Growth of liver allografts over time in pediatric transplant recipients.

The liver's capacity to grow in response to metabolic need is well known. However, long-term growth of liver allografts in pediatric recipients has not been characterized. A retrospective review of pediatric recipients at a single institution identified patients who had cross-sectional imaging at 1, 5, and 10 years post-transplant. Using volumetric calculations, liver allograft size was calculated and percent SLV were compared across the different time points; 18 patients ranging from 0.3 to 17.7 years old were identified that had imaging at 2 or more time points. Measured liver volumes increased by 59% after 5 years and 170% after 10 years. The measured liver volumes compared to calculated %SLV for these patients were 123 ± 37%, 97 ± 19%, and 118 ± 27% at 1, 5, and 10 years after transplant, respectively. Our data suggest that liver allografts in pediatric recipients increase along with overall growth, and reach SLVs for height and weight by 5 years post-transplantation. Additionally, as pediatric recipients grow, the livers appear to maintain appropriate SLV.

The pharmacogenetics of codeine pain relief in the postpartum period.

The objective of this study was to examine interindividual variability in codeine requirements and pain management by examining select genetic polymorphisms in the codeine pharmacological pathway. The study included a nested cohort of 98 women who were prescribed codeine following cesarean section. Participants were genotyped for select polymorphisms of the COMT, ABCB1, CYP2D6, UGT2B7 and OPRM1 genes and instructed to describe their level of pain using the visual analog scale (mm) 1 h following each dose of codeine. Analysis revealed that reported pain increases with maternal age (P=0.041). Asians required more codeine than Caucasians (P=0.048). Significant differences in mean dose consumption were seen among the genotypic groups of the OPRM1 A118G (P=0.001) and UGT2B7 C802T (P=0.015) variants. These variants were found to predict codeine consumption in the cohort overall (P=0.000) and among Caucasians (P=0.001). These findings will assist in customizing therapy to effectively manage postpartum pain.

Tendon overload results in alterations in cell shape and increased markers of inflammation and matrix degradation.

Tendon injury is thought to involve both damage accumulation within the matrix and an accompanying cell response. While several studies have characterized cell and matrix response in chronically injured tendons, few have assessed the initial response of tendon to overload-induced damage. In this study, we assessed cell response to cyclic loading. Fascicle bundles from the equine superficial digital flexor tendon were exposed to cyclic loading in vitro, designed to mimic a bout of high-intensity exercise. Changes in cell morphology and protein-level alterations in markers of matrix inflammation and degradation were investigated. Loading resulted in matrix damage, which was accompanied by cells becoming rounder. The inflammatory markers cyclooxygenase-2 and interleukin-6 were increased in loaded samples, as were matrix metalloproteinase-13 and the collagen degradation marker C1,2C. These results indicate upregulation of inflammatory and degradative pathways in response to overload-induced in vitro, which may be initiated by alterations in cell strain environment because of localized matrix damage. This provides important information regarding the initiation of tendinopathy, suggesting that inflammation may play an important role in the initial cell response to tendon damage. Full understanding of the early tenocyte response to matrix damage is critical in order to develop effective treatments for tendinopathy.

Mucosal (oral and vulval) lichen planus in women: are angiotensin-converting enzyme inhibitors protective, and beta-blockers and non-steroidal anti-inflammatory drugs associated with the condition?

AIM: To determine whether there is an association between the use of angiotensin-converting enzyme (ACE) inhibitors, beta-blockers and nonsteroidal anti-inflammatory drugs (NSAIDS) in women with mucosal (oral and vulval) lichen planus (LP) compared with a control population. METHODS: This was a retrospective review of medical records in dedicated vulval and oral clinics in hospitals. The study population comprised 141 women with vulval LP and 106 women with oral LP. Medications taken at the time of diagnosis were recorded. RESULTS: Patients with mucosal LP were more likely to be on NSAIDS and beta-blockers, but less likely to be on ACE inhibitors compared with controls. All three groups were found to have an inverse relationship with ACE inhibitors, but no association was found between patients with oral LP and beta-blockers. CONCLUSIONS: Beta-blockers and NSAIDS are associated with LP, suggesting that withdrawal of these drugs should be considered. Further studies are needed to confirm or refute the inverse relationship between mucosal LP and use of ACE inhibitors.

Synthesis, structural characterisation and antibacterial activity of bis(1-phenyl-1,3-butanedionato)non-oxovanadium(IV) hydroxamates.

