Surgical challenges of giant parathyroid adenomas weighing 10 g or more

PURPOSE

An average parathyroid adenoma (PA) weighs < 1 g. This study aimed to characterise giant PAs ≥ 10 g (GPAs) to facilitate surgical management of primary hyperparathyroidism (PHPT).

METHODS

All patients with a GPA confirmed on histology were recruited from the Monash University Endocrine Surgery Unit database. Clinical and demographic data were collected and compared to a group of non-GPA patients.

RESULTS

A total of 14 GPAs were identified between 2007 and 2018 out of 863 patients (1.6%) with a single PA excised for PHPT. The GPA patients were compared to a control group of 849 non-GPA patients in the same period with similar mean age (62 ± 16 vs 63 ± 14, P = 0.66) and gender distribution (64% vs 75% female, P = 0.35). Pre-operative calcium (Ca) and parathyroid hormone (PTH) levels were significantly higher in GPA patients (P < 0.001). A higher percentage of GPA patients (79%) had concordant localisation studies (ultrasound and sestamibi) than control patients (59%), (P = 0.13), but they were significantly less likely to undergo MIP (55% vs 82%, P = 0.02). The median GPA weighed 12.5 g (IQR 10.5-24.3). Median serum Ca normalised by day 1 post-operatively, while PTH remained elevated. Both serum Ca and PTH levels were in the normal range at 3 months. All GPA lesions were benign on histopathology.

CONCLUSION

GPAs are rare and display severe clinical and biochemical abnormalities. Despite their large size, concordant pre-operative imaging was not always achieved, and a few patients were suitable for MIP.

A review on the recycling processes of spent auto-catalysts: Towards the development of sustainable metallurgy

Spent auto-catalysts are considered as promising platinum group metals (PGMs) resources based on their rapidly increasing demand along with the underlying uncertainty of the sustainability and long-term availability of PGMs. Recycling spent auto-catalysts presents attractive advantages, particularly for the conservation of primary resources reserves, and for the reduction of negative environmental impact due to exploitation. PGM reclamation is the major aim of recycling operations despite their minor concentration in spent auto-catalysts, which implies that the remaining materials are disposed of as unwanted solid waste after the extraction process. This poses a genuine challenge, as well as a motivation to develop recycling processes for spent auto-catalysts capable of recovering all components/valuable metals, while moderating environmental pollution and global warming. The focus herein involves the description of the available technologies, including pyro- and hydro-metallurgical processes, to recover PGMs from spent auto-catalysts, and specifically an analysis of the developmental trends in recycling methods to ensure "sustainable metallurgy".

Total recycling of all the components from spent auto-catalyst by NaOH roasting-assisted hydrometallurgical route

Total recycling of all valuable metals such as PGMs, Ce, Al and Mg from the spent automobile catalysts has been explored. The alkali roasting was performed under NaOH, 0.5-3.0 g; temperature, 300-800 °C; and time, 10-60 min. The phase transformation from cordierite to the soluble products (NaAlO₂, Na₂MgSiO₄) was influenced by the temperature, following the diffusion-controlled model (E_a(roasting), 6.4 kJ/mol). XRD analysis of the roasted mass revealed that the refractory phases of cordierite and γ-alumina could be eliminated at ≥600 °C at sample-to-NaOH mass ratio, 1:1. The leaching of the roasted mass followed an intermediate-controlled mechanism for aluminum leaching with (E_{a(Al-leaching)} value of 20.3 kJ/mol), while it was diffusion-controlled for magnesium leaching (E_{a(Mg-leaching)}, 8.9 kJ/mol). At the optimum leaching condition (1.0 M H₂SO₄, 90 °C, 60 min, yielding >95% aluminum and magnesium), a significant amount of PGMs was also leached. Thereafter, the cementation process was investigated with Al⁰-powder that could precipitate >99% PGMs within 15 min at 90 °C. The yielded concentrate of PGMs and CeO₂ was subsequently leached in 6.0 M HCl with 2.0 M NaClO₃ that dissolved >97% PGMs, leaving the residue as the CeO₂ concentrate. Individual metals can be recovered by following established separation and purification techniques.

P6155Early computed tomographic evaluation for out-of-hospital cardiac arrest survivors: the CT-FIRST trial

Background

Patients surviving an out-of-hospital cardiac arrest (OHCA) commonly present without an obvious etiology, but computed tomography (CT) can provide rapid, comprehensive anatomic evaluation of potential OHCA causes.

Purpose

To assess the diagnostic capabilities of whole body CT imaging in OHCA survivors.

Methods

From 11/2015 to 2/2018, the CT-FIRST (CT Feasibility In Resuscitated patient for Sudden death Triage) protocol enrolled 104 OHCA survivors without obvious OHCA cause to an early (<6 hours from hospital arrival) dual source Sudden Death CT (SDCT) scan protocol that included a non-contrast head, ECG-gated cardiac/thoracic angiography, and non-gated venous phase abdominal CT's. Cardiac CT analysis was blinded, but other SDCT findings were clinically available. Patients needing urgent cardiac catheterization or hemodynamically unable to tolerate CT were excluded. Primary endpoints were SDCT diagnosis compared to OHCA causes from adjudicated record review, and any significantly altered therapy based on SDCT. Acute coronary syndrome by SDCT was conservatively assumed if >50% stenosis was identified in major coronary artery(ies).

Results

SDCT scans identified 39% (41/104) of all OHCA causes and 95% (41/43) of causes potentially identifiable with SDCT (Table). No inappropriate treatments resulted from SDCT findings. SDCT changed or expedited treatments in 21/23 (95%) patients, including antibiotics, anticoagulants, and invasive evaluations or treatments. SDCT found or confirmed resuscitation complications including liver/spleen laceration (n=5), pneumothorax (n=7), and hemopericardium (n=1).

N=104 OHCA Cause SDCT Diagnosis of OHCA Cause N (%) N (%) Acute coronary syndrome 13 (13%) 13 (100%) Cardiomyopathy 8 (8%) 7 (88%) Pneumonia 11 (11%) 11 (100%) Hemorrhagic stroke 3 (3%) 3 (100%) Pulmonary embolism 4 (3%) 4 (100%) Perforated viscus 2 (2%) 2 (100%) Gut necrosis 1 (1%) 1 (100%) Pulmonary hemorrhage 1 (1%) 1 (100%) Substance use 22 (21%) 0 (0%) Unknown 7 (7%) 0 (0%) Other 32 (31%) 0 (0%)

Conclusion

This pilot study suggests the SDCT protocol has considerable promise to diagnose OHCA causes and complications of resuscitation, as well as change clinical treatment.

