Protein redox by a piezoelectric acousto-nanodevice

Protein redox is responsible for many crucial biological processes; thus, the ability to modulate the redox proteins through external stimuli presents a unique opportunity to tune the system. In this work, we present an acousto-nanodevice that is capable of oxidizing redox protein under ultrasonic irradiation via surface-engineered barium titanate (BTO) nanoparticles with a gold half-coating. Using cytochrome c as the model protein, we demonstrate nanodevice-mediated protein oxidation. BINased on our experimental observations, we reveal that the electron transfer occurs in one direction due to the alternating electrical polarization of BTO under ultrasound. Such unique unidirectional electron transfer is enabled by modulating the work function of the gold surface with respect to the redox center. The new class of ultrasonically powered nano-sized protein redox agents could be a modulator for biological processes with high selectivity and deeper treatment sites.

739 The Management and Outcomes of Patients with Fractured Neck of Femur During The COVID-19 Pandemic; A District General Hospital Experience

Background

The UK announced a “lockdown” in response to COVID-19 on 23/03/2020, despite this NHS England did not anticipate a significant decrease in hip fracture cases. Early data from Europe had shown mortality rates of up to 30.4% in patients who develop COVID-19 and a hip fracture.

Method

Prospective study of patients presenting with a hip fracture between 23/03/2020 and 18/05/2020. Primary outcomes were 30-day mortality and COVID-19 status. Secondary outcomes were length of stay, discharge destination and readmission.

Results

50 patients identified, mean age 82. 49 patients underwent operation, 34 (69.4%) within 48 hours of admission. 14 Patients (28%) tested positive for COVID-19 within 30 days. 30-day mortality was 10% (n = 5). 2 patients who died were COVID-19 positive. Mean length of stay was 12.3 days. 7 patients (14%) re-admitted within 30 days, 4 with COVID-19.

Conclusions

Despite extra strain on the hospital, we believe we achieved good outcomes for this cohort. Compared to previous NHFD data we decreased our length of stay and time to operation. 30-day mortality increased (8.4% in 2018) but we believe this to be expected in vulnerable patients during a pandemic. We hope to take lessons we have learnt during the pandemic into the post-pandemic era.

Metastatic alveolar rhabdomyosarcoma on the fine-needle aspiration cytology of cervical lymph node in an elderly patient, with FISH confirmation: A case report

INTRODUCTION

Alveolar rhabdomyosarcoma (RMS) usually occurs in adolescents and young adults, and most frequently arises in the extremities.

CASE REPORT

We present a rare case of metastatic alveolar RMS from a nasal primary to cervical lymph nodes (LNs) in an elderly patient, diagnosed on the fine-needle aspiration (FNA) biopsy. Smears showed malignant round cells featuring focal rhabdoid appearance, with rhabdomyoblastic differentiation further supported by immunocytochemical stains. Diagnosis of alveolar RMS was confirmed by fluorescence in situ hybridization (FISH) identifying FOXO1 gene involvement with dual colour break-apart probes at locus 13q14.

DISCUSSION

The differential diagnosis for a small round blue cell tumour in the elderly generally includes metastatic small cell carcinoma, lymphoma, malignant melanoma, RMS, desmoplastic small round cell tumour and Ewing's sarcoma/primitive neuroectodermal tumour. Subtle morphological analysis and expression pattern of immunostaining for skeletal muscle differentiation led to the diagnosis of RMS. Cytogenetic testing on the FOXO1 gene rearrangement helps definite subtyping of alveolar RMS.

A radiological and histological comparison of two unusual adrenal incidentalomas

INTRODUCTION

The increasing use of radiological imaging studies has given rise to 'incidentalomas'.

CASE REPORT

We describe two unusual and diverse incidental adrenal gland lesions, an adenomatoid nodule and a mature ganglioneuroma. Both are deemed 'indeterminate' on radiological assessment. On histology, an adenomatoid nodule is composed of variably-dilated thin-walled cysts lined by bland flattened cells and solid areas of tubules lined by eosinophilic cells with plump nuclei and prominent nucleoli. The lining cells are immunoreactive for calretinin and WT1 while negative for CK5/6, ERG and CD31. Mature ganglioneuroma features fascicles of bland spindle cells with intermixed mature ganglion cells disposed within a background myxoid stroma with no immature neuroblastic component. These spindled Schwann cells are S100 positive.

