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Articles by Ashish Sawhney in JoVE

 JoVE Chemistry

Determination of the Gas-phase Acidities of Oligopeptides

1Department of Chemistry, University of the Pacific


JoVE 4348

The determination of the gas-phase acidities of cysteine-containing oligopeptides is described. The experiments are performed using a triple quadrupole mass spectrometer. The relative acidities of the peptides are measured using collision-induced dissociation experiments, and the quantitative acidities are determined using the extended Cooks kinetic method.

Other articles by Ashish Sawhney on PubMed

Tuberous Sclerosis with Portal Vein Thrombosis, Protein C and S Deficiency

A 29-year-old lady with a bad obstetric history and portal vein thrombosis, presented to the Skin OPD for facial lesions. On examination, angiofibromas on face, shagreen patch and periungual fibromas were observed. She also had dental pits and a retinal hamartoma. Investigations revealed hamartomas in the brain and kidney. Hematological work-up showed protein C and S deficiency with Factor V Leiden positivity. Except for the cutaneous symptoms, the patient did not have any clinical manifestations in other organs affected by tuberous sclerosis. A similar association of tuberous sclerosis with protein C deficiency has been reported in only one case in literature.

Diagnosis and Management of Typical Atrial Flutter

Can "past decade" be rephrased to refer to more specific years? Typical atrial flutter (AFL) is a common atrial arrhythmia that may cause significant symptoms and serious adverse effects, including embolic stroke, myocardial ischemia and infarction, and, rarely, a tachycardia-induced cardiomyopathy resulting from rapid atrioventricular conduction. As a result of the well-defined anatomic and electrophysiologic substrate and the relative pharmacologic resistance of typical AFL, radiofrequency catheter ablation has emerged since its first description in 1992 as a safe and effective first-line treatment. This article reviews the electrophysiology of typical AFL and techniques currently used for its diagnosis and management.

Acute Bone Crises in Sickle Cell Disease: the T1 Fat-saturated Sequence in Differentiation of Acute Bone Infarcts from Acute Osteomyelitis

To prove the hypothesis that acute bone infarcts in sickle cell disease are caused by sequestration of red blood cells (RBCs) in bone marrow, and to evaluate the unenhanced T1 fat-saturated (fs) sequence in the differentiation of acute bone infarction from acute osteomyelitis in patients with sickle-cell disease.

Antibody to a High-prevalence Blood Group Antigen Ata Associated with Sjögren's Syndrome

Solar Photocatalytic Removal of Cu(II), Ni(II), Zn(II) and Pb(II): Speciation Modeling of Metal-citric Acid Complexes

The present study is targeted on solar photocatalytic removal of metal ions from wastewater. Photoreductive deposition and dark adsorption of metal ions Cu(II), Ni(II), Pb(II) and Zn(II), using solar energy irradiated TiO2, has been investigated. Citric acid has been used as a hole scavenger. Modeling of metal species has been performed and speciation is used as a tool for discussing the photodeposition trends. Ninety-seven percent reductive deposition was obtained for copper. The deposition values of other metals were significantly low [nickel (36.4%), zinc (22.2%) and lead (41.4%)], indicating that the photocatalytic treatment process, using solar energy, was more suitable for wastewater containing Cu(II) ions. In absence of citric acid, the decreasing order deposition was Cu(II)>Ni(II)>Pb(II)>Zn(II), which proves the theoretical thermodynamic predictions about the metals.

Clinical Judgment Versus the Pneumonia Severity Index in Making the Admission Decision

The Pneumonia Severity Index (PSI) is a validated risk assessment tool for patients with community-acquired pneumonia (CAP). Guidelines endorse outpatient treatment for patients deemed low risk, but experience shows that such patients are frequently hospitalized. We investigated the limitations of the PSI as a triage tool by examining outcomes in patients whose disposition from the Emergency Department differed from that predicted by the PSI. PSI scores were calculated by retrospective chart review for all adults with CAP presenting to the Emergency Department of a university medical center. Disposition was classified as consistent with the PSI when low-risk patients were discharged and high-risk patients were admitted. Charts of low-risk patients whose disposition was inconsistent with the PSI were abstracted for documentation of comorbidities contributing to the admission decision, as well as length of stay and level of care. There were 174 patients with CAP who met inclusion criteria, and 32% had a disposition inconsistent with the PSI. Eighty-six percent of the inconsistencies involved low-risk patients admitted to the hospital, and 41% of all low-risk patients with CAP were hospitalized. Hypoxia contributed to the decision to admit in 48% of these patients. Average length of stay was 5.2 days, and 78% of patients remained in the hospital > 48 h. Hypoxia was the most frequent factor contributing to admission of low-risk patients with CAP. Low-risk inpatients had a significant length of stay, suggesting that clinical judgment appropriately superseded the PSI in these cases.

Aqueous Extract of Rhodiola Imbricata Rhizome Inhibits Proliferation of an Erythroleukemic Cell Line K-562 by Inducing Apoptosis and Cell Cycle Arrest at G2/M Phase

Rhodiola imbricata is a medicinal plant having immunostimulating properties. The anti-proliferative effects of Rhodiola aqueous extract (RAE), were studied in human erythroleukemic cell line K-562 using MTT cell proliferation assay. The proliferation of K-562 was significantly decreased after 72h incubation with RAE at 100 and 200microg/ml. However, almost no suppressive effects could be detected in normal human peripheral blood lymphocytes or mouse macrophage cell line RAW-264.7. RAE was also found to induce intracellular reactive oxygen species (ROS) in K-562 cells at 200microg/ml when incubated overnight. The increased ROS generation may cause apoptosis, which was observed in AnnexinV-FITC and propidium iodide (PI) staining of cells treated with RAE for 72h in K-562 cells. Moreover, RAE arrested cell cycle progression in G2/M phase in early and late period of exposure. The anti-cancer activity of RAE was also confirmed by increased NK cell cytotoxicity. These observations suggest that aqueous extract of R. imbricata rhizome has very potent anti-cancer activities, which might be useful in leukemia cancer treatment.

Risk Factors for Severe Delayed Postpolypectomy Bleeding

Postpolypectomy bleeding is a rare but serious adverse event. The aim of this study was to identify factors associated with the risk of severe delayed postpolypectomy bleeding.

Prognostic Significance of Post-clopidogrel Platelet Reactivity Assessed by a Point-of-care Assay on Thrombotic Events After Drug-eluting Stent Implantation

The aim of this study was to determine whether platelet reactivity on clopidogrel therapy, as measured by a point-of-care platelet function assay, is associated with thrombotic events after percutaneous coronary intervention (PCI) with drug-eluting stents (DESs).

Unsupervised Learning of Discriminative Edge Measures for Vehicle Matching Between Nonoverlapping Cameras

This paper proposes a novel unsupervised algorithm learning discriminative features in the context of matching road vehicles between two non-overlapping cameras. The matching problem is formulated as a same-different classification problem, which aims to compute the probability of vehicle images from two distinct cameras being from the same vehicle or different vehicle(s). We employ a novel measurement vector that consists of three independent edge-based measures and their associated robust measures computed from a pair of aligned vehicle edge maps. The weight of each measure is determined by an unsupervised learning algorithm that optimally separates the same-different classes in the combined measurement space. This is achieved with a weak classification algorithm that automatically collects representative samples from same-different classes, followed by a more discriminative classifier based on Fisher' s Linear Discriminants and Gibbs Sampling. The robustness of the match measures and the use of unsupervised discriminant analysis in the classification ensures that the proposed method performs consistently in the presence of missing/false features, temporally and spatially changing illumination conditions, and systematic misalignment caused by different camera configurations. Extensive experiments based on real data of over 200 vehicles at different times of day demonstrate promising results.

A Dose Dependent Adaptogenic and Safety Evaluation of Rhodiola Imbricata Edgew, a High Altitude Rhizome

To examine the dose dependent adaptogenic activity aqueous extract of Rhodiola imbricata root was orally administered in rats at different doses, 30 min prior to cold (5 degrees C)-hypoxia (428 mm Hg)-restraint (C-H-R) exposure. The maximal effective adaptogenic dose of the extract was 100 mg/kg body weight. The acute and sub-acute toxicity of the extract was also studied in rats. Sub-acute toxicity studies included administration of single oral dose of 1 g/kg and 2 g/kg of extract once daily for 14 days and maximal effective single oral dose of 100 mg/kg once daily for 30 days. At the end of each treatment period the biochemical parameters related to liver function, kidney function, lipids (triglycerides, cholesterol) and hematological parameters were estimated in serum and blood. Biochemical and hematological analysis showed no significant changes in any of the parameters examined in treated group's animal, in comparison to control animals. No significant change was observed in organ weight/body weight ratios, of any organ studied in comparison to control rats. The oral LD(50) of the extract was observed to be >10 g/kg, indicating an adequate margin of safety. No histopathological changes were observed in the vital organs studied of the treated animals. These results suggest that aqueous extract of R. imbricata root possess potent adaptogenic activity with no acute and sub-acute toxicity.

Massive Abdominal Wall Hemorrhage from Injury to the Inferior Epigastric Artery: a Retrospective Review

To identify the etiology of inferior epigastric artery injury (IEAI) in patients referred to the interventional radiology service and determine the efficacy of diagnostic imaging and embolization in these patients.

Tongue Base Schwannoma: Report, Review, and Unique Surgical Approach

Base of tongue schwannomas are exceedingly rare and therefore often are not immediately included in the differential diagnosis and treatment of oropharyngeal tumors. After a thorough review of the English literature, we found only 6 previously reported cases of tongue base schwannomas. We are contributing a report of a 37-year-old woman with progressive dysphagia, dysarthria, and large tongue base schwannoma. Diagnosis was confirmed by imaging studies and biopsy followed by surgical excision designed to preserve nerve function. A number of surgical approaches have been described for tongue base schwannomas. Each has its own degree of postoperative morbidity. The use of a unilateral transcervical incision with blunt dissection was simple and quickly accomplished with protection of nearby nerves. Histologic identification of Antoni A and B areas along with strong and diffuse staining with S-100 stain pathologically completed the diagnosis of schwannoma.

Angiogenesis and Angiogenic Inhibitors in Renal Cell Carcinoma

In most patients with renal cell carcinoma (RCC) of clear cell subtype, there is inactivation of the von Hippel-Lindau (VHL) tumor-suppressor gene, which leads to a proangiogenic state with overexpression of vascular endothelial growth factor (VEGF). This molecular level knowledge has led to the development of multiple antiangiogenic therapies directed against the VEGF protein or the VEGF receptor. These therapies have significant clinical activity in metastatic RCC. Therefore, a therapeutic strategy based on targeting VEGF in RCC has a sound molecular basis and therapy with VEGF-targeting agents has significant clinical activity. To further improve efficacy, future research should focus on better identification of patients who will most benefit from such therapy. We reviewed the published literature regarding angiogenesis, the VHL gene, VEGF biology, and antiangiogenic therapies in metastatic RCC. This article reviews the role of angiogenesis in RCC and summarizes data regarding antiangiogenic therapy in metastatic RCC.

Widespread Metastases After Resection of Noninvasive Thymoma

What Have We Learned About Atrial Arrhythmias from Ablation of Paroxysmal Atrial Fibrillation?

Cardiac Output Monitoring: Comparison of a New Arterial Pressure Waveform Analysis to the Bolus Thermodilution Technique in Patients Undergoing Off-pump Coronary Artery Bypass Surgery

To analyze the clinical agreement between the conventional intermittent bolus thermodilution (TD) technique and a new arterial pressure waveform analysis (APCO) technique (FloTrac; Edward Lifesciences, Irvine, CA) for cardiac output (CO) estimation.

Mumps Vaccination Coverage and Vaccine Effectiveness in a Large Outbreak Among College Students--Iowa, 2006

Following implementation of a routine childhood two-dose measles-mumps-rubella vaccination strategy, mumps disease levels dropped dramatically in the US and an elimination goal was set for 2010. However, a 2006 epidemic involved >5700 cases nationwide, with many reported among fully vaccinated college students. In an outbreak in two Iowa colleges, we investigated: (1) vaccination coverage using electronic records verified by provider records and (2) vaccine effectiveness assessed by comparison of dose-specific attack rates. Mumps was classified as typical (parotitis/orchitis) or atypical (parotid tenderness or submandibular/sublingual adenitis). Two-dose mumps vaccination coverage was 90% both for the student population (2128/2363) and case-students (97/108). Two-dose vaccine effectiveness was 76-88% with no significant difference for attack rates between one and two doses. Among two-dose vaccine recipients, 74% of the population (1482/2009) and 79% of the case-students (75/95) had received the second dose >10 years before. A large mumps outbreak occurred despite high two-dose vaccination coverage in a population most of whom had received the second dose >10 years before. Two-dose vaccine effectiveness was similar to previous one-dose estimates. Further studies are needed to examine the persistence of two-dose mumps vaccine-induced immunity and to determine whether US mumps elimination can be achieved with the current vaccination strategy.

Effect of Seabuckthorn (Hippophae Rhamnoides) Flavone on Immune System: an In-vitro Approach

There are several reports, which suggest that the consumption of foods rich in flavonoids is associated with a lower incidence of certain degenerative diseases, including cardiovascular disease. Flavones, of Seabuckthorn (SBT) (Hippophae rhamnoides L.) fruit berry can modulate the production and level of several signaling molecules associated with immune function and inflammation in vitro, including several cytokines. We have evaluated the immunomodulatory activity of ethanolic solution of SBT flavone (FLV) in human peripheral blood mononuclear cells (PBMCs). The SBT flavone was found to stimulate production of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) in PBMCs. However, increased expressions of p-IkappaB, NF-kappaB, and p-p38 were found in flavone-treated human PBMCs with significantly suppressed expression of CD25 (IL-2R). There was no alteration found in the nitric oxide (NO) production in mouse macrophage cell line RAW 264.7. These observations suggest that stimulation of IL-6 and TNF-alpha secretion may contribute to the putative beneficial effects of dietary flavone against microbial infection.

Effect of Hippophae Rhamnoides Leaf Extract Against Dengue Virus Infection in Human Blood-derived Macrophages

Dengue virus occurs as four distinct serotypes, called Dengue 1, 2, 3, and 4. Symptomatic dengue virus infection ranges from a self limited febrile illness, dengue fever (DF), to a more severe disease, dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS). The anti-Dengue treatment is severely hampered as no specific therapeutic agents are available. Even present treatment strategies for Dengue are more supportive than curative. In the present study anti-dengue activity of Hippophae rhamnoides (Seabuckthorn, SBT) leaf extract was evaluated in Dengue virus type-2 infected blood-derived human macrophages as macrophages are the primary target of Dengue virus infection. Infected cells were treated with SBT leaf extract and compared with commercially available anti-viral drug, Ribavirin. The extract was able to maintain the cell viability of Dengue-infected cells at par with Ribavirin along with the decrease and increase in TNF-alpha and IFN-gamma respectively. Anti-dengue activity of SBT extract was further determined by the traditional plaque assay. These observations suggest that the SBT leaf extract has a significant anti-dengue activity and has the potential for the treatment of Dengue.

