A Common Pain in Pregnancy with an Uncommon Cause

Case Diagnosis: We present a case of a patient with hip pain during pregnancy determined to be pigmented villonodular synovitis (PVNS). Case Description: A 41-year-old woman presented with 9-months of persistent atraumatic left hip pain localized to the groin that had started in her second trimester of pregnancy. Five months after delivery at presentation to clinic, her symptoms had progressively worsened to require a cane for ambulation. On exam, hip range of motion was limited: flexion to 90o, external rotation to 20o, and internal rotation to 10o. She had groin pain with internal and external rotation. She was neurovascularly intact without lymphadenopathy. Radiographs showed significant erosion of the left femoral head and acetabulum with mild protrusio. Apple core erosions were visualized at the femoral neck. MRI showed extensive bone edema on both sides of the joint, with erosion of the femoral head and acetabulum. There was joint effusion, synovial hypertrophy, and excessive synovial tissue. Differential diagnoses included PVNS, avascular necrosis, rapidly progressive osteoarthritis, inflammatory arthritis, septic arthritis, insufficiency fractures, synovial chondromatosis, and transient osteoporosis of the hip. A needle biopsy confirmed the diagnosis of PVNS. She was treated with synovectomy and total hip arthroplasty, and has remained pain free and without evidence of disease for the last 5 years. Discussions: PVNS is a disorder characterized by synovial proliferation. There are only two previous case reports of patients who were diagnosed with PVNS during pregnancy, both of whom had monoarticular involvement of the knee. Conclusions: Synovectomy is the mainstay of surgical treatment of PVNS. Although, in patients with extensive articular involvement, synovectomy and arthroplasty may be required. The current understanding is that cytokines have a trophic influence leading to growth of the tumor. Further studies are needed to establish a definitive connection between PVNS and pregnancy

Efficacy and Safety of COX-2 Inhibitors in the Clinical Management of Arthritis: Mini Review

In the clinical management of arthritis, the choice of nonsteroidal anti inflammatory drug (NSAID) remains confusing and controversial. A common practice on the choice of NSAID in clinical management of arthritis is the risk benefit ratio. The main objective of this review is to addresses the main arguments for the pharmacological and clinical use of COX-2 inhibitors in relation to nonselective NSAIDs for the clinical management of arthritis. This review concluded that, both NSAIDs and COX-2 inhibitors are equally effective and are associated with increased risk of GI, renal, and CV, adverse effects. Complete understanding of the patient's comorbid conditions and concomitant medications, coupled with precise monitoring during the treatment, may help to decrease the threat of adverse effects induced by nonselective NSAIDs and selective COX-2 inhibitors

Synthesis and characterization of integrated layered nanocomposites for lithium ion batteries

The series of Li[NixMxLi1/3-xMn2/3-x]O2 cathodes, where M is cobalt or chromium with a wide compositional range x from 0 to 0.33, were prepared by hydroxide coprecipitation method with subsequent quenching. The sample structures were investigated using X-ray diffraction results which were indexed completely on the basis of a trigonal structure of space group R3m¯ with monoclinic C2/m phase as expected. The morphologies and electrochemical properties of the samples obtained were compared as the value of x and substituted transition metal. The particle sizes of cobalt-substituted Li[NixCoxLi1/3-xMn2/3-x]O2 samples are much smaller than those of the Li[NixCrxLi1/3-xMn2/3-x]O2 system. The electrode containing Li[NixCoxLi1/3-xMn2/3-x]O2 with x = 0.10 delivered a discharge capacity of above 200 mAh/g after 10 cycles due to the activation of Li2MnO3

Computational Modelling of Pisum Sativum L. Superoxide Dismutase and Prediction of Mutational Variations through in silico Methods

Superoxide dismutase (SOD) is one of the major enzymes expressed in the oxidative stress pathway in plants. Its expression is also evident in other taxonomic group in oxidative reactions. Pisum sativum a common plant is being studied in the present work where SOD is characterized using computational tools. SOD sequence of P. sativum [CAA42737.1] Ala and Leu rich protein with alkaline pI value was used as query sequence and used to obtain nine similar sequences through BLASTp. Phylogenetic tree was constructed using MEGA 5.0 based on neighbour joining method. Physiochemical parameters and amino acid composition was studied and compared with query sequences and other similar sequences. Secondary structures were predicted to understand the dominant components. Homology modeling of P. sativum SOD was done using SWISS MODEL and quality was evaluated using standard methods. 27 active sites were detected in SOD predicted model which were Lys rich

