Socioeconomic Disparities in Anal Cancer: Effect on Treatment Delay and Survival.

BACKGROUND: Socioeconomic inequities have implications for access to health care and may be associated with disparities in treatment and survival. OBJECTIVE: To investigate the impact of socioeconomic inequities on time to treatment and survival of anal squamous-cell carcinoma. DESIGN: This is a retrospective study using a nationwide data set. SETTINGS: The patients were selected from the National Cancer Database and enrolled from 2004 to 2016. PATIENTS: We identified patients with stage I to III squamous-cell carcinoma of the anus who were treated with chemoradiation therapy. MAIN OUTCOMES MEASURES: Socioeconomic factors, including race, insurance status, median household income, and percentage of the population with no high school degrees, were included. The association of these factors with treatment delay and overall survival was investigated. RESULTS: A total of 24,143 patients who underwent treatment for grade I to III squamous-cell carcinoma of the anus were identified. The median age was 60 years, and 70% of patients were women. The median time to initiation of treatment was 33 days. Patients from zip codes with lower median income, patients with a higher percentage of no high school degree, and patients with other government insurance followed by Medicaid insurance had treatment initiated after 60 days from diagnosis. Kaplan-Meier survival analysis showed that the late-treatment group had worse overall survival compared to the early treatment group (98 vs 125 months; p < 0.001). LIMITATIONS: No detailed information is available about the chemoradiotherapy regimen, completion of treatment, recurrence, disease-free survival, and individual-level socioeconomic condition and risk factors. CONCLUSION: Patients from communities with lower median income, level of education, and enrolled in public insurance had longer time to treatment. Lower socioeconomic status was also associated with poorer overall survival. These results warrant further analysis and measures to improve access to care to address this disparity. See Video Abstract . DESIGUALDADES SOCIOECONMICAS EN CASOS DE CNCER ANAL EFECTOS EN EL RETRASO DEL TRATAMIENTO Y LA SOBREVIDA: ANTECEDENTES:Las desigualdades socio-económicas tienen implicaciones en el acceso a la atención médica y pueden estar asociadas con disparidades en el tratamiento y la sobrevida.OBJETIVO:Indagar el impacto de las desigualdades socio-económicas sobre el tiempo de retraso en el tratamiento y la sobrevida en casos de carcinoma a células escamosas del ano (CCEA).DISEÑO:Estudio retrospectivo utilizando un conjunto de datos a nivel nacional.AJUSTES:Todos aquellos pacientes inscritos entre 2004 a 2016 y que fueron seleccionados de la Base Nacional de Datos sobre el Cáncer.PACIENTES:Identificamos pacientes con CCEA en estadíos I-III y que fueron tratados con radio-quimioterápia.PRINCIPALES MEDIDAS DE RESULTADOS:Se incluyeron factores socio-económicos tales como la raza, el tipo de seguro de salud, el ingreso familiar medio y el porcentaje de personas sin bachillerato de secundaria (SBS). Se investigó la asociación entre estos factores con el retraso en iniciar el tratamiento y la sobrevida global.RESULTADOS:Se identificaron un total de 24.143 pacientes que recibieron tratamiento para CCEA estadíos I-III. La mediana de edad fue de 60 años donde 70% eran de sexo femenino. La mediana del tiempo transcurrido desde el diagnóstico hasta el inicio del tratamiento fue de 33 días. Los pacientes residentes en zonas de código postal con ingresos medios más bajos, con un mayor porcentaje de individuos SBS y los pacientes con otro tipo de seguro gubernamental de salud, seguidos del seguro tipo Medicaid iniciaron el tratamiento solamente después de 60 días al diagnóstico inicial de CCEA. El análisis de Kaplan-Meier de la sobrevida mostró que el grupo de tratamiento tardío tuvo una peor supervivencia general comparada con el grupo de tratamiento precoz o temprano (98 frente a 125 meses; p <0,001).LIMITACIONES:No se dispone de información detallada sobre el tipo de radio-quimioterapia utilizada, ni sobre la finalización del tratamiento o la recurrencia, tampoco acerca de la sobrevida libre de enfermedad ni sobre las condiciones socio-económicas o aquellos factores de riesgo a nivel individual.CONCLUSIÓN:Los pacientes de comunidades con ingresos medios más bajos, con un nivel de educación limitado e inscritos en un seguro público tardaron mucho más tiempo en recibir el tratamiento prescrito. El nivel socio-económico más bajo también se asoció con una sobrevida global más baja. Los presentes resultados justifican mayor análisis y medidas mas importantes para mejorar el acceso a la atención en salud y poder afrontar esta disparidad. (Traducción-Dr. Xavier Delgadillo ).

