Efficacy of near-infrared fluorescence cholangiography using indocyanine green in laparoscopic cholecystectomy: A retrospective study.

Context: While laparoscopy has been the standard procedure for gallstone treatment, recent advances including the use of indocyanine green (ICG) in laparoscopic cholecystectomy have made it easier to understand the biliary tree and reduce the risk of bile duct injury. Aims: In this retrospective study, we aim to determine the efficacy of ICG in near-infrared fluorescence cholangiography (NIRFC) for visualising biliary anatomy. Settings and Design: A total of 90 patients with the symptoms of cholelithiasis were enrolled for this retrospective study. Subjects and Methods: All the patients underwent cholecystectomy approximately 53.8 min (40-90 min) after the intravenous administration of mean volume 1.6 ml (1-2 ml) ICG. The surgeons used NIRFC along with ICG for real-time visualisation of biliary anatomy. Results: The mean operative time for the surgery was 65.7 min (25-120 min) with no post-surgical complications observed in the patients. The average length of stay was 2 days (1-3 days). ICG usage with NIRFC enabled identification of cystic duct, common hepatic and common bile duct, the junction between common hepatic and bile duct, right and left hepatic duct in 87.7%, 94.4%, 80% and 14.4% of cases, respectively. Conclusions: ICG fluorescence allowed successful visualisation of at least 1 biliary structure in 100% of cases.

Novel bio-analytical technique for estimation of gamma oryzanol in rat plasma and brain homogenate using HPLC.

Gamma oryzanol, a component of rice bran oil is used for its anticancer and antihyperlipidemic properties. Bioanalytical method for rat plasma and brain homogenate was developed by HPLC system with a PDA detector in which drug elution was performed using C-18 column (4.6mm×150cm, 5µ) with 1% acetic acid in methanol: acetonitrile (65/35, v/v) as mobile phase at 1.2ml/min flow rate and detected at 326nm wavelength. Liquid liquid extraction method was chosen for extraction of oryzanol from plasma as well as brain homogenate as it provided highest recovery (95% in plasma, 85% in brain homogenate). Various extraction solvents for each body fluid were analysed, out of which highest recovery for plasma (95%), in acetone: IPA (1/1, v/v) and for brain homogenate (85%) in isopropyl alcohol (IPA) was observed. Observed linearity was between 500ng/mL-5000ng/mL. The interday and intraday precision (i.e. %RSD) was less than 10% and accuracy was±5%. Selectivity and matrix effect was checked and found as per USFDA criteria. Plasma samples were found to be stable over the analysis period, HQC samples were stable up to third cycle in freeze and thaw stability while LQC samples were stable over fourth cycle. The method proved to be simple, useful and is appropriate, for preclinical and experimental research.

A pilot denture service collaboration between Den-Tech denture charity and Crisis at Christmas Dental Service (CCDS): A Plan-Do-Study-Act analysis.

Introduction The Crisis at Christmas Dental Service (CCDS) provides dental treatment for homeless and vulnerably housed people each year during the Christmas period. In 2017, Den-Tech piloted a same-day field-laboratory denture service alongside CCDS to provide new dentures, additions and repairs for people experiencing social exclusion who have limited access to dental care.Objectives To evaluate the service in terms of: (i) treatment need for denture service; (ii) patient-reported feedback; (iii) clinician-reported feedback; and (iv) learning outcomes from the pilot denture service.Methods Clinicians recorded their dental activity on a standard pro forma and records of the dentures were maintained by the Den-Tech volunteer laboratory technicians. Patient feedback was collected on standardised feedback forms at the dental reception and volunteer feedback was collected via an online survey. The team undertook a quality improvement evaluation using the Plan-Do-Study-Act methodology.Results During the seven-day treatment period in 2017, 24 dentures were produced by the Den-Tech technicians, and in 2018, 31 dentures were created for people experiencing homelessness. In 2017, feedback was collected from 353 patients who attended the service: 99.4% were satisfied with their treatment and 98.3% would have recommended the service to others. Similarly, high levels of positive feedback were received in 2018. Of the dental volunteers who responded, 97.8% of volunteers felt that the denture service benefitted the patients.Conclusions The Den-Tech denture service was well-received by patients and volunteers alike. For the first time at Crisis at Christmas, patients were able to have dental extractions and immediate replacement of these teeth without compromising their dignity and overall appearance.Learning outcomes A quality improvement project utilising real-time volunteer and patient feedback can be a useful tool in reflecting upon the challenges and successes of a service as well as supporting its continual development.

