Platelet indices as prognostic markers of ischemic stroke and their correlation with lipid profile

OBJECTIVE

Stroke is the cause of one in eight deaths and adds a dreadful burden of disability for the patients. Ischemic stroke is caused by a loss of blood supply to brain due to sudden occlusion of the arterial system, caused by an emboli or thrombus. Our aim was to correlate platelet indices, total cholesterol ratio, and various comorbidities with stroke.

METHODS

A cross-sectional study was performed from 2020-2022 with 132 stroke patients admitted to the SRM Medical College Hospital and Research Center, India. Detailed clinical examination was performed. Venous blood samples were drawn at the time of admission to estimate platelet count, mean platelet volume (MPV), platelet distribution width (PDW), and platelet crit (PCT). Overnight fasting serum samples were obtained for lipid profiling.

RESULTS

Among the participants in our study, maximum belonged to the age group 50 to 59 years (34.1%) and majority were males (79.5%). In terms of comorbidities, 85.6% of the participants had diabetes, 42.4% had hypertension and 22% had dyslipaedemia. All platelet and lipid parameters were found to be similar between patients with and without comorbidities. While all platelet indices increased with the increase in severity of stroke, we found that PDW is most reliable in predicting stroke with an area under the receiver operator curve of 0.942, with a sensitivity and specificity of 92.1% at cut-off value 14. All platelet parameters also significantly increased in patients with severe lipid dysfuction, establishing a correlation between lipid profile, platelet indices and stroke.

CONCULSION

We found a significant relationship between all platelet parameters and stroke. Thus, we believe that patients with risk factors for atherosclerosis should have their platelet indices assessed periodically before the development of cerebrovascular events. Furthermore, dyslipidemia if properly treated, is a modifiable risk factor for stroke, which can decrease morbidity and mortality leading to a healthier society.

DIPG-56. Development and application of a novel antibody against CD99 as a therapeutic strategy in Diffuse Midline Glioma

BACKGROUND: There is an unmet need to identify novel targeted therapies for Diffuse Midline glioma (DMG) which is currently a refractory disease. Recently, we identified high expression of a cell surface antigen, CD99 in H3K27M-mutant expressing DMGs compared to other normal brain counterparts. We developed a novel chimeric CD99 antibody and tested the anti-tumor efficacy of this antibody in vitro and in vivo. METHOD: Bio-legend cell-surface screening was performed in H3K27M-mutant and WT DMG cells. Functional role of CD99 was studied using CD99 proficient and depleted tumors. Designed and synthesized CD99 antibody with a new binding sequence on a human IgG scaffold and performed cell toxicity and growth-inhibitory studies using DMG tumor and normal cells. We also performed these studies in combination with radiation. Multiple patient-derived orthotopic DMG xenograft models was used to test the antibody efficacy. Different antibody delivery routes, that are clinically relevant were investigated. RESULTS: CD99 expression is transcriptionally regulated by H3K27M and is enriched on the cell surface of K27M tumors compared to WT DMG tumors. Our new CD99 antibody (10D1 clone) significantly reduced DIPG tumor cell proliferation in vitro. Intravenous infusion of this antibody in DIPG tumor bearing mice showed complete clearance of tumor that prolonged animal survival suggesting the enhanced anti-tumor efficacy of 10D1-CD99 and importantly, its ability in crossing the blood-brain-barrier and reaching the pons target site. Loco-regional administration of 10D1 showed similar anti-tumor effects even at much reduced antibody concentrations while toxicity to CD99-expressing T cells was minimum. Radiation increased CD99 expression and enhanced the cytotoxic effect of 10D1-CD99. CONCLUSION: We have developed a novel CNS penetrant CD99 antibody that is an attractive therapeutic strategy in treating DMG. 10D1 is currently in development as a therapeutic.

A systematic review of interventions and outcomes in lung cancer metastases to the spine

Seventy percent of cancer patients will have metastatic bone disease, most commonly in the vertebra. Prognosis of metastatic lung cancer is poor and treatment is mostly palliative. To-date, there is no systematic review on the ideal treatment for lung cancer with spinal metastases in regards to mortality. Literature searches were performed based on PRISMA guidelines for systematic review. Thirty-nine studies comprising 1925 patients treated for spinal metastases of lung cancer met inclusion criteria. All analyses were performed using SAS and SPSS. Data were analyzed for meaningful comparisons of baseline patient characteristics, primary cancer type, metastatic lesion characteristics, treatment modality, and clinical and radiologic outcomes. Significantly greater mean survival length was seen in the non-surgical group (8.5 months, SD 6.6, SEM 0.17) compared to the surgical group (7.5 months, SD 4.5, SEM 0.25; p = 0.013). There was no statistically significant survival difference between different types of primary lung cancer: NSCLC (8.3 months, SD 13.8, SEM 0.91) and SCLC (7.0 months, SD 4.6, SEM 0.46; p = 0.36). Number of vertebral levels involved per lesion also did not exhibit significant difference: single lesion (11.3 months, SD 6.8, SEM 2.2) and multiple lesions (13.8 months, SD 15.7, SEM 3.6; p = 0.64). For patients with symptomatic spinal metastases from lung cancer, non-operative approaches experience significantly better survival outcomes (p = 0.013). Future clinical studies are needed to determine the best treatment algorithm to help maximize outcomes and minimize mortality in metastatic lung cancer.

