Binary Pluronics based mixed micellar systems: Effective solution for improved solubilization of Biochanin A

The present work was carried out to appraise the solubilization of Biochanin (BCA), a natural hydrophobic drug in pure Pluronics (P84, P123 and F127) as well as binary mixed micelles (P84-P123 and F127-P123) followed by an interactional study using various state of art techniques. The critical micelle concentration (CMC) of binary mixtures P84-P123 and F127-P123 was found to be significantly lower than pure Pluronics justifying the candidature of mixed micelles (MMs) as a better solubilizer for BCA. UV-visible studies revealed the enhanced solubility of BCA in P84-P123 (1:2) MMs (3.51 ± 0.087 mg/mL) and F127-P123 (1:2) MMs (2.94 ± 0.046 mg/mL) as compared to micelles of pure Pluronics (10% w/v), P84 (2.25 ± 0.039 mg/mL) and F127 (1.12 ± 0.036 mg/mL). Differential pulse voltammetry (DPV) results demonstrated significantly superior binding of BCA with P84-P123 (1:2) MM (Ka = 2.60 × 105 M-1) as compared to pure P84 (Ka = 1.415 × 105 M-1). Mixed micellization (P84-P123 (1:2)) leads to increase in micellar hydrodynamic diameter (Dh = 16.09 nm) as compared to pure Pluronic P84 micelles (Dh = 15.71 nm) which was further amplified (Dh = 17.69 nm) after BCA loading. Different formulations of pure and MMs were subjected to in vitro drug release and MMs were found to slow down BCA release as compared to pure Pluronics (P84, P123). The results obtained in this study proved that P84-P123 (1:2) MMs are superior and more effective for the solubilization of BCA than pure and other MMs. Thus, the examined MMs hold the potential for advancing the development of solubilization techniques for other hydrophobic drugs with significant pharmacological value.

Improving the ACS Triage-Using High Sensitivity TroponinI and Copeptin for Early 'Rule-Out' of AMI

Rule-out of acute myocardial infarction (AMI) in patients presenting with acute chest pain at the emergency department (ED) is a major challenge across the globe. Patients presenting very early with chest pain may provide a diagnostic challenge even when using a cardiac necrosis specific biomarker, high sensitivity troponin (hs-Tn) as they are elevated at 3-6 h after the symptom onset. Copeptin is a marker of acute hemodynamic stress which is released within few minutes of the occurrence of MI and is elevated immediately at the presentation of patients with AMI. This indicates a complementary pathophysiology and kinetics of these two biomarkers. Hence, we evaluated whether or not a protocol with combined testing of copeptin and hs-TnI at admission in patients presenting with chest pain within 6 h in low to intermediate risk and suspected ACS leads to an earlier diagnosis of AMI and thereby, aids to prevent a higher proportion of major adverse cardiac events than the current standard protocol followed in ED. A total of 148 patients as per the inclusion criterion were recruited for the study. The dual biomarker copeptin and hs-TnI allows a rule-out of AMI at presentation with a sensitivity of 100% and NPV of 99.8%. Hence, the use of dual biomarker in conjunction with clinical assessment may obviate the need for a prolonged stay in the ED and retesting hs-TnI after 2 h (for delta check) in more than two-thirds of the patients. The inclusion of these tests could have an impact on the economic burden of the ED without jeopardizing the outcome for the patient.

Factors Affecting School Performance in the Adolescents of USA- Youth Risk Behavior Surveillance System

Introduction

Poor academic performance has been linked to factors such as sleep, health, illicit drug use, physical fighting, social media use, cyber bullying, physical activity, homelessness, times spent in video games and television. It is difficult to get a sense of the interplay between and relative importance of different behaviours/factors on academic performance as only limited research has been aimed at quantifying these factors.

Objectives

To evaluate association of school performance and variables in five categories of the YRBSS: physical fighting, diet/lifestyle, electronic device usage, concurrent substance use, and violence/self-harm.

Methods

The CDC Youth Risk Behavior Surveillance System (YRBSS) data from 1991-2019 was used in study. Respondents were grouped by good and poor school performance and variables related to nutrition/lifestyle, electronic device use, concurrent substance use, mood/violence/self-harm were analyzed using chi-square test.

