Utility of P63 in Differentiating Giant Cell Tumor from Other Giant Cell-Containing Lesions.

OBJECTIVE: To assess P63 expression in giant cell-containing lesions of the bone (GCLB) and to determine its utility in differentiating giant cell tumor of the bone (GCTB) from other GCLBs. MATERIAL AND METHOD: Cases diagnosed as GCLB on histopathology were included in the study. P63 immunohistochemistry was performed in all the cases. The percentage of cells showing nuclear positivity was assessed in the non-giant cell component. Statistical analysis was performed using the Mann-Whitney U test. RESULTS: Of the total 53 cases studied, the majority were GCTBs (23), followed by 12 cases of chondroblastomas (CBL) and 18 other giant cell lesions (GCLs). All giant cell-containing lesions except one case of CBL and brown tumor of hyperparathyroidism (BTH) showed P63 staining in the non-giant cell component. However, the mean P63 labeling of GCT (52.6%) was higher compared to CBL (28.3%), aneurysmal bone cyst (ABC) (15.2%), non-ossifying fibroma (NOF) (24.5%), giant cell lesion of small bones (GCLSB) (11%), BTH (6.8%) and chondromyxoid fibroma (CMF) (12.3%), with a p-value of < 0.001. CONCLUSION: Although p63 was present in majority of the GCLBs, its percentage positivity was significantly higher in GCTB compared to the other GCLBs. The diagnosis of GCTB is likely if cut-off value of > 50% is applied.

Solvation of NiOxfor hole transport layer deposition in perovskite solar cells.

A series of nickel oxide (NiOx) inks, in the perovskite antisolvent chlorobenzene (CB) containing 15% ethanol, were prepared for the fabrication of p-i-n perovskite solar cells by blade coating. The inks included triethylamine (Et3N) and alkyl xanthate salts as ligands to disperse NiOxparticle aggregates and stabilize suspension. A total of four inks were evaluated: 0X (Et3N with no alkyl xanthate), 4X (Et3N + potassiumn-butyl xanthate), 12X (Et3N + potassiumn-dodecyl xanthate), and 18X (Et3N + potassiumn-octadecyl xanthate). The inks were characterized by UV-visible spectroscopy and FT-IR spectroscopy and the resulting films analyzed by thermogravimetry and scanning electron microscopy. Devices prepared using the 0X ink resulted in a peak power conversion efficiency (PCE) of 14.47% (0.25 cm2) and 9.96% (1 cm2). The 0X devices showed no significant loss of PCE after 100 days in a nitrogen flow box. Devices prepared with inks containing alkyl xanthate ligand had lower PCE that decreased with decreasing chain length, 18X > 12X > 4X.

Bone metastases: A compilation of 365 histologically verified cases spanning over two decades from a single center.

OBJECTIVE: To analyze the clinicopathological features of metastatic bone tumors over a period of two decades and identify the primary site of malignancy in metastasis of unknown origin. MATERIALS AND METHODS: A total number of 365 cases were included in the study. The clinical features and location of the tumors were noted. The histopathological features of all the cases were studied. Immunohistochemistry (IHC) was done either to categorize or confirm the primary diagnosis using organ specific/organ restricted markers. RESULTS: A total 712 bony sites were involved by metastasis in 365 patients, of which spine was the most commonly affected. Metastasis was the initial presentation in 69.5% patients. The primary site was known in 220 patients and almost half of them were detected after the diagnosis of metastasis. IHC was used as adjunct to suggest the possible origin in cases with unknown primary in 27.4%. Among the metastatic carcinoma, adenocarcinoma was the most common histological subtype with thyroid being the most frequent primary site of origin followed by lung and breast. CONCLUSION: More than two-third of cases in surgical pathology practice present as initial manifestations. Detection rate of primary depends on extent of metastatic work-up and IHC with organ specific/organ restricted markers to facilitate treatment with bone targeting agents.

Clinical and echocardiographic predictors of outcomes in patients with peripartum cardiomyopathy: A single centre, six month follow-up study.

