The Importance of Ultrasound-Guided Synovial Biopsy in the Workup of Seronegative Inflammatory Arthritis: A Case Report

We report a case of a 74-year-old male who presented with typical clinical features of rheumatoid arthritis (RA), as well as elevated markers of inflammation. However, the patient did not respond to multiple RA treatments, and an ultrasound-guided synovial biopsy (UGSB) of the right wrist was performed, which established the diagnosis of amyloidosis. A variety of inflammatory conditions sometimes get misdiagnosed as seronegative RA due to similarities in clinical presentation. This case report highlights the importance of a thorough workup in patients who appear to have seronegative RA. Given the wide availability of ultrasound-guided, minimally invasive synovial biopsies, these procedures should be employed more often to detect rare conditions that may mimic seronegative RA, such as amyloidosis.

Magnetic Adsorbent Fe3O4/ZnO/LC for the Removal of Tetracycline and Congo Red from Aqueous Solution

Zeolitic imidazolate frameworks (ZIFs) can be used as an adsorbent to efficiently adsorb organic pollutants. However, ZIF nanoparticles are easy to form aggregates, hampering the effective and practical application in practical adsorption. In this study, the ZIF-8 was successfully loaded onto lignocellulose (LC) to further produce ZnO/LC by in situ growth method and hydrothermal treatment, and then Fe3O4 nanoparticles (Fe3O4 NPs) were loaded onto ZnO/LC to prepare magnetic Fe3O4/ZnO/LC adsorbent for removing tetracycline (TC) and congo red (CR) pollutants from aqueous solution. The adsorption properties of the adsorbent were systematically analyzed for different conditions, such as adsorbent dosage, solution pH, contact time, temperature and initial concentration. The experimental data were fitted using adsorption kinetic and isotherm models. The results showed that the pseudo-second-order model and Sips model were well fitted to the adsorption kinetic and adsorption isotherm, respectively. The adsorption capacities of TC and CR reached the maximum value of 383.4 mg/g and 409.1 mg/g in experimental conditions. The mechanism of the removal mainly includes electrostatic interaction, hydrogen bonding and π-π stacking. This novel adsorbent could be rapidly separated from the aqueous solution, suggesting its high potential to remove pollutants in wastewater.

Gastrointestinal (GI) Amyloidosis Presenting As Chronic Diarrhea: A Diagnostic Dilemma

This case report describes a 63-year-old male patient with a four-year history of chronic diarrhea. Extensive diagnostic investigations failed to reveal a cause. Subsequent upper and lower gastrointestinal (GI) endoscopic procedures revealed the presence of amyloidosis in the GI tract. The patient was referred for further evaluation, but unfortunately, he presented with hypotension and shock, and ultimately succumbed to systemic amyloidosis involving multiple organs. GI amyloidosis, although rare, should be considered in patients presenting with chronic diarrhea, unexplained weight loss, or GI bleeding. Early recognition and appropriate management are crucial for optimizing patient outcomes. Healthcare providers should maintain a high index of suspicion for GI amyloidosis to ensure timely intervention and improve patient care.

Removal of the Basic and Diazo Dyes from Aqueous Solution by the Frustules of Halamphora cf. salinicola (Bacillariophyta)

Industrial wastes with hazardous dyes serve as a major source of water pollution, which is considered to have an enormous impact on public health. In this study, an eco-friendly adsorbent, the porous siliceous frustules extracted from the diatom species Halamphora cf. salinicola, grown under laboratory conditions, has been identified. The porous architecture and negative surface charge under a pH of 7, provided by the various functional groups via Si-O, N-H, and O-H on these surfaces, revealed by SEM, the N₂ adsorption/desorption isotherm, Zeta-potential measurement, and ATR-FTIR, respectively, made the frustules an efficient mean of removal of the diazo and basic dyes from the aqueous solutions, 74.9%, 94.02%, and 99.81% against Congo Red (CR), Crystal Violet (CV), and Malachite Green (MG), respectively. The maximum adsorption capacities were calculated from isotherms, as follows: 13.04 mg g^-1, 41.97 mg g^-1, and 33.19 mg g^-1 against CR, CV, and MG, respectively. Kinetic and isotherm models showed a higher correlation to Pore diffusion and Sips models for CR, and Pseudo-Second Order and Freundlich models for CV and MG. Therefore, the cleaned frustules of the thermal spring-originated diatom strain Halamphora cf. salinicola could be used as a novel adsorbent of a biological origin against anionic and basic dyes.

