Impacts of Groundwater Pumping for Hydraulic Fracturing on Aquifers Overlying the Eagle Ford Shale

Hydraulic fracturing (HF) events consume high volumes of water over a short time. When groundwater is the source, the additional pumping by rig/frack supply wells (RFSWs) may impose costs on owners of other sector wells (OSWs) by lowering the hydraulic head. The Carrizo-Wilcox aquifer in south Texas is the main source of water for HF of the Eagle Ford Shale (EFS) Play. The objectives are to assess the impacts of groundwater pumping for HF supply on: (1) hydraulic heads in OSWs located nearby an RFSW and (2) volumetric fluxes between layers of the regional aquifer system compared to a baseline model without the effect of RFSW pumping. The study area spans the footprint of the EFS Play in Texas and extends from 2011 to 2020. The pumping schedules of 2500 RFSWs were estimated from reported pumped water volumes to supply 22,500 HF events. Median annual drawdowns in OSWs ranged from 0.2 to 6.6 m, whereas 95th percentile annual drawdowns exceeded 20 m. The magnitudes of drawdown increased from 2011 to 2020. Of the four layers that comprise the Carrizo-Wilcox aquifer, the upper Wilcox was the most intensively pumped for HF supply. During the peak HF year of 2014, the net flux to the upper Wilcox was 292 Mm3 compared to the baseline net flux for the same year of 278 Mm3-a relative gain of 14 Mm3. Pumping for HF supply has the potential to negatively impact nearby OSWs by capturing water from adjacent aquifer layers.

Tunnel-Structured ζ-V2O5 as a Redox-Active Insertion Host for Hybrid Capacitive Deionization

Much of the earth's water has a salt content that is too high for human consumption or agricultural use. Enhanced oil recovery operations generate massive volumes of produced water waste with a high mineral content that can substantially exacerbate water distress. Current deionization techniques such as reverse osmosis function by removing the water (majority phase) from the salt (minority phase) and are thus exceedingly energy-intensive. Furthermore, these methods are limited in their ability to selectively extract high-value ions from produced water waste and brine streams. Hybrid capacitive deionization holds promise for enabling both desalination and resource recovery. In this work, we demonstrate the construction of a hybrid capacitive deionization cell that makes use of tunnel-structured ζ-V₂O₅ as a redox-active positive electrode material. By augmenting surface adsorption with Faradaic insertion processes, a 50% improvement in the ion removal capacity for K and Li ions is obtained as compared to a capacitive high-surface-area carbon electrode. The extracted ions are accommodated in surface sites and interstitial sites within the one-dimensional tunnel framework of ζ-V₂O₅. The kinetics of ion removal depend on the free energy of hydration, which governs the ease of desolvation at the electrode/electrolyte interface. The overall ion removal capacity additionally depends on the solid-state diffusion coefficient. ζ-V₂O₅ positive electrodes show substantial selectivity for Li⁺ removal from mixed flow streams and enrichment of the Li-ion concentration from produced water waste derived from the Permian Basin.

Herniation of ureter: a rare cause of hydroureteronephrosis

Background

Omentum and bowel loops are commonly seen in inguinal hernia. An unusual case of extraperitoneal herniation of ureter was detected in hernial sac with other contents, on computed tomography (CT) urography.

Case presentation

A 54-year-old male presented with inguinal hernia, with no previous history of surgery or trauma. Pre-operative screening showed a unilateral hydroureteronephrosis involving the pelvicalyceal system and entire ureter. No calculus was visualized in the ureter on ultrasound. On non-contrast CT (NCCT) followed by CT urography, the ureter was seen descending into the hernia sac causing hydroureteronephrosis. The patient subsequently underwent mesh repair surgery of the inguinal hernia with meticulous reduction of the herniated contents including the ureter, resulting in complete resolution of the hydroureteronephrosis.

Conclusion

An isolated extraperitoneal inguinal herniation of the ureter without concomitant urinary bladder involvement is extremely rare, especially with no prior history of trauma or surgery, as seen in our case. The case also exemplifies the role of pre-operative imaging as a protocol in cases of inguinal hernia to prevent per-operative complications.

1283 The Management of Multiple Morton’s Neuromas in the Same Foot: A Systematic Review

Aim

The optimal treatment strategy for the presentation of multiple Morton’s neuromas in adjacent intermetatarsal spaces of the same foot is yet to be determined. This systematic review aims to summarise and assess the efficacy of current treatment strategies.

