Diagnostic value of bone marrow cell morphology in visceral leishmaniasis-associated hemophagocytic syndrome:Two case reports

BACKGROUND Visceral leishmaniasis related-hemophagocytic lymphohistiocytosis(VL-HLH)is a hemophagocytic syndrome caused by Leishmania infection.VL-HLH is rare,especially in nonendemic areas where the disease is severe,and mortality rates are high.The key to diagnosing VL-HLH is to find the pathogen;therefore,the Leishmania must be accurately identified for timely clinical treatment.CASE SUMMARY We retrospectively analyzed the clinical data,laboratory examination results,and bone marrow cell morphology of two children with VL-HLH diagnosed via bone marrow cell morphology at Kunming Children’s Hospital of Yunnan,China.Both cases suspected of having malignant tumors at other hospitals and who were unresponsive to treatment were transferred to Kunming Children’s Hospital.They are Han Chinese girls,one was 2 years old and the other one is 9 mo old.They had repeated fevers,pancytopenia,hepatosplenomegaly,hypertriglyceridemia,and hypofibrinogenemia over a long period and met the HLH-2004 criteria.Their HLH genetic test results were negative.Both children underwent chemotherapy as per the HLH-2004 chemotherapy regimen,but it was ineffective and accompanied by serious infections.We found Leishmania amastigotes in their bone marrow via morphological examination of their bone marrow cells,which showed hemophagocytic cells;thus,the children were diagnosed with VL-HLH.After being transferred to a specialty hospital for treatment,the condition was well-controlled.CONCLUSION Morphological examination of bone marrow cells plays an important role in diagnosing VL-HLH.When clinically diagnosing secondary HLH,VL-HLH should be considered in addition to common pathogens,especially in patients for whom HLH-2004 chemotherapy regimens are ineffective.For infants and young children,bone marrow cytology examinations should be performed several times and as early as possible to find the pathogens to reduce potential misdiagnoses.

Special IgD-λtype multiple myeloma based on bone marrow cell morphology:A case report

We aimed to explore the changes of laboratory indexes of IgD-λtype multiple myeloma with special cell morphology,and to improve the cognition of IgD-λtype MM.To explore the changes of laboratory indexes of IgD-λtype 1 multiple myeloma with special cell morphology,and to improve the cognition of IgD-λtype MM.The morphology of bone marrow cells,immunofixation electrophoresis,serum free light chain(sFLC)and other detection indexes of a patient with IgD-λtype MM treated in Handan Central Hospital in December 2020 were analyzed.The patient bone marrow smears showed 62%of abnormal cells-which were distributed in clusters and resembled lymphoma and metastatic cancer cells.The Flowcytometry indicates that the cell is a plasma cell tumor.Immunoglobulin IgG,IgA and IgM were all lower than the normal range.There is a monoclonal light chainλcomponent in immunofixation electrophoresis.The serum free light chainλwas 2700.00 mg/L,light chain k/λis 0.0023,the high of serum calcium,LDH,β2 microglobulin.IgD-λtype MM is a rare type of MM.The age of onset is young,the invasiveness is strong,the prognosis is poor,the clinical manifestation is complex,and it is easy to be misdiagnosed or missed.The analysis of the clinical symptoms and laboratory characteristics of the disease plays a positive role in the diagnosis,treatment and prognosis of the disease.

The Last Pterosaurs: First Record from the Uppermost Maastrichtian of the Tremp Syncline (Northern Spain)

Pterosaur bones are for the first time reported from the Tremp Syncline （Spain） and the southern Pyrenees. They come from the Torrebilles-2 site （Isona, Lleida Province） in the upper Maastrichtian part of the Tremp Formation, which falls within the C29r magnetochron. Fragmentary long bones are referred to the Pterosauria based on their cortical thinness, micro-architecture, and histological features. They belong to very large to possibly giant individuals. The most complete specimen is possibly a partial right femur. The review of the Maastrichtian pterosaur record shows that only a few specimens can be referred to the C29r （which contains the K/Pg boundary）. The identification of fragmentary remains could improve our knowledge about the abundance and distribution of these flying sauropsids just before the end-Cretaceous mass extinction.