Kissing Balloon-expandable Iliac Stents Complicated by Stent Fracture

A Methodology for Evaluation and Selection of Nanoparticle Manufacturing Processes Based on Sustainability Metrics

A set of sustainability metrics, covering the economic, environmental and sociological dimensions of sustainability for evaluation of nanomanufacturing processes is developed. The metrics are divided into two categories namely industrial engineering metrics (process and safety metrics) and green chemistry metrics (environmental impact). The waste reduction algorithm (WAR) is used to determine the environmental impact of the processes and NAIADE (Novel Approach to Imprecise Assessment and Decision Environments) software is used for evaluation and decision analysis. The methodology is applied to three processes used for silica nanoparticle synthesis based on sol-gel and flame methods.

Modulatory Effects of Seabuckthorn (Hippophae Rhamnoides L.) in Hypobaric Hypoxia Induced Cerebral Vascular Injury

Cerebral edema caused by vascular leakage is a major problem in various injuries of the CNS, such as stroke, head injury and high-altitude illness. A common feature of all these disorders is the fact that they are associated with tissue hypoxia. Hypoxia has been suggested to be a major pathogenic factor for the induction of vascular leakage in the brain. The objective of the present study was to evaluate potential of seabuckthorn (SBT) (Hippophae rhamnoides L.) seed oil in curtailing hypoxia induced transvascular fluid leakage in brain of hypoxia-exposed rats. Exposure of animals to hypobaric hypoxia (9144 m, 5h) caused a significant increase in the transvascular leakage studied by measuring water content and leakage of sodium fluorescein dye in the brain. Hypoxic stress also significantly enhanced the oxidative stress markers such as free radicals and malondialdehyde and it accompanied with decreased levels of antioxidants such as glutathione, glutathione peroxidase and superoxide dismutase. Pretreatment of animals with SBT seed oil significantly restricted the hypoxia induced increase in fluorescein dye leakage suggesting protection against hypoxia induced transvascular leakage in the brain. Hypoxia induced increase in the levels of free radicals and malondialdehyde were significantly lowered after SBT pretreatment. The SBT seed oil pretreatment also resulted in the significantly improved hypoxic tolerance as evidenced by increased hypoxic gasping time and survival time and decreased plasma catecholamine levels, as compared to hypoxic animals. These observations suggest that SBT seed oil possesses significant hypoxia protection activity and curtailed hypoxia induced enhanced vascular leakage in the brain.

Effect of Institution-wide Policy of Colonoscopy Withdrawal Time > or = 7 Minutes on Polyp Detection

Practice guidelines recommend that endoscopists spend at least 7 minutes examining the colonic mucosa during colonoscopy withdrawal to optimize polyp yield. The aim of this study was to determine if the implementation of an institution-wide policy of colonoscopy withdrawal time > or = 7 minutes was associated with an increase in colon polyp detection.

Perioperative Beta Blockers in Patients Having Non-cardiac Surgery: a Meta-analysis

American College of Cardiology and American Heart Association (ACC/AHA) guidelines on perioperative assessment recommend perioperative beta blockers for non-cardiac surgery, although results of some clinical trials seem not to support this recommendation. We aimed to critically review the evidence to assess the use of perioperative beta blockers in patients having non-cardiac surgery.

Relation of Beta-blocker-induced Heart Rate Lowering and Cardioprotection in Hypertension

The purpose of this study was to evaluate the role of heart rate reduction with beta-blockers on the risk of cardiovascular events in patients with hypertension.

Tolosa-Hunt Syndrome: MRI Appearances

A review of MRI findings in seven patients with Tolosa-Hunt syndrome was carried out. Seven patients presented with unilateral painful ophthalmoplegia. Magnetic resonance imaging studies were carried out to evaluate the cavernous sinuses and orbits. Coronal fast spin-echo T2-weighted images and fat-saturated T1-weighted coronal and transverse images with and without contrast enhancement were obtained for the cavernous sinuses and orbits. All patients showed focal-enhancing masses expanding the ipsilateral cavernous sinus. In one patient the mass was extending to the orbital apex and intraorbitally. All patients recovered on corticosteroid therapy and resolution of the masses was documented on follow-up MRI studies in five patients. One patient had a relapse of symptoms after discontinuing therapy. Magnetic resonance imaging studies of the cavernous sinus and orbital apex show high sensitivity for the detection and follow up of inflammatory mass lesions in Tolosa-Hunt syndrome. Magnetic resonance imaging should be the initial screening study in these patients.

Implementation of a Multidisciplinary Treatment Team for Hepatocellular Cancer at a Veterans Affairs Medical Center Improves Survival

Several methods of treatment for hepatocellular carcinoma (HCC) are often used in combination for either palliation or cure. We established a multidisciplinary treatment team (MDTT) at the San Francisco Veterans Affairs Medical Center in November 2003 and assessed whether aggressive multimodality treatment strategies may affect survival. A prospective database was established and follow-up information from patients with presumed HCC was collected up to November 2006. Information from the American College of Surgeons (ACS) cancer registry from January 2000 to November 2003 identified patients with HCC that were evaluated at the same institution prior to the establishment of the MDTT. The establishment of a MDTT resulted in the doubling of patient referrals for treatment. Significantly more patients were evaluated at earlier stages of disease and received either palliative or curative therapies. The overall survival (p<0.0001) and length of follow-up (p<0.05) were significantly improved after the establishment of the MDTT. Stage-by-stage comparisons indicate that aggressive multimodality therapy conferred significant survival advantage to patients with American Joint Commission on Cancer (AJCC) stage II HCC (odds ratio 15.50, p<0.001). Multidisciplinary collaboration and multimodality treatment approaches are important in the management of hepatocellular carcinoma and improves patient survival.

A Poly-herbal Formulation Accelerates Normal and Impaired Diabetic Wound Healing

In the present study, a poly-herbal formulation (PHF) was prepared by combining the aqueous lyophilized leaf extracts of Hippophae rhamnoides L. and Aloe vera L. and the ethanol rhizome extract of Curcuma longa L., in an optimized ratio (1 : 7 : 1). The efficacy of PHF treatment was studied in normal and impaired diabetic rats using a full-thickness cutaneous wound model. Topical PHF treatment increased cellular proliferation and collagen synthesis at the wound site in normal rats, as evidenced by the significant increase in DNA, total protein, hydroxyproline, and hexosamine contents in comparison with a positive control treated with a povidone-iodine ointment. The histological examinations and matrix metalloproteinases expression also correlated well with the biochemical findings, confirming the efficacy of PHF in normal wounds. In the streptozotocin-induced diabetic rats, PHF treatment increased hydroxyproline and hexosamine content. A faster wound contraction was also observed in PHF-treated normal and diabetic rats. The PHF also promoted angiogenesis as evidenced by an in vitro chick chorioallantoic membrane model and in vivo up-regulated vascular endothelial growth factor expression. The results suggest that PHF possesses significant wound healing potential in both normal as well as chronic diabetic wounds.

Tc-99m Tetrofosmin Scintimammography for the Detection of Recurrent Breast Cancer in a Patient with Equivocal Mammography Study

This is a case report describing a patient at Sultan Qaboos University Hospital, Oman, with recurrent local breast cancer and axillary lymph node metastasis. The cancer was detected with (99)Tc-(m) tetrofosmin scintimammography after an equivocal mammography study.

Prenatal MRI Image of a Fetus with Semilobar Holoprosencephaly

Tracheal Bronchus

Right Aortic Arch with Aberrant Left Subclavian Artery

Effect of Nitric Oxide and Putrescine on Antioxidative Responses Under NaCl Stress in Chickpea Plants

Chickpea plants were subjected to salt stress for 48 h with 100 mM NaCl, after 50 days of growth. Other batches of plants were simultaneously treated with 0.2 mM sodium nitroprusside (NO donor) or 0.5 mM putrescine (polyamine) to examine their antioxidant effects. Sodium chloride stress adversely affected the relative water content (RWC), electrolyte leakage and lipid peroxidation in leaves. Sodium nitroprusside and putrescine could completely ameliorate the toxic effects of salt stress on electrolyte leakage and lipid peroxidation and partially on RWC. No significant decline in chlorophyll content under salt stress as well as with other treatments was observed. Sodium chloride stress activated the antioxidant defense system by increasing the activities of peroxidase (POX), catalase (CAT) superoxide dismutase (SOD) and ascorbate peroxidase (APX). However no significant effect was observed on glutathione reductase (GR) and dehydro ascorbate reductase (DHAR) activities. Both putrescine and NO had a positive effect on antioxidant enzymes under salt stress. Putrescine was more effective in scavenging superoxide radical as it increased the SOD activity under salt stress whereas nitric oxide was effective in hydrolyzing H2O2 by increasing the activities of CAT, POX and APX under salt stress.

Aquaculture: Environmental, Toxicological, and Health Issues

Aquaculture is one of the fastest growing food-producing sectors, supplying approximately 40% of the world's fish food. Besides such benefit to the society, the industry does have its problems. There are occupational hazards and safety concerns in the aquaculture industry. Some practices have caused environmental degradation. Public perception to farmed fish is that they are "cleaner" than comparable wild fish. However, some farmed fish have much higher body burden of natural and man-made toxic substances, e.g. antibiotics, pesticides, and persistent organic pollutants, than wild fish. These contaminants in fish can pose health concerns to unsuspecting consumers, in particular pregnant or nursing women. Regulations and international oversight for the aquaculture industry are extremely complex, with several agencies regulating aquaculture practices, including site selection, pollution control, water quality, feed supply, and food safety. Since the toxicological, environmental, and health concerns of aquaculture have not been adequately reviewed recently, we are providing an updated review of the topic. Specifically, concerns and recommendations for improving the aquaculture industry, and for protection of the environment and the consumers will be concisely presented.

Differential Expression of Proteins in the Wild Type and 7B-1 Male-sterile Mutant Anthers of Tomato (Solanum Lycopersicum): a Proteomic Analysis

In the 7B-1 male-sterile mutant of tomato, pollen development breaks down prior to meiosis in microspore mother cells (MMCs). We have used the proteomic approach to identify differentially expressed proteins in the wild type (WT) and mutant anthers with the objective of analyzing their roles in normal pollen development and in male sterility. By using 2-DE and DIGE technologies, over 1800 spots were detected and of these 215 spots showed 1.5-fold or higher volume ratio in either WT or 7B-1 anthers. Seventy spots, either up-regulated in WT, or in 7B-1, were subjected to mass spectrometry and 59 spots representing 48 distinct proteins were identified. The proteins up-regulated in WT anthers included proteases, e.g., subtilase, proteasome subunits, and 5B-protein with potential roles in tapetum degeneration, FtsZ protein, leucine-rich repeat proteins, translational and transcription factors. In 7B-1 anthers, aspartic protease, superoxide dismutase, ACP reductase, ribonucleoprotein and diphosphate kinase were up-regulated. Also, cystatin inhibitory activity was high in the mutant and correlated with the expression of male sterility. Other proteins including calreticulin, Heat shock protein 70, glucoside hydrolase, and ATPase, were present in both genotypes. The function of identified proteins in tapetum and normal pollen development, and in male sterility is discussed.

A Novel Role of ERK5 in Integrin-mediated Cell Adhesion and Motility in Cancer Cells Via Fak Signaling

In metastatic cancer, high expression levels of vitronectin (VN) receptors (integrins), FAK, and ERK5 are reported. We hypothesized that integrin-mediated ERK5 activation via FAK may play a pivotal role in cell adhesion, motility, and metastasis. ERK5 and FAK phosphorylation when metastatic MDA-MB-231 and PC-3 cells were plated on VN was enhanced. Further experiments showed co-immunoprecipitation of integrins beta1, alpha V beta 3, or alpha V beta 5 with ERK5 and FAK. To gain better insight into the mechanism of ERK5, FAK, and VN receptors in cell adhesion and motility, we performed loss-of-function experiments using integrin blocking antibodies, and specific mutants of FAK and ERK5. Ectopic expression of dominant negative ERK5/AEF decreased ERK5 and FAK (Y397) phosphorylation, cell adhesion, and haptotactic motility (micromotion) on VN. Additionally, DN FAK expression attenuated ERK5 phosphorylation, cell adhesion, and motility. This study documents the novel finding that in breast and prostate cancer cells, ERK5 is a critical target of FAK in cell adhesion signaling. Using different cancer cells, our experiments unveil a novel mechanism by which VN receptors and FAK could promote cancer metastasis via ERK5 activation.

Diagnosis and Management of Typical Atrial Flutter

Typical atrial flutter (AFL) is a common atrial arrhythmia that may cause significant symptoms and serious adverse effects including embolic stroke, myocardial ischemia and infarction, and rarely a tachycardia-induced cardiomyopathy as a result of rapid atrioventricular conduction. As a result of the well-defined anatomic and electrophysiological substrate, and the relative pharmacologic resistance of typical AFL, radiofrequency catheter ablation has emerged in the past decade as a safe and effective first-line treatment. This article reviews the electrophysiology of typical AFL and the techniques currently used for its diagnosis and management.

Cytoplasmic Accumulation of Activated Leukocyte Cell Adhesion Molecule is a Predictor of Disease Progression and Reduced Survival in Oral Cancer Patients

Activated leukocyte cell adhesion molecule (ALCAM) has been proposed to function as a cell surface sensor for cell density, controlling the transition between local cell proliferation and tissue invasion in cancer progression. Herein, we determined ALCAM expression in 107 oral squamous cell carcinomas (OSCCs), 78 oral lesions (58 hyperplasias and 20 dysplasias) and 30 histologically normal oral tissues using immunohistochemistry and correlated with clinicopathological parameters. Significant increase in ALCAM immunopositivity was observed from normal oral mucosa, hyperplasia, dysplasia to OSCCs (p(trend) < 0.001). Increased ALCAM expression was observed in cytoplasm of epithelial cells as early as in hyperplasia (p = 0.001, OR = 3.8). Sixty-five of 107 (61%) OSCCs showed significant overexpression of ALCAM protein in cytoplasm/membrane of tumor cells (p = 0.043; OR = 3.3) in comparison with the normal oral tissues. Among OSCCs, cytoplasmic ALCAM was associated with advanced tumor size, tumor stage and tobacco consumption. Importantly, cytoplasmic ALCAM was an independent predictor of poor prognosis of OSCCs in multivariate analysis (p = 0.012, OR = 6.2). In an attempt to understand the molecular basis of cytoplasmic localization of ALCAM, 14-3-3 zeta and 14-3-3 sigma were identified as its novel binding partners in oral cancer cells. In conclusion, increased expression of ALCAM is an early event in oral tumorigenesis; its cytoplasmic accumulation in tumor cells is a predictor of poor prognosis of OSCCs, underscoring its potential as a candidate prognostic marker for oral cancer.