DISCUSSION

Both adenomatoid nodule and mature ganglioneuroma are rare benign adrenal tumours that need to be differentiated from other, more common adrenal lesions. The management of adrenal incidentalomas is challenging. Surgical excision is indicated if an adrenal incidentaloma is more than 4 cm in size, shows malignant features on imaging or evidence of hormone excess.

Electrochemical sensing of nicotine using CuWO4 decorated reduced graphene oxide immobilized glassy carbon electrode

A novel and selective electrochemical sensing of nicotine is studied using copper tungstate decorated reduced graphene oxide nanocomposite (CuWO₄/rGO) nafion (Nf) immobilized GC electrode (GCE). The CuWO₄/rGO nanocomposite is synthesized using sonication method and characterized by HR-TEM (High resolution transmission electron microscopy), SEM (Scanning electron microscopy), FT-IR (Fourier transform infrared spectroscopy), SAED (Selected area of electron diffraction pattern), XRD (X-ray diffraction), Raman spectroscopy, Thermo gravimetric analysis (TGA) and EDX (Energy dispersive X-ray diffraction) techniques. The CuWO₄/rGO/Nf immobilized GCE shows better electrocatalytic response for the detection of nicotine as compared to bare GCE. A better selectivity and sensitivity is achieved using CuWO₄/rGO/Nf immobilized GCE to detect 0.1 µM nicotine in the presence of 100-fold excess concentrations of different interferents. The present CuWO₄/rGO/Nf immobilized GCE electrochemical sensor exhibits an ample range of sensing from 0.1 µM to 0.9 µM and the low detection limit is found to be 0.035 µM (S/N = 3). Comparable results are achieved for the determination of nicotine in various real samples such as cigarettes (Gold flake and Wills) and urine samples with improved recoveries.

Effect of cabergoline monotherapy in Cushing's disease: an individual participant data meta-analysis

CONTEXT

The primary treatment of choice for Cushing's disease (CD) is the removal of the pituitary adenoma by transsphenoidal surgery (TSS). The surgical failure is seen in up to 75% of cases depending on the experience of the surgeon in different studies. Medical therapy is one of the options for the treatment of recurrent or persistent CD.

METHODOLOGY

The primary outcome of this meta-analysis was to find the proportion of patients achieving normalisation of 24-h urinary free cortisol (remission of CD) following cabergoline monotherapy. Literature search was conducted in January 2018 in PubMed/MEDLINE database from its date of inception to 31st December 2017. The search strategy used was "[(cushing) OR Cushing's] AND cabergoline". Individual participant data were extracted from the included studies and risk of bias was analysed by review checklist proposed by MOOSE.

RESULTS

The individual participant data of 124 patients from six observational studies were included in this meta-analysis. 92 patients (74.2%) had past pituitary surgery. The proportion of patients achieving remission of Cushing’s disease (CD) with cabergoline monotherapy was 34% (95% confidence interval 0.26–0.43; P = 0.001) [corrected]. The previous surgery [odds ratio (OR) 28.4], duration of cabergoline monotherapy (OR 1.31) and maximum cabergoline dose (OR 0.19) were predictors for remission of CD. Mild and severe side effects were reported in 37.3% and 5.6% of patients, respectively, during cabergoline monotherapy.

CONCLUSIONS

This meta-analysis shows that cabergoline monotherapy is a reasonable alternative for subjects with persistent or recurrent CD after TSS. It can also be used in CD patients either as a bridge therapy while waiting for surgery or in those unwilling for surgery or have contraindication to it.

Biocompatible Collagen Nanofibrils: An Approach for Sustainable Energy Harvesting and Battery-Free Humidity Sensor Applications

In contrast with the conventional ceramic/oxide humidity sensors (HSs), a self-powered piezoelectric biopolymer HS with reasonable sensitivity, reliability, and a nontoxic and eco-friendly nature is highly desirable. A piezoelectric nanogenerator (PNG)-driven biopolymer-based HS provides a pathway toward a sustainable and greener environment in the field of smart sensors. For that, a piezoelectric collagen nanofibril biopolymer coated on to a cotton fabric has dual functionality (energy harvesting and sensor). Collagen PNG generates a maximum of 45 V/250 nA upon 5 N and can also work as a sensor to measure various percentages of relative humidity (% RH). The HS shows a linear response with a good sensitivity (0.1287 μA/% RH) in the range of 50-90% RH. These results open a field of eco-friendly multifunctional nanomaterials toward the development of noninvasive, implantable smart bio-medical systems.

