WO3-x nanorods/rGO/AgBiS2 Z-scheme heterojunction with comprehensive spectrum response and enhanced Fenton and photocatalytic activities

Tetracycline (TC) antibiotics and dyes are the prevalent water contaminants, and their removal from the water through photocatalysis is a plausible approach. However, most semiconductors in their pristine form need to be improved to be exploited in photocatalysis owing to poor photoresponse, intense carrier recombination, and inertness without irradiation. Herein, we demonstrate the modification of defective WO3-x by rGO and AgBiS2 in the form of WO3-x/rGO/AgBiS2 (R2). It exploits the superior conductivity and synergism of rGO to inhibit carrier recombination; thereby, Z-scheme heterojunction with AgBiS2 provides high redox potential. Defects in WO3-x enable electron (e-) storage in R2, which decomposes H2O2 to generate ROS without irradiation. Owing to these essences and broad-spectrum response, it removed 93.72, 82.77, and 84.82% of TC during photo-Fenton (PFR), night-Fenton (NFR), and photocatalytic (PCR) reactions, respectively. Its removal rates reached 94.74, 81.54, and 87.50% against rhodamine B (RhB) during PFR, NFR, and PCR, respectively. It is superior to memory catalysis (MC) and conventional Fenton reactions (CFR) because it can perform without and with irradiation across a broader pH range. So, this work is conducive to designing WO3-x-based catalysts to combat environmental and energy crises.

Efficient structure tuning over the defective modulated zirconium metal organic framework with active coordinate surface for photocatalyst CO2 reduction

Structure engineering of zirconium-based metal organic frameworks (MOFs) aims to develop efficient catalysts for transforming intermittent renewable energy into value-added chemical fuels. In order to have a deeper understanding of industrial scaling, it is vital to ascertain the favourable operational parameters that are necessary for projecting at the atomic level. The proposed paradigm provides a robust basis for the efficient design of MOFs based heterogeneous photocatalysts. In this study, set of defective MOF (D-NUiO66) was effectively produced using a modular acidic method. Afterwards, the D-NUiO66 was combined with CeO2 to form the D-CeNUiO66 heterojunction for the purpose of carbon dioxide reduction. The morphological aspect of the composite investigation suggested that D-CeNUiO66 had a mesoporous structure with favourable adsorption properties. The optimized D-CeNUiO66 photocatalyst showed the high activity for the reduction of CO2 to CO, with a rate of 38.6 µmolg-1h-1 and demonstrated remarkable repeatability in terms of CO production. The incorporation of defect sites in the D-NUiO66 enhanced the light response to visible light, resulting in reduced band gap of 2.9 eV. The photoelectrochemical tests indicated that the introduction of defects in the UiO66 and coupling CeO2 in the D-CeNUiO66 composite induced fast charge transfer, therefore suppressing the charge recombination rate. This study provides valuable insights into the use of defective engineering and heterojunction approaches to metal-organic frameworks for photocatalytic applications.

First-principle calculations to investigate structural, electronic, mechanical, optical, and thermodynamic features of promising (La, In)-doped AlSb for optoelectronic applications

CONTEXT

A remarkable change in lattice parameters and bulk modulus is achieved by the suitable addition of Al (Al_1-x La_x Sb) and In (Al_1-x In_x Sb) atoms in the AlSb compound. Electronic responses like band structure, the total partial density of states, and the elemental density of states are thoroughly investigated. The computed values indicate that the binary compound AlSb is an indirect band gap and an optically inactive response. After increasing the doping concentrations (0.25, 0.5, 0.75) of La and In in AlSb, the band gap changes from indirect to direct nature. Hence, Al_1-0.75 La_0.25 Sb, Al_1-0.50 La_0.50 Sb, Al_1-0.75 In_0.25Sb, and Al_1-0.50 In_0.50Sb become optically active. The illustrious roles of Al-3p and In-4d states on the band gap and nonlinear responses of these compounds are extensively explored by the comparison between the computed results of ultra-soft and norm converging pseudopotentials. The excess specific heat (C_V), enthalpy of mixing (Hm), and phonon dispersion curves resulting from the concentrations "x" are estimated in order to investigate the thermodynamic stability responses of the pristine and doped AlSb. The obtained C_V and thermal coefficient statistics for Al_1-x La_x Sb and Al_1-x In_x Sb may be useful for a good mapping of experimental results and examining these compounds' enharmonic responses. There is a valuable change in optical characteristics like dielectric functional, absorption, conductivity, and refractive index due to the addition of (La, In) impurities in AlSb. It is further observed that Al_1-0.75 La_0.25 Sb, Al_1-0.50 La_0.50 Sb, Al_1-0.75 In_0.25Sb, and Al_1-0.50 In_0.50Sb are significantly mechanically stable compared to pristine AlSb. The above results suggest that Al_1-x La_x Sb and Al_1-x In_x Sb are high-performance optical materials and can be promising potential candidates for optoelectronic applications.

