Negative pressure therapy for stoma closure sites-a nonrandomised case control study.

AIM: The PICO (Smith & Nephew, UK) dressing is a single use negative pressure wound therapy (NPWT) system that is designed to be used for up to 7 days for closed wounds. We aimed to assess its use for stoma closure wounds. METHOD: We conducted a retrospective analysis of stoma reversal wounds from April 2018 to June 2019. The wound was partially closed with an absorbable subcutaneous suture in a purse-string fashion. A 15 cm × 15 cm PICO dressing was applied directly over this wound. A control group who had received partial purse string closure with packing over the same time period was identified. Patients were contacted and information collected using a questionnaire. The primary outcome measure was the number of visits for dressing changes in the community. Further information was collected about length of stay, time to resolution of pain and return to work. RESULTS: On average, the patients with PICO dressings attended the community nurses 1.9 times. The patients in the PICO group stated it took 1-2 weeks to return to full work/daily activities. The control group averaged attending the community nurse 11.9 times, and 33% had not returned to work/daily activities in 1-2 weeks. CONCLUSION: Those who had a PICO dressing required fewer visits to the community nurse and the majority were able to return to work or resume usual activities within 1 to 2 weeks. This pilot study suggests that negative pressure dressings may be a useful aid for stoma closure site wounds.

Adverse childhood experiences and substance misuse in young people in India: results from the multisite cVEDA cohort.

BACKGROUND: Adverse childhood experiences (ACEs) increases vulnerability to externalising disorders such as substance misuse. The study aims to determine the prevalence of ACEs and its association with substance misuse. METHODS: Data from the Consortium on Vulnerability to Externalising Disorders and Addictions (cVEDA) in India was used (n = 9010). ACEs were evaluated using the World Health Organisation (WHO) Adverse Childhood Experiences International Questionnaire whilst substance misuse was assessed using the WHO Alcohol, Smoking and Substance Involvement Screening Test. A random-effects, two-stage individual patient data meta-analysis explained the associations between ACEs and substance misuse with adjustments for confounders such as sex and family structure. RESULTS: 1 in 2 participants reported child maltreatment ACEs and family level ACEs. Except for sexual abuse, males report more of every individual childhood adversity and are more likely to report misusing substances compared with females (87.3% vs. 12.7%). In adolescents, family level ACEs (adj OR 4.2, 95% CI 1.5-11.7) and collective level ACEs (adj OR 6.6, 95% CI 1.4-31.1) show associations with substance misuse whilst in young adults, child level ACEs such as maltreatment show similar strong associations (adj OR 2.0, 95% CI 1.1-3.5). CONCLUSION: ACEs such as abuse and domestic violence are strongly associated with substance misuse, most commonly tobacco, in adolescent and young adult males in India. The results suggest enhancing current ACE resilience programmes and 'trauma-informed' approaches to tackling longer-term impact of ACEs in India. FUNDING: Newton Bhabha Grant jointly funded by the Medical Research Council, UK (MR/N000390/1) and the Indian Council of Medical Research (ICMR/MRC-UK/3/M/2015-NCD-I).

Oral Health in the Population Assessment of Tobacco and Health Study.

Tobacco use is a well-established risk factor for multiple adverse oral conditions. Few nationally representative oral health data sets encompass the current diversity of tobacco and nicotine products. This investigation examines the validity of oral health measures in the Population Assessment of Tobacco and Health (PATH) Study to assess relationships between tobacco use and oral health. Cross-sectional data from PATH Study wave 4 (N = 33,643 US adults, collected 2016-2018) were used to obtain estimates for 6 self-reported oral conditions (e.g., bone loss around teeth, tooth extractions) and compared with analogous estimates from the National Health and Nutrition Examination Survey (NHANES) cycle 2017-2018 (N = 5,856). Within the PATH Study, associations were calculated between tobacco use status and lifetime and past 12-mo experience of adverse oral conditions using survey-weighted multivariable logistic regression. Nationally representative estimates of oral conditions between the PATH Study and NHANES were similar (e.g., ever-experience of bone loss around teeth: PATH Study 15.2%, 95% CI, 14.4%-15.9%; NHANES 16.6%, 95% CI, 14.9%-18.4%). In the PATH Study, combustible tobacco smoking was consistently associated with lifetime and past 12-mo experience of adverse oral health (e.g., exclusive cigarette smoking vs. never tobacco use, adjusted odds ratio [AOR] for loose teeth in past 12 mo: 2.02; 95% CI, 1.52-2.69). Exclusive smokeless tobacco use was associated with greater odds of loose teeth (AOR, 1.93; 95% CI, 1.15-3.26) and lifetime precancerous lesions (AOR, 3.85; 95% CI, 1.73-8.57). Use of other noncigarette products (e.g., pipes) was inconsistently associated with oral health outcomes. PATH Study oral health measures closely align with self-reported measures from NHANES and are internally concurrent. Observed associations with tobacco use and the ability to examine emerging tobacco products support application of PATH Study data in dental research, particularly to examine potential oral health effects of novel tobacco products and longitudinal changes in tobacco use behaviors.

