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Stromal cells possess unique properties to regenerate themselves and cure various chronic illnesses. An easily available and ethical source for procurement of stromal cells is umbilical cord blood which is now being stored for future use. Vedic texts also describe the cord blood as a source of life. However, Indian traditions seem to preserve one more alternative for storage and procurement of stromal cells. Traditionally, in many parts of India, the umbilical cord stump is dried and stored for future use. It is used as a medicine for some illness and to treat infertility. Since Indian traditions are an excerpt of Vedic science, it points towards the possible emergence of dried stump as an easy and cost-effective means for stromal cell procurement and storage. The present review compiles the literature available on these traditional practices and stresses upon the need of rigorous experimental and theoretical research in the area.

Introduction Multiple myeloma (MM) forms a significant proportion of hematological malignancies. Autologous transplantation continues to be an effective consolidation strategy in resource-restricted settings such as India. Objectives The main objective of the study was to analyze the clinical outcomes of autologous hematopoietic stem cell transplant (HSCT) in MM patients in a single tertiary care center in north India over a period of 5 years. Materials and Methods This retrospective observational study was conducted in a tertiary care center in north India. Data of all MM patients who underwent HSCT between January 2014, and December 2018, were analyzed. The outcome of HSCT was investigated in terms of transplant-related mortality (TRM), progression-free survival (PFS), overall survival (OS), and relapse. PFS and OS were calculated by Kaplan–Meier method and differences between the groups were tested for statistical significance using the two-tailed log-rank test. Life-table method was used for the estimation of survival rate at 1, 3, 5, and 6 years. Results Patient characteristics and survival post-transplant was similar to other published Indian studies. In total, 378 patients were diagnosed with MM in our hospital between 2014 and 2018. One hundred ninety-three patients were found to be eligible for autologous HSCT, out of which 52 ended up having a transplant giving us a high percentage (26.9%) of patients receiving a transplant in our setting. Transplant-related mortality (TRM) was nil in the present study. The mean PFS and OS were 62.8 and 70.1 months, respectively. The mean PFS and OS rates at 5 years were 75.3% and 84.2%, respectively. The average cost estimate of HSCT in our setting was 7.2 lakh Indian national rupees. Conclusion Autologous HSCT is a safe procedure with nil 100-day mortality in present series. Moreover, considering the cost of novel agents, autologous transplant remains a cost-effective way for prolonging remission and time-to-next treatment in India.

The treatment landscape of chronic lymphocytic leukemia (CLL) has witnessed immense changes in the past decade. Several newer target therapies and their combinations with anti-CD 20 therapies have got approval for management of CLL in the treatment-naïve and relapsed/refractory setting. Also, the availability of newer diagnostic techniques has helped differentiate the disease into high- and low-risk CLL which acts not just as a prognostic marker but also helps decide the best drug management that can be administered to the patients. Targeted therapy has largely overtaken chemoimmunotherapy in the management of CLL, except for a small subset of the population (young and fit with IGHV mutation). However, with targeted therapy, there is also an issue of previously uncommon treatment-emergent adverse events, the duration of therapy, and financial toxicity. The aim of this review article is to gather results from all landmark CLL trials and discuss the feasibility of incorporating Acalabrutinib in the CLL landscape from an Indian perspective.

Universe is considered as the largest condensed matter system. After the big bang, when the universe began to form, some topologically stable structures were left behind during spontaneous symmetry...

Background Eosinophilic myocarditis (EM) is rare but accounts for 12–22% of histologically proven acute myocarditis cases. Acute necrotizing EM is considered an aggressive, life-threatening disease which is usually treated by high-dose corticosteroid therapy. Case summary We report the case of a 27-year-old man with acute severe pericarditic chest pain, moderately reduced left ventricular (LV) ejection fraction, and a small pericardial effusion. Troponin I level was highly elevated in the absence of coronary artery disease, leading to the diagnosis of acute myopericarditis. In the absence of blood eosinophilia and despite a negative cardiac magnetic resonance study, LV endomyocardial biopsy revealed an acute necrotizing EM. With conventional antiphlogistic and heart failure therapy, the patient became symptom-free and inflammatory and cardiac necrosis markers as well as LV ejection fraction normalized within days. Thus, in the absence of a systemic hypereosinophilic disorder, there was no need for steroid therapy. Long-term follow-up over 12 months showed sustained normalization of cardiac structure and function. Discussion Acute necrotizing eosinophilic myopericarditis is not always a dreadful cardiac disease. There are idiopathic cases which may quickly resolve without immunosuppression. There seems to be a publication bias towards critical cases.

