Unveiling Scapular Pseudo-winging: A Case Report on Ventral Osteochondroma of the Scapula in a 21-year-old.

Introduction: Scapular pseudo-winging caused by ventral osteochondromas is a rare condition that has been reported in only a handful of cases. This case report describes a 21-year-old male patient with scapular pseudo-winging due to ventral osteochondromas of the scapula. This report adds to the limited literature on this topic and highlights the importance of considering ventral osteochondromas as a possible cause of scapular pseudo-winging. Case Report: A 21-year-old male presented with a swelling on his left upper back that had gradually increased in size over the past 10 years. Physical examination revealed a bony hard swelling arising from the medial border of the scapula, with associated scapular pseudo-winging. Diagnostic imaging confirmed the presence of two ventral osteochondromas located on the body of the scapula. Surgical excision was performed to address the patient's cosmetic concerns. Conclusion: This case report highlights the importance of considering ventral osteochondromas as a possible cause of scapular pseudo-winging. It contributes to the existing literature by documenting a rare presentation and providing insights into the clinical course, diagnostic imaging, and surgical management of this condition. By raising awareness among tumor surgeons and orthopedic surgeons, this report may aid in early recognition and appropriate management of scapular pseudo-winging cases caused by ventral osteochondromas. Furthermore, this report expands our understanding of the etiology and treatment options for scapular pseudo-winging, potentially benefiting patients across various clinical specialties. Categories: Oncology, orthopedics.

Construction of Adipogenic ceRNA Network Based on lncRNA Expression Profile of Adipogenic Differentiation of Human MSC Cells.

The Long non-coding RNA (lncRNA) expression profile data of ten samples including human Mesenchymal Stem Cell (MSC) adipogenic differentiation 0, 3, and 6 days from the GEO database, and then perform gene ID conversion, BLAST comparison, and annotation marking. Finally, group A (treatment group on day 3 of differentiation and control group on day 0 of differentiation) obtained a total of 1180 mRNA and 185 lncRNA; group B (treatment group on day 6 of differentiation and control group on day 0 of differentiation). A total of 1376 mRNA and 206 lncRNA were obtained. Finally, we processed the differential lncRNAs and mRNAs obtained in the two groups, and obtained 113 shared differential lncRNAs to further predict the targeted miRNA, a total of 815 lncRNA-miRNA pairs. The targeted mRNA was further predicted, and the grouped differential mRNAs were combined to obtain 64 differential mRNAs. In the end, we obtained 216 ceRNAs containing 26 lncRNAs, 27 miRNAs and 64 mRNAs. We found that the mRNAs in the ceRNA network were mainly enriched with 45 Gene Ontology (GO) terms, mainly including glucose homeostasis mechanism and insulin stimulation response. 69 Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways were mainly enriched. It mainly includes many pathways related to lipid metabolism such as Adenosine 5'-monophosphate (AMP)-activated protein kinase (AMPK), Rap1, cAMP, mitogen-activated protein kinase (MAPK), Ras, hypoxia inducible factor-1 (HIF-1), PI3K-Akt, insulin signaling and so on. In the end, we identified 216 ceRNA regulatory relationships related to obesity research. Our research provides a clearer direction for understanding the molecular mechanism of obesity, the screening and determination of drug targets biomarkers in the future.

Liver infarct masquerading as intrahepatic cholangiocarcinoma.

Cholangiocarcinoma is one of the most lethal tumors because of its complex location and lack of good chemoradiotherapy options. When it is diagnosed, urgent intervention is needed, often involving radical surgical resection. It generally presents as a liver mass with biliary obstruction. We discuss the case of a young patient presenting with liver dysfunction and imaging mimicking a liver mass concerning for cholangiocarcinoma, where he actually had a liver infarct from splanchnic venous thrombosis from primary myelofibrosis.

Characteristics of Biotin lipoyl attachment and 2-oxoacid dehydrogenase acyltransferase of the parasitic nematode Haemonchus contortus and its modulatory functions on goat PBMCs in vitro.