Method

A systematic review was performed using the PRISMA guidelines. The review is registered in the international prospective register of systematic reviews (CRD42020213631). A computer-based search was completed in PubMed, Embase, Cinahl, Web of Science, Scopus and Emcare, for articles reporting the treatment of multiple neuromas in the same foot. Two authors independently performed title/abstract and full text screening according to a-priori selection criteria. Considering the four studies reporting treatment of a cohort containing both patients with a single neuroma and those with multiple neuromas, the proportion of cases in the latter group was 51/354 (14.41%).

Results

A total of 253 articles were identified, with 7 articles, involving 383 patients being included in the review. The most common treatment strategy reported was simultaneous neuroma excision using a single incision, whilst two studies each describe simultaneous excision with two separate incisions and delayed excision, respectively. The proportion of patients

Discussion

There is no strong evidence favouring use of delayed excision or multiple incisions. However, there is currently a lack of evidence focusing on this presentation of neuroma specifically. A number of studies fail to separate results of single and multiple neuroma excision. Further high-quality research is therefore required to make more definitive conclusions and future research should investigate other strategies such as non-operative treatment.

Pro-poor policies and improvements in maternal health outcomes in India

BACKGROUND

Since 2005, India has experienced an impressive 77% reduction in maternal mortality compared to the global average of 43%. What explains this impressive performance in terms of reduction in maternal mortality and improvement in maternal health outcomes? This paper evaluates the effect of household wealth status on maternal mortality in India, and also separates out the performance of the Empowered Action Group (EAG) states and the Southern states of India. The results are discussed in the light of various pro-poor programmes and policies designed to reduce maternal mortality and the existing supply side gaps in the healthcare system of India. Using multiple sources of data, this study aims to understand the trends in maternal mortality (1997-2017) between EAG and non EAG states in India and explore various household, economic and policy factors that may explain reduction in maternal mortality and improvement in maternal health outcomes in India.

METHODS

This study triangulates data from different rounds of Sample Registration Systems to assess the trend in maternal mortality in India. It further analysed the National Family Health Surveys (NFHS). NFHS-4, 2015-16 has gathered information on maternal mortality and pregnancy-related deaths from 601,509 households. Using logistic regression, we estimate the association of various socio-economic variables on maternal deaths in the various states of India.

RESULTS

On an average, wealth status of the households did not have a statistically significant association with maternal mortality in India. However, our disaggregate analysis reveals, the gains in terms of maternal mortality have been unevenly distributed. Although the rich-poor gap in maternal mortality has reduced in EAG states such as Bihar, Odisha, Assam, Rajasthan, the maternal mortality has remained above the national average for many of these states. The EAG states also experience supply side shortfalls in terms of availability of PHC and PHC doctors; and availability of specialist doctors.

CONCLUSIONS

The novel contribution of the present paper is that the association of household wealth status and place of residence with maternal mortality is statistically not significant implying financial barriers to access maternal health services have been minimised. This result, and India's impressive performance with respect to maternal health outcomes, can be attributed to the various pro-poor policies and cash incentive schemes successfully launched in recent years. Community-level involvement with pivotal role played by community health workers has been one of the major reasons for the success of many ongoing policies. Policy makers need to prioritise the underperforming states and socio-economic groups within the states by addressing both demand-side and supply-side measures simultaneously mediated by contextual factors.

893 Intestinal Stoma - A challenge for the Patient

Introduction

Formation of intestinal stoma is a widely performed surgical procedure worldwide. It is associated with variable complications which can impact physical and mental health of the patient. The purpose of this study is to study the aspects (indications, complications, change in quality-of-life etc) and make necessary recommendations for quality improvement and to make patient experience better.

Method

study included 150 patients with stoma formation. Data categorised according to indications, complications, based on their response to change to quality of life.

Results

A total of 150 patients were included in this study. There were 89 male (59.3%), female (40.6%). 63 patients (42%) had loop ileostomy;38 patients (25.3%) had transverse colostomy. 77 patients (51.3%) had bowel malignancy, diverticular perforation in 19.3%. 21 patients (14%) mentioned change into their self-esteem following the surgery, 14% patients reported decline in their sexual life.

Conclusions

Pre & postoperative assessments should be carried out in detail with the patient to help them understand the implications of having a “stoma”. Stoma nurse involvement helps the patient to accept the changes to their life after the surgery. Psychological &sexual consultation helps in improving patient’s response to the challenge it may impose.

