Efficacy and Safety of Cryoablation Compared with Cooled Radiofrequency Ablation of Genicular Nerves in Advanced Osteoarthritis of the Knee: A Study Protocol of Single-Centric, Assessor-Blinded, Randomized, Parallel-Group, Non-inferiority Study.

PURPOSE: In patients with symptomatic osteoarthritis knee (OAK), cryoneurolysis (CRYO) and cooled radiofrequency ablation (C-RFA) are reported to be effective and safe; however, they have not been compared directly. The objective of this study is to compare CRYO and C-RFA of the genicular nerve (GN) in terms of efficacy and safety profile in patients with Kellgren and Lawrence (KL) grade ≥ 3 OAK. METHODS: This single-centric, assessor-blinded, randomized, parallel-group, non-inferiority study will include 80 patients with KL grade ≥ 3 OAK. The patients with ≥ 50% pain relief on diagnostic block of three GNs will be randomized to one of the two groups, i.e., CRYO (n = 40) or C-RFA (n = 40). The three target GNs for the interventions will include: superior medial, superior lateral, and inferior medial. The primary outcome will be efficacy of CRYO or C-RFA at 2, 12, and 24 weeks post-procedure based on the 11-point Numerical Pain Rating Scale. The secondary outcomes will be functional improvement based on 12-item Oxford Knee Score and safety of both the procedures. The study is registered in the Clinical Trials Registry-India. CONCLUSION: CRYO and C-RFA provide pain relief and improve functional outcome by preventing transmission of pain signals, though by distinct mechanisms. While C-RFA is an established treatment modality, recent evidence supports CRYO in patients with OAK. This study intends to demonstrate non-inferiority of CRYO against C-RFA, thereby supporting the use of CRYO as an additional treatment modality in patients with KL grade ≥ 3 OAK.

Metabolic syndrome in patients with lichen planus: A case-control study.

Background: Lichen Planus (LP) is a chronic dermatosis affecting the skin and mucous membranes. Chronic inflammation and oxidative stress in patients with LP is a trigger predisposing to Metabolic Syndrome. Objectives: To study the association of Metabolic Syndrome in patients with LP. Materials and Methods: A hospital-based prospective case-control study was conducted from April 2021 to January 2023 including 75 histopathologically confirmed patients with LP and 82 age and sex-matched controls according to the inclusion and exclusion criteria. Metabolic Syndrome was diagnosed using Modified National Cholesterol Education Programme Adult Treatment Panel III criteria. Statistical analysis of the data was performed using Statistical Package for the Social Sciences software, version 26. The chi-square test was used for data analysis. Results: The majority (30.6%) of the patients belonged to the age group 31-40 years. The mean age of patients with LP was 46.13 ± 14.9 years. Female predominance (69.3%) was observed in our study. Patients with classic LP (54.6%) were predominantly observed. Metabolic Syndrome was significantly prevalent in LP patients than in controls (32% vs. 13.4%, p = 0.005, OR 3.037) and was significantly associated with morphology (only oral mucosal involvement, 61.5%, p 0.027, OR 3.9), severity (severe LP, 58.6%, p < 0.001, OR 7.79), and duration of the disease (≥6 months, 55.5%, p 0.001, OR 5.42). 71% of Metabolic Syndrome was observed in females (p 0.847). Among patients with metabolic syndrome, the majority belonged to the age group between 31 and 40 years (37.5%, p 0.378). Systolic and Diastolic Blood Pressure values (≥130/85 mm of Hg), Serum Triglycerides (≥150 mg/dl), and Low-Density Lipoprotein (>130 mg/dl) were significantly elevated, and High-Density Lipoprotein (<40 mg/dl) was significantly low in LP than in controls (p < 0.05). Conclusion: The study showed a significant association of Metabolic Syndrome in patients with LP. Thus, patients with LP need to be screened to avoid complications associated with Metabolic Syndrome that is, Diabetes Mellitus, Cardiovascular Disease, colorectal cancer, and stroke.

