Methylation study of tumor suppressor genes in human aberrant crypt foci, colorectal carcinomas, and normal colon.

BACKGROUND: Aberrant crypt foci (ACF) are the earliest preneoplastic lesions in human colon, identifiable on chromoendoscopic screening. Our objective was to evaluate the %methylation of APC, CDKN2A, MLH1, RASSF1, MGMT, and WIF1 tumor suppressor genes (TSG) in ACF, corresponding colorectal carcinomas (CRC), and normal colonic mucosal controls. METHODS: In this study, macroscopically normal-appearing mucosal flaps were sampled 5-10 cm away from the tumor mass from 302 fresh colectomy specimens to identify ACF-like lesions. Thirty-five cases with multiple ACFs were selected (n 35) as the main study group, with corresponding sections from CRC (n 35) as disease controls, and mucosal tissue blocks from 20 colectomy specimens (normal controls), operated for non-neoplastic pathologies. Genomic DNA was extracted, and methylation-specific polymerase chain reaction (PCR) was performed on a customized methylation array model. %Methylation data were compared among the groups and with clinicopathological parameters. Selected target mRNA and protein expression studies were performed. RESULTS: %Methylation of TSGs in ACF was intermediate between normal colon and CRC, although a statistically significant difference was observed only for the WIF1 gene (P < 0.01). Also, there was increased nuclear ß-catenin expression and upregulation of CD44-positive cancer-stem cells in ACF and CRCs than in controls. Right-sided ACFs and dysplastic ACFs had a higher %methylation of CDKN2A (P < 0.01), whereas hyperplastic ACFs had a higher %methylation of RASSF1 (P 0.04). The topographic characteristics of ACFs did not correlate with TSG %methylation. CONCLUSIONS: Early epigenetic methylation of WIF1 gene is one of the mechanisms for ACF development in human colon.

Effect of the magnetic core in alginate/gum composite on adsorption of divalent copper, cadmium, and lead ions in the aqueous system.

The change of composition of an adsorbent material has been widely used as a method to increase its adsorption capacity, particularly concerning adsorbents made of polysaccharides. Introducing magnetic adsorbents into contaminated water treatment systems is a highly promising strategy, as it promotes the metal ions removal from water. Considering this, gum Arabic (GA) was associated with alginate (Alg), when magnetite nanoparticles were present or absent, to produce beads that were utilised to take up Cu(II), Cd(II), and Pb(II) from aqueous solution. After a complete characterisation (for which Fourier transform infrared spectroscopy, thermogravimetric analysis, scanning electron microscopy, and swelling were used), the adsorption properties were established using batch and column tests. The magnetic beads (MAlg/GA) demonstrated improved adsorption in comparison with the beads made without magnetite (Alg/GA) under the same conditions. In normal adsorption conditions (pH 6.0, 25 °C, 2.5 g L-1 of adsorbent dosage), the highest uptake capacities recorded for the MAlg/GA beads were: for Cu(II), 1.33 mmol g-1; Cd(II), 1.59 mmol g-1; and for Pb(II), 1.43 mmol g-1. The pseudo-second-order kinetics and Langmuir isotherm models provided good fits for the adsorption of these metals. Overall, ion exchange and physical forces led to the uptake of these metals by both Alg/GA and MAlg/GA; moreover, the functional groups on the beads played crucial roles as binding sites. Additionally, it was observed that flow rates of >2 mL min-1 did not produce noticeable changes in uptake levels over the same flow period. It was found that the efficient eluting agent was HNO3 (0.2 M). In some cases, the metals were not removed fully from the used beads during the first five cycles of regeneration and reuse. The results of this investigation show that these beads are efficient adsorbents for the removal of metal ions from spiked well water samples.

Risk and protective factors associated with adolescent depression in Singapore: a systematic review.