Results

A total of 41,235 student respondents.Nutrition/Lifestyle, electronic device use, concurrent substance use, mood/violence/self-harm are found to be significantly correlated with school performance.

	Poor Performance n(%)	Good Performance n(%)	Total n(%)	p-Value
Nutrition/Lifestyle
Daily breakfast	2,715(26)	11,429(38.22)	14,144(35.06)	<0.0001
Sodas ≥2/day	1,998(19.12)	2,710(9.03)	4,708(11.63)	<0.0001
Concurrent Substance Use
Alcohol use	3,544(37.55)	8,067(28.49)	11,611(30.75)	<0.0001
Cigarette smoking	1,616(15.74)	1,845(6.17)	3,461(8.61)	<0.0001
Mood/Violence/Self-Harm
Difficulty concentrating	4,188(46.34)	7,327(28.27)	11,516(32.94)	<0.0001
Felt sad or hopeless	4,373(41.06)	9,038(29.67)	13,410(32.62)	<0.0001
Considered suicide	2,567(24.14)	4,810(15.8)	7,377(17.96)	<0.0001

Conclusions

In national data, we found school performance is affected by nutrition, lifestyle, substance use, mood and exposure to surrounding violence, and self-harm. Further studies should be planned to evaluate benefits from the risk stratification to reduce this burden amongst US adolescents.

Disclosure

No significant relationships.

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Molecularly Imprinted Polymer Nanoparticles Enable Rapid, Reliable, and Robust Point-of-Care Thermal Detection of SARS-CoV-2

Rapid antigen tests are currently used for population screening of COVID-19. However, they lack sensitivity and utilize antibodies as receptors, which can only function in narrow temperature and pH ranges. Consequently, molecularly imprinted polymer nanoparticles (nanoMIPs) are synthetized with a fast (2 h) and scalable process using merely a tiny SARS-CoV-2 fragment (∼10 amino acids). The nanoMIPs rival the affinity of SARS-CoV-2 antibodies under standard testing conditions and surpass them at elevated temperatures or in acidic media. Therefore, nanoMIP sensors possess clear advantages over antibody-based assays as they can function in various challenging media. A thermal assay is developed with nanoMIPs electrografted onto screen-printed electrodes to accurately quantify SARS-CoV-2 antigens. Heat transfer-based measurements demonstrate superior detection limits compared to commercial rapid antigen tests and most antigen tests from the literature for both the alpha (∼9.9 fg mL-1) and delta (∼6.1 fg mL-1) variants of the spike protein. A prototype assay is developed, which can rapidly (∼15 min) validate clinical patient samples with excellent sensitivity and specificity. The straightforward epitope imprinting method and high robustness of nanoMIPs produce a SARS-CoV-2 sensor with significant commercial potential for population screening, in addition to the possibility of measurements in diagnostically challenging environments.

Understanding aquaporin regulation defining silicon uptake and role in arsenic, antimony and germanium stress in pigeonpea (Cajanus cajan)

Understanding of aquaporins (AQPs) facilitating the transport of water and many other small solutes including metalloids like silicon (Si) and arsenic (As) is important to develop stress tolerant cultivars. In the present study, 40 AQPs were identified in the genome of pigeonpea (Cajanus cajan), a pulse crop widely grown in semi-arid region and areas known to affected with heavy metals like As. Conserved domains, variation at NPA motifs, aromatic/arginine (ar/R) selectivity filters, and pore morphology defined here will be crucial in predicting solute specificity of pigeonpea AQPs. The study identified CcNIP2-1 as an AQP predicted to transporter Si (beneficial element) as well as As (hazardous element). Further Si quantification in different tissues showed about 1.66% Si in leaves which confirmed the predictions. Furthermore, scanning electron microscopy showed a higher level of Si accumulation in trichomes on the leaf surface. A significant alleviation in level of As, Sb and Ge stress was also observed when these heavy metals were supplemented with Si. Estimation of relative water content, H₂O₂, lipid peroxidation, proline, total chlorophyll content and other physiological parameters suggested Si derived stress tolerance. Extensive transcriptome profiling under different developmental stages from germination to senescence was performed to understand the tissue-specific regulation of different AQPs. For instance, high expression of TIP3s was observed only in reproductive tissues. Co-expression network developed using transcriptome data from 30 different conditions and tissues, showed interdependency of AQPs. Expression profiling of pigeonpea performed using real time PCR showed differential expression of AQPs after Si supplementation. The information generated about the phylogeny, distribution, molecular evolution, solute specificity, and gene expression dynamics in article will be helpful to better understand the AQP transport system in pigeonpea and other legumes.