METHODS

The structural, electronic, mechanical, vibrational, and optical responses of the pure and doped Al_1-0.75 La_0.25 Sb, Al_1-0.50 La_0.50 Sb, Al_1-0.75 In_0.25Sb, and Al_1-0.50 In_0.50Sb are investigated, using Heydscuseria-Ernzerhof screened hybrid functional (HSEO6) and generalized gradient approximation (GGA) with norm-converging and ultra-soft pseudopotential techniques in the density functional theory.

Skin healing effects of an innovative polymer-based oil Nigella sativa: a rabbit model experimental study

OBJECTIVE

Natural wound dressings composed of gelatin (GEL) and chitosan (CH) impregnated with bioactive compounds (Nigella sativa oil) were prepared and characterized to evaluate their potential application.

MATERIALS AND METHODS

The formulated composite was subjected to γ-irradiation. In vitro, the ferric-reducing antioxidant power (FRAP) assay and antibiofilm activities were evaluated. In vivo, the tissue wound-healing process was studied by applying GEL-CH-Nigella in dorsal skin rabbit tissue. On days 7 and 14, the biochemical biomarker and histological analysis were determined.

RESULTS

At 10 kGy, FRAP assays exhibited the highest antioxidant activity (380 mmol/kg). A significant inhibition of anti-biofilm activity was observed against Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli) (p<0.01). Fourteen days post-surgery, a significant reduction in thiobarbituric acid-reactive compounds (TBARs) was observed compared to the GEL-CH group. Concerning oxidative stress status, GEL-CH-Nigella significantly improved superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) activities. A histological analysis revealed that GEL-CH-Nigella accelerated wound closure and improved collagenisation and enhanced epidermal tissue thickness.

CONCLUSIONS

These results indicate that GEL-CH-Nigella wound dressing is a promising biomaterial for engineered tissue.

Optimal tuning of sigmoid PID controller using Nonlinear Sine Cosine Algorithm for the Automatic Voltage Regulator system

Automatic Voltage Regulator (AVR) is fabricated to sustain the voltage level of a synchronous generator spontaneously. Several control strategies have been introduced into the AVR system with the aim of gaining a better dynamic response. One of the most universally utilized controllers is the Proportional-Integral-Derivative (PID) controller. Despite the PID controller having a relatively high dynamic response, there are still further possibilities to improve in order to obtain more appropriate responses. This paper designed a sigmoid-based PID (SPID) controller for the AVR system in order to allow for an accelerated settling to rated voltage, as well as increasing the control accuracy. In addition, the parameters of the proposed SPID controller are obtained using an enhanced self-tuning heuristic optimization method called Nonlinear Sine Cosine Algorithm (NSCA), for achieving a better dynamic response, particularly with regards to the steady-state errors and overshoot of the system. A time-response specifications index is used to validate the proposed SPID controller. The obtained simulation results revealed that the proposed method was not only highly effective but also greatly improved the AVR system transient response in comparison to those with the modern heuristic optimization based PID controllers.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

Cryptic footprints of rare earth elements on natural resources and living organisms

BACKGROUND

Rare earth elements (REEs) are gaining attention due to rapid rise of modern industries and technological developments in their usage and residual fingerprinting. Cryptic entry of REEs in the natural resources and environment is significant; therefore, life on earth is prone to their nasty effects. Scientific sectors have expressed concerns over the entry of REEs into food chains, which ultimately influences their intake and metabolism in the living organisms.

OBJECTIVES

Extensive scientific collections and intensive look in to the latest explorations agglomerated in this document aim to depict the distribution of REEs in soil, sediments, surface waters and groundwater possibly around the globe. Furthermore, it draws attention towards potential risks of intensive industrialization and modern agriculture to the exposure of REEs, and their effects on living organisms. It also draws links of REEs usage and their footprints in natural resources with the major food chains involving plants, animals and humans.

