Shear Strength of Hybrid Fibre-Reinforced Ternary Blend Geopolymer Concrete Beams under Flexure.

The need to promote sustainable civil infrastructure is one of the most important concerns in the construction industry. Geopolymer composites are one of the promising eco-friendly materials for the development of low carbon concrete. The main objective of this experimental investigation is to study the effect of hybrid fibres on the shear strength of flexural members made with ternary blend geopolymer concrete (TGPC). A total number of 27 reinforced concrete beams of size 100 mm × 150 mm × 1200 mm were cast and tested for shear. M55 grade of concrete was considered in this study. Crimped steel fibres and polypropylene fibres with an aspect ratio of 66 and 300, respectively, were used in this work. The main variables considered in this investigation involve two volume proportions of steel fibres, viz., 0.5% and 1% as well as four volume proportions of polypropylene fibres viz., 0.1%, 0.15%, 0.2% and 0.25%. The hybrid fibre-reinforced ternary blend geopolymer concrete (HTGPC) beams were compared with TGPC beams without fibres. From the test results, it was clear that incorporating hybrid fibres improved the shear strength and changed the type of failure of the beam from shear to flexure. Moreover, a method to predict the ultimate shear strength of HTGPC was proposed, and the estimated values were found to be the same as the test results.

Potential of repurposing chloroquine as an adjunct therapy for melioidosis based on a murine model of Burkholderia pseudomallei infection.

Burkholderia pseudomallei is the etiologic agent of melioidosis, a major cause of community-acquired pneumonia and sepsis in the endemic areas. The overall mortality of patients with severe melioidosis remains high due to severe sepsis attributed to overwhelming inflammatory cytokine response in spite of recommended antibiotic therapy. It is crucial that therapeutic approaches beyond just effective antibiotic treatment such as adjunct therapy be considered to mitigate the dysregulated inflammatory signaling and augment host defenses. In an acute B. pseudomallei infection model, we have previously demonstrated that treatment with anti-malarial drug, chloroquine, modulated inflammatory cytokine levels and increased animal survivability via Akt-mediated inhibition of glycogen synthase kinase-3ß (GSK3ß). GSK3ß is a downstream effector molecule within the phosphatidylinositol 3-kinase (PI3K)/ Akt axis which plays a pivotal role in regulating the production of pro- and anti-inflammatory cytokines. Here we evaluate the effect of chloroquine treatment in combination with a subtherapeutic dose of the antibiotic doxycycline on animal survivability, cytokine levels and phosphorylation states of GSK3ß (Ser9) in a murine model of acute melioidosis infection to investigate whether chloroquine could be used as an adjunct therapy along with doxycycline for the treatment of melioidosis. Our findings revealed that 50 mg/kg b.w. chloroquine treatment together with a dose of 20 mg/kg b.w. doxycycline improved survivability (100%) of mice infected with 3 X LD50 of B. pseudomallei and significantly (P<0.05) lowered the bacterial loads in spleen, liver and blood compared to controls. B. pseudomallei-infected mice subjected to adjunct treatment with chloroquine and doxycycline significantly (P<0.05) reduced serum levels of pro-inflammatory cytokines (TNF-α, IFN-γ and IL-6) but increased levels of antiinflammatory cytokines (IL-4 and IL-10). Western blot analysis demonstrated that the intensities of pGSK3ß (Ser9) in liver samples from mice treated with chloroquine and doxycycline combination were significantly (P<0.05) higher suggesting that the adjunct treatment resulted in significant inhibition of GSK3ß. Taken together the bacteriostatic action of doxycycline coupled with the cytokine-modulating effect of chloroquine gave full protection to B. pseudomallei-infected mice and involved inhibition of GSK3ß. Findings from the present study using B. pseudomallei-infected BALB/c mice suggest that chloroquine is a plausible candidate for repurposing as adjunct therapy to treat acute B. pseudomallei infection.

GSK3ß: A plausible molecular target in the cytokinemodulating effect of exogenous insulin in a murine model of malarial infection.

