The effect of upper limb loading with external weights on gait and trunk control in ambulatory children with spastic hemiplegic cerebral palsy: a randomized controlled trial.

OBJECTIVE: Children with hemiplegic cerebral palsy (CP) are typically ambulant with high motor functioning levels but with gait asymmetry and a greater risk of instability and falling. Physiotherapy is considered the core part of CP rehabilitation due to the risk of neurosurgery and the side effects of drug interventions. Although growing evidence has looked at the effect of upper limb loading during walking in many populations, such interventions in children with CP remain unexplored yet. The purpose of this study was to investigate if loading the upper limbs with external weights could improve walking speed, trunk control, and balance in ambulatory children with hemiplegic CP. PATIENTS AND METHODS: The following outcome measures were recorded at baseline and six weeks after the intervention: gait speed [10-Meter Walk Test (10 MWT)], trunk control [Trunk Control Measurement Scale (TCMS)], and balance [Pediatric Balance Scale (PBS)]. Multiple 2 (groups) x 2 (time-points) mixed analysis of variance models (ANOVAs) were used for analysis. RESULTS: Both groups showed a significant improvement (p < 0.001) in 10 MWT, TCMS, and PBS scores post-intervention. However, the magnitude of change in the outcome measures was higher in the intervention group (10 MWT = 0.59 m/s, TCMS = 10.41, PBS = 9.35) compared to the control group (10 MWT = 0.37 m/s, TCMS = 6.43, PBS = 4.68). CONCLUSIONS: This study demonstrated that although both control and intervention groups showed improvements in terms of gait speed, trunk control, and balance, the intervention group that had upper limb loading showed higher significant improvements.  Clinicaltrial.gov ID: NCT05444387.

Research and economic perspectives on an integrated biorefinery approach for the simultaneous production of polyhydroxyalkanoates and biohydrogen.

Alarming environmental impacts have been resulted across the globe due to the recovery and consumption of fossil fuels. The elevated global carbon footprint has paved the way to an alternative to combat the prevalent pollution. On the other hand, the fossil-based plastics produced from the byproducts of petroleum remain intact in the environment leading to pollution. Fossil abated bioproducts are in high demand due to the increase in pollution. This call to utilize feedstock for simultaneous production of biologically useful products through carbon capture utilisation where the leftover carbon-rich substrate is converted into usable chemicals like bioplastics, methanol, urea and various other industrially essential components. The present review extensively focuses on the research and economic perspectives of an integrated biorefinery and addresses technical breaches, bottlenecks, and efficient strategies for the simultaneous production of biohydrogen and polyhydroxyalkanoates.

One-pot green synthesis of iron oxide nanoparticles from Bauhinia tomentosa: Characterization and application towards synthesis of 1, 3 diolein.

The green synthesis of NPs through plant extracts can be a modest, one-pot alternative synthesis to the conventional physical or chemical method. The prime focus of this study is to produce MNPs by the reducing effect of Bauhinia tomentosa leaf extract, and it was immobilized in porcine pancreatic lipase (PPL). Synthesized NPs were characterized by field emission scanning electron microscopy (FESEM), X-ray diffraction (XRD) and Raman spectroscopy, UV-Vis Spectrometry, Thermogravimetry, and Differential Scanning Calorimeter (DSC), Zeta potential test, VSM, BET and Fourier Transform Infrared Spectroscopy (FTIR). The effect of process parameters was studied, about the efficiency of immobilization are enzyme stability, the extent of enzyme reusability, its separation from products, the activity of immobilized enzyme, recovery, and its loss. Finally, the immobilized lipase was used for the synthesis of 1,3-diolein using enzyme-mediated esterification of oleic acid and glycerol. Under optimized condition (reaction temp-55 [Formula: see text]C; molar ratio-2.5:1; pH-7) diolein yield was achieved to be 94%. Therefore, this work was further used for the industrial production of 1,3-diacylglycerol since a perfect enzyme-catalyzed process was observed.

A Systematic Review of Clinical Practice Guidelines for Identification and Management of Frailty.