Left inferior vena cava from the perspective of laparoscopic donor surgeon: Anatomic considerations and surgical implications

Renal vascular aberrations are not uncommon cause for rejection of living kidney donors. While screening a donor for laparoscopic nephrectomy, we encountered a rare, yet important aberration in the form of left-sided inferior vena cava (IVC). There was an initial dilemma regarding the acceptability of the donor and which side kidney to select for donation. Scant literature is available on this particular clinical scenario, and only after a detailed study of the embryology and anatomy of IVC, were we able to make an informed choice. This article highlights the surgical anatomy and clinical implications of this rare condition from the perspective of laparoscopic donor surgeon.

Predictors of Non-adherence to Immunosuppressive Therapy in Asian Liver Transplant Recipients

BACKGROUND

Adherence to immunosuppressive medications has been shown to affect post-transplant outcomes. We aimed to determine the level of adherence to immunosuppressive therapy in liver transplant (LT) recipients and to elucidate factors associated with it, as well as patient preferences on the dosing schedule.

METHODS

LT recipients were recruited during transplant clinic follow-up. A validated Morisky 8-item questionnaire was completed by patients to assess their adherence to immunosuppressive therapy. Adherence was determined by the sum of the responses to the questionnaire. Low, medium, and high adherence were defined by a Morisky score of >2, 1 to 2, and 0, respectively. Data on the patient's socio-economic and clinical background, dosing schedule of immunosuppressant medications, and patient preferences were included in the questionnaire.

RESULTS

A total of 107 LT recipients were approached and 75 completed the questionnaire. The majority of patients (48/74, 64.9%) preferred a once-daily medication regimen. The proportion of high adherence was 24/75 (32.0%), medium adherence was 51/75 (42.7%), and low adherence was 19/75 (25.3%). Multivariate analysis showed younger age and post-transplant duration >5 years as independent predictors for low adherence. Among low-adherence patients, 16/19 (84.2%) patients were on a twice-daily regimen, and, of these, 14/16 (87.5%) preferred their medications to be reduced to once daily.

CONCLUSIONS

A significant proportion (68%) of LT recipients had low to moderate adherence to medications, with younger age and longer post-transplant duration of >5 years as independent predictors. Early identification of at-risk patients is essential to allow implementation of measures to improve adherence. Simplifying medication regimens to once daily is a potential way to improve adherence.

A case report of an intracaval extrathoracic solitary fibrous tumour

Solitary fibrous tumours are infrequent neoplasms based in the pleura that are predominantly benign with malignant pathology and behaviour described in 10-36% of cases. Extrathoracic solitary fibrous tumours (ESFTs) have been considered separately to their intrathoracic counterparts and comprise a third of all solitary fibrous tumours. The extrathoracic location was identified as an adverse prognostic factor for local recurrence but not for metastatic disease. So far, there have not been any reports of solitary fibrous tumours demonstrating caval infiltration. We present a case of a benign ESFT infiltrating into the perirenal inferior vena cava. Together with extrauterine leiomyomas, ESFTs should also be considered as a differential diagnosis for the rare benign lesions invading the inferior vena cava.

A case report of an intracaval extrathoracic solitary fibrous tumour

Solitary fibrous tumours are infrequent neoplasms based in the pleura that are predominantly benign with malignant pathology and behaviour described in 10-36% of cases. Extrathoracic solitary fibrous tumours (ESFTs) have been considered separately to their intrathoracic counterparts and comprise a third of all solitary fibrous tumours. The extrathoracic location was identified as an adverse prognostic factor for local recurrence but not for metastatic disease. So far, there have not been any reports of solitary fibrous tumours demonstrating caval infiltration. We present a case of a benign ESFT infiltrating into the perirenal inferior vena cava. Together with extrauterine leiomyomas, ESFTs should also be considered as a differential diagnosis for the rare benign lesions invading the inferior vena cava.

