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Effluent from nuclear power plants, rocks, and minerals contains hazardous radionuclides that adversely affect human health and seriously threaten the environment. To address this issue, simple, economic, and sustainable magnetite nanoparticle loaded sodium alginate copper metal-organic framework composite beads (MNPs-SA@Cu MOF composite beads) have been designed, and their performance has been evaluated under varying conditions of pH, time, adsorbent dose, and initial concentration and have been studied by batch adsorption studies for optimizing the adsorption conditions. In this work, MNPs-SA@Cu MOF composite beads have been prepared in situ for the adsorptive removal of uranium [U(VI)] and thorium [Th(IV)] ions from an aqueous solution. The synthesized MNPs-SA@Cu MOF composite beads were characterized by model analytical techniques like Fourier transform infrared spectroscopy, X-ray photoelectron spectroscopy, field emission scanning electron microscopy, Brunauer-Emmett-Teller, and thermal gravimetric analysis. Here, 6 mg of adsorbent with 10 mL of 50 mg/L uranium and thorium ion solution at pH 5 was capable of removing the U(VI) and Th(IV) ions with 99.9 and 97.7% removal efficiencies, respectively. The obtained results showed that the adsorption behavior of the adsorbent for U(VI) and Th(IV) follows pseudo-second-order kinetics, and Langmuir isotherm fitted well with a maximum adsorption capacity of 454.54 and 434.78 mg/g, respectively. The adsorption mechanism indicated that electrostatic interaction and hydrogen bonding are the main driving forces for removing the U(VI) and Th(IV) ions. It can be reused for up to 10 adsorption-desorption cycles with minimal loss of removal efficiency. The easy synthesis method of MNPs-SA@Cu MOF composite beads and the high removal efficiency of U(VI) and Th(IV) ions reveal that they can potentially treat radionuclide waste effectively.
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OBJECTIVE: No available scale, at the time of initial evaluation for necrotizing enterocolitis (NEC), accurately predicts, that is, with an area under the curve (AUC) ≥0.9, which preterm infants will undergo surgery for NEC stage III or die within a week. STUDY DESIGN: This is a retrospective cohort study (n = 261) of preterm infants with <33 weeks' gestation or <1,500 g birth weight with either suspected or with definite NEC born at Parkland Hospital between 2009 and 2021. A prediction model using the new HASOFA score (Hyperglycemia, Hyperkalemia, use of inotropes for Hypotension during the prior week, Acidemia, Neonatal Sequential Organ Failure Assessment [nSOFA] score) was compared with a similar model using the nSOFA score. RESULTS: Among 261 infants, 112 infants had NEC stage I, 68 with NEC stage II, and 81 with NEC stage III based on modified Bell's classification. The primary outcome, surgery for NEC stage III or death within a week, occurred in 81 infants (surgery in 66 infants and death in 38 infants). All infants with pneumoperitoneum or abdominal compartment syndrome either died or had surgery. The HASOFA and the nSOFA scores were evaluated in 254 and 253 infants, respectively, at the time of the initial workup for NEC. Both models were internally validated. The HASOFA model was a better predictor of surgery for NEC stage III or death within a week than the nSOFA model, with greater AUC 0.909 versus 0.825, respectively, p < 0.001. Combining HASOFA at initial assessment with concurrent or later presence of abdominal wall erythema or portal gas improved the prediction surgery for NEC stage III or death with AUC 0.942 or 0.956, respectively. CONCLUSION: Using this new internally validated prediction model, surgery for NEC stage III or death within a week can be accurately predicted at the time of initial assessment for NEC. KEY POINTS: · No available scale, at initial evaluation, accurately predicts which preterm infants will undergo surgery for NEC stage III or die within a week.. · In this retrospective cohort study of 261 preterm infants with either suspected or definite NEC we developed a new prediction model (HASOFA score).. · The HASOFA-model had high discrimination (AUC: 0.909) and excellent calibration and was internally validated..