OBJECTIVE: This study aims to appraise and summarize consistent recommendations from clinical practice guidelines (CPGs) for identification and management of frailty to maintain and improve functional independence of elderly population. METHODS: A systematic search of Ovid MEDLINE, Embase, PubMed, PsycINFO, and CINAHL electronic databases using database-specific search terms in two broad areas "guidelines" and "frailty", and a manual search of websites with the key phrase "frailty guideline" was performed. The inclusion criteria included CPGs focusing on identifying and managing frailty in population >65 years old, published in English since January 2010. Three reviewers independently assessed guideline quality using the AGREE II instrument. Data extraction was performed, followed by compilation and comparison of all recommendations to identify the key consistent recommendations. RESULTS: Six CPGs met the inclusion criteria; however, only three CPGs had high methodological quality in accordance with AGREE II appraisal. The average AGREE II scores of all six CPGs were: 84.5%, 68%, 46.5%, 81.5%, 56.3%, and 60.2% for domains 1-6 (scope and purpose, stakeholder involvement, rigour of development, clarity of presentation, applicability, and editorial independence) respectively. A total of 54 recommendations were identified, with 12 key recommendations suggested frequently by the CPGs. CONCLUSION: The AGREE II instrument identified strengths and weaknesses of the CPGs, but failed to assess clinical implications and feasibility of the guidelines. Further research is needed to improve clinical relevance of CPGs in the identification and management of frailty. The feasibility in implementing these guidelines with regards to cost-effectiveness of frailty screening warrants further investigation.

Bioconversion of Calophyllum inophyllum oilcake for intensification of rhamnolipid and polyhydroxyalkanoates co-production by Enterobacter aerogenes.

The biologically derived products are highly valued due to their biodegradability, low toxicity, and renewability. However, most production processes are exorbitant due to high raw material cost and the downstream processing required for product recovery and purification. Therefore, the present study utilized the low-cost lignocellulosic biomass, Calophyllum inophyllum oilcake for the simultaneous production of PHA and rhamnolipid by a facultative anaerobe Enterobacter aerogenes. Both the products are produced during the stationary phase and constitute ß- hydroxyalkanoic acids, which makes it feasible for the co-production through a single fermentation process. From the batch fermentation studies, it was revealed that the under optimum condition rhamnolipid and PHA yield are 5.81 g/L and 4.2 g/L: 5%(v/v) of inoculum size, pH of 6.5, C:N ratio of 5:1 and urea are found to be the best nitrogen source for the fermentation process. Characterization studies for extracted PHA and RL was done using- FTIR, NMR and TGA analysis.

Production and optimization of polyhydroxyalkanoates from non-edible Calophyllum inophyllum oil using Cupriavidus necator.

Polyhydroxyalkanoates (PHA) are biodegradable polymers found in the cellular masses of a wide range of bacterial species and the demand for PHA is steadily growing. In this work we have produced PHA from a low-cost substrate, Calophyllum inophyllum oil, using Cupriavidus necator. Effects of various process parameters such as Oil concentration, Nitrogen source and inoculum size on the production of PHA were studied using Response Surface Methodology. A quadratic equation was used in the model to fit the experimental data. It was found that the model could satisfactorily predict the PHA yield (R2=99.17%). Linear, quadratic and interaction terms used in the model were found to be statistically significant. Maximum PHA yield of 10.6gL-1 was obtained under the optimized conditions of oil concentration - 17.5%, inoculum concentration - 50mL/L and nitrogen content - 1.125gL-1, respectively. The product obtained was characterized using FTIR and NMR to confirm that it was PHA. The results demonstrate that C. inophyllum oil, a non-edible oil, can be potentially used as a low-cost substrate for the production of PHA.

Production of biodiesel by enzymatic transesterification of waste sardine oil and evaluation of its engine performance.

Waste sardine oil, a byproduct of fish industry, was employed as a low cost feedstock for biodiesel production. It has relatively high free fatty acid (FFA) content (32 mg KOH/g of oil). Lipase enzyme immobilized on activated carbon was used as the catalyst for the transesterification reaction. Process variables viz. reaction temperature, water content and oil to methanol molar ratio were optimized. Optimum methanol to oil molar ratio, water content and temperature were found to be 9:1, 10 v/v% and 30 °C respectively. Reusability of immobilized lipase was studied and it was found after 5 cycles of reuse there was about 13% drop in FAME yield. Engine performance of the produced biodiesel was studied in a Variable Compression Engine and the results confirm that waste sardine oil is a potential alternate and low-cost feedstock for biodiesel production.

