Schwannoma in an accessory branch of the posterior cord of the brachial plexus: a rare case report.

BACKGROUND: Variation in the posterior cord of the brachial plexus is complicated and creates a risky relationship with the neighbouring structures. This is of importance to the surgeons and anaesthetists who must deal with the region in surgeries and procedures. Moreover, any benign tumour like schwannoma is rare in the plexus comprising 5% of total head and neck schwannomas. MATERIALS AND METHODS: We present a case of schwannoma of the brachial plexus in a cadaver during routine anatomy dissection for the medical students. The origin and order of branching of the posterior cord were recorded and photographs were taken. The tumour was present in an accessory branch of the posterior cord and removal was made in-toto. An immunohistochemistry study was done for confirmation of diagnosis. RESULTS: The classical branching of the posterior cord was present. Additionally, a branch existed that was supplying the triceps muscle and emerged directly from the posterior cord. Tumour having the dimension of 2 × 1.8 × 0.5 cm was present. CONCLUSIONS: Schwannomas are indolent but may cause compression of the nerve and resulting neurological symptoms. They might mimic nodules of supraclavicular fossa in breast carcinoma. Variations of the brachial plexus can also make the surgeons confused during surgery due to which anatomical knowledge of the possible variations is important. Pre- and post-operative complications can be easily predicted from it. Follow-up of the tumour is essential to track its progress and differentiation.

Vertebral arteries bilaterally passing through stellate (cervicothoracic) ganglion.

Vertebral artery is a branch of the first part of subclavian artery. Vertebral artery arising from the aortic arch most commonly presents on the left side. The cervical part of sympathetic trunk is closely related to the vertebral artery in the cervical region. Though lots of variations regarding anomalous origin, course of vertebral artery is reported in the literature, here we present a rare anomaly in which vertebral artery after originating from aortic arch is passing through stellate ganglia and it enters into the transverse foramina of higher cervical vertebra (C5). Such variation should be kept in mind by anaesthetist during stellate ganglion block in order to relieve intractable pain in central nervous system lesion. Surgeons should keep this anomaly in mind during cervical spine surgery otherwise vertebral artery may get injured leading to haemorrhage.

Identification and tracking of problematic host cell proteins removed by a synthetic, highly functionalized nonwoven media in downstream bioprocessing of monoclonal antibodies.

The repertoire of complex proteins produced by the host cell during monoclonal antibody (mAb) production has generated a bottleneck in downstream bioprocessing. Low ppm levels of host cell proteins (HCPs) must be achieved at the downstream purification process stage to generate an end product suitable for use in humans. The increased demand for mAb drug products globally has driven research to focus on affordability of mAb production platforms. This has fuelled advancements in manufacturing R&D to deliver higher product titres with better economics without sacrificing product quality. This study highlights the beneficial effects of inclusion of the Emphaze™ AEX Hybrid Purifier, compared to a conventional clarification process, for removal problematic HCPs during downstream bioprocessing of mAbs. Advanced proteomic methods were used to track and identify known 'problematic' HCPs through a multi-cycle Protein A purification process. Removal of histone proteins was observed, along with an average total HCP reduction of 38-fold and an average reduction of 2.3 log in HCDNA concentration. Chromatographic clarification using the Emphaze™ AEX Hybrid Purifier in conjunction with Protein A chromatography resulted in the removal of problematic HCPs including 78 kD glucose-regulated protein, nidogen-1, heat shock proteins, actin, serine protease HTRA1 and matrix metalloproteinase-19. It is shown herein that the Emphaze™ AEX Hybrid Purifier, which is readily incorporated into a mAb purification process during the clarification stage, has the potential to increase Protein A resin lifetime and potentially reduce the number of subsequent polishing chromatographic steps needed to remove HCPs that have a tendency to co-purify with mAb products.

Does vitamin D supplementation alleviate chronic nonspecific musculoskeletal pain? A systematic review and meta-analysis.

Chronic nonspecific musculoskeletal pain (CNMP) is an idiopathic condition often seen in general practice and rheumatology clinics, the aetiology of which may include vitamin D deficiency. The objective of the present study is to evaluate the effectiveness of vitamin D supplementation in the management of CNMP through a systematic review and meta-analysis. According to PRISMA guidelines, PubMed, Embase, Web of Science, Cochrane and Scopus electronic databases were searched for randomised controlled trials comparing vitamin D supplementation to a control or placebo in CNMP patients; the search was not limited by language or date. Meta-analysis was performed using the mean and standardised mean difference which was computed with 95 % confidence intervals, and overall effect size was calculated. Both fixed and random effects models were used in meta-analysis to account for heterogeneity in the studies. The initial search identified 107 studies, of which 10 were potentially relevant, with 7 studies excluded because they did not meet selection criteria. Three studies were included in the meta-analysis. We found no effect of vitamin D supplementation (standardised mean difference (SMD) 0.004; 95 % confidence interval (CI) -0.248 to 0.256) on pain in CNMP patients. Forest plot is used to present the results from meta-analysis. Contrary to a widespread clinical view, there is a moderate level of evidence that vitamin D supplementation is not helpful for treating CNMP patients.

Template-free TiO2 photoanodes for dye-sensitized solar cell via modified chemical route.

Surfactant and template-free Titanium dioxide (TiO2) spheres have been deposited via ultrasonic rinsing assisted modified successive ionic layer adsorption and reaction (M-SILAR) method. The effect of M-SILAR cycle variation on the growth of TiO2 films and power conversion efficiency (PCE) of dye-sensitized solar cells (DSSCs) has been reported. Also, the significant influence of the dye adsorption time of photoelectrodes on the overall PCE of TiO2 based DSSCs has been investigated systematically. The SEM images reveal that the TiO2 microspheres are made up of densely packed and interconnected nanospheres. After dye loading maximum absorption peak around 500nm is seen with broader coverage in the visible region of the solar spectrum. The excess amount of dye for dye loading time 15h did not contribute to current and is suspected to be present either in multilayers or physisorbed on the surface of TiO2. The DSSC prepared using photoelectrode TO125 and dye loading time of 12h exhibited the highest power conversion efficiency (PCE) of 1.16% with short-circuit current density (Jsc) of 8.17mA/cm2, open circuit voltage (Voc) of 0.42V and fill factor of 0.34. The PCE is attributed to the large molecular interconnected TiO2 spheres diffusing visible light to enhance the light absorption. Also, it possesses relatively superior 3-D microsphere like structure and thus provides the effective pathway to the photogenerated electrons with low recombination rate, leading to attaining the high PCE.