A systematic review and meta-analysis of diagnostic performance of fluorescein-guided sentinel lymph node biopsy in early breast cancer.

BACKGROUND: Evaluation of axillary lymph nodes status in cN0 axilla is performed by sentinel lymph node biopsy (SLNB) utilizing a combination of radioactive isotope and blue dye or alternative to isotope like Indocyanine green (ICG). Both are very resource-intensive; which has prompted development of low-cost technique of Fluorescein Sodium (FS)-guided SLNB. This systematic review and meta-analysis evaluate the diagnostic performance of FS-guided SLNB in early breast cancer. OBJECTIVES: The objective was to evaluate the diagnostic performance of FS for sentinel lymph node biopsy. METHODS: Eligibility criteria: Studies where SLNB was performed using FS. INFORMATION SOURCES: PubMed, EMBASE, Cochrane library and online clinical trial registers. Risk of bias: Articles were assessed for risk of bias using the QUADAS-2 tool. SYNTHESIS OF RESULTS: The main summary measures were pooled Sentinel Lymph Node Identification Rate (SLN-IR) and pooled False Negative Rate (FNR) using random-effects model. RESULTS: A total of 45 articles were retrieved by the initial systematic search. 7 out of the 45 studies comprising a total of 332 patients were included in the meta-analysis. The pooled SLN-IR was 93.2% (95% confidence interval [CI], 0.87-0.97; 87% to 97%). Five validation studies were included for pooling the false negative rate and included a total of 211 patients. The pooled FNR was 5.6% (95% confidence interval [CI], 2.9-9.07). CONCLUSION: Fluorescein-guided SLNB is a viable option for detection of lymph node metastases in clinically node negative patients with early breast cancer. It achieves a high pooled Sentinel Lymph Node Identification Rate (SLN-IR) of 93% with a false negative rate of 5.6% for the detection of axillary lymph node metastasis.

Immunoinformatics based designing a multi-epitope vaccine against pathogenic Chandipura vesiculovirus.

Chandipura vesiculovirus (CHPV) is a rapidly emerging pathogen responsible for causing acute encephalitis. Due to its widespread occurrence in Asian and African countries, this has become a global threat, and there is an urgent need to design an effective and nonallergenic vaccine against this pathogen. The present study aimed to develop a multi-epitope vaccine using an immunoinformatics approach. The conventional method of vaccine design involves large proteins or whole organism which leads to unnecessary antigenic load with increased chances of allergenic reactions. In addition, the process is also very time-consuming and labor-intensive. These limitations can be overcome by peptide-based vaccines comprising short immunogenic peptide fragments that can elicit highly targeted immune responses, avoiding the chances of allergenic reactions, in a relatively shorter time span. The multi-epitope vaccine constructed using CTL, HTL, and IFN-γ epitopes was able to elicit specific immune responses when exposed to the pathogen, in silico. Not only that, molecular docking and molecular dynamics simulation studies confirmed a stable interaction of the vaccine with the immune receptors. Several physicochemical analyses of the designed vaccine candidate confirmed it to be highly immunogenic and nonallergic. The computer-aided analysis performed in this study suggests that the designed multi-epitope vaccine can elicit specific immune responses and can be a potential candidate against CHPV.

Role of integrative medicine in the continuum of care of breast cancer patients in the Indian context.

Breast cancer is the most frequently diagnosed cancer among women in both transitioned and transitioning countries and has become a major women's health problem. Although recent advances in our understanding of the biological nature of cancer, improved awareness coupled with better early detection facilities, use of chemotherapy, hormone therapy, and targeted therapy have significantly improved survival from cancer, there are many gaps in providing individual-centric, holistic care. Integrative medicine refers to the use of traditional medicine alongside conventional preventive or therapeutic interventions (allopathic medicine) as a comprehensive, individual-centered, evidence-based care. The three pillars of complementary medicine (lifestyle modifications, mind-body practices, and use of natural products) have the potential for cancer prevention and improving quality-of-life and even treatment response in cancer patients when combined with conventional oncology care. Therefore, continued research into integrative therapies is required to extend the benefits to a broader patient population and improve outcomes in breast and other common cancers. In the present review article, the possible role of integrative medicine across the breast cancer care continuum has been discussed along with the concept of integrating complementary practices into mainstream health delivery. We have focused on breast cancer as a model cancer that is well amenable to prevention, early detection and stage appropriate treatment. However, our observations are pertinent for other common cancers, for which there are several opportunities for improving the continuum of care, especially in developing countries like India.