Nanoparticles, carbon nanotubes and polymers are widely used nowadays to improve biosensing phenomenon. However, studies considering impact of their combination on biosensor sensitivity are rarely ...

Background Creation of an iatrogenic aorto-right atrial fistula is a rare but clinically relevant complication of cardiac surgery. Transfemoral percutaneous closure is an attractive alternative to surgical repair, but there are no reports about transcatheter repair using a complete arm access. Case summary We present the case of a 44-year-old woman with heart failure (NewYork Heart Association Class III) due to a longstanding iatrogenic fistula from the non-coronary aortic cusp to the right atrium (RA) with aorta to RA shunting and severe tricuspid regurgitation (TR) caused by mitral valve replacement 15 years ago. The patient was successfully treated by percutaneous closure with an Amplatzer Vascular Plug II using complete brachial access. Following the procedure right heart chambers and TR decreased and symptoms resolved. Discussion To the best of our knowledge this is the first report of percutaneous repair of an aorto-right atrial fistula using total arm accesses (radial artery and basilic vein). In appropriately selected patients, this approach is an attractive alternative to femoral access.

Chronic myeloid leukemia (CML) is characterized by increased and unregulated proliferation of granulocytic lineage in the bone marrow and presence of these immature myeloid cells in the peripheral blood with presence of Philadelphia (Ph) chromosome. Tyrosine kinase inhibitors are the most important drugs in the CML therapy and provide long disease-free survival. Due to the increased survival of CML patients with continual administration of these drugs, the chance of development of secondary malignancies may increase. The most common secondary malignancies are prostate, colorectal and lung cancer, non-Hodgkin lymphoma, malignant melanoma, non-melanoma skin tumors and breast cancer. Herein, we are describing a rare case of Hodgkin lymphoma in a patient of CML after ten year of primary disease presentation. Hodgkin lymphoma in a known case of CML is very rare and further studies are also needed to know the pathogenic relationship between the two entities and to assess the risk of secondary Hodgkin lymphoma in CML patients treated with tyrosine kinase inhibitors. CML itself is a risk factor for development of solid cancers and hematologic malignancies. In addition, patients on chemotherapy are immune-compromised and may be at greater risk of neoplasm driven by infectious agents such as Epstein-Barr virus.

Fifteen apparently healthy male buffalo calves aged between 6 months to one year with body weight range of 70 - 140 Kg divided into 3 groups of 5 buffalo calves each were used in the present investigation. Endotoxic shock was produced by IV infusion of Escherichia coli endotoxin @ 5 μg/kg BW/hr for 3 hours followed by administration of three different treatment regimens comprising of intravenous infusion of hypertonic saline solution(HSS) @ 4 ml/Kg bw, flunixin meglumine @ 1.1 mg/Kg bw and blood @ 20 ml/Kg bw to group-I, HSS, Dextran-40 and Flunixin meglumine to group-II and HSS, Dextran-40, whole blood and Flunixin meglumine to group-III with the objectives to study the major physio-pathological changes during induced endotoxemia in buffalo calves and to compare the effects of different treatment options to find out the best treatment option out of the three combinations. All the animals were further observed up to day 2 or death whichever was earlier. Endotoxin infusion to all the animals caused symptoms of restlessness, respiratory distress, snoring, diarrhoea, profuse salivation along with the significant hypoproteinemia, hypoalbuminemia, hypoglobulinemia, hypokalemia and hypocalcemia. The treatment with HSS, flunixin meglumine and blood infused as one time infusion to these endotoxemic buffalo calves not only alleviated the above mentioned symptoms but also significantly raised the circulating albumin level at 5.5 hrs and day 2 and Fibrinogen level at day 2 of observation. A significant hypocalcaemia was observed at 4.5 hours along with an increase in Alkaline Phosphatase at 3.5, 4.5 and 6.5 hrs. All the endotoxemic buffalo calves which died were subjected to post mortem and histopathological studies. Epicardial and endocardial haemorrhages, haemorrhages on intestinal mucosa, congestion, haemorrhages, emphysema and fibrinous thrombi in microvasculature of lungs were salient histopathological findings. On comparison with observations of the other treatment regimens tried, it was found that the IV infusion of the combination of HSS, Flunixin meglumine, Dextran-40 and blood was found to be the most effective leading to full recovery of 3 out of 5 buffalo calves of group-III where as only 1 out of 5 animals recovered in group-II. None of the group-I animals recovered and all of these succumbed to shock after day-2.

