Recurrent and transformation of borderline to malignant phyllodes tumour with osteoid differentiation: a case report and literature review.

Phyllodes tumours or cystosarcoma phyllodes are fibroepithelial tumours of the breast and represent 1% of breast tumours. A 20-year-old nullipara presented with an enlarging left breast mass over 6 months. Although widely excised, it was reported to be a 12 × 10 × 5.5-cm borderline phyllodes tumour with involvement of the superior and inferior margins. Seven months later, she presented with a new ipsilateral breast lump measuring 8.5 × 7.5 × 4.6 cm. She underwent a left mastectomy, a three-rib resection with titanic rods for the thoracic cage reconstruction, and a latissimus dorsi flap wound closure. Histopathology revealed a high-grade malignant phyllodes tumour with features of osteoid differentiation with the nearest deep margin measuring 3 mm. She developed metastasis to the ipsilateral axillary lymph nodes and contralateral lung 2 months postoperatively. She was given palliative radiotherapy 60 Gy in 30 fractions to the left axilla. She developed sudden lower-limb weakness due to spinal metastases. The symptoms resolved with radiotherapy to the thoracic spine (T4-T8). As the lesion continued to grow rapidly from the anterior chest wall encircling towards the back, it was deemed unresectable. She was given palliative chemotherapy (doxorubicin six cycles, followed by ifosfamide one cycle) but had disease progression. She passed away 3 months later. The mainstay of treatment for phyllodes tumour is excision with a minimal margin of 1 cm. Although margins were involved after the first surgery, she was followed up as the pathology was a borderline phyllodes. When the lump recurred and had transformed, despite extensive surgery, it returned shortly and progressed. A borderline phyllodes should be excised to obtain a minimal margin of 1 cm, even if it means performing a mastectomy, to minimise recurrence. A recurrence may undergo malignant transformation which is largely chemotherapy and radiotherapy resistant. This will result in a poor outcome and decreased survival.

Impact of Particle Shape and Surface Group on Membrane Fouling.

Membrane fouling remains one of the most critical drawbacks in membrane filtration processes. Although the effect of various operating parameters-such as flow velocity, concentration, and foulant size-are well-studied, the impact of particle shape is not well understood. To bridge this gap, this study investigated the effect of polystyrene particle sphericity (sphere, peanut and pear) on external membrane fouling, along with the effect of particle charge (unmodified, carboxylated, and aminated). The results indicate that the non-spherical particles produce higher critical fluxes than the spherical particles (i.e., respectively 24% and 13% higher for peanut and pear), which is caused by the looser packing in the cake due to the varied particle orientations. Although higher crossflow velocities diminished the differences in the critical flux values among the particles of different surface charges, the differences among the particle shapes remained distinct. In dead-end filtration, non-spherical particles also produced lower flux declines. The shear-induced diffusion model predicts all five particle types well. The Derjaguin-Landau-Verwey-Overbeek (DLVO) and extended DLVO (XDLVO) models were used to quantify the interaction energies, and the latter agreed with the relative critical flux trends of all of the PS particles. As for the flux decline trends, both the DLVO and XDLVO results are in good agreement.

Cross-Linked Polycarbonate Microfiltration Membranes with Improved Solvent Resistance.

In this study, we report a facile preparation of an organic solvent-resistant membrane through the formation of urethane bonds between polycarbonate and polyethyleneimine groups. The modified membrane was further cross-linked with 1,4-butanediol diglycidyl ether (BDG) to enhance its solvent resistance as well as its thermal and mechanical stability. The cross-linked polycarbonate membranes exhibited improved solvent resistance with various organic solvents, giving a maximum swelling degree of 6%. It also showed better mechanical and thermal stability, as well as excellent permeance and rejection performance. This study demonstrates BDG as an attractive cross-linker for polycarbonate microfiltration membranes to transform them toward organic solvent filtration applications.

Tabernaemontana divaricata leaves extract exacerbate burying behavior in mice.

OBJECTIVE: Tabernaemontana divaricata (TD) from Apocynaceae family offers the traditional folklore medicinal benefits such as an anti-epileptic, anti-mania, brain tonic, and anti-oxidant. The aim of the present study was to evaluate the effect of ethanolic extract of TD leaves on burying behavior in mice. MATERIALS AND METHODS: Mice were treated with oral administration (p.o.) of ethanolic extract of TD (100, 200, and 300 mg/kg). Fluoxetine (FLX, a selective serotonin reuptake inhibitor) was used as a reference drug. Obsessive-compulsive behavior was evaluated using marble-burying apparatus. RESULTS: TD at doses of 100, 200, and 300 mg/kg dose-dependently inhibited the obsessive and compulsive behavior. The similar results were obtained from 5, 10, and 20 mg/kg of FLX. TD and FLX did not affect motor activity. CONCLUSION: The results indicated that TD and FLX produced similar inhibitory effects on marble-burying behavior.

