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26.  Towards Creating the Perfect In Vitro Cell Model 
Stem Cells International  2016;2016:3459730.
doi:10.1155/2016/3459730
PMCID: PMC4756226  PMID: 26955392
27.  The Characteristics Variation of Hepatic Progenitors after TGF-β1-Induced Transition and EGF-Induced Reversion 
Stem Cells International  2016;2016:6304385.
Profibrogenesis cytokine, transforming growth factor- (TGF-) β1, induces hepatic progenitors experiencing epithelial to mesenchymal transition (EMT) to matrix synthesis cells, even tumor initiating cells. Our previous data found that epidermal growth factor (EGF) blocks and reverses TGF-β1-induced transition. The aim of this study is to determine the characteristic changes of hepatic progenitors after TGF-β1-induced transition and EGF-induced reversion. Hepatic oval cells, rat hepatic progenitors, were isolated from rats fed a choline-deficient diet supplemented with ethionine. TGF-β1-containing medium was used for inducing EMT, while EGF-containing medium was used for reversing EMT. During TGF-β1-induced transition and EGF-induced reversion, hepatic oval cells sustained their progenitor cell marker expression, including α-fetoprotein, albumin, and cytokeratin-19. The proliferation ability and differentiation potential of these cells were suppressed by TGF-β1, while EGF resumed these capacities to the level similar to the control cells. RNA microarray analysis showed that most of the genes with significant changes after TGF-β1 incubation were recovered by EGF. Signal pathway analysis revealed that TGF-β1 impaired the pathways of cell cycle and cytochrome P450 detoxification, and EGF reverted TGF-β1 effects through activating MAPK and PI3K-Akt pathway. EGF reverses the characteristics impaired by TGF-β1 in hepatic oval cells, serving as a protective cytokine to hepatic progenitors.
doi:10.1155/2016/6304385
PMCID: PMC4756202  PMID: 26955393
28.  Taurine Transporter Gene Expression in Mononuclear Blood Cells of Type 1 Diabetes Patients 
Journal of Diabetes Research  2016;2016:7313162.
Background. Taurine transporter gene expression (RNA-TauT) has a role in retinal cell function and is modulated in vitro and in vivo by hyperglycemia and/or oxidative stress. This study was aimed at testing whether RNA-TauT gene expression is modified in blood mononuclear peripheral cells (MPCs) of type 1 diabetic patients, is related to plasma markers of oxidative stress or endothelial dysfunction, or, finally, is related to presence of retinopathy. Methods. RNA-TauT was measured in MPCs by real-time PCR-analysis in 35 type 1 diabetic patients and in 33 age- and sex-matched controls, additionally measuring plasma and cell taurine and markers of oxidative stress and endothelial dysfunction. Results. RNA-TauT, expressed as 2−ΔΔCt, was significantly higher in MPCs of type 1 diabetic patients than in controls [median (interquartile range): 1.32(0.31) versus 1.00(0.15); P = 0.01]. In diabetic patients RNA-TauT was related to HbA1c (r = 0.42; P = 0.01) and inversely to plasma homocysteine (r = −0.39; P = 0.02) being additionally significantly higher in MPCs of patients without retinopathy [(n = 22); 1.36(0.34)] compared to those with retinopathy [(n = 13); 1.16(0.20)], independently from HbA1c or diabetes duration. Conclusions. RNA-TauT gene expression is significantly upregulated in MPCs of type 1 diabetes patients and is related to HbA1c levels and inversely to plasma homocysteine. Finally, in diabetes patients, RNA-TauT upregulation seems to be blunted in patients with retinopathy independently of their metabolic control or longer diabetes duration.