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Enterocolitis Necrotizante , Recien Nacido Prematuro , Humanos , Enterocolitis Necrotizante/mortalidad , Enterocolitis Necrotizante/cirugía , Estudios Retrospectivos , Recién Nacido , Masculino , Femenino , Enfermedades del Prematuro/mortalidad , Enfermedades del Prematuro/cirugía , Edad Gestacional , Lactante , Área Bajo la Curva , Puntuaciones en la Disfunción de Órganos , Índice de Severidad de la EnfermedadRESUMEN
BACKGROUND: Genetic predisposition and environmental factors are considered risk factors for polycystic ovary syndrome (PCOS). Genome-wide association studies (GWAS) have been reported from various subpopulations to evaluate SNPs associated with PCOS risk. No PCOS-associated GWAS study has been reported from India so far. PURPOSE: The current study was conducted to identify the PCOS-susceptible loci among the North Indian population and to validate the significant loci reported by previous GWAS studies. METHODS: A total of 272 participants with 134 PCOS patients and 138 age-matched healthy controls were recruited. Genomic DNA was isolated and genotyped by using Infinium Global Screening Array v3.0 microchip considering HWE 10e-5 statistically significant. RESULTS: A total of fifteen markers have been identified as candidate PCOS risk factors. Only two SNPs, namely rs17186366 and rs11171739 have been identified through replication analysis while comparing the previously reported PCOS GWAS data. In-silico analysis was performed to study the functional impact of identified significant genes for gene ontology, pathways related to gene set, and cluster analysis to determine protein-protein interaction among genes or gene products. CONCLUSION: The study suggests that multiple variants play an important role in PCOS pathogenesis and emphasizes the importance of further genetic studies among Indian subpopulations. The study also validates two previously reported SNPs in the Indian population. What this study adds to clinical work Study summarizes the importance of candidate gene markers validated by replication and in-silico functional study, significantly involved in PCOS pathogenesis in the studied population. These markers can be used in the future as diagnostic markers for clinical phenotype identification.
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Estudio de Asociación del Genoma Completo , Síndrome del Ovario Poliquístico , Femenino , Humanos , Síndrome del Ovario Poliquístico/metabolismo , Predisposición Genética a la Enfermedad , Genotipo , Fenotipo , Polimorfismo de Nucleótido SimpleRESUMEN
PURPOSE: Basilar artery strokes are rare but can have characteristic imaging findings that can often be overlooked. This retrospective study aims to assess radiology residents' ability to identify CT imaging findings of basilar artery occlusion in a simulated call environment. METHODS: The Wisdom in Diagnostic Imaging Emergent/Critical Care Radiology Simulation (WIDI SIM)-a tested and reliable computer-aided emergency imaging simulation-was employed to assess resident readiness for independent radiology call. The simulations include 65 cases of varying complexity, including normal studies, with one case specifically assessing basilar artery stroke. Residents were presented with a single, unique case of basilar artery occlusion in two separate years of testing and were only provided with non-contrast CT images. Residents' free text responses were manually scored by faculty members using a standardized grading rubric, with errors subsequently classified by type. RESULTS: A total of 454 radiology residents were tested in two separate years on the imaging findings of basilar artery occlusion using the Wisdom in Diagnostic Imaging simulation web-based testing platform. Basilar artery occlusion was consistently underdiagnosed by radiology residents being tested for call readiness irrespective of the numbers of years in training. On average, only 14% of radiology residents were able to correctly identify basilar artery occlusion on non-contrast CT. CONCLUSIONS: Our findings underscore a potential gap in radiology residency training related to the detection of basilar artery occlusion, highlighting the potential need for increased educational efforts in this area.
