Time-domain heart rate dynamics in the prognosis of progressive atherosclerosis.

BACKGROUND AND AIM: The regular uptake of a high-fat diet (HFD) with changing lifestyle causes atherosclerosis leading to cardiovascular diseases and autonomic dysfunction. Therefore, the current study aimed to investigate the correlation of autonomic activity to lipid and atherosclerosis markers. Further, the study proposes a support vector machine (SVM) based model in the prediction of atherosclerosis severity. METHODS AND RESULTS: The Lead-II electrocardiogram and blood markers were measured from both the control and the experiment subjects each week for nine consecutive weeks. The time-domain heart rate variability (HRV) parameters were derived, and the significance level was tested using a one-way Analysis of Variance. The correlation analysis was performed to determine the relation between autonomic parameters and lipid and atherosclerosis markers. The statistically significant time-domain values were used as features of the SVM. The observed results demonstrated the reduced time domain HRV parameters with the increase in lipid and atherosclerosis index markers with the progressive atherosclerosis severity. The correlation analysis revealed a negative association between time-domain HRV parameters with lipid and atherosclerosis parameters. The percentage accuracy increases from 86.58% to 98.71% with the increase in atherosclerosis severity with regular consumption of HFD. CONCLUSIONS: Atherosclerosis causes autonomic dysfunction with reduced HRV. The negative correlation between autonomic parameters and lipid profile and atherosclerosis indexes marker revealed the potential role of vagal activity in the prognosis of atherosclerosis progression. The support vector machine presented a respectable accuracy in the prediction of atherosclerosis severity from the control group.

Andrographolide: A Herbal-Chemosynthetic Approach for Enhancing Immunity, Combating Viral Infections, and Its Implication on Human Health.

Plants consistently synthesize and accumulate medically valuable secondary metabolites which can be isolated and clinically tested under in vitro conditions. An advancement with such important phytochemical production has been recognized and utilized as herbal drugs. Bioactive andrographolide (AGL; C20H30O5) isolated from Andrographis paniculate (AP) (Kalmegh) is a diterpenoid lactones having multifunctional medicinal properties including anti-manic, anti-inflammatory, liver, and lung protective. AGL is known for its immunostimulant activity against a variety of microbial infections thereby, regulating classical and alternative macrophage activation, Ag-specific antibody production during immune disorder therapy. In vitro studies with AGL found it to be effective against multiple tumors, neuronal disorders, diabetes, pneumonia, fibrosis, and other diverse therapeutic misadventures. Generally, virus-based diseases like ZIKA, influenza A virus subtype (H1NI), Ebola (EBOV), Dengue (DENV), and coronavirus (COVID-19) epidemics have greatly increased scientific interest and demands to develop more effective and economical immunomodulating drugs with minimal side effects. Trials and in vitro pharmacological studies with AGL and medicinally beneficial herbs might contribute to benefit the human population without using chemical-based synthetic drugs. In this review, we have discussed the possible role of AGL as a promising herbal-chemo remedy during human diseases, viral infections and as an immunity booster.

Assessing the impacts of historical and future land use and climate change on the streamflow and sediment yield of a tropical mountainous river basin in South India.

In this study, the impacts of land use/land cover (LULC) and climate change on the streamflow and sediment yield were investigated for the Payaswani River Basin, Western Ghats, India. The LULC was determined using Landsat images, and climate data were procured from five general circulation models for representative concentration pathway (RCP) 4.5 (moderate emission) and 8.5 (high emission). The land change modeler was used to derive the future LULC and its changes from 1988 (historical) to 2030 (future) by using the transition matrix method. The SWAT model was used to assess the impacts of LULC and climate change for the streamflow and sediment yield. The results showed that decrease in forests and grasslands and increase in plantation, agricultural, and urban areas from 1988 to 2030 would lead to an increase in the mean streamflow (11.23%) and sediment yield (17.41%). Under RCP 4.5, climate change would decrease the streamflow by 2.38% in 2030. However, under RCP 8.5, climate change would increase the streamflow by 0.12% in 2030. The sediment yield under RCP 4.5 and 8.5 would increase by 1.23% and 3.33%, respectively. In comparison with the baseline condition, by 2030 future changes in the LULC and climate would increase the streamflow by 7.05% and 11.71% under RCP 4.5 and 8.5, respectively. The sediment yield would increase by 7.92% and 27.11% under RCP 4.5 and 8.5, respectively. The streamflow and sediment yield were predicted to increase in the summer and winter but decrease in the monsoon season.

Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition.

Chronic diarrhoea is a common problem, hence clear guidance on investigations is required. This is an updated guideline from 2003 for the investigations of chronic diarrhoea commissioned by the Clinical Services and Standards Committee of the British Society of Gastroenterology (BSG). This document has undergone significant revision in content through input by 13 members of the Guideline Development Group (GDG) representing various institutions. The GRADE system was used to appraise the quality of evidence and grading of recommendations.

A Retrospective Comparative Analysis of 2D Versus 3D Laparoscopy in Total Laparoscopic Hysterectomy for Large Uteri (≥ 500g).

STUDY OBJECTIVE: To evaluate the outcomes of total laparoscopic hysterectomy using 3D vision in comparison with 2D vision in women with large uteri (≥500g). DESIGN: Retrospective analytical study Design Classification: Canadian Task Force II-1 Setting: Tertiary referral center for advanced gynecological surgery. PATIENTS: Five hundred forty six women who underwent total laparoscopic hysterectomy over a period of 13 years were studied: 301 under 2D vision and 245 under 3D vision. INTERVENTIONS: Total laparoscopic hysterectomy Measurements: Surgical time, blood loss and complications were recorded for every case in both groups. MAIN RESULTS: The duration of surgery for hysterectomy in the 3D laparoscopy group (88.01?36.95 min) was significantly shorter than that in the 2D group (112.61?42.59 min, p=.0001). Blood loss in the 500-1000g group was significantly less in the 3D group (p=.005). The total complication rates for 3D surgery (3.37 %) and 2D surgery (6.64%) were comparable (p=.25). CONCLUSION: Three-dimensional laparoscopy provides stereoscopic vision and increases precision and safety. The availability of depth perception adds to the ease of surgery, especially in cases of large uteri, leading to reductions in both the duration of surgery and blood loss, which improves patient outcomes.

Three-dimensional laparoscopy: Principles and practice.

The largest challenge for laparoscopic surgeons is the eye-hand coordination within a three-dimensional (3D) scene observed on a 2D display. The 2D view on flat screen laparoscopy is cerebrally intensive. The loss of binocular vision on a 2D display causes visual misperceptions, mainly loss of depth perception and adds to the surgeon's fatigue. This compromises the safety of laparoscopy. The 3D high-definition view with great depth perception and tactile feedback makes laparoscopic surgery more acceptable, safe and cost-effective. It improves surgical precision and hand-eye coordination, conventional and all straight stick instruments can be used, capital expenditure is less and recurring cost and annual maintenance cost are less. In this article, we have discussed the physics of 3D laparoscopy, principles of depth perception, and the different kinds of 3D systems available for laparoscopy. We have also discussed our experience of using 3D laparoscopy in over 2000 surgeries in the last 4 years.

Jasmonate-induced biosynthesis of andrographolide in Andrographis paniculata.

Andrographolide is a prominent secondary metabolite found in Andrographis paniculata that exhibits enormous pharmacological effects. In spite of immense value, the normal biosynthesis of andrographolide results in low amount of the metabolite. To induce the biosynthesis of andrographolide, we attempted elicitor-induced activation of andrographolide biosynthesis in cell cultures of A. paniculata. This was carried out by using methyl jasmonate (MeJA) as an elicitor. Among the various concentrations of MeJA tested at different time periods, 5 µM MeJA yielded 5.25 times more andrographolide content after 24 h of treatment. The accumulation of andrographolide was correlated with the expression level of known regulatory genes (hmgs, hmgr, dxs, dxr, isph and ggps) of mevalonic acid (MVA) and 2-C-methyl-d-erythritol-4-phosphate (MEP) pathways. These results established the involvement of MeJA in andrographolide biosynthesis by inducing the transcription of its biosynthetic pathways genes. The coordination of isph, ggps and hmgs expression highly influenced the andrographolide biosynthesis.

Small-intestinal length measurement on MR enterography: comparison with in vivo surgical measurement.

