Bifidobacterium bifidum in probiotic Edam cheese: influence on cheese ripening.

A study was conducted to determine the efficacy of Edam cheese as a carrier of probiotic bifidobacteria. Probiotic Edam cheese containing 10(7) viable cells of Bifidobacterium bifidum was monitored over a period of 3 months for ripening changes. Lactose in control as well as experimental cheeses was depleted within 15 days. Moisture decreased from 46.61 and 47.24 % to 42.06 and 42.46 % in control and experimental samples, respectively while pH in both the cheeses increased from ~5.20 to ~5.45. The free fatty acids increased from 2.23 % and 2.31 % on 0-day to 2.78 % and 2.83 % after 3 months, in control and probiotic cheeses, respectively. The 0-day and 3-month values of total volatile fatty acids in both samples were ~2.30 and ~2.95 ml NaOH (0.1 N) used per 10 g cheese, respectively. The soluble protein increased respectively from 5.42 and 5.30 % to 15.00 and 14.96 % after 3 months of storage in control and experimental cheeses. More of α-casein was degraded than ß-casein after 3 months in both the samples. The study demonstrated that Edam cheese may be a suitable vehicle for delivering probiotic bifidobacteria to the end user.

St Andrew's COVID-19 surgery safety (StACS) study: Elective plastic surgery, trauma & burns.

INTRODUCTION: This study evaluates COVID-19 related patient risk, when undergoing management within one of the largest specialist centres in Europe, which rapidly implemented national COVID-19 safety guidelines. METHOD: A prospective cohort study was undertaken in all patients who underwent surgical (n = 1429) or non-operative (n = 191) management during the UK COVID-19 pandemic peak (April-May 2020); all were evaluated for 30-day COVID-19 related death. A representative sample of elective/trauma/burns patients (surgery group, n = 729) were selected and also sub-analysed within a controlled cohort study design. Comparison was made to a random selection of non-operatively managed (non-operative group, n = 100) or waiting list (control group, n = 250) patients. These groups were prospectively followed-up and telephoned from the end of June (control group) or at 30 days post-first assessment (non-operative group)/post-operatively (surgery group). RESULTS: Complex general (9.2%, 136/1483) or regional (5.0%, 74/1483) anaesthesia cases represented 14.2% (210/1483) of operations undertaken. There were no 30-day post-operative (0/1429)/first assessment (0/191) COVID-19 related deaths. Neither the three sub-speciality plastic surgery, or non-operative groups, displayed increases in post-operative/first assessment symptoms in comparison to each other, or to control. The proportion of COVID-19 positive tests were: 7.1% (1/14) (non-operative), 5.9% (2/34) (burns) and 3.0% (3/99) (trauma); there were however no significant differences between these groups, the elective (0%, 0/54) and control (0%, 0/24) groups (p = 0.236). CONCLUSION: We demonstrate that even heterogeneous sub-speciality patient groups, who required operative/non-operative management, did not incur an increased COVID-19 risk compared to each other or to control. These highly encouraging results were achieved with described, rapidly implemented service changes that were tailored to protect each patient group and staff.

Proteinuria and perinatal lethality in mice lacking NEPH1, a novel protein with homology to NEPHRIN.

A high-throughput, retrovirus-mediated mutagenesis method based on gene trapping in embryonic stem cells was used to identify a novel mouse gene. The human ortholog encodes a transmembrane protein containing five extracellular immunoglobulin-like domains that is structurally related to human NEPHRIN, a protein associated with congenital nephrotic syndrome. Northern analysis revealed wide expression in humans and mice, with highest expression in kidney. Based on similarity to NEPHRIN and abundant expression in kidney, this protein was designated NEPH1 and embryonic stem cells containing the retroviral insertion in the Neph1 locus were used to generate mutant mice. Analysis of kidney RNA from Neph1(-/-) mice showed that the retroviral insertion disrupted expression of Neph1 transcripts. Neph1(-/-) pups were represented at the expected normal Mendelian ratios at 1 to 3 days of age but at only 10% of the expected frequency at 10 to 12 days after birth, suggesting an early postnatal lethality. The Neph1(-/-) animals that survived beyond the first week of life were sickly and small but without edema, and all died between 3 and 8 weeks of age. Proteinuria ranging from 300 to 2,000 mg/dl was present in all Neph1(-/-) mice. Electron microscopy demonstrated NEPH1 expression in glomerular podocytes and revealed effacement of podocyte foot processes in Neph1(-/-) mice. These findings suggest that NEPH1, like NEPHRIN, may play an important role in maintaining the structure of the filtration barrier that prevents proteins from freely entering the glomerular urinary space.

Free flap surgery in the elderly: Experience with 110 cases aged ≥70 years.

