Hybrid surgical approach excision of gastrointestinal stromal tumor (GIST): A case report of GIST at an unusual location and review of the literature.

Gastrointestinal stromal tumors are the most common malignant subepithelial lesions involving the gastrointestinal tract. Surgical techniques have been the mainstay of treatment, however, in recent times hybrid surgeries are being introduced yielding better clinical outcomes.

Efficient adsorption of hexavalent chromium ions onto novel ferrochrome slag/polyaniline nanocomposite: ANN modeling, isotherms, kinetics, and thermodynamic studies.

The current research is concerned with the adsorption behavior of chromium (IV) ions in an aqueous solution using a novel ferrochrome slag/polyaniline nanocomposite (FeCr-PANI) adsorbent. The effect of process parameters such as temperature, pH solution, initial Cr (VI) ions concentration, adsorbent dosage, and contact time on the adsorption process is experimentally investigated in this study. Furthermore, we have trained a multilayer artificial neural network (ANN) using the experimental data of various process parameters to successfully predict the adsorption behavior of chromium (IV) ions onto the FeCr-PANI adsorbent. The ANN model was trained using the Lavenberg-Marquardt algorithm and ten neurons in the hidden layer and was able to estimate the % removal efficiency of chromium (IV) under the influence of different process parameters (R2 = 0.991). Initial solution pH was observed to have a significant influence on the % removal efficiency. The % removal efficiency was found to be high at 97.10% for the solution with pH 3 but decreased to 64.40% for the solution with pH 11. Cr (VI) % removal efficiency was observed to increase with an increase in solution temperature, adsorbent dosage, and contact time. However, the % removal efficiency was found to decrease from 96.9 to 54.8% with increasing the initial dye concentration from 100 to 400 ppm. Furthermore, the adsorption capacity increased from 9.69 to 21.93 mg/g with an increase in the initial concentration from 100 to 400 ppm, as expected. The Langmuir isotherm model exhibited the best fit with the experimental data (R2 = 0.9977). The maximum adsorption capacity was found to be 22.523 mg g-1 at 298 K. The experimental data fitted well with the pseudo-second-order kinetic model.

Conductive Polymers and Their Nanocomposites as Adsorbents in Environmental Applications.

Proper treatment and disposal of industrial pollutants of all kinds are a global issue that presents significant techno-economical challenges. The presence of pollutants such as heavy metal ions (HMIs) and organic dyes (ODs) in wastewater is considered a significant problem owing to their carcinogenic and toxic nature. Additionally, industrial gaseous pollutants (GPs) are considered to be harmful to human health and may cause various environmental issues such as global warming, acid rain, smog and air pollution, etc. Conductive polymer-based nanomaterials have gained significant interest in recent years, compared with ceramics and metal-based nanomaterials. The objective of this review is to provide detailed insights into different conductive polymers (CPs) and their nanocomposites that are used as adsorbents for environmental remediation applications. The dominant types of CPs that are being used as adsorbent materials include polyaniline (PANI), polypyrrole (Ppy), and polythiophene (PTh). The various adsorption mechanisms proposed for the removal of ODs, HMIs, and other GPs by the different CPs are presented, together with their maximum adsorption capacities, experimental conditions, adsorption, and kinetic models reported.

Liver Transplant in Acute Liver Failure - Looking Back Over 10 Years.

BACKGROUND: Acute liver failure (ALF) is the leading cause for emergency liver transplantation (LT) all over the world. We looked at the profile of cases who required LT for ALF from a single centre to identify the possible predictors of poor outcomes. METHODOLOGY: During the 10-year period starting from 2007, 320 cases of ALF were treated at our institution, of which 70 (median age 24 years, Male:Female 1:2) underwent LT. Retrospective analyses of these 70 patients were performed. RESULTS: Etiology was identifiable in 73% (n = 51) of cases (yellow phosphorous [YP] poisoning [n = 16], Hepatitis A virus [HAV] [n = 15], Hepatitis B virus [HBV] [n = 5], Hepatitis E virus [HEV] [n = 1], anti-tubercular therapy [ATT] induced [n = 6], acute Wilson's [n = 3], and autoimmune [n = 5]]. Upon meeting King's College Hospital criteria, 69 had live donor LT (61 right lobe grafts, three left lobe grafts, five left lateral segment grafts) and one had deceased donor LT. Among these, there were five auxiliary partial orthotopic grafts and four ABO-incompatible transplants. Overall, 90-day mortality was 35.7% (n = 25), predominantly due to sepsis. Significant risk factors for mortality on multivariate analysis included indeterminate etiology, pre-op renal dysfunction, and Grade IV hepatic encephalopathy (HE). Cumulative 10-year survival of the remaining survivors was 95.6% (n = 45). CONCLUSION: LT for ALF carries high perioperative mortality (35.7%) in those presenting with indeterminate etiology, pre-op renal dysfunction, and Grade IV HE. Nevertheless, if they survive the perioperative period, long-term survival is excellent.

