Expression of CD4 on peripheral blood granulocytes. a novel finding in a case of myelodysplastic syndrome in association with t(5;12)

Myelodysplastic syndromes (MDS) are associated with cell maturation defects that can manifest as abnormal surface antigen expression. We describe a patient with refractory anemia with excess blasts, who presented with infection and extensive dysplastic features in peripheral blood granulocytes. The granulocytes expressed CD11b, CD13, CD15, CD33, and CD43. The granulocytes also expressed CD4 antigen. Cytogenetic analysis showed a clonal t(5;12)(q33;p13). The patient improved on antibiotics with partial improvement in the dysplastic features. However, shortly after, the patient experienced paravertebral extramedullary blast transformation followed by a leukemia phase of acute monoblastic leukemia. The patient died a few days later. This is the first report describing anomalous expression of CD4 on granulocytes in MDS. Since the breakpoint on chromosome 12 is near the CD4 gene, which is mapped to 12p12, we hypothesize that dysregulation of the CD4 gene may have occurred resulting in its persistent expression on mature and maturing granulocytes.     

Temporary antibiotic loaded acrylic hip replacement: a novel method for management of the infected THA

Postoperative infection after hip joint replacement is an uncommon but potentially devastating complication in contemporary orthopaedics. Management in two stages is the more favored approach in North America. This introduces difficulty with patient management in the interval between stages, delays rehabilitation, and introduces technical difficulty during the second stage. A method has been developed whereby a temporary antibiotic-loaded facsimile of the hip is introduced at the first stage, designed to maintain stability of the joint, length of the limb, and mobility of the patient. It has been used in a total of 86 cases to date. The results in 46 cases with a minimum follow-up of 2 years are reviewed in this article. The infection was controlled in 93.5% of cases.     

Regional differences in evoked dopamine efflux in brain slices of rat anterior and posterior caudate putamen

Summary Fast cyclic voltammetry using carbon fibre microelectrodes in rat brain slices, was used to investigate regional differences in electrically-evoked dopamine (DA) efflux at 10 different sites in the anterior caudate putamen (aCPu) and 10 sites in the posterior caudate putamen (pCPu). For each site DA overflow was evoked by both single pulse (1P) stimulation and by trains of 25 pulses applied at a frequency of 50 Hz (25P/50 Hz). Peak DA efflux evoked by 1P was about 58% greater in the aCPu (0.19 mol/l DA) than in the pCPu (0.12 mol/l DA), but showed no mediolateral variation in either region. Peak DA efflux evoked by 25P/50 Hz relative to 1P efflux also varied between the two regions; the aCPu contained predominantly low ratio (25P/50 HZ: 1P) sites ranging from 1.47 to 3.71, whereas in the pCPu these ratios were higher, ranging from 2.73 to 9.40, and were particularly high in the dorsomedial region of the pCPu. Efflux detected in low ratio sites of the aCPu showed little dependence on the frequency (10 to 500 Hz), or the number of pulses (5 to 20) in a train. By contrast DA efflux evoked in high ratio sites of the pCPu responded in a pulse and frequency dependent manner, the maximum ratio (approximately 8 times 1P) being at 20P/20 Hz. Interestingly the frequency response relationship obtained in the pCPu resembled the profile observed in the nucleus accumbens (NAc).Voltammetric evidence and experiments with selective reuptake blockers indicated that only DA was measured in our studies and 5-HT did not significantly contribute to the frequency dependent pattern of efflux detected in high ratio sites of the pCPu, where striatal 5-HT concentrations are highest. Experiments with the selective D₂ receptor antagonists metoclopramide or (–)sulpiride revealed that under our experimental conditions, DA efflux in the aCPu was not modulated by DA autoreceptor activation. By contrast, autoreceptor modulation did occur in high ratio sites of the pCPu at stimulations lasting longer than approximately 1000 ms.These observations support the concept that the caudate putamen is heterogeneously organised with respect to the frequency characteristics of evoked DA release. The factors controlling frequency dependent release under these conditions may be a function of A10 innervation, since high ratio release sites occur in areas where the density of such innervation is greatest, for example, the dorsomedial pCPu. This is supported by the observation that high ratio release sites are also found in the NAc, which receives dopaminergic fibres predominantly from an A10 region. However, the involvement of different regionally distributed transmitters acting on presynaptic receptors involved in the regulation of dopamine release, or differences between nerve terminals in striosomes and matrix, cannot be excluded. Send offprint requests to S. J. Trout at the above address     

Importance of pre-operative embolization in the surgery of nasopharyngeal angiofibroma

Juvenile Nasopharyngeal Angiofibroma are rare vasoformative¹ neoplasms of the Nasopharynx. Due to innocuous nature of their presenting symptoms, the tumour frequently has extranasopharyngeal extensions at the time of initial diagnosis. The advances in radiographic CT techniques² and pre-operative embolization³ have reduced the mortality and morbidity to a great extent. We analysed nine cases of angiofibroma with and without embolization and concluded that preoperative embolization reduces intraoperative blood loss considerably giving excellent surgical clearance of the tumour mass with minimal risk of recurrence.     