Complexes with a composition of VCl(2-n)(bzac)(2)(HL(1,2))(n) (I - IV) (where bzac = 1-phenyl-1,3-butanedionate anion (C(6)H(5)COCHCOCH(3)(-)); HL(1)=C(6)H(5)OCH(2)C(O)NHO(-), HL(2) = C(6)H(5)CH=CHC(O)NHO(-), n = 1 and 2) have been synthesised from the reactions of (VCl(2)(bzac)(2)) with equi- and bi-molar amounts of potassium phenoxyacetohydroxamate and cinnamohydroxamate (KHL(1,2)) in THF + MeOH solvent medium. The complexes have been characterised by elemental analyses, molar conductivity, magnetic measurements, IR, electronic and mass spectral studies. The physicochemical and spectral studies suggest a distorted octahedral geometry around vanadium in the complexes. The antibacterial activities of the newly synthesised complexes, vanadium precursor and ligands have been screened in vitro against six bacterial species. The complexes have shown higher antibacterial effect than the free ligands.

Artificial intelligence technology for diagnosing COVID-19 cases: a review of substantial issues.

Today, the world suffers from the rapid spread of COVID-19, which has claimed thousands of lives. Unfortunately, its treatment is yet to be developed. Nevertheless, this phenomenon can be decelerated by diagnosing and quarantining patients with COVID-19 at early stages, thereby saving numerous lives. In this study, the early diagnosis of this disease through artificial intelligence (AI) technology is explored. AI is a revolutionizing technology that drives new research opportunities in various fields. Although this study does not provide a final solution, it highlights the most promising lines of research on AI technology for the diagnosis of COVID-19. The major contribution of this work is a discussion on the following substantial issues of AI technology for preventing the severe effects of COVID-19: (1) rapid diagnosis and detection, (2) outbreak and prediction of virus spread, and (3) potential treatments. This study profoundly investigates these controversial research topics to achieve a precise, concrete, and concise conclusion. Thus, this study provides significant recommendations on future research directions related to COVID-19.

Phlegmasia cerulea dolens--a rare, life-threatening condition.

Phlegmasia cerulea dolens is a rare form of massive proximal venous thrombosis of the lower extremities associated with a high degree of morbidity, presenting with sudden severe lower extremity pain with edema and cyanosis. Venous gangrene, venous congestion with massive fluid sequestration leading to circulatory collapse, and shock causing death can ensue if not promptly diagnosed and treated. We present a clinical image of a 55-year-old man with newly diagnosed cholangiocarcinoma who presented with worsening left lower extremity pain. We found painful swelling with purple discoloration extending up to the ankle joint. Distal arterial pulses were palpable. Doppler ultrasound revealed extensive thrombosis in all segments of the deep vein bilaterally except the right iliac segment. Anticoagulation with heparin was initiated. The patient underwent an emergency left iliac thrombectomy for salvage of the limb and placement of a prophylactic inferior vena cava filter. The patient's symptoms resolved.

Artificial neural network-genetic algorithm approach to optimize media constituents for enhancing lipase production by a soil microorganism.

Results of lipase production by a soil microorganism, expressed in terms of lipolytic activities of the culture were modeled and optimized using artificial neural network (ANN) and genetic algorithm (GA) techniques, respectively. ANN model, developed based on back propagation algorithm, were highly accurate in predicting the system with coefficient of determination (R2) value being close to 0.99. Optimization using GA, based on the ANN model developed, resulted in the following values of the media constituents: 9.991 ml/l oil, 0.100 g/l MgSO4 and 0.009 g/l FeSO4. And a maximum value of 7.69 U/ml of lipolytic activity at 72 h of culture was obtained using the ANN-GA method, which was found to be 8.8% higher than the maximum values predicted by a statistical regression-based optimization technique-response surface methodology.

Comparative analysis of low complexity regions in Plasmodia.

Low complexity regions (LCRs) are a common feature shared by many genomes, but their evolutionary and functional significance remains mostly unknown. At the core of the uncertainty is a poor understanding of the mechanisms that regulate their retention in genomes, whether driven by natural selection or neutral evolution. Applying a comparative approach of LCRs to multiple strains and species is a powerful approach to identify patterns of conservation in these regions. Using this method, we investigate the evolutionary history of LCRs in the genus Plasmodium based on orthologous protein coding genes shared by 11 species and strains from primate and rodent-infecting pathogens. We find multiple lines of evidence in support of natural selection as a major evolutionary force shaping the composition and conservation of LCRs through time and signatures that their evolutionary paths are species specific. Our findings add a comparative analysis perspective to the debate on the evolution of LCRs and harness the power of sequence comparisons to identify potential functionally important LCR candidates.