doi:10.1155/2016/7313162
PMCID: PMC4756203  PMID: 26955642
29.  An Evaluation of Root Phytochemicals Derived from Althea officinalis (Marshmallow) and Astragalus membranaceus as Potential Natural Components of UV Protecting Dermatological Formulations 
As lifetime exposure to ultraviolet (UV) radiation has risen, the deleterious effects have also become more apparent. Numerous sunscreen and skincare products have therefore been developed to help reduce the occurrence of sunburn, photoageing, and skin carcinogenesis. This has stimulated research into identifying new natural sources of effective skin protecting compounds. Alkaline single-cell gel electrophoresis (comet assay) was employed to assess aqueous extracts derived from soil or hydroponically glasshouse-grown roots of Althea officinalis (Marshmallow) and Astragalus membranaceus, compared with commercial, field-grown roots. Hydroponically grown root extracts from both plant species were found to significantly reduce UVA-induced DNA damage in cultured human lung and skin fibroblasts, although initial Astragalus experimentation detected some genotoxic effects, indicating that Althea root extracts may be better suited as potential constituents of dermatological formulations. Glasshouse-grown soil and hydroponic Althea root extracts afforded lung fibroblasts with statistically significant protection against UVA irradiation for a greater period of time than the commercial field-grown roots. No significant reduction in DNA damage was observed when total ultraviolet irradiation (including UVB) was employed (data not shown), indicating that the extracted phytochemicals predominantly protected against indirect UVA-induced oxidative stress. Althea phytochemical root extracts may therefore be useful components in dermatological formulations.
doi:10.1155/2016/7053897
PMCID: PMC4756206  PMID: 26953144
30.  The IL-1β Receptor Antagonist SER140 Postpones the Onset of Diabetes in Female Nonobese Diabetic Mice 
Journal of Diabetes Research  2016;2016:7484601.
The cytokine interleukin-1β (IL-1β) is known to stimulate proinflammatory immune responses and impair β-cell function and viability, all critical events in the pathogenesis of type 1 diabetes (T1D). Here we evaluate the effect of SER140, a small peptide IL-1β receptor antagonist, on diabetes progression and cellular pancreatic changes in female nonobese diabetic (NOD) mice. Eight weeks of treatment with SER140 reduced the incidence of diabetes by more than 50% compared with vehicle, decreased blood glucose, and increased plasma insulin. Additionally, SER140 changed the endocrine and immune cells dynamics in the NOD mouse pancreas. Together, the data suggest that SER140 treatment postpones the onset of diabetes in female NOD mice by interfering with IL-1β activated pathways.
doi:10.1155/2016/7484601
PMCID: PMC4756207  PMID: 26953152
31.  Synthesis of Polyformate Esters of Vegetable Oils: Milkweed, Pennycress, and Soy 
Journal of Lipids  2016;2016:3128604.
In a previous study of the characteristics of acyl derivatives of polyhydroxy milkweed oil (PHMWO), it was observed that the densities and viscosities of the respective derivatives decreased with increased chain length of the substituent acyl group. Thus from the polyhydroxy starting material, attenuation in viscosity of the derivatives relative to PHMWO was found in the order: PHMWO ≫ PAcMWE ≫ PBuMWE ≫ PPMWE (2332 : 1733 : 926.2 : 489.4 cSt, resp., at 40°C), where PAcMWE, PBuMWE, and PPMWE were the polyacetyl, polybutyroyl, and polypentanoyl ester derivatives, respectively. In an analogous manner, the densities also decreased as the chain length increased although not as precipitously compared to the viscosity drop. By inference, derivatives of vegetable oils with short chain length substituents on the triglyceride would be attractive in lubricant applications in view of their higher densities and possibly higher viscosity indices. Pursuant to this, we have explored the syntheses of formyl esters of three vegetable oils in order to examine the optimal density, viscosity, and related physical characteristics in relation to their suitability as lubricant candidates. In the absence of ready availability of formic anhydride, we opted to employ the epoxidized vegetable oils as substrates for formyl ester generation using glacial formic acid. The epoxy ring-opening process was smooth but was apparently followed by a simultaneous condensation reaction of the putative α-hydroxy formyl intermediate to yield vicinal diformyl esters from the oxirane. All three polyformyl esters milkweed, soy, and pennycress derivatives exhibited low coefficient of friction and a correspondingly much lower wear scar in the 4-ball antiwear test compared to the longer chain acyl analogues earlier studied.
doi:10.1155/2016/3128604
PMCID: PMC4756210  PMID: 26955488
32.  Load Balancing in Cloud Computing Environment Using Improved Weighted Round Robin Algorithm for Nonpreemptive Dependent Tasks 
The Scientific World Journal  2016;2016:3896065.