Biotin lipoyl attachment and 2-oxoacid dehydrogenase acyltransferase (BLAODA), as an essential excretion of Haemonchus contortus (HcESPs), was identified to have antigenic functions. T helper-9 (Th9) cells secrete interleukin (IL)-9, a signature cytokine associated with tumour immunology, allergy and autoimmunity. Nonetheless, the understanding of modulatory functions of BLAODA on Th9 and other immune cells is limited. In this study, the BLAODA gene was cloned, and the recombinant (r) protein of BLAODA (rHcBLAODA) was expressed and immunoblotting was performed. The results revealed that HcBLAODA gene was successfully cloned and rHcBLAODA protein was expressed. The localization of rHcBLAODA was confirmed on the surface of gut sections from adult H. contortus. The rHcBLAODA protein capability to react precisely with anti-H. contortus antibodies were confirmed by immunoblotting and immunofluorescence assay (IFA). Further functional analysis showed that interaction of rHcBLAODA with host cells significantly enhanced Th9 cells generation, IL-9 expression, nitric oxide production and cell apoptosis while suppressing the cells proliferation and cells migration depending on the concentration. Overall, these findings suggest that rHcBLAODA protein could modulate the host immune response by inducing Th9 cells to secrete IL-9 cytokine in vitro.

A Case to Overcome the Stigma of Testicular Cancer.

Testicular cancer is seen commonly in young males and has a high cure rate if diagnosed and treated early. It clinically presents with painless testicular swelling. We discuss the case of a young previously healthy male with an aggressive testicular cancer which started with a testicular swelling but the primary site underwent necrosis secondary to its own vascular demand thus giving the false impression of resolution, but not before metastasizing to the rest of the body. With this case, we aim to highlight the importance of increasing awareness of testicular cancer and its presenting symptoms in young males and the need to overcome the stigma around the evaluation of testicular swellings.

Nanoparticles (PLGA and Chitosan)-Entrapped ADP-Ribosylation Factor 1 of Haemonchus contortus Enhances the Immune Responses in ICR Mice.

ADP-ribosylation factor 1 (HcARF1) is one of the Haemonchus contortus (H. contortus) excretory/secretory proteins involved in modulating the immune response of goat peripheral blood mononuclear cells (PBMC). Here, we evaluated the immunogenic potential of recombinant HcARF1 (rHcARF1) against H. contortus infection in Institute of Cancer Research (ICR) mice. Briefly, rHcARF1 was entrapped in poly (D, L-lactide-co-glycolide) (PLGA) and chitosan (CS) nanoparticles (NP) and injected into mice as a vaccine. Fifty-six ICR mice were assigned randomly into seven groups, with eight animals in each group, and they were vaccinated subcutaneously. At the end of the experiment (14th day), the blood and the spleen were collected from euthanized mice to detect lymphocyte proliferation, cytokine analysis, and the production of antigen-specific antibodies. Scanning electron microscope was used to determine the size, morphology, and zeta potential of nanoparticles. Flow cytometry was performed, which presented the increase percentages of CD4+ T cells (CD3e+CD4+), CD8+ T cells (CD3e+CD8+) and dendritic cells (CD11c+CD83+, CD11c+CD86+) in mice vaccinated with rHcARF1+PLGA NP. Immunoassay analysis show raised humoral (Immunoglobulin (Ig)G1, IgG2a, IgM) and cell-mediated immune response (Interleukin (IL)-4, IL-12, and IL-17, and Interferon (IFN)-γ) induced by rHcARF1+PLGA NP. Experimental groups that were treated with the antigen-loaded NP yield higher lymphocyte proliferation than the control groups. Based on these results, we could propose that the rHcARF1 encapsulated in NP could stimulate a strong immune response in mice rather than administering alone against the infection of H. contortus.

Unveiling the Immunomodulatory Characteristics of Haemonchus contortus Ephrin Domain Containing Protein in the Parasite-Host Interactions.