"Dial of a Clock" Search Pattern for Clinical Breast Examination.

BACKGROUND: Clinical breast examination (CBE) is an integral component of triple assessment for women presenting with symptomatic breast disease. Four common search patterns of CBE are "dial of a clock" (DC), "vertical strips" (VS), "quadrant-wise" (QW), and "concentric circles" (CC). The most sensitive search pattern of CBE has not been established. METHODS: A cross-sectional study was conducted on women with symptomatic breast disease, to measure various diagnostic performance indices of four different search patterns of CBE by a professor, a surgical resident trainee, and a trained nurse. Women were examined one at a time randomly by three examiners. Each examiner examined with four different search patterns of CBE, one method at a time. Any nodularity or lump detected was noted and the findings were compared with breast sonography, which was considered as the gold standard. Statistical analysis was done using STATA 14, SPSS 20, and OpenEpi software for diagnostic test indices. RESULTS: Sixty women (mean age = 39.6) with palpable findings of both breasts were included (n = 120). Most women presented with complaints of breast lump (70%) and mastalgia (27%). Sensitivity was highest for DC as elaborated [% (95% confidence interval)]: DC[73.2 (60-83)] > CC[66 (53-77)] > VS[62.5 (49-73)] > QW[58.9 (45-70)] for professor; DC[64.2 (51-75)] > VS[62.5 (49-73)] > CC[57.1 (44-69)] > QW[57.1 (44-69)] for resident; and DC[82.1 (70- 90)] > VS[78.5 (66-87)] > CC(75 (62-84)] > QW[73.2 (60-83)] for nurse. The minimum sonographic tumor size picked up by DC by all the examiners was 7 mm. CONCLUSIONS: The DC search pattern of CBE demonstrated the highest sensitivity for all the examiners. The trained nurse achieved the highest sensitivity among all the examiners.

Paravertebral anaesthesia with or without sedation versus general anaesthesia for women undergoing breast cancer surgery.