Next-Generation Sequencing Technology: Current Trends and Advancements.

The advent of next-generation sequencing (NGS) has brought about a paradigm shift in genomics research, offering unparalleled capabilities for analyzing DNA and RNA molecules in a high-throughput and cost-effective manner. This transformative technology has swiftly propelled genomics advancements across diverse domains. NGS allows for the rapid sequencing of millions of DNA fragments simultaneously, providing comprehensive insights into genome structure, genetic variations, gene expression profiles, and epigenetic modifications. The versatility of NGS platforms has expanded the scope of genomics research, facilitating studies on rare genetic diseases, cancer genomics, microbiome analysis, infectious diseases, and population genetics. Moreover, NGS has enabled the development of targeted therapies, precision medicine approaches, and improved diagnostic methods. This review provides an insightful overview of the current trends and recent advancements in NGS technology, highlighting its potential impact on diverse areas of genomic research. Moreover, the review delves into the challenges encountered and future directions of NGS technology, including endeavors to enhance the accuracy and sensitivity of sequencing data, the development of novel algorithms for data analysis, and the pursuit of more efficient, scalable, and cost-effective solutions that lie ahead.

Hydrogen production from macroalgae by simultaneous dark fermentation and microbial electrolysis cell.

Hydrogen production from Saccharina Japonica by simultaneous dark fermentation (DF) and microbial electrolysis cell (MEC), called sDFMEC, was studied. In the novel sDFMEC process, substrates were converted to H2 and volatile fatty acids (VFAs) by DF in the bulk phase, and VFAs are simultaneously oxidized by the exoelectrogens in the microbial film on anode electrode with further production of H2 at the cathode. The sDFMEC process was compared with DF and a combined process of DF and MEC in series (DF-MEC) in terms of H2 production. The overall H2 production from S. Japonica in sDFMEC process was higher (438.7 ± 13.3 mL/g-TS), than DF (54.6 ± 0.8 mL/g-TS) and DF-MEC (403.5 ± 7.9 mL/g-TS) process, respectively, which is approximately 3-times higher than those reported in the literature.

Predicting polysomnographic severity thresholds in children using machine learning.

BACKGROUND: Approximately 500,000 children undergo tonsillectomy and adenoidectomy (T&A) annually for treatment of obstructive sleep disordered breathing (oSDB). Although polysomnography is beneficial for preoperative risk stratification in these children, its expanded use is limited by the associated costs and resources needed. Therefore, we used machine learning and data from potentially wearable sensors to identify children needing postoperative overnight monitoring based on the polysomnographic severity of oSDB. METHODS: Children aged 2-17 years undergoing polysomnography were included. Six machine learning models were created using (i) clinical parameters and (ii) nocturnal actigraphy and oxygen desaturation index. The prediction performance for polysomnography-derived severity of oSDB measured by apnea hypopnea index (AHI) >2 and >10 were evaluated. RESULTS: One hundred and ninety children were included. One hundred and eight were male (57%), mean age was 6.7 years [95% confidence interval; 6.1, 7.2], and mean AHI was 10.6 [7.8, 13.4]. Predictive performance utilizing clinical parameters was poor for both AHI > 2 (accuracy range: 48-56% for all models) and AHI > 10 (50-61%). Combining oximetry and actigraphy improved the accuracy to 87-89% for AHI > 2 and 95-96% for AHI > 10. CONCLUSIONS: Machine learning with oximetry and actigraphy identifies most children needing overnight monitoring as determined by polysomnographic severity of oSDB, supporting a potential resource-conscious screening pathway for children undergoing T&A. IMPACT: We provide proof of principle for the utility of machine learning, oximetry, and actigraphy to screen for severe obstructive sleep apnea syndrome (OSAS) in children. Clinical parameters perform poorly in predicting the severity of OSAS, which is confirmed in the current study. The predictive accuracy for severe OSAS was improved by a smaller subset of quantifiable physiologic parameters, such as oximetry. The results of this study support a lower cost, patient-friendly screening pathway to identify children in need of in-hospital observation after surgery.