Malaria is a life-threatening disease caused by the Plasmodium sp. parasite. Infection results in heightened pro-inflammatory response which contributes to the pathophysiology of the disease. To mitigate the overwhelming cytokine response, host-directed therapy is a plausible approach. Glycogen synthase kinase-3ß (GSK3ß), a serine/threonine kinase plays a pivotal role in the regulation of inflammatory response during pathogenic infections. The present study was conducted to investigate the chemo-suppressive and cytokine-modulating effects of insulin administration in malaria-infected mice and the involvement of GSK3ß. Intraperitoneal administrations of 0.3 and 0.5 U/kg body weight insulin each for four consecutive days into Plasmodium berghei NK65 (PbN)-infected mice resulted in chemo-suppression exceeding 60% and improved median survival time of infected mice (20.5 days and 19 days respectively compared to 15.5 days for non-treated control). Western analysis revealed that pGSK3ß (Ser9) intensity in brain samples from insulin-treated (0.3 and 0.5 U/kg body weight) infected mice each were 0.6 and 2.2 times respectively than that in control. In liver samples, pGSK3ß (Ser9) intensity from insulin-treated infected mice were significantly higher (4.8 and 16.1 fold for 0.3 and 0.5 U/kg bw respectively) than that in control. Insulin administration decreased both brain and liver pNF-κB p65 (Ser536) intensities (to 0.8 and 0.6 times for 0.3 U/kg bw insulin; and to 0.2 and 0.1 times for 0.5 U/kg bw insulin respectively compared to control). Insulin treatment (0.5 U/kg bw) also significantly decreased the serum levels of pro-inflammatory cytokines (TNF-α (3.3 times) and IFN-γ (4.9 times)) whilst significantly increasing the levels of anti-inflammatory cytokines (IL-4 (4.9 fold) and IL-10 (2.1 fold)) in PbN-infected mice. Results from this study demonstrated that the cytokinemodulating effects of insulin at least in part involve inhibition of GSK3ß and consequent inhibition of the activation of NF-κB p65 suggesting insulin as a potential adjunctive therapeutic for malaria.

Enhanced biological phosphorus removal in the retrofitting from an anoxic selector to an anaerobic selector in a full-scale activated sludge process in Singapore.

This paper presents the investigation results of retrofitting an anoxic selector to an anaerobic selector through stepwise reduction of air supply in a full-scale activated sludge process with a focus on enhanced biological phosphorus removal (EBPR). The process experienced gradual shift from a Ludzack-Ettinger (LE) to an anaerobic-anoxic-oxic (A(2)O) process and subsequently, an anaerobic-oxic (A/O) process. The major findings are: (i) the average influent-based PO(4) (3-)-P release in the anaerobic selector compartment was 16.3 mg P l(-1) and that in the secondary clarifier was 1.7 mg P l(-1). 75% of the SCOD and 93% of the acetic acid in the primary effluent were taken up in the anaerobic selector compartment, respectively; (ii) PO(4) (3-)-P uptake contributed by both aerobic and denitrifying phosphorus accumulating organisms (DPAOs) occurred mainly in the first and second aerobic lanes together with simultaneous nitrification and denitrification (SND) while there was not much contribution from the last aerobic lane; (iii) The average PO(4) (3-)-P concentration of the final effluent was 2.4 mg P l(-1) corresponding to a removal efficiency of 85%; (iv) the SVI was satisfactory after retrofitting; and (v) the increase of NH(4) (+)-N in the final effluent from the commencement to the completion of the retrofitting resulted in an approximate 40-50% reduction in oxygen demand and a significant aeration energy saving was achieved.

Disruption of transforming growth factor-beta signaling through beta-spectrin ELF leads to hepatocellular cancer through cyclin D1 activation.

Transforming growth factor-beta (TGF-beta) signaling members, TGF-beta receptor type II (TBRII), Smad2, Smad4 and Smad adaptor, embryonic liver fodrin (ELF), are prominent tumor suppressors in gastrointestinal cancers. Here, we show that 40% of elf(+/-) mice spontaneously develop hepatocellular cancer (HCC) with markedly increased cyclin D1, cyclin-dependent kinase 4 (Cdk4), c-Myc and MDM2 expression. Reduced ELF but not TBRII, or Smad4 was observed in 8 of 9 human HCCs (P<0.017). ELF and TBRII are also markedly decreased in human HCC cell lines SNU-398 and SNU-475. Restoration of ELF and TBRII in SNU-398 cells markedly decreases cyclin D1 as well as hyperphosphorylated-retinoblastoma (hyperphosphorylated-pRb). Thus, we show that TGF-beta signaling and Smad adaptor ELF suppress human hepatocarcinogenesis, potentially through cyclin D1 deregulation. Loss of ELF could serve as a primary event in progression toward a fully transformed phenotype and could hold promise for new therapeutic approaches in human HCCs.