Aqueous Extract of Rhodiola Imbricata Rhizome Stimulates Toll-like Receptor 4, Granzyme-B and Th1 Cytokines in Vitro

Rhodiola imbricata is a medicinal plant, native to mountainous regions of Asia, parts of Europe, and the Arctic. Traditionally it is recommended to help combat fatigue and restore energy. It exhibits anti-stress, anti-cancer, and immunostimulatory activities. However, the effect of Rhodiola on immunological responses largely remains unknown. In this study, we have investigated the effect of aqueous extract of R. imbricata rhizome (RAE), on Toll-like receptor-4 (TLR-4) and intracellular granzyme-B expression in mouse splenocytes. Furthermore, TH1/TH2 cytokine profile was analyzed in RAE-treated human peripheral blood mononuclear cells (PBMCs) using multiplex flowcytomix kit. Our findings suggest that RAE induces TLR-4 expression and intracellular granzyme-B in treated splenocytes while RAE stimulated IL-1beta, IL-6, and TNF-alpha in human PBMCs. The present study suggests that RAE stimulates the innate immune pathway and has potent immunostimulatory activity, which can be used in modulating the immune system of immunocompromised individuals.

Comparison of Carcinoembryonic Antigen and Molecular Analysis in Pancreatic Cyst Fluid

Pancreatic-cyst fluid carcinoembryonic antigen (CEA) levels and molecular analysis are useful diagnostic tests in differentiating mucinous from nonmucinous cysts.

Sudden Cardiac Arrest in Patients with Preserved Left Ventricular Systolic Function: a Clinical Dilemma

Stratifying the risk for sudden cardiac arrest (SCA) in individuals with preserved systolic function remains a pressing public health problem. Current guidelines for the implantation of cardiac defibrillators largely ignore patients with preserved systolic function, even though they account for the majority of cases of SCA. Risk stratification for such individuals may be increasingly feasible. Notably, most individuals who experience SCA have structural heart disease, even if undiagnosed. Thus, clinical risk scores have been developed to identify individuals at high risk. Moreover, there are now promising data that T-wave alternans, alone and in combination with other indices, effectively predicts SCA in this population. This article presents our current understanding of SCA caused by ventricular arrhythmias in patients with preserved left ventricular systolic function, and attempts to build a framework to predict risk in this population.

Cytoprotective and Antioxidant Activity of Seabuckthorn (Hippophae Rhamnoides L.) Flavones Against Tert-butyl Hydroperoxide-induced Cytotoxicity in Lymphocytes

This study was designed to determine the cytoprotective activity of flavones of seabuckthorn (Hippophae rhamnoides L.) against tert-butyl hydroperoxide (tert-BOOH), used as an oxidant to induce oxidative damage, with lymphocytes as the model system. Addition of tert-BOOH (250 microM) to the cells resulted in enhanced cytotoxicity and free radical production. The intracellular calcium levels, caspase activity, and apoptosis were significantly increased following tert-BOOH treatment. Seabuckthorn flavones at the concentration of 100 microg/mL significantly inhibited tert-BOOH-induced cytotoxicity and free radical production and also restored the antioxidant status to that of control cells. Seabuckthorn flavones also significantly restricted tert-BOOH-induced apoptosis by decreasing intracellular calcium levels and caspase activity. The extract also decreased tert-BOOH-induced formation of DNA breaks by 30%. These observations suggest that the flavones of seabuckthorn have marked cytoprotective properties, which could be attributed to the antioxidant activity.

Patients with a High Probability of Choledocholithiasis Are Best Managed with ERCP Without EUS

Survival and Dialysis Initiation: Comparing British Columbia and Scotland Registries

Outcomes are a major metric for evaluating effectiveness of dialysis. Comparisons between different populations reveal significant variation. In addition, the question of optimal timing of dialysis start lacks robust data from which to generate conclusions.

Characterization of Germanium Linear Kinoform Lenses at Diamond Light Source

The unprecedented brilliance achieved by third-generation synchrotron sources and the availability of improved optics have opened up new opportunities for the study of materials at the micrometre and nanometre scale. Focusing the synchrotron radiation to smaller and smaller beams is having a huge impact on a wide research area at synchrotrons. The key to the exploitation of the improved sources is the development of novel optics that deliver narrow beams without loss of brilliance and coherence. Several types of synchrotron focusing optics are successfully fabricated using advanced miniaturization techniques. Kinoform refractive lenses are being developed for hard X-ray beamlines, and the first test results at Diamond are discussed in this paper.

What is the Optimal Approach for Ablation of Paroxysmal Atrial Fibrillation?

The optimal approach for catheter ablation of paroxysmal atrial fibrillation (PAF) is the subject of some controversy. Recent guidelines define PAF as recurrent AF that terminates spontaneously within seven days. For patients with PAF, the three most commonly employed approaches for ablation include, (1) segmental ostial or antral pulmonary vein isolation (PVI), (2) circumferential pulmonary vein ablation (CPVA) alone or in combination with additional left atrial linear ablation (LALA), and (3) complex fractionated atrial electrograms (CFAE) ablation alone or in combination with segmental PVI or CPVA (with or without additional LALA). Each of these approaches will be described in detail in this article. Overall evidence suggests that segmental antral PVI may be as effective as CPVA with or without LALA in prevention of AF recurrence, but that CPVA with or without LALA may be associated with a higher incidence of atypical atrial flutter recurrence.

Safety and Healing Efficacy of Sea Buckthorn (Hippophae Rhamnoides L.) Seed Oil on Burn Wounds in Rats

The present investigation was undertaken to determine the safety and efficacy of supercritical CO2-extracted Hippophae rhamnoides L. (Sea buckthorn) (SBT) seed oil on burn wound model. SBT seed oil was co-administered by two routes at a dose of 2.5 ml/kg body weight (p.o.) and 200 microl (topical) for 7 days on experimental burn wounds in rats. The SBT seed oil augmented the wound healing process as indicated by significant increase in wound contraction, hydroxyproline, hexosamine, DNA and total protein contents in comparison to control and reference control treated with silver sulfadiazine (SS) ointment. Histopathological findings further confirmed the healing potential of SBT seed oil. SBT seed oil treatment up-regulated the expression of matrix metalloproteinases (MMP-2 and 9), collagen type-III and VEGF in granulation tissue. It was observed that SBT seed oil also possesses antioxidant properties as evidenced by significant increase in reduced glutathione (GSH) level and reduced production of reactive oxygen species (ROS) in wound granulation tissue. In acute and sub-acute oral toxicity studies, no adverse effects were observed in any of the groups administered with SBT seed oil. These results suggest that the supercritical CO2-extracted Sea buckthorn seed oil possesses significant wound healing activity and have no associated toxicity or side effects.

Structural Insight into the Quinolone-DNA Cleavage Complex of Type IIA Topoisomerases

Type II topoisomerases alter DNA topology by forming a covalent DNA-cleavage complex that allows DNA transport through a double-stranded DNA break. We present the structures of cleavage complexes formed by the Streptococcus pneumoniae ParC breakage-reunion and ParE TOPRIM domains of topoisomerase IV stabilized by moxifloxacin and clinafloxacin, two antipneumococcal fluoroquinolones. These structures reveal two drug molecules intercalated at the highly bent DNA gate and help explain antibacterial quinolone action and resistance.

Incidence of Urinary Retention in Patients with Thoracic Patient-controlled Epidural Analgesia (TPCEA) Undergoing Thoracotomy

Up to 100% of patients treated with epidural analgesia can experience urinary retention, which may be related to dermatomal level of the epidural block, epidural medication, and surgical procedure. This study was designed to identify the incidence of urinary retention in patients who receive thoracic patient-controlled epidural analgesia (TPCEA) after thoracotomy. Forty-nine patients were enrolled and received epidural infusion of ropivacaine 0.2% or mixture of bupivacaine 0.1% with hydromorphone 0.015 mg/mL. Epidural catheter placement level was verified by chest X-rays. Indwelling urinary catheters were removed between 12 and 48 h after surgery when no longer required for fluid monitoring. Four hours later, patients were assessed for urinary retention using bladder ultrasound. Residual bladder volume was recorded, and urinary retention was defined as an inability to void or a bladder volume of greater than 600 mL at 4 h. Twenty-four hours after the catheter removal, patients completed a questionnaire to assess their perception of the indwelling catheter before and after its removal. Five participants (approximately 10%) with epidural catheters between T3 and T5 with bupivacaine/hydromorphone epidural solution were recatheterized. No association was established between catheter level, drug type, infusion rate, and urinary retention. Although 76% of patients did not report any physical discomfort with the indwelling urinary catheter, 66% felt relief after its removal and 18% did not ambulate with the inserted urinary catheter. The incidence of postoperative urine retention was low (10%), indicating that unless required for other purposes, indwelling urinary catheters may be removed between 12 and 48 h after surgery while receiving TPCEA.

Incomplete Carney Triad--a Review of Two Cases

A curious association of three rare tumours was described by Carney in 1977. 'Carney's triad' characteristically includes multifocal pulmonary chondroma, gastric stromal sarcoma and extra-adrenal paraganglioma. Patients may exhibit complete or incomplete expression of the triad. Carney acknowledged that, of 79 patients, only 17 possessed all three tumours. We report here two patients with incomplete expression of Carney's triad.

International Consensus Guidelines for Surgical Resection of Mucinous Neoplasms Cannot Be Applied to All Cystic Lesions of the Pancreas

International consensus guidelines, aimed at predicting malignancy, are available for surgical resection of mucinous cysts but not for other cystic lesions of the pancreas. We sought to determine whether the consensus guidelines can be applied to all cystic lesions of the pancreas.

Five-year Outcomes After Segmental Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation

Most studies evaluating the efficacy of atrial fibrillation (AF) ablation report follow-up periods of 1 year to 2 years, but few report long-term results of > or =5 years after ablation. Therefore, we evaluated the long-term efficacy (i.e., >5 years) of segmental antrum pulmonary vein isolation (PVI) for paroxysmal AF. Seventy-one patients (60 +/- 10 years, 56 men) who underwent PVI for paroxysmal AF from January 1, 2002, to August 31, 2003, were followed for at least 5 years after their index ablation procedure. Five-year outcomes were determined at last clinic visit, by telephone encounters, and by cardiac monitoring when available. After 1 ablation, off antiarrhythmic drugs, 61 patients (86%) were free of symptomatic AF at 12 months, 56 patients (79%) at 24 months, and 40 patients (56%) at 63 +/- 5 months. Sixteen patients (22.5%) had AF recur after the second year after ablation. Thirty-one patients underwent > or =1 repeat ablations (1.6 +/- 0.9 per patient). After multiple procedures, 58 patients (81%) were free of symptomatic AF off antiarrhythmic drugs at 63 +/- 5 months after their initial ablation; however, in 18 of these patients who received multiple ablation procedures, mean duration of follow-up after the last ablation was only 13.5 +/- 2.1 months. In conclusion, overall 5-year outcome after PVI for paroxysmal AF is similar to that previously reported for shorter-term follow-up (< or =2 years). However, late recurrences >2 years after initial ablation were frequent, and repeat ablation was often required to maintain freedom from symptomatic AF.

Dynamics of Protein Expression During Pollen Germination in Canola (Brassica Napus)

The proteome of mature (MP) and in vitro germinating pollen (GP) of canola (Brassica napus) were analyzed using the DIGE technology with the objective of identifying proteins and their function in pollen germination. Of the 2,238 protein spots detected in gel images, 344 were differentially expressed in MP and GP samples of which 165 were subjected to MALDI-TOF/TOF and 130 were successfully identified using the NCBInr and Brassica EST databases. The major proteins up-regulated in GP, relative to MP, have roles in carbohydrate metabolism, protein metabolism, and cell wall remodeling. Others with roles in cytoskeleton dynamics, nucleotide and amino acid metabolism, signal transduction, and stress response also showed higher expression in GP. Proteins concerned with transcriptional regulation and ion transport were similar in MP and GP, and some catalases and LEA proteins were down-regulated in GP. A number of proteins including, oleosin, cruciferin, and enolase, were released into the pollen germination medium indicating their potential role in pollen-stigma interaction. Glycosylated proteins were also identified in MP and GP, but their protein profiles were not different. This study has documented the dynamics of protein expression during pollen germination and early tube growth in B. napus and provides insights into the fundamental mechanisms involved in these processes, and in cell growth, cell-cell communication, and cell signaling.

Assessment of Patient-reported Outcomes of Insulin Pen Devices Versus Conventional Vial and Syringe

Patient-reported outcomes (PROs) associated with insulin therapy are potentially important determinants of adherence to diabetes management programs. This article reviews published evidence of PROs over the past 3 decades in patients with type 1 diabetes (T1D) and/or type 2 diabetes (T2D) who used vial and syringe for insulin delivery compared to those who used insulin pens. Based on predetermined selection criteria, articles were identified through a search of primary sources published from January 1980 to February 2008. Two independent reviewers determined study eligibility and performed a detailed evaluation of the articles that met the selection criteria. Of the 124 articles screened, 41 met selection criteria. Approximately 75% of the selected articles were published between 1990 and 2008, and a majority (78%) of the research studies was conducted outside the United States. Most (>75%) of the studies evaluated male and female patients with T1D and/or T2D and mean ages around 45 years. Studies used varied comparative study designs with follow-up periods ranging from 2 weeks to 5 years. The PROs assessed in these articles included preference, acceptability, treatment satisfaction, ease of use, convenience, injection pain, handling, and dosing. Most articles (n = 36) showed more favorable PROs for insulin pen users compared to vial and syringe users. These findings have potential clinical and policy implications for patients, diabetes care providers, and/or payers to make evidence-based decisions regarding ways to facilitate initiation and management of insulin therapy.

Bacterial Biofilm Formation, Pathogenicity, Diagnostics and Control: An Overview

Bacterial biofilms are complex, mono- or poly-microbialn communities adhering to biotic or abiotic surfaces. This adaptation has been implicated as a survival strategy. The formation of biofilms is mediated by mechanical, biochemical and genetical factors. The biofilms enhance the virulence of the pathogen and have their potential role in various infections, such as dental caries, cystic fibrosis, osteonecrosis, urinary tract infection and eye infections. A number of diagnostic techniques, viz., bright-field microscopy, epifluorescence microscopy, scanning electron microscopy, confocal laser scanning microscopy and amplicon length heterogeneity polymerase chain reaction, have been employed for detection of these communities. Researchers have worked on applications of catheter lock solutions, a fish protein coating, acid shock treatment, susceptibility to bacteriophages, etc., for biofilm control. However, we need to rearrange our strategies to have thorough insight and concentrate on priority basis to develop new accurate, precise and rapid diagnostic protocols for detection and evaluation of biofilm. Above all, the strict compliance to these techniques is required for accurate diagnosis and control.