OBJECTIVE: The purpose of this study is to assess the feasibility and accuracy of small-bowel length measurement on MR enterography examinations compared with surgical in vivo measurements. SUBJECTS AND METHODS: Thirty-one consecutive patients who were undergoing elective laparotomy for Crohn disease were included in the study. These patients underwent a prior MR enterography examination, and true fast imaging with steady-state precession MR enterography images from the examinations were used to measure small-intestinal length. The MR enterography measurement was compared with a surgical measurement to assess accuracy and correlation. RESULTS: MR enterography measurements had a significant positive correlation with surgical measurements (r(2) = 0.98; p < 0.001) irrespective of bowel length. The average (± SD) percentage difference between MR enterography and surgical intestinal length measurement was 4.59% ± 0.44%. An average time of 36.5 ± 2.8 minutes was required for bowel length measurement on MR enterography. A significantly longer time was required for measurement of bowel length greater than 300 cm versus shorter bowel length. CONCLUSION: Small-bowel length measurements on MR enterography are accurate compared with anatomic measurements. MR enterography can provide an effective noninvasive investigation in planning surgical and nutritional intervention in patients with compromised bowel length.

Diffusion-weighted MR imaging of the gastrointestinal tract: technique, indications, and imaging findings.

Diffusion-weighted magnetic resonance (MR) imaging has emerged as an important tool in the diagnostic work-up of patients with bowel cancer and inflammatory conditions of the gastrointestinal tract. It functions on the basis of the microscopic motion of water molecules in a cellular environment and provides functional information about the water in body tissues. Diffusion-weighted imaging serves to complement conventional MR imaging, and its use may improve the accuracy of tumor detection and staging. It does not rely on the use of intravenous contrast material and may be performed in patients with renal impairment. Because it provides quantitative information about tissue cellularity, diffusion-weighted imaging may be used to distinguish between tissues with altered cellularity (eg, tumors and metastases) and normal tissues. Data from diffusion-weighted MR images enable the calculation of apparent diffusion coefficient (ADC) values, which provide useful information about response to treatment. Malignant gastrointestinal tract tumors have low ADC values, which increase after successful therapy. Diffusion-weighted imaging also plays a role in the evaluation of patients with inflammatory bowel disease and may help assess inflammation and complications, such as abscesses and fistulas. Quantitative measurements of signal intensity at diffusion-weighted imaging may help differentiate actively inflamed bowel from normal bowel, and ADC values provide useful information about disease activity and response to treatment.

Laparoscopic Management of Median Arcuate Ligament Syndrome: A Case Report.

Median arcuate ligament syndrome (MALS) is an uncommon disorder characterized by postprandial abdominal pain, vomiting, anorexia, and weight loss. The symptoms are due to the MAL compressing the celiac artery and irritating the celiac plexus/ganglion. We report the case of one patient who presented with chronic abdominal pain, bloating, vomiting, and weight loss. Computed tomography angiography led to the diagnosis of MALS. The patient was treated surgically by laparoscopic division of the MLA and excision of the celiac plexus. He was discharged on day two without complications. On one-month follow-up, he was symptom-free, eating well, and had gained weight. He is on regular follow-up.

A Single-Center Experience With Gynecomastia Treatment Using Liposuction, Complete Gland Removal, and Nipple Areola Complex Lifting Plaster Technique: A Review of 448 Patients.

Background: Gynecomastia is defined as a benign enlargement of male breast glandular tissue. It is the most common breast condition in male, and the prevalence ranges from 32% to 72%. No standardized treatment exists for gynecomastia. Objectives: The authors treat gynecomastia patient with liposuction and complete gland excision through periareolar incision without skin excision. In case of skin redundancy, the authors use their special technique called nipple areola complex (NAC) plaster lift technique. Methods: The authors conducted the retrospective analysis of patient who underwent gynecomastia surgery between January 2020 and December 2021 at Chennai Plastic Surgery. All patients were treated with liposuction, gland excision, and NAC lifting plaster when required. The follow-up period ranges from 6 to 14 months. Results: A total of 448 patients (896 breasts) were included in our study with average age of 26.6 years. Grade II gynecomastia was most common in our study. The average BMI of the patients was 27.31 kg/m2. One hundred and sixteen patients (25.9%) experienced some form of complication. Seroma was most common complications in our study followed by superficial skin necrosis. Patient satisfaction rate was high in our study. Conclusions: Gynecomastia surgery is safe and highly rewarding procedure for surgeons. Various technologies and methods like liposuction, complete gland excision, and NAC lifting plaster technique should be adopted in gynecomastia treatment to give a better patient satisfaction. Complications are common in gynecomastia surgery but easily manageable.

