In-vivo lymphoscintigraphy of sinonasal tumors identifies retropharyngeal node and level I as predominant sentinel nodes.

OBJECTIVE: To evaluate by in- vivo lymphoscintigraphy and SPECT-CT imaging, the lymphatic drainage patterns of para-nasal sinus(PNS) tumors. To confirm or refute the belief of the retropharyngeal lymph node (RPLN) being the significant draining lymph node for such tumors. METHODS: Prospective cohort study conducted on previously untreated PNS tumors with no clinico-radiological evidence of lymph node metastasis. Lymphoscintigraphy undertaken by nasal endoscopic assisted peritumoral injection of 99mTc Sulfur colloid. Injections were classified as anterior or posterior as per a vertical line along the maxillary sinus ostium. RESULTS: 17 patients were included. Lymphoscintigraphy successfully identified 17 sentinel nodes in 15 patients and was unsuccessful (lymphoscintigraphy failure) in 2 patients. Predominant sites of sentinel lymphatic drainage were noted to be the RPLN (n = 8; 47%), and Level I (n = 7; 42%). Occasional drainage was identified at the peri-parotid node(n = 1) and at Level II (n = 1). Contralateral drainage was noted in 2 patients (level I-1 and RPLN-1). Anterior injections drained predominantly to Level I (6/8) and RPLN (2/8), while posterior injections drained predominantly to the RPLN ( 6/7). The relative risk of RPLN being identified as the sentinel node was significantly higher for posteriorly placed injections than for anteriorly placed injections (RR- 3.43; 95% CI-1.0-11.8, p = 0.05). CONCLUSION: The RPLN is noted as a frequent draining node for sino-nasal tumours and merits routine attention in all sino-nasal tumors. The radio-colloid SPECT-CT technique described here offers an excellent in-vivo technique to further explore and validate the lymphatic drainage pathways of these tumours.

Trapping of Aqueous Droplets under Surface Acoustic Wave-Driven Streaming in Oil-Filled Microwells.

Microwell arrays are ideal platforms for cell culturing, cell separation, and low-volume liquid handling. The ability to manipulate droplets in microwells could open up the opportunity for developing new biochemical assays. Here, we study the trapping of aqueous droplets in an oil-filled microwell driven by the application of nanometer amplitude vibrations called surface acoustic waves (SAW). We elucidate the dynamics of the droplet within the vortex toward the final trapping location and the physics of the trapping phenomenon using a theoretical model by considering the relevant forces. Our study revealed that the combined effect of acoustic radiation and hydrodynamic forces leads to droplet migration and trapping. We demarcate the trapping and nontrapping regimes in terms of the minimum critical input power required for the trapping of droplets of different sizes and densities. We find that the critical power varies as the square of the droplet size and is higher for a denser droplet. The effects of input power and droplet size on the trapping location and trapping time are also studied.

Acoustic particle trapping driven by axial primary radiation force in shaped traps.

We study particle trapping driven by the axial primary radiation force (A-PRF) in shaped traps exposed to standing bulk acoustic waves (S-BAW) using numerical simulations and experiments. The utilization of the stronger A-PRF as the main retention force is a consequence of standing-wave formation along the flow direction, instead of the orthogonal direction as in the case of traditionally used lateral-PRF S-BAW trapping setups. The study of particle dynamics reveals that the competition between A-PRF and viscous drag force governs particle trajectory. The ratio of the acoustic energy to the viscous work (ß) provides a general criterion for particle trapping at a distinctive off-node site that is spatially controllable. Particles get trapped for ß≥ß_{cr} at some distance away from the nodal plane and the distance varies as ß^{-c} (c=0.6-1.0). The use of A-PRF as the retention force could potentially allow traditional S-BAW trapping systems to envisage high-throughput advancements surpassing the current standards in cell-handling unit operations.

Dynamical motion of a pair of microparticles at the acoustic pressure nodal plane under the combined effect of axial primary radiation and interparticle forces.

The dynamical motion of a pair of microparticles exposed to acoustic standing waves and located at the pressure nodal plane is studied using numerical simulations and experiments. The insight into their dynamical behavior along the pressure nodal plane due to the competition between the axial primary radiation and interparticle forces is elucidated. An expression for axial primary radiation force acting on a particle is derived, and the particle dynamics is simulated using fluid-structure interaction model based on the arbitrary Lagrangian-Eulerian method. Considering the total radiation force acting on a particle is the sum of the axial primary radiation force and the interparticle force, three distinct dynamical regimes are observed depending upon the relative magnitudes of the acoustic forces which in turn depend on the gradient of the acoustic energy density. Acceleration, deceleration, and constant velocity motion of the pair of approaching particles are observed, which are explained by the interplay of the acoustic and non-acoustic forces. The dynamical motion of the pair of particles predicted using the model is in very good agreement with the experimental observations.