Clinicopathological and morphological spectrum of gastrointestinal stromal tumours on multi-detector computed tomography

Purpose: To describe the clinicopathological and morphological features of gastrointestinal stromal tumours (GISTs) on multi-detector computed tomography (MDCT). Material and methods: MDCT (plain and post contrast) images of 25 confirmed cases of GISTs were retrospectively evaluated from our hospital database. The images were analysed for the location, size, growth pattern, attenuation pattern, relation to adjacent structures, presence or absence of ulceration, calcification, metastases, lymphadenopathy, and for any complications such as haemorrhage, intestinal obstruction, etc. Institutional Ethics Committee clearance was obtained prior to the commencement of the study. Statistics used included percentage frequency. Results: Our study group comprised 14 males and 11 females. The mean age of our study population was 60 years (age range: 40 to 82 years). The mean tumour size was 11.7 cm. The stomach and small bowel accounted for 76% of the primary tumour site. The commonest imaging appearance of GIST observed in our study was that of an exophytic mass (76%) with a heterogenous pattern of enhancement (96%) with intratumoural necrosis (76%). MDCT demonstrated complications in three patients (12%). Six patients presented with metastatic foci (five to the liver and one to the lung), while lymphadenopathy was observed in five patients (20%). Associated complications included intestinal obstruction (8%) and retrogastric haematoma (4%). Incidental findings included uterine fibroid (n = 1), ovarian dermoid (n = 1), and chronic pancreatitis (n = 1). Conclusions: GISTs are predominantly large tumours with a well circumscribed and exophytic pattern on MDCT, with or without cystic/necrotic areas, and they mostly show a heterogenous pattern of enhancement on post-contrast administration

Evaluation of flow after transcatheter aortic valve replacement in patients with low-flow aortic stenosis : a secondary analysis of the PARTNER randomized clinical trial

Importance: Low-flow (LF) severe aortic stenosis (AS) is an independent predictor of mortality in patients undergoing aortic valve replacement (AVR). Little is known about improvement in flow after AVR and its effects on survival. Objective: To determine whether higher flow (left-ventricular stroke volume index [LVSVI]) after transcatheter AVR (TAVR) would indicate better clinical outcomes in this at-risk population. Design, Setting, and Participants: A substudy analysis of data from the Placement of Aortic Transcatheter Valves (PARTNER) randomized clinical trial and continued-access registry was conducted. A total of 984 participants with evaluable echocardiograms and baseline LF AS (LVSVI =35 mL/m2) were included. The trial was conducted at 26 sites in the United States and Canada. Patients were stratified after TAVR into tertiles by discharge LVSVI status (severe low flow [SLF], moderate low flow [MLF], and normal flow [(NF]). The present study was conducted from May 11, 2007, to January 9, 2012, with data analysis performed from April 25, 2014, to January 21, 2016. Main Outcomes and Measures: The primary end point was all-cause mortality at 1 year. Results: Baseline characteristics of 984 patients with LF AS included mean (SD) age, 84 (7) years; 582 (59.1%) men; mean Society of Thoracic Surgeons (STS) score, 11.4% (4.0%); and mean LVSVI, 27.6 (5.0) mL/m2. The discharge LVSVI values by group were SLF, 23.1 (3.5) mL/m2; MLF, 31.7 (2.2) mL/m2; and NF, 43.1 (7.0). All-cause mortality at 1 year was SLF, 26.5%; MLF, 20.1%; and NF, 19.6% (P¿=¿.045). Mean LVSVI normalized by 6 months in the MLF (35.9 [9.3] mL/m2) and NF (38.8 [11.1] mL/m2) groups, but remained low in the SLF group at 6 months and 1 year (31.4 [8.4] and 33.0 [8.3] mL/m2], respectively) (P¿<¿.001 for all groups). Reported as multivariate hazard ratio, mortality at 1 year was higher in the SLF group compared with the other groups (1.61; 95% CI, 1.17-2.23; P¿=¿.004). In addition to SLF, sex (1.59; 95% CI, 1.18-2.13; P¿=¿.002), presence of atrial fibrillation (1.41; 95% CI, 1.06-1.87; P¿=¿.02), STS score (1.03; 95% CI, 1.01-1.06; P¿=¿.02), presence of moderate or severe mitral regurgitation at discharge (1.65; 95% CI, 1.21-2.26; P¿=¿.001), pre-TAVR mean transvalvular gradient (0.98; 95% CI, 0.97-0.99; P¿=¿.004), and effective orifice area index (1.87; 95% CI, 1.09-3.19; P¿=¿.02) were independent predictors of 1-year mortality.CONCLUSIONS AND RELEVANCE: Severe LF at discharge is associated with an increased risk of mortality following TAVR in patients with severe AS and preexisting LF. The identification of remedial causes of persistent LF after TAVR may represent an opportunity to improve the outcome of these patients