Reproducibility, Sensitivity and Compatibility of the ProteoExtract Subcellular Fractionation Kit with Saturation Labeling of Laser Microdissected Tissues

Laser microdissection (LMD), a method of isolating specific microscopic regions of interest from a tissue that has been sectioned, is increasingly being applied to study proteomics. LMD generally requires tissues to be fixed and histologically stained, which can interfere with protein recovery and subsequent analysis. We evaluated the compatibility and reproducibility of protein extractions from laser microdissected human colon mucosa using a subcellular fractionation kit (ProteoExtract, Calbiochem). Four protein fractions corresponding to cytosol (fraction 1), membrane/organelle (fraction 2), nucleus (fraction 3) and cytoskeleton (fraction 4) were extracted, saturation labeled with Cy5 and 5 microg separated by both acidic (pH 4-7) and basic (pH 6-11) 2-DE. The histological stains and fixation required for LMD did not interfere with the accurate subcellular fractionation of proteins into their predicted fraction. The combination of subcellular fractionation and saturation CyDye labeling produced very well resolved, distinct protein spot maps by 2-DE for each of the subcellular fractions, and the total number of protein spots consistently resolved between three independent extractions for each fraction was 893, 1128, 1245 and 1577 for fractions 1, 2, 3 and 4, respectively. Although significant carryover of protein did occur between fractions, this carryover was consistent between experiments, and very low inter-experimental variation was observed. In summary, subcellular fractionation kits are very compatible with saturation labeling DIGE of LMD tissues and provide greater coverage of proteins from very small amounts of microdissected material.

Violaceous Discoloration Around the Eyes

Improving Outpatient Safety Through Effective Electronic Communication: a Study Protocol

BACKGROUND: Health information technology and electronic medical records (EMRs) are potentially powerful systems-based interventions to facilitate diagnosis and treatment because they ensure the delivery of key new findings and other health related information to the practitioner. However, effective communication involves more than just information transfer; despite a state of the art EMR system, communication breakdowns can still occur. [1-3] In this project, we will adapt a model developed by the Systems Engineering Initiative for Patient Safety (SEIPS) to understand and improve the relationship between work systems and processes of care involved with electronic communication in EMRs. We plan to study three communication activities in the Veterans Health Administration's (VA) EMR: electronic communication of abnormal imaging and laboratory test results via automated notifications (i.e., alerts); electronic referral requests; and provider-to-pharmacy communication via computerized provider order entry (CPOE). AIM: Our specific aim is to propose a protocol to evaluate the systems and processes affecting outcomes of electronic communication in the computerized patient record system (related to diagnostic test results, electronic referral requests, and CPOE prescriptions) using a human factors engineering approach, and hence guide the development of interventions for work system redesign. DESIGN: This research will consist of multiple qualitative methods of task analysis to identify potential sources of error related to diagnostic test result alerts, electronic referral requests, and CPOE; this will be followed by a series of focus groups to identify barriers, facilitators, and suggestions for improving the electronic communication system. Transcripts from all task analyses and focus groups will be analyzed using methods adapted from grounded theory and content analysis.

Management of a Massive Thoracoabdominal Impalement: a Case Report

A 26 year old male was impaled through his chest and upper abdomen with an iron angle, one and half meter long and five centimeters thick. The iron angle entered the chest, through the epigastrium and exited posteriorly just inferior to the angle of left scapula. The patient was transported to hospital with the iron angle in situ. Positioning the patient for intubation proved a major challenge. An unconventional position for intubation allowed a successful airway management. Paucity of time prevented us from gauging the nature and extent of injury. The challenges posed by massive impalement could be successfully managed due to rapid pre-hospital transfer and co-ordinated team effort.

The Value of Serial Personal Photographs in Timing the Onset of Unilateral Cataracts in Children

To determine the value of serial personal photographs in timing the onset of unilateral cataracts in children over 6 months of age.

A Patient with Rashes and Limb Weakness

Diagnostic Imaging of Esophageal Epithelium with Clinical Endoscopic Polarized Scanning Spectroscopy Instrument

This letter reports the development of an endoscopic polarized scanning spectroscopy (EPSS) instrument compatible with existing endoscopes. This instrument uses light scattering spectroscopy (LSS). In proof-of-principle studies using a single-point instrument, LSS has successfully demonstrated the ability to identify pre-cancer in the epithelial tissues of five different organs, including Barrett's esophagus (BE). The EPSS instrument can provide real time in vivo information on the location of otherwise invisible high grade dysplasia (HGD), a predictor of adenocarcinoma, and thus can serve as a guide for biopsy. It should greatly reduce the time and labor involved in performing screening and obtaining diagnoses, cause less patient discomfort and ensure that fewer biopsies are required for the reliable location of pre-cancerous lesions.

Improving Follow-up of Abnormal Cancer Screens Using Electronic Health Records: Trust but Verify Test Result Communication

Early detection of colorectal cancer through timely follow-up of positive Fecal Occult Blood Tests (FOBTs) remains a challenge. In our previous work, we found 40% of positive FOBT results eligible for colonoscopy had no documented response by a treating clinician at two weeks despite procedures for electronic result notification. We determined if technical and/or workflow-related aspects of automated communication in the electronic health record could lead to the lack of response.

Familial Aggregation of Blood Pressure with Respect to Anthropometric Variables in a Business Community of Punjab, a North Indian State

This study aimed to examine the familial aggregation of blood pressure with respect to anthropometric variables in an upper-middle class business community in Punjab, a northern state of India. The results were evaluated in a sample of 75 families, constituting 305 individual from three generations such as offspring, parental and grandparental. The data were analyzed through familial correlations, multiple regressions, percent of variance and univariate analysis. The data indicate a strong familial aggregation of blood pressure in this population especially in offspring generations and show that such a familial influence on blood pressure can be detected from the different anthropometric variables, genetic factors, shared household environment and age. These effects were strong in SBP and moderate in DBP. SBP and DBP have showed higher genetic correlation with many anthropometric characters in offspring generation as compared to other generations. These correlations are negligible in male grandparental generation. The results suggest that almost all measured variables are significant multivariate correlates with blood pressure.

Alkaptonuria Associated with Degenerative Collagenous Palmar Plaques

Posterior Circulation Stroke Following Embolization of Glomus Tympanicum?relevance of Anatomy and Anastomoses of Ascending Pharyngeal Artery. A Case Report

Summary: Embolization in the territory of the ascending pharyngeal artery (APA) can be unsafe even after detailed pretherapeutic angiographic evaluation due to changes in haemodynamics and opening of anastomotic channels. A 60-year-old woman underwent angiogram and embolization for glomus tympanicum tumour. The glomus tympanicum tumour was embolized using contour PVA particles of 150-250 um. At the end of the particulate injection the patient had posterior circulation stroke. The check angiogram showed near total devascularisation of the tumour and in addition filling of the left vertebral artery through an anastomotic channel. MRI confirmed the infarct in the posterior circulation. The ascending pharyngeal artery has potential anastomoses to all neighbouring major arteries, and the anastomoses to the vertebral artery in our case were through the musculospinal artery. This case highlights the importance of potential vascular anastomotic channels as a cause of ischaemic complication during the embolization procedure. It also highlights the fact that dangerous anastomoses may only be visualised in the later phase of embolization probably due to changes in the haemodynamic pressure. The angiographic anatomy of APA is reviewed with potential communications with the internal and external carotid and vertebrobasilar systems.

Docetaxel-induced Photolichenoid Eruption

A 58-year-old man presented with complaints of blackish discoloration of forearms and face of five months duration. The lesions occurred episodically after taking anti-cancer medications, each episode lasting for two weeks. Histopathology confirmed a lichenoid eruption. Photolichenoid eruption to docetaxel is a dermatological adverse effect not reported in literature earlier.

Gastric Adenocarcinoma in Association with Tuberous Sclerosis: Case Report

We report the first case of gastric cancer in association with tuberous sclerosis. Tuberous sclerosis is an autosomal dominant disorder which presents with a constellation of signs including benign tumours in the brain and in other vital organs such as the kidneys, heart, eyes, lungs, and skin. A combination of symptoms may include seizures, developmental delay, behavioural problems, skin abnormalities, and lung and kidney disease. It is caused by mutations on either of two genes, tuberous sclerosis genes, TSC1 or TSC2, which encode for the proteins hamartin and tuberin respectively. These proteins act as tumour growth suppressor agents that regulate cell proliferation and differentiation. Tuberous sclerosis has been associated with hamartomatous growths and angiomyolipomas, an association with gastric cancer has not been reported; however, this could be a co-incidental finding and further cases need to be reported.

Metastatic Malignant Melanoma During Pregnancy: Case Report and a Review of the Literature

Malignant melanoma is one of the most rapidly increasing cancers and, when it occurs during pregnancy, it can frequently metastasise to the placenta and the foetus. Earlier reports suggested a rapid progress of the disease during pregnancy with a poor prognosis; however, recent controlled studies found that stage for stage, the prognosis of melanoma during pregnancy is similar to that in a non-pregnant state. Early diagnosis and prompt treatment can avoid a tragic outcome.

Marjolin's Ulcer: Radiographic and Magnetic Resonance Appearances in Two Cases

Marjolin's ulcers are malignancies that arise in chronic venous ulcers, scars, burns, long standing wounds or sinuses. Radiography provides important information regarding bone destruction and periosteal reaction, and magnetic resonance (MR) imaging provides excellent soft tissue detail, like tumour extent, depth, margins, any underlying bone cortical or marrow involvement, or involvement of adjacent neuro-vascular structures. We report two cases of Marjolin's ulcer and describe their radiographic and MR appearances.

Uninterrupted Warfarin for Periprocedural Anticoagulation in Catheter Ablation of Typical Atrial Flutter: a Safe and Cost-effective Strategy

Many patients undergoing catheter ablation of atrial flutter (AFL) require periprocedural anticoagulation. We compared a strategy of conversion to low molecular weight heparin (LMWH) periprocedure to uninterrupted warfarinization in a nonrandomized, case-controlled study.

Periductal Hypoechoic Sign: an Endosonographic Finding Associated with Pancreatic Malignancy

Despite advances in imaging, differentiating benign from malignant causes of pancreatic duct dilation is difficult.

Effect of Mitral Isthmus Block on Development of Atrial Tachycardia Following Ablation for Atrial Fibrillation

Successful mitral isthmus (MI) ablation may reduce recurrence of atrial fibrillation (AF) and macro-reentrant atrial tachycardia (AT) after pulmonary vein isolation (PVI) for AF.

CIMP Status of Interval Colon Cancers: Another Piece to the Puzzle

Colon cancers diagnosed in the interval after a complete colonoscopy may occur due to limitations of colonoscopy or due to the development of new tumors, possibly reflecting molecular and environmental differences in tumorigenesis resulting in rapid tumor growth. In a previous study from our group, interval cancers (colon cancers diagnosed within 5 years of a complete colonoscopy) were almost four times more likely to demonstrate microsatellite instability (MSI) than non-interval cancers. In this study we extended our molecular analysis to compare the CpG island methylator phenotype (CIMP) status of interval and non-interval colorectal cancers and investigate the relationship between the CIMP and MSI pathways in the pathogenesis of interval cancers.

Provider Management Strategies of Abnormal Test Result Alerts: a Cognitive Task Analysis

Electronic medical records (EMRs) facilitate abnormal test result communication through "alert" notifications. The aim was to evaluate how primary care providers (PCPs) manage alerts related to critical diagnostic test results on their EMR screens, and compare alert-management strategies of providers with high versus low rates of timely follow-up of results.

Thoracic Epidural Analgesia in Obese Patients with Body Mass Index of More Than 30 Kg/m2 for off Pump Coronary Artery Bypass Surgery

Perioperative Thoracic epidural analgesia (TEA) is an important part of a multimodal approach to improve analgesia and patient outcome after cardiac and thoracic surgery. This is particularly important for obese patients undergoing off pump coronary artery bypass surgery (OPCAB). We conducted a randomized clinical trial at tertiary care cardiac institute to compare the effect of TEA and conventional opioid based analgesia on perioperative lung functions and pain scores in obese patients undergoing OPCAB. Sixty obese patients with body mass index >30 kg/m2 for elective OPCAB were randomized into two groups (n=30 each). Patients in both the groups received general anesthesia but in group 1, TEA was also administered. We performed spirometry as preoperative assessment and at six hours, 24 hours, second, third, fourth and fifth day after extubation, along with arterial blood gases analysis. Visual analogue scale at rest and on coughing was recorded to assess the degree of analgesia. The other parameters observed were: time to endotracheal extubation, oxygen withdrawal time and intensive care unit length of stay. On statistical analysis there was a significant difference in Vital Capacity at six hours, 24 hours, second and third day postextubation. Forced vital capacity and forced expiratory volume in one second followed the same pattern for first four postoperative days and peak expiratory flow rate remained statistically high till second postoperative day. ABG values and PaO2/FiO2 ratio were statistically higher in the study group up to five days. Visual analogue scale at rest and on coughing was significantly lower till fourth and third postoperative day respectively. Tracheal extubation time, oxygen withdrawal time and ICU stay were significantly less in group 1. The use of TEA resulted in better analgesia, early tracheal extubation and shorter ICU stay and should be considered for obese patients undergoing OPCAB.

Bimanual, Intra-operative, Fluoroscopy-guided Removal of Nasopharyngeal Migratory Fish Bone from Carotid Space

We report a rare and unusual case of a patient with an ingested fishbone which migrated from the oropharynx to the anterior compartment of the retropharyngeal space and then to the deep neck space in the nasopharynx (i.e. the carotid space). This report aims to describe a successful, minimally invasive method of foreign body removal which avoided both major skull base surgery and any potential life-threatening complications. A secondary aim is to highlight the role of intra-operative fluoroscopy, an under-used tool.

Application of Kinoform Lens for X-ray Reflectivity Analysis

In this paper the first practical application of kinoform lenses for the X-ray reflectivity characterization of thin layered materials is demonstrated. The focused X-ray beam generated from a kinoform lens, a line of nominal size approximately 50 microm x 2 microm, provides a unique possibility to measure the X-ray reflectivities of thin layered materials in sample scanning mode. Moreover, the small footprint of the X-ray beam, generated on the sample surface at grazing incidence angles, enables one to measure the absolute X-ray reflectivities. This approach has been tested by analyzing a few thin multilayer structures. The advantages achieved over the conventional X-ray reflectivity technique are discussed and demonstrated by measurements.

Stereotactic Body Radiotherapy and Gemcitabine for Locally Advanced Pancreatic Cancer

Patients with nonmetastatic locally advanced unresectable pancreatic cancer have a dismal prognosis. Conventional concurrent chemoradiotherapy requires 6 weeks of daily treatment and can be arduous. We explored the safety and effectiveness of a 3-day course of hypofractionated stereotactic body radiotherapy (SBRT) followed by gemcitabine in this population.

Fecal Occult Blood Test in Patients on Low-dose Aspirin, Warfarin, Clopidogrel, or Non-steroidal Anti-inflammatory Drugs

To determine the effect of anticoagulants and antiplatelet medications on the positive-predictive-value of fecal occult blood test (FOBT).

Is BRAF Mutation Associated with Interval Colorectal Cancers?

Colon cancers diagnosed in the interval after a complete colonoscopy may occur due to limitations of colonoscopy or due to rapid tumor growth. The aim of this study was to compare the association of BRAF V600E mutation in interval versus non-interval colorectal cancers and to determine the relationship between BRAF mutation and 5-year survival.

