Sneddon's syndrome: it is all in the ectoderm

A 51-year-old man gave a 2-year history of worsening mobility, cognitive decline and headaches. He had a history of thromboembolic stroke, recurrent transient ischaemic attacks and a spontaneous intraventricular haemorrhage. On examination, he had livedo reticularis and perniosis and a systolic murmur. Catheter cerebral angiography showed peripheral small-vessel and medium-vessel vasculopathy resulting in pruning of the distal cortical vessels and tortuous irregular distal collaterals. Skin biopsy showed subtle vasculopathy with ectasia of capillaries and postcapillary venules but no frank vasculitis or arterial thrombosis. Repeated serum antiphospholipid antibody titres were negative. The clinical features, skin biopsy and angiogram findings strongly supported a diagnosis of Sneddon's syndrome. Clinicians should consider Sneddon's syndrome in patients with livedo reticularis and stroke. There are treatment dilemmas in this situation when ischaemic and haemorrhagic cerebral events coexist.

Recent advances in mycotoxins detection

Mycotoxins contamination in both food and feed is inevitable. Mycotoxin toxicity in foodstuff can occur at very low concentrations necessitating early availability of sensitive and reliable methods for their detection. The present research thrust is towards the development of a user friendly biosensor for mycotoxin detection at both academic and industrial levels to replace conventional expensive chromatographic and ELISA techniques. This review critically analyzes the recent research trend towards the construction of immunosensor, aptasensor, enzymatic sensors and others for mycotoxin detection with a reference to label and label free methods, synthesis of new materials including nano dimension, and transuding techniques. Technological aspects in the development of biosensors for mycotoxin detection, current challenges and future prospects are also included to provide a overview and suggestions for future research directions.

Chronic relapsing remitting Sweet syndrome--a harbinger of myelodysplastic syndrome

Sweet syndrome (SS) is an acute febrile neutrophilic dermatosis. It has been associated with malignant disease, especially acute myeloid leukaemia (AML), infections, autoimmune disorders and drugs, particularly granulocyte colony-stimulating factor (GCSF). No cause is found in the rest, which are labelled idiopathic. We describe 15 patients with SS, which we believe represent 'immune dysregulation' secondary to myelodysplastic syndrome (MDS). We initially identified 31 patients with SS in a cohort of 744 patients with MDS and 215 with AML seen over a 6-year period (2004-10). The cause in 16 patients could be attributed either to administration of GCSF or chemotherapy. The eruption was brief and resolved spontaneously or following withdrawal of GCSF. Fifteen patients however, had a chronic debilitating illness dominated by the skin eruptions. Diagnosis of chronic relapsing SS was delayed because the pathology was not always typical of classical neutrophil-rich SS and included lymphocytic and histiocytoid infiltrates and bone marrow was not always performed because the relevance of the eruption to MDS was often not immediately appreciated. All these patients had 'low risk' MDS, diagnosed at a median of 17 months (range 0-157) following the diagnosis of SS. We describe a chronic debilitating episodic clinically distinctive skin eruption with features of SS but not always definitive histopathology often associated with immunological abnormalities affecting other systems related to underlying low risk MDS.

α MnMoO₄/graphene hybrid composite: high energy density supercapacitor electrode material

A unique and cost effective hydrothermal procedure has been carried out for the synthesis of hexahedron shaped α MnMoO4 and its hybrid composite with graphene using three different weight percentages of graphene. Characterization techniques, such as XRD, Raman and FTIR analysis, established the phase and formation of the composite. The electrochemical characterization of the pseudocapacitive MnMoO4 and the MnMoO4/graphene composites in 1 M Na2SO4 displayed highest specific capacitances of 234 F g(-1) and 364 F g(-1), respectively at a current density of 2 A g(-1). Unlike many other pseudocapacitive electrode materials our prepared materials responded in a wide range of working potentials of (-)1 V to (+)1 V, which indeed resulted in a high energy density without substantial loss of power density. The highest energy densities of 130 Wh kg(-1) and 202.2 Wh kg(-1) were achieved, respectively for the MnMoO4 and the MnMoO4/graphene composite at a constant power delivery rate of 2000 W kg(-1). The synergistic effect of the graphene with the pseudocapacitive MnMoO4 caused an increased cycle stability of 88% specific capacitance retention after 1000 consecutive charge discharge cycles at 8 A g(-1) constant current density, which was higher than the virgin MnMoO4 with 84% specific capacitance retention.

Factors predicting mortality in newborn ventilation

OBJECTIVE

Prediction of mortality among newborns on mechanical ventilation is difficult. Our aim was to develop a scoring system for predicting mortality among such neonates.

METHODS

This multi centre prospective study was performed to develop and validate a scoring system among two equal cohorts of ventilated newborns in India. Mechanical ventilator was used in pressure-limited time-cycled mode. Arterial blood gas, initial pulmonary pressures, septicemia screen along with other basic parameters were recorded in a pre-structured proforma. Blood samples were analyzed for malondialdehyde to determine the possible role and predictive validity of free radical injury. Multiple logistic regression analysis was done to find out independent predictors of mortality for the variables those were significantly associated with outcome after univariate analysis.