METHODS

Scientific literature preferably spanning over the last five years was obtained online from the MEDLINE and other sources publishing the latest studies on REEs distribution, properties, usage, cycling and intrusion in the environment and food-chains. Distribution of REEs in agricultural soils, sediments, surface and ground water was drawn on the global map, together with transport pathways of REEs and their cycling in the natural resources.

RESULTS

Fourteen REEs (Ce, Dy, Er, Eu, Gd, Ho, La, Lu, Nd, Pr, Sm, Tb, Th and Yb) were plighted in this study. Wide range of their concentrations has been detected in agricultural soils (<15.9-249.1 μg g^-1) and in groundwater (<3.1-146.2 μg L^-1) at various sites worldwide. They have strong tendency to accumulate in the human body, and thus associated with kidney stones. The REEs could also perturb the animal physiology, especially affecting the reproductive development in both terrestrial and aquatic animals. In plants, REEs might affect the germination, root and shoot development and flowering at concentration ranging from 0.4 to 150 mg kg^-1.

CONCLUSIONS

This review article precisely narrates the current status, sources, and potential effects of REEs on plants, animals, humans health. There are also a few examples where REEs have been used to benefit human health. However, still there is scarce information about threshold levels of REEs in the soil, aquatic, and terrestrial resources as well as living entities. Therefore, an aggressive effort is required for global action to generate more data on REEs. This implies we prescribe an urgent need for inter-disciplinary studies about REEs in order to identify their toxic effects on both ecosystems and organisms.

Effect of Alkali Carbonates (Single, Binary, and Ternary) on Doped Ceria: A Composite Electrolyte for Low-Temperature Solid Oxide Fuel Cells

Samarium-doped ceria (SDC) carbonate has become an attractive electrolyte for fuel cells because of its remarkable ion conductivity and high performance. Different doped ceria-carbonate (single-carbonate SDC, binary-carbonate SDC, and ternary-carbonate SDC) electrolytes were synthesized by the coprecipitation/oxalate method, to optimize the electrochemical performance. The structure; morphology; and thermal, optical, and surface properties have been studied using a variety of techniques. The X-ray diffraction results confirmed the successful incorporation of samarium into ceria as a crystalline structure and inclusion of carbonate, which is amorphous in nature. To analyze the conduction mechanism, direct current conductivity was measured in a H₂/O₂ atmosphere. Doped ceria-binary carbonate ((Li/Na)CO₃-SDC) showed the best conductivity of 0.31 S cm^-1 and power density of 617 mW cm^-2, at 600 °C. The enhancement in the ionic conductivity and performance of the composites is due to the contribution of hybrid ions (O^2-, H⁺). The crystallite size of the composites was in the range 21-41 nm. For the calculation of band gaps, optical absorption spectra of the synthesized powders were analyzed, and they showed a red shift with the band gap energy in the range 2.6-3.01 eV, when compared to that of pure ceria (3.20 eV).

Protective Effect of Guggulipid in High Fat Diet and Middle Cerebral Artery Occlusion (MCAO) Induced Ischemic Cerebral Injury in Rats

AIM

The role of guggulipid was evaluated in high fat diet and middle cerebral artery occlusion (MCAO) induced ischemic cerebral dysfunctions in rats of either sex.

MATERIALS AND METHODS

Ethyl acetate extract of guggul known as guggulipid was prepared and administered to rats. Animals were divided into 9 groups, consisting 6 rats, each receiving different treatments per orally for 8 weeks. Control group rats received normal control diet while rest of the other groups animals were fed high fat diet (HFD) for 8 weeks. Cerebral ischemia was induced for 2 h followed by reperfusion for 22 h. Locomotor activity and grip strength tests were performed immediately after 24 h of reperfusion followed by biochemical estimations and histopathology.

RESULTS

Locomotor activity and grip strength were significantly decreased in HFD and HFD fed MCAO groups and improved significantly in pretreatment groups. Cerebral infarction, thiobarbituric acid reactive substances (TBARs), nitric oxide and tumor necrosis factor alfa (TNFα) levels were increased, pretreatment of guggulipid alone and with aspirin significantly reduced these markers. Reduced glutathione (GSH), superoxide dismutase (SOD) and catalase, levels were decreased but all drug pretreated groups showed significant improvement in those markers.