An epidemic of avoidable caesarean deliveries in the private sector in India: Is physician-induced demand at play?

PURPOSE AND SETTING OF RESEARCH

Caesarean section (C-section) rates of over 15% suggest overuse of the surgery which may be difficult to justify on medical grounds. One important contributor to the rise in Csection rates is the rapid expansion of unregulated private-sector providers in number of settings. This study analyses the contribution of private sector in the rapid rise in Csection deliveries in India and the extent to which these can be justified on medical grounds.

METHODS

This is a cross sectional study design using National Family Health Surveys. Logistic regression and propensity score matching (PSM) analyses are performed. The main outcome measured is avoidable C-sections in the private sector.

PRINCIPAL FINDINGS

Our findings suggest that the rising trend in C-section rates in the private sector cannot be explained by medical reasons alone. The odds of C-section among women who chose to deliver in private was over 4 times higher than women who chose to delivery in public facilities. Despite, controlling for medical complications, women's characteristics and preferences, our PSM analysis suggest that the public-private gap has doubled over the years and that the difference cannot be explained by known determinants of C-section. Over supply of avoidable C-section to the extent of 21%, as a result of physician induced demand and perverse financial incentives was observed in the private sector.

CONCLUSIONS

This paper attempts to understand the reason for the high C-section rates in the private sector in India and the extent to which these are avoidable. Our analysis supports the assumption that physician induced demand as a result of perverse financial incentives in the private sector is at play.

Trigeminal neuralgia: When does neurovascular contact turn into a conflict?

Background

The most common cause for trigeminal neuralgia is contact of the trigeminal nerve with an offending vessel which is also observed routinely in many asymptomatic patients. Therefore, the aim of this study was to determine when an asymptomatic Neuro Vascular Contact (NVC) turned into a neurovascular conflict and made the patient symptomatic.

Methods

All patients who underwent Magnetic Resonance Imaging (MRI) brain with clinical diagnosis of trigeminal neuralgia formed the study group and all cases of sensorineural hearing loss formed the control group.

Results

Out of 51 cases of trigeminal neuralgia 27 were males and 24 were females. The neurovascular contact was seen in 41 (80.4%) cases and 17 (28.3%) controls. Change in caliber of trigeminal nerve was seen in 27 (52.9%) cases and only in 01 (1.66%) control. Arterial imprint on nerve was seen in 26 (50.9%) cases and 01 (1.66%) control. Distortion of the course of nerve was seen in 12 (23.5%) cases and 01 (1.66%) control. Superior cerebellar artery was commonest vessel seen in contact with nerve on affected side in 25 (61%) cases.

Conclusion

Demonstrating neurovascular contact alone is not enough for diagnosis of conflict as it is also present in some asymptomatic individuals, therefore it is important to identify thinning of nerve, arterial imprint or grooving and distortion in course of nerve, as these are more reliable signs of a conflict between the vessel and the nerve, and these cases are best treated surgically by Micro Vascular Decompression (MVD).

Mind the gap: Temporal trends in inequalities in infant and child mortality in India (1992-2016)

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Temporal trends in inequalities in infant and child mortality over two and half decades in India.

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Relative change in inequalities in child mortality over survey periods.

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Scatter plots to identify states with largest inequalities among wealth index groups.

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Concentration Index by various background characteristics and decomposition analysis to identify factors contributing in inequality in infant mortality between richest and poorest groups.

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Gap between the poorest and richest groups has narrowed in most states in India in recent years.

Intracranial hypotension: An uncommon entity with common presentation

Headache disorders are among the most common presenting complaints in any neurology outpatient department. International Headache Society classifies headaches as "primary" or "secondary". The causes of secondary headaches are varied and intracranial hypotension is one of them. It typically presents clinically with postural headaches but most of the times, its diagnosis is delayed, as it is an uncommon cause and there is poor awareness among the medical fraternity about this condition. Imaging, especially magnetic resonance imaging (MRI), plays a crucial role in the diagnosis of intracranial hypotension by not only confirming the diagnosis but also detecting the cause in some cases. This case series tries to highlight the MRI findings of intracranial hypotension in three cases with different etiologies.

Tubercular spondylitis: A review of MRI findings in 80 cases

Background

Tuberculosis of spine is known as tubercular spondylitis or Pott's spine. The vertebral involvement leads to various pathological processes such as abscess formation, cord compression, and gibbus deformity. Magnetic Resonance Imaging (MRI) is the imaging modality of choice which not only helps in diagnosing a case of Pott's spine but also gives valuable information about its impending complications, thereby, aiding in management of these cases.

