Bangle pessary: An unusual cause of vesicovaginal fistula.

Vaginal pessaries are commonly used for uterine prolapse. Long forgotten pessaries get incarcerated in the vagina and may erode in the bladder and rectum. We present a unique case of a 60-year-old female patient who presented with dysuria and urge incontinence. In remote areas, bangles are still used as a pessary, which may present with atypical symptoms due to bladder perforation, encrustation, and Vesicovaginal fistula (VVF). VVF with a long curved tract can heal with prolonged catheterization. To our knowledge, this is the first case of glass bangle pessary being reported.

A Microengineered Airway Lung Chip Models Key Features of Viral-induced Exacerbation of Asthma.

Viral-induced exacerbation of asthma remains a major cause of hospitalization and mortality. New human-relevant models of the airways are urgently needed to understand how respiratory infections may trigger asthma attacks and to advance treatment development. Here, we describe a new human-relevant model of rhinovirus-induced asthma exacerbation that recapitulates viral infection of asthmatic airway epithelium and neutrophil transepithelial migration, and enables evaluation of immunomodulatory therapy. Specifically, a microengineered model of fully differentiated human mucociliary airway epithelium was stimulated with IL-13 to induce a T-helper cell type 2 asthmatic phenotype and infected with live human rhinovirus 16 (HRV16) to reproduce key features of viral-induced asthma exacerbation. We observed that the infection with HRV16 replicated key hallmarks of the cytopathology and inflammatory responses observed in human airways. Generation of a T-helper cell type 2 microenvironment through exogenous IL-13 stimulation induced features of asthmatic airways, including goblet cell hyperplasia, reduction of cilia beating frequency, and endothelial activation, but did not alter rhinovirus infectivity or replication. High-resolution kinetic analysis of secreted inflammatory markers revealed that IL-13 treatment altered IL-6, IFN-λ1, and CXCL10 secretion in response to HRV16. Neutrophil transepithelial migration was greatest when viral infection was combined with IL-13 treatment, whereas treatment with MK-7123, a CXCR2 antagonist, reduced neutrophil diapedesis in all conditions. In conclusion, our microengineered Airway Lung-Chip provides a novel human-relevant platform for exploring the complex mechanisms underlying viral-induced asthma exacerbation. Our data suggest that IL-13 may impair the hosts' ability to mount an appropriate and coordinated immune response to rhinovirus infection. We also show that the Airway Lung-Chip can be used to assess the efficacy of modulators of the immune response.

Association of heart rate variability and C-reactive protein in patients with depression.

Background: Depression has been shown to be correlated with cardiovascular (CV) morbidity and mortality. Inflammation and autonomic nervous system (ANS) dysfunction are possible causes. Numerous clinical studies have found an association between inflammatory pathways and the ANS. The aim of this study was to investigate the relationship between different heart rate variability (HRV) parameters and C-reactive protein (CRP) levels in depressed patients without concomitant diseases. Materials and Methods: Sixty-five depressed patients who were not taking medication participated in this cross-sectional study. The Tenth Revision of the International Classification of Diseases and Related Health Problems (ICD-10) categorization of mental and behavioral disorders served as the basis for the diagnosis of depression. HRV processing and analysis were performed using ADInstrument's Pro LabChart (PowerLab 8Pro) data analysis software. HRV was recorded for 5 min in an upright sitting position using a lead II electrocardiogram (ECG) (short-term HRV). CRP levels were measured using an ELISA (enzyme-linked immunosorbent assay) test. Results: None of the measures of HRV showed a significant relationship with pulse rate, systolic blood pressure, diastolic blood pressure, or body mass index (BMI). Weight and BMI were strongly positively related (r = 0.420, P = 0.003) to pRR50 (percentage of successive RR intervals differing by more than 50 ms). Very low frequency (VLF), low frequency (LF), and the LF/HF (high frequency) ratio were all strongly positively correlated with CRP (r = 0.595, P = 0.001), whereas HF was also significantly negatively correlated (r = 0.383, P = 0.007). CRP had a significant negative correlation with the logarithm (ln) HF and a significant positive correlation with lnVLF, lnLF, and lnLF/HF. Conclusion: Measurement of resting HRV and CRP may be helpful in detecting CV disease in depressed patients. Low HRV and elevated serum CRP should prompt physicians to begin treatment for risk CV as soon as possible.