Opportunities for medical students to perform four common ward procedures in a Malaysian teaching hospital

Introduction: Undergraduate medical education should be broad-based, holistic, integrated and should promote a framework for the development of higher order cognitive skills like communication, professionalism and teamwork to prepare the student for a life-long challenging medical career. Recent calls for a competency-based medical education require, in addition, competency in clinical and procedural skills prior to graduation. This study investigates how often opportunities exist for medical students to perform four common ward procedures prior to graduation. Method: A prospective cross-sectional study to assess the opportunities a medical student have in performing four common ward procedures, comprising intravenous cannulation, nasogastric tube insertion, urinary catheterisation and chest tube insertion, in a State General hospital in Malaysia was done. Results: A medical student has sufficient opportunity to perform only intravenous cannulation prior to graduation. He has a remote chance to insert a urinary catheter and is unlikely to have the opportunity to insert a nasogastric tube or insert a chest tube prior to graduation. Conclusion: Although competency in clinical skills and procedural skills prior to graduation are desirable, this is increasingly difficult to achieve due to shortage of clinical material, teachers to supervise, the large numbers of medical students and house officers, the short time spent on the main disciplines and the failure of many universities to invest heavily in skills laboratories staffed by full time clinicians. The calls to introduce competency-based medical education in undergraduate medical education, particularly in procedural competence, should take into account the challenges in delivery and the realities in the hospitals today. This is necessary to avoid demoralising students who are unable to achieve their quota of procedures through no fault of theirs.

Lagenaria siceraria fruit extract ameliorate fat amassment and serum TNF-α in high-fat diet-induced obese rats

OBJECTIVE@#To investigate the effects of ethanolic extract of Lagenaria siceraria fruit (ELSF) on fat amassment and serum TNF- α in high-fat diet-induced obese rats.@*METHODS@#The high fat diet induced obese rats were orally treated with orlistat (50 mg/kg) and ELSF (100, 200, 300 mg/kg/day) to the respective treatment groups. The body weight, fasting blood glucose level, lipid profile, serum levels of tumor necrosis factor- α (TNF-α) in rats were measured after 30 days of treatment and compared to the obese control animals.@*RESULTS@#ELSF significantly (P < 0.001) reduced the body weight gain, fasting blood glucose, total cholesterol, triglyceride, total protein and TNF-α.@*CONCLUSIONS@#These encouraging findings suggest that Lagenaria siceraria has excellent pharmacological potential to prevent fat amassment.

The influence of Alpinia calcarata extract on the serum lipid and leptin levels of rats with hyperlipidemia induced by high-fat diet

Objective: To study the effect of ethanolic extract from Alpinia calcarata rhizomes on the serum lipid and leptin levels of rats with hyperlipidemia induced by high-fat diet. Methods: Male wistar rats were divided into six groups: normal, high-fat diet control (HFD) and ethanolic extract of Alpinia calcarata rhizomes (ACRE) (100, 200 and 300 mg/kg; p.o.) was administered to the high fat-diet-induced hyperlipidemic rats for 30 days to evaluate its antihyperlipidemic activity. Atorvastatin (10 mg/kg; p.o.) was used as a standard drug. Results: The results demonstrated that in HFD-induced hyperlipidemic rat, ACRE reduced rat weight gain, triglyceride (TG), total cholesterol levels (TC), low-density lipoprotein (LDL), very low-density lipoprotein (VLDL), total protein (TP) and leptin level (pg/mL). Conclusions: These encouraging findings suggest that ACRE has excellent pharmacological potential to prevent hyperlipidemia.

Overview of cases and prevalence of jaundice in neonatal intensive care unit.

This study was undertaken to know the pattern of jaundice prevalent among the babies admitted at the Neonatal Intensive Care Unit (NICU) of the B. P. Koirala Institute of Health Sciences (BPKIHS). A total of 293 neonates including 201 (68.6%) males and 92 (31.4%) females were admitted over a period of one year (15th June 2001 to 14th June 2002). Prematurity (30.0%), birth asphyxia (29.0%), neonatal septicemia (25.9%) and respiratory distress (23.9%) were the most common reasons for admission to the NICU. There were 42 cases of neonatal jaundice, among which babies born to primigravidae (59.5%), exceeded those born to multigravidae (40.5%). Pathological jaundice was found in 64.3% of the admitted cases of neonatal jaundice. Prematurity (33.3%) and neonatal septicemia (25.9%) were the most common causes of pathological jaundice, while prematurity with neonatal septicemia (14.8%), ABO incompatibility (11.1%), Rh incompatibility (7.4%) and prematurity, neonatal septicemia and ABO incompatibility combined (7.4%) accounted for the remaining cases of jaundice. A more detailed study related to the pathogenesis of jaundice among neonates is needed for the prevention of this disease in them.