Temperature measurement using frequency comb absorption spectroscopy of CO2

Absorption spectroscopy on CO₂ for the determination of gas temperature is reported. Direct absorption of a frequency comb laser through a gas cell at atmospheric conditions is analysed with a virtually imaged phased array spectrometer. Several measurement and analysis techniques are investigated to find the parameters most sensitive to changes in the temperature. Some of these show qualitative agreement with theoretical predictions where the trend is similar to the calculated values.

Chikungunya virus infection in West Bengal, India

BACKGROUND

Chikungunya virus has recently re-emerged in India.

OBJECTIVES

Assess prevalence of Chikungunya.

MATERIALS AND METHODS

Study conducted from April 2011 to September 2011. Two hundred and six patients (206) of both sexes (100 males and 106 females) of all age groups studied. Serum separated and CHIKV MAC IgM ELISA and Hemagglutination inhibition assay done.

RESULTS

76 cases (36.89%) sero-positive by both the methods.

CONCLUSION

Re-emergence and resurgence of the Chikungunya virus requires continuous monitoring.

Comb mode filtering silver mirror cavity for spectroscopic distance measurement

In this work we present a design of an external optical cavity based on Fabry-Perot etalons applied to a 100 MHz Er-doped fiber optical frequency comb working at 1560 nm to increase its repetition frequency. A Fabry-Perot cavity is constructed based on a transportable cage system with two silver mirrors in plano-concave geometry including the mode-matching lenses, fiber coupled collimation package and detection unit. The system enables full 3D angle mirror tilting and x-y off axis movement as well as distance between the mirrors. We demonstrate the increase of repetition frequency by direct measurement of the beat frequency and spectrally by using the virtually imaged phased array images.

Exhaled breath profiling using broadband quantum cascade laser-based spectroscopy in healthy children and children with asthma and cystic fibrosis

Exhaled breath analysis is a potential non-invasive tool for diagnosing and monitoring airway diseases. Gas chromatography-mass spectrometry and electrochemical sensor arrays are the main techniques to detect volatile organic compounds (VOC) in exhaled breath. We developed a broadband quantum cascade laser spectroscopy technique for VOC detection and identification. The objective of this study was to assess the repeatability of exhaled breath profiling with broadband quantum cascade laser-based spectroscopy and to explore the clinical applicability by comparing exhaled breath samples from healthy children with those from children with asthma or cystic fibrosis (CF). Healthy children and children with stable asthma or stable CF, aged 6-18 years, were included. Two to four exhaled breath samples were collected in Tedlar bags and analyzed by quantum cascade laser spectroscopy to detect VOCs with an absorption profile in the wavenumber region between 832 and 1262.55 cm(-1). We included 35 healthy children, 39 children with asthma and 15 with CF. Exhaled breath VOC profiles showed poor repeatability (Spearman's rho  =  0.36 to 0.46) and agreement of the complete profiles. However, we were able to discriminate healthy children from children with stable asthma or stable CF and identified VOCs that were responsible for this discrimination. Broadband quantum cascade laser-based spectroscopy detected differences in VOC profiles in exhaled breath samples between healthy children and children with asthma or CF. The combination of a relatively easy and fast method and the possibility of molecule identification makes broadband quantum cascade laser-based spectroscopy attractive to investigate the diagnostic and prognostic potential of volatiles in exhaled breath.

Application of full field optical studies for pulsatile flow in a carotid artery phantom

A preliminary comparative measurement between particle imaging velocimetry (PIV) and laser speckle contrast analysis (LASCA) to study pulsatile flow using ventricular assist device in a patient-specific carotid artery phantom is reported. These full-field optical techniques have both been used to study flow and extract complementary parameters. We use the high spatial resolution of PIV to generate a full velocity map of the flow field and the high temporal resolution of LASCA to extract the detailed frequency spectrum of the fluid pulses. Using this combination of techniques a complete study of complex pulsatile flow in an intricate flow network can be studied.

Serological diagnosis of dengue in laboratory practice in Kolkata

PURPOSE

To find out the most suitable serological investigative procedures to diagnose dengue cases effectively in the laboratory practice identifying primary and secondary cases as well as period of suffering.

MATERIALS AND METHODS

Dengue suspected cases sent to the laboratory in 2012 in central Kolkata by the local physicians were categorised into seven panels according to the investigations asked for such as (1) only dengue-specific NS1 antigen (2) only IgM antibodies, (3) NS1+IgM+IgG antibodies, (4) only IgM and IgG, (5) NS1+IgM, (6) NS1+IgG and (7) only IgG.

RESULTS

Out of 1892 suspected cases, dengue was diagnosed in 725 (38.3%). Through panels I, II, III, IV, V, VI and VII, it was possible to diagnose dengue in (I) 35.98% (435/1209), (II) 37.5% (24/60), (III) 49% (173/354), (IV) 30.8% (68/221), (V) 60.5% (23/38), (VI) 40% (2/5) and (VII) 0 of cases respectively. Detail information such as confirmed diagnosis, duration of the disease (whether early or prolonged) and classification of primary and secondary dengue in such early or prolonged stages would only be possible in panel III, which information would be helpful for effective monitoring and treatment of dengue patients. In all other panels, merely fragmentary information would be obtained.

CONCLUSIONS

Serodiagnostic tests dengue-specific NS1 antigen and IgM and IgG antibodies when conducted simultaneously would be able to diagnose confirmed dengue cases categorising primary and secondary dengue along with the duration of the disease, whether early or prolonged.

Multicomponent gas analysis using broadband quantum cascade laser spectroscopy

We present a broadband quantum cascade laser-based spectroscopic system covering the region between 850 and 1250 cm(-1). Its robust multipass cavity ensures a constant interaction length over the entire spectral region. The device enables the detection and identification of numerous molecules present in a complex gas mixture without any pre-treatment in two minutes. We demonstrate that we can detect sub-ppmv concentration of acetone in presence of 2% of water at the same wavenumber region.

Dynamic light scattering from pulsatile flow in the presence of induced motion artifacts

Continuous health monitoring has become a major theme of our aging society. Portable devices play an important role here. Many optical portable devices are susceptible to motion induced artifacts. We have performed an experimental study for detection of fluid pulsation based on multi-exposure speckle images, in presence of motion induced artifacts. Induced motion of a wide range of frequencies and amplitudes were generated to resemble sensor motion with respect to skin. The data was analyzed using speckle contrast and correlation. We concluded that both techniques have their own advantages, depending on the measurement configuration. A study of angles between illumination and detection revealed that larger angles yields better signal. Shorter exposure time was more successful in extracting the signal. We also performed in-vivo measurements that agree with the in-vitro case. We also show that a minimum collection of two pixels from the speckle image is sufficient to extract relevant results.

Laser-speckle-based detection of fluid pulsation in the presence of motion artifacts: in vitro and in vivo study

We have performed an in vitro and in vivo study, based on laser speckle contrast analysis, to detect fluid pulsation in the presence of artifacts caused by the relative motion between the sample and the illumination source. We observe that the pulsation signal is clearly detectable for a range of motion amplitudes and oscillation frequencies; however, for higher amplitudes and oscillation frequencies of motion, the signal, due to pulsation, becomes increasingly difficult to detect.

Many-wavelength interferometry with thousands of lasers for absolute distance measurement

We demonstrate a new technique for absolute distance measurement with a femtosecond frequency comb laser, based on unraveling the output of an interferometer to distinct comb modes with 1 GHz spacing. From the fringe patterns that are captured with a camera, a distance is derived by combining spectral and homodyne interferometry, exploiting about 9000 continuous wave lasers. This results in a measurement accuracy far within an optical fringe (λ/30), combined with a large range of nonambiguity (15 cm). Our technique merges multiwavelength interferometry and spectral interferometry, within a single scheme.