Circumferential Pulmonary Vein Ablation with Additional Linear Ablation Results in an Increased Incidence of Left Atrial Flutter Compared with Segmental Pulmonary Vein Isolation As an Initial Approach to Ablation of Paroxysmal Atrial Fibrillation

There has been growing concern that linear ablation is associated with an increased risk of iatrogenic arrhythmias in patients undergoing ablation for atrial fibrillation (AF). Therefore, we compared circumferential pulmonary vein ablation plus left atrial linear ablation (CPVA+LALA) with segmental pulmonary vein isolation (PVI)in patients with paroxysmal AF.

Persistent Psychological or Physical Symptoms Following Endoscopic Procedures: an Unrecognized Post-endoscopy Adverse Event

Depression and post-traumatic stress disorder have been described after surgical procedures, but not after gastrointestinal endoscopy.

Clinical Significance of Phosphatidyl Inositol Synthase Overexpression in Oral Cancer

We reported increased levels of phosphatidyl inositol synthase (PI synthase), (enzyme that catalyses phosphatidyl inositol (PI) synthesis-implicated in intracellular signaling and regulation of cell growth) in smokeless tobacco (ST) exposed oral cell cultures by differential display. This study determined the clinical significance of PI synthase overexpression in oral squamous cell carcinoma (OSCC) and premalignant lesions (leukoplakia), and identified the downstream signaling proteins in PI synthase pathway that are perturbed by smokeless tobacco (ST) exposure.

Resolution of Brugada-pattern ECG After Withdrawal of the Selective Serotonin Reuptake Inhibitor Paroxetine

Efficacy of a Prototype Endoscope with Two Deflecting Working Channels for Endoscopic Submucosal Dissection: a Prospective, Comparative, Ex Vivo Study

Optimizing the visualization of the cutting line of the submucosal layer is essential to performing an effective and safe endoscopic submucosal dissection (ESD).

Utility of Digital Stereo Images for Optic Disc Evaluation

To assess the suitability of digital stereo images for optic disc evaluations in glaucoma.

Lipoprotein-A and Carotid Intima Media Thickness As Cardiovascular Risk Factors in Patients of Chronic Kidney Disease

Patients in all stages of chronic kidney disease (CKD) are considered in the "high-risk group" for development of cardiovascular disease (CVD). The study was undertaken in 60 adult patients of chronic renal failure. The patients were divided into three groups: Group I had subjects with CKD (stages 1 and 2); Group II had subjects with CKD (stages 3 and 4) on conservative therapy for 3 months; and Group III had subjects with CKD (stage 5) on regular hemodialysis for at least 3-4 weeks. Carotid sonography was done in all patients at the time of inclusion in the study. The patients in all the groups were then followed for 6 months and the relevant investigations were carried out, initially at the time of presentation, and then at third- and sixth-month interval. The patients were monitored for various renal parameters along with serum lipoprotein-A [Lp (A)]. The value of carotid intima media thickness (CA-IMT) was increased in group II and III as compared to group I. The calcification of carotids was higher in patients of group III. The maximum number of patients having plaques and stenosis in the carotids were seen in group III (50%), followed by group II (20%). Patients in group III had 5-10 times higher levels of Lp (A) as compared to patients in group I. The comparison of Lp (A) levels between group I and group II was also highly statistically significant.

Ten Strategies to Improve Management of Abnormal Test Result Alerts in the Electronic Health Record

Misdirected Central Venous Catheter

Iatrogenic Asystole on the ITU

Toll-like Receptor Agonists: Are They Good Adjuvants?

Therapeutic immunization leading to cancer regression remains a significant challenge. Successful immunization requires activation of adaptive immunity, including tumor specific CD4 T cells and CD8 T cells. Generally, the activation of T cells is compromised in patients with cancer because of immune suppression, loss of tumor antigen expression, and dysfunction of antigen-presenting cells. Antigen-presenting cells such as dendritic cells (DCs) are key for the induction of adaptive antitumor immune responses. Recently, attention has focused on novel adjuvants that enhance dendritic cell function and their ability to prime T cells. Agonists that target toll-like receptors are being used clinically either alone or in combination with tumor antigens and showing initial success both in terms of enhancing immune responses and eliciting antitumor activity. This review summarizes the application of these adjuvants to treat cancer and the potential for boosting responses in vivo.

Granuloma After Short-term Epidural Catheterisation

Strongyloides Stercoralis: There but Not Seen

Diagnosis of Strongyloides stercoralis is often delayed owing to patients presenting with nonspecific gastrointestinal complaints, a low parasite load and irregular larval output. Although several diagnostic methods exist to detect the presence of S. stercoralis there is no gold standard. In immunocompromised hosts (patients with malignancy, organ transplantation or concurrent human T-cell-lymphocytic virus 1 infection or those on corticosteroid therapy), autoinfection can go unchecked with large numbers of invasive Strongyloides larvae disseminating widely and causing hyperinfection with dissemination, which can be fatal. This review will highlight current published research on improved diagnostic methods for S. stercoralis and the immune mechanisms thought to be responsible for hyperinfection syndrome.

Laboratory Tests in Pediatric Rheumatology

Laboratory tests in rheumatology are important tools that help to support the diagnosis of autoimmune diseases, evaluate the disease activity, monitor the side effects of therapy, and also assist the physician to exclude rheumatologic mimics. Few relevant tests should be ordered after a detailed clinical review of the patient has been carried out and a provisional clinical diagnosis has been reached. There is no test that can rule in or rule out any rheumatologic disease and therefore, there is no role of a detailed "Rheumatology panel" of investigations. In this review, routine blood investigations, acute phase reactants, auto antibodies, HLA B27 and complements have been discussed.

The Place of Pediatric Rheumatology in India

Rheumatology is a relatively new specialty in the field of Pediatrics in India where there are only a few centres of excellence. Awareness about these conditions in childhood is lacking and patients are often referred late resulting in poor long term outcomes. This article highlights the needs of the paediatric rheumatology patients which are complex and should encompass both acute and chronic care and also plan a smooth transition to the adult rheumatology world. In the year 2010, attaining remission is the goal for every child with a rheumatologic disorder, which is seldom achieved for the Indian pediatric rheumatologic patient. The article discusses the reasons for poor awareness, the current outcome for these patients and details the burden of disease in India. The health care delivery system and finally the way forward have been discussed.

Impacted Toothbrush in the Oropharynx: a Challenging Airway

Outcome Measures in Pediatric Rheumatology

Children with rheumatologic disorders need periodic systematic evaluation of their disease status so that all aspects of the child's life that are affected can be adequately assessed. The commonest rheumatologic disease that afflicts children is Juvenile Idiopathic Arthritis (JIA). The child with JIA should have several domains assessed at regular intervals. These outcome measures include the physical, functional and the quality of life assessment measures. No single measure can capture the full impact of the disease on the child's life. This article highlights the key outcome measures in a child with JIA and introduces the readers to several disease measurement tools that have been developed for assessment of outcome for the child with JIA.

The Incidence and Cost of Unexpected Hospital Use After Scheduled Outpatient Endoscopy

Data on complications of gastrointestinal endoscopic procedures are limited. We evaluated prospectively the incidence and cost of hospital visits resulting from outpatient endoscopy.

Periprocedural Complications by Child-Pugh Class in Patients Undergoing Transcatheter Arterial Embolization or Chemoembolization to Treat Unresectable Hepatocellular Carcinoma at a VA Medical Center

For patients with compensated cirrhosis, transcatheter arterial embolization with and without additive chemotherapy has been shown to improve survival. The aim of this study was to compare periprocedural complications in a population with hepatitis C virus-related hepatocellular carcinoma to evaluate for differences in complications by severity of liver disease.

Ross Syndrome with Ana Positivity: a Clue to Possible Autoimmune Origin and Treatment with Intravenous Immunoglobulin

A 28-year-old serving soldier presented with patchy areas of absence of sweating and blurring of vision. On examination he was found to have segmental anhidrosis, right sided tonic pupil and absent ankle jerks. Investigations revealed ANA positivity with no other abnormalities. He was treated with Intravenous immunoglobulin. This case of Ross syndrome is reported for its rarity as well as a clue to its probable autoimmune origin and treatment option with intravenous immunoglobulins.

Automatic Blood Vessel Localization in Small Field of View Eye Images

Localizing blood vessels in eye images is a crucial step in the automated and objective diagnosis of eye diseases. Most previous research has focused on extracting the centerlines of vessels in large field of view images. However, for diagnosing diseases of the optic disk region, like glaucoma, small field of view images have to be analyzed. One needs to identify not only the centerlines, but also vessel widths, which vary widely in these images. We present an automatic technique for localizing vessels in small field of view images using multi-scale matched filters. We also estimate local vessel properties - width and orientation - along the length of each vessel. Furthermore, we explicitly account for highlights on thick vessels - central reflexes - which are ignored in many previous works. Qualitative and quantitative results demonstrate the efficacy of our method - e.g. vessel centers are localized with RMS and median errors of 2.11 and 1 pixels, respectively in 700×700 images.

First Orally Active DRI Aliskiren--a New Prospect in Management of Hypertension and Beyond

Hypertension is a major public health problem and leading cause for diseases involving cardiovascular & renal system. It is fourth largest contributor for premature deaths in developed countries and seventh largest in developing world. The major pharmacological strategies currently utilized for hypertension management include volume control with diuretics, suppression of central and peripheral sympathetic nervous system activity, vasodilatation with ion channel manipulation and blockade of renin-angiotensin-aldosterone system. Activation of the renin-angiotensin-aldosterone system in the pathogenesis of cardiovascular diseases and renal disease is well established. It also has been established that inhibition of renin-angiotensin-aldosterone system, is an effective way to intervene with pathogenesis of these disorders. Therapies like beta blockers, renin inhibitors, angiotensin converting enzyme inhibitors, angiotensin receptor blockers and aldosterone inhibitors, that inhibit renin-angiotensin-aldosterone system have proven to be highly successful for treatment of hypertension & related cardiovascular diseases. Renin inhibitors block the renin-angiotensin-aldosterone system at its origin, and thus offer a new approach to pharmacotherapy of Hypertension. Aliskiren is the first in a new class of orally active, non-peptide, low molecular weight direct renin inhibitor available for clinical use and potential new approach to the blockade of the renin-angiotensin-aldosterone system. Studies in humans demonstrate to an effectual blood Pressure lowering effect of aliskiren with placebo like tolerability, when used as monotherapy or in combination with other agents and has the potential to be useful in this wide spectrum of conditions

Low-dose and High-dose Methotrexate Are Two Different Drugs in Practical Terms

Methotrexate (MTX) was originally synthesised as an anti-cancer drug. Soon it was also used in immunoinflammatory diseases, mainly in the field of rheumatology. However, the dose used in oncology is several-fold higher as compared to the dose used in systemic immunoinflammatory rheumatological diseases. This led to the use of terms 'low-dose MTX' (LD-MTX) and 'high-dose MTX' (HD-MTX) respectively for its use in immunoinflammatory rheumatological diseases as against its use in oncology. Extensive studies have demonstrated that therapeutic action, clinical indications, adverse effects and mechanisms of action of LD-MTX and HD-MTX are quite different. It is somewhat akin to low-dose aspirin versus high-dose aspirin with entirely different spectra of therapeutic action and adverse effects. It is important to understand this difference. This would help in allaying unfounded fear of adverse effects of LD-MTX that is often mistakenly considered the same as that of HD-MTX used in oncology.

Structural Characterization of Thin Layered Materials Using X-ray Standing Wave Enhanced Elastic and Inelastic Scattering Measurements

By measuring the intensities of the x-ray standing wave induced elastic and inelastic x-ray scattering from thin multilayer structures, we show that structural characterizations of the high and low z (atomic number) material layers can be performed independently. The method has been tested by analyzing the structural properties of an Nb/C/Nb trilayer and an Mo/Si periodic multilayer structure. The results of the x-ray scattering measurements have been compared with those obtained using x-ray reflectivity and conventional x-ray standing wave fluorescence techniques. It has been demonstrated that the present approach is especially suitable for studying multilayer structures comprising low atomic number layers, as it eliminates the requirement of a fluorescence signal, which is very weak in the case of low z materials.

Vertebral Sarcoid Mimicking Ankylosing Spondylitis or Just a Co-incidence?

To illustrate that among the protean musculoskeletal manifestations of sarcoidosis back pain that could mimic inflammatory back pain of ankylosing spondylitis (AS), should also be considered.

Response Surface Optimization of Osmotic Dehydration Process for Aonla Slices

Response surface methodology was used to investigate the effect of sugar concentration (50-70° Brix), solution temperature (30-60°C), solution to fruit ratio (4:1-8:1) and immersion time (60-180 min) on the water loss, solute gain, rehydration ratio, vitamin-C loss, colour change and sensory overall acceptability of Indian gooseberry (aonla) slices. The optimum process parameters obtained by computer generated response surfaces, canonical analysis and contour plot interpretation were: sugar concentration, 59° Brix solution temperature 51°C, solution to fruit ratio 4:1 and immersion time of 60 min.

Modulation of Hypoxia-Induced Pulmonary Vascular Leakage in Rats by Seabuckthorn (Hippophae Rhamnoides L.)

Cerebral and pulmonary syndromes may develop in unacclimatized individuals shortly after ascent to high altitude resulting in high altitude illness, which may occur due to extravasation of fluid from intra to extravascular space in the brain, lungs and peripheral tissues. The objective of the present study was to evaluate the potential of seabuckthorn (SBT) (Hippophae rhamnoides L.) leaf extract (LE) in curtailing hypoxia-induced transvascular permeability in the lungs by measuring lung water content, leakage of fluorescein dye into the lungs and further confirmation by quantitation of albumin and protein in the bronchoalveolar lavage fluid (BALF). Exposure of rats to hypoxia caused a significant increase in the transvascular leakage in the lungs. The SBT LE treated animals showed a significant decrease in hypoxia-induced vascular permeability evidenced by decreased water content and fluorescein leakage in the lungs and decreased albumin and protein content in the BALF. The SBT extract was also able to significantly attenuate hypoxia-induced increase in the levels of proinflammatory cytokines and decrease hypoxia-induced oxidative stress by stabilizing the levels of reduced glutathione and antioxidant enzymes. Pretreatment of the extract also resulted in a significant decrease in the circulatory catecholamines and significant increase in the vasorelaxation of the pulmonary arterial rings as compared with the controls. Further, the extract significantly attenuated hypoxia-induced increase in the VEGF levels in the plasma, BALF (ELISA) and lungs (immunohistochemistry). These observations suggest that SBT LE is able to provide significant protection against hypoxia-induced pulmonary vascular leakage.

Noninvasive Evaluation of Splanchnic Tissue Oxygenation Using Near-infrared Spectroscopy in Preterm Neonates

Diagnosis of necrotizing enterocolitis (NEC) in preterm neonates is challenging. We hypothesized that regional splanchnic oxygen saturation (rsSOâ‚‚) measured by near-infrared spectroscopy (NIRS) is a biomarker for mesenteric perfusion.

