Localized deferoxamine injection augments vascularity and improves bony union in pathologic fracture healing after radiotherapy

BackgroundMedically based efforts and alternative treatment strategies to prevent or remediate the corrosive effects of radiotherapy on pathologic fracture healing have failed to produce clear and convincing evidence of success. Establishing an effective pharmacologic option to prevent or treat the development of non-unions in this setting could have immense therapeutic potential. Experimental studies have shown that deferoxamine (DFO), an iron-chelating agent, bolsters vascularity and subsequently enhances normal fracture healing when injected locally into a fracture callus in long bone animal models. Since radiotherapy is known to impede angiogenesis, we hypothesized that the pharmacologic addition of DFO would serve to mitigate the effects of radiotherapy on new vessel formation in vitro and in vivo.Materials and MethodsIn vitro investigation of angiogenesis was conducted utilizing HUVEC cells in Matrigel. Endothelial tubule formation assays were divided into four groups: Control, Radiated, Radiated + Low-Dose DFO and Radiated + High-Dose DFO. Tubule formation was quantified microscopically and video recorded for the four groups simultaneously during the experiment. In vivo, three groups of Sprague–Dawley rats underwent external fixator placement and fracture osteotomy of the left mandible. Two groups received pre-operative fractionated radiotherapy, and one of these groups was treated with DFO after fracture repair. After 40 days, the animals were perfused and imaged with micro-CT to calculate vascular radiomorphometrics.ResultsIn vitro, endothelial tubule formation assays demonstrated that DFO mitigated the deleterious effects of radiation on angiogenesis. Further, high-dose DFO cultures appeared to organize within 2 h of incubation and achieved a robust network that was visibly superior to all other experimental groups in an accelerated fashion. In vivo, animals subjected to a human equivalent dose of radiotherapy (HEDR) and left mandibular fracture demonstrated quantifiably diminished μCT metrics of vascular density, as well as a 75% incidence of associated non-unions. The addition of DFO in this setting markedly improved vascularity as demonstrated with 3D angiographic modeling. In addition, we observed an increased incidence of bony unions in the DFO treated group when compared to radiated fractures without treatment (67% vs. 25% respectively).ConclusionOur data suggest that selectively targeting angiogenesis with localized DFO injections is sufficient to remediate the associated severe vascular diminution resulting from a HEDR. Perhaps the most consequential and clinically relevant finding was the ability to reduce the incidence of non-unions in a model where fracture healing was not routinely observed.     

Performance evaluation of a low-cost,novel vanadium nitride xerogel (VNXG) as a platinum-free electrocatalyst for dye-sensitized solar cells

A vanadium nitride xerogel (VNXG) was synthesised by a simple and effective method of ammonialising a vanadium pentoxide xerogel at a higher temperature. Xerogel-structured materials possess salient features such as high surface area, tunable porosity and pore size that result in enhancing the catalytic activity by a fast electron-transport pathway and increase electrolyte diffusion channels. Metal nitrides are reported as promising alternate low-cost counter electrodes to replace the conventional and expensive platinum (Pt) counter electrode. Though few studies are reported on aerogel-based CEs for DSSCs, the present work is the first attempt to synthesize and evaluate the performance of xerogel-structured metal nitrides as counter electrode materials for dye-sensitized solar cells. The synthesized material was well characterized for its structural and morphological characteristics and chemical constituents by photoelectron spectroscopy. Finally, the VNXG was tested for its electrocatalytic performance as a choice of counter electrodes for dye-sensitized solar cells (DSSCs). The photo-current studies were performed under standard 1 SUN, class AAA-simulated illumination with AM1.5G. The consolidated results revealed that the vanadium nitride xerogel exhibited good photocatalytic activity and low charge transfer resistance. This identified it as a promising low-cost counter electrode (CE) material for dye-sensitized solar cells. The photo-current conversion efficiency of the vanadium nitride xerogel CE-based DSSC reached 5.94% comparable to that of the conventional thermal decomposed Pt CE-based DSSC, 7.38% with the same iodide/triiodide electrolyte system. Moreover, the 28 days stability study of VNXG CE DSSCs provided an appreciably stable performance with 37% decrement in the PCE under the same test condition.

A vanadium nitride xerogel (VNXG) was synthesised by a simple and effective method of ammonialising a vanadium pentoxide xerogel at a higher temperature. The electrochemical and photo-current studies were performed towards a counter electrode for DSSC.     

Role of tumor necrosis factor inhibitor in granulomatous interstitial nephritis secondary to Crohn’s disease

A 17-year-old male with attention deficit hyperactivity disorder was admitted to the hospital with generalized weakness. Vital signs and physical examination were normal. Laboratory data were notable for a creatinine of 4.5 mg/dL (baseline 0.6 mg/dL), estimated glomerular filtration rate of 18 ml/min/1.73 m² and hemoglobin 10 g/dL. Urinalysis revealed only 30 mg/dL protein. Serology for autoimmune workup was negative. Renal ultrasound was normal. Kidney biopsy showed noncaseating granulomas and acute on chronic tubulointerstitial nephritis (TIN) with lymphocytes, macrophages, plasma cells and no eosinophils. Acid fast bacilli and Grocott’s methenamine silver stains were negative. Granulomatous interstitial nephritis (GIN) was diagnosed. Prednisone at 60 mg/day was started and tapered. He was then noted to have diarrhea. Colonoscopy showed active enteritis with granulomatous inflammation consistent with Crohn’s disease (CD). Azathioprine was started but due to worsening renal function and diarrhea, it was discontinued. He did not tolerate continued higher doses of prednisone because of mood swings and cushingoid features. Infliximab was initiated with improvement in renal function. There was rapid worsening of renal function when infliximab therapy was interrupted but improved when both prednisone and inflixamb were reinitiated.