Pseudotumoral Amyloidosis Presentation With Upper Digestive Bleeding

Amyloidosis is a condition related to the extracellular deposition of abnormal fibrillar proteins. Gastric involvement may present as a systemic or localized form of the disease. The endoscopic presentation can vary from nodular, ulcerated, or infiltrative lesions. Clinical manifestations are nonspecific, including hyporexia, nausea, vomiting, weight loss, epigastralgia, and abdominal discomfort. Thus, amyloidosis can clinically and endoscopically mimic other diseases, such as neoplasms, syphilis, tuberculosis, and Crohn's disease, requiring a high suspicion. When it manifests with gastrointestinal bleeding, it most commonly occurs as intermittent melena. This report aims to present an unusual case of a patient with upper gastrointestinal bleeding exteriorized through melena secondary to amyloidosis with gastric involvement.

Solitary amyloid tumor of the palate: A case report and literature review

Amyloidosis is often caused by the abnormal extracellular accumulation of amyloid in organs and tissues. This condition, affecting the head and neck region, is typically localized, and may also involve the oral cavity, particularly the tongue and buccal mucosa. As a solitary manifestation, the localized amyloidosis occurring intraosseous is highly infrequent. In addition, localized amyloidosis has a great rate of recurrence. In this paper, a 50-year-old female patient with the chief complaint of pain in the anterior of the maxilla is reported. According to clinical examination, no significant pathologic lesion was seen. The radiographic image showed a radiolucent lesion around teeth four and five. The treatment of choice for the patient was an excisional biopsy. As amyloidosis diagnosis is clinically challenging, biopsy and histologic examination of lesions are necessary in this regard. Accordingly, it is concluded that long-term follow-up is mandatory in case of localized amyloidosis because late recurrence can occur in some cases.

3D Hierarchical Porous and N-Doped Carbonized Microspheres Derived from Chitin for Remarkable Adsorption of Congo Red in Aqueous Solution

A novel adsorbent of N-doped carbonized microspheres were developed from chitin (N-doped CM-chitin) for adsorption of Congo red (CR). The N-doped CM-chitin showed spherical shape and consisted of carbon nanofibers with 3D hierarchical architecture. There were many micro/nano-pores existing in N-doped CM-chitin with high surface area (455.703 m² g^-1). The N element was uniformly distributed on the carbon nanofibers and formed with oxidize-N graphitic-N, pyrrolic-N, and pyridinic-N. The N-doped CM-chitin showed excellent adsorption capability for CR and the maximum adsorption amount was approximate 954.47 mg g^-1. The π-π/n-π interaction, hydrogen-bond interactions, and pore filling adsorption might be the adsorption mechanisms. The adsorption of N-doped CM-chitin was considered as a spontaneous endothermic adsorption process, and which well conformed to the pseudo-second-order kinetic and Langmuir isotherm model. The N-doped CM-chitin exhibited an effective adsorption performance for dynamic CR water with good reusability. Therefore, this work provides new insights into the fabrication of a novel N-doped adsorbent from low-cost and waste biomasses.

Synthesis and Characterization of High Viscosity Cationic Poly(Proline-Epichlorohydrin) Composite Polymer with Antibacterial Functionalities

We report microbial resistance and catalytic activity of high viscosity cationic poly(proline-epichlorohydrin) composite (PRO-EPI) in the aqueous system. The PRO-EPI was prepared by a simple polycondensation, followed by FTIR, ¹H NMR, SEM, DLS, viscosity, and DSC/TGA characterization. Several concentrations of the PRO-EPI were tested against Gram-negative (E. coli and Pseudomonas aeruginosa) and Gram-positive (Staphylococcus aureus) microorganisms. The antimicrobial screening revealed that PRO-EPI was a potent antimicrobial agent with the least inhibitory concentrations (MICs) of 128 µg/mL against Gram-negative microorganisms. The PRO-EPI indicated no inhibitory effect against Gram-positive microorganisms. It was determined that PRO-EPI contains polymeric-quaternary ammonium compounds that inactivate the Gram-negative microorganisms by a dual mode of action and carries domains for electrostatic interaction with the microbial membrane and an intracellular target. To study the removal of toxic industrial wastewater, congo red (CR) was tested using sodium borohydride as a reducing agent. Adsorption was achieved within 20 min at a rate constant of 0.92 ks⁻¹. UV–vis spectra showed that the removal of CR in the reaction solution was due to the breakup of the azo (–N=N–) bonds and adsorption of aromatic fragments. PRO is biodegradable and non-toxic, and PRO-EPI was found to be both antimicrobial and also acts as a catalyst for the removal of congo red dye.