East Asians, Asian Indians and Amerindians have a five to ten-fold lower age-adjusted incidence rate (AAIR) of chronic lymphocytic leukaemia (CLL) compared with persons of predominately European descent. The data we review suggest a genetic rather than environmental basis for this discordance. All these populations arose from a common African Black ancestor but different clades have different admixture with archaic hominins including Neanderthals, Denisovans and Homo erectus, which may explain different CLL incidences. There are also some differences in clinical laboratory and molecular co-variates of CLL between these populations. Because the true age-adjusted incidence rate in African Blacks is unknown it is not possible to determine whether modern Europeans acquired susceptibility to CLL or the other populations lost susceptibility and/or developed resistance to developing CLL. We also found other B-cell lymphomas and T- and NK-cell cancers had different incidences in the populations we studied. These data provide clues to determining the cause(s) of CLL.

Background and Objectives: Enumeration of Hematopoietic Progenitor Cell (HPC) is vital to decide the Time To Initiate Harvest (TTIH) and Adequacy Of Harvest Dose (AOHD). Standard of care used for HPC enumeration is flowcytometric CD34+ enumeration, but it is expensive, time-consuming and requires skilled staff to perform the test. Alternatively, HPC-count by advanced automated cell analyzer is cheaper, quicker and easy-to-perform test. Our objective was to find correlation of HPC count with CD34+ enumeration in leukapheresis. Materials and Methods: An observational, prospective study was conducted in the year 2018-2019. A total of 126 samples were included in the study, the peripheral blood group comprised of 42 samples and apheresis group of 84 samples. The samples were simultaneously tested for CD34+ expression and complete blood count (CBC) which included the HPC count, WBC count, MNC count and IG (Immature Granulocyte) index and correlation analysis was performed with CD34 + flowcytometric count. The cut-off of peripheral blood HPC count for the target dose of 5*106 CD34+ cells/kg was established using Receiver Operator Curve. Results: The correlation coefficient (r) of HPC with CD34+ count was 0.617 and 0.699 for peripheral blood and apheresis sample respectively, which was statistically significant. The correlation with MNC, IG and WBC count was not very significant. A cut-off value of PB HPC was established to be 66 HPC/µL with a positive predictive value of 94.12%.The cost of CD34+ flow cytometric enumeration was six times that of HPC enumeration by analyzer. Conclusion: The HPC count is a cheaper, rapid and easy test and can be clinically applied to predict TTIH. Funding Statement: None. Declaration of Interests: None. Ethics Approval Statement: The study was approved by Institutional Review Board. (MICR-849/2018).

Erdheim–Chester disease (ECD) is a rare multi-system, non-Langerhans cell histiocytic disorder (NLCHD) with only a few hundred cases reported in the literature. Its diverse clinical manifestations require a high level of diagnostic suspicion. BRAFV600E mutation analysis is of critical significance, as it has implications for targeted therapy with BRAF inhibitors such as vemurafenib and dabrafenib. We report a case of symptomatic, central nervous system (CNS)-predominant ECD initially presenting with CNS mass lesions mimicking meningiomas on imaging and prominent periorbital xanthogranulomas. CNS presentation of ECD, although not infrequent, bears particular significance here from a therapeutic point of view, since only partial debulking was possible owing to anatomical complexities. Radiological evaluation following surgery showed no significant change in the size of the lesions. Targeted therapy was commenced following histopathology, immunohistochemistry (IHC), and molecular testing, resulting in marked improvement of clinical symptoms and tumor regression. Thus, diagnostic accuracy was imperative for symptomatic relief in this rare but aggressive neoplasm with a complex clinical presentation and misleading initial radiological impressions, bearing an otherwise grim prognosis.

