Feeding tube use and complications in Prader-Willi syndrome: Data from the Global Prader-Willi Syndrome Registry.

Guidance on indications for, and types of, feeding tubes recommended in Prader-Willi syndrome (PWS) is needed. A Global PWS Registry survey was developed to investigate nasogastric (NG) and gastrostomy (G) tube use and associated complications. Of 346 participants, 242 (69.9%) had NG-tubes, 17 (4.9%) had G-tubes, and 87 (25.1%) had both NG- and G-tubes. Primary indication for placement was "feeding difficulties and/or poor weight gain" for both NG- (90.2%) and G-tubes (71.2%), while "aspiration/breathing difficulties" was the procedural indication for 6.4% of NG-tubes and 23.1% of G-tubes. NG-tubes were generally removed by age 6 months (NG Only: 82.9%; NG/G: 98.8%), while G-tubes were often removed by age 2 years (G Only: 85.7%; NG/G: 70.5%). The severe complication rate from G-tubes was 31.7% and from NG-tubes was 1.2%. Overall, caregivers indicated the presence of an NG- or G-tube had a positive effect on quality of life. Feeding difficulties in PWS are largely managed by NG-tube alone. The severe complication rate from G-tubes was about 25 times higher than from NG-tubes; yet, G-tube placement rates have generally increased. G-tube placement puts individuals with PWS at risk for anesthesia and surgery-related complications and should be considered judiciously by a multidisciplinary team.

SEROEPIDEMIOLOGY OF HBV ANTIGEN AND ANTI-HCV AMONG GENERAL POPULATION IN A RURAL LOCAL IN BAUCHI STATE, NIGERIA.

Background: HBV and HCV infections are a significant public health issue in developing countries with weak healthcare systems, high poverty rates, illiteracy, low HBV immunization coverage, and low public health education. A study assessed the sero epidemiology of HBV antigen, anti- HCV markers, biochemical and heamatological indices of 559 participants in Dambam local government during hepatitis day. A structured questionnaire was administered to assess demographic information and risk factors. Rapid latex immunochromtographic kits were used for HBV, HCV, and HBV Combo serological markers, with positive and negative control included in each batch analysis. Descriptive statistics analysis was conducted on the data. Results: The 559 study participants, had a mean age of 35.5+10.9years, majority within the age- group, 18-39years 279(49.04%), female accounted for 291(52.1%) compared to male 268(47.9), educational background, tertiary 244(43.6%), married, 356(68.7%) and student were 254(45.4%). Seroprevalence of HBsAg was 10.7%, serological markers as follows, HbsAb 1.7%, HbeAg 13.3%, HbeAb 60.0% HbcAb 95.0% and Anti-HCV of 3.4%. Gender breakdown(M vs F) of HBV(13.4% vs 8.2%) and HCV(3.0% vs 3.8%). Significant association was observed in the seroprevalence of HBV and HCV with age-group, gender, marital status and occupation(<0.05). No significant difference was observed with the risk factors of HBV and HCV. Biochemical and heamatological indices showed a significant difference between seropositive and negative study participants(<0.05). Conclusion: The study's findings affirmed the endemicity of HBV infection and the increasing trend of HCV infection in Bauchi state, posing serious public health concerns. HBV serological markers suggest a low HBV immunization coverage rate and exposure of participants to the viral etiology in the community. Strengthening immunization coverage and population-based surveillance is strategic in the prevention and control of viral hepatitis in Bauchi state.

Urinary proteomics combined with home blood pressure telemonitoring for health care reform trial-First progress report.