BACKGROUND: Breast cancer is one of the most common cancers among women. Surgical removal of the cancer is the mainstay of treatment; however, tumour handling during surgery can cause microscopic dissemination of tumour cells and disease recurrence. The body's hormonal response to surgery (stress response) and general anaesthesia may suppress immunity, promoting tumour dissemination. Paravertebral anaesthesia numbs the site of surgery, provides good analgesia, and blunts the stress response, minimising the need for general anaesthesia. OBJECTIVES: To assess the effects of paravertebral anaesthesia with or without sedation compared to general anaesthesia in women undergoing breast cancer surgery, with important outcomes of quality of recovery, postoperative pain at rest, and mortality. SEARCH METHODS: On 6 April 2020, we searched the Specialised Register of the Cochrane Breast Cancer Group (CBCG); CENTRAL (latest issue), in the Cochrane Library; MEDLINE (via OvidSP); Embase (via OvidSP); the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal; and ClinicalTrials.gov for all prospectively registered and ongoing trials. SELECTION CRITERIA: We included randomised controlled trials (RCTs) conducted in adult women undergoing breast cancer surgery in which paravertebral anaesthesia with or without sedation was compared to general anaesthesia. We did not include studies in which paravertebral anaesthesia was given as an adjunct to general anaesthesia and then this was compared to use of general anaesthesia. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted details of trial methods and outcome data from eligible trials. When data could be pooled, analyses were performed on an intention-to-treat basis, and the random-effects model was used if there was heterogeneity. When data could not be pooled, the synthesis without meta-analysis (SWiM) approach was applied. The GRADE approach was used to assess the certainty of evidence for each outcome. MAIN RESULTS: Nine studies (614 participants) were included in the review. All were RCTs of parallel design, wherein female patients aged > 18 years underwent breast cancer surgery under paravertebral anaesthesia or general anaesthesia. None of the studies assessed quality of recovery in the first three postoperative days using a validated questionnaire; most assessed factors affecting quality of recovery such as postoperative analgesic use, postoperative nausea and vomiting (PONV), hospital stay, ambulation, and patient satisfaction. Paravertebral anaesthesia may reduce the 24-hour postoperative analgesic requirement (odds ratio (OR) 0.07, 95% confidence interval (CI) 0.01 to 0.34; 5 studies, 305 participants; low-certainty evidence) compared to general anaesthesia. Heterogeneity (I² = 70%) was attributed to the fixed dose of opioids and non-steroidal analgesics administered postoperatively in one study (70 participants), masking a difference in analgesic requirements between groups. Paravertebral anaesthesia probably reduces the incidence of PONV (OR 0.16, 95% CI 0.08 to 0.30; 6 studies, 324 participants; moderate-certainty evidence), probably results in a shorter hospital stay (mean difference (MD) -79.39 minutes, 95% CI -107.38 to -51.40; 3 studies, 174 participants; moderate-certainty evidence), and probably reduces time to ambulation compared to general anaesthesia (SWiM analysis): percentages indicate vote counting based on direction of effect (100%, 95% CI 51.01% to 100%; P = 0.125; 4 studies, 375 participants; moderate-certainty evidence). Paravertebral anaesthesia probably results in higher patient satisfaction (MD 5.52 points, 95% CI 1.30 to 9.75; 3 studies, 129 participants; moderate-certainty evidence) on a 0 to 100 scale 24 hours postoperatively compared to general anaesthesia. Postoperative pain at rest and on movement was assessed at 2, 6, and 24 postoperative hours on a 0 to 10 visual analogue scale (VAS). Four studies (224 participants) found that paravertebral anaesthesia as compared to general anaesthesia probably reduced pain at 2 postoperative hours (MD -2.95, 95% CI -3.37 to -2.54; moderate-certainty evidence). Five studies (324 participants) found that paravertebral anaesthesia may reduce pain at rest at 6 hours postoperatively (MD -1.54, 95% CI -3.20 to 0.11; low-certainty evidence). Five studies (278 participants) found that paravertebral anaesthesia may reduce pain at rest at 24 hours postoperatively (MD -1.19, 95% CI -2.27 to -0.10; low-certainty evidence). Differences in the methods of two studies (119 participants) and addition of clonidine to the local anaesthetic in two studies (109 participants), respectively, contributed to the heterogeneity (I² = 96%) observed for these two outcomes. Two studies (130 participants) found that paravertebral anaesthesia may reduce pain on movement at 6 hours (MD-2.57, 95% CI -3.97 to -1.17) and at 24 hours (MD -2.12, 95% CI -4.80 to 0.55; low-certainty evidence). Heterogeneity (I² = 96%) was observed for both outcomes and could be due to methodological differences between studies. None of the studies reported mortality related to the anaesthetic technique. Eight studies (574 participants) evaluated adverse outcomes with paravertebral anaesthesia: epidural spread (0.7%), minor bleeding (1.4%), pleural puncture not associated with pneumothorax (0.3%), and Horner's syndrome (7.1%). These complications were self-limiting and resolved without treatment. No data are available on disease-free survival, chronic pain, and quality of life. Blinding of personnel or participants was not possible in any study, as a regional anaesthetic technique was compared to general anaesthesia. Risk of bias was judged to be serious, as seven studies had concerns of selection bias and three of detection bias. AUTHORS' CONCLUSIONS: Moderate-certainty evidence shows that paravertebral anaesthesia probably reduces PONV, hospital stay, postoperative pain (at 2 hours), and time to ambulation and results in greater patient satisfaction on the first postoperative day compared to general anaesthesia. Paravertebral anaesthesia may also reduce postoperative analgesic use and postoperative pain at 6 and 24 hours at rest and on movement based on low-certainty evidence. However, RCTs using validated questionnaires are needed to confirm these results. Adverse events observed with paravertebral anaesthesia are rare.

Regulatory safety pharmacology and toxicity assessments of a standardized stem extract of Cassia occidentalis Linn. in rodents.

