A case of intravascular lymphoma diagnosed with a primary vitreoretinal lymphoma-like fundus lesion

Purpose We report a case of intravascular lymphoma with primary vitreoretinal lymphoma-like fundus findings. Case A 61-year-old man with a one-week history of temporal visual field defect in the left eye was referred by a local ophthalmologist to our department. A yellowish-white raised patchy lesion was found in the nasal fundus of the left eye. Vitreoretinal lymphoma was suspected, and vitrectomy was performed in the left eye for diagnostic purpose. However, vitreous interleukin-10 concentration was low and no significant result was obtained. He had fever of around 38 °C, and respiratory failure that started 2 weeks before ophthalmological examination, worsened. Intravascular lymphoma was diagnosed from the results of histopathological examinations of transbronchial lung biopsy, bone marrow biopsy and random skin biopsy. With the start of systemic chemotherapy, the subretinal lesions shrank gradually and systemic condition was stable. However, 5 months after the start of chemotherapy, spread to the central nervous system was observed, and chimeric antigen receptor T cell (CAR-T) therapy was started in another hospital. After the start of CAR-T therapy, the subretinal lesions shrank further. Conclusions Intravascular lymphoma may be accompanied by primary vitreoretinal lymphoma-like intraocular lesions. If intraocular lesions are accompanied by systemic symptoms such as fever of unknown origin, the possibility of intravascular lymphoma should be suspected and systemic work-up should be performed.

Recent Endoscopic Ultrasound-Related Publications With Potential to Influence Clinical Practice

The field of endoscopic ultrasound (EUS) has evolved significantly over the last two decades from being a tool of only diagnostic purpose to tissue acquisition and now therapeutic potential. There have been several important publications in the field of EUS in the last few years, which had a major impact in the clinical management of various gastrointestinal disorders. In this review, we discuss four such articles that in our opinion will significantly impact the role of EUS in treating various conditions. The first article is a randomized controlled trial comparing EUS-guided gall bladder drainage with percutaneous gall bladder drainage for high-risk acute cholecystitis. The second article is a randomized controlled trial comparing EUS versus minimally invasive surgery for necrotizing pancreatitis. The third article is a novel human study of EUS-guided portal pressure measurement in patients with portal hypertension. The last article is also a randomized controlled trial evaluating the role of rapid on-site evaluation for EUS-guided fine needle biopsy in solid pancreatic lesions.

Evaluating the presence of deregulated tumoral onco-microRNAs in serum-derived exosomes of gastric cancer patients as noninvasive diagnostic biomarkers

Introduction: Exosomal microRNAs (miRNAs) are emerging diagnostic biomarkers for different types of cancers. We aim to detect gastric cancer (GC)-specific miRNAs in serum exosomes with diagnostic potential. Methods: A pair of 43 tumor and tumor-adjacent tissue biopsies obtained from GC patients, also 5 mL peripheral blood (following 12h fasting) were collected from the same patients and healthy controls (HCs). QIAGEN miRCURY LNA miRNA Focus PCR Panel applied to screen differentially expressed onco-miRNAs. The candidate miRNAs with the highest fold changes proceeded for validation by qRT-PCR in individuals. Results: We identified that exosomal miR-10a-5p, miR-19b-3p, miR-215-5p, and miR-18a-5p were significantly upregulated in GC patient’s exosomes in contrast to HCs exosomes, Roc curve analysis indicated area under the ROC curve (AUC) of 0.801, 0.721, 0.780 and 0.736 respectively. The Roc curve analysis for the combined signature of four exosomal miRNAs indicated AUC of 0.813. Also, Spearman's correlation coefficients indicated that the miRNA expression is highly correlated between tumor and exosome. Conclusion: Herein, we specifically identified four miRNAs in serum exosomes of GC patients for a diagnostic purpose which are directly associated with tumoral miRNA expression profile.