Treatment-Related Changes in Heart Rate Variability in Children with Sleep Apnea.

OBJECTIVE: Heart rate variability (HRV), a noninvasive indicator of autonomic regulation of cardiac rhythm, may represent the physiologic burden of obstructive sleep apnea (OSA). We hypothesized that the treatment-related effects of OSA on HRV in children are causally attributable to the improvement in OSA severity. STUDY DESIGN: Secondary analysis of outcomes from the Childhood Adenotonsillectomy Trial (CHAT). SETTING: Analysis of database. SUBJECTS AND METHODS: Time- and frequency-domain HRV parameters along with polysomnographic (PSG) and demographic variables were obtained from the CHAT study, which compared early adenotonsillectomy (eAT) to watchful waiting (WW) in children with OSA. The relative contributions of PSG variables and covariates to each HRV parameter were quantified. The proportion of changes in HRV parameters causally attributable to changes in OSA severity, measured by the apnea-hypopnea index (AHI) and oxygen desaturation index (ODI), was estimated. RESULTS: In total, 404 children aged 5 to 10 years were included. The median (interquartile range) age was 6 (3-9) years. The median body mass index percentile was 82 (53), 195 (48%) children were male, and 147 (36%) were African American. The average heart rate during PSG was the strongest independent predictor of each HRV parameter (P < .001). Although eAT resulted in statistically significant changes in the majority of HRV parameters, these effects were not causally attributable to treatment-related changes in AHI or ODI. CONCLUSIONS: The average heart rate strongly modulates HRV in children with OSA. Although eAT results in discernible changes in HRV, it appears to not be causally attributable to specific treatment-related changes in AHI or ODI.

Refining screening questionnaires for prediction of sleep apnea severity in children.

PURPOSE: Screening instruments are poor predictors of the severity of pediatric obstructive sleep apnea (OSA). We hypothesized that their performance could be improved by identifying and eliminating redundant features. METHODS: Baseline scores from three screening questionnaires for pediatric OSA were obtained from the Childhood Adenotonsillectomy Trial (CHAT). The questionnaires included the (i) modified Epworth sleepiness scale (ESS), (ii) the sleep-related breathing disorders subscale of the pediatric sleep questionnaire (PSQ), and the (iii) obstructive sleep apnea-18 (OSA-18) scale. Key features from each questionnaire were identified using variable selection methods. These selected features (SF) were then assessed for their ability to predict the severity of OSA, measured by the apnea-hypopnea index (AHI) and oxygen desaturation index (ODI). In addition, prediction performance of SF was also calculated for AHI > 5 and > 10 and ODI > 5 and > 10, respectively. RESULTS: Four hundred fifty-three children aged 5-10 years were included. The majority of the pairwise correlations among the items within the 3 screening questionnaires were statistically significant. The prediction of AHI and ODI by overall questionnaire scores was poor. Four-item SF, comprising apneic pauses, growth problems, mouth breathing, and obesity predicted AHI and ODI significantly better than each of the individual questionnaires. Furthermore, SF also predicted AHI > 5 and > 10, as well as ODI > 5 and > 10 significantly better than the original questionnaires. CONCLUSIONS: Elimination of redundant items in screening questionnaires improves their prediction performance for OSA severity in children with high pre-test probability for the condition.

Polysomnography and Treatment-Related Outcomes of Childhood Sleep Apnea.