Use of Ionic Liquid Pretreated and Fermented Sugarcane Bagasse as an Adsorbent for Congo Red Removal

A large amount of industrial wastewater containing pollutants including toxic dyes needs to be processed prior to its discharge into the environment. Biological materials such as sugarcane bagasse (SB) have been reported for their role as adsorbents to remove the dyes from water. In this study, the residue SB after fermentation was utilized for the dye removal. A combined pretreatment of NaOH and methyltrioctylammonium chloride was given to SB for lignin removal, and the pretreated SB was utilized for cellulase production from Bacillus aestuarii UE25. The strain produced 118 IU mL^-1 of endoglucanse and 70 IU mL^-1 of β-glucosidase. Scanning electron microscopy and FTIR spectra showed lignin and cellulose removal in fermented SB. This residue was utilized for the adsorption of an azo dye, congo red (CR). The thermodynamic, isotherm and kinetics studies for the adsorption of CR revealed distinct adsorption features of SB. Untreated SB followed Langmuir isotherm, whereas pretreated SB and fermented SB obeyed the Freundlich isotherm model. The pseudo-second-order model fitted well for the studied adsorbents. The results of thermodynamic studies revealed spontaneous adsorption with negative standard free energy values. Untreated SB showed a 90.36% removal tendency at 303.15 K temperature, whereas the adsorbents comprised of pretreated and fermented SB removed about 98.35% and 97.70%, respectively. The study provided a strategy to utilize SB for cellulase production and its use as an adsorbent for toxic dyes removal.

Adsorption Behavior of Crystal Violet and Congo Red Dyes on Heat-Treated Brazilian Palygorskite: Kinetic, Isothermal and Thermodynamic Studies

The effect of heat treatment on the adsorptive capacity of a Brazilian palygorskite to remove the dyes crystal violet (CV) and congo red (CR) was investigated. The natural palygorskite was calcined at different temperatures (300, 500 and 700 °C) for 4 h. Changes in the palygorskite structure were evaluated using X-ray diffraction, X-ray fluorescence, thermogravimetric and differential thermal analysis, N₂ adsorption/desorption and Fourier transform infrared spectroscopy. The adsorption efficiency of CV and CR was investigated through the effect of initial concentration, contact time, temperature, pH and dosage of adsorbent. The calcination increased the adsorption capacity of palygorskite, and the greatest adsorption capacity of CV and CR dyes occurred in the sample calcined at 700 °C (Pal-700T). The natural and calcined samples at 300 and 500 °C followed the Freundlich isothermal model, while the Pal-700T followed the Langmuir isothermal model. Adsorption kinetics results were well described by the Elovich model. Pal-700T showed better adsorption performance at basic pH, with removal greater than 98%, for both dyes. Pal-700T proved to be a great candidate for removing cationic and anionic dyes present in water.

Carbon Dot-Doped Titanium Dioxide Sheets for the Efficient Photocatalytic Performance of Refractory Pollutants

Broad solar light harvesting and fast photoinduced electron-hole migration are two critical factors for the catalytic capacity of photocatalytic system. In this study, novel visible light-driven carbon dot-TiO₂ nanosheet (CD-TN) photocatalysts are successfully prepared by loading CDs on the surface of TNs through the hydrothermal method. The microstructure, chemical components, and optical properties of the prepared samples are characterized via X-ray diffraction, Fourier transform infrared spectroscopy, transmission electron microscopy, UV-visible diffuse reflectance spectroscopy, and X-ray photoelectron spectroscopy analysis. Congo red (CR), rhodamine B (RhB), and tetracycline (TC) are selected as pollutants to assess the catalytic performance of CD-TNs. As expected, the removal efficiencies of CD-TNs for CR, RhB, and TC are 94.6% (120 min), 97.2% (150 min), and 96.1% (60 min), respectively, obviously higher than that of pure TNs. The enhanced degradation efficiency of CD-TNs is predominantly ascribed to the merits of CDs (excellent up-conversion property and electron transfer property). Moreover, according to the several degradation cycles, CD-TNs possess the excellent stability, having removed 93.3% of CR after 120 min irradiation.

Tracheobronchial amyloidosis in primary Sjögren syndrome: A case report

RATIONALE

Tracheobronchial amyloidosis (TBA) associated with Sjögren syndrome is very rare. Here, we describe a case with this phenomenon, in order to better understand the condition.

PATIENT CONCERNS

A 52-year-old woman presented after 6 months of coughing, sputum, and dyspnea. Chest computed tomography revealed thickened bronchial walls, which were irregular on the left side the trachea. She had a history of dry eye and dry mouth of at least 3 years' duration.

