Enthesitis-related arthritis in Kikuchi–Fujimoto disease

Histiocytic necrotizing lymphadenitis or Kikuchi–Fujimoto disease (KFD) is a rare, benign and self-limiting disorder that characteristically presents with fever and cervical lymphadenopathy. Articular manifestations in the form of arthralgias are common but frank arthritis is distinctly rare and dactylitis has not been reported yet. Herein, we describe a young boy who presented with arthritis and dactylitis as the initial manifestation of KFD. A 14-year-old boy presented with a two-week history of fever, generalized lymphadenopathy and asymmetric polyarthritis, enthesitis and dactylitis of the toes. Two years earlier he presented with arthritis of the knee and ankle joints, which lasted for 12 months. However, he had been asymptomatic for one year. Investigations revealed anemia, leukopenia and raised acute phase reactants. Work-up for infectious etiology, systemic lupus erythematosus and leukemia and lymphoma was negative. Excision biopsy of the cervical lymph node confirmed KFD. Fever, lymphadenopathy and leukopenia dissipated with nonsteroidal anti inflammatory drug therapy, but the arthritis persisted. A trial of methotrexate led to the resolution of the arthritis.     

Activity regulates functional connectivity from the vomeronasal organ to the accessory olfactory bulb

The mammalian accessory olfactory system is specialized for the detection of chemicals that identify kin and conspecifics. Vomeronasal sensory neurons (VSNs) residing in the vomeronasal organ project axons to the accessory olfactory bulb (AOB), where they form synapses with principal neurons known as mitral cells. The organization of this projection is quite precise and is believed to be essential for appropriate function of this system. However, how this precise connectivity is established is unknown. We show here that in mice the vomeronasal duct is open at birth, allowing external chemical stimuli access to sensory neurons, and that these sensory neurons are capable of releasing neurotransmitter to downstream neurons as early as the first postnatal day (P). Using major histocompatibility complex class I peptides to activate a selective subset of VSNs during the first few postnatal days of development, we show that increased activity results in exuberant VSN axonal projections and a delay in axonal coalescence into well defined glomeruli in the AOB. Finally, we show that mitral cell dendritic refinement occurs just after the coalescence of presynaptic axons. Such a mechanism may allow the formation of precise connectivity with specific glomeruli that receive input from sensory neurons expressing the same receptor type.     

Transplantation of autologous differentiated urothelium in an experimental model of composite cystoplasty

Background

Enterocystoplasty is associated with serious complications resulting from the chronic interaction between intestinal epithelium and urine. Composite cystoplasty is proposed as a means of overcoming these complications by substituting intestinal epithelium with tissue-engineered autologous urothelium.

Objective

To develop a robust surgical procedure for composite cystoplasty and to determine if outcome is improved by transplantation of a differentiated urothelium.

Design, setting, and participants

Bladder augmentation with in vitro–generated autologous tissues was performed in 11 female Large-White hybrid pigs in a well-equipped biomedical centre with operating facilities. Participants were a team comprising scientists, urologists, a veterinary surgeon, and a histopathologist.

Measurements

Urothelium harvested by open biopsy was expanded in culture and used to develop sheets of nondifferentiated or differentiated urothelium. The sheets were transplanted onto a vascularised, de-epithelialised, seromuscular colonic segment at the time of bladder augmentation. After removal of catheters and balloon at two weeks, voiding behaviour was monitored and animals were sacrificed at 3 months for immunohistology.

Results and limitations

Eleven pigs underwent augmentation, but four were lost to complications. Voiding behaviour was normal in the remainder. At autopsy, reconstructed bladders were healthy, lined by confluent urothelium, and showed no fibrosis, mucus, calculi, or colonic regrowth. Urothelial morphology was transitional with variable columnar attributes consistent between native and augmented segments. Bladders reconstructed with differentiated cell sheets had fewer lymphocytes infiltrating the lamina propria, indicating more effective urinary barrier function.

Conclusions

The study endorses the potential for composite cystoplasty by (1) successfully developing reliable techniques for transplanting urothelium onto a prepared, vascularised, smooth muscle segment and (2) creating a functional urothelium-lined augmentation to overcome the complications of conventional enterocystoplasty.     

Bilateral medial cerebellar infarction in a patient positive for lupus anticoagulant

Bilateral medial cerebellar infarction occurring simultaneously is rare. We describe a middle aged male with bilateral cerebellar infarction complicated by subsequent left superior cerebellar artery infarction. Lupus anticoagulant was positive. Though the prognosis is usually considered good, our patient made poor recovery.     