BACKGROUND: Polysomnography is central to the diagnosis and management of childhood obstructive sleep apnea (OSA). However, it is not known whether the treatment-related outcomes of OSA are causally associated with its resolution or changes in severity as determined by polysomnography. METHODS: Polysomnographic, cognitive, behavioral, quality-of life, and health outcomes at baseline and at 7 months were obtained from the Childhood Adenotonsillectomy Trial, a randomized trial comparing the outcomes of early adenotonsillectomy to watchful waiting in children with OSA. We used causal mediation analysis to measure the changes in 18 outcomes independently attributable to polysomnographic resolution or changes in severity after adjusting for confounding variables. RESULTS: A total of 398 children aged 5 to 9 years were included. A total of 244 (61%) experienced resolution of OSA at follow-up. Polysomnographic resolution of the condition accounted for small but significant proportions of changes in symptoms (proportion mediated [95% confidence interval] 0.13 [0.07 to 0.21]; P < .001) and disease-specific quality of life (0.11 [0.04 to 0.20]; P = .004). Changes in polysomnographic severity similarly mediated symptom score (proportion mediated 0.18 [0.11 to 0.26]; P < .001) and disease-specific quality-of-life outcomes (0.20 [0.10 to 0.31]; P = .004). Importantly, significant mediation effects were not identified for any of the other 16 outcomes. No significant interactions were observed between the trial arms. CONCLUSIONS: The majority of the treatment-related changes in outcomes of OSA in school-aged children are not causally attributable to polysomnographic resolution or changes in its severity. These results underscore the limited utility of polysomnographic thresholds in the management of childhood OSA.

Quaternized cellulose and graphene oxide crosslinked polyphenylene oxide based anion exchange membrane.

Anion exchange membrane fuel cells (AEMFCs) have captivated vast interest due to non-platinum group metal catalysts and fuel flexibility. One of the major shortcomings of AEMFCs, however, is the lack of a stable and high anion conducting membrane. This study introduces a new strategy for fabrication of high conducting anion exchange membrane (AEM) using a hybrid nanocomposite of graphene oxide (GO), cellulose, and poly(phenylene oxide) (PPO), which are functionalized with 1,4-diazabicyclo[2.2.2]octane. The compositional ratio of GO/cellulose/PPO was optimized with respect to ionic conductivity, water uptake, swelling ratio, and mechanical properties. The membrane at GO/cellulose/PPO weight ratio of 1/1/100 displayed an impressive hydroxyl conductivity of ∼114 mS/cm at 25 °C and ∼215 mS/cm at 80 °C, which is considerably higher than the highest value reported. Further, the hybrid composite membranes were mechanically stable even when operating at high temperature (80 °C). The result indicates that the introduction of quaternized GO and cellulose into a polymer matrix is a promising approach for designing high performance AEMs.

PITUITARY IMAGING BY MRI AND ITS CORRELATION WITH BIOCHEMICAL PARAMETERS IN THE EVALUATION OF MEN WITH HYPOGONADOTROPIC HYPOGONADISM.

Objective: A significant ambiguity still remains about which patient deserves a magnetic resonance imaging (MRI) scan of the pituitary during evaluation of hypogonadotropic hypogonadism (HH) in men. Methods: Retrospective case series of 175 men with HH referred over 6 years. Results: A total of 49.7% of men had total testosterone (TT) levels lower than the Endocrine Society threshold of 5.2 nmol/L. One-hundred forty-two patients (81.2%) had normal appearance of pituitary MRI, whereas others had different spectrum of abnormalities (empty sella [n = 16], macroadenoma [n = 8], microadenoma [n = 8], and pituitary cyst [n = 1]). In men with TT in the lowest quartile, MRI pituitary findings were not significantly different from men in the remaining quartiles (P = .50). Patients with raised prolactin had higher number of abnormal MRI findings (38.9% vs. 13.7%; P = .0014) and adenomatous lesions (macro and micro) (27.8% vs. 4.3%; P = .01) in comparison to men with normal prolactin. The prolactin levels (median [interquartile range]) were highest in men with macroadenomas in both groups (9,950 [915]; P = .007 and 300 [68.0] mU/L; P = .02, respectively), with concomitant lower levels of other pituitary hormones. Multivariate logistic regression showed an association of abnormal pituitary MRI with insulin-like growth factor 1 (IGF-1) standard deviation score (SDS) (odds ratio [OR], 1.78 [95% confidence interval (CI), 1.15 to 2.77]; P = .009) and prolactin (OR, 1.00 [95% CI, 1.00 to 1.03]; P = .01). Conclusion: MRI of the pituitary is not warranted in all patients with HH, as the yield of identifiable abnormalities is quite low. Anatomic lesions are likely to be present only when low levels of TT (<5.2 nmol/L) are found concomitantly with high levels of prolactin and/or low IGF-1 SDS. Abbreviations: CI = confidence interval; FT4 = free thyroxine; GH = growth hormone; HH = hypogonadotropic hypogonadism; IGF-1 = insulin-like growth factor; LH = luteinizing hormone; MRI = magnetic resonance imaging; OR = odds ratio; SDS = standard deviation score; TSH = thyroid-stimulating hormone; TT = total testosterone.