High blood pressure (BP) and type-2 diabetes (T2DM) are forerunners of chronic kidney disease and left ventricular dysfunction. Home BP telemonitoring (HTM) and urinary peptidomic profiling (UPP) are technologies enabling risk stratification and personalized prevention. UPRIGHT-HTM (NCT04299529) is an investigator-initiated, multicenter, open-label, randomized trial with blinded endpoint evaluation designed to assess the efficacy of HTM plus UPP (experimental group) over HTM alone (control group) in guiding treatment in asymptomatic patients, aged 55-75 years, with ≥5 cardiovascular risk factors. From screening onwards, HTM data can be freely accessed by all patients and their caregivers; UPP results are communicated early during follow-up to patients and caregivers in the intervention group, but at trial closure in the control group. From May 2021 until January 2023, 235 patients were screened, of whom 53 were still progressing through the run-in period and 144 were randomized. Both groups had similar characteristics, including average age (62.0 years) and the proportions of African Blacks (81.9%), White Europeans (16.7%), women 56.2%, home (31.2%), and office (50.0%) hypertension, T2DM (36.4%), micro-albuminuria (29.4%), and ECG (9.7%) and echocardiographic (11.5%) left ventricular hypertrophy. Home and office BP were 128.8/79.2 mm Hg and 137.1/82.7 mm Hg, respectively, resulting in a prevalence of white-coat, masked and sustained hypertension of 40.3%, 11.1%, and 25.7%. HTM persisted after randomization (48 681 readings up to 15 January 2023). In conclusion, results predominantly from low-resource sub-Saharan centers proved the feasibility of this multi-ethnic trial. The COVID-19 pandemic caused delays and differential recruitment rates across centers.

Synchronous Primary Parosteal Osteosarcoma and Primary Mediastinal Germ Cell Tumour with Atypical Mycobacterial Infection - A Rare Phenomenon: A Case Report.

Mediastinal germ cell tumours are a rare group of extragonadal germ cell tumours with less than 5% prevalence of all germ cell tumours. Primary mediastinal germ cell tumours themselves account for 16-36% of the extragonadal germ cell tumours. Along the spectrum of osteosarcoma, parosteal osteosarcoma is a well-differentiated surface osteosarcoma with a prevalence of 4% of all osteosarcoma. As such synchronous primary parosteal osteosarcoma and primary mediastinal germ cell tumour are exceedingly rare. This leads to complexity in determining the most appropriate chemotherapy for two different types of tumours and its potential side effects of reduced immunity leading to potential secondary infection. Here we report a case of a 16-year-old boy who presented with synchronous primary osteosarcoma and primary mediastinal germ cell tumour, complicated with atypical mycobacterial infection post-operatively. Additionally, we discuss our choice of chemotherapy and the management of the atypical mycobacterial infection.

PRDECT-ID: Indonesian product reviews dataset for emotions classification tasks.

Recognizing emotions is vital in communication. Emotions convey additional meanings to the communication process. Nowadays, people can communicate their emotions on many platforms; one is the product review. Product reviews in the online platform are an important element that affects customers' buying decisions. Hence, it is essential to recognize emotions from the product reviews. Emotions recognition from the product reviews can be done automatically using a machine or deep learning algorithm. Dataset can be considered as the fuel to model the recognizer. However, only a limited dataset exists in recognizing emotions from the product reviews, particularly in a local language. This research contributes to the dataset collection of 5400 product reviews in Indonesian. It was carefully curated from various (29) product categories, annotated with five emotions, and verified by an expert in clinical psychology. The dataset supports an innovative process to build automatic emotion classification on product reviews.

[Bromhexine is a potential drug for COVID-19; From hypothesis to clinical trials].

COVID-19 (novel coronavirus disease 2019), caused by the SARS-CoV-2 virus, has various clinical manifestations and several pathogenic pathways. Although several therapeutic options have been used to control COVID-19, none of these medications have been proven to be a definitive cure. Transmembrane serine protease 2 (TMPRSS2) is a protease that has a key role in the entry of SARS-CoV-2 into host cells. Following the binding of the viral spike (S) protein to the angiotensin-converting enzyme 2 (ACE2) receptors of the host cells, TMPRSS2 processes and activates the S protein on the epithelial cells. As a result, the membranes of the virus and host cell fuse. Bromhexine is a specific TMPRSS2 inhibitor that potentially inhibits the infectivity cycle of SARS-CoV-2. Moreover, several clinical trials are evaluating the efficacy of bromhexine in COVID-19 patients. The findings of these studies have shown that bromhexine is effective in improving the clinical outcomes of COVID-19 and has prophylactic effects by inhibiting TMPRSS2 and viral penetration into the host cells. Bromhexine alone cannot cure all of the symptoms of SARS-CoV-2 infection. However, it could be an effective addition to control and prevent the disease progression along with other drugs that are used to treat COVID-19. Further studies are required to investigate the efficacy of bromhexine in COVID-19.

