A biologically functional bioink based on extracellular matrix derived collagen for 3D printing of skin.

Over the past few years, several advancements have been made to develop artificial skin that mimics human skin. Artificial skin manufactured using 3D printing technology that includes all epidermal and dermal components, such as collagen, may offer a viable solution. The skin-specific bioink was derived from digested chicken skin and incorporated into PVA (polyvinyl alcohol) and gelatin. The prepared bioink was further analyzed for its structure, stability, biocompatibility, and wound healing potential in in vitro, in ovo, and in vivo models. The 3D-printed skin showed excellent mechanical properties. In vitro scratch assays showed the proliferation and migration of cells within 24 h. In an in ovo assay, the 3D-printed skin facilitated the attachment of cells to the scaffolds. In the animal study, the quick cellular recruitment at the injury site accelerated wound healing. Further, hydroxyproline content was estimated to be 0.9-1.2 mg/ml, and collagen content was 7.5 %, which confirmed the epithelization. The relative expressions of MMP-9, COMP, TNF-α, and IL-6 genes were found to be increased compared to the control. These results demonstrate that 3D bioprinting represents a suitable technology to generate bioengineered skin for therapeutic and industrial applications in an automated manner.

Decellularized small intestine scaffolds: a potential xenograft for restoration of intestinal perforation.

Small intestine perforation is a serious medical condition that requires immediate medical attention. The traditional course of treatment entails resection followed by anastomosis; however, it has complications such as small bowel syndrome (SBS), anastomotic leakage, and fistula formation. Here, a novel strategy is demonstrated, that utilizes the xenogeneic, decellularized goat small intestine as a patch for small intestine regeneration in cases of intestinal perforation. The goat small intestine scaffold underwent sodium dodecyl sulfate decellularization, which revealed consistent, quick, and effective decellularization. Decellularization contributed the least amount of extracellular matrix degradation while maintaining the intestinal architecture. By implanting the decellularized goat small intestine scaffolds (DGSIS) on the chorioallantoic membrane (CAM), no discernible loss of angiogenesis was seen in the CAM region, and this enabled the DGSIS to be evaluated for biocompatibility in ovo. The DGSIS was then xeno-transplanted as a patch on a small intestine perforation rat model. After 30 days post transplant, barium salt used as contrast gastrointestinal X-ray imaging revealed no leakage or obstruction in the small intestine. Histology, scanning electron microscopy, and immunohistochemistry assisted in analyzing the engraftment of host cells into the xeno patch. The xeno-patch expressed high levels of E-cadherin, α-smooth muscle actin (α-SMA), Occludin, Zonnula occluden (ZO-1), Ki 67, and Na+/K+-ATPase. The xeno-patch was consequently recellularized and incorporated into the host without causing an inflammatory reaction. As an outcome, decellularized goat small intestine was employed as a xenograft and could be suitable for regeneration of the perforated small intestine.

Case report on unusual tumor with synchronous cutaneous and gastrointestinal tract involvement.

Histiocytic sarcoma (HS) is an exceedingly rare lymphohematopoietic malignancy with morphological and immunophenotypic characteristics of mature tissue histiocytes. We report a unique case of a HS with synchronous skin and gastrointestinal tract involvement which has not been reported in literature till date to the best of our knowledge. A 70-year-old male farmer presented with multiple ulcerated skin lesions ranging from 0.5 to 10 cm all over the body. Autopsy revealed multiple transmural nodular deposits in stomach, intestines, head of pancreas, and peripancreatic tissue. Histopathology and immunohistochemistry profile was consistent with HS exhibiting positivity for CD68, CD163, and lysozyme. CD 163 identifies histiocytic malignancies with high degree of specificity and has become a promising marker for their diagnosis.

Leiomyoma of esophagus-A case report.

INTRODUCTION: Benign tumors of the esophagus are rare. However, among them, leiomyomas are common. Tumors larger than 5 cm are rare and may present as dysphagia or epigastric pain. Combined esophagoscopy and video-assisted thoracoscopic surgery or laparoscopic trans hiatal resection are used the management of leiomyoma of esophagus. PRESENTATION OF CASE: This case report illustrates the case of a young male who presented with dysphagia and occasional dyspnea. Imageology demonstrated an esophageal mass which on surgical exploration and histopathology, confirmed the diagnosis of leiomyoma. DISCUSSION: Esophageal leiomyomas vary in their presenting size from a few centimeters to greater than 5 cm which are rare. The preferred surgical technique for leiomyomas is transthoracic enucleation without opening the mucosa, which is easier, faster, and safer compared to resection. In our patient, due to the size and location of the tumor, it was resected using an abdominal approach, and a distal esophagectomy and esophagogastrostomy were performed. CONCLUSION: A multi-modal approach involving both the endoscopic and radiologic examinations is crucial in ensuring that the morbidity of malignancy is avoided.

Milan System for Reporting Salivary Gland Cytopathology- An Experience from Western Indian Population.