CONCLUSION

Guggulipid demonstrated neuroprotection owing to its hypolipidemic, antioxidant, anti-inflammatory and anti-thrombotic activities but further research is warranted to confirm its role in cerebral ischemia.

Effect of Sarcosine (a Glycine Transport 1 Inhibitor) and Risperidone (an Atypical antipsychotic Drug) on MK-801 Induced Learning and Memory Deficits in Rats

The present study was carried out to evaluate whether the combined administration of sarcosine with risperidone possess any advantageous effects on dopaminergic and NMDA receptor-mediated glutamatergic neurotransmissions as compared to single drug administration in rats. The Wistar rats were divided into 7 groups each with different treatments. MK-801 (0.1 mg/kg, i.p.) was injected as single dose on 14th day for inducing learning and memory deficits in animals. Sarcosine (300 and 600 mg/kg, i.p.) and risperidone (0.2 mg/kg, i.p.) were administered daily for 14 days. Spatial habituation learning and hole board tests were performed on 14th day followed by measurement of GABA and 5-HT levels in brain tissues of rats. Pretreatment of sarcosine (600 mg/kg, i.p.) non-significantly improved learning and memory deficits induced by non-competitive NMDA receptor antagonist MK-801, significantly increased the GABA and decreased the 5-HT levels (p<0.05). Combined administration of sarcosine (300 mg/kg, i.p.) with risperidone (0.1 mg/kg, i.p.) synergistically improved cognitive deficits significantly, decreased % errors in hole board learning test, and increased centre time, corner time in spatial habituation learning test (p<0.05). The combined administration also potentiated the GABA and decreased 5-HT levels, indicating that the increased synaptic glycine concentrations may enhance NMDA receptor function which is directly linked with increased GABAergic transmission in striatum region and decreased 5-HT levels showed antagonistic action hence, enhancing the cognition. Our results suggest that combined administration of sarcosine with risperidone may strengthen glutamatergic tone in striatum. Thus, it may be a novel regime to improve psychotic symptoms and cognitive deficit in schizophrenia.

Relationship between corneal thickness, corneal curvature, and intraocular pressure before and after laser treatment for simple myopia

PURPOSE

To determine the relationship of central corneal thickness (CCT), curvature (CC), and intraocular pressure (IOP) as determinative factors for corneal biomechanics and in refractive surgery.

METHODS

The study investigated 48 eyes from subjects who visited the Excimer Laser Surgery Clinic at the Department of Ophthalmology. The refractive error, IOP, CCT, and CC were measured in all participants. After 3 months, all examinations were repeated.

RESULTS

Linear regression demonstrated a significant positive relationship between pre- and postoperative CCT, CC, and IOP values. The IOP showed a significant correlation with CCT (P = 0.033) for pre-PRK, but no significant relationship was seen post-PRK. The CCT also correlated significantly with CC both pre- and post-PRK (P < 0.05).

CONCLUSION

The IOP was significantly correlated with CCT before PRK, but its behavior differed after surgery. Nearly the same correlation was seen between CCT and CC before and after the PRK; nevertheless, IOP measurements should be calculated or estimated more precisely after PRK based on CCT corrections.

Comparison of RIPASA and Alvarado scores for the diagnosis of acute appendicitis

INTRODUCTION

The accuracy of the Alvarado score in diagnosing acute appendicitis in an Asian population has been disappointingly low. We prospectively compared the RIPASA score with the Alvarado score for the diagnosis of acute appendicitis.

METHODS

200 consecutive patients who presented to the Accident and Emergency Department with right iliac fossa pain were recruited in the study. Both the RIPASA and Alvarado scores were derived, but decisions for appendicectomy were based on clinical judgement. Receiver operating curve (ROC), sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for both scoring systems were calculated.

RESULTS

Only 192 out of the 200 patients who satisfied the inclusion and exclusion criteria were included in the analysis. At the optimal cut-off threshold score of 7.5 derived from the ROC, the sensitivity, specificity, PPV, NPV and diagnostic accuracy of the RIPASA score were 98.0 percent, 81.3 percent, 85.3 percent, 97.4 percent and 91.8 percent, respectively. At the cut-off threshold score of 7.0 for the Alvarado score, the sensitivity, specificity, PPV, NPV and diagnostic accuracy were 68.3 percent, 87.9 percent, 86.3 percent, 71.4 percent and 86.5 percent, respectively. The RIPASA score correctly classified 98 percent of all patients confirmed with histological acute appendicitis to the high-probability group (RIPASA score greater than 7.5) compared with 68.3 percent with the Alvarado score (Alvarado score greater than 7.0; p-value less than 0.0001).

