine, one on Infliximab. The study on Azathioprine had high risk of bias, small sample size and low quality (Level 2 evidence) with high attrition rate but it revealed reduction of daily prednisolone with Azathioprine. A high quality RCT (Level 1) did not confirm a steroid sparing effect with Infliximab vs placebo, and there was no significant difference between relapse or remission rate. Methotrexate studies showed conflicting results: one high quality RCT (Level 1) and one low quality RCT (Level 2) on Methotrexate revealed statistically significant steroid sparing effect, however the remaining study did not demonstrate between Methotrexate and placebo. Two methotrexate studies assessed the risk of relapse, with conflicting results (relapses 73% placebo vs 47% methotrexate; or no difference).

Methotrexate was not associated with increased adverse effects in any of the studies. Azathioprine was associated with significant adverse events resulting in high attrition.

A meta analysis was not performed for methotrexate as the studies were heterogenous.

Conclusion:

There is a lack of evidence regarding DMARDs and biologics in PMR. Methotrexate is an effective steroid sparing agent, and is not associated with increased adverse events. Azathioprine may be effective but is associated with significant adverse events. Infliximab is not an effective steroid sparing agent in PMR. More high quality RCTs are needed to study the efficacy of steroid sparing agents.

References:

[1]Bhaskar Dasgupta, Frances A. Borg, Nada Hassan, Kevin Barraclough, Brian Bourke, Joan Fulcher, Jane Hollywood, Andrew Hutchings, Valerie Kyle, Jennifer Nott, Michael Power, Ash Samanta, on behalf of the BSR and BHPR Standards, Guidelines and Audit Working Group, BSR and BHPR guidelines for the management of polymyalgia rheumatica,Rheumatology, Volume 49, Issue 1, January 2010, Pages 186–190

Disclosure of Interests:

None declared

Neuroendocrine tumor of larynx: A review of literature

Neuroendocrine neoplasms of the larynx are rare but are the most common nonsquamous tumors of this organ. There are 4 different types of laryngeal neuroendocrine tumors composed of paraganglioma, typical carcinoid, atypical carcinoid tumor, and small cell neuroendocrine carcinoma. Carcinoids and small cell neuroendocrine carcinomas are epithelial neoplasms, whereas paragangliomas are of neural origin. Diagnosis is based primarily on light microscopy and confirmed by immunohistochemistry and electron microscopy. Precise diagnosis is essential because the natural history, treatment, and prognosis vary widely for the different neoplastic categories. Typical carcinoids are very rare and are treated by wide local excision, usually partial laryngectomy, without elective neck dissection. Atypical carcinoid tumors are more common and more aggressive. They are treated by partial or total laryngectomy with elective or therapeutic neck dissection. Adjuvant chemo/radiotherapy may be of benefit in some cases. Small cell neuroendocrine carcinomas are highly aggressive and should be considered disseminated at initial diagnosis. The treatment is by irradiation and chemotherapy as surgery has proven to be of a little benefit. Paragangliomas are treated by local excision or partial laryngectomy.

Linitis plastica like primary signet ring cell carcinoma of the gallbladder - an extremely rare variant

Signet ring carcinoma (SRCC) of gallbladder is an extremely rare tumor accounting for approximately 3% of all gallbladder carcinomas, with a handful of case reports in the literature. We report a case of signet ring cell carcinoma of the gallbladder in a 70 year-old female who was operated upon after the preoperative diagnosis of cholecystitis with cholelithiasis, based on ultrasonographic findings and subsequently diagnosed as signet ring cell carcinoma of the gallbladder on histopathological examination. Grossly there was no discrete growth, instead tumor presented as linitis plastica like diffuse thickening of the gallbladder wall. Microscopic examination revealed a diffusely infiltrative carcinoma comprised exclusively of signet ring cells and confirmed by periodic acid-Schiff (PAS), Alcian blue & Cytokeratin 7 stains. Post -operative clinico-radiological workup was done to exclude secondary. This highly aggressive signet ring cell carcinoma of gallbladder is being reported because of its rarity, its unique histomorphological features and diagnostic inadequacy of the routinely performed ultrasonography as well as highlighting the use of special stains and immunohistochemistry to exclude other possibilities. Our case highlights that routine histopathological examination of all the cholecystectomy specimens is a must to facilitate the early diagnosis of aggressive signet ring cell carcinoma gallbladder.