Human Heme Oxygenase-1 Deficiency Presenting with Hemolysis, Nephritis, and Asplenia

Heme oxygenase-1 (HO-1) is a stress-induced enzyme that catalyses the oxidation of heme to biliverdin. The primary deficiency of this enzyme has been shown in HO-1 knockout mice, and is characterized by intrauterine death and chronic inflammation. The first case of human HO-1 deficiency was reported in 1999. Human HO-1 deficiency has been observed to involve the endothelial cells more severely, resulting in hemolysis and disseminated intravascular coagulation. We report another case of human HO-1 deficiency in a young girl with congenital asplenia, who presented with severe hemolysis, inflammation, nephritis, which was refractory to therapy with corticosteroids, cyclophosphamide, and rituximab.

Device-associated and Multidrug-resistant Infections in Critically Ill Trauma Patients: Towards Development of Automated Surveillance in Developing Countries

A Prospective Assessment of Sedation-related Adverse Events and Patient and Endoscopist Satisfaction in ERCP with Anesthesiologist-administered Sedation

Despite the increasing use of anesthesiologist-administered sedation for monitored anesthesia care (MAC) or general anesthesia in patients undergoing ERCP, limited prospective data exist on the effectiveness, safety, and cost of this approach.

Pleiotropic Role for Monocyte C-fms Protein in Response to Vascular Injury: Potential Therapeutic Target

We examined the role of C-fms+ cells in response to vascular injury with a focus on the temporal and spatial platelet interactions, monocyte survival and proliferation within the evolving neointimal lesion and monocyte proliferation within the circulation and specified monocyte reservoir sites. Finally, we investigated the therapeutic effect of C-fms kinase inhibition (CFKI) on neointimal hyperplasia post vessel injury.

Para Hisian Pacing: Is There More Than One Way to Conduct From The Ventricle Back to The Atria?

Understanding the Management of Electronic Test Result Notifications in the Outpatient Setting

Notifying clinicians about abnormal test results through electronic health record (EHR) -based "alert" notifications may not always lead to timely follow-up of patients. We sought to understand barriers, facilitators, and potential interventions for safe and effective management of abnormal test result delivery via electronic alerts.

A Prospective Evaluation of Fatty Pancreas by Using EUS

Fatty liver is associated with obesity, diabetes, hyperlipidemia, and the metabolic syndrome. The pathophysiology of fatty pancreas is poorly understood, but it may be closely related to fatty liver.

Induction Gemcitabine and Stereotactic Body Radiotherapy for Locally Advanced Nonmetastatic Pancreas Cancer

Stereotactic body radiotherapy (SBRT) has been used successfully to treat patients with locally advanced pancreas cancer. However, many patients develop metastatic disease soon after diagnosis and may receive little benefit from such therapy. We therefore retrospectively analyzed a planned strategy of initial chemotherapy with restaging and then treatment for those patients with no evidence of metastatic progression with SBRT.

Polymorphisms of Toll-like Receptors and Their Pathways in Viral Hepatitis

Toll-like receptors (TLRs) are an important part of the innate immune response to a variety of pathogens including hepatic viral infections. Activation of TLRs stimulates a complex intracellular signalling cascade that results in production of proinflammatory cytokines and interferons important for antiviral responses as well as induction of the adaptive arm of the immune system. There is substantial evidence for an important role for TLRs and TLR-mediated signalling in the pathogenesis and outcomes of hepatitis B and C in particular, but it might also influence responses to other viral hepatitis infections. Several single nucleotide polymorphisms (SNPs) of TLRs, relevant adaptor molecules and cytokines mediated by TLR signalling have been described that alter innate immune responses and have been implicated in a variety of human diseases including viral and other infections. There is now significant evidence that a number of TLR SNPs can affect various clinical outcomes in Caucasian patients with chronic HCV. However, the role of these polymorphisms in acute and other chronic hepatitis infections, including HBV as well as in non-Caucasian populations, has not been elucidated. In addition, results for SNPs downstream of TLR activation, such as in relevant cytokines, are inconsistent and their influence requires further investigation to determine the clinical significance of genetic variations in these mediators.

High Efficiency Nano-focusing Kinoform Optics for Synchrotron Radiation

Modern synchrotron sources have provided for decades intense beams of photons over a large energy spectrum. The availability of improved optics and detectors has opened up new opportunities for the study of matter at the micrometre and nanometre scale in many disciplines. Whilst exploitation of micro-focused beams occurs almost daily in many beamlines, the production of beams of 100 nm is achieved on few instruments which use specialised optics. Refractive lenses, zone plates, curved mirrors, multilayers, and multilayer Laue lenses, can all focus x-rays to less than 50 nm under strict beam stability conditions. Focusing the synchrotron radiation to beam sizes smaller than 10 nm is considered the ultimate goal for the current decade. Silicon micro-technology has so far provided some of the most advanced x-ray refractive lenses; we report on design and characterisation of a novel silicon kinoform lens that is capable of delivering nano-beams with high efficiency.

Ontogeny of Floral Organs in Flax (Linum Usitatissimum; Linaceae)

Flax (Linum usitatissimum) is an important crop worldwide; however, a detailed study on flower development of this species is lacking. Here we describe the pattern of initiation and a program of key developmental events in flax flower ontogeny. This study provides important fundamental information for future research in various aspects of flax biology and biotechnology.

DNA Methylation in Thyroid Tumorigenesis

Thyroid cancer is the most common endocrine cancer with 1,690 deaths each year. There are four main types of which the papillary and follicular types together account for >90% followed by medullary cancers with 3% to 5% and anaplastic carcinomas making up <3%. Epigenetic events of DNA hypermethylation are emerging as promising molecular targets for cancer detection. Our immediate and long term goal is to identify DNA methylation markers for early detection of thyroid cancer. This pilot study comprised of 21 patients to include 11 papillary thyroid cancers (PTC), 2 follicular thyroid cancers (FTC), 5 normal thyroid cases, and 3 hyperthyroid cases. Aberrant promoter methylation was examined in 24 tumor suppressor genes using the methylation specific multiplex ligation-dependent probe amplification (MS-MLPA) assay and in the NIS gene using methylation-specific PCR (MSP). The frequently methylated genes were CASP8 (17/21), RASSF1 (16/21) and NIS (9/21). In the normal samples, CASP8, RASSF1 and NIS were methylated in 5/5, 4/5 and 1/5 respectively. In the hyperthyroid samples, CASP8, RASSF1 and NIS were methylated in 3/3, 2/3 and 1/3 respectively. In the thyroid cancers, CASP8, RASSF1, and NIS were methylated in 9/13, 10/13, and 7/13 respectively. CASP8, RASSF1 and NIS were also methylated in concurrently present normal thyroid tissue in 3/11, 4/11 and 3/11 matched thyroid cancer cases (matched for presence of both normal thyroid tissue and thyroid cancer), respectively. Our data suggests that aberrant methylation of CASP8, RASSF1, and NIS maybe an early change in thyroid tumorigenesis regardless of cell type.

Updated Survival Analysis in Patients with Stage IIIB or IV Non-small-cell Lung Cancer Receiving BLP25 Liposome Vaccine (L-BLP25): Phase IIB Randomized, Multicenter, Open-label Trial

To present an updated survival analysis of an open-label, parallel-group, phase IIB trial of BLP25 liposome vaccine (L-BLP25) in patients with stage IIIB or IV non-small-cell lung cancer (NSCLC).

Anaesthetic Management and Implications of a Case of Chronic Inflammatory Demyelinating Polyneuropathy

A 60-year-old man with chronic inflammatory demyelinating polyneuropathy (CIDP) was posted for surgery of the neck femur fracture and was successfully managed. We discuss the anaesthetic considerations during regional and general anaesthesia of this patient with CIDP. A brief review of the available literature reveals no consensus on the choice of anaesthetic management.

Analyzing Fat Embolism Syndrome in Trauma Patients at AIIMS Apex Trauma Center, New Delhi, India

Fat embolism syndrome (FES) is a constellation of symptoms and signs subsequent to orthopedic trauma.

Risk Factors and Management Approach for Deep Sternal Wound Infection After Cardiac Surgery at a Tertiary Medical Centre

Deep sternal wound infection (DSWI) is a rare but severe complication following cardiac surgery. Our study investigated the risk factors and treatment options for patients who developed DSWI at our institution between May 1988 and April 2008.

Transarterial Chemoembolization in Patients with Hepatocellular Carcinoma: Predictors of Survival

Transarterial chemoembolization (TACE) is the mainstay of management for patients with hepatocellular carcinoma who are not suitable for curative treatments.

X-ray Wavefront Characterization Using a Rotating Shearing Interferometer Technique

A fast and accurate method to characterize the X-ray wavefront by rotating one of the two gratings of an X-ray shearing interferometer is described and investigated step by step. Such a shearing interferometer consists of a phase grating mounted on a rotation stage, and an absorption grating used as a transmission mask. The mathematical relations for X-ray Moiré fringe analysis when using this device are derived and discussed in the context of the previous literature assumptions. X-ray beam wavefronts without and after X-ray reflective optical elements have been characterized at beamline B16 at Diamond Light Source (DLS) using the presented X-ray rotating shearing interferometer (RSI) technique. It has been demonstrated that this improved method allows accurate calculation of the wavefront radius of curvature and the wavefront distortion, even when one has no previous information on the grating projection pattern period, magnification ratio and the initial grating orientation. As the RSI technique does not require any a priori knowledge of the beam features, it is suitable for routine characterization of wavefronts of a wide range of radii of curvature.

Recovery of Mitral Isthmus Conduction Leads to the Development of Macro-reentrant Tachycardia After Left Atrial Linear Ablation for Atrial Fibrillation

Left atrial linear ablation for atrial fibrillation (AF) may be proarrhythmic, leading to left atrial macro-reentrant tachycardia (LAT). Whether due to failure to achieve block initially or to recovery of conduction after ablation is unknown. This study was designed to evaluate the frequency of recovery of mitral isthmus (MI) conduction compared with cavo-tricuspid isthmus (CTI) conduction, and the relationship between recovery of MI conduction and postablation LAT.

A Very Rapid Visual Recovery of Posterior Reversible Encephalopathy Syndrome

Mylohyoid Advancement Flap for Closure of Composite Oral Cavity Defects

To describe a new surgical procedure in the reconstruction of composite oral cavity resections.

An Alternative to Bite Block in a Patient with Restricted Mouth Opening

High-precision Soft X-ray Polarimeter at Diamond Light Source

The development and performance of a high-precision polarimeter for the polarization analysis in the soft x-ray region is presented. This versatile, high-vacuum compatible instrument is supported on a hexapod to simplify the alignment with a resolution less than 5 μrad, and can be moved with its own independent control system easily between different beamlines and synchrotron facilities. The polarimeter can also be used for the characterization of reflection and transmission properties of optical elements. A W/B(4)C multilayer phase retarder was used to characterize the polarization state up to 1200 eV. A fast and accurate alignment procedure was developed, and complete polarization analysis of the APPLE II undulator at 712 eV has been performed.

Dermatitis Herpetiformis, Primary Hypothyroidism and Pituitary Mass Mimicking Macroadenoma Regression After Treatment with Thyroxin, Corticosteroids and Dapsone

We report a case of 15-year-old girl who was diagnosed as a case of pituitary macroadenoma on computed tomography and magnetic resonance imaging (MRI) scans for her complains of diminished vision in the left eye and headache. On investigation she was found to have optic atrophy of left eye and primary hypothyroidism. She was started on thyroxin therapy in October 2008 and planned for transcranial excision of the tumor. Just before the date for planned surgery she developed mildly itchy vesico-bullous rash and the surgery was postponed. On histopathology and immunoflourescence studies it was confirmed to be the rash of dermatitis herpetiformis (DH) and treatment was started with corticosteroids in the last week of December 2008 and dapsone was added from mid January 2009. The lesions responded dramatically and within 6 weeks of starting treatment, she had become asymptomatic except for persisting diminution of vision. Repeat MRI scans in mid-February 2009 revealed total regression of pituitary mass. The case is being reported for interesting association of primary hypothyroidism, pituitary mass mimicking macroadenoma and DH; its successful outcome with medical management in the form of total regression of pituitary mass, thereby avoiding an unnecessary surgery.

Technique Tips--a Simple Technique to Correct Tooth Rotation

Post Operative Pain Relief Through Intermittent Mandibular Nerve Block

Mandibular nerve block is often performed for diagnostic, therapeutic and anesthetic purposes for surgery involving mandibular region. Advantages of a nerve block include excellent pain relief and avoidance of the side effects associated with the use of opiods or Non-steroidal anti-inflammatory drug (NSAIDs). A patient with maxillo facial trauma was scheduled for open reduction and internal fixation of right parasymphyseal mandibular fracture. The mandibular nerve was approached using the lateral extraoral approach with an 18-gauge i.v. cannula under general anesthesia. He received 4 ml boluses of 0.25% plain bupivacaine for intraoperative analgesia and 12 hourly for 48 h post operatively. VAS scores remained less than 4 through out observation period. The only side effect was numbness of ipsilateral lower jaw line, which subsided after local anesthetic administration was discontinued. Patient was discharged after four days.

Angiotensine Converting Enzyme Inhibitors In Acute Myocardial Infarction--a Review

Coronary artery diseases (CADs) are preventable and controllable disorders, but they continue to be a major cause of morbidity and premature mortality across globe. India is projected to have 62 million CAD patients by 2015, with nearly 1/3rd of this burden shared by patients younger than 40 years. The renin-angiotensin-aldosterone system (RAAS) plays a pivotal role in blood pressure (BP) regulation and fluid and electrolyte homoeostasis. Activation of RAAS has long been implicated in the pathogenesis of acute myocardial infarction (AMI) and benefits of inhibition of RAAS as an effective way to intervene in the pathogenesis of AMI is well documented. In the setting of AMI, angiotensin-II plays a significant detrimental role, contributing to cardiac remodeling, a process that predisposes to subsequent arrhythmia and cardiac failure. Angiotensin converting enzyme inhibitors (ACEls) play a key role in the clinical management of several cardiovascular disease (CVD)s such as AMI, by inhibiting the actions of angiotensin-II, ACEIs would be expected to modify unwanted post-AMI events. ACEIs trials have tested AMI patients with two different approaches: selective (those with left ventricular dysfunction (LVD) treated over a long-term) and relatively unselective (those treated early over the course and for a short-period, up to 6 weeks). In general, results are consistent and beneficial as regards to reduction in both short-term & long-term mortality and heart failure. There are evidences that suggest yielding of an extra protection (reduced mortality and occurrence of severe LVD) with early introduction of ACEIs in the course of AMI. Trials have also shown ACEIs effective and consistent protection against re-infarction and management of arrhythmias after AMI. Large clinical trials have proven ACEIs to be superior to ARB, in preventing CV deaths in high-risk AMI subjects. They have proven to be safe & effective in diabetic & older population. With wealth of evidence available supporting use of ACEIs in patients with MI, The use of ACEIs in AMI has moved form experimental to standard therapy.

