Timing of Surgery and Pre-operative Physiological Parameters as Clinical Predictors of Surgical Outcomes in Traumatic Subaxial Cervical Spine Fractures and Dislocations.

Objective To evaluate the risk factors and outcomes in patients surgically treated for subaxial cervical spine injuries with respect of the timing of surgery and preoperative physiological parameters of the patient. Methods 26 patients with sub-axial cervical spine fractures and dislocations were enrolled. Demographic data of patients, appropriate radiological investigation, and physiological parameters like respiratory rate, blood pressure, heart rate, PaO2 and ASIA impairment scale were documented. They were divided pre-operatively into 2 groups. Group U with patients having abnormal physiological parameters and Group S including patients having physiological parameters within normal range. They were further subdivided into early and late groups according to the timing of surgery as U early , U late, S early and S late . All the patients were called for follow-up at 1, 6 and 12 months. Results 56 percent of patients in Group S had neurological improvement by one ASIA grade and a good outcome irrespective of the timing of surgery. Patients in Group U having unstable physiological parameters and undergoing early surgical intervention had poor outcomes. Conclusion This study concludes that early surgical intervention in physiologically unstable patients had a strong association as a risk factor in the final outcome of the patients in terms of mortality and morbidity. Also, no positive association of improvement in physiologically stable patients with respect to the timing of surgery could be established.

Timing of Surgery and Pre-operative Physiological Parameters as Clinical Predictors of Surgical Outcomes in Traumatic Subaxial Cervical Spine Fractures and Dislocations / Momento da cirurgia e parâmetros fisiológicos pré-operatórios como fatores preditivos clínicos de desfechos cirúrgicos em fraturas e luxações traumáticas subaxiais da coluna cervical

Abstract Objective To evaluate the risk factors and outcomes in patients surgically treated for subaxial cervical spine injuries with respect of the timing of surgery and preoperative physiological parameters of the patient. Methods 26 patients with sub-axial cervical spine fractures and dislocations were enrolled. Demographic data of patients, appropriate radiological investigation, and physiological parameters like respiratory rate, blood pressure, heart rate, PaO2 and ASIA impairment scale were documented. They were divided pre-operatively into 2 groups. Group U with patients having abnormal physiological parameters and Group S including patients having physiological parameters within normal range. They were further subdivided into early and late groups according to the timing of surgery as Uearly, Ulate, Searly and Slate. All the patients were called for follow-up at 1, 6 and 12 months. Results 56 percent of patients in Group S had neurological improvement by one ASIA grade and a good outcome irrespective of the timing of surgery. Patients in Group U having unstable physiological parameters and undergoing early surgical intervention had poor outcomes. Conclusion This study concludes that early surgical intervention in physiologically unstable patients had a strong association as a risk factor in the final outcome of the patients in terms of mortality and morbidity. Also, no positive association of improvement in physiologically stable patients with respect to the timing of surgery could be established.

Resumo Objetivo Avaliar os fatores de risco e os desfechos em indivíduos submetidos ao tratamento cirúrgico de lesões subaxiais da coluna cervical em relação ao momento da cirurgia e aos parâmetros fisiológicos pré-operatórios dos pacientes. Métodos O estudo incluiu 26 pacientes com fraturas e luxações subaxiais da coluna cervical. Dados demográficos, investigação radiológica apropriada e parâmetros fisiológicos, como frequência respiratória, pressão arterial, frequência cardíaca, pressão parcial de oxigênio (PaO2) e escalas de disfunção da American Spine Injury Association (ASIA), foram documentados. No período pré-operatório, os pacientes foram divididos em dois grupos. O grupo instável (I) continha pacientes com parâmetros fisiológicos anormais e o grupo estável (E) era composto por pacientes com parâmetros fisiológicos dentro da faixa de normalidade. Os pacientes foram ainda subdivididos em grupos de tratamento precoce e tardio de acordo com o momento da cirurgia como Iprecoce, Itardio, Eprecoce e Etardio. Todos os pacientes foram chamados para consultas de acompanhamento em 1, 6 e 12 meses. Resultados Cinquenta e seis por cento dos pacientes do grupo E apresentaram melhora neurológica em um grau ASIA e desfecho bom independentemente do momento da cirurgia. Os desfechos em pacientes do grupo I com parâmetros fisiológicos instáveis e submetidos à intervenção cirúrgica precoce foram maus. Conclusão Este estudo conclui que a intervenção cirúrgica precoce em pacientes com instabilidade fisiológica teve forte associação como fator de risco no desfecho final em termos de mortalidade e morbidade. Além disso, não foi possível estabelecer nenhuma associação positiva de melhora em pacientes com estabilidade fisiológica em relação ao momento da cirurgia.