Amoebic chronic appendicitis: a rare entity

Rarely intestinal parasites can cause acute appendicitis. Amoebic appendicitis is rare and infection with Entamoeba Histolytica usually develops as an extension of caecal infection. I report a rare case of amoebic chronic appendicitis diagnosed on histopathology examination. It mimics the features of acute pappendicitis but may not always be responsible for acute appendicitis

Outcome of lumbar spinal fusion surgery in obese patients

The aim of this study was to determine whether obesity affects pain, surgical and functional outcomes following lumbar spinal fusion for low back pain (LBP).

A systematic literature review and meta-analysis was made of those studies that compared the outcome of lumbar spinal fusion for LBP in obese and non-obese patients. A total of 17 studies were included in the meta-analysis. There was no difference in the pain and functional outcomes. Lumbar spinal fusion in the obese patient resulted in a statistically significantly greater intra-operative blood loss (weighted mean difference: 54.04 ml; 95% confidence interval (CI) 15.08 to 93.00; n = 112; p = 0.007) more complications (odds ratio: 1.91; 95% CI 1.68 to 2.18; n = 43858; p < 0.001) and longer duration of surgery (25.75 mins; 95% CI 15.61 to 35.90; n = 258; p < 0.001). Obese patients have greater intra-operative blood loss, more complications and longer duration of surgery but pain and functional outcome are similar to non-obese patients. Based on these results, obesity is not a contraindication to lumbar spinal fusion.

Cite this article: Bone Joint J 2015;97-B:1395–1404.

Identifying the source of tar balls deposited along the beaches of Goa in 2013 and comparing with historical data collected along the West Coast of India

Deposition of oil residues, also known as tar balls, is a seasonal phenomenon, and it occurs only in the southwest monsoon season along the west coast of India. This has become a serious environmental issue, as Goa is a global tourist destination. The present work aims at identifying the source oil of the tar balls that consistently depositing along the Goa coast using multi-marker fingerprint technique. In this context, the tar ball samples collected in May 2013 from 9 beaches of Goa coast and crude oils from different oil fields and grounded ship were subject to multi-marker analyses such as n-alkanes, pentacyclic terpanes, regular steranes, compound specific isotope analysis (CSIA) and principle component analysis (PCA). The n-alkane weathering index shows that samples have been weathered to various degrees, and the status of weathering is moderate. Since the international tanker route passes closer to the west coast of India (WCI), it is generally presumed that tanker wash is the source of the tar balls. We found that 2010/2011 tar balls are as tanker wash, but the present study demonstrates that the Bombay High (BH) oil fields can also contribute to oil contamination (tar balls) along ≈ 650 km stretch of the WCI, running from Gujarat in the north to Goa in the south. The simulated trajectories show that all the particles released in April traveled in the southeast direction, and by May, they reached the Goa coast with the influence of circulation of Indian monsoon system.

To report a case of unilateral proliferative retinopathy following noncerebral malaria with Plasmodium falciparum in Southern India

The retinopathy in association with malaria fever described so far includes retinal hemorrhages, vessel changes, retinal discoloration/whitening and papilledema. Malaria retinopathy has been mostly described in severe cases, associated with Plasmodium falciparum, correlating the patho-physiology of retinal and cerebral manifestations. We report an unusual case of proliferative retinopathy as a manifestation of malaria fever, caused by P. falciparum with no cerebral involvement. The patient had features of unilateral retinal vascular occlusion with proliferative changes and vitreous hemorrhage. To the best of our knowledge, such a case has never been reported so far in the literature. This report highlights the possible occurrence of severe proliferative changes associated with malaria fever, which if diagnosed early can prevent possible blindness.

Accuracy of real-time vs. blinded offline diagnosis of neoplastic colorectal polyps using probe-based confocal laser endomicroscopy: a pilot study

BACKGROUND AND STUDY AIMS

Probe-based confocal laser endomicroscopy (pCLE) is a new imaging modality that enables histological examination of gastrointestinal mucosa during endoscopic procedures. Most studies have evaluated offline interpretation of pCLE images. In clinical practice, real-time interpretation is necessary to assist decision-making during the procedure. The aim of this pilot study was to compare the accuracy of real-time pCLE diagnosis made during the procedure with that of blinded offline interpretation to provide accuracy estimates that will aid the planning of future studies.