Arsenic Exposure and Haematological Derangement in Cervical Cancer Cases in India.

Cervical cancer is the second most common gynecological malignancy worldwide. According to HPV Information Centre, Spain (Aug'2014), in India approximately 1,22,844 women are diagnosed with the disease every year and of them 67,477 die due to the disease. CaCx is said to be mediated by HPV but recent data published reveal the role of Oxidative Stress in different Cancers. Arsenic is also one of the agents for causing Oxidative Stress. Arsenic has been linked with different types of cancer. Arsenic is considered responsible for generation of free radicals and eventually for apoptosis. Early diagnosis of CaCx is presently a matter of concern and clinical presentation in advanced stages become difficult for complete clinical response. For determination of oxidative stress, Malondialdehyde (MDA) was taken as an identifier and arsenic estimation was performed with the help of Atomic Absorption Spectrometer (AAS). RBC count and Haemoglobin levels were performed according to standard protocol. MDA was in direct proportion with arsenic concentration and inversely proportional to RBC and Haemoglobin in CaCx patients. Arsenic is one of the major causative agents for oxidative stress and hence may be a risk factor leading to cancer including CaCx.

Patterns of arteriosclerotic lesions of the lower extremity in a West Indian population based on angiographic findings and ethnicity.

INTRODUCTION: This study aimed to determine whether ethnic differences show different patterns of arterial disease in the lower limb. METHODS: A prospective analysis of 100 consecutive patients with 160 lower limb arteriograms was performed looking at the pattern of disease with relation to ethnicity in Trinidad and Tobago. RESULTS: There were 53 male and 47 female patients with an age range of 43-90 years (mean: 66 years). Of the 100 patients, 45 were of East Indian descent, 36 of Afro-Caribbean descent, 14 of mixed descent and 5 had other backgrounds. There were 32 smokers and 69 diabetics. The most commonly affected artery in East Indians was the anterior tibial artery (ATA, 70%) followed by the peroneal artery (60%), superficial femoral artery (SFA, 60%), posterior tibial artery (PTA, 57%) and tibioperoneal trunk (TPT, 39%). In Afro-Caribbeans, the most commonly affected artery was the ATA (79%) followed by the PTA (74%), peroneal artery (66%) and TPT (55%). The mixed group showed the PTA (85%) to be most diseased followed by the peroneal artery (75%), ATA (70%), SFA (70%), dorsalis pedis artery (DPA, 60%) and TPT (50%). Overall, the most diseased vessel in all groups was the ATA (73%) followed by the PTA (66%), peroneal artery (64%), SFA (59%), TPT (46%), DPA (38%), popliteal artery (31%) and medial plantar artery (MPA, 29%), with the proximal vessels not being affected severely. CONCLUSIONS: Ethnic divisions were only statistically significant (p<0.05) with East Indians showing worse disease in the profunda femoris artery and Afro-Caribbeans showing worse disease in the PTA, DPA and MPA. This suggests that environmental factors may play a significant role in the disease process including smoking and dietary factors rather than purely genetics.

Molecular and cellular characterization of buffalo bone marrow-derived mesenchymal stem cells.

Immune privileged mesenchymal stem cells (MSCs) can differentiate into multiple cell types and possess great potential for human and veterinary regenerative therapies. This study was designed with an objective to isolate, expand and characterize buffalo bone marrow-derived MSCs (BM-MSCs) at molecular and cellular level. Buffalo BM-MSCs were isolated by Ficoll density gradient method and cultured in Dulbecco's modified Eagle's medium supplemented with fetal bovine serum (FBS). These cells were characterized through alkaline phosphatase (AP) staining, colony-forming unit (CFU) assay, mRNA expression analysis (CD 73, CD 90, CD 105, Oct4 and Nanog), immunolocalization along with flow cytometry (Stro 1, CD 73, CD 105, Oct4, Sox2 and Nanog) and in situ hybridization (Oct4 and Sox2). Multilineage differentiation (osteogenic, adipogenic and chondrogenic) was induced in vitro, which was further assessed by specific staining. Buffalo BM-MSCs have the capacity to form plastic adherent clusters of fibroblast-like cells and were successfully maintained up to 16(th) passage. These cells were AP positive, and further CFU assay confirmed their clonogenic property. RT-PCR analysis and protein localization study showed that buffalo BM-MSCs are positive for various cell surface markers and pluripotency markers. Cytoplasmic distribution of mRNA for pluripotency markers in buffalo BM-MSCs and multilineage differentiation were induced in vitro, which was further assessed by specific staining. To the best of our knowledge, this is the first report of buffalo BM-MSCs, which suggests that MSCs can be derived and expanded from buffalo bone marrow and can be used after characterization as a novel agent for regenerative therapy.