INTRODUCTION: Peripartum cardiomyopathy (PPCM) is an important cause of maternal mortality and morbidity. But, there is a paucity of prospective data on outcomes and prognostic markers in patients receiving contemporary evidence-based therapy, particularly in developing countries. METHODS: This was a single centre, prospective, cohort study on 43 PPCM patients who were followed for 6 months. The primary endpoint was a composite incidence of decompensation related re-hospitalization, all-cause death, and poor recovery (defined as left ventricular ejection fraction, LVEF: <45% at 6 months). Multivariate logistic regression analysis was performed to identify the independent predictors and Kaplan-Meier plots for event (re-hospitalization or death) free survival were computed at their optimal cut-offs. RESULTS: Mean LVEF at presentation was 34.7%. Two patients died during index hospitalization but there were no deaths during follow-up and 63.4% of patients had full LV recovery after discharge. 32.5% of the study population experienced the composite endpoint with high left atrial volume index (LAVi), and low right ventricular fractional area change (RVFAC) at presentation as independent predictors. Use of Inotropic therapy during index hospitalization (with dobutamine or levosimendan) and bromocriptine therapy were not associated with better outcome. CONCLUSIONS: At the end of 6 months after PPCM diagnosis, about 61% of patients had full LV functional recovery with a mortality rate of 4.7%. RVFAC (<31.4% with 86% accuracy) and LAVi (>29.6 ml/m2 with 72% accuracy) at presentation but not LVEF, predicts poor outcomes. Presence of both these risk factors at index hospitalization was associated with a significantly lower event free survival compared to patients without these predictors.

Clinical outcomes of patients with mitral prosthetic valve obstructive thrombosis treated with streptokinase or tenecteplase.

Agent of choice for thrombolytic therapy (TT) in prosthetic valve thrombosis (PVT) is unknown. 84 mitral obstructive-PVT episodes treated with TT (43: Tenecteplase; 41: Streptokinase) were included in this prospective study. The incidence of primary end-point (CCS: complete clinical success, defined as complete or partial hemodynamic success with no complications or surgery) was 84.5% with recurrent PVT as a sole predictor. Bleeding and embolic manifestations were noted in 8.3% and 4.7% of episodes respectively. Tenecteplase use was associated with lower complication rate and a mitral EOA of <0.74 cm2 at presentation predicts the need for extended thrombolysis (accuracy, 78.6%).

Association between 2D echocardiographic right atrial volume to left atrial volume (RAV/LAV) ratio and in-hospital prognosis in thrombolysed acute pulmonary thromboembolism patients.

Right atrial volume/Left atrial volume (RAV/LAV) ratio is a good hemodynamic parameter in acute pulmonary thromboembolism (PTE), whose prognostic ability by 2D echocardiography is not studied to date. We conducted a 27 month, prospective observational study on 55 eligible acute PTE thrombolysed (29: Tenecteplase; 26: Streptokinase) patients. The primary endpoint was a composite of in-hospital death and poor right ventricular reverse remodelling at the time of discharge. The incidence of primary end-point and death were 40% and 7.2% respectively. On regression analysis, RAV/LAV ratio was the only predictor of the primary endpoint, with an optimal cut-off of 3.8 (accuracy 75%).

Left Ventricular Thrombus: An Interesting Presentation of Primary Antiphospholipid Antibody Syndrome with a Mini-review of the Literature.

Antiphospholipid syndrome (APLS) is characterized by recurrent thrombosis. We report the case of a 36-year-old male who had acute right-sided ischemic stroke and right leg ischemia secondary to left ventricular (LV) thrombus caused by primary APLS. The literature review suggested that the LV thrombus presented most commonly with systemic embolism and was associated with a mortality rate of 22.2% with treatment. Thrombophilic workup in young patients with a systemic thromboembolic episode (s) is advised.

Effect of preoperative application of buprenorphine transdermal patch on analgesic requirement in postoperative period in hip and knee replacement surgeries.