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Internado y Residencia , Radiología , Accidente Cerebrovascular , Humanos , Arteria Basilar/diagnóstico por imagen , Competencia Profesional , Radiología/educación , Estudios RetrospectivosRESUMEN
BACKGROUND AND PURPOSE: Suppurative retropharyngeal lymphadenitis is a retropharyngeal space infection almost exclusively seen in the young (4-8 years old) pediatric population. It can be misdiagnosed as a retropharyngeal abscess, leading to unnecessary invasive treatment procedures. This retrospective study aims to assess radiology residents' ability to independently identify CT imaging findings and make a definitive diagnosis of suppurative retropharyngeal lymphadenitis in a simulated call environment. MATERIALS AND METHODS: The Wisdom in Diagnostic Imaging Emergent/Critical Care Radiology Simulation (WIDI SIM) is a computer-aided emergency imaging simulation proven to be a reliable method for assessing resident preparedness for independent radiology call. The simulation included 65 cases across various imaging modalities of varying complexity, including normal studies, with one case specifically targeting suppurative retropharyngeal adenitis identification. Residents' free text responses were manually scored by faculty members using a standardized grading rubric, with errors subsequently classified by type. RESULTS: A total of 543 radiology residents were tested in three separate years on the imaging findings of suppurative retropharyngeal lymphadenitis using the Wisdom in Diagnostic Imaging simulation web-based testing platform. Suppurative retropharyngeal lymphadenitis was consistently underdiagnosed by radiology residents being tested for call readiness irrespective of the numbers of years in training. On average, only 3.5% of radiology residents were able to correctly identify suppurative retropharyngeal lymphadenitis on a contrast-enhanced computed tomography (CT). CONCLUSIONS: Our findings underscore a potential gap in radiology residency training related to the accurate identification of suppurative retropharyngeal lymphadenitis, highlighting the potential need for enhanced educational efforts in this area.
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Internado y Residencia , Linfadenitis , Radiología , Humanos , Niño , Preescolar , Estudios Retrospectivos , Radiología/educación , Competencia Profesional , Linfadenitis/diagnóstico por imagenRESUMEN
Rice, a critical cereal crop, grapples with productivity challenges due to its inherent sensitivity to low temperatures, primarily during the seedling and booting stages. Recognizing the polygenic complexity of cold stress signaling in rice, a meta-analysis was undertaken, focusing on 20 physiological traits integral to cold tolerance. This initiative allowed the consolidation of genetic data from 242 QTLs into 58 meta-QTLs, thereby significantly constricting the genetic and physical intervals, with 84% of meta-QTLs (MQTLs) being reduced to less than 2 Mb. The list of 10,505 genes within these MQTLs, was further refined utilizing expression datasets to pinpoint 46 pivotal genes exhibiting noteworthy differential regulation during cold stress. The study underscored the presence of several TFs such as WRKY, NAC, CBF/DREB, MYB, and bHLH, known for their roles in cold stress response. Further, ortho-analysis involving maize, barley, and Arabidopsis identified OsWRKY71, among others, as a prospective candidate for enhancing cold tolerance in diverse crop plants. In conclusion, our study delineates the intricate genetic architecture underpinning cold tolerance in rice and propounds significant candidate genes, offering crucial insights for further research and breeding strategies focused on fortifying crops against cold stress, thereby bolstering global food resilience. Supplementary Information: The online version contains supplementary material available at 10.1007/s12298-024-01412-1.
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In the current scenario of growing world population, limited cultivable land resources, plant diseases, and pandemics are some of the major factors responsible for declining global food security. Along with meeting the food demand, the maintenance of food quality is also required to ensure healthy consumption and marketing. In agricultural fields, pest infestations and bacterial diseases are common causes of crop damage, leading to massive yield losses. Conventionally, antibiotics and several pesticides have been used to manage and control these plant pathogens. However, the overuse of antibiotics and pesticides has led to the emergence of resistant strains of pathogenic bacteria. The bacteriophages are the natural predators of bacteria and are host-specific in their action. Therefore, the use of bacteriophages for the biocontrol of pathogenic bacteria is serving as a sustainable and green solution in crop protection and production. In this review, we have discussed the important plant pathogens and their impact on plant health and yield loss. Further, we have abridged the role of bacteriophages in the protection of crops from bacterial disease by discussing various greenhouse and field trials. Finally, we have discussed the impact of bacteriophages on the plant microbiome, phage resistance, and legal challenges in the registration and commercial production of bacteriophage-based biopesticides. Supplementary Information: The online version contains supplementary material available at 10.1007/s12088-024-01204-x.