Inhibition of epidural scar tissue formation after spinal surgery: external irradiation vs. spinal membrane application

PURPOSE: The scar tissue that forms after lumbar dissection is a severe complication and a cause of lumbar and radicular pain. It was recently shown that radiotherapy could inhibit peridural fibrosis after laminectomy. In this study, the efficiency of external irradiation was compared with spinal membrane application. METHOD AND MATERIALS: Thirty male New Zealand rabbits underwent L5 laminectomy. Ten rabbits each received a single fraction of 900-cGy external irradiation administered by 9-MeV electron beam 24 h after the surgery. Ten other rabbits each had spinal membrane applied during laminectomy. The remaining 10 rabbits constituted the control group. All of the rabbits were killed 30 days after the laminectomy. Axial histologic sections through the laminectomy defect were evaluated. Each specimen was scored for the extent and density of fibrosis and arachnoidal adherence. RESULTS: The extent and density of fibrosis and arachnoidal adherence differed significantly between the control group and the treatment groups (p < 0.05). However, the extent and density of fibrosis and arachnoidal adherence did not differ significantly between the spinal membrane and irradiation groups (p > 0.05). CONCLUSION: This preliminary study showed that high-single-fraction/low-total-dose administered postoperatively can successfully inhibit postsurgical epidural fibrosis as effectively as applied spinal membrane.     

Growth of Nitrogen Incorporated Ultrananocrystalline Diamond Coating on Graphite by Hot Filament Chemical Vapor Deposition

This article shows the results of experiments to grow Nitrogen incorporated ultrananocrystalline diamond (N-UNCD) films on commercial natural graphite (NG)/Cu anodes by hot chemical vapor deposition (HFCVD) using a gas mixture of Ar/CH₄/N₂/H₂. The experiments focused on studying the effect of the pressure in the HFCVD chamber, filament-substrate distance, and temperature of the substrate. It was found that a substrate distance of 3.0 cm and a substrate temperature of 575 C were optimal to grow N-UNCD film on the graphite surface as determined by Raman spectroscopy, SEM, and TEM imaging. XPS analysis shows N incorporation through the film. Subsequently, the substrate surface temperature was increased using a heater, while keeping the substrate-filament distance constant at 3.0 cm. In this case, Raman spectra and SEM images of the substrate surface showed a major composition of graphite in the film as the substrate-surface temperature increased. Finally, the process pressure was increased to 10 Torr where it was seen that the growth of N-UNCD film occurred at 2.0 cm at a substrate temperature of 675 C. These results suggest that as the process pressure increases a smaller substrate-filament distance and consequently a higher substrate surface temperature can still enable the N-UNCD film growth by HFCVD. This effect is explained by a mean free path analysis of the main precursors H₂ and CH₃ molecules traveling from the filament to the surface of the substrate The potential impact of the process developed to grow electrically conductive N-UNCD films using the relatively low-cost HFCVD process is that this process can be used to grow N-UNCD films on commercial NG/Cu anodes for Li-ion batteries (LIBs), to enable longer stable capacity energy vs. charge/discharge cycles.     

Cold atmospheric plasma driven self-assembly in serum proteins: insights into the protein aggregation to biomaterials

The self-assembly of proteins is crucial in many biomedical applications. This work deals with understanding the role of cold atmospheric plasma (CAP) on the self-assembly of two different proteins present in the serum – BSA and hemoglobin and to elucidate the process associated with the direct application of physical plasma on or in the human (or animal) body, which has implications in therapeutics. The work has been corroborated by several spectroscopic studies such as fluorescence spectroscopy, circular dichroism spectroscopy, and SEM analysis. Through steady-state fluorescence spectroscopy and by following the tryptophan fluorescence, we observed that the emission intensity was quenched for the protein when treated with plasma radiation. Circular dichroism spectroscopy revealed that the structure of the protein was altered both in the case of BSA and hemoglobin. N-Acetyl tryptophanamide (NATA), which resembles the tryptophan in the protein, was treated with CAP and we observed the similar quenching of fluorescence as in the proteins, indicating that the protein underwent self-assembly. Time-resolved fluorescence spectroscopy with a decrease in the lifetime revealed that the protein self-assembly was promoted with CAP treatment, which was also substantiated by SEM micrographs. The ROS/RNS produced in the CAP has been correlated with the protein self-assembly. This work will help to design protein self-assembled systems, and in the future, may bring possibilities of creating novel biomaterials with the help of plasma radiation.

