The flux dynamics behavior of the two competing high temperature superconducting phases in underdoped LaCuO4.06.

In complex transition metal oxides (TMO) an arrested electronic phase separation (PS) appears by tuning the system near a Lifshitz transition in multiband Hubbard models. The PS in La2CuO4+y near insulator to metal transition (IMT) is made of short range Charge Density Wave (CDW) order inhomogeneity coexisting with quenched lattice disorder. While at high doping y = 0.1 percolation gives a single superconducting phase, near the IMT at y = 0.06 two coexisting superconducting phases appear: the first one with a critical temperature Tc1 = 16 K and the second one with Tc2 = 29 K. It is known that the two superconducting phases are characterized by two different space geometry because of two different spatial distributions of both CDW order and dopants self-organization. Here we show that these two phases show different flux dynamic regimes using alternating current (AC) multi-harmonic susceptibility experiments. This is a unique technique capable to investigate multi-phase superconductors and characterize their transport properties in a percolative scenario. Results point out that the low critical temperature phase is well described by a bulk-like flux pinning with a 2D geometry while the phase with higher critical temperature shows a 'barrier pinning' mechanism providing direct evidence of two different superconducting vortex dynamics in different complex geometrical spaces.

Can acoustic radiation force impulse elastography be a substitute for liver biopsy in predicting liver fibrosis?

AIM: To evaluate the clinical feasibility and accuracy of acoustic radiation force impulse (ARFI) elastography for the detection of liver fibrosis in patients with chronic viral hepatitis. MATERIALS AND METHODS: ARFI-based ultrasound elastography was performed in 69 patients with chronic liver disease (CLD) of viral aetiology and 36 healthy volunteers. Fifty-eight patients with CLD also underwent liver biopsy. RESULTS: ARFI was feasible in all 36 healthy volunteers and all 69 CLD patients, while valid measurements were obtained in 65 patients (95.6%) and all healthy volunteers. The mean shear-wave velocity (SWV) in healthy volunteers was 1.12±0.2 m/s. A gradual increase in mean SWV was noted from fibrosis of Grade F0 to F6 (Ishak's score) and a high positive correlation was found between the mean SWV on ARFI and fibrosis scores at liver biopsy (rho=0.789). The difference between the mild (F1 and F2) versus significant fibrosis (F3 and F4) was also statistically significant (p<0.001). The difference in the SWV measurements obtained from consecutive groups (i.e., F1 versus F2, F2 versus F3, and F3 versus F4) was not statistically significant. Using the area under the receiver operating characteristic curve (AUROC), the best calculated cut-off SWVs for the presence of fibrosis (≥F1), significant fibrosis (≥F3), severe fibrosis (≥F4), and cirrhosis (F6) were found to be 1.207, 1.347, 1.513, and 1.92 m/s, respectively. ARFI values were significantly higher in cirrhotic patients than in other patients (p<0.001). CONCLUSIONS: ARFI elastography allows valid non-invasive evaluation of liver stiffness and may help to distinguish between no/mild fibrosis and significant fibrosis and guide management decisions.

Microneedle-mediated intradermal delivery of epigallocatechin-3-gallate.

OBJECTIVE: Epigallocatechin-3-gallate (EGCG) is the physiologically most active and abundant flavanol, accounting for 50-80% of green tea catechins. It is an anti-inflammatory, antioxidant, chemopreventive and skin photoprotective agent. However, light sensitivity and low permeability of EGCG across the stratum corneum due to its high molecular weight as well as strong binding to the lipid bilayers in the skin make it difficult to be used as a key ingredient in cosmetic products. This study aimed to formulate a photostable hydrogel of EGCG with good rheological properties for dermal application and investigate the effect of skin microporation using maltose microneedles on its permeation through dermatomed porcine skin. METHODS: Effect of l-glutathione on photodegradation of EGCG was investigated by exposing samples to ultraviolet irradiation for 1 h using a solar simulator. Hydrogels with varying concentrations of Carbopol 980 (0.5-2% w/v) as an gelling agent were prepared, and their rheological properties were evaluated using a rheometer. Skin microporation was confirmed by assessing the skin resistance, transepidermal water loss and calcein imaging of the microchannels created by the microneedles. Permeation of EGCG from aqueous solution as well as the rheologically optimized hydrogel through the dermatomed porcine skin (untreated and microneedle treated) was evaluated using static vertical Franz diffusion cells. RESULTS: l-glutathione acting as a co-antioxidant and photostabilizer significantly (P < 0.05) reduced the degradation of EGCG from 21.53 ± 2.78% to 1.0 ± 0.68% after 1 h of ultraviolet irradiation. Rotational and oscillatory rheological tests indicated that the hydrogel containing 1.5% Carbopol 980 is acceptable for topical application in terms of flow behaviour, elasticity, spreadability, structural stability and thixotropy. Microneedle-treated skin showed significant enhancement (P < 0.05) in the delivery of EGCG to viable epidermis and dermis from the aqueous solution (38.67 ± 2.96 µg cm(-2) ) as well as hydrogel (24.60 ± 2.62 µg cm(-2) ) in comparison with the untreated skin (24.16 ± 2.11 and 15.62 ± 0.24 µg cm(-2) for aqueous solution and hydrogel, respectively). CONCLUSION: Addition of glutathione in EGCG formulations significantly reduces its photodegradation. Skin microporation with maltose microneedles facilitates the penetration of EGCG across the stratum corneum into the deeper skin layers - viable epidermis and dermis.