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Wheat, an important cereal crop globally, faces major challenges due to increasing global population and changing climates. The production and productivity are challenged by several biotic and abiotic stresses. There is also a pressing demand to enhance grain yield and quality/nutrition to ensure global food and nutritional security. To address these multifaceted concerns, researchers have conducted numerous meta-QTL (MQTL) studies in wheat, resulting in the identification of candidate genes that govern these complex quantitative traits. MQTL analysis has successfully unraveled the complex genetic architecture of polygenic quantitative traits in wheat. Candidate genes associated with stress adaptation have been pinpointed for abiotic and biotic traits, facilitating targeted breeding efforts to enhance stress tolerance. Furthermore, high-confidence candidate genes (CGs) and flanking markers to MQTLs will help in marker-assisted breeding programs aimed at enhancing stress tolerance, yield, quality and nutrition. Functional analysis of these CGs can enhance our understanding of intricate trait-related genetics. The discovery of orthologous MQTLs shared between wheat and other crops sheds light on common evolutionary pathways governing these traits. Breeders can leverage the most promising MQTLs and CGs associated with multiple traits to develop superior next-generation wheat cultivars with improved trait performance. This review provides a comprehensive overview of MQTL analysis in wheat, highlighting progress, challenges, validation methods and future opportunities in wheat genetics and breeding, contributing to global food security and sustainable agriculture.
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Fitomejoramiento , Triticum , Triticum/genética , Fitomejoramiento/métodos , Sitios de Carácter Cuantitativo , Fenotipo , Productos Agrícolas/genética , Grano Comestible/genéticaRESUMEN
Antimicrobial resistance (AMR) is on an upsurge as more and more broad-spectrum antibiotics are being used haphazardly, resulting in imbalances in the ecosystem and disrupting common/systematic clinical protocols. To combat this issue, metal-organic framework embedded zinc-copper-benzenedicarboxylate@calcium alginate composite beads (Zn-Cu-BDC@CA CBs) were synthesized and utilized for the adsorption of tetracycline (TC) from water. The surface morphology, presence of functional groups, surface area, and thermal stability of Zn-Cu-BDC@CA CBs were evaluated by field emission scanning electron microscopy (FESEM), Fourier transform infrared spectroscopy (FTIR), Brunauer-Emmett-Teller (BET), and thermal gravimetric analysis (TGA), respectively. Batch adsorption experiments were also carried out to optimize the adsorption performance of Zn-Cu-BDC@CA CBs for TC by adjusting the key parameters, including pH of the solution, contact time, adsorbent dosage, temperature, and initial concentration of TC. From the RSM model, 96.8% removal of TC takes place under the optimum conditions (pH = 7.3, mass = 17.2 mg, concentration = 21.3 ppm, time = 3.4 h, and temperature = 31.8 °C), which aligns closely with the experimental batch study, where the addition of 20 mg of adsorbent to a 20 mL TC solution (20 mg/L) at a pH of 7 and a temperature of 27 °C yielded an impressive TC removal efficiency of 96.55% within 180 min. Zn-Cu-BDC@CA CBs possess homogeneous adsorption surfaces, and TC is adsorbed via monolayer chemisorption, according to the results derived from the Langmuir isotherm model and pseudo-second-order kinetic model. The thermodynamic analysis indicated that the adsorption process is both endothermic and spontaneous. In their entirety, the synthesized Zn-Cu-BDC@CA CBs exhibit certain operational advantages, such as simple separation, satisfactory adsorption performance, and decent recyclability, indicating their viability for industrial application of elimination of TC residues from aquatic environments.
