The lipopeptides fengycin and iturin are involved in the anticandidal activity of endophytic Bacillus sp. as determined by experimental and in silico analysis.

In this study, an endophytic Bacillus sp. strain (K7) was isolated from the medicinally important ornamental plant, Jasminum officinale. Biochemical analyses were conducted to evaluate the nature of the extracted product, which displayed strong anticandidal activity against Candida albicans (CA) SC5314, as evident from the results obtained in agar-cup diffusion tests, phase-contrast microscopy, scanning electron microscopy and minimum inhibitory concentration assays. After confirming the presence of the gene clusters encoding the lipopeptides iturins and fengycin in the genome of K7, their corresponding molecular ions were identified using MALDI-TOF-MS. 3D structures of the lipopeptides were downloaded from specific databases and molecular docking was performed against a vital CA enzyme, exo-1,3-beta-glucanase, involved in cell wall remodelling, adhesion to polymer materials and biofilm formation. The docking score of iturins was found to be -8·6 and -8·2 kcal mol-1 and for fengycin it was -9·4 kcal mol-1 , indicating a strong affinity of these cyclic lipopeptides towards exo-1,3-beta-glucanase. The combined in vitro and in silico anticandidal studies suggested that these secreted lipopeptides from Bacillus sp. may be used as potential therapeutics against opportunistic and complicated infections of CA.

Nonagenarian surgical admissions for the acute abdomen: who benefits?

INTRODUCTION: Patients 90 years and older form an increasing proportion of the general population. Outcomes of their acute surgical admissions are not well documented. METHODS AND MATERIALS: Surgical management of 49 consecutive nonagenarian admissions (median age: 92 years) with an acute abdomen was compared with the management and outcome of 50 younger patients (median age: 53.5) admitted with a suspected acute abdomen over the same period. RESULTS: Nonagenarian group consisted of mainly women (71% vs. 50%; p = 0.003). The use of laboratory investigations and imaging was similar for the patients aged over 90 and the younger patients, although proportionately fewer nonagenarians were investigated by abdominal CT scan (8% vs. 24%). Of the 49 nonagenarian patients admitted, only 4% (n = 2) were operated on. In contrast, 38% (n = 19) of patients aged 50-59 (p = 0.0001) underwent a surgical intervention. A much greater proportion of nonagenarians died in hospital than patients in the 50-59 comparator group (16% nonagenarians vs. 4% comparator patients; p = 0.04). The very large majority of survivors in both age groups were discharged back to their preadmission domicile [39 (95%) nonagenarians vs. 46 (96%) comparator 50-59 year group]. CONCLUSIONS: In this study, when compared with younger patients, very few nonagenarian patients (2%) with a suspected acute abdomen benefited from surgical admission. Instead, the large majority of nonagenarians either died or were discharged back to their home address without surgery.

Hotel NHS and the acute abdomen - admit first, investigate later.

AIM: To determine the financial consequences of a policy of admission first, followed by definitive investigation for patients with an admission diagnosis of suspected acute abdomen. RESULTS: Over a 1-month period, 122 patients were admitted with a suspected surgical diagnosis of acute abdomen (55 men, 67 women); age range 16-95 years (median: 56.5). Based on surgical operation required (n = 36), death after admission (n = 6, three postoperative deaths) and/or severe surgical illness (n = 17), 56 required surgical inpatient admission, while 66 did not. The patients who did not require admission spent significantly shorter time in hospital than those who required admission (median: 5 days vs. 8.5 days; p = 0.0000). Total hospital hotel and investigation cost (not including ITU or theatre costs) for all 122 patients was 330,468 pounds. Overall, 205,468 pounds was consumed by these 56 patients who required admission, while 125,000 pounds was spent on 66 patients whose clinical course did not justify admission; 92% of which was spent on hospital hotel costs and 8% on the cost of imaging and/or endoscopy. DISCUSSION AND CONCLUSION: On a national basis, emergency General Surgery admissions account for 1000 Finished Consultant Episodes per 100,000 population. The findings of this study suggest that this equates to a national NHS spend of 650 million pounds each year, for the hotel costs of patients that could arguably avoid surgical admission altogether. Continuing to admit patients with a suspected acute abdomen first and then requesting definitive investigation makes neither clinical nor economic sense.

Sustained release of ferrous sulfate from polymer-coated gum arabica pellets.