Methods

In this study, MRI scans of 80 proven cases of tubercular spondylitis were studied retrospectively for the various pathological processes affecting the spine.

Results

Of the 80 cases included in this study, 68.8% of cases were male and 31.2% of cases were females. Majority of cases were seen in 21-40 yrs age group. Lumbar vertebrae were more commonly affected than the dorsal vertebrae. Contiguous two vertebral involvement was the most common pattern, and skip lesions were seen in 5% of cases. Pre-, paravertebral and epidural soft tissue component was seen in 96.25% and 62.5% of cases, respectively. Intervertebral disc Involvement was noted in 95% of cases, and cord edema was seen in 15% of cases.

Conclusion

Tubercular spondylitis or Pott's spine is an extrapulmonary form of tuberculosis which affects the spine. MRI is the imaging modality of choice not only in diagnosing the condition but also in guiding the surgical management. The cases of spinal tuberculosis were systematically analyzed for various pathological lesions which are produced in the spine as the disease progresses.

Corticosteroid injection for Morton's neuroma with or without ultrasound guidance: a randomised controlled trial

AIMS

The objective of this double-blind randomised controlled trial was to assess whether ultrasound guidance improved the efficacy of corticosteroid injections for Morton's neuroma (MN).

PATIENTS AND METHODS

In all, 50 feet (40 patients) were recruited for this study but five feet were excluded due to the patients declining further participation. The mean age of the remaining 36 patients (45 feet) was 57.8 years (standard deviation (sd) 12.9) with a female preponderance (33F:12M). All patients were followed-up for 12 months. Treatment was randomised to an ultrasound guided (Group A) or non-ultrasound guided (Group B) injection of 40 mg triamcinolone acetonide and 2 ml 1% lignocaine, following ultrasound confirmation of the diagnosis.

RESULTS

The mean visual analogue score for pain improved significantly in both groups (Group A - from 64 mm, sd 25 mm to 29 mm, sd 27; Group B - from 69 mm, sd 23 mm to 37 mm, sd 25) with no statistical difference between them at all time-points. The failure rate within 12 months of treatment was 11/23 (48%) and 12/22 (55%) in Groups A and B, respectively (p = 0.458). The improvement in Manchester Oxford Foot Questionnaire Index and patient satisfaction favoured Group A in the short-term (three months) that almost reached statistical significance (p = 0.059 and 0.066 respectively). However, this difference was not observed beyond three months.

CONCLUSION

This study has shown that ultrasound guidance did not demonstrably improve the efficacy of corticosteroid injections in patients with MN.

TAKE HOME MESSAGE

In the presence of a clear diagnosis of MN, a trained clinician who understands the forefoot anatomy may perform an injection without ultrasound guidance with good and safe results.

An evaluation of dark field microscopy, culture and commercial serological kits in the diagnosis of leptospirosis

CONTEXT

This study was conducted to analyze the clinical utility of various leptospira diagnostic modalities.

AIMS

To evaluate the role of dark field microscopy (DFM), culture, immunochromatography (IgM Leptocheck), IgM enzyme-linked immunosorbent assay (IgM ELISA), macroscopic slide agglutination test (MSAT) and microscopic agglutination test (MAT) in diagnosing leptospirosis in febrile patients.

SETTINGS AND DESIGN

Descriptive study conducted in a tertiary care hospital from January 2011 to April 2012.

SUBJECTS AND METHODS

Blood, urine and paired sera from 100 patients with clinical suspicion of leptospirosis (study group) were collected and subjected to DFM, culture, IgM Leptocheck, IgM ELISA and MSAT. Fifty randomly selected sera from febrile patients tested positive for infections other than leptospirosis (control sera) were also subjected to the aforementioned serological assays. All the leptospira seropositive samples were subjected to MAT.

STATISTICAL ANALYSIS USED

Positive predictive values (PPV) and coefficient of agreement (kappa).

RESULTS

None of the clinical samples showed positivity by DFM. Leptospira inadai was isolated from a urine sample. The seropositivity of IgM Leptocheck, IgM ELISA and MSAT was 16%, 46% and 47%, respectively. The PPV of these assays was 14.3%, 8.7% and 6.5%, respectively. Poor agreement was obtained among these assays. Only four study group leptospira seropositive samples were confirmed by MAT with Australis being the predominant serovar. None of the leptospira-positive control sera were confirmed by MAT.