Introduction: Adolescent depression is prevalent, and teen suicide rates are on the rise locally. A systemic review to understand associated risk and protective factors is important to strengthen measures for the prevention and early detection of adolescent depression and suicide in Singapore. This systematic review aims to identify the factors associated with adolescent depression in Singapore. Methods: A systematic search on the following databases was performed on 21 May 2020: PubMed, EMBASE and PsycINFO. Full texts were reviewed for eligibility, and the included studies were appraised for quality using the Newcastle Ottawa Scale. Narrative synthesis of the finalised articles was performed through thematic analysis. Results: In total, eight studies were included in this review. The four factors associated with adolescent depression identified were: (1) sociodemographic factors (gender, ethnicity); (2) psychological factors, including childhood maltreatment exposure and psychological constructs (hope, optimism); (3) coexisting chronic medical conditions (asthma); and (4) lifestyle factors (sleep inadequacy, excessive internet use and pathological gaming). Conclusion: The identified factors were largely similar to those reported in the global literature, except for sleep inadequacy along with conspicuously absent factors such as academic stress and strict parenting, which should prompt further research in these areas. Further research should focus on current and prospective interventions to improve mental health literacy, targeting sleep duration, internet use and gaming, and mitigating the risk of depression in patients with chronic disease in the primary care and community setting.

Ossified upper thoracic intradural mature teratoma in a teenager - A technical case report with special emphasis on surgical strategy.

Spinal teratomas are heterogeneous neoplasms and are extremely rare in the upper thoracic spine. They are sub-classified as mature, immature, or malignant. They may be calcified or rarely ossified; the latter posing a major surgical challenge due to surgical difficulties in safe removal. Clinicoradiologico-pathological and operative experience of ossified spinal intradural mature teratomas is extremely rare. We present a case of ossified upper thoracic intradural mature teratoma managed by microsurgical drilling and resection under neuromonitoring.

High-grade mixed neuroendocrine non-neuroendocrine neoplasm of the gastroesophageal junction: A rare case report and review of literature.

Mixed neuroendocrine non-neuroendocrine neoplasm (MiNeN) is a recently described entity of the esophagus in the latest (fifth) edition of WHO Classification of Digestive System Tumors. It is often a difficult pathological diagnosis, especially in small preoperative biopsies. We herein report a case of high-grade MiNeN of gastroesophageal junction diagnosed as a squamous cell carcinoma in preoperative biopsy and subsequently as a high-grade MiNeN in esophagogastrectomy specimen comprising areas of mucoepidermoid carcinoma and large-cell neuroendocrine carcinoma (NEC). This report accentuates the importance of deeper multisite preoperative biopsies as the management is completely different in a MiNeN from esophageal squamous cell carcinoma.

Unusual giant pleural lipomas: imaging features.

Pleural lipomas are rarely encountered in the thoracic cavity. Sometimes, they infiltrate the intercostal space to have a component on either side of the intercostal space forming a hourglass configuration. They are generally solitary, small and asymptomatic. We present the case of a 49-year-old man with two giant pleural lipomas, both originating from the right parietal pleura, and one of which was passing through the intercostal space giving rise to a hourglass-shaped configuration. When they occur, although benign, considering the evolutionary potential, excision is recommended.

Synthesis of Gum Arabic-g-polyaniline using diode laser.

Grafting of polyaniline (PANI) on Gum Arabic (GA) was carried out in the presence of ceric ammonium nitrate (CAN) under acidic conditions by diode laser as initiator. The grafting condition was optimized by varying the diode laser power, exposure time, concentrations of PANI, CAN, GA, reaction time and temperature were carefully optimized to achieve the highest percentage of grafting yield % GY (90%) and percentage of graft efficiency % GE (36%). The Fourier-transform infrared spectroscopy (FTIR), 1H NMR, X-ray Diffraction (XRD), Thermogravimetric Analysis (TGA), and Scanning electron micrographs (SEM) techniques have been used for the characterization of the produced graft copolymer GA-g-PANI, which used as drug delivery carrier to control cancer in brain. This study focused to new trends and latest developments in this area where diode laser was found to be efficient and, clean method for synthesis GA-g-PANI.

Hypoxia due to intrapulmonary vascular dilatation in a toddler with a congenital portacaval shunt: case report.