Context: Secondary acute myeloid leukemia (sAML) may arise from a previous clonal disorder of hematopoiesis, usually from myelodysplastic syndrome, chronic myeloproliferative neoplasm, or as a complication in patients receiving chemotherapy or radiotherapy for a primary malignancy, including hematological and non-hematological/solid malignancies (therapy-related AML [t-AML]). Overall, frequencies of sAML and tAML were 19.8% and 6.6%, respectively. It is associated with specific clinical features with a uniformly poor prognosis. Objective: To study patients of t-AML with respect to clinical presentation, laboratory parameters (including flow cytometry immunophenotyping), cytogenetic and molecular studies, and clinical outcome. Design: This study was a retrospective analysis of patients of t-AML from January 2011 to December 2019. Patients: The patients underwent a detailed hematological work up: peripheral blood smear, bone marrow examination along with flow cytometric immunophenotyping, and karyotyping and molecular studies (NPM1, FLT3ITD/TKD, BCR/ABL, PML/RARA, INV16, AML-ETO). Outcomes of the patients were also reviewed. Results: A total of 20 cases of therapy-related AML were diagnosed in patients treated for various malignancies of the breast (9 cases), prostate (3 cases), and pancreas (2 cases), as well as lymphomas (NHL: 4 cases and HL: 2 cases). There were 7 males and 13 females (M:F: 1:1.85) with a median age of 63 years (range 35–82 years). Median latency period to t-AML was 3.5 years (range 0.5–11.0 years). Median haemoglobin was 72.5 g/L (61–151 g/L), WBC count 3.7× 109/L (1.02–169.1×109/L), platelet count 40 × 109/L (12–257 ×109/L, peripheral blood and bone marrow blast percentage 48% (5-98%) and 76% (20–98%), respectively. AML with monocytic differentiation was the most common morphological and flow cytometric subtype (50% cases). Complex karyotype was seen in 50% cases. Molecular studies for NPM, FLT3ITD/TKD, PML/RARA, AML-ETO, and INV16 showed 8 cases with NPM1 positivity and 4 case with FLT3ITD positivity. Only 4 patients (20%) achieved complete remission but relapsed within 1 year of duration. Ten patients succumbed to their disease, the majority within 1 year of t-AML diagnosis. Conclusion: The study highlights the development of therapy-related AML following chemotherapy and/or radiotherapy as an important therapy-related complication. The latency period and clinical manifestations may differ depending on the type of cytotoxic drug, cumulative dose, and dose intensity. A close hematological follow-up should always be done for an accurate and timely diagnosis.

Ruxolitinib is a Janus kinase (JAK) 2 inhibitor that is an effective therapeutic agent for primary myelofibrosis (PMF), which helps significantly to reduce constitutional symptoms and spleen size. However, this drug has significant immunomodulatory effects that may lead to various opportunistic infections. Reactivation of tuberculosis and certain viral infections have been well documented. Although a few reports of patients with pulmonary cryptosporidiosis on ruxolitinib exist, an extensive literature review shows only one previously reported case of cryptococcal meningoencephalitis in an immunocompetent patient on ruxolitinib, with a history of avian exposure. Here we report another extremely rare incidence of cryptococcal meningitis in a fully immunocompetent male patient on ruxolitinib, with no history of contact with birds. Although this is an approved and effective therapy for PMF, careful evaluation, screening, and prophylaxis in susceptible individuals should be considered before starting therapy.