Ephrin domain containing protein (EPH), a significant excreted and secreted product (ESPs) of Haemonchus contortus, has been identified to have antigenic functions. Over the past years, a new subset of CD4 + T named as T helper 9 cells that secrete interleukin-9 (IL-9) as a signature cytokine is associated with tumor immunity and allergy. Nonetheless, the understanding of immunomodulatory roles of EPH on goat Th9 and other immune cells remains limited. Herein, EPH from H. contortus (HcEPH) was cloned and expressed in pET-28a. Immunofluorescence assay (IFA) was carried-out to localize rHcEPH within H. contortus adult worms and to bind with goat peripheral blood mononuclear cells (PBMCs). Besides, the impact of rHcEPH on signature cytokine IL-9 expression in goat PBMCs was evaluated. Flow cytometry was employed to examine Th9 cells production and cell apoptosis. The results revealed success in the expression and localization of rHcEPH in surface of adult H. contortus gut sections. According to IFA analysis, the rHcEPH protein was capable to react precisely with anti-H. contortus antibodies. Further functional analysis showed that correlation between rHcEPH and host PBMCs significantly enhanced Th9 cell differentiation, IL-9 expression, cell apoptosis efficiency, and cell migration, whereas cell proliferation was suppressed significantly depending on the concentration. Our observations indicated that rHcEPH protein is linked to modulate the host immune cells and could enhance protective immunity by inducing Th9 responses.

Combined Use of Indirect ELISA and Western Blotting with Recombinant Hepatocellular Carcinoma-Associated Antigen 59 Is a Potential Immunodiagnostic Tool for the Detection of Prepatent Haemonchus contortus Infection in Goat.

Haemonchus contortus is recognized as one of the important health problems in small ruminants, leading to reduced production and economic loss for farmers worldwide. Prepatent diagnosis of H. contortus infection is crucial to improve control strategies as this helminth may remove up to one-fifth of total erythrocytes and may cause anemia, edema, diarrhea, and ultimately death in young animals. In this study, one of the excretory and secretory products, rHc-HCA59, was purified and used as antigen to detect specific antibodies in H. contortus infected goats during prepatent stage of infection using indirect enzyme linked immunosorbent assay (ELISA) as screening test. All goats (n = 38) were housed indoor, experimentally infected with 8000 infective larvae (L3) of H. contortus, and serum samples were collected prior to infection and at 14th day of infection. Immunoblotting was performed to confirm the results of indirect ELISA, evaluate the cross reactivity against rHc-HCA59 in sera of most common co-infecting parasites and rectify the false negative samples. Furthermore, three different batches of rHc-HCA59 were produced to evaluate the repeatability of ELISA. No eggs were detected in feces of all goats collected at 7th and 14th day of infection but, H. contortus eggs were detected at 21 days post infection in the feces. Indirect ELISA performed in this study showed 87% sensitivity and 100% specificity. The western blot analysis confirmed immunoreactivity in serum samples which scored positive in indirect ELISA and recognized the samples as negative which had OD450 lower than negative cut-off value in indirect ELISA. Furthermore, all false negative sera (n = 5) that had OD450 value between positive and negative cut-off value in rHc-HCA59 based ELISA were clearly positive in western blot. Moreover, no cross-reactivity was detected in ELISA and western blotting against rHc-HCA59 in positive sera of Toxoplasma gondii, Fasciola hepatica, and Trichinella spiralis. The results of this study concluded that combined use of indirect ELISA and western blotting with rHc-HCA59 is a potential immunodiagnostic tool for the detection of H. contortus infection during prepatent period in goats.

An efficient catalytic degradation of trichloroethene in a percarbonate system catalyzed by ultra-fine heterogeneous zeolite supported zero valent iron-nickel bimetallic composite.

Zeolite supported nano iron-nickel bimetallic composite (Z-nZVI-Ni) was prepared using a liquid-phase reduction process. The corresponding surface morphologies and physico-chemical properties of the Z-nZVI-Ni composite were determined using scanning electron microscopy (SEM), transmission electron microscopy (TEM), Energy dispersive X-ray spectra (EDS), Brunauer Emmett Teller (BET) adsorption, wide angle X-ray diffractometry (WA-XRD), and Fourier transform infrared spectroscopy (FTIR). The results indicated high dispersion of iron and nickel nano particles on the zeolite sheet with an enhanced surface area. Complete destruction of trichloroethene (TCE) and efficient removal of total organic carbon (TOC) were observed by using Z-nZVI-Ni as a heterogeneous catalyst for a Fenton-like oxidation process employing sodium percarbonate (SPC) as an oxidant. The electron spin resonance (ESR) of Z-nZVI-Ni verified the generation and intensity of hydroxyl radicals (OH•). The quantification of OH• elucidated by using p-chlorobenzoic acid, a probe indicator, confirmed the higher intensity of OH•. The transformation products were identified using GC-MS. The slow iron and nickel leaching offered higher stability and better catalytic activity of Z-nZVI-Ni, demonstrating its prospective long term applications in groundwater for TCE degradation.