Long distance measurement with femtosecond pulses using a dispersive interferometer

We experimentally demonstrate long distance measurements with a femtosecond frequency comb laser using dispersive interferometry. The distance is derived from the unwrapped spectral phase of the dispersed interferometer output and the repetition frequency of the laser. For an interferometer length of 50 m this approach has been compared to an independent phase counting laser interferometer. The obtained mutual agreement is better than 1.5 μm (3×10(-8)), with a statistical averaging of less than 200 nm. Our experiments demonstrate that dispersive interferometry with a frequency comb laser is a powerful method for accurate and non-incremental measurement of long distances.

Time-frequency distribution of interferograms from a frequency comb in dispersive media

We investigate general properties of the interferograms from a frequency comb laser in a non-linear dispersive medium. The focus is on interferograms at large delay distances and in particular on their broadening, the fringe formation and shape. It is observed that at large delay distances the interferograms spread linearly and that its shape is determined by the source spectral profile. It is also shown that each intensity point of the interferogram is formed by the contribution of one dominant stationary frequency. This stationary frequency is seen to vary as a function of the path length difference even within the interferogram. We also show that the contributing stationary frequency remains constant if the evolution of a particular fringe is followed in the successive interferograms found periodically at different path length differences. This can be used to measure very large distances in dispersive media.

Tensor fascia lata flap reconstruction in groin malignancy

INTRODUCTION

Block dissection of inguinal lymph nodes is done in cases of malignant inguinal lymphadenopathy, which requires the removal of skin where it is involved, or elevation of the flaps which have precarious blood supply leading to necrosis. Thus, wound closure presents a big challenge. It can be done either by primary closure which is frequently complicated by necrosis, or by split thickness skin graft which is complicated by rejection on radiotherapy. Another option is to cover the wound by a vascularised pedicled graft. This prospective study was conducted after obtaining clearance from the ethical committee. The results were compared with the accepted complication rates of the operation.

METHODS

We presented our experience of coverage of wounds after block dissection of inguinal lymph nodes for malignant deposits in 15 patients (with median age of 46 years) by pedicled tensor fascia lata thigh flap.

RESULTS

The results following the surgery were good. Healing was satisfactory in all 15 cases. There were two cases of marginal flap necrosis, and three cases developed lymphoedema which was managed by stockings. There were two cases of infection which were settled by antibiotics. There were three cases of loss of a small area of skin graft at the donor site. There was no reported case of recurrence in the inguinal region.

CONCLUSION

This technique of coverage of the defect after inguinal block dissection is easy with predictable good results.

High-accuracy long-distance measurements in air with a frequency comb laser

We experimentally demonstrate that a femtosecond frequency comb laser can be applied as a tool for long-distance measurement in air. Our method is based on the measurement of cross correlation between individual pulses in a Michelson interferometer. From the position of the correlation functions, distances of up to 50 m have been measured. We have compared this measurement to a counting laser interferometer, showing an agreement with the measured distance within 2 microm (4x10(-8) at 50 m).

MYC gene amplification reveals clinical association with head and neck squamous cell carcinoma in Indian patients

BACKGROUND

Amplification of the MYC gene is reported to be associated with the development of head and neck squamous cell carcinoma (HNSCC). This study is focused to analyze the correlation between MYC gene amplification and various clinicopathological features and outcome in a cohort of 49 dysplastic and 187 primary head and neck lesions.

METHODS

MYC gene amplification was assessed by differential polymerase chain reaction using primer sets from the MYC gene as target locus and DRD2 gene as the control locus.

RESULT

The MYC gene amplification was detected in a total of 23.7% (56/236) head and neck lesions comprising 14.2% (7/49) dysplastic lesions and 26% (49/187) HNSCC samples. The clinicopathological association study between MYC gene amplification with the different clinical parameters like sex, tumor stage, tumor differentiation, lymph node status, tobacco habit and HPV 16/18 status determined significant association of MYC amplification with tumor progression (P = 0.009). Kaplan Meier analysis revealed MYC gene has no prognostic significance on survival in HNSCC.

CONCLUSION

In conclusion, our results suggest that MYC gene amplification is associated with tumor progression in HNSCC.

High fat diet induces obesity in British Angora rabbit: a model for experimental obesity

A reliable and cost-effective animal model for human obesity with its manifested disorders is yet to be established in the context of increased morbidity and mortality due to obesity and its related problems. Therefore, an attempt was made to produce obesity in locally available British Angora Rabbits (BAR) and examine the effect on metabolic and cardiovascular parameters. Adult male BARs weighing nearly 2 kg were randomly divided into two groups, one of the groups was fed with high fat diet (HFD) ad libitum for 10 weeks and the control group received standard normal rabbit chow for same period. Body weight, skinfold thickness, serum cholesterol, serum glucose and resting heart rate were measured before and after the dietary regimens. After 10 weeks, HFD group of rabbits demonstrated significant (P < 0.05) increase in body weight (+24%) and skinfold thickness (+37%). The gain in body weight was positively correlated to skinfold thickness (r = 0.61). Serum cholesterol, serum glucose and resting heart rate were also increased by 46%, 52% and 15%, respectively. Whereas no such increases in any of these parameters were observed in control group of rabbits. Our results suggest that obesity can be produced in BARs by feeding HFD. The obesity manifests with cardiovascular and metabolic changes. It is proposed that this may serve as a valid and reliable model of experimental obesity.

Obesity attenuates formalin-induced tonic pain in British Angora rabbits

Obesity is known to alter various physiological parameters including the pain sensitivity. There are conflicting reports on the pain sensitivity in obesity. In this context, the present study was aimed to investigate the tonic pain response in obese rabbit model. To achieve this aim, two groups of adult male British Angora rabbits were used. One of the groups was fed with standard rabbit chow and served as control. The other group was fed high fat diet (HFD) for 10 weeks to produce obesity. The standard formalin test was performed at the start and after 10 weeks of dietary regimen in both the groups. Timed behavioral responses (limping, elevation of paw, licking, biting, grooming etc.) were categorized and quantified with the help of standard pain rating scale. The total average pain rating score decreased significantly from 2.01 +/- 0.02 to 1.47 +/- 0.08 (P < 0.05) in HFD group after 10 weeks of dietary regimen, whereas there was no change in the control group. A significant negative correlation was observed between body weight and pain rating score in HFD group of rabbits (P < 0.05, r = -0.62). Results suggest that obesity attenuates the tonic pain responses induced by formalin in British Angora rabbits.

Gastrointestinal stromal tumours overexpress fatty acid synthase

Fatty acid synthase (FASN), a key enzyme for de novo lipogenesis, is overexpressed in many malignant tumours and is associated with aggressive biological behaviour. FASN expression and its possible relationship with more aggressive behaviour in gastrointestinal stromal tumours (GISTs) have not been addressed to date. Here, FASN expression was assessed by immunohistochemistry in 60 primary GISTs (28 low/intermediate risk and 32 high risk) and seven metastatic GISTs. Sixteen smooth muscle gastrointestinal tumours were used as controls. FASN was overexpressed in 36 of 60 GISTs (60%): in 12 of 28 (42%) low/intermediate-risk GISTs and in 24 of 32 (75%) high-risk GISTs (p<0.05). Two primary and seven metastatic GISTs and five GIST cell lines (GIST882, GIST430, GIST522, GIST62, and GIST48), analysed by western blot, showed variable FASN expression. Most metastatic samples expressed high levels of FASN protein. Additionally, seven of 60 GISTs showed a proliferation rate higher than 10% by Ki67 and all of them expressed FASN (p<0.04). Finally, proliferation and apoptosis were investigated after FASN silencing in GIST882 cells, which displayed the highest FASN expression. siRNA-mediated FASN knock-down inhibited expression of the proliferation marker cyclin A, whereas no changes in p27 and cleaved PARP expression were seen. It is concluded that FASN is preferentially overexpressed in high-risk and metastatic GISTs, and that its overexpression likely contributes to cell proliferation.