The anti-malarial chloroquine modulated cytokine levels and increased animal survivability via Akt-mediated inhibition of GSK3ß in Burkholderia pseudomalleiinfected mice.

Melioidosis is a common cause of fatal community-acquired septicaemia and pneumonia in endemic regions even with appropriate antibiotic treatments. The involvement of inflammatory cytokines in the manifestation of melioidosis is well-documented. Antibacterial and anti-inflammatory therapies may prove more efficacious against melioidosis rather than just anti-bacterial therapy alone. The phosphatidylinositol 3-kinase (PI3K)/Akt pathway has a central role in regulating the host inflammatory response; and glycogen synthase kinase-3ß (GSK3ß), a downstream effector molecule within this axis, plays a pivotal role in regulating the production of pro- and anti-inflammatory cytokines. The anti-malarial drug, chloroquine is a novel activator of Akt, and can elicit inhibition of GSK3ß via PI3K/Akt signalling. LiCl, a GSK3 inhibitor is reported to increase survivability and modulate cytokine production in B. pseudomallei-infected mice. Here we determined the effects of chloroquine administration on animal survivability, cytokine levels and phosphorylation states of GSK3ß (Ser9), Akt (Ser473) and NF-κB p65 (Ser536) in a murine model of acute melioidosis infection. Administration of 50 mg/kg b w chloroquine improved survivability (mean 67.0 ± 6.3%) of mice infected with 3 X LD50 B. pseudomallei compared to controls. Bacterial loads in spleen, liver, lung and blood of infected mice administered with chloroquine were significantly lower than controls. Western blot analysis revealed that the intensities of pAkt (Ser473) and pGSK3ß (Ser9) in liver samples of mice administered with chloroquine were significantly (Pandlt;0.05) higher (2.3- and 4.4-fold respectively) compared to controls. On the other hand, chloroquine treatment signicantly decreased (Pandlt;0.05) phosphorylation of NF-κB p65 (Ser536) by 0.7-fold compared to control. Chloroquine administration also resulted in significantly reduced levels of pro-inflammatory cytokines (TNF-α, IFN-γ, IL-1ß and IL-18) but increased levels of antiinflammatory cytokines (IL-4 and IL-10) in sera and liver of B. pseudomallei-infected mice. Findings from this study demonstrate that the increased survivability of B. pseudomalleiinfected mice after chloroquine administration is at least in part due to its cytokine-modulating effects elicited via Akt-mediated inhibition of GSK3ß that resulted in inhibition of NF-κB activation. This study represents laboratory evidence of the use of chloroquine for cytokine modulation and a plausible effective adjunctive therapeutic for B. pseudomallei infection.

Asian venous thromboembolism guidelines: updated recommendations for the prevention of venous thromboembolism.