Cloud computing uses the concepts of scheduling and load balancing to migrate tasks to underutilized VMs for effectively sharing the resources. The scheduling of the nonpreemptive tasks in the cloud computing environment is an irrecoverable restraint and hence it has to be assigned to the most appropriate VMs at the initial placement itself. Practically, the arrived jobs consist of multiple interdependent tasks and they may execute the independent tasks in multiple VMs or in the same VM's multiple cores. Also, the jobs arrive during the run time of the server in varying random intervals under various load conditions. The participating heterogeneous resources are managed by allocating the tasks to appropriate resources by static or dynamic scheduling to make the cloud computing more efficient and thus it improves the user satisfaction. Objective of this work is to introduce and evaluate the proposed scheduling and load balancing algorithm by considering the capabilities of each virtual machine (VM), the task length of each requested job, and the interdependency of multiple tasks. Performance of the proposed algorithm is studied by comparing with the existing methods.
doi:10.1155/2016/3896065
PMCID: PMC4756214  PMID: 26955656
33.  Differences in GPR30 Regulation by Chlorotriazine Herbicides in Human Breast Cells 
Over 200,000 cases of invasive breast cancer are diagnosed annually; herbicide contaminants in local water sources may contribute to the growth of these cancers. GPR30, a G protein coupled receptor, was identified as a potential orphan receptor that may interact with triazine herbicides such as atrazine, one of the most commonly utilized chlorotriazines in agricultural practices in the United States. Our goal was to identify whether chlorotriazines affected the expression of GPR30. Two breast cancer cell lines, MDA-MB-231 and MCF-7, as well as one normal breast cell line, MCF-10A, were treated with a 100-fold range of atrazine, cyanazine, or simazine, with levels flanking the EPA safe level for each compound. Using real-time PCR, we assessed changes in GPR30 mRNA compared to a GAPDH control. Our results indicate that GPR30 expression increased in breast cancer cells at levels lower than the US EPA drinking water contamination limit. During this treatment, the viability of cells was unaltered. In contrast, treatment with chlorotriazines reduced the expression of GPR30 in noncancerous MCF-10A cells. Thus, our results indicate that cell milieu and potential to metastasize may play a role in the extent of GPR30 response to pesticide exposure.
doi:10.1155/2016/2984081
PMCID: PMC4756223  PMID: 26955487
34.  Post-operative care to promote recovery for thoracic surgical patients: a nursing perspective 
Journal of Thoracic Disease  2016;8(Suppl 1):S71-S77.
The change in patient population leads to an inevitable transformation among the healthcare system. Over the past decades, thoracic surgical technique has been evolving from conventional open thoracotomy to minimally invasive video assisted thoracoscopic surgery (VATS). Thoracic nursing team of Prince of Wales Hospital (PWH) grows together with the evolution and aims at providing holistic and quality care to patients require thoracic operation. In order to enhance patient post-operative recovery, few strategies have been implemented including early mobilization, staff training and clinical audit. On the other hand, nursing case management approach was proved to be a cost-effective method in managing patients. It is also suitable for thoracic patients, especially for those who are suffering from thoracic neoplasm. It is believed that, the introduction of nursing case management approach would provide a better holistic care to the thoracic patients.
doi:10.3978/j.issn.2072-1439.2015.10.68
PMCID: PMC4756229  PMID: 26941973
Perioperative nursing; early ambulation; case management; nursing audit
35.  Telescoping and Gender Differences in the Time Course of Disordered Gambling: Evidence from a General Population Sample 
Addiction (Abingdon, England)  2014;110(1):144-151.
Background and aim
The course of disordered gambling in women has been described as “telescoped” compared with that in men, with a later age at initiation of gambling but shorter times from initiation to disorder. This study examined the evidence, for the first time, for such a telescoping effect in a general population rather than a treatment-seeking sample.
Method
Participants in a large community-based Australian twin cohort (2,001 men, 2,662 women) were assessed by structured diagnostic telephone interviews in which they reported the ages at which they had attained various gambling milestones and additional information to be used as covariates (the types of gambling in which they had participated and history of symptoms of alcohol dependence, major depression, and adult antisocial behavior). Cox proportional hazards regression models were used to examine differences between men and women in the time from gambling initiation to the first disordered gambling symptom and a diagnosis of disordered gambling.
Results
Men had a higher hazards than women for the time to the first disordered gambling symptom (HR = 3.13, p < .0001) and to a diagnosis of disordered gambling (HR = 2.53, p < .0001). These differences persisted after controlling for covariates. Earlier age of initiation was the most potent predictor of progression to the first symptom.
