3D tumor angiogenesis models: recent advances and challenges.

The development of blood vessels, referred to as angiogenesis, is an intricate process regulated spatially and temporally through a delicate balance between the qualitative and quantitative expression of pro and anti-angiogenic molecules. As angiogenesis is a prerequisite for solid tumors to grow and metastasize, a variety of tumor angiogenesis models have been formulated to better understand the underlying mechanisms and associated clinical applications. Studies have demonstrated independent mechanisms inducing angiogenesis in tumors such as (a) HIF-1/VEGF mediated paracrine interactions between a cancer cell and endothelial cells, (b) recruitment of progenitor endothelial cells, and (c) vasculogenic mimicry. Moreover, single-cell sequencing technologies have indicated endothelial cell heterogeneity among organ systems including tumor tissues. However, existing angiogenesis models often rely upon normal endothelial cells which significantly differ from tumor endothelial cells exhibiting distinct (epi)genetic and metabolic signatures. Besides, the existence of intra-individual variations necessitates the development of improved tumor vascular model systems for personalized medicine. In the present review, we summarize recent advancements of 3D tumor vascular model systems which include (a) tissue engineering-based tumor models; (b) vascular organoid models, and (c) organ-on-chips and their importance in replicating the tumor angiogenesis along with the associated challenges to design improved models.

Microbial Community Distribution and Core Microbiome in Successive Wound Grades of Individuals with Diabetic Foot Ulcers.

Diabetic foot ulcer (DFU) is a major complication of diabetes with high morbidity and mortality rates. The pathogenesis of DFUs is governed by a complex milieu of environmental and host factors. The empirical treatment is initially based on wound severity since culturing and profiling the antibiotic sensitivity of wound-associated microbes is time-consuming. Hence, a thorough and rapid analysis of the microbial landscape is a major requirement toward devising evidence-based interventions. Toward this, 122 wound (100 diabetic and 22 nondiabetic) samples were sampled for their bacterial community structure using both culture-based and next-generation 16S rRNA-based metagenomics approach. Both the approaches showed that the Gram-negative microbes were more abundant in the wound microbiome. The core microbiome consisted of bacterial genera, including Alcaligenes, Pseudomonas, Burkholderia, and Corynebacterium in decreasing order of average relative abundance. Despite the heterogenous nature and extensive sharing of microbes, an inherent community structure was apparent, as revealed by a cluster analysis based on Euclidean distances. Facultative anaerobes (26.5%) were predominant in Wagner grade 5, while strict anaerobes were abundant in Wagner grade 1 (26%). A nonmetric dimensional scaling analysis could not clearly discriminate samples based on HbA1c levels. Sequencing approach revealed the presence of major culturable species even in samples with no bacterial growth in culture-based approach. Our study indicates that (i) the composition of core microbial community varies with wound severity, (ii) polymicrobial species distribution is individual specific, and (iii) antibiotic susceptibility varies with individuals. Our study suggests the need to evolve better-personalized care for better wound management therapies.IMPORTANCE Chronic nonhealing diabetic foot ulcers (DFUs) are a serious complication of diabetes and are further exacerbated by bacterial colonization. The microbial burden in the wound of each individual displays diverse morphological and physiological characteristics with unique patterns of host-pathogen interactions, antibiotic resistance, and virulence. Treatment involves empirical decisions until definitive results on the causative wound pathogens and their antibiotic susceptibility profiles are available. Hence, there is a need for rapid and accurate detection of these polymicrobial communities for effective wound management. Deciphering microbial communities will aid clinicians to tailor their treatment specifically to the microbes prevalent in the DFU at the time of assessment. This may reduce DFUs associated morbidity and mortality while impeding the rise of multidrug-resistant microbes.

Nodular Fasciitis - Fine Needle Aspiration Cytology Diagnosis and Its Pitfalls, with Review of Literature.

BACKGROUND AND OBJECTIVE: Nodular fasciitis (NF) is a self-limiting, transient neo- plasm composed of fibroblasts and myofibroblasts. Since it regresses spontaneously, diagnosis by fine needle aspiration (FNA) cytology plays a major role in its management. METHODS: We present a series of 8 cases with either FNA or biopsy diagnosis ofNF, and study the major cytological features with a review of literature on diagnostic criteria and its pitfalls. RESULTS AND CONCLUSION: The 8 cases occurred in patients between the age of 14 to 72 years, with equal sex distribution. FNA diagnosis concurred in 4 cases. Causes of wrong diagnosis included lack of clinical information and paucicellular smear. FNA cytology is an important tool in the diagnosis of nodular fasciitis, in appropriate clinico-radiologicalsetting.

Idiopathic granulomatous mastitis: an institutional experience.