The Asian venous thromboembolism (VTE) prophylaxis guidelines were first published in 2012. Since its first edition, the Asian Venous Thrombosis Forum (AVTF) working group have updated the Asian VTE epidemiology and reviewed issues that were not addressed in the previous guidelines. The authors noted that the rising incidence of VTE across Asia may be attributable to aging population, dietary changes, and increasing incidence of obesity and diabetes. The new additions in the guideline include role of thrombophilia in VTE, bleeding risk in Asians, individual risk assessment, updates in the prevention of VTE in medically ill, bariatric surgery, cancer, orthopedic and trauma patients. The influence of primary thrombophilia in perioperative VTE is still unclear. The secondary risk factors, however, are similar between Asians and Caucasians. The group found no evidence of increased risk of bleeding while using pharmacological agents, including the use of novel anti-coagulants. At present, Caprini risk assessment model is widely used for individual risk assessment. Further validation of this model is needed in Asia. In medically ill patients, pharmacological agents are preferred if there is no bleeding risk. Intermittent pneumatic compression device (IPC) is recommended in patients with bleeding risk but we do not recommend using graduated compressive stockings. In bariatric patients, data on VTE is lacking in Asia. We recommend following current international guidelines. A high index of suspicion should be maintained during postbariatric surgery to detect and promptly treat portomesenteric venous thrombosis. Different cancer types have different thrombotic risks and the types of surgery influence to a large extent the overall VTE risk. Cancer patients should receive further risk assessment. In patients with higher thrombotic risk, either due to predisposing risk or concomitant surgery, low molecular weight heparin is indicated. Different countries appear to have different incidence of VTE following trauma and major orthopedic surgery. We recommend mechanical prophylaxis using IPC as the main method and additional pharmacological prophylaxis if the thrombotic risk is high. As for obstetric practice, we propose adherence to the UK Greentop guideline that is widely accepted and utilized across Asia. To improve VTE thromboprophylaxis implementation in the region, we propose that there should be better health education, establishment of hospital-based guidelines and multidisciplinary collaboration.

Patterns and predictors of prehypertension among "healthy'' urban adults in India.

Cardiovascular disease is still on the increase in India owing to changing socioeconomic factors and unhealthy lifestyles. Better understanding of the role of hypertension (HTN) has led to new Joint National Committee (JNC-7) guidelines for its diagnosis and management. The authors aimed to evaluate the predictors and correlates of prehypertension (PreHTN) among adults in urban India. Study design is a cross-sectional survey among 2,007 adults in Chennai in July 2003; 1,505 men and 502 women over the age of 18 years were studied. Demographic data collected by direct interview were the following: age, smoking, alcohol intake, type of work, exercise patterns, and monthly income. Anthropometric data of height, weight, and waist and hip dimensions were measured. Blood pressure (BP) was recorded thrice, with at least 15 minutes between readings 2 and 3. The mean of readings 2 and 3 was taken for the study. Of the 2,007 people studied, 951 (47.4%) had PreHTN and 696 (34.7%) had HTN. PreHTN was found in 46.6% of the men and 49.8% of the women. PreHTN was prevalent in 47.4% of adults, and another 34.7% had hypertension (Stage I, 20%, and Stage II, 14.7%). In urban India less than 18% of adults have normal BP of less than 120/80. Multiple logistic regression analysis after age and sex correction identified obesity, diet, family history and middle-income group as correlating with PreHTN. The factors that predict HTN were age, sex, smoking, alcohol intake, sedentary lifestyle, and type of work.

An unusual ECG pattern in restrictive cardimyopathy.

Restrictive cardiomyopathy is the least common type of primary cardiomyopathies. Electrocardiographic recording is abnormal in 99% of patients with RCM. Biatrial enlargement, obliquely elevated ST segment with notched or biphasic late peaking T waves are considered characteristic ECG finding. Significant ST depression with T inversion mimicking subendocardial ischemia has also been reported in patients with RCM and is even suggested as a predictor of sudden cardiac death. We noted a similar ECG pattern in a 16 yr girl with Idiopathic restrictive cardiomyopathy. Coronaries were normal, stress perfusion imaging did not show any perfusion defect. This diffuse resting ST depression with T inversion in precordial & inferior leads along with ST elevation in aVR was persistent for more than six months.

Estimation of annual risk of tuberculosis infection (ARTI) among children aged 1-9 years in the south zone of India.

OBJECTIVE: To estimate the annual risk of tuberculosis infection (ARTI) among children aged 1-9 years in the south zone of India. SETTING: The survey was carried out in a representative sample of villages and census enumeration blocks of towns in four south Indian states, as a part of a nationwide tuberculin survey. DESIGN: Six districts were selected through systematic random sampling. Four hundred and twenty rural clusters and 180 urban clusters were selected from these districts on the basis of the rural-urban ratio in the entire zone. To obtain the required sample of 12,000 children without bacille Calmette-Guérin (BCG) vaccination, 51,000 had to be covered. Eighty-five children from each cluster were tuberculin tested and read for reaction sizes. The ARTI was computed from the estimated prevalence of TB infection among children without a BCG scar. RESULT: Among 52,951 children registered for the study, 50,846 (96%) had a tuberculin test result. The BCG coverage for the study population was about 65%. Among 17,811 children without a BCG scar, the prevalence of infection was 5.9% (95%CI 4.0-7.7%); the corresponding ARTI was 1.0% (95%CI 0.7-1.4%) [correction]. CONCLUSION: The estimated ARTI for the south zone is 1.0%, as compared to the national average of 1.7% used for programme evaluation. This baseline information should be useful for the assessment of future trends.