Liquid deformable mirror for high-order wavefront correction

We propose and demonstrate a novel liquid deformable mirror, based on electrocapillary actuation, for high-order wavefront correction. The device consists of a two-dimensional array of vertically oriented microchannels filled with two immiscible liquids, an aqueous electrolyte, and a viscous dielectric liquid, where the dielectric liquid overfills the top end of the channel and forms a thin layer on top. To remedy the poor reflectivity of pure liquids, a free-floating reflective membrane or a dye-coated liquid can be used. The proposed device offers several advantages for adaptive optics applications. These advantages include a high number of actuators, high stroke dynamic range, low power dissipation, fast response time, an initially flat surface, and low cost. However, the device is mainly suitable for dynamic wavefront correction and is limited by its orientation.

Placental umbilical cord whole blood transfusion to combat anemia in the background of tuberculosis and emaciation and its potential role as an immuno-adjuvant therapy for the under-resourced people of the world

Tuberculosis causes approximately 1.5 billion latent infections, 8 million new clinical cases, and 3 million deaths annually, making it the most prevalent infectious disease in the world. Anemia and malnutrition are essential comorbidities with tuberculosis. Cord blood, because of its rich mix of fetal and adult hemoglobin, high platelet and WBC counts, and a plasma filled with cytokine and growth factors, as well as its hypo-antigenic nature and altered metabolic profile, has all the potential of a real and safe alternative to adult blood transfusion. We transfused 106 units (48 ml-148 ml mean 81 ml +/- 6.6 ml SD, median 82 ml, mean packed cell volume 49.4 +/- 3.1 SD, mean percent hemoglobin concentration 16.3 g/dl +/- 1.7 g/dl SD) of placental umbilical cord whole blood (from 1 April 1999 to 1st 2005) after lower uterine cesarean section from consenting mothers to 21 informed consenting patients with tuberculosis who had percent plasma hemoglobin of 8 g/dl or less. After collection, the blood was immediately transfused following the standard adult blood transfusion protocol. Each case was passed through the institutional ethical committee. The patients received 2-21 units of freshly collected placental umbilical cord blood without encountering any clinical, immunological or non-immunological reactions. Three days after completion of the placental umbilical cord blood transfusion, the peripheral blood hematopoietic stem cell (CD34) estimation revealed a rise from the pretransfusion base level (.09%), varying from 2.99% to 33%, which returned to base level in 66.66% at the three-month CD34 re-estimation, without provoking any clinical graft vs host reaction in any of the patients.

A preliminary report of 123 units of placental umbilical cord whole blood transfusion in HIV-positive patients with anemia and emaciation

Cord blood, because of its rich mix of fetal and adult hemoglobin, high platelet and WBC counts, and a plasma filled with cytokine and growth factors, as well as its hypo antigenic nature and altered metabolic profile, has all the potential of a real and safe alternative to adult blood transfusion. Our team's experience (from 1st April 1999 to 1st July 2005) with 123 units of placental umbilical cord whole blood (62 ml-154 ml mean 85 ml +/- 8.4 ml SD, median 82 ml, mean packed cell volume 48.8 +/- 4.2 SD, mean percent hemoglobin concentration 16.3 g/dl +/- 1.6 g/dl SD; after collection the blood was immediately preserved in a refrigerator and transfused within 72 hours of collection) collected after lower uterine cesarean section (LUCS), and the transfusion to 16 consenting HIV-positive patients (12 cases had full blown AIDS) with anemia and emaciation is presented here. On the basis of our preliminary experience of cord blood transfusion, we are of the opinion that umbilical cord whole blood transfusion is safe in HIV-positive patients. This blood has the potential to carry more oxygen than adult blood and it does not trigger any clinical, immunological or non-immunological reaction after its transfusion to an adult host with a HIV-positive status. Apart from the correction of anemia, there was also definite improvement in the energy and fatigue levels in individuals with HIV, i.e., physical functioning, a sense of well-being and weight gain from two to five pounds, within three to ten months of the commencement of transfusion. There was also an immediate rise in CD34 levels of peripheral blood in the HLA-randomized host after transfusion, without any clinical graft vs host reaction.

Placental umbilical cord blood transfusion: a new method of treatment of patients with diabetes and microalbuminuria in the background of anemia

Diabetes mellitus is the commonest endocrine disease in all populations and all age groups. It is a syndrome of disturbed intermediary metabolism caused by inadequate insulin secretion or impaired insulin action, or both. Anemia is a common accompaniment of diabetes, particularly in those with albuminuria justifying tubulointestitial injury or reduced renal function. There are other additional factors present in diabetes, which may contribute to the development of an increased risk of anemia. Cord blood, because of its rich mix of fetal and adult hemoglobin, high platelet and WBC counts, hypo-antigenic nature, altered metabolic profile and high affinity for oxygen, may be an ideal choice for cases of diabetes with severe anemia necessitating blood transfusion. This article presents my team's experience with 78 units of placental umbilical cord whole blood (from 1 April 1999 to April 2005), collected after lower uterine cesarean section (LUCS) from consenting mothers (56 ml-138, ml mean 82 ml +/- 5.6 ml SD, median 84 ml, mean packed cell volume 49.7 +/- 4.2 SD, mean percent hemoglobin concentration 16.6 g/dl +/- 1.5 g/dl SD) and transfused to diabetes patients with microalbuminuria and severe anemia necessitating transfusion. After collection, the blood was transfused, in most cases immediately after completion of the essential norms of transfusion. In rare cases, it was kept in the refrigerator and transfused within 72 hours of collection to a suitable recipient. For inclusion in this study, the patient's percent plasma hemoglobin had to be 8 g/dl or less (the pretransfusion hemoglobin in this series varied from 5.2 g/dl to 7.8 g/dl) in the background of type two diabetes (fasting sugar 200 mg or more), along with features of microalbuminuria (albumin excretion 30-299 mg/g creatinine). This study included 39 informed consenting patients (22 males + 17 females, aged 48-74 yrs, mean 59.6 yrs). The patients were randomized into two groups: Group A (control cases N = 15, males = 8 and females = 7) and Group B (study group N = 24, males = 14 and females = 10). In Group A the rise of hemoglobin (Hgb) after two units of adult blood transfusion was 1.5 to 1.8 g/dl, as seen after a 72-hour blood sample assessment. The rise of Hgb as noted after 72 hours of two units of freshly collected cord blood transfusion was .6 g/dl to 1.5 g/dl. Each patient received two of four units of freshly collected cord blood transfusion (two units at a time), depending on availability and compatibility. Microalbuminuria was assessed in both groups after one month of treatment with transfusion and other identical support. The mean result was 152 +/- 18 m SD of albumin per gram of creatinine excreted through 24-hour urine (pre-transfusion mean excretion was 189 +/- 16 mg) in Group A and 103 +/- 16 mg SD of albumin excretion per gram of creatinine in 24-hour excretion of urine in Group B (pretransfusion mean excretion was 193 +/- 21 mg). Univariate analysis using Fisher's exact test was performed for the results of Groups A and B. The difference between Group A and B values and its comparison with the pre-transfusion microalbuminuria appeared to be statistically significant (p < less than .003). We have not encountered any clinical, immunological or non-immunological reaction so far in either group. Fetomaternal cell traffic has been implicated as the cause of scleroderma in mothers delivering male babies. In the present series, we did not see any such rare and unusual complication due to neonatal blood transfusion in the adult system in Group B patients in the six years from the initiation of the study.