Ecdysteroids from the Stem Bark of Vitex doniana Sweet (Lamiaceae; ex. Verbenaceae): A Geographically Variable African Medicinal Species.

Vitex doniana Sweet is an African medicinal species that is prescribed as an aqueous bark extract to be applied topically or orally to achieve anti-infective outcomes. In select regions it is also taken orally as an antimalarial agent. The aim of the current study was to explore the biological properties of V. doniana and isolated compounds in the context of pathogenic bacteria and the protozoan parasite Plasmodium falciparum. Three compounds were isolated and assigned by nuclear magnetic resonance spectroscopy as ecdysteroids: (1) 20-hydroxyecdysone, (2) turkesterone, and (3) ajugasterone C. Interestingly, two of these compounds had not previously been identified in V. doniana, providing evidence of chemical variability between regions. The bark extract and three ecdysteroids were screened for activity against a panel of pathogenic bacteria associated with skin, stomach and urinary tract infections, and the protozoan parasite P. falciparum. The crude extract of the bark inhibited all bacterial strains with MIC values of 125-250 µg.mL-1. The three isolated compounds demonstrated less activity with MIC values of 500-1000 µg.mL-1. Furthermore, no activity was observed against P. falciparum at the screening concentration of 4.8 µg.mL-1. Nevertheless, we present a hypothesis for the possible mechanism for symptomatic relief of malarial fever, which may involve reduction of prostaglandin E(1) & E(2) activity in the hypothalamus via modulation of the monoaminergic system. While further studies are required to identify all antimicrobial agents within this plant species and to determine the cytotoxicity of each of these compounds, these data suggest that the traditional application of this species as an antiseptic is valid.

Correlation between Echocardiographic Left Ventricular Hypertrophy and various Electrocardiographic Criteria of Left Ventricular Hypertrophy among Black Hypertensives.

BACKGROUND: Systemic hypertension remains an important risk factor for cardiovascular diseases and a major global public health problem. Left ventricular hypertrophy (LVH) is a recognized complication of systemic hypertension and strongly predicts cardiovascular morbidity and mortality. In Nigeria, few studies have evaluated the correlation of ECG criteria in the diagnosis of left ventricular hypertrophy among hypertensives and almost all the previous studies on ECG LVH used only one or two criteria. This study sets out to determine the correlations between various ECG criteria of LVH and echocardiographic LVH among patients with hypertension using six ECG LVH criteria. METHODS: One hundred and seventy-eight hypertensives and eighty- nine age and sex matched controls were recruited consecutively into the study. All participants including hypertensives and control subjects had echocardiography whereas only hypertensive subjects had both echocardiography and ECG. ECG LVH was determined using Sokolow-Lyon, Cornell voltage, Goldberger, Massoleini, Romhilt-Estes and Cornell duration product ECG criteria. RESULTS: Sokolow-Lyon and Cornell voltage criteria had significant positive correlation with echocardiographic LVH (p=0.001 and 0.003, respectively). Although Goldberger and Massoleini criteria had positive correlation coefficients, these were not statistically significant. CONCLUSION: There are significant correlations between echocardiographic LVH and ECG LVH determined by Cornell voltage and Sokolow-Lyon criteria.