Cassia occidentalis Linn (CO) is an annual/perennial plant having traditional uses in the treatments of ringworm, gastrointestinal ailments and piles, bone fracture, and wound healing. Previously, we confirmed the medicinal use of the stem extract (ethanolic) of CO (henceforth CSE) in fracture healing at 250 mg/kg dose in rats and described an osteogenic mode of action of four phytochemicals present in CSE. Here we studied CSE's preclinical safety and toxicity. CSE prepared as per regulations of Current Good Manufacturing Practice for human pharmaceuticals/phytopharmaceuticals and all studies were performed in rodents in a GLP-accredited facility. In acute dose toxicity as per New Drug and Clinical Trial Rules, 2019 (prior name schedule Y), in rats and mice and ten-day dose range-finding study in rats, CSE showed no mortality and no gross abnormality at 2500 mg/kg dose. Safety Pharmacology showed no adverse effect on central nervous system, cardiovascular system, and respiratory system at 2500 mg/kg dose. CSE was not mutagenic in the Ames test and did not cause clastogenicity assessed by in vivo bone marrow genotoxicity assay. By a sub chronic (90 days) repeated dose (as per OECD, 408 guideline) study in rats, the no-observed-adverse-effect-level was found to be 2500 mg/kg assessed by clinico-biochemistry and all organs histopathology. We conclude that CSE is safe up to 10X the dose required for its osteogenic effect.

Corynebacterium striatum: An emerging nosocomial skin and soft-tissue pathogen.

The genus Corynebacterium is composed of Gram-positive, aerobic, non-motile, non-spore-forming bacilli that are widely distributed throughout the environment. They are usually found as commensals on the skin and are often considered as mere contaminants when isolated from clinical samples. We describe a patient with skin and soft-tissue infections due to Corynebacterium striatum following exploratory laparotomy identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry. The clinical importance and pathogenic potential of Corynebacterium species, especially C. striatum, cannot be underestimated. This report is a reminder to physicians of the possible pathogenicity of non-diphtherial Corynebacteria.

Improving and calibrating channel erosion simulation in the Water Erosion Prediction Project (WEPP) model.

The Water Erosion Prediction Project (WEPP) model has been widely used to assess the impacts of management practices and climate change on runoff and soil loss at both hillslope and watershed scales. However, the representation of channel erosion processes in WEPP has not been changed significantly since it was released. The current (WEPP v2012.8) and previous WEPP versions assume that channel input erodibility parameters are constant through time, which may lead to erroneous channel detachment predictions, especially for cropland with substantial tillage operations. In this research, the temporally constant values of channel erodibility and critical shear stress were replaced by daily updated values, using the same temporal erodibility and critical shear stress adjustments that are applied in hillslope profile simulations for rill detachment. Observed watershed-scale runoff and soil erosion data from six agricultural watersheds were used to calibrate and compare the WEPP model performance in simulating channel runoff volumes and soil losses before and after the modification. The research showed both WEPP v2012.8 and the modified WEPP model (WEPP_CE) could satisfactorily simulate event-based hydrology and soil erosion at the watershed outlets after calibration. The WEPP_CE model with temporally varying channel erodibility and critical shear stress values demonstrated improved representation of the physical processes in channel soil detachment. Continued improvement in the representation of channel erosion processes in WEPP and other process-based models is needed. The improved WEPP model can be used to evaluate the effectiveness of soil conservation practices on hydrology and erosion in further research.

Endoscopic thyroidectomy: Which one is the better technique for the beginners?