Biocatalytic and antibacterial visualization of green synthesized silver nanoparticles using Hemidesmus indicus.

In the present investigation, we described the green synthesis of silver nanoparticles using plant leaf extract of Hemidesmus indicus. The synthesized silver nanoparticles were characterized by UV-visible spectroscopy, fourier transform infra-red spectroscopy (FTIR), X-ray diffraction (XRD), transmission electron microscopy (TEM) and energy dispersive X-ray spectroscopy (EDX). TEM images proved that the synthesized silver nanoparticles were spherical in shape with an average particle size of 25.24 nm. To evaluate antibacterial efficacy, bacteria was isolated from poultry gut and subjected to 16S rRNA characterization and confirmed as Shigella sonnei. The in vitro antibacterial efficacy of synthesized silver nanoparticles was studied by agar bioassay, well diffusion and confocal laser scanning microscopy (CLSM) assay. The H. indicus mediated synthesis of silver nanoparticles shows rapid synthesis and higher inhibitory activity (34 ± 0.2 mm) against isolated bacteria S. sonnei at 40 µg/ml.

Natural history of asymptomatic gallstones: differential behaviour in male and female subjects.

OBJECTIVE: The natural history of asymptomatic (silent) gallstones has been inadequately studied. Existing information derives from studies based on oral cholecystography or relatively small sample sizes. We planned a retrospective cohort study in subjects with gallstones to determine conversion rates from asymptomatic to symptomatic. METHODS: We extracted data from computerised databases of one government hospital and two private clinics in Malaysia. Files were scrutinised to ensure that criteria for asymptomatic gallstones were fulfilled. Patients were called on telephone, further questioned to confirm that the gallstones at detection were truly asymptomatic, and asked about symptoms that were consistent with previously defined criteria for biliary colic. Appropriate ethical clearances were taken. RESULTS: 213 (112 males) patients fulfilled the criteria for asymptomatic gallstones and could be contacted. 23 (10.8%) developed pain after an average follow up interval of 4.02 years (range 0.1-11 years). Conversion rates from asymptomatic to symptomatic gallstones were high in the first two years of follow up, averaging 4.03±0.965 per year. Over time the conversion rates slowed, and by year 10 the annual conversion rate averaged only 1.38±0.29. Conversion rates were much higher for females compared to males (F:M hazard ratio 3.23, SE 1.54, p>z 0.014). The lifetime risks for conversion approached 6.15% for males, and 22.1% for females. CONCLUSION: In conclusion, asymptomatic gallstones are much more likely to convert to symptomatic in females than in males. Males in whom asymptomatic stones are discovered should be advised conservative treatment. Surgery may be preferable to conservative management if the subject is a young female.

Modeling and steady state simulation: production of xanthan gum from sugarcane broth.

The work is focused on developing a mathematical model for continuous process of xanthan gum production. The main objective of the study is to simulate the model, observe the behavior of substrate consumption, biomass and product formation with respect to dilution rate and determine the optimum dilution rate for which the reactor is to be designed. Systems with and without recycling of cells are considered and the optimum dilution rate is found. For the kinetic parameters used, the optimum dilution rate for the system with no recycling is 0.205 and 0.35 h(-1) for the system that includes recycling of cells.

Ammonium dichromate poisoning: A rare cause of acute kidney injury.

Ammonium dichromate is an inorganic compound frequently used in screen and color printing. Being a strong oxidizing agent, it causes oxygen free radical injury resulting in organ failure. We report a 25-year-old female who presented with acute kidney injury after consumption of ammonium dichromate. She was managed successfully with hemodialysis and supportive measures. This case is reported to highlight the toxicity of ammonium dichromate.

Biohydrogen and polyhydroxyalkanoate co-production by Enterobacter aerogenes and Rhodobacter sphaeroides from Calophyllum inophyllum oil cake.