PATIENTS AND METHODS

pCLE was performed in patients undergoing screening and surveillance colonoscopy. Once a polyp had been identified, one endoscopist analyzed pCLE images during the procedure and made a provisional "real-time" diagnosis. Saved video recordings were de-identified, randomized, and reviewed "offline" 1 month later by the same endoscopist, who was blinded to the original diagnoses.

RESULTS

Images from a total of 154 polyps were recorded (80 neoplastic, 74 non-neoplastic). The overall accuracy of real-time pCLE diagnosis (accuracy 79%, sensitivity 81%, specificity 76%) and offline pCLE diagnosis (83%, 88%, and 77%, respectively) for all 154 polyps were similar. Among polyps < 10 mm in size, the accuracy of real-time interpretation was significantly lower (accuracy 78%, sensitivity 71%, specificity 83%) than that of offline pCLE interpretation (81%, 86%, 78%, respectively). For polyps ≥ 10 mm, the accuracy of pCLE diagnosis in real-time was better (accuracy 85%, sensitivity 90%, specificity 75%) than offline pCLE diagnosis (81%, 97%, and 50%, respectively).

CONCLUSIONS

These results suggest that real-time and offline interpretations of pCLE images are moderately accurate. Real-time interpretation is slightly less accurate than offline diagnosis, but overall both are comparable. Additionally, there was contrasting accuracy between the two methods for small and large polyps.

Efficacy of less invasive posterior lumbar interbody fusion as revision surgery for patients with recurrent symptoms after discectomy

Recurrence of back or leg pain after discectomy is a well-recognised problem with an incidence of up to 28%. Once conservative measures have failed, several surgical options are available and have been tried with varying degrees of success. In this study, 42 patients with recurrent symptoms after discectomy underwent less invasive posterior lumbar interbody fusion (LI-PLIF). Clinical outcome was measured using the Oswestry Disability Index (ODI), Short Form 36 (SF-36) questionnaires and visual analogue scales for back (VAS-BP) and leg pain (VAS-LP). There was a statistically significant improvement in all outcome measures (p < 0.001). The debate around which procedure is the most effective for these patients remains controversial. Our results show that LI-PLIF is as effective as any other surgical procedure. However, given that it is less invasive, we feel that it should be considered as the preferred option.

A peer group approach model of oral health promotion among orphans at Puduchery, South India

BACKGROUND

Interactions between oral and systemic health are bi-directional and complex, involving many pathways. The orphans have been sympathized with, ignored, vitrified or even hidden away in the community. Hence, providing health care services for orphans remains a challenge. Oral health education has a positive impact in lowering plaque and gingivitis scores in health educational programs.

OBJECTIVE

The objective of this study is to assess the effectiveness of peer group health promotion model among 11 to 16 year old orphans at Puduchery, South India.

MATERIALS AND METHODS

A clinical trial of 6 months duration was carried out among 72 orphans with age ranging from 11 to 16 years residing in Cluny Padmini Sneha Illam, at Puduchery, India. The baseline data regarding oral health and oral hygiene practices were obtained using a pre-tested close-ended questionnaire. Oral health education was provided to 4 randomly picked children who in turn provided the same to their peer group orphans, supervised by the investigator. Tooth brushes and fluoridated tooth pastes were provided to all the participants throughout the study period. Oral hygiene of the participants was assessed using Modified Plaque Index by Loe H and Gingival Index by Loe H and Silness at baseline, 3(rd) and 6(th) month interval. Paired Student t test was used to analyze the categorical data.

RESULTS

Majority of the respondents felt consuming sugar was not harmful for dental health, while 15 respondents were not sure about the outcome. When asked if oral hygiene was important for general health, 45.8% were not aware of its association. Although all the participants brushed their teeth daily, none of them reported the use of dental floss. The findings of this study indicated a statisticallysignificant lower mean plaque score of 0.54 ± 0.20 at 6(th) month when compared to the baseline score of 1.76 ± 0.24. Similarly, statistically significant lower gingival index score of 0.65 ± 0.11 at 6(th) month was observed when compared to the baseline score of 1.76 ± 0.24.

CONCLUSIONS

The results of this study indicate that oral hygiene of orphans was improved using a peer group approach model of oral health promotion.

Oesophageal eosinophilic infiltration in patients with noncardiac chest pain

BACKGROUND

Eosinophilic oesophagitis clinically presents with recurrent episodes of dysphagia and food impaction. Recently, we observed patients with noncardiac chest pain and eosinophilic oesophagitis.