Advances in the therapeutic delivery and applications of functionalized Pluronics: A critical review

Pluronic (PEO-PPO-PEO) block copolymers can form nano-sized micelles with a structure composed of a hydrophobic PPO core and hydrophilic PEO shell layer. Pluronics are U.S. Food and Drug Administration approved polymers, which are widely used for solubilization of drugs and their delivery, gene/therapeutic delivery, diagnostics, and tissue engineering applications due to their non-ionic properties, non-toxicity, micelle forming ability, excellent biocompatibility and biodegradability. Although Pluronics have been employed as drug carrier systems for several decades, numerous issues such as rapid dissolution, shorter residence time in biological media, fast clearance and weak mechanical strength have hindered their efficacy. Pluronics have been functionalized with pH-sensitive, biological-responsive moieties, antibodies, aptamers, folic acid, drugs, different nanoparticles, and photo/thermo-responsive hydrogels. These functionalization strategies enable Pluronics to act as stimuli responsive and targeted drug delivery vehicles. Moreover, Pluronics have emerged in nano-emulsion formulations and have been utilized to improve the properties of cubosomes, dendrimers and nano-sheets, including their biocompatibility and aqueous solubility. Functionalization of Pluronics results in the significant improvement of target specificity, loading capacity, biocompatibility of nanoparticles and stimuli responsive hydrogels for the promising delivery of a range of drugs. Therefore, this review presents an overview of all advancements (from the last 15 years) in functionalized Pluronics, providing a valuable tool for industry and academia in order to optimize their use in drug or therapeutic delivery, in addition to several other biomedical applications.

DRESS syndrome induced by imatinib

Drug rash with eosinophilia and systemic symptoms (DRESS syndrome) is a severe, potentially life-threatening drug-induced hypersensitivity reaction characterized by cutaneous eruptions, fever, diffuse lymphadenopathy, along with eosinophilia and elevated liver enzymes. The severity and potential organ damage associated with DRESS mandates withdrawing the offending drug and provide a suitable replacement. We report a 55-year-old man who developed prolonged fever, generalized maculopapular rash and facial edema after 3 weeks of starting imatinib for chronic myeloid leukemia (CML). A diagnosis of DRESS was confirmed by eosinophilia and skin biopsy findings, along with a consistent RegiSCAR score. Imatinib was stopped and he was initiated on low-dose steroids, which led to complete resolution of rash and eosinophilia. A rechallenge with imatinib was positive, and he was switched to dasatinib for further therapy, following which he attained an optimal molecular response. DRESS following imatinib has only been reported in eight patients so far. In this report we summarize the current evidence for managing DRESS and its impact on the treatment of CML.

MIPs for commercial application in low-cost sensors and assays - An overview of the current status quo

Molecularly imprinted polymers (MIPs) have emerged over the past few decades as interesting synthetic alternatives due to their long-term chemical and physical stability and low-cost synthesis procedure. They have been integrated into many sensing platforms and assay formats for the detection of various targets, ranging from small molecules to macromolecular entities such as pathogens and whole cells. Despite the advantages MIPs have over natural receptors in terms of commercialization, the striking success stories of biosensor applications such as the glucose meter or the self-test for pregnancy have not been matched by MIP-based sensor or detection kits yet. In this review, we zoom in on the commercial potential of MIP technology and aim to summarize the latest developments in their commercialization and integration into sensors and assays with high commercial potential. We will also analyze which bottlenecks are inflicting with commercialization and how recent advances in commercial MIP synthesis could overcome these obstacles in order for MIPs to truly achieve their commercial potential in the near future.