Construction of Host Plant Insect-Resistance Mutant Library by High-Throughput CRISPR/Cas9 System and Identification of A Broad-Spectrum Insect Resistance Gene.

Insects pose significant challenges in cotton-producing regions. Here, they describe a high-throughput CRISPR/Cas9-mediated large-scale mutagenesis library targeting endogenous insect-resistance-related genes in cotton. This library targeted 502 previously identified genes using 968 sgRNAs, generated ≈2000 T0 plants and achieved 97.29% genome editing with efficient heredity, reaching upto 84.78%. Several potential resistance-related mutants (10% of 200 lines) their identified that may contribute to cotton-insect molecular interaction. Among these, they selected 139 and 144 lines showing decreased resistance to pest infestation and targeting major latex-like protein 423 (GhMLP423) for in-depth study. Overexpression of GhMLP423 enhanced insect resistance by activating the plant systemic acquired resistance (SAR) of salicylic acid (SA) and pathogenesis-related (PR) genes. This activation is induced by an elevation of cytosolic calcium [Ca2+ ]cyt flux eliciting reactive oxygen species (ROS), which their demoted in GhMLP423 knockout (CR) plants. Protein-protein interaction assays revealed that GhMLP423 interacted with a human epidermal growth factor receptor substrate15 (EPS15) protein at the cell membrane. Together, they regulated the systemically propagating waves of Ca2+ and ROS, which in turn induced SAR. Collectively, this large-scale mutagenesis library provides an efficient strategy for functional genomics research of polyploid plant species and serves as a solid platform for genetic engineering of insect resistance.

Use of Optical Coherence Tomography in Dentistry.

Optical coherence tomography (OCT) is an optics-based imaging technique, which may be called an "optical biopsy." It can be used to acquire structural information about a tissue at a resolution comparable to histopathology. OCT is based on the principle of low-coherence interferometry where near-infrared (NIR) light is shown on a tissue sample and then cross-sectional images are obtained based on backscattered light and echo time delay. Two main types of OCT are characterized as time-domain OCT (TD-OCT) and Fourier-domain OCT (FD-OCT). The applications of OCT in dentistry can be broadly divided into two groups, i.e., assessment of pathologies and assessment of surfaces and interfaces. Lately, OCT has made its transition from experimental laboratories to mainstream clinical applications. Starting from the short-term training courses, clinicians working in specialities like oral pathology, oral medicine, and oral implantology may find it a useful tool for their practices. It is now clear that OCT will be considered a gold standard diagnostic tool for the detection and characterization of several conditions and lesions of the orofacial region. However, the next challenge will be to incorporate it into the undergraduate and postgraduate curriculum and train dental healthcare staff in the use of these devices.

Exploring the potential impact of GLP-1 receptor agonists in cancer therapy.

Glucagon-like peptide-1 (GLP-1) receptor agonists are used in diabetes management and can have a potential application in cancer therapy. While their involvement in cancer treatment is still being studied, recent research suggests they may have benefits in cancer therapy. A comprehensive literature search was conducted using search engines like Google Scholar, Scopus, and PubMed to explore the effects of GLP-1 receptor agonists in tumor suppression and regression. Mostly in-vitro studies on GLP-1 receptor agonists have shown promising effects in inhibiting cancer cell growth, inducing apoptosis, and modulating angiogenesis and have been reported to be beneficial in colon, prostate, gall bladder, ovarian, and endometrial carcinomas. However, concerns have been raised about potential tumorigeneses, as liraglutide has been reported to be associated with increased incidence of breast, thyroid, and pancreatic carcinomas. Whereas combination therapy of exendin-4 with gemcitabine may be beneficial in pancreatic cancer. GLP-1 receptor agonists may have significant potential in oncology, due to their various mechanisms of action and favorable safety profiles. Limited clinical application, lack of awareness, and the need for further research are current barriers. Future studies should focus on optimal dosage, patient selection, and interdisciplinary collaboration to integrate GLP-1 receptor agonists into routine oncological practice for improved outcomes, warranting large randomized clinical trials in this field.

