A single cell atlas of frozen shoulder capsule identifies features associated with inflammatory fibrosis resolution

Frozen shoulder is a spontaneously self-resolving chronic inflammatory fibrotic human disease, which distinguishes the condition from most fibrotic diseases that are progressive and irreversible. Using single-cell analysis, we identify pro-inflammatory MERTKlowCD48+ macrophages and MERTK + LYVE1 + MRC1+ macrophages enriched for negative regulators of inflammation which co-exist in frozen shoulder capsule tissues. Micro-cultures of patient-derived cells identify integrin-mediated cell-matrix interactions between MERTK+ macrophages and pro-resolving DKK3+ and POSTN+ fibroblasts, suggesting that matrix remodelling plays a role in frozen shoulder resolution. Cross-tissue analysis reveals a shared gene expression cassette between shoulder capsule MERTK+ macrophages and a respective population enriched in synovial tissues of rheumatoid arthritis patients in disease remission, supporting the concept that MERTK+ macrophages mediate resolution of inflammation and fibrosis. Single-cell transcriptomic profiling and spatial analysis of human foetal shoulder tissues identify MERTK + LYVE1 + MRC1+ macrophages and DKK3+ and POSTN+ fibroblast populations analogous to those in frozen shoulder, suggesting that the template to resolve fibrosis is established during shoulder development. Crosstalk between MerTK+ macrophages and pro-resolving DKK3+ and POSTN+ fibroblasts could facilitate resolution of frozen shoulder, providing a basis for potential therapeutic resolution of persistent fibrotic diseases.

AL amyloidosis presenting with isolated lumbosacral radiculoplexus neuropathy

A 45-year-old man presented with an isolated sciatic mononeuropathy, which then evolved into a lumbosacral radiculoplexus neuropathy. His initial symptoms included lower limb pain, sensory disturbance and later weakness, without autonomic dysfunction. Neurophysiology suggested a postganglionic neuropathy. MR and ultrasound scans of the thighs showed right sciatic nerve thickening, and CSF analysis showed albuminocytological dissociation. Fluorodeoxyglucose positron emission tomography (FDG PET) was unremarkable. He then developed orthostatic symptoms and urinary disturbance, and was found to have an IgM paraprotein. Fat aspirate, cardiac and whole-body imaging found no amyloid deposition, and genetic testing for transthyretin amyloidosis was negative. A bone marrow biopsy was unremarkable. However, neuropathology review of a proximal, fascicular nerve biopsy identified a lambda chain-restricted plasma cell population with positive Congo red staining, leading to a diagnosis of peripheral nerve restricted amyloid light amyloidosis. We discuss the diagnostic approach to this case from the perspectives of neurology, neurophysiology, radiology and neuropathology.

Vulnerable newborn types: analysis of subnational, population-based birth cohorts for 541 285 live births in 23 countries, 2000-2021

OBJECTIVE

To examine prevalence of novel newborn types among 541 285 live births in 23 countries from 2000 to 2021.

DESIGN

Descriptive multi-country secondary data analysis.

SETTING

Subnational, population-based birth cohort studies (n = 45) in 23 low- and middle-income countries (LMICs) spanning 2000-2021.

POPULATION

Liveborn infants.

METHODS

Subnational, population-based studies with high-quality birth outcome data from LMICs were invited to join the Vulnerable Newborn Measurement Collaboration. We defined distinct newborn types using gestational age (preterm [PT], term [T]), birthweight for gestational age using INTERGROWTH-21st standards (small for gestational age [SGA], appropriate for gestational age [AGA] or large for gestational age [LGA]), and birthweight (low birthweight, LBW [<2500 g], nonLBW) as ten types (using all three outcomes), six types (by excluding the birthweight categorisation), and four types (by collapsing the AGA and LGA categories). We defined small types as those with at least one classification of LBW, PT or SGA. We presented study characteristics, participant characteristics, data missingness, and prevalence of newborn types by region and study.

RESULTS

Among 541 285 live births, 476 939 (88.1%) had non-missing and plausible values for gestational age, birthweight and sex required to construct the newborn types. The median prevalences of ten types across studies were T+AGA+nonLBW (58.0%), T+LGA+nonLBW (3.3%), T+AGA+LBW (0.5%), T+SGA+nonLBW (14.2%), T+SGA+LBW (7.1%), PT+LGA+nonLBW (1.6%), PT+LGA+LBW (0.2%), PT+AGA+nonLBW (3.7%), PT+AGA+LBW (3.6%) and PT+SGA+LBW (1.0%). The median prevalence of small types (six types, 37.6%) varied across studies and within regions and was higher in Southern Asia (52.4%) than in Sub-Saharan Africa (34.9%).

CONCLUSIONS

Further investigation is needed to describe the mortality risks associated with newborn types and understand the implications of this framework for local targeting of interventions to prevent adverse pregnancy outcomes in LMICs.

