Association between cerebral blood flow changes and blood-brain barrier compromise in spontaneous intracerebral haemorrhage.

AIM: To quantitatively evaluate blood-brain barrier (BBB) permeability in the perihaematomal region of spontaneous intracerebral haemorrhage (ICH) and investigate the association between the alterations in cerebral blood flow and BBB permeability around the haematoma. MATERIALS AND METHODS: Spontaneous ICH patients underwent unenhanced computed tomography (CT) and CT perfusion (CTP) simultaneously. Haematoma volume was measured on CT. The values of cerebral haemodynamic parameters including cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), time to peak (TTP), and permeability-surface area product (PS) were measured in the perihaematomal region and the contralateral mirror region, and then relative values were calculated for statistical analysis. Linear regression was used to evaluate associations between BBB permeability and variables. RESULTS: A total of 87 ICH patients were included in this study. The focally elevated BBB permeability was observed in the perihaematomal region in ICH patients. Linear regression showed that reduced rCBF (ß = -0.379, p=0.001) and increased rCBV (ß = 0.412, p=0.000) correlated independently with increased relative PS (rPS) value in deep ICH, while only increased rCBV (ß = 0.423, p=0.071) correlated to increased rPS value in patients with lobar ICH. CONCLUSIONS: BBB permeability is focally elevated in the region around the haematoma. Cerebral haemodynamic alterations are associated with increased BBB permeability. Cerebral hypoperfusion may aggravate BBB compromise, and a compensatory increase in CBV may lead to reperfusion injury on BBB.

Is the Management of Rectal Cancer Using a Watch and Wait Approach Feasible, Safe and Effective in a Publicly Funded General Hospital?

AIMS: Although there is emerging evidence to suggest equivalent oncological outcomes using a watch and wait approach compared with primary total mesorectal excision surgery, there is a paucity of evidence about the safety and efficacy of this approach in routine clinical practice. Here we report the long-term outcomes and quality of life from patients managed with watch and wait following a clinical complete response (cCR) to neoadjuvant therapy. MATERIALS AND METHODS: Patients with adenocarcinoma of the rectum with cCR following neoadjuvant therapy managed using watch and wait were retrospectively identified. Demographic data, performance status, pretreatment staging information, oncological and surgical outcomes were obtained from routinely collected clinical data. Quality of life was measured by trained clinicians during telephone interviews. RESULTS: Over a 7-year period, 506 patients were treated for rectal cancer, 276 had neoadjuvant therapy and 72 had a cCR (26.1%). Sixty-three were managed with watch and wait. Thirteen patients had mucosal regrowth. There was no significant difference in the incidence of metastatic disease between the surgical and watch and wait cohorts (P = 0.38). The 13 patients with mucosal regrowth underwent salvage surgery. Eleven of the patients who underwent surgical resection had R0 resections. There was also a statistically and clinically significant improvement in the Functional Assessment of Cancer Therapy - Colorectal (FACT-C) trial outcome index (P = 0.022). CONCLUSION: This study shows that watch and wait is safe and effective outside of tertiary referral centres. It suggests that an opportunistic cCR is durable and when mucosal regrowth occurs it can be salvaged. Finally, we have shown that quality of life is probably improved if a watch and wait approach is adopted.

A reliable chemiresistive sensor of nickel-doped tin oxide (Ni-SnO2) for sensing carbon dioxide gas and humidity.

Herein, we report the chemiresistive gas and humidity sensing properties of pristine and nickel-doped tin oxide (Ni-SnO2) gas sensors prepared by a microwave-assisted wet chemical method. The structural and optical properties are characterised using X-ray diffraction, scanning electron microscopy, scanning transmission electron microscopy, ultraviolet spectroscopy, Fourier transform infrared spectroscopy, and X-ray photoelectron spectroscopy. The structural elucidation and morphology analyses confirm a particle size of 32-46 nm, tetragonal rutile crystal structure and small cauliflower-type surface appearance. Nickel doping can tune the structure of NPs and morphology. The tested carbon dioxide gas and humidity sensing properties reveal a rapid sensing performance with high-to-moderate sensitivity. Also, the materials favour gas sensing because their sensitivity is enhanced with the increase in nickel concentration. The sensing results suggest that nickel is a vibrant metal additive to increase the gas sensitivity of the sensor. However, nickel doping decreases the electron density and increases the oxygen vacancies. Ultimately, the gas sensor produces highly rapid sensing with a response time of 4 s.

Systematic interconnected web-like architecture growth of sprayed TiO2 films.