Factors precipitating acute ulcerative colitis.

Ulcerative colitis is characterized by mucosal inflammation of a variable length of the colon starting from the rectum. The precise etiopathogenesis is unknown but it occurs in genetically susceptible individuals who manifest an abnormal immunological response against gut commensal bacteria. The disease course is-characterized by multiple spontaneous relapses and remissions. Two pathogens namely CMV and C. difficile have been associated with disease exacerbation in specific clinical situations. Whereas C. difficile may produce worsening of the disease in those exposed to broad spectrum antibiotics, CMV reactivation is seen only in patients with moderate to severe steroid refractory disease. The importance of these two super-infections can be gauged by the fact that both the ACG and the ECCO recommend testing for these two pathogens in appropriate clinical situations. The applicability of these guidelines in the Indian scenario has yet to be determined in view of the bacterial and parasitic infections endemic in tropical countries. The guidelines for diagnosis and management of these two super-infections in the presence of ulcerative colitis are discussed in this review.

Prognostic value of Angiographic Perfusion Score (APS) following percutaneous interventions in acute coronary syndromes.

INTRODUCTION: Identifying reperfusion and predicting post procedure risk is important following Percutaneous Coronary Interventions (PCI). An Angiographic Perfusion Score (APS) combining TIMI flow (TFG) and myocardial perfusion (TMPG) grades before and after PCI can accurately measure both epicardial and myocardial perfusion and predict Major Adverse Cardiac Events (MACE). PATIENTS AND METHODS: APS was calculated in 226 (88 ST elevation Myocardial Infarction (STEMI) and 138 Non STEMI) patients. Maximum score being 12, reperfusion was defined as failed: 0-3, partial: 4-9, and full APS: 10-12. Thirty day MACE were observed. RESULTS: APS identified reperfusion significantly more than TMPG alone (STEMI: 50.6% vs 11.8% (p < 0.001); Non STEMI, early reperfusion: 69.4% vs 52.8% (p < 0.01) and Non STEMI late reperfusion: 38.2% vs 7.8%; (p ≤ 0.001) respectively. A significantly lower incidence of MACE was observed in the full as compared to the failed APS group (1.8% vs 22.5%) (p < 0.001). No differences were noted between TMPG 0-2 (9.8%, 9.4%, 7.3%, respectively) (p = NS). CONCLUSION: Compared to MPG alone APS detects more low risk reperfused patients, post PCI.

Giant coronary artery aneurysm following implantation of Endeavour stent presenting with fever.

Coronary artery aneurysms are a known but uncommon complication of percutaneous coronary intervention (PCI) probably related to effects of vessel wall trauma and possibly a combination of hypersensitivity and incomplete endothelisation associated with drug-eluting stents (DES). We present here a case of giant coronary artery aneurysm 3 months following implantation of a zotarolimus eluting endeavour stent presenting with fever.

The psychological impact of facial changes in scleroderma.

The physical disabilities associated with scleroderma are well known but the psychological impact of the condition has received less attention. Few studies have examined appearance related issues, most notably of the face. The aim of this study is to evaluate the psychological impact of facial, aesthetic and functional changes in scleroderma. One hundred seventy-one patients with a clinical diagnosis of scleroderma were recruited into the study. Digital photographs were objectively graded into groups based on severity of disfigurement as judged by an observer. Facial movement was recorded using a modified House-Brackmann Grading Scale. Psychological evaluation comprised the Derriford Appearance Scale short-form (DAS), the Noticeability and Worry score and the Hospital Anxiety and Depression Scale (HADS). Severity of disfigurement predicted decreased mouth opening, the extent to which participants judged their appearance as noticeable to others, and the level of appearance-related concern as measured by the DAS24. There was an inverse relationship with age. Facial changes were ranked as the most worrying aspect of the condition. This study shows facial disfigurement impacts on patient with scleroderma independent of functional changes related to systemic disease. The major difficulty is with the perceived noticeably of the condition to other people and the resulting self-consciousness in social encounters.