Sustained release of ferrous sulfate (FeSO4) from gum arabica pellets has been achieved for 7 h. Release is further sustained for 12 to 600 h by coating the pellets with polyvinyl acetate and ethylene vinyl acetate, respectively. An increase in the amount of gum arabica in the pellets decreases the rate of release due to the gelling property of gum arabica. The gel layer acts as a barrier and retards the rate of diffusion of FeSO4 through the pellet. In coated pellets, an increase in thickness of membrane helps to sustain the release of FeSO4 for a longer duration. Thus, the release of FeSO4 can be sustained for the required duration by adjusting the amount of gum arabica in the pellet and the composition and thickness of polymeric coat. The mechanism of release accordingly varies from Fickian to zero-order and super case II transport.

Targeting STAT3 phosphorylation by neem leaf glycoprotein prevents immune evasion exerted by supraglottic laryngeal tumor induced M2 macrophages.

Tumor-associated macrophages (TAMs) are preferentially M2 skewed and promote tumor growth, angiogenesis, invasion, and/or metastasis. In this study, we have analyzed the in vitro immunomodulatory potential of a non-toxic neem leaf glycoprotein (NLGP) in reprogramming Stage III supraglottic laryngeal tumor cell lysate (SLTCL) induced M2 TAMs to their classical anti-tumor shape (M1). Data generated from this study support that NLGP is effective in preventing the SLTCL induced generation (CD68(+)CD206(+)IL-10(high) to CD68(+)CD206(-)IL-10(low) TAMs) and functions (NO(low) to NO(high), MHC-I(low) to MHC-I(high), CD80(low) to CD80(high)) of pro-tumorous M2 macrophages, which in turn associated with sustained anti-tumor effector functions by promoting cytotoxic T cell activities and suppressing regulatory T cells. Furthermore, our data also suggest that NLGP prevents M2 skewness of TAMs by downregulating phosphorylation of targeted STAT3.

Actinomycosis: an unusual cause of unresectable rectal cancer.

We present a very unusual case of a woman with an intrauterine contraceptive device (IUCD) who developed pelvic actinomycosis during long course chemoradiotherapy for rectal cancer, which presented a significant diagnostic challenge and eventually rendered the cancer unresectable. IUCDs are often implicated in the development of pelvic actinomycosis but there is no current evidence or guideline to suggest that they should be removed prior to oncological treatment. Owing to the devastating consequences of this combination of disease, we suggest that it may be prudent to remove IUCDs in this setting.

Oncovascular surgery.

BACKGROUND: Surgical resection remains the cornerstone for the curative treatment of oncological disease. When a tumour mass encases a critical arterial or venous structure, successful symptom relief and long-term oncological control may be achieved through careful preoperative planning within a multi-disciplinary team incorporating oncological and vascular specialists. To highlight the strategic issues pertaining to the vascular management of these patients, this review addresses the principles in planning oncovascular surgery, namely where cancer resection necessitates concurrent ligation or reconstruction of a major vascular structure. DESIGN: A multiple electronic health database search was performed, including Medline, Embase, and Scopus. RESULTS: The published outcomes for different malignancies suggest that survival is dependent upon complete clearance of the primary pathology and tumour biology rather than vascular-related complications. CONCLUSION: Major vessel involvement of a tumour mass should not necessarily be considered a barrier to en bloc resection and hence curative surgery. Radical surgical resection may offer the only chance for cure or palliation for these patients. Detailed preoperative planning within an extended multi-disciplinary team that includes vascular specialists is essential for these complex patients.

Results of Treatment of Squamous Cell Carcinoma of Maxillary Sinus: A 26-Year Experience.

BACKGROUND: Five-year survival in squamous cell carcinoma of maxillary antrum is low. This article examines the results of various approaches to treatment as given in our hospital in past 26 years. METHODS: From 1979 to 2005, 379 patients with squamous cell carcinoma of maxillary antrum managed with curative intent were studied. Twenty-eight patients had T2, 237 patients had T3, and 114 had T4 tumors. The N classification was N0 in 316 patients, N1 in 21 patients, N2a in 28 patients and N2b in 14 patients. Treatment to the primary site comprised of surgery (Sx) and radiation therapy (RT) in 284 patients, RT alone in 57 patients and chemotherapy (CTx) with radiotherapy in 38 patients. RESULTS: There was a difference in survival between patients who underwent Sx with RT compared with patients who received RT alone or CTx with RT. The most common pattern of recurrence was in the primary site, 187 (49.3%) patients. Local control at 3 and 5 years was 71% and 63.8% respectively in Sx with RT, 31.6% and 28% respectively in RT, and 28.9% and 26% in CTx with RT group. CONCLUSIONS: The type of treatment to the primary site is an important determinant of survival and local control. Surgery with radiation is a better treatment option.

Optimizing results of breast cancer surgery: a 8 yrs' experience.

Management of breast cancer in developing country, in contrast to Western countries, is challenging considering more number of advanced cases and poor understanding of the disease and its management by the population and even many physicians. We tried to look prospectively at our experience with breast cancers, trying to optimize the results given the wide- variety of cases we see.