Au-TiO2 Coated Photonic Crystal Fiber Based SPR Refractometric Sensor for Detection of Cancerous Cells.

A surface plasmon resonance (SPR) refractometric sensor based on gold (Au) and titanium dioxide (TiO2) coated Photonic Crystal Fiber (PCF) is presented for the quick detection of various types of cancerous cells. The cancerous cells and their corresponding normal cells are both considered to be liquid cells each with their unique refractive index (RI). Normally these cells are found in liquid form in the suitable media (food) required to live the cancerous/normal cell lines. Also in our detection case, liquid samples are easy to pump into the sensing channel of the proposed PCF by employing either pressure or capillary forces.The proposed PCF sensor works on the SPR principle, with the Au coating serving as the plasmonic material. This sensor is investigated using the COMSOL Multiphysics software computational tool that is based on the full-vector finite element method (FEM). A TiO2 coating has been applied to enhance adhesion between the Au layer and the PCF surface. Above the Au coating, cancerous cells samples are filled into the PCF. When the core mode of the PCF is coupled with the surface plasmon polariton (SPP) mode under the specific resonance circumstances, SPR will occur on the interface of the gold-sample cell, and in the core mode, the loss peak is observed at the resonance wavelength. Cancerous cells samples have a distinct loss peak than normal cells samples therefore the cancerous cells can be diagnosed by measuring the shift in resonance wavelength corresponding to the loss peak of cancerous and their normal cells samples. The proposed sensor may identify various cancerous cells such as MDAMB-231, MCF-7, PC12, HeLa, and Jurkat for the diagnosis of breast cancer type-1, breast cancer type-2, adrenal glands, cervical, and blood cancer respectively. The computed wavelengths sensitivities of the proposed PCF are 9428.57nm/RIU, 10714.28nm/RIU, 7571.43nm/RIU, 5500nm/RIU, and 6000nm/RIU for the MDAMB-231, MCF-7, PC12, HeLa, and Jurkat cancerous cells, respectively. However, for various cancerous cells, the maximum amplitude sensitivity varies from -1387 RIU-1 to -1599 RIU-1. Moreover, the sensor resolution ranges between 0.93 ×10-5 RIU and 1.82 ×10-5 RIU with a 0.024 maximum detection limit. Because of its improved sensing capability, the presented SPR refractometric sensor is appropriate for the early detection of cancerous cells.

The impact of curated educational videos on pathology health literacy for patients with a pancreatic, colorectal, or prostate cancer diagnosis.

Despite patients having increased access to their own electronic health record (EHR) in recent times, patients are often still not considered a primary audience of pathology reports. An alternative to in-person patient education is the use of multimedia programming to enhance health literacy. Curated video presentations designed to explain diagnosis-specific pathology terms were reviewed by a board-certified pathologist and oncologist team and then shown to patients with a primary diagnosis of either pancreatic, colorectal, or prostate cancer in-clinic; these patients then completed a secure electronic survey immediately afterwards. Seventy patients were surveyed, with 91% agreeing or strongly agreeing that the video they watched increased their understanding of the medical terms used in their pathology reports, with a corresponding average Likert score (ALS) of 4.21 (SD = 0.77, CI = ± 0.18). Furthermore, 95% agreed or strongly agreed that the video they watched both enhanced their understanding of the role of the pathologist in diagnosing cancer (ALS = 4.27; SD = 0.65, CI = ± 0.15) and reported they found the video useful (ALS = 4.27; SD = 0.53, CI = ± 0.13). Curated videos such as those utilized in this study have the potential to increase patient health literacy and inform patients of the multidisciplinary nature of cancer diagnosis.

Isolated Myeloid Sarcoma: A Diagnostic Dilemma.

Myeloid sarcoma (MS)/granulocytic sarcoma/myeloblastoma/chloroma is a rare extramedullary proliferation of blast cells of one or more myeloid lineages along with the destruction of the normal architecture of adjacent tissue. Isolated MS is a rare entity with an incidence of 0.7 out of 1 million children and 2 out of 1 million adults. Varied clinical presentation, the rarity of the diagnosis, inadequate immunophenotyping, and lack of available literature makes the disease difficult to manage. Here, we report a case of MS in a 44-year-old male with an initial presentation of testicular mass without bone marrow involvement, causing diagnostic challenges. In this case report, we discuss the pathogenesis, diagnostic challenges, and therapeutic options of MS.

Cancer cell detection by a heart-shaped dual-core photonic crystal fiber sensor.