Degradation of chlorinated organic solvents in aqueous percarbonate system using zeolite supported nano zero valent iron (Z-nZVI) composite.

Chlorinated organic solvents (COSs) are extensively detected in contaminated soil and groundwater that pose long-term threats to human life and environment. In order to degrade COSs effectively, a novel catalytic composite of natural zeolite-supported nano zero valent iron (Z-nZVI) was synthesized in this study. The performance of Z-nZVI-catalyzed sodium percarbonate (SPC) in a heterogeneous Fenton-like system was investigated for the degradation of COSs such as 1,1,1-trichloroethane (1,1,1-TCA) and trichloroethylene (TCE). The surface characteristics and morphology of the Z-nZVI composite were tested using scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Total pore volume, specific surface area, and pore size of the natural zeolite and the Z-nZVI composite were measured using Brunauer-Emmett-Teller (BET) method. SEM and TEM analysis showed significant elimination of aggregation and well dispersion of iron nano particles on the framework of natural zeolite. The BET N2 measurement analysis indicated that the surface area of the Z-nZVI composite was 72.3 m(2)/g, much larger than that of the natural zeolite (0.61 m(2)/g). For the contaminant analysis, the samples were extracted with n-hexane and analyzed through gas chromatograph. The degradation of 1,1,1-TCA and TCE in the Z-nZVI-catalyzed percarbonate system were 48 and 39 % respectively, while strong augmentation was observed up to 83 and 99 %, respectively, by adding the reducing agent (RA), hydroxyl amine (NH2OH•HCl). Probe tests validated the presence of OH(●) and O2 (●-) which were responsible for 1,1,1-TCA and TCE degradation, whereas both free radicals were strengthened with the addition of RA. In conclusion, the Z-nZVI/SPC oxidation with reducing agent shows potential technique for degradation of groundwater contaminated by 1,1,1-TCA and TCE.

Role of prophylactic antibiotics in low risk elective laparoscopic cholecystectomy: is there a need?

BACKGROUND: Elective cholecystectomy for symptomatic gall stone disease carries low risk of postoperative infective complications. Yet the routine use of prophylactic antibiotic is in vogue in many centres. The aim of this study was to find out the efficacy of antibiotic prophylaxis in preventing postoperative infective complications in low risk elective laparoscopic cholecystectomy patients. METHOD: Randomised controlled trial was carried out in our hospital from 1st Nov 2009 to 15th Oct 2011. A total of 350 patients were included in the study and were divided into Group A (n = 177). and Group B (n = 173). Group A was given single dose of injection Celfuroxime 1.5 gm as prophylactic antibiotic at the time of induction of anaesthesia, and Group B was not given any antibiotic. In both groups, age, sex, duration of surgery, American Society of Anesthesiologists classification, duration of surgery and length of hospital stay were recorded. Patients were followed-up weekly for 4 weeks and rates of superficial surgical site infections as well as intra-abdominal infections were recorded. RESULTS: There were no significant differences in both groups in terms of age, sex, duration of surgery, length of hospital stay. Eight (4.5%) cases of superficial surgical site infection were noted in Group A and 7 (4.0%) in Group B which was insignificant statistically (p > 0.05). CONCLUSION: In low risk patients antibiotic prophylaxis does not seem to affect the incidence of postoperative infective complications in elective laparoscopic cholecystectomy. The use of prophylactic antibiotics should be reserved for high risk patients undergoing laparoscopic cholecystectomy.

Importance of clinical assessment in diagnosis of acute appendicitis and its role in decreasing negative appendicectomy rate.