Study on Serum Calcium Level in Patients with Chronic Kidney Disease

Patients often present with chronic kidney disease (CKD) complicated with hypocalcaemia. Lower serum calcium is independently associated with chronic kidney disease. Aim of this study was to assess of serum calcium level in chronic kidney diseased patients in order to compare this parameter with healthy subjects. This analytical type of cross-sectional study was carried out in the Physiology department, Mymensingh Medical College, Mymensingh, Bangladesh from July 2018 to June 2019. A total number of 200 subjects, age range 30-70 year were included in this study. Among 200 subjects, 100 healthy were taken as control group (Group I) and 100 chronic kidney diseased patients were taken as study group (Group II). Control group (Group I) subdivided into male healthy subject (Group IA) and female healthy subject (Group IB). Also study group (Group II) subdivided into male chronic kidney diseased patient (Group IIA) and female chronic kidney diseased patient (Group IIB). The results were calculated and analyzed by using SPSS version-21. Expression of data as mean±SE and statistical significance of difference among the group was calculated by unpaired student's 't' test. In this study we found that mean±SE serum calcium of Group IA and Group IIA were 9.60±0.09mg/dl & 8.04±0.03mg/dl respectively. The mean±SE serum calcium of Group IB and Group IIB were 9.38±0.096mg/dl & 8.19±0.05mg/dl respectively. Serum calcium was significantly decreased in study groups in comparison with control groups (p<0.001). By this study we therefore recommended that routine estimation of this parameter is important for prevention of complication related to chronic kidney disease for leading a healthy life.

Relationship between Body Mass Index and Serum Alanine Transaminase Concentration in Obese Female

The serum Alanine Transaminase (ALT) activity has been regarded as a reliable and sensitive marker of liver disease. In the context of obesity ALT may also be a good indicator of overall health. Obesity has been reported as a risk factor associated with elevation of ALT, which is a surrogate marker of Non-alcoholic fatty liver disease (NAFLD). Elevated ALT may correlate with the severity of NAFLD in obese female. This study was done to evaluate the changes of serum ALT in obese female age ranged 30-60 years in comparison to normal healthy female of same age. At the same time we can know the relationship between body mass index and serum ALT concentration in obese female. This analytical cross-sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh from January 2020 to December 2020. A total number of 100 female subjects were included in this study. Among them fifty (50) normal healthy female were taken as control group (Group I) and fifty (50) obese female were taken as study group (Group II). The level of serum ALT was determined by Ultra violet (UV) method. Data were expressed as mean±SD and statistical significance of difference among the group was calculated by unpaired Student's 't' test. Pearson's correlation coefficient test was done to find the correlation of serum ALT with BMI by using SPSS (version 21.0). During interpretation of results, p values of <0.001 were considered as statistically highly significant. In this study, serum level of ALT was significantly higher (p<0.001) in obese female compared to those of healthy control female. In addition, there is a positive correlation of serum ALT with BMI. From the results of the present study, it can be concluded that, elevated ALT was significantly associated with high BMI as well as with other feature of NAFLD.

159 Antibiotic Omissions: A Missed Dose Means A Missed Chance to Save A Life! Is E-Prescribing the Answer?

Omissions and delay in antimicrobial therapy are common in acute hospitals with an untowrds impact on patient outcomes resulting in harm and prolong stay. We carried out a Quality Improvement Project (QIP) assessing 2 interventions in PDSA cycles to improve situation. This QIP was done in 3 stages and involved about 80 patients over 7 months. We collected data regarding antibiotic omissions on 3 random separate days which gave baseline omission rate. This was 8.5% and quite higher than the national average (5.3%). The reason for the omissions was not documented on the drug kardexes on most occasions. Initial intervention included staff education, verbally and through posters. Post intervention data was collected again on 3 separate days. This showed improvement and the omission rate fell from 8.5% to 5.6%. The percentage of omissions with no code written reduced from 56.25% to 18.18%. The second intervention included participation in EPMA (Electronic prescribing and medicines administration) pilot on the ward. Post EPMA, the omission rate reduced to 4.59%. All omissions had now a code written. The phenomenon of Antibiotic Omissions is an open challenge and its consequences are serious. We can conclude from our study that educational measures though effective are likely to be short-lived.Therefore, it can be asserted that Electronic prescribing is appropriate solution for antibiotic omissions and it also opens up new horizons for patient safety.

Plasmonic enhancement of aqueous processed organic photovoltaics

Sodium tungsten bronze (Na_xWO₃) is a promising alternative plasmonic material to nanoparticulate gold due to its strong plasmonic resonances in both the visible and near-infrared (NIR) regions. Additional benefits include its simple production either as a bulk or a nanoparticle material at a relatively low cost. In this work, plasmonic Na_xWO₃ nanoparticles were introduced and mixed into the nanoparticulate zinc oxide electron transport layer of a water processed poly(3-hexylthiophene):phenyl-C₆₁-butyric acid methyl ester (P3HT:PC₆₁BM) nanoparticle (NP) based organic photovoltaic device (NP-OPV). The power conversion efficiency of NP-OPV devices with Na_xWO₃ NPs added was found to improve by around 35% compared to the control devices, attributed to improved light absorption, resulting in an enhanced short circuit current and fill factor.

Plasmonic Na_xWO₃ nanoparticles were introduced to aqueous processed organic photovoltaics with 35% device enhancement.

Dual-energy CT in the diagnosis of occult acute scaphoid injury: a direct comparison with MRI

Objectives

Scaphoid injuries occult on plain radiography often require further imaging for definitive diagnosis. We investigate the utility of dual-energy computed tomography (DECT) for the detection of acute bone marrow oedema and fracture of scaphoid compared to MRI.