Evolutionary Understanding of Aquaporin Transport System in the Basal Eudicot Model Species Aquilegia coerulea

Aquaporins (AQPs) play a pivotal role in the cellular transport of water and many other small solutes, influencing many physiological and developmental processes in plants. In the present study, extensive bioinformatics analysis of AQPs was performed in Aquilegia coerulea L., a model species belonging to basal eudicots, with a particular focus on understanding the AQPs role in the developing petal nectar spur. A total of 29 AQPs were identified in Aquilegia, and their phylogenetic analysis performed with previously reported AQPs from rice, poplar and Arabidopsis depicted five distinct subfamilies of AQPs. Interestingly, comparative analysis revealed the loss of an uncharacterized intrinsic protein II (XIP-II) group in Aquilegia. The absence of the entire XIP subfamily has been reported in several previous studies, however, the loss of a single clade within the XIP family has not been characterized. Furthermore, protein structure analysis of AQPs was performed to understand pore diversity, which is helpful for the prediction of solute specificity. Similarly, an AQP AqcNIP2-1 was identified in Aquilegia, predicted as a silicon influx transporter based on the presence of features such as the G-S-G-R aromatic arginine selectivity filter, the spacing between asparagine-proline-alanine (NPA) motifs and pore morphology. RNA-seq analysis showed a high expression of tonoplast intrinsic proteins (TIPs) and plasma membrane intrinsic proteins (PIPs) in the developing petal spur. The results presented here will be helpful in understanding the AQP evolution in Aquilegia and their expression regulation, particularly during floral development.

Advances in Omics Approaches for Abiotic Stress Tolerance in Tomato

Tomato, one of the most important crops worldwide, has a high demand in the fresh fruit market and processed food industries. Despite having considerably high productivity, continuous supply as per the market demand is hard to achieve, mostly because of periodic losses occurring due to biotic as well as abiotic stresses. Although tomato is a temperate crop, it is grown in almost all the climatic zones because of widespread demand, which makes it challenge to adapt in diverse conditions. Development of tomato cultivars with enhanced abiotic stress tolerance is one of the most sustainable approaches for its successful production. In this regard, efforts are being made to understand the stress tolerance mechanism, gene discovery, and interaction of genetic and environmental factors. Several omics approaches, tools, and resources have already been developed for tomato growing. Modern sequencing technologies have greatly accelerated genomics and transcriptomics studies in tomato. These advancements facilitate Quantitative trait loci (QTL) mapping, genome-wide association studies (GWAS), and genomic selection (GS). However, limited efforts have been made in other omics branches like proteomics, metabolomics, and ionomics. Extensive cataloging of omics resources made here has highlighted the need for integration of omics approaches for efficient utilization of resources and a better understanding of the molecular mechanism. The information provided here will be helpful to understand the plant responses and the genetic regulatory networks involved in abiotic stress tolerance and efficient utilization of omics resources for tomato crop improvement.

Impact of Aromatic Counter-Ions Charge Delocalization on the Micellization Behavior of Surface-Active Ionic Liquids

The nature of counter-ions governs the micellar and structural characteristics of surface-active ionic liquids (SAILs). Especially, the introduction of aromatic counter-ions significantly increases their surface adsorption and induces the formation of various types of aggregates like prolate ellipsoidal micelles, rodlike micelles, vesicles, lamellars, etc. The present study reports the role of charge delocalization of two different aromatic counter-ions in the micellization behavior of their respective SAILs in aqueous medium. For this purpose, we have synthesized two SAILs, namely, 1-tetradecyl-3-methylimidzolium phenolate [C₁₄mim][PO] and 1-tetradecyl-3-methylimidzolium benzoate [C₁₄mim][BZ]. The O-atom of phenolate (PO^-) possesses negative charge, which is delocalized on its phenyl ring. Conversely, the negative charge of benzoate (BZ^-) is not delocalized on its phenyl ring. The more hydrophobic BZ^- counter-ion increases the hydrophobic interactions and reduces the electrostatic repulsions more efficiently as compared to PO^-, which results in a lower critical micelle concentration (cmc) of [C₁₄mim][BZ] than that of [C₁₄mim][PO]. Interfacial properties obtained by tensiometry reveal better surface activity and absorption efficiency of [C₁₄mim][BZ] as compared to [C₁₄mim][PO]. The increase of cmc and degree of counter-ion binding (β) with the rise of temperature for both SAILs has been observed by conductometry. The decrease in the polarity of pyrene microenvironment explains the higher compactness of [C₁₄mim][BZ] aggregates than that of [C₁₄mim][PO], observed by fluorimetry. The position of PO^- and BZ^- is in the stern and palisade layers of C₁₄mim⁺ aggregates, respectively, located by ¹H NMR. The existence of prolate ellipsoidal micelles for both SAILs has been established by small-angle neutron scattering measurements. Thus, the interfacial and bulk properties of [C₁₄mim][PO] lie somewhere in between those of the SAILs having perfect aromatic counter-ions, [C₁₄mim][BZ], and the SAILs having regular inorganic counter-ions like Cl^-, Br^-, etc.

