The bright Easter bunny sign: a useful aide-memoire on MRI for costotransverse joint inflammation in axial spondyloarthritis.

AIM: To assess the significance of the "bright Easter bunny" sign on magnetic resonance imaging (MRI) to indicate inflammatory costotransverse joint (CtJ) lesions to diagnose axial spondyloarthritis (ax-SpA). MATERIALS AND METHODS: Consecutive cases of patients with ax-SpA from a specialist rheumatology clinic were analysed retrospectively over two cohorts, between 2012-2014 and 2018-2020, to determine newly diagnosed patients under the Assessment of SpondyloArthritis international Society (ASAS) criteria. Biological naive adult patients who underwent spine MRI and sacroiliac imaging with full immunological work-up and a C-reactive protein reading within 3 months of the scan were included. Blinded images were reviewed by experienced musculoskeletal radiologists. RESULT: From the 1,284 cases that were identified, 40 cases met the inclusion criteria for this study. Seven out of the 40 cases (17.5%) identified inflammatory lesions at the CtJ with five (70%) showing concordance with the bright Easter bunny sign. CONCLUSION: The bright Easter bunny sign is concordant with inflammatory costotransverse enthesitis. This aide-memoire radiological sign is often on overlooked edge-of-field sections and this emphasises the need to ensure adequate coverage of the CtJ on spine MRI protocols as an important anatomical site of inflammatory change in ax-SpA assessment.

Anesthetic management for lobectomy of a 2-month-old infant with bronchogenic cyst: Case report along with review of literature.

Bronchogenic cyst, a benign congenital cystic lesion of the lung, is a rare cause of respiratory distress in children comprising 7.5% of all mediastinal masses. A thorough preoperative evaluation is crucial to plan for definitive intra- and post-operative management. All patients should be thoroughly evaluated for the presence of compression, deviation or distortion of airways and great veins. The easiest means of providing one lung ventilation in pediatrics is to intubate the main stem bronchus of the nonoperated lung. Other options available for pediatric one lung ventilation are single lumen endobronchial tubes, micro cuff tubes, Marraro bilumen tubes, and bronchial blockers. We hereby present a case report of a 2-month-old infant posted for excision of bronchogenic cyst along with a review of literature.

Obstructive nephropathy and chronic kidney disease secondary to uterine leiomyomas.

We present three cases of chronic kidney disease secondary to large fibroid uterus. The difficulties experienced in their clinical management and a review of literature is outlined.

Decolorization of triphenylmethane dye-bath effluent in an integrated two-stage anaerobic reactor.

In the present study, decolorization of a simulated dye waste containing three different triphenylmethane (TPM) dyes--Magenta, Malachite Green and Crystal Violet, was investigated in a laboratory scale, two-stage anaerobic high-rate reactor. The effect of various parameters (influent dye concentration, hydraulic and co-substrate loading rates) on color and COD removal efficiency of the reactor has been studied. It has been shown that the influent dye concentration had little effect on overall COD and color removal efficiency. More than 99% color removal and 96% COD removal efficiency were maintained even at a dye concentration of 500 mg/l and a dye loading rate of 1000 mg/l day. However, a minimum level of glucose as supplementary carbon source is required to maintain the maximum color removal efficiency and it drops appreciably when no glucose is added to the influent. The study also showed that the acidogenic phase of the reaction plays an important role in decolorization of the TPM dyes. In addition, the two-stage anaerobic reactor was observed to have distinct advantages over the single-stage system, as the drop in color and COD removal efficiency of stage 1 are adequately compensated by stage 2 of the reactor especially under high dye loading rates accompanied by low co-substrate loading and under reduced HRTs.

Co-treatment with grapefruit juice inhibits while chronic administration activates intestinal P-glycoprotein-mediated drug efflux.

P-Glycoprotein (P-gp) mediated efflux is recognized as a significant biochemical barrier affecting oral absorption for a number of drugs. Various conflicting reports have been published regarding the effects of grapefruit juice (GFJ) on P-gp-mediated drug efflux, in which GFJ has been shown both to inhibit and activate it. Hence, the present study adopted a two-way approach, involving both co-treatment and chronic administration. Bi-directional transport of paclitaxel (PCL) was carried out in the absence and presence of GFJ extract, in rat everted ileum sac. Further, the effect of chronic administration of GFJ to rats was characterized by permeability studies with indinavir (INDI). Co-treatment of GFJ extract at 100% concentration reduced the asymmetric transport of PCL (efflux ratio = 20.8) by increasing absorptive (A --> B) transport by 921% and reducing secretory (B --> A) transport by 41%. Further, GFJ showed a concentration dependent effect on PCL permeability. Imipramine, a passive permeability marker with absorptive permeability of 15.33 +/- 4.26 x 10(-6) cm/s showed no asymmetric transport and also no significant (P < 0.05) change in permeability in the presence of GFJ. Chronic administration of GFJ resulted in a significant decrease in absorptive transport of indinavir, which was even greater than that produced by rifampicin pretreatment. No change in permeability of propranolol, a passive permeability marker, was observed. Further, the decrease in absorptive transport of INDI was reversed by the P-gp inhibitor verapamil. In conclusion, GFJ extract inhibited P-gp-mediated efflux in co-treatment, whereas chronic administration led to increased levels of P-gp expression, thus having a profound effect on intestinal absorption and GFJ-drug interactions in vivo.

Electrolytically generated oxygen microgradients for cell culture.

We present a microdevice capable of electrochemically generating user-defined oxygen gradients for use in cell and tissue culture. Electrolytic dissolved oxygen generation at multiple electrodes evolves 1D and 2D oxygen gradients across several millimeters with microscale precision and has the potential to test the effect of localized oxygen doses on a wide range of tissue and cell samples. The developed microgradients are stable for days, enabling experiments of physiologically relevant duration. We present the basic theory of operation and initial results.

Neuromuscular ventilatory insufficiency: effect of home mechanical ventilator use v oxygen therapy on pneumonia and hospitalization rates.

The purpose of this study was to determine rates of pneumonia and hospitalization for patients receiving oxygen therapy, patients having indwelling tracheostomy tubes, and those using tracheostomy or noninvasive methods of home mechanical ventilation. Six hundred eighty-four users of assisted ventilation for 13,751 patient-years or 19.8 years per patient were surveyed by mail and twice by telephone over a span of four years. Pneumonia and hospitalization rates were significantly higher for ventilator users with chronic obstructive pulmonary disease or with neuromuscular ventilatory insufficiency and gastrostomy tubes than for ventilator users with neuromuscular ventilatory insufficiency without gastrostomy tubes. Of the latter group, more than 90% of the pneumonias and hospitalizations were triggered by otherwise benign intercurrent upper respiratory tract infections. Oxygen therapy was associated with a significantly (P < 0.001) higher rate of pneumonias and hospitalizations than that seen for untreated patients after initial episodes of respiratory distress or during the use of either tracheostomy intermittent positive pressure ventilation or noninvasive ventilatory assistance methods. The lowest pneumonia and hospitalization rates (P < 0.001) were by full-time, noninvasive intermittent positive pressure ventilation users. We conclude that oxygen therapy is not an effective substitute for assisted ventilation for patients with primarily ventilatory insufficiency. Noninvasive ventilatory aids can be used effectively for up to full-time ventilatory support for patients with neuromuscular conditions whose bulbar muscle function is adequate to avert the need for gastrostomy tube placement.