Maternal depression is not just a problem early on.

INTRODUCTION: Little is known about the onset of depression beyond the first postpartum year. This study examines the onset and course of depression over an 18 month period among a socio-economically diverse, community-wide sample of women. MATERIALS & METHODS: A prospective longitudinal telephone survey of 249 women was conducted at two weeks, two months, six months and 18 months after delivery. Depression was measured using the Edinburgh Postnatal Depression Scale (EPDS), and onset was defined as the first EPDS score of 12+ on the 30-point scale. Temporal trends were assessed using generalized estimating equation (GEE) regression. RESULTS: There was a significant temporal trend for EPDS scores decreasing until six months and then rebounding at 18 months; mean EPDS 5.5, 4.3, 4.2, and 4.9 at two weeks, two months, six months and 18 months respectively, GEE, P < .001. Depression onset followed a similar trend and was found to be 6.8%, 2.6%, 2.7% and 6.0% at two weeks, two months, six months and 18 months respectively, GEE, P = .068. The high scores of the early-onset group (mean 14.4 at two weeks) contributed to the early depression spike, while the high scores of the late-onset group (mean 13.9 at 18 months) contributed to the late spike. CONCLUSIONS: Two peaks of depression were identified, one early and one late. They appear to be the result of two processes: (1) elevated depression symptoms at two-weeks and again at 18 months postpartum experienced by the full sample and, thus, they may be a normal trend, and (2) onset of major depression by two sub-groups of women, one at each time period. Therefore, continued screening after one-year post delivery is indicated.

Good clinical outcomes following transjugular intrahepatic portosystemic stent-shunts in Budd-Chiari syndrome.

BACKGROUND: There have been encouraging reports on transjugular intrahepatic portosystemic stent-shunt (TIPSS) for Budd-Chiari syndrome (BCS). Long-term data are lacking. AIM: To assess long-term outcomes and validate prognostic scores following TIPSS for BCS. METHODS: A single centre retrospective study. Patients underwent TIPSS using bare or polytertrafluoroethane (PTFE)-covered stents. RESULTS: Sixty-seven patients received successful TIPSS between 1996 and 2012 using covered (n = 40) or bare (n = 27) stents. Patients included had a Male: Female ratio of 21:46, and were characterised (mean ± s.d.) by age 39.9 ± 14.3 years, Model of end stage liver disease (MELD) 16.1 ± 7.0 and Child's score 8.8 ± 2.0. Seventy-eight percent had haematological risk factors. Presenting symptoms were ascites (n = 61) and variceal bleeding (n = 6). Nine patients underwent hepatic vein dilatation or stenting prior to TIPSS. Mean follow-up was 82 months (range 0.5-184 months). Fifteen percent had post-TIPSS encephalopathy. Two have been transplanted. Primary patency rates (76% vs. 27%, P < 0.001) and shunt re-interventions (22% vs. 100%, P < 0.001) significantly favoured covered stents. Secondary patency was 99%. Six-, 12-, 24-, 60- and 120-month survival was 97%, 92%, 87%, 80% and 72% respectively. Six patients had liver related deaths. Two patients developed hepatocellular carcinoma. The BCS TIPS PI independently predicted mortality in the whole cohort, but no prognostic score was a significant predictor of mortality after subgroup validation. CONCLUSIONS: Long-term outcomes following TIPSS for Budd-Chiari syndrome are very good. PTFE-covered stents have significantly better primary patency. The value of prognostic scores is controversial. TIPSS should be considered as first line therapy in symptomatic patients in whom hepatic vein patency cannot be restored.

Draft Genome Sequence of Petroleum Hydrocarbon-Degrading Pseudomonas aeruginosa Strain PK6, Isolated from the Saurashtra Region of Gujarat, India.

Pseudomonas aeruginosa strain PK6, a potential petroleum hydrocarbon-degrading soil bacterium, was isolated from a site contaminated by a petroleum hydrocarbon spill from an automobile service station in Junagadh, Gujarat, India. Here, we provide the 6.04-Mb draft genome sequence of strain PK6, which has genes encoding enzymes for potential and related metabolic pathways of the strain.

