Exploring selection signatures in the divergence and evolution of lipid droplet (LD) associated genes in major oilseed crops.

BACKGROUND: Oil bodies or lipid droplets (LDs) in the cytosol are the subcellular storage compartments of seeds and the sites of lipid metabolism providing energy to the germinating seeds. Major LD-associated proteins are lipoxygenases, phospholipaseD, oleosins, TAG-lipases, steroleosins, caleosins and SEIPINs; involved in facilitating germination and enhancing peroxidation resulting in off-flavours. However, how natural selection is balancing contradictory processes in lipid-rich seeds remains evasive. The present study was aimed at the prediction of selection signatures among orthologous clades in major oilseeds and the correlation of selection effect with gene expression. RESULTS: The LD-associated genes from the major oil-bearing crops were analyzed to predict natural selection signatures in phylogenetically close-knit ortholog clusters to understand adaptive evolution. Positive selection was the major force driving the evolution and diversification of orthologs in a lineage-specific manner. Significant positive selection effects were found in 94 genes particularly in oleosin and TAG-lipases, purifying with excess of non-synonymous substitution in 44 genes while 35 genes were neutral to selection effects. No significant selection impact was noticed in Brassicaceae as against LOX genes of oil palm. A heavy load of deleterious mutations affecting selection signatures was detected in T-lineage oleosins and LOX genes of Arachis hypogaea. The T-lineage oleosin genes were involved in mainly anther, tapetum and anther wall morphogenesis. In Ricinus communis and Sesamum indicum > 85% of PLD genes were under selection whereas selection pressures were low in Brassica juncea and Helianthus annuus. Steroleosin, caleosin and SEIPINs with large roles in lipid droplet organization expressed mostly in seeds and were under considerable positive selection pressures. Expression divergence was evident among paralogs and homeologs with one gene attaining functional superiority compared to the other. The LOX gene Glyma.13g347500 associated with off-flavor was not expressed during germination, rather its paralog Glyma.13g347600 showed expression in Glycine max. PLD-α genes were expressed on all the tissues except the seed,δ genes in seed and meristem while ß and γ genes expressed in the leaf. CONCLUSIONS: The genes involved in seed germination and lipid metabolism were under strong positive selection, although species differences were discernable. The present study identifies suitable candidate genes enhancing seed oil content and germination wherein directional selection can become more fruitful.

An original study assessing biomarker success rate in breast cancer recurrence biomarker research.

BACKGROUND: Breast cancer is the second most common cause of cancer mortality worldwide. Biomarker discovery has led to advances in understanding molecular phenotyping and thus has a great potential for precision management of this diverse disease. Despite increased interest in the biomarker field, only a small number of breast cancer biomarkers are known to be clinically useful. Therefore, it is very important to characterise the success rate of biomarkers in this field and study potential reasons for the deficit. We therefore aim to achieve quantitative characterisation of the biomarker translation gap by tracking the progress of prognostic biomarkers associated with breast cancer recurrence. METHODS: An electronic systematic search was conducted in Medline and Embase databases using keywords and mesh headings associated with breast cancer recurrence biomarkers (1940-2023). Abstracts were screened, and primary clinical studies involving breast cancer recurrence biomarkers were selected. Upon identification of relevant literature, we extracted the biomarker name, date of publication and journal name. All analyses were performed using IBM SPSS Statistics and GraphPad prism (La Jolla, California, USA). RESULTS: A total of 19,195 articles were identified, from which 4597 articles reported breast cancer biomarkers associated with recurrence. Upon data extraction, 2437 individual biomarkers were identified. Out of these, 23 are currently recommended for clinical use, which corresponds to only 0.94% of all discovered biomarkers. CONCLUSIONS: This study characterised for the first time the translational gap in the field of recurrence-related breast cancer biomarkers, indicating that only 0.94% of identified biomarkers were recommended for clinical use. This denotes an evident barrier in the biomarker research field and emphasises the need for a clearer route from biomarker discovery through to implementation.

Maternal-Periconceptional Vitamin B12 Deficiency in Wistar Rats Leads to Sex-Specific Programming for Cardiometabolic Disease Risk in the Next Generation.

