A Malignant Granular Cell Tumor Excised with Mohs Micrographic Surgery

Malignant granular cell tumors are extremely rare, aggressive neoplasms displaying rapid growth and frequent associated metastatic disease. Excision and evaluation for metastatic disease are mandatory. We present a 54-year-old patient with a malignant granular cell tumor, treated with Mohs micrographic surgery. Cutaneous granular cell tumors are uncommon neoplasms, likely of perineural origin. Most follow a benign and uneventful course, with wide local excision being the treatment of choice (Enzinger, 1988). The malignant granular cell tumor is an extremely rare, aggressive variant, which provides a diagnostic challenge and management dilemma, especially with early presentation when it may be mistaken for other entities. There is also controversy regarding surgical management and follow-up of both benign and malignant granular cell tumors

Xanthelasma palpebrarum: A new side effect of nilotinib

Chronic myeloid leucaemia (CML) is a chronic myeloproliferative disorder characterised by a reciprocal translocation between the chromosomes 9 and 22 resulting in constitutionally active tyrosine kinase signalling. BCR-ABL tyrosine kinase inhibitors (TKIs) are highly effective molecules in the treatment of CML. Unfortunately, these novel therapeutic agents are accompanied by various side effects, and haematological, cutaneous and metabolic abnormalities are among the most prevalent. Nilotinib, a secondgeneration TKI, has been shown to cause both- cutaneous lesions and lipid profile abnormalities. We present two CML cases developing xanthelasma palpebrarum while receiving nilotinib. Case 1 also acquired a lipid abnormality following the start of nilotinib therapy, while case 2 meanwhile stayed normolipidemic. In addition to a low cholesterol diet, atorvastatin was prescribed to case 1. Currently, both cases are normolipidemic and continuing their nilotinib therapy. Xanthelasma palpebrarum secondary to nilotinib therapy is new to the literature

The autologous hematopoietic stem cell transplantation in adult patients with lymphoma: Turkish Bone Marrow Transplantation Registry results

Turkish Bone Marrow Transplantation Registry (TBMTR) was established in 1995. Since 1992, data of adult lymphoma patients from fifteen national transplantation centers were collected and analyzed by TBMTR. A total of 437 adult lymphoma patients (185 Hodgkin's and 252 non-Hodgkin's lymphoma) undergoing autologous hematopoietic stem cell transplantation (HSCT) were registered in TBMTR from 1992 to 2002. Peripheral blood as stem cell source was used in 94% of the transplantations. Non-TBI (total body irradiation) conditioning regimens were administered in 88% of the cases. The 100-day transplantation-related mortality (TRM) was 11% in relapsed and 11% in primary refractory Hodgkin's lymphoma patients whilst TRM was found to be 9% and 30% in non-Hodgkin's lymphoma patients in first remission and in primary refractory cases, respectively. Infection was the most common cause of TRM. 10-year and 5-year survival rates were 50% and 49% in relapsed cases and primary refractory cases with Hodgkin's lymphoma, respectively; while in non-Hodgkin's lymphoma patients 10-year survival rate was 65% in cases in first remission, 7-year survival rate was 50% in sensitive relapse, 2-year survival rate was 0% in resistant relapse and 3-year survival was 24% in primary refractory cases. In conclusion, TBMTR results are comparable to EBMT and IBMTR results. Therefore, autologous HSCT may provide long-term survival in patients with Hodgkin's lymphoma as well as in patients with non-Hodgkin lymphoma in first remission and in sensitive relapse

Curcuminoids activate p38 MAP kinases and promote UVB-dependent signalling in keratinocytes.

Curcuminoids exhibit anti-proliferative properties in many cell lines by modulating signalling pathways to inhibit cell growth. However, the specific effects of curcuminoids on human keratinocytes are not well defined, and this situation impairs mechanistic thinking regarding potential therapeutic uses. We hypothesized that curcuminoids would modulate key growth regulatory pathways in keratinocytes to inhibit cell proliferation. To test this hypothesis, the effects of curcumin and tetrahydrocurcumin (THC) on mitogen-activated protein (MAP) kinase signalling in keratinoctyes were determined. Primary human keratinocytes treated with curcumin or THC demonstrated decreased activation of p44/42 MAP kinases but increased levels of activated p38 MAP kinases. These data suggest that curcuminoids specifically activate stress-induced MAP kinases while inhibiting mitogen-induced MAP kinases. Curcuminoids also promote the phosphorylation of p53 on serine 15 in a dose-dependent and p38-dependent manner, suggesting that these compounds may activate p53. The effects of curcuminoids on keratinocytes mirrored some aspects of UVB and could be inhibited by N-acetylcysteine, suggesting that these compounds activate p38 through a mechanism that involves glutathione depletion. Both curcuminoids induced G2/M block and inhibited keratinocyte growth, and THC increased cellular levels of p21, a known p53 transcriptional target. These data demonstrate that curcuminoids can differentially regulate MAP kinases to inhibit keratinocyte growth while inducing p21. Curcuminoids also synergize with UVB to enhance p53 phosphorylation. The findings provide a rationale for testing curcuminoids in disorders associated with impaired p53 function or in which UVB-treatment is efficacious

