Alternating Layers of Morselized Allograft and Injectable Ceramic Bone Graft Substitute in Acetabular Reconstruction: A Novel 'Sandwich' Technique.

Background: Impaction of morselized allograft is an appealing procedure for addressing the bone defects. However, concerns remain about its suitability for massive defects. We used a novel "sandwich" technique by impacting the morselized allograft in layers with an intervening layer of injectable bone graft substitute for restoring bone defects during acetabular reconstruction in total hip arthroplasties. Methods: From August 2015 to June 2017, 17 revisions, 4 rerevisions, and 3 complex primary total hip arthroplasties were operated by this novel technique. Postoperatively, serial X-rays were evaluated at regular intervals. Clinical and functional outcomes were assessed by the Harris hip score. To examine if introducing an injectable bone substitute into allograft stock increased its load-bearing capability, simulated mechanical testing using Synbone samples was conducted in the laboratory. Results: The mean Harris hip score significantly improved from 54.6 preoperatively to 86.8 at the latest follow-up. Graft incorporation was seen in all the cases. There was no evidence of component migration or loosening as compared to the X-rays at 3 weeks and 3 months in all the cases. With revision of component as end point, the survivorship was 100% at 82 months. The mechanical testing reported a higher capability of allograft samples when compared to those without bone substitutes. Conclusions: Our data confirms that the use of the "sandwich" technique is a reliable option for major acetabular reconstruction. Early weight bearing is a significant value addition, and short-term results confirm good clinical and functional outcome. Longer follow-up is necessary to assess the status of the construct in the long term.

Genome-Transcriptome Transition Approaches to Characterize Anthocyanin Biosynthesis Pathway Genes in Blue, Black and Purple Wheat.

Colored wheat has gained enormous attention from the scientific community, but the information available on the anthocyanin biosynthetic genes is very minimal. The study involved their genome-wide identification, in silico characterization and differential expression analysis among purple, blue, black and white wheat lines. The recently released wheat genome mining putatively identified eight structural genes in the anthocyanin biosynthesis pathway with a total of 1194 isoforms. Genes showed distinct exon architecture, domain profile, regulatory elements, chromosome emplacement, tissue localization, phylogeny and synteny, indicative of their unique function. RNA sequencing of developing seeds from colored (black, blue and purple) and white wheats identified differential expressions in 97 isoforms. The F3H on group two chromosomes and F3'5'H on 1D chromosomes could be significant influencers in purple and blue color development, respectively. Apart from a role in anthocyanin biosynthesis, these putative structural genes also played an important role in light, drought, low temperature and other defense responses. The information can assist in targeted anthocyanin production in the wheat seed endosperm.

An in silico model for woven bone adaptation to heavy loading conditions in murine tibia.

Existing in silico models for lamellar bone adaptation to mechanical loading are unsuitable for predicting woven bone growth. This anomaly is due to the difference in mechanobiology of the woven bone with respect to that of the lamellar bone. The present study is aimed at developing an in silico bone-adaptation model for woven bone at cellular and tissue levels. The diffusion of Ca2+ ions reaching lining cells from the osteocytic network and the bone cortex in response to a mechanical loading on the cortical bone has been considered as a stimulus. The diffusion of ions within osteocytic network has been computed with a lacunar-canalicular network (LCN) in which bone cells are uniformly arranged. Strain energy density is assumed to regulate ion flow within the network when the induced normal strain is above a threshold level. If the induced strain exceeds another higher threshold level, then the strain with a power constant is additionally assumed to regulate the stimulus. The intracellular flow of Ca2+ ions within the LCN has been simulated using Fick's laws of diffusion, using a finite element method. The ion diffusion from bone cortex to vesicles has been formulated as a normal strain with a power constant. The stimuli reaching the surface cells are assumed to form the new bone. The mathematical model closely predicts woven bone growth in mouse and rat tibia for various in vivo loading conditions. This model is the first to predict woven bone growth at tissue and cellular levels in response to heavy mechanical loading.

Rising Demand for Healthy Foods-Anthocyanin Biofortified Colored Wheat Is a New Research Trend.