BACKGROUND: Maternal vitamin B12 deficiency plays a vital role in fetal programming, as corroborated by previous studies on murine models and longitudinal human cohorts. OBJECTIVES: This study assessed the effects of diet-induced maternal vitamin B12 deficiency on F1 offspring in terms of cardiometabolic health and normalization of these effects by maternal-periconceptional vitamin B12 supplementation. METHODS: A diet-induced maternal vitamin B12 deficient Wistar rat model was generated in which female rats were either fed a control AIN-76A diet (with 0.01 g/kg vitamin B12) or the same diet with vitamin B12 removed. Females from the vitamin B12-deficient group were mated with males on the control diet. A subset of vitamin B12-deficient females was repleted with vitamin B12 on day 1 of conception. The offspring in the F1 generation were assessed for changes in body composition, plasma biochemistry, and molecular changes in the liver. A multiomics approach was used to obtain a mechanistic insight into the changes in the offspring liver. RESULTS: We showed that a 36% reduction in plasma vitamin B12 levels during pregnancy in F0 females can lead to continued vitamin B12 deficiency (60%-70% compared with control) in the F1 offspring and program them for cardiometabolic adversities. These adversities, such as high triglycerides and low high-density lipoprotein cholesterol, were seen only among F1 males but not females. DNA methylome analysis of the liver of F1 3-mo-old offspring highlights sexual dimorphism in the alteration of methylation status of genes critical to signaling processes. Proteomics and targeted metabolomics analysis confirm that sex-specific alterations occur through modulations in PPAR signaling and steroid hormone biosynthesis pathway. Repletion of deficient mothers with vitamin B12 at conception normalizes most of the molecular and biochemical changes. CONCLUSIONS: Maternal vitamin B12 deficiency has a programming effect on the next generation and increases the risk for cardiometabolic syndrome in a sex-specific manner. Normalization of the molecular risk markers on vitamin B12 supplementation indicates a causal role.

Design and fabrication of a microelectrode array for studying epileptiform discharges from rodents.

Local field potentials, the extracellular electrical activities from brain regions, provide clinically relevant information about the status of neurophysiological conditions, including epilepsy. In this study, a 13-channel silicon-based single-shank microelectrode array (MEA) was designed and fabricated to record local field potentials (LFPs) from the different depths of a rat's brain. A titanium/gold layer was patterned as electrodes on an oxidized silicon substrate, and silicon dioxide was deposited as a passivation layer. The fabricated array was implanted in the somatosensory cortex of the right hemisphere of an anesthetized rat. The developed MEA was interfaced with an OpenBCI Cyton Daisy Biosensing Board to acquire the local field potentials. The LFPs were acquired at three different neurophysiological conditions, including baseline signals, chemically-induced epileptiform discharges, and recovered baseline signals after anti-epileptic drug (AED) administration. Further, time-frequency analyses were performed on the acquired biopotentials to study the difference in spatiotemporal features. The processed signals and time-frequency analyses clearly distinguish between pre-convulsant and post-AED baselines and evoked epileptiform discharges.

The thermal effect of lasers in urology: a review article.

Lasers as a technology have a leading role in the modern urological treatment armamentarium. In this article, the application of lasers in different areas of urology is described. The major uses are in urolithiasis, benign prostatic enlargement (BPE), and management of many urological malignancies and other benign pathologies. Lasers have become an established treatment modality in urolithiasis, an acceptable alternative with the least side effect profile in BPE patients, and a novel and promising therapy in many other fields of Urology.

Segmentation and Classification Approaches of Clinically Relevant Curvilinear Structures: A Review.