Impact of Aromatic Counter-Ions Charge Delocalization on the Micellization Behavior of Surface-Active Ionic Liquids

The nature of counter-ions governs the micellar and structural characteristics of surface-active ionic liquids (SAILs). Especially, the introduction of aromatic counter-ions significantly increases their surface adsorption and induces the formation of various types of aggregates like prolate ellipsoidal micelles, rodlike micelles, vesicles, lamellars, etc. The present study reports the role of charge delocalization of two different aromatic counter-ions in the micellization behavior of their respective SAILs in aqueous medium. For this purpose, we have synthesized two SAILs, namely, 1-tetradecyl-3-methylimidzolium phenolate [C₁₄mim][PO] and 1-tetradecyl-3-methylimidzolium benzoate [C₁₄mim][BZ]. The O-atom of phenolate (PO^-) possesses negative charge, which is delocalized on its phenyl ring. Conversely, the negative charge of benzoate (BZ^-) is not delocalized on its phenyl ring. The more hydrophobic BZ^- counter-ion increases the hydrophobic interactions and reduces the electrostatic repulsions more efficiently as compared to PO^-, which results in a lower critical micelle concentration (cmc) of [C₁₄mim][BZ] than that of [C₁₄mim][PO]. Interfacial properties obtained by tensiometry reveal better surface activity and absorption efficiency of [C₁₄mim][BZ] as compared to [C₁₄mim][PO]. The increase of cmc and degree of counter-ion binding (β) with the rise of temperature for both SAILs has been observed by conductometry. The decrease in the polarity of pyrene microenvironment explains the higher compactness of [C₁₄mim][BZ] aggregates than that of [C₁₄mim][PO], observed by fluorimetry. The position of PO^- and BZ^- is in the stern and palisade layers of C₁₄mim⁺ aggregates, respectively, located by ¹H NMR. The existence of prolate ellipsoidal micelles for both SAILs has been established by small-angle neutron scattering measurements. Thus, the interfacial and bulk properties of [C₁₄mim][PO] lie somewhere in between those of the SAILs having perfect aromatic counter-ions, [C₁₄mim][BZ], and the SAILs having regular inorganic counter-ions like Cl^-, Br^-, etc.

Temperature-Dependent Solubilization of the Hydrophobic Antiepileptic Drug Lamotrigine in Different Pluronic Micelles-A Spectroscopic, Heat Transfer Method, Small-Angle Neutron Scattering, Dynamic Light Scattering, and in Vitro Release Study