CNS-immune reconstitution inflammatory syndrome in the setting of HIV infection, part 1: overview and discussion of progressive multifocal leukoencephalopathy-immune reconstitution inflammatory syndrome and cryptococcal-immune reconstitution inflammatory syndrome.

SUMMARY: While uncommon, CNS-IRIS developing after the initiation of HAART in the setting of HIV-related severe immunosuppression is characterized by an intense inflammatory reaction to dead or latent organisms or to self-antigens due to a heightened but dysregulated immune response. While this reaction can range from mild to fulminating, encompassing a very wide clinical spectrum, it is important to recognize because changes in medical management may be necessary to prevent neurologic decline and even death. Once contained, however, this inflammatory response can be associated with improved patient outcome as immune function is restored. Among the infectious organisms that are most commonly associated with CNS-IRIS are the JC virus and Cryptococcus organisms, which will be the subject of this review. CD8 cell infiltration in the leptomeninges, perivascular spaces, blood vessels, and even parenchyma seems to be the pathologic hallmark of CNS-IRIS. While recognition of CNS-IRIS may be difficult, the onset of new or progressive clinical symptoms, despite medical therapy and despite improved laboratory data, and the appearance on neuroimaging studies of contrast enhancement, interstitial edema, mass effect, and restricted diffusion in infections not typically characterized by these findings in the untreated HIV-infected patient should raise the strong suspicion for CNS-IRIS. While CNS-IRIS is a diagnosis of exclusion, the neuroradiologist can play a critical role in alerting the clinician to the possibility of this syndrome.

Elevated level of prostate specific antigen among prostate cancer patients and high prevalence in the Gangetic zone of Bihar, India.

Prostate cancer (CaP) is a common reproductive cancer among men. This study was conducted to correlate the cancer incidence with Gangetic zone and to correlate the tumor marker prostate specific antigen (PSA) level in serum with different age groups and stage of malignancy. Patients suffering from CaP in the pathology unit of Mahavir Cancer Sansthan (Hospital and Research Centre), Patna, Bihar, India were studied from June 2009 to May 2010. PSA level in the serum of CaP patients was estimated by ELISA method. CaP incidence was highly recorded in Gangetic zone than the non-Gangetic zone. Maximum patients were in the 56 - 75 years age group with a marked predominance. Results of PSA examination showed that serum PSA level was not correlating with the age of patient and stage of malignancy. Significantly, elevated level of more than 10 ng/ml of PSA was recorded among the studied cancer patients. In this study, it is concluded that Gangetic zone habitat have high risk of CaP and elevated level of PSA was marked in Bihar, India.

Extension of shelf life of pear fruits using different packaging materials.

An experiment was conducted on pear fruit (cv. 'Lagoon') to extend the shelf life by using different packaging materials. Fruits were packed in low density polyethylene (LDPE, 0.025 mm), polypropylene (PP, 0.025 mm), linear low density polyethylene (LLDPE, 0.0125 mm) and high density polyethylene (HDPE, 0.025 mm) with or without perforation and stored at ambient condition (25 ± 2 °C and 65.0 ± 5% RH). Periodical observations were recorded on CO2 & O2 concentration (%), physiological loss in weight (PLW, %), decay loss (%), firmness (kgf), colour value (colour difference and colour index), total soluble solid (TSS, °Brix), acidity (mg of malic acid/g), and ascorbic acid loss (%) at 3 days interval. Reduced rate of PLW and decay losses was recorded in pear fruits packed in PP non-perforated (8.04%) and PP perforated (12.5%), respectively as compared to other treatments. The maximum firmness (5.18 kgf) and minimum ascorbic acid loss (49.97%) were also recorded in PP non-perforated up to 12 and 15 days of storage, respectively. It could be inferred that the, PP non-perforated (0.025 mm) was the most suitable packaging materials for extending the shelf life of pear fruits up to 15 days at ambient condition.

Immune reconstitution inflammatory syndrome in natalizumab-associated PML.