AIMS

To estimate the prevalence of abnormal eosinophilic infiltration in noncardiac chest pain patients and examine diagnostic utility of demographic, clinical and endoscopic variables to predict eosinophilic oesophagitis.

METHODS

Retrospective study of 171 consecutive patients referred for EGD evaluation of noncardiac chest pain. Endoscopic signs consistent with eosinophilic oesophagitis were recorded. The histological findings were grouped as normal: 0-5 eosinophils/high power field (e/hpf), indeterminate: 6-20 e/hpf, and eosinophilic oesophagitis: ≥21 e/hpf. Abnormal eosinophilic infiltration was defined as ≥6 e/hpf.

RESULTS

Abnormal eosinophilic infiltrate was noted in 24 patients (14%). Thirteen (8%) had indeterminate counts, while 11 (6%) had eosinophilic oesophagitis. Compared with normal, those with abnormal oesophageal eosinophilic infiltration were more likely to be male (71% vs. 34%, P=0.001), have allergies (29% vs. 12%, P=0.050), have current GER symptoms (42% vs. 18%, P=0.013), rings (54% vs. 22%, P=0.002), furrows (21% vs. 1%, P<0.001) and abnormal eosinophilic oesophagitis findings on endoscopy (67% vs. 32%, P=0.001). Of the 24 abnormal patients, 23 (96%) were either male or had rings, furrows, or white specks. Conversely, 68 of 69 patients (99%) who were female did not have rings, furrows, or white specks, and endoscopy was normal. Eight patients (33%) with abnormal eosinophilic infiltration had a normal endoscopy.

CONCLUSIONS

Eosinophilic oesophagitis should be considered in the evaluation of noncardiac chest pain. Our findings suggest that oesophageal biopsies should be obtained particularly in males with recurrent unexplained chest pain, whether endoscopy is normal or abnormal.

Safety and efficacy of cytology brushings versus standard fine-needle aspiration in evaluating cystic pancreatic lesions: a controlled study

BACKGROUND AND STUDY AIMS

Cystic pancreatic lesions (CPLs) are increasingly detected by various imaging studies. Mucinous CPLs carry a risk of malignant transformation but this is often difficult to diagnose preoperatively. In a previous report of 10 suspected mucinous CPLs, the cellular yield of endoscopic ultrasonography (EUS)-guided cytology brushings was found to be superior to the yield from standard fine-needle aspiration (FNA). The aim of this prospective and blinded study was to compare the cytology yield of mucinous epithelium from brushing with FNA in suspected mucinous CPLs.

PATIENTS AND METHODS

In total, 37 patients with 39 CPLs measuring at least 20 mm were enrolled between June 2006 and July 2008 for EUS-cytobrushing and EUS-FNA of CPLs. Demographic, clinical, EUS, cytopathologic, and surgical data were recorded whenever available. Yield of cytology brushings was compared with that of FNA. Procedure morbidity was evaluated after 30 days. The main outcome assessed was yield of intracellular mucin (ICM) on cytobrushing specimens compared with EUS-FNA for the diagnosis of suspected mucinous CPL.

RESULTS

Cytobrushings were more likely to detect ICM than the EUS-FNA method ( P = 0.001). In three patients with hypocellular FNA, dysplasia was found on cytology brushing and later confirmed by surgical pathology. Significant complications occurred in three patients (8 %): one postbrushing bleeding and two acute pancreatitis.

CONCLUSIONS

Cytology brushings are more likely to provide an adequate mucinous epithelium specimen than standard FNA and could aid the diagnosis of CPLs in a selective group of patients.

The complexity of mitogen-activated protein kinases (MAPKs) made simple

The mitogen-activated protein kinase (MAPK) pathways are known to be involved in various processes of growth, differentiation and cell death. In spite of their ubiquitous presence and seemingly enormous cross-talk with each other, their action is very specific. This review deals with various aspects of the three different MAPK pathways (ERK, p38 and JNK) and how their specificity is brought about.