Prevalence of Psychiatric Comorbidities in Patients With Neurofibromatosis.

Objective: To assess the prevalence of psychiatric comorbidities in patients with neurofibromatosis.Methods: In this cross-sectional study, we used the 2010-2014 National Inpatient Sample database. Patients ≥ 18 years of age with a primary or secondary diagnosis of neurofibromatosis and psychiatric comorbidities were queried.Results: A total of 43,270 patients with a mean age of 48.7 years (female: 55.7%, White: 70.1%) were included in the study. Overall, psychiatric comorbidities were present in 46.5% of patients; mood disorders (22.1%) and anxiety disorders (12.2%) were the most prevalent comorbidities. Although previous studies report prevalence rates of attention-deficit/hyperactivity disorder in up to 50% of patients with neurofibromatosis, our study found that the rate was much lower at 1.10%. Female sex and non-White race were less associated with psychiatric comorbidities (odds ratio = 0.868 [P = .003] and 0.689 [P < .001], respectively). The moderate-to-extreme loss of function illness severity category was associated with 1.35-times higher odds of having psychiatric comorbidities compared to mild-to-moderate or no loss of function (P < .001). The total length of stay was similar in patients with and without psychiatric comorbidities (mean = 4.98 [95% CI, 4.72-5.24] vs mean = 4.83 [95% CI, 4.60-5.07], respectively; P = .34).Conclusions: In adult patients with neurofibromatosis, 46.5% were found to have at least one psychiatric comorbid diagnosis. The most frequent psychiatric comorbid disorders were mood disorders and anxiety disorders. Female sex and non-White race predicted a lower likelihood of having a psychiatric disorder.Prim Care Companion CNS Disord 2023;25(5):23m03514. Author affiliations are listed at the end of this article.

A feasibility study of several 3D printing methods for applications in epilepsy surgery.

OBJECTIVE: To describe the process of three-dimensional printing in epilepsy surgery using three different methods: low-force stereolithography (SLA), filament deposition modeling (FDM), and Polyjet Stratasys, while comparing them in terms of printing efficiency, cost, and clinical utility. MRI and CT images of patient anatomy have been limited to review in the two-dimensional plane, which provides only partial representation of intricate intracranial structures. There has been growing interest in 3D printing of physical models of this complex anatomy to be used as an educational tool and for surgical visualization. One specific application is in epilepsy surgery where there are challenges in visualizing complex intracranial anatomy in relation to implanted surgical tools. METHODS: MRI and CT data from patients with refractory epilepsy from a single center that underwent surgery are converted into 3D volumes, or stereolithography files. These were then printed using three popular 3D printing methods: SLA, FDM, and Polyjet. Faculty were surveyed on the impact of 3D modeling on the surgical planning process. RESULTS: All three methods generated physical models with an increasing degree of resolution, transparency, and clinical utility directly related to cost of production and accurate representation of anatomy. Polyjet models were the most transparent and clearly represented intricate implanted electrodes but had the highest associated cost. FDM produced relatively inexpensive models that, however, were nearly completely opaque, limiting clinical utility. SLA produced economical and highly transparent models but was limited by single material capacity. SIGNIFICANCE: Three-dimensional printing of patient-specific anatomy is feasible with a variety of printing methods. The clinical utility of lower-cost methods is limited by model transparency and lack of multi-material overlay respectively. Polyjet successfully generated transparent models with high resolution of internal structures but is cost-prohibitive. Further research needs to be done to explore cost-saving methods of modeling.

Macrofungi as Medicinal Resources in Uzbekistan: Biodiversity, Ethnomycology, and Ethnomedicinal Practices.