INTRODUCTION: Endoscopic thyroidectomy is an advanced procedure and has a long learning curve. Most commonly employed approach is combined axillary-breast approach (ABA). Recently, transoral endoscopic thyroidectomy vestibular approach (TOETVA) is being popularised as a scarless procedure. However, it is not established whether TOETVA or ABA approach is better to begin with. PURPOSE: The purpose of the study was to compare the initial experience of TOETVA and ABA with respect to difficulties and outcomes. METHODOLOGY: A prospective non-randomised interventional study was conducted including the initial ten patients in each group who underwent hemithyroidectomy for benign solitary thyroid nodule. Sigma plot version 12.3 was used for the statistical analysis. RESULTS: All the patients were female and comparable with respect to age (33.2 vs. 28.2 years) and size of nodule (2.7 vs. 3 cm) (TOETVA vs. ABA). The operative time (121 vs. 138.5 min, P = 0.34) and blood loss (50 vs. 60 ml, P = 0.9) were similar in both the groups. Even though the flap raising time was significantly less with TOETVA group (29.3 vs. 47.2 min, P < 0.001), it was associated with more difficulty in approaching upper pole (P = 0.02) and lower pole (P < 0.001), more intra-operative events (30% vs. 10%, P = 0.58) and conversions to open (20% vs. 10%, P = 1). Similarly, post-operative pain scoring was more with TOETVA (3 vs. 2, P = 0.04). Hospital stay was similar in both the groups (2.5 vs. 3 days, P = 1). Patients in both the groups had both overall and cosmetic satisfaction. CONCLUSIONS: Axillary-breast approach should be preferred to start learning the endoscopic thyroidectomy, as it is easier and safer than transoral endoscopic vestibular approach.

Screening of physicochemical and functional attributes of fermented beverage (wine) produced from local mango (Mangifera indica) varieties of Uttar Pradesh using novel saccharomyces strain.

Mango (Mangifera Indica L.) is a major tropical fruit rich in sugar, organic acids and flavonoids, making it suitable fruit for wine making. In the present study, five varieties of mango (Baganpalli, Langra, Dashehari, Alphonso, and Totapuri) were utilized for wine production using two different yeast strains namely, Saccharomyces cerevisiae MTCC 178 and isolated yeast. The physiochemical analysis of wine produced from chosen mango varieties showed that North Indian local mango variety (Dashehari) gave better results in terms of organoleptic and functional attributes. The Saccharomyces cerevisiae MTCC 178 treated Dashehari wine possessed 6.1 ± 0.26% TSS, 2.1 ± 0.08% reducing sugar, 0.657% titratable acidity, 0.11 ± 0.00% volatile acidity, 12% ethanol (v/v) and pH 3.7 ± 0.10 comparable to Baganpalli mango wine. HPLC analysis of Saccharomyces cerevisiae MTCC 178 inoculated Dashehari mango wine revealed the presence of primarily; gallic acid (RT-4.4 min), Galloyl-A-type, procyanidin (RT-5.2 min), 2,2,6-Trimethyl-6-vinyltetrahydropyran (RT-8.91 min), ß-Pinene (RT-11.47 min) and Caffeoyl-quinic acid (RT-12.15 min) showing potential antioxidant, anti-cancerous, anti-inflammatory and antimicrobial properties. The local mango varieties wine showed significant (p < 0.05) physicochemical properties, antioxidant potential and ethanol content comparable to Baganpalli wine and was cost effective.

Comparison of Non-Operative Mesotherapy and Surgery in the Management of Superficial Lipomas.

BACKGROUND: Lipomas are benign adipocytic tumours. Surgical excision is the gold standard for treating such lipomas, but it results in unaesthetic scarring. METHODS: A total of 126 patients were randomised into two groups. The patients in Group A underwent mesotherapy (n = 66) and those in Group B underwent surgery (n = 60). The patients in Group A group received six sessions of mesotherapy treatment at 2-week intervals. Both groups were followed up for 12 weeks, during which they were assessed for complications arising from treatment, reduction of the size of the lipoma and cosmetic outcomes. RESULTS: The overall mean age of the patients was 32.93 (± 10.1) years old and the mean volume of the lipomas was 2.29 (± 3.8) mL. A 55.86% (P = 0.0032) mean reduction in the volume of lipomas was noted in the patients who received mesotherapy, while one patient showed a gain of 16% by volume. The patients in Group A (cosmetic score ≥ 4: 63%) were happier with the treatment than those in Group B (cosmetic score ≥ 4: 21%). CONCLUSION: Our findings indicate that mesotherapy modestly reduces the volume of lipomas with very few and minor complications and excellent cosmetic outcomes.

MAPK cascade gene family in Camellia sinensis: In-silico identification, expression profiles and regulatory network analysis.