Proof of concept percutaneous treatment system to enable fast and finely controlled ablation of biological tissue.

A prototype system has been developed for producing controllable ablation of spherical lesions with a diameter of up to 2 cm. The system is based on a solid-state energy source operating in the super high frequency (SHF is defined as being a frequency of between 3 and 30 GHz) region of the electromagnetic spectrum. Results obtained from preliminary tissue testing, performed on morbid tissue samples prepared in a laboratory environment, show repeatability in terms of shape and size of ablation, and demonstrate the ability to produce controlled ablation in morbid liver and kidney models.

Point of sale tobacco advertisements in India.

BACKGROUND: The effect of any legislation depends on its implementation. Limited studies indicate that tobacco companies may tend to use such provision for surrogate advertising. The point of sale advertisement provision has been placed in the Indian Tobacco Control legislation. The study was undertaken to assess the Indian scenario in this regard. OBJECTIVE: To assess if there are any violations related to provision of point of tobacco sale advertisements under India's comprehensive tobacco Control legislation in different parts of India. MATERIALS AND METHODS: Boards over various shops showing advertisements of tobacco products were observed in the cities of Delhi, Mumbai, Kolkata, Trivandrum and Jaipur, between September 2005 and March 2006. RESULTS: The point of sale advertisements mushroomed after the implementation of 2004 tobacco control legislation. Tobacco advertisement boards fully satisfying the point of sale provision were practically non-existent. The most common violation of point of sale advertisements was the larger size of the board but with tobacco advertisement equal to the size indicated in the legislation and remaining area often showing a picture. Invariably two boards were placed together to provide the impression of a large single repetitive advertisement. More than two boards was not common. Tobacco advertisement boards were also observed on closed shops/ warehouses, shops not selling tobacco products and on several adjacent shops. CONCLUSION: The purpose of the point of sale advertisements seems to be surrogate advertisement of tobacco products, mainly cigarettes.

Safety in out-of-hours operating in trauma and orthopaedics at a district general hospital.

INTRODUCTION According to the National Confidential Enquiry into Perioperative Deaths (NCEPOD), out-of-hours operating in trauma and orthopaedics should be reserved for life or limb threatening cases only. The aim of our study was to determine the nature of non-emergency work carried out in our trust at night in 2015. The overall efficacy and clinical safety of the services provided was evaluated. METHODS Surgical activity undertaken after 9pm was reviewed along with patient ASA (American Society of Anesthesiologists) grade, grade of operating surgeon and any complications that occurred following the procedure. Furthermore, the clinical urgency and safety of cases was assessed based on whether there was any record of life or limb threatening indications at the time of admission. RESULTS Overall, 131 procedures were performed after 9pm, with 102 performed between 9pm and midnight, and 29 after midnight. Consultants performed 16 cases and the remaining 115 cases were operated on by middle grades or specialty trainees. A fifth (20%) of the cases were genuinely life or limb threatening. A total of 123 procedures were classed as having good outcomes. The complication rate was 8%. CONCLUSIONS In our study, 80% of the procedures performed after 9pm could not be categorised as life or limb threatening. Appropriate NCEPOD classification would ensure that only life or limb threatening cases were listed for theatre after 9pm. Alternative methods of operating within working hours should be considered.

Frequency of gonadal tumours in complete androgen insensitivity syndrome (CAIS): A retrospective case-series analysis.