BACKGROUND: The term hepatopulmonary syndrome typically applies to cyanosis that results from "intrapulmonary vascular dilatation" due to advanced liver disease. Similar findings may result from a congenital portosystemic shunt without liver disease. An adverse consequence of such shunts is intrapulmonary vascular dilatation, which affects the microvascular gas exchange units for oxygen. CASE PRESENTATION: Here, we describe a toddler with chronic cyanosis, exercise intolerance, and finger clubbing due to a malformation shunt between the portal vein and the inferior vena cava. A transcatheter embolization of the shunt resulted in resolution of his findings. CONCLUSIONS: Congenital portosystemic shunts need to be considered in the differential diagnosis of cyanosis.

BiodentineTM versus formocresol pulpotomy technique in primary molars: a 12-month randomized controlled clinical trial.

BACKGROUND: The objective of this clinical study was to prospectively compare the clinical and radiographic success rates of BiodentineTM pulpotomies versus formocresol pulpotomies in children vital primary molars. METHODS: A randomized, split-mouth study design was used with a sample of 37 healthy children aged 4- to 8-year-old. A total of 56 pairs (112 teeth) of carious primary teeth, 1 pair per child, were selected for treatment. One tooth from each pair was randomly assigned to either the BiodentineTM pulpotomy group or the formocresol pulpotomy group. Children were followed-up at 3, 6 and 12 months for clinical evaluation and at 6 and 12 months for radiographic evaluation. Data were collected, tabulated and analyzed using Fisher exact and McNemar tests. The level of significance was set at P < 0.05. RESULTS: At 12 months, the clinical success rates of both BiodentineTM and formocresol groups were 100%, while the radiographic success rates for BiodentineTM and formocresol groups were 100% and 98.1%, respectively. There was no statistically significant difference between both groups (P=1). The only observed radiographic failure was furcal radiolucency in the formocresol group at 12-month interval. Pulp canal obliteration was radiographically observed in 10/56 (17.9%) and 7/56 (12.5%) cases in the BiodentineTM and formocresol groups, respectively. CONCLUSIONS: Both BiodentineTM and formocresol pulpotomy techniques demonstrated favorable clinical and radiographic outcomes over a 12-month period without any significant difference. TRIAL REGISTRATION: Registered on NCT03779698 . Date of Registration: 18 December 2018.

Dilemma of renal disease in elderly.

The aging process results in profound anatomic and functional changes in a number of human body systems. Changes in kidney function with normal aging are the most dramatic of any human organ or organ system. These include anatomical, physiological, hemodynamic and immunological changes. Increased propensities of systemic diseases and exposure to poly-pharmacy of the aged group have an additive deleterious effect. The aforementioned changes have its implications on clinical presentations, management and prognosis of all renal diseases in elderly. Atypical presentation, more frequent and longer course are the characteristics of acute renal failure in this age group. Also, presentation of glomerular diseases, clinical course, prognosis, decision of performing a renal biopsy and use of immunosuppressive drugs in elderly specially those subgroup above 80 years of age are still a big challenges that needs a consensus and standardization.

What is the most appropriate formula to use in estimating glomerular filtration rate in adult Arabs without kidney disease?