Materials and methods

Twenty patients who presented acutely (without prior injury) to the emergency department with clinically suspected occult scaphoid fracture and had MRI of the wrist were prospectively recruited to have DECT (GE Revolution CT). Material decomposition images of the water-calcium base pair were generated and assessed in conjunction with the monochromatic images to permit correlation of marrow signal changes with any cortical disruption for fracture confirmation. The assessment was performed by two musculoskeletal radiologists blinded from MRI results. The statistical difference of MRI and reviewers’ detection of acute bone oedema (1 = present, 0 = absent) was performed using the Friedman test (SPSS v.16).

Results

MRI showed acute scaphoid fracture and/or bone marrow oedema in 14/20 patients of which 6 also had cortical disruption. On DECT, reviewer A identified oedema in 13 and cortical disruption in 10 patients while reviewer B identified oedema in 10 and cortical disruption in seven of the 14 MRI positive patients. No statistically significant difference in oedema detection on MRI and reviewers of DECT (p value 0.61) but DECT was more sensitive at detecting cortical disruption.

Conclusion

DECT has the capability to detect acute scaphoid oedema in addition to cortical fractures. However, compared to MRI, DECT has lower contrast resolution and less sensitive in the detection of mild oedema.

Key Points

• Dual-energy CT is able to detect acute traumatic scaphoid marrow oedema.

• Dual-energy CT has greater detection rate of scaphoid fractures than MRI.

• Dual-energy CT is an alternative to MRI for occult scaphoid injury.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00330-020-07604-z.

Morton's neuroma: review of anatomy, pathomechanism, and imaging

Morton's neuroma is a commonly encountered cause of forefoot pain, which may limit weight-bearing activities and footwear choices. Although the aetiology and pathomechanism of this condition is controversial, the histological endpoint is well established as benign perineural fibrosis of a common plantar digital nerve, typically within the third intermetatarsal space. The diagnosis of Morton's neuroma is mainly based on characteristic symptoms and clinical findings, but may be confirmed by ultrasonography. Although ultrasound is a highly accurate diagnostic tool for Morton's neuroma, it is subject to interoperator variability due to differences in technique and level of experience. In this paper, the authors review the anatomy of the common plantar digital nerves and surrounding structures in the forefoot, which are deemed relevant to the understanding of Morton's neuroma, especially from a sonographic point of view. Several theories of the pathomechanism of Morton's neuroma are briefly discussed. The main purpose of this article is to illustrate the ultrasound techniques for evaluating Morton's neuroma and performing ultrasound-guided corticosteroid injections.

The anterolateral ligament in acute knee trauma: patterns of injury on MR imaging

OBJECTIVE

To delineate the spectrum of traumatic knee injuries associated with injury of the anterolateral ligament of the knee (ALL).

MATERIALS AND METHODS

A retrospective review of 200 MRI scans undertaken for acute knee trauma was performed. In each scan, the ALL was scored as normal, sprained or torn. The menisci, ligaments and tendons of each knee were also assessed.

RESULTS

The mean age was 27.4 years (range, 9-69 years), and 71.5% (n = 143) of the patients were male. The anterolateral ligament (ALL) was graded as ruptured in 17 cases (8.5%), sprained in 58 cases (29%), normal in 116 cases (58%) and not visible in 9 cases (4.5%). Of cases with injury of the ALL (n = 75), there was associated injury of the anterior cruciate ligament (ACL) in 61 cases, medial collateral ligament (MCL) in 51 cases, popliteofibular ligament (PFL) in 29 cases, medial meniscus in 29 cases, lateral meniscus in 24 cases, lateral collateral ligament in 9 cases, posterior cruciate ligament in 8 cases, biceps femoris in 5 cases, popliteus tendon in 4 cases and fluid or oedema was seen adjacent to the iliotibial band in 59 cases. No cases of isolated ALL injury were seen.

CONCLUSIONS

ALL injury is not uncommon in acute knee trauma and is typically associated with significant internal derangement of the knee, especially anterior cruciate ligament rupture, ITB sprain, medial collateral ligament injury, meniscal tears and injury to the popliteofibular ligament.

Ectopic breast tissue presenting as an enlarging abdominal mass

Ectopic breast tissue (EBT) is an uncommon entity that occurs in about 6% of the population, more frequently in Asian people. It manifests as a nonspecific soft tissue mass that can develop in any location along the "milk-line," with the axilla being the most frequently reported location. As with normal breast tissue, both benign and malignant processes can arise from EBT. Therefore, imaging plays an important role in the adequate assessment of these soft tissue lesions, characterizing its shape, borders, internal components, and vascularity, as well as its relationship with the deep fascia and adjacent structures. Here we present a case of a 33-year-old female Indian patient with an 8 cm soft tissue mass in the upper left abdominal quadrant with a recent increase in size. Clinical and imagiological evaluation were nonspecific but established the nonaggressive behavior of the lesion. To ultimately exclude malignancy, an ultrasound-guided biopsy was performed providing the histological diagnosis of EBT. This case report illustrates the value of clinical, radiological, and histological correlation in the approach of indeterminate soft-tissue tumors, with special focus on lesions in close proximity to the native breasts, where EBT should not be forgotten amongst differentials.