Antifibrotic effect of N-acetyl-seryl-aspartyl-lysyl-proline on bile duct ligation induced liver fibrosis in rats

AIM:To investigate the preventive effect of N-acetyl-seryl-aspartyl-lysyl-proline (AcSDKP) on bile duct ligation (BDL)induced liver fibrosis in rats. METHODS:Liver fibrosis in rats was induced by BDL and AcSDKP was infused subcutaneously for 2 wkvia a osmotic minipump (Alzet 2ML4) immediately after BDL operation. After scarifying, serum and liver specimens were collected. Hematoxylin and eosin staining, Sirius red staining, enzyme linked immunosorbent assay, Western blot or real-time polymerase chain reaction were used to determinate liver functions, histological alterations, collagen deposition, mRNA expression of markers for fibroblasts, transforming growth factor-β1 (TGF-β1) and bone morphogenetic protein-7 (BMP-7). RESULTS:When compared to model rats, chronic exogenous AcSDKP infusion suppressed profibrogenicTGF-β1 signaling, α-smooth muscle actin positivity (α-SMA), fibroblast specific protein-1 (FSP-1) staining and collagen gene expression. Col Ⅰ, Col Ⅲ, matrix metalloproteinase-2, tissue inhibitors of metallopro-teinase-1 and tissue inhibitors of metalloproteinase-2 mRNA expressions were all significantly downregulated by AcSDKP infusion (2.02 ± 1.10vs 14.16 ± 6.50, 2.02 ± 0.45vs 10.00 ± 3.35, 2.91 ± 0.30vs 7.83 ± 1.10, 4.64 ± 1.25 vs 18.52 ± 7.61, 0.46 ± 0.16 vs 0.34 ± 0.12, respectively, P < 0.05). Chronic exogenous AcSDKP infusion attenuated BDL-induced liver injury, inflammation and fibrosis. BDL caused a remarkable increase in alanine transaminase, aspartate transaminase, total bilirubin, and prothrombin time, all of which were reduced by AcSDKP infusion. Mast cells, collagen accumulation, α-SMA, TGF-β1, FSP-1 and BMP-7 increased. The histological appearance of liver specimens was also improved. CONCLUSION:Infusion of exogenous AcSDKP attenu-ated BDL-induced fibrosis in the rat liver. Preservation of AcSDKP may be a useful therapeutic approach in the management of liver fibrosis.

Tissue level microstructure and mechanical properties of the femoral head in the proximal femur of fracture patients

This study aims to investigate the regional variations of trabecular morphological parameters and mechanical parameters of the femoral head,as well as to determine the relationship between trabecular morphological and mechanical parameters.Seven femoral heads from patients with fractured proximal femur were scanned using a micro-CT system.Each femoral head was divided into 12 sub-regions according to the trabecular orientation.One 125 mm^3 trabecular cubic model was reconstructed from each sub-region.A total of 81 trabecular models were reconstructed,except three destroyed sub-regions from two femoral heads during the surgery.Trabecular morphological parameters,i.e.trabecular separation（Tb.Sp）,trabecular thickness（Tb.Th）,specific bone surface（BS/B V）,bone volume fraction（BV/TV）,structural model index（SMI）,and degree of anisotropy（DA） were measured.Micro-finite element analyses were performed for each cube to obtain the apparent Young＇s modulus and tissue level von Mises stress distribution under 1%compressive strain along three orthogonal directions,respectively.Results revealed significant regional variations in the morphological parameters（P〈0.05）.Young＇s moduli along the trabecular orientation were significantly higher than those along the other two directions.In general,trabecular mechanical properties in the medial region were lower than those in the lateral region.Trabecular mechanical parameters along the trabecular orientation were significantly correlated with BS/BV,BV/TV,Tb.Th,and DA.In this study,regional variations of microstructural features and mechanical properties in the femoral head of patients with proximal femur fracture were thoroughly investigated at the tissue level.The results of this study will help to elucidate the mechanism of femoral head fracture for reducing fracture risk and developing treatment strategies for the elderly.