DIAGNOSES

Sjögren syndrome was diagnosed based on her symptoms, ophthalmological and parotid examination, and immunological and autoantibody tests. The diagnosis of TBA was confirmed by Congo red staining of a tracheal biopsy.

INTERVENTIONS

The patient was given glucocorticoids without any other immunosuppressants.

OUTCOMES

The symptoms improved after 6 months.

LESSONS

TBA associated with Sjögren syndrome is a rare condition. TBA is characterized by amyloid deposition to the trachea in the absence of systemic amyloidosis. Diagnosis requires tissue biopsy with demonstration of amyloid deposition.

Homogeneous Polymerization of Self-standing Covalent Organic Framework Films with High Performance in Molecular Separation

Covalent organic frameworks (COFs) are typically isolated as microcrystalline powders. It remains fundamentally challenging to fabricate COFs into high-quality self-standing films to take full advantage of their ordered pore channels for molecular separation. Here, we report a new strategy for fabricating self-standing imine-linked COF films via homogeneous polymerization where films emerge from clear solutions without forming amorphous precipitates. The abundant basic nitrogen atoms of the monomers acted as a reaction controller to realize the homogeneous polymerization and also promoted the tight self-aggregation of COF crystallites to form compact films via H-bonding. The chemically supported self-standing COF films on nylon membranes were also developed via an in situ growth method. The resulting films showed an unprecedentedly ultrafast permeance of 2822 L m^-2 h^-1 MPa^-1 with a high rejection rate (99.8%) in the filtration of a congo red (CR) solution, demonstrating the advantage of this new strategy in fabricating high-quality self-standing COF films.

Graphitic mesoporous carbon-silica composites from low-value sugarcane by-products for the removal of toxic dyes from wastewaters

Highly porous carbon-silica composites (CSC) were prepared for the first time through a simple wet impregnation process and subsequent pyrolysis of low-value sugarcane by-products, namely molasses. These CSC materials demonstrate a distinct range of functionalities, which significantly differ from similar materials published in the literature. Importantly, the carbon-silica composites prepared at 800°C exhibited exceptional adsorption capacities for the azo-dye congo red (445 mg g-1), due to the graphitic carbon coating and unique functionality including C-O-C within the porous structure. Congo red adsorption capacity of the highly mesoporous graphitic carbon-silica composites significantly exceeds that of commercial activated carbon and silica, these carbon-silica composites therefore represent an effective step towards the development of porous bio-derived adsorbent for remediation of dye wastewaters. Both the porous properties (surface area and pore size distribution) and the functionality of the carbon coating were dependent on the temperature of preparation. The sustainable synthetic methods employed led to a versatile material that inherited the mesoporosity characteristics from the parent silica, demonstrating mesoporous volumes greater than 90% (as calculated from the total pore volume). Adsorption on the 800°C prepared carbon-silica composites demonstrated an excellent fit with the Langmuir isotherm and the pseudo-first-order kinetic model.

Eco-friendly synthesis of silver and gold nanoparticles with enhanced antimicrobial, antioxidant, and catalytic activities

The present work is emphasised on the bio-fabrication of silver and gold nanoparticles in a single step by a microwave-assisted method using the leaf extract of Synedrella nodiflora as both reducing and stabilising agent. The synthesised nanoparticles are highly stable and show surface plasmon resonance peak at 413 and 535 nm, respectively, for silver and gold nanoparticles in UV-Vis spectrum. The functional group responsible for the reduction of metal ions were obtained from Fourier transform infrared spectroscopy. The crystalline nature of nanoparticles with face-centred cubic geometry was confirmed by the X-ray diffraction and selected area electron diffraction patterns. The morphology and sizes of the silver and gold nanoparticles were obtained from transmission electron microscopy images. The nanoparticles exhibit effective antimicrobial activities against various pathogenic strains. These antimicrobial properties were analysed by employing agar well diffusion method. The nanoparticles show significant antioxidant properties, and it was determined using 2, 2-diphenyl-1-picrylhydrazyl assay. The nanoparticles also show potent catalytic activity in the degradation of anthropogenic pollutant dyes Congo red and eosin Y by excess NaBH4. Thus, the current study demonstrates the potential use of S. nodiflora as a reducing and stabilising agent for the synthesis of silver and gold nanoparticles and their relevance in the field of biomedicine and catalysis.

Evaluation of Biofilm Formation and Presence of Ica Genes in Staphylococcus epidermidis Clinical Isolates

Objectives

Biofilm formation is one of the important features of Staphylococcus epidermidis, particularly in nosocomial infections. We aimed to investigate the biofilm production by phenotypic methods and the presence of ica genes in S epidermidis.