A study of placental umbilical cord whole blood transfusion in 72 patients with anemia and emaciation in the background of cancer

In the under-resourced world, transfusion to advanced oncological patients involves two major problems, i.e., (a) transfusion transmitted disease, and (b) infrastructural deficiency. Many hospitals cannot cope with the specialized requirements of immunocompromised cancer victims, for instance, leucoreduction, selective apheresis, irradiation of the blood, viral inactivation of the blood by solvent and/or detergent treatment or photochemical inactivation using psoralen or long wavelength ultraviolet light and cytomegalovirus safe blood. The exorbitant cost of red blood cell (RBC) substitutes like hemoglobin-based oxygen carriers or perflurocarbon emulsions, liposome encapsulated hemoglobin, is simply unacceptable for an average oncological patient in the developing world. Moreover, it should be underscored that none of the total blood functions are replaced by any available so-called blood substitute, the primary function of which is oxygen delivery and volume expansion only. A more accurate term should be red cell substitute. Cord blood, because of its rich mix of fetal and adult hemoglobin, platelet and white blood cell (WBC) count, and plasma filled with cytokine and growth factors--as well as its hypoantigenic nature and altered metabolic profile--has all the potential of a real and safe alternative to adult blood during emergencies or any etiology of blood loss. In the present series, the collection of cord blood varied from 54 ml-128 ml, mean 82 ml +/- 7.6 ml SD; mean packed cell volume 48 +/- 4.1% SD; mean percent hemoglobin concentration 16.4 g/dl +/- 1.6 g/dl SD. Not a single case of immunological or non immunological reaction has been encountered so far after transfusion of cord blood to cancer patients with percent of hemoglobin 8 g/dl or less. It appears that the medical fraternity can safely use this precious gift of nature-- which is free from infection, hypoantigenic with altered metabolic profile, filled with growth factors and cytokine-filled plasma, and has the potential of a higher oxygen carrying capacity than adult blood--as an emergency source of blood for the management of advanced cancer cases with anemia.

Placental umbilical cord whole blood transfusion to combat anemia in the background of advanced rheumatoid arthritis and emaciation and its potential role as immunoadjuvant therapy

Rheumatoid arthritis is the commonest form of inflammatory arthritis and affects about 1-3% of the population in the West and even more in the developing world due to the compounded factors of late detection and inadequate treatment in the overall background of poverty, deprivation, and improper macro and micronutrients in the diet in a sizeable segment of the population. Nearly 90% of patients with aggressive disease will become clinically disabled within 20 years. Furthermore, in patients with severe disease or extra-articular symptoms, mortality is equal to that for patients with triple artery coronary artery disease or Stage IV Hodgkin's lymphoma. Anemia is a very common comorbidity of rheumatoid arthritis. Anemia in rheumatoid arthritis is caused by various factors, for instance, cytokine impact of the advanced arthritic process on the host, or lack of proper nutrition and essential micronutrients in the diet, or coexistent helminthiasis, and/or impact of antiarthritic drugs on the host system, i.e., high steroid induced gastritis or ulcerations in gastric mucosa or subclinical or clinical hepatitis due to methotrexate or salazopyrin effects on bone marrow, only to name a few. Other pre-existing or compounding gastrointestinal problems, which alter the available iron stores or cause bone marrow dysfunction, may also help in adding to an anemic condition. If the anemia is 8 g/dl or less, blood transfusion or erythropoietin injection with adequate hematinic reserve is effective in normal situations, but is not that effective in anemia with a chronic disease background like rheumatoid arthritis. Cord blood, because of its rich mix of fetal and adult hemoglobin, high platelet and white blood cell (WBC) counts, and a plasma filled with cytokine and growth factors, as well as its hypo antigenic nature and altered metabolic profile, has all the potential of a real and safe alternative to adult blood transfusion. Seventy-eight units (42 ml -136 ml mean 80.6 ml +/- 3.6 ml SD, median 82.4 ml, mean packed cell volume 48.2 +/- 2.1 SD, mean percent hemoglobin concentration 16.4 g/dl +/- 1.5 g/dl SD) of placental umbilical cord whole blood was transfused (from 1 April 1999 to April 2005) after lower uterine cesarean section (LUCS) from consenting mothers to 28 informed consenting patients with advanced rheumatoid arthritis who had plasma hemoglobin of 8 g/dl or less. After collection, the blood was immediately transfused following the standard adult blood transfusion protocol. Each case was passed through the institutional ethical committee. The patients received two to six units of freshly collected placental umbilical cord blood without encountering any clinical, immunological or non-immunological reactions. Three days after completion of the transfusion of placental umbilical cord blood, the peripheral blood hematopoietic stem cell (CD34) estimation revealed a rise from the pretransfusion base level (.09%), varying from 2.03 to 23%, which returned to base level in most of the cases at the three-month CD34 re-estimation, without provoking any clinical graft vs host reaction in any of the patients.

Transient spontaneous engraftment of CD34 hematopoietic cord blood stem cells as seen in peripheral blood: treatment of leprosy patients with anemia by placental umbilical cord whole blood transfusion

Cord blood, because of its rich mix of fetal and adult hemoglobin, high platelet and white blood cell (WBC) counts, and a plasma filled with cytokine and growth factors, as well as its hypoantigenic nature and altered metabolic profile, has all the potential of a real and safe alternative to adult blood transfusion. Our experience of 74 units (50 ml-146 ml mean, 86 ml +/- 7.6 ml SD, median 80 ml, mean packed cell volume 48 +/- 4.1 SD, mean percent hemoglobin concentration 16.2 g/dl +/- 1.8 g/dl of placental umbilical cord whole blood collection (from 1 April 1999) after lower uterine cesarean section (LUCS) from consenting mothers and transfusion of the same to 16 informed, consenting patients with percent plasma hemoglobin 8 g/dl or less, is presented here. After collection the blood was immediately preserved in the refrigerator and transfused within 72 hours of collection. Fifteen males and one female, aged 12-72 yrs (mean 48.4 yrs) participated: five cases were pausibacillary type (PB) and 11 cases were multibacillary type (MB). The clinical spectrum of the cases varied widely from the tuberculoid to the lepromatous type and one patient presented with gangrene of the leg preceding an auto amputation which was infested with maggots. Each case was approved by the institutional ethical committee and received two to eight units of freshly collected placental umbilical cord blood in one transfusion without encountering any clinical, immunological or non-immunological reaction. Seven days after completion of the placental umbilical cord blood transfusion, the peripheral blood hematopoietic stem cell (CD34) estimation revealed a rise from the pretransfusion base level (.09%), varying from 3.6% to 16.2%, in 75% of the cases, without provoking any clinical graft vs host reaction in any of the leprosy victims. This value returned to normal within three months in most cases.

Spontaneous transient rise of CD34 cells in peripheral blood after 72 hours in patients suffering from advanced malignancy with anemia: effect and prognostic implications of treatment with placental umbilical cord whole blood transfusion

Cord blood, because of its rich mix of fetal and adult hemoglobin, platelet and WBC counts, and a plasma filled with cytokine and growth factors, as well as its hypoantigenic nature and altered metabolic profile, has all the potential of a real and safe alternative to adult blood during emergencies or any etiology of blood loss.

STUDY DESIGN

In the present study transfusion-related CD34 levels of the peripheral blood from six randomly selected patients suffering from advanced clinical Stage IV malignancy were analyzed between 16 August 1999 and 16 May 2001. This study attempts to ascertain the fate of hematopoietic stem cells (CD34) after placental umbilical cord whole blood transfusion, as assessed from the peripheral blood CD34 level 72 hours after cord blood transfusion in sex- and HLA-randomized patients.

RESULTS AND ANALYSIS

Among the six cases, Case 2 (breast sarcoma) received the lowest amount of card blood (6 units), while Case 6 (breast cancer) received the largest amount (32 units). The youngest patient, suffering from non-Hodgkin's lymphoma (Case 3), was a 16-year-old boy who received eight units of cord blood to combat anemia. Other patients received amounts varying from 7-15 units: Case 4 received 15 units (metachronous lymph node metastatsis), Case 1 received 14 units (breast cancer), and Case 5 received seven units (lung cancer). There was no transfusion-related clinical immunological or nonimmunological reaction. Studies of CD34 levels showed an initial rise followed by a fall in two cases, two cases registered very little effect on the CD34 level, i.e., no change from the baseline, and one case demonstrated a very slow rise from the baseline. However, one case showed a frequent steep rise up to 99% and a sustained high CD34 level. This patient is alive with clinical remission of the disease.