Department of Computing and Software at Mc-Master University and Highmark Global are collaborating on a research project to develop an efficient blockchain-based marketplace for software testing. In this paper, we propose a consensus protocol for the blockchain platform in medical related technologies. The proposed consensus protocol incorporates a software testing algorithm that takes into account the capability and credibility of software testers and temporally adjusts these qualities based on the performance of testing jobs completed by the testers. In addition, the protocol maintains a quantifiable measure of testers' capabilities based on the past jobs they have completed. We expect to implement this protocol and deploy on a blockchain platform to automate the software testing validation process and resolve discrepancies that arise between testing results from different testers.

We report an unusual case of paragonimiasis in a Nepali patient presenting with massive pericardial effusion and pericardial tamponade. The patient reported neither the consumption of crabs or crayfish nor the consumption of wild animal meat, which are the usual sources of infection. It is suspected that the source of infection was instead the ingestion of raw live slugs as part of a traditional medicine treatment.

In the present study, the optical, thermal, and mechanical properties of liquid crystal elastomers (LCEs) were investigated using various techniques. The presence of functional groups in LCE was studied using Fourier transform infrared spectroscopy. The phase transition temperatures were confirmed via polarizing optical microscopy and Fabry–Perot scattering studies. The differential thermal analysis was used for investigating the thermal behavior. A dynamic mechanical analysis was used to study the mechanical properties of LCE. The significant mechanical changes with a considerable reversible effect were observed for this soft material. The changes in the mechanical shape with the temperature are attributed to the change in the phase of the LCE material.

Background: Hematopoietic progenitor stem cell transplantation (HPSCT) is used as a standard treatment option to improve outcome in hematological and nonhematological disorders. It is important for new HPSCT program to look at its patient outcome data and compare it with the published data to evaluate the efficacy of program. Aims: The aim was to compile and collate the patient outcome data of HPSCT and compare with published reports. Materials and Methods: Patient demographics, indications, stem cell harvest by apheresis, dose collected, infusion, engraftment, and follow-up data were collected from hospital information system from 2010 to 2013 in a tertiary care hospital. HPSCs were mobilized with granulocyte colony-stimulating factor, and harvests were done on the 5th day. Engraftment was decided for neutrophil when counts were 0.5 × 109/L and for platelets when counts were 20 × 109/L on two consecutive days without any transfusion support. Results: There were 133 harvests for 95 patients with various disorders; multiple myeloma was most common in autologous and acute lymphoblastic leukemia in allogeneic group. One hundred harvests were done for autologous and 33 for allogeneic HPSCT. In autologous group, of 66 patients, 60 (90.9%) received stem cell infusion at median dose of 4.63 × 106 CD34+ cells/kg. Similarly, in allogeneic group, of 29 patients, 27 (93.10%) received infusion at median dose of 5.8 × 106 CD34+ cells/kg. 58 (96.9%) patients and 25 (92.6%) engrafted in autologous and allogeneic group, respectively. The median time for neutrophils engraftment was 11 days in autologous group and 12 days in allogeneic group. The median time for platelet engraftment was 11.5 days in autologous group and 13 days in allogeneic group. The 100-day survival rate was 95% n = 57) in autologous group and 77.8% n = 21) in allogeneic group. Conclusion: This data analysis shows reasonably good results of HPSCTs with majority of patients surviving at 100-day follow-up.

Since 1888, the liquid crystal display (LCD) industry is facing a fierce competition due to serious limitations such as poor contrast ratio and response time. Although some new materials have offered new applications and opened new markets for LCDs, materials with improved contrast ratio are highly desirable in LCD industry to sustain in the current market. This work reports a new behaviour in nano-material-doped liquid-crystal composite which is suitable for eradicating limitations of contrast ratio. Here, a high concentration of carbon nanotubes (CNTs) is doped in liquid crystal (LC) materials wherein the CNTs form aggregates in the LC composition. In these heavily doped samples, the phase change takes place with application of bias. This reversible process improves the contrast ratio as the material oscillates between crystalline and LC phases with field.