A novel highly selective and sensitive detection of serotonin based on Ag/polypyrrole/Cu2O nanocomposite modified glassy carbon electrode

A silver/polypyrrole/copper oxide (Ag/PPy/Cu₂O) ternary nanocomposite was prepared by sonochemical and oxidative polymerization simple way, in which Cu₂O was decorated with Ag nanoparticles, and covered by polyprrole (PPy) layer. The as prepared materials was characterized by UV-vis-spectroscopy (UV-vis), FT-IR, X-ray diffraction (XRD), thermo-gravimetric analysis (TGA), scanning electron microscopy (SEM) with EDX, high resolution transmission electron microscopy (HR-TEM) and X-ray photoelectron spectroscopy (XPS). Sensing of serotonin (5HT) was evaluated electrocatalyst using polypyrrole/glassy carbon electrode (PPy/GCE), polypyrrole/copper oxide/glassy carbon electrode (PPy/Cu₂O/GCE) and silver/polypyrrole/copper oxide/glassy carbon electrode (Ag/PPy/Cu₂O/GCE). The Ag/PPy/Cu₂O/GCE was electrochemically treated in 0.1MPBS solution through cyclic voltammetry (CV) and differential pulse voltammetry (DPV). The peak current response increases linearly with 5-HT concentration from 0.01 to 250 µmol L^-1 and the detection limit was found to be 0.0124 μmol L^-1. It exhibits high electrocatalytic activity, satisfactory repeatability, stability, fast response and good selectivity against potentially interfering species, which suggests its potential in the development of sensitive, selective, easy-operation and low-cost serotonin sensor for practical routine analyses. The proposed method is potential to expand the possible applied range of the nanocomposite material for detection of various concerned electro active substances.

Fabrication of g-C3N4/NiO heterostructured nanocomposite modified glassy carbon electrode for quercetin biosensor

Herein, we report a one-pot synthesis of structurally uniform and electrochemically active graphitic carbon nitride/nickel oxide (g-C₃N₄/NiO) nanocomposite and an investigation on the electrocatalytic oxidation of quercetin (QR). The synthesized g-C₃N₄/NiO nanocomposite has uniform surface distribution, which was characterized with scanning electron microscopy (SEM). Moreover, the composition of synthesized g-C₃N₄/NiO nanocomposite was characterized by UV-vis-spectroscopy, X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FT-IR spectra), BET, SEM and HRTEM. The g-C₃N₄/NiO was electrochemically treated in 0.1 MPBS solution through cyclic voltammetry (CV) and differential pulse voltammetry (DPV). The peak current response increases linearly with QR concentration from 0.010 μM to 250 µM with a fast response time of less than 2 s and a detection limit of 0.002 μM. To further evaluate the feasibility of using this sensor for real sample analysis, QR content in various real samples including green tea, green apple, honey suckle were determined and satisfactory results were achieved.

Human Interactive Triboelectric Nanogenerator as a Self-Powered Smart Seat

A lightweight, flexible, cost-effective, and robust, single-electrode-based Smart Seat-Triboelectric Nanogenerator (SS-TENG) is introduced as a promising eco-friendly approach for harvesting energy from the living environment, for use in integrated self-powered systems. An effective method for harvesting biomechanical energy from human motion such as walking, running, and sitting, utilizing widely adaptable everyday contact materials (newspaper, denim, polyethylene covers, and bus cards) is demonstrated. The working mechanism of the SS-TENG is based on the generation and transfer of triboelectric charge carriers between the active layer and user-friendly contact materials. The performance of SS-TENG (52 V and 5.2 μA for a multiunit SS-TENG) is systematically studied and demonstrated in a range of applications including a self-powered passenger seat number indicator and a STOP-indicator using LEDs, using a simple logical circuit. Harvested energy is used as a direct power source to drive 60 blue and green commercially available LEDs and a monochrome LCD. This feasibility study confirms that triboelectric nanogenerators are a suitable technology for energy harvesting from human motion during transportation, which could be used to operate a variety of wireless devices, GPS systems, electronic devices, and other sensors during travel.

