Rapid Growth of Nanostructured Diamond Film on Silicon and Ti–6Al–4V Alloy Substrates

Nanostructured diamond (NSD) films were grown on silicon and Ti–6Al–4V alloy substrates by microwave plasma chemical vapor deposition (MPCVD). NSD Growth rates of 5 μm/h on silicon, and 4 μm/h on Ti–6Al–4V were achieved. In a chemistry of H₂/CH₄/N₂, varying ratios of CH₄/H₂ and N₂/CH₄ were employed in this research and their effect on the resulting diamond films were studied by X-ray photoelectron spectroscopy, Raman spectroscopy, scanning electron microscopy, and atomic force microscopy. As a result of modifying the stock cooling stage of CVD system, we were able to utilize plasma with high power densities in our NSD growth experiments, enabling us to achieve high growth rates. Substrate temperature and N₂/CH₄ ratio have been found to be key factors in determining the diamond film quality. NSD films grown as part of this study were shown to contain 85% to 90% sp³ bonded carbon.     

Living donor liver transplantation in maple syrup urine disease – Case series and world's youngest domino liver donor and recipient

MSUD occurs due to deficiency of enzyme BCKAD required for metabolism of leucine, isoleucine, and valine leading to the accumulation of these and their ketoacids causing acute metabolic decompensation manifesting as encephalopathy or sudden death. The patient requires special protein‐restricted diet to survive. As this enzyme is expressed in liver, liver transplantation has been successfully performed as a cure. We report two patients of MSUD who underwent LDLT while their livers were used as a domino graft for other biliary cirrhotic patients. A 22‐month‐old male child diagnosed as a case of classic MSUD underwent LDLT from an altruistic aunt as donor following which his serum leucine levels normalized on an unrestricted protein diet. His liver was used as a domino graft. A 38‐month‐old female child with diagnosed MSUD underwent LDLT from a swap donor, and her liver was used as a domino graft. Her DQ improved post‐transplant. LDLT from non‐heterozygous donors is a cure for classical MSUD. Their livers can be used as domino grafts for non‐MSUD cases.     

Changes in potassium concentration and haematocrit associated with cardiopulmonary bypass in paediatric cardiac surgery

INTRODUCTION: A blood prime is frequently required for paediatric bypass surgery to maintain adequate haematocrit (Hct). However, stored blood can have high extracellular potassium levels and this study aims to investigate the effect of stored blood on the potassium concentration, both in the prime and subsequently in the patient after cardiopulmonary bypass (CPB) has been established. In neonatal surgery, the stored blood may be irradiated if there is a question of impaired immunity. Irradiation may cause a further increase in potassium levels. METHODS: Blood-primed circuits prepared for 320 consecutive paediatric bypass cases were analysed for electrolyte levels, Hct and acid-base status before and immediately after establishment of CPB. Patients were divided into three groups according to body weight (<5kg, 5-10kg and > 10 kg) and both stored blood and irradiated blood primes were compared. RESULTS: The potassium concentration was above the physiological range in all bypass primes pre-CPB and was significantly higher when using irradiated blood (8.12 +/- 2.54 mmol/L versus 4.94 +/- 3.35 mmol/L, p < 0.0001). Despite this, on commencing CPB, the potassium level remained within the physiological range in the majority of patients (4.16 +/- 2.72mmol/L for stored blood prime and 4.55 +/- 1.01mmol/L for irradiated blood, p = 0.02). However, in smaller patients (<5 kg) who had irradiated blood prime potassium level > 7.0 mmol/L, there was resultant hyperkalaemia (5.60 +/-0.90 mmol/L) on commencing CPB, that returned to normal later. No adverse clinical events were associated with the hyperkalaemia. Hct was well maintained on CPB (22-25%) in all groups and was not related to patient weight. CONCLUSION: Blood primes result in high potassium concentrations in the prime fluid that is more severe if irradiated blood is used. The concentration is not sufficient to cause hyperkalaemia in the patients on commencing CPB except when irradiated blood prime is used in infants < 5 kg. Hct is well maintained in all patient groups with the use of blood prime.     

India’s first successful intestinal transplant: The road traveled and the lessons learnt

Intestinal transplant is a therapeutic challenge not just surgically but also logistically because of the multidisciplinary expertise and resources required. A large proportion of patients who undergo massive bowel resection and develop intestinal failure have poor outcome, because of inability to sustain long-term parenteral nutrition and limited availability of intestinal and multi-visceral transplantation facilities. We report the first successful isolated intestinal transplant from India.     