BACKGROUND: Mitogen Activated Protein Kinase (MAPK) cascade is a fundamental pathway in organisms for signal transduction. Though it is well characterized in various plants, there is no systematic study of this cascade in tea. RESULT: In this study, 5 genes of Mitogen Activated Protein Kinase Kinase (MKK) and 16 genes of Mitogen Activated Protein Kinase (MPK) in Camellia sinensis were found through a genome-wide search taking Arabidopsis thaliana as the reference genome. Also, phylogenetic relationships along with structural analysis which includes gene structure, location as well as protein conserved motifs and domains, were systematically examined and further, predictions were validated by the results. The plant species taken for comparative study clearly displayed segmental duplication, which was a significant candidate for MAPK cascade expansion. Also, functional interaction was carried out in C. sinensis based on the orthologous genes in Arabidopsis. The expression profiles linked to various stress treatments revealed wide involvement of MAPK and MAPKK genes from Tea in response to various abiotic factors. In addition, the expression of these genes was analysed in various tissues. CONCLUSION: This study provides the targets for further comprehensive identification, functional study, and also contributed for a better understanding of the MAPK cascade regulatory network in C. sinensis.

Case 283: Breast Filariasis.

History A 44-year-old woman who was a resident of Bihar, which is a state in eastern India, presented to the surgical outpatient department of our hospital with a history of gradually increasing swelling of the right breast associated with redness, pain, and itching over the past month. She reported a general sense of malaise and experienced episodes of chills over the past 6 months; however, she had no documented fever. There was no history of breast trauma. No history suggestive of a possible hypercoagulable state could be elicited (she was a nonsmoker, had undergone uncomplicated normal vaginal delivery 15 years earlier, was not taking oral contraceptives, and had no history to suggest past deep venous thrombosis). General physical examination findings were unremarkable. On local examination, she was found to have diffuse enlargement of the right breast. The skin over the lateral part of the breast was erythematous and showed the presence of prominent superficial veins. On palpation, few ill-defined firm mobile masses were found in the upper outer quadrant with overlying skin induration. No skin ulceration or nipple discharge was present. Few firm and discrete lymph nodes were palpable in the right axilla. Laboratory investigations showed mild anemia (hemoglobin level, 10 g/dL; normal range, 12-15 g/dL), a total leukocyte count of 14 000 cells per microliter (14 cells × 109/L) (normal range, 4500-11 000 cells per microliter [4.5-11 cells × 109/L]), a normal differential leukocyte count (74% neutrophils [normal range, 40%-80%], 24% lymphocytes [normal range, 20%-40%], and 2% eosinophils [normal range, 1%-4%]), and an erythrocyte sedimentation rate of 31 mm per hour (normal range, 0-29 mm per hour). She underwent both mammography and US. Real-time US showed mobile structures on the series of US images obtained seconds apart. On the basis of the imaging findings, US-guided fine-needle aspiration cytology was performed to confirm the diagnosis, and appropriate treatment was instituted.

Case 283.

History A 44-year-old woman who was a resident of Bihar, which is a state in eastern India, presented to the surgical outpatient department of our hospital with a history of gradually increasing swelling of the right breast associated with redness, pain, and itching over the past month (Fig 1). She reported a general sense of malaise and experienced episodes of chills over the past 6 months; however, she had no documented fever. There was no history of breast trauma. No history suggestive of a possible hypercoagulable state could be elicited (she was a nonsmoker, had undergone uncomplicated normal vaginal delivery 15 years earlier, was not taking oral contraceptives, and had no history to suggest past deep venous thrombosis). General physical examination findings were unremarkable. On local examination, she was found to have diffuse enlargement of the right breast. The skin over the lateral part of the breast was erythematous and showed the presence of prominent superficial veins. On palpation, few ill-defined firm mobile masses were found in the upper outer quadrant with overlying skin induration. No skin ulceration or nipple discharge was present. Few firm and discrete lymph nodes were palpable in the right axilla. Laboratory investigations showed mild anemia (hemoglobin level, 10 g/dL; normal range, 12-15 g/dL), a total leukocyte count of 14 000 cells per microliter (14 cells × 109/L) (normal range, 4500-11 000 cells per microliter [4.5-11 cells × 109/L]), a normal differential leukocyte count (74% neutrophils [normal range, 40%-80%], 24% lymphocytes [normal range, 20%-40%], and 2% eosinophils [normal range, 1%-4%]), and an erythrocyte sedimentation rate of 31 mm per hour (normal range, 0-29 mm per hour). She underwent both mammography (Fig 2) and US (Fig 3). Real-time US showed mobile structures on the series of US images obtained seconds apart (Fig 4). On the basis of the imaging findings, US-guided fine-needle aspiration cytology was performed to confirm the diagnosis, and appropriate treatment was instituted.