Small CAB-like proteins prevent formation of singlet oxygen in the damaged photosystem II complex of the cyanobacterium Synechocystis sp. PCC 6803.

The cyanobacterial small CAB-like proteins (SCPs) are single-helix membrane proteins mostly associated with the photosystem II (PSII) complex that accumulate under stress conditions. Their function is still ambiguous although they are assumed to regulate chlorophyll (Chl) biosynthesis and/or to protect PSII against oxidative damage. In this study, the effect of SCPs on the PSII-specific light-induced damage and generation of singlet oxygen ((1)O(2)) was assessed in the strains of the cyanobacterium Synechocystis sp. PCC 6803 lacking PSI (PSI-less strain) or lacking PSI together with all SCPs (PSI-less/scpABCDE(-) strain). The light-induced oxidative modifications of the PSII D1 protein reflected by a mobility shift of the D1 protein and by generation of a D1-cytochrome b-559 adduct were more pronounced in the PSI-less/scpABCDE(-) strain. This increased protein oxidation correlated with a faster formation of (1)O(2) as detected by the green fluorescence of Singlet Oxygen Sensor Green assessed by a laser confocal scanning microscopy and by electron paramagnetic resonance spin-trapping technique using 2, 2, 6, 6-tetramethyl-4-piperidone (TEMPD) as a spin trap. In contrast, the formation of hydroxyl radicals was similar in both strains. Our results show that SCPs prevent (1)O(2) formation during PSII damage, most probably by the binding of free Chl released from the damaged PSII complexes.

Singlet oxygen scavenging activity of plastoquinol in photosystem II of higher plants: electron paramagnetic resonance spin-trapping study.

Singlet oxygen (¹O2) scavenging activity of plastoquinol in photosystem II (PSII) of higher plants was studied by electron paramagnetic resonance (EPR) spin-trapping technique. It is demonstrated here that illumination of spinach PSII membranes deprived of intrinsic plastoquinone results in ¹O2 formation, as monitored by TEMPONE EPR signal. Interestingly, the addition of exogenous plastoquinol (PQH2-1) to PQ-depleted PSII membranes significantly suppressed TEMPONE EPR signal. The presence of exogenous plastoquinols with a different side-chain length (PQH2-n, n isoprenoid units in the side chain) caused a similar extent of ¹O2 scavenging activity. These observations reveal that plastoquinol exogenously added to PQ-depleted PSII membranes serves as efficient scavenger of ¹O2.

MR enterography of Crohn disease: part 1, rationale, technique, and pitfalls.

OBJECTIVE: The purpose of this article is to review the technique of performing MR enterography examinations and to review the imaging findings suggestive of Crohn disease. This article will also allow the reader to self-assess and improve his or her skills in the performance and interpretation of MR enterography examinations. CONCLUSION: MRI plays a valuable role in providing accurate information about the severity of and complications related to Crohn disease and can help in guiding surgical or medical treatment.

MR enterography of Crohn disease: part 2, imaging and pathologic findings.

OBJECTIVE: The purpose of this article is to review MR enterography technique and imaging findings suggestive of Crohn disease on these examinations. This article will also allow the reader to self-assess and improve his or her skills in the performance and interpretation of MR enterography examinations. CONCLUSION: This article reviews the technique of performing MR enterography examinations. MRI plays a valuable role in providing accurate information about severity of and complications related to Crohn disease and can help in guiding surgical or medical treatment.

Imaging of uncommon retroperitoneal masses.

Retroperitoneal masses not arising from major solid organs are uncommon. Although there is no simple method of classifying retroperitoneal masses, a reasonable approach is to consider the masses as predominantly solid or cystic and to subdivide these into neoplastic and nonneoplastic masses. Because the treatment options vary, it is useful to be able to differentiate these masses by using imaging criteria. Although the differential diagnosis of retroperitoneal masses can be narrowed down to a certain extent on the basis of imaging characteristics, patterns of involvement, and demographics, there is still a considerable overlap of imaging findings for these masses, and histologic examination is often required for definitive diagnosis. Computed tomography (CT) and magnetic resonance (MR) imaging play an important role in characterization and in the assessment of the extent of the disease and involvement of adjacent and distant structures. Familiarity with the CT and MR imaging features of various retroperitoneal masses will facilitate accurate diagnosis and staging for aggressive lesions.