Conclusions
When assessed at the general population level, female gamblers do not appear to show a telescoped disordered gambling trajectory compared with male gamblers.
doi:10.1111/add.12717
PMCID: PMC4270904  PMID: 25171127
36.  MYC and Transcription Elongation 
Most transcription factors specify the subset of genes that will be actively transcribed in the cell by stimulating transcription initiation at these genes, but MYC has a fundamentally different role. MYC binds E-box sites in the promoters of active genes and stimulates recruitment of the elongation factor P-TEFb and thus transcription elongation. Consequently, rather than specifying the set of genes that will be transcribed in any particular cell, MYC’s predominant role is to increase the production of transcripts from active genes. This increase in the transcriptional output of the cell’s existing gene expression program, called transcriptional amplification, has a profound effect on proliferation and other behaviors of a broad range of cells. Transcriptional amplification may reduce rate-limiting constraints for tumor cell proliferation and explain MYC’s broad oncogenic activity among diverse tissues.
The cancer-associated protein MYC is a transcription factor that increases the production of transcripts from active genes. It appears to play an important role at the pause-release and/or elongation stages of transcription.
doi:10.1101/cshperspect.a020990
PMCID: PMC3869279  PMID: 24384817
37.  Children’s Recall of Generic and Specific Labels Regarding Animals and People 
Cognitive development  2015;33:84-98.
Although children tend to categorize objects at the basic level, we hypothesized that generic sentences would direct children’s attention to different levels of categorization. We tested children’s and adults’ short-term recall (Study 1) and longer-term recall (Study 2) for labels presented in generic sentences (e.g., Kids like to play jimjam) versus specific sentences (e.g., This kid likes to play jimjam). Label content was either basic level (e.g., cat, boy) or superordinate (e.g., animal, kid). As predicted, participants showed better memory for label content in generic than specific sentences (short-term recall for children; both short and longer-term recall for adults). Errors typically involved recalling specific noun phrases as generic, and recalling superordinate labels as basic. These results demonstrate that language influences children’s representations of new factual information, but that cognitive biases also lead to distortions in recall.
doi:10.1016/j.cogdev.2014.05.002
PMCID: PMC4292889  PMID: 25598575
generic noun phrases; conceptual development; memory; inference; categorization; language development
38.  Giant leiomyosarcoma: A case report 
Introduction
Uterine leiomyosarcoma is a rare uterine malignancy. Most of the patients lack symptoms or present with a rapidly enlarging pelvic mass.
Presentation of case
We report on a very large leiomyosarcoma in a woman presenting with a 3 months history of rapidly growing adominal mass and fatigue. Laparotomy was performed and diagnosis was confirmed by pathologic and histologic analysis. Patient refused chemotherapy after surgery and died from recurrence at 4th postoperative month.
Discussion
Uterine leiomyosarcomas may follow a rapid clinical course with a doubling time of four weeks. There is no reliable method to distinguish uterine sarcoma from benign leiomyomas preoperatively.
Conclusion
This case represents the largest leiomyosarcoma reported in the literature.
doi:10.1016/j.ijscr.2015.12.042
PMCID: PMC4756200  PMID: 26745314
Leiomyosarcoma; Size; Leiomyoma
39.  Comparison of True and Smoothed Puff Profile Replication on Smoking Behavior and Mainstream Smoke Emissions 
Chemical Research in Toxicology  2014;28(2):182-190.
To estimate exposures to smokers from cigarettes, smoking topography is typically measured and programmed into a smoking machine to mimic human smoking, and the resulting smoke emissions are tested for relative levels of harmful constituents. However, using only the summary puff data—with a fixed puff frequency, volume, and duration—may underestimate or overestimate actual exposure to smoke toxins. In this laboratory study, we used a topography-driven smoking machine that faithfully reproduces a human smoking session and individual human topography data (n = 24) collected during previous clinical research to investigate if replicating the true puff profile (TP) versus the mathematically derived smoothed puff profile (SM) resulted in differences in particle size distributions and selected toxic/carcinogenic organic compounds from mainstream smoke emissions. Particle size distributions were measured using an electrical low pressure impactor, the masses of the size-fractionated fine and ultrafine particles were determined gravimetrically, and the collected particulate was analyzed for selected particle-bound, semivolatile compounds. Volatile compounds were measured in real time using a proton transfer reaction-mass spectrometer. By and large, TP levels for the fine and ultrafine particulate masses as well as particle-bound organic compounds were slightly lower than the SM concentrations. The volatile compounds, by contrast, showed no clear trend. Differences in emissions due to the use of the TP and SM profiles are generally not large enough to warrant abandoning the procedures used to generate the simpler smoothed profile in favor of the true profile.
doi:10.1021/tx500318h
PMCID: PMC4332039  PMID: 25536227
40.  Transsphincteric tumor resection in case of a pararectal solitary fibrous tumor 
Highlights
•We reinvented an “old” surgical approach.•We analyzed data for treatmant of solitary fibrous tumors.•We showed feasibility of transsphincteric surgery.