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A field study was conducted to investigate the influence of MgO-NPs priming on growth and development of mustard. Priming of mustard seeds before sowing with MgO-NPs at concentration 10, 50, 100, and 150 µg/ml enhanced the vegetative parameters of plants, with considerable increase in leaf area. MgO-NPs exposure increased the photosynthetic pigment accumulation in mustard that led to increase in biomass, carbohydrate content, and the yield in terms of total grain yield. Increased chlorophyll has simultaneously increased the oxidative stress in plants, and hence stimulated their antioxidant potential. A consistent increase was observed in the content of mustard polyphenols and activity of SOD, CAT, and APX on MgO-NPs exposure. MgO-NPs induced oxidative stress further reduced the protein content and bioavailability in mustard. We further, evaluated the influence of MgO-NPs on the quality of mustard harvested seeds. The seeds harvested from nanoprimed mustard possessed increased antioxidant potential and reduced oxidative stress. The carbohydrate and protein accumulation was significantly enhanced in response to nanopriming. Reduced chlorophyll content in seeds obtained from nanoprimed mustard indicated their potential for disease resistance and stability on long term storage. Therefore, the seeds harvested from MgO-NPs primed mustard were biochemically rich and more stable. Therefore, MgO-NPs priming can be potentially used as a novel strategy for growth promotion in plants where leaves are economically important and a strategy to enhance the seed quality under long term storage conditions.
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Óxido de Magnesio , Nanopartículas , Óxido de Magnesio/metabolismo , Óxido de Magnesio/farmacología , Antioxidantes/metabolismo , Planta de la Mostaza/metabolismo , Semillas/metabolismo , Clorofila/metabolismo , Carbohidratos , Nanopartículas/químicaRESUMEN
In sheep, MHC variability is studied widely to explore disease association. The aim of the current study was to explore the genetic diversity of Ovar-DRB diversity across sheep breeds of India. Here, Ovar-DRB1 locus was studied across 20 sheep breeds. DRB1 was amplified (301 bp) and sequenced using a PCR-sequence-based typing approach. Results revealed a high degree of heterozygosity across breeds (mean: 73.99%). Overall mean distance for DRB1 was highest in Sangamneri (0.18) and lowest in Madgyal sheep (0.10). There was a higher rate of transition, across breeds. Further, 39 alleles were isolated in different breeds, out of which 10 were new. To allow easy access and use of the immune-polymorphic database, an online database management system was launched (http://www.mhcdbms.in/). Nucleotide content across breeds for the DRB1 region revealed the richness of GC content (59.26%). Wu-Kabat index revealed vast genetic variation across peptide binding sites (PBS) of DRB1. Residues 6, 66, 69, 52, and 81, were polymorphic showing utility for antigen presentation. All breeds were under positive selection for DRB1 locus (dN > dS). Study revealed the importance of DRB locus diversity for beta chain specifically at PBS across sheep breeds of the Indian subcontinent and presented evidence of positive selection for DRB owing to its evolutionary significance.
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Variación Genética , Genética de Población , Ovinos/genética , Animales , Variación Genética/genética , Secuencia de Bases , Alelos , Reacción en Cadena de la PolimerasaRESUMEN
Genetic variability at the major histocompatibility complex (MHC) is important in any species due to significant role played by MHC for antigen presentation. DQA locus has not been studied for its genetic variability across sheep population in India. In the present study, MHC of sheep at DQA1 and DQA2 loci were evaluated across 17 Indian sheep breeds. Results revealed high degree of heterozygosity (10.34% to 100% for DQA1 and 37.39 to 100% for DQA2). 18 DQA1 alleles and 22 DQA2 alleles were isolated in different breeds. Nucleotide content for DQA region revealed richness of AT content (54.85% for DQA1 and 53.89% for DQA2). DQA1 and DQA2 sequences clustered independently. We could see evidence of divergence of DQA as DQA1 and DQA2 across sheep breeds. Wu-Kabat variability index revealed vast genetic variation across DQA1 and DQA2, specifically at peptide binding sites (PBS) that consisted 21 residues for DQA1 and 17 residues for DQA2. Evolutionary analysis revealed the presence of positive and balancing selection for DQA1 locus, however DQA2 was under purifying selection across sheep breeds. Higher heterozygosity and large diversity at both loci especially at PBS indicated the fitness of the sheep population for evading pathogens and adapt to the harsh tropical climate.