The use of ABO-incompatible grafts in living donor liver transplantation—First report from India

ABO incompatibility is the commonest reason for rejection of donors in living donor liver transplantation (LDLT). The donor pool could be expanded by 25 % to 35 % if the ABO barrier is overcome. In the absence of pre-conditioning, transplantation across the blood groups is fraught with the almost universal risk of antibody-mediated rejection (AMR) that rapidly leads to graft loss. However, AMR can be prevented by removal of preformed antibodies and reducing their production by B cells. We describe our initial experience of three cases of ABO-incompatible (ABO-i) LDLT: a 42-year-old male, an 8-month-old male and a 28-month-old female, all of blood group O+ who received blood group B + right lobe, B + left lateral segment, and A + left lateral segment liver grafts, respectively. Pre-LDLT conditioning included administration of anti-CD20 antibody (Rituximab^®) to the adult 4 weeks prior, and four to seven sessions of double-filtration plasmapheresis to all, to remove preformed antibodies and achieve anti-donor blood group antibody (ADA) titers of ≤1:16 IgG and ≤1:8 IgM, respectively. In addition, cases 1 and 3 received mycophenolate mofetil for 7 days prior to LDLT. After LDLT, all three patients achieved normal graft function over 8–17 days with no evidence of AMR and without the need for further plasmapheresis. Postoperative complications included portal vein thrombosis (one successfully re-explored), CMV (one), Pseudomonas and Klebsiella sepsis (one each), and abdominal collection (one treated with percutaneous drainage). All are currently well with normal graft function and low ADA titers at 8, 16, and 19 months after ABO-i LDLT.     

Efficacy of systemic bisphosphonate delivery on osseointegration of implants under osteoporotic conditions: Lessons from animal studies

Background

The aim was to systematically review the role of systemic bisphosphonate (BP) delivery on osseointegration of implants under osteoporotic conditions.

Methods

The addressed focused question was “Does systemic BP delivery enhance osseointegration of implants under osteoporotic conditions?” PubMed/MEDLINE and Google-Scholar databases were searched from 1994 up to and including December 2013 using different combinations of the following keywords: “bone to implant contact”, “implant”, “bisphosphonate”, “osseointegration” and “osteoporosis”. Review articles, case-reports, commentaries, letters to the Editor, unpublished articles and articles published in languages other than English were excluded.

Results

Fifteen animal studies fulfilled our eligibility criteria. Osteoporotic conditions were induced via bilateral ovariectomy (OVX). BPs used in the studies were ibandronate, zoledronic acid and alendronate. Results from 12 studies showed that systemic BP delivery significantly increased bone volume and bone-to-implant contact under osteoporotic conditions. Two studies reported no significant difference in osseointegration among OVX animals with and without systemic BP delivery. In one study, systemic BP delivery negatively influenced implant osseointegration. Rough-surfaced and polished implants were used in 11 and one study respectively. In 3 studies implant surface characteristics remained unclear.

Conclusion

Within the limits of the present study, it is concluded that systemic BP delivery enhances implant osseointegration in animals with induced osteoporotic conditions. However, in a clinical scenario, the potential risk of BP related ONJ in osteoporotic patients undergoing dental implant therapy cannot be disregarded.     

Induced sputum nitrites correlate with FEV1 in children with cystic fibrosis

Aim: To determine the difference in the levels of nitrites in induced sputum of children with cystic fibrosis (CF) and controls. Furthermore, to evaluate the association between induced sputum nitrites and lung function in children with CF. Methods: Nitrites, cell differentials, white blood cell count, were estimated in induced sputum of 20 children with CF and 10 age‐matched healthy controls. Nitrites in induced sputum samples were measured using the Greiss assay. Lung function was ascertained by spirometry. Results: We observed high levels of nitrites in CF (184.8 ± 11.07 μM/L) versus controls (56.4 ± 5.7 μM/L) (p < 0.01). A positive correlation between neturophil percent and nitrites, white blood cell count and nitrites (p < 0.05) in children with CF was observed. Sputum nitrites correlated negatively with FEV₁ (p < 0.05) in children with CF. Conclusion: Induced sputum nitrite could serve as a useful non invasive marker for assessing the degree of inflammation in the airways of children with CF.