Regression of Coronary Atherosclerosis Through Healthy Lifestyle in Coronary Artery Disease Patients--Mount Abu Open Heart Trial

To evaluate the efficacy of a unique healthy and happy lifestyle (HLS) program in regression of coronary atherosclerosis and reduction in cardiac events in an open trial.

Correlation of Serum Biomarkers (TSA & LSA) and Epithelial Dysplasia in Early Diagnosis of Oral Precancer and Oral Cancer

Oral cancer is currently the most frequent cause of cancer-related deaths, which is usually preceded by oral pre-cancerous lesions and conditions. Altered glycosylation of glycoconjugates, such as sialic acid, fucose, etc. are amongst the important molecular changes that accompany malignant transformation. The purpose of our study was to evaluate usefulness of serum Total Sialic Acid (TSA) and serum Lipid-Bound Sialic Acid (LSA) as markers of oral precancerous lesions and histopathologically correlating them with grades of epithelial dysplasia.

Mild Chronic Kidney Disease is an Independent Predictor of Long-term Mortality After Emergency Angiography and Primary Percutaneous Intervention in Patients with ST-elevation Myocardial Infarction

Moderate renal impairment (RI) with a glomerular filtration rate (GFR) <60 ml/min/1.73 m2 is known to predict survival. The authors investigated whether mild RI with an estimated GFR of 60-89 ml/min/1.73 m2 independently predicts survival in a contemporary population with ST segment elevation myocardial infarction (STEMI).

Expression, Purification, and Characterization of Coiled Coil and Leucine Zipper Domains of C-terminal Myosin Binding Subunit of Myosin Phosphatase for Solution NMR Studies

Protein-protein interactions between MBS and PKG are mediated by the involvement of C-terminal domain of MBS, MBS(CT180) and N-terminal coiled coil (CC) leucine zipper (LZ) domain of PKG-Iα, PKG-Iα1(-59). MBS(CT180) is comprised of three structurally variant domains of non-CC, CC, and LZ nature. Paucity of three-dimensional structural information of these MBS domains precludes atomic level understanding of MBS-PKG contractile complex structure. Here we present data on cloning, expression, and purification of CC, LZ, and CCLZ domains of MBS(CT180) and their biophysical characterization using size exclusion chromatography (SEC), circular dichroism (CD), and two-dimensional (1)H-(15)N HSQC NMR. The methods as detailed resulted in high level protein expression and high milligram quantities of purified isotopically ((15)N and (13)C) enriched polypeptides. SEC, CD, and (1)H-(15)N HSQC NMR experiments demonstrated that recombinantly expressed MBS CC domain is well folded and exists as a dimer within physiologic pH range, which is supported by our previous findings. The dimerization of CC MBS is likely mediated through formation of coiled coil conformation. In contrast, MBS LZ domain was almost unfolded that exists as non-stable low structured monomer within physiologic pH range. Protein folding and stability of MBS LZ was improved as a function of decrease in pH that adopts a folded, stable, and structured conformation at acidified pH 4.5. SEC and NMR analyses of LZ vs. CCLZ MBS domains indicated that inclusion of CC domain partially improves protein folding of LZ domain.

Single-operator Cholangioscopy for the Extraction of Cystic Duct Stones (with Video)

Off-pump Cardiac Surgery (OPCAB) in a Patient with Recent Leech Therapy

Adenoma Detection Rates Vary Minimally with Time of Day and Case Rank: a Prospective Study of 2139 First Screening Colonoscopies

Adenoma detection rate is an important measure of colonoscopy quality; however, factors including procedure order that contribute to adenoma detection are incompletely understood.

Carinal Injury: An Airway Challenge for Anesthesiologists

Tracheobronchial disruption is a potentially life-threatening airway challenge for all the anesthesiologists. Carinal rents, although rare, if not timely managed can be catastrophic. We describe a patient with carinal rent being managed successfully by prompt diagnosis, use of low pressure ventilation, and bronchoscopic sealing using tissue glue.

The Role of a Complete Blood Count with Differential for the Surgeon

Hepatocellular Carcinoma Mimicking Primary Peritoneal Carcinomatosis

Central Nervous System Lupus Presenting As Paranoia

X-ray Submicrometer Phase Contrast Imaging with a Fresnel Zone Plate and a Two Dimensional Grating Interferometer

The application of a two dimensional (2D) grating interferometer-Fresnel zone plate combination for quantitative submicron phase contrast imaging is reported. The combination of the two optical elements allows quick recovery of the phase shift introduced by a sample in a hard X-ray beam, avoiding artifacts observed when using the one dimensional (1D) interferometer for a sample with features oriented in the unsensitive direction of the interferometer. The setup provides submicron resolution due to the optics magnification ratio and a fine sensitivity in both transverse orientations due to the 2D analysis gratings. The method opens up possibilities for sub-micro phase contrast tomography of microscopic objects made of light and/or homogeneous materials with randomly oriented features.

Is Co-morbid Depression Adequately Treated in Patients Repeatedly Referred to Specialist Medical Services with Symptoms of a Medical Condition?

Patients with a medical condition and co-morbid depression have more symptoms and use more medical services. We aimed to determine the prevalence of depression and the adequacy of its treatment in patients who had been repeatedly referred from primary to specialist medical care for the assessment of a medical condition.

A Cross-sectional Survey on Prevalence and Risk Factors for Persistent Postsurgical Pain 1 Year After Total Hip and Knee Replacement

There is a paucity of large multi-institutional surveys to determine the prevalence of and risk factors for persistent pain after total hip (THR) and knee (TKR) replacements. We surveyed a variety of practices and patients and also correlated persistent pain with health-related quality-of-life outcomes.

An Aggressive Sphenoid Wing Meningioma Causing Foster Kennedy Syndrome

Foster Kennedy syndrome is a rare neurological condition with ophthalmic significance that can manifest as acute visual loss. It is classically characterised by unilateral optic nerve atrophy and contralateral papilledema resulting from an intracranial neoplasm. Physicians should consider Foster Kennedy syndrome in patients who present with visual loss and who have a history of intracranial neoplasm. In addition to ophthalmologic examination, neuroimaging is essential for the diagnosis of Foster Kennedy syndrome.

Geometrical Factor Correction in Grazing Incident X-ray Fluorescence Experiment

The geometrical factor in the grazing incident x-ray fluorescence analysis is an important angle-dependent term, which can have a great effect on the measured data. In this paper, the effects of the geometrical factor on the florescence yield have been demonstrated. A formula is presented to estimate the geometrical factor, which includes the experimental parameters of the beam and setup. The validity of this formula is proven by the good agreement between the calculated fluorescence yields with the experimental results in grazing incident x-ray fluorescence analysis.

Technique Tips--modified Transpalatal Appliance: a Simple Non-invasive Technique for Maxillary Molar Intrusion

Ultrasound Guided Alcohol Ablation of Morton's Neuroma

Morton's neuroma is a common cause of metatarsalgia. This study evaluated the efficacy of ultrasound guided alcohol injection as a treatment for this condition.

Epidural Analgesia: What Nurses Need to Know

Granular Cell Tumor of Skin Diagnosed on Fine Needle Aspiration Cytology

Predictors for Moderate to Severe Acute Postoperative Pain After Total Hip and Knee Replacement

The ability to identify and focus care to patients at higher risk of moderate to severe postoperative pain should improve analgesia and patient satisfaction, and may affect reimbursement. We undertook this multi-centre cross-sectional study to identify preoperative risk factors for moderate to severe pain after total hip (THR) and knee (TKR) replacement.

An Unusual Cause of Delayed Recovery from Anesthesia

Interpretation of Probe-based Confocal Laser Endomicroscopy of Indeterminate Biliary Strictures: is There Any Interobserver Agreement?

Probe-based confocal laser endomicroscopy (pCLE) has enabled in vivo histopathology by obtaining high resolution images of the mucosal layers of the gastrointestinal tract. For indeterminate bile duct strictures, biopsy, cytologic brushing and needle aspiration have low levels of diagnostic accuracy.

A Simple and Novel Method for RNA-seq Library Preparation of Single Cell CDNA Analysis by Hyperactive Tn5 Transposase

Deep sequencing of single cell-derived cDNAs offers novel insights into oncogenesis and embryogenesis. However, traditional library preparation for RNA-seq analysis requires multiple steps with consequent sample loss and stochastic variation at each step significantly affecting output. Thus, a simpler and better protocol is desirable. The recently developed hyperactive Tn5-mediated library preparation, which brings high quality libraries, is likely one of the solutions.

Stellate Ganglion Block As a Limb Salvaging Technique

Use of an Endobronchial US Endoscope in a Nearly Obstructing Esophageal Tumor

No Spot Solutions: Vitamin A Supplementation in India

Correlations Among Attributes of Senescence and Antioxidative Status of Leaf Discs During Epiphyllous Bud Differentiation in Kalanchoe Pinnata Lam. (Pers.)

Leaf detachment is a common signal that triggers both the differentiation of dormant epiphyllous buds as well as the onset of foliar senescence in Kalanchoe pinnata Lam. (Pers.). The present study looked for any probable correlations among selected attributes of foliar senescence, e.g. soluble proteins, chlorophylls a and b (Chl(a+b)), and membrane stability index (MSI), and the antioxidative status, e.g. phenolics, ferric reducing ability in plasma equivalence (FRAP(eq)), and membrane protection index (MPI), during epiphyllous bud differentiation. The experimental system comprised 0.75-cm leaf discs, with or without a dormant epiphyllous bud, cultured in vitro and exposed for ten days to continuous light or dark. A steady depletion of soluble proteins and Chl(a+b), and lowering of MSI in the leaf discs were observed, the decline being relatively faster and of higher magnitude in discs exposed to dark rather than to light. The pigment loss in discs with differentiating epiphyllous buds was greater and faster than in those lacking buds, a somewhat reverse situation was observed in case of soluble proteins. Simultaneously, a time-dependent decrease in the level of phenolics was also observed. Their content was found to be lower in discs exposed to dark as compared to light, pointing to a relationship with a higher rate of senescence-related degradative processes in the dark. The change in the content of Chl(a+b) was found to be significantly correlated with the variation in the level of phenolics. The average FRAP(eq) after ten days was one half that of the initial level, which could be correlated with the decreasing levels of phenolics (intra-correlation) and maximally correlated with variations in Chl(a+b) and protein contents (inter-correlation). Aqueous alcohol foliar extracts significantly (p < 0.05) protected membranes against peroxidative stress, although the pattern was not found to be in line with that of the phenolics content or FRAP(eq). The diminishing Chl(a+b) content was found to be maximally correlated with alterations in the membrane protection.

A Novel, Minimally-invasive Surgical Approach for Ablation of Ventricular Tachycardia Originating Near the Proximal Left Anterior Descending Coronary Artery

Catheter Malposition in Infants: A Preventable Complication

In Situ Beamline Analysis and Correction of Active Optics

At the Diamond Light Source, pencil-beam measurements have enabled long-wavelength slope errors on X-ray mirror surfaces to be examined under ultra-high vacuum and beamline mounting without the need to remove the mirror from the beamline. For an active mirror an automated procedure has been implemented to calculate the actuator settings that optimize its figure. More recently, this in situ pencil-beam method has been applied to additional uses for which ex situ measurements would be inconvenient or simply impossible. First, it has been used to check the stability of the slope errors of several bimorph mirrors at intervals of several weeks or months. Then, it also proved useful for the adjustment of bender and sag compensation actuators on mechanically bent mirrors. Fits to the bending of ideal beams have been performed on the slope errors of a mechanically bent mirror in order to distinguish curvatures introduced by the bending actuators from gravitational distortion. Application of the optimization procedure to another mechanically bent mirror led to an improvement of its sag compensation mechanism.

Role of Omega-3 Ethyl Ester Concentrate in Reducing Sudden Cardiac Death Following Myocardial Infarction and in Management of Hypertriglyceridemia: An Indian Consensus Statement

Sudden cardiac death (SCD) is the most lethal manifestation of heart disease. In an Indian study the SCDs contribute about 10% of the total mortality and SCD post ST elevation myocardial infarction (MI) constitutes for about half of total deaths.

A Vanishing Act: the Incredible Erlotinib

Chaos Theory and Suicide

GAD65 Positive Autoimmune Limbic Encephalitis: A Case Report and Review of Literature

Limbic encephalitis is a rare disorder affecting the medial temporal lobe of the brain, sometimes also involving hippocampus atrophy. It was initially considered to be only of paraneoplastic origin but now auto-immune (non-paraneoplastic) cases have also been reported. Most common non paraneoplastic antibodies associated with limbic encephalitis are Voltage gated potassium channel antibodies, NMDA receptor antibodies and GAD receptor antibodies. We present a case of limbic encephalitis which presented with sudden onset seizures which was preceded by confusion, disorientation and other psychiatric symptoms for a period of 5 weeks. No tumor was found on imaging and the classic paraneoplastic panel was negative. CSF and serum examination showed high titers GAD65 antibody guiding towards a diagnosis of non paraneoplastic limbic encephalitis. Her symptoms and GAD 65 antibody titers showed significant improvement following immunomodulatory therapy. The case presented here is unique and scientifically relevant, as it intends to raise awareness of Auto-immune Limbic Encephalitis, a potentially reversible cause of a medical emergency.

Current Genomics in Cardiovascular Medicine

Cardiovascular disease (CVD) is a heterogeneous, complex trait that has a major impact on human morbidity and mortality. Common genetic variation may predispose to common forms of CVD in the community, and rare genetic conditions provide unique pathogenetic insights into these diseases. With the advent of the Human Genome Project and the genomic era, new tools and methodologies have revolutionised the field of genetic research in cardiovascular medicine. In this review, we describe the rationale for the current emphasis on large-scale genomic studies, elaborate on genome wide association studies and summarise the impact of genomics on clinical cardiovascular medicine and how this may eventually lead to new therapeutics and personalised medicine.

Congenital Narrowing of a Pulmonary Vein: Slit-like Pulmonary Vein Ostium

We report the case of a 60-year-old female with a history of refractory paroxysmal atrial fibrillation. Preablation contrast enhanced pulmonary vein computed tomography (CT) scan demonstrated a slit-like narrowing of the left inferior pulmonary vein ostium. The narrowing measured approximately 3 mm, with poststenotic dilation. The patient had no prior history of ablation. The patient subsequently underwent segmental antral isolation of all four pulmonary veins and cavo-tricuspid isthmus ablation with bidirectional block. The diagnosis of preexisting congenital pulmonary vein stenosis had an impact on the type of ablation procedure performed (antral rather than ostial) and will affect the interpretation of postablation CT scans.