Detection of curvilinear structures from microscopic images, which help the clinicians to make an unambiguous diagnosis is assuming paramount importance in recent clinical practice. Appearance and size of dermatophytic hyphae, keratitic fungi, corneal and retinal vessels vary widely making their automated detection cumbersome. Automated deep learning methods, endowed with superior self-learning capacity, have superseded the traditional machine learning methods, especially in complex images with challenging background. Automatic feature learning ability using large input data with better generalization and recognition capability, but devoid of human interference and excessive pre-processing, is highly beneficial in the above context. Varied attempts have been made by researchers to overcome challenges such as thin vessels, bifurcations and obstructive lesions in retinal vessel detection as revealed through several publications reviewed here. Revelations of diabetic neuropathic complications such as tortuosity, changes in the density and angles of the corneal fibers have been successfully sorted in many publications reviewed here. Since artifacts complicate the images and affect the quality of analysis, methods addressing these challenges have been described. Traditional and deep learning methods, that have been adapted and published between 2015 and 2021 covering retinal vessels, corneal nerves and filamentous fungi have been summarized in this review. We find several novel and meritorious ideas and techniques being put to use in the case of retinal vessel segmentation and classification, which by way of cross-domain adaptation can be utilized in the case of corneal and filamentous fungi also, making suitable adaptations to the challenges to be addressed.

Correlation between Severity of Thrombocytopenia and Portal Hypertensive Gastropathy in Patients with Chronic Liver Disease.

INTRODUCTION: Portal hypertensive gastropathy (PHG) is known but under detected complication of cirrhosis of liver. Patients with stable liver disease are more prone to internal bleeding due to portal hypertension. Thrombocytopenia is a common complication associated with chronic liver disease and it is associated with poor prognosis. The aim of this study is to find out the association between correlation between severity of thrombocytopenia and portal hypertensive gastropathy in patients with chronic liver disease. MATERIALS: This cross-sectional analytical study was conducted in a tertiary care centre at Saveetha Medical College Hospital and Research Centre. A total of 80 consecutive subjects were included in this study. All adult patients admitted with diagnosis chronic liver disease underwent upper GI endoscopy; those with portal hypertensive gastropathy were included in this study. The patient with liver disease with only varices but not gastropathy was excluded. Patient less than 18 years and with poor preparation were excluded from this study. Platelet count was estimated and severity of gastropathy was classified. Correlation of thrombocytopenia and severity of gastropathy was studied. RESULT: Patients with mild portal hypertensive gastropathy category had normal platelet count between 1.5-4.5 lakhs/mm3 . But in patients with severe PHG, almost 80% of patients had thrombocytopenia, in which 8% had severe thrombocytopenia <50,000 cells/mm3 . The inverse relationship between the platelet count and the severity of PHG was statistically significant. CONCLUSION: The severity of thrombocytopenia increased with increasing grade of portal hypertensive gastropathy. Hence platelet count can serve as the prognostic marker of chronic liver disease induced portal hypertensive gastropathy References Chung WJ. Management of portal hypertensive gastropathy and other bleeding. Clin Mol Hepatol 2014;20(1):1-5. Madhwani R, Hanif FM, Ul Haque MM, et al. Noninvasive clinical predictors of portal hypertensive gastropathy in patients with liver cirrhosis. J Transpl Int Med 2017;5(3):169-173.

Outcomes of Renal Trauma in Indian Urban Tertiary Healthcare Centres: A Multicentre Cohort Study.

BACKGROUND: Renal trauma is present in 0.5-5% of patients admitted for trauma. Advancements in radiologic imaging and minimal-invasive techniques have led to decreased need for surgical intervention. We used a large trauma cohort to characterise renal trauma patients, their management and outcomes. METHODS: We analysed "Towards Improved Trauma Care Outcomes in India" cohort from four urban tertiary public hospitals in India between 1st September 2013 and 31st December 2015. The data of patients with renal trauma were extracted using International Classification of Diseases 10 codes and analysed for demographic and clinical details. RESULTS: A total of 16,047 trauma patients were included in this cohort. Abdominal trauma comprised 1119 (7%) cases, of which 144 (13%) had renal trauma. Renal trauma was present in 1% of all the patients admitted for trauma. The mean age was 28 years (SD-14.7). A total of 119 (83%) patients were male. Majority (93%) were due to blunt injuries. Road traffic injuries were the most common mechanism (53%) followed by falls (29%). Most renal injuries (89%) were associated with other organ injuries. Seven of the 144 (5%) patients required nephrectomy. Three patients had grade V trauma; all underwent nephrectomy. The 30-day in-hospital mortality, in patients with renal trauma, was 17% (24/144). CONCLUSION: Most renal trauma patients were managed nonoperatively. 89% of patients with renal trauma had concomitant injuries. The renal trauma profile from this large cohort may be generalisable to urban contexts in India and other low- and middle-income countries.