Myelodysplastic syndromes (MDS) are fairly common hematological disorder of elderly. They are a group of clonal malignant hematopoietic stem cell disorders characterized by dysplastic morphology, variable cytopenia and a variable threat of transformation to AML. These dysplastic changes are a result of chromosomal abnormalities and somatic mutations. MDS is the most common myeloid neoplasm of the older adults with median age at diagnosis being 72 years and an average incidence rate of 0.2 per 100,000 people per year. MDS is diagnosed and classified according to the WHO 2008 classification system, which utilizes peripheral blood and bone marrow findings. Other essential investigations include flow cytometry, genetic profile and chromosomal analysis. Various prognostic scoring system have been developed which help guide the treatment. Treatment of complications associated with MDS also forms an essential component of the management of this disease.

Anaplastic large cell neuroblastomas ALCNB are a subset of undifferentiated neuroblastomas with marked pleomorphic and anaplastic cytomorphological features which are characterized by the absence or marked paucity of histological clues for the diagnosis of neuroblastoma that render them diagnostically challenging Here in we are presenting a case of ALCNB in which the clinical radiological and cytological features were misleading to a diagnosis of lymphoma High degree of cytological suspicion especially when an abdominal mass with internal calcification presents in children less than years of age in the absence of classical cytological picture of neuroblastoma like resetting and neuropil but presence of nuclear anaplasia with many bizarre and multinucleated cells mimicking lymphoma might help in delineating these cytological twins Further study of this variant of neuroblastoma is required as it poses a diagnostic dilemma due to the presence of similar types of cells as that of anaplastic large cell lymphoma ALCL It not only elucidates the prognosis but also aids in establishing an appropriate differential diagnosis and determine the optimal therapy

Due to their exceptional properties, liquid crystals are useful for a wide range of applications. As reported in the literature, a slight dispersion of liquid crystals with carbon nanotubes has a detectable effect on the liquid-crystal properties making them appropriate for various applications. The present work reports a new application of these composites disclosing a process of transformation of commercially available high-temperature liquid crystals into low-temperature liquid crystals. This is accomplished by using high concentration of carbon nanotubes in liquid-crystal materials wherein the carbon nanotubes form cluster inside the liquid-crystal cells. The application of bias on these heavily doped samples resulted in the appearance of liquid-crystal phases at room temperature which, in the case of pure liquid crystals, were observable only at high temperature. The process is reversible and hence phase change can be controlled by external field.

Polyaniline (PANI) synthesized through the in situ polymerization method and its composites with zinc oxide nanoparticles loaded in various weight percentages were studied. The formation of PANI and its composites was characterized using different characterizing tools, and detailed analysis was done to investigate the structural and morphological properties of the composites. The presence of the vibration band of the metal oxide and other characteristic bands of the composites, as characterized via Fourier transmission infrared spectroscopy, confirmed the synthesis of the polymer nanocomposites. The X-ray diffraction patterns of the nanocomposites revealed their polycrystalline nature. The dielectric responses of PANI and the ZnO-doped PANI composites were investigated within the frequency range of 20 Hz to 1 MHz. The dielectric constant of the ZnO-doped PANI composite was found to be higher than that of the pure PANI. The value of the dielectric constant decreased with increasing frequency, and it became...

OF THE THESIS STUDY OF SONAR FOR IMAGING OF THE SOLID-LIQUID INTERFACE INSIDE LARGE TANK by Nitin Sood Florida International University, 2005 Miami, Florida Professor Kang Yen, Major Professor Retrieval, treatment, and disposal of high-level radioactive waste (HLW) are expected to cost between 100 and 300 billion dollars. The risk to workers, public health, and the environment are also a major area of concern for HLW. Visualization of the interface between settled solids and the optically opaque liquid is needed for retrieval of the waste from underground storage tanks. The profiling sonar selected for this research generates 2-D image of the interface. Multiple experiments were performed to demonstrate the effectiveness of sonar in real-time monitoring of the interface inside HLW tanks. Initial experiments demonstrated that various objects shapes could be identified even when 30% of solids were entrained in liquid. Simulations of the sonar system validated these results. The second set of experiments confirmed the sonar’s ability to detect a solid interface with density similar to the liquid. The third set of experiments determined the effects of nearby objects on image resolution. The final set of experiments demonstrated functionality and chemical capability of the sonar in highly caustic solutions.