Evaluation of Stem Cell Laden Collagen + Polycaprolactone + Multi-Walled Carbon Nano-Tubes Nano-Neural Scaffold with and Without Insulin Like Growth Factor-I For Sciatic Nerve Regeneration Post Crush Injury in Wistar Rats.

BACKGROUND/AIMS: All body functions are activated, synchronized and controlled by a substantial, complex network, the nervous system. Upon injury, pathophysiology of the nerve injury proceeds through different paths. The axon may undergo a degenerative retraction from the site of injury for a short distance unless the injury is near to the cell body, in which case it continues to the soma and undergoes retrograde neuronal degeneration. Otherwise, the distal section suffers from Wallerian degeneration, which is marked by axonal swelling, spheroids, and cytoskeleton degeneration. The objective of the study was to evaluate the potential of mesenchymal stem cell laden neural scaffold and insulin-like growth factor I (IGF-I) in nerve regeneration following sciatic nerve injury in a rat model. METHODS: The animals were anaesthetized and a cranio-lateral incision over left thigh was made. Sciatic nerve was exposed and crush injury was introduced for 90 seconds using haemostat at second locking position. The muscle and skin were sutured in routine fashion and thus the rat model of sciatic crush injury was prepared. The animal models were equally distributed into 5 different groups namely A, B, C, D and E and treated with phosphate buffer saline (PBS), carbon nanotubes based neural scaffold only, scaffold with IGF-I, stem cell laden scaffold and stem cell laden scaffold with IGF-I respectively. In vitro scaffold testing was performed. The nerve regeneration was assessed based on physico-neuronal, biochemical, histopathological examination, and relative expression of NRP-1, NRP-2 and GAP-43 and scanning electron microscopy. RESULTS: Sciatic nerve injury model with crush injury produced for 90 seconds was standardized and successfully used in this study. All the biochemical parameters were in normal range in all the groups indicating no scaffold related changes. Physico-neuronal, histopathological, relative gene expression and scanning electron microscopy observations revealed appreciable nerve regeneration in groups E and D, followed by C and B. Restricted to no regeneration was observed in group A. CONCLUSION: Carbon nanotubes based scaffold provided electro-conductivity for proper neuronal regeneration while rat bone marrow-derived mesenchymal stem cells were found to induce axonal sprouting, cellular transformation; whereas IGF-I induced stem cell differentiation, myelin synthesis, angiogenesis and muscle differentiation.

Bilateral Whole Lung Lavage in Hereditary Pulmonary Alveolar Proteinosis in a 4-year-old Child Using Extracorporeal Membrane Oxygenation.

The hereditary form of pulmonary alveolar proteinosis (PAP) is an uncommon entity. We report a case of PAP due to colony-stimulating factor 2 receptor alpha (CSF2RA) gene mutation. The standard of care includes whole lung lavage (WLL). We faced two challenges: Firstly, a severely hypoxemic patient, and secondly, the nonavailability of appropriate size of double-lumen endotracheal tube for pediatric patients for a WLL while permitting single-lung ventilation. Hence, we performed WLL using venovenous extracorporeal membrane oxygenation (VV ECMO) with a successful outcome. The patient has been discharged and is off oxygen support since more than a year. There are only a few case reports of children having hereditary PAP treated with WLL using ECMO in Indian and Western literature. HOW TO CITE THIS ARTICLE: Prabhudesai P, Khosla I, Kulkarni S, Arya MK, Pandey A, Yadav N. Bilateral Whole Lung Lavage in Hereditary Pulmonary Alveolar Proteinosis in a 4-year-old Child Using Extra corporeal Membrane Oxygenation. Indian J Crit Care Med 2021;25(9):1069-1072.

Efficacy and safety of prolonged daily hemodialysis in critically ill children weighing less than 10 kg.