BACKGROUND: Complete androgen insensitivity syndrome (CAIS) is an X-linked recessive disorder of sex development (DSD) where affected individuals are phenotypically female, but have an XY karyotype and testes. The risk of gonadal tumour development in CAIS may increase with age; incidence rates have been reported to be 0.8-22% in patients who have retained their gonads into adulthood. Consequently, gonadectomy has been recommended either during childhood or after puberty is complete, although there is no consensus on the optimal timing for this procedure. OBJECTIVE AND HYPOTHESES: To establish the frequency of histological abnormalities in CAIS in relation to the age at gonadectomy. METHOD: Data were collected from the Cambridge DSD database on patients with CAIS (n = 225; age range 3-88 years) who had undergone gonadectomy, and their age of gonadectomy, gonadal histology and immunohistochemistry. RESULTS: Evaluable data were obtained from 133 patients. Median age at gonadectomy was 14.0 years (range: 18 days-68 years). Pubertal status was: prepuberty, n = 62; postpuberty, n = 68. Thirteen cases were aged >20 years at gonadectomy. The pattern of histology is summarised in the Summary table. DISCUSSION: In this large case series of CAIS patients who had undergone gonadectomy, while the combined malignant and premalignant gonadal histology prevalence was 6.0%, the findings confirm the low occurrence of gonadal malignancy in CAIS, with a frequency of 1.5%. The two cases of malignancy were postpubertal. Germ cell neoplasia in situ (GCNIS) was observed in six cases, of which one occurred prepuberty and five postpuberty. The study highlighted difficulties in diagnosis of GCNIS and the need for histological analysis in expert centres. CONCLUSION: The results support the current recommendation that gonads in CAIS can be retained until early adulthood. The small number of individuals with gonadectomy after age 20 years do not allow firm conclusion regarding later adulthood. Therefore, it is recommended that the option of gonadectomy be discussed in adulthood. Some form of regular surveillance of the gonads is then recommended, although none of the available options are ideal.

Sub-segmental pulmonary embolism in three academic teaching hospitals: a review of management and outcomes.

BACKGROUND: The availability of computed tomography pulmonary angiography (CTPA) has led to an increase in the diagnosis of sub-segmental pulmonary embolism (SSPE). Current clinical practice guidelines do not make any treatment distinctions for SSPE, though the benefits of anticoagulation for SSPE have not been established. OBJECTIVES: To review the frequency of pulmonary embolism and sub-segmental pulmonary embolism identified through CTPA as well as their management. METHODS: Cross-sectional review of the charts of 2213 patients who underwent CTPA in three Hamilton teaching hospitals from 2009 to 2011. In-depth review of the charts of patients with SSPE was undertaken to determine the frequency with which patients received anticoagulation therapy for SSPE, as well as bleeding complications and recurrent thrombosis. RESULTS: A total of 2216 CTPAs were reviewed. The frequency of PE was 24.8% (n = 550). The most frequent filling defect was SSPE in 82 patients (3.9% of total scans and 15.0% of identified PEs). In 55 of these 82 SSPEs, an alternative diagnosis to PE was identified on CT to explain the patients' symptoms. Approximately 52.4% (n = 43) received anticoagulation for SSPE. Major life-threatening bleeding complications occurred in two of the 43 who received anticoagulation for SSPE. There was no documented recurrent thrombosis in any patients with SSPE, with or without anticoagulation. SUMMARY/CONCLUSIONS: A substantial proportion of patients received anticoagulation for SSPE (52%) and two developed life-threatening bleeding complications. Randomized controlled trial data are needed to further investigate the risks and benefits of anticoagulation in patients with SSPE.

Laceration of the left pulmonary artery during removal of a bronchogenic cyst by right thoracotomy.

Major vascular involvement by a bronchogenic cyst is rare; most large cysts cause respiratory symptoms. We present a case in which a large bronchogenic cyst was adherent to the left pulmonary artery. During removal of the cyst by right thoracotomy, the artery lacerated. Repair of the artery in such a situation taxes the surgeon's ingenuity and decision-making process.

Antigenic cross-reactivity among isolates of group JK corynebacteria.

Using rocket and rocket-line immunoelectrophoresis and immunoblotting it was demonstrated that a group of antibiotic-resistant bacteria, including several authenticated Corynebacterium jeikeium strains, shared many cross-reacting antigens. Only weak cross-reactivity was demonstrated with representatives of three other skin corynebacteria, C. bovis, C. hofmanii and C. minutissimum or with non-coryneforms. Differences within C. jeikeium are sufficient to permit the use of immunoblotting as an epidemiological tool.

Folic acid enhances lithium prophylaxis.

A double-blind trial was carried out to investigate the effect on affective morbidity of a daily supplement of 200 micrograms folic acid or a matched placebo in a group of 75 patients on lithium therapy. During the trial the patients with the highest plasma folate concentrations showed a significant reduction in their affective morbidity. Patients who had their plasma folate increased to 13 ng/ml or above had a 40% reduction in their affective morbidity. It is suggested that a daily supplement of 300-400 micrograms folic acid would be useful in long-term lithium prophylaxis.