Increased serum renalase in peritoneal dialysis patients: Is it related to cardiovascular disease risk?

Background: Renalase, with possible monoamine oxidase activity, is implicated in degradation of catecholamines; which suggests novel mechanisms of cardiovascular complications in patients with chronic kidney diseases. Epicardial adipose tissue (EAT) has been found to correlate with cardiovascular diseases (CVD) in dialysis patients. The present study aimed to evaluate the association of serum renalase levels with EAT thickness and other CVD risk factors in peritoneal dialysis (PD) patients. Methods: The study included 40 PD patients and 40 healthy controls. All subjects underwent blood pressure and anthropometric measurements. Serum renalase was assessed by using a commercially available assay. Transthoracic echocardiography was used to measure EAT thickness and left ventricular mass index (LVMI) in all subjects. Results: The median serum renalase level was significantly higher in the PD patients than in the control group [176.5 (100–278.3) vs 122 (53.3–170.0) ng/ml] (p = 0.001). Renalase was positively correlated with C-reactive protein (r = 0.705, p < 0.001) and negatively correlated with RRF (r = −0.511, p = 0.021). No correlation was observed between renalase and EAT thickness or LVMI. There was a strong correlation between EAT thickness and LVMI in both the PD patients and the controls (r = 0.848, p < 0.001 and r = 0.640, p < 0.001 respectively). Conclusions: This study indicates that renalase is associated with CRP and residual renal function but not with EAT thickness as CVD risk factors in PD patients

The reliability and success of peritoneal dialysis during the COVID-19 pandemic

We evaluated the symptoms, changes in laboratory findings during the novel coronavirus disease (COVID-19) pandemic, and the effect of depression in patients with peritoneal dialysis (PD). This is an observational and cross-sectional study. All patients were asked to fill the clinical assessment form and Beck depression and anxiety inventory. Also, the last two laboratory evaluations during this period were examined. A total of 123 patients performing PD were included. None of the patients were diagnosed with COVID-19. In the total study population, parathyroid hormone (PTH), serum albumin, phosphorus and ferritin levels significantly elevated at the end of 97 +/- 31 days. PTH and phosphorus levels remained stable in remote monitoring automated PD (RM-APD) group (p = 0.4 and p = 0.5), they tended to increase in continuous ambulatory PD group and significantly increased in automated PD group (p = 0.09 and p = 0.01 for PTH and p = 0.06 and p = 0.001 for phosphorus, respectively). Moderate to severe depression was associated with dyspnoea, weight gain more than 5 kg, fatigue, palpitation and increased anxiety. PD is a reliable and successful form of dialysis and can be safely administered even if hospital access is restricted. Also, RM-APD may be a better choice because of providing more stable bone-mineral metabolism. Moreover, evaluating depression and anxiety is essential for the accurate clinical assessment

CFD based design of a 4.3MW Francis turbine for improved performance at design and off-design conditions

Hydraulic turbines are designed for the available head and flow rate of the hydroelectric power plant. Design point usually gives the best efficiency. However, when the turbine is used at off-design conditions where the flow rate and head change mostly because of seasonal fluctuations, efficiency significantly reduces. Therefore, the objective of hydraulic turbine design is not only satisfying the power requirements and maximum efficiency at the design point, but also improved characteristics at off-design conditions. In this work, a 4.3 MW Francis turbine is designed with the help of Computational fluid dynamics. All turbine components are designed separately, and then full turbine analyses are performed to confirm the design. Once an efficient design is obtained for the design head and flow rate, CFD simulations for off-design conditions are performed to confirm the high efficiency of the turbine at these flow rate-head combinations. The efficiency of the designed turbine is in the range of 90 to 92 % for a wide range of head and flow rates.This research is financially supported by Turkish Ministry of Development. Computations are performed using the computational cluster of TOBB ETU Hydro Energy Research Laboratory (ETU Hydro)