Interest in edible and medicinal macrofungi is millennial in terms of their uses in health and food products in Central Asia, while interest in inedible and medicinal macrofungi has grown in popularity in recent years. Edible and inedible medicinal basidiomycetes were collected during field surveys from different regions of Uzbekistan. The morphological characters and similarity assessment of rDNA-Internal Transcribed Spacer sequence data were used to measure diversity and habitat associations. A number of 17 species of medicinal macrofungi of ethnomycological and medicinal interest was found associated with 23 species of trees and shrubs belonging to 11 families and 14 genera. Polyporaceae and Hymenochaetaceae were represented by the highest number of species followed by Ganodermataceae, Fomitopsidaceae, Auriculariaceae, Cerrenaceae, Grifolaceae, Phanerochaetaceae, Laetiporaceae, Schizophyllaceae, and Stereaceae. The highest number of medicinal basidiomycete species was reported in the following host genera: Acer, Betula, Celtis, Crataegus, Juglans, Juniperus, Lonicera, Malus, Morus, Platanus, Populus, Prunus, Quercus, and Salix. An updated list of edible and inedible medicinal mushrooms identified in Uzbekistan, their morphological characteristics, and phylogenetic placement are given for the first time. Information is provided on their uses in traditional and modern medicine. Their bioactive compounds and extracts can be applied as medicines, as well as food and cosmetic ingredients.

Optimization of the photocatalytic degradation of phenol using superparamagnetic iron oxide (Fe3O4) nanoparticles in aqueous solutions.

The present work was carried out to remove phenol from aqueous medium using a photocatalytic process with superparamagnetic iron oxide nanoparticles (Fe3O4) called SPIONs. The photocatalytic process was optimized using a central composite design based on the response surface methodology. The effects of pH (3-7), UV/SPION nanoparticles ratio (1-3), contact time (30-90 minutes), and initial phenol concentration (20-80 mg L-1) on the photocatalytic process were investigated. The interaction of the process parameters and their optimal conditions were determined using CCD. The statistical data were analyzed using a one-way analysis of variance. We developed a quadratic model using a central composite design to indicate the photocatalyst impact on the decomposition of phenol. There was a close similarity between the empirical values gained for the phenol content and the predicted response values. Considering the design, optimum values of pH, phenol concentration, UV/SPION ratio, and contact time were determined to be 3, 80 mg L-1, 3, and 60 min, respectively; 94.9% of phenol was eliminated under the mentioned conditions. Since high values were obtained for the adjusted R2 (0.9786) and determination coefficient (R2 = 0.9875), the response surface methodology can describe the phenol removal by the use of the photocatalytic process. According to the one-way analysis of variance results, the quadratic model obtained by RSM is statistically significant for removing phenol. The recyclability of 92% after four consecutive cycles indicates the excellent stability of the photocatalyst for practical applications. Our research findings indicate that it is possible to employ response surface methodology as a helpful tool to optimize and modify process parameters for maximizing phenol removal from aqueous solutions and photocatalytic processes using SPIONs.

Research progress in physiological effects of resistant substances of Urtica dioica L. on animal performance and feed conversion.

Several members of family Urticaceae are mainly found in the temperate and subtropical zones of the Northern Hemisphere and are important medicinal plants. Among them, Urtica dioica L. (Urticaceae) is an annual or perennial herb that has been used for feeding and medicinal purposes since long time and is the most exploited species of Urticaceae. Recently, it has received attention to be used as animal feed, as its fresh leaves fed to animals in moderate, dried, and other forms. This review details the advantages of U. dioica as an alternative feed in terms of germplasm specificity, nutritional composition, and feed application status. Its roots, stems, leaves, and seeds are rich in active ingredients. It has also been found to have anticancer effects through antioxidant action and promotion of apoptosis of cancer cells. In shady conditions, U. dioica is highly adaptable while under stressful conditions of drought; it also reduces light absorption and ensures carbon assimilation through light energy conversion efficiency. Therefore, it can be added to animal diets as a suitable feed to reduce costs and improve economic efficiency. This paper investigates the feasibility of using U. dioica as a feed and systematically presents the progress of research and exploitation of U. dioica.

Applications of Metformin in Dentistry-A review.