Hypopituitarism as unusual sequelae to central nervous system tuberculosis

Neurological tuberculosis can very rarely involve the hypophysis cerebri. We report a case of an eighteen year old female who presented with five months duration of generalised apathy, secondary amenorrhea and weight gain. She was on irregular treatment for tuberculosis of the central nervous system for the last five months. Neuroimaging revealed sellar and suprasellar tuberculomas and communicating hydrocephalus requiring emergency decompression. Endocrinological investigation showed hypopituitarism manifesting as pituitary hypothyroidism, hypocortisolism, hypogonadotropic hypogonadism, and hyperprolactinemia. Restarting anti-tuberculosis treatment, hormone replacement therapy, and a ventriculo-peritoneal shunt surgery led to remarkable improvement in the general condition of the patient.

Ring Opening Metathesis Polymerization of Polyoctahedral Oligomeric Silsesquioxanes (POSS) Incorporated Oxanorbornene-5,6-dicarboximide: Synthesis, Characterization, and Surface Morphology of Copolymers

The synthesis and characterization of N-propyl-POSS-7-oxanorbornene-5,6-dicarboximide (NPONDI) and N-3-(trifluoromethyl)phenyl-7-oxanorbornene-5,6-dicarboximide (TFNDI) was reported. The synthesis of the POSS-based (co)polymers were accomplished by ring opening metathesis polymerization (ROMP). The monomers and polymers were characterized using FT-IR, 1H-, 13C-, 29Si-NMR, and GPC techniques. Thermal properties of TFNDI-NPONDI copolymers were evaluated by differential scanning calorimetry (DSC) and thermogravimetric analysis (TGA). Transmission electron microscopic (TEM) analysis of optically transparent and flexible copolymer films revealed the presence of 50 nm-sized POSS agglomerates. Atomic force microscopy analysis of the film surface exhibited a modest increase in surface roughness of TFNDI-NPONDI copolymers as compared with homopoly[N-3(trifluoromethyl)phenyl-7-oxanorbornene-5,6-dicarboximide] (HTFNDI). The POSS incorporated polymers such as 1NPONDI, 2NPONDI, and 3NPONDI increased the hydrophobicity as compared with HTFNDI. This was measured by static contact angle analysis. The study focussed on the dispersion, surface morphology, and the microstructure of POSS in TFNDI-NPONDI copolymer as determined by scanning electron microscopy (SEM).

Sustainable leprosy related disability care within integrated general health services: findings from Salem District, India

The main focus of leprosy control has been case detection and treatment delivery with relative neglect of prevention of disability. Absence of reliable data and lack of research have added to the problem. This raised concerns about the capacity of the general health system to address the needs of people living with leprosy-related disabilities. In this prospective study appropriate services for people living with leprosy-related disabilities were introduced in the form of self-care training, guidance and monitoring by the general health staff facilitated by a non-governmental organisation leprosy centre in a district in south India with a population of 3.1 million (estimated in 2005). The staff identified 1232 people with leprosy-related disabilities and trained them in self-care. Follow-up assessments indicated that 86% were found to be practising self-care regularly and all the 239 general health workers were found to be actively involved. The most heartening outcome was the healing of plantar ulcers in 70% of people at the 1-year follow up. This intervention is sustainable because of the simplicity of the procedures and the involvement of all health staff including supervisors.

Virtual hepatic resection using three-dimensional reconstruction of helical computed tomography angioportograms

OBJECTIVE

To establish the accuracy of virtual hepatic resection using three-dimensional (3D) models constructed from computed tomography angioportography (CTAP) images in determining the liver volume (LV) resected during resectional liver surgery.

SUMMARY BACKGROUND DATA

The ability to measure LV before surgery could be useful in determining the extent and nature of hepatic resection. Accurate assessment of LV and an estimate of liver function may also allow prediction of postoperative liver failure in patients undergoing resection, assist in volume-enhancing embolization procedures, help with the planning of staged hepatic resection for bilobar disease, and aid in selection of living-related liver donors.

METHODS

A retrospective study was conducted involving 27 patients scheduled for liver resection. Using mapping technology, 3D models were constructed from helical CTAP images. From these 3D models, tumor volume, total LV, and functional LV were calculated and were compared with body weight. The 3D liver models were subjected to a virtual hepatectomy along established anatomical planes, and the resected LV was calculated. The resected volume predicted by radiologists (unaware of the actual weight) was compared with the specimen weight measured after actual surgical resection.

RESULTS

A significant correlation was found between body weight and functional LV but not total LV. The computer prediction of resected LV after virtual hepatectomy of 3D models compared well with resected liver weight.