Self-assembly of proteins after CAP treatment.     

Endovascular management of renal angiomyolipomas: Do coils have a benefit in terms of clinical success rates?

PURPOSEThis study evaluated single-center results of endovascular treatment in renal angiomyolipoma (AML) to determine whether there is clinical relevance of adding proximal coil embolization to distal particle embolization in terms of safety, efficacy, and retreatment rates.METHODSA retrospective analysis was performed to evaluate patients undergoing transarterial embolization for renal AMLs from January 2007 to October 2020. Parameters regarding patient and tumor characteristics, embolization technique, treatment outcome, and complications were recorded. Patients were divided into 2 groups as A (only particle group) and B (particle + coil group) based on the type of embolic agent used for treatment. Comparative analysis was performed between the 2 groups in terms of tumor size reduction, retreatment, and complication rates. RESULTSIn this study, 42 patients (37 (88.1%) females and 5 (11.9%) males) harboring 48 AMLs were included. The mean age was 43.46 (range, 20-78). The technical success rate was 95.8% (46 of 48 procedures). The mean size reduction was 1.94 ± 1 cm (P  < .001) after treatments; however, no significant difference was seen between groups in terms of tumor size reduction. Retreatment rates were 3.1% (1 of 32 cases) in group A and 14.3% (2 of 14 cases) in group B (P  = .21). No significant difference was found between groups in terms of bleeding and complication rates during the perioperative period. Mean follow-up duration was 26.48 ± 25.71 (range, 2-102) months.CONCLUSIONIn this study, no clear supplementary benefit was observed in terms of safety and efficacy with the adjunction of coils to distal particle embolization in the management of AMLs.

Main points

• Transarterial embolization is safe and effective in reducing lesion size and bleeding rates in the management of angiomyolipomas.
• Lesion size reduction can be achieved with both techniques; solely microparticle embolization or distal microparticle embolization plus proximal coil embolization.
• Proximal coil embolization does not provide an additional benefit with lesions having intratumoral microaneurysms ≥5 mm as the study showed no difference in complication and bleeding rates.

Renal angiomyolipoma (AML) is one of the most common benign tumors of the kidney, with an incidence of 0.4% in the general population.^1,2 AMLs are seen in 2 forms; sporadic and tuberosclerosis (TSC) related. Sporadic form accounts for 80% of the AML cases. TSC-related AMLs tend to be bilateral, multifocal, larger with a faster growth rate and are more symptomatic than the sporadic type.³ AMLs have slow growth rates and rarely necessitate invasive treatment at all times.⁴ Historical data suggest that AMLs equal to or larger than 4 cm and those that have 5 mm or larger microaneurysms tend to be more symptomatic and prone to hemorrhage.^5,6 Although a treatment indication based on tumor size larger than 4 cm is subject to dispute,⁷ treatment decisions are often made using these cut-off values in the literature. Treatment options consist of medical treatment, surgery, transarterial embolization (TAE), and thermal ablation with no definitive recommendation on the first-line treatment choice.^8,9 However, because of its less-invasive nature, TAE is a favored choice in the management of AMLs over surgery. So far, various embolic agents (ethanol, microparticles, coils, gel foam, etc.) have been used in the management of patients with AML.¹⁰ Concerning the embolic materials, Patatas et al.¹¹ compared solely coil embolization with solely microparticle embolization in transarterial embolization of AMLs. They found similar reduction rates on computed tomography (CT) follow-up between the 2 groups. Ewalt et al.¹² showed that microparticle plus coil embolization is effective in terms of size reduction in large (>4 cm) and symptomatic and TSC-related AMLs. Although based on the literature, coils, microparticles, and microparticle + coil embolization are all safe and efficient, there are no clear data on the additional benefit of adding coil embolization to microparticle embolization in terms of treatment efficacy. Therefore, this study aimed to evaluate within single-center results whether there is clinical relevance of adding proximal coil embolization to distal microparticle embolization in terms of safety, efficacy, and retreatment rates.