A Case of Xanthoma of Bilateral Tendoachilles Reconstructed with Fascia Lata Graft X

Aims and background: Cerebrotendinous xanthoma is an autosomal recessive disorder characterized by a lack of production of primary bile acids and accumulation of cholestanol in various tissues like the brain, spinal cord, peripheral nerves, eyes, and tendon in the form of xanthomas. This is a case report of one such patient who had xanthoma of both tendoachilles. Case description: A 30-year-old female patient had swelling in both legs. Gradually, it became painful while walking. On examination, she had a swelling of size 10 by 4 cm attached to tendoachilles. Magnetic resonance imaging (MRI) showed features of xanthoma. Staged surgery was done. The mass was fleshy and pale yellow and replaced the entire tendon. The entire mass was removed, creating a defect of about 20 cm. Fascia lata of size 20 by 6 cm was harvested and made into a fourstrand graft. Proximally, it was sutured with fiber wires to the distal part of the muscle. Distally, it was fixed to the calcaneum using a 5 mm suture anchor. Flexor hallucis longus (FHL) tendon was used to augment the reconstruction. At 1 year, she was asymptomatic and gained good strength and ROM in the ankle. Conclusion and clinical significance: Cerebrotendinous xanthoma causes impairment in joint mobility and ambulation. Deposition of cholestanol in the neurons causes atrophy and secondary demyelination. Simple excision of tendoachilles xanthoma will do more harm to the patient who is more prone to neurological and mobility-related issues. Fascia lata graft has the advantage of limited donor site morbidity and adequate length

Notch signaling during human T cell development

Notch signaling is critical during multiple stages of T cell development in both mouse and human. Evidence has emerged in recent years that this pathway might regulate T-lineage differentiation differently between both species. Here, we review our current understanding of how Notch signaling is activated and used during human T cell development. First, we set the stage by describing the developmental steps that make up human T cell development before describing the expression profiles of Notch receptors, ligands, and target genes during this process. To delineate stage-specific roles for Notch signaling during human T cell development, we subsequently try to interpret the functional Notch studies that have been performed in light of these expression profiles and compare this to its suggested role in the mouse

Isolation and antibiotic susceptibility of bacteria from foot infections in the patients with diabetes mellitus type I and type II in the district of Kancheepuram, Tamil Nadu, India

Background:Diabetic foot infections are important cause of morbidity and mortality among persons with diabetes mellitus. The reported prevalence rates in India range from 0.9–8.3%. Diabetes foot lesions are the leading cause of non-traumatic amputations worldwide. A study has been conducted to isolate and find the antibiotic susceptibility pattern of the bacteria from diabetic foot infections from the patients of Kancheepuram district, Tamil Nadu, India.Methods:Sixty patients previously diagnosed or newly diagnosed as diabetic, presented with lower extremity infection attending Tagore medical college and hospital and its peripheral centres were selected for the study. Various specimens (pus, wound exudates, or tissues biopsy) for microbiological studies were obtained from the infected region. The specimens were cultured on blood agar and MacConkey agar for aerobic / facultative anaerobic organisms and on Neomycin Blood Agar for anaerobic organism. The plates were then incubated at 37°C. For anaerobic culture the plates were incubated in the McIntosh anaerobic jar. Isolates obtained are identified by standard laboratory techniques.Results:The result showed that Pseudomonas aeruginosa (48.3%) is the predominant bacterium followed by Staphylococcus aureus (38%) and other bacteria. The anaerobic bacteria are also isolated from the diabetic foot ulcers. The Peptostreptococcus species (26.7%) are the predominant bacteria followed by other bacteria. Further the results showed that 22 patients (37%) showed the multi-bacterial infection and remaining 38 patients (63%) showed mono bacterial infection. The drugs like amikacin, cefepine, ciprofloxacin, cotrimoxazole and roxythromycin are sensitive to many gram positive bacterial isolates.Conclusion:The present study has given the data of various bacteria encountered in the diabetic foot ulcer in the district of Kancheepuram, Tamil Nadu, India and its antibiotic sensitivity pattern. The results clearly reveal that there is no definite aetiology in diabetic foot infections. Many patients presented the infection with the involvement of many bacteria. Further it is evident that many bacteria are multi drug resistant and thus complicating the management of diabetic foot infections.

Free-vibration Characteristics of Laminated Angle-ply Non-circular Cylindrical Shells

This paper deals with the free-vibration behaviour of anisotropic laminated angle-ply noncircular cylindrical shells using finite element approach. The formulation is based on first-ordershear deformation theory. The present model accounts for in-plane and rotary inertia effects. A detailed study has been carried out to highlight the effects of shell geometry, cross-sectionalproperties, lay-up and ply-angles on the natural frequencies of different types of modes of vibration of non-circular elliptical shell structures

Compensating control participants when the intervention is of significant value: experience in Guatemala, India, Peru and Rwanda