GRANULOMATOUS DISEASE OF UNUSUAL SITES CAUSING HYPERCALCEMIA: TWO CASE REPORTS.

OBJECTIVE: Hypercalcemia with suppressed parathyroid hormone (PTH) levels is mostly due to granulomatous disease (GD) or neoplastic disease. In GD, autonomous activity of extra-renal 1α-hydroxylase enzyme is usually the underlying cause. We describe a pair of cases where hypercalcemia resulted from GD of unusual sites posing significant diagnostic challenges. METHODS: We describe 2 cases of PTH-independent hypercalcemia due to GD of the prostate gland and the stomach. RESULTS: Both cases presented with marked hypercalcemia and suppressed PTH levels. Case 1 is an elderly male who presented with marked symptomatic hypercalcemia on multiple occasions. Investigations revealed elevated levels of 1,25-dihydroxyvitamin D3 and prostate-specific antigen but normal PTH-related protein. Transrectal biopsy of the prostate gland confirmed the presence of chronic granulomatous prostatitis. The patient responded very well to steroids which entirely normalized his calcium level. Case 2 is a male who presented similarly with significant hypercalcemia but had upper gastrointestinal symptoms and anemia at onset. Endoscopy and biopsy established the presence of granulomatous gastritis likely due to Crohn disease which responded to steroids resulting in normalization of calcium levels within a short span of time. CONCLUSION: While the majority of PTH-independent hypercalcemia cases are due to GDs of lymph nodes or malignancy, our cases indicate that in uncertain cases, granulomatous processes involving unusual sites should be considered in the evaluation of hypercalcemia with suppressed PTH.

Cinacalcet: A Viable Therapeutic Option for Primary Hyperparathyroidism in the Elderly.

OBJECTIVE: Parathyroidectomy is usually curative in primary hyperparathyroidism (PHPT), but its utility would be limited if patients are elderly who may either refuse surgery or may have advanced frailty and multimorbidity. We evaluated the effectiveness of cinacalcet, an allosteric modulator of calcium-sensing receptor in PHPT in an elderly cohort of patients. METHODS: A prospective analysis of 29 patients who had PHPT and despite fulfilling criteria for surgery were unable to undergo parathyroidectomy either due to self-refusal (n = 12) or due to advanced multimorbidity (n = 17). All patients completed treatment with cinacalcet for at least for 6 months. Analysis were performed as per age (<75 and ≥75 years) and Charlson comorbidity index (CCI) score (≤5 and >5). RESULTS: Our patients were the elderly (77 ± 12.7 years). In the whole group, complete normocalcemia was observed in 72.4% of patients (mean reduction: -0.55 mmol/l [confidence interval (CI) 0.4--0.7; P < 0.0001]) and parathormone (PTH) normalized (≤6.9 pmol/l) in 33.4% of patients [mean reduction: -5.5 pmol/l (CI -11.6-0.6; P = 0.0015)]. In subgroup analysis, the severity of hypercalcemia was found to be higher patients with age <75 years and also in patients with CCI score >5. Cinacalcet lowered adjusted calcium in both age groups (P < 0.0001) with a greater reduction (20.5% vs. 16.2%; P < 0.0001 for both) in patients with CCI score >5. PTH fell in both age groups but significantly (-6.7 pmol/l [CI -14.9-1.5]; P = 0.008) in ≥ 75 years category and likewise, the drop was greater in patients with higher CCI scores (-7.1 pmol/l [CI -15.8-1.6); P = 0.009] vs. [-4.5 pmol/l [CI -3.9--5.10]; P = 0.001). Patients with age <75 years and with CCI score ≤5 needed higher doses of cinacalcet to achieve biochemical targets. CONCLUSION: Cinacalcet is a viable and valuable treatment strategy for elderly patients with multiple comorbidities who suffer from PHPT but either cannot or refuse to undergo parathyroidectomy.