A scoping review of literature describing the nutritional status and diets of adolescents in Côte d'Ivoire.

OBJECTIVE: Adolescents living in resource-limited settings remain a neglected population regarding their nutritional health. We reviewed what studies on nutrition have been conducted for adolescents living in Côte d'Ivoire. DESIGN: A scoping literature review, searching for any quantitative studies published from 1 January 2000 to 1 May 2019, referenced in PubMed and grey literature, related to adolescent nutritional status and diet, written in English or French. SETTING: Côte d'Ivoire, West Africa. SUBJECTS: Adolescent girls and boys (aged 10-19 years). RESULTS: We used three search strategies to explore studies related to (1) diet and nutritional practices, (2) anthropometry and (3) micronutrient intakes/status. Each identified 285, 108 and 84 titles and abstracts, respectively, resulting in 384 full-text articles to review. Finally, after adding five relevant studies from the grey literature, thirty articles were included. Two-thirds were cross-sectional observation studies. The main topics were anaemia and parasitic diseases. Among seven intervention studies, most focused on micronutrient supplementation or deworming. No studies on macronutrients or food supplementation were found. Overall, studies showed a high prevalence of undernutrition, along with emerging overweight and obesity. Anaemia and Fe deficiency were highly prevalent, with Fe supplementation showing modest improvements. Malaria and gut parasite infections remain a major burden, affecting adolescents' nutritional status. CONCLUSIONS: Few specific relevant studies have been published regarding adolescent nutrition in Côte d'Ivoire, and most studies being focused on younger children. There are knowledge gaps about many nutritional aspects in this population, which urgently need to be addressed.

Adolescent nutrition and physical activity in low-income suburbs of Abidjan, Côte d'lvoire: the gap between knowledge, aspirations and possibilities.

OBJECTIVE: To explore adolescents' perceptions, knowledge and behaviours regarding nutrition and physical activity in low-income districts of Abidjan, Côte d'Ivoire, taking into consideration their caregivers' perspectives. DESIGN: Two investigators conducted six focus group discussions. SETTING: The study was carried out in two low-income suburbs, Yopougon and Port-Bouët, in Abidjan, Côte d'Ivoire. PARTICIPANTS: Adolescents and their caregivers were recruited into the study via local head teachers and heads of settlement. RESULTS: Overall, seventy-two participants, including forty-six adolescents and twenty-six caregivers, took part. Participants demonstrated good nutrition knowledge, relating nutritional health to a balanced diet and hygiene. Sustained physical activity was reported. However, adopting good practices was challenging due to participant's economic circumstances. Their environment was a barrier to improving health due to dirtiness and violence, with a lack of space limiting the possibility to practice sport. Adolescents and their caregivers differed in their response to these constraints. Many caregivers felt powerless and suggested that a political response was the solution. Alternatively, adolescents were more likely to suggest new creative solutions such as youth-friendly centres within their community. CONCLUSIONS: Participants were aware that their nutritional habits were not in line with what they had learnt to be good nutritional practices due to socio-economic constraints. Physical activity was part of adolescent life, but opportunities to exercise were restricted by their environment. Strategies for improving adolescent health in these settings need to be developed in collaboration with adolescents in a manner that accommodates their opinions and solutions.

Ferritin and Hemoglobin as Predictors of Fatal Outcome in COVID-19: Two Sides of the Same Coin.