CONTEXTE: L'hypertension systémique reste un facteur de risque important pour les maladies cardiovasculaires et un problème majeur de santé publique mondiale. L'hypertrophie ventriculaire gauche (HVG) est une complication reconnue de l'hypertension systémique et prédit fortement la morbidité et la mortalité cardiovasculaires. Au Nigeria, peu d'études ont évalué la corrélation des critères ECG dans le diagnostic de l'hypertrophie ventriculaire gauche chez les hypertendus et presque toutes les études précédentes sur l'ECG HVG n'utilisaient qu'un ou deux critères. Cette étude vise à déterminer les corrélations entre divers critères ECG de l'HVG et l'HVG échocardiographique chez les patients hypertendus à l'aide de six critères ECG LVH. MÉTHODES: Cent soixante-dix-huit hypertendus et quatre-vingtneuf témoins appariés selon l'âge et le sexe ont été recrutés consécutivement dans l'étude. Tous les participants, y compris les hypertendus et les sujets témoins, ont eu une échocardiographie alors que seuls les sujets hypertendus ont eu à la fois une échocardiographie et un ECG. ECG L'HVG a été déterminée en utilisant les critères ECG de produit de durée de Sokolow-Lyon, de tension de Cornell, de Goldberger, de Massoleini, de Romhilt-Estes et de Cornell. RÉSULTATS: Les critères de tension de Sokolow-Lyon et de Cornell avaient une corrélation positive significative avec l'HVG échocardiographique (p=0,001 et 0,003, respectivement). Bien que les critères de Goldberger et Massoleini aient des coefficients de corrélation positifs, ceux-ci n'étaient pas statistiquement significatifs. CONCLUSION: Il existe des corrélations significatives entre l'HVG échocardiographique et l'HVG ECG déterminées par le voltage de Cornell et les critères de Sokolow-Lyon. MOTS-CLÉS: Corrélation; échocardiographie; électrocardiographie; Hypertrophie ventriculaire gauche; Hypertendus noirs.

Innovative electrochemical sensor for the precise determination of the new antiviral COVID-19 treatment Favipiravir in the presence of coadministered drugs.

Due the current pandemic of COVID-19, an urgent need is required for serious medical treatments of a huge number of patients. The world health organization (WHO) approved Favipiravir (FAV) as a medication for patients infected with corona virus. In the current study, we report the first simple electrochemical, greatly sensitive sensor using MnO2-rGO nanocomposite for the accurate determination of Favipiravir (FAV). The developed sensor showed a high improvement in the electrochemical oxidation of FAV comparing to the unmodified screen-printed electrode (SPE). The suggested platform constituents and the electrochemical measurements parameters were studied. Under optimal experimental parameters, a current response to the concentration change of FAV was found to be in the linear range of 1.0 × 10-8-5.5 × 10-5 M at pH 7.0 with a limit of detection 0.11 µM and a quantification limit of 0.33 µM. The developed platform was confirmed by the precise analysis of FAV in real samples including dosage form and plasma. The developed platform can be applied in different fields of industry quality control and clinical analysis laboratories for the FAV determination.

Quackery as a Cause of Maxillofacial Infections and Its Implications.

Background: In recent times, the prevalence of quackery in oral and maxillofacial practice has become rampant with complications, one of which is odontogenic infections. This study was aimed to identify how common quackery is among our patients with odontogenic infections and the outcome of the patients. Materials and Methods: The study was a descriptive cross-sectional study of all patients presenting with odontogenic infections seen at the accident and emergency unit and the oral and maxillofacial surgery clinics of a tertiary hospital in North Central Nigeria from January 2017 to December 2021. Information obtained included sociodemographic characteristics, presenting complaints, duration of illness, prehospital care, diagnosis, duration of hospital stay, where the patient was first managed, what is the "doctor/dentist" status, and outcome. Results: A total of 237 patients were recruited with a male to female ratio of 1:1.3. The commonest presenting complaints were toothache and jaw swelling with patients been ill for up to 2 weeks before presenting. About 41.8% of the patients have a co-existing health condition, and 46.4% of the patients had tooth extraction by a quack, with 82.7% taking antibiotics prescribed by a chemist before presentation. About 11.0% of the patients died; 96.2% of those that died had their tooth extracted by quacks. Patients with preexisting health conditions and preadmission tooth extraction were more likely to die with odds ratio (OR) = 2.230; 95% confidence interval (CI) = 1.06-4.71 and OR = 28.9; 95% CI = 3.97-209.6, respectively. Conclusion: Quackery is very common in our society. The odds of death are increased in patients with odontogenic infection if the patient has a preexisting health condition and even more significant if they had their tooth extracted by quacks.