Wheat is a vital and preferred energy source in many parts of the world. Its unique processing quality helps prepare many products such as bread, biscuit, pasta, and noodles. In the world of rapid economic growth, food security, in terms of nutritional profile, began to receive more significant interest. The development of biofortified colored wheat (black, purple, and blue) adds nutritional and functional health benefits to the energy-rich wheat. Colored wheat exists in three forms, purple, blue, and black, depending upon the types and position of the anthocyanins in wheat layers, regulated by the bHLH-MYC transcription factor. Colored wheat lines with high anthocyanin, iron, and zinc contents showed antioxidant and anti-inflammatory activity and possessed desirable product-making and commercial utilization features. The anthocyanin in colored wheat also has a broad spectrum of health implications, such as protection against metabolic syndromes like obesity, diabetes, hypertension, and dyslipidemia. The idea of developing anthocyanin-biofortified wheat shapes human beings' lifestyles as it is a staple food crop in many parts of the world. This review is a compilation of the currently available information on colored wheat in the critical aspects, including biochemistry, food processing, nutrition, genetics, breeding, and its effect on human health. Market generation and consumer awareness creation are vital challenges for its exploitation as a function food on a large scale.

Modeling cortical bone adaptation using strain gradients.

Cyclic and low-magnitude loading promotes osteogenesis (i.e. new bone formation). Normal strain, strain energy density and fatigue damage accumulation are typically considered as osteogenic stimuli in computer models to predict site-specific new bone formation. These models however had limited success in explaining osteogenesis near the sites of minimal normal strain, for example, neutral axis of bending. Other stimuli such as fluid motion or strain gradient also stimulate bone formation. In silico studies modeled the new bone formation as a function of fluid motion, however, computation of fluid motion involves complex mathematical calculations. Strain gradients drive fluid flow and thus can also be established as the stimulus. Osteogenic potential of strain gradients is however not well established. The present study establishes strain gradients as osteogenic stimuli. Bending-induced strain gradients are computed at cortical bone cross-sections reported in animal loading in vivo studies. Correlation analysis between strain gradients and site of osteogenesis is analyzed. In silico model is also developed to test the osteogenic potential of strain gradients. The model closely predicts in vivo new bone distribution as a function of strain gradients. The outcome establishes strain gradient as computationally easy and robust stimuli to predict site-specific osteogenesis. The present study may be useful in the development of biomechanical approaches to mitigate bone loss.

Influence of Biofortified Colored Wheats (Purple, Blue, Black) on Physicochemical, Antioxidant and Sensory Characteristics of Chapatti (Indian Flatbread).

Biofortified colored wheat (black, blue, and purple) is rich in anthocyanins and phenolic acid compounds that impart positive physiological effects in humans. A large proportion of wheat is consumed in the form of Chapatti in Asian countries. The effect of chapatti cooking on the proximate composition, bioactive compounds (anthocyanins and phenolics), and antioxidant activities of these wheat varieties were checked in this study. Apart from acceptable sensory parameters, good taste, and soft texture of chapatti, biofortified colored wheat chapatti and flour had higher dietary fibers, protein content, and lower carbohydrate content. Higher soluble and insoluble phenolic compounds, anthocyanin content, and antioxidant activity were in the order of black > blue > purple > white. Chapatti making has reduced their antioxidant activity and anthocyanin content in comparison to flour. Moreover, the reduction in antioxidant activity is less as compared to the decrease in anthocyanin content. Our results suggest that colored wheat can be a better alternative to normal wheat for preparing chapatti as it would have additional health-promoting activities.

An Invertible Mathematical Model of Cortical Bone's Adaptation to Mechanical Loading.

Determination of mechanical loading regimen that would induce a prescribed new bone formation rate and its site-specific distribution, may be desirable to treat some orthopaedic conditions such as bone loss due to muscle disuse, e.g. because of space flight, bed-rest, osteopenia etc. Site-specific new bone formation has been determined earlier experimentally and numerically for a given loading regimen; however these models are mostly non-invertible, which means that they cannot be easily inverted to predict loading parameters for a desired new bone formation. The present work proposes an invertible model of bone remodeling, which can predict loading parameters such as peak strain, or magnitude and direction of periodic forces for a desired or prescribed site-specific mineral apposition rate (MAR), and vice versa. This fast, mathematical model has a potential to be developed into an important aid for orthopaedic surgeons for prescribing exercise or exogenous loading of bone to treat bone-loss due to muscle disuse.