Acknowledgement/Funding

Medic One Foundation

Hydrometallurgical recycling of surface-coated metals from automobile-discarded ABS plastic waste

The ammoniacal leaching of surface-coated metals from automobile-discarded ABS plastics followed by their recovery through solvent extraction has been investigated. The leaching of ABS (typically containing 4.1% Cu, 1.3% Ni, and 0.03% Cr) could efficiently dissolve the ammine complexes of Cu and Ni, leaving Cr unleached as fine particles. The optimization studies for achieving the maximum efficiency revealed that the leaching of metal ions in different ammoniacal solutions follows the order CO₃^2- > Cl^- > SO₄^2-. The leaching carried out in a carbonate medium by maintaining the total NH₃ concentration 5.0 M at a NH₄OH/(NH₄)₂CO₃ ratio of 4:1, pulp density of 200 g/L, agitation speed of 400 rpm, temperature of 20 °C, and time of 120 min yielded the optimum efficiency of >99% Cu and Ni (i.e., 8.14 g/L and 2.57 g/L, respectively, in the leach liquor). Subsequently, the solvent extraction of metals from ammoniacal leach liquor as a function of extractant (LIX 84-I) concentration and organic-to-aqueous (O:A) phase ratio was examined. Based on the extraction data, a three-stage counter-current extraction at O:A = 1:1 was validated using 0.8 M LIX 84-I, yielding the quantitative extraction of both metals into the organic phase. Thereafter, the stripping of metals in acid solutions indicated that 0.5 M H₂SO₄ could quantitatively strip Ni from the loaded organic phase; however, ∼27% Cu was also co-stripped. The rest of Cu from the Ni-depleted organic phase was separately stripped with 1.0 M H₂SO₄ that can be directly sent to the electrowinning process. On the other hand, the co-stripped metals from the acidic solution can be easily separated, again using LIX 84-I as the extractant, by adopting the pH-swing method. Finally, a process has been proposed for the hydrometallurgical recovery of surface-coated metals from waste ABS plastics; that does not affect the physicochemical characteristics of the polymer substances for their reuse.

Beyond disease susceptibility-Leveraging genome-wide association studies for new insights into complex disease biology

Genetic studies in complex diseases have been highly successful, but have also been largely one-dimensional: predominantly focusing on the genetic contribution to disease susceptibility. While this is undoubtedly important-indeed it is a pre-requisite for understanding the mechanisms underlying disease development-there are many other important aspects of disease biology that have received comparatively little attention. In this review, I will discuss how existing genetic data can be leveraged to provide new insights into other aspects of disease biology, why such insights could change the way we think about complex disease, and how this could provide opportunities for better therapies and/or facilitate personalised medicine. To do this, I will use the example of Crohn's disease-a chronic form of inflammatory bowel disease that has been one of the main success stories in complex disease genetics. Indeed, thanks to genetic studies, we now have a much more detailed understanding of the processes involved in Crohn's disease development, but still know relatively little about what determines the subsequent disease course (prognosis) and why this differs so considerably between individuals. I will discuss how we came to realise that genetic variation plays an important role in determining disease prognosis and how this has changed the way we think about Crohn's disease genetics. This will illustrate how phenotypic data can be used to leverage new insights from genetic data and will provide a broadly applicable framework that could yield new insights into the biology of multiple diseases.

Development of a New Pulsatile Extracorporeal Life Support Device Incorporating a Dual Pulsatile Blood Pump

A new pulsatile extracorporeal life support device (ECLS) has been developed, designed to sustain pulsatile blood flow during emergency cardiopulmonary resuscitations and cardiopulmonary operations. This device features two identical pulsatile pumps that operate alternately and can therefore provide blood inflow in a more uniform manner than similar systems featuring a single-pump configuration. In order to confirm the presumed benefits of this newly-developed dual pulsatile pump configuration, we have conducted a series of in vitro experiments designed to compare the properties of the new system with a single pump system, specifically with regard to pump delivery rate and active filling efficiency. Our results reveal that the dual pump configuration can, indeed, deliver a higher flow than can the single-pump system, and exhibits an active filling efficiency superior to that of the single-pump configuration. We performed a series of animal experiments to measure the pulsatility of the dual-pump configuration in terms of equivalent energy pressure (EEP). In order to measure EEP, we measured femoral arterial pressure and pump outflow. The results of our animal experiments revealed that the newly-developed pulstile ECLS exhibits sufficient pulsatility in terms of the EEP considerations.

Severe hyperkalaemia complicating parathyroidectomy in patients with end-stage renal disease

We evaluated the incidence of perioperative hyperkalaemia in end-stage renal disease (ESRD) patients undergoing parathyroidectomy and investigated possible contributors to this phenomenon. This was a retrospective cohort study looking at patients who had undergone parathyroidectomy for chronic kidney disease-associated mineral bone disease (CKD-MBD) at The Alfred Hospital, Melbourne, since 2001. Baseline demographics including age, gender, aetiology of renal failure and mode of renal replacement therapy as well as anaesthetic technique and duration of surgery were studied as possible contributors. Perioperative potassium values were compared to preoperative baseline. Following stratification into normokalaemic and hyperkalaemic groups, demographic and operative data were compared. Twenty-two patients met the inclusion criteria with a median (interquartile range, IQR) age of 48.5 (42-59) years. There was a male predominance of 68%. The median (IQR) surgical time was 131 (115-164) minutes. Potassium levels rose perioperatively, with a 27.3% incidence of perioperative hyperkalaemia. Median duration of surgery was longer in the hyperkalaemic patients (167 minutes versus 125 minutes). Following the withdrawal of cinacalcet, parathyroidectomy is increasingly required in ESRD patients with CKD-MBD. Potentially life-threatening hyperkalaemia poses a significant risk in the perioperative period. Serial electrolyte monitoring is crucial to safety in this patient group. A multidisciplinary approach to perioperative management is required to ensure optimal timing of renal replacement therapy and appropriate means of serial blood sampling.

A probiotic combination attenuates experimental colitis through inhibition of innate cytokine production

Inflammatory bowel disease (IBD) is a severe immune cell-mediated syndrome characterised by extensive inflammatory and effector mucosal responses leading to tissue destruction in the colon and small intestine. The leading hypothesis is that dysbiosis of the gut flora causes an excessive immune response and inflammation in the gastrointestinal track. Lactic acid bacteria (LAB) can correct dysbiosis of the normal microbiota. In the current study, the therapeutic potential of seven LAB strains in combination to treat IBD was evaluated using experimental colitis model. This LAB cocktail, designated GI7, includes four strains of Lactobacillus acidophilus, Lactobacillus plantarum, Lactobacillus rhamnosus, Lactococcus lactis, two strains of Bifidobacterium bifidum, Bifidobacterium breve, and one strain of Streptococcus thermophilus. We confirmed that GI7 suppressed pro-inflammatory cytokines in Raw264.7 macrophages. When dextran sulphate sodium-induced colitic mice were treated with GI7, their symptoms of colitis, as assessed by body weight, colon length, myeloperoxidase activity, intestinal bleeding, and histological damage, were reduced compared to untreated mice. In addition, GI7 treatment significantly inhibited the production of innate pro-inflammatory cytokines during colitic progression. Therefore, we suggest that GI7, a combination of seven LAB, has a potential role in the treatment of IBD.