BACKGROUND: Appendicitis is a common diagnosis, but is by no means a simple one to establish. It is impractical to have a definitive preoperative diagnosis, which leads to an appreciable rate of negative appendicectomy as reported in world literature varying from 20-40% with its morbidity around 10%. This retrospective study investigated the value of clinical assessment and medical imaging (ultrasonography) for patients with suspected appendicitis. Negative appendicectomy rate and appendiceal perforation with or without medical imaging were used as end points for this investigation. METHODS: This study reviewed all patients admitted in Sheikh Khalifa Bin Zaid Hospital with suspected acute appendicitis. The patient cohort was identified from the unit registry and review of medical records. The medical records were analysed, and the outcomes of patients were followed up. RESULTS: Between June 2010 to June 2012, 375 patients' medical records were audited. These included 56.3% males and 43.7% females. The negative appendicitis rate was 7.2% and appendiceal perforation rate was 5.3%. Ultrasound was done in 103 (27.4%) patients in whom diagnosis of appendicitis was doubtful. Medical imaging had a 50% prediction rate for acute appendicitis, 40% false-negative rate, and 10% false-positive rate. Overall, the prediction rate for appendicitis by clinical assessment supplemented by laboratory tests and medical imaging at clinician's discretion was 92.8%. CONCLUSIONS: Despite studies advocating routine use of medical imaging for patients with suspected acute appendicitis, this study showed that the clinical evaluation is still paramount to the management of patients with suspected acute appendicitis before considering medical imaging.

Aplastic anemia: clinicohaematological features, treatment and outcome analysis.

OBJECTIVE: To determine the clinicohaematological features, treatment and outcome of children diagnosed with aplastic anemia at a single institution. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, from January 1999 till December 2008. METHODOLOGY: Medical records of children aged less than 15 years of age diagnosed with aplastic anemia were reviewed. Clinicohaematological features, treatment and its response to therapy and outcome were recorded. Results were described in percentages. RESULTS: Ninety patients were diagnosed to have aplastic anemia (AA); 65 were male during the study period. Age ranged from 1 to 15 years. Fever in 65 patients (72.2%), pallor in 53 (58.8%), skin bleeding in 49 (54.4%) and epistaxis in 31(34.4%) were the most common and frequent presenting features. Congenital (Fanconi's) anemia was found in 15 (16.6%) and acquired idiopathic in 75 (83.4%) of patients. Very severe aplastic anemia (VSAA) was seen in 29 (32.2%), 26 (28.9%) had severe AA and 17 (18.9%) had moderate AA. Eight patients (8.9%) underwent haematopoietic stem cell transplantation (HSCT), 12 (13.3%) received immunosuppressive therapy (IST) and 70 patients (77.7%) received other and supportive therapy. Five (62.5%) patients showed complete response to HSCT and 3 (37.5%) failed to engraft. IST showed complete response in 3 (25%), partial response in 5 (41.6%) and no response in 4 (33.3%). Twenty two patients (24.4%) expired either due to infection in 16 (72.7%, fungal in 6, bacterial in 10) and intracranial haemorrhage in 6 (27.3%) cases. CONCLUSION: Majority of cases with AA were acquired and idiopathic in etiology. VSAA and SAA were frequent. Response to HSCT and IST was sub-optimal.

Laparoscopic cholecystectomy: an audit of 500 patients.

BACKGROUND: The Gold standard treatment for symptomatic gallstone disease is laparoscopic cholecystectomy (LC) since 1990. LC can be performed safely as a day case procedure. The objective of this study was to evaluate the results of laparoscopic cholecystectomy in symptomatic gall stones disease in terms of length of hospital stay, complications, morbidity and mortality. METHODS: This retrospective descriptive study was carried out in Department of General & Laparoscopic Surgery, AK CMH, Muzaffarabad. Notes of all patients who underwent laparoscopic cholecystectomy in the department over a 26 month period were reviewed from department register. Demographics as well as details of cases, conversion to open operation and complications of surgery and anaesthesia were reviewed from clinical notes and departmental register and noted on a designed Performa. Data were analysed using SPSS-18 and results compared with international studies. RESULTS: Out of 500 patients, 443 (88.6%) were females and 57 (11.4%) were males. The mean age of the patients was 42.47 +/- 11.43 years. Mean operative time was 40.09 +/- 11.16 minutes. Seven (1.4%) patients developed port site wound infection. Sixteen (3.2%) cases were converted to open surgery in face of obscured anatomy of Calot's triangle. Two (0.4%) cases has cystic duct stoma leak secondary to missed Common duct stones and were dealt with ERCP and stone extraction. There was no case of bile duct injury, major haemorrhage or bowel injury. There was no mortality associated with laparoscopic cholecystectomy in our series. CONCLUSION: Laparoscopic cholecystectomy is a safe and effective management of gall stone disease. Better training, careful case selection, meticulous technique and high standard equipment are of paramount importance for ensuring good results in laparoscopic cholecystectomy.