Thermodynamics of ferredoxin binding to cyanobacterial nitrate reductase.

The role of the seven negatively charged amino acids of Synechocystis sp. PCC 6803 ferredoxin (Fd), i.e., Glu29, Glu30, Asp60, Asp65, Asp66, Glu92, and Glu93, predicted to form complex with nitrate reductase (NR), was investigated using site-directed mutagenesis and isothermal titration calorimetry (ITC). These experiments identified four Fd amino acids, i.e., Glu29, Asp60, Glu92, and Glu93, that are essential for the Fd binding and efficient electron transfer to the NR. ITC measurements showed that the most likely stoichiometry for the wild-type NR/wild-type Fd complex is 1:1, a Kd value 4.7 µM for the complex at low ionic strength residues and both the enthalpic and entropic components are associated with complex formation. ITC titrations of wild-type NR with four Fd variants, E29N, D60N, E92Q, and E93N demonstrated that the complex formation, although favorable, was less energetically favorable when compared to complex formation between the two wild-type proteins, suggesting that these negatively charged Fd residues at these positions are important for the effective and productive interaction with wild-type enzyme.

Role of tranexamic acid in axillary lymph node dissection in breast cancer patients.

Axillary lymph node dissection (ALND) is an important step in the management of node-positive operable breast cancer. It is associated with large amount of axillary drainage and increased risk of wound-related infection. Tranexamic acid (TA) has antifibrinolytic property and is being extensively used in controlling blood loss. However, its role in reducing axillary drainage after ALND is still not well-established. The aim of this study is to evaluate the effectiveness of TA in reducing the axillary drainage, early removal of the drain, and decreasing the wound-related infection in breast cancer patients undergoing ALND. This is a prospective nonrandomized double-armed cohort study. Total of 47 patients were included in the TA group and 46 in the nontranexamic (NTA) group. All the patients in TA group received a single dose of intravenous (IV) TA at the time of induction followed by oral TA for five days after surgery. Both TA and NTA groups had similar proportions of locally advanced breast cancers (57.4% vs 56.5%, P = .90). Majority of them underwent modified radical mastectomy (MRM) (70.2% vs 67.4%, P = .76). Patients in TA group had significantly lower axillary drainage (440 ml vs 715.5 ml, P = .003) with earlier removal of the drain (8 vs 11 days, P = .046). Seroma formation (19.1% vs 32.6%, P = .13) and wound-related infection (4.3% vs 8.7%, P = .43) were nonsignificantly lower in the TA group. Tranexamic acid reduces axillary drainage and facilitates early removal of the drain after axillary lymph node dissection.

Primary vs delayed primary closure in patients undergoing lower limb amputation following trauma: A randomised control study.

Lower limb crush injury is a major source of mortality and morbidity in trauma patients. Complications, especially surgical site infections (SSIs) are a major source of financial burden to the institute and to the patient as it delays rehabilitation. As such, every possible attempt should be made to reduce any complications. We, thus, aimed to compare the outcomes in early vs delayed closure of lower extremity stumps in cases of lower limb crush injury requiring amputation, so as to achieve best possible outcome. A randomised controlled study was conducted in the Division of Trauma Surgery & Critical Care at Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi from 1 September 2018 to 30 June 2019 and included patients undergoing lower limb amputation below hip joint. Patients were randomised in two groups, in one group amputation stump was closed primarily, while in the second group delayed primary closure of stump was performed. We compared rate of SSI, length of hospital stay, and number of surgeries in both the groups. Fifty-six patients with 63 amputation stumps were recruited in the study. Mean age of patients in the study was 34 years, of which about 95% patients were males. The most common mechanism of injury was road traffic injury in 66% of patients. Mean injury severity score was 12.28 and four patients had diabetes preoperatively. Total 63 extremities were randomised with 30 cases in group I and 33 cases in group II as per computer-generated random number. Above knee amputations was commonest (57.14%) followed by below knee amputations (33.3%). Two patients died in the current study. In group I, In-hospital infection was detected in 7 cases (23.3%) and in group II 9 cases (27.3%) had SSI during hospital admission (P > .05). Mean hospital stay in group I was 10.32 ± 7.68 days and in group II was 11 ± 8.17 days (P > .05). Road traffic injuries and train-associated injuries are a major cause of lower limb crush injuries, leading to limb loss. Delayed primary closure of such wounds requires extra number of surgical interventions than primary closure. There is no difference in extra number of surgical interventions required in both the groups. Thus, primary closure can be safely performed in patients undergoing lower limb amputations following trauma, provided that a good lavage and wound debridement is performed.