Delayed activation of PKCdelta and NFkappaB and higher radioprotection in splenic lymphocytes by copper (II)-Curcumin (1:1) complex as compared to curcumin

A mononuclear 1:1 copper complex of curcumin had been found to be superior to curcumin in its anti-oxidant properties. This paper describes the radio-protective effects of the complex in splenic lymphocytes from swiss mice. The complex was found to be very effective in protecting the cells against radiation-induced suppression of glutathione peroxidase, catalase and superoxide dismutase (SOD) activities. Both curcumin and the complex protected radiation-induced protein carbonylation and lipid peroxidation in lymphocytes with the complex showing better protection than curcumin. It also showed better overall protection by decreasing the radiation-induced apoptosis. The kinetics of activation of PKCdelta and NFkappaB after irradiation in presence or absence of these compounds was looked at to identify the molecular mechanism involved. The modulation of irradiation-induced activation of PKCdelta and NFkappaB by curcumin and the complex was found different at later time periods although the initial response was similar. The early responses could be mere stress responses and the activation of crucial signaling factors at later time periods may be the determinants of the fate of the cell. In this study this delayed effect was observed in case of complex but not in case of curcumin. The delayed effect of the complex along with the fact that it is a better free radical scavenger must be the reason for its better efficacy. The complex was also found to be less cytotoxic then curcumin at similar concentration.

Hyperplastic Polyposis following Treatment of Gastric Vascular Ectasia: A Case Report and Review of Clinical Correlates

The etiology of gastric antral vascular ectasia (GAVE) and hyperplastic polyps (HP) is not fully understood, but there is no known overlap. We report a case of gastroduodenal HP arising in a patient treated for GAVE.

Clinicopathological review of 18 cases of liver allografts lost due to bile duct necrosis

Clinical, radiographic, and pathological features of 18 patients with biliary necrosis in their explanted liver allografts were reviewed. Twelve patients were men and ages ranged from 27 to 72 years. Indications for initial liver transplant (LT) were viral hepatitis (n = 7), steatohepatitic cirrhosis (n = 3), cryptogenic cirrhosis (n = 3), secondary sclerosing cholangitis (n = 2), primary sclerosing cholangitis (n = 1), biliary atresia (n = 1), and nodular regenerative hyperplasia (n = 1). Donor age ranged from 16 to 75 years. Duct-to-duct biliary anastomoses were fashioned in 13 cases; warm and cold ischemia times were not significantly different from general LT population. Seventeen allograft biopsies after recirculation had no significant findings. Post-LT, clinical and radiographic evaluation indicated biliary strictures (n = 7), bile leak (n = 7), intrahepatic abscess (n = 1), and duodenal perforation (n = 1). Radiographic vascular studies suggested hepatic arterial thrombosis or stenosis in 11 cases. Biopsies prior to retransplantation were performed on 17 patients and showed acute rejection (n = 10), biliary outflow impairment (n = 4), normal histology (n = 2), and centrilobular necrosis (n = 1). Retransplantation was performed 14 to 334 days after initial LT. Pathological examination of explants revealed perihilar duct necrosis in all cases, with bacterial colonies (n = 10) and fungal organisms (n = 2). Arterial thrombi were seen in 10 cases, and two had prominent arteriosclerosis. Infarction and centrilobular necrosis were seen in 9 and 13 cases, respectively. Four explants showed features of biliary outflow impairment. Twelve patients were alive 6 to 18 months following retransplantation. We conclude that post-LT biliary necrosis is associated with ischemia, and such a complication is rarely evident in allograft biopsies. Biliary and vascular imaging studies are essential in evaluating patients for this complication.

Mating success of males with and without wing patch in Drosophila biarmipes

Some males of D. biarmipes--synonym of D. rajasekari and D. raychaudhuri have a black patch on the wing. The patch extends from the apical margin of wing to the third longitudinal vein. Field and laboratory studies have been carried out in D. biarmipes to study role of male's wing patch in mating success. The field study shows that nature favors D. biarmipes males with patch. Although males without patch mated, males with patch have higher mating success suggesting the role of wing patch during courtship. Further, among mating males, males with patch had longer wings than males without patch. During courtship, males with patch oriented and mated faster; performed courtship acts such as tapping, scissoring, vibration, licking and twist dance more times than males without patch in both competitive and non-competitive situations. The results indicate that there is a casual relationship between the presence of wing patch, mating speed and success. Also there is a correlation between presence of wing patch, size of the flies and mating success.

Hepatitis C-related posttransplant plasma cell proliferative disorder with hepatitis C virus in neoplastic plasma cells: a new posttransplant disease entity?