RESULTS

On univariate analysis, birth-weight, oxygenation-index, septicaemia, malondialdehyde level, and inotropic support were significantly associated with mortality. However, after multiple regression analysis gestational-age, pH and FiO₂ lost their significance as predictors. According to cut-off values of ROC-curve, a scoring system ranging from 0 to 20 and four mortality risk groups were developed. Area under ROC-curve was 0.94, compared to 0.90 for both APACHE-III and CRIB-scores; and 0.92 for PRISM-score.

CONCLUSIONS

Birth-weight, oxygenation-index, malondialdehyde level, inotropic support, and septicemia are independent mortality predictors of neonatal ventilation. Increase in malondialdehyde level is associated with higher mortality rate, indicating possible role of free radical injury. Pediatr Pulmonol. 2015; 50:271-275. © 2014 Wiley Periodicals, Inc.

Adaptive radiotherapy in lung cancer: dosimetric benefits and clinical outcome

OBJECTIVE

Anatomical changes during radiotherapy (RT) might introduce discrepancies between planned and delivered doses. This study evaluates the need for adaptive treatment in lung cancer RT.

METHODS

15 patients with non-small-cell lung cancer, undergoing radical RT with or without concurrent chemotherapy, consecutively underwent planning CT scans at baseline and after 44-46 Gy. Target volumes were delineated on both scans. Phase I delivered 44-46 Gy to the initial planning target volume (PTV). Two Phase II plans for 16-20 Gy were developed on initial and mid-treatment scans, the treatment being delivered with the mid-treatment plan. The second CT structure set was fused with the initial scan data set using dose wash. Volumetric and dosimetric changes in target volumes and critical structures were assessed.

RESULTS

There was significant reduction in primary gross tumour volume (34.00%; p = 0.02) and PTV (34.70%; p < 0.01) in the second scan. In Plan 2, delivering the same dose to the initial PTV would have resulted in a significantly higher dose to the lung PTV (V20, 52.18%; V5, 21.76%; mean, 23.93%), contralateral lung (mean, 29.43%), heart (V10, 81.47%; V5, 56.62%; mean, 35.21%) and spinal cord (maximum dose, 37.53%).

CONCLUSION

Treatment replanning can account for anatomical changes during RT and thereby enable better normal tissue sparing, while allowing radical target doses with the possibility of maximizing local control.

ADVANCES IN KNOWLEDGE

This study supports the sparse dosimetric data regarding the quantitative tumour volume reduction, re-emphasizing the need for adaptive replanning for minimizing normal tissue toxicity without compromising local control, and adds to the existing body of literature.

Gold-Nanoparticle Decorated Graphene-Nanostructured Polyaniline Nanocomposite-Based Bienzymatic Platform for Cholesterol Sensing

A novel nanobiocomposite bienzymatic amperometric cholesterol biosensor, coupled with cholesterol oxidase (ChOx) and horseradish peroxidase (HRP), was developed based on the gold-nanoparticle decorated graphene-nanostructured polyaniline nanocomposite (NSPANI-AuNP-GR) film which was electrochemically deposited onto indium-tin-oxide (ITO) electrode from the nanocomposite (NSPANI-AuNP-GR) dispersion, as synthesized by in situ polymerization technique. The gold nanoparticle-decorated graphene-nanostructured polyaniline nanocomposite (NSPANI-AuNP-GR) offers an efficient electron transfer between underlining electrode and enzyme active center. The bienzymatic nanocomposite bioelectrodes ChOx-HRP/NSPANI-AuNP-GR/ITO have exhibited higher sensitivity, linearity, and lower Km value than monoenzymatic bioelectrode (ChOx/NSPANI-AuNP-GR/ITO). It is inferred that bienzyme-based nanobioelectrodes offer wider linearity (35 to 500 mg/dL), higher sensitivity (0.42 μAmM−1), low km value of 0.01 mM and higher accuracy for testing of blood serum samples than monoenzyme system. Mechanism of the overall biochemical reaction has been proposed to illustrate the enhanced biosensing performance of the bienzyme system. The novelty of the electrode lies on reusability, extended shelf life, and accuracy of testing blood serum samples.

Association of polymorphisms in 9p21 region with CAD in North Indian population: replication of SNPs identified through GWAS

Coronary artery disease (CAD) is one of the leading causes of death worldwide that is influenced by both environmental as well as genetic factors. Several recent genome-wide association studies (GWAS) have reported the association of multiple single nucleotide polymorphisms (SNPs) mainly in the 9p21 region with CAD. However, the association of these SNPs with CAD has not been rigorously tested in Indian population, which accounts for the largest incidences of CAD in the world. Herein, we genotyped six such SNPs (rs10116277, rs10757274, rs1333040, rs2383206, rs2383207 and rs1994016) identified through GWAS, in 754 individuals (311 angiography-confirmed CAD patients and 443 treadmill test controls) recruited mainly from North India to evaluate if these SNPs were associated with CAD. The minor allele frequency of these six SNPs was comparable to that reported in the respective GWAS. We found that three of these SNPs (rs10116277, rs1333040 and rs2383206) present at the locus 9p21 were significantly associated with CAD even after controlling for the confounding factors such as age, sex, body mass index, homocysteine, hypertension, diabetes, smoking, diet, etc. In conclusion, the locus 9p21 found to be significantly associated with cardiovascular diseases in the Caucasian populations seems to be also important in North Indian population.