Synthesis and characterization of aliphatic polyurethane fiber: a potential suture material.

Polyurethane fibers were synthesized and characterized by IR, 1H NMR, DSC, and GPC. Their properties as fiber were compared with commercially available sutures of polypropylene, polyamide, polyester, and silk.

Haemangioma of maxillary sinus.

Though haemangioma of nose is a common tumor, those arising from the paranasal sinuses are not very common. Very few cases have been reported. Because of its rarity under the backdrop of existing literature we are reporting our present case.

Occurrence of polyploidy and multinuclearity in the differentiating liver of chick embryo.

Increase in nuclear size in liver has been used as an index of polyploidy. It has long been considered that the occurrence of polyploidy and multinuclearity are characteristics of mammalian liver. The present study shows the occurrence of these phenomena in the liver of birds, so these features are not confined to mammals. 3 classes of nuclear size groups have been identified. The simultaneous occurrence of polyploidy and binuclearity indicates some sort of interrelationship between them.

Sustained release of antimicrobial drugs from polyvinylalcohol and gum arabica blend matrix.

Synthetic polymers are widely used in biomedical applications. Polymer blends have recently paved their way in this field. An attempt to prepare blend of synthetic polymer polyvinylalcohol and natural macromolecule gum arabica is made in this paper. Characterization of these blends by NMR, DSC and viscoelastic studies reveal preparation of a blend composition with synergistic properties. The blend composition with synergistic properties was used to release various antimicrobial drugs. The duration and release of the drug depends on the amount of drug loaded in the matrix and solubility of the drug in the matrix and release medium. The advantage of this system is that the release kinetics of the drug from the system can be tailored by adjusting plasticizer, homopolymer and crosslinker composition depending on the drug to be released.

Giant dentigerous cyst.

Dentigerous cyst - a cyst of dental origin, though common in lower jaw is relatively uncommon in upper jaw. Here a 14 years, F, presented with huge swelling of unilateral maxilla and clinicoradiologically diagnosed as dentigerous cyst is being reported along with brief review of literature.

Rhabdomyosarcoma of nasopharynx.

Rhabdomyosarcoma is a highly invasive malignant tumour arising from the mesenchymal tissue. Here, we reported a rare case of embryonal rhadomyosarcoma of nasopharynx with extension to different spaces of base of skull and orbit. Rarity of the case difficulty in diagnosis encourages its reporting.

A case report of esthesioneuroblastoma.

Esthesioneuroblastoma (Olfactory Neuroblastoma) arises from the olfactory placode in the olfactory area of the nasal cavity. The age incidence ranges from 3 years to 79 years. It usually presents with nasal symptoms like obstructed nasal breathing and epistaxis. The diagnosis may be delayed for several months due to its slow growing nature. It may be misdiagnosed with other small round cell tumors. One such case is reported here due to its rare incidence, difficulty in early diagnosis and very aggressive behaviour compared to the reported series inspite of recommended treatment by different modalities.

Expression of cyclooxygenase isoforms in normal human skin and chronic venous ulcers.

Chronic venous ulcers are an example of abnormal wound healing showing chronic inflammation which together with the underlying vascular pathology results in delayed healing. Prostaglandins are among the most important mediators of inflammation. They have proinflammatory effects, predominantly by affecting the vasculature. Cyclooxygenase (COX) is the rate-limiting enzyme in prostanoid synthesis. It is present in two isoforms: COX-1 (constitutive cyclooxygenase) which is produced in the body to maintain normal haemostatic functions, and COX-2 (inducible cyclooxygenase), which is induced during inflammation in response to cytokines. Using immunoenzymatic labelling and western blot analysis, this study has shown that both COX-1 and COX-2 were up-regulated in chronic venous leg ulcers by comparison with normal human skin. De novo appearance of COX-2 in chronic venous ulcers was demonstrated, which is not seen in normal human skin. The main cellular sources of both COX isoforms are macrophages and endothelial cells. COX-2 is also produced by mast cells and fibroblasts. A COX radioimmunoassay showed up-regulation of COX activity in chronic venous ulcers compared with normal skin (p<0.05). Up-regulation of COX-1 in chronic venous leg ulcers could produce prostacyclin, which contributes to angiogenesis. Thus, inhibition of COX-1 by non-steroidal anti-inflammatory drugs (NSAIDs) could increase the local ischaemia and hypoxia associated with chronic venous ulcers. On the other hand, up-regulation of COX-2 is most likely responsible for the persistent inflammation in chronic venous leg ulcers. COX-2 selective inhibitors could therefore be effective in the treatment of chronic venous ulcers.