Photoprotective Effect of Carpomitra costata Extract against Ultraviolet B-Induced Oxidative Damage in Human Keratinocytes

Natural marine products show various biological properties such as antiphotoaging, antioxidant, anticancer, and anti-inflammation. This study evaluated the protective effects of the brown alga Carpomitra costata (Stackhouse) Batters (Sporochnaceae) against ultraviolet B (UVB)-provoked damage in human HaCaT keratinocytes. C. costata extract (CCE) effectively reduced superoxide anion, hydroxyl radical, and UVB-stimulated intracellular reactive oxygen species (ROS) levels. CCE also restored the expression and activity of UVB-suppressed antioxidant enzymes. Furthermore, CCE decreased UVB-triggered oxidative damage to cellular components including DNA, protein, and lipid and defended the cells against mitochondrial membrane depolarization-medicated apoptosis. The results of this study indicate that CCE can safeguard human keratinocytes against UVB-induced cellular damage via a potent antioxidant mechanism. CCE may find utility as part of a therapeutic arsenal against the damaging effects of UVB radiation on the skin.

Astrocytes regulate α-secretase-cleaved soluble amyloid precursor protein secretion in neuronal cells: Involvement of group IIA secretory phospholipase A2

Astrocytes are major supportive cells in brains with important functions including providing nutrients and regulating neuronal activities. In this study, we demonstrated that astrocytes regulate amyloid precursor protein (APP) processing in neuronal cells through secretion of group IIA secretory phospholipase A2 (sPLA2-IIA). When astrocytic cells (DITNC) were mildly stimulated with the pro-inflammatory cytokines, such as TNF α and IL-1β, sPLA2-IIA was secreted into the medium. When conditioned medium containing sPLA2-IIA was applied to human neuroblastoma (SH-SY5Y) cells, there was an increase in both cell membrane fluidity and secretion of α-secretase-cleaved soluble amyloid precursor protein (sAPPα). These changes were abrogated by KH064, a selective inhibitor of sPLA2-IIA. In addition, exposing SH-SY5Y cells to recombinant human sPLA2-IIA also increased membrane fluidity, accumulation of APP at the cell surface, and secretion of sAPPα, but without altering total expressions of APP, α-secretases and β-site APP cleaving enzyme (BACE1). Taken together, our results provide novel information regarding a functional role of sPLA2-IIA in astrocytes for regulating APP processing in neuronal cells.

Long noncoding RNA profiles of adrenocortical cancer can be used to predict recurrence

Adrenocortical carcinoma (ACC) is an aggressive malignancy with high rates of recurrence following surgical resection. Long noncoding RNAs (lncRNAs) play an important role in cancer development. Pathogenesis of adrenal tumours have been characterised by mRNA, microRNA and methylation expression signatures, but it is unknown if this extends to lncRNAs. This study describes lncRNA expression signatures in ACC, adrenal cortical adenoma (ACA) and normal adrenal cortex (NAC) and presents lncRNAs associated with ACC recurrence to identify novel prognostic and therapeutic targets. RNA was extracted from freshly frozen tissue with confirmation of diagnosis by histopathology. Focused lncRNA and mRNA transcriptome analysis was performed using the ArrayStar Human LncRNA V3.0 microarray. Differentially expressed lncRNAs were validated using quantitative reverse transcriptase-PCR and correlated with clinical outcomes. Microarray of 21 samples (ten ACCs, five ACAs and six NACs) showed distinct patterns of lncRNA expression between each group. A total of 956 lncRNAs were differentially expressed between ACC and NAC, including known carcinogenesis-related lncRNAs such as H19, GAS5, MALAT1 and PRINS (P≤0.05); 85 lncRNAs were differentially expressed between ACC and ACA (P≤0.05). Hierarchical clustering and heat mapping showed ACC samples correctly grouped compared with NAC and ACA. Sixty-six differentially expressed lncRNAs were found to be associated with ACC recurrence (P≤0.05), one of which, PRINS, was validated in a group of 20 ACCs and also found to be associated with metastatic disease on presentation. The pathogenesis of adrenal tumours extends to lncRNA dysregulation and low expression of the lncRNA PRINS is associated with ACC recurrence.

Wntless regulates dentin apposition and root elongation in the mandibular molar

Wnt signaling plays an essential role in the dental epithelium and mesenchyme during tooth morphogenesis. However, it remains unclear if Wnt ligands, produced from dental mesenchyme, are necessary for odontoblast differentiation and dentin formation. Here, we show that odontoblast-specific disruption of Wntless (Wls), a chaperon protein that regulates Wnt sorting and secretion, leads to severe defects in dentin formation and root elongation. Dentin thickness decreased remarkably and pulp chambers enlarged in the mandibular molars of OC-Cre;Wls(CO/CO) mice. Although the initial odontoblast differentiation was normal in the mutant crown, odontoblasts became cuboidal and dentin thickness was reduced. In immunohistochemistry, Wnt10a, β-catenin, type I collagen, and dentin sialoprotein were significantly down-regulated in the odontoblasts of mutant crown. In addition, roots were short and root canals were widened. Cell proliferation was reduced in the developing root apex of mutant molars. Furthermore, Wnt10a and Axin2 expression was remarkably decreased in the odontoblasts of mutant roots. Deletion of the Wls gene in odontoblasts appears to reduce canonical Wnt activity, leading to inhibition of odontoblast maturation and root elongation.

Osterix regulates tooth root formation in a site-specific manner

Bone and dentin share similar biochemical compositions and physiological properties. Dentin, a major tooth component, is formed by odontoblasts; in contrast, bone is produced by osteoblasts. Osterix (Osx), a zinc finger-containing transcription factor, has been identified as an essential regulator of osteoblast differentiation and bone formation. However, it has been difficult to establish whether Osx functions in odontoblast differentiation and dentin formation. To understand the role of Osx in dentin formation, we analyzed mice in which Osx was subjected to tissue-specific ablation under the control of either the Col1a1 or the OC promoter. Two independent Osx conditional knockout mice exhibited similar molar abnormalities. Although no phenotype was found in the crowns of these teeth, both mutant lines exhibited short molar roots due to impaired root elongation. Furthermore, the interradicular dentin in these mice showed severe hypoplastic features, which were likely caused by disruptions in odontoblast differentiation and dentin formation. These phenotypes were closely related to the temporospatial expression pattern of Osx during tooth development. These findings indicate that Osx is required for root formation by regulating odontoblast differentiation, maturation, and root elongation. Cumulatively, our data strongly indicate that Osx is a site-specific regulator in tooth root formation.