Using an integrated software package for clinical data analysis on a microcomputer.

An integrated software package was used effectively for entering, organizing and analyzing clinical research data on a microcomputer. Both the database and the spreadsheet components of the package were used in the process. The database component enabled a form to be created for entering the data. The spreadsheet component was used in the organization and analysis of data. Macros were written within the spreadsheet environment for the statistical analysis of data. The purpose of this paper is to illustrate how an integrated software like Symphony could offer features beyond simply the use of a spreadsheet for the analysis of research data. Also highlighted are the other useful features of the integrated software that are not directly related to data analysis.

An overview of acute scrotal pain.

Acute scrotal pain requires immediate medical attention to determine the underlying cause and to treat accordingly. The diagnosis may not be straightforward and in some patients, immediate surgery may be necessary in order to treat torsion of the testes early to achieve good results. The aim of this retrospective study is to evaluate the underlying causes and the outcome of acute scrotal pain. It includes a total of 116 patients over a period of 18 months who were admitted to the general urology ward. Seventy-six percent of the patients complained of pain only, 13% complained of pain with fever, 7% complained of urinary symptoms and 4% a combination of the three. After evaluation, 44 patients were diagnosed to have torsion of the testes and all of these patients were below 20 years old. Thirty-eight of the patients complained of pain only and 2 had pain with fever. Two patients were thought to have torsion and exploration was performed. They were found to have infection. The rest had orchidopexy done and only 2 had orchidectomy due to infarction. Fifty-two patients had acute epididymo-orchitis, 50 of these were above 20 years old and half (n = 25) of this group of patients admitted to having had exposure to sexually transmitted diseases, 11 patients had a history of instrumentation and 14 had no known causes. From this study, age appeared to be the main differentiating point between torsion and epididymo-orchitis. for equivocal cases, new technology such as the Doppler ultrasound and testicular scan may be useful in future to improve the diagnosis of this urogenital emergency.

Genetic variability and diversity for protein and calcium contents in finger millet (Eleusine coracana (L.) Gaertn) in relation to grain color.

Analysis of 36 genotypes of finger millet (Eleusine coracana (L.) Gaertn) with varying seed colors revealed a wide range of protein and calcium contents. White seeded genotypes had higher protein contents, while brown seeded types had a wide range of values. The brown seeded genotype GE 2500 had the highest protein content. Although protein content had significant negative association with calcium content, white seeded types had moderate levels of calcium. The genotypic coefficients of variability were moderate and high for protein and calcium, respectively. High heritability coupled with high genetic advance indicated their governance by additive gene action. A negative significant correlation was observed between protein content and grain yield. Mahalanobis D2 analysis grouped the 36 genotypes into eight clusters. Clustering pattern failed to indicate any relationship between genetic diversity and geographic diversity. Based on genetic diversity and performance, the genotypes MS 1168, MS 174 and CO 13 were found to be suitable for use as parents in a hybridization program for improving yield; the genotypes MS 1168, MS 174 and MS 2869 for protein and Malawi 1915 and CO 11 for calcium. Protein and calcium contents contributed less to genetic divergence.

Piperacillin monotherapy compared with metronidazole and gentamicin combination in penetrating abdominal trauma.

The therapeutic efficacy and safety of piperacillin (4.5 g, every 6 hours) were compared with combined gentamicin (80 mg, every 8 hours) and metronidazole (500 mg every 6 hours) therapy in 246 patients hospitalized for penetrating abdominal injuries. Sixty-five patients had penetrating injury of the colon, rectum, or terminal ileum. The overall clinical cure rate was about 94% in both treatment groups. Adverse clinical experiences or biochemical abnormalities required discontinuation of therapy in three patients on gentamicin/metronidazole and in no patients on piperacillin.