An epidemiological profile of chronic obstructive pulmonary disease: A community-based study in Delhi

BACKGROUND

Different definitions used for chronic obstructive pulmonary disease (COPD) preclude getting reliable prevalence estimates. Study objective was to find the prevalence of COPD as per standard Global Initiative for Chronic Obstructive Lung Disease definition, risk factors associated, and treatment seeking in adults >30 years.

METHODOLOGY

Community-based cross-sectional study was conducted in Delhi, among 1200 adults, selected by systematic random sampling. Pretested questionnaire was used to interview all subjects and screen for symptoms of COPD. Postbronchodilator spirometry was done to confirm COPD.

STATISTICAL ANALYSIS

Adjusted odds ratio (aOR) was calculated by multivariable analysis to examine the association of risk factors with COPD. Receiver operating characteristic (ROC) curve was developed to assess predictability.

RESULTS

The prevalence of COPD was 10.1% (95% confidence interval [CI] 8.5, 11.9%). Tobacco smoking was the strongest risk factor associated (aOR 9.48; 95% CI 4.22, 14.13) followed by environmental tobacco smoke (ETS), occupational exposure, age, and biomass fuel. Each pack-year of smoking increased 15% risk of COPD. Ex-smokers had 63% lesser risk compared to current smokers. Clinical allergy seems to preclude COPD (aOR 0.06; 95% CI 0.02, 0.37). ROC analysis showed 94.38% of the COPD variability can be assessed by this model (sensitivity 57.4%; positive predictive value 93.3%). Only 48% patients were on treatment. Treatment continuation was impeded by its cost.

CONCLUSION

COPD prevalence in the region of Delhi, India, is high, and our case-finding population study identified a high rate of patients who were not on any treatment. Our study adds to creating awareness on the importance of smoking cessation, early diagnosis of COPD, and the need for regular treatment.

Non-competitive cyclic peptides for targeting enzyme-substrate complexes

Affinity reagents are of central importance for selectively identifying proteins and investigating their interactions. We report on the development and use of cyclic peptides, identified by mRNA display-based RaPID methodology, that are selective for, and tight binders of, the human hypoxia inducible factor prolyl hydroxylases (PHDs) - enzymes crucial in hypoxia sensing. Biophysical analyses reveal the cyclic peptides to bind in a distinct site, away from the enzyme active site pocket, enabling conservation of substrate binding and catalysis. A biotinylated cyclic peptide captures not only the PHDs, but also their primary substrate hypoxia inducible factor HIF1-α. Our work highlights the potential for tight, non-active site binding cyclic peptides to act as promising affinity reagents for studying protein-protein interactions.

The role of global and regional DNA methylation and histone modifications in glycemic traits and type 2 diabetes: A systematic review

BACKGROUND

New evidence suggests the potential involvement of epigenetic mechanisms in type 2 diabetes (T2D) as a crucial interface between the effects of genetic predisposition and environmental influences.

AIM

To systematically review studies investigating the association between epigenetic marks (DNA methylation and histone modifications) with T2D and glycemic traits (glucose and insulin levels, insulin resistance measured by HOMA-IR).

METHOD AND RESULTS

Six bibliographic databases (Embase.com, Medline (Ovid), Web-of-Science, PubMed, Cochrane Central and Google Scholar) were screened until 28th August 2015. We included randomized controlled trials, cohort, case-control and cross-sectional studies in humans that examined the association between epigenetic marks (global, candidate or genome-wide methylation of DNA and histone modifications) with T2D, glucose and insulin levels and insulin metabolism. Of the initially identified 3879 references, 53 articles, based on 47 unique studies met our inclusion criteria. Overall, data were available on 10,823 participants, with a total of 3358 T2D cases. There was no consistent evidence for an association between global DNA-methylation with T2D, glucose, insulin and insulin resistance. The studies reported epigenetic regulation of several candidate genes for diabetes susceptibility in blood cells, muscle, adipose tissue and placenta to be related with T2D without any general overlap between them. Histone modifications in relation to T2D were reported only in 3 observational studies.

CONCLUSIONS AND RELEVANCE

Current evidence supports an association between epigenetic marks and T2D. However, overall evidence is limited, highlighting the need for further larger-scale and prospective investigations to establish whether epigenetic marks may influence the risk of developing T2D.

Ab initio studies of phoshorene island single electron transistor

Phosphorene is a newly unveiled two-dimensional crystal with immense potential for nanoelectronic and optoelectronic applications. Its unique electronic structure and two dimensionality also present opportunities for single electron devices. Here we report the behaviour of a single electron transistor (SET) made of a phosphorene island, explored for the first time using ab initio calculations. We find that the band gap and the charging energy decrease monotonically with increasing layer numbers due to weak quantum confinement. When compared to two other novel 2D crystals such as graphene and MoS2, our investigation reveals larger adsorption energies of gas molecules on phosphorene, which indicates better a sensing ability. The calculated charge stability diagrams show distinct changes in the presence of an individual molecule which can be applied to detect the presence of different molecules with sensitivity at a single molecular level. The higher charging energies of the molecules within the SET display operational viability at room temperature, which is promising for possible ultra sensitive detection applications.

Allergic Rhinitis: A neglected disease - A community based assessment among adults in Delhi

BACKGROUND AND OBJECTIVES

Allergic Rhinitis is rather erroneously viewed as a trivial disease. It is important in that it can significantly affect quality of life. There is paucity of community based prevalence studies on the disease in India. This study was planned to assess the prevalence of allergic rhinitis in adults, the proportion of asthmatics among them, risk factors associated and treatment seeking behaviour among the patients.