INTRODUCTION: Infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have multisystemic involvement with hyperinflammation being a cardinal feature and deranged iron metabolism having a possible role. In this premise, we studied the prognostic value of two markers of iron metabolism ferritin and hemoglobin. METHODOLOGY: A retrospective-cohort study was carried out in a tertiary hospital in northern India involving 210 hospitalized COVID-19 patients aged 15-and above. Analysis was done for clinical profile, comorbidities and basic laboratory indices including ferritin-hemoglobin ratio (FHR) with primary end-point being in-hospital all-cause mortality. RESULTS: Median serum ferritin levels (640.00ng/mL vs 220.00ng/mL) were significantly higher among non-survivors as against survivors while median hemoglobin levels were significantly lower (12.12g/dL vs 13.73g/dL). Serum ferritin levels >400ng/mL (Sn 80%, Sp 70%) predicted mortality with high sensitivity and specificity. Notably, serum ferritin levels >400ng/mL (HR 11.075 [1.481-82.801]) and anemia, defined as a hemoglobin of <12g/dL for females and < 13g/dL for males and were significantly associated with the risk of mortality in a univariable Cox-proportional hazards regression. The median FHR was significantly higher among non-survivors compared to survivors (56.98 vs 17.17). FHR>31 (Sn 85% Sp 71.6%) was highly sensitive and specific for predicting mortality. The multivariable analysis indicated that FHR >31 remained an independent risk factor for mortality (HR 12.293 [3.147-48.028]). CONCLUSION: Ferritin-hemoglobin ratio (FHR), which encompasses into a single index, the effects of both elevated levels of ferritin and the severity of anemia, seems to perform particularly well as a prognostic marker and emerged as an independent risk factor for mortality in COVID-19 patients. Hyperferritinemia and anemia, both, are inexorably interlinked in addition to having a role, directly or indirectly in the disease pathophysiology. Ferritin and hemoglobin, hence should be seen as two sides of the same coin rather than as two discrete entities.

Participation in and outcomes from a 12-month tailored exercise programme for people with multiple sclerosis (MSTEP©): a randomized trial.

OBJECTIVE: To estimate, among people with multiple sclerosis, the extent to which a personally tailored exercise programme (MSTEP©) resulted in greater improvements in exercise capacity and related outcomes over 12 months in comparison with general exercise guidelines. DESIGN: Two-group randomized trial. SUBJECTS: Ambulatory and sedentary. INTERVENTIONS: MSTEP©, a personally adapted exercise regimen done on most days including two days of high intensity exercise; guidelines recommending 30 minutes of moderate intensity aerobic and strength training two times per week. MAIN MEASURES: Primary outcome was peak oxygen consumption (VO2peak) at 12 months; secondary outcomes were composite measures of physical function, fatigue, and health-related quality of life. RESULTS: In total, 137 people were randomized, 66 were lost over 12 months leaving 71 with outcome data, 34 in MSTEP© group, and 37 in the Guideline group. Exercise enjoyment and confidence and exercise-induced fatigue predicted retention. There were no differences between groups on the proportion making a 10% increase in VO2peak (27.1% MSTEP© vs 29.6% Guidelines; OR: 0.83; 95% CI: 0.23-3.08) by the 12 month assessment. The effect on fatigue was larger in the MSTEP© group than the Guideline groups (OR: 1.59; 95% CI: 0.93-2.74), the effect on physical function was more modest (OR: 1.35; 95% CI: 0.80-2.25), and null for health-related quality of life outcomes. CONCLUSIONS: The disappointing exercise retention suggests that people with multiple sclerosis may not consider exercise important to their brain health. Either type of exercise resulted in stable exercise capacity over 1 year in those sticking with the programme.

Origin, transmission, diagnosis and management of coronavirus disease 2019 (COVID-19).

Coronavirus has emerged as a global health threat due to its accelerated geographic spread over the last two decades. This article reviews the current state of knowledge concerning the origin, transmission, diagnosis and management of coronavirus disease 2019 (COVID-19). Historically, it has caused two pandemics: severe acute respiratory syndrome and Middle East respiratory syndrome followed by the present COVID-19 that emerged from China. The virus is believed to be acquired from zoonotic source and spreads through direct and contact transmission. The symptomatic phase manifests with fever, cough and myalgia to severe respiratory failure. The diagnosis is confirmed using reverse transcriptase PCR. Management of COVID-19 is mainly by supportive therapy along with mechanical ventilation in severe cases. Preventive strategies form the major role in reducing the public spread of virus along with successful disease isolation and community containment. Development of a vaccine to eliminate the virus from the host still remains an ongoing challenge.