Liquid-liquid extraction of Cd(II) from pure and Ni/Cd acidic chloride media using Cyanex 921: a selective treatment of hazardous leachate of spent Ni-Cd batteries

The present paper is focused on solvent extraction of hazardous Cd(II) from acidic chloride media by Cyanex 921, a new extractant mixed with 10% (v/v) TBP in xylene. The optimum conditions for extraction and stripping of Cd(II) were investigated with an aqueous feed of 0.1 mol/L Cd(II) in 2.0 mol/L HCl. McCabe-Thiele diagram was in good agreement with the simulation studies, showing the quantitative extraction (99.9%) of Cd(II) within two counter-current stages utilizing 0.30 mol/L Cyanex 921 at O/A ratio of 3/2 in 10 min. Stoichiometry of the complexes extracted was determined and confirmed by numerical treatment and graphical method, revealing the formation of HCdCl3 · 2L and HCdCl3 · 4L for Cyanex 921(L) concentration in the range 0.03-0.1 mol/L and 0.1-1.0 mol/L, respectively. The thermodynamic parameters for the extraction of cadmium were also determined. The stripping efficiency of cadmium from the loaded organic with 0.10 mol/L HCl was 99.6% in a three-stage counter-current process at an O/A ratio of 2/3. Cyanex 921 was successfully applied for the separation of Cd(II) from Ni(II) in the simulated leach liquor of spent Ni-Cd batteries. The study demonstrates the applicability of the present hydrometallurgical approach for the treatment of hazardous waste, the spent Ni-Cd batteries.

Seasonal phenology of Amphorophora agathonica (Hemiptera: Aphididae) and spread of viruses in red raspberry in Washington

Amphorophora agathonica (Hottes) is the primary vector of aphid-transmitted viruses in red raspberry in the Pacific Northwest region of the United States. To better understand the biology of the aphid, we estimated the lower developmental threshold and studied the seasonal activity of A. agathonica in commercial fields in northern Washington state. In addition, we monitored the spread of raspberry viruses (raspberry latent virus and raspberry leaf mottle virus, RLMV) to determine how rapidly fields became infected and whether there was a relationship between aphid presence and infection. The lower developmental threshold of A. agathonica was estimated to be 2.7°C. In the field, apterous and alate aphid populations began rapidly increasing at ≍800 growing degree-days and peaked at 1,050 growing degree-days. RLMV spread rapidly, with 30-60% of plants in four different commercial fields testing positive after three growing seasons. There was no discernible relationship between the presence or abundance of aphids based on 10 leaves sampled per plant location, and the odds of that plant becoming infected with RLMV.

Development of biological control of Tetranychus urticae (Acari: Tetranychidae) and Phorodon humuli (Hemiptera: Aphididae) in Oregon hop yards

The temporal development of biological control of arthropod pests in perennial cropping systems is largely unreported. In this study, the development of biological control of twospotted spider mite, Tetranychus urticae Koch, and hop aphid, Phorodon humuli (Schrank), in a new planting of hop in Oregon is described over a period of 9 yr (2005-2013). Both the abundance and diversity of natural enemies increased over time. Known predators of hop aphid (Coccinellidae and Anthocoridae) were present in all years; however, stable biological control of hop aphid was not achieved in most years and aphicides were required to suppress populations at commercially acceptable levels in 5 of 9 yr. Populations of aphidophagous coccinellids developed synchronously with hop aphid populations, and temporal correlations indicated these are the primary predatory insect associated with hop aphid regulation. However, sampling methods did not assess levels of aphid parasitoids and hyperparasitoids and their contribution to biological control was unquantified. Spider mite biological control was associated primarily with predatory mites (Phytoseiidae) and Stethorus spp. (Coccinellidae). The magnitude of temporal correlations of abundance of these predators with spider mites was found to be greatest on the same sampling dates and at lags of 7-14 d. Stable biological control of spider mites occurred after four field seasons, suppressing spider mites to levels similar to those commonly achieved with chemical control. A survey of 11 commercial hop yards in Oregon documented pest and natural enemy densities under commercial management practices over a period of 4 yr (2008-2011). Natural enemy abundance in commercial hop yards was similar to that of a 2- to 3-yr-old hop yard with limited disturbance. Whereas total reliance on biological control for hop aphid is unlikely to be successful, there appears to be unrealized potential for biological control of spider mites in commercial production. Dynamic action thresholds that consider the value of natural enemies are needed for both pests.

Acapsular clinical Staphylococcus aureus isolates lack agr function

Staphylococcus aureus is a major human pathogen causing community- and hospital-acquired infections. Capsule production of S. aureus confers protection against host defence. There is a lack of information concerning the association of capsular polysaccharide (CP) expression and activity of the accessory gene regulator (agr) in clinical S. aureus isolates. Production of CP and agr expression were assessed in 195 S. aureus isolates from infected patients at a German University Hospital. Northern blot analysis revealed that S. aureus strains with a non-functional agr locus were more likely to be CP-negative than strains with a functional agr locus.

Early plasma soluble receptor for advanced glycation end-product levels are associated with bronchiolitis obliterans syndrome

Early epithelial injury after lung transplantation may contribute to development of bronchiolitis obliterans syndrome (BOS). We evaluated the relationship between early postoperative soluble receptor for advanced glycation end-product (sRAGE) levels, a marker of type I alveolar cell injury and BOS. We performed a cohort study of 106 lung transplant recipients between 2002 and 2006 at the University of Pennsylvania with follow-up through 2010. Plasma sRAGE was measured 6 and 24 h after transplantation. Cox proportional hazards models were used to evaluate the association between sRAGE and time to BOS, defined according to ISHLT guidelines. Sixty (57%) subjects developed BOS. The average time to BOS was 3.4 years. sRAGE levels measured at 6 h (HR per SD of sRAGE: 1.69, 95% CI: 1.11, 2.57, p = 0.02) and 24 h (HR per SD of sRAGE: 1.74, 95% CI: 1.14, 2.65, p = 0.01) were associated with an increased hazard of BOS. Multivariable Cox regression indicated this relationship was independent of potential confounders. Elevated plasma sRAGE levels measured in the immediate postoperative period are associated with the development of BOS. Early epithelial injury after transplantation may contribute to the development of fibrosis in BOS.