Comparative Study of Complex-Ratio-Measuring Circuits and Coaxial Probe in Diagnosis of Breast Tumors

A developed six-port reflectometry (SPR) system was integrated to measure the relative permittivity of tumor and normal breast tissue for medical diagnostic purpose. In order to obtain an accurate and precise measurement, the calibration process was done to the SPR using the well-known three-standard technique. Next, the studied dielectric probe was connected to the calibrated measurement-port of the SPR. The open end of the probe aperture was dibbed into the normal and tumor synthetic breast tissue samples to measure the synthetic breast tissues dielectric constant, ɛrʹ, and loss factor, ɛrʺ in the frequency range of 1.5 GHz to 3.3 GHz. Finally, the comparative studies were conducted between commercial VNA with Keysight 85070E dielectric probe and the studied SPR-probe system based on the measured magnitude of the reflection coefficient, phase shift, dielectric constant, and loss factor of the synthetic breast samples. The maximum absolute errors of the measured reflection coefficient magnitude, phase shift, dielectric constant, and loss factor were found to be 0.01, 1.07°, 1.12, and 0.75, respectively. It was ascertained that the predicted dielectric constant, ɛrʹ, is able to differentiate between normal, (ɛrʹ < 50) and tumor, (ɛrʹ > 50) breast tissues.

Diagnosis and Recommendation Integrated System (DRIS) Norms for Identifying Yield Limiting Nutrients in Byadgi Chilli Fruits Grown in Northern Transitional Zone and Dry Zones of Karnataka (India)

Fruit samples collected from different part of northern Karnataka districts of Dharwad, Gadag and Haveri, when peak fruit harvesting stage were collected the samples, were processed and analysed for various nutrients and thus, the data bank was established. By using Diagnosis and Recommendation Integrated System (DRIS), nutrient expressions, which have shown higher variance and lower coefficient of variation, were selected as norms viz, N/P(4.98), N/K (0.73), N/Ca (1.17), N/Mg (4.65), S/N(0.10), N/Fe(0.02), N/Zn(0.08) etc. In addition, five nutrient ranges have been derived using mean and standard deviation as low, deficient, optimum, high and excess for each nutrient to serve as a guide for diagnostic purpose. The optimum N ranged from 2.30 to 2.84%, P from 0.48 to 0.56%, K from 3.16 to 3.44%, Ca from 2.08 to 2.74%, Mg from 0.60 to 0.88% and S from 0.24 to 0.27%. Among the micronutrients, the optimum Zn ranged from 28.71 to 29.78 ppm, Fe from 113.60 to 150.03 ppm for byadgi chilli crop.

A Cross Sectional Study to Assess Agility Skills of Kumite Karate Players Aged 15-20 Years in Mumbai Suburban Area

Background: Karate is one of the most popular martial arts, and it describes the fact that it involves the use of kicks, punches, and blocking techniques. Kumite is the term used for sparring with an opponent. Agility is defined as combination of speed of the movements with quick changes in the directions along with good body control. Agility tests are best used for diagnostic purpose to determine which karate athlete is the most agile, and which one requires more additional practice to perform better. Hence, the aim of this study was to evaluate agility in kumite karate players using Illinois Agility Test and T-drill test. Objective: To evaluate speed of movement, zigzag crossing of kumite karate players, speed, lateral movement and coordination using Illinois agility test and T-drill test respectively. Materials and Methods: 100 kumite karate players (60 males; 40 females) were selected on the basis of inclusion and exclusion criteria and consent was taken. Subjective details and demographic data were obtained prior to the agility testing. Illinois agility test and T-drill test were performed. The data was obtained and statistically analysed. Result: Data was collected and then mean and standard deviation was analysed for demographic data such as age (17.43±1.74 years), height (1.65±5.46 cm), weight (53.91±6.04 kg), BMI (19.80±1.36 kg/m²), IAT score (17.58±1.44 seconds) and T-drill test score (10.50±0.92 seconds). Correlation values of BMI and IAT is 0.866 & that of BMI and T-drill is 0.904. Conclusion: Agility was better in male players than females because male players have more strength, power, more muscle mass and less body fat. Key words: Agility, Karate, Kumite, Illinois agility test, T-drill test.

Design, Modeling, and Analysis of Piezoelectric-Actuated Device for Blood Sampling

In recent years, micro electro-mechanical system (MEMS)-based biomedical devices have been investigated by various researchers for biomedicine, disease diagnosis, and liquid drug delivery. The micropump based devices are of considerable significance for accurate drug delivery and disease diagnosis. In the present study, design aspects of the piezoelectric actuated micropump used for extraction of blood sample are presented. A pentagonal microneedle, which is an integral part of the micropump, was used to extract the blood volume. The blood was then delivered to the biosensor, located in the pump chamber, for diagnosis. The purpose of such low-powered devices is to get sufficient blood volume for the diagnostic purpose at the biosensor located within the pump chamber, with a minimum time of actuation, which will eventually cause less pain. ANSYS® simulations were performed on four quarter piezoelectric bimorph actuator (FQPB) at 2.5 volts. The modal and harmonic analysis were carried out with various load conditions for FQPB. The extended microneedle lengths inside the pump chamber showed improved flow characteristics. Enhanced volume flow rate of 1.256 µL/s was obtained at 22,000 Hz applied frequency at the biosensor location.