CONCLUSION

Virtual hepatectomy of 3D CTAP reconstructed images provides an accurate prediction of liver mass removed during subsequent hepatic resection. The authors intend to combine this technology with an assessment of liver function to attempt to predict patients at risk for liver failure after hepatic resection.

Distribution of colorectal liver metastases in patients referred for hepatic resection

BACKGROUND

There is a perception that streamline flow of blood in the portal vein may influence the anatomic distribution of liver metastases, depending on the site of the primary tumor. It has previously been reported that cancers arising in the right colon are distributed to the right lobe of the liver 10 times more commonly than to the left lobe, whereas liver metastases from tumors arising from the left colon and rectum are believed to be distributed homogenously.

METHODS

Data were collected prospectively on the anatomic site of hepatic metastases in 207 patients with colorectal metastases referred for consideration for surgery. Anatomic site was established by a combination of computed tomography scanning and either laparoscopic or intraoperative ultrasonography. The site of the primary tumor was known in all cases.

RESULTS

A total of 708 metastases were identified, of which 67% were in the right hemiliver and 33% were in the left. The ratio of involvement of the right and left hemilivers by metastases arising from right colon tumors was 2. 02:1 and for left colon tumors 2.1:1. When patients with unilobar disease only were considered, the ratio of involvement of the right and left hemilivers increased to 2.9:1, but again no difference was evident that depended on the site of the primary tumor.

CONCLUSIONS

This study could not find any evidence to support a differential pattern of metastasis within the liver dependent on the location of the primary colorectal carcinoma.

Does the subspecialty of the surgeon performing primary colonic resection influence the outcome of patients with hepatic metastases referred for resection?

OBJECTIVE

To compare resection rates and outcome of patients subsequently referred with hepatic metastases whose initial colon cancers were resected by surgeons with different specialty interests.

SUMMARY BACKGROUND DATA

Variation in practice among noncolorectal specialist surgeons has led to recommendations that colorectal cancers should be treated by surgeons trained in colorectal surgery or surgical oncology.

METHODS

The resectability of metastases, the frequency and pattern of recurrence after resection, and the length of survival were compared in patients referred to a single center for resection of colorectal hepatic metastases. The patients were divided into those whose colorectal resection had been performed by general surgeons (GS) with other subspecialty interests (n = 108) or by colorectal specialists (CS; n = 122). RESULTS No differences were observed with respect to age, sex, tumor stage, site of primary tumor, or frequency of synchronous metastases. Comparing the GS group with the CS group, resectable disease was identified in 26% versus 66%, with tumor recurrence after a median follow-up of 19 months in 75% versus 44%, respectively. Recurrences involving bowel or lymph nodes accounted for 55% versus 24% of all recurrences, with respective median survivals of 14 months versus 26 months.

CONCLUSION

Fewer patients referred by general surgeons had resectable liver disease. After surgery, recurrent tumor was more likely to develop in the GS group; their overall outcome was worse than that of the CS group. This observation is partly explained by a lower local recurrence rate in the CS group.

Pattern regulation in the ventral histoblasts of the housefly: induction of sternal pattern abnormalities by mechanical wounding of larval epidermal cells

In higher Diptera, two nests of diploid cells called the ventral histoblasts, located one on either side of each abdominal segment among the polytene larval epidermal cells, give rise to the sternite and its surrounding pleura. During metamorphosis of the insect, these two groups of cells migrate and meet with each other in the midventral region of the developing adult. The cuticular pattern elements and pigmentation in the fifth sternite of the male housefly, when compared to those of other segments as well as the tergites of both sexes, are quite distinct. The above-mentioned features, coupled with the smaller number and predictable occurrence of one of the pattern elements in this sternite, viz, the primary forceps, help one to determine the developmental potential of the histoblast nest and the regulation of its potential which occur at the time of fusion of the two contralateral nests of this segment. A simple operation of slitting the larval epidermal cells (LEC) in a hemisegment in the vicinity of the histoblast nest or extirpation or rotation of a small rectangular piece of LEC between the ventral nest and the midventral line produced pattern abnormalities including mirror image duplication in the hemisternite. An analysis of these pattern abnormalities in the different segments and, in particular, in the fifth segment provides a dynamic picture of the formation of the median sternite. Further, these abnormalities indicate the significance of the presence of the intervening pleural cells between the confronting hemisternites under experimental conditions. Thus, each of the fifth ventral nests has the developmental potential to form more than half of the final sternite pattern. Possible mechanisms for the formation of the normal median sternite during metamorphosis and for the formation of duplicated hemisternites and their fusion products under experimental conditions are discussed in light of current models of pattern regulation.