Systematic improvement in interconnected web-like architecture with thickness of TiO2 films synthesized by spray pyrolysis method is reported and characterized for the structural, optical, surface morphological, and wettability properties. Deposited TiO2 films were crystalline with [120] direction orientation, uniform and adherent to the glass substrate. Interestingly, with increase in film thickness, fuzzy and blurred web-like architecture becomes more clear and sharp with well-defined boundaries. The band gap energy was decreased with increase in film thickness. Change in surface architecture resulted into smaller surface wettability in thick film compared to thin one.

Nanostructured tin oxide films: Physical synthesis, characterization, and gas sensing properties.

Nanostructured tin oxide (SnO2) films are synthesized using physical method i.e. thermal evaporation and are further characterized with X-ray diffraction, X-ray photoelectron spectroscopy, scanning electron microscopy, transmission electron microscopy, and atomic force microscopy measurement techniques for confirming its structure and morphology. The chemiresistive properties of SnO2 films are studied towards different oxidizing and reducing gases where these films have demonstrated considerable selectivity towards oxidizing nitrogen dioxide (NO2) gas with a maximum response of 403% to 100ppm @200°C, and fast response and recovery times of 4s and 210s, respectively, than other test gases. In addition, SnO2 films are enabling to detect as low as 1ppm NO2 gas concentration @200°C with 23% response enhancement. Chemiresistive performances of SnO2 films are carried out in the range of 1-100ppm and reported. Finally, plausible adsorption and desorption reaction mechanism of NO2 gas molecules with SnO2 film surface has been thoroughly discussed by means of an impedance spectroscopy analysis.

A comparison of oral midazolam and oral dexmedetomidine as premedication in pediatric anesthesia.

CONTEXT: Oral premedication is widely used in pediatric anesthesia to provide preoperative anxiolysis and ensure smooth induction. Midazolam is currently the most commonly used premedicant, but newer drugs such as the α2-agonists have emerged as alternatives for premedication in children. AIMS: The aim of this study was to compare clinical effects of oral midazolam and oral dexmedetomidine on preanesthetic sedation and postoperative recovery profile in children. SETTINGS AND DESIGN: Randomized controlled trial. MATERIALS AND METHODS: We performed a prospective, randomized, controlled study in 60 children, aged 1-7 years undergoing elective, minor, lower abdominal surgeries under general anesthesia. Patients were randomly assigned to receive either oral midazolam 0.75 mg/kg (Group M, n = 30) or oral dexmedetomidine 4 µg/kg (Group D, n = 30) 40 min prior to mask induction. Preoperative sedation and anxiolysis, the response at parental separation, quality of mask acceptance and recovery profile were compared for the two groups. STATISTICAL ANALYSIS USED: Results were analyzed using unpaired Student's t-test and Chi-squared test. P < 0.05 was considered statistically significant. RESULTS: There was no significant difference in the levels of preoperative sedation and anxiolysis between the two groups, but the onset of sedation was significantly faster with midazolam (18.90 ± 3.68 min) than with dexmedetomidine (30.50 ± 4.44 min). Response to parental separation and quality of mask acceptance was comparable between two groups (P > 0.05). The incidence of postoperative agitation was significantly less in the dexmedetomidine group (P < 0.05). CONCLUSIONS: In this study, premedication with oral dexmedetomidine produced equally effective preoperative sedation and a better recovery from anesthesia in children in comparison to oral midazolam.

Assessment of cognitive function in elderly patients treated with naproxen. A prospective study.

Cognitive functions were assessed in 12 elderly patients prior to and following a three-week therapeutic course of Naproxen, 750 mg/day. Four of the patients deteriorated in one of the four cognitive tests, one of these patients in two tests. However, none of these changes reached statistical significance. Although non-steroidal anti-inflammatory drugs can cause some cognitive alteration in the elderly, this change is mild, and its clinical meaning questioned.

A study of extracellular alkaline protease from Bacillus subtilis NCIM 2713.

An alkaline protease was isolated from culture filtrate of B. subtilis NCIM 2713 by ammonium sulphate precipitation and was purified by gel filtration. With casein as a substrate, the proteolytic activity of the purified protease was found to be optimal at pH 8.0 and temperature 70 degrees C. The purified protease had molecular weight 20 kDa, Isoelectric point 5.2 and km 2.5 mg ml(-1). The enzyme was stable over the pH range 6.5-9.0 at 37 degrees C for 3 hr. During chromatographic separation this protease was found to be susceptible to autolytic degradation in the absence of Ca2+. Ca2+ was not only required for the enzyme activity but also for the stability of the enzyme above 50 degrees C. About 62% activity was retained after 60 min at pH 8.0 and 55 degrees C. DFP and PMSF completely inhibited the activity of this enzyme, while in the presence of EDTA only 33% activity remained. However, it was not affected either by sulfhydryl reagent, or by divalent metal cations, except SDS and Hg2+. The results indicated that this is a serine protease.