Inferior polar nephrectomy and vesicocalicostomy for complete ureteric stricture following antibody-mediated rejection in ABO-incompatible living donor kidney transplant: a report of a rare case.

Renal transplant recipients are prone to urological complications, the most common of which is stricture of the transplant ureter. We present a rare case of complete ureteric stricture in a 37-year-old man who had undergone spousal living donor kidney transplantation with ABO incompatibility. Initially, treatment involved creating an anastomosis between the native right ureter and the renal pelvis of the transplanted kidney. However, the stricture recurred. Subsequently, the patient was successfully treated with inferior polar nephrectomy and vesicocalicostomy, which entailed anastomosing the lower calyx of the transplanted kidney to the bladder. After 7 months of follow-up, the patient continued to exhibit stable renal function without stricture recurrence.

Application of Artificial Intelligence in Neuroendocrine Lung Cancer Diagnosis and Treatment: A Systematic Review.

Neuroendocrine tumors (NETs) represent a heterogeneous group of neoplasms with diverse clinical presentations and prognoses. Accurate and timely diagnosis of these tumors is crucial for appropriate management and improved patient outcomes. In recent years, exciting advancements in artificial intelligence (AI) technologies have been revolutionizing medical diagnostics, particularly in the realm of detecting and characterizing pulmonary NETs, offering promising avenues for improved patient care. This article aims to provide a comprehensive overview of the role of AI in diagnosing lung NETs. We discuss the current challenges associated with conventional diagnostic approaches, including histopathological examination and imaging modalities. Despite advancements in these techniques, accurate diagnosis remains challenging due to the overlapping features with other pulmonary lesions and the subjective interpretation of imaging findings. AI-based approaches, including machine learning and deep learning algorithms, have demonstrated remarkable potential in addressing these challenges. By leveraging large datasets of radiological images, histopathological samples, and clinical data, AI models can extract complex patterns and features that may not be readily discernible to human observers. Moreover, AI algorithms can continuously learn and improve from new data, leading to enhanced diagnostic accuracy and efficiency over time. Specific AI applications in the diagnosis of lung NETs include computer-aided detection and classification of pulmonary nodules on CT scans, quantitative analysis of PET imaging for tumor characterization, and integration of multi-modal data for comprehensive diagnostic assessments. These AI-driven tools hold promise for facilitating early detection, risk stratification, and personalized treatment planning in patients with lung NETs.

Evaluation of Diagnostic Efficacy of Novel Red Blood Cell Parameters as Potential Screening Test for Detecting Latent Iron Deficiency in Blood Donors.

Iron deficiency anemia (IDA) forms a major share of global burden of anemia. Frequent blood donation is a common iatrogenic cause of iron insufficiency in healthy adults. Serum iron and hemoglobin levels are normal despite low serum ferritin levels, referred to as latent iron deficiency (LID). Aim of the present study was to evaluate the role of novel RBC parameters-percentage of hypochromic RBCs (%HPO), percentage of microcytic RBCs (%MIC), and haemoglobin content of reticulocytes (MCHr) of Abbott Alinity autoanalyzer as indicators of latent iron deficiency in blood donors. 260 consenting and eligible blood donors were included in the study. Complete blood counts including new RBC parameters on Abbott Alinity autoanalyzer and serum iron profile were measured for all donors. Donors were categorized into LID and No LID based on Ferritin and Transferrin saturation (TSAT). Serum transferrin receptors (sTfR) were studied in a subset of samples [LID (n = 46), No LID (n = 18) and IDA (n = 27)]. Statistical analyses was done on IBM SPSS version 22. Among 260 donors, 56 (21.5%) were found to have LID. The difference in mean values for % HPO, % MIC, and MCHr were not found to be statistically significant in LID and No LID groups. sTfR results between LID, No LID and IDA sub-groups revealed significant difference. This study does not support the role of % HPO, % MIC and MCHr measured on Abott Alinity analyzer, as potential screening parameters for LID amongst blood donors. STfr was more informative in this regard. Further research on much larger sample size is required to confirm these findings. Supplementary Information: The online version contains supplementary material available at 10.1007/s12288-023-01683-w.