MATERIALS AND METHODS

A community based cross sectional study was conducted in Mehrauli, South Delhi among 1200 adults, aged 30 years and over selected by systematic random sampling from two randomly selected wards. A pre-tested questionnaire was used to collect information regarding symptoms, risk factors and treatment seeking behaviour. Allergic Rhinitis was diagnosed as per ARIA guidelines. Spirometry was done to diagnose asthma among them. Multivariate logistic regression analysis was done to find the association of risk factors with disease.

RESULTS

The prevalence of Allergic Rhinitis was found to be 11% (132 subjects) and 33.3% (44 patients) among them also had asthma. Overcrowding (aOR = 6.4), absence of cross-ventilation (aOR = 2.5), occupational exposure to dust/ smoke (aOR = 2.1), tobacco smoking (aOR = 2.1), family history of allergic diseases (aOR = 2.7) and clinical allergy (aOR = 10.2) were found to be independent risk factors associated with Rhinitis. More patients of Rhinitis with asthma (75%) took treatment, relative to those without asthma (40%) who, mostly relied on home remedies (42%) or, did not seek any treatment (18%) (P = 0.031). Interpretations and Conclusion: The burden of Allergic Rhinitis is high with a considerable overlap with asthma. These allergic diseases and emphasize the importance of early and regular treatment.

Sugars and adiposity: the long-term effects of consuming added and naturally occurring sugars in foods and in beverages

OBJECTIVE

The aim of this study was to determine if the association with adiposity varies by the type (added vs. naturally occurring) and form (liquid vs. solid) of dietary sugars consumed.

METHODS

Data from the 10-year National Heart, Lung, and Blood Institute (NHLBI) Growth and Health Study (n = 2,021 girls aged 9-10 years at baseline; n = 5,156 paired observations) were used. Using mixed linear models, 1-year changes in sugar intake, body mass index z-score (BMIz) and waist circumference (WC) were assessed.

RESULTS

The results showed mean daily added sugar (AS) intake: 10.3 tsp (41 g) liquid; 11.6 tsp (46 g) solid and naturally occurring sugar intake: 2.6 tsp (10 g) liquid; 2.2 tsp (9 g) solid. Before total energy adjustment, each additional teaspoon of liquid AS was associated with a 0.222-mm increase in WC (p = 0.0003) and a 0.002 increase in BMIz (p = 0.003). Each teaspoon of solid AS was associated with a 0.126-mm increase in WC (p = 0.03) and a 0.001 increase in BMIz (p = 0.03). Adjusting for total energy, this association was maintained only between liquid AS and WC among all and between solid AS and WC among those overweight/obese only. There was no significant association with naturally occurring sugar.

CONCLUSIONS

These findings demonstrate to suggest a positive association between AS intake (liquid and solid) and BMI that is mediated by total energy intake and an association with WC that is independent of it.

Clinical Profile of Peripheral Neuropathy in Leprosy

The objectives of the study were to see the association of peripheral neuropathy in leprosy and to find out the clinical profile of peripheral neuropathy and disability status in leprosy. It was descriptive type of cross sectional study was conducted among the cases of leprosy attended in the out-patient departments of neurology, Mymensingh Medical College Hospital (MMCH) and Mymensingh tuberculosis and leprosy hospital that fulfilled the inclusion criteria were included in this study, during the study period of January 2010 to December 2011.In this study of 62 cases revealed that leprosy is more common in male (71%) people and 21% leprosy patient had contact with known case of leprosy. Leprosy causes peripheral neuropathy (61.3%). Duration of occurrence of peripheral neuropathy was prolonged (>6 month) in most of the patients (47.4%) and the disease progression was also slow (63.2%). Numbness was complained by 89.4% patients and 65.8% subjects complained of weakness of limbs. Deformities and ulcers were present in 26.3% and 50% of patients respectively. Ulnar nerve (43.6%), Lateral popliteal nerve (41.9%), Posterior tibial nerve (41.9%) and Great auricular nerve (17.7%) were the most commonly involved thickened peripheral nerves. The rate of visible physical impairment (WHO Grade 2 disability) among people affected by leprosy in feet was 27.4% and in hands was 16.1%. The position and vibration sense was found to normal all patients of peripheral neuropathy.

Patterns of relapse in extrapulmonary small cell carcinoma: retrospective analysis of outcomes from two cancer centres

OBJECTIVES

We conducted a retrospective review of patients with extrapulmonary small cell carcinomas (EPSCCs) to explore the distribution, treatments, patterns of relapse and outcomes by primary site.

SETTING

We have reviewed the outcomes of one of the largest data sets of consecutive patients with EPSCC identified from two major cancer centres.

PARTICIPANTS

Consecutive patients with a histopathological diagnosis of EPSCC from the two institutions were retrospectively identified.

PRIMARY AND SECONDARY OUTCOME MEASURES

Outcomes were evaluated including stage at presentation, treatments given, sites of relapse, time to distant relapse, progression-free survival and overall survival (OS).