Methods

A total of 41 S epidermidis isolates were recovered from different clinical specimens. Biofilm formation was evaluated by microtiter plate, tube method and Congo red agar method. The presence of icaA and icaD genes was investigated by PCR. Validity of methods (sensitivity and specificity), and metrics for test performance (positive/negative predictive value, and positive/negative likelihood ratio) were determined.

Results

By both microtiter plate and tube method, 53.6% of S epidermidis isolates were able to produce biofilm, whilst only 24.4% of isolates provided a biofilm phenotype on Congo red agar plates. icaA and icaD genes were found in 100% and 95.1% of isolates, respectively. Biofilm phenotypes accounted for 4.8% by microtiter plate assay, despite the absence of the ica gene. Congo red agar and PCR exhibited a lower sensitivity (18% and 45.5%, respectively) for identifying the biofilm phenotype in comparison to microtiter plate.

Conclusion

The microtiter plate method remains generally a better tool to screen biofilm production in S epidermidis. In addition, the ability of S epidermidis to form biofilm is not always dependent on the presence of ica genes, highlighting the importance of ica-independent mechanisms of biofilm formation. The use of reliable methods to specifically detect biofilms can be helpful to treat the patients affected by such problematic bacteria.

Study of Adsorption Mechanism of Congo Red on Graphene Oxide/PAMAM Nanocomposite

Graphene oxide/poly(amidoamine) (GO/PAMAM) nanocomposite adsorbed high quantities of congo red (CR) anionic dye in 0.1 M NaCl solution, with the maximum adsorption capacity of 198 mg·g⁻¹. The kinetics and thermodynamics of adsorption were investigated to elucidate the effects of pH, temperature, shaking rate, ionic strength, and contact time. Kinetic data were analyzed by the KASRA model and the KASRA, ISO, and pore-diffusion equations. Adsorption adsorption isotherms were studied by the ARIAN model and the Henry, Langmuir, and Temkin equations. It was shown that adsorption sites of GO/PAMAM at experimental conditions were phenolic hydroxyl groups of GO sheets and terminal amine groups of PAMAM dendrimer. Analysis of kinetic data indicated that amine sites were located on the surface, and that hydroxyl sites were placed in the pores of adsorbent. CR molecules interacted with the adsorption sites via hydrogen bonds. The molecules were adsorbed firstly on the amine sites, and then on the internal hydroxyl sites. Adsorption kinetic parameters indicated that the interaction of CR to the –NH₃⁺ sites was the rate-controlling step of adsorption of CR on this site and adsorption activation energies calculated for different parts of this step. On the other hand, kinetic parameters showed that the intraparticle diffusion was the rate-controlling step during the interaction of CR molecules to –OH sites and activation energy of this step was not calculable. Finally, the used GO/PAMAM was completely regenerated by using ethylenediamine.

Atrophic nodular cutaneous amyloidosis

Primary cutaneous amyloidosis is limited to the skin without involving any other tissue. Nodular amyloidosis is rare, and atrophic nodular cutaneous amyloidosis is even rarer. We describe the fourth case of atrophic nodular cutaneous amyloidosis by searching PubMed databases. A 52-year-old female presented to our hospital with a 2-year history of orange papules and nodules without subjective symptom on her right abdomen. Review of systems was negative. Atrophic nodular amyloidosis may progress to primary systemic disease in up to 7% of cases. Because our patient had no systemic involvement, she was diagnosed with atrophic nodular cutaneous amyloidosis based on characteristic symptoms and histopathologic examination. Routine follow-up for this patient is necessary to detect any potential disease progression.

Green synthesis of the Ag/ZnO nanocomposite using Valeriana officinalis L. root extract: application as a reusable catalyst for the reduction of organic dyes in a very short time

A facile and green synthesis of the Ag/ZnO nanocomposite by extract of Valeriana officinalis L. root in the absence of any stabiliser or surfactant has been reported in this work. The green synthesised Ag/ZnO nanocomposite was characterised by Field emission scanning electron microscopy (FESEM), transmission electron microscopy (TEM), energy dispersive X‐ray spectroscopy (EDS), elemental mapping, Fourier‐Transform infrared (FT‐IR), X‐ray diffraction analysis (XRD) and UV‐Vis spectroscopy. According to SEM and TEM images, the Ag and ZnO particles are spherical with diameters of less than 20 and 40–50 nm, respectively. The Ag NPs/ZnO nanocomposite proved to be an effective catalyst in the reduction of various dyes including methyl orange (MO), Congo red (CR) and methylene blue (MB) in the presence of NaBH4 in aqueous media at ambient temperature. A maximum degradation (100%) of dyes was performed using Ag/ZnO nanocomposite. The extraordinary performance of the prepared Ag/ZnO nanocomposite is attributed to the synergetic effect induced by both ZnO and Ag NPs in the catalytic degradation of organic dyes. The catalyst could be reused and recovered several times with no significant loss of catalytic activity.