We report our experience with free tissue transfer in the elderly based on a retrospective review of patients aged ≥70 years who underwent surgery during a 7-year period. A total of 110 free tissue transfers in 104 patients, with a mean age of 78 years (range: 70-92 years), were identified for inclusion. The demographic and operative variables and postoperative medical and surgical complications were analyzed. Sixty-four of the 110 procedures encountered at least one complication. Medical complications were observed in 25 cases and were predominantly pulmonary, whereas surgical complications occurred in 54 cases in addition to one perioperative death. Successful free tissue transfer was achieved in 105 of the 110 flaps. There was no statistically significant difference in the rate of postoperative complications between patients aged 70-79 years and those aged ≥80 years. Anesthetic time was a statistically significant predictor of postoperative medical complications (odds ratio 1.345, 95% confidence interval 1.117-1.663, P = 0.001). Preoperative comorbidity status, graded according to the ACE-27 index, was a statistically significant predictor of flap recipient site complications. Free tissue transfer may be performed in aging patients with a high degree of technical success and low operative mortality. Chronological age alone should not be used as a criterion when evaluating a patient for free tissue transfer. The patient's premorbid status should be carefully assessed. To minimize postoperative medical complications, duration of general anesthesia should be kept to a minimum.

Varied uses of the medial sural artery perforator flap.

BACKGROUND AND AIM: The aim of the study was to demonstrate how the medial sural artery perforator flap can be used in a wide range of settings and not focused on one area, as previous papers have done. We also wanted to demonstrate that larger flaps can be harvested from the donor site and still closed directly to optimise the appearance of the donor site. METHODS: We describe the use of the medial sural artery perforator flap in 18 patients with defects of the head and neck, upper and lower limbs. RESULTS: All 18 flaps survived, although one suffered some delayed partial loss due to pressure damage. All donor sites were closed directly to optimise the appearance of the donor site. There were complications with the donor site wound in 2 patients. This resulted in further surgery in one case. CONCLUSION: The advantages of the flap are discussed over some of the more commonly used options for reconstruction of these areas. It is a good source of thin, pliable soft tissue with a long pedicle, which makes it very adaptable. The skin paddle is small but if designed appropriately allows the donor site to be closed directly, leaving an aesthetically good result.

The effect of aminopterin-induced folic acid deficiency on spermatogenesis.

Folic acid deficiency was produced by injecting aminopterin into adult male albino rats, resulting in inhibition of spermatogenesis. Bone marrow smears were studied to serve as an index of folic acid deficiency; however, changes in spermatogenesis were noticed earlier than the bone marrow changes. Meiotic division was affected more than mitotic division. The nuclei of spermatogenic cells showed degenerative changes. Chromosomal abnormalities, chiefly sticky chromosomes, were noticed in squashed preparations of seminiferous tubules.

Diplopodia with double fibula and agenesis of tibia. A case report.

A 14-year-old girl with a congenitally deformed and shortened right leg and foot is described. The patient could not bear weight on the deformed limb and had to hop on the left leg. The deformed foot faced backwards and had nine toes. The right leg was shorter than the left by 26 centimetres. Radiologically, the lower end of the right femur was ill-developed and there was no knee joint. There were two fibulae and the tibia and the patella were absent. A through-knee disarticulation was done and a prosthesis fitted later. The amputated leg and foot were dissected. Many of the muscles in the leg and foot were duplicated. There were two calcanei, one talus, one navicular, two cuboids and four cuneiforms. Ther were nine metatarsals, and all the toes had three phalanges except for one which had two.

Medium thickness plantar skin graft for the management of digital and palmar flexion contractures.

The fundamental principle of reconstruction is to replace the lost tissue with similar tissue. Because of the unique similarities in characteristics, plantar skin is an excellent donor area for skin grafting for the palmar aspect of the digits and hand. It provides an ideal color and texture match and long durability with an inconspicuous donor site. However, the use of plantar skin in management of digital and palmar defects is only rarely reported in the literature. Doubts were raised on donor site healing and incidence of recurrence of contracture. There are reports of using full thickness skin graft and dermal grafting from planta in similar cases. We have used medium thickness split grafts from sole of foot in correcting 262 cases of flexion contracture of digits and palms. Thick split skin grafts, full thickness grafts, local flaps and Z plasties were used in numbers of other cases. The technique of plantar skin grafts, application and results with reference to take of graft, quality of skin, donor area healing and recurrence are discussed and compared with available methods and studies.

Transverse lumbar flap for sacral bed sores.

Over the last 30 months, we covered all the 21 cases of sacral pressure sores admitted to our section with the transverse lumbar flap. All the flaps survived. The rationale of the flap design, its technique, and complications are described. The advantages and the drawbacks of the flap are also described. One of the major principles of bed-sore flaps, i.e., that the flap should be as large as possible, need not be adhered to.