RESULTS

From a total 159 patients, 114 received first-line chemotherapy, 80.5% being platinum-based. Response rate was 48%. Commonest primary sites were genitourinary and gynaecological. 44% of patients presented with metastatic disease. 55.9% relapsed with liver the commonest site, whereas only 2.5% developed brain metastases. Median OS was 13.4 months for all patients, 7.6 months and 19.5 months for those with metastatic and non-metastatic disease, respectively. Gynaecological and head and neck patients had significantly better OS compared to gastrointestinal patients.

CONCLUSIONS

EPSCCs demonstrate high response rates to chemotherapy and high rates of distant metastases. Primary sites may influence prognosis, and survival is optimal with a radical strategy. Brain metastases are rare and we therefore do not recommend prophylactic cranial irradiation.

Catalytic pyrolysis of lignocellulosic bio-packaging (jute) waste – kinetics using lumped and DAE (distributed activation energy) models and pyro-oil characterization

The present study concentrates on the catalytic pyrolysis of a waste bio-packaging material, namely, jute, under iso-thermal and non-isothermal conditions using a 50 mm diameter and 164 mm long semi-batch pyrolyzer and a TGA set-up, respectively.

Disentangling in vivo the effects of iron content and atrophy on the ageing human brain

Evidence from magnetic resonance imaging (MRI) studies shows that healthy aging is associated with profound changes in cortical and subcortical brain structures. The reliable delineation of cortex and basal ganglia using automated computational anatomy methods based on T1-weighted images remains challenging, which results in controversies in the literature. In this study we use quantitative MRI (qMRI) to gain an insight into the microstructural mechanisms underlying tissue ageing and look for potential interactions between ageing and brain tissue properties to assess their impact on automated tissue classification. To this end we acquired maps of longitudinal relaxation rate R1, effective transverse relaxation rate R2* and magnetization transfer - MT, from healthy subjects (n=96, aged 21-88 years) using a well-established multi-parameter mapping qMRI protocol. Within the framework of voxel-based quantification we find higher grey matter volume in basal ganglia, cerebellar dentate and prefrontal cortex when tissue classification is based on MT maps compared with T1 maps. These discrepancies between grey matter volume estimates can be attributed to R2* - a surrogate marker of iron concentration, and further modulation by an interaction between R2* and age, both in cortical and subcortical areas. We interpret our findings as direct evidence for the impact of ageing-related brain tissue property changes on automated tissue classification of brain structures using SPM12. Computational anatomy studies of ageing and neurodegeneration should acknowledge these effects, particularly when inferring about underlying pathophysiology from regional cortex and basal ganglia volume changes.

First Report of Sudden Death Syndrome of Soybean Caused by Fusarium virguliforme in South Dakota

During the 2012 soybean growing season, soybean (Glycine max (L.) Merr.) plants submitted to South Dakota State University Plant Diagnostic Clinic exhibited symptoms typical of sudden death syndrome (SDS) caused by Fusarium virguliforme (Aoki, O'Donnell, Homma, & Lattanzi). In the 2013 soybean growing season, a soybean survey targeting SDS-symptomatic plants was carried out in 20 eastern South Dakota counties between July and August when plants were at the beginning seed and beginning seed maturity growth stages. Soybean plants with SDS-like symptoms were found in eight counties at very low incidence (<3%). Approximately 15 plants per field that had symptoms resembling those of SDS were collected and fungal isolations were made. Leaf symptoms included some necrosis and slight interveinal chlorosis. The tap roots also had areas of necrosis and the vascular system was brown. Isolations were made from the symptomatic tap root sections. The tap root sections were surface sterilized using a 10% NaOCl for 1 min and then rinsed once for 1 min with sterile water before being placed on an acidified potato dextrose agar. Slow growing isolates of F. virguliforme with characteristic blue sporodochia were isolated from these symptomatic plant roots. The conidia were banana-shaped with 4 to 5 septae, a typical characteristic for F. virguliforme. Koch's postulates were performed using a modified layer test method (2). Briefly, the conidia from the isolate (PL1200158 from Yankton county, SD) was used to infest sterile sorghum seed. In the greenhouse, three holes were punched in the bottom of 32 oz. Styrofoam cups. The bottom 11 cm of the cup was then filled with vermiculite. A 2-cm layer of fully colonized sorghum seed was placed on top of the vermiculite. This was covered with a 2- to 5-cm layer of vermiculite. Fifteen soybean cv. Sloan seeds were placed on top of this vermiculite layer and covered with approximately 2 cm more vermiculite for each cup for a total of 12 cups. The temperature in the greenhouse was approximately 23°C with 14 h of light and 10 h of darkness for 21 days. Leaves began to show necrosis and the roots had brown, rotted lesions. Symptoms did not develop on non-inoculated controls. After 5 weeks under greenhouse conditions, the roots of infected plants were removed, surface sterilized, and F. virguliforme was re-isolated. SDS was further confirmed by PCR using primers designed from FvTox1 gene. FvTox1, a single-copy gene, has been found to be highly species specific and primers from this region delineate F. virguliforme from other Fusarium species (1). The PCR product size matched that of expected size. The PCR product was sequenced and a BLAST search matched (100%) only the sequences of F. virguliforme FvTox1 gene (GenBank Accession No. JF440964). The confirmation of SDS in eight counties in South Dakota indicates that SDS may be widespread and a concern for soybean production when conditions are conducive for SDS to develop. References: (1) G. C. Y. Mbofung, et al. Plant Dis. 95:1420, 2011. (2) A. F. Schmitthenner and R. G. Bhatt. Useful Methods for Studying Phytophthora in the Laboratory. Special Circular, Ohio Agricultural Research and Development Center, Wooster, OH, 1994.