CONCLUSION

It appears from this preliminary study that freshly collected cord blood transfusion may cause a transient transplant impact of transfused cord blood CD34 stem cells on the host without provoking clinical graft vs host disease due to a of background immune suppression in advanced malignancy. The growth factor cytokine system of freshly collected cord blood may have a potentiating role on the immune system of the host.

Placental umbilical cord blood transfusion: A novel method of treatment of patients with malaria in the background of anemia

Malaria is an annual killer of over one million people globally and its essential co-morbidity is anemia. Cord blood, because of its rich mix of fetal and adult hemoglobin, high platelet and WBC counts, hypo-antigenic nature, altered metabolic profile, high affinity for oxygen and the antimalarial effect of cord blood, is an ideal choice in case of malaria with anemia necessitating blood transfusion. This article presents our experience with 94 units of placental umbilical cord whole blood (52 ml-143 ml, mean 81 ml +/- 6.6 ml SD, median 82 ml, mean packed cell volume 48.9 +/- 4.1 SD, mean percent hemoglobin concentration 16.4 g/dl +/- 1.6 g/dl SD; after collection the blood was immediately preserved in the refrigerator and transfused within 72 hours of collection). It was collected after lower uterine cesarean section (LUCS) from consenting mothers (from 1 April 1999 to April 2005) and transfused to 39 informed, consenting patients (24 males + 15 females, aged 8-72 yrs, mean 39.4 yrs). Twenty-two patients were infected with Plasmodium falciparum and 17 had plasmodium vivax infection. For inclusion in this study, the patient's percent plasma hemoglobin had to be 8 g/dl or less (the pretransfusion hemoglobin in malaria-infected patients in this series varied from 5.4 g/dl to 7.9 g/dl). The rise of hemoglobin within 72 hours after two units of freshly collected cord blood transfusion was .5 g/dl to 1.6 g/dl. Each patient received two to six units of freshly collected cord blood transfusion (two units at a time), depending on availability and compatibility. No clinical, immunological or non-immunological reactions have been encountered so far.

Correcting movement errors in frequency-sweeping interferometry

Absolute distance measurements can be performed with an interferometric method that uses only a single tunable laser. This method has one major drawback, because a small target movement of the order of one wavelength during a measurement will be interpreted as a movement of one synthetic wavelength. This effect is usually mitigated by adding a second (nonscanning) laser. We show that absolute distance measurements can be performed with only one laser if the movements encountered are smooth, on the time scale of one measurement. In this case the movement errors can be compensated with a simple algorithm that combines several subsequent measurements. First experimental results show good agreement with theory.

Influence of virtual images on the signal-to-noise ratio in digital in-line particle holography

A theoretical analysis describing the dependence of the signal-tonoise ratio (SNR) on the number of pixels and the number of particles is presented for in-line digital particle holography. The validity of the theory is verified by means of numerical simulation. Based on the theory we present a practical performance benchmark for digital holographic systems. Using this benchmark we improve the performance of an experimental holographic system by a factor three. We demonstrate that the ability to quantitatively analyze the system performance allows for a more systematic way of designing, optimizing, and comparing digital holographic systems.

Placental umbilical cord blood transfusion in transfusion-dependent beta thalassemic patients: a preliminary communication

The term blood substitute is actually a misnomer because only a part of the total functions of the blood is replaced by any available so-called substitute, i.e., oxygen delivery and volume expansion only. Therefore, a more accurate term should be red cell substitute. Cord blood, because of its rich mix of fetal and adult hemoglobin, high platelet and WBC counts, and a plasma filled with cytokine and growth factors, as well as its hypoantigenic nature and altered metabolic profile, has all the potential of a real and safe alternative to adult blood during emergencies due to any etiology of blood loss and anemia. Our experience of 92 units of cord blood transfusion in patients with beta thalassemia with severe anemia (hemoglobin concentration varying from 3.5 to 5.9 g/dl with mean hemoglobin 4.6 g/dl) proved to be extremely effective in 14 patients as an emergency substitute of adult conc RBC transfusion (male: female ratio 1:1, age varying from 6 months to 38 years). In the present series, the collection of the blood varied from 57 ml-136 ml mean 84 ml +/- 7.2 ml SD, median 87 ml, mean packed cell volume 45 +/- 3.1 SD, mean hemoglobin concentration 16.4 g/dl +/- 1.6 g/dl SD. After collection the blood was immediately preserved in the refrigerator and transfused within 72 hours of collection from the consenting mother undergoing lower uterine cesarean section. We did not encounter a single case of immunological or non immunological reaction. We suggest that the medical fraternity use this precious gift of nature, which is free from infection, hypoantigenic with an altered metabolic profile, filled with growth factor and cytokine filled plasma with potential higher oxygen carrying capacity than for adult blood, as an emergency source of blood for the management of transfusion-dependent beta thalassemics.

Analysis of molecular alterations in chromosome 8 associated with the development of uterine cervical carcinoma of Indian patients

OBJECTIVES

We have been done the detailed deletion mapping of chromosome (chr.) 8p21.3-23 to localize the candidate tumor suppressor gene(s) (TSGs) loci as well as studied the mechanism of activation of c-myc gene, located at chr.8q24.1, by analyzing the amplification/rearrangement/HPV integration within approximately 580 kb of c-myc locus in uterine cervical carcinoma (CaCx) of Indian patients. The association between the deletions in chr.8p21.3-23 and alterations in the c-myc locus has also been analyzed.

METHODS

The deletion mapping of chr.8p21.3-23 was done by 15 microsatellite markers and the alterations in the c-myc locus were analyzed by Southern hybridization using the pal-1/c-myc/mlvi-4/HPV 16/18 probes in seven cervical intraepithelial neoplasia (CIN) and 55 primary uterine cervical carcinoma. The alterations in chr.8p/q have been correlated with the different clinicopathological parameters.

RESULTS

Three discrete minimal deleted regions with high frequencies of loss of heterozygosity (LOH) (37-43%) were identified in the chr.8p23.1-23.2 (D1), 8p23.1 (D2), and 8p 21.3-22 (D3) regions within 0.41-4.62 Mb. The deletion in the D1 region was significantly associated with the deletion in the D2 region (P = 0.03), whereas the deletion in D2 was marginally associated with the deletion in the D3 region (P = 0.07). The alterations in the c-myc locus were seen in 43% of the samples. About 35% of the samples showed coalterations in both arms of chr.8. No significant association was observed with the alterations in chr.8p/q as well as with the different clinicopathological parameters.

CONCLUSIONS

The deletions in chr.8p21.3-23 and the alterations in the c-myc locus are independently associated with the development of CaCx. The D1-D3 regions in chr.8p21.3-23 could harbor candidate TSGs associated with the development of this tumor. The c-myc gene was activated by amplification/rearrangement at the pal-1/c-myc/mlvi-4 loci as well as HPV integration in the pal-1 locus in this tumor.

Three discrete areas within the chromosomal 8p21.3-23 region are associated with the development of breast carcinoma of Indian patients

Deletion in the 22.9 -Mb chromosomal (chr.) 8p21.3-23 region has been shown to be necessary for the development of breast carcinoma (CaBr). In this study, we have attempted to detect the minimal deleted region(s) in the chr.8p21.3-23 region in 62 primary breast lesions having 56 CaBr tumors and six other breast lesions of Indian patients using 15 microsatellite markers. The loss of heterozygosity (LOH) was observed for at least one marker in 96.4% (54/56) of the CaBr samples. Three discrete minimal deleted regions with high frequencies of LOH (39-65%) were identified in the chromosomal 8p23.1-23.2 (D1), 8p23.1 (D2) and 8p 21.3-22 (D3) regions within 2.03, 0.41, 2.47 Mb, respectively. No significant correlation was observed with the high deleted regions and the different clinicopathological parameters. Interestingly, 51.8% (29/56) CaBr samples showed either loss of chr.8p or interstitial deletions in this arm, indicating the importance of chr.8p in the development of CaBr. The pattern of allelic loss in the bilateral lesions had indicated that the lesions were clonal in origin and probably the deletion in the D3 region was the early event among the D1-D3 regions. Thus, our data have indicated that the D1-D3 regions could harbor candidate tumor suppressor gene(s) (TSGs) associated with the development of CaBr.