The feasibility of coupled biohydrogen and polyhydroxyalkanoate production by Enterobacter aerogenes and Rhodobacter sphaeroides using Calophyllum inophyllum oil cake was studied under dark and photo fermentation conditions. The utilization of a non-edible acidic oil cake (C. inophyllum), and exploitation of a modified minimal salt media led to reduction in the cost of media. Cost of fermentation is reduced by implementation of alternate dark-photo fermentative periods and through the use of a co-culture consisting of a dark fermentative (E. aerogenes) and a photo fermentative (R. sphaeroides) bacterium. The biohydrogen and polyhydroxyalkanoate produced were 7.95 L H2/L media and 10.73 g/L media, respectively, under alternate dark and photo fermentation and were 3.23 L H2/L media and 5.6g/L media, respectively under complete dark fermentation. The characteristics of the oil cake and alternate dark (16 h) and photo (8h) fermentative conditions were found to be supportive in producing high biohydrogen and polyhydroxyalkanoate (PHA) yield.

ROCK1 & 2 perform overlapping and unique roles in angiogenesis and angiosarcoma tumor progression.

The serine/threonine protein kinase paralogs ROCK1 & 2 have been implicated as essential modulators of angiogenesis; however their paralog-specific roles in endothelial function are unknown. shRNA knockdown of ROCK1 or 2 in endothelial cells resulted in a significant disruption of in vitro capillary network formation, cell polarization, and cell migration compared to cells harboring non-targeting control shRNA plasmids. Knockdowns led to alterations in cytoskeletal dynamics due to ROCK1 & 2-mediated reductions in actin isoform expression, and ROCK2-specific reduction in myosin phosphatase and cofilin phosphorylation. Knockdowns enhanced cell survival and led to ROCK1 & 2-mediated reduction in caspase 6 and 9 cleavage, and a ROCK2-specific reduction in caspase 3 cleavage. Microarray analysis of ROCK knockdown lines revealed overlapping and unique control of global transcription by the paralogs, and a reduction in the transcriptional regulation of just under 50% of VEGF responsive genes. Finally, paralog knockdown in xenograft angiosarcoma tumors resulted in a significant reduction in tumor formation. Our data reveals that ROCK1 & 2 exhibit overlapping and unique roles in normal and dysfunctional endothelial cells, that alterations in cytoskeletal dynamics are capable of overriding mitogen activated transcription, and that therapeutic targeting of ROCK signaling may have profound impacts for targeting angiogenesis.

An innovative method of reconstruction of large skeletal chest wall defects.

The reconstruction of large skeletal defects of the chest wall is considered complex and difficult. A simple technique for this repair, using polymethylmethacrylate ribs that are prefabricated in a prosthodontic laboratory using heat cure polymer, is presented. These ribs are used as bone substitutes while reconstructing the chest wall defect. The prefabricated polymethylmethacrylate ribs have been used to reconstruct the large chest wall defects after resection of chest wall tumors in three patients. There was risk of severe paradoxical movement of the chest wall without the skeletal defect reconstruction. In all of the cases, there was no need for postoperative mechanical ventilation and there was no paradoxical movement. Cosmetically, it was highly satisfactory. In one patient, the stainless steel wire caused a sinus after 1 year of reconstruction, requiring removal of the wire and the rib, but it did not compromise the stability of the chest wall. We conclude that reconstruction of large chest wall defects with prefabricated polymethylmethacrylate ribs is simple, cost-effective, and easy to plan and execute.

An inexpensive self fabricated pressure clip for the ear lobe.

Pressure therapy is an integral part of keloid treatment. There are certain areas of the body which are prone to keloid formation but are not amenable to pressure therapy. The ear lobe is one such area. A simple, self fabricated and inexpensive pressure clip has been used for applying postoperative pressure to the ear lobe. This is fabricated with cold-cure poly methyl methacrylate and orthodontic wire. This has been used in 41 ear lobe keloids in 26 patients along with postexcisional triamcinolone acetonide therapy, 5 ear lobe reconstructions and 2 cases of ear lobe clefts over a period of 8 years. Although these clips are not very aesthetic, still the acceptability is very high as the patients were well motivated. A total of 27 ear lobes in 18 patients of ear lobe keloids have undergone ear boring after 6-18 months of pressure therapy. The only complication noticed is in the form of pressure ulcer due to continuous pressure in two patients at the beginning of our experience with these clips. These healed well after temporarily stopping the use of the clip.