Plasma cell proliferative disorder (PCPD) developed in two patients with actively replicating hepatitis C virus (HCV) in neoplastic plasma cells after orthotopic liver transplantation for HCV-related end-stage liver disease. PCPD was confined to the transplanted liver and was associated with monoclonal proteins in blood. Bone marrow biopsy did not show any evidence of PCPD. Epstein-Barr virus was not detected by in situ hybridization in either case. In situ hybridization for HCV RNA with sense and antisense probes in liver biopsy specimens showed signals in neoplastic plasma cells as well as in hepatocytes. We suggest that our patients had posttransplant PCPD resulting from HCV. It may represent a new posttransplant disease entity different from previously described posttransplant lymphoproliferative disorder. The findings raise intriguing questions about the role of HCV in PCPDs in patients with chronic HCV infection.

Review of 31 Cases of Morphologic Hepatitis in Liver Transplant Patients Not Related to Disease Recurrence

AIMS

We examined the clinical and pathologic features of morphologic hepatitis occurring after liver transplantation (LT) that is unrelated to disease recurrence.

METHODS

Between February 1998 and December 2003, 704 primary LTs were performed at our center. Patients transplanted for diagnoses with low risk of disease recurrence were considered for our study (n = 282). Those with hepatitis C (HCV), hepatitis B (HBV), primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), and autoimmune hepatitis (AIH) were excluded. Those with morphologic hepatitis comprised our case series and had medical records reviewed for clinical associations, duration, and outcome.

RESULTS

Thirty-one cases were identified. They were transplanted for cryptogenic cirrhosis (n = 13), steatohepatitis (n = 12), alpha-1-antitrypsin deficiency (n = 3), tumor (n = 2), and acetaminophen toxicity (n = 1); 22 cases (67%) presented within the first 8 months post-LT (range, 0.5-72 months). Histological activity was mild in 19 and moderate in 12. Associated conditions were identified in 19 patients (57%) with 3 categories being identified: probable drug toxicity (n = 7), systemic infection (n = 4), and mechanical or hemodynamic abnormalities (n = 8). Of the 25 cases that underwent follow-up biopsy 2 to 32 months (mean, 15.5 months) after the index biopsy, 10 cases had resolution and 15 cases had persistence of the infiltrate. One patient had evidence of de novo HBV infection.

CONCLUSIONS

Morphologic hepatitis occurred in 11% of patients at low risk for disease recurrence. Associated conditions could be grouped into three categories: drug toxicity, systemic infection, and mechanical or hemodynamic factors. Most cases did not appear to progress or improved over time, with no allograft loss occurring as a result of chronic hepatitis.

Photodynamic therapy and endoscopic metal stent placement for esophageal papillomatosis associated with squamous cell carcinoma

Esophageal squamous papillomatosis is a rare condition associated with human papilloma virus infection and has been complicated by the development of squamous cell carcinoma. Photodynamic therapy using porfimer sodium has been used for the treatment of esophageal cancer but has not been utilized in the treatment of esophageal squamous papillomatosis. We report here the first case of papillomatosis and obstructing squamous cell carcinoma of the esophagus palliated with porfimer sodium photodynamic therapy indicating successful photosensitizer uptake in papilloma-laden tissue. Extensive debulking of papilloma and tumor allowed esophageal recanalization and placement of a self-expanding metal stent for long-term dysphagia palliation. This unique case highlights the combined use of endoscopic techniques for optimal treatment results.

Mitogen-activated protein kinases: specificity of response to dose of ionizing radiation in liver

Ionizing radiation is known to activate both the cytotoxic stress-activated kinases (SAPK/JNK, p38) and the cytoprotective mitogen-activated protein kinases (MAPKs, ERKs), which send divergent signals to the nucleus. However, all these kinases could not be activated simultaneously and at all the doses. An attempt has been made in this study to establish the dose and temporal response of these kinases with a view to establish the identity of the transcription factors that remain activated because only these will be translated into an effect. The study indicates that the stress-activated kinases (SAPK/JNK and p38) are activated by very low doses (0.1 Gy) of ionizing radiation. An induction of expression of MKK4, precursor to SAPK and p38, was found at lower doses (0.1-0.5 Gy). However, the cytoprotective ERK2 showed a progressive increase in expression with dose, except at 3 Gy where it shows a marginal decline. The stress-activated kinases show an increased expression or activation at early periods, unlike ERK2, which shows a prolonged response to stimuli. This study reveals that in the in vivo condition there is a chronological order of activation of the kinases and a dose-dependent activation. The activations of the cytoplasmic kinases and the transcription factors, Elk-1 and c-Jun, both show prolonged activation and maximum response at high doses.