Conceptual data sampling for breast cancer histology image classification.

Data analytics have become increasingly complicated as the amount of data has increased. One technique that is used to enable data analytics in large datasets is data sampling, in which a portion of the data is selected to preserve the data characteristics for use in data analytics. In this paper, we introduce a novel data sampling technique that is rooted in formal concept analysis theory. This technique is used to create samples reliant on the data distribution across a set of binary patterns. The proposed sampling technique is applied in classifying the regions of breast cancer histology images as malignant or benign. The performance of our method is compared to other classical sampling methods. The results indicate that our method is efficient and generates an illustrative sample of small size. It is also competing with other sampling methods in terms of sample size and sample quality represented in classification accuracy and F1 measure.

Predicting malignancy in thyroid nodules: feasibility of a predictive model integrating clinical, biochemical, and ultrasound characteristics.

BACKGROUND: Although the majority of thyroid nodules are benign the process of excluding malignancy is challenging and sometimes involves unnecessary surgical procedures. We explored the development of a predictive model for malignancy in thyroid nodules by integrating a combination of simple demographic, biochemical, and ultrasound characteristics. METHODS: Retrospective case-record review. We reviewed records of patients with thyroid nodules referred to our institution from 2004 to 2011 (n = 536; female 84 %, mean age 51 years). All malignancy was proven histologically while benign disease was either confirmed histologically, or on cytology with minimum 36-month observation period. We focused on the following predictors: age, sex, smoking status, thyroid hormones (FT4 and TSH) and nodule characteristics on ultrasound. Variables were included in a multivariate logistic regression and bootstrap analyses were used to confirm results. RESULTS: Independent predictors of malignancy in the fully adjusted model were TSH (OR 1.53, 95 % CI 1.10, 2.12, p = 0.01), male gender (OR 3.45, 95 % CI 1.33, 8.92, p = 0.01), microcalcifications (OR 6.32, 95 % CI 2.82, 14.1, p < 0.001), and irregular nodule margins (OR 5.45, 95 % CI 1.61, 18.6, p = 0.006) Bootstrap analyses strengthened these associations and a parsimonious analysis consisting of these variables and age-group demonstrated an area under the curve of 0.77. A predictive score was sensitive (86.9 %) at low scores and highly specific (94.87 %) at higher scores for distinguishing benign from malignant disease. CONCLUSIONS: A predictive model for malignancy using a combination of clinical, biochemical, and radiological characteristics may support clinicians in reducing unnecessary invasive procedures in patients with thyroid nodules.

Thyroid antibody-negative euthyroid Graves' ophthalmopathy.