BACKGROUND AND AIMS: Although no pain control following hip and knee replacement surgeries has attained gold standard, it is clear that patients should have optimum pain control after total knee arthroplasty and total hip arthroplasty for enhanced satisfaction and function. We conducted this study to evaluate the effect of preoperative application of buprenorphine transdermal patch on analgesic requirement in perioperative period after knee and hip replacement surgeries. MATERIAL AND METHODS: Following institutional ethical committee approval and written informed consent, a prospective study was conducted in 50 patients of either gender belonging to ASA1 or ASA2 status, requiring either knee or hip replacement. The patients were assessed in preoperative period, and buprenorphine patch of 10 mg (sustained release of 10 µg/h) was applied either on the chest or on outer side of the arm 12 h before surgery. Total knee arthroplasty/total hip arthroplasty was done under combined spinal epidural blockade. Epidural infusion with 0.125% bupivacaine at a rate of 4-5 mL/h was continued in postoperative period. Intravenous opioid analgesics were avoided in postoperative period, and whenever required only iv paracetamol 1g was given. Outcome in terms of requirement of iv analgesic, visual analog pain score, any associated nausea vomiting, itching, and level of somnolence was noted in postoperative period at 1,2,3,4,8,12,16,20,24,48, and 72 h, respectively. RESULTS: None of the patient required rescue analgesia in the first 2 h. During 72 h postoperative period of observation 32% of patients demanded rescue analgesics at 8th hour, followed by 20% at 4th hour and 16% at 12th hour. CONCLUSION: Preoperative application of transdermal patch significantly reduces the requirement of postoperative intravenous opioid and nonopioid analgesic drugs.

Metachronous multicentric giant cell tumour of bone.

Metachronous multicentric giant cell tumour (GCT) of bone is rare. We report a case of a 21-year-old man with metachronous multicentric GCTs, with five (including one recurrence) documented lesions reported over a span of 9 years involving various sites, which included the fifth metacarpal bone of the right hand, the intermediate cuneiform bone of the right foot, the left proximal humerus and the lateral malleolus of the right tibia. The radiological appearance of these lesions in these various sites with correlation among clinical history, histopathology and the treatment approach is described in this report. He is undergoing regular follow-up and has now once again presented with recurrence of the right tibial lesion. The case is reported for its rarity.

Enhancement of Y123 dye-sensitized solar cell performance using plasmonic gold nanorods.

The role of the surface plasmon resonance (SPR) of gold nanorods (Au NRs) on the performance of Y123 dye-sensitized solar cells (DSSC) was investigated. DSSCs were fabricated by incorporating different concentrations (0.6 to 3.0 wt%) of Au NRs into TiO2 photoanodes. With an increase in the concentration of the Au NRs, the light absorption by the Y123 dye loaded photoanodes enhanced linearly, but the charge extraction was susceptible to the concentration of the Au NRs. With optimized concentrations (∼1.8 wt%) of the Au NRs, the photocurrent of the DSSC enhanced from 12.45 to 15.74 mA cm-2, and the power conversion efficiency (PCE) improved from 5.31 to 8.86%. The DSSC performance was also verified using Au nanoparticles (the PCE was enhanced from 5.31 to 7.72%) for comparison with the Au NR DSSC performance, which demonstrated the advantage of the Au NRs' shape effect with longitudinal SPR due to the modified light interaction. To explain the experimental observations of the plasmonic DSSC, the Au NRs' extinction efficiency and spatial distribution of the near-fields in complete and porous TiO2 media were also estimated using the finite-element method.

Fabrication of perovskite films using an electrostatic assisted spray technique: the effect of the electric field on morphology, crystallinity and solar cell performance.

An electric field assisted spray deposition method is employed for improving the perovskite film morphology, crystallinity, and surface coverage, and for further fabricating an efficient solar cell. By applying different voltages ranging from 0.5 to 2.0 kV during spray deposition, we observed a large variation in the film morphology and surface coverage compared to those fabricated without an electric field, which is due to improved atomization from the Coulomb fission process. The optimized applied voltage of 1.5 kV during spraying led to completion of the reaction between CH3NH3I and PbI2 on a hot substrate for pure phase CH3NH3PbI3 thin film formation with improved grain growth and surface coverage. The cells fabricated using perovskite films showed clear applied voltage dependence in the energy conversion process and alleviation in J-V hysteresis; with 1.5 kV applied voltage the average cell efficiency of 8.9% was obtained compared to films fabricated without applying voltage providing only 6.5%. The best efficiencies are 10.9% and 7.37% for applied voltages of 1.5 kV and 0 kV, respectively. The enhancement in efficiency with applied voltage is due to the formation of more uniform and dense films with large perovskite crystals, which resulted in efficient electron transportation (enhanced photocurrent and modified series and shunt resistances) by minimizing the charge carrier recombination at grain boundaries (resulting in enhanced open circuit voltage). With further optimization of the perovskite film thickness by adjusting the CH3NH3I spray volume, the average cell efficiency of ∼11.0% was obtained.