Intra-articular nodular fasciitis: an unexpected diagnosis for a joint lesion: a case report

Pathological lesions in and around a joint can arise from underlying dermis, subcutis, deep muscle, bone or synovium. Clinical presentation can include joint pain, joint swelling, palpable masses and mechanical restriction. Whilst giant cell tumour of tendon sheath, pigmented villonodular synovitis, synovial chondromatosis, lipoma arborescens, juxta articular myxomas and inflammatory arthritis are the better-known conditions of the joint. Intra-articular nodular fasciitis, on the other hand, is less well recognized both clinically and radiologically. It is rarely seen in routine practice and is only described in case reports in the literature. Due to the non-specific clinical and radiological findings as well as the unfamiliarity with the entity, the diagnosis of intra-articular nodular fasciitis is usually clinched only after histological examination. We present a case of intra-articular nodular fasciitis arising in the knee joint which was not suspected clinically or radiologically.

Ketamine and pulmonary oedema-report of two cases

SUMMARY

Perioperative pulmonary oedema is one of the most challenging complications faced by anaesthesiologists. In most of the instances, coronary artery disease, valvular heart diseases, hypertension may precipitate pulmonary oedema due to increased hydrostatic pressure while acid aspiration, airway obstruction may cause it due to increased vascular permeability. In a few instances, acute pulmonary oedema can present in an otherwise healthy patient to cause diagnostic difficulties. We report two such cases of intra operative pulmonary oedema with the use of ketamine which were identified and managed successfully. The most probable cause is also described.

Parafibromin expression in breast cancer: a novel marker for prognostication?

BACKGROUND

Parafibromin is a novel protein product of HRPT2, a recently identified tumour suppressor gene. Mutations of the HRPT2 gene are common in parathyroid carcinomas, and these exhibit reduced protein expression. Parafibromin expression in breast cancer has not been previously studied.

AIMS

To determine the distribution of parafibromin in breast cancer tissues, and correlate its expression with conventional pathological parameters.

METHODS

Tissue microarrays were constructed from archival paraffin embedded breast cancer samples. Sections cut from tissue microarray blocks were subjected to immunohistochemistry. Immunopositivity for parafibromin and intensity-percentage scores were derived by blinded evaluation. Findings were correlated with clinicopathological parameters.

RESULTS

163 breast cancers were assessed. Larger tumours were less likely to express parafibromin than smaller ones, with the association approaching statistical significance (p = 0.05). Staining intensity correlated inversely with tumour size (p = 0.016) and pathological stage (p = 0.008); as did parafibromin intensity-percentage score with pathological stage (p = 0.03), lymphovascular invasion (p = 0.03) and cerbB2 intensity-percentage score (p = 0.04).

CONCLUSION

Parafibromin in breast cancer, as in parathyroid tumours, appears to have tumour suppressor functions, with loss of protein expression associated with adverse pathological parameters. These findings may indicate a potential role of parafibromin as a prognostic marker in breast cancer.

Pathological diagnosis of columnar cell lesions of the breast: are there issues of reproducibility?

AIMS

To assess inter/intraobserver variability in the interpretation of a series of digitised images of columnar cell lesions (CCLs) of the breast.

METHODS

After a tutorial on breast CCL, 39 images were presented to seven staff pathologists, who were instructed to categorize the lesions as follows: 0, no columnar cell change (CCC) or ductal carcinoma in situ (DCIS); 1, CCC; 2, columnar cell hyperplasia; 3, CCC with architectural atypia; 4, CCC with cytological atypia; 5, DCIS. Concordance with the tutor's diagnosis and degree of agreement among pathologists for each image were determined. The same set of images was re-presented to the pathologists one week later, their diagnoses collated, and inter/intraobservor reproducibility and level of agreement for individual images analysed.

RESULTS

Diagnostic reproducibility with the tutor ranged from moderate to substantial (kappa values, 0.439-0.697) in the first exercise. At repeat evaluation, intraobserver agreement was fair to perfect (kappa values, 0.271-0.832), whereas concordance with the tutor varied from fair to substantial (kappa values, 0.334-0.669). There was unanimous agreement on more images during the second exercise, mainly because of agreement on the diagnosis of DCIS. The lowest agreement was seen for CCC with cytological atypia.

CONCLUSIONS

Interobserver and intraobserver agreement is good for DCIS, but more effort is needed to improve diagnostic consistency in the category of CCC with cytological atypia. Continued awareness and study of these lesions are necessary to enhance recognition and understanding.