TCT-117 Quality of Life Outcomes Among High-Risk Patients Undergoing TAVR via the Transapical Approach: A PARTNER Continued Access Substudy

El fin de este artículo es realizar una comparación entre dos técnicas empleadas para la Resolución de Ambigüedades basándose en su expresión matemática más simple y en su aplicación a las medidas geodésicas

Accelerated growth of the Indian pearl oyster Pinctada fucata in Kollam Bay, southwest coast of India.

Seed production of Pinctada fucata using induced breeding techniques were developed by the CMFRI to support the pearl culture industry. Subsequent to this, the growth of hatchery produced pearl oyster spat transplanted to pearl farms near the natural oyster beds in the Gulf of Mannar were studied. Observations indicated that the pearl spat (3 to 5 mm) produced in the hatchery have to be reared for 12 to 20 months before they reach an implantable size. Currently pearl culture farms located along the southeast coast face the problem of long grow out phase

LncRNA VEAL2 regulates PRKCB2 to modulate endothelial permeability in diabetic retinopathy

Long non‐coding RNAs (lncRNAs) are emerging as key regulators of endothelial cell function. Here, we investigated the role of a novel vascular endothelial‐associated lncRNA (VEAL2) in regulating endothelial permeability. Precise editing of veal2 loci in zebrafish (veal2 (gib005Δ8/+)) induced cranial hemorrhage. In vitro and in vivo studies revealed that veal2 competes with diacylglycerol for interaction with protein kinase C beta‐b (Prkcbb) and regulates its kinase activity. Using PRKCB2 as bait, we identified functional ortholog of veal2 in humans from HUVECs and named it as VEAL2. Overexpression and knockdown of VEAL2 affected tubulogenesis and permeability in HUVECs. VEAL2 was differentially expressed in choroid tissue in eye and blood from patients with diabetic retinopathy, a disease where PRKCB2 is known to be hyperactivated. Further, VEAL2 could rescue the effects of PRKCB2‐mediated turnover of endothelial junctional proteins thus reducing hyperpermeability in hyperglycemic HUVEC model of diabetic retinopathy. Based on evidence from zebrafish and hyperglycemic HUVEC models and diabetic retinopathy patients, we report a hitherto unknown VEAL2 lncRNA‐mediated regulation of PRKCB2, for modulating junctional dynamics and maintenance of endothelial permeability

Stratification of Outcomes After Transcatheter Aortic Valve Replacement According to Surgical Inoperability for Technical Versus Clinical Reasons

ObjectivesThe goal of this study was to examine the impact of reasons for surgical inoperability on outcomes in patients undergoing transcatheter aortic valve replacement (TAVR).BackgroundPatients with severe aortic stenosis may be deemed inoperable due to technical or clinical reasons. The relative impact of each designation on early and late outcomes after TAVR is unclear.MethodsPatients were studied from the inoperable arm (cohort B) of the randomized PARTNER (Placement of Aortic Transcatheter Valve) trial and the nonrandomized continued access registry. Patients were classified according to whether they were classified as technically inoperable (TI) or clinically inoperable (CLI). Reasons for TI included porcelain aorta, previous mediastinal radiation, chest wall deformity, and potential for injury to previous bypass graft on sternal re-entry. Reasons for CLI were systemic factors that were deemed to make survival unlikely.ResultsOf the 369 patients, 23.0% were considered inoperable for technical reasons alone; the remaining were judged to be CLI. For TI, the most common cause was a porcelain aorta (42%); for CLI, it was multiple comorbidities (48%) and frailty (31%). Quality of life and 2-year mortality were significantly better among TI patients compared with CLI patients (mortality 23.3% vs. 43.8%; p < 0.001). Nonetheless, TAVR led to substantial survival benefits compared with standard therapy in both inoperable cohorts.ConclusionsPatients undergoing TAVR based solely on TI have better survival and quality of life improvements than those who are inoperable due to clinical comorbidities. Both TI and CLI TAVR have significant survival benefit in the context of standard therapy. (THE PARTNER TRIAL: Placement of AoRTic TraNscathetER Valve Trial; NCT00530894