[Safety aspects of ultrasound diagnostics]. / Sicherheitsaspekte der Ultraschalldiagnostik.

Ultrasonography is free of ionizing radiation but during the examination it is accompanied by energy deposition in the tissue. Therefore, users should be familiar with the mechanisms of action and possible risks. Thermal and non-thermal (e.g. cavitation) effects are related to the intensity and sound pressure of ultrasound waves and are therefore also dependent on the ultrasound modality used, e.g., B­mode, color Doppler and/or pulsed wave (pw) Doppler. With B­mode ultrasound no dangerous thermal effects are to be expected. In embryos and foetuses as well as febrile patients caution should be exercised. The pw Doppler mode can cause temperature spikes and the risks increase with the duration of use. Ultrasound contrast media are pathogenic for cavitation and should be avoided during the 24 h prior to shock wave lithotripsy. In ultrasound modalities with high local energy deposition, the values for the thermal index (TI) and mechanical index (MI) displayed on the screen should be observed and as with ionizing radiation, the ALARA (as low as reasonably achievable) principle should be adhered to.

[Legal questions in geriatric medicine-an overview]. / Rechtsfragen in der Altersmedizin ­ ein Überblick.

As a consequence of demographic developments, legal questions regarding medical treatment of the elderly are receiving increasing attention. In the first instance, elderly patients are of course just normal patients. However, they often require a special degree of medical care from physicians and nurses. From a legal perspective, this leads to a heightened level of due diligence from medical practitioners. Specific legal challenges come into play when dealing with patients who are unable to give consent, or who are subject to personal custody. Additionally, patient's provisions and health care proxies are playing an ever more important role. Thus, an overview of the different legal aspects has become absolutely necessary for medical practitioners.

Tracheostomy in Adult Intensive Care Unit: An ISCCM Expert Panel Practice Recommendations.

BACKGROUND AND AIM: Critically ill patients on mechanical ventilation undergo tracheostomy to facilitate weaning. The practice in India may be different from the rest of the world and therefore, in order to understand this, ISCCM conducted a multicentric observational study "DIlatational percutaneous vs Surgical tracheoStomy in intEnsive Care uniT: A practice pattern observational multicenter study (DISSECT Study)" followed by an ISCCM Expert Panel committee meeting to formulate Practice recommendations pertinent to Indian ICUs. MATERIALS AND METHODS: All existing International guidelines on the topic, various randomized controlled trials, meta-analysis, systematic reviews, retrospective studies were taken into account to formulate the guidelines. Wherever Indian data was not available, international data was analysed. A modified Grade system was followed for grading the recommendation. RESULTS: After analyzing the entire available data, the recommendations were made by the grading system agreed by the Expert Panel. The recommendations took into account the indications and contraindications of tracheostomy; effect of timing of tracheostomy on incidence of ventilator associated pneumonia, ICU length of stay, ventilator free days & Mortality; comparison of surgical and percutaneous dilatational tracheostomy (PDT) in terms of incidence of complications and cost to the patient; Comparison of various techniques of PDT; Use of fiberoptic bronchoscope and ultrasound in PDT; experience of the operator and qualification; certain special conditions like coagulopathy and morbid obesity. CONCLUSION: This document presents the first Indian recommendations on tracheostomy in adult critically ill patients based on the practices of the country. These guidelines are expected to improve the safety and extend the indications of tracheostomy in critically ill patients. HOW TO CITE THIS ARTICLE: Gupta S, Dixit S, Choudhry D, Govil D, Mishra RC, Samavedam S, Tracheostomy in Adult Intensive Care Unit: An ISCCM Expert Panel Practice Recommendations. Indian J Crit Care Med 2020;24(Suppl 1):S31-S42.

Opioid-Free Analgesia for Supratentorial Craniotomies: A Systematic Review.