Heart rate variability time domain features in automated prediction of diabetes in rat.

Diabetes is a very common occurring disease, diagnosed by hyperglycemia. The established mode of diagnosis is the analysis of blood glucose level with the help of a hand-held glucometer. Nowadays, it is also known for affecting multi-organ functions, particularly the microvasculature of the cardiovascular system. In this work, an alternative diagnostic system based on the heart rate variability (HRV) analysis and artificial neural network (ANN) and support vector machine (SVM) have been proposed. The experiment and data recording has been performed on male Wister rats of 10-12 week of age and 200 ± 20 gm of weight. The digital lead-I electrocardiogram (ECG) data are recorded from control (n = 5) and Streptozotocin-induced diabetic rats (n = 5). Nine time-domain linear HRV parameters are computed from 60 s of ECG data epochs and used for the training and testing of backpropagation ANN and SVM. Total 526 (334 Control and 192 diabetics) such datasets are computed for the testing of ANN for the identification of the diabetic conditions. The ANN has been optimized for architecture 9:5:1 (Input: hidden: output neurons, respectively) with the optimized learning rate parameter at 0.02. With this network, a very good classification accuracy of 96.2% is achieved. While similar accuracy of 95.2% is attained using SVM. Owing to the successful implementation of HRV parameters based automated classifiers for diabetic conditions, a non-invasive, ECG based online prognostic system can be developed for accurate and non-invasive prediction of the diabetic condition.

Water-splitting manganese complex controls light-induced redox changes of cytochrome b559 in photosystem II.

The effect of water-splitting Mn complex on light-induced redox changes of cytochrome b(559) (cyt b(559)) was studied in spinach photosystem II (PSII) membranes. Photoreduction of the heme iron in the intact PSII membranes was completely suppressed by DCMU, whereas photoreduction and photooxidation of the heme iron in the Mn-depleted PSII membranes were unaffected by DCMU. Interestingly, photoreduction and photooxidation of the heme iron in the Mn-depleted PSII membranes were completely diminished by exogenous superoxide dismutase (SOD), whereas no effect of SOD on photoreduction of the heme iron was observed in the intact PSII membranes. The current work shows that the light-induced redox changes of cyt b(559) proceed via a different mechanism in the both types of PSII membranes. In the intact PSII membranes, photoreduction of the heme iron is mediated by plastoquinol. However, in the Mn-depleted PSII membranes, photoreduction and photooxidation of the heme iron are mediated by superoxide anion radical formed in PSII.

Use of echocardiography and modalities of patient monitoring of trauma patients.

PURPOSE OF REVIEW: Trauma patients require evaluation of the anatomic structure as well as the hemodynamic profile of the heart to improve effectiveness of resuscitation. They are prone to hemodynamic instability and must be monitored with various modalities to detect deterioration early. Newer, less invasive ultrasound technologies are replacing familiar 'gold standard' modalities of the past. This article reviews the indications, roles, imaging approaches, and limitations of modern echocardiography. A brief review of other ICU monitoring modalities is also presented. RECENT FINDINGS: Echocardiography has emerged as a first-line diagnostic tool for assessment of trauma patients, especially those with hemodynamic compromise. It yields crucial information about structural damage as well as the hemodynamic profile and can be performed through either the transesophageal or transthoracic route. Quick and systematic use of echocardiography for diagnosis and management of critically injured patients may lead to improved outcomes. SUMMARY: Echocardiography plays an important role in the trauma bay for diagnosis of thoracic injury and at the bedside in the ICU for evaluation of the hemodynamic profile.

Utility of high-resolution MR imaging in demonstrating transmural pathologic changes in Crohn disease.

Magnetic resonance (MR) imaging has emerged as an imaging modality that can be used to help diagnose and evaluate Crohn disease of the small and large bowel. MR imaging has high diagnostic accuracy in the detection of Crohn disease, and high-resolution thin-section MR images can demonstrate transmural pathologic changes of Crohn disease from the level of the mucosa to that of the mesentery. High-resolution MR image data also may be used to construct high-quality multiplanar and endoluminal views that may provide additional diagnostic information. Knowledge of the MR imaging findings of Crohn disease and how they correlate with the pathologic features of the disease is important to facilitate accurate diagnosis and detect complications.