UNLABELLED: TSH receptor antibodies (TRAbs) are the pathological hallmark of Graves' disease, present in nearly all patients with the disease. Euthyroid Graves' ophthalmopathy (EGO) is a well-recognized clinical entity, but its occurrence in patients with negative TRAbs is a potential source of diagnostic confusion. A 66-year-old female presented to our endocrinology clinic with right eye pain and diplopia in the absence of thyroid dysfunction. TRAbs were negative, as measured with a highly sensitive third(-)generation thyrotropin-binding inhibitory immunoglobulin (TBII) ELISA assay. CT and MRI scans of the orbit showed asymmetrical thickening of the inferior rectus muscles but no other inflammatory or malignant orbital pathology. Graves' ophthalmopathy (GO) was diagnosed on the basis of the clinical and radiological features, and she underwent surgical recession of the inferior rectus muscle with complete resolution of the diplopia and orbital pain. She remained euthyroid over the course of follow-up but ultimately developed overt clinical and biochemical hyperthyroidism, 24 months after the initial presentation. By this time, she had developed positive TRAb as well as thyroid peroxidase antibodies. She responded to treatment with thionamides and remains euthyroid. This case highlights the potential for negative thyroid-specific autoantibodies in the presentation of EGO and underscores the variable temporal relationship between the clinical expression of thyroid dysfunction and orbital disease in the natural evolution of Graves' disease. LEARNING POINTS: Euthyroid Graves' ophthalmopathy can present initially with negative thyroid-specific autoantibodies.Patients with suggestive symptoms of ophthalmopathy should be carefully evaluated for GO with imaging studies even when thyroid function and autoantibodies are normal.Patients with EGO can develop thyroid dysfunction within 4 years of follow-up underpinning the need for long-term follow-up and continued patient and physician vigilance in patients who have been treated for EGO.

Nickel/cobalt oxide-decorated 3D graphene nanocomposite electrode for enhanced electrochemical detection of urea.

A NiCo2O4 bimetallic electro-catalyst was synthesized on three-dimensional graphene (3D graphene) for the non-enzymatic detection of urea. The structural and morphological properties of the NiCo2O4/3D graphene nanocomposite were characterized by X-ray diffraction, Raman spectroscopy, and scanning electron microscopy. The NiCo2O4/3D graphene was deposited on an indium tin oxide (ITO) glass to fabricate a highly sensitive urea sensor. The electrochemical properties of the prepared electrode were studied by cyclic voltammetry. A high sensitivity of 166 µAmM(-)(1)cm(-)(2) was obtained for the NiCo2O4/3D graphene/ITO sensor. The sensor exhibited a linear range of 0.06-0.30 mM (R(2)=0.998) and a fast response time of approximately 1.0 s with a detection limit of 5.0 µM. Additionally, the sensor exhibited high stability with a sensitivity decrease of only 5.5% after four months of storage in ambient conditions. The urea sensor demonstrates feasibility for urea analysis in urine samples.

Resistant hypertension with adrenal nodule: are we removing the right gland?

UNLABELLED: Resistant hypertension is often difficult to treat and may be associated with underlying primary aldosteronism (PA). We describe the case of an elderly gentleman who presented with severe and resistant hypertension and was found to have a left adrenal incidentaloma during evaluation but had aldosterone excess secondary to unilateral adrenal hyperplasia (UAH) of the contralateral gland, which needed surgical intervention. A 65-year-old gentleman was evaluated for uncontrolled high blood pressure (BP) in spite of taking four antihypertensive medications. The high BP was confirmed on a 24-h ambulatory reading, and further biochemical evaluation showed an elevated serum aldosterone renin ratio (ARR) (1577 pmol/l per ng per ml per h). Radiological evaluation showed an adrenal nodule (15 mm) in the left adrenal gland but an adrenal vein sampling demonstrated a lateralization towards the opposite site favouring the right adrenal to be the source of excess aldosterone. A laparoscopic right adrenalectomy was performed and the histology of the gland confirmed nodular hyperplasia. Following surgery, the patient's BP improved remarkably although he remained on antihypertensives and under regular endocrine follow-up. PA remains the most common form of secondary and difficult-to-treat hypertension. Investigations may reveal incidental adrenal lesions, which may not be the actual source of excess aldosterone, but UAH may be a contributor and may coexist and amenable to surgical treatment. An adrenal vein sampling should be undertaken for correct lateralization of the source, otherwise a correctable diagnosis may be missed and the incorrect adrenal gland may be removed. LEARNING POINTS: Severe and resistant hypertension can often be associated with underlying PA.ARR is an excellent screening tool in patients with suspected PA.Lateralization with adrenal venous sampling is essential to isolate the source and differentiate between unilateral and bilateral causes of hyperaldosteronism.Adrenal incidentalomas and UAH may coexist and the latter may often be the sole cause of excess aldosterone secretion.Decisions about adrenalectomy should be made only after integrating and interpreting radiological and biochemical test findings properly.