OBJECTIVE: To study the outcome of patients with multiple sclerosis (MS) and with natalizumab-associated progressive multifocal leukoencephalopathy (PML) and immune reconstitution inflammatory syndrome (IRIS). METHODS: MedWatch reports from Biogen-Idec (manufacturer of natalizumab, Tysabri(®)) were reviewed which comprised all 42 cases of natalizumab-related PML cases since its reintroduction until March 2010. RESULTS: All except 2 patients with natalizumab-related PML were managed by discontinuation of natalizumab and plasmapheresis/immunoadsorption (PLEX/IA). Seventeen patients had contrast enhancement of PML lesions on neuroimaging at the time of diagnosis before withdrawal/removal of natalizumab (early-PML-IRIS) and 23 patients developed contrast enhancement only after withdrawal/removal of natalizumab (late-PML-IRIS). All patients developed IRIS. IRIS was defined as worsening of neurologic deficits during the immune reconstitution following discontinuation of natalizumab, corroborated by inflammatory changes on neuroimaging. Following PLEX/IA, JC viral load in CSF increased by >10 fold in those with early-PML-IRIS but <2 fold in late-PML-IRIS. IRIS developed earlier and was more severe in early-PML-IRIS (p < 0.05). At the last follow-up, all patients had worse EDSS scores but this was higher in patients with early-PML-IRIS compared to those with late-PML-IRIS (p > 0.05). Mortality was comparable between the 2 groups, 29.4 ± 11% vs 21.7 ± 8.8%. Corticosteroid therapy during IRIS was associated with better Expanded Disability Status Scale outcome, p < 0.05. CONCLUSION: Early immunologic rebound in natalizumab-associated PML has worse survival and neurologic outcome. PLEX/IA may accelerate IRIS and its impact on the final outcome is unclear. Corticosteroid therapy provides a modest benefit and needs to be systemically studied in a controlled manner in the management of natalizumab-associated PML-IRIS.

Prevalence of hepatitis B virus infection in non-Hodgkin lymphoma: a systematic review and meta-analysis.

BACKGROUND AND AIM: A recent meta-analysis has demonstrated an association between hepatitis C virus and non-Hodgkin lymphoma (NHL). There is also evidence on the association between hepatitis B virus (HBV) and NHL. The aim of this study was to evaluate this evidence using a meta-analytic approach. METHODS: We searched the MEDLINE database from 1962 to 2008 for case-control studies that have reported the association of HBV with NHL. We calculated the odds ratio (OR) and 95% confidence intervals (CI) to assess the prevalence of HBV infection and pooled the results using three different statistical models. RESULTS: Our search yielded 12 studies with 11 studies (3262 NHL patients, 1,523,205 controls) evaluating HBV infection in NHL and one study (3888 HBV-infected individuals, 205,203 controls) that had investigated for NHL in HBV infection. The OR of detecting HBV infection in NHL when compared with the control population was 2.56 (95% CI, 2.24-2.92) by the fixed effects model; 2.61 (95% CI, 2.29-2.98) by the exact method and 2.67 (95% CI, 2.04-3.49) by the random effects model suggesting a high prevalence of HBV carrier state in lymphoma. There was evidence of statistical heterogeneity which disappeared after exclusion of retrospective studies on sensitivity analysis. CONCLUSIONS: The results of this study suggest a possible causal relation between HBV infection and NHL which needs to be confirmed by experimental and epidemiological studies. In countries where prevalence of HBV infection is 1% or more, it may be prudent to screen patients with NHL for occult HBV infection.

Profile of behavioural risk factors of non-communicable diseases in an urban setting in New Delhi.

The present study was conducted to assess the prevalence of behavioural risk factors of non communicable diseases among urban adult population. The study participants included 531 adults residing in Mata Sundari road, which is an urban colony in New Delhi. They were interviewed using the WHO STEPS 1 questionnaire on lifestyle factors. Smoking prevalence was found to be 18.4% out of which over three fourth smoked more than one packet of cigarettes per day. Almost one third of known hypertensive patients were not on any treatment regimen. 80.6% did not undertake any kind of physical activity. 43% consumed only one serving of green vegetable in a day while 58% included fruits as a part of diet only once or twice in a week. There is a need to develop strong community based lifestyle behavioural intervention programs.

Hypohidrotic ectodermal dysplasia with atrophic rhinitis and nasal myiasis.

Hypohidrotic/anhidrotic ectodermal dysplasia is a rare inherited disorder characterized by hypohidrosis/anhidrosis, hypotrichosis, dysodontia and heat intolerance. Most common mode of transmission is X-linked recessive, showing complete expression in males, and only partial manifestations in the female carrier heterozygotes. Features like atrophic rhinitis, nasal and aural myiasis, syndactyly, cleft lip and/or palate, mental retardation and immunodeficiency are uncommonly seen in this syndrome. We hereby report a case of hypohidrotic ectodermal dysplasia with unusual features of atrophic rhinitis and nasal myiasis.