The chemistry and biological activities of Citrus clementina Hort. Ex Tanaka (Rutaceae), a vegetatively propagated species.

We report the chemistry and biological activities of a Cameroonian Citrus clementina Hort. Ex Tanaka, a vegetatively propagated species. The compounds isolated from this plant were determined to be the known 5-hydroxy-6,7,8,3',4'-pentamethoxyflavone (1), tangerine (3), nobilletin (4), 5,7,8,4'-tetramethoxyflavone (5), citracridone I (6), 5-hydroxynoracronycine (7), citracridone III (8), xanthyletin (10), suberosin (9), E-suberenol (11), E-methoxysuberenol (13), 6-formylumbelliferone (12), aurantiamide acetate (2), limonin (14), stigmasterol, ß-sitosterol and ß-sitosterol-3-O-ß-D-glucoside. The structures of the compounds were established on the basis of their NMR spectroscopic data and comparison with published data. Methanol leaf extract and compounds 1, 2, 4, 6, 7 and 10 were evaluated for their anti-inflammatory, antioxidant, urease and anti-diabetic effects. Compound 10 showed antioxidant activity, anti-inflammatory effect, urease activity and anti-diabetic activity with IC50 values of 47.3 µM, 33.5 µM, 25.2 µM and 33.9 µM respectively, values that were comparable to the respective positive standards.

Hypercalcemia in Children Using the Ketogenic Diet: A Multicenter Study.

CONTEXT: The ketogenic diet is associated with progressive skeletal demineralization, hypercalciuria, and nephrolithiasis. Acute hypercalcemia has been described as a newly recognized complication of this treatment. OBJECTIVE: To describe the clinical characteristics of acute hypercalcemia in children on the ketogenic diet through analysis of the presentation, response to treatment, and natural history in a large cohort of patients. DESIGN: A multicenter case series was performed including children who developed acute hypercalcemia while treated with the ketogenic diet. Information on clinical presentation, treatment, and course of this complication was collated centrally. RESULTS: There were 14 patients (median (range) age 6.3 (0.9 to 18) years) who developed hypercalcemia 2.1 (range, 0.2-12) years after starting the ketogenic diet. All had low levels of parathyroid hormone and levels of 1,25-dihydroxyvitamin D were low in all except one. Seven (50%) had impaired renal function at presentation. All except the 2 oldest had low alkaline phosphatase levels for age. Once normocalcemia was achieved, hypercalcemia recurred in only 2 of these patients over observation of up to 9.8 years. One patient discontinued the ketogenic diet prior to achieving normocalcemia while 4 more stopped the diet during follow-up after resolution of hypercalcemia. CONCLUSIONS: Ketotic hypercalcemia can occur years after starting the ketogenic diet, especially in the setting of renal impairment. The mechanism is unknown but appears to be due to reduced osteoblast activity and impaired bone formation. We recommend close attention to optimizing bone health in these children, and screening for the development of ketotic hypercalcemia.

Ent-clerodane and ent-trachylobane diterpenoids from Croton dictyophlebodes.