How growing tumour impacts intracranial pressure and deformation mechanics of brain

Brain is an actuator for control and coordination. When a pathology arises in cranium, it may leave a degenerative, disfiguring and destabilizing impact on brain physiology. However, the leading consequences of the same may vary from case to case. Tumour, in this context, is a special type of pathology which deforms brain parenchyma permanently. From translational perspective, deformation mechanics and pressures, specifically the intracranial cerebral pressure (ICP) in a tumour-housed brain, have not been addressed holistically in literature. This is an important area to investigate in neuropathy prognosis. To address this, we aim to solve the pressure mystery in a tumour-based brain in this study and present a fairly workable methodology. Using image-based finite-element modelling, we reconstruct a tumour-based brain and probe resulting deformations and pressures (ICP). Tumour is grown by dilating the voxel region by 16 and 30 mm uniformly. Cumulatively three cases are studied including an existing stage of the tumour. Pressures of cerebrospinal fluid due to its flow inside the ventricle region are also provided to make the model anatomically realistic. Comparison of obtained results unequivocally shows that as the tumour region increases its area and size, deformation pattern changes extensively and spreads throughout the brain volume with a greater concentration in tumour vicinity. Second, we conclude that ICP pressures inside the cranium do increase substantially; however, they still remain under the normal values (15 mmHg). In the end, a correlation relationship of ICP mechanics and tumour is addressed. From a diagnostic purpose, this result also explains why generally a tumour in its initial stage does not show symptoms because the required ICP threshold has not been crossed. We finally conclude that even at low ICP values, substantial deformation progression inside the cranium is possible. This may result in plastic deformation, midline shift etc. in the brain.

Diagnostic application of sensitive and specific phage-exposed epitopes for visceral leishmaniasis and human immunodeficiency virus coinfection

The diagnosis of visceral leishmaniasis (VL) has improved with the search of novel antigens; however, their performance is limited when samples from VL/human immunodeficiency virus (HIV)-coinfected patients are tested. In this context, studies conducted to identify more suitable antigens to detect both VL and VL/HIC coinfection cases should be performed. In the current study, phage display was performed using serum samples from healthy subjects and VL, HIV-infected and VL/HIV-coinfected patients; aiming to identify novel phage-exposed epitopes to be evaluated with this diagnostic purpose. Nine non-repetitive and valid sequences were identified, synthetized and tested as peptides in enzyme-linked immunosorbent assay experiments. Results showed that three (Pep2, Pep3 and Pep4) peptides showed excellent performance to diagnose VL and VL/HIV coinfection, with 100% sensitivity and specificity values. The other peptides showed sensitivity varying from 50.9 to 80.0%, as well as specificity ranging from 60.0 to 95.6%. Pep2, Pep3 and Pep4 also showed a potential prognostic effect, since specific serological reactivity was significantly decreased after patient treatment. Bioinformatics assays indicated that Leishmania trypanothione reductase protein was predicted to contain these three conformational epitopes. In conclusion, data suggest that Pep2, Pep3 and Pep4 could be tested for the diagnosis of VL and VL/HIV coinfection.

Extracellular Vesicles in Acute Kidney Injury and Clinical Applications

Acute kidney injury (AKI)––the sudden loss of kidney function due to tissue damage and subsequent progression to chronic kidney disease––has high morbidity and mortality rates and is a serious worldwide clinical problem. Current AKI diagnosis, which relies on measuring serum creatinine levels and urine output, cannot sensitively and promptly report on the state of damage. To address the shortcomings of these traditional diagnosis tools, several molecular biomarkers have been developed to facilitate the identification and ensuing monitoring of AKI. Nanosized membrane-bound extracellular vesicles (EVs) in body fluids have emerged as excellent sources for discovering such biomarkers. Besides this diagnostic purpose, EVs are also being extensively exploited to deliver therapeutic macromolecules to damaged kidney cells to ameliorate AKI. Consequently, many successful AKI biomarker findings and therapeutic applications based on EVs have been made. Here, we review our understanding of how EVs can help with the early identification and accurate monitoring of AKI and be used therapeutically. We will further discuss where current EV-based AKI diagnosis and therapeutic applications fall short and where future innovations could lead us.