Congenital intestinal malrotation presenting in octogenarians: a report of two cases.

Malrotation is part of a spectrum of small and large bowel positional and fixational abnormalities caused by the failure of the fetal intestine to complete a 270-degree rotation around the superior mesenteric artery axis. Rarely, it presents in the adult as a cause of acute small bowel obstruction. Chronic symptoms of malrotation in adults are subtle, and include intermittent abdominal pain, nausea and vomiting. We present two cases of malrotation in octogenarian men presenting acutely with small bowel obstruction. Both patients were treated with emergency surgery. In one case the chronic symptoms resolved postoperatively. Malrotation and midgut volvulus should be considered as a rare differential diagnosis for small bowel obstruction in adults. Suspicions should be increased when there is a history of recurrent presentations with similar symptoms.

Small bowel obstruction secondary to diaphragmatic herniation following transabdominal cardiac ablation.

We report an unusual case of strangulated diaphragmatic hernia secondary to a pericardial ablation, which resulted in necrosis of the incarcerated small bowel. Through a literature search, we have found a limited number of similar cases introducing a case series for this rare but potentially fatal condition.

Engineered Protein Polymer-Gold Nanoparticle Hybrid Materials for Small Molecule Delivery.

We have fabricated protein polymer-gold nanoparticle (P-GNP) nanocomposites that exhibit enhanced binding and delivery properties of the small hydrophobic molecule drug, curcumin, to the model breast cancer cell line, MCF-7. These hybrid biomaterials are constructed via in situ GNP templated-synthesis with genetically engineered histidine tags. The P-GNP nanocomposites exhibit enhanced small molecule loading, sustained release and increased uptake by MCF-7 cells. When compared to the proteins polymers alone, the P-GNPs demonstrate a greater than 7-fold increase in curcumin binding, a nearly 50% slower release profile and more than 2-fold increase in cellular uptake of curcumin. These results suggest that P-GNP nanocomposites serve as promising candidates for drug delivery vehicles.

Molecular analysis of the recA gene of Agrobacterium tumefaciens C58.

The complete nucleotide sequence of the Agrobacterium tumefaciens recA gene was determined. A comparison of the translated open reading frame of the gene with other known recA sequences revealed significant sequence conservation. However, unlike its Escherichia coli equivalent, A. tumefaciens recA lacks the upstream 'SOS box', suggesting a different mechanism of regulation for this gene.

Protein growth factor(s) from C6 glioma cells that promote the growth of murine hybridomas.

C6 glioma cell conditioned medium (C6CM) has been used as a growth supplement for murine hybridomas. At 10% C6CM has been found to increase cell proliferation by 3-4-fold. This effect is observed in the presence of saturating concentration of FCS. Clonal growth is also enhanced 6.7-fold. No growth promoting effect is seen on murine myelomas or spleen cells. The factor(s) appear to be protein in nature.

Identification of two alternatively spliced transcripts of STEP: a subfamily of brain-enriched protein tyrosine phosphatases.

A brain-enriched protein tyrosine phosphatase termed STEP46 (striatal enriched phosphatase) was previously isolated and characterized. Immunological studies with a STEP monoclonal antibody recognized several STEP-immunoreactive proteins, and suggested that additional STEP-related polypeptides existed. This study reports the isolation of two alternatively spliced transcripts of the STEP gene. One of these, STEP20 (with a predicted molecular mass of 20 kDa) was further characterized and found to lack the conserved tyrosine phosphatase domain. Northern analysis detected a 2.8 kb STEP20 message in mouse brain. The second alternatively spliced transcript, STEP61, has a 5'-extended open reading frame that encodes a protein with a predicted molecular mass of 61 kDa and contains a single tyrosine phosphatase domain. The exon-intron organization responsible for the novel STEP20 and STEP61 sequences was determined in the mouse STEP genomic DNA. We propose that the original STEP46, along with STEP20 and STEP61, are members of a brain-enriched subfamily of protein tyrosine phosphatases, and that STEP isoforms may have distinct functions within the central nervous system.