Draft Genome Sequence of Textile Azo Dye-Decolorizing and -Degrading Pseudomonas aeruginosa Strain PFK10, Isolated from the Common Effluent Treatment Plant of the Ankleshwar Industrial Area of Gujarat, India.

Here, we report the draft genome sequence of Pseudomonas aeruginosa strain PFK10, isolated from the common effluent treatment plant (CETP) of the Ankleshwar industrial area of Gujarat, India. The 6.04-Mb draft genome sequence of strain PFK10 provides information about the genes encoding enzymes that enable the strain to decolorize and degrade textile azo dye.

Genome Sequence of Salt-Tolerant Bacillus safensis Strain VK, Isolated from Saline Desert Area of Gujarat, India.

Bacillus safensis strain VK was isolated from the rhizosphere of a cumin plant growing in the saline desert of Radhanpar, Gujarat, India. Here, we provide the 3.68-Mb draft genome sequence of B. safensis VK, which might provide information about the salt tolerance and genes encoding enzymes for the strain's plant growth-promoting potential.

Complete Genome Sequence of Escherichia Phage ADB-2 Isolated from a Fecal Sample of Poultry.

Escherichia phage ADB-2 was isolated from a chicken fecal sample. It is a virulent phage and shows effective inhibition of Escherichia coli strains. Here we announce the completely sequenced genome of Escherichia phage ADB-2, and major findings from its annotation are described.

Whole-genome shotgun sequencing of the extremophile Alkalibacillus haloalkaliphilus C-5, of Indian origin.

Alkalibacillus haloalkaliphilus C-5 is a haloalkaliphilic bacterium that was isolated from a soil sample from the salty Sambhar Lake, Rajasthan, India. The organism is capable of alkaline protease production under conditions of pH 10 and 10% (wt/vol) salt. We sequenced and have reported the whole genome of Alkalibacillus haloalkaliphilus C-5, of Indian origin, for the first time.

Coronoidectomy, masticatory myotomy and buccal fat pad graft in management of advanced oral submucous fibrosis.

The purpose of this study is to evaluate coronoidectomy, masticatory myotomy and buccal fat pad graft in advanced (Stage III-IV) oral sub mucous fibrosis (OSF). 10 patients with clinically and histologically confirmed advanced OSF underwent surgery entailing bilateral coronoidectomy, masticatory muscle myotomy and closure with a pedicled buccal fat pad graft followed by vigorous mouth opening exercises. The result was evaluated using the interincisal distance at maximum mouth opening as the objective outcome measure over a follow up period of 12 months. Results showed a mean interincisal opening of 14.7 mm preoperatively and 32.5 mm at 12 months postoperatively. Relapse was encountered in one patient who did not cooperate with the postoperative exercise regime. Results suggest this regime is effective.

Protective effect of Lactobacillus rhamnosus 231 against N-Methyl-N'-nitro-N-nitrosoguanidine in animal model.

The protective effect of Lactobacillus rhamnosus 231 (Lr 231) against potent carcinogen N-Methyl-N'-Nitro-N-Nitrosoguanidine (MNNG) in the rat model is studied. Daily feeding with Lr 231 improved the body weight of male Wistar rats compared with control groups. Fecal azoreductase (p < 0.001) and nitroreductase (p < 0.01) enzyme activity decreased significantly in Lr 231 group in comparison with control groups that received only phosphate buffer or MNNG. Oral administration of MNNG led to a significant increase in Glutathione transferase (GST) while Glutathione reductase (GSH) showed decreased activity. Conversely, feeding Lr 231 showed significantly increased GSH and decreased GST activity in comparison to the MNNG group, emphasizing the protection provided by Lr 231 against MNNG. Histopathological analysis of liver, spleen and colon showed decreased signs of inflammation in the Lr 231 group. The present study highlights that inclusion of active Lr 231 in regular diets could be used to prevent MNNG induced colon carcinoma.

Myelitis as a presenting feature of systemic lupus erythromatosus.

A young female patient was admitted with myelitis. She had oral ulcers, hair loss and redness of hand suggestive of lupus. Diagnostic work including an MRI confirmed lupus myelitis. Unusual features of this case along with relevant literature are reviewed.