This paper contributes a novel design of sensor with a heart-shaped dual-core photonic crystal fiber (PCF) to detect cancerous cells in human cervical, blood, adrenal glands, and breast. Cancer-infected cells and their normal cells are considered in liquid form having their own refractive indices. In the designed PCF, the two heart-shaped cores separated by a large circular air hole serve as two independent waveguides. The large circular air hole is infiltrated by sample cells from different body parts. Detection of cancer-contaminated cells by the proposed PCF is based on the mode-coupling theory. According to the mode-coupling theory, the guided optical light transmits periodically from one core to another, throughout the PCF length. During this transmission, the optical light interacts with the cancerous cell, which is filled in the center air hole of the PCF. Due to this interaction, the dip wavelength of the transmission spectrum is sensitive to the corresponding cancerous cell filled in the center air hole of the PCF. The variation in the PCF transmission spectrum for cancerous cells and their normal cells is observed by using the finite element method. The dip wavelength shift of the cancer cell in reference to its normal cell has been measured from the transmission spectrum to determine the sensing performance of the proposed sensor. The sensitivity achieved of the proposed sensor for cervical cancer cell, blood cancer cell, adrenal gland cancer cell, and breast cancer cells are 7916.67 nm/RIU, 8571.43 nm/RIU, 9285.71 nm/RIU, and 10,000 nm/RIU, respectively, with a maximum detection limit of 0.024. Therefore, the proposed PCF sensor suggests high sensitivity with a rapid cancer detection mechanism.

M. tuberculosis Secretory Protein ESAT-6 Induces Metabolic Flux Perturbations to Drive Foamy Macrophage Differentiation.

The Foamy Macrophage (FM) differentiation forms a major component of the host dependent survival axis of M. tuberculosis. The FM which are characterized by the intracellular accumulation of lipid bodies (LBs), ensure a privileged existence for the bacilli through ready provision of nutrients and by conferring protection against bactericidal pathways. The mycobacterial secretory protein ESAT-6 has been identified as the molecular mediator of the FM differentiation process although little is known about the mechanism through which it induces this process. In the present study, we show that ESAT-6 induces GLUT-1 mediated enhanced glucose uptake by macrophages which is coupled to metabolic flux perturbations in the glycolytic pathway caused by differential rates of reaction at several steps in the pathway. Two major changes identified were the simultaneous buildup of DHAP (for Triglyceride synthesis) and AcCoA (for synthesis of 3-HB, ligand for the anti-lipolytic GPR109A). We also show that part of the observed effects involve protein- protein interactions between ESAT-6 and the macrophage glycolytic enzymes, Enolase1 and Phosphoglycerate kinase1.

Do Diametric Measurements Provide Sufficient and Reliable Tumor Assessment? An Evaluation of Diametric, Areametric, and Volumetric Variability of Lung Lesion Measurements on Computerized Tomography Scans.

Diametric analysis is the standard approach utilized for tumor measurement on medical imaging. However, the availability of newer more sophisticated techniques may prove advantageous. An evaluation of diameter, area, and volume was performed on 64 different lung lesions by three trained users. These calculations were obtained using a free DICOM viewer and standardized measuring procedures. Measurement variability was then studied using relative standard deviation (RSD) and intraclass correlation. Volumetric measurements were shown to be more precise than diametric. With minimal RSD and variance between different users, volumetric analysis was demonstrated as a reliable measurement technique. Additionally, the diameters were used to calculate an estimated area and volume; thereafter the estimated area and volume were compared against the actual measured values. The results in this study showed independence of the estimated and actual values. Estimated area deviated an average of 43.5% from the actual measured, and volume deviated 88.03%. The range of this variance was widely scattered and without trend. These results suggest that diametric measurements cannot be reliably correlated to actual tumor size. Access to appropriate software capable of producing volume measurements has improved drastically and shows great potential in the clinical assessment of tumors. Its applicability merits further consideration.

Host-pathogen interactome analysis of Chikungunya virus envelope proteins E1 and E2.

The envelope proteins of Chikungunya virus (CHIKV) are known to play crucial roles in viral infection and spread. Although the role of envelope proteins in viral infection has been studied, the cellular interactors of these proteins are still elusive. In the present study, the ectodomains of CHIKV envelope proteins (E1 and E2) have been used for a high throughput yeast two-hybrid (Y2H) screening to identify the interacting host protein partners. Following a comparative analysis between the viral-host protein interaction data generated from Y2H and computational approach, five host proteins interacting with E1 and three host proteins interacting with E2 common to both datasets were identified. These associations were further verified independently by pull down and protein interaction ELISA. The identified interactions shed light on the possible cellular machinery that CHIKV might be employing during viral entry, trafficking, and evasion of immune system.