Requirement of a Booster Dose of Hepatitis B Vaccine in Children With Thalassemia After 5 Years of Primary Vaccination: A Prospective Study.

OBJECTIVE: To determine anti-HBs antibody levels in multi-transfused children with beta-thalassemia major who had received primary hepatitis B vaccination ≥5 years ago, and to document their antibody response to a booster dose of hepatitis B vaccine. METHODS: We included 85 children each of beta-thalassemia major and age-matched healthy controls, who had completed primary hepatitis B vaccination ≥5 years ago. Participants were assessed for anti-HBs titres, and those with beta-thalassemia major who were seronegative (titres<10 mIU/mL) were administered a single booster dose of hepatitis B vaccine. CD4 counts, serum levels of IL-2 and IFN-g, and anti-HBs titres were evaluated at baseline and following booster dose of vaccine. RESULTS: Seroprotection rates for hepatitis B after an average (SD) duration of 10.8 (3.8) years of completion of primary immunization were significantly higher among children with beta thalassemia major compared to healthy controls (72.9% vs. 52.9%, P=0.007). All the 23 seronegative children with beta-thalassemia major achieved seroprotection after a single booster dose of hepatitis B vaccine. CONCLUSIONS: A single booster dose of hepatitis B vaccine after 5 years of primary immunization is adequate to provide seroprotection to multi-transfused children with beta-thalassemia major.

Anatomic Snuffbox (Distal Radial Artery) and Radial Artery Access for Treatment of Intracranial Aneurysms with FDA-Approved Flow Diverters.

BACKGROUND AND PURPOSE: Transradial access for neurointerventional procedures has been proved a safer and more comfortable alternative to femoral artery access. We present our experience with transradial (distal radial/anatomic snuffbox and radial artery) access for treatment of intracranial aneurysms using all 3 FDA-approved flow diverters. MATERIALS AND METHODS: This was a high-volume, dual-center, retrospective analysis of each institution's data base between June 2018 and June 2020 and a collection of all patients treated with flow diversion via transradial access. Patient demographic information and procedural and radiographic data were obtained. RESULTS: Seventy-four patients were identified (64 female patients) with a mean age of 57.5 years with a total of 86 aneurysms. Most aneurysms were located in the anterior circulation (93%) and within the intracranial ICA (67.4%). The mean aneurysm size was 5.5 mm. Flow diverters placed included the Pipeline Embolization Device (Flex) (PED, n = 65), the Surpass Streamline Flow Diverter (n = 8), and the Flow-Redirection Endoluminal Device (FRED, n = 1). Transradial access was successful in all cases, but femoral crossover was required in 3 cases (4.1%) due to tortuous anatomy and inadequate support of the catheters in 2 cases and an inability to navigate to the target vessel in a patient with an aberrant right subclavian artery. All 71 other interventions were successfully performed via the transradial approach (95.9%). No access site complications were encountered. Asymptomatic radial artery occlusion was encountered in 1 case (3.7%). CONCLUSIONS: Flow diverters can be successfully placed via the transradial approach with high technical success, low access site complications, and a low femoral crossover rate.

Synthesis of novel triterpenoid (lupeol) derivatives and their in vivo antihyperglycemic and antidyslipidemic activity.

The triterpenoid, lupeol (1) has been isolated from the leaves extract of Aegle marmelos. Few novel derivatives (2-13) were synthesized from the naturally occurring lupeol (1) and screened for their antihyperglycemic activity (2-11) and antidyslipidemic activity (2-4 and 12-13). The derivative 4 lowered the blood glucose levels by 18.2% and 25.0% at 5h and 24h, respectively, in sucrose challenged streptozotocin induced diabetic rats (STZ-S) model at the dose of 100mg/kg body weight. The compound 4 also significantly lowered 40% (P <0.001) in triglycerides, 30% (P <0.05) in glycerol, 24% (P <0.05) in cholesterol quantity and also improved the HDL-cholesterol by 5% in dyslipidemic hamster model at the dose of 50mg/kg b.wt.