The stem bark and root bark extracts of Croton dictyophlebodes (Euphorbiaceae) yielded seven undescribed ent-clerodanes: 15,16-epoxy-17,12(S)-olide-ent-cleroda-1,3,13(16),14-tetraen-18-oic acid methyl ester (crotodictyo A), 3ß,4ß:15,16-diepoxy-ent-cleroda-13(16),14-dien-20-al (crotodictyo B), 3ß,4ß:15,16-diepoxy-ent-cleroda-13(16),14-dien-19,20-dioic acid (crotodictyo C), 3ß,4ß:15,16-diepoxy-ent-cleroda-13(16),14-dien-20,19-olide (crotodictyo D), 3ß,4ß:15,16-diepoxy-20,12(R)-olide ent-cleroda-13(16),14-dien-19-oic acid methyl ester (crotodictyo E), 15,16-epoxy-ent-cleroda-3,13(16),14-trien-12-oxo-18-oic acid (crotodictyo F) and 15,16-epoxy-ent-cleroda-1,3,13(16),14-tetraen-12-oxo-18-oic acid (crotodictyo G), in addition to 15,16-epoxy- ent-cleroda-3,13(16),14-trien-12-oxo-18-oic acid methyl ester (crotodictyo H), reported previously as a synthetic derivative, and acetyl aleuritolic acid. The root extract yielded two ent-trachylobanes, ent-trachylobane-18,19-diol, the undescribed ent-trachylobane-2α,19-diol, along with ent-kaur-16-en-19-oic acid and 2-methoxybenzyl benzoate. Compounds were evaluated against the NCI 60 panel of human tumour cell lines at a single dose of 10-5 M, but showed no significant activity.

Cytotoxic diterpenoids from the leaves and stem bark of Croton haumanianus (Euphorbiaceae).

The leaf extract of Croton haumanianus J. Léonard (Euphorbiaceae) yielded twenty-six compounds, including eight previously reported ent-kauranes and an ent-labdane and eight undescribed ent-kauranes, ent-16R-kauran-17-al, ent-3ß-hydroxy-16R-kauran-17-al, ent-16S,17-epoxykauran-19-ol, ent-16S,17-epoxykauran-3ß-ol, ent-17-palmityloxykaurane-3ß,16ß-diol, ent-17-palmityloxykauran-16ß-ol, ent-3α,18-cyclokaurane-16ß,17-diol and 19-nor-16α,17-dihydroxy-ent-kaur-4(18)-ene and three undescribed ent-clerodanes, dimethyl ent-15,16-epoxy-6ß-hydroxy-1,3,13(16),14-clerodatetraen-20,12S-olide-18,19-dioate (saniolide A), dimethyl ent-15,16-epoxy-6ß-hydroxy-1,3,13(16),14-clerodatetraen-20,12R-olide-18,19-dioate (12-epi-saniolide A), methyl ent-15,16-epoxy-1,3,13(16),14-clerodatetraen-18,6R:20,12S-diolide-19-oate (saniolide B). The stem bark extract yielded the ent-clerodane crotocorylifuran, and five undescribed ent-isopimaranes, ent-isopimara-8(14),15-dien-18-al, ent-18-hydroxyisopimara-8(14),15-dien-7-one, ent-isopimara-7,15-dien-18-oic acid, ent-isopimara-7,15-dien-18-ol and ent-isopimara-8,15-dien-7-oxo-18-oic acid. Three compounds, ent-kaurane-3ß,16ß,17-triol, ent-17-palmityloxykaurane-3ß,16ß-diol and ent-17-palmityloxykauran-16ß-ol, showed selective activity against three of the NCI 60 cancer cell lines, the colon (HCT-116), the melanoma (M14) and the renal (786-0) cancer cell lines at a concentration of 10-5 M.

Bufadienolides and anti-angiogenic homoisoflavonoids from Rhodocodon cryptopodus, Rhodocodon rotundus and Rhodocodon cyathiformis.