BCNU toxicity presenting with a large pericardial and pleural effusion.

BACKGROUND: Carmustine (BCNU), 1, 3-bis (2-chloroethyl)-1-nitosourea, is an alkylating agent which is commonly used as a part of conditioning regimen for autologous peripheral blood stem cell transplantation. Despite the widespread use of BCNU therapy in adults, cardiopulmonary toxicity presenting with cardiac tamponade has not been reported. CASE REPORT: We present a patient who received BCNU as part of her conditioning regimen followed by autologous peripheral blood stem cell transplantation. This patient subsequently developed bilateral upper lobe pulmonary infiltrates with bilateral pleural effusions and a large pericardial effusion which was a result of BCNU toxicity. CONCLUSIONS: Early institution of glucocorticoids for patients receiving high dose BCNU containing chemotherapeutic regimens has shown to significantly reduce BCNU induced cardio-pulmonary toxicity.

Bifunctional recombinant fusion proteins for rapid detection of antibodies to both HIV-1 and HIV-2 in whole blood.

BACKGROUND: Availability of accurate diagnostic tests has been helpful in curtailing the spread of HIV infection. Among these, simple, point of care, inexpensive tests which require only a drop of blood from finger-prick and give reliable results within minutes are a must for expansion of testing services and for reaching mobile and marginalized populations. Such tests will not only be a boon for the infrastructure-starved developing and underdeveloped countries but will also be extremely useful in developed countries where post-testing compliance is a major problem. Our laboratory has been involved in developing reagents for heamagglutination-based rapid detection of antibodies to HIV in whole blood using recombinant molecules specific for either HIV-1 or HIV-2. Since it is not required of a screening test to differentially detect HIV and HIV-2, it would useful to create a single molecule capable of simultaneous detection of both HIV-1 and HIV-2 in a drop of blood. RESULTS: The present paper describes designing, high-level expression and large-scale purification of new molecules comprising recombinant anti-RBC Fab fused to immunodominant regions of envelope sequences from both gp41 of HIV-1 and gp36 of HIV-2. These immunodominant regions of HIV envelope contain cysteine residues, which make disulfide bond and can interfere with the assembly of light chain and heavy chain fragment to make Fab molecule in vitro. To circumvent this problem, a series of fusion proteins having different combinations of native and mutant envelope sequences were constructed, purified and evaluated for their efficacy in detecting antibodies to HIV-1 and HIV-2. A chimeric molecule comprising native envelope sequence of gp41 of HIV-1 and modified envelope sequence of gp36 of HIV-2 gave good production yield and also detected both HIV-1 and HIV-2 samples with high sensitivity and specificity. CONCLUSION: The new bifunctional antibody fusion protein identified in this study detects both HIV-1 and HIV-2 infected samples efficiently and can be used in place of molecules that detect only HIV-1 or HIV-2. This will make reagent production more economical as only one molecule has to be produced in place of two molecules. Also, it will simplify the testing procedure allowing detection of both HIV-1 and HIV-2 infections in a single drop of blood.

Whole-blood agglutination assay for on-site detection of human immunodeficiency virus infection.

Simple and rapid diagnostic tests are needed to curtail human immunodeficiency virus (HIV) infection, especially in the developing and underdeveloped nations of the world. The visible-agglutination assay for the detection of HIV with the naked eye (NEVA HIV, which represents naked eye visible-agglutination assay for HIV) is a hemagglutination-based test for the detection of antibodies to HIV in whole blood. The NEVA HIV reagent is a cocktail of highly stable recombinant bifunctional antibody fusion proteins with HIV antigens which can be produced in large quantities with a high degree of purity. The test procedure involves mixing of one drop of the NEVA HIV reagent with one drop of blood sample on a glass slide. The presence of anti-HIV antibodies in the blood sample leads to clumping of erythrocytes (agglutination) that can be seen with the naked eye. Evaluation with commercially available panels of sera and clinical samples has shown that the performance of NEVA HIV is comparable to those of U.S. and European Food and Drug Administration-approved rapid as well as enzyme-linked immunosorbent assay kits. The test detects antibodies to both HIV type 1 (HIV-1) and HIV-2 in a single spot and gives results in less than 5 min. The test was developed by keeping in mind the practical constraints of testing in less developed countries and thus is completely instrument-free, requiring no infrastructure or even electricity. Because the test is extremely rapid, requires no sample preparation, and is simple enough to be performed by a semiskilled technician in any remote area, NEVA HIV is a test for the hard-to-reach populations of the world.