A prospective study of collapsing focal segmental glomerulosclerosis.

Collapsing focal segmental glomerulosclerosis (cFSGS) is characterized by rapid progression to end-stage renal disease (ESRD). We evaluated the clinicopathological spectrum of cFSGS and compared its clinical behavior to steroid and tacrolimus (TAC)-resistant noncollapsing focal segmental glomerulosclerosis (FSGS). All patients (>14 years) diagnosed with cFSGS were enrolled in the study. Staining for differentiated podocyte markers such as WT 1, PAX and KI67 were performed in all patients. The outcome and histological features of cFSGS was compared with a prospectively followed cohort of steroid and TAC-resistant noncollapsing FSGS. The study included 22 cFSGS patients and 19 cases of steroid and TAC-resistant FSGS. Complete remission, partial remission, steroid resistance, progression to ESRD and death were observed in 13.6%, 4.5%, 27.3%, 36.4% and 18.2% patients, respectively. Patients with cFSGS had higher serum creatinine and more advanced tubulointerstitial changes compared to resistant FSGS. Twenty-six percent of therapy resistant noncollapsing FSGS progressed to ESRD after two years of stopping TAC. However, there was no difference in progression to ESRD between cFSGS and therapy-resistant noncollapsing FSGS at the end of two years. Glomerular collapse in the setting of FSGS is poorly responsive to treatment and has a high rate of progression to ESRD. The long-term prognosis of cFSGS and steroid and TAC-resistant FSGS are similar.

Tacrolimus combined with corticosteroids versus Modified Ponticelli regimen in treatment of idiopathic membranous nephropathy: Randomized control trial.

AIM: There have been very few studies comparing cyclophosphamide (CTX) and calcineurin inhibitor based regimens in the management of non-immunosuppressive symptomatic therapy (NIST) resistant idiopathic membranous nephropathy (IMN). The present study was aimed at comparing the efficacy and safety of tacrolimus (TAC)/steroids with cyclical CTX/steroids (Modified Ponticelli regimen (MPR)) in patients with IMN. METHODS: Idiopathic membranous nephropathy patients (n = 70) with persistent nephrotic syndrome after at least 6 months of antiproteinuric therapy or with complications of nephrotic syndrome were equally randomized to receive TAC with oral prednisolone (TAC*) or MPR. Antibodies against m-type phospholipase A2 receptor (PLA2R Ab) were tested for at baseline and, at 6 and 12 months after the start of therapy. The primary end point was achievement of remission and secondary objectives were adverse effects and estimated glomerular filtration rate in both the study groups. RESULTS: Intention-to-treat analysis showed that remissions at the end of 6 (74% with TAC* vs. 60% with MPR; P = 0.30) and 12 months (71% with TAC* vs. 77% with MPR; P = 0.78) were comparable. PLA2R Ab titres at 6/12 months correlated with urine protein (r 0.54/0.58) and serum albumin (r -0.49/-0.53) at the end of therapy. Patients on CTX had a significantly higher risk of amenorrhea and while those on TAC had a greater risk of reversible nephrotoxicity. CONCLUSION: In NIST refractory IMN, both TAC* and MPR are comparable, but with different adverse effect profile. PLA2 R Ab has a very good association with proteinuria, and should be regularly monitored on clinical follow-up.

Comparison of low-dose intravenous cyclophosphamide with oral mycophenolate mofetil in the treatment of lupus nephritis.