Expression of a marrow stroma and thymus-associated antigen (ST3) in the rat brain: comparison with Thy-1.

Cells of the immunohemopoietic and nervous systems express certain molecules that generally are not found in other tissues. One example is the 'ST3' antigen, which is present on the major population of fibroblastoid cells grown from rat bone marrow, but is not detected on adherent cells from most peripheral organs (e.g. lung). An immunohistological survey revealed ST3 also in the thymic cortex, the glomerular mesangial area, and the brain. Because this pattern of distribution is similar to that described for Thy-1, we compared the localization of the two antigens in the adult rat brain and found that there were areas where it was congruent and others where it was distinct. Staining for ST3 was absent from the white matter, but was especially notable in discrete layers of the frontal, orbital, parietal, and cingulate cortices, the substantia nigra, the inferior olivary nuclei, and the deep molecular layer of the cerebellum, as well as other scattered regions in the gray matter. This is in contrast to Thy-1, which stained more diffusely throughout the gray zones. In further experiments using primary brain cell cultures, ST3 was demonstrated on neurons, but not on oligodendrocytes or astrocytes. Similarly, it was found on the surface of cells of the PC12 neuronal line, but not on the C6 astrocytoma. This restricted distribution on a subpopulation of neurons raises the possibility that the ST3 epitope might be part of a cell interaction molecule of the marrow stroma, thymus, and brain.

Recombinant erythropoietin and blood transfusion in selected preterm infants.

OBJECTIVES: To comprehensively identify preterm infants likely to require blood transfusion and to investigate the effectiveness of recombinant erythropoietin in this high risk subgroup. DESIGN: Double blind randomised controlled trial. SETTING: Neonatal Intensive Care Unit, Middlemore Hospital, Auckland, New Zealand. PATIENTS: Preterm infants < 33 weeks gestation and < 1700 g birth weight meeting specific criteria indicating a high possibility of requiring blood transfusion. INTERVENTIONS: Predictors of blood transfusion were determined by analysis of preterm infants admitted to a neonatal intensive care unit over a two year period. Using the criteria developed, high risk infants entered the study and received erythropoietin or sham treatment until 34 weeks completed gestation. The sample size was calculated to detect a reduction of one blood transfusion per infant (significance level 5%, power 80%). RESULTS: The selection criteria had a positive predictive value for transfusion of 91% and a negative predictive value of 94%. Mean birth weights and gestational ages were similar in the two groups. Absolute reticulocyte counts and haemoglobin values were higher in the group receiving erythropoietin. There was no significant difference in the number of blood transfusions received in the treatment and control groups. However, comparing transfusions given to < 1000 g infants after 30 days of age, there were significantly fewer transfusions in the erythropoietin group (mean (SD) 0.5 (0.7) in those receiving erythropoietin and 1.6 (1.1) in the controls). No adverse effects were noted. CONCLUSIONS: The selection criteria for the study were highly predictive of subsequent transfusion. In the group receiving erythropoietin, a reduction in transfusion requirements was apparent only in the < 1000 g birthweight group after 1 month of age.

Supracostal approach in percutaneous nephrolithotomy: experience with 102 cases.

PURPOSE: To assess retrospectively the safety and efficacy of the supracostal approach in percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS: Among 862 patients who underwent PCNL between April 1986 and December 1999, supracostal puncture was performed in 102. Their stones were either solitary (66.5%), multiple (15.7%), or staghorn (19.6%). Upper ureteral calculi were the commonest indication (32.4%). The interspace between the 11th and 12th ribs was used in all cases. After tract dilatation with telescopic metal dilators, pneumatic or ultrasound lithotripsy was used for fragmentation. RESULTS: Complete clearance was achieved in 79.5%. Ten patients (9.8%) had pleural violation in the form of hydrothorax, pneumothorax, or hydropneumothorax. All of these patients were managed successfully by intercostal chest tube drainage. CONCLUSION: Supracostal puncture in a safe and effective approach with acceptable morbidity in selected cases of staghorn, upper ureteral, and upper caliceal calculi.

Third-degree heart block during spinal anesthesia for cesarean delivery.

A 34-year-old parturient developed third-degree atrioventricular block, in the setting of hypotension, after spinal anesthesia for cesarean delivery. The arrhythmia fully resolved with anticholinergic and sympathomimetic drugs. Considering the increasing maternal morbidity and potential risk of maternal cardiac arrest, this critical state is reviewed, and a treatment algorithm is suggested.

A neuronal protein tyrosine phosphatase induced by nerve growth factor.