Excessive Wnt/β-catenin signaling disturbs tooth-root formation

BACKGROUND AND OBJECTIVE

Wingless-type MMTV integration site family (Wnt)/β-catenin signaling plays an essential role in cellular differentiation and matrix formation during skeletal development. However, little is known about its role in tooth-root formation. In a previous study, we found excessive formation of dentin and cementum in mice with constitutive β-catenin stabilization in the dental mesenchyme. In the present study we analyzed the molar roots of these mice to investigate the role of Wnt/β-catenin signaling in root formation in more detail.

MATERIAL AND METHODS

We generated OC-Cre:Catnb(+/lox(ex3)) mice by intercrossing Catnb(+/lox(ex3)) and OC-Cre mice, and we analyzed their mandibular molars using radiography, histomorphometry and immunohistochemistry.

RESULTS

OC-Cre:Catnb(+/lox(ex3)) mice showed impaired root formation. At the beginning of root formation in mutant molars, dental papilla cells did not show normal differentiation into odontoblasts; rather, they were prematurely differentiated and had a disorganized arrangement. Interestingly, SMAD family member 4 was upregulated in premature odontoblasts. In 4-wk-old mutant mice, molar roots were about half the length of those in their wild-type littermates. In contrast to excessively formed dentin in crown, root dentin was thin and hypomineralized in mutant mice. Biglycan and dentin sialophosphoprotein were downregulated in root dentin of mutant mice, whereas dentin matrix protein 1 and Dickkopf-related protein 1 were upregulated. Additionally, ectonucleotide pyrophosphatase/phosphodiesterase 1 was significantly downregulated in the cementoblasts of mutant molars. Finally, in the cementum of mutant mice, bone sialoprotein was downregulated but Dickkopf-related protein 2 was upregulated.

CONCLUSION

These results suggest that temporospatial regulation of Wnt/β-catenin signaling plays an important role in cell differentiation and matrix formation during root and cementum formation.

Leaching studies for tin recovery from waste e-scrap

Printed circuit boards (PCBs) are the most essential components of all electrical and electronic equipments, which contain noteworthy quantity of metals, some of which are toxic to life and all of which are valuable resources. Therefore, recycling of PCBs is necessary for the safe disposal/utilization of these metals. Present paper is a part of developing Indo-Korean recycling technique consists of organic swelling pre-treatment technique for the liberation of thin layer of metallic sheet and the treatment of epoxy resin to remove/recover toxic soldering material. To optimize the parameters required for recovery of tin from waste PCBs, initially the bench scale studies were carried out using fresh solder (containing 52.6% Sn and 47.3% Pb) varying the acid concentration, temperature, mixing time and pulp density. The experimental data indicate that 95.79% of tin was leached out from solder material using 5.5M HCl at fixed pulp density 50 g/L and temperature 90°C in mixing time 165 min. Kinetic studies followed the chemical reaction controlled dense constant size cylindrical particles with activation energy of 117.68 kJ/mol. However, 97.79% of tin was found to be leached out from solder materials of liberated swelled epoxy resin using 4.5M HCl at 90°C, mixing time 60 min and pulp density 50 g/L. From the leach liquor of solder materials of epoxy resin, the precipitate of sodium stannate as value added product was obtained at pH 1.9. The Pb from the leach residue was removed by using 0.1M nitric acid at 90°C in mixing time 45 min and pulp density 10g/L. The metal free epoxy resin could be disposed-of safely/used as filling material without affecting the environment.

Location of the mechanism of resistance to Amphorophora agathonica (Hemiptera: Aphididae) in red raspberry

The aphid Amphorophora agathonica Hottes (Hemiptera: Aphididae) is an important virus vector in red (Rubus idaeus L.) and black (Rubus occidentalis L.) raspberries in North America. Raspberry resistance to A. agathonica in the form of a single dominant gene named Ag1 has been relied upon to help control aphid-transmitted plant viruses; however, the mechanism of resistance to the insect is poorly understood. Aphid feeding was monitored using an electrical penetration graph on the resistant red raspberry 'Tulameen' and compared with a susceptible control, 'Vintage'. There were no differences in pathway feeding behaviors of aphids as they moved toward the phloem. Once in the phloem, however, aphids feeding on resistant plants spent significantly more time salivating than on susceptible plants, and ingested significantly less phloem sap. This suggests that a mechanism for resistance to A. agathonica is located in the phloem. Reduced ingestion of phloem may result in inefficient acquisition of viruses and is a likely explanation for the lack of aphid-transmitted viruses in plantings of resistant cultivars.

Imaging of muscle injury in the elite athlete

Injuries to muscle in the elite athlete are common and may be responsible for prolonged periods of loss of competitive activity. The implications for the athlete and his/her coach and team may be catastrophic if the injury occurs at a critical time in the athlete's diary. Imaging now plays a crucial role in diagnosis, prognostication and management of athletes with muscle injuries. This article discusses the methods available to clinicians and radiologists that are used to assess skeletal muscle injury. The spectrum of muscle injuries sustained in the elite athlete population is both discussed and illustrated.

Surface-enhanced Raman scattering of whole human blood, blood plasma, and red blood cells: cellular processes and bioanalytical sensing

SERS spectra of whole human blood, blood plasma, and red blood cells on Au nanoparticle SiO(2) substrates excited at 785 nm have been observed. For the sample preparation procedure employed here, the SERS spectrum of whole blood arises from the blood plasma component only. This is in contrast to the normal Raman spectrum of whole blood excited at 785 nm and open to ambient air, which is exclusively due to the scattering of oxyhemoglobin. The SERS spectrum of whole blood shows a storage time dependence that is not evident in the non-SERS Raman spectrum of whole blood. Hypoxanthine, a product of purine degradation, dominates the SERS spectrum of blood after ~10-20 h of storage at 8 °C. The corresponding SERS spectrum of plasma isolated from the stored blood shows the same temporal release of hypoxanthine. Thus, blood cellular components (red blood cells, white blood cells, and/or platelets) are releasing hypoxanthine into the plasma over this time interval. The SERS spectrum of red blood cells (RBCs) excited at 785 nm is reported for the first time and exhibits well-known heme group marker bands as well as other bands that may be attributed to cell membrane components or protein denaturation contributions. SERS, as well as normal Raman spectra, of oxy- and met-RBCs are reported and compared. These SERS results can have significant impact in the area of clinical diagnostics, blood supply management, and forensics.