Pluronics (tri-block copolymers) have a significant role in the pharmaceutical industry and are being used to enhance the solubility and delivery of hydrophobic drugs in different marketed formulations. However, instability and unsatisfactory drug-loading capacity are the major weak spots of these pluronic micelles. The present research work is designed to solve the existing issues by the solubilization study of hydrophobic drugs in different pluronic micelles at variable temperatures. The solubilization of the hydrophobic antiepileptic drug lamotrigine (LAM) in five different pluronic micelles viz. P84, P85, F127, F108, and F68 was studied at different temperatures, 37, 47, and 57 °C, using UV-visible spectroscopy. The solubilization of LAM in pluronic micelles increased with the increase in temperature. Small-angle neutron scattering (SANS) measurements were used to observe the morphological and structural changes taking place in pluronics by increasing the temperature. The SANS results showed the morphological changes of spherical P84 micelles to prolate ellipsoidal micelles at 57 °C due to remarkable increase in the aggregation number. This morphological conversion was further confirmed by the heat transfer method (HTM) and dynamic light scattering (DLS) measurements. DLS measurements confirmed that LAM-loaded micelles showed a greater hydrodynamic diameter (D h) compared to unloaded micelles, assuring LAM solubilization in the pluronic micelles. The rate of controlled release of LAM from five different pluronic micelles was accessed by using different kinetic models to evaluate the in vitro release profile. This is the first report in which HTM measurements are established for the analysis of morphological changes in the thermoresponsive pluronic micelles in real time. The present work corroborates how we can control the drug-loading capacity, morphological structure of the drug carrier, as well as drug release by simply changing the temperature of pluronic micellar media.

Sodium deoxycholate mediated enhanced solubilization and stability of hydrophobic drug Clozapine in pluronic micelles

In this report, the solubilization behaviour of a hydrophobic drug Clozapine (CLZ) in micellar suspensions of pluronics having different hydrophilic lipophilic balance (HLB) ratios viz. P84, F127 and F108 in the absence and presence of bile salt sodium deoxycholate (SDC) has been studied. UV-Vis spectroscopy has been exploited to determine the solubilization capacity of the investigated micellar systems in terms of drug loading efficiency, average number of drug molecules solubilized per micelle (n_s), partition coefficient (P) and standard free energy of solubilization (∆G^°). The morphological and structural changes taking place in pluronics in different concentration regimes of SDC and with the addition of drug CLZ has been explored using dynamic light scattering (DLS) and small angle neutron scattering (SANS) measurements. The SANS results revealed that aggregation behaviour of pluronic-SDC mixed micelles gets improved in the presence of drug. The micropolarity measurements have been performed to shed light on the locus of solubilization of the drug in pure and mixed micellar systems. The compatibility between CLZ and drug carriers (pluronics and SDC) was confirmed using powder X-ray diffraction (PXRD) and Fourier transform infrared spectroscopy (FTIR) techniques. Among the investigated systems, P84-SDC mixed system was found to be highly efficient for CLZ loading. The long term stability data indicated that CLZ loaded P84-SDC mixed micellar formulation remained stable for 3months at room temperature. Further, it was revealed that the CLZ loaded P84-SDC mixed micelles are converted into CLZ loaded pure P84 micelles at 30-fold dilutions which remain stable up to 48-fold dilutions. The results from the present studies suggest that P84-SDC mixed micelles can serve as suitable delivery vehicles for hydrophobic drug CLZ.

Aggregation and Morphological Aptitude of Drug-Based Ionic Liquids in Aqueous Solution

Here, we present how replacing the usual inorganic counter ion with a pharmaceutically active aromatic one can greatly affect the interfacial as well as bulk properties of ionic liquids (ILs). We have synthesized a series of novel drug-based ILs, namely, 1-alkyl-3-methylimidazolium diclofenate ([C _n mim][DF]; n = 6, 8, 10, 12, and 14) abbreviated as DF-ILs, wherein DF^- is a well-recognized analgesic and nonsteroidal anti-inflammatory drug. We show strong synergistic interactions between C _n mim⁺ and aromatic DF^- attributed to reduced electrostatic repulsions and increased hydrophobicity from their incorporation, reflecting a 300-fold smaller critical aggregation concentration than that of their Cl^- analogue [C _n mim][Cl]. Interfacial properties for such strongly associating systems are discussed and clearly established to have remarkably improved properties than those of their Cl^- analogues. The decreasing polarity of the cybotactic region of pyrene with increase in the chain length "n" indicates an increased extent of packing of cationic head groups in the Stern layer. DF^- ion seems to play a vital role in the formation of the resulting aggregates, as probed by small angle neutron scattering and transmission electron microscopy. The thermodynamical insights of the aggregation process have been studied using isothermal titration calorimetry and temperature-dependent conductivity experiments. Unilamellar vesicles are formed at extremely low concentration, and also it is the first report that puts into picture the formation of vesicles for [C₆mim][DF] with such a short chain.