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Antígenos de Histocompatibilidad Clase II , Clima Tropical , Ovinos/genética , Animales , Secuencia de Aminoácidos , Antígenos de Histocompatibilidad Clase II/genética , India , Alelos , Variación Genética/genética , Genes MHC Clase IIRESUMEN
Green synthesis of NPs is preferred due to its eco-friendly procedures and non-toxic end products. However, unintentional release of NPs can lead to environmental pollution affecting living organisms including plants. NPs accumulation in soil can affect the agricultural sustainability and crop production. In this context, we report the morphological and biochemical response of spinach nanoprimed with MgO-NPs at concentrations, 10, 50, 100, and 150 µg/ml. Nanopriming reduced the spinach root length by 14-26%, as a result a reduction of 20-74% in the length of spinach shoots was observed. The decreased spinach shoot length inhibited the chlorophyll accumulation by 21-55%, thus reducing the accumulation of carbohydrates and yield by 46 and 49%, respectively. The reduced utilization of the total absorbed light further enhanced ROS generation and oxidative stress by 32%, thus significantly altering their antioxidant system. Additionally, a significant variation in the accumulation of flavonoid pathway downstream metabolites myricitin, rutin, kaempferol-3 glycoside, and quercitin was also revealed on MgO-NPs nanopriming. Additionally, NPs enhanced the protein levels of spinach probably as an osmoprotectant to regulate the oxidative stress. However, increased protein precipitable tannins and enhanced oxidative stress reduced the protein digestibility and solubility. Overall, MgO-NPs mediated oxidative stress negatively affected the growth, development, and yield of spinach in fields in a concentration dependent manner. Supplementary Information: The online version contains supplementary material available at 10.1007/s12298-023-01391-9.
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Palliative care should be an important component in the management of drug resistant tuberculosis (DRTB); however, it is not given much importance. Even in the current scenario, many patients and their caregivers consider multidrug-resistant and extensively drug-resistant tuberculosis (TB) as a terminal illness and considering it almost as a death sentence, this group of patients also require palliative care. There is a misconception about considering palliative care as a treatment component in the terminal stage of an illness where curative treatment has no role in improving the survival of the patient. However, the real meaning of palliative care is to relieve suffering in all stages of the disease and is not limited to end-of-life care only. Palliative care in DRTB aims to improve the quality of life, intractable symptoms and physical, psychosocial and spiritual suffering of patients as well as their caregivers. There is an imminent need to train all TB healthcare workers regarding basic palliative care and integrate palliative care into the TB healthcare system.
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Galactomannans are neutral hemicellulose biopolymers that strengthen the plant cell walls by interacting with cellulose in the form of storage polysaccharides. They are abundant in nature and are majorly present in the secondary walls of flowering plants. They are primarily extracted from the leguminous seed endosperms and display a wide variation at the structural and abundance level amongst different plant species. Over the last few decades, galactomannans have attracted huge attention due to their unique functional, solution and rheological properties, generally defined by their molar mass and the degree of substitution by galactosyl side chain, which differs between plants. Further, they are nontoxic, originate from renewable sources, fairly inexpensive, and are amenable to both chemical and biochemical modification. Moreover, excellent thickening, stabilizing and gelling abilities of these biopolymers have found extensive use in food, pharmaceutical, biomedical and cosmetic industries. Significant progress has been made to identify and characterize the genes responsible for biosynthesis of galactomannan along with the elucidation of controlling networks by using genetic, bioinformatics and biochemical approaches. This is the first comprehensive coverage on galactomannans which combines detailed structural and physicochemical properties as well as biology associated with the metabolism of galactomannans. It also focuses on different leguminous sources leading to various food and non-food applications of galactomannans.