Funding Pattern Comparison Pre- and Post-Ayushman Bharat National Health Scheme (AB-PMJAY) in Active Females Undergoing TKA for Advanced Knee Arthritis with Clinical, QoL Analysis and AB-PMJAY Technical Data.

Introduction: Patients visiting for Knee Arthroplasty have often been treated at neighborhood clinics and bonesetters. India floated world's largest publicly funded national health insurance program -AB-PMJAY covering Knee Arthroplasty. AB-PMJAY's data for Arthroplasty has not been published. Methods: A Prospective study from Jan 2016- Jan 2023 on females undergoing TKA. Age, DEXA Score, Walking Ability, KSS, 10MWT, SF36 Scores, Funding Pattern before and after AB-PMJAY, Time to Approval, Time to discharge, Time to Query reply and Rejection Rates were documented. Results: 790 patients (91.86%) received treatment previously. 650 (78.54%) patients lived with family & 32 patients lost to follow-up. 37.67% & 62.32% patients had Grade. 3 & 4 osteoarthritis respectively. Commonest comorbidity was Vitamin D deficiency followed by Menopause and Hypertension. Post-treatment Vitamin D deficiency reduced from 68.59% to 2.17% at 3 months. Post-surgery, Functional Scores improved significantly at 1st and 6th month. VAS dropped significantly from 7.8 to 3.6 at 1st month follow up. At 6 months, 81.52% patients were independent outdoor walkers compared to 9.42% (baseline). Average hospital stay-54 hours and Return to work- 42 days. Central health scheme beneficiaries rose significantly from 12% (pre-PMJAY) to 42% (post-PMJAY). With AB-PMJAY, no rejection for surgical procedures, Time to surgery approval was 16 hours (mean) and Time to Discharge was 8 hours (mean). Time to reply was 6 hours (mean). Conclusion: Evident rise in patients getting TKA done through AB-PMJAY. TKA has become an affordable and achievable target for financially deprived patients, post regulation of knee implant prices & AB-PMJAY.

PAX8 and PAX2 expression in endocervical adenocarcinoma in situ and high-grade squamous dysplasia.

Transcription factors PAX2 and PAX8 are expressed in the nuclei of Müllerian glandular epithelial cells. In situ carcinomas of the cervix are exemplified by adenocarcinoma in situ (AIS) and high-grade squamous intraepithelial lesions (HSILs), both of which present histologically as hyperchromatic crowded groups of epithelial cells exhibiting loss of polarity. Herein, we sought to investigate the immunohistochemical expression of PAX8 and PAX2 in AIS and HSIL. A total of 66 and 55 cases of AIS and HSIL were examined, respectively. PAX8 positivity was observed in 64 (97%) of 66 cases of AIS. Nuclear PAX2 expression was completely lost in 59 (89%) of the 66 cases of AIS. Eleven (20%) of the 55 HSILs were positive for PAX8. The difference in PAX8 positivity rates between AIS and HSIL was statistically significant (P<0.0001). The PAX2 immunostain was completely negative in the 18 HSILs examined for PAX2 expression. PAX8 and PAX2 immunostaining patterns in benign endocervical glandular epithelium were examined for 98 and 62 cases, respectively. The benign endocervical glandular epithelium was positive for PAX8 and PAX2 expression in 100% and 97% of cases, respectively. In conclusion, immunohistochemical analysis for PAX2 is effective in discriminating AIS from benign endocervical glandular epithelium. The majority of AIS lesions and a subset of HSILs are PAX8(+). With regard to the distinction between AIS and HSIL, a PAX8(-) immunophenotype is particularly predictive of high-grade squamous dysplasia.

Primary adenocarcinoma with yolk sac differentiation in the transplant ureter and salvage of the transplant kidney: a rare case report.