Metformin is a versatile drug with numerous medical uses. It is known primarily as an anti-hyperglycemic drug that has become the main oral blood-glucose-lowering medication for managing type 2 diabetes mellitus globally. Its use has been reported in a variety of oral conditions and dentistry in general. Recent clinical trials have indicated the effectiveness of adjunct topical application of metformin in improving the periodontal parameters of patients with diabetes and periodontitis. Additionally, studies have suggested that metformin stimulates odontogenic differentiation and mineral synthesis of stem cells in the tooth pulp. Metformin also stimulates osteoblast proliferation, decreases osteoclast activity and exerts regenerative effects on periodontal bone, thus making it a viable candidate for periodontal regeneration. Metformin monotherapy significantly enhances osseointegration of endosseous implants and has been reported to have anti-cancer effects on oral squamous cell carcinoma by impeding tumor progression. Animal studies have indicated that metformin improves orthodontic tooth movement and resists orthodontic appliance corrosion. This narrative review aims to provide a current summary of research highlighting the prospective uses of metformin in dentistry.

Rice Nutraceuticals and Bioactive Compounds: Extraction, Characterization and Antioxidant Activity: A Review.

Rice (Oryza sativa L.), a cereal grass, belongs to the genus Oryza from the family Poaceae, which encompasses twenty-five species cultured in many countries of Asia, and partly in the rest of the world. From these species, two viz. Oryza sativa (O. sativa) Asian rice and Oryza glaberrima (O. glaberrima) African rice are commonly found and the most widely consumed staple food by a large part of the human population in the world, especially in Asia due to their nutritional and nutraceutical prospects. Rice, a popular source of carbohydrates, also contains a good amount of dietary fiber, minerals (Ca, Zn, Se, P, K, Mg, Fe, and Mn), protein and vitamin B along with several other medicinally important bioactives such as tocols (α-tocopherols and α-tocotrienols) (ßsitosterol) phenolic acids, flavonoids (apiginine), and oryzanol (24-Methylenecylcoartanyl transferulate). Rice bran is a byproduct of the rice polishing industry and is valuable in terms of containing 15-20% high-value oil. Because of the natural antioxidants present in rice, several medicinal benefits and biological properties can be attributed to rice consumption. The nutrient profile of rice varies based on several factors, such as grains (white, brown, red, and black/purple), the extent of polishing, and the preparation method. Considering the importance of rice as a traditional diet rich in high-value bioactives, together with the existing gap of related information, it is worthwhile to assemble a comprehensive review that focuses on the detailed profile of valuable nutrients and high-value phytochemicals and biological activities of rice to explore its functional food and nutraceutical applications. This review attempts to provide collective information on the essential rice cereal for its nutritional and antioxidant potential.

Clinicopathological correlation of aspartate aminotransferase-to-platelet ratio (APRI) and aspartate aminotransferase-to-alanine aminotransferase ratio (AAR) with survival in esophageal carcinoma patients: a retrospective cohort analysis of 951 patients.

Esophageal cancer is the eighth most prevalent cancer globally. Previously, several biomarkers have been used to predict the prognosis, although with variable reliability. Interestingly, it is noted that changes in liver function tests levels before and after neoadjuvant treatment are predictive in terms of cancer recurrence. Objectives: The objectives of the current study were to associate novel markers, including aspartate aminotransferase-to-platelet ratio (APRI) and aspartate aminotransferase-to-alanine aminotransferase ratio (AAR) with survival in esophageal malignancy. Materials and Methods: A retrospective study in a tertiary care hospital (single-center) included 951 patients having diagnosed esophageal carcinoma of any age group. Results: The median (interquartile range) age of study participants were 50 (38-60) years, including 43% males and 57% female patients, while the median (interquartile range) levels of AAR and APRI were 0.97 (0.81-1.25) and 0.19 (0.13-0.29), respectively. AAR was found to be higher in dysphagia for solids only and dysphagia for both liquids and solids rather than liquids only (P=0.002), while other associations included well-differentiated tumor grade (P=0.011), finding of esophageal stricture on esophagogastroduodenoscopy (P=0.015), and characteristic of mass on computerized tomography scan being both circumferential and mural (P=0.005). APRI was found to be higher in adenocarcinoma (P=0.038), and finding of circumferential±ulcerated mass on esophagogastroduodenoscopy (P<0.001). On survival analysis, adenocarcinoma (P<0.001), luminal narrowing (P=0.002), AAR greater than 1.0 (P=0.006), and APRI greater than 0.2 (P=0.007) were found to be poor survival predictors. On Cox proportional hazards regression, APRI was found to be more associated with poor survival than AAR (Hazard ratio: 1.682, 1.208-2.340, P=0.002). Conclusion: This study correlated clinical and pathological features of esophageal malignancy with noninvasive markers of hepatic function.