Microbicides in India-present and future.

India continues to wage a battle against the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) epidemic. Despite an array of preventive and control efforts directed against the disease, it continues to finds its way from the high risk groups to the general population. Women are more vulnerable to HIV/AIDS because of biological as well as socio-cultural factors. Microbicides appear to provide an attractive option as a means of protection to be used by women. At present, microbicide trials are in study phases I and II in India. The development of an ideal microbicide candidate which would be effective and confirms to user satisfaction poses a major challenge to researchers.

Pharmacology and clinical applications of selective estrogen receptor modulators.

Compounds that can be described as selective estrogen receptor modulators (SERMs) have expanded dramatically over the past two decades. The ability of SERMs to act as estrogens in certain tissues while remaining inert or acting as an anti-estrogen in other tissues has opened up opportunities for treating specific estrogen-modulated diseases without accepting the risk of systemic estrogen activity. SERM development has resulted in significant therapeutic advances for breast cancer, osteoporosis and potentially other diseases associated with the menopause. After the publication of the Women's Health Initiative, interest in compound selectivity that reduces menopausal symptoms while protecting bone, breast, uterus and the heart has increased. Future SERMs may also have a therapeutic profile that can be tailored to specific patient populations, including men. This review paper summarizes the characteristics of different SERMs from various pharmacological categories and the feasibility and scope of their use for a large range of disease/health conditions.

PML-IRIS in patients with HIV infection: clinical manifestations and treatment with steroids.

BACKGROUND: Progressive multifocal leukoencephalopathy (PML) is an opportunistic infection that develops in immunosuppressed patients with HIV infection. Paradoxically, some of these patients may develop PML during combined antiretroviral therapy in the setting of immune reconstitution. We describe the types of PML in relation to immune reconstitution inflammatory syndrome (IRIS) and the effects of steroid use in these patients. METHODS: We performed a retrospective review of the literature (1998 to 2007) and of all HIV-infected patients diagnosed with PML-IRIS at Johns Hopkins Hospital (2004 to 2007). We recorded information on clinical features, microbiologic and virological analysis, neuroimaging, pathology, treatment, and outcome. RESULTS: Of 54 patients with PML-IRIS, 36 developed PML and IRIS simultaneously (PML-s-IRIS) and 18 had worsening of preexisting PML (PML-d-IRIS) after the initiation of combined antiretroviral therapy. PML-IRIS developed between 1 week and 26 months after initiation of antiretroviral therapy. PML-d-IRIS patients developed IRIS earlier, had higher lesion loads on MRI of the brain, had shorter durations of survival, and had higher mortality rate compared to PML-s-IRIS patients. Twelve patients received treatment with steroids, of which five died and seven showed good neurologic recovery. Patients who survived had received steroids early after IRIS diagnosis for longer durations and had contrast enhancement on IRIS neuroimaging. CONCLUSIONS: Immune reconstitution following initiation of combined antiretroviral therapy may lead to activation of an inflammatory response to detectable or latent JC virus infection. Early and prolonged treatment with steroids may be useful in these patients but requires further investigation.

Disseminated rhinosporidiosis with unusual involvement of the nail apparatus.

Rhinosporidiosis is an uncommon chronic granulomatous disease caused by Rhinosporidium seeberi. It primarily affects the nasal mucosa and the nasopharynx. The disease may disseminate to the skin, larynx, trachea, genitalia, bones and even the internal organs. Although simultaneous onset of nasal and disseminated lesions has been reported, dissemination usually occurs several years after the onset of nasal lesions. We report a rare case of disseminated rhinosporidiosis involving both nares, the nasal mucosa, nasopharynx, oral cavity and oropharynx, as well as widespread cutaneous lesions over the trunk and the limbs with nail involvement. This last feature has not, to our knowledge, been previously reported.

Non-healing ulcer on the great toe due to cellular schwannoma.

Cellular schwannoma (CS) occurring in the foot is uncommon, and when it does occur, it usually presents as a slowly growing tumour. Ulceration of CS on the foot is rare. We report a 20-year-old woman who presented with a painful and non-healing ulcer on the lateral area of the right great toe, which failed to heal despite treatment. Six months after onset of the ulcer, a small swelling appeared below it. Histological examination of a biopsy taken from the edge of the ulcer established the diagnosis of CS. Preoperative magnetic resonance imaging delineated the mass on the lateral area of the right great toe. The mass was surgically excised, which led to resolution of the symptoms. This case highlights the fact that chronic ulcers in the foot can be due to CS. Correct diagnosis and management depend on a histopathological diagnosis.