Renal transplant recipients are prone to a high risk of subsequent upper tract urothelial carcinoma, occurring in both native and transplant ureters. We report a rare case of adenocarcinoma with yolk sac differentiation of the transplant ureter, which was managed successfully with transplant ureterectomy and pyelovesicostomy, thereby salvaging the functioning transplant kidney.

Controlling basal plane sulfur vacancy in water splitting MoSx/NiF electrocatalysts through electric-field-assisted pulsed laser ablation.

Eco-friendly, efficient, and durable electrocatalysts from earth-abundant materials are crucial for water splitting through hydrogen and oxygen generation. However, available methods to fabricate electrocatalysts are either hazardous and time-consuming or require expensive equipment, hindering the large-scale, eco-friendly production of artificial fuels. Here, we present a rapid, single-step method for producing MoSx/NiF electrocatalysts with controlled sulfur-vacancies via electric-field-assisted pulsed laser ablation (EF-PLA) in liquid and in-situ deposition on nickel foam, enabling efficient water splitting. Electric-field parameters efficiently control S-vacancy active sites in electrocatalysts. Higher electric fields yield a MoSx/NiF electrocatalyst with a larger density of S-vacancy sites, suited for HER due to lower Gibbs free energy for H∗ adsorption, while lower electric fields produce an electrocatalyst with lower S-vacancy sites, better suited for OER, as shown by both experimental and theoretical results. The present work opens a horizon in designing high-efficiency catalysts, for a wide range of chemical reactions.

COVID-19 pandemic: An analysis of popular YouTube videos as an alternative health information platform.

Dispersal of COVID-19 related information from YouTube plays a vital role in containing the pandemic and diminishes associated anxiety in the population. This study investigated the characteristics of popular YouTube videos related to COVID-19 outbreak. YouTube videos were searched using the COVID-19 related specific keywords with the eligibility of at least 1 million views. The videos were classified as types of videos (News, TV Shows, Educational, and Documentary) and sentiment-based titled videos (Positive and Negative). Total viewership, length of videos, comments, likes, subscribers of the channel, and the number of days since upload was recorded as video and user engagement characteristics. A total of 93 videos were found eligible to include in the study. About 44.1% of videos were educational and 32.3% of videos were news updates related to COVID-19. Furthermore, 45.7% of videos had a positive sentiment-based title whereas 53.2% of videos had a negative sentiment-based title. Viewer's comment responses were classified into nine various categories; most frequent comments were sarcastic/humorous (21.5%) category. Results revealed the differences in audience behavior in response to different types of videos and sentiment-based titled videos. YouTube has a significant amount of informative COVID-19 videos and incorporating certain characteristics can increase YouTube video popularity.

Partial paternity does not always select for female-biased care.

The theoretical literature predicts that parentage differences between the sexes, due to females mating with multiple males, select males to provide less parental care and females to care more for the offspring. We formulate simple evolutionary games to question the generality of this prediction. We find that the relationship between paternal care and fitness gained from extra-pair matings is important. A trade-off between these two quantities is required for partial paternity and complete maternity to bias the evolutionary stable strategy (ESS) toward more female care. We argue that this trade-off has been implicitly or explicitly assumed in most previous theories. However, if there is no trade-off between paternal care and extra-pair matings, parentage differences do not influence the ESS sex roles. Moreover, it is also possible for these two quantities to have a positive relationship, in which case we predict selection for male care is possible. We support these predictions using agent-based simulations. We also consider the possibility that caring males have greater opportunities to guard their paternity, and find that this mechanism can also select for male-biased care. Hence, we derive the conditions under which male care may be selected despite partial paternity and complete maternity.

Modeling alcohol-associated liver disease in a human Liver-Chip.