Periampullary diverticula and technical success of endoscopic retrograde cholangiopancreatography.

INTRODUCTION/AIM: Periampullary diverticula (PAD) discovered incidentally during endoscopic retrograde cholangiopancreatography are usually asymptomatic, but can be a source of significant morbidity. The size of the diverticula and position of the papilla in relation to the diverticula are variable. The twofold aim of this study was to determine the prevalence of PAD in adult Indian patients and technical success of endoscopic retrograde cholangiopancreatography (ERCP). METHODS: Patients with PAD (group I) were prospectively entered into a database from May 2006 to May 2007. Diverticula were categorized based on size into small (<1.5 cm) and large (>1.5 cm). Papilla was arbitrarily defined as type A when located outside the diverticulum and type B when the position was intradiverticular. Requirement of needle knife papillotomy (NKP), sphincterotomy, and overall success/failure of the procedure were recorded. One hundred consecutive patients without PAD undergoing ERCP served as controls (group II). RESULTS: PAD were present in 46 (7.5%) of the 600 patients undergoing ERCP for various indications (group I). Mean age of patients with PAD (51 +/- 15 years) was significantly higher than control group (39 +/- 17 years) (p < 0.001). Of the 46 diverticula, 26 diverticula (56.5%) were large. In small diverticula, the papilla was extradiverticular (type A) in all 20 (100%) patients, whereas in the group with diverticula >1.5 cm only 57% was extradiverticular. Successful cannulation was achieved in 97% (45/46). NKP was done in six patients, five of whom had type A papilla. There was a significant high rate of NKP inpatients without PAD compared with patients with PAD (p = 0.001), whereas the rate of endoscopic papillotomy (EPT) was similar in both groups. Complete common bile duct (CBD) clearance was achieved in 93% patients in PAD group as compared with 96% in the non-PAD group (p = nonsignificant). Complications after ERCP were similar in both groups. CONCLUSION: PAD were present in 7.5% of patients. Fifty-six percent of PAD were large and in the vast majority (76%) papilla was extradiverticular in location. PAD were not associated with an increased risk of EPT-related complications.

Peripartum cardiomyopathy presenting with ventricular tachycardia: a rare presentation.

A 25-year-old previously asymptomatic pregnant woman at 36 weeks' gestation was noticed to have repetitive monomorphic ventricular tachycardia. A dilated left ventricle with moderately reduced systolic function was found on echocardiographic examination. This is a very rare presentation of peripartum cardiomyopathy (PPCMP) presenting with repetitive monomorphic ventricular tachycardia.

Neoadjuvant denosumab: its role and results in operable cases of giant cell tumour of bone.

AIMS: The aims of this study were to evaluate the efficacy of preoperative denosumab in achieving prospectively decided intention of therapy in operable giant cell tumour of bone (GCTB) patients, and to document local recurrence-free survival (LRFS). PATIENTS AND METHODS: A total of 44 patients received preoperative denosumab: 22 to facilitate curettage, 16 to facilitate resection, and six with intent of converting resection to curettage. There were 26 male and 18 female patients. The mean age was 27 years (13 to 47). RESULTS: The mean number of denosumab treatments was five (2 to 7) per patient. In 42 of 44 patients (95%), denosumab helped to achieve prospectively decided intention. A total of 41 patients were available for follow-up at a mean follow-up of 34 months (24 to 48). There were 12 local recurrences (29%), in 11 patients (11/25, 44%) who had curettage and in one patient (1/16, 6%) who had resection. The mean time to local recurrence was 16 months (8 to 25). The LRFS was 76% at two years: 94% for cases with resection and 64% for cases with curettage (p = 0.013). CONCLUSION: Although local control rates are unlikely to improve with use of preoperative denosumab, a short preoperative course of denosumab can facilitate surgery in certain cases of operable GCTB, with a high risk of local recurrence making curettage or resection technically easier. It may also help in converting a lesion requiring resection to a lesion that could possibly be treated with curettage.

Temperature dependent local atomic displacements in NaSn2As2 system.