Comparative Osteology of Two Far Eastern Species of Ratsnakes(Serpentes:Colubridae), Elaphe dione(Pallas, 1773) and E. schrenckii(Strauch, 1873), for the Purpose of Palaeontological Studies

The taxonomic identification of Quaternary remains requires a comparison of fossil bones with the skeletons of existing taxa based on the morphological criteria. However, the osteology of most modern snake species has not yet been studied. This work is aimed at finding differences in the bone morphology of Amur and Dione’s ratsnakes and the criteria for their identification. The variety of bone morphology depends on several parameters. First, these are species differences which determine the systematic position of the animal. Second, it is individual varia bility.Third, these are progressive changes in the vertebrae morphology along the vertebral column from the first vertebra to the last. Fourth, it is age-related variability. 20 skeletonised specimens: 12 specimens of Elaphe dione and 8 specimens of Elaphe schrenckii were used to define diagnostic osteological characters. The bones of the two studied species are very similar and their variability overlaps. However, differences and identification criteria were found for 13 skull bones:nasal, frontal, parietal, supraoccipital, maxilla, quadrate,palatine, pterygoid, ectopterygoid, basiparasphenoid,basioccipital, dentary and the compound bone. In addition, the variability and differences of the cervical,trunk, cloacal, and caudal vertebrae were examined.

Stereo morphology of temporal bone and ear

Background The temporal bone has the most complicated anatomic feature among the whole human body, which always challenges otolaryngologists. This study was to study three-dimensional (3D) morphology of the temporal bone and the ear by means of a computer image processing technique, for the purpose of providing a 3D image to help in pathological, diagnostic and surgical procedures Methods Forty sets of temporal bone celloidin serial sections with reference points were prepared and the contours of selected structures and reference points were entered into a graphics programme The technique of computer-aided 3D reconstruction was applied to obtain 3D images and parameters of the temporal bones and the ears Stereo views of the ossicles (n=5), the facial nerves (n=11), the posterior tympanic sinuses (n=11), the posterior ampullary nerves (n=4), the endolymphatic ducts and sacs (n=5), and the bony and membranous labyrinth (n=1) were reconstructed Results Three-dimensional images, including the cochlea, the ossicles, the nerves, the tendons and the endolymphatic fluid system in the temporal bone, were obtained Stereo picture pairs and 3D parameters of spatial dimensions, angle and volume for these reconstructed structures were calculated The arrangement of the ossicles, spatial relationship of the bony and membranous labyrinth, the whole course of the facial nerves, the endolymphatic sac and posterior tympanic cavity were clearly observable Stereo picture pairs made the spatial relationships among the above-mentioned structures much clearer The operation of the posterior ampullary nerve transection was designed and simulated on the graphic computer based on 3D anatomic investigations Conclusion The technique of computer-aided 3D reconstruction provides a new tool to observe the morphology of the temporal bone and thus may allow design and study of new surgical approaches

Kidney Tubular-Cell Secretion of Osteoblast Growth Factor Is Increased by Kaempferol:A Scientific Basis for "The Kidney Controlling the Bone" Theory of Chinese Medicine

Objective： To study, at the cytological level, the basic concept of Chinese medicine that “the Kidney （Shen） controls the bone”. Methods： Kaempferol was isolated form Rhizoma Drynariae （Gu Sui Bu, GSB） and at several concentrations was incubated with opossum kidney （OK） cells, osteoblasts （MC3T3 El） and human fibroblasts （HF） at cell concentrations of 2 x 104/mL. Opossum kidney cell-conditioned culture media with kaempferol at 70 nmol/L （70kaθOKM） and without kaempferol （oOKM） were used to stimulate MC3T3 E1 and HF proliferation. The bone morphological protein receptors I and Ⅱ （BMPR I and Ⅱ） in OK cells were identified by immune-fluorescence staining and Western blot analysis. Results： Kaempferol was found to increase OK cell growth （P〈0.05）, but alone did not promote MC3T3 E1 or HF cell proliferation. However, although OKM by itself increased MC3T3 E1 growth by 198% （P〈0.01）, the 70kaθOKM further increased the growth of these cells by an additional 127% （P〈0.01）. It indicates that the kidney cell generates a previously unknown osteoblast growth factor （OGF） and kaempferol increases kidney cell secretion of OGF. Neither of these media had any significant effect on HF growth. Kaempferol also was found to increase the level of the BMPR Ⅱ in OK cells. Conclusions： This lends strong support to the original idea that the Kidney has a significant influence over bone-formation, as suggested by some long-standing Chinese medical beliefs, kaempferol may also serve to stimulate kidney repair and indirectly stimulate bone formation.