CONCLUSION

The RIPASA score at a cut-off threshold total score of 7.5 is a better diagnostic scoring system than the Alvarado score for the diagnosis of acute appendicitis in our local setting.

Measuring hip outcomes: common scales and checklists

INTRODUCTION

Assessing the outcomes of patients following surgical interventions is a challenging task. Traditionally the end results of joint replacement were based on morbidity/mortality rates and operative complications. The modern approach to outcomes following Orthopaedic surgery has shifted from the success or failure of implants towards patient satisfaction and the quality of life achieved. The aim of this paper was to identify and analyse the common scoring systems present in the medical literature for evaluating outcomes after hip interventions.

METHODS

A pub-med search was performed using terms 'scoring system, functional outcomes, hip joint'. Specific limitations and exclusion criteria were used and the reference lists of the articles included in the study were subjected to further analysis for identification of additional relevant papers.

RESULTS

293 articles were identified of which 40 met the inclusion criteria. The outcome measures were divided into: (i) hip specific outcomes, (ii) disease-specific measures and (iii) generic quality of life measures. Based on our analysis, we would recommend a combination of the hip specific Oxford Hip Score (OHS) and the disease specific WOMAC score. The OHS is quick and easy to complete, has a very high response rate and is free from clinician bias. On the other hand, the majority of hip pathology is related to degenerative disease, thus making the WOMAC the most appropriate measure to use. Where comparison between different conditions is required, then an additional generic quality of life (QOL) score, such as EQ5D, that can enable comparisons in cost-effectiveness term can be used.

CONCLUSION

The ideal outcome measure should be one that is specific for the hip joint, possesses a generic component and takes into consideration co-morbidities and the use of walking aids. Although many validated generic measures exist, additional validation studies, including the OHS, are desirable to evaluate all the hip specific measures of outcome.

Outcome of traumatic subtrochanteric femoral fractures fixed using cephalo-medullary nails

We performed a retrospective review of 101 patients sustaining 102 traumatic, non-pathological subtrochanteric fractures treated with cephalo-medullary nailing over a period of 6 years from 1999 to 2005. Mean follow up was 24 weeks (range: 6-96). Twenty patients were lost to follow up and 21 died, whilst 57 of 60 fractures were followed to union. There were 19 fractures fixed in varus, as defined as a varus angulation of greater than 10 degrees at the fracture site. Implant failure, 9 of the 10 malunions and all 3 of the non-unions occurred in the varus group whilst only 1 malunion occurred in the satisfactory reduction group. This difference in outcome is statistically significant (p<0.0001). Twenty four of the 60 patients had undergone open reduction at the time of fixation. There were three malunions and one non-union in the open reduction group compared with six and two, respectively in the closed group (p>0.05). Post-operative recovery rates, infection rates and other complications were similar for both groups. We therefore advocate the use of open reduction where necessary to avoid varus malreduction to avoid such complications, particularly as open reduction was not associated with a higher complication rate in this series. The study supports the use of cephalo-medullary nailing for subtrochanteric fractures with a union rate of 95%.

Intracellular biopolymer productions using mixed microbial cultures from fermented POME

This study aimed to produce polyhydroxyalkanoates (PHAs) from organic wastes by mixed bacterial cultures using anaerobic-aerobic fermentation systems. Palm oil mill effluent (POME) was used as an organic source, which was cultivated in a two-step-process of acidogenesis and acid polymerization. POME was operated in a continuous flow anaerobic reactor to access volatile fatty acids (VFAs) for PHAs production. During fermentation, VFA concentration was produced in the range of 5 to 8 g/L and the COD concentration reduced up to 80% from 65 g/L. The VFA from anaerobic fermentation was then utilised for PHA production using a mixed culture in availability of aerobic bioreactor. Production of PHAs was recorded high when using a high volume of substrates because of the higher VFA concentration. Even though the maximum PHA content was observed at only 40% of the cell dried weight (CDW), their production and performance are significant in mixed microbial culture.