Amelioration of heat stress induced disturbances of antioxidant defense system in chicken by brahma rasayana

Since the range of comfort zone or thermo neutral zone of domestic chickens is narrow, they become easily susceptible to heat and cold environmental stress. We evaluated Brahma Rasayana (BR) supplementation on concentrations of certain oxidative stress markers associated with heat stress. A total of 48 egg type male chickens of local strain were divided into six groups (n = 8) for the study. Three groups were fed with BR orally at the rate of 2 g/kg bw daily for 10 days prior to and during the period of experiment. Two of the four groups that were exposed to heat stress (HST i.e. to a temperature of 40 +/- 1 degrees C and relative humidity of 80 +/- 5% in an environmental chamber) for 4 h daily for 5 or 10 days, received BR orally. The other two groups remained as BR treated and untreated non-heat stressed (NHST) controls. There was a significant (P < 0.05) increase in the activities of antioxidant enzymes in blood such as catalase (CAT) and superoxide dismutase (SOD), as well as liver CAT, glutathione peroxidase (GPX) and glutathione reductase (GR) in NHST-BR treated and HST-BR treated (both 5 and 10 days) chickens when compared with untreated controls. A great deal of significant (P < 0.05) variations were seen in serum and liver reduced glutathione (GSH) concentration in NHST-BR treated and HST-BR treated (both 5 and 10 days) chickens. Serum and liver lipid peroxidation levels were found to be significantly (P < 0.05) higher in HST-untreated (both 5 and 10 days) chickens when compared with other groups. Thus BR supplementation during HST brings about enhanced action of enzymatic and non-enzymatic antioxidants, which nullified the undesired side effects of free radicals that are generated during HST.     

Lack of clinical association with antibodies to ribosomal P proteins in Indian patients with systemic lupus erythematosus

OBJECTIVE: We examined the prevalence and clinical association of the antiribosomal antibodies in our cohort of patients with systemic lupus erythematosus (SLE). METHODS: IgG antiribosomal P protein (anti-P) antibodies were detected in 202 consecutive patients with SLE and 212 age and sex matched healthy subjects by an in-house ELISA, using the 22-mer C-terminal peptide. In 13 patients, IgG anti-P antibodies were also tested in paired cerebrospinal fluid (CSF) and sera samples. Clinical variables were compared in the antibody-positive and negative groups using appropriate statistical tests. RESULTS: Of the 202 patients, 15 were male. Their median age was 30 years and the median disease duration was 36 months. Thirty-one patients (15.35%) were positive for IgG anti-P antibodies, of which 24 were also positive by Western blot. No association with SLE Disease Activity Index, nervous system disease, nephritis, hepatitis, skin disease, arthritis, and juvenile onset disease could be demonstrated. Levels of IgG anti-P antibodies in CSF were 100-fold less compared to levels in serum, and correlated well with the latter (r = 0.86; p < 0.01). CONCLUSION: The prevalence of IgG anti-P antibodies is similar in Indian and Caucasian patients with SLE. No association with specific organ involvement or age at onset could be demonstrated.     

Prediction and Detection of Cervical Malignancy Using Machine Learning Models

Objective: Human papillomavirus and other predicting factors are responsible causing cervical cancer, and early prediction and diagnosis is the solution for preventing this condition.  The objective is to find out and analyze the predictors of cervical cancer and to study the issues of unbalanced datasets using various Machine Learning (ML) algorithm-based models. Methods: A multi-stage sampling strategy was used to recruit 501 samples for the study. The educational intervention was the video-assisted counseling which is consisted of two educational methods: a documentary film and face-to- face interaction with women followed by reminders. Following the collection of baseline data from these subjects, they were encouraged to undergo Pap smear screening. Women having abnormal Pap tests were sent for biopsy. Machine learning classification methods such as Decision Tree (DT), Random Forest (RF), Logistic Regression (LR), Multi-layer Perceptron (MLP) and Naive Bayes(NB) were used to evaluate the unbalanced input and target datasets. Result: Merely 398 women out of 501 showed an interest to participate in the study, but only 298 stated a willingness for cervical screening. Atypical malignant cells were discovered on the cervix of 26 women who had abnormal pap tests. These women had guided for further tests, such as a cervical biopsy, and seven women had been diagnosed with cervical cancer. LR in models 1, 2, and 4 showed 88% to 94% sensitivity with 84% to 89% accuracy, respectively for cervical cancer prediction, whereas DT in models 3, 5, and 6 algorithms exhibited 83% to 84% sensitivity with 84% to 88% accuracy, respectively. The NB and LR algorithms produced the highest area under the ROC curve for testing dataset, but all models performed similarly for training data. Conclusion: In current study , Logistic Regression and Decision Tree algorithms were identified as the best-performed ML algorithm classifiers to detect the significant predictors.