Optimistic update bias increases in older age

BACKGROUND

Healthy older adults report greater well-being and life satisfaction than their younger counterparts. One potential explanation for this is enhanced optimism. We tested the influence of age on optimistic and pessimistic beliefs about the future and the associated structural neural correlates.

METHOD

Eighteen young and 18 healthy older adults performed a belief updating paradigm, measuring differences in updating beliefs for desirable and undesirable information about future negative events. These measures were related to regional brain volume, focusing on the anterior cingulate cortex (ACC) because this region is strongly linked to a positivity bias in older age.

RESULTS

We demonstrate an age-related reduction in updating beliefs when older adults are faced with undesirable, but not desirable, information about negative events. This greater 'update bias' in older age persisted even after controlling for a variety of variables including subjective rating scales and poorer overall memory. A structural brain correlate of this greater 'update bias' was evident in greater grey matter volume in the dorsal ACC in older but not in young adults.

CONCLUSIONS

We show a greater update bias in healthy older age. The link between this bias and relative volume of the ACC suggests a shared mechanism with an age-related positivity bias. Older adults frequently have to make important decisions relating to personal, health and financial issues. Our findings have wider behavioural implications in these contexts because an enhanced optimistic update bias may skew such real-world decision making.

A Hybrid Atomistic Approach for the Mechanics of Deoxyribonucleic Acid Molecules

The paper proposes a new modeling approach for the prediction and analysis of the mechanical properties in deoxyribonucleic acid (DNA) molecules based on a hybrid atomistic-finite element continuum representation. The model takes into account of the complex geometry of the DNA strands, a structural mechanics representation of the atomic bonds existing in the molecules and the mass distribution of the atoms by using a lumped parameter model. A 13-base-pair DNA model is used to illustrate the proposed approach. The properties of the equivalent bond elements used to represent the DNA model have been derived. The natural frequencies, vibration mode shapes, and equivalent continuum mechanical properties of the DNA strand are obtained. The results from our model compare well with a high-fidelity molecular mechanics simulation and existing MD and experimental data from open literature.

The use of molecular imaging combined with genomic techniques to understand the heterogeneity in cancer metastasis

Tumour heterogeneity has, in recent times, come to play a vital role in how we understand and treat cancers; however, the clinical translation of this has lagged behind advances in research. Although significant advancements in oncological management have been made, personalized care remains an elusive goal. Inter- and intratumour heterogeneity, particularly in the clinical setting, has been difficult to quantify and therefore to treat. The histological quantification of heterogeneity of tumours can be a logistical and clinical challenge. The ability to examine not just the whole tumour but also all the molecular variations of metastatic disease in a patient is obviously difficult with current histological techniques. Advances in imaging techniques and novel applications, alongside our understanding of tumour heterogeneity, have opened up a plethora of non-invasive biomarker potential to examine tumours, their heterogeneity and the clinical translation. This review will focus on how various imaging methods that allow for quantification of metastatic tumour heterogeneity, along with the potential of developing imaging, integrated with other in vitro diagnostic approaches such as genomics and exosome analyses, have the potential role as a non-invasive biomarker for guiding the treatment algorithm.

Concomitant myasthenia gravis and macroprolactinoma: the immunomodulatory role of prolactin and its potential therapeutic use

Considerable evidence attests to the role of the hypothalamic-pituitary endocrine axis (HPA) in the maintenance of normal immunocompetence. The immune and neuroendocrine systems are integrally linked and coordinated with bidirectional communication maintaining immune balance. Any disturbance of the normal function of the HPA may significantly alter native immunocompetence and therefore be associated with the development of disorders which have a clearly established autoimmune basis. Molecular and functional evidence shows prolactin, produced by the anterior pituitary, to be a cytokine, exerting its effect via both paracrine and endocrine mechanisms [1]. Its involvement in the activation of multiple immune responses may adversely upregulate certain autoimmune diseases. Myasthenia gravis (MG) has long been recognized as an autoimmune disorder. In this mini review, we present the coterminous presentation of MG and prolactin-secreting macroadenoma. We review published cases in the world literature, discuss pathological mechanism, and consider future targeted therapies.

Comparison of broiler performance using Plantain (Plantago lanceolata L.), Bio-Sel-E and commercial diet

An experiment was conducted to determine the impact of Plantain (PL), Bio-Sel-E and commercial broiler diet on the growth performance, feed conversion ratio, performance index and carcass yield of broiler. A total of 160 day old broiler chicks (Cobb-500) were randomly distributed into four groups with four replication in each group and having 10 birds in each replication. Basal diet was used for group 1 (control), Basal diet was supplemented with PL (0.5% of DM basis) and Bio-Sel-E (5g/50 birds in drinking water) for group 2 and 3 respectively and for group 4 used commercial broiler diet (Quality Feed Ltd.). Total feed intake was similar among the groups. Feed conversion ratios of PL diet, Bio-Sel-E diet, and commercial broiler diet were comparable, and were lower (P<0.05) than the control diet. Significantly higher body weight gain and performance index were found in PL, Bio-Sel-E and commercial broiler diet groups than control diet. The dressing yield of PL diet and commercial broiler diet were comparable, and they were higher (P<0.05) than Control diet and Bio-Sel-E diet. It could be concluded that the Supplementation of 0.5% PL in the diet had positive effect on growth, feed intake, feed conversion ratio, performance index and carcass characteristics of broilers almost similar of Bio-Sel-E and commercial broiler diet. DOI: http://dx.doi.org/10.3329/bjas.v42i2.18492 Bang. J. Anim. Sci. 2013. 42 (2): 123-130

Can stormwater harvesting restore pre-development flows in urban catchments in South East Queensland?