Removal of Congo Red from Aqueous Solution by Anion Exchange Membrane (EBTAC): Adsorption Kinetics and Themodynamics

The adsorption behavior of anionic dye congo red (CR) from aqueous solutions using an anion exchange membrane (EBTAC) has been investigated at room temperature. The effect of several factors including contact time, membrane dosage, ionic strength and temperature were studied. Kinetic models, namely pseudo-first-order and pseudo-second-order, liquid film diffusion and Elovich models as well as Bangham and modified freundlich Equations, were employed to evaluate the experimental results. Parameters such as adsorption capacities, rate constant and related correlation coefficients for every model were calculated and discussed. The adsorption of CR on anion exchange membranes followed pseudo-second-order Kinetics. Thermodynamic parameters, namely changes in Gibbs free energy (∆G°), enthalpy (∆H°) and entropy (∆S°) were calculated for the adsorption of congo red, indicating an exothermic process.

Detergent induces the formation of IgG aggregates: a multi-methodological approach

Role of micellar environment created by Triton X-100 (TX-100) and CHAPSO on protein conformation using IgG as a model system has been studied in this paper. A substantial amount of secondary structure with the reduction in constant tertiary contacts was obtained in both bovine and human IgG in the presence of 0.12 mM TX-100 where as 6 and 8 mM CHAPSO concentration was required for this type of secondary structure. Further addition of either of the detergents result in the induction of α-helix in both the IgGs as evident by helix specific peaks in the amide I region of FTIR and circular dichroism spectra. Tryptophan and 8-anilino-1-naphthalene-sulphonic acid (ANS) fluorescence confirmed changes in protein conformation upon addition of detergents. Maximum ANS binding at 0.12 mM TX-100 in both while 6 and 8 mM CHAPSO in bovine and human IgG respectively, indicate a compact ''molten-globule''-like conformation. An increase addition of these detergents results in the burial of hydrophobic patches of both IgG owing to aggregation. Presence of aggregates at 0.2 and 0.16 mM TX-100 and 8 and 9 mM CHAPSO, for bovine and human IgG respectively, was further confirmed by reduction in ANS fluorescence, dynamic light scattering study, thioflavin T fluorescence and congo red absorbance.

Detection of amyloid in abdominal fat pad aspirates in early amyloidosis: Role of electron microscopy and Congo red stained cell block sections

Background:

Fine-needle aspiration biopsy (FNA) of the abdominal fat pad is a minimally invasive procedure to demonstrate tissue deposits of amyloid. However, protocols to evaluate amyloid in fat pad aspirates are not standardized, especially for detecting scant amyloid in early disease.

Materials and Methods:

We studied abdominal fat pad aspirates from 33 randomly selected patients in whom subsequent tissue biopsy, autopsy, and/or medical history for confirmation of amyloidosis (AL) were also available. All these cases were suspected to have early AL, but had negative results on abdominal fat pad aspirates evaluated by polarizing microscopy of Congo Red stained sections (CRPM). The results with CRPM between four reviewers were compared in 12 cases for studying inter observer reproducibility. 24 cases were also evaluated by ultrastructural study with electron microscopy (EM).

Results:

Nine of thirty-three (27%) cases reported negative by polarizing microscopy had amyloidosis. Reanalysis of 12 mixed positive-negative cases, showed considerable inter-observer variability with frequent lack of agreement between four observers by CRPM alone (Cohen's Kappa index of 0.1, 95% CI -0.1 to 0.36). EM showed amyloid in the walls of small blood vessels in fibroadipose tissue in four out of nine cases (44%) with amyloidosis.

Conclusion:

In addition to poor inter-observer reproducibility, CRPM alone in cases with scant amyloid led to frequent false negative results (9 out of 9, 100%). For improved detection of AL, routine ultrastructural evaluation with EM of fat pad aspirates by evaluating at least 15 small blood vessels in the aspirated fibroadipose tissue is recommended. Given the high false negative rate for CRPM alone in early disease, routine reflex evaluation with EM is highly recommended to avert the invasive option of biopsying various organs in cases with high clinical suspicion for AL.

Renal failure due to primary amyloidosis: a case report and literature review

CONTEXT

Primary amyloidosis, also known as AL amyloidosis, is commonly caused by clonal expansion of plasma cells in the bone marrow, thereby segregating light chains of clonal immunoglobulin that settle in tissues in the form of insoluble amyloid fibrils. The aim of this study was to report a case of primary amyloidosis with renal failure, diagnosed in Hospital São João, Porto, Portugal, focusing on the diagnostic difficulties and presenting a literature review.