The Household Air Pollution Intervention Network (HAPIN) trial is a randomised controlled trial in Guatemala, India, Peru and Rwanda to assess the health impact of a clean cooking intervention in households using solid biomass for cooking. The HAPIN intervention—a liquefied petroleum gas (LPG) stove and 18-month supply of LPG—has significant value in these communities, irrespective of potential health benefits. For control households, it was necessary to develop a compensation strategy that would be comparable across four settings and would address concerns about differential loss to follow-up, fairness and potential effects on household economics. Each site developed slightly different, contextually appropriate compensation packages by combining a set of uniform principles with local community input. In Guatemala, control compensation consists of coupons equivalent to the LPG stove’s value that can be redeemed for the participant’s choice of household items, which could include an LPG stove. In Peru, control households receive several small items during the trial, plus the intervention stove and 1 month of fuel at the trial’s conclusion. Rwandan participants are given small items during the trial and a choice of a solar kit, LPG stove and four fuel refills, or cash equivalent at the end. India is the only setting in which control participants receive the intervention (LPG stove and 18 months of fuel) at the trial’s end while also being compensated for their time during the trial, in accordance with local ethics committee requirements. The approaches presented here could inform compensation strategy development in future multi-country trials

Identification of potential serum biomarkers of glioblastoma: serum osteopontin levels correlate with poor prognosis

Background: The aim of this study is to identify serum biomarkers with classification and prognosis utility for astrocytoma, in particular glioblastoma (GBM). Methods: Our previous glioma microarray database was mined to identify genes that encode secreted or membrane-localized proteins. Subsequent analysis was done using significant analysis of microarrays, followed by reverse transcription-quantitative PCR (RT-qPCR) and immunohistochemical validation in tumor tissues, ELISA and Western blot validation in sera, and correlation with survival of GBM patients. Results: Significant analysis of microarrays identified 31 upregulated and 3 downregulated genes specifically in GBMs. RT-qPCR validation on an independent set of samples confirmed the GBM-specific differential expression of several genes, including three upregulated (CALU, CXCL9, and TIMP1) and two downregulated (GPX3 and TIMP3) novel genes. With respect to osteopontin (OPN), we show the GBM-specific upregulation by RT-qPCR and immunohistochemical staining of tumor tissues. Elevated serum OPN levels in GBM patients were also shown by ELISA and Western blot. GBM patients with high serum OPN levels had poorer survival than those with low serum OPN levels (median survival 9 versus 22 months respectively; P = 0.0001). Further, we also show high serum TIMP1 levels in GBM patients compared with grade II/III patients by ELISA and downregulation of serum GPX3 and TIMP3 proteins in GBMs compared with normal control by Western blot analysis. Conclusions: Several novel potential serum biomarkers of GBM are identified and validated. High serum OPN level is found as a poor prognostic indicator in GBMs. Impact: Identified serum biomarkers may have potential utility in astrocytoma classification and GBM prognosis

Case studies on heat stress related perceptions in different industrial sectors in southern India

Linkages between thermal loads and its physiological consequences have been widely studied in non-tropical developed country settings. In many developing countries like India, despite the widespread recognition of the problem, limited attempts have been made to estimate health impacts related to occupational heat stress and fewer yet to link heat stress with potential productivity losses. This is reflected in the ubiquity of workplaces with limited or no controls to reduce exposures. As a prelude to understanding the feasibility of alternative interventions in different industrial sectors, we present case studies from 10 different industrial units in Tamil Nadu, Chennai, which describe perceptions of occupational heat stress among the workers and supervisors/management

Air pollution from household solid fuel combustion in India: an overview of exposure and health related information to inform health research priorities

Environmental and occupational risk factors contribute to nearly 40% of the national burden of disease in India, with air pollution in the indoor and outdoor environment ranking amongst leading risk factors. It is now recognized that the health burden from air pollution exposures that primarily occur in the rural indoors, from pollutants released during the incomplete combustion of solid fuels in households, may rival or even exceed the burden attributable to urban outdoor exposures. Few environmental epidemiological efforts have been devoted to this setting, however. We provide an overview of important available information on exposures and health effects related to household solid fuel use in India, with a view to inform health research priorities for household air pollution and facilitate being able to address air pollution within an integrated rural–urban framework in the future

Cardiac Hypertrophy Involves Both Myocyte Hypertrophy and Hyperplasia in Anemic Zebrafish

Background: An adult zebrafish heart possesses a high capacity of regeneration. However, it has been unclear whether and how myocyte hyperplasia contributes to cardiac remodeling in response to biomechanical stress and whether myocyte hypertrophy exists in the zebrafish. To address these questions, we characterized the zebrafish mutant tr265/tr265, whose Band 3 mutation disrupts erythrocyte formation and results in anemia. Although Band 3 does not express and function in the heart, the chronic anemia imposes a sequential biomechanical stress towards the heart. Methodology/principal findings: Hearts of the tr265/tr265 Danio rerio mutant become larger than those of the sibling by week 4 post fertilization and gradually exhibit characteristics of human cardiomyopathy, such as muscular disarray, re-activated fetal gene expression, and severe arrhythmia. At the cellular level, we found both increased individual cardiomyocyte size and increased myocyte proliferation can be detected in week 4 to week 12 tr265/tr265 fish. Interestingly, all tr265/tr265 fish that survive after week-12 have many more cardiomyocytes of smaller size than those in the sibling, suggesting that myocyte hyperplasia allows the long-term survival of these fish. We also show the cardiac hypertrophy process can be recapitulated in wild-type fish using the anemia-inducing drug phenylhydrazine (PHZ). Conclusions/significance: The anemia-induced cardiac hypertrophy models reported here are the first adult zebrafish cardiac hypertrophy models characterized. Unlike mammalian models, both cardiomyocyte hypertrophy and hyperplasia contribute to the cardiac remodeling process in these models, thus allowing the effects of cardiomyocyte hyperplasia on cardiac remodeling to be studied. However, since anemia can induce effects on the heart other than biomechanical, non-anemic zebrafish cardiac hypertrophy models shall be generated and characterized