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Fabaceae , Galactosa/análogos & derivados , Mananos , SemillasRESUMEN
BACKGROUND: Aprepitant has been shown to reduce chemotherapy-induced nausea and vomiting in children receiving highly emetogenic chemotherapy (HEC). In this study, we assessed the cost-effectiveness of aprepitant for children receiving HEC in India, United Kingdom, and the United States. PROCEDURE: We utilized individual patient-level outcome data from a pediatric randomized trial, which demonstrated the superiority of an aprepitant-based anti-emetic prophylaxis over standard ondansetron and dexamethasone for HEC. Health state for each day of follow-up was analyzed and quality-adjusted life years (QALYs) were estimated. The incremental cost-utility ratio (ICUR), incremental cost-effectiveness ratio (ICER), and net monetary benefit (NMB) for each country were estimated. Sensitivity analyses by varying cost of aprepitant, hospitalization, and health state utility values by ±25% were conducted. RESULTS: Use of the aprepitant-based regimen resulted in gain of 0.0019 QALY per chemotherapy cycle along with cost savings of $22.25, $1335.52, and $6612.10 for India, United Kingdom, and the United States, respectively. The cost savings per QALY was estimated to be $12,355.84 for India, $734,282.90 for the United Kingdom, and $3,567,564.11 for the United States. The cost savings for 50% gain in the percentage of days without grade 3 vomiting was $124.18 for India, $7451.63 for the United Kingdom, and $36,892.76 for the United States. The NMB for gain in QALY was $33.62, $1418.60, and $6727.01 for India, United Kingdom, and the United States, respectively. The estimates remained cost-effective across all scenarios of the sensitivity analyses. CONCLUSION: Aprepitant-based anti-emetic regimen is cost-effective for children receiving HEC. It results in overall cost savings and reduced healthcare-resource utilization.
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Antieméticos , Antineoplásicos , Antieméticos/uso terapéutico , Antineoplásicos/efectos adversos , Aprepitant/uso terapéutico , Niño , Análisis Costo-Beneficio , Análisis de Datos , Dexametasona/uso terapéutico , Humanos , Morfolinas/uso terapéutico , Vómitos/inducido químicamente , Vómitos/tratamiento farmacológico , Vómitos/prevención & controlRESUMEN
PURPOSE OF REVIEW: Chicago Classification has standardized clinical approach to primary esophageal motility disorders. With new clinical data and advancing treatments, Chicago Classification has undergone multiple revisions to reflect updated findings and enhance diagnostic accuracy. This review will describe the recently published Chicago Classification version 4.0 (CCv4.0), which aimed to enhance diagnostic characterization and limit overdiagnosis of inconclusive esophageal motility diagnoses. RECENT FINDINGS: Key revisions outlined in CCv4.0 include (1) a modified standardized HRM study protocol performed in supine and upright positions, (2) recommended ancillary testing and manometric provocation for inconclusive manometric diagnoses (3) the required presence of obstructive symptoms for conclusive diagnoses of esophagogastric junction outflow obstruction, distal esophageal spasm and hypercontractile esophagus, and (4) requirement of confirmatory testing for esophagogastric junction outflow obstruction. These key modifications aim to improve diagnostic accuracy and consistency of clinically relevant esophageal motility disorders, and subsequently clinical outcomes.