No previous study has compared mycophenolate mofetil (MMF) with low-dose cyclophosphamide (CYC) in the treatment of lupus nephritis (LN). To do so, we recruited patients with LN (class III, IV, or V) and randomized them to receive either low-dose CYC or oral MMF. Those with crescentic LN, a serum creatinine over 265 µmol/l, and neurological or pulmonary lupus were excluded. MMF was prescribed at daily doses of 1.5-3 g for 24 weeks, while CYC was administered as six fortnightly infusions of 500 mg each. All patients received three methylprednisolone injections, followed by oral corticosteroids. Maintenance therapy with azathioprine and low-dose corticosteroid was started at end of induction therapy. The primary end point was treatment response at 24 weeks, while secondary end points were complete remission, Systemic Lupus Erythematosus Disease Activity Index and adverse events. Of the 173 patients recruited, 100 were equally randomized to receive either CYC or MMF. Baseline characteristics were similar, except for higher 24 h proteinuria in the CYC group. At 24 weeks, 37 patients in each group achieved the primary end point. The complete remission rate was 50% in CYC and 54% in MMF group. Gastrointestinal symptoms were significantly more frequent in patients receiving MMF (52 vs. 4%). However, other adverse events were similar. Thus, low-dose intravenous CYC is comparable in safety and efficacy to oral MMF in the induction treatment of less severe LN.

Seed Pro-Nutra Care: A tool for characterization of seed storage proteins and database of bioactive peptides having potential health benefits.

UNLABELLED: Seed storage proteins, the major food proteins, possess unique physicochemical characteristics which determine their nutritional importance and influence their utilization by humans. Here, we describe a database driven tool named Seed Pro-Nutra Care which comprises a systematic compendium of seed storage proteins and their bioactive peptides influencing several vital organ systems for maintenance of health. Seed Pro-Nutra Careis an integrated resource on seed storage protein. This resource help in the (I) Characterization of proteins whether they belong to seed storage protein group or not. (II) Identification the bioactive peptides with their sequences using peptide name (III) Determination of physico chemical properties of seed storage proteins. (IV) Epitope identification and mapping (V) Allergenicity prediction and characterization. Seed Pro-Nutra Care is a compilation of data on bioactive peptides present in seed storage proteins from our own collections and other published and unpublished sources. The database provides an information resource of a variety of seed related biological information and its use for nutritional and biomedical application. AVAILABILITY: http://www.gbpuat-cbsh.ac.in/departments/bi/database/seed_pro_nutra_care/

Assessing overall functioning with adolescent inpatients.

The current study sought to evaluate the validity and reliability of a brief measure of overall functioning for adolescents. Clinicians were asked to complete the Overall Functioning Scale (OFS) for 72 adolescents consecutively admitted to the adolescent psychiatric inpatient service of a community safety net medical center. The results revealed that this new measure is related to the patients' length of stay, clinician-rated measures of social cognition and object relations, Global Assessment of Functioning (GAF) score at admission, as well as global rating of engagement in individual psychotherapy. The results also showed that the OFS was related to the patients' history of nonsuicidal self-harm as well as treatment outcome as assessed by measures of psychological health and well-being as well as symptoms. Hierarchical regressions reveal that the OFS shows incremental validity greater than the admission GAF score in predicting length of stay. The results also showed that the OFS demonstrates interrater reliability in the excellent range (intraclass correlation coefficient(1,2)) of 0.88. Clinical implications of the use of this tool and areas of future research are discussed.

A "clean" technique for managing bleeding duodenal ulcer with a new aortic prosthesis: endoscopic-assisted repair of bleeding duodenal ulcer.

Aortic graft infection is one of the most dreaded surgical complications. In the perioperative patient with fresh aortic prosthesis, this is a particularly complex problem. Opening the bowel changes an operation to a "clean-contaminated" or "contaminated" case. This increases the risk of all infectious complications in the patient. Theoretically, our method of repair reduces the risk of infection by eliminating the duodenotomy. The direct visualization with the endoscope replaces the need to open the potentially contaminated bowel and reduces the risk of bacterial translocation and bacteremia. By not opening the bowel, this keeps the case "clean," and likely reduces the risk of contamination and subsequent infection of the prosthetic graft. As the potential morbidity of aortic graft infection is so devastating, and now that we have the available technology and operative skill, we propose our technique as a potential alternative to possibly reduce the incidence of aortic graft infection.