INTRODUCTION: Extracorporeal renal replacement therapy may be needed in those infants in whom peritoneal dialysis is not feasible or is ineffective. Prolonged daily hemodialysis (PDHD) remains the only available extracorporeal dialytic modality in children weighing less than 10 kg, in setups where continuous renal replacement therapy is unavailable and sustained low-efficiency dialysis is not feasible due to lack of dedicated HD machines capable of delivering very low dialysate flows. The use of PDHD in critically ill children weighing less than 10 kg has not received much attention. METHODS: Retrospective analysis of the efficacy and safety of PDHD in critically ill children weighing less than 10 kg. FINDINGS: Four critically ill children received a total of 49 sessions of PDHD for acute kidney injury (AKI) associated with sepsis and multiorgan dysfunction syndrome (MODS). PDHD was delivered for a duration of 6 to 8 hours daily with low ultrafiltration rates, low blood flow rates but with dialysate rates that were four times the blood flow rates, due to limitations of minimal dialysate flow rate on standard machines. The mean duration of the sessions was 6.59 ± 1.61 hours. Mean hourly ultrafiltrate (UF) rate during the sessions was 9.28 ± 2.57/kg/hour with mean patient fluid removal rate of 5.4 ± 2.56 mL/kg/hour. Predialysis serum creatinine decreased to 30% of the starting value by the fourth hemodialysis (HD) session. Thirty-three (67.4%) sessions were heparin free. Intradialytic hypotension occurred in 10 (20.4%) sessions. Premature termination of the session occurred in six (12.4%), due to hypotension in two and filter clotting in four. Hypokalemia was seen in 12 (24.4%) and hypophosphatemia in 6 (12.24%). All four patients survived. On follow-up, three are dialysis free and one is on maintenance hemodialysis. CONCLUSION: PDHD is effective and safe in critically ill small children.

Computer-aided diagnosis of cirrhosis and hepatocellular carcinoma using multi-phase abdomen CT.

PURPOSE: High mortality rate due to liver cirrhosis has been reported over the globe in the previous years. Early detection of cirrhosis may help in controlling the disease progression toward hepatocellular carcinoma (HCC). The lack of trained CT radiologists and increased patient population delays the diagnosis and further management. This study proposes a computer-aided diagnosis system for detecting cirrhosis and HCC in a very efficient and less time-consuming approach. METHODS: Contrast-enhanced CT dataset of 40 patients (n = 40; M:F = 5:3; age = 25-55 years) with three groups of subjects: healthy (n = 14), cirrhosis (n = 12) and cirrhosis with HCC (n = 14), were retrospectively analyzed in this study. A novel method for the automatic 3D segmentation of liver using modified region-growing segmentation technique was developed and compared with the state-of-the-art deep learning-based technique. Further, histogram parameters were calculated from segmented CT liver volume for classification between healthy and diseased (cirrhosis and HCC) liver using logistic regression. Multi-phase analysis of CT images was performed to extract 24 temporal features for detecting cirrhosis and HCC liver using support vector machine (SVM). RESULTS: The proposed method produced improved 3D segmentation with Dice coefficient 90% for healthy liver, 86% for cirrhosis and 81% for HCC subjects compared to the deep learning algorithm (healthy: 82%; cirrhosis: 78%; HCC: 70%). Standard deviation and kurtosis were found to be statistically different (p < 0.05) among healthy and diseased liver, and using logistic regression, classification accuracy obtained was 92.5%. For detecting cirrhosis and HCC liver, SVM with RBF kernel obtained highest slice-wise and patient-wise prediction accuracy of 86.9% (precision = 0.93, recall = 0.7) and 80% (precision = 0.86, recall = 0.75), respectively, than that of linear kernel (slice-wise: accuracy = 85.4%, precision = 0.92, recall = 0.67; patient-wise: accuracy = 73.33%, precision = 0.75, recall = 0.75). CONCLUSIONS: The proposed computer-aided diagnosis system for detecting cirrhosis and hepatocellular carcinoma (HCC) showed promising results and can be used as effective screening tool in medical image analysis.

Development of a Stand-Alone Independent Graphical User Interface for Neurological Disease Prediction with Automated Extraction and Segmentation of Gray and White Matter in Brain MRI Images.