A new protein tyrosine phosphatase (PC12-PTP1) was identified in nerve growth factor (NGF)-treated PC12 cells. The mRNA level of PC12-PTP1 is increased 9-fold over the initial 8 h of NGF treatment and then decreases dramatically after 24 h of treatment. In rat brain, three transcripts corresponding to 1.5, 2.6, and 3.0 kilobases (kb) in size are detected by Northern blot analysis. Although the 1.5- and 2.6-kb transcripts are present in brain and other tissues, the 3-kb transcript is exclusively expressed in brain and the expression of this transcript alone increases following NGF treatment. PC12-PTP1 is a non-receptor protein tyrosine phosphatase (PTP) with a 50% sequence homology in the phosphatase domain with several other non-receptor PTPs. PC12-PTP1 fusion protein exhibits tyrosine phosphatase activity, and in vitro translation of the PC12-PTP1 transcript produces a major protein of 39 kDa. The data presented suggest that NGF regulates the expression of PC12-PTP1 during periods of neuronal growth and differentiation.

Equivalent refractive index of multiple-quantum-well waveguides by variational analysis.

We propose a new semianalytical method using variational analysis for developing an equivalent three-layer model of a multiple-quantum-well waveguide. Waveguiding properties such as effective index and field distribution of this equivalent waveguide are compared with those of previously reported equivalents and with the results obtained from the exact multilayer analysis of the multiple-quantum-well waveguide. The waveguiding properties are accurately predicted by this method, and the computational effort is significantly reduced.

Exact ray paths in bent waveguides.

We present here the Lagrangian formalism for studying the ray paths in cylindrically symmetric media. We have used the analysis to obtain the exact ray paths in bent slabs as well as in bent fibers with a separable profile.

Stemflow: A Source of Nutrients in some Naturally Growing Epiphytic Orchids of the Sikkim Himalaya.

A study on five naturally growing epiphytic orchids viz., Bulbophyllum affine Lindl., Coelogyne ochracea Lindl., Otochilus porrecta Lindl., Cirrhopetalum cornutum Lindl. and C. cornutum (var.) was carried out in the subtropical belt of Sikkim Himalaya. Stemflow leachates formed the main source of ammonium-N and nitrate-N for uptake by these orchids. Phosphorus concentration in the tissues of these orchids was high. Phosphate-P from stemflow does not seem to be a regular source of phosphorus for these orchids. Absorption/desorption results indicate that organic-N from stemflow leachates is not utilized by these orchids.

Adenovirus 12-mediated down-regulation of the major histocompatibility complex (MHC) class I promoter: identification of a negative regulatory element responsive to Ad12 E1A.

In highly oncogenic adenovirus (Ad) 12-transformed cells, major histocompatibility complex (MHC) class I gene expression is down-regulated by the products of the viral E1A oncogene at the level of initiation of transcription. However, class I gene expression is unaltered or elevated in non-oncogenic Ad2- or Ad5-transformed cells. These changes in class I expression may permit Ad12-transformed cells to escape host immune surveillance and elicit tumour formation. Here we show that the 2kb of 5' flanking region of the mouse H-2Kb class I gene is sufficient to mediate down-regulation of transcription driven from homologous or heterologous (HSV thymidine kinase) basal promoter elements in cells expressing Ad12 E1A, but not in Ad2 E1A-expressing cells. Deletion analysis of the 2kb region showed that sequences from -1.18 to -1.44kb (relative to the cap site) were a target for Ad12 E1A-mediated transcriptional down-regulation. Deletion of this entire region from the 2kb flanking sequence of the H-2Kb gene abolished Ad12 E1A-mediated down-regulation of transcription. Computer analysis of the -1.18 to -1.44kb sequence identified two 6/7bp matches with the AP-1 transcription factor consensus sequence and two matches with the pig MHC class I PD1 repressor element. Gel retardation analysis using overlapping DNA fragments derived from the -1.18 to -1.44kb sequence revealed several DNA:protein complexes formed using nuclear extract derived from Ad12-, but not from Ad2- or Ad5-transformed cells. Some of these DNA:protein complexes were also present, but at lower levels, in nuclear extracts from untransformed rat cells suggesting the possible involvement of cellular factors in the mechanism of down-regulation mediated by Ad12 E1A. A binding site for the AP-1 factor failed to compete for protein binding to fragments within the -1.18 to -1.44 sequence, while the PD1 site competed for binding only in the -1.15 to -1.23 region. These results indicate that novel factors (as well as a previously identified class I repressor, PD1) may be involved in Ad12 E1A-mediated down-regulation of MHC class I transcription.