Rapid bacterial diagnostics via surface enhanced Raman microscopy

There is a continuing need to develop new techniques for the rapid and specific identification of bacterial pathogens in human body fluids especially given the increasing prevalence of drug resistant strains. Efforts to develop a surface enhanced Raman spectroscopy (SERS) based approach, which encompasses sample preparation, SERS substrates, portable Raman microscopy instrumentation and novel identification software, are described. The progress made in each of these areas in our laboratory is summarized and illustrated by a spiked infectious sample for urinary tract infection (UTI) diagnostics. SERS bacterial spectra exhibit both enhanced sensitivity and specificity allowing the development of an easy to use, portable, optical platform for pathogen detection and identification. SERS of bacterial cells is shown to offer not only reproducible molecular spectroscopic signatures for analytical applications in clinical diagnostics, but also is a new tool for studying biochemical activity in real time at the outer layers of these organisms.

Narrowing oF the critical hydration window for cryopreservation of Salix caprea seeds following ageing and a reduction in vigour

We investigated the effects of desiccation, rehydration and cryopreservation on the viability of seeds of a wild mountain species and seven clones of Salix caprea L. Seeds responded differently to all treatments depending on clone, seed initial moisture content (MC) and seed vigour. Fresh seeds of two randomly selected clones tolerated desiccation to MC 8.5-9.6 % FW (0.09-0.11 g water per g dry mass. g/gdw) without any noticeable loss in viability and were successfully cryopreserved at MCs ranging from 8.5 to 23.4 % (0.09-0.30 g/gdw). Storage at 5 degree C for approximately 10 weeks significantly reduced the viability of seed lots of a wild species and of three S. caprea clones, whilst viability of seeds of four other clones remained unaffected. Since all clones tested were genetically derived from one tree, this variation is unlikely to be of maternal origin. Most probably paternal x environmental factors have influenced seed behavior during desiccation and storage. As viability decreased due to partial ageing, seeds became more susceptible to desiccation stress. When seeds of three clones were cryopreserved, the hydration window for survival was wider for highly vigorous seeds (c. 0.05-0.28 g/gdw) than for seeds with intermediate vigour (c. 0.10-0.24 g/gdw) and low vigour (c. 0.20-0.37 g/gdw). Rehydration to MC above 0.15 g/gdw improved germination of low vigour seeds, both in controls and after cryopreservation. In contrast, cryopreservation of high vigour seeds rehydrated to MCs above 0.11 g/gdw resulted in a sharp decrease in normal seedling production. Whilst no effect of cryogenic temperature on germination and normal seedling production was observed when seeds of seven clones were cryopreserved within their hydration windows, the results indicate the need to account for seed lot vigour when designing cryopreservation protocols.

Upregulation of CXCR4 is functionally crucial for maintenance of stemness in drug-resistant non-small cell lung cancer cells

The hypothesis of cancer stem cells has been proposed to explain the therapeutic failure in a variety of cancers including lung cancers. Previously, we demonstrated acquisition of epithelial-mesenchymal transition, a feature highly reminiscent of cancer stem-like cells, in gefitinib-resistant A549 cells (A549/GR). Here, we show that A549/GR cells contain a high proportion of CXCR4+ cells that are responsible for having high potential of self-renewal activity in vitro and tumorigenicity in vivo. A549/GR cells exhibited strong sphere-forming activity and high CXCR4 expression and SDF-1α secretion compared with parent cells. Pharmacological inhibition (AMD3100) and/or siRNA transfection targeting CXCR4 significantly suppressed sphere-forming activity in A549 and A549/GR cells, and in various non-small cell lung cancer (NSCLC) cell lines. A549/GR cells showed enhanced Akt, mTOR and STAT3 (Y705) phosphorylation. Pharmacological inhibition of phosphatidyl inositol 3-kinase or transfection with wild-type PTEN suppressed phosphorylation of Akt, mTOR and STAT3 (Y705), sphere formation, and CXCR4 expression in A549/GR cells, whereas mutant PTEN enhanced these events. Inhibition of STAT3 by WP1066 or siSTAT3 significantly suppressed the sphere formation, but not CXCR4 expression, indicating that STAT3 is a downstream effector of CXCR4-mediated signaling. FACS-sorted CXCR4+ A549/GR cells formed many large spheres, had self-renewal capacity, demonstrated radiation resistance in vitro and exhibited stronger tumorigenic potential in vivo than CXCR4- cells. Lentiviral-transduction of CXCR4 enhanced sphere formation and tumorigenicity in H460 and A549 cells, whereas introduction of siCXCR4 suppressed these activities in A549/GR cells. Our data indicate that CXCR4+ NSCLC cells are strong candidates for tumorigenic stem-like cancer cells that maintain stemness through a CXCR4-medated STAT3 pathway and provide a potential therapeutic target for eliminating these malignant cells in NSCLC.

Bio-processing of solid wastes and secondary resources for metal extraction - A review

Metal containing wastes/byproducts of various industries, used consumer goods, and municipal waste are potential pollutants, if not treated properly. They may also be important secondary resources if processed in eco-friendly manner for secured supply of contained metals/materials. Bio-extraction of metals from such resources with microbes such as bacteria, fungi and archaea is being increasingly explored to meet the twin objectives of resource recycling and pollution mitigation. This review focuses on the bio-processing of solid wastes/byproducts of metallurgical and manufacturing industries, chemical/petrochemical plants, electroplating and tanning units, besides sewage sludge and fly ash of municipal incinerators, electronic wastes (e-wastes/PCBs), used batteries, etc. An assessment has been made to quantify the wastes generated and its compositions, microbes used, metal leaching efficiency etc. Processing of certain effluents and wastewaters comprising of metals is also included in brief. Future directions of research are highlighted.

Evaluation of airborne methyl salicylate for improved conservation biological control of two-spotted spider mite and hop aphid in Oregon hop yards

The use of synthetic herbivore-induced plant volatiles (HIPV) to attract natural enemies has received interest as a tool to enhance conservation biological control (CBC). Methyl salicylate (MeSA) is a HIPV that is attractive to several key predators of two-spotted spider mite, Tetranychus urticae Koch (Acari: Tetranychidae), and hop aphid, Phorodon humuli (Schrank) (Homoptera: Aphididae). A 2-year study was conducted to evaluate the recommended commercial use of MeSA in hop yards in Oregon. Slow-release MeSA dispensers were stapled to supporting poles in 0.5 ha plots and these plots were compared to a paired non-treated plot on each of three farms in 2008 and 2009. Across both years, there was a trend for reduced (range 40-91%) mean seasonal numbers of T. urticae in five of the six MeSA-baited plots. Stethorus spp., key spider mite predators, tended to be more numerous in MeSA-baited plots compared to control plots on a given farm. Mean seasonal densities of hop aphid and other natural enemies (e.g., Orius spp. and Anystis spp.) were similar between MeSA-treated and control plots. Variability among farms in suppression of two-spotted spider mites and attraction of Stethorus spp. suggests that the use of MeSA to enhance CBC of spider mites in commercial hop yards may be influenced by site-specific factors related to the agroecology of individual farms or seasonal effects that require further investigation. The current study also suggests that CBC of hop aphid with MeSA in this environment may be unsatisfactory.