Comparison of the Analgesic Efficacy of a Single Dose of Epidural Dexmedetomidine versus Fentanyl as an Adjuvant to Bupivacaine in Abdominal Surgery.

BACKGROUND: Fentanyl as an epidural additive act on spinal opioid receptors, while dexmedetomidine has selective alpha-2 receptor agonist action enhancing analgesic effects. AIMS: We aimed to compare the postoperative analgesic efficacy of single doses of dexmedetomidine against fentanyl as epidural adjuvant to 0.125% bupivacaine. SETTINGS AND DESIGN: A prospective, randomized, controlled, double-blind trial was conducted in a tertiary care teaching institute. PATIENTS AND METHODS: Forty-six patients undergoing abdominal surgery under general anesthesia with epidural analgesia were allocated into two groups to receive postoperative analgesia with single doses of 10 mL 0.125% bupivacaine with the addition of dexmedetomidine 0.5 µg.kg-1 (Group D) or fentanyl 0.5 µg.kg-1 (Group F). The primary outcome was the duration of postoperative analgesia between the two groups. The secondary outcomes were hemodynamic variations, vasopressor need, and motor blockade. STATISTICAL ANALYSIS: Chi-square test for static parameters and Student's t-test or Mann-Whitney test for continuous variables were used for analysis. RESULTS: The duration of analgesia was longer in Group D (5.0 ± 2.0 h) versus Group F (2.9 ± 1.4 h), Sixteen patients in Group D versus seven patients in Group F needed vasopressors after the bolus to maintain the blood pressure (BP) within 20% of prebolus value (P = 0.018). Heart rate and mean and systolic BP were lower in Group D at various time points following bolus administration. CONCLUSION: A single dose of dexmedetomidine as an additive to epidural local anesthetic postoperatively prolongs the duration of analgesia in comparison to fentanyl but is associated with changes in hemodynamics, including the need for the administration of vasoactive drugs.

The heat shock protein-90 co-chaperone, Cyclophilin 40, promotes ALK-positive, anaplastic large cell lymphoma viability and its expression is regulated by the NPM-ALK oncoprotein.

BACKGROUND: Anaplastic lymphoma kinase-positive, anaplastic large cell lymphoma (ALK+ ALCL) is a T cell lymphoma defined by the presence of chromosomal translocations involving the ALK tyrosine kinase gene. These translocations generate fusion proteins (e.g. NPM-ALK) with constitutive tyrosine kinase activity, which activate numerous signalling pathways important for ALK+ ALCL pathogenesis. The molecular chaperone heat shock protein-90 (Hsp90) plays a critical role in allowing NPM-ALK and other signalling proteins to function in this lymphoma. Co-chaperone proteins are important for helping Hsp90 fold proteins and for directing Hsp90 to specific clients; however the importance of co-chaperone proteins in ALK+ ALCL has not been investigated. Our preliminary findings suggested that expression of the immunophilin co-chaperone, Cyclophilin 40 (Cyp40), is up-regulated in ALK+ ALCL by JunB, a transcription factor activated by NPM-ALK signalling. In this study we examined the regulation of the immunophilin family of co-chaperones by NPM-ALK and JunB, and investigated whether the immunophilin co-chaperones promote the viability of ALK+ ALCL cell lines. METHODS: NPM-ALK and JunB were knocked-down in ALK+ ALCL cell lines with siRNA, and the effect on the expression of the three immunophilin co-chaperones: Cyp40, FK506-binding protein (FKBP) 51, and FKBP52 examined. Furthermore, the effect of knock-down of the immunophilin co-chaperones, either individually or in combination, on the viability of ALK+ ALCL cell lines and NPM-ALK levels and activity was also examined. RESULTS: We found that NPM-ALK promoted the transcription of Cyp40 and FKBP52, but only Cyp40 transcription was promoted by JunB. We also observed reduced viability of ALK+ ALCL cell lines treated with Cyp40 siRNA, but not with siRNAs directed against FKBP52 or FKBP51. Finally, we demonstrate that the decrease in the viability of ALK+ ALCL cell lines treated with Cyp40 siRNA does not appear to be due to a decrease in NPM-ALK levels or the ability of this oncoprotein to signal. CONCLUSIONS: This is the first study demonstrating that the expression of immunophilin family co-chaperones is promoted by an oncogenic tyrosine kinase. Moreover, this is the first report establishing an important role for Cyp40 in lymphoma.