Transsphincteric resection of rectal tumors was first described about 120 years ago. Nowadays, this approach faded into obscurity due to standardized guidelines and practice in surgical oncology including lymphadenectomy, mesorectal excision and radical dissection of veins. However, transsphincteric resection seems reasonable in some cases, especially if an abdominal approach can be avoided.
In the following, we will present and describe the technique of the transsphincteric approach with its variations in rectal surgery in the case of a rare pararectal tumor.
doi:10.1016/j.ijscr.2015.12.027
PMCID: PMC4756220  PMID: 26773876
Transsphincteric resection; Mesorectum; Kraske approach
41.  Endoscopic evaluation of gastric conduit perfusion in minimally invasive Ivor Lewis esophagectomy 
Highlights
•Indocyanine green fluorescent imaging enables visualization of gastric conduit perfusion in real time.•Endoscopic ICG fluorescent imaging enables a minimally invasive assessment of gastric conduit perfusion and esophagectomy completion.•Minimally invasive esophagectomy using endoscopic ICG fluorescent imaging is a safe and time efficient procedure.
Introduction
Laser-assisted indocyanine green (ICG) fluorescent dye angiography has been used in esophageal reconstructive surgery where it has been shown to significantly decrease the anastomotic leak rate. Recent advances in technology have made this possible in minimally invasive esophagectomy.
Presentation of case
We present a 69-year-old male with a cuT2N0M0 adenocarcinoma of the esophagus at the gastroesophageal junction who presented to our clinic after chemoradiation and underwent a minimally invasive Ivor Lewis esophagectomy. The perfusion of the gastric conduit was assessed intraoperatively using endoscopic ICG fluorescent imaging system. The anastomosis was created at the well-perfused site identified on the fluorescent imaging. The patient tolerated the procedure well, had an uneventful recovery going home on postoperative day 6 and tolerating a regular diet 2 weeks after the surgery.
Discussion
Combination of minimally invasive surgery and endoscopic evaluation of perfusion of gastric conduit provide improved outcomes for surgical treatment for patients with esophageal cancer.
Conclusion
The gastric conduit during minimally invasive Ivor Lewis esophagectomy can be evaluated using endoscopic ICG fluorescent imaging.
doi:10.1016/j.ijscr.2015.12.029
PMCID: PMC4756224  PMID: 26745315
Minimally invasive esophagectomy; Indocyanine green; Laser angiography
42.  Arthroscopic correction for concomitant cam impingement in a patient with idiopathic osteonecrosis of the femoral head: A case report 
Highlights
•It is important to accurately diagnose the status of idiopathic osteonecrosis of the femoral head and to consider another possible pathogenesis when a patient with idiopathic osteonecrosis of the femoral head has hip pain even without femoral-head collapse.•Ignored or misdiagnosed concomitant femoroacetabular impingement in a patient with idiopathic osteonecrosis of the femoral head might leads to poor outcomes of surgical treatments such as bipolar hemiarthroplasty or osteotomies.•In a patient with idiopathic osteonecrosis of the femoral head, it should be paid attention if concomitant femoroacetabular impingement exists or not.