CASE REPORT

A 68-year-old Caucasian man was admitted to the Internal Medicine Department of the hospital with a condition of anasarca and nephrotic syndrome. After performing a renal biopsy that tested positive using Congo red and immunohistochemistry, lambda light chain amyloidosis was diagnosed. This evolved into terminal renal disease, which led to hemodialysis and several episodes of urinary and catheter infections. He was started on chemotherapy, consisting of bortezomib 0.7 mg/m(2) and dexamethasone 40 mg in six cycles. This led to clinical improvement, stabilization of the illness and good tolerance of the treatment.

CONCLUSION

Amyloidosis is a rare entity that is difficult to diagnose. This is because of the unspecific early clinical manifestations of the disease. The hypothesis of amyloidosis is only considered when specific organ failure occurs. This case consisted of primary amyloidosis with involvement of the kidneys as an initial presentation of the disease and its difficulties were shown, going from the clinical approach to the final diagnosis.

Binding mode of Thioflavin T and other molecular probes in the context of amyloid fibrils-current status

Because understanding amyloid fibrillation in molecular detail is essential for development of strategies to control amyloid formation and overcome neurodegenerative disorders, increased understanding of present molecular probes as well as development of new probes are of utmost importance. To date, the binding modes of these molecular probes to amyloid fibrils are by no means adequately described or understood, and the large number of studies on Thioflavin T (ThT) and Congo Red (CR) binding have resulted in models that are incomplete and conflicting. Different types of binding sites are likely to be present in amyloid fibrils with differences in binding modes. ThT may bind in channels running parallel to the long axis of the fibril. In the channels, ThT may bind in either a monomeric or dimeric form of which the molecular conformation is likely to be planar. CR may bind in grooves formed along the β-sheets as a planar molecule in either a monomeric or supramolecular form.

Amyloid myopathy: a diagnostic challenge

Amyloid myopathy (AM) is a rare manifestation of primary systemic amyloidosis (AL). Like inflammatory myopathies, it presents with proximal muscle weakness and an increased creatine kinase level. We describe a case of AL with severe, rapidly progressive myopathy as the initial symptom. The clinical manifestation and muscle biopsy were suggestive of inclusion body myositis. AM was not suspected until amyloidosis was seen in the gastric mucosal biopsy. The muscle biopsy was then re-examined more specifically, and Congo red staining eventually showed vascular and interstitial amyloid accumulation, which led to a diagnosis of AM. The present case illustrates the fact that the clinical picture of AM can mimic that of inclusion body myositis.

Copper abolishes the beta-sheet secondary structure of preformed amyloid fibrils of amyloid-beta(42)

The observation of the co-deposition of metals and amyloid-beta(42) (Abeta(42)) in brain tissue in Alzheimer's disease prompted myriad investigations into the role played by metals in the precipitation of this peptide. Copper is bound by monomeric Abeta(12) and upon precipitation of the copper-peptide complex thereby prevents Abeta(42) from adopting a beta-sheet secondary structure. Copper is also bound by beta-sheet conformers of Abeta(42), and herein we have investigated how this interaction affects the conformation of the precipitated peptide. Copper significantly reduced the thioflavin T fluorescence of aged, fibrillar Abeta(42) with, for example, a 20-fold excess of the metal resulting in a ca 90% reduction in thioflavin T fluorescence. Transmission electron microscopy showed that copper significantly reduced the quantities of amyloid fibrils while Congo red staining and polarized light demonstrated a copper-induced abolition of apple-green birefringence. Microscopy under cross-polarized light also revealed the first observation of spherulites of Abeta(42). The size and appearance of these amyloid structures were found to be very similar to spherulites identified in Alzheimer's disease tissue. The combined results of these complementary methods strongly suggested that copper abolished the beta-sheet secondary structure of pre-formed, aged amyloid fibrils of Abeta(42). Copper may protect against the presence of beta-sheets of Abeta(42) in vivo, and its binding by fibrillar Abeta(42) could have implications for Alzheimer's disease therapy.

Chromoendoscopic surveillance in hereditary diffuse gastric cancer: an alternative to prophylactic gastrectomy?

BACKGROUND

Hereditary diffuse gastric cancer (HDGC) is defined by germline mutations in the E-cadherin gene, CDH-1. The first family in which CDH-1 mutations were identified was a large Maori kindred, where lifetime penetrance is 70%. Prophylactic gastrectomy is an unacceptable option for many mutation carriers. The results of annual chromoendoscopic surveillance using the methylene blue/congo red technique in 33 mutation carriers over a five year period are described.