Hairy polyp of nasopharynx--a case report.

A specific subtype of teratoid tumour occurring in nasopharynx and oropharynx has been mentioned as 'hairy polyp'. This is a rare lesion and is to be differentiated from true teratomas. A case of hairy polyp of nasopharynx in a 12 year old girl is reported.

Outcome of Interlay Grafting in Type 1 Tympanoplasty for Large Central Perforation.

A prospective, cohort, clinical study was conducted at Dr. D. Y. Patil Hospital, Kolhapur from August 2010 to August 2013. The aim was to evaluate the results of type 1 interlay tympanoplasty with respect to graft uptake, hearing improvement and complications. Total of 100 cases with a mucosal type of chronic suppurative otitis media and a large central perforation (involving more than 50 % of tympanic membrane) were operated for type 1 tympanoplasty where the graft was placed by interlay method (below the fibro-squamous layer and above the mucosal or endothelial layer). Patients were followed up with ear microscopy at each follow up visit and an audiometry at the end of 3rd month. Statistical analysis was done by statcal software using paired t test and two sample t test for proportion. 96 (96 %) cases had a successful graft uptake. The mean pre-operative air-bone gap was 36.42 ± 12.0 dB; whereas the mean post-operative air-bone gap was 9.7 ± 6.71 dB. Except for residual perforation in four patients and partial tympanomeatal flap necrosis in two patients no other complications were encountered. Thus, we conclude that, the interlay tympanoplasty is a safe and effective method of graft placement for large central perforation.

Rhinocerebral mucormycosis: A deadly disease on the rise.

According to WHO, there will be epidemic of diabetes world over and India is going to be 'A diabetes capital of the world' by 2025. With the increasing incidence of diabetes, the associated complications are also bound to increase. Rhinocerebral mucormycosis is one of them.Rhinocerebral Mucormycosis is an opportunistic, fulminating fungal infection, caused by Rhizopus species of order of mucorales, frequently seen in diabetic and immunocompromised patients. Mucormycosis has a very high mortality rate.Early diagnosis and treatment with Amphotericin-B is the key to combat this disease successfully. We have seen 13 cases in last 3 years (2002-2005) in our area. This incidence is significant, as this type of cases were rarely seen before 2002, in this geographical area. We present an account of these cases; treatment strategies adopted, review of literature, and highlight 'the role of ENT surgeon in diagnosis and management of this dreadful disease'.

Remodeling of hippocampal GABAergic system in adult offspring after maternal hypoxia and magnesium sulfate load: immunohistochemical study.

A strong relationship between hypoxia and fetal brain damage has been described. Specific susceptibility of the GABAergic neurons to these conditions may be crucial to the damage induced. We have previously shown, in a mouse model, that maternal pretreatment with magnesium sulfate (Mg) partially prevented the behavioral consequences of maternal hypoxia in the adult offspring. Here, we tested the effect of maternal hypoxia and maternal Mg load on the GABAergic system of 8-month-old offspring. The immunoreactivity (IR) of several proteins expressed in GABAergic neurons and inhibitory synapses was analyzed in the following regions of the adult offspring brain: hippocampus, cortical M1, caudate putamen, and lateral globus pallidus. Maternal hypoxia reduced the density of parvalbumin (PV)-IR neurons in the hippocampus. The density of PV-IR and calbindin (CB)-IR neurons was also reduced in the deep and superficial layers of the M1. Maternal pretreatment with Mg had a prophylactic action in the superficial, but not the deep, layers of M1. Also, in offspring from the maternal hypoxia group, the vesicular GABA transporter (VGAT)-IR was enhanced in the hippocampal CA1 and hilus regions. No effect of maternal hypoxia on VGAT-IR was observed in the M1. However, maternal pretreatment with Mg enhanced VGAT-IR and glutamate decarboxylase-IR in the deep layers of the M1. In the globus pallidus, maternal hypoxia enhanced CB-IR, which was prevented by maternal pretreatment with Mg. In conclusion, maternal hypoxia induced a loss of PV-IR and CB-IR neurons; maternal pretreatment with Mg partially protected these neuron populations. An increase in proteins of inhibitory synapses, observed under hypoxic conditions in several brain regions, may be a result of some compensatory mechanism.