Chrysin Is Immunomodulatory and Anti-Inflammatory against Complete Freund's Adjuvant-Induced Arthritis in a Pre-Clinical Rodent Model.

Chrysin (5,7-dihydroxyflavone) has many pharmacological properties including anti-inflammatory actions. The objective of this study was to evaluate the anti-arthritic activity of chrysin and to compare its effect with the non-steroidal anti-inflammatory agent, piroxicam, against complete Freund's adjuvant (CFA)-induced arthritis in a pre-clinical model in rats. Rheumatoid arthritis was induced by injecting CFA intra-dermally in the sub-plantar region of the left hind paw of rats. Chrysin (50 and 100 mg/kg) and piroxicam (10 mg/kg) were given to rats with established arthritis. The model of arthritis was characterized using an index of arthritis, with hematological, biological, molecular, and histopathological parameters. Treatment with chrysin significantly reduced the arthritis score, inflammatory cells, erythrocyte sedimentation rate, and rheumatoid factor. Chrysin also reduced the mRNA levels of tumor necrosis factor, nuclear factor kappa-B, and toll-like recepter-2 and increased anti-inflammatory cytokines interleukin-4 and -10, as well as the hemoglobin levels. Using histopathology and microscopy, chrysin reduced the severity of arthritis in joints, infiltration of inflammatory cells, subcutaneous inflammation, cartilage erosion, bone erosion, and pannus formation. Chrysin showed comparable effects to piroxicam, which is used for the treatment of rheumatoid arthritis. The results showed that chrysin possesses anti-inflammatory and immunomodulatory effects that make it a potential drug for the treatment of arthritis.

Citrous Lime-A Functional Reductive Booster for Oil-Mediated Green Synthesis of Bioactive Silver Nanospheres for Healthcare Clothing Applications and Their Eco-Mapping with SDGs.

Silver nanoparticles (Ag-NPs) are most effective against pathogens and have widely been studied as antibacterial agents in commodity clothing, medical textile, and other hygiene products. However, prolonged utilization of silver and rapid mutation in bacterium stains has made them resistant to conventional silver agents. On the other hand, strict compliance against excessive utilization of toxic reagents and the current sustainability drive is forcing material synthesis toward green routes with extended functionality. In this study, we proposed an unprecedented chemical-free green synthesis of bioactive Ag-NPs without the incorporation of any chemicals. Cinnamon essential oil (ECO) was used as a bio-reducing agent with and without the mediation of lime extract. A rapid reaction completion with better shape and size control was observed in the vicinity of lime extract when incorporated into the reaction medium. The interaction of natural metabolites and citrus compounds with nanoparticles was established using Fourier transform infrared spectroscopy (FTIR) and Raman spectroscopy. The application of as-prepared nanoparticles on textiles encompasses extended bioactivity to treated fabric with infused easy-care performance. To the best of our knowledge, this is the first reported instance of utilizing bioactive silver nanoparticles as a functional finish, both as an antimicrobial and as for easy care in the absolute absence of toxic chemicals. The easy-care performance of fabric treated with lime-mediated nanoparticles was found to be 141O, which is around 26% better than bare cotton without any significant loss in fabric strength. Furthermore, to enlighten the sustainability of the process, the development traits were mapped with the United Nations Sustainable Development Goals (SDGs), which show significant influence on SDGs 3, 8, 9, and 14. With the effective suspension of microorganisms, added functionality, and eco-mapping with SDGs with the chemical-free synthesis of nanoparticles, widespread utilization can be found in various healthcare and hygiene products along with the fulfillment of sustainability needs.

Membrane reactor for production of biodiesel from nonedible seed oil of Trachyspermum ammi using heterogenous green nanocatalyst of manganese oxide.