BACKGROUND: Post-craniotomy pain can be severe and is often undermanaged. Opioids can interfere with neurological monitoring and are associated with adverse effects. This systematic review aimed to identify measures of opioid-free analgesia and compare their effectiveness with opioid analgesia for post-craniotomy pain in patients with supratentorial tumors. METHODS: EMBASE, MEDLINE, and Cochrane databases were searched from their inception to February 14, 2017, for randomized controlled trials (RCTs) evaluating opioid versus non-opioid analgesia post-supratentorial craniotomy. Two reviewers independently carried out study selection and data extraction. Risk of bias assessment was performed using the Cochrane Collaboration's tool. Outcomes were pain control (changes to pain scores or use of rescue analgesia) and adverse effects. Considering the number of studies and heterogeneity, a narrative synthesis was done without pooling and results were summarized using tables. Non-opioids were assessed for the potential to be equivalent to opioid-based analgesics for pain relief and adverse effects. RESULTS: Of 467 RCTs, 4 met our inclusion criteria (n = 186 patients). Patients with scalp blocks (2 RCTs) had less post-operative nausea and vomiting (PONV), but scalp block was not superior to morphine for analgesia. Acetaminophen (1 RCT) was less likely to induce PONV but provided inadequate pain relief compared to morphine and sufentanil. Dexmedetomidine (1 RCT) was not superior to remifentanil for analgesia although it delayed time to rescue analgesia. CONCLUSIONS: Limited evidence suggests that scalp blocks and dexmedetomidine have the potential to eliminate the need for opioid analgesia. Multimodal analgesia should be considered as significant opioid-sparing effects have been shown.

Analgésie sans opioïdes dans les craniotomies supratentorielles: revue systématique. Contexte: La douleur post-craniotomie peut être sévère et n'est souvent pas maintenue. Les opioïdes peuvent interférer avec la surveillance neurologique et sont associés à des effets indésirables. Cette revue systématique visait à identifier les mesures d'analgésie sans opioïdes et à comparer leur efficacité à celle des analgésiques opioïdes pour le traitement de la douleur post-craniotomie chez les patients atteints de tumeurs supratentorielles. Méthodes: Les bases de données EMBASE, MEDLINE et Cochrane ont été explorées depuis leur création jusqu'au 14 février 2017 dans le cadre d'essais contrôlés randomisés (ECR) évaluant l'analgésie opioïde ou non opioïde après la craniotomie supratentorielle. Deux examinateurs ont indépendamment sélectionné les études et extrait les données. L'évaluation du risque de biais a été réalisée à l'aide de l'outil Cochrane Collaboration. Les résultats ont été un contrôle de la douleur (modification des scores de douleur ou l'utilisation d'une analgésie de secours) et des effets indésirables. Compte tenu du nombre d'études et de l'hétérogénéité, une synthèse narrative a été réalisée sans regroupement et les résultats ont été résumés à l'aide de tableaux. Les non-opioïdes ont été évalués pour leur potentiel équivalent aux analgésiques à base d'opioïdes pour le soulagement de la douleur et les effets indésirables. Résultats: Sur 467 ECR, 4 répondaient à nos critères d'inclusion (n = 186 patients). Les patients avec des blocs de cuir chevelu 14 (2 ECR) avaient moins de nausées et de vomissements postopératoires (NVPO), mais le bloc de cuir chevelu n'était pas supérieur à la morphine pour l'analgésie. L'acétaminophène (1 ECR) était moins susceptible d'induire des NVPO, mais ne soulageait pas suffisamment la douleur par rapport à la morphine et au sufentanil. La dexmédétomidine (1 ECR) n'était pas supérieure au rémifentanil pour l'analgésie, bien qu'elle ait retardé le délai de récupération de l'analgésie. Conclusions: Des preuves limitées suggèrent que les blocs du cuir chevelu et la dexmédétomidine pourraient éliminer le besoin d'une analgésie opioïde. Une analgésie multimodale doit être considérée, car des effets importants, qui permettent d'épargner les opioïdes, ont été démontrés.

Comparison Between Common Performance-Based Tests and Self-Reports of Physical Function in People With Multiple Sclerosis: Does Sex or Gender Matter?

