Clinical improvements following bilateral anterior capsulotomy in treatment-resistant depression.

BACKGROUND: The purpose of this study was to evaluate a programme of lesion surgery carried out on patients with treatment-resistant depression (TRD). METHOD: This was a retrospective study looking at clinical and psychometric data from 45 patients with TRD who had undergone bilateral stereotactic anterior capsulotomy surgery over a period of 15 years, with the approval of the Mental Health Act Commission (37 with unipolar depression and eight with bipolar disorder). The Beck Depression Inventory (BDI) before and after surgery was used as the primary outcome measure. The Montgomery-Asberg Depression Rating Scale was administered and cognitive aspects of executive and memory functions were also examined. We carried out a paired-samples t test on the outcome measures to determine any statistically significant change in the group as a consequence of surgery. RESULTS: Patients improved on the clinical measure of depression after surgery by -21.20 points on the BDI with a 52% change. There were no significant cognitive changes post-surgery. Six patients were followed up in 2013 by phone interview and reported a generally positive experience. No major surgical complications occurred. CONCLUSIONS: With the limitations of an uncontrolled, observational study, our data suggest that capsulotomy can be an effective treatment for otherwise TRD. Performance on neuropsychological tests did not deteriorate.

Novel TRPV4 Pathogenic Variant in Severe Metatropic Skeletal Dysplasia: A Case Report.

We report an eight-year-old girl with a novel homozygous TRPV4 gene pathogenic variant c.2355G>T p. (Trp785Cys) with mesomelic shortening, odontoid hypoplasia, multiple joint contractures, thoracolumbar kyphosis, pectus carinatum, halberd pelvis, and dumb-bell shaped long bones. The novel variant caused a severe recessive form of metatropic dysplasia.

Synthesis of substituted 1-norbornylamines with antiviral activity.

The reaction of (+/-)-camphor (7) with triflic anhydride (Tf2O) yields the bridgehead triflate 8. The Nametkin rearrangement of 8 to 3 was realized by treatment with triflic acid (TfOH). The solvolysis of the bridgehead triflates 3 and 8 in acetonitrile affords the N-acetyl-1-norbornylamines 4 and 9. The Pd(0)-catalyzed hydrogenation of 4 and 9 gives the amides 5 and 10. The corresponding 1-norbornylamines 2 and 13 and the N-ethyl derivatives 1, 6, 11, and 12 were obtained by basic hydrolysis or reduction with LiAlH4, respectively, of the amides 4, 5, 9, and 10. The antiviral activity of the hydrochlorides of some of the obtained 1-norbornylamines was evaluated against influenza A, herpes simplex 2, and African swine fever virus. Particularly noticeable is the activity of the hydrochlorides of 1 and 11 against influenza A virus (SI (selectivity index) = 1000).

Acetyl-11-keto-beta-boswellic acid (AKBA): structure requirements for binding and 5-lipoxygenase inhibitory activity.

1. 5-Lipoxygenase (5-LOX) products from endogenous arachidonic acid in ionophore-stimulated peritoneal polymorphonuclear leukocytes (PMNL) and from exogenous substrate (20 microM) in 105,000 g supernatants were measured. 2. The effects of natural pentacyclic triterpenes and their derivatives on 5-LOX activity were compared with the inhibitory action of acetyl-11-keto-beta-boswellic acid (AKBA), which has been previously shown to inhibit the 5-LOX by a selective, enzyme-directed, non-redox and non-competitive mechanism. 3. The 5-LOX inhibitory potency of AKBA was only slightly diminished by deacetylation of the acetoxy group or reduction of the carboxyl function to alcohol in intact cells (IC50 = 1.5 vs. 3 and 4.5 microM, respectively) and in the cell-free system (8 vs. 20 and 45 microM). 4. beta-Boswellic acid (beta-BA), lacking the 11-keto function, inhibited 5-LOX only partially and incompletely, whereas the corresponding alcohol from beta-BA, as well as amyrin, acetyl-11-keto-amyrin, 11-keto-beta-boswellic acid methyl ester had no 5-LOX inhibitory activity up to 50 microM in either system. 5. beta-BA only partially prevented the AKBA-induced 5-LOX inhibition, whereas the non-inhibitory compounds, amyrin and acetyl-11-keto-amyrin, almost totally antagonized the AKBA effect and shifted the concentration-inhibition curve for the incomplete inhibitor beta-BA to the right. In contrast, the non-inhibitory 11-keto-beta-BA methyl ester exerted no antagonizing effect. 6. The results demonstrate that the pentacyclic triterpene ring system is crucial for binding to the highly selective effector site, whereas functional groups (especially the 11-keto function in addition to a hydrophilic group on C4 of ring A) are essential for 5-LOX inhibitory activity.