Significance of smoking history and FDG uptake for pathological N2 staging in clinical N2-negative non-small-cell lung cancer

BACKGROUND

This study was conducted to evaluate whether smoking history and the standardized uptake value (SUV) of 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG) uptake are associated with unexpected pathological N2 status (pN2) in non-small-cell lung cancer (NSCLC).

PATIENTS AND METHODS

We analyzed the data of 220 patients who underwent surgical resection with clinical N2-negative status on computed tomography (CT) and positron emission tomography (PET)-CT. The maximum SUV of primary tumor was chosen for logistic analysis.

RESULTS

Seventy-two patients (33%) had never smoked. The SUV ranged from 1.0 to 29.0 (median 9.1). In univariate analysis, adenocarcinomas (P = 0.019), female gender (P = 0.010), N1 on CT (P = 0.025), and N1 PET-CT (P = 0.001) were associated with a high probability of pN2. The proportion of pN2 in never smokers was higher than in ever smokers (26% versus 10% respectively; P = 0.002). The SUV remained on a multivariate logistic model (odds ratio 1.1; 95% confidence interval 1.0-1.2; P = 0.010) and it had a better predictive value in never smokers than in ever smokers (P = 0.017).

CONCLUSIONS

This study indicates an association between smoking history and pN2 in clinically negative N2 NSCLC. The different roles of FDG uptake were also suggested based on smoking history.

Cognitive and functional decline in Huntington's disease: dementia criteria revisited

The importance of designating criteria for diagnosing dementia lies in its implications for clinical treatment, research, caregiving, and decision-making. Dementia diagnosis in Huntington's disease (HD) is often based on criteria developed for Alzheimer's disease requiring memory loss. However, it is likely that other cognitive deficits contribute to functional impairment in HD before memory declines. The goal is to identify cognitive deficits that contribute to functional impairment to support dementia criteria that reflect HD neuropathology. Eighty-four HD mutation-positive subjects completed neuropsychological tests and the Unified Huntington's Disease Rating Scale Functional Independence Scale (FIS). Functional impairment was defined as 80 or below on the FIS. Speed of processing, initiation, and attention measures accounted for 70.0% of the variance in FIS ratings (linear regression) and correctly classified 91.7% of subjects as functionally impaired or intact (logistic regression). Measures of memory, motor impairment except dysarthria, neuroleptic use, and depressed mood did not improve prediction. A definition of HD dementia that includes cognitive impairment in at least two areas of cognition but does not require a memory deficit, in the context of impaired functional abilities and a deteriorating course, more accurately reflects HD neuropathology and could lead to improved research methods and patient care.

Musculoskeletal sonography of the normal foot

Traumatic, degenerative and rheumatological injuries of the foot are common and can be managed by an ever increasing number of treatments and surgical interventions. High-frequency sonography is inexpensive, portable and is unique in allowing true dynamic assessment of the ligamentous, muscular and tendinous structures. The ultrasound technique demonstrates a steep learning curve and requires detailed knowledge of the foot anatomy. Ultrasound assessment plays an important role in the diagnosis and management of injuries of these structures by guiding rehabilitation and surgical intervention without delay. However, intimate knowledge of the ultrasound appearances of the foot anatomy and normal variants is paramount to correctly identify pathological conditions. We describe the normal sonographic appearances of the foot musculoskeletal structures with MR correlation including joints and their ligaments, dorsal and plantar surfaces of the foot, and the arches of the foot and their supporting structures.

The clinical characteristics of Anisakis allergy in Korea

Anisakidae larvae can cause anisakiasis when ingested by humans. Although several groups have reported a gastrointestinal Anisakis allergy among people in Spain and Japan, our report is the first to summarize the clinical features of 10 Anisakis allergy cases in Korea. We enrolled 10 Korean patients (6 men and 4 women) who complained of aggravated allergic symptoms after ingesting raw fish or seafood. Sensitization to Anisakis was confirmed by detecting serum specific IgE to Anisakis simplex. The most common manifestation of anisakiasis was urticaria (100%), followed by abdominal pain (30%) and anaphylaxis (30%). All patients presenting with these symptoms also exhibited high serum specific IgE (0.45 to 100 kU/L) to A. simplex. Nine patients (90%) exhibited atopy and increased total serum IgE levels. The fish species suspected of carrying the Anisakis parasite were flatfish (40%), congers (40%), squid (30%), whelk (10%), and tuna (10%). Anisakis simplex should be considered as a possible causative food allergen in adult patients presenting with urticaria, angioedema, and anaphylaxis following the consumption of raw fish or seafood.

Hospital outbreak of Burkholderia stabilis bacteraemia related to contaminated chlorhexidine in haematological malignancy patients with indwelling catheters

Burkholderia cepacia complex (BCC) is an opportunistic pathogen that occasionally causes hospital outbreaks. This paper describes an outbreak of BCC bacteraemia in haematological malignancy patients related to a contaminated chlorhexidine gluconate solution. Eight BCC isolates were obtained from patients hospitalised in the same ward of a cancer centre in a Korean hospital. A further three BCC isolates were obtained from 0.5% chlorhexidine gluconate used in the same ward. The isolates were identified as B. stabilis and exhibited identical pulsed-field gel electrophoresis profiles. All patients with B. stabilis bacteraemia had indwelling intravenous catheters, which were treated with chlorhexidine to disinfect the catheters. Following identification of the source of contamination, strict controls regarding surveillance cultures for disinfectants have been enforced. No further B. stabilis infections have been found in the hospital.