Spherulitic copper-copper oxide nanostructure-based highly sensitive nonenzymatic glucose sensor.

In this work, three different spherulitic nanostructures Cu-CuOA, Cu-CuOB, and Cu-CuOC were synthesized in water-in-oil microemulsions by varying the surfactant concentration (30 mM, 40 mM, and 50 mM, respectively). The structural and morphological characteristics of the Cu-CuO nanostructures were investigated by ultraviolet-visible (UV-vis) spectroscopy, X-ray diffraction, scanning electron microscopy, and high-resolution transmission electron microscopy techniques. The synthesized nanostructures were deposited on multiwalled carbon nanotube (MWCNT)-modified indium tin oxide (ITO) electrodes to fabricate a nonenzymatic highly sensitive amperometric glucose sensor. The performance of the ITO/MWCNT/Cu-CuO electrodes in the glucose assay was examined by cyclic voltammetry and chronoamperometric studies. The sensitivity of the sensor varied with the spherulite type; Cu-CuOA, Cu-CuOB, and Cu-CuOC exhibited a sensitivity of 1,229, 3,012, and 3,642 µA mM(-1)·cm(-2), respectively. Moreover, the linear range is dependent on the structure types: 0.023-0.29 mM, 0.07-0.8 mM, and 0.023-0.34 mM for Cu-CuOA, Cu-CuOB, and Cu-CuOC, respectively. An excellent response time of 3 seconds and a low detection limit of 2 µM were observed for Cu-CuOB at an applied potential of +0.34 V. In addition, this electrode was found to be resistant to interference by common interfering agents such as urea, cystamine, L-ascorbic acid, and creatinine. The high performance of the Cu-CuO spherulites with nanowire-to-nanorod outgrowths was primarily due to the high surface area and stability, and good three-dimensional structure. Furthermore, the ITO/MWCNT/Cu-CuOB electrode applied to real urine and serum sample showed satisfactory performance.

Can Postoperative Nutrition be Favourably Maintained by Oral Diet in Patients with Emergency Temporary Ileostomy? A Tertiary Hospital Based Study.

INTRODUCTION: Temporary ileostomy is an emergency procedure performed in cases having septic peritonitis in presence of perforation or obstruction or gangrene of small intestine. These patients usually suffer from gross malnutrition following surgery. AIM: To measure nutritional status of patients with emergency temporary ileostomy and to determine whether their postoperative nutrition can be favourably maintained by oral diet alone. MATERIALS AND METHODS: Sixty patients were enrolled for the study on the basis of inclusion and exclusion criteria during the study period from January 2012 to December 2013. Oral feeding was started as soon as ileostomy started functioning and patients expressed hunger, about 48-72 hours postoperatively. An individualized diet chart was formulated for each patient using Harris Benedict Equation. Nutritional assessment was done on 1) 1(st) day of oral feeding, 2) After 7 days of oral feeding, 3). After three months of oral feeding. Nutritional parameters (anthropometric, biochemical) employed were tabulated and statistically analysed with SPSS v 17, Chicago. RESULTS: Out of 60 patients, 36 males and 24 females were enrolled in the study. The patients were in the age group of 20-60 years with a mean age of 45 years. After 7 days of oral nutrition the nutritional status deteriorated with a significant decrease in body weight (p<0.001) and serum haemoglobin (p <0.001). However, at the end of the study, the patients had their nutritional status restored satisfactorily with normalization of basic parameters like bodyweight, haemoglobin and serum albumin (p<0.001). CONCLUSION: Proper dietary advice and oral nutrition were found to be sufficient for gradual restoration and maintenance of satisfactory nutritional status in the postoperative period.