Conventional homogeneous-based catalyzed transesterification for the production of biodiesel can be replaced with a membrane reactor that has an immobilized heterogeneous catalyst. Combining reaction with separation while utilizing membranes with a certain pore size might boost conversion process. this investigation to study the effectiveness of membrane reactor in combination with heterogeneous green nano catalysis of MnO2. Techniques such as XRD, EDX, FTIR, SEM, and TGA were used to characterize the synthesized MnO2 nano catalyst. The highest conversion of around 94% Trachyspermum ammi oil was obtained by MnO2. The optimum process variables for maximum conversion were catalyst loading of 0.26 (wt.%), 8:1 M ratio, 90 °C reaction temperature, and time 120 min. The green nano catalyst of MnO2 was reusable up to five cycles with minimum loss in conversion rate of about 75% in the fifth cycle. Nuclear magnetic resonance validated the synthesis of methyl esters. It was concluded that membrane reactor a promising technique to efficiently transesterify triglycerides into methyl esters and enable process intensification uses MnO2 as a catalyst.

Comparison Of Outcome Between Open Haemorrhoidectomy Versus Trans-Anal Doppler Guided Hemorrhoidal Artery Ligation With Recto-Anal Repair In 3rd And 4th Degree Haemorrhoids.

BACKGROUND: Haemorrhoids are very common but their exact prevalence is not known as most of the people suffering from them do not seek medical or surgical advice. The literature states their prevalence to be about 39% and commonly affect people aged between 45-65 years of age. Objective of the study was to compare the outcomes of open haemorrhoidectomy Vs Trans anal Doppler ultrasound guided hemorrhoidal artery ligation with recto-anal repair in 3rd and 4th degree haemorrhoids. It was a Randomized control trial, conducted at the Department of Surgery, King Edward Medical University, Lahore; from October 2019 to March 2021. METHODS: This was a randomized control trial study where the results of 70 patients of haemorrhoids including 3rd and 4th degree disease fulfilling the selection criteria, who underwent open haemorrhoidectomy (OH) and Doppler guided haemorrhoidal artery ligation with rectoanal repair (HAL RAR) procedure on elective and emergency operating lists, were analyzed with regards to post-operative pain, bleeding and hospital stay. RESULTS: From our seventy patients the minimum age was 23 and maximum age limit was 55 years (mean: 35.09±7.47). There were 49 (70%) males and 21 (30%) females. Mean post-op pain on day 7 for OH was 1.12±0.72 and for HAL RAR it was 1.06±0.52. Post-op bleeding (POB) occurred in 4 (10%) patients in OH group and 2(6.66%) patients in HAL RAR group. Mean hospital stay for OH group was 2±0.45 and for HAL RAR it was 1.20±0.40, for POB, it was 1.9±0.30 in OH group and 1.86±0.34 in HAL-RAR group. CONCLUSIONS: There was no significant difference in mean post-op pain on day seven, and post-op bleeding, but there was significant difference in terms of mean hospital stay between the two groups.

Nimbolide attenuates complete Freund's adjuvant induced arthritis through expression regulation of toll-like receptors signaling pathway.

Nimbolide is an active constituent of Azadirachta indica and is known for its anti-inflammatory, anti-oxidant, immune-modulatory, and anti-cancer effects. Few studies suggest that nimbolide treatment influences the responses to rheumatoid arthritis, but the underlying molecular mechanisms involved are not yet well established. Therefore, the present study was designed to determine the effect of nimbolide on expression regulation of toll-like receptors to attenuate rheumatoid arthritis. The rheumatoid arthritis model was established by injecting complete Freund's adjuvant (CFA) intra-dermally into the sub-plantar region of the left hind paw of rats. Nimbolide (20 mg/kg) and piroxicam (10 mg/kg) were given to arthritic rats. Rats treated with nimbolide showed a significant reduction in inflammatory cells, rheumatoid factor, ESR, and improved the body weight. The results indicated that nimbolide possesses the capacity to attenuate rheumatoid arthritis by downregulating toll-like receptors, IL-17, IL-23, HSP70, and IFN-γ expression levels. Nimbolide treatment showed significant reduction in the severity of inflammation and destruction of joints and showed comparable effects to piroxicam, which is a standard non-steroidal anti-inflammatory drug used for the treatment of rheumatoid arthritis. It can be concluded that nimbolide can be considered as a potential candidate for therapeutic targeting of the toll-like receptors pathway in rheumatoid arthritis.