Isolation, identification, and carriage of candidal species in PHLAs and their correlation with immunological status in cases with and without HAART.

AIMS AND OBJECTIVES: To know the prevalence of Candidal colonization, and to isolate and know the Candidal species prevalent in the oral cavity from the oral rinse samples collected from the individuals attending to the Voluntary Counseling and Confidential Testing Center (VCCTC) and the antiretro-viral therapy (ART) Center at Government General Hospital, Guntur, Andhra Pradesh, South India. MATERIALS AND METHODS: The study group consisted of 50 HIV negative asymptomatic individuals (Group I); 50 HIV positive individuals (people living with HIV AIDS [PLWHA's]), who are naïve to antiretro-viral therapy (direct walk-in clients of VCCTC) (Group II); and 50 HIV positive individuals with CD4+ count less than 250 and who are started on highly active anti retroviral therapy (HAART) (Group III). Routine mycological tests for the isolation of pure cultures of Candida and also the speciation procedures were done. RESULTS: In the study group, 53 (Group I=11; Group II=23; Group III=19) were culture positive. The prevalence of Candida was comparatively high in the age range between 41-50 years in Group II; 51-60 years, in Group III. A male predominance was observed in the Group I (M:F=16:6) and Group III (M:F=20:18), with a slight female predominance in the Group II (F:M=24:22). The overall culture positivity was 35.3%. Candida albicans was the highest prevalent species (47.17% of the isolates). A comparison of the culture positivity with the CD(4) counts of the study subjects was statistically highly significant. A pair wise comparison of the culture positivity with that of the colony forming units/mL from the subjects showed a high significance between Group I and Group II, and between Group I and Group III. CONCLUSION: Candidal infections in immuno compromised patients are often severe, rapidly progressive, and difficult to treat and such patients have a definitive risk of developing oral candidiasis wherein, even the members of the normal oral flora may become pathogenic. Candida albicans is the common isolate. Nonalbicans species are also emerging as opportunistic pathogens. In view of this changing pattern, it is strongly recommended that species identification can help in much better treatment strategies, and thus, gain a good control over the disease. The findings of this study would be helpful in any further studies which, if done prospectively on a larger cohort, can be confirmatory.

Leiomyoma of the mandible in a child.

Leiomyomas are the benign tumors of the smooth muscle that usually arise in the gastrointestinal system and in the uterus. Oral leiomyomas are uncommon due to the paucity of the smooth muscles in the mouth (except in blood vessels) and those of the mandible are extremely rare. Leiomyomas have been classified as solid, angiomyoma (vascular leiomyoma), and epithelioid variants. Here, we report a rare case of leiomyoma of the mandible in a 9-year-old child, together with conventional histopathologic and immunohistochemical findings.

Malignant melanoma of the mandibular gingiva: a rare occurrence.

Primary mucosal malignant melanoma of the oral cavity is a rare tumor. It accounts for only 0.2-8% of all malignant melanomas. This malignancy commonly affects male subjects and is more frequently seen on the hard palate and maxillary gingiva. The peak age for diagnosis of oral melanoma is between 55 and 65 years. A biopsy is required to establish a diagnosis. Ablative surgery with tumor-free margins remains the treatment of choice. It has a much poorer prognosis than its counterpart on the skin. Here, we present a case of malignant melanoma of the mandibular lingual gingiva in a 55-year-old male patient. Immunohistochemistry and special stains were conducted for confirmatory diagnosis.