NaSn2As2 is mechanically exfoliable layered van der Waals (vdW) Zintl phase that is getting interesting due to its low thermal conductivity and recently observed superconductivity. Here, we have investigated the temperature dependent local structure of NaSn2As2 by a combined analysis of As K-edge and Sn K-edge extended x-ray absorption fine structure measurements. The system is intrinsically disordered with the interatomic distances largely consistent to those estimated by average structure measurements. The stretching force constants of different bond distances have been determined using temperature dependent mean square relative displacements. The Sn-As distance is the strongest bond in this system, having covalent nature, unlike the weaker interlayer distances which are characterized by vdW type bonding. Among them, As-Na distance is slightly weaker than Sn-Sn(i) below ∼200 K and tends to get stronger above this temperature. The anomalous behavior of As-Na bond suggests that the mechanical exfoliation in this system is likely to be temperature dependent. The anomaly in the interlayer atomic correlations may be due to a charge density wave-like instability around this temperature, indicated by earlier experiments. The local structure and disorder are discussed in relation to the physical properties of NaSn2As2.

Clinicopathologic profile of 470 giant cell tumors of bone from a cancer hospital in western India.

Over 20 years, 470 cases of giant cell tumor of bone diagnosed at a tertiary cancer hospital were analyzed. Male predominance (57%), predilection for bones around the knee joint (42%), and occurence in the 21- to 30-year-old age group (49.1%) with 6% being in the immature skeleton are well known facts. Accurate diagnosis was possible in 66% and 88% of cases on radiology and biopsy, respectively. Tumors measured 6 to 20 cm and, in 402 cases, showed "usual" histology comprising uniformly scattered multinucleate giant cells amidst mononuclear stromal cells, together imparting a syncitium-like appearance. Presence of osteoid, hemorrhage, and aneurysmal bone cyst-like areas; spindle cells in sheets (devoid of giant cells); or storiform pattern and intravascular osteoclasts were less common. The less common histologic features posed diagnostic difficulty in the setting of a small biopsy. Treatment included intralesional curettage (33.19%), marginal excision (4.2%), wide excision (31%), or radical surgeries (14.25%). Recurrences seen in 170 cases were multiple in 47 cases. Metastases largely to the lung were recorded in 24 cases. The histology of all the tumors, namely, primary, recurrent, or metastatic was identical. Statistical analysis using the computer software SPSS (SPSS Inc, Chicago, Ill)was performed with particular reference to the unusual histologic features vs recurrence and metastasis by chi(2) test. The only statistically significant factors were occurrence in the axial skeleton vs appendicular skeleton (P = .001) and primary treatment elsewhere vs at this hospital (P = .045), each of these being associated with increased frequency for local recurrence but not metastasis.

A t(X; 18) SYT-SSX2 positive synovial sarcoma in the pelvis of a young adult male: a rare case report with review of literature.

Synovial sarcoma is uncommonly documented in the pelvis. Rarely, such cases have dealt with molecular analysis. A 19-year-old boy presented with pain and swelling in his left lower limb of two months duration. He developed acute urinary retention four days prior to his hospital admission, wherein radiological examination unraveled a large soft tissue mass, displacing his pelvic muscles, along with a lytic lesion involving his right pubic bone. Biopsy showed a cellular spindle cell sarcoma, exhibiting hemangiopericytoma-like vascular pattern with focal necrosis. Immunohistochemistry (IHC) showed positivity for vimentin, BCL-2, calponin and MIC 2. Cytokeratin (CK) and epithelial membrane antigen (EMA) were negative. MIB 1 count was 70% (high). P53 was positive. Diagnosis of a poorly differentiated synovial sarcoma was offered and confirmed with a positive t(X; 18) SYT-SSX2 translocation. This case highlights the value of molecular analysis in diagnosis of a synovial sarcoma at rare sites, especially when IHC results are equivocal and the biopsy material is limited.

Effect of propofol in altering pentylenetetrazol induced seizure threshold in rats.

The present study was undertaken to evaluate the role of propofol in altering pentylenetetrazol induced seizure threshold in rats. Total 42 Wistar rats were used to evaluate different parameters (onset of action, duration of seizure, seizure severity score and number of seizure) following propofol injection. The present results showed that there was significant reduction in the time required for onset of seizure in propofol treated groups following PTZ treatment. If treated with propofol alone (2 and 5 mg/kg), there was no significant difference as compared to controls. In seizure severity score assessment, there was no significant difference with various doses of propofol alone treated groups, but the difference was observed in propofol (2 and 5 mg/kg) treated groups following PTZ treatment. Duration of seizure also significantly increased in propofol (5 mg/kg) treated group, but at 2 mg/kg of propofol treatment, no significant difference was observed. The present results showed that propofol ameliorate seizure threshold and caused prolongation of duration of seizure. However, further study and trials are needed to confirm the present results.