Educational status and dietary fat and anti-oxidant intake in urban subjects.

To assess correlation of dietary atherogenic and anti-atherogenic factors with socio-economic status (SES) we performed nutritional survey among 182 (122 men, 60 women) randomly selected individuals using 24 hour diet recall and a food-frequency questionnaire. SES was assessed by educational level which strongly correlated with occupational class (r = 0.55) and income levels (r = 0.88). There was significant (p < 0.05) positive correlation (r values) of educational level with intake of calories (0.55), proteins (0.19), fat (0.45), fat derived energy (en%) (0.14), saturated fat en% (0.45), linoleic acid (0.17), vitamin A (0.14), vitamin C (0.16), vitamin E (0.44), fruits and vegetables (0.34) and fibre (0.24) and negative correlation with intake of linolenic acid (-0.35), monounsaturated fat (MUFA) en% (-0.15), polyunsaturated fat (PUFA)/saturated fat (SFA) (-0.33) and MUFA/SFA (-0.42). In persons of highest educational level (> 15 years education) vs illiterates, the daily intake of SFA (29.1 +/- 15 vs 7.8 +/- 6), SFA en% (13.2 +/- 5 vs 6.7 +/- 4), linoleic acid en% (5.4 +/- 3 vs 3.9 +/- 2) and n6/n3 (24.0 +/- 58 vs 4.5 +/- 5) was more and intake of linolenic acid en% (0.7 +/- 1 vs 1.6 +/- 1), MUFA en% (8.6 +/- 7 vs 15.6 +/- 9), PUFA/SFA (0.6 +/- 1 vs 1.0 +/- 1) and MUFA/SFA (0.7 +/- 1 vs 4.0 +/- 5) was less. Intake of antioxidant vitamins A, C and E and fruits and vegetables was significantly more in better educated.

Functional capabilities of lower limb amputees.

Five hundred lower limb amputees were evaluated by personal interview at the Artificial Limb Centre, Pune, India. Information thus obtained on activities of daily living and functional capabilities with their prostheses was analysed. The analysis showed that 55% of the amputees were totally independent, 40% had to use a crutch or cane and only 5% were solely dependent on a wheelchair for ambulation. Further, it was also confirmed that as age increased, functional independence decreased, and that below-knee amputees were more independent than above-knee and bilateral amputees. When compared with reports of other workers from the developed countries, the results were equally good, and in some functions, were even better.

Assessment of hospital services and patient reactions.

This paper deals with the study of assessment of hospital services and patient reactions carried out amongst 473 respondents, both in-door (3 wards) and out-door patients in M.L.B. Medical College Hospital, Jhansi (Uttar Pradesh). The patients were from three wards medical, surgical and gynaecological wards and consisted of 373 discharged and 100 out-door patients.

Perforator flaps of the facial artery angiosome.

For small to moderate-sized defects in the head and neck region, local flaps have been the mainstay of reconstruction for years. However, in certain instances, additional flap translation is required be it advancement, transposition or rotation. In such cases, the local flap concept is combined with perforator flap know-how, allowing larger loco-regional flaps to be raised to reconstruct relatively larger defects, even in cosmetically-expensive areas. In our cohort of fifteen patients', we have utilised detailed microanatomy of the facial artery perforators to reconstruct such defects with good results.

Single flap reconstruction for complex oro-facial defects using chimeric free fibular flap variants.

In this article, we describe the use of chimeric free fibular flaps to reconstruct three-dimensional spatial defects in the orofacial region. Recent insights into permutations possible with the chimeric fibular flap have allowed us to achieve our reconstructive objectives with a single chimeric flap and minimise donor-site morbidity as well as operating time. In an overall series of 34 free fibular flaps from 2009 to 2012, we performed twelve cases of free chimeric fibular flaps with osseo-myo-cutaneous/OMC (n=7), multi-pedicled osseo-musculo-cutaneous/Mp-OMC (n=4) and multi-pedicled osseo-cutaneous/Mp-OC (n=1) variants for either post-excisional defects or osteo-radionecroses. We had an overall flap survival rate of 100% with one partial flap loss due to the 'puppeteer' effect. Based on our experiences, we find the chimeric fibular flap to be an excellent addition to our reconstructive arsenal for complex orofacial defects.

Congenital vascular malformation associated with multiple cranial, vertebral and upper limb skeletal abnormalities.

The association between congenital vascular malformations and altered bone growth, the so-called vascular bone syndrome, is well documented. Various eponymous syndromes each with their individual traits, such as Klippel-Trenaunay, Parkes-Weber and Servelle-Martorell syndrome have been described, along with variations. We report on a previously undescribed case of congenital vascular malformation associated with multiple skeletal abnormalities affecting the skull, vertebrae and right upper limb, and discuss the literature.