BACKGROUND: Homoisoflavonoids have been shown to have potent anti-proliferative activities in endothelial cells over other cell types and have demonstrated a strong antiangiogenic potential in vitro and in vivo in animal models of ocular neovascularization. Three species of Rhodocodon (Scilloideaea subfamily of the Asparagaceae family), endemic to Madagascar, R. cryptopodus, R. rotundus and R. cyathiformis, were investigated. PURPOSE: To isolate and test homoisoflavonoids for their antiangiogenic activity against human retinal microvascular endothelial cells (HRECs), as well as specificity against other ocular cell lines. METHODS: Plant material was extracted at room temperature with EtOH. Compounds were isolated using flash column chromatography and were identified using NMR and CD spectroscopy and HRESIMS. Compounds were tested for antiproliferative effects on primary human microvascular retinal endothelial cells (HRECs), ARPE19 retinal pigment epithelial cells, 92-1 uveal melanoma cells, and Y79 retinoblastoma cells. HRECs exposed to compounds were also tested for migration and tube formation ability. RESULTS: Two homoisoflavonoids, 3S-5,7-dihydroxy-(3'-hydroxy-4'-methoxybenzyl)-4-chromanone (1) and 3S-5,7-dihydroxy-(4'-hydroxy-3'-methoxybenzyl)-4-chromanone (2), were isolated along with four bufadienolides. Compound 1 was found to be non-specifically antiproliferative, with GI50 values ranging from 0.21-0.85 µM across the four cell types, while compound 2 showed at least 100-fold specificity for HRECs over the other tested cell lines. Compound 1, with a 3S configuration, was 700 times more potent that the corresponding 3R enantiomer recently isolated from a Massonia species. CONCLUSION: Select homoisoflavonoids have promise as antiangiogenic agents that are not generally cytotoxic.

Ent-abietane and ent-pimarane diterpenoids from Croton mubango (Euphorbiaceae).

Twelve ent-abietane and two ent-pimarane diterpenoids were isolated from the leaves of Croton mubango Müll. Arg. (Euphorbiaceae) collected in the Democratic Republic of the Congo. 2ß-Hydroxy-ent-abieta-7,13-dien-3-one, 15-hydroxy-ent-abieta-7,13-dien-3-one, 13α,15-dihydroxy-ent-abieta-8(14)-en-3-one, 2ß,9,13-trihydroxy-ent-abieta-7-en-3-one, 2ß,7ß-dihydroxy-ent-abieta-8,11,13-trien-3-one, 15-hydroxy-ent-abieta-8,11,13-trien-3-one and ent-pimara-8(14),15-dien-3-one and the ent-forms of the previously reported normal series diterpenoids, ent-abieta-8,11,13-trien-3-one, 7ß-hydroxy-ent-abieta-8,11,13-trien-3-one, 3α-hydroxy-ent-abieta-8,11,13-triene, 15-hydroxy-ent-abieta-8,11,13-triene and 6ß-hydroxy-ent-abieta-8,11,13-triene are reported here for the first time. Structures were established using HRESIMS, FTIR, NMR, DP4+ probability calculations and by comparison of the experimental and calculated electronic circular dichroism (ECD) spectra. Ent-pimara-8(14), 15-dien-3-one, showed antiproliferative activity against melanoma (MALME-3M), renal (UO-31) and ovarian cancer cell lines (IGROV1) at a concentration of 10-5 M in the NCI 60 screen.

The value of intraoperative parathyroid hormone assay in the surgery of mediastinal ectopic parathyroid adenoma (A case series).