The HercepTest and routine C-erbB2 immunohistochemistry in breast cancer: any difference?

INTRODUCTION

The proto-oncogene c-erbB2, located on chromosome 17q21, encodes a 185-kD transmembrane glycoprotein. It is known to be overexpressed, amplified, or both in 20% to 30% of breast cancers. C-erbB2 belongs to the human epidermal growth factor receptor (tyrosine kinase receptor) family that plays an important role in cell cycle regulation and differentiation. Although there are various methods to assess c-erbB2 status in breast cancer, protein overexpression determined by immunohistochemistry and gene amplification using fluorescence in situ hybridisation are most commonly utilised. This study compares the results of the DAKO HercepTest with the immunohistochemical assay (A0485, DAKO), which is routinely used in our pathology laboratory.

MATERIALS AND METHODS

Paraffin-embedded breast cancer tissues from 41 patients operated in a tertiary hospital during the year 2000 were subjected to immunohistochemistry by the above methods. C-erbB2 positivity was defined by cytoplasmic membrane staining of 2+ or 3+ intensity.

RESULTS

Overexpression of c-erbB2 protein was present in 36.6% and 41.5% of cases when detected by HercepTest and the DAKO A0485 antibody, respectively. There was almost perfect agreement between both methods (k = 0.898) when positive versus negative results were considered, and moderate agreement in terms of individual staining intensities (k = 0.554).

CONCLUSION

Routine immunohistochemistry using the DAKO A0485 antibody is a reliable, cost-effective alternative to the HercepTest in determining prognosis and suitability of patients for Herceptin therapy.

A plasma kallikrein-dependent plasminogen cascade required for adipocyte differentiation

Here we show that plasma kallikrein (PKal) mediates a plasminogen (Plg) cascade in adipocyte differentiation. Ecotin, an inhibitor of serine proteases, inhibits cell-shape change, adipocyte-specific gene expression, and lipid accumulation during adipogenesis in culture. Deficiency of Plg, but not of urokinase or tissue-type plasminogen activator, suppresses adipogenesis during differentiation of 3T3-L1 cells and mammary-gland involution. PKal, which is inhibited by ecotin, is required for adipose conversion, Plg activation and 3T3-L1 differentiation. Human plasma lacking PKal does not support differentiation of 3T3-L1 cells. PKal is therefore a physiological regulator that acts in the Plg cascade during adipogenesis. We propose that the Plg cascade fosters adipocyte differentiation by degradation of the fibronectin-rich preadipocyte stromal matrix.

Stromelysin-1 regulates adipogenesis during mammary gland involution

The matrix metalloproteinase MMP-3/stromelysin-1 (Str1) is highly expressed during mammary gland involution induced by weaning. During involution, programmed cell death of the secretory epithelium takes place concomitant with the repopulation of the mammary fat pad with adipocytes. In this study, we have used a genetic approach to determine the role of Str1 during mammary involution. Although Str1 has been shown to induce unscheduled apoptosis when expressed ectopically during late pregnancy (Alexander, C.M., E.W. Howard, M.J. Bissell, and Z. Werb. 1996. J. Cell Biol. 135:1669-1677), we found that during post-lactational involution, mammary glands from transgenic mice that overexpress the tissue inhibitor of metalloproteinases, TIMP-1 (TO), or mice carrying a targeted mutation in Str1 showed accelerated differentiation and hypertrophy of adipocytes, while epithelial apoptosis was unaffected. These data suggest that matrix metalloproteinases (MMPs) do not induce unscheduled epithelial cell death after weaning, but instead alter the stromal microenvironment. We used adipogenic 3T3-L1 cells as a cell culture model to test the function of MMPs during adipocyte differentiation. Fibroblastic 3T3-L1 progenitor cells expressed very low levels of MMPs or TIMPs. The transcription of a number of MMP and TIMP mRNAs [Str1, MT1-MMP, (MMP-14) collagenase-3 (MMP-13), gelatinase A (MMP-2), and TIMP-1, -2 and -3] was induced in committed preadipocytes, but only differentiated adipocytes expressed an activated MMP, gelatinase A. The addition of MMP inhibitors (GM 6001 and TIMP-1) dramatically accelerated the accumulation of lipid during differentiation. We conclude that MMPs, especially Str1, determine the rate of adipocyte differentiation during involutive mammary gland remodeling.