Fetal cell/tissue therapy in adult disease: a new horizon in regenerative medicine

Fetal tissue is the richest source of primordial stem cells and has several properties that make it particularly useful for transplantation. It is superior to adult (mature) tissue in certain respects. First, fetal cells are capable of proliferating faster and more often than mature, fully differentiated cells. This means that these donor cells are able to quickly reverse the lost function of the host. In addition, these fetal cells can often differentiate in response to the environmental cues around them. This is because of their location--they can grow, elongate, migrate, and establish functional connections with other cells around them in the host. It has been found that fetal tissue is not easily rejected by the recipient due to the low levels of histocompatibility antigens in the fetal tissue. At the same time, angiogenic and trophic factors are at high levels, enhancing their ability to grow once they are transplanted. Since early fetal hematopoietic tissue lacks lymphocytes, graft vs host reactions are minimized. Fetal cells tend to survive excision, dissection, and grafting better because they generally do not have long extensions or strong intercellular connections. Finally, fetal tissue can survive at lower oxygen levels than mature cells. This would make them more resistant to the ischemic conditions found during transplantation or in vitro situations. Studies on fetal cell/tissue transplant have been encouraging. Fetal tissue can be used in different indications, for instance, fetal liver transplants may be used in combating aplastic anemia, placental umbilical cord whole blood transfusion can serve as an emergency alternative to adult whole blood transfusion, fetal adrenal transplant has been tried in combating intractable pain in arthritis, and fetal thymic transplant in combating leucopenia in non-Hodgkin's lymhoma and other immunodeficiency conditions like DiGeorge Syndrome, only to name a few. Fetal brain tissue transplant has also been done in a heterotopic site and the proliferation of the tissue has been observed. Neurotransplantation with fetal tissue in Parkinsonism shows positive results in some globally accepted studies. There are futuristic potential uses of fetal tissue in bioengineering through coating/seedling of fetal tissue on implants, stents and other artificial surgical life-saving devices to improve their functioning, and it may also extend the life of these costly gadgets. By properly using pre-HLA fetal tissue seedling in orthopedic, thoracic and also neurosurgical appliances, there could be a reduction of long-term irritation sequelae of the implant and the host interphase, and thus, a better device, i.e., a more biofriendly interphase could be developed. This may help in the reduction of pseudomembrane formation, loss of patency and other resultant TH2 reactions of the host system.

The benefits of liver transplantation in glycogenosis type Ib

There are few reports of liver transplantation in glycogenosis type Ib (GSD Ib). We present two cases who had dramatic catch-up growth and reduced infections after transplantation, despite persistent neutropenia.

Holographic simultaneous readout polarization multiplexing based on photoinduced anisotropy in bacteriorhodopsin

Bacteriorhodopsin (bR) is a reversible photochromic protein that can be used as a holographic medium. The dichroic absorption of the bR molecule is polarization dependent, thereby allowing for the recording of polarization holograms. The properties of polarization holograms can be used to multiplex two independent images in a single bR film. A new technique and associated polarization-multiplexing scheme are demonstrated that allow for simultaneous readout of two orthogonally polarized images while achieving a high normalized diffraction efficiency for each of the individual images.

Association of deletion in the chromosomal 8p21.3-23 region with the development of invasive head & neck squamous cell carcinoma in Indian patients

BACKGROUND & OBJECTIVES

Deletions in chromosome 8 (chr.8) have been shown to be necessary for the development of head and neck squamous cell carcinoma (HNSCC). Attempts have been made in this study to detect the minimal deleted region in chr.8 associated with the development of HNSCC in Indian patients and to study the association of clinicopathological features with the progression of the disease.

METHODS

The deletion mapping of chr.8 was done in samples from 10 primary dysplastic lesions and 43 invasive squamous cell carcinomas from the head and neck region of Indian patients to detect allelic alterations (deletion or size alteration) using 12 highly polymorphic microsatellite markers. The association of the highly deleted region was correlated with the tumour node metastasis (TNM) stages, nodal involvement, tobacco habit and human papilloma virus (HPV) infection of the samples.

RESULTS

High frequency (49%) of loss of heterozygosity (LOH) was seen within 13.12 megabase (Mb) region of chromosomal 8p21.3-23 region in the HNSCC samples, whereas the dysplastic samples did not show any allelic alterations in this region. The highest frequency (17%) of microsatellite size alterations (MA) was observed in the chr.8p22 region. The loss of short arm or normal copy of chr.8 and rare bi-allelic alterations were seen in the stage II-IV tumours (939, 5184, 2772, 1319 and 598) irrespective of their primary sites. The highly deleted region did not show any significant association with any of the clinical parameters. However, HPV infection was significantly associated (P < 0.05) with the differentiation grades and overall allelic alterations (LOH/MA) of the samples.

INTERPRETATION & CONCLUSION

Our data indicate that the 13.12 Mb deleted region in the chromosomal 8p21.3-23 region could harbour candidate tumour suppressor gene(s) (TSGs) associated with the progression anti invasion of HNSCC tumours in Indian patients.

Allelic imbalance at chromosome 11 in head and neck squamous cell carcinoma in an Indian patient population

BACKGROUND

Genetic instability of chromosome 11 is a frequent event in many solid tumours, including head and neck squamous cell carcinoma (HNSCC).

AIMS

To perform allelic imbalance analysis of cytogenetically mapped altered regions of human chromosome 11 in patients with HNSCC from eastern India.

METHODS

Genomic alterations were investigated using highly polymorphic microsatellite markers in both HNSCC and leukoplakia tissues.

RESULTS

Microsatellite markers D11S1758 from 11p13-15 and D11S925 from 11q23.3-24 had the highest frequency (38% and 32%, respectively) of loss of heterozygosity among all the markers analysed. Allelic loss at the marker D11S925 was seen in both leukoplakia and in all stages of HNSCC tumour tissues suggesting that it is an early event in HNSCC tumorigenesis. Microsatellite size alteration was also found to be high (> 20%) in several markers. In leukoplakia samples microsatellite instability was seen at a higher frequency than loss of the allele, indicating such alterations might initiate the process of tumorigenesis in HNSCC.

CONCLUSIONS

The high rate of chromosomal alterations at 11q21-24 in HNSCC suggests the presence of a putative tumour suppressor gene in this region.

Can human fetal cortical brain tissue transplant (up to 20 weeks) sustain its metabolic and oxygen requirements in a heterotopic site outside the brain? A study of 12 volunteers with Parkinson's disease

BACKGROUND

Neural and stem cell transplantation is emerging as a potential treatment for neurodegenerative diseases from Parkinson's to Huntington's disease. Stereotactic placement of dopaminergic neurons in the caudate-putamen (striatum), is being attempted in centers of excellence and has proved to be beneficial. Basic research using cell transplantation indicates that structural development mechanisms seen in immature brains, i.e., fetal brains, can also function in the adult brain. The adult brain consumes 15% of the resting cardiac output for its metabolic needs. While most human tissues can sustain an anaerobic assault for a few minutes up to 30 minutes, a sudden total lack of oxygen supply to the brain cells in an adult will render the person unconscious within five to ten seconds. Our team has been working on the problem of human fetal tissue response to antigenic assault for the last two decades. In the present series, 12 patients with prolonged histories of Parkinsonism, who were not responding to anti-Parkinsonian drugs, and could not afford costly stereotactic surgery or deep brain stimulation and other modalities of recent Parkinson's disease treatment, were enrolled in the study.