PATIENTS AND METHODS

Thirty three confirmed CDH-1 mutation carriers (18 males, 15 females), median age 32 years (range 14-69), were enrolled in 1999-2003. Medical records, endoscopy, and pathology were reviewed retrospectively.

RESULTS

Over five years, 99 surveillance endoscopies were performed, of which 93 were chromo-dye enhanced. Sixty nine chromoendoscopies were normal. In 24 procedures, 1-6 pale areas/stomach (size 2-10 mm) were detected post chromo-dye application (totalling 56 pale lesions). One biopsy was taken from each pale lesion: 23 lesions (41%) showed signet ring cell carcinoma (10 patients), 10 lesions (18%) gastritis (four patients), and 23 (41%) normal mucosa (10 patients). No chromo-dyes were used in six procedures with macroscopic lesions (two HDGC, four ulceration). Total gastrectomies from patients with carcinoma were macroscopically normal but pathological mapping showed multiple microscopic foci of early signet ring cell carcinoma. Correlation of chromoendoscopic and gastrectomy findings showed that congo red/methylene blue detected carcinoma foci 4-10 mm in size but not foci <4 mm.

CONCLUSIONS

The use of chromoendoscopy following normal white light gastroscopy facilitated detection of early gastric carcinoma foci not visible with white light gastroscopy. If these findings are validated in other HDGC kindred, chromogastroscopy represents an improved surveillance technique that can be safely considered alongside prophylactic gastrectomy.

Cellulose orientation in the outer epidermal wall of angiosperm roots: implications for biosystematics

The net orientation of cellulose fibrils in the outer epidermal wall of the root elongation zone of 57 angiosperm species belonging to 29 families was determined by means of Congo Red fluorescence and polarization confocal microscopy. The angiosperms can be divided in three groups. In all but four plant families, the net orientation of the cellulose fibrils is transverse to the root axis. Three families, the Poaceae, Juncaceae and Cyperaceae, have a totally different organization. In the root elongation zone of these plants, the net orientation of cellulose fibrils in the outer epidermal wall is parallel with the root axis. In roots of one family, the Arecaceae, an elongation zone in the literal sense of the word is absent and cellulose fibrils are randomly oriented.

Alpha-1-antichymotrypsin promotes beta-sheet amyloid plaque deposition in a transgenic mouse model of Alzheimer's disease

Alpha(1)-antichymotrypsin (ACT), an acute-phase inflammatory protein, is an integral component of the amyloid deposits in Alzheimer's disease (AD) and has been shown to catalyze amyloid beta-peptide polymerization in vitro. We have investigated the impact of ACT on amyloid deposition in vivo by generating transgenic GFAP-ACT-expressing mice and crossing them with the PDGF-hAPP/V717F mice, which deposit amyloid in an age-dependent manner. The number of amyloid deposits measured by Congo Red birefringence was increased in the double ACT/amyloid precursor protein (APP) transgenic mice compared with transgenic mice that only expressed APP, particularly in the hippocampus where ACT expression was highest, and the increase was preceded by elevated total amyloid beta-peptide levels at an early age. Our data demonstrate that ACT promotes amyloid deposition and provide a specific mechanism by which inflammation and the subsequent upregulation of astrocytic ACT expression in AD brain contributes to AD pathogenesis.

Sequential mechanism of solubilization and refolding of stable protein aggregates by a bichaperone network

A major activity of molecular chaperones is to prevent aggregation and refold misfolded proteins. However, when allowed to form, protein aggregates are refolded poorly by most chaperones. We show here that the sequential action of two Escherichia coli chaperone systems, ClpB and DnaK-DnaJ-GrpE, can efficiently solubilize excess amounts of protein aggregates and refold them into active proteins. Measurements of aggregate turbidity, Congo red, and 4,4'-dianilino-1, 1'-binaphthyl-5,5'-disulfonic acid binding, and of the disaggregation/refolding kinetics by using a specific ClpB inhibitor, suggest a mechanism where (i) ClpB directly binds protein aggregates, ATP induces structural changes in ClpB, which (ii) increase hydrophobic exposure of the aggregates and (iii) allow DnaK-DnaJ-GrpE to bind and mediate dissociation and refolding of solubilized polypeptides into native proteins. This efficient mechanism, whereby chaperones can catalytically solubilize and refold a wide variety of large and stable protein aggregates, is a major addition to the molecular arsenal of the cell to cope with protein damage induced by stress or pathological states.