OBJECTIVE: To study idiopathic granulomatous mastitis with respect to its various clinical features, etiologic factors, treatment modalities and complications. MATERIAL AND METHODS: Retrospective study of all patients who were diagnosed with idiopathic granulomatous mastitis from 1st January 2006 to 31st December 2014 at Kasturba Hospital, Manipal, India (a tertiary care referral centre). The research was performed according to the World Medical Association Declaration of Helsinki. Informed consent was taken from the patient before invasive procedures including surgery. Data was analysed using the Statistical Package for Social Sciences version 16.0 wherever appropriate. RESULTS: 73 patients diagnosed with idiopathic granulomatous mastitis during the time period were included. One patient was a male (1.37%), rest were all females (98.63%). The mean age of presentation was 32.67 years (range 23 to 66 years). 70 patients (95.89%) were parous females. Average duration since last childbirth was 4.6 years (range: 3 months to 33 years). 8 patients (10.95%) were lactating. History of oral contraceptive pill use was present in 40 patients (54.79%). The right breast was affected in 44 patients (60.27%), and the left breast in 29 patients (39.73%). None of the patients had bilateral disease. The most common symptom was a painless lump (61.64%). Rest of the patients (38.36%) presented with features of a breast abscess. 19 out of 39 FNACs done (48.72%) were positive for granulomatous mastitis. 59 were primarily managed surgically (lumpectomy/wide excision-33, incision & drainage-26). One patient was treated primarily with prednisolone. 13 patients did not receive specific treatment, and were only kept on regular follow-up. Patients managed with lumpectomy/wide excision had the least rate of complications & recurrence (18.18%). CONCLUSION: Patients with idiopathic granulomatous mastitis can present with a wide variety of symptoms which mimic other more common conditions. Surgical management in the form of wide excision appears to provide the best long term outcome in patients with idiopathic granulomatous mastitis.

Evaluation of efficacy of thermographic breast imaging in breast cancer: A pilot study.

BACKGROUND: Thermographic imaging is a non-invasive and radiation free imaging modality that measures the infrared radiation released by the body. Recently, there is a renewed interest regarding the scope of thermal imaging for breast cancer. OBJECTIVE: To evaluate the efficacy of thermographic breast imaging in detecting breast cancer. METHODS: A Prospective observational study was carried out from January 2014 to December 2014 at Kasturba Hospital, Manipal, India. Patients in whom breast cancer was confirmed on FNAC or biopsy, were included in the study and further evaluated with thermographic imaging of the breast. RESULTS: 65 patients with FNAC or biopsy proven breast carcinoma were included in the study. Using thermographic imaging, malignancy was accurately detected in 60 patients (92.31%). Mammography was able to detect malignancy in 62 out of the 65 patients (95.38%). Thermography was able to detect malignancy in all 3 cases in which conventional mammography missed it. CONCLUSION: Thermography may have a role in detection of breast cancer. However, it is too early to recommend thermographic imaging as a standard imaging modality for breast cancer. Larger studies are required to evaluate the usefulness of thermography in diagnosis and/or screening of breast cancer.

Successful management of pleural lipoma by video-assisted thoracoscopic surgery.

Pleural lipoma is an extremely rare clinical entity. Symptomatic pleural lipoma is rarer. We report a case of symptomatic pleural lipoma which was successfully managed by video-assisted thoracoscopic surgery (VATS). A brief review of relevant literature has been included in the article.

Ileocolic mucormycosis - an unusual cause of a mass in the right iliac fossa.

Mucormycosis is a relatively uncommon, aggressive and lethal mycosis. Fungi from the order Mucorales are the etiological agents of mucormycosis. The condition is more common among the immunocompromised, diabetic patients with ketoacidosis and people with iron overload syndromes. Diagnosis of mucormycosis requires a high index of suspicion regarding the possibility of the condition in high-risk individuals. Timely diagnosis is critical to survival and minimization of morbidity. A favourable outcome is possible only if appropriate treatment is initiated as early as possible. The present article reports a case of ileocolic mucormycosis involving a patient with chronic renal failure and familial hyperuricemia.

La mucormycose est une mycose relativement rare, agressive et fatale. Les champignons de l'ordre Mucorales en sont les agents étiologiques. La pathologie est plus courante chez les patients diabétiques immunosupprimés ayant une acidocétose et chez les personnes ayant des syndromes de surcharge en fer. Pour poser un diagnostic de mucormycose, il faut un fort indice de suspicion quant à sa possibilité chez les personnes très vulnérables. Il est essentiel de poser le diagnostic rapidement pour assurer la survie et réduire au minimum la morbidité. Si on veut favoriser une issue positive, il faut absolument amorcer un traitement convenable le plus tôt possible. Le présent article traite d'un cas de mucormycose iléocolique touchant un patient atteint d'insuffisance rénale chronique et d'hyperuricémie familiale.

Superior mesenteric artery syndrome secondary to brucellosis - A case report.

Superior mesenteric artery (SMA) syndrome is a rare condition characterized by duodenal obstruction due to extrinsic compression by SMA. Any condition which results in rapid, significant weight loss can cause SMA syndrome. Brucellosis is a common cause of pyrexia of unknown origin which can result in loss of appetite and weight loss. Brucellosis resulting in SMA syndrome has not been described in literature. We present a case of SMA syndrome resulting from weight loss due to brucellosis along with a brief review of relevant literature.

Open infected Achilles tendon injury--reconstruction of tendon with fascia lata graft and soft tissue cover with a reverse flow sural flap.

We present a patient with an open, infected Achilles tendon injury with a soft tissue defect of 12 cm x 5 cm and a tendon defect of 10 cm. He underwent a two-stage procedure. A first stage debridement of tendon and soft tissue was followed by a second stage tendo Achilles reconstruction using fascia lata graft and soft tissue cover with a reverse flow sural flap. He had a good functional outcome with minimal donor site morbidity.