The use of orthognathic surgery to facilitate implant placement: a case report.

When attempting to restore an edentulous posterior segment of the mandible into which space the opposing maxillary segment has supererupted, it is necessary to idealize the maxillary occlusal plane to accommodate the final restoration. This report discusses superior repositioning of the posterior segment of the maxilla using rigid fixation with simultaneous implant placement into the corresponding posterior edentulous mandibular space.

The anti-oxidant activity of turmeric (Curcuma longa).

The turmeric anti-oxidant protein (TAP) had been isolated from the aqueous extract of turmeric. The anti-oxidant principle was found to be a heat stable protein. Trypsin treatment abolished the anti-oxidant activity. The anti-oxidant principle had an absorbance maximum at 280 nm. After gel filtration, the protein showed a 2-fold increase in anti-oxidant activity and showed 2 bands in the SDS-PAGE with approximate molecular weight range of 24,000 Da. The protein showed a concentration-dependent inhibitory effect on the promoter induced lipid peroxidation. A 50% inhibitory activity of lipid peroxidation was observed at a protein concentration of 50 micrograms/ml. Ca(2+)-ATPase of rat brain homogenate was protected to nearly 50% of the initial activity from the lipid peroxidant induced inactivation by this protein. This protection of Ca(2+)-ATPase activity was found to be associated with the prevention of loss of -SH groups.

Myelofibrosis and true histiocytic lymphoma.

A 60-year-old female presented with a history of progressive shortness of breath, fever, and weight loss of 55 pounds. The work-up consisting of computerized axial tomography (CT) scan of thorax and abdomen, mediastinoscopy, and bilateral bone marrow aspiration and biopsy revealed a large-cell or histiocytic lymphoma involving bone marrow with myelofibrosis. Further immunologic and ultrastructural investigation confirmed the true histiocytic origin of the tumor. The patient was treated with 12 courses of intravenous cyclophosphamide, onconvin, doxorubicin, and prednisone and achieved a complete remission with disappearance of clinical symptoms, normal CT scan of thorax and abdomen, and normal bone marrow with disappearance of myelofibrosis from the same site as the previous bone marrow test. At present the patient is in complete remission. We present this case because of the previously unreported association between histiocytic lymphoma and myelofibrosis, and the unusually good response to chemotherapy and the disappearance of fibrosis from the marrow.

Value of antibiotic therapy in tuberculin-positive children with parenchymal lung lesions.

BACKGROUND: A tuberculin-positive child with radiological evidence of a parenchymal lung lesion is likely to be treated for tuberculosis by a physician. However, non-tuberculous microbial infections may also cause parenchymal lung lesions. We tried to distinguish tuberculous from non-tuberculous lung lesions by administering a course of antibiotics. METHODS: Three hundred and five tuberculin-positive children with parenchymal lung lesions due to pneumonia, bronchiectasis (cylindrical and reversible) and minor fissure opacification were studied at the Tuberculosis Clinic, Institute of Child Health, Madras. Those with more serious forms of tuberculosis like miliary, cavitary and segmental lesions and with grade III and IV undernutrition were excluded. Three weeks of oral antibiotic therapy, with erythromycin (30 mg/kg/day) and chloramphenicol (50 mg/kg/day) for the first two weeks followed by co-trimoxazole (trimethoprim 6 mg/kg/day and sulphamethoxazole 25 mg/kg/day) for the third week, was given. Chest X-rays were taken before and after antibiotic therapy. RESULTS: Sixty per cent of the children with pneumonia, 57% with bronchiectasis and 62% with minor fissure opacification showed complete radiological clearance. CONCLUSION: In tuberculin-positive children with parenchymal lung lesions radiological clearance was seen in 60% after three weeks of antibiotic therapy indicating that the parenchymal lung lesions were caused by non-tuberculous organisms. Hence a course of antibiotic therapy in these children may have diagnostic value as well as considerable financial, social and therapeutic implications.

Ranolazine, a partial fatty acid oxidation inhibitor, its potential benefit in angina and other cardiovascular disorders.