Anal Adenocarcinoma Arising From a Fistula-in-Ano: A Case Report.

Crohn's disease (CD) is an inflammatory disease that can affect any portion of the gastrointestinal tract (GIT). Although it can present with a number of complications, perianal fistulae are among the most common consequences in patients with CD. In very rare cases, these patients can develop fistula-associated anal adenocarcinoma (FAAA). In this case report, we discuss a 72-year-old man with a long-term history of CD complicated by perianal fistulae, which failed medical and surgical management, ultimately presenting with acute anal pain in the outpatient setting. The physical examination revealed a seton traversing through a fistula surrounded by circumferential granulation tissue suspicious for malignancy. A biopsy of the tissue confirmed grade 3 mucinous-type infiltrating adenocarcinoma of the perianal skin. The patient was diagnosed with an anal verge malignancy associated with a fistula in the context of long-standing CD, and MRI staging demonstrated a T3N1 lesion with potential left inguinal node involvement. He completed neoadjuvant chemo-radiotherapy using capecitabine for five weeks with minimal tumor response, and subsequently, an abdominoperineal resection (APR) was performed with patient discharge on the fifth post-procedure day. Post-operative chemotherapy with oxaliplatin/leucovorin/fluorouracil was administered with minimal complications. Although rare, this report demonstrates the importance of consistent follow-up and mitigation of risk factors in patients with CD, along with the significance of prompt multimodal treatment in the event of developing FAAA.

Outcomes with mismatched unrelated donor allogeneic hematopoietic stem cell transplantation in adults: A systematic review and meta-analysis.

Background: Allogeneic hematopoietic stem cell transplantation (HSCT) is a potentially curative therapy for various hematologic disorders. Alternative donor strategies such as mismatched unrelated donors (MMUD) offer the option of HSCT to patients lacking a human leukocyte antigen (HLA)-matched donor. We conducted a systematic review and meta-analysis to evaluate outcomes after MMUD-HSCT. Methods: A literature search was performed on PubMed, Cochrane Library, and ClinicalTrials.gov from the inception date through April 6, 2022. After screening 2477 manuscripts, 19 studies were included. Data was extracted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Pooled analysis was done using the meta-package by Schwarzer et al. Proportions with 95% confidence intervals (CI) were computed. Results: A total of 3336 patients from 19 studies were included. The median age was 52.1 years, and 53% of recipients were males. The graft source was bone marrow in 19% and peripheral blood stem cells in 81% of recipients. The median time to transplant from hematologic diagnosis was 10 (1-247) months. Hematologic diagnoses included myeloid (82.9%), lymphoid (41.1%), and other disorders (3%). The reduced intensity and myeloablative conditioning were used in 65.6% and 32% of recipients, respectively. In-vivo T-cell depletion was performed in 56.7% of the patients. Most patients had one (87.9%) or two (11.4%) antigen HLA-mismatch. The pooled 1-year overall survival (OS) was 63.9% (95% CI 0.57-0.71, n=1426/2706), and the pooled 3-year OS was 42.1% (95% CI 0.34.2-0.50, n=907/2355). The pooled progression-free survival was 46.6% (95% CI 0.39-0.55, n=1295/3253) after a median follow-up of 1.8 (range 1-6) years. The pooled relapse rate was 26.8% (95% CI 0.22-0.32, n=972/3253) after a median follow-up of 2.25 (1-3) years. The pooled incidence of acute (grade II-IV) graft-versus-host disease (GVHD) and chronic GVHD was 36.4% (95% CI 0.31-0.42, n=1131/3030) and 41.2% (95% CI 0.35-0.48, n=1337/3228), respectively. The pooled non-relapse mortality was 22.6% (95% CI 0.17-0.29, n=888/3196) after a median follow-up of 2.6 (1-5) years. Conclusion: MMUD-HSCT has demonstrated favorable outcomes with an acceptable toxicity profile. It represents a promising option in patients lacking an HLA-matched or haploidentical donor and may expand HSCT access to underrepresented racial and ethnic populations.