Alcohol-associated liver disease (ALD) is a global health issue and leads to progressive liver injury, comorbidities, and increased mortality. Human-relevant preclinical models of ALD are urgently needed. Here, we leverage a triculture human Liver-Chip with biomimetic hepatic sinusoids and bile canaliculi to model ALD employing human-relevant blood alcohol concentrations (BACs) and multimodal profiling of clinically relevant endpoints. Our Liver-Chip recapitulates established ALD markers in response to 48 h of exposure to ethanol, including lipid accumulation and oxidative stress, in a concentration-dependent manner and supports the study of secondary insults, such as high blood endotoxin levels. We show that remodeling of the bile canalicular network can provide an in vitro quantitative readout of alcoholic liver toxicity. In summary, we report the development of a human ALD Liver-Chip as a powerful platform for modeling alcohol-induced liver injury with the potential for direct translation to clinical research and evaluation of patient-specific responses.

Infusion of gingerols into candied mango enhances shelf-life by inhibiting browning and associated quality parameters during storage.

The study reports shelf-life enhancement of candied mango by infusion of gingerols. Gingerols infused product (GIP), with 3.67 mg gingerols/100 g and non-infused products (control) were packed in multilayer metalized (MET), and ethylene vinyl alcohol (EVOH) based pouches and stored at 25, 35 and 45 °C for 120 days. Degradation kinetics of browning and related parameters showed following order: kß-carotene > ksensory (color) > knon-enzymatic browning > kvitamin C > kantioxidant capacity > k sensory (overall) > ktotal phenolics > kgingerols, resulting in multiple cutoff criteria and predicted shelf-lives (SLpredicted). The application of chemometrics simplified the kinetic interpretations and hence the predictions. Gingerols infusion retarded the deterioration of all quality parameters and substantially enhanced SLpredicted of GIP over control, irrespective of storage conditions. Finally, chemometric based SLpredicted of 144 days closely predicted the actual shelf-life of 142 days for control samples stored in EVOH pouches at 25 °C, in contrast to kinetics based SLpredicted of 185 days.

Anisogamy selects for male-biased care in self-consistent games with synchronous matings.

We reexamine the influential parental investment hypothesis proposed by Trivers for the causal relationship between anisogamy and widespread female-biased parental care. We build self-consistent versions of Maynard Smith's simple evolutionary game between males and females over parental care, and incorporate consequences of anisogamy for gamete production and its trade-off with parental care, and for patterns of mate limitation. As male mating opportunities are limited by females, frequency-dependent selection acts on male strategies. Assuming synchrony of matings in the population, our analytical models find either symmetric sex roles or male-biased care as an evolutionarily stable strategy (ESS), in contrast to Trivers' hypothesis. We simulate evolution in asynchronously mating populations and find that diverse parental roles, including female care, can be ESS depending on the parameters. When caring males can also remate, or when females can increase the clutch size by deserting, there is stronger selection for male-biased care. Hence, we argue that the mating-caring trade-off for males is neither a necessary consequence of anisogamy nor sufficient to select for female-biased care. Instead, the factors excluded from our models-costly competitive traits, sexual selection, and partial parentage-may be necessary for the parental investment hypothesis to work.

Can Magnetic Resonance Imaging Predict Pathologic Findings for Endometrioid Endometrial Cancer?

This pilot study aimed to assess the feasibility of precisely measuring tumor diameter and myometrial invasion in patients with endometrioid endometrial cancer (EEC) using preoperative contrast-enhanced magnetic resonance imaging (MRI). Adult patients with confirmed diagnosis of complex hyperplasia with atypia or EEC were included. Three radiologists separately measured tumor diameter and myometrial invasion. Basic descriptive statistics were used to describe patient characteristics and to compare radiology- and pathology-measured tumor diameter and myometrial invasion. Using the pathology results for tumor diameter as the gold standard for comparison, at least 1 radiologist was able to predict largest tumor diameter within 5 mm for 41.7% of patients. Similarly, based on pathology results for myometrial invasion, at least 1 radiologist was able to predict myometrial invasion within 5% for 50% of patients. All radiologists were able to predict superficial (<50%) or deep (≥50%) myometrial invasion for 75% of patients, with greater sensitivity, specificity, and accuracy for deep myometrial invasion. Given variation among radiologic measurements, it is difficult to recommend preoperative MRI as a basis for measuring tumor diameter and myometrial invasion. Even so, the ability to predict superficial versus deep myometrial invasion may benefit patients with EEC for whom surgery is not a viable option or for those seeking fertility-sparing treatment options.