Ninety Days of Repeated Gavage Administration of Rhodiola Imbricata Extract in Rats

Rhodiola imbricata is a high-altitude plant, possesses adaptogenic, immunomodulatory, anti-oxidant and cytoprotective activity, and is widely used in traditional medicine. The present study was designed to ascertain the safety of aqueous extract of R. imbricata root when administered by gavage to rats for 90 days. Four groups of animals, each consisting of 15 males and 15 females, were administered 0, 100, 250 or 500 mg kg(-1) extract, in a single dose per day. The experimental rats when administered 100 mg kg(-1) of extract did not show any significant change in their body weight gain, organ/body weight ratio, or histological, hematological and biochemical variables studied. However, at higher doses of 250 and 500 mg kg(-1) extract, an increase in the body weight of rats of both the sexes was apparent without any change in their organ/body weight ratio. Furthermore, a noteworthy increase in plasma glucose and protein levels was recorded at both the higher doses, which were restored to normal after a 2-week withdrawal of treatment. Based on the findings of this study, the no observed effect level was 100 mg kg(-1) body weight per day of aqueous root extract of R. imbricata in rats administered subchronically. Copyright © 2011 John Wiley & Sons, Ltd.

Management of Pathologic Fractures of the Mandible Secondary to Osteoradionecrosis

To review our experience with late Marx stage III osteoradionecrosis (ORN) of the mandible in patients who present with pathologic fracture.

Treatment of Depression in People with Lung Cancer: a Systematic Review

Lung cancer commonly occurs in older adults who live in deprived areas and have multiple medical comorbidities. As well as suffering severe physical deterioration they are aware of their poor prognosis. It is therefore unsurprising that people with lung cancer have a high rate of depression. Whilst there are effective treatments for depression in people who do not have cancer, it is uncertain which treatments, if any, are effective in depressed cancer patients; the special characteristics of the condition only increase that uncertainty for people with lung cancer. We therefore conducted a systematic review of relevant randomised controlled trials to determine which, if any, treatments have been found to be effective for depression in patients with lung cancer. Surprisingly, we found no completed trials of treatments in patients selected for having depression and no trials that had evaluated treatments known to be effective for depression in the general population. We did, however, find six trials of interventions intended to improve quality of life in unselected patients with lung cancer. These suggested that enhanced care is more effective in reducing depressive symptoms than standard care. Whilst it may be reasonable to treat depression in individuals with lung cancer with standard treatments until more specific evidence is available, clinicians should be aware that the effectiveness and potential adverse effects of these treatments remain unknown in this patient group. Evidence from randomised trials is urgently required.

A Bilateral Primary Yolk Sac Tumor of the Lung Associated with Chromosome 3 Polysomy: Understanding the Oct 3/4 and Sox 2 Interaction

Extragonadal germ cell tumors (EGCTs) in the lung are extremely rare and their pathogenesis is poorly understood. We report a case in a 48-year-old female which was very aggressive and stained positive for primoridial germ cell markers. Interestingly, there was chromosome 3 polysomy noted. To our knowledge this is the first chromosomal aberration noted in a primary germ cell tumor of the lung.

Prevalence of Depression in Adults with Cancer: a Systematic Review

Depression has substantial effects on cancer patients' quality of life. Estimates of its prevalence vary widely. We aimed to systematically review published studies to obtain the best estimate of the prevalence of depression in clinically meaningful subgroups of cancer patients.

Primary Care Practitioners' Views on Test Result Management in EHR-enabled Health Systems: a National Survey

Failure to notify patients of test results is common even when electronic health records (EHRs) are used to report results to practitioners. We sought to understand the broad range of social and technical factors that affect test result management in an integrated EHR-based health system.

Miniplate Fixation of Fractures of the Symphyseal and Parasymphyseal Regions of the Mandible: a Review of 218 Patients

To review our experience with miniplate fixation of fractures of the symphyseal and parasymphyseal regions of the mandible.

Screening Medical Patients for Distress and Depression: Does Measurement in the Clinic Prior to the Consultation Overestimate Distress Measured at Home?

BACKGROUND: Medical patients are often screened for distress in the clinic using a questionnaire such as the Hospital Anxiety and Depression Scale (HADS) while awaiting their consultation. However, might the context of the clinic artificially inflate the distress score? To address this question we aimed to determine whether those who scored high on the HADS in the clinic remained high scorers when reassessed later at home. Method We analysed data collected by a distress and depression screening service for cancer out-patients. All patients had completed the HADS in the clinic (on computer or on paper) prior to their consultation. For a period, patients with a high score (total of ⩾15) also completed the HADS again at home (over the telephone) 1 week later. We used these data to determine what proportion remained high scorers and the mean change in their scores. We estimated the effect of 'regression to the mean' on the observed change. RESULTS: Of the 218 high scorers in the clinic, most [158 (72.5%), 95% confidence interval (CI) 66.6-78.4] scored high at reassessment. The mean fall in the HADS total score was 1.74 (95% CI 1.09-2.39), much of which could be attributed to the estimated change over time (regression to the mean) rather than the context. CONCLUSIONS: Pre-consultation distress screening in clinic is widely used. Reassuringly, it only modestly overestimates distress measured later at home and consequently would result in a small proportion of unnecessary further assessments. We conclude it is a reasonable and convenient strategy.

Interobserver Agreement for Confocal Imaging of Ampullary Lesions: a Multicenter Single-blinded Study

Malignant ampullary lesions can be difficult to classify by endoscopy alone. Probe-based confocal laser endomicroscopy (pCLE) permits in vivo assessment of mucosal structures in the gastrointestinal tracts in the real time.

Lumbar Epidural Injections for Low Back Pain

Location of Bile Leak Predicts the Success of ERCP Performed for Postoperative Bile Leaks

ERCP is effective for treating a bile leak (BL) after cholecystectomy (CCY), but few data exist on its effectiveness after hepatobiliary surgery (HBS).

Clinical Progression of Multiple Myeloma Presenting As Parotid Gland Plasmacytoma

Toll-like Receptor 3 and 7/8 Function is Impaired in Hepatitis C Rapid Fibrosis Progression Post-liver Transplantation

Recurrence of hepatitis C (HCV) postliver transplant is universal, with a subgroup developing rapid hepatic fibrosis. Toll-like receptors (TLRs) are critical to innate antiviral responses and HCV alters TLR function to evade immune clearance. Whether TLRs play a role in rapid HCV recurrence posttransplant is unknown. We stimulated peripheral blood mononuclear cells (PBMCs) from 70 patients with HCV postliver transplant with TLR subclass-specific ligands and measured cytokine production, TLR expression and NK cell function. Rate of fibrosis progression was calculated using posttransplant liver biopsies graded by Metavir scoring (F0-4; R=fibrosis stage/year posttransplant; rapid fibrosis defined as >0.4 units/year). Thirty of 70 (43%) patients had rapid fibrosis progression. PBMCs from HCV rapid-fibrosers produced less IFNα with TLR7/8 stimulation (p=0.039), less IL-6 at baseline (p=0.027) and with TLR3 stimulation (p=0.008) and had lower TLR3-mediated monocyte IL-6 production (p=0.028) compared with HCV slow fibrosers. TLR7/8-mediated NKCD56 dim cell secretion of IFNγ was impaired in HCV rapid fibrosis (p=0.006) independently of IFNα secretion and TLR7/8 expression, while cytotoxicity remained preserved. Impaired TLR3 and TLR7/8-mediated cytokine responses may contribute to aggressive HCV recurrence postliver transplantation through impaired immune control of HCV and subsequent activation of fibrogenesis.

Gender Difference in Coronary Sinus Anatomy and Left Ventricular Lead Pacing Parameters in Patients with Cardiac Resynchronization Therapy

Background: Recent studies have suggested better outcomes from cardiac resynchronization therapy (CRT) in women. Gender differences in coronary sinus (CS) anatomy and left ventricular (LV) lead parameters in patients undergoing CRT, however, have not been well studied. Methods and Results: Two hundred and twenty-three consecutive patients, undergoing CRT at the University of California in San Diego Medical Center from 2003 to 2011 were included in this study. The location of the LV lead was assessed on coronary venography and chest X-ray recorded at the time of device implantation. Optimal LV lead position was defined as either mid-lateral or posterolateral LV wall. The relationship between LV lead position (optimal or non-optimal position) and LV lead parameters at completion of implant were compared between genders. No statistically significant gender differences were noted in baseline characteristics. LV lead implantation was successful in 217 patients (97.3%). Lateral or posterolateral CS branches were unavailable in more women than men (26.3% vs. 10.8%, P=0.011). Women had a higher LV lead pacing threshold than men (P=0.003) and gender was an independent risk factor of high LV lead pacing threshold (P=0.008). Conclusions: Women had an anatomical disadvantage for LV lead placement and had higher LV lead pacing threshold compared to men. Implanting physicians should be aware of gender differences during LV lead placement in order to maximize CRT benefits.  (Circ J 2013; 77: 1424-1429).

Information Overload and Missed Test Results in Electronic Health Record-based Settings

Incidence, Clinical Predictors and Outcome of Acute Renal Failure Among North Indian Trauma Patients

There is a need for identifying risk factors aggravating development of acute renal failure after attaining trauma and defining new parameters for better assessment and management. Aim of the study was to determine the incidence of acute renal failure among trauma patients, and its correlation with various laboratory and clinical parameters recorded at the time of admission and in-hospital mortality.

X-ray Wavefront Characterization of a Fresnel Zone Plate Using a Two-dimensional Grating Interferometer

The x-ray wavefront downstream of a Fresnel zone plate (FZP) was characterized using a two-dimensional grating interferometer. Transverse wavefront slope maps, measured using a raster phase-stepping scan, allowed accurate phase reconstruction of the x-ray beam. Wavefront measurements revealed that the wavefront error is very sensitive to the input beam entering the FZP. A small stack of one-dimensional compound refractive lenses was used to introduce astigmatism in the probing x-ray beam to investigate the contribution of the incoming beam in contrast to the optical aberrations. Experimental data were shown to be consistent with theoretical calculations.

Endoscopic Ultrasound-guided Pancreatic Fiducial Placement: How Important is Ideal Fiducial Geometry?

Image-guided radiation therapy allows precise tumor targeting using real-time tracking of radiopaque fiducial markers. To enable appropriate tracking, it is recommended to place fiducials with "ideal fiducial geometry" (IFG). Our objectives were to determine the proportion of patients in whom IFG can be achieved when fiducials are placed by endoscopic ultrasound (EUS) and surgery and to determine if attaining IFG is necessary for delivering radiation.

Are Patients Admitted to Emergency Departments with Regular Supraventricular Tachycardia (SVT) Treated Appropriately?

Regular supraventricular tachycardia (SVT) is frequently encountered in clinical practice. Guidelines are available from the National Service Framework (NSF) for the treatment of patients attending emergency departments (ED) with SVT. These recommend a thyroid-function test (TFT) and arrhythmia electrocardiography (ECG), and referral to a heart-rhythm specialist on discharge. Hospital admission is rarely required. In our multicentre study, we examined the implementation of these guidelines among patients attending the ED with SVT. Only 34% of patients had specialist referrals, with an average wait of 50.3 days (the majority of delays resulted from referral requests from general practitioners). A history of previous SVT, the mode of tachycardia termination, patient age and/or comorbidities were similar for the 27 (23.5%) patients who were admitted overnight. Of these, 15 (13%) of the total 115 patients who attended ED with regular SVT were referred for Holter monitoring despite having ECGs demonstrating arrhythmia. Low referral rates, unnecessary investigations and admissions indicate a need for improvement for better patient care and to minimise healthcare costs. We have formulated a standard operating procedure, which will be available via the College of Emergency Medicine website.

Defining the Accuracy of Secretin Pancreatic Function Testing in Patients With Suspected Early Chronic Pancreatitis

OBJECTIVES:The diagnosis of chronic pancreatitis in patients with characteristic symptoms but normal pancreatic imaging is challenging. Assessment of pancreatic function through secretin pancreatic function testing (SPFT) has been advocated in this setting, but its diagnostic accuracy is not fully known.METHODS:This was a retrospective review of patients who received SPFT at our tertiary care institution between January 1995 and December 2008 for suspected chronic pancreatitis. For all patients, medical records were reviewed for evidence of subsequent development of chronic pancreatitis by imaging and/or pathology. Patients were then categorized as "true positive" or "true negative" for chronic pancreatitis based on follow-up imaging or histologic evidence.RESULTS:In all, 116 patients underwent SPFT. Of the 27 patients who tested positive, 7 were lost to follow-up. Of the remaining 20 SPFT-positive patients, 9 (45%) developed radiologic or histologic evidence of chronic pancreatitis after a median of 4 years (1-11 years). Of the 89 patients who had negative SPFT testing, 19 were lost to follow-up. Of the remaining 70 patients, 2 were eventually diagnosed with chronic pancreatitis based on subsequent imaging/histology after a median follow-up period of 7 years (3-11 years). The sensitivity of the SPFT in diagnosing chronic pancreatitis was 82% with a specificity of 86%. The positive predictive value (PPV) of chronic pancreatitis was 45% with a negative predictive value (NPV) of 97%.CONCLUSIONS:In patients with suspected early chronic pancreatitis and normal pancreatic imaging, SPFT is highly accurate at ruling out early chronic pancreatitis with a NPV of 97%.Am J Gastroenterol advance online publication, 28 May 2013; doi:10.1038/ajg.2013.148.

Assessment of Hemostatic Changes After Crystalloid and Colloid Fluid Preloading in Trauma Patients Using Standard Coagulation Parameters and Thromboelastography

The choice of an ideal fluid administered post trauma and its subsequent influence on coagulation still poses a clinical dilemma. Hence, this study was designed to assess the influence of in vivo hemodilution with various fluid preparations (4% gelatin, 6% hydoxyethyl starch (HES), Ringer's lactate, 0.9% normal saline) on coagulation using standard coagulation parameters and real-time thromboelastography (TEG) in patients undergoing elective surgery post trauma.

The History of Parathyroid Endocrinology

The parathyroid glands are now recognized as being essential for life. Their structure and function is well delineated, and their disease and dysfunction, well characterized. Diagnosis and management of parathyroid disease has improved in the past few decades. The path of parathyroid science, however, has been far from smooth. This paper describes the early history of parathyroid endocrinology. In doing so, it focuses on major events and discoveries, which improved the understanding and practice of our specialty. Contribution in anatomy, physiology, pathology, medicine, surgery and biochemistry are reviewed.

Treatment of Depression in Adults with Cancer: a Systematic Review of Randomized Controlled Trials

BACKGROUND: Depression is a leading cause of disease burden worldwide and is especially problematic in people with chronic diseases, including cancer. Although depression can be effectively treated in the general population using antidepressant medication and psychological treatments, these treatments may have different benefits and harms in cancer patients. Previous reviews have not adequately addressed this topic. We therefore aimed to determine which, if any, treatments are effective for patients with diagnoses of both cancer and depression. Method We conducted a systematic review of relevant randomized controlled trials identified through searches of Medline, EMBASE, PsycINFO and The Cochrane Central Register of Controlled Trials (CENTRAL). RESULTS: Seven relatively small trials met the selection criteria. These provided some evidence that antidepressant medication, given alone or in combination with a psychological treatment, may be effective. We found no good evidence for psychological treatments given alone or for any other forms of treatment. CONCLUSIONS: There is very limited evidence from clinical trials to guide the treatment of cancer patients with a diagnosis of depression, especially for psychological treatments. High quality trials of treatments for depression in patients with cancer are urgently needed.

Lumbar Epidural Injections for Low Back Pain

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