Chronic Angina resistant to medical treatment with hemodynamically acting agents is a major problem in clinical setup. For such patients, large number of clinical trials have documented the beneficial effect of Ranolazine. It acts as an anti-anginal agent that controls myocardial ischemia through intracellular metabolic changes. Ranolazine is a partial fatty acid oxidation inhibitor which shifts cardiac energy metabolism from fatty acid oxidation to glucose oxidation. Since the oxidation of glucose requires less oxygen than the oxidation of fatty acids, ranolazine can help maintain myocardial function in times of ischemia. In addition, ranolazine has minimal effect on blood pressure and heart rate. Ranolazine, by inhibiting cellular ionic channels, prolongs the corrected QT interval. However, ranolazine has not yet been associated with any incidences of ventricular arrhythmia. Other possible mechanism by which Ranolazine could act is by reducing the formation of reactive oxygen species (ROS) and improves reperfusion mechanical function. Ranolazine has been approved by US FDA for the treatment of chronic angina pectoris in combination with amlodipine, beta-blockers or nitrates in patients who do not show adequate response to other anti-anginals. Ranolazine is a metabolic modulator that is being developed by CV Therapeutics (CVT), under license from Roche (formerly Syntex), as a potential treatment for angina. Ranolazine is available as brand name 'Ranexa' as extended release oral tablets. This review focuses on the clinical effects, the mechanism of actions, drug interactions and beneficial effects of Ranolazine in chronic angina and other cardiometabolic disorders.

A clinical study of Osteomyelitis and septic arthritis.

Sixty-nine cases of Osteomyelitis, and 27 of septic arthritis have been presented. 69/96 (71%) were children below 12. The sites frequently involved were tibia, femur and humerus. Septic arthritis commonly involved the knee. The commonest organism was Penicillin - resistant Staphylococcus aureus. Though we sought but failed to establish that overt clinical malnutrition was aetiologically important, since 54% were well-fed children, the virulence of the sepsis in which an entire bone shaft may die is disturbing but unexplained. Whereas arthrotomy plus antibiotics gave uniformly good results for septic arthritis, in osteomyelitis, no single treatment regime was outstanding. We would recommend the tetracyclines, (eg. "Reverin"), in addition to appropriate surgery, as a routine.

Boswellic acids: novel, specific, nonredox inhibitors of 5-lipoxygenase.

Isomers (alpha- and beta-) of boswellic acids (BAs), 11-keto-beta-BA and their acetyl derivatives were isolated from the gum resin of Boswellia serrata. BA and derivatives concentration dependently decreased the formation of leukotriene B4 from endogenous arachidonic acid in rat peritoneal neutrophils. Among the BAs, acetyl-11-keto-beta-BA induced the most pronounced inhibition of 5-lipoxygenase (5-LO) product formation with an IC50 of 1.5 microM. In contrast to the redox type 5-LO inhibitor nordihydroguaiaretic acid, BA in concentrations up to 400 microM did not impair the cyclooxygenase and 12-lipoxygenase in isolated human platelets and the peroxidation of arachidonic acid by Fe-ascorbate. The data strongly suggest that BAs are specific, nonreducing-type inhibitors of the 5-LO product formation either interacting directly with the 5-LO or blocking its translocation.

Two wound-inducible soybean cysteine proteinase inhibitors have greater insect digestive proteinase inhibitory activities than a constitutive homolog.

Diverse functions for three soybean (Glycine max L. Merr.) cysteine proteinase inhibitors (CysPIs) are inferred from unique characteristics of differential regulation of gene expression and inhibitory activities against specific Cys proteinases. Based on northern blot analyses, we found that the expression in leaves of one soybean CysPI gene (L1) was constitutive and the other two (N2 and R1) were induced by wounding or methyl jasmonate treatment. Induction of N2 and R1 transcript levels in leaves occurred coincidentally with increased papain inhibitory activity. Analyses of kinetic data from bacterial recombinant CysPI proteins indicated that soybean CysPIs are noncompetitive inhibitors of papain. The inhibition constants against papain of the CysPIs encoded by the wound and methyl jasmonate-inducible genes (57 and 21 nM for N2 and R1, respectively) were 500 to 1000 times lower than the inhibition constant of L1 (19,000 nM). N2 and R1 had substantially greater inhibitory activities than L1 against gut cysteine proteinases of the third-instar larvae of western corn rootworm and Colorado potato beetle. Cysteine proteinases were the predominant digestive proteolytic enzymes in the guts of these insects at this developmental stage. N2 and R1 were more inhibitory than the epoxide trans-epoxysuccinyl-L-leucylamide-(4-guanidino)butane (E-64) against western corn rootworm gut proteinases (50% inhibition concentration = 50, 200, and 7000 nM for N2, R1, and E-64, respectively). However, N2 and R1 were less effective than E-64 against the gut proteinases of Colorado potato beetle. These results indicate that the wound-inducible soybean CysPIs, N2 and R1, function in host plant defense against insect predation, and that substantial variation in CysPI activity against insect digestive proteinases exists among plant CysPI proteins.