Gingerols infusion and multi-step process optimization for enhancement of color, sensory and functional profiles of candied mango.

Presence of pungent gingerols in ginger oleoresin makes it an ideal natural flavoring candidate for the food industry. The study reports its incorporation for synergistic enhancement of flavor and nutraceutical portfolio of candied mango. The process is systematically optimized at bench-scale for gingerols infusion and subsequent candying treatment in a range of hypo and hypertonic osmotic solutions for critical transport properties. After that, optimization of the drying process and the scale-up study was conducted with a 200 folds increase in the batch size. Collated effects of multistep optimization resulted in 85.6, 76.8, 60.2% retention in ß-carotene, total phenolics, Vitamin C, respectively, along with minor color difference and significant improvement in sensory scores over fresh mango. Mass transfer and quality parameters were comparable in both scales, implying excellent repeatability and scalability of the process. Compared with a similar commercial product, substantial improvement in quality characteristics along with 376.7% reduction in overall processing time was achieved.

Direct sunlight enabled photo-biochemical synthesis of silver nanoparticles and their Bactericidal Efficacy: Photon energy as key for size and distribution control.

It is highly desirable to discover novel green synthesis methods for cheap and scalable synthesis of nanoparticles (NPs) to reduce the negative impact on the environment. But these approaches generally impose great challenge in controlling size, shape, and homogeneity of product NPs. Here in the present study, we report a novel approach enabling direct sunlight and oyster mushroom (Pleurotus citrinopileatus) extract for the photo-biochemical synthesis of Ag NPs. Sunlight of different wavelength was used to control the size and distribution of photo-biochemically produced NPs. Interestingly, it is observed that a smaller wavelength of sunlight produces smaller sized of NPs with a narrow size distribution. For examples; blue sunlight produces colloidal silver NPs with an average diameter of ~ 3.28 nm and 0.72 nm size distribution, while full sunlight produces comparatively larger sized (7.08 nm) NPs with wider (2.92 nm) size distribution. Since present approach uses only direct sunlight, freely available renewable energy source, a cheap biological extract as reducing and capping agent and cheap silver precursor, therefore it is an environment-friendly approach and can be used for the synthesis of NPs at industrial scale. Moreover, the size-dependent bactericidal effect has also been studied against pathogenic, Escherichia coli, bacteria. The minimum inhibitory concentration (MIC) 25 ppm and MBC 30 ppm have been observed for silver NPs of 3.28 nm average diameter.

End-of-life care of terminally ill geriatric cancer patients in northern India.

BACKGROUND: The geriatric population in India is increasing, and so is the prevalence of cancer. We aimed to study the knowledge, attitude and practices of end-of-life care issues of terminally ill geriatric cancer patients in our region. METHODS: A pilot cross-sectional qualitative study using case studies, focus group discussions on providers and recipients of palliative care, an open-ended, interviewer administered questionnaire on specialist doctors and practitioners (50), geriatric cancer patients (20) and healthy family members of patients (30), was done in Lucknow, the capital of Uttar Pradesh, India. RESULTS: Only 14 physicians (28%) could enumerate more than 3 important technical elements of end-of-life care. Two physicians (4%) utilized palliative care services but none had received training themselves. The explanations and counselling provided by physicians were mostly inadequate, incomplete and did not fully satisfy the patients and their relatives. Of the cancer patients, 19 (95%) desired to use special services but were unaware of such facilities. There was only one charitable organization for needy geriatric cancer patients in Lucknow. No specific health scheme existed in the programme of the Government of Uttar Pradesh. CONCLUSION: The knowledge and practices of physicians and specialists were not up to the expectations and requirements of terminally ill cancer patients. Curriculum-based learning or organized teaching of end-of-life care issues was non-existent. Western countries have well-organized subspecialty facilities for end-of-life needs; such facilities are lacking in India. Capacity building for the care of terminally ill geriatric cancer patients is urgently required in north India.