MATERIALS AND METHOD

After obtaining proper informed consents from the patients or their guardians and from the multidisciplinary ethical committee, the patients, varying in age from 45 to 75 years and suffering for many years with Parkinsonism, were enrolled in the heterotopic brain tissue transplant programme. We followed standard antiseptic, aseptic and premedication protocols, after selecting a proposed site of transplantation of the brain in the axillary fold of the skin, under local infiltration anaesthesia. In an adjacent OR, a fetus was collected from a consenting patient undergoing hysterotomy and ligation (before 20 weeks), under general anaesthesia. Within a minute of hysterotomy, the fetal brain tissue was dissected, and under the guidance of the operative microscope, 1 g of fetal cortical brain tissue was dissected and weighed in an electronic machine. The tissue was collected from around 1 cm of the frontal opercula of the developing human fetal brain and grafted in the already dissected and prepared subcutaneous site in the axilla and the skin was closed. Hematological parameters (Hgb; total count, Tc; differential count, Dc; erythocyte sedimentation rate, ESR) were estimated sequentially up to one month. A small portion of the transplanted tissue was retrieved after one to two months, and a serial histological study was done along with a clinical assessment of the disease condition as per the specifications of the Unified Parkinson's Disease Rating Scale. The results were matched with the pre-transplant ratings of the individual cases. Presenting dyskinesia was also rated (0-4), on the basis of objective criteria assessment like walking, putting on a coat, lifting a cup to drink, etc.

RESULTS AND ANALYSIS

Initially 30 patients suffering from advanced Parkinson's disease (PD) were approached after getting the necessary clearance from the institutional multidisciplinary ethical committee; however, we have been able to arrange transplantation in only 12 cases so far. These patients were evaluated at the pre- and one month post-transplant period by the Unified Parkinson's Disease Rating Scale (0-108) and the minimum score was 40 in the motor portion of the unified scale at the pre-transplant state. Evaluation of the patients after one month revealed mild improvement of the pre-transplant scoring (up to 33.3%) in 41.6% of the cases, and moderate improvement (up to 66.6%) in another 41.6% of the cases. While 16.8% of the cases did not show any improvement from the basal score, i.e., the pre-transplant score, there was a definite sense of well being and rise in weight (2-4 pounds) noted in each case and there was also a reduction of the L-Dopa dosage in 75% of the cases. There was also a 58.3% improvement in the bradykinesia scoring from the pre-transplant level. What is intriguing is the survival, growth and proliferation of the grafted fetal brain tissue in the HLA- and sex-randomized adult axilla without any immunosuppressive support. Not a single histological study of the fetal brain tissues after removal from the axilla showed any signs of graft vs. host or inflammatory reaction (Figures 1-9) but there were features of growth of the transplanted cortical brain tissue along with its different components like neurogenesis, gliogenesis, early neovascularisation and angiogenesis, etc. There was also no systemic leucocytosis or lymphocytosis.

DISCUSSION AND CONCLUSION

Histological evidence at the transplanted tissue site suggests that fetal cortical brain tissue can sustain life in sex-randomized, HLA-randomized adult hosts, without the support of immuno-suppressive drugs and the tacit support of the blood-CSF and blood-brain barrier and other specific requirements of adult brain cells in the skull. Whether the clinical improvement in PD is transient or long lasting is presently under investigation along with basic questions like, is it due to transplanted fetal dopaminergic or non-dopaminergic neurons or is it the growth factors and the cytokine mediated hitherto unknown reactions causing the clinical improvement.

Human fetal adrenal transplant: a possible role in relieving intractable pain in advanced rheumatoid arthritis

BACKGROUND

The art of transplant surgery has gone a long way in establishing itself as an important discipline in medicine with the support of molecular biology, immunology, biochemistry, etc., as the ultimate treatment for the restoration of function of a failing organ. With the progressive increase in the life expectancy of human beings, there is an increasing discrepancy in the demand and supply of organ grafts. A less efficient alternative could be synthetic or mechanical grafts. Nucleated cell therapy, that is, cellular transplant, is a promising new area of study with its proven efficacy in neuro-degenerative disorders, hematopoietic disorders, diabetes and trauma-induced tissue loss, to name a few. Human fetal cell/tissue with its intrinsic hypo-antigenic advantage (up to 20 weeks of study), could be an interesting area of cellular/tissue transplant. Our research group has earlier reported on the safe use of umbilical cord whole blood and the successful transplant of a human fetal lung, heart, pancreas, liver, thymus, in an artificially prepared vascular subcutaneous axillary fold in which there was no feature of hyper-acute, acute or chronic rejection of the graft in HLA- and sex-randomized adult recipients, without concomitant immunosuppressives or radiation of the host to potentiate the survival of the fetal graft (within 20 weeks of gestation) within the lowest observation period of one month. The present study was aimed at examining the role of developing fetal adrenal transplants for patients with rheumatoid arthritis and severe pain due to involvement of inflammatory and neuropathic components.

MATERIALS AND METHOD

Ten cases were enrolled in the present study after thorough informed consent and approval by the ethical committee of the institute. The age of the patients varied from 50 to 76 years and the group was comprised of three males and seven females. The age of the adrenal grafts varied from 16 to 20 weeks and these were collected from mothers admitted for hysterotomy and ligation. These long-standing rheumatoid patients (suffering for five to 15 years), presented with at least four of the seven 1987 revised criteria of the American College of Rheumatology for diagnosis of rheumatoid arthritis. A 2.5 cm long and 2 cm deep tissue space was dissected and prepared in each transplant recipient at the axilla using diathermy and knife after infiltrating the site with one percent lignocaine solution. The tissue collected from the consenting mother undergoing hysterotomy and ligation was inserted into this site, and the site was closed with 00 atraumatic vicryl. All necessary pre- and postoperative surgical precautions were taken to prevent infections. Sequential total count and differential count of leucocytes were undertaken to analyze the impact of the transplant on the host. After one month, a part of the transplanted fetal tissue was recovered for histological staining to examine whether there was any graft versus host reaction.

RESULTS AND ANALYSIS

All ten patients tolerated the transplant procedure well. There was no fever, intractable pain or any other specific serious side-effect which could justify the removal of the transplant before one month. There was no discharge from the incision site and the healing of the scar was by and large normal. There was no unusual leucocytosis, lymphocytosis and the retrieved graft tissue did not suggest transplant rejection. However, there was definite pain relief, reduction in swelling and improvement of mobility of varying degree in a majority of the patients which was perceivable from the 15th day onwards. There was also a sense of well being (in 80%) and a gain in weight of three pounds or more (in 70%) among the fetal transplant recipients.

DISCUSSION AND CONCLUSION

To understand the underlying mechanism, in case of pregnancy immunotolerance, we are of the opinion that emphasis should be placed on the role of non-specific and non-cytopathic blocking antibodies produced during pregnancy. The hypo-antigenicity of the developing human fetal system may possibly contribute to the production of this blocking antibody during pregnancy, and thus may play a role in the lack of recognition by the host's HLA system. This behaviour of the developing human fetal tissue provides some advantages over adult tissue for fetal cell/tissue transplantation purposes. The relief of pain, inflammation and restoration of mobility may be due to the effect of the transplanted adrenal graft, with the medullary component contributing to endorphin-like substance liberation and the cortical component contributing to glucocorticoid synthesis.

Fetal tissue/organ transplant in HLA-randomized adult vascular subcutaneous axillary folds: preliminary report of 14 patients

BACKGROUND

In the year 1902, the first successful experimental organ transplant, i.e., an autotransplant of a dog's kidney from its normal position to the vessels of the neck, which resulted in some urine flow, was performed in the Vienna Physiology Institute under the direction of Hofrath Exner by Dr. Emerich Ullman (1861-1937). Since then, the art of transplant surgery has come a long way in establishing itself as an important discipline with the support disciplines of immunology, molecular biology, etc., for the restoration of a failing organ. Today there is a major discrepancy in the demand and supply of organ grafts. The aim of the present study is to see whether fetal organ and tissue, with its intrinsic advantages of hypo-antigenicity, can survive in a HLA and sex-randomized host in a surgically prepared vascular subcutaneous axillary fold, without any immunosuppressive support. We have earlier reported two cases of fetal thymic transplant, collected from consenting mothers undergoing hysterotomy and ligation.