Maternal inheritance of transcripts from three Drosophila src-related genes

The Drosophila genome contains three major sequences related to the v-src gene. Previously published molecular studies have confirmed the structural homology between v-src and two of the Drosophila sequences. We have sequenced a portion of the third v-src-related Drosophila gene and found that it also shares structural homology with vertebrate and Drosophila src-family genes. RNA sequences from each of the src genes are present in pre-blastoderm embryos indicating that they are of maternal origin. As embryogenesis proceeds, the levels of each of the src RNA sequences decline. The pre-blastoderm src gene transcripts contain poly(A) and are present on polyribosomes suggesting that they are functional mRNAs. Since the Drosophila src transcripts were maternally inherited, we also investigated their distribution in adult females. The majority of the src transcripts in adult females were contained in ovaries. Only low levels of the transcripts were detected in males. These results strongly suggest that an abundant supply of src protein is required during early embryogenesis, perhaps at the time of cellularization of the blastoderm nuclei.

Family of developmentally regulated, maternally expressed Drosophila RNA species detected by a v-myc probe

Drosophila melanogaster genomic sequences that hybridize with v-myc have been reported (B.-Z. Shilo and R. A. Weinberg, Proc. Natl. Acad. Sci. U.S.A. 78:6789-6792, 1981). We have detected Drosophila RNA sequences that also hybridize with v-myc. In an attempt to characterize these RNA sequences, we used v-myc hybridization probes to isolate Drosophila genomic segments. None of the Drosophila genomic or cDNA clones that we have isolated hybridize with the 3' exon of v-myc. Preliminary nucleotide sequence analyses have revealed sufficient homology to account for the observed hybridization between v-myc and the Drosophila clones but have failed to detect significant amino acid sequence homology. Thus is seems unlikely that the mRNA sequences or the genomic sequences that we have isolated by hybridization with v-myc represent homologs of the vertebrate myc gene. Despite the lack of structural homology between the cloned Drosophila sequences and v-myc, we have investigated the pattern of expression of those RNA species that hybridize with v-myc. Polyadenylic acid-containing transcripts of 2.7, 2.2, and 1.7 kilobases (kb) in embryos, pupae, adults, and Kc cells and an additional 1.4-kb transcript in adults were complementary to the Drosophila genomic clones and to v-myc. The 1.7- and 2.2-kb transcripts were localized on polyribosomes in Kc cells. The 1.7- and 2.2-kb transcripts were present after 45 min, 2 h, and 4 h of embryonic development, but by 16 h of development their levels had decreased by more than sixfold. During metamorphosis, two peaks of expression of the 1.7- and 2.2-kb transcripts were observed, at 6 and 72 h postpupariation. The 1.4-kb RNA species was first detected at 72 h postpupariation. In adults, the 1.7- and 2.2-kb transcripts were detected only in ovaries in females, whereas the 1.4-kb transcript was present in female nonovarian RNA and in males. These results suggest that the transcripts in early embryos are of maternal origin.

Do larval epidermal cells possess the blueprint for adult pattern in Drosophila?

When the diploid histoblasts, the precursors of adult abdominal epidermal cells, of the larva of Drosophila are deleted by gamma-radiation, the polytene larval epidermal cells survive metamorphosis and secrete cuticle and cuticular outgrowths. A comparison of the morphology of the cuticle secreted by the larval epidermal cells in the different regions of the abdominal segments to that secreted by the histoblasts of the unirradiated animal suggests that the former contain the blueprint for the pattern of landscape of the adult abdominal cuticle and possibly could provide this information to the dividing and spreading histoblasts during the normal ontogeny of the fly.

Morphogenesis of the epidermis of adult abdomen of Drosophila

Mitotic pattern in the different histoblast nests, and the temporal sequence of fusion and differentiation of these nests and spiracular anlagen resulting in the formation of the different regions of the adult abdomen of Drosophila melanogaster were studied by examining whole mount preparations and histological sections of the epidermis from closely timed developmental stages. The relationship between the boundaries of the primary (larval) and secondary (adult) segments was determined by following the points of insertion of the dorsal internal oblique muscles which persist through metamorphosis. These studies indicate that the descendants of the anterior dorsal histoblast nest form the hairy and bristled region of the tergum, while those of the anterior and posterior groups of the posterior dorsal nest give rise to the intersegmental membrane and acrotergite respectively; the ventral histoblast cells give rise to the sternum and pleural region while the spiracular anlage forms the spiracle. These findings confirm and extend the conclusions derived from genetic analysis or after experimental inductions of defects, on the lineage of the various histoblast nests.