BACKGROUND: In clinical practice, the glomerular filtration rate (GFR) is often estimated by the Modification of Diet in Renal Disease (MDRD) or Cockcroft-Gault (CG) formulae. No data are available, however, on the performance of these formulae in Arab individuals. METHODS: Plasma creatinine samples were obtained from 90 consecutive normal Arab kidney donors for the estimation of GFR (eGFR) using the simplified MDRD and CG formulae. The GFR was measured in these donors with chromium labelled EDTA {[51Cr] EDTA). Bias was assessed by calculating the difference between the measured GFR and the calculated GFR using each of the two formulae; precision was calculated using the r value of the regression analysis. RESULTS: The group studied consisted of 90 donors, of whom 64 were males (71%). The mean age was 30.8 years (+/- 9.8) and mean BMI was 25.7 (+/- 5.7). The measured GFR (mean 112.4 +/- 17.5) correlated better with the calculated GFR by CG formula (mean 107.7 +/- 29.7) and showed poor correlation with the GFR estimated by the MDRD (mean 89.2 +/- 13.8); bias = 4.8 and 23.3, respectively (p = 0.1 and < 0.0001, respectively). The correlation with CG formula was better in males (bias = 2, p = 0.5) and those under 30 years of age (bias = 1.0, p = 0.9). Based on our data, we calculated a correction factor to the CG formula to improve the correlation with the measured GFR in Arab individuals. By multiplying the CG formula by 1.0446, the bias was reduced from 4.8 (p = 0.1) to 0.0 (p = 0.5) with an increase in precision from 0.2 (p = 0.05) to 0.43 (p = 0.0001). Using CG formula, the frequency for values within 30% of the mean of the measured value was 75%, which improved to 80% using the revised formula. CONCLUSIONS: CG formula was found to be the most appropriate for calculation of GFR in Arab individuals. It is possible to reduce the bias and improve precision in Arab individuals with normal renal function by multiplying the result obtained by CG formula by 1.0446.

Comparative crossover controlled study using polysulphone and vitamin E coated dialyzers.

OBJECTIVE: There is relatively little clinical experience reported on the use of the vitamin E coated dialyzer (CL-EE12, Terumo). This study compares its efficacy and intradialytic symptoms with a polysulphone dialyzer in 2 groups of patients in a controlled crossover trial design. METHODS: This study was carried out at the Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia, during the time period January to March 2002. In group A, 34 patients were dialyzed for 4 weeks with vitamin E dialyzer then switched over to Fresenius 60 (F60) for 4 weeks. In group B, 41 patients were dialyzed with F60 for 4 weeks then switched to vitamin E coated dilayzers for 4 weeks. The following parameters were measured weekly, hemoglobin level, urea reduction ratio (URR), urea clearance ratio (Kt/V), pre and post dialysis diastolic blood pressure (DBP) and systolic blood pressure (SBP), interdialytic weight gain. The patients were observed for interdialytic hypotension or symptoms. RESULTS: No significant findings were found in any of the parameters except more dialyzer clotting was observed with vitamin E dialyzer than in F60 dialyzers (1.6% of dialysis sessions versus 0.1% P<0.03). The interdialytic weight gain tended to be less in the vitamin E group but did not reach statistically significant difference. The Kt/V and URR were slightly higher when using the vitamin E dialyzer only in the second and third weeks. hypotensive episodes (P<.007) less leg cramp (P<.31) and less itching (P<.02) in the vitamin E coated treated group within group B. CONCLUSION: There were only minor differences noted between the 2 dialyzers in the parameters measured.

Long-term intravenous calcitriol in secondary hyperparathyroidism: the role of technetium-99m-MIBI scintigraphy in predicting the response to treatment.

BACKGROUND: Despite the effectiveness of intravenous calcitriol in suppressing parathyroid hormone secretion in patients with uremic hyperparathyroidism, 50% of the patients remain refractory to this treatment. There are conflicting reports regarding the factors that can predict the response to treatment. Technetium-99m-MIBI scintigraphy was found to be correlated with functional activity of the parathyroid gland. METHODS: We, retrospectively, evaluated 16 chronic hemodialysis patients, who were maintained on i.v. calcitriol for 36 months or longer, and who had MIBI scan either at the start of, or within the first 6 months of starting calcitriol. Nine patients had a positive uptake (+ve group), and 7 patients had a negative uptake (-ve group). All patients had an elevated iPTH (iPTH > 300 pg/ml) at the start of treatment. RESULTS: The percentage reduction of iPTH in the (-ve) and the (+ve) groups was 65% versus 45% at 12 months, and 65% versus 10% at 36 months respectively. In long-term follow-up of 36 months, all the patients in the (-ve) group responded to calcitriol; while 8 of the 9 patients (89%) in the (+ve) group didn't respond. The difference in response between the 2 groups was statistically significant (p<0.001). CONCLUSION: We conclude that MIBI scan is a reliable technique in predicting the response to treatment with i.v. calcitriol in patients with secondary hyperparathyroidism.