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Trastornos de la Motilidad Esofágica , Espasmo Esofágico Difuso , Espasmo Esofágico Difuso/diagnóstico , Humanos , Manometría/métodos , CintigrafíaRESUMEN
The adenosine triphosphate (ATP)-binding cassette efflux transporter G2 (ABCG2) was originally discovered in a multidrug-resistant breast cancer cell line. Studies in the past have expanded the understanding of its role in physiology, disease pathology and drug resistance. With a widely distributed expression across different cell types, ABCG2 plays a central role in ATP-dependent efflux of a vast range of endogenous and exogenous molecules, thereby maintaining cellular homeostasis and providing tissue protection against xenobiotic insults. However, ABCG2 expression is subjected to alterations under various pathophysiological conditions such as inflammation, infection, tissue injury, disease pathology and in response to xenobiotics and endobiotics. These changes may interfere with the bioavailability of therapeutic substrate drugs conferring drug resistance and in certain cases worsen the pathophysiological state aggravating its severity. Considering the crucial role of ABCG2 in normal physiology, therapeutic interventions directly targeting the transporter function may produce serious side effects. Therefore, modulation of transporter regulation instead of inhibiting the transporter itself will allow subtle changes in ABCG2 activity. This requires a thorough comprehension of diverse factors and complex signaling pathways (Kinases, Wnt/ß-catenin, Sonic hedgehog) operating at multiple regulatory levels dictating ABCG2 expression and activity. This review features a background on the physiological role of transporter, factors that modulate ABCG2 levels and highlights various signaling pathways, molecular mechanisms and genetic polymorphisms in ABCG2 regulation. This understanding will aid in identifying potential molecular targets for therapeutic interventions to overcome ABCG2-mediated multidrug resistance (MDR) and to manage ABCG2-related pathophysiology.
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Transportador de Casetes de Unión a ATP, Subfamilia G, Miembro 2/genética , Resistencia a Múltiples Medicamentos/genética , Resistencia a Antineoplásicos/genética , Animales , Humanos , Proteínas de Neoplasias/genética , Polimorfismo Genético/genética , Transducción de Señal/genéticaRESUMEN
BACKGROUND: Spontaneous abortions are the most severe complication of early pregnancy and are a major reproductive health problem. Although this could be caused due to various cytogenetic, immunological, or endocrinological reasons, role of environmental toxicants cannot be ruled out. In order to explore the role of cadmium and lead in causing spontaneous abortions, current systematic review and meta-analysis had been carried out. METHODOLOGY: Literature search was performed using appropriate keywords in PubMed, Science Direct, Cochrane Library, and Google Scholar databases up to December 25 2020 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). Metananalysis was carried out with the help of RevMan software (version 5.3). RESULTS: Meta-analysis of nine studies on cadmium concentrations in blood of women with at least one spontaneous abortions and controls revealed standardized mean difference (SMD)=3.39, 95% CI (2.17, 4.61), with p < .05. Similarly, meta-analysis of eight studies on lead concentrations revealed standardized mean difference (SMD)=6.24, 95% CI (4.34, 8.14), with p < .05. CONCLUSION: Populations exposed to heavy metals such as cadmium and lead are at higher risk of pregnancy loss. Therefore, couples experiencing repeated pregnancy losses may be screened for heavy metal load.
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Aborto Espontáneo/sangre , Aborto Espontáneo/epidemiología , Cadmio/sangre , Plomo/sangre , Exposición a Riesgos Ambientales , Femenino , Humanos , EmbarazoRESUMEN
BACKGROUND: Pineal region tumours remain challenging neurosurgical pathologies. METHODS: Detailed anatomical knowledge of the posterior incisural space and its variations is critical. An opaque arachnoidal membrane seals the internal cerebral and basal veins, leading to thalamic, basal ganglia, mesencephalic/pontine infarctions if injured. Medium-size tumours can be removed en-bloc with all traction/manipulation applied on the tumour side, virtually without contact of ependymal surfaces of the pulvinars or third ventricle. Sacrifice of the cerebello-mesencephalic fissure vein may be required. CONCLUSIONS: The sitting position offers superior anatomical orientation and remains safe with experienced teams. Meticulous microsurgical techniques and detailed anatomical knowledge are likely to secure safe outcomes.