CONCLUSIONS

DFM and culture have limited utility in diagnosing leptospirosis with serology being the mainstay. The present study shows discordant results with the commercially available serological kits. Further studies should be done to evaluate the various diagnostic modalities.

The safety and feasibility of probiotics in children and adolescents undergoing hematopoietic cell transplantation

Hematopoietic cell transplantation (HCT) has become a standard treatment for many adult and pediatric conditions. Emerging evidence suggests that perturbations in the microbiota diversity increase recipients' susceptibilities to gut-mediated conditions such as diarrhea, infection and acute GvHD. Probiotics preserve the microbiota and may minimize the risk of developing a gut-mediated condition; however, their safety has not been evaluated in the setting of HCT. We evaluated the safety and feasibility of the probiotic, Lactobacillus plantarum (LBP), in children and adolescents undergoing allogeneic HCT. Participants received once-daily supplementation with LBP beginning on day -8 or -7 and continued until day +14. Outcomes were compliance with daily administration and incidence of LBP bacteremia. Administration of LBP was feasible with 97% (30/31, 95% confidence interval (CI) 83-100%) of children receiving at least 50% of the probiotic dose (median 97%; range 50-100%). We did not observe any case of LBP bacteremia (0% (0/30) with 95% CI 0-12%). There were not any unexpected adverse events related to LBP. Our study provides preliminary evidence that administration of LBP is safe and feasible in children and adolescents undergoing HCT. Future steps include the conduct of an approved randomized, controlled trial through Children's Oncology Group.

Cystathionine-gamma-lyase gene silencing with siRNA in monocytes/macrophages protects mice against acute pancreatitis

Hydrogen sulphide (H2S) is an endogenous inflammatory mediator produced by cystathionine-γ-lyase (CSE) in monocytes/macrophages. To determine the role of H2S and macrophages in inflammation, we used small interference RNA (siRNA) to target the CSE gene and investigated its effect in a mouse model of acute pancreatitis. Acute pancreatitis is characterised by increased levels of plasma amylase, myeloperoxidase (MPO) activity and pro-inflammatory cytokines and chemokines in the pancreas and lung. SiRNA treatment attenuated inflammation in the pancreas and lungs of mice following caerulein-induced acute pancreatitis. MPO activity increased in caerulein-induced acute pancreatitis (16.21 ± 3.571 SD fold increase over control) and treatment with siRNA significantly reduced this (mean 3.555 ± 2.522 SD fold increase over control) (p < 0.0001). Similarly, lung MPO activity increased following treatment with caerulein (3.56 ± 0.941 SD fold increase over control) while siRNA treatment significantly reduced MPO activity (0.8243 ± 0.4353 SD fold increase over control) (p < 0.0001). Caerulein treatment increased plasma amylase activity (7094 ± 207 U/l) and this significantly decreased following siRNA administration (5895 ± 115 U/l) (p < 0.0001). Cytokine and chemokine levels in caerulein-induced acute pancreatitis reduced following treatment with siRNA. For example, siRNA treatment significantly decreased pancreatic and lung monocyte chemoattractant protein (MCP)-1 (169.8 ± 59.75 SD; 90.01 ± 46.97 SD pg/ml, respectively) compared to caerulein-treated mice (324.7 ± 103.9 SD; 222.8 ± 85.37 SD pg/ml, pancreas and lun,g respectively) (p < 0.0001). These findings show a crucial pro-inflammatory role for H2S synthesised by CSE in macrophages in acute pancreatitis and suggest CSE gene silencing with siRNA as a potential therapeutic approach for this condition.

"Breast within a breast" sign: Mammary hamartoma

Breast hamartomas are uncommon benign tumors of the breast. Imaging appearance of a breast hamartoma can vary widely. "Breast within a breast" sign on mammography is considered pathognomonic of this unusual entity. We describe mammographic and Magnetic Resonance Imaging (MRI) appearance of a case of hamartoma breast.

Septo-optic dysplasia: Magnetic Resonance Imaging findings

Septo-optic dysplasia is a rare congenital disorder involving brain and optic pathways. We present typical Magnetic Resonance Imaging (MRI) findings of a case of Septo-optic dysplasia in a 19 year old female patient.

First metatarsophalangeal joint arthrodesis - Do joint configuration and preparation technique matter?

BACKGROUND

The purpose of this study was to investigate the influence of joint configuration and preparation on first metatarsophalangeal (MTPJ) union rates.