MATERIALS AND METHODS

Fourteen cases were recruited for the present study after thorough informed consent and approval by the Ethical Committee of the Project. Of these, five patients were suffering from advanced cancer, three from diabetic gangrene, three from ischaemic heart disease and three from rheumatoid arthritis, liver abscess and disc prolapse. The ages of the patients varied from 39 to 82 years. Six fetal thymuses, three fetal liver tissues, three fetal cardiac tissues, one fetal pancreas and one fetal lung tissue were transplanted. All the fetuses were dissected and the selected tissues/organs were transplanted within one to three minutes after collecting them from the consenting mothers undergoing hysterotomy and ligation. The fetal tissue graft was placed in a surgically prepared subcutaneous vascular axillary fold, 2x1 cm, under local anaesthesia in the consenting adult recipient. Sequential Hb, Tc, Dc, ESR were done to see the impact of the transplant on the host system. After one month, the transplanted fetal tissue was taken out by an elliptical incision and the tissue was processed for histological staining.

RESULTS AND ANALYSIS

All the 14 patients tolerated the transplant procedure well. There was no fever, intractable pain or any other specific serious side-effect justifying removal of the transplant earlier. There was no discharge from the incision site and the healing and scar were by and large normal. There was no unusual leucocytosis or lymphocytosis. The serial histological study did not suggest features of transplant rejection.

DISCUSSION AND CONCLUSION

Pregnancy and neoplasm are two outstanding examples of natural tolerance to homograft. In both cases, blocking antibody has an important role in the phenomenon of immunotolerance. From our experiments mentioned above transplantation and our earlier reported studies, we believe that the hypo-antigenic fetal tissue has distinct advantages over adult tissue for transplant purposes.

Implementation of quantum search algorithm using classical Fourier optics

We report on an experiment on Grover's quantum search algorithm showing that classical waves can search a N-item database as efficiently as quantum mechanics can. The transverse beam profile of a short laser pulse is processed iteratively as the pulse bounces back and forth between two mirrors. We directly observe the sought item being found in approximately square root[N] iterations, in the form of a growing intensity peak on this profile. Although the lack of quantum entanglement limits the size of our database, our results show that entanglement is neither necessary for the algorithm itself, nor for its efficiency.

A unique experience with human pre-immune (12 weeks) and hypo-immune (16 weeks) fetal thymus transplant in a vascular subcutaneous axillary fold in patients with advanced cancer: a report of two cases

BACKGROUND

The successful development of fetal cell/tissue transplantation in adults has resulted in the possibility of eventual therapeutic solutions with a variety of intractable diseases. Umbilical cord whole blood transplantation appears to be safe in the adult system. In severe forms of DiGeorge Syndrome, cultured thymus transplant can help in the reconstitution of the immune condition of the host. Successful fetal tissue transplant in adults has raised the hope of future effective gene transplant and its manipulation prospects to combat many diseases including hemopathies, inborn errors of metabolism, immunodeficiencies and even cancer and AIDS.

MATERIALS AND METHOD

Two cases of advanced cancer were treated with fetal (pre-immune 12 weeks and hypo-immune 16 weeks) thymus transplants in subcutaneous vascular axillary folds, which were removed after one month. Thymuses were collected from consenting mothers undergoing hysterotomy and ligation.

RESULTS AND ANALYSIS

Patient I was suffering from non-Hodgkins lymphoma (Ann Arbor Stage IV) and was receiving cyclophosphomide, doxorubicin, vincristine and prednisolone after a course of radiotherapy; she developed leucopenia (2.400/cmm), which improved after receiving a 16-week human fetal thymic graft. The leucopenia was eventually over-corrected and the leucocyte count reached 44,000/cmm within a month, which was reversed after the thymus was taken out. Histology of the excised thymic graft showed growth and proliferation without any graft vs. host (GVH) reaction. Patient 2 was suffering from breast duct carcinoma (T4, N2, M0,) with estrogen, progesterone, and epidermal growth factor negative status, and was treated with modified radical mastectomy and axillary clearance followed by chemotherapy with cyclophosphomide, methotrexate and 5-fluorouracil for six cycles. She also received a 12-week-old human fetal thymus at the contra-lateral axilla which was removed after one month. In this case the peripheral leucocyte count did not show appreciable variation as in the first case. However, histology of the excised thymic graft showed growth and proliferation with an appearance of Hassel's corpuscles.

CONCLUSION

Pre-immune and hypo-immune human fetal thymic transplant is not rejected in patients suffering from advanced cancer within one month (observation period). Thymic lymphocyte shedding in the correction of leucopenia in the background of non-Hodgkin's lymphoma may have many therapeutic implications.

Pim-1: a serine/threonine kinase with a role in cell survival, proliferation, differentiation and tumorigenesis

Pim-1 belongs to a family of serine/threonine protein kinases that are highly conserved through evolution in multicellular organisms. Originally identified from moloney murine leukemia virus (MuLV)-induced T-cell lymphomas in mice, Pim-1 kinase is involved in the control of cell growth, differentiation and apoptosis. Expression of Pim-1 kinase can be stimulated by a variety of growth factors and regulated at four different levels: transcriptional, post-transcriptional, translational and post-translational. Several signal transduction pathways may be associated with the regulation of Pim-1's expression; accumulating data support that the expression of Pim-1 protein is mediated through activation of JAK/STATs. Recent studies of Pim family kinases indicate that Pim-1 kinase plays important roles outside of the hematopoietic system as well.

A case of atypical dengue haemorrhagic fever

A case of atypical dengue haemorrhagic fever is being described in a 30 years old male along with a short discussion on the subject.

A study report of 174 units of placental umbilical cord whole blood transfusion in 62 patients as a rich source of fetal hemoglobin supply in different indications of blood transfusion

BACKGROUND

In the animal kingdom, even herbivorous animals swallow the placenta after the birth of the baby (for example, the cow). In the human system, we do not know about the proper utilization of the placenta and membranes although there are suggestions regarding this on the basis of research on placental umbilical cord blood stem cells as an alternative to bone marrow transplantation. In this present series of placental umbilical cord whole blood transfusions, we wanted to examine the safety aspect of other components of cord blood transfusion, e.g., fetal RBC, growth factors and cytokine filled plasma, etc., in different indications of blood transfusion, from the pediatric to the geriatric age group, in malignant and non-malignant disorders affecting our patients.

METHODS

One hundred and seventy-four units of umbilical cord whole blood were collected aseptically from the umbilical vein after caesarean section in standard pediatric blood transfusion bags, after the removal of the baby from the operative field and after confirming the stable condition of the mother. The volume of cord blood varied from 50 ml to 140 ml with a mean of 86 ml+/-16 ml.

RESULTS AND ANALYSIS

The cord blood was transfused immediately (within three days of collection) to 62 patients from nine years to 78 years of age, of whom 32 were suffering from varying stages and grades of malignancy from 1 April 1999 till date i.e., 11 Aug 2000, after obtaining adequate consent and following the precautions of standard blood transfusion protocol. The remaining 30 patients included patients suffering from thalassemia major, aplastic anemia, systemic lupus erythematosus, chronic renal failure, rheumatoid arthritis, ankylosing spondylitis and a geriatric group of patients with benign prostatic hypertrophy. All have tolerated the procedure without any immunological or non-immunological reactions.

CONCLUSION

On the basis of our experience with 174 units of placental umbilical cord whole blood transfusion in malignant and non-malignant conditions (within three days of collection and preservation at 1-6 degrees C in a refrigerator), we are of the opinion that this is a safe transfusion protocol which takes advantage of the safety of nature's finest biological sieve, i.e., the placenta, as an alternative to adult whole blood transfusion. It also has the advantage of a higher oxygen carrying capacity of fetal hemoglobin in addition to many growth factors and other cytokine filled cord blood plasma along with its hypoantigenicity.