India's first successful intestinal transplant: the road traveled and the lessons learnt

Intestinal transplant is a therapeutic challenge not just surgically but also logistically because of the multidisciplinary expertise and resources required. A large proportion of patients who undergo massive bowel resection and develop intestinal failure have poor outcome, because of inability to sustain long-term parenteral nutrition and limited availability of intestinal and multi-visceral transplantation facilities. We report the first successful isolated intestinal transplant from India.

Use of ABO-incompatible grafts in living donor liver transplantation--first report from India

ABO incompatibility is the commonest reason for rejection of donors in living donor liver transplantation (LDLT). The donor pool could be expanded by 25 % to 35 % if the ABO barrier is overcome. In the absence of pre-conditioning, transplantation across the blood groups is fraught with the almost universal risk of antibody-mediated rejection (AMR) that rapidly leads to graft loss. However, AMR can be prevented by removal of preformed antibodies and reducing their production by B cells. We describe our initial experience of three cases of ABO-incompatible (ABO-i) LDLT: a 42-year-old male, an 8-month-old male and a 28-month-old female, all of blood group O+ who received blood group B + right lobe, B + left lateral segment, and A + left lateral segment liver grafts, respectively. Pre-LDLT conditioning included administration of anti-CD20 antibody (Rituximab(®)) to the adult 4 weeks prior, and four to seven sessions of double-filtration plasmapheresis to all, to remove preformed antibodies and achieve anti-donor blood group antibody (ADA) titers of ≤ 1:16 IgG and ≤ 1:8 IgM, respectively. In addition, cases 1 and 3 received mycophenolate mofetil for 7 days prior to LDLT. After LDLT, all three patients achieved normal graft function over 8-17 days with no evidence of AMR and without the need for further plasmapheresis. Postoperative complications included portal vein thrombosis (one successfully re-explored), CMV (one), Pseudomonas and Klebsiella sepsis (one each), and abdominal collection (one treated with percutaneous drainage). All are currently well with normal graft function and low ADA titers at 8, 16, and 19 months after ABO-i LDLT.

Imaging of the female urethral diverticulum

Female urethral diverticulum is a localized out-pouching of the urethra that is becoming increasingly prevalent, but often poses a diagnostic challenge. Traditionally, conventional voiding cystourethrography has been used to make the preoperative diagnosis. With the development of higher-resolution images acquired through ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI), the anatomy and various abnormalities of the female urethra can be better elucidated. This article focuses on the imaging features of female urethral diverticulum, with emphasis on diagnostic pearls, particularly using MRI. Female urethral diverticulum can be best identified by their location in the posterolateral urethra and by their communication with the urethral lumen. Improved imaging techniques combined with increased physician awareness of urethral diverticulum will lead to more prompt and accurate diagnosis of this entity, leading to better treatment of affected patients.

Teratomas of the tongue present at birth

A large teratoma of the tongue, present at birth, was successfully removed at 32 h of age. It contained immature neural tissue consisting of a loose neurofibrillary matrix with primitive neurons, rossettes, and papillary tissue. Serum alpha fetoprotein was present at 8 days of age, as reported in some patients with malignant teratomas. Our case, however, had no histologic evidence of malignancy, no serum alpha fetoprotein at 7 months of age, and no recurrence at 1 years. The four glossal tumors reported in the literature, including one with immature neural elements, were all present at birth. In 1 case, another teratoma of the tongue was found 5 months after removal of the congenital one. It may not have been a recurrence, as the mass was located in a different area of the tongue. It appears that congenital teratomas of the tongue do not behave in a malignant fashion, at least in the 5 known cases.

Anomalous coronary artery simulating parachute mitral valve

Anomalous left coronary artery, arising from the pulmonary valve, may produce a clinical and radiologic picture mimicking parachute mitral valve (PMV). The pathogenesis is related to left myocardial hypoxia and consequent fibrosis. The authors report a patient with such involvement of the myocardium and contiguous anterior papillary muscle. The result was fibrous atrophy with consequent physiologic and radiologic abnormalities that occur in PMV because of the absence of this muscle, and superficial resemblance to its characteristic morphology.