BACKGROUND AND AIMS: Ectopic parathyroid adenoma is a rare entity. Its clinical management is challenging due to varying locations in the mediastinum. The aim of our study is to report our experience about the preoperative localization of the ectopic parathyroid adenoma and to emphasize the major role of the intraoperative parathyroid hormone assay in such circumstances. METHODS: It is a monocentric, retrospective study about patients diagnosed with EPA (ectopic parathyroid adenoma) from January 2015 to December 2016. Clinical aspects, preoperative management as well as the surgical procedures have been analyzed. RESULTS: There were 7 women, with an average age of 59.14 years. Six patients presented with biological disorders of the phosphocalcic metabolism such as spontaneous bone fracture and recurrent renal lithiasis. In one case, EPA was discovered in the setting of malignant hypercalcemia. The topographic preoperative assessment with a cervicothoracic CT (computed tomography) showed spontaneously hyperdense tissular masses of variable localizations in the mediastinum. A Tc-99 m (99mTc - MIBI) scintigraphy was performed in 5 patients and showed uptake in all cases. We performed cervicotomy in 1 case, manubriotomy in 2 patients, neck manubriotomy in 2 cases, total vertical sternotomy in 1 case, and posterolateral thoracotomy in 1 patient. The lesion was localized in the mediastinum in 1 patient in the perithymic fat in 1 case; EPA was laterotracheal in 1 case, retro tracheal in 1 case, intra-thymic in 2 cases, inter-jugulo-carotidian with contact with the left subclavial artery in 1 case, and anterior mediastinal in 1 patient. The 1-h after-parathormonemia following removal of the surgical specimens showed a decrease value of 45 and 80% of the baseline value. No surgical morbidity was noted after an average follow-up of 7.9 months (range of 5-18 months). CONCLUSION: The preoperative topographic diagnosis of ectopic parathyroid adenoma is challenging for the surgeon despite progress in the morphological assessment. The intraoperative parathyroid hormone assay is a valuable tool for an appropriate surgical management.

Renewable energy in Southeast Asia: Policies and recommendations.

Southeast Asian countries stand at a crossroads concerning their shared energy future and heavily rely on fossil fuels for transport and electricity. Within Asia, especially India and China lead the world renewable energy generation undergoing a period of energy transition and economic transformation. Southeast Asian countries have huge potentials for sustainable energy sources. However they are yet to perform globally in renewable energy deployment due to various challenges. The primary objective of the study is to examine the renewable energy growth and analyse the government policies to scale up the deployment of renewables for power generation substantially. The study also offers policy recommendations to accelerate renewable energy exploitation sustainably across the region. To achieve the ambitious target of 23% renewables in the primary energy mix by 2025, ASEAN Governments should take proactive measures like removal of subsidies of fossil fuels, regional market integration and rapid implementation of the existing project. Eventually, each of this strategy will necessitate sustained leadership, political determination, and concrete actions from stakeholders, in particular, increased cooperation across the region.

Body Mass Index Is a Better Indicator of Body Composition than Weight-for-Length at Age 1 Month.

OBJECTIVE: To assess whether body mass index (BMI) provides a better assessment of measured adiposity at age 1 month compared with weight-for-length (WFL). STUDY DESIGN: Participants were healthy term-born infants in the Infant Growth and Microbiome (n = 146) and the Baby Peas (n = 147) studies. Length, weight, and body composition by air displacement plethysmography were measured at 1 month. World Health Organization-based WFL and BMI z-scores were calculated. Within-cohort z-scores of percent fat-Z, fat mass-Z, fat mass/length2-Z, fat mass/length3-Z, fat-free mass-Z, and fat-free mass/length2-Z were calculated. Correlation and multiple linear regression (adjusted for birth weight) analyses tested the associations between body composition outcomes and BMI-Z vs WFL-Z. Quantile regression was used to test the stability of these associations across the distribution of body compositions. RESULTS: The sample was 52% female and 56% African American. Accounting for birth weight, both BMI-Z and WFL-Z were strongly associated with fat mass-Z (coefficients 0.56 and 0.35, respectively), FM/L2-Z (0.73 and 0.51), and FM/L3-Z (0.79 and 0.58), with stronger associations for BMI-Z compared with WFL-Z (P < .05). Even after accounting statistically for birth weight, BMI-Z was persistently more strongly associated than WFL-Z with body composition outcomes across the distribution of body composition outcomes. CONCLUSIONS: We demonstrate in 2 distinct cohorts that BMI is a better indicator of adiposity in early infancy compared with WFL. Our findings support the preferred use of BMI for growth and nutritional status assessment in infancy.