Effects of mutations in potential phosphorylation sites on transcytosis of FcRn.

The neonatal Fc receptor, FcRn, transports immunoglobulin G (IgG) across intestinal epithelial cells of suckling rats and mice from the lumenal surface to the serosal surface. In cell culture models FcRn transports IgG bidirectionally, but there are differences in the mechanisms of transport in the two directions. We investigated the effects of mutations in the cytoplasmic domain of FcRn on apical to basolateral and basolateral to apical transport of Fc across rat inner medullary collecting duct (IMCD) cells. Basolateral to apical transport did not depend upon determinants in the cytoplasmic domain. In contrast, an essentially tailless FcRn was markedly impaired in apical to basolateral transport. Using truncation and substitution mutants, we identified serine-313 and serine-319 as phosphorylation sites in the cytoplasmic domain of FcRn expressed in Rat1 fibroblasts. Mutations at Ser-319 did not affect transcytosis across IMCD cells. FcRn-S313A was impaired in apical to basolateral transcytosis to the same extent as tailless FcRn, whereas FcRn-S313D transported at wild-type levels. FcRn-S313A recycled more Fc to the apical medium than the wild-type receptor, suggesting that Ser-313 is required to allow FcRn to be diverted from an apical recycling pathway to a transcytotic pathway.

Phage display selection can differentiate insecticidal activity of soybean cystatins.

Plant cysteine proteinase inhibitors (phytocystatins) have been implicated as defensive molecules against Coleopteran and Hemipteran insect pests. Two soybean cystatins, soyacystatin N (scN) and soyacystatin L (scL), have 70% sequence identity but scN is a much more potent inhibitor of papain, vicilin peptidohydrolase and insect gut proteinases. When these cystatins were displayed on phage particles, papain-binding affinity and CPI activity of scN were substantially greater than those of scL, in direct correlation with their relative CPI activity as soluble recombinant proteins. Furthermore, scN substantially delayed cowpea weevil (Callosobruchus maculatus (F.)) growth and development in insect feeding bioassays, whereas scL was essentially inactive as an insecticide. Papain biopanning selection of phage-displayed soyacystatins resulted in a 200-1000-fold greater enrichment for scN relative to scL. These results establish that binding affinity of cystatins can be used in phage display biopanning procedures to select variants with greater insecticidal activity, illustrating the potential of phage display and biopanning selection for directed molecular evolution of biological activity of these plant defensive proteins.

Synthesis and optical limiting properties of axially bridged phthalocyanines: [(tBu4PcGa)2O] and [(tBu4PcIn)2O].

Highly soluble [(tBu(4)PcM)(2)O] phthalocyanine dimers (M=Ga(III) (3), In(III) (4)) were prepared by the reaction of [tBu(4)PcMCl] (M=Ga(III) (1), In(III) (2)) with excess of concentrated H(2)SO(4) at -20 degrees C. The Mbond;Obond;M linkages in 3 and 4 are not stable against concentrated H(2)SO(4) at room temperature, 6 n HCl at reflux, or during isolation under column chromatographic conditions (e.g. silica gel/toluene). The stability of 3 in solution is considerably higher than that of 4. The mu-oxo-bridged phthalocyanine dimers 3 and 4 have a more intense photoluminescence emission in the red region than the monomers 1 and 2. The gallium phthalocyanines 1 and 3 have fluorescence lifetimes of a few nanoseconds, while those of the indium phthalocyanines 2 and 4 last for only several hundred picoseconds. Comparison of the fluorescence lifetimes of monomers 1 and 3 with dimers 2 and 4, reveals that the dimers have longer lifetimes of the excited singlet states. The transient absorption spectrum is similar for all of the compounds, and the transient absorption band at about 520 nm, observed by nanosecond laser irradiation, can be assigned to the transition from the lowest triplet excited state to the upper triplet excited states (T-T absorption). The magnitude of the optical limiting exhibited by 1, 2, 3, and 4 in toluene at 532 nm laser pulse irradiation is in the order: 4>3>2>1 [corrected]. The values of the imaginary third-order nonlinear susceptibility Im[chi((3))] of the above compounds at 532 nm in toluene are also reported. These results demonstrate that these compounds are candidates for optical limiting applications.