Increases in the impervious area due to urbanisation have been shown to have negative impacts on the physical and ecological condition of streams, primarily through increased volume and frequency of runoff. The harvesting and detention of runoff has a potential to decrease this impact. This paper describes the effects of urbanisation on catchment flow and of stormwater harvesting on reducing those adverse impacts on a stream in South East Queensland (SEQ), Australia. A largely undeveloped catchment located southeast of Brisbane city was calibrated and validated using the Stormwater Management Model (SWMM). This model was used to investigate the effect of a range of future increases in urbanisation (represented by impervious area) on stream hydrology as well as the potential of stormwater harvesting to return the catchments to predevelopment flow conditions. Stormwater harvesting was modelled according to flow frequency measures specified in current SEQ development guidelines. These guidelines stipulate the capture of the first 10 mm of runoff from impervious areas of 0-40% and the first 15 mm from impervious areas of 40% or greater for urban developments. We found that increases in the impervious area resulted in increases in the mean, frequency and duration of high flows, and an increase in the mean rate of rise and fall for storm events in the catchment. However, the predevelopment (non-urbanised) flow distribution was very flashy in comparison with all urbanised scenarios; i.e. it had the quickest response to rainfall indicated by a high rate of rise to and fall from peak flow volume, followed by a return to zero flow conditions. Capturing the runoff according to the development guidelines resulted in a reduction in flow towards the flow distribution of a lower impervious area, however this was insufficient to meet predevelopment conditions. This suggests a stronger influence of impervious areas in this catchment on the volume of runoff than flow frequency measures are able to ameliorate.

Effective mechanical properties of hexagonal boron nitride nanosheets

We propose an analytical formulation to extract from energy equivalence principles the equivalent thickness and in-plane mechanical properties (tensile and shear rigidity, and Poisson's ratio) of hexagonal boron nitride (h-BN) nanosheets. The model developed provides not only very good agreement with existing data available in the open literature from experimental, density functional theory (DFT) and molecular dynamics (MD) simulations, but also highlights the specific deformation mechanisms existing in boron nitride sheets, and their difference with carbon-based graphitic systems.

The Indian and Nepalese programmes of indoor residual spraying for the elimination of visceral leishmaniasis: performance and effectiveness

Although, when applied under controlled conditions in India and Nepal, indoor residual spraying (IRS) has been found to reduce sandfly densities significantly, it is not known if IRS will be as effective when applied generally in these countries, via the national programmes for the elimination of visceral leishmaniasis. The potential benefits and limitations of national IRS programmes for the control of sandflies were therefore evaluated in the districts of Vaishali (in the Indian state of Bihar), Sarlahi (in Nepal) and Sunsari (also in Nepal). The use of technical guidelines, levels of knowledge and skills related to spraying operations, insecticide bio-availability on the sprayed surfaces, concentrations of the insecticide on the walls of sprayed houses, insecticide resistance, and the effectiveness of spraying, in terms of reducing sandfly densities within sprayed houses (compared with those found in unsprayed sentinel houses or control villages) were all explored. It was observed that IRS programme managers, at district and subdistrict levels in India and Nepal, used the relevant technical guidelines and were familiar with the procedures for IRS operation. The performance of the spraying activities, however, showed important deficiencies. The results of bio-assays and the chemical analysis of samples from sprayed walls indicated substandard spraying and suboptimal concentrations of insecticide on sprayed surfaces. This was particularly obvious at one of the Nepali study sites (Sunsari district), where no significant vector reduction was achieved. Sandfly resistance to the insecticide used in India (DDT) was widespread but the potential vectors in Nepal remained very susceptible towards a pyrethroid similar to the one used there. The overall short-term effectiveness of IRS was found to be satisfactory in two of the three study sites (in terms of reduction in the densities of the sandfly vectors). Unfortunately, the medium-term evaluation, conducted 5 months after spraying, was probably made invalid by flooding or lime plastering in the study areas. Preparation for, and the monitoring of, the IRS operations against sandfly populations in India and Nepal need to be improved.

Vibration and symmetry-breaking of boron nitride nanotubes

The unique features of axial, torsional, transverse and radial breathing vibrations are captured for armchair and zigzag singlewalled boron nitride nanotubes (BNNTs) based on molecular mechanics simulations and continuum mechanics theories. Equivalent Young's modulus 1 TPa and shear modulus 0.4 TPa are obtained independent of the chirality of BNNTs. In particular, a distorted optimized structure is observed for the first time for BNNTs with sufficiently large diameter and length. It is found that the deformed structures result in behaviours of BNNTs deviating from those of classical columns/beams. Such symmetry-breaking could also exert significant impacts on the structural instability (buckling) and electronic properties of BNNTs that are sensitive to the structural symmetry.