A 53-year-old man presented with pain in the right hip. Radiological examination showed idiopathic osteonecrosis of the femoral head (ONFH) combined with a cam lesion. Findings on physical examination were consistent for femoroacetabular impingement. At surgery, we performed isolated arthroscopic correction for the cam lesion but did not use other treatment options such as hip arthroplasty or osteotomies for the ONFH. At the latest follow-up evaluation 3 years after surgery, findings indicted a satisfactory outcome, with a Harris hip score of 93.2 (compared with 76.4 before surgery), no joint-space narrowing, and no collapse of the femoral head. It is important to accurately diagnose the status of idiopathic ONFH and to consider another possible pathogenesis when a patient with idiopathic ONFH has hip pain even without femoral-head collapse.
doi:10.1016/j.ijscr.2015.12.021
PMCID: PMC4756222  PMID: 26773875
Cam impingement; Osteonecrosis of the femoral head; Hip arthroscopy
43.  Nano-Gold Corking and Enzymatic Uncorking of Carbon Nanotube Cups 
Because of their unique stacked, cup-shaped, hollow compartments, nitrogen-doped carbon nanotube cups (NCNCs) have promising potential as nanoscale containers. Individual NCNCs are isolated from their stacked structure through acid oxidation and subsequent probe-tip sonication. The NCNCs are then effectively corked with gold nanoparticles (GNPs) by sodium citrate reduction with chloroauric acid, forming graphitic nanocapsules with significant surface-enhanced Raman signature. Mechanistically, the growth of the GNP corks starts from the nucleation and welding of gold seeds on the open rims of NCNCs enriched with nitrogen functionalities, as confirmed by density functional theory calculations. A potent oxidizing enzyme of neutrophils, myeloperoxidase (MPO), can effectively open the corked NCNCs through GNP detachment, with subsequent complete enzymatic degradation of the graphitic shells. This controlled opening and degradation was further carried out in vitro with human neutrophils. Furthermore, the GNP-corked NCNCs were demonstrated to function as novel drug delivery carriers, capable of effective (i) delivery of paclitaxel to tumor-associated myeloid-derived suppressor cells (MDSC), (ii) MPO-regulated release, and (iii) blockade of MDSC immunosuppressive potential.
doi:10.1021/ja511843w
PMCID: PMC4308760  PMID: 25530234
44.  Spontaneous aortoenteric fistula involving the sigmoid: A case report and review of literature 
Highlights
•PAEF might have an atypical presentation.•Colonoscopy, ultrasound and surgical examinations can be misleading.•An aggressive diagnostic approach is indicated with the use of a CT-angiography.•Surgical treatment is beneficial for the long-term outcome.
Introduction
Primary aortoenteric fistula (PAEF) is a pathological communication between the aorta and any portion of the gastrointestinal tract. The pathology is very rare and easily overlooked during the diagnostic process.
Presentation of Case
We report the exceptional case of an 86-year-old man with episodes of abdominal pain and rectal bleeding of unknown cause over a period of 1,5 months due to a PAEF to the sigmoid. A sigmoidectomy was performed and a rifampicin-soaked aortic graft was placed. The patient had an uneventful post-operative recovery. The duration of symptoms, the anatomic location of the fistula and the outcome after surgery makes this case unique.
Discussion
With an incidence of 0.04–0.07% in all patients with aortic aneurysms a PAEF is very rare. Only 2% of PAEF's involves the sigmoid. The most common cause is an atherosclerotic aortic aneurysm. Patients with PAEF can present with a triad of symptoms including gastrointestinal bleeding, abdominal pain and a pulsating mass. A contrast-enhanced computer-tomography scan (CTa) is the most accurate tool to demonstrate a PAEF. Without a strong clinical suspicion, diagnosing a PAEF is hard and frequently delayed. The overall PAEF-related mortality is high (61–100%) and decreases after surgery (30–40%).
Conclusion
A primary aortoenteric fistula involving the sigmoid is very rare. Clinical presentation can vary, diagnosis can be difficult and surgical options may differ. Even with low suspicion of PAEF, we recommend performing a CTa. With a high overall mortality of more than 60% due to exsanguinating, surgical treatment is always indicated.
doi:10.1016/j.ijscr.2015.12.015
PMCID: PMC4756094  PMID: 26741274
Primary enteral fistula; Hartmann; Aortic aneurysm; Ruptured aneurysm
45.  Spontaneous rupture of a giant renal angiomyolipoma—Wunderlich’s syndrome: Report of a case 
Highlights
•Swelling of the left lateral abdominal area.•Disruptions of the retroperitoneum and a pulseless, sizeable, abnormal bleeding mass occupied all of the left retroperitoneal area.•Giant haemorrhagic mass (25 × 18 × 8 cm) originated from the left kidney.•Renal angiomyolipoma with haemorrhagic infiltrations.
Introduction
Herein we present a rare case of pontaneous rupture of a giant renal angiomyolipoma (AML), with symptoms of hypovolemic shock (Wunderlich’s syndrome), which was managed by urgent total nephrectomy.