OBJECTIVE: To estimate the extent to which sex or gender differences affect the relations between tests of physical performance and self-reports about function in everyday life activities. Ecological validity is an important psychometric property when choosing tests of physical function, because they need to relate to everyday function. In multiple sclerosis (MS), the EQUI scale, modified Canadian Aerobic Fitness Test, grip strength, vertical jump, push-up, partial curl-up, gait speed (comfortable or fast), 6-minute walk test, and 9-hole peg test are commonly used but the extent to which they relate to everyday function is understudied and the extent to which ecological validity of these tests differ between women and men is unknown. DESIGN: A cross-sectional analysis was conducted on a random sample of men and women recruited for a study on the life effect of MS. Correlations between pairs of performance outcome (PerfO) and self-reported outcome (SRO) items pairs of variables with theoretical coherence were calculated and gender effects identified using linear regression. SETTING: Participants were recruited from MS clinic at Montreal Neurological Hospital. PARTICIPANTS: The sample (N=188) consisted of 140 women and 48 men with MS. INTERVENTIONS: Not applicable. RESULTS: The mean age ± SD of the participants was 43±10. Sixty PerfO and SRO items yielded 165 theoretically linked pairs separately for women and men. Of these 330 possible pairs, 77 pairs (23%) had correlations ≥0.8, showing strong support for the link between performance tests and everyday function; 203 pairs provided moderate support (r≥0.5). Thirty-one pairs had a statistically significant interaction with gender with men having higher correlations than women (n=27/31). CONCLUSION: The results support the ecological validity for physical performance tests, particularly balance tests and particularly for men. The observation that many indicators of everyday function derived from SROs were related to physical performance supports the routine use of SROs in clinical practice to guide therapy to meet the needs of clients with MS.

[Quantitative methods in sonography]. / Quantitative Verfahren in der Sonographie.

B­mode and color Doppler ultrasound are standard radiological methods to quantify tissue echo texture and tissue perfusion. Microstructure and composition of tissue influence echo texture parameters and acoustic parameters, such as speed of sound, attenuation and backscatter and quantitative color Doppler image parameters are influenced by the hemodynamics in depictable vessels. Dynamic contrast-enhanced ultrasound enables quantification of tissue perfusion and ultrasound elastography assists in assessing tissue stiffness. B­mode texture analysis, analysis of high-frequency echo signals and quantitative color Doppler image analysis are able to contribute to the assessment of tissue microstructure but have so far not been implemented clinically due to their complexity. Dynamic contrast-enhanced ultrasound and ultrasound elastography have proven to be robust under clinical conditions.

Assessment of the Efficacy of Periodontal Tissue Regeneration using Non-resorbable and Bioabsorbable GTR Membrane-A Clinical Comparative Study.

AIM: The present study aims to assess the efficacy of non-resorbable and bioabsorbable guided tissue regeneration (GTR) membrane periodontal tissue regenerative methods. MATERIALS AND METHODS: Thirty teeth taken from 20 patients (8 males and 12 females) within the age range of 20-55 years having chronic periodontitis were enrolled in this trial. All the enrolled patients underwent phase I therapy which included scaling and root planing performed in two sittings by a single practitioner. Patients who fulfilled the selection criteria entered the study and were randomly allocated to the three groups. Group I: control group, group II: patients who received a non-resorbable GTR membrane, and group III: patients who received a bioabsorbable GTR membrane. The clinical parameters that were documented at baseline, 3 months, and 6 months postoperatively were the gingival index, plaque index, and probing depth (vertical and horizontal) for all the three groups. RESULTS: The mean gingival index score was 1.64 ± 0.32 in group III at baseline, which decreased to 1.20 ± 0.10 at 6 months postoperatively. The plaque index reduced from 1.36 ± 0.46 at baseline to 1.04 ± 0.01 at 6 months postoperatively. The vertical and horizontal probing depths demonstrated a statistically significant difference between all the three groups. CONCLUSION: The present study established that both membranes resulted in clinically and statistically significant improvements in the treatment of grade II furcation defects.