This research presents an independent stand-alone graphical computational tool which functions as a neurological disease prediction framework for diagnosis of neurological disorders to assist neurologists or researchers in the field to perform automatic segmentation of gray and white matter regions in brain MRI images. The tool was built in collaboration with neurologists and neurosurgeons and many of the features are based on their feedback. This tool provides the user automatized functionality to perform automatic segmentation and extract the gray and white matter regions of patient brain image data using an algorithm called adapted fuzzy c-means (FCM) membership-based clustering with preprocessing using the elliptical Hough transform and postprocessing using connected region analysis. Dice coefficients for several patient brain MRI images were calculated to measure the similarity between the manual tracings by experts and automatic segmentations obtained in this research. The average Dice coefficients are 0.86 for gray matter, 0.88 for white matter, and 0.87 for total cortical matter. Dice coefficients of the proposed algorithm were also the highest when compared with previously published standard state-of-the-art brain MRI segmentation algorithms in terms of accuracy in segmenting the gray matter, white matter, and total cortical matter.

Diabetic Ketoacidosis with Extreme Hypernatremia in a 4-Year-Old Girl.

A 4-year-old girl admitted with altered mental status, new-onset diabetes mellitus, and diabetic ketoacidosis (DKA) had a rapid rise in serum sodium from 158 mEq/L (corrected sodium 165 mEq/L) at the admission to 204 mEq/L within 18 hours of admission despite standard fluid and insulin therapy recommended for the treatment of DKA. During her illness, she developed arterial and deep vein thrombosis (DVT), bloodstream infection with Candida species, and extensive skin blistering and denudation. The child needed mechanical ventilation, insulin infusion, careful fluid titration to bring down the sodium gradually, and low-molecular weight heparin for her DVT. She had a prolonged Intensive Care Unit and hospital stay but recovered completely without any neurological sequelae.

Total arterial anaortic off-pump coronary artery bypass grafting in a patient with heart failure - Case report.

A 69-year-old male diabetic patient of heart failure underwent successful off-pump coronary artery bypass grafting (CABG) using both internal thoracic arteries and left radial artery. There was improvement of left ventricular ejection fraction within 4 days. This is the first ever case report of off-pump CABG in a heart failure patient.

Self-assembly of mesoscopic materials to form controlled and continuous patterns by thermo-optically manipulated laser induced microbubbles.

The formation of continuous patterns of nanostructured materials using directed self-assembly under external fields has generated considerable current research interest. We demonstrate for the first time such continuous patterning by inducing irreversible self-assembly leading to nucleation in mesocopic materials (inorganic, organic, and nanoparticles) using a tightly focused laser beam in an optical tweezers apparatus. A dense aqueous dispersion or solution of the material which has high absorption at the laser wavelength is taken in a sample holder so that some material is adsorbed on the top surface. A hot spot is created on the top surface when the adsorbed material absorbs the high intensity at the focus of the laser beam (a submicrometer sized spot), due to which a water vapor bubble is formed. This causes self-assembly of material around the bubble due to Gibbs-Marangoni convection and capillary flow after which the material eventually nucleates into a crystalline state. The bubble is "trapped" at the hot spot due to the temperature gradient around it and can be manipulated by thermal forces generated optically, so that the system may be described as a "thermo-optical" tweezers. We translate the trapped bubble using the microscope sample holder stage of the apparatus so that the nucleation site of the material is simultaneously translated generating continuous patterns. We have demonstrated the technique using exotic inorganic materials such as soft oxometalates, an organic material such as glycine, and a fluorescent dye such as perylene as well as with carbon nanotubes. We have written patterns over lengths of nearly 1 mm at the rate of 1 Hz, with best resolution of about 4 µm. The technique has potential for a wide range of applications ranging from solution processed printable electronics to controlled catalysis.

Ochoa or Urofacial syndrome.

We report a 10 year old boy presenting with bilateral hydronephrosis and peculiar facial expression suggestive of Ochoa Syndrome or Urofacial syndrome. He had chronic renal failure which was managed conservatively.