Enrichment of the metallic components from waste printed circuit boards by a mechanical separation process using a stamp mill

Printed circuit boards incorporated in most electrical and electronic equipment contain valuable metals such as Cu, Ni, Au, Ag, Pd, Fe, Sn, and Pb. In order to employ a hydrometallurgical route for the recycling of valuable metals from printed circuit boards, a mechanical pre-treatment step is needed. In this study, the metallic components from waste printed circuit boards have been enriched using a mechanical separation process. Waste printed circuit boards shredded to <10mm were milled using a stamp mill to liberate the various metallic components, and then the milled printed circuit boards were classified into fractions of <0.6, 0.6-1.2, 1.2-2.5, 2.5-5.0, and >5.0mm. The fractions of milled printed circuit boards of size <5.0mm were separated into a light fraction of mostly non-metallic components and a heavy fraction of the metallic components by gravity separation using a zig-zag classifier. The >5.0mm fraction and the heavy fraction were subjected to two-step magnetic separation. Through the first magnetic separation at 700 Gauss, 83% of the nickel and iron, based on the whole printed circuit boards, was recovered in the magnetic fraction, and 92% of the copper was recovered in the non-magnetic fraction. The cumulative recovery of nickel-iron concentrate was increased by a second magnetic separation at 3000 Gauss, but the grade of the concentrate decreased remarkably from 76% to 56%. The cumulative recovery of copper concentrate decreased, but the grade increased slightly from 71.6% to 75.4%. This study has demonstrated the feasibility of the mechanical separation process consisting of milling/size classification/gravity separation/two-step magnetic separation for enriching metallic components such as Cu, Ni, Al, and Fe from waste printed circuit boards.

Global experiences with vardenafil in men with erectile dysfunction and underlying conditions

OBJECTIVE

Vardenafil has demonstrated efficacy for the pharmacological management of erectile dysfunction (ED). Accumulating evidence suggests that ED is frequently associated with underlying cardiovascular and metabolic conditions which are thought to be involved in the aetiology of ED. The present review aims to summarise and discuss the available evidence for the efficacy, safety and tolerability of vardenafil in patients with underlying conditions including diabetes, hypertension and dyslipidaemia.

METHODS

Relevant articles were identified through a PubMed search of clinical trials and postmarketing surveillance studies of vardenafil in patients with ED including those with diabetes, hypertension and dyslipidaemia.

RESULTS

Across all trials, vardenafil showed good efficacy for the treatment of ED in patients with diabetes, hypertension and dyslipidaemia. Vardenafil also showed a favourable safety and tolerability profile. The concomitant use of medication to treat hypertension or dyslipidaemia was not associated with an increase in adverse events following vardenafil treatment.

CONCLUSIONS

The prevalence of both diagnosed and undiagnosed underlying conditions is high among men with ED. The evidence presented in this review suggests that vardenafil is efficacious and well tolerated in patients with ED and diabetes, hypertension and/or dyslipidaemia and can be recommended as first-line treatment for ED in patients with these conditions.

Multiple sclerosis: chemokine receptor expression on circulating lymphocytes in correlation with radiographic measures of tissue injury

BACKGROUND

Leukocytes expressing inflammatory chemokine receptors (CKRs), most consistently CCR2, CCR5, and CXCR3, have been identified in multiple sclerosis (MS) tissue lesions and provide attractive therapeutic targets. Our previous studies found large inter-individual differences in expression of these CKRs but stable levels over time within subjects. This observation suggests a CKR "set-point" within individuals, which might relate to inflammatory injury in MS. We evaluated the correlation between CKR levels and magnetic resonance imaging (MRI) measures of disease activity.

METHODS

Fifty-five relapsing remitting MS (RRMS) and secondary progressive MS (SPMS) patients were prospectively followed with annual CKR and MRI studies. Multiparameter flow cytometry was used to determine CCR2, CCR5, and CXCR3 expression on CD4 and CD8 cells. Simultaneous cranial MRIs were performed, and quantitative measures of T2, T1, and gadolinium lesions, brain parenchymal fraction (BPF), and whole brain and fractionated magnetization transfer ratio (MTR) were performed using automated software. Spearman's rank correlations evaluated the relationship between CKR levels and MRI measures.

RESULTS

Significant correlations were observed between CXCR3 expression on CD8 cells and measures of new (T1) and total (T1, T2) lesion volumes, lesion MTR, and BPF; higher levels of CXCR3 expression were correlated with greater injury on MRI (|r| = 0.27-0.42). In contrast, CD4 cell CKR expression was only minimally correlated with MRI measures.

CONCLUSIONS

Over 2 years, we observed significant correlations between the percent of CD8 cells expressing CXCR3 and MRI measures of MS inflammatory activity and tissue destruction. These observations are consistent with a pathogenic role for cytotoxic T cells in MS brain and have significant implications regarding T-cell targeted therapeutic strategies.

Clinics in diagnostic imaging (120). Right rhinogenic optic neuritis secondary to mucocoele of the Onodi cell

Acute visual loss can be caused by retrobulbar optic neuritis, radiation optic neuropathy or ischaemic optic neuropathy. Sinusitis affecting the Onodi cell, a posterior ethmoidal air cell that has encroached on the adjacent sphenoid bone forming the optic canal, can present rarely with visual loss. We report a 60-year-old man, who developed a sudden ache on the nasal aspect of his right eye, and deterioration of the vision in his right eye. This case illustrates the typical radiological appearances of the Onodi cell on MR imaging and CT. The diagnosis of right rhinogenic optic neuritis secondary to mucocoele of the Onodi cell was confirmed at surgery. Functional endoscopic sinus surgery with decompression of the Onodi cell was performed. Physicians should be familiar with the presentation, performed. Physicians should be familiar with the presentation, diagnosis and management of this rare but important condition.

Effects of tert-butyl acetate on maternal toxicity and embryo-fetal development in Sprague-Dawley rats

This study investigated the potential adverse effects of tert-butyl acetate (TBAc) on maternal toxicity and embryo-fetal development after maternal exposure of pregnant rats from gestational days 6 through 19. TBAc was administered to pregnant rats by gavage at 0, 400, 800, and 1,600 mg/kg/day. All dams were subjected to a Caesarean section on day 20 of gestation, and their fetuses were examined for any morphological abnormalities. At 1,600 mg/kg, maternal toxicity manifested as increases in the incidence of clinical signs and death, lower body weight gain and food intake, increases in the weights of adrenal glands and liver, and a decrease in thymus weight. Developmental toxicity included a decrease in fetal weight, an increase in the incidence of skeletal variation, and a delay in fetal ossification. At 800 mg/kg, only a minimal developmental toxicity, including an increase in the incidence of skeletal variation and a delay in fetal ossification, were observed. In contrast, no adverse maternal or developmental effects were observed at 400 mg/kg. These results show that a 14-day repeated oral dose of TBAc is embryotoxic at a maternally toxic dose (i.e., 1,600 mg/kg/day) and is minimally embryotoxic at a nonmaternally toxic dose (i.e., 800 mg/kg/day) in rats. However, no evidence for the teratogenicity of TBAc was noted in rats. It is concluded that the developmental findings observed in the present study are secondary effects to maternal toxicity. Under these experimental conditions, the no-observed-adverse-effect level of TBAc is considered to be 800 mg/kg/day for dams and 400 mg/kg/day for embryo-fetal development.