Effects of passive smoking on children's health: a review

Since the mid-1980s there has been increasing interest in the effects of passive smoking on the health of children. It has been estimated that the total nicotine dose received by children whose parents smoke is equivalent to their actively smoking between 60 and 150 cigarettes per year. This review article considers the evidence for a relationship between passive smoking and disorders such as: prenatal damage to the fetus; poor growth indicators; respiratory illness; atopy and asthma; coronary heart disease; and sudden infant death syndrome. We conclude that paediatricians should not be complacent about the hazards of passive smoking for children and that public health education efforts should be continued.

Protective role of Delphinium denudatum (Jadwar) against morphine induced tolerance and dependence in mice

Chronic treatment with Delphinium denudatum (Dd) (Jadwar) (family: Ranunculaceae, 200-1600 mg/kg) suppressed morphine withdrawal jumps in a dose-dependent manner, a sign of the development of dependence to opiate as assessed by naloxone (2 mg/kg) precipitation withdrawal on day 10 of testing in mice. Repeated administration of Dd (200-1600 mg/kg) for 9 days attenuated the development of tolerance to the analgesic effect of morphine (10 mg/kg), also produces significant change in tail-flick latency from the saline pretreated group in a dose-dependent manner.

Magnetic resonance imaging of the normal and injured lateral collateral ligaments of the ankle

BACKGROUND AND AIMS

To study the role of MR Imaging in evaluating both normal and injured lateral collateral ligaments of the ankle.

MATERIALS AND METHODS

Twenty-four patients with clinically diagnosed inversion injury to the ankle and 20 healthy volunteers underwent Magnetic Resonance Imaging (MRI) of the ankle with special emphasis on the lateral complex ligaments.

RESULTS

The anterior talofibular (ATFL) and posterior talofibular ligaments (PTFL) were identified in 100% of the ankles of normal volunteers in the axial plane. The PTFL was identified in 100% in the coronal plane. The calcaneofibular ligament (CFL) was identified in 76% of the ankles in the axial, 84% in the coronal and 88% in the sagittal plane. Of the 24 patients with inversion injury, MRI showed ligament abnormalities in 16 patients, ten of these were isolated ATFL tears, five had combined ATFL and CFL tears and one case showed in addition abnormal signal in the PTFL. MRI revealed associated injuries to other ligaments and other soft tissue and osseous structures of the ankle in twelve patients.

CONCLUSION

MRI is a non-invasive, accurate technique for evaluation of the normal and injured lateral collateral ligaments of the ankle.

Complex chromosome 4, 9, and 22 rearrangement in a patient presenting with AML-FAB M2

Fluorescence in situ hybridization (FISH) and the reverse transcription-polymerase chain reaction (RT-PCR) were used to examine a patient presenting with acute myelogenous leukemia (AML) FAB M2, and a complex t(4;9;22)(p14;q34;q11.2). The patient's clinical course was characterized by an aggressive leukemia, resistant to intensive therapy including allogeneic bone marrow transplantation. FISH analysis, using two chromosome painting probes and a BCR/ABL specific probe, confirmed the cytogenetic observation of a 22q11.2-->4p14 and a 4p14-->9q34 exchange, and revealed the presence of a 9q34-->22q11.2, respectively. In addition, RT-PCR demonstrated the presence of a BCR/ABL transcript derived from the major breakpoint cluster region (M-bcr) of the BCR gene. This transcript has been shown to generate an active 210 kDa tyrosine kinase protein more commonly observed in chronic myelogenous leukemia. Because the presentation of AML with this ABL-->BCR fusion product is a rare event, it would seem likely that the additional complex chromosomal rearrangement involving chromosomes 4, 9, and 22 played a role in the aggressive presentation and clinical behavior of this patient's leukemia.

Myelofibrosis and pancytopenia in systemic lupus erythematosus

A 13-year-old Saudi girl presented with severe clinical features of systemic lupus erythematosus of 3 months' duration. In addition to laboratory evidence of the disease, the patient was found to have pancytopenia and myelofibrosis. While pancytopenia was considerably improved by steroids, myelofibrosis was not reversed. The coexistence of myelofibrosis and pancytopenia in patients with systemic lupus erythematosus has been reported, but their possible causal relationship remains unresolved.