Evaluation of Effect of Propranolol on Serum Vascular Endothelial Growth Factor and Tissue Inhibitor of Metalloproteinase-2 Levels in Infantile Hemangioma.

BACKGROUND: Infantile hemangioma is the most common tumor of infancy. Currently, propranolol is a preferred drug for treating hemangioma. The exact mechanism of action of propranolol is not known. In this study, we attempted to assess whether propranolol has any effect on vascular endothelial growth factor (VEGF) and tissue inhibitor of metalloproteinase-2 (TIMP-2) over a period of time, and if it is there, how long it affects it. MATERIALS AND METHODS: Propranolol was administered in the dosage of 2-3 mg/kg. The first serum sample was collected before starting the propranolol treatment. Thereafter, samples were collected at monthly intervals up to a total of six samples. The samples were assessed for TIMP-2 and VEGF using enzyme-linked immunosorbent assay kit. RESULTS: The duration of this study was from June 2016 to November 2017. The total number of patients in this study was 15. Thirteen patients responded to treatment. The mean age of patients was 7.1 months. The mean value of baseline VEGF was 0.234 ± 0.059 and that of TIMP-2 was 1.338 ± 0.679. As compared to baseline value, the P value was statistically not significant in any of sequential values. In category-wise analysis, apart from statistically significant value in the 6th month in excellent category and good response category in the 1st month, all other values did not reveal any significant change in VEGF analysis. The analysis of TIMP-2 revealed a significant change in the levels from Sample 2 to Sample 6 in the excellent response group; however, the levels did not show a specific trend either increasing or decreasing. CONCLUSION: Despite its beneficial action in regression of hemangioma, the exact mechanism is yet to be identified. The exact duration of treatment needs further evaluation.

Chromium Influenced High Magnetic Moment and Half-Metallic Nature of GaN Nanotube.

Density functional theory-based calculations have been performed to analyze the electronic and magnetic properties of chromium doped (6, 0) GaN nanotube. The structural stability of GaN nano-tube has been defined in terms of formation energy, which increases as a function of magnetic impurity (Cr). The study demonstrates that the direct band gap semiconducting GaN nanotube transforms to half-metallic as a function of Cr introduction to GaN. This half metallic nature with high magnetic moment of Cr doped GaN nanotube can be a key parameter for its use in spintronics applications.

Low coherence quantitative phase microscopy with machine learning model and Raman spectroscopy for the study of breast cancer cells and their classification.

Early-stage detection of breast cancer is the primary requirement in modern healthcare as it is the most common cancer among women worldwide. Histopathology is the most widely preferred method for the diagnosis of breast cancer, but it requires long processing time and involves qualitative assessment of cancer by a trained person/doctor. Here, we present an alternate technique based on white light interference microscopy (WLIM) and Raman spectroscopy, which has the capability to differentiate between cancerous and normal breast tissue. WLIM provides quantitative phase information about the biological tissues/cells, whereas Raman spectroscopy can detect changes in their molecular structure and chemical composition during cancer growth. Further, both the techniques can be implemented very quickly without staining the sample. The present technique is employed to perform ex vivo study on a total of 80 normal and cancerous tissue samples collected from 16 different patients. A generalized machine learning model is developed for the classification of normal and cancerous tissues, which is based on texture features obtained from phase maps with an accuracy of 90.6%. The correlation of outcomes from these two techniques can open a new avenue for fast and accurate detection of cancer without any trained personnel.