METHODS

We performed a retrospective analysis of first MTPJ arthrodeses undertaken in our institution. Clinical notes, radiographs and postal questionnaires were used to determine outcome.

RESULTS

Two hundred first MTPJ arthrodeses (172 patients) were included in the analysis (34 male: 138 female; mean age 62 yr). The overall union rate was 93.5%. Union was achieved in 109/118 MTPJs (92.4%) prepared in the flat-on-flat configuration and in 78/82 (95%) prepared in the ball-and-socket configuration (p=0.438). Higher union rates favoured low-velocity joint preparation [using rongeur only 21/21 (100%), rongeur and burr 26/27 (96.3%) and conical reamer 31/34 (91.2%)] but this did not reach statistical significance (p=0.317). There was a 95% satisfaction rate with surgery but male patients were less satisfied (p=0.031).

CONCLUSION

Union rates were not influenced by joint configuration or preparation techniques.

Clinical mimics of acute appendicitis: Is there any role of imaging?

Acute appendicitis (AA) is a common surgical emergency. Accurate and timely diagnosis of AA is essential for successful outcome. Imaging plays an important role in the diagnosis, exclusion of AA as well as diagnosing alternative clinical conditions which can closely simulate AA. A correct alterative diagnosis may obviate the need of unnecessary appendectomy or may even change the treatment regime altogether. This pictorial essay illustrates various clinical conditions which mimicked AA clinically during our day to day practice.

A case–control study of surgical site infection following operative fixation of fractures of the ankle in a large UK trauma unit

Most of the literature on surgical site infections following the surgical treatment of fractures of the ankle is based on small series of patients, focusing on diabetics or the elderly. None have described post-operative functional scores in those patients who develop an infection. We performed an age- and gender-matched case–control study to identify patient- and surgery-related risk factors for surgical site infection following open reduction and internal fixation of a fracture of the ankle. Logistic regression analysis was used to identify significant risk factors for infection and to calculate odds ratios (OR). Function was assessed using the Olerud and Molander Ankle Score. The incidence of infection was 4% (29/717) and 1.1% (8/717) were deep infections. The median ankle score was significantly lower in the infection group compared with the control group (60 vs 90, Mann–Whitney test p < 0.0001). Multivariate regression analysis showed that diabetes (OR = 15, p = 0.031), nursing home residence (OR = 12, p = 0.018) and Weber C fractures (OR = 4, p = 0.048) were significant risk factors for infection.

A low incidence of infection following open reduction and internal fixation of fractures of the ankle was observed. Both superficial and deep infections result in lower functional scores.

Cite this article: Bone Joint J 2014;96-B:636–40.

Dry imaging cameras

Dry imaging cameras are important hard copy devices in radiology. Using dry imaging camera, multiformat images of digital modalities in radiology are created from a sealed unit of unexposed films. The functioning of a modern dry camera, involves a blend of concurrent processes, in areas of diverse sciences like computers, mechanics, thermal, optics, electricity and radiography. Broadly, hard copy devices are classified as laser and non laser based technology. When compared with the working knowledge and technical awareness of different modalities in radiology, the understanding of a dry imaging camera is often superficial and neglected. To fill this void, this article outlines the key features of a modern dry camera and its important issues that impact radiology workflow.

Evidence for the transmission of neoplastic properties from transformed to normal human stem cells

The in vivo relationship between human tumor cells and interacting normal cells in their local environment is poorly understood. Here, using a uniquely developed in vitro co-culture system for human embryonic stem cells (hESCs), we examined the interactions between transformed and normal human stem cells. Co-culture of transformed-hESCs (t-hESCs) with normal hESCs led to enhanced self-renewal and niche independence in normal hESCs. Global gene expression analysis of normal hESCs after timed exposure to t-hESCs indicated a transition of the molecular network controlling the hESC state, which included epigenetic changes, towards neoplastic features. These included enhanced pluripotent marker expression and a differentiation blockade as major hallmark changes. Functional studies revealed a loss in normal terminal differentiation programs for both hematopoiesis and neural lineages after normal stem cell co-culture with transformed variants. This transmission of neoplastic properties from t-hESCs to normal hESCs was dependent on direct cell-cell contact. Our study indicates that normal human stem cells can co-opt neoplastic cancer stem cell properties, raising the possibility that assimilation of healthy cells towards neoplastic behavior maybe a contributing feature of sustained tumorigenesis in vivo.