Presentation of case
A 53 year old female was transferred to the emergency room with progressive acute painful swelling of the left lateral abdominal area, duration of 5 h. An emergent ultrasonic examination, revealed a heterogeneous—solid mass with maximum diameter of 23 cm, with probable origin from the left kidney. Due to worsening of the clinical status (hypovolemic shock), loss of consciousness and acute drop of haematocrit level to 17.8%, the patient was urgently intubated in the emergency room and transferred to the operating theater. A giant haemorrhagic mass was found originating from the left kidney, which removed en-block with the left kidney. The patient was transferred to the intensive care unit. Her recovery was uneventful. The histopathologic examination revealed a giant renal angiomyolipoma (25 × 18 × 8 cm) with extensive bleeding.
Discussion
Enlarged renal AMLs can rupture. This can be sudden and painful with manifestations of hypovolemic shock. The management of AMLs has been correlated with symptoms. Patients with life-threatening retroperitoneal haemorrhage, require urgent exploration as retroperitoneal bleeding can lead to severe complications, increasing morbidity.
Conclusion
In case of giant angiomyolipoma with intratumoral haemorrhage, and symptoms of Wunderlich’s syndrome, partial or total nephrectomy is a good treatment option in order to save the patient’s life.
doi:10.1016/j.ijscr.2015.12.017
PMCID: PMC4756198  PMID: 26764888
Giant angiomyolipoma; Wunderlich’s syndrome; Hypovolemic shock; Retroperitoneal hemorrhage; Nephrectomy
46.  Acute acalculous cholecystitis caused by Hepatitis C: A rare case report 
Highlights
•We present a very rare case of acute Acute acalculous cholecystitis (AAC).•Hepatitis C virus infection has not been documented as a cause of Cholecystitis.•Management of AAC mostly conservative, rarely need surgical intervention.•Understanding pathophysiology of AAC in crucial for the management.
Introduction
Acute acalculous cholecystitis (AAC) is rarely encountered in clinical practice and has a high morbidity and mortality. AAC caused by viral hepatitis, with hepatitis A, B and EBV infections are rare, but well documented in the literature. Hepatitis C virus has not been reported as cause of AAC. This case report documents the first case of AAC associated with Acute Hepatitis C.
Presenting concerns
We present a 40 years old female with abdominal pain. She has a history of previous HCV infection. Her liver function tests were markedly deranged with elevated inflammatory markers. USS scan showed rather a very unusual appearance of an inflamed gallbladder with no gallstones and associated acute hepatitis, confirmed by an abdominal CT scan. HCV RNA PCR confirms flair up of the virus. The patient was managed conservatively in the hospital with follow up USS scan and Liver function tests showed complete recovery. Follow up HCV RNA PCR also returned to an undetectable level. The patient recovered completely with no adverse outcomes.
Conclusion
This case report is to the first to document the association between acute HCV and AAC. Despite being uncommon in western countries, viral hepatitis should be suspected as a causative agent of AAC, particularly when there is abnormal liver function test and no biliary obstruction.
doi:10.1016/j.ijscr.2015.12.020
PMCID: PMC4756201  PMID: 26722714
Acute Hepatitis C; Acute acalculous cholecystitis; case report
47.  Impact of sperm DNA chromatin in the clinic 
The paternal contribution to fertilization and embryogenesis is frequently overlooked as the spermatozoon is often considered to be a silent vessel whose only function is to safely deliver the paternal genome to the maternal oocyte. In this article, we hope to demonstrate that this perception is far from the truth. Typically, infertile men have been unable to conceive naturally (or through regular IVF), and therefore, a perturbation of the genetic integrity of sperm heads in infertile males has been under-considered. The advent of intracytoplasmic sperm injection (ICSI) however has led to very successful treatment of male factor infertility and subsequent widespread use in IVF clinics worldwide. Until recently, little concern has been raised about the genetic quality of sperm in ICSI patients or the impact genetic aberrations could have on fertility and embryogenesis. This review highlights the importance of chromatin packaging in the sperm nucleus as essential for the establishment and maintenance of a viable pregnancy.
doi:10.1007/s10815-015-0624-x
PMCID: PMC4758997  PMID: 26678492
Chromatin; Genetic integrity; Aneuploidy; Sperm DNA fragmentation
48.  Trans-femoral thromboaspiration for upper extremity ischemia 
Highlights
•Trans-femoral aspiration of thrombus in upper extremity ischemia is feasible.•Cerebral infarction is a significant complication of surgical embolectomy.•Conservative management results in poor functional outcomes.
Introduction
Endovascular trans-femoral access catheter aspiration of thrombus within the proximal subclavian, brachial, radial and ulnar arteries for symptomatic upper extremity ischemic pain has not been previously reported. We describe a case in which a successful clinical outcome was achieved using long length neuro-endovascular aspiration catheters.
Presentation of case
A 45 year old female presented with diffuse left upper limb pain. Sonography revealed compromised upper extremity blood flow. Thrombus was identified in the proximal left subclavian artery by CT angiography. Surgical retrograde brachial artery access thrombectomy was performed. Occlusion of the left vertebral artery with embolic infarcts of the cerebellar hemispheres was noted post-procedurally.
Trans-femoral mechanical aspiration thrombectomy and angioplasty of the subclavian, brachial, ulnar and radial arteries was subsequently performed with successful recanalization.
Conclusion
Recanalization of vasculature to the upper arm through safer femoral access can be achieved with thrombo-aspiration catheters of sufficient length.
doi:10.1016/j.ijscr.2015.12.006
PMCID: PMC4756093  PMID: 26708945
Upper extremity ischemia; Thromboaspiration
49.  Reversible cardiomyopathy after radiofrequency ablation of 30-year persistent atrial tachycardia 
BMJ Case Reports  2013;2013:bcr2013008727.
Tachycardia-induced cardiomyopathy (TIC) is a reversible form of the left ventricular (LV) systolic dysfunction and is believed to be a relatively acute process. We report a TIC case with a 30-year history of long-lasting persistent atrial tachycardia involving a 44-year-old man previously diagnosed with dilated cardiomyopathy and a low LV ejection fraction (LVEF) of 20%. ECG revealed atrial tachycardia at 110–120 bpm. He was hospitalised with a worsening heart failure. His clinical status was New York Heart Association functional class III, and echocardiography revealed LV dilation and an LVEF of 9%. A two-dimensional speckle-tracking strain measurement revealed LV mechanical dyssynchrony. He underwent radiofrequency ablation for atrial tachycardia. After restoring sinus rhythm, his cardiac symptoms improved immediately. The LV mechanical dyssynchrony decreased a week after ablation, without changes in the LV dilation or LVEF. Thereafter, the LV dilation and systolic function gradually improved, and atrial tachycardia and heart failure remained absent.
doi:10.1136/bcr-2013-008727
PMCID: PMC3863102  PMID: 24326427
50.  Ion-Specific Control of the Self-Assembly Dynamics of a Nanostructured Protein Lattice 
ACS Nano  2014;9(1):180-190.
Self-assembling proteins offer a potential means of creating nanostructures with complex structure and function. However, using self-assembly to create nanostructures with long-range order whose size is tunable is challenging, because the kinetics and thermodynamics of protein interactions depend sensitively on solution conditions. Here we systematically investigate the impact of varying solution conditions on the self-assembly of SbpA, a surface-layer protein from Lysinibacillus sphaericus that forms two-dimensional nanosheets. Using high-throughput light scattering measurements, we mapped out diagrams that reveal the relative yield of self-assembly of nanosheets over a wide range of concentrations of SbpA and Ca2+. These diagrams revealed a localized region of optimum yield of nanosheets at intermediate Ca2+ concentration. Replacement of Mg2+ or Ba2+ for Ca2+ indicates that Ca2+ acts both as a specific ion that is required to induce self-assembly and as a general divalent cation. In addition, we use competitive titration experiments to find that 5 Ca2+ bind to SbpA with an affinity of 67.1 ± 0.3 μM. Finally, we show via modeling that nanosheet assembly occurs by growth from a negligibly small critical nucleus. We also chart the dynamics of nanosheet size over a variety of conditions. Our results demonstrate control of the dynamics and size of the self-assembly of a nanostructured lattice, the constituents of which are one of a class of building blocks able to form novel hybrid nanomaterials.
doi:10.1021/nn502992x
PMCID: PMC4310639  PMID: 25494454
protein interactions; biomaterials; nanostructures; self-assembly dynamics; Ca2+ binding

Results 26-50 (1530)