INTRODUCTION: Fine-needle aspiration cytology (FNAC) can be challenging to provide a precise diagnosis in salivary gland cytopathology due to diversity of lesions and cytomorphological convergence between the tumors and within the same tumor of salivary gland. The recently proposed Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) provides a risk stratification-based classification system with an intrinsic risk of malignancy (ROM) for each diagnostic category, which aims to furnish useful information to the clinicians. This study was undertaken to evaluate the diagnostic utility and validity of MSRSGC. METHODS AND MATERIAL: In this retrospective study, FNAC done for all salivary gland lesions over a period of two years were retrieved. All cases were categorized according to MSRSGC and correlated with histopathological follow-up, wherever available. ROM was calculated for each category. RESULTS: The cases belong to following categories: non-diagnostic (1.27%), non-neoplastic (30.38%), atypia of undetermined significance (5.06%), benign neoplasm (46.84%), salivary gland neoplasm of uncertain malignant potential (1.27%), suspicious for malignancy (1.27%), and malignant (13.92%). Out of 79 cases, 50.63% had follow-up. The ROM were 0% for category II and IVa, 50% for category III, and 100% for category IVb, V, and VI. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were recorded as 77.78%, 100%, 100%, 91.3%, and 93.33%, respectively. CONCLUSIONS: Application of MSRSGC has immense value for standardization of reporting of salivary gland FNAC. Our data corresponds to the studies done worldwide and recommends the use of MSRSGC for future diagnostic purposes.

Bochdalek's hernia in an elderly male - A case report.

Diaphragmatic hernia is protrusion of the abdominal contents into the thoracic cavity. It is a congenital defect of the diaphragm. It is most commonly encountered in infancy but rarely in adults. Here, we would like to present a rare case of 75-year-old male with Bochdalek's hernia. The patient had presented for the first time in his life for his symptoms. This case report emphasises the rare presentation of Bochdalek's hernia in an elderly male. The patient was treated using minimal access surgery i.e., laparoscopic approach and hence had a better post-operative outcome.

In vitro activity of ceftaroline: A novel antibiotic against methicillin-resistant Staphylococcus aureus.

INTRODUCTION: Staphylococcus is one of the most common causes of nosocomial infection, especially pneumonia, surgical site infections, blood stream infections, and continues to be a major cause of community-acquired infections. The emergence of penicillin resistance followed by the development and spread of strains resistant to the semisynthetic penicillins such as methicillin, oxacillin and nafcillin, macrolides, tetracycline, and aminoglycosides has made the treatment of staphylococcal infection a global challenge. To treat this multidrug-resistant methicillin-resistant Staphylococcus aureus (MRSA), the only option available is glycopeptides such as vancomycin. However, recently, vancomycin-intermediate S. aureus and vancomycin-resistant S. aureus strains have emerged with different resistance mechanism. There are newer drugs in the pipeline against MRSA such as ceftaroline, dalbavancin, oritavancin, and tedizolid; however, very little data are available for their use. Recently, ceftaroline has been approved by the US Food and Drug Administration for the treatment of acute bacterial skin and soft tissue infections and community-acquired bacterial pneumonia due to MRSA. Hence, we tried to evaluate in vitro activity of ceftaroline against MRSA. AIM: The aim of this study was to detect in vitro activity of new cephalosporin, ceftaroline, against MRSA. MATERIALS AND METHODS: Thirty nonduplicate MRSA strains were collected from various clinical samples, and minimum inhibitory concentration (MIC) was detected using ceftaroline E-test strips. RESULTS: Twenty-eight MRSA isolates (93.33%) were found to be susceptible to ceftaroline. CONCLUSION: Ceftaroline demonstrated promising potency and coverage against MRSA isolates and can be considered an effective alternative treatment keeping vancomycin and linezolid as a reserved option.

Interobserver variation is a significant limitation in the diagnosis of Burkitt lymphoma.

CONTEXT: The pathology of classic Burkitt lymphoma (BL) remains a challenge despite being a well-defined entity, in view of the significant overlap with atypical BL and B-cell lymphoma intermediate between DLBL (diffuse large B cell lymphoma) and BL. They are difficult to be segregated in resource-limited setups which lack molecular testing facilities. This is further affected by interobserver variability and experience of the reporting pathologist. AIMS: The aim of our study was to quantitate variability among a group of pathologists with an interest in lymphomas (albeit with variable levels of experience) and quantitate the benefit of joint discussions as a tool to increase accuracy and reduce interobserver variability of pathologists, in the diagnosis of BL in a resource-limited setup. MATERIALS AND METHODS: A set of 25 non-Hodgkin lymphoma cases in which a diagnosis of BL was entertained were circulated to 14 participating pathologist within the Mumbai lymphoma study group. A proforma recorded the morphologic and immunohistochemical features perceived during the initial independent diagnosis followed by a consensus meeting for discussion on morphology and additional information pertinent to the case. STATISTICAL ANALYSIS AND RESULTS: The concordance was poor for independent diagnosis among all the pathologists with kappa statistics (±SE) of 0.168 (±0.018). Expert lymphoma pathologists had the highest (albeit only fair) concordance (kappa = 0.373 ± 0.071) and general pathologists the lowest concordance (kappa = 0.138 ± 0.035). Concordance for morphological diagnosis was highest among expert lymphoma pathologists (kappa = 0.356 ± 0.127). Revision of diagnoses after consensus meeting was highest for B-cell lymphoma intermediate between DLB and BL. To conclude, interobserver variation is a significant problem in BL in the post WHO 2008 classification era. Experience with a larger number of cases and joint discussion exercises such